Child Welfare for the Twenty-first Century: A Handbook of Practices, Policies, and Programs [second edition] 9780231525350

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CHILD WELFARE FOR THE T W E N T Y- F I R S T C E N T U R Y

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CHILD WELFARE FOR THE T W E N T Y- F I R S T CENTURY A Handbook of Practices, Policies, and Programs SECOND EDITION

Edited by

G E R A L D P. M A L L O N AND

PEG MCCARTT HESS

COLUMBIA UNIVERSITY PRESS New York

Columbia University Press Publishers Since 1893 New York Chichester, West Sussex cup.columbia.edu Copyright © 2014 Columbia University Press All rights reserved Library of Congress Cataloging-in-Publication Data Child welfare for the twenty-first century: a handbook of practices, policies, and programs / Gerald P. Mallon and Peg McCartt Hess, editors. — 2d ed. pages cm Includes bibliographical references and index. ISBN 978-0-231-15180-1 (cloth: alk. paper) — ISBN 978-0-231-52535-0 (e-book) 1. Child welfare—United States. I. Mallon, Gerald P. II. Hess, Peg McCartt. HV741.C516 2014 362.70973—dc23 2013027817

Columbia University Press books are printed on permanent and durable acid-free paper. This book is printed on paper with recycled content. Printed in the United States of America c 10 9 8 7 6 5 4 3 2 1 Cover design: Shaina Andrews References to websites (URLs) were accurate at the time of writing. Neither the author nor Columbia University Press is responsible for URLs that may have expired or changed since the manuscript was prepared.

Y CONTENTS

Preface Acknowledgments Introduction: An Overview of Children, Youth, and Family Services, Policies, and Programs in the United States

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GERALD P. MALLON AND PEG M C CARTT HESS

Historical Evolution of Child Welfare Services

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BRENDA G. M C GOWAN

PART 1 CHIL D AN D ADOL ESCEN T W EL L -BEIN G

Family Support Services

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SUSAN P. KEMP, TRACEY K. BURKE, KARA ALLEN-ECKARD, MELISSA F. BECKER, AND AMY ACKROYD

Meaningful Family Engagement

70

NICOLE BOSSARD, ANGELA BRAXTON, AND DEBRA CONWAY

Engaging Latino Families

86

HILDA RIVERA-RODRÍGUEZ

Health Care for Children and Youth

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JAN M C CARTHY AND MARIA WOOLVERTON

Mental Health Care for Children and Youth

115

MARTHA MORRISON DORE

Educational Issues for Children and Youth

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KRISTIN KELLY, KATHLEEN M C NAUGHT, AND JANET STOTLAND

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CONTENTS

LGBT Youth and Their Families

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DIANE ELZE

Customary Adoption for American Indian and Alaskan Native Children

373

TERRY L. CROSS

Runaway and Homeless Youth

179 Kinship Care

KAREN M. STALLER

382

REBECCA L. HEGAR AND MARIA SCANNAPIECO

PA RT 2 C H I L D A N D A D O LE S C E N T S A FE T Y

Adoption

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GERALD P. MALLON

Prevention of Child Abuse and Neglect

207 Birth Mothers

NEIL B. GUTERMAN, KRISTIN L. BERG, AND CATHERINE A. TAYLOR

Child Protective Services

424

LESLIE DOTY HOLLINGSWORTH

236

DIANE D E PANFILIS

Adoption Disruption

437

TRUDY FESTINGER

AND THERESA COSTELLO

Risk Assessment

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ARON SHLONSKY AND EILEEN GAMBRILL

Unpacking Permanency for Youth: Overuse/Misuse of Another Planned Permanent Living Arrangement (APPLA) as a Permanency Goal

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JENNIFER RENNE AND GERALD P. MALLON

Family Preservation

270 Youth Development and Transitional Living Services

MARIANNE BERRY AND SARA M C LEAN

Sexual Abuse Issues

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467

MARY ELIZABETH COLLINS

KATHLEEN COULBORN FALLER

Family Foster Care Substance Abuse Issues

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480

MADELYN FREUNDLICH

JOSEPH P. RYAN AND HUI HUANG

Residential Services Domestic Violence Issues

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AND LARRY W. OWENS

JUDY L. POSTMUS

Sibling Issues

PA RT 3 PE RM A N E N CY F O R C H ILD R E N AN D A D O L E SCE NT S

Reunification

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BARBARA A. PINE, ROBIN SPATH,

MARK F. TESTA AND JENNIFER MILLER

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REBECCA L. HEGAR

AND STEPHANIE GOSTELI

Guardianship

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LLOYD BULLARD, KATHERINE GAUGHAN,

Visits: Critical to the Well-Being and Permanency of Children and Youth in Care

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PEG M C CARTT HESS

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Postpermanency Services MADELYN FREUNDLICH AND LOIS WRIGHT

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CONTENTS

PA RT 4 S YST E M I C I SSU E S IN C H I L D WE L FA RE

The Child and Family Services Reviews

Child Welfare Supervision

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CATHRYN C. POTTER, MICHELE HANNA, AND CHARMAINE BRITTAIN

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LINDA MITCHELL, MIRANDA LYNCH THOMAS,

Research and Evaluation

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CRYSTAL COLLINS-CAMARGO

AND BONITA PARKER

Placement Stability

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AMY C. D’ANDRADE AND SIGRID JAMES

Foster Parent Recruitment, Retention, Development, and Support

Disproportionate Representation of Children and Youth

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RUTH G. M C ROY

Fatherhood 601

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TANYA M. COAKLEY

EILEEN MAYERS PASZTOR

Immigrant Children, Youth, and Families

AND MYRNA L. M C NITT

Legal and Judicial Engagement

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MARVIN VENTRELL

Child Welfare Workforce Issues SARA MUNSON, MARY M C CARTHY, AND NANCY DICKINSON

710

ILZE EARNER, ROWENA FONG, AND CAROL SMOLENSKI

624

Contributors Index

721 727

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Y PREFACE

Almost three decades ago, Joan Laird and Ann Hartman reminded us that “every society at every time must make some provision for its children in need” (1985:xvi–xvii). When Laird and Hartman, the editors of what many child welfare professionals believe to be a seminal text on child welfare, A Handbook of Child Welfare: Context, Knowledge and Practice, wrote this, the field of child welfare was determinedly implementing a new federal mandate that outlined such provisions. The Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) identified a range of management and practice requirements intended to prevent the unnecessary placement of children and to reunify families when placement could not be prevented. Laird and Hartman’s Handbook of Child Welfare outlined the philosophical underpinnings as well as the policy and practice emphases of that period; it provided detailed discussions that shaped the understanding and commitments of numerous cohorts of students who subsequently entered practice in the field. As coeditors of this volume, it is important for us to acknowledge the influence Laird and Hartman’s text has had in our teaching, in our professional child welfare practice, and in our development of the first, and now second, edition of this text. Our work has been inspired by, yet differed from, that seminal work. Since 1985, when Laird and Hartman collected the essays in their volume, child welfare as an institution and a field of practice has continued to experience transformation in the provisions for its children, youth, and families in need. Despite the hope associated with the passage of the Adoption Assistance and Child Welfare Act, the field has struggled during the intervening years with insufficient funding, increased public concerns about the safety of children, instability in the public child welfare ix

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workforce, and generally disappointing outcomes with regard to achieving permanency for children and youth who entered care. Throughout the country, stresses within and upon the child welfare system have kept many state agencies on the defensive and in the news. As reflected throughout this second edition, many changes continue to occur in practice and in ideological and planning orientations. Change has perhaps most vividly been seen in the primary legislation that forms the current foundation of child welfare policy in the U.S.: the Adoption and Safe Families Act of 1997 (ASFA; P.L. 105-89) and, more recently (2008), in the opportunities for further reform provided by the passage of Fostering Connection to Success and Increasing Adoptions Act (P.L. 110-351). Safety, permanency, and well-being of children, youth, and their families form the foundation for the ASFA legislation that replaced the Adoption Assistance and Child Welfare Act of 1980 (Title IV-E of the Social Security Act, P.L. 96-272). These principles have been affirmed and further bolstered by Fostering Connections. Both ASFA and Fostering Connections put into place legislative provisions to ensure that child safety is the paramount concern in all child welfare decision making, shorten the time frames for making permanency planning decisions, and promote the adoption of children and youth who cannot safely return to their own homes. These legislative acts also require a focus on positive results for children, youth, and families and promote the strengthening of partnerships between child welfare agencies and other service delivery systems to support families at the community level. During the first decade of the twenty-first century, numerous changes have taken place in national child welfare outcomes and contextual factors. Some of these are hopeful, such as the decreased numbers of children in out-ofhome placements between FYs 2o02 and 2011, 523,000 to 401,000, a change of 23.3 percent (Children’s Bureau 2013a:2), and a decline in numbers of children in foster care for all major

non-Hispanic race groups (Administration on Children, Youth, and Families 2013:1). Other changes are discouraging, such as CFSR findings that many states that reunified children with their families in a more timely manner between 2008 and 2011 also had a high percentage of children who reentered foster care within 12 months of the reunification (Children’s Bureau 2013a: 4, 6). Although during this same period (2008–2011) 24 percent of states improved in performance regarding reunification of children with their families within 12 months of the child’s placement, 29 percent of states declined in performance regarding children’s reentry into care within 12 months of reunification (2013b:36). Summaries of recent national child welfare demographics and outcomes can be found at the cited websites. Recognizing the significance of these multiple and complex changes, but especially attentive to the increasingly felt influence of both ASFA and Fostering Connections on child welfare policy, programs, and practice, we have again utilized safety, permanency, and well-being as the conceptual framework for the second edition of this volume. We believe that this framework has permitted our contributors to thoroughly examine both the explicit and subtle challenges in and opportunities for improving child welfare practice and to offer practice and policy guidelines that fall within the broad strokes of the ASFA and Fostering Connections decisionmaking framework. We asked our contributors to outline the major assumptions and values of child welfare today in the twenty-first century and to identify and elaborate the expanding knowledge that currently supports practice in a wide range of areas relevant to the field. Contributors have also reviewed recent research as well as the ever-increasing body of literature, which has grown exponentially since the introduction of word processing and the Internet. Even as the contributors have been writing their chapters, the states and the U.S. Children’s Bureau have been engaged in an extensive

PREFACE

review process that has now been completed. The findings from the first two rounds of fifty-two Child and Family Services Reviews (CFSRs), which have been integrated into the chapters where relevant, provide additional information regarding the current strengths and concerns of child welfare, thereby further informing the agenda for change efforts in the future. (See Children’s Bureau 2013b for median state performance and change in performance over time 2008–2011 as well as each state’s performance relevant to the seven national child welfare outcomes.) As of this writing the third round of Child and Family Services Reviews has not yet been scheduled. Both of us, like Laird and Hartman (1985:xxiii), subscribe to an ecological perspective. This perspective provides an excellent framework for understanding and evaluating the nature of social and institutional responses to children, youth, and families in need. Further, we both believe that it is important to stress the importance of family-centeredness in child welfare as well as the need to support and meaningfully engage families. The concepts “family-centered practice” and “permanency planning” are infused throughout this text, thereby acknowledging the complex reality that, while a family is the best place in which children and youth can grow up, families of origin, for some, may be neither safe nor nuturing. Providing as much support as possible to birth families to assist them in being safe and nurturing permanent caregivers for their children, while at the same time planning for another permanency option if these efforts are not successful (“concurrent planning”), must be accomplished through a family-centered orientation. Further, we know that, when planning for another option, we reflect the family-centeredness of our practice by seeking the optimal connection a child can have to family, culture, and community. A text that integrates familycentered practice with the goal of permanence makes a statement that strengthening and supporting all families—birth, adoptive, kinship,

guardian, and resource or foster—is the best way to ensure children and youth’s timely permanence, stability, safety, and continuity in family relationships. Through its provisions, ASFA, which has been strengthened by Fostering Connections, legally reinforces the linkage between families and positive outcomes for children and youth. Although it places the safety of children and youth first, it also provides a framework for child welfare practice that requires strengthening family preservation and family support services to prevent children from being removed from their families, maintaining a commitment to agencies undertaking reasonable efforts to preserve families, encouraging concurrent planning to ensure permanency through either reunification or another permanent placement within shorter time frames, and encouraging the initiation of permanency planning efforts as a child and the child’s family has an initial contact with the child welfare system. Almost seventeen years since the passage of ASFA, and five since the passage of Fostering Connections, child welfare practitioners continue working to change their policies and practices to better serve children, youth, and families, while striving to comply with complex legal mandates of other child welfare legislation. An urgent need remains to strengthen the capacity of child welfare practitioners to integrate policy and practices that are designed to increase accountability and demonstrate systemic improvement in services and outcomes for children, youth, and families. Another orientation that guides our work is that of evidence-based practices (Gambrill 2003; Roberts & Yeager 2006; Wodarski & Hopson 2011). Over the past twenty years, this orientation has increasingly permeated child welfare in ways that have moved the field in new directions. We asked contributors to acknowledge and identify not only promising approaches to child welfare practice but also those practices that are grounded in empirical evidence. In doing so, some contributors have

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referenced online resources have been developed to assist child welfare professionals and consumers in identifying evidence-based programs and practices. These include the National Registry of Evidence-based Programs and Practices (NREPP), which is a searchable online database of mental health and substance abuse interventions initiated in 2007 and maintained by the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). NREPP is accessed at http://www.nrepp.samhsa. gov/Index.aspx. At www.homevee.acf.hhs.gov, the U.S. Department of Health and Human Services has launched Home Visiting Evidence of Effectiveness (Hom VEE), which provides an assessment of the evidence of effectiveness for home visiting program models that target families with pregnant women and children from birth to age 5, including programs designed to prevent child maltreatment. Another resource, the California Evidence-Based Clearinghouse for Child Welfare (CEBC), informs the child welfare community about the research evidence for programs being used or marketed in California. Accessed at www.cebc4cw.org, the CEBC also lists programs outside California recommended by a topic expert. The profession of social work, as well as society more broadly, is placing greater emphasis on evaluating to what degree identifiable outcomes have been achieved; that value on outcomes extends to the field of child welfare. We therefore asked our contributors to address the significant value and ethical issues relevant to their discussions. With safety, permanence, and well-being as the organizing and guiding principles, this second edition of the text provides a framework for examining child welfare practices and policies in twenty-first century. Within this framework there are clearly differences of perspective among our authors. The field of child, youth, and family services as well as, indeed, the social work profession embrace a wide array of diverse perspectives and practices. While every

edited volume should have a unifying framework to provide structure for the authors and for the readers, it has been our intention that diverse perspectives and practices be incorporated as well. In Part 1, a historical and legislative overview of child welfare, grounds the text in time and place and provides elements of context critical to all subsequent parts of the volume. Part 2 explores and examines the varied perspectives that frame what is currently known about child and adolescent well-being. Although safety is given prominence in ASFA legislation and language, we have intentionally situated the initial focus on child and adolescent well-being, which some have argued was the intent of the Fostering Connections Act. Philosophically, we believe that, without adequate attention to well-being, there is a weakening of the foundation for both safety and permanency and important developmental issues will be disregarded. The chapters in part 2 provide a needs-based approach to understanding experiences and services that support well-being. The first chapters address the broader issues of this area, beginning with an in-depth examination grounded in resilience of family support in communities followed by assessment and meaningful engagement of families with children and youth. The section then addresses the various realms of children’s and youth’s health; child, adolescent, and family mental health; and educational needs. The section concludes with a range of well-being-oriented issues focusing on lesbian, gay, bisexual, and trans (LGBT) youth and their families and runaway and homeless youth. Part 3 examines and explores the critical issues pertaining to child and adolescent safety. Drawing from the theoretical literature, research, and best practices in the area of child maltreatment, this section begins with an overview of the salient issues pertaining to prevention of physical abuse and neglect; it then moves into extensive discussions in the areas of child protection and child and youth at risk. Part 3

PREFACE

also provides a comprehensive overview of the policies, practices, and research that provide a foundation for family preservation services and sexual abuse policy and practice. Over the past two decades, the field of child welfare has recognized the need to develop programs and practice approaches that address particular problems that increasingly place large numbers of children and youth at risk of placement outside their homes. Therefore, part 3 concludes with comprehensive reviews of the practices, policies, and research as these apply to two critical problems confronted daily in serving children, youth, and families: substance abuse and domestic violence. Part 4 is devoted to a wide array of issues related to permanency for children and youth. This section provides an extensive overview of each major permanency goal—Reunification, Kinship, Guardianship, Adoption, Customary Adoption, and Another Planned Permanent Living Arrangement (APPLA)—and on the primary types of out-of-home placement settings. These include foster family care, relative care, and residential programs. Other content areas

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relevant to the selection and achievement of permanency goals as well as to understanding appropriate placements for children and youth are explored in this section. These include sibling connections, adoption disruption, youth development, family visits, and postpermanency services. The volume concludes with a view of the systemic issues that affect children, youth, and family services. The chapters in part 4 focus on practice-related systemic issues, including placement stability, recruitment and retention of foster families, the role of courts and the legal system in child welfare, the child welfare workforce, and supervision. Attention to other systemic issues follows, including research and evaluation, the process and outcomes of the federal Child and Family Services Reviews, and the roles of continuous quality improvement and accreditation in child welfare. The overrepresentation of children and youth of color, father involvement in child welfare services, and issues relating to immigration complete this section. Each part of the text is preceded by an introduction to its organization and its authors.

REFERENCES

Administration on Children, Youth and Families (2013). Recent demographic trends in foster care. PDF data_ brief_foster_care_trends1.pdf at http://www.acf.hhs. gov. Children’s Bureau (2013a). Child welfare outcomes 2008–2011: Report to Congress executive summary. PDF of executive summary brochure at http://www. acf.hhs.gov/programs/cb/resource/cwo-08-11. Children’s Bureau (2013b). Child welfare outcomes 2008– 2011: Report to Congress. PDF of entire report at http:// www.acf.hhs.gov/programs/cb/resource/cwo-08-11.

Gambrill, E. (2003). Evidence-based practice: Sea change or the emperor’s new clothes. Journal of Social Work Education, 39, 3–23. Laird, J., & Hartman, A. (eds.). (1985). A handbook of child welfare: Context, knowledge, and practice. New York: Free Press. Roberts, A., & Yeager, K. (2006). Foundations of evidencebased social work practice. New York: Oxford University Press. Wodarski, J., & Hopson, L. (2011). Research methods for evidence-based practice in social work. New York: Sage.

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Y ACKNOWLEDGMENTS

Writing and compiling an edited volume, especially one as comprehensive as this, can be a complicated business. From conceptualizing and developing the prospectus for this revised edition, to identifying and inviting potential contributors, to the review and revisions of the chapters in various stages, and, finally, to the submission of the manuscript, is a lengthy journey. It is gratifying to complete these tasks and to know that others, especially social work students, will be able to develop their knowledge by using these chapters in their course work and hopefully keep it as a resource long after they complete their studies. One of the most gratifying aspects of the process is being able to acknowledge and thank those people who contributed to this effort and those who helped to sustain and encourage us along this journey. Both of us began our social work careers in child welfare: Gary as a child welfare worker in St. Dominic’s Home, working on the front line with children, youth, and families in Blauvelt, New York, and Peg as a social work intern at the Juvenile Protective Association of Chicago, an agency providing intensive family-centered, home-based placement prevention services. Much of Peg’s work has subsequently continued to focus on placement prevention services as well as on the critical importance of visits, or family time, in the lives of children in care and their families, particularly as it relates to family reunification. Gary’s work has emphasized the importance of developing an affirming lesbian, gay, bisexual, and transgender (LGBT) perspective in working with children, youth, and families. We have both been blessed with good colleagues and friends along the way as well as inspiring teachers, fine supervisors, and many, many children, youth, and families who have taught us much more than we ever could have imagined when we began our careers. xv

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More recently, Gary’s work at the Silberman School of Social Work at Hunter College in New York, where he is the executive director of the National Center for Child Welfare Excellence, has brought him in touch with federal, state, and tribal leaders in child welfare throughout the country. These valuable associations and dialogues have provided a stimulating context for the planning, coordination, and completion of this text. The ideas, discussions, and principles presented in this edition are those of the volume’s coeditors and contributing authors. They do not represent the official position of the Children’s Bureau or the U.S. Department of Health and Human Services, nor were funds from any grant used in the development of this book. While working on this edition, Peg has been involved in multiple reviews of case files of foster children in various states for Children’s Rights, a national advocacy group working to reform failing child welfare systems. The findings of these reviews have served as reminders of the very troubling gap between what is currently known about effective child welfare practice and what many children and their families actually experience. Peg has also continued to consult with states and local programs concerning family visiting of children in care. In contrast to the serious shortcomings in some areas of the public child welfare system, the innovative programs and other resources designed to protect children’s relationships with their parents, siblings, and extended family and to facilitate healing, exemplify the creativity, expertise, and tireless dedication of many child welfare professionals. They are making the kind of tangible difference in children and families’ lives we all hope to make. Both of us recognize and acknowledge how much we have benefited from others. We have learned from our interactions with countless social work practitioners, caseworkers, supervisors, out-of-home caregivers, and administrators in child welfare agencies across the country and with child and family advocates

as we have consulted, provided training, and studied a wide array of child welfare issues. We also acknowledge the equally important and profound lessons we have learned from the innumerable children, youth, and families who have touched our lives with their courage and resilience in the least desirable of circumstances. The initial idea for this book came about ten years ago when Gary proposed working on this text with Peg; we met over coffee on Broadway near Columbia University in New York, where we had both worked as faculty and come to know each other as colleagues and friends. Now more than a decade into the twenty-first century, we have had the opportunity to identify and examine those areas in child welfare where new legislation and knowledge are resulting in needed change as well as those areas where needed change has not yet been realized. Our collaboration as coeditors has been rich, rewarding, and satisfying from start to finish on both editions. Our debt to colleagues who contributed to this volume is inestimable. Both of us on many occasions have noted how fortunate we have been to have such knowledgeable and devoted child welfare professionals writing for this collection. Our contributors have been delightful to work with; but, more important, the depth of their knowledge and their willingness to share it with students and others who will use this handbook is quite remarkable. We are extremely grateful for their exceptional contributions to the field of child welfare and to the second edition of this volume. It is also important to us to acknowledge the consistent strong support and encouragement provided by one of the finest people in academic publishing, our senior editor at Columbia University Press, the late John Michel, who passed away right before the publication of the first edition in 2005. As we have worked on this second edition, we have recalled how John, in his gentle and always humorous way, gave us wise counsel at every step in the process.

ACKNOWLEDGMENTS

We remain deeply saddened by the loss of our colleague and friend and regret that John was never able to see the published work he jokingly called “the mammoth volume” or this second edition. We gratefully acknowledge senior executive editor Lauren Dockett’s attentive and very skillful guidance, as she moved the proposal for this edition through reviews, and Jennifer Perillo’s final reviews and editing for publication as

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well as the remarkably efficient and competent editing provided by Columbia University Press colleagues. Our final thanks are extended to our partners Binho and Howard, our children and grandchildren, and our families (kin and fictive), who support, nurture, and sustain us in personal ways that, in turn, permit us to spend time away from them, immersed in professional endeavors that sustain us in different ways.

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CHILD WELFARE FOR THE T W E N T Y- F I R S T C E N T U R Y

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Introduction An Overview of Children, Youth, and Family Services, Policies, and Programs in the United States

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he passage of the Adoption and Safe Families Act (ASFA) in 1997 (P.L. 10589) and the Fostering Connection to Success and Increasing Adoptions Act of 2008 (P.L. 110-351) marked the culmination of several decades of reform in the child welfare field. These significant legislative acts reinforce and clarify the intent of the Child Welfare and Adoption Assistance Act (P.L. 96-272), which was enacted into law in 1980 because of growing concern that children and youth were being “lost” in foster care. The 1980 act reflected the expanding evidence and evolving philosophy that, through the provision of family-centered services and permanency planning, children and youth who had been subjected to or were at risk of maltreatment would be more likely to experience safety, stability, and security. ASFA and Fostering Connections build on earlier laws and codify many innovative state policies and practices that were emerging to respond to the multiple, often complex, needs of children, youth, and families (see McGowan’s chapter for the history and context of child welfare). All children and youth need a stable, nurturing, and enduring relationship with at least one adult who assures that their physical, emotional, educational, and social needs are met and who protects them from harm. The major role of the child welfare system in the twenty-first century is to ensure the safety, permanency, and well-being of children and youth whose families are not meeting these needs or protecting them. Increasingly, attention is being given to programs designed to

prevent child abuse and neglect (see the chapter by Guterman, Berg, and Taylor). Despite these efforts, however, every day, public child welfare systems across the country receive many reports about children who allegedly are not receiving adequate care and protection from their parents or other permanent caregivers. When such reports are received, the child welfare system’s legally mandated first response is to immediately and thoroughly investigate the nature and degree of harm experienced by the child. This first response is crucial; in some instances it has life-and-death consequences for the child involved. In almost all cases the first response will shape the work with the identified family. At this initial juncture, agency staff must determine whether the child can safely remain at home if supportive services are provided to improve the parents’ level of care (see the chapters by DePanfilis and Costello and by Shlonsky and Gambrill). Whether children and their families are served through in-home services or children are placed in out-of-home care, the public child welfare system is responsible for providing service to children, youth, and families who come to its attention, in partnership with the courts (see the chapter by Ventrell), private child welfare structures, and other service systems, such as mental health (see Dore’s chapter), substance abuse (see the chapter by Ryan and Huang), health care (see McCarthy and Woolverton’s chapter), education (see the chapter by Kelly, McNaught, and Stotland), and family violence programs (see Postmus’s 1

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chapter). Those practitioners serving children and families must ensure that the array of services is individualized and culturally relevant (see the chapters by Cross, RiveraRodríguez, McRoy, Elze, and Earner, Fong, and Smolenski). In-Home Services If, after the initial assessment, it is determined that the child can safely remain in her own home with services provided to improve the parents’ level of care, the public child welfare system, which is state administered in some areas, county administered in others, is responsible for t
assisting families in solving the problems that caused abuse or neglect, t
helping children and youth to be maintained safely in their homes by supporting families in their communities, and t
preserving families by preventing separation of children and youth from their families. To these ends, agency staff must develop an appropriate service plan, with the goal of preventing out-of-home placement, and monitor its implementation and the child’s continuing safety in the home. Services designed to help families stay together while ensuring the well-being and safety of children and youth are sometimes called in-home services. As the name implies, in-home services are provided in the homes and communities in which families reside. In-home services, discussed in parts 1 and 2 of this volume (see the chapters by Kemp, Allen-Eckard, Ackroyd, Becker, and Burke and by Berry and McLean), assist families in learning the skills necessary for providing care and protection of children and youth and work to prevent outof-home placements. In some cases, participation in these services is voluntary; in others, in-home services are mandated (see Faller’s chapter on sexual abuse). In states, tribes, and

localities, these services are known by different names, but they are collectively most generally known as t
family support services, t
family preservation services, t
intensive home-based services, t
family crisis services, or t
family-centered services. In-home services are based on the principles of client empowerment. Therefore, in-home services are designed to encourage families to take charge of their own lives and to be active partners in the process of supporting their own families. Such services first ensure that the child and family’s basic needs are addressed (e.g., food, shelter, clothing, health care, child care, employment training) and then attend to the problems that must be resolved to prevent the child’s placement in out-of-home care. Out-of-Home Services When agency staff members determine that the young person cannot safely remain in his own home, the child welfare agency is required to provide for the child’s welfare and protection by taking legal and physical custody of the child. These services are often called out-of-home services. Out-of-home services provide twentyfour-hour care by the child welfare system for children and youth who need to be temporarily separated from their families. Modeled after the 1977 Education of All Handicapped Children Act, these placements are mandated to be guided by the least restrictive setting principle; that is, placement settings are selected that most closely approximate a child’s family setting. In addition, placement selections are to be based on sound ecological principles, taking into account the importance of placement in close geographic proximity to the child’s own home, school, and other neighborhood supports. There are many different types of placements, which collectively are typically referred to as

INTRODUCTION

foster care. The range of residential services (reviewed by Bullard, Gaughan, and Owens in their chapter) includes t
kinship care (sometimes known as relative care placement); t
family foster homes (with a licensed foster family not related to the child); t
therapeutic and medical foster homes (licensed foster parents with additional training to meet the special needs of the child); t
emergency shelters (very short-term temporary housing for children and youth awaiting a more appropriate setting); t
group homes (state-licensed, communitybased facilities with twenty-four-hour staff, with eight to twelve children usually of the same age); t
supervised independent living settings (state licensed, community-based settings, without twenty-four-hour staff, for older adolescents preparing to transition to adulthood); and t
residential treatment centers (state-licensed congregate care settings with an on-site educational facility and intensive health, mental health, and social services). In making the determination that placement in out-of-home care is necessary, the public child welfare agency accepts the critical responsibility of functioning as the child’s parent or caregiver. Consequently, the system staff is expected to ensure that care and protection are provided at a level fully adequate to meet each child’s basic and individual special needs. The public child welfare agency is challenged further to always provide care at a higher level than that of the parent or caregiver from whom the child was separated. Federal laws specifically mandate that states and local child welfare agencies take full responsibility for the children and youth in their legal custody. Agencies are responsible for

t
ensuring that children and youth are safe and protected from further harm while separated from their families; t
ensuring that, while in care, children and youth receive adequate physical, emotional, and educational attention and that their special needs are fully met; t
working expeditiously to reunify children and youth with their families if they have been separated from their families; and t
developing and implementing a plan (referred to as the child’s plan for permanency) to provide a safe, nurturing, and permanent home for children and youth who cannot return home to their families. This includes recruiting, retaining, and supporting suitable permanent homes. In this volume the section on permanency is extensive. The chapter authors in this section either examine a placement alternative or one of the various permanency pathways that may be utilized to develop plans to achieve the intended long-term, stable home for the child or youth. Providing a Safe and Nurturing Placement A child’s family is at the center of her world. It follows, for almost all children and youth, that the experience of being removed from their family is extremely traumatic. No matter what harms children have experienced, they are attached to their parents/caregivers and thus experience profound loss and fear at being taken to live with strangers. Therefore the public agency must be prepared to immediately provide the child a safe, nurturing placement and ensure that, in every way possible, the child is afforded support and stability. For example, every effort must be made to place children with caring relatives and with all siblings also in legal custody, which provides reassurance and comfort to them (see Hegar and Scannapieco’s comprehensive overview of kinship care and Hegar’s chapter on siblings), and to place school-aged children near their own schools,

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thus preventing the loss of familiar teachers and friends. These important efforts reduce the negative impact of separation from family and neighborhood upon the child. Within days of an out-of-home placement, the public agency must provide children contact with their parents/caregivers (see Hess’s chapter on family visiting of children in care), including the child’s paternal resources (see Coakley’s chapter on fathers and the child welfare system), preferably in person. This contact reassures children and youth that they have not been abandoned and that the adults responsible for their care understand their deep need to maintain a relationship with their parents and other family members. If it is determined that children and youth cannot safely be placed with a relative or other familiar person, the public agency is responsible for identifying a placement with caregivers who are fully prepared to meet not only the child’s basic needs but also his special needs (see Freundlich’s chapter on foster care). For example, a child who has been chronically neglected may have severe developmental delays or medical needs; a child who has been repeatedly abused and lived in a violent household may be withdrawn and uncommunicative or aggressive and unresponsive to typical household rules (see Postmus’s chapter). A child or youth who has been sexually abused may relate to adults and other children in ways that place him at further risk for exploitation. Depending on their nature and extent, children’s special needs may be met through placement in a relative or nonrelative foster family home or may require more specialized services, such as a therapeutic or medical foster home. Some children’s special needs, including diagnosed mental illness, require the intensive services and structure provided in a group or residential treatment setting. Therefore, at the time of placement, an accurate and full assessment must be made regarding the level of caregiver training and competence, placement structure, and medical, mental health, and educational

services required to ensure that the child’s special needs are fully met while in custody . Otherwise, children continue to be subjected to repeated traumatic events at a time of already heightened vulnerability. To address all these issues, the child’s public agency caseworker or case manager is charged with coordinating an assessment and service planning process. Through this process, in partnership with the child’s family and other professionals, the agency determines the child’s service and placement needs, selects an appropriate placement setting, and develops a plan for delivery of needed service. The child’s plan for services (the “case plan”) is monitored through court and other reviews every six months at a minimum and revised as indicated by the parent’s use of services and the child’s or adolescent’s needs. In addition, throughout the child’s placement the public agency caseworker/case manager is responsible for maintaining frequent, regular, face-to-face contact with the child or adolescent, his parents, siblings placed separately, and the child’s caregiver to ensure that the child is safe, that caregivers have the information and support necessary to provide for the child’s care, that the continuity of family relationships and connections is preserved for children, and that progress toward the permanent plan is taking place. Family Reunification as a Permanency Goal Because most children and youth want to live with their families and because, both legally and morally, parents and other legal permanent caregivers have a right to raise their children when they can do so safely, the public agency is required to make reasonable efforts to provide services that enhance family’s capacities and facilitate the child’s or adolescent’s safe return home. This placement outcome is called family reunification (see Pine, Spath, and Gosteli’s chapter on reunification) and is to be achieved within twelve to fifteen months of the child’s entry into legal custody.

INTRODUCTION

To achieve reunification, services must be individualized to address the family’s particular needs, accessible, and provided in a timely manner by competent professionals. Thus it is the public agency’s responsibility to ensure that at or immediately following the child’s placement the family’s service needs are identified, appropriate services are offered, and obstacles to service provision are addressed. Such services necessarily include frequent, regular parent-child (and, when placed separately, sibling-sibling) visits and other contacts. Without frequent contact, already fragile family relationships cannot be maintained and children inevitably experience abandonment and deep loss. Without frequent contact, family reunification is much less likely to occur and to occur successfully. Again, the child’s well-being, safety, and permanency are at stake. When it has been determined that a child may safely be returned to his home, an assessment must be made of the follow-up services required to support the family in this often difficult transition. Simply returning a child who has lived out of the home back into the family unit without services to support changes in family members’ behaviors predictably results in further harm to the child or adolescent due to neglect and abuse. Adoption and Other Permanency Goals In some instances, due to the neglect and/or abuse’s severity, a parent’s diagnosed condition, or a family’s history, it can be determined at the time of a child’s or an adolescent’s placement that family reunification cannot safely be achieved. In other instances, such a determination is made after reunification services have been provided and it becomes clear, based on the parents’ inability or unwillingness to make the changes required for the child’s safe return to their care, that reunification will not be achieved. In either case, under timetables mandated by federal law, the public agency is responsible for identifying another viable plan for the child’s

future that provides the child with stability and a sense of permanence. The agency must determine what plan is appropriate for the child—permanent placement with relatives, adoption, or, in some cases, Another Planned Permanent Living Arrangement (APPLA; see Renne and Mallon’s chapter). Steps to achieve this permanent plan must be identified, taken in a timely manner, and fully documented in the case record. For example, achieving the goal of adoption typically requires the legal termination of the parents’ rights, recruitment of an appropriate adoptive family, and preparation of the adoptive family and the child or adolescent for adoption (see Mallon’s chapter, this volume). Services designed to support birth parents when reunification cannot occur, although not mandated and generally underfunded, are also increasingly being made available by service providers (see the chapter by Hollingsworth). In all instances, achieving permanency for the child through means other than family reunification will require services that support the child in working through the realization that she will not be returning to her parent’s care (see Testa and Miller’s chapter on guardianship). Permanency arrangements for youth have frequently been defaulted to what was known as “long-term foster care” or “independent living.” More recently, services for youth have begun to be reconceptualized to focus more on promoting lifetime connections for youth and less on a permanency goal of independent living services (see Collins’s discussion on youth development issues and Staller’s chapter on the unique needs of runaway and homeless youth). In all instances, achieving permanency for the child or youth requires that the potential permanent caregiver is fully informed of the young person’s basic and special needs and is willing and able to meet those needs. And, once the child is placed with the potential permanent caregiver, services to support and to maintain the child’s integration into the caregiver’s

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family are essential (see Festinger’s chapter on adoption disruption, as well as Freundlich and Wright’s chapter on postpermanency services). Placement of a child in foster care is intended to be a temporary measure. Children should be placed in out-of-home care only when a careful assessment determines that the child’s safety and well-being cannot be ensured even with the provision of intensive services to the family. In those instances, out-of-home family placement with relatives or others or in a group care setting, depending upon the child’s or adolescent’s special needs, is a time-limited measure, taken to protect the child until the child can be safely returned to her home. When the preferred placement outcome of family reunification cannot be achieved, placement then is necessarily extended. But placement remains a temporary measure, taken until the child can be permanently and legally placed with another family, either relatives or an adoptive family. In only a few instances should children be required to stay for longer periods in legal custody, including those in which the young person’s special needs require treatment that cannot be provided in a family setting. The child welfare system is not intended to serve as a replacement for the families that children need and deserve. However, when the child welfare system fails to follow the legally mandated processes we have outlined, it will inevitably fail to achieve the goals for permanency it is mandated to accomplish. As a consequence, children and adolescents will predictably spend longer periods of their lifetimes in legal custody than is necessary or acceptable. For more than fifty years, research has consistently found that the longer children are permitted to remain in care, the greater the likelihood that they will never return to their own families or move into another stable permanent home. And, during lengthy stays in legal custody, if they are exposed to multiple placement changes and/or to other harms, including caregiver neglect and abuse, their emotional, physical, social, and educational

status will deteriorate, often markedly. Young children, particularly, who rely on a stable, continuous nurturing adult relationship to develop the capacity for healthy human attachments, are often irreparably harmed by neglect and abuse in care and multiple placement changes (see chapter by D’Andrade and James). Practice and accreditation standards and federal and state legislation have been devised to prevent such harms to already vulnerable children. Children in custody necessarily rely on others to document their needs and experiences. Professionals in the child welfare system understand that if it is not written down, it is as if it never happened. Without a full and accurate record of the child’s needs and experiences, the child’s well-being and safety are in constant jeopardy. Given the life-altering nature of the decisions made in the child protection and permanency planning process, decisions based on incomplete or inaccurate documentation are not only likely to be unwise but may also be seriously harmful, and even life-threatening, to a child. In addition, without timely, accurate, and thorough documentation of the child’s experiences during care, critical aspects of the child’s history will be lost. The agency will then be unable to fully and accurately inform others, such as placement caregivers or service providers, about a child’s needs while in care or to inform a child’s birth or adoptive family about the child’s needs upon discharge from legal custody. The circumstances that bring child welfare practitioners into the homes and lives of children, youth, and families are often ambiguous and challenging. The child welfare practitioner is asked to make decisions quickly, based on the best and most complete information available to him. This information will always have limitations, yet decisions based on it will have profound, long-term consequences for children and families. The decision-making process is more effective when agency staff work together as a team within the agency and with the family

INTRODUCTION

and community partners (see the chapter by Bossard, Braxton, and Conway) to develop service interventions that include the following elements of good child welfare practice:

assessment, the competent and timely provision of appropriate services, and the complete and accurate documentation of service provision and outcomes.

t
child-focused: the safety, permanency, and well-being of children and youth are the leading criteria in all child welfare decisions; t
family-centered: children, youth, parents, and extended family members are involved as partners in all phases of engagement, assessment, planning, and implementation of case plans; t
strengths-based: practices emphasize the strengths and resources of children, youth, biological and extended families, and their communities; t
attentive: practices take into account both risk and resilience factors for children, youth, and families; t
individualized: case plans are developed to address the unique needs of the child, youth, and family and to appropriately address needs for safety and permanency; t
culturally competent: problems and solutions are defined within the context of the family’s culture and ethnicity; t
comprehensive: services address a broad range of family conditions, needs, and contexts; t
community partnership oriented: planning and implementation of case plans are undertaken in partnership with staff and agencies from different systems that together make a formal commitment to provide the services and supports that the child and family need; and t
outcome based: there are measurable outcomes for services regarding the safety, permanency, and well-being of children and youth.

Systemic Issues On a systemic level, states and local child welfare agencies have had to make strategic decisions about how to use existing financial and staff resources, work in partnership with the courts, develop purposeful agreements to coordinate with community-based organizations and other child serving agencies, and continuously redesign their service delivery so individualized case plans can be developed that will ensure the safety of children and youth. The principles and provisions of ASFA and Fostering Connections, the most recent federal legislation concerning child welfare practice, are designed to ensure child safety, decrease the time required to reach permanent placements, increase the incidence of adoption and other permanent options, and enhance states’ capacity and accountability for reaching these goals. This law has had a significant impact on children and families, the child welfare and court systems, child welfare practice on the front lines, and community-based organizations that are enlisted to help meet the comprehensive needs of children and their families. The influence of this law has been made manifest in the key findings from the two rounds of Child and Family Services Reviews (see Mitchell, Thomas, and Parker’s chapter), now completed in all fifty states as well as in the District of Columbia and Puerto Rico. The CFSRs process examines statewide data indicators and qualitative information to determine state achievement in two areas: 1. outcomes around safety, permanency, and well-being; and 2. systemic factors that directly impact the state’s capacity to deliver services that support improved outcomes. Seven systemic factors are also identified for examination by the federal review process:

At every stage, and for every child and family, the cornerstone of effective child welfare practice is formed by comprehensive and ongoing

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1. Statewide information system: the state can readily identify the status, demographic characteristics, location, and goals for the placement of every child who is—or has been within the preceding twelve months—in foster care. 2. Case review system: the state provides a written case plan for each child to be developed jointly with the child’s parent(s); provides a periodic review of the status of each child no less than once every six months; ensures that each child in foster care has a permanency hearing no later than twelve months from the date the child entered foster care and not less than every twelve months thereafter; provides a process for termination of parental rights proceedings; and provides foster parents, preadoptive parents, and relative caregivers of children in foster care with notice of and an opportunity to be heard in any review or hearing. 3. Quality assurance system: the state ensures that children in foster care placements receive quality services that protect their safety and health and evaluates and reports on these services. 4. Staff training: development and training programs support the goals and objectives in the state’s Child and Family Services Plan; address services provided under both subparts of Title IV-B and the training plan under Title IV-E of the Social Security Act; and provide training for staff that provide family preservation and support services, as well as child protective, foster care, adoption, and independent living services. Ongoing training is also provided for staff that addresses the skills and knowledge necessary to carry out their duties within the state’s Child and Family Services Plan (see Munson, McCarthy, and Dickinson’s chapter on child welfare workforce issues and Potter, Hanna, and Brittain’s chapter on child welfare supervision). Short-term training is also offered for current or prospective foster parents, adoptive parents, and the staff of state-licensed/approved child care institutions that care for foster and adopted children.

5. Service array: the state has an array of services that assesses the strengths and needs of children and families; addresses the needs of the family, as well as the individual child, to create a safe home environment; and enables children at risk of foster care placement to remain with their families when their safety and well-being can be reasonably assured. Services are designed to help children achieve permanency; be accessible to families and children in all political subdivisions covered in the state’s Child and Family Services Plan; and be individualized to meet children’s and families’ unique needs. 6. Agency responsiveness to the community: the state engages in ongoing consultation, coordination, and annual progress reviews with a variety of individuals and organizations representing the state and county agencies responsible for implementing the Child and Family Services Plan and with other major stakeholders in the services delivery system, including, at minimum, tribal representatives, consumers, service providers, foster care providers, the juvenile court, and other public and private child and family servicing agencies. 7. Foster and adoptive parent licensing, recruitment, and retention: the state establishes and maintains standards for foster family homes and child care institutions, applies standards to every licensed/approved foster family home or child care institution that receives Title IV-E or IV-B funds, and complies with the safety requirements for foster care and adoption placements. In addition, each state has a process to recruit foster and adoptive families who reflect the racial diversity of children in the state, developing and implementing plans for the effective use of cross-jurisdictional resources to facilitate timely adoption or permanent placement (see Pasztor and McNitt’s chapter). Each of these systemic factors is addressed at various points in this text. These factors greatly affect the experiences not only of those served by the

INTRODUCTION

system but also of those who are responsible for serving them. By and large, the keys to improving the experiences of children, youth, and families currently in or entering the child welfare system are to continue to identify evidence-based approaches to achieving child and youth safety, well-being, and permanency, to promote more effective methods of implementing those approaches regardless of the jurisdiction within which children and youth reside, and to adequately fund those services essential to achieving child safety, well-being, and permanency (see Collins-Camargo’s chapter on child welfare research and evaluation). Certainly, evaluation of policies and practices resulting from the implementation of ASFA and Fostering Connections will help the field better understand how to promote the best interests of individual children and youth. Target Audiences This edited volume has been designed to support and enhance the professional education of social

workers by providing a foundation and advanced level of knowledge about the field of practice known as “children, youth, and family services.” This text can also be utilized as a training guide for child welfare professionals already engaged in work with children, youth, and families. Moreover, it may be informative to representatives of other related agencies (e.g., the courts, mental health professionals, school personnel, juvenile justice system staff) and to those involved in policy development, program planning and evaluation, and child and family advocacy. The editors of this book have intentionally not cited references from any of the four parts that frame each area, as it is our thought that their inclusion would break the flow of this introduction. Clearly, this volume and the ideas contained within these pages include knowledge, wisdom, and practice insights from numerous academics, researchers, legal and judicial personnel, child welfare administrators, supervisors, and practitioners, many of whom are contributors and/or cited extensively throughout the following chapters.

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Historical Evolution of Child Welfare Services

T

he major forces shaping the provision of child welfare services in this country—the size and composition of the population at large and the child population at risk; social, economic, and technological demands on families; prevailing ideologies regarding the proper relationships among children, parents, church, and state; dominant views about the causes of poverty, illness, and crime; and the political influence of different interest groups—have all shifted significantly since early colonial days. Yet many of the issues that plague the child welfare field today reflect the unresolved tensions and debates of the past. These include t
parents’ rights versus children’s needs; t
child saving versus family support; t
child protection versus family preservation; t
federal versus state versus local responsibility; t
public versus voluntary financing and service provision; t
developmental versus protective services; t
in-home services versus foster family versus institutional care; t
appropriate boundaries between the child welfare, family service, juvenile justice, mental health, and persons with developmental disabilities systems; t
individualized, pluralistic modes of interventions versus uniform standards and treatment; t
specialized professional services versus informal, natural helping networks; and t
social costs versus benefits of providing varying levels of care.

All these issues appear and reappear in the major historical documents on the American child welfare system. The one theme that never disappears is the search for a panacea, a solution to the problems of children and youth whose parents are unable to provide adequate care. The proposed solution today is a confluence of safety, permanency, and well-being issues, but a careful reading of history suggests that implementation of these concepts is no more likely to eliminate the need for extensive, ongoing public provision for children and youth who are poor, neglected, unwanted, socially deficient, or disabled than infanticide, warehousing, banishment, and foster home programs of the past. The earliest biblical accounts of Moses, Abraham, Isaac, and Jesus all address, in different ways, the problems of dependent and maltreated children. Therefore, although the concepts of well-being, safety, and permanence seem to offer a promising route for service provision, it would be naive to assume that movements in this direction will meet all the needs of the child welfare population without creating or drawing attention to other problems. In this chapter I present a broad overview of the historical evolution of the child welfare system via examination of the major trends and shifts in service provision for dependent, neglected, and troubled children. This historical overview will give readers a clearer understanding of the sources of some of the current dilemmas and strains in the child welfare field, thereby providing an analytical base for 11

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addressing problematic issues that are likely to arise in the future. Social trends seldom fit into neat lines of demarcation. Unlike historical events, the beginnings of social movements can rarely be traced to a single action or a specific date. They are the result of numerous forces that come together at an approximate time. Although century boundaries are used as the organizing framework for this chapter, such intervals cannot be taken too literally. To do so poses the risk of historical distortion, for social movements and social changes often span more than one century. Seventeenth and Eighteenth Centuries The early American settlers were preoccupied with issues of freedom and survival for themselves and their new country. The demands of exploring, settling, and cultivating vast expanses of land were enormous; the small size of the population meant that contributing members of society were at a premium. The family was the basic economic unit, and all members were expected to contribute to the work of the household. The concept of childhood, as it is currently understood, was unknown except for very young children. Although there was a high birthrate, approximately two-thirds of all children died before the age of four. Those who lived past this age were expected to start contributing labor as soon as possible by helping with household and farming chores, caring for younger siblings, and so forth. Hence children moved quickly from infant status to serving essential economic functions for their families. Children were perceived as a scarce and valued resource for the nation, but little attention was paid to individual differences or needs. The concept of children’s rights was nonexistent. As Hillary Rodham (1973), aka Hillary Clinton, commented: “In eighteenth-century English common law, the term children’s rights would have been a non sequitur. Children were regarded as chattels of the family and wards of

the state, with no recognized political character or power and few legal rights.” Although there was no child welfare system as such in those early days, two groups of children were presumed to require attention from the public authorities: orphans and children of paupers. Because of high maternal mortality rates and adult male death rates caused by the vicissitudes of life in the New World, large numbers of children were orphaned at a relatively young age and required special provisions for their care. Children of paupers were also assumed to require special attention because of the high value placed on work and self-sufficiency and the concomitant fear that these children would acquire the “bad habits” of their parents if they were not taught a skill and good working habits at an early age. Parents who could not provide adequately for their children were deprived of the right to plan for their children and were socially condemned. Social provisions for dependent children during this early period derived from the English poor law tradition. Children and dependent adults were treated alike and were generally handled in one of four ways: 1. outdoor relief: a public assistance program for poor families and children consisting of a meager dole paid by the local community to maintain families in their own homes; 2. farming out: a system whereby individuals or groups of paupers were auctioned off to citizens who agreed to maintain the paupers in their homes for a contracted fee; 3. almshouses or poorhouses established and administered by public authorities in large urban areas for the care of destitute children and adults; and 4. indenture: a plan for apprenticing children to households where they would be cared for and taught a trade, in return for which they owed loyalty, obedience, and labor until the costs of their rearing had been worked off.

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

In addition to these provisions under the public authorities, dependent children were cared for by a range of informal provisions arranged through relatives, neighbors, or church officials. A few private institutions for orphans were also established during this early colonial period. The first such orphanage in the United States was the Ursuline Convent, founded in New Orleans in 1727 under the auspices of Louis XV of France (Folks 1978). However, prior to 1800 most dependent children were cared for in almshouses and/or by indenture, the most common pattern being that very young children were placed in public almshouses until the age of eight or nine, and then they were indentured until they reached majority. Thus the social provisions for dependent children during the first two centuries of American history can be characterized as meager arrangements made on a reluctant, begrudging basis to guarantee a minimal level of subsistence. The arrangements were designed to ensure that children were taught the values of industriousness and hard work and received a strict religious upbringing. Provisions were made at the lowest cost possible for the local community, in part because of the widespread concern that indolence and depravity not be rewarded. Parents who were unable to provide for their children were thought to have abrogated their parental rights, and children were perceived primarily as property that could be disposed of according to the will of their owners—parents, masters, and/ or public authorities who assumed the costs of their care. The goal was to make provisions for dependent children that would best serve the interests of the community, not the individual child. Nineteenth Century Massive social changes occurred in the United States during the nineteenth century, all of which influenced the nature of provisions for dependent children. The importation of large numbers of slaves and the eventual abolition of slavery first reduced the number of requests

for indentured white children and later created opposition to a form of care for white children that was no longer permitted for blacks. The emergence of a bourgeois class of families in which the labor of children and wives was not required at home permitted upper-income citizens to turn their attention to the educational and developmental needs of their own children as well as the orphaned, poor, and delinquent. The large-scale economic growth of the country after the Civil War helped to expand the tax base and free funds for the development of private philanthropies aimed at improving the lives of the poor. The massive wave of immigrants from countries other than England created a large pool of needy children, primarily Catholic and Jewish, from diverse cultural backgrounds. Finally, the Industrial Revolution changed the entire economic and social fabric of the nation. New industries required different, more dangerous types of labor from parents and youth and created a new set of environmental hazards and problems for low-income families. The Rise of the Institution Perhaps the most significant change in the pattern of care for dependent children during the early nineteenth century was the dramatic increase in the number of orphanages, especially during the 1830s. These facilities were established under public, voluntary, and sectarian auspices and were designed to care for children whose parents were unable to provide adequately for them as well as for true orphans. Two reports issued in the 1820s contributed heavily to the expansion of congregate care facilities and the decline of the earlier system of indenture and outdoor relief. The 1821 Report of the Massachusetts Committee on Pauper Laws concluded that “outdoor relief was the worst and almshouse care the most economical and best method of relief, especially when it provided opportunities for work” (Abbot 1938:121). The second report, known as the Yates Report of 1824, was issued by the secretary of state for New York following a year’s

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study of poor laws. This report took an even stronger position against outdoor relief and indenture and advocated the care of dependent children and adults in county-administered almshouses. A major expansion in almshouse care occurred in the years succeeding the publication of these reports. However, the early advocates of the use of almshouses did not foresee the physical and social risks to children posed by housing them with all classes of dependent adults. Although facilities in some of the larger cities established separate quarters for children, most were mixed almshouses that cared for young children, “derelicts,” the insane, the sick, the blind, the deaf, the retarded, the delinquent, and the poor alike. By mid-century, investigations of the living conditions of children in poorhouses had started, creating strong pressure for the development of alternative methods of care. For example, a Select Committee of the New York State Senate (New York State Senate 1857, as cited in Bremner 1970–1974:321) reported on a study conducted in 1856, just thirty-two years after the publication of the Yates Report: The evidence taken by the committee exhibits such a record of filth, nakedness, licentiousness, general bad morals, and disregard of religion and the most common religious observances, as well as of gross neglect of the most ordinary comforts and decencies of life, as if published in detail would disgrace the State and shock humanity. . . . They are for the young, notwithstanding the legal provision for their education, the worst possible nurseries; contributing an annual accession to our population of three hundred infants, whose present destiny is to pass their most impressible years in the midst of such vicious associations as will stamp them for a life of future infamy and crime.

State after state issued similar reports, characterizing almshouses as symbols of human wretchedness and political corruption and

calling for special provisions for the care of young children in orphanages under public or private auspices. But reform came slowly, in part because public funds had been invested in the poorhouses and in part because there were no readily available alternatives for the large number of children housed in these facilities. Therefore, laws prohibiting the care of children in mixed almshouses were not passed until the latter part of the century (Abbott 1938). The history of child welfare up to this point, excluded African American children. Black dependent children who were not sold as slaves were cared for primarily in the local almshouses or within kinship care arrangements informally arranged by black families caring for other black families. African American children and youth were explicitly excluded from most of the private orphanages established prior to the Civil War. Consequently, several separate facilities for black children were founded during this period, the first of which was the Philadelphia Association for the Care of Colored Children established by the Society of Friends in 1822. To ensure the survival of these facilities, their founders attempted to separate the orphanages from the abolitionist movement with which they were identified. However, the shelter in Philadelphia was burned by a white mob in 1838 and the Colored Orphan Asylum in New York was set on fire during the Draft Riot of 1863 (Billingsley & Giovannoni 1972). The Beginnings of “Foster” Care With the recognition of the condition of children cared for in mixed almshouses, the stage was set for a number of reform efforts. One such effort began in 1853 with the founding of the Children’s Aid Society in New York by Charles Loring Brace. By the end of the century, Children’s Aid Societies had been established in most of the other major Eastern cities. Brace was strongly committed to the idea that the best way to save poor children from the evils of urban life was to place them in Christian homes in the country where they would

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

receive a solid moral training and learn good work habits. Consequently, he recruited large numbers of free foster homes in the Midwest and upper New York State and sent trainloads of children to these localities. By 1879 the Children’s Aid Society in New York City had sent forty thousand homeless or destitute children to homes in the country (Bremner 1970–1974; O’Connor 2004)). A somewhat parallel development was the establishment of the Children’s Home Society movement. These societies, statewide childplacing agencies under Protestant auspices, were also designed to provide free foster homes for dependent children. The first such society was established by Martin Van Buren Van Arsdale in Illinois in 1883. His idea spread rapidly, and by 1916 there were thirty-six Children’s Home Societies located primarily in Midwestern and Southern states (Thurston 1930). The free foster home movement was not without its critics for several reasons. First, although Brace and Van Arsdale viewed their programs as conceptually quite different from the indenture system of the past, in practice it was difficult to make such a distinction. Their arrangements involved essentially the same three-part contract between the family, the child, and the agency officially responsible for the child. Children were expected to pay for their bread and board through their labor. Investigations of the receiving families were minimal, and many reports were received of children who suffered poor treatment and were exposed to negative influences during their placement. A second concern voiced was that foster families, almost by definition, did not have the structure and specialized resources necessary to ensure that children received a formal education and thorough training in the tenets of the children’s own religion. Finally, a number of Roman Catholic leaders opposed this movement on the grounds that children were placed primarily in Protestant homes and were likely to lose their religious faith if they

were not given the opportunity to be raised in Catholic settings. The Care of Delinquent Youth Parallel to the recognition that children are different from adults and need different forms of care came the realization that not all children should be cared for in the same way. While it had long been recognized that there were differences between dependent children who needed care because their parents could not provide for them and children who needed to be “punished” because they had committed criminal acts, early nineteenth-century America often cared for both groups in the same way—the almshouse. This had not been the case in colonial America; hence reformers during this later period sought to reestablish differences in the care of these two groups of children. Under English common law, children over the age of seven who committed criminal offenses were treated the same as adults and subjected to harsh, cruel punishments such as whipping, mutilation, banishment, and even death. The early American colonies adopted very similar procedures and continued to use various forms of corporal punishment for children until the concept of confinement was introduced in the eighteenth century. The predominant mode of punishment shifted to various types of confinement. By the beginning of the nineteenth century, many of the public almshouses and workhouses held a mixed population of juvenile and adult offenders as well as the dependent children and paupers for whom they were originally intended. This created pressure to establish special facilities for child offenders. In 1824 the Society for the Reformation of Juvenile Delinquents established the New York City House of Refuge, an asylum for vagrant youth and juvenile offenders designed to provide work training and some formal education (Abbott 1938). Other cities quickly followed the New York example. Lyman School, the first state reform school in the United States, opened in

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Massachusetts in 1848. Numerous other states established separate institutions for delinquent children in the years preceding and following the Civil War, all of which emphasized rigid discipline and hard work. Although many of these facilities were designed as experimental efforts in the reformation of troubled youth, they were forced to derive much of their income from the contracted labor of the juvenile inmates. This inevitably resulted in institutional corruption, exploitation, and brutal treatment of the youth. During the latter part of the century there were a number of investigations and exposés of institutional abuse in reform schools. Many public officials and concerned citizens made valiant attempts to improve the quality of life for youngsters in these facilities. But these reform efforts had little impact. Attention gradually turned to developing voluntary institutions for juvenile offenders and finding alternative, community-based means of caring for these youth. Massachusetts and Michigan passed laws permitting the appointment of state probation officers for delinquents, and several other states authorized voluntary aid societies to represent youth in court and supervise their probation. The passage of the first juvenile court law in 1899 represented what Bremner termed “the culmination of various efforts to reform children without committing them to reform schools” (Bremner 1970–1974:440). The development of the juvenile court has long been viewed by authorities in the child welfare field as a landmark event in the history of services to dependent and delinquent children. As suggested previously, it did not represent a major shift in orientation. The reform efforts of the nineteenth century had been moving toward an approach that emphasized the concept of treatment rather than punishment for youth who had committed delinquent offenses and of separate, individualized services for different groups of children. However, the passage of this law did signal a significant change in the degree to which courts would sanction state intervention in the lives of children.

The first juvenile court law in Illinois resulted from the efforts of a coalition of middle-class reform groups representing a range of civic, feminist, and children’s interests. Two of the best-known leaders of this coalition were Julia Lathrop and Jane Addams. Frustrated by their inability to effect any basic reforms in the institutions caring for delinquent youth, they decided that more fundamental changes were necessary to ensure that youngsters could be removed from corrupting influences. But they needed to find a constitutionally acceptable basis for intervening in the lives of children considered at risk. After much effort, a bill was worked out with a committee from the Chicago Bar Association giving the Illinois courts of equity jurisdiction over juvenile offenders. These noncriminal courts of equity derive from the English chancery courts that exercise the privilege of the state as parens patriae and do not require the application of rigid rules of law to permit state intervention designed to protect the interest of children (Abbott 1938:330–332). The concept of the juvenile court took hold quickly, spreading rapidly throughout the United States and to various European countries during the early twentieth century. It has had a major impact on the development of children’s services in the twentieth century. In fact, debates engendered by the actions of the juvenile court regarding punishment versus treatment of juvenile offenders and children’s rights versus children’s needs persist to this day. The Expansion of Services Until the last quarter of the nineteenth century, state intervention in a child’s life occurred, for the most part, only when the child threatened the social order. Dominant members of society feared that dependent children would grow up without the moral guidance and education necessary to enable them to become productive members of society. Children violating the law posed not only an immediate threat but also the fear that, without intervention, they would grow up to be adult criminals.

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

During the latter part of the nineteenth century, the focus of concern began to change. Voluntary organizations founded during this period recognized that families had an obligation to provide for their children’s basic needs. If they did not, it was argued, society had the right and obligation to intervene. Thus the concept of minimal social standards for child rearing was introduced. The founding of the New York Society for the Prevention of Cruelty to Children in 1874 signaled the beginning of this broader concept of societal intervention on the child’s behalf. Similar societies were quickly established in other areas of the country, and by 1900 there were more than 250 such agencies (Bremner 1970–1974). The New York society was established in the wake of the notorious case of “little Mary Ellen” (Shelman & Lazoritz 2003). A friendly visitor (the forerunner of the modern social worker) from child’s neighborhood was horrified by the abusive treatment the child had received from her caregiver and sought help from several child welfare institutions to no avail. Finally she turned to Henry Bergh, president of the Society for the Prevention of Cruelty to Animals, who promptly brought the case to court, requesting that the child be removed from her caregiver immediately. As reported in the New York Times (1874, as cited in Bremner 1970–1974:190), “the apprehension and subsequent conviction of the persecutors of little Mary Ellen . . . suggested to Mr. Elbridge T. Gerry, the counsel engaged in the prosecution of the case, the necessity for the existence of an organized society for the prevention of similar acts of atrocity.” Newspaper accounts of the early meetings of the society indicate that the founders saw their primary function as prosecuting parents, not providing direct services to parents or children. In fact, the society was denied taxexempt status by the State of New York in 1900 because its primary purpose was defined as law enforcement, not the administration of charity (Bremner 1970–1974). However, this agency, as

well as the other early child protection societies, quickly turned its interests to all forms of child neglect and exploitation, not confining its activities merely to the prevention of physical abuse of children in their own homes. The establishment of the Charity Organization Society movement, starting in 1877, also contributed to the expansion of services to children. Founded as a response to unorganized outdoor relief and indiscriminant giving, these societies set out to rationalize charity. Initially their leaders perceived poverty as the fault and responsibility of the individual, and their programs were designed to help the individual correct the situation. They were opposed to monetary giving and to any public sector involvement in the relief of destitution; government was not to be trusted or to provide a “dole,” which would encourage laziness and moral decay. In order to accomplish this mission, the societies enlisted the aid of “friendly visitors”— whose responsibilities were to seek out the poor, investigate their need, and certify them as worthy for private help. They were to provide a role model, advice, and moral instruction to the poor in order that they could rid themselves of poverty. These ideas had a profound influence on the orientation of the early social workers in the family service field. However, what the friendly visitors discovered was that much poverty was the result of societal forces far beyond the individual’s control. Many children were destitute not because their parents were lazy or immoral, but because jobs were not available, breadwinners were incapacitated by industrial accidents, or parents had died. While the friendly visitors continued to minister to the poor on a case-by-case basis, their recognition of the social roots of poverty converged with the philosophy underlying the establishment of the first settlement houses at the end of the nineteenth century. The settlement house movement was a middle-class movement designed to humanize the cities. It emphasized total life involvement,

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decentralization, experimental modes of intervention, and learning by doing. Although the early leaders shared the Charity Organization Societies’ suspicion of public institutions, they were influenced by the concepts of philosophical idealism and pragmatism that shaped the Progressive era. Consequently, they had a more communal orientation, were concerned about environmental as well as individual change, and placed a strong priority on empirical investigation of social conditions. Their programs included “developmental” services such as language classes, day-care centers, playgrounds, family life education, and so forth. Convinced of the worth of the individuals and immigrant groups they served and the importance of cultural pluralism in America, the Charity Organization Societies saw the causes of many social problems in the environment and sought regulations to improve them. Thus, by the end of the nineteenth century, services were expanded to protect children and provide for some of their developmental needs within their own homes and communities. Such services were further developed and expanded in the twentieth century. The Administration of Services By the last quarter of the nineteenth century, two distinct systems of out-of-home care for children had evolved to replace the care of children in mixed almshouses: free foster homes and children’s institutions. Four different models were eventually adopted to administer these systems, each typified by the respective provisions of the laws enacted in Massachusetts, New York, Michigan, and Ohio (Abbott 1938). The major distinctions among these service delivery models relate to the allocation of responsibility between state, county, and local governmental units, the relative emphasis given to foster home versus institutional care, and the degree of public reliance on and subsidy of voluntary agency services. In Massachusetts, almshouse care for children was abolished in 1879. In 1887, legislation

was passed requiring that city overseers place dependent children in private homes. If cities failed to comply, the State Board of Charities was authorized to place children at the expense of the local communities. Although some private institutions had been established in the state earlier in the century, there was little public subsidy for these facilities. Hence the Massachusetts solution was primarily a system of state and locally funded foster home care for dependent children (Abbott 1938). A very different approach was followed in New York State after the care of children in almshouses was prohibited in 1875. Local communities were given the responsibility of planning for these children and had the option of providing either subsidies to private agencies or developing a county-based system of public care. However, an earlier law required that children be placed in facilities under the auspices of the same religious faith as their parents, and sectarian agencies were pressing hard for subsidy. Consequently, a system developed whereby local communities paid a per capita subsidy to voluntary, primarily sectarian, agencies for the care of dependent children (Abbott 1938). Michigan adopted still another approach after almshouse care for children was prohibited in 1881. A state school for dependent children had been established in 1871, which included a program to investigate and supervise foster homes for children placed by the school. This facility became the major resource for dependent children, although local counties were permitted to provide their own care and a few elected to do so (Abbott 1938). Finally, instead of developing a state program of care as Michigan did, the Ohio legislature authorized the establishment of children’s homes or orphanages in every local county (Abbott 1938). Each of the remaining states adopted a slightly different model of care following the abolition of almshouse care for children. However, these models tended to cluster around the example of one of the four state plans described earlier. Remnants of these four

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

patterns of service provision can be seen today in different states’ organization of child welfare services. Related to the development of state systems of child care was the introduction of state policies and procedures for licensing and regulating child care facilities. As Grace Abbott (1938:15) noted in her classic documentary history, The Child and the State: Most of the states drifted into the policy of aiding private institutions because they were unwilling to accept responsibility for the care of the dependent, and because it seemed to be cheaper to grant some aid to private institutions than for the state to provide public care.  .  .  . Private agencies increased and expanded when public funds became available, and as the money was easily obtained, they accepted children without sufficient investigation of the family needs and resources and kept them permanently or long after they could have been released to their families. This was costly to the taxpayer, but even more important, large numbers of children were deprived of normal home life by this reckless policy.

Later she goes on to say: The responsibility of the state to know how its dependent children are cared for was not recognized and was little discussed until the end of the nineteenth century . . . At the meetings of the National Conference of Charities and Correction, discussion of the need and the results that might be expected from state supervision of child caring agencies began during the nineties.  .  .  . It was pointed out that the state should know where its dependent children are, its agents should visit and inspect institutions and agencies at regular intervals—including local public as well as all private agencies—and both should be required to make full reports to the State. Usually welcomed and even demanded by the best private agencies, state supervision was opposed by the poorer agencies and by many individuals who thought a private charity sponsored

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by a church or one, which included the names of leading citizens on the list of board members, was, of course, well-administered. (pp. 17–18)

What is important about Abbott’s comments from a historical perspective is that, by the turn of the nineteenth century, leaders in the child welfare field had begun to recognize 1. the state’s responsibility for all dependent children; 2. the potential conflict between agencies’ needs for ongoing funding and support and children’s need for permanency planning; and 3. the importance of instituting strong regulatory systems including licensing, service monitoring, and case accountability to protect the interests of children in the child care system. Thus by the end of the nineteenth century the roots had been laid for a complex system of child care. Dependent children were cared for by one group of agencies providing institutional and foster care services. Child offenders were being cared for in a different system. Still a third set of agencies, characterized by the Charity Organization Societies and the settlement houses, had developed what were later identified as different types of family service programs to care for children in their “own homes.” Twentieth Century The developments at the end of the nineteenth century set the stage for what were to become the hallmarks of the child welfare field during the twentieth century: bureaucratization, professionalization, and expanded state intervention in the lives of families and children. The social status of children was elevated, but this came at the price of some loss of individual freedom and some diminution of voluntary involvement and community control. Bremner (1970–74:117) notes: As the state intervened more frequently and effectively in the relations between parent and child in

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1909 1912 1935 1961 1962 1967

1974 1975 1978 1980 1993 1994 1996 1997 1999 2000 2001 2003 2005 2006

2008

Time Line: Evolving Federal Role in Family and Children’s Services First White House Conference on Children Creation of U.S. Children’s Bureau Social Security Act, Title IV, ADC; and Title V, Child Welfare Services Program Social Security Amendment, AFDC Foster Care Social Security Amendment Social Security Amendments Title IVB (Child Welfare Services Program, originally authorized under Title V) Authorized use of IVA funds for purchase of service from voluntary agencies Child Abuse Prevention and Treatment Act, P.L. 93-247 (amended in 1978, 1984, 1988, 1992, 1996, 2003) Title XX of the Social Security Act Indian Child Welfare Act Adoption Assistance and Child Welfare Act, P.L. 96-272 (Title IVE) Family Preservation and Support Services Program (enacted as part of the Omnibus Budget Reconciliation Act, P.L. 103-66, and amended Title IVB) Multiethnic Placement Act Personal Responsibility and Work Opportunities Act , P.L. 104-193 (eliminated financial assistance entitlement under AFDC and replaced this with Temporary Assistance to Needy Families, i.e., TANF program Adoption and Safe Families Act (ASFA), P.L. 105-89 (Amended Title IVE) Foster Care Independence Act, P.L. 106-109 Child Abuse Prevention and Treatment Act, P.L. 106-177 Promoting Safe and Stable Families Amendment, P.L. 107-133 (Amended Title IV-B) Adoption Promotion Act, P.L. 108-145 Keeping Children and Families Safe Act, P.L.108-36 Fair Access Foster Care Act, P.L. 109-113 Tax Relief and Health Care Act, P.L. 109-432 Child and Family Services Improvement Act, P.L. 109-288 Adam Walsh Child Protection and Safety Act, P.L. 109-248 Safe and Timely Interstate Placement of Foster Children Act, P.L. 109-239 Deficit Reduction Act, P.L. 109-171 Fostering Connections to Success and Increasing Adoptions Act, P.L. 110-351

order to protect children against parental mismanagement, the state also forced children to conform to public norms of behavior and obligation. Thus the child did not escape control; rather he experienced a partial exchange of masters in which the ignorance, neglect, and exploitation of some parents were replaced by presumably fair and uniform treatment at the hands of public authorities and agencies. The transfer of responsibilities required an elaboration of administration and judicial techniques of investigation, decision, and supervision.

Some of the factors that contribute to current issues in child welfare are directly related to these shifts in responsibility. Table 1.1 presents a time line of the evolving federal role in family and children’s services during the twentieth century.

The Children’s Bureau The first major event affecting the development of child welfare services in the twentieth century was the establishment of the U.S. Children’s Bureau in 1912, three years after the first White House Conference on Children. The movement to create a federal agency representing children’s interests was led by Jane Addams and Lillian Wald and included a coalition of leaders from the state boards of charities and corrections, voluntary social service agencies, settlement houses, labor and women’s groups, and the National Child Labor Committee. Although the initial funding for the Children’s Bureau was very small, restricting the number and range of activities it could undertake, it was given a very broad mandate to “investigate and report . . . upon all matters pertaining to

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

the welfare of children and child life among all classes of our people, and . . . investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, legislation affecting children in the several states and territories” (U.S. Statutes 1912, as cited in Parker & Carpenter 1981:62). What was most significant about the passage of this law was that it represented the first Congressional recognition that the federal government has a responsibility for the welfare of children. It also introduced the concept of public responsibility for all children, not just the groups of poor, neglected, disturbed, and delinquent children served by public and private agencies. Julia Lathrop was appointed the first chief of the Children’s Bureau. Under her skilled leadership, the office gained widespread public support and multiplied its annual budget rapidly, enabling its staff to undertake a wide range of investigatory, reporting, and educational activities. The Sheppard-Towner Act of 1921 gave the bureau responsibility for administering grants-in-aid to the states for maternal and child health programs, thereby expanding its influence even further and introducing the concept of federal payment for direct service provision. The entry of the federal government into the children’s field did not occur without conflict. The initial bill authorizing the establishment of the bureau was opposed by some of the leaders in the voluntary social welfare sector who feared governmental monitoring and scrutiny and by others who viewed the creation of such a federal agency as an unnecessary intrusion on states’ rights. The debate on the SheppardTowner Act was vitriolic, perhaps because of the early successes of the Children’s Bureau and perhaps because by 1921 the country had again entered a more conservative social era. For example, a senator from Kansas commented: Fundamentally the scheme of the bill amounts to this: We are asked to select from all the millions of

women of the United States four or five spinsters, whose unofficial advice would probably not be sought by a single mother in the land. . . . We are asked to confer upon these inexperienced ladies a title and salary, whereupon it is assumed they will immediately become endowed with wisdom and be qualified to instruct the mother, who has been with her baby before it was born and after it was born, how to take care of that baby. Also it is assumed that this band of lady officials can perform that function in the homes of a hundred and ten million people. To what purpose do we make this revolutionary change? Why do we create this new army of government employees? . . . If it is claimed that the Children’s Bureau is to devote its attention chiefly to the poor, my answer is that the poor are entitled to the best as well as the rich. . . . But this is not the purpose of the bill. I repeat that its basic idea is that the American people do not know how to take care of themselves; and that the state must force its official nose into the private homes of the people; that a system of espionage must be established over every woman about to give birth to a child and over the child, at least until it arrives at school age. (Congressional Record 1921, as cited in Bremner 1970–74:1017–18)

Despite such periodic attacks, the Children’s Bureau served as the primary governmental agency representing the interests of children for many years. As the leadership shifted from those concerned with broad economic and social issues affecting the welfare of children to those who focused more narrowly on issues and problems in the child welfare field, the activities of the Children’s Bureau changed considerably. Despite differing emphases and varying levels of influence, the Children’s Bureau continued to carry out its primary functions of investigation, advocacy, standard setting, public education, research, and demonstration. When it was reorganized as a subdivision of the federal Department of Health, Education, and Welfare, the Children’s Bureau lost its strong leadership role;

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however, it continues to carry out its primary functions. Currently, the Children’s Bureau is a division of the Administration for Children and Families, a subdivision of the U.S. Department of Health and Human Services (see www.acf. hhs.gov/programs/cb/ for information about the Children’s Bureau). Early Developments in the Organization and Provision of Services During the first three decades of the twentieth century, many of the trends in child welfare initiated during the late nineteenth century continued. In part because of the leadership of the Children’s Bureau, notable progress was made during the early part of the century in improving the administration of child welfare services. An increased number of public child welfare agencies were established; some of the more progressive states created separate children’s bureaus or divisions within the department of public welfare. Many states moved to countybased rather than local systems of service provision, and state departments of welfare assumed increased responsibility for setting standards, licensing, and regulation of public and voluntary child care facilities. Before 1935 the states had little leverage for influencing service provision at the local or county level. However, Alabama assumed the lead in developing a coordinated system of state and county child welfare services, in part via the use of state grants-in-aid to counties for administration of the state truancy law. As additional numbers of state grants-in-aid were made available, other states followed this model. Significant progress was also made in establishing civil service standards for the hiring and promotion of personnel in child welfare positions. This ensured that a larger proportion of the child welfare workforce was comprised of persons who were qualified to carry out what were increasingly recognized as professional tasks (Abbott 1938). Two major national voluntary organizations concerned with standard setting,

coordination, agency accreditation, research, and knowledge dissemination in the field of family and children’s services were established during this period: the American Association for Organizing Family Social Work (later the Family Service Association of America) in 1919 and the Child Welfare League of America in 1920. Both organizations have had a long record of influence on the nature of family and child welfare services, especially in relation to the role of the social work profession in this service arena. Also during this era, the long, rather notable history of child welfare research was initiated with the publication in 1924 of Sophie Van Theis’s (1924) outcome study of 910 children placed in foster care by the New York State Charities Aid Association. Although it is never certain what combination of facts, values, and external social circumstances contribute to the shaping of public policy in a specific service domain, it is clear that the extensive research on child welfare services conducted since this first study has contributed heavily to the various ongoing debates regarding goals and models of service provision. In spite of the concerns expressed by some immigrant and minority groups about excessive state intervention in their children’s lives, the scope and level of juvenile court activities also increased considerably during this period. By 1919 all but three states had passed juvenile court legislation; in many locations, the jurisdiction of the court had been extended (Abbott 1938). Also related to increased court intervention in family life were the expansion of court services, the assignment of the work of the courts to specialists trained in social investigation, the establishment of the first court clinic in Chicago in 1909 by psychologist William Healy, and the initiation of the child guidance movement a few years later with the founding of the Judge Baker Clinic in Boston. These developments both reflected and contributed to a different understanding of the causes and solutions for juvenile delinquency, leading to

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

a greater emphasis on individual treatment of children in the community and a blurring of the distinctions between delinquent, disturbed, and dependent youth. Protective services for children were also expanded during this period, especially after 1912 when public agencies began to be charged with responsibility for this population (Bremner 1970–74). These agencies gradually moved away from their earlier emphasis on law enforcement and focused on providing casework services to parents to permit children to remain in their own homes. At the same time, foster boarding homes and child care institutions for dependent children continued to expand. And the debate regarding the relative merits of foster homes versus institutions, a debate that traditionally had strong religious overtones because of the lack of sufficient foster homes for Roman Catholic and Jewish children, continued well into the 1920s (Bremner 1970–74). Another significant development of the 1920s was the establishment of adoption as a child welfare service. Informal adoptions had, of course, occurred since early colonial days. In the mid-nineteenth century a number of states passed laws providing for public record of the legal transfer of parental rights from biological parents to adoptive parents. However, public recognition of the need to protect the interests of children in these transactions did not develop until the early twentieth century. Minnesota, in 1917, was the first state to pass a law requiring judges to refer nonrelative adoption cases to a voluntary or public welfare agency for investigation prior to approval of the petition to adopt. By 1938 twenty-four states had passed similar legislation (Abbott 1938:64–66). Preadoption investigations were intended to ensure that the biological family ties had been appropriately terminated and that the adopting parents could provide adequate care and would accept full parental responsibilities. However, adoption at that time was viewed primarily as a service for couples unable to have children of

their own, not as a service for dependent children in need of care. Adoption was provided only for young, healthy, white children, most of whom were born out of wedlock to middleclass women. This service was seldom planned for children of the poor or children of color. Moreover, although public agencies carried out many of the court-ordered investigations of adoptive parents, separate adoption services were established only under voluntary auspices. At that time, adoption was not considered a right or even a need of dependent children in care of public agencies (Billingsley & Giovannoni 1972). Expansion of In-Home Services In reviewing various developments in the organization and provision of children’s services during the early twentieth century, special emphasis must be given to Bremner’s comment (247–48): “The great discovery of the era was that the best place for normal children was in their own homes. This idea conflicted with the widespread dislike of public relief but coincided with the philanthropic desire to preserve the integrity of the family.” Delegates to the first White House Conference on Children in 1909 went on record as supporting the following principles: 1. Home life is the highest and finest product of civilization.  .  .  . Children should not be deprived of it except for urgent and compelling reasons. Children of parents of working character, suffering from temporary misfortune, and children of reasonably efficient and deserving mothers who are without the support of the normal breadwinners should as a rule be kept with their parents, such aid being given as may be necessary to maintain suitable homes for the rearing of the children. 2. The most important and valuable philanthropic work is not the curative, but the preventive; to check dependency by a thorough study of its causes and by effectively remedying or eradicating them should be the constant aim of society. (Letter to the President 1900, as cited in Bremner 1970–74:365)

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Progress was made in the succeeding years toward the goal of maintaining children in their own homes by the institution of mothers’ pensions or public aid to dependent children in their own homes. Illinois provided leadership in this direction by passing a Fund to Parents Act in 1911; twenty other states passed similar legislation within the next two years. By 1935 all but two states had passed some type of mothers’ aid laws (Abbott 1938). These funds were provided on a very restricted and somewhat arbitrary basis. But even this small improvement in public assistance provisions for children in their own homes did not take place without controversy. However, other leading social reformers and social workers of the time vigorously supported the concept of maintaining children in their own families. By 1923 “the number of dependent children being maintained in their own homes was approaching the number of those in institutions and far in excess of those in foster homes” (Bremner 1970–74:248). A statement from the annual report of the New York Children’s Aid Society for 1923 conveys the consensus that was gradually emerging among professional child welfare workers: “There is a well-established conviction on the part of social workers that no child should be taken from his natural parents until everything possible has been done to build up the home into what an American home should be. Even after a child has been removed, every effort should be continued to rehabilitate the home and when success crowns one’s efforts, the child should be returned. In other words, every social agency should be a “ ‘home builder’ and not a ‘home breaker’ ” (New York Children’s Aid Society 1923, as cited in Thurston 1930:138). The nature of services provided to dependent children was further modified in the 1920s by the growing preoccupation of leading social work educators with psychoanalytic theory and individual treatment. In conjunction with an expanding professional knowledge base about

the developmental needs of children and adolescents, this trend led to widespread adoption of the goal of providing individualized services to dependent children and attending to their emotional needs as well as to their needs for economic security. This expanded understanding of children’s emotional needs contributed greatly to the development of improved child welfare services, it also, however, had two unfortunate consequences. First, it led to increased emphasis on individual psychopathology rather than social conditions as the source of family and child dysfunction and hence to the expansion of psychological rather than environmental services in the voluntary child care sector. Second, it contributed to the increased separation of voluntary family service and child welfare agencies, as the former were more likely to be staffed by professional workers interested in providing pure “casework,” that is, counseling, whereas workers in the latter were required to provide a broader range of services. These early twentieth-century developments in the field of family and children’s services had a major impact on the nature and scope of programs designed to help American families cope with the economic and social problems experienced in the aftermath of the depression that began in 1929. The trends that had special significance for subsequent policy and program development were t
expansion of public sector involvement in the lives of families and children; t
intensification of the traditional separation between the public and voluntary service sectors, especially in the Eastern and Midwestern states where the voluntary agencies were firmly entrenched; t
increasing preoccupation with psychological modes of treatment, especially among professional workers in the voluntary sector as they relinquished responsibility for traditional forms of almsgiving and concrete service provision; and

HISTORICAL EVOLUTION OF CHILD WELFARE SERVICES

t
crystallization of boundaries between voluntary child welfare and family service fields due to increasing emphasis on specialization in out-of-home versus in-home treatment. Arrangements for the Care of African American Children The history of child welfare services prior to the passage of the Social Security Law in 1935 essentially documents services for white children. Standard texts on the history of child welfare provide little information on services for black children; in fact, because of the middleclass white bias that has pervaded most studies of American history, relatively little was known about services for African American families and children until the publication of a text by Billingsley and Giovannoni (1972) on black children and American child welfare. Because African American children were systematically excluded from the child welfare services that developed for white children in the late nineteenth and early twentieth centuries—sometimes by explicit exclusionary clauses, sometimes by more subtle forms of discrimination—the black community developed what was essentially a separate system of care for dependent children. During the period after the Civil War, black children were cared for through a variety of informal helping arrangements and through a range of orphanages, old folks and children’s homes, day nurseries, and homes for working girls (Billingsley & Giovannoni 1972; see also Peebles-Wilkins 1995). This picture remained relatively constant until the 1920s when several converging factors led to changes in the child welfare system’s response to African American children. One was the establishment in 1910 of the National Urban League, an organization that took a vocal, active role in pressing for more equitable distribution of child welfare services as part of its broader mission to achieve freedom and equality for all African Americans. Another major impetus for change was the large-scale

migration of Southern blacks to urban areas during and after World War I, a development that forced increased recognition of the needs of Afro-American children. Finally, the changes taking place in the child welfare system itself created greater openness to African American children, e.g., the increasing number of public facilities, changes in many of the voluntary agencies’ exclusionary intake policies, and the shift from institution to foster home as the predominate form of care permitted agencies to recruit black foster homes for African American children, thereby avoiding potential racial tensions (Billingsley & Giovannoni 1972). Thus, by 1930, there was a general expectation, strongly supported by the participants at the White House Conference on Children, that black children were entitled to the same standards of care as white children and that they should generally be served through the existing child welfare system. This changed perception of the needs of African American children had obvious benefits in relation to the goal of racial integration. But it also had several unfortunate consequences, as it halted the growth of the black child care system, limited the possibility of African Americans assuming leadership roles in agencies caring for black children, and served to hide some of the subtler but ongoing forms of discriminatory treatment of African American children in the child welfare system (Billingsley & Giovannoni 1972; Roberts 2003). Passage of the Social Security Act It has often been suggested that the legislation introduced in the first one hundred days of the Roosevelt administration in 1933 changed the entire social fabric of the country by redefining the role of the federal government in addressing social welfare problems and moving the United States reluctantly, but inexorably, toward becoming a welfare state. Certainly the Social Security Act, passed in 1935, had a major impact on the structure and financing of child welfare services; in fact, some of the deficiencies in the current service system can be traced

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directly to later amendments to this law (see the introduction to part 1 by Mallon and Hess). Yet the roots of many of the current policy dilemmas and service delivery problems were present before the passage of this law. To summarize briefly, prior to 1935 the emerging issues in the child welfare field can be characterized as follows: 1. The goals of child welfare services had begun to shift, in principle, from rescuing the children of poor families and providing them a minimal level of sustenance, moral guidance, and work training via the provision of substitute care to providing the supports necessary to enable parents to care adequately for children in their own homes, arranging substitute care only on the basis of individualized assessment of case need. 2. The concept of state intervention in family life to protect the interests of children was gaining increased acceptance, and efforts had been made to expand societal provisions and protections for all children via the establishment of free compulsory education, child labor protections, the development of limited homemaker services, day nurseries, maternal and child health programs, mothers’ pensions, and child guidance clinics. 3. As a consequence of the establishment of the juvenile court, juvenile offenders were receiving more individualized treatment, a larger number of youth were coming under the purview of the legal system, and boundaries between the child welfare and criminal justice systems were becoming increasingly blurred. 4. The increasing bureaucratization and professionalization of the child welfare field, although improving standards for service and highlighting the goal of providing equal treatment to all, also functioned to increase the social distance between service providers and consumers and to deepen the gap between the goals and realities of service provision.

5. Large numbers of children continued to be placed in substitute care arrangements with little individualized case planning. 6. African American children continued to receive inferior, more punitive treatment than white children, and poor families and children served through the public sector were less likely to receive the intensive individualized treatment available to those served by some of the voluntary, primarily sectarian, agencies. 7. Adoption was viewed as a service designed primarily for adoptive parents, and white, healthy infants of middle-class unmarried mothers were the only children likely to be placed in adoptive homes. Two components of the Social Security Act of 1935, both stemming in large measure from the recommendation of the Children’s Bureau, had a significant impact on the subsequent development of child welfare services. Title IV, Grants to States for Aid to Dependent Children, sought to extend the concept of mothers’ pensions by providing federal matching funds for grants to fatherless families, requiring a single state agency to administer the program and mandating coverage of all political subdivisions in each state. It was designed as a federal grant-in-aid program and permitted state autonomy in setting eligibility standards, determining payment levels, and developing administrative and operational procedures. The program, later named Aid to Families with Dependent Children (AFDC), was eventually extended to families with a permanently and totally disabled parent and, at state option, to families with an unemployed parent. More than any other social program AFDC undoubtedly contributed to the goal of enabling children at risk of placement to remain with their own families. Unfortunately, the AFDC program became increasingly expensive and controversial in later years and was replaced in 1996 by the Temporary Assistance to Needy Families

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(TANF) program that eliminated AFDC recipients’ entitlement to financial assistance. The other major component of the Social Security Act that affected the subsequent provision of child welfare services was Title V, part 3, Child Welfare Services. This program was designed not only to help children in their own families but also to benefit those in substitute care by “enabling the United States, through the Children’s Bureau, to cooperate with State public welfare agencies in establishing, extending, and strengthening, especially in predominantly rural areas, public welfare services . . . for the protection and care of homeless, dependent, and neglected children, and children in danger of becoming delinquent” (Title V, Social Security Act 1935, as cited in Bremner 1970–74:615). Although the funding for this program was quite modest, states quickly took advantage of this relatively permissive legislation to obtain federal funding for child welfare services. To illustrate, prior to the passage of the Social Security Act, the organization of child welfare services at the state and county level was in relative disarray in most jurisdictions. However, by 1938, all but one state had submitted a plan for the coordinated delivery of child welfare services (Bremner 1970–74). This component of the Social Security Act, later subsumed under Title V-B, has had continuing influence on the development of child welfare services. The Decades from 1940 to 1960 The period from the late l930s to the late 1950s was a time of relative quiet, consolidation, and gain for the child welfare field. The total number and rate of children placed in foster home and institutional care declined substantially after 1933 (Low 1966, as cited in Bremner 1970– 74), while the proportion of children receiving services in their own homes, the total public expenditures for child welfare, and the total number of professional staff in public child welfare increased significantly during this period (Richan 1978). The Children’s Bureau and the Child Welfare League of America made major

strides in formulating and monitoring standards for service provision. Every state made significant progress in expanding professional educational opportunities for child welfare staff (Bremner 1970–74). And, because of the growing emphasis in the social work profession on the development of clinical knowledge and skills, the quality of services provided to families and children was greatly enhanced during this period. The only significant shifts in types of service provision during these years took place in the voluntary sector, partly as a consequence of the shift of many of the functions formerly assumed by private agencies to the public sector and partly as the result of demographic changes. The Child Welfare League of America published its first standards for adoption practice in 1938, and many agencies initiated and expanded adoption services in the years after World War II. More elaborate procedures were instituted for studying potential adoptive couples, “matching” children and families, and monitoring the adoptive families during the period preceding legal adoption. Adoption studies were frequently assigned to the most experienced staff, and adoption workers began to acquire special status in the child welfare field. Although the emphasis shifted from viewing adoption primarily as a service for parents to seeing the child as the primary client, in most settings healthy white infants continued to be considered the only real candidates for adoption. However, as the number of adoptive applicants increased, a few agencies began to experiment with intercountry and interracial adoptions. Also, the National Urban League sponsored a major project on foster care and adoption of black children from 1953 to 1958. In addition, a five-year interagency demonstration adoption project was established in 1955 by thirteen adoption agencies in the New York City area to develop and implement methods of recruiting adoptive families for black and Latino children (Billingsley & Giovannoni 1972).

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During the 1940s and 1950s increased emphasis was also given to services for unmarried mothers. Although illegitimacy had been viewed as a social problem for centuries, and special programs for unwed mothers were developed in this country early in the century, the historical concern was the protection of the child and the punishment of the mother. It was not until the late 1930s that social workers started to focus attention on the needs of the unmarried mother. During the next two decades there was a great upsurge in social work publications on the psychodynamic causes of unwed motherhood, the meaning and potential benefits of surrendering a child for adoption, and the role of the caseworker in working with unmarried mothers (see Bernstein 1960; Young 1954). As the illegitimate birthrate began to increase following World War II, many voluntary child welfare agencies established special services for unwed parents incorporating these new theoretical insights (Costin 1969). During this same period, many of the traditional child care facilities were being converted into various types of residential treatment centers. Thus there was also a marked shift in the types of institutional care provided to dependent youth. For example, in 1950 45 percent of the white children in residential care were in institutions for dependent children, and 25 percent were in institutions for the mentally disabled. By 1960 only 29 percent were in child care institutions and 36 percent were in facilities for the mentally disabled. Although the distribution of nonwhite children showed a similar trend, in 1960 over half of the nonwhite children (54 percent) were confined in correctional facilities compared to only 25 percent of the white children (Low 1965, as cited in Billingsley & Giovannoni 1972:89), suggesting that the trend toward individualized treatment planning was not sufficiently strong to counter patterns of racially discriminatory treatment. The problem of disproportionate treatment of children of color in child welfare persists to this day.

The relatively slow pace of change in the child welfare field during the 1940s and 1950s can be explained in part by the fact that social workers were forced to deal with other, more pressing problems—the aftermath of the depression and World War II. They needed time to implement, refine, and expand existing services before turning their attention to new service needs. Much professional energy during this period was also devoted to exploring psychological problems, improving casework methods, and enhancing professional status by providing service to clients above the poverty line. Most child welfare workers during this period tended to view the provision of individual casework (counseling) services as the most prestigious and critical of their professional tasks. Having been relieved of their earlier public assistance functions, social workers were endeavoring to provide high-quality therapeutic services to the clients who happened to request help from their agencies. They raised few questions about what was happening to the families and children not referred for casework services or to those who were unable to benefit from the types of service offered in the established family service and child welfare agencies. In the 1950s the problems of the poor were again brought to the attention of the social work profession with the publication of several studies discussing efforts to work with “multiproblem,” “disorganized,” and “hard-to-reach” families (see Buell 1952; Geisman & Ayers 1958; New York City Youth Board 1958). However, these developments served primarily to stimulate workers to seek more effective ways of providing existing modes of casework service to this population. Although it was clear that this subgroup of poor families was demanding a disproportionate amount of attention from public assistance, family service, child welfare, and public health agencies, direct service providers gave relatively little thought to their inability to work effectively with this population. Questions that should have been raised about the organization of services and the

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effectiveness of prevailing interventive strategies were rarely discussed. The 1960s In the early 1960s the child welfare field was a relatively small, self-contained service system with limited staff and resources. It maintained rather rigid system boundaries, making it difficult for many children and families to gain access to services and equally difficult for other clients to be discharged from care. Quality and coverage were very uneven. While some agencies, primarily in the voluntary sector, were providing intensive, highly specialized, professional services to a small number of select clients, other public and voluntary agencies struggled to provide minimum care and protection to large numbers of needy youngsters. Services were geared almost entirely toward placement, and individual casework was the primary interventive modality. Concepts of community control and clients’ rights were essentially nonexistent. (For a review of this period, see Kahn 1969). Although the Children’s Bureau attempted to provide leadership and direction via the promulgation of standards and the administration of small research and demonstration grants, overall federal participation in the child welfare field was minimal until the late 1960s. While organizational and funding arrangements varied from state to state, most areas utilized some combination of state and local responsibility for service provision. The participation of the public sector in the financing and direct provision of child care services had increased steadily since the turn of the century; however, control of program planning and development, service priorities and policies, and program monitoring and evaluation remained primarily in the voluntary sector under the auspices of local coordinating councils and welfare planning bodies. Consequently, there were minimal efforts to ensure case integration or program coordination within the child welfare system. Boundaries

and linkages between child welfare and other social service systems were frequently haphazard and often dysfunctional; agency accountability mechanisms were minimal. Early in the 1960s child welfare agencies began to be severely criticized for their failure to attend to the changing needs of the child welfare population. The first major challenge to the field was the publication of Maas and Engler’s (1959) study, Children in Need of Parents. This study of children in foster care in nine communities posed many of the questions that have been raised repeatedly since that time about children in “limbo,” children who had drifted into foster care, had no permanent family ties, and were not being prepared for adoptive placement. A comprehensive study by Ryan and Morris (1967) of child welfare services in metropolitan Boston illustrated quite graphically the nature of child welfare services in this era. They concluded that the concept of a comprehensive child welfare service network was essentially a myth. The lack of flexibility in intake policies and decision-making processes, combined with the lack of resources necessary to deal with the magnitude of the problems, made it impossible for the participating agencies to accept and serve many of the clients who had been appropriately referred for services. Ryan and Morris’s recommendations reflected the thinking of many other leaders in the field at the time that the system needed to develop a comprehensive, public family and children’s service system; joint planning between the public and voluntary child welfare sectors; rational policies on specialization by voluntary agencies; expanded resources, financing, and staff; joint planning, coordinating, and accountability mechanisms for subsystems within the child welfare network; decentralization of program operations; closer coordination at the local level with other major public service systems; and expansion of preventive service and social action efforts. The juvenile court also began to come under attack at this time. Several histories of

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American child welfare have challenged the traditional view of the juvenile court as protecting the interests of children and representing a radical change in their treatment. For example, in their analysis of the impact of the American child welfare system on black children, Billingsley and Giovannoni (1972) suggest that the labeling process by which black youth were described as “delinquent” in order to remove them from what were considered the less acceptable nineteenth-century forms of child care forced them to accept a more socially deviant label and to enter a less desirable system of care than that available to white youth. Studies such as these have focused attention on the problems in the field and set a number of internal reform processes in motion. But the more significant determinant of changes in the child welfare field has been the external environment: demographic shifts, political events, changing economic and social conditions, shifting interest groups, and belief systems that shape the context in which child welfare services operate. The inauguration of the Kennedy administration in 1961 ushered in an era of tremendous social ferment and change. To recap briefly, in the 1960s we witnessed the rediscovery of poverty as a public issue and the War on Poverty under the Johnson administration; the expansion of the civil rights movement, leading to the passage of the 1964 Civil Rights Act and the subsequent shocking realization that the guarantee of civil rights alone could not ensure justice; the emergence of the concept of black power and the racial conflicts of the late 1960s; the development of the welfare rights movement and the establishment of other related types of clients’ rights groups; the burgeoning of a youth culture that symbolized many challenges to traditional American values and mores; and the perpetuation of an unpopular war in Vietnam that contributed to the growing distrust and alienation of large segments of the population from governmental institutions.

The studies I have discussed clearly convey the nature of the concerns about family and children’s services in the 1960s that precipitated and accompanied many of the subsequent changes in the organization and delivery of social services. Forces for reform were again in ascendancy during these years. Several advisory committees and task forces composed of leading social welfare experts and key policy makers in the Kennedy administration were formed to study public welfare policy and consider needed changes in public assistance and social service programs. The 1961, 1962, and 1967 amendments to the Social Security Act reflected the recommendations of these advisory bodies, particularly in relation to the expansion of provisions for public social services. The 1961 amendment, called AFDC-Foster Care, was initiated to address a problem that had arisen in Louisiana after the state passed a “suitable home law” saying that children in homes where there was an illegitimate birth would no longer be entitled to AFDC (then called ADC). Not accidentally, since this occurred in the era in which Louisiana and many other Southern states were experiencing major conflicts around issues of desegregation, the burden of this state law fell disproportionately on black children. A wide range of advocacy groups mobilized to fight the way Louisiana was implementing this law. Eventually, the secretary of the federal Department of Health, Education and Welfare issued a new administrative ruling stating that, if a child were judged to be living in an “unsuitable home,” the state had an obligation to improve the conditions at home and maintain AFDC payments or remove the child from the home. This ruling and the Congressional amendment that quickly followed gave increased support to the view that children are entitled to receive protective services from the state and families receiving welfare should also receive social services (Lindhorst & Leighninger 2003). Moreover, the law authorized use of AFDC funds for the costs of foster care for

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AFDC-eligible children removed from their homes because of a judicial determination of need. Although this amendment received little public notice at the time of its original passage, as an unintended consequence it may have done more than any subsequent legislation to increase the number of children entering foster care because it is the only open-ended federal funding for child welfare services. The 1962 amendment to the Social Security Law provided federal matching funds for state/ local expenditures for social services for current, former, and potential welfare recipients (75 percent federal, 25 percent state funds). The 1967 amendments replaced the original Title V with Title IV-B, Child Welfare Services Program, and authorized the use of Title IV-A funds for purchase of service from voluntary agencies. These amendments set a policy framework for subsequent developments in this sphere. What is important from a historical perspective is that the clear intention of the social welfare leaders involved in deliberations around these Social Security Act amendments was to develop a comprehensive public service system that would meet the service needs of lowincome families, diminish the dysfunctional separation between child welfare and family service programs, and ensure that children in families receiving AFDC received the services and benefits available to children in foster care. In other words, it was hoped that the development of comprehensive public social services for families and children would help to alleviate many service delivery problems and inequities. Unfortunately, this goal was essentially doomed from the start because of the unrealistic expectations, conflicting objectives, hopes, and fears that quickly developed among advocates and skeptics alike around the concept of expanded public social services. Social welfare leaders, envisioning a grand new scheme of service provision, failed to anticipate the degree to which legislative intent and rational social planning could be undermined by

restrictive federal and state administrative regulations; political, bureaucratic, and staffing constraints within the public sector; and the intransigence of established interest groups in the family and children’s service field. Political and civic leaders, concerned about the escalating costs of public assistance, supported the concept of expanded social services on the assumption that they would help to reduce welfare rolls. They were then sorely disillusioned when welfare costs continued to multiply as a consequence of changing demographic patterns, relaxed eligibility requirements, and increased “take-up” among potential AFDC recipients. Direct service providers and consumers were led to believe that the expansion of public funding would enhance the quality and quantity of service provision, and they were frequently frustrated, often enraged, when these expectations were not fulfilled. Civil rights and consumer groups, concerned about the potential for social control and invasion of privacy inherent in any effort to tie public assistance to service provision, became increasingly wary of efforts to expand state intervention in family life, no matter how well intentioned the motivation. And welfare rights activists and leaders of the War on Poverty, committed to the concept of maximum feasible participation of the poor, disparaged the so-called service strategy as a naive attempt to solve the problems of poverty via the provision of casework services. Instead they argued that organizing efforts should be directed toward placing more resources in the hands of the poor, deprofessionalizing services, and challenging the policies and practices of established agencies (Wickenden 1976). Despite tremendous ambivalence about the potential costs and benefits of an expanded role for the public sector in the provision of services to families and children, federal and state investments in social services escalated rapidly during the 1960s, especially after the 1967 amendments to the Social Security Act, which permitted the purchase of service from

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voluntary agencies. Community and professional expectations regarding the social good and social reform that might be achieved through these investments expanded equally rapidly. Many established child welfare agencies responded readily to the demands and opportunities posed by this changing perception of public responsibility for service provision. They expanded their range of service provision, increased efforts to ensure better coordination of services, initiated demonstration projects aimed at reaching newly defined populations at risk, developed more specialized foster home and group care facilities, and invested heavily in efforts to enhance the general level of staff training and program administration. But, during the very period that the field was attempting to improve the quantity and quality of its service provision, it was also being exposed to new challenges and expectations. Foster parent and adoptive parent groups began to organize, demanding more equitable treatment for themselves and the development of new types of adoption and foster care programs for children with “special needs” within the existing child welfare population. The movement toward deinstitutionalization of youngsters confined in correctional facilities, mental hospitals, and schools for the retarded yielded whole new populations of children and youth, which child welfare agencies were expected to serve. The emergence of the child advocacy movement in the late 1960s created pressure for child welfare workers to engage in social action efforts aimed at improving the quality of services provided by schools, hospitals, mental health facilities, and other community agencies impinging on the lives of children. Legal reformers concerned about parents’ and children’s rights began to challenge established agency policies and procedures regarding the movement of children in and out of care as well as the quality, accessibility, and appropriateness of substitute care provisions. And renewed concern about the problems of child abuse and

neglect led to the passage of state mandatory reporting laws, a dramatic increase in the number of cases of alleged child abuse and neglect that agencies were required to investigate, and expanded requests for assistance from police and hospital personnel attempting to provide protective services to children who were being defined as a new population at risk. As a consequence of the various forces that merge in the late 1960s and early 1970s, the child welfare field was pressured to expand its boundaries in four basic directions: 1. to enhance and expand in-home services for families and children, especially for those of lowincome, minority backgrounds; 2. to establish more specialized substitute care resources for children formerly channeled to other service systems; 3. to develop opportunities for adoptive placement of the formerly “un-adoptable” special needs children in long-term foster care; and 4. to respond to increasing numbers of complaints of alleged child abuse and neglect. Yet these demands were exploding at a time when established child welfare agencies were losing their preeminence in the social welfare field; social work, long the dominant profession in the welfare field, was under attack for its failure to solve the problems of poverty; the medical and legal professions were redefining critical policy and service delivery issues in the children’s field; community groups were demanding increased consumer participation in agency decision making; agencies were being expected to develop new funding sources and new patterns of service coordination; the distribution of power among voluntary, state, and local service planners was shifting; the Child Welfare League of America, the primary research, standardsetting, and accrediting body in the voluntary sector, was being challenged for defining its organization’s priority as membership services, not social action (Steiner, 1976); and the Children’s Bureau, the only federal agency with an established record of commitment to improving the delivery of child welfare services, was partially decimated by the reorganization of the

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Department of Health, Education and Welfare in 1969. In other words, the child welfare field was attempting to respond to new demands and expectations by expanding its service boundaries and resources at the same time that the very underpinnings of the field were under attack. The result was an inevitable system overload. The 1970s and 1980s The forces for change began to shift slightly in the 1970s. The women’s liberation movement exploded on the American scene; blacks and other minority groups organized to develop political and economic power; the call for affirmative action and equal treatment replaced the push for civil rights and equal opportunities; self-help and advocacy groups representing a wide range of interests such as children, prisoners, gays and lesbians, psychiatric patients, people with disabilities, retarded citizens, and single parents began to recognize the sources of their own oppression and to organize more effectively to secure their rights. Quite inevitably, “middle America” began to react. Concern was growing about the national economy, rampant inflation, and unemployment; the United States seemed to be losing its status as a world power and leader of the forces for good; fear of crime was becoming universal; the role of the churches was declining; the problems of divorce, delinquency, illegitimacy, and drug abuse could no longer be viewed solely as the province of the poor; historical allocations of power and resources were changing; and traditional values, beliefs, and modes of behavior no longer seemed to bring promised results. In some ways all these pressures seem far removed from developments in the child welfare field, but, unfortunately, they are intimately related. The children served by this system— poor, often minority, neglected, dependent, abused, delinquent, and disturbed—constitute the very populations that should have benefited most from the broad social reform efforts initiated in the 1960s. Yet these youngsters and their families continued to be troublesome to the

larger community, and their very visibility and vulnerability made them convenient scapegoats for the inadequacies and failures of the reform efforts and for the discomfort and alienation experienced by so many families. Child Abuse Prevention and Treatment Act, P.L. 93-247 The first important federal legislative action of the 1970s in relation to child welfare services was passage of the Child Abuse Prevention and Treatment Act of 1974 (CAPTA). This law provided a small amount of funding to states for research and demonstration projects dealing with child maltreatment. The law stipulated that in order to qualify for funding, states had to pass child abuse and neglect laws requiring mandated reporting of suspected and known cases of maltreatment, immunity for reporters, confidentiality, and a number of other minor provisions. Unfortunately, the law did not specify how child abuse and/or neglect were to be defined or operationalized. This lack of clear operational definitions has created innumerable problems over time for clients as well as social service and court personnel. The law has served to focus enormous public attention on problems of child abuse and led every state to pass a mandatory child abuse reporting law. However, CAPTA has consistently been funded at low levels, leading to many unfulfilled expectations; and despite the title of the law, its focus has consistently been child abuse reporting, not child abuse prevention or treatment. In addition to the mandates imposed by CAPTA, emerging directions in social service provision during the 1970s began to create still different expectations for child welfare services. As Wickenden (1976) has suggested, “it is difficult to fix an exact year or month when the goal of a ‘comprehensive public welfare system’ . . . began to be replaced by its opposite, the ideal of separation of services and money payments.” Nor is it possible to determine precisely when the basic concepts underlying the structure of service provision in this country began to be reformulated. But, early in the 1970s, it was

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clear that the winds of change had again arrived. Congress imposed a $2.5 billion dollar ceiling on funding for social services in 1972, and in 1975 Title XX of the Social Security Act was passed, redefining historical concepts regarding the appropriate decision-making responsibility, objectives, intervention strategies, and organizational and funding patterns for social services in this country. The basic shifts in the policies and patterns of service provisions reflected in this legislation can be summarized briefly as follows: t
greater state responsibility for social service planning and program development; t
public participation in service needs assessment and review; t
sharp reduction in the range and extent of federal regulations governing service provision; t
development of comprehensive, integrated service plans; t
complex and varied funding packages between the various levels of government and public and private provider agencies; t
diversification in the range of service provision; t
diminished provisions for categorical programs aimed at special populations at risk; t
expansion of joint public-voluntary programs; t
increased emphasis on the objectives versus the process of service delivery; t
diminished role for social workers in the administration and delivery of services; t
expanded opportunities for provision of services to families above the poverty line; t
democratization and decentralization of funding decisions and allocations; and t
increased emphasis on fiscal and program accountability. Commenting on the implications of Title XX for social services, Austin (1980:19) suggested that “the financing, regulation and management of human service programs has become a major

domestic policy issue in the United States.” This development had enormous implications for the child welfare field because it placed on the public agenda the issue of appropriate responsibility and care for dependent, neglected, troubled, and troublesome children. It transferred the awesome responsibility for shaping the lives of children—a responsibility formerly entrusted only to parents and/or persons with professional expertise in child welfare—to competing forces in the political arena, and it created increased emphasis on rationality, efficiency, and control in the exercise of that trust (see also Gilbert 1977; Miller 1978). The child welfare field was attacked repeatedly in the 1970s—from both within and outside—for its failure to ensure permanency planning, its inability to prevent placement, its failure to place children in need of protection, its inherent racism and classism, its antifamily bias, its violation of parents’ and children’s rights, its arbitrary decision-making procedures, the incompetency and inefficiency of its staff, its costs, and its mismanagement (see, for example, Bernstein, Snider, & Meezan 1975; Gruber 1978; Knitzer, Allen, & McGowan 1978; Persico 1979; Strauss 1977; Temporary State Commission on Child Welfare 1975; Vasaly 1976). Most of these critics focused specifically on the failure of child welfare agencies to keep children out of placement, to minimize costs while maintaining appropriate resources for children who must be placed in temporary substitute care, and to move children back into their own families or into permanent adoptive homes as quickly as possible. The tenor of these critiques contrasted markedly with the concerns raised by other commentators regarding the need to broaden the base of service delivery, reach underserved populations, and expand economic and social supports for all families (Billingsley & Giovannoni 1972; Kenniston 1977; Schorr 1974). In essence, earlier visions of using public funding to stimulate the expansion of child welfare services that would enhance the development of

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all children at risk were replaced by the expectation that the child welfare field should serve only those children for whom state intervention is essential to ensure a minimal level of care and protection and that these children should be cared for in as rational, time-limited, and costefficient a manner as possible. This redefinition of the expectations and potentials of the child welfare system significantly diminished the priority given to children’s services within the human service sector and led to some marked changes in the way child welfare services are organized and delivered. To illustrate, a study of child welfare in twenty-five states provided some interesting insights regarding changing patterns of service provisions in the 1970s (Child welfare in 25 states 1976). The researchers observed that the development of child welfare service delivery systems in various states was very uneven, that the structures and organization of these delivery systems were constantly changing. As a consequence of widespread reorganization of state human service departments and frequent redefinitions of the client groups and services falling within the province of “child welfare,” child welfare services seemed to be losing their organizational visibility and coherence. Another concern raised by this study and echoed in the findings of a related study focused on the clients seeking services from public social service agencies was the competency of staff now providing child welfare services (Jenkins 1981). The merger of public welfare and child welfare staff in many states, combined with the general trend toward lower educational and experience requirements for social service personnel and reduced opportunities for workers to receive advanced training and specialized consultation, resulted in a gradual deprofessionalization of child welfare services. This raised serious questions about the capacity of staff to provide the quality and range of services required by the families and children entering the child welfare system.

Despite the concerns raised about organizational viability and staff competency, efforts to reform the delivery of child welfare services during this period were directed primarily toward revising the statutory base governing state intervention in family life and increasing the requirements for public accountability of service providers. For example, by 1977 twenty states plus the District of Columbia had instituted some type of formal judicial, courtadministered, or citizen review (Chappell & Hevener 1977). Many others followed, and the trend toward developing increasingly complex systems for internal case monitoring and program review became virtually universal. Three other developments of the late 1970s also contributed to the major shift in child welfare policy that occurred in 1980. The first was one of the most significant legislative events of the 1970s, the passage of the Indian Child Welfare Act (ICWA) of 1978. The ICWA described the role that Native American families and tribal governments must play in decisions about the protection and placement of their children. It strengthened the role of tribal governments in determining the custody of Native American children and specified that preference should be given first to placements with extended family, then to Native American foster homes. The law mandated that state courts act to preserve the integrity and unity of Native American families. The second was a new focus on the concept of permanency planning, precipitated by the theoretical writings of Goldstein, Solnit, and Freud (1973, 1979) on the concept of psychological parenting and the reports of successful demonstration projects designed to prevent placement and/or promote permanence for children in foster care through reunification or adoption (Burt & Balyeat 1973; Pike 1976; Emlen, L’Ahti, & Downs 1978). The third significant development was a series of Senate subcommittee hearings focused first on issues of adoption and, later, on broader foster care issues (Allen & Knitzer 1983:119).

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Adoption Assistance and Child Welfare Act, P.L. 96-272 The concerns embodied in these reform efforts were translated into explicit public policy with passage of P.L. 96-272, the Adoption Assistance and Child Welfare Reform Act of 1980. Had this act been adequately funded and properly implemented, it would have had the potential to greatly enhance the quality of traditional child welfare services. It essentially reversed the trend toward a diminished role for the federal government in the funding and structuring of social service provision and it directly addressed many of the most frequently documented problems in the child welfare system. However, it sharply underlined the thrust toward viewing the child welfare system itself, rather than the children and families this field was developed to serve, as the primary object of concern—the essential target for social reform. Hailed as the most important piece of child welfare legislation enacted in three decades, the Adoption Assistance and Child Welfare Reform Act required states to establish programs and make procedural reforms to serve children in their own homes, prevent out-ofhome placement, and facilitate family reunification following placement. This act officially introduced the concept of permanency planning as a primary objective of federal child welfare policy. The specific components of the bill were aimed at redirecting funds from foster care to preventive and adoption services, providing due process for all people involved, decreasing the time children spend in foster care, ensuring placement for children in the least detrimental alternative setting, and ensuring state planning and accountability. Perhaps most important for later developments in child welfare services was the law’s requirement that states make “reasonable efforts” to prevent foster placements. The bill adopted what has been termed a “carrot and stick” approach (Allen & Knitzer 1983) by 1. amending Title IV-B to create new funding for preventive services;

2. setting a cap on funding for foster care services that was to become effective once funding for Title IV-B reached a specified level; 3. requiring state inventories of all children in foster care longer than six months; 4. requiring development of state plans for foster care and adoption services and routine collection of aggregate and case data to monitor implementation of these state plans; 5. requiring individual case reviews of all children in placement after six months and judicial reviews of all children in care longer than eighteen months; and 6. providing open-ended funding for adoption subsidies for children defined as “hard to place.” No effort was made in this legislation to address inherent conflicts with the provisions of the Child Abuse Prevention and Treatment Act. After President Reagan was inaugurated in 1981, there were a number of Congressional battles to eliminate funding for the CAPTA and to fold funding for P.L. 96-272 into a block grant for social services. These efforts failed, but the effects of the conservative Reagan administration were felt in other ways in the child welfare arena. In 1981 Congress passed a social services block grant as part of the Omnibus Budget Reconciliation Bill of 1981. This bill compounded all the drawbacks of Title XX by decreasing social service funding, reducing federal monitoring and regulation, reducing service standards, and decreasing emphasis on equity within and across state lines. The cutbacks in federal funding for social services did not impact directly on child welfare because funding P.L. 96-272 was kept out of the block grant. However, child welfare agencies experienced serious indirect results related to an increased need for services among families at risk and to increased family poverty created by cutbacks in entitlement programs such as AFDC and Medicaid. States, localities, and voluntary agencies struggled to respond to these needs, primarily by emphasizing provision of

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last-ditch, crisis services. Consequently, families at risk tended to defer routine, early intervention services and to present at child welfare agencies in greater need than they might have in earlier years. Although the number of children in foster care leveled off briefly after passage of P.L. 96-272, reports of child abuse and neglect increased markedly, as did foster placements, during the later 1980s. There is no consensus as to the reasons for these trends. Some argued that these increases were the result of increased reporting, suggesting that there was no real increase in the problem of child maltreatment, simply an increase in the degree to which suspected cases were reported. Others attributed these trends to increased maternal substance abuse, family homelessness, or poverty. Still others blamed the dramatic growth in kinship foster care that occurred following the U.S. Supreme Court decision in Miller vs. Yoakum (1979), which stated that children living in relatives’ homes are entitled to the same level of foster care payments as children living with nonkin. Despite these increases in child abuse reporting and foster placement, a number of programs were initiated during this period that were designed to demonstrate “reasonable efforts” to prevent placement of children in foster care. There were many variations in the type and duration of family-centered services offered, but they all were generally described as family preservation services. Homebuilders, started by the Behavioral Sciences Institute in Tacoma, Washington, ultimately received the most attention. The Edna McConnell Clark Foundation became very invested in this program model, called “intensive family preservation services,” and formed a loose coalition of national organizations to work on developing materials that would assist in policy implementation at the state level, providing funding in the late 1980s for a group of states to engage in strategic implementation of Homebuilderstype services.

The 1990s By 1992 this group of states had made progress in implementing intensive family preservation services as a significant aspect of state child welfare policy and had generated widespread support among professionals, state administrators, and legislators for family preservation as an important component of child welfare policy. Thus a significant coalition of national organizations was ready to advocate for federal legislation that would provide federal support for intensive family preservation services (Farrow 2001). Family Preservation and Support Services Program, P.L. 103-66 In 1993 Congress passed the Family Preservation and Support Services Program (FPSSP) as part of the Omnibus Budget Reconciliation Act. This earmarked federal funds for family support services and increased the funds available for family preservation services. The intent of this law was to help communities build a system of family support services to assist vulnerable children and families in an effort to prevent child maltreatment. Family preservation services were designed to help families experiencing crises that might lead to the placement of their children in foster care. This law provided some funding for family preservation and family support services, officially recognizing the practice of family preservation, although the implementing regulations defined family preservation much more broadly than did the original model of Homebuilderstype services. States were to use the new funds to integrate preventive services into treatmentoriented child welfare systems, to improve service coordination within and across state service agencies, and to engage broad segments of the community in program planning at the state and local levels. More importantly, the FPSSP stipulated that the planning process should include parents and consumers of services, communitybased service providers, representatives of

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professional and advocacy organizations, and child welfare agency line staff, administrators, and supervisors. The intent was to make child welfare systems more responsive to families and communities by involving a broad range of stakeholders. Although family preservation programs continued to expand during the 1990s, providing many high-risk families with the help they needed to maintain their children at home, several forces converged to raise concern about the value of these services (McGowan & Walsh 2000). These included, first, the continued rise in child abuse and neglect complaints, leading to increased foster care placements. Second, in contrast to earlier reports of the success of intensive family preservation services, carefully designed studies began to document some of the limitations of this model of service (Schuerman, Rzepnicki, & Littell 1994; Nelson 1997). Third, conservative lay commentators began to stir public anger about the dramatic rise in kinship foster care and the possibility of relatives of “bad” parents receiving money from the state to care for the children of their relatives (Weisman 1994; MacDonald 1999). Fourth, the resurgence of conservative political forces began to legitimize public attacks on families in poverty dependent on AFDC who may have difficulty providing proper care for their children (MacDonald 1994). Finally, public exposés about a few isolated cases in which children in families that received family preservation services were later abused by their parents precipitated widespread debate about the relative value of family preservation versus child protection and the need to give priority to children’s safety (Farrow 2001). The legislation that followed passage of the Family Preservation and Support Services Program in 1993 essentially reflected this shift away from the concept of preserving families toward that of protecting children.

1994 (MEPA) was passed to encourage adoption of children waiting in foster homes and prohibited agencies receiving any federal funds from delaying, denying, or otherwise discriminating when making a foster care or adoptive placement on the basis of the parent or child’s race, color, or national origin. The act also required states to develop plans for recruitment of homes that reflect the ethnic and racial diversity of children in the state needing placement and required the federal government to impose fiscal penalties for states not in compliance with the antidiscrimination provision.

The Multiethnic Placement Act of 1994, P.L. 103-382 The Multiethnic Placement Act of

Adoption and Safe Families Act, P.L. 105-89 The most significant change in child welfare

The Personal Responsibility and Work Opportunities Act of 1996, P.L. 104-193 The Personal Responsibility and Work Opportunities Act of 1996, commonly known as the “welfare reform law,” eliminated the concept of financial entitlement under AFDC and replaced this with the Temporary Assistance for Needy Families (TANF) Program (to which I referred earlier in this chapter). Passed with no real consideration of its potential impact on families in need of child welfare services, the law has a number of provisions that may make it more difficult for high-risk families in poverty to maintain their children safely at home. As Courtney (1997) commented: “The passage of P.L. 104-193 marks the first time in U.S. history when federal law mandates efforts to protect children from maltreatment, but makes no guarantee of basic economic supports for children.” To illustrate, the law imposes a five-year lifetime limit on receipt of TANF funds, imposes strict work requirements on parents receiving TANF, prohibits individuals convicted of drug-related offenses after passage of the law from receiving TANF or Food Stamp benefits for life, and permits states to establish a family cap that denies cash benefits to children born into families already receiving TANF.

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policy since the Adoption Assistance and Child Welfare Reform Act of 1980 was the passage of the Adoption and Safe Families Act of 1997 (ASFA), which amended Title IV-E of the Social Security Act. Reflecting some of the same conservative sentiments that led to the passage of the welfare reform act the preceding year, the enactment of this law, frequently referred to as ASFA, makes the safety of children the priority in all decision making, diminishes the emphasis on family preservation, and promotes speedy termination of parental rights and adoptive placement when parents cannot quickly resolve the problems that led to placement. Although the law reaffirms the concept of permanency planning and reauthorized the Family Preservation and Support Services Program, renaming it “Safe and Stable Families program,” it specifies a number of circumstances under which states are not required to make “reasonable effort” to preserve or reunify families. It mandates a permanency hearing after a child has been in care for twelve months, and every twelve months thereafter, and requires states, with certain exceptions, to file a termination of parental rights petition in cases in which a child has been in care for fifteen of the past twenty-two months. This means that parents who cannot resolve the problems that led to placement and may require longer treatment, e.g., substance abusers, are at risk of having their rights terminated no matter what the age of the child or the degree of parentchild attachment. In some ways, this law seemed designed primarily to promote adoptions, providing additional funding for states that increase their number of completed adoption and authorizing the Department of Health and Human Services (HHS) to provide technical assistance to states and localities to help them reach their adoption targets. As Halpern (1998) commented, this law indicates that “Congress believes adoption is the new panacea for the problems of foster care.” States that do not comply with its provisions risk losing a portion of their Title IV-E and Title IV-B funds.

On a positive note, the law signals a willingness to increase the federal role in child welfare services and to demand state accountability by mandating HHS to develop outcome measures to monitor state performance. The department, in response, developed national standards with benchmark indicators of success to measure performance on statewide data indicators; in 2000 HHS adopted a new process of monitoring state child welfare programs on the basis of onsite reviews of individual cases known as Child and Family Services Reviews (CFSRs, see the Mitchell, Thomas, and Parker chapter, this volume). John H. Chafee Foster Care Independence Program The John H. Chafee Foster Care Independence Program (CFCIP), Title I of the Foster Care Independence Act of 1999 (P.L. 106-169), provides funds to states to assist youth and young adults (up to age twenty-one) in the foster care component of the child welfare system in making a smoother, more successful transition to adulthood. This program replaces and expands section 477 of the Social Security Act and allows states to use these funds for a broader array of services to youth “aging out” of the foster care system, including room and board. This legislation revises the program of grants to states and expands opportunities for independent living programs, providing education, training, employment services, and financial support for foster youth to prepare for living on their own. It requires the development of outcome measures to assess state performance in operating independent living programs and mandates national data collection on services, the individuals served, and outcomes. In addition, CFCIP provides states with the option to extend Medicaid coverage to eighteen to twenty-one year olds who have been emancipated from foster care. The program emphasizes permanence for youth and increased funding for adoption incentive payments. Most importantly, CFCIP enables states to expand the scope and improve the quality

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of educational, vocational, practical, and emotional supports in their programs for adolescents in foster care and for young adults who have recently left foster care. Twenty-First Century Child and Family Ser vices Reviews (CFSRs) Although previous reviews had been effective in promoting state accountability for meeting requirements associated with state foster care programs, they were less worthwhile in ensuring positive outcomes for the children and families served by state child welfare agencies. The Child and Family Service Reviews (CFSRs), initiated in 2000, are the first systematic effort to focus on the outcomes rather than the processes of the various programs supported by Titles IV-B and IV-E. One of the primary goals is to examine child welfare practices at the ground level, capturing the actual practice among caseworkers, children and families, and service providers and determining the effects of those interactions on the children and families involved. The emphasis on child welfare practice is based on a belief that, although certain policies and procedures are essential to an agency’s capacity to support positive outcomes, it is the dayto-day casework practices and the values upon which these are based that most influence such outcomes. Fostering Connections to Success and Increasing Adoptions Act of 2008, P.L. 110-351 This law, which received bipartisan support and was signed by the president in October 2008, is designed to connect and support relative caregivers, improve outcomes for children in foster care, improve incentives for adoption, and provide federally recognized Indian tribes the option to operate a title IV-E program. More specifically, the law gives states the option to provide kinship guardianship assistance payments on behalf of children living with grandparents or other relatives who have assumed

legal guardianship It also authorizes matching grants to state, local, and tribal child welfare agencies to help children at risk of placement to reconnect with family members; requires states to exercise due diligence in notifying all adult relatives within thirty days of a child’s removal from parental custody; and permits waiver of state licensing standards on a case-by-case basis for kinship foster homes. Another major component of this law gives states and tribes the option to extend Title IV-E foster care, adoption, and assisted guardianship payments to youths up to the age of twenty-one if they meet certain education, training, or work requirements. It requires personalized transition planning during the ninety- days prior to a child’s emancipation from care. In addition, the law extends and supports the Adoption Incentives Program, and it “delinks” a child’s adoption assistance eligibility from AFDC eligibility requirements. To assist states and tribes with the implementation of this law, several foundations agreed to support a new organization, FosteringConnections.org, that provides nonpartisan tools, information, and technical assistance on each section of the bill and hosts a network of state-based and local stakeholders to help them stay informed on key issues and identify best practices. The two key federal developments of the current century, the CFSRs and the Fostering Connections Act, offer promising approaches to addressing some of the difficulties that have long plagued the child welfare system. Unfortunately, neither of these developments addresses the long-standing problem of inadequate child welfare agency staffing. To illustrate, in a report titled “Child Welfare: Improved Federal Oversight Could Assist States in Overcoming Key Challenges,” released January 28, 2004, the General Accounting Office concluded that “child welfare agencies face a number of challenges related to staffing and data management that hinder their ability to protect children

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from abuse and neglect” (GAO-04-418T, 2004:2, retrieved February 7, 2004). More specifically, the report notes that low salaries hinder staff recruitment and retention and lack of adequate numbers of trained staff limit the capacity of remaining staff to develop relationships with families and make decisions that ensure safe and stable placements for children. Neither of these initiatives offers any solution to the problems of poorly trained staff or high staff turnover. Moreover, they fail to address the long-standing problem of disproportionate treatment of children of color in the child welfare system. Some promising programmatic initiatives at the ground level have included the redesign of protective services in some areas, following Waldfogel’s (1998) recommendations; the Family-to-Family and Making Connections programs initiated by the Annie E. Casey Foundation; and new types of programs designed to blur the boundaries between in-home and placement services by offering respite care, whole-family group care, and multiple forms of kinship care (Whittaker & Maluccio 2002:127–28). These and the federal initiatives cited suggest promising policy directions. Moreover, a number of agencies are experimenting with new and promising evidence-based practice approaches. See, for example, Chaffin and Friedrich (2004), Littell and Shlonsky (2010) and NRCPFC (2013). However, it would be a mistake to think that any of these initiatives will “fix” all the current problems in the child welfare system. This is true for several reasons. First, the ongoing economic crisis is making it extremely difficult for states to provide the public funding required to support family and child well-being, and child welfare agencies are suffering from the lack of fiscal resources necessary to maintain

skilled staff and to support promising practice approaches. Second, the field seems caught in a repetitive pattern of one step backward for every two steps forward. As I first wrote more than thirty years ago (McGowan 1983:44): “We are writing in the midst of a rapidly changing social climate. It would be foolhardy, if not impossible, to predict the ultimate impact of current political forces on reform efforts in the child welfare system. But the history of American child welfare suggests that many of the dilemmas confronting the field today reflect the solutions devised to address the problems of the past, and we can anticipate that although current proposals for change will resolve some issues, they will create still others.” Only a few relatively self-evident lessons seem clear from the child welfare history reviewed in this chapter: t
child welfare services are shaped primarily by social forces and trends in the larger society; t
individuals and groups engaged in the design and provision of child welfare service can contribute—modestly and imperfectly, but consistently—to improving the quality of life for children; t
the inherent tensions between the interests of children, parents, and the communityat-large can never be perfectly resolved; t
American society’s willingness to invest in programs designed to enhance the wellbeing of families and children is meager and begrudging at best; and t
the nature and definition of children’s needs may shift over time, but social responsibility for the provision of supports and services responsive to these needs remains constant.

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Abbott, G. (1938). The child and the state (vols. 1–2). Chicago: University of Chicago Press. Adoption and Safe Families Act (1997). P.L. 105-89. Adoption Assistance and Child Welfare Act (1980). P.L. 96-272. Allen, M. L., & Knitzer, J. (1983). Child welfare: Examining the policy framework. In B.  G. McGowan & W. Meezan (eds.), Child welfare: Current dilemmas, future directions, pp. 93–141. Itasca, IL: Peacock. Austin, D. M. (1980). Title XX and the future of social services. Urban and Social Change Review, 13 (Summer), 19. Bernstein, R. (1960). Are we still stereotyping the unmarried mother? Social Work, 5 (July), 22–28. Bernstein, B., Snider, D., & Meezan, W. (1975). Foster care needs and alternatives to placement. Albany, NY: New York State Board of Social Welfare. Billingsley, A., & Giovannoni, J. (1972). Children of the storm: Black children and American child welfare. New York: Harcourt Brace Jovanovich. Bremner, R. (ed.). (1970–74). Children and youth in America: A documentary history (vols. 1–3). Cambridge: Harvard University Press. Brooks, D., Barth, R.  P., Bussiere, A., & Patterson, G. (1999). Adoption and race: Implementing the Multiethnic Placement Act and the Interethnic Adoptions Provisions. Social Work, 44, 167–78. Buell, B. (1952). Community planning for human services. New York: Columbia University Press. Burt, M., & Balyeat, R. (1973). A new system for improving care of neglected and abused children. Child Welfare, 53, 167–79. Chaffin, M., & Friedrich, B. (2004). Evidence-based treatments in child abuse and neglect. Chidren and Youth Services Review, 26, 1097–1113. Chambers, C. A. (1963). Seedtime of Reform: American Social Service and Social Action, 1918–1933. Minneapolis: University of Minnesota Press, 1963. Chappell, B., & Hevener, B. (1977). Periodic review of children in foster care: Mechanisms for reviews. Newark, NJ: Child Service Association. Child welfare in 25 states: An overview (1976). Washington, DC: U.S. Department of Health, Education and Welfare. Costin, L. (1969). Child welfare: policies and practices (2d ed.). New York: McGraw Hill. Courtney, M. E. (1997). Welfare reform and child welfare services. In S. B.Kamerman & A. J.Kahn (eds.), Child welfare in the context of “welfare reform,” pp. 1–35. New York: Cross-National Studies Research Program, Columbia University School of Social Work. Emlen, A.  C., L’Ahti, J., & Downs, S.  W. (1978). Overcoming barriers to planning for children in foster care. Washington, DC: U.S. Government Printing Office. Family Preservation and Support Services Program (1993). P.L. 103-66.

Farrow, F. (2001). The shifting policy impact of intensive family preservation services. Chicago: Chapin Hall Center for Children at the University of Chicago. Folks, H. (1978). The care of destitute, neglected and delinquent children (classic ed.). New York: National Association of Social Workers. Foster Care Independence Act (1999). P.L. 106-169. Geisman, L. L., & Ayers, B. (1958). Families in trouble. St. Paul: Greater St. Paul Community Chests and Councils. Gilbert, N. (1977). The transformation of social services. Social Service Review, 51 (December), 624–41. Goldstein, J., Freud, A., & Solnit, A. J. (1973). Beyond the best interests of the child. New York: Free Press. Goldstein, J., Freud, A., & Solnit, A.  J. (1979). Beyond the best interests of the child (2d ed). New York: Free Press. Gruber, A. (1978). Children in foster care: Destitute, neglected, betrayed. New York: Human Sciences. Halpern, M. (1998). Abandoning family preservation in a rush to adoption. Interdisciplinary Report on AtRisk Children & Families, 1 (1), 10–11. Hofstadter, R. (1955). The Age of Reform. New York: Random House, 1955. Jenkins, S. (1981). Beyond intake: The first ninety days. Washington, DC: U.S. Department of Health and Human Services. Kahn, A. J. (1969). Studies in social policy and planning. New York: Russell Sage Foundation. Kenniston, K. (1977). All our children. New York: Harcourt Brace Jovanovich. Knitzer, J., Allen, M. L., & McGowan, B. (1978). Children without homes. Washington, DC: Children’s Defense Fund. Lathrop, J. (1919). Presidential address—child welfare standards: A test of democracy. In Proceedings of the National Conference of Social Work (June 1–8, 1919), 5–41. Atlantic City, NJ. Lindhorst, T., & Leighninger, L. (2003). “Ending welfare as we know it” in 1960: Louisiana’s Suitable Home Law. Social Service Review, 77, 564–84. Littell, J. H., & Shlonsky, A. (2010). Toward evidenceinformed policy and practice in child welfare. Research on Social Work Practice, 20 (6), 723–25. Maas, H., & Engler, R. (1959). Children in need of parents. New York: Columbia University Press. MacDonald, H. (1994). The ideology of family preservation. Public Interest, 115, 45–60. MacDonald, H. (1999). Foster care’s underworld. City Journal, 9 (Winter), 44–53. McDonald, J., Salyers, N., & Shaver, M. (2004). The foster care straitjacket: Innovation, federal financing & accountability in state foster care reform. Chicago: Fostering Results. McGowan, B.  G. (1983). Historical evolution of child welfare services. In B.  G. McGowan & W. Meezan (eds.), Child welfare: Current dilemmas, future directions, pp. 44–90. Itasca, IL: Peacock.

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McGowan, B. G., & Walsh, E. M. (2000). Policy challenges for child welfare in the new century. Child Welfare, 79, 11–27. Miller, D. (1978). Children’s services and Title XX from a national perspective. Child Welfare, 57, 134–39. Miller vs. Yoakum (1979). 440 U.S. Multiethnic Placement Act. (1994). P.L. 103-382. Miller, M. (1955). Casework service for the unmarried mother. In Casework Papers (pp. 91–101). New York: Family Service Association of America. National Resource Center for Permanency and Family Connections (NRCPFC) (2013). Evidence based practices in child welfare. New York: NRCPFC. Retrieved October 26, 2013 from http://nrcpfc.org/ ebp/index.html. Nelson, K.  E. (1997). Family preservation—what is it? Children and Youth Services Review, 19, 101–18. New York City Youth Board (1958). Reaching the unreached family. Youth Board Monograph No. 5. New York: Author. O’Connor, S. (2004). Orphan Trains: The Story of Charles Loring Brace and the Children He Saved and Failed. Chicago: University of Chicago Press. Parker, J. K., & Carpenter, E. M. (1981). Julia Lathrop and the children’s bureau: The emergence of an institution. Social Service Review, 55 (March), 62. Peebles-Wilkins,W. (1995). Janie Porter Barrett and the Virginia Industrial School for Colored Girls: Community response to the needs of African American children. Child Welfare, 74, 143–61. Persico, J. (1979). Who knows? who cares?: Forgotten children in foster care. New York: National Commission on Children in Need of Parents. Personal Responsibility and Work Opportunities Act (1996). P.L. 104-193. Pew Commission on Children in Foster Care (2004a). Voices from the inside, executive summary; retrieved June 25, 2004, from pewfostercare.org. Pew Commission on Children in Foster Care (2004b). Pew Commission on Children in Foster Care releases sweeping recommendations to overhaul nation’s foster care system. Washington, DC: Pew Foundation. Pike,V. (1976). Permanent planning for foster children: The Oregon Project. Children Today, 6, 22–41. Pike, V., Downs, S. W., & Emlen, A. C. (1977). Permanent planning for children in foster care: A Handbook for social workers. DHEW publication no. (OHDS) 77-30124.Washington, DC: U.S. Government Printing Office. Platt, A. (1969). The child savers: The invention of delinquency. Chicago: University of Chicago Press. Richan, W.  C. (1978). Personnel issues in child welfare services. Washington, DC: U.S. Department of Health, Education and Welfare. Roberts, D. (2003). Shattered bonds: The color of child welfare. New York: Basic Civitas. Rodham, H. (1973). Children under the law. Harvard Educational Review, 43, 489.

Ryan, W., & Morris, L. (1967). Child welfare: Problems and potentials. Boston: Massachusetts Committee on Children and Youth. Schorr, A. (ed.) (1974). Children and decent people. New York: Basic Books. Schram, S. (1981). Politics, professionalism and the changing federalism. Social Service Review, 55 (March), 78–92. Schuerman, J. R., Rzepnicki, T. L., & Littell, J. H. (1994). Putting families first; An experiment in family preservation. New York: Aldine de Gruyter. Shelman, E. A., & Lazoritz, S. (2003). Out of darkness: The story of Mary Ellen Wilson. New York: Dolphin Moon. Special issue on public social services: From title IVA to title XX. (1980). Urban and Social Change Review, 13 (Summer). Steiner, G. (1976). The children’s cause. Washington, DC: Brookings Institution. Strauss, G. (1977). The children are waiting: The failure to achieve permanent homes for foster children in New York City. New York: New York City Comptroller’s Office. Temporary State Commission on Child Welfare (1975). The children and the state: A time for change in child welfare. Albany, NY: Author. Thurston, H. W. (1930). The dependent child. New York: Columbia University Press. Urban and Social Change Review. Special issue on public social services: From Title IVA to Title XX. (1980). Urban and Social Change Review, 13 (Summer). U.S. Department of Health and Human Services (2004a). Findings from the Initial Child and Family Services Reviews 2001–2004.Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. U.S. Department of Health and Human Services (2004b). Child welfare outcomes 2001: Annual report to Congress, executive summary. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. Van Theis, S. (1924). How foster children turn out. New York: Charities Aid Association. Vasaly, S. (1976). Foster care in five states. Washington, DC: U.S. Department of Health, Education and Welfare. Vincent, C. (1961). Unmarried mothers. New York: Free Press. Waldfogel, J. (1998). Rethinking the paradigm for child protection. Future of Children, 8 (10), 104–19. Weisman, M. L. (1994).When parents are not in the best interests of the child. Atlantic Monthly, (July), 43–63. Whittaker, J. K., & Maluccio, A. N. (2002). Rethinking “child placement”: A reflective essay. Social Service Review, 76, 108–34. Wickenden, E. (1976). A perspective on social services: An essay review. Social Service Review, 50 (December), 574–88. Young, L. (1954). Out of wedlock. New York: McGraw Hill.

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Child welfare has traditionally been concerned with the safety and well-being of children. However, the Adoption and Safe Families Act of 1997—ASFA (P.L. 105-89)—and the Fostering Connection to Success and Increasing Adoptions Act (P.L. 110-351) mandate that specific and focused attention be given to promotion of positive outcomes of well-being for children and youth. Without doubt, however, well-being has remained the most ambiguous of the ASFA trinity of safety, permanency, and well-being. Renewed attention to the role of trauma and the need for positive attachment experiences and the consequences of the lack of positive attachment experiences have also surfaced in recent years as critical issues with respect to the overall well-being of children, youth, and families, especially for those whose lives have been affected by the child welfare system. Philosophically, we believe that without adequate attention to well-being and to the resilience and protective factors that support children, youth, and families there is a weakening of the foundation for both safety and permanency and important developmental issues are likely to be disregarded. Therefore, although safety is given prominence in AFSA legislation and language, a focus on child and adolescent well-being is intentionally situated at the beginning in this volume. The coeditors of this volume recognize that chapters placed in other sections also relate, often very directly, to the well-being of children and youth who are served by the child welfare system. To illustrate, one might reasonably argue that all of the systemic issues in child welfare, discussed in part 4, directly affect the well-being of children and youth. Placement instability, for example, a very serious problem not yet resolved in the majority if not all of child welfare systems, potentially affects all children placed in legal custody for their protection. This observation holds true for chapters in the other parts of this volume as well. Therefore, the coeditors encourage readers to remain mindful of the complex and often nuanced ways in

which a child or adolescent’s day-to-day experiences within the child welfare service delivery system from case opening through case closure may affect well-being for the better or for the worse. As identified in the outcomes for the Child and Family Service Reviews (CFSRs) process, there are three well-being variables. However, in actuality, the first of these is the most prevalent and the most wide-ranging. The three wellbeing variables in this framework include the following: t
Well-Being 1: Families have enhanced capacity to provide for their children’s needs. This includes consideration of the needs of and services to children, parents, and foster parents and the involvement of children, youth, and families in case planning. In the federally derived framework, well-being 1 also includes the critical area of worker visits with children and with parents. This is critical, because the first two rounds of the completed federal reviews in fifty states and two territories have found a strong, statistically significant positive relationship between caseworker visits with children and other safety and permanency outcomes. t
Well-Being 2: Children and youth receive appropriate services to meet their educational needs. t
Well-Being 3: Children and youth receive adequate services to meet their physical and mental health needs. In ensuring the well-being of children and youth, there are numerous issues that a child welfare professional must attend to: t
Assessing the situation from the young person’s perspective and actively either safely serving children and youth while they live with their families or preparing them for reunification, foster care placement, or adoption (Bellamy 2008).

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t
Supporting the child or youth’s adjustment to temporary placement in foster family homes and/or facilities, placement with an adoptive family, or reunification. t
Supporting the child or youth in dealing with feelings of loss, depression, and anxiety due to separation from parents and siblings. t
Supporting birth families, foster or resource families, and the child or youth during the process. t
Including the birth family, fathers and paternal resources, foster or resource parents, and the young person herself in case planning. t
Considering the preferences, norms, culture, and experiences of the child or youth and family when making the placement selection. t
Helping the child or youth maintain relationships with the birth family, relatives, informal support systems, and the community. This means children and youth must be placed geographically in a community that facilitates maintaining family relationships through frequent visits with parents and with siblings placed separately and that prevents unnecessary changes for children in school enrollment. t
Using frequent worker-parent, workerchild visits to facilitate permanency plans. t
Ensuring that the plan for the child or youth includes all domains of development (e.g., school performance, health, and physical and emotional well-being). In the first chapter of part 1, Kemp and colleagues review the critical concepts and issues relevant to understanding resilience in family support systems. From a strengths perspective, their focus on practice principles and strategies that support resilience frameworks resonates with the overarching philosophy that all families, despite the presence of some risk factors, possess factors that promote resilience. Therefore, the family’s strengths can be utilized to

enhance its capacity to provide for the child or youth’s needs. In the chapters that follow, the authors focus on several factors necessary for the meaningful engagement of families and for supporting the well-being of children and youth. Philosophically, we believe that an agency’s approach to engagement influences the effectiveness of the assessment, which in turn determines the appropriateness of the child’s or youth’s and family’s case plan and service implementation and, ultimately, the placement and service outcomes for children, youth, and families. Engagement Meaningfully engaging families in service planning and delivery early and in a focused way is essential for achieving the best possible outcomes for children and their families within the time frames set by ASFA. The goal of meaningful family engagement is to develop and maintain a mutually beneficial partnership with the family that will sustain the family’s interest in and commitment to change. Frontline workers must find ways to meaningfully engage families that protect the children and support maximum family involvement in defining needs and strengths and identifying solutions. During the first contact with the family, the child welfare worker must engage the family around the concern for the child’s or youth’s safety. Once parents understand the safety concerns, attention can be given to what it will take for the family to protect the child and create the safe, stable, nurturing home environment that provides for the child’s or youth’s needs. As trust builds over time, multiple issues families may be struggling with emerge and the family and frontline worker frankly discuss the relevant issues and the urgency in addressing them. Engagement must continue throughout the life of the case. Skilled workers will engage and reengage families in the change process, even following a “relapse.” The caseworker may consider focusing on an issue that is of immediate interest to the family and communicating a

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concern for or appreciation of it. For example, engaging the family around the child’s developmental needs and sense of time will make clear that reunification will happen when families can provide a nurturing environment. Acknowledging explicitly and often the demonstrable signs of progress while continuing to discuss safety and service planning can also facilitate continued engagement. A worker’s ability to engage families is significantly affected by the families’ perception of the process—parents often perceive this process as an intrusion into the privacy and integrity of their families. As Bossard, Braxton, and Conway stress in their chapter, whatever the cause of the initial intervention, frontline workers must be cognizant of the family’s feelings toward the system and find effective ways to engage families and help family members identify needs and solutions, while at the same time protecting the child(ren). Understanding cultural differences is also crucial to the staff ’s ability to engage the family and build relationships as discussed by RiveraRodríguez in her exploration of Latino families and their communities. Misinterpretation of culture can result in miscommunication and inappropriate or inaccurate interpretations and judgments that are likely to negatively impact the agency-family relationship and case decisions. The agency’s engagement with other professionals, extended family members, and caregivers also becomes critical. This engagement should promote focused assessment and decision making and encourage everyone involved—agencies, extended families, birth families, and foster/adoptive families—to work together to identify and resolve problems that resulted in a child’s out-of-home placement. Assessment The goal of assessment is to gather and analyze information that will support sound decision making regarding the safety, permanency, and well-being of the child or youth and, based on

assessment, determine appropriate services for the child and his family. Assessment, therefore, is addressed repeatedly throughout this volume. Assessment is based on the principle that all families have strengths that must be used to resolve the issues of concern; therefore, assessment provides an opportunity for families and workers to review family concerns, strengths, and resources together. Assessment includes an evaluation of family functioning and service needs based on information obtained from the family and other sources, such as schools, medical agencies, churches, and others. As such, it provides the information that lays the foundation for subsequent selection and implementation of services and strategies aimed at problem resolution. Assessment that engages relevant staff from related child- and family-serving agencies helps to highlight the comprehensive needs of the child and family and begins to identify how multiple agencies and community resources can support the family. Assessment must be an ongoing process and should be conducted throughout the agency’s involvement with the family. With the implementation of ASFA and Fostering Connections and their emphasis on the timely achievement of permanency for children and youth in the child welfare system, comprehensive, timely, and accurate assessment of families and children takes on renewed importance. To make realistic decisions about child safety, family preservation, reunification, and termination of parental rights, increased attention must be given to the appropriate assessment of the family’s strengths and needs and to the length of time required for the family to provide a safe, stable home environment. An important challenge facing frontline workers is to take a comprehensive, ecological view of families’ situations and to understand the contributions of various problematic behaviors to child maltreatment. Child maltreatment is complicated by many factors, including a parent’s personal physical and emotional health and substance use/abuse, as well as environmental, social, and economic factors. No less

CHILD AND ADOLESCENT WELL-BEING

complex than the problems of their parents are the needs of the children. Research indicates that maltreated children are at higher risk for a variety of poor developmental outcomes. The accuracy and utility of the ongoing assessment process depends upon the timely and active involvement of members of the immediate and extended family, others identified by the family, and professionals with expertise relevant to these issues of concern. Case Planning and Implementation The goal of case and/or service planning is to develop an individualized, strengths-based, needs-driven case plan that addresses the unique needs of children and their families as identified through the assessment while at the same time meets the standards of professional social work practice and the safety and permanency requirements of federal and state mandates. Service implementation involves providing ongoing support for the family and children through brokering, facilitating, monitoring, coordinating, connecting, developing, and/or providing services identified in the case plan as well as reporting relevant information to the courts and working with administrative reviewers. A family-centered and strengths-based approach to planning and implementation results in a worker-family relationship and plan for services that will best enhance the safety, permanency, and well-being of individual children, youth, and their families. The child’s needs—which inevitably change over time—are a continuing frame of reference during planning and implementation. As discussed by the authors who have contributed to part 1, child welfare agency staff and biological and foster/ adoptive families must be constantly mindful of the wide range of children’s needs. In the first chapter addressing well-being, Jan McCarthy and Maria Woolverton present an overview of issues that impact the health of children and youth who are involved with the child

welfare system. The authors discuss the health status and special health care needs of these young people, the child welfare system’s responsibility to forge linkages with other systems and with families to ensure that these needs are met, and the challenges faced in doing so. McCarthy and Woolverton also present a framework of critical components around which to develop approaches for overcoming the myriad challenges in order to ensure children and youth with access to appropriate health care services. Taken together, the components of this framework describe a comprehensive, communitybased health care system designed to meet the health care needs of children, youth, and families served by the child welfare system. They also discuss important ethical issues and dilemmas related to the implementation of various approaches as well as the knowledge and skills that social workers need to coordinate health care services for children and youth. Utilizing case examples woven throughout the chapter to illustrate salient points, Martha Morrison Dore focuses on child and adolescent mental health issues. This chapter explores current understanding of the etiology of mental health problems in children and adolescents. It also examines the processes available for identifying and classifying disorders in childhood as well as the types of disorders most often observed in young people and their prevalence across various domains. Current treatments are identified, particularly those that are evidence based, i.e., have strong empirical support for effectiveness. Finally, Dore looks at the system-of-care concept that currently drives provision of children’s mental health services in the U.S., where those services are provided, and the public policies, including funding structures, that support or undermine the timely and effective provision of mental health care to children, youth, and their families today. In their chapter “Educational Issues for Children and Youth,” Kristin Kelly, Kathleen McNaught, and Janet Stotland stress that

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children and youth in foster care with unmet educational needs are at high risk for school dropout, poverty and public assistance, homelessness, and juvenile court involvement. Permanency outcomes are also affected by unmet educational needs; children and youth whose educational outcomes are more positive and who have fewer sociobehavioral problems in school are more likely to return home or achieve another permanency outcome than youth with multiple school problems. This chapter outlines the requirements of the Fostering Connections Act regarding full-time student status for children and youth in foster care as well as for those receiving adoption assistance or subsidized guardianship payments. It also describes a framework for achieving educational success for children in custody through appropriate placement planning and educational supports, such as preventing school changes for children at the time of placement and while in custody. The final two chapters in this section—“Practice with LGBTQ Children: Youth and Families in Child Welfare Systems” by Diane Elze; and “Runaway and Homeless Youth: Policy and Services” by Karen Staller—do not fit neatly into the identified well-being variables as outlined in the CFSR process. However, children

and youth’s experiences in these areas can support or undermine their well-being. Tracing the history of LGBT youth in child welfare systems with literature and a review of practices and policies, Elze asserts that child welfare professionals now have a wealth of resources and technical assistance at their disposal to provide effective, sensitive, and culturally competent services to LGBTQ youths and their families. While the current, strong leadership that exists at the federal level within the Administration of Children and Families is a positive step in supporting LGBT children, youth, and families, Elze notes how stronger ongoing leadership is needed at state-, county- and agency-levels if LGBTQ youths and their families are to receive quality care in child welfare systems. Karen Staller’s chapter highlights a highly undesirable experience and its effects upon children and youth’s well-being—homelessness. With a focus on runaway and homeless youth, who are at great risk for involvement in the child welfare system, Staller addresses both policy and services relevant to the well-being of these populations of children and youth. This chapter provides a comprehensive overview of the issues that affect these young people, who are frequently overlooked by the traditional domains of child welfare.

S U S A N P. K E M P TRACEY K. BURKE KARA ALLEN-ECKARD M E L I S S A F. B E C K E R AMY ACKROYD

Family Support Services

F

or most child welfare–involved families, meeting daily needs is an ongoing struggle. Therefore, access to a range of supportive services, from help with poverty-related stresses to connections with supportive allies, is vital to these families’ ability to care adequately for their children. Nonetheless, public child welfare services have long struggled with how best to meet complex family needs. In the United States, as in most English-speaking Western countries, the public child welfare system is organized around a focus on child protection. Rather than viewing protecting children and supporting families as inextricably paired, philosophically this approach separates family support from the “investigation, apprehension, litigation, care” nexus (Cameron & Vanderwoerd 1997) at the core of child protective services. Over time, investments in supportive services by child welfare services have thus ebbed and flowed, hostage to shifts in public sentiment, available resources, and prevailing practice models (McGowan 1990). Currently, after more than a decade of preoccupation with child safety, observers of the American child welfare system are noting resurgent interest in supportive and preventive services (Wilson 2010b; Gilbert, Parton, & Skivenes 2011), driven in large part by the growing number of families on child welfare caseloads who have significant unmet needs for economic and other supports (Duva & Metzger 2010). In response, child welfare systems

across the country are becoming more actively involved in comprehensively assessing needs, mobilizing formal and informal supports, and working collaboratively with community-based providers and other services to ensure that vulnerable families get the help they need. Family support nonetheless remains a relatively under-specified area of public child welfare practice, and one which continues to inspire debate as to whether it is appropriately part of a child welfare portfolio. Scholars such as Elizabeth Bartholet (1999), Richard Gelles (1996), and Jill Duerr Berrick (2009), for example, consider the provision of supportive services to be an important social investment but one that lies outside the purview of mandated child protective services. A range of arguments underlie this position. One is that efforts to preserve families can go too far, leaving children in homes that are manifestly unsafe. Critics also worry that adding supportive services to the mandate of already over-extended and under-funded child welfare services risks actively undermining the system’s charge to protect children. As Berrick (2009) points out, a vast array of programs and services cluster under the family support umbrella, many of them only loosely related to child protection. Moreover, there currently is limited evidence that these interventions are effective in preventing maltreatment (and thus entry into foster care) or enhancing reunification. In Berrick’s view, therefore, although family support services are an essential community 51

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resource, redirecting child welfare resources to family support is not justifiable. Rather, the public child welfare system should continue to focus on its central responsibilities: reunification, foster care, and permanency efforts. The family support arena is indeed a “mixed bag” (Whittaker & Maluccio 2002). Nonetheless, the child welfare system routinely encounters families with extensive needs for supportive services. More than 70 percent of families reported for maltreatment are assessed as not meeting risk thresholds for child welfare intervention, even though many have significant needs that leave the family vulnerable to a crisis further down the line. Of the remainder, 20 percent become involved in protective services; another 10 percent are assessed as requiring court action and child removal (Waldfogel 1998a). When families are systeminvolved, needs for supportive services take on new urgency because persistent and unresolved problems often factor into and negatively influence consequential decisions about child placement, reunification, and termination of parental rights. Material hardship (and its attendant challenges) and recent homelessness, for example, decrease the likelihood that families will reunify (Berrick 2009). For these families and the kinships networks that increasingly care for their children, supportive services are as necessary in the context of protective services involvement as they would have been before problems escalated to the point of child welfare intervention. Rather than drawing a bright line between family support and child protection, therefore, this chapter takes an integrative approach, arguing that attention to families’ needs for support is inevitably and necessarily an essential component of child welfare services across the spectrum of child welfare involvement. At the same time, we concur that it is important to be clear about the scope and function of supportive services in the child welfare context, and to ground them in the best available research and practice evidence. From this

starting point, the chapter has two primary goals: 1. to describe the contemporary landscape of supportive family services in child welfare practice; and, 2. to lay the foundations for more intentional and evidence-informed use of supportive practices by child welfare practitioners, while also orienting readers to some of the dilemmas and challenges facing work in this area. Although we view the provision of universally available supports to families (or primary prevention) as a vital element of a comprehensive child welfare system (see e.g. Stagner & Lansing 2009), this chapter focuses on secondary and tertiary prevention: the provision of supportive services to families already in contact with child welfare services, either because of concerns that they are at risk of maltreatment or because they have open child welfare cases. In this context, supportive services are linked to efforts to ensure that children can safely remain at home, or, if they have already been placed in out-of-home care, that the family can be reunified. Other scholars (e.g. McCroskey & Meezan 1998) have defined these as family preservation services, terminology that appropriately captures their larger aims (see Berry & McLean’s chapter, this volume). However, since for many readers this term is associated with a relatively defined group of programs and our focus here is broader, we have opted for the more expansive term “supportive services.” We begin the chapter with a brief historical review of supportive services as a component of child welfare services. In the body of the chapter, we review risk and protective factors, connect these to the key elements of supportive interventions, and describe the main forms of supportive practice in contemporary public child welfare practice We illustrate this discussion by our work on Community Family Support Meetings. We conclude with reflections on the challenges and opportunities inherent in implementing supportive interventions in the complex environment that is contemporary public child welfare practice.

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Supportive Services in Public Child Welfare in Historical Perspective Historically, supportive services have had a piecemeal, indeed precarious existence in child welfare services. The child rescue movement of the late nineteenth and early twentieth centuries prioritized protecting children from “unfit” parents over providing services to poor families. In the years before World War I, faced with the grim realities of urban poverty, social reformers became increasingly focused on the social and environmental causes of family breakdown. The 1909 White House Conference on the Care of Dependent Children concluded that poverty alone was no reason to separate children from their families and recommended that where possible, supports should be provided to prevent family disruption (McGowan 1990, see also McGowan, this volume). In turn, these commitments informed the 1935 Social Security Act, which established child welfare as a public institution and, through Aid to Families with Dependent Children (AFDC), provided vulnerable families with vital economic support. Although states were provided with limited federal funding for preventive as well as protective services, most used these monies to fund out-of-home care, which for the ensuing decades become the centerpiece of child welfare services. Indeed, from this point the public welfare system arguably became the primary vehicle for the support of poor families. In the 1960s and 1970s, as the work of Kempe and others revived public awareness of child abuse, the child welfare pendulum swung to focus squarely on child protection (Pelton 1987). Although the 1980 Adoption Assistance and Child Welfare Act (PL 96-272) mandated that child welfare services undertake “reasonable efforts” to preserve children’s families, most child welfare resources continued to be used to support out-of-home placements, including new provisions for subsidized adoptions. By the mid-1980s, however, rising foster care caseloads and criticisms that there was a lack of services to children’s families in their

own homes brought calls for greater emphasis on supporting and preserving families as well. Much of this effort centered not on the sustained, multifaceted services most needed by poor and overwhelmed families but rather on Intensive Family Preservation Services (IFPS): short-term, narrowly focused programs of intensive home-based supports targeted to families at imminent risk of child placement (McGowan 1990; Pelton 1997). By the turn of the twenty-first century, even this relatively delimited approach to supporting families lost traction. In the wake of a series of highly publicized child deaths and in the face of increasing fiscal pressures, child welfare discourse returned once again to a more narrowly constructed concern with children’s safety and well-being. Embodying this shift was the 1997 Adoption and Safe Families Act (P.L. 105-89). This legislation prioritized child safety over family preservation, shifted funding for supportive services towards timelimited, treatment-oriented reunification and adoption services, and mandated the achievement of permanency outcomes within time lines that militate against the provision of open-ended supportive services to children’s families. For a decade following the enactment of ASFA, a range of pressures, including public concern over high-profile incidents of child maltreatment and related demands for high levels of professional accountability for child welfare outcomes, supported a relatively single-minded focus on child safety and protection. Yet the intransigent social and structural challenges confronting poor and marginalized families continue to demand attention. In the United Kingdom, efforts to refocus child welfare policy and practice on support as well as on protection have been a hallmark of child welfare reforms since the late 1980s (Parton & Berridge 2011). Canada has likewise experimented with approaches that integrate child protection and family support (Cameron & Vanderwoerd 1997). In the United States, advocates of a more

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ramified child welfare system have included the Edna McConnell Clark Foundation, Lizbeth Schorr, and the Annie E. Casey Foundation, whose Family to Family Program (Omang & Bonk 1999) provided a blueprint for child welfare services that build networks of supports for families in their neighborhoods and communities. Jane Waldfogel’s (1998b, 2000) proposal for a child welfare system, organized so that a range of formal and informal services and resources are available to respond to families on a customized basis, has been particularly influential: by 2008, twenty-six states had implemented “differential” or alternative response systems either statewide or in some jurisdictions (Waldfogel 2008). Progress toward more balanced investment in supportive as well as protective services has nonetheless been uneven, with considerable variation within as well as across states. In part this variation reflects the interaction of caseload dynamics and fiscal realities. As Wilson (2010b) points out, “new and expanded family support services must usually be funded with foster care savings” (p. 3): if foster care caseloads are stable or growing, new investments in supportive services are unlikely. When child welfare systems experience high-profile child deaths, furthermore, energy and resources typically go to child protection, not family support. At the most fundamental level, however, this uneven landscape undoubtedly also reflects the “chronic ambivalence” (Halpern 1999, p.189) toward poor families at the core of the child protection paradigm. Vulnerability and Protection: Matching Supportive Services to Needs No more compelling argument exists for the importance of attention to supportive services as a component of child welfare services than data on the everyday realities of families who become public child welfare clients, particularly the increasing proportion of families (more than 70 percent of cases annually) who enter the system for neglect (Sedlak et al. 2010).

Neglectful families typically struggle with a toxic, cascading mix of severe economic stress, social marginality, lack of social supports, and long-term family issues, which in concert progressively overtake already fragile parental and family coping systems (Berry, Charlson, & Dawson 2003; Wilson & Horner 2005). In a large-scale survey of poor families in the UK, for example, 90 percent of families experiencing four or more risk factors described themselves as not coping (Ghate & Hazel 2002). In the sections that follow, we review risk and protective factors relevant to supportive interventions at four intersecting system levels: social/ structural, neighborhood and community, family and household, and personal (Kemp, Whittaker & Tracy 1997). Risks and Vulnerabilities Social Marginality and Exclusion Child welfare-involved families experience multiple, interlocking forms of social exclusion and oppression, including poverty, racism, geographic and social isolation, and unemployment. Disproportionally, they are families of color. Many live in neighborhoods characterized by concentrated poverty, racial segregation, and inequities in resources, services, and health and social outcomes. Families in these neighborhoods not only have less access to services, but are less likely to use those that are available (Cortis 2011). With rising social inequality, persistently high unemployment, a stagnant job market, and an increasingly frayed safety net, these already marginalized families are rapidly becoming even more vulnerable (Anthony, King, & Austin 2011). At the policy and program levels, awareness of the social determinants of child welfare involvement is central to generating supportive interventions that go beyond prevailing tendencies to focus on the personal difficulties of individual caregivers and families. A structural analysis is also vital in everyday practice with child welfare-involved families, who more often than not experience child welfare services

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as stigmatizing and coercive. In this context, interactions between families and workers frequently involve “reciprocal exclusionary processes” (Mitchell & Campbell 2011:7). Parents tend to have low expectancies that services will be helpful and are at best distrustful and at worst hostile: if (as often happens) workers respond negatively, these low expectations are confirmed, resulting in even greater distancing and disconnection. In turn, workers’ initial judgments about families influence the nature of the services they offer: a recent European study, for example, found that workers’ early pessimism about case outcomes translated into reduced services over the life of the case (Jud, Perrig-Chiello, & Voll 2011). Particularly negatively affected are families of color (Chand & Thoburn 2005; Roberts 2002), parents seen as noncompliant by workers (Holland 2000), and parents who are seen as having limited capacity for change. Neighborhood Neighborhood-level factors significantly related to child maltreatment include high rates of poverty, housing stress, unemployment, drug and alcohol availability, high levels of child care burden (as measured by the extent to which adults in the neighborhood are available to care or look out for children), and low levels of neighborhood resources and support (Freisthler, Merritt & LaScala 2006; Lery 2009). Many of these neighborhoods lack services of all kinds, from supermarkets to social agencies. In recent work on the “geography of the safety net,” Allard (2009) found that residents in “high-poverty areas have access to almost half as many social services as low-poverty areas” (p. 7). Areas that are predominantly black or Hispanic have considerably less access to services than predominantly white areas. Although often overlooked, poor rural families also experience significant spatial inequalities in availability of and access to resources and services, with negative effects on reunification and termination of parental rights (Pruitt & Wallace 2012).

Family and Household Poverty Poverty and child welfare involvement are highly correlated, particularly in relation to neglect (Duva & Metzger 2010). Many neglectful families are not just poor, but deeply poor (Wilson 2010a, b). Economic factors linked to neglect include “public benefit receipt, financial assistance from family members, food pantry use, inability to receive medical care for a sick family member, difficulty paying rent, short duration of residence, utility shut-offs, and cutting meals” (Slack et al. 2011:1359). For these families, many of whom are “economically disconnected” in that they are neither employed nor receiving cash assistance (Marcenko et al. 2012), meeting basic needs and addressing poverty-related stressors are clearly priorities. Yet many child welfare systems and workers continue to treat economic issues as peripheral, focusing instead on changing caregiver behaviors (Penn & Gough 2002; Wilson 2010a, b). Housing Housing difficulties—from outright homelessness to various forms of unstable or suboptimal housing (Shdaimah 2009)—are pervasive among child welfare-involved families. Housing-related needs include help with finding housing, advocacy with landlords, assistance with furnishings, and attention to needed repairs or unsafe conditions such as faulty wiring, lead paint, and lack of heat (Shdaimah 2009). In a catch-22 scenario, housing problems can both precipitate child welfare involvement and follow from it, for example, if a mother complies with a court order and enters in-patient drug treatment but then loses her public housing (Shdaimah 2009). Although safe and stable housing is vital to preventing placement and supporting reunification (Farrell et al. 2010), child welfare services have long struggled with providing assistance in this area. Social Isolation Many child welfare-involved parents lack positive, supportive relationships with family, friends, and community resources

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(Thompson 1995; DePanfilis & Zuravin 1999). Some vulnerable caregivers have few social ties. Others are connected with kin and friends who are part of the problem, for example, if they are active substance users. Compounding these difficulties, parents often distrust formal service systems (Winkworth et al. 2010) and instead lean on overburdened personal social networks in order to get by (Mitchell & Campbell 2011), which negatively impacts on already stressed relationships. Personal The chronically stressful living conditions associated with poverty and social exclusion have disabling effects on parenting and parental well-being. Personal and interpersonal problems associated with child maltreatment include substance abuse, depression, and other mental health issues, adult interpersonal violence, health problems, parenting stress, decreased self-efficacy, and a range of child health and mental health issues (Slack et al. 2011). Frequently, parents feel “anxious, depressed, fearful, and overwhelmed” (Duva & Metzger 2010:65). At the same time, many have conflicted relationships with child welfare, and thus are hesitant about engaging in services. Protective Factors: Bridging Needs and Services Five clusters of protective factors are commonly identified as relevant to preventing child maltreatment and/or restoring effective family functioning. These include 1. nurturing and attachment, 2. parental resilience, 3. knowledge of parenting and child development, 4. social connections (with family, friends, peers, and larger social networks), and 5. concrete supports in time of need, both material resources (such as economic and housing assistance) and activities that “reduce social isolation and provide the necessary information, referrals and supports for families to access needed formal community resources” (U.S. Department of Health and Human Services, Administration for Children and Families 2011a).

The last two of these are centrally related to supportive services. A robust body of research evidence points to the direct and indirect benefits of supportive relationships, formal and informal, to child welfare–involved parents (Cameron & Vanderwoerd 1997), including affirmation and emotional support, information, assistance with navigating complex systems, and connections to other community resources (Moran & Ghate 2005; Kemp et al. 2009). As a consequence, relationally focused supportive interventions (such as mentoring, mutual aid, and peer advocacy programs) are increasingly widely used in child welfare services. At the same time, a growing body of evidence underscores the importance, given endemic poverty-related stressors, of concurrently providing practical and material supports (Slack et al. 2011). Indeed, the two are likely mutually reinforcing. As Loman (2010) points out in relation to research on differential response systems, “the important variable in making concrete services effective seems to have been ongoing contact [with workers] and the important variable in making ongoing contact effective seems to have been the provision of concrete services.” Supportive Interventions: Key Elements Many child welfare service plans are generic, one-size-fits-all, and behaviorally-focused (Berrick 2009): inadequate, in other words, as responses to the complex needs of child welfare-involved families. Nonetheless, the key elements of a more responsive, broadly constructed approach to supporting families are readily identifiable in the literature. These include t
an emphasis on family-centered, strengthsbased, collaborative, and culturally responsive practice; t
a systematic focus on fostering engagement in services; t
comprehensive assessments that clearly identify needs as well as risks;

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t
individualized service plans that are responsive to parent-identified needs; t
multidimensional, cross-systems services; t
services that are local, accessible, flexible, and sustained. Family-Centered, Strengths-Based, Collaborative, and Culturally Responsive Practice Family-centered services aim to empower parents and families to define their needs and enhance their capabilities (Dunst & Trivette 1994; Lightburn & Kemp 1994). They share a commitment to affirming and enhancing families’ collective and cultural strengths and to partnering with caregivers to prioritize needs and access relevant services and resources (Family Resource Coalition 1996). Workers’ use of family-centered, collaborative practices is positively related to satisfaction with services (Ghate & Hazel 2002; Moran & Ghate 2005), engagement and participation (Kemp et al. 2009), and the extent to which services offered are effective (Loman 2010). Findings across studies indicate that a strengths-based empowerment approach is particularly effective with families where maltreatment has already occurred (MacLeod & Nelson 2000). A Focus on Engagement As Loman (2010) points out, “Providing services . . . is only effective when caregivers want to participate and do participate.” Active efforts to reduce obstacles to caregiver engagement in services are thus essential. Tested strategies for enhancing engagement range from brief, structured interventions to more extensive programs of parent education and empowerment (for an overview, see Kemp et al. 2009). The provision of material and relational supports also enhances parents’ engagement with other child welfare services (Loman 2010). Comprehensive Assessments Holistic assessments that focus on needs, broadly constructed, as well as risks, are an essential starting point for the provision of services that respond

more effectively to the issues bringing families into contact with child welfare services (Tanner & Turney 2003; Loman 2010). Comprehensive assessments “go beyond the investigation to permit the identification and provision of services that are specifically targeted to address the family’s needs and problems” (Schene 2005:4). Individualized Service Plans, Responsive to Family-Identified Needs Too often “we ask families to define the supports they need and then ignore what they tell us” (Halpern 1991:345). Whereas workers tend to focus on behavioral issues, parents stress the importance of services that have practical value, meet their self-defined needs, and are readily available (Ghate & Hazel 2002). They view economic and material concerns as particularly urgent and indeed may be unable to fully engage with other services until these are addressed (Mitchell & Campbell 2011). Research findings also offer guidance on tailoring services to family needs. For example, a recent study (Chambers & Porter 2009) identified three subgroups of neglectful families: 1. low needs, 2. substance using, and 3. a highneed/high-risk group experiencing a combination of economic distress and personal challenges (and the highest level of child placement). Based on these findings, the authors recommend a differential approach to service planning: with low-needs families, interventions might focus primarily on parenting skills, social support, and assistance with basic needs; where problems center around substance abuse, interventions will typically involve both treatment and safety planning; with high-risk families, interventions should probably focus on meeting basic needs, addressing mental health concerns, and ensuring safety from domestic violence, with attention to parenting issues coming later. Multidimensional, Cross-Systems Services Given the range of challenges facing child welfare-involved families, interventions optimally

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include “a flexible mix of concrete, clinical, and supportive help” (Halpern 1995:104; see also Moran & Ghate 2005). To provide these supports, child welfare social workers and agencies invariably need to collaborate with a range of community partners, formal and informal (U.S. Department of Health and Human Services, Administration for Children and Families 2010). Services That Are Local, Accessible, Flexible, and Sustained A growing body of evidence points to the importance of locally accessible supports (Allard 2009; Kissane 2010). Proximity to services has a number of benefits: it reduces practical obstacles to seeking help (such as transportation difficulties and child care concerns), increases the likelihood that services will be perceived as culturally congruent, and makes drop-in services more feasible (Hess, McGowan, & Botsko 2003). A Canadian study comparing accessible (locally based) public child welfare services and centralized services found that parents were more likely to make use of accessible services, to get to know workers (and thus find services less stigmatizing), and to be satisfied with the services they receive (Cameron et al. 2011). On a cautionary note, however, an ethnographic study of service use by low-income women of color in Philadelphia found that women’s perceptions also played an important role in whether or not they used local services (Kissane 2010). This study reminds us that even though accessibility is a very important mediator of service use, even nearby services may be avoided if parents see them or the area in which they are located as physically or culturally unsafe. To effectively address chronic, complex problems, supportive services also need to be longer term (Wilson & Horner 2005; MacLeod & Nelson 2000; Tanner & Turney 2003) and readily available when issues arise (Loman 2008). Two recent studies suggest that sustained services can result in positive changes even with the

“frequently encountered” families that workers and agencies typically view as least likely to change (Chaffin et al. 2011; Jonson-Reid et al., 2010). Realistically, these services are often best provided by local agencies capable of providing ongoing support in less stigmatizing, culturally congruent settings (Chand & Thoburn 2005; Winkworth et al. 2010). The Contemporary Landscape of Supportive Services in Child Welfare Supportive interventions offered under the auspices of child welfare services, either directly or through contracts with community agencies, cluster in six main groups: 1. solution-based casework; 2. alternative or differential response programs, including flexible funding using IV-E waivers; 3. family group decision-making models; 4. parent-to-parent and mentoring models; 5. family preservation services; and 6. community-based child welfare services and community partnerships. Although not addressed here, a wide range of community-based family support programs also serve as important resources for child welfare-involved families (for an overview, see Pecora et al. 2009). Solution-Based Casework A number of child welfare jurisdictions, including Kentucky, Tennessee, and Washington state, have implemented Solution-Based Casework (SBC), a family-centered practice model that incorporates systematic attention to creating partnerships with families, building on family strengths, and addressing families’ pragmatic life challenges. By comprehensively and collaboratively assessing family needs, SBC and related practice models set the stage for more effectively providing needed supports. Small studies of SBC using chart reviews suggest that workers with SBC training more actively connected clients with resources and services. Families where SBC was used also had higher rates of attendance and service completion (Antle et al. 2008).

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Differential/Alternative Response Services At least twenty-six states now have Differential Response (DR) or alternative response systems in some or all child welfare jurisdictions (Waldfogel 2008). At the point where an allegation of maltreatment is made, DR provides the opportunity for caseworkers to offer lower-risk families supportive services tailored to families’ immediate needs rather than proceeding to investigation. Most DR services use participatory approaches (such as family team meetings) in assessing needs, setting goals, and prioritizing services. Typically these are provided on a flexible basis, frequently in partnership with community agencies and resources. As Duva and Metzger (2010) note, “the service array . . . made available on the alternative track permits immediate, targeted, and customized interventions capable of meeting a family’s basic needs” (p. 68). To facilitate these efforts, several jurisdictions (e.g. Indiana) have used Title IV-E funding waivers to redirect funding from outof-home care to a range of supportive services, significantly enhancing their ability to respond nimbly to families’ needs (U.S. Department of Health and Human Services, Administration for Children and Families 2011a, b). Research findings indicate that DR has significant if modest positive effects on rates of rereferral and out-of-home placement and more robust effects on access to supportive services, the development of collaborative relationships between clients and workers, and client satisfaction (Loman 2010; see also Waldfogel 2008). Satisfaction appears to be linked in particular to the provision of concrete services such as food, housing, transportation, financial assistance, and medical care. Family Group Decision-Making Models This cluster of models includes Family Group Conferences, Family Team Meetings, Family Decision Meetings, and Team Decision Meetings. Originating in New Zealand with family group conferencing, family decision-making

models (FGDMs) are based in two key principles: 1. that efforts to ensure child safety, permanency, and well-being require partnerships between family networks and child welfare services and 2. that a fundamental element of such partnerships is the structured involvement of immediate and extended families in decision making and problem solving (Burford 2000; Marcynyszyn et al. 2012; Merkel-Holguin 1996). By providing a forum for eliciting families’ perceptions of their needs, creating collaboratively developed service plans, and linking caregivers with relevant supports (Hassall 1996), FGDMs have considerable potential to bridge family support and child protection. Indeed, Vesneski (2009) has described the growth of FGDMs in the United States as “a defacto family support policy” (p. 2). Research findings indicate that the most robust effects of FGDMs are on intermediate outcomes, such as parents experiencing meetings as inclusive and collaborative, and the successful development of participatory plans (Crampton 2007; Morris & Connolly 2011; Rauktis, Huefner, & Cahalane 2011). Translating plans into longerterm supports can however be more difficult. For example, one of the few experimental studies of FGDMs (Center for Social Services Research 2004) found that they had significant positive effects on parent-worker collaborations, but were less effective in mobilizing ongoing community resources for families. Other research studies, including our own work on Community Family Support Meetings (described in more detail later in this chapter), likewise suggest that effectively linking families to needed services continues to be a challenge for child welfare services (see e.g. Zielewski et al. 2006). Supportive Relationships: Parent to Parent and Mentoring Models “Meaningful connections with supportive adults are the bedrock of effective practice with child welfare involved families” (Kemp et al. 2009:114). Building on this long-standing insight, a range of programs have emerged to provide additional support,

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advocacy, and mentoring to children’s parents, including peer-to-peer and veteran parent programs (Nilsen, Affronti, & Coombes 2009), birth parent advocates, and foster parent mentoring programs. In California the Parent Partner Program uses alumni birthparents to provide support to those who are newly involved with the system (Cohen & Canan 2006). In Washington state the Parent Mentoring Program puts children’s parents in contact with experienced foster parents (not their child’s foster parents) who can provide relational support, information, assistance with system navigation, and practical help (Marcenko et al. 2010). Although empirical evidence on these and other parent-to-parent programs is limited, preliminary data on program experiences and outcomes, including anecdotal feedback from parents, are promising (Marcenko et al. 2010). Family Preservation Services Family preservation services (FPS) are flexible, individualized, family-centered, and often relatively time-limited home-based services provided to families where there is risk of family disruption (see Berry & McLean’s chapter, this volume) Based on family support principles as well as crisis intervention and behavioral models, FPS focus on skill building, rehabilitative services, and, to a lesser extent, the provision of a range of social and material supports (McCroskey & Meezan 1998). Widely used across child welfare jurisdictions (Pecora et al. 2009), many family preservation services are provided by external agencies on a contractual basis. Within this broader umbrella, intensive family preservation services (IFPS) are high intensity, shortterm services targeted to families at imminent risk of losing children to placement or working on reunification. Research findings on the outcomes of family preservation services evidence mixed results, particularly in relation to prevention of out-ofhome placement. In general, positive findings cluster around intermediate outcomes, including (among others) improvements in supports

available to families, living conditions, family cohesion, level of family stress, and parentchild interactions. Reviewing this literature, McCroskey and Meezan (1998) concluded that family preservation services are particularly helpful in terms of stabilizing families. Nonetheless, as McGowan (1990) had earlier pointed out in relation to the IFPS, they typically are too short-term, behaviorally focused, and crisis oriented to be a sufficient response to the complex, long-term needs of many child welfare–involved families. Community-Based Child Welfare Services and Community Partnerships Communitybased child welfare services emphasize the importance of “integrat[ing] child welfare services with other service systems at the neighborhood level to support families and children through the provision of culturally competent services in locations that are both familiar and convenient” (Chahine, van Straaten, & Williams-Isom 2005:142). Common components include the outplacement of child welfare staff in local neighborhoods, encouragement of neighborhood-based foster care, and, increasingly, efforts to forge robust partnerships with community agencies and resources (Chahine, van Straaten, & Williams-Isom 2005; Schene 2006). Leadership in the development of community-centered child welfare services has been provided by the Annie E. Casey Foundation, notably through the Family to Family Program (Crampton et al. 2011; Omang & Bonk 1999). New York’s Center for Family Life (CFL) also serves as a national model for the integration of child welfare services, including foster care, into a larger program of community-centered services and supports for families (Hess, McGowan, & Botsko 2003). On a broader scale, the Prevention Initiative Demonstration Project in Los Angeles is emerging as a very promising model for comprehensive, community-based child abuse prevention at the primary, secondary, and tertiary levels (McCroskey et al. 2012; Pecora et al. 2013).

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Although the evidence base on communitybased child welfare services is fledgling, there is consensus that in general they are more accessible, less stigmatizing, more culturally responsive, and more effective at connecting parents with community services and supports than centralized child welfare services (Gray 2003; Hess, McGowan, & Botsko, 2003). A recent quasi-experimental Canadian study (Cameron et al. 2011) comparing accessible (locally based) and centralized child welfare services found that parents at accessible sites saw workers as more knowledgeable about their family circumstances, described themselves as both more connected to needed supports and less stressed, and perceived that they had benefited more from child welfare involvement than parents at centralized sites. Community-based social workers, in turn, reported that more formal and informal partnerships were available to support families. The researchers found no significant change in personal and family functioning in the study period, a finding they interpreted as indicating that accessible child welfare services need to be linked with more intensive services to significantly impact these kinds of issues. However, studies of other community-based models have reported preliminary evidence of positive impacts on child welfare outcomes, including entry to care and rereferrals (McCroskey et al. 2010), length of stay, and reunification with parents (Hess, McGowan, & Botsko 2003; Usher et al. 2010). Practice Exemplar: Community Family Support Meetings Community Family Support Meetings were a central component of the Community Family Partnership Program (CFPP), a pilot demonstration program developed by the Washington State Division of Children and Family Services in 1998 with support from the Stuart Foundation.1 Inspired by Annie E. Casey Foundation’s Family to Family Program (Omang & Bonk 1999), CFPP aimed to more fully include family and community resources, to build strong

public agency/community partnerships, and to integrate family support principles into public child welfare practice. Key elements of CFPP included the development: of a network of community foster homes; local foster parent support groups; a Time Dollars program that allowed the business community to contribute to foster parent recruitment and support; education and outreach by public child welfare workers in project communities; and Community Family Support Meetings (CFSMs). The project also hired five “community partners,” including foster parents, a relative caregiver, a Head Start social worker, and a family support program director who worked closely with program staff to develop and deliver program services relevant to their particular communities. The CFSM model is based in family group decision-making models (particularly the Oregon Family Unity Meetings, Keys 1996) but is distinctive in its emphasis on the systematic inclusion of community resources and partners. The aim of the meetings is to build partnerships that help families not only to meet agency mandates but also to develop relationships with resources in their local ecologies that can help them to weather future crises. CFSMs also provide a forum for strengthening the connections between the child welfare system and community agencies (Pranis 2000). An extensive description of the process of CFSMs can be found in Kemp et al. (2005). Briefly, these are participatory decision-making meetings facilitated by an independent facilitator who is responsible for ensuring that all aspects of the process support the empowerment of the family and shared ownership of the plan. Before any community representatives are invited to the meeting, for example, the primary family member is consulted. Workers, family members, and community participants remain together throughout the meeting and process of decision making. All participants are invited to offer resources and ideas and to participate fully in the process of the meeting and the development of the plan.

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At the front end of the system, CFSMs provide a forum for public child welfare workers to partner with families and local community resources with the aim of preventing problems from escalating. When families are formally involved with child protective services, CFSMs focus on the resources needed to prevent outof-home placement or to support reunification. Meetings are also useful at key transition points, such as when children are being returned home or youth are preparing for independent living. With growing use of kinship placements, meetings can likewise be used to address the support needs of relative caregivers, who may be unaware of the resources available to them or fearful of involvement with formal services. Evaluation Findings Findings from the program evaluation indicated that FSMs were experienced by family members and other meeting participants as affirming, supportive, and helpful.2 They provided families with a space for articulating their needs and priorities and with initial connections to relevant community resources and supports. Overall, meeting participants had positive feedback on the involvement of community service providers in the meetings. Respondents also noted that families left the meetings with more knowledge regarding services that are available in their communities. The professionals we interviewed agreed that CFSMs are a very useful way of increasing networking and collaboration among service providers and between community agencies and DCFS. Social workers liked being able to develop partnerships with other providers working in the same community, and with the same families, as well as the networking opportunities the meetings provided. The process evaluation also underscored the important role of the community partners. Nonetheless, getting the right community participants to the table, with the information they needed in order to be maximally helpful to families, emerged as a more challenging

task. Most of the community participants represented formal or semiformal resources and services; links to informal supports were more difficult to establish. Respondents also reported challenges in generalizing the connections made in meetings to the work that followed, particularly as follow-through on information about resources was largely the responsibility of family members. For some families, therefore, meeting plans did not result in ongoing changes in their connections with community resources. Taken as a whole, these findings suggest that meetings such as CFSMs are not only valuable as inclusive, participatory spaces for child welfare decision making, but have considerable potential as vehicles for building stronger connections between families and community supports and between public child welfare agencies and community providers. To fully realize this potential, however, requires careful attention to the postmeeting activities, so that plans made carry through into meaningful connections with needed resources and supports. Supportive Interventions: What Do We Know About Outcomes? Looking across the supportive interventions presented here, what can we reasonably expect from supportive services? Although the gold standard for efficacy in child welfare services focuses on key child welfare outcomes—safety, stability, permanency—it can be challenging to produce changes in these domains with family support interventions, particularly where families are experiencing multiple personal, social, and economic challenges (Berrick 2009). Indeed, reviews of supportive interventions suggest that in general their ability to prevent new or repeat maltreatment is limited (Conley & Berrick 2010; MacLeod & Nelson 2000; Chaffin, Bonner, & Hill 2001). Exceptions include recent studies of differential response systems, which have found that these programs have positive if modest impacts on child maltreatment reports and out-of-home placement

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(Waldfogel 2000, 2008; Loman 2010). Similar results have been reported for programs providing families with enhanced material supports, such the Norman Program in Illinois, which provided families with cash assistance and housing advocacy (Shook & Testa 1997, cited in Eamon & Kopels 2004). In considering the mixed findings on family support interventions and child welfare outcomes, two issues warrant clarification. First, there is considerable lack of precision in the literature. Reviews often clump disparate interventions together, making it difficult to determine which programs are most effective (and how), and potentially washing out withingroup differences. More fine-grained analyses are, however, revealing. In a statewide study of maltreatment outcomes among moderateand high-risk families served by a wide range of home-based family preservation and support programs, for example, Chaffin, Bonner, and Hill (2001) found “a discouraging pattern of results” in relation to prevention of child abuse and neglect (p. 1284). Looking within their larger sample of programs, however, they found that material supports and mentoring approaches were more effective than parenting and child development-oriented programming. For higher-risk families, “the simple provision of basic concrete needs seemed to perform as well, or better than, many of the more involved and typical FPFS parenting approaches, including in-home services” in preventing maltreatment (p. 1284). Several implications can be drawn from these findings. Most obviously, they underscore the importance of addressing basic needs. Beyond this, however, the differences in outcomes between the interventions highlight the importance of more carefully specifying what we mean by “support” in relation to high-risk families and where and how different kinds of support may be useful: for example, these data suggest that until basic survival needs are addressed, caregivers may be unable to engage effectively with services targeted to other family issues.

Second, it is likely that supportive interventions have indirect rather than direct effects on outcomes such as maltreatment or placement prevention. By reducing poverty-related stressors and/or enhancing interpersonal supports, for example, they mediate (or set the stage for) caregivers’ ability to successfully address challenges such as substance abuse or parenting issues that more directly link to the achievement of key child welfare outcomes (Kemp et al. 2009). From this perspective, supportive interventions primarily influence proximal or intermediate outcomes. Lightburn and Adamson-Warren (2006) conceptualize these as “sensitive outcomes” or “steps-on-the-way” to more distal goals. Intermediate outcomes shown to be positively correlated with supportive interventions include 1. relief of immediate material and practical needs (Loman 2010); 2. increased access to information and referrals; 3. increased satisfaction with services and workers (Crampton 2007; Loman 2010: Cameron et al. 2011); 4. enhanced engagement in services (both buy-in and use) (Loman 2010); 5. increased personal, interpersonal, and community support and/or reduced social isolation (Ghate & Hazel 2002); 6. reduced stress; and 7. increased self-efficacy and self-confidence (Lupton & Nixon 1999). Findings such as these indicate that supports for families are an important component of the continuum of child welfare services. Even so, supportive interventions are no panacea: realistically, gains from the relatively delimited and frequently remedial supports now available are likely to be fragile (Fuchs 1995), particularly given the rapidly compounding social and economic risks currently facing vulnerable families and children. Supportive Child Welfare Services: Constraints and Opportunities In recent years child welfare systems in the United States have made important moves toward more extensive investments in supportive services (Gilbert, Parton, & Skivenes 2011).

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This rebalancing is evident in the rise of differential response systems and related investments in community partnerships and other services focused on early intervention, collaborative problem solving, and the enhancement of community-based resources. Increasingly, child welfare systems are paying deliberate attention to addressing poverty-related needs as well as providing social and relational supports. Family-centered interventions such as comprehensive assessments and family decision making also continue to flourish. Nonetheless, we continue to be mindful, as Paul Nixon (2000) has cautioned, of the tendency for innovations in child welfare to operate as “parallel systems,” running alongside but not quite transforming the inner core of child protection practice. Significantly more federal and state funding still goes to out-of-home placements than to family support services (Wilson 2010b). Furthermore, prioritizing supports to families tends to be difficult for child welfare jurisdictions contending with fiscal constraints, intense public scrutiny, concerns about risks to child safety, and ambivalence as to whether such an approach is appropriate for child protective services. Given these countervailing pressures, there is always the possibility that systems will ‘“revert to type’” (Gilbert, Parton, & Skivenes 2011:256). In the larger scheme of things, therefore, additive approaches to supportive services are not in themselves sufficient to address the multiple and complex challenges facing very vulnerable families. More fundamental changes are needed in this country’s child welfare paradigm towards a comprehensive, prevention-oriented approach that provides families with ongoing access to a continuum of supports appropriate to their economic, social, and cultural needs (Lindsey & Shlonsky 2009; Peckover & Smith 2011). Given widening social, economic, and racial disparities, moreover, efforts to more effectively provide supportive services will need to be linked with structural interventions aimed at reducing poverty and social exclusion.

In the current fiscal and political climate, however, realism suggests that needed changes are unlikely to happen quickly. Meanwhile, we can only hope that the rebalancing of family support and child protection evident in recent years will be sustained. To this end, policy-level efforts to maintain and grow investments in supportive services, through, for example, creative use of Title IV-E funding waivers and more effective partnerships with other service systems, are essential. At the organizational level, investments in workers need to go hand in hand with investments in services: as Wilson (2010a) points out, reforms are very difficult to sustain in the face of rapid staff changes and their negative impacts on expertise and morale. On the ground, attention to more thoroughly integrating family support principles and practices into frontline child welfare practice will continue to be important. Faced with busy caseloads, agency priorities that emphasize work with children (Smith & Donovan 2003), and ever-expanding paperwork requirements (Cameron et al. 2011), many public agency social workers find little time in their daily practice for working with families. Furthermore, by no means all of them see time spent on supportive services as appropriate. When Cameron and Vanderwoerd (1997) talked with child welfare staff, for example, they found frontline workers more resistant to using a supportive approach (and more strongly identified with investigatory child protection frameworks) than mid-level supervisors and managers. To appropriately balance family support and child safety, workers need solid preparatory training and ongoing access to reflective supervision. They also need supportive work with families to be valued by their agency, enough time in their schedules to be able to do it well, and the ability to access the resources that families need. When these things are in place, social workers report that they serve families more effectively and that their practice is more satisfying (Loman 2010).

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We are not suggesting that the child welfare system should invest willy-nilly in supportive services. To the extent possible, innovations in this area should be based in the best available evidence that they appropriately target family needs and are demonstrably connected to key child welfare outcomes, both proximal and distal. In general, the field needs a well-calibrated continuum of supportive interventions grounded in good evidence for their differential use (Thomlison 2003). Developing such a portfolio will require further investments in rigorously evaluating current and emerging interventions. In addition, we see a pressing need for the development of program theory or specification of the pathways by which different kinds of supportive interventions translate into intermediate and distal outcomes. Better

NOTES

1. The Community Family Partnership Project and its evaluation were made possible with funding from the Stuart Foundation; and with the support of the Washington State Department of Child and Family Services. The opinions expressed herein are, however, those of the authors. 2. An evaluation of the Community Family Partnership Project (CFPP) was conducted concurrent with project implementation. The focus of the CFSM component of the evaluation is the meeting process—how meetings work and what people’s perceptions, opinions, and insights are regarding the meetings. Data sources for this component include postmeeting interviews with meeting participants (parents, family members, friends, community service providers, and caseworkers) as well as surveys from facilitators. Other data include the plans that came out of the CFSMs and selected case record data from some families in the evaluation. In addition, researchers interviewed the project team, community partners, and other caseworkers and administrators in the public child welfare office, focusing on the process of day-to-day project administration and the reach of the project through the office and the five project communities. Specific to our focus in this chapter, the process interviews included questions regarding the implementation of the CFSM component.

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understanding not only of what works, but how, and for whom, will in turn allow for better targeting of services and for more intentional mixing and phasing of supportive services and targeted treatment interventions. In closing, we end where we began. In our view, the central justification for supportive services lies in the bitter daily realities of families struggling to raise their children in the face of poverty, racism, persistent hardship, and social exclusion. Given these realities, efforts to strengthen available supports warrant dogged attention at every level of the service system, from policy to the front lines of daily practice. As Robert Halpern (1999) has aptly observed, “there are no shortcuts to strengthening supportive services for poor families” (p. 258).

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and organizational realities. New York: Aldine de Gruyter. Cameron, G., Hazineh, L., et al. (2011). The impacts of accessible child protection services on services, jobs, and families. Children and Youth Services Review, 33, 945–54. Center for Social Services Research. (2004). California’s Title IV-E child welfare waiver demonstration study evaluation: Final report. Berkeley: University of California Center for Social Services Research. Chaffin, M., Bard, D., Hecht, D., & Silovsky, J. (2011). Change trajectories during home-based services with chronic child welfare cases. Child Maltreatment, 16, 114–25. Chaffin, M., Bonner, B., & Hill, R. (2001). Family preservation and family support programs: Child maltreatment outcomes across client risk levels and program types. Child Abuse & Neglect, 25, 1269–89. Chahine, Z., van Straaten, J., & Williams-Isom, A. (2005). The New York City neighborhood-based services strategy. Child Welfare, 84, 141–52. Chambers, R., & Porter, C. (2009). Family needs in child neglect cases: A cluster analysis. Families in Society, 90, 18–27. Chand, A., & Thoburn, J. (2005). Child and family support services with minority ethnic families: What can we learn from research? Child and Family Social Work, 10, 169–78. Cohen, E. & Canan, L. (2006). Closer to home: Parent mentors in child welfare. Child Welfare, 85, 867–84. Conley, A., & Berrick, J. (2010). Community-based child abuse prevention: Outcomes associated with a differential response program in California. Child Maltreatment, 15, 282–92. Cortis, N. (2011). Overlooked and under-served? Promoting service use and engagement among “hardto-reach” populations. International Journal of Social Welfare, DOI: 10.1111/j.1468–2397.2011.00825.x. Crampton, D. (2007). Family group decision-making: A promising practice in need of more programme theory and research. Child and Family Social Work, 202–9. Crampton, D., Usher, C., Wildfire, J., Webster, D, & Cuccaro-Alamin, S. (2011). Does community and family engagement enhance permanency for children in faster case? Findings from an evaluation of the Family-to-Family Initiative. Child Welfare, 90, 61–77. DePanfilis, D., & Zuravin, S. (1999). Rates, patterns, and frequency of child maltreatment recurrences among families known to CPS. Child Abuse & Neglect, 23, 729–43. Dunst, C. J., & Trivette, C. (1994). Aims and principles of family support programs. In C. J. Dunst, C. Trivette, & A. Deal (eds.), Supporting and strengthening families: Methods, strategies, and practices (pp. 30–48). Cambridge: Brookline. Duva, J., & Metzger, S. (2010). Addressing poverty as a major risk factor in child neglect: Promising policy and practice. Protecting Children, 25, 63–74.

Eamon, M., & Kopels, S. (2004). “For reasons of poverty”: Court challenges to child welfare practices and mandated programs. Children and Youth Services Review, 26, 821–36. Family Resource Coalition (1996). Guidelines for family support practice. Chicago: Family Resource Coalition. Farrell, A., Britner, P., Guzzardo, M., & Goodrich, S. (2010). Supportive housing for families in child welfare: Client characteristics and their outcomes at discharge. Children and Youth Services Review, 32, 145–54. Freisthler, B. (2009). Need for and access to supportive services in the child welfare system: An analysis using geographic information systems (GIS). California Center for Population Research online working paper, accessed August 17, 2011 at http://papers. ccpr.ucla.edu/papers/PWP-CCPR-2009–037/PWPCCPR-2009–037.pdf. Freisthler, B., Merritt, D., & LaScala, E. (2006). Understanding the ecology of child maltreatment: A review of the literature and directions for future research. Child Maltreatment, 11, 263–80. Fuchs, D. (1995). Preserving and strengthening families and protecting children: Social network intervention, a balanced approach to the prevention of child maltreatment. In J. Hudson & B. Galaway (eds.) Child welfare in Canada: Research and policy implications (pp. 113–22). Toronto: Thompson Educational. Gelles, R. (1996). The book of David—how preserving families can cost children’s lives. New York: Basic Books. Ghate, D., & Hazel, N. (2002). Parenting in poor environments: Stress, support, and coping. Philadelphia: Kingsley. Gilbert, N., Parton, N. & Skivenes, M. (2011). Changing patterns of response and emerging orientations. In N. Gilbert, N. Parton, & M. Skivenes (eds.). Child protection systems: International trends and orientations (pp. 243–357). New York: Oxford University Press. Gray, B. (2003). Social exclusion, poverty, health, and social care in Tower Hamlets: The perspectives of families on the impact of the Family Support Service. British Journal of Social Work, 33, 361–80. Halpern, R. (1991). Supportive services for families in poverty: Dilemmas of reform. Social Service Review, 65, 343–64. Halpern, R. (1995). Parent support and education programs: Their role in the continuum of child and family services. In I. Schwartz & P. AuClaire (eds.). Home-based services for troubled children (pp. 73– 112). Lincoln: University of Nebraska Press. Halpern, R. (1997). Good practice with multiply vulnerable families: Challenges and principles. Children and Youth Services Review, 19, 253–75. Halpern, R. (1999). Fragile families, fragile solutions: A history of supportive services for families in poverty. New York: Columbia University Press. Hassall, I. (1996). Origin and development of family group conferences. In J. Hudson, A. Morris, G. Maxwell,

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Presentation at Differential Response Conference, Anaheim, CA; accessed online at http://www.iarstl. org/papers/DiffResponseConfPresentation2010.pdf Lupton, C. & Nixon, P. (1999). Empowering practice? A critical examination of the family group conference approach. Bristol: Policy. McCroskey, J., & Meezan, W. (1998). Family-centered services: Approaches and effectiveness. Future of Children, 8, 54–71. McCroskey, J., et al. (2010). Prevention Initiative Demonstration Project (PIDP): Year Two Evaluation Report. Casey Family Programs; accessed online at http://www.casey.org/resources/publications/PIDP/ pdf/PIDP_year2_ES.pdf. McGowan, B. (1990). Family-based services and public policy: Context and implications. In J. Whittaker, J. Kinney, E. Tracy, & C. Booth (eds.), Reaching high risk families: Intensive family preservation in human services (pp. 65–87). New York: Aldine de Gruyter. MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A metaanalytic review. Child Abuse & Neglect, 24, 1127–49. Marcenko, M, Brown, R., DeVoy, P., & Conway, D. (2010). Engaging parents: Innovative approaches in child welfare. Protecting Children, 25, 23–34. Marcenko, M., Hook, J., Romich, J., & Lee, J. (2012). Multiple jeopardy. Child Maltreatment, 17, 195–206. Marcynyszyn, L., Small Bear, P., Geary, E., Conti, R., Pecora, P., Day, P., & Wilson, S. (2012). Family Group Decision making (FGDM) with Lakota families in two tribal communities: Tools to facrlatate FGDM implementation and evaluation. Child Wellfare, 9, 113–134. Merkel-Holguin, L. (1996). Putting families back into the child protection partnership: Family group decision making. Protecting Children, 12, 4–7. Mitchell, G., & Campbell, L. (2011). The social economy of excluded families. Child and Family Social Work, doi: 10.1111/j.1365–2206.2011.00757.x. Moran, P., & Ghate, D. (2005). The effectiveness of parenting support. Children & Society, 19, 329–36. Morris, K., & Connolly, M. (2011), Family decision making in child welfare: Challenges in developing a knowledge base for practice. Child Abuse Review, doi: 10.1002/car.1143. Nilsen, W., Affronti, M., & Coombes, M. (2009). Veteran parents in child protective services: Theory and implementation. Family Relations, 58, 520–35. Nixon, P. (2000). Family group conference connections: Shared problems and solutions. In G. Burford & J. Hudson (eds.), Family group conferencing: New directions in community-centered child & family practice (pp. 93–104). New York: Aldine de Gruyter. O’Donnell, M., Scott, D., & Stanley, F. (2008). Child abuse and neglect—is it time for a public health approach? Australian and New Zealand Journal of Public Health, 32, 325–30.

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Meaningful Family Engagement

E

ngaging families is a foundational principle of good social work practice in child welfare (DePanfilis & Salus 1992). At every phase along the service continuum, child welfare professionals are expected to engage families—from the initial investigation, to the intake/assessment, to case planning, to case management and service provision, and to permanency. A family-centered, strengths-based, partnership-driven approach to service planning and delivery reflects the ethical and philosophical assumptions consistent with social work values, such as collaboration, mutuality, and shared power (Altman 2005; Pecora, ReedAshcraft, & Kirk 2001). Across child- and family-serving systems there has been increasing attention to meaningful engagement between professional service providers, agency administrators, policy makers, and the families that receive services (Hornberger et al. 2005). Partnerships between agencies and families are changing the form, function, and outcomes of these systems. Moreover, the push toward collaborative and empowering practices is creating new spaces at the table for families in child- and familyserving systems (Sawyer & Lohrback 2005). As a result, families are emerging as a powerful resource in numerous service delivery systems across the human services spectrum (Bossard 2011). These include children’s mental health (Adams et al. 2000; Osher 2005; Osher et al. 1999), public education (Weiss & Stephen 2009), behavioral health (Daniels et al. 2010), public health (Philadelphia Health Management

Corporation 2003; Spencer, Gunter, & Palmisano 2010), child abuse prevention (FRIENDS National Resource Center for CBCAP 2007; Jennings 2002; Jeppson et al. 1997; Parents Anonymous 2005; Polinsky & Polin-Berlin 2001), and, as discussed in this chapter, child protection and child welfare (Anthony et al. 2009; Cohen & Canan 2006; Frame, Berrick, & Knittel 2010; Frame, Conley, & Berrick 2006; Nilsen, Affronti, & Coombes 2009). Although there have been marked improvements, engaging families remains a challenge in public child welfare systems, especially related to engaging fathers, incarcerated parents, and substance-affected families (National Conference of State Legislators 2010). Partnerships with families beyond the case plan present altogether different challenges for child welfare systems that are making the transition from the expertbased models of practice to collaborative ones. An important recent development within child welfare is the emergence of families, with former case histories of their own, in new roles as peer mentors and system change agents (Berrick, Cohen, & Anthony 2011; Bossard 2011; Nilsen, Affronti, & Coombes 2009). This chapter provides a brief overview of the shift in child welfare from the traditional professional-as-expert model to current emerging practices of collaboration and engagement as well as a working definition of meaningful family engagement and its contribution to improved child welfare outcomes. The authors highlight three key areas critical to the success of local efforts to improve family engagement practice: 70

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1. within the case plan, 2. as parent mentors and navigators, and 3. as systems change agents within collaborative decision-making bodies (National Technical Assistance and Evaluation Center for Systems of Care 2010:27–36). These domains of engagement provide solid footing within child welfare agencies on which to establish and build collaborative capacity for partnering with families. The authors, three birth parent leaders and change agents, describe innovative approaches that utilize a shared power and accountability framework between families and child welfare professionals as well as practical strategies for building family-agency partnerships within child welfare agencies. The chapter concludes with recommendations for further study and exploration. Our goal is that this chapter will help agency staff and families partner in more meaningful ways throughout the child welfare system. Once established, collaborative partnerships and meaningful engagement must be systemically, intentionally, and persistently nurtured in order for these practices to become a natural and established part of the organizational culture. Without careful attention, from the frontline to the executive leadership team to the nuances of collaborative practice, the gravitational pull of doing things “the way they have always been done” will inevitably drag efforts back to the status quo. Unfortunately, as a consequence, families may then continue to be disempowered and disenfranchised by the hierarchical relationships implicit in traditional child welfare approaches (Merkel-Holguin 2003). The Changing Landscape in Child Welfare The conventional service model focuses on a family’s deficiencies, to be resolved by the social work professional with the presumed expertise and knowledge to create a case plan for the family. Expert-based models of practice are typically deficit-focused and thereby solidify a hierarchical relationship that imposes a similar structure on the helping process; the

social work professional diagnoses the problem, prescribes a solution, and the family is to do what’s expected of them (Ronnau 2001). In organizational systems where the expert model is primary, the authority and knowledge of the expert is reinforced throughout the system. Consequently, in child welfare the social worker’s knowledge becomes prioritized over the family’s knowledge, resulting in a process that reinforces practices of compliance and deception rather than mutuality, collaboration, and engagement. The imbalance of power in child welfare is exacerbated further by the interlocking sources of authority of the social worker over the family receiving services (Webb 2000). However, the professional-as-expert model is giving way to a more cooperative relationship between social workers and families (DePanfilis & Salus 1992). While there is an expanding evidence base that illustrates the value of family engagement to the achievement of safety, permanency, and well-being for children and youth in care, child welfare agencies struggle to engage families in day to day practice (Altman 2005, 2008; Dawson & Berry 2002). Increasingly, public child welfare agencies are engaging families in new partnerships to strengthen their systems reform efforts as demonstrated by reviews of State Program Improvement Plans developed after the first round of the Child and Family Service Reviews (Munson & Freundlich 2008). However, as families move into these partnerships within child welfare systems, policies and procedures often have not caught up with the practice innovations that brought the families to these new roles (Frame, Berrick, & Knittel 2010; National Technical Assistance and Evaluation Center for Systems of Care 2010). Despite the growing consensus that child- and familyserving systems benefit from the authentic involvement of families as partners in reform efforts, systemic barriers such as no or minimal compensation impede long-term sustainability of agency-family partnerships (Bossard 2011; Horwath & Morrison 2007).

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W H AT W E M E A N B Y M E A N I N G F U L F A M I L Y E N G A G E M E N T A N D W H Y I T M AT T E R S

The very term family involvement is problematic. By introducing “systems thinking” . . . a more relevant and effective framework can be established. This framework suggests that families are already critical participants in the ecosystem that raises and serves children. The task is not to bring families into an arena that they’ve not previously belonged to. The task is to fully recognize and honor the membership they already have—a membership that is absolutely central to the life of the child. Once this membership is acknowledged, the task is simplified. In short, it consists of creating linkages between all the members of the system—between the professionals and the families. Linkages, or “feedback loops,” are basic to the process of optimizing the role of every member of the system. That optimization is key to any system evolving toward its most effective functioning, and to the strength and sustainability of that system. Adams et al. 2000:3

Meaningful family engagement means seeing families, particularly birth mothers and fathers,1 as essential resources and partners, not only in their case but also throughout the child welfare system. Consequently, meaningfully engaging families provides real opportunities for collaborative and authentic inclusion of families’ voices in decision making about services, supports, systemic issues, and policy (Adams et al. 2000). The complexity of the child welfare system from the systems thinking paradigm recognizes that meaningful family engagement will necessarily seek different means and ends at various phases and points of connection within the system. Consequently, family engagement would look vastly different during the investigation and intake than case planning and service coordination phases of connection. Recognizing families as integral parts of the interconnected systems that care for children, even those in foster care,

suggests new possibilities for how meaningful family engagement is conceptualized and implemented throughout the child welfare system. The systems thinking paradigm shifts the focus from “bringing in the families” to strengthening and improving the points of connections between members of the system. Another important reframe that the systems paradigm provides is that it directly challenges traditional notions of power and empowerment. Power within this framework does not originate or end with legitimized authorities, i.e., social workers, supervisors, administrators, in the system. Rather, power is distributed throughout the system and is enacted by multiple members. Empowerment, then, is a mutual process that flows multilaterally between members, in this case, between families and social workers. When applied to the child welfare context, the systems thinking paradigm suggests that empowerment and the helping process are accessed and shared throughout the system by multiple members in any number of ways. The National Technical Assistance and Evaluation Center for Systems of Care (2010:27–36) has conceptualized family involvement across three primary domains of engagement: 1. case, 2. peer, and 3. system. We have used the three domains as a conceptual framework to discuss meaningful family engagement within and beyond the case plan. Meaningful engagement at the case level is actualized through the use of individualized, strengths-based, solutionfocused, family-centered, and family-driven practices, e.g., Family Group Decision Making, Wraparound Services, Team Decision Making, and Child and Family Teams. Said another way, agencies utilize models of practice that implicitly and explicitly assert the equal and interdependent voice of families within the context of the case plan in ways that shift the power dynamic to a dis tributed, shared leadership paradigm (Merkel-Holguin 2003). Within the peer domain, meaningful family engagement utilizes former service recipients

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with their own firsthand experience of the child welfare system to help other families successfully navigate the service system. In child welfare there are a number of emerging models in which birth parents, former child welfare service recipients, fulfill paraprofessional roles as mentors, advocates, navigators, and networkers (FRIENDS National Resource Centre for CBCAP 2013; Rauber 2009). Meaningful family engagement within the systems domain includes families as active and authentic participants in systems improvement activities. Within the systems domain, families may conduct or cofacilitate orientation training for families, train new social workers on engaging families, participate in policy reviews, or facilitate cross-system collaborative workgroups on service improvement. A growing body of research and practice literature suggests that meaningful family engagement in the case, peer, and systems domains contributes to improved outcomes on a number of measures. Jennings (2002) has noted that when families are involved as true partners 1. services are better delivered, more cost effective, and more culturally sensitive; 2. customer satisfaction is improved; 3. the likelihood of positive family outcomes is higher; 4. the system is more responsive; 5. families are better able to use services and help other families; 6. families build skills; 7. communities are healthier as their capacities to better support families are enhanced; and 8. parents model for children ways they can be involved and contribute. Meaningfully engaging families contributes not only to the well-being of the child but also to the well-being of the family and community. We have established the practical and empirical basis for meaningful engagement with families as partners. Now we focus on how child welfare professionals and families

can approach this new terrain of mutuality, empowerment, and collaboration throughout the child welfare system. Partnering with Families: Meaningfully Engaging Families in the Case Plan As child welfare agencies seek to improve outcomes for families, increasing attention must be paid to the quality of the relational connection within day-to-day practice throughout the organization as a whole (Schreiber et al. 2013; Smith 2008; Hartling & Sparks 2008). The increased attention to the relational quality of the engagement practice between social workers and families has implications for what meaningful engagement looks like within the case, peer, and systems domains and how it is carried out. In this section we have included the direct experiences of families and child welfare staff wherever possible to prioritize practical learning and application. “Engagement is about motivating and empowering families to recognize their own needs, strengths, and resources and to take an active role in changing things for the better” (Steib 2004). As Steib aptly points out, engagement goes beyond cursory involvement and compliance. Steib’s description of engagement also suggests that a different set of skills and values are needed to achieve engagement than those used to achieve involvement or compliance. Meaningful engagement is complicated in child welfare by the fact that though some families are voluntarily involved, most families are not (Shireman 2003; Yatchmenoff 2005). The emotions of anger, guilt, and shame that often accompany a family’s experience of child welfare involvement can greatly impede efforts toward engagement (Gopalan et al. 2011; Whipple & Zalenski 2006). The trauma inherent in the functioning of the child welfare system raises important concerns about how to engage the helping process from a systems thinking framework within the context of the case plan (Birrell & Freyd 2006). Birth parents recall what they needed from their social workers:

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Based on your own experience and now your work with child welfare agencies across the country, what would you want prospective or new social workers to know about meaningful family engagement within the case plan? ANGELA: Well, first off, they should understand that for me [in the very beginning], I was in crisis. I was broken and laying there in a million pieces. Therefore, I was pretty angry, mostly at myself, not the social worker, but the only way I knew how to handle it at the time was to blow off and yell. I was mad at me, but I needed to be able to vent a little. I want social workers to remember to meet [the parent] where they are at, and not put us off until we cool down. Don’t stop engaging because of that. DEBBIE: Yeah, it is important for social workers to understand that for some of us we may not have learned any other skills yet to handle our emotions or crisis. For the social worker to be able to handle a venting period is a big help because it can help us normalize the healing process and give an outlet for some deep pain that comes from the guilt and shame when we start to recognize the results of our choices. For some of us parents, especially when substance abuse is a factor, it isn’t until our children are removed that we start to think, ‘It might be me. I might be the problem.’ If that parent has not found recovery yet, social workers should know that denial, lies, and manipulation are a part of the disease of addiction. And, in my work with child welfare social workers, I always tell them, with numbers like 65 to 90 percent of child welfare cases being substance affected, they have to learn more about the disease of addiction and what recovery looks like. ANGELA: The other thing I want social workers to know is that when I do cool down, don’t put a case plan in front of me to sign when you haven’t engaged me. That’s not my case plan. That’s your case plan for me, and I’m already NICOLE:

overwhelmed and don’t know how I’m going to do this. But, here’s the thing, most parents are not going to tell you that they are scared or overwhelmed. They will just keep noddin’ and signin’ because we’ll do anything to get our kids back. DEBBIE: Yeah, I’m happy you said that. It doesn’t matter what we look like on paper, or how bad our addiction is, it’s not that we don’t love our kids, For some of us parents, it’s not that we are trying to be noncompliant. But, sometimes where we come from, like for me if you’d asked me during my active addiction to cut off my right arm for my kids, I would have done it in a minute. But, go to treatment?! I didn’t even think I had a problem. I just want social workers to remember that no matter what’s in the record it has nothing to do with how much we love our kids. Of course, the social worker has to look at safety and risk, but with the disease of addiction as we find recovery we have to learn new skills that we don’t have while in the very beginning. NICOLE: Hearing both of your responses to what you want social workers to know, I am curious to hear what you would want social workers to do. What are the action steps that can promote meaningful engagement within the case plan? DEBBIE: One thing I always tell social workers is that even though they are extremely busy, take the time to fully explain the expectations and responsibilities of the parent. Don’t assume parents know the rules or expectations behind the court order because this is a whole new world to them, They may not know the rules of this world yet. Sometimes some of us have many generations of addiction or poverty or homelessness and what you are asking of us we don’t know all the background. So I tell social workers to make sure to explain things in as much detail as possible and ask the parents if they have questions a lot because it can take a long time to have the trust where the parent will

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ask something they don’t know. One thing with that trust piece, be real honest and upfront about what will be in the case record before you get in front of the judge. A parent can feel so betrayed when they haven’t heard something from their social worker, especially something that’s bad, until they are in court. ANGELA: What I would say to social workers is sometimes it’s the simple things. Like, you know, return a phone call from your family. When we step out of that office and try to navigate those court-ordered services, we’re on our own. That social worker isn’t there. Nobody is but the parent. So, when you get a phone call from that Mom or Dad, or you said you would do something, follow through. And, when you can’t, let the parent know what’s happening. Basically, treat that parent how you would want to be treated if you were on the other side trying to put your life back together. DEBBIE: There’s one more thing I want to say about what social workers can do. You know, it’s real important to remember to think about how your words can impact a family. I like to tell social workers to do random acts of affirmation and acknowledgment for parents. Those words and acts of encouragement go a long way as we move through all the services and do our healing. In my own case, my social worker attended my one-year anniversary of being clean and sober. That meant a lot to me, for her to see my progress in such a positive way. Beyond the emotional overloads on both sides of the desk, there is another issue that requires careful attention particularly within the case level: social worker power and authority within the context of the helping relationship. There are several ways that the power of the social worker over the family receiving child welfare services is reinforced within the organizational structure of the child welfare system: 1. access to needed services; 2. “law and

legal powers pertaining to social workers,” e.g., the right to remove children at risk from their parents’ custody; 3. the respect and deference given to those in authority and to those who are educated and can speak and use language well; and 4. recognition of “‘professional’ status” (Webb 2000:paragraph 7; Juhila et al. 2003). All these sociostructural processes are sitting at the desk right along with the social worker and the parent with every phone call, face-to-face meeting, and court appearance. The sociostructural dynamics of imbalanced power and authority are present whether the case plan was created collaboratively or without the partnership of the family. No matter how skillful the social worker is and how willing the family members are to mutually engage the case planning and management process, the dynamics related to the social worker’s power and authority are embedded within the helping process and within the service delivery system; this dimension of the worker-family relationship raises important considerations for practice (Smith 2008). Namely, what do social workers need to know as they come to the table with families? The responses of Ms. Conway and Ms. Braxton provide several practical strategies that create and strengthen opportunities for authentic engagement. The strategies presented are not intended to be comprehensive; there is a robust and expansive practice literature on improving the social worker-family engagement skills (de Boer & Coady 2007; Drake 1996; Gockel, Russell, & Harris 2008; Saint-Jacques et al. 2006; Smith 2006). Rather, we here put on offer a short list of strategies that can be incorporated into existing program models, workflow routines, and supervisory practices. Beyond issues of feasibility and application, we also wanted to prioritize the voice of family leaders, particularly birth mothers and fathers, who have taken their own experiences within the child welfare system and strategically use them as foundational learning tools to improve practice in child welfare. This is an important

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E N G A G E M E N T S T R AT E G I E S F O R T H E SOCIAL WORKER TOOLKIT

Learn more about grief and loss in the change process Don’t underestimate the power of shame, grief, and hopelessness to impede or halt altogether the family’s engagement with the social worker and with case plan objectives. Likewise, expanding social worker knowledge of the impact of substance abuse disorders is also crucial to effective engagement with substance-affected families. The most simple things can make the greatest impact Random acts of acknowledgment that are parentoriented not child-oriented, that are true and authentic, can provide a needed boost of confidence or a glimmer of hope that things can get better and that Mom or Dad are on the right track. Remember, the system is full of unknowns for most families, and knowing that she or he is moving in the right direction can be of great encouragement and reassurance. Follow up and follow through Do what you say or at least communicate honestly with the family when you can’t. This is an important modeling behavior for families, but it also helps to equalize the helping relationship in which accountability is essential, i.e., the social worker explicitly embraces being accountable for her part of the case plan as much as the family is expected to do the same. Be honest and direct without being cruel Take the time to explain things clearly without sugarcoating to parents so that they can be informed consumers and decision makers regarding their family. For example, don’t assume that families understand all the spoken and unspoken expectations related to court-ordered services.

distinction, as the trauma of child welfare involvement can be significant for families. Finding ways to give back that also support continued growth and healing is essential for

family leaders and advocates in child welfare (Bossard 2011). Engaging Parents Beyond the Case Plan: Parents as Partners We are parents whose children were removed from our care due to allegations of abuse or neglect. We are parents who have worked hard to regain custody of our children. We are parents who understand what it takes to get through these difficult times. We are parent partners. —Clark County Parent Partner Program Brochure

An exciting innovation that is gaining increased attention in child welfare is the development of peer support programs that pair families with former case histories with families with a child or children placed in foster care (Child Welfare Organizing Project 2006; Casey Family Programs 2008; Nilsen, Affronti, & Coombes 2009; Rauber 2009; Frame, Berrick, & Knittel 2010; National Technical Assistance and Evaluation Center for Systems of Care 2010). We will briefly focus on the following elements of peer support programs for families: 1. What do families typically do in this peer support role? 2. What are the common structural elements of peer support program models emerging in child welfare? 3. What agency supports are needed for longterm sustainability of peer support programs for families? A review of the research and practice literature reveals an interesting lexicon surrounding family-driven peer support programs in child welfare. Programs have included Family Coaches (National Technical Assistance and Evaluation Center for Systems of Care 2010), Parent Partners (Anthony et al. 2009), Parent Advocates (National Resource Center for Permanency and Family Connections 2011(1); Parent Mentors (Taylor et al. 2010), Veteran Parents

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(Nilsen, Affronti, & Coombes 2009), Family Leaders (National Technical Assistance and Evaluation Center for Systems of Care 2010), and Parent Leaders (Bossard 2011). We use the designation parent mentors throughout this section to refer to family members in peer support roles. Within the expanding list of parent mentor programs, the core guiding principle is that “having walked in someone else’s shoes makes a person uniquely able to connect, support, and inspire” (Taylor et al. 2010:20). Two key elements are embedded within this description: 1. the central focus on the helping and healing capacity of the life experience of someone “who’s been there” (Cohen & Canan 2006) and 2. the use of one’s lived personal experience to engage families and to inspire hope and change in families (Bossard 2011). The essential thread that connects peer support programs is that the parent mentor has had his own experience within the child welfare system and, related to that, has learned how to use that experience to help other families successfully navigate the complexities of the child welfare system and services required for reunification (Rauber 2009, 2010; Taylor et al. 2010). It is worth noting that for some programs the role of parent mentor includes helping families understand and navigate the termination of their parental rights (National Technical Assistance and Evaluation Center 2010; Bossard 2011). The parent mentor’s shared life experience becomes the foundation for a deep level of trust, willingness to engage the case plan and the broader system of supports, and ultimately builds the confidence of parents currently involved in the child welfare system that change in possible. Parent mentors become adept at using their own experiences with the child welfare system to support and assist other families. Indeed, a critical role of a parent mentor is helping parents believe that they can change. Parent mentors work alongside families in the child welfare system and learn to share their life experiences as a living textbook for the process of change. Parent mentors also become

a positive social support for a mom or dad who may have lost contact with kin long ago. The positive connection is particularly important with substance-affected families for whom isolation can be an impetus to abuse substances (Akin & Gregoire 1997). The goals of the parent mentor’s support can be clustered around the several central aspects of the service experience in child welfare: t
increased understanding of what is happening at each stage in the process; t
developing skills in self-empowerment, communication, and advocacy; t
assistance in navigating through the system and accessing services successfully; t
mentoring and guidance on integration of new knowledge and life skills; t
managing relationships with the multiple service providers, child welfare agency staff, and court professionals that families encounter as they work the case plan; t
and, perhaps most importantly, the peer supports offer encouragement, hope, and inspiration to the family. The support that parent mentors provide is also very practical. For example, parent mentors in Contra Costa County, California provide public transportation training with families (National Technical Assistance and Evaluation Center 2010). The public transportation training supports a family by enhancing the family’s ability to engage services, but, beyond that, it gives families a skill that will serve their needs more broadly, i.e., transport to work, healthy activities with their children, and accessing other needed community resources. In addition to helping a family understand the process, parent mentors also typically work closely with social workers to provide greater insight and clarity into the ways that families sometimes experience the system as well as how family members might be inclined to handle it, i.e., not following through on case goals and objectives, relapse, ineffective coping, or

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communication strategies, etc. Consequently, parent mentors help to establish crucial bridges of understanding between the family, the social worker, court staff, and service providers (Bossard 2011). For example, in Vancouver, WA, parent mentors helped to create an informational program, the “Here’s The Deal” class, in which all the partnering systems that families encounter while involved with the Department of Child and Family Services meet with families to explain their respective roles throughout the duration of the case (Marcenko et al. 2010). As parent mentor programs continue to grow across the country, there is a growing evidence base that is catching up, but slowly. As an emerging area of practice in child welfare, much of the early evidence is exploratory and descriptive. However, researchers have begun to examine the connections between services provided by parent mentors and the impact of these services on child welfare outcomes, particularly reduction in children’s length of stay in care and rates of placement reentry following family reunification. To illustrate, an independent evaluation of Contra Costa County’s (California) parent mentor program revealed that 62 percent of children whose parents were served by a peer mentor reunified with their parents within eighteen months of their entry into legal custody compared to 37 percent of children whose parents did not have a parent mentor (National Technical Assistance and Evaluation Center for Systems of Care 2010). The Child Welfare Organizing Project in New York City is also demonstrating impressive preliminary results: “over 70% of participants who had children in foster care at the point of enrollment [in the CWOP Parent Leadership Curriculum] had regained custody by completion of the curriculum” (Lalayants 2012) Although preliminary, these early evaluative results suggest that parent mentors provide an important support that has the potential to improve child welfare outcomes. “With a new program like this you have to build it.” —Valerie Earley, director, Child and Family Services Director, Contra Costa County, CA

Parent mentor programs in child welfare are generating very encouraging results, but such results don’t just happen. As the quote indicates, agencies must thoughtfully build the necessary infrastructure and supports for parent mentor programs to produce the intended outcomes. As with any new program, agencies benefit from taking a comprehensive, systemic approach to planning and implementing a parent mentor program. A comprehensive approach might include, for example, engaging families to get feedback on existing services; hosting facilitated forums between families and staff to begin the trust building and collaborative team design of what a local parent mentor program should include; identifying training needs of families and agency staff; and reviewing and, where indicated, revising policies to support a parent mentor program and identify a strategy for funding parent mentors. In establishing a parent mentor program, an agency must attend to a number of issues: securing the endorsement of agency leadership endorsement and support, identifying hiring criteria for parent mentors, developing strategies for recruitment and training of parent mentors, clarifying roles and responsibilities of parent mentors with child welfare and court staff and developing working guidelines for the parties, developing adequate staff support and supervision for the parent mentors, and establishing a resource for compensating parent mentors. In short, it is not sufficient to bring parents to the table and expect that their own family’s successful reunification will prepare them to become a successful parent mentor. Child welfare administrators and program managers must be attentive to the needs of the parents who will provide parent mentoring (National Technical Assistance and Evaluation Center for Systems of Care 2011). It is beyond the scope of this chapter to outline in detail the steps for building parent mentor programs. However, we have assembled a list of resources at the conclusion of this chapter that agency staff can access for additional guidance.

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Meaningfully engaging families in the parent mentor role represents a unique opportunity for authentic engagement between social workers and families. Expanding child welfare services to include parent mentors and integrating parent mentors into the helping process alongside social workers, as equal partners, reflects the values of mutuality, empowerment, and collaborative practice. In addition, seeing parent mentors “on the floor” in this new capacity inspires and rejuvenates not only the families but also the agency’s social work staff (National Technical Assistance and Evaluation Center for Systems of Care 2011). Despite the advantages to establishing a parent mentor program, there may be concerns among agency and court staff about working with parents in this new shared power paradigm. Social workers may have legitimate questions and concerns about having to communicate with yet another “partner” involved the lives of the families on their caseload (National Technical Assistance and Evaluation Center 2011). These and other concerns may emerge as agency staff and parent mentors acclimate to a new relationship: from us and them, helper and helpee, to a collaborative partnership of equals.

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with families. A solid program will include adequate training for parent mentors on the child welfare system, maintaining healthy boundaries with families, and calendaring and time management and other professional development training. Parent mentors will be prepared for their job. However, they should not be expected to be minisocial workers. A good parent mentor is clear that she is not, nor does she want to be, the family’s social worker. Look for ways to share power Remember that what families bring to the helping process is as valid and important as what agency staff bring. Also, it is important for agency staff to remain open to the critique families may have of the system and its policies. Though it may initially be uncomfortable, working through such discussions as a team will strengthen the effectiveness of both social workers and parent mentors. Give it time Laying the groundwork for an agency parent mentor program infrastructure can take some time. It is not useful or realistic to expect that everything will run without a hitch. It’s child welfare. There are necessary learning curves associated with the implementation of any new program. However, as a social worker, if you have concerns, don’t hold on to them. Instead, participate in the initial brainstorming and program development phase of the parent mentor program.

SOCIAL WORKER TOOLKIT

Be mindful of personal/professional biases about parents When entering into a collaborative partnership it is helpful to be aware of any personal/professional assumptions that may negatively impact the partners’ ability to work together. For example, continuing to see families with case histories based on their past involvement with the child welfare agency is likely to impede one’s ability to develop an effective partnership with parent mentors. Don’t expect parent mentors to function like social workers Parent mentors have their own expertise, skills, and knowledge base from which to draw as they work

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For families and professionals to work together as equal partners, we have to stop dividing the world into “helpers” and “helpees,” as though these represented two different species. It is time to acknowledge that stressors like substance abuse, loss, illness, divorce, and mental illness occur in the lives of professionals as well as the lives of clients. They, too, can have . . . problems [that place their children at risk]. We all are subject to the human condition and all have the same needs for comfort and hope when we are struggling. Adams et al. 2000

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As public child welfare agencies continue the difficult work of systems reform and improving outcomes, families are becoming a powerful constituency for change. Like no one else at most decision-making tables, families know firsthand what the service experience really is, not what the theoretical frameworks or policies and procedures say it should be. However, families that become systems change agents and leader-partners in child welfare have the unique experience of walking on both sides of the street: the helpee and the helper. Families often bring a level of passion for the system and its improvement that is unparalleled. Families also bring the force of truth that reminds all of us that we are, in fact, “subject to the human condition” (Adams et al. 2000). Families help professionals “keep it real” when they remind us where agency practice falls short or is inconsistent. Likewise, they are in the perfect position to tell us where the system and staff are doing great work. However, if there is no systemic expectation for families to participate fully at the decision-making tables, agency professionals miss the invaluable experience and insight families can bring. “We need you at this meeting.” The statewide collaborative coordinator, Ray, has finalized the meeting agenda, secured a commitment to attend from other state and provider agencies, but there’s just one final detail that’s missing as he reviews the invitation list—where’s the family voice? Realizing the missing link, Ray quickly scrambles through a stack of old meeting minutes looking for the name of that parent who shared her story at the last meeting. The coordinator e-mails the parent, Pat, informing her about all the meeting details, and follows up with a phone call since the meeting is next week. Pat receives Ray’s e-mail and is excited about participating in this follow-up meeting. However, she notices that the meeting is scheduled for 10:00 A.M. next Wednesday, which conflicts with her work schedule. With time so short, she thinks it might still be possible to get a coworker to switch shifts, and since the meeting is during school time she thinks she can make child

care work if she can get her mother to watch her son for a couple of hours after school. As Pat continues to work out the details of her schedule with her coworkers and supervisor, she calls Ray to tell him that she’s excited about participating and will do her best to get everything handled so that she can attend the meeting. However, with the meeting at the state office building, Pat will need to commute two hours each way. When she mentions this to Ray, and asks about help to cover gas, Pat is told that there’s no budget to reimburse collaborative members for committee work. She then asks if there’s a stipend that can offset the gas she’ll expend traveling to and from the meeting. Again, Ray reiterates how important her voice is at these meetings and tells Pat, “we really need you at this meeting, but that there is no budget for a stipend or mileage for community volunteers.” Excepted from National Resource Center for Permanency and Family Connections 2011

The excerpt provides a typical experience of how families are invited to participate at the systems level. Though there seems to be great enthusiasm for family participation, there is not always the planning necessary to make family engagement truly collaborative or meaningful. For example, Ray hadn’t considered the layered costs of Pat’s attendance. There was no mechanism for her to offset the expense of her invested time and energy. Every other professional attending at the collaborative meeting is being paid as a part of their job responsibility to be there. However, for Pat there is not even so much as a gas stipend. The cautionary note here is that as child welfare agencies continue partnering with families in innovative ways, staff must ensure that policies and procedures keep pace in ways that support mutual, collaborative partnerships, e.g., maintaining a budget line item from which to reimburse and pay for family’s time when working on behalf of the agency on collaborative initiatives. Likewise, having a dedicated staff person who can field questions from the family as they prepare for the meeting is key.

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In some instances, family members may not have experience attending business meetings and may need a primer so that they are adequately prepared to be full participants (National Resource Center for Permanency and Family Connections 2011). Publicly and privately funded systems reform initiatives have expanded in recent years, and nearly all explicitly identify consumer involvement in decision making as an essential component (Horwath & Morrison 2007). However, it is not sufficient to solicit feedback and input; true consumer involvement requires that families become a part of determining how the system will function. It is not enough for child welfare agencies to extend the meeting invitation. Social work professionals and families have to be willing to engage in new levels of accountability, relational accountability (Bossard 2011). It is also important to help families feel at ease and prepared to participate. For example, the Family Engagement Supervisor of the Contra Costa County Parent Partner Program will call the meeting contact person to gather the details for a meeting that Parent Partners have been asked to attend, i.e., meeting location, available parking, advanced copy of the agenda, what is expected of the Parent Partner, will there be follow-up, what’s the dress code for the meeting, etc. (National Technical Assistance and Evaluation Center for Systems of Care 2010). These types of questions reflect a level of respect that can support long-term engagement of families within the systems domain. The actions of the Family Engagement Supervisor also remind us of the value of the role of someone who can identify and translate the written, spoken, and unspoken expectations associated with families’ participation in the agency decision-making process. This is very similar to what parent mentors do between service recipients and social workers—make evident the invisible infrastructure that creates and maintains meaningful engagement throughout the system.

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Always invite more than one family member to large meetings Being the lone voice at the table can be intimidating for families new to this arena of participation. Be thoughtful about how to support the long-term engagement of families Take the time to make sure that families have all the information they need to be effective, but also provide the name of a person who can be contacted with additional questions. As in the other domains of engagement, it is important to establish a comfort level that encourages inquiry and participation. Respect the family member’s time Devise a way to honor the contributions of families to the child welfare agency and system through compensation and reimbursement for expenses. Remember, if families are not employed by the state or local child welfare agency as employees or contractors, they are not being paid to be there and, in some cases, they are losing money for their participation, e.g., taking time away from work, travel expenses, and child care. In short, make it manageable for families to participate. Be open to family feedback By bringing families to participate at this level, be prepared for agency staff to hear comments that may make some uncomfortable. However, if the goal is to improve systems and outcomes, it will be important to take the feedback from families seriously and look for ways to demonstrate that families have been heard.

In efforts to build a collaborative culture in which meaningful family engagement is the status quo, it is necessary to establish organizational spaces for direct, respectful, shared engagement with all stakeholder partners within the system, including families (Lasker &

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Weiss 2003; Bushe 2006). We cannot assume that extending an invitation for family members to speak or conducting focus groups with families to access their feedback and ideas will achieve meaningful or collaborative engagement. We would do well to make room for the presence and partnership of families as empowered equal participants rather than perpetuate an underlying tokenism in which families are treated as an afterthought. Reframing our understanding of what “system” means helps us reconceptualize engagement in a more meaningful way for families and agency staff. YYY

As agencies continue to develop partnerships with families throughout the child welfare NOTE

1. Throughout this chapter, the authors have focused specifically on engaging birth parents, mothers and fathers, as partners throughout the child welfare system. Family engagement certainly expands beyond birth parents, i.e., children, youth, foster and adoptive parents. However it has often been the case that birth parents have been considered secondarily in child welfare and often experience a level of stigma for child welfare involvement to which other service users are not subjected (Mizrahi, Lopez Humphreys, & Torres 2009).

REFERENCES

Adams, J., Biss, C., Burrell Mohammad, V., Meyers, J., & Slaton, E. (2000). Family-professional relationships: Moving forward together. Alexandria, VA: National Peer Technical Assistance Network’s Partnership for Children’s Mental Health. Akin, B., & Gregoire, T. (1997). Parents’ views on child welfare’s response to addiction. Families in Society: The Journal of Contemporary Human Services, 78, 393–404. Altman, J. (2003). A qualitative examination of client participation in agency-initiated services. Families in Society: The Journal of Contemporary Human Services, 84, 471–79. Altman, J. (2005). Engagement in children, youth, and family services: Current research and promising approaches. In G. Mallon & P. Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 72–86). New York: Columbia University Press.

system, there are new frontiers in practice and research that promise great benefit to the field. Among them are a comprehensive review and dissemination of practice approaches and peer mentor models; the development of mechanisms to finance parent mentors; continued research on the impact of parent mentor programs on child welfare outcomes related to safety, permanency, and well-being; more resources written or coauthored by parent mentors available to families receiving child welfare services and in the literature; explorations into the kinds of supports that parent mentors need to have longevity in this work (i.e., the impact of secondary trauma on parent mentors); and continued exploration into the impact of partnering with parent mentors on social worker job satisfaction and workload. Altman, J. (2008). Engaging families in child welfare services: Worker versus client perspectives. Child Welfare, 87, 41–61. Anthony, E., Berrick, J., Cohen, E., & Wilder, E. (2009). Partnering with parents: Promising approaches to improve reunification outcomes for children in foster care. Berkeley: Center for Social Services Research. Berrick, J. D., Cohen, E., & Anthony, E. (2011). Partnering with parents: Promising approaches to improve reunification outcomes for children in foster care. Journal of Family Strengths, 11 (1). Birrell, P., & Freyd, J. (2006). Betrayal trauma. Journal of Trauma Practice, 5, 49–63. de Boer, C. & Coady, N. (2007). Good helping relationships in child welfare: Learning from stories of success. Child and Family Social Work, 12, 32–42. Bossard, N. (2011). Enough hope to spare: The transformative experience of birth parents as leaders in child welfare. Ph.D. diss., Seattle, WA: Antioch University. Braxton, A. (2006). A woman with an issue: A mother’s memoir of addiction, loss, redemption and recovery. Charleston, NC: Advantage. Brown, D. (2006). Working the system: Re-thinking the institutionally organized role of mothers and the reduction of risk in child protection work. Social Problems, 53, 352–70. Bruner, C. (1991). Thinking collaboratively: Ten questions and answers to help policy makers improve children’s services. Washington, DC: Education and Human Services Consortium. Bushe, G. (2006). Sense making and the problems of learning from experience: Barriers and requirements

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for creating cultures of collaboration. In S. Schuman (ed.), Creating a culture of collaboration: The International Association of Facilitators handbook (pp. 151– 72). San Francisco: Jossey-Bass. Child Welfare Organizing Project (2006). A parent leadership curriculum: Developing the potential of parents as advocates, organizers, and a positive force for public child welfare reform. New York: Author. Chrislip, D. (2002). The collaborative leadership fieldbook: A guide for citizens and civic leaders. San Francisco: Jossey-Bass. Chrislip, D., & Larson, C. (1994). Collaborative leadership. San Francisco: Jossey- Bass. Cohen, E., & Canan, L. (2006). Closer to home: Parent mentors in child welfare. Child Welfare, 85, 867–84. Dale, P. (2004). “Like a fish in a bowl”: Parents’ perceptions of child protection services. Child Abuse Review, 13, 137–57. Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., & Goodale, L. (eds). (2010). Pillars of peer support: Transforming mental health systems of care through peer support services. Available at www.pillarsofpeersupport.org. Dawson, K. & Berry, M. (2002). Engaging families in child welfare services: An evidence-based approach to best practice. Child Welfare, 81, 293–317. DePanfilis, D., & Salus, M. (1992). Child protective services: A guide for caseworkers. McLean, VA: National Center on Child Abuse and Neglect. Diorio, W. (1992). Parental perceptions of the authority of public child welfare workers. Families in Society: The Journal of Contemporary Human Services, 73, 222–35. Drake, P. (1996). Consumer and worker perceptions of key child welfare competencies. Children and Youth Services Review, 18, 261–79. Dumbrill, G. (2006). Parental experience of child protection intervention: A qualitative study. Child Abuse and Neglect, 30, 27–37. Forrester, D., Kershaw, S., Moss, H., & Hughes, L. (2008). Communication skills in child protection: How do social workers talk to parents? Child and Family Social Work, 13, 41–51. Frame, L., Berrick, J., & Knittel, J. (2010). Parent mentors in child welfare: A paradigm shift from traditional services. Helping Professionals Help Families Affected by Drugs and/or HIV, 20, 2–5. Frame, L., Conley, A., & Berrick, J. (2006). The real work is what they do together: Peer support and birth parent change. Families in Society: The Journal of Contemporary Human Services, 87, 509–20. FRIENDS National Resource Center for CBCAP (2007). Parent engagement and leadership: Factsheet #13; retrieved from http://www.slocap.org/pages/ PSLTA-FRIENDSfactsheet.pdf. FRIENDS National Resource Center for CBCAP (2010). Meaningful parent leadership: A guide for success. Chapel Hill, NC: FRIENDS National Resource

Center for CBCAP; retrieved from http://www. friendsnrc.org. FRIENDS National Resource Centre for CBCAP (2013). Implementing Systems Change. Chapel Hill, NC: FRIENDS National Resource Centre for CBCAP. Retrieved from www.friends.org. Gockel, A., Russell, M., & Harris, B. (2008). Recreating family: Parents identify worker-client relationships as paramount in family preservation programs. Child Welfare, 87, 91–112. Goldman, J., Salus, M., Wolcott, D., & Kennedy, K. (2003). A coordinated response to child abuse and neglect: The foundation for practice. Washington, DC: National Clearinghouse on Child Abuse and Neglect Information. Gopalan, G., Bannon, W., Dean-Assael, K., Fuss, A., Gardener, L., LaBarbera, B., & McKay, M. (2011). Multiple family groups: an engaging intervention for child welfare-involved families. Child Welfare, 90, 135–56 Hartling, L. (2008). Strengthening resilience in a risky world: It’s all about relationships. Women & Therapy, 31, 51–70. Hartling, L., & Sparks, E. (2008). Relational-cultural practice: Working in a non-relational world. Women & Therapy, 31, 165–88. Hornberger, S., Gardner, S., Young, N., Gannon, N., & Osher, T. (2005). Improving the quality of care for the most vulnerable children, youth, and their families: Finding consensus. Washington: Child Welfare League of America Press. Horwath, J., & Morrison, T. (2007). Collaboration, integration and change in children’s services. Child Abuse & Neglect, 31, 55–69. Jennings, J. (2002). Parent leadership: Successful strategies. January; retrieved from http://www.friendsnrc. org/download/parent_leader_strategies.pdf. Jeppson, E, Thomas, J., Markward, A., Kelly, J., Koser, G., & Diehl, D. (1997). Making room at the table: Fostering family involvement in the planning and governance of formal support systems. Facilitators guide. Chicago: Family Resource Coalition of America. Juhila, K., Pösö, T., Hall, C., & Parton, N. (2003). Introduction: Beyond a universal client. In C. Hall, K. Juhila, N. Parton, & T. Poso (eds.), Constructing clienthood in social work and human services: Interaction, identities and practices (pp. 11–26 ). London: Jessica Kingsley. Lalayants. M. (2012). Child Welfare Organizing Project: Program Evaluation Community Connections. New York: National Resource Center for Permanency and Family Connections. Lasker, R. D., and Weiss, E. S. (2003). Broadening participation in community problem-solving: A multidisciplinary model to support collaborative practice and research. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 80, (1), 14–47.

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McGlade, K., & Ackerman, J. (2006). A hope for foster care: Agency executives in partnerships with parent leaders. Journal of Emotional Abuse, 6, 97–112. Marcenko, M., Brown, R., DeVoy, P., & Conway, D. (2010). Engaging parents: Innovative approaches in child welfare. Protecting Children, 25, 23–34. Merkel-Holguin, L. (2003). Promising results, potential new directions: International FGDM research and evaluation in child welfare. Protecting Children, 18, 1. Milner, J. (2003). Changing the culture of the workplace. Closing plenary session, Annual Meeting of State and Tribes. January 29; retrieved from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/ changing_culture.htm. Milner, J., Mitchell, L., & Hornsby, W. (2005). Child and family services reviews: An agenda for changing practice. In G. Mallon & P. McCartt Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 707–18). New York: Columbia University Press. Mizrahi, T., Lopez Humphreys, M., & Torres, D. (2009). The social construction of client participation: The evolution and transformation of the role of service recipients in child welfare and mental disabilities. Journal of Sociology & Social Welfare, 36, 35–61. Munson, S., & Freundlich, M. (2008). Families gaining their seat at the table: Family engagement strategies in the first round of child and family services reviews and program improvement plans. Englewood, CO: American Humane Association. National Conference of State Legislators. (2010). State actions to promote healthy communities. Washington, DC: Author. National Resource Center for Permanency and Family Connections (2011). Permanency Planning Today. New York: Children’s Bureau. Available at http:// www.nrcpfc.org/newsletter/ppt-winter-2011.pdf. National Technical Assistance and Evaluation Center for Systems of Care (2007). A closer look: Family involvement in public child welfare driven systems of care; retrieved from www.childwelfare.gov/pubs/ acloserlook/familyinvolvement/. National Technical Assistance and Evaluation Center for Systems of Care (2010). Family involvement in the improving child welfare outcomes through systems of care initiative. Washington, DC: Children’s Bureau. Available at www.childwelfare.gov/management/reform/ soc/communicate/initiative/evalreports/reports/ FamilyInvolvement_Report.pdf. National Technical Assistance and Evaluation Center for Systems of Care (2011). Family engagement in child welfare video series. Washington, DC: Children’s Bureau. Available at http://www.childwelfare.gov/management/ reform/soc/communicate/initiative/familyvideos/. Nilsen, W., Affronti, M., Coombes, M. (2009). Veteran parents in child protective services: Theory and implementation. Family Relations, 58, 520–35.

Osher, T. (2005). Collaboration for family-driven systems and services. In S. Hornberger, S. Gardner, N. Young, N. Gannon, & T. Osher (eds.), Improving the quality of care for the most vulnerable children, youth, and their families: Finding consensus (pp. 51–62). Washington, DC: CWLA. Osher, T., deFur, E., Nava, C., Spencer, S., & Toth-Dennis, D. (1999). New roles for families in systems of care. In Systems of care: Promising practices in children’s mental health (vol. 1). Washington, DC: Center for Effective Collaboration and Practice, American Institutes for Research. Parents Anonymous. (2005). Pathways to meaningful shared leadership; retrieved from http://www.parentsanonymous.org/paTEST/publications1/ Pathways_ Final_sm.pdf. Pecora, P.J., Reed-Ashcraft, K.B., & Kirk, R.S. (2001) Family-centered services: A typology, brief history and overview of current program implementation and evaluation challenges. In E. Walton, P. A. Sandau-Beckler, & M. Mannes (eds.), Setting direction for family-centered services in child welfare into the twenty-first century: Theory, practice, policy, and research. New York: Columbia University Press. Polinsky, M., & Polin-Berlin, L. (2001). Research on parent leadership: Significance and findings. Research profile number 2; retrieved from http://www.parentsanonymous.org/paTEST/publications1/PA_ResearchProfilePur ple05.pdf. Rauber, C. (2009). Fixing families: Parents, power, and the child welfare system. New York: Routledge. Ronnau, J. (2001). Values and ethics for family-centered practice. In E. Walton, P. Sandau-Beckler, & M. Mannes (eds.), Balancing family-centered services and child well-being: Exploring issues in policy, practice, theory, and research (pp. 34–54). New York: Columbia University Press. Russell, M., Harris, B., & Gockel, A. (2008). Parenting in poverty: Perspectives of high- risk parents. Journal of Children and Poverty, 14, 83–98. Saint-Jacques, M., Drapeau, S., Lessard, G., & Beaudoin, A. (2006). Parent involvement practices in child protection: A matter of know-how and attitude. Child and Adolescent Social Work Journal, 23, 196–215. Sawyer, R., and Lohrback, S. (2005). Differential response in child protection: Selecting a pathway. Protecting Children, 20 (2, 3), 44. Schreiber, J., Fuller, T., & Paceley, M. (2013). Engagement in child protection services: Parent perceptions of worker skills. Children and Youth Services Review, 35, 707–15. Shireman, J. (2003). Critical issues in child welfare. New York: Columbia University Press. Smith, B. (2008). Child welfare service plan compliance: Perceptions of parents and caseworkers. Families in Society: The Journal of Contemporary Social Services, 89, 521–31.

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Weiss, H. & Stephen, N. (2009). From periphery to center: A new vision for family, school, and community partnerships; retrieved from http://www.hfrp. org/family-involvement/publications-resources/ from-periphery-to-center-a-new-vision-for-familyschool-and-community-partnerships. Whipple, C., & Zalenski, J. (2006). The other side of the desk: Honoring diverse voices and restoring effective practice in child welfare and family services. Learning tool 9. January; retrieved from http://www.friendsnrc.org/download/diverse_voices.pdf. Yatchmenoff, D. (2005). Measuring client engagement from the client’s perspective in non-voluntary child protective services. Research on Social Work Practice, 15, 84–96.

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Engaging Latino Families

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ngaging Latino families involved in the child welfare system requires the planning and delivery of an array of comprehensive and culturally competent services and programs. The lack of knowledge of the cultural needs, values, and strengths of these families often leads to assumptions and misconceptions that can weaken the quality of services. That system must have culturally competent child welfare practitioners who are committed to working actively with these families to achieve safety, stability, and permanency planning for children and youth. Moreover, we all have to come together through collaborations involving our local communities, academia, private and nonprofit organizations, and government to assess the child welfare system’s readiness to engage Latino children and youth and their families and its effectiveness in serving them. While Latino communities share many characteristics and values, they are diverse in terms of race, national origin, language, religion, educational background, socioeconomic factors, traditions, lifestyles, immigration experiences, and citizenship status, among others. Acknowledging diversity within the Latino population represents a step in the right direction, but will itself not lead to a more culturally responsive practice. Child welfare practitioners and managers need to build on this recognition and emphasize the importance of expanding their knowledge and skills for planning and implementing culturally competent services that could address the needs and strengths of this population. The task brings serious challenges,

undoubtedly, that require a degree of selfawareness, receptivity, and openness as well as the willingness to find and support innovative ways to reach out to the Latino community and engage them to work collaboratively toward the safety, stability, and welfare of its children and youth. This chapter discusses guidelines for developing a culturally competent practice in the child welfare system, focusing on work with Latino families in their communities. First, a sociodemographic overview of the Latino populations living in the United States is presented, followed by a discussion of their cultural values and assets. The chapter then outlines the main components of a cultural competence model, proposing this approach as a practice to engage Latino families in a meaningful way that values and appreciates the richness and diversity of their culture. Hopefully, it will promote critical thinking and an open dialogue about the implications for developing a culturally competent practice in child welfare organizations. Sociodemographic Overview Latinos are the largest and fastest growing ethnic group in the United States. According to the 2010 Census, 50.5 million individuals, comprising 16 percent of the United States population, self-reported being of Hispanic or Latino origin. This suggests a growth of 15.2 million Latinos in the past decade, accounting for more than half the total population growth in the United States. Most Latinos reported living in the states of Arizona, California, Colorado, 86

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Florida, Illinois, New Jersey, New York, and Texas, but there was considerable population growth in every state, notably in Arkansas, Georgia, Nebraska, Nevada, North Carolina, and Tennessee (U.S. Census Bureau 2010). The term Latino is typically used to refer to all people who live in the United States and share a common Latin American ancestry, with sets of accompanying characteristics and values. Importantly, the term does not denote race, as Latinos may be of any racial and ethnic background. Geographically, Latinos are associated with individuals and families that come from over nineteen different countries, including Argentina, Bolivia, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela. According to the 2010 Census, the three largest Latino subgroups in the U.S. are Mexicans, which account for 31.8 million, followed by Puerto Ricans and Cubans. Growing rapidly are other immigrant groups that have come from countries in Central and South America. Within Latino families the Spanish language, culture, and traditions are usually cherished and transmitted from generation to generation (Delgado 2007). Nevertheless, the language spoken at home may vary depending on each family’s country of origin and linguistic region (Zuniga 2001). For example, some Latinos speak Quechua, which is an indigenous language spoken by large numbers of people in South American countries. Moreover, Spanish may be spoken as a first language or as a second language or may not be spoken at all in the home. Religious practices may also vary. While many Latinos are thought to be Roman Catholics, many families identify themselves as Christians, Jews, Jehovah’s Witnesses, and Pentecostals, among other religious affiliations. Furthermore, a significant number of Latinos practice rituals influenced by their African and/or indigenous heritage and beliefs such as Santería and Espiritismo (Negroni-Rodríguez &

Morales 2001). Likewise, there are Latinos who are spiritual, but are not religious. Immigration experiences and citizenship status vary among Latino families. Although immigration and citizenship status tend to be wrongly assumed (i.e., noncitizen) by the individual’s appearance, socioeconomic background, language proficiency, and/or speech accent, the fact is that many Latinos living in the United States are documented and have the legal status to live in the United States (Earner 2007). While some Latino immigrants lack documentation, it is important to note that they still have rights within the U.S. legal system. Nevertheless, Latino families’ own fear and concern about their immigration and citizenship status often prevent them from accessing and using needed services to which they may be legally entitled (Dettlaff, Earner, & Phillips 2009). In FY 2011 (U.S. Department of Health and Human Services 2012), of the 676.569 (unique count) ‘’victims” of children abuse and neglect, i.e., those for whom at least one reported maltreatment was substantiated or indicated, 22.1 percent were of Hispanic ethnicity (p. 43). Preliminary FY 2012 data from the Adoption and Foster Care Analysis and Reporting System (AFCARS; 2013:1) indicate that 399,546 children and youth were in foster care on September 30; 21 percent were of Hispanic ethnicity (p. 2). Also in FY 2012, 23 percent of the 101,719 children and youth waiting to be adopted were Hispanic (p. 4) . Cultural Values and Assets Staff in child welfare services must understand how cultural values can affect decision making in daily life. Delgado (2007) emphasizes that practitioners working with Latinos should start from the position of understanding family and community assets as resources. This approach can enhance problem solving and the process of seeking help, including how families are empowered to use resources within the child welfare system. For instance, systems theory, the ecological model, and the strengths

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perspective could be applied as part of the process for identifying the resources and assets that Latinos have, regardless of their needs, within their own families and community. The use of the resilience model can also significantly influence child welfare practice on a number of levels to enhance a participatory approach among Latino families, especially recent immigrants. Latino families tend to share strong interpersonal values of respeto (respect), personalismo (personalism), and símpatia (sympathy), as well as confianza (trust), which establish communication and build significant relationships (Negroni-Rodríguez & Morales 2001). In addition, the values of familia (familism) and cooperación and colectivismo (cooperation and collectivism) underline the importance of empathy and mutual aid by establishing strong bonds with extended family members, neighbors, and community members (Zuniga 2001). The opinions and support of grandparents, aunts, uncles, and godparents are often part of the safety net and consulted when making important life decisions. This sense of cooperation and collectivism is considered an important community asset for confronting limitations and overcoming difficult times (Delgado 2007). Challenges and Needs Although little is known about the actual number of immigrant children and youth involved in the child welfare system, it has been suggested that their numbers are increasing, especially in the long-term foster care population (Earner 2007). This uncertainty gets complicated by the limited research on the risk factors that call Latino families to the attention of child welfare services as well as their patterns of service utilization once they are in the system (Dettlaff, Earner, & Phillips 2009). Recent literature, however, has pointed to a number of factors that could contribute to the need for Latino families to receive child welfare services, especially those who are immigrants. For instance, they may be at risk of encountering disruptions in family life

due to the stress and difficulties faced by the immigration experience, including the isolation and uncertainty of the process of new settlement (Altman & Michael 2007; Earner 2007). Stresses associated with poverty, lack of adequate health care, food, housing, education, and employment opportunities, among others, result in the need for multiple services that are linguistically and culturally responsive (Dettlaff & Rycraft 2010; Gutiérrez, Yeakley, & Ortega 2000; NegroniRodríguez & Morales 2001). It brings great concern that Latino families in need of services underutilize and/or are underserved by the child welfare system and other systems of care for a variety of complex reasons. Some factors mentioned in the literature are related to: (a) the stigma of the child welfare system in the community, (b) fear of being discriminated against, (c) lack of familiarity and understanding of the child welfare system’s procedures and policies, (d) lack of culturally and linguistically sensitive services and resources that could respond to family’s needs and strengths, and (d) lack of knowledge and skills to deal with diversity in a holistic manner (Altman & Michael 2007; Dettlaff, Earner, & Phillips 2009; Earner 2007; Rivera 2002). In addition, the lack of attention to organizational behaviors and attitudes toward issues of racism, oppression, and discrimination could seriously affect the development of policies, programs, and services that should be culturally responsive. Some examples of such misdirected policies would include standards for foster and adoptive parents that have the effect of excluding extended family members, the misinterpretation of parents’ behavior, and assumptions based on a family’s language proficiency that could result in their exclusion from the planning and decision-making process. Often Latino families involved in the child welfare system also receive services from other systems of care, making it necessary to address services in a collaborative and coordinated manner (Ortiz-Hendricks 2005) as this case study illustrates:

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L A FA M I L I A S A N T O S

Mirabel and Carlos Santos have been married for fifteen years. The Santoses moved from Puerto Rico to New York City in 1980 and live in the East Harlem section of Manhattan. Mirabel works in her home, Carlos works as medical technician at Metropolitan Hospital in their community. The Santoses have three children, Paula, age twelve, Tiago, age ten, and Liliana, age three. Paula and Tiago are in the local public school; Liliana is developmentally disabled and has been enrolled in the New York University Child Study Center for early childhood intervention education in Queens, outside of their community. Mirabel is the primary caretaker of the children and takes Liliana to all of her appointments. One of the requirements of the New York University Child Study Center is that all family members engage in weekly ongoing family therapy. Mirabel and the other children are ready to attend in spite of the difficulties this requirement poses for them, but Carlos has difficulty attending because of his job hours, the distance to the center from his job, and, finally, because he feels uncomfortable in an environment which requires that he speak English. Carlos feels that he can best express himself in his first language, which is Spanish, but a Spanish-speaking therapist is unavailable to meet with them. This causes stress in the family system and in the family’s ability to access culturally competent services that are accessible for all family members and within their community.

Such collaborations must identify and work across different disciplines and many levels of information and sources, including help-seeking behaviors, language and communication styles, disclosure of information, and support systems practices, among others (Dettlaff & Rycraft 2010). Working collaboratively with other systems of care is an important step toward making services more accessible and responsive to the cultural and linguistic needs of Latino families. Moreover, child welfare collaborations or coalitions must involve Latino families, communities, academia, private organizations, and government

to systematically assess cultural competency issues and embark on problem-solving efforts (Dawson & Berry 2002). Far from working in isolation, the child welfare system should actively seek opportunities to convene representatives from different sectors to evaluate the effectiveness of current policies and programs as well as marshal available resources for services that are more responsive to the needs and strengths of Latino families in their communities. Effective child welfare collaborations can produce beneficial results, such as opening communication among all involved in the case assessment and permanency planning efforts and potentially reducing the duplication of services (Rivera 2002). Culturally Competent Practice Cultural competence has been described as a set of behaviors, attitudes, skills, policies, and organizational structures that come together as a paradigm or model enabling professionals to work effectively in cross-cultural situations (Lum 1999). The development of a culturally competent practice in the child welfare system needs to be a proactive decision supported by management and staff at all levels. This is not a skill that will be acquired in a series of monthly workshops but rather an ongoing effort that requires the intentional, continuous expansion of cultural knowledge, skills, and resources. This process should be adequately supervised and guided by clear ethical standards of practice along with opportunities to train child welfare staff over an extended period of time. Engaging in a culturally competent process results in an ability to understand, communicate with, and effectively interact with people across cultures in a respectful and accepting manner. It requires a sense of empathy and genuine interest in learning about the stories, immigration experiences, and perceptions of others. In working with Latino families, it is important to create nourishing environments where families feel safe to open up about their feelings and fears. While some cultural guidelines might be helpful in assessing and intervening with these families, practitioners must remember that each family is

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unique and different. As an important principle for engaging Latino families, child welfare practitioners must provide the space for families to define themselves and their communities of support rather than stereotyping them or making assumptions based upon nationality, immigrant status, and language proficiency, among others (Altman 2008; Rycraft & Dettlaff 2009). A cultural competence model usually includes the following components: (a) self-awareness, (b) recognition of attitudes toward cultural differences, (c) knowledge of different cultural practices, and (d) cross-cultural skills (Lum 1999). Self-awareness is crucial to working with the complexities of a multicultural setting such as the child welfare system. If awareness reflects a consciousness of one’s own racial and cultural heritage, personal values, beliefs, and reactions to people who are different, then staff in child welfare organizations should reflect on the possible prejudices and stereotypes they may have about those who are different than themselves. Indeed, self-awareness helps us to start moving away from biased perceptions that may be long held. The self-reflection requires us to be honest and humble as well as commit to doing the hard work necessary for undoing racism and liberating ourselves from discrimination and oppression. Recognition and assessment of individual and organizational attitudes regarding groups different from our own must be part of the ongoing process of becoming culturally competent. The belief that culture makes no difference and that traditional intervention approaches are universally applicable to all families demonstrates a cultural blindness that will undermine the effectiveness of child welfare policies and programs (Netting & O’Connor 2003). Nevertheless, many child welfare organizations have moved from being “culturally blind” to a stage that might be called cultural precompetence where staffs realize shortcomings in working with cross-cultural populations. As part of this shift, it has been observed that some agencies, for example, recruit and hire Latino persons to the agency staff, board of directors, or advisory committee. While encouraging staff diversity, it must be stressed that this activity

alone will not make the agency culturally competent. Sometimes when personnel are hired as part of a strategy to attain organizational diversity, they may be excluded from key decision-making roles, setting false expectations and losing valuable opportunities for broader thinking and experience among core management (Kettner 2002). Similarly, when staff persons are asked to attend a one-time retreat or training on the topic of cultural diversity, the event may introduce some cross-cultural knowledge and outreach skills in the service area, but this activity by itself will not achieve cultural competency. Shallow or under-resourced efforts will not make for meaningful impact in this arena. Having a culturally competent practice in child welfare organizations means accepting, respecting and appreciating differences, and valuing other cultures. It means having staff at all levels embark on a process of continuous self-assessment regarding culture and race as well as enhance their critical thinking about the dynamics of power. Certainly, the staff along with the organization must possess a genuine interest and desire to expand their cultural knowledge, skills, and resources (Kettner 2002). With those objectives, child welfare organizations should commit to searching for necessary resources and adapting the services to ensure cultural relevance in the communities where they are located (Netting & O’Connor 2003). Recommendations include integrating a variety of activities, such as working with specialists in culturally competent practices, hiring and integrating culturally diverse staff in program planning activities, ensuring that practitioners have the linguistic skills to communicate with families, conducting research on new culturally competent interventions and approaches, advocating for cultural competence throughout the child welfare system, and developing interagency and cross-sector collaborations (Earner 2007; Ortiz-Hendricks 2005; Rivera & Earner 2006). Implications for Practice For Latino families involved in the child welfare system to successfully engage and actively participate in the helping process toward change,

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services must respond to their cultural needs and strengths (Altman & Michael 2007; Dawson & Berry 2002). This response typically requires opening up the relationships between staff and clients. It also frequently demands that child welfare practitioners engage with families in the places where they live, that is, in their local communities (Rycraft & Dettlaff 2009). This community-based approach, specifically one that focuses on the assets of families and their extended support systems, dovetails with a cultural competence model. Family Engagement As engagement is an interpersonal process involving empathy, commitment, and the building of trust or confianza in the helping relationship, it does not occur overnight (Negroni-Rodríguez & Morales 2001). Child welfare practitioners must be flexible, open, and willing to accept the engagement as a mutual learning process—this is an attitude that informs practice. The work environment needs to foster respect, curiosity, and acceptance. Once confianza is obtained, it is important to begin to negotiate the structure, characteristics, and extent of the family’s engagement and participation in the case planning process. Some would argue that while establishing that level of trust, the process of engagement has already begun (Altman 2008). With this approach, we can shed greater light on the issues of racism, prejudice, discrimination and oppression toward the Latino community, and others. When practitioners open up, they can recognize more readily that despite the issues that may bring families to the attention of the child welfare agencies, these same families are experts on their own families. As such they need to be actively involved in planning and making decisions for their children and youth. Preparing staff at all levels for this work requires ongoing training. The asset-based approach mentioned earlier, when implemented, demands that child welfare practitioners listen and learn about the cultures of the persons they seek to engage in the helping

process. When working with Latino immigrants, for example, it means learning about the culture of their home countries, understanding their immigrant status and experiences, their reasons for migration, and the ways that migration has impacted family dynamics (Dettlaff, Earner, & Phillips 2009; Dettlaff & Rycraft 2009). Training for workers who deal with immigrant populations should be about understanding the migration experience and identifying strengths that families have to cope with stressful situations within the family, among other important issues (Altman & Michael 2007; Earner 2007). With training, reinforcement, and appropriate supervision, practitioners can apply active listening skills to their interactions with families and identify which strengths and resources can be utilized in the help-seeking and intervention processes toward change. The Importance of Community Relations and Community Involvement The importance that Latinos tend to put into community relations can be a strong source of support, and this recognition brings implications for child welfare practice. Staff should explore how these systems of support could influence family help-seeking behaviors and their capacity to achieve service plans’ goals. Delgado (2007) offers an analytical lens to assess the broader community-level engagement, noting four main factors: 1. the level of service provision and willingness of local community organizations to get involved; 2. agency capability, such as having culturally competent staff; 3. relationship with the community (positive, neutral, negative); and 4. willingness to collaborate. Finding innovative ways to integrate the community in different efforts—such as child abuse prevention campaigns—requires a willingness to think outside the box or at least get staff out of the office. While census data, questionnaires, surveys, interviews, and ecological maps are useful instruments to gather information, walks around the neighborhoods, attendance at town meetings, and visits to local

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establishments are important. Some staff members in child welfare organizations do not know the neighborhoods where they work, but they should. Talking with community leaders and members to make themselves familiar with the local history, cultural traditions, and values can add real value to the child welfare practice. Staff personnel at all levels may be delighted by the receptivity of community members when the latter are approached by respectful and sympathetic listeners. When families are given the right opportunity, they can share information related to their problems, help-seeking patterns, and sources of support. The practice of going into and learning about the local community helps build cultural competence. In addition to “walking around,” more formal types of assessment and interaction should be planned. Along with other service agencies in the community, child welfare organizations can undertake community assessments (sometimes called environmental scans), employ asset-mapping exercises, and participate in local cultural events. Through these activities, the agency raises staff visibility as they express a genuine interest in getting to know the community where their families live (Rivera 2002). They also begin to better understand interrelated systems of care that exist through a network of extended family, neighbors, and local leaders. From this work, it becomes more apparent that opening to and involving community organizations into child welfare practices require an emphasis on interdisciplinary and cross-sector collaboration (Rycraft & Dettlaff 2009). A commitment on the part of agencies to embrace different constituencies and sectors (public, private, and nonprofit) must be at the base of that effort. Beyond wishful thinking about diversity, agencies need to create real opportunities to involve the families and communities in the governance and decision-making concerning certain agency practices (Kettner 2002). But, without administrative adaptations and changes by the agency, partnerships between

families and communities and the child welfare agency that serves them will not develop. As practitioners, supervisors, and policy advisers, we can advocate for these changes now. Expanding our Knowledge Base Still, more research is needed on a variety of important points. We need to know more about the factors that bring Latino families into the child welfare system, their help-seeking behaviors, and their service utilization patterns (Earner 2007). We also need to understand the challenges that the child welfare system has in reaching out to them; possible reasons that may influence underutilization and underservice must be seriously examined (Dettlaff & Rycraft 2009). Furthermore, as there is a need for more coordinated and integrated services across different systems of care, we need to expand our knowledge base on the development and evaluation of collaborative initiatives involving a variety of public and private agencies and community sectors. Further research on staff training and capacity building is needed to incorporate best practices related to the planning and delivery services in a coordinated and integrated manner. We need to turn the lens on our own knowledge, skills, and attitudes toward culturally diverse populations. We need trainings that enable staffs at child welfare organizations to become more open to other cultures, more active listeners, and more involved in the communities where they work with Latino families. Finally, we need rigorous evaluations of training to tell us what kinds of training works best as well as evaluations of the child welfare agencies’ practice in order to better identify the ways in which service organizations must change to provide an environment where a culturally competent practice can thrive. YYY

Child welfare practitioners and policy makers committed to developing a culturally competent

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practice will find the process of working with and learning from the Latino community exciting and rewarding. In this path the significant degree of diversity within the Latino population will be seen not as a hurdle but as a tremendous opportunity to engage families and communities in working together toward the safety and well-being of children and youth. This chapter has briefly discussed the organizational and practical components of a cultural competency model with its emphases on asset-based and community-oriented approaches. Developing cultural competence is a dynamic and evolutionary process that includes not only

self-awareness but also a purposeful expansion of knowledge and skills. The fundamental precepts of cultural competence include respecting and valuing differences among participants. A culturally competent approach to services requires that policy makers, managers, and practitioners at all levels examine and potentially transform each component of the child welfare system to respond more effectively to the needs and strengths of Latino families. Hopefully, this chapter will promote a dialogue and foster bridges of communication that can help us to unite forces toward a shared goal, which is the safety and wellbeing of all our children and youth.

REFERENCES

competent practice: Skills, interventions, and evaluations (pp. 132–62). Boston: Allyn & Bacon. Netting, F., & O’Connor, M. (2003). Organization practice: A social workers’ guide to understanding human services. Boston: Allyn & Bacon. Ortiz-Hendricks, C. (2005). The multicultural triangle of the child, the family, and the school: Culturally competent approaches. In E. Congress & M. González (eds.), Multicultural perspectives in working with families (pp. 71–92). New York: Springer. Rivera, H. (2002). Developing collaborations between child welfare agencies and Latino communities. Child Welfare, 81, 371–84. Rivera, H., & Earner, I. (2006). A model of collaboration between schools of social work and immigrantserving community-based organizations to ensure child well-being. Protecting Children, 21, 36–52. Rycraft, J., & Dettlaff, A. (2009). Hurdling the artificial fence between child welfare and the community: Engaging community partners to address disproportionality. Journal of Community Practice, 17, 464–82. U.S. Census Bureau (2010). Population profile of the United States. Washington, DC: U.S. Government Printing Office. U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, Children Bureau (2012). Child maltreatment 2011. Washington, DC: U.S. Government Printing Office. U.S. Department of Health and Human Services, Administration for Children, Youth and Families, Children Bureau (2013). The AFCARS Report; Preliminary Estimates for FY 2012 as of July 2013(20) Retrieved on October 17, 2013, from www.acf.hhs.gov/ programs/cb. Zuniga, M. (2001). Latinos: Cultural competence and ethics. In R. Fong & S. Furuto (eds.), Culturally competent practice: Skills, interventions, and evaluations (pp. 47–60). Boston: Allyn & Bacon.

Altman, J. (2008). Engaging families in child welfare services: Worker versus client perspectives. Child Welfare, 87, 41–61. Altman, J., & Michael, S. (2007). Exploring the immigrant experience: An empirically-based tool for practice in child welfare. Protecting Children, 22, 42–54. Dawson, K., & Berry, M. (2002). Engaging families in child welfare services: An evidence-based approach to best practice. Child Welfare, 87, 293–317. Delgado, M. (2007). Social work with Latinos: A cultural assets paradigm. New York: Oxford University Press. Dettlaff, A., Earner, I., & Phillips, S. (2009). Latino children of immigrants in the child welfare system: Prevalence, characteristics, and risk. Children and Youth Services Review, 31, 775–83. Dettlaff, A., & Rycraft, J. (2009). Culturally competent systems of care with Latino children and families. Child Welfare, 88, 109–26. Dettlaff, A., & Rycraft, J. (2010). Adapting systems of care for child welfare practice with immigrant Latino children and families. Evaluation and Program Planning, 33, 303–10. Earner, I. (2007). Immigrant families and public child welfare services: Barriers to services and approaches to change. Child Welfare, 86, 63–91. Gutiérrez, L., Yeakley, A., & Ortega, R. (2000). Educating students for social work with Latinos: Issues for the new millennium. Journal of Social Work Education, 36, 541–57. Kettner, P. (2002). Achieving excellence in the management of human service organizations. Boston: Allyn Bacon. Lum, D. (1999). Cultural competent practice: A framework for power and action. CA: Brooks/Cole. Negroni-Rodríguez, L., & Morales, J. (2001). Individual and family assessment skills with Latino/Hispanic Americans. In R. Fong & S. Furuto (eds.), Culturally

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Health Care for Children and Youth

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nsuring that the health care needs of children and youth in the child welfare system are met is the responsibility of many, including their families, the child welfare agency, their out-of-home caregivers, the health care system, the mental health system, and the court system. Children’s and youth’s health outcomes as well as their chances for having permanent, safe, and secure homes can be improved with access to a comprehensive health care system and adequate support for their families. We use the term comprehensive health care to refer to strategies and services for meeting the physical, dental, mental, emotional, and/or developmental needs of children and youth. It includes primary, tertiary, and specialty health care. In this chapter we present an overview of issues that impact the health of children and youth who are involved with the child welfare system, particularly those who are placed in out-of-home care. We discuss the health status and special health care needs of these young people, recent policy developments aimed at better addressing health care needs, and the challenges that that remain. We then present a framework of “critical components” around which to develop a comprehensive approach to health care for children and youth involved with the child welfare system, including approaches for overcoming the myriad of challenges that exist. Taken together, the components of this framework describe a comprehensive, community-based health care system designed to provide children in child welfare with access to appropriate health care

services to meet their needs. The framework is based in large part on a three-year study conducted by the Georgetown University Center for Child and Human Development (see McCarthy 2002; Woolverton 2002) for more detailed information on this study). We also discuss the knowledge and skills that social workers need to coordinate health care services for children and youth. The chapter concludes with a summary analysis. Because much of the research literature (as well as state efforts at system improvement to date) have focused on the needs of children who are in out-of-home care, our review of the current state of knowledge and practice in the field will, by necessity, cover this population more extensively than that of children and youth who are not in state custody. However, ensuring the well-being, including healthy development, of all children and youth touched by the child welfare system remains the ultimate goal. We also recognize the importance of meeting the emotional and behavioral needs of children and youth and the impact that involvement with the child welfare system can have on a child’s emotional health. For more information about mental health issues, we refer you to the chapter by Dore, which provides an in-depth discussion of child and adolescent mental health. Health Care Needs of Children and Youth in Child Welfare Children involved in the child welfare system have certain risks to their health and development by virtue of the conditions that brought 94

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them to the system’s attention. These conditions include physical, sexual, and/or emotional abuse; neglect; parental substance abuse; domestic violence; unstable living arrangements; and poverty. Among children served by the child welfare system, those who are separated from their families and placed in state protective custody have additional vulnerabilities and needs related to out-of-home placement itself. For these young people, existing risk factors may be exacerbated due to the trauma of separation from their families and frequent placement changes. Silver, Amster, and Haecker (1999) describe how these effects can be particularly profound for very young children, placed in foster care, whose health and development may be undermined by a lack of secure and stable attachments. An additional health concern posed by entry into foster care is that many children come into the system with little information about their birth and their developmental or health history. Child welfare workers often cite difficulty in obtaining this information at the time a child is removed from the home. This lack of information can lead to delays in provision of appropriate health services and can pose a safety issue for children with unknown health conditions, such as allergies, asthma, seizure disorder or psychiatric disorders, and for those who are on medications. During the 1990s there was increased attention to the needs and health issues for children in foster care. A 1994 policy statement by the American Academy of Pediatrics (1994) revealed that children and youth in foster care suffer much higher rates of serious emotional and behavioral problems, birth defects, chronic physical disabilities, developmental delays, and poor school achievement compared to those from similar socioeconomic backgrounds that were not in foster care. Similarly, a U.S. Government Accountability Office (1995) report claimed that foster children are among the most vulnerable individuals in the welfare population and, as a group, are sicker than children

and youth who are homeless and those living in the poorest sections of inner cities. At the same time, studies conducted during the 1990s in a number of states and localities examined a variety of health and mental health indicators and repeatedly documented that this population of children and youth has many unmet needs. For example, a study of health care issues for California’s foster care population (Institute for Research on Women and Families 1998) found that 40 percent to 76 percent of children in the state’s foster care system had chronic medical conditions, and 50 percent to 60 percent had moderate-to-severe mental health problems. Another study conducted in a clinic providing health examinations for children entering foster care in an East Coast city found that more than half needed urgent or nonurgent referrals for medical, dental, and mental health services. Nearly a quarter of children under age five had abnormal or suspect results on developmental screenings (Chernoff et al. 1994). Until more recently, however, there existed no national level data that could be used to document the health status of children and youth who come to the attention of the child welfare system. The National Survey of Child and Adolescent Well-Being (NSCAW), sponsored by the federal Administration for Children and Families (ACF), was undertaken in 1999 to learn about the experiences of children, youth, and families who come in contact with the child welfare system. Now in its second round, which began in 2008, NSCAW is a longitudinal study that gathers information from a nationally representative sample of children who were the subject of child welfare investigations. The study collects comprehensive information (through interviews, direct assessments, and case reviews) on children’s health, mental health, and developmental risks and documents their functioning, service needs, and service use. Recent findings from NSCAW’s second cohort (NSCAW II) indicate that children

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investigated for maltreatment in 2008 were at higher risk for poor health and mental health outcomes than children in the general population (Casanueva et al. 2011). For example, the two most common health conditions reported by children’s caregivers at the study’s baseline data collection point were attention-deficit/ hyperactivity disorder (ADHD; 16.4 percent) and asthma (16.1 percent), both of which were higher than the proportion reported in the general population (9 percent and 10 percent, respectively; Sondik, Madans, & Gentleman 2010). Among children up to 5 years old, 32 percent were found to have indications of developmental problems, and among children 1.5 to 17 years old, 41 percent had a mental health need (Casanueva et al. 2011). The rate of psychotropic medication use among children 1.5 to 17 years old (11.7 percent; Ringeisen et al. 2011) was double the percentage found in a general population of children 4 to 17 years old (6.0 percent, Simpson et al. 2008). NSCAW and other studies also document a continued gap in the receipt of services to address both health and mental health needs of children who come to the attention of the child welfare system. Particularly prominent gaps exist in access to needed dental services, mental health services, substance abuse services, and adolescent health services, including reproductive health services (e.g., see McCarthy 2002). One group that is particularly at risk for not receiving needed services is infants and young children. For example, among the 32 percent of young children found to have developmental needs in the NSCAW II baseline data collection, only 13 percent got referred for services (Ringeisen et al. 2011). And while we previously mentioned that the majority of research and policy efforts to date have focused on health care issues for children in foster care, children who remain in their own homes or in informal kin placements are emerging as a group less likely to receive needed services than children in formal foster care. The GAO reported that young people placed with relatives received

fewer health-related services of all kinds than did their peers placed with nonrelative foster parents, as relatives received less monitoring and assistance from caseworkers (U.S. GAO 1995). There is increasing evidence that these children and youth are at risk for poor health outcomes as well (e.g., Leslie et al. 2002; Ringeisen et al. 2011). Standards and Policies for Addressing the Health Care Needs of Children in Child Welfare The studies we have described reveal that not only do children enter the child welfare system at greater risk for poor health outcomes but, on the whole, current systems are also not adequately addressing their many and complex health care needs. Children in the child welfare system (including those in foster care, those who live in their own homes, and those living with kin) are a group who require extensive and coordinated health care services. The federal government, state governments, local agencies, and national organizations have passed laws, developed policies, and set standards intended to improve practice and assist in meeting the health care needs of children in the child welfare system. In this section we will discuss these efforts, the progress that has been made, and the challenges that remain. Federal Policies and Initiatives Historically, the primary focus of the child welfare system has been to keep children and youth safe and to find permanent homes for them. This mission has involved protecting children from abuse and neglect and providing them with stable, permanent living situations, lifelong relationships with nurturing caregivers, and continuous relationships with family members. More recently, however, the system has recognized the importance of focusing on a child’s total well-being as well—ensuring that children and youth receive adequate services to meet their physical health, mental health, and educational needs.

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The concept of well-being was introduced in the Adoption and Safe Families Act of 1997 (ASFA, P.L. 105-89); it is a major focus area of the federal Child and Family Services Reviews (CFSRs) which began in 2001 (see Mitchell and colleagues’ chapter, this volume). It is also addressed in the health care provisions of the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351). In addition, amendments to the Child Abuse Prevention and Treatment Act (CAPTA, P.L. 93-247) in 2003 and 2010 were designed to increase access to early intervention services for young children coming to the attention of the child welfare system who might have developmental needs. The second round of CFSR results (Administration for Children and Families see site ACF, 2011) show that 86 percent of the 2,530 children whose cases were reviewed in 50 states received appropriate services to meet their physical and mental health needs. Children in foster care fared better than children in their own homes, as 81 percent of the children in foster care were receiving appropriate services and 86 percent of the children living at home received appropriate services. The CFSR case review process examines whether the child welfare agency assesses children’s physical, dental, and mental health needs and provides services to meet the identified needs. For children in foster care, the agency also must have up-to-date health records, address health needs in the child’s case plan, and provide health care records to the child’s foster parents or other caregivers. Fostering Connections to Success and Increasing Adoptions Act of 2008 The Fostering Connections to Success and Increasing Adoptions Act, which became law in October 2008, includes multiple provisions for improving outcomes for children in foster care. It requires every state to develop a plan for the ongoing oversight and coordination of health care services for children in foster care

placement. This plan must be developed in coordination with the state Medicaid agency and in consultation with pediatricians, other experts in health care, and experts in and recipients of child welfare services (section 422(b)(15) of the act). The plan must include an outline of t
a schedule for initial and follow-up health screenings that meet reasonable standards of medical practice; t
how health needs identified through screenings will be monitored and treated; t
how medical information for children in care will be updated and shared (this may include implementing an electronic health record); t
steps to ensure continuity of health care services (this may include establishing a medical home for every child in care); t
the oversight of prescription medicines; and t
how the state actively consults with and involves physicians or other appropriate medical or nonmedical professionals in assessing the health and well-being of children in foster care and in determining appropriate medical treatment. The act requires child welfare agencies to develop transition plans with youth aging out of foster care who are near age eighteen. This plan must address, among other issues, health insurance and continuing support services for the youth. Effective October 2010, the Patient Protection and Affordable Care Act (P.L. 111-148) amended the Fostering Connections Act to require that the youth’s transition plan address the importance of designating someone to make health care treatment decisions on behalf of the youth in foster care if the youth is unable to do so. It also provides the youth with the option to execute a health care power of attorney, health care proxy, or other similar document recognized under state/tribal law. Additionally, effective in 2014, the act makes mandatory the current

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option for states to extend Medicaid coverage up to age twenty-six for youth who have aged out of the foster care system. Health Care Standards for Children in Out-of-Home Care Concern about the significant health care needs of children and youth in foster care led both the Child Welfare League of America (CWLA) and the American Academy of Pediatrics to issue health care standards for children and youth in out-of-home care (Child Welfare League of America 1988, 2007; American Academy of Pediatrics 1994, 2000). Based on a growing body of knowledge about quality health care services to children in out-of-home care, the original CWLA Standards developed in 1988 were revised in 2007. The revised standards offer guidance on best practices and recognize that the needs, strengths, and resources of children and families are the heart of how best practices are defined and implemented (Child Welfare League of America 2007). The principles and practices set forth in the standards are intended to be useful to a broad array of child welfare, social service, medical, and mental health practitioners. Ongoing Challenges to Meeting the Health Care Needs of Children in Child Welfare While there has been a great deal of attention and resources directed at strategies for improving health care for children in child welfare, ongoing challenges remain. Even in a perfect system, the extent and complexity of the health care needs of children in the child welfare system would present challenges to providing appropriate care. The challenges to providing health care both for young people in state custody and those living in their own homes arise from impediments in the child welfare and health care systems and from difficulties coordinating care across systems. Challenges in the Child Welfare System Many child welfare agencies face system-wide

problems, such as high caseloads, limited resources, and high rates of turnover in social workers, attorneys, and foster parents. These problems affect their ability to ensure comprehensive health care for the children they serve. In addition, specific health care–related obstacles experienced in the child welfare system include t
confusion and/or disagreement about who is responsible for consenting to evaluation and treatment of children and youth in foster care and difficulty in obtaining that consent; t
lack of knowledge about health care issues among some social workers and caregivers; t
missing or incomplete information about child and family health history and inadequate strategies for gathering this information from parents or other caregivers; t
placement of children in homes that are geographically distant from their previous health care providers, resulting in changes in providers, loss of continuity of health care, and delays in the start of treatment; t
inconsistent efforts to include birth parents in the health care of their children and youth; and t
lack of transition supports and continuity of care when a child returns home, changes placements, is adopted, or moves into the adult system. Challenges in the Health Care System The principal funding source for both health and behavioral health services for children in the child welfare system is Medicaid. In most states close to 100 percent of children in foster care are eligible for publicly funded health insurance through Medicaid. Many publicly funded health care systems face challenges serving their constituencies. These difficulties are compounded for children in the child welfare system who need access to providers who understand and can meet their intensive and multilayered needs. Some specific challenges include

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t
insufficient service capacity and access to care (e.g., a lack of qualified providers to serve children and families on Medicaid; a shortage of dentists who accept Medicaid; long waiting lists for mental health services); t
low reimbursement rates for Medicaid providers; t
delays in obtaining Medicaid coverage when children enter foster care; and t
loss of coverage at transition points, such as exiting foster care or placement changes. In addition, health care systems are traditionally administered separately from child welfare systems, and health care providers do not have ready access to information about how the child welfare system works. Providers frequently are confused about the roles of foster and birth parents as well as about issues regarding consent for treatment and the role of the court in ordering and monitoring health care services. In most states and communities Medicaid recipients receive health care services in managed care systems that are intended to promote access to needed services and improve quality while controlling costs and reducing overutilization of services. Managed care may pose unique obstacles for children in the child welfare system, particularly if the managed care system has not been designed to accommodate the complex health care needs of this population. Cross-System Challenges Creating a comprehensive system for meeting the health care needs of children in the child welfare system requires multiple systems to work together. Cross-system challenges in working with the courts, child welfare, and health and mental health care systems include t
clarifying among systems the roles and responsibilities for health and mental health service provision;

t
strengthening communication between health care providers and child welfare workers; t
integrating physical health and mental health care; t
persuading courts to discuss child and family health needs during court proceedings; t
navigating complicated management information systems and sharing incompatible data formats across systems; t
addressing confidentiality issues about access to data; t
working with inflexible funding sources; and t
overcoming the lack of consistent crosssystem training and education. Forging Links Across Systems to Meet the Health Care Needs of Young People in the Child Welfare System Although child welfare is the system responsible for ensuring the safety, permanency, and wellbeing of its charges, it must forge links with families and with other systems to accomplish these goals. As the primary caregiver, a child’s family (birth, relative, foster, or adoptive) can make or break a well-thought-out health plan. Families provide daily care; they observe and understand their children’s strengths and needs, and they are responsible for ensuring that their children have regularly scheduled appointments with health care providers. Without support for and from the family, it is difficult to guarantee that a child’s health care needs will be met. Most of the health care services needed by those served in the child welfare system are available through the health care system, not from the child welfare agency itself. As the challenges we have listed indicate, barriers to comprehensive health care are a cross-system problem. Improving access to quality services requires a cross-system approach involving at a minimum the child welfare, health, mental health, substance abuse, early intervention, education, juvenile justice, and court systems.

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The judicial role in decision making for children in the child welfare system is unique, as the courts are actively involved in planning for such children (see Ventrell’s chapter, this volume). In most states judges have the final authority to make decisions about the need for placement of a child, and they are charged with approving plans for a child’s care when the child is under protective supervision. In some states this authority extends to ordering or approving health care services for the child or the child’s parents (Battistelli 1996). Every court proceeding presents an opportunity to inquire about a child’s health needs and order appropriate health services (New York State Permanent Judicial Commission on Justice for Children 1999). Courts also can act as powerful and effective conveners of multiple systems to communicate, coordinate, and collaborate with regard to a child’s health plan (American Bar Association Center on Children and the Law 2011). Framework for a Comprehensive Approach to Health Care As discussed earlier in this chapter, children in the child welfare system have multiple and complex health, mental health, and developmental needs. Attending fully to their needs requires the creation of a comprehensive, community-based health care system that includes a number of specific components. In Meeting the Health Care Needs of Children in the Foster Care System, McCarthy (2002) defines the components needed in a comprehensive system, as will be discussed here. This framework reflects practices and strategies offered in many states and communities, national health care standards such as those developed by the Child Welfare League of America (1988 & 2007) and the American Academy of Pediatrics (1994), and the values embraced by family-centered practice and community-based systems of care that serve children with mental health needs (Pires 2002; Stroul & Friedman 1994). A system

of care incorporates a broad array of services and supports that is organized into a coordinated network, integrates care planning and management across multiple levels, is culturally and linguistically competent, and builds meaningful partnerships with families and youth at service delivery and policy levels. Critical Components The critical components of the comprehensive approach include t
initial screening and comprehensive health assessment, t
access to health care services and treatment, t
managing and sharing health care data and information, t
coordination of care, t
collaboration among systems, t
family participation, t
attention to cultural issues, t
monitoring and evaluation, t
training and education, t
funding strategies, and t
tailoring managed care to fit the needs of the child welfare population. The framework highlights the kinds of issues to consider when designing a comprehensive approach to health care for children in the child welfare system. It is used by states and communities to assess their health care systems, prioritize the steps involved in transformation, and envision what a comprehensive, well-functioning system should look like. The comprehensive framework is not a prescription for change, but rather a catalyst to prompt and guide discussion and planning. Provided below are definitions of each component as well as features, characteristics, related issues, and some strategies that are effective in implementing the components. Initial Screening and Comprehensive Health Assessment In the comprehensive framework,

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initial health screenings and comprehensive health assessments are provided, as needed, for any child in the child welfare system. All children who enter foster care receive an initial health screening upon entry to identify health problems that require immediate attention. Comprehensive health assessments of children in foster care are conducted shortly after placement (usually within thirty days), at regular intervals during their stay in out-of-home placement, and as they reunify with their families or move to another placement. Both screenings and assessments are conducted by qualified providers, in comfortable, accessible settings and are appropriate to a child’s age, culture, and individual situation. Comprehensive assessments are more extensive than initial screens and address a child’s physical, dental, mental/emotional, and developmental strengths and needs. They focus on the child, the family, and the environment in which the child lives. Initial screens and comprehensive assessments often confirm suspicions and provide valuable information to help parents, caregivers, schools, judges, social service workers, and health care providers understand the child better and meet the child’s health care needs more appropriately. Key features and characteristics of this component include

t
individualizing each assessment and ensuring that assessment tools are culturally appropriate; t
recognizing the unique needs of adolescents in the child welfare system; t
using providers with the experience, knowledge, and skill to work with children and youth in the child welfare system; t
sharing results with the child or youth, family, out-of-home caregivers, other providers, social services, and the court when appropriate; t
following up systematically on recommended care; t
assessing the strengths, needs, and medical histories of other members of the child’s family; t
reassessing at strategic intervals, such as when youth leave foster care to live independently and when children or youth return home or change placements; t
presuming that every child who enters foster care will be eligible for Medicaid, which allows for immediate screening, assessment, and emergency services; and t
adhering to Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT) standards.

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implementing a strategy for obtaining child and family health history; t
implementing a system to identify and refer all children and youth who enter outof-home care; t
providing accessible screening and assessment sites (i.e., within a reasonable distance of the child’s home and open for extended hours); t
minimizing the trauma a child is experiencing by making the screening and assessment as comfortable as possible; t
involving informed adult participants who know the child well to provide needed information and comfort the child;

The importance of gathering health history and family medical history prior to or at the time of a child’s placement and immediately providing this information to a child’s caregivers cannot be overstated. Without this information, both the child’s caregivers and health care providers are forced to manage a child’s routine and emergency health care “in the dark.” The safety of children cannot be guaranteed if their medical history is unknown when they move into out-of-home placements. The following case example of a three-year-old child, Tamika, illustrates this point (adapted from Silver, Amster, & Haecker 1999).

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TA M I K A

Tamika was brought to the emergency room by ambulance, having just had a seizure in her foster parent’s home. Ms. Bordon, the foster mother, although visibly shaken, tried to answer the questions of the medical staff. However, she did not know if Tamika had a history of seizures, whether she was allergic to anything, or whether she was on medication. There had been an unmarked bottle of pills given to Ms. Bordon when Tamika was placed with her, but she had been afraid to administer them because she did not know what they were or how they were to be taken. No medical information had accompanied Tamika when she had been placed one week before. Tamika had seemed well, although she did not talk as much as Ms. Bordon’s own children at this age. The seizure had come on suddenly and lasted fifteen to twenty minutes.

While the CFSRs and the Fostering Connections to Success and Increasing Adoptions Act of 2008 require states to have guidelines for initial screenings, comprehensive assessments, and ongoing health evaluations, they do not specify time frames for performing these assessments. Standards such as those proposed by CWLA , the American Academy of Pediatrics, and the Council on Accreditation do establish specific time frames (e.g., initial screening by a health care professional within seventy-two hours of placement; comprehensive health assessment within thirty days of placement; and follow-up health visits within sixty to ninety days of placement) (Allen 2010). A 50-state survey conducted in 2010 by the Center for Health Care Strategies determined that all but one state required an initial screening, and all states expect comprehensive assessments to be conducted when necessary, with 63 percent specifically requiring them. The study noted a wide variation in time frames among states for completion of the various screenings and assessments, ranging from 1 day to 90 days for screening and from 3 days to 183 days for assessments (Allen 2010).

Access to Health Care Services and Treatment In the comprehensive framework, children are able to access both primary and specialty health care services. Strategies to ensure access are addressed (i.e., immediate eligibility for Medicaid, transportation, no waiting lists, availability of providers who know and understand the needs of children and youth in the child welfare system, location of health care services, levels of care to meet specific needs, and payment sources for services). In addition, emphasis is placed on providing a comprehensive array of health care services, from prevention to intensive intervention, that are responsive to the trauma many children in foster care have experienced and that address the special physical, dental, emotional, and developmental health care needs of children in the child welfare system. Family support services that enable caregivers to attend to a child’s health care needs also are available. Different strategies exist to help children and youth in the child welfare system access appropriate services. In some locales, agency social workers have this responsibility; in others, health care consultants are available to assist child welfare staff or there are health care providers on-site at the child welfare agency. Children may receive health care services from individual providers in the community, through foster care clinics, through community-based clinics, or through special networks of health care providers created to serve young people in the child welfare system. Included are the following key features and characteristics of this component: t
an established system for accessing care. Procedures are in place for access to primary care physicians, regular well-child exams, immunizations, specialty care, and consultation with medical experts. These procedures are applicable for all children in the system. The system supports individual social workers, parents, and caregivers so that they do not have to establish procedures on a case-by-case basis;

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t
strategies for recruiting and training qualified providers who are located near the children, their families, and their out-ofhome caregivers. These include incentives for providers to participate and established qualifications for those who do participate. Such strategies expand the array of services available; t
established protocols for emergency response, so that families and out-of-home caregivers have uninterrupted access to staff and providers on call; and t
community liaisons, such as public health nurses and mental health clinicians who are knowledgeable about community resources, to facilitate access to services. These liaisons are often located in the child welfare agency. As states and communities develop strategies for ensuring that children and youth in the child welfare system have access to appropriate health care services, they grapple with a number of complex issues. Consider the dilemma between providing continuity of health care and special expertise for children and youth while they are in foster care (e.g., through a centralized foster care clinic) versus offering choice for foster parents and continuity of care when a child/youth returns home or emancipates from foster care (e.g., by choosing an individual provider or continuing with the child’s previous health care provider). For the short term, it may be more efficient and effective to centralize health care. There is evidence to support the fact that the presence of a foster care clinic in a community can improve immunization rates, reduce emergency hospitalizations, and improve placement stability for children with complex medical needs. Horowitz, Owens, and Simms (2000) found that children seen in a specialized foster care clinic were more likely to receive recommended follow-up services and to have developmental and mental health problems identified. Health care providers in a foster care clinic know and understand

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the needs of children and families involved with the child welfare system. Despite these advantages, children and families sometimes complain that centralized clinics limit choice for foster families who wish to obtain health care in their own communities or utilize providers who care for other members of their families. Some children entering foster care will have a health care provider who could follow them while in care and when they return home. Using a centralized clinic may interfere with this continuity of health care. Older youth may perceive “in-house” foster care providers or a foster care clinic as not confidential and private, resulting in the youth’s reluctance to engage in treatment (American Bar Association Center on Children and the Law 2011). Thus, when implementing any specific approach, there will be necessary trade-offs that need to be considered from multiple perspectives in advance of implementation. Managing and Sharing Health Care Data and Information The framework ensures that information about a child’s health care and health status is gathered, organized, retained, and shared in a way that assures the information is complete, updated regularly, and available to persons closely involved with the care of the child. Health care history information about the child and family is gathered at the time of the initial contact. Relevant information about health care is transferred when children enter or leave the child welfare system and when they change placements. An organized method for documenting, storing, updating, and sharing health information about each individual child (e.g., through a health passport or a computerized information system) is in place. Health data related to individual children can be aggregated to determine system-wide needs, gaps in services, outcomes, and policies. For children in foster care, one method for managing their health care records is by using health passports (known in some communities

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as medical passports). Passports usually include medical history, demographic information, immunization records, health care visit summaries, medications, test results, growth information, insurance information, and other special health, mental health, and developmental information. Some passports include educational information and a child’s placement history. The passport is designed to move with the child from placement to placement and to be given to birth or adoptive parents when a child leaves the foster care system (Woolverton 2002). Although passports are commonly used, there are a number of obstacles to using them successfully. Paper passports can be lost when children move, and it is difficult to ensure that they will be completed regularly and kept up to date. Using electronic passports requires extensive clerical support, often not available in child welfare agencies. In addition to health care passports, other data management methods include using standardized health forms, using computerized management information systems, integrating health care data in service planning, and aggregating health care data. We have stated earlier that coordinating health care across many different systems requires the exchange of information and compatibility of data systems. This increased access to information needs to be balanced with confidentiality issues for the child, youth, and family. Protocols may need to be established to address the handling of confidential information, such as results of mental health assessments and HIV tests. Youth need to be educated about their own medical and mental health conditions and should be clearly informed regarding confidentiality, consent, and access to their records. Key features and characteristics important to implementing data management strategies include

for creating and updating the passport; establish procedures for gathering child and family health history information at the time of placement; decide who will hold the record; provide incentives for providers and foster parents to use and complete the passports; ensure adequate clerical support; and guarantee that the passport accompanies children and youth when they move. t
Standardized health forms. Use these forms to record the results of children’s and youth’s health exams and doctor visits, ensure that children receive health care according to EPSDT standards, and provide a permanent, uniform, centralized health care data record for each child. t
Computerized management information systems. Use these to track and monitor services provided for each child, as a tickler system to identify when medical appointments are to occur, and to share health care information online among social workers, providers, and care coordinators. t
Integration of health care data in service planning. Review health care summaries on individual children during administrative case review processes, court hearings, in child and family team meetings, and during home visits with the caretakers. Integrate the health care data tracked in computerized information systems into individual child/youth service plans. t
Aggregation/analysis of health care data. Identify emerging health issues for children, service gaps, and resource needs by aggregating health care data collected on individual children. Utilize data to assist in making appropriate policy and practice decisions and to determine trends, such as whether children with certain health problems remain in the system longer than other children or experience more placements than do other children.

t
Health care passports. Determine whether manual (paper) or electronic passports are most useful; decide who will be responsible

Coordination of Care In the comprehensive framework, responsibility for coordination of health care is assigned to a specific person

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(e.g., care coordinator, medical case manager) or unit (e.g., health care management unit, liaison office). An individualized child health plan that documents health care needs and services provided is developed and maintained for each child. Coordination of a child’s health care by a person or specified unit is extremely important to ensure that the child’s health care needs will be met. Many states and communities rely on nurses to fill the role of care coordinators and to develop health care plans for children and youth in the child welfare system. The following key features contribute to effective care coordination: t
the organizational structure supports assignment of health care coordination responsibilities to one or more persons. Sufficient time and resources are committed to care coordination. Care coordinators are trained both in health care and in understanding how the child welfare system works. Care coordinators have manageable caseloads; t
health care coordinators ensure that each child has a medical home. “Medical home” refers to a specific entity responsible for continuous management of a child’s health care. The American Academy of Pediatrics supports a medical home approach for children with special health care needs. This approach is family centered (i.e., recognizing the family as principal caregiver and pediatricians as partners with parents), continuous (the pediatrician is available through a child’s life and transitions), coordinated, comprehensive, and culturally competent. The medical home might be a community-based primary-care physician or pediatrician, a foster care clinic, or a community-based clinic (Parent Educational Advocacy Training Center n.d.). Medical homes, available to children and youth in foster care regardless of placement changes, promote continuity of medical care and avoid fragmentation of services (American Bar Association 2010).

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In addition, health care coordinators ensure that each child has an individualized health care plan that is integrated with her permanency plan. The health care coordinator supports integration of the child’s physical and mental health care, follow-through on recommendations made by providers, and discussion of the child’s health needs in all case reviews and court hearings. The care coordinator often serves as a bridge between the health care system, the child welfare system, and children’s families and outof-home caregivers. The following comment from a child’s foster care worker illustrates the benefits of establishing an ongoing relationship with the health care coordinator or a child’s medical home.

REGGIE

“I work with a child, Reggie, who is medically fragile, and so have requested help from the pediatrician at the foster care clinic on numerous occasions. The pediatrician has been able to offer her invaluable opinion on the skills that foster parents need to care for Reggie. Another time, I asked the clinic to call the hospital when I felt that the hospital was going to release Reggie too soon. I feel that he would not have received the attention he needed if this had not been done. The pediatrician has also written letters to the court for me at trial time so that the judge would have a better understanding of Reggie’s special needs.”

Collaboration Among Systems Health, mental health, child welfare, juvenile justice, courts, education, and other systems serving children; providers; families; out-of-home caregivers; and community organizations collaborate to meet the health care needs of children and youth in the child welfare system with a comprehensive framework approach. The Fostering Connections to Success and Increasing Adoptions Act of 2008 acknowledges the importance of collaboration and requires states to describe how they

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consult with and actively involve physicians and other medical personnel in assessing the health and well-being of children in foster care and in determining appropriate medical treatment for them. Collaboration may be approached in a variety of ways: through co-location of staff, sharing of financial resources, cross-system training, interagency collaborative service and/ or planning teams, advisory boards that are representative of the collaborators, formal interagency agreements, and/or consultation regarding individual children and youth. As stated before, the child welfare agency cannot establish a comprehensive framework for children’s health care alone. Providing appropriate health care requires a cross-systems approach for individual children and families as well as for system-level reform. Features that facilitate cross-system collaboration include t
devising strategies for consistent informal and formal communication across systems, such as interagency team meetings, memoranda of understanding and interagency agreements, designated liaisons, sharing office space, cross-system training on health care issues, and formal contracts; t
facilitating participation of communitybased agencies, such as local health departments and clinics; t
working strategically with the courts and judges, e.g., providing them with health care information about individual children and youth so they can make informed decisions; harnessing the influence of the courts to order needed services; providing information about new and relevant child welfare laws/policies such as the Fostering Connections to Success and Increasing Adoptions Act of 2008; and suggesting potential questions to ask from the bench that focus on the health care needs of children and youth before the judge. Family and Youth Participation and Voice From the comprehensive framework

perspective, families—birth, relative, foster, and adoptive—are viewed as partners in providing health care for their children. They are involved as vital sources of information about the child’s health care history, needs, and ongoing care and to ensure continuity of care in the transition from out-of-home care to permanent placements. A child’s health care is addressed in the context of his family’s strengths, needs, culture, beliefs, and environment. Families receive support services that will enhance their capacity to provide for their children’s health care needs. Children in the child welfare system may be included in several types of family. They may live with or be working toward reunification with their birth parents. They may live with extended family members who serve as their guardians, an arrangement often called kinship care. They may live with foster families, and those who cannot safely return to their birth families may be adopted. Ensuring family participation entails listening to, involving, and addressing the needs of all of these families. However, this ideal is not always realized. As mentioned previously, findings from several sources indicate that children living in their own homes are less likely to receive adequate physical and mental health services than are those in foster care. Even though approximately 70 percent of children in the foster care system are reunified with their birth parents or other relatives, efforts in many states and communities to include families in planning for their children’s health care focus more on foster parents than on a child’s birth parents or relatives (McCarthy 2002). Key features for promoting families’ participation in the health care of their children include t
family-friendly strategies for gathering health history and consent from parents when children and youth are placed in foster care; t
participation of parents and out-of-home caregivers in their children’s and youth’s health care visits;

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t
home visits by nurses to provide specialized training about a child’s specific health care needs and to support parents and other caregivers in obtaining follow-up care; t
provision of needed health care for other family members; t
educating families about the need for certain types of consent as it relates to their child’s health care, including their rights to provide or deny consent, and involving them in the consent process; and t
focus groups with families and evaluation of family satisfaction with health care services. Families are usually the best resources for information about their children’s health care needs, but some social workers, and frequently the “system” itself, do not take advantage of their knowledge, as illustrated in the following case example (McCarthy et al. 2003). JOYCE

Joyce, the parent of two young children, put it this way, “At first, it was hard to work on the plan. I didn’t feel like I was a member of the team; most of them were strangers. I wasn’t really involved in the plan, but I still showed up for every meeting. I heard harsh things about what they said that I had done and what I had not done for my children. “In the beginning it felt like they were talking over my head. My mother and sister were taking care of my kids. Catena was four weeks old when I left her with my mother. She was born drug affected. They talked more to my mother than they did to me. I was doing what I was supposed to do. I had gone to treatment and was ninety days sober, but they still didn’t talk to me. I knew something about my children—things that only a mother knows. I wanted to tell them that Catena was colicky and Tyrone had the shakes, but they asked my mother about this instead of me. “I put my hand on the table and said, ‘Please talk to me.’ When the team couldn’t hear what I was saying, I wrote a personal letter for my worker to read to the team. She read it at the meeting. This really helped. It was the icebreaker for me.”

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Youth voice is also essential. Youth are given the opportunity to articulate the qualities they would like in their health and mental health providers and what types of treatment work and do not work for them. Youth are informed regarding confidentiality, consent, and access to their records. They are given the tools to become their own advocates. They are educated about their medical and mental health conditions, their treatment options, available medical services, and how to manage their conditions and maintain their health (American Bar Association 2010). Health care plans are developed with, not for, youth. Everyone involved with adolescents, including their social workers, must be ready for the ride and willing to include youth as central actors in planning for their own futures. One young woman, who was in foster care from age eleven through eighteen, poignantly describes what it felt like, at fifteen, to be left out of the planning process. My case review was scheduled for the middle of the afternoon. I had to get permission to leave school and go to the agency office. I arrived a little late, and the review had already started. They talked about my grades, my foster parents, and my birth mom. I listened to the conversation. Near the end, my social worker presented the plan for me to sign. I looked at it and discovered that in the health section it said, “Begin taking birth control pills.” I was astonished. At that point in my life, I had never had sex, I had no boyfriend, and I did not need birth control pills. I asked why this was part of the plan. My worker said that they wanted to be sure that I didn’t get pregnant. It really upset me that everyone at the table assumed that I was sexually active and that no one knew me well enough to know how I felt about my own sexuality. I refused to sign the plan.

Family-centered practice models acknowledge, in order to meet the needs of the families and youth they serve, that they must ask them about what kinds of services work for them. Because they are the ones with the expertise

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to pinpoint needed resources and recommend policy changes, families and youth are included at the system level in planning, implementing, and evaluating strategies for providing health care. Attention to Cultural Issues A knowledge of the diverse cultures represented among the children and families served by the child welfare system influences program development in a comprehensive framework for children’s health care. This knowledge is used in the creation of the provider network, during staff training, and in the design and delivery of health care services to meet the needs of individuals from these different cultures. The system incorporates an understanding of how people’s cultures and beliefs shape their view of health and illness. The system is responsive to diverse children, youth, and families, including those with limited English proficiency, low literacy skills, and/or disabilities. The system recognizes that children from different racial and ethnic backgrounds and lesbian, gay, bisexual, or transgender (LGBT) youth may have different health care needs; and families who are served by the child welfare system may have different cultural beliefs and practices that affect the delivery of health care services (Child Welfare League of America 2007). Traditional and nontraditional approaches to health care are offered. Providing culturally competent health care services for children in the child welfare system is a challenge in many communities. McCarthy (2002) found that many agencies interviewed for a study of health care approaches to children in child welfare did not collect data to substantiate the number of children and families served from various cultures. They identified challenges more easily than strengths related to providing culturally competent health care services. Challenges included t
assessment tools that are not adapted for different cultures;

t
assessment teams that are primarily white working with children who are primarily of color; t
pediatricians who have difficulty working with families of different cultures; t
difficulty finding providers who speak the language of the children served; and t
written reports that are not translated into a family’s native language. Characteristics that do facilitate the delivery of culturally competent health care for children and youth in the child welfare system include: t
recruiting culturally and linguistically diverse providers who reflect the population being served; t
developing community-based provider networks and locating clinics in the neighborhoods where children live; t
making health passports and other written materials available in the child’s or family’s primary language; t
implementing cultural competence training for child welfare and health care staff; t
implementing therapeutic interventions based in the child’s culture; and t
using trained medical interpreters. Monitoring and Evaluation Monitoring and evaluation in a comprehensive framework for children’s health care ensures that the health care procedures developed for children are actually being followed. Health outcomes for children are tracked; family, child, and provider satisfaction are assessed; and cost effectiveness is examined. Improvements are made based on the results of this monitoring system. Many states and communities find it difficult to determine and track individual child health outcomes. They are more likely to assess whether health care procedures are being followed than to ascertain change in the children’s health status. This tendency is due to a lack of resources and funding devoted to assessing health outcomes and to the short duration of

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involvement of many children with the child welfare system. The more common types of monitoring and evaluation activities include

Features that facilitate training about health care for children and youth in the child welfare system include

t
measurement of adherence to procedural requirements (e.g., tracking the number of children and youth who receive initial health screenings and comprehensive assessments, the percentage of children and youth who are assigned a primary care physician, the percentage of children and youth with up-to-date immunizations); t
follow-up care compliance (e.g., tracking whether the recommendations made in assessments are actually followed, tracking whether children with special health care needs receive appropriate services, determining whether children who meet the criteria for enrollment in early intervention services through part C of Individuals with Disabilities Education Act (P.L. 105-17) actually enrolled); t
monitoring provider performance; t
measuring child and family satisfaction; and t
tracking achievement of service plan goals.

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institutionalizing training about health care issues for children and adolescents in the child welfare system at all levels (e.g., as part of new worker training, in-service training, core training for new foster parents, ongoing training for experienced foster parents); t
providing hands-on training for families whose children have special medical needs (provided by nurses in the families’ homes); t
conducting informal consultation that occurs when health care and child welfare staff are located in the same office, when nurses are included in multidisciplinary team meetings, and when parents and foster parents make clinic and doctor visits with their children; t
providing cross-system training (i.e., new social work staff and foster care nurses participate in the same orientation sessions); and t
providing training for students and interns (e.g., rotations in foster care clinics that are part of teaching hospitals).

Training and Education As one component of establishing a comprehensive health care approach, training is offered to parents, caregivers, health care providers, child welfare staff, and other stakeholders. Training is individualized to fit the audience and may focus on such issues as general health and developmental information, special health care needs of children and adolescents in the child welfare system, access to resources and services, health care policies and procedures, and operation of the child welfare system. Parents, youth, and caregivers participate as co-trainers, helping others to learn from their experiences. Specific training about how to meet an individual child’s special health care needs is provided for caregivers. Cross-system training is a vehicle for helping the child welfare and health care systems work well together.

Funding Strategies State and community leaders understand how to use a variety of funding resources that are targeted for different aspects of health care (e.g., treatment services, care coordination, data management, administration, training). Flexibility in funding strategies is encouraged, waivers are requested, and different Medicaid options are pursued when necessary to ensure comprehensive health care services for children and youth in the child welfare system. Child-serving agencies enter into interagency agreements around the transfer of funds from one agency to another when needed to maximize funding resources. Medicaid and state funds are the primary funding sources for health and mental health

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services for children in the child welfare system; however, other sources are also used. Strategies for funding comprehensive health care services for children and youth in the child welfare system include t
using Medicaid funds strategically to cover administrative costs, case management, and clinical services; t
offering enhanced Medicaid rates for screening and assessing children in foster care; t
creating mechanisms to cover administrative costs (e.g., using special state budget allocations to cover administrative costs that are not funded through Medicaid, through a contracted arrangement with an organization that manages the system); t
pursuing funding from different sources and sharing the cost of services among the different systems (e.g., if a parent or a family member other than the identified child is not eligible for Medicaid, the child welfare agency may pay for health care services for these family members); and t
using incentives to encourage provider involvement and the provision of special services (e.g., fiscal incentives to motivate providers to complete health passports, patient management fees to help recruit pediatricians for long-term service). Tailoring Managed Care When children in the child welfare system are included in publicly funded managed care plans, the comprehensive approach ensures that their special needs are addressed in the design of the managed care system, contracts, the setting of capitation and case rates, the makeup of provider networks, and development of special provisions. Special provisions might relate to eligibility, enrollment, authorization of services, medical necessity criteria, the available service array, data collection, provider rates, and tracking outcomes.

Mechanisms exist to solve problems that arise from managed care and to ensure access, continuity of care (especially when children change placements), services for family members (in addition to the identified child), and understanding of the unique needs of this population. Training and ongoing support are offered to families to assist them in navigating the managed care system. Most states and communities now offer publicly funded health care services through some form of managed care. A national survey conducted in 2003 confirmed that 74 percent of the managed care systems responding to the survey cover children and youth in the child welfare system who are eligible for Medicaid. Sixty-six percent of the managed care systems cover children in state custody. In 90 percent of these systems, the enrollment of children in custody is mandatory rather than voluntary, and 42 percent of the systems covering these children are responsible for screening them as they enter custody to identify mental health problems and treatment needs (Stroul, Pires, & Armstrong 2004). Many parents who experience the multiple stresses that lead to involvement with the child welfare system need health, mental health, and substance abuse services and supports that are offered through managed care systems. If their needs are not identified and addressed by the managed care system, it will be more difficult to ensure the safety, permanency, and well-being of their children (McCarthy & McCullough 2003). Features that contribute to making managed care work for children and families in the child welfare system include t
participation by the child welfare system in the design, implementation, and evaluation of the managed care system and a commitment by the managed care organizations to serving children and families supported by the child welfare system; t
institutionalized problem-solving strategies and communication structures between the

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managed care and child welfare systems to address problems that inevitably occur (i.e., special liaisons or units in the child welfare agency who work closely with the managed care organization); and t
an established process to assist families and social workers in understanding and navigating the managed care system. Knowledge, Skills, and Attitudes Child welfare stakeholders must be prepared to fill many different roles (e.g., direct service, management, administration) when designing, implementing, and participating in a system of health care services for children and their families. Effectively fulfilling these roles requires certain knowledge, skills, and attitudes. The requisite knowledge includes understanding t
basic health care issues for any child (e.g., screening and assessment, check-ups, symptoms and treatments of common childhood diseases, immunization schedules and side effects); t
child development and the characteristics of a variety of developmental disabilities (typical and atypical behaviors); t
community health care resources; t
legislation that guarantees care and services for certain children and youth (e.g., the Individuals with Disabilities Education Act); t
how Medicaid works; t
principles, practice, and technology of managed care; t
impact that a child’s disabilities and special health care needs may have on his or her family; and t
issues related to attachment, separation, and trauma. In addition, caseworkers must have the skills to be able to t
collaborate with health care providers, families, and schools;

t
interview children, youth, families, and health care providers—knowing the pertinent questions to ask; t
determine when more information about specific health care issues is needed and seek out the information; t
facilitate and/or participate in family team meetings where child/family health care needs and services are addressed; t
navigate health care and managed care systems; t
help families navigate these systems; t
strategically access resources; t
observe and recognize the warning signs of developmental delays, disabilities, and special health care needs; t
make referrals for care; t
follow up appropriately on recommendations; t
monitor one’s caseload to ensure that no child falls through the cracks; and t
integrate safety, permanency, and wellbeing in planning with the child and family without sacrificing one goal for another. Attitudes that frame an effective approach to a health care system include t
strengths-based approach to service delivery; t
belief in collaborative processes; t
commitment to services that are provided within the context of the family and the community in which a child lives; t
acknowledgment that a child’s health and development influences his chance for safety, permanency, and well-being; t
strong belief in partnering with families, including all families involved with the child; t
support for a community-based approach in which the locus of services and the management and decision making rest at the community level; and t
respect for and attention to cultural diversity. YYY

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In this chapter we have discussed the complex health care needs of children in the child welfare system and the enormous challenge these needs pose for states and communities to create a comprehensive health care system that integrates health and social services for each child and family. We presented a framework for a comprehensive approach to health care in which t
each child’s physical health, mental health, and developmental needs are identified and then addressed in a predictable, timely, and thorough fashion; t
a designated person is responsible for coordinating each child’s care; t
providers of services are skilled, knowledgeable, and have sufficient time to devote to each child’s needs, as well as the needs of parents and caregivers; t
preventive health care is instituted and maintained; t
each child’s progress is monitored; t
caregivers and birth parents are fully informed and consulted about their children’s health care; t
intervention changes as circumstances change; t
all health information is documented and follows each child in a seamless fashion. Whether children and youth receive services in their own homes, in a relative’s home, in foster care, or in an adoptive home, they benefit from access to such a comprehensive health care system and appropriate services. The comprehensive system also enhances the ability of a state or community to achieve the three major goals of the child welfare system: safety, permanency, and well-being. For example, a child’s safety cannot be ensured if she requires medication the family cannot afford, if an untreated medical condition creates undue stress in the family and the potential for abuse, or if her medical history is unknown when the child is placed in foster care. Foster

parents who are unaware of a child’s allergies or medical conditions (e.g., asthma) are not prepared to respond appropriately in a health care emergency. To ensure a child’s safety and avoid life-threatening situations, parents, caregivers, agency social workers, and providers must have a clear understanding of a child’s health care needs and the services and supports required to meet those needs. Improving access to health care enhances a child’s chance for permanency. Access to adequate health care information assists parents, agencies, and courts in making appropriate placement decisions. Receiving appropriate health care services and supports increases the likelihood that a child’s placement (temporary or permanent) will succeed and remain stable. For children and youth to achieve positive well-being, their physical and mental health needs must be addressed along with their developmental and educational needs. In addition, parents must receive the services they need to enhance their capacity to provide for their children. Early and comprehensive care enhances a child’s chance for healthy development, provides supports for caregivers, can reverse bleak prognoses, and can strengthen families and enhance permanency (New York State Permanent Judicial Commission on Justice for Children 1999). As stated earlier, the Fostering Connections to Success and Increasing Adoptions Act of 2008 expanded federal requirements related to children in foster care by mandating that states explicitly create a plan for the ongoing oversight and coordination of health care services for these children. The provisions of this section of the act (section 205) support a collaborative approach and require that the plan be developed in consultation with pediatricians, other experts in health care, and experts in and recipients of child welfare services. This includes families and youth. The state plans will include many components of the comprehensive framework—identifying health care needs through screening, monitoring that the

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identified needs are treated, updating and sharing medical information, ensuring continuity of care, providing oversight of prescription meds, collaborating with others to determine appropriate treatment, and addressing continuing health care services for youth who are transitioning from the child welfare system to the adult health care system. In 2005, when the original version of this chapter was published, we acknowledged that, while many communities had been successful in developing and implementing promising approaches around one or more of the

framework’s components, it was rare to find any one community or state that had fully addressed all the components. Over the past few years more states and communities have attempted a comprehensive approach to health care for children in the child welfare system. With the recent support of federal legislation, it is anticipated that many more will follow. The outlook for expansion of a thoughtful, purposeful, and comprehensive approach to health care for children and youth in the child welfare system is looking significantly better than it did a few years ago.

REFERENCES

Child Welfare League of America (1988). Standards for health care services for children in out-of-home care. Washington, DC: Child Welfare League of America. Child Welfare League of America (2007). Standards of excellence for health care services for children in out-of-home care; retrieved September 26, 2010 from http://www.cwla.org/programs/standards/standards introhealthcare.pdf. Halfon, N., Inkelas, M., Flint, R., Shoaf, K., Zepeda, A., & Franke, T. (2002). Assessment of factors influencing the adequacy of health care services to children in foster care. Los Angeles: UCLA Center for Healthier Children, Families and Communities. Horowitz, S., Owens, P., & Simms, M. (2000). Specialized assessments for children in foster care. Pediatrics, 106, 59–66. Howze, K. (2002). Health for teens in care—a judge’s guide. Washington, DC: American Bar Association. Institute for Research on Women and Families, California Foster Children’s Health Project. (1998). Code blue: Health services for children in foster care. Sacramento: Center for California Studies, California State University. Leslie, L., Gordon, J., Ganger, W., & Gist, K. (2002). Developmental delay in young children in child welfare by initial placement type. Infant Mental Health Journal, 23, 496–516. McCarthy, J. (2002). Meeting the health care needs of children in the foster care system: Summary of state and community efforts. Washington, DC: Georgetown University Child Development Center. McCarthy, J., & McCullough, C. (2003). Promising approaches for behavioral health services to children and adolescents and their families in managed care systems: A view from the child welfare system. Washington, DC: Georgetown University Center for Child and Human Development. McCarthy, J., Marshall, A., Collins, J., Arganza, G., Deserly, K., & Milon, J. (2003). A family’s guide to

Administration for Children and Families 2011. Federal Child and Family Services Reviews Aggregate Report, Rond 2 Fiscal Years 2007–2010 December 16, 2011 retrieved October 26, 2013 from http://www.acf. hhs.gov/sites/default/files/cb/fcfs_reprot.pdf. Allen, K. (2010). Health screening and assessment for children and youth entering foster care: State requirements and opportunities. Issue Brief. Center for Health Care Strategies. American Academy of Pediatrics. (1994). Health care of children in foster care. Pediatrics, 93, 335–38. American Academy of Pediatrics (2000). Developmental issues for young children in foster care. Pediatrics, 106, 1145–50. American Bar Association (2010). Charting a better future for transitioning foster youth: Report from a National Summit on the Fostering Connections to Success Act. American Bar Association Commission on Youth at Risk Report; retrieved September 26, 2011, from http://www.abanet.org/youthatrisk. American Bar Association Center on Children and the Law (2011). Judicial guide to implementing the Fostering Connections to Success and Increasing Adoptions Act of 2008; retrieved September 26, 2011 from http:// www.nysnavigator.org/documents/JudicialGuidetoFosteringConnections.pdf. Battistelli, E. (1996). Making managed health care work for kids in foster care: A guide to purchasing services. Washington, DC: Child Welfare League of America. Casanueva, C., Ringeisen, H., Wilson, E., Smith, K., & Dolan, M. (2011). NSCAW II baseline report: Child well-being. OPRE Report #2011–27b, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Chernoff, R., Combs-Orme, T., Risley-Curtiss, C., Heisler, A. (1994). Assessing the health status of children entering foster care. Pediatrics, 93, 594–601.

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the child welfare system. Washington, DC: Georgetown University Center for Child and Human Development. Milner, J., Mitchell, L., & Hornsby, W. (2005). Child and Family Services Reviews: An agenda for changing practice. In G. Mallon & P. Hess (eds.), Child welfare for the Twenty-first Century (p. 718). New York: Columbia University Press. New York State Permanent Judicial Commission on Justice for Children (1999). Ensuring the healthy development of foster children: A guide for judges, advocates, and child welfare professionals. White Plains: New York State Permanent Judicial Commission on Justice for Children. Parent Educational Advocacy Training Center (n.d.). A system of caregivers—caring for children’s health; retrieved June 30, 2004, from www.peatc.org/FosterCare/children’s_health_2.htm. Pires, S. (2002). Building systems of care: A primer. Washington, DC: National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center. P.L. 93–247, Child Abuse Prevention and Treatment Act (CAPTA), (1974) and the CAPTA amendments of 2003 and 2010. P.L. 104–193, Personal Responsibility and Work Opportunities Act, (1996). P.L. 105–17, Individuals with Disabilities Education Act (IDEA) and the IDEA amendments of 1997, (1997). P.L. 105–89, Adoption and Safe Families Act of 1997, (1997). P.L. 110–351, Fostering Connections to Success and Increasing Adoptions Act of 2008, (2008). P.L. 111–148, Patient Protection and Affordable Care Act (2010). Ringeisen, H., Casanueva, C., Smith, K., & Dolan, M. (2011). NSCAW II baseline report: Children’s services. OPRE Report #2011–27f, Washington, DC: Office

of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Silver, J., Amster, B., & Haecker, T. (1999). Young children and foster care: A guide for professionals. Baltimore: Brookes. Simpson, G., Cohen, R., Pastor, P., & Reuben, C. (2008). Use of mental health services in the past 12 months by children aged 4–17 years: United States 2005–2006. NCHS data brief, no 8. Hyattsville, MD: National Center for Health Statistics. Sondik, E., Madans, J., & Gentleman, J. (2010). Summary health statistics for U.S. children: National Health Interview Survey, 2009. National Center for Health Statistics. Vital Health Statistics, 10, 247. Stroul, B., & Friedman, R. (1994). A system of care for children and youth with severe emotional disturbances. Rev. ed. Washington, DC: Georgetown University Child Development Center, Child and Adolescent Service System Program (CASSP) Technical Assistance Center. Stroul, B., Pires, S., & Armstrong, M. (2004). Health care reform tracking project: Tracking state health care reforms as they affect children and adolescents with behavioral health disorders and their families—2003 state survey. Tampa: Research and Training Center for Children’s Mental Health, Department of Child and Family Studies, Division of State and Local Support, Louis de la Parte Florida Mental Health Institute, University of South Florida. U.S. General Accounting Office (1995). Foster care health needs of many young children are unknown and unmet. GAO/HEHS-95–114. Washington, DC: U.S. General Accounting Office. Woolverton, M. (2002). Meeting the health care needs of children in the foster care system: Strategies for implementation. Washington, DC: Georgetown University Child Development Center.

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Mental Health Care for Children and Youth

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exy is the single parent of Patti, fourteen, Julie, eleven, and Tommy, eight. Tommy has pervasive developmental disorder and requires twenty-four-hour-a-day special care. Each morning, Lexy gets up at 5:00 A.M. to begin preparing for her day. She throws a load of clothes into the washing machine and feeds the cats before she showers and dresses, hoping against hope that Tommy will not wake up until she finishes putting on her makeup. The moment Tommy awakens, the turmoil begins. He calls out for her, and if she does not appear immediately he begins a high-pitched wail that quickly awakens Patti and Julie, sleeping in the next room. Next he begins banging his forehead on the wall, unless Lexy can immediately put his helmet on him to discourage this behavior. Then Lexy tries to persuade Tommy to use the bathroom and get dressed. Often this results in a physical altercation, with Tommy running out of the room and Lexy chasing him around the house to get him dressed. As he grows larger and stronger, the effort increasingly leaves Lexy exhausted and disheveled by the time the van arrives at 8:00 A.M. to pick Tommy up for his day treatment program. On several occasions during the morning effort to get him ready for school, Tommy has run out of the house and into the street, with Lexy grabbing him and physically dragging him back into the house. She can only imagine what the neighbors are saying about her failures as a single parent. Nancy and Bob Elliot dread the ringing of the telephone between the hours of nine and ten in the morning, the time the school calls to tell them that their thirteen-year-old daughter

Annalee has left school again. Often, Nancy has barely removed her coat from driving Annalee to school and delivering her to the door of her homeroom when the call comes. Nancy gets back in the car and heads downtown to “the strip,” an arcade that is the local hangout for high school dropouts, unemployed older men, and teenagers who have decided to cut school that day. She usually stops to pick up Bob at his office, as, alone, she cannot manage Annalee and, anyway, she tells herself, Annalee listens better to her father’s booming directives. If they are lucky, Nancy and Bob will quickly spot Annalee’s spikey dyed purple hair in the crowded arcade. Their daughter is usually hanging over the back of some leather-jacketed, heavily tattooed older teenager seated at one of the many video games, all of which seem to involve killing and destruction. After a scene, which often includes a gathering crowd of threatening-looking teens who curse and shout comments at Nancy and Bob, drawing the attention of the arcade security guard, who asks all three of them to leave, the Elliots manage to get Annalee into the car and drive home. All the way home, Nancy and Bob listen to a diatribe from their enraged daughter, telling them how much she hates them and threatening yet another suicide attempt (there have been three, all of which have resulted in brief psychiatric hospitalizations) or to run away from home and live on the streets like some of her friends on the strip. By the time they arrive home, Nancy is usually in tears, and Bob is in a silent fury. Annalee slams out of the car and locks herself in her bedroom, refusing 115

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to come out, even for dinner. On several occasions, the Elliots thought they detected the sweet smell of marijuana smoke drifting from under the locked door of Annalee’s room. Esther and Kevin Ross were thrilled when their caseworker with the public child welfare agency told them they had been approved as adoptive parents for three-year-old Sammy, their foster son. They knew that Sammy had been born with crack in his system and that he had spent the first eighteen months of his life living with his homeless, crack-addicted mother, who moved from man to man and place to place, occasionally landing in a homeless shelter where the staff would observe her harsh and careless treatment of her little boy. Finally, after several reports to protective services, as a result of which nothing was done, Sammy’s mother left him in the care of a fellow homeless shelter resident to run to the store for milk. She never returned. Sammy was placed into foster care with the Rosses, a middle-aged couple whose own children were grown. The Rosses quickly fell in love with Sammy, who seemed to need them desperately, crying hysterically when either one of them left his sight for even a few minutes. Because the child welfare agency could not locate Sammy’s mother and had no identity for his father, the agency moved quickly to terminate parental rights and free Sammy for adoption by the eager Rosses. After a very rocky first year of tantrums, night terrors, and eating and soiling problems, Sammy seemed to settle in to his adoptive home. Thus the Rosses were surprised and confused when Sammy started preschool and they began to get complaints from the teachers and other parents that Sammy was hitting and biting other children, especially the boys. He was caught repeatedly trying to put his hands down little girls’ pants. The Rosses’ two older children, both married with young children of their own, dropped by their parents’ home less and less often. Their younger daughter finally confessed that she had caught Sammy lying

on top of her two-year-old daughter, making sexual movements, and that she and her sister were afraid Sammy would physically harm their children. The Rosses contacted the child welfare agency that had placed Sammy with them for some direction and guidance, only to be told that once the child was adopted, because he had not been identified as a special needs child, the agency’s responsibility had ended. In each of the situations I have described, parents are struggling to care for children with serious mental, emotional, and behavioral (MEB) disorders. Scenarios like these are repeated hundreds of times daily all over the United States. Current epidemiological studies estimate that 18 percent to 22 percent of children and adolescents suffer from one or more diagnosable MEB disorders at any given time in this country, depending on the population studied and how data are collected (O’Connell, Boat, & Warner 2009). Recent studies of MEB in very young children have found similar rates of MEB disorders, with one review of available studies of preschool children age two through five determining an overall rate of disorder at close to 20 percent (Egger & Angold 2006). It is estimated that 9 percent to 13 percent of these children and youth are severely impaired in their daily functioning, depending on the type of diagnosis, number of symptoms, and comorbidity (Costello, Egger & Angold 2005). A recent report (Centers for Disease Control and Prevention 2013) presents data from different sources from 2005–2011 regarding numbers of children with specific MEB disorders. As the stories of Tommy, Annalee, and Sammy illustrate, MEB disorders can manifest themselves at any age, even in very young children. Externalizing disorders such as conduct disorders, attention-deficit/hyperactivity disorder (ADHD), and oppositional disorders are more commonly found in boys, while the internalizing disorders such as mood and anxiety disorders are more frequently identified in girls (Rutter, Caspi, & Moffit 2003). Mental, emotional, and behavioral disorders can

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interfere with a child’s developmental progress and her ability to interact with others, progress in school, and participate in community life and the workplace. And not only do MEB disorders negatively affect the child, they affect other individuals in the child’s environment as well, including parents, siblings, teachers, peers, and even neighbors. They also have a negative impact on community resources. Costello and her colleagues (2007) found that a substantial portion of the cost of treating MEB disorders was incurred by the child welfare, education, and juvenile justice systems in one community they studied. One estimate has put the cost to society of MEB disorders in children and adolescents at $237 billion annually (National Research Council & Institute of Medicine 2009). Since the early 1980s the mental health community in the United States has sought ways to respond more effectively to the mental, emotional, and behavioral problems of children. There have been a series of federal studies of this issue, including the influential Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda (U.S. Public Health Service 2000). This report called for improving the recognition and assessment of mental health needs in children as well as the widespread adoption of science-based prevention and treatment services. This was followed a few years later by a report to Congress, Promotion and Prevention in Mental Health: Strengthening Parenting and Enhancing Child Resilience (Substance Abuse and Mental Health Services Administration 2007), which incorporated a public health perspective to call for populationbased promotion of mental health and prevention of mental illness. Shortly thereafter, the Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions, a joint project of the National Research Council and the Institute of Medicine, issued a report on its own study of the prevention of mental, emotional,

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and behavioral disorders in young people (O’Connell, Boat, and Warner 2009). Each of these efforts has documented the extensive service needs and the lack of access to mental health services for a large portion of affected children and their families. Research indicates that only about one in five children who needs mental health services actually receives them. Among those living in poverty, in rural communities, and those who are members of minority groups, these figures are much lower (Flisher et al. 1997; Halfon, Inkelas, & Wood 1995; Owens et al. 2002). For the majority of children and adolescents, schools are the entry point to the mental health system, with the mental health and general health care systems a close second (Farmer et al. 2003). Children’s emotional and especially behavioral disorders are most often first identified in an educational setting, where teachers quickly become aware when a child’s difficulties negatively impact the classroom as a whole, as did Sammy’s. Over the past decade, the construct of executive function (EF) has emerged as key to self-regulation of behavior and development of social and cognitive competence in the preschool years as precursor to the capacity for learning in school (Best & Miller 2010; Center on the Developing Child at Harvard University 2011; Rueda, Posner, & Rothbart 2005). EF includes 1. working memory or the capacity to retain information and instructions for a sufficient period of time to inform performance of necessary tasks, 2. inhibitory control or the ability to master thoughts and impulses and resist distractions to focus on the tasks at hand, and 3. mental flexibility or the ability to respond in differing ways to different demands or to revise ways of doing things in response to new information. The study of EF is informed by recent discoveries in neuroscience about brain development in the earliest years of life and contributes to our understanding of the challenges that some children face in their readiness to manage the demands of a structured learning environment like kindergarten or first grade.

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Children like Sammy who experience trauma and adversity in their earliest years are more likely to have difficulties in EF that place them at profound disadvantage when they enter school or even preschool. Recent research on the effects of emotional deprivation and trauma in infancy has found that such exposure results in neurobiological changes that increase the risk of mental and emotional disorders in children and adults (Nemeroff 2004). Studies of children adopted from institutions in eastern Europe where they experienced extreme emotional neglect have found a pattern of significant MEB problems, including quasi-autism, disinhibited attachment, and inattention/overactivity (Colvert et al. 2008). There is growing evidence that adverse experiences in infancy and early childhood lead to long-lasting physical and chemical changes in the brain that impact development of cognitive skills like learning and memory, leading once again to problems in EF. Pediatricians and other health care providers are common sources of identification of serious problems in functioning in infants and toddlers. In Tommy’s case, his mother, who had two older children, noticed when he was just a baby that Tommy did not respond to her as her girls had done as infants. His tiny body stiffened when she held him and, when she tried to make eye contact with Tommy as she nursed him, he looked away as though avoiding her gaze. Tommy also rarely slept more than thirty minutes at a time, even at night, and seemed to startle and become frantic at the slightest noise. When she expressed her concerns to her pediatrician, he referred her to a local early intervention program designed to provide a multidisciplinary developmental assessment and evaluation for infants and toddlers thought to be suffering from physical, cognitive, communication, and/or social/emotional delays. For older children and adolescents, entry into the juvenile justice system is another point at which serious emotional or behavioral health problems may be identified (Farmer et al. 2003). Adolescents like Annalee, whose problems are

manifested in acting out behaviors such as skipping school, staying out past curfew, hanging out in unsavory areas of town, using illegal or controlled substances, and running away from home may find themselves reported to the juvenile authorities and detained as ungovernable or as a “person in need of supervision” in the local juvenile detention center. Many state juvenile justice systems now routinely screen all detained youth for mental health problems as well as indications of danger to themselves or others (Grisso & Underwood 2003; Nordness et al. 2002). A growing body of research is demonstrating that a high percentage of delinquent youth has one or more diagnosable mental disorders. One study of nearly two thousand youths in an Illinois detention facility corroborated earlier estimates that approximately 60 percent of youthful offenders meet DSM IV-R diagnostic criteria for at least one psychiatric disorder (Teplin et al. 2002). In the Illinois study 56.5 percent of female juvenile detainees and 45.9 percent of male detainees met criteria for two or more disorders. The most common co-occurring disorders were substance use, oppositional disorders, and conduct disorders. Children like Sammy, who come to the attention of child welfare authorities because of parental maltreatment, are at particularly high risk of MEB problems. Recent studies suggest that up to 80 percent of children entering foster care have significant MEB disorders (Leslie et al. 2004; Maughan & Cicchetti 2002; Teisl & Cicchetti 2008). This contrasts with 18 percent to 20 percent of children in the general population (O’Connell, Boat, and Warner 2009). A study by the Urban Institute found that, compared with other children, foster children had higher levels of emotional and behavior problems; more often had physical, learning, or mental health conditions that limited their psychosocial functioning; and were less engaged in school and more likely to have been expelled (Kortenkamp & Earle 2002). These findings are not unexpected given current understanding of the detrimental effects of trauma on early brain

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development and the finding that children in the first five years of life have the highest incidence of severe maltreatment. In one national study, just over 75 percent of children who died from child abuse or neglect were younger than four years old, and the highest death rate was between birth and one year of age (U.S. Department of Health and Human Services 2009). Even compared with children from similar socioeconomic and demographic backgrounds, children who enter foster care are at greatly increased risk for psychopathology (Burns et al. 2004; Jee et al. 2011; Stahmer et al. 2005). Despite research documenting the pervasive mental health needs of children and adolescents in the child welfare system, there is evidence that these needs are seldom adequately met (Hurlburt et al. 2004; Pecora et al. 2009). One national study of children in foster care found that just 15.8 percent of those in care for at least twelve months received any mental health services. Of children who scored within the clinical range on a well-established measure of child behavior problems (47.9 percent of children in the sample), 36.2 percent received no mental health services at all (Burns et al. 2004). In the round 2 of the Child and Family Service Reviews, states performed better on variables focusing on meeting the mental health needs of children and youth. Across the states, 77 percent of all applicable cases were rated a strength for assessing and meeting children’s mental health needs. The mental health items assess the agency’s ability to identify needs and facilitate appropriate services to meet those needs rather than determining the mental health of the child. While improvement was noted from round 1 to round 2 of the CFSRs, a common challenge remained with respect to this aspects of well-being in that the mental/behavioral health services available were insufficient to meet identified needs in thirty-two States. While it is likely that state child welfare agencies have worked to upgrade their provision of mental health services since the first round of Child and Family Service Reviews, findings

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such as those from the National Study of Child and Adolescent Well-Being (NSCAW) suggest significant problems in the ability of state child welfare authorities to address the extensive mental health needs of maltreated children like Sammy who enter out-of-home care (Hurlburt et al 2004; Stahmer et al. 2005). Once serious MEB problems are identified in children and adolescents, the question becomes one of cause and response: what combination of factors in the child and in the child’s environment is contributing to maladaptive functioning and what can be done about it? In this chapter I begin by exploring current understanding of the etiology of mental health problems in children and adolescents. I then discuss the processes available for identifying and classifying disorders in childhood as well as the types of disorders most often observed in young people and their prevalence across various domains. Current treatments are identified, particularly those that are evidence based or have strong empirical support for their effectiveness. Finally, I look at the system-of-care concept that informs provision of children’s mental health services in the United States, where those services are provided, and the public policies, including funding structures, that support or present obstacles to provision of mental health care to children and youth today. Etiology of Emotional and Behavioral Disorders in Children and Adolescents Although historically the debate over the causes of serious MEB in children centered on the relative contributions of nature or heredity versus nurture or the environment, currently the focus is on the processes by which nature and nurture interact to result in psychopathology (Calkins et al. 2007; Cicchetti & Blender 2006; Gunnar 2007; Isles & Wilkinson 2008; Masten 2011; National Scientific Council on the Developing Child 2010a; Rutter, Moffitt, & Caspi 2006; Teisl & Ciccheti 2008). Advances in the field of neuroscience and studies of the developing brain have increasingly revealed

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how the prenatal environment and experiences in infancy and earliest childhood can influence how a child’s genetic inheritance is expressed (National Scientific Council on the Developing Child 2010b). The brain and cardiovascular, immune, and other systems in the body communicate with one another through neural and endocrine processes. These processes respond to stress on the organism, which is interpreted by the brain. Stress and stress hormones produce both adaptive and maladaptive effects on the brain, which, in turn, alter physiological and behavioral responses in the human organism. In this way early life events influence development of patterns of emotion and behavior manifested throughout the life course (McEwen 2007). The concept of a normal developmental process that contains wide individual variations is a central tenet of current understanding of child psychopathology. That is, the normal behaviors of children at all ages vary considerably; however, at each developmental stage there are certain behaviors outside the boundaries of what is considered normal functioning (Cicchetti 2006; Cummings, Davies, & Campbell 2000). Thus, for an eight year old like Tommy, repetitive rocking, head banging, screaming when mother does not appear promptly, and running outdoors to avoid getting dressed for school are all behaviors that are clearly outside normal expectations for a child of that age. For Sammy and Annalee, their deviations from developmental norms are somewhat less clear. For a child of three to bite and scratch his schoolmates is verging on abnormal, although one might give a child like Sammy, who had little appropriate socialization in his earliest years, some latitude to see if he responds to the clear boundaries set by his classroom teachers. Similarly, Annalee, who is thirteen and in the throes of early adolescence, is exhibiting, in extreme form, some of the earlier developmental tasks of separation and individuation that are revisited at puberty. Her behavior could be better understood if viewed

in context: Is this new behavior for this child? Or does she have a history of oppositional and defiant behavior across previous developmental stages? In this current interpretation of childhood MEB disorders, there is an assumption that a child’s psychosocial development represents a series of adaptations, or, occasionally, maladaptations, to new experiences or changing situations determined by biological capacity, previous life experiences, and current environmental demands (Bierman et al. 2008). Some children who function within the bounds of normalcy at one developmental stage may be cognitively, emotionally, or behaviorally ill-equipped or ill-prepared to manage the demands of the next stage (Best & Miller 2010). Sammy, for example, may have functioned normally as a toddler at home with his adoptive parents, where the environment was familiar and highly structured and novel stimuli were limited. However, when he started preschool with new demands for controlling his inhibitions and other elements of executive functioning, coupled with heightened stimulation from the noise and excitement of other children, new surroundings, and a new routine, Sammy was unable to function within normative expectations. He reverted to an earlier, more primitive level of functioning, handling stress by biting and hitting other children. Adaptive and maladaptive behaviors in children overlap. They are inextricably linked, and to recognize the latter it is important to understand the former. As Achenbach (1990:4) noted, “many problems for which help is sought are quantitative variations on characteristics that may normally be evident at other developmental periods to a less intense degree, in fewer situations, or in ways that do not impair developmental progress.” Research on brain development, particularly in children who in early life have suffered physical and sexual abuse and/or physical and emotional neglect, helps us understand the psychosocial functioning of a child like Sammy (Nemeroff 2004). Maltreatment in infancy has

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effects on the developing brain that lead to biological modifications, resulting in changes in cognition and behavior and increasing vulnerability to stress, predisposing such children to development of psychiatric illnesses throughout life (Lieberman et al. 2011; Scheeringa et al. 2005). Trauma in infancy disrupts homeostasis in areas of the brain that respond to the stress of perceived threats. Clinical studies of severely maltreated children have identified symptoms of various mental and physical responses to trauma, including hyperarousal and dissociation (Chu & Lieberman 2010; Finkelhor, Ormrod, & Turner 2007). From a neurodevelopmental perspective, continuous arousal of these responses in infancy, when the brain is very malleable, floods the brain with certain chemicals, shaping its physical structure in particular ways and leading to sensitization, exaggerated responses to certain stimuli, and, eventually, maladaptive personality traits (Bogat et al. 2006; National Scientific Council on the Developing Child 2010b; Teicher et al. 2002). Observed sequelae of early childhood trauma thought to result from distortions in brain function include altered cardiovascular system regulation, affective lability, behavioral impulsivity, increased anxiety, increased startle response, and sleep abnormalities (Bogat et al. 2006; Margolin & Vickerman 2007). Based on magnetic resonance imaging of the brains of abused and neglected children, researchers find that trauma in infancy stunts development of areas of the brain that govern advanced cognitive functions, such as cause-and-effect reasoning and problem solving, essential components of the working memory dimension of executive functioning. As a result of both increased sensitivity to perceived threat and deficits in the capacity to understand or interpret events as other than threats to their physical and/or emotional safety, children like Sammy may respond in primitive ways to stressful situations and to developmental demands. Because the brain is still developing rapidly up until about age three, the effects of trauma on brain development can

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be ameliorated somewhat during that period. However, after age three these effects become a more permanent part of the child’s psychosocial functioning and require specialized treatment (Cohen, Mannarino, & Deblinger 2006; Fisher et al. 2006; Lieberman et al. 2011; Vickerman & Margolin 2007). Another area of research that has informed current understanding of the etiology of severe MEB disorders in children like Sammy is the study of infant/caregiver attachment. According to attachment theory, the nurturing relationships that an infant experiences with its earliest caregivers set the stage for the child’s ability to relate to others throughout life (Bowlby 1969). Attachment is constructed through day-to-day interactions between caregiver and child, the product of a process of mutuality driven by qualities in both the infant and the caregiver. The security children feel in these caregiving relationships allows them to venture forth to explore their environment, expanding their understanding and awareness of the world, and thereby promoting cognitive and social development. In cognitive terms, the quality of attachment enables the young child to develop an internal representational model of himself in relation to others and the expected responses of others when approached for protection and reassurance (Main, Kaplan, & Cassidy 1985). Frightening and stressful experiences may undermine a child’s confidence in a caregiver as protector, particularly if the caregiver is the source of those experiences. Our current knowledge regarding early attachment is the result of years of observational studies of parent-infant interaction in natural settings across various cultures. These studies have categorized types of attachment into three primary groupings—secure, anxious, and avoidant—which describe how the infant responds to her caregiver in a stressful situation (Ainsworth 1969; Ainsworth et al. 1978; Egeland & Farber 1984). More recent studies of infants raised by a rejecting or maltreating caregiver have identified a fourth category of

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attachment, termed “disorganized/disoriented” (Main & Solomon 1990). In this form of attachment the child has no organized pattern or coherent strategy for seeking protection in stressful situations, unlike children in the other three groups who react in predictable ways (Carlson et al. 1989). Young children who exhibit disorganized/disoriented strategies for seeking comfort when threatened or frightened are thought to have no effective means of managing stress. They are therefore likely to use more primitive methods of handling anxietyprovoking situations such as aggression and withdrawal. Whether these patterns of attachment established in infancy are lifelong is open to question. There is evidence that even secure attachments can be disrupted by subsequent stressful life events in childhood, such as the loss of a parent, or a traumatic experience, such as sexual abuse. Several studies have found a close relationship between the type of early attachment exhibited by a young child and that same child’s psychosocial functioning later in childhood (Carlson 1998; Carlson & Sroufe 1995; Lyons-Ruth, Alpern, & Repacholi 1993). Carlson (1998) found clear associations between disorganized/disoriented attachment in infancy, the mother/ child relationship in the preschool years, and disorders in behavioral functioning throughout childhood. Scholars currently believe that early attachment is not directly predictive of later functioning, but rather indicates the presence of a set of conditions that are associated with particular developmental paths for children (Sroufe, Carlson, Levy, & Egeland 1999). Developmental scientists now see attachment as “the dominant approach to understanding early socioemotional and personality development” (Thompson 2000:148). Longitudinal studies of children’s development began the process of identifying specific factors that place children at high risk of MEB disorders. These risk factors may be located in the child, in the family system, or in the environment within which the child

and family reside. One of the earliest longitudinal studies of the developmental life course of children was conducted on the Hawaiian island of Kauai by Emmy Werner (1986, 1993). This study, whose findings have been corroborated by other longitudinal studies, identified poverty, limited parental education, parental alcoholism, and parental mental illness as factors in the family system that present high risks to a child’s psychosocial development. Additional family factors such as large family size with closely spaced births, parent involvement in criminal behavior, loss of a parent through death or divorce, and severe marital discord (now termed intimate partner abuse or IPV) have been subsequently identified by other researchers as also having negative consequences for children’s future functioning (Egeland, Carlson, & Sroufe 1993; Luthar & Ziegler 1993; Rutter 1993). Child-specific risk factors identified in various longitudinal studies include premature birth, difficult temperament, male gender, low intelligence, and physical disability (Garmezy & Masten 1991; Luthar 1991). Community-level risk factors include high rates of interpersonal violence, crime, and drug trafficking; deteriorating housing stock; inadequate community institutions, such as schools, parks, and recreation facilities; and low levels of social supports for families (Coulton 1996; Ernst 2001; Levanthal, Dupere, & Brooks-Gunn 2009). Those who study factors that place children at high risk of MEB disorders stress that these risk factors are not predictive of psychopathology, but, instead, contribute to processes that may result in poor outcomes (Calkins et al. 2007; Cicchetti & Blender 2006; Masten 2011). Furthermore, the effects of risk factors are not uniform across different situations or among different people. Some researchers believe that there is a multiplicative effect, such that the co-occurrence of two or more risk factors exponentially increases the likelihood of maladaptive functioning in children (Owens & Shaw 2003; Sameroff, Gutman, & Peck 2003).

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Unfortunately, risk factors do tend to co-occur. Poverty, for example, is often accompanied by other risk factors such as limited parent education, large family size, single parenthood, residence in neighborhoods with high rates of crime and violence, and few family or community supports. The child poverty rate has climbed steadily as the economy has declined in the U.S. In 2009 the Census Bureau reported a child poverty rate of 20.7 percent, a significant increase over the already high rate of 18 percent just two years earlier. Evidence of the stressful effects of poverty and its associated risks on the mental health of children is found in a comparison of parental reports of high levels of behavioral and emotional problems in the National Survey of America’s Families, conducted in 2002. Poor parents reported rates of MEB disorders of 9.1 percent in their 6–11 year old children and of 11.1 percent in their 12–17 year olds. This contrasts significantly with rates of 5.8 percent and 7.0 percent reported by parents in higher income families (Duncan, ZiolGuest, & Kalil 2010). Although much is now known about individual risk factors, less is understood about the processes by which risk factors operate to produce poor outcomes for children. Certain risk factors, such as severe child maltreatment, appear to have a direct precipitating impact on the development of child psychopathology because of a negative impact on brain development (National Scientific Council on the Developing Child 2010a). Other factors, such as male gender or parental depression, contribute to dysfunctional outcomes only in conjunction with various direct factors. If we were to look closely at Annalee’s family over time, we might note a history of marital discord, paternal aggression, and maternal depression going back to Annalee’s birth. If Annalee was a baby with a difficult temperament—fussy, colicky, and difficult to soothe—with an emotionally fragile mother who was struggling to connect emotionally with her newborn and to please a loud, demanding, and threatening husband,

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the stage would have been set for problems in attachment between Annalee and her mother, which may have resulted in ongoing developmental vulnerability, currently manifested in early adolescence in struggles with autonomy and identity. Resilient is the term used to characterize individuals, children included, who exhibit positive psychosocial functioning in spite of the presence of significant risk factors and/or stressful events in their lives. Early researchers who identified factors that presented heightened risks for development of child psychopathology through their longitudinal studies also became aware of children who managed to survive, even thrive, despite adversity in their early lives (Masten 2007). They began to look for characteristics in children, families, and the environment that seemed to provide some protection against risks (Egeland 2007). Child attributes include an easygoing temperament, positive self-esteem, female gender, and internal locus of control (the belief that one can influence the external environment). Family characteristics include family cohesion and warmth, secure attachment to at least one consistent caregiver, and a positive, stable relationship between parent figures. Protective factors in the larger environment include the availability of a positive adult role model outside the home such as a teacher, coach, or religious leader; engagement in school; relationships with prosocial peers; and a safe, stable neighborhood with childfocused resources such as sports and recreation programs, boys and girls clubs, out-of-school time programs, and accessible health care. Current approaches to primary and secondary prevention of MEB disorders in children focus on identifying and reducing factors that place children at high risk for psychopathology such as family violence, parental substance abuse or mental disorders, or child maltreatment, as well as locating and enhancing factors that offer protection and increase resilience (Calkins et al. 2007; Cicchetti & Blender 2006; Luthar & Brown 2007).

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Mental Disorders in Children and Adolescents Types of Disorders and Their Prevalence Epidemiological studies of nonclinical community samples have provided an increasingly clear picture of the prevalence of MEB disorders among children and youth in the United States. The most common disorders up to age twentyfive as defined by the recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) include conduct disorder; oppositional defiant disorder, attention-deficit/hyperactivity disorder; anxiety disorders, including posttraumatic stress disorder; mood disorders; and substance abuse disorders. Some MEB disorders, such as the autism spectrum disorders and pervasive developmental disorders, bipolar disorder, eating disorders, schizophrenia, and obsessive compulsive disorder, are less frequent; however, these disorders are often profoundly challenging to those children and youth who have them and to their families and others who care for them. According to statistics from the Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults (O’Connell, Boat, & Warner 2009), the overall prevalence of MEB disorders in young people is 17 percent. For depression, the prevalence rate is 5.2 percent, for anxiety disorders it is 8.0 percent, for ADHD it is 4.5 percent, for any disruptive behavior disorder (conduct disorder and/or oppositional defiant disorder) 6.1 percent, and for substance use disorder 10.3 percent. These prevalence rates are fairly consistent across multiple studies and across cultures. About half the children and youth with these diagnoses are significantly impaired in their daily functioning in the commonly measured domains of relationships with family and peers, learning in school, and community participation. Studies have also looked at the percent of children and youth who have ever received a diagnosis of an MEB disorder and found that, by age sixteen, 37 percent to 39 percent of youth have received such a diagnosis (Jaffee, Harrington, Cohen, &

Moffitt 2005). By age twenty-one this percentage rises to 40 percent to 50 percent. According to researchers, children often have more than one MEB disorder, and there are common patterns of comorbidity among these disorders. For example, children and youth with disruptive behavior disorders are also commonly diagnosed with ADHD and substance abuse disorders, while those with mood disorders often have accompanying anxiety disorders (Roberts, Roberts, & Xing 2007). Perhaps even more important than the presence of a diagnosis of an MEB disorder or constellation of disorders in children is the impact of the disorder on a child’s psychosocial functioning. Although an anxiety disorder or simple phobia may be limiting to a child and frustrating to the immediate family, research suggests that it is the so-called externalizing disorders— substance abuse, disruptive behavior disorders, and ADHD—that have the most detrimental effect on a child’s functioning across all life domains. As we shall see later in this chapter, with the possible exception of ADHD, these are also the MEB disorders that are least likely to be effectively treated in school settings, where most early problems are identified. Until the law was revised by Congress in 2004, youth with externalizing disorders could be denied services under the Individuals with Disabilities Education Act (IDEA) because of an exclusionary provision for children deemed “socially maladjusted.” With the 2004 reauthorization of IDEA, whose name was changed to the Individuals with Disabilities Education Improvement Act (IDEIA), a child whose problem behavior was a symptom of a diagnosed MEB disorder could not be denied a free appropriate public education in the least restrictive, most normal environment available. Further, for a school to expel or remove a child from her current educational setting for more than ten days in a row because of the child’s conduct, a manifestation determination hearing must be held to determine whether the behavior in question was “caused by, or had a direct and substantial

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relationship to, the child’s disability” (U.S. Department of Education 2009). If so, school personnel, in collaboration with the child’s parent(s) or other caregiver, must conduct a functional behavioral assessment to identify the context of the problem behavior (antecedents and consequences) and develop a behavioral intervention plan. Exceptions to the requirement to retain a child whose behavioral difficulties are associated with a specific diagnosis include a child who carries a weapon to school, uses or sells illegal or controlled substances on school property, or has inflicted serious bodily injury on another person while on the school premises. In these instances school personnel can require the removal of a child to an alternative educational setting that is more appropriate for the child. Not long ago Annalee’s parents, Nancy and Bob Elliot, were notified by the principal of Annalee’s junior high school that if their daughter missed as few as four more school days during the year, she would fail all of her subjects and be retained in her current grade for the following year. The Elliots knew that if that happened Annalee would drop out of school altogether and they would lose her completely to the streets. At the suggestion of a neighbor who had experienced similar difficulties with her son, the Elliots responded with a letter to the principal requesting an evaluation for special education services for their daughter as required by part B of IDEIA. In response, they received a letter from the school notifying them that a psychological and educational evaluation of their daughter had been scheduled and informing them of the Elliots’ rights as parents to participate as part of the team in the preparation of an Individualized Educational Plan (IEP) if Annalee is assessed as having special educational needs under IDEIA. In Annalee’s case this would likely entail a DSM V psychiatric diagnosis. The letter also described their rights under the Family Educational Rights and Privacy Act (FERPA) and informed them of the appeal procedures available if they disagree

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with the findings of the evaluation or the services offered to Annalee in her IEP. Assessment and Diagnosis of Mental Disorders in Children and Adolescents The purpose of assessment and diagnosis of MEB disorders in children and adolescents is twofold: 1. to understand the unique dimensions of individual biopsychosocial functioning and 2. to identify signs and symptoms of specific diagnostic categories. Thus the focus is on both understanding the child within its unique biopsychosocial context and fitting that child into a nosological scheme that can inform interpretation and aid treatment of a particular disorder. The Diagnostic and Statistical Manual of the American Psychiatric Association, which first added specific child-related classifications in 1980, has undergone a number of revisions over the past thirty-plus years to better reflect current research and clinical knowledge regarding childhood disorders. Diagnostic criteria are increasingly specific to ensure reliability in diagnosis. Despite these efforts, assigning diagnostic labels to children is more challenging than with adults because the expression, manifestation, and course of disorders in children is less clear than in adults and is often age and developmental-level specific. For example, the diagnostic significance of biting in young children changes radically over a period of just months. When an eighteen month old bites the arm of another child, we are not especially alarmed about the biter’s psychosocial functioning; infants and toddlers use their mouths in a variety of ways to express themselves and explore the world. However, when Sammy at age three bites his classmates, particularly as one of a constellation of aggressive behaviors, it is cause for concern. Or, consider Annalee’s oppositional defiant behavior, which, although of concern because of its potential for placing her in high-risk situations with long-term negative consequences, is not uncommon and unexpected in an adolescent girl of thirteen in the throes of puberty. If Annalee were a few

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years older and still engaging in this behavior, it would have very different diagnostic implications and be of much greater concern regarding the prognosis for a stable adulthood. Developing a clearer understanding of Annalee’s difficulties requires a more nuanced picture of her present and past biopsychosocial functioning and stressful life events than simply knowledge of her current symptoms. Contextualized understanding of a child’s functioning requires assessing multiple domains of the child’s life. This involves gathering information from a diverse array of informants: parents or other caregivers (grandparents, foster parents, older siblings, extended family); daycare providers, classroom teachers, and other school personnel such as social workers or guidance counselors who may have had contact with the child; pediatricians or other health care providers who have observed the child over time; and religious leaders, coaches, and others in the community who may have played a significant role in the child’s life. As the earlier quotation from Achenbach and the identification of domain-specific functional impairments suggest (Blair 2002; Colvert, Rutter et al. 2008; Luthar & Brown 2007), maladaptive behavior in children may be limited to a single domain, such as home or school, or it may be pervasive across all areas of a child’s life. Assessing the child’s ability to function in each domain allows for a more complete and complex understanding of the level and type of disturbance and of treatment possibilities. Labeling a child like Tommy as having pervasive developmental disorder only describes a child with a set of limiting conditions, not an individual with strengths and potential (Volkmar et al. 2004). Developing an understanding of an individual child’s potential as well as his limitations is crucial in assessment and treatment planning. Partnering with parents and other family members in this process, as now called for in most mental health legislation, helps practitioners focus on a child’s or an adolescent’s strengths;

most parents, even those as worn out with caring for a challenging child as Tommy’s mother, Lexy, see their child as much more than his special needs. Lexy and Tommy’s sisters Patti and Julie notice Tommy’s small achievements, like putting on his socks with the heels in the right place or spreading peanut butter on bread without covering the table with it; they smile at his delight in the dolphins cavorting at the zoo or at the ants that busily scurry across the garden path. Assessment of a child with an MEB disorder is a narrative of who that child is and who she can become. This narrative should encompass more than disability; it should also include possibility—for the child and for the family. Treatment of Mental, Emotional, and Behavior Disorders in Children and Adolescents Until the latter part of the twentieth century, the range of treatments for childhood MEB disorders was relatively limited; play and talk therapies, milieu therapy, recreation therapy, and behavioral interventions based on social learning theory represented the extent of the clinical repertoire. Since the early 1980s, with extensive funding support from the National Institute of Mental Health, there has been an explosion in the development and testing of new models of treatment for children and adolescents, both psychopharmacological and psychosocial. Currently, the expectation is that treatments will be evidence informed if not wholly evidence based. Evidence-based treatments are those whose effectiveness with a particular population and diagnosis or condition has been demonstrated through rigorous scientific research and whose application is welldefined and replicable (Brestan & Eyberg 1998; Burns, Hoagwood, & Mrazek 1999; Compton, Burns, & Egger 2002; Farmer, Compton, Burns, & Robertson 2002; Gleason et al. 2007; Kazdin 2003; McClellan & Werry 2003). In response to federal mandates to demonstrate the effectiveness of various approaches to treating MEB disorders in children and youth,

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as well as to pressure from managed care companies to contain health care costs, efforts in the psychiatric community have increasingly focused on classifying childhood disorders and specifying targeted treatments, particularly psychopharmacological interventions. A 2002 article written by the head of the Child and Adolescent Treatment and Preventive Intervention Research Branch of the National Institute of Mental Health focused almost exclusively on the use of psychotropic medications for a range of childhood disorders, including depression and anxiety, ADHD, autism, and schizophrenia (Vitiello 2002). Although both the National Institutes of Health and the American Academy of Child and Adolescent Psychiatry had issued psychosocial treatment recommendations (American Academy of Child and Adolescent Psychiatry 2001), the Vitiello article acknowledged that research on psychosocial interventions for children has been hampered by the inability to garner private sources of research funding compared to the extensive funding of pharmacotherapy studies by the pharmaceutical industry. A study published in the journal of the American Medical Association “found that the number of preschoolers taking stimulants more than doubled between 1991 and 1995, and the number of children taking antidepressants increased 200 [percent]” (Zito et al. 2000). In more recent studies of preschoolers with MEB disorders, 12 percent to 16 percent have been treated with psychotropic medications (DeBar et al. 2003; Luby, Stalets, & Belden 2007). In 2007 a work group formed under the auspices of the American Academy of Child and Adolescent Psychiatry to study the use of pharmacotherapy in young children noted that there is not a broad evidence base for the use of most psychotropic medications in children under six years of age (Gleason et al. 2007) and encouraged avoidance of medications when effective psychosocial interventions are available. Much of the application of psychopharmacological treatments in children is based on the use of these medications in adults. The

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underlying assumption is one of continuity in psychiatric disorders throughout the life span; however, there is limited research supporting this belief. Symptoms of MEB disorders in children are generally more global and less categorical than in adults. Because of their limited cognitive development and abbreviated range of behavioral responses, a specific symptom in a child may indicate a variety of problems. For example, early morning wakefulness, which in adults is often a symptom of depression, may, depending on a child’s developmental stage and individual biopsychosocial functioning, signify a still unregulated biological clock, a nightmare, hunger, a wet diaper, or a response to a change in environment or routine such as a move to a new dwelling. It might also signify a child’s entry into a new developmental stage, such as beginning kindergarten. For some adult mental illnesses, such as bipolar disorder, which has been increasingly diagnosed in even very young children over the past decade (Moreno et al. 2007), there is the question as to whether these mental illnesses can actually occur in children because of the underdevelopment of certain parts of the brain until late adolescence or early adulthood (American Academy of Child and Adolescent Psychiatry 2007). Psychopharmacological Interventions with Children There is no question that some medications are strikingly effective in treating certain childhood disorders. For example, the effectiveness of methylphenidate (Ritalin) for treatment of ADHD is well-established (American Academy of Child and Adolescent Psychiatry 2002; Gleason et al. 2007;Wilens et al. 2005). Randomized clinical trials, the gold standard for establishing evidence-based treatments, have repeatedly demonstrated that methylphenidate is effective in managing core ADHD symptoms of inattentiveness, distractibility, and agitation as well as increasing compliance and reducing aggression in children three years of age and older (Gleason et al. 2007; McClellan & Werry 2003). There

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is also good clinical evidence supporting the use of selective serotonin reuptake inhibitors (SSRIs) for treatment of depression and clomipramine for obsessive-compulsive disorder in children (Bridge et al. 2007). According to one review of evidence-based psychopharmacological treatments, some studies support the use of SSRIs with other anxiety disorders in children as well (McClellan & Werry 2003). However, in 2004, the U.S. Food and Drug Administration issued a warning that SSRIs (Prozac, Zoloff, Paxil, Luvox, and others) may cause an increase in suicidal thoughts and behaviors in children and adolescents. While subsequent studies have not found such an association (Simon et al. 2006), it is generally advised that youth who are prescribed an SSRI should be monitored carefully for any increase in depressive symptoms. Other psychopharmacological treatments of childhood disorders are generally based on limited studies or have been extrapolated from adult use. Such issues as small sample sizes, problems with diagnostic inclusion criteria, high placebo response rates, and short treatment duration have limited the number of well-designed and executed studies that can establish the effectiveness of psychopharmacological treatments in children. Furthermore, there are few studies establishing the long-term physiological effects of such treatments over time. Some drugs, particularly some of the neuroleptics, are known to have serious side effects in adults; how these will affect the developing organism in a child is unknown (Gleason et al. 2007). Thus, in addition to using evidence-based psychopharmacological treatments instead of unproven ones, children’s mental health experts advocate using psychosocial interventions with proven effectiveness. Evidence-Based Psychosocial Interventions for Children and Adolescents Historically, individual psychotherapy was the treatment of choice for older children, whereas play therapy was used to treat emotional and behavior problems in younger children.

Traditional forms of psychotherapy include supportive, psychodynamic, cognitive-behavioral, and interpersonal therapies, as well as those based on family systems theory. Since the early 1990s, however, there has been a significant push to use only those treatments with wellestablished scientific evidence supporting their effectiveness. This effort has gained momentum in the last decade such that most federal and state agencies as well as private insurers that fund children’s mental health services require evidence-based treatments to be used whenever possible. Several handbooks for practitioners outlining evidence-based therapies for children and adolescents have been published (LeCroy 2008; Gullotta, Blau & Ramos 2007; Steele, Elkin & Roberts 2008; Weisz & Kazdin 2010; Weisz 2004), including for specific child populations such as infants and young children (Mowder, Robinson, & Yasik 2009) and for specific practice locations such as schools (Macklem 2011; Mayer et al. 2011). One widely used form of psychotherapy with children for which there is strong evidentiary support is cognitive-behavioral treatment. This treatment has proven effective for a variety of emotional and behavior disorders exhibited by children and adolescents, including anxiety and depression, PTSD, adjustment and conduct disorders, eating disorders, and ADHD (Chorpita & Daleiden 2009; Chorpita et al. 2011; Weisz & Gray 2008; Wethington et al. 2008). Cognitive distortions are believed to play a major role in many children’s MEB disorders because their immature cognitive development heightens the possibility of misinterpreting or misperceiving situations or events. The focus of treatment is on 1. identifying and changing cognitive distortions that contribute to the child’s difficulties, 2. learning new behaviors or skills for coping with situations that provoke anxiety or reactive behavior in the child, 3. testing newly acquired skills in novel situations, and 4. processing their outcomes with the therapist. Such cognitive strategies as self-talk and guided imagery are taught to the child to help mediate anxiety.

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Cognitive-behavioral therapies are usually time limited, often lasting for sixteen sessions or less. Supplementary meetings are held with parents or other caregivers to teach them the basic principles of the approach so they can reinforce its continued use after formal treatment ends. Another form of evidence-based treatment for children and youth with oppositional and aggressive behaviors is parent management training (Dretzke et al. 2005; Kazdin 2008). Parent management training is based on research that shows that parents or caregivers unintentionally reward a child’s negative behavior by overresponding to the child when such behavior occurs and, at the same time, ignoring the child when his behavior is positive. The child’s negative behavior is reinforced by the parents’ attention even when the attention is also negative, such as yelling, name-calling, threats, or physical aggression. This type of interaction between parent and child is termed the “coercive family process” and is thought to contribute to development of oppositional and conduct disorders in children (Patterson 1982). The focus of parent management training is on teaching parents to alter this coercive interaction pattern by not responding to their child’s provocative behaviors, by attending to and rewarding positive or desired behavior, and by ignoring or delivering mild forms of punishment to extinguish negative behavior. Parents are helped to set clear rules and expectations for their child to follow and taught how to negotiate and compromise with their child to achieve desired outcomes. Treatment sessions are held primarily with parents to allow them to review and practice their newly learned skills, role-play situations in which they apply the principles they are learning, and review the behavior change program they are implementing at home. Treatment is relatively short-term, the length depending on the extent of the child’s difficulty and the parents’ ability to grasp and apply the program’s principles—usually from four to eight weeks for parents of young children and somewhat longer, twelve-plus weeks,

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for parents of adolescents with serious conduct problems (Kazdin 2008). Parent management training has been extensively studied and is well supported by empirical research (Dretzke et al. 2005; Mabe, Turner, & Josephson 2001). The model has been applied in diverse settings (home, school, community, residential institutions) with a range of age groups and across cultures. Improvements observed in child behavior have been maintained for as long as ten to fourteen years. Adaptations of this model using videotapes of groups of parents of young children with conduct problems have received strong empirical support as well. Disruptive behavior like Sammy’s, which can range from relatively minor actions (e.g., talking back) to more severe forms of aggression (e.g., hitting, biting) is the most common reason for referral of preschool children for mental health services (Mowder, Rubinson, & Yasik 2009). One evidence-based treatment designed to assist children like Sammy and their parents is parent-child interaction therapy (PCIT) (Eyberg & Bussing 2010; Zisser & Eyberg 2010). This intervention focuses on strengthening the attachment between parent and child, essential for a child like Sammy who has an early history of disordered/disorganized attachment resulting from maltreatment as well as separation and loss of a birth parent: PCIT posits that “a secure, nurturing relationship is a necessary foundation for establishing effective limit setting and consistency in discipline that will achieve lasting change in the behaviors of parent and child” (Brinkmeyer & Eyberg 2003:205). There are two phases to PCIT. The first focuses on developing the parent-child relationship, and the goal of the second phase is to improve parents’ ability to set limits and apply consistent discipline. The effectiveness of PCIT in reducing children’s disruptive behavior and increasing parenting competency has been demonstrated in a number of controlled studies comparing outcomes for families receiving PCIT to those for families on a treatment wait-list (Berkovitz et al. 2009).

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Intervention with young behaviorally disordered children like Sammy is essential because studies have repeatedly shown that children with severe MEB disorders in the preschool years are at greater risk for antisocial behaviors and criminal involvement as adolescents and young adults (Burke, Loeber, & Birmaher 2002; Egger & Angold 2006; Webster-Stratton, Reid, & Hammond 2004). Given the current understanding of children’s MEB disorders as having multiple causes, it follows that several of the treatments considered to be evidence-based focus on the multiple systems that interact to support or ameliorate a child’s problematic functioning. For youth with conduct disorder and associated comorbid disorders, such as substance abuse, there are several family- and community-based approaches that have been shown to be effective in multiple outcome studies. These include multisystemic family therapy (MST), which works simultaneously with the family, youth, peers, and school to identify and address obstacles and establish supports for the youth and family in their quest for change (Henggeler et al. 2009). The developers of MST have worked to ensure treatment fidelity by tailoring the intervention’s application to antisocial behavior and MEB disorders and by licensing the intervention and mandating training from MST Services (www.mstservices. com/programdesign.pdf). The MST model has been empirically tested in a number of studies, including several using randomized controlled trials (Schaffer & Borduin 2005; Stambaugh et al. 2007; Timmons-Mitchell et al. 2006). However, Littell (2005) has raised questions regarding the model’s effectiveness (see Henggeler, Schoenwald, & Borduin 2006 for a response to this critique). In their review of evidence-based practice in child and adolescent mental health services, Hoagwood and her colleagues (2001) cited MST as having among the strongest empirical support of any children’s treatment. These authors note that research on MST suggests that supervision and training of clinical

staff and institutional support for the model are key to successful outcomes. Other family-focused treatment models with strong empirical support include multidimensional family therapy (MDFT), developed to treat adolescent substance abuse and associated conduct problems. It has been empirically tested in multiple studies with ethnically diverse populations and a range of problem severities (Liddle et al. 2008; Liddle et al. 2009); MDFT is listed on the federal National Registry of Evidence-Based Programs and Practices as a treatment model that has a strong evidentiary base (www.nrepp.samhsa.gov). Similarly, the familybased treatment model developed in Pennsylvania under that state’s Child and Adolescent Service System Program (CASSP) initiative was found to be effective in a study of nearly two thousand participating families in preventing crisis hospitalization of children with severe MEB disorders and stabilizing them in their families and communities (Lindblad-Goldberg, Jones, & Dore 2004). This intervention is based on ecosystemic and structural family therapy principles. Research on this model highlights the multidetermined nature of MEB disorders in children, finding that one-third of families in the study were known to multiple state service systems, including child welfare, substance abuse, adult mental health, and criminal justice (Lindblad-Goldberg, Dore, & Stern 1998). Another family-based treatment listed on the National Registry of Evidence-Based Programs and Practices is brief strategic family therapy (BSFT), developed at the Center for Family Studies at the University of Miami specifically for conduct disorders and substance-abusing Hispanic youth and their families (Robbins et al. 2010). According to its authors, BSFT was developed from a Hispanic perspective, recognizing and addressing cultural factors, particularly those stemming from different rates of acculturation between parents and children, which contribute to development and maintenance of serious conduct problems in youth (Coatsworth 2001). BSFT, whose outcomes

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have been tested in randomized clinical trials (Santisteban et al. 2003), is highly structured, problem-focused, and directive. It is intended to provide parents with practical experiences in effecting changes in their child’s functioning (Robbins et al. 2010). Each of these family-based treatments views the child or adolescent with severe MEB disorders as embedded in a context described by family, school, community, and peers, all of which must be engaged to support improved psychosocial functioning in the child. Even family-based treatments that originally drew primarily on family systems theory to inform their intervention strategies have expanded their purview well beyond the family to target the youth’s social ecology, including peers, school personnel, community organizations and agents, other involved service systems, and the family’s formal and informal support networks. In Annalee’s case a family-based approach might begin working with Annalee and her parents together to assess the situation and develop a clearer understanding of the history of their current difficulties as well as the commitment of each family member to changing the situation. Concurrent individual treatment with Annalee might aim to help her establish personal goals for herself and identify strategies and actions to achieve those goals. Treatment with Annalee’s parents together would draw on principles of parent management training to help Nancy and Bob Elliot learn new ways of responding to and managing their daughter’s oppositional and defiant behavior. The clinician might also help the Elliots seek out a couples group for parents of early adolescent girls with MEB challenges. Local chapters of the National Federation of Families for Children’s Mental Health (www.ffcmh.org) often sponsor groups for parents of children with MEB disorders and, if not, have information about accessing such groups locally. State affiliates of the National Federation go by various names such as Parent Support Network: National Federation of

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Families for Children’s Mental Health; a list of state and local organizations and their contact information can be found on the National Federation Web site. Parents repeatedly report that being put in contact with other parents who have the same or similar struggles with children with MEB disorders is the single most helpful intervention they experience. These local parent organizations often have helpful information about resources for families and children with MEB disorders such as schools, summer camps, and after-school programs. They also play an advocacy role with local, state, and federal funders of services for children with these disorders. Intervention with Annalee’s school would focus on securing an educational assessment to determine if there are any undiagnosed special learning challenges or needs and to access the services and supports she would require to succeed in high school. Community resources would also be engaged to help Annalee find satisfying and sustaining supports outside the family as she seeks to establish her autonomy in more prosocial ways. Young teens like Annalee can often be engaged in volunteer activities that help to build a sense of self-esteem and feelings of self-efficacy by giving to others. Helping Annalee engage with prosocial peers would also be a focus of a family-based approach. Connecting with activities that interest a young adolescent girl, such as an art class, a modeling class, or a theater group, where other teenagers with similar interests can be found, is an essential component of a multidimensional treatment approach. Mental Health Services for Children and Youth Prior to the late twentieth century, mental health services for children consisted primarily of two types of care: 1. long-term care in inpatient settings, such as residential treatment centers and state psychiatric hospitals, and 2. outpatient treatment in a mental health center, psychiatrist’s office, or child guidance clinic.

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Partial hospital or day-treatment programs, usually affiliated with an inpatient psychiatric facility or residential treatment center, were available in some urban communities, as were treatment foster homes or group homes for MEB-disordered youth. The latter were often run by religious or secular child-serving organizations with minimal efforts at treatment. Mental health care of children during this time was dominated by psychodynamic theories of the origins of childhood mental disorders that frequently saw the family, particularly the mother, as the primary causal agent in the child’s distress. Separating the child from the family was a preferred course of treatment. In some facilities, such as Bruno Bettelheim’s residential treatment center, the Sonia Shankman Orthogenic School, located on the University of Chicago campus, parents were not allowed any contact at all with their children for as long as a year because of Bettelheim’s belief about their lethality to the child’s recovery process. Indeed, Bettelheim was one of the chief proponents of the then popular, now discredited, theory of the “refrigerator mother” whose withholding of maternal affection resulted in childhood autism (Bettleheim 1967). Many social factors converged to bring about a sea change in children’s mental health services during the last decades of the twentieth century. The family therapy movement, which began in the late 1950s and gathered steam during the 1960s and 1970s, strongly rejected psychodynamic interpretations of children’s MEB disorders. Family therapy, informed by general systems theory newly popular in the hard sciences, focused on the functioning of the family system as a whole and on the role played by the child’s symptoms in maintaining dysfunctional family interaction. In the view of family therapists of the time, it was a mistake to treat the child apart from the family, as systems theory suggested that removal of one family member’s symptoms would simply result in another family member becoming symptomatic and assuming the role of the identified patient in order to

maintain the system’s customary functioning. Although this approach helped remove parents as the focus of blame and engaged them as partners in the therapeutic process, the most prominent early family therapists, many of whom were male psychiatrists, continued the traditional medical role of expert authority. It was another, parallel movement that gave parents a real voice in their children’s treatment process. During the mid-twentieth century, a series of lawsuits brought by advocates and parents whose children were residing in state-run facilities for persons with developmental disabilities and mental illnesses challenged the level of care provided in such institutions. Graphic court testimony about the abuse and neglect perpetrated on hapless and helpless residents led to a series of legal decisions requiring states to provide adequate care for all those with handicapping conditions in the least restrictive, most normal settings possible. In response, large state institutions downsized practically overnight or closed their doors completely, releasing residents, including many children with serious MEB disorders, back into their families and communities. Parents who had become skilled advocates in working for institutional reform now turned their attention to ensuring that community institutions, such as schools and mental health centers, provided the services their children required. In 1982 Jane Knitzer and her colleagues at the Children’s Defense Fund documented the consequences of failing to provide adequate community mental health services for children. In response to Knitzer’s findings and to pressure from parent advocacy groups, the federal government initiated the Child and Adolescent Service System Project (CASSP), designed to assist the states in developing a continuum of mental health services for children (Pumariega, Winters, & Huffine 2003). The CASSP initiative incorporated a set of principles intended to inform creation of a “system-of-care” for children’s mental health services. These principles, first articulated by Stroul and Friedman

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in 1986, have become the central organizing force shaping development of children’s mental health services in the United States today. System-of-care principles include 1. attention to the individual needs, preferences, and cultural characteristics of the child and family; 2. use of a strengths-based rather than deficits-informed approach to assessment and treatment; 3. involvement of families in their children’s care and in program and system development; 4. cross-agency coordination and collaboration in service system management and service delivery; and 5. use of the least restrictive service setting that is clinically appropriate. Although today these principles may seem quite routine, at the time they were first initiated, the call for family involvement in treatment planning and for culturally aware and competent service delivery was perceived as a radical departure from expected practice. Along with the CASSP initiative, a second piece of federal legislation significantly reshaped the community-based care of children with MEB disorders. In 1987 Congress passed the Education for All Handicapped Children Act (P.L. 94-142), which mandated that children with special education needs, including those with serious MEB disorders, be served in community schools, mainstreamed in regular classes with support when possible and in self-contained classrooms when necessary. P.L. 94-142, as it was known, required that all children with special educational needs have an IEP that focused on how the school would meet the child’s particular learning needs. According to the law, parents were to be partners in developing this plan and were required to sign off, approving its provisions. Schools were mandated to provide whatever services the child required to succeed academically, including psychological services, transportation, social work services, therapeutic recreation, and even a full-time classroom aide. The legislation that supplanted P.L. 94-142, IDEA, first enacted by Congress in 1990 and revised in 1997, allowed schools to classify a

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child with an MEB disorder as either emotionally disturbed (ED) or as “other health impairment” (OHI). To qualify as ED under IDEA, a child had to exhibit one or more of the following: 1. an inability to learn that is not explained by intellectual, health, or sensory factors; 2. an inability to build or maintain satisfactory interpersonal relationships with peers or teachers; 3. inappropriate types of behavior or feelings under normal circumstances; and 4. a tendency to develop physical symptoms or fears associated with personal or school problems (Roberts et al. 2003). These qualifying conditions were determined by school personnel based on observation and experience with the child in the academic setting. When there is a DSM Axis I diagnosis by an outside mental health professional, the child may qualify for special education services under the OHI designation if the symptoms interfere with the child’s educational process, not simply on the basis of the diagnosis. Despite federal mandates directing schools to provide the services required for all children to function academically, by the end of the 1990s the Surgeon General’s report on mental health estimated that only about 2 percent of children with MEB disorders were receiving appropriate educational services (U.S. Department of Health and Human Services 1999). Differential demand for and availability of services, disagreements over responsibility for funding and providing such services, and conflicting legal interpretations regarding mandated services and educational needs colored implementation of educational services for children with MEB disorders at the end of the twentieth century. One of the difficulties proved to be the lack of well-defined boundaries between educationally related services mandated under IDEA and services that are rehabilitative in nature. When is psychological treatment necessary to enable a child to form the interpersonal relationships with peers and teachers that facilitate learning, and when is it intended to restore a child’s overall psychosocial functioning? In the first

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instance, the child’s school district would be responsible for providing and paying for such treatment under IDEA; in the second instance it would not. These kinds of distinctions were the subject of numerous court cases, as parents and school districts fought to determine legal responsibility for funding the services required to support a child’s educational performance. In hindsight, given what we have learned in the ensuing years about the relationship between executive functioning, a concept that includes working memory, attention and inhibitory control, and the ability to learn in school, these earlier efforts to parse elements of a child’s MEB disorder that relate specifically to classroom functioning clearly missed the essential connection between cognition and emotion (Bierman et al. 2008; Blair 2002; Blair & Diamond 2008; National Scientific Council on the Developing Child 2008). In 1992, building on the CASSP foundation, the federal government initiated the Comprehensive Community Mental Health Services for Children and Their Families program to expand the availability of community-based mental health services for children by developing local systems-of-care across the U.S. The local systems-of-care sites funded by this initiative were quite varied and included whole states, such as Vermont and Rhode Island; entire counties, such as Stark County, Ohio, and Ventura and San Mateo counties in California; inner-city neighborhoods, such as East Baltimore and Mott Haven in the Bronx; and one American Indian tribe, the Navajo Nation, which spans several states. By the end of the decade, more than forty thousand children and their families had received services in sites funded by this initiative (Holden, Friedman, & Santiago 2001). A five-year evaluation of the first twentytwo sites funded under the Comprehensive Community Mental Health Services program found that, in comparison with sites providing children’s mental health services using a traditional service delivery model, services within the system-of-care sites were more child- and

family-centered, community-based, and culturally competent (Hernandez et al. 2001). According to the evaluators, their findings indicated that the system-of-care philosophy was influencing mental health practice at the clinical level, not simply at the larger systems level. As a result of these and other evaluation findings, the Surgeon General’s Report on Mental Health, issued in 1999 (U.S. Department of Health and Human Services), incorporated the system-of-care philosophy in its recommendations for service system reform and delivery of mental health services to children and their families. Intensive case management (ICM) and wraparound services are two forms of communitybased services that have developed significantly as a result of the system-of-care philosophy designed to support and sustain children with MEB disorders in their families and communities and modeled on adult mental health services for individuals who are chronically mentally ill and require ongoing support and assistance to remain stable in the community. Children’s ICM works with families to coordinate provision of the array of community services needed to maintain the child in the least restrictive setting possible (Evans, Armstrong, & Kuppinger 1996). Depending on the ICM model employed, the case manager plays a wide variety of roles—assessor of service need, service broker, purchaser of services, and provider of clinical care. Studies have shown that children receiving ICM services spend fewer days in psychiatric inpatient settings and more days in community settings with longer periods between hospitalizations (Evans et al. 1996; Hoagwood et al. 2001). “Wraparound services” is a term used to describe a model of community-based care that “wraps” individualized services around a specific child and family designed to maintain the child in the home and community (Dore & De Toledo 2011). According to its proponents, wraparound is “an individualized, family-driven and youth-guided team planning process that is

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underpinned by a strong value base that dictates the manner in which services for youth with complex needs should be delivered” (Bruns et al. 2010:315). Although the model has been in existence since the 1970s, beginning in 2004, efforts were made to articulate the wraparound model so that it could be substantiated as an evidencebased practice (Mears, Yaffe, & Harris 2009; Suter & Bruns 2009). These efforts coalesced into the National Wraparound Initiative, which works to support the fidelity and integrity of the model (www.nwi.pdx.edu). A number of states have mandated use of the wraparound model as a focal element in the state’s children’s mental health services system-of-care. Wraparound services have proven effective in preventing out-of-home placement of children like Tommy. A wraparound program might provide an early-morning aide who would come to Tommy’s home to assist his mother in getting him ready for school. The aide would also help Lexy design and implement a behavior modification plan that would help Tommy learn to get ready for school in such a way that eventually the aide’s help would no longer be needed and the experience would not be so exhausting and demoralizing for Lexy. Similarly, when Tommy is ready to be mainstreamed into a regular public school classroom, wraparound services might provide a classroom aide who would remain at Tommy’s side throughout the day to assist him in managing the academic and social demands of the classroom until he is able to do so with less intensive support. Wraparound services could also include weekend respite services so that Lexy and her daughters could enjoy some time together, a carpenter to modify the front door of their house so Tommy cannot escape at will into the street, and even an evening get-together for Lexy and her neighbors with Tommy’s wraparound care manager so the neighbors can be helped to understand Tommy’s special needs and the parenting demands on Lexy. Huffine (2002) describes wraparound services like these as “practical accommodations” (p. 809). With wraparound

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services in place, it is likely that Lexy and her children would experience a more stable, less stressful, and more satisfying family life. Access to Mental Health Care for Children and Youth As noted previously, it is estimated that only about one in five children who needs mental health care actually receives it. Despite efforts by the federal government to expand access to mental health care for children through the initiatives described, other social and economic factors have resulted in funding directed primarily at individuals with severe and persistent disorders. Preventive services and those aimed at children and adolescents whose emotional and behavioral difficulties are not yet severe enough to cause disruption to the systems with which they interact are extremely limited. Introduction of managed care, cost containment, and benefit limits in private insurance, along with expanded drug benefits, have reshaped the delivery of mental health services in the private sector. Child psychiatry is now focused almost entirely on the management of psychotropic medications rather than delivery of psychosocial interventions. Medicaid, a jointly funded, federal-state program that provides health coverage to lowincome individuals, is the largest provider of mental health services for children in the United States, especially for children in foster care. However, modest provider reimbursement and bureaucratic inefficiencies have resulted in fewer providers accepting this form of payment. Even providers who do accept Medicaid are restricted in the amount of treatment time that is reimbursable, depending on state guidelines. Medicaid funds inpatient psychiatric hospitalization, residential treatment, and group care for children and youth with MEB disorders. To fund home- and community-based treatment programs, such as MST, states must apply for waivers to the usual reimbursement for out-ofhome care. The waiver program allows states to apply to the Center for Medicare and Medicaid

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Services (CMS) to expand community-based services for children with MEB disorders who would otherwise require inpatient psychiatric hospitalization. This program was expanded in 2006 under the federal Deficit Reduction Act to include waivers for community care for children whose treatment needs would otherwise require residential treatment, considered a less restrictive form of out-of-home care than psychiatric hospitalization. Medicaid funds the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, which provides for the screening of Medicaid-eligible children for physical, dental, vision and hearing problems. EPSDT also covers medically necessary services designed to correct physical and mental conditions; however, although they can do so under the legislation, few states elect to cover screening for mental health problems in their EPSDT programs. Thus MEB disorders whose treatments are covered under this program are seldom identified. The federal government also provides supplemental insurance under the State Children’s Health Insurance Program (SCHIP) for working families whose income is too high to qualify for Medicaid coverage, but too low to afford private health insurance. States can choose to expand Medicaid to cover these children, to insure them through a separate program, or some combination of the two options. Children insured under an expanded Medicaid program are entitled to EPSDT screening and services; however, mental health coverage under the separate program provision is quite variable. The 2008 passage of the Paul Wellstone–Pete Domenici Mental Health Parity and Addiction Equity Act required that group health plans provide the same range and scope of mental health and substance use treatment services that they provide for medical services. Insurers are no longer able to set higher copays or put stricter limits on mental health and substance use benefits as they did previously; however, they can apply

equitable cost containment across all services. This legislation went into effect January 1, 2010, and mental health professionals and providers are determining how the law will be implemented. Advocates for children, particularly those who advocate for community-based services, are concerned how health insurers will treat services such as home-based treatments that are not part of the traditional psychiatric repertoire. A significant change in public mental health policy for children in recent years is the substantial increase in funding to the public education system to address mental health and psychosocial concerns. There has also been a trend toward school-community collaboration in meeting the mental health needs of young people. Recent studies have shown that as many as three-fourths of children who receive any mental health services receive them in school settings. For most of these children, school-based services are the only mental health care they receive. Mental health service use also varies by type of disorder and ethnicity. Studies have shown that children with disruptive disorders are much more likely to be identified as needing services than those with anxiety or mood disorders. Similarly, studies of mental health service use by ethnicity and funding have found that Hispanic youth are least likely to receive needed services, whereas youth with publicly funded health care such as those in foster care, receive more mental health care than children with private health insurance or children with no insurance at all (Kataoka, Zhang, & Wells 2002). Despite their access to services, foster children with MEB disorders are at risk for longer-term foster care (Akin et al. 2012). And, despite these findings of differential access to care, the most common finding across all studies is the low level of service access by children in need of mental health care. YYY

In this chapter I have examined child mental health: the etiology of MEB disorders in

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children and youth; the types and prevalence of these problems in children and adolescents across the U.S.; how these problems are currently being assessed and treated; and the service system and public policy that supports this treatment. We have seen how mental health problems are manifested differently in children and adolescents by viewing the experiences of three families struggling to meet the caregiving demands of children at different developmental stages with varying forms of maladaptive behavior. Their life experiences and the unique symptoms of their disorders suggest differing dynamic processes of nature and nurture, as reflected in the stories of Tommy, Sammy, and Annalee. It is likely that Tommy’s current psychosocial functioning, reflective of pervasive developmental disorder, is primarily the result of a biological process, perhaps with a genetic component. Although positive nurturing by his mother Lexy and others in his environment can help to modify the negative effects of Tommy’s disorder and enhance positive aspects of his functioning, this case illustrates the limitations of nurture when nature has dealt a crippling hand. Sammy represents a child whose maladaptive functioning reflects the inadequate nurturing and traumatic effects of his early life experiences. Although he may have been biologically vulnerable because of the toxic prenatal environment that resulted from his mother’s drug use and accompanying lack of adequate nutrition, Sammy’s physical and emotional neglect as a newborn, as well as the physical and sexual abuse he is said to have suffered at the hands of his mother’s male partners, make Sammy a child whose personality and functioning were formed more by nurture than nature. Annalee, our third case study, represents a young adolescent whose current emotional and behavioral difficulties suggest developmental vulnerability resulting from the interaction of nature and nurture over the course of her

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childhood. She was a sensitive, somewhat fussy infant cared for by a mother who was struggling with her own postpartum depression and marital difficulties. As a young child, Annalee was anxious, timid, and somewhat school phobic. In elementary school she was an outsider with few friends. Thus the stage was set for heightened reactivity to the biological changes and psychosocial demands of puberty. We have also explored the application of various evidence-based interventions with Tommy, Sammy, and Annalee and their families. We saw that wraparound services, designed in collaboration with Lexy and others involved in Tommy’s life, would provide the range of supports needed to maintain Tommy in his family, school, and community and to maximize the possibilities for realizing his full potential. We noted that PCIT was designed to help youngsters like Sammy—with problems in attachment and disturbances in their psychosocial functioning—experience the kind of positive nurturing relationship that will form the basis for authoritative caregiving by his loving adoptive parents. PCIT will teach the Rosses how to set clear limits with Sammy and shape his behavior in ways that were unnecessary with their biological children, who never suffered the traumatic early abuse and neglect that Sammy did. The Rosses will learn the importance of consistent early intervention with children like Sammy, whose aggressive behavior can be predictive of lifelong disturbance in psychosocial functioning. Finally, we identified family-based therapy as the treatment of choice for Annalee and her family, who are challenged to cope with her oppositional and defiant behavior in transition to adolescence. The chaos she creates for the family is reawakening her mother’s depression and triggering her emotional withdrawal from her daughter as well as exacerbating her father’s tendency to become rigid and authoritarian. Neither of these emotional responses will aid Annalee in resolving her developmental

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struggles. Family-based treatment will help this family regain its emotional balance by addressing the immediate crisis in ways that allow for growth and change in all family members. These three narratives of Tommy, Sammy, and Annalee highlight the varied mental health

needs of children and their families and reflect the importance of continued development of the system-of-care that informs provision of mental health services to children and adolescents in the U.S.

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Educational Issues for Children and Youth

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ith high caseloads and so much at stake regarding the safety and permanency of children in out-of-home care, prioritizing their education and wellbeing can be a challenge. However, by focusing on the educational needs of children and youth in foster care, caseworkers and child welfare agency staff can vastly improve their education outcomes and support their permanency. Together with the education system and dependency court, social workers can make a difference. This chapter outlines the current education outcomes for children in out-of-home care, provides a framework to support the education needs of children in care, discusses relevant federal laws and policies, and provides resources to assist child welfare staff in their education advocacy. Why Focus on Education? Children in foster care, perhaps more than other students, need a solid education to help ensure a successful future. Success in school can positively counter the abuse, neglect, separation, and impermanence experienced by the more than four hundred thousand children and youth in foster care at the end of 2012. Unfortunately, the current educational outcomes of most children in foster care are dismal (National Working Group on Foster Care and Education 2011:1–16). Studies show that youth in foster care with unmet education needs are at higher risk for homelessness, poverty, public assistance, and juvenile or adult court involvement (Courtney

et al. 2005). In contrast, one research study (Ayasse 1995:207–16) and the experiences of countless caseworkers and child advocates across the country have found that when school programs focus on education needs of children in care, educational performance improves while maladaptive behaviors and dropout rates decline, all of which aid successful transitions to employment or higher education. Addressing education needs also promotes permanency for children in foster care. Youth who are on track educationally, attending school regularly, and not having behavior problems at school can return home or find permanence more easily than youth with multiple school problems. (Legal Center for Foster Care and Education 2009:1–2). What Is Education Success for Children and Youth in Out-of-Home Care? Advocating for a child’s educational needs is critical to ensuring educational success for children in foster care. But what does that mean and where do you start? The following eight goals form the framework developed by the Legal Center for Foster Care and Education, Blueprint for Change: Education Success for Children in Foster Care.1 When a child receives the appropriate educational supports and services to achieve positive education outcomes, each of these goals can be met. Goal 1: Youth Are Entitled to Remain in Their Same School When Feasible Youth in out-ofhome care live, on average, in two to three different placements each year (U.S. Department 145

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of Health and Human Services 2009). When youth are moved to a different placement, they often change schools. Frequent school changes negatively affect students’ educational growth and graduation rates (Jacobsen 2001:3). Youth in care are entitled to educational stability, and efforts must be made to keep them in their same school whenever possible. School may be the one place the youth has had and can continue to have consistency and continuity. Therefore the first step toward achieving school success for children in foster care is maintaining school stability. Goal 2: Youth Are Guaranteed Seamless Transitions between Schools and School Districts When School Moves Occur Although school stability is critical, sometimes school moves may be in the best interests of the child. These school moves should avoid disrupting the youth’s education. When state or local requirements or agency delays in providing the documents that are necessary for the child’s enrollment postpone her enrollment, critical classroom time is lost. Youth need immediate enrollment in the new school and full access to all academic programs and activities. All records and information about the student’s prior schooling must follow the youth to the new school, with appropriate credit for work completed at the previous school. Goal 3: Young Children Enter School Ready to Learn When thinking about education, individuals often focus only on school-age children. According to the American Academy of Pediatrics, children in foster care have higher rates of physical, developmental, and mental health problems, and may enter foster care with unmet medical and mental health needs (Leslie et al. 2003:134–42). These critical health needs must be addressed in the early years to ensure young children are developing appropriately and will benefit from school. Critical to addressing the prelearning needs of young children is linking them to the full range of screening and early

intervention services available (American Bar Association 2009). Goal 4: Youth Have the Opportunity and Support to Fully Participate in All Aspects of the School Experience Children and youth in care are often prevented from accessing school services available to all other youth. Not only must youth in foster care receive equal treatment, they also will frequently need additional supports. The absence of family and educational stability, combined with histories of abuse and neglect, mean youth in care experience higher rates of grade retention and lower academic achievement than their peers (National Working Group on Foster Care and Education 2011:1–16). Responding to these needs may require creating specific policies and supports to improve academic achievement and broaden foster youth’s access to all aspects of the school experience. Goal 5: Youth Have Supports to Prevent School Dropout, Truancy, and Disciplinary Actions Youth in foster care have dropout, truancy, and disciplinary rates far higher than the general student population (Courtney et al. 2005; Sullivan, Jones, & Mathiesen 2010: 164–70). When youth are frustrated by frequent moves and rough transitions, they are more likely to act out, skip school, or drop out altogether. Children who have undergone abuse or neglect and have been removed from their parents often experience learning difficulties and other problems that interfere with school success. These youth need appropriate support, programs, and interventions to keep them engaged and in school. In addition, youth in care need trained advocates who will ensure the best possible placement and increase the odds that the youth will complete their education. Goal 6: Youth Are Involved and Engaged in All Aspects of Their Education and Educational Planning and Are Empowered to Be Advocates for Their Education Needs and Pursuits Encouraging youth to engage in education decision making

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and planning helps them take an active role in their educational futures and gives direction and guidance to the professionals and adults advocating on their behalf. Participating in court proceedings, school meetings, the special education process, and transition planning for postsecondary education or jobs allows youth to advocate on their own behalf. Appropriately trained professionals must facilitate this participation.

How Can I Support Education Success for Children in Out-of-Home Care? The following sections outline the importance of promoting school stability and continuity, advocating for special education, and supporting youth engagement in education planning that includes postsecondary education. These topics are critical for children and youth in care; caseworkers and child welfare agency staff can directly influence these goals.

Goal 7: Youth Have an Adult Who Is Invested in His or Her Education During and After His or Her Time in Out-Of-Home Care Youth need supportive adults to help them achieve their education goals. All students, particularly students with disabilities, need an identified and available adult with authority to make education decisions on their behalf. Youth must have adults to advocate for their rights and needs and to serve as mentors as they navigate the educational system. Traumasensitive training and a full understanding of federal disability law is necessary for any adult who advocates for a child in care or serves as a surrogate parent or authorized decision maker.

School Stability and Continuity Why Does School Stability and Continuity Matter? When youth in foster care move, they face unique challenges. Many spend considerable time out of school when poor coordination or lack of communication between child welfare and school personnel and caregivers prevents prompt enrollment in their new schools. They often must repeat courses and even grades because of difficulties related to transferring their records and course credits from prior schools. Additionally, moving schools— challenging for any student—can be emotionally overwhelming for children in the foster care system who are also dealing with separating from their parents and siblings, neighborhoods, and everything familiar to them, as well as adjusting to new caregivers and family members in the new household or group setting. These challenges can cause youth in legal custody to fall behind their peers in school, lose hope, and ultimately drop out of school.

Goal 8: Youth Have Supports to Enter into, and Complete, Postsecondary Education Although youth in foster care have college aspirations, studies show lower college enrollment and completion rates among young people in foster care than among other young adults (National Working Group on Foster Care and Education 2011:4). To achieve their full potential, older youth in care and those exiting care need support and opportunities to participate in a wide range of postsecondary programs. Research shows that education outcomes improve when youth can stay in care beyond age eighteen (Courtney et al. 2009). In addition, these youth need career and college counseling, assistance with applications and financial aid, and support while participating in their educational program of choice.

What Laws Support Education Stability for Children and Youth in Foster Care? Fostering Connections to Success and Increasing Adoptions Act (Fostering Connections) Under the law, child welfare agencies must include “a plan for ensuring the educational stability of the child while in foster care” as part of every child’s case plan (42 U.S.C. § 675(1)(G)). As part of this plan, the agency must include assurances that: 1. the placement of the child in foster care takes into account the appropriateness of the current educational setting and the proximity to the

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school in which the child is enrolled at the time of placement (42 U.S.C. § 675(1)(G)(i)) and 2. the state child welfare agency has coordinated with appropriate local educational agencies to ensure the child remains in the school where the child is enrolled at the time of placement (42 U.S.C. § 675(1)(G)(ii)). Fostering Connections also expands the definition of “foster care maintenance payments” to include reasonable transportation to a child’s school, thus supporting the ability for child welfare agencies to ensure children remain in their school (42 U.S.C. § 675(4)(A)). Additionally, the law requires that if remaining in that school is not in the best interest of the child, the case plan must include assurances by the child welfare agency and the local educational agencies that they will 1. provide immediate and appropriate enrollment in a new school and 2. provide all educational records of the child to the school (42 U.S.C. § 675(1)(G)(ii) (II)). Finally, Fostering Connections supports the well-being of children in foster care by requiring states to provide assurances in their Title IV-E state plans that every school-age child in foster care, and every school-age child receiving an adoption assistance or subsidized guardianship payment, is a full-time elementary or secondary school student or has completed secondary school (42 U.S.C. § 671(a)(30)). McKinney-Vento Homeless Assistance Education Act (McKinney-Vento) The McKinneyVento Act is a federal law designed to increase the school enrollment, attendance, and success of children and youth who lack a fixed, regular, and adequate nighttime residence. It provides modest grants to states to provide supplemental services to eligible youth. The McKinneyVento Act applies to children and youth living in unstable or inadequate situations, including children in emergency or transitional shelters or those “awaiting foster care placement” (42 U.S.C. §11434A(2)(B)(i)). Although the act does not define this term, many state and local child welfare agencies and education agencies

have defined who is considered to be “awaiting foster care placement” in their state or locality.2 The McKinney-Vento Act’s protections are invaluable in helping children in out-of-home care succeed in school. Eligible children are entitled to many rights and services, including 1. the right to remain in their school of origin (42 U.S.C. §11432(g)(3)(G)),3 even if their temporary living situation is in another school district or attendance area, as long as remaining in that school is in their best interest (42 U.S.C. §11432(g)(3)); 2. the right to receive transportation to and from the school of origin (42 U.S.C. §11432(g)(1)(J)(iii)); 3. the right to enroll in a new school and begin participating fully in all school activities immediately, even if they cannot produce normally required documents, such as birth certificates, proof of guardianship, school records, immunization records, or proof of residency (42 U.S.C. §11432(g)(3)(C)); and (4) supplemental services such as tutoring and mentorship. If a caseworker suspects a student is eligible for McKinney-Vento, he should contact the McKinney-Vento homeless education liaison from the school district immediately. Every school district must designate a liaison responsible for determining eligibility under the act and ensuring that services are provided. If the school or district office is unable to provide the liaison’s contact information, the McKinney-Vento state coordinator should have that information.4 Many child welfare agencies also employ education specialists who can provide information about the McKinney-Vento Act and assist in communication with the liaison. Family Educational Rights and Privacy Act (FERPA) Often, confidentiality concerns contribute to delays in enrollment and hinder advocates’ access to their clients’ education records. Access to education records is critical to ensure appropriate placements and services for children and youth in care; therefore caseworkers must understand how to obtain records appropriately. Passed in 1974, FERPA

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is a federal law that protects the privacy interests of parents and students regarding students’ education records (20 U.S.C. § 1232g; 34 C.F.R. § 99). Generally, FERPA protects the rights of parents to control who may access their children’s education records by preventing access to third parties without the written consent of the parent, but many exceptions exist (20 U.S.C. § 1232g(b)). Applying FERPA, there are three ways child welfare professionals can access education records: 1. Parental consent—advocates should always first attempt to obtain permission from a parent and have the parent sign a written consent. 2. Qualifying as a parent—where parents are unwilling or unavailable to sign a consent form, a representative from the child welfare agency may often obtain the records by qualifying as the child’s “parent” for purposes of FERPA. This option depends on how the school interprets the parent definition: FERPA regulations define a parent as “a natural parent, a guardian, or an individual acting as a parent in the absence of a parent or guardian.” 3. Court order—child welfare professionals and advocates can access a child’s school record through the court order exception. Because children and youth in foster care are already under court jurisdiction, this is often the easiest way to gain access. The Uninterrupted Scholars Act of 2013 amends federal law to streamline parental consent issues regarding release of school records for foster children (American Bar Association Center on Children and the Law 2013). What Can Child Welfare Agency Staff Do to Ensure School Stability and Continuity? The following checklist provides strategies for caseworkers: 1. Obtain records from the school to ensure the child is receiving appropriate educational

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supports and services; request a court order when necessary. Maintain and update the child’s case plan with the child’s education records. Consult with the child’s teachers, other key school staff, service providers, and all other individuals who are involved in the child’s life to discuss the child’s education needs. Know who the child’s education decision maker is and, if no such individual has been designated, ask to have one appointed.5 Keep living placements stable whenever possible. When a youth must move, seek a living placement within the current school boundaries. Help youth remain in their same school even when they are placed in a different school district, including arranging or providing transportation if necessary. Think creatively: Could the foster parents or others be reimbursed for providing transportation? Will the school add a new stop to the bus route or use special education or magnet school transportation? When school changes must be made, ensure seamless transitions. Clarify who will enroll the child. Confirm the child is immediately enrolled, records are transferred, and appropriate credits are transferred. Ensure the child’s special education needs are being met, especially when there are school transfers. Ensure the child is enrolled in the appropriate classes, has opportunities to enroll in extracurricular or other school activities, and receives needed supports and services, such as a mentor.

Special Education Why Is Special Education Advocacy So Critical for Children in Foster Care? Children in foster care experience higher rates of emotional and behavioral problems affecting their education than their peers who have not been involved in the child welfare system. Several studies show children and youth in foster care are between 2.5 and 3.5 times more likely to receive special

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education services than their nonfoster care peers. Many other children may need these services, but have not been identified (National Working Group on Foster Care and Education 2011:4), while some have been identified inappropriately. As a caseworker, a basic understanding of how the federal Individuals with Disabilities Education Act (IDEA) (20 U.S.C. §§1400, et seq., 34 C.F.R. Part 300)6—the major law governing the special education process— works can help you ensure that children with disabilities receive the special help they need. The IDEA leaves some key questions to the states, so it is also important to understand your state’s special education laws and procedures. Check with your state’s protection and advocacy system for more information about the IDEA, including the special rules for infants and toddlers with disabilities (www.ndrn.org). Understanding the IDEA and what services are available to children in the foster care system is critical to navigating the special education process. Failing to obtain needed services under IDEA is wasting an important source of education assistance for these children. What Can I Do to Ensure Children Receive Needed Special Education Services? Special Education Decision Makers Making sure that each child in the child welfare system has an “IDEA Parent” to make special education decisions on her behalf is crucial for the child to benefit from the IDEA or any state special education law. Only the IDEA Parent can consent to the initial evaluation or for services to begin for the first time for a child. Only the IDEA Parent has a right to represent the child at the Individualized Education Program (IEP) team meetings and agree or disagree with the school district’s proposals for the child. However, for many children in the child welfare system, deciding who the IDEA Parent is—and ensuring that the IDEA Parent is actively representing the child—can be complicated. It could be the birth or adoptive parent, but it could also be the foster parent if the birth

parent is lost or is not “attempting to act as the parent.” Sometimes a court or a school district has appointed another person, often called a surrogate parent, to make education decisions for a child. Except in one situation—when a court has appointed the caseworker to consent to the initial evaluation of a child in accordance with 34 C.F.R. §300.300(a)(2)—the child’s caseworker, or any other employee of an agency that is involved in the education or care of a child, can never be the IDEA Parent.7 Getting the Child Evaluated While some children in foster care have visible disabilities (e.g., orthopedic impairments or blindness), other disabilities, such as specific learning disabilities and behavioral disabilities, are sometimes hard to identify. It is important to get information about the family’s and the child’s medical history. Watch for signs that the child is having school difficulties, such as: poor grades, difficulties with academic achievements, delays in developmental milestones, lack of interest in school, refusal to attend school, or behavior problems at school and at home. It is important to remember, in determining whether a child might have a disability that affects his learning and need a special education evaluation, a current assessment, or an update of a prior assessment of the child or youth may be necessary. The critical determination as to whether more focused regular education services would get the child back on track should be based on thorough professional evaluation. Every child who struggles academically needs extra help, but not necessarily special education. Consult the family and health and behavioral health professionals who already know the child—what do they think is wrong and what do they think is needed? Also consider whether the child welfare agency should arrange for the child to be evaluated or at least arrange a meeting with an expert to help you determine whether a special education referral is warranted. If the child needs a special education evaluation, the parent or IDEA parent, or anyone

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interested in the child’s education, must make a written request to the school district for an “initial evaluation.” The IDEA gives the school system sixty calendar days to complete an evaluation from the date the IDEA Parent signs the consent for the initial evaluation to begin (34 C.F.R §300.301(c)(1)(i)). However, the IDEA also permits states to adopt a different timeline, either longer or shorter. Children must be reevaluated at least every three years, although this can be waived by the IDEA Parent. A reevaluation should be conducted whenever conditions warrant or if the child’s parent or teacher requests one (34 C.F.R. §300.303). Moreover, the school system cannot decide that a child is no longer eligible for special education services without first evaluating the child (34 C.F.R. § 300.305(e)). Preparing for IEP Meetings If the child or youth is found eligible for special education, the next step is for the school to convene an IEP team meeting to decide what services the child should receive and in what educational setting. The IEP is the contract between the school district and the family that explains what “special education” and “related services” the child will receive, when the services will start and end, how much of each service the child will receive, the educational annual goals that the IEP team expects the child to achieve, and how success will be measured (34 C.F.R §300.34). Key IEP elements include the child’s present levels of educational and functional performance; measurable annual goals (including short-term objectives for children taking alternative assessments aligned to alternate achievement standards); a description of how the child’s progress toward meeting the annual goals will be measured and when reports on progress will be provided to the IDEA Parent; a statement of the special education and related services and supplementary aids and services (based on peer-reviewed research); program modifications and staff supports to help the child advance toward her annual

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goals and be involved in and make progress in the curriculum and extracurricular and nonacademic activities provided to all students; and a statement of accommodations the child needs to participate in state or district assessments of academic and functional performance (and any alternate assessment if appropriate) (34 C.F.R. § 300.320(a)). The IEP must also state the extent to which the child will participate in regular classrooms and activities with children without disabilities. This is known as the “least restrictive environment” requirement, or the child’s right to be educated in regular classrooms with children who do not have disabilities, with the “supplementary aids and services” the child needs to succeed in that setting. If possible, the child or youth should be educated in the same school the child would attend if he did not have a disability. Unfortunately, many children in the child welfare system change their living situations— and their schools—often. Fortunately, the IDEA mandates that when a child with an IEP transfers from one school district to another in the same year, the new school district must provide the child with comparable IEP services until the old IEP is adopted or a new IEP is developed and approved. To facilitate the child’s transition, the new school district must take reasonable steps promptly to obtain the child’s records, including the special education records, from the previous school (34 C.F.R §300.323(e),(f), (g)). If an IEP meeting is scheduled,8 confirm who the child’s IDEA Parent is and ensure this person attends the meeting. Ask the IDEA Parent whether she would like you to attend. Use this list to prepare or help the IDEA Parent prepare for meeting: 1. What would you like to see the child accomplish in the coming year? Talk to the child’s parents, relatives, foster parent(s), or other individuals who know the child. Consider listing the child’s strengths, needs, and interests and your major concerns about his education.

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2. Collect and bring any documentation describing the child’s disability, behaviors, and school progress (e.g., evaluations, schoolwork examples). 3. Review materials you have collected and any materials the school has sent you. Make sure you bring and have read the child’s school record, particularly any evaluation reports, report cards, and other information on how well the child is doing. Review the evaluations and determine if you agree with the conclusions and if the described behavior in the evaluation matches what you know of the child. 4. If the child has been receiving special education services, review the last few IEPs. What were the goals? Do they seem right from what you know or have learned about the child? What were the measures of success? Did the child achieve them? 5. Check with any experts that are working with or have evaluated the child. Does the agency need to identify an expert to provide an independent education or other evaluation of the child? 6. Share your knowledge about the child and carefully listen to what others say about the child to be able to respond appropriately. If you do not understand something, ask for clarification. 7. Obtain a copy of the notes and all documents from the meeting. If anyone at the meeting has promised you additional information, follow up with that team member, preferably in writing.

Ensuring Child Receives Services in IEP After the IEP is developed, it is important that child welfare agency staff and the child’s IDEA Parent monitor the implementation of the IEP to ensure that it is being implemented. After an IEP is in place, monitor and assess how the services are working for the child. Review the child’s assignments and tests when possible.

Find out what the child thinks about the new services, whether they are helpful, and what, if anything, needs to be changed. Help the IDEA Parent communicate regularly with the child’s teachers through phone calls, e-mails, and/or progress reports. The IDEA Parent can request an IEP meeting at any time if there is reason to believe the IEP is not being implemented appropriately or if something needs to be added or changed. At minimum, the IDEA requires annually reviewing the IEP for achievement of past goals and to set the goals and services for the coming year. Dispute Resolution and Enforcement The IDEA has a detailed and complex process related to dispute resolution, mediation, complaints, and administrative hearings. If you have a problem related to special education, remember to bring it to the attention of your supervisor or the dependency court immediately. Depending on the issue, the dependency court may need to identify the IDEA Parent, order a party to pursue the issues, or appoint an education attorney for the child. Youth Engagement, Transition Planning, and Postsecondary Education Why Is Youth Engagement in Education Planning and Obtaining Postsecondary Education Critical? Often youth in foster care are not engaged or involved in their case planning and court hearings. Youth involvement is critical for education planning and pursuits beyond high school. Youth must receive support to identify and develop further education goals, including services to help them prepare for, enter, and complete postsecondary education, if that is their goal. Successful advocacy for older youth includes being aware of available services and supports, promoting higher education or vocational education, and supporting youth in attaining their postsecondary education or vocational goals.

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What Laws and Programs Support Youth in a Successful Transition to Adulthood? Child and Family Services Improvement Act of 2006. Recognizing the importance of involving and engaging youth in their case planning and court hearings, the Child and Family Services Improvement Act of 2006 (P.L. 109-288) amended Title IV-B of the Social Security Act to require procedural safeguards. These safeguards assure that the court or administrative body conducting a permanency hearing involving older and transitioning youth consults with the youth about the proposed permanency or transition plan. These consultations must be conducted in an age-appropriate manner (42 U.S.C.A. § 675(5)(c)). Because of this requirement, caseworkers should ensure the child’s perspective is shared with the court and that the child attends court if he chooses. Preparing youth for court also helps them feel comfortable to participate and share their perspective. Debrief youth after court to make sure they understand the actions and court orders. While all children benefit from court involvement, this is especially critical for older and transitioning youth to meet their transition needs, including those related to education. Social Security Act Requirements, Including Foster Care Independence Act of 1999 (FCIA) (P.L. 106-169) and Education Training Vouchers (ETV) (P.L. 107–133) The Social Security Act requires the child welfare agency to include as part of the case plan for children age sixteen and older a “written description of the programs and services which will help such a child prepare for the transition from foster care to independent living” (42 U.S.C. 675 (1)(D)). This plan, often referred to as the “independent living plan” (ILP), should be created closely with the youth and should include at least information related to the youth’s education, physical and mental health care, and housing. It should also address efforts the child welfare agency is making for the youth to develop permanent relationships

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with caring adults and relatives, including siblings. The ILP should detail services the youth needs to prepare for adulthood, including daily living activities and an understanding of community resources and public benefits. Furthermore, the plan should identify outcomes and time frames, as well as the specific individual or agency responsible for the youth completing each element of the ILP. Recognizing the need for improved planning and services for older youth in foster care, the FCIA increased the supports for children who are likely to leave the child welfare system at age eighteen to continue their education, find employment, and obtain life skills to be successful adults. It doubled the federal funds (Chafee funds) provided to states for services to older teens and gave states increased flexibility in using the funds. States can use Chafee funds to aid education goals in the following ways: tuition, tutoring, education planning, financial aid, and other education expenses related to receiving a high school diploma, GED, or postsecondary education. For students in postsecondary education, education services may include assistance with tuition, room and board expenses, or personal support services to complete postsecondary education. Some states have used Chafee program funds to pay for agreements with state colleges and universities for free housing and for counseling and support for youth who were previously in foster care. For those youth in care involved in the state’s Chafee program, advocates should ensure services are documented in the child’s ILP. Finally, Education and Training Vouchers (ETV) provide funding up to $5,000 per year for postsecondary education to youth who have aged out of foster care or entered guardianships or adoption after age sixteen. To apply for a voucher, youth should contact their regional or state Independent Living/Chafee program coordinator through the National Resource Center for Youth Development (http://www. nrcys.ou.edu/yd/). In addition to ETVs, many

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states have state tuition vouchers or waivers for children who were or are in foster care.9 Child welfare agency staff must be aware of available scholarship programs and tuition supports for older clients. Fostering Connections Act One way the Fostering Connections Act works to improve outcomes for older youth in care is by requiring a “transition plan.” This requirement strengthens practice by creating the impetus to plan early so acceptable transition plans can be developed. It also increases accountability by developing standards for acceptable discharge plans. The child welfare agency must develop a “transition plan” within the ninety-day period before a youth is discharged from care. The plan must be developed under the direction of the youth with the child’s caseworker or other child welfare agency staff and other “representatives of the child” (including the child’s attorney, guardian ad litem, court appointed special advocate, mentor, teacher, foster parent, relative, or any other individuals the youth requests). The plan must be personalized and directed by the child. It must include options for housing, health insurance, education, local opportunities for mentors and continuing support services, and workforce supports and employment services (42 U.S.C. § 675(3)(H)). Caseworkers must ensure the plans are thorough and individualized and that youth are not discharged from care without being able to transition successfully to independence.10 Although the new ninety-day transition plan is critical to ensure youth have all necessary services and supports before transitioning from care, this plan serves primarily as a final discharge plan. The child welfare agency should be developing detailed, individualized Transitional Living Plans at the direction of the youth beginning when the youth is at least age sixteen, if not before. Only when these two plans are viewed as steps in the process toward transitioning to adulthood will either fulfill their true purpose. The child welfare agency must actively engage

and empower youth throughout the transition planning process and include all individuals who may provide insight or support including teachers, guidance counselors, or other education staff. Additionally, Fostering Connections permits states, at their option, to receive Title IV-E reimbursement for the cost of placement and services for youth until age nineteen, twenty, or twenty-one (42 U.S.C § 675(8)(B)). To remain in care, youth must be attending school, working, or involved in a program designed to remove obstacles to employment or education. Before Fostering Connections, states could only receive Title IV-E reimbursement until a youth turned eighteen, or nineteen for youth still in high school. The option to receive federal reimbursement past age eighteen provides an important incentive to states to extend care for youth over age eighteen, which for states that already provide this support has translated to improved educational outcomes (Courtney et al. 2009). Individuals with Disabilities Education Act (IDEA) Children in foster care receiving special education services require an additional transition plan—an IEP. Beginning not later than the first IEP to be in effect when the child is sixteen, and updated annually thereafter, the IEP must include measurable postsecondary goals based on age-appropriate transition assessments related to training, education, employment, and, where appropriate, independent living skills and transition services to help the child reach those goals. (For more on general IEP development, see previous section. Recognizing the poor education outcomes of children transitioning out of the special education system, the 2004 IDEA regulations added more protections for youth by defining and clarifying the required “transition services.” The plan must be part of “a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from

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school to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation.” Further, the plan should be based on the child’s needs, accounting for the child’s strengths, preferences, challenges, and interests to achieve a postschool goal. Finally, the plan should include required instruction, related services, community experiences, employment and other postschool adult living objectives, daily living skills objectives, and provision of a functional vocational evaluation. The IDEA now requires that, for transition planning, youth must be invited to attend IEP meetings. If youth cannot attend, the education agency must “take other steps to ensure the child’s preferences and interests are considered.” Like the plans required by the child welfare agency, the education plan also requires that youth are actively engaged and empowered in their transition planning. In addition to the youth and the IEP team members from the school, the IDEA also provides that, at the discretion of the education agency or parent (including foster parents), other individuals with knowledge or special expertise about the child, including related services personnel, should be included in IEP meetings. For children in foster care, it is critical to consult those already involved in a youth’s ILP and transition planning, including caseworkers, attorneys or GALs (Guardians Ad Litem), CASAs (court-appointed special advocates for children), relatives of the child, and others about a child’s IEP. While many individuals help develop a child’s IEP, only the child’s IDEA Parent can approve the IEP. Therefore, the IDEA Parent should be clearly identified and actively engaged throughout the process.11 Higher Education Opportunity Act (P.L. 110-315) The Higher Education Opportunity Act, enacted in August 2010, reauthorizes the Higher Education Act and includes numerous

]

amendments that increase foster students’ access to postsecondary education. The law now makes youth in foster care (including youth who have left foster care after reaching age thirteen) automatically eligible for all TRIO programs. The Federal TRIO programs consist of programs that support at-risk junior high and high school students to graduate from high school, enter college, and complete their degrees. These programs include Talent Search, Upward Bound, Student Support Services, Educational Opportunity Centers, Staff Development Activities, and Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR-UP). Students in foster care are at great risk of academic failure due to their extreme poverty and residential instability, yet, before this reauthorization, they were not specifically mentioned or targeted by any TRIO programs. The law also makes clear that Student Support Services funds can be used for “securing temporary housing during breaks in the academic year for students who are (A) homeless or formerly homeless under McKinney or (B) in foster care or aging out of the foster care system.” Caseworkers should use these provisions to ensure youth in foster care access these critical services. College Cost Reduction and Access Act of 2008 The complexities of the financial aid process often create an obstacle for youth in foster care to apply to and enroll in higher education. The College Cost Reduction Act (P.L. 110-84) makes clear that, for the purposes of federal financial aid, an “independent student” includes a youth who is “an orphan, in foster care, or a ward of the court at any time when the individual was 13 years of age or older.” This provision significantly increases the number of former and current youth in care who may fall into this category. If a youth is considered “independent,” only the youth’s income, not that of a parent or guardian, is considered in determining eligibility for financial aid.

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What Can Caseworkers Do to Engage Youth in Transition Planning and Support Postsecondary Education? To engage youth in child welfare and education transition planning to ensure a successful entry into adulthood, including entry and completion of postsecondary education or training, child welfare professionals should 1. ensure youth have a positive educational and learning environment and are on track educationally; 2. ensure youth have strong education advocates and mentors and are exposed to postsecondary education and career opportunities, starting by age twelve; 3. ensure youth are attending court and are actively engaged and empowered in their future planning, especially relating to their education goals and pursuits; 4. ensure youth have clear information and concrete help obtaining and completing admission and financial aid documents, explain to youth that they qualify as independent students for FAFSA, and know how Chafee funds can be used and advocate using these funds to help your clients; 5. advocate for youth to access ETVs and other financial supports for higher education pursuits and be alert for news about the funding for new ETV programs;

NOTES

1. The Legal Center for Foster Care and Education (www.abanet.org/child/education) developed the Blueprint for Change: Education Success for Children in Foster Care as a framework for advocates seeking to promote positive education outcomes for children in foster care. There are eight goals for youth, with corresponding benchmarks that indicate progress. Finally, following each goal, there are national, state, and local examples of policies, programs, or laws that promote the goals and benchmarks. The blueprint is available for download at http://www.americanbar.org/groups/child_law/ projects_initiatives/education/blueprint.html. 2. For more information, see Julianelle (2008), The McKinney-Vento Act and children and youth await-

6. use transition plan requirements to ensure older youth receive supports they need, ensure youth help develop all plans and that they are detailed and based on the youth’s needs, coordinate the various child welfare and education transition plans to leverage resources and confirm services are in place; 7. ensure youth have access to academic, social, and emotional supports during and after completing their postsecondary education; in states that allow youth to remain in care beyond age eighteen, support youth to remain in care so they can receive support and protection while pursuing postsecondary education or employment.

YYY

Supporting the education needs of children in out-of-home care is essential to their lifelong success. While it can seem overwhelming, small changes can make a big difference; the active participation of child welfare agency staff, school personnel, children’s caregivers, and others familiar with the children’s needs and experiences are essential to ensuring their well-being. With the appropriate supports and advocacy, all children in care can thrive.

ing foster care placement: Strategies for improving educational outcomes through school stability; National Association for the Education of Homeless Children and Youth, Legal Center for Foster Care and Education, School stability and continuity: state chart, http://www.americanbar.org/groups/child_ law/projects_initiatives/education/stability.htm. 3. “School of origin” is defined as the school the student attended when permanently housed or the school in which the student was last enrolled. 4. A list of state coordinators is available at http:// www.serve.org/nche/downloads/sccontact.pdf. 5. For more information on special education decision makers, please see http://www.americanbar. org/groups/child_law/projects_initiatives/education/special_education_decisionmaking.html.

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6. Other laws that provide protections for children with disabilities in the public education context are §504 of the Rehabilitation Act of 1973 and its implementing regulations, 29 U.S.C. §794, 34 C.F.R. §104.1, et seq., and the Americans with Disabilities Act, 42 U.S.C. §§12101, et seq., 28 C.F.R. Part 35. For more information about basic legal rights under IDEA and other federal laws related to education, see McNaught, K., Education Law Primer for Child Welfare Professionals, ABA Child Law Practice 22 (1 & 2), 1. 7. For more information about special education decision making, see the article series and fact sheets developed by the Legal Center for Foster Care and Education, http://www.americanbar.org/groups/ child_law/projects_initiatives/education/special_ education_decisionmaking.html. 8. For information on planning for an IEP meeting, see Planning your child’s individualized education program: Some suggestions to consider, Minneapolis: Families and Advocates Partnership for Education, Pacer Center, September 2001, http:// www.fape.org/pubs/FAPE25%20Planning%20 Your%20Childs%20IEP.pdf. 9. A list of all states tuition vouchers is available at http://www.nrcys.ou.edu/yd/state_pages/search. php?search_option=tuition_waiver. 10. For an example of a transition plan, see Foster Club’s Transition Toolkit, http://www.fosteringconnections.org/tools/assets/files/transition_ toolkit.pdf. 11. For more on this topic, see the Legal Center for Foster Care and Education’s special education decision-making series: http://www.americanbar. org/groups/child_law/projects_initiatives/education/special_education_decisionmaking.html. REFERENCES

American Bar Association Center on Children and the Law (2009). Healthy beginnings, healthy futures. American Bar Association Center on Children and the Law (2013). New law amends FERPA. Retrieved October 17, 2013 from www.americanbar.org/groops/ child_law/what_we_do/projects/education.html. Ayasse, R. (1995). Addressing the needs of foster children: The foster youth services program. Social Work in Education, 17, 207–16. Burley, M., & Halpern, M. (2001). Educational attainment of foster youth: Achievement and graduation outcomes for children in state care. Olympia: Washington State Institute for Public Policy. Child and Family Services Improvement Act of 2006, P.L. 109-288 (2006). College Cost Reduction and Access Act of 2007, P.L. 11084 (2007).

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Courtney, M., Dworsky, A., & Lee, J. (2010). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age twenty-three and twenty-four. Chicago: Chapin Hall at the University of Chicago. Courtney, M., Dworsky, A., Peters, C., & Pollack, H. (2009). Extending foster care to age twenty-one: Weighing the costs to government against the benefits to youth. Chicago: Chapin Hall Center for Children at the University of Chicago. Courtney, M., Dworsky, A., Ruth, G., Keller, T., Havlicek, J., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age nineteen. Chicago: Chapin Hall Center for Children at the University of Chicago. Courtney, M., Terao, S., & Bost, N. (2004). Midwest evaluation of the adult functioning of former foster youth: Conditions of youth preparing to leave state care. Chicago: Chapin Hall Center for Children at the University of Chicago. Family Education Rights and Privacy Act, PL–93–380 (1974). Foster Care Independence Act of 1999, P.L. 106–169 (1999). Fostering Connections to Success and Increasing Adoptions Act of 2008, P.L. 110–351 (2008). Higher Education Opportunity Act, P.L. 110–315 (2008). Individuals with Disabilities in Education Act, P.L. 108446 (2004). Jacobson, L. (2001). Moving targets. Education Weekly, April 4. Legal Center for Foster Care and Education (2013). Questions and answers: How child welfare can access education records under FERPA. Leslie, L., Hurlburt, M., Landsverk, J., Rolls, J., Wood, P., Kelleher, K. (2003). Comprehensive assessments for children entering foster care: A national perspective. Pediatrics, 112, 134–42. McKinney-Vento Homeless Assistance Act (2001). McMillen, C., Auslander, W., Elze, D., White, T., & Thompson, R. (2003). Educational experiences and aspirations of older youth in foster care. Child Welfare, 82, 475–95. National Working Group on Foster Care and Education (2011). Education is the lifeline for youth in foster care. Promoting Safe and Stable Families Amendments of 2001, P.L. 107–133 (2001). Sullivan, M., Jones, L., & Mathiesen, S. (2010). School change, academic progress, and behavior problems in a sample of foster youth. Children and Youth Services Review, 32, 164–70. U.S. Department of Health and Human Services (2013). Adoption and foster care analysis and reporting system (AFCARS) FY 2012 data. Wolanin, T.  R. (2005). Higher education opportunities for foster youth: A primer for policymakers. Washington, DC: Institute for Higher Education Policy.

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or the last two decades, research has consistently shown that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youths in child welfare systems (i.e., child welfare and juvenile justice) are often poorly served and in urgent need of sensitive, appropriate, and culturally competent child welfare services (Child Welfare League of America [CWLA] 1991; DeCrescenzo & Mallon 2000; Feinstein et al. 2001; Mallon 1992a, 1992b, 1997c, 1998, 1999a, 1999b, 2001, 2009a; Majd, Marksamer, & Reyes 2009; Marksamer 2011; Sullivan 1994; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Few state child welfare agencies have policies in place that prohibit discrimination against youths on the basis of sexual orientation and gender variance, nor do they require training of child welfare workers and foster and adoptive parents on addressing the psychosocial needs of LGBTQ youths in care (Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006). Child welfare settings are often ill-prepared to meet the unique needs of this population, particularly of transgender youths (DeCrescenzo & Mallon 2000; Mallon 2009a; Mallon & DeCrescenzo 2006; Marksamer 2011; Thaler, Bermudez, & Sommer 2009; Woronoff, Estrada, & Sommer 2006). LGBTQ youths in out-of-home care continue to report verbal and physical victimization at the hands of peers and adults despite extant regulations prohibiting such abuse (DeCrescenzo & Mallon 2000; Freundlich, Avery, & Padgett 2007; Mallon 1992a, 1992b, 1997c, 1998, 2001; Mallon, Aledort, & Ferrera 2002; Mallon &

DeCrescenzo 2006; Sullivan, Sommer, & Moff 2001; Thaler, Bermudez, & Sommer 2009; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Best practice guidelines for working with LGBTQ youths in child welfare systems and their families have been available, but have yet to be systematically incorporated into training curricula for child welfare workers and foster and adoptive parents in most states (CWLA 1991; DeCrescenzo & Mallon 2000; Mallon 1992a, 1997c, 1999a, 2001; Mallon, Aledort, & Ferrera, 2002; Mallon & DeCrescenzo 2006; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Although progress has been slow, important gains have recently been made on behalf of LGBTQ youth involved with child welfare systems. LGBTQ youth-focused training curricula are now available for child welfare professionals and biological, foster, and adoptive parents (e.g., McHaelen 2006; McHaelen & Elze 2009), along with other training models (e.g., Craig-Oldsen, Craig, & Morton 2006; Mallon 1997b). Precedent-setting casework, advocacy, and education by the National Center for Lesbian Rights (NCLR), Lambda Legal Defense and Education Fund (LLDEF), and Gay and Lesbian Advocates and Defenders (GLAD) have advanced the rights of LGBTQ youths to safety and appropriate treatment in child welfare institutions (Estrada & Marksamer 2006a, 2006b). Recently, the commissioner of the U.S Department of Health and Human Services’ Administration for Children and Families issued a memorandum to all Title IV agencies 158

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and organizations in which he asserted that every child in out-of-home care is entitled to a “safe, loving and affirming foster care placement, irrespective of the young person’s sexual orientation, gender identity or gender expression,” and he urged all Title IV-E agencies to develop procedures to ensure the safety of all LGBTQ youth in care (Samuels 2011:1). Practice and policy recommendations on behalf of LGBTQ youth now exist for diverse child welfare settings (e.g., foster care, group homes, and residential treatment centers; juvenile justice facilities; homeless youth services) (American Bar Association 2012; National Alliance to End Homelessness et al. 2009; Majd et al. 2009; Marksamer 2011; Wilber, Reyes, & Marksamer 2006; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). This chapter will provide child welfare professionals and students of child welfare practice and policies with information about LGBTQ youths involved with child welfare systems, including the risks and challenges they face in out-of-home care, best practices in addressing their service needs, their legal rights within child welfare institutions, and recommendations for LGBTQ-affirming policies. Because transgender people are often marginalized in research, education, clinical practice, programming, and policy, with people frequently adding the T to LGBQ without promoting any real inclusion, the acronym LGBTQ is used only when the research and practice substantively incorporates transgender youths (Gainor 2000; Wilchins 1997). Demographic Patterns LBGTQ Youth Representation in the Population It is difficult to determine how many young people in the population identify their sexual orientation as lesbian, gay, bisexual, queer or questioning, and their gender identity as transgender or queer. Many young people are now eschewing labels such as gay, lesbian, bisexual, male, and female, preferring to identify

]

themselves as queer or genderqueer or rejecting labels altogether, although the extent to which this occurs is unknown and may vary by geographical region, urban versus rural residence, socioeconomic status, and culture (Diamond 2005; Kosciw et al. 2010; Savin-Williams 2005). It is clear, however, that many youths endorse same-sex attractions, engage in same-sex sexual behaviors, and participate in same-sex romantic relationships without claiming a gay, lesbian, or bisexual identity (Diamond 2005; Goodenow, Netherland, & Szalacha 2002; Remafedi et al. 1992; Savin-Williams 2001, 2005). More youths report same-sex attractions than are involved in same-sex romantic relationships (Russell & Joyner 2001). It is also clear that gay, lesbian, and bisexual youths have been coming out at younger ages, raising critical questions about how best to ensure their health and wellbeing (D’Augelli & Hershberger 1993; Elze 2002; Herdt & Boxer 1993; Rosario et al. 1996; SavinWilliams 1998). Of the 7,261 students (67 percent white, 33 percent youth of color, ages thirteen to twentyone) that participated in the 2009 National School Climate Survey conducted by the Gay, Lesbian, and Straight Education Network, 92.6 percent identified their sexual orientation as gay, lesbian, or bisexual; 4.5 percent as other (e.g., queer, pansexual); and 3 percent as questioning or unsure. Nearly 10 percent endorsed a gender identity other than male” or female; 5.7 percent identified as transgender and 4 percent as other gender (e.g., genderqueer, androgynous) (Kosciw et al. 2010). The Family Acceptance ProjectTM recruited 245 young adults, 9 percent of whom identified as transgender (Ryan et al. 2010). According to the American Psychological Association, an estimated 1 in 10,000 biological males and 1 in 30,000 biological females are transsexuals (American Psychological Association 2006). However, this estimate does not include people who identify as transgender, genderqueer, cross-dressers, or other gender-variant self-identifications.

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The availability of state-level and national population-based survey data on adolescents has allowed researchers to estimate the proportion of adolescents that endorses same-sex sexual attractions, same-sex romantic relationships, same-sex sexual behaviors, and/or a gay, lesbian, bisexual, or questioning sexual identity. Seven states (i.e., Delaware, Maine, Massachusetts, Rhode Island, Vermont, Connecticut, and Wisconsin) and six large urban school districts (Boston, Chicago, New York City, San Francisco, Milwaukee, and San Diego) incorporate questions about same-sex sexual behaviors (twelve sites) and/or sexual identity (nine sites) into their Youth Risk Behavior Surveys, part of the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS), which monitors adolescents’ health-risk behaviors (Centers for Disease Control and Prevention [CDC] 2011). The National Longitudinal Study of Adolescent Health (Add Health), a longitudinal study of adolescents’ health-related behaviors, used a school-based representative sample of adolescents in grades 7–12 (Resnick et al. 1997). Participants were asked about their romantic attractions to females and males and the sex of their romantic relationship partners and other sexual partners (Udry & Chantala 2002). However, none of these surveys asked about gender identity other than asking youths to identify as male or female. Within the states that asked about sexual identity in their YRBSS surveys, between 1.0 percent and 2.6 percent of the youths identified as gay or lesbian, 2.9 percent to 5.2 percent as bisexual, and 1.3 percent and 4.7 percent as unsure (CDC 2011). Across the sites that asked about same-sex sexual behaviors, between .7 percent and 3.9 percent of the youths reported having only same-sex sexual contact, and 1.9 percent to 4.9 percent reported having contact with both sexes (CDC 2011). Approximately 6 percent of Add Health participants reported same-sex romantic attractions (i.e., 7.3 percent of boys and 5 percent of girls) and 1.5 percent

had been involved in same-sex relationships (i.e., 1.1 percent of boys and 2 percent of girls) (Russell, Franz, & Driscoll 2001; Russell & Joyner 2001; Udry & Chantala 2002). LGBTQ Youth Representation in Child Welfare Systems LGBTQ youth comprise a largely invisible population within child welfare systems, hiding their sexual orientation and/or gender identity out of fear of receiving differential treatment and negative reactions from professionals and biological, foster, and adoptive parents (Feinstein et al. 2001; Gallegos et al. 2011; Majd, Marksamer, & Reyes 2009; Mallon 1997b, 1998, 1999a, 2001; Ragg, Patrick, & Ziefert 2006; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006) or upon the advice of program staff who encourage them not to disclose for their own safety (Berberet 2006). Service providers and advocates have long asserted that LGBTQ youths are disproportionately represented among young people in out-of-home care, including juvenile detention facilities, or who are homeless because of the increased likelihood they will be thrown out, harassed, assaulted, or rejected by caregivers who negatively react to their sexual orientation and/or gender identity, subsequently leading to involvement with the juvenile justice system for status offenses or street-connected crimes (Majd, Marksamer, & Reyes 2009; Mallon 1999a; Mallon, Aledort, & Ferrera 2002; Sullivan Sommer, & Moff, 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Although researchers have estimated that between 20 percent and 60 percent of adolescents in foster care are LGBTQ (Woronoff, Estrada, & Sommer 2006), a longitudinal study of youth aging out of the child welfare system in three Midwestern states found that 6.6 percent at age nineteen selfidentified as “bisexual,” “mostly homosexual,” or “100% homosexual” (Courtney et al. 2005). This percentage is slightly higher than the proportion of youths in the Add Health study that

LGBTQ YOUTH AND THEIR FAMILIES

reported same-sex attractions and exceeds the proportion of youths in the YRBSS that identified as gay, lesbian, or bisexual. By ages twentythree or twenty-four, 11.3 percent of the young women and 4 percent of the young men selfidentified as “bisexual,” “mostly homosexual,” or “100% homosexual” (Courtney et al. 2010). These rates are higher than those found in the National Health and Social Life Survey (Laumann et al. 1994), a comprehensive survey of sexual behavior in the adult population (i.e., 1.4 percent of women and 2.8 percent of men identified as gay, lesbian, or bisexual). An additional 3.9 percent of the youths formerly in foster care reported that they were unsure of their sexual orientation (Courtney et al. 2010). In 2006, 188 adolescents receiving foster care services from Casey Family Programs in 2006 participated in the Casey Field Office Mental Health Study; 5.4 percent of these young people identified as lesbian, gay, bisexual, or questioning, and 11.5 percent had questioned their sexual orientation at some point in their lives (Gallegos et al. 2011). However, neither of these studies asked about transgender or gender variant identity. Irvine (2010) conducted two needs assessments with youths in the juvenile justice system, one involving 230 male and female youths in Santa Cruz County, California, and the other with 176 young women in Sonoma County, California. Among the youths in these studies, 14 percent and 13 percent, respectively, identified as gay/lesbian, bisexual, or unsure about their sexual orientation. In a subsequent survey of 2,100 youths in pretrial detention in six juvenile justice jurisdictions (i.e., Minneapolis, Albuquerque, Las Vegas, Santa Cruz, Birmingham, and Portland), 11 percent of respondents endorsed one or more of the following: (a) an LGB identity, (b) same-sex attractions, (c) peer harassment based on perceived sexual orientation, or (d) running away or being kicked out due to their sexual orientation. Six percent of participants reported harassment for not being sufficiently masculine or feminine (Irvine 2010).

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PSYCHOSOCIAL STRENGTHS AND NEEDS TO EXPLORE WITH LGBTQ YOUTHS Individual

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PSYCHOSOCIAL STRENGTHS AND NEEDS TO EXPLORE WITH LGBTQ YOUTHS (CONTINUED) Peers

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and mental health professionals. Sources: Elze 2002, 2013; Hershberger & D’Augelli 2000; Lev 2004; Ryan et al. 2009, 2010; Ryan & Futterman 1998; Tully 2000.

Multiple studies with homeless youths suggest that approximately 20 percent in the larger magnet cities identify as lesbian, gay, or bisexual, with smaller representations of sexual minority youth outside of large urban areas (Whitbeck et al. 2004). A study of 900 homeless and street-connected youths in New York City had 35 percent of the participants identify as LGB (Clatts et al. 1998). Van Leeuwen et al. (2006) conducted a same-day public health survey in eight cities across six states in order

to measure and compare risk factors between LGB and non-LGB homeless youth. Nearly one-quarter (22.4 percent) of the 670 participants identified as LGB, and significantly more LGB youth than non-LGB youth (44 percent versus 32 percent) reported having been in the custody of social services. Like their heterosexual peers, LGB youths find themselves involved with child welfare systems or experience homelessness due to family conflict, parental abuse, and/or neglect (Thrane et al. 2006; Tyler et al. 2001; Tyler & Cauce 2002), parental substance abuse and mental illness, or death of a caregiver (Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006). Other LGBTQ adolescents enter out-of-home care as infants or young children, where they later discover their sexual orientation and/or gender identity (Mallon 1997c, 1998, 1999a; Mallon, Aledort, & Ferrera 2002; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006). Unlike their heterosexual and gender-conforming peers, LGBTQ youths often face familial rejection in response to their sexual orientation and/or gender identity and gender expression. Heterosexism in families can directly result in the youth’s ejection from the home, or it can exacerbate other parental problems, heightening familial conflict until the youth is kicked out or leaves (Mallon 1997c, 1998; Mallon, Aledort, & Ferrera 2002; Mallon & DeCrescenzo 2006; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006). Their subsequent homelessness, truancy from school, or substance abuse often precipitates their involvement with the juvenile justice and/or foster care systems (Majd, Marksamer, & Reyes 2009; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006). Of four hundred LGBTQ or HIV-positive youths, ages twelve to twenty-four, living in out-of-home care or homeless in San Diego, 39 percent had been kicked out of their homes or placements due to their sexual orientation or gender identity, 65 percent had been in a foster home or group home, and 45 percent reported

LGBTQ YOUTH AND THEIR FAMILIES

involvement with the juvenile justice system (Berberet 2006). LGBTQ youth may come to the attention of juvenile justice and child welfare systems due to severe acting-out behavior, substance abuse, and/or truancy that might, in part, be related to victimization within their homes, schools, and communities due to their actual or perceived sexual orientation and/or gender identity (Feinstein et al. 2001; Wilber, Ryan, & Marksamer 2006). Societal Context Over the last two decades, the cultural landscape for LGBTQ youth has shifted dramatically with heightened public visibility of LGBTQ youth issues, important changes in social policies and laws, and the rise of queer youth activism (LLDEF 2008; Russell et al. 2009). Nearly four thousand school-based GSAs or LGBTQ-affirmative diversity clubs are registered with the Gay, Lesbian and Straight Education Network (GLSEN 2010). Information and support for LGBTQ youth figure prominently on the Web sites of federal agencies, such as the Centers for Disease Control and Prevention (http://www. cdc/gov/healthyouth/disparities/smy.htm) and the Administration for Children and Families (Samuels 2011). Fifteen states and the District of Columbia explicitly prohibit bias-related discrimination, harassment, and bullying of students that includes sexual orientation and gender identity; three additional states cover sexual orientation (but not gender identity) in their laws addressing school-based victimization (Human Rights Campaign Fund 2011). Despite these gains, many LGBTQ youths must still navigate family, school, and community environments marked by victimization, stigmatization, discrimination, and a lack of support from peers and adults (D’Augelli, Pilkington, & Hershberger 2002; Elze 2002, 2003; Himmelstein & Bruckner 2010; Kosciw et al. 2010; Mallon 1992a, 1992b, 1997c, 1998, 2001; Mallon, Aledort, & Ferrera, 2002; Nolan 2006; Mallon & DeCrescenzo 2006; Rosario, Schrimshaw, Hunter, & Gwadz 2002; Russell, Franz, &

]

Driscoll 2001; Ryan et al. 2009). Multiple studies suggest that LGBTQ youth experience more physical and verbal abuse and harassment from family members during adolescence than their heterosexual peers (Horliss, Cochran, & Mays 2002; Saewyc et al. 1998; Saewyc et al. 2006). Schools remain highly contested spaces for LGBTQ youths and their allies (Rienzo et al. 2006; Elia & Eliason 2010. Secondary analyses of data from seven population-based surveys of youth, including the Add Health Study, found that youths who reported same-sex behaviors, attractions, and/or a LGB identity were more likely to report physical and sexual abuse than their heterosexual peers, with some studies finding bisexual youths more at risk for physical abuse than their gay and lesbian peers (Saewyc et al. 2006). Evidence continues to mount that victimization and stigmatization are associated with psychological distress and health risk behaviors (D’Augelli, Pilkington, & Hershberger 2002; Elze 2002; Hatzenbuehler 2011; Russell & Joyner 2001; Ryan et al. 2009 ) into young adulthood (Needham & Austin 2010; Russell et al. 2011) and poorer educational outcomes and other school-related problems (Greytak, Kosciw, & Diaz 2009; Russell, Seif, & Truong 2001), particularly for youth of color (Diaz & Kosciw 2009). However, many LGB youths (lesbian, gay, and bisexual youths) do quite well (Savin-Williams 2005). Findings from the CDC analysis of Youth Risk Behavior Survey data showed that sexual minority students reported significantly more health risks than their heterosexual peers, including substance use, risky sexual behaviors, and victimization (CDC 2011). Less is known about transgender youths compared to LGB youth, but emerging research shows a similar pattern of heightened risk and vulnerability within their families, schools, and communities (Garofalo et al. 2006; Greytak, Kosciw, & Diaz 2009; Grossman & D’Augelli 2006, 2007; Grossman, D’Augelli, & Frank 2011; Grossman et al. 2005; Grossman, D’Augelli, &

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Salter 2006; McGuire et al. 2010). This is particular the case for transgender youth of color (Diaz & Kosciw 2009; Garofalo et al. 2006). Studies have also reported poor treatment of transgender youths at the hands of school personnel (Greytak, Kosciw, & Diaz et al. 2009; Mallon & DeCrescenzo 2006; Sausa 2005), child welfare professionals (Mallon 1998, 1999a, 2001, 2009b; Mallon, Aledort, & Ferrera 2002; Mallon & DeCrescenzo 2006; Marksamer 2011), and physical and mental health care providers (Garofalo et al. 2006; Grossman & D’Augelli 2006; Israel & Tarver 1997; Lev 2004; Mallon & DeCrescenzo 2006). Evidence exists that transgender youths are at extremely high-risk for family violence and rejection (Grossman, D’Augelli, & Salter 2006; Grossman, D’Augelli, & Frank 2011); suicidal ideation and attempts (Grossman & D’Augelli 2007); involvement with the criminal justice system (Garofalo et al. 2006; Marksamer 2011); survival sex and HIV infection (Garofalo et al. 2006; Mallon, Aledort, & Ferrera 2002; Mallon & DeCrescenzo 2006); unemployment or underemployment (Garofalo et al. 2006; Mallon & DeCrescenzo 2006); and lack of appropriate and adequate physical and mental health care (Garofalo et al. 2006; Grossman & D’Augelli 2006; Israel & Tarver 1997; Lev 2004; Mallon & DeCrescenzo 2006). Vulnerabilities and Risk Factors for LGBTQ Youths in Child Welfare Systems Most lesbian, gay, and bisexual adolescents are functioning quite well, enjoying psychological, emotional, physical, and social well-being (Murdock & Bolch 2005; Russell 2005; SavinWilliams 2005) just like the majority of adolescents (Irwin, Burg, & Cart 2002), and they perceive themselves to be developmentally similar to their heterosexual peers (Eccles et al. 2004). However, sexual minority youths, like other adolescents, traverse a variety of developmental trajectories (Diamond 2003; Rosario, Schrimshaw, & Hunter 2011a; Savin-Williams & Diamond 2000), and their lives involve complex interactions with multiple environments

that expose them to continual of risk and protection (Elze 2007). That some sexual minority youths are more at risk than others should come as no surprise given what is already known about adolescents who must negotiate social ecologies marked by environmental risks (Costa et al. 2005). Child welfare professionals should keep in mind that LGBTQ youths are, of course, in various stages of awareness and comfort with their sexual orientation and gender identity. LGBTQ youth in out-of-home care and homeless LGBTQ youth, many of whom have been involved with child welfare systems, are among the most at risk of sexual minority youths (Berberet 2006; Ray 2006; Rosario, Scrimshaw, & Hunter 2011b; Wilber, Ryan, & Marksamer 2006). Policies, procedures, and practices within child welfare systems place LGBTQ youths at risk, over and above the individual, family, peer, and community risk factors present in their lives. Within child welfare systems, LGBTQ youth are victimized, stigmatized, denied appropriate services, and live in fear of judgment and retaliation (Mallon 1992a, 1992b, 1997c, 1998, 1999a, 1999b, 2001; Mallon, Aledort, and Ferrera 2002; Mallon & DeCrescenzo 2006; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). LGB homeless youths, like other homeless youths (see Staller’s chapter, this volume), report histories of multiple traumatic events in their families and on the streets and an associated high prevalence of posttraumatic stress disorder that is frequently comorbid with other psychiatric disorders (Whitbeck et al. 2007). Compared to their non-LGB homeless peers, however, LGB homeless youth report a higher prevalence of physical and sexual victimization prior to leaving home (Rew et al. 2005; Tyler & Cauce 2002; Whitbeck et al. 2004), more frequent participation in survival sex and other risky sexual behaviors, and more substance abuse and mental health problems (Cochran et al. 2002; Van Leeuwen et al. 2006; Whitbeck et al. 2004).

LGBTQ YOUTH AND THEIR FAMILIES

System-Level Risk Factors System-level risk factors impacting LGBTQ youth include (a) agency policies that subject LGBTQ youth to differential and unfair treatment that violate youths’ constitutional rights and (b) agency practices that impose ineffective and culturally incompetent services on LGBTQ youth and fail to ensure their safety (Mallon 1992a, 1992b, 1997c, 1998, 1999a, 2001, 2009b; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Inappropriate practices include violating youths’ confidentiality related to sexual orientation and/or gender identity (Marksamer 2011; Ragg, Patrick, & Ziefert 2006; Wilber, Ryan, & Marksamer 2006); pressuring LGBTQ youths to conform to stereotypical expressions of gender (DeCrescenzo & Mallon 2000; Mallon 2009b; Mallon & DeCrescenzo 2006); subjecting LGBTQ youth to stigmatization, rejection, and a lack of support and failing to interrupt their victimization at the hands of peers and staff (Mallon 1992a, 1992b, 1997c, 1998, 1999a, 1999b, 2001; Sullivan, Sommer, & Moff 2001; Woronoff, Estrada, & Sommer 2006); and neglecting permanency planning for LGBTQ youths in care (Jacobs & Freundlich 2006; Mallon 1997c; Mallon, Aledort, & Ferrera 2002; Woronoff, Estrada, & Sommer 2006; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Wilber, Reyes, & Marksamer 2006). Of concern is that only 11 percent of the 606 CWLA member agencies responded to a brief national survey in 2006 that asked about LGBTQ-affirming practices and policies (Rosenwald 2009). Although the majority of respondent agencies incorporated sexual orientation as a protected category in nondiscrimination (78 percent) and recruitment (52 percent) policies, far fewer included gender identity (46 percent and 28 percent, respectively). Additionally, while most reported that they provided a safe and nurturing environment for LGBTQ youths, they rarely provided services to the families of LGBTQ youths, nor did they train foster and adoptive parents on sexuality and gender issues

]

(Rosenwald 2009). The extremely low response rate may indicate that the majority of CWLA member agencies give little attention to the needs of LGBTQ youths in their care. Differential Treatment Different standards are often applied to LGBTQ youth in child welfare systems, resulting in unfair and developmentally inappropriate treatment. Transgender youths are housed in congregate care settings incongruent with their gender identity (Mallon & DeCrescenzo 2006; Mallon 2009a, b; Marksamer 2011; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). A lack of staff knowledge and sensitivity on how to support LGBTQ youth in their identity and gender expression leave LGBTQ youth isolated. Staff persons lack skills in appropriately handling youths’ disclosures that might occur in group settings. LGBTQ youths’ problems are often wrongly assumed to be related to their identity, and their identity is viewed as a sexual problem or threat to other youth. More serious consequences are leveled against them for engaging in age appropriate, same-sex, sexual exploration than for heterosexual youth. If they are caught engaging in sexual behaviors with a same-sex peer, an assumption is often made that the LGBTQ youth is a “predator.” Juvenile detention facilities have been known to house LGBTQ youth in sex offender units, even when they were never accused of a sex offense (Marksamer 2011; Wilber, Ryan, & Marksamer 2006), or to isolate and segregate LGBTQ youth, depriving them of educational and recreational programming and peer contact (Estrada & Marksamer 2006a, 2006b; Wilbur, Ryan, & Marksamer 2006). Although heterosexual adolescents in out-of-home care may be allowed and encouraged to date and pursue romantic relationships, LGBTQ do not always receive support for doing the same (Mallon 1992a, 1998, 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Out of discomfort or antiLGBTQ biases, foster parents might forbid

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their LGBTQ child from having friends over under the same circumstances that they would welcome the friends of heterosexual youths in their care. LGBTQ youth often do not receive assistance from their caregivers in accessing LGBTQ-affirmative physical and mental health services, affirming religious institutions, and community-based LGBTQ youth groups. Victimization Multiple studies with LGBTQ youths in out-of-home care or on the streets have found that victimization by peers and staff in foster homes, congregate care settings, and juvenile detention facilities is a major concern (Berberet 2006; Feinstein et al. 2001; Freundlich, Avery, & Padgett 2007; Majd, Marksamer, & Reyes 2009; Mallon 1992a, 1992b, 1997c, 1998, 1999a, 2001; Mallon, Aledort, & Ferrera 2002; Mallon & DeCrescenzo 2006; Marksamer 2011; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Victimization takes the form of verbal harassment; physical, sexual or emotional abuse; and medical neglect (e.g., when transgender youths are denied medically necessary hormone treatments). Emotional abuse includes subjecting LGBTQ youth to religious proselytizing and forcing them to attend religious institutions that preach against same-sex sexuality. Transgender youth are consistently referred to with the wrong names or pronouns, sometimes intentionally, and they are often forced to wear clothing that is incongruent with their gender identity. Over half (56 percent) of a sample of gay and lesbian youth in the New York City child welfare system said they felt safer living on the streets than residing in a foster or group home (Mallon 1998); 75 percent of the LGBTQ youth in another study reported that group homes and congregate care settings were not safe for them, and over 50 percent chose the streets at some point due to safety concerns (Mallon, Aledort, & Ferrera 2002). Evidence exists that many adult service providers are unaware of LGBTQ youths’ victimization in their programs. While nearly all

(90 percent) of the four hundred youths in the San Diego study said that safety was a concern in group homes and shelters, and that they did not feel safe accessing available support services, only 20 percent of the fifty service providers surveyed identified safety as one of the top five concerns (Berberet 2006). An investigation of youths’ and professionals’ perceptions of safety for adolescents living in congregate care facilities within the New York City foster care system revealed that child welfare agency representatives were less likely to perceive safety concerns compared to family court judges, law guardians, social workers associated with legal service organizations, advocates for youths in foster care, and young adults formerly in foster care (Freundlich, Avery, & Padgett 2007). These results highlight a disconnection between service providers’ perceptions and LGBTQ youths’ needs. In contrast, Mallon, Aledort, & Ferrera (2002) found that 88 percent of the providers interviewed were aware of safety concerns; however, these providers worked for LGBTQaffirming agencies. Multiple Placements LGBTQ youth in outof-home care are likely to experience multiple placements because of unsafe congregate care and foster home environments, anti-LGBTQ biases on the part of staff and foster and adoptive parents, and peer rejection and conflict related to sexual orientation and gender identity issues (Mallon 1998, 1999a, 2001; Mallon, Aledort, & Ferrera 2002; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Mallon, Aledort, & Ferrera (2002) found that 80 percent of the youths in their study reported an average of 6.35 placements, with some reporting as many as 40 different foster care placements. They also spent a much longer time in foster care (4.2 years) (Mallon, Aledort, & Ferrera 2002) than the time limits required by the Adoption and Safe Families Act (i.e., 15 to 22 months) (Child Welfare Information Gateway 2011a).

LGBTQ YOUTH AND THEIR FAMILIES

Confidentiality LGBTQ youths in out-ofhome care express serious concerns about their agency file; they fear that staff will disclose their sexual orientation or gender identity to biological, foster, and adoptive parents without their consent (Ragg, Patrick, & Ziefert 2006). Disclosure carries with it risks of ridicule, rejection, and abuse if the information falls into the wrong hands. Child welfare agencies often lack policies that address confidentiality around sexual orientation and gender identity, including policies on written documentation. Model practice and policy guidelines for managing confidential information about youths’ sexual orientation and gender identity are easily accessed (Wilber, Ryan, & Marksamer 2006). Child welfare systems are legally obligated to treat youths’ sexual orientation and gender identity the same way that any other confidential information is handled (Wilber, Ryan, & Marksamer 2006). If disclosure is necessary to protect or secure a benefit for the youth, disclosure should not occur without actively engaging the youth in a discussion about risks and benefits and securing the youth’s permission (Wilber, Ryan, & Marksamer 2006; Marksamer 2011). The management of client information should be resolved in favor of the youth’s interests, rather than for the agency’s convenience. Permanency Planning Multiple, unstable, and unsupportive placements undermine youths’ chances for permanence (Feinstein et al. 2001; Jacobs & Freundlich 2006; Mallon 2001, 2011; Mallon, Aledort, & Ferrera 2002; Sullivan, Sommer, & Moff 2001; Wilber, Reyes, & Marksamer 2006; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). LGBTQ youths are profoundly affected by an overall lack of LGBTQ-friendly placements of all types, from foster homes to residential treatment centers (Majd, Marksamer, & Reyes 2009; Mallon 1998, 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). As a consequence of both their disconnected family relationships and the child welfare systems’

]

lack of LGBTQ-friendly foster homes, LGBTQ youth may be placed in congregate care settings even when they do not need that level of care or structure (Mallon, Aledort, & Ferrera 2002; Wilber, Ryan, & Marksamer 2006). Such inappropriate placements increase the likelihood that LGBTQ youth will run away and age out of systems of care, thus decreasing their chances for permanence (Mallon, Aledort, & Ferrera 2002; Sullivan, Sommer, & Moff 2001; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006). Additionally, caseworkers’ biases and lack of competencies in helping LGBTQ youths’ biological, foster, and adoptive parents adjust and adapt to youths’ sexual orientation and gender variance interfere with permanency planning. Caseworkers wrongly assume that family preservation efforts or reconnection with biological family members are destined to fail if family members react negatively to their children’s sexual orientation and/or gender identity (Mallon 1997c, 1998, 1999a, 2001; Mallon, Aledort, & Ferrera 2002; Woronoff, Estrada, & Sommer 2006). Child welfare professionals may also lack skills in working with families on these issues; moreover, anti-LGBTQ attitudes and beliefs also prevent workers from recruiting LGBTQ foster and adoptive parents (Woronoff, Estrada, & Sommer 2006). Although they may bring an array of fears and concerns to permanency planning, LGBTQ youths in out-of-home care desire meaningful and long-lasting connections with adults (Mallon, Aledort, & Ferrara 2002); their hope for such connections should be supportively addressed (Jacobs & Freundlich 2006). To increase the likelihood of permanence for LGBTQ youth, workers should help youths maintain attachments to supportive extended family members (Mallon, Aledort, & Ferrara 2002). In addition, agencies should develop guidelines, policies, and procedures to support permanency plans for LGBTQ youth, including reunification when appropriate. Agencies should also actively recruit, train, and support

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LGBTQ and LGBTQ-affirming foster and adoptive parents. Child welfare professionals urgently need training to help biological, foster, and adoptive families work through their questions and concerns related to sexual orientation and gender identity diversity and to facilitate family acceptance and reunification when possible (Mallon, Aledort, & Ferrara 2002). The absence of interventions to prevent family disruption over sexual orientation or gender identity issues increases the likelihood that families will break apart and fail to reunite. LGBTQ youths should be given a seat at the permanency planning table and be asked to identify LGBTQ-affirming adults in their lives (Wilber, Ryan, & Marksamer 2006). Resiliencies and Protective Factors Little research has investigated protective factors influencing LGBTQ adolescents and even less is known about the mechanisms or processes that underlie the relationship between particular risk, vulnerability, and protective factors and youths’ well-being. Diamond (2003) issued a strong appeal for researchers to test hypotheses about main, mediating, and moderating effects, particularly when investigating how youths’ sexual and gender identities may impact their development. Emerging research from the Family Acceptance ProjectTM provides evidence that family reactions to youths’ sexual orientation and gender identity strongly affect the well-being of LGBTQ youths and suggests specific intervention strategies. Ryan et al. (2009) found that LGB young adults who experienced high levels of family rejection during adolescence reported significantly more negative health outcomes (e.g., suicide attempts, serious depression, illegal drug use, unprotected sexual intercourse) than their peers with no or low levels of family rejection. Further, LGBT Latino and nonLatino white young adults that had experienced greater family acceptance also reported higher self-esteem, better overall health, more social support, and less depression, suicidality, and

substance abuse than their less accepted peers, although transgender young adults reported less social support and poorer general health (Ryan et al. 2010). Although little research exists, LGBTQ youths in child welfare systems or who are homeless have shared their stories of resilience (Lowery 2010; Woronoff, Estrada, & Sommer 2006). They creatively seek out supportive peers and adults and find community-based supports despite the obstacles placed in their paths. They hide their sexual orientation and gender identity when they sense danger. They stick up for themselves and each other when bullied, harassed, and abused. To affirm their sense of self, they bravely and stubbornly defy rigid gender proscriptions and unfair and differential treatment. They organize and advocate for themselves and their peers. They exhibit tremendous stamina, courage, and resilience when they leave hostile environments and create families of choice that help them survive. Current Policies at Federal and State Levels Legal Protections for LGBTQ Youth in Care According to legal advocates, LGBTQ youths in out-of-home care have constitutional rights to safety and protection from physical, mental, and emotional harm; to freedom from isolation or segregation based on their sexual or gender identity; to appropriate medical and mental health care; to express their sexual orientation and/or gender identity while in state custody (e.g., clothing, hairstyle, grooming); to participate in religious activities of their choice and to be free from religious indoctrination; and to equal protection under the law, including the right to be treated equally in the provision of all placements and services and in the agency’s response to complaints of harassment and abuse (Estrada & Marksamer 2006a, 2006b; Marksamer 2011; Wilbur, Ryan, & Marksamer 2006). The New York State Office of Children and Family Services (OCFS) has adopted

LGBTQ YOUTH AND THEIR FAMILIES

a comprehensive policy prohibiting discrimination in OCFS facilities on the basis of actual or perceived sexual orientation, gender identity and gender expression, and has disseminated guidelines for LGBTQ-supportive practices with children and adolescents in out-of-home care. Implementation of the policy has been supported by mandated training of OCFS staff and a requirement that all youth in OCFS programs receive information about the policy (Majd, Marksamer, & Reyes 2009). California law expressly prohibits discrimination in the foster care system based on actual or perceived sexual orientation or gender identity (Wilber, Reyes, & Marksamer 2006). As of 2009, thirty-six states and the District of Columbia had adopted codes of judicial conduct that explicitly prohibit sexual orientationand gender-based bias in court proceedings, including in juvenile courts (Majd, Marksamer, & Reyes 2009). Laws on LGBTQ Adoption and Foster Parenting In their written policies or laws , most states do not explicitly address whether LGBTQ individuals or same-sex couples may adopt children or become foster parents. Through laws or child welfare systems’ policies, six states currently restrict adoption by LGBTQ individuals (i.e., Nebraska, Florida, Michigan, Mississippi, North Dakota, and Utah); Mississippi is the only state that expressly disallows gay and lesbian people from adopting children (Serdjenian 2010). Four states (i.e., North Dakota, Nebraska, Utah, and Arkansas) restrict LGBTQ individuals from becoming foster parents (Serdjenian 2010). Programs and Child Welfare Contributions Programs Serving LGBTQ Youths and Families Green Chimneys in New York City and Gay and Lesbian Adolescent Social Services in West Hollywood, California (which closed in 2009), provided child welfare systems with models of multiservice LGBTQ-affirming environments

]

for sexual minority youth in need of residential and educational services (Mallon 1997c; Mallon, Aledort, & Ferrera 2002; Nolan 2006). Other residential programs for LGBTQ youth include the Home for Little Wanderers in Boston, Lutheran Children and Family Services in Philadelphia, and the Ruth Ellis Center in Detroit (Woronoff, Estrada, & Sommer 2006). Many other promising programs and initiatives are transforming child welfare systems on behalf of LGBTQ youth and their families.

FOCI OF INTERVENTIONS FOR LGBTQ YOUTHS Clinical interventions with LGBTQ adolescents.

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FOCI OF INTERVENTIONS FOR LGBTQ YOUTHS (CONTINUED) Clinical interventions with LGBTQ adolescents.

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PG
grief, loss, anger, fear, shame, guilt. t
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professionals and LGBTQ-affirmative spiritual/ religious leaders. Interventions to reduce stigmatization in community environments

t
*ODSFBTF
UIF
DBQBDJUZ
PG
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UP
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interrupt oppressive behavior. t
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BOUJ-(#52
slurs or jokes. t
4VQQPSU
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networks. t
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PG
-(#52
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training curricula. t
&OBDU
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BHFODZ
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antiharassment policies. t
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UP
-(#52
agency employees. t
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training to child welfare agencies. Sources: Hershberger & D’Augelli, 2000; Mallon 1997a, 1997c, 2009; Ryan & Futterman 1998; Ryan et al. 2009, 2010; Tully, 2000; Wilber, Ryan et al. 2006.

Interventions to Strengthen the Families of LGBTQ Youths Programs serving LGBTQ youths have typically focused on the youths as individuals, rather than serving them within their family context (Jacobs & Freudenlich, 2006; Mallon 1997c, 1999a, 2001; Mallon, Aledort, & Ferrera 2002; Wilber, Ryan, & Marksamer

2006; Woronoff, Estrada, & Sommer 2006). The Family Acceptance ProjectTM is developing evidence-based interventions to support and strengthen the families of LGBTQ youths and assist family members with increasing accepting behaviors and decreasing rejecting behaviors toward their children (Ryan et al. 2009; 2010). ). Many other barriers undermine family reunification efforts for LGBTQ youths, such as lack of agency commitment; deficient worker knowledge, skills, and attitudes; and a scarcity of LGBTQ-affirming placements (Mallon 1997c). Intensive home-based services are needed to address crisis situations that may arise when parents discover that a youth is LGBTQ, with the aim of keeping the family intact if the youth’s safety can be assured (Mallon 1997c; Mallon, Aledort, & Ferrera 2002; Wilber, Ryan, & Marksamer 2006). Biological, foster, and adoptive parents need accurate information about sexual orientation and gender identity within the context of normal adolescent development; supportive guidance to help them adjust to their child’s identity; and empathic counseling to address their negative and positive feelings, attitudes, and behaviors toward their child’s sexual orientation and/or gender identity (Ryan et al. 2009, 2010; Wilber, Ryan, & Marksamer 2006). Child welfare professionals must dissuade parents from seeking harmful and unethical reparative therapies that aim to change youths’ sexual orientation or gender identity (Mallon & DeCrescenzo 2006). MEZZO- AND MACRO-LEVEL INTERVENTIONS Physical environment

t
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to stop anti-LGBTQ harassment. t
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interrupt verbal abuse and derogatory remarks. t
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transgender youths’ chosen names and pronouns.

LGBTQ YOUTH AND THEIR FAMILIES

t
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with their gender identity or gender-neutral bathrooms. t
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congregate care environments that are congruent with their gender identity. t
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resource lists are displayed in agency offices and lounges and are available to youth. t
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dances, are welcoming environments for LGBTQ youths, same-sex couples when appropriate, and gender variant young people. Chaperones are trained to be LGBTQ-affirmative. t
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LGBTQ youth issues. t
-(#52
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for youths, parents, and other caretakers. t
"DUJWFMZ
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GPTUFS
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QBSFOUT Knowledgeable and supportive staff and caregivers

t
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parents with ongoing training to improve their knowledge and skills for effective intervention on behalf of LGBTQ youth. t
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PO
-(#52
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needs and rights and on the agency’s legal obligations to protect all youths from harm. Policies

t
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in care. t
&OBDU
BOE
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around sexual orientation and gender identity, including policies on written documentation. t
&OBDU
BOE
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BHFODZ
BOUJIBSBTTNFOU
BOE
nondiscrimination policies that include sexual orientation, gender identity, and gender expression. t
&EVDBUF
BMM
ZPVUI
BHFODZ
TUBČ
BOE
GPTUFS
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BEPQUJWF
parents on the specific behaviors prohibited under these policies and the procedures for reporting violations. t
"QQMZ
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DPEFT
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B
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youth to dress in a manner that reflects their gender identity. t
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BOE
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prohibit discrimination and harassment on the basis of sexual orientation, gender expression, and gender identity in youth-serving environments. Sources: Feinstein et al. 2001; Mallon 1997a, 1997c, 2009; Mallon, Aledort, & Ferrera 2002; Marksamer 2011; McHaelen & Elze 2009; Thaler, Bermudez, & Sommer 2009; Tully 2000; Sullivan, Sommer, & Moff 2001; Wilber, Reyes, & Marksamer 2006; Wilber, Ryan, & Marksamer 2006; Woronoff, Estrada, & Sommer 2006.

]

Youth Development Programs The California Youth Connection promotes youth participation in policy development and legislative advocacy to improve the state’s foster care system (Wilber, Reyes, & Marksamer 2006). The Y.O.U.T.H. Training Project, in conjunction with the NCLR, produced a film that was written and directed by LGBTQ youth formerly in foster care, Breaking the Silence: Lesbian, Gay, Bisexual, Transgender, and Queer Foster Youth Tell Their Stories (http://www.NCLRights.org/Youth_BTS). This film tells their stories about their experiences (Marksamer 2011). Training, Consultation, Technical Assistance, and Advocacy The National Resource Center for Permanency and Family Connections (NRCPFC), funded by the Children’s Bureau, provides training, consultation, and a wide array of Web-based, downloadable resources to enhance the capacity of agencies to deliver culturally competent, LGBTQ-affirmative services to LGBTQ youths, their parents, and LGBTQ parents, including a wealth of resources to facilitate agency recruitment and retention of LGBTQ foster and adoptive parents (http://www.hunter.cuny.edu/ socwork/nrcfcpp). Since 2002, the CWLA and the Lambda Legal Defense and Education Fund (LLDEF) have collaborated on a joint initiative, the Fostering Transitions Project, to support LGBTQ youths and adults involved with child welfare systems (Wilber, Ryan, & Marksamer 2006). Project staff held a series of regional listening forums in thirteen cities around the country to hear about the experiences of LGBTQ youth in out-of-home care and their service providers (Woronoff, Estrada, & Sommer 2006). Two valuable products emerged from this project: (a) the CWLA/Lambda Legal National LGBTQ Advisory Network, a growing network of over two hundred child welfare professionals, advocates, trainers, academicians, and youth, which shares resources,

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and (b) the toolkit Getting Down to Basics: Tools to Support LGBTQ Youth in Care. The Model Standards Project, a collaborative effort between Legal Services for Children and the NCLR, has developed and disseminated model practices and policies governing the care of LGBTQ youth in child welfare and juvenile justice facilities (Wilber, Reyes, & Marksamer 2006; Wilber, Ryan, & Marksamer 2006). These two San Francisco-based organizations also launched the Out-of-Home Youth Advocacy Council (OHYAC), in partnership with Family Builders by Adoption, in 2003, and the Equity Project, in partnership with the National Juvenile Defender Center, two years later. The OHYAC is a multidisciplinary collaborative of stakeholders dedicated to improving out-of-home care for LGBTQ youth in the Bay Area (Wilbur, Reyes, & Marksamer 2006). The OHYAC has been focused on training child welfare workers and foster and adoptive parents. The Equity Project was launched to ensure dignified, respectful, and fair treatment of LGBTQ youth within the juvenile justice system (Majd, Marksamer, & Reyes 2009). More recently, LLDEF, the National Alliance to End Homelessness, the NCLR, and the National Network for Youth (2009) issued best practices for serving LGBTQ homeless youths; in addition, the NCLR and the Sylvia Rivera Law Project have published a guide for group care facilities on serving transgender and gender nonconforming youths (Marksamer 2011). Programs to Assist with LGBTQ Adoption and Foster Parenting Although gay and lesbian people have always fostered and adopted children (Mallon 2007), rapid progress has occurred over the last decade in promoting and developing LGBTQ-headed

foster and adoptive placements. This has been facilitated by progressive changes in state laws (Human Rights Campaign Foundation 2009). Gates and colleagues estimate that approximately two million LGBTQ individuals are interested in adopting and that nearly eighty thousand children are living with foster or adoptive LGBT parents (Gates et al. 2007). Many program initiatives, informational resources, and advocacy efforts now exist to help LGBTQ adults become foster or adoptive parents and to develop agencies’ capacities to successfully recruit, train, and maintain them as viable placements for children and adolescents (Child Welfare Information Gateway 2011b; Serdjenian 2013). The Human Rights Campaign Foundation has published a comprehensive self-assessment and best practices guide for agencies interested in building their capacity to promote LGBTQ foster and adoptive parenting. Another important initiative funded by the Children’s Bureau, AdoptUsKids, supports efforts by Title IV agencies to recruit, train, and retain LGBTQ foster and adoptive parents (http://adoptuskids.org). YYY

Child welfare professionals now have a wealth of resources and technical assistance at their disposal to provide effective, sensitive, and culturally competent services to LGBTQ youths and their families. No longer can inaction be excused because of a knowledge gap. Currently, strong leadership exists at the federal level within the Administration of Children and Families, but leadership changes as presidential administrations change. Stronger ongoing leadership is needed at state-, county-, and agency-levels if LGBTQ youths and their families are to receive quality care in child welfare systems.

LGBTQ YOUTH AND THEIR FAMILIES GLOSSARY OF TERMS

Bisexual: a person whose sexual attraction, both physical and affectional, is directed toward persons of both sexes, though the degree of attraction may vary. Coming out: the developmental process of becoming aware of one’s sexual orientation or gender identity and disclosing it to others. Gender: gender is an ascribed social status to which we are assigned at birth, based on the sex category to which we are assigned. Our society (though not all) has constructed two genders—“man” and “woman.” Gender dysphoria: Clinical symptoms of excessive discomfort, confusion, pain, and anguish from feeling an incongruity with the gender assigned to one at birth (Israel & Tarver 1997; Lev 2004). Gender dysphoric young people often suppress and hide these feelings from others. Not all transgender youths experience gender dysphoria, but rather have stable identities. Gender expression: the communication of gender or gender identity through behaviors (e.g., mannerisms, speech patterns, dress) and appearance culturally associated with a particular gender. The ways in which people express and view gender are influenced by societal definitions of gender. Gender identity: a person’s inner sense of being male, female, both, or something else; the gender with which one identifies, regardless of their biological sex. Gender role: the society’s prescriptions for being male and female; the pattern of attitudes, behaviors, and beliefs dictated by society that defines what it means to be male and female. Heterosexism: an ideological system that devalues and stigmatizes any nonheterosexual identity, behavior, relationship, or community (Herek 1990), and exists at the personal, interpersonal, institutional, and cultural levels. Homosexual: a person whose sexual attraction, both physical and affectional, is primarily directed toward persons of the same sex. Gay and lesbian are contemporary synonyms to refer to men and women, respectively. Some young people prefer the word queer, finding it more inclusive. People may be involved in same-sex sexual activities and relationships, but not identify themselves as gay, lesbian, or bisexual. Internalized homophobia (biphobia, transphobia) or heterosexism: the acceptance and internalization of negative stereotypes and images about LGBTQ people by LGBTQ people. Sex: in this culture, sex means biologically male or biologically female. A person is assigned to a sex category at birth on the basis of what the genitalia looks like. Intersex refers to a person who is born with sex chromosomes, external genitalia, or an internal

]

reproductive system that is not considered to be society’s norm for either male or female. Sexual orientation: the direction of one’s sexual attraction, or physical and affectional attraction, which can be toward same-sex (homosexuality) or other sex (heterosexuality), both sexes (bisexuality), or no one. Gay, lesbian, and bisexual people are gender variant in that they are violating societal norms around sexual object choice. Transgender: an umbrella term that describes people whose gender identity and/or gender expression may be different from their biological sex or in violation of societal gender norms. They are, in other words, gender variant. This term may include preoperative transsexuals, postoperative transsexuals, nonoperative transsexuals, cross-dressers, gender benders, drag kings, and drag queens. (Not all transsexuals desire genital reassignment surgery.) Transgender people may be heterosexual, bisexual, gay, lesbian, or asexual. Gender variance in children may forecast a same-sex sexual orientation or transgenderism (with or without gender dysphoria) or may simply indicate variance in gender expression (Lev 2004).

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gender students of color in our nation’s schools. New York: Gay, Lesbian and Straight Education Network. Eccles, T. A., Sayegh, M. A., Fortenberry, J. D., & Zimet, G. D. (2004). More normal than not: A qualitative assessment of the developmental experiences of gay male youth. Journal of Adolescent Health, 35(5), 425. e11–e18. Elia, J. P, & Eliason, M. J. (2010). Dangerous omissions: Abstinence-only-until-marriage school based sexuality education and the betrayal of LGBTQ youth. American Journal of Sexuality Education, 5, 17–35. Elizur, Y. & Ziv, M. (2001). Family support and acceptance, gay male identity formation, and psychological adjustment: A path model. Family Process, 40, 12–144. Elze, D. (2002). Risk factors for internalizing and externalizing problems among gay, lesbian, and bisexual adolescents. Social Work Research, 26, 89–100. Elze, D. (2003). Gay, lesbian and bisexual adolescents’ perceptions of their high school environments and factors associated with their comfort in school. Children & School, 25, 225–39. Elze, D. (2007). Research with sexual minority youths: Where do we go from here? Journal of Gay and Lesbian Social Services, 18 (2), 73–99. Elze, D. (2013). Working with a lesbian, gay, bisexual, transgender, queer, and questioning students. In C. Franklin, M. B. Harris, & P. Allen-Meares (eds), The school services sourcebook, 2nd ed (pp. 821–36). New York: Oxford University Press. Estrada, R., & Marksamer, J. (2006a). Lesbian, gay, bisexual and transgender young people in state custody: Making the child welfare and juvenile justice systems safe through litigation, advocacy and education. Temple Law Review, 79, 415–38. Estrada, R, & Marksamer, J. (2006b). The legal rights of LGBT youth in state custody: What child welfare and juvenile justice professionals need to know. Child Welfare, 85, 171–94. Feinstein, R., Greenblatt, A., Hass, L., Kohn, S., & Rana, J. (2001). Justice for all? A report on lesbian, gay, bisexual and transgendered youth in the New York juvenile justice system. New York: Urban Justice Center; retrieved from http://www.urbanjustice.org/publications/index,html. Freundlich, M., Avery, R. J., & Padgett, D. (2007). Care or scare: The safety of youth in congregate care in New York City. Child Abuse & Neglect, 31, 173–86. Gainor, D.A. (2000). Including transgender issues in lesbian, gay, and bisexual psychology: Implications for clinical practice and training. In B. Greene & G. L. Croom (eds.), Education, research, and practice in lesbian, gay, bisexual, and transgendered psychology (pp. 131–60). Thousand Oaks, CA: Sage. Gallegos, A., White. C.R., Ryan, C., O’Brien, K., Pecora, P.J., & Thomas, P. (2011). Exploring the experiences of lesbian, gay, bisexual, and questioning adolescents in foster care. Journal of Family Social Work, 14, 226–36.

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Garofalo, R., Deleon, J., Osmer, E., Doll, M., & Harper, G. (2006). Overlooked, misunderstood, and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. Journal of Adolescent Health, 38, 230–36. Gates, G., Badgett, L. M. V., Macomber, J. E., & Chambers, K. (2007). Adoption and foster care by lesbian and gay parents in the United States. Washington, DC: Williams Institute, UCLA School of Law & the Urban Institute; retrieved from http://www.urban.org/UploadedPDF/411437_Adoption_Foster_Care.pdf. Gay, Lesbian and Straight Education Network (2010). About Gay-Straight Alliances (GSAs); retrieved from http://www.glsen.org/cgi-bin/iowa/all/library/ record/2342.html?state=what. Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey. American Journal of Public Health, 92, 203–10. Greytak, E. A., Kosciw, J. G., & Diaz, E. M. (2009). Harsh realities: The experiences of transgender youth in our nation’s schools. New York: Gay Lesbian and Straight Education Network. Grossman, A. H., & D’Augelli, A. R. (2006). Transgender youth: Invisible and vulnerable. Journal of Homosexuality, 51, 111–28. Grossman, A. H., & D’Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37, 527–37. Grossman, A. H., D’Augelli, A. R., & Frank, J. A. (2011). Aspects of psychological resilience Among transgendered youth. Journal of LGBT Youth, 8, 103–15. Grossman, A. H., D’Augelli, A. R., Howell, T. J., & Hubbard, S. (2005). Parents’ reactions to transgender youths’ gender nonconforming expression and identity. Journal of Gay & Lesbian Social Services, 18, 3–16. Grossman, A. H., D’Augelli, A. R., & Salter, N. P. (2006). Male-to-female transgender youth: Gender expression milestones, gender atypicality, victimization, and parents’ responses. Journal of GLBT Family Studies, 2, 71–92. Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127, 896–903. Herdt, G., & Boxer, A. (1993). Children of Horizons: How gay and lesbian teens are leading a new way out of the closet. Boston: Beacon. Herek, G. M. (1990). The context of anti-gay violence: Notes on cultural and psychological heterosexism. Journal of Interpersonal Violence, 5 (3), 316–333. Hershberger, S. L., & D’Augelli, A. R. (2000). Issues in counseling lesbian, gay, and bisexual adolescents. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 225–47). Washington, DC: American Psychological Association.

]

Himmelstein, K. E. W., & Bruckner, H. (2010). Criminal-justice and school sanctions against nonheterosexual youth: A national longitudinal study. Pediatrics, 127, 49–57. Horliss, H. L., Cochran, S. D., & Mays, V. M. (2002). Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults. Child Abuse & Neglect, 26, 1165–78. Human Rights Campaign Fund Foundation (2009). Promising practices in adoption and foster care: A comprehensive guide to policies and practices that welcome, affirm and support lesbian, gay, bisexual and transgender foster and adoptive parents; retrieved from http://www.hrc.org/documents/HRC-Foundation_Promising_Practices_Guide_3rd_Edition_ Printer_Friendly.pdf. Human Rights Campaign Fund (2011). Statewide school laws & policies; retrieved from http://hrc.org/ documents/school_laws.pdf. Irvine, A. (2010). “We’ve had three of them”: Addressing the invisibility of lesbian, gay, bisexual, and gender non-conforming youths in the juvenile justice system. Columbia Journal of Gender and Law, 19 (3), 6745–701. Irwin, C. E., Burg, S. J., & Cart, C. U. (2002). America’s adolescents: Where have we been, where are we going? Journal of Adolescent Health, 31, 91–121. Israel, G. E., & Tarver, D. E. (1997). Transgender care: Recommended guidelines, practical information & personal accounts. Philadelphia: Temple University Press. Jacobs, J., & Freundlich, M. (2006). Achieving permanency for LGBTQ youth. Child Welfare, 85, 299–316. Kosciw, J. G., Greytak, E. A., Diaz, E. M., & Bartkiewicz, M. J. (2010). The 2009 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York: Gay, Lesbian and Straight Education Network. Lambda Legal Defense & Education Fund. (2008).Out, safe & respected: Your rights at school. New York: Lambda Legal Defense & Education Fund. Laumann E. O, Gagnon J. H., Michael R. T., & Michaels, S. (1994). The social organization of sexuality. Chicago: University of Chicago Press. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender variant people and their families. New York: Haworth. Lowery, S. (ed.) 2010. Kicked out. Ypsilanti, MI: Homofactus. McGuire, J. K., Anderson, C. R., Toomey, R. B., & Russell, S. T. (2010). School climate for transgender youth: A mixed method investigation of student experiences and school responses. Journal of Youth and Adolescence, 39, 1175–88. McHaelen, R. (2006). Bridges, barriers, and boundaries: A model curriculum for training youth service professionals to provide culturally competent service for sexual and gender minority youth in care. Child Welfare, 85, 407–38.

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McHaelen, R., & Elze, D. (2009). Moving the margins: Curriculum for child welfare services with LGBTQQ youth in out-of-home care. Washington, DC: National Association of Social Workers & Lambda Legal Defense & Education Fund. Majd, K., Marksamer, J., & Reyes, C. (2009). Hidden in justice: Lesbian, gay, bisexual, and transgender youth in juvenile courts. San Francisco: Legal Services for Children, National Juvenile Defender Center, and National Center for Lesbian Rights. Mallon, G. (1992a). Gay and no place to go: Assessing the needs of gay and lesbian adolescents in out-ofhome care settings. Child Welfare, 71 (6), 547–56. Mallon, G. (1992b). Serving the needs of gay and lesbian youth in residential treatment centers. Residential Treatment for Children & Youth, 10 (2), 47–61. Mallon, G. P. (1997a). Basic premises, guiding principles, and competent practices for a positive youth development approach to working with gay, lesbian, and bisexual youths in out-of-home care. Child Welfare, 76, 591–609. Mallon, G. P. (1997b). Entering into a collaborative search for meaning with gay and lesbian youth in out-of-home care: An empowerment-based model for training child welfare professionals. Child and Adolescent Social Work Journal, 14, 427–44. Mallon, G. P. (1997c). Toward a competent child welfare service delivery system for gay and lesbian adolescents and their families. Journal of Multicultural Social Work, 5 (3/4), 177–94. Mallon, G. P. (1998). We don’t exactly get the welcome wagon: The experiences of gay and lesbian adolescents in child welfare systems. New York: Columbia University Press. Mallon, G. P. (1999a). Let’s get this straight: A gay- and lesbian-affirming approach to child welfare. New York: Columbia University Press. Mallon, G. P. (ed.) (1999b). Social services with transgendered youth. New York: Harrington Park. Mallon, G. P. (2001). Lesbian and gay youth issues: A practical guide for youth workers. Washington, DC: CWLA. Mallon G. P. (2007). Assessing lesbian and gay prospective foster and adoptive families: A focus on the home study process. Child Welfare, 86, 67–86. Mallon, G. P. (2009a). A call for organizational transformation. In G. P. Mallon (ed.), Social work practice with transgender and gender variant youth (2d ed., pp. 163–74). New York: Routledge. Mallon, G. P. (2009b) Social work practice with transgender and gender variant youth (2d ed.). New York: Routledge. Mallon, G. P. (2011). Permanency for LGBTQ youth. Protecting Children: A Publication of the American Humane Society, 26 (1), 49–57. Mallon, G. P., Aledort, N., & Ferrera, M. (2002). There’s no place like home: Achieving safety, permanency, and well-being for lesbian and gay ado-

lescents in out-of-home care settings. Child Welfare, 51, 407–39. Mallon,G. P., & DeCrescenzo, T. (2006). Transgender children and youth: A child welfare practice perspective. Child Welfare, 85, 215–41. Marksamer, J. (2011). A place of respect: A guide for group care facilities serving transgender and gender non-conforming youth. San Francisco and New York City: National Center for Lesbian Rights and the Sylvia Rivera Law Project; retrieved from http://www. nclrights.org/site/DocServer/A_Place_of_Respect. pdf?docID=8301. Murdock, T. B., & Bolch, M. B. (2005). Risk and protective factors for poor school adjustment in lesbian, gay, and bisexual high school youth: Variable and person-centered analyses. Psychology in the Schools, 42, 159–72. National Alliance to End Homelessness, Lambda Legal Defense and Education Fund, National Center for Lesbian Rights, and National Network for Youth (2009). National recommended best practices for serving LGBT homeless youth. New York: Authors; retrieved from http://www.endhomelessness.org/ content/article/detial/2239. Needham, B. L., & Austin, E. L. (2010). Sexual orientation, parental support, and health during the transition to young adulthood. Journal of Youth and Adolescence, 39, 1189–98. Nolan, T. C. (2006). Outcomes for a transitional living program serving LGBTQ youth in New York City. Child Welfare, 85, 385–406. Ragg, D. M., Patrick, D., & Ziefert, M. (2006). Slamming the closet door: Working with gay and lesbian youth in care. Child Welfare, 85, 243–65. Ray, N. (2006). Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless; retrieved from http://www.thetaskforce//downloads/ HomelessYouth.pdf. Remafedi, G., Resnick, M., Blum, R., & Harris, L. (1992). Demography of sexual orientation in adolescents. Pediatrics, 89, 714–21. Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., Tabor, J., Beuhring, T., Sieving, R. E., Shew, M., Ireland, M., Bearinger, L. H., & Udry, R. J. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health, Journal of the American Medical Association, 278, 823–32. Rew, L., Whittaker, T. A., Taylor-Seehafer, M. A., & Smith, L. R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing, 10, 11–19. Rienzo, B. A., Button. J. W., Sheu, J., & Li, Y. (2006). The politics of sexual orientation issues in American schools. Journal of School Health, 76, 93–97.

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Rosario, M., Meyer-Bahlburg, H. F. L., Hunter, J., Exner, T. M., Gwadz, M., & Keller, A. M. (1996). The psychosexual development of urban lesbian, gay, and bisexual youths. Journal of Sex Research, 33, 113–26. Rosario, M., Schrimshaw, E. W., & Hunter, J. (2011a). Different patterns of sexual identity development over time: Implications for the psychological adjustment of lesbian, gay, and bisexual youths. Journal of Sex Research, 48, 3–15. Rosario, M., Schrimshaw, E. W., & Hunter, J. (2011b). Homelessness among lesbian, gay, and bisexual youth: Implications for subsequent internalizing and externalizing symptoms. Journal of Youth and Adolescence, DOI 10.1007/s10964-011-9681-3. Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: A longitudinal examination. Journal of Counseling and Clinical Psychology, 70, 967–75. Rosenwald, M. (2009). A glimpse within: An exploratory study of child welfare agencies’ practices with LGBGQ youth. Journal of Gay & Lesbian Social Services, 21, 343–56. Russell, S. T. (2005). Beyond risk: Resilience in the lives of sexual minority youth. Journal of Gay and Lesbian Issues in Education, 2, 5–18. Russell, S. T., Driscoll, A. K., & Troung, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 92, 198–202. Russell, S. T., Franz, B. T., & Driscoll, A. K. (2001). Same-sex romantic attraction and experiences of violence in adolescence. American Journal of Public Health, 91, 903–6. Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276–81. Russell, S. T., Muraco, A., Subramaniam, A., & Laub, C. (2009). Youth empowerment and high school gaystraight alliances. Journal of Youth and Adolescence, 38, 891–903. Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J. (2011). Lesbian, gay, bisexual, and transgender adolescent school victimization: Implications for young adult health and adjustment. Journal of School Health, 81, 223–30. Russell, S. T., Seif, H., & Truong, N. L. (2001). School outcomes of sexual minority youth in the United States: Evidence from a national study. Journal of Adolescence, 24, 111–27. Ryan, C., & Futterman, D. (1998). Lesbian & gay youth: Care & counseling. New York: Columbia University Press. Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–52.

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Ryan, C., Russell, S. T., Huebner, D., Diaz, R. M., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23, 205–13. Saewyc, E. M., Skay, C. L., Bearinger, L. H., Blum, R. W., & Resnick, M. D. (1998). Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents. Journal of Adolescent Health, 23, 238–47. Saewyc, E. M., Skay, C. L., Pettingell, S. L., Reis, E. A., Bearinger, L., Resnick, M., Murphy, A., & Combs, L. (2006). Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada. Child Welfare, 85, 195–213. Saltzburg, S. (2004). Learning that an adolescent child is gay or lesbian: The parent experience. Social Work, 49, 109–18. Samuels, B. (2011). Information memorandum: Lesbian, gay, bisexual, transgender, and questioning youth in foster care. Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services, ACYF-CB-IM-11–03; retrieved from http://www.acf.hhs.gov/programs/cb/laws_ policies/policy/im/2011/im1103.htm. Sausa, L. A. (2005). Translating research into practice: Trans youth recommendations for improving school systems. Journal of Gay and Lesbian Issues in Education, 3, 15–28. Savin-Williams, R. C. (1998). “ . . . And then I became gay”: Young men’s stories. New York: Routledge. Savin-Williams, R. C. (2001). A critique of research on sexual-minority youths. Journal of Adolescence, 24, 5–13. Savin-Williams, R. C. (2005). The new gay teenager. Cambridge: Harvard University Press. Savin-Williams, R. C., & Diamond, L. (2000). Sexual identity trajectories among sexual minority youths: Gender comparisons. Archives of Sexual Behavior, 29, 607–27. Serdjenian, T. (2010). LGBT adoptive and foster parenting; retrieved from http://www.adoptuskids.org/ images/resourceCenter/LGBT-foster-and-adoptiveparenting.pdf. Serdjenian, T. (2013). Caring for LGBTQ youth in foster care. Presentation to Wisconsin Statewide Foster Care Coordinators Conference (September 2013); retrieved from http://www.nrcpfc.org/WI LGBTQ. pdf. Sullivan, T. R. (1994). Obstacles to effective child welfare service with gay and lesbian youths. Child Welfare, 73, 291–304. Sullivan, C., Sommer, S., & Moff, J. (2001). Youth in the margins: A report on the unmet needs of lesbian, gay, bisexual, and transgender adolescents in foster care. New York: Lambda Legal Defense and Education Fund. Swann, S., & Herbert, S.E. (1999). Ethical issues in the mental health treatment of gender dysphoric adolescents. Journal of Gay & Lesbian Social Services. 10, 19–34.

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Thaler, C., Bermudez, F., & Sommer, S. (2009). Legal advocacy on behalf of transgender and gender nonconforming youth. In G. P. Mallon (ed.), Social work practice with transgender and gender variant youth (2d ed., pp. 139–62). New York: Routledge. Thrane, L. E., Hoyt, D. R., Whitbeck, L. B., & Yoder, K. A. (2006). Impact of family abuse on running away, deviance, and street victimization among homeless rural and urban youth. Child Abuse & Neglect, 30, 1117–28. Tully, C. (2000). Lesbians, gays, and the empowerment perspective. New York: Columbia University Press. Tyler, K. A., & Cauce, A. M. (2002). Perpetrators of early physical and sexual abuse among homeless and runaway adolescents. Child Abuse & Neglect, 26, 1261–74. Tyler, K., Hoyt, D., Whitbeck, L., & Cauce, A. (2001). The impact of childhood sexual abuse on later sexual victimization among runaway youth. Journal of Research on Adolescence, 11, 151–76. Udry, J. R., & Chantala, K. (2002). Risk assessments of adolescents with same-sex relationships. Journal of Adolescent Health, 31, 84–92. Van Leeuwen, J. M., Boyle, S., Salomonsen-Sautel, S., Baker, N., Garcia, J. T., Hoffman, A., & Hopfer, C. J. (2006). Lesbian, gay, and bisexual homeless youth:

An eight-city public health perspective. Child Welfare, 85, 151–70. Whitbeck, L. B., Chen, X., Hoyt, D. R., Tyler, K. A., & Johnson, K. D. (2004). Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. Journal of Sex Research, 41 (4), 329–42. Whitbeck, L. B., Hoyt, D. R., Johnson, K. D., & Chen, X. (2007). Victimization and posttraumatic stress disorder among runaway and homeless adolescents. Violence and Victims, 22, 721–34. Wilber, S., Reyes, C., & Marksamer, J. (2006). The Model Standards Project: Creating inclusive systems for LGBT youth in out-of-home care. Child Welfare, 85, 133–49. Wilber, S., Ryan, C., & Marksamer, J. (2006). CWLA best practices guidelines: Serving LGBT youth in out-of-home care. Washington, DC: Child Welfare League of America. Wilchins, R. A. (1997). Read my lips: Sexual subversion and the end of gender. Ithaca, NY: Firebrand. Woronoff, R., Estrada, R., & Sommer, S. (2006). Out of the margins: A report on regional listening forums highlighting the experiences of lesbian, gay, bisexual, transgender, and questioning youth in care. New York: Lambda Legal Defense and Education Fund.

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Runaway and Homeless Youth

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nasmuch as programs for runaway and homeless youth currently fall outside of the domain of traditionally defined child welfare services (Fitzgerald 1996), runaway and homeless youth have always been present. Although the labels used to describe them have changed, social reformers, child advocates, jurists, historians, and others have documented their existence over the centuries (Brace 1872; Mayhew 1968 [1861–1862]; Miller 1991; Riis 1892, 1971 [1892]; Rothman 1991; Staller 1999; Glassman, Karno, & Erdem 2010). In the mid-nineteenth century they were called waifs, orphans, half-orphans, temporarily homeless, outcasts, maladjusted, destitute, indigent, wayward, wanderers, incorrigibles, child street vendors, newsies, little laborers, morally depraved, fallen, and friendless. In the 1960s we talked about status offenders as well as hippies, flower children, and love children. More recently we have called them runaways, homeless, throwaways, castaways, shoveouts, and street kids. Although these labels are not completely interchangeable, they have tended to describe youth who share some characteristics. In general, they are teenagers who have left their families or other legal caregivers, either voluntarily or involuntarily, for some amount of time. Perhaps the single unifying characteristic is that they make decisions and act outside the governance of their legal custodians at a point in life when we generally find such independence socially unacceptable or at least questionable. Whitbeck and Hoyt have called this “precocious independence” (1999:10).

In an attempt to address the large topic of “runaway and homeless youth” both “policy and services” in this chapter, the author will t
examine the historical and societal context for our most recent discussions on “runaway” youth; t
consider the policy and program responses that emerged in light of these discussions as well as trace the expansion since that time; t
examine the challenging and complicated problem of defining “runaway” youth; t
look at the demographic patterns and characteristics associated with runaway and homeless youth; t
examine the current social science literature on vulnerabilities and risks associated with running away and with the “runaway” youth population; t
look at the small but growing literature on resilience and protective factors exhibited by runaway youth; t
outline the range of programs that serve these youth and examine what we know about program effectiveness; t
identify some of the major ethical and value dilemmas associated with working with this population. Finally the chapter closes with some concluding issues for the reader’s consideration. Historical and Societal Context The most recent incarnation of the runaway and homeless youth problem arguably emerged 179

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in the mid-1960s. Several societal factors contributed to shaping our current understanding of the runaway problem, runaway youth policies, and services. First, in the early 1960s states began to separate “status offenses” from other legal interventions targeted at youth. As a matter of public policy in the late 1960s and early 1970s policy makers diverted and deinstitutionalized status offenders from restrictive facilities, and “alternative” services for runaway youth began to emerge as grassroots, community-based efforts to meet the needs of drifting and wandering youth. One alternative service was the “runaway shelter,” which supplemented and supplanted the “crash pads” of the 1960s counterculture; another was the “runaway hotline,” which grew out of concern for the safety of runaway youth. Both models are still offered as core services under current federal legislation found in the Runaway and Homeless Youth Act.

as running away, didn’t warrant incarceration or other restrictive measures associated with the juvenile justice system. In 1967 President Lyndon Johnson’s Commission on Law Enforcement and the Administration of Justice produced a report on juvenile delinquency and its prevention. Among other things it recommended that status offenses be decriminalized, that offenders be deinstitutionalized, and that youth be diverted from the juvenile justice system to community-based alternatives (Siegel & Senna 2000; Glassman, Karno, & Erdem 2010; Staller 2004). Taken together, these policy priorities reflected a growing sense that runaway youth should be diverted to community-based alternative programs rather than dealt with through law enforcement and juvenile delinquency mechanisms. Given this political and social context, the question was what invention model or models would best serve runaway youth.

Status Offenses In the arly 1960s many states began conceptually separating “status offenses” from “abused and neglected” youth and from “juvenile delinquents.” Status offenses, also known as “in need of supervision” cases, covered habitual behaviors that were regulated only because of the youth’s status as a minor. In addition to running away, these behaviors included truancy, violating curfews, being ungovernable or incorrigible, and the like. In general, abused and neglected youth were referred to the child welfare system and juvenile delinquents (children who committed acts that would be criminal if they were adults) were referred to the juvenile justice system. Status offenders did not have an obvious institutional home. Although communities developed programs for dealing with status offenders, in general, they didn’t fit neatly within the existing systems.

The 1967 Summer of Love and Huckleberry House During the mid-1960s, hippies and other free spirits gathered in identifiable counterculture areas such as Haight-Ashbury in San Francisco and the East Village in New York City. The crash pads, communes, and other shared living opportunities in these communities were mostly operated by young adults, but younger, drifting teenagers were rarely turned away. In 1967 Haight-Ashbury hosted a mediatouted “Summer of Love,” meant to be a celebratory gathering of youth. However, local residents worried that many of the arriving love pilgrims would be younger, more vulnerable youth. This concern gave rise to an experimental program called Huckleberry House (Beggs 1969; Staller 1999), one of the first runaway youth shelters of the era. Soon other communities were creating similar “alternative” runaway programs, including Covenant House in New York City, Ozone House in Ann Arbor, Looking Glass in Chicago, and Bridge Over Troubled Water in Boston, among others.

Diversion and Deinstitutionalization Policy makers and service providers in the 1960s and 1970s argued that behaviors, such

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Initially, these community-based, privately funded, experimental agencies ran afoul of parents, police, and traditional service providers because they offered a new type of service. Youth autonomy and self-determination were at the core of their service philosophy. Young people were not “ordered” or “placed” into the programs by courts through the juvenile justice or child welfare systems. Instead, youth often sought out these services on their own and self-referred. Furthermore, although, in order not to violate custodial interference laws, the programs generally required parental notification at some point, in general, providers would not return an unwilling child home nor report a child to authorities. This made the programs attractive to precociously independent youth. Corll Murders, Runaway Safety, and Runaway Hotlines In 1973 the gruesome activities of Dean Corll, an unassuming candy-store owner in Houston, Texas, came to national attention. For several years, Corll had been inviting boys, mostly runaways, to parties at his house. He sexually assaulted, tortured, and then murdered them. He even hired two teenagers, Wayne Henley and David Brooks, to procure runaways for him, paying them $100 for this service. When Corll threatened Henley, Henley murdered Corll and led police to the bodies of twenty-seven boys. At that point it was the largest serial murder in U.S. history. Concerned about the safety of runaway youth, the Houston community organized the first runaway hotline, Operation Peace of Mind (OPM), designed to allow runaways to obtain information on safe shelters and to convey messages to their worried parents. OPM quickly made its service accessible to runaways nationwide. From this tragedy emerged a second service approach to runaway youth, the twenty-four-hour, nationwide runaway hotline. Policy Response and Programs Runaway Youth Act of 1974 In 1974, with Houston fresh in the public mind, Congress

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enacted the Runaway Youth Act (RYA). Significantly, the RYA was situated within the Juvenile Justice Delinquency and Prevention Act (JJDPA) and characterized as a delinquencyprevention measure (Staller 2004; Glassman, Karno, & Erdem 2010). The RYA provided grants to local runaway youth shelters and to a Chicago-based runaway hotline that evolved into the National Runaway Switchboard (NRS; 800-621-4000; http://www.1800runaway.org/). The RYA seemed to wed all the societal interests of the day. It dealt with runaways outside the system of law enforcement and juvenile justice, thus diverting them from public systems of care. It supported community-based alternatives that promised to prevent delinquency and/or save youth from exploitation. It favored youth autonomy, which was in keeping with increasingly protected constitutional rights of young people. And it provided grants to experienced runaway programs. In short, it was a nice fit on all fronts. Runaway and Homeless Youth Act Expansion Since 1974 the RYA legislation has been amended and expanded, helping to define the scope of the public problem and to fund services targeting the runaway and homeless youth population (Cooper 2006; Glassman, Karno, & Erdem 2010; Slesnick et al. 2009). In 1980 the legislation was renamed the Runaway and Homeless Youth Act (RHYA) and the focus population expanded to include “homeless” as well as “runaway” youth. The legislation was expanded again, and the Runaway, Homeless, and Missing Children Protection Act (RHMCPA; P.L. 108-96) both reauthorized and amended the RHYA and the Missing Children’s Assistance Act of 2004 (Cooper 2006; Glassman, Karno, & Erdem 2010; Staller 2009). Most recently, the RHYA has been amended by the Reconnecting Homeless Youth Act of 2008 (P.L. 110-378). Currently, the populations of youth identified and covered under the act include homeless youth, street youth, and home-based youth as well as runaways.

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The latest amendments did not alter the basic service structure but did increase the length of time that youth may be served. The increasingly diverse services funded under the RHYA now include crisis shelters, transitional living, street outreach, aftercare, prevention, and the runaway hotline. The Department of Health and Human Services, through the Family and Youth Services Bureau (FYSP), administers and coordinates the three primary programs funded under the RHYA: the Basic Centers Programs (emergency shelters), Transitional Living Programs (TLP), and the Street Outreach Programs (SOP) (Cooper 2006; Slesnick et al. 2009). Basic Center Program services may include food, clothing, temporary shelter (up to twentyone days), medical care referrals, and counseling and recreational programs. These programs seek to meet the basic needs of runaway and homeless youth while away from home (Cooper 2006). The Transitional Living Programs were designed for those youth aged sixteen to twenty-two who could not return home and needed longer-term assistance—up to twentyone months—than short-term emergency crisis shelters could provide. The TLP could be structured as group homes, supervised apartments, or placements with host families. Among other services, TLPs provided stable living accommodations, basic life skills classes (budgeting, food preparation, housekeeping, etc.), GED preparation, and job preparation (Cooper 2006; Glassman, Karno, & Erdem 2010). In 2003 this section of the RHYA was amended (P.L. 108-96) to include “maternity group homes” in order to provide transitional living for pregnant and parenting young people. Services could include classes in parenting, child development, health, nutrition, family budgeting, and other topics specific to young parents. Street Outreach Programs (SOP) target youth deemed to be at risk for sexual abuse and/or exploitation. Street-based projects include crisis intervention and counseling, housing information and referral, transitional living, and

health care service referrals, as well as advocacy, education, and prevention services for alcohol and drug abuse, STDs (including HIV/AIDS), and physical and sexual assault. For updated information on these programs see the FYSP Web site at http://www.acf.hhs.gov/programs/ fysb/content/programs/rhy.htm. In addition to expanded services for maternity group homes, amendments to the RHYA in 2003 included reference to providing “linguistically appropriate” services, suggesting that Congress is increasingly aware of the diversity of youth seeking services (P.L. 108-96). Taken together, this package of services (i.e., crisis care; outreach intervention; education and advocacy concerning safe sex, health, and housing needs; home-based counseling; and transitional living) is the range of programs theoretically available to runaway and homeless youth. However, actual service offerings vary dramatically from community to community. Population Definitions Federal officials, private social service providers, and social science researchers often disagree on the proper typology for use when dealing with the population (Glassman, Karno, & Erdem 2010). The RHYA (2008) defines a runaway youth as “an individual who is less than eighteen years of age and who absents herself from home or a place of legal residence without the permission of parents or legal guardian” and a homeless youth as an individual who is t
less than 21 years of age, or, in the case of a youth seeking shelter in a [Basic] center  .  .  . less than 18 years of age or is less than a higher maximum age if the State where the center is located has an applicable State or local law (including a regulation) that permits such higher age in compliance with licensure requirements for child- and youth-serving facilities; and t
and for the purposes of part B [Transitional Living Programs], not less than 16 years of age and either

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t
less than 22 years of age; or t
not less than 22 years of age, as the expiration of the maximum period of stay permitted under section 322(a)(2) [635 days] if such individual commences such stay before reaching 22 years of age; t
for whom it is not possible to live in a safe environment with a relative; and t
who has no other safe alternative living arrangement. Street youth is defined as an individual who is t
a runaway youth; or t
indefinitely or intermittently a homeless youth; and t
spends a significant amount of time on the street or in other areas that increase the risk to such youth for sexual abuse, sexual exploitation, prostitution, or drug abuse.

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by social scientists and youth advocates and replaced it with thrownaway because it “unambiguously conveys what has been done to the child” rather than a “quality of the child” (Sweet 1990:3). Subsequently runaway and thrownaway were collapsed into one “runaway/thrownaway” category for reporting purposes because researchers found that the distinction between the two “was less than clear cut” (Hammer, Finkelhor, & Sedlak 2002). In this study a runaway episode was defined as

t
Who is less than 18 years of age; and t
Who has a history of running away from the family of such individual; t
Whose parent, guardian, or custodian is not willing to provide for the basic needs of such individual; or t
Who is at risk of entering the child welfare system or juvenile justice system as a result of the lack of services available to the family to meet such needs (RHYA P.L 110–378; 42 U.S.C. 5732a).

t
a child leaves home without permission and stays away overnight; t
a child of fourteen years old or younger (or older and mentally incompetent) who is away from home chooses not to come home when expected to and stays away overnight; t
a child fifteen years old or older who is away from home chooses not to come home and stays away two nights. t
A thrownaway episode is defined as: t
a child is asked or told to leave home by a parent or other household adult, no adequate alternative care is arranged for the child by a household adult, and the child is out of the household overnight; t
a child who is away from home is prevented from returning by a parent or other household adult, no adequate alternative care is arranged for the child by a household adult, and the child is out of the household overnight.

Note the struggle to define and distinguish these populations utilizing a combination of factors relating to age, risk, living situations, parental involvement, and behaviors. Perhaps the most controversial definitions involve youth who have been excluded intentionally from their family homes by their adult caretakers. The Office of Juvenile Justice and Delinquency Prevention (OJJDP), for example, rejected the term throwaway commonly used

The exercise of considering these various definitions and the implications that can be drawn from them is illuminating. It is clear that youth leave home for different reasons and for different amounts of time, and that they have different opportunities for returning. Characteristics at issue include the age of the child, his mental capacity, time away, estrangement from home, etc. As a result, the service needs of these various youth differ quite dramatically. While

Finally, the RHYA defines Youth at Risk of Separation From the Family as an individual

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runaways may need “crisis” intervention (such as food and shelter for a night), those gone for longer periods may require extensive transitional help. Given the variety of definitions used, students are warned to consider carefully how terms are defined when they read reports, study findings, program evaluations, newspaper articles, or statistics about the population’s size or characteristics. The various, sometimes conflicting portraits painted reflect how the population is being conceptualized. Demographic Patterns Given the struggle over definitions, it is not surprising that the size of the runaway and homeless youth population and its basic characteristics have been found to vary dramatically from study to study. Additionally, researchers attempting to estimate the number of runaway youth are plagued by many of the methodological and logistical problems faced by those enumerating other hard-to-reach subcultures such as the adult homeless. Furthermore, within the runaway and homeless youth population, subgroups such as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth or undocumented aliens may be still harder to reach. Estimates have placed the number of runaway and homeless youth between 500,000 and 2.8 million (Cooper 2006; Slesnick 2009). The National Alliance to End Homelessness (2013) estimates that there are fifty thousand youth sleeping on the streets in the United States. In one of the most rigorous studies available, Hammer, Finkelhor, and Sedlak (2002) conducted an extensive second wave research project called the National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART-2) for the OJJDP (https:// www.ncjrs.gov/html/ojjdp/nismart/04/). These data were drawn from three sources: household surveys of adult caregivers, household surveys of youth, and a study of juvenile facilities.

Although there are obvious limitations to what parents and/or youth might report in a survey, this is the most comprehensive examination to date of the scope of the runaway and homeless youth problem. Hammer, Finkelhor, and Sedlak determined that 1,682,900 youth had experienced a runaway/thrownaway incident in 1999 and 71 percent of those were endangered during the incident. Characteristics of the Runaway and Homeless Youth Population Sanchez, Waller, and Greene (2006) have found that running away was predicted by biological gender, age, region, urbanicity, and family structure. Some incidence studies find that girls and boys experience runaway/thrownaway episodes in equal numbers (Hammer, Finkelhor, and Sedlak 2002). Other researchers, using different data sources, have found it more common behavior among girls (Sanchez, Waller, & Greene 2006). Treatment outside the home and/or service use may reflect gender differences. For example, the NaRS reported that 72 percent of its calls in 2012 came from girls (National Runaway Safeline 2013). In 1990 OJJDP reported that “girls, whites, and youth 14 through 16 years old were more likely than other youth to be referred to court for running away” (Sickmund 1990:1). FBI statistics indicate that 59.4 percent of the national runaway arrests in 2001 were of girls (2002). Researchers have reported that boys are more likely to be older and to be classified as homeless or thrownaway than girls, who are more likely to be younger and labeled runaways (Government Accounting Office 1989; Kufeldt, Durieux, & Nimmo 1992; Kurtz et al. 2000; Thompson, Pollio, & Bitner 2000). Taken together, these findings suggest the need to be attentive to service use and institutional responses based on gender. It is difficult to report threshold or average ages that youth run away from home. The NRS trends suggest that the growth rates of

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adolescents running away—when compared with other age groups—are accelerating in the very young (under twelve) and those over eighteen (Pergamit et al. 2010). However, problems related to grasping an understanding of runaway and homeless youth’s ages abound. In part this is because data collected reflect institutional realities and agency constraints. For example, state and local arrests of runaways compiled by the FBI are used as an indicator of the size and characteristics of the population. Its data indicate that approximately 80 percent of all runaway arrests in 2001 occurred between the ages of thirteen and sixteen, and, of those, 36.8 percent occurred between thirteen and fourteen (2002). However, these statistics also reflect jurisdictional age limits. For example, New York State defined runaways as below the age of sixteen until 2002, when it moved the age up to eighteen years old. Researchers frequently rely on the age guidelines of the agencies or outreach programs they use to conduct their studies. Edelbrock (1980) included children and youth between the ages of four and sixteen years in his study, while Unger and colleagues (1997) included adolescents and young adults from ages thirteen to twenty-three. This age range, from four to twenty-three, hints at the numerous practical problems and various developmental issues associated with serving youth lumped under the runaway and homeless categories. The incidence study on runaway/thrownaway youth conducted by Hammer, Finkelhor, and Sedlak (2002) found that they “did not come disproportionately from any of the major racial and ethnic groups.” Other studies have reported that youth of color are represented disproportionately in the homeless youth population as compared to the runaway youth population (GAO 1989). Researchers have more recently turned their attention to ethnic differences among runaway and homeless youth. For example, Slesnick, Vasquez,

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and Bittinger (2011) found differences between Hispanic and Anglo runaway youth in drug use, family functioning, and problem behaviors, while Thompson, Kost, and Pollio (2003) found differences in the likelihood of family reunification among white, African American, Hispanic, Native American, and Asian runaway youth using shelter services. These researchers have all argued for more culturally sensitive interventions. At the time the RYA was enacted, Congress expressed concern for the interstate nature of the runaway problem. However, it appears that the majority of runaways/thrownaways stay relatively close to home and usually within their home state. Hammer, Finkelhor, and Sedlak (2002) report that about 38 percent of the runaways/thrownaways travel less than ten miles from home. Thirty-one percent travel between ten and fifty miles and another 23 percent travel over fifty miles. Eighty-three percent did not leave the state. Most left home for less than a week (76 percent) and, of those, 18 percent were gone less than twenty-four hours. Significantly, however, 15 percent left for more than a week, but less than a month, and another 7 percent left for more than a month. In general, relatively few youth travel long distances and/or are away from home for long periods of time. Nonetheless, these youth are likely to have the most pressing service needs and be most at risk for negative outcomes. The sexual orientation profile of the runaway and homeless youth population is a subject of debate. Whitbeck and Hoyt (1999) found that 94 percent of the boys and 95 percent of the girls in their study identified as heterosexual. However, researchers and clinicians who specialize in work with LGBTQ youth are quick to point out that “they are socialized to hide,” making it difficult to quantify their numbers and making “service provision indisputably more complex” (Mallon 1999:129). Many runaway and homeless youth providers posit that LGBTQ youth (see Elze’s chapter,

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this volume) are overrepresented in the street youth population. Estimated rates among the homeless population have ranged from 6 percent to 42 percent (Cochran et al. 2002; Mallon 1999). Mallon reported on a survey conducted by Streetworks Project—an outreach and dropin program in New York City—that found that 42 percent of the youth identified as gay, lesbian, or bisexual. This wide range in estimates may reflect genuine geographic differences in rates (for example, LGBTQ youth may drift to geographic areas that they find more tolerant); however, the differential rates may also reflect varying comfort levels of youth in disclosing their preferences to researchers. Vulnerabilities and Risks Researchers have consistently found that runaway youth disproportionately come from high-conflict home environments (Pergamit et al. 2010; Sanchez, Waller, & Greene 2006). Furthermore, the existing research as well as common sense supports the contention that extended or repeated absences from home are correlated with a host of poor outcomes that jeopardize the futures, and sometimes the lives, of adolescents. The portrait of runaway and homeless youth is bleak, in part, because much of the research draws study samples from relatively high-risk environments like streetbased programs, drop-in clinics, and runaway and homeless youth shelters. Nonetheless, for the youth who end up in these situations there are some serious and troubling correlates and consequences. Even worse, for those who leave home for extended periods of time there is evidence that the cumulative effect of multiple risk factors seriously jeopardize their long-term well-being. Family Composition and Home Environment There are several reasons that youth leave home, but family tension is often a primary factor, stemming from family recomposition, allegations of physical and/or sexual abuse, or other family problems (Pergamit et al. 2010). While

increasing numbers of American children and youth are being raised in reconstituted and blended families, an OJJDP study found that runaways came “disproportionately from stepparent-type households” compared to the general population (Finkelhor, Hotaling, & Sedlak 1990:11). Sanchez, Waller and Greene (2006) found that “youth living with biological parents were least likely to run away, followed by those with at least one nonbiological parent, those with single mothers, and those in other family structures” (p. 779). In a large-scale study of homeless youth, Shane (1991) found that less than 20 percent of the population was living in “traditional” two-parent families (with both biological and/or adoptive parents present), roughly 63 percent came from single-parent families, and 20 percent came from “reconstituted” families. Problematic areas reported by children include abuse (sexual, physical, and emotional) by stepparents, tension with new parental figures and stepsiblings, and increased tension with the biological parent over the new family constellation. Self-reported physical and sexual abuse among homeless youth is not only common, but it also has been found to have an enduring negative impact (Keeshin & Campbell, 2010; Kim et al. 2009; Melander & Tyler 2010). Janus, Burgess, & McCormack (1987) found that 71.5 percent of shelter-based youth reported physical abuse and 38.2 percent reported having been raped or attacked in the past. Male runaways in a shelter-based population exhibited “dramatically higher rates of sexual abuse than did those of randomly sampled populations” (p. 410). Using a homebased sample rather than a shelter-based one, Hammer et al. (2002) reported that 21 percent of the runaway/thrownaway population had been “physically or sexually abused at home in the year prior to the episode or was afraid of abuse upon return” (p. 8). Cochran et al. (2002) found that while LGBT youth left home for many of the same reasons as their heterosexual counterparts, LGBT youth

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were at greater risk for actually leaving home than youth identifying as heterosexual. Others assert that LGBTQ youth are particularly susceptible to being asked or forced to leave home (Lowery 2010; Mallon 1999). Data from the National Runaway Switchboard in 2002 indicate that a substantial number of callers identify “family dynamics” as the problem (41.4 percent), while significantly fewer discuss alcohol/drug use (3.6 percent), physical abuse (3.6 percent), emotional/verbal abuse (3.0 percent), neglect (1.6 percent), and sexual abuse or sexual assault (1.15). These discrepancies among studies make sense given the source and type of information collected; however, in their totality studies point to family troubles and tensions as a significant factor in runaway and homeless youths’ lives. Of note, many of the studies of family characteristics rely on self-report data from youth and thus raise issues of validity. Whitbeck, Hoyt, and Ackley (1997) compared the reports of adolescents and their parents and found that although there were significant differences between them, the reports were in the same direction and presented similar portraits. They concluded that runaway and homeless youth depicted their family environments accurately. Public Care Instability Disturbingly high rates of runaway and homeless youth report involvement in the foster care and/or juvenile justice systems (Courtney et al 2005). In a nationwide survey of 360 runaway youth programs, agency staff reported that 1 out of 5 youths who arrived at shelters came directly from a foster home or group home; 38 percent had been in foster care at some time during the previous year; and another 27 percent had been in “trouble with juvenile justice system” (Bass 1992:9). The Child and Family Research Center (2011) found that the number of unrelated children in a foster home was associated with the risk of running away, while placement in foster care with a sibling actually decreased the risk of children running away (p.3). Mallon (1998)

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reports that gay and lesbian youth are more likely than other youth to flee foster care for safety reasons and can end up on the street (Mallon 1998). Janus, Burgess, and McCormack (1987) reported that more than one-half (57 percent) of his study population had been arrested and had been involved with the juvenile justice system. The OJJDP found that 15 percent of its thrownaway subjects had been in a juvenile detention center (Finkelhor, Hotaling, & Sedlak 1990). Furthermore, OJJDP estimated that in 1988, 12,800 youth ran from juvenile facilities, including group foster homes, residential treatment centers, and other mental health facilities (1989). According to this report, these “children tended to have even more serious” runaway episodes; almost one-half left the state (p. 73). Thus, it is clear that runaway and homeless youth travel between and among public and private institutional settings during their journeys. School In addition to problems at home, researchers have found that runaway and homeless youth have problems at school (Brennan, Huizinga, & Elliot 1978; Thompson, Safyer, & Pollio 2001). Shane (1991) found that nearly half his sample had “education/school problems,” and Bass (1992) reported that 53 percent of her national sample of service providers reported that their clients had problems with school, making it the highest-ranking factor influencing runaway behavior in her study. In a GAO study on homeless youth, 50 percent of the population had “dropped out or been expelled from school” (1989:16). The report noted this percentage was significantly higher than the 14–29 percent nationwide estimates. Shelter-based studies confirm what seems intuitively obvious—that the longer the youth is away from home, the lower the youth’s school attendance (GAO 1989). In a shelterbased regional study, Kurtz, Jarvis, and Kurtz (1991) found that homeless youth were “significantly less likely than non-homeless youth to attend school regularly and more likely to

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be dropouts” (Kurtz, Jarvis, & Kurtz 1991:311). These findings are troubling, particularly when considering the long-range employment prospects for homeless youth. Lack of Life Skills Taken together, early and repeated flights from troubled homes or foster care placements coupled with failures in school suggest that runaway and homeless youth will have difficulty surviving on their own. Securing basic resources (food, shelter, clothing, etc.) can be difficult for several reasons. Policies such as compulsory education, truancy statutes, and child labor laws are obviously—and reasonably—geared toward keeping youth in school and out of the work force. Furthermore, for youth under the age of majority (usually eighteen years old), many activities of adulthood (such as signing a lease, loan, or employment contract) require the signature of a legal custodian. For older youth, limited education further reduces employment opportunities; as a consequence, runaway and homeless youth face serious constraints in securing resources independently. Policy makers and service providers worry that because youth have limited resources, they will either make poor life decisions (thereby endangering themselves) or be forced into dangerous situations. For example, the public worries about youth being driven to “survival sex” (prostitution or bartering sex for shelter), being exploited and victimized (by pimps, johns, drug dealers, etc.), or engaging in criminal activities (petty theft, trespassing, etc.) in order to meet their basic needs. Sexual Risk Behaviors and “Survival Sex” Runaway and homeless youth are at increased risk for both physical and sexual victimization (Tyler & Beal 2010; Tyler et al. 2001). Although adolescence is a time of sexual development and exploration, researchers have documented several sexual risk behaviors associated with runaway and homeless youth that give cause for

concern. Among them are early onset of sexual behavior (Moon et al. 2000; Rotheram-Borus et al. 1992), multiple sexual partners (Cochran et al. 2002; Forst 1994; Pennbridge, Freese, & MacKenzie 1992; Rotheram-Borus et al. 1992; Rotheram-Borus & Koopman 1991), alcohol and drug use (Koopman, Rosario, & RothmanBorus 1994; Pennbridge, Freese, & MacKenzie 1992), unsafe sex practices including inconsistent condom use (Forst 1994; MacKellar et al. 2000; Pennbridge, Freese, & MacKenzie 1992; Rotheram-Borus et al. 1992). Seroprevalence rates for HIV among the runaway and homeless youth population are reported to be high, particularly in urban areas such as New York City, Los Angeles, and San Francisco (Athey 1991; Stricof et al. 1991). Some researchers report minority and gay youth to be at even higher risk for HIV infection (Moon et al. 2000; Rotheram-Borus et al. 1992; Rotheram-Borus, Rosario, & Koopman 1991). Runaway and homeless girls are at risk of pregnancy (Crawford et al. 2011). For example, Greene and Ringwalt (1998) found that lifetime pregnancy rates for adolescent girls (aged fourteen to seventeen) who had lived on the streets were 48 percent as compared with 33 percent for those who had resided in a runaway shelter. Much has been written about “survival sex” and homeless youth. Survival sex refers to bartering sex for money, drugs, or shelter to meet basic needs, or to involvement in the sex industry (such as pornography or performing in nightclubs) because of limited legitimate employment opportunities. Several researchers have explored the extent to which runaway and homeless youth are driven to these activities out of need (Forst 1994; Greene, Ennett, & Ringwalt 1999; Pennbridge, Freese, & MacKenzie 1992; Rotheram-Borus et al. 1992; Yates et al. 1991). Greene, Ennett, and Ringwalt (1999) found that 28 percent of the street youth and 10 percent of the shelter-based youth in their representative samples had engaged in survival sex. Youth who engage in prostitution are at greater risk for many health-related problems and are more

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than five times as likely to report their sexual identity as homosexual or bisexual (Yates et al. 1991). Some have documented the sugar daddy or kept youth phenomena in which youth barter sexual favors in exchange for shelter and/or food. Kruks (1991) argues that these relationships are damaging for several reasons, including the fact that promises of love and nurturing are “compelling” even though the sugar daddy relationships “in many ways have similar dynamics to incest” (p. 518). Other researchers note that youth don’t see these exchanges for drugs, food, or shelter as exploitative but rather as the “beginning of a potential relationship” (Whitbeck & Hoyt 1999:86). In fact, Whitbeck and Hoyt found that one of the strongest predictors of engaging in survival sex was a prior history of sexual abuse by adult caregivers. Thus youth may not be driven to survival sex suddenly out of desperation, but may instead be acting on familiar behavior and relationship patterns. Further, there is some debate in the literature regarding how to characterize these relationships and from whose perspective. What is clear is that the accumulation of sexual risk factors, such as multiple partners, unprotected sex, drug and alcohol use, and lack of resources place runaway and homeless adolescents at higher risk for health-related problems. Moreover, and not surprisingly, pathways into and out of these commercial, bartered, sexual, and survival relationships are complicated (Williams 2010). Physical and Mental Health Risk Factors Homeless street youth are at high risk for poor physical and mental health outcomes and have limited access to health care (Klein et al 2000; Tucker et al. 2011).1 Researchers have found that homeless youth exhibited a “package” of acute disorders (including “upper respiratory infections, skin ailments, lice infestations, and trauma of all sorts”) and chronic disorders (including “peripheral vascular disease, tuberculosis, GI disorders, poor dentition, nutritional deficiency

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disorders,” and, for girls, “pregnancy-related problems”) directly and immediately associated with a homeless existence (Wright 1991:31). Wright concluded that “nearly one homeless teen in five is afflicted with some infectious or communicable disorder that poses a potential threat to the public health” (p. 30). Mental health problems associated with runaway and homeless youth include depression (Crawfort et al. 2011; Maxwell 1992; Thompson, Bender, & Kim 2011; Tucker et al. 2011; Smart & Walsh 1993; Unger et al. 1997); posttraumatic stress (Thompson et al. 2007); low self-esteem (Maxwell 1992; Unger et al. 1997); suicide ideation, suicide attempts, and self-injurious behavior including self-mutilation (Leslie, Stein, & Rotheram-Borus 2002; Molnar et al. 1998; Rotheram-Borus 1993; Stiffman 1989; Teare, Authier, & Peterson 1994; Thompson et al. 2002; Tyler et al. 2003; Unger et al. 1997; Yoder, Hoyt, & Whitbeck 1998) and other psychotic symptoms (Mundy et al. 1990). Studies have found that a history of abuse (physical and sexual) is a predictor of mental health problems (especially depression, suicide ideation, and suicide attempts) in the homeless youth population (Molnar et al. 1998; Unger et al. 1997; Yoder, Hoyt, & Whitbeck 1998). Furthermore, runaway and homeless street youth have difficulty obtaining health and mental health services (Council on Scientific Affairs 1989; Kennedy 1991; Shane 1991; Stiffman 1989). Therefore, their ailments are likely to be undertreated or untreated. In addition, geographic differences are evident. Homeless and runaway youth in Los Angeles were “almost twice as likely to report that they were tested for HIV than were youth in San Diego” (De Rosa et al. 2001:144). Differential access to health care is likely to contribute to differential treatment. Studies suggest that it is also critical to attend to youth’s perceptions of health information and their access to health care (Ensign & Gittelsohn 1998; Sobo et al. 1997). Most of these health-related studies were conducted in major metropolitan areas on the

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East or West Coast of the United States. Some researchers have challenged these findings as not representative of youth in other parts of the country. Zimet et al. (1995) studied runaway youth in Cleveland and found lower than average drug use, sexual risk behaviors, and other health-compromising behaviors than were reported in studies conducted elsewhere in the country. This work is a clear warning not to generalize study results too broadly, particularly when the dire findings come from unique urban areas such as New York City or Los Angeles. Substance Use and Abuse Risk Factors Studies have found that runaway and homeless youth use tobacco, alcohol, and other drugs at substantially higher rates than the general population of nonrunaway and nonhomeless youth (Ferguson et al. 2009; Thompson et al. 2010; Van Leeuwen et al. 2004). Hammer, Finkelhor, and Sedlak (2002) report relatively high percentages of involvement with drugs (19  percent of the children were reportedly “substance dependent”; 18 percent were in the company of someone “known to be abusing drugs”; 17 percent were reportedly using “hard drugs”). Thompson et al. (2002) found that 94 percent of their shelter sample had used marijuana. Frequently, substance abuse has been studied in association with risk factors such as mental health problems (Tucker et al. 2011; Slesnick & Prestopnik 2005; Smart & Walsh 1993; Stiffman 1989; Unger et al. 1997) and sexual behavior (Pennbridge, Freese, & MacKenzie et al. 1992; Zimet et al. 1995). Criminal Activity and Delinquency Risk Factors Hagan and McCarthy studied extensively the relationship between street youth and crime in two Canadian cities. In their own words, their findings paint “a mostly grim picture of the daily lives of urban street youth” (1997:200). Using the theoretical notions of criminal embeddedness, capital, and social learning,

they develop the theoretical notion of “criminal capital” which helps explain how and why youth get entrenched in a street-based lifestyle (McCarthy & Hagan 1995:63). They find that street youth spend a “large part of the time looking for food, shelter, and money” and “hanging out, panhandling, partying, and foraging in the shadow economy of the street” (Hagan & McCarthy 1997:200). They conclude that the outlook for most street youth is bleak (Hagan & McCarthy 1997; McCarthy & Hagan 1995). Other researchers report on the struggles homeless adolescents face in making money to pay for their basic needs and note the insecurity that accompanies that kind of lifestyle (Dachner & Tarasuk 2002; Gaetz & O’Grady 2002). Using qualitative research methods and storied representation, Finley and Finley (1999) provide a fascinating account of the flavor of life on the streets for homeless youth that vividly captures some of these struggles. Baron and Hartnagel (1997) found that homelessness, drug and alcohol use, having peers who engage in criminal behavior, and lack of income all contributed to increased criminality in street youth. They also found that there was an increased risk for violent behavior for youth who were in the long-term homeless category when they had minimal economic resources and perceived lack of opportunity and when they had a history of victimization on the street or a history of physical abuse at home. Cumulative Risk Factors There is a growing body of literature on the longitudinal trajectory of runaway and homeless youth development thanks to the work of Whitbeck and colleagues. They have developed and utilized a Risk Amplification Model in examining the pathways through which “street experiences amplify negative developmental effects originating in the family” (Whitbeck, Hoyt, & Yoder 1999:274). In other words, they consider the cumulative effect of early family experiences (e.g., abuse, victimization, and other factors) coupled with additional street-based

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experiences (e.g., affiliation with deviant peers, risky sexual behavior, deviant survival strategies, substance use, etc.) as a part of the youth’s overall life development. The researchers have explored a number of different associations between childhood and family background and street risk factors. For example, childhood victimization was found to increase the likelihood of later victimization on the streets (Hoyt, Ryan, & Cauce 1999; Tyler et al. 2001) and familial and street risk factors were associated with alcohol misuse (McMorris et al. 2002) and gang membership (Yoder, Whitbeck, & Hoyt 2003). Furthermore, Simons and Whitbeck (1991) found support for their hypothesis that chronic runaways are at risk for adult homelessness. These studies are important for many reasons. First, they examine the longitudinal development of youth (although they use crosssectional data to do so). Second, they examine the cumulative effect of life experiences—or chain of events—rather than studying isolated incidents. Finally, they offer a theoretical framework to help understand the connection between family-based experiences, street-based experiences, and adult outcomes (absent intervention). This work begins to piece together an important, but often neglected longitudinal and developmental picture. Resilience and Protective Factors As previously suggested, the runaway and homeless youth literature is replete with studies of negative outcomes for youth. However, much less attention has been given to the resiliency or protective factors associated with running away: which runaway and homeless youth make successful transitions to adulthood and how? The work of Lindsey, Kurtz, Jarvis, and Nackerud has explored these factors. This research team has applied a strengths-based approach to looking at how runaway youth successfully navigate the troubled waters between adolescence and adulthood. Specifically, they looked at the role of formal and informal helpers (Kurtz et al.

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2000) and at personal strengths and resources (Lindsey et al. 2000). In their first study they found that youth identified family, friends, and professional helpers as important and that their help fell into five categories: caring, trustworthiness, setting boundaries and holding youth accountable, concrete assistance, and counseling. In the second study, former runaway youth identified learning new attitudes and behaviors, personal attributes, and spirituality as helping them make successful transitions to adulthood. Given the fact that family conflict has long been associated with increased risk of running away, it is not surprising that parental attachment has been found to serve as a protective factor. Stein and colleagues (2009) found that “positive maternal relationships predicted less survival sex behavior” and that paternal attachments, in particular, were “protective against many deleterious behaviors” (p. 39). In a pilot study on “successful runaways,” informants were recruited at a competitive, prestigious university through an advertisement in a student newspaper asking for volunteers in good academic standing with histories of running away as teenagers (Staller 2004). Students who responded were doing extremely well, both personally and academically. They offer a very different picture of their experience than the one painted by drawing from our best empirical evidence to date. In this pilot study most subjects disliked the label runaway which they felt—not unreasonably—had negative connotations. When asked for a substitute description, to paraphrase one, he had merely taken a short vacation from home to get away from bickering, out-of-control parents, seeking refuge in the more tranquil home offered by a friend’s family. Leaving home briefly was a very good thing for him. In addition, running away empowered some youth to have important conversations with their parents that they had been unable to initiate. In this study, youth made safe and wise decisions, in part because they had other resources at their disposal (including success in school and the support

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of friends, teachers, or coaches). The findings of this pilot study—along with data from NISMART-2, which indicated that most runaway youth return home—suggests that if we want to understand how running away is used by youth, it is necessary to consider seriously the full range of their behaviors. The bias in the literature toward homeless and street youth may do a disservice to social work practitioners who are called upon to deal with various runaway episodes that may expose youth to fewer life-threatening risks, but may, nonetheless, have important developmental consequences. Programs and Program Effectiveness Further research is also necessary in the areas of outcome studies, program effectiveness, and policy evaluation. Although runaway and homeless youth shelters have been in use since the late 1960s, remarkably little has been written evaluating their effectiveness or examining the outcomes for youth who use the services. The few available meta-analyses evaluating the runaway and homeless youth policy, services, and intervention literatures point to the weaknesses of existing studies and considerable gaps in our knowledge (Slesnick et al. 2009; Altena, Brilleslijper-Kater, & Wolf 2010). For example, following a systematic review of the intervention literature, Altena, Brilleslijper-Kater, and Wolf (2010) located only eleven studies published between 1985 and 2008 that met their criteria for review. They found “no compelling evidence that specific interventions are effective for homeless youth, owing to moderate study quality and the small number of intervention studies” (p. 637). Furthermore, they found that conclusions were limited by “heterogeneity of interventions, participants, methods, and outcome measures” (p. 637). That said, they found “most convincing, but still marginal, were results of interventions based on cognitivebehavioral approaches” (p. 637). They conclude that more research is needed to “identify and disentangle the crucial elements of specific interventions and relate them to appropriate

primary and secondary outcome measures based on a sound underlying theoretical structure” (p. 643). Slesnick et al. (2009) conducted a systematic review of the literature (thirtytwo articles) and reported six general findings: youth’s use of runaway shelters showed short-term benefits; case management is widely used, but there is little evidence of its utility; brief, motivational interventions have not been shown to be effective with street-based and/or drop-in center youth; interventions focusing on HIV prevention and sexual risk reduction alone do not appear effective in reducing risk behaviors among runaway and homeless youth; qualitative studies seem to “converge on similar conclusions” suggesting that there are some similarities in runaway and homelessness experiences; and, finally, because of the diversity of the population, both diverse and flexible treatment options are needed (pp. 740–41). In spite of these troubling findings, systematic work has been undertaken by particular teams of researchers, such as Thompson, Pollio, and others (Pollio, Thompson, & North 2000; Teare, Authier, & Peterson 1994; Thompson, Pollio, & Bitner 2000; Thompson et al. 2002; Thompson, Safyer, & Pollio 2001). In general, these researchers have found that various subgroups of shelter users were discharged to home environments at differential rates, that those who go home fare better than those discharged elsewhere, and that improvements are sustained in the short term, but perhaps not in the long term. It is difficult, but not impossible, to track crisis shelter consumers after their discharge (Pollio, Thompson, & North 2000). Thompson, Pollio, and Bitner (2000) found that youth who return home after a brief shelter stay reported more positive outcomes on several measures than youth discharged to other settings. Thompson et al. (2002) found that the short-term outcomes for youth, measured at six weeks postdischarge, indicated improvement when compared to intake assessments. These improvements included feelings of support from family, better relationships with

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schools, more youth were employed, diminished sexual activity, and higher self-esteem. However, they found these positive outcomes are attenuated by the six-month postdischarge point (Barber et al. 2005; Pollio et al. 2005; Thompson et al. 2002). Pollio et al. (2005) concluded that “crisis shelter services appear to facilitate broad-based short-term gains, but do not appear sufficient to maintain these gains over an extended period” (p. 860). Existing evidence suggests that engagement of the young people’s families during and/or aftercare runaway shelter use is an important component of successful intervention (Nebbitt et al. 2007). However, almost nothing is known about the outcomes of youth discharged from shelters to nonhome environments. It is essential to continue to investigate the effectiveness of runway and homeless services—both short- and longterm—as well as the outcomes for youth discharged from shelters to a variety of different settings. In addition to evaluating the effectiveness of the runaway shelter as an overall intervention, there are very few studies evaluating the efficacy of targeted services delivered within shelters. One such study, conducted by Rotheram-Borus and colleagues (2003), examined an HIVprevention program called Street Smart at two runaway shelters and compared the results to those for youth at two control shelters. Among other findings, they determined that girls who had received intensive HIV intervention programs significantly reduced their unprotected sexual acts and drug use over the long term. Thus it is equally important to examine the package of services offered youth at crisis shelters and transitional living facilities. Ethical Issues and Value Dilemmas For service providers (social workers, physicians, lawyers, etc.), working with runaway and homeless youth can be problematic because parental consent is generally necessary to serve underaged clients. While the youth may be quick to declare themselves “emancipated”

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from their legal custodians and insist on their independence, in most states emancipation proceedings require affirmative and formal legal action. Furthermore, most states have laws making it criminal to interfere with the custodial rights of parents, harbor a minor, contribute to the delinquency of a minor, or threaten the welfare of a minor. At the heart of most of the ethical issues and value dilemmas associated with serving these populations is the central question of how much autonomy (or self-determination) should be afforded precociously independent youth (Staller & Kirk 1997). When should a youth’s civil rights be protected, even if that means protecting his right to engage in behavior that might be harmful? When should a youth’s decisions give way to parental or state authority? When should the state intervene, for what purpose, and to what extent? Self-determination Should runaway and homeless youth have a protected liberty interest in making bad decisions? Who determines that the decisions are “bad”? For example, if a sixteen-year-old boy is living on the street and engaged in high-risk sexual behavior, what should we do? Let him continue because it is his choice? Intervene to protect him because he is putting himself at risk? Intervene to protect the public from him because his behavior is a public health risk? If we choose intervention, how coercive should it be? Should we counsel him and hope he makes wiser decisions in the future? Should we send him to a restrictive facility so he is prohibited from engaging in this behavior until he has reached the chronological age of adulthood? These questions can, and should, be debated at length. Parental Consent Parental consent is an ever present issue when working with runaway and homeless minors. By definition, these youth are in conflicted relationships with their legal caregivers. Given that, the question becomes when and for what kinds of services should, or must,

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parental consent be obtained? For example, must parents give permission for a youth to sleep at a runaway shelter for the night? What about getting medical attention (including contraception, testing for pregnancy or HIV, drug treatment, etc.)? What about parental participation in developing a case plan for an adolescent who refuses to return home? What if parents are not available? The answers to these questions will vary depending on the age and circumstances of the youth and her family. Nonetheless, they involve an array of ethical and legal complexities that make working with this population a challenge. Confidentiality Most runaway shelters, hotlines, and other services promise confidentiality to clients in an effort to gain their trust and engage them in services. What if the social worker learns that the youth has committed a crime, has an outstanding warrant, is a drug dealer, is suicidal, or is engaged in activities that place her sexual partners at high risk? When and with whom must information be shared and from whose perspective should that determination be made? Mandated Reporting Social work practitioners are mandated to report child abuse and neglect. Although the legal rules may seem clear about when they should make such a report, as a practical matter, when dealing with runaway and homeless adolescents, these rules can be very difficult to apply. First, unlike younger youth where blame for neglect is easily placed with parents, in the case of adolescents, parental neglect arguments are sometimes complicated by the youth’s own “bad” behavior. Are parents neglectful or are adolescents defiant and ungovernable? Second, many runaway and homeless youth have already taken leave of foster care (sometimes for good reason). Is there any point trying to return them to a system or program that hasn’t worked? Finally, as a purely practical matter, foster care services are scarce

for older adolescents, particularly those with many problems (e.g., mental health issues, substance abuse, sexual acting out, etc.). In short, balancing the abstract reporting requirements of the state with real-world limitations and consequences for adolescent clients is challenging. Should social workers report older adolescent cases when they know no services are available? YYY

The body of runaway and homeless youth literature has grown substantially since 1974 when the Runaway Youth Act was enacted, but much is still unknown. Several broad areas merit particular attention. First, we must learn more about the dynamic nature of runaway behavior. We need to learn how and why youth move between and among systems of care; closely associated to that is continuing to develop the longitudinal picture for these youth. However, efforts must be made to ensure that this longitudinal picture includes those youth who do well in addition to those who don’t. If we learn what factors and characteristics distinguish one from the other, we may learn how to increase positive outcomes for all at-risk youth. Second, we need to develop theoretical frameworks with which to integrate the existing knowledge on runaway and homeless youth. How can we make sense of what we know? How can we put the pieces together in a comprehensive picture to better understand and serve these youth? Third, we need further work on program and policy evaluation to determine the effectiveness of our interventions, which will require defining meaningful short- and long-term outcome measures and utilizing more rigorous study designs. Developing these lines of inquiry should help us implement better overall service strategies for the runaway and homeless youth population. Finally, there is extremely limited research with respect to runaway and homeless youth and their use of new technologies and social media

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(Young & Rice 2011). Nonetheless, NRS reports high percentages of youth having access to cell phones and e-mail while away from home. Furthermore, the majority also have MySpace and/ or Facebook accounts (Pergamit et al. 2010). Given rapid technological change and adolescents’ pervasive use of it, this area is overdue for rigorous exploration. Given the state of the runaway and homeless youth literature, there is cause for concern as we piece together a comprehensive policy and service picture. The sequence of amendments to the Runaway Youth Act is illustrative (Staller 2009). First, increasingly troubled and socially estranged youth are being served (runaways, homeless, street youth). Second, responsibility for these youth is being shifted away from better-funded public or quasi-public entities (schools, mental health, law enforcement, foster care, juvenile justice) to the nonprofit, voluntary sector (runaway shelters, drop-in centers, outreach programs, etc). This incremental legislative tinkering suggests “runaway” policy is expanding in two directions—population expansion and system diversion (Staller 2009).

Taken together, these two legislative trends are troubling. On the surface, they seem to excuse, or partially excuse, an expanding array of public systems from care, discipline, treatment, education, and socialization of increasingly troubled youth. This is of particular concern when one considers the research findings that indicate that many youth arrive at runaway shelters directly from foster care, have been expelled from school, and/or have serious mental health problems. It raises a fundamental question: is this really an alternative for those youth who need it because they do not succeed in our public systems, or are we allowing public systems to abandon the most challenging and difficult kids, without proper support and guidance, at younger ages? If future research finds that the increasing array of programs under the RHYA is providing an effective alternative for some youth, then they are serving a necessary niche. However, to the extent that alternative services permit public entities to estrange youth from their systems of care even further, they may hurt the very youth they are designed to help.

NOTE

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Whitbeck, L. B., Hoyt, D. R., & Yoder, K. A. (1999). A risk-amplification model of victimization and depressive symptoms among runaway and homeless adolescents. American Journal of Community Psychology, 27 (2), 273–96. Williams, L.  M. (2010). Harm and resilience among prostituted teens: Broadening our understanding of victimization and survival. Social Policy & Society, 9 (2), 243–54. Wright, J. D. (1991). Health and homeless teenagers: Evidence from the National Health Care for the Homeless Program. Journal of Health & Social Policy, 2 (4), 15–35. Yates, G. L, MacKenzie, R. G., Pennbridge, J., & Swofford, A. (1991). A risk profile comparison of homeless youth involved in prostitution and homeless youth not involved. Journal of Adolescent Health, 12 (7), 545–48. Yoder, K. A., Hoyt, D. R., & Whitbeck, L. B. (1998). Suicidal behavior among homeless and runaway adolescents. Journal of Youth and Adolescence, 27 (6), 753–71. Yoder, K. A., Whitbeck, L.B., & Hoyt, D. R. (2003). Gang involvement and membership among homeless and runaway youth. Youth & Society, 34 (4), 441–67. Young, S. D. and Rice, E. (2011). Online social networking technologies, HIV knowledge, and sexual risk and testing behaviors among homeless youth. AIDS Behavior, 15, 253–60. Zimet, G.  D., Sobo, E.  J., Zimmerman, T., Jackson, J., Mortimer, J. Yanda, C.  P., & Lazebnik, R. (1995). Sexual behavior, drug use, and AIDS knowledge among Midwestern runaways. Youth and Society, 26 (4), 450–62.

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Underscored by the mandate that “the safety of children is the paramount concern that must guide all child welfare services,” the passage of the Adoption and Safe Families Act (ASFA) of 1997 (P.L. 105-89) affirmed that child welfare agencies have a primary responsibility for assuring that children and youth are safe from abuse and neglect. Fostering Connections of 2008 (P.L. 110-351) supported and affirmed ASFA with additional provisions to keep children and youth safe. Prevention of Neglect and Abuse The abuse and neglect of children and youth pose a grave hazard to their overall health and well-being, with both immediate and lifelong physical, psychological, and social consequences. The presence of child abuse and neglect constitutes the primary reason that most children and adolescents come to the attention of the child welfare services system in the United States. As traditionally constituted, services aimed at protecting children and youth who have been identified as abused or neglected have been of paramount importance to the field of children, youth, and family services. However, a more recent and growing movement in the U.S. is represented by strategies and programs that aim to prevent child abuse before it has the chance to occur and that thereby aim to avert the frequently damaging consequences of such maltreatment for children, their families, and the wider social fabric. We begin this section on safety with a chapter that examines what is known about the prevention of child abuse and neglect by Guterman, Berg, and Taylor. These authors provide the rationale for child abuse and neglect prevention and present the possibilities as well as the dilemmas and challenges that face the field of prevention as it advances into the twenty-first century. Child Protective Services (CPS) To emphasize the importance of safety, ASFA legislation t
states explicitly that child safety is the paramount consideration in decision making

regarding service provision, placement, and permanency planning for children; t
clarifies the reasonable efforts requirements related to preserving and reunifying families by reaffirming the importance of reasonable efforts, yet also identifies those dangerous circumstances in which states are not required to make such efforts to keep the child with the parents. Furthermore, in the CFSR process, the safety variables, which are considered first, are summarized and evaluated in two areas: Safety 1: Children and youth are, first and foremost, to be protected from abuse and neglect. One aspect of this variable is timeliness of initiating investigations of reports of child maltreatment; the second is the prevention of repeated maltreatment. Safety 2: Children and youth are safely maintained in their own homes whenever possible and appropriate. The primary aspect of this variable is the provision of services to the family to protect children and youth in their homes and to prevent removal and risk of harm to children/youth. Within the child welfare system the initial attention to the safety of children and youth is located with Child Protective Services programs. CPS is the core program in all child welfare agencies and, in collaboration with other community agencies and organizations, such as schools, leads the efforts to ensure child safety. More broadly, CPS refers to a highly specialized set of laws, funding mechanisms, and agencies that together constitute the government’s response to reports of child abuse and neglect. Each state’s laws provide the basis for its CPS programs; define child abuse and neglect; and specify how CPS agencies should respond to reports of child maltreatment. Caseworkers in CPS agencies are responsible to address the effects of child maltreatment, to implement service responses that will keep children and

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youth safe from abuse and neglect, and to work with families to prevent the likelihood of child maltreatment in the future. In their chapter on child protection, DePanfilis and Costello trace the path of child abuse and neglect reports from the point of referral through the process of providing ongoing services to children, youth, and families involved in the child protection system. After first describing the philosophy and policy context for child protection programs and the nature and extent of child abuse and neglect in the United States, the authors address the purposes of these. Finally, they provide information on the effectiveness of CPS programs and a brief summary of CPS reforms being implemented across the United States. Risk Assessment Aron Shlonsky and Eileen Gambrill, in their chapter on child and adolescent risk assessment, remind the reader that child welfare staff members make many decisions about child safety based on judgments. Life-changing decisions are made in a context of uncertainty. Caseworkers must distinguish between child neglect, poor parenting, and the effects of poverty, and they must do this without the aid of accurate assessment tools. One such judgment concerns risk assessment. The child welfare professional must ask herself a series of questions that will lead to a reasoned assessment of risk, among them: Will this parent abuse or reabuse his child in the near future? What is the probability that he will do so? Risk assessment requires the integration of various kinds of data (e.g., self-report, observation, agency protocol) that differ in their accuracy, complexity, and subsequent value when making key decisions. Risk assessment is subject to a host of errors, including overestimating or underestimating the true probability of risk to a child. These errors may result either in failing to protect children from harm or imposing unneeded services that increase rather than decrease risk, such as unwarranted placement of the children in foster care. Efforts to improve decision making in child welfare

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have typically focused on the development of risk assessment tools. Although the assessment of risk is sometimes a flawed process, steps must be taken to protect children from abuse while maximizing the decision-making freedom of parents. Family Preservation: Both a Goal and a Form of Service When children have suffered maltreatment or lack of protection at the hands of their families, a common emotional and professional response has been to remove the children from harm’s way, separating children and their parents and/or siblings. For many years, this had been the first response, with the number of children and youth placed into alternative or foster homes growing throughout the 1970s. In their overview on family preservation, Marianne Berry and Sara McLean remind readers that family preservation is a widely used term in services to children and families, and it represents both a service goal (preserving the connection between children and their parents and extended family) and also a specific form of services, often called Intensive Family Preservation Services, or IFPS. The distinction between the goal of family preservation and the specific means by which to achieve this goal is an important one; agencies and practitioners can agree on the goal, yet employ different methods by which to achieve the preservation of family relationships. Family preservation services, notes Berry, should not be confused with family support services, but often are. Family support programs (addressed in the well-being section of this chapter) are typically less intensive and more widely available to a range of families in need. Families do not have to be experiencing substantiated child maltreatment to access family support services; these services are generally available to all who seek them. Family preservation services, in contrast, are provided to families that are involved in the public child welfare system for substantiated child maltreatment. Such families are usually mandated either to

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participate in these services or lose their children to foster care. Berry and McLean discuss the evolution of family preservation and presents the basic tenets and components of family preservation service models. Following the description of two major service models, the chapter provides detail about promising approaches that are empirically supported. Special attention is also given to the assumptions and values underlying the goal of family preservation and method of working with families. Following a discussion on the difficulty of conducting definitive research in an area in which practice models are intended to be as applied, creative, and individualized as are IFPS, the chapter concludes with a review of the values, skills, and training that are helpful for those seeking to work to preserve families at risk of disintegration. Sexual Abuse Estimates are that about half of sexual abuse cases are intrafamilial; they involve a child’s caregiver as the abuser (e.g., father or stepfather) or as being neglectful and not preventing sexual abuse (e.g., when a babysitter is the abuser and the caregiver has knowledge of the abuse). The remainder of sexual abuse cases are extrafamilial. In most communities the child welfare system is only responsible for intrafamilial cases. Extrafamilial cases are handled solely by law enforcement. However, since law enforcement also has responsibility for intrafamilial sexual abuse, child protective services and law enforcement are expected to work together on intrafamilial cases of sexual abuse. Kathleen Faller’s chapter on sexual abuse addresses child sexual abuse allegations, investigations, and interventions, focusing on how the child welfare system handles these. Since child sexual abuse is also a crime and requires multiagency collaboration, attention is also given to how the criminal justice system and other systems interface with the child welfare system on sexual abuse cases.

Substance Abuse Maltreatment is rarely the only issue for families that enter into the child welfare system. Substance abuse and other addictions, serious physical and/or mental illness, domestic violence, and HIV/AIDS are often additional critical factors. Poverty is pervasive, and inadequate or unsafe housing is also a significant problem. These serious difficulties can result in extremely complex family situations that need multiple and coordinated services. Ryan and Huang in this chapter focus specifically on parental substance abuse and substance dependence in the context of the child welfare system. These authors discuss how substance abuse is currently defined and measured in the literature, provide estimates of substance abuse in child welfare populations, and identify critical child and adolescent outcomes affected by substance abuse. This chapter concludes with a discussion of recent innovations in service options and of clinical developments in the field of parental substance abuse. Domestic Violence The overlap of domestic violence with child abuse and the concern about the impact of domestic violence on the lives of children are not new concerns. Over the past twenty-five years, researchers, child advocates, battered women advocates, and policy makers have grappled with how to best keep families safe while protecting the adult and child victims of violence. Questions left unanswered surround who should be held accountable for exposure to domestic violence—the mother, the usual caregiver who is unable to protect her children, or the father, most often the abuser of the mother but frequently invisible in the child’s case plan. How should child welfare systems respond to families with domestic violence? Does exposure to domestic violence indicate child maltreatment? Does the role of child welfare systems include removing children for their own protection from domestic violence and to break the cycle of violence?

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In her chapter on this topic, Judy Postmus discusses the answers to these questions by reviewing the research, including studies concerning the number of children impacted by domestic violence and the consequences faced when children are exposed. She follows with a discussion of the philosophical challenges existing between the child welfare system and domestic violence service providers along with the barriers and assumptions faced when professionals attemp to address these challenges. A brief description of state and local initiatives is also presented, along with some practical guidelines for screening, assessing, and intervening with children from families with domestic violence. The chapter concludes with practice, policy, and research implications for the future of addressing children’s exposure to domestic violence. Practice Issues Throughout part 2 a number of practice issues relevant to the protection of children are identified. ASFA emphasizes the importance of maintaining children and youth safely in their own homes. Among the practice activities in relation to child/youth safety is the development and implementation of a plan that ensures safety. Child/youth safety must be the first consideration during planning and implementation of services (while the child/youth remains in the home, for reunification, selection of placement resources, visiting arrangements, and/or termination of services). Another critical task aimed at ensuring the safety of the child or youth in placement is the completion of substitute caregiver criminal background checks, the review of licensing or certification files, and the assessment of the physical environment. Since parents must demonstrate safe parenting before a child or youth may be reunified

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with them, parental compliance with the plan for services alone is not sufficient to justify reunification. Practitioners must assess whether sufficient changes have resulted in the problems that contributed to the child’s placement to assure that the child can safely return home. One of the challenges of child welfare practice is the integration of family-centered practice with protective authority. An important factor in achieving this balance is the involvement of children, youth, and parents or other primary caregivers, including fathers and paternal resources, in all aspects of planning and implementation to the degree that they are able and to the extent permitted by any outstanding court orders. The use of family resources (including extended family, fictive kin, and paternal resources) should first be considered when creating a safety plan, and the use of family preservation practices should be considered when appropriate to safely maintain a child or youth in her own home. Community members—such as neighbors and groups—should also be considered as resources, while agency intervention—such as out-of-home placement—should be the last option. It is critical that practitioners clarify what is and is not negotiable about the case plan and the family’s overall involvement with the child welfare system (for example, court orders and safety considerations). Options and alternatives should be considered with the family should reunification not appear immediately possible (e.g., voluntary surrender or parental rights, directed consent, kinship care, guardianship). In every phase of services, safety planning is a priority; safety planning is not a one-time activity that occurs and may then be forgotten.

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Prevention of Child Abuse and Neglect

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he physical abuse and neglect of children poses a grave threat to their overall health and well-being, with both immediate and longer-term biological, psychological, and social consequences.1 The presence of child abuse and neglect constitutes the primary reason that most children encounter the traditional child welfare services system in the United States. As traditionally constituted, child protective services aim to protect children who have been identified as abused or neglected. However, a more recent and growing movement in the U.S. is represented by strategies and programs that aim to prevent child abuse before it has the chance to ever occur and that thereby aim to avert the frequently damaging consequences of such maltreatment for children, their families, and the wider social fabric. This chapter examines physical child abuse and neglect and its prevention, the rationale and support for prevention, and some of the present challenges and dilemmas facing the prevention field as it advances. Physical Child Abuse and Neglect: A Threat to Child Health and Development Although some lack of consensus remains concerning what precisely constitutes an incident of physical child abuse and neglect given varying legal, practical, scholarly, and contextually informed points of view, practitioners and scholars most often adopt as a working definition those acts of commission or omission by parents or responsible caregivers that result in or pose substantial risk of injury or harm to a child (cf. DePanfilis & Salus 1992;

Dubowitz & Guterman 2005). Drawing from such a definition, the breadth of the problem of physical child abuse and neglect is extensive. Although the effects of maltreatment may vary, an array of biological, neurological, emotional, and social-behavioral consequences have been consistently linked with exposure to child abuse and neglect. Biological consequences may include physical injuries, such as traumatic brain injury, retinal hemorrhages, burns, bone fractures, neurological damage, and delayed physical growth (Bonnier, Nassogne, & Evrard 1995; Chiesa & Duhaime 2009, Lancon, Haines, & Parent 1998; Libby et al. 2003; Perry & Pollard 1997; Perry et al. 1995). These children are also at increased risk for having cognitive and language deficits (Azar, Barnes, & Twentyman 1988; Cicchetti & Beeghly 1987; Fantuzzo 1990; Kolko 1992) as well as a host of emotional disorders or problems including anxiety, depression, post-traumatic stress, low self-esteem, suicidal ideation and behavior, and problems with self-regulation of emotions (Cicchetti & Lynch 1993; Diaz, Simantov, & Rickert 2002; Dykman et al. 1997; Lansford et al. 2002; Shields, Cicchetti, & Ryan 1994; Silverman, Reinherz, & Giaconia 1996). Abused or neglected children are also at heightened risk for developing multiple social-behavioral problems, including difficulties with social relationships and developing trust and attachments (Carlson et al. 1989; Egeland & Sroufe 1981; Kaufman & Cicchetti 1989; Lansford et al. 2002; Main 1986), increased aggression, externalizing behavior, and later criminal activities 207

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(Widom & Maxfield 2001), and also substance and/or alcohol abuse in later life (Diaz., Simantov, & Rickert 2002; Malinosky-Rummell & Hansen 1993; Widom & White 1997). Unfortunately, the consequences of abuse are most devastating for the youngest victims. In addition to facing heightened risk for fatality (e.g. U.S. Department of Health and Human Services 2012), very young children who are maltreated are at inordinate risk for nonorganic failure to thrive, shaken baby syndrome, mental retardation, impaired growth and dwarfism, brain injuries, blindness, and/or injuries to other parts of the body (Chiesa & Duhaime 2009; Mrazek 1993; National Research Council 1993). Furthermore, recent advances in neurological assessment document a variety of sequelae that may have profound implications for later life, including brain contusions, intracranial hemorrhages, brain atrophy, and alterations in the development of the limbic system linked with memory, emotions, and basic drives (Cheah et al. 1994; Frank, Zimmerman, & Leeds 1985; Ito et al. 1993; Teicher et al. 1996). Indeed, evidence from recent epidemiological studies indicates that the effects of adverse childhood experiences (ACE) can lie dormant for decades, erupting into illness and disease during middle and late adulthood (Felitti et al. 1998; Shonkoff, Boyce, & McEwen 2009). As adults, abused and neglected children are more susceptible to a wide variety of debilitating conditions including cancer, respiratory disorders, severe obesity, cardiovascular disease, psychiatric disorders, liver disease, and autoimmune disease (Anda et al. 2006; Brown et al. 2009; Dube et al. 2009; Felitti et al. 1998;. Shonkoff, Boyce, & McEwen 2009). Having so far reviewed the substantial risks that maltreatment poses to children, the remainder of this chapter will focus on the incidence and etiology of the problem; emerging prevention efforts that appear most promising, namely, home visitation, social support services, multilevel interventions, and universal efforts; and challenges and dilemmas that need to be addressed as the prevention field grows and moves forward.

Incidence of Physical Child Abuse and Neglect Child abuse and neglect remain a significant public health concern in the United States. According to the National Child Abuse and Neglect Data System (NCANDS), FY 2011 for every 1,000 children in the U.S., about 45.8 reports of maltreatment were made to protective services (U.S. Department of Health and Human Services 2012). Of those referrals, approximately 18.5 percent were substantiated as maltreatment (U.S. Department of Health and Human Services 2012). According to these latest data, this indicates that approximately 681,000 children were victims of abuse and neglect in the year 2011. Although a variety of forms of child maltreatment are reported to the nation’s child protective services system, cases of neglect (78.5 percent) and physical abuse (17.6 percent) constitute the majority of the reports confirmed as maltreatment in the United States (U.S. Department of Health and Human Services 2012). Of these forms of child maltreatment, most data sources indicate that the younger the child, the higher the risk of victimization, particularly in its most severe forms. For example, eight out of ten child maltreatment fatalities (81.6 percent) occur in children three years old or younger, and 42.4 percent of all child maltreatment related fatalities occur during the first year of life (U.S. Department of Health and Human Services 2012). Indeed, the first week of life poses the highest risk of homicide to infants (Paulozzi & Sells 2002). Based on statistics from the US DHHS Child Maltreatment annual reports 2001–2010, the Every Child Matters Education Fund reports that “15,510 children died from child abuse and neglect during the 2001–2010 period” (2012: 9); in 2010, “the child abuse and neglect fatality rate, in the states where there was a fatality, was 13 times greater in the bottom state than in the top (p. 9).” Despite these grim statistics, national data suggest that most forms of child maltreatment are on the decline (Finkelhor, Jones, & Shattuck 2011). According to the NCANDS, substantiated cases of physical abuse and neglect decreased by 55 percent and

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10 percent, respectively, between 1990–2009 (Finkelhor, Jones, & Shattuck 2011). These national trends in maltreatment are further replicated by declines in victim self-reports, local agency records of maltreatment, and other measures of child and adolescent wellbeing—an indicator that that this downward trend is not a statistical artifact and reflects a real decline (Finkelhor, Jones, & Shattuck 2011). Etiology of Physical Child Abuse and Neglect Evidence from several decades of research has identified a wide array of factors that appear to contribute to the likelihood that a child will be physically abused and/or neglected and therefore suggest a variety of pathways for prevention. These factors have commonly been organized according to a multileveled rubric, often using what has been termed an “ecological” or “ecological developmental” framework (e.g., Belsky 1980; Cicchetti & Lynch 1993; Garbarino 1977). This framework highlights that physically abusive and/or neglectful behavior derives from the complex set of transactions within and between t
the microsystem representing the parent, child, and their interactions; t
the meso- and exosystems in which the parent-child dyad are embedded, including the settings, networks of relationships, and institutions in which the parent and child socialize and are sustained; and, t
the macrosystem comprised of overarching social structural elements within which the meso- and exosystems are themselves lodged (Badr 2001; Belsky 1980; Bronfenbrenner 1977; Garbarino 1977; Garbarino & Stocking 1980). While it is beyond the scope of this chapter to comprehensively present the known etiological findings related to physical child abuse and neglect,2 we will highlight some of the clearest themes in the existing etiological research. In the parent-child microsystem, the primary attachments that parents have formed with their own

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parent figures during childhood appear as a key etiological factor, particularly in the degree to which parents themselves experienced abuse and/or neglect (e.g., Belsky & Jaffee 2006; Egeland, Jacovitz, & Sroufe 1988; Widom 1989). Although little evidence supports the popular assumption that the presence of parental mental illness, in a general sense, is associated with maltreatment risk, several specific problematic aspects of socioemotional functioning have been linked with negative parenting behaviors. Parents at risk of becoming physically abusive and neglectful often exhibit depression and low self-esteem (e.g., Belsky & Jaffee 2006; Conron et al. 2009; Chaffin, Kelleher, & Hollenberg 1996; Ethier, Lacharite, Couture 1995; Stith et al. 2009). Problems with the abuse of alcohol and/or other psychoactive substances have also been specifically linked with maltreatment risk (Chaffin, Kelleher, & Hollenberg 1996; U.S. Department of Health and Human Services 1999), especially during the early childhood years: children four years of age or younger are the victims in approximately one-half of all substantiated cases of child maltreatment involving substance or alcohol abuse (National Center on Child Abuse and Neglect 1993). Moreover, substance abuse is implicated in the most serious forms of child maltreatment: as many as twothirds of child maltreatment fatalities involve a drug- or alcohol-addicted caregiver (Wells 2009; Reid, Machetto, & Foster 1999). Maltreating parents have often been observed to hold specific deficits in social coping skills, including a hyperresponsivity to child-related stimuli and deficits in reading and responding to social cues (e.g., Milner & Crouch 1998; Pruitt & Erickson 1985). Maltreating parents often also report feeling “out of control” in their lives and frequently hold an external locus of control orientation (Ellis & Milner 1981; Gynn-Orenstein 1981; Nurius, Lovell, & Maggie 1988; Wiehe 1992). Work by Bugental (Bugental, Blue, & Cruzcosa 1989; Bugental et al. 1999), Patterson (Patterson 1982; Reid & Patterson 1989) and colleagues has demonstrated that abusive or neglectful parent-child interactions can, in

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part, be understood as resulting from a cyclical pattern in which a child’s behavior is perceived as difficult or stressful by a parent and responded to in a coercive or insecure fashion, provoking still further difficult or stressful behaviors from the child, in turn promoting a potential downward cyclical spiral toward abusive parental behaviors. As well (and consistent with the “learned helplessness” theory of Seligman 1975), parents may respond to child behaviors perceived as difficult or stressful by withdrawing, becoming depressed, and showing decreased responsiveness and sensitivity to their children’s cues (e.g., Donovan, Leavitt, Walsh 1998; Murray et al. 1996). It has been shown that children responded to in such ways tend to display “dysregulated” behavioral patterns through excessively demanding behaviors, excessive crying, or through exhibiting their own depressive behavior patterns (Cox 1987; Field 1992, 1998). Such dyadic interaction processes may spiral downward over time into neglectful parenting behaviors. Importantly, findings by Field (1998) indicate that a dyadic depressive, potentially neglectful interaction may be linked with the presence of biochemical substrates, which may appear at birth or even in utero. Beyond stressful interactions with their children, parents at risk for abuse and neglect face an array of life stressors both within the family and in the “mesosystem” in which parent-child interactions are embedded (Hillson & Kupier 1994; Kolko et al. 1993; Kotch et al. 1999). Studies have documented that parental stressors such as material deprivation, unemployment, low educational attainment, and multiple life events or geographic moves are associated with heightened risk for child maltreatment (e.g. Chan 1994; Justice, Calvert, & Justice 1985; Murphey & Braner 2000; Straus & Kantor 1987). Given that twice as many female-headed as male-headed single-parent households live below the poverty line (31.6 percent versus 15.8 percent; DeNavas-Walt, Proctor, & Smith

2011), the role of fathers in child maltreatment is an important factor to consider (Fields & Casper 2001). Higher maltreatment rates are common in single-parent, female-headed homes, likely due to multiple mechanisms such as fewer psychosocial contributions to the family (e.g. Amato 2005; Gelles 1989; Guterman et al. 2009a). Further, fathers and male partners, when present, are highly overrepresented as perpetrators of child abuse, especially that which is fatal or otherwise severe (Brewster et al. 1998; Krugman 1985; Margolin 1992). A growing body of evidence indicates that, in particular, men who enter parenthood at an early age or who abuse alcohol and other substances are more likely to mistreat their children (Ammerman et al. 1999; Lee, Guterman, & Lee 2008). Findings are less robust pertaining to a father’s economic/employment status and risk for child maltreatment. Paternal poverty or unemployment may increase the possibility of child abuse and neglect among at-risk families, but appears to play a lesser role among diverse samples of families (Lee, Bellamy, & Guterman 2009). The quality of the relationship between the mother and her partner, however, appears to play an important role in parent-child relationships (cf. Belsky 1979; Brunelli et al. 1995; Lee, Bellamy, & Guterman 2009). While a positive relationship between parents may serve as a buffer against abuse and neglect, a negative or unsupportive one may heighten risk. The presence of domestic violence between partners can be particularly foreboding. Domestic violence co-occurs at high rates with physical child abuse and neglect, especially in its most lethal forms. Studies of children suspected of being maltreated who were seen in hospital settings have reported that between 45 percent and 59 percent of mothers showed evidence of being battered by their partners (MacLeod & Nelson 2000; McKibben, De Vos, & Newberger 1991; Stark & Flitcraft 1988), and domestic violence has been shown to be present in over 40 percent of child maltreatment fatalities (Child Fatality Review Panel 1993; Felix &

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McCarthy 1995; Oregon Children’s Services Division 1993). Perhaps most importantly, a study of over twenty-five hundred at-risk mothers involved in a home visiting program found that not only does domestic violence often co-occur with child maltreatment, but it also frequently predates it, raising the odds of child abuse within the family threefold (McGuigan & Pratt 2001). Just as parental relationships may have a positive or negative impact on risk for abuse and neglect, so may the broader social networks and characteristics of the communities in which families live. In particular, social networks may alter the relationship between parents’ perceived stresses (such as those that are socioeconomically derived) and their parenting behaviors. Research spanning three decades has consistently discerned important links between problematic aspects of families’ social networks and heightened child maltreatment risk (e.g. Chan 1994; Coohey 1996; Gaudin et al. 1993; Gracia & Musitu 2003; MacKenzie, Kotch, & Lee 2011; Straus & Smith 1992). Studies have tended to report that, when compared with nonmaltreating families, maltreating families have smaller, less dense social networks with whom they carry out contact and reciprocal exchanges (e.g. Corse, Schmid, & Trickett 1990; Crittenden 1985; Elmer 1967; Kotelchuck 1982; Lovell 1988; Salzinger, Kaplan, & Artemyeff 1983). It has also been reported that maltreatment risk is higher for families living in community settings characterized by a lack of cohesion amongst neighbors and where community life consists of instability, disorganization, and high degrees of community violence (Coulton et al. 1995; Coulton et al. 2007; Covington, 2013; Di Lorenzo et al. 2013; Osofsky et al. 1993; Richters & Martinez 1993). However, the dynamics that account for the association between neighborhood disadvantage and reports of parental child abuse and neglect are not yet well understood (Coulton et al. 2007). Further research is needed to clarify how neighborhood selection bias (families

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select into neighborhoods), divergent reporting processes, or actual behavioral differences in parenting account for concentrations of child maltreatment reports in particular neighborhoods (Coulton et al. 2007) and to what degree neighborhood processes interact and are mediated by parental perceptions of stress and control as they shape maltreatment risk (Guterman, Lee, Taylor, & Rathouz 2009). One of the central stressors identified in maltreatment risk is that of family poverty. Studies have found that families reported to child protective service systems are more likely to have single mothers, unemployed fathers, receive public assistance, and/or live in poor neighborhoods (e.g. Coulton et al. 1995; Coulton et al. 2007; Drake & Pandey 1996; Hampton & Newberger 1985; Lindsey 1994; Zuravin 1989). As summarized by Pelton (1994:166–67), “there is overwhelming and remarkably consistent evidence . . . that poverty and low income are strongly related to child abuse and neglect and to the severity of child maltreatment.” At the same time, it is also important to emphasize that the vast majority of impoverished families are never identified as maltreating their children (e.g. Sedlack & Broadhurst 1996). Although economic impoverishment is one of the most consistently observed predictors of physical child abuse and neglect, it must be considered in combination with other risk and protective factors that may modify the risk (c.f. Sameroff & Gutman 2004). Finally, although a highly complex issue, cultural influences have been considered for some time in the ways they may protect or shape the risk for child maltreatment. The role of culture has most frequently been considered as the means by which cultural messages convey norms of parenting behavior along with sanctions and allowances for a variety of parenting practices (Finkelhor & Korbin 1988; Korbin 1987, 1994). Wide variation has been noted across cultural contexts regarding culturally accepted and normative supervisory arrangements, the number and nature of caregivers,

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and the disciplinary and indigenous medical practices employed with children (e.g. Fischler 1985; Korbin 1994; Ritchie & Ritchie 1981). Corporal punishment that may appear to be physical abuse within some cultural contexts may be wholly acceptable and normative within other contexts (Solheim 1982). According to some scholars, what may be accepted as normative child-rearing patterns within a specific cultural context may be misconstrued across cultural boundaries as child maltreatment, especially in situations where professionals must enact child protection laws and policies derived from a majority cultural value system (e.g. Gray & Cosgrove 1985). Other scholars, however, argue that cultural explanations for child-raising variations must be interpreted with caution (Durrant 2008; Elliot & Urquiza 2006). Members of the same culture or racial/ethnic group have heterogeneous parenting styles; all members of a group do not necessarily value the same disciplinary strategies (Bluestone & Tamis-LeMonda 1999; Durrant 2008). Moreover, contend scholars, spanking and other forms of corporal punishment may not be the outcome of ethnicity so much as parental mental health or other factors (i.e. depression, low SES) (Chung et al. 2004; Durrant 2008). More research needs to be conducted not only to untangle concepts of culture from race/ethnicity (and other parental factors) but also to ascertain direct (as opposed to proxy) measures of cultural and racial socialization processes that may contribute to child-rearing practices (Elliot & Urquiza 2006; Feiring 2010). In sum, a variety of factors are associated with risk of parental child abuse and neglect. Indeed, no single risk factor (parental substance abuse, child temperament, culture) may be as powerful a predictor of maltreatment as the total accumulation of adversities faced by families (MacKenzie, Kotch, & Lee 2011). That is, risk of child maltreatment is heightened when placed in the context of other household and neighborhood adversities, including intimate partner violence,

parental substance abuse, parental criminal history, and neighborhood disadvantage (Gewirtz & Edelson 2007; Hartley 2002; Herrenkohl et al. 2008; Tajima 2004). Although a great many questions still remain in our understanding of the multiple dynamics that influence and lead to a parent’s physical child abuse and neglect of a child(ren), we nonetheless have developed a substantial body of knowledge in considering efforts to prevent and treat physical child abuse and neglect when it occurs. Dominant Strategies in Child Abuse Prevention Organized efforts to address the problem of physical child abuse and neglect have been identifiable for more than a century in the United States. It was in 1874 when Ms. Etta Wheeler, a “friendly visitor,” unmasked a horrific case of child abuse (“little Mary Ellen”), which led to the formation of the world’s first child protection organization, the New York Society for the Prevention of Cruelty to Children (NYSPCC; Guterman 2001). However, it was not until the latter half of the twentieth century that professionalized clinical intervention was initiated, seeking to address the problem of child abuse and neglect. The “discovery” of the “battered child syndrome” in the 1950s and early 1960s has long been credited with the initiation of a national movement that spurred the development of federal and state policies, programs, and clinical interventions aimed at preventing and treating the problem of child maltreatment in the U.S. (cf. Lindsey 1994). During this time the nation’s child protective services system was established and institutionalized and several major policy initiatives established a legal and programmatic framework within which the problem of child maltreatment is presently addressed. It was not until the most recent three decades that child abuse prevention efforts began to emerge on a visible scale with the initiation of home visitation services—a strategy that has reconfigured the landscape of child abuse prevention.

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Home Visitation Services Early home visitation is a strategy for providing services to families in their homes during the perinatal period and through early childhood (Stoltzfus & Lynch 2009). Although home visitation programs come in a variety of formats, most offer a range of services and supports to promote parent functioning, parent and child health, and child development during the early childhood period (Stoltzfus & Lynch 2009). To achieve these outcomes, home visitors may provide case management services, parental guidance (i.e., breastfeeding support, coping with crying), educational trainings and materials, child development information, assistance with home safety, and linkage with community supports and resources. While home visitation programs vary across models, personnel employed, and communities in which they are anchored, all aim to foster the parent-child attachment, to provide supports to the parent during the highly vulnerable and sensitive perinatal period, and ultimately to realize better long-term outcomes for children, families, and communities (Stoltzfus & Lynch 2009). Several broad historical developments spurred the growth of early home visitation services as the predominant strategy to prevent child abuse and neglect. These include deinstitutionalization within children’s services, which increasingly acknowledged the detrimental effects of separating children from their parents and the benefits of supporting the parent-child attachment (e.g., Bowlby 1951; Goldfarb 1945; Spitz 1945; Yarrow 1961). Accompanying this was an increasing scholarly emphasis on attachment theory (Bowlby 1969) and an ecological model of child development and maltreatment (Belsky 1980; Bronfenbrenner 1977; Garbarino 1977), which provided the initial intellectual undergirding for early intervention services in the home. Finally, scholars and advocates increasingly recognized that child abuse prevention efforts, namely child protective services, were often “too little, too late.” Child protective services only intervened after mothers and

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fathers lost control of the parenting process and did so in an adversarial and coercive manner; an approach that frequently alienated families and did little to solve the problem of child maltreatment (Guterman 2001). In the context of these developments, C. Henry Kempe first proposed and later tested a “health visitor” program in the U.S. as a preventive measure specifically for the problem of child abuse and neglect (Kempe 1976). Kempe was well aware of promising findings reported in allied early intervention studies and the increasing emphasis on the parentinfant bonding process. At the same time, he recognized that the vast majority of families at risk were accessible before maltreatment could take place via health care settings at the point of birth or during prenatal medical visits. Kempe, along with Jane Gray and colleagues, first studied early home visitation aimed at reducing future maltreatment risk in a controlled fashion and reported hopeful findings linked with a possible reduction of severity of maltreatment related injuries; their overall findings, however, were not reported as statistically significant (Gray et al. 1979). Influenced by the findings of Kempe and colleagues, Calvin Sia, a pediatrician and member of Hawaii’s child protective services advisory committee, invited Kempe to plan child abuse prevention activities for families in Hawaii. In 1975, Dr. Sia obtained a grant from the National Center for Prevention and Treatment of Child Abuse and Neglect to implement a pilot home visitation program developed by Kempe and a CPS advisory committee (Earle 1995). This home visitation program, named Hawaii Healthy Start, sought to prevent child maltreatment through home visitation via the following strategies: improving family coping; promoting positive parenting; facilitating parent-child attachment; promoting optimal child development; and improving the use of community resources, particularly ongoing access to a “medical home” for the family. Early evaluations of the Hawaii Healthy Start model were

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promising and attracted the attention of Prevent Child Abuse America (or PCA America, formerly the National Committee to Prevent Child Abuse), leading to nationwide efforts to expand the Healthy Start model (Guterman 2001). In 1992 PCA America launched Healthy Families America (HFA), a home visitation program modeled on Health Start Hawaii. Within ten years, Healthy Families America was operating in forty states and serving over forty thousand parents (Asawa, Hansen & Flood 2008). Preliminary results from twenty-nine quasi experimental evaluations suggested that HFA positively impacted rates of child maltreatment and boosted maternal and child health (Asawa, Hansen & Flood 2008; Daro & Donnelly 2002). Parallel to the Healthy Families America developments, David Olds and colleagues first initiated the Nurse Home Visitation Program (then referred to as the Prenatal/Early Infancy Project) in 1977; this was a milestone in the advancement of early home visitation services in the U.S. (Olds 1982; Olds, Henderson, Chamberlin, & Tatelbaum 1986; Olds, Henderson, Tatelbaum, & Chamberlin 1986). The Nurse Home Visitation Program was designed to address broad areas of maternal and child development and was specifically targeted to improve the outcomes of pregnancy, the qualities of maternal caregiving, child health and development, and maternal life course development (Kitzman et al. 1997; Olds et al. 1997). The initial evaluation study, conducted in Elmira between 1978–1982, reported a select but broad array of positive outcomes in the domains of pregnancy (e.g., increased birthweight, decreased smoking), child development (e.g., infants’ cognitive development in smoking mothers), and maternal life course (e.g., fewer subsequent pregnancies, fewer months on welfare; Olds et al. 1999; Olds, Henderson, Tatelbaum, & Chamberlin 1986). And, promising for maltreatment prevention, during the first two years of life only 4 percent (one case) of low-income unmarried teen mothers who received nurse home visitation were substantiated for maltreatment, in

comparison to 19 percent (eight cases) of lowincome unmarried teens not receiving home visitation (reported as a marginally statistically significant finding) (Olds, Henderson, Chamberlin, & Tatelbaum 1986). In addition, infants of nurse-visited women were seen in the hospital emergency room fewer times than those of controls, and low-income teens who were nurse-visited punished and restricted their children less frequently and provided their children with a larger number of appropriate play materials (Olds, Henderson, Chamberlin, & Tatelbaum 1986). Because of the careful research design executed in the Elmira trial, the positive outcomes of Nurse Home Visitation Program were touted as the first hard evidence that early home visitation services, if designed and implemented appropriately within the right context, could indeed reduce child maltreatment risk before the fact. Two decades later, Nurse Family Partnership continued to demonstrate success, branching out to twenty-three states and reaching the doorsteps of over ten thousand families per year (Asawa, Hansen, & Flood 2008; Child Trends 2003). The Elmira study and subsequent NFP studies in other locations have been complemented by an increasing assortment of scientific findings on the benefits of home visitation programs, including the results of Parents as Teachers (PAT), Early Head Start, and various Healthy Family America sites (Guterman 2001; Stoltzfus & Lynch 2009). Preliminary findings suggested that parenting behaviors and child outcomes could be altered through the vehicle of home visitation (Guterman 2001; Howards & Brooks-Gunn 2009). Given the promising evidence base in home visitation services, the U.S. Advisory Board on Child Abuse and Neglect issued a report recommending “the replacement of the existing child protection system with a new, national, child-centered, neighborhood-based child protection strategy” (U.S. Advisory Board on Child Abuse and Neglect 1991:ix). Within this approach, the board singled out as its most important recommendation the immediate

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phasing in of a “universal voluntary neonatal home visitation system” of services (U.S. Advisory Board on Child Abuse and Neglect 1991:xlvii). Buoyed by funding from multiple sources, including the Maternal and Child Health Bureau, the Office of Juvenile Justice and Delinquency Prevention, and Temporary Assistance to Needy Families (TANF), the number of home visiting programs proliferated into the thousands (Gomby, Culross, & Behrman 1999) By 2008, more than 550,000 families were opening their doors to home visitors (Stoltzfus & Lynch 2009). Home Visitation Today: The Second Generation As of today, a second generation of home visitation programs continues to serve roughly a half million families at any given time (Stoltzfuz & Lynch 2009). Of these programs, Healthy Families America, Nurse Family Partnership, Parents as Teachers, Early Head Start, and SafeCare are some of the most widely disseminated in the field of child maltreatment prevention (see table for an overview). For example, the Nurse Family Partnership currently serves over thirtytwo thousand families in thirty-two states, while Healthy Families America provides home visiting services to an additional forty-five thousand families in thirty-five states (Child Trends 2003; Nurse Family Partnership 2011). This second generation of programs is more realistic about the multiple adversities facing at-risk families and children and the real world challenges within the home visitation field. That is, the field has recognized that, in order to produce more consistent and enduring positive outcomes among an array of at-risk families, home visitation had to move beyond a “one size fits all” model toward a complex matching of scientifically supported interventions to particular risk factors. For example, maternal depression, intimate partner violence, and substance abuse have posed considerable challenges to home visitation programs, prompting programs to reassess the efficacy of their

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interventions (Duggan et al. 2009; Tandon et al. 2005). Recognizing and addressing these factors is an emerging priority for home visitation programs as they seek to maximize their preventive benefits. The following section reviews a number of the enhancements and modifications developed by home visitation programs to address some of the most formidable factors in the etiology of child maltreatment. Maternal Depression For many home visitors, maternal depression is one of the most significant barriers to effective service delivery (Ammerman et al. 2010; LeCroy & Whitaker 2005). Depressed mothers are more difficult to engage in services and, according to home visitors, are generally “unmotivated” to participate and “uncommitted” to program success (Ammerman et al. 2010:194). Even if such mothers do engage in services, the majority of home visitors lack the professional training and expertise to address their mental health needs (Duggan et al. 2009). As a result of these gaps in knowledge and training, home visitation programs consistently demonstrate little or no effect on levels of maternal depression (Ammerman et al. 2010). Several home visitation programs have recently invested in new interventions to tackle the problem of maternal depression. For example, a Healthy Families America site used basic cognitivebehavioral techniques to address mothers’ attributions toward their children (Bugental et al. 2002). A clinical evaluation of this intervention indicated that altering maternal attributions not only decreased symptoms of depression but also tempered harsh parenting practices (Bugental et al. 2002). Following the success of HFA’s intervention, other programs, including NFP and Early Head Start, also experimented with new therapeutic components (Ammerman et al. 2009). The first approach, piloted by NFP and HFA, introduced cognitive behavioral therapy (IH-CBT) to their repertoire of standard home visitation services. Mothers who participated in IH-CBT experienced a

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TA B L E 1 0 . 1

Program

Objectives

Early Head Starta

Improve postnatal outcomes; enhance child development; strengthen family functioning

Healthy Families America (HFA)b

Target population

Beneficial outcomes related to PCAN prevention

Staff

Timing/Dosage

Low income parents with children

Trained paraprofessionals

Prenatal/birth through three years

↑ Healthy and safety of child ↑ Quality of home environment ↑ Maternal responsivity ↓ Harsh parenting practices

Prevent child abuse and neglect; enhance child development; encourage positive parenting

Families or pregnant women identified as at risk at birth of child

Paraprofessionals

Prenatal or birth to pre-K or kindergarten; weekly visits for the first 6 months, then biweekly

↓ Self-reported PCAN ↑ Quality of home environment

Nurse Family Partnership (NFP)c

Improve pregnancy outcomes; promote children’s health and development; improve parental self sufficiency

Low income, first time mothers

Registered, public health nurses

Pregnancy through 24 months; approx. 64 one hour visits over a 2 ½ year period

↓ Substantiated PCAN ↑ Healthy and safety of child ↑ Maternal responsivity ↓ Harsh parenting practices

Parents as Teachers (PAT)d

Prevent child maltreatment; promote knowledge of child development; teach parenting skills; enhance school readiness

Expectant mothers and families with children

Certified “parent educators” or paraprofessionals with specialized training

Prenatal to age three or five; weekly, biweekly, or monthly, hour-long visits depending on need; group meetings

MIXED FINDINGS ↓ Substantiated PCAN (for enhanced PAT with case management)

SafeCaree

Improve parenting skills (behavioral management) and parent-child interactions; promote home safety; assist parents in recognizing illness/ injury and seeking appropriate help

Parents at risk / have been reported for child maltreatment

Specialized SafeCare training and certification. No prior educational requirements

Birth through age 5; weekly 1–2 hour visits over an 18–20 week period

↑ Healthy and Safety of Child ↓ Substantiated PCAN ↑ Quality of Parent-Child Interactions

a

Howard & Brooks-Gunn 2009. Howard & Brooks-Gunn 2009. c Howard & Brooks-Gunn 2009. d Reynolds, Mathieson, & Topitzes 2009; Pfannenstiel, Lambson, & Yarnell 1991; Wagner & Clayton 1999. e Gershater-Molko, Lutzker, & Wesch 2002; Gershater-Molko, Lutzker, & Wesch 2003; Hecht et al. 2008. b

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significant drop in depression in comparison to mothers in the control condition (Ammerman et al. 2005). The second approach, developed by Beeber and colleagues (2004), delivered interpersonal psychotherapy (IP) to mothers enrolled in Early Head Start (EHS). Mothers enrolled in the IP condition reported a significant reduction in depression in comparison to mothers in the standard EHS program (Beeber et al. 2004; Beeber et al. 2010). In sum, the field of home visitation has made significant strides in addressing and understanding maternal depression in the context of early childhood. Although maternal depression still remains a formidable obstacle for many programs, these interventions, if taken to scale, may boost the capacity of home visitors to effectively address maternal mental health and thereby improve parent and child well-being. Intimate Partner Violence Like maternal depression, intimate partner violence (see Postmus’s chapter, this volume), poses a significant risk to children’s health and wellbeing. In homes characterized by IPV, children are at risk of child maltreatment in its most lethal forms, including homicide. Yet intimate partner violence remains largely unaddressed by home visitation programs. Indeed, many home visitors report being uncomfortable addressing issues of domestic violence and inconsistently refer battered women to community supports/ services (Duggan et al. 2004). Recent research, however, suggests that home visitation has the capacity to address intimate partner violence. Two programs, Hawaii Healthy Start and Healthy Families Alaska, have demonstrated that home visitation, in some cases, reduced incidence of IPV despite the home visitors’ lack of training or expertise in domestic violence (Bair-Merrit et al. 2010; Duggan et al. 2009). However, the overwhelming number of home visitors who continue to struggle with family IPV has prompted the development of innovative trainings and interventions to address this particular challenge. The Nurse Family

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Partnership, with funding from the Centers for Disease Control, is currently piloting a home visitation program with an IPV component. Enrollment and participation in the program began in 2010; evaluation of the program will compare the efficacy of the IPV component in reducing domestic violence versus standard NFP services. Likewise, the Domestic Violence Enhanced Home Visitation Project (DOVE) is a multistate study investigating the impact of a public health nurse home visitation program on rates of intimate partner violence among new mothers (Eddy et al. 2008). Although the results of these new programs are as of yet unknown, the specialized attention to intimate partner violence and the development of new training and curricula in this domain will undoubtedly advance the state of knowledge in the home visitation field. More importantly, if these programs are successful they have the capacity to reduce exposure to violence among young children and potentially attenuate incidence of child maltreatment and fatality among some of the most at-risk families. Fathers Although fathers play a crucial role in child maltreatment risk, too often home visitation programs fail to recognize and address the needs of men in their services (Guterman 2001; Guterman et al. 2009a, b; Lee, Bellamy, & Guterman 2009). In theory, programs may allude to the entire family; in practice, however, most home visitation services engage with mothers. This may occur either because the program specifically focuses on maternal outcomes, the implementation (i.e. daytime visits/ place of visit) prevents fathers from participating, or because fathers (due to substance abuse or violence perpetration) are prohibited from participating by mothers (Duggan et al. 2004, see also the Coakley chapter, this volume). A few programs, however, are attempting to remedy this oversight through father engagement efforts. For example, Early Head Start, a federally funded program that includes a mix

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of home visiting and center-based services, has begun recruiting fathers (residential and nonresidential) for participation (Azzi-Lessing 2010; Johnson 2004). Emerging evidence from Early Head Start is promising: fathers who participated in services were more responsive to children and reportedly were less likely to employ corporal punishment (Administration for Children and Families 2002; Azzi-Lessing 2010). Other models, including the Parents as Teachers program, have received funding from the Responsible Fatherhood Initiative to adapt their home visiting programs to the needs of low-income fathers. “Dads in the Mix,” a pilot father engagement program implemented by PAT, recruited fathers to participate in a mix of group sessions and home visits. Of the ninetythree fathers recruited for participation, seventy-nine completed the program, including eight hours of skills-based training. According to a preliminary evaluation of the results, program effects included positive changes in paternal nurturing and attachment, child development/knowledge of parenting, and overall family functioning (Wakabayashi et al. 2011). Other programs, including Healthy Start, and Healthy Families America have also initiated programs and groups to engage and support men in their role as fathers. Because the inclusion of fathers in home visitation programs is relatively new, empirical evidence on the efficacy of these programs is limited (Guterman 2001). Further research is needed to advance our knowledge of the determinants of father engagement in home visitation services and both the anticipated and unanticipated effects of this approach on the entire family (Duggan et al. 2004). Substance Abuse Substance abuse is implicated in a substantial proportion of child abuse and neglect cases (See Ryan and Huang’s chapter, this volume). Yet, substance abuse interventions rarely address parenting issues, and parenting interventions (i.e., home visitation) rarely address substance abuse (Barth 2009). In the last few decades a

smattering of home visiting programs have attempted to address substance abuse and parenting through the vehicle of home visitation. Unfortunately, most of these programs have yielded little or no success in improving child and parent outcomes. For example, Black and colleagues (1994) tested the effects of an eighteen-month home visitation program using the HELP at Home: Hawaii Early Learning Profile (Parks 1988) and the Carolina Curriculum for Handicapped Infants and Infants at Risk (Johnson-Martin, Jens, & Attermeier 1986) on pregnant women with substance abuse disorders (Black et al. 1994; Suchman et al., 2006). This program provided biweekly nurse home visits to enhance parent-child interactions and bolster knowledge of child development, but had little effect upon parenting sensitivity, the quality of the home environment, or personal sobriety (Black et al. 1994; Osterling & Austin 2008). A second intervention, based upon the Infant Health and Development Program (IHDP), targeted the parenting attitudes and competencies of drug-addicted mothers (Schuler, Nair & Black 2002). Weekly paraprofessional home visits from two weeks to six months postpartum and biweekly visits from six to eighteen months focused on maternal empowerment and child development. Despite the high service dosage, the home visiting program had no effect on quality of parent-child interactions (Schuler, Nair & Black 2002). Rather, drug use was the most powerful predictor of parenting competence at eighteen months (Schuler, Nair & Black 2002). Finally, Ernst and colleagues (1999) randomly assigned drug-addicted mothers to a home visitation intervention delivered through the Seattle Birth to Three Program (Ernst et al. 1999; Osterling & Austin 2008). This program provided three years of paraprofessional home visitation services with a focus on relationship building, advocacy, and community linkage (Ernst et al. 1999). The authors claimed that mothers in the treatment condition were more likely to avoid incarceration, maintain sobriety, use birth control, and retain custody of their children (Ernst et al. 1999). However,

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the authors failed to provide tests of statistical significance on the results of their program, an oversight that makes it difficult to interpret the true impacts of their intervention (Ernst et al. 1999; Grant, Ernst, Pagalilauan & Streissguth 2003; Osterling & Austin 2008). Recent developments in Australia, however, hold promise for the field of home visitation and substance abuse. The Parents Under Pressure (PUP) program, developed in Queensland, Australia, is an ecologically based intervention that delivers home-based services to address parental functioning in multiple domains: psychological well-being, parenting skills, affect regulation (i.e., mindfulness training), and access to support/resources (i.e., child care, housing, etc.; Dawes & Harnett 2007). A randomized test of the PUP intervention demonstrated that treatment families, in comparison to control families, made significant progress in multiple areas, including improvements in parenting attitudes, child behavior, and a reduction in child maltreatment potential (Dawes & Harnett 2007). Although additional tests must be conducted to verify its efficacy, PUP is rapidly gaining the attention of service providers and governmental bodies. In sum, the field of home visitation is making significant progress in addressing some of the most challenging problems (mental illness, IPV, substance abuse) facing high-risk families. Although this second generation of programs is still in its infancy, evidence suggests that home visitation, despite its limitations in meeting the needs of high-risk families, has had positive impacts upon child and family outcomes. For example, metaanalyses conducted by Geeraert and colleagues (2004), Sweet and Applebaum (2004), and others demonstrate a significant reduction in emergency room visits (Sweet & Applebaum 2004), reports to Child Protective Services (Geeraert et al. 2004), and self-reported acts of child abuse or neglect among home-visited families (Daro 2006; LeCroy & Milligan 2005; Mitchel-Herzfeld et al. 2005; Olds et. al. 1995). Moreover, as home visitation programs advance their knowledge in the domains of

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maternal depression, intimate partner violence, and substance abuse, program impacts are expected to become more powerful and enduring. Such significant findings on perinatal home visitation services were and continue to be pivotal in propelling early home visitation approaches forward as a hopeful solution to the problem of child maltreatment and its consequences. In 2010, President Obama signed into law the first ever federal funding stream for home visitation services under the landmark 2010 Patient Protection and Affordable Care Act (H.R. 3590). This unprecedented act offers the necessary infrastructure and coordination to expand home visitation to thousands of underserved families and children across the United States with the potential to reduce rates of child maltreatment and fatality in the decades to come (Boller, Strong, & Daro 2010). In September 2013, the U.S. Department of Health and Human Services announced expansion of its Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. This program facilitates collaboration and partnership at the federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs. MIECHV includes grants to states and six jurisdictions and grants to Indian Tribes, Tribal Organizations, and Urban Indian Organizations. The authorizing legislation requires that at least 75 percent of grant funds be spent on programs to implement evidence-based home visiting models. Currently, thirteen home visiting models meet the HHS criteria, including Early Head Start, Healthy Families America, Nurse Family Partnership, Parents as Teachers, and Safe Care, reviewed in table 10.1 in this chapter. Other Programs Targeting Child Maltreatment: Social Support and Self-Help Interventions Several social support intervention models have received preliminary support in addressing some of the broader contextual challenges implicated in child maltreatment by helping

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at-risk parents overcome social isolation and more effectively tap informal support networks for material, emotional, and informational support. For example, after participating in a social support skills training group, pregnant and parenting teens demonstrated improvements in social skills and social supports (Barth & Schinke 1984; Schinke et al. 1986). Likewise, the Social Network Intervention Project (SNIP) engaged parents at risk of child neglect in social skills training and linked them with mutual aid groups and neighborhood helpers. Parents receiving SNIP services reported improvements in their social networks and a broad range of parenting attitudes linked with child neglect (Gaudin et al. 1990–1991). Select group-based enhancements to home visitation programs have also specifically been linked with positive parenting outcomes. One such program, focused on improving parentchild attachment, was associated with greater participation in home visiting services and a trend toward improved parental perceptions regarding infants’ needs (Constantino et al. 2001). Similarly, Guterman (2012) has reported augmented improvements in parents’ social networks, abuse risk, stress, and sense of control for families receiving a social network group enhancement to home visiting services over and above those found in families receiving home visiting alone (Guterman 2012). Perhaps the largest-scale social support intervention in practice aiming to prevent child abuse is Parents Anonymous, a self-help group model that integrates professional clinical guidance indirectly, but is run by parents who have identified themselves as at-risk for abusing their children. Initially founded in 1970, Parents Anonymous groups have expanded across the United States and provide support to an estimated one hundred thousand parents per year (Rafael & Pion-Berlin 1999). Participants in Parents Anonymous groups set their own agendas, often addressing parenting and family communication skills, and are encouraged to be in contact with one another outside the group meetings for support and to begin to

take leadership and responsibility in the group functioning. Importantly, Parents Anonymous has developed into a national movement and organization providing technical assistance and advocacy, seeking to foster changes in the policies and programming that may aid in addressing the problem of child abuse on a larger scale. As with other self-help movements in the United States, there is a paucity of outcome data on the effectiveness of Parents Anonymous. An initial evaluation found that participating parents self-reported changes in parenting behaviors, more appropriate child development expectations, and reduced incidence of child abuse (Rafael & Pion-Berlin 1999). Recently, the U.S. Office of Juvenile Justice and Delinquency Prevention initiated an effort to study Parents Anonymous under more carefully controlled conditions. The results of this study, published in 2010, suggest that parents who participated in Parents Anonymous experienced significantly less distress and rigidity and engaged in fewer acts of psychological aggression toward children (Polinsky et al. 2010). Parents also reported improvements in other domains related to risk of child maltreatment, including reduced emotional domestic violence and substance abuse (Polinsky et al. 2010). These and further additional findings will be instructive to the widening interest in socially supportive preventive strategies. Multilevel Approaches to Prevention: “Triple P” The previous prevention strategies—home visitation and social support—target one level of the parent-child ecosystem for intervention (e.g., the parent-child relationship or the parent’s social network). In contrast, a comprehensive approach to child maltreatment prevention uses a variety of approaches to alter child and parent outcomes. The most established of these types of interventions is the Triple P program— a multiple-level, evidence-based intervention developed in Australia to strengthen positive parenting and reduce behavioral issues among children. Triple P consists of five graduated levels of intervention, each building upon the

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former with a greater intensity of service (Barth 2009; Sanders 2008). Level 1, or Universal Triple P, is a broad-based media campaign that provides educational information about parenting. Level 2, or Selected Triple P, provides parents with information or advice about specific developmental tasks or minor behavioral issues via direct (i.e., phone) contact or seminar. Level 3, or Primary Care Triple P, offers a brief program (4 sessions, 80 minutes long) to parents who have a specific behavioral or developmental concern regarding their child. Level 4, or Standard Triple P, offers intensive training sessions in effective parenting (8–10 sessions of about 60 minutes each) to parents of children with significant behavioral problems (conduct disorder, etc). Level 5, or Enhanced Triple P, offers intensive, individualized programs for families of children with behavioral disorders and concomitant family dysfunction. Practitioners may also employ home visits to monitor the family’s progress in learning new skills and behaviors (Barth 2009; Sanders 2008). Multiple studies have demonstrated the efficacy of Triple P in altering parenting behaviors, including a population-based study involving the random assignment of 18 counties to control and Triple P intervention groups (Prinz et al. 2009). After 2 years of implementation, counties in the Triple P condition reported a robust reduction in child abuse and neglect. According to Prinz and colleagues (2009), in a population of 100,000 the results of Triple P would equate to 688 fewer cases of substantiated child abuse and neglect, 240 fewer instances of out of home placement, and 60 fewer emergency room visits for injuries due to child abuse and neglect. The success of Triple P in the United States and other countries illustrates the power of a comprehensive, multilevel intervention to proactively prevent child maltreatment and its sequelae of effects upon individuals, families, and communities. Universal Prevention Strategies Universal preventive strategies addressing the problem of physical child abuse and neglect are analogous to other universal preventive health

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strategies, like child immunization or water fluoridation, in that they seek to intervene with an entire population, regardless of identified risk (Chahine & Sanders 2013; Covington 2013; Cull, Rzepnicki, O’Day, & Epstein 2013). Universal interventions avoid the potential stigma that may accompany the targeting and associated labeling of at-risk groups. Some efforts have been made to engage in broad-based public campaigns, for example, through the distribution of educational magazines for parents of infants (Laurendeau et al. 1991) or the provision to all new parents of educational materials about the risks of shaking babies (e.g. Showers 1992), but very little evidence sheds light on the efficacy of these strategies in reducing child maltreatment. Of the universal campaigns, Safe Haven Laws, Shaken Baby Syndrome prevention programs, and “No Spanking” Zones may be the most publicized. Safe Haven Laws In the 1990s the media uncovered a wave of infant abandonments, including shocking tales of infants dumped in garbage cans and left on doorsteps (Hammond, Miller, & Griffin 2010). The national outrage over what appeared in the media as a series of cases of infanticide led to the rapid-fire, unanimous passage of “Safe Haven” legislation in multiple states—laws that permit parents to anonymously surrender babies to legally designated sites without risk of prosecution (Dreyer 2002; Hammond, Miller, & Griffin 2010). Although Safe Haven laws have emotional and political appeal— they symbolically address the problem of child abandonment—the evidence regarding their efficacy is ambiguous (Hammond, Miller, & Griffin 2010). Some states, including the New Jersey Department of Children and Families (2008), provide evidence that the number of babies abandoned safely has increased significantly since the passage of legislation. In other states, including South Carolina and Texas, however, mothers continue to illegally abandon infants (Hammond, Miller, & Griffin 2010). For example, in Texas, eighty-two of ninety-three infants were illegally abandoned in the years

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1996–2006 following the passage of Save Haven (Pruitt 2008a, b). In addition to questionable efficacy, Safe Haven legislation may entail a host of unwanted effects, including influencing women to hide their pregnancies and abdicate their parental rights through abandonment (instead of other less harsh options) while denying biological fathers the right to paternity (Hammond, Miller, & Griffin 2010). However, as Thomas Atwood contests, “Just how many lives have to be saved to make these laws worthwhile?” (Pruitt 2008b:101). More research needs to be conducted to determine the efficacy of Safe Haven legislation in saving lives, its implications for parents, families, and communities, and whether other measures or amendments might more effectively prevent infant fatality. Prevention of Abusive Head Trauma (Shaken Baby Syndrome) As the leading source of child maltreatment fatalities, Abusive Head Trauma (AHT; Shaken Baby Syndrome) takes top priority among child maltreatment prevention researchers. Several prevention programs have been launched to combat AHT, including the Ohio-based Don’t Shake the Baby program (Showers 1992) and a countywide, hospitalbased parent education intervention in New York (Dias et al. 2005). The results of these studies are suggestive; in Ohio, approximately 50 percent of participants stated that they were less likely to commit Abusive Head Trauma as a result of receiving the Don’t Shake the Baby information packet (Krugman, Lane, & Walsh 2007; Showers 1992). In New York Dias and colleagues (2005) reported a 47 percent reduction in the annual incidence of Abusive Head Trauma over a five-year period (41.5 AHT per 100,000 to 22.2 AHT/ 100,000). A third intervention, the Period of PURPLE Crying program, was developed in cooperation with the National Center on Shaken Baby Syndrome; this program presents parents with educational materials about infant development and ways to cope with inconsolable crying (Barr

et al. 2009). The results of randomized control trials revealed that mothers in the PURPLE intervention demonstrated more knowledge about infant crying and were more likely to use effective coping strategies (walking away) when infants were fussy (Barr et al. 2009). These initial finds on the efficacy of AHT prevention programs led to the enactment of education laws in several states, including New York and Pennsylvania, and the dissemination of AHT prevention programs in hospitals across the country (Krugman et al. 2007). More research on the efficacy of Abusive Head Trauma prevention will be available as these programs are taken to scale in different states and localities (Krugman, Lane, & Walsh 2007). Prevention of Corporal Punishment Beginning with Sweden in 1979, there has been a growing movement to ban spanking and other forms of corporal punishment in countries around the world. Various governmental bodies, including the United Nations, have declared corporal punishment of children to be a violation of human rights law and have exhorted nations to illegalize the practice (Committee on the Rights of the Child 2006; Gershoff & Bitensky 2007; Pinheiro 2006). As of 2010, all forms of corporal punishment were banned in thirty countries and undergoing legislative review and/or reform in an additional twenty-three states (Global Initiative to End All Corporal Punishment of Children & Save the Children Sweden 2010). Undergirding this growing movement is the disconcerting association between corporal punishment and physical child abuse (Gershoff & Bitensky 2007; Straus & Gelles 1990; ). Although hotly contested among scholars (Baumrind, Larzelere, & Cowan 2002; Zolotor et al. 2008), a mounting body of research suggests that physical abuse frequently occurs in the context of child misbehavior and results from the punitive actions of frustrated parents (Bugental, Martorell, & Barraza 2003; Clement et al. 2000; Crandall, Chiu & Sheehan 2006; Gershoff 2010; Gershoff

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& Bitensky 2007; Jaffee et al. 2004; Kadushin & Martin 1981; Zolotor et al. 2008). Although far from conclusive, some evidence suggests that such legislative bans hold the potential to substantially influence public attitudes and behaviors regarding physical punishment and, more importantly, reduce infant fatality from severe maltreatment (Durrant 1999; Krugman, Lane, & Walsh 2007). For example, in several countries, corporal punishment bans have been linked with a concomitant decline in parental acceptance and use of corporal punishment and the incidence of severe physical abuse (Durrant 1999; Komen 2003; Zolotor & Puzia 2010). These results, however, have been greeted with skepticism by opponents of corporal punishment prohibitions (Zolotor & Puzia 2010). These scholars contend that few studies have rigorously examined child maltreatment rates proceeding and following legislation and those that do have frequently relied on a single data source to evaluate outcomes (Zolotor & Puzia 2010). Second, reports of child maltreatment often increase in response to legislation, making it difficult to accurately interpret trends in child abuse and neglect (Zolotor & Puzia 2010). Finally, such a ban remains politically unfeasible in some countries, including the United States, which sustains high rates of physical punishment (Regalado et al. 2004). Indeed, legislative attempts to curb parental rights (regarding corporal punishment, etc.) in the United States have generally been ineffective and are largely incompatible with a legal tradition that emphasizes a family’s right to privacy and freedom from state interference (Global Initiative to End All Corporal Punishment of Children & Save the Children 2010; Guterman 2001). Other Universal Programs Universal strategies also have the distinctive capacity to address macro-level factors related to child maltreatment risk, such as poverty and social norms (i.e., social recognition of child rights) (Klevens & Whitaker 2007). For example, universal programs that increase the value

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of children in society (teacher/caregiver salaries, public funding for education and childcare) and programs that promote the well-being of families (paid parental leave, universal health care, inexpensive childcare, affordable housing, livable wages) may impact child maltreatment rates either through changed social norms (value of child well-being) or through more concrete effects, including lower poverty rates and enhanced social support systems for at-risk families (Klevens & Whitaker 2007; Sanders, Montgomery, & Brechman-Toussaint 2000). Although little evidence exists on social policy and maltreatment outcomes, some research suggests that wage supplements combined with health insurance and child care improve quality of parenting (Huston et al. 2003; Klevens & Whitaker 2007). Given the expense of such universal measures coupled with recent welfare retrenchment in the United States, such strategies have received less attention to date and efforts to enact such broad policies have not fared well (Katz 1996). However, the recent passage of the Obama administration’s Patient Protection and Affordable Care Act, which holds the promise for broadly expanded health care and home visitation services, is a historic step forward in the field of universal child and family well-being. Challenges and Dilemmas in Child Abuse Prevention While the reviewed programs and strategies offer much hope in the prevention of child abuse and neglect, multiple challenges have yet to be fully addressed to meet with the complexity of this issue. According to Daro and Donnelly (2002), the field has made mistakes, such as oversimplifying the issue, ignoring crucial connections with child protective services, ignoring the need to shore up political will through multiple mechanisms, sacrificing the quality of programs for increased availability of services, and overstating the promise of known solutions. We also emphasize several additional challenges facing the field of physical child abuse and neglect prevention.

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Population Focus: Issues of Targeting and Screening Although some prevention programs have sought to serve all families giving birth to a child within an identified health care system (universal strategy), in an effort to allocate resources most wisely (targeted strategy; Gomby 2000), the majority of programs have limited services to families believed to be at higher risk for future maltreatment. For example, the most frequently used factors to identify at-risk parents are poverty, young age, mental health challenges, substance abuse, and exposure to intimate partner violence (Child Welfare Information Gateway 2011; Howard & Brooks-Gunn 2009). Although screening and risk assessment of families appear sensible from an economic standpoint, they raise a host of complicated and problematic issues with important implications for the future of maltreatment prevention. Risk screening for maltreatment, for example, raises issues of additional costs, the potential stigma associated with being positively screened, and, most troubling, the many persistent problems with the accuracy of such screens (c.f. Caldwell, Bogat, & Davidson 1988; McDonald & Marks 1991). For example, the vast majority of parents who are young or poor do not commit acts of parental abuse and neglect, yet may be overidentified for “intervention” based upon targeted characteristics. More significantly, some abusive families who exhibit none of the above risk factors may pass screening tests and thereby be denied desperately needed prevention services (Child Welfare Information Gateway 2011). Finally, risk of abuse and neglect changes over time; families may be functional at one stage of the life cycle (i.e., pregnancy), but violent at another (i.e., elementary school years) because of various changes in social support, parenting attitudes, social stressors, etc. (Asawa, Hansen, & Flood 2008; Guterman 2001). Beyond the difficulties with over-/underidentification, perhaps the most fundamental problem with  psychosocial screening is the mismatch between program capability and the presenting problems of violent families (Guterman 2001).

Programs have historically targeted families struggling with substance abuse and domestic violence yet rarely had the tools to address such challenges. Although a few programs are piloting interventions to address some of them, the majority may be “screening in” families that they are unequipped to serve (Guterman 2001). While it is beyond the scope of this chapter to thoroughly examine the difficulties associated with risk screening, it is important to recognize that sound targeting strategies must be closely integrated with the services delivered. Without these strategies, even the most rigorously designed and tested preventive interventions are likely to be mismatched with the population served, thus ineffective (c.f. Guterman 2001 for further discussion). Engagement and Retention in Services Assuming that the appropriate families have been targeted for intervention, a second ongoing challenge faced by early prevention strategies is how to engage and retain targeted families in services—a persistent concern as the impact of a program is likely to be compromised for families that leave services prematurely or receive fewer than the recommended number of visits (Gomby 2000). Fortunately, a growing body of empirical findings is providing some guidance with respect to factors that are linked with successful engagement and retention of families in such programs. Studies have linked variability in program participation rates with multiple family, program, provider, and community characteristics. Mothers who are young, with low education and with high biological-risk infants, were found to have higher rates of engagement (Duggan et al. 2000), whereas those who were white and socially isolated had lower engagement rates (McGuigan, Katzev, & Pratt 2003). In recent studies, higher retention rates have been found for mothers who are older, nonwhite, married, unemployed, nonsmoking, enrolled during their first or second trimester of pregnancy, and with greater social support needs (Daro et al. 2003;

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McCurdy, Gannon, & Daro 2003; McGuigan, Katzev, & Pratt 2003; Navaie-Waliser et al. 2000); however, the role of maternal age, ethnicity, and social support status appears equivocal (Herzog, Cherniss, & Menzel 1986; Luker & Chalmers 1990; Olds & Kitzman 1993). Family characteristics that also impede program participation include domestic violence, unemployment, frequent moves, and telephone disconnection (Brookes et al. 2006). Provider (i.e., home visitor) characteristics also play a role in family engagement, with higher retention rates found for home visitors who are younger, African American, receive more supervision, provide consistent conscientious service, and persist with difficult-to-engage families (Azzi-Lessing 2010; Brookes et al. 2006). Perhaps the most important factor predicting family engagement is the quality of the relationship between the parent and provider (i.e., home visitor) (AzziLessing 2010). For example, providers who convey respect to parents and address the families’ expressed needs, including the basic necessities many low-income families lack, are more likely to have strong relationships with participants and, consequently, higher family retention (AzziLessing 2010; Brookes et al. 2006; Damashek et al. 2011). Program characteristics also play a role in family retention. Specifically, programs that have lower caseloads, permit flexibility in service provision, demonstrate cultural competence, and match participants and providers based on both parenting status and ethnicity are linked with higher rates of family engagement (Azzi-Lessing 2010; Brookes et al. 2006; Huang & Isaacs 2007; McCurdy, Gannon, & Daro 2003; McGuigan, Katzev, & Pratt 2003). Finally, communitylevel factors have also proved significant, with lower rates of engagement and retention found for mothers in communities with lower overall health indicators and higher rates of community violence, respectively (Daro et al. 2003; McGuigan, Katzev, & Pratt 2003). Because the effectiveness of a program strongly depends on the engagement and retention of participants in

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services, factors that influence these rates should be carefully considered during program development prior to implementation. Implementation Challenges Not all child abuse prevention programs are created or implemented equally. Programs may vary by the components they employ, the professionals or paraprofessionals who provide the services, the service dosage delivered, the populations served, and the specific outcomes or mediating factors they hope to address. For example, controversy remains regarding the optimal service providers for home visitation programs, with some evidence suggesting that health professionals, such as nurses or mental health professionals, demonstrate more favorable outcomes than do paraprofessionals (at least in shorter-term programs) (Hahn et al. 2003; Olds 2002). Others have argued that the evidence base does not yet clarify who the optimal service deliverers are (Bilukha et al. 2005; Guterman, Anisfeld, & McCord 2003). Likewise, some debate exists over the “on the ground” flexibility that characterizes child maltreatment home visitation programs. This flexibility in service provision, although a strength of home visiting programs in general, also generates inconsistencies in program implementation, making it difficult to analyze the true impact of such programs on parenting and child outcomes. Further, evidence is accumulating that preventive strategies such as home visitation may work for some populations and have lessened impact on others. For example, the same factors that moderate program engagement and efficacy are implicated in risk of child maltreatment. Thus, the families most in need of preventative services (ie., families characterized by IPV, substance abuse, mental illness, and social isolation) are also the families least likely to participate and benefit from services (Eckenrode et al. 2000; McGuigan, Katzev, & Pratt 2003). Emerging program evaluations signal the need for more careful consideration and review of precisely what components of various

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programs are most successful and under what conditions and for which populations. Only with these advances in the knowledge base will we most likely ensure that the most effective strategies will be advanced and replicated. YYY

It must be recognized that although we have made important headway in addressing the problem of physical child abuse and neglect in the last half century, we are presently in our infancy in developing a rigorous knowledge base upon which to guide our prevention and treatment efforts. Major gaps remain in understanding, such as how to prevent physical abuse and neglect in substance-abusing or domestically violent families and, perhaps most troublingly, how to prevent maltreatment-related

NOTES

1. This chapter does not attend to the important problems of child sexual abuse or emotional abuse/neglect; rather, it maintains a specific focus on the interrelated problems of physical abuse and neglect involved in approximately 80 percent of child maltreatment cases reported to child protective services systems in the U.S. (U.S. Department of Health and Human Services 2003). 2. For a more in-depth discussion of the etiology of physical child abuse and neglect, the reader is referred to National Research Council 1993; and Guterman 2001. REFERENCES

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Child Protective Services

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he passage of the Adoption and Safe Families Act (ASFA) of 1997 (P.L. 105–89) affirms that child welfare agencies have as their primary responsibility ensuring that children and youth are safe from abuse and neglect (U.S. Department of Health and Human Services 2000). In essence, providing for child safety is the core mission of public child welfare agencies (American Public Human Services Association 2009). The Child Protective Services (CPS) program, a core program in all public child welfare agencies, leads efforts to ensure child safety in collaboration with community agencies. More broadly, CPS “refers to a highly specialized set of laws, funding mechanisms, and agencies that together constitute the government’s response to reports of child abuse and neglect” (Waldfogel 1998a:105). The basis for CPS programs stems from laws established in each state that define child abuse and neglect and specify how CPS agencies should respond to reports of child maltreatment. Workers in CPS agencies have the responsibility to address the effects of child maltreatment and work with families to keep their children safe from child maltreatment in the future (DePanfilis & Salus 2003; Waldfogel 2009). According to the American Public Human Services Association (APWA; 2009), child welfare agencies are obligated to furnish a range of preventive and/or supportive services to families who are identified as having difficulty providing safe and permanent environments for their child(ren). Providing a range of services reflects the recognition that better outcomes

for children are achieved by engaging families in a safety assessment process and engaging, strengthening, and supporting families to care safely for their own children. When families are unable or unwilling to remedy conditions that threaten the safety of their child(ren), it is the mandate of the CPS program in the designated public child welfare agency to take the least restrictive action to secure the child(ren)’s safety. This includes first providing safety services to the family while the child(ren) remain at home, and, if and when safety cannot be achieved with in-home services, placing children in temporary out-of-home care. The Child Welfare League of America (CWLA) also affirms this mission by suggesting that the CPS agency assess the risk to and safety of children and youth and provide or arrange for services to achieve safe, permanent families for children and youth who have been abused or neglected or who are at risk of abuse or neglect. The CPS agency also facilitates community collaborations and engages formal and informal community partners to support families and protect children from abuse and neglect (; Center for the Study of Social Policy n.d.; Child Welfare League of America 1999). The field of child welfare has recently directed greater attention to defining and implementing the essential components of a system that effectively protects children. According to Lund and Renne (2009), a child safety intervention system is defined and formed by seven necessary elements, each of which is discussed in this chapter: 236

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Policy Rules and regulations form the boundaries within which child safety intervention operates. Policy identifies in specific terms what child safety intervention entails, what must be done. Policy assures statutory standards are applied. Policy establishes expectations concerning acceptable practices, decision making, and time frames. Policy sets forth the philosophy and values that support child safety intervention. Procedure Procedure determines how child safety intervention is to be done. Procedures set forth how practice is to occur, how relationships and interactions with clients are to be maintained, what information is to be collected, how decisions are to be made, and when actions and decisions are to occur. Procedures provide methods for step-by-step guidance for implementing child safety intervention and completing child safety intervention work. Information System The information system provides structure for directing child safety intervention and accountability for how child safety intervention is occurring. The information system reveals the picture of the reality of child safety intervention implementation case by case and collectively as a program. Staff Development Staff development, typically in the form of training, prepares staff to implement child safety intervention. Staff development promotes policy and procedure and advances the understanding and application of acceptable child safety intervention practices and decision making. Staff development occurs as a process of readying staff to assume responsibility for child safety intervention and continues to reinforce the development of competence and mastery. Supervision Supervision assures the effective implementation of child safety intervention. Supervision provides oversight case by case to regulate practice and decision making

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and evaluates individual as well as child safety intervention model performance. Supervision supplies support and guidance to staff through case and general consultation focused on case practice, decision making, and building staff competency. The supervisor serves as the primary authority concerning the interpretation of child safety intervention and approval of actions taken and decisions made. Program Management Program management provides leadership that creates the child safety intervention approach and establishes the necessary structure to carry it out. Program management puts in place the components of the child safety intervention model, promulgates that which gives child safety intervention form and function, generates sufficient resources to effectively implement child safety intervention, and assures the effectiveness of safety management across all cases. Quality Assurance Continuous review and adjustment is a necessary part of assuring the effectiveness and necessary modification of a child safety intervention system. Quality assurance evaluates child safety intervention practice and decision making against standards that form the child safety intervention model and guide casework practice and decision making. Quality assurance provides feedback to management in order to control quality, establish benchmarks for competency, and reveal the need for adjustment or enhancement. The purpose of this chapter is to trace the path of child abuse and neglect reports from the point of referral through the process of providing ongoing services to children, youth, and families involved in the child protection system. Before doing this, we describe the philosophy and policy context for CPS programs and the nature and extent of child abuse and neglect in the United States. Finally, we provide a brief summary on the effectiveness of CPS programs and a synthesis about CPS reforms being implemented across the United States.

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Philosophy of CPS CPS agencies operate on the philosophical belief that every child has a right to adequate care and supervision and to be free from abuse, neglect, and exploitation. Laws to protect children and youth assume that it is the responsibility of parents to see that the physical, mental, emotional, educational, and medical needs of their children are adequately met. Further assumptions are that CPS should intervene only when parents request assistance or fail, by their acts or omissions, to meet their children’s basic needs and keep them safe from abuse or neglect as defined by state civil laws (DePanfilis & Salus 2003). When there is a need to intervene following a report of abuse or neglect, CPS agencies do so on the belief that most parents want to be good parents and have the strength and capacity, when adequately supported by CPS and the community, to care for their children and youth and keep them safe. Intervention proceeds on the assumption that most children are best cared for in their own families. Therefore CPS focuses on families’ strengths and provides the assistance needed for families to keep their children and adolescents safe so that the family may stay together. Only when safety cannot be assured are actions taken to protect children by placing them in out-of-home care. Some CPS programs across the country have implemented a “differential or alternative” response approach (DR) which allows for a voluntary offer of services to low-risk families, thus avoiding a traditional CPS investigation and allowing services to be provided to the family to reduce risk and avoid more intrusive intervention. As of October 31, 2012, twenty seven states, territories, or localities were implementing DR, with twelve considering or planning to do so (Allan & Howard 2013:3). It is believed that children and adolescents do best with families where there has been a foundation of love, trust, safety, and security; therefore, when children and youth are placed in out-of-home care because their safety cannot be ensured, the preferred CPS plan is to

reunify them with their families. Thus services provided to the family focus on changes that families may make to increase their protective capacity and therefore enhance their ability to keep their children safe. Only when a successful family reunification cannot occur are other, more permanent options, such as adoption, considered for children and youth. Legal Basis for CPS The legal framework regarding the parent-child relationship, referred to as parens patriae, has traditionally balanced the rights and responsibilities between parent, child, and state. It has long been recognized that parents in this society have a fundamental liberty interest, protected by the Constitution, to raise their children as they see fit. This parent-child relationship grants certain rights, duties, and obligations to both parent and child, including the responsibility of the parent to protect the child’s safety and wellbeing. If a parent, however, is unable to meet this responsibility, the state has the power and authority to protect a child or youth from significant harm; this authority is enacted through the CPS agency (Goldman & Salus 2003). CPS agencies operate under civil laws that guide reporting of child abuse and neglect and dictate the basis for intervening in family life when a child or youth may have been abused or neglected. This is in contrast to criminal laws that guide intervention by law enforcement agencies. The legal threshold for intervention in the lives of children and families under civil laws is “present or impending danger,” which is a judgment that there are behaviors or conditions that immediately threaten the child, the caregivers lack protective capacity, and the child is vulnerable (Lund & Renne 2009). Federal Laws Focusing About Prevention of Abuse and Neglect Child Abuse Prevention and Treatment Act (CAPTA) CAPTA (1974; P.L. 93–247) was established in 1974. Through numerous authorizations and

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amendments since that time, most recently in 2010, the Federal government provides funding to states in support of prevention, assessment, investigation, prosecution, and treatment activities. It also provides grants for demonstration programs and projects to public agencies and nonprofit organizations, including Indian Tribes and Tribal organizations. Additionally, CAPTA identifies the federal role in supporting research, evaluation, technical assistance, and data collection activities; establishes the Office on Child Abuse and Neglect; and mandates the Child Welfare Information Gateway. CAPTA also sets forth a minimum definition of child abuse and neglect as one standard required for states to meet in their child abuse and neglect reporting laws (Child Welfare Information Gateway 2011a). Strengthening Abuse and Neglect Courts Act This act (2000; P.L. 106–314) was designed to improve the efficiency and effectiveness of the courts’ handling of abuse and neglect cases consistent with the Adoption and Safe Families Act of 1997. State Laws State child abuse and neglect reporting laws have been enacted in all fifty states, the District of Columbia, and the U.S. territories. These statutes specify procedures that a mandatory or voluntary reporter must follow when making a report of child abuse or neglect. In most states, statutes require mandated reporters to make a report immediately upon any suspicion of abusive or neglectful situations (Child Welfare Information Gateway 2009). Although there are variations, most state laws identify professionals, such as social workers, as mandated reporters and require reporting when these individuals come in contact with children whom they suspect may have been maltreated according to the definitions in state law. In all jurisdictions, the initial report may be made orally to either the CPS agency or to a law enforcement agency. These reporting laws

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also define child abuse and neglect, structure the requirements for investigation or assessment of reports, and may further delineate the purposes of CPS and other service responses. In addition to child abuse and neglect reporting laws, state laws define the basis for intervention to protect children and youth and the circumstances under which CPS agencies may petition the juvenile or family court to intervene on behalf of victimized children (Feller et al. 1992). According to Davidson (1997:483), “a civil child protection action— also commonly referred to as care, protection, endangerment, dependency, abuse, or neglect proceeding—is the most frequent judicial response to child maltreatment.” In civil child protection cases, the decision to go to court is usually made by the CPS worker and supervisor when the assessment suggests that the child or youth will not be safe without court intervention. Family and juvenile courts have the authority to make decisions about what happens to a child or youth after he or she has been identified as in need of the court’s protection (Goldman & Salus 2003). Social workers who practice in CPS and other child welfare service programs must be comfortable to present information to the court (see Ventrell’s chapter, this volume), as a proportion of all substantiated reports of child abuse and neglect result in petitions to the court to arrange for the safety of the child. Definitions of Child Abuse and Neglect Definitions of child maltreatment (i.e., physical abuse, sexual abuse, neglect, and psychological abuse or neglect) in each state law provide the legal basis for intervention by CPS agencies. Criminal definitions establish when acts or omissions may be considered criminal offenses. And researchers may define abuse or neglect in other ways to evaluate the effectiveness of an intervention or identify the relationship between certain characteristics and child maltreatment. For states to receive federal funds through CAPTA, the federal government sets

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minimum standards that must be incorporated in the definitions of child maltreatment in state laws: “The term ‘child abuse and neglect’ means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” Sample definitions that may guide CPS intervention for each of the four types of child abuse and neglect are given here. Neglect may be defined as omissions in care by a person responsible for the child’s care (e.g., parent or other caregiver), resulting in significant harm or the risk of significant harm to the child or youth (Dubowitz 2000a). Neglect may further be defined as failure to meet children’s basic needs for physical care, supervision and protection, nurturance, education, and health care. Definitions of neglect vary depending on whether one takes a legal, medical, psychological, social service, or lay perspective (Erickson & Egeland 2011). Physical abuse may be defined as an act inflicted by a person responsible for the child’s or youth’s care, resulting in significant physical injury or the risk of such injury (Dubowitz 2000b). Examples of inflicted acts include punching, beating, kicking, biting, shaking, throwing, stabbing, choking, burning, or hitting with a hand, stick, strap, or other object (Goldman & Salus 2003). Sexual abuse may be defined as nonconsensual sexual acts, sexually motivated behaviors involving children and youth, and sexual exploitation of children below the legal age of consent, which is typically fourteen to eighteen years (Berliner 2000, 2011) by a person responsible for the child’s care. Child sexual abuse includes a wide range of behaviors, such as oral, anal, or genital penile penetration; anal or genital digital or other penetration; genital contact with no intrusion; fondling of a child’s breasts or buttocks; indecent exposure; inadequate or inappropriate supervision of a child’s voluntary sexual activities; and use of a child or

adolescent in prostitution, pornography, Internet crimes, or other sexually exploitative activities (Goldman & Salus 2003). Psychological maltreatment consists of psychological abuse or neglect (Hart et al. 2011) and may be defined as a repeated pattern of behavior or extreme incident by persons responsible for the child’s care that conveys to the child that he or she is worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs (American Professional Society on the Abuse of Children 1995). Psychological maltreatment includes both abusive acts against a child or youth and omissions of care. Forms of psychological maltreatment include spurning (e.g., hostile, rejecting, and degrading behavior); terrorizing (e.g., threats to harm a child or someone important to a child); exploiting or corrupting (e.g., encouraging the child or youth to participate in self-destructive or criminal behaviors); denying emotional responsiveness (e.g., ignoring or failing to express affection); and isolating (e.g., confining a child from experiencing developmentally appropriate experiences; Brassard & Hart 2000). Psychological maltreatment may occur by itself or in association with physical abuse, sexual abuse, or physical neglect. Incidence of Child Abuse and Neglect In 2011, state CPS agencies received 3.4 million referrals alleging maltreatment related to approximately 6.2 million children and youth (U.S. Department of Health and Human Services 2012). However, as illustrated in figure 11.1, only 60.8 percent were “screened in” for a response by CPS agencies. The rates of screening in of maltreatment reports vary substantially among states, from a low of 24.4 percent in Vermont to a high of 98.6 percent in Alabama. Nearly one-quarter of all reports were found to include one or more victims of maltreatment and received dispositions of substantiated, indicated, or alternative response victims. In four-fifths of maltreatment reports CPS found all allegations to be

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3.4 million Referrals (6.2 million children)

60.8% screened in for investigation or assessment

18.5% substantiated, 1.0% indicated, .5% alternative response

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39.2% screened out, no further action

75.1% unsubstantiated

69.9% no services

30.1% received services

38.8% no services

61.2% received services, -39.1% in-home services, -20.8% out-of-home services

F I G U R E 1 1 . 1 . CPS screening and response to child abuse and neglect reports in 2011. Based on data provided in U.S. Department of Health and Human Services 2012.

unsubstantiated or intentionally false. A finding of unsubstantiated means that sufficient evidence of child abuse or neglect was not found by the CPS worker (U.S. Department of Health and Human Services 2012). The rate of victimization per one thousand children in the national population dropped from 13.4 children in 1990 to 9.1 children in 2011. In 2011 more than 78 percent of child and youth victims experienced neglect; in contrast, approximately 18 percent were physically abused, 9 percent were sexually abused, 9 percent were emotionally maltreated, and 2 percent were medically neglected. In addition, 10 percent were associated with other types of maltreatment based on specific state laws and

policies, such as abandonment, threat of harm to the child, or congenital drug addiction. Some children and youth experienced more than one type of maltreatment; therefore the total adds up to more than 100 percent (U.S. Department of Health and Human Services 2012). In 2011, the overall rate of child fatalities was 2.10 deaths per one hundred thousand childern. Receipt of Services Following a Report of Child Abuse or Neglect According to state statistics in 2011, as the result of a CPS investigation or assessment, approximately 61 percent of victims and 30 percent of nonvictims, such as siblings, received services. Approximately 60 percent of victims

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received some type of postresponse service: 63 percent of victims received in-home services; and 37 percent were removed from their homes. In addition, approximately 12 percent of nonvictims also experienced a removal—usually a short-term placement during the course of the investigation (U.S. Department of Health and Human Services 2012). CPS Case Process: Receiving Reports of Child Abuse or Neglect Mandatory child maltreatment reporting statutes (civil laws) provide definitions of child abuse and neglect to guide those individuals mandated to identify and report suspected child abuse and neglect. These reports activate the child protection process. When a CPS agency receives a report alleging child abuse or neglect, a decision is made to either accept the report for a traditional CPS investigation or, in an increasing number of jurisdictions, to accept the report for an “alternative” or “differential” response. This decision is made based upon the assessment of safety and/or risk at the point of intake, prior to making face-to-face contact with the family. Cases that are accepted for an “alternative” or “differential” response are by design voluntary cases in which there are no safety concerns. There are also a small number of jurisdictions that accept reports that fail to meet the criteria for abuse and neglect; these reports are accepted as prevention cases and assigned to community agencies for a voluntary preventive response (Merkel-Holguin, Kaplan, & Kwak 2006). Stages of the Child Protective Services Process To fulfill the purposes previously described, CPS receives reports of suspected child maltreatment, assesses the risk to and safety of children and youth, and provides or arranges for services to increase the safety and well-being of those children and youth who have been abused or neglected or who are at risk of abuse or neglect. Each situation proceeds through one or more of a series of CPS process stages:

1. intake, 2. initial assessment/investigation, 3. family assessment, 4. case planning, 5. service provision, 6. evaluation of case progress, and 7. case closure. Key decisions vary at each of these process stages (DePanfilis & Salus 2003; DePanfilis 2011). Intake CPS is responsible for receiving and responding to reports of suspected child abuse and neglect. Key decisions at this stage are 1. to determine if the reported information meets the statutory and agency guidelines for child maltreatment and should therefore result in a face-to-face contact with the child or youth and family and, if so, 2. to determine the urgency with which the agency must respond to the report. For those jurisdictions implementing “alternative” or “differential” response, reports that meet the statutory or agency guidelines are assigned to either an investigative or family assessment track, depending on the safety and risk information identified at intake. To make these decisions, CPS intake workers interview the persons who call with concerns about a report of suspected child abuse or neglect. In some states there is a statewide hotline for receiving such reports. In others, reports are made to the local CPS agency. Initial Assessment After receiving a report, CPS conducts an initial assessment/investigation by interviewing the child or youth, siblings, parents or other caregivers, and other individuals who may have information concerning the alleged maltreatment. If the referral information suggests that a crime may have been committed, these contacts by CPS are usually coordinated with law enforcement. The most important assessment that is conducted at this stage is an assessment of the child(ren)’s safety (i.e., whether there is present or impending danger). Some jurisdictions also assess the risk of maltreatment (i.e., the likelihood of future child maltreatment). Key decisions at this stage are to determine 1. whether child maltreatment occurred as defined by state law; 2. whether the

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child’s or youth’s immediate safety is a concern and, if it is, the interventions that will ensure the child’s protection; 3. whether there is a risk of future maltreatment and the level of that risk; and 4. whether continuing agency services are needed to help the family keep the child safe, reduce the risks of future maltreatment, and address any effects of child maltreatment. Some cases are closed at this stage if there is no basis to provide services to the child or youth and family. For agencies that have implemented “alternative” or “differential” response, the first assessment is also a safety assessment to rule out present or impending danger. The key decisions in an alternative response case do not focus on determining if abuse or neglect has occurred, but focus instead on the interventions that the family and worker believe will help the family to function more effectively and address the concerns reported. The key to alternative response cases is family engagement and voluntary provision of services for a more limited time frame than is usually provided when a child has been determined to be unsafe. Family Assessment The goal for all assessments in CPS are to gather and analyze information that will support sound decision making regarding the safety, permanency, and well-being of the child or youth. Once a determination of child abuse and neglect has been made and the child’s immediate safety has been ensured, an assessment of the family is conducted. The family assessment is a comprehensive process through which those factors that affect the child’s or youth’s safety, permanency, and well-being are identified, considered, and weighed. The assessment goal is to develop, in partnership with the family, the plans and services needed to assure the child’s safety, permanency, and well-being (U.S. Department of Health and Human Services 2000). During this stage, the CPS worker engages family members in a process to understand their strengths, identified safety threats, and intervention needs. Key decisions at this stage are to evaluate 1. the

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safety threats that resulted in CPS intervention; 2. the protective capacities that will improve child safety and therefore reduce the likelihood of future maltreatment; 3. the effects of maltreatment observed in the child and/or other family members; and 4. the family members’ level of motivation or readiness to participate in intervention. Case Planning To achieve the programmatic outcomes of CPS (i.e., child safety, child permanency, child well-being, and family well-being), intervention must be planned and purposeful. These outcomes are achieved through three types of plans: first, a safety plan, which is developed whenever it is determined that the child is unsafe. The safety plan articulates specific safety services that will protect the child while at home or, when that is not possible, articulates the decision to place the child(ren) in foster care. Second, the development of a case plan follows the family assessment; it sets forth outcomes and goals; describes how the family will work toward these outcomes; and identifies what the CPS agency and other providers will provide to support the achievement of outcomes and goals. Third, if a child has been placed in out-of-home care, a concurrent case plan, which identifies alternative forms of permanency and addresses both how reunification may be achieved and how legal permanency with a new parent may be achieved if efforts to reunify fail. Key decisions at the case planning stage include 1. the case outcomes, which will be the target of intervention (e.g., enhanced caregiver protective capacity and family functioning, behavioral control of emotions, enhanced social support, enhanced parent-child interaction); 2. the case goals, written in specific, measurable, achievable, realistic, and time-limited (SMART) terms, that will help family members achieve these outcomes; 3. the interventions that will best support the achievement of these goals and outcomes; and 4. the best provider(s) of these interventions (DePanfilis & Salus 2003; DePanfilis 2011).

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Service Provision It is at this stage that the case plan is implemented. It is the role of the CPS worker to arrange for, provide, and/or coordinate the delivery of services to maltreated children, their parents or other caregivers, and the family. The services that are selected to help families achieve outcomes and goals are based on an appropriate match of services to achieve specific goals and on best practice principles. Other chapters in this volume provide examples of the types of services and treatment that CPS workers and/or other community service providers might employ to enhance child safety and/or help a child or other family member address the effects of maltreatment. Key decisions at this stage include 1. identifying the specific services that will be delivered, including service intensity and duration; 2. determining who is best positioned to deliver these services; 3. determining appropriate intervals for evaluating family progress; and 4. specifying mechanisms for coordination among service providers (e.g., developing and sharing information, scheduling of team meetings). Evaluation of Progress Assessment is an ongoing process that begins with the first client contact and continues throughout the life of the case. Progress toward achievement of outcomes and goals should be formally evaluated at least every three months. During this stage of the process, key decisions include assessment of the 1. current safety status of the child or youth; 2. level of achievement of family outcomes; 3. level of achievement of goals and tasks in the case plan; 4. changes in the protective capacities previously identified; and 5. level of success that has been achieved in enhancing the child(ren)’s well-being, particularly focused on addressing any effects of maltreatment on the child and other family members. Case Closure The process of ending the relationship between the CPS worker and the family involves a mutual review of progress and includes a review of the beginning, middle,

and end of the helping relationship. Optimally, cases are closed when families have achieved their outcomes and goals, children and youth are safe, and the caregiver’s protective capacities have been enhanced to support child safety long term. Cases are sometimes closed, however, when families still need assistance. When needs that go outside the scope and legal mandates of the CPS system are still apparent, every effort is made to help the family receive services through appropriate community agencies. Some closings occur because the client discontinues services, and the agency does not have a sufficient basis to refer the situation to juvenile or family court. When this occurs, the caseworker must carefully document those safety concerns that are still present so that this information is available should the family again be referred to the agency in the future. Outcomes of CPS With the passage of ASFA in 1997, CPS agencies are required to design their intervention systems to measure the achievement of outcomes. There has been consensus in the field that child welfare outcomes at the program level may be organized around four domains: child safety, child permanence, child well-being, and family well-being. Although all four are important, federal and state laws emphasize the safety and permanence of children and youth; these two outcomes are often used in a global evaluation of agency or system performance. In contrast, at the individual case level, caseworkers usually attempt to achieve child safety and permanence through efforts to ensure child and family well-being (Courtney 2000). Child and Youth Safety The safety of children and youth is the paramount concern that guides CPS practice. Children and youth are safe when they are first and foremost protected from abuse and neglect and safely maintained in their own homes whenever possible (U.S. Department of Health and Human Services 2000). When safety is assessed, caseworkers determine the degree to which a child or youth is secure from

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the threat of present or impending danger and evaluate the capacities of the caregiver to protect the child (ACTION for Child Protection 2003). Safety is the overarching consideration in casework decision making, service provision, placement, and planning for permanency (American Public Human Services Association 2009; U.S. Department of Health and Human Services 2000).

recent testimony before the U.S. House of Representatives Committee on Ways and Means, Administration on Child, Youth and Families Commissioner Bryan Samuels asserted that child welfare systems and their mental health agency partners must be designed to more effectively respond to the social-emotional well-being of children who have been maltreated (SERIAL 112-HR4 2011).

Child and Youth Permanence Permanency focuses primarily on ensuring that children and youth have stability in their living situations and that the continuity of their family relationships and connections is preserved (U.S. Department of Health and Human Services 2000). Creating permanent living arrangements and emotional attachments for children and youth is a primary CPS outcome, particularly when they have been placed in out-of-home care due to abuse or neglect. This goal is based on the assumption that stable, caring relationships in a family setting are essential to achieve children’s healthy growth and development. The emphasis is on providing reasonable efforts to prevent children’s removal from their families and, when removal is necessary for their protection, to reunify families; when children and youth cannot safely return to their own families, promoting their timely adoption is emphasized (Courtney 2000; U.S. Department of Health and Human Services 2000).

Family Well-Being Families must function at some basic level to provide a safe and permanent environment for raising children and adolescents. This includes demonstrating caregivers’ capacities to protect children; caregivers’ capacities for financial, emotional, and social self-sufficiency; caregivers’ capacities to provide age-appropriate supervision; and caregivers’ capacities to develop and sustain nurturing parent-child relationships. Caseworkers are expected to facilitate change in the family so that the family can meet the basic needs of its members and ensure their protection. Interventions are geared to maximize family strengths and build caregiver protective capacities to improve child safety and well-being.

Child and Youth Well-Being Although CPS practice focuses primarily on safety and permanency for children and youth, the well-being of maltreated children and youth must also be addressed. In particular, the CPS worker is concerned that any effects of child maltreatment on the child’s or youth’s physical, emotional, behavioral, and/or cognitive development be identified and addressed. This requires that the child’s physical and mental health, educational, and other needs are assessed and that preventive or treatment services are either provided or arranged (Courtney 2000). In his

Effectiveness of CPS Since passage of ASFA in 1997, the U.S. Department of Health and Human Services (DHHS) has been charged to determine the extent to which states are successful in attaining targeted outcomes and identify areas where assistance is needed (see the chapter by Mitchell, Thomas, and Parker, this volume). One way that the DHHS fulfills this mandate is by producing an annual report to Congress related to state performance on seven national child welfare outcomes (U.S. Department of Health and Human Services 2010b). Data for this report are based both on the states’ self-assessments and on-site Child and Family Service Reviews (CFSRs). Three outcome areas most directly related to the CPS program’s responsibility include two child safety measures: 1. recurrence of child maltreatment (for children living at home); 2. new

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reports of substantiated maltreatment (for children living in foster care); and one well-being measure: 3. families have enhanced capacity to provide for their children’s needs (well-being). Outcome measure 1.1—reduce recurrence of child abuse and/or neglect. CFSR National Standard: of all children who were victims of substantiated or indicated child abuse and/or neglect during the first six months of the period under review, what percentage had another report within a six-month period? In 2007 fifty states reported sufficient data to the National Child Abuse and Neglect Data System to calculate outcome measure 1.1. Analyses of these data suggested differences between states, as the percentages of maltreatment recurrence within a six-month period ranged from 1.4 to 13.1, with a median of 5.6 (U.S. Department of Health and Human Services 2010b). Between 2008 and 2011, 48 percent of states demonstrated improved performance with regard to the measure of recurrence of child maltreatment (measure 1.1). In addition, the median across states for this measure improved to 5.2 percent in 2011. However, four out of ten states (42 percent), demonstrated a decline (U.S. Department of Health and Human Services 2013). Outcome measure 2.1—reduce the incidence of child abuse and/or neglect in foster care. CFSR National Standard: of all children who were in foster care during the year, what percentage were the subjects of substantiated or indicted maltreatment by a foster parent or facility staff member? In 2007, state performance regarding the maltreatment of children while in foster care (measure 2.1) ranged from 0.03 to 1.38 percent, with a median of 0.34 percent (U.S. Department of Health and Human Services 2010b). In 2011 State performance regarding the maltreatment of children while in foster care ranged from 0.00 to 1.59 percent, with a median of .32 percent (a lower percentage is desirable for this measure) (U.S. Department of Health and Human Services 2013). Two syntheses of CFSR findings from the second round of reviews in thirty-two states

(Sherrard 2010) and fifty states and the District of Columbia and Puerto Rico (U.S. Department of Health and Human Services n.d.) combined indicate the following concerns related to performance on safety outcomes: 1. lower risk reports not investigated in a timely fashion; 2. reports on open cases not investigated; 3. insufficient risk or safety assessments; 4. lack of ongoing assessment of the risk and safety of children and youth, particularly at key decision points; 5. safety plans for children and youth not appropriately developed and/or monitored; 6. inconsistent services to protect children at home; 7. inconsistent services to address risk and safety concerns related to in-home service cases (e.g., lack of worker contacts with families); and 8. inconsistent monitoring of families. Outcome measure well-being 1: families have enhanced capacity to provide for their children’s needs. To evaluate this outcome, CFSR case reviewers focus on assessing whether the area of assessment is a “strength” or “needs improvement”: 1. item 17—needs and services of child, parent, foster parent; 2. item 18— child and family involvement in case planning; 3. item 19—caseworker visits with child; and 4. item 20—caseworker visits with parents (U.S. Department of Health and Human Services 2007b). The synthesis of fifty-two CFSR case reviews found that no states were in substantial compliance with the well-being 1 outcome measure. Common well-being concerns related to in-home services were 1. inconsistent match of services to families’ and children’s needs; 2. inconsistency in conducting needs assessments; 3. parents and children not involved in case planning; 4. inadequate caseworker visits with children and parents; and 5. failure to engage fathers. Further analyses indicated that, in particular, caseworker visits to parents and children were associated with 1. risk of harm to children; 2. needs and services for children and parents; 3. child and parent involvement in case planning; 4. services to protect children at home; 5. safety outcome 1; and 6. safety outcome 2.

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Alternatively, CFSR federal staff (Adams 2008) point to several trends as potential explanations for states that have demonstrated improvements in safety outcomes: 1. increasing use of standardized tools in the initial and ongoing assessments of risk and safety as well as at critical points of cases; 2. enhanced community involvement in the development and implementation of safety planning; and 3. more supervisory oversight in decision making. At a system level, the results of the Harvard Executive Session, a task force that studied the child protection system, suggested that CPS system problems could be categorized into five primary criticisms (Waldfogel 1998b). These conclusions have been confirmed by the literature cited below. (1) Over inclusion. Some families are referred to CPS who should not be. Families may have other problems that warrant intervention by other service systems, but reporting sources contact CPS out of ignorance. Referral may also occur for malicious reasons. In either case, some families come in contact with the CPS system inappropriately. If CPS intake systems were to standardize and improve the quality of information collection at the time of first referral, ACTION for Child Protection asserts that the overall burden on CPS systems would be reduced (2008). (2) Capacity. The number of families referred to the system exceeds the system’s ability to respond effectively. The resources devoted to support CPS systems have not kept pace with the demands on the systems to accept and respond to reports of child maltreatment effectively. Studies conducted by the Government Accountability Office (1980, 1997, 2003) and others have confirmed this conclusion. (3) Under inclusion. Some families who should be referred to CPS are not. It is well documented that many more children are suspected to be victims of child maltreatment than are actually reported to CPS (Sedlak et al 2010).

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(4) Service orientation. The authoritative approach of some CPS systems is not appropriate for many of the families referred to it. Because child abuse and neglect is the consequence of the complex interplay between risk and protective factors, families are identified with problems at all stages of problem development. Not all families will benefit from an investigative response. As a result, some states are implementing differential or alternative response systems (which have already been described). (5) Service delivery. Many families do not receive the services they need. Results summarized from the CFSR reviews and from the National Survey of Child and Adolescent Well-Being and its companion survey, Caring for Child in Child Welfare confirm this conclusion—many families receive few services beyond periodic visits by usually overburdened caseworkers (Haskins, Wulczyn, & Webb 2007). As reflected in figure 11.1, many families referred with problems caring for their children are not provided any services through our current CPS system. CPS Reforms Partially prompted by the CFSR process that involves states in developing performance improvement plans (PIPs) to address the areas in their child welfare systems found not to be in substantial conformity with federal requirements, all states have implemented system reforms to their child welfare systems, policies, and practices. Based on a synthesis of strategies from fifty-two PIPs (U.S. Department of Health and Human Services n.d.), states and territories have planned and/or implemented the following types of strategies focused on improving safety of children being served in their homes: 1. develop new practices or processes (forty-seven states) including the revision of safety and risk assessment protocols, implementation of differential or alternative response systems, methods for enhanced engagement and planning with families,

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revision of practice models to improve consistency and quality of in-home services, and creation of special units or reorganization of units; 2. develop or enhance policies (thirty-eight states); 3. develop or revise training programs (thirty-eight states); 4. modify information systems (twenty-five states); 5. develop or enhance existing services (twentyone states); 6. implement research and evaluation (twenty-one states; e.g., studying the impact of related problems—substance abuse, juvenile justice, domestic violence, analyzing data about special populations, pilot specific practices); 7. implement new procedures for collaboration with community partners, other state agencies, and tribal child welfare systems (sixteen states); and 8. focus on the supervisory role in risk/safety assessments and the delivery of in-home services (eleven states). Some of the strategies classified above were also focused on improving safety in foster care and include the following: 1. revise policies to require background checks for relative placements; 2. develop policies to standardize the response to abuse and neglect allegations made on foster families and residential facilities; 3. enhance training and services to foster parents; 4. focus on supervisory oversight of safety and risk assessments; and 5. enhance quality assurance procedures for improved oversight of residential facilities. The scope of this chapter precludes a complete review of all these strategies; however, a brief summary of safety-focused reforms to enhance practices and processes in three areas has included 1. implementation or revision of safety assessment and management systems; 2. implementation of differential or alternative response systems; and 3. implementation of practice models (in addition to safety assessment/management models). Safety Assessment/Management Intervention Systems The National Resource Center for Child Protective Services (NRCCPS) is part of the Children’s

Bureau National Training and Technical Assistance Network and is charged with assisting states to implement CPS system reforms to improve their performance on safety, permanence, and well-being CFSR outcomes and systematic factors. The majority of the technical assistance they provide focuses on supporting CPS agencies to strengthen their safety intervention systems. Their conceptual framework assesses and installs strategies in multiple domains required to successfully implement a safety assessment/ management intervention system (Costello & DePanfilis 2010; NRCCPS 2005). Since judges in abuse and neglect proceedings are charged with ensuring safety of maltreated children, it is essential that all court personnel are educated about the CPS safety intervention system, its core principles and components, and the standards necessary for arriving at effective safety decision. Information standards for safety decision making are necessary components of all safety intervention systems. The following six domains represent the basis for quality safety decision making: maltreatment, nature of maltreatment, child functioning, adult functioning, parenting, and discipline. Differential or Alternative Response Systems One of the most significant reforms to the CPS system is the introduction of “differential” or “alternative” response systems. This nonadversarial approach offers a flexible response to family circumstances and allows for a voluntary intervention without making a formal case finding. In this approach, systems are redesigned to deliver quality supportive services the first time red flags are identified instead of waiting for children and youth to experience serious and sometimes fatal injuries from neglect or abuse. Community agencies in partnership with CPS work to triage services so that together the community can help families meet the basic needs of their children and keep them safe. A national study of child welfare reforms (U.S. Department of Health and Human Services

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2003) identified twenty states that offered one or more alternatives to the traditional CPS investigative response. In policy, the overall goals of the alternative response systems identified by this study were to provide a response option to those families whose situations did not meet the mandate or criteria for CPS involvement, to serve low-risk or low-severity situations, and/ or to ameliorate family situations. State policies emphasized overlapping but slightly different purposes of alternative response options. Eleven states (55.0 percent) identified child safety as the purpose, nine states (45.0 percent) identified family preservation or strengthening as the purpose, and four states (20.0 percent) identified preventing child abuse and neglect as the purpose. An updated review identified fourteen states with legislated alternative response systems that are either to be implemented or piloted (Williams-Mbengue, Ramirez-Fry, & Crane 2013). A number of evaluations have been completed that support the differential response approach. Findings across sites suggest that the approach does not result in an increase in re-reporting or in new substantiated reports; that workers are more satisfied with this type of approach, which is more focused on family engagement; that families are generally satisfied with the approach and actually receive more services in a differential response case than in a traditional CPS case (Center for Child & Family Policy 2004; Institute of Applied Research 2004, 2006; Kyte, Trocme & Chamber-land

REFERENCES

ACTION for Child Protection (2003). Judging CPS response: A child safety decision. Charlotte, NC: ACTION for Child Protection, November. Retrieved October 16, 2011, from http://www.actionchildprotection.org/safety_articles/archives.php. ACTION for Child Protection (2008). Intake: A functional component within a safety intervention system. Charlotte, NC: ACTION for Child Protection, December. Retrieved October 15, 2011, from http:// www.actionchildprotection.org/safety_articles/ archives.php.

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2013; Loman & Siegel 2012; Shusterman et al. 2005; Siegel et al. 2008). YYY

CPS is the central agency responding to reports of child abuse and neglect and intervening to increase the safety of children and youth, reduce the risk of future maltreatment, and address the effects of child abuse and neglect. To be truly successful, CPS intervention must be coordinated with other community agencies at each stage of the CPS process. At intake, CPS depends on other professionals, community providers, and the general public to identify children and youth who may be at risk of child abuse or neglect. At initial assessment, CPS often coordinates the initial assessment with law enforcement’s investigation. During family assessment, the CPS worker depends on assessments provided by mental health professionals and addictions specialists to truly understand the strengths and needs of all family members. During service provision, the CPS worker may coordinate services provided by other community service providers who may be in the best position to respond to the complex treatment needs of the child or youth and other family members. Finally, evaluating family progress and deciding when services are no longer necessary are best accomplished in collaboration with the family and all members of the intervention team. Ultimately, the protection of children and youth is a community responsibility.

Adams, D. (2008). Spotlight on the CFSRs: What are we learning from round two? Children’s Bureau Express, 9 (7). Retrieved October 14, 2011, from http:// cbexpress.acf.hhs.gov/index.cfm?event=website.view Articles&issueid=98§ionid=2&articleid=2262. Adoption and Safe Families Act. (1997). P.L. 105–89. Adoption Assistance and Child Welfare Act. (1980). P.L. 96–272. Allan, H., & Haward, M. (2013). Disparities in child welfare: Considering the implementation of Differential Response. Issue Brief: Kempe Centre for the Prevention and Treatment of Child Abuse and Neglect.

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American Professional Society on the Abuse of Children (1995). Practice guidelines on the psychosocial evaluation of suspected psychological maltreatment in children and adolescents. Chicago: American Professional Society on the Abuse of Children. American Public Human Services Association (2009). A framework for safety in child welfare. Washington, DC: American Public Human Services Association. Retrieved October 2, 2011, from http://www.napcwa. org/home/safety_framework_download.asp. Berliner, L. (2000). What is sexual abuse? In H. Dubowitz & D. DePanfilis (eds.), Handbook for child protection practice (pp. 18–22). Thousand Oaks, CA: Sage. Berliner, L. (2011). Child sexual abuse: Definitions, prevalence, and consequences. In J. Myers (ed.), The APSAC handbook on child maltreatment (pp. 215–32). Los Angeles: Sage. Brassard, M., & Hart, S. (2000). What is psychological maltreatment? In H. Dubowitz & D. DePanfilis (eds.), Handbook for child protection practice (pp. 23–27). Thousand Oaks, CA: Sage. Center for Child and Family Policy (2004). Multiple response system (MRS) evaluation report to the North Carolina Division of Child Welfare Services (NCDSS). Raleigh, NC: Sanford Institute of Public Policy, Duke Foundation. Retrieved October 17, 2011, from http:// www.ncdhhs.gov/dss/publications/docs/mrs_eval_ rpt_6_30_06_all_combined.pdf. Center for the Study of Social Policy (n.d.). Community partnerships for the protection of children. Retrieved October 15, 2011, from http://www.cssp.org/reform/ child-welfare/community-partnerships-for-the-protection-of-children. Child Abuse Prevention and Treatment Act (1974, as amended). P.L. 93–247. 42 USC 5101 et seq; 5116 et seq. Retrieved October 4, 2011, from http://www.acf. hhs.gov/programs/cb/laws_policies/cblaws/capta/. Child Welfare Information Gateway (2009). Making and screening reports of child abuse and neglect: Summary of state laws. Retrieved October 4, 2011, from http://www.childwelfare.gov/systemwide/laws_policies/statutes/repproc.cfm. Child Welfare Information Gateway (2011a). About CAPTA: A legislative history. Retrieved October 2, 2011, from www.childwelfare.gov/pubs/factsheets/ about.cfm. Child Welfare Information Gateway (2011b). Major Federal legislation concerned with child protection, child welfare, and adoption. Retrieved October 2, 2011, from http://www.childwelfare.gov/pubs/otherpubs/majorfedlegis.pdf. Child Welfare League of America (1999). CWLA standards of excellence for services for abused or neglected children and their families (rev. ed.). Washington, DC: Child Welfare League of America. Costello, T., & DePanfilis, D. (2010) Using implementation science to protect children in diverse communities. IVIII ISPCAN International Congress:

Strengthening Children and Families Affected by Personal, Intra-Familial and Global Conflict. Honolulu, Hawaii, September 26–29, 2010. Retrieved October 16, 2011, from http://www.family.umaryland.edu/ryc_research_and_evaluation/publication_product_files/selected_presentations/index. Courtney, M. (2000). What outcomes are relevant for intervention? In H. Dubowitz & D. DePanfilis (eds.), Handbook for child protection practice (pp. 373–83). Thousand Oaks, CA: Sage. Davidson, H. (1997). The courts and child maltreatment. In M. Helfer, R. Kempe, & R. Krugman (eds.), The battered child (5th ed., pp. 482–99). Chicago: University of Chicago Press. DePanfilis, D. (2011). Child protection system, In J. Myers (ed.), The APSAC handbook on child maltreatment (pp. 39–52). Los Angeles: Sage. DePanfilis, D., & Salus, M. (2003). Child protective services: A guide for caseworkers. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 7, 2011, from http://www.childwelfare.gov/pubs/usermanuals/cps/index.cfm. Dubowitz, H. (2000a). What is child neglect? In H. Dubowitz & D. DePanfilis (eds.), Handbook for child protection practice (pp. 10–14). Thousand Oaks, CA: Sage. Dubowitz, H. (2000b). What is physical abuse? In H. Dubowitz & D. DePanfilis (eds.), Handbook for child protection practice (pp. 15–17). Thousand Oaks, CA: Sage. Erickson, M. F., & Egeland, B. (2011). Child neglect. In J. E. B. Myers (ed.), The APSAC handbook on child maltreatment (pp. 103–24). Los Angeles: Sage. Feller, J., Davidson, H., Hardin, M., & Horowitz, R. (1992). Working with the courts in child protection. Washington, DC: National Center on Child Abuse and Neglect. Retrieved October 17, 2011, from http://www.childwelfare.gov/pubs/usermanuals/ courts/. Family Preservation and Support Services Program Act of 1993, P.L. 103–66. Retrieved October 5, 2011, from http://www.childwelfare.gov/systemwide/laws_policies/federal/index.cfm?event=federalLegislation. viewLegis&id=23. Fostering Connections to Success and Increasing Adoptions Act of 2008, P.L. 110–351, 122 Stat. 3949 (2008). Retrieved October 17, 2011, from http://www. govtrack.us/congress/bill.xpd?bill=h110–6893. Goldman, J., & Salus, M. K. (2003). A coordinated response to child abuse and neglect: The foundation for practice. Washington, DC: Department of Health and Human Services. Retrieved October 7, 2011, from http://www.childwelfare.gov/pubs/usermanuals/foundation/foundation.pdf. Government Accountability Office (1980). Report to the Congress of the United States. Increased federal efforts needed to better identify, treat, and prevent child abuse and neglect. HRD-80-66. Washington,

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DC: Government Accountability Office. Retrieved October 15, 2011, from http://www.gao.gov/products/HRD-80–66. Government Accountability Office (1997). Child protective services: Complex challenges require new strategies. GAO-03-357. Washington, DC: Government Accountability Office. Retrieved October 15, 2011, from http://www.gao.gov/archive/1997/he97115.pdf. Government Accountability Office (2003). Child welfare: HHS could play a greater role in helping child welfare agencies recruit and retain staff. GAO-03–357. Washington, DC: Government Accountability Office. Retrieved October 15, 2011, from http://www. gao.gov/new.items/d03357.pdf. Hart, S., Brassard, M., Davidson, H., Rivelis, E., Diaz, V., & Binggeli, N. (2011). Psychological maltreatment, In J. Myers (ed.), The APSAC handbook on child maltreatment (pp. 125–144). Los Angeles: Sage. Haskins, R., Wulczyn, F., & Webb, M. (2007). Using high-quality research to improve child protection practice: An overview. In R. Haskins, F. Wulczyn, & M. Webb (eds), Child protection: Using research to improve policy and practice (pp. 1–20). Washington: Brookings Institution. Retrieved October 15, 2011, fromhttp://www.brookings.edu/~/media/Files/Press/ Books/2007/childprotection/childprotection_chapter. pdf Institute of Applied Research (2004). Minnesota alternative response evaluation: A review of pilot project findings from 2001–2004. St. Louis: Institute of Applied Research. Retrieved October 16, 2011, from http://www.dhs.state.mn.us/main/idcplg? IdcService=GET_DYNAMIC_CONVERSION&dD ocName=id_001627&RevisionSelectionMethod=La testReleased. Institute of Applied Research (2006). Extended followup study of Minnesota’s Family Assessment Response. St. Louis: Institute of Applied Research. Retrieved October 16, 2011, from http://www.dhs.state.mn.us/ main/idcplg?IdcService=GET_DYNAMIC_CONV ERSION&dDocName=id_001627&RevisionSelectio nMethod=LatestReleased. Kyte, A., Trocme, N., & Chamberland, C. (2013). Evaluating where we’re at with differential response. Child Abuse & Neglect, 37, 125–132. Loman, L., & Siegel, G. (2012). Effects of anti-poverty services under the differential response approach to child welfare. Children and Youth Services Review, 34, 1659–1666 Lund, T., & Renne, J. (2009). Child safety: A guide for judges and attorneys. Washington, DC: American Bar Association and ACTION for Child Protection. Retrieved October 17, 2011, from http://www.nrccps. org/documents/2009/pdf/The_Guide.pdf. Merkel-Holguin, L., Kaplan, K., & Kwak, A. (2006). National study on differential response in child welfare. Denver: American Humane Association and Child Welfare League of America. Retrieved October 17,

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2011, from http://www.americanhumane.org/assets/ pdfs/children/pc-2006-national-study-differentialresponse.pdf. Myers, J. (2011). A short history of child protection in America. In J. E. B. Myers (ed.), The APSAC handbook on child maltreatment (pp. 3–15). Los Angeles: Sage. NRCCPS (2005). Oregon Children, Adults, and Families expert review of safety intervention system. Charlotte, NC: NRCCPS and ACTION for Child Protection. Retrieved October 16, 2011, from http://www.oregon. gov/DHS/abuse/publications/children/nrccps_ report.pdf. Omnibus Budget Reconciliation Act. (1993). P.L. 103–66. PPCWG (n.d.). What is the guidance? retrieved October 17, 2011, from http://www.ppcwg.org/purpose.html. Sedlak, A., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Liu, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. Retrieved October 15, 2011, at http://www.acf.hhs.gov/programs/ opre/abuse_neglect/natl_incid/. SERIAL 112-HR4 (2011). Improving programs designed to protect at-risk youth before the Human Resources Subcommittee of the House Committee on Ways and Means, 112th Congress (1991; testimony of Bryan Samuals). Sherrard, E. (2010). Using CFSR findings to inform continuous quality improvement in safety, permanency, and well-being. Presentation at the 2010 Policy to Practice Dialogue, October, Arlington, VA. Retrieved from http://www.nrcadoption.org/wpcontent/uploads/Using-CFSR-Findings-to-InformContinuous-Improvement-in-Safety-Permanencyand-Well-Being1.pdf. Shusterman, G., Hollinshead, D., Fluke, J., & Yuan, Y. (2005). Alternative responses to child maltreatment: Findings from NCCANDS. Washington, DC: Walter R. McDonald & Associates. Retrieved October 16, 2011, from http://aspe.hhs.gov/hsp/05/child-maltreat-resp/. Siegel, G., Loman, A., Cline, J., Shannon, C., & Sapokaite, L. (2008). Nevada differential response pilot project interim report. St. Louis: Institute of Applied Research. Retrieved October 17, 2011, from http:// www.americanhumane.org/assets/pdfs/children/ differential-response/nevada-dr-interim-reportdec-08.pdf. Strengthening Abuse and Neglect Courts Act. (2000). P.L. 106–314. U.S. Department of Health and Human Services (2000). Rethinking child welfare practice under the Adoption and Safe Families Act of 1997. Washington, DC: U.S. Government Printing Office. U.S. Department of Health and Human Services (2003). National study of child protective services systems and

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reform efforts review of state CPS policy. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 4, 2011, from http://aspe. hhs.gov/hsp/cps-status03/state-policy03/index.htm. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (n.d.). 52 Program Improvement Plans: Strategies for improving child welfare services and outcomes. Retrieved October 15, 2011, from http://www.acf.hhs. gov/programs/cb/cwmonitoring/. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2007a). Child and Family Services Review Program Improvement Plan Instructions and Matrix. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 15, 2011, from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2007b). Child and Family Services Review summary of findings form. Retrieved October 15, 2011, from http://www.acf.hhs.gov/programs/cb/cwmonitoring/. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, & Families, Children’s Bureau (2012). Child maltreatment 2011: Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2010b). Child welfare outcomes 2004–2007

report to congress. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 4, 2011, from www.acf.hhs.gov/programs/cb/ pubs/cwo04–07/cwo04–07.pdf. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2011). The Children’s Bureau National Training and Technical Assistance Network 2011 Directory. Retrieved October 17, 2011, from http://www.acf.hhs. gov/programs/cb/tta/cbttan.pdf. U.S. Department of Health and Human Services Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2013). Child welfare outcomes 2008–2011 report to Congress. Report PDF at www.acf.hhs.gov/ programs/cb/resource/cwo-08-11. Waldfogel, J. (1998a). Rethinking the paradigm for child protection. The Future of Children 8, 104–19. Retrieved October 17, 2011, from http://futureofchildren.org/futureofchildren/publications/journals/. Waldfogel, J. (1998b). The future of child protection. Cambridge: Harvard University Press. Waldfogel, J. (2009). Prevention and the child protection system. Future of Children, 19, 195–210. Retrieved October 17, 2011, from http://futureofchildren.org/futureofchildren/publications/journals/. Williams-Mbengue, N., Ramirez-Fry, K., & Crane, K. (2013). Differential response approach in child protective services: An analysis of state legislative provisions. National Quality Improvement Center on Differential Response in Child Protective Services. Retrieved October 16, 2013, from www.ncsl.org/issues-research/ human-services/state-legislation-differentialresponse.aspx.

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Risk Assessment

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hild welfare staff members make many different kinds of decisions. One concerns risk assessment: Will this parent reabuse her child in the near future? What is the probability that he will do so? Risk assessment requires the integration of various kinds of data (e.g., self-report, observation, agency protocol) that differ in their accuracy, complexity, and subsequent value when making decisions. It is subject to a host of errors, including overestimating or underestimating the true probability of risk to a child. Such errors may result in failing to protect children from harm or imposing unneeded services that increase rather than decrease risk, for example, unwarranted placement of children in foster care. Efforts to improve decision making in child welfare have tended to focus on the development of risk assessment tools. By 1996 at least 76 percent of U.S. states used some type of risk assessment measure as a decision aid in child welfare cases (Tatara 1994); however, many of these may have been of questionable reliability and/or validity (Barber et al. 2008; Camasso & Jagannathan 2000; Lyons, Doueck, & Wodarski 1996; Wald & Woolverton 1990). More recent actuarial instruments developed by the Children’s Research Center have the potential to lessen some of these concerns (Baird & Wagner 2000; Baird et al. 1999; Shlonsky & Wagner 2005), yet other issues remain as described in this chapter. The Decision-Making Context Decisions are made in a context of uncertainty. Caseworkers must distinguish between

child neglect, bad parenting, and the effect of poverty, and they must do this with imperfect assessment tools. Both personal and environmental factors influence decisions. Barriers to accurate decisions include 1. limited knowledge; 2. limited information processing capacities; 3. personal obstacles, such as lack of perseverance, reliance on ineffective problemsolving strategies, and lack of familiarity with problem-related knowledge; and 4. the task environment. Problems that confront clients are often difficult, challenging even the most skilled staff. Predictions must be made under considerable uncertainty in terms of the relationship between the information at hand (predictor variables) and service outcome. Rarely is all relevant material available, hampering problem-solving efforts. Even when a large amount is known, this knowledge is usually in the form of statistical associations that cannot readily be calculated without assistance (Dawes 1988). Competing values may also influence error. For example, steps must be taken to protect children from abuse while maximizing the decision-making freedom of parents. Although the strategies we use to simplify the task of making difficult judgments may often help us to make accurate judgments, at other times they may result in errors. Preconceptions may get in the way as well as day-to-day mood changes that influence judgment. Not only are initial beliefs resistant to new evidence, they also are remarkably resistant to challenges of the evidence that led to them (see Gambrill 2012; Hastie & Dawes 2001). We are subject to a number of confirmation biases. For example, 253

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we tend to disregard data that do not support our preferred beliefs and assign exaggerated importance to data that do support our beliefs. The fundamental attribution error is common, in which causes are mistakenly attributed to dispositional characteristics of the person (e.g., impulsivity) and environmental variables (e.g., poor quality housing) are overlooked. These sources of error highlight the importance of developing risk assessment measures that minimize their influence. Innumercy (lack of skill in understanding probabilities) is prevalent, both among professionals and nonprofessionals (Gaissmaier, & Gigerenzer 2011; Gigerenzer et al 2007). For example, social workers vastly overestimate the accuracy of tests for AIDS. Misunderstandings regarding probabilities can result in faulty judgments. Common errors in assessing how closely two or more events are related include ignoring nonoccurrences, preconceptions about which events are related, and attempted proof by selected instances (attending to observed rather than relative frequency). Environmental characteristics also influence decisions. Decisions made in child welfare are affected by the values and policies of agencies and the broader community (Costin, Karger, & Stoesz 1996; Pelton 2008). A blame culture may result in focusing on individual workers, ignoring systemic causes of avoidable errors. Time pressures and distractions may encourage a mindless, mechanical approach in which decisions are made with little care. Pressure to conform may result in poor decisions, as illustrated by the play of “group think” in case conferences (Dingwall, Eekelaar, & Murray 1983; Janis 1982). Group think refers to neglecting alternative views in a group focused on attaining agreement with one particular view (see, for example, Janis 1982). Actuarial/Statistical Versus Clinical Decision Making The many sources of bias suggest the need for procedures that minimize them. Statistical models (of which actuarial approaches

are but one) are designed to address some of these biases (see Gambrill & Shlonsky 2000). They are based on empirical relationships between certain predicted variables and outcomes. Actuarial and statistical models can be contrasted to consensus-based systems in which practitioners assess selected characteristics identified by agreement among experts and then make their own judgment about an outcome such as risk. Both can be contrasted to clinical intuition, which is not informed by expert consensus. To date, over 130 studies have found actuarial models to be superior to clinical prediction in a variety of complex circumstances (Dawes, Faust, & Meehl 1989; Grove & Meehl 1996). Risk assessment models in child welfare are, essentially, lists of variables (e.g., caregiver and child characteristics or attributes, abuse circumstances, or environmental circumstances) that have been found to predict an outcome of interest (e.g., the initial occurrence or the recurrence of abuse). Concerns about actuarial processes raised by Wald and Woolverton nearly two decades ago (1990) remain (see later section on methodological challenges). Decision making in child welfare has been consistently characterized by low reliability (Lindsey 1992). Reliability refers to the degree to which different workers make the same placement decisions when presented with the same data. Lindsey (1992) generously estimates the reliability of placement decisions to be .25 and, using figures derived from a nationwide survey (Lindsey 1991), estimates that, even with perfect validity (the degree to which a measure actually predicts an event), the actual “hit rate” (number of correctly classified cases) with this reliability can only reach 72 percent. According to Lindsey, this finding means that, overall, 48 percent of placements were unnecessary and 45 percent of the children needing placement remained at home. Following up on Lindsey’s work, Ruscio (1998) showed that the hit rate assuming zero validity (completely random) is 58 percent. Thus the actual hit rate probably

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lies between 58 percent and 78 percent, indicating that there is a high error rate in child protective services placement decisions. More recently, Barber et al. (2008) found that a consensus-based tool had very poor reliability and predictive validity, and Baird and Wagner (2000) found that an actuarial model (the Michigan Family Risk Model) had far greater predictive validity compared to two consensual models (the Washington and California Models). Yet the hit rate of this reliable and valid tool is still low enough to be of concern and indicates that statistically driven tools are not sufficiently accurate to be used as the sole source of information for making decisions (Shlonsky & Wagner 2005). Methodological Challenges While actuarial models outpredict clinical decisions, many factors are limited in their predictive capacity. Other tools may be useful for different types of case decisions, but suffer from many of the same factors. Definitional Dilemmas Vague definitions of outcome measures make predicting child abuse and neglect more difficult. The criteria defining maltreatment are diffuse across studies, making meta-analysis problematic (Wald & Woolverton 1990). Although neglect is the most common form of child maltreatment, with occurrence nationwide estimated at 78.5 percent of investigated or alternative response referrals (U.S. Department of Health and Human Services 2012:21), the definition is characterized by subjectivity (Rose & Meezan 1996), decreasing the likelihood of accurate assessment. For example, Zuravin (1999) reviewed all empirical studies with findings regarding child neglect that were published in a major child maltreatment journal between 1992 and 1996. Only two of twenty-five articles used the same operational definition. Nonetheless, a systematic review examining fifteen studies from the United States and one study from Australia found that the four most consistent

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factors predicting future maltreatment included the number of previous episodes of maltreatment, neglect (as opposed to other forms of maltreatment), parental conflict, and parental mental health problems (Hindley, Ramchandani, & Jones 2006). To date, actuarial tools in child welfare use substantiation (protective service worker finding that maltreatment has occurred) as their outcome variable measuring the recurrence of abuse, and this is usually done retrospectively. However, substantiation may not be the most valid measure of recurrence (Drake 1996; Wolock et al. 2001). In addition, the purpose of using the instrument must also be considered. Is the tool being used to initially assess risk, to assess whether a child should be returned to his biological parents, or at some other point in the life of the case? Concerns About Reliability and Validity Although the distinctions mentioned in the previous section have varying types of risk associated with varying sets of predictors, the same risk assessment instrument may be used by agencies at different points in time, resulting in varying degrees of reliability and validity (Camasso & Jagannathan 2000; Wald & Woolverton 1990). Reliability refers to the consistency in use of a measure: Does a measure yield the same results at different times and with different raters? Validity refers to whether a measure actually measures what it was designed to measure. A variety of other factors, such as changes in risk over time and lack of baserate data (see sections that follow) also may compromise reliability. In addition, research concerning risk assessment often makes use of previously constructed measures (see English & Graham 2000), or some portion of them, which then is essentially a new measure (see Wolock et al. 2001). Examples include measures of social isolation, family conflict, parenting skills, and depression. There is a lack of attention to and concern with reliability and validity

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of measures used (e.g., of parenting skills, child behavior, and so on). Sensitivity and Specificity Despite being an improvement over clinical and consensus-based models, actuarial models are rarely able to predict re-abuse at acceptable levels of sensitivity (correctly classifying those children who will be re-abused). There is an inverse relationship between sensitivity and specificity (correctly classifying those children who will not be re-abused). That is, as the sensitivity of an instrument is increased, its specificity decreases. High sensitivity results in a high percentage of True Positives (children identified as high risk who subsequently experience re-abuse) as well as a high percentage of False Positives (children identified as high risk who do not subsequently experience re-abuse). High specificity results in a high percentage of True Negatives (children identified as low risk who do not subsequently experience re-abuse) as well as a high percentage of False Negatives (children identified as low risk who subsequently experience re-abuse). The baserate of re-abuse will influence the percentage of false positives and false negatives. Assigning risk involves establishing cut points—a value at which a different decision is made above and below that value. Media coverage surrounding a child abuse fatality might prompt a shift to “conservative” policies (lowering of cut points), resulting in an increase in the number of false positives. However, attending to false positives and false negatives may not be the best way to assess the efficacy of risk assessment tools. Rather than relying on a binary prediction (reabuse/no re-abuse), an actuarial classification scheme has been proposed that categorizes people into varying degrees of risk (e.g., low, medium, high, very high); this graduated classification scheme is being used as a decision aid that identifies those children at ever-increasing risk of re-abuse (Baird & Wagner 2000). Thus, while the hit rate will be similar, the user gets a more nuanced sense of the degree of risk.

Changes in Risk Over Time/Stages of Development Risk may change over time (DePanfilis & Zuravin 1998), and we may be unaware of the point in the cycle at which we are intervening. This has implications for prediction. If escalation is always assumed at the point of risk assessment, the false positive rate might be very high (low specificity). If escalation is not assumed, the number of false negatives might be high (low sensitivity). We may get some of the more obvious serious cases at a certain stage in the process (high escalation) and encounter a certain number of low risk cases with the potential to escalate, only we do not know how to identify them. The Absence of Baserate Data The risk of recurrence cannot be explored in the absence of intervention by child protective service agencies (Wald & Woolverton 1990). For instance, we cannot know the real rates of recurrence of the most obvious and severe maltreatment since children experiencing such abuse are most likely removed from the homes of their abusers or major steps are taken to ensure their safety. Therefore, we are limited mostly to knowing the rates of recurrence among those who committed less serious offenses, those for whom the discovery of the extent of maltreatment was limited, or those for whom the maltreatment is in the beginning stages of a more severe progression. Given these limitations, obtaining an accurate baserate of maltreatment is probably impossible. Further, discovering the false positive rate is almost impossible. Once the risk has been responded to (i.e., child welfare services are provided) the likelihood of recurrence of abuse in the absence of intervention cannot be determined. Child abuse investigation is, by definition, a reactive process. Predicting for Individuals While an instrument may have high overall predictive validity, the predictive capacity for

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an individual is lower due to the wide variation among individuals. Thus, while using a good assessment instrument can improve the overall rate of correct predictions over time, predictions for specific individuals are less certain. Severity as a Problem Although severity of abuse is listed in almost every consensus-based and actuarial model, there is little or no indication that this factor is related to recurrence of abuse (Camasso & Jagannathan 2000; Wald & Woolverton 1990). This may be due, in part, to the high likelihood that the most severe cases result in the most severe interventions (placement), thereby eliminating the possibility of future harm (again, we come back to the intervention effect). If this is the case, severity of abuse should be left out of the model once intervention has occurred. An examination of the severity of reabuse (as opposed to severity of initial abuse) may be more fruitful. When examining recurrence, however, severity of abuse is not usually addressed. Most studies use rate of re-report, rate of re-substantiation, and rate of reentry to foster care as indicators of reabuse. These measures do not address severity. A notable exception is Children’s Research Center’s models of re-abuse resulting in injury or hospitalization (Johnson 2004; Wagner, Johnson, & Johnson 1998). These measures, while promising, are still limited by the low base rate of occurrence of injury. Dynamic Versus Static Factors Actuarial tools typically consist of a large number of static or unchanging risk factors (e.g., history of child welfare involvement). Once such a risk factor is endorsed, that factor stays with a family for the foreseeable future. Some would argue that risk assessment tools should include dynamic or changeable factors so that the tools can be used to monitor change over time (Schwalbe 2008). Theoretically, such a tool would be preferable. However, there are concerns that when moving from theory to actual use, such tools exchange predictive power for

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practical utility (Baird 2009). In other words, dynamic tools simply do not seem to predict as well and should be viewed with cautious optimism. Implications for the Design and Use of Risk Assessment Tools Collaborative efforts on the part of researchers, child welfare administrators, and line staff will be required to address challenges to the development of valid risk assessment tools. Increasing Reliability Researchers, while leaving room for innovation, should standardize the operational definitions of key variables included in studies of risk. Many individual risk items are open to interpretation and are based on clinical decisions. Each interpretation and action is subject to error. Individual risk measures, such as “level of social or familial support,” “seriousness of injury,” and “severity of abuse,” require judgments that may be influenced by a variety of biases. In addition, protective service workers make decisions about the authenticity of claims made by parents, family members, abuse reporters, and others as they input items into the risk assessment instrument. Once risk has been estimated, clinical skills are used to conduct an in-depth assessment, develop and carry out service plans, identify other needs, and evaluate progress. These tasks create other sources of risk, including avoidable risk created by gaps between knowledge, skills, and resources needed for accurate assessment on what is available. We live in a society in which biomedical framing of personal problems is dominant. This often results in ignoring environmental circumstances related to risk (e.g., Cohen & Timimi 2008). Clearly Describe Reliability and Validity Authors should clearly describe the reliability and validity of measures they use and clearly inform readers when measures used are of unknown reliability and validity. The aim is to provide sufficient information so that readers

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can review the status of the reliability and validity of scales used. Considering Baserates Consideration of the baserates of relevant events in the general population should be incorporated into risk assessment models. For instance, child injuries occur in non-CPS involved families and the rate of occurrence in the child welfare population is misleading if a comparable rate of occurrence in the non-involved population is not considered in statistical calculations. (See also Munro 2002). The baserates of relevant events within the given population should also be listed alongside risk classifications. It is insufficient to label a case “high risk” without knowing what the actual risk might be. For instance, if 20 percent of all families return to the child protection system with another substantiated maltreatment event, and high risk cases return 40 percent of the time, we know that the risk of recurrence is twice the average but that, more often than not, a recurrence will not happen (i.e., for every ten cases investigated and rated as high risk, only four of them will actually have a recurrence). Temporal Considerations Simply taking a cross-section of child welfare cases, random or otherwise, counting the numbers of children who are re-abused, and comparing risk factors can lead to inaccurate results as a consequence of sampling bias. Families involved in the child welfare system for longer periods of time would have a greater probability of study inclusion than would families entering and exiting care more quickly, yet these two types of families may be very different. Attending to Strengths Although there is a great deal of emphasis on family strengths in the child welfare literature, this emphasis is often lost in risk assessment models. Protective influences may interact with identified risk factors to minimize the likelihood of negative events (Jensen & Fraser 2010; Macdonald

& Macdonald 1998). Further, risk may not be additive (i.e., adding deficits and subtracting strengths), but multiplicative (i.e., a specific combination of risk factors modifies their individual effect, increasing or decreasing risk in different ways) or have some other non-linear function (for a good discussion, see Selvin 1996). In order to incorporate strengths into a statistical model, detailed information about family strengths must be present in the case file (Wagner 2003). Otherwise, deficits will continue to predominate simply for lack of more complete information. Establishing Clinical Overrides Overrides should be tracked to establish their reliability and validity in comparison with the model as part of the model improvement process. However, the actuarial classification should only be overridden when the known probability of the outcome is close to zero. Otherwise, there will be a tendency to make more errors in the opposite direction and the two will not balance out (Grove & Meehl 1996). Statistical Concerns Although certain variables may be significant when considered individually, they may be highly correlated; significance may fade when they are included in a multivariate analysis. Statistical bias is also a concern. For example, while relative risk between groups can be estimated using logistic regression, results are reported in terms of relative odds ratios (e.g., a high risk case is four times as likely as a low risk case to have a recurrence). 1 Relative odds ratios, however, always overestimate relative risk if the true relative risk is less than 1 (less likely) or greater than 1 (more likely). These terms are only equivalent when there is no association (true relative risk = 1). In addition, relative risk is not the same as absolute risk. That is, a comparison of the risk for two groups is not the same as the overall likelihood that an event will occur for either group. Both measures of risk are essential.

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Implementation Concerns A clumsy implementation process that is not attuned to the culture of the agency may undermine a tool’s use, despite its ability to predict well (for an overview of implementation features that are likely to be important, see Fixsen et al. 2005). Risk assessment tools should be implemented in a context of careful evaluation, including review of the fidelity of the implementation process. All staff should be trained in the proper use of the tool and proficiency tests should be given to check the effectiveness of training (e.g., in enhancing reliability). Risk assessment tools should be developed and implemented in an environment that supports consistency, constructive criticism, and accountability at all staff levels, as well as with contracted service providers, to increase safety and reduce risk to children, youth, families, child welfare staff, and involved agencies (Gray 2001). This will require a comprehensive risk management program designed to minimize risks and maximize benefits (see Gambrill & Shlonsky 2001). The Need for Systemic Risk Management Programs Risk assessment in child welfare has largely focused on identifying individual or family risk factors associated with future harm or on the value of various assessment tools constructed of such factors, paying scant attention to risks posed by the system and its larger context. The term risk assessment implies that there is an effort to assess risk to children when, if one examines what is done, only some potential sources of risk are addressed (e.g., risk of biological parents to their children). A narrow approach has been taken to assessing risk to children who are potentially or actually involved in the child welfare system: developing risk assessment instruments to predict which children should come into care and which should not. This narrow approach ignores a host of other factors that may influence risk to children, including quality of assessment and services provided to children and families and

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the validity of evaluation methods. If we are concerned about risk to children, we should make efforts to identify and minimize all sources of avoidable risk. Research regarding risks suggests that this will require systemic risk management programs that attend to multiple sources of risk to children, including staff and management practices and policies that contribute to risk. Ideally, risk management should minimize risk from all sources that contribute to unwanted outcomes (e.g., harm to children). Such risks include not only those posed by parents to their children, but risks posed by child welfare staff and service providers to clients and all procedures put in place to decrease both. Risks may be avoidable or unavoidable. We suggest that avoidable risks now taken in child welfare include incomplete assessment, referring clients to agencies offering ineffective services, and the pursuit of vague outcomes. Unnecessarily risky decisions during early phases influence risk during later phases. For example, if assessment is fragmented and incomplete, ineffective or harmful services may be selected (Budd 2005). We can draw on practice-related research to identify practices and policies that minimize risk. Unnecessary risks may also result from the use of invalid risk assessment instruments and the misuse of valid measures. Research by Munro (1999) suggests that assessments of risk made by child welfare staff are based on a narrow range of evidence. A key avoidable risk to children may be the lack of an individualized assessment that permits judicious selection of service plans most likely to maximize hopedfor outcomes. Approaches to assessment that pose unnecessary risk to children, youth, and families include use of invalid measures (e.g., of parenting skills), vague descriptions of outcomes, pathologizing clients, and overlooking assets. It does little good to spend money to develop actuarial prediction methods if we then fail to provide appropriate services. Combining

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accurate assessment with high-quality services is essential for risk management (Moss 1995). Combining accurate risk assessment and evidence-informed selection of services is a key step in minimizing risk to children, parents, social workers, and agencies. Currently, there is little clear description of variations in services (e.g., substance abuse, parenting programs, placement options) and their outcomes. For instance, parents are referred to many different parent training programs. Are they all equally effective? Are any effective? Are certain types of parent training better for certain types of parenting problems? At present, there is little clear information about what services are offered to what effect. For example, there is little information about the extent to which current parent training programs offered in child welfare take advantage of information available about effectiveness of parent training programs and barriers to their implementation (e.g., see Barth et al. 2005). We should describe variations in services and their outcomes, including clear description of services used (e.g., number of sessions, format used, duration of each session), outcomes sought including intermediate steps, criteria used to evaluate whether each is attained, and the degree to which service components are empirically informed (i.e., have survived critical tests of their effectiveness in relation to hoped-for outcomes). Other important questions include the following: How effective are these services for families identified by actuarial tools as high risk? Low risk? Are follow-up data available? What arrangements are made for generalization and maintenance of gains? How long do gains last? Purchasing ineffective or harmful services increases risk to children by losing opportunities to alter factors related to child maltreatment. For any service provider, we should examine the gap between services they provide to referred clients, what should be provided based on related research findings, and the acceptability of the services to the client.

For each service purchased we should ask: “Is anything known about its effectiveness?” If so, what? Does it t
Do more good than harm? t
Do more harm than good? t
Is it t
Of unknown effect—not being evaluated in research setting or being evaluated poorly? t
Of unknown effect, but in good quality research program (Gray 2001)? The absence of information on the effectiveness of programs does not mean such programs should not be used. There are undoubtedly a number of effective services that simply have not been evaluated. However, the state of the evidence about a service should be made transparent to the client and the client’s progress with respect to stated goals monitored diligently. Vague agreements between child welfare agencies and referral agencies pose another unnecessary risk to children. Unless service agreements are clear regarding what is expected, such as timely reports, providers cannot be held responsible for meeting hoped-for outcomes such as timely reports. Providing services without carefully evaluating their impact opens the door to “wishful thinking” that services will be successful when indeed there may be no progress or effects are in fact harmful, ultimately increasing rather than decreasing risk. In addition, risk management requires an organizational culture and climate that facilitates and maintains related components (e.g., see Helmreich & Merritt 1998). Reason (1997) suggests that a safety culture is comprised of four critical components: 1. a reporting culture defined as “an organizational climate in which people are prepared to report their errors and near misses” (p. 195); 2. a just culture described as “an atmosphere of trust in which people are encouraged, even rewarded, for providing essential safety-related information—but in which they are also clear

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about where the line must be drawn between acceptable and unacceptable behavior” (p. 195); 3. a flexible culture, for example shifting from a hierarchal mode of taking charge “to a flatter professional structure, where control passes to the task experts on the spot” (p. 196); and 4. a learning culture, which “involves the willingness and the competence to draw the right conclusion from its safety information system, and the will to implement major reforms when their need is indicated” (p. 196). Agencies should undertake a cultural assessment to identify opportunities to shape their culture toward effective management programs that minimize risk (see the Culture of Thoughtfulness Scale in Gambrill & Gibbs 2009). An effective risk management program will require careful attention to contingencies in effect in an agency. That is, what behaviors are reinforced, punished, or ignored? Are behaviors that contribute to risk management reinforced? Are tools and cues arranged that increase the likelihood that they occur? In order to change old norms or develop a new culture, meaningful incentives will have to be provided to establish and maintain behaviors that minimize risk. Yet another way to minimize risk is to track errors, accidents, and mistakes, both avoidable and unavoidable, and use this feedback to minimize those that are avoidable before a breach in the system occurs. Studies of risk and error reveal a systemic process that typically involves a number of latent causes (those that precede the point at which an error is made) that contribute to manifest causes (the point at which a mistake occurs; Reason 1997; Reason 2001; Vincent 2001). Examples of latent causes in child welfare include policies regarding home visitation and caseload size. For instance, due to high caseloads (latent cause), a worker may fail to visit a child or not spend sufficient time with the family to adequately assess risk (manifest cause), and a parent may later abuse that child. Inappropriate blame and subsequent organizational response may stem from hindsight bias. Macdonald and Macdonald (1998) define this

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basic error in risk assessment as regarding “the outcome as evidence of the prior existence of a risk at a sufficiently high probability to justify intervention” (p. 3). They view hindsight bias as a misunderstanding of risk, not as overattention to outcome. We should also distinguish between errors and moral lapses. The former are made in a context of good intentions. The latter are characterized by indifference to the rights of clients and the potential harms they may suffer. An environment must be created whereby an open and informed analysis of individual and organizational errors, both latent and manifest, can occur. Open systems characterized by free flow of information and clear documentation should permit greater error recognition and encourage the uptake of promising systemic innovations. Routinely reviewing clients’ complaints also provides information about how services can be improved. Ignoring or neglecting to harvest them poses another source of avoidable risk to children. A quality improvement program including ongoing audit of key indicators is an integral part of an overall risk management program. Moss (1995) suggests that essential features of quality improvement are that it is “reflective and not punitive or defensive; that it relies on learning and improving; and that it is based on an understanding of the needs of the customer [client] and on good evidence” (p. 97). Thus we suggest that staff at all levels have responsibilities in relation to risk management. Administrators have a responsibility to arrange policies, audit systems and contingency systems that minimize risks to children, while also attending to safeguarding the assets of the organization. They should be integrally involved in establishing effective risk management systems and critically reviewing the quality of these programs, arranging required training, and improving the program based on ongoing feedback. Supervisors have a responsibility to see that agency policies are implemented effectively. Line staff members have a responsibility to report errors and maintain a

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level of expertise regarding agency procedures, measures used, and effective interventions for the clients they serve. Line staff should also be involved in maintaining and upgrading the system as well as promoting a culture conducive to risk management. Improvements in database technology as well as knowledge mobilization should lead to better use of data to manage system-level risk. Harnessing state administrative data to better understand case flow through the child welfare system is crucial for understanding, at a broad level, who to serve and at what point in time (Webster et al. 2008). For instance, if infants have a different trajectory through the child welfare system than older children, different decisions regarding placement or permanent plans might be made sooner (Wulczyn et al. 2005). Barriers to Systemic Risk Management Programs Risk management programs highlight the uncertainty involved in making decisions. This may be an unpleasant topic to clients and social workers who search for certainty. Risk management programs cast the searchlight regarding what is done to what effect on staff and policy at all levels, not just on clients. This calls for an openness to criticism—in fact a welcoming of criticism as a way to enhance the quality of services, including a candid discussion of how much risk can be attenuated without altering basic structural arrangements (e.g., political, social, and economic realities) that contribute to the likelihood of risk (e.g., see Halpern 1990). This broader view may be threatening, particularly in cultures in which mistakes are not viewed in their systemic context as opportunities for improvement, in which authoritarian practice/policy reigns and clients have little say (e.g., complaints are not carefully harvested and attended to in improving services), and in which there is reluctance to alter broad structural arrangements. The management of risk is closely connected to the knowledge we seek, the knowledge we

ignore, and what we do with what we learn, all of which is related to our cognitive biases and risk-taking styles (e.g., see Mullen & Roth 1991). Decisions about what knowledge to seek, use, and disseminate influence risk to all parties involved in the child welfare systems: clients, staff, politicians, and taxpayers. Many decisions prevent the discovery of knowledge. We suggest that knowledge that helps to minimize the risk and increase the safety of children in the child welfare system includes the following: 1. a clear description of the reliability and validity of assessment methods used; 2. a description of what services are used to what effect; 3. a candid recognition of uncertainties involved in child welfare practice; 4. a description of avoidable and unavoidable errors including their rates and contexts; and 5. clear descriptions of the gaps between methods used and what research suggests is most likely to result in hoped-for outcomes. This call for transparency of what is done to what effect will be threatening to many, but nonetheless should be pursued. We can draw on literature regarding innovation to design programs that increase the likelihood that valid assessment, intervention, and evaluation methods will be adopted and used appropriately (see, for example, Rogers 1995). Factors That Encourage Implementation of Systematic Risk Management Programs A number of current interrelated developments encourage systemic risk management systems in child welfare. These include increased attention to harming in the name of helping in the professions, to mistakes and their systemic nature, and to research describing the influences of organizational culture and climate on employee behavior (Reason 1997, 2001; Vincent 2001). Another key advance is the process and philosophy of evidence-based practice, which draws on rigorous reviews of practice-related claims, attends to ethical issues (e.g., involves clients as informed participants), and helps both professionals and clients attain access to practice/policy related research findings and

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to critically appraise what they find. Evidencebased medicine (EBM) arose as an alternative to authority-based medicine in which decisions are based on criteria such as consensus, anecdotal experience, or tradition (e.g., see Chalmers 1983; Sackett et al. 1997; Sackett et al. 2000). Evidence-based practice (EBP) involves “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual [clients]” (Sackett et al 1997:2). It involves “integrating individual clinical expertise with the best available external clinical evidence from systematic research concerning the efficacy and safety of therapeutic, rehabilitative, and preventive regimens” (Sackett et al. 1997:2). Clinical expertise is used to integrate information from diverse sources (Haynes, Devereaux, & Guyatt 2002). Steps involved in EBP include the following: Step 1. Converting information needs related to practice decisions (for example, about prevention, diagnosis, prognosis, therapy, causation) into answerable questions. Step 2. Tracking down with maximum effectiveness, the best evidence with which to answer them. Step 3. Critically appraising that evidence for its validity (accuracy), impact (size of the effect), and applicability (usefulness in practice). Step 4. Applying the results of this appraisal to practice and policy decisions. This involves deciding whether evidence found (if any) applies to the decision at hand (e.g., is a client similar to those studied?) and considering client values and preferences in making decisions as well as other applicability concerns. Step 5. Evaluating our effectiveness and efficiency in carrying out steps and seeking ways to improve them in the future (Sackett et al. 2000:3–4). Advantages of EBP include 1. enabling staff and clients to make decisions based on the best available evidence (e.g., helping practitioners

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to keep up-to-date with current research findings related to important decisions that affect children and their families); 2. encouraging participation in evidence-based continuing education programs that contribute to highquality practice; 3. honoring ethical obligations to clients (e.g., to offer competent services and to fully inform them); and 4. clearly describing outcomes sought and progress indicators and tracking these on an ongoing basis. Hallmarks of EBP are transparency in what is done to what effect and a consideration of the values and expectations of clients, including involving clients as informed (rather than misinformed or uninformed) participants in decision-making. Transparency of what is done to what effect should encourage risk management programs that minimize errors, mistakes, and harm and maximize use of services found to help clients achieve valued outcomes. Increased attention to errors, mistakes, and harm in the helping professions and recognition of limited resources should also encourage risk management programs. These trends will increase accessibility of information related to important decisions for both clients and professionals. The relationship of EBP to risk assessment is suggested in figure 12.1. Using current best evidence as an entry point, an actuarial assessment of risk can target scarce resources to clients at highest risk. Relevant data sources include the Cochrane and Campbell collaboration libraries of systematic reviews (Littell & Shlonsky 2010). A contextual assessment is needed to identify environmental circumstances related to concerns as well as individual resources and needs and client preferences (Shlonsky & Wagner 2005). At this point, current best evidence is again sought regarding assessment frameworks (e.g., psychiatric, social learning) and tools such as depression inventories and child behavioral indicators and the effectiveness of service options such as parenting classes. What is found is integrated with client circumstances and characteristics, including their preferences, drawing on clinical expertise to integrate data

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Contextual Assessment

Clinical State and Circumstances

Clinical Expertise

Clients Preferred Or At Least Willing To Try?

Client Preferences and Actions

Current Best Evidence

Appropriate For This Client?

Actual Risk Assessment Other Assessment Instruments Effective Services

Barriers (E.g., Cultural Conflict) FIGURE 12.1.

The process of EBP in risk management. Haynes, Devereaux, and Guyatt 2002.

from diverse sources. Both risk assessment using an actuarial tool and contextual assessment are decision aids used in evidence-based practice. To be viable, both must be supported by child welfare agencies. This will require an agency in which the values of EBP are incorporated, including transparency of what is done to what effect, integrating research and practice, involving clients as informed participants, and addressing application barriers. Effective services should be identified and made available for locally prevalent problems. For instance, using data from actuarial and contextual assessment tools, each agency should identify interventions that are most successful with high-risk families. This requires an ongoing effort to evaluate the impact of services. The use of high-quality experimental and quasiexperimental designs that incorporate intent to treat analyses, where appropriate, can be used to explore effectiveness of interventions for clients at various risk levels. N of 1 studies are compatible with clinical needs in that data are provided concerning progress in a timely ongoing fashion. Administrative data are valuable in monitoring broad trends and suggest future directions for services. In addition, we

should take advantage of helpful guidelines for communicating and understanding risk (e.g., Gigerenzer & Gray 2011) and attend carefully to involved parties’ interests and background beliefs about risk so that appropriate risk communicative tools are created (Morgan et al. 2002; Paling 2006). EBP and Risk Assessment: An Abbreviated Example To illustrate how risk assessment, EBP, and elements of risk management can be used at the client level, suppose an investigative CPS worker is presented with the following client scenario. A referral comes in from the local clinic stating that Mary, a single mother (age twenty-two) has continually failed to provide medical care for her only child, David (age five months). Specifically, Mary has not followed through with treatment for David’s chronic skin condition (not life threatening), and refuses to have her son immunized. The child also consistently appears dirty and unkempt. Mary and David live with Mary’s mother Joan (age fifty) in public housing. She has no job or prospects of one. Income is limited. Upon investigation, the caseworker observes that the child does,

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indeed, have an apparently untreated skin condition, has been in the same dirty diaper for quite some time, and the house is not “infant safe” (i.e., small ingestible items, many sharp edges, heavy objects on unstable platforms, accessible harmful chemicals, exposed wiring, and other safety hazards abound). A safety plan is developed whereby immediate hazards are rectified and the child remains in the care of his mother. During the course of the investigation, the caseworker conducts a contextual assessment (Gambrill 2012; MacDonald 2002) describing the strengths and needs of this family. Some highlights include 1. Mary’s mother (Joan) is a source of emotional and financial support, as is a network of relatives and friends; 2. Mary provides for her child to the best of her current ability and is very strong in her conviction that she can take care of her child; and 3. Mary lacks some of the skills necessary to effectively and safely parent this child. In particular, she is unaware of many of David’s developmental needs, has unrealistic developmental expectations, and her disciplinary skills are largely limited to yelling and angry protests. Fourth and finally, there are some concerns that Mary suffers from depression (a Beck Depressive Inventory (BDI_-2 was scored well above the clinical cut point). At the close of investigation, a risk assessment instrument was completed (California Family Risk Assessment—see table 12.1) finding this family to have a moderate degree of risk of having a recurrence of maltreatment in the next eighteen to twenty-four months (the family received a score of four out of a possible ten on the neglect subscale of the instrument). If unsafe housing conditions had not been corrected during the investigation, the score would have been five, placing the family in the highrisk category. Prior to the close of investigation, the caseworker began developing a case plan using the process of EBP (Sackett et al. 2000) as highlighted in Gibbs (2003). An effectiveness question was posed (for depressed single mothers of infants with a substantiated allegation of

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child neglect, what intervention is most likely to prevent further incidents of maltreatment?). A search was conducted using the Cochrane Collaboration database (CDSR, ACP Journal Club, DARE, CCTR), Medline, and PsycInfo incorporating methodological filters; and findings were evaluated for rigor (see Gibbs 2003 for a more detailed description). This search revealed that home visitation by nurses may have some success at preventing child abuse and may also be effective in decreasing accidental injury in high-risk cases (Hahn et al. 2003), though it should be noted that most families’ involvement in studies preceded any contact with child protective services. The caseworker found that nurses were more effective than paraprofessionals (Olds et al 2002) and that the presence of domestic violence in the home might compromise the benefits of the service (Eckenrode et al. 2000). Due to the risk rating and the nature of the challenges faced by the family, the decision was made to open the case for in-home services. The results of the search were discussed with the client, and she was amenable to nurse home visiting services. She stated that she preferred nurses to doctors, indicating that she felt she would be more likely to listen to a nurse about how to best meet her child’s needs. As a result of the agency’s ongoing commitment to finding and obtaining high-quality services with evidence of effectiveness, home visiting services had already been developed and were available through the County Department of Health. A referral was made, and services were initiated promptly. The continuing social worker on the case proceeded to address Mary’s depression using the same EBP process. Risk assessment in child welfare is a necessary, but uncertain endeavor, compromised by the lack of information needed to develop valid risk assessment tools (such as provision of services, which hinders knowledge regarding what would have happened without them). Actuarial tools for risk assessment have the best batting average, but go only so far. For example, they

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T A B L E 1 2 . 1 Components of Risk Management Systems in Child Welfare

1. 2. 3.

4.

5.

6.

7.

8.

9. 10. 11. 12. 13.

14.

15.

16.

Clear description of practice and policy components likely to maximize attainment of hoped-for outcomes. Effective implementation of a risk assessment instrument that contributes to sound decisions. Clear performance standards for all staff and selection of standards based on what has been found, via rigorous appraisal, to maximize hoped-out outcomes (e.g., increase safety for children). Monthly random audit of a sample of cases of each staff member and provision of individualized feedback and training based on this review. Hiring supervisors with the values, knowledge, and skills required to help staff maintain desired staff performance levels and an audit of a random sample of related supervisory behaviors/products. Hiring staff who possess the values, knowledge, and skills required to fulfill expected tasks at minimal levels of competence as demonstrated by their performance on related tasks. Hiring administrators who encourage evidencebased practices and policies and who are expert in arranging positive contingencies to support related staff behaviors; routine review of their policies and practices in relation to key indicators. Up-to-date, clear descriptions of services offered and outcomes attained by local agencies related to areas of interest (e.g., parent training, substance abuse). This should include critical reviews of the evidentiary base of each service offered. Descriptions of variations in services provided and related outcomes are provided to both staff and clients. Clear description of what is needed to achieve hopedfor outcomes and what is provided on each case. Access to resources provided by a knowledge manager. Access to computer databases that facilitate sound decision making. A whistle-blowing policy that contributes to constructive criticism of alternatives to current agency policies and practices. A nonpunitive system for identifying errors and mistakes and use of these data to improve service quality. An accountable, accessible, user-friendly client feedback system and regular review of complaints and compliments to enhance quality of services. Complaint forms should be readily accessible in every office. Selection of evidence-based training programs for staff (e.g., programs that include instructional formats that maximize learning and that include content found to help clients achieve certain outcomes via rigorous appraisal) and evaluation of training via review of on-the-job practices and outcomes.

Source: Gambrill & Shlonsky 2001, reprinted by permission.

do not provide an individualized assessment that may be required to plan services. Methodological challenges to assessing risk include lack of sensitivity and specificity of measures, definitional dilemmas, temporal issues including changes in risk over time, absence of base rate data, difficulties predicting for individuals, and lack of reliability and validity of measures. And there are many sources of risk to children, including harm by their biological parents and poor services from child welfare staff. These multiple sources of risk, typically ignored to date, include ineffectiveness or harm of services provided to children, lack of careful assessment of resources and needs, an agency culture that is reactive rather than proactive in its pursuit of risk reduction, and dysfunctional professional education programs. Evidence-informed practice and policy is designed to integrate evidentiary (do services do more good than harm?), ethical (e.g., are staff competent to provide services?), and application concerns (are resources adequate?). Our ethical obligation to clients calls on us to maximize opportunities to protect children from harm and increase their safety, including use of valid risk assessment tools. The quality of decisions in child welfare will be influenced by the reliability and validity of risk assessment tools used as well as by the quality of systemic risk management programs (if any) in effect. The increased interest in evidence-informed practice and its emphasis on a rigorous search for and critical appraisal of practice/policy claims, involvement of clients as informed participants, and transparency of what is done to what effect should contribute to enhancing the quality of services provided to children and families. In order for this to occur, however, changes in agency culture will be required as well as changes in the culture of professional education. Methodological problems regarding risk assessment are also significant and must be addressed. The children and families we serve deserve no less than our best in addressing these challenges.

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NOTE

1. The correct way to make this statement is to specify that a high-risk case has four times the odds of recurrence as a low-risk case.

REFERENCES

Baird, C. 2009. A Question of evidence: A critique of risk assessment models used in the justice system. Special report of the National Council on Crime and Delinquency. Available at http://nccd-crc.issuelab. org/sd_clicks/download2/question_of_evidence_a_ critique_of_risk_assessment_models_used_in_the_ justice_system_a. Baird C. & Wagner D. (2000). The relative validity of actuarial and consensus-based risk assessment systems. Children and Youth Services Review, 22, 839–71. Baird, C., Wagner, D., Healy, T., & Johnson, K. (1999). Risk assessment in child protective services: Consensus and actuarial model reliability. Child Welfare, 78, 723–48. Barber, J., Shlonsky, A., Black, T., Goodman, D., & Trocmé, N. (2008). Reliability and predictive validity of a risk assessment tool. Journal of Public Child Welfare, 2, 173–96. Barlow, J. (1997). Systematic review of the effectiveness of parent-training programmes in improving behaviour problems in children aged 3–10 years. Oxford: Health Services Research Unit, Department of Public Health, Oxford University. Barth, R., Landsverk, J., Chamberlain, P., Reed, J., Rolls, J., Hurlburt, M., Farmer, E., James, S., McCabe, K., & Kohl, P. (2005). Parent-training programs in child welfare services: Planning for a more evidence-based approach to serving biological parents. Research on Social Work Practice, 15, 353–71. Budd, K. (2005). Assessing parenting capacity in a child welfare context. Children and Youth Services Review, 27, 429–44. Camasso, M.  J., & Jagannathan, R. (2000). Modeling the reliability and predictive validity of risk assessment in child protective services. Children and Youth Services Review, 22, 873–95. Chalmers, I. (1983). Scientific inquiry and authoritarianism in perinatal care and education. Birth, 10, 151–66. Cohen, C., & Timimi, S. (eds.) (2008). Liberatory psychiatry: Philosophy, politics, and mental health. New York: Cambridge University Press. Costin, L., Karger, J., & Stoesz, D. (1996). The politics of child abuse in America. New York: Oxford University Press. Dawes, R. M. (1988). The robust beauty of improper linear models in decision-making. American Psychologist, 34, 571–82. Dawes, R., Faust, D., & Meehl, P. (1989). Clinical versus actuarial judgment. Science, 243, 1668–74.

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DePanfilis, D., & Zuravin, S. (1998). Rates, patterns, and frequency of child maltreatment recurrences among families known to CPS. Child Maltreatment, 3, 27–42. Dingwall, R., Eekelaar, J., & Murray, T. (1983). The protection of children: State intervention and family life. Oxford: Blackwell. Drake, B. (1996). Predictors of preventive services provision among unsubstantiated cases. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 1, 168–75. Eckenrode, J., Ganzel, B., Henderson, C., Smith, E., Olds, D., Powers, J., Cole, R., Kitzman, H., & Sidora, K. (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. JAMA: Journal of the American Medical Association, 284, 1385–91. English, D., & Graham, J. (2000). An examination of relationships between children’s protective services social worker assessment of risk and independent LONGSCAN measures of risk constructs. Children and Youth Services Review, 22, 897–933. Fixsen, D., Naoon, S., Blase, K., Friedman, R., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, the National Implementation Research Network. Gaissmaier, W., & Gigerenzer, G. (2011). When misinformed patients try to make informed health decisions. In G. Gigerenzer & J. Gray (eds.). Better doctors, better patients, better decisions: Envisioning health care 2020 (pp. 29–44). Cambridge: MIT Press. Gambrill, E. (2012). Social work practice: A critical thinker’s guide (3d ed.). New York, NY: Oxford University Press. Gambrill, E., & Gibbs, L. (2009). Critical thinking for helping professions: A skills-based workbook (3d ed.). New York: Oxford. Gambrill, E., & Shlonsky, A (2000). Risk assessment in context. Children and Youth Services Review, 22, 813–37. Gambrill, E., & Shlonsky, A. (2001). The need for comprehensive risk management systems in child welfare. Children and Youth Services Review, 23, 79–107. Gibbs, L. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Pacific Grove, CA: Brooks/Cole-Thompson Learning. Gigerenzer, G., & Edwards, A. (2003). Simple tools for understanding risks: from innumeracy to insight. British Medical Journal, 327, 741–44. Gigerenzer, G., & Gray, J. (2011). Better doctors, better patients, better decisions: Envisioning health care 2020. Cambridge: MIT Press. Gigerenzer, G., Gassmaier, W., Kurz-Milcke, E., Schwartz, L. M., & Woloshin, S. (2007). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8, 53–96.

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Gray, J. (2001). Evidence-based health care. Churchill Livingstone. Grove, W., & Meehl, P. (1996). Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures. Psychology, Public Policy, and Law, 2, 293–323. Hahn, R., Bilukha, O. O., Crosby, A., Fullilove, M. T., Liberman, A., Moscicki, E.  K., et al. (2003). First reports evaluating the effectiveness of strategies for preventing violence: early childhood home visitation. Findings from the Task Force on Community Preventive Services. Morbidity & Mortality Weekly Report. Recommendations & Reports, 52 (RR-14), 1–9. Halpern, R. (1990). Fragile families, fragile solutions: An essay review. Social Service Review, 64, 637–48. Hastie, R., & Dawes, R. (2001). Rational choice in an uncertain world: The psychology of judgment and decision making. Thousand Oaks, CA: Sage. Haynes, R., Devereaux, P. J., & Guyatt, G. (2002). Clinical expertise in the era of evidence-based medicine and patient choice. ACP Journal Club (March/April). Helmreich, R., & Merritt, A. (1998). Culture at work in aviation and medicine: National, organizational, and professional influences. Brookfield, VT: Ashgate. Hindley, P., Ramchandani, D., & Jones, D. (2006) Risk factors for recurrence of maltreatment: A systematic review. Archives of Diseases in Childhood. 91, 744–52. Janis, I. (1982). Groupthink: Psychological studies of policy decisions and fiascoes (2d ed.). Boston: Houghton Mifflin. Jenson, J., & Fraser, M. (2010). Social policy for children and families: Risks and resilience perspectives (2d ed.). Thousand Oaks, CA: Sage. Johnson, W. (2004). Effectiveness of California’s child welfare structured decision-making (SDM) model: A prospective study of the validity of the California Family Risk Assessment. Oakland, CA: Alameda County Social Services Agency. Lindsey, D. (1991). Factors affecting the foster care placement decision: An analysis of national survey data. American Journal of Orthopsychiatry, 61, 272–81. Lindsey, D. (1992). Reliability of the foster care placement decision: A review. Research on Social Work Practice, 2, 65–80. Littell, J., & Shlonsky, A. (2010). Toward evidence-informed policy and practice in child welfare. Research on Social Work Practice, 20, 723–25. Lyons, P., Doueck, H., & Wodarski, J. (1996). Risk assessment for child protective services: A review of the empirical literature on instrument performance. Social Work Research, 20, 143–55. Macdonald, K., & Macdonald, G. (1998). Perceptions of risk. In P. Parsloe (ed.), Risk assessment in social care and social work: Research highlights. (pp. 17–52). London: Jessica Kingsley.

Margolin, L. (1997). Under the cover of kindness: The invention of social work. Charlottesville: University of Virginia Press. Morgan, M., Fischoff, B., Bostrom, A., & Atman, C. (2002). Risk communication. New York: Cambridge University Press. Moss, F. (1995). Risk management and quality of care. In C. Vincent (ed.), Clinical risk management (pp. 88–102). London: BMJ. Mullen, J., & Roth, B. (1991). Decision-making: Its logic and practice. Savage, MD.: Rowman & Littlefield. Munro, E. (1999). Common errors of reasoning in child protection work. Child Abuse & Neglect, 23, 745–58. Munro, E. (2002). Effective child protection. Thousand Oaks, CA: Sage. Munro, E. (2004). A simpler way to understand the results of risk assessment instruments. Children and Youth Services Review, 26, 873–83. Nickerson, R. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2, 175–220. Olds, D., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt L., Henderson C., Sheff, K., Korfmacher, J., & Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110, 486–96. Oxman, A., & Guyatt, G. (1993). The science of reviewing research. In K. Warren & F. Mosteller (eds.), Doing more good than harm: The evaluation of health care interventions (pp. 125–34). New York: New York Academy of Sciences. Paling, J. (2006). Helping patients understand risks: 7 simple strategies for successful communication (2d ed.). Gainesville, FL: Risk Communications Institute. Pelton, L. (1989). For reasons of poverty: A critical analysis of the public child welfare system in the United States. New York: Praeger. Pelton, L. (2008). Informing child welfare: The promise and limits of empirical research. In D. Lindsey & A. Shlonsky (eds.), Child welfare research: Advances for practice and policy (pp. 25–48). New York: Oxford. Reason, J. (1997). Managing the risks of organizational accidents. Aldershot: Ashgate. Reason, J. (2001). Understanding adverse events: The human factor. In C. Vincent (ed.), Clinical risk management (2d ed., pp. 9–30). London: BMJ. Rogers, E. (1995). Diffusion of innovation (4th ed.). New York: Free Press. Rose, S., & Meezan, W. (1996). Variations in perceptions of child neglect. Child Welfare, 75, 139–60. Ruscio, J. (1998). Information integration in child welfare cases: An introduction to statistical decision making. Child Maltreatment, 3, 143–56. Sackett, D., Richardson, W., Rosenberg, W., & Haynes, R. (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone. Sackett, D., Straus, S, Richardson, W., Rosenberg, W., & Haynes, R. (2000). Evidence-based medicine:

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How to practice and teach EBM (2d ed.). New York: Churchill Livingstone. Schwalbe, C. (2008). Strengthening the integration of actuarial risk assessment with clinical judgment in an evidence-based practice framework. Children and Youth Services Review 30:1458–64. Selvin, S. (1996). Statistical analysis of epidemiologic data (2d ed.). New York: Oxford University Press. Shlonsky, A., & Wagner, D. (2005). The next step: Integrating actuarial risk assessment and clinical judgment into an evidence-based practice framework in CPS case management. Children and Youth Services Review, 27, 409–27. Tatara, T. (1994). Some additional explanations for the recent rise in the U.S. child substitute care population: An analysis of national child substitute care flow data and future research questions. In R. Barth, J. Berrick, & N. Gilbert (eds.), Child Welfare Research Review (vol. 1, pp. 126–45). New York: Columbia University Press. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2012). Child Maltreatment 2011. Available at http://www.acf.hhs.gov/programs/cb/stats_research/ index.htm#can. Vincent, D., ed. (2001). Clinical risk management: Enhancing patient safety (2d ed.). London: BMJ.

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Wagner, D. (2003). Symposium on Decision Making in Child Welfare. University of California, Berkeley, December 4. Berkeley, California. Wagner, D., Johnson, K., & Johnson, W. (1998). Using actuarial risk assessment to target service interventions in pilot California Counties. Paper presented at the 13th National Roundtable on CPS Risk Assessment, San Francisco, CA. Wald, M., & Woolverton, M. (1990). Risk assessment: The emperor’s new clothes? Child Welfare, 69, 483–511. Webster, D., Usher, C., Needell, B., & Wildfire, J. (2008). Self-evaluation: Using data to guide policy and practice in public child welfare agencies. In D. Lindsey & A. Shlonsky (eds.), Child welfare research (pp. 261– 70). New York: Oxford University Press. Wolock, I., Sherman, P., Feldman, L., & Metzger, B. (2001). Child abuse and neglect referral patterns: A longitudinal study. Children and Youth Services Review, 23, 21–47. Wulczyn, F., Barth, R., Yuan, Y, Jones Harden, B., & Landsverk, J. (2005). Beyond common sense: Child welfare, child well-being, and the evidence for policy reform. New Brunswick, NJ: Aldine. Zuravin, S. (1999). Child neglect: A review of definitions and measurement research. In H. Dubowitz (ed.), Neglected children: Research, practice, and policy (pp. 24–46). Thousand Oaks: Sage.

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Family Preservation

F

amily preservation is a widely used term in services to children and families. The term represents both a goal of services (preserving the connection between children and their parents and extended family) as well as a specific form of services, often called intensive family preservation services (IFPS). The distinction between the goal of family preservation and the specific means by which to achieve it is an important one; agencies and practitioners can agree on the goal while employing different methods to preserve family relationships. Family preservation services should not be confused with family support services, but they often are. Family support programs are less intensive and more widely available to a range of families in need. Families do not have to be experiencing substantiated child maltreatment to access family support services; they are generally available to all who seek them. Family preservation services, in contrast, are provided to families that are involved in the public child welfare system for substantiated child maltreatment. Such families are usually mandated to participate in these services; if they are not willing to do so, their children will likely be placed in foster care for their protection. In this chapter we discuss the evolution of family preservation as a goal and present the basic tenets and components of family preservation service models. Special attention is paid to the assumptions and values underlying this goal and method of working with families. After a basic description of two major service models, we provide some detail about promising approaches that are empirically supported.

We then discuss the difficulty of conducting definitive research in an area in which practice models are intended to be as applied, creative, and individualized as IFPS. Finally, the chapter ends with a discussion of the values, skills, and training that are helpful for professionals working to preserve families at risk of disintegration. Family Preservation as a Goal When children have suffered maltreatment or lack of protection at the hands of their families, a common emotional and professional response is to remove those children from harm’s way and to separate children and their parents and/or siblings. For many years, this was the first response, with the number of children and youth placed into alternative or foster homes, growing throughout the 1970s. In 1980, in response to the increasing number of children growing up in these alternative homes, a federal law, the Adoption Assistance and Child Welfare Act of 1980, was passed. This act mandated that, in order for states to receive their full share of foster care payments from the federal government, they had to show they had first made reasonable efforts to keep children and youth with their families by reducing the risk of harm to those children. The goal of family preservation was thus enacted into federal (and subsequently state) laws in the early 1980s. Following that legislation, individual states were compelled to determine how to show that they had made reasonable efforts to preserve the family before they could legally place the child into foster care with another family and perhaps even move toward adoption of that child 270

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by another family. Even while the child was living with a foster family or in another placement, the first goal of business for agencies was to try to improve the conditions in the child’s home so that the child could safely return to his primary or extended family. Only states that could show they made reasonable efforts to preserve families and family ties could receive their full share of foster care funding for the children and youth who were temporarily separated or who could not return home. This requirement of making reasonable efforts toward preserving families led to an increased call for programs and practice models that could satisfy the requirement that reasonable efforts to preserve families had been made. Family Preservation as a Service or Practice Model During the decade following the Adoption Assistance and Child Welfare Act of 1980, there occurred rapid growth of programs that promised to reasonably and effectively keep a large proportion of maltreated and troubled children safe at home with their families. Often purported to have begun with the Homebuilders program in California and then Washington State, these programs quickly spread across the country and the world. Their growth in the United States was driven by early reports of effectiveness with child welfare populations (AuClaire & Schwartz 1987; Bribitzer & Verdieck 1988; Kinney et al. 1977) and the need for state programs to show their legislatures and the federal government that they were indeed making credible efforts toward the goal of family preservation. To meet the requirement for making reasonable efforts to preserve families, states, counties, and child service agencies turned toward IFPS. The first service model adopted by many had been developed and tested by the Homebuilders agency beginning in the 1970s, so this model was largely functional when the demand for distribution grew. Since the introduction of the Homebuilders model, other programs have

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proliferated. These have been primarily modifications on the same theme. Here we discuss the original model, the modifications to it, and their contributions to preserving families. Homebuilders In the 1980s, creators of Homebuilders were very clear that there are several tenets of their IFPS model that are critical to its integrity and success (Kinney, Haapala, & Booth 1991). First of all, the model is indeed intensive. Caseworkers carry a caseload of two families at one time, but serve each family for six weeks or less. The theoretical basis of the intervention is cognitive-behavioral, with families learning techniques of praise, rewarding positive behavior, keeping charts of positive and negative child behaviors, learning nonpunitive punishment techniques, and the like. Much greater emphasis is put on resolving problems occurring at the moment than on understanding the origins of problematic interactions. The model emphasizes the importance of serving the family in its own home, where problems are occurring and where a more accurate assessment of family interactions, problems, and assets can be gained (Kinney, Haapala, & Booth 1991). Interventions are based on an individualized assessment of family strengths and needs. Caseworkers are trained extensively in cognitive-behavioral techniques and in serving as a model of positive parent-child interaction and problem solving. Caseworkers are encouraged to spend as much time as possible with the family in the environment when and where problems occur (e.g., at home around the dinner table, after school during homework time, at school with teachers). Caseworkers are also given great autonomy and creativity in solving problems, congruent with the individualized approach to treating families. There are no standard requirements for number of work hours spent in the office or on certain activities. One of the most important tenets of the intensive family preservation model created by the Homebuilders team is the combination of

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both soft and concrete services in the strengthening of families (Kinney, Haapala, & Booth 1991; Van Puyenbroeck et al. 2009). In working with families during the 1970s, Homebuilders staff and supervisors realized that most families who were reported to the agency for parent-child interaction problems, such as maltreatment or troubled adolescents, also had such basic needs as safe housing, adequate food, space for privacy within the home, and paid utilities. Attempting to work with families to achieve calm and positive social interaction patterns when children were hungry or there was no heat in the home was doomed to failure. Services therefore became very concrete in the early stages of each case. What distinguishes the intensive family preservation model and its skill-based orientation is that caseworkers do not arrange for landlords or community agencies to provide these ancillary resources. Instead, the caseworker becomes a teacher of how to do modest home repair, how to shop economically for nutritious meals for the family, and how to negotiate with landlords and others for household or community improvements. These hands-on interactions become “teaching moments” for problem solving; helping families work together; and building patience, hope, and a sense of mastery. Although families are encouraged to learn the skills to solve their own problems, the Homebuilders creators also recognize that no intervention of four to six weeks will bring all families to complete safety and positive interaction. Therefore, an important part of intervention is also introducing families to the formal and informal community resources that can continue to support the family once the shortterm service has ended. Finally, and perhaps most important, the Homebuilders founders created a list of value statements, both intensive and generic about the work of family preservation that has influenced several generations of familycentered services. Reflected in the value statements are the beliefs that the caseworker may

have expertise about problem solving and other positive techniques, but that the family also has an expertise: about its history, its view of its strengths and problems, and the way its members would like things to improve. This leveling and sharing of authority and responsibility for change is reflected in both big and small interactions between caseworker and family members. The use of caseworker authority and coercion is held to a minimum. Instead, the constant tenor of the caseworker is to build and maintain hope that the family can make positive changes and the home can be a safe place for everyone to live. Seven Principles of the Homebuilders Program

1. It is our job to instill hope. 2. We cannot know ahead of time if a situation is hopeless. 3. Clients should have as much power as possible. 4. Clients are our colleagues. 5. Respect is contagious. 6. Not knowing can be valuable. 7. We can do harm.1

Modifications and New Models of Family Preservation Services Family preservation programs can also focus on family systems and social network interventions, enhancing and enlarging a family’s relationships and social networks as a safety net and supportive circle (Bitonti 2002; Dagenais et al. 2004; Mosier et al. 2001; Nelson, Landsman, & Dentelbaum 1990). The growth of family preservation programs that seek to enhance social networks is a logical result of the evolution in family services to community-based networks and systems of care. Social network interventions utilize a case management role of the social worker in which linkages between agencies are dependent on good communication and collaboration on behalf of the family.

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Another widely adopted model of family preservation that has emerged from the University of South Carolina and Scott Henggeler, is Multi-Systemic Therapy (MST; Henggeler et al. 1993; Henggeler, Schoenwald, & Pickrel 1995). This service model was initially focused on the prevention and reduction of serious chronic delinquent and criminal behavior by adolescents. Following an extensive review of the empirical literature on the contributing factors to delinquency and on promising approaches, the MST model was developed to work with the adolescent and the multiple systems in which the adolescent is embedded (family, friends, school, and neighborhood). Highly trained therapists work intensively with the adolescent and the multiple systems to end or reduce negative relationships, learn problem solving and positive activities, and ultimately decrease or eliminate delinquent and criminal behavior. Often the therapeutic work takes place in a clinical setting rather than at the home. This tenet is based on the dedication of MST developers to controlling extraneous influences on the therapeutic process. Researchers also have an enhanced ability to monitor treatment fidelity when work takes place in a clinical setting (Henggeler, Schoenwald, & Pickrel 1995). Similarities and Differences Among Family Preservation Programs The MST and other models are consistent with the original Homebuilders principles and structures in that treatment is focused on the present, is action oriented, uses cognitivebehavioral approaches to skill building, is embedded in the home and community, and includes family members as active participants and planners in the intervention. Treatment is planned to be intensive, and practitioners have low caseloads so that they can spend the time required to produce important changes in the skills and relationships in the family. Treatment is also planned to be relatively short term, based on the cognitive-behavioral tenet that learning

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new skills does not require long-term uncovering of historical development of the problem or slow and gradual insight into current patterns of behavior. The two models diverge, however, in that MST founders are much more dedicated to monitoring and ensuring treatment fidelity and measuring therapists’ adherence to the model (Henggeler, Schoenwald, & Pickrel 1995). This commitment to monitoring treatment fidelity has enabled model proponents to identify the circumstances under which the model is effective. Historically, the inability to do this has been a critical shortcoming for the Homebuilders model. This situation has been partially addressed with Homebuilders developing a set of publicly available program fidelity measures in relation to the structure and delivery of intervention. Although the MST model has been more rigorously monitored and evaluated, the population served by MST has been more narrow, primarily limited to juvenile offenders and youth with serious emotional disturbances or antisocial behavior. A recent systematic review of MST found that the evidence for the effectiveness of MST compared with other interventions for youth was inconclusive (Littell, Popa, & Forsythe 2005). Earlier pilot expansions of the model with populations of abused and neglected children reported negligible results (Brunk, Henggeler, & Whelan 1987). Since then, the Building Stronger Families (BSF) program, based on MST, has been developed, although it has not been subject to evaluation. This program aims to eliminate parental substance abuse while keeping the child within her family or extended family (Swenson et al. 2009). There has been one randomized trial of MST, adapted for use with families in which there is physical abuse (Swenson et al. 2010). It was more effective than augmented standard community treatment in improving parental social support and more effective in reducing youth mental health symptoms, parent distress and unhelpful behavior, youth out-of-home placements,

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and changes in youth placement. It did not, however, result in significantly lower reports of re-abuse (Swenson et al. 2010). The model has continued to be widely utilized with antisocial and emotionally disturbed adolescent populations. Context Surrounding Family Preservation Programs Family Preservation and Child Maltreatment IFPS are embedded in the child welfare service array, which contains many services, including prevention of child maltreatment, investigation of allegations of child maltreatment, family support services, placement prevention, foster care, adoption, community-based mental health services, and juvenile justice services. IFPS are typically among those services provided to families who have been investigated and substantiated for child maltreatment to try to reduce or eliminate the maltreatment behaviors and thereby prevent the need for the out-of-home placement of the child. This service model is but one component of a full range of service options for families with differing needs. Thus, in the child welfare arena, IFPS are provided to families experiencing child maltreatment—physical child abuse, child neglect, sexual abuse, or a combination of these problems. In most cases family preservation programs do not serve sexual abuse cases because the most common response in such cases is to remove the perpetrator from the home. If this is not possible, then the child is usually removed from the perpetrator’s home and placed into foster care for her own protection. In such situations, family preservation is not the service of choice. Note that, among the child welfare population of families, child neglect is much more common than is abuse (Heim et al. 2010; Sedlak & Broadhurst 1996). Child neglect, or the inability or unwillingness to meet a child’s basic needs, is often associated with material poverty, as poor families often cannot adequately feed, clothe, and medically care for

their children, regardless of their intent. Once it has been determined that the children are neglected, child welfare agencies are required to serve as a general financial safety net for families in poverty. Services for these families can largely consist of securing the financial and material resources not provided to the population of families receiving general assistance. Indeed, it is anticipated that many families who have exceeded their eligibility for Temporary Assistance for Needy Families will become clients of the child welfare system when their general benefits run out (Loprest 1999). There are substantial differences in the nature of the two forms of maltreatment, abuse and neglect. Child neglect is an act of omission in which children are chronically deprived of basic needs such as food, clothing, adequate shelter, and adequate parenting practices including hygiene, health care, supervision, safety precautions, and minimal nurturing and attention. In contrast, child abuse is an act of commission, in which parents or others act violently or cruelly toward the child, including spontaneous physically injurious acts and habitual use of severe disciplinary practices. Abuse and neglect can happen to children of any age. Infants are particularly susceptible to neglect because of their inability to meet their own needs. As children grow older, physical abuse can increase until children learn ways to escape it or protect themselves (often by using their own forms of violence). Both forms of maltreatment can exist in the same family and happen to the same child. What is largely common to all forms of child maltreatment is the environmental context in which it occurs. Families who abuse or neglect their children are often overwhelmed by living in an environment bombarded by stress of all kinds. Maltreating families often have few financial resources; live in dangerous or impoverished neighborhoods; have few or stressful social relationships, including adult relationships; and have little awareness of or access to formal supports, such as child care, respite

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from parenting, recreational opportunities, and education. Although not all families who experience these stressors subsequently abuse or neglect their children, the presence of these conditions can exacerbate parenting practices that are already ineffectual. Further contributing to child maltreatment, drug and alcohol use are a common coping mechanism for overwhelmed parents. The U.S. Department of Health and Human Services (1999) estimates that 675,000 children are seriously mistreated each year by an alcoholic or drug-abusing caregiver. Furthermore, it has been found that drugs and alcohol are involved or implicated in as many as 80 percent of foster care placements in the United States (Anthony, Austin, & Cormier 2010). Finally, although poverty can be a significant contributor to familial stress and child maltreatment, abuse and neglect do not only occur in poor communities or populations in poverty. Child maltreatment can occur in families of any social status. However, those families with greater financial resources are less likely to be reported to child welfare agencies by hospital personnel who examine children for suspicious injuries or illnesses (Benbenishty et al. 2010; DePanfilis 1997; Lindsey 1994). Those families with greater resources who are reported often have access to legal representation or other alternatives to child welfare involvement. Poverty and its concomitant demons are significant factors for the families served by child welfare agencies and must therefore be concretely addressed in any attempts to reduce ongoing maltreatment. Societal Context for Family Preservation IFPS are a response to two important and alarming trends in the United States (and other counties around the world). First, the incidence of maltreatment to children has been increasing. Using a stringent Harm Standard definition, more than 1.25 million children (an estimated 1,256,600 children) experienced maltreatment

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during the NIS-4 (U.S. Department of Health and Human Services 2010) study year (2005– 2006).2 This corresponds to 1 child in every 58 in the United States. A large percentage (44 percent, or an estimated total of 553,300) were abused, while most (61 percent, or an estimated total of 771,700) were neglected. Most of the abused children experienced physical abuse (58 percent of the abused children, an estimated total of 323,000). Slightly less than one-fourth were sexually abused (24 percent, an estimated 135,300), while slightly more than one-fourth were emotionally abused (27 percent, an estimated 148,500). Almost one-half of the neglected children experienced educational neglect (47 percent of neglected children, an estimated 360,500 children), more than onethird were physically neglected (38 percent, an estimated 295,300 children), and one-fourth were emotionally neglected (25 percent, an estimated 193,400 children). Child welfare agencies can only serve those families who come to their attention, however. Of those families who are investigated for child maltreatment, a minority actually receive child welfare services. The number of children who experienced harm standard abuse declined significantly, by 26 percent, from an estimated 743,200 in the NIS-3 to 553,300 in the NIS-4 (U.S. Department of Health and Human Services 2010). About one-third of incidents reported to NIS monitors and meeting maltreatment criteria were investigated by child protective services (CPS). Although the proportion of cases investigated has decreased over time, the actual number of investigations has remained steady, suggesting that the investigative capacity of CPS is at its limit. At the same time, although the number of children going into foster care in the United States has decreased, there are more than 399,546 children in foster care in the United States (U.S. Department of Health and Human Services 2013). As the number of families reported for child maltreatment has increased,

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the demand for the system to protect these children has become critical. Second, other societal trends that exacerbate familial stress have also increased in the past decade. Unemployment rates have increased, as have rates of poverty for several segments of society. Increases in drug and alcohol use and abuse have been substantial in the past decade, and drugs and alcohol are implicated in the majority of child maltreatment reports (Anthony, Austin, & Cormier 2010). These societal conditions are not easily improved, especially by an overwhelmed and under-resourced child welfare system. The services and resources needed to address poverty, unemployment, and drug and alcohol abuse are expensive and often politically unpopular. Therefore, child welfare services and particularly “family preservation services are expected to solve major social problems, one family at a time” (Schuerman, Rzepnicki, & Littell 1994:241). It is no wonder that child welfare systems are often pressed to place children into foster care when they cannot solve or ameliorate these larger problems. Policy Context for Family Preservation Beyond their community and social contexts, family preservation services are also embedded in the policies and structures required by federal and state child welfare policy. As mentioned previously, the Adoption Assistance and Child Welfare Act of 1980 had significant and far-reaching effects on the demand for child welfare agencies to work to preserve families and provide services that could accomplish this goal in a short period of time. The act mandated that family preservation be accomplished in two years; if this has not be achieved, the public child welfare agency must initiate proceedings to terminate parental rights and locate a permanent adoptive home for the child. In 1997 the Adoption and Safe Families Act was enacted in federal legislation. In this legislation, the time frame for family preservation attempts was shortened to twelve months.

In  other words, child welfare agencies have twelve months to show that children have been safely maintained in their own homes and that the family can make it on their own, or agencies must move toward termination of parental rights and adoption of the child. Family preservation services are now faced with significantly compressed time frames in which to accomplish the remediation of significant personal, family, and community problems. Characteristics of Families Receiving Family Preservation Services Although there is no typical family in the child welfare service system or family preservation program, there are common risk factors and vulnerabilities observed in this population. The parent or associated adult has usually been found to have physically abused or neglected his child. Often, the family is headed by a single parent (usually the mother) who has multiple children younger than school age; these children are therefore in need of all-day attention. She is usually young, often less than thirty years old, and has little education beyond high school. The parenting problems center around inconsistent attention to or discipline of the children, low patience or tolerance of frustration, and inappropriate knowledge about or expectations of children’s behavior. These parental problems are intensified if the parent(s) is developmentally delayed or impaired by drug or alcohol use. Because of their history of neglect and/or abuse, the children are likely to have behavior problems. Due to limited access to health care in poor communities, they are also likely to have medical, physical, developmental, or learning disabilities that have often gone undetected by the medical community. Because the children are likely to be less than six years old, they require constant and diligent attention, a level of attention that overwhelmed mothers and fathers can seldom sustain. The more special needs that a child has, the greater the likelihood of abuse and/or neglect; family

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preservation programs are therefore highly likely to serve this population of children with special needs, which expands the range of services necessary. Environmentally, the family is often living in substandard housing and communities with poor resources. As mentioned previously, material poverty is a frequent contributor to the family stress that leads to child maltreatment. For families living in rural areas, public transportation and employment opportunities can be rare or nonexistent. The availability of such community services as mental health centers, drug and alcohol treatment centers, and day care can vary widely from community to community, but is particularly salient for families who are experiencing child maltreatment and familial stress. Resilience and Protective Factors The families served by family preservation programs also have strengths. Because IFPS are reserved for those families that are at the greatest risk of having their children placed in foster care, families in these programs are often highly motivated to change. When parents are introduced to the program, they are made to understand that this may be their last, best hope to remain a family. This realization can jolt parents into action, even though previous services of a more general or conventional nature have failed to work. Most family preservation programs operate from a strengths perspective, which posits that all families have strengths, including their expertise about how their family works and behaves, what their own hopes and dreams are for themselves and their members, and what has worked and failed in the past. Family preservation caseworkers use this expert knowledge of the family to help them craft a plan for change, including strategies to not repeat mistakes of the past, to build on past and current successes and resources, and to make sure that the plan is congruent with the hopes and dreams of the family members.

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The most critical element of success for any plan for family change, including family preservation program plans, is the engagement of family members in that plan. Therefore, family preservation caseworkers use an arsenal of techniques to assess and utilize the strengths of family members; use non-blaming and nonshaming language and practices; and constantly affirm, praise, and support members’ attempts at change and the learning of new skills. These techniques are built on recognition of the strengths and capacities of family members for change and hope, the most important assets in any family. Promising Approaches Research on formal IFPS has been performed for almost thirty years. The results have been mixed and quite controversial. Many studies have been done, plagued by the problems of questionable methodologies, comparisons of a variety of types of family preservation programs with questionable fidelity to program models, and application of IFPS to a plethora of families and problems (Berry, Bussey, & Cash 2001; Rossi 1992). Large evaluations of family preservation programs have in general found placement rates to be identical between treatment and comparison groups (Heneghan, Horwitz, & Leventhal 1996; O’Reilly et al. 2010). On close review of evaluation methodologies, one finds that the treatment and comparison groups are sometimes not equivalent, despite the best efforts to achieve random assignment (Schuerman, Rzepnicki, & Littell 1994; U.S. Department of Health and Human Services 2001), and that samples are too small to detect treatment effects (Fraser, Nelson, & Rivard 1997; O’Reilly et al. 2010; Rossi 1992). Critics have lamented the fallibility of using child placement as an outcome measure when it is also an intervention (Berry 1992; Rossi 1992; Schuerman, Rzepnicki, & Littell 1994). They have called for additional and more clinically meaningful outcome measures, including the recurrence of maltreatment and other

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measures of child and family well-being (Meezan & McCroskey 1996). Others (Besharov 1994; Gelles 1996) have blasted the wholesale adoption of such an untested or unproven approach as political ideology and cost-cutting run amok. Child welfare programs are an applied field of study: one cannot select a sample of abused and neglected children and randomly deny services to half the group so as to determine the effect of some treatment on the other half. States and agencies are federally and morally mandated to intervene in all known cases of child maltreatment. Therefore true experimental designs in the study of family preservation services are rare. Researchers and evaluators have tried creative and elaborate methods to tease out the effects of family preservation services compared to “conventional” child welfare services (which are more ill-defined than family preservation services) and to perhaps further isolate the effects of the specific service components of the service. Here we review the findings of important research in the study of intensive family preservation programs. Effectiveness of Family Preservation Programs Is intensive family preservation successful in preserving families and keeping their members safe? After receiving the service t
are families more likely than controls to be preserved? t
are families less likely to abuse or neglect their children (because preserving wellbeing and safety is at least as important as preserving family ties)? t
are families more likely than controls to be better off in terms of improved skills, conditions, and relationships? Effectiveness in Preserving Families Despite the myriad complications in the morass of program evaluations in this field, certain specific studies and methodologies helped to

tease out whether these programs are effective and, more important, what components of these programs seem to be most critical (Kirk & Griffith 2004; McCroskey & Meezan 1997; Schuerman, Rzepnicki, & Littell 1994). The most sophisticated study of IFPS has been conducted in North Carolina (Kirk & Griffith 2004). In this study, the authors examined the archival records of all families at high risk of child placement by the state’s child welfare system over a six-year period. The authors compared results for families who received IFPS with those who received conventional child welfare services. They measured whether IFPS providers were indeed faithful to the model in terms of an immediate response, short-term service, higher intensity of service in the initial weeks, and the direct provision of services between caseworker and family. They also measured whether those families receiving IFPS were indeed high risk. The IFPS families had younger parents, children with more serious injuries, more prior substantiated reports of maltreatment, and more prior placements in foster care. Thus the families receiving IFPS were a much higher-risk group for both subsequent reports of maltreatment and subsequent placement. Including only those cases demonstrating fidelity to the IFPS model, the authors found no significant difference in placement rate at one year following intake, which most past studies would have concluded as evidence of the ineffectiveness or lack of improvement of IFPS over conventional services. However, given the much higher risk present in these families, the similar placement rates are quite remarkable. Using event history analysis to control for the risk factors, the study found a significant positive effect for IFPS. As Kirk and Griffith (2004:9) put it, “when risk factors were controlled during the analysis in both treatment and comparison cases, IFPS significantly outperformed traditional child welfare services in every comparison by preventing or delaying out of home placement.”

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Who is most likely to stay out of placement or keep their children at home? The best predictor of success in family preservation services is the engagement of families (Berry, Cash, & Brook 2000; Bitonti 2002; Lewis 1991; Littell & Tajima 2000; Littell & Schuerman 2002). When families are asked what caseworker behaviors most contributed to their engagement and cooperation, they are likely to mention the early provision of concrete resources and services (e.g., household repairs, payment of utility bills, location of respite, and day care). Families are also likely to remark that family preservation caseworkers listen to them in ways that other caseworkers have not (Lewis 1991). This is assumed to be a reflection of the emphasis in family preservation services on individualized treatment, empowerment of family members to participate in case planning and goal setting, and the intensity and duration of time spent in direct contact with the family. Placement rates are lower when families say they can trust their caseworker and feel that they are treated fairly (Fraser, Pecora, & Haapala 1991). Consistent across most research of family preservation programs, families who are most successful in avoiding placement during and following family preservation are those with acute rather than chronic problems. Acute physical abuse is more likely to be successfully treated than is chronic child neglect or caregiving by developmentally delayed parents (Berry 1997; Berry, Cash, & Brook 2000; Chaffin, Bonner, & Hill 2001; McCroskey & Meezan 1997). Placement is also particularly likely when parents have not learned consistent parenting techniques during treatment (Berry, Cash, & Brook 2000). Drug-addicted parents are particularly difficult to treat in this short-term program, largely due to the incongruence of embedding long-term drug treatment in a short-term family preservation case plan. These parents have the poorest outcomes in family preservation services (Littell & Schuerman 2002). In one study, parents of a lower socioeconomic

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status were also found to have poorer outcomes (MacLeod & Nelson 2000). What kinds of children are least likely to benefit from IFPS? Children with acting-out or aggressive behavior problems are the most likely to be placed into foster care, despite having received IFPS (Bitonti 2002; McCroskey & Meezan 1997). In addition, children who have been in foster care in the past are likely to be replaced into foster care, regardless of the services they receive (Maluccio 2000; McCroskey & Meezan 1997). Children are more likely to be placed into foster care from family preservation services if they are African American, poor, and/or have an incarcerated family member (Denby & Curtis 2003; McCroskey & Meezan 1997). The characteristics of the services most associated with placement prevention are certainly important to identify. Consistently, researchers have noted the significant contribution of concrete services to placement prevention rates (Berry 1997; Chaffin, Bonner, & Hill 2001). Programs that can help meet the basic needs of families ameliorate compounded stressors. Such programs reduce the financial stress of meeting children’s basic needs and the likelihood that social workers and family court judges will assess the parents as unfit providers. In addition, the provision of concrete help early in treatment helps to show the family that the caseworker “means business” and can get things done. Findings regarding the structure of family preservation services are mixed. Some studies have found outcomes are the same regardless of whether services are delivered in three months or six months (Chaffin, Bonner, & Hill 2001). Some researchers have found that successful families are those who have received more direct service time with their caseworker (Berry, Cash, & Brook 2000), whereas others find that the longer the service is provided the more likely the outcome will be poor (perhaps reflecting more severe problems or ineffective services) (Berry, Cash, & Brook 2000). Other

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research has found no effect of service duration or intensity (Chaffin, Bonner, & Hill 2001; Littell & Schuerman 2002). Effectiveness in Increasing Safety Many evaluations of IFPS have gone beyond measuring whether families have remained intact and have examined whether children remained safe at home. Keeping children home while in continued danger of maltreatment has never been a goal of family preservation programs. Using subsequent reports of child maltreatment as the marker of service failure, results are mixed as to the ability of family preservation to prevent further abuse. In a statewide study of IFPS in Illinois in the late 1990s, Schuerman, Rzepnicki, and Littell (1994) reported that 30 percent of all cases had a report of child maltreatment subsequent to receiving IFPS. New reports of abuse were particularly likely when the family members were experiencing cocaine addiction or housing problems. No characteristics concerning the intensity or duration of the service had any effect on either child placement or continued abuse. In other words, re-abuse was no less likely whether the family had received shorterterm service or lower amounts of visits/time from their caseworker. Littell and Schuerman (2002) note cocaine addiction and housing problems as substantial “marker variables” that significantly test the ability of a short-term family preservation intervention to produce positive effects. Several studies of outcomes in child welfare services, not only those of family preservation programs, have found that good services cannot rush good outcomes (Barth & Berry 1994). Although expedience is a factor that is in the best interest of children (by reducing the harm to their sense of continuity and permanence), outcomes are less than satisfactory when services and preparations of children and families are rushed or incomplete. Studies of intensive family reunification programs (programs to support families in reunifying

with their children in foster care) have found that re-abuse is more likely when children are returned before spending six months in care (Courtney 1995). Effectiveness in Enhancing Parent, Child, and Family Well-Being Very few studies have had the resources and wisdom to measure improvements in family functioning beyond the prevention of placement and re-abuse. Asking caseworkers and families to rate family well-being at multiple points throughout the life of a case and locating field instruments sensitive enough to detect change in families within a two- to three-month time frame are daunting tasks in a clinical setting, much less in the world of highly stressed families and their caseworkers. One study that has measured gains in wellbeing among a child welfare population was conducted in Los Angeles by McCroskey and Meezan (1997). While participating in a family preservation program for an average of nineteen weeks, families and caseworkers rated families on a number of measures of well-being. By the end of treatment and at follow-up points, families participating in the intensive program had made significant improvements. For example, infants and toddlers had improved in their emotional and verbal responsiveness, and preschoolers showed improvement in learning. Children of all ages displayed reduced actingout behaviors, but these improvements were lost by one year post-treatment. Parents showed few improvements in their mental health, but showed significant improvements in their living conditions and financial stability. A multiple regression analysis (McCroskey & Meezan 1997:208) found that those families who were most likely to improve in parentchild relations following family preservation services had “parents with less severe problems at case opening who were more emotionally unstable, less likely to use good judgment, and who received help handling their financial matters.” When asked to rate what worked with

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each family, caseworkers attributed the success of the program in most cases to parental cooperation, direct service time (rather than work with collaterals), using teaching skills rather than counseling skills, and the provision of financial and housing assistance.

are not everything. But given our continuing reluctance to alter basic social arrangements and priorities that cause damage to so many children and families, we should at least commit ourselves to the objective of assuring them good quality services.”

Lessons Learned Note that many studies have identified the contribution of direct service time with the caseworker as a critical correlate of successes, including placement prevention, prevention of re-abuse, and improvement in family skills and relations. This finding lends support to the conceptualization of IFPS as a home-based, intensive, hands-on form of service in which caseworker and family members work in partnership toward mutually agreed-upon goals. Families who receive more direct service time with their caseworker say they are more cooperative and have more trust in their caseworker, and outcomes are better when families are cooperative (Littell 2001). The question remains, however, as to the benefit of short-term services. The rationale for a short-term model is the decades of research demonstrating that cognitive-behavioral techniques so critical to producing behavior change can obtain results in a short period of time when intensively and consistently applied (Halliday-Boykins & Henggeler 2001). For this reason, IFPS can be very effective when the problems are of an acute nature and center on parenting practices or interactions between family members. However, as noted previously, most of the families served by the child welfare system for child maltreatment are also besieged by more intractable problems, including poverty, unemployment, low education, mental illness, and substance abuse. These conditions are not easily solved by learning new behavior patterns within eight weeks—or even six months. As Halpern (1990:647) states: “Services cannot alter the social conditions that produce or exacerbate, and ultimately reproduce, individual and family problems. . . . Good services

Limitations of the Research One important caveat is critical when interpreting research findings about placement prevention. Those personnel and programs that deliver family preservation services are usually not the ones responsible for the primary outcome: the decision whether children are ultimately removed from their families and placed into foster care. Family court judges and review panels are the ultimate arbiters of any foster care removal; although they may take agency recommendations on family progress and safety into account in their decision to remove, they can also diverge from this recommendation. As the number of investigations of maltreatment has increased and the severity of injuries and neglectful conditions has worsened (Sedlak & Broadhurst 1996), many courts are exercising greater vigilance, placing children out of the home as a safety precaution. In these cases family preservation agencies and caseworkers may feel that families have shown adequate progress in skills and safety among their members, but the families suffer the consequences of case failure and child placement. The Problem of Treatment Infidelity The program structure and content of family preservation programs are fairly well specified and can be expensive. For example, both Homebuilders and MST recommend low caseloads and experienced and well-trained staff. The cost of serving low caseloads can be offset by the short time frame that each family is served (e.g., a caseworker can equally serve four families every three months or sixteen families for a year with the same level of effort). But, if agencies demand higher productivity, it is difficult to hold caseloads to a low level. Similarly,

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both the Homebuilders and MST models require significant time spent in direct contact between caseworker and family; meeting this requirement for extensive direct contact can be difficult if agencies require in-office supervision, staffing, court appointments, and the like. For this reason, there have been widespread modifications of the original models to fit the realities of child welfare. These modifications have driven evaluators and policy makers to distraction. Programs have reported their placement prevention rates and their prevention of re-abuse as attributed to their family preservation program, but without specific information on the structure and nature of the program. Assumptions are made about the effectiveness of family preservation programs, even though the service that was provided could be significantly watered down or no longer recognizable as IFPS. Let the buyer—or reader of these program evaluations or newspaper editorials—beware. For example, the MST model has been adopted by many agencies, some licensed to practice the model and some adopting the principles of the model without intensive training in it. In this respect, the MST model is experiencing much the same proliferation and unmonitored modification as did the Homebuilders program in the 1980s. The MST model does not yet have a strong evidence base with child welfare populations experiencing child abuse and neglect (Brunk, Henggeler, & Whelan 1987), but it has been applied to this population nonetheless. Just as for the Homebuilders model, as the MST model has gained notoriety and offered evidence of effectiveness, aspects of the model have been adopted and adapted for use in a variety of populations without the treatment fidelity emphasized by its founders. Straying from the Model Therefore let us consider program modifications that are not supported, or are at least questioned, by the findings of research and evaluation to date. Most notably, the research

findings reviewed point to the importance of low caseloads for family preservation work. The critical service component of large amounts of time spent on direct service and the teaching of skills, which leads to better client engagement, cooperation, and trust, appears to be the bedrock of efforts to prevent abuse, prevent placement, and improve family skills and relationships. The types of changes warranted for families who abuse their children do not occur easily or in partnership with strangers. The kinds of changes required of abusive or neglectful parents also do not occur in classrooms. The findings of research on family preservation and on parenting programs in general find that didactic teaching of skills, where teachers teach and parents listen, are wholly ineffective at producing lasting behavior change (Macdonald 2001). For parents to learn new skills, they need the ability to practice those skills with their children in the settings in which parenting challenges occur—the home, the car, the grocery store. For this reason, it is unwise for family preservation programs to modify their structure to include multiple referrals to didactic instruction, such as anger management or parent training classes. Given what parents say about the importance of a trusting relationship with their caseworker, it appears to be important that these skills are taught and modeled by the family preservation caseworker. Once family preservation work moves to a model of case management, the central behavioral tenets, which have been supported by research as critical to success, have evaporated. Finally, child maltreatment occurs in a social context. Family preservation work is largely carried out with impoverished families living in dangerous neighborhoods. Programs must have the capacity to address the financial problems of the families they serve, with flexible funding available to pay utility bills, repair automobiles, buy furniture, make household repairs, and the like. The solving of these concrete problems is critical to the health and well-being of family

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members and also contributes to the family’s appreciation and belief in the caseworker as an effective partner. Although caseworkers do advocate for community resources to help all families, what families say is particularly effective is that caseworkers do not hire the concrete work out to paid laborers, but work with the family or community to learn how to repair the home, furniture, or car. The result for the family is the acquisition of a concrete and lifelong skill; the result for the partnership is an increasing and visible pattern of success. Assessments and Interventions The empirical research we have reviewed provides many insights and recommendations to those contemplating working in family preservation services or with families who abuse or neglect their children. First and foremost, it is critical that caseworkers and therapists conduct a thorough and contextual assessment of the family—one that captures a family’s strengths as well as its needs. Although most instruments currently in use focus on problems and on the parent-child relationship alone, there are some instruments more appropriate to family preservation work. The North Carolina Family Assessment Scale (NCFAS; Kirk & Reed-Ashcraft 1998) was developed specifically for use with family preservation and family reunification work and captures the strengths and needs in the domains of environment, social support, parenting skills and conditions, and child wellbeing. It was ranked as one of the top three family assessment instruments in a recent review of family assessment measures (Johnson et al. 2008). The measure has high reliability and validity, and caseworkers like it (Berry, Cash, & Mathiesen 2003). A second, critical lesson learned from the empirical research on family preservation programs is the importance of using handson cognitive-behavioral methods, applied and modeled in the home with the family. Caseworkers cannot expect to be effective at changing long-standing patterns of maladaptive

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behavior by referring families to a myriad of agencies and counselors who may or may not provide congruent advice or techniques. Given the empirical evidence for the effectiveness of cognitive-behavioral techniques in changing the behaviors of maltreating parents, these are the techniques that should be applied for change to occur in a short time frame. With federal mandates for the termination of parental rights unless behavior changes within twelve months, using proven methods of change is the only ethical practice for caseworkers and therapists that is ethical with this population. The third lesson that informs effective family preservation practice is the provision of concrete supports to families and the provision of such supports in such a way that caseworkers and families develop concrete skills beyond learning to pick up the phone for help. As discussed earlier, families and caseworkers benefit in many ways from the partnership involved in securing and using concrete supports to reduce stress in families. This calls for agencies and administrators to support caseworkers in their need for concrete resources for and concrete skills with families, which may demand additional training and funding. Family preservation work is necessarily creative and sometimes odd. For caseworkers to individualize the treatment approaches and resources to the family’s needs, the caseworker must be afforded some level of autonomy and flexibility. For caseworkers to be in the home when problems are occurring, their work hours will primarily be after hours and on weekends, in the homes and communities where families live. The resources and materials deemed relevant to family goals may be unorthodox, but when past methods and resources have not been effective it is time to try new approaches. Finally, family preservation work cannot and should not be provided as a case management model. The intensity and creativity demanded, as well as the constant modeling of positive patterns of interaction between family

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members, calls for a hands-on approach by a dedicated caseworker or team. Asking families to attend multiple services at multiple agencies around the community violates many assumptions and proven tenets of the model. This type of case management approach may be effective with families with fewer needs or those who are suffering fewer stressors related to imminent child removal, but will not work to preserve and strengthen families at this level of need. Ethical Issues and Value Dilemmas Is family preservation in the best interest of the child? Not always. As mentioned earlier, IFPS are but one program model in the entire array of child welfare services available to families; IFPS should not be provided to all families entering the child welfare system. There are children for whom immediate removal and placement into foster care is the correct decision—children who are not safe at home and cannot be made safe at home in the near future. There are families for whom less intensive, less expensive service options are appropriate, such as those families who do not need the intensity or intrusion of a home-based practitioner following them to the kitchen or grocery store to model new patterns of behavior. Given the proven ineffectiveness of family preservation models with parental drug addiction and homelessness, it is necessary to rethink the approach to these families when maltreatment is the presenting issue. Shortterm solutions have not been shown to be effective, regardless of the intensity. Problems of addiction, mental illness, and poverty are chronic conditions, not maladaptive behavior patterns easily overcome by learning new behavior responses to stress. The child welfare system continues to be challenged to develop new responses to these problems that will not result in the wholesale removal of children from large segments of the population. So when and how do we decide to move toward the termination of parental rights? Is

parental drug involvement the death knell for a child’s connection to his family? Under current federal legislation, it is. Can we find new homes, even kinship homes, for all the children affected by parental drug abuse? What about chronic neglect, often accompanied by parental mental delay or illness, particularly depression? Children are to be placed in a new family if their parents cannot overcome these problems within twelve months. Can intensive family preservation programs treat mental illness and developmental delays of parents in such a short time frame? If not, are we cheating children by delaying their inevitable removal? These are the thorny questions facing advocates for children and families who are trying to find sturdy solutions for these fragile families (Halpern 1990). YYY

Family preservation is an individualized model of services that specifies the use of particular skills and techniques. It is not merely a goal or a wish that families can remain safely together when experiencing child maltreatment. Practicing a family preservation approach means that agencies and caseworkers have low caseloads, work intensively with families in the setting in which problems are occurring, and use cognitive-behavioral techniques to produce behavior change in a short time frame. In addition, the home-based practitioner access community resources to support families that experience more than the usual familial stresses and work creatively with each family to craft a plan that addresses their specific challenges and uses their particular strengths. All of these tenets of the model are jeopardized by a political arena that is not family friendly, particularly to families who have issues with substances, mental illness, or other long-term problems. IFPS can only be one approach, reserved for those families who can benefit from short-term cognitive-behavioral home-based treatment. For families with more chronic, intractable problems, it is imperative

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that longer-term and broader societal solutions be identified and implemented. Current legislative mandates that terminate parental rights to children in short order may be seen as in the best interests of children’s need for safety, but

the severing of the connection between parent and child, physical and emotional, is not to be taken lightly. Family relationships are basic, complicated, and enigmatic: this is no place for a rush to judgment.

NOTE

Bitonti, C. (2002). Formative evaluation in family preservation: Lessons from Nevada. Children and Youth Services Review, 24, 653–72. Bribitzer, M., & Verdieck, M. (1988). Home-based, family-centered intervention: Evaluation of a foster care prevention program. Child Welfare, 67, 255–66. Brunk, M., Henggeler, S., & Whelan, J. (1987). A comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 311–18. Chaffin, M., Bonner, B., & Hill, R. (2001). Family preservation and family support programs: Child maltreatment outcomes across client risk levels and program types. Child Abuse and Neglect, 25, 1269–89. Courtney, M. (1995). Reentry to foster care of children returned to their families. Social Service Review, 69, 226–41. Dagenais, C., Begin, J., Bouchard, C., & Fortin, D. (2004). Impact of intensive family support programs: A synthesis of evaluation studies. Children and Youth Services Review, 26, 249–63. Denby, R., & Curtis, C. (2003). Why special populations are not the target of family preservation services: A case for program reform. Journal of Sociology and Social Welfare, 30, 149–74. DePanfilis, D. (1997). Intervening with families when children are neglected. In H. Dubowitz (ed.), Neglected children: Research, practice and policy. Thousand Oaks, CA: Sage. Fraser, M., Nelson, K., & Rivard, J. (1997). Effectiveness of family preservation services. Social Work Research, 21, 138–53. Fraser, M., Pecora, P., & Haapala, D. (1991). Families in crisis: The impact of intensive family preservation services. New York: Aldine de Gruyter. Gelles, R. (1996). The book of David: How preserving families can cost children’s lives. New York: Basic Books. Halliday-Boykins, C., & Henggeler, S. (2001). Multisystemic therapy: Theory research and practice. In E. Walton, P. Sandan-Beckler, & M. Mannes (eds.), Balancing family-centered services and child well-being. New York: Columbia University Press. Halpern, R. (1990). Fragile families, fragile solutions: An essay review. Social Service Review, 64, 637–48. Heim, C., Shugart, M., Craighead, W., & Nemeroff, C. (2010). Neurobiological and psychiatric consequences of child abuse and neglect. Developmental Psychobiology, 671–90. DOI 10.1002/dev.20494.

1. These principles come from Kinney, Haapala, & Booth (1991), p. 62. 2. NIS have been conducted approximately once each decade. REFERENCES

Adoption and Safe Families Act. (1997). P.L. 105–89. Anthony, E., Austin, M., & Cormier, D. (2010). Early detection of prenatal substance exposure and the role of child welfare. Children and Youth Services Review, 32, 6–12. AuClaire, P., & Schwartz, I. (1987). Are home-based services effective? A public child welfare agency’s experiment. Children Today, 16, 6–9. Barth, R., & Berry, M. (1994). Implications of research for the welfare of children under permanency planning. In R. Barth, J. Berrick, & N. Gilbert (eds.), Child welfare research review (vol. 1). New York: Columbia University Press. Benbenishty, R., Davidson-Arad, B., Chen, W., Glasser, S., Tzur, S., & Lerner-Geva, L. (2010). The decision of hospital-based child protection teams to report to community child protective services. British Journal of Social Work, 1–19, doi:10.1093/ bjsw/bcq133. Berry, M. (1992). An evaluation of family preservation services: Fitting agency services to family needs. Social Work, 37, 314–21. Berry, M. (1997). The family at risk: Issues and trends in family preservation services. Columbia: University of South Carolina Press. Berry, M., Bussey, M., & Cash, S. (2001). Evaluation in a dynamic environment: Assessing change when nothing is constant. In E. Walton, P. Sandau-Beckler, & M. Mannes (eds.), Balancing family-centered services and child well-being. New York: Columbia University Press. Berry, M., Cash, S., & Brook, J. (2000). Intensive family preservation services: An examination of critical service components. Child and Family Social Work, 5, 191–203. Berry, M., Cash, S., & Mathiesen, S. (2003). Validation of the strengths and stressors tracking device with a child welfare population. Child Welfare, 82, 293–318. Besharov, D. (1994). Looking beyond 30, 60, 90 days. Children and Youth Services Review, 16, 445–52.

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Heneghan, A., Horwitz, S., & Leventhal, J. (1996). Evaluating intensive family preservation services: A methodological review. Pediatrics, 97, 535–42. Henggeler, S., Melton, G., Smith, L., Schoenwald, S., & Hanley, J. (1993). Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2, 283–93. Henggeler, S., Schoenwald, S., & Pickrel, S. (1995). Multisystemic therapy: Bridging the gap between university- and community-based treatment. Journal of Consulting and Clinical Psychology, 63, 709–17. Johnson, M., Stone, S., Lou, C., Vu, C., Ling, J., Mizrahi, P., et al. (2008). Family assessment in child welfare services: Instrument comparisons. Journal of Evidence-Based Social Work, 5, 57–90. Kinney, J., Haapala, D., & Booth, C. (1991). Keeping families together: The Homebuilders model. Hawthorne, NY: Aldine de Gruyter. Kinney, J., Madsen, B., Fleming, T., & Haapala, D. (1977). Homebuilders: Keeping families together. Journal of Consulting and Clinical Psychology, 45, 667–73. Kirk, R., & Griffith, D. (2004). Intensive family preservation services: Demonstrating successful placement prevention using event history analysis. Social Work Research, 28, 5–15. Kirk, R., & Reed-Ashcraft, K. (1998). User’s guide for the North Carolina Family Assessment Scale, version 2.0. Chapel Hill: University of North Carolina School of Social Work, Jordan Institute for Families. Lewis, R. (1991). What are the characteristics of intensive family preservation services? In M. Fraser, P. Pecora, & D. Haapala (eds.), Families in crisis: The impact of intensive family preservation services. Hawthorne, NY: Aldine de Gruyter. Lindsey, D. (1994). The welfare of children. New York: Oxford University Press. Littell, J. (2001). Client participation and outcomes of intensive family preservation services. Social Work Research, 25, 103–13. Littell, J., Popa, M., Forsythe, B. (2005). Multisystemic therapy for social, emotional, and behavioral problems in youth aged 10–17. Campbell Systematic Reviews 2005:1. DOI: 10.4073/csr.2005.1. Littell, J., & Schuerman, J. (2002). What works best for whom? A closer look at intensive family preservation services. Children and Youth Services Review, 24, 673–99. Littell, J., & Tajima, E. (2000). A multilevel model of client participation in intensive family preservation services. Social Service Review, 74, 405–35. Loprest, P. (1999). Families who left welfare: Who are they and how are they faring? Assessing the New Federalism (pp. 122–34). Washington, DC: Urban Institute. McCroskey, J., & Meezan, W. (1997). Family preservation and family functioning. Washington, DC: Child Welfare League of America.

Macdonald, G. (2001). Effective interventions for child abuse and neglect. Chichester, NY: Wiley. MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse and Neglect, 24, 1127–49. Maluccio, A. (2000). Foster care and family reunification. In P. Curtis, G. Dale, & J. Kendall (eds.), The foster care crisis: Translating research into policy and practice. Lincoln: University of Nebraska Press. Meezan, W., & McCroskey, J. (1996). Improving family functioning through intensive family preservation services: Results of the Los Angeles experiment. Family Preservation Journal, 1, 9–31. Mosier, J., Burlingame, G., Wells, M., Ferre, R., Latkowski, M., Johansen, J. M., Peterson, G., & Walton, E. (2001). In-home, family-centered psychiatric treatment for high-risk children and youth. Children’s Services: Social Policy, Research, and Practice, 4, 51–68. Nelson, K., Landsman, M., & Dentelbaum, W. (1990). Three models of family-centered placement prevention services. Child Welfare, 71, 177–88. O’Reilly, R., Wilkes, L., Luck, L., Jackson, D. (2010). The efficacy of family support and family preservation services on reducing child abuse and neglect: What the literature reveals. Journal of Child Health Care, 14, 82–94. DOI: 10.1177/1367493509347114. P.L. 96–272, (Title IV-E), Adoption Assistance and Child Welfare Act. Rossi, P. (1992). Assessing family preservation programs. Children and Youth Services Review, 14, 77–97. Schuerman, J., Rzepnicki, T., & Littell, J. (1994). Putting families first. Hawthorne, NY: Aldine de Gruyter. Sedlak, A., & Broadhurst, D. (1996). Executive summary of the Third National Incidence Study of Child Abuse and Neglect. Washington, DC: National Clearinghouse on Child Abuse and Neglect. Swenson, C., Schaeffer, C., Hengeler, S., Faldowski, R., & Mayhew, A. (2010). Multisystemic Therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology, 24, 497–507. Swenson, C., Schaeffer, C., Tuerk, E., Henggeler, S., Tuten, M., Panzarella, P., Lau, C., Remmele, L., Foley, T., Cannata, E., & Guillorn, A. (2009). Adapting Multisystemic Therapy for co-occurring child maltreatment and parental substance abuse: The Building Stronger Families Project. Emotional and Behavioral Disorders in Youth, Winter, 3–8. U.S. Department of Health and Human Services (1999). Blending perspectives and building common ground: A report to Congress on substance abuse and child protection. Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services (2001). Evaluation of family preservation and reunification programs. Washington, DC: U.S. Department of Health and Human Services.

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U.S. Department of Health and Human Services (2010). The fourth national incidence study of child abuse and neglect (NIS-4). Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services (2013). Adoption and foster care analysis and reporting system (AFCARS) report: Preliminary FY 2012. Retrieved

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from http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report20.htm. Van Puyenbroeck, H., Loots, G., Grietens, H., Jacquet, W., Vanderfaeillie, J., & Escudero, V. (2009). Intensive family preservation services in Flanders: An outcome study. Child and Family Social Work, 14, 222–32.

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his chapter will address child sexual abuse allegations, investigations, and interventions, focusing on how they are handled in the child welfare system. Since child sexual abuse is also a crime and requires multiagency collaboration, attention will be given to how the criminal justice system and other systems interface with the child welfare system on sexual abuse cases. Estimates are that about half of sexual abuse cases are intrafamilial; they involve a child’s caregiver as the abuser (e.g., father or stepfather) or as being neglectful and not preventing sexual abuse (e.g., when a babysitter is the abuser and the caregiver has knowledge of the abuse) (e.g., Faller 2003). The remainder of sexual abuse cases are extrafamilial. In most communities the child welfare system is only responsible for intrafamilial cases. Extrafamilial cases are handled solely by law enforcement, but, since law enforcement also has responsibility for intrafamilial sexual abuse, child protective services and law enforcement are intended to work together on intrafamilial cases of sexual abuse (Pence & Wilson 1994). Definition of Child Sexual Abuse The definition of sexual abuse found in the CAPTA, the Federal Child Abuse Prevention and Treatment Act, is as follows: the term “sexual abuse” includes—“the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the

purpose of producing a visual depiction of such conduct”; or “the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children” (CAPTA 2010). For states to be eligible for federal discretionary funds, their state statute definition must be consistent with the federal one.

Child welfare professionals, however, further define sexual abuse in terms of 1. the types of the sexual acts and 2. criteria for differentiating an abusive versus a nonabusive sexual encounter. Types of Sexual Acts Although definitions vary somewhat, generally sexual acts include 1. non-contact behavior (voyeurism, making sexually explicit remarks, exposure of private parts, and sexually explicit Internet content); 2. sexual contact (touching of the breasts, vagina, penis, and anus); 3. oral sexual acts (tongue kissing, cunnilingus, fellatio, analingus); 4. sexual penetration (digital, penile, and object penetration of the vagina and anus; and 5. sexual exploitation (child prostitution, child pornography). Sexual contact, oral sex, and sexual penetration may involve the offender committing the act against the child or requiring the child to engage in the act on the body of the offender. When children view sexual content on the Internet, caregivers may be defined as neglectful and as inadequately supervising their children. There is also an increased incidence and awareness of Internet crime involving sexual exploitation of children 288

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(Finkelhor, Mitchell, & Wollack 2000), but in these instances the offenders are usually not the child’s caregivers. Nonetheless, caregivers may be viewed as neglectful because they did not protect their children from exploitation. Defining an Encounter as Abusive Sexual acts 1–4 are neither abusive nor illegal when they involve consenting adults. For the act to be considered abusive, the sexual act is usually characterized by an age differential between offender and the child victim, a knowledge differential between offender and victim, a power differential, and lack of victim informed consent. States vary in the maximum age for child protective services, usually seventeen; Tribal Law and Order Act (TLOA) (Public Law 111-211). As a rule, child sexual abuse is defined as sexual acts involving a child (a person under the age of eighteen) and a person five or more years older than the child. The child is often naive about the meaning of the act (its sexual nature and/or that it is a crime), but the offender is not. Although the offender may use a variety of inducements to engage the child, such as saying the act is a game or is educational, ultimately the offender has greater physical and psychological power than the child. Some acts are physically pleasant for the child, but abusive acts are primarily for the sexual gratification of the offender. Finally, even though the child may agree to the act, because of lack of knowledge and power, the child cannot provide informed consent to the sexual act (Finkelhor 1979). Demographic Patterns for Children, Youth, and Families Affected Sexual abuse cases currently represent about 10 percent of annual reports of child maltreatment as found in the National Child Abuse and Neglect Data System (NCANDS 2011). Sexual abuse reports increased from 1976, when national data were first collected (3 percent of reports, 6,000 cases) until 1986 (15 percent of reports, 132,000 cases; American Association for the Protection of Children 1985–89.

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There were then three years with no national federal government reports of child maltreatment while the Children’s Bureau developed the NCANDS (Faller 2003). In 1990, when NCANDS data first became available, sexual abuse still represented 15 percent of reports. However, since the early 1990s, the number of reports of child sexual abuse has declined (Finkelhor & Jones 2006). There have been comparable declines in reports of physical abuse, but not of neglect (Sedlak et al. 2010). Other than providing incidence rates for sexual abuse, the NCANDS (2011) provides little information about the demographic patterns of child sexual abuse. The National Incidence Studies (NIS-1, 2, 3, 4) do, however; NIS studies gather data from a nationally representative sample of “sentinals,” professionals who are mandated reporters. Data collection involves queries of sentinals about how many child maltreatment cases they encountered in a threemonth period and how many were reported. The research compares sentinel identification and child welfare system responses, uses sentinel reports to make national projections, and provides findings on characteristics of different types of child maltreatment, including child sexual abuse (Sedlak et al. 2010). In addition, knowledge of sexual abuse comes from studies of representative samples and special populations of adults, who are asked about their sexual abuse during childhood (e.g., Kilpatrick & Saunders 1999; Russell & Bolen 2000), and a few telephone surveys of youth, which ask them about their experiences of victimization, including sexual abuse (Finkelhor 2008). These studies can inform us about the prevalence, risk factors, and characteristics of child sexual abuse. Finally, there are studies of sexual offenders, who may be incarcerated or in treatment, that shed some light on the problem of sexual abuse (e.g., Abel, Mittelman, & Becker 1985; Prentky, Knight, & Lee 2006). Unlike physical abuse and neglect, there is scant evidence that sexual abuse is related to the stress and circumstances of poverty and

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disadvantage (Finkelhor & Baron 1986; Russell & Bolen 2000). Research and practice suggest that the primary causes are 1. sexual arousal to children on the part of the offender, which may be circumstantial and/or fixed, and 2. the offender’s willingness to act on the arousal (Faller 1988, 2003; Lanning 2001; Prentky, Knight, & Lee 2006). This is not to say that family and environmental factors do not contribute to the risk of sexual abuse, but they are not prerequisites (Faller 1988). Despite the lack of association between sexual abuse and poverty/disadvantage, cases of sexual abuse that come to the attention of the child welfare system are more likely to involve poor and disadvantaged families because these cases are more likely to come to the attention of professionals who comply with reporting statutes (Sedlak et al. 2010). Similarly, child sexual abuse does not appear to be related to race (Finkelhor 1994a, b; Russell, Schurman, & Trocki 1988). There are, however, cultural differences in how sexual abuse is perceived, experienced, and responded to (Fontes 1995; Fontes & Faller 2007; Fontes & Plummer 2010). Thus there are no risk differentials based upon racial identity. Virtually every study finds that girls are at greater risk for sexual abuse than boys. In terms of prevalence, Bolen and Scannapieco’s meta analysis (Bolen & Scannapieco 1999) found that between 30–40 percent of females experience sexual abuse during childhood. There are fewer studies of male sexual abuse victimization, but estimates are that between 8 and 20 percent of males are sexually victimized during childhood (Bolen & Scannapieco 1999; Finkelhor 1979; Gorey & Leslie 1997). Regarding incidence rates, approximately 80 percent of reports involve female victims, and 20 percent males (Finkelhor & Baron 1986; Sedlak et al. 2010). However, boy victims may be less willing to self-identify as victims than girls, and, because of gender differences in sexual socialization, boys may be less likely to perceive a sexual encounter with an adult as an assault than

girls and may experience it as an “opportunity for sex” (Faller 2003; Finkelhor & Baron 1986). Perpetrators of sexual abuse are predominantly males, an estimated 90–95 percent being males (Russell & Bolen 2000). In the NIS-4 study, 87 percent of offenders were males (Sedlak et al. 2010). However, there are concerns that both professionals and the public fail to recognize female sex offenses and that many acts by female perpetrators go undetected because they occur in the privacy of the home (Faller 1995). There is some evidence that children living with only one of their parents are at greater risk for sexual abuse (Finkelhor & Baron 1986; Moore, Gallup, & Schussel 1995; Sedlak et al. 2010). This increased risk may derive from having a stepfather, the fact that a mother has a nonrelated partner (either live-in or not), or the fact that children in single-parent families live in changing and unpredictable circumstances. Societal Context of Child Sexual Abuse Although child sexual abuse is against the law and clearly considered abusive behavior, experts in sexual abuse note cycles of disbelief and belief of sexual abuse reports. These cycles characterize both professional and the public responses (Mildred 2003; Olafson, Corwin, & Summit 1993). The influence of Sigmund Freud and psychiatry contextualizes these cycles. Freud is considered to be the father of psychoanalysis and, arguably, of psychotherapy (Brill 1938; Brown 1972). In 1896 Freud gave a paper entitled “The Aetiology of Hysteria,” in which he proposed that the origin of hysterical illness, a mental illness currently labeled a somatoform disorder (DSM-IV-TR 2000:485), was traumatic sexual abuse during childhood. His paper received a chilly reception from his Viennese colleagues (Masson 1984). In 1905 he formally retracted the theory that his patients had experienced actual sexual abuse and proposed instead that their reported experiences were oedipal fantasies—that is, wishes to have sex with the named adult (Masson 1984).

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This recasting of the alleged victim into a perpetrator and alleged perpetrator into a victim had a profound effect on views about sexual abuse allegations. Based upon Freud’s later work and writings, for more than fifty years mental health professionals believed that the overwhelming majority of children’s accusations of sexual abuse had their basis in fantasy (Faller & Corwin 1995; Lipian, Mills, & Brantman 2004; Masson 1984; Olafson, Corwin, & Summit 1993). Child sexual abuse, especially intrafamilial sexual abuse, was considered a rare penomenon (Riemer 1940). After the passage of the Child Abuse Prevention and Treatment Act in 1974, sexual abuse cases began to be reported in increasing numbers. Ironically, child protection investigators, most of whom were not trained in Freudian psychology, did not initially approach such allegations with skepticism. They “believed the child” (Faller 1988). The “believe the child” response to sexual abuse reports, however, was short-lived. In the late 1980s and early 1990s, Child Protective Services (CPS) experienced a general backlash (Hechler 1988; Myers 1994). The system was criticized for both overreaching and incompetence. Most of the criticism was directed toward the handling of child sexual abuse allegations (Finkelhor 1994a, b; Myers 1994). Myers identified three reasons for the particular focus on child sexual abuse: 1. the degree of emotion generated by sexual abuse of children, 2. society’s blind spot (about child sexual abuse), and 3. the failings of the child protection system (Myers 1994b:19). Faller (1993) identified competing affective responses to child sexual abuse, “rage” (how could someone commit the heinous act of sexual abuse on a child?) and “denial” (no one would sexually abuse a child), as playing an important role in the pendulum swing between belief and disbelief. However, very important in the backlash is the fact that middle-class and prominent people were being accused of sexually abusing children, persons with power and resources (e.g., Michael Jackson and Woody Allen). In

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addition, the backlash was fueled by a number of multivictim cases with a great deal of media coverage (e.g., the McMartin preschool case in Manhatten Beach, California. These cases challenged belief in a way that the more typical case (a one-time instance of sexual abuse of a single child) does not (Berliner & Loftus 1992). Subsequent to the backlash of the late 1980s and early 1990s, cases involving sexual abuse by clergy, focusing primarily on Roman Catholic clergy, have decreased skepticism about child sexual abuse. In large part because of the role of investigative journalists, beginning in 2002 clergy sexual abuse began to be taken seriously (e.g., Bruni & Burkett 2002; Goodstein, Zirilli, & New York Times research staff 2003). In that year the U.S. Conference of Catholic Bishops commissioned a study of church records conducted by the John Jay College of Criminal Justice (Terry 2010). This study spanned records from the years 1950–2002 and documented sexual abuse cases involving more than four thousand Catholic clergy and over ten thousand children. Clergy abuse cases are not usually handled by Child Protective Services, but their documentation moderated the backlash and skeptical response to allegations of child sexual abuse. Nevertheless, certain types of cases, for example those involving parents who are not together and may be adversarial, are especially likely to encounter a skeptical response by child protection workers when they are reported (McGraw & Smith 1992). Current Policies at Federal and State Levels CAPTA has a “sunset clause,” that is, it is time limited. Thus, it requires periodic reauthorization (Child Welfare Information Gateway 2011). Altogether there have been eleven reauthorizations and amendments, the most recent being in December 2010. These changes frequently involve the inclusion of new policy or the refinement of existing policy. Policy updates may also be made via other federal child welfare

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statutes, for example, the Victims Compensation and Assistance Act of 1984 (VOCA).

may result in the child being a less distraught witness (TF-CBT WEB 2005).

The “Criminalization” of Child Sexual Abuse Policy changes related to sexual abuse have shifted the child welfare response from treating this type of maltreatment as a parental problem to responding to it as a crime. Changes include fostering joint investigations of sexual abuse allegations by child protection and law enforcement, the development of sex offender registries, and not requiring reasonable efforts toward family reunification when sexual abuse has been proven in the child protection court (CAPTA 2010). An unanticipated outcome of these changes has been some goal displacement in the child welfare system. The priority goal of the sexual abuse investigation and intervention has shifted from child safety, permanence, and well-being to gathering information for successful criminal prosecution. Although statutory changes have played a role in this shift, so has the relative status of child welfare professionals (lower) and legal professionals (higher) and differences in their cultures (problem solving versus confrontation) (Faller & Vandervort 2007). Because, in most criminal cases, the child must testify in court, the child’s role may be transformed from a victim in need of protection and treatment to a vehicle for proving the criminal case. Law enforcement and the prosecutor may dictate interventions. Emphasis during the investigative interview of the child may shift from what is most helpful for the child to what is “forensically defensible” in a criminal court. Criminal litigation is often protracted. Research indicates that delays in the court process exacerbate child trauma (Runyan et al. 1994). Sometimes a prosecutor delays the child’s individual or group treatment to avoid the defense’s challenge that the child’s account has been contaminated as well as to try to ensure that the child will be emotional on the witness stand. Since one goal of treatment is to address the child’s emotional dysregulation, treatment

Children’s Advocacy Centers Another important policy and programmatic innovation has been the development of Children’s Advocacy Centers (CACs; National Children’s Advocacy Center 2011). Although the primary goal of CACs is to gather information for criminal prosecution, CACs also focus on the child. The core concept is that the child should come to one child-friendly place (the CAC) for all of the investigative procedures: a forensic interview conducted by a skilled interviewer and a medical exam conducted by a medical professional experienced in conducting child abuse medical exams. Usually CACs have multidisciplinary teams, led by the prosecutor, but involving child protective services, law enforcement, a victim advocate, and sometimes mental health professionals who can provide treatment. These professionals may be behind a one-way mirror observing the child’s forensic interview or the interview may be videotaped for later viewing by key professionals. Goals of CACs also include minimizing the number of times the child is interviewed and coordinating case intervention (National Children’s Advocacy Center 2011). The first CAC was developed by the district attorney in Huntsville, Alabama, Bud Cramer, in 1984 (National Children’s Advocacy Center 2011). The concept caught on, and soon there was a loose network of twenty-three CACs (National Children’s Alliance 2006). Children’s Advocacy Centers received national recognition and federal financial support when District Attorney Cramer became U.S. Congressman Cramer. In 1992 Cramer persuaded his colleagues in Congress to add a provision to the Victims of Child Abuse legislation funding CACs (Faller & Palusci 2007). Today there are over seven hundred seventy-five CACs accredited by the National Children’s Alliance (NCA), which is a membership organization of CACs (NCA: 2013). The NCA website reports that in 2012 Childrens

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Advocacy Centers served primarily sexual abuse victims (65 percent of total children served). The NCA sets standards for membership and administers the federal funds to support CACs. Standards that must be satisfied include 1. a multidisciplinary team, 2. cultural competency and diversity, 3. forensic interviews, 4. victim support and advocacy, 5. medical evaluations, 6. some mental health services, 7. case review, 8. case tracking, 9. organizational capacity, and 10. a child-focused setting. These standards are intended to engender uniformity in CACs, but in fact there is considerable variability because of the venues where centers are located and the differences in the professions instrumental in each center’s development. CACs may be freestanding entities, located in hospitals, found in treatment agencies, under the umbrella of the prosecutor’s office, or a part of child protective services. Professionals instrumental in their development include child protection staff, prosecutors, mental health professionals, medical professionals, and police. A challenge faced by communities as they develop CACs is how the CAC interfaces with the mandated institutions (child protective services and law enforcement) on child sexual abuse cases. Despite the popularity of and federal funding for CACs, there was no evaluation of the CACs until 2002 (Jones et al. 2007), when the Department of Justice funded their national evaluation. By that time there were over 600 CACs and collecting data on outcomes for all of them was not feasible. The researchers used a design in which they selected four well-established CACs and matched them with contiguous jurisdictions without CACs (e.g., Cross et al. 2007). The evaluation involved case record reviews of over 1,000 cases (Cross et al. 2007) and qualitative interviews with 203 parents and 65 youth (Jones et al. 2007). Thus, despite the limited number of jurisdictions involved, this evaluation was a very complex undertaking. Selected findings follow. With regard to whether the investigation took place in a child-friendly environment, 85 percent of CAC

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investigations did, whereas in non-CAC communities investigative interviews occurred in the family home, in the CPS office, or at the police station. CAC investigations were more likely to involve both CPS and law enforcement (Cross et al. 2007). In the CAC and comparison counties, children typically experienced two or fewer interviews. However, the mean number of interviews at CACs was significantly higher (1.42) than non-CAC communities (1.29, p < .05) (Faller & Palusci 2007). That said, more than a single interview by the same professional is not problematic (Faller 2007:51–53; Faller & Palusci 2007). There were too many missing data to examine whether CAC investigations were more likely to result in criminal prosecution. When CAC and non-CAC data are combined, 329 cases had sufficient information to determine whether criminal charges were filed. The researchers determined that cases with evidence in addition to the child’s disclosure (e.g., confession, an eye witness, physical evidence) were more likely to result in criminal charges (Walsh et al. 2010). Children interviewed at CACs were twice as likely as non-CAC children to receive a medical exam (Walsh et al. 2007). Finally, in general, parents were more satisfied with CAC investigations than non-CAC investigations, but the only difference found for children was that they were less scared if they were interviewed at a CAC (Jones et al. 2010). Evidence-Based Interventions The salience of child sexual abuse in child welfare has led to important innovations. Two evidence-based interventions will be discussed in this section, forensic interview protocols and trauma-focused cognitive behavior therapy. These interventions subsequently have been applied to other types of child maltreatment. Forensic Interviewing One of the positive outcomes of the backlash of disbelief of sexual abuse reports was the development of better strategies for investigation of sexual abuse cases. When child protection

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workers began to encounter sexual abuse reports in the late 1970s, they lacked skills for investigation (Faller 1988). These workers and others interviewing possible sexual abuse victims were charged with “confirmatory bias,” that is, only gathering data to support sexual abuse. They were also accused of asking leading and suggestive questions (e.g., Ceci & Bruck 1995). What emerged out of this challenge to child protection was a series of efforts to develop forensic interviewing protocols (e.g., American Professional Society on the Abuse of Children 1997; Bourg et al. 1999; Carnes & LeDuc 1998; Davies et al. 1996; Faller 2003, 2007; Merchant & Toth 2001; Poole & Lamb 1998; Yuille 2002). A major purpose of these protocols is to avoid an interview that might lead to a false accusation (Faller 2007). Interview protocols specify phases of the interview and vary in flexibility from completely scripted to allowing interviewer discretion. A useful way to conceptualize the interview structure is as having a beginning (introduction of interviewer and purpose of the interview, ground rules, rapport building, and practicing narratives); a middle (inquiry about abuse with follow-up probes); and an end (ascertaining other sexual abuse, providing closure, and giving information about next steps) (Faller 2007:66–67). Interview protocols specify phases of the interview and vary in flexibility from completely scripted to allowing interviewer discretion. Forensic interview protocols also define appropriate types of questions and differ somewhat in what are considered appropriate questions. Nevertheless, there is general agreement that open-ended questions and probes (e.g., “Tell me the reason you came to talk to me today”), which are more likely to elicit a narrative response and accurate information, are preferred. Protocols then advise either narrative cues (e.g., “Say more about that.” “Then what happened?”) (e.g., Faller 2007; Lamb, Orbach, Hershkowitz, Esplin, & Horowitz 2007) or “wh” questions (e.g., “Where were other people?” “What room were you in?” Bourg et al. 1999).

Most protocols advise using yes/no and multiple choice questions sparingly because they do not elicit a narrative account. Finally, most protocols warn against the use of leading questions (e.g., “Isn’t it true that Mr. Jones touched your peepee?”) because they may elicit false positives (e.g., Faller 2007; Lamb et al 2007). Despite the proliferation of protocols, by far the most influential and evidence based is the National Institute of Child Health and Human Development (NICHD) forensic interview protocol (Lamb et al. 2007). The NICHD protocol was built upon child development research (Lamb & Sternberg 1999). Moreover, NICHD researchers have partnered with frontline investigators in order to conduct field studies of their protocol. These partnerships have been developed in the U.S. (Salt Lake City), Quebec, England, and Israel (e.g., Lamb et al. 2009; Lamb et al. 2007). The most impressive partnership has been with Israel, where Israeli youth investigators (the equivalent of child protection workers) conduct investigative interviews of children when there are allegations of intrafamilial and extrafamilial physical and sexual abuse using the NICHD protocol. These interviews are audiotaped and therefore can be transcribed for analysis. In addition, these researchers have a data bank that includes over twenty-five thousand physical and sexual abuse cases interviewed by Israeli youth investigators over a five-year period (Hershkowitz, Horowitz, & Lamb 2005). These U.S. and international research collaborations have resulted in dozens of articles and several books (e.g., Pipe, Lamb, Orbach, & Cederborg 2007; Lamb et al. 2008) that demonstrate the utility of the NICHD protocol and answer pressing questions about how best to interview a child when sexual abuse is suspected (e.g., Hershkowitz et al. 2006; Lamb, Orbach, Hershkowitz, Horowitz, & Abbott 2007). Today, in most jurisdictions, part of the child protection new worker training involves instruction on how to conduct a forensic interview. Some states have a forensic interview protocol that workers are required to follow

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when they interview a child about sexual abuse (e.g., Michigan Forensic Interview Protocol 2011). Treatment for Sexual Abuse Victims Beginning when children were identified as having been sexually abused in the 1980s, the assumption was that they needed treatment (Staller & Faller 2010). However, unlike that for sex offenders (see, for example, the Association for the Treatment of Sexual Abusers Web site, ATSA), there was little attention to the treatment’s type and effectiveness. In the 1990s, initiatives by the National Center on Child Abuse and Neglect (a program of the Children’s Bureau) and the National Institute of Mental Health (one of the National Institutes of Health) funded research to study the treatment of sexually abused children. Universitybased programs, using cognitive behavioral approaches to sexual abuse treatment, received this support. They shared findings, and out of these collaborations came trauma-focused cognitive behavioral therapy (TF-CBT) (e.g., Cohen, Berliner, & Mannarino 2000; Deblinger & Hefflin 1996; Deblinger et al. 2006). These clinicians/researchers have demonstrated the effectiveness of TF-CBT for children with a history of sexual abuse in both a multisite study (Deblinger et al. 2006) and longitudinal followup (Deblinger, Steer, & Lipmann 1999). Trauma-focused cognitive behavioral therapy (TF-CBT) is a short-term treatment of twelve to sixteen sessions; however, the number of sessions can be varied depending on the child and family’s needs. The treatment is manualized and comprised of individual sessions for the child, caretaker(s), and joint caretaker-child sessions. It also offers free Web-based training (TF-CBT WEB 2005). This training is modularized, takes about ten hours, and leads to a certificate. The development of the Web-based training was supported by the National Child Traumatic Stress Network (NCTSN.org), a network of programs under the umbrella of the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and

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Human Services. The majority of the NCTSN programs are child welfare programs. Child sexual abuse is an enormously challenging type of maltreatment for the child welfare system. However, the ready availability of training in evidence-based treatment for sexual abuse has enhanced the ability of the child welfare system to provide treatment to children it identifies as having been sexually abused. A drawback is that the initial TF-CBT model assumed a single source of trauma and the availability of a supportive caregiver. The current challenge is to adapt this model so that it is a better fit for sexually abused children in the child welfare system. Although reports have been declining from a high of 15–17 percent of child welfare maltreatment cases to approximately 10 percent (Finkelhor & Jones 2006), 10 percent nevertheless represents a substantial proportion of the caseload. Sexual abuse cases evoke strong emotions that can interfere with case management decisions (Faller 1993). Evidence that is used to substantiate or deny sexual abuse usually comes from the child’s statements and behavior. However, relying on this evidence may raise questions about the child’s perception, memory, and suggestibility (e.g., Ceci & Bruck 1995). Nonetheless, considerable progress has been made in how child protection and other professionals interview children. Child sexual abuse cases also require a great deal of coordination, especially with law enforcement. This coordination has been facilitated by the availability of Children’s Advocacy Centers in many communities. Another challenge is that permanency is often difficult to achieve because family reunification is not necessarily the appropriate goal (CAPTA 2010). Finally, although there is evidence-based treatment for sexual abuse, TF-CBT, this model assumes a single trauma (child sexual abuse); sexual abuse may be but one of several traumas experienced by a sexually abused child. This model also assumes a supportive caregiver who is also involved in treatment. However,

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the child’s caregiver may be the perpetrator or may have been neglectful because she put the child in harm’s way or did not reactive protectively after becoming aware of sexual abuse. Therefore, the treatment model’s conditions

may not be present in sexual abuse cases in the child welfare system. Despite these many challenges, the child welfare system has made notable progress in its response to child sexual abuse in the last forty years.

REFERENCES

acf.hhs.gov/programs/cb/laws_policies/index. htm#laws. Child Welfare Information Gateway (2011). About CAPTA: A legislative history. Retrieved September 30, 2011, from http://www.childwelfare.gov/pubs/ factsheets/about.cfm. Cohen, J., Berliner, L., &, Mannarino, A. (2000). Treating traumatized children: A research review and synthesis. Trauma, Violence, and Abuse, 1, 29–46. Cross, T., Jones, L., Walsh, W., Simone, M., & Kolko, D. (2007). Child forensic interviewing in Children’s Advocacy Centers: Empirical data on a practice model. Child Abuse & Neglect, 31, 1031–52. Davies, D., Cole, J., Albertella, G., McCulloch, L., Allen, K., & Kekevian, L. (1996). A model for conducting forensic interviews with child victims of abuse. Child Maltreatment, 1, 189–99. Deblinger E., & Heflin, A. (1996). Treatment for sexually abused children and their non-offending parents: A cognitive-behavioral approach. Thousand Oaks: Sage. Deblinger E., Mannarino, A., Cohen, J., & Steer, R. (2006). A follow-up study of a multi-site, randomized, controlled trial for children with sexual abuse related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1474–84. Deblinger, E., Steer, R., & Lippman, J. (1999). Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse & Neglect 23, 1371–78. Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV-TR) (2000). Washington, DC: American Psychiatric Association. Faller, K. (1988). Child sexual abuse: An interdisciplinary manual for diagnosis, case management, and treatment. New York: Columbia University Press. Faller, K. (1993). Child sexual abuse: Intervention and treatment issues. Washington, DC: Department of Health and Human Services. Faller, K. (1995). A clinical sample of women who have sexually abused children. Journal of Child Sexual Abuse, 4, 13–30. Faller, K. (2003). Understanding and assessing child sexual maltreatment (2d ed.). Thousand Oaks, CA: Sage. Faller, K. (2007). Coaching children about sexual abuse: A pilot study of professionals' perceptions. Child Abuse and Neglect, 31, 947–59. Faller, K., & Corwin, D. (1995). Children’s interview statements and behaviors: Role in identifying

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sexually abused children. Child Abuse and Neglect, 19, 71–82. Faller, K., & Palusci, V. (2007). Commentary. Children’s Advocacy Centers: Do they lead to positive case outcomes? Child Abuse & Neglect: The International Journal 31, 1021–29. Faller, K., & Vandervort, F. (2007). Interdisciplinary clinical teaching of child welfare practice to law and social work students: When world views collide. Journal of Law Reform, 41, 121–65. Finkelhor, D. (1979). What’s wrong with sex between adults and children? American Journal of Orthopsychiatry, 49, 692–97. Finkelhor, D. (1994a). Current information on the scope and nature of child sexual abuse. Future of Children, 4, 31–53. Finkelhor, D. (1994b). The “backlash” and the future of child protection advocacy: Insights from the study of social issues. In J. Myers (ed.), The backlash: Child protection under fire (pp. 1–16). Thousand Oaks, CA: Sage. Finkelhor, D. (2008). Childhood victimization: Violence, crime, and abuse in the lives of young people. New York: Oxford University Press. Finkelhor, D., & Baron, L. (1986). High risk children. In D. Finkelhor, Sourcebook on child sexual abuse (pp. 60–88). Newbury Park, CA: Sage. Finkelhor, D., & Jones, L. (2006). Why have child maltreatment and child victimization declined? Journal of Social Issues, 62, 685–716. Finkelhor, D., Mitchell, K., & Wolak, J. (2000). Online victimization: A report on the nation’s youth. Washington, DC: National Center for Missing and Exploited Children. Fontes, L. (1995). Sexual abuse in nine North American cultures: Treatment and prevention. Thousand Oaks, CA: Sage. Fontes, L., & Faller, K. (2007). Conducting culturally competent sexual abuse interviews with children from diverse racial, cultural, and socioeconomic background. In K. Faller, Interviewing children about sexual abuse: Controversies and best practice. New York: Oxford. Fontes, L., & Plummer, C. (2010). Cultural issues in disclosures of child sexual abuse. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 19, 491–518. Goodstein, L., Zirilli, A., & New York Times research staff. (2003). Trail of pain in church crisis leads to nearly every diocese. New York Times, January 12. Gorey, K., & Leslie, D. (1997). Prevalence of child sexual abuse: Integrative review and adjustment for potential response and measurement bias. Child Abuse & Neglect, 21, 391–98. Hechler, D. (1988). The battle and the backlash: The child sexual abuse war. Lexington, MA: Lexington. Hershkowitz, I., Horowitz, D., & Lamb, M. (2005). Trends in children’s disclosure of abuse in Israel: A national study. Child Abuse & Neglect, 29, 1203–14.

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Hershkowitz, I., Orbach, Y., Lamb, M., Sternberg, K., & Horowitz, D. (2006). Dynamics of forensic interviews with suspected abuse victims who do not disclose abuse. Child Abuse & Neglect, 30, 753–69. Home Office (1992). Memorandum of good practice on video recorded interviews with child witnesses in criminal proceedings. London: Her Majesty’s Stationery Office. Jones, L., Atoro, K., Walsh, W., Cross, T., Shadoin, A, & Magnuson, S. (2010). Nonoffending caregiver and youth experiences with child sexual abuse investigations. Journal of Interpersonal Violence, 25, 291–314. Jones, L., Cross, T., Walsh, W., & Simone, M. (2007). Do Children’s Advocacy Centers improve families’ experiences of child sexual abuse investigations? Child Abuse & Neglect, 31, 1069–85. Kilpatrick, D., & Saunders, B. (1999). Prevalence and consequences of child victimization: Results from the national survey of adolescents. No 93-IJ-CX-0023. Charleston: National Crime Victims Research and Treatment Center, Department of Psychiatry, Medical University of South Carolina. Lamb, M., Hershkowitz, I., Orbach, Y., & Esplin, P. (2008). Tell me what happened: Structured investigative interviews of child victims and witnesses. Hoboken, NJ: Wiley. Lamb, M., Orbach, Y., Hershkowitz, I., Esplin, P., & Horowitz, D. (2007). A structured forensic interview protocol improves the quality and informativeness of investigative interviews with children: A review of research using the NICHD Investigative Interview Protocol. Child Abuse & Neglect, 31, 1201–31. Lamb, M., Orbach, Y., Hershkowitz, I., Horowitz, D., & Abbott, C. (2007). Does the type of prompt affect the accuracy of information provided by alleged victims of abuse in forensic interviews? Applied Cognitive Psychology, 21, 1117–30. Lamb, M., Orbach, Y., Sternberg, K., Aldridge, J., Pearson, S., Stewart, H., & Bowler, L. (2009). Use of a structured investigative protocol enhances the quality of investigative interviews with alleged victims of child sexual abuse in Britain. Applied Cognitive Psychology, 23, 449–67. Lamb, M., & Sternberg, K. (1999). Eliciting accurate investigative statements from children. Presentation given at the Fifteenth National Symposium on Child Sexual Abuse, March, Huntsville, AL. Lanning, K. (2001). Child molesters: A behavioral analysis (4th ed.). Online Books. Retrieved July 18, 2011, at http://onlinebooks.library.upenn.edu/webbin/book/ lookupid?key=olbp45739. Lipian, M., Mills, M., & Brantman, A. (2004). Assessing the verity of children’s allegations of abuse: A psychiatric overview. International Journal of Law and Psychiatry, 27, 249–63. Lippert, T., Cross, T., Jones, L., & Walsh, W. (2009). Telling interviewers about sexual abuse: Predictors of child disclosure at forensic interviews. Child Maltreatment, 14, 100–13.

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Lippert, T., Cross, T., Jones, L., & Walsh, W. (2010). Suspect confession of child sexual abuse to investigators. Child Maltreatment, 15, 161–70. Masson, J. (1984). The assault on truth: Freud’s suppression of the seduction theory. New York: Farrar, Straus & Giroux. McGraw, J., & Smith, H. (1992). Child sexual abuse allegations amidst divorce and custody proceedings: Refining the validation process. Journal of child sexual abuse, 1, 49–62. Merchant, L., & Toth, P. (2001). Child interview guide. Seattle: Harborview Center for Sexual Assault and Traumatic Stress. Michigan Forensic Interview Protocol, 3d ed. (2011). DHS Publication 779. Retrieved October 15, 2011, from http://www.michigan.gov/documents/dhs/DHSPUB-0779_211637_7.pdf. Mildred, J. (2003). Claimsmakers in the child sexual abuse “wars”: Who are they and what do they want? Social Work, 48, 492–500. Moore, D., Gallup, G., & Schussel, R. (1995). Disciplining children in America: A Gallup poll report. Princeton, NJ: Gallop Organization. Myers, J., ed. (1994). The backlash: Child protection under fire. Thousand Oaks, CA: Sage. NCANDS (2011). Child maltreatment report, 2011. Ithaca, NY: Cornell University: National Data Archive on Child Abuse and Neglect (NCANDS). National Children’s Advocacy Center (2011). History. Retrieved October 10, 2011, from http://www.nationalcac.org/history/history.html. National Children’s Alliance (2006). History of NCA and the CAC movement. Retrieved January 20, 2007, from http://www.nca-online.org/pages/page. asp?page_id=4021. National Children’s Alliance (2008). Standards for accreditation. Retrieved October 10, 2011, from http://www.nationalchildrensalliance.org/index. php?s=76. National Children’s Alliance (2011). About us. Retrieved October 10, 2011, from http://www.nationalchildrensalliance.org/index.php?s=6. National Children’s Alliance (2013). National Childrens Alliance 2012. annual report. Retrieved October 28, 2013, from www.nationalchildrensalliance.org/ NCAAnnualReport. Olafson, E., Corwin, D., & Summit, R. (1993). Modern history of child sexual abuse awareness: Cycles of discovery and suppression. Child Abuse & Neglect, 17, 7–24. Pence, D., & Wilson, C. (1994). Team investigation of child sexual abuse. Thousand Oaks, CA: Sage. Pipe, M., Lamb, M., Orbach, Y., & Cederborg, A., eds. (2007). Child sexual abuse: Disclosure, delay, and denial. Mahwah, NJ: Erlbaum. Poole, D., & Lamb, M. (1998). Investigative interviews of children. Washington, DC: American Psychological Association.

Prentky, R., Knight, R., & Lee, A. (2006). Child sexual molestation: Research issues. In C. Bartol, A. Bartol, C. Bartol, A. Bartol (eds.), Current perspectives in forensic psychology and criminal justice (pp. 119–29). Thousand Oaks, CA: Sage. Riemer, S. (1940). A research note on incest. American Journal of Sociology, 45, 554–56. Runyan, D., Hunter, W., Everson, M., & Whitcomb, D. (1994). The Intervention Stressors Inventory: A measure of the stress of intervention for sexually abused children. Child Abuse & Neglect, 18, 319–29. Russell, D., & Bolen, R. (2000). The epidemic of rape and child sexual abuse in the United States. Thousand Oaks, CA: Sage. Russell, D., Schurman, R., & Trocki, K. (1988). Longterm effects of incestuous abuse: A comparison of Afro-American and white American women (pp. 119–34). In G. Wyatt (ed.), The lasting effects of child sexual abuse. Thousand Oaks, CA.: Sage. Saywitz, K., Mannarino, A., Berliner, L., & Cohen, J. (2003). Treatment for sexually abused children and adolescents. In M. Hertzig & E. Farber (eds.), Annual progress in child psychiatry and child development: 2000–2001 (pp. 455–76). New York: BrunnerRoutledge. Sedlak, A., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress, Executive Summary. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. Staller, K. & Faller, K. (eds.). (2010). Seeking justice in child sexual abuse: Shifting burdens & sharing responsibilities. New York: Columbia University Press. Terry, M. (2010). The nature and scope of sexual abuse of-minors-by-Catholic-priests-and-deacons-in-theUnited-States-1950–2002. Retrieved September 1, 2011, from http://www.usccb.org/issues-and-action/ child-and-youth-protection/upload/TheNature-and-Scope-of-Sexual-Abuse-of-Minorsby-Catholic-Priests-and-Deacons-in-the-UnitedStates-1950–2002.pdf. TF-CBT WEB (2005). Retrieved October 14, 2011, from http://tfcbt.music.edu/. Tribal Law and Order Act (TLOA) (Public Law 111-211). Walsh, W., Cross, T., Jones, L., Simone, M., & Kolko, D. (2007). Which sexual abuse victims receive a forensic medical examination? The impact of Children’s Advocacy Centers. Child Abuse & Neglect, 31, 1053–68. Walsh, W., Jones, L., Cross, T., & Lippert, T. (2010). Prosecuting child sexual abuse: The importance of evidence type. Crime & Delinquency, 56, 436–54. Yuille, J. (2002). The step-wise interview: Guidelines for interviewing children. Available from John C. Yuille, Ph.D., Department of Psychology, University of British Colombia.

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indings from developmental studies are consistent and convincing: Family stability and family cohesion are important protective factors for the healthy development of children and adolescents. Family stability is associated with a broad range of outcomes including higher cognitive scores, fewer child behavioral problems, improved health, and a sense of security (Craigie, Brooks-Gunn, & Waldfogel 2010). Similarly, family cohesion is associated with the emergence of fewer internalizing (emotionally reactive, depressive, withdrawn) and externalizing (attention deficits, aggressive) problems (Buehler et al. 1997). Unfortunately, parental substance abuse disrupts family stability and family cohesion and jeopardizes the safety and well-being of children. Moreover, substance abuse is frequently one of the causes of children’s out-of-home placement and must be addressed before family reunification can safely occur. For these reasons, parental substance abuse is a major concern to all those involved in serving children, youth, and families. In this chapter we focus specifically on parental substance abuse and substance dependence in the context of the child welfare system. We discuss how substance abuse is defined and measured, provide estimates of substance abuse in child welfare populations, and identify critical child and adolescent outcomes affected by substance abuse. This chapter also includes a discussion of recent innovations with regard to service options and clinical developments in the field. We do not include a discussion of adolescent substance

abuse in child welfare. Although the use of illicit drugs and the consumption of alcohol are important issues for youth in substitute care settings, that literature is beyond the scope of this chapter. Definitions and Measurement Strategies Substance abuse is defined as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs (World Health Organization 2011). Illicit drugs may include marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type drugs, of which there are four categories: pain relievers, tranquilizers, stimulants, and sedatives. Prescription-type drugs include some substances that are manufactured and distributed illegally, such as the stimulant methamphetamine (Substance Abuse and Mental Health Services Administration 2010). Hashish is considered marijuana, and crack is considered cocaine. Peyote, LSD, PCP, mescaline, psilocybin mushrooms, and “Ecstasy” (MDMA) comprise the hallucinogens. Inhalants refer to many substances, including nitrous oxide, amyl nitrite, cleaning fluids, gasoline, spray paint, other aerosol sprays, and glue. Although the effects—both short and long term—of these substances vary, they share similar diagnostic criteria for determining misuse. In the current chapter we limit our discussion of diagnostic criteria and instruments to those with good reliability and validity. We categorize measurements into three groups: diagnostic instruments, multidimensional assessments, and drug testing. 299

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Diagnostic instruments use a categorical approach to differentiate substance abusers from nonabusers. In contrast with a measure of severity, the categorical approach simply indicates the presence or absence of a particular problem. The most commonly used diagnostic instrument is Diagnostic and Statistical Manual of Mental Disorders 5 (American Psychiatric Association 2013).1 In the DSM-5, substance use disorder includes substance dependence and substance abuse. Dependence is considered more severe because it involves the psychological and physiological effects of tolerance and withdrawal (Substance Abuse and Mental Health Services Administration 2010). Substance dependence (American Psychiatric Association 2000) is defined as a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same twelvemonth period: 1. tolerance; 2. withdrawal; 3. use of the substance in larger amounts or over a longer period of time than intended; 4. a persistent desire or unsuccessful efforts to reduce substance use; 5. devotion of a large portion of time to obtaining, using, or recovering from the use of the substance; 6. reduction of important social, recreational, or occupational activities due to substance use; and 7. continuing use of the substance despite knowing that a persistent or recurrent physical or psychological problem is likely to have been related to substance use. In contrast, substance abuse is limited to individuals that have never met the criteria for substance dependence (American Psychiatric Association 2000). Substance abuse is manifested by one or more of the following, occurring within a twelve-month period: 1. recurrent substance use leading to a failure to fulfill major role obligations at work, school, or home; 2. recurrent substance use in physically hazardous situations (e.g., driving an automobile or operating machinery when impaired); 3. recurrent legal problems caused by substance use (e.g., substance-related disorderly conduct);

and 4. continuing use of substance despite having persistent or recurrent social or interpersonal problems initiated or exacerbated by the effects of the substance (e.g., loss of personal relationships, frequent physical domestic altercations). In addition to the DSM-IV-TR diagnostic criteria, the World Health Organization has developed two instruments; the International Classification of Diseases (ICD) and the Composite International Personal Interview (CIDI). The CIDI Short Form (CIDI-SF) is used in child welfare as part of the National Survey of Child and Adolescent Well-Being (NSCAW; National Center on Substance Abuse and Child Welfare 2009). The CIDI-SF has separate sections for alcohol and drug dependence. Each section opens with screening question(s). In the alcohol section the screening question is “what is the largest number of drinks you had in any single day during the past twelve months?” If a respondent answers four or more drinks a day, he will be asked to complete dependencerelated questions. In the drug section the screening questions focus on the use of nine illicit drugs (i.e., marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives) during the past twelve months. If a respondent indicates drug use, she will be asked to complete dependence questions. Each section contains seven dependence questions corresponding to the seven substance dependence criteria noted in the DSM-IV-TR (Gibbons, Barth, & Martin in press). Multidimensional measurement strategies focus on substance use as well as other areas of individual functioning (employment, medical/psychiatric symptoms, family/social relationships). Multidimensional assessments are frequently used because individuals with substance problems often report experiencing other health and social difficulties (McLellan et al. 2006). The designers of multidimensional assessments and authors in the larger field of

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substance abuse and child welfare argue that co-occurring problems increase the risk of substance abuse and further contribute to the risk of relapse (Marsh et al. 2006; McLellan et al. 2006; Testa & Smith 2009). Thus it is important to capture the presence of co-occurring problems. One of the most commonly used multidimensional assessments is the Addiction Severity Index (ASI), developed by researchers from the Treatment Research Institute. The ASI measures seven functional domains: alcohol and drug use, medical and psychiatric health, employment/self support, family relations, and illegal activity. Information is collected to capture events within two time periods: lifetime and the most recent thirty days. Information within each time frame is used to evaluate the duration and severity of each problem. Information from the past thirty days is especially useful for monitoring change in patient status through subsequent readministrations (McLellan et al. 2006). Studies show that the ASI has satisfactory reliability and validity among all adults in most large ethnic groups (Kosten, Rounsaville, & Kleber 1983; McLellan et al. 1985). The ASI and its training manual are available online (Treatment Research Institute 2009). According to McLellan et al. (2006:113), “the ASI is a standard in virtually all clinical trials of addicted patients, and it is part of the standard clinical assessment of alcohol- and drug-abusing patients in more than twenty states and fifty cities in the United States, as well as the Veterans Administration, the Indian Health Service, and the federal prison system.” Drug testing is the final method for estimating illicit substance use. Drug testing refers to the use of various biologic sources such as urine, saliva, sweat, hair, breath, blood, and meconium to determine the presence of specific substances and/or their metabolites in an individual’s system (Center for Substance Abuse Treatment 2010). Drug testing can be completed in or out of a laboratory setting. Some child welfare agencies conduct drug tests on all

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parents under court supervision. The results are used to inform decisions on child placement, family support services, family reunification, and termination of parental rights (Center for Substance Abuse Treatment 2010). The effectiveness and accuracy of drug testing varies by specimen types (Center for Substance Abuse Treatment 2010). The following introduction on various specimen types is based on the drugtesting guidelines published by U.S. Department of Health and Human Services (Center for Substance Abuse Treatment 2010). Urine analysis is the most widely used, cost effective, and well-researched approach. A urine specimen is usually collected in a urine specimen cup with a drug test strip, which generally costs less than ten dollars. Five minutes after urine collection, the results can be read from the color change on the drug test strip. Although less effective, oral fluid, or saliva, has gained recent popularity. An oral fluid specimen is collected on a swab placed inside the cheek and is used to estimate drug use within the previous twenty-four hours. Sweat specimens are collected by applying an adhesive patch to the upper arm or upper back, typically for a seven-day period. The patch provides a cumulative record of the individual’s drug use when the patch is worn, but the effectiveness depends on the amount of sweat produced by individuals. Hair specimen tests can detect drug use over several months and pinpoint long-term changes in drug use patterns. The greatest limitation of this approach is that hair specimens cannot detect drug use within the last three days or discriminate between recent drug use and use that occurred months earlier. For these reasons, it has limited application in child welfare settings. Blood specimens are collected to detect use of both alcohol and drugs, but require analysis by qualified and trained personnel. Meconium specimens (the contents of fetal intestines) can be used to identify substance-exposed infants. Meconium specimens indicate the mother’s substance use after thirteen weeks of pregnancy.

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Estimating Substance Abuse and Dependence According to the 2012 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration 2013), an estimated 22.2 million persons aged twelve or older were classified with substance dependence or abuse in the past year (8.5 percent of the population is aged twelve or older). Of these, 2.8 million were dependent on or abused both alcohol and illicit drugs, 4.5 million were dependent on or abused only illicit drugs, and 14.9 million were dependent on or abused only alcohol. Estimating the extent of substance abuse by clients served within the child welfare system is more complicated because of variations in definitions across states and measurement strategies between studies (Testa & Smith 2009). Nonetheless, estimates in child welfare populations do exist. For example, in those states included in these analyses, 2 Child Maltreatment 2011 reports that, for FFY 2011, 18.6 percent of unique child maltreatment victims had caregiver drug abuse as a risk factor (2012:50); 98 percent of victims had caregiver alcohol abuse as a risk factor (2012:49). The prevalence of substance abuse among in-home cases has ranged from approximately 10 percent to 68 percent. The prevalence largely depends on the type of measurement and the sampling pool. Jones (2004) drew a random sample of 443 children from all in-home cases in San Diego County between January 1 and June 30, 1995. The author reported that 68 percent of the mothers abused alcohol or drugs, and 37 percent abused both alcohol and drugs. The author used a variety of substance abuse measures, including treatment records, history of having substance-exposed infants, self-reports, reports from helping professionals, and reports from family members. Mothers were classified as substance abusers if any of the measures yielded a positive indication. This

measurement approach tends to provide a high prevalence rate. Estimates from more recent national studies arrive at significantly lower estimates. Using a sample from NSCAW, Libby et al. (2006) reported that 13.2 percent of Caucasian, 11.3 percent of African American, 6.1 percent of Hispanic, and 7.5 percent of American Indian caregivers have a substance abuse problem. Some argue that the NSCAW estimates are low because the CIDI-SF measures substance dependence rather than substance abuse (Young, Boles, & Otero 2007). For example, a recent study (Marcenko, Lyons, & Courtney 2010) in Washington State reported that 21.8 percent of 318 mothers with children remaining in her home met the criteria for alcohol or drug abuse/dependence in the past twelve months. These authors used the Mini-International Neuropsychiatric Interview to measure substance abuse/dependence. As compared with in-home cases, the prevalence of substance abuse/dependence associated with parents of children in foster care is significantly higher. Yet variation still exists due to measurement and sampling protocols. Murphy and colleagues (1991) studied a sample of 206 foster care cases in Boston and reported that 43 percent of the parents had a documented problem with either alcohol or drugs. The General Accounting Office (1994) published a study of 414 foster children from Los Angeles, New York City, and Philadelphia. The authors estimated that 78 percent of foster children had at least one parent who was abusing alcohol or drugs at the time of temporary custody. Another study published by the GAO (1998) looked at a sample of 519 foster children from Los Angeles and Cook County in 1998 and estimated that approximately two-thirds of all foster children in both California and Illinois had at least one parent who abused drugs or alcohol, and most had been doing so for at least five years. Estimates from the NSCAW indicate that 28.7 percent of

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primary caregivers were abusing alcohol and 37.4 percent were abusing drugs at the time of investigation (U.S. Department of Health and Human Services 2005). Relatively high rates are also reported from the Illinois Alcohol and Drug Abuse Waiver Demonstration (Ryan 2011). Beginning in 2000, parents suspected of alcohol and drug use were screened for substance abuse or dependence at the temporary custody hearing. As of December 2010, 64 percent of screened parents were identified as either substance abusing or substance dependent using DSM criteria. This estimate is only for those parents referred for screening. If all parents were included, that is, every parent associated with a temporary custody hearing referred for screening or not, approximately 43 percent would have been identified as either substance abusing or substance dependent. In Illinois these are the most accurate estimates associated with substitute care placements. In addition to the estimates associated with in-home and out-of-home placements, the number of substance-exposed infants represents an important indicator for child welfare systems. Approximately 440,000 infants (10–11 percent of all births) are affected by prenatal alcohol or illicit drug exposure (Young et al. 2009). However, there are few up-to-date statewide prevalence estimates of SubstanceExposed Infants (SEI) (Young et al. 2009). In Washington, researchers (Washington State Department of Health 2009) estimated that 8,000–10,000 SEI are born each year in Washington. Testa and Smith (2009) provided the SEI rates in Illinois between 1985–2007. They report that the rate peaked at twenty per thousand births in fiscal year 1994 and decreased to five per thousand births in fiscal year 2007. Although the rate of SEI reports decreased, the percentage of indicated cases among SEI reports remained at more than 90 percent throughout these years, which reflected that Illinois legislation considers newborns whose

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blood, urine, or meconium contains any amount of a controlled substance or its metabolites to be an abused or neglected minor (Testa & Smith 2009). They also reported that the SEI reports were disproportionately distributed among ethnicity groups. For example, among all infants born in Illinois 1995, 59 percent were non-Hispanic white and 20 percent were African American. In the same year, 12 percent of SEIs were non-Hispanic white, while 83 percent were African American. The authors suggest that the disproportionate distribution was related to different drug surveillance practices (e.g., publicly funded, inner-city hospitals more likely to test for substance exposure). This is an important point as, perhaps more than other types of maltreatment, the policy context greatly affects the variation of SEIs identified each year and the state’s response to those identified. Currently sixteen states consider substance abuse during pregnancy to be child abuse; three consider it grounds for civil commitment (Anthony, Austin, & Cormier 2010). Although several state statutes (e.g., Minnesota, Iowa, Kentucky, North Dakota, Virginia) currently require health practitioners to administer toxicology tests when they suspect prenatal use of illegal substances, health practitioners generally determine their own testing and screening policies and procedures (National Abandoned Infants Assistance Resource Center 2006). Perhaps surprisingly, there exist no federal requirements for drug testing at birth. The only requirement as stipulated by the Child Abuse and Prevention Treatment Act (CAPTA) is that hospitals must have a mechanism in place to connect with child protection when substance exposed infants are identified. Yet it is important to note that a single test is often insufficient with regard to the absolute determination of child maltreatment, the extent of potential maltreatment, or the extent of substance abuse/dependence. Thus

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experts encourage using a combination of random drug tests, self-reports, and observations of behavioral indicators by substance abuse treatment providers or professionals and child welfare workers (Center for Substance Abuse Treatment 2010). Observations include deteriorating hygiene and grooming; impaired functioning in daily life; impaired work behavior; and involvement with people, places, and things associated with drug use. Utilizing a combination of drug testing, self-report, and observational strategies is viewed as the most reasonable and appropriate response by child welfare professionals. The literature is clear— what happens in the family home is a more accurate predictor of long-term child wellbeing as compared with a single positive drug screen (Lester, Freier, & LaGasse 1995). The response from caseworkers and judges should reflect such findings. Promising Practice for SubstanceAbusing Families Parental substance abuse compromises appropriate parenting practices and creates problems in the parent-child relationship (Famularo, Kinscherff, & Fenton 1992; Jaudes, Ekwo, & Van Voorhis 1995; Kelleher et al. 1994; Nurco et al. 1998). Specifically, substance abuse decreases emotional involvement (Hans, Bernstein, & Henson 1999), decreases parental flexibility (Tronick et al. 2005), disrupts the interpretation of infant and child cues (Burns et al. 1991), and helps to create an environment that is often not responsive to the material and emotional needs of children (Magura & Laudet 1996). In a study of parenting practices, Eiden, Chavez, and Leonard (1999) report that substanceabusing parents display lower sensitivity and higher negative affect in their interactions with their infants as compared with nonsubstance-abusing parents. Measures of sensitivity included visual contact, flexibility, and the ability to read child cues. Measures of negative affect included hostile voice, hostile mood, aggression, and criticism. Escalating periods of

drug use further erode the home environment. In a study of recovering heroin addicts, McKeganey, Barnard, and McIntosh (2002) report that during periods of increased drug use the needs of children become secondary to the needs of the drug user. Thus it is not surprising that children in substance-abusing families are at an increased risk of physical abuse and neglect, even after controlling for a wide range of covariates (Chaffin, Kelleher, & Hollenberg 1996). Once involved in the child welfare system, substance-abusing parents are more likely to experience subsequent allegations of maltreatment as compared with nonsubstance-abusing parents (Smith & Testa 2002). In addition to the increased risk of maltreatment, access to and engagement with treatment providers is often limited (Maluccio & Ainsworth 2003). Consequently, children of substance-abusing parents remain in substitute care for significantly longer periods of time and experience significantly lower rates of family reunification relative to almost every other subgroup of families in the child welfare system (Government Accounting Office 1998). For these reasons, it is important to identify and rigorously evaluate innovative strategies with substance-abusing families. Although somewhat limited, there is a growing literature focused on services for substanceabusing parents served by the child welfare system. Marsh, D’Aunno, and Smith (2000) used a nonequivalent control group design to examine the impact of enhanced services for substance-abusing women involved with child protection. The study compared clients who received enhanced services with those who received regular substance use treatment. The use of linkage services (e.g., transportation, child care) increased social service access and decreased subsequent levels of substance use. Smith and Marsh (2002) used the same sample of substance-abusing mothers to examine the impact of matching client-identified needs with services. The authors report that matched counseling services (e.g., domestic violence, family

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counseling) were associated with reports of reduced substance use, and matched social services (e.g., housing, job training, legal services) were associated with clients’ satisfaction with treatment. Using data from the NSCAW, Barth, Gibbons, and Guo (2006) investigated the association between substance abuse treatment and subsequent reports of child maltreatment for intact family cases. Using propensity score matching (PSM) to approximate random assignment, the authors report that families in the treatment condition were significantly more likely to experience a new allegation of maltreatment as compared with families in the nontreatment group. The authors present various explanations for this unexpected finding, including potential problems associated with self-reported measures of addiction severity, the inability of services to meet client needs, and the treatment group’s involvement with an additional mandated reporter (i.e., substance abuse treatment provider). In much of the previous work it is often unclear what is meant by treatment group and by services. This problem is not limited to the substance abuse literature; still, the lack of welldefined interventions does present challenges when agencies and systems are searching for evidence-based programming. In recent years, however, several fairly well-articulated service models have been developed for and tested with substance-abusing parents in child welfare. These models include motivational interviewing, recovery coaches, and family dependency drug treatment courts. Motivational Interviewing Motivational interviewing is a brief client-centered approach to increasing intrinsic motivation so that parents can explore and reduce ambivalence (Miller & Rollnick 2002). Clients are believed to approach behavioral changes with varying levels of readiness. Engaging in motivational interviewing is intended to assist the client in becoming more aware of the consequences

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associated with maintaining the behavioral status quo. The clinician remains nonjudgmental throughout the sessions. The basic components of this approach are expressing empathy, developing discrepancies (between problem behavior and personal views), rolling with resistance (in contrast with challenging resistance), and supporting self-efficacy (capacity to cope with obstacles) (Burke, Arkowitz, & Menchola 2003; Lundahl et al. 2010). In a meta-analysis of thirty controlled clinical trials, Burke, Arkowitz, and Menchola (2003) report that motivational interviewing is “equivalent to other active treatments and superior to no-treatment or placebo controls for problems involving alcohol, drugs, and diet and exercise” (p. 856). The effects noted in the meta-analysis are not limited or specific to child welfare populations, but, given the findings, motivational interviewing and adaptations of motivational interviewing are now commonly utilized as part of treatment planning for substance abusing parents in child welfare. The results, however, are mixed. Chaffin and colleagues (2009) tested motivational interviewing in combination with parent-child interaction therapy (PCIT). The authors report that the combination of pretreatment motivation interviewing and PCIT improved program retention for individual parents with low to moderate motivation. Negative effects were reported for parent with high initial motivation. The authors note that improvements in retention cannot be attributed to motivational interviewing alone. Similarly, Mullins et al. (2004) tested motivational interviewing with a randomized control trial of women involved with child welfare. The authors focused on session attendance, group attendance, and urine screenings. In contrast with studies in the general population, Mullins et al. (2004) report no differences between the motivational interviewing and educational control condition. The authors speculate that perhaps motivational interviewing is less effective with coerced populations. In short, motivational interviewing is seen as an effective tool in

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substance abuse settings. Yet additional studies with child welfare populations are necessary to determine 1. why similar effects in retention are not observed and 2. whether motivational interviewing can improve rates of reunification. Although all professionals are generally supportive of increasing rates of treatment access and program retention, the future of motivational interviewing in child welfare will be limited if this clinical approach has no significant affect on reuniting children with their biological parents. Recovery Coaches Since 2000, Illinois, and, in particular, Cook County, has been engaged in a concerted effort to address the problem of substance abuse in child welfare. Specifically, the county developed and implemented an integrated model for substance-abusing caregivers. This integrated model emerged out of an existing service partnership between the Division of Alcoholism and Substance Abuse (DASA) and the Illinois Department of Children and Family Services (IDCFS), and represents one of three ongoing Title IV-E waiver demonstrations in the state of Illinois. Title IV-E waivers permit states to bypass federal regulations related to the financing of foster care services in order to develop and test innovative strategies for serving children and families. Waiver demonstrations are approved by the Children’s Bureau and require cost neutrality. The Illinois AODA Waiver Demonstration Project tested a model of intensive case management using recovery coaches. The use of recovery coaches is intended to increase access to substance abuse services, improve substance use disorder treatment outcomes, shorten length of time in substitute care placement, and affect child welfare outcomes, including increasing rates of family reunification. To achieve these stated goals, recovery coaches engage in a variety of activities, including comprehensive clinical assessments, advocacy, service planning, outreach, and case management. The clinical assessments focus on a variety of

problem areas, such as housing, domestic violence, parenting, mental health, and family support needs. Recovery coaches visit the family home and the AODA treatment provider agencies. Recovery coaches also make joint home visits with child welfare caseworkers, AODA agency staff, or both. Recovery coach services are provided for the duration of the case, and such services may also be continued for a period of time subsequent to case’s closing. The empirical evidence supports the recovery coach efforts in Illinois. The families assigned to the recovery coach group are significantly more likely to achieve reunification (27 percent versus 20 percent) and significantly more likely to achieve adoption as a secondary option for permanency (38 percent versus 33 percent) five years post-assignment. Moreover, the parents associated with recovery coach services are significantly less likely to be associated with a subsequent substance-exposed infant (Marsh et al. 2006; Ryan et al. 2008; Ryan et al. 2006; Ryan 2011). The recovery coach model provides services at the individual client level. In contrast, the family dependency drug treatment courts represent a macro-level intervention; changing the context within which substance abusing parents are processed and monitored in child welfare.3 Drug Courts Family dependency drug treatment courts are part of a larger category of problem-solving courts that include adult drug courts (for nonviolent adult offenders), community courts (in which the offender is expected to give back to the community as compensation), domestic violence courts, gambling courts, DWI courts, mental health courts (which divert defendants with mental illness to community-based treatments), and truancy courts (school-based courts focused on education). The purpose of the family drug court is to help states meeting the permanency requirements associated with the Adoption and Safe Families Act and improve the level of functioning for substance-abusing families

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(Boles et al. 2007). Family drug courts differ from traditional child protection courts in that the frequency of judicial monitoring is increased, the provision of substance abuse treatment for parents in the child welfare system is prioritized, parents are subjected to regular drug tests, and judges issues sanctions (e.g., incarceration) and rewards (e.g., progress/ graduation ceremonies often associated with token gifts) for service compliance (Edwards & Ray 2005). The increase and popularity of these courts is stunning. The number of drug courts (of any kind) in the United States increased from 230 in 1997 to 2,147 in 2007. Similarly, family dependency drug treatment courts (which were essentially nonexistent in 1997) have doubled in recent years (153 in 2004 to 301 in 2007; Huddleston, Marlowe, & Casebolt 2008). Although caution is generally viewed as good advice with the exponential replication of any service model, there is some evidence to warrant the family drug courts’ growth. Green and colleagues (2007) evaluated the effectiveness of family treatment drug courts in four geographically diverse locations. The evaluation focused on a range of important outcomes (short and long term) including treatment access, treatment retention, treatment completion, family reunification, and maltreatment recurrence. The authors used a quasi-experimental nonequivalent control group design. Each site identified 50 family drug court cases and 50 comparison cases. The authors report that parents in the family drug court group entered treatment more quickly (73 versus 182 days), spent more time in treatment (303 versus 185 days), completed treatment at a higher rate (45 percent versus 34 percent), were more likely to achieve family reunification (57 percent versus 44 percent), and were no more likely to experience a subsequent substantiated report of maltreatment (23 percent versus 15 percent). Similar results are reported for an evaluation of a family drug court in Sacramento, California (Boles, Young, Moore, & DiPirroBeard 2007). Such evidence is encouraging. Yet

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to fully understand the true valued added by family drug courts, court personnel, researchers, and funding agencies need to invest in more rigorous designs. Currently, family drug courts are voluntary. At the time of temporary custody, parents are given the option of participating in family drug court (perhaps a dedicated calendar/docket within the larger family court). This creates problems in the identification of equivalent comparison groups—as volunteers are undoubtedly different from those declining participation. Although propensity score matching and other statistical adjustments can help correct for selection bias (i.e., removing the volunteer effect), given the widespread use and rapid growth of family drug courts, an evaluation utilizing an experimental design is necessary. The lack of experimental designs is not limited to family drug courts or even child welfare more broadly. In fact, the general lack of rigorous experimental designs has given rise to a surge of concerns about the quality of empirical evidence in all the applied social sciences (Boruch, Snyder, & DeMoya 2000). Such concerns will only limit the identification and replication of “best practices” or “evidence-based practices” in child welfare. From a practice perspective, it is important to recognize that problems with substance abuse rarely occur in isolation. The comorbidity rates with other health and social problems for substance-abusing adults is high. In part, the problem of comorbidity makes working with substance-abusing clients in child welfare particularly challenging. The National Institute of Mental Health Epidemiological Catchment Area Program reports that 37 percent of adults with an alcohol disorder and 53 percent of adults with a drug disorder also report a comorbid mental disorder. These estimates represent the general population. Significantly higher rates of comorbidity are reported in prison and other high-risk populations (Regier et al. 1990). Within the child welfare system, co-occurring mental health, domestic violence, and inadequate housing are frequently documented. In

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a study of substance abuse and co-occurring problems in the Illinois child welfare system, Marsh et al. (2006) found that 92 percent of substance-abusing families report simultaneously struggling with mental health, domestic violence, and/or housing problems. Specifically, in Illinois, between 2000 and 2010, substance-abusing families involved with the child welfare system in Cook County reported high rates of domestic violence (43 percent), mental health diagnoses (61 percent), unemployment (72 percent), and homelessness (8 percent). These estimates have important implications for practice and policy, as the presence of such problems increases the risk of continued maltreatment and decreases the likelihood of achieving family reunification (Aron & Olson 1997; Faller & Bellamy 2000; Hess, Folaron, & Jefferson 1992; Hoffman & Rosenheck 2001; Jones 1998; Landsverk et al. 1996; Marsh et al. 2006; Newton, Litrownik, & Landsverk 2000; Park et al. 2004). Given high rates of co-occurring problems and the consequences associated with such problems, many of the innovations in child welfare practice for substance-abusing parents involve specialized, shared, or integrated service models. (e.g. Choi et al. 2012; SAMSA 2012; Thompon et al. 2013, Twomey et al. 2011). YYY

Substance abuse and substance dependence complicate and interfere with the healthy development of children. Moreover, parents struggling with substances are likely to encounter great difficulties and perhaps insurmountable obstacles on the road to achieving family reunification. There is some evidence to suggest that both individual-level (e.g., recovery coaches) and organizational-level (e.g., family drug courts) interventions work in terms of improving treatment access and family reunification. We believe and argue that parents will achieve the greatest level of success when child welfare service delivery systems embrace changes at both the individual and organizational level. Interventions are required at both micro and

macro levels because this is where the critical decision makers reside. If we focus only on the caseworkers and parents (individual level), we fail to account for the judges’ authority and final decision concerning reunification. The experiment with recovery coaches in Illinois highlights the limitations of an intervention delivered only at the individual level. The recovery coach model is based on the assumption that if substance abusers can be identified and connected with treatment providers, progress toward recovery could be accomplished more quickly and, in turn, family reunification could be achieved. Some of these assumptions are supported by the data. Families did access services and achieve reunification at significantly higher rates. Yet the level of success was less than anticipated; data from Illinois indicate that even when families complete all the mandated substance abuse treatments required by caseworkers, a fairly large proportion is still unable to achieve reunification and experience case closure. Why is that? What would prevent reunification subsequent to the completion of substance abuse treatment—especially when the problem of substance abuse was a primary reason for placement? Several authors argue, and there is evidence to support, that cooccurring problems help explain such a finding (Marsh et al. 2006; Testa & Smith 2009). That is, despite progress in the domain of substance abuse, the presence of domestic violence in the home remains a primary obstacle. An alternative explanation is that many judges lack the sufficient knowledge base and understanding of substance abuse in general and the recovery process more specifically. A limited knowledge base helps to create a risk-aversive atmosphere and consequently contributes to reunification delays. For example, judges that perceive relapse as a certainty in the recovery process might be less inclined to return children from foster care, regardless of service compliance. Intervention at the court level (e.g., judicial training), even in the absence of an established family drug court, might help to address such problems. Such an

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intervention would not ignore or deny the fact that relapse occurs, but rather recognizes the idea that reunification can often be achieved as parents make significant progress toward sobriety. To date, little research focuses on the judges’ perceptions of substance-abusing parents and the association between these perceptions and case dispositions. Studies in this area would make a significant contribution to the literature and help inform practice innovations and partnerships with the courts.

“One day at a time for the rest of my life” is an adage commonly repeated in recovery groups. This statement indicates that the work of recovery is never complete. Substance-abusing parents will always be striving to achieve and maintain sobriety. Our policies and practices in child welfare ought to reflect this reality. In working with substance-abusing parents, progress, and not perfection, should be the primary objective and benchmark of success in the child welfare system.

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Development and outcomes. Child Maltreatment, 12, 161–71. Boruch, R., Snyder, B., & DeMoya, D. (2000). The importance of randomized field trials. Crime and Delinquency, 46, 156–80. Buehler, C., Anthony, C., Krishnakumar, A., Stone, G., Gerard, J., & Pemberton, S. (1997). Interparental conflict and youth problem behaviors: A meta-analysis. Journal of Child and Family Studies, 6, 233–47. Burke, B., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–61. Burns, K., Chethik, L., Burns, W., & Clark, R. (1991). Dyadic disturbances in cocaine-abusing mothers and their infants. Journal of Clinical Psychology, 47, 316–19. Center for Substance Abuse Treatment (2010). Drug testing in child welfare: Practice and policy considerations. HHS Pub. No. (SMA) 10-4556. Rockville, MD: Substance Abuse and Mental Health Services Administration. Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse & Neglect, 20, 191–203. Chaffin, M., Valle, L., Funderburk, B., Gurwitch, R., Silovsky, J., Bard, D., McCoy, C., & Kees, M. (2009). A motivational intervention can improve retention in PCIT for low-motivation child welfare clients. Child Maltreatment. 14, 356–68. Choi, S., Huang, H., & Ryan, J. (2012). Substance abuse treatment completion in child welfare: Does substance abuse treatment completion matter in the decision to reunify families? Children and Youth Services Review, 34, 1639–45 Craigie, T., Brooks-Gunn, J., & Waldfogel, J. (2010). Family structure, family stability and early child wellbeing. Working Papers 1275. Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Research on Child Well-being.

1. The content in this section has not been revised to reflect revisions to DSM-IV-TR made in DSM-5 (American Psychiatric Association 2013), which was published while this volume was in production. Please see chapter references for access to reports by the American Psychiatric Association regarding these changes. 2. Child Maltreatment 2011 excludes states from these analyses if fewer than 1 percent of victims were reported with this caregiver risk factor (2012:27). 3. These courts are also referred to throughout the literature as dependency drug courts and family drug courts. REFERENCES

American Psychiatric Association (2013). Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. PDF at www.dsm5.org/Pages/ Default.aspx American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: SM-5 (5th ed.). Washington, DC: American Psychiatric Association. Anthony, E., Austin, M., & Cormier, D. (2010). Early detection of prenatal substance exposure and the role of child welfare. Children and Youth Services Review, 32, 6–12. Aron, L., & Olson, K. (1997). Efforts by child welfare agencies to address domestic violence: The experiences of five communities. U.S. Department of Justice Document No. 166054. Retrieved July 29, 2011, from https://www.ncjrs.gov/pdffiles1/nij/ grants/166054.pdf. Barth, R., Gibbons, C., & Guo, S. (2006) Substance abuse treatment and the recurrence of maltreatment among caregivers with children living at home: A propensity score analysis. Journal of Substance Abuse Treatment, 30, 93–104. Boles, S., Young, N., Moore, T., & DiPirro-Beard, S. (2007). The Sacramento dependency drug court:

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abusive and neglectful parents in a community-based sample. American Journal of Public Health, 84, 1586–90. Kosten, T., Rounsaville, B., & Kleber, H. (1983). Concurrent validity of the Addiction Severity Index. Journal of Nervous and Mental Disease, 171, 606–10. Landsverk, J., Davis, I., Ganger, W., Newton, R., & Johnson, I. (1996). Impact of child psychosocial functioning on reunification from out-of-home care. Children and Youth Services Review, 18, 447–62. Lester, B., Freier, K., & LaGasse, L. (1995). Prenatal cocaine exposure and child outcome: What do we really know? In M. Lewis & M. Bendersky (eds.), Mothers, babies and cocaine: The role of toxins in development (pp. 19–39). Hillsdale, NJ: Erlbaum. Libby, A., Orton, H., Barth, R.., Webb, M., Burns, B., Wood, P., & Spicer, P. (2006). Alcohol, drug and mental health specialty treatment services by race/ ethnicity: A national study of children and families involved with child welfare. American Journal of Public Health, 96, 628–31. Lundahl, B., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137–60. McKeganey, N., Barnard, M., & McIntosh, J. (2002), Paying the price for their parents’ addiction to drugs. Drugs, Education, Prevention and Policy, 9, 233–46. McLellan, A., Cacciola, J., Alterman, A., Rikoon, S., Carise, D. (2006). The addiction severity index at 25: Origins, contributions and transitions. American Journal of Addictions, 15, 113–24. McLellan, A., Luborsky, L., Cacciola, J., Griffith, J., Evans, F., Barr, H., & O’Brien, C. (1985). New data from the Addiction Severity Index: Reliability and validity in three centers. Journal of Nervous and Mental Disease, 173, 412–23. Magura, S., & Laudet, A. (1996). Parental substance abuse and child maltreatment: Review and implications for intervention. Children and Youth Services Review, 18, 193–220. Maluccio, A. & Ainsworth, F. (2003). Drug use by parents: A challenge for family reunification practice. Children and Youth Services Review, 25, 511–33. Marcenko, M., Lyons, S., & Courtney, M. (2010). Mothers’ experiences, resources, and needs: The context for reunification. Children and Youth Services Review, 33, 431–38. Marsh, J., D’Aunno, T., & Smith, B. (2000). Increasing access and providing social services in drug abuse treatment for women with children. Addiction, 95, 1237–47. Marsh, J., Ryan, J., Choi, S., & Testa, M. (2006). Integrated services for families with multiple problems: Obstacles to family reunification. Children and Youth Services Review, 28, 1074–87. Miller, W., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford.

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Mullins, S., Suarez, M., Ondersma, S., & Page, M. (2004). The impact of motivational interviewing on substance abuse treatment retention: A randomized control trial of women involved in child welfare. Journal of Substance Abuse Treatment, 27, 51–58. Murphy, J., Jellinek, M., Quinn, D., Smith, G., Poitrast F., & Goshko, M. (1991). Substance abuse and serious child mistreatment: Prevalence risk and outcome in a court sample. Child Abuse & Neglect, 15, 197−211. National Abandoned Infants Assistance Resource Center (2006). Substance exposed infants: Noteworthy policies & practices. Retrieved June 20, 2011, from http://aia.berkeley.edu/media/pdf/sen_issue_brief. pdf. National Center on Substance Abuse and Child Welfare (2009). Research studies on the prevalence of substance use disorders in the child welfare population. Retrieved June 20, 2011, from http://www.ncsacw. samhsa.gov/files/Research_Studies_Prevalence_ Factsheets.pdf. Newton, R., Litrownik, A., & Landsverk, J. (2000). Children and youth in foster care. Child Abuse and Neglect, 24, 1363–74. Nurco, D., Blatchley, R., Hanlon, T., O’Grady, K., & McCarren, M. (1998). The family experiences of narcotic addicts and their subsequent parenting practices. American Journal of Drug and Alcohol Abuse, 24, 37–60. Park, J., Metraux, S., Brodbar, G., & Culhane, D. (2004). Child welfare involvement among children in homeless families. Child Welfare, 83, 423–36. Regier, D., Farmer, M., Rae, D., Locke, B., Keith, S., Judd, L.., & Goodwin, F. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association, 264, 2511–18. Ryan, J. (2011). Policy and practice options related to exit issues experimenting and improving the recovery coach model. Working Conference on Race and Child Welfare Cambridge, MA, January 29, 2011. Retrieved July 20, 2011, from http://www.law.harvard.edu/programs/about/cap/cap-conferences/rdconference/rd.conference.papers.html. Ryan, J., Choi, S., Hong, J., Hernandez, P., & Larrison, C. (2008). Recovery coaches and substance exposure at birth. Child Abuse and Neglect. 32, 1072–79. Ryan, J., Marsh, J., Testa, M., & Louderman, R. (2006). Integrating substance abuse treatment and child welfare services: Findings from the Illinois AODA Waiver Demonstration. Social Work Research, 30, 95–107. Smith, B., & Marsh, J. (2002). Client-service matching in substance abuse treatment for women with children. Journal of Substance Abuse Treatment, 22, 161–68.

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Smith, B., & Testa, M. (2002). The risk of subsequent maltreatment allegations in families with substanceexposed infants. Child Abuse & Neglect, 26, 97–114. Substance Abuse and Mental Health Services Administration (SAMHSA) (2012). Supporting infants, toddlers and families impacted by caregiver mental health problems, substance abuse, and trauma. DHHS Publication No. SMA-12-4726. Rockville, MD: Substance Abuse and Mental Health Service Administration. Substance Abuse and Mental Health Services Administration (SAMHSA) (2013). Results from the 2012 national survey on drug use and health: Summary of national findings. NSDUH Series H-46, HHS Publication No. (SMA) 13–4795 Rockville, MD: author. Testa, M., & Smith, B. (2009). Prevention and drug treatment. Future of Children, 19, 147–68. Treatment Research Institute (2009). The Addiction Severity Index. Retrieved June 19, 2011, from http:// www.tresearch.org/resources/instruments.htm. Tronick, E., Weinberg, M., Seifer, R., Shankaran, S., Wright, L., Messinger, D., Lester, B. M., Seifer, R., Tronick, E. Z., Bauer, C. R., Shankaran, S., Bada, H. S., Wright, L. L., Smeriglio, V. L., & Liu, J. (2005). Cocaine exposure is associated with subtle compromises of infants’ and mothers’ social-emotional behavior and dyadic features of their interaction in the face-to-face still-face paradigm. Developmental Psychology, 41, 711–22. U.S. Department of Health and Human Services (1999). Blending perspectives and building common ground: A report to Congress on substance abuse and child protection. Washington, DC: Government Printing Office. U.S. Department of Health and Human Services (2005). National survey of child and adolescent wellbeing (NCSAW): CPS sample component wave 1 data analysis report. Washington, DC: Administration for Children and Families. Washington State Department of Health (2009). Substance abuse during pregnancy: Guidelines for screening. Olympia: Washington State Department of Health. World Health Organization (2011). Substance Abuse. Retrieved June 20, 2011, from http://www.who.int/ topics/substance_abuse/en/. Young, N., Boles, S., & Otero, C. (2007). Parental substance use disorders and child maltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12, 137−49. Young, N., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. (2009). Substanceexposed infants: State responses to the problem. HHS Pub. No. (SMA) 09–4369. Rockville, MD: Substance Abuse and Mental Health Services Administration.

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oncern about how domestic violence affects children and youth is long-standing. Still, numerous researchers, child advocates, battered women advocates, and policy makers grapple with how best to keep families safe. The different and sometimes conflicting orientations that domestic violence and child protective services (CPS) professionals bring to their work make it difficult to agree on a single strategy, frustrating families who need help. Yet to be resolved are questions about who should be held accountable for the exposure to domestic violence. Should it be the mother, the usual caregiver, who has allegedly “failed” to protect her children from abuse? Or should it be the father or father surrogate, most often the abuser, who may be invisible to the child welfare system? And how should CPS respond to families experiencing domestic violence? Do the harms children suffer from exposure to domestic violence constitute child maltreatment? Should CPS remove children so exposed for their own protection and to break the cycle of violence? This chapter will address these questions by first defining domestic violence and its prevalence, followed by describing the extent, nature, and consequences of children’s exposure to domestic violence. Next I review the very different philosophies with which CPS and domestic violence service providers approach the problems created by children’s exposure to domestic violence. The third section describes state and local initiatives that address this issue. The final section concludes with a discussion of practice, policy, and research implications.1

Domestic Violence Defined Domestic violence, also known as intimate partner violence, is defined as a pattern of behavior where the batterer intentionally attempts to physically, sexually, psychologically, emotionally, or economically harm the victim with whom there is an intimate relationship. Physical violence may include pushing, shoving, grabbing, kicking, biting, hitting, choking, or threatening with a weapon. Psychological and emotional abuse may include humiliation, isolation, fear and intimidation, threats, emotional withholding, and verbal attacks. Economic abuse includes controlling or exploitative tactics that keep victims financially dependent on abusers for economic resources (Huang et al. 2013). Regardless of the type of abuse or the tactics employed, the goal of the abuser is to gain control over an intimate partner. The National Violence Against Women Survey conducted between 1995 and 1996 (Tjaden & Thoennes 1998) indicates that each year 1.4 million women are victims of violence committed by an intimate partner, defined as current or former husband, cohabiting partner, or date. Indeed, approximately 44 percent of women in the U.S. experience domestic violence at least once in their lifetime (Thompson et al. 2006). Additionally, Tjaden and Thoennes (1998) have reported that women are at greater risk of violence than are men, and, as the seriousness of the violence and injuries increases, the number of female victims increases while the number of male victims decreases. The results also indicate that women are six times more likely to be 312

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injured by intimate partner violence than are men and that the risk of serious or lethal violence increases when women leave the relationship (Tjaden & Thoennes 1998). While the data indicate that most victims of domestic violence or intimate partner violence are women, men are also victims—although not as often and not as overwhelmingly as women are victims. Thus this chapter will refer to victims of domestic violence as women and batterers as men because this is the most common domestic violence scenario where intervention is required. However, domestic violence may also be initiated by women against male or female partners. Children and Youth Exposed to Domestic Violence Exposure to domestic violence can be direct or indirect and can include being a co-victim during an abusive episode, watching or hearing violent events, or suffering the consequences when a primary parent is partially or fully disabled by abuse, such as depression. Additionally, children and youth may be exposed as a result of experiencing the aftermath of the events, such as watching a father being arrested. Exposure also includes being manipulated by the batterer to gain further control over his partner. This may include being used to spy on a mother before or after separation, being made to watch abuse, or being used as a pawn during a custody dispute. Approximately 23 states and Puerto Rico address in statute the issue of children who witness domestic violence in their homes (Child Welfare Information Gateway 2013). Statutes typically define the circumstances that constitute “witnessing” and the consequences under the law; however, as discussed in this chapter, professionals differ as to whether witnessing domestic violence, on its own, warrants CPS intervention (Child Welfare Information Gateway 2009). Unfortunately, the words witness and exposure fail to capture the nuanced and

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multifaceted nature of this experience. By reviewing how many children are exposed to or witness domestic violence and understanding the consequences of that exposure, we can begin to grasp the enormity of what children experience when exposed to domestic violence. Prevalence The most commonly cited estimates are that between 3.3 million (Carlson 1984) and ten million children (Straus 1991) witness domestic violence each year. However, these estimates are problematic because they are based primarily on reports from adult victims who are asked about their children’s exposure or asked whether they themselves were exposed as children to domestic violence. Therefore, there are problems associated with accurate recall of events that may have happened long ago or in the midst of a crisis. Another problem with these estimates of prevalence is that parents often believe their children are not exposed to or even aware of domestic violence occurring in the home. In fact, children consistently report witnessing domestic violence even when their parents insist they have not (O’Brien et al. 1994). And it is difficult to interpret these statistics because the actual nature of exposure is not detailed. Researchers tend to pose the issue of exposure as a “yes” or “no” dichotomy and, as a result, fail to capture the 1. coincidence of exposure with actual harm to the child; 2. severity, type, frequency, type, and/or duration of violence to which children are exposed; and 3. the developmental age of the child at the time of exposure and/or or the child’s reaction. Indeed, most studies that examine the impact of domestic violence on children focus on physical violence, ignoring other forms of violence including psychological abuse (Chang et al. 2008). All these factors tend to be significant in shaping how children are affected. Even with these caveats, the estimates of children exposed directly or indirectly to domestic violence make this a significant social problem.

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As suggested, children can be inadvertently injured during domestic violence incidents. However, data gathered at the scene of these incidents suggest this may occur in fewer than 3 percent of the incidents in which police make an arrest, presumably those incidents at the higher end of severity (Stark 2002). This percentage merits concern, particularly when considering the frequency and duration of domestic violence. Nevertheless, while the prevalence of injury to children during domestic violence incidents is slightly higher than the estimated incidence of child abuse in the general population (3 percent versus 2.5 percent), it is probably lower than the percentage of children estimated to be abused by foster families (5 percent; Stark 2002). In 2011, 25.1 percent (unique count) of the children found to be victims of maltreatment (U.S. Department of HHS 2012:22) were identified as having been exposed to domestic violence in the home for those states reporting on this risk factor2. Consistent with this finding, the analysis of data from National Survey of Child and Adolescent Well-Being II (NSCAW II; Casanueva et al. 2013) indicates that parents reported for child maltreatment have experienced high rates of domestic violence. Twenty-five percent of parents whose children remained home subsequent to reports of maltreatment, self-reported experiencing physical domestic violence during the prior twelve months. In comparison, the caseworkers investigating these reports reported that only one in ten had experienced active domestic violence, strongly suggesting that CPS staff may under-identify both domestic violence and the need for domestic violence services for families whose children remain at home. Similarly, in a earlier study that queried a national sample of families referred to CPS, almost 4 percent of female parents or caregivers experienced domestic violence at some point in their life—29 percent of the parents had experienced domestic violence in the year prior to the survey (Hazen et al. 2004). In another study, 31 percent of mothers involved with CPS reported

domestic violence, but only 12 percent of those mothers were reported by the CPS workers assigned to their cases (Kohl et al. 2005). Consequences Children may be deliberately abused during an attack on their mother, inadvertently hurt (e.g., if the mother is holding a baby when she is assaulted), or hurt because they try to stop the abuse or otherwise intervene when their mother is being attacked. Thus children may either become involved in the conflict or may distance themselves from it, either physically (by going somewhere else in the house to hide) or psychologically. Among the psychological consequences of children’s exposure to domestic violence are the behaviors children use to cope. These include “internalizing” behaviors, where children defend against their fear by disguising it in other problems, such as withdrawal, anxiety, sleep disturbances, somatic problems, and post-traumatic stress disorder, as well as “externalizing” behaviors such as exhibiting aggression against others (including their mother) and delinquency (Kernic et al. 2003; Lehmann 2000; Levendosky et al. 2002; Wolfe et al. 2003). Indeed, in one study, children exposed to domestic violence were found to be two times more likely to develop internalizing and externalizing behavior problems when compared to children not exposed (Sternberg et al. 2006). Exposure may also lead to problems with school, including difficulties forming peer relationships, acting out in classrooms, diminished concentration and memory, challenges with organizational or language abilities, and perfectionist tendencies (Cole et al. 2005). Indirectly, children may be affected by the lack of consistent parenting; by the secondary consequences of abuse of their primary parent, such as alcohol or drug abuse; or by the high levels of irritability and tension typical in violent homes. Children may also be affected by the threat of violence toward the mother; the rigid or authoritarian parenting style of the batterer; being used by the batterer to undermine the

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mother’s authority; and by the fear of abduction. Violence against a mother may escalate during a separation or after a divorce, and children may be harmed during visitation exchanges or be used in a range of ways by the abuser who seeks to control his former partner but cannot do so directly. Finally, abused women are also more likely to abuse their children than are nonabused women (Norman 2000). While domestic violence may directly or indirectly influence children in any of the ways already described, the extent of these effects differs depending on the type, duration, and severity of domestic violence to which children are exposed. Children’s developmental age and the developmental tasks associated with their age also determine how children are affected by domestic violence. Infants and toddlers appear to react differently to being exposed to domestic violence than do school age children or teenagers, for instance (Levendosky, HuthBocks, & Semel 2002; Levendosky et al. 2002; Osofsky 2003). Since attachment and bonding are critical tasks for younger children, an abuserelated separation or fear of separation induced by witnessing an assault against a primary parent is likely to be more traumatic for a younger child than for a teen who may have some experience getting by on his own. A child’s sex may also influence how the child is affected. Some research suggests that boys are more likely to become aggressive as a result of witnessing domestic violence, whereas girls are more likely to exhibit passive adaptations, such as withdrawal (Jaffe, Wolfe, & Wilson 1990). Not all researchers agree on this, however (Lehmann & Rabenstein 2002). Other important factors contributing to the effects of domestic violence on children include the nature of institutional interventions and whether these are perceived as helpful or not. Children who reside in domestic violence shelters also display trauma symptoms as a result of moving suddenly, living in an often chaotic and disruptive shelter environment, and being removed from friends and school (Levendosky et al. 2002).

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Importantly, the stress levels—hence the probability of behavioral adaptations—appear to be cumulative rather than incident specific, with those children exposed to abuse for a longer period reacting more strongly than do those children who are exposed to fewer incidents. Aspects of children’s lives may protect them from the effects of exposure as well as increase their risk. These protective factors include the characteristics of the child, the quality of family support, and the quality of extrafamilial support. We know, for example, that poverty, divorce, exposure to violence in the community, and other stressors may have many of the same effects on children as exposure to domestic violence. When child psychologists Emmy Werner and Ruth Smith (1992) studied children in Hawaii, they found that children exhibited extraordinary resilience even in the face of extreme poverty, neglect, and abuse, particularly if there was a caring and supportive adult present. Indeed, other researchers have noted that parental warmth, positive expectations, and support positively impact children’s behavior regardless of exposure to adverse social problems (Katz & Gottman 1997; Kim-Cohen et al. 2004). In a more recent study, those children exposed to domestic violence demonstrated more positive and fewer antisocial behaviors when mothers exhibited greater authority and control (Levendosky & GrahamBermann 2000). In contrast, constant exposure to domestic violence led to internalizing and externalizing behavior in children; however, limited exposure (i.e. only once or early in life) was not associated with resilience (MartinezTorteya et al. 2009). Yet these same researchers found that when children had an easygoing temperament and when the mother was not depressed, the combination resulted in positive outcomes or enhanced resilience for children who had limited exposure (Martinez-Torteya et al. 2009). Thus only by knowing the protective and risk factors in a particular situation can we predict how a child will be affected by exposure to domestic violence.

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Just as estimates about the prevalence of child-witnessing violence may be questioned, generalizations from research on child exposure can also be challenged. First, many studies of children’s behaviors are based on reports provided by their mothers while residing in domestic violence shelters. These women have typically experienced abuse that is more severe and long lasting than the violence experienced by other victims. In addition, because of their education about domestic violence, they may be prone to interpret their children’s behavior differently from other adults and from the children themselves. Additionally, children’s behavior may be influenced by the disruption of their normal routine by going to a shelter, the experience of living in a shelter itself, or by their emotional reaction to leaving home and possibly a father figure whom they love. Study designs and interviewers may also not have considered or given adequate weight to demographic factors, including age, gender, intellectual functioning, socioeconomic status, race, unemployment, and age of parents. Other family factors are known to affect children adversely, such as parents’ substance abuse, paternal or maternal physical or mental health difficulties, pathology, and the level of stress, degree of parenting ability, and the stability of the home environment. The Philosophical Conflicts Even if we cannot predict exactly how a child will be harmed by exposure to domestic violence, or whether she will be harmed at all, there can be no question that children so exposed are at an increased risk of suffering some adverse short or long-term reaction. The challenge, then, is how to best intervene with families experiencing domestic violence while keeping children and their mothers safe from further abuse. Apart from the police, the two systems that are most directly responsible for family members in these cases are child protective services (CPS) and domestic violence services. So it is worth considering how these services approach families experiencing domestic violence.

Tension and sometimes open conflict is a common feature of the relationship between CPS and domestic violence service providers (Moles 2008). Much of this tension stems from a difference in philosophy and in the preferred approach to dealing with violence in the home. The public mandate of CPS is to protect children. The preferred approach is to keep children in their homes by providing services or support that strengthens the family’s capacity to keep them safe. Temporary removal is an option if services fail or the risk to the child is deemed eminent. Permanent placement and termination of parental rights are the most extreme interventions if efforts to reunify the family fail. Once a case is referred, CPS workers investigate reports of child maltreatment to determine if the report is substantiated, assess the risk of harm to the child, and determine what combination of services, support, or other interventions are needed. In contrast, the first priority of battered women advocates is the safety of the adult victim. This, they believe, is best accomplished through a collaborative approach known as empowerment whereby victims and advocates work together to identify the victims’ goals, which often include keeping themselves and their children safe. In this view, safety is a timeconsuming and frustrating process that may involve victims struggling with life-changing decisions about leaving their partners and becoming economically and emotionally independent. Hence, while child safety is important to battered women advocates and most shelter programs today also provide services and support for children, the physical, emotional, and financial needs of the victim as she perceives them are paramount. Advocates also emphasize “accountability” for violence, usually by encouraging the arrest of an abusive partner. Both CPS and domestic violence programs want women and children to be safe. But there are a number of obstacles that make it difficult for them to address this goal without conflict. On a practical level, there may be an adversarial

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relationship because CPS and domestic violence services compete for funding from the same general pool. Child protective services practices often include opening child abuse cases in the name of the primary caregiver, usually the mother, who may or may not be the perpetrator of the abuse. Moreover, CPS workers typically develop a service plan that focuses on the mother’s ability to protect her children, regardless of whether she herself remains at risk. If she continues to remain in an abusive home, CPS workers will often try to convince a mother to leave an abuser or charge her with “neglect” or with “failure to protect” her own children. One result is that many mothers fear and distrust CPS workers, feel powerlessness to resist CPS mandates, and overtly resist any interventions. Early on, in an attempt to work with child protective services staff, many battered women advocates supported laws equating exposure to domestic violence with child abuse because they believed charges would be filed against the partner responsible for the abuse, usually the man. But their support of such laws turned into opposition when it became clear that abused women were often being charged with failing to protect the children even when they themselves had been victimized. Advocates were also concerned that such laws would lead to mandatory reporting of child abuse in domestic violence cases. By contrast, CPS workers often become frustrated with the long process needed for victims to achieve safety; they often struggle with advocating for a mother when her decision, or lack thereof, jeopardizes her children. Indeed, as time passes, CPS workers may become more critical and controlling of a victim’s decisions and may identify her as the person solely responsible for protecting the children. Additionally, CPS workers may think they lack the authority to legally pursue the batterer. Hence, by not focusing on holding the abuser accountable and keeping the mother as well as her children safe, CPS advocates may unknowingly

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increase the problems faced by domestic violence victims and their children. Both CPS and domestic violence service approaches assume that the needs and goals of abused women and their children are in conflict. Unfortunately, in the midst of this conflict, little attention is paid to the abuser. If the abuser is neither the legal guardian nor the biological parent, he is often missing from the case file and is not officially a party to the service plan or any court decisions. This may make him largely inaccessible to CPS. One response is for CPS workers to hold a victimized mother responsible for seeking a restraining order to remove her partner, even if this is not the safest option, or, worse, to demand she leave him regardless of the risks she perceives this may pose. When she fails to meet these requirements, CPS may initiate a legal proceeding to place the children in out-of-home care. Assumptions The ideal situation is for CPS and domestic violence services to work jointly and collaboratively on protecting all victimized parties in the family and to clearly target the partner responsible for any violence in the home. Unfortunately, the conflicts between the two fields are largely a function of the assumptions made by CPS workers and other helping professionals about domestic violence. These assumptions frame policy, the mandates that constrain the discretion of caseworkers, the services offered to mothers and their children, and the methods used to evaluate the efficacy of these services. This section explores three of the core assumptions about children exposed to domestic violence that have historically guided the practices and policies of the child welfare system. Assumption #1: Children Who Witness Domestic Violence Are More Likely to Become Abusers or Victims as Adults Deciding whether exposure to domestic violence is a form of maltreatment may depend on one’s theoretical perspectives concerning the causes of domestic violence. To policy makers,

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CPS workers, and others who, based upon the social learning model, hold that children learn behaviors from their parents and transmit them intergenerationally, it seems obvious that any child exposed to domestic violence is at risk of becoming an abusive adult, regardless of any mediating factors. However, if one concurs with the feminist theory that domestic violence is not a personal problem, but political, rooted in sexism, sexual inequality, and a patriarchal culture that tolerates and even encourages male domination over females, then one would assume that the impact of a child’s exposure to domestic violence ought to be assessed individually, based on the nature, frequency, and severity of the exposure. Hence, one’s belief about the cause of domestic violence and the corresponding impact on children exposed to such violence will influence one’s decisions about when and how to intervene with families experiencing domestic violence. Research conducted from a social learning theory perspective concludes that being exposed to domestic violence as a child is positively correlated to involvement in a domestic violent relationship as an adult and that children learn how to use violence to control others from observing a parent doing so. Stith and her colleagues (2000) conducted a meta analysis of thirty-nine studies and concluded that when children grow up in families experiencing domestic violence they are more likely to be involved in violent marital relationships as adults. Another study found that children who had witnessed domestic violence were more likely than children who had not witnessed domestic violence to respond violently when they felt excluded or personally rejected (Ballif-Spanvill, Clayton, & Hendrix 2007). Unfortunately, most research in this area fails to consider other risk factors that might predispose children to violence, including the media, schools, or communities. Clearly, although research has found that a child’s exposure to domestic violence increases the risk of violent behavior as an adult, this is

not automatic. One issue with research in this area lies in the samples studied. For example, despite the self-interest persons have in justifying their current situation by finding a cause in their childhood, much of the evidence to support the intergenerational thesis comes from interviews with adult batterers and victims. In comparing children who did or did not witness domestic violence, for instance, Ballif-Spanvill, Clayton, & Hendrix (2007) found that neither group used violence involving limited resources, intimidation, or jealousy. They concluded, “finding so many children with prosocial responses emphasizes the importance of assessing a range of positive social behaviors and exploring adaptive abilities in all children, even those who have been exposed to family violence” (p. 210). Thus, while exposure is a risk factor, other protective or resiliency factors may mediate the outcomes for children. Studies have found that such factors include 1. having a strong relationship with a caring parent or other significant adult; 2. having safe and supportive locations, whether located in schools, community centers, or religious havens; 3. developing athletic, scholastic, or artistic talents; 4. being able to avoid self-blame; and 5. having strong positive peer relationships (Bancroft & Silverman 2002). Much of the discussion about CPS intervention in domestic violence situations highlights the need to “break the cycle of violence.” However, a range of protective or resiliency factors mediate any connection between exposure to domestic violence as a child and adult abuse. CPS workers and others who fail to assess these factors on a case-by-case basis may unwittingly make decisions that negatively impact children and their mothers. Cross et al. (2012) note that differential response programs hold promise for addressing children’s exposure to domestic violence. Assumption #2: Victimized Mothers Often Abuse or Neglect Their Children While we know there is often an overlap between domestic violence and child abuse, the challenge is to determine who is the abuser

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of the children, particularly if this means that children will be protected if the abusive partner is removed. A number of explanations have been offered for why battered women may abuse their children, including controlling the children to prevent both the mother and children from being abused by the batterer, using the children as an outlet for their frustration at being abused themselves, or blaming the children for their abuse (Mills et al. 2000). Other explanations focus on the mother’s mental health. Studies have found that mothers suffering from psychological distress (e.g. depression or PTSD, which is commonly found in abused women) are less available to and supportive of their children (Katz & Windecker-Nelson 2006; Levendosky et al. 2006). Another widespread belief is that abuse causes mothers to be emotionally unavailable to their children and/or causes them to be more likely to use corporal punishment than nonabused mothers. To test this belief, psychologist Cris Sullivan and her colleagues (2000) examined how women’s victimization related to their parenting stress and, in turn, how their parenting affected their children’s adjustment. They found that, despite the fact that mothers had experienced substantial levels of physical abuse, they continued to be emotionally available to their children and enjoyed their role as parent. Moreover, battered women were more likely than nonbattered women to use nonviolent forms of discipline, including using timeout, removing privileges, or grounding their children. All of these results were confirmed by the children (Sullivan et al. 2000). However, a secondary analysis of the National Survey of Child and Adolescent Well-Being (NSCAW) found mixed results among women involved in CPS who also had experienced domestic violence (Kelleher et al. 2006). These results indicate that women who reported recent domestic violence victimization were almost eleven times more likely than women with no domestic violence experiences to also report physical aggression toward their

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children. Indeed, the researchers conclude that women who experience domestic violence were more physically and psychologically aggressive toward their children (Kelleher et al. 2006). Recent research confirms these findings. An analysis of the impact of different types of abuse on mothers’ mental health and parenting found economic abuse and psychological abuse impact a mother’s depression and use of spanking; psychological abuse impacts mothers’ engagement with their children (Postmus 2012). Batterers also abuse their children as a means of controlling or hurting their adult partners and/or may use the children to spy on the mother’s movements and relationships. While mothers are more often cited for child abuse than fathers, in the most severe forms of child abuse, men are most often the perpetrators. In one recent study that examined the role of psychological abuse in families, results indicate that when the male partner psychologically abused his female partner, their children were five times more likely to experience neglect than were the children in families without psychological abuse (Chang et al. 2008). Finally, children can be hurt accidentally by getting in the middle of a violent episode either intentionally, in an attempt to protect their mother, or unintentionally because they happen to be in the same room. In one study of battered women in shelter, 44 percent of the children surveyed reported that they had attempted to protect their mothers on at least one occasion; 37 percent reported being hit in the process (Mills et al. 2000). Can battered women become abusers themselves? Absolutely. Even in these instances, however, it may important to understand the role of the batterer. Assumption #3: Battered Women Must Leave the Abusive Relationship in Order to Keep Themselves and Their Children Safe The common reaction of most service providers, including CPS and many domestic violence providers, is to protect women and children

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from harm by urging them to separate from the abuser. Since CPS uses removal as a means to protect children, it seems logical to some that the same tactic can be effective in protecting children from domestic violence. Even if we set aside the concerns raised by the Nicholson case (which I discuss in the following section), this approach raises a number of problems. First, removing children from their home and placing them in foster care does not necessarily protect children from physical or psychological harm. We know that removal and long-term separation can be even more traumatic for children than the initial maltreatment, an important reason why courts have increasingly required CPS to make their case for removal by weighing the harms this would cause against the harms of not removing. Additionally, longitudinal research has shown that living in multiple homes (often in foster care) is more predictive of poor outcomes in adulthood than is the original maltreatment (McDonald et al. 1996). In any case, limited resources make it impossible for CPS in most states to provide protective services for any but those children and families who have suffered the greatest harm. Second, removing women and their children from the home does not automatically mean they are safe from further harm. Women may actually be more likely to be seriously injured or killed by their abusive partners when they leave the relationship than if they stay (Bachman & Saltzman 1995; Browne & Bassuk 1997; Fleury, Sullivan, & Bybee 2000). And, for those who leave, their perpetrators continue to harass or hurt them during a separation or after a divorce. So even where leaving is encouraged, it is not a stand-alone solution. Meanwhile, a growing body of work (Bancroft & Silverman 2002) suggests that a mother’s efforts to protect her children can significantly reduce the danger posed by a batterer. Hence we must identify ways in which mothers keep themselves and their children safe whether or not they continue in the relationship with an abusive partner.

Instead of removing the children and the mother from the family’s home, an alternative is to remove the perpetrator by having him arrested or getting a restraining order—strategies the domestic violence movement frequently uses. CPS may lack the authority to remove the adult perpetrator, particularly if he is unrelated to the child; in some cases, “no contact” orders may be used as part of a service contract to avoid placement of children and their mother in a shelter. Unfortunately, the remedies used to keep women and children safe have not always been effective in protecting battered mothers and their children. For instance, in my own research, I have found that restraining orders are inconsistently enforced and have varying effects on stopping abuse for women (Postmus 2007). Research finds the efficacy of mandatory arrest, dedicated prosecution, and other criminal justice approaches mixed at best. Other research also indicates that mothers’ experiences with CPS were mixed; some felt blamed for the abuse or were given additional tasks to complete while others experienced fair and supportive responses from CPS workers (Johnson & Sullivan 2008). Finally, while women generally rate their shelter experiences positively, there is little evidence that a shelter stay ends violence in most cases. Unintended Consequences Although these assumptions have a weak empirical foundation, they have exerted a powerful ideological force on public policy and the institutional response. One result of these assumptions has been pressure on states to require professionals to report children who witnessed domestic violence to the state’s abuse hotlines and to include exposure to domestic violence as a form of child abuse or neglect. Initially, both child welfare staff and battered women advocates supported the enactment of these laws; unfortunately, several unintended consequences resulted.

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For example, when Massachusetts and Minnesota enacted policies that required all cases of domestic violence be reported to CPS, the states’ already overburdened and underfunded services were quickly overwhelmed, reducing the states’ capacity to respond appropriately to cases where abuse or neglect were clearly identified. Additionally, battered women may be less willing to disclose domestic violence to professionals who are mandated reporters because they fear CPS involvement may lead to losing their children. Other states left their reporting policies ambiguous, leaving the decision to report up to the individual professional. States also use ambiguous protocols for investigations and assessments, giving the worker broad discretion on whether to assess for and include domestic violence in their findings and whether to substantiate a finding of neglect in domestic violence cases. Ambiguous policies, a wide range of discretion, frustrations and/or fear of working with batterers, and pressures to resolve the report in a timely fashion may contribute to CPS workers’ reliance on their mandate to protect children from harm and consequently place the blame on the mother for not protecting her children from exposure to domestic violence. In such instances, CPS workers may fail to officially “see” domestic violence at all. Another unintended consequence of actions based upon these questionable assumptions is that CPS workers are citing victimized mothers with “neglect” and removing children for witnessing domestic violence. In a study of children labeled as abused or neglected, Stark and Flitcraft (1988) have reported that the children of battered women are more likely to be removed from the home than children from nonbattered mothers even when the level of harm to the child is the same. Using data from NSCAW, over half (52 percent) of families currently experiencing domestic violence were substantiated compared to only 29 percent of families with a history of domestic violence or 22 percent of families with no domestic violence (Kohl et al. 2005). Most of

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the substantiated cases fell under the neglect category, with the blame or person responsible being assigned to the mother. CPS workers rarely identified past or current domestic violence as the critical factor in their decision making unless other risk factors (i.e. substance abuse, mental health issues) were also present. The researchers emphasized the importance of using consistent risk assessment protocols that differentiate between past and present domestic violence in a family as well as the importance of staff receiving appropriate training on the multiple challenges that plague families. To gain an even fuller picture of the CPS response to domestic violence, English, Edleson, & Herrick (2005) examined two thousand randomly selected CPS cases. Their results indicate that fewer than half of the cases in which domestic violence had been reported to CPS were accepted for investigation; of those accepted, most were viewed as “high standard of investigation” requiring a face-to-face interview with a CPS worker. Domestic violence was listed as a risk factor in 40 percent of the cases investigated (20 percent of all referrals). In cases where domestic violence was indicated (i.e., classified as moderate to high risk after investigation and opened for services), four out of five children were removed from their homes, a far higher proportion than in other cases (English, Edleson, & Herrick 2005). The practice of charging battered mothers with neglect and placing their children in foster care either because of the domestic violence or because they had refused services mandated due to domestic violence led to a federal class action lawsuit in 2001 in New York City, Nicholson vs. Scoppetta. After a trial that included dozens of caseworkers, administrators, researchers, and mothers as experts, Judge Weinstein ruled that the city’s removal practices were unconstitutional and that “government may not penalize a mother, not otherwise unfit, who is battered by her partner, by separating her from her children; nor may children be separated from the mother, in effect visiting upon them the sins

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of their mother’s batterer” (Carter 2002). The judge further stated that reasonable efforts, a term not unfamiliar to CPS, must be made to separate the batterer from the victim and her children while providing reasonable, adequate protection, such as assisting in helping the family find shelter or other safe accommodations and filing a protective order against the batterer. Additionally, the judge stated that mothers are to be informed of their rights and those of their children prior to CPS taking any actions to remove children and that these rights be provided in both English and Spanish. Finally, the judge ordered that training and supervision be given to CPS workers and contractual service providers, a domestic violence specialist be hired as part of a clinical consultant team, and a review committee be established to enforce the terms of the findings and provide the court and all other interested parties with monthly reports. The agency targeted by the lawsuit, the Administration for Children’s Services (ACS) in New York City, appealed Judge Weinstein’s decision. The case was resolved when the New York Court of Appeals, to whom the case had been referred by the federal court, concurred with Judge Weinstein and added the stipulation that ACS, in its petitions for removal of children from the family’s home, had to weigh the harms of leaving a child in the home against the trauma of removal. After three years of operation, the Nicholson Review Committee (NRC), representing all the parties to the lawsuit, concluded that the practice of removing children solely because of domestic violence had largely ended in New York City. Current Practices The case of Nicholson vs. Scoppetta had a ripple effect across the country. Child protective services staff began examining the strategies used to intervene in families experiencing domestic violence. Many states are still examining how to best serve families that experience domestic violence. In this section, the current practices of local and state agencies are reviewed.

The response of state agencies, domestic violence programs, and communities has not kept pace with research on the overlap of domestic violence and child maltreatment. Few states have developed strategies to address the overlap of these problems in families; moreover, those states that have initiated policies addressing the overlap of domestic violence and child maltreatment have generally failed to evaluate their programs and service outcomes to see if recently implemented strategies are working. In addition to those states with statutes concerning child witnessing of domestic violence, many other states have attempted to include screening and services for children exposed to domestic violence as part of CPS. In general, most of these efforts involve collaborating with other agencies and/or training for CPS workers to screen and intervene with families experiencing domestic violence. The review of these efforts includes those with promising ideas as well as those that are empirically supported. Massachusetts Massachusetts has a long history of addressing the challenges when children are exposed to domestic violence. In a review of their case files, the Department of Social Services (DSS) discovered that 70 percent of referrals for intensive services included domestic violence; however, the investigative worker identified domestic violence in fewer than half these cases (Schechter & Edleson 1994 as cited in Aron 1997). In response to these findings, the Massachusetts DSS piloted a project that required professionals to report child abuse and initiate an investigation if a child was exposed to domestic violence. As a result of the project, reports of domestic violence increased dramatically, but without additional funds or staff to handle the reports. Additionally, they found that women were reluctant to disclose their abuse to professionals for fear of losing their children to DSS. Rather than continuing the pilot project, DSS created a domestic violence unit staffed

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by advocates or specialists from the domestic violence field. This unit provides training and consultation to child protective services staff; offers education, training, and collaboration to other community agencies including shelters; and provides direct services to battered women identified by CPS. A six-month followup (Mills et al. 2000) showed that 70 percent of all CPS cases were referred to the new DSS unit for domestic violence services, a dramatic increase compared to the proportion of cases in which domestic violence had been identified prior to co-locating a battered women advocate with CPS workers. Michigan Similar to Massachusetts, Michigan has a long-standing history of addressing the challenges faced when CPS works with families experiencing domestic violence. In the mid1990s Michigan established the Domestic Violence Prevention and Treatment Board, a statewide coordinated effort to end domestic violence. The focus of the board’s mandate included CPS collaborating with family preservation services and domestic violence programs. The collaboration resulted in the establishment of Families First, a program that recognized that children’s safety can best be achieved by ensuring the safety and selfsufficiency of their mothers (Aron & Olson 1997; Saunders & Anderson 2000). The focus of Families First was to provide cross-training on domestic violence for all program managers, supervisors, and caseworkers as well as battered women advocates and domestic violence shelter staff. The biggest change in services occurred when shelter staff was permitted to directly refer families to the Families First program. Previously, cases could only be referred to the CPS hotline, whose staff would decide whether a domestic violence referral was appropriate. Through a collaboration of battered women advocates with Families First staff, mandated training is provided for all CPS workers in

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Michigan. These training sessions focus on batterers, the criminal and civil laws pertaining to domestic violence, community resources, and related topics such as substance abuse, sexual abuse, parenting, and child development. An evaluation found that, as a result of their training, caseworkers decreased their blame of holding victims responsible for their children’s safety from 54 to 40 percent and decreased their referrals to couples counseling from 74 to 46 percent. The proportion of CPS workers empathizing with battered women increased, and less emphasis was placed on ending the relationship (Saunders & Anderson 2000). New Jersey In the late 1990s New Jersey Department of Children and Families (DCF), Division of Youth and Family Services (DYFS), launched the PALS program—Peace: A Learned Solution—an intensive therapeutic treatment program for children exposed to domestic violence. PALS uses different modalities of art therapy (e.g. drama, dance, music, art). PALS’ intent is to provide children a safe environment to heal from their experiences with domestic violence without having to directly talk about those experiences. Treatment lasts for six months in which children attend therapy twice a week—once for individual and once for group therapy. The children’s mothers also receive therapy and case management services. Early evaluation results suggest that 80 percent of children (n = 68) who participated in PALS showed improvements in their anxiety, depression, withdrawal, and aggression symptoms.3 The program remains in place in several of the state’s domestic violence organizations, but is not available statewide. No further evaluation has been conducted since the initial one. In the last few years New Jersey has embarked on an unprecedented state-level effort to create a comprehensive, integrated response to the cooccurrence of domestic violence and child maltreatment through the creation of a Domestic

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Violence Liaison (DVL) program.4 This effort has included collaborations between the DCF, DYFS, the courts, and the New Jersey Coalition for Battered Women (NJCBW). The results from this collaboration included the finalization and implementation of the DCF Domestic Violence Protocol, the adoption of a directive for the courts, and the creation of the DVL program: DVLs are specially trained professionals with extensive knowledge of domestic violence and available services and are employed and clinically supervised by the local domestic violence program. They are co-located at DYFS offices to assist DYFS caseworkers in on-site assessment, case planning and safe interventions and domestic violence safety planning, support, and advocacy for domestic violence victims and their children. Services of the DVL for domestic violence victims and their children also include advocacy within DYFS; advocacy and referrals to other community-based services, including health and criminal justice; and support and services through individual and group counseling. The goals and outcomes of New Jersey’s DVL program include the following: 1. ensure the safety of children whose family is experiencing the co-occurrence of child abuse and/or neglect and domestic violence, from reporting through case termination; 2. develop a safety protection plan with the nonoffending parent (NOP) or caregiver to ensure that each child is safe from harm and substantial risk of harm; 3. enable the child to live in a stable and nurturing home environment, with the nonabusive parent wherever and whenever possible; 4. provide individualized, strengths-based, needs-driven services to children and families; and 5. reduce the subsequent reports of domestic violence and/or child abuse and neglect while DYFS provides services and after-case closure.

Unfortunately, the DVL program has not yet been evaluated to determine if the stated goals are being accomplished. The Greenbook Initiative A committee designated by the National Council of Juvenile and Family Court Judges to develop recommendations on how to best work with families with children who are exposed to domestic violence produced a report, formally called Effective Intervention in Domestic Violence and Child Maltreatment Cases: Guidelines for Policy and Practice (Schechter & Edelson 1999), commonly known as the Greenbook. In early 1991 the U.S. Departments of Justice and the Health and Human Services funded six sites across the U.S. to implement the Greenbook’s recommendations and focus on coordinating efforts between the courts, CPS, domestic violence shelters, and other professional groups involved with families experiencing domestic violence—law enforcement, medical providers, and schools—in a “seamless service delivery system.” Early on, evaluators identified several obstacles to the success of these collaborative efforts, including a lack of trust among participating organizations, which hindered their willingness to work together to overcome ideological differences; inadequate resources; and a compromised ability for the organizations to work collaboratively due to the inclusion of some members that hurt the effort (Caliber 2004). More recent evaluation projects have found significant changes in policy and practice in CPS when responding to families experiencing child abuse and domestic violence. For example, 72 percent of CPS staff reported that they had a formal mechanism to address domestic violence, with another 17 percent reporting an informal structure to share information with others (Banks et al. 2008). This same evaluation found that 73 percent of CPS staff had formal contact with local domestic violence providers, and 28 percent of agencies had battered women advocates co-located within the offices

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(Banks et al. 2008). Unfortunately, only a few of the CPS caseworkers knew how to use the colocated advocate (Banks, Landsverk, & Wang 2008). Significant changes have been reported due to CPS participation in the Greenbook Initiative; however, the implementation continues to face challenges and obstacles in moving beyond the adoption of revised policy and procedure to actual changes in practice and collaboration between CPS workers and advocates. Family to Family (F2F) F2F initiative, funded by the Annie E. Casey Foundation in the early 1990s and later expanded to sixty cities in seventeen states, has encouraged CPS to place children who are removed from their homes in their own neighborhoods and to keep families involved with their children.5 The F2F grantees realized that failing to address domestic violence could significantly interfere with their ability to reach their stated outcomes, but lacked the resources or knowledge needed to adequately respond to these cases. A more recent assessment noted the wisdom of these fears, citing the philosophical differences between CPS staff and battered women advocates and their reluctance to frankly acknowledge and discuss these differences as major barriers (Cohen & Davis 2006). The participating sites also noted difficulties in gathering information about domestic violence with children, their families, foster families, and/or adoptive families as well as the lack of screening for domestic violence in foster families or support for victims in these families. The sites were also frustrated with the lack of knowledge and training on domestic violence for all involved, including community representatives (Cohen & Davis 2006). Safe Start Demonstration Projects As a result of a national summit in 1999 to create “a multidisciplinary continuum of prevention, intervention, and accountability,” the U.S. Departments of Justice and Health and Human Services created the Safe Start Demonstration

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Project, piloted in eleven sites throughout the U.S. between 2000–2005. The idea was similar to the Greenbook Initiative—developing partnerships and collaborations between and among service providers, law enforcement, and the courts with the intent to create a comprehensive and coordinated system of care for families experiencing domestic violence. The major achievement of this initiative involves the materials and information produced, including policies, protocols, and a judicial checklist (Maze 2006). Evaluative results concerning Safe Start have indicated that most of the perpetrators were the biological father (31 percent) or mother (9 percent) and that the children were more often witnesses (35 percent) than actual victims of violence (9 percent) (Kaufman et al. 2011). Additionally, 25 percent of the children who were exposed to domestic violence had PTSD and almost 50 percent of the parents reported stress related to parenting. A specific intervention (e.g., police) sparked a referral for 21 percent of the children; another 10 percent were identified through routine screening. Program evaluators identified the value of providing training with many different community agencies to provide such referrals for services to children exposed (Kaufman et al. 2011). Unfortunately, with varying implementation of the Safe Start Initiative across eleven sites, limited information exists to determine if the program produced any positive outcomes. Responding to the Problem In addition to training and collaboration and coordination between agencies, the literature discusses methods for screening and assessing domestic violence and responding with appropriate interventions for all family members involved, including the children, the victims, and the batterers. Given the dynamics of domestic violence, including fear, isolation, secrecy, and control, domestic violence is often not detected by CPS (McKay 1994). Add the fear of having children removed and perceptions of

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professionals who blame them for the abuse, and women may hesitate to report domestic violence. Screening and Assessing Screening procedures should include direct and indirect questions regarding the existence of abuse in the family and should be a routine part of the assessment. Direct inquiry includes questions such as “Have you ever been hit, slapped, poked, pushed by an intimate partner?” Indirect inquiry includes questions such as “Many women today are physically and emotionally abused by their significant others. Has this ever happened to you?” An important caution should be noted when screening for domestic violence: always ask these questions in private, out of the hearing of the alleged batterer. If the batterer refuses to allow the worker to meet privately with the mother and/or the children, the worker should set up a time for a private meeting. The worker may also have routine answers that dictate the privacy of the questions, such as “Agency rules dictate that I must meet individually and privately with every member of the family.” In New York City an intake questionnaire was developed by the Family Violence Prevention Project, a program designed to address the co-existence of domestic violence and child maltreatment (Magen, Conroy, & Tufo 2000). The questionnaire had five sections including a face sheet, interview questions, the extent of domestic violence, caseworker’s assessment, and applicant’s evaluation. The face sheet included basic demographic information about individuals in the house. The interview questions guided the caseworker in asking about “normal” marital conflict and arguments to actual abusive behavior using questions from the Revised Conflict Tactics Scale (Straus et al. 1996). If the interview questions revealed the presence of domestic violence, then the worker was instructed to determine the extent of the domestic violence, a section designed to collect specific information on the type and frequency of abuse as well as protective measures

the victim has used to keep herself and her children safe. The fourth section presented a caseworker’s assessment, and included current and past abuse and the action steps taken by the worker to help the client deal with the abuse. The final section of the questionnaire, the applicant’s evaluation, contained consumer satisfaction questions about the perceived helpfulness of the questionnaire. The evaluation of the implementation of this questionnaire showed some positive results. First, the questionnaire led to a 300 percent increase in the number of women identified as victims (Magen, Conroy, & Tufo 2000). The data generated also indicated that many of the women were victims of severe and life-threatening violence, reported having taken some form of action to stop the abuse, and responded positively to the caseworker’s interventions. Finally, the majority of women expressed favorable perceptions to having been asked about domestic violence by the caseworker (Magen, Conroy, & Tufo 2000). Fleck-Henderson (2000) interviewed Massachusetts Department of Social Services supervisors as part of a needs assessment, asking them about challenges when working with families with domestic violence. The ten challenges they listed include: 1. assessing dangerousness; 2. assessing kids to determine the impact of domestic violence on them and deciding whether to keep a case open or not; 3. understanding risk if abuse is minimized; 4. knowing responsibilities when dealing with batterers; 5. knowing when focusing on safety actually increases the risk of violence and what to do; 6. collaborating with other agencies and maintaining confidentiality; 7. knowing where to find more resources for all family members including children, victims, and batterers; 8. considering cultural differences; 9. taking care of their own and workers’ safety and liability; and 10. managing frustration as well as their own and their workers’ feelings of powerlessness (Fleck-Henderson 2000). The ten challenges listed by the supervisors were used to develop training to address them.

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The results of these studies indicate the need for screening and assessing for domestic violence among families involved with CPS. Assessments should take into account the frequency and severity of domestic violence, any parental or child injury, the parental ability to nurture, and any actual or attempted actions to protect themselves and their children from further abuse (Kaufman-Kantor & Little 2003). Additionally, workers should assess multiple forms of victimization including physical, sexual, emotional, psychological, and economic abuse in the parents’ current relationship, past relationships, and as children (Kaufman-Kantor & Little 2003). Workers should also talk with children, if age appropriate, about the violence in the home and provide outlets for children to express their feelings and thoughts about the violence (Eriksson 2009). Finally, once domestic violence has been identified, workers should evaluate the danger posed to the children and the mother; the physical, emotional, and developmental impact of domestic violence on the children; and the strategies that the mother has used to protect herself and her children (Carter & Schechter 1997). Once domestic violence has been identified, CPS workers as well as other human service providers should work with the mothers who have survived domestic violence by demonstrating core social work values, such as holding a nonjudgmental attitude, showing empathy, explaining the process, and keeping mothers informed of decisions made (Johnson & Sullivan 2008). Interventions After screening and assessing for domestic violence, the worker must provide appropriate and sensitive interventions. The CPS worker should attempt to meet three goals with all domestic violence cases: protect the child, help the abused mother protect herself and her children using noncoercive and supportive interventions, and hold the batterer accountable and responsible for stopping the abusive behavior

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(Carter & Schechter 1997). Practice principles that underlie good interventions include that protecting the battered woman will also protect the child; that attempting to individualize services will help the worker realize not every case of family violence is the same; and that holding the batterer accountable for the abuse and not blaming the mother will help protect her children (Goodmark 2001). Wolak and Finkelhor (1998) suggest guidelines for practitioners when working with children in either a crisis or noncrisis situation. In a crisis situation, such as when the police have been called or the mother is fleeing the home, practitioners should focus on assisting the mother and her children to complete a safety plan, including what to do if the violence reoccurs. In a noncrisis situation, practitioners should be developmentally and culturally appropriate when encouraging children to reveal their exposure to the abuse. Practitioners should also coordinate their efforts with other professionals, including battered women advocates and teachers. In addition, workers should be aware of any child custody issues (Wolak & Finkelhor 1998). Finally, when working with children exposed to domestic violence, the goals of intervention should include to promote an open discussion of the children’s experiences; help children understand and cope with their emotions while producing positive behaviors; reduce the symptoms experienced as a result of the violence; and help the family create a safe, stable, and nurturing environment for the child(ren) (Groves 1999). When interviewing children to determine if domestic violence is present in the home, Faller (2003) describes several approaches, including cognitive interviewing and narrative elaboration. Cognitive interviewing, for example, would prompt the worker to discuss everything about the domestic violence event to reconstruct the context of the abuse. Narrative elaboration techniques are useful for schoolaged children and include the use of cue cards to serve as triggers of the violent event. The

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worker should use different types of questions, including general questions, focused questions, invitational questions, and multiple choice questions (Faller 2003). Little has been written on individual therapy provided to children exposed to domestic violence, with the exception of the small evaluation of the PALS program in New Jersey. More research is needed in this area. Implications and Conclusion Does exposure to domestic violence indicate child maltreatment? How should CPS and domestic violence service providers respond to families with domestic violence? This chapter has attempted to answer these complicated questions by reviewing research on the number of children impacted by domestic violence, and the consequences faced by children when exposed. The philosophical challenges between CPS and domestic violence organizations have been discussed, and state and local initiatives were then presented in a review of the efforts of these systems to collaborate. What can we learn from this review? This concluding section outlines the implications for collaboration, training, practice, and policy for those planning for, working with, or encountering families experiencing domestic violence. Implications for Collaboration When working with families experiencing domestic violence, collaboration among all interested organizations and agencies is crucial. The Greenbook and Safe Start Initiatives outline solid first steps in encouraging communities to work together to keep families safe; however, much more work and evaluation are needed. It is common for service-providing organizations in the community to work together either voluntarily or as a mandate from federal, state, and local governments. Indeed, as discussed earlier, many communities have developed collaborative efforts between CPS, domestic violence service providers, and other

entities. Unfortunately, there is little empirical evidence suggesting that successful interagency collaboration leads to improved client outcomes. Past research on interagency collaboration “suggests that organizations whose cultures support teamwork, flexibility, and participation in decisions, with an open flow of communication and a shared vision, tend to be better able to deliver positive outcomes for clients” (Johnson et al. 2003). Johnson and colleagues also caution that there will be problems with collaboration when evidenced-based practices are vague or when there are different philosophical views— such as the differences discussed earlier between CPS and domestic violence agency staff. Child welfare agency practitioners must take the initiative to learn about domestic violence and to work closely with different professionals. They must also make efforts to forge a common commitment to keep families safe without blaming the mother and leaving the abuser unaccountable for his actions. Workers must also be patient: system change, community change, and individual change do not occur overnight. Nonjudgmental support is essential to working with others, whether professionals or battered women and their children. Implications for Training While training has been helpful for CPS workers, it is not a panacea to deal with the complex issues faced by families experiencing domestic violence (Postmus & Merritt 2010). The issues raised by battered women and their children are often complex and cannot be solved through training alone. Issues such as poverty, substance abuse, and mental health may complicate plans to keep women and children safe from further abuse. Moreover, the attitudes and beliefs of CPS workers may impact the decisions they make regarding assessment and intervention with families experiencing domestic violence. Finally, training can be a fruitless endeavor if not coupled with changes at the organizational and supervisory levels.

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CPS, judicial, medical, or domestic violence staff members may have the best knowledge regarding services to families experiencing domestic violence, yet still be thwarted by policies or protocols established by their respective organizations. Practice Implications Successful practice with families experiencing domestic violence, as suggested in the literature, establishes and achieves the goals of holding the batterer accountable, supporting the battered woman and her children, and keeping the family safe from further harm (Edleson 1999; Child Welfare Information Gateway 2009; Ogbonnaya & Pohle 2013). Both CPS and domestic violence service providers must come to an agreement to how to help families and keep everyone safe from harm. Gewirtz and Menakem (2004) recommend the following as elements for a common practice framework: 1. all family members need to be safe; 2. children need to experience warm, supportive, nurturing relationships with parents; 3. all members of the family should have their basic needs met; 4. service providers need to be welcoming, supportive, and culturally competent; and 5. services should include strengths-based interventions that avoid unintended consequences. Additional practice principles outlined by experts in the field include 1. professionals must be willing to collaborate together across disciplines in a coordinated manner; 2. services to families at risk should focus on prevention and be supportive; 3. service providers must think developmentally about prevention and intervention services; 4. service efforts should emphasize keeping mothers safe so that they, in turn, will keep children safe; 5. the law must be enforced, holding perpetrators accountable; 6. adequate resources must be provided; 7. service providers must rely on sound, evidence-based practices; and 8. service providers must collaborate with others to create a culture of nonviolence at the individual, family, and community levels (Maze 2006).

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Policy Implications Child welfare agencies and domestic violence service providers must evaluate current policies and practices to determine what does and does not work when it comes to keeping women and children safe from abuse. Without statewide policy shifts, reallocation of resources, changes in agency philosophy, and the development of standard procedures or protocols for screening, protective investigations, and case management, agency staff will be frustrated not only in their dealings with battered women but also with their place of employment. Additionally, policy makers should establish minimum competency standards that include training for all levels of staff that might encounter families experiencing domestic violence. Protocols should also be established that clearly provide direction to CPS workers and supervisors when they encounter the overlap of child abuse and domestic violence as well as to advocates and administrators working in the domestic violence field. These standards and protocols should include information and guidance on working with any family, including those with different cultural, ethnic, or immigrant backgrounds. It is imperative that staff from CPS and domestic violence service providers be involved in the development and implementation of practice standards and protocols and be responsible for providing training and consultation when necessary to their peers in their respective fields. When I conduct training on domestic violence, CPS supervisors frequently express their frustrations at wanting to give women time to go through the process of leaving an abusive relationship; however, they are required to maintain the deadlines dictated by the Adoption and Safe Families Act (ASFA). ASFA requires that permanency be achieved for every child placed in legal custody within a specific time period; hence the clock begins ticking once a family becomes part of a CPS caseload. Even if a CPS worker is sensitive to the challenges faced by survivors of domestic violence,

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the worker is required to adhere to federal policies regarding the amount of time allowed for families to become safe. Additionally, supervisors express frustrations with local law enforcement’s inability to hold batterers accountable—especially those that violate restraining orders. While their frustrations are anecdotal, more work is needed to examine how child welfare and criminal justice may hinder agency staff members as they attempt to be supportive of battered women. Research Implications A review of the literature indicates that it is imperative that additional research be conducted to evaluate current practices and initiatives. What does and does not work must be determined. States must be encouraged to open case files to researchers to examine

NOTES

1. Please note that a revised version of the original chapter appeared in Stark and Buzawa (2009), Violence Against Women in Families and Relationships: Making and Breaking Connections, vol. 2: The Family Context by ABC-CLIO. 2. Child Maltreatment 2011 excludes states from these analyses if fewer than 1 percent of victims were reported with this caregiver risk factor (U.S. Department of HHS 2012:27). 3. See www.njleg.state.nj.us/legislativepub/PUBHEAR/ 050201RS.pdf. 4. See http://www.state.nj.us/dcf/prevention/DPCP flyer.pdf. 5. See http://www.aecf.org/MajorInitiatives/Family %20to%20Family/Resources.aspx. REFERENCES

Aron, L. Y., & Olson, K. K. (1997). Effort by child welfare agencies to address domestic violence: The experiences of five communities. Retrieved July 10, 1999, from http://www.urban.org/welfare/ARON3.htm. Bachman, R., & Saltzman, L. E. (1995). Violence against women: Estimates from the redesigned survey. No. NCJ-14348. Washington, DC: U.S. Department of Justice. Ballif-Spanvill, B., Clayton, C.  J., & Hendrix, S.  B. (2007). Witness and nonwitness children’s violent and peaceful behavior in different types of simulated conflict with peers. American Journal of Orthopsychiatry, 77, 206–15.

current practices and to offer suggestions on ways to improve services without condemning or blaming agencies or individual workers. Finally, researchers must not lose sight of battered women themselves as they develop methodologies and sampling plans when evaluating policies or practices. Too often the voices of women are not heard when it comes to policy or program evaluation (Nichols-Casebolt & Spakes 1995). In conclusion, the future lies with service providers from different fields being able to set aside their differences, collaborate closely and learn from each other, and create meaningful policies and innovative programs that address the needs of families experiencing domestic violence. Without such coordination, collaboration, and creativity, we will continue to punish families by removing children, blaming mothers, and not holding abusers accountable.

Bancroft, L., & Silverman, J. (2002). The batterer as parent: Addressing the impact of domestic violence on family dynamics. Thousand Oaks: CA: Sage. Banks, D., Hazen, A.  L., Coben, J.  H., Wang, K., & Griffith, J.  D. (2008). Collaboration between child welfare agencies and domestic violence service providers: Relationship with child welfare policies and practices for addressing domestic violence. Children and Youth Services Review, 31, 497–505. Banks, D., Landsverk, J., & Wang, K. (2008). Changing policy and practice in the child welfare system through collaborative efforts to identify and respond effectively to family violence. Journal of Interpersonal Violence, 23, 903–32. Browne, A., & Bassuk, S. (1997). Intimate violence in the lives of homeless and poor housed women: Prevalence and patterns in an ethnically diverse sample. American Journal of Orthopsychiatry, 67, 261–78. Caliber (2004). The Greenbook Demonstration Initiative: Process evaluation report, phase I (January 2001–June 2002). Retrieved July 8, 2004, from www. thegreenbook.info. Carlson, B. E. (1984). Children’s observations of interparental violence. In A. R. Roberts (ed.), Battered women and their families (pp. 147–67). New York: Springer. Carter, J. (2002). Policy talks. Washington, DC: Family Violence Prevention Fund. Carter, J., & Schechter, S. (1997). Child abuse and domestic violence: Creating community partnerships. Retrieved July 9, 1999, from http://www.igc. org/fund/materials/speakup/child_abuse.html.

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Casanueva, C., Ringeisen, H., Smith, K., & Dolan, M. (2013). NSCAW child well-being spotlight: Parents reported for maltreatment experience high rates of domestic violence. OPRE Report #2013-04. Washington, DC: Office for Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Chang, J. J., Theodore, A. D., Martin, S. L., & Runyan, D. K. (2008). Psychological abuse between parents: Associations with child maltreatment from a population-based sample. Child Abuse & Neglect, 32, 819–29. Child Welfare Information Gateway (2013). Child witnesses to domestic violence. Retrieved October 29, 2013, from https://www.childwelfare.gov/systemwide/ laws_policies/statutes/witnessdv.cfm. Cohen, E., & Davis, L. (2006). Creating safety and stability for children exposed to family violence: A working paper for Family to Family sites. San Francisco: Family Violence Prevention Fund. Cole, S.  F., O’Brien, J.  G., Gadd, M.  G., Ristuccia, J., Wallace, D. L., & Gregory, M. (2005). Helping traumatized children learn: Supportive school environments for children traumatized by family violence. Boston: Massachusetts Advocates for Children. Cross, T., Mathews, B., Tommyr, L., Scott, D., & Ouimet, C. (2012). Child welfare policy and practice on children’s exposure to domestic violence. Child Abuse & Neglect, 36, 210–16. Edleson, J. L. (1999). The overlap between child maltreatment and woman battering. Violence Against Women, 5, 134–54. English, D. J., Edleson, J. L., & Herrick, M. E. (2005). Domestic violence in one state’s child protective caseload: A study of differential case dispositions and outcomes. Children and Youth Services Review, 27, 1183–201. Eriksson, M. (2009). Girls and boys as victims: Social workers’ approaches to children exposed to violence. Child Abuse Review, 18, 428–45. Faller, K.  C. (2003). Research and practice in child interviewing: Implications for children exposed to domestic violence. Journal of Interpersonal Violence, 18, 377–89. Fleck-Henderson, A. (2000). Domestic violence in the child protection system: Seeing double. Children and Youth Services Review, 22, 333–54. Fleury, R.  E., Sullivan, C.  M., & Bybee, D.  I. (2000). When ending the relationship doesn’t end the violence: Women’s experiences of violence by former partners. Violence Against Women, 6, 1363–83. Gewirtz, A., & Menakem, R. (2004). Working with young children and their families: Recommendations for domestic violence agencies and batterer invention programs. Minneapolis: University of Minnesota Press. Goodmark, L. (2001). A balanced approach to handling domestic violence in child welfare cases. ABA Child Law Practice, 20, 49–58.

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Groves, B. M. (1999). Mental health services for children who witness domestic violence. Future of Children, 9, 122–33. Hazen, A.  L., Connelly, C.  D., Kelleher, K., Landsverk, J. A., & Barth, R. P. (2004). Intimate partner violence among female caregivers of children reported for child maltreatment. Child Abuse & Neglect, 28, 301–19. Huang, C., Postmus, J., Vikse, J., & Wang, L. (2013). Economic abuse, physical violence, and union formation. Children and Youth Services Review 35, 780–86. Jaffe, P., Wolfe, D., & Wilson, S. (1990). Children of battered women. Newbury Park, CA: Sage. Johnson, P., Wistow, G., Rockwell, S., & Hardy, B. (2003). Interagency and interprofessional collaboration in community care: The interdependence of structures and values. Journal of Interprofessional Care, 17 , 69–83. Johnson, S.  P., & Sullivan, C.  M. (2008). How child protection workers support or further victimize battered mothers. Affilia, 23, 242–58. Katz, L. F., & Gottman, J. M. (1997). Buffering children from marital conflict and dissolution. Journal of Clinical Child Psychology, 26, 157–71. Katz, L. F., & Windecker-Nelson, B. (2006). Domestic violence, emotion coaching, and child adjustment. Journal of Family Psychology, 20, 56–67. Kaufman-Kantor, G., & Little, L. (2003). Defining the boundaries of child neglect: When does domestic violence equate with parental failure to protect? Journal of Interpersonal Violence, 18, 338–55. Kaufman, J. S., Ortega, S., Schewe, P. A., & Kracke, K. (2011). Characteristics of young children exposed to violence: The Safe Start Demonstration Project. Journal of Interpersonal Violence, 26, 2042–72. Kelleher, C. C., Lynch, J. W., Daly, L., Harper, S., Fitzsimon, N., Bimpeh, Y., Daly E, & Ulmer H. (2006). The “Americanisation” of migrants: Evidence for the contribution of ethnicity, social deprivation, lifestyle and life-course process to the mid-20th-century coronary heart disease epidemic in the U.S. Social Science & Medicine, 63. Kernic, M.  A., Wolf, M.  E., Holt, V.  L., McKnight, B., Huebner, C.  E., & Rivara, F.  P. (2003). Behavioral problems among children whose mothers are abused by an intimate partner. Child Abuse & Neglect, 27, 1231–46. Kim-Cohen, J., Moffitt, T.  E., Caspi, A., & Taylor, A. (2004). Genetic and environmental processes in young children’s resilience and risk to socioeconomic deprivation. Child Development, 75, 651–68. Kohl, P.  L., Barth, R.  P., Hazen, A.  L., & Landsverk, J. A. (2005). Child welfare as a gateway to domestic violence services. Children and Youth Services Review, 27, 1167–82. Kohl, P. L., Edleson, J. L., English, D. J., & Barth, R. P. (2005). Domestic violence and pathways into child welfare services: Findings from the National Survey of Child and Adolescent Well-Being. Children and Youth Services Review, 27, 1167–82.

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Lehmann, P. (2000). Posttraumatic stress disorder (PTSD) and child witnesses to mother-assault: A summary and review. Children and Youth Services Review, 22, 275–306. Lehmann, P., & Rabenstein, S. (2002). Children exposed to domestic violence: The role of impact, assessment, and treatment. In A. Roberts (ed.), Handbook of domestic violence intervention strategies (pp. 333–95). Oxford: Oxford University Press. Levendosky, A. A., & Graham-Bermann, S. A. (2000). Trauma and parenting in battered women: An addition to an ecological model of parenting. Journal of Aggression, Maltreatment, & Trauma, 3, 25–35. Levendosky, A.  A., Huth-Bocks, A., & Semel, M.  A. (2002). Adolescent peer relationships and mental health functioning in families with domestic violence. Journal of Clinical Child and Adolescent Psychology, 31, 206–18. Levendosky, A.  A., Huth-Bocks, A.  C., Semel, M.  C., & Shapiro, D. L. (2002). Trauma symptoms in preschool-age children exposed to domestic violence. Journal of Interpersonal Violence, 17, 150–64. Levendosky, A.  A., Leahy, K.  L., Bogat, G.  A., Davidson, W. S., & von Eye, A. (2006). Domestic violence, maternal parenting, maternal mental health, and infant externalizing behavior. Journal of Family Psychology, 20, 544–52. McDonald, T. P., Allen, R. I., Westerfelt, A., & Piliavin, I. (1996). Assessing the long-term effects of foster care. Washington, DC: Child Welfare League of America. McKay, M. M. (1994). The link between domestic violence and child abuse: Assessment and treatment considerations. Child Welfare, 73, 29–39. Magen, R.  H., Conroy, K., & Tufo, A. D. (2000). Domestic violence in child welfare preventative services: Results from an intake screening questionnaire. Children and Youth Services Review, 22, 251–74. Martinez-Torteya, C., Bogat, A., von Eye, A., & Levendosky, A.  A. (2009). Resilience among children exposed to domestic violence: The role of risk and protective factors. Child Development, 80, 562–77. Maze, C. (2006). A judicial checklist for children and youth exposed to violence: Children reflect what they see. Reno, NV: National Council of Juvenile and Family Court Judges. Mills, L., Friend, C., Conroy, K., Fleck-Henderson, A., Krug, S., Magen, R.  H., Thomas, R., & Trudeau, J. H. (2000). Child protection and domestic violence: Training, practice, and policy issues. Child and Youth Services Review, 22, 315–332. Moles, K. (2008). Bridging the divide between child welfare and domestic violence services: Deconstructing the change process. Children and Youth Services Review, 30, 674–88. Nichols-Casebolt, A., & Spakes, P. (1995). Policy research and the voices of women. Social Work Research, 19, 49–55.

Norman, J. (2000). Should children’s protective services intervene when children witness domestic violence? Trauma, Violence and Abuse, 1, 291–93. O’Brien, M., John, R. S., Margolin, G., & Erel, O. (1994). Reliability and diagnostic efficacy of parents’ reports regarding children’s exposure to marital aggression. Violence & Victims, 9, 45–62. Ogbonnaya, I. & Pohle, C. (2013). Case outcomes of child-welfare involved families affected by domestic violence: A review of the literature. Children and Youth Services Review, 35, 1400–7. Osofsky, J. D. (2003). Prevelance of children’s exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child and Family Psychology Review, 6, 161–70. Postmus, J. L. (2007). Challenging the negative assumptions surrounding civil protection orders: A guide for advocates. Affilia, 22, 347–56. Postmus, J. L., Huang, C., & Mathisen-Stylianou, A. (2012). The impact of physical and economic abuse on maternal mental health and parenting. Children and Youth Services Review, 34, 1922–28. Postmus, J. L., & Merritt, D. (2010). When child abuse overlaps with domestic violence: The factors that influence child protection workers’ beliefs. Children and Youth Services Review, 32, 309–17. Saunders, D.  G., & Anderson, D. (2000). Evaluation of a domestic violence training for child protection workers and supervisors: Initial report. Children and Youth Services Review, 22, 375–98. Schecter, S. & Edelson, J. (1999). Effective intervention in domestic violence & child maltreatment cases: Guidelines for policy and practice. Recommendations from the National Council of Juvenile & Family Court Judges Family Violence Department. Reno, Nevada: National Council of Juvenile and Family Court Judges. Stark, E. (2002). The battered mother in child protective service caseload: Developing an appropriate response. Women’s Rights Law Reporter, 23, 107–31. Stark, E., and Buzawa, D. P. (2009). Violence against women in families and relationships: Making and breaking connections, The Family Context (vol. 2). ABC-CLIO. Stark, E., & Flitcraft, A. H. (1988). Women and children at risk: A feminist perspective on child abuse. International Journal of Health Services, 18, 97–118. Sternberg, K. J., Baradaran, L. P., Abbott, C. B., Lamb, M.  E., & Guterman, E. (2006). Type of violence, age, and gender differences in the effects of family violence on children’s behavioral problems: A mega analysis. Developmental Review, 26. Stith, S.  M., Rosen, K.  H., Middleton, K.  A., Busch, A.  L., Lundeberg, K., & Carlton, R.  P. (2000). The intergenerational transmission of spouse abuse: A meta-analysis. Journal of Marriage and the Family, 62, 640–54.

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Straus, M.  A. (1991). Children as witnesses to marital violence: A risk factor for lifelong problems among a nationally representative sample of American men and women. Paper presented at the Ross Roundtable on Children and Violence, Washington, DC. Straus, M.  A., Hamby, S.  L., Sugarman, D.  B., & Boney-McCoy, S. (1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283–316. Sullivan, C. M., Nguyen, H., Allen, N. E., Bybee, D. I., & Juras, J. (2000). Beyond searching for deficits: Evidence that physically and emotionally abused women are nurturing parents. Journal of Emotional Abuse, 2, 51–71. Thompson, R. S., Bonomi, A. E., Anderson, M., Reid, R. J., Dimer, J. A., Carrell, D.,& Rivara F. P. (2006). Intimate partner violence: Prevalence, types, and

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chronicity in adult women. American Journal of Preventative Medicine, 30, 447–57. Tjaden, P., & Thoennes, N. (1998). Prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey. Washington, DC: National Institute of Justice. Werner, E. E., & Smith, R. (1992). Overcoming the odds: High risk children from birth to adulthood. Ithaca: Cornell University Press. Wolak, J., & Finkelhor, D. (1998). Children exposed to partner violence. In J. L. Jasinski & L. M. Williams (eds.), Partner violence: A comprehensive review of 20 years of research (pp. 73–112). Thousand Oaks, CA: Sage. Wolfe, D. A., Crooks, C. V., McIntyre-Smith, A., & Jaffe, P.  G. (2003). The effects of children’s exposure to domestic violence: A meta-analysis and critique. Clinical Child and Family Psychology Review, 6, 171–87.

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PART III Permanency for Children and Youth Y

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The concept of permanency planning has served for more than three decades as the broad practice and legal umbrella for the provision of the continuum of child welfare services. This framework was initially legally mandated with the passage in 1980 of the Adoption Assistance and Child Welfare Act (P.L. 96-272); almost fifteen years ago by the Adoption and Safe Families Act (ASFA; P.L. 105-89); and, most recently, in 2008, by the Fostering Connection to Success and Increasing Adoptions Act (P.L. 110-351). Building upon the knowledge derived from demonstration and research projects, permanency planning involves a mix of familycentered, child-focused, and culturally relevant philosophies, management and program components, and practice strategies designed to help children and youth live in families that offer a continuity of relationships with nurturing parents or caregivers and the opportunity to establish lifetime relationships. Because it is widely acknowledged that separation, loss, and unresolved grief as well as the uncertain and often long-term nature of the foster care experience can have a very negative impact on children’s overall sense of belonging, identity formation, and emotional well-being, the process and outcomes of permanency planning are intended to safely limit entry into placement and, failing that, to limit the time children and youth spend in care. Thus planning for children and youth’s permanency as well as their safety and developmental well-being should begin when a child and the child’s family first come in contact with the child welfare agency. From this initial contact, permanency efforts are supported by actively including families and children and/or youth in individualized case planning; by assuring that workers visit both the child and parents frequently; and by coordinating service delivery and competent decision making, including by legal entities, about where children and youth will grow up. Permanency planning requires that case-by-case assessments (which integrate a safety or risk assessment) and interventions balance the time needed for a

family to make necessary changes with a young person’s need for continuity of relationships, secure attachments, and the ability to tolerate separation and loss. In the federal Child and Family Services Review (CFSR) process, the permanency variables have been conceptualized in two broad areas: Outcome Permanency 1: Children have permanency and stability in their living situations through t
decreasing foster care reentries; t
achieving the stability of foster care placement; t
establishing a permanency goal for the child; t
accomplishing reunification, guardianship, or permanent placement with relatives; t
adoption; or t
permanency goal of other planned permanent living arrangements. Outcome Permanency 2: The continuity of family relationships and connections is preserved for children through t
proximity of the child’s foster care placement to the parents’ home; t
placement with siblings also in care; t
frequent, regular visits with parents and siblings in foster care; t
preservation of connections; t
placement with a relative; and t
maintaining a relationship between the child in care and her parents and also between the child and siblings placed separately. An array of permanency outcomes (each of these is discussed in this volume) is desirable for children and youth, with priority given to those that maintain the child’s existing family and kin relationships and connections. Therefore, achieving permanency calls for initially attempting to keep children and youth at home

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safely with their parents to prevent the trauma of unnecessary separation and placement and, failing that, placing children with relatives when possible and with other siblings entering care. These issues are fully explored in Hegar and Scannapieco’s chapter on preservation of the extended family and kinship care and in Hegar’s chapter exploring the importance of maintaining sibling connections. For children and youth who cannot safely remain with their families and for whom placement in family foster care is therefore necessary, numerous issues must be considered. These are discussed in Freundlich’s overview of family foster care and in Bullard, Gaughan, and Owens’s examination of group care settings. For the majority of children and youth, family reunification (see Pine, Spath, and Gosteli’s chapter) is the preferred permanency option. Parent-child visiting, at the heart of reunification, is explored by coeditor Peg Hess. When children and youth cannot return home within the federally mandated time frame of twelve to fifteen months, alternative permanency options should be pursued, including adoption by relatives, foster parents, or a new family (coeditor Mallon explores these issues in his overview of the topic); customary adoption in Indian communities (see Cross’s chapter); legal guardianship with relatives, foster parents, or another caring adult (see Testa and Miller’s chapter); and, in special circumstances, another planned alternative living arrangement with relatives, foster parents (considered by Renne and coeditor Mallon), or a small communitybased group or residential setting—each with attention to nurturing and preserving lifetime family connections. Increasingly, child welfare practitioners understand that their work, even when reunification is not possible, must also involve birth families (see Hollingsworth’s chapter on birthmothers whose parental rights are terminated). Practitioners must also consider the effects of permanency efforts that may not be positive (see Festinger’s work on adoption disruption).

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Wright and Freundlich review the salient issues concerning postpermanency services that support families in achieving continued permanence and stability. Permanency planning balances the rights and needs of children, youth, and parents with the harm that can be brought by the passage of time and delays in decision making. While there is no one correct outcome for achieving permanency for all children and youth, the challenge is to arrive in a timely manner at the permanency outcome that offers the greatest measure of emotional and legal permanency for each child or youth. In a chapter focused on youth development by Mary Elizabeth Collins the unique circumstances of youth in foster care are considered. As explored in depth in part 3, permanency planning involves a mix of family-centered casework and legal strategies designed to assure that children and youth have safe, caring, stable, and lifetime families in which to grow up. According to the National Resource Center for Permanency and Family Connections at the Hunter College School of Social Work (2011), these strategies include the following: t
Targeted and appropriate efforts to protect safety, achieve permanence, and strengthen family and child well-being. t
Early intervention and prevention with reasonable efforts to prevent unnecessary outof-home care when safety can be assured. t
Safety as a paramount concern throughout the life of the case with the identification of those aggravated circumstances in which reasonable efforts to preserve or reunify families may not be required. t
Appropriate least restrictive out-of-home placements within family, culture, and community, with comprehensive family and child assessments, written case plans, goal-oriented practice, and concurrent permanency plans required. t
Reasonable efforts to reunify families and maintain family connections and

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continuity in children’s relationships when safety can be assured. t
Reasonable efforts to find alternative permanency options when children can not return to their parents through adoption, legal guardianship, or, in special circumstances, another planned alternative permanent living arrangement outside the child welfare system. t
Filing of termination of parental rights petitions at fifteen months after placement when this action is in the best interests of the child and when exceptions do not apply. t
Collaborative case activity—partnerships between birth parents, foster parents, agency staff, court and legal staff, and community service providers. t
Frequent and quality parent-child visits as well as worker-child and worker-parent visits. t
Timely case reviews, permanency hearings, and decision making about where children will grow up, taking into account the child’s sense of time.

REFERENCES

National Resource Center for Permanency and Family Connections at the Hunter College School of Social

Fulfilling the promise of permanency requires that children, youth, and family service practitioners are aware of the need to include the following elements in their practice: t
Family-centered and strengths and needs based practice t
Community-based service delivery t
Cultural competence and respect for diversity t
Open and inclusive practice t
Nonadversarial approaches to problem solving and service delivery t
Concurrent rather than sequential consideration of all permanency options The chapters in this section address a broad range of issues. Further, since the chapters are written by academics, practitioners, and others with a wide range of experiences in the field, the reader will also find diverse opinions and perspectives concerning permanency planning and, in some cases, about child welfare in general.

Work (2011). Web-based toolkit on concurrent permanency planning. New York: National Resource Center for Permanency and Family Connections.

BARBARA A. PINE R O B I N S PAT H STEPHANIE GOSTELI

Reunification

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his chapter focuses on an important aspect of child welfare practice—family reunification. It begins with national statistics on the number of children in foster care in the United States and presents a brief overview of the policy context of family reunification. The discussion outlines a broad definition of positive outcomes in family reunification and provides information on the risk and protective factors of families working toward reunification. Promising practice approaches in this area based on research are identified, and the skills and values needed for effective practice in family reunification are outlined. The ethical aspects of practice are also discussed. Case examples are provided throughout to illustrate practice principles for working with children in out-of-home care and their families. Children in Out-of-Home Care In response to child maltreatment, state child protective service agencies often remove children from their homes and place them in foster care. In 2011 approximately 681,000 children were victims of abuse and neglect in the United States (U.S. Department of Health and Human Services 2012), and 399,546 children were in the foster care system because of maltreatment (U.S. Department of Health and Human Services 2013). Demographic Characteristics What were the characteristics of these children who were separated from their birth families? Girls

were almost as likely as boys to be in out-of home care: 48 percent of children in care are girls, compared with 52 percent boys. In terms of age, those between the ages of one and ten make up 53 percent of the foster care population, while children ages eleven to eighteen represent 40 percent. Only 6 percent of children are younger than a year old; 2 percent are nineteen or older, reflecting most state policies of aging children out of care at age eighteen. The largest group of children in care is white (42 percent) followed by black non-Hispanic (26 percent). The third largest racial group of children in care is Hispanic (21 percent), with the race/ethnicity of the remaining children in care consisting of American Indian, Asian, Alaskan Native, or unknown (U.S. Department of Health and Human Services 2013). As these figures show, children of color are greatly overrepresented in the population of children who are separated from their families and placed in foster care. Placement Settings and Service Goals Almost half (47 percent) of the children in care were placed in nonrelative foster family homes, and just over one quarter (28 percent) were in kinship care placements. Nine percent of children were placed in an institution and 6 percent were in a group home. The remaining 12 percent had run away or had been placed in preadoptive homes, supervised independent living, or their home for a trial visit (U.S. Department of Health and Human Services 2013). According to these government statistics, reunification is 339

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the case goal for more than half the children in care (53 percent); during the 2012 fiscal year, 51 percent of children who exited foster care were reunified with their parent(s) or primary caregiver(s). This outcome—going back home to their birth family—has typically been viewed as the goal of foster care practice. More recently, however, as will be discussed in the next section, this limited view of positive outcomes for children has been challenged, and new objectives have emerged in both policy and practice. Defining Family Reunification The Adoption Assistance and Child Welfare Act (P.L. 96-272) passed in 1980 amid growing concern about the length of time children spent in foster care; this federal law emphasized placement prevention and family reunification. When children could not return to their family of origin, new permanent families, chiefly through adoption, were to be found. The law also demanded greater accountability from state child welfare agencies in achieving policy goals (Pine 1986). As a result of this landmark legislation in permanency planning, agencies placed renewed emphasis on reunification, viewing outcomes as either children were returned home or they were not. This dichotomous view did not seem to fit with the many needs of the families who were receiving child welfare services, however, and some began to question its usefulness. “It is time to challenge this all or nothing premise as too simplistic, and to view family reunification as a flexible, dynamic approach to meeting the needs of children and their families in an individualized and carefully thought-through way—as a response to the unique qualities, needs, and situations of each child and family” (Maluccio, Warsh, & Pine 1993:5–6). These authors developed a new definition of family reunification as follows: “Family reunification is the planned process of reconnecting children in out-of-home care with their families by means of a variety of services and supports to the children, their families, and their foster parents or other service providers.

It aims to help each child and family to achieve and maintain, at any given time, their optimal level of reconnection—from full reentry of the child into the family system to other forms of contact, such as visiting, that affirm the child’s membership in the family” (p. 6). Moreover, the child welfare field often uses the terms reunification and reintegration interchangeably. However, Petr and Entriken (1995) note that it is important to make a distinction between the terms reunification and reintegration. “Reintegration refers to the physical reintegration of children with their families and reunification is a more encompassing term that includes reintegration as one component” (p. 525). This definition views reunification outcomes on a continuum rather than as a dichotomy. Not every parent can care for her child on a daily full-time basis. However, with this expanded view of reunification, which includes reintegration, the parent-child bond can still exist and be maintained through other types of connections, as the following case example illustrates. Maria Gonzalez was an eighteen-year-old mother of two who had both of her children removed from her care due to severe neglect. She was committed to both of her children, but had been a single parent since the age of fifteen. Having been a foster child herself, Maria did not have an extended family who could provide her with the support she needed to parent successfully. Maria’s oldest child, Angel, was three at the time she was placed in foster care; her younger daughter, Jessica, was one and a half. The siblings were placed together in a two-parent foster home with three older birth children. Shortly after being placed, it became clear that Angel was presenting with severe behavioral problems, including impulsivity that could potentially place her in harm’s way. Angel appeared to have a fascination with hot things and would attempt to touch the hot stove or hot water if it was running. She would run into the street, and at times she had attempted to climb out of windows. All of the members of Angel’s foster family actively participated in watching Angel to make sure she remained safe.

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Angel’s mother, Maria, disclosed that she had had similar problems keeping Angel safe, and had frequently used corporal punishment as a way to try to stop the behavior. Maria acknowledged that Angel may have experienced sexual abuse by one of her relatives. Angel received early intervention through the school system, as well as therapy; she continued to be a very loving but challenging child. Maria worked diligently with a private nonprofit reunification program, and, with the assistance of her children’s foster parents, she was able to make significant gains in her parenting abilities. During this time, Maria also became involved with Juan. When they began to live together, Juan participated in reunification services. Together they began to build a stable family unit, which included the birth of their own child. Due to the newfound stability and improved parenting skills, they were able to have Jessica reunified with them. However, when Maria became pregnant again, they realized that they would not be able to meet the challenges of parenting Angel. At this point both Maria and Juan had developed a strong relationship with the foster family and were able to realize that Angel would continue to receive the care she needed if she remained with them. Both families were able to agree to an open adoption that allowed Angel to remain with a family who was committed to her, while also maintaining ties to her birth family.

New Policy Developments Family reunification has taken on a special significance in child welfare practice since the passage of the Adoption and Safe Families Act (ASFA) in 1997 (P.L. 105-89). This federal legislation revised and clarified many of the policies established under the Adoption Assistance and Child Welfare Act enacted in 1980 (P.L. 96-272). Congress had several goals in mind when it passed these revisions, including improvement in child safety and the promotion of permanency for children through adoption and other permanent plans as well as through reunification. ASFA establishes new guidelines for the amount of time children should spend in out-of-home care

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before a petition to terminate their parents’ rights is filed. Under ASFA, states are required to develop a concurrent plan while working toward reunification. They must file for termination of parental rights and implement the concurrent plan in cases where a child has been in care fifteen months out of the most recent twenty-two months, if family reunification is not possible during this period. There are some exceptions to this time line for families facing extremely challenging issues (Child Welfare League of America n.d.b). However, the establishment of these time lines places a renewed emphasis on family reunification practice, and ASFA specifically provides funding for intensive reunification services (National Family Preservation Network 2003). ASFA also clarifies a key part of the previous legislation, outlining clearly the exceptions allowed to states for making reasonable efforts to preserve and reunify families. Other key components of ASFA include the following: t
Maintaining federal adoption subsidies for children when there is disruption of the adoption or the adoptive parents die; t
Providing financial incentives to the states for adoption increases; t
Maintaining state records on adoption efforts; t
Expanding health care coverage to adopted special needs children t
Developing state-level policies that address geographic barriers to adoption t
Requiring criminal background checks for prospective foster and adoptive parents t
Providing temporary caregivers information on upcoming court reviews, as well as the opportunity to participate in these proceedings; t
Developing clear quality standards for foster care services for both public and private agencies; t
Extending independent living services for children who meet certain financial requirements;

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Expanding state demonstration project waivers; and t
Authorizing the states’ use of the Federal Parent Locator Services to find absent parents (Child Welfare League of America n.d.b). On October 7, 2008, the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351) was signed into law. This legislation provides additional supports for relative guardianship and adoption, thereby strengthening the requirements for states to create permanent families for children in foster care who cannot return to their parents’ care. These supports include allowing the use of Title IV-E funds to support and educate kinship caregivers, requiring states to create a system to notify relatives when a child enters foster care, and increasing program resources through family connection grants. These grants provide support to programs that help keep children with their parents and out of foster care or those programs that assist in returning children in foster care to their parents or other relatives (Child Welfare League of America n.d.c). In summary, the Fostering Connections to Success and Increasing Adoptions Act highlights the importance of furnishing programming that promotes permanency for children through adoption, kinship care, and family reunification. Vulnerabilities and Strengths of Families Receiving Reunification Services Characteristics of the families and their children who are to be reunified, or elements in the family’s environment, have been found to influence reunification. Some parents are incarcerated, which makes visiting, a key intervention in family reunification, challenging if not impossible. The length of a parent’s prison sentence may not fit with the time lines for reunification. When children are removed for sexual abuse or when families have three or more children, reunification is less likely (Barth et al.

2008; Connell et al. 2006). Families dealing with domestic violence issues also face unique obstacles to reunification. Different intervention models guide the various systems that may be working with the family, such as the judicial, social service, or health care systems. Therefore, there may be different priorities and goals for the family that may be incompatible with each other and create conflict (Adler et al. 2000). Substance abuse is also a significant risk factor for families working towards reunification (Frame, Berrick, & Brodowski 2000; Hoffman & Rosenheck 2001; Hohman & Butt 2001; Karoll & Poertner 2002; Richie 2001; Ryan et al. 2006), as are children’s difficulties (Connell et al. 2006; Landsverk et al. 1996; Yampolskaya, Armstrong, & Vargo 2007). Landsverk and his colleagues found that children who had emotional or behavioral problems were half as likely to be reunified with their families when compared to children without such problems (Landsverk et al. 1996). Additionally, parents with serious mental illness often face barriers to reunification with their children (Risley-Curtiss et al. 2004). In a study of adolescent status offenders (mostly runaways) that also examined likelihood of reunification, Nugent and his colleagues found that older youths, those not currently in school, those for whom child abuse was the presenting problem, and those involved in either the juvenile justice or the child welfare system, were the least likely to be reunified with their families (Nugent, Carpenter, & Parks 1993). A few research studies have also examined ethnicity and the likelihood of family reunification; findings indicate that white children are reunified at a higher rate than are black children (Connell et al. 2006; Courtney 1994; Hayward & DePanfilis 2007; Westat 2001). However, recent research has found that these families face complex challenges, including social and economic risk factors (e.g., poverty, educational disparity), which, along with race, can contribute to lower reunification rates, specifically in African American families (Hines et al. 2007).

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Poverty and the challenges resulting from poverty are major risk factors for separated families. Several factors related to poverty can impact reunification efforts, including a low level of education, employment in low-skill or unskilled jobs, and unstable housing (Landy & Munro 1998). Jones (1998) notes that, “poverty and economic deprivation, as expressed by inadequate housing, may be the greatest risk from the social environment for successful reunification” (p. 320). The loss of welfare benefits when a child is removed can decrease the likelihood of reunification, whereas the likelihood of reunification can increase if a parent is employed at the time of removal (Kortenkamp, Geen, & Stagner 2004). The service system also can create barriers to reunification by not focusing enough attention on the reunification goals, placing children in foster care far from their family and community, allowing the juvenile justice system to take on a primary and guiding role, lacking a community-based system of services, or failing to collaborate with and involve the family in the reunification process (Petr & Entriken 1995). Moreover, being forced to exchange welfare for work due to benefit time limits can greatly impede reunification. In a study of those who leave welfare in one Ohio county, Wells and her colleagues found that as many as 75 percent of their children in foster care remained there after eighteen months, as compared to 4 percent of children whose mothers continued to receive benefits (Wells, Guo, & Li 2000). Placement setting also has been found to influence family reunification. Children placed in kinship care were less likely to reunify with their parents (Courtney 1994; Hayward & DePanfilis 2007); these same children also remained in care twice as long as when compared to children in nonkinship placements (Pabustan-Claar 2007). Many children and youth in care have already experienced one or more failed reunification efforts (Maluccio, Abramczyk, & Thomlison 1996). Estimates of recidivism range from 20

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to 40 percent (Maluccio, Fein, & Davis 1994; Rzepnicki, Schuerman, & Johnson 1997; Tatara 1993; Terling 1999). However, few studies have examined factors associated with reentry into foster care or developed profiles of families least likely to be reunified in the first place. One study of reentry, by Terling (1999), showed a high correlation between parental substance abuse and a child’s return to care. Terling also found that parental competence was a factor in reentry. When parents were unable to provide an environment that complied with child protection standards because they either could not comprehend or accept the agency’s negative assessment, their children were more likely to return to out-of-home care (Terling 1999). When Festinger (1996) compared a group of children who returned to care with a similar group that did not, she found that lower ratings of parental skills, fewer social supports, and the number and severity of the children’s problems were all predictors of reentry within two years of their original discharge from foster care. In families that are experiencing economic deprivation or who have children with medical or behavioral issues, there is a greater likelihood of children and youth reentering the foster care system. The same study found that neglect “predicted re-referral but not re-entry” into the child welfare system (Jones 1998:321). Another study (Hess, Folaron, & Jefferson 1992; Hess & Folaron 1991) examined sixty-two children’s unsuccessful reunification with their families and their reentry into care. The most frequent contributor to placement reetry was nonresolution of the parent problems(s) that precipitated placement. Multiple service delivery system problems, including high caseload size, staff turnover, and insufficient regulation of reunification practice interacted with the serious nature of families’ problems to reduce the chances for successful reunification. In addition, Hess and Folaron (1991:404) reported that in more than half of the first forty cases examined “the parent’s ambivalent attitude [about reunification] was found to contribute

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specifically and directly to placement reentry. . . . It would appear that it would have been an appropriate service goal to aid the parents in becoming less ambivalent and either more committed to reunification or clearer about their distinterest in parenting and therefore more able to work toward another permanency goal.” Despite the challenges they face, many families whose children have been removed due to abuse and neglect have some protective factors that increase the likelihood of reunification. One of the most important factors related to successful reunification is economic status. Caregivers with higher levels of income and greater job stability are more likely to be reunified with their children. Housing is another factor that is related to economic status. Families with stable, safe housing are more likely to be reunified. The size and quality of the families’ social support network also has shown to be positively correlated with reunification (Festinger 1996; Fraser et al. 1996). It is critical that any intervention with families focus on finding and using these protective factors and family strengths, as in the following practice example. One private nonprofit child welfare agency providing reunification services to families whose children have been removed by the local child welfare department uses such a “strengths perspective.” As part of the program intake, a comprehensive assessment that focuses on the family strengths is completed. This strengths perspective is important to both the engagement with the family as well as service goal planning, which frequently uses the strengths a family has as a means to accomplish the goals that they, together with their assigned worker, agree to work toward. During the assessment phase, strengths are identified, by interviewing clients, collaborating with other family members and important others, working with the family to complete a family genogram and/or ecomap, as well as collaborating with other service providers and personnel in children’s schools. Investing the time to complete a

comprehensive assessment that includes information from an array of professional and nonprofessional sources at the outset of work with a family is vital to having a solid foundation on which to build the subsequent work.

The benefit of this approach to assessment is aptly demonstrated in the following example of a family successfully reunified. Understanding a family’s culture is always a vital part of any assessment process. When working with the Sanchez family, state child welfare workers who did not speak Spanish made the decision to remove the twelve-year-old son after his father had hit him in the face. The child had come to school with a bruised cheek, and after some prodding had stated that his father was responsible for the injury. Although there is clearly no justification for injuring a child, during intake into a specialized family reunification program the social worker ascertained that the father had lost his temper when his son arrived home after midnight having been out driving around in a car with a fourteen-yearold friend. This intact family was originally from Puerto Rico and had moved to the United States to provide more opportunities to their five children. The parents were now struggling with the influences of the urban living environment on their sons. Information from the school system and community partners validated that this father had no previous history of violent episodes and maintained an otherwise strong and positive presence in his children’s lives. Once the father’s position as the respected head of his household had been restored, this family was open to services and to addressing the tensions within it that led to the outburst and injury. The local child welfare department was able to advocate for the family to obtain a Section 8 housing voucher, which allowed them to move to a better neighborhood into a house with enough room for everyone.

A focus on strengths is at the core of practice approaches to reunifying families, discussed in the next section.

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Promising Practices in Family Reunification Most studies of family reunification have looked at what facilitates family reunification. These studies have focused mainly on the importance of factors such as service variables and child and family characteristics. For example, Fraser and his colleagues report the achievement of a 93 percent reunification rate with the fiftyseven children whose families were involved in a program that used a ninety-day intensive family preservation model with separated families. Success was attributed to service variables such as the provision of concrete services, the establishment of strong worker-family relationships, and the provision of skills training to parents (Fraser et al. 1996; Lewis 1994; Walton et al. 1993). Staff and Fein (1994) reported on another experimental family reunification program; they also found that concrete assistance to the families involved promoted reunification. Nugent, Carpenter, and Parks (1993) found that adolescents and their families who participated in family therapy and completed all the services planned for the family were more likely to be reunified than those who did not. Ryan and his colleagues (2006) found that families receiving intensive case management that linked substance abuse and child welfare services were more likely to achieve family reunification. Another study found that the rates of reunification in an intensive, home-based model that included an innovative support group for parents were double that of families receiving standard state agency services (Berry, McCauley, & Lansing 2007). The research has shown that the standard child welfare model for reunification services is not adequate in helping families achieve reunification when they are experiencing challenges such as lack of housing and substance abuse; these families require a more integrated approach to services (Choi and Ryan 2007; Marsh et al. 2006). Finally, Courtney and Wong (1996) showed that the earlier youths exited from care the more likely they were to be reunified with

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their families, a finding that supports early and intensive intervention. Visiting One service variable—visiting— has received the most attention in the research. Between 1978 and 1993 there were at least 12 studies that examined the impact of parentchild visiting on reunification (Hess 1999). Most of this research supports the view that visiting is good for parents and children. In fact, visiting has been called “the heart of family reunification” (Hess & Proch 1993). As Hess and Proch indicate, visiting helps maintain family ties, gives reassurance to children and parents, and provides opportunities to assess parent-child interaction and the development of new skills. In their study of 925 children, Davis and her colleagues found that visits were the key to discharge from care. Where visit plans were developed, the likelihood of visits was increased; the majority of children who visited with their parents at the level recommended by the courts were reunified with their families (Davis et al. 1996). In addition, when staff plays a positive coaching role during visits, this can contribute to the development of a strong working alliance with the family, which is an important element of reunification practice (Jenson et al. 2009). Family-Centered Practice Programs designed to reunify children with their families should be based upon a family-centered practice orientation. The Child Welfare League of America describes family-centered practice as “a way of working with families, both formally and informally, across service systems to enhance the capacity of families to care for and protect their children” (Child Welfare League of America n.d.a). A key component of familycentered practice is recognizing and building on the strengths of families and family relationships and meeting a variety of their needs to achieve optimal outcomes. This approach may benefit families dealing with many challenges, including eviction, family violence, child maltreatment, substance abuse, lack of

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food, incarcerated parents, and physical or mental health issues (Child Welfare League of America 1989). The following case example illustrates a family-centered approach to reunification practice: Ms. Walker, a thirty-five-year-old mother of three children, Steven, age thirteen, Susan, age ten, and Dani, age eight, had a severe history of depression, with psychotic features, and substance abuse. Ms. Walker had been involved with the local child welfare department for a number of years, and they had provided assistance with mental health and drug treatment as well as shelter housing. Ms. Walker had a supportive family network that included her mother and sister, both of whom lived locally. The combined efforts of family members and a committed child welfare worker had previously been able to prevent placement of the children. However, when Ms. Walker’s continued substance abuse led to further allegations of neglect as well as eviction from her state-subsidized housing, all three children were removed from her care. Ms. Walker’s family rallied once again, and her sisters were able to take the children. One sister took the two oldest children, Steven and Susan, and another sister took the youngest, Dani. Ms. Walker herself went to live with her mother. Ms. Walker entered a dual diagnosis treatment program and received intensive outpatient services. She also worked with an intensive family reunification program for over a year. Despite the concentration of the services and collaboration between service providers, Ms. Walker was not able to maintain her treatment and provide a home for her children and herself. The demands of both were simply too much. Ms. Walker was supported in her decision to commit to her own continued recovery so that she could have a positive relationship with her children. Ms. Walker’s family was initially very angry with her and accused her of abandoning her children. By making use of the Family Conferencing Model, the family was able to work through their anger and agree to a plan whereby all the children were reunified under the care of Ms. Walker’s older sister, with Ms. Walker continuing to be an important visiting

resource for the children.1 Ms. Walker was committed to her children; however, her own severe mental illness prevented her from being a full-time parent. The solution created by her family and service providers allowed her to remain an important part of her children’s lives.

Intensive Family Reunification Services A promising program model in this area of child welfare practice that follows the familycentered intervention approach is intensive family reunification services (Fraser et al. 1996; Pierce & Geremia 1999; Pine et al. 2009; Walton 1998). In a study of a model intensive, familycentered, home-based family reunification program, findings indicated that the length of time children are in out-of-home care is likely to be shorter for children receiving intensive services than for those who receive standard reunification services. In addition, family participation in an intensive program was found to decrease the number of moves children experience while in care as well as to improve their chances of safety and stability once they are reunified (Pine et al. 2009). The National Family Preservation Network defines intensive family reunification services as “short-term, intensive, family-based [programs that are] designed to reunite families when children are likely to remain in outof-home placement for longer than six months without this intervention” (National Family Preservation Network 2003). Therefore, intensive services are not appropriate or necessary for families that are likely to be reunified after a brief time in foster care, ideally within two to three months from the time of removal. The National Family Preservation Network (2003) has outlined basic standards for intensive family reunification services, which include the following: t
Staff availability on twenty-four-hour basis, every day of the week; t
small caseloads for staff—ideally two to four families;

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t
one-on-one contact with the family immediately after a referral is made—ideally within seventy-two hours; t
predominantly home-based services that are intensive—between five to twenty hours a week; t
programming that includes weekend and evening services; and t
time-limited services—ideally between sixty to ninety days.

t
Behavior management, t
Marital counseling, t
Life skills training, t
Self-management of moods/behavior, t
School interventions, t
Safety planning, t
Relapse prevention, t
Concrete and advocacy services, and t
Other services as needed (National Family Preservation Network 2003).

Use of Assessment Tools Since families often face many challenges that could be barriers to reunification, a wide array of services may be needed, in addition to assistance that addresses the jeopardy issue(s) that resulted in the child being removed from their home and placed in out-of-home care. It is essential that a comprehensive assessment be conducted with the family to determine needed services. A number of new assessment tools are available. One of these is the North Carolina Family Assessment Scale for Reunification (NCFAS-R). Initial studies using the NCFAS-R indicate that this is a promising instrument to use in reunification practice; it has been adopted by several state and private nonprofit child welfare agencies (Colorado Department of Human Services 2003; Kirk n.d.; Kirk, Kim, & Griffith 2005). The NCFAS-R is designed to assess families in seven key areas or domains: environment, parental capabilities, family interactions, family safety, child well-being, caregiver/child ambivalence, and readiness for reunification. These domains reflect the major areas that practitioners should consider when working with families toward an optimal level of family functioning that ensures child safety and well-being. Using an intensive family reunification services program model, the NCFAS-R could be useful in determining if a family needs services in any one of the following areas:

Social Work Staff with Specialized Competencies Pine, Warsh, and Maluccio (1993) delineate five competency areas for social workers involved in family reunification practice: valuing families, assessing readiness for reunification, planning goals for reunification, implementing the reunification plan, and maintaining the reunification and ending the service. Valuing families relates to the values and attitudes that guide a social worker’s practice, especially valuing the birth family as the preferred child-rearing unit, but also seeing family reunification as a process with a variety of possible outcomes over time. Social workers in this field of practice would benefit from having an understanding and an appreciation of family diversity, including differences in family membership, lifestyles, and parenting methods. Social workers also need to develop the skills necessary to assess the readiness of the family for reunification. Interactions with the family need to be approached in a manner that promotes and builds trust and confidence. Without this, the ability to comprehensively assess the family may be compromised. Therefore it is important that the cultural and racial background of the family be considered when deciding what assessment approaches and tools to use with each family. In addition, recognizing barriers to reunification outside the family system should be an integral part of the assessment process. Finally, the assessment should include both the strengths and challenges facing a family, rather than just the obstacles to

t
Parent training, t
Family communication building,

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reunification, because, as noted earlier, an understanding of family strengths is essential to success in reunification. After a social worker has worked with a family and developed a comprehensive assessment, the next step is to develop goals based on the strengths and challenges outlined in the assessment and to provide support to the family in helping them reach these goals. Involving families in both the assessment and goal planning is essential; if this partnership is not established, there may be many additional barriers to overcome when working toward reunification. And, as indicated earlier, parent-child visits are a key component to reunification practice, therefore, an understanding of parenting skills and theories, as well as of child development, is also necessary for practitioners. Once a permanent plan has been put into place for a family, either reunification or another plan, it is important to provide postreunification services to the family. The family may need continued services and supports during the adjustment phase. Additionally, the family ought to be prepared for the termination of services, which should include a closing session to outline the accomplishments and strengths of the family as well as to help them establish priorities for reaching any goals that may remain. Moreover, the social supports currently in place should be reviewed and any additional needed support put in place prior to termination. Finally, as Pine, Warsh, & Maluccio (1993) note, social workers working with families toward reunification require several additional areas of competencies, including “family therapy, child abuse, and legal issues in child welfare” (p. 40). In addition, it is important for them to have basic knowledge of substance abuse and the dynamics of recovery when working in the area of family reunification (McAlpine, Marshall, & Doran 2001). A comprehensive discussion of practice competencies in reunification can be found in Warsh, Maluccio, and Pine (1994).

A Service Environment That Supports Competent Practice Competent staff can only be effective in reunifying families if they work in an environment where they and their work are supported. This includes elements of the services system, such as the agency’s mission, policies on reunification, attention to cultural competence, the design of reunification services, and elements of the work environment, such as workload, training, and supervision (Hess, Folaron, & Jefferson 1992). As noted by Spath, Werrbach, and Pine (2008), “the complexity of problems facing vulnerable families, such as those in the child welfare system, demands a collaborative approach that emphasizes positive relationships, shared resources, and integration of service efforts” (p. 503). Therefore, the agency’s relationships with other organizations bears on effectiveness, including those with the court system, schools, law enforcement agencies, the media, and other governmental bodies (Warsh, Pine, & Maluccio 1996). Evidence That Is Not Yet Available Increased federal tracking of outcomes indicates that the relationships between reunification and reentry remain unclear as do the relationships between the effects of policy and practice changes on these outcomes. The 2010 data suggest that reunifications occurring in less than twelve months was between 67 and 69 percent (median across states). Yet many states with high percentages of timely reunifications also had high percentages of children reentering care in less than twelve months (U.S. Department of Health and Human Services 2012b: 4, 6). Therefore much still remains unknown about both service variables and the characteristics of families that affect success in reunification (Berry, McCauley, & Lansing 2007; Brook & McDonald 2007; Maluccio, Abramczyk, & Thomlison 1996). For example, it is not known whether culture or ethnicity influences outcomes or what service approaches are most effective with special populations (Maluccio, Abramczyk, &

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Thomlison 1996). Nor is it known what role language may play in either service delivery or outcomes, an important consideration given the growth of Spanish-speaking populations likely to be served by child welfare agencies. As Alpert (2005) notes: “Parents’ experience with mandated services is an important element in the life of a child protection case,” and yet their relationship to case outcomes is not clearly understood (p. 361). What is the impact on outcomes of social class, social class differences between staff and caregivers, and families served? What outcomes besides a child’s return home, for example, improvements in family functioning and child development, are influenced by services? Given the extent of problems many children and families in the child welfare system face, do intensive, short-term services make a difference (Fraser, Nelson, & Rivard 1997)? What services are needed to achieve lasting gains for these families (Maluccio, Abramczyk, & Thomlison 1996)? What other factors affect outcomes—for example, specialized training of family reunification practitioners and foster parents (Fraser, Nelson, & Rivard 1997; Warsh, Maluccio, & Pine 1994; Warsh, Pine, & Maluccio 1996)? In addition, studies of family preservation and reunification programs and services have yet to show the differential contribution of the core elements of a program to its outcomes (Fraser, Nelson, & Rivard 1997). Another area that needs further exploration is a key intervention in family reunification practice: visiting. Future research needs to study and clearly delineate “the black box” of services provided with parent-child visits (Davis et al. 1996; Hess 1987; Hess, McGowan, & Botsko, 2003; Staff & Fein 1994). Ethical Issues in Reunification Practice There are several major ethical dilemmas faced by social workers working with families toward reunification. Protective services staff generally remove and place children in out-of-home care for a particular issue or event that has been reported to and investigated by the agency. However, once a family becomes involved with

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the child protection system, the assessment and treatment process may open a Pandora’s box of other challenges faced by the family. This type of situation presents several dilemmas for social workers. Should these newly discovered challenges confronting the family, in addition to the jeopardy issue that brought the child into care, be included in the treatment goals that the family must address to be reunified? How does one define “good enough” parenting? What presents a greater risk to a child, remaining in foster care or returning home? Or, when is removal of a child and the resulting trauma associated with the parent-child separation necessary if a parent clearly displays deficits in his ability to keep his children safe?—a dilemma the following example illustrates: The Jones family’s ten-year-old son was removed from their care for unexplained injuries. The other Jones children, five in all, remained in the care of their parents. The family had managed to obtain a Section 8 housing voucher that allowed them to live in a middle-class suburban neighborhood with a very good school system. However, the Jones family home was infamous in the neighborhood, as it was in disrepair and frequently had large amounts of trash in the yard. Needless to say, the neighbors were suspicious about the care that the children received. In addition, the children would arrive at school looking unkempt and were frequently absent. When the ten year old arrived at school with a gash near his eye only two weeks after having arrived at school with his arm in a cast from being broken, the school became concerned and contacted the state child welfare department. This child had a long history of injuries resulting from minor accidents, and the parent’s description of events was vague and appeared to blame the other children without taking any responsibility themselves. Therefore, the state child welfare department decided to remove the tenyear-old child from the home. Family reunification social workers assigned to this family found some unusual dynamics, in that Mr. Jones suffered from epileptic seizures as the result of a severe industrial accident. This accident

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had left Mr. Jones with significant impairments, which, in addition to the seizures, at times included slurred speech and tangential thought processes. Mr. Jones’s interactions with his children appeared disjointed, and his statements to workers were frequently inappropriate. Mrs. Jones presented as the stabilizing force within the family, but she too had several serious medical conditions and frequently became overwhelmed with the demands of caring for five children and her husband. The family survived on the small disability pension that Mr. Jones received as well as some side jobs he could get from time to time. The children’s clothing was often obtained from donations as well as thrift stores; the children’s appearance often stood in stark contrast to the more affluent students at the schools they attended. The family had thus become known to the school system and clearly had been stigmatized because of their significant and obvious class differences. The children recognized this and were embarrassed to go to school, the underlying cause of the frequent absences. Both Mr. and Mrs. Jones appeared unable to address this issue either with their children or with the school system. The parents’ ability to provide the necessary oversight for the five active children remaining in the home also seemed to be compromised and led to the many injuries incurred. Despite the many challenges this family faced, one of the unifying forces was their love of baseball. All the children played, and Mr. Jones coached their Little League teams. If Mr. Jones experienced a seizure, the children would work together to get him to the car so that Mrs. Jones could drive him home. While in foster care, the Jones’ ten-year-old son exhibited severe withdrawal and both eating and sleep disturbances. The child repeatedly requested to be returned home and would pine between family visits. Through weekly parent-child visits the reunification practitioners were able to see a very closeknit family that was clearly a strong family unit in spite of the many issues they faced. They were able to discover that the child in question was actually accident prone; at the same time, however, they worked with both parents to recognize the steps they could take to keep him as safe as possible. By presenting

this more complete picture of the many ways that Mr. Jones was, indeed, a “good enough” parent, a swift reunification was effected with the focus of the work on postreunification services. Family members were also supported in their efforts to advocate for their members in both the medical and educational systems they came into contact with. In many ways, they were a “different” family, but a family nonetheless.

Social workers also may face the conflicting goals of permanency and child safety. The very fact of involvement by child welfare authorities may threaten family integrity; sometimes child welfare intervention can represent such an unwelcome and threatening intrusion that the family has difficulty getting beyond this to focus on the concerns that have been raised about them, as the following Smith family case illustrates. The case also underscores the ethical imperative of cultural competence in working with families toward reunification. Ms. Smith, who was originally from Jamaica, had her nine-year-old son, Kenneth, removed from her care for neglect. Kenneth had repeatedly arrived at school dirty and unkempt, and the efforts of school personnel to address the issue with his mother had been unsuccessful. Ms. Smith had interacted with school personnel erratically and, at times, in bizarre ways, leading to concerns around her mental health. On one particular day, Kenneth arrived at school in a concerning state and also had bruises on his arms that he would not explain. The school contacted the local department of child welfare and made a report. When the child welfare worker attempted to question Ms. Smith, she refused to cooperate; she took the position that what she did with her child was none of their business. Due to the lack of cooperation and concerns regarding Ms. Smith’s mental health, and the poor care that Kenneth had received, he was removed from the home and placed in foster care. Ms. Smith’s mother was ruled out as a resource as Ms. Smith was currently residing with her and did not appear to have any other resources available to her.

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When the reunification social worker began to work with Ms. Smith, it became clear that Ms. Smith was having great difficulty engaging in the work; she simply did not agree that there was any justification to remove her son. Attempts to move beyond this point and focus on the steps necessary for him to return were unsuccessful. In an effort to better understand Kenneth’s family and the resources they represented for him, the social worker began to work with Ms. Smith on a family genogram. By actively engaging Ms. Smith in the creation of the family genogram and by reaffirming her position as expert on her own family, the worker was able to understand the strengths available within the family system as well as the family history. Through the use of the genogram narrative, Ms. Smith was able to explain that both she and her mother had struggled with bouts of severe depression throughout their lives. Ms. Smith, in fact, had an older son who had needed to be cared for by her cousin when he was younger. This shared caregiving within the family system was acceptable and had been supported by Ms. Smith’s family and the community, an experience that stood in stark contrast to the current situation in which the state had become involved. By reframing the current situation in terms of the past, Ms. Smith was able to acknowledge that her own mental health challenges made it difficult for her to parent her son all the time. By using the genogram as a means of exploring the family that was available to Kenneth, the worker was able to “discover” Ms. Smith’s cousin, who had cared for her older son and continued to live right next door. By bringing the problem solving back into the family, Kenneth was able to be placed with his mother’s cousin, and Ms. Smith was more willing to address some of her own mental health needs.

What if a family self-refers to child protective services? This may occur when the family is looking for assistance because they do not have the resources to meet their basic needs, such as clean and safe housing. What if, as a result of the parents’ self-referral, their children are removed? What criteria should be used for reunification in these cases?

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Sometimes policy mandates, such as ASFA’s strict time lines for reunification, mentioned earlier, cause problems for parents. While social workers have ethical obligations to advocate for needed services, how can they deal with a criminal justice system in which so many of the families they work with have incarcerated parents? Do their agencies have visiting programs in place for the children of these parents? Are workloads structured in such a way as to enable social workers to drive long distances to arrange parent-child visits? Do agencies advocate against public housing policies that prohibit residence based on criminal records, thus making it difficult for parents to comply with child welfare requirements of safe and stable housing? The following case illustrates these dilemmas and the realities of the challenges in reunification practice. Mr. Cooper was an incarcerated twenty-two-yearold father of two when his two-and-a-half–year-old son was removed from his mother’s care and placed in foster care. By the time Mr. Cooper was released from jail, his son had already been in foster care for over eight months. Upon his release, Mr. Cooper immediately contacted the state child welfare department and informed them of his wish to be reunified with his son. Mr. Cooper was asked to provide information regarding his compliance with his parole as well as proof of stable housing. He was able to provide both, and weekly parent-child visits were instituted. Mr. Cooper clearly loved his son, and their interactions were extremely positive. Mr. Cooper planned to have his son live with him in the home of his current girlfriend, who was also mother to his younger daughter. Due to the seriousness of Mr. Cooper’s past crimes, the state child welfare department required him to demonstrate his ability to provide a stable and safe environment for his son and to complete mandatory treatment programs prior to any reunification. During the time frame in which this work was scheduled to occur, Mr. Cooper began to experience difficulties with his current relationship.

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His girlfriend, who had four children of her own, appeared less than willing to undergo the requirements to have Mr. Cooper’s son reunified to their home. Mr. Cooper then lost his employment and was thus unable to obtain any independent housing. Initially, Mr. Cooper continued to visit with his son, but as it became clear that he would not be able to provide for his son’s needs, these visits became too painful and gradually diminished. Mr. Cooper had formed a relationship with his son’s foster parent and continues to sporadically check in to see how he is doing, but reunification is no longer something he discusses. The plan at this time is for the foster parent to adopt his son.

As this chapter makes clear, work with families already separated by out-of-home

NOTE

1. See also Proceedings of the West Coast Scientific Symposium on Health Care of Runaway Street Youth, published as the November 1991 edition of Journal of Adolescent Health, 12 (7). REFERENCES

Adler, M. A., Hax, H., Stanley, J., & Zhou, W. (2000). Coordinated community responses to domestic violence in three Maryland communities. Blacksburg, VA: Southern Sociological Society (SSS). Alpert, L. T. (2005). Research review: Parents’ service experience—a missing element in research on foster care case outcomes. Child and Family Social Work, 10, 361–66. Barth, R., Weigensberg, E., Fisher, P., Febrow, B., & Green, R. (2008). Reentry of elementary aged children following reunification from foster care. Children and Youth Service Review, 30, 252–364. Berry, M., McCauley, K., & Lansing, T. (2007). Permanency through group work: A pilot intensive reunification program. Child & Adolescent Social Work Journal, 24, 477–93. Brook, J., & McDonald, T. (2007). Evaluating the effects of comprehensive substance abuse intervention on successful reunification. Research on Social Work Practice, 17, 664–73. Child Welfare League of America (1989). Standards for services to strengthen and preserve families with children. Washington, DC: Child Welfare League of America.

placement is one of the most challenging practice areas in child welfare. These families face many challenges in the struggle to be together again—child abuse and neglect, poverty, homelessness, substance abuse, domestic violence, and mental illness. Recent and renewed attention to family reunification has produced some promising practice approaches and new thinking about family connectedness and permanency for children. At the core of successful family reunification practice is a belief in “the essential bonds of the family, in the family’s ability to make change, and in the importance of focusing on a family’s strengths to achieve (and maintain) reunification” (Zamosky et al. 1993:174) and the commitment to providing the services and supports each family and child needs.

Child Welfare League of America (n.d.a). Glossary of Terms. Retrieved June 15, 2011, from http://www. cwla.org/newsevents/terms.htm. Child Welfare League of America (n.d.b). Summary of the Adoption and Safe Families Act of 1997. Retrieved June 15, 2011, from http://www.cwla.org/advocacy/ asfapl105–89summary.htm. Child Welfare League of America (n.d.c). Fostering connections to success: Resources in seven key areas. Retrieved July 15, 2011, from http://www.cwla.org/ advocacy/adoptionhr6893resources.htm. Choi, S., & Ryan, J. (2007). Co-occurring problems for substance-abusing mothers in child welfare: Matching services to improve family reunification. Children and Youth Services Review, 29, 1395–410. Colorado Department of Human Services (2003). Child and Family Services review: Program improvement plan. Retrieved June 15, 2011, from http://cospl.coalliance. org/fez/eserv/co:1157/hu6152im72003internet.pdf. Connell, C., Katz, K.., Saunders, L., & Tebes, J. (2006). Leaving foster care—the influence of child and case characteristics on foster care exit rates. Children and Youth Services Review, 28, 780–98. Courtney, M.  E. (1994). Factors associated with the reunification of foster children with their families. Social Service Review, 68, 81–108. Courtney, M. E., & Wong, Y. I. (1996). Comparing the timing of exits from substitute care. Children and Youth Services Review, 18, 307–34. Davis, I. P., Landsverk, J., Newton, R., & Ganger, W. (1996). Parental visiting and foster care reunific-

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ation. Children and Youth Services Review, 18, 363–82. Festinger, T. (1996). Going home and returning to foster care. Children and Youth Services Review, 18, 383–402. Frame, L., Berrick, J., & Brodowski, M.. (2000). Understanding reentry to out-of-home care for reunified infants. Child Welfare, 79, 339–69. Fraser, M., Nelson, K., & Rivard, J. (1997). Effectiveness of family preservation services. Social Work Research, 21, 138–53. Fraser, M., Walton, E., Lewis, R., & Pecora, P. (1996). An experiment in family reunification: Correlates of outcomes at one-year follow-up. Children and Youth Services Review, 18, 335–61. Hayward, R., & DePanfilis, D. (2007). Foster children with an incarcerated parent: Predictors of reunification. Children and Youth Services Review, 29, 1320–34. Hess, P. (1987). Parental visiting of children in foster care: Current knowledge and a research agenda. Children and Youth Services Review, 9, 29–50. Hess, P., ed. (1999). Visitation: Promoting positive visitation practices for children and their families through leadership, teamwork, and collaboration. Harrisburg, PA: Commonwealth of Pennsylvania, Department of Public Welfare. Hess, P., & Folaron, G. (1991). Ambivalences: A challenge to permanency for children. Child Welfare, 60, 403–24. Hess, P., Folaron, G., & Jefferson. A. (1992). Effectiveness of family reunification services: An innovative evaluative model. Social Work, 37, 304–11. Hess, P., McGowan, B., & Botsko, M. W. (2003). Nurturing the one, supporting the many: The Center for Family Life in Sunset Park, Brooklyn. New York: Columbia University Press. Hess, P., & Proch, K. (1993). Visiting: The heart of reunification. In B. Pine, R. Warsh, & A. Maluccio (eds.), Together again: Family reunification in foster care (pp. 119–39). Washington, DC: Child Welfare League of America. Hines, A., Lee, P., Osterling, K., & Drabble, L. (2007). Factors predicting family reunification for African American, Latino, Asian and white families in the child welfare system. Journal of Child and Family Studies, 16, 275–89. Hoffman, D., & Rosenheck, R. (2001). Homeless mothers with severe mental illnesses and their children: Predictors of family reunification. Psychiatric Rehabilitation Journal, 25, 163–69. Hohman, M., & Butt, R. (2001). How soon is too soon? Addiction recovery and family reunification. Child Welfare, 80, 53–67. Jenson, C., Pine, B., Spath, R., & Kerman, B. (2009). Developing strong helping alliances in family reunification. Journal of Public Child Welfare, 3, 331–53.

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Jones, L. (1998). The social and family correlates of successful reunification of children in foster care. Children and Youth Services Review, 20, 305–23. Karoll, B., & Poertner, J. (2002). Judges’, caseworkers’, and substance abuse counselors’ indicators of family reunification with substance-affected parents. Child Welfare, 81, 249–69. Kirk, R. (n.d.). North Carolina Family Assessment Scale for Reunification: Research report. Retrieved June 15, 2011, from http://www.nfpn.org/images/stories/files/ ncfas-r_research_report.pdf. Kirk, R., Kim, M., & Griffith, D. (2005). Advances in the reliability and validity of the North Carolina family assessment scale. Journal of Human Behavior in the Social Environment, 11, 157–76. Kortenkamp, K., Geen, R., & Stagner, M. (2004) The role of welfare and work in predicting foster care reunification rates for children of welfare recipients. Children and Youth Services Review, 26, 577–90. Landesverk, J.Davis, I., Ganger, W., & Johnson, I. (1996). Impact of child psychosocial functioning on reunification from out-of-home placement. Children and Youth Services Review, 18 (4–5), 447–62. Landy, S., & Munro, S. (1998). Shared parenting: Assessing the success of a foster parent program aimed at family reunification. Child Abuse and Neglect, 22, 305–18. Lewis, R. (1994). Application and adaptation of intensive family preservation services to use for the reunification of foster children with their biological parents. Children and Youth Services Review, 16, 339–61. McAlpine, C., Marshall, C., & Doran, N. (2001). Combining child welfare and substance abuse services: A blended model of intervention. Child Welfare, 80, 129–49. Maluccio, A., Abramczyk, L., & Thomlison, B. (1996). Family reunification of children in out-of-home care: Research issues and perspectives. Children and Youth Services Review, 18, 287–305. Maluccio, A., Fein, E., & Davis, I. (1994). Family reunification: Research findings, issues, and directions. Child Welfare, 73, 489–504. Maluccio, A., Warsh, R., & Pine, B. (1993). Family reunification: An overview. In B. A. Pine, R. Warsh, & A.  N. Maluccio (eds.), Together again: Family reunification in foster care (pp. 3–19). Washington, DC: Child Welfare League of America. Marsh, J., Ryan, J., Choi, S., & Testa, M. (2006). Integrated services for families with multiple problems: Obstacles to family reunification. Children and Youth Services Review, 28, 1074–87. National Family Preservation Network (2003). Intensive family reunification services protocol. Retrieved April 3, 2004, from http://www.nfpn.org/reunification/files/ ifrs_protocol.pdf.

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Nugent, W., Carpenter, D., & Parks, J. (1993). A statewide evaluation of family preservation and family reunification services. Research on Social Work Practice, 3, 40–65. Pabustan-Claar, J. (2007). Achieving permanence in foster care for young children: A comparison of kinship and non-kinship placements. Journal of Ethnic & Cultural Diversity in Social Work, 16, 61–94. Petr, C., & Entriken, C. (1995). Services system barriers to reunification. Families in Society, 76, 523–33. Pierce, L., & Geremia, V. (1999). Family reunion services: An examination of a process used to successfully reunite families. Family Preservation Journal, 4, 13–30. Pine, B. (1986). Child welfare reform and the political process. Social Services Review, 60(3), 339–59. Pine, B., Spath, R., Werrbach, G., Jenson, C., Kerman, B. (2009). A better path to permanency for children in out-of-home care. Child and Youth Services Review, 31, 1135–43. Pine, B., Warsh, R., & Maluccio, A., eds. (1993). Together again: Family reunification in foster care. Washington, DC: Child Welfare League of America. Richie, B. (2001). Challenges incarcerated women face as they return to their communities: Findings from life history interviews. Crime and Delinquency, 47 (3), 368–89. Risley-Curtiss, C., Stromwall, L., Hunt, D., & Teska, J. (2004). Identifying and reducing barriers to reunification for seriously mentally ill parents involved in child welfare cases. Families in Society, 85, 107–18. Ryan, J. P., Marsh, J., Testa, M., & Louderman, R. (2006). Integrating substance abuse treatment and child welfare services: Findings from the Illinois alcohol and other drug abuse waiver demonstration. Social Work Research, 30, 95–107. Rzepnicki, T., Schuerman, J., & Johnson, P. (1997). Facing uncertainty: Reuniting high-risk families. In J. Berrick, R. Barth, & N. Gilbert (eds.), Child welfare research review (vol. 2, pp. 229–51). New York: Columbia University Press. Spath, R., Werrbach, G., & Pine, B. (2008). Sharing the baton, not passing it: Collaboration between public and private child welfare agencies to reunify families. Journal of Community Practice, 16, 481–507. Staff, I., & Fein, E. (1994). Inside the black box: An exploration of service delivery in a family reunification program. Child Welfare, 73, 195–211. Tatara, T. (1993). Characteristics of children in substitute and adoptive care: A statistical summary of the VCIS national child welfare data base. Washington, DC: American Public Welfare Association. Terling, T. (1999). The efficacy of family reunification practices: Reentry rates and correlates of reentry for abused and neglected children reunited with their families. Child Abuse and Neglect, 23, 1359–70.

U.S. Department of Health and Human Services, Administration for Children and Families (2013). The AFCARS report: Preliminary FY 2012 estimates as of July 2013 (20). Retrieved October 26, 2013, from http://www.acf.hhs.gov/programs/cb/stats_research/ afcars/tar/report20.htm. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2012a). Child maltreatment 2011. Washington, DC: U.S. Government Printing Office. Available at http://www.acf.hhs.gov/programs/cb/stats_research/ index.htm#can. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau (2012b). Child welfare outcomes 2007–2010: Report to Congress executive summary. Retrieved on October 26, 2013, from www.acf.hhs.gov/programs/ cb/resources/cwo-07-10-summary. Waites, C., Macgowan, M., Pennell, J., Carlton-LaNey, I., & Weil, M. (2004). Increasing the cultural responsiveness of family group conferencing. Social Work, 49, 291–300. Walton, E. (1998). In-home family-focused reunification: A six-year follow-up of a successful experiment. Social Work Research, 22, 205–14. Walton, E., Fraser, M., Lewis, R., & Pecora, P. (1993). Inhome family-focused reunification: An experimental study. Child Welfare, 72, 473–87. Warsh, R., Maluccio, A., & Pine, B. (1994). Teaching family reunification: A sourcebook. Washington, DC: Child Welfare League of America. Warsh, R., Pine, B., & Maluccio, A. (1996). Reconnecting families: a guide to strengthening family reunification services. Washington, DC: Child Welfare League of America. Wells, E., Guo, S., & Li, F. (2000). Impact of welfare reform on foster care and child welfare in Cuyahoga County, Ohio: Interim report. Cleveland: Mandel School of Applied Social Sciences, Case Western Reserve. Westat. (2001). Evaluation of family preservation and reunification programs: interim report. Washington, DC: Assistant Secretary for Planning and Evaluation Department of Health and Human Services. Yampolskaya, S., Armstrong, M., & Vargo, A. (2007). Factors associated with exiting and reentry into outof-home care under community-based care in Florida. Children and Youth Services Review, 29, 1352–67. Zamosky, J., Sparks, J., Hatt, R., & Sharman, J. (1993). Believing in families. In B. Pine, R. Warsh, & A. Maluccio (eds.), Together again: Family reunification in foster care (pp. 155–75). Washington, DC: Child Welfare League of America.

M A R K F. T E S TA JENNIFER MILLER

Guardianship

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he right of every child to guardianship of the person, either natural guardianship by birth or adoption or legally appointed guardianship by the courts, was first promulgated by child welfare professionals in the 1950s (Smith 1955; Weissman 1964). The impetus was the discovery that many dependent and neglected children as well as child beneficiaries of the major federal cash assistance programs— veteran’s pensions, survivor benefits, and aid to dependent children—lacked the protection of either a natural or legal guardian to safeguard the child’s interests, make important decisions in the minor’s life, and maintain a personal relationship with the child (Breckinridge & Stanton 1943; U.S. Department of Health and Human Services 1961). Consideration was given briefly in the 1960s to promoting legal guardianship as a permanency option by offering subsidies to foster parents and relatives who assumed legal responsibility for foster children (Taylor 1966). But this approach was soon eclipsed by more aggressive efforts in the 1970s to conserve children’s natural guardianship through family preservation and reunification and, when this was not possible, to secure its substitute through adoption. Interest in subsidized legal guardianship rekindled in the 1980s for the thousands of neglected and abused children placed formally in foster care with kin. States were searching for novel permanency options that were less disruptive of existing familial relationships than termination of parental rights and adoption. Unlike adoption, legal guardianship does not

require termination of parental rights before legal responsibility can be transferred. Birth parents still retain residual rights to visit their children and consent to their adoption. Guardianship also does not relieve birth parents of the financial obligation of child support, which usually happens after parental rights have been terminated. It preserves natural lines of inheritance. Also, children retain rights of association with their siblings, grandparents, and other extended family members, which usually become unenforceable once the links through the birth parents have been legally severed. Beginning in the 1990s, the federal government granted waivers to selected states to mount demonstrations in the use of Title IV-E funds to finance subsidized legal guardianship programs for foster children who otherwise would have remained in public custody (Cornerstone Consulting Group 1999). Bolstered by the positive findings from the largest of these demonstrations in the state of Illinois, legislation was introduced in both chambers of the U.S. Congress in the mid-2000s to make legal guardianship a subsidized permanency option under the Social Security Act. After successful replications of the demonstration in the states of Wisconsin and Tennessee, key features of these bills were later incorporated into the guardianship assistance program that Congress created as part of the bipartisan Fostering Connections to Success and Increasing Adoptions Act (FCSIA) of 2008 that President Bush signed into law (P.L. 110-351). The new entitlement program authorizes states to amend their IV-E 355

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plans in order to claim federal reimbursements for subsidies paid to licensed relative foster parents who become the permanent legal guardians of IV-E-eligible children formerly under their foster care. This chapter traces the evolution of subsidized legal guardianship from promising practice to federal law, beginning with Taylor’s Law of Guardian and Ward (1935). Thirty years after her book’s publication, she called for a federal demonstration to test the benefits and costs of providing financial subsidies to families who assume legal guardianship of dependent and neglected children (Taylor 1966). However, her plea went unheeded at the time, as permanency planning advocates rallied around the passage of the Adoption Assistance and Child Welfare Act (AACWA) of 1980 (P.L. 96-272), which emphasized family reunification and adoption as solutions to “foster care drift.” Even though the new law recognized legal guardianship as a permanency option, AACWA did not provide for ongoing federal financial assistance to legal guardians as it did for foster care and adoption. Once caregivers assumed legal guardianship of children formerly under their foster care, federal IV-E reimbursements ended. Most states found it difficult to fund legal guardianship programs entirely from state and local resources at the same level of financial assistance that foster care and subsidized adoption provided. Some financial assistance was available to the families through the federal Aid to Families with Dependent Children (AFDC) program, but the amounts were far less than the assistance they received as foster parents. Predictably, legal guardianship became a seldom used permanency option for those already in foster care and eventually was forgotten. The chapter examines the resurgence of interest in subsidized guardianship as a child welfare resource after initial enthusiasm over the AACWA’s capacity to deliver on its promise of permanence began to wane in the wake of rising foster care caseloads in the mid-1980s.

During this period the growth of kinship foster care prompted a number of states to initiate or expand their state-subsidized guardianship programs through some combination of federal waivers, state funding, and federal Temporary Assistance to Needy Families (TANF) block grants that replaced the AFDC entitlement (Allen, Bissell, & Miller 2003). After the passage of the Adoption and Safe Families Act (ASFA) of 1997 (P.L. 105-89), the country as a whole succeeded in besting President Clinton’s challenge of doubling the number of adoptions and guardianships over a five-year period (McDonald, Salyers, & Testa 2003). Data gathered by the Congressional Research Service showed that in 2002 the number of children in IV-E assisted adoption arrangements surpassed the number of children remaining in IV-E-funded foster care (U.S. House Ways and Means Committee 2008). Approximately 92 percent of children adopted out of foster care in 2012 received a subsidy (U.S. Department of Health and Human Services 2013a). The implementation of the federal guardianship assistance program is expected to tilt the expenditure of federal funds even further in the direction of family permanence. As of July 2013 thirty-one states had approved title IV-E plan amendments to establish federal kinship guardianship assistance programs (U.S. Department of Health & Human Services 2013b). The Obama administration had thrown its weight behind further reductions in long-term foster care by dedicating $100 million dollars over a five-year period to developing innovative intervention strategies that help move more children into permanent homes (Obama 2011). Even though the bipartisan commitment to family permanence remains unbroken, there is a growing consensus that more postpermanency services must be made available to adoptive and guardian families to help them deal with the traumatic effects of foster care removal experiences and to help

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preserve the safety and stability of the small fraction of permanent living arrangements that may be jeopardized as the children age into adolescence. The chapter concludes with a discussion of the challenges that federal, state, and local governments continue to face in adapting their public child welfare to the shifting balance from foster care to family permanence in the care and protection of neglected and abused children. Evolution of Legal Guardianship as a Child Welfare Resource The institution of guardianship was well established in American legal history prior to the law of adoption (Taylor 1966). Deriving from English common law (Weissman 1964), the law of guardian and ward was originally fashioned to safeguard the inheritance of orphaned children. State child welfare statutes later extended the law to transfer guardianship of the persons of dependent, neglected, and abused children from birth parents to an agency administrator, probation officer, or county or state department (also called public guardianship). Despite its long history, it was only in the mid-twentieth century that child welfare authorities seriously began to explore the use of legal guardianship as a way to provide children in foster care with another route to family permanence. Taylor laid the foundation for this thinking in her 1935 monograph. She proposed that legal guardianship be extended to all children, not only those with property, who lacked the natural guardianship of parents by reason of death, absence, neglect, or abuse. Her proposal encompassed children placed with nonrelated and related foster parents as well as children left informally by parents in the care of relatives, friends, and neighbors. Responding to this proposal and related work by Breckinridge and her students (Breckinridge & Stanton 1943), the Children’s Bureau sponsored a study of the need for guardianship in postwar America (Weissman 1964).

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The Children’s Bureau report (Weissman 1964) recommended the development of procedures for finding and routinely reporting children in need of guardianship so that new guardians could be judicially appointed. It urged that such procedures also be used to regulate the passing along of children to the informal custody of relatives, friends, and neighbors. But it stopped short of recommending making such procedures mandatory. Although acknowledging that, unlike birth or adoptive parents, guardians were not legally liable for the support of their wards, the report made no special recommendations regarding compensation of legal guardians or the provision of public subsidies to offset the costs of guardianship. The case for subsidized guardianship was first made in an article that Taylor (1966) published thirty years after her Law of Guardian and Ward. In it she proposed a federal demonstration to test whether a permanent home with a court-appointed guardian was preferable to long-term foster care. She suggested that a demonstration would not only help to assess the costs of expanding eligibility for public assistance to nonrelated guardians (AFDC was available only to parents and relatives), but would also help deal with the uncertainty that some agencies and workers felt over whether guardianship added much value beyond what adoption or substitute care already provided. Preference for Natural Guardianship by Birth or Adoption Support for subsidized guardianship as a child welfare resource took a back seat in the 1970s as the nascent “permanency planning” movement gave new urgency to the principle of every child’s right to natural guardianship through birth or adoption. Child advocates and policy makers had viewed with alarm the substantial numbers of children remaining in foster care for long periods, often until they reached adulthood (Pike, Downs, & Emlem 1977). Recognition of every child’s need for permanence had

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been building ever since the problem of foster care drift was first documented in 1959 (Maas & Engler 1959). In the 1970s, the Children’s Bureau funded a child welfare demonstration in the state of Oregon that helped to popularize the concept of permanency planning. Its purpose was to test the feasibility of finding permanent homes for children who otherwise would have grown up in long-term foster care (Emlen, Lahti, & Downs 1978). Although the architects of the Oregon demonstration recognized legal guardianship as a form of permanence, they placed primary emphasis on upholding natural guardianship through either reunification or adoption. As they explained, the customary way in which children’s rights, welfare, and interests are protected in American society is by those adults whom the law holds to be their parents, either biological or adoptive (Emlen, Lahti, & Downs 1978). The preference for biological or adoptive parenthood over legal guardianship later found expression in AACWA of 1980. That act required states to make “reasonable efforts” to preserve families prior to foster placement or, if the child must be removed, to make possible the child’s timely return to the home. In situations in which reunification was judged not to be in the child’s best interest, AACWA permitted states to make adoption assistance payments to adoptive parents of foster children with special needs. Although AACWA also recognized legal guardianship as a permanency option, it made no special provision for guardianship assistance payments similar to the assistance available to adoptive parents of foster children. Tilt Toward Termination of Parental Rights and Adoption A decade after AACWA enunciated every child’s right to natural guardianship by birth or adoption, optimism over the act’s capacity to bring stability and security to the lives of foster children began to fade. Although reliable time

series on foster care trends are lacking for the period immediately prior to AACWA’s passage, some federal officials pieced together statistics from different sources to advance the claim that the number of children in out-of-home care had decreased dramatically as a result of AACWA—from an estimated half million in 1977 to less than one-quarter million in 1983. Other observers disputed this assertion, citing state and federal Title IV-E statistics that failed to show any such pattern consistent with so dramatic a change (Testa 2009). Nonetheless, whatever gains may have been made care following AACWA’s passage in reducing the numbers of children in out-of-home care, voluntary reporting of foster care statistics from the states showed that, by the late 1980s, foster care caseloads were again on the rise. Between federal fiscal year 1986 and FFY1990, the size of the U.S. foster care population expanded by 45 percent: from 280,000 to 407,000 (Tatara 1991). In the opinion of the lead researcher at the American Public Welfare Association who maintained the Voluntary Cooperative Information System (VCIS),1 the size of the substitute care population had grown mainly because of a marked decline in the rate of exits from care. This decline in the rate of exits from care contributed to the accumulation of children in long-term foster care (Tatara 1993). As the gap between the numbers of exits from and entrants to the child welfare system widened, the size of the foster care population swelled during the early 1990s to more than 500,000 children—the highest ever reported by states up to that time. According to surveys conducted by the Child Welfare League of America (1994), at least 100,000 of the 500,000 children in foster care were waiting for adoptive homes. Yet only 27,000 children were adopted from public foster care in the mid-1990s. The disparity between the large number of children in foster care who needed permanent homes and the smaller number actually adopted prompted President Clinton in 1996

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to direct the secretary of Health and Human Services to make specific recommendations for doubling, over the next five years, the annual number of foster children who are adopted or permanently placed. This resulted in Adoption 2002, an initiative to promote bipartisan federal leadership in adoption and other permanent placements for children in the public child welfare system. Shortly thereafter, Congress passed ASFA in 1997. The new law once again recognized legal guardianship as a permanency option, which it defined as “[a] judicially created relationship between child and caretaker which is intended to be permanent and self-sustaining as evidenced by the transfer to the caretaker of the following parental rights with respect to the child: protection, education, care and control of the person, custody of the person, and decision-making” (42 U.S.C. § 675(7)). Still, ASFA failed to address the need for financial assistance to support guardianship families. Instead it reinforced adoption as the primary solution for the backlog of children in foster care who could not or should not return home. The law sought to spur state administrative action by authorizing the payment of adoption bonuses to states. While state and federal initiatives concentrated on adoption as the solution for long-term foster care, a revolution in permanency planning with kin was quietly unfolding at the state level. Growth of Kinship Foster Care Innovations in permanency planning with kin were stimulated by the growing public reliance on relatives as foster parents in the late 1980s (U.S. Department of Health and Human Services 2000; see also Hegar and Scannapieco’s chapter, this volume). Although relatives had always provided the first line of protection for children who could not live with their birth parents, most of this caregiving occurred informally, outside the child welfare system. When grandparents, aunts, and uncles needed financial aid to care for their dependent kin,

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they were referred to state and federal public assistance programs rather than to the foster care system. Even when children were formally removed from parental custody and placed with kin, most public agencies continued to pay relatives the lower public assistance amount when their homes qualified for the higher-licensed foster care subsidy (Testa 1997). The widespread practice of treating kin differently from nonkin was struck down as unconstitutional by the 1979 Supreme Court decision Miller vs. Youakim. This ruling stipulated that families who met the same foster home licensing standards as nonrelatives could not be denied federal foster care benefits for reasons of kinship alone. The impact of Miller vs. Youakim on foster care caseloads was not felt completely until the mid-1980s. Between 1986 and 1990 the percentage of children placed in formal foster care with relatives rose from 18 percent to 31 percent of public placements in the twenty-five states that were able to supply such information to the HHS (Spar 1993). As the national foster care population swelled from four hundred thousand foster children in 1990 to more than five hundred thousand children in 1995 (U.S. House Ways and Means Committee 2002), child welfare researchers began spotting connections between the caseload growth and the rise in kinship foster care. They noticed that although foster children living with kin tended to have more stable placements than did children living with nonkin (Iglehart 1994; Scannapieco, Hegar, & McAlpine 1997; Wulczyn & Goerge 1992), their rates of reunification and adoption were much lower (Berrick, Barth, & Needell 1994; Testa 1997; Thornton 1991), thereby contributing to the backlog of foster children in long-term care. In an effort to resolve the anomaly of greater placement stability but lesser family permanence, researchers initiated a number of studies on kinship care and permanence. Some of the early research suggested that, while they were prepared to raise their dependent kin to adulthood, relatives were reluctant to adopt.

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Some scholars reported that most caregivers were resistant to the idea of adopting their own kin because their attachment was already sealed by blood ties (Thornton 1991). Other observers posited that African American customs worked against the formalization of kinship bonds through adoption (Burnette 1997). Mindful of the long-standing African American tradition of “informal adoption” (Hill 1977) and Native American interest in “customary adoption” (Cross 2003, see also Cross’s chapter, this volume), both of which did not necessitate terminating parental rights, policy analysts began searching for alternative permanency options that were less disruptive of customary kinship norms than adoption. Time and again, the search led back to the guardianship discussions that the Children’s Bureau had initiated in the aftermath of World War II. Rediscovery of Legal Guardianship as a Child Welfare Resource Most child welfare advocates today accept the principle, as did Taylor decades ago, that adoption is superior to legal guardianship and longterm foster care whenever it is possible and appropriate. This is particularly true for nonrelatives. But the circumstances under which adoption is now viewed as possible and appropriate have vastly changed since Taylor, Breckinridge, Weissman, and others first entertained the idea of legal guardianship as a child welfare resource. Most of these early champions of guardianship held fast to the conventional belief that adoption was an alternative means of family formation. It was perceived as primarily for infertile married couples seeking to adopt infants who physically resembled them. Infants who were not healthy or did not match the physical characteristics of the majority of adoption seekers, who were white, were generally thought of as “unadoptable” (Smith 1997). So when Taylor (1935) enumerated the sorts of children she believed were likely candidates for legal guardianship, she was working from

a much longer list than would be recognized today as “unadoptable,” including handicapped infants, older juveniles, and minority children. Since Taylor made her original case for subsidized guardianship in the 1960s, ideas about the adoptability of children and the motivations of adoptive parents have both evolved. Influenced by the permanency planning movement, definitions of adoptable children have broadened to include older juveniles, minority children, and children with special developmental, emotional, and behavioral needs. Paralleling this change has been a shift in the underlying motivations for adoptions from infertility to what some researchers call “preferential adoption” (Chandra et al. 1999). Families now also adopt to express humanitarian values, provide a permanent home for a foster child, and preserve a child’s ties to a kinship, ethnic, or cultural group (Hoksbergen 1986). In addition, federal adoption subsidies under AACWA have expanded adoption opportunities to families who formerly would not have been able to afford the support of another child. These changes in child adoptability, parental motivation, and adoption affordability have altered perceptions of the desirability of legal guardianship as a permanency option in two ways. First, the trend toward preferential adoption has expanded the circumstances in which adoption is deemed as appropriate or possible and narrowed the circumstances in which guardianship is viewed as the only practical alternative to long-term foster care. Second, the trend has also prompted practitioners to delineate more precisely the conditions under which guardianship might be more appropriate than long-term foster care or adoption. Leashore (1985) specified a number of conditions under which guardianship might better serve the interests of the child, birth parent, substitute caregiver, and the state than would either long-term foster care or adoption. In cases in which the legal grounds are insufficient to prove parental unfitness but reunification

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is still undesirable, legal guardianship creates legal certainty and stability in the substitute care relationship that is lacking when the state retains legal custody of the child. Guardianship also allows for the continued involvement of birth parents in the lives of their children because birth parents retain visiting rights. For this reason, guardianship might help to lessen the separation trauma and identity conflicts that sometimes develop when children are adopted, particularly if they maintain contact or are old enough to remember their parents. Also legal guardianship is less expensive than foster care because the costs of casework services, public guardianship administration, foster home licensing, and judicial review are no longer incurred when the child welfare case is closed. The concept of guardianship as a supplemental permanency option to adoption was later endorsed by Williams (1992), who served as associate commissioner of the Children’s Bureau from 1994 to 1999. Like other scholars, she recognized the advantages of guardianship over long-term foster care, but, unlike Thornton (1991) and Burnette (1997), she did not perceive the unique circumstances of kinship care as posing an insurmountable obstacle to formal adoption by kin. She recommended that guardianship be pursued only when adoption was inappropriate or unavailable as a permanency option. Although she acknowledged that legal guardianship is designed to be self-sustaining, she recognized that access to guardian subsidies and postguardianship services may be necessary to ensure the stability of the relationship. Support for the concept of subsidized guardianship as a supplementary permanency option, especially for children in long-term kinship care, grew steadily during the 1990s. The idea was endorsed by numerous“blue-ribbon” committees that were convened on the subject of kinship foster care (American Bar Association 1999; American Public Welfare Association 1997; Child Welfare League of America 1994;

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New York City Mayor’s Commission for the Foster Care of Children 1993). In its report, the Child Welfare League of America (1994:83) recommended “providing federal reimbursement to states for children in kinship care under a program similar to subsidized special needs adoption.” Although no specific legislative action was taken as a result of these blue-ribbon recommendations, the HHS did invite states to submit applications for subsidized guardianship demonstrations “which would allow children to stay or be placed in a familial setting that is more cost effective than continuing them in foster care” (Federal Register 1995:31483). Five states—Delaware, Illinois, Maryland, North Carolina, and Oregon—initially received waivers to mount subsidized guardianship demonstrations. An additional five states— Minnesota, Montana, New Mexico, Tennessee, and Wisconsin—were later approved before HHS authority to grant new IV-E waivers expired in 2005. Subsidized Guardianship Waiver Demonstrations By the early 2000s, results from the first round of IV-E waiver demonstrations on subsidized guardianship began to appear. In 2004 the HHS released a synthesis of the findings that gave qualified support to the efficacy of subsidized guardianship as a permanency option. As its report noted, only the Illinois demonstration found strong, statistically significant evidence that the availability of subsidized guardianship increased overall permanence, defined as exits from foster care placement to reunification, adoption, or guardianship. No other state at the time could report conclusive evidence that subsidized guardianship improved permanency outcomes for children. Several design choices and implementation problems hampered the ability of other demonstration sites to draw valid inferences about the average causal effect of subsidized guardianship on permanency outcomes. Delaware, North

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Carolina, and Oregon opted for nonequivalent, comparison-group designs that made it difficult to isolate the causal impact of the intervention from other influences. While Maryland, Montana, and New Mexico opted for the more rigorous randomized control-experimental designs, inadequate statistical power (New Mexico), low take-up rates in the intervention group (Maryland), and insufficient follow-up time (Montana) worked against finding a statistically significant effect. Only Illinois had a sufficiently large sample size and rigorous experimental design to detect a practically significant effect. In its final report (Testa et al. 2003), the state reported a combined permanency rate (reunification, adoption, and guardianship) of 71.8 percent in the control group (n = 3,470) and 77.9 percent in the experimental group (N = 3,287) for a net statistically significant difference of 6.1 percent percent (p < .02). Partly on the strength of the Illinois findings (McDonald, Salyers, & Testa 2003), the bipartisan Pew Commission on Children in Foster Care (2004:18) included in its report on reforming federal child welfare financing a recommendation to provide: “federal guardianship assistance to all children who leave foster care to live with a permanent, legal guardian.” Also during this time, U.S. Congressional momentum began to build up behind the concept. In 2004 Senators Hillary Clinton (D-NY) and Olympia Snowe (R-ME) introduced legislation (S. 2607) to allow states to use Title IV-E child welfare funding to subsidize guardianship placements for children living with relatives. This was followed by the introduction of legislation in the House (H.R. 2188) by Illinois Representatives Danny Davis (D-IL) and Timothy Johnson (R-IL) to extend the Illinois guardianship program nationwide. Despite the growing support, however, lingering doubts about the cost-effectiveness of subsidized guardianship and uncertainty over the generalizability of the Illinois findings beyond the state’s unique historical and policy circumstances stymied efforts to bring the legislation to a full floor vote.

Lessons Learned from the First Round of Waiver Demonstrations The mixed results from the first round of the IV-E waiver demonstrations have helped to highlight several features of an effective subsidized guardianship program. Foremost was the importance of equalizing the benefit amounts made available to caregivers whether they remained in foster care, adopted, or took legal guardianship. Both Maryland and North Carolina pegged the monthly guardianship subsidy much lower than the amounts available to licensed foster parents or adoptive parents. Because licensed relatives stood to lose as much as half their previous level of support by accepting subsidized guardianship, the take-up of the guardianship offer was very low among licensed kin. Another lesson was the concern that foster children and their legal advocates expressed about losing services and supports similar to those they could receive as foster children. This was especially true for older children, who, if adopted or taken into guardianship, would become ineligible for college scholarships, “room and board” allowances, and other transitional services they were eligible to receive under the federal Chaffee Foster Care Independence Program (CFCIP) if they stayed and simply aged out of foster care. In focus groups that Illinois conducted to learn why the take-up rate of guardianship offers was much lower than projected for youth aged fourteen and older, the youth characterized the loss of benefits as a “bad deal.” As a result, Illinois sought and received an extension of its waiver in 2003 for another five years that would test the benefits of youth’s retaining eligibility for CFCIP services if they entered guardianship or were adopted at age fourteen years old or older (Quinn et al. 2009). Last, there was recognition of the importance of training caseworkers about where along the permanency planning continuum legal guardianship fits and how to present the various options to families. Because federal

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policy had been heavily geared toward adoption as the solution to foster care drift, many caseworkers were unfamiliar with how legal guardianship differed from adoption and when it might be appropriate to pursue as a permanency option. Further muddying the waters was the stipulation inserted into most of the waiver’s terms and conditions that both reunification and adoption had to be “ruled out” before the permanency goal could be changed to legal guardianship. The absence of clear guidelines as to what constitutes rule-out permitted some caseworkers to select permanency goals or embrace values that reflected the culture of the caseworker rather than that of the family. Some declined to make caregivers aware of the guardianship option until they received a definite “no” to adoption. Others went so far as to interpret the provision as requiring the removal of a child from the custody of relatives who refused to adopt if there was another family willing to adopt. Over time, however, best practice evolved to recommend that committed relatives and foster parents be fully informed of all their options and, after careful consideration, select the permanency plan that best fit their particular circumstances and sense of family (Cohen 2004). Illinois’ training, for example, recognized that a caregiver’s desire to maintain her extended family identity as the grandparent, aunt, or uncle rather than become mom or dad by adoption was a valid reason for finding that adoption is not appropriate. For nonrelated foster parents as well as kin, additional reasons for determining that adoption is not appropriate could include any of the following: 1. a child aged fourteen years old or older does not want to be adopted; 2. there are no legal grounds for termination of the parental rights and the parents refuse to consent or surrender their parental rights; or 3. the birth parents remain in contact with the child and can play a supportive role in the child’s upbringing. Although these guidelines were never formally incorporated

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into the second round of subsidized guardianship waivers, the terms and conditions for both the Wisconsin and Tennessee demonstrations followed the model of presenting both options of adoption and guardianship concurrently to identify the most appropriate permanency goal (U.S. Department of Health and Human Services 2005). Replications of the Illinois Model The Wisconsin waiver was approved in 2005, and the Tennessee waiver in 2006. Both states set the guardianship assistance payment equal to the monthly foster care subsidy, as Illinois had done. Both states also received the same permission that Illinois secured for its waiver extension to provide education and training vouchers and other CFCIP services to children who exited to guardianship after age fourteen years old. In all three states, children of all ages were eligible for the program after meeting minimum time-in-care requirements (ranging from six months to a year) if they resided with kin. In Illinois, children who resided with nonrelated foster parents were also eligible if they had lived in the home for more than a year. In Wisconsin and Tennessee, children who resided with nonrelated foster parents who had a preexisting “kinlike” bond with the children, such as a godparent, teacher, or family friend, or developed one over time, such as a long-term foster parent, could also qualify for guardianship assistance payments. The final evaluation reports showed that the percentages of children who were discharged to legal guardianship in Wisconsin (23 percent) and Tennessee (41 percent) surpassed the 17 percent that Illinois reported at the end of its first five-year demonstration period (Testa & Cohen 2009; Testa et al. 2010). When legal guardianships were added to reunifications, adoptions, and transfers to the custody of relatives, overall 69 percent of children in the experimental group were discharged to permanent homes in Wisconsin, 78 percent in Tennessee, and 78 percent in Illinois. Compared to the overall

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permanency rates in the control groups, the differences were 18.8 percentage points higher in Wisconsin, 11.2 percentage points higher in Tennessee, and 6.1 percentage points higher in Illinois. Each of the differences was statistically significant at the .05 level or better. Fostering Connections to Success and Increasing Adoptions Act of 2008 The advocacy efforts that followed up on the Pew Commission’s 2004 recommendations (aided by grants from the Pew Charitable Trusts) helped put the issue of child welfare financial reform on the federal “policy agenda” (Kingdon 1984). The strong evidence base that was being established by the waiver demonstrations in Illinois, Wisconsin, and Tennessee helped to move the commission’s subsidized guardianship recommendation higher up on the “short list” of proposals that legislative staff was willing to consider. Separate legislation had already been introduced in the House and Senate. Key provisions from these bills found their way into the FCSIA legislation (H.R. 6893) that Representatives Jim McDermott (D-WA) and Jerry Weller (R-IL) cosponsored and forwarded to the House Committee on Ways and Means in September of 2008. Crucial to the support of the legislation was the cost projection prepared by the Congressional Budget Office, which extrapolated from the cost-neutrality experiences of Illinois, Wisconsin, and Tennessee. It estimated that the guardianship assistance program would save $791 million, on net, over the 2009 to 2018 period as a result of the reduced length of stay and the associated administrative savings obtained from children’s exiting foster care to legal guardianship (Congressional Budget Office 2008). The bill passed out of committee and was agreed to by voice vote in the House on September 17, 2008. It was passed without amendment by unanimous consent in the Senate a week later. President Bush signed the legislation, and it became law (P.L 110–351) on October 7, 2008.

Kinship Guardianship Assistance Payments P.L. 110-351 expands the title of Section 473 (42 U.S.C. 673) of the U.S. Social Security Act to the Adoption and Guardianship Assistance Program. The program reflects many of the lessons learned from the IV-E waiver demonstrations. The law requires that the IV-E agency first determine that the children demonstrate a strong attachment to the prospective relative guardian and that the relative guardian has a strong commitment to caring permanently for the child. It specifies that children of fourteen years of age or older are to be consulted concerning the kinship guardianship arrangement. The law also requires the agency to determine that return home and adoption are not appropriate permanency options for the child. To give time for parents to comply with reunification plans and for the prospective guardians to demonstrate commitment, the law requires the child to reside for at least six consecutive months in the home of a prospective guardian prior to pursuing subsidized guardianship as a permanency plan. The federal program also omits key features of the waiver demonstrations because legislative consensus was lacking on the desirability of certain elements, such as the provision of guardianship subsidies to nonrelated foster parents and the eligibility of nonlicensed kinship caregivers for guardianship assistance payments. Whereas adoption advocates were amenable to extending subsidized guardianship as a “second best” (Patten 2004) solution to relatives, the federal programs restricts eligibility for guardianship assistance payments to relatives only. Furthermore, the program limits eligibility only to children who were previously eligible for IV-E foster care maintenance payments, largely for federal cost containment reasons. Implementation of the Guardianship Assistance Program by the States After more than a half-century of advocacy on behalf of subsidized guardianship and a decade

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of rigorous research on the efficacy and costeffectiveness of the program, the availability of federal Title IV-E funds to support legal guardianship arrangements for foster children finally became a reality. Although coverage is not as broad as originally conceived and tested in the waiver demonstrations, because the meaning of relative is undefined in the law, a number of states have been able to extend coverage like Wisconsin and Tennessee did to children in nonbiologically related families who have preexisting or developed kinlike relationships with their caregivers. For foster children placed with relatives and kin, the availability of subsidized guardianship fills an important niche in the permanency planning continuum. To take advantage of the new entitlement program, states must submit a Title IV-E plan amendment that reflects the federal statutory requirements for guardianship assistance payments. In 2009 thirty-eight states and the District of Columbia were administering subsidized guardianship programs (Iowa Policy Research Organization 2009:1). In four states (Minnesota, Missouri, Montana, and New Jersey) there were two separate subsidized guardianship programs providing different services for children of different ages. The sluggishness of the remaining states reflects, to some extent, lingering doubts about the long-term affordability and desirability of subsidized guardianship as a permanency option. Even though subsidized guardianship qualifies as a level 1 evidence-based intervention (Thomlison 2003), and the federal program embodies key lessons from the IV-E waiver experiments, child welfare administrators in the states that have not submitted plan amendments have been struggling to determine if their state numbers among the jurisdictions to which this generalization applies or instead is one of the exceptions to the rule. Some of the reticence is a left over from explorations done before the availability of federal guardianship subsidies. Projections showed that discharging children from

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federally reimbursable foster care to entirely state-funded guardianship arrangements would impose too costly a drain on state resources in spite of the administrative savings. Even though the passage of FCSIA now renders this concern moot, many administrators still find it difficult to conceive how foreclosing future reunification opportunities by guaranteeing families a guardianship subsidy until the child turns eighteen can possibly be cost-effective. As it turns out, the conjecture that many more children would return home if their families were denied the option of subsidized guardianship doesn’t hold up when the counterfactual (i.e., what might happen to the children in the absence of the waiver) is approximated under controlled experimental conditions. In all the demonstration sites that adhered to the Illinois model, there were no statistically significant differences in rates of reunification between the experimental and control groups. Overall reunification rates after assignment to the demonstration were quite low: ranging from 5 percent in Illinois to 10 percent in Wisconsin. Administrators might wish the rates to be higher, but the findings indicate that the availability of subsidized guardianship is not the reason for the low rates of children’s returning home. Dueling Concepts of Permanence: Lasting or Binding The permanency outcome that subsidized guardianship does appear to impact is the rate of adoption. At the ten-year follow-up in Illinois, the data suggested that of the 26 percent of children in the experimental group who were discharged to subsidized guardianship, perhaps as many as 60 percent might have been adopted in the absence of the waiver. Tennessee data suggested a similar impact at the fouryear mark. Only the Wisconsin demonstration showed no substitutions of guardianships for adoptions. There was approximately the same percentage of adoptions in both the experimental and control groups, around 38 percent at the

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five-year mark. Thus the loss of adoptions is not inevitable. Nonetheless, the results from Illinois and later the Tennessee demonstration helped to spark a debate over the question: Is the forfeiture of higher permanency rates in pursuit of more adoptions worth subordinating subsidized guardianship as a permanency goal? The answer to this question depends on whether you define the nature of permanence as “lasting” or as “binding” (Testa 2002, 2005). The former holds that the biological bonds and social attachments of kinship are sufficiently lasting to ensure a family’s intention to raise a foster child to adulthood. The latter contends that the commitment must be made legally binding through formal adoption in order to enforce the obligation of permanence. Historically the former concept applied to kinship care, and the latter to unrelated foster care. Adoption laws were never intended to interfere with the customary practice of relatives assuming informal responsibility for children deprived of parental care (Schwartz 1997). Both the laws of foster care and adoption were geared toward the regulation of substitute care outside the extended family. The care of dependent and neglected children by relatives was supported under the same federal program of AFDC as parental care of children deprived of parental support. Only after the Supreme Court ruled in 1979 that it was illegal to bar kinship caregivers from receiving the much higher federal foster care benefits did kinship care become incorporated into the formal foster care system (Testa 1997). As the size of the kinship foster care population grew in the 1980s, a shift in federal policy orientation toward relative foster homes occurred. The federal government tightened Title IV-E regulations to require that relatives be licensed under the same standards as unrelated foster homes in order to receive federal reimbursements. Previously many states had developed separate standards to accommodate the different circumstances of kinship caregivers. Similarly, kinship foster care was brought

under the same definition of binding permanence that once applied primarily to unrelated foster families. This redefinition demotes guardianship as a permanency goal because it is more easily vacated by the caregiver and more vulnerable to legal challenge by birth parents than termination of parental rights and adoption. In 1999 the federal government issued permanency planning guidelines that endorsed subordination of legal guardianship to the higher-ranked goals of reunification and adoption (Duquette, Hardin, & Dean 1999). The guidelines stated that legal guardianship should be used only when adoption has been thoroughly explored and found inappropriate for the needs of a particular child. Even when permanent placement with a relative is proper for a child, the guidelines urged that the placement is best formalized through an adoption—“a traditional status in which the child is psychologically and legally absorbed into the adoptive family in a way not achieved by the other permanency options” (Duquette, Hardin, & Dean 1999:II-3). The official preference for absorbing foster children into the nuclear family as opposed to sharing parental roles through guardianship has been questioned by some legal scholars. While it is widely accepted that permanency commitments should not be broken casually, there is grave concern that forcing all caregiving commitments into the nuclear family mold of adoption might cause more harm than good. Patten (2004) argues that the subordination of subsidized guardianship to adoption is based on outdated psychology theories that fail to appreciate the benefits to the child from maintaining stable relationships with several different attachment figures, including the biological parent. Coupet (2005:405) also argues that by subordinating guardianship to adoption “the system risks coercing kinship caregivers into accepting a solution that may be an all around poor fit and, consequently, counter-therapeutic for all parties involved.”

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Despite these dissenting opinions in the scholarly literature, FCSIA was written to reinforce the hierarchy of preferable permanency goals that ranks legal guardianship below reunification and adoption. The law specifies that the permanency plan for a child placed with a relative guardian who receives kinship guardianship assistance payments must describe the steps taken by the agency to determine that it is not appropriate for the child to be returned home or adopted. Furthermore, the plan must delineate the reasons why a permanent placement with a fit and willing relative through a kinship guardianship assistance arrangement is in the child’s best interests. This includes the efforts the state agency has made to discuss adoption by the child’s relative foster parent as a more permanent alternative to legal guardianship. In the case of a relative foster parent who has chosen not to pursue adoption, the agency must document the reasons therefore. Thus even though FCSIA removes a major financial obstacle that previously limited the use of legal guardianship as a child welfare resource, the new law reinforces the federal government’s emphasis on adoption as the main solution to foster care drift. Stability of Guardianship and Adoption The FCSIA’s declaration that adoption is more permanent than legal guardianship is certainly true under the definition of permanence as binding. But is this the case under the original definition of permanence as lasting? Since its beginnings in the early 1970s, the permanency planning movement in the United States has promoted a concept of permanence as “lasting.” The goal was to find a foster child a home that is intended to last indefinitely, in which the sense of belonging is rooted in cultural norms, has definitive legal status, and conveys a respected social identity (Emlen, Lahti, & Downs 1978). With the passage of FCSIA, this definition has been supplanted by a newer one that asserts that the commitment needs to be made legally “binding” in order truly to qualify as permanence.

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Are the biological bonds and social attachments of kinship sufficiently lasting to ensure a relative’s intention of raising a child to adulthood? Or are the legal obligations of adoption necessary to give a child a lifelong family? The best evidence for answering these questions comes from a series of follow-up studies of children assigned to the Illinois subsidized guardianship demonstration (Testa 2005, 2010). At the seven-year mark of the Illinois demonstration as of June 30, 2004, 18.5 percent of the children whose caregivers were interviewed in the experimental group had ever been discharged to subsidized guardianship arrangements. Another 61.9 percent had ever been adopted. This compares to the 71.5 percent who had ever been adopted in the control group. If adoption was indeed more “permanent,” one would expect that placements in the experimental group would break down more readily than their counterparts in the control group. As it turns out, stability rates were almost identical in the two groups: 82.8 percent in the experimental group and 82.5 percent in the control group. However, if a simple comparison is done between adopted cases in the control group and guardianship cases in the experimental group, it appears that guardianship cases are 81 percent more likely to result in a placement change than the adopted cases (Testa 2010). This conforms to the impression that many caseworkers and court personnel have formed about the greater fragility of guardianship commitments. But such a simple comparison between guardianship and adoption cases is misleading, because it fails to take into account dissimilarities in the kinds of children who are adopted and those who are discharged to legal guardianship. On average, children and caregivers in guardianship cases tend to be older than adoption cases; their racial profiles, relationship to caregivers, and other characteristics differ as well (Testa 2010). In the study conducted by Testa (2010), he attempted to account for these differences by matching the 307 guardianship cases in the

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experimental group to their closest 307 counterparts in the control group. After matching, the two groups were statistically equivalent on the measured characteristics that one might assume could impact stability rates, such as the child’s and caregiver’s ages and the kind of relationship between child and caregiver. The reason the 307 matched cases from the control group provide a better approximation of the desired counterfactual, i.e., the fate of the children in the absence of the waiver demonstration, rather than looking only at the adopted cases, is that matching picks up those guardianship cases that might otherwise have stayed in foster care (29 percent) if subsidized guardianship were not a possibility. When the comparison is made with the matched cases, it turns out that the guardianship cases are 14 percent less likely to result in a placement change than their matched counterparts; however, this difference is not statistically significant. Thus the findings from this study suggest that the forfeiture of higher permanency rates in pursuit of more binding permanence through adoption does not always result in more lasting permanence for the children who are denied the option of subsidized guardianship. On the other hand, upholders of the guardianship option should not overlook the results of surveys that show caregivers are much more amenable to adopting their own kin than commonly supposed. Survey results from Tennessee, which replicate similar findings in Illinois and Wisconsin, showed that less than 15 percent of biological relatives agreed with the statement “Adoption by a relative stirs up too much trouble in the family” (Testa & Cohen 2009). Fully 90 percent disagreed with the statement “Adoption is really only for children who aren’t related to you.” Postpermanency Support Even though the availability of subsidized legal guardianships does not adversely impact placement stability, it is important to recognize that legal permanence is not impervious to placement interruptions. Regular casework

and judicial oversight may no longer be necessary, but some fraction of these homes will still need occasional support to ensure child well-being, and sometimes more intensive interventions, to preserve family stability. To estimate the magnitude of the potential need, the Illinois Department of Children and Family Services funded the Adoption Preservation and Linkages (APAL) program in 2008 to assess the postpermanency needs of adolescents aged thirteen and sixteen years old in adoptive and guardianship homes. The completed survey with 237 of the 335 families (71 percent) targeted for service by the APAL program was conducted six months after referral. A similar survey was conducted with a comparison group of 219 out of the 335 families (65 percent) selected for interview (Testa et al. 2010). Although there were no differences in the unmet needs of the children targeted for APAL services and those in the comparison group, the survey offered some interesting insights into the prevalence of met and unmet need among still active subsidy cases discharged to guardianship and adoptive arrangements between July of 1997 and June of 2004. An estimated 80.4 percent of caregivers (± 4 percent, 95 percent CL) reported no unmet needs for the focal child under their care (Testa et al. 2010). Among the remainder, the largest unmet need was for orthodontia services. While just 14 percent of caregivers reported that their child needed this service, only 6 percent of respondents reported that their efforts to obtain this service were successful, 5 percent were unsuccessful, and another 3 percent said their children needed orthodontia services but they never tried to obtain the service. The next largest unmet need was for counseling services, but most caregivers who sought this service were successful in obtaining it. Of the 38 percent who reported that their child needed counseling, 28 percent of respondents reported that their efforts to obtain this service were successful, 4 percent were unsuccessful, and another 6 percent said their children needed counseling

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but they never tried to obtain the service. The remaining unmet needs, rank ordered from highest to lowest, were as follows: mentoring services (3 percent), respite care, psychological treatment, summer camp (2 percent each), day care, family therapy, educational services, support groups, family preservation services, psychiatric help, speech therapy (1 percent each), and psychiatric hospitalization and specialized medical care (less than 1 percent each). While some adoption and guardianship cases continue to require outside help, the prevalence of unmet needs appears to be of a magnitude that is easily managed outside the foster care system with appropriate policies in place, e.g., access to orthodontia services and respite care and adequate postpermanency support from the agency. Family Duty or Social Entitlement One of the biggest impediments to some states’ signing on to the federal guardianship assistance program has been the large numbers of children who continue to be looked after informally by kin. At its peak size in the early 2000s, the estimated 130,000 to 200,000 U.S. children in the formal foster care system (Murray, Macomber, & Geen 2004) accounted for less than 10 percent of the estimated 2.2 million children who were living apart from their parents under the care of grandparents (64 percent) and other relatives (Kreider & Fields 2005). Many county welfare systems, particularly smaller and rural ones, continue to rely on informal kinship care as the first line of protection against child abuse and neglect. Even if children are placed formally with kin, many counties discharge them back to the legal custody of relatives, which is another disposition that family or juvenile courts have at their disposal. In some states, a child’s custodian acquires lesser decision-making powers than a guardian to act on the child’s behalf, but in many states differences between custodians and guardians are minimal (Schwartz 1997). With the availability of federal guardianship assistance, however, a major difference arises

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because only guardians are eligible for federal subsidies. This puts some states in a quandary over whether to sign on to the federal program and run the risk that relative caregivers will no longer accept legal custody of the children or continue with the status quo so that there is no financial advantage to caregivers of switching from custodian to guardian. The bottom-line impact of switching to the federal guardianship program for the county and state child welfare agencies is that they continue to bear some of the costs for the guardianship assistance payments whereas they can discontinue payments to relative custodians who must turn to the much lower TANF payments for support. Simulations conducted for New York State on the potential costs of enacting kinship guardianship assistance legislation suggested very little impact on rates of discharge to relative custody for the state as a whole (Testa & Cohen 2010). In New York, historical trends show that no more than 4 percent to 6 percent of children who have been residing with kin for more than a year exit foster care to the legal custody of relatives. This is approximately the same proportion that exited to relative custody in the matched samples of New York cases to cases in the waiver demonstration sites of Illinois, Tennessee, and Wisconsin. These similarities suggest that there may always be a small fraction of kin who desire to be free of the foster care system even if it involves a substantial loss in financial aid. The upper limit of 4 percent to 6 percent on legal custody outcomes, however, applies only to the larger, urbanized counties and jurisdictions, which tend to dominate statewide trends. Outside of Chicago, Nashville, Memphis, Milwaukee, and New York City, reliance on legal custody can sometimes account for as many as 20 percent to 60 percent of all discharges from kinship foster care (Testa & Cohen 2010). This wide variation reflects different local sensibilities over the extent to which kinship foster care should be regarded as a family duty or a social entitlement. The U.S. Supreme Court came down on the side of its being an entitlement in

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the Youakim decision that declared illegal the widespread practice of denying federal foster care benefits to families for reasons of kinship alone. Still, local opinions in many smaller and rural counties continue to regard kinship care as a family duty. Some communities are wary about any change that might erode kinshipbased patterns of loyalty and mutual aid, which raises the following questions: Should local governments be permitted to exploit the natural altruism of kin to care for family members, or must they incorporate relative caregivers into the same formal structure that defines the entitlements and responsibilities of unrelated foster parents? Undoubtedly the introduction of subsidized guardianship will heat up discussion of this long simmering issue. It is a debate worth having openly in the public forum. YYY

The evolution of legal guardianship as a child welfare permanency resource has progressed in the United States through several stages from promising practice to federal law. Originally conceived broadly in the 1950s as a solution to the large number of child beneficiaries of federal aid programs who lacked the protection of a natural guardian, it became more narrowly focused in the 2000s as a solution to the longterm kinship care of foster children for whom reunification and adoption were not appropriate permanency options. This narrowing of focus resulted both from the successes of adoption advocates in shortening the list of children who were once considered unadoptable, e.g.

NOTE

1. VCIS was operated by the American Public Welfare Association and funded by the U.S. Department of Health and Human Services. It collected information voluntarily submitted by the states and compiled it in an annual report starting in FY1982. Prior to the regular reporting of data from the Adoption and Foster Care Analysis and Reporting System in 1997, VCIS was the primary source of data on the national child welfare system.

handicapped, older, and minority children, and from the subordination of the older definition of permanence as emotionally lasting to a newer definition of permanence as legally binding. In spite of the strong emphasis on adoption, the opinions of adoption advocates eventually yielded to the evidence obtained from the federal subsidized guardianship demonstrations that showed subsidized guardianship to be a cost-effective alternative to maintaining children in long-term foster care. On the strength of these findings and the argument that “one size doesn’t fit all,” several Congressional bills were introduced to create a federal guardianship assistance program that was later enacted as part of the Fostering Connections to Success and Increasing Adoptions Act of 2008. States still deciding whether or not to take advantage of the new entitlement have to come to grips with several issues. After the misinformation and myths about affordability and lesser permanence are cleared away, a layer of concern remains that is not so easily dismissed. The biggest obstacle is how best to reconcile the bureaucratic uniformity and costs of the new entitlement program with the traditions and customs of informal kinship care that many communities still rely on as the first line of defense against child dependency and neglect. As more states decide to make the right of every child to guardianship an affordable reality for families, thousands of the nation’s foster children who would otherwise have grown up in long-term foster care can look forward to finding lasting permanence with loving relatives and kin.

REFERENCES

Allen, M., Bissell, M., & Miller, J. (2003). Expanding permanency options for children: A guide to subsidized guardianship programs. Washington, DC: Children’s Defense Fund and Cornerstone Consulting Group. American Bar Association (1999). Guidelines for kinship placements. Washington, DC: American Bar Association.

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American Public Welfare Association (1997). Report of kinship care. Washington, DC: American Public Welfare Association. Berrick, J., Barth, R., & Needell, B. (1994). A comparison of kinship foster homes and foster family homes: Implications for kinship foster care as family preservation. Children and Youth Services Review, 16, 33–64. Breckinridge, S., & Stanton, M. (1943). The law of guardian and ward with special reference to the children of veterans. Social Service Review, 17, 265– 302. Burnette, D. (1997). Grandparents raising grandchildren in the inner city. Families in Society: Journal of Contemporary Human Services, 23, 489–501. Chandra, A., Abma, J., Maza, P., & Bachrach, C. (1999). Adoption, adoption seeking, and relinquishment for adoption in the United States. Advance Data from Vital and Health Statistics, No. 306. Hyattsville, MD: National Center for Health Statistics. Child Welfare League of America (1994). Kinship care: A natural bridge. Washington, DC: Child Welfare League of America. Cohen, L. (2004). Rule-out. In M. Bissell & J. Miller (eds.), Using subsidized guardianship to improve outcome for children: Key questions to consider (pp. 19–25). Washington, DC: Children’s Defense Fund and Cornerstone Consulting Group. Congressional Budget Office (2008). Cost estimate: H.R. 6893 Fostering Connections to Success and Increasing Adoptions Act of 2008. Washington, DC: Budget Analysis Division. Cornerstone Consulting Group (1999). Child welfare waivers: Promising directions, missed opportunities. Houston: Cornerstone Consulting Group. Coupet, S. (2005). Swimming upstream against the great adoption tide: Making the case for “impermanence.” Capitol University Law Review, 34, 405–58. Cross, T. (2003). Guiding values and philosophy. In Developing culturally based tribal adoption laws and customary adoption codes. A technical assistance manual and model code. Portland, OR: National Indiana Child Welfare Association. Duquette, D., Hardin, M., & Dean, C. (1999). Adoption 2002: The president’s initiative on adoption and foster care, guidelines for public policy and state legislation governing permanence for children. Washington, DC: Children’s Bureau. Emlen, A., Lahti, C., & Downs, S. (1978). Overcoming barriers to planning for children in foster care. DHEW Publication no. (OHDS) 78-30138. Washington, DC: U.S. Government Printing Office. Federal Register (1995). The Federal Register. Washington, DC: Office of the Federal Register, National Archives and Records Administration. Hill, R. (1977). Informal adoption among black families. Washington, DC: National Urban League Research Department.

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Hoksbergen, R., ed. (1986). Adoption in worldwide perspective. Lisse: Swets & Zeitlinger. Iglehart, A. (1994). Kinship foster care; Placement, service, and outcome issues. Children and Youth Services Review, 16, 107–22. Iowa Policy Research Organization (2009). Subsidized Guardianship. Retrieved November16, 2012, from http://www.childwelfare.gov/permanency/guard_ sub.cfm. Kingdon, J. (1984). Agendas, alternatives and public policy. Boston: Little, Brown. Kreider, R., & Fields, J. (2005). Living arrangements of children: 2001. Current Population Reports, P70–104. Washington, DC: U.S. Census Bureau. Leashore, B. (1985). Demystifying legal guardianship: An unexplored option for dependent children. Journal of Family Law, 23, 391–400. Maas, H., & Engler, R. (1959). Children in need of parents. New York: Columbia University Press. McDonald, J., Salyers, N., & Testa, M. (2003). Nation’s child welfare system doubles number of adoptions from foster care. Chicago: Fostering Results. Murray, J., Macomber, J., & Geen, R. (2004) Estimating financial support for kinship caregivers. New federalism: National survey of America’s families. Washington DC: Urban Institute. New York City Mayor’s Commission for the Foster Care of Children (1993). Report from the Mayor’s Commission for the foster care of children in New York City. New York: Office of the Mayor. Obama, B. (2011). Presidential Proclamation—Nation Foster Care Month, April 29. Washington, DC: White House. Patten, E. (2004). The subordination of subsidized guardianship in child welfare proceedings. New York University Review of Law and Social Change, 29, 237–76. Pew Commission on Children in Foster Care (2004). Fostering the future: Safety, permanence and wellbeing for children in foster care. Washington, DC: Pew Commission on Children in Foster Care. Pike, V., Downs, S., & Emlen, A. (1977). Permanent planning for children in foster care; A handbook for social workers. DHEW Publication no. (OHDS) 77-30124. Washington, DC: U.S. Government Printing Office. P.L. 96-272, Adoption Assistance and Child Welfare Act. (1980). P.L. 105-89, Adoption and Safe Families Act. (1997). P.L. 110-351 Fostering Connections to Success and Increasing Adoptions Act (2008). Quinn, L., MacAllum, C., Ciarico, J. & Rogers, J. (2009). Illinois permanence for older wards waiver: Final evaluation report. Rockville, MD: Westat. Scannapieco, M., Hegar, R., & McAlpine, C. (1997). Kinship care and foster care: A comparison of characteristics and outcomes. Families and Society, 78, 480–88.

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Schwartz, M. (1997). Reinventing guardianship: Subsidized guardianship, foster care, and child welfare. New York University Review of Law and Social Change, 22, 441–82. Smith, A. (1955). The right to life. Chapel Hill: University of North Carolina Press. Smith, J. (1997). The realities of adoption. New York: Madison. Spar, K. (1993). Kinship foster care: An emerging federal issue. Washington, DC: Library of Congress, Congressional Research Service. Tatara, T. (1991). Overview of child abuse and neglect. In J. Everett, S. Chipungu & B. Leashore (eds.), Child welfare: An Africentric perspective (pp. 187–219). New Brunswick, NJ: Rutgers University Press. Tatara, T. (1993). Characteristics of children in substitute and adoptive care: A statistical summary of the VCIS National Child Welfare Data Base. Washington, DC: American Public Welfare Association. Taylor, H. (1935). Law of guardian and ward. Chicago: University of Chicago Press. Taylor, H. (1966). Guardianship or “permanent placement” of children. In J. Tenbroek and the California Law Review (eds.), The law of the poor (pp. 417–23). San Francisco: Chandler. Testa, M. (1997). Kinship foster care in Illinois. In R. Barth, J. Berrick, & N. Gilbert (eds.), Child welfare research (vol. 2, pp. 103–26). New York: Columbia University Press. Testa, M. (2002). Subsidized guardianship: Testing an idea whose time has finally come. Social Work Research, 26, 145–58. Testa, M. (2005). The quality of permanence—lasting or binding? Virginia Journal of Social Policy and Law, 12, 499–534. Testa, M. (2009). How the bear evolved into a whale: A rejoinder to Leroy Pelton’s note contesting Mark Testa’s version of national foster care population trends, Children and Youth Services Review, 31, 491–94. Testa, M. (2010). “Evaluation of child welfare interventions.” In M. Testa & J. Poertner (eds.), Fostering accountability: Using evidence to guide and improve child welfare policy (pp. 195–230). Oxford: Oxford University Press. Testa, M., & Cohen, L. (2009). Tennessee permanent guardianship assessment and evaluation: Final evaluation report. Urbana, IL: Children and Family Research Center. Testa, M. & Cohen, L. (2010) Pursuing permanence for children in foster care: Issues and options for establishing federal guardianship assistance program in New York State. Chapel Hill: University

of North Carolina at Chapel Hill School of Social Work. Testa, M., Cohen, L. Smith, G., & Westat. (2003). Illinois subsidized guardianship waiver demonstration: Final evaluation report. Springfield, IL: Department of Children and Family Services. Testa, M., Rolock, N., Liao, M., & Cohen, L. (2010). Adoption, guardianship, and access to post-permanency services. Presentation at the Society for Social Work Research Annual Conference, San Francisco, January 14–17. Testa, M., Slack, K., Gabel, G., Evans, M, & Cohen, L. (2010). Wisconsin subsidized guardianship assessment and evaluation: Final evaluation report. Rockville, MD: Westat. Thornton, J. (1991). Permanency planning for children in kinship foster homes. Child Welfare, 70, 593–601. Thomlison, B. (2003). Characteristics of evidencebased child maltreatment interventions. Child Welfare, 82, 541–69. U.S. Department of Health and Human Services (1961). Legislative guides for the termination of parental rights and responsibilities and the adoption of children. No.  394. Washington, DC: Social Security Administration. U.S. Department of Health and Human Services (2000). Report to Congress on kinship foster care. Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services (2005). Waiver authority, State: Wisconsin. Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services (2013a). The AFCARS report: Preliminary FY 2012 Estimates. Washington, DC: U.S. Department of Health and Human Services. U.S. Department of Health and Human Services (2013b). Title IV-E Guardianship assistance. Retrieved October 26, 2013, from www.acf.hhs.gov/programs/ cb/resource/title-iv-e-guardianship-assistance. U.S. House Ways and Means Committee (2002). 2002 green book. Washington, DC: U.S. Government Printing Office. Weissman, I. (1964). Guardianship: Every child’s right. Annals of the American Academcy of Political and Social Science, 355, 134–39. Williams, C. (1992). Expanding the options in the quest for permanence in child welfare. In J. Everett, B. Leshore & S. Chipungu (eds.), An Africentric perspective of child welfare (pp. 113–29). New Brunswick, NJ: Rutgers University Press. Wulczyn, F., & Goerge, R. (1992). Foster care in New York and Illinois: The challenge of rapid change. Social Service Review, 66, 278–94.

TERRY L. CROSS

Customary Adoption for American Indian and Alaskan Native Children For many of those who are sitting in the privacy of their offices or homes reading this .  .  . cultural extinction is not a thought that haunts them. Yet, cultural extinction is a very real nightmare for many . . . members of the tribal nations. Madrigal (2001:103)

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he issue of adoption of Indian children has a long and complicated history fraught with trauma for Indian people and their communities (Duran & Duran 1995; Locust 1998; Robin, Rasmussen, & GonzalezSantin 1999). Before the passage of the Indian Child Welfare Act (ICWA) of 1978, Indian children were removed from their homes by the hundreds of thousands by child welfare professionals and agencies that believed Indian homes were generally unfit. Widespread poverty and social problems on reservations were not addressed, but rather were cited as reasons for the wholesale removal of children to non-Indian homes. Cultural differences also accounted for inappropriate removals. Foremost among these differences is the concept of “family” itself. Whereas, in mainstream America, the individual’s primary source of identity is the nuclear family, in many Indian communities the individual is defined by his membership in the extended family, clan, and tribe. Extended kin families share responsibility for the welfare of all family members. This practice is reflected in the names applied to relatives. Terms such as mother, father, aunt, and uncle are interchangeable for all relatives of a child of a certain age, and brother or sister

apply to cousins as well as to siblings in some traditional Indian cultures (Swinomish Tribal Mental Health Project 1991). Often children are raised, temporarily or permanently, by relatives (placed informally or customarily). Mainstream child welfare workers sometimes mistook these arrangements for abandonment. By the mid 1970s the removal of Indian children from their homes and communities reached epidemic proportions. As stated by Pevar (2002:133): “Imagine the outcry if the government announced a plan to take one-fourth of all the white children in the country, separate them from their parents, and then place them in institutions or in foster care or adoptive homes. Until 1978, it was as if such a plan actually existed for reservation Indian children.” A survey of states with large Indian populations by the Association on American Indian Affairs between 1969 and 1974 found that 25 percent to 35 percent of all Indian children had been separated from their families and placed in foster care homes, adoptive homes, or institutions (Byler 1977; George 1997). Congressional hearings documented that most of these removals were inappropriate, unnecessary, and conducted without due process. The provisions of ICWA (P.L. 95-608) specifically address the abuses of the past by creating legal requirements for state courts that wish to take Indian children into custody. Among other provisions, ICWA makes the termination of parental rights in Indian families more difficult than in mainstream families and, when a child is removed from her parents, 373

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provides explicit preferences for placing the child in an adoptive home: 1. with a member of the child’s extended family, 2. with other members of the child’s tribe, or 3. with other Indian families. Before the passage of ICWA, Indian children were placed in foster care homes at rates as high as 5 to 8 times that for other children (Byler 1977; Kunesh 2008); after ICWA, they were placed in foster care at a rate 3.6 times higher than that for others (Plantz et al. 1998). Although this decrease demonstrates progress, the rate of removal of Indian children from their homes is still alarmingly high. According to Plantz and colleagues (1998), in the late 1980s Indian children were .9 percent of the children’s population but 3.1 percent of the total substitute care population. SHANNON CROSSBEAR The sounds of five young ones, running in and out, admonishments of “close the screen door” and “if you’re coming in, you have to stay in, no more in and out” echo through the house. My grandchildren are here. There are five of them. Cory James, at eight, leads the cadre of children and is always at the edge of creating an adventure that the adults interpret as a “scheme.” Allaura, at six, has drama queen down to a fine art, baby blues, and a knack for sensitivity that substitutes on occasion for common sense. Brianna is a wise five, with an intellect that matches her intensity. She is precocious and has a perfected pout that makes any attempt at discipline difficult. Chris is also five and constantly in the process of catching up with his older siblings. He has a sweet shyness and can retain a single focus while maintaining complete oblivion to what is going on around him. Rashone, at two and a half, is like a bundle of curiosity, with an on button. The words Run and Rashone are interchangeable when it comes to this young one. When he wraps his arms around your knees, it doesn’t matter that he has not yet mastered language and speech; he communicates with clarity his every need. These are my grandchildren. C.J. with his clear voice, present at the drum, learning the songs and

taking his place as a singer. Allaura with butterfly movements, a shawl dancer, who lives up to her name, Proud When She Dances. Brianna with her straight back, hands on hips, elbows out, in fluid motion as she dances the medicine dance of the jingle dress. Chris explodes with the action of the grass dancer, low-to-the-ground shimmer, a slight breeze moving through the fields of grass, then eruption into dancing, swirling, free, and in flight. Rashone, intent on demonstrating his commitment to entering into the world of his brothers and his dad, alternates between picking up the drumstick and attempting the sounds of the songs and dancing in full abandonment to the beat of the drum. The thing is, that this family would be incomplete without any one of them. It was not always so. You see, the two girls were biologically born to my son and daughter-in-law. The three boys were gifted to us in another way. This is a story about the Indian Child Welfare Act. It doesn’t look like what happens in non-native communities. The three boys, along with their grandpa, were always present at the drum and dance group that my son and his family participated in. The girls played with the boys and other children attending the weekly social gatherings. Then after several weeks of not seeing the boys, they asked about them. What they heard next would change all our lives. The boys had been removed from the household. They were currently in a shelter, no blood family members were available or eligible to be considered for their care, and they would be separated, if and when they could find a placement. My son, Patrick, looked at Rachel and there was no question as to what would happen next. They spoke with the girls and all agreed that the boys would come to stay with them for whatever time was needed. They would do what ever it took to keep these boys in community, with relatives and raised as Ojibwa children. It was not an easy or smooth path. There was the emergency placement, then the qualifying for foster care status. Then, after months of attempts at reunification, a determination regarding permanent placement occurred. Family contact was maintained, sometimes with challenging results, leading

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to jealousy and accusations in the community. Still, they continue in determining the boundaries and protocols that would allow for the best interest of the children. The determination was such that Pat and Rachel would “adopt” the boys, raise them, nurture and protect them. Loving them was a given. Adoption, all the rights and responsibilities of parenting, while allowing their mother and father to not terminate their parental rights. This allowed for supports to be put in place for the continued care of the children, to address needs as they arise, and not remove the possibility of reunification if future circumstances allow for a healthy relationship to be forged with the biological parents. Meanwhile, we welcome our expanded family while contributing to the cultural shield that leads to resilience as individuals and as a community. This could not happen without the opportunities, supports, and protection of the Indian Child Welfare Act, without the special conditions allowed under nonrelinquishments of rights and guardianships and tribal and state agreements. The three boys would be separated, most likely unconnected to family and culture, lost in a sea of foster families with the additional trauma inflicted by those losses. We pray that their parents will be able to someday find peace with those things that prevent them from fulfilling their parenting role, but we are grateful to have the gift of these children in our lives to teach about our relationship to each other and us. Perhaps the best demonstration is in the bonding of siblings. Recently, the young ones each received some money, which they decided, on their own, to pool and give to the oldest sibling with a new broach for his regalia. When asked why, they responded, “C.J. is our big brother and we want him to look good when he dances because he is part of our family and we love him.” These are OUR children and grandchildren, and I am proud to be part of their family and I love them.

Yet, clearly, there is still a need for the adoption of Indian children whose current family

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situation is chaotic or dysfunctional. While in the old days these children would have been parceled out among other tribal members, preferably relatives, today they are likely to be removed by mainstream or even tribal child welfare workers. Frequently these workers are unable to find them permanent homes. Since the passage of ICWA, adoption rates of Indian children have plummeted. In 1996 MacEachron and colleagues reported that the adoption rate of Indian children had dropped an estimated 93 percent between 1978 (the year ICWA was passed) and 1986. Thus the children being removed from Indian families are more likely than ever to be placed in foster care or other nonpermanent situations such as residential or institutional care. In a study of thirty-six thousand California children who entered out-of-home care from 1988 through 1992, Barth, Webster, and Lee concluded that “American Indian/Alaska Native children in California appear to have unique adoption patterns that emphasize adoption by kin and especially by aunts and uncles” (2002:155). However, they found that the rates of adoption versus remaining in long-term care were substantially lower for Indian children compared to white or Latino children and that it was relatively rare for Indian children in California to be adopted by Indian couples. These results illustrate both the preferences of Indians for placement with relatives and the current difficulties associated with finding unrelated, permanent Indian homes. These difficulties include lack of resources as well as lack of culturally relevant models of care for families who may be willing to adopt. For rural communities, which include Indian reservations, the problems of transportation and isolation exacerbate the difficulties of finding and maintaining both foster and permanent homes. In addition, such problems as fetal alcohol syndrome, prevalent in Indian families, lead to unique challenges for adoptive children and parents (Dorris 1989).

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Trends in Adoption/Child Welfare Policy and Practice The Adoption and Safe Families Act of 1997 (ASFA), enacted almost twenty years after ICWA, compounded the problem of finding Indian homes for Indian children and youth. ASFA, with provisions heavily weighting permanency options toward termination of parental rights and adoption, did not specifically address how provisions that conflict with ICWA would be addressed (Simmons & Trope 1999). However, because ICWA is a specific law, and ASFA more general, ICWA provisions still apply, despite ASFA. ASFA timelines and procedures, if followed without attention to ICWA, can create unnecessary conflicts. Although the Multi-Ethnic Placement Act of 1994 (Curtis & Alexander 1996) also postdated ICWA, it clearly did not apply to children covered by the ICWA (Barth, Webster, & Lee 2002). The National Indian Child Welfare Association (NICWA) and other associations and agencies that are committed to protecting Indian children and their culture have been working with federal and state agencies to clarify some of the ASFA/ ICWA overlap and conflict while also working to improve practice. In the meantime, these organizations and agencies have been implementing ICWA with an overall goal of maintaining the integrity of tribal communities. Among the many initiatives undertaken, programs have been developed to assist Indian children in finding culturally appropriate homes. The Indian Adoption program, sponsored by the Jewish Family and Children’s Service of Phoenix, Arizona, was founded immediately after the passage of ICWA. This program emphasized the recruitment of Indian parents for Indian children and the permanent placement of these children in stable, loving homes (Morrison et al. 2010). Two years after ICWA, 100 children had been placed (Goodluck & Eckstein 1978; Goodluck & Short 1980). The Indian Child and Family Consortium (ICFC), also founded shortly after the passage

of ICWA, provides education for families, therapy sessions for at-risk children and teens, activities and events to promote cultural values, and assistance in grant writing for preserving tribal culture. ICFC works with other local county programs to provide a support network for children in care. A special program assists families in transporting children to powwows, group therapy, theater, special tribal events, and other functions (Madrigal 2001). These programs have just begun the work that needs to be accomplished to overcome four centuries of the destruction of Indian homes and communities. Permanency Issues Although permanency planning is a rather new development in the field of child welfare, the concept of belonging—the heart of permanency planning—is central to Indian culture (Atwood 2008). Tribal society is based first and foremost on the family. In Indian culture, family membership means much more than being the child of given parents. It means belonging to an extended family or interdependent, nurturing support network. In many tribes these extended family networks are organized into larger groups or clans that offer individuals another point of reference in their sense of belonging. The tribe offers a formalized group recognition of belonging that goes beyond family and clan (Morrison et al. 2010). When these reference points are intact, they offer the individual a sense of trust over an extended period of time—a crucial aspect of permanency. The group or interdependent nature of Indian society offers the individual strength, a sense of purpose, and a sense of commonality with its other members. This sense of commonality promotes the individual’s commitment to the group, as well as the group’s commitment to the individual, and is reinforced by tribal custom and the oral tradition. It is unfortunate that, over time, this cultural system has eroded somewhat and there are Indian families that have lost the

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ties that bind them to extended family, tribe, and culture. Although not all Indians are served by the cultural system in the way they were historically, it is also true that these reference points for belonging still exist and can be sought out and enhanced as resources, even for those individuals estranged from their culture. ICWA embodies this belief in its order of placement preferences. Permanency planning in Indian child welfare, therefore, has as much to do with maintaining a child’s connection and sense of belonging to the extended family, clan, or tribe as it does with maintaining ties to the biological parents (Cross, Bartgis, & Fox 2010). In the mainstream child welfare system, when children cannot be safely reunified with family, termination of parental rights (TPR) to free the child for adoption is valued as the method of choice to ensure permanence. However, in Indian child welfare TPR has the potential of severing the child’s connection to an extended family or tribe. Tribes must ask themselves if termination of parental rights serves a viable function in an extended family system in which connectedness and belonging go far beyond emotional bonds with biological parents. Only careful community-based decision making can answer this question. Although termination of parental rights may or may not be an acceptable option, permanence is a highly valued concept among Indians, and alternative, culturally based methods to achieve it are necessary and legitimate. Indian Traditional Adoptions In many Indian/Alaska Native communities, individuals are adopted formally or informally into an existing family. Adoptees include not only children but also adults who have come to be associated with a family. Elders may adopt children who have few other family ties, and children or young people may adopt elders as grandparents. Family membership can be a way to define who is “in” or “out” of a social group (Swinomish 1991).

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Historically, adoptions in Indian tribes/ nations were conducted with great ceremony, entailing the full, unqualified acceptance of a child or adult into not only the family but also into the tribe. Mary Jemison, adopted by the Seneca in 1755, reported “I was ever considered and treated by them as a real sister, the same as though I had been born of their mother” (Seaver 1991:61). Traditional naming ceremonies for children born or adopted into a tribe not only “give children a path in life, they also build a spiritual network that organizes kinship obligations with respect to meeting physical, health, and emotional needs of children” (Red Horse 1997:246). Naming ceremonies are held for both birth children and adopted children or adults. One of the most promising developments for Indian children incorporates traditional forms of adoption into customary adoption. This approach to permanency can be viewed as a midway point on a continuum between termination of parental rights and legal guardianship. Customary adoption promotes the use of Indian traditions to guide the conduct of permanency, as opposed to formal adoption, which includes termination of parental rights. Customary adoption fits culturally with the extended family concept, and it formalizes and protects ongoing care of the child by an extended family member or other recognized potential parents. It eliminates the philosophical barrier to adoption as conducted in mainstream society; namely, abhorrence for termination of parental rights. Customary Adoption In many tribes customary adoption is the process of creating relatives and joining individuals into family relationships. It expands family resources for a young person without terminating preexisting relationships. Customary adoption modifies the custodial and legal relationship of the birth parents with the child, but does not terminate a birth parent’s emotional relationship with the child, the child’s

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relationships with the birth parent or extended birth family, or the extended family’s relationship with the child. Key Definitions of Customary Adoption Several key definitions are central to this discussion and are essential to the formulation of legal elements of an emerging model currently being developed by NICWA and collaborators (Cross 2002). “Adoption” means a tribal legal process pursuant to tribal law, including custom, which gives a child a legally recognized permanent parent-child relationship with a person other than the child’s birth parent and severs or modifies the legal parent-child relationship between the child and the child’s birth parent but does not sever the child’s relationship with the child’s clan or the child’s birth or extended family (under certain circumstances). In the case of an adult adoptee, it is a tribal legal process pursuant to tribal law, including custom, which gives an adult a legally recognized permanent parent-child relationship with a person other than the adult’s birth parent. Custom means a long-established, continued, reasonable, and certain practice considered by the tribal community to be binding, or a usage or practice common to many community members or to a particular place in the community that has not been developed by the tribal or any other government, and that the court or other appropriate entity can enforce. Customary adoption means a traditional tribal practice recognized by the community that gives a child a permanent parent-child relationship with someone other than the child’s birth parent. Recently NICWA has developed a culturally specific child welfare practice and judicial process for the recognition and certification of customary law regarding the adoption of Indian children. Furthermore, it has set out a culturally based conceptual framework for tribes to conduct formal adoptions without termination of parental rights. Whether to formulate either or both these concepts into law is a landmark

policy decision for tribes and represents one of the most important exercises of sovereignty that a tribe can undertake. This approach to permanency is but one potential solution to a complex set of problems affecting Indian children, families, and tribes today. Almost every tribe has customs associated with adoption, so it is not a foreign concept. In fact, in surveying tribes, NICWA has found none that did not have current or historical customary processes for adoption. Also, no tribes were found to have expressed customs equivalent to termination of parental rights. Although it is safe to assume that such things probably did happen, NICWA could not find ceremonies, rituals, or common practices that ended relationships between parents and children. In fact, many tribes actively abhor the idea and will not subject their children to this unthinkable act. Other means are seen as appropriate for achieving permanency. It is true that there are many differences among tribes, both in their superficial circumstances and in the deepest foundations of their cultures and histories. There are also many similarities. In this context—the care of children and youth—it is possible to identify areas where cultural values play a particularly important role. Discussion of the exact meaning of the role of those values in policy should be left to each tribe. One of the similarities that impacts the current discussion is that in Indian tribal systems a child is born into a particular family and, from the moment of birth, that child’s place in the world is defined by her relationships with her mother’s and father’s families. In a fundamental sense, a child’s very definition as a human being is in the context of the family in which he is born. Although historically a child might have been given to a member of the parent’s family or clan for a variety of reasons, permission from an official agency or department was not envisioned or necessary. However, there are at least three concerns that may now compel a tribe to consider the need for official approval

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of customary adoption. First, federal law and policies are weighted heavily toward the termination of parental rights and require the implementation of permanency plans when children cannot return to birth families in a reasonable time frame. Second, important financial and programmatic resources, such as adoption assistance, are available only when a child is legally regarded as adopted. Third, legally recognized consents are necessary for education and medical treatment. In addition, it is important to acknowledge that not all customary placements are voluntary. When they see the child at risk, family members may have to intervene and take a child into their control, pursuant to the customary responsibility afforded the family. Legal processes may be necessary to forestall fighting and family “tugs-of-war” when families cannot resolve these issues on their own (Cross et al. 2003). Legal Basis for Tribal Adoption Laws Because Indian tribes are governmental entities that predate the United States, they retain sovereign authority over a variety of areas. One of the tribe’s basic sovereign rights is the right to decide the custody of its children. As part of its sovereign right, a tribe has the power and jurisdiction to articulate and formally certify through law its own customary practices concerning child custody and to create law based on its historical, customary, and current unique cultural interpretations of civil relationships. This power includes the authority to enact formal adoption procedures and to conduct adoption of children pursuant to custom, or traditional law, as part of tribal law, and formally certify, through its legal process, adoptions made pursuant to tribal custom. In the exercise of their sovereignty, each tribal government must address the following questions: How do we handle these unique and complex relationships between children and youth, birth parents, extended family, and adoptive parents? In the context of federal

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policy, which pressures us to change what we are, how do we form policy that protects children, preserves culture, and meets the needs of a diverse population? What if tradition says that it is the extended family whose “parental rights” cannot be culturally terminated? Only the extended family, not the tribe or governments, can limit or terminate the “rights” or responsibilities of the birth parents. Should tribal governments intervene, and, if so, when? Answering these and other complex questions and implementing those answers in the form of code, policy, and programs is the essence of sovereignty. Tribes can set policy and regulations that define adoption in all its forms, its meaning in the tribal society, and the legal consequences of its conduct. In many tribes, customary adoption is the process of creating relatives and joining individuals into family relationships. It represents expanding family resources for a child without terminating existing relationships. By most customs, adoption modifies the custodial and legal relationship of the birth parents with the child, but does not terminate a birth parent’s emotional relationship with the child, the child’s relationships with the birth parent or extended family of birth, or the extended family’s relationship with the child. By some customs, the rights of the birth parents are subordinate to the rights and responsibilities of the extended family and adoptive parents, and the best interests of the child guide the division of rights and responsibilities toward the child. Historically, tribes had to deal with parental behavior that was so severe that relatives intervened to remove children, in some cases permanently. Thus termination of parental rights may be culturally based in some tribal communities. Despite having the authority to enact customary practices into code, few tribes would choose to write the particulars of a ceremony, ritual, or traditional practice into code, thereby freezing it in time and making it public. It is, however, possible for a tribe to treat customary

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laws or practices in two ways for the purpose of writing laws. It can formally sanction a practice and affirm that the outcome of the practice has the force of law; it could also use the underlying legal theories and premises of the customary practices to frame, codify, and support modern interpretations of historic practices. By choosing to certify a customary adoption as having the force of law, a tribe does not codify the practice. It does not describe it, freeze it in time, or even dictate what it is. It simply sets up a process whereby a specified individual, usually the adoptive parent, can petition the court to certify that the customary adoption occurred and that it meets the criteria set broadly by the code. In addition, the code can set out safeguards to ensure the safety and well-being of the child or adolescent. A customary adoption is a practice, ceremony, or process conducted in a manner that is long-established, continued, reasonable, and certain and considered by the people of a tribe to be binding or found by the court to be authentic as a usage or practice common to many tribal members. One major legislative change in sanctioning customary adoption occurred on October 11, 2009, when Governor Arnold Schwarzenegger of California signed into law Assembly Bill 1325 In an effort to meet the permanency needs of dependent Indian children in a way consistent with tribal culture, this law allows “tribal customary adoption” for American Indian children in foster care. The law went into effect on July 1, 2010. This statute adds to state law “tribal customary adoption” as a permanency option for a child who is a dependent of the juvenile court and eligible under ICWA. It further defines tribal customary adoption as an adoption, which occurs under the customs, laws, or traditions of child’s tribe. Termination of parental rights is not required to effect the tribal

customary adoption. While tribal customary adoption is unique, it is intended to be a seamless integration into the current process of conventional adoption. Aligned with the state’s existing concurrent planning policies, when applicable, it allows, at the tribe’s option, for tribal customary adoption to be included as an alternative permanent plan to family reunification throughout the dependency case. This new law, which many hope is the first of many to be enacted on the state level, is a major change in policy and practice.1 The Fostering Connections Law (P.L. 110-351) provides provisions that encourage good faith state-tribal relationships. The spirit of the law provides hope for increased cooperation between states and tribes where there had historically been tensions.2 Tribal adoption law based in culture must consider that children cannot protect themselves and depend on adults to protect them, their rights, and their resources. Neither can children ensure that they have a family to grow up in and call their own. Tribes are developing and implementing customary adoption laws designed to ensure permanency as well as solve complex cross-jurisdictional and cross-cultural challenges. At the same time, these tribes are striving to protect the child’s safety; preserve the child’s sense of belonging; protect and preserve the child’s identity, rights, and obligations as a member of a tribe, clan, and extended family; protect the child’s assets, resources, and potential opportunities; and assist courts to make determinations in the best interests of the child when the parties cannot agree about placement decisions or when the court determines that the agreement is not in the child’s best interest. These are not small challenges, but, as is often the case, tribes are turning to their culture for answers to complex problems and finding that the wisdom of established traditions is providing the guidance needed for today’s world.

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NOTE

1. See http://theacademy.sdsu.edu/TribalSTAR/ resources/customaryadopt.htm (retrieved October 8, 2011). 2. www.nrcpfc.org/fostering connections (retrieved October 9, 2011). REFERENCES

Atwood, B. (2008). Achieving permanency for American Indian and Alaska Native Children: Lessons from tribal traditions. Capitol University Law Review, 37, 220–33. Barth, R., Webster, D., & Lee, S. (2002). Adoption of American Indian children: Implications for implementing the Indian Child Welfare and Adoption and Safe Family Acts. Children and Youth Services Review, 24, 139–58. Byler, W. (1977). The destruction of American Indian families. In S. Unger (ed.), The destruction of American Indian families (pp. 1–11). New York: Association on American Indian Affairs. Canby, W. (1998). American Indian law in a nutshell. St. Paul, MN: West. Child Welfare League of America (2000). Child abuse and neglect: A look at the states. Washington DC: Child Welfare League of America. Cross, T. (2002). Customary adoption; Making family. Portland, OR: National Indian Child Welfare Association. Cross, T., Mc Nevins, M., Grossman, T., Deloria, P., & Dorsay, C. (2003). Developing culturally based tribal adoption laws and customary adoption codes: A technical assistance manual and model code. Portland, OR: National Indian Child Welfare Association. Cross, T., Bartgis, J., & Fox, K. (2010). Rethinking the systems of care definition: An indigenous perspective. Evaluation and Program Planning, 33, 28–31. Curtis, C., & Alexander, R. (1996). The Multi-ethnic Placement Act: Implications for social work practice. Child and Adolescent Social Work Journal, 13, 401–10. Dorris, M. (1989). The broken cord. New York: Harper & Row. Duran, E., & Duran, B. (1995). Indian postcolonial psychology. Albany: State University of New York Press. George, L. (1997). What the need for the Indian Child Welfare Act? Journal of Multi-Cultural Social Work, 5, 165–75. Goodluck, C., & Eckstein, F. (1978). American Indian adoption program: An ethnic approach to child welfare. White Cloud Journal, 1, 3–6. Goodluck, C., & Short, D. (1980). Working with American Indian parents: A cultural approach. Social Casework, 61, 472–75.

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Kunesh, P. (2008). Borders beyond borders—Protecting essential tribal relations off reservation under the Indian Child Welfare Act. New England Law Review, 42, 2007–18. Locust, C. (1998). Split feathers: Adult American Indians who were placed in non-Indian families as children. Pathways, 13, 4–5. MacEachron, A., Gustavsson, N, Cross, S., & Lewis, A. (1996). The effectiveness of the Indian Child Welfare Act. Social Services Review, 70, 451–63. Madrigal, L. (2001) Indian Child Welfare Act: Partnership for preservation. American Behavioral Scientist, 44, 1505–11. Morrison, C. (2006). Bringing the spirit of truth and reconciliation to tribal communities’ adoption work. Pathways Practice Digest (Summer), 4, 1–2. Morrison, C., Fox, K., Cross, T., & Paul, R. (2010). Permanency Through Wabanaki eyes: A narrative perspective from “The People Who Live Where the Sun Rises.” Child Welfare, 89, 223–48. Pevar, S. (2002). The rights of Indians and tribes: The authoritative guide to Indian and Tribal rights, third ed. Carbondale and Edwardsville: Southern Illinois University Press. P.L. 95-608, Indian Child Welfare Act (1978). P.L. 103-382, Multiethnic Placement Act (1993). P.L. 105-89, Adoption and Safe Families Act. (1997). P.L. 110-351, Fostering Connections Act (2008). Plantz, M., Hubbell, R., Barrett, G., & Dobrec, A. (1998). Indian child welfare: A status report of the survey of Indian child welfare and implementation of the Indian Child Welfare Act and section 428 of the Adoption Assistance and child Welfare Act of 1980. Washington DC: U.S. Department of Health and Human Services and U.S. Department of the Interior, Bureau of Indian Affairs. Red Horse, J. (1997). Traditional American Indian family systems. Families, Systems, and Health, 15, 243–50. Robin, R., Rasmussen, J., & Gonzalez-Santin, E. (1999). Impact of out-of-home placement on a Southwestern American Indian tribe. Journal of Human Behavior in the Social Environment, 2, 69–89. Seaver, J. (1991). The Life of Mary Jemison, Deh-he-wamis. Baltimore, MD: Gateway. Simmons, D., & Trope, J. (1999). P.L. 105-89 Adoption and Safe Families Act of 1997: Issues for tribes and states serving Indian children. Portland: National Resource Center for Organizational Improvement, Edmund S. Muskie School of Public Service, University of Southern Maine. Swinomish Tribal Mental Health Project. (1991). A gathering of wisdoms, tribal mental health: A cultural perspective. LaConner, WA: Swinomish Community.

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Kinship Care Preservation of the Extended Family inship foster care is the placement of children who are in state custody in the homes of their relatives (by birth, marriage, or adoption) or in the homes of other close family associates, such as godparents or fictive kin. Both in the United States and internationally, use of kinship foster homes for child placement has attracted considerable professional interest, particularly since about 1980 (Child Welfare League of America 2000; Greeff 1999; Hegar & Scannapieco 1999; Ryburn 1998). In the United States the relatively high proportion of foster children who are placed with their kin by the state is part of a larger American demographic tableau: children living in the homes of relatives without state intervention. That pattern is referred to in this chapter as kinship caregiving. We address both kinship caregiving and kinship foster care in this chapter, although the primary emphasis is on kinship foster care. In this chapter we first introduce the scope of kinship caregiving and kinship foster care by summarizing demographic trends and patterns. We also provide a brief historical overview and consider how governmental policy has shaped the evolution of kinship foster care. We review the research literature with regard to several topics: outcomes for children, youth, and families involved in kinship foster care; tools for those working in kinship care to provide assessment and interventions; and promising approaches and programs using kinship foster care and their evaluation. The chapter

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concludes with case studies, a discussion of value-based and ethical issues, and an assessment of the role of kinship care in preserving extended families. Demographic Patterns Involving Kinship Caregiving and Kinship Foster Care Kinship Caregiving The phenomenon of children living in households without either of their parents being present may have been more common earlier in our history, when premature adult death was much more frequent and successful single parenthood was less feasible because of the unavailability of day care and financial aid. However, by the middle of the twentieth century that family pattern was very rare in the general U.S. population. Census data show that in 1960 and 1970 less than 2 percent of American children lived in households without either parent, and the proportion had risen only to 2.2 percent in the 1980s (Saluter 1989). Beginning in the later 1980s, however, there was a notable increase to 4.3 percent by 1995 (Saluter 1996). The recent 2010 census shows that, overall, 4 percent of U.S. children live in households without either parent present, 3 percent of them with relatives, and most of those (2.2 percent) with one or both grandparents (U.S. Census 2010a). However, there has been a substantial increase in numbers and proportions of children who co-reside with grandparents in homes where their parents also may be present, with 7 million children 382

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now living in homes that include grandparents. Children living with at least one grandparent comprise 9 percent of the population of all children in the United States (U.S. Census Bureau 2010b). Of these children, 4.5 million live in a grandparent’s home. Based on U.S. Census Bureau figures, the number of children living in their grandparents’ homes increased by 8 percent from 2009 to 2010 and had doubled since 1970 (Tavernise 2010). Kinship caregiving in the United States has not been evenly distributed among racial and ethnic groups, and the most recent data confirm the continuation of this reality. For example, census data for both 1960 and 1980 reported more than 11 percent of African American children living in family settings without a parent (Saluter 1989). The proportion began to decline slightly during the 1990s (Saluter 1996), and the most recent data show 7.3 percent of African American children living in family homes without their parents (U.S. Census 2010a). This rate can be compared with 4 percent of Hispanic and 3.1 percent of white children (U.S. Census 2010a). Reasons for the differences may include cultural patterns, differential rates of poverty and single parenthood, and the effects of discrimination that we and others have discussed in detail elsewhere (Barrio & Hughes 2000; Brown, Cohon, & Wheeler 2002; Burton 1992; Hegar 1999a, b; Hegar & Scannapieco 1995; Scannapieco & Jackson 1996). Black and Hispanic children living without parents in the homes of grandparents are highly likely to be poor. The percentages living in households with incomes less than the federal poverty level are 51 percent for African Americans (including those identifying additional racial backgrounds) and 32 percent for Hispanics (U.S. Census Bureau 2010a). Kinship Foster Care What is known about the numbers and characteristics of children in kinship foster care comes primarily from national child welfare statistics (e.g., U.S. Department of Health and

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Human Services, Children’s Bureau 2000, 2003, 2013), a national survey (Ehrle & Geen 2002), and research studies of state or local child welfare programs, which may not be representative of the country as a whole. For example, much of the available research has been done in relatively few states and urban areas, including jurisdictions in California, Illinois, and Maryland. Although the literature has been reviewed more thoroughly elsewhere (Cuddeback 2004; U.S. Department of Health and Human Services, Children’s Bureau 2000), this section provides a brief overview. Studies suggest that the children in kinship foster care are most likely to be grade school aged and that it is common for sibling groups to live together in kinship foster care (Berrick, Barth, & Needell 1994; Dubowitz, Feigelman, & Zuravin 1993; Grogan-Kaylor 2000; Hegar & Rosenthal 2009; Welty, Geiger, & Magruder 1997). Frequently reported reasons for placement include substance abuse (including prenatal drug exposure) and parental neglect (Beeman, Kim, & Bullerdick 2000; Berrick, Barth, & Needell 1994; Dubowitz, Feigelman, & Zuravin 1993; Grogan-Kaylor 2000; Iglehart 1994; Thornton 1991). African American children are greatly overrepresented in the foster care population, and they are also disproportionately likely to be placed in kinship foster care rather than in traditional foster care (Beeman, Kim, & Bullerdick 2000; GroganKaylor 2000). Kinship foster care is typically provided by female relatives, most often children’s maternal grandmothers and aunts (Le Prohn & Pecora 1994; Scannapieco, Hegar, & McAlpine 1997). These relatives tend to be older than traditional foster parents and are more likely to be single, have lower levels of education and income, and have poorer health (Berrick, Barth, & Needell 1994; Dubowitz, Feigelman, & Zuravin 1993; Gebel 1996; Le Prohn & Pecora 1994; Scannapieco, Hegar, & McAlpine 1997).

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Societal Context of Kinship Foster Care History and the Role of Policy Although kinship caregiving is a pattern found in virtually all of the world’s cultures. It has roots in biblical law, ancient literature, and medieval European courts, and in many traditional cultures, particularly those in the Pacific and African regions (Ernst 1999; Hegar 1999b). However, the formal use of kinship foster care is quite a recent phenomenon. Indeed, any foster care involving payment for the child’s board and lodging is only about 100 years old, having been advocated as the child welfare service of the future by Folks in 1902 (Folks 1978 [1902]). In Western society kin have frequently had legal obligations to support one another in times of need. For example, the English Poor Law of 1601 required that grandparents and grandchildren, as well as parents and children, provide support and care for one another when necessary (Jansson 1997). In general the cultural expectation has been that kin will provide for one another without being financially compensated. However, during the latter twentieth century, that assumption also began to change. The relative-payee Aid for Families with Dependent Children grant, which aided a family when a child came from an eligible household and was living in the home of a relative, was explicitly addressed in the Social Security amendments of 1962 (Axinn & Stern 2001). Relatives also qualified as providers of home health aid under Medicaid. Then, in 1977, the Supreme Court ruled in Miller vs. Youakim that relatives who meet foster care licensing standards must be permitted to receive federal foster care funds. For years, many states were slow to add relatives to the foster care rolls, but additional policy on the federal level has helped create momentum for change. The next federal impetus for kinship care came in 1978, with the Indian Child Welfare Act, which established a hierarchy of preferred placements for Native American children.

Placement with extended family is the first preferred option. Then, in 1980, the Adoption Assistance and Child Welfare Act expressed a preference for the least restrictive, most family-like placement option, which may also have supported use of kinship foster care. During the 1990s, legislation added additional impetus to the use of kinship foster care, beginning with the Social Security Act Amendments of 1994. Federal waivers were authorized for a limited number of states to use Title IV-B and IV-E monies in innovative ways, and several states designed programs to support kinship foster parents and offer some subsidized guardianships (U.S. Health and Human Services, Children’s Bureau 2000). In addition, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 expressed a preference that states place children with relatives over nonrelatives, as long as the relatives meet state child protection standards. The Adoption and Safe Families Act of 1997 reiterated the preference for permanent placement with relatives and exempted kinship foster placements from a new requirement that termination of parental rights take place within a set time period. Despite the movement of federal policy to support kinship foster care, the legislation of the 1990s also gave states considerable latitude in implementation, part of the trend called the “new federalism.” This devolution of authority to the states led to extensive variation among states in funding and services for kinship foster care (Geen & Berrick 2002; Gleeson 1996, 1999a; Gleeson & Craig 1994; Hegar & Scannapieco 2000; Leos-Urbel & Geen 2002). Most recently the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351) has made federal funding available to states to encourage kinship caregivers to take guardianship of children in their care. Through the Title IV-E Guardianship Assistance Program (GAP), states and tribes with a title IV-E agreement may claim funding to support the care of children by relative caregivers

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who assume legal guardianship after a period of providing foster care and when neither reunification with parents nor adoption is possible. Current State of Kinship Foster Care Kinship placements are currently used in three ways that can be viewed in sequence as a child and family encounter the child welfare system (Scannapieco 1999a). First, a child or youth may be placed with relatives as a way to divert the family from the juvenile court and formal child placement. This is probably the most traditional approach. It is used extensively in many jurisdictions, including some that do not report many children in formal kinship foster care. Services may be provided to the kinship caregivers on a voluntary basis for a period of time, and they may be eligible for a childonly Temporary Assistance for Needy Families (TANF) grant or, in a few locations, for special state funding for kinship caregivers. At least thirty-nine states have reported diverting children from foster care by facilitating kinship placements for children (Leos-Urbel & Geen 2002), and the number of children affected may approach two hundred thousand (Ehrle & Geen 2002). These children and their relatives become informal kinship caregiving situations, as discussed earlier. Second, a child or youth may be formally adjudicated and placed in foster care with a kinship home that meets either all state foster care standards or standards adapted specifically for kinship foster homes. In this case the child and family receive child welfare services and either the full or a reduced state board payment, depending on state policy (Hegar & Scannapieco 2000). The evidence suggests that about one-quarter of children in state custody are placed in kinship foster homes (U.S. Department of Health and Human Services, Children’s Bureau 2003, 2013). According to the Adoption and Foster Care Analysis and Reporting System (AFCARS), the preliminary estimate for the number of

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children living in a relative foster family home as of September 30, 2012, was 109,619, 28 percent of children in foster care (U.S. Department of Health and Human Services 2013). That proportion has remained fairly stable since the beginning of the 1990s (Beeman, Kim, & Bullerdick 2000; Geen & Berrick 2002). However, the proportion of foster children in kinship homes is significantly higher in some states and many urban areas. For example, researchers report 43 percent of foster children in California and 47 percent of those in Illinois in such arrangements (Beeman, Kim, & Bullerdick 2000; Needell et al. 2001; Testa 1997). The third way in which kinship foster care is used in child placement is as a planned permanent home for a foster child. This placement can occur when a kinship foster home that has had the child in placement for some time agrees to accept guardianship or to pursue adoption. It may allow the state to cease providing financial support and services, although in many cases transitional services would be provided. Several states are experimenting with subsidized guardianship that is similar to subsidized adoption. When either subsidized adoption or guardianship is possible, the state usually continues to provide medical coverage and may include a monthly subsidy. Permanent kinship placement also can occur when a relative home is located for a child who has been in traditional foster care. Relatives then sometimes assume custody or guardianship through the courts without first having been foster parents. Federal reports reflect that either going to live with a relative or being placed in guardianship (almost always with a relative) was the case goal in 2012 for 15 percent of the 399,546 children in foster care (U.S. Department of Health and Human Services, Children’s Bureau 2013). Furthermore, of the 52,039 children estimated to have been adopted from public child welfare agencies in fiscal 2012, 30 percent were adopted by relatives. If this proportion holds in the

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future, almost one-third of the children for whom the long-term plan is adoption (30 percent) also may be placed permanently with relatives. These FFY 2012 figures suggest that approximately 45  percent of foster children may ultimately leave state custody for placement in the homes of relatives through adoption, guardianship, or less formal kinship caregiving. In some states, the proportion is certainly much higher. Outcomes, Risks, and Benefits Related to Kinship Foster Care Outcome research on kinship foster care is inconclusive, making it difficult to know its strengths and challenges and how they affect families and children. However, there is a growing body of literature that provides some evidence of the risks and benefits related to kinship foster care. This section explores differences between children in kinship foster care and those in the general population, as well as those in nonkinship care. Variables that have been examined in the research literature are the duration and stability of placements, permanency-planning goals, child well-being, educational and health variables, and the kin caregivers’ intentions concerning continued care. Kinship foster care placements last longer than traditional foster home placements and reunification rates are lower (Berrick, Barth, & Needell 1994; Courtney & Needell 1997; Hurley 2008; Krinsky 2005; Testa 1997; Wulczyn & Goerge 1992; Wulczyn, Kogan, & Harden 2003). These conditions prevailed even before the enactment of Adoption and Safe Families Act of 1997, previously discussed, the provisions of which can be expected to amplify this difference. Placements with relatives have been widely reported to be relatively stable (Berrick, Barth, & Needell 1994; Courtney & Needell 1997; Dubowitz et al. 1994; Iglehart 1994; Leslie et al. 2000; Perry, Daly, & Kotler 2012; Scannapieco, Hegar, & McAlpine 1997; Testa & Rolock 1999; Usher, Randolph, & Gogan 1999). Compared with traditional

foster care, children in kinship homes have been found to be less likely to reenter care after they have gone home or been adopted (Hurley 2008; Koh & Testa 2011), and researchers report other comparatively better outcomes for kinship placements (Hegar & Rosenthal 2009; Rubin et al. 2008; Winokur et al. 2008). However, the evidence is not entirely consistent (Cuddeback 2004). In follow-up studies of foster care that examine the differences between kinship and nonkinship placements, Benedict, Zuravin, and Stallings (1996) and Glisson, Bailey, and Post (2000) found no difference in length of stay in care, whereas Wells and Guo (1999) report no difference in reunification rates following kinship and nonkinship placements. Testa (2002) found that reunification and stability in care were related to the kinship caregivers’ perceptions of the parents’ cooperativeness. Children whose parents were perceived by the caregivers as not participating in the case plan and not cooperating with visiting were less likely to be reunified and more likely to experience replacement in another home. Another factor that may influence both reunification and stability in care is financial reimbursement received by the kinship caregiver (Testa 2002). It is possible that receipt of welfare payments for relative children in care may reduce reunification rates (Courtney & Needell 1997). This possibility is supported by Testa (2002), who reports that, as payment decreases to kinship caregivers, replacement of children increases, as does reunification. Many kinship foster parents express commitment to the children in their care and indicate their willingness to care for them as long as needed (Berrick, Barth, & Needell 1994; Dubowitz et al. 1994; Gebel 1996; Gordon et al. 2003; Thornton 1991). In many studies such relatives have expressed reluctance or unwillingness to adopt children who are already related to them (Berrick, Barth, & Needell 1994; Gleeson 1999b; Gordon et al. 2003; Thornton 1991) and they have historically been unlikely to assume legal

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guardianship of the children (Iglehart 1994). However, as already noted, 30 percent of public agency adoptions are by relatives (U.S. Department of Health and Human Services, Children’s Bureau 2013). Therefore, the assumption that relatives do not adopt may be changing. Even a number of years ago, Gebel (1996) found no difference between relatives and nonrelatives, either in the length of time they were willing to care for children or in their willingness to consider adopting children placed with them. Emerging research comparing traditional adoption with kinship adoption shows some mixed outcomes but reveals positive findings related to permanence and satisfaction with the adoption (Ryan, Hinterlong, Hegar, & Johnson 2010). The Title IV-E GAP offers an alternative permanency option that aligns more closely with the family and cultural values of many of the children in long-term foster care. (See chapter by Testa & Miller in this Volume.) Although evidence is preliminary, there is compelling support for the practice of guardianship assistance as a permanency option (U.S. Department of Health and Human Services 2008). Findings indicate the availability of guardianship assistance decreases time spent in foster care, increases the overall permanency rates, has no effect on reunification rates, is as safe as other permanency options, is equally as stable as adoption, and engenders an equally strong sense of belonging to a family (Testa 2005, 2008). Studies vary widely concerning permanency planning goals for children in kinship care. However, Scannapieco, Hegar, and McAlpine (1997) found that children in kinship and traditional foster care do not differ with respect to agency permanency planning goals. The benefits and risks to children in kinship foster care can be gauged by comparing their well-being with that of the general child population and with children who are in nonrelative foster care. Reports about the physical health status of children appear to vary with the source of assessment. Based on medical evaluations,

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Dubowitz and colleagues (1992) found that only 10 percent of the children in kinship care are free of any medical problems, and Eleoff and colleagues (2010) concluded that children in kinship care are more likely to have special health care needs. However, Grogan-Kaylor (2000) reported that children with health problems are significantly less likely to be placed in kinship foster care. Findings are mixed on behavioral and mental health problems experienced by children in kinship care. Hurley (2008) found children in kinship homes have fewer behavioral problems than children in traditional foster homes. Eleoff and colleagues (2010) found children and youth in kinship care to have higher rates of mental health problems (anxiety, depression, attention-deficit or conduct disorder). Behavior in school is judged to be satisfactory for children in kinship care in approximately 60 percent of the cases (Berrick, Barth, & Needell 1994; Dubowitz et al. 1994; Iglehart 1994). However, with regard to scholastic performance, 36 percent (Iglehart 1994) to 50 percent (Dubowitz et al. 1994) of the kinship care children are performing below grade level compared to the general population, but they are less likely to repeat a grade than the rest of the foster care population (Benedict, Zuravin, & Stallings 1996; Brooks & Barth 1998). Hegar & Rosenthal (2009) report no significant differences in school performance, except in the case of some interactions with other variables. When children in kinship foster care are compared with others using standardized instruments for assessing childhood behavior, the results are mixed. Berrick, Barth, and Needell (1994) found that children of all ages in kinship foster care score at least one standard deviation above the norm on the Behavior Problem index, and Dubowitz and colleagues (1994) found that 35 percent of the children have an overall Child Behavior Checklist score in the clinical range. However, it is noteworthy that Berrick, Barth, and Needell (1994) report

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that kinship foster children between the ages of four and fifteen have fewer behavioral problems than do children in the same age group in traditional foster care. In the same vein, Iglehart (1994) reports that, although 33 percent of children in kinship care have behavioral problems serious enough to be noted in the case record, children in traditional foster care are even more likely to have adjustment problems. Benedict, Zuravin, and Stallings (1996) also report that children in relative care are less likely to have developmental or behavioral problems than are children in nonrelative care. Gebel (1996) found that kinship foster parents rated more children as good-natured and fewer children as being difficult to handle than did unrelated foster parents. Shore and colleagues (2002) have reported that teachers’ perceptions of the behavior of youth in kinship and nonkinship foster care did not differ significantly. Neither group differed from the general population on most scales of the Teacher’s Report form. Finally, Hegar and Rosenthal (2009) note fewer behavioral problems for children in kinship care, as assessed by caregivers on the Child Behavior Checklist. As mentioned above, very little research has compared the adult functioning of individuals who had been placed as children in relative versus nonrelative care. In one such study (Zuravin, Benedict, & Stallings 1999), no difference was found in education, employment, income, or housing variables. Social support and experiences with life stressors were reported at similar levels for both groups. Differences were found, however, in the area of physical health: young people from nonrelative care reported higher levels of hypertension than did young people from kinship care. And, although the rates of cocaine and marijuana use were similar between the groups, a greater number of young people who had been placed with kin reported using heroin at sometime in their lives. Additionally, a significantly higher number of youth from kinship care reported trading sex for drugs (Zuravin, Benedict, & Stallings 1999).

Assessments and Interventions As discussed earlier, kinship foster placements typically are quite stable. Some models of kinship foster care have required less rigorous training and offered less supervision of kinship homes than is true of traditional homes (Scannapieco & Hegar 1995). We previously have suggested that the stability and length of kinship placements, as well as the diminished supervision often offered to them, call for two kinds of screening (initial approval of the home and a permanency evaluation) before placement of children in kinship foster homes, except when the placement is made on a strictly emergency, time-limited basis (Scannapieco & Hegar 1996). This proposal directs attention to two sets of factors: those associated with the first use of any home for child placement (including parenting and family aspects, matters of safety and protection of the children, and physical environment) and those associated with selecting a permanent placement for particular children (including an assessment of what the home offers along the three dimensions of attachment, permanence, and kinship; Hegar 1993). Across all of these factors, kinship placements raise issues that are substantially different from those encountered in traditional foster care, suggesting that each criterion for assessment must be adapted for use with kinship homes. Shlonsky and Berrick (2001) have proposed a comprehensive framework for assessing and understanding the care children receive in kinship and nonkinship homes. They conceptualize the domains of quality of care as seven factors: child safety, educational support, mental health and behavioral support, developmental factors, furtherance of positive reciprocal attachment, characteristics of quality caregivers, and quality of life. These authors caution that, despite the legal and philosophical mandate for kinship care placement, assessment of the quality of care is essential in improving outcomes for children. Jackson (1996, 1999) also discusses how the assessment process is unique when children are

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placed with relatives. She advocates a shift from assessing the dyad (parent and child) to assessing the triad of the child or children, parent, and extended family (Jackson 1996) and to providing services to the triad (Jackson 1999). Individualized assessment must focus on understanding the extended family system and the strengths and challenges the triad brings to the kinship foster placement (Jackson 1996; Shlonsky & Berrick 2001). According to Jackson (1996), the bases of an assessment framework for kinship foster care placements are an intergenerational perspective of the triad members; a multidimensional assessment of interpersonal, family, and environmental systems; and acknowledgment of cultural realities in extended families. Research strongly suggests that workers’ thoughts, feelings, and beliefs about kinship foster care may influence their placement decisions, including their screening and assessments (Peters 2005). Peters recommends training and policy changes that would address worker concerns about the demands on time and risk of decreased ability to protect children that heighten their ambivalence about kinship placements. Another thoughtful approach to the assessment of kinship foster homes has been developed by Chipman, Wells, and Johnson (2002). Based on a qualitative study of caregivers, children, and agency staff, they point to differences between kinship and nonkinship placements, review existing guidelines for evaluating kinship homes, and suggest additional factors to consider in the process of studying and approving kinship placements. Kinship home assessments clearly need to be approached differently than traditional foster home studies. The different strengths that families bring to kinship care need to be considered, and issues of permanency must be viewed from the perspective of the kinship network. Kinship Foster Care Programs, Promising Approaches, and Their Evaluation It is well documented that kinship caregivers and foster homes receive fewer resources, services, and training than do nonkinship

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foster homes (Brooks & Barth 1998; Burnette 1999; Ehrle & Geen 2002; Eleoff et al. 2010; Gebel 1996; Harden et al. 2004; Hurley 2008; Iglehart 1994; U.S. General Accounting Office 1999), yet they are in greater need of services and resources than are traditional foster parents (Berrick, Needell, & Barth 1999; Ehrle & Geen 2002). Kinship caregivers are often unprepared to take on the responsibility of caring for one or more children, and they may experience substantial adjustment difficulties in their lives (Gordon et al. 2003; Minkler & Roe 1993; Osby 1999). It would benefit the child welfare system to ensure that kinship care families receive the needed services and supports that promote the safety, permanency, and well-being of the children in its care. Elsewhere we have discussed the array of support and intervention needs of kinship caregivers and foster parents (Scannapieco & Hegar 2002). In this chapter we highlight some innovations and culturally sensitive approaches and programs designed to meet the needs of kinship caregivers or foster parents and the children in their homes. Mediation Through Family Group Conferencing One of the most quickly proliferating practice concepts is family group decision making to mediate best placement decisions for children. Involving extended family members in the mediation planning process brings detailed knowledge and information about the kinship network and its strengths and challenges; it also empowers the family in the decisionmaking process (American Humane Association 1996; Berrick, Needell, & Barth 1995; Ryburn 1998; Wilcox et al. 1991). The key elements to family group conferencing are the following: t
family meetings are called if a child welfare agency performs an initial assessment and determines a child is in need of care and protection;

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t
family members who currently or potentially play a role in the child’s life attend the meeting, including the child’s parents, extended family members, close friends, godparents, and others whom the family defines as kin; t
family members are prepared for the conference to clarify the process, tasks, and roles; t
child welfare staff, teachers, psychologists, and other professionals who are working with the family also typically attend the meeting; t
parents may limit participation by other family members; t
the meeting setting is amiable and in a neutral location, so that all participants feel comfortable about expressing their thoughts and feelings; t
the major underlying principle of family decision making is the involvement of the extended family in brainstorming about options for the care and protection of the children; t
children are given an opportunity to give input about where and with whom they would prefer to live; and t
child welfare workers or designated professionals not involved in the case (professional mediators) mediate the decision-making process by helping the family develop a plan for the child or children. Family meetings, no matter the configuration, generally produce a plan that is acceptable to professionals and includes placement within the kinship network (Ryburn 1998). Additionally, they have been found to reduce out-ofhome placement and increase placement of children in their same ethnic, racial, and/or religious group (American Humane Association 1996). In that way, family group conferencing is culturally sensitive and is proving to be quite effective in addressing the goals of safety, permanency, and child well-being.

Subsidized Guardianship Other innovations in kinship foster care concern financial benefits available to relatives. The child welfare system provides services to kinship families through one of two federally funded programs: TANF and the foster care program through Title IV-E funds. State kinship foster care programs can be viewed within a framework defined primarily by their funding source and, secondarily, by the continuum of services: diversion, foster care, or permanent placement. The decision-making process that takes place within this framework ideally is based on an assessment of the families’ and children’s needs, permanency planning issues, risk and safety issues, and family preservation. Not all kinship care situations need to be part of the formal foster care system on a long-term basis; the inception of guardianship subsidies in 1996 created an alternative option for permanent placement. Prior to 1996, permanency options for children in kinship care were long-term kinship care (with TANF grants or foster care payment), private guardianship (with no payment), or adoption (with or without subsidy). Adoption was the only federally subsidized option for achieving permanency for children who were abused or neglected and unable to return home to their families. With the dramatic increase in kinship foster care placements since the early 1990s (U.S. Department of Health and Human Services, Children’s Bureau 2000), and in recognition of the limitations of adoption for kinship placements, subsidized guardianship was proposed as an additional option. Beginning in 1996, the Department of Health and Human Services funded seven demonstration projects in the states of Delaware, Illinois, Maryland, Montana, New Mexico, North Carolina, and Oregon (Administration for Children and Families 2003). All seven states designed their guardianship programs for children whose needs for permanent placement could not met by reunification or adoption. In addition to the guardianship programs allowed

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by federal waiver, a majority of states implemented subsidized guardianship using funds from other sources (U.S. Department of Health and Human Services 2001). Beginning in the 1990s, the state-level experimentation with guardianship programs led to incorporation of the Title IV-E GAP into the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351), which we already have discussed. Guardianship subsidies present an alternative means of changing a temporary care situation into a permanent one. The most important advantage is the underlying assumption that such subsidies provide children with permanent and stable homes that will promote positive developmental outcomes. As a permanency option, guardianship subsidies have several additional advantages: t
The rights of biological parents need not be terminated. t
Children are removed from the continuing jurisdiction of the court system. t
Kinship caregivers retain their identities (e.g., as grandparents, aunts, uncles). t
Child welfare agencies can end their case management responsibilities. t
Kinship providers are assured some level of financial support. t
Child welfare agencies and courts save costs. In an important study of the effects of guardianship subsidies, Testa and Shook Slack (2002) have reported that the programs have merit as options to adoption. Illinois, the largest state to receive funding for one of the demonstration projects, provides good evidence of the potential benefits. Children placed in families that were given the option of receiving guardianship subsidies were significantly more likely to achieve permanency than those children in families that were not given the option (Testa & Shook Slack 2002). Additionally, withdrawal of administrative oversight and case management

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from the families did not result in higher rates of child abuse and neglect (Administration for Children and Families 2003) Value Conflicts and Ethical Dilemmas Value Conflicts The Oxford English Dictionary includes no definition of value or values that approximates the way the word is used in contemporary U.S. political debate. In our own sense of the meaning, values express preferred norms based on individual or cultural beliefs rather than on proof or evidence. As might be expected, value issues and conflicts permeate issues surrounding placement of children in state custody. Among them are: How serious should maltreatment, or the risk of it, be before children should be removed from parents? How long should parents have to improve family conditions before losing permanent custody of children? Should relatives be the placement of choice for foster children? These are not questions to which there are verifiable answers, only ranges of perspectives. This section focuses on three value considerations that underpin kinship care policy: the importance of family ties or kinship; the nature of duty to kin; and the role of race, ethnicity, and/or religion in child placement. Each of these complex issues can be considered here only very briefly. Importance of Family Ties At the core of any debate over the use of kinship foster care is the importance of family and blood kinship. American culture, like most others, assumes that children and parents belong together; a weaker version of this assumption extends to relatives with more distant degrees of kinship. However, we are not as “clan-minded” as some cultures, and it is possible that in many circumstances the societal value we place on individualism tempers our commitment to family ties. Yet it is the intrinsic value of family ties that lawmakers embraced when they legislated preferences for kinship placements

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in the Indian Child Welfare Act, the Adoption and Safe Families Act, and the Fostering Connections to Success and Increasing Adoptions Act. Such legislative preferences are rooted in the “rights paradigm” that bases social policy on legal claims (Rappaport 1981). Some observers who prefer residual, nongovernmental solutions no doubt are also motivated by the hope that the state can be less involved with, and perhaps less financially committed to, kinship placements. Nature of Duty to Kin For many decades, relatives who care for the children of kin received none of the assistance that society began to make available to nonkin foster parents about one hundred years ago (Hegar & Scannapieco 1995). A great many kinship caregivers still receive no such assistance. Why do they continue to engage in kinship foster care? Testa and Shook Slack (2002) have contributed to the literature a thoughtful and scholarly paper that examines kinship foster care as a “gift relationship,” in the sense that Titmuss (1997) first used the term in 1971 to denote acts  of selflessness. They apply the latter’s concepts of altruism and reciprocity and incorporate aspects of game and exchange theory to construct hypotheses about what kinship foster parents will do about continuing to provide care in different situations. They also test their hypotheses in a study of a large population of children (983 individuals) in kinship care in Cook County, Illinois. Partway through the study, a change in the state’s approach to funding allowed the authors to include the impact of funding levels on participation in kinship foster care. Although funding did have a significant effect on continuing to provide kinship fostering (76.7 percent of those with full funding continued; 58.7 percent of those with reduced funding did so), Testa and Shook Slack (2002:101) conclude that the continued participation of the majority in both groups “suggests that kinship altruism and family duty still play

a major role in upholding the willingness of extended families to take responsibility for their dependent kin.” Role of Race, Ethnicity, and Religion Although the overrepresentation of black children in kinship care has made race an important research variable, the additional dimensions of ethnicity and religion are also relevant in a discussion of value conflicts. It is clear from all available research that both kinship caregiving and kinship foster care are much more prevalent in African American communities and somewhat more prevalent in Hispanic communities than they are in the U.S. population as a whole. Reasons given in the literature are mostly speculative, but they include cultural acceptability of kinship caregiving, historical exclusion from traditional child welfare services, continued belief in family duty and group self-help, economic and employment pressures on parents, and the destructive impact of the drug culture and related criminality on the parental generation (Barrio & Hughes 2000; Brown, Cohon, & Wheeler 2002; Hegar 1999b; Hegar & Scannapieco 1995; Minkler & Roe 1993; Scannapieco & Jackson 1996). These speculations suggest that kinship placements are made because specific communities of color are more open to them and, perhaps, in greater need of them. However, there is also a policy dimension to the issue of the differential use of kinship foster care, one that illustrates a key value conflict. With the passage of the Multiethnic Placement Act of 1994, the Interethnic Adoption Provisions of 1996, and the Adoption and Safe Families Act of 1997, the child placement system was given two directives: First, not to consider race in foster care and adoption decisions, and, second, to give preference to relatives in making placements. It is not possible even to recap here the decades of debate over transracial placements (see Brooks et al. 1999; McRoy & Hall 1995; McRoy, Oglesby & Grape 1997; Shireman 1994), but it seems reasonable to say that many

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social workers in the child welfare field continue to believe that, whenever such a placement is possible, children are best served by placement within their racial or ethnic communities. There are, of course, other observers who disagree (e.g., Simon & Altstein 1987). Although the Interethnic Adoption Provisions of 1996 declare consideration of race in child placement impermissible, placement of black, Hispanic, or any children in kinship foster care ordinarily allows them to continue life within their specific racial/ethnic/religious communities. Therefore, the use of kinship foster care may allow some child placement staff, members of communities of color, and individual families to pursue values that favor same-race placements in the face of national policy to the contrary. Ethical Dilemmas An ethical dilemma arises when two or more ethical precepts conflict and it is impossible to apply them simultaneously. A classic example is the conflict between client confidentiality and child abuse reporting, which the National Association of Social Workers (1999) code of ethics (NASW Code) and state laws address directly, in favor of reporting. However, neither the NASW Code nor laws help social workers resolve all ethical dilemmas. The NASW Code begins with six overarching ethical principles, three of which are highly relevant to policy and practice involving kinship foster care. One principle is that “social workers recognize the central importance of human relationships” (National Association of Social Workers 1999:113). The NASW Code elaborates that “social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities” (1999:4). The relevance of this ethical mandate for kinship foster care is immediately evident. When appropriately carried out, kinship placements can indeed strengthen relationships among children, extended families,

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and their communities. Their capacity to do so has led many organizations and practitioners to promote the use of kinship foster care (e.g., Child Welfare League of America 1992, 1994; National Black Child Development Institute 1989; National Commission on Family Foster Care 1991). Two other ethical principles from the NASW Code also have relevance for kinship care policy and practice, and these are the key to the dilemmas that may confront conscientious social workers. They are “social workers’ primary goal is to help people in need and to address social problems” and “social workers challenge social injustice” (National Association of Social Workers 1999:5). It should be clear from the discussion in this chapter that diversion of children from the child welfare system into kinship caregiving is likely to leave many of their economic needs unmet, particularly if the families involved are black, Hispanic, or headed by a single grandmother, because the official poverty rates for these three types of kinship caregiving families range from 46 percent to 52 percent (U.S. Census Bureau 2003). Even for children placed in kinship foster care, the studies cited here (as well as official U.S. policy reports such as the one we will quote) conclude that formal (public) kinship foster parents share many unmet needs for services with informal (private) kinship caregivers: Kinship caregivers usually receive little if any advance preparation for assuming their role. Agency-involved and private kinship caregivers are often constrained by limited decision making authority. Public and private kinship caregivers are older and are more likely to be single and African American. Public kinship caregivers are also more likely never to have married, to be the only adult in the household, and to take care of fewer children. Kinship caregivers’ homes are more likely to be in the center of cities, although this appears to be largely because African Americans are concentrated in urban areas. Both

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public and private kinship caregivers are likely to have less education and lower incomes and are more likely to receive public benefits than non-kin foster parents. Public kinship caregivers are less likely to report being in good health and appear to be more likely to experience economic hardship. (U.S. Department of Health and Human Services, Children’s Bureau 2000:39)

Is it ethical for social workers, seeking to recognize and strengthen family relationships, to place children, and to write policies to place children, in conditions rife with human need and social injustice? The differences between traditional foster care and kinship placements, coupled with the racial differences between the children in the two types of placements, have lead us and other observers to suggest that a racially segregated, two-tier system of foster care is emerging in the United States (Brown & Bailey-Etta 1997; Hegar & Scannapieco 1995; Scannapeico & Hegar 1999). Kinship foster care poses ethical dilemmas that are not easily resolved! Case Examples The following are actual case vignettes from our experience in practice and consultation with social work agencies. They highlight some of the issues raised in this chapter, and each has a bearing on the final section concerning kinship foster care as extended family preservation. DECIDING WHETHER TO MAKE A PLACEMENT CHANGE None of the four children of a single mother remain with her, and none has had any involvement with their fathers. The oldest girl, now fourteen, has been raised by her great aunt, a divorced woman of about fifty-eight with several grown children. A boy is in foster care in another state. The two children in agency custody are a girl, five, and her half brother, four, who is HIV-positive and physically frail. These two African American children are placed in a foster home with white parents who specialize in HIV/

AIDS children. The other foster children in the home are all male infants and preschoolers with HIV. The children’s great aunt wishes to offer a permanent home to the five-year-old girl, who is her godchild and who was placed with her (by another agency) for about a year as an infant. The great aunt is employed full time. She has adult children with their own families, one of whom lives nearby and would offer the child a home if the latter could no longer, for any reason, be cared for by her great aunt. This daughter also would provide after-school care. The great aunt does not have a separate room for the boy, nor does she feel able to cope with his medical needs. The five year old has had many visits in her home, whereas her brother has not. The five year old feels close to her great aunt and to her fourteen-yearold sister who has grown up there. Finally, the family attaches cultural and religious significance to the ties between godparent and godchild, which implies that the children’s mother gave the great aunt special responsibility for this particular child. After assessing the children using appropriate doll families and the children’s drawings, interviewing all adults, observing in both homes, and reviewing agency records and collateral contacts, an outside evaluator contracted by the public child welfare agency recommended kinship placement for the five-year-old girl, even though that involved separating the siblings. The major rationale was that the children had different needs for permanence and specialized care. ASSESSING SERVICES NEEDED IN A KINSHIP PLACEMENT Sixty-one-year-old Gloria Stewart has been caring for her two grandchildren, Robert, seven and Marie, four, for the past two years. They live in a small city where Ms. Stewart has a two-bedroom apartment. The juvenile court has granted her custody of Robert, but not Marie. Marie is in the custody of the public child welfare agency. Robert’s father is incarcerated; Marie’s father lives in the city and has a job at a clothing factory. Once a month, he visits her home and gives Ms. Stewart $30 toward Marie’s care. This is his only contact with his daughter, although he has expressed an interest in seeking custody of Marie. When asked what prevents his

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assuming the care of his child, he cites the obstacles of child care, his lack of parenting skills, and his living arrangements. In spite of his failure to address these issues, he has objected to Ms. Stewart having custody of Marie. The children appear to be attached to their grandmother, who loves them dearly. But she is frustrated because she has had to forfeit several of her favorite activities, including singing in the church choir and her Wednesday Bible class. She also is beginning to show signs of impatience with Robert. Robert has had serious behavioral problems for several years. For a short time, he attended therapy at a local mental health center. Ms. Stewart discontinued the visits because the center was inconvenient to visit, and she believes that Robert will outgrow his problems. Meanwhile, Robert continues to become involved in neighborhood fights, steal, and wet the bed nightly. Marie is also experiencing difficulties. As an infant, she was diagnosed with physical problems as a result of her mother’s drug use during pregnancy. She is developmentally delayed in the areas of social and cognitive skills. Lack of custody has prevented Ms. Stewart from adequately addressing Marie’s school and medical needs. Ms. Stewart does not seek health check-up visits for either child, only medical treatment for emergencies and symptomatic problems. Robert is on medical assistance and is assigned to a local HMO; Marie has medical assistance coverage, but is not assigned to any participating medical plan. Ms. Stewart receives TANF payment of $130 a month for Robert and $320 a month in foster care payments for Marie. She does not receive food stamps. Ms. Stewart works at a part-time job for which she earns $500 a month, but she does not receive medical or leave benefits. The child welfare agency provides day care for Marie; however, Robert is ineligible for Title IV-A day care funds, as Ms. Stewart is not a part of his TANF case. Robert might be eligible for Title XX subsidized day care, but, even if he is eligible, there is a long waiting list. At this point, Ms. Stewart is considering allowing the agency to take custody of Robert because the financial allowance for foster care would be much greater. But she is not happy with the requirements of foster care.

]

Ms. Stewart’s situation highlights many common themes in kinship caregiving and kinship foster care. One of these themes is that, although the line between the two roles is somewhat artificial, that artificial line nonetheless determines benefits and services. Another common thread is that the relatives who provide care for children typically require public services themselves, and the additional role of caring for children taxes their emotional and financial resources. Finally, this case, like the previous one, illustrates that children requiring kinship placement frequently have unmet needs for medical, educational, and behavioral intervention. Kinship Foster Care as Extended Family Preservation It should be clear from the discussion thus far that kinship foster care has become a significant feature of the U.S. child welfare system, just as informal kinship caregiving is an important part of the landscape of American families. Both are more prevalent among families of color, particularly in African American communities, than in the general population. The trend toward kinship placements has been fueled by both the growth of foster care and the shortage of traditional foster homes. Since the 1970s, several federal statutes and court decisions also have worked to promote kinship placement of children; for example, the Adoption and Safe Family Act of 1997 shifted the emphasis further toward kinship foster care, particularly for children needing placement for longer periods. Child welfare agencies use kinship placements in three ways: as a means of diverting children from court adjudication and foster care placement, as formal foster homes, and as permanent placements that allow children to grow up within their extended families. Research suggests that many families involved in each of these roles face significant challenges related to low incomes, difficulty accessing services, and lack of agency support. Children in

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kinship care also face academic, emotional, and behavioral challenges, although not necessarily more so than other foster children. Empirical evidence of the outcomes of kinship foster care is still very sparse, but thus far it suggests that children placed with relatives may do as well as other children with similar backgrounds. Much of the impetus to place children in the homes of kin comes not from evidence that it works but from strong convictions that it is the right thing to do. For many advocates, it is a value-based policy choice that has to do with preserving the extended family when the nuclear family is too stressed to function. As we have discussed, placement within extended families often also allows children to continue to live in familiar ethnic, religious, and geographical communities. Kinship care is a practice with deep roots in historical and cultural tradition. As a policy direction, it first places responsibility for children at the family level. It also is a policy that minimizes state involvement in the

forms of supervision, provision of services, and financial support. Although some policy analysts and advocates may accept the ways kinship caregiving and kinship foster care currently operate, as residual services that require less state commitments of staff and funds than traditional foster care, others are more troubled by the value conflicts and ethical dilemmas presented in this chapter. We support the role that kinship placements play in extended family preservation, but are concerned about the impact on kinship caregivers of federal, state, and local cutbacks in transfer payments and social services. Certainly there have also been some encouraging developments, such as federal waivers to allow subsidized guardianship in several states and other innovative programs to support both permanent and shorter-term kinship placements. Kinship foster care can contribute to family preservation, but few of the families involved are in positions to take on responsibility for children without the support of the larger community and society.

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G E R A L D P. M A L L O N

Adoption

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doption is the social, emotional, and legal permanency process in which children and youth who will not be raised by their birth parents become full and permanent legal members of another family while maintaining genetic and psychological connections to their birth family. Adoption has many aspects and affects people in different ways—depending on their role and perspective. In this chapter I first introduce the scope of adoption by summarizing demographic trends and patterns. I also provide a brief historical overview and consider how governmental policy has shaped the evolution of adoption in the United States. I review the research literature with regard to several topics: clinical core issues in adoption, youth, and families involved in adoption; tools for those working in adoption practice to provide assessment and interventions; and promising approaches and programs using adoption and their evaluation. Case studies are integrated throughout the chapter.1

Data on Adoption Adoption is multifaceted and complex. There are several distinct groups of adopted persons. The first group to be explored in this chapter are those children and youth who achieve permanency through adoption from the foster care system. Adoption and Foster Care Analysis and Reporting System (AFCARS) 20 data for Fiscal Year 2012, as of September, 2012, indicates that there are a total of 399,546 children/youth in foster care. In this same time period, 51,229

(21 percent) of children and youth exiting foster care were adopted. As of September 30, 2012, there were 101,719 children and youth waiting to be adopted who had been in continuous foster care an average of 34.4 months. The mean age of waiting children and youth was 6.3 years old, slightly more than half (52 percent) were male and 48 percent were female. Racially the majority of waiting children and youth are of color (26 percent African American, 23 percent Latino, 7 percent two or more races). At the time of discharge, 56 percent of the children and youth were living in family-based foster care, 30 percent were living in relative care placement. As of September 2012, 52,039 children and youth were adopted from the public foster care system. Prior to their adoption, 30 percent of these children were living with relatives, 56 percent were adopted by foster parents, and fourteen percent were adopted by nonrelatives. Myra and her partner Barbara, a couple for ten years, live in Minneapolis. Barbara was previously married and has one grown daughter and two grandchildren. Five years ago, at 2 A.M., Myra and Barbara received an emergency call from the police notifying them that Barbara’s granddaughter, age two, and grandson, age six months, were about to be taken into foster care due to the arrest of their mother who is Barbara’s daughter. Barbara’s daughter had a history of substance abuse, and although she had tried to get sober on several occasions, was now arrested for selling drugs from her apartment. The caller from the Department of Children and Family Services inquired about whether Barbara

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could care for her grandchildren. Without question, Barbara, supported by her partner Myra, immediately said yes and set about getting dressed to pick up her grandchildren. What Barbara and Myra assumed would be a temporary caring situation soon moved into a more permanent parenting role. After many months of intervention and planning with the Department of Children and Family Services, Barbara’s daughter made a decision to voluntarily relinquish her rights as long as her mother and Myra agreed to adopt the children. At eighteen months, the adoption was finalized; the children know their grandmother and Myra as Grammy and Gram and maintain regular connections with their mother as Mommie.

A second group of adopted persons, representing the biggest shift in adoption populations, consists of those who live with one birth parent and are subsequently adopted by the parent’s spouse, who is not otherwise related to the child (a stepparent adoption). In the majority of states stepparent adoptions are the most common (Barth 1992), reflecting the general societal trend of stepfamilies replacing nuclear families as the dominant form of family life in the United States. Usually stepparent adoptions involve stepfathers adopting a stepchild. This type of adoption has been classified as a related adoption and comprises about half of all adoptions in the United States (Stolley 1993). The third group of adopted persons consists of healthy infants, who are predominantly placed for adoption with middle- and upper-middle-class families. About one-third of unrelated domestic adoptions are arranged independently (Stolley 1993), meaning that children are placed directly in adoptive families without agencies acting as intermediaries. In independent adoptions, the primary intermediaries are usually attorneys. Some observers (Barth 1992; Stolley 1993) estimate that infant adoptions account for approximately 15 percent of adoptions. However, infant adoptions may actually comprise less than 5 percent of adoptions in the United States. The exact

percentage is not known, but infant adoptions have decreased since the 1970s. Lynne and Mike, a married couple from Denver, Colorado had tried to have a child for all seven years of their marriage. After multiple tests, several attempts at in vitro, and several miscarriages, they decided to pursue adoption as an option for creating their family. Lynne and Mike had read about the Adoption Exchange in Aurora, Colorado online by visiting their Web site and decided to attend an orientation session. After the orientation they decided to participate in the agency’s MAPP training, a twelve-part series of training specifically designed for those deciding on pursuing adoption. They completed the MAPP training and were surprised about some of the challenges that they were exposed to about children and youth in foster care and some of the lifelong issues of adoption. Although they participated fully in the training and learned a great deal about the child welfare system and adoption, in the back of their minds they thought “this won’t happen to us and our child.” After completing the training they were assigned a social worker and worked toward completing their home study. Both Lynne and Mike felt that some of the home study process was intrusive and deeply personally invasive of their lives, but they were willing to do whatever was necessary to “get their baby.” At the end of almost eighteen months of paperwork, training, and home studies, Lynne and Mike finally get the call that the agency has identified a three-week-old infant boy for them. They are overjoyed and think to themselves, “our journey is finally over.” Little did they know that this was only the beginning.

In 2010 about 11,058 children entered the United States from other countries. Over the past fifteen years, there have been more than 100,000 children adopted from other countries. Since 2005, when foreign adoptions were at their height (22,734), there has been a steady decline in foreign adoptions. The 2000 Census estimates that 13 percent of children that have been adopted came from foreign countries (U.S. Census Bureau 2003). About half the children

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adopted since 1990 came from Asia, about onethird from Russia and other Eastern European countries, and less than 10 percent from Central or South America. The children from Asia were mostly from China or South Korea, those from Eastern Europe were predominantly from Russia, and the children from Central or South America were primarily from Guatemala (U.S. Department of State 2010). More girls than boys are adopted (U.S. Census Bureau 2003). This trend is the result of a number of factors, such as women preferring to adopt girls, single parents adopting mostly girls, and international adoptions comprising mostly girls. Although cultural attitudes traditionally favor male over female children, it is interesting to note that, in the arena of adoption, girls are preferred over boys. One explanation is that women are the driving force in initiating adoption in married couples, and women prefer to raise daughters. The increase of international adoption has also supported the increase of girls. The most recent statistics indicate that nearly 65 percent of children adopted internationally are female (U.S. Department of State 2010). An adjunct to explaining the preponderance of girls is that China, now the leading country in facilitating international adoptions, places mostly female children (more than 90 percent). A final factor in the gender imbalance is that adoption by single women has increased over time, and these women have a preference for female adopted persons. Rachel Jones, a white, Jewish, single, never married forty-five-year old from New York City has always wanted to be a parent. Rachel often thought she would marry and have children, but when that did not happen she decided to explore adoption as a single woman. After exploring foster care and private domestic adoption, Rachel decided that she wanted a child between the ages of three and six years, and preferably a girl. She also decided that international adoption was the best option for her and, since she had read about adoption of girls in China, she decided to adopt from that country. Rachel contacted

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a large, well-known international adoption agency on the West Coast, and, after completing the initial paperwork, she was told that she would have to undergo MAPP training and have a home study completed. Rachel found an agency close to where she lived to attend the MAPP training course, and the same agency was able to complete her home study. After completing her MAPP training and home study, Rachel was told by the international adoption agency that a four-year-old girl was identified for her in China. Rachel traveled alone to China and met Ming, whom she was told was abandoned by her family in a province near Shanghais. After completing the necessary paperwork as per the Hague Convention, Rachel brought Ming back to her New York City apartment to start their lives together. Rachel was full of hope and sure that everything would work out just fine. She still had many questions about adoption, including how to raise a child of a different culture than her own, but she was positive that her love for Ming would conquer all obstacles.

These general patterns describe the multiple facets of adoption in the United States. To some degree, social policies have both affected these patterns and responded to the patterns. It is important for any practitioner in adoption to understand the policy context of adoption. History of Adoption While the practice of adoption has been around for millennia, the recent history of adoption in the United States can be tracked to the 1850s, with the passage of the first “modern” adoption law in Massachusetts that recognized adoption as a social and legal process based on the interest of children rather than those of adults (see http://pages.uoregon.edu/adoption/timeline. html downloaded 10/13/2011). The 1850s also began the era of the orphan trains that relocated children from New York to live with families throughout the United States and Canada. In 1891 Michigan was the first state to require that “the [the judge] shall be satisfied as to the good moral character, and the ability to support and educate such child, and of the suitableness of

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the home, or the person or persons adopting such child.” Eight years later, the New York State Charities Aid Association was organized, one of the first organizations in the United States to establish a specialized child placement program. The early part of the twentieth century saw many changes in adoption practices, policies, and laws. In 1917 Minnesota passed the first law mandating social investigation of all adoptions (including home studies and providing for the confidentiality of adoption records). Between 1919 and 1929 the first empirical field studies of adoption by Sophie Van Theies gathered basic information about how many adoptions were taking place, of whom and by whom. The first specialized adoption agencies were founded during the two decades between 1910–1930, including the Spence Alumni Society, the Free Synagogue Child Adoption Committee, and the Alice Chapin Nursery (all in New York) and the Cradle in Evanston, Illinois. Valentine P. Wasson published The Chosen Baby, a landmark in the literature on telling children about their adopted status, in 1939. Other publications followed this important work. Helen Doss (1954) published The Family Nobody Wanted; Jean Paton (1954) published The Adopted Break Silence, the first book to offer a variety of first-person adoption narratives and promote the notion that adoptees had a distinctive identity. Ten years later, H. David Kirk (1964) published Shared Fate: A Theory of Adoption and Mental Health, the first book to make adoption a serious issue in the sociological literature on family life and mental health. Many, many other important books on adoption have been written, but several deserve special mention: Twenty Things Adopted Kids Wish Their Adoptive Parents Knew by Sherrie Eldridge (1999) is an essential book for adopted persons and adoptive families. The Family of Adoption: Completely Revised and Updated by Joyce Maguire Pavao (2005) is one of the most thoughtful and developmentally appropriate books about people whose lives have been

affected by adoption, including adopted persons, adoptive families, and birth parents. Ann Fessler’s (2007) The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade is written from narratives based on indepth interviews with birth mothers who “surrendered” their children before Roe v. Wade. Finally, Journey of the Adopted Self: A Quest for Wholeness by Betty Jean Lifton (1995), and her Lost and Found (1988), are classic works written from the perspective of the adopted person. From an academic perspective, there are many publications, and the research and evaluation of adoption-related programs is burgeoning. For an excellent and in-depth overview of adoption issues written from a scholarly perspective I would direct readers to Handbook of Adoption: Implications for Researchers, Practitioners, and Families by Rafael Art Javier and colleagues (2006). Adoption Laws Federal legislation sets the framework for adoption in the United States, and states pass laws to comply with federal requirements and become eligible for federal funding. Thus, state laws regulate adoption, and these laws vary from state to state. Find resources in this section on laws related to both domestic and intercountry adoption. The Hague Convention on Intercountry Adoption is a multilateral treaty that was approved by sixty-six nations on May 29, 1993. This international legal document was operationalized from the UN Convention on the Rights of the Child (1989). The UN Convention broadened the rights of children more than any other legal document and directly created the groundwork for the Hague Convention. The purpose of the Hague Convention on intercountry adoptions is to set standards to protect the rights of the adopted child as well as of birth and adoptive parents. Another purpose directly related to the treaty is the prevention of child trafficking internationally. Prior to the Hague

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Convention, international adoptions remained largely unregulated, as opposed to domestic adoptions, for which governing bodies oversee the adoption process. The absence of regulation related to international adoption has given rise to charges of setting program fees for child placement akin to a market value. Criticism of international adoption has been that it relegates children to be traded as commodities (Groza & Ileana 1999). The Intercountry Adoption Act of 2000 (P.L. 106-279), which was the U.S. implementation of the Hague treaty, was signed into law by President Clinton. In 2002 forty-six countries had ratified the treaty; thirteen had signed. The full implementation of the Hague Convention provisions in the United States occurred in 2005. A summary of the Hague Convention is as follows. A child has the right to a family; however, the country of origin must first try to place the child or reunite the child with the biological parents. An intercountry adoption will take place if it is in the best interests of the child and consent to the adoption has been given freely. In addition, the receiving country must assess and determine that the prospective parents are suited to adopt. Adoptions can occur only from one Hague Convention country to another. Furthermore, each participating nation must establish a central authority to oversee the implementation of the convention. In the United States the State Department will serve as the central authority. Adoption agencies and individual providers must be accredited to standards set up by the central authority. Although rare exceptions may be permitted, no contact will be made between the prospective parents and parent or institution where the child temporarily resides until certain requirements have been satisfied. Although the Hague Convention has many benefits with regard to providing legal provisions to discourage child trafficking and has supportive guidelines for regulation of international adoption, the treaty has not been without criticism. Some adoption agencies and professionals

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in the United States have questioned several aspects of the legislation. One criticism has been that the increased bureaucracy in the form of regulation and accreditation will increase costs incurred by adoptive parents. In addition, child placement and permanency will be delayed because of increased paperwork for both sending and receiving countries. A final criticism is that children must first be referred in-country, where in many developing nations the child welfare agencies are weak and cannot adequately support domestic adoption for the immediate placement and safety of waiting children. Language in Adoption Definitions in adoption and the language used to describe them differ depending on the role of the person in the adoption constellation and their perspective. Birth parent, adoptive parent, and adopted person, which I use throughout this chapter, are terms coined by Barbara Thompson and Paula Davis, my colleagues at Catholic Charities in Baton Rouge, Louisiana. The use of language in adoption is complex, changing, and sensitive. What is considered “positive” by one part of the constellation may seem offensive to another. The terms that seem to be generally agreed upon by many are use of the term adopted person rather than adopted child, adoptive family to designate the person or persons who legally adopt the adopted person, and birth parents for the persons who biologically created and gave birth of the adopted person. My colleague Joyce Maguire Pavao (2005) expands these definitions and, in fact, expands the concept of family to include the term complex blended families. t
Root families are families where the mother and father who gave birth to the child are also parenting the child together. t
Complex families are every other type of family structure. t
Complex blended families are a blending of many families by adoption, fostering, kinship care, remarriage, or alternative reproductive technologies.

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People whose lives are affected by adoption, as well as child welfare practitioners and policy makers will continue to change and develop language concerning adoption. Respectful and sensitive adoption language is important for all child welfare practitioners and policy makers to utilize. The consequences of insensitivity are apparent in this case example: Anne and her husband Bob are the parents of five children adopted from Korea. As Anne tells it, many people in her community are very curious about their family, especially because they appear to be a transracial family. One day while shopping for groceries at their local supermarket, Anne and her five children (all of whom were clinging to the shopping cart) were moving along within the store from aisle to aisle, shopping for the week’s groceries, when they were stopped by an apparently well-intentioned person, who said in a very loud voice and clearly directed toward Anne and her children— “Oh, my God, they are so cute! Do they speak English?” Anne was mortified and unprepared to discuss her family situation with a stranger in a public place. But she politely said, “These are my children, and, yes, they very much speak English.” If the initial exchange was not offensive enough, the woman continued by asking a series of rapid-fire questions, “Where did you get them? How much does it cost to adopt them? And then, most offensive of all: “So, you’re not their real mother, are you?” At this point, Anne and her children, who are by now looking at their mother, remarked, “I’m sorry but we just don’t talk about our family with people we don’t know.” As they walked away, Anne was feeling exposed and a little angry and her children asked many questions, including “what did she mean when she said how much does it cost to adopt them?”

Clinical Core Themes Informed by Adoption Adoption is a lifelong process for everyone involved (the adopted person, the adoptive family, and the birth family), with significant emotional and legal impacts. Adoption is an

intergenerational process that unites the constellation of birth families, adopted persons, and adoptive families forever. Adoption, as noted by Susan Soon-Kuem Cox, is “bittersweet.”2 Having an awareness of the core themes in adoption is essential for those whose lives are affected by adoption as well as for all professionals who practice in the area of adoption in order to better understand the lifelong effects of everyone involved in the adoption experience. Practice Themes in Adoption For many couples who experience infertility, adoption is considered the “next best” choice. Often such couples seek to adopt healthy infants and operate from the mistaken assumption that, there will be little chance, if the adoption is “closed” (i.e., the birth parents do not know the identity or location of the adoptive family and vice versa), the birth parent(s) will try to get the baby back. In such situations, adoptive parents often seek to take the baby home and raise her as if the she had been born to them. They may even deny that the child is adopted. Core themes that often must be resolved include secrecy, denial, loss, and shame (see Hollingsworth, this volume; Rosenberg & Groze 1997). These practices can lead to a number of risks for the child and the family. The lack of information about the birth family can interfere with the adopted person’s identity development. Lack of information or inaccurate information about the reason for placement can lead to low self-esteem in the adopted person and the development of rescue fantasies concerning the birth parent. Secrecy concerning the adoption can lead to a deep sense of betrayal when the adopted person learns that he has been deceived. The adoptive parents’ silence concerning the adoption can lead the child to assume that he is part of a secret that is too horrible to discuss. Finally, lack of information about the birth family can deny the adopted person and her adoptive family access to vital information about medical history and health and psychological risks. All these factors can

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interfere with the development of a strong and healthy bond between the adopted person and her adoptive family. Best practice encourages the adoptive family and adopted person to grieve the losses (Rosenberg & Groze 1997) and explore the reasons that may have made them fearful of having contact with the birth family. Adoptive families do best when they neither deny nor insist on the differences between their families and the children’s birth families (Kirk 1964). Healthy adoptive families acknowledge and are open to discussing adoption without dwelling on it. Finally, it is important to encourage families to consider a range of openness in adoption and to consider the child’s best interest when determining the level of information to be given the child and the nature and frequency of contact with members of the birth family. Openness ranges from being completely open with ongoing contact to the traditional closed adoption; moreover, the degree of openness may and often does change over the life cycle. Families considering adoption should be aware of all the options and variations in options that are available to them regarding information about and contact with an adopted person’s birth parents. A number of practitioners have written about core clinical themes that may emerge for adopted persons, even those placed as infants. Clearly, the specific experiences of constellation members vary, but there is a commonality of affective experiences that persists throughout the individual’s or family’s life cycle development. The recognition of these similarities permits dialogue among triad members and allows those professionals with whom they interface to intervene in proactive as well as curative ways. The presence of these themes does not indicate, however, that either the adopted person or the institution of adoption is pathological or pseudo pathological. Rather, these are themes that adoption practitioners should anticipate and that evolve logically out of the nature of the adoption experience. Many themes inherent in the adoption experience converge when

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the adopted person reaches adolescence. During adolescence, three factors intersect: an acute awareness of the significance of being adopted; a drive toward transitioning from childhood to adulthood; and a biopsychosocial striving toward the development of an integrated identity. Adoption triggers seven lifelong or core themes for all constellation members, regardless of the circumstances of the adoption or the characteristics of the participants. Adoption alters the course of life for each member of the adoption constellation, often presenting those involved with unexpected and/or additional hurdles in their development, which may hinder growth, self-actualization, and the evolution of self-control. Although it is beyond the scope of this chapter to review these in detail, the seven clinical core issues of adoption are generally agreed to be: Loss, Rejection, Guilt/ Shame, Grief, Identity, Intimacy, and Mastery/Control.Birth parents, adoptive parents, and adopted persons all have feelings, experiences, and questions related to these themes and issues. The experience of adoption, then, can be one of loss, rejection, guilt/shame, grief, diminished identity, thwarted intimacy, and threats to self-control and the accomplishment of mastery. These seven core or lifelong themes permeate the lives of constellation members regardless of the circumstances of the adoption. Identifying these core themes can assist constellation members and professionals in establishing an open dialogue and alleviating some of the pain and isolation that so often characterize adoption. Constellation members may need professional assistance to recognize that they may have become trapped in the negative feelings generated by the adoption experience. Armed with this new awareness, they can choose to catapult themselves into growth and strength. Constellation members may repeatedly do and undo their adoption experiences in their minds and in their vacillating behaviors while striving toward mastery. They will benefit from

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identifying, exploring, and ultimately accepting the role of the seven core themes in their lives. These core issues draw heavily on psychoanalytical orientations (Lifton 1988, 1994; Verrier 1993), psychological models (Brodzinsky 1990), and are often best understood within a family-systems framework (Groza & Rosenberg 2001; Reitz & Watson 1992). The following case example highlights some of the themes mentioned here. GREG, MARK, AND JOSHUA Greg and Mark are a middle-aged gay couple with a twelve-year-old adopted son, Joshua. They are experienced parents, with another adopted son age sixteen years old. Both children were two weeks old at the time of adoption. Both parents are Caucasian, and Joshua is African American. Greg and Mark are working upper-middle-class professionals. Mark, who is the primary caregiver for the boys, is a computer programmer in a large corporation; two days a week he telecommutes, so he has been able to be at home for his sons. Greg is a professor in the psychology department of a large university. Until recently Joshua attended the local public school in his community; his older brother had attended the same school, and his parents were involved with the school’s Parent Association. Joshua did well academically, although he hated to do homework, was a B student, and socialized appropriately with his peers. He and his brother, Andrew, who was four years older, had some sibling rivalry issues and occasionally fought, but generally got along well playing video games and skateboarding. After graduating from the sixth grade and a brief stint in the local public junior high school, Joshua was placed by his parents in a private school. After three months in his new school, Joshua has begun to act out: he is refusing to go to school, stubborn, noncompliant, engaging in physical confrontations with his parents, locking himself in his room or the bathroom, and stealing money from his parents. Joshua was an active baby, smiling easily and walking early. Mark and Greg have limited information about his birth family. Joshua was born full

term, weighing 8 lbs 8 oz., and the developmental/ pediatric evaluation showed normal development in all areas. Joshua’s birth mother is a thirty-yearold unmarried woman with three other children. She voluntarily surrendered Joshua to an adoption agency in Arkansas and relinquished her parental rights. The rights of the birth father (whereabouts unknown) were terminated. She told her family that the baby had died. Mark and Greg are concerned about Joshua’s recent behavior. They are particularly concerned about his refusal to go to school and his angry outbursts. He seems to have changed from a wellbehaved, even-tempered child into an angry, defiant child almost overnight—it is almost as if he has had a personality transplant. He recently has been socializing with a more “street-youth”-oriented group, dressing in hip-hop style clothing, listening exclusively to rap music, and talking a great deal about his interest in smoking pot. He denied that anyone at school picked on him. His recent refusal to attend school has become problematic for his parents, who cannot go to work when he refuses to attend school and have tried many different approaches, from positive reinforcement for good behavior to punishment, i.e., taking away his text messaging–capable cell phone. His response to both positive and negative reinforcement is “I don’t care what you people do to me. I am getting kinda sick of all you white people trying to tell me what to do.” After Mark and Greg contacted an adoption competent therapist and participated in family therapy, Joshua’s therapist suggested that his family initiate a search for his birth parents. After three months of working with the therapist and initiation of the search for his birth family, many of Joshua’s extreme behaviors began to dissipate.

Older Children in the Public Child Welfare System With the increasing number of children entering the public child welfare system due to abuse, neglect, abandonment, or parental substance abuse, incarceration, or poverty, and the increasing emphases of federal and state laws

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on timely permanency, more and more older children are being placed in adoptive homes. Children who are adopted beyond infancy often pose additional challenges. Even though adoption is considered to be a permanent and legally binding arrangement of bonding a child to a family, stories abound of adoptions disrupting (i.e., the parents asking to be relieved of their responsibility for the child before the adoption is legalized) or dissolving (i.e., parents petitioning the court to “give the child back” legally; see the chapter by Festinger, this volume). Disruption rates from 7 percent to 60 percent have been reported (Barth & Berry 1988; Groze 1986; Kagan & Reid 1986; Rosenthal, Schmidt, & Conner 1988). The range in rates is attributed to the age of the child, with older children who have behavioral and emotional problems experiencing higher rates of disruption. The most commonly used estimate is that about 15 percent of adoptions disrupt (Barth & Berry 1988), which means that most adoptions remain intact. Risk factors include the child’s history of multiple separations and maltreatment; difficulties in attachment; the increased likelihood of medical or psychological conditions due to drug or alcohol exposure in utero or later; inadequate nutrition and physical care; delays in physical, psychological, or social development; and lack of preparation and postplacement support for adoptive families. It is important for social workers to ensure that all the available background information about the child and her birth family is gathered and reviewed in order to determine not only the child’s current functioning, but how her past is likely to impact future functioning. This information should be shared fully and truthfully with prospective adoptive parents to assist them in making a realistic decision about placement. In addition, it is crucial that adoptive parents be educated about lifelong adoption themes and the special vulnerabilities of older children who have been placed in the public child welfare system. Ongoing support, including pre- and postadoption individual and family

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counseling; concrete services, such as adoption subsidies; access to support groups; and assistance with advocacy for the child’s special needs in the educational system are all ways that the social worker can strengthen and support the adopted person and her family. Several trends have been identified through practice wisdom and research concerning the clinical themes that may emerge for adopted persons placed as older children. Some approaches draw heavily on post-psychoanalytic orientations by focusing on attachment (Keck & Kupecky 1998, 2002; O’Connor & Zeanah 2003). Others draw from psychological models, such as cognitive-behavioral approaches (Beck 1995) and family systems models (Groze 1994, 1996; Groze & Rosenthal 1991). There is increasing recognition that the clinical and practice themes for both infant and older adopted persons are similar (Groza & Rosenberg 2001); use of the same interventions for both populations has been recommended. The following is a case example that touches on these themes. JESSICA GARCIA AND ALBA A single Latina female, Jessica Garcia is mom to an eighteen-year-old adopted daughter, Alba. Mrs. Garcia is an experienced parent, with two other birth children, Laura, age twenty-two years, and Sonia, age twenty-eight years, both married and living outside the home. Alba has lived with Mrs. Garcia since the age of thirteen years in a rented apartment in a suburban neighborhood. Mrs. Garcia owns her own beauty salon and has raised her children as a single mother. She has, over the years, dated occasionally, having had a steady boyfriend for six years; the couple ended their relationship two years ago. Alba is an excellent student in a local public high school and is preparing to graduate. Alba has a boyfriend, Pablo, who is also eighteen years old and attends the same high school; they have been dating for two years. She and her boyfriend are closely bonded and their relationship is strong. Alba is considering college. She has recently become reclusive, staying in her room for long periods of time,

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socializing almost exclusively with her boyfriend. She is fearful about leaving home to attend college and, at present, besides attending school, almost never leaves her home. Alba was born full term, weighing 6 lbs. 3 oz, to a young teenage mother who tried to care for her. After six months she was placed in foster care on a neglect petition. Several reports of neglect were filed with the county; her mother, who also abused substances, allegedly neglected Alba. Alba had lived in seven foster homes before coming to live with Mrs. Garcia; she had been free for adoption, but insisted to her social worker that she did not want to be adopted. At the time of placement in Mrs. Garcia’s home as a foster child, Alba was described by Mrs. Garcia as serious and tentative young teen. After an initial period of adjustment, Alba began to relax in the home, and she and Mrs. Garcia began developing a close bond. Alba told her social worker that Mrs. Garcia’s home was a “loving home,” not like some of the other homes she had been in. Since Mrs. Garcia was willing to adopt Alba, and since Alba had begun to warm up to the idea, Mrs. Garcia and Alba moved toward adoption. In the last six months, Mrs. Garcia has become increasingly concerned about Alba’s reclusive behavior. Her relationship with her mother had become strained, but they do talk when they ride together in the car. Mrs. Garcia is particularly concerned about Alba’s fear of going to college and her almost complete refusal to leave the house to engage in social events. Alba has no social contacts with peers other than her boyfriend. Her plan, if she attends college, is to go with her boyfriend. Alba’s fear about leaving home, deep connection to her boyfriend, and distancing from her mother can all be described as normative behaviors for a teen, but, Alba is a teen who has experienced multiple moves and losses while in the legal custody of the child welfare system. Mrs. Garcia is concerned and would like for Alba to see a therapist on a more regular basis.

Single-Parent Adoption In the early 1970s, if an individual had gone to an adoption agency as a single person and

applied to adopt a child, that individual would have, unfortunately, been told that he was unable to adopt. Prior to the 1970s, adoption by single persons was not a practice employed by most adoption agencies. In some states there were laws against single-parent adoption. In the twenty-first century, there are thousands of children in the United States and other countries are living with single men and women who have chosen to become parents and who have been given the opportunity to provide a loving permanent home for a child. In the last 40 years there has been a steady, sizable increase in the number of single-parent adoptions— some people feel that it is the fastest growing trend in the adoption field. Approximately 25 percent of the adoptions of children with special needs are by single men and women, and it is estimated that about 5 percent of all other adoptions are by single people. AFCARS data (AFCARS, 2011) identify 3 percent (n = 1,392) of all adoptions were finalized by single men and 28 percent (n = 14,465) by women for a total of 15,857 adoptions by single persons. The outlook for single-parent adoption is encouraging as it becomes more widely accepted. Evidence suggests (Groze 1991; Groze & Rosenthal 1991; Shireman & Johnson 1976, 1985) that single people make great parents for many adopted children and youth. Transracial Adoption Transracial or transcultural adoption means placing a child or youth who is of one race or ethnic group with adoptive parents of another race or ethnic group. In the United States these terms usually refer to the placement of children of color or children from another country with Caucasian adoptive parents (Simon & Roordea 2000; Steinberg & Hall 2000; Trenka, Oparah, & Shin, 2006). People choose to adopt transracially or transculturally for a variety of reasons (Crumbley 1999; Fogg-Davis 2002). Fewer young Caucasian children are available for adoption in the United States than in years past, and some

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adoption agencies that place Caucasian children do not accept single parents or applicants older than forty. Some prospective adoptive parents feel connected to a particular race or culture because of their ancestry or through personal experiences, such as travel or military service. Others simply like the idea of reaching out to children in need. Adoption experts have different opinions about this kind of adoption. Some say that children available for adoption should always be placed with a family with at least one parent of the same race or culture as the child (Smith et al. 2011) so that the child can more easily develop a strong racial or cultural identity. These practitioners claim that adoption agencies with a strong commitment to working with families of color and that are flexible in their procedures are very successful in recruiting “same race” families. Other experts say that race should not be considered at all when selecting a family for a child. To them, a loving family that can meet the needs of a particular child is all that matters. Still others suggest that after an agency works very hard to recruit a samerace family for a certain period of time but does not find one, the child should be placed with a loving family of any race or culture who can meet the child’s needs. Despite these differing opinions, there are many transracial and transcultural families, and many more will be formed. Those who wish to be a parent in one of these should consider answering two questions: 1. What should one do to prepare for adopting a child of a race or culture different from one’s own? and 2. After adoption, what can parent(s) do to help their child become a stable, happy, healthy individual, with a strong sense of cultural and racial identity? Preparation for adoption is important for anyone thinking about adopting a child or youth. It is particularly important for persons considering transracial or transcultural adoption because it introduces applicants to all aspects of adoptive parenthood and assists applicants to realistically identify the type of

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child one wishes to and is able to parent. Any adoption agency that conducts and supervises transracial or transcultural adoptions should provide this important service. Persons who are undertaking an independent adoption should seek preadoptive counseling, And potential adoptive parents should also read as many articles and books as possible on the subject (Crumbley 1999) and expose themselves to the experience through films and documentaries. The following sections describe some issues that persons considering a transracial or transcultural adoption to consider. While adoptive applicants may feel that they know themselves and their family very well, it is important to examine one’s beliefs and attitudes about race and ethnicity before adopting a child of another race or culture. Applicants should examine their assumptions about people of various racial and ethnic groups. There are two reasons for this exercise: 1. to check oneself— to be sure this type of adoption will be right for oneself, and 2. to prepare to be considered “different.” When a person adopts a child of a different race or culture, it is not only the child who is different. The adoptive family becomes a “different” family. Some people are comfortable with difference, and find difference to be interesting, wonderful, and special. Others are not as comfortable with difference, and may be very uncomfortable with it. Thus, some friends, family members, acquaintances, and even strangers will rush to adoptive applicants’ sides to provide support, while others may make negative comments and distance themselves from the potential adoption. During the pre-adoption phase, adoptive applicants should consider how they will respond to the second group in a way that will help an adopted child(ren) feel good about himself. Before considering a transracial or transcultural adoption, prospective adoptive parents should be encouraged to take a look at their current lifestyle. It is important for children of color growing up with Caucasian parents

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to be around adults and children of many ethnic groups, particularly to see adult role models who are of the same race or ethnic group. Can the potential adoptive parents make these types of relationships available for their child? Do they already live in an integrated neighborhood with integrated schools? If not, would they consider moving to a new neighborhood? Do they have friends of different races and ethnic groups? Do they visit one another’s homes regularly? Do they attend multicultural festivals and enjoy different kinds of ethnic foods? How much of a leap would it be for them to start doing some of these things? It’s common for adopted children and youth to grapple with questions about where they come from and how they fit into their new family. But those questions can be particularly hard to navigate when adoptive parents and children don’t look alike. When children are young, an extra hug and a heart-to-heart talk may be all it takes to help them through difficult situations. While the hugs and the heart-to-heart talks never stop, as children get older, adoptive parents and their children often need more specific coping skills to deal with the racial, cultural, or other biases they face together as a family. Adoptive applicants should be helped to understand the experiences and issues they may encounter as adoptive parents. Today, approximately 40 percent of adoptions in America are transracial, and that number is growing. In decades past, many American parents of transracial adoptions simply rejected racial categories, raising their children as though racial distinctions didn’t matter. Dr. John Raible, a transracially adopted person and adoption advocate says, “Social workers used to tell parents, ‘You just raise your child as though you gave birth to him.’”3 He continues: “An extreme majority of transracially adopted kids . . . grew up wishing they were white or thinking they were white, not wanting to look in mirrors while living in ‘whitesville.’ It is the obligation of the white parents of a child of color to do their homework and to make

changes in their own lives in order to ensure that no adopted child of color grows up wishing they were not the color they are!” Raible further reflects that “turning a blind eye to race wasn’t good for anybody. Social workers preparing to work with transracially adopted children and their families need to be aware of the plethora of issues and challenges they and those they serve will undoubted encounter. LGBT Persons as Adoptive Parents For the last two decades, a quiet revolution has occurred in the lesbian, gay, bisexual, and transgender (LGBT) community. An increasing number of LGBT persons from all walks of life are becoming parents through foster care and adoption. Lesbians and gay men become parents for many of the same reasons that heterosexual people do. Some pursue parenting as a single person and others seek to create family as a couple; still other lesbians and gay men became parents when they were in a heterosexual relationship. Although there are many common themes between lesbian and gay parenting and heterosexual parenting, there are also some unique features. Unlike their heterosexual counterparts who couple, get pregnant, and give birth, most LGBT individuals and couples who wish to parent must consider many other variables in deciding whether to become parents since the birth option is not the only one. LGBT individuals and couples who wish to parent will have to give careful consideration to how they will become parents and at the outset will need to be open to different ways of becoming a family and parenting children (Mallon 2004, 2006, 2008, 2011). Some LGBT persons choose to parent as a couple and some parent as single persons. Those who choose to parent as single parents will face stresses that have more to do with single parenting than with their sexual orientation. Those who parent as a couple will also face challenges to their status as a couple or a family. On the positive side, LGBT persons who choose to create families have the advantage of redefining

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and reinventing their own meaning for family and parenting—by definition their family will exist outside the traditionally defined “family.” They have the unique opportunity to break out of preconceived gender roles and be a new kind of father or mother to a child (Mallon & Betts 2005). Most LGBT persons who parent are not invested in raising lesbian or gay children as suggested by some, but to raise children who will be authentic, happy, and self-confident – children who they will love, nurture, and support regardless of the child’s expressions of gender or sexual orientation. It is important to recognize that, although there are many similarities, LGBT parenting families also differ from the heterosexually parented family. The conventional notion of a family presumes there will be two parents, one of each gender, that they will share a loving relationship and live under one roof, that they will both be biologically related to the children they raise and recognized legally as a family. In Western culture, this mom-and-dad nuclear family is the baseline model against which all other models of family are measured. This family type is assumed by most to be the optimal environment for child development, compared to which all other types of families are viewed by many as deficient in some way. This model, however, does not apply to most families with a LGBT parent(s). In families with a LGBT couple there is usually at least one parent who has no biological relationship to the child. There is almost always at least one parent-child relationship not recognized or protected by the law (Ryan, Pearlmutter, & Groza 2004). Social workers have a key role to play in the lives of LGBT parents. From direct practice with family systems to policy and legislative advocacy, the array of opportunities for social workers in practice with LGBT parents continues to broaden. As LGBT parents are increasingly out and open in many geographic locations of the country, they can no longer be viewed as an invisible population. Although heterosexual privilege continues to dominate mainstream

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consciousness, assuming that all children live within the context of heterosexually headed families, working with LGBT headed families is an experience that most social workers will encounter in their practice. Best practices suggest that social workers should accept the premise that it is quality of care and not family constellation that determines what is optimal for children’s healthy development: LGBT parents have the same ability to provide for the social and emotional health of their children as do heterosexual parents. As social workers, we must examine our own notions of family and be open to understanding what constitutes family based on the loving bonds of responsibility both intended and fulfilled and not solely on biological, legal, or conventional definitions. Best practices for professional social workers who work with LGBT parents involve an LGBTaffirming approach to practice. These strategies might include working with LGBT individuals to assess their desire to become parents, working to support LGBT persons who are in various stages of pursuing parenting, supporting those who have already become parents deal with the everyday reality of parenting, and assisting couples and families in more traditional couples or family therapy situations. Policy practice is the responsibility of all social workers. Within the specialization of practice with LGBT parents, professional social workers partner with or represent the interests of persons and families who may request assistance in advocating for policy or legislative changes. Such activities might include advocating on the local, state, or federal levels for changes in fiscal allocations and services, speaking with legislators or bureaucrats, gathering data for policy analyses and performing such analyses, and navigating with LGBT parents through the complex child welfare and other service delivery systems. The most effective policy practice activities involve consumer advocates who are knowledgeable regarding gaps in services, unmet needs, or solutions

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from their experience. Within the area of practice with LGBT persons, the LGBT person and/or family are usually the “experts” when it comes to best practices. It is the responsibility of social workers to learn to identify needs, assist in procuring services, navigate the maze of services, and promote policies and services to better serve this population. Kinship Adoption When children must come into the custody of child welfare agencies, recent federal laws, including the ASFA, Fostering Connections, and the Personal Responsibility and Work Opportunity Act, view placing the child with kin as the first and best placement option. Kinship care (see Hegar and Scanapeico’s chapter, this volume, for a full discussion of kinship care) offers several benefits to children, including providing familiar caregivers and continuity in familial relationships, promoting sibling relationships, reducing the trauma of separation, reinforcing children’s sense of identity and self-esteem, offering greater placement stability, and reducing the stigma of being placed in foster care (Beeman & Boisen 1999). Approximately one-third of all children in custody are reported to be placed with relatives (Needell & Gilbert 1997), which makes kinship foster care the fastest growing out-of-home placement (Bonecutter & Gleeson 1997). Although this form of placement provides many benefits, numerous challenges also exist. First and foremost is that the child welfare system itself was not originally developed to view kin as placement resources. There has been little recognition that kinship caregivers have their own special needs, including the tendency to be older, less educated, more likely to be living in poverty and having health problems than are nonrelative foster family placements (Bonecutter & Gleeson 1997; Scannapieco, Hegar, & McAlpine 1997). At the same time, children placed with relatives have the same needs as the children in the child welfare system who are placed with strangers. Despite the similar

needs of children placed with kin, studies show that kinship care families receive fewer services, experience more delays in receiving concrete services, and are monitored less frequently than are other families (Davidson 1997; Needell & Gilbert 1997). In addition to all the issues and challenges that any foster or adoptive family faces, kinship foster families often struggle with the disappointment, loss, and stigma related to knowing that a child has come into care because of the failing of a family member. Placement of a relative’s children can produce a great deal of stress on the kin family system. This often results in the need for a range of services from legal consultation, financial support, medical and mental health services, educational resources for the child, parent education and counseling, support group information, and/or other concrete services. Social opinion that relatives “should take care of their own” has led to fewer services and supports being available to kin families, putting them at higher risk for problems in the placement. Without these supports, children formally placed in relatives’ homes are at greater risk for return to the child welfare system. The following is an example of themes that emerge in kinship adoptions. THE GALLAGHERS The Gallagher household underwent a drastic change when Joan and Gary adopted Joan’s sister’s children, aged four, nine, and eleven, after their mother was sentenced to twelve years on a felony drug charge. The family grew from two children— aged two and six—to five children under the age of eleven. Joan had worked as a administrative assistant and had placed her youngest child in day care, but found she needed to stop working to attend to the needs of her niece and nephews who presented some challenging behaviors. The children had been left alone and with strangers and had been severely neglected; the youngest one had terrible nightmares and the oldest was very parentifed, acting as if she was the mother of the two younger siblings. The older children had reading difficulties and were reported to get into frequent conflicts with peers in school.

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Joan found herself being called to the school on an almost daily basis. The youngest child was developmentally delayed and needed an early intervention educational program. The Gallaghers’ birth children reported feeling angry that their cousins were taking all of their parents’ time and energy. Joan and Gary reported with frustration that they were receiving little financial or emotional support from the agency that placed the children with them. They initially felt it was their obligation to take care of their family members, but were now so overwhelmed with the demands of caring for the children that they were considering placing the children back with the department of children and family services.

International Adoption Unlike the child welfare system in the United States, where children are placed in foster family care for temporary placement or adoption if they cannot remain with the biological family, the majority of children adopted internationally enter their adoptive families directly from orphanages or other child welfare institutions (Groze 1986). The regimentation and ritualization of institutional life do not provide children with the quality of life or the experiences they need to become healthy, happy, fully functioning adults. In group care, the child’s needs are often secondary to the requirements of the group’s routine. Relationships between adults and children may be superficial and brief, with little continuous warmth and affection. Institutional staff members do not typically connect emotionally or physically with children in the same way that families connect with children. Often, there are too many children and an insufficient number of staff, with the result that few children receive individualized attention or care and, as a consequence, suffer emotional neglect (Miller 2000), if not physical neglect. Institutionalized children, because of often inadequate sanitation, nutrition, and medical care and an ineffective nurturing environment, are at high risk for impaired health, development difficulties, behavioral aberrations, and

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attachment problems (Miller 2000; Rutter et al. 1995). Children raised in institutions have fewer opportunities to develop selective attachments (Smyke, Dumitrescu, & Zeanah 2002), and institutional care is therefore typically associated with attachment problems (Ames 1997; Chisholm 1998; Smyke, Dumitrescu, & Zeanah 2002). Families adopting internationally often need comprehensive services prior to and following adoptive placement. Aggressive gathering and full disclosure of all background information are critical components of effective practice. Comprehensive background information provides the starting point for preparing the family to anticipate their needs for services and support. Informal supports appear to be utilized and desired more often than formal, agencyrelated supports. Social serving families adopting internationally may want to pay particular attention to social support systems in the home study phase and, perhaps more importantly, develop ways to extend greater support to families over the course of the adoption. Adoptive parent support groups provide formal and informal support, educate the parents about a myriad of themes, normalize the adoptive experience, and encourage families to advocate for their children. Supporting Adoption: Promising Approaches Sibling Adoption For most individuals, the relationship with siblings is the longest relationship they will have in their lifetimes. Although the sibling relationship may be primary at some times in life and more distant at others, a person’s identity is intricately interwoven with her siblings. Studies suggest that of children in foster care, 93 percent of the children had full, half, or stepsiblings (Timberlake & Hamlin 1982) and up to 85 percent of children enter foster care with a sibling (Wedge & Mantle 1991). According to Hochman, Huston, and Feathers-Acuna (1992),

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30 percent—almost one-third—of the children entering foster care are part of sibling groups of four or more. A crucial question facing social workers when making decisions concerning foster or adoptive placement is whether it is better to place all brothers and sisters together, individually, or in subgroups. Best practice in adoption assumes that siblings should be kept together. Multidimensional assessments of the sibling relationship (see Groza et al 2003) must occur prior to making placement decisions, and siblings should always be placed together unless an assessment produces compelling reasons to separate them. Although there may be many factors that complicate sibling placement, there are several strategies for keeping them together. These include clear agency policies concerning the value of sibling relations; making sibling groups a priority at the time that children enter placement; exploring extended family and kinship resources; and spending more effort recruiting, training, and retaining families that wish to adopt siblings. Other strategies include flexibility in licensing of foster and adoptive homes and visiting policies that encourage regular contact among siblings who are placed apart. It must be remembered that the job of placement professionals is to find families for children, not children for families. Thus efforts must be expended to fully assess the sibling relationship and prepare and support families who are open to fostering and adopting sibling groups. Although loss is very much a part of adoption, the loss of one’s siblings can be prevented by concerned and competent social workers. FABIO, MARCO, AND ROSA Fabio, Marco, and Rosa are siblings. Fabio lives with his paternal grandmother in a rural area of Mississippi and has lived with her for ten years. He is ten. Marco, seven, and Rosa, five, had been living with their birth parents until a year ago. Their mother went to prison for murdering another man in a drug deal. The father abandoned the children with the maternal grandmother. Six months ago, pa-

rental rights were terminated. The maternal grandmother said she did not want to raise the kids. Three months ago, without the case worker knowing it, the grandmother had placed the two children in separate households. Marco went to family friends, a couple that was unable to have children and were about the age as Marco’s birth parents. The friends visited with the maternal grandmother about once a month, where Marco would see his sister. Marco liked the parents, and the father, an athlete, often played sports with him. Rosa went to a niece. The niece had a child four years ago, a girl, who had died of leukemia. She and her husband suffered from secondary infertility. Rosa is settled and happy in her placement. A family group conferencing therapist suggested that the county close the case because the family had made a placement decision. They should support the current placements for adoption. A therapist reported that the children were very attached to one another, had never lived apart, wanted to be together, and that the lifelong relationship between the siblings was more important to maintain than the temporary attachments to the current placements.

Tools for Working in Adoption The ability to put information about one’s life into perspective is necessary to develop a good self-concept. For adopted persons, there are often significant gaps in the information they have about their own history. Adopted persons often do not have many or any details about their birth families; what they do know is often only distorted facts or stories of dysfunctional episodes. The life book, ecomap, social network map, life map, and placement genogram (Aust 1981; Hartman 1984; McMillen & Groze 1994; Pinderhughes & Rosenberg 1990; Wheeler 1978) are particularly helpful tools for assessment and intervention with adopted persons and adoptive families. In what follows, these tools are discussed in more detail. There are also resource materials that examine the unique themes in the adoptive family life cycle (Rosenberg 1992), as well as practice techniques

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specifically for the adoptive family (Reitz & Watson 1992). Understanding and using these tools and being familiar with the growing body of literature about adoptive families can help practitioners work more skillfully and sensitively with these families. Search and Reunion Issues Adopted people and their birth parents and relatives who were separated by adoption may decide to search for each other at some point during their lives. In some cases the search is an internal one, meaning that the adopted person or the birth person thinks about searching, but does not pursue the search. In other cases, the search is thought of and initiated by either the adopted person, the birth parent, or, in some cases, the relatives of the birth parent. If their search is successful, some will pursue meeting their birth relatives. Some search and do not have a reunion, others search and have an actual reunion. This section is designed to briefly explore the importance of such searches for adopted people who are searching for birth parents or other birth relatives as well as for birth parents (both mothers and fathers) who want to locate a child who was adopted. There are as many adoption search and reunion scenarios as there are people involved. Every social worker who has worked in this field, who has been part of the process, or who is a member of one of the supporting families will tell you of the joys and the challenges inherent in this process. Why would someone want to search? The answer to this question lies deep within the heart of the matter. The “matter” being that, at some time and in some way, the natural course of a family’s shape and structure has been disrupted by the removal of some fundamental part—the parent of its child or the child of its parents, brothers and sisters of each other, and grandparents of their grandchildren. These disruptions may occur for a variety of reasons, including those identified above in this chapter, but the end result is one of an imbalance in the

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order of things and a need experienced by many people to regain that order. First one has to separate the “search” from the “reunion.” These are two distinct parts of the adoption journey. The Search It is important to remember that the onus of the search will fall on the searcher. It is his responsibility to learn as much as possible about reunions, to read as much as is available, to talk to experienced people, to listen carefully to the advice that is given, and to work out a careful game plan. The “searchee” knows none of this. She will not be prepared. She may be shocked at being found and may feel like the only adoptee or birth parent in the universe who has been in this situation. Many books have been written about searching and search techniques (Martinez-Dorner 1999). There might be some “typical” form letters to copy, but not much direction on what to really say! The books describing what to do with information that the searching person possesses—the name and address of a birth relative, the location of one’s surrendered child’s new family—are few and far between. Although each case is very different, there are some basic rules around searching that never lose their truth. Be Very Discreet Do not, if at all possible, discuss the adoption story with anyone except the person you are seeking. Many, many times searchers are so excited about finding a family member that they will blurt out the whole reason why they are looking for “Millie,” thereby blowing Millie’s cover. It is not necessary to tell the whole story to everyone! Remember a Searching Person May Only Have One Chance to Make a Certain Phone Call Try to get it right the first time. One should have a prepared list of the questions one wishes answered to jog memory. If the searching person calls back with more questions, she risks raising suspicion about her right to know. Once a family’s drums start to beat, there is no way to stop it.

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Remember That the Other Person may not Be as Thrilled to Be Found as the searching person is to Find Them There may be much more to the story than one can imagine. Every family has its own special dynamic. Persons searching should not Phone Everyone in the Phone Book or on the web with the Same Name Especially if it is a rare name or the person sought lives in a small community, the searching person should not call everyone by that name in the phone book. A searcher should exhaust other options first before resorting to this. Use search tools such as Internet sources instead of contacting everyone indiscriminately. Remember That Every Source of Information Used May Be of Use to the People Coming After You Others would like that resource to remain available, so do not talk too much about how and what you are researching. Make Good Search Plans and Keep Good Records All original documents should be photocopied and the originals stored in a safe place, such as a safety deposit box. Keep a search binder with clear plastic sleeves for the pages that may necessarily be looked at again and again. Be sure to keep good notes of whom you call, whom you speak to, and what was said and when. Be Patient! A search can take a very long time and require painstaking application. But searches can also reach a point of “critical mass” and just take on lives of their own. Seek Out the Assistance and/or Guidance of Experienced Searchers and Support Groups Sometimes days seem like years and waiting can be stressful, exhausting, and frustrating. A good search buddy can keep searchers from making a move that could seriously disrupt the potential reunion. Moreover, a search and support group is often a safer and

more appropriate place to share the emotions of search than casual friends or acquaintances Try to Make the Call or Write the Letter Yourself If this is really too difficult or stressful, get the help of someone who is experienced—like a search facilitator. Searchers should practice a call with a friend and try to anticipate the obvious questions. The Reunion Reunions come in many styles and with many variations, but the essence is still the same. Many reunions take years to “normalize” and reach a stage where the participants have built up shared memories and familiar relationships. Each reunion, therefore, must be studied and planned with a careful, almost military, precision, if the goal of the exercise is a long-term relationship with the newfound relatives. This is the “meeting”—the reconnection—of two people who for all intents and purposes are closely related, but who are relative strangers. Like the development of any relationship, that of the adopted person and birth relative takes time and effort. There is something profoundly mystical and magical about reunions. They require lots of work, lots of concentration, and, above all, a sense of humor. Be Honest There have been enough lies and secrets. Share Information as Appropriate Share both in the initial call (if there is one) and later, when there is a meeting. Sometimes questions come reflexively and may not need to be answered at that very moment. For example, to “How did you find me?” a searcher might respond, “It was not easy. I’ll tell you the whole story sometime. Right now let’s enjoy this wonderful meeting.” To “Who is my birth father?” one might respond, “I will tell you the whole story, but right now I need some time to reflect on what has happened. But I promise I’ll tell you the truth.” A related principle is that if

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an immediate answer to a searcher’s question is not forthcoming, try to be patient—within reason—with the other person. Try to Laugh This is a joyful situation. Don’t make it into a frightening experience. Try to Keep It Simple In birth parent searches, do not try to find both parents at once (unless, of course, they are still together). The emotional upheaval that may ensue could spoil the hope of future successes. Plan the First Meeting in a Place Where Either Party Can Feel Confident and Safe The situation is emotional enough without adding to it the fear of not being able to “get away” if there is a problem. Keep the First Meeting Shorter Rather Than Longer If possible, keep it short. This gives everyone time to take a breather, reassess the situation, and consider the future relationship. It is always easier meeting for the second time. (If a searcher has to travel some distance to meet, the “second time” may be the day after the initial meeting.)Try to Avoid a Huge Family Picnic as the Way to Introduce Your Newfound Relative to the Clan It can be very overwhelming to meet fifty new relatives at once. Keep an Open Mind The birth family may be very different from the adoptive family. Try not to judge one against the other. Have Realistic Expectations The moment of reunion is not the time for the searcher to decide he really only wanted “medical information” or that he is not ready to pursue a relationship. A searcher should be honest with and try to look at her reasons for searching and the limits to what she can accept. Searchers should talk with their support systems ahead of time about the limits; if in an uncomfortable situation, try to resolve it directly and privately.

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Have a Frank Discussion About How the Adopted Person will Address the Birth Parent and Other Birth Relatives Some birth mothers want their surrendered children to call them Mom, but adoptees already have one “Mom” in their life and may not be comfortable using that title for anyone but their adoptive mother. Likewise, some adoptees are eager to call their birth mother Mom, but the birth mother may not be comfortable being called Mom by a child she did not raise. One needs to be very flexible. If this issue becomes one of contention, a reexamination of expectations may be in order. Don’t Try to Compete with Established Family Holiday Procedures Unless Everyone Agrees Like the name issue, this is not worth the anguish it can cause. Keep it simple. Many reunited relatives get bogged down in the minutiae of names and festivals instead of being thrilled that they have found each other. Try to Respect the Other Person’s Wishes About Sharing the Reunion with Other Members of the Family For some birth parents, a reluctance to share can go on too long. Try to set limits to one’s own impatience and wait it out. At some point adoptees in this situation may need to reassess their expectations and make decisions about the future path of the relationship. Advice from an experienced searcher or support group is recommended. Be Stoic if the Other Party Feels a Need to Pull Back for a While Such need to pull away is often seen in the reunion process. It allows the person to take stock or reassess the reunion and its effect on her life. Although very painful to the other person, it is best treated with patience and lots of reading. Support groups are great for dealing with the sadness. Don’t Blame Oneself for Problems in the Other Person’s Life Birth mothers often feel great guilt if the child they relinquished did not grow up as advantaged as they might have hoped or if

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religion is not as important in their child’s life as it is to them (or vice versa). Adoptees can sometimes feel guilty if the relinquishment experience had a negative impact on the birth mother’s life. This relationship starts from the day of the reunion. Keep it positive. Don’t Plan on Moving in with Your New Relatives Relatives may be delighted to meet the searching person, but they are not looking for a permanent house guest. Enjoy the Reunion So .  .  . is search and reunion a good thing? Yes, for most people it is a very positive experience. But it should be carefully thought through (Strauss 1994; Bailey & Gibben 2001). Families must integrate the adoptive child or children into their family systems, which requires flexibility. As part of the home study process, families should be assessed in their level of adaptability. Less adaptable families should be seen as at risk. They should not be screened out of the adoption process, but they may need special assistance as part of their preparation for adoption and ongoing support to enhance their flexibility. After placement, preventive models, such as the family-bonding model (Pinderhughes & Rosenberg 1990), offer a psychoeducational approach to assist with the themes the new adoptive family must resolve to promote integration. Adopted families with adequate resources are stable and can manage the different stresses and difficulties they encounter. In the assessment of resources and stressors to the family, an ecomap (Hartman & Laird 1983) and social network map (Tracy & Whittaker 1990) can be helpful. The ecomap visually diagrams the resources and stressors in the life space of the family, and the social network map examines both the structure and function of social networks. Both can be used to assess family resources, gaps in resources, and stressors. For older adopted children, two instruments that can help both parents and therapists in

their cognitive work with children are the life book and the placement genogram. The life book (Aust 1981; Wheeler 1978; Child Welfare 1986) is a scrapbook that contains photos, drawings, and other mementoes from the child’s life experiences. It is used to help children connect and integrate their past to the present and assist in planning for the future. If children do not have a life book when they enter adoptive placement, they can be assisted in developing one postplacement that can serve as a guide for addressing past relationship themes. The placement genogram (McMillen & Groze 1994) is a diagramming technique that traces the child’s placement history, starting from birth, and records pertinent information about each placement. For instance, the date of parental rights termination, allegations of abuse, and relationships with significant caregivers might be documented on the placement genogram. This information can help provide insight into the themes raised by adoptive families as they try to understand the child’s behavior and its impact on their family (Hartman & Laird 1983). The placement genogram also helps the child to explore the meaning of relationships and how those relationships have influenced his life. As a practitioner helps a child to unfold the life history, she can begin to explore the child’s “working models” of relationships and help the child to cognitively restructure the models to increase attachment in the adoptive home. Melina (1986) suggests that adoptive parents can facilitate attachment cognitively by assisting children in examining and understanding their past, giving them a vision for the future, and using appropriate and positive physical contact. These are a few of the tools available for working with adoptive families. As adoption practice grows, more tools will be developed and existing ones modified. The most important aspect of working in adoption, regardless of the tools and techniques used, is building a relationship with the adoptive family. A practitioner has to be knowledgeable about

ADOPTION

the various aspects and themes in adoption, but knowledge will not substitute for good relationship-building skills. Once a practitioner has a good relationship, then knowledge and evidence-based practice will be critical to working in adoption.

The Future of Adoption Over the past twenty years, there have been many positive changes with regard to adoption. Improvements in counseling services, education campaigns, and the shift to open adoption are but a few reasons we have seen greater awareness and acceptance of adoption than in decades past. As a result, families interested in adoption today have greater access to resources to help make informed decisions that are right for them and their child.

NOTES

1. The specifics about how to pursue adoption are not reviewed in detail; that information can be found online from government and state-based sources (see http://www.childwelfare.gov/adoption/adoptive/; http://www.adoptuskids.org/resourcecenter/ howtoadopt.aspx; retrieved October 13, 2011) and from many other nongovernment sources (http:// www.nacac.org/howtoadopt/howtoadopt.html; http://www.adoptex.org; retrieved October 13, 2011). 2. Personal communication with Susan Cox, September 20, 2011. 3. Personal communication with Dr. John Raible, October 20, 2011. REFERENCES

Adoption and Foster Care Analyis and Reporting System (2011). Administration for Children and Families, National Adoption and Foster Care Statistics 18. Washington, DC: Adoption and Foster Care Analysis and Reporting System. Ames, E.  W. (1997). The development of Romanian orphanage children adopted to Canada. Burnaby: Simon Fraser University. Aust, P. H. (1981). Using the life story book in treatment of children in placement. Child Welfare, 40 (8), 535–60. Babb, L. A. (1999). Ethics in American adoption. Westport, CT: Bergin and Garvey.

]

Tremendous strides have been made over the last two decades in adoption. Adopted children and youth, or birthparents who create an adoption plan, are less often the subject of ridicule or scorn. Invaluable resources are available throughout and after the adoption process to promote the health of the adopted child, the birthparents, and the adoptive family. Moving forward, there is a need to continue to work toward promoting the proven benefits of postadoption services: education and counseling on post-traumatic stress and improving family life together can be necessary for years beyond the actual placement of a child/youth into a family. Many believe that the adoption landscape will continue to change socially, economically, and practically over the next decade—and many believe that the field must continue to focus on maintaining positive advancements.

Babb, A. (2001). Ethics in contemporary American adoption practice. In V. Groza & K. Rosenberg (eds.), Clinical and practice themes in adoption: Bridging the gap between adopted persons placed as infants and as older children (rev. ed., pp. 105–55). Westport, CT: Bergen and Garvey. Bailey, J. J., & Gibben, L. N. (2001). The Adoption reunion survival guide: Preparing yourself for the search, reunion, and beyond. NY: New Harbinger. Barth, R. (1992). Adoption. In P. J. Pecora, J. K. Whittaker, A. N. Maluccio, R. P. Barth, & R. D. Plotnick (eds.), The child welfare challenge: Policy, practice, and research (pp. 361–98). Hawthorne: New York: Aldine de Gruyter. Barth, R. P., & Berry, M. (1988). Adoption and disruption: Rates, risks, and responses. New York: Aldine de Gruyter. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford. Beeman, S., & Boisen, L. (1999). Child welfare professional’s attitudes towards kinship foster care. Child Welfare 78, 315–37. Bonecutter, F. J., & Gleeson, J. P. (1997). Broadening our view: Lessons from kinship foster care. Journal of Multicultural Social Work, 5 (1), 99–119. Brodzinsky, D. (1990). A stress and coping model of adoption adjustment. In D. Brodzinsky & M. Schecter (eds.), The psychology of adoption (pp. 3–24). New York: Oxford University Press.

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Child Welfare (1986). Book review of The Book of Me by Gail Folaron. Child Welfare 65, 509. Chisholm, K. (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development, 69, 1092–1106. Crumbley, J. (1999). Transracial Adoption and Foster Care: Practice Issues for Professionals. Washington, DC: Child Welfare League of America. Davidson, B. (1997). Service needs of relative caregivers: A qualitative analysis. Families in Society, 78, 502–10. Doss, H. (1954). The Family nobody wanted. Boston: Northeastern University Press. Eldridge, S. (1999). Twenty things adopted kids wish their adoptive parents knew. New York: Delta. Fogg-Davis, H. G. (2002). The ethics of transracial adoption. Ithaca: Cornell University Press. Fessler, A. (2007). The girls who went away: The hidden history of women who surrendered children for adoption in the decades before Roe v. Wade. New York: Penguin. Fostering Connections to Success and Increasing Adoptions Act of 2008. P. L. No. 110-351, Stat 3949 (2008). Freundlich, M. (2002). Adoption research: An assessment of empirical contributions to the advancement of adoption practice. Journal of Social Distress and the Homeless, 2, 143–66. Freundlich, M. (2000a). Adoption and ethics: The market forces in adoption. Washington, DC: Child Welfare League of America and Evan B. Donaldson Adoption Institute. Freundlich, M. (2000b). Adoption and ethics: The role of race, culture, and national origin in adoption. Washington, DC: Child Welfare League of America and Evan B. Donaldson Adoption Institute. Freundlich, M., & Liberthal, J. K. (2001). Adoption and ethics: The impact of adoption on members of the triad. Adoption and Ethics series. Washington, DC: Child Welfare League of America and Evan B. Donaldson Adoption Institute. Groza, V., & Ileana, D. (1999). International adoption and adoption services. In T. Tepper & L. Hannon (eds.), International adoption: Challenges and opportunities (pp. 42–61). Pittsburgh: Parent Support Network for the Post Institutionalized Child. Groza, V., Maschmeier, C., Jamison, C., & Piccalo, T. (2003). Siblings and out-of-home placement: Best practices. Families in Society, 84, 480–90. Groza, V., & Rosenberg, K., eds. (2001). Clinical and practice themes in adoption: Bridging the gap between adopted persons placed as infants and as older children (rev. ed.). Westport, CT: Bergen and Garvey. Groze, V. (1986). Special needs adoption. Children and Youth Services Review, 8, 81–91. Groze, V. (1991). Adoption and single parents: A review. Child Welfare, 70, 321–32. Groze, V., & Rosenthal, J. A. (1991). Single parents and their adopted children: A psychosocial analysis. Families in Society, 72, 67–77.

Hartman, A. (1984). Working with adoptive families beyond placement. New York: Child Welfare League of America. Hartman, A., and Laird, J. (1983). Family-centered social work practice. New York: Free Press. Hochman, G., Huston, A., & Feathers-Acuna, A. (1992). The sibling bond: Its importance in foster care and adoptive placement. Washington, DC: National Adoption Information Clearinghouse. Javier, R. A., Baden, A., Biafora, F. A., & CamachoGingerich, A. (2007). Handbook of adoption: Implications for researchers, practitioners, and families. Thousand Oaks, CA: Sage. Kagan, R. M., & Reid, W. J. (1986). Critical factors in the adoption of emotionally disturbed youth. Child Welfare, 65, 63–73. Keck, G. C., & Kupecky, R. M. (1998). Adopting the hurt child: Hope for families with special-needs kids: A guide for parents and professionals. Colorado Springs: Pinion. Keck, G.  C., & Kupecky, R.  M. (2002). Parenting the hurt child: Helping adoptive families heal and grow. Colorado Springs: Pinion. Kirk, D. (1964). Shared fate: A theory of adoption and mental health. London: Free Press of Glencoe. Lifton, B. J. (1988). Lost and found: The adoption experience. New York: Harper & Row. Lifton, B. J. (1994). Journey of the adopted self: A quest for wholeness. New York: Basic Books. McMillen, J.  C., & Groze, V. (1994). Using placement genograms in child welfare practice. Child Welfare, 73, 307–18. Mallon, G. P. (2004). Gay men choosing parenthood. New York: Columbia University Press. Mallon, G. P. (2006). Lesbian and gay foster and adoptive parents: Recruiting, assessing, and supporting an untapped resource for children and youth. Washington, DC: Child Welfare League of America. Mallon, G. P. (2008). Social work practice with LGBT parents and their children. In G. P. Mallon (ed.), Social work practice with lesbian, gay, bisexual, and transgender people (pp. 267–310). New York: Routledge. Mallon, G. P. (2011). Lesbian and gay prospective foster and adoptive families: The home study assessment process. In D. Brodzinsky & A. Pertman (eds.), Adoption by lesbians and gay men: A new dimension in family diversity (pp. 130–49). New York: Oxford University Press. Mallon, G., & Betts, B. (2005). Recruiting, assessing and retaining lesbian and gay foster and adoptive families: A good practise guide for social workers. London: British Association of Adoption and Foster Care. Martinez-Dorner, P. (1999). How to open an adoption. San Antonio, Texas: Adoption Counseling & Search. Melina, L. R. (1986). Raising adopted children: A manual for adoptive parents. New York: Harper & Row. Miller, L. C. (2000). Initial assessment of growth, development, and the effects of institutionalization in internationally adopted children. Pediatric Annals, 29 (4), 224–32.

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National Resource Center for Permanency Planning (2000). Legislative Summary. New York: National Resource Center for Permanency Planning. Needell, B., & Gilbert, N. (1997). Child welfare and the extended family. In R.  P. Barth, J.  D. Berrick, & N. Gilbert (eds), Child welfare research review (pp. 85–99). New York: Columbia University Press. O’Connor, T. G., & Zeanah, C. H. (2003). Attachment disorders: Assessment strategies and treatment approaches. Attachment and Human Development, 5, 223–44. Paton, J. M. (1954). The Adopted Break Silence. Philadelphia: Life History Study Center. Pavao, J. (1992). Normative crises in the development of the adoptive family. Adoption Therapist, 3 (2), 1–4. Pavao, J. (2005). The family of adoption (2d ed). Boston: Beacon. Pinderhughes, E.  E., & Rosenberg, K. (1990). Family bonding with high-risk placements: A therapy model that promotes the process of becoming a family. In L. M. Glidden (ed.), Formed families: Adoption of children with handicaps (pp. 261–82). Binghamton, NY: Haworth. P.L. 96–272, Adoption Assistance and Child Welfare Act. (1980). P.L. 103–382, Multiethnic Placement Act. P.L. 104–188, The Interethnic Adoption Act of 1996, Removal of Barriers to Interethnic Adoption. P.L. 104–193, Personal Responsibility and Work Opportunities Act. P.L. 105–89, Adoption and Safe Families Act. (1997). P.L. 106–279, Intercountry Adoption Act (2000). Reitz, M., & Watson, K.  W. (1992). Adoption and the family system: Strategies for treatment. New York: Guilford. Rosenberg, E. B. (1992). The adoption life cycle: The children and their families through the years. New York: Free Press. Rosenberg, K.  F., & Groze, V. (1997). The impact of secrecy and denial in adoption: Practice and treatment issues. Families in Society, 78, 522–30. Rosenthal, J.  A., Schmidt, D., & Conner, J. (1988). Predictors of special needs adoption disruption: An exploratory study. Children and Youth Services Review, 10, 101–17. Rutter, M., Quinton, D., Hay, D., Dunn, J., O’Connor, T., & Marvin, R. (1995). The social and intellectual development of children adopted into England from Romania. London: Department of Health. Ryan, S., Pearlmutter, S., & Groza, V. (2004). Coming out of the closet: Opening agencies to gay and lesbian adoptive parents. Social Work, 49, 85–96. Scannapieco, M., Hegar, R. L., & McAlpine, C. (1997). Kinship care and foster care: A comparison of characteristics and outcomes. Families in Society, 78, 480–88. Shireman, J. F. (1988). Growing up adopted: An examination of some major themes. Chicago: Chicago Child Care Society.

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Shireman, J.  F., & Johnson, P.  R. (1976). Single persons as adoptive parents. Social Service Review, 50, 103–16. Shireman, J.  F., & Johnson, P.  R. (1985). Single-parent adoptions: A longitudinal study. Children and Youth Services Review, 7, 321–34. Simon, R., & Roordea, R.M. (2000). In their own voices: Transracial adoptees tell their stories. New York: Columbia University Press. Smith, D., Jacobson, C. K., Juarez, B. G., & Feagin, J. R. (2011). White parents, black children: Experiencing transracial adoption. Boston: Rowman & Littlefield. Smyke, A. T., Dumitrescu, A., & Zeanah, C. H. (2002). Attachment disturbances in young children. I: The continuum of caretaking casualty. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 972–82. Steinberg, G., & Hall, B. (2000). Inside transracial adoption. Indianapolis: Perspectives. Stolley, K. S. (1993). Statistics on adoption in the United States. In I. Schulman (ed.), The future of children (pp. 26–42). Los Altos, CA: Center for the Future of Children. Strauss, J. (1994). Birthright: A guide to search and reunion for adoptees, birthparents and Adoptive Parents. New York: Penguin. Timberlake, E. M., & Hamlin, E. R., II. (1982). The sibling group: A neglected dimension of placement. Child Welfare, 61, 545–52. Tracy, E. M., & Whittaker, J. K. (1990). The social network map: Assessing social support in clinical practice. Families in Society, 71 (8), 461–70. Trenka, J. J., Oparah, J. C., Shin, S. Y., eds. (2006). Outsiders within: Writing on transracial adoption. Boston: South End. U.S. Census Bureau (2003). Adopted children and stepchildren: 2000. Washington, DC: U.S. Census Bureau. U.S. Department of State (2010). Immigrant visas themed to orphans coming to the U.S. Retrieved October 13, 2010, from travel.state.gov/orphan_ numbers.html. U.S. Department of Health and Human Services (2013). The AFCARS Report #20: Final estimates for FY2012, Retrieved October 26, 2013, from http://www.acf. hhs.gov/programs/cb/stats_research/afcars/tar/ report20.htm. van Senden Theis, S. (1924). How foster children turn out. Publication no. 165. New York: New York State Charities Aid Association. Verrier, N. N. (1993). The primal wound: Understanding the adopted child. Baltimore: Gateway. Wasson, V. P. (1939). The chosen baby. New York: Lippincott. Wedge, P., & Mantle, G. (1991). Sibling groups and social work: A study of children referred for permanent substitute family placement. Brookfield, MA: Avebury. Wheeler, C. (1978). Where am I going? Making a life story book. Juneau: Winking Owl.

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Birth Mothers

B

irth mothers who do not have custody of their children have been in large part either overlooked or deemphasized in child welfare literature and are a population that is inadequately served by the child welfare system. Women who have relinquished their parental rights so that their biological child or children are legally free for adoption have often been perceived as having made a mistake and joined by the professionals serving them in a collective societal effort to forget the “mistake” and move on with their lives. As “special needs” adoptions of older children began to replace traditional infant adoptions, consideration has been given to whether an adoption would be open (to contact with the birth parent) or closed (to such contact), but with control of the agreed upon contact often in the hands of the adoptive parents. Birth parents who have come into the social welfare system as perpetrators of child abuse or neglect, are frequently subject to perceptions that they are undeserving of having their own needs and interests attended to or undeserving of continuing to parent their children. What is known about the effects of loss of custody on birth mothers has been derived primarily from phenomenological studies of relinquishing mothers, i.e., mothers who have voluntarily given up their parental rights. Table 22.1 provides a list of these studies and the characteristics of the study samples. Readers are also referred to The Girls Who Went Away (Fessler 2006), which draws upon Fessler’s interviews with more than one hundred mothers who relinquished their babies for adoption from

1945 to 1973 to provide a detailed depiction of their experiences. The findings from these relinquishment studies suggest the women may be left with significant health, mental health, substance abuse, and family problems. They are also vulnerable to the societal attitudes and social policies that perpetuate these experiences. Such women are therefore likely to make up a substantial proportion of individuals receiving health, mental health, substance abuse, and interpersonal services in the United States. Limited knowledge has been developed with regard to the experiences of birth mothers whose parental rights are terminated. Mason and Selman (1997) provide results of eighteen interviews with twenty-one birth parents whose parental rights were terminated and whose children were subsequently adopted. Freundlich (2002) summarizes results of several studies of birth parents whose parental rights were terminated. These studies involved relatively small samples and were conducted in Great Britain. Hollingsworth’s study of child custody loss among women with persistent severe mental illness (1999) provides additional knowledge of the experience of women in this circumstance. In their review of clinical and empirical literature on birth parents in the adoption triad, Wiley and Baden (2005) include “involuntary relinquishment” (pp. 21–25). While they concur with the finding of a dearth of knowledge in this area, they do provide some updating and include a case study. Laufer’s (2006) dissertation 424

BIRTH MOTHERS TA B L E 2 2 . 1

]

Overview of Relinquishment Studies Reviewed

Author(s)

Year

N

Data Collection and Sample Characteristics

Pannor, Baran, & Sorosky*

1978

38

Interviews to study the effects of relinquishment with participants who contacted the pilot project (included two birthfathers). Time since relinquishment: 1–33 years.

Burnell & Norfleet*

1979

80

300 multiple choice format questionnaires were mailed to a randomly selected sample of women who had placed their children through an agency. The majority had relinquished 1.5–3 years previously.

Lamperelli & Smith*

1979

19

Interviews with and observations of women throughout the pregnancy and postpartum period in a maternity home.

Rynearson*

1982

20

Psychiatric outpatients (none in psychiatric therapy specifically for issues related to relinquishment). Women with psychotic or schizophrenic disorders were excluded. Time since relinquishment: 15–21 years.

Deykin, Campbell, & Patti*

1984

334

Written questionnaire completed by members of a support group for relinquishing parents (321 birthmothers, 13 birthfathers).

Winkler & VanKeppel

1984

213

Mailed questionnaire and personal interview with single women between 15 and 25 years old at relinquishment who relinquished their first born within 3 months of birth. Time since relinquishment: 0–20 + years.

Millen & Roll*

1985

22

Interviews with women receiving psychotherapy (two specifically for the issue of relinquishment). Time since relinquishment: 5–20 + years.

Condon*

1986

20

Interviews with birthmothers attending a support group for women. Time since relinquishment: 1–35 years.

Tennyson*

1988

1

Case study in which the respondent was interviewed during the third trimester and at 48 hours and 1 month postbirth.

Blanton & Descher*

1990

59

Interviews with women who had relinquished their infants at least 1 year before the study through one of four adoption agencies in open or closed adoptions.

Faulkner

1991

3

One group interview lasting several hours. Time since relinquishment: 20–23 years.

Brodzinsky, A.*

1992

214

Mailed surveys to birthmothers recruited through letters from adoption agencies with which they had relinquished their first child 19.3 months prior to the study, on average.

Field

1992

444

Mailed survey to women in New Zealand who relinquished a child 27–40 years prior. Compared women who had reunified with the child to those women who had not.

Lancette & McClure*

1992

5

Interviews with mothers who had contacted a pregnancy help line. Time since relinquishment: < 2 years.

McAdoo

1992

41

Semi-structured interviews with birthmothers recruited through personal familiarity with the research, an adoption search and support organization, and word of mouth.

Davis*

1994

14

Interviews with searching mothers. Time since relinquishment: 6–27 years.

Lauderdale and Boyle

1994

12

In-depth interviews with birthmothers recruited through search and support organizations and word of mouth. Relinquishment period: 1950–1969. (continued)

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TA B L E 2 2 . 1

Overview of Relinquishment Studies Reviewed (Continued)

Author(s)

Year

N

Data Collection and Sample Characteristics

Weinreib & Knostam

1995

8

Interviews with Caucasian women who had relinquished, recruited through support groups for women and local newspapers. Women were 18–28 years old at the time of relinquishment. Time since relinquishment: 16–35 years.

De Simone

1996

264

Mailed questionnaire completed by mostly Caucasian birth mothers who had relinquished an infant for adoption and who were reunited. Recruited from adoption organizations, word of mouth, newspaper advertisements.

Logan

1996

30

Interviews using semi-structured questionnaires with 28 birth mothers and 2 birth fathers in Manchester, England who had relinquished at least one child when they were in their “low teens to late thirties.”

Author(s)

Year

N

Data Collection and Sample Characteristics

Wile & Scheidt

1996

28

Reviews of medical records of women with histories of psychiatric hospitalizations, also including 22 women who had had abortions and 32 women with no children.

Thomas & Tori

1999

38

Structured interviews with women in the four locked psychiatric units at a large general hospital. Study was subsequently expanded to include 36 women who had had abortions and 45 women who had experienced both abortions and relinquishments.

This table builds on one developed in a review by of relinquishment studies by Askren and Bloom (1999). Asterisks (*) identify studies that were part of the original Askren & Bloom (1999) study.

study investigated birth mothers’ reactions in “final visits” after termination of parental rights, providing information about how birth mothers experience the losses involved. “Final visits” are in-person visits in which an opportunity is provided for parents whose rights have been terminated and their children to say good-bye to each other since further contact is generally prohibited by the judicial system. In this chapter the information available from studies of birth mothers’ experiences with termination of their parental rights is reviewed to expand the knowledge base and extend a research agenda. Case material will supplement conceptualized and empirical knowledge. Because most studies have been limited to women, and because women are heavily represented in the child welfare system, this chapter focuses on the experiences of women and on their service needs. However, this decision has been made with recognition that the lack of knowledge about the experience of birth fathers

in the child welfare system also represents a serious gap. Finally, the emphasis of the chapter on the experiences of birth mothers does not reduce the importance of the best interests of the children who have often been victimized. This chapter seeks to close a gap in assessment and interventions to address the effects of the loss of custody of a child on a parent’s well-being. Greater awareness of the effects of termination of parental rights both supports and guides service providers as they acknowledge and address loss of custody as a serious precipitant in parents’ psychosocial and somatic problems. This chapter also provides continued direction for research on policies that would lend future support for services to persons affected. Finally, it is hoped that this chapter will raise readers’ awareness with regard to the human qualities of persons who have legally lost the right to raise their children due to their abuse and/or neglect of them and contribute to more adequate identification of and services to address the needs of these parents.

BIRTH MOTHERS

Demographic Patterns for Children, Youth, and Families Affected Relinquishments historically have occurred among young, unmarried, Caucasian women from middle- to higher-class socioeconomic backgrounds. In the period when relinquishments were highest, the percent of children relinquished by never married Caucasian women less than 45 years of age was 19.3, compared to 1.5 percent of children of never married African American women under 45. Bachrach, Stolley, and London (1992) analyzed 1982 and 1988 data from the National Survey of Family Growth involving 430 unintended premarital births to non-Hispanic Caucasian women. In a multivariate analysis in which a number of other variables were controlled, women were less likely to relinquish in later years, when they were out of school before the pregnancy occurred, when they had worked or were working for pay, when they had had a prior birth, and when the child was male. The finding regarding age was in the opposite direction from what had been anticipated and was believed to be explained by the association of age with other variables in the model. The National Survey of Family Growth (NSFG) is the only natural source of data on voluntary relinquishment for adoption (Child Welfare Information Gateway 2005). According to the 1995 NSFG, less than 1 percent of children born to never married woman were relinquished for adoption from 1989 to 1995; applying this rate to determine children born to never married women who gave birth in 2003, would mean fewer than fourteen thousand children were relinquished by their mothers in 2003 (Child Welfare Information Gateway 2005). Voluntary relinquishment is increasingly rare in the U.S. Since agency records tend to be kept in children’s rather than in parents’ names, the number of parents who have had their parental rights terminated involuntarily is not known. However, of the 399,546 children who were in foster care on September 30, 2012, the parental rights of 58,587 (15 percent) of them had been terminated

]

(U.S. Department of Health and Human Services, 2013).We do not know the demographic characteristics of these parents. However, we do know that child maltreatment is the primary reason parental rights are terminated. Laufer (2006) notes that state petitions to the court for parents’ rights to be terminated are most often enacted in situations where children have been placed in legal custody for severe abuse or neglect and the parents have not made the necessary changes to the conditions that resulted in the child’s placement. Children of color are consistently overrepresented in the foster care system (see McRoy’s chapter, this volume) compared to their presence in the population. However, it is important to note that at least 45 percent of the children in the 2012 AFCARS statistics were Caucasian, reminding us that, a large proportion of Caucasian women also experience the termination of their parental rights. In the Wattenberg et al. Minnesota sample, 64 percent of mothers were Caucasian, almost 21 percent were African American, 9.3 percent were American Indian, and 5.7 percent were multiracial, of other races, or of undesignated races. Women whose parental rights are terminated may also be more likely to have a psychiatric problem or diagnosis or a substance abuse problem or both. Among the characteristics of 206 severely abused and/or neglected children brought to Boston Juvenile Court on care and protection orders (Jellinek et al. 1992), 43 percent of parents were found to have a documented diagnosis of substance abuse, and 31 percent had a documented psychiatric diagnosis; an additional 11 percent had historical or behavioral evidence of a psychiatric diagnosis. In the Wattenberg, Kelley, and Kim (2001) Minnesota sample, almost 58 percent of women whose parental rights had been terminated had a substance abuse history, and 47.5 percent had diagnoses of serious, persistent mental illness, including depression, bipolar disorder, schizophrenia, or personality disorders. More than 80 percent of the women had dual or multiple disorders.

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Societal Context The experience of having one’s parental rights terminated is characteristic, from a societal standpoint, of disenfranchised grief (Aloi 2009, citing Doka). Doka has defined disenfranchised grief as grief that is not openly acknowledged, socially accepted, or publicly mourned. Termination of parental rights typically results from a parent’s abuse or neglect of a child—abuse or neglect severe enough to cause serious harm to the child and persistent enough to suggest that the likelihood of rehabilitation from such behavior is negligible. Given this context, many may be surprised that such birth parents would even have any grief. Perceived as having abused or neglected her child and therefore as being a bad mother, a woman who loses parental rights may be considered by some to be incapable of mourning. Laufer (2006) notes that parents often view involuntary termination as condemnation by the child welfare system and the court. Mason and Selman (1997) found that birth parents felt they were being publicly branded as bad parents in the court system where their parental rights were terminated. Charlton, Crank, Kansara, and Oliver (cited in Freundlich 2002) described birth parents’ feelings that their involvement with the court system involved a loss of selfworth and confidence in addition to the loss of their children. Swift (1995) has described a Canadian child welfare system that produces the concept of “bad mothers” who do not care for their children, who are therefore unworthy of help. Such women are considered to deserve only to have their children helped through exertion of a state authority over the family. Swift points out that this approach on the part of the state reproduces the conditions of poverty, marginalization, and violence that the families live in the first place. Collins has described (1997) an emerging population policy that distinguishes between genetic mothers (who contribute biologically to the genetic material of the nation’s children), gestational mothers (who carry the developing fetus until birth), and social mothers (who care

for the children once born). Middle-class and affluent Caucasian women were perceived as social mothers, superior in caring for and raising the children while working-class women are encouraged to become genetic and gestational mothers, but are increasingly seen as unfit to serve as the social mothers of the nation. Thus the latter group is perceived as increasingly encouraged to give up their children for adoption. Collins notes that changes in abortion policy, affirmative action, and welfare policies support such directions. Hollingsworth (2001) called attention to similar concerns related to the passage of the Adoption and Safe Families Act (1997), which, while directed at protecting the health and safety of children, made it easier for disadvantaged birth parents to lose custody and for advantaged persons to acquire infants and young children who were more desirable for adoption. Vulnerabilities and Risk Factors Certain characteristics have been identified among women whose parental rights are terminated, suggesting these characteristics may put women at increased risk for such terminations. In addition to younger age at the birth of their first child and as abusing a substance and/or having a severe, persistent mental illness diagnosis, almost 31 percent of Minnesota women experiencing involuntary terminations had a history of having been abused or placed in the foster care system as children. Similarly, caseworkers who participated in Laufer’s (2006) study of “final visits” that preceded termination of parental rights described many of the birth mothers as having been victims of child maltreatment themselves. Almost 23 percent of women in the Minnesota study experienced a relationship in which domestic violence was present, and almost 27 percent had a prostitution or criminal record (Wattenberg, Kelley, & Kim 2001). At the time of the termination proceeding, almost 58 percent had unresolved chemical dependency problems, 36 percent were in abusive domestic relationships, 35 percent had an active mental

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illness, 31 percent were unable to maintain stable housing, over 17 percent had intellectual limitations considered severe enough to interfere with adequate parenting, and 9 percent were incarcerated. Studies of British women whose parental rights have been terminated indicate their vulnerability to “a continuing sense of anger and guilt that persisted long after their children were adopted, and significant psychological problems” (Mason & Selman 1997, citing Hughes & Logan). Having their children adopted after termination of their parental rights was described by Mason and Selman as having “a devastating and long-term effect on the lives of most of the parents, leaving them with feelings of isolation and emptiness” (p. 25). These birth parents reported adverse effects on mental and physical health and ongoing concerns about their children’s whereabouts and well-being (Mason & Selman 1997). The most commonly reported problems identified by Freundlich (2002, citing Charlton et al.) in interviews with sixty-five birth parents whose parental rights were terminated were physical symptoms associated with bereavement and trauma, such as sleeping problems, poor appetite, and dreams about either the loss of the child or about searching and the return of the child to them. Many birth parents also described relationship difficulties, particularly with new partners; a reluctance to enter new relationships; and/or a sense of isolation from the new partner (who did not share the experience of the loss of the child). In interviews regarding “final visits” before termination hearings, caseworkers in Laufer’s (2006) study described behaviors of biological parents that rendered such visits unsuccessful and that were frequently reasons for not holding the visits. Such behavior included “parents saying hurtful things about their children, exhibiting disruptive behaviors, mak[ing] the children feel responsible for the [termination], or telling the children they (parents) would be regaining their parental rights” (p. 76). In addition, “the expression of extreme sadness,” [including]

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“excessive crying” . . . [and] strugg[ling] to let go of their child” (pp. 77–78) were associated with unsuccessful final visits. Interestingly, many of these behaviors are consistent with descriptions of stages of grief. For example, Kübler-Ross (1969) described the stages of grief as denial, anger, bargaining, depression, and acceptance. The behaviors described seem consistent with the first two if not the first four stages. The effects for which birth mothers whose parental rights are terminated are vulnerable are similar to those for which women who relinquish “voluntarily” have been found to be vulnerable. Long-term symptoms can be categorized into three types: psychological, psychosomatic, and marital/family. The symptoms often persist years beyond the relinquishment, until reunion with the adoptee, or throughout the birth mother’s life. Psychologically, women who have relinquished have alternately described or presented with symptoms such as depression, social anxiety, agoraphobia, and other anxiety/phobic states; isolation and withdrawal; emotional numbing and dissociation; feelings of loss of self, inadequacy, or a damaged sense of self, coupled with self-mutilation and self-destructive behavior; guilt about having relinquished, made more intense because they, and others, feel they have only themselves to blame. Others identify anger at and disillusionment with professionals, birth fathers, parents, and others who could have prevented the loss and did not; recurrent feelings of stress, alarm, and anguish; fantasies of reunion with the child and the birth father; and recurrent preoccupation with fear that the child may be in danger or worry about the child’s happiness, health, and well-being. In one study reviewed by Stiffler (1991), forty-nine of sixty-four relinquishing birth mothers studied reported thoughts of committing suicide and fourteen had attempted it. Health or psychosomatic symptoms have been found to include recurrent gynecologic infections, frequent or severe headaches, sexual dysfunction, secondary infertility, and other somatic symptoms (Askren & Bloom 1999).

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Problematic marital and family outcomes include failure to become pregnant again (36 percent; Stiffler 1991); being perfectionistic, possessive, and/or overprotective with subsequent children; or feeling tense and uneasy around children in general. Sexual dysfunction is also reported by some women. Although not all birth mothers who relinquished have all the symptoms that have been presented, none of the studies reported a total absence of symptoms. Resiliencies and Protective Factors Little is known about how birth mothers cope with the termination of their parental rights. Laufer (2006) writes that “when an involuntary termination is enacted, it can at times be a relief for the parents who struggled to make the decision whether to voluntarily relinquish their parental rights due to feelings of guilt and shame, financial incentive, and pressure from family members (p. 27).” Laufer cites Kay and Westman (Laufer 2006:27) that “some parents are able to view the termination of their rights as a means of providing better opportunities for their biological children as the children can be placed with an adoptive family that can better care for them.” Laufer acknowledges that a decision to terminate the rights of a biological parent is a complex and emotional one for all. In semi-structured interviews with seventy-nine women with severe, persistent mental illness who lost custody of a child temporarily or permanently and who answered a question of whether and why they considered their child’s placement as helpful for themselves (Hollingsworth 1999:224), 58 percent felt the placement had been helpful, 33 percent did not, and 9 percent had a mixed or ambivalent response. Of the seventy-seven women in the same sample who answered a question of whether and why they felt their child’s placement was helpful for the child, 49 percent felt the placement had been helpful for their child, 26 percent did not, and 25 percent gave a mixed or ambivalent response. It should be

noted that the sample included women whose children were reunified with them and women whose parental rights were terminated. Given that caution, however, it was noteworthy that a much larger percentage of women had mixed or ambivalent feelings about the helpfulness of placement for their child than for themselves. This may suggest differences based on the permanency of the placement or that the women were able to think of the placement from the perspective of their child’s best interests. Other factors may explain the difference in response as well. One protective factor seems to be the informal assistance provided by relatives and friends to birth mothers attempting to cope with active symptoms of serious mental illness while parenting their children. Hollingsworth (2005) found that the largest proportion of persons providing help were sisters of the birth mother, followed by the birth mother’s own mother, and the children’s biological father from whom the birth mother was estranged. Friends also were a noteworthy source of support. In recent years, some birth mothers have participated in support groups and activist activities through organizations such as Adoption Healing (2011), which, according to their Web site, is a not-for-profit “dedicated to helping people who have been separated by adoption find each other. We are part of an international effort to preserve families, open adoption records, and educate the public about adoption related issues.” Current Policies at the Federal and State Level Several federal policies have or have had particular implications for parental rights terminations. The Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) placed an emphasis on family preservation and reunification. However, concern about slow progress with family preservation and children “languishing” for long periods in foster care while awaiting reunification led to passage of the

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Adoption and Safe Families Act of 1997 (P.L. 105-89). This legislation has made the child’s health and safety foremost in decision making. While permanency is a goal, several elements of the legislation favor adoption. These include a requirement for making an adoption plan concurrent with work toward reunification; reduction of the amount of time allowed for “reasonable efforts” toward reunification to be made; and identifying circumstances in which such reasonable efforts to reunify would not be required. In 2008 the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110–351) was passed. Among other provisions, this legislation has as its goal facilitating relative caregiving when children must be placed, particularly through financial support to kinship guardianships that is commensurate with incentives associated with legal adoption. The law also calls for reasonable efforts to place siblings together. Under these provisions, birth parents whose parental rights are terminated may be comforted in the knowledge that relatives are caring for their children, thereby potentially reducing grief associated with the loss of the children. This raises several possible complications, however. Children placed with relatives may be more likely to have contact with their birth parents when such contact is generally legally forbidden under parental rights terminations. Also, birth parents may have adversarial relationships with relatives with whom a child is placed, increasing the birth parents’ feelings of loss and powerlessness associated with the termination. States have the power to enact laws that may be more severe than those required under federal legislation. As one example, following federal enactment of the Adoption and Safe Families Act of 1997, which reduced the requirement for reasonable efforts to twelve out of the fifteen months a child was in care, Minnesota reduced the time allowed until permanency from twelve to six months for children under age eight (Wattenberg, Kelley, & Kim 2001).

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Programs and Child Welfare Contributions Promising Approaches The Children’s Bureau of the U.S. Department of Health and Human Services, Administration for Children and Families (2011), through its Child and Family Services Reviews, identifies approaches to child welfare services that are labeled “promising.” The bureau makes no representations as to the effectiveness of the approaches, however, and has not verified that they have been properly evaluated. In round 2 of the reviews, which began in 2007, two services were designated as promising and appear to have prevention implications for birth mothers whose children are in foster care. First, the State of Hawaii has implemented a three-tiered system of response and standardized intake, safety, risk and strength assessments for reports of child abuse and neglect; a family conferencing service that brings family members together to facilitate all levels of planning for children; and increased partnerships with the local Hawaiian community, including its elders, to help prevent maltreatment, strengthen families, and leverage cultural values and beliefs to improve the lives of children and families who are at risk of removal and/or termination of parental rights. In state fiscal year 2008, the disproportionality of Hawaiian and part-Hawaiian children in the state’s foster care system was reduced from 49.7 percent (out of a total population in the state of 31.3 percent) to 34.9 percent, more closely approximating their proportion of the state population. Second, in 2005, the State of Maine adopted the collaborative approach of a national initiative designed to reduce childhood abuse and neglect. The program has been successful in engaging communities, training community members to facilitate family team meetings for families in crisis, establishing a parent partner program, and offering support groups, training, and other assistance to parents with open cases in the local child welfare system. Engagement was identified as critical in creating successful

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outcomes for families. Stakeholder comments and feedback from case reviewers demonstrate that the approach has continued, is working as intended, and is becoming integrated at the local level. Program Models The U.S. programs identified in an earlier version of this chapter as providing services directly or indirectly to birth parents whose parental rights had been terminated continue. Center for Family Connections of Cambridge, Massachusetts provides services to those affected by and affecting adoption including birth parents, adopted persons, adoptive parents, and extended family members in individual, group, or family sessions. The program is described as emphasizing attention to the needs and perspectives of all involved. The center also provides professional training and consultation to practitioners, policy makers, and other professionals involved in adoption. Pavao (1998) has provided information about the center’s philosophy, practice methods, and numerous examples. Two observations by Pavao have particular implications for practitioners providing services to birth mothers whose parental rights have been terminated. First, Pavao observes that as many as 80 percent of these women have backgrounds themselves that involved experiences of trauma. This is consistent with the findings of others (Wattenberg, Kelley, & Kim 2001; Laufer 2006). Thus interventions appropriate for persons with trauma issues may be considered. Pavao also notes that, since child abuse or neglect have often been involved, women who have had their parental rights terminated often must acknowledge their own role in the termination before they are able to move forward in their healing. This is consistent with approaches to therapy with persons who have perpetrated other forms of abuse. Interventions that focus on micro-, meso- and macrosystems issues are appropriate here. A reading resource list available on the Web site of this agency includes materials that specifically address birth mothers’ issues.

Catholic Human Services in Traverse City, Michigan, provides preplacement services to birth mothers that are primarily microsystemic in nature. Services are provided to women faced with making a decision regarding their pregnancy. While traditional services have involved addressing issues of shame and social stigma, services currently tend to be to single women facing the birth of a second, third, or fourth child who do not have the resources to provide for the child. In some instances, women, anticipating an automatic termination because of having had parental rights terminated previously (related to state policy), seek placement as a way of assuming some control over the decision making regarding their child. Regardless of the surrounding circumstances, issues of ambivalence, grief, and regret surface and are addressed, as are needs for relationship counseling, housing, financial assistance, and legal services and planning and implementing an adoptive placement and exploring decisions regarding the openness of the placement. Finally, the Family and Children’s Resource Program is provided through the Jordan Institute for Families of the University of North Carolina School of Social Work, Chapel Hill. Through this program a two-day, competencybased curriculum entitled “The Emotional Aspects of Termination of Parental Rights” is offered to child welfare workers. This training focuses on topics such as the impact of termination of parental rights on birth parents, children, and child welfare workers and the issues of grief and loss for all involved in the termination and adoption. Such training should have an impact on provision of services to birth parents and their children. Assessments and Interventions In their review and integration of clinical and empirical literature on birth parents and adoption, Wiley and Baden (2005:23) write: “We found neither research nor documented counseling programs that addressed birth parents following the involuntary termination of their

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parental rights. Although a single study [not identified] was found that discussed group therapy issues for birth parents whose children were in foster care, no literature addressed treatment following involuntary relinquishment.” A computerized search for evidencebased assessment and diagnostic tools and intervention models that address birth parent issues related to termination of parental rights was similarly unsuccessful with the exception of the Laufer (2006) study. The following assessment components are implicit in Wiley and Baden’s (2005) presentation of a multiply diagnosed woman with serious mental illness and substance abuse and history of parental rights termination: presenting problem; history and effects of the parental rights termination; background history (including childhood history of maltreatment, child welfare system involvement, parental substance abuse and mental illness history); intimate relationship history; the client’s perception of the social and psychological context within which parental rights were terminated; and current psychological and social risks. Treatment strategies considered by Wiley and Baden as potentially effective included development of an assessment-based treatment plan in which psychiatric and substance abuse problems were addressed first, with subsequent attention to the psychosocial experience and current effect of the parental rights termination. Cognitivebehavioral, mindfulness, and grief therapies were applied, along with utilization of community resources (a self-help/support group and vocational counseling) and psychotropic medication and advocacy on the part of the mental health therapist. The therapist’s understanding and acceptance of the various phases of the client’s grief reaction and reframing of her reaction as normative in the context of grief and loss were explained as increasing the client’s feeling of being understood and validated. Aloi (2009) presents Worden’s model of grief counseling, which includes four aspects considered necessary for successful resolution.

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These are 1. acceptance of the reality of the loss, 2. experiencing the pain of grief, 3. adjustment to the environment from which the lost person is missing, 4. withdrawal of emotional energy from the lost person and reinvestment of emotional energy in someone or something else. Assistance with Accepting the Reality of the Loss Using findings from Laufer’s (2006) study of “final visits,” birth parent behaviors that seem consistent with normative grieving may be interpreted as interfering with successful facilitation of such visits and are likely used as reasons for not providing such a visit. In assisting birth parents with acceptance of the loss, Laufer recommends that birth parents be provided coaching prior to the final visit. This should include at least one face-to-face meeting with the facilitator to plan the visit and develop a plan regarding how the birth parent will explain, in language that the child can understand, the nature of the final separation to her children. Laufer cites Knight and Swanson and Schaefer in recommending that the final visit will be their last time together. Planning may also include a discussion of what the birth mother would like to accomplish during the visit and any concerns she may have with regard to the separation. This may involve explanations of why the parents’ rights were terminated, why contact with their children will cease, and how the “final visit” can benefit the child or children involved. Assistance with Experiencing the Pain of Grief To go through and experience the pain of grieving termination from their children and to ensure birth parents’ emotional needs are met, support must be provided.. Laufer suggests that facilitators of the final visit be cognizant of how a parent may be feeling and how this can impact the final visit. Understanding parents’ as well as children’s behavior in the context of stages of grief and loss may be helpful here. Facilitators are encouraged to listen empathically to the birth parents and

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acknowledge the pain they may be feeling as a result of the impending separation. Facilitators should be willing to cancel or postpone the visit if the parent feels it would be too difficult and traumatizing for them. Assisting with Adjustment to the Environment in Which the Child Is Absent To prepare birth parents to adjust to or cope with their environment without the presence of their child, Laufer suggests parents may be assisted in creating a voice recording (Levy & Zelman; Swanson & Schaefer as cited in Laufer 2006), engaging in family remembrance rituals, writing good-bye letters, taking pictures, and recalling both positive and negative memories about the children. Assisting with Withdrawing and Re-investing Emotional Energy The fourth and final aspect of Worden’s recommendations for successful grief resolution is withdrawal of emotional energy from the lost person and reinvestment of emotional energy in someone or something else. Haight et al. and Jarratt (as cited in Laufer 2006) include biological parents among those for whom support and comfort following the “final visit” are important. As noted earlier, many parents who lose their parental rights due to abuse and neglect of their children have themselves been raised in families where maltreatment was extensive. Mennen and O’Keefe (as cited in Laufer 2006) report that individual therapy appears to be beneficial for the parents to assist them with processing their own history as well as the current loss of their children. Effects of Openness of Adoptions Open adoptions have become an option for adoptive and birthparents as a humane way of reducing the long-term effects on children of experiencing the grief and loss associated with the termination of their parents’ rights. Outcome studies (Askren & Bloom 1999) reveal mixed results. In some instances, particularly where birth mothers felt more control in

placement decisions, pathological symptoms were reduced. However, for other birth mothers, openness in adoption meant that the pain experienced with the loss was never ending. In a study of sixty-one relinquishing birth mothers for whom data at Wave 1 (four to twelve years postplacement) and Wave 2 (twelve to twenty years postplacement) were available, and for whom there were matching data from the adoptive family at both waves (Henney et al. 2007), the relationship between openness and grief outcomes was found to be a complex one. The majority of those birth parents who decreased or remained stable in their grief feelings over time had some form of ongoing openness in the adoption. However, openness did not entirely mitigate grief. Several birth mothers with ongoing openness reported increased grief over the study period. In addition, factors such as the birth mother’s subsequent marriage, birth of additional children, length of time since the relinquishment, and key developmental milestones in the child’s life were influential, emphasizing the complex nature of adoption openness and its relationship to parental grief and loss. Illustrations and Discussion The following two excerpts from interviews with women who lost permanent custody of their children provide a glimpse into the ways in which birth parents may experience the termination of their rights as parents. 1. After a long legal battle, interspersed with psychiatric hospitalizations—one of which occurred during the final divorce hearing so that she was not present—a woman fortyseven years old at interview and diagnosed with major depression and her husband were divorced. Her husband obtained full custody. Asked whether she felt the loss had had an effect on her, she replied: I think it was unfair the way I lost them and it really has affected my life, worrying about them

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on a daily basis. Do they have enough food to eat, are they being taken care of emotionally, how are they doing in school, and questions like that. . . . Yes, it has an effect on them because they are not, you know, how when you grow up you have a mother to teach you how to put your clothes away and do things like that. They don’t have that kind of order. They have not developed that.

2. The parental rights of a woman thirtyeight years old at interview and diagnosed with bipolar disorder and unspecified personality disorder were terminated. This resulted in loss of custody of her nine-year-old and fourteenyear-old children to relatives, where they remained until adulthood. The birth mother was under a court order not to visit the children. Asked whether she felt it had been helpful to her for someone else to raise the children, she responded: No, I still cry a lot about it. . . . I still scream at officials, and I still get politically involved with other families that have been tormented the way I’ve been tormented.

In this chapter, I have sought to demonstrate that the termination of parental rights, though generally associated with child maltreatment not immediately responsive to correction, can be a source of grief and loss for birth parents. While the majority of relevant research has been conducted in Great Britain, the experience has some similarities to that of birth mothers who “voluntarily” relinquished their children for adoption. For example, both those who voluntarily relinquish their rights and those whose parental rights are involuntarily terminated are vulnerable to certain psychological, psychosomatic, and marital/family ills. However,the reactions of a birth mother whose rights have been involuntarily terminated may be misunderstood and may precipitate rejection and

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condemnation by child welfare workers and others. Activism on the part of birth mothers who are no longer parenting, supportive family members and friends, and the ability of birth parents to find benefits in their children’s placements may all serve as protective elements with the potential for increasing the resilience of birth mothers in dealing with the long-term effects of termination. Evidence-based assessment tools and intervention models continue to constitute a gap in research and practice regarding the experience of birth parents with termination of their parental rights. Knowledge described in this chapter, however, can support efforts to design such practice-related research and evidence-based practice. YYY

The Girls Who Went Away (Fessler 2006) has provided an examination of the long-term grief and loss experienced by women who, as adolescents and young adults, relinquished their infants after becoming pregnant out of wedlock. While no similar work exists with regard to birth parents whose rights have been terminated, knowledge exists that can serve as a starting point for developing practice approaches that can be evaluated for effectiveness. Further research regarding the experiences of birth parents whose parental rights are either voluntarily or involuntarily terminated is important. Currently, even the most basic knowledge is not available, such as how many birth parents voluntarily relinquish their rights to their children and how many birth parents involuntarily lose parental rights each year. Additional research that explores and further identifies the range of reactions birth parents have in these situations is essential to support conceptualization of services that would assist them in their healing and prevent maladaptive responses to this loss.

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REFERENCES

Adoption and Safe Families Act of 1997, P. L. No. 105–89, Stat 2115, Page 111 (1997). Adoption Assistance and Child Welfare Act of 1980, P. L. No. 96–272, Stat 500 (1981). Adoption Healing (2011). Retrieved on September 15, 2011, from http://www.adoptionhealing.com/index .html. Aloi, J. (2009). Nursing the disenfranchised: Women who have relinquished an infant for adoption. Journal of Psychiatric and Mental Health Nursing, 16, 27–31. Askren, H., & Bloom, K. (1999). Postadoptive reactions of the relinquishing mother: A review. Journal of Obstetric, Gynecological, and Neonatal Nursing, 28, 395–400. Bachrach, C., Stolley, K., & London, K. (1992). Relinquishment of premarital births: Evidence from national survey data. Family Planning Perspectives, 24, 27–48. Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Boston: Harvard University Press. Child Welfare Information Gateway (2005). Voluntary relinquishment for adoption. Retrieved October 27, 2013, from https://www.childwelfare.gov/pubs/s_ place.cfm. Collins, P. (1997). Producing the mothers of the nation: Race, class, and contemporary U.S. population policies. Annual Conference, National Council on Family Relations, Kansas City, November. Fessler, A. (2006). The girls who went away: The hidden history of women who surrendered children for adoption in the decades before Roe v. Wade. New York: Penguin. Fostering Connections to Success and Increasing Adoptions Act of 2008. P. L. No. 110-351, Stat 3949 (2008). Freundlich, M. (2002). Adoption research: An assessment of empirical contributions to the advancement of adoption practice. Journal of Social Distress and the Homeless, 2, 143–66. Henney, S., Ayers-Lopez, S., McRoy, R., & Grotevant, H. (2007). Evolution and resolution: Birthmothers’ experience of grief and loss at different levels of adoption openness. Journal of Social and Personal Relationships, 24, 875–89. Hollingsworth, L. (1999). Symbolic interactionism, African American families, and the transracial adoption controversy. Social Work, 44, 219–28.

Hollingsworth, L. (2001). Adoption policy in the U.S.: A word of caution. Social Work, 45, 183–86. Hollingsworth, L. (2005). Ethical considerations in prenatal sex selection. Health Social Work, 30, 126–34. Jellinek, M., Bishop, S., Murphy, J., Bierderman, J., & Rosenbaum, J. (1992). Screening for dysfunction in the children of outpatients at a psychopharmacology clinic. American Journal of Psychiatry, 148, 1031–36. Kübler-Ross, E. (1969). On death and dying. New York: Macmillan. Laufer, R. (2006). Facilitating impossible goodbyes: The final visit after termination of parental rights. PsyD diss., Antioch New England Graduate School. Mason, K., & Selman, P. (1997). Birth parents’ experiences of contested adoption. Adoption & Fostering, 21, 21–28. National Survey of Family Growth (1995). Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics. Pavao, J. (1998). The family of adoption. Boston: Beacon. Sedlak, A., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress, Executive Summary. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. Stiffler, L. (1991). Adoption’s impact on birthmothers: “Can a mother forget her child?” Journal of Psychology & Christianity, 10, 249–59. Swift, K. (1995). Manufacturing “bad mothers”: A critical perspective on child neglect. Toronto: University of Toronto Press. Promising approaches. U.S. Department of Health and Human Services, Administration for Children & Families (n.d.). Retrieved June 23, 2011, from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/ promise/index.htm. U.S. Department of Health and Human Services (2013). AFCARS 20. Washington, DC: Administration for Children and Families. Wattenberg, E., Kelley, M., & Kim, H. (2001). When the rehabilitation ideal fails: A study of parental rights termination. Child Welfare, 80, 405–31. Wiley, M., & Baden, A. (2005). Birth parents in adoption: Research, practice, and counseling psychology. Counseling Psychologist, 33, 13–50.

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Adoption Disruption

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ver the years, there have been widespread changes in the policies, practices, and attitudes toward foster child adoption in the United States. One of the more noticeable changes in recent years has been in the volume of adoptions. According to federal estimates, the number of adoptions of children in public out-of-home care between 1983 and 1995 remained quite flat, between seventeen and twenty thousand (Maza 2000). Since then, however, the numbers have increased considerably in response to various federal legislative initiatives. For example, the Adoption Assistance and Child Welfare Act of 1980 mandated permanency planning for all children in state custody. Courts and agencies were directed to pursue the goal of adoption for children who were unlikely to return to their birth families. The legislation also required states to establish an adoption subsidy program and provided federal funds to be used as part of the states’ subsidies for children adopted from foster care. The most recent rise in adoptions has been in response to the Adoption Incentive program (also known as the Adoption Bonus program) of the Adoption and Safe Families Act of 1997 (ASFA), which provided both policy and fiscal incentives to states for increasing the number of adoptions. It was the first outcome-oriented incentive program (Maza 2000), as it authorized payments to states for increasing the number of children adopted from public outof-home care. This program was enhanced some years later by passage of the 2008 Fostering Connections to Success and Increasing

Adoptions Act (H.R. 6893). In 2010 for example, The Department of Health and Human Services awarded $39 million to 38 states and Puerto Rico (HHS 2010) for increasing the number of adoptions. Various public outreach programs, such as AdoptUSKids, were also created to spur adoptions (Pertman 2011). Thus, in FY 1998, 37,000 adoptions had taken place (Maza 2000); in 2002 (Children’s Bureau 2006) there were 53,000 adoptions. A 2013 report of finalized adoptions in FY 2012 estimated that 52,039 children were adopted from the public child welfare system nationwide. On September 30 of FY 2012, 101,719 children in care were waiting to be adopted; 58,587 of these waiting children were legally freed for adoption through termination of all living parents’ rights during FY 2012 (Childrens Bureau 2013). The national increase in foster care adoptions has been accompanied by a rise in professional concerns that more adoptive placements would disrupt and more adoptions would fail. Before discussing the professional concerns, it is necessary to clarify these two situations. In the adoption literature the term disruption has commonly referred to the removal of a child from an adoptive placement before the adoption has been legalized (Barth & Berry 1988; Festinger 1986, 1990). Situations in which a child has been returned to the custody of the child welfare system following legal adoption have been termed dissolution, a term that was coined early on by professionals in the adoption field (Donley 1978) and continues to be used officially (Child Welfare Information Gateway 2012). 437

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Concerns about adoption disruption and dissolution are not new. Years ago they were fueled by the belief that disruptions and dissolutions were apt to increase dramatically as caseworkers sought adoptive homes for children who earlier had been considered unadoptable. More recently concerns have been intensified as a result of the focus on increasing adoptions and on speeding the adoption process. In fact, some observers in the past have suggested that efforts to promote adoptions might lead to more adoptions that end (Barth et al. 1988; Coakley & Berrick 2008). It has been noted that part of the concern has been based on an assumption that increases in adoptive placements and adoption would be a function of speedy and inadequate home selection (Barth & Miller 2000). Worries have also been kindled by guesses and rumors about high rates of disruption. Such concerns are not surprising, because disruptions are painful for all involved—the children, the adoptive parents, and the caseworkers. Rumors and guesses sometimes fill the void when there is a dearth of knowledge. In this regard, however, there is a sizable empirical literature on rates of disruption, showing that it is not such a frequent occurrence. In contrast, very little is known about the frequency of dissolution following legal adoption because it is so difficult to obtain accurate data. The limited data that are available show dissolution to be a rather rare event (Festinger 2002; Bruning 2007). In this chapter I focus on disruption. I begin with a review of available research on rates of adoption disruption, followed by a summary of child, family, agency, and other factors related to disruption and a discussion of practice implications. Parts of this review rely heavily on a previous article (Festinger 1990) that dealt with both disruption rates and correlates. Rates of Adoption Disruption Past reports on rates of disruption are quite scattered. Until the early 1970s, adoption disruption was rarely mentioned, probably because the phenomenon occurred so infrequently. For instance, Kadushin (1980) cites

nine studies, including one of his own (Kadushin & Seidl 1971), covering the period up to 1970. These studies were mainly concerned with children who were white, very young, and without known handicaps at placement. Although there were minor variations among the studies, of the more than thirty-four thousand adoptive placements of children that were monitored, only 1.9 percent disrupted. More recent studies have increasingly focused on or included children who were older, from minority groups, or handicapped. These studies have reported higher rates of disruption. For example, Kadushin (U.S. Congress 1975) cites figures from a North Carolina agency that showed a disruption rate of 8 percent among 410 placements of children with special needs who were placed between 1967 and 1974. Statistics from California public agencies noted a disruption rate of 7.6 percent in 1973, a considerable increase over the 2.7 percent reported by the same agencies in 1970. The increase apparently reflected “the increasing number of older children being placed” (Bass 1975:115). A Michigan agency that specialized in the placement of children with special needs (Unger, Dwarshuis, & Johnson 1977) reported that of 199 children placed from 1968 through 1976, the rate of disruption was 10.6 percent. A Canadian report (Cohen 1981) cited an increase in annual adoption disruptions in Ontario from 4 percent to 7 percent between 1971 and 1978, noting that disruptions occurred with greater frequency among private and kin placements than in agency placements. Disruption figures were also reported by the evaluators of an effort to place 115 children with special needs from a number of New York State counties. Of the 41 adoptive placements between 1975 and 1977, 15 percent had disrupted by the time data collection ended in 1977 (Welfare Research 1978). Developmentally disabled children placed for adoption during a 12-month period between 1978 and 1979 were the subject of a report of a mail survey of agencies in the United States and Canada (Coyne & Brown 1985). The authors reported descriptive data on 693 children,

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over half of preschool age, placed in adoptive homes by 292 agencies. An overall disruption rate of 8.7 percent was reported, which was a conservative estimate as it did not include information from workers who were no longer with an agency. Soon thereafter, a report from Connecticut (Fein, Davies, & Knight 1979) of a program serving emotionally disturbed children of “latency age” reported disruptions of placements for 4 of the 13 children placed in adoptive homes. At roughly the same time in Ohio, a report by Roberts (1980) of a demonstration project designed to expand adoption services to children with special needs noted a 13.6 percent rate of disruption for the 59 children placed. A small study of children from a group care setting in North Carolina (Borgman 1981) reported that nine out of 19 initial adoptive placements did not hold. In 1982 Lahti reported the results of a follow-up of cases from a demonstration project in Oregon. Of 107 children in adoptive placements with new or former foster parents, the placements of 5.6 percent had disrupted, with no differences apparent between these two sets of foster parents. Furthermore, no differences in rates of disruption were noted among cases assigned to workers who had been specially trained to work intensively with families and a comparison group receiving regular casework services. Another agency study (Kagan & Reid 1986) of adoptive placements between 1974 and 1982 of 78 older youths with severe emotional and learning problems noted that roughly 53 percent had earlier been in at least one adoptive placement that disrupted. Unfortunately, such calculations, based on prior disruptions, are not comparable to other reports on rates. Roughly at the same time, Tremitiere (1984) distributed questionnaires to 116 agencies in Pennsylvania and 40 agencies serving children with special needs located outside that state. Based on usable responses received from 45 agencies, Tremetiere reports on the range of disruption proportions within various age groupings of children over a 5-year period. My calculations

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from her tables show that disruptions of placements among the youngest children (those under 6) were fairly level between 1979 (1.4 percent) and 1982–1983 (1.6 percent). For older children (those who were 6 to 18), however, the proportion of disruptions rose from 7.2 percent in 1979 to roughly 12 percent in 1982–1983. Furthermore, a report from a New Jersey agency that specialized in adoptive placements of children with special needs showed that of 309 children, the adoptive placements of 21.4 percent had disrupted by the end of the data collection period in 1981 (Boyne et al. 1984). Argent (1984) reported on the work of Parents for Children, a British agency dedicated to the adoptive placement of children with special needs. Between late 1976 and early 1983, the agency placed 75 children into 56 families. By May 1983, the placements of 14 children (18.7 percent) had disrupted. A few years later, Partridge, Hornby, and McDonald (1986) presented data on 235 placements of 212 children from six agencies in four northeastern states. Most of the children were white, nearly 8 years old on average at the time of adoptive placement, and almost all were considered to have special needs. Based on information about disruptions or dissolutions from 1982–1984, the investigators arrived at a disruption rate of 8.6 percent. Another report highlighted the problems of estimating rates of disruption and presented figures from five state agencies (Benton, Kaye, & Tipton 1985). In some instances, disruption rates were based on the ratio of disruptions (of placements that could have begun in prior years) to new placements in a given year, whereas in others they were based on a cross-sectional sample of cases in adoptive home placements. In three state agencies current disruptions were counted, whereas in two states prior histories of disruptions of children in current adoptive placements were used. Data obtained from this mixture of approaches showed disruption rates for 1984–1985 ranging from 6.9 percent to 20 percent. In only one of the states, Virginia, was a sample tracked over time. This consisted

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of 53 children who were placed in adoptive homes in 1983. It is reported that eighteen to twenty-four months later, by June 1985, 19 percent of these had one or more disruptions. Another study around this time (Groze 1986), based on data from a southwestern agency, reported a 14.9 percent rate of disruption among ninety-one cases examined. A New York City study (Festinger 1986) used a longitudinal approach, following more than nine hundred children in adoptive placements in March 1983; the children were ages six or older at the time of those placements. A large majority was designated black or Latino. During the first year roughly 8.2 percent of all adoptive placements disrupted. There was a relatively steady trickle of disruptions during the second and third years of adoptive placement, so that the overall rate was estimated to fall between 12 percent and 14 percent. Age was a factor here, as the estimated rate of disruption for those who were eleven or older was roughly between 16 percent and 19 percent, whereas for those aged six to ten the rate was a lower 8 percent to 11 percent. Soon thereafter, a California study (Barth & Berry 1988; Barth et al. 1988) reported on 926 children age 3 or older in adoptive placements between 1980 and mid-1984. Intake placement forms filed with the state were used to obtain data about adoptive placements, supplemented by information on case outcomes from adoption workers in 13 counties. In addition, the investigators conducted a variety of interviews with a smaller subgroup of families. Most of the 926 children were white, placed with foster parents, placed alone rather than with siblings, and ranged in age from 3 to 17.9 years at the time of their adoptive placement. By 1986 roughly 10 percent of placements had disrupted, with a higher proportion (18.8 percent) of placements from 1980 than for subsequent placement years. Thus for placements of 1982 a lower rate (9.2 percent) had disrupted by 1986, this proportion dropping to 7.4 percent among placements of 1984. A related report (Berry &

Barth 1990) focused on 99 adolescents aged 12 to 17 from the larger California study just mentioned. Among these teenagers the rate of disruption was reported to be 24.2 percent, with lower rates among Latino (10 percent) and black adolescents (14 percent) than among whites (23 percent) who constituted most of the sample. A few years later, McDonald and colleagues (1991) reported on a study of 212 children representing 235 placements from six agencies between January 1982 and July 1984 (see also Partridge, Hornby, & McDonald 1986). Most were children with special needs, aged 3 and older, and white. Data were collected using content analyses of case records, augmented by agency statistics and interviews with agency administrators. All disruptions and dissolutions combined were compared to a randomly selected 25 percent sample of placements initiated between January 1982 and July 1984. The 212 children consisted of 54 whose placement had disrupted and 158 whose placements had not. Disruptions of greater than 20 percent are reported. But because the comparison group of 158 was based on a 25 percent sample, the overall rate of disruption for 686 children is, according to my calculations, roughly 8 percent (as also reported in the Partridge, Hornby, & McDonald 1986 report) rather than the much larger percentage reported in the 1991 published article. The subject of disruption has been of interest in the United Kingdom as well. Thus a report from a city in the northeast of England (Holloway 1997) describes a retrospective 5-year cohort study of 129 children placed for adoption between January 1986 and December 1990. Almost all (95.3 percent) were aged 6 or younger at adoptive placement. In fact, more than half were under age 1 at the time. It is therefore not too surprising that only 2 percent of these placements disrupted. In stark contrast, a 1998 report from the United States (Pinderhughes 1998) focused on families who adopted 53 children older than 5 through four agencies

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in New England and Ohio in the mid-1980s. The children were on average 10.8 years of age at adoptive placement. The placements of 13 children (24.5 percent) disrupted. In an attempt to document the rate of disruption across all segments of an adoptive population, Goerge and colleagues (1997) presented data from a multivariate, longitudinal analysis of children entering care in Illinois between 1976 and 1994. Among a total 4,840 cases of adoptive placement, 583 (12.1 percent) disrupted. Because this figure included some placements made near the end of data collection that might disrupt in time, a rate of 13.4 percent for placements prior to 1987 was considered more accurate, as it eliminated the problem of right-censored data. It is of interest that the authors report a decline in the disruption rate following the 1980 passage of the Adoption Assistance and Child Welfare Act to an average 9.9 percent between 1981 and 1987, a time when the rate of adoption was gradually increasing. Finally, a recent study addressing the rate of disruption used administrative data from the Illinois Department of Children and Family Services (Smith et al. 2006). The investigators report on the outcomes of 15,947 children placed into their first adoptive homes between 1995–2000. By the end of data collection in 2003, a 9 percent rate of disruption was found. At that time 4 percent of children were still in care, hence the final rate was probably somewhat higher. The investigators report an interesting and to some a surprising finding, namely, a decrease in the rate of disruption in the three years after 1997, the post ASFA period, at a time when the number of children placed for adoption increased (Smith et al. 2006:33). Before leaving the discussion of rates, a comment on adoptive or legal guardianship placements with kin is in order. Although kinship foster care placements during the first 3 years of care have been shown to be more stable than non-kin foster placements (Testa 2001), there is a dearth of data on disruption following

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adoptive placements among kin not traveling the legal guardianship route (Freundlich & Wright 2003). Although one study of kinship placements (Terling-Watt 2001) reported a rather high disruption rate among 875 kinship placements in Texas (29 percent in the first 6 months of placement), it is not clear whether these were adoptive placements; in addition, the definition of disruption used was very broad and therefore not comparable to other studies reported here. Studies of disruption cited earlier may have included, but not reported on, kinship placements. A recent multivariate analysis noted a decreased likelihood of disruption among kin adoptive placements when compared to nonkin placements (Smith et al. 2006). Most likely, kinship adoptive placement disruption is a rare phenomenon, as the placement would have deteriorated earlier and not become an adoptive (or guardianship) placement to begin with. The variety of approaches used in these reports and studies attests to the difficulty faced when attempting to arrive at an accurate estimate of the rate of disruption. Some researchers focused on new adoptive placements, whereas others used all children already in an adoptive placement at a particular point in time (thus losing their history), following the children until an outcome was known. Most reports focused only on disruptions, but a few included dissolutions, which are impossible to disentangle. Some did not differentiate between single child and group sibling placements, although the inclusion of the latter can affect the rates reported and can result in problems of independence with respect to some data, such as the characteristics of the adoptive parents. Finally, with the exception of the Goerge et al. (1997) and Smith et al. (2006) studies, which used administrative data to track cases forward over time, the studies have used shorter followup periods, thus probably missing some cases because of the right-censoring problem. Nevertheless, what can one say about all of these results? For one, the figures generally

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show that the proportion of disruptions has increased since the 1970s. This trend appears to hold regardless of problems of methodology and precision and probable variations in the definitions used. The general rise in disruption rates is not terribly surprising, as adoptive homes were increasingly sought for older children and for those with other special needs (e.g., sibling groups; children with physical, educational, and/or emotional handicaps). It is also clear that disruption rates are not uniform. This must be kept in mind as one thinks about rates: a global rate is really a composite of many rates that may differ depending on which particular group or subgroup is examined. Furthermore, the focus on disruption, although dramatic, distorts the picture. When evaluating levels of disruption, it is best not to think of such rates in isolation, but to view them in conjunction with completed adoptions. Worries and rumors about disruption rates appear to have exaggerated the extent of the problem. It is indeed impressive that the rates reported since the mid-1980s and mid-1990s, despite some variations here and there, appear to show a downward trend. Excluding studies that singled out small groups of older children, disruption rates have mostly varied from about 9 percent to 15 percent, although a recent summary mentions a range of “about 6 percent to 11 percent” (Coakley & Berrick 2008:102). Among older children the reported rate has reached roughly 25 percent. Such rates hardly need to arouse astonishment or be viewed in a negative light. In the long run the vast majority of children will have been adopted. Correlates of Adoption Disruption A focus on rates alone is not much use for practitioners, who, when working with a child and an adoptive family, are faced with numerous factors describing the child and her history, the adoptive family, and the services available, to mention a few. So let us turn to factors that have been reported as associated with adoptive disruption when these have been compared to

adoptions. Many of the studies already mentioned, in addition to some others, generated a plethora of factors, too many to report on here. Because many studies did not utilize multivariate analyses, it is often not clear which factors are the strongest predictors of disruption. So I use a bit of poetic license to present some highlights in a summary that attempts to capture the flavor of what has been reported, while omitting many of the details. A cautionary note is in order, as various problems are overlooked, such as differences in the method of sampling and in the data gathering methods, the nature and wording of questions that may have been asked of workers and/or families, the depth of analyses, and even in the working definition of disruption. The reader also needs to be aware that different studies addressed different factors. Therefore, when a particular factor is identified as a correlate of disruption in four studies, it is a mistake to assume that all the other studies also examined that factor. Children and Their Placement History Most demographic characteristics of the children have no bearing on the outcome of adoptive placements. In most studies the gender of the children made no difference. Among a few studies that showed gender to be a factor (Barth et al. 1988; Barth & Berry 1988; Boneh 1979; Rosenthal, Schmidt, & Conner 1988; Schmidt 1986), males were overrepresented among disruptions. The Smith et al. (2006) study showed white children at a lower risk of disruption when compared to African American children. With the exception of that study, the race of children was rarely a factor, as was the case for religion. In contrast, more than a dozen studies have shown age to be a consistent predictor of disruption (e.g., Barth & Berry 1988; Benton, Kaye, & Tipton 1985; Festinger 1986; Goerge et al. 1997; Groze 1986; Hudspeth 2008; MacDonald et al. 1991; Smith et al. 2006). Whether one examines age at entry into foster care, age when the children became legally free for adoption,

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or age at the time of the adoptive placement, children whose placements disrupted were older than those who were adopted. In addition, a few researchers have reported that the disruption group took longer to become legally free than those whose placements held (Boneh 1979; Partridge, Hornby, & McDonald 1986), whereas others reported no time lag differential (Boyne et al. 1984; Festinger 1986). The total length of time in foster care prior to the adoptive placement has also yielded mixed results as a predictor of disruption. Some investigators have found that this time was longer for those whose placements eventually disrupted than for the adoptees (Boneh 1979; Partridge 1986), whereas other investigators either have found no such connection (Festinger 1986; Groze 1986; Smith & Howard 1991) or indicate that the time was shorter (Berry & Barth 1990; Goerge et al. 1997; Smith et al. 2006; Zwimpfer 1983). Several investigators have focused on the children’s histories prior to their adoptive placements, noting that the histories of those whose placements disrupted showed a higher incidence of various kinds of abuse or neglect compared to children whose placements held (Nalavany et al. 2008; Partridge, Hornby, & McDonald 1986; Schmidt 1986), or were more likely to show a history of sexual acting out (Smith & Howard 1991) or of sexual abuse (Smith & Howard 1994). In addition, a prior removal from a foster home due to inadequate parenting has been found to be a factor in disruption (Boneh 1979). The average number of placements in foster homes and group settings also has been a fairly consistent predictor of disruption. These averages have been considerably higher for disruption than for adoption outcomes (Boneh 1979; Festinger 1986; McDonald et al. 1991; Schmidt 1986), although some researchers have reported no differences (Groze 1986; Smith & Howard 1991). Previous disruptions of adoptive placements have also been cited (Barth & Berry 1988; Barth et al. 1988; Boyne 1984; Festinger 1986; Partridge, Hornby, & McDonald 1986).

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The nature of past placements also differed for the two outcomes. More children whose placements eventually disrupted had at some point resided in a group facility (Boneh 1979; Festinger 1986; Pinderhughes 1998) when compared to the adoptees. However, Smith et al. (2006) report a lower risk of disruption for youth who had spent some time in a residential or group home. Some children were placed together with their siblings, whereas others were placed singly. Study findings as to whether this was a factor connected to the outcome are exceedingly mixed: three studies have found that placements with siblings were overrepresented among disruption outcomes (Benton, Kaye, & Tipton 1985; Boneh 1979; Kadushin & Seidl 1971); three studies have indicated that such placements were less likely to disrupt (Festinger 1986; Rosenthal, Schmidt, & Conner 1988; Schmidt 1986); and four studies and one research review have found no difference in the outcome (Barth et al. 1988; Boyne et al. 1984; Groze 1986; Hegar 2005; Smith & Howard 1991). Furthermore, a recent multivariate analysis has shown that small sibling groups are at greater risk for disruption than are large sibling groups (Smith et al. 2006). Such a mixture of results suggests that other factors related to sibling placements were at work. For instance, it may be important to examine sibling placements in relation to the household composition as a whole. In sum, compared to children who were adopted, those whose placements disrupted were older at all stages of the process. They had more placements of all sorts, had been placed in more families, and their longest stay there was more protracted. Furthermore, they were more apt to have had a previous adoptive placement. Prior histories of care were more problematic. Their more checkered placement history suggests that these children exhibited more problems early on or developed them during their stay in care. They entered into an adoptive relationship in the wake of a more

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varied placement history. Because that history included a longer family placement, one can imagine past disappointments when these relationships ended and perhaps greater wariness about subsequent placements. Because they were older, they brought with them a history of past experiences. It is plausible to assume that they were therefore less adaptable and had greater difficulties adapting to new situations in foster care. In short, they were more difficult to manage. One can speculate that the older children may have been faced with a conflict between their growing need for independence in conjunction with a nonidealization of parents and the attachment tasks inherent in adoption. These difficulties could have been exacerbated if adoptive parents lacked sufficient skills and the flexibility required to bend with and be responsive to the ebb and flow of emotions of older children. It is also quite possible that, because of their older age, more of these children had developed firmer psychological links to their families of origin and may even have viewed adoption as an act of disloyalty. All these elements combined are apt to have interfered with their assimilation into their adoptive families. Adoptive Parents The demographic characteristics of the adoptive parents—their age, race, education, and income—has had either no bearing on or mixed associations with the outcome of adoptive placements. For instance, several studies showed higher education to be related to disruption (Barth et al. 1988; Rosenthal, Schmidt, & Conner 1988), whereas more than seven studies showed education not to be a factor. The employment outside the home of either or both adoptive parents has also had no bearing on the outcome (Benton et al. 1985; Festinger 1986), although a father’s lower occupational status has been linked to disruption (Westhues & Cohen 1990). The couple or single status of the adoptive parents is unrelated to the outcome, with the

exception of one study’s finding that single parents were overrepresented among disruptions (McDonald et al. 1991; Partridge, Hornby, & McDonald 1986). On the other hand, one review reports fewer disruptions among older children suffering attachment disorders who were adoptively placed with single parents (Burrell Cowan 2004). Factors such as length of marriage and prior divorce, mentioned in a few studies, have either had mixed results or had no bearing on outcome. Social worker ratings of parental functioning and parenting skills have also been reported as strongly associated with intact, rather than disrupted, placements (Rosenthal, Schmidt, & Conner 1988). Unfortunately, the raters knew the outcome, which no doubt influenced these ratings. The background of adoptive parents has received little attention. Two studies that examined this issue (Rosenthal, Schmidt, & Conner 1988; Schmidt 1986) found that parents in the disruption group came from families with fewer or no children. More than six studies have examined whether the adoptive families were foster parents with whom the children had been living for some time or were new families. It is hardly surprising that almost all these report that among placements that disrupted, a larger proportion of the children were with new families rather than with foster families (e.g., Coyne & Brown 1985; Rosenthal, Schmidt, & Conner 1988; Schmidt 1986; Smith & Howard 1991). There has been very limited investigation of adoptive placements with relatives. One study that included a moderate number of such homes found that these placements were less likely to disrupt (Festinger 1986). A recent multivariate study also reported a decreased likelihood of disruption among kinship adoptive placements (Smith et al. 2006). A few investigators have also examined parental preferences about the characteristics of children they want to adopt. Disruptions were more likely when adoptive parents stated requests, for instance, on a child’s age, were not

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met (Boneh 1979; Schmidt 1986) or when a child was “considerably different from what parents had expected” (Brodzinsky & Pinderhughes 2002:297). Among placements that disrupted when compared to those that did not, a larger proportion of adoptive parents were less flexible in their preferences or had a greater number of preferences. Clearly, such pickiness at the start did not augur well in the long run. Composition of the Home Questions concerning a possible effect of the presence of biological children on disruption have generated considerable interest; hence a number of investigators have examined this issue with mixed results. For instance, four studies found no connection to outcome (Barth & Berry 1988; Boyne et al. 1984; Festinger 1986; Zwimpfer 1983), one study (Groze 1986) found the presence of other children in the home to be associated with reduced risk of disruption, whereas two found that disruption was more likely if biological children resided in the adoptive home (Boneh 1979; Kadushin & Seidl 1971). Kadushin and Seidl (1971) suggested, however, that this result was probably confounded. That is, adoptive parents with biological children were older and were in turn offered older children for adoption; the older age of the placed children was the factor that was linked to disruption. Using a somewhat different measure, Pinderhughes (1998) noted that adoption disruption was more likely among smaller families. A number of other factors, such as the ages of other children, their gender, and the racial composition of the home, has also been examined. For instance, one study found that the difference in age between the children in the home was unrelated to outcome, but the age distribution was. Sample children who were in the middle position, flanked by both older and younger children who were not biological siblings of the sample children, were found to be more vulnerable to adoption disruption than were those who occupied the oldest or

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youngest position (Festinger 1986). However, another study noted that when the adoptive child assumed the position of eldest, disruption was more likely (Boneh 1979). Finally, the gender of other children in the home and the racial composition of the adoptive home have been investigated and found to be unconnected to the outcome (Festinger 1986). In sum, most aspects of these adoptive households—the number of other children and their ages, sex, and race—were not linked to outcome. Here and there, elements distinguished between disruptions and adoptions. These are isolated findings, warranting replication. Overall, one is impressed by the limited significance of household composition in the outcome of adoptive placements. Children’s Problems In more than ten studies, the number and severity of a child’s problems at the time of the adoptive placement has been a consistent predictor of disruption (e.g., Benton, Kaye, & Tipton 1985; McDonald et al. 1991; Rosenthal, Schmidt, & Conner 1988; Smith & Howard 1991; Smith et al. 2006). Usually these factors consist of one or a combination of emotional, cognitive, or physical problems. Smith and Howard (1991) examined rosters of potential behavioral and emotional problems following the adoptive placement and highlighted the prevalence of sexual acting out, vandalism, defiance, stealing, and lying as prevalent among the disrupted group. Other investigators have noted that although various problems were linked to disruption, mental retardation (Boyne et al. 1984) and physical and/or intellectual handicaps were not (Benton, Kaye, & Tipton 1985; Smith & Howard 1991). The existence of specific problem behaviors prior to the adoptive placement has also been examined. Thus, in contrast to nondisruptions, a larger proportion of those whose placements disrupted exhibited such behaviors as serious eating problems, sexual promiscuity, stealing, suicidal behavior, fire setting, wetting

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or soiling, vandalism, or physical aggression toward others (Partridge, Hornby, & McDonald 1986). A more recent study (Smith & Howard 1991), however, found no such differences prior to adoptive placement, with the exception of sexual acting out, which was seen more frequently among children whose placement eventually disrupted. Finally, adoptive parents’ capacity to cope with the problems presented by the children has been examined. It is no surprise that disruption outcomes were more frequently linked to lower ratings of the parents’ capacity than was the case among adoptions (Festinger 1986; Schmidt 1986). Contact with Biological Parents and Others That a child may have unresolved feelings about separation from past biological family members has been suggested as an important element in his ability to accept and attach to an adoptive family. Festinger (1986) approached this issue by collecting information about the timing of each child’s last contact with biological parents. The recency of their contacts was immaterial to the outcome. However, children whose placements disrupted were older at the last contact than those who were adopted. This finding was in line with their older age at all stages of the process and suggested that more of those children whose placements disrupted had developed firmer psychological links to their families of origin than was true of youngsters who were adopted. Another study (Smith & Howard 1991) used case record information to rate attachment to birth parents, finding that although both adoption and disruption groups had weak attachments to birth parents, the placements of those who were rated strongly attached to their birth mothers were more likely to disrupt. Motivation and Placement Risk It comes as no surprise that lower ratings of the strength of parents’ motivation to adopt or, of children to be adopted, were linked to

disruption (Festinger 1986). Furthermore, couples who shared an equal commitment to the adoption were less likely to experience a disruption (Partridge, Hornby, & McDonald 1986), as was the case among families where fathers were affectively involved and played a sustaining role (Westhues & Cohen 1990). A larger proportion of disruptions were thought to be risky situations at the time of the adoptive placement compared to adoptions. The ratings of motivation and risk, like some other ratings reported earlier, were undoubtedly influenced by the fact that the ratings relied to some extent on inferences made after the outcome was known. Therefore the differences just discussed are probably exaggerated. In view of this likely distortion, it is noteworthy that in one study, roughly 42 percent of the children with disruption outcomes (Festinger 1986), and in another study more than 60 percent with that outcome (Zwimpfer 1983), were in placements that were not considered particularly risky. Apparently there were some surprises when trouble arose. In fact, one study reported that for nearly one-half of the children whose placements disrupted, signals of trouble were never given or recognized or were first noted only four or more months after the adoptive placement (Festinger 1986). Another study indicated that in 58 percent of cases of disruption the worker did not learn of the problems until two months or less before the actual disruption (Partridge, Hornby, & McDonald 1986). Through a review of the records, Zwimpfer attempted to provide evidence of a “suspected tendency by social workers to ignore warning signals” and noted that less than 20 percent of cases of disruption “attracted any negative observations at all by the social workers during the supervision period” (1983:172). The tendency not to recognize signs of trouble in adoptive placements has, in the past, been discussed by others as well (Brown 1963; Gochros 1967). What was going on? Perhaps home visits were cursory because staff had too many other responsibilities. Perhaps signs of problems were

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overlooked because the implications of recognizing that one may have made a mistake are upsetting (Brown 1963). However, there may be an alternative interpretation. Let us look at the larger picture. Generally, the children whose placements disrupted were older and had been in foster care for some time; most were thought to exhibit problems of one sort or another. Finding new families or encouraging foster families to adopt often could take considerable effort. As has been stated by Meezan and Shireman (1982), this no doubt sometimes involved persuasion of people who were reluctant to take such a serious step and at times led workers to oversell a child (Kadushin 1980). In recent years, pressures for the timely achievement of adoption goals possibly prompted workers to pressure people to avoid delays in making decisions. In the process, workers probably also persuaded themselves about the strengths of these placements. Thus it is plausible that, once the goal of an adoptive placement was achieved, workers overvalued the families and exaggerated the families’ desires and abilities to cope. Risks may have been inadequately assessed, signals of trouble missed or belatedly recognized. This is not to say that all disruptions could have been avoided, but rather to suggest that a more open and conscious recognition of practices that include persuasion, and the attendant effects of such practices on workers themselves, could be beneficial. Such recognition would help workers to anticipate and therefore increase their accuracy in assessing the weaknesses or potential areas of risk in many situations at an early stage. This greater accuracy could in turn lead workers to explore ways to counteract forces that contribute to the deterioration of placements. Service Characteristics Sometimes children were adoptively placed with families whose homes had been studied and approved by a different agency. This circumstance occurred more often among placements that disrupted than among adoptions

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(Boneh 1979; Festinger 1986; Partridge, Hornby, & McDonald 1986). It would be incorrect to conclude that reliance on adoption studies completed by others is risky, because in most such instances the children were placed with new families rather than with former foster families, and placements with new families were more apt to disrupt for reasons other than who had studied and approved the home. Time spent in preparing the child for the adoptive placement has been found to be unrelated to the eventual outcome (Boneh 1979). Other researchers have shown that preplacement meetings between the child or foster family and the adoptive parents were unrelated to the outcome (Boyne et al. 1984; Festinger 1986). Yet others have reported that group sessions with the current caregiver, once referred to as “the good-bye blessing,” prior to the adoptive placement either reduced the likelihood of disruption (Partridge, Hornby, & McDonald 1986) or had no bearing on outcome (Schmidt 1986). Although one study noted that the number of workers carrying a case was not associated with outcome (Smith & Howard 1991), staff discontinuities of a particular sort have been linked to disruption (Festinger 1986). That is, staffing patterns in which the same workers did not simultaneously prepare both a child and an adoptive family were disproportionately in evidence among placements that disrupted. Apparently, when different workers had responsibility for preparing children and their families, the risk of disruption increased, perhaps because disparate information was communicated to the child and family. Furthermore, situations in which the last worker who prepared the child did not then supervise the adoptive home were also more frequently seen among disruption than adoption outcomes. When preparation and supervision were carried out by different staff members, the child was not only faced by a new family but also by a new worker. It is also possible that the relationship between foster care and adoption staff members may

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sometimes have been strained (Donley 1978), and this strain played a role in the clarity of what was communicated. All these things could have hindered a smooth transition into an adoptive placement. During the period of supervision that followed the adoptive placement, worker contacts with adoptive families and children were, on the whole, more frequent for placements that disrupted than for those resulting in adoption (Festinger 1986; Partridge, Hornby, & McDonald 1986; Smith & Howard 1991). Worker time with the families and children, referrals for counseling and support groups, and the use of respite care clearly increased somewhat in response to serious problems in these placements. It is interesting that the training of staff has been rarely studied. One recent report, however, notes that children placed in adoptive homes by caseworkers with more experience had a lower risk of disruption (Smith et al. 2006) than those placed by caseworkers with less experience. Disruption Circumstances Studies have reported on lengthy rosters of reasons given by workers for disruption, reflecting the complex nature of family-child interactions as well as numerous, sometimes idiosyncratic, situational elements that were at play (Benton, Kaye, E., & Tipton 1985; Festinger 1986; Kadushin & Seidl 1971; Partridge, Hornby, & McDonald 1986; Smith & Howard 1991). In view of the variations in the categories used to classify these reasons, and variations across studies in the meaning of each category, I can only attempt a very crude summary. Nevertheless, there is general agreement that the largest group of reasons for disruption concerned the families’ inabilities or reduced willingness to cope with the children’s problems, demands, and behaviors, combined with unrealistic parental expectations. Various attachment difficulties also have been mentioned. Reasons related to the marital relationship or situational factors, such as illness of parents or financial stress,

are much less frequently cited. Although interviews with adoptive parents were conducted by few investigators, when adoptive parents were interviewed (Barth & Berry 1988; Benton, Kaye, & Tipton 1985; Partridge, Hornby, & McDonald 1986), many differences between their perceptions and the perceptions of their workers emerged. For instance, with respect to the reasons for disruption, Benton, Kaye, and Tipton (1985) have noted that, whereas workers emphasized a child’s behavior, parents either cited their lack of preparation for or knowledge of a child’s problems or felt they were misinformed about a child’s prognosis. Furthermore, whereas workers spoke of a child’s not meeting parental expectations or failing to bond to the parent, parents emphasized a child’s not wishing to be adopted or spoke of a child’s failure to bond to other siblings. Some Thoughts about Correlates It is difficult to arrive at a neat summary statement about factors that predict disruption because the picture is so complex, involving the children and their histories, the adoptive families and their circumstances, and service factors. Factors in all these areas have been found to distinguish between placements that did and did not disrupt. Such a plethora of findings is partly a function of the limitations of univariate analyses among factors in many studies. Many of these factors were probably correlated, and their number would have been reduced by using multivariate approaches. Findings were also often quite contradictory. This was apt to be in part a function of differences among samples and methodologies, but it also leads one to question whether the group of disrupted placements is actually composed of several subgroups that require separate analyses for clarity in prediction. For instance, there would be merit in separating the analyses of foster parent adoptive placements and new (sometimes called “legal risk” or “stranger”) placements. The former, for example, has consistently been shown to have lower rates of

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disruption, most likely because the child and family have in many instances been together for some time. If problems in these placements arose, the placements would have “disrupted” before they became adoptive and thus were not part of an adoption disruption group. The common prediction that foster parent placements are less likely to disrupt is in a sense an artifact of a select group of placement “remainers” that did not experience a prior replacement. But this conclusion, as Barth and Berry (1988) have also suggested, requires further study. The other two factors that have most commonly predicted disruption are the older age of the child at adoptive placement (or at entry into foster care or legal freeing) and the psychological and behavior problems exhibited by the child. As already mentioned, older children bring a longer history of past experiences, possibly including a greater number of prior placements and more families, stronger psychological links to birth families, greater wariness about entering into new relationships, and perhaps less adaptability with respect to new family constellations and situations. The problems that some of these children exhibited were more difficult for families to manage and presented the adoptive families with major challenges to their patience and skills. Interviews with adoptive parents following disruption (Barth & Berr 1988; Schmidt, Rosenthal, & Bombeck 1988; Valentine, Conway, & Randolph 1987), although based on small samples of volunteers, provide some clues about their disappointments, sense of failure, guilt and sorrow, and perspective on what they felt went awry. Important themes concerned the attachment problems of the children and the parents’ expectations for a less difficult child, a difference between what parents had imagined and the reality. Other themes concerned such things as children’s difficulty “letting go” of birth families and gaps in information about the child’s background. Parents felt the information about the child was neither accurate nor complete, that they were given a sales pitch, and

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that they felt ill-prepared to handle the problems presented by the youths placed in their homes. Some felt the children were not ready to be adopted. Parents also spoke of little support from agencies following the placements. Practice Implications These studies point directly to the importance of extensive and accurate preparation of all parties—the children and the prospective adoptive parents—and the parents’ recognition that children adopted when older have greater adjustment difficulties than do infants (Sharma, McGue, & Benson 1996). Prospective parents for older children may require help in moving beyond such recognition to an acceptance of that likely reality. Furthermore, prospective parents need to be given as much accurate information as possible about the children and their backgrounds to avoid being enticed into stretching beyond their comfort level with regard to the kind of child they had in mind (Nelson 1985). At the same time, families may need help in altering idealistic notions that their love and acceptance are sufficient to overcome the children’s sense of deprivation and loss. This is especially important because such beliefs can arouse considerable guilt if children begin to exhibit emotional and/or behavior problems. In this regard, adoptive parents can be helped to recognize that many children come from highrisk backgrounds that include genetic vulnerabilities as well as adverse past environmental experiences (Cadoret 1990; Erich & Leung 2002; Nalavany et al. 2008; Rutter 2000). Individually or in combination, these vulnerabilities are likely to have a bearing on the child’s psychological makeup. However, adoptive parents should also be told that studies show there is much individual variation in children’s responses to such past conditions, possibly due to various protective influences, including factors related to resilience. Much has been written about the elements of thorough pre- and postplacement preparation,

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indicating that various supports may be needed at different points in time (Barth & Berry 1988; Berry 1997; Groza & Rosenberg 2001; Laws 2001; Smith & Howard 1999). Unfortunately, all these recommendations have been set forth amid an absence of any evaluation of their effectiveness. For the child, the importance of including her voice in the adoption process (Schwartz 2006), the construction of a life book, the establishment of the child’s level of commitment to adoption, and contact with other adoptees individually as peer mentors or as a support group have been recommended. For the adoptive family, full disclosure of a child’s background and difficulties and the availability of both the birth parents’ medical records and the child’s birth records are considered very important. Adoptive parents have also suggested that child-specific information from sessions with a child’s current or previous caregiver can be very helpful. Handouts that set forth the potential pitfalls have been suggested, as has, above all, the availability of postplacement services (Bruning 2007; Kramer & Houston 1998). Research has found large discrepancies between the information social workers reported that they gave and the information the parents stated they received (Barth & Berry 1988). Although it is unclear which assessment is accurate, this difference does lead to the conclusion that it is important for social workers to ensure that parents hear and understand the information provided. In this regard, it can be useful to ask families to predict possible child behaviors and have the family role-play responses. This exercise can also provide the social worker an opportunity to discuss various parenting skills and strategies. Support groups, including a “buddy” family as mentor, meetings with other adoptive families, and online support groups; warm lines (telephone support services); and respite care have been discussed in the literature. Also, assigning readings, providing factual information about adoption, and discussing subsidy contract negotiations and relevant tax

laws have been suggested. Furthermore, it has been recommended that agencies ensure that, as a preventive approach, adoptive parents are provided training in behavior management methods, adoption preservation services, and help in advocating for the child in day care and school (Laws 2001). Also, if the intended adoption is a so-called open one with some level of connection maintained between the child and his birth parents, there are additional considerations for support (Grotevant & McRoy 1998). For all adoptions, following the placement, social worker contact with the family is vital so that the family can discuss whatever questions and concerns may arise and workers can assist families in developing plans and strategies or provide referrals, if needed. Finally, adoptive parents need information about accessing various community supports and services so that they know where to turn in case when such services are wanted. After Disruption What happened to these children after their adoptive placements disrupted? This is a key question, for the answer is of utmost importance when considering adoption disruption. The focus here is on the number of these children who were ultimately adopted or were, at a minimum, in another adoptive placement awaiting legalization. Unfortunately, accurate figures are not available because the percentages reported are totally a function of when, after placements disrupted, the investigators asked the question. Therefore, the figures underestimate the final outcome. Nevertheless, a brief review is useful. For example, Kadushin and Seidl (1971) indicated that about 50 percent of the children were adopted by other families and that adoptive placements were planned for yet more. Unger, Dwarshuis, & Johnson (1977) reported that roughly 90 percent of the children were replaced in other adoptive families. Based on accumulated information from a number of specialized adoption programs, Donley (1978) noted that more than 75 percent were successfully replaced. Boneh (1979) stated that nearly

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40 percent of those whose placement disrupted had been legalized in another placement by the end of the study period. Boyne and colleagues (1984:159) reported that “many of those who disrupted” went on to a legalized adoption with other families. Benton, Kaye, and Tipton (1985) indicated that, in one state for which information was usable, 41 percent of the children subsequently resided in another adoptive home and that others possibly would be so placed. Partridge, Hornby, & McDonald (1986) noted that 58 percent were placed again for adoption, but that 24 percent of the replaced cases had again disrupted when case records were reviewed. Festinger (1986) found that within six to eighteen months after a disruption, 42 percent had either been adopted or were in adoptive homes awaiting legalization; adoption remained the plan for another 21 percent. Finally, Rosenthal, Schmidt, and Conner (1988) reported that 74 percent of those who had experienced a disrupted placement were successfully placed. It is evident that disruptions, when they occur, are not the final blow to the children’s adoption. Nor can it be said that these children could not make an adequate adjustment to an adoptive placement. The figures just cited show otherwise. In view of the emotional baggage that children bring to a placement, the multiplicity of factors in the home environment, and the flaws in our ability to predict their interaction, it is inevitable that some disruptions will occur. The point is that disruptions neither end the hope for, nor likelihood of, a later successful adoption. In the process, children, families, and workers can learn how to improve the chances that the next placement will hold. The figures on replacement suggest that, in many cases, there may have been a mismatch, in the sense that the “chemistry” appeared to be wrong or soured after a time. This is akin to what has been called a problem in the “goodness of fit” (Thomas & Chess 1984:1), when the properties of the environment, its expectations and demands, are not in accord with the child’s “own capacities, motivations, and

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style of behaving.” It is also possible that some families misjudged their own abilities or were encouraged or stretched to adopt children whose needs and/or behaviors were in fact greater than the families could handle. Whatever the reason, at this particular point in time “these specific children and these specific parents were a failing combination” (Kadushin & Seidl 1971:34). It is apparent that some configurations of factors are more risky and require more concentrated service efforts and that staff training must emphasize child and family assessment (Coakley & Berrick 2008). In addition, the problems posed by staff discontinuities require review. Adoption services need to consider ways to assist workers to recognize any tendency to ignore warning signals in order to help workers anticipate and assess vulnerability and areas of risk so that early intervention is possible before a crisis erupts. The wonder is that, in the long run, most of the children placed in adoptive homes are adopted. However, such happy news is quickly forgotten when disruptions occur; it is a jarring experience for all involved. Moves in foster care are handled with much more equanimity. The expectation that moves will not occur in adoptive placements all too often leads all parties to the adoption to feel they have failed. Debriefing sessions are needed to understand what was not working so that the parents, the child, and the agency can learn from the experience. Furthermore, agencies can provide an open forum for discussion of these situations (Fitzgerald 1985) and thereby foster an environment that avoids recrimination, blame, and defensiveness—one that moves “away from a model of practice based on success or failure” (Aldgate & Hawley 1986:45). Adoptive placements of older children and of children with problems oblige agencies to take risks. To do so implies that goals may not be reached. But not to do so also entails risk—the risk of not giving children who are waiting the opportunity to grow up in families they can call their own.

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REFERENCES

Adoption and Safe Families Act. (1997). P.L. 105-89. Adoption Assistance and Child Welfare Act. (1980). P.L. 96-272. Aldgate, J., & Hawley, D. (1986). Helping foster families through disruption. Adoption and Fostering, 10, 44–49. Argent, H. (1984). Find me a family. London: Souvenir. Barth, R., & Berry, M. (1988). Adoption & disruption: Rates, risks and responses. Hawthorne, NY: Aldine de Gruyter. Barth, R., Berry, M., Yoshikami, R., Goodfield, R., & Carson, M. (1988). Predicting adoption disruption. Social Work, 33, 227–33. Barth, R., & Miller, J. (2000). Building effective postadoption services: What is the empirical foundation? Family Relations, 49, 447–55. Bass, C. (1975). Matchmaker-matchmaker: Older-child adoption failures. Child Welfare, 54, 505–11. Benton, B., Kaye, E., & Tipton, M. (1985). Evaluation of state activities with regard to adoption disruption. Washington, DC: Urban Systems Research and Engineering. Berry, M. (1997). Adoption disruption. In R. Avery (ed.), Adoption policy and special needs children (pp. 77–106). Westport, CT: Auburn House. Berry, M., & Barth, R. (1990). A study of disrupted adoptive placements of adolescents. Child Welfare, 69, 209–25. Boneh, C. (1979). Disruptions in adoptive placements: A research study. Boston: Department of Public Welfare, Office of Research Evaluation. Borgman, R. (1981). Antecedents and consequences of parental rights termination for abused and neglected children. Child Welfare, 60, 391–404. Boyne, J., Denby, L., Kettenring, J., & Wheeler, W. (1984). The shadow of success: A statistical analysis of outcomes of adoptions of hard-to-place children. Westfield, NJ: Spaulding for Children. Brodzinsky, D., & Pinderhughes, E. (2002). Parenting and child development in adoptive families. In M. H. Bornstein (ed.), Handbook of parenting (vol. 1, pp. 279–311). Mahwah, NJ: Erlbaum. Brown, F. (1963). Supervision of the child in the adoptive home. In I. Smith (ed.), Readings in adoption (pp. 332–42). New York: Philosophical Library. Bruning, P. (2007). The crisis of adoption disruption and dissolution. In N. Webb (ed.), Play Therapy with Children in Crisis (pp. 152–72). New York: Guilford. Burrell Cowan, A. (2004). New strategies to promote the adoption of older children out of foster care. Children and Youth Services Review, 26, 1007–20. Cadoret, R. (1990). Biologic perspectives of adoptee adjustment. In D. Brodzinsky & M. Schechter (eds.), The psychology of adoption (pp. 25–41). New York: Oxford University Press. Children’s Bureau (2006). The AFCARS report: Final estimates for FY 1998 through FY 2002 (12). Washington,

DC: U.S. Department of Health and Human Services. Children’s Bureau (2013). The AFCARS report: Preliminary FY 2012 estimates as of July 2013. Washington, DC: U.S. Department of Health and Human Services. Child Welfare Information Gateway (2012). Adoption disruption and dissolution. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Coakley, P., & Berrick, J. (2008). Research review: In a rush to permanency: Preventing adoption disruption. Child and Family Social Work, 13, 101–12. Cohen, J. (1981). Adoption breakdown with older children. Toronto: University of Toronto. Coyne, A., & Brown, M. (1985). Developmentally disabled children can be adopted. Child Welfare, 64, 607–15. Donley, K. S. (1978). The dynamics of disruption. Adoption and Fostering, 92, 34–39. Erich, S., & Leung, P. (2002). The impact of previous type of abuse and sibling adoption upon adoptive families. Child Abuse and Neglect, 26, 1045–58. Fein, E., Davies, L., & Knight, G. (1979). Placement stability in foster care. Social Work, 24, 156–57. Festinger, T. (1986). Necessary risk: A study of adoptions and disrupted adoptive placements. Washington, DC: Child Welfare League of America. Festinger, T. (1990). Adoption disruption. In D. Brodzinsky & M. Schechter (eds.), The psychology of adoption (pp. 201–18). New York: Oxford University Press. Festinger, T. (2002). After adoption: Dissolution or permanence? Child Welfare, 81, 515–25. Fitzgerald, J. (1985). When adoption fails—Understanding disruption. Journal of the Royal Society of Health, 4, 133–38. Freundlich, M., & Wright, L. (2003). Post-permanency services. Washington, DC: Casey Family Programs. Gochros, H. (1967). Not parents yet: A study of the post-placement period in adoption. Child Welfare, 46, 317–49. Goerge, R., Howard, E., Yu, D., & Radomsky, S. (1997). Adoption, disruption, and displacement in the child welfare system, 1976–94. Chicago: University of Chicago, Chapin Hall Center for Children. Grotevant, H., & McRoy, R. (1998). Openness in adoption: Exploring family connections. Thousand Oaks, CA: Sage. Groza, V., & Rosenberg, K. (2001). Clinical and practice issues in adoption. Westport, CT: Bergin & Garvey. Groze, V. (1986). Special-needs adoption. Children and Youth Services Review, 8, 363–75. Hegar, R. (2005). Sibling placement in foster care and adoption: An overview of international research. Children and Youth Services Review, 27, 717–34. Holloway, J. S. (1997). Outcome in placements for adoption or long-term fostering. Archives of Disease in Childhood, 76, 227–30.

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H.R. 6893 (2008). Fostering Connections to Success and Increasing Adoptions Act of 2008, signed into law Oct. 7, 2008. Hudspeth, D. (2008). Adoption disruption, stability, success, and attachment security of adoptive parents. Ph.D. diss., Texas Woman’s University, Texas. Kadushin, A. (1980). Child welfare services (3d ed.). New York: MacMillan. Kadushin, A., & Seidl, F. (1971). Adoption failure: A social work postmortem. Social Work, 16, 32–38. Kagan, R., & Reid, W. (1986). Critical factors in the adoption of emotionally disturbed youths. Child Welfare, 65, 63–73. Kramer, L., & Houston, D. (1998). Supporting families as they adopt children with special needs. Family Relations, 47, 423–32. Lahti, J. (1982). A follow-up study of foster children in permanent placements. Social Service Review, 56, 556–71. Laws, R. (2001). The history, elements, and ongoing need for adoption support. In V. Groza & K. Rosenberg (eds.), Clinical and practice issues in adoption: Bridging the gap between adoptees placed as infants and as older children (pp. 81–103). Westport, CT: Bergin & Garvey. McDonald, T., Lieberman, A., Partridge, S., & Hornby, H. (1991). Assessing the role of agency services in reducing adoption disruption. Children and Youth Services Review, 13, 425–38. Maza, P. (2000). Using administrative data to reward agency performance: The case of the federal adoption incentive program. Child Welfare, 79, 444–56. Meezan, W., & Shireman, J. (1982). Foster parent adoption: A literature review. Child Welfare, 61, 525–35. Nalavany, B., Ryan, S., Howard, J., & Smith, S. (2008). Preadoptive child sexual abuse as a predictor of moves in care, adoption disruptions, and inconsistent adoptive parent commitment. Child Abuse & Neglect, 32, 1084–88. National Adoption Information Clearinghouse (2002). Disruption and dissolution. Washington, DC: U.S. Department of Health and Human Services. Nelson, K. (1985). On the frontier of adoption: A study of special-needs adoptive families. New York: Child Welfare League of America. Partridge, S., Hornby, H., & McDonald, T. (1986). Legacies of loss—visions of gain: An inside look at adoption disruptions. Portland: Center for Research and Advanced Study, University of Southern Maine. Pertman, A. (2011). Adoption nation: How the adoption revolution is transforming our families—and America (2d ed.). Boston, MA: Harvard Common Press. Pinderhughes, E. (1998). Short-term placement outcomes for children adopted after age five. Children and Youth Services Review, 20, 223–49. Roberts, B. (1980). Adoption project for handicapped children: Ohio District 11. Washington, DC: Office of Human Development Services.

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Rosenthal, J., Schmidt, D., & Conner, J. (1988). Predictors of special needs adoption disruption: An exploratory study. Children and Youth Services Review, 10, 101–17. Rutter, M. (2000). Children in substitute care: Some conceptual considerations and research implications. Children and Youth Services Review, 22, 685–703. Schmidt, D. (1986). Presentation of research findings on prevention of adoption disruption. In D. M. Schmidt (ed.), Special needs adoption: A positive perspective (pp. 124–32). Denver: Colorado State Department of Social Services. Schmidt, D., Rosenthal, J., & Bombeck, B. (1988). Parents’ views of adoption disruption. Children and Youth Services Review, 10, 119–30. Schwartz, L. (2006). When adoptions go wrong: Psychological and legal issues of adoption disruption. Binghamton, NY: Haworth. Sharma, A., McGue, M., & Benson, P. (1996). The emotional and behavioral adjustment of United States adopted adolescents, part 2: Age at adoption. Children and Youth Services Review, 18, 101–14. Smith, S., & Howard, J. (1991). A comparative study of successful and disrupted adoptions. Social Service Review, 65, 248–65. Smith, S., & Howard, J. (1994). The impact of previous sexual abuse on children’s adjustment in adoptive placement. Social Work, 39, 491–501. Smith, S., & Howard, J. (1999). Promoting successful adoptions—practice with troubled families. Thousand Oaks, CA: Sage. Smith, S., Howard, J., Garnier, P., & Ryan, S. (2006). Where are we now? A post-ASFA examination of adoption disruption. Adoption Quarterly, 9, 19–44. Terling-Watt, T. (2001). Permanency in kinship care: An exploration of disruption rates and factors associated with placement disruption. Children and Youth Services Review, 23, 111–26. Testa, M. (2001). Kinship care and permanency. Journal of Social Service Research, 28, 25–43. Thomas, A., & Chess, S. (1984). Genesis and evolution of behavioral disorders: From infancy to early adult life. American Journal of Psychiatry, 141, 1–9. Tremetiere, B. (1984). Disruption: A break in commitment. Presentation given at the Ninth North American Council of Adoptable Children Conference, Chicago, August 1–4, 1984. Unger, C., Dwarshuis, G., & Johnson, E. (1977). Chaos, madness, and unpredictability .  .  . Placing the child with ears like Uncle Harry’s. Ann Arbor, MI: Spaulding for Children. U.S. Congress (1975). Adoption and foster care. Hearings before the Senate Subcommittee on Children and Youth of the Committee on Labor and Public Welfare. Washington, DC: U.S. Government Printing Office. U.S. General Accounting Office (2003). Foster care: States focusing on finding permanent homes for children, but long-standing barriers remain. Testimony before the

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House Subcommittee on Human Resources, Committee on Ways and Means. Washington, DC: U.S. Government Printing Office. U.S. Health and Human Services (2010). Health and Human Services award $39 million to states for increasing adoptions. Washington, DC: U.S. Department of Health and Human Services. Available at www.hhs.gov/news/press/2010pres/09/20100915b. html. Valentine, D., Conway, P., & Randolph, J. (1987). Placement disruptions: Perspectives of adoptive parents.

In D. Valentine (ed.), Infertility and adoption: A guide for social work practice (pp. 231–44). Binghamton, NY: Haworth. Welfare Research (1978). Evaluation of the test of regional planning in adoption. Albany, NY: Welfare Research. Westhues, A., & Cohen, J. (1990). Preventing disruption of special-needs adoption. Child Welfare, 69, 141–55. Zwimpfer, D. (1983). Indicators of adoption breakdown. Social Casework: Journal of Contemporary Social Work, 64, 169–77.

JENNIFER RENNE G E R A L D P. M A L L O N

Unpacking Permanency for Youth Overuse/Misuse of Another Planned Permanent Living Arrangement (APPLA) as a Permanency Goal

LUPE’S STORY Eighteen-year-old Lupe has been in foster care since she was nine. Her mother was a substance abuser; her father was never in her life. Upon entering the foster care system, Lupe was placed in a foster home with Mr. and Mrs. Rodriguez, an older married couple with three grown children. Things went pretty well in that home. Lupe occasionally visited her birth mother, but, despite promises to “get sober,” her mother was unable to do so. Lupe’s permanency goal was always reunification with a concurrent plan for adoption. The Rodriguez’s had indicated that, if she became freed for adoption, they would not be able to adopt Lupe because there were some inheritance issues with their older children. But they promised the worker that “we will always be there for her, even if she isn’t adopted by us.” After fifteen months of working toward reunification, Lupe’s social worker and the team decided to move toward the goal of adoption, as it was increasingly evident that Lupe’s birth mother was not working toward being a permanent resource for her. The termination of parental rights process was initiated, but there were many procedural delays. After three years in the Rodriguez foster home, Lupe’s mother’s parental rights were still not terminated, and Mrs. Rodriguez unexpectedly died. Lupe was devastated by the death of her “second Mom.” Mrs. Rodriguez’s adult children lived in another state and did not feel that they could provide a home for Lupe, now aged twelve. Mr. Rodriguez had many chronic illnesses and also felt unable to care for Lupe, so the city child welfare agency began to consider other placement options for Lupe. After many attempts at finding Lupe the best, most nurturing family, Lupe was placed in a

foster home with Mrs. Ramos and three other teenaged foster children. Lupe’s bereavement issues were never fully processed by her social worker, but her law guardian and social worker worked together to try to assist her in obtaining counseling outside of the agency. Lupe went for only one session and then refused to attend subsequently scheduled counseling sessions, saying, “I’m not crazy, just sad.” After one year, the situation in the Ramos home deteriorated. Lupe, now thirteen, had great difficulty getting along with two of the other young women placed in the home. Following multiple attempts at trying to preserve this foster home placement, Lupe, her social worker, and her law guardian made a plan for her to be placed temporarily in a community-based group home. At age fourteen Lupe was informed that her mother’s parental rights had been terminated, and she was free for adoption. But her social worker made it clear that, given her age, finding an adoptive home for her would be very difficult. Lupe gave up all hope of ever being adopted and no one ever asked her about whether she wanted to be adopted or to be connected to someone for a lifetime. In the meantime, Lupe’s “temporary” group home placement now extended to more than four years. Lupe’s social worker and law guardian tried diligently to connect her to permanent resources in the community. One day, Lupe’s social worker found her a mentor, and this connection changed the course of Lupe’s life. In Lupe’s words: I lived in a group home for four years, no family to speak of, no visits .  .  . nothing .  .  . I was pretty much on my own. One day, my social worker got me this lady who they said was gonna be my mentor. 455

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I thought, “Oh, yeah, same crap as always, some volunteer to work with the troubled teen for a couple of weeks and then I’ll never see her again.” But, I was wrong. Margaret, my mentor, is a great woman. She became like family to me. In fact, after I left care, she was my biggest support. She is the person I could call at 2 A.M. or whenever I needed to talk with someone. Margaret always remembers my birthday . . . I am at her house on Christmas . . . at Thanksgiving . . . she is my family. This past year, she and I decided that we should make our relationship permanent and legal. I was already free for adoption, so we decided to petition the court so that Margaret could adopt me.”

Facilitating permanency for older youth in foster care can be very challenging work. As evidenced by this case example, many teens who have been in the child welfare system have experienced multiple placements and multiple other losses in their young lives and are at a challenging crossroads between childhood and adulthood. Adults who work with such youth must help them identify caring, committed adults with whom they might be able to establish a lifelong connection. The policies and practices of the child welfare system maintain a very clear focus for younger children in need of permanency. However, its efforts toward facilitating permanency for adolescents have been less explicit. The practice and professional literature speaks to the importance of permanence for adolescents and how continued instability increases the long-term risks for teens, which may continue well into adulthood. In this chapter, we explore the prominent issues regarding permanency for older adolescents, but focus on why the permanency goal of long-term foster care (LTFC)—which was in fact deleted from the Adoption and Safe Families Act (ASFA)—or another planned permanent living arrangement (APPLA)—which is a permanency goal identified in ASFA legislation, but often misunderstood by child welfare professionals—are utilized as the default permanency plans for adolescents. Using the case example at the start of the chapter, several

questions about permanency for adolescents are explored to frame this discussion. Overutilization of LTFC or the use of independent living as a permanency goal for adolescents has emerged for several reasons. Contemporary child welfare, despite systemic reform efforts, has held firmly to a crisis orientation that tends to focus on younger children, whom the system views as a more vulnerable population in need of protection. In addition, the development of Title IV-E independent living as a separate program with a separate funding stream, combined with questions regarding adolescent adoptability and/or willingness to be adopted, have contributed to the system’s further estrangement from its adolescent population, who often experience long lengths of stay in care. Although independent living is not, in fact, a permanency goal, but rather an array of useful services for older adolescents, independent living as shrouded in the mantle of LTFC has become for many workers the convenient default plan for adolescents in foster care. All adolescents, even those who live with their birth families, require independent living skills—a set of self-sufficiency and transitional skills to assist them in transitioning toward young adulthood and independence. But all youth need stability and permanence in their lives as well. Even with solid life skills training and practice, youth in foster care need a familial support system when they exit care that allows for lifelong connections (see Freundlich et al. 2006). In addition to the challenge of defining what permanency means for adolescents, state agencies have struggled with how achieving permanency affects the independent living program. In 1980 and 1997 the United States implemented large-scale child welfare improvement efforts; however, neither the Adoption Assistance and Child Welfare Act nor ASFA fully addressed the needs of older youth in care. Although the government created separate legislation to address the needs of this group, it did not chart a clear youth permanency pathway.

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(The John H. Chafee Foster Care Independence program was created with the passage of the Foster Care Independence Act in 1999; the Chafee Foster Care Independence program replaced the Title IV-E Independent Living initiative of 1986.) Chaffee legislation provided funds to states to assist them in preparing youth to transition from foster care to adulthood; the legislation did not, however, speak to the need for family-based permanency (Kerman, Freundlich, & Maluccio 2009) or to the need for youth to develop lifetime connections to meaningful adults. The permanency needs of adolescents in foster care do not rest solely on a false dichotomy of independent living versus adoption. Such “either/or” arguments suggest that much more work needs to be done with respect to defining youth permanency, examining the various pathways to permanency for adolescents, and moving toward integration of youth development strategies to assist young people in their transition from adolescence to young adulthood (for further discussion, see National Resource Center for Permanency and Family Connections (2004). APPLA The Adoption and Safe Families Act (ASFA) defines the term APPLA as “any permanent living arrangement not enumerated in the statute.” As stated in the ASFA legislation, APPLA is a permanency goal for youth, which may be used if compelling reasons are documented in the case record and in court. However, it is a goal that has become increasingly overused and inappropriately employed as a default plan for many older adolescents in foster care. As outlined by Fiermonte and Renne (2002), there are several grounds for establishing compelling reasons to set a legitimate goal of APPLA: 1. an older teen who specifically requests that emancipation be established as his permanency plan; 2. the case of a parent and youth who have a significant bond, but the parent is unable to care for the youth because of an

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emotional or physical disability and the youth’s foster parents have committed to raising her to the age of majority and to facilitating visits with the disabled parent; or 3. the tribe has identified another planned permanent living arrangement for the youth. In many cases the misuse of APPLA as a permanency goal has replaced what was formerly known as LTFC, which was clearly deleted from the statute. The preamble to the regulations further explains: “Far too many children and youth are given the permanency goal of longterm foster care, which is not a permanent living situation for a child” (P.L. 105-89; 65 Fed. Reg. 4036). Using APPLA, without providing supports to establishing permanency, as a replacement for LTFC is an unsuitable permanency goal because LTFC has seldom been stable, may disrupt often, and thus may predictably lead to frequent moves for the youth. This is the antithesis of permanency (Tao et al. 2013). As such, APPLA, like independent living, has conveniently become for many the “default” permanency goal for many adolescents in foster care. As discussed in the Call to Action presented by Frey, Greenblatt, & Brown (2005), the child welfare system must develop integrated strategies, approaches, and policies that assist agencies as they prepare to focus additional attention and provide leadership for the complex issues of facilitating permanency for older adolescents. In some cases, organizational entities have provided leadership. For example, the National Resource Center for Permanency and Family Connections, the National Resource Center for Legal and Judicial Issues, the National Resource Center for Youth Development, the Child Welfare League of America, the National Resource Center for Adoption, and other organizations such as Casey Family Services have increasingly focused attention on the promotion of positive permanency outcomes for older adolescents in foster care (Casey Family Services 2008; Charles & Nelson 2000).

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Meeting the Needs of Youth in Foster Care ASFA requires child welfare agencies to focus more intently on an adolescent’s need for safety, permanency, and well-being. An emphasis on effective casework and permanency planning that begins the moment a young person enters care is essential in meeting the accelerated time frames for achieving permanency as mandated by ASFA. A concrete demographic portrait of adolescents in out-of-home care is needed to establish a clear picture of what this ASFA mandate means for child welfare agencies. Estimates from the federal Adoption and Foster Care Analysis and Reporting System (AFCARS) 18 Preliminary Estimates for FY 2012 (U.S. Department of Health and Human Services 2013) from all fifty states indicate that on September 30, 2010, there were 399,546 children/ youth in foster care. Youths aged eleven years and older accounted for 42 percent (158,921) of this total number. Gender is almost equally split, with males representing 52 percent of the population. Nationally, 56 percent of the children and youth in care are children and youth of color, with African Americans and Latinos representing the largest proportion at 26 percent and 21 percent, respectively. Placement settings for all children and youth in care were nonrelative foster family home (47 percent), relative foster family home (28 percent), institution (9 percent), group home (6 percent), preadoptive home (4 percent), and supervised independent living program (1 percent), with 6 percent on trial discharge to their families and 1 percent listed as runaways. The average length of stay for all children and these youth was 22.7 months. Despite the reported length of time in care, the largest majority of these children and youth had a case goal of reunification, accounting for 53 percent of the total. Adoption was the second most frequent goal, at 24 percent. Even though it was deleted from ASFA, long-term care was the goal for 5 percent (20,095) of these children and youth. Five percent (20,251) of the youth had a goal of emancipation.

In FY 2012 254,162 children and youths entered foster care. Of that number, 41 percent were between the ages of eleven and eighteen. During this same period, 241,254 children and youth exited foster care. The average length of stay of those who exited care during FY 2010 was 20.4 months. The majority (51 percent: 122,401) of these children and youth were reunified with parents or caretakers. Twenty-one percent (51,299) achieved a goal of adoption, and 11 percent were slated for emancipation (U.S. Department of Health and Human Services 2013). These statistics provide some indication of the number and the demographic and case characteristics of the thousands of older foster youth in the child welfare system. It is generally agreed that between twenty thousand and twenty-five thousand youths age out of the system each year, many of who are unprepared or marginally prepared to transition to adulthood (Courtney et al. 2010). With these numbers as background, we now turn to an examination of the outcomes for older youth exiting the foster care system. In recent years a number of studies have examined outcomes for older youth as a result of the Title IV-E independent living program (Avery 2009; Courtney et al. 2007; Courtney et al. 2010; Pearlmutter et al. 2011). This research has evaluated the impact of services for youth both before and after exiting care. There is a growing body of knowledge indicating that life skills instruction has a positive impact on outcomes for older foster youth (Cook 1991, 1994); however, studies have also demonstrated that these youth are still inadequately prepared to make the transition to adulthood (Courtney et al. 2007; Courtney et al. 2010; Courtney, Piliavin, & Grogan-Taylor 1995; Courtney et al. 1998, 2001). Although much of this literature has been reviewed elsewhere, one point bears repeating. Several studies (Barth 1986, 1990; Frey, Cushing, Freundlich, & Brenner 2008; Scott & Gustavsson 2010; Inglehart 1994) found that foster youth who have contact with their birth

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parents while in care have better outcomes than do youth who do not maintain these contacts. The importance of these relationships holds true even after youth leave the foster care system. These young people, many of whom have spent years in foster care, return to the very homes from which they were removed years before (Cook 1991; Courtney et al. 1998; Getman & Christian 2011; Mallon 1998, 2004; Mech 1988a,b, 1994; McMillen & Tucker 1999). Youth also seek out relatives and remain connected to foster parents or others they met while in the foster care system. It is these relationships—these emotional connections—that will have the greatest impact on the young person’s ability to navigate the difficult transitions into adulthood. Although older foster youth benefit from the services they receive through the federal Chaffee program, these services are not in themselves adequate to prepare adolescents for the transition to adulthood. The potential benefit of families (or other permanent, lifelong connections, not just a “childhood family” or care until one is eighteen years old) to the development and emancipation of adolescents has been frequently overlooked or dismissed. Some service providers mistakenly assume that adolescents should “move on” or emotionally detach from families and other significant permanent connections (Freundlich et al. 2006). Others have promoted the concept of interdependence as opposed to independence, making the case that no one ever truly lives as independent. However, foster care youth need the same permanent family connections as do youth in the general population. The system must do better in fostering and supporting these connections. The Fostering Connections to Success and Increasing Adoption Act (2008; P.L. 110-351) provides additional opportunities to improve practice for older youth. Fostering Connections provides new supports and services to promote permanency and improved well-being for older youth in foster care. These include a state option to continue providing Title IV-E reimbursable foster care, adoption, or guardianship assistance

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payments to children after the age of eighteen; a requirement that personal transition plans for youth aging out are developed within ninety days prior to youth exiting foster care; extending eligibility for independent living program services to children adopted or placed in kinship guardianship at age sixteen or older; and extending eligibility for education and training vouchers to children who exit foster care to kinship guardianship at age sixteen or older (those adopted after age sixteen were already eligible). All of these provisions offer opportunities to enhance outcomes for youth transitioning from foster care to adulthood, building upon opportunities offered by previous legislative efforts. Although each of these permanency options may be valid and appropriate for youth, in this chapter we examine what we believe is the most misunderstood and misused of permanency goals, APPLA, and discuss its appropriate application. Planned Permanent Living Arrangements The assignment of the permanency goal APPLA assumes that reunification, adoption, legal guardianship, and relative placement have been ruled out. ASFA revised the list of permanency goals for children and youth originally provided in the Adoption Assistance and Child Welfare Act and eliminated reference to LTFC as an option. ASFA, however, did define as a successful permanency outcome planned permanent living arrangements other than reunification or adoption. As noted previously, in AFCARS 20 data, 5 percent of the children in care had LTFC as a permanency goal (U.S. Department of Health and Human Services 2013. These data have had a downward turn (down 7 percent from stats in 2005) from data obtained in 2005 to the present. As the mandates of ASFA are fully implemented, fewer young people will likely remain in foster care for extended periods of time, and LTFC will be used less frequently as the permanency goal for youth. In some states, LTFC is currently used only in certain situations and, by policy, is permitted only for young people in care who are twelve or older.

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ASFA created APPLA as a final permanency option for children. It is the opinion of these authors that such a use of APPLA remains problematic. Although ASFA is clear that APPLA is the least preferred permanency option, the term is somewhat ambiguous and has generated many questions in the child welfare community. Because this area is so confusing at times for many professionals and because it has such relevance for older adolescents in foster care, we supply more detail in this section on APPLA. Fiermonte and Renne (2002) have provided an excellent review of these issues in their earlier work. Emancipation Emancipation is unfortunately what sometimes happens when young people leave foster care without a permanent plan. Emancipation and independent living are not permanency goals, they are services. As such, they lack certain permanency features as spelled out by APPLA. Emancipation certainly has specific relevance for some older children who are close to transitioning out of the foster care system, but it is not and should not be considered a permanency pathway for youth (Lee et al. 2013). Efforts to finalize a permanency plan are to be assessed twelve months after foster care entry. The inquiry should include whether the agency conducted early assessment and planning when the youth was placed. Often children are placed on an emergency basis with foster parents who are not willing to adopt or to commit to providing long-term care. There is sometimes a lack of intentional planning as the agency leaves the teen in an arrangement originally intended as an emergency placement. Permanency planning may become more complicated as the young person becomes attached to the foster parents. For example, at the twelve-month permanency hearing, when the agency may request approval of its APPLA and a finding that reasonable efforts to finalize the APPLA have been made, it might be discovered that the agency provided few services

early in the case. Thus what might have been a successful reunification case, or relative placement case, has now become APPLA because the agency was delinquent in its initial efforts. Earlier chapters of this volume have discussed the other permanency options under ASFA: reunification, adoption, legal guardianship, customary adoption, and permanent placement with relatives (see chapters by Pine, Spath and Gosteli; Mallon; Cross; Testa and Miller; Hegar and Scannapieco). At every permanency hearing and each six-month review for children and youth, workers should ask whether a more preferred permanency option is possible (reunification, guardianship, or adoption). Because circumstances change, a youth’s permanency plan must be revisited at subsequent hearings. It is important to remember that when APPLA is selected as the permanency goal, it may sometimes turn out to be temporary, in spite of efforts to make it permanent. The permanency plan must be revisited at the required permanency hearing at least annually and may be reviewed more frequently. Circumstances change in a young person’s life, and sometimes a more preferred permanency option can be achieved later in the case. For example, at one hearing, the plan might be APPLA, but by the following hearing a relative may have come forward and expressed a willingness to care for the youth on a longterm or permanent basis. A mentor relationship between a young person and an adult may initially be a guardianship plan and later evolve into an adoption. What Efforts Has the Agency Made to Identify and Recruit a Permanent Placement? The worker should determine whether the agency has thoroughly searched for relatives. Has the agency asked current and former caregivers, including former foster parents, if they are willing to commit to providing long-term care for the youth? Are there any mentors, coaches, teachers, counselors, or employers

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who might be appropriate and willing to provide a permanent home for the youth? What Are the Youth’s Preferences? Often the youth can identify a possible placement that the caseworker has not considered. The youth can provide input not only on the issue of placement, but also can suggest who might be a good mentor or respite care provider. Sometimes the youth uncovers resources other individuals have overlooked. The notion of permanency should include cultivating lifelong relationships, especially for older teenagers. This is illustrated by the following case example: PAUL’S STORY Paul is a seventeen-year-old youth with a goal of APPLA from New Orleans, Louisiana. He has lived in six different foster homes over the course of a tenyear period of time in care. At the time of this intervention, Paul was living in a congregate care setting in a rural community in North Louisiana because of his multiple placements and because he had been labeled as “hard to place.” Paul’s social worker, Ellen, an MSW intern, has been assigned to work with him. After attending an intensive technical assistance session focusing on session on “Unpacking the No of Adolescent Permanency” and learning some new skills about how to ask youth about possible connections, Ellen decided to ask Paul about his former foster home placements. Paul repeated over and over that he had a great relationship with his third set of foster parents, the Comeauxs, who lived in New Orleans. He told Ellen that the Comeauxs had always loved him and that he just lost track of them. He asked Ellen to contact them. When Ellen shared this information with her supervisor and colleagues in the office, they all laughed and joked that “those people won’t want to take in a seventeen year old.” Undeterred, Ellen, searched through Paul’s case record and found a phone number for the Comeauxs and called them. Almost immediately upon hearing that Ellen was speaking about Paul, Mrs. Comeaux asked when he could come to visit them, telling Ellen,

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“we love Paul, we have never forgotten him, and we just lost track of him.” After several successful visits, the Comeauxs asked about the possibility of Paul moving in with them and seemed interested in moving toward adoption. After ten months of visiting, and some challenges, which they confronted and resolved, the Comeauxs claimed Paul as their son and adopted him. Ellen always wondered what would have happened to Paul if she had not made that call.

The agency’s reasonable efforts to secure APPLA should include ongoing discussions with the youth about who might provide longterm care or support and guidance. The judge hearing the case should consider hearing from the child on these issues as well. What Are the Compelling Reasons Why a More Preferred Permanency Plan Is Not Being Selected? If the agency concludes, after considering reunification, adoption, legal guardianship, and relative placement, that the most appropriate permanency plan is APPLA, the agency must document for the court the compelling reason(s) this conflicts with the statement that independent living is not a permanency plan, but rather a service for the alternate plan. The judge presiding over the case must evaluate the compelling reasons why a more preferred option is not being pursued. The term compelling means convincing and persuasive and implies a strong burden of proof and persuasion. The regulations give three examples of a compelling reason for establishing APPLA as a permanency plan: 1. an older teen who specifically requests that emancipation be established as her permanency plan; 2. a parent and youth who have a significant bond, but the parent is unable to care for the youth because of an emotional or physical disability, and the youth’s foster parents have committed to raising the youth to the age of majority and to facilitate visits with the disabled parent; or 3. an Indian tribe has identified APPLA.

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The regulations clearly state that no permanency option should be ruled out for an entire group of the foster care population. These three examples are thus not meant to create broad categories to be generally applied. For instance, all fifteen year olds who are requesting emancipation cannot be treated the same. For one youth an APPLA might be appropriate, but for another reunification might remain a possibility, or a relative willing to care for the youth may have recently been identified. The point is that permanency planning is based on the specific best interests, individual needs, and circumstances of each child or youth. Is the Proposed Plan Actually a Permanent Living Arrangement? Child welfare and legal professionals should ask how the proposed arrangement will be more stable and secure than ordinary foster care. Is this the most family-like arrangement for the youth? Which adults will maintain a continuing, close parent-child relationship with the young person? Permanent placement with foster parents who agree to care for the youth indefinitely is an acceptable APPLA, but permanent long-term placement in the foster care system without a specific family who will commit long-term to the youth is not an appropriate permanency plan for the youth and, in fact, may be harmful to the young person. A family network may provide permanence and stability for a youth. For example, there might be long-distance relatives who want to share custody or older relatives who do not want to assume custody alone because they fear they may not be alive much longer so would prefer a shared custody arrangement. What Support Structures Are in Place? APPLA implies a permanency plan that is markedly more stable and family-like than a mere extension of foster care. Support structures that enhance the stability of a living arrangement are vital when a youth is not living with a specified adult. Independent living is often the

permanency plan for older children. This is distinct from emancipation because independent living contemplates an arrangement that is stable and secure, with a focus on those features of the plan that enhance permanency. In contrast, emancipation implies a discharge from foster care by virtue of the youth’s age. Often, independent living services focus on the youth’s educational, vocational, or mental health needs, without identifying and working with or involving adults with whom the young person can establish or strengthen a relationship. Consequently, many individuals eighteen and older may leave foster care with no caregivers and no alternative homes or families (Carnochan et al. 2013). Moreover, in many instances teens exit foster care with no ongoing relationships with adults who care about them and their futures. By considering alternative placements and services that allow them to maintain close ties with biological parents, relatives, foster parents, and perhaps even formal mentors, the agency locates potential supporters who can provide further assistance while the youth is in foster care and beyond. The reasonable efforts by the agency that are described here could contribute to finalizing APPLAs for older youth. These elements do not necessarily make the placement an APPLA, but they contribute to the stability and permanency of the living arrangement. Mentoring This arrangement provides adult supervision and guidance for the youth and may include a formal, structured, subsidized arrangement. It allows shared parenting responsibilities when no single person can provide for a young person and is appropriate for some older children. The teenaged youth may even live independently. Formal mentoring from a network of adults gives the youth the support system needed to function during the transition to adulthood (Greeson, 2013). Another strength of this arrangement is that it builds ties and relationships between the youth and mentors that last well beyond

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the youth’s adolescence and placement in legal custody. Mentors can provide educational or employment advice and assistance and help prevent juvenile crime, unemployment, school dropout, and teen pregnancy. The child welfare system has not traditionally taken advantage of these programs, and resources for formal mentor programs are often lacking. In existence since 1902, the Big Brother/Big Sister program is an example of an effective mentoring program. Less formal arrangements can be achieved by looking to the adults already involved in the youth’s life. These adults may include, for example, a foster parent of the youth’s siblings. Community-Based Programs In some cultures the community in which children are raised offers various services and plays a prominent role in children’s upbringing. For example, much attention focuses on the disproportionate representation of African American children in foster care (see the chapter by McRoy, this volume). In crafting alternative permanency plans for African American children, the child welfare system could better use the informal, communal nature of extended families within the African American community. Some advocates, particularly in Indian communities, argue for a broader concept of parental rights that includes many community members beyond biological and foster parents (see the chapter by Cross, this volume). A network of supportive adults may be more valuable than a single supportive caregiver, especially as children age out of the system. Therefore, it is sometimes necessary for the agency to explore and develop a network of community members to respond to the youth’s needs. Does the Youth Have Any Special Needs, and What Services Is the Agency Providing? The agency must continue to provide for the youth’s needs. Sometimes as the young person deals with mental health issues and makes behavioral and educational progress, prospective caregivers are more willing to commit to

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providing a permanent home for the youth. Such changing circumstances make it important to revisit the issue of compelling reasons at every permanency hearing for the youth. For example, at the first permanency hearing, APPLA might be accepted as the permanency plan, based on the compelling reasons that there are no identifiable caregivers and that the youth needs residential treatment to address severe emotional problems associated with a history of sexual abuse. As the youth’s special needs are met and treatment succeeds, the case might be up for review twelve months later, and the youth might have been discharged from residential treatment, living with a supportive aunt. APPLA would no longer be the appropriate permanency plan, as the agency could explore relative placement, legal guardianship, or even adoption with the aunt. To satisfy any permanency plan, including an APPLA, workers must make sure the youth’s special needs are being met. What Efforts Has the Agency Made to Assess the Safety, Quality, and Stability of the APPLA? Once the APPLA has been identified, the agency must ensure that the youth will be safe and well cared for. This may involve a formal home study. Sometimes a provider delivers independent living services, and the agency should verify the living arrangements as safe and appropriate. Teenagers in foster care can be a challenging population to work with; too often they are not provided proper care and supervision. Crafting a stable, planned, permanent arrangement can have a major impact on their future success. The agency should therefore regularly assess the degree to which the placement is safe and appropriate. Can Group Care Be Considered an APPLA? Rarely is group care a living arrangement that is planned and permanent. Consider the following factors to determine if group care placement is a suitable APPLA.

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Temporary Versus Permanent It is helpful to distinguish between a temporary group care arrangement and an APPLA. A youth can be placed in a group home temporarily without the placement constituting a permanency plan. For example, a youth temporarily placed in a group home may have a permanency plan of returning home. Group care should not be considered an APPLA if the youth’s release from group care is reasonably likely during the youth’s minority. Instead, group care is a step toward achieving the youth’s permanency plan—be it adoption, reunification, or some other action. Group care as an APPLA requires clear evidence that the young person will not be able to function in a family setting before reaching adulthood. Stability, Predictability, and Continuity The assumption that group care must last through a youth’s minority is not sufficient to make group care an APPLA. For reasons previously stated, a plan for a single placement should not be considered necessary or sufficient to make group care a plan for permanence. If a single group placement was enough, an orphanage would be considered an APPLA. A plan to keep a youth in a specific facility or program might, however, be a factor—if it helps demonstrate the stability, predictability, and continuity of the arrangement. Advocate or Guardian An individual designated as the youth’s permanent advocate or guardian can help qualify a group care facility or program as an APPLA. To make an advocate or guardian a factor, there should be reason to believe that such a person will play a major and enduring role in the youth’s life. There must be 1. strong assurances that the advocate will continue indefinitely and 2. reasons to believe a close relationship exists between the advocate and youth. The adult should be committed to helping the youth reach adulthood and, ultimately, until the youth leaves group care.

Designated Contacts What if there is a long-term plan for “transfers up” within a facility when the youth demonstrates progress functioning in a family or in society? This condition alone should not qualify the group care as an APPLA because it provides the youth no stable, enduring relationship with an adult or couple. The analysis might depend on whether there is some assurance that the young person will have a continuing and specific set of persons to relate to and work with. Can paid staff ever qualify to perform that role? Group care might, however, qualify as an APPLA if there are designated contacts with specific individuals, such as relatives. Component Areas Clearly, issues pertaining to the overuse of LTFC and inappropriate application of APPLA have serious long-term consequences for youth in foster care. Most policy makers and practitioners have long advocated for a reframing of the issues of permanency for youth. The National Resource Center for Permanency and Family Connections offers an organizing framework that can be used by child welfare agencies across the country to help young people achieve and maintain permanence. It neither prescribes nor recommends best practice models, but instead identifies six key components that should be addressed so that public child welfare agencies can best identify and support permanence for young people in out-of-home care. It may also promote a viable alternative to the overuse of LTFC or the inappropriate designation of APPLA for youth in foster care. The belief and value that every child and young person deserves a permanent family relationship is paramount in this work. Permanence is not a philosophical process, a plan, or a foster care placement, nor is it intended to be a family relationship that lasts only until the child turns eighteen. Instead, permanence is about locating and supporting a lifelong family. For young people in out-of-home placement,

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planning for permanence should begin at entry into care and be youth-driven, family-focused, continuous, and approached with the highest degree of urgency. Child welfare agencies, in partnership with the larger community, have a moral and professional responsibility to find a permanent family relationship for each child and young person in foster care. Permanence should bring physical, legal, and emotional safety and security in the context of a family relationship and allow multiple relationships with a variety of caring adults. At the same time, young people in out-of-home care must be given opportunities within the family and community environment for learning the array of life skills necessary to become independent and interdependent adults. Ensuring that children have both permanent relationships and life skills for independence is critical to future well-being (Roller-White et al. 2013).

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Permanence is achieved within a family relationship that offers safe, stable, and committed parenting, love, unconditional lifelong support, and legal family membership status. Permanence can be the result of reunification with the birth family or legal guardianship or adoption by kin, fictive kin, or caring and committed others. YYY

This framework of youth permanency and the discussions that will emerge, especially those helping to Unpack the No of Permanency for Adolescents, can move the field of children, youth, and family services away from the destructive overuse of LTFC and the inappropriate use of APPLA and toward the promotion of more positive family-based outcomes for youth in foster care.

REFERENCES

Adoption and Foster Care Analysis and Reporting System (2004). Administration for Children and Families, National Adoption and Foster Care Statistics. Washington, DC: Adoption and Foster Care Analysis and Reporting System. Avery, R.  J. (2009). Final Evaluation Report: Permanent Parents for Teens Project. New York: You Gotta Believe Adoption Agency. Avery, R.  J. (2010). An Examination of Theory and Promising Practice for Achieving Permanency for Teens Before They Age Out of Foster Care. Children and Youth Services Review, 32, 399–408. Avery, R. J., & Freundlich, M. (2009). You’re all grown up now: Termination of foster care support at age 18. Journal of Adolescence, 32, 247–57. Barth, R.  P. (1986). Emancipation services for adolescents in foster care. Social Work, 67, 165–71. Barth, R. P. (1990). On their own. Child and Adolescent Social Work, 7, 419–40. Carnochan, S., Lee, C. & Austin, M. J. (2013). Achieving Exits to Permanency for Children in Long Term Care. Journal of Evidence-Based Social Work Special Issue: Performance Measurement in the Child Welfare System: Policy and Performance Pointers, 10(3), 220–34. Casey Family Services (2008). National Convening on Youth Permanency. New Haven, CT. Charles, K., & Nelson, J. (2000). Permanency planning: Creating life-long connections—what does it mean for

adolescents? Tulsa, OK: National Resource Center for Youth Development. Cook, R. (1991). A national evaluation of Title IV-E foster care independent living programs for youth: Phase 2 final report. Rockville, MD: Westat. Cook, R. (1994). Are we helping foster youth prepare for their future? Children and Youth Services Review, 16, 13–29. Courtney, M.  E., Dworsky, A., Cusick, G.  R., Keller, T., Havlicek, J., & Perez, A. (2007). Midwest evaluation of adult functioning of former foster youth: Outcomes at age 21. Chicago: University of Chicago, Chapin Hall Center for Children. Courtney, M., Dworsky, A., Lee, J., & Rapp, M. (2010). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 23 and 24. Chicago: University of Chicago, Chapin Hall Center for Children. Courtney, M.  E., Piliavin, I., & A. Grogan-Taylor. (1995). The Wisconsin study of youth aging out of out-of-home care: A portrait of children about to leave care. Madison, WI: Institute for Research on Poverty. Courtney, M.  E., Pilavin, I. Grogan-Kaylor, A., & Nesmith, A. (1998). Foster youth transitions to adulthood: Outcomes 12 to 18 months after leaving out-of-home care. Madison: University of Wisconsin– Madison.

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Courtney, M.  E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A. (2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80, 685–87. Fiermonte, C., & Renne, J.  L. (2002). Making it permanent: Reasonable efforts to finalize permanency plans for foster children. Washington, DC: American Bar Association, Center on Children and the Law/ National Resource Center on Legal and Judicial Issues. Freundlich, M. (2009). Permanence for older children and youth: Law, policy, and research. In B. Kerman, M. Freundlich, & A. N. Maluccio (eds.), Achieving permanence for older children and youth in foster care (pp. 127–46). New York: Columbia University Press. Freundlich, M., Avery, R. J, Munson, S., & Gerstenzang, S. (2006). The meaning of permanency in child welfare: Multiple stakeholder perspectives. Children and Youth Services Review, 28, 741–60. Frey, L., Cushing, G, Freundlich, M., & Brenner, E. (2008). Achieving permanency for youth in foster care. Child & Family Social Work, 13, 218–26. Frey, L, Greenblatt, S.  B., & Brown, J. (2005). A call to action: An integrated approach to youth permanency and preparation for adulthood. New Haven: Casey Family Services. Getman, S, & Christian, S. (2011). Reinstating parental rights: Another path to permanency? Protecting children: A Professional publication of American Humane Association, 26, 58–74. Greeson, J. K. P. (2013). The Theoretical and Conceptual Basis for Natural Mentoring, Emerging Adulthood, 1(1), 40–51. Kerman, B., Freundlich, M., & Maluccio, A. (2009). Achieving permanency for older children and youth in foster care. New York: Columbia University Press. Inglehart, A. P. (1994). Adolescents in foster care: Predicting readiness for independent living. Children and Youth Services Review, 16, 159–69. Lee, B. R., Hwang, J., Socha, K., Pau, T., & Shaw, T.V. (2013). Going Home Again: Transitioning Youth to Families After Group Care Placement. Journal of Child and Family Studies, 22(4), 447–59. McMillen, J. C., & Tucker, J. (1999). The status of older adolescents at exit from out-of-home care. Child Welfare, 78, 339–60. McRoy, R. G., & Madden, E. (2009). Youth permanence through adoption. In B. Kerman, M. Freundlich, & A.  N. Maluccio (eds.), Achieving permanence for older children and youth in foster care (pp. 244–65). New York: Columbia University Press. Mallon, G. P. (1998). After care, then where? Evaluating outcomes of an independent living program. Child Welfare, 77, 61–78.

Mallon, G. P. (2004). Facilitating permanency for older adolescents: A toolbox for youth permanency. Washington, DC: Child Welfare League of America. Mech, E.  V. (1988a). Preparing foster adolescents for self support: A new challenge for child welfare services. Child Welfare, 67, 487–95. Mech, E. V., ed. (1988b). Independent-living services for at-risk adolescents. Washington, DC: Child Welfare League of America. Mech, E.  V. (1994). Preparing foster youth for adulthood: A knowledge-building perspective. Children and Youth Services Review, 16, 141–46. Muskie School of Public Service, University of Southern Maine (2003). Partnering with youth: Involving youth in child welfare training and curriculum development. Portland, MN: Muskie School of Public Service, University of Southern Maine. National Resource Center for Permanency and Family Connections (2004). Framework and Measures for Youth Permanency. New York: National Resource Center for Permanency and Family Connections. Pearlmutter, S., Groza, V., Garafolo, T., & Norris, B. (2011). Adopt Cuyahoga’s Kids: Securing Adoptive Placements for Older Youth in Cuyahoga County’s Public Child Welfare System. Protecting children: A Professional publication of American Humane Association, 26, 74–91. P.L. 96–272, Adoption Assistance Child Welfare Act. (1980). P.L. 105–89, Adoption and Safe Families Act. (1997). P.L. 106–169, Foster Care Independence Act, (1999). P.L. 110–351, The Fostering Connections to Success and Increasing Adoption Act (2008). Roller-White, C., Corwin, T., Buher, A., & O’Brien, K. (2013). The Multi-Site Accelerated Permanency Project. Seattle: Casey Family Programs. Scott, T., & Gustavsson, N. (2010). Balancing Permanency and Stability for Youth in FosterCare. Children and Youth Services Review, 32, 619–25. Tao, K.W., Ward, K. J., O’Brien, K., DiLorenzo, P., & Kelly, S. (2013). Improving Permanency: Caseworker Perspectives of Older Youth in Another Planned Permanent Living Arrangement. Child and Adolescent Social Work Journal, 30 (3) 217–35. U.S. Department of Health and Human Services (2011). Adoption and Foster Care Analysis and Report #19. Retrieved October 31, 2012, from www.acf.hhs.gov/ programs/cb/publications/afcars/report19.htm. U.S. Department of Health and Human Services. (2013). The AFCARS Report #20: Final estimates for FY2012, Retrieved October 26, 2013, from http://www.acf. hhs.gov/programs/cb/stats_research/afcars/tar/ report20 .htm. Walters, D. (2011). What Finding Permanency Means from a Youth Perspective. Protecting children: A Professional publication of American Humane Association, 26, 8–10.

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Youth Development and Transitional Living Services

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he circumstances of youth who leave foster care for adulthood have justly received increased attention in the last twenty-five years. We now know more about their experiences in care prior to exit and in the early years following their exit. Professionals are much more cognizant of the challenges of transition and increasingly adept at providing needed assistance. Some important, albeit still limited, federal and state policies have been enacted, and numerous program initiatives have been developed in local settings. This chapter addresses this area of policy and practice, identifying what is known about this population and the interventions designed to assist with the transition to adulthood. Demographic Patterns: Data The most recent national data from the Adoption and Foster Care Analysis and Reporting System indicated 23,439 foster youth exited foster care in FY 2012 via emancipation; that is 10 percent of all exits from foster care during this year (U.S. Department of Health and Human Services 2013). These data, reported for each year since 1998, reveal the number and percentage of youth leaving care due to emancipation has been increasing overall; in 1998 17,310 youth emancipated from foster care, 7 percent of all foster care exits (U.S. Department of Health and Human Services 2006). Although the current number for FY 2012 is a decrease since FY 2011 (26,286), the percentage exiting via emancipation (10, 11 percent) is similar.

Data indicators associated with the Child and Family Service Reviews (CFSRs) also provide relevant information. As one measure of permanency, data are reported on “children growing up in foster care,” which is defined as the percentage of children in foster care for three years or longer who either 1. have been discharged from foster care with a discharge reason of emancipation or 2. reached their eighteenth birthday while in foster care. The percentage among states ranged from 15.8–76.9 percent, with a median of 47.8 percent (U.S. Department of Health and Human Services 2010). No federal standard is identified for this indicator of permanency. The high percentage indicates a continuing problem of large numbers leaving care via emancipation versus preferred permanency alternatives (return home or adoption). Moreover, the wide range of percentages across states indicates the variability in the extent to which states are effectively serving these youth. Other data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) provide a description of the characteristics of foster children, some of which are particularly relevant to transition (U.S. Department of Health and Human Services 2013). Data on race/ ethnicity continue to document the overrepresentation of black (26 percent) and Hispanic (20 percent) children compared to white nonHispanic children (42 percent) in the foster care population. The existence of this racial disparity in child welfare is well documented (Hines, Lemon, & Wyatt 2004). Children of color are less likely to be returned home to families, less 467

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likely to be adopted, and more likely to leave care without a permanent connection to an adult (McRoy 2005). This cumulative disparity throughout all stages of experience in child welfare systems suggests that youth of color are disproportionately likely to leave care via emancipation versus other types of exits (Wertheimer 2002). Other FY 2012 descriptive data relevant to the experience of aging out is the fairly large percentage of older youth in foster care (38 percent were ages twelve to twenty years old); the long lengths of stay (9 percent had been in care three to four years and another 6 percent had been in care for five or more years); and the percentages placed in institutional (9 percent) and group care (6 percent) rather than foster homes or other settings. Entering foster care at an older age and being placed in a group setting have been found to be related to likelihood of aging out of care (Wertheimer 2002). Societal Context For most young people the process of becoming an independent adult is a gradual one. Youth receive some support from families during this long process; they have family resources to tap when they run into challenges; and, optimally, they are prepared for this independence by their schooling, life experiences, and other opportunities that lead to reasonably healthy development. This scenario contrasts with the experience of many former foster youth who emancipate to adulthood directly from the foster care system. These youth are more likely to lack key supports from family; to be beset by longstanding and unresolved difficulties related to histories of poverty, maltreatment, substance use, and mental illness; and to have had few opportunities to develop the human capital (i.e., education, work skills, experiences) and social capital (i.e., friends, relationships, social skills) usually needed to effectively succeed as an adult. Moreover, historically the transition for foster youth has been quite abrupt; at the age of eighteen these young people were often

discharged to live on their own with minimal preparation or guidance. Knowledge of the social context for young adulthood in the contemporary U.S. is therefore helpful in understanding societal expectations for adulthood. Particularly relevant theoretical perspectives are based in identity development and attachment (Smith 2011), life course and life transitions (Elder 1985; George 1993; Shanahan 2000), especially in young adulthood (Arnett 2000, 2004), and within social and cultural context (Arnett 1998; Côté 2000). The concept of emerging adulthood proposed by Arnett (2000) as a new stage of development for the period from the late teenage years through the twenties has gained resonance for understanding the experience post–foster care for young adults. In contemporary American society this period is for many young people expected to be exploratory, unstable, and fluid in several domains (e.g., relationships, living situation, employment; Arnett 2004). In the general population, residential changes are frequent and sizable percentages of young adults move back to parental homes after initially moving out (Goldscheider & Goldscheider 1994; Rindfuss 1991). These expectations differ from those of youth in earlier generations for whom patterns of transition to adulthood were more defined. Sequencing has been a particularly important component of the study of transition for foster youth, because foster youth have been forced to attain independence prior to achieving stability in housing, education, and employment. Moreover, transitions that occur either early or late, compared to societal norms, can put individuals at some developmental risk (Marini, Shin & Raymond 1989). Former foster youth may be early in residential independence and parenthood, for example, but delayed in adult roles related to educational attainment and steady employment. Changes in societal culture can exacerbate challenges of successfully transitioning to adulthood among the general population. Young people in contemporary Western societies are

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not provided sufficient supports from societal institutions to assist them in the transition to adulthood; rather there is increased pressure for each young person to be a self-determining agent (Côté 2000). This trajectory places increasing pressure on families to support young people financially and in other ways for much longer periods of time. Consequently, many young people in the U.S. have access to parental resources. Approximately two-thirds of those in their early twenties and 40 percent in their late twenties receive financial assistance from parents (Schoeni & Ross 2005). Moreover, there are numerous other mechanisms by which middle-class parents transfer social class advantages to their children, including access to resources such as schools, communication patterns, engagement in beneficial social networks, and socialization regarding aspirations and values (Swartz 2008). Former foster youth rarely have access to either substantial financial or other resources of their parents. While some level of their disadvantage stems from their family’s problems, in young adulthood they are further disadvantaged by the lack of access to this wide range of socioeconomic supports. These theoretical perspectives regarding young adult years and the empirical data regarding patterns of young adulthood are instructive in identifying some of the potential reasons why youth aging out of foster care are subject to poor outcomes. The vast difference between the transition to adulthood experiences of the foster care population versus the more standard processes for young adults in the general population provides justification for efforts to increase supports to foster youth. Additionally, utilization of these theoretical perspectives may enhance creative thinking about appropriate means of intervention. Vulnerability and Resilience Factors Outcome evidence for former foster youth has long compellingly demonstrated the profound challenges facing these young people as they enter into adulthood. Studies have found

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high rates of homelessness, poor physical and mental health, limited educational attainment, high unemployment, and high rates of parenting, substance abuse, incarceration, and other poor outcomes (e.g., Barth 1990; Cook 1994; Collins & Ward 2011; Courtney & Dworsky 2006; Courtney, Dworsky, Lee, & Raap 2010; Courtney et al. 2001; Festinger 1983; Iglehart & Becerra 2002; Lindsey & Ahmed 1999; McMillen & Tucker 1999; Mallon 1998; Pecora et al. 2006; Reilly 2003). Many of these studies were conducted at state or local levels and had a variety of methodological limitations, particularly related to sample selection and size. Nonetheless, they tell a consistent story about a population with heightened vulnerability. Housing related outcomes have received particular attention in this body of research. The three largest and most rigorous studies of outcomes of former foster youth provide a consistent estimate of the risk of homelessness. In the only national study of former foster youth, Cook (1994) found an estimated one-quarter of the sample had experienced at least one night without a place to stay. In the Midwest Evaluation of Adult Functioning of Former Foster Youth (studying youth in Illinois, Wisconsin, and Iowa), 24 percent of study participants aged twenty-three or twenty-four had ever been homeless, defined as “sleeping in a place where people weren’t meant to sleep, or sleeping in a homeless shelter, or not having a regular residence in which to sleep” (Courtney et al. 2010). In the Northwest Foster Care Alumni study (drawing a sample from Washington and Oregon), 22 percent of the sample “experienced homelessness for one day or more within a year of leaving foster care” (Pecora et al. 2006:1471). Each of these studies also has utilized comparisons with national samples in order to place data regarding foster care populations in context. Cook (1994) compared her findings to data from the Current Population Survey (CPS) of eighteen to twenty-four year olds in the general population. In this comparison, 54 percent of the former foster youth had a high

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school completion rate, 60 percent of the young women had given birth, and 30 percent of the sample received public assistance, compared to 78 percent, 24 percent, and 5 percent, respectively, in the CPS sample. Comparing former foster youth ages twenty-three to twenty-four with young adults in a nationally representative sample of the same age group who participated in the National Longitudinal Study of Adolescent Health, Courtney et al. (2010) report that the former foster care youth were doing less well than the comparison group. When compared to the national sample, the Midwest study participants were over three times as likely not to have a high school diploma or GED, half as likely to have completed any college, and onefifth as likely to have a college degree. Only 48 percent of the Midwest study participants were currently employed compared to 76 percent of the national sample. Additionally, almost half of the Midwest study participants reported some material hardship (e.g., not enough money to pay bills) compared to less than a quarter of the national sample. Pecora et al. (2006) also compare the rates of the foster care alumni in their study with national level data. For example, they found an employment rate among those eligible for work to be 80 percent, lower than the national average of 95 percent (for ages twenty to thirty-four during 2000). Moreover, 17 percent of foster care alumni were receiving cash assistance from public assistance programs compared to 3 percent of U.S. households in the same time period. One-third of alumni lived in a household at or below the poverty line, three times the national rate. The reasons for these generally very poor outcomes are complex and may include system-induced factors from spending long periods of time in care (e.g., instability, lack of access to normative supports); effects of the circumstances that brought them into care in the first place (e.g., abuse, neglect, family dysfunction); and socioeconomic characteristics consistent with other disadvantaged groups, especially poverty and its related disadvantages.

Yet, despite the serious risk of poor outcomes facing this population, there is heterogeneity in both experiences and outcomes. Children and youth come into care for different reasons, have varying experiences in care, and bring a unique set of personal strengths and challenges in their individual development. Thus a focus on resiliency has also been critical to understanding and intervening with this population. Drawing upon the work of Masten (2001) and Werner and Smith (1992), among others, a focus on resiliency has led to a focus on the strengths of young people in foster care as well as the protective factors they possess or experience that lead them to achieve a reasonable level of healthy stability in young adulthood. Hines, Merdinger, and Wyatt (2005) applied resiliency theory explicitly to foster youth transitioning from care. In their qualitative study of former foster youth, the researchers found that despite adversities the youth had several protective factors at the individual level (intelligence, steady disposition, persistence, engagement in positive activities) as well as exposure to nonparental positive role models and experience with educational and foster care systems perceived as “safe havens.” One key resiliency factor critical for this population is access to various forms of social support. Perry (2006) examined types of support networks of foster youth and their effects. This research found that, compared to youth with no strong networks, those with three strong networks were found to be significantly less likely to experience depression and anxiety. Furthermore, multiple strong social networks were needed to have an ameliorating effect on psychological stress. Sources of support often include members of the family of origin; substantial percentages of former foster youth return to live with parents or extended family upon release from care at adulthood (Collins, Paris, & Ward 2008). Other studies have identified support from “natural mentors” and that this support was associated with improved outcomes (Collins, Spencer, &

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Ward 2010; Munson & McMillen 2008). Counselors and caseworkers also have been identified as sources of support (Lemon, Hines, & Merdinger 2005). In a recent qualitative study (Ahrens et al. 2011), youth described multiple types of support and positive contributions to their development from nonparental adults. Findings also identified several obstacles to relationship formation (e.g., youth’s fears of emotional risk, fears of indebtedness to the mentor) and facilitators of initial connection (e.g., adult’s patience/persistence, adult’s authentic displays of affection). Another recent study (Singer, Berzin, & Hokanson in press), found “holes” in the support provided to youth by informal network members, especially appraisal and instrumental support. In summary, the vulnerability of this population to potential poor outcomes remains a serious threat, as documented by researchers and observed by practitioners. But resilience is exhibited as well and a key part of the equation. Like all matters of human development, each individual youth aging out of care exhibits a complex mix of vulnerability and resilience. Consequently, efforts to assist youth in transition necessarily focus simultaneously on reducing risk and enhancing resilience. Current Policies: Federal and State The initial federal legislation aimed to provide some assistance in preparing foster youth for independence was the Independent Living Initiative (ILP; P.L. 99-272; 1986), which amended Title IV-E of the Social Security Act to provide federal funds to states. The aim was to help adolescent foster youth plan for the transition from care and develop independent living skills. This legislation was critical in providing the impetus for states to begin to address their role in helping adolescent foster care youth prepare for independence. Notable limitations included the small amount of funding and the restrictions that funds could only be used for youth while in care (not those who had recently aged out) and could not be used to provide housing. Thus, while the Independent Living Initiative was

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important as an initial step in the federal effort to assist these youth, it was quite small in scope and intensity given the needs of the population. The Foster Care Independence Act (P.L. 106-169; 1999) created the Chafee Foster Care Independence Program, which doubled federal funding for services and allowed funding to be used for housing. Core elements of the Chafee Foster Care Independence Program included a $140 million capped entitlement (requiring a 20 percent state match); an updated funding allocation formula based on the proportion of a state’s children in Title IV-E and state-funded foster care; expansion of eligibility up to age twenty for those who are “likely to remain in foster care until age eighteen” and those who have aged out of foster care without regard to their eligibility for Title IV-E funded foster care; allowable use of up to 30 percent of funds for room and board for those ages eighteen to twenty-one who left foster care because they reached age eighteen; and an option for states to extend Medicaid coverage to young people ages eighteen to twenty-one who were in foster care on their eighteenth birthday. The legislation also has required states to involve youth in the design of independent living programs and to give youth a voice in developing their case plans. The Promoting Safe and Stable Families Amendments of 2001 added a new purpose to the Chafee Foster Care Independence Program, focused specifically on financial support to access education and training. The objective of the Chafee Education and Training Voucher Program (ETV) is to provide resources to states to make available vouchers for postsecondary training and education (up to $5,000 per year) to youths aging out of the foster care system or to youths adopted from public foster care after age sixteen. The most recent federal legislation with potential to positively influence the transition of foster youth is the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351; 2008). This legislation extended the age of federal foster care eligibility from eighteen to twenty-one and can therefore potentially

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provide states needed federal resources to continue to aid foster youth after age eighteen. The act also mandated enhanced attention to transition planning. During the ninety-day period prior to the child turning eighteen years (or the maximum age allowed by the state for receiving foster care assistance), a caseworker of the state agency and any other appropriate representatives of the child must “provide the child with assistance and support in developing a transition plan that is personalized at the direction of the child” including “specific options on housing, health insurance, education, local opportunities for mentors and continuing support services, information on designating a health care agent, and work force supports and employment services” (McMillen et al. 1997:273). Because this legislation has recently been enacted, there is limited information available regarding its ability to influence the circumstances of youth transitioning from care. Primary focus is on its implementation. The Commission on Youth at Risk (2010) has discussed state implementation of the Fostering Connections Act (FCA), identifying potential implementation challenges for state policy makers and other community leaders in implementing this act. These key challenges include 1. the need to identify which sections of the law are mandatory and which are optional (e.g., are foster care payments allowable to go directly to foster youth after age eighteen?); 2. making decisions about funding some of the optional provisions of the FCA (e.g., to what extent will state funds be devoted to expanding foster care after age eighteen?); and 3. managing potential unintended consequences (e.g., does extending foster care to age twenty-one create potential disincentives to permanency for older youth?). According to the National Resource & Center for Youth Development (2013) seventeen states have received federal approval for their Title IV-E plan amendments to extend care beyond age eighteen (www. nrcyd.ou.edu/state-pages).

Considerable variability exists between states regarding the extent and manner in which they support youth with the transition to adulthood. Policy in some states is moving toward extending assistance to former foster youth after age eighteen; however, in many jurisdictions it remains common that the transition continues to be abrupt at age eighteen or shortly thereafter. Uncertainty remains regarding the implementation of the FCA, its variation among states, and its eventual effect on the target population. Programs and Child Welfare Contributions Numerous programmatic interventions have been developed to address the needs of adolescent youth moving toward independence from the child welfare system and to enhance their circumstances to support them in sustaining a healthy productive lifestyle in adulthood. There is great variability in the ILP services offered by states, additional variability within states, and little knowledge about the scope and type of services offered (U.S. General Accounting Office 1999). There also is no explicit typology of these services. Many are generically labeled “independent living services” and lack specificity about the type of assistance provided. Additionally, some categories of assistance provided, for example, housing assistance, may include a much larger range of supports than the label suggests. With this caveat regarding the difficulty of organizing these programs within a clear typology, I will describe some of the major areas of service provision. Transition Planning and Life Skills The Fostering Connections Act’s inclusion of a requirement to craft transition plans with youth ninety days prior to their turning eighteen (or the state’s age for emancipation) increases attention to this component of transition work. Although transition planning has long been a critical component of work with youth leaving care, it is often taken for granted. More consideration could be given to the process of transition planning in order to make sure plans are fully individualized to address the specific circumstances

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of youths’ lives. Walters and colleagues (2010) recently highlighted this component of the work. They provide a review of key practice principles for transition planning (e.g., emphasis on permanency and connection, strengthsbased, youth driven) and identify examples of promising state practices in this area. Life Skills Training Life skills training has been one of the foundational approaches to assisting adolescent foster youth with preparation for adulthood. Over the years a variety of resources (e.g., curricula, workbooks, experiential exercises) in different formats has been developed to provide life skills training to foster youths. There has been little standardization to the development of these materials; consequently, the quality and content of the materials and specific target audience varies widely. Reviews of the multiple approaches and their impact on outcomes have been conducted (Collins 2001; Smith 2011). Naccarato and DeLorenzo (2008) summarized information and findings from nineteen studies about independent living services They suggest three recommendations for improving practice: 1. work to recruit and engage youth to attend ILP programs consistently; 2. create a standardized curriculum for use across states; and 3. establish mechanisms to ensure that youth’s needs and skills are matched to the interventions offered. Consistent with the localized nature of services in this area, most evaluations have related to state or local initiatives. However, one national study of independent living has been conducted by Cook (1994). This study found that youths receiving skills training in five key areas (money management, credit management, consumer skills, education, and employment) had significantly better outcomes in living independently than those receiving no training in these areas. Not all ILP services were related to outcomes. Receipt of ILP services did not influence rates of early parenthood, change in educational status after discharge, or having a social network. The study also found that

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services are most effective when a specific set of services is targeted toward a specific goal. Within individual states, Lindsey and Ahmed (1999) found that independent living program participants had better outcomes with regard to living independently, completing a vocational program, and enrollment in college than did the individuals in a comparison group. Reilly (2003) found that most youth had exposure to independent living training while in care, although few reported receiving concrete assistance for independence or actual services at discharge. Lemon, Hines, and Merdinger (2005) compared two groups of foster youth, those who had received ILP services and those who had not. Data suggested that ILP participants may have been more at risk than the non-ILP group; however, they were achieving comparable success in terms of education attainment, which might have been attributed to their participation in ILP services and their greater connection to caseworkers and counselors. A study by Pecora et al. (2006) indicates that placement stability while in care and extensive independent living services, including concrete resources, contribute to better educational and employment outcomes of transitioning youth in adulthood. These types of transition services are generally viewed positively, but are limited in scope and do not serve all those eligible (Collins & Ward 2011; McMillen et al. 1997). As a whole, the evaluation data do indicate some modest impacts. Yet the ability to fundamentally alter the course of the transition trajectory in a positive direction that impacts outcomes at a substantial level has not been demonstrated. This may be partly related to a narrow focus on independent living skills and the lack of a substantial “dosage” level consistent with participating youths’ high level of need. Concerns have also been articulated that efforts to enhance foster youth’s independent living skills have largely neglected the need for development of permanent relationships for these youth. Avery (2010) articulates this perspective: “Independent Living (IL) programs have proven inadequate to

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prepare youth for independence in any meaningful way. Too many youth leave care unconnected to committed adults in their lives who could buffer the challenges they face and serve as safe havens in times of need” (2010:399). IL services and programs—by themselves—are unlikely to achieve sizeable gains in key outcome areas. Housing Support The threat of homelessness for this population has been well documented (Collins & Curtis 2011). Absent the financial support of the child welfare system, and often lacking sufficient education and marketable skills, it is simply too difficult for many former foster youth to live independently. Clearly, the limited assistance provided by the federal Independent Living Initiative, which focused on preparation for leaving care, but disallowed federal spending on housing, could do little to protect against homelessness. The Foster Care Independence Act has allowed states to use 30 percent of federal funds for room and board for foster youth after the age of eighteen. These policy changes—allowing use of funds for housing and extending the age of services for transition-age youth—may better support programs’ capacity to protect against experiences of homelessness (and other poor housing outcomes) than the receipt of independent living services alone. Expansion of foster care eligibility through the Fostering Connections Act may also prove effective in protecting against former foster youths’ homelessness in their early adult years. Specific housing supports remain highly variable. In reality, there are limited federal or state policy supports that provide housing for this population (Collins & Curtis 2011). Most of the initiatives occur in localities, are developed through concentrated efforts of public and private entities, and are designed to meet the needs within an individual community. Housing interventions might focus on emergency, transitional, or permanent housing and might include a variety of accompanying supportive

services. Additionally, they might specifically target the aging-out population or serve other adolescent and young adult populations with housing needs. Focused specifically on housing funding, Torrico and Bhat (2009) suggest five financing strategies: access federal housing resources, tap child welfare resources, access community development resources, create public-private partnerships, and improve coordination across systems. They provide some specific examples in different localities. Other sources (e.g., Casey Family Programs 2005; National Association of Public Child Welfare Administrators 2010; National Center for Housing and Child Welfare 2010) provide additional information about the range of housing options and specific localized programs. One of the best-known agencies providing housing support to former foster youth is Lighthouse Youth Services in southeastern Ohio. Kroner and Mares (2008) have provided descriptive data on a large sample (n = 455 over six years) served within this well-established program. Clients are referred by the county child welfare services and the state department of youth services to Lighthouse Youth Services shortly before they reach the age of majority. This program primarily uses the scatteredsite housing model. The authors recognize the limitations of the data provided to assess this program (e.g., characteristics of those served, primary treatment outcomes), but are also mindful of the need for empirically based descriptive studies of existing programs. Largescale studies are rare, but relatively low-cost descriptive studies could provide meaningful data concerning the multiple unanswered questions about appropriate models for the various youths served. Youth Development In addition to the development of independent living skills and housing supports, a wide variety of interventions based on youth development principles have also been utilized to support the transition

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from foster care to independent adulthood. Although numerous definitions exist, youth development can be summarized as “a combination of all of the people, places, supports, opportunities, and services that most of us inherently understand that young people need to be happy, healthy, and successful. Youth development currently exists in a variety of different places, forms, and under all sorts of different names” (Center for Youth Development 2011:1). Central to the positive youth development approach is the idea that a deficit orientation to youth work with a primary focus on problem behavior (e.g., substance abuse, school failure, delinquency) is not appropriate. Although positive youth development has been associated primarily with communitybased programming, some child welfare experts have identified the need for public child welfare agencies to shift toward practice approaches more oriented to positive youth development (Clay, Amodeo, & Collins 2010; Nixon 1997; Seita 2000). A variety of approaches are reported in the literature. For example, Howse, Diehl, and Trivette (2010) describe and evaluate an asset-based camp program for older youth in foster care; this program is designed to increase the development of assets in youth and lead to achievement of positive permanency outcomes, especially adoption. Kaplan, Skolnik, and Turnbull (2009) review empowerment-oriented programs and services for youth in foster care. They classify these services into several areas: mentoring, academic services through high school, post–high school education attainment, employment services, court-related programs, supported housing, and group approaches to decision making and intervention. They also provide a listing of selected model programs in each area, although supportive data are scarce. The activities described within the label of “youth development” are those that may be taken for granted among the general population of youth but can be in short supply among foster care populations. One effort to provide these added supports for youth was initiated

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by the Rise Above Foundation (2011), a Massachusetts nonprofit organized specifically “to respond to the growing need to give youth in foster care opportunities that will give them a sense of normalcy, provide comfort, and build self-esteem.” This foundation funds individual requests (e.g., prom expenses, music lessons, special event tickets) made by social workers on behalf of specific foster youth. In this way some foster youth have access to the things that are a normal part of healthy development for young people, but often routinely denied to youth in foster care. Mentoring programs are also frequently included in a discussion regarding youth development approaches. While there is excitement about the potential of mentoring approaches, the limited evidence on effectiveness has been mixed. Rhodes, Haight, and Briggs (1999) have identified a positive impact of “formal mentors” on pro-social and self-esteem outcomes; however, Britner and Kraimer-Rickaby (2005) found no difference between programmatically mentored youth with intact matches and nonmentored youth. Despite the enthusiasm for mentoring foster youth, there is reason to proceed cautiously. There is little doubt that healthy relationships with a variety of nonparental adults might help transitioning foster youth. Yet translating that normative ideal into an effective program that promotes youth development, leads to good outcomes, and causes no harm to vulnerable young people has a number of challenges (Spencer et al. 2010). Discussion Theoretical and empirical comparisons of the aging-out population of youth in foster care with the general population of young adults continues to identify the multiple and interrelated disadvantages facing youth as they leave care. Narrowing the chasm between normative life experiences (family, schooling, and other opportunities) afforded to youth in the U.S. and the life experiences of those with heavy involvement in child welfare systems must be

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the explicit goal of policy and program interventions. A moral argument also underlies policy supports to aid in this transition: the state, having intervened to remove the child from her home, now has an obligation to provide needed assistance consistent with standards of family life in the U.S. As identified in this chapter, federal policy in this area has developed slowly and incrementally. Heretofore the assistance has not been sufficient to substantially improve outcomes for this population. In the most optimistic scenarios, these policy changes have provided funding support to allow agencies to assist youth in the transition from foster care in a less abrupt, more planful manner. As a result, some youth may be marginally better prepared and have some access to a variety of concrete and emotional supports. Even if this optimistic scenario has become the reality for a small number, many more remain poorly served in regard to transition-related services. Part of the challenge is that although the needs of transitioning foster youth have become more apparent, this population remains comparatively small and marginalized within child welfare systems. Child welfare systems address many child and family needs and operate within highly charged political environments. Advocates must constantly bring the needs of these youth to the attention of decision makers, otherwise they are at great risk of being overlooked within the chronically overburdened systems that serve them. Moreover, states and localities have been highly variable in their approaches to assisting youth in the transition from foster care. Practice among the agencies that serve these youth at the local level often exhibits great commitment and innovation. However, evaluation of these efforts is typically minimal. As a consequence, no compelling body of research exists to identify programs that should be replicated on a larger scale. Neither research evidence nor institutionalized support exists for many transition-focused programs. Hence, if services are

trimmed in times when budgets are tight, programs with comparatively short histories that are not entitlements are the most likely to be threatened. Given the current status of policy and programming, there is substantial room for additional efforts to improve the prospects of those emancipating from foster care. Policy efforts should be made on three fronts. First, overall improvements to child welfare systems in terms of prevention and family support are likely to have an indirect effect on prospects for these youth. If, due to appropriate intervention that strengthens the family of origin, children never enter the system and are never removed from their families, their transition trajectory to adulthood is likely to more closely mirror that of the normative population. Second, policy interventions aimed at the general young adult population, particularly in the areas of employment, education, and health, may aid the well-being and life chances of the foster care population, other youth with system involvement, and the large population of young people from poor and low-income backgrounds. Third, specialized policies that target support to this specific population must continue to be developed. Despite the increasing commitment to these youth, large numbers remain completely unserved, and many others receive a haphazard experience in service provision. Intervention should be characterized by comprehensiveness and individualization. Numerous strategies of intervention are required; these include permanent connection, transition planning, life skills development, provision of concrete supports, and access to normative developmental opportunities. Each strategy furnishes but one part of the comprehensive approach needed to appropriately assist transitioning foster youth. Assistance that is too limited in focus (e.g., only life skills) or insufficient in depth will be unlikely to make much difference. Like many aspects of child welfare policy, it is a challenge to design policies for the general

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case that work well in individualized circumstances. Consequently, a well-trained work force capable of engaging youth in a focused, planful approach to transition is a key part of effective transition policies. Workers must be capable of providing an individualized approach to transition that takes account of youth strengths, capabilities, and other elements of resilience. The reality is that interventions are likely to be costly. Provision of concrete supports like housing are particularly important to the well-being of transitioning youth, but can be neglected in policy solutions that are unwilling to acknowledge issues of cost. Similarly, development of a capable professional workforce with transition-related expertise requires significant investment. To make further advances in improving the prospects of foster youth who are transitioning to adulthood, policy commitment needs to demonstrate that foster youth are worthy of these investments.

REFERENCES

Ahrens, K., DuBois, L., Garrison, M., Spencer, R., Richardson, L., & Lozano, P. (2011). Qualitative exploration of relationships with important non-parental adults in the lives of youth in foster care. Children and Youth Services Review, 33, 1012–23. Arnett, J. (1998). Learning to stand alone: The contemporary American transition to adulthood in cultural and historical context. Human Development, 41, 295–315. Arnett, J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–80. Arnett, J. (2004). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press. Avery, R. (2010). An examination of theory and promising practice for achieving permanency for teens before they age out of foster care. Children and Youth Services Review, 32, 399–408. Barth, R. (1990). On their own: The experiences of youth after foster care. Child and Adolescent Social Work, 7, 419–40. Britner, P., & Kraimer-Rickaby, L. (2005). Abused and neglected youth. In D. DuBois & M. Karcher (eds.), Handbook of youth mentoring (pp. 482–92). Thousand Oaks, CA: Sage. Casey Family Programs (2005). It’s my life: Housing guide. Seattle: Casey Family Programs.

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The focus of this chapter has been on the specific circumstances of foster youth transitioning from care and the interventions specifically targeted to aid this group with this often difficult transition. In addition to continued attention to the further development and evaluation of programs in this area, the prospects for these young people will also be enhanced by overall improvements in the child welfare system that provide additional family supports, increase placement stability, and emphasize permanency. Moreover, good employment prospects, reasonable housing costs, and other opportunities for all young adults would also benefit the specific group of former foster youth. Approaches that combine targeted assistance to this group of youth, general improvements in the child welfare system, and opportunities available to all young adults are needed.

Center for Youth Development (2011). What is youth development? Retrieved June 8, 2011, from http:/cyd. aed.org/whatis.html. Clay, C., Amodeo, M., & Collins, M. (2010). Youth as partners in curriculum development and training delivery: Roles, challenges, benefits, and recommendations. Families in Society: Journal of Contemporary Human Services, 91, 135–41. Collins, M. (2001). Transition to adulthood for vulnerable youth: A review of research and implications for policy. Social Service Review, 75, 271–91. Collins, M., & Curtis, M. (2011). Conceptualizing housing careers for vulnerable youths: Implications for policy. American Journal of Orthopsychiatry, 81, 387–97. Collins, M., Paris, R., & Ward, R. (2008). The permanence of family ties: Implications for youth transitioning from foster care. American Journal of Orthopsychiatry, 78, 54–62. Collins, M., Spencer, R., & Ward, R. (2010). Supporting youth in the transition from foster care: Formal and informal connections. Child Welfare, 89, 125–43. Collins, M., & Ward, R. (2011). Services and outcomes for transition-age foster care youth: Youths’ perspectives. Vulnerable Children and Youth Studies, 6, 157–65. Commission on Youth at Risk (2010). Charting a better future for transitioning foster youth: Report from a national summit on the Fostering Connections to

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Success Act. Washington, DC: American Bar Association. Cook, R. (1994). Are we helping foster care youth prepare for their future? Children and Youth Services Review, 16, 213–29. Côté, J. (2000). Arrested adulthood: The changing nature of maturity and identity. New York: New York University Press. Courtney, M., & Dworsky, A. (2006). Early outcomes for young adults transitioning from out-of-home care in the USA. Child and Family Social Work, 11, 209–19. Courtney, M., Dworsky, A., Lee, J., & Raap, M. (2010). Midwest evaluation of adult functioning of former foster youth: Outcomes at age 23 and 24. Chicago: Chapin Hall at the University of Chicago. Courtney, M., Piliavin, I., Grogan-Kaylor, A., & Nesmith. A. (2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80, 685–717. Elder, G., Jr. (1985). Life course dynamics. Ithaca: Cornell University Press. Festinger, T. (1983). No one ever asked us: A postscript to foster care. New York: Columbia University Press. Fostering Connections Resource Center (2011). Retrieved June 20, 2011, from http://www.fosteringconnections.org/resources?id=0009. George, L. (1993). Sociological perspectives on life transitions. Annual Review of Sociology, 19, 353–73. Goldscheider, F., & Goldscheider, C. (1994). Leaving and returning home in twentieth-century America. Population Bulletin, 48, 1–35. Hines, A., Lemon, K., & Wyatt, P. (2004). Factors related to the disproportionate involvement of children of color in the child welfare system: A review and emerging themes. Children and Youth Services Review, 26, 507–27. Hines, A., Merdinger, J., & Wyatt, P. (2005). Former foster youth attending college: Resilience and the transition to youth adulthood. American Journal of Orthopsychiatry, 75, 381–91. Howse, R., Diehl, D., & Trivette, C. (2010). An assetbased approach to facilitating positive youth development and adoption. Child Welfare, 89, 101–16. Inglehart, A., & Becerra, R. (2002). Hispanic and African American youth: Life after foster care emancipation. Social Work with Multicultural Youth, 11, 79–107. Kaplan, S., Skolnik, L., & Turnbull, A. (2009). Enhancing the empowerment of youth in foster care: Supportive services. Child Welfare, 88, 133–61. Kroner, M., & Mares, A. (2008). Lighthouse Independent Living Program: Characteristics of youth served and their outcomes at discharge. Children and Youth Services Review, 31, 563–71. Lemon, K., Hines, A., & Merdinger, J. (2005). From foster care to young adulthood: The role of independent living programs in supporting successful transitions. Children and Youth Services Review, 27, 251–70.

Lindsey, E., & Ahmed, F. (1999). The North Carolina Independent Living Program: A comparison of outcomes for participants and nonparticipants. Children and Youth Services Review, 21, 389–412. McMillen, J., & Tucker, J. (1999). The status of older adolescents at exit from out-of-home care. Child Welfare, 78, 339–60. McMillen, J. C., Rideout, G., Fisher, R., & Tucker, J. (1997). Independent-living services: The views of former foster youth. Families in Society, 78, 471–79. McRoy, R. (2005). Overrepresentation of children and youth of color in foster care. In G. Mallon & P. Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 623–33). New York: Columbia University Press. Mallon, G. (1998). After care, then where? Outcomes of an independent living program. Child Welfare, 77, 61–78. Marini, M., Shin, H., & Raymond, J. (1989). Socioeconomic consequences of the process of transition to adulthood. Social Science Research, 18, 89–135. Masten, A. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–38. Munson, M., & McMillen, J. (2008). Natural mentoring and psychosocial outcomes among older youth transitioning from foster care. Children and Youth Services Review, 31, 104–11. Naccarato, T., & DeLorenzo, E. (2008). Transitional youth services: Practice implications from a systematic review. Child and Adolescent Social Work Journal, 25, 287–308. National Association of Public Child Welfare Administrators (2010). Youth housing issue brief. Retrieved October 30, 2011, from http://www.napcwa.org/ Youth/docs/YouthHousingIssueBrief2010.pdf. National Center for Housing and Child Welfare (2010). Funding sources to address the housing needs of youth aging out of foster care. Retrieved October 29, 2011, from http://nchcw.org/files/housing/ ABA%20-%20Youth%20Housing%20Funding%20 Sources.pdf. National Resource Center for Youth Development (2013). Federally funded foster care beyond 18. Retrieved October 27, 2013 from www.nrcyd. ou.edu/state-pages. (search federally funded foster care beyond 18) Nixon, R. (1997). What is positive youth development? Child Welfare, 76, 571–81. Pecora, P., Kessler, R., O’Brien, K., White, C. R., Williams, J., Hiripi,, E., English, D., White, J., & Herricks, M. (2006). Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study. Children and Youth Services Review, 28, 1459–81. Perry, B. (2006). Understanding social network disruption: The case of youth in foster care. Social Problems 53, 371–91.

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Reilly, T. (2003). Transition from care: Status and outcomes of youth who age out of foster care. Child Welfare, 82, 727–46. Rhodes, J., Haight, W., & Briggs, E. (1999). The influence of mentoring on the peer relationships of foster youth in relative and nonrelative care. Journal of Research on Adolescence, 9, 185–201. Rindfuss, R. (1991). The young adult years: Diversity, structural change, and fertility. Demography, 28, 493–512. Rise Above Foundation (2011). Mission statement. Retrieved October 28, 2011, from www.weriseabove. org. Schoeni, R., & Ross, K. (2005). Material assistance from families during the transition to adulthood. In, R. Settersten Jr., F. Furstenberg Jr. & R. Rumbaut (eds). On the frontier of adulthood: Theory, research, and public policy (pp. 396–416). Chicago: University of Chicago Press. Seita, J. (2000). In our best interest: Three necessary shifts for child welfare workers and children. Child Welfare, 79, 77–92. Shanahan, M. (2000). Pathways to adulthood in changing societies: Variability and mechanisms in life course perspective. Annual Review of Sociology, 26, 667–92. Singer, E., Berzin, S., & Hokanson, K. (in press). Voices of former foster youth: Supportive relationships in the transition to adulthood. Children and Youth Services Review (available online October 26, 2013). Smith, W. (2011). Youth leaving foster care: A developmental, relationship-based approach to practice. New York: Oxford University Press. Spencer, R., Collins, M., Ward, R., & Smashnaya, S. (2010). Mentoring for youth leaving foster care: Promise and potential pitfalls. Social Work, 55, 225–34.

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Swartz, (2008). Family capital and the invisible transfer of privilege: Intergenerational support and social class in early adulthood. New Directions for Child and Adolescent Development, 119, 11–24. Torrico, R. & Bhat, S. (2009). Connected by 25: Financing housing supports for youth transition out of foster care. Washington, DC: Finance Project. U.S. Department of Health and Human Services (2010). Table A: Data Indicators for the Child and Family Services Review. Retrieved July 13, 2011, from www. acf.hhs.gov/programs/cb/cwmonitoring/data_ indicators.htm. U.S. Department of Health and Human Services (2012). The AFCARS Report (19). DHHS/Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, www.acf.hhs. gov/programs/cb. U.S. Department of Health and Human Services (2013). The AFCARS Report (20) DHHS/Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, www.acf.hhs. gov/programs/cb. U.S. General Accounting Office (1999). Foster care: Effect of independent living program services unknown. Washington, DC: General Accounting Office. Walters, D., Zanghi, M., Ansell, D., Armstrong, E., & Sutter, K. (2010). Transition planning with adolescents: A review of principles and practices across systems. Tulsa: National Resource Center for Youth Development. Werner, E., & Smith, R. (1992). Overcoming the odds: High risk children from birth to adulthood. Ithaca: Cornell University Press. Wertheimer, R. (2002). Youth who “age out” of foster care: Troubled lives, troubling prospects. Washington, DC: Child Trends.

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Family Foster Care

F

oster care is a complex service. It serves children who have experienced abuse or neglect, their biological parents and families, and their foster parents. Children in foster care may live with unrelated foster parents, relatives, families who plan to adopt them, or in group homes or residential treatment centers. Because foster care is designed as a temporary service that responds to crises in the lives of children and their families, it is expected that children who enter care will either return to their parents as soon as possible or be provided with safe, stable, and loving families through placement with relatives or adoption. Some children and youth, however, remain in foster care for extended periods; many young people age out of the system and live on their own. In this second decade of the twenty-first century, foster care faces new and increasing demands. Therefore, policies and practice must respond in ways that ensure that children, their families, and their caregivers receive the highest-quality service possible. This chapter examines the foster care system of today: the population trends that currently shape foster care, the factors that affect the families and children served through foster care, and key aspects of practice that currently shape foster care. We conclude with a look at the future of foster care. The Dynamics of Foster Care Federal data and other supplemental sources help to establish a picture of the population of young people in foster care: children whom child

protective service agencies find to be abused or neglected; rates of entry, exit, and reentry into foster care; placement stability while children are in foster care; and lengths of stay. Child Abuse and Neglect In FY 2009, approximately 3.6 million reports of child abuse and neglect were made, compared to 3.3 million in FY 2008 (U.S. Department of Health and Human Services 2009a, 2010a). As in FY 2008, nearly one-quarter of the FY 2009 reports (467,161) were substantiated or indicated. Four-fifths (78.3 percent) of these child victims were neglected, 17.8 percent were physically abused, 9.5 percent were sexually abused, 7.6 percent were psychologically maltreated, and 2.4 percent were medically neglected. Another 9.6 percent experienced “other” types of maltreatment, such as “abandonment,” “threats of harm to the child,” or “congenital drug addiction” (U.S. Department of Health and Human Services 2009a, 2010a). Of the children with substantiated or indicated reports of child maltreatment, one-fifth (124,000 children) were removed from their families and placed in foster care (U.S. Department of Health and Human Services 2013). This number is substantially smaller than the number of children placed in foster care in FY 2012 (254,162 children) (U.S. Department of Health and Human Services 2013). Consistently, data indicate that the majority of children who enter foster care do so because of neglect (U.S. Dept of HHS, 2013. Preschool children and adolescents are at greater risk of entering foster care 480

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than are children ages six through twelve (U.S. House of Representatives Committee on Ways and Means 2009). Entries, Exits and Reentries Following a multiyear period of steady annual growth in the number of children in foster care, in the early 2000s the population of children in care began to decline. Between FY 2002 and FY 2010, the number of children in foster care declined by 22 percent to a FY 2012 population of 399,546 (U.S. Department of Health and Human Services 2011a). Historically, each year far more children have entered foster care than exited (U.S. Department of Health and Human Services 2013). However, in the mid-2000s the difference in the number of children entering and exiting foster care each year began to narrow; in FY 2008 and 2009 more children exited foster care than entered (U.S. Department of Health and Human Services 2009b, 2010c). In FY 2012 the number of entering children (254,162) closely aligned with the number of children exiting (241,254 U.S. Department of Health and Human Services 2013). Of serious concern is the high percentage of children exiting foster care that subsequently reenter legal custody, a reality that has been considered a “perpetual problem for foster care services” (Hatton & Brooks 2008:4). Studies indicate that foster care reentry rates vary significantly from state to state, ranging from 21 percent to 38 percent (Wulcyzn, Hislop, & Goerge 2000). There are multiple adverse consequences associated with reentry: the child’s reexperience of abuse and neglect as well as of another separation from his family and neighborhood; the lack of safety and stability for the child; and the reintroduction of uncertainty into the child’s life. Placement Stability and Length of Stay in Care As with reentry into care, the multiple placement moves many children experience while in care has been and continues to be of concern.

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An analysis by the Congressional Research Service over the period FY 2001 to FY 2007 found that the longer children remain in care, the more placement moves they are likely to experience. Progress has been noted for children in care less than twelve months, with the percentage of children having only one or two placements rising from 48.0 percent in FY 2001 to 57.3 percent in FY 2007. However, the percentage of children with three or more placements who have been in care for twelve months or more held steady at 81 percent throughout the same time period (U.S. House of Representatives Committee on Ways and Means 2009). Although, as noted earlier, in FY 2012 the number of children entering legal custody closely aligned with the number of children exiting, the length of time that children remain in foster care on average has declined. In FY 2000 the median length of stay was 15.6 months; in FY 2010 the median was 14 months (U.S. House of Representatives Committee on Ways and Means 2009; U.S. Department of Health and Human Services 2011b). The percentage of children in foster care for 5 years or more has declined from 16.5 percent in FY 2000 to 11 percent in FY 2010 (U.S. House of Representatives Committee on Ways and Means 2009; U.S. Department of Health and Human Services 2011b). The following vignette illustrates the complexity of children’s experiences in foster care., the different outcomes associated with multiple placements while in care, and the efforts required to maintain a single supportive placement for a foster child that supports a mother’s efforts to reunify with her child as well. TAMARA Tamara spent eight years in foster care. She was originally placed in care at age ten as a result of severe maltreatment by her parents, who had a history of substance abuse. While in care, she had twelve placements, including seven with foster families and five in different group homes. Because of these placement changes, Tamara was also required to change

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schools many times. She dropped out of school when she was seventeen and in the ninth grade. Tamara was discharged from foster care when she was eighteen years old. She was living in a homeless shelter when she became pregnant. She was working at a minimum wage job and could not afford to rent an apartment on her own, so she moved in with the baby’s father, who was dealing and using drugs. She too became involved with drug use. When Tamara’s daughter, Saba, was one, the child’s father was arrested and sent to prison for a drugrelated offense. Tamara struggled to maintain her job, pay the rent, and care for Saba. She had no support from her family, as she had lost all contact with them during her time in foster care. She was isolated and alone. A report was made to Child Protective Services (CPS) when Tamara overdosed on drugs and was brought to the emergency room and later admitted to the hospital. The family court ordered Saba into the custody of the child welfare agency. When no maternal or paternal kin could be located, the agency placed Saba with a foster family. The court also ordered services to Tamara so that she and her daughter could be reunified. Tamara received substance abuse treatment at a community-based treatment center. She again lived in a shelter while she participated in the program. The foster family provided frequent visiting opportunities in their home between Saba and Tamara. Tamara and the foster mother developed a very supportive relationship, resulting in the enhancement of Tamara’s parenting and social skills. She had been in recovery for a year, had a full-time job, and was working on her GED; housing, however, remained an issue that prevented implementation of the reunification plan. Tamara’s social worker helped Tamara get on the waiting list for the local housing authority’s Family Unification Program, which provided apartment rent subsidies. When Saba was two and a half years old, Tamara received the subsidy and moved into her own apartment. The foster family’s church program helped Tamara with furniture and household items and provided a scholarship for Saba’s enrollment in the church-run child development center. After

Saba had a series of overnight visits with Tamara, the agency recommended, and the court approved, the reunification plan and returned custody of Saba to Tamara. The foster family continues to be a part of their lives.

Factors Affecting Families and Children Served by Foster Care Historically, broad economic and political realities have affected the welfare of families, children, and youth. These factors—poverty, homelessness, adolescent parenthood, and parental substance abuse—impact the overall functioning and well-being of families and thus consistently play a key role in the extent to which child abuse and neglect occur and foster care is needed. Poverty Poverty has always affected the well-being of children and families. Although the United States is one of the wealthiest nations in the world, it has high rates of poverty, particularly child poverty. Poverty has taken on a new meaning with the Great Recession of 2007 which, though declared officially over in June 2009, continues to deeply impact American families (Issacs 2009). In 2008, prior to the full onset of the recession, almost 21 percent of children in the United States—14.1 million children— already were poor (U.S. Census Bureau 2009). One report has estimated that the number of children in poverty may increase by 5 million or more over the next few years as a result of the recession (Monea & Sawhill 2008). Some commentators have projected that child poverty will reach 24 percent in 2012 (Ryg 2010). Studies have consistently documented that children living in poverty are substantially more likely than children of affluence to be reported as abused or neglected and placed in legal custody (Coulton et al. 2007). The relationship between poverty and maltreatment is particularly significant with respect to child neglect because it encompasses environmental

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deprivation, such as inadequate food and shelter, as well as other forms of necessary care (Boyer & Halbrook 2011). The relationship between poverty, child neglect, and foster care placement is a long-standing concern among child welfare professionals; some states have statutorily barred the removal of children from their parents for poverty-related reasons (Walsh 2010). Nonetheless, child maltreatment rates have been found to increase when measured in conjunction with almost every marker of low socioeconomic status (Sedlack et al. 2010). Studies also consistently find that children whose parents are unemployed are at increased risk for experiencing poverty, homelessness, and child abuse and neglect. The Fourth National Incidence Study of Child Abuse and Neglect found that children whose parents were unemployed had about two times the rate of child abuse and two to three times the rate of neglect when compared with children with employed parents (Sedlack et al. 2010). This study further found that children in low socioeconomic households—defined as families with household incomes below $15,000 a year, parents’ highest educational level less than high school, or any household member being a participant in a poverty program—experienced more than three times the rate of child abuse and seven times the rate of neglect than other children (U.S. Department of Health and Human Services 2009b). Stress also has been understood to play a significant role in family functioning, although the exact relationship with child abuse and neglect is not completely understood. However, physical abuse has been found to be associated with stressful life events, including losing a job, and some studies have found that families that are neglectful report more day-to-day stress than families that are not neglectful (Milner & Dopke 1998; Greeson et al. 2011; Pence 2011. Some studies indicate that stressful situations, such as unemployment, may exacerbate certain family members’ characteristics such as anxiety or depression and may aggravate an existing level of family conflict

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(Rycus & Hughes 1998). One study found that with each percentage point increase in state-level unemployment there was an associated increase in child abuse reports of approximately .50 per 1,000 children (Sege 2010). Homelessness Increasingly, the homeless population in the United States includes families with children. The recession of the 2000s has played a prominent role in escalating rates of homelessness. In one survey of homelessness rates since the beginning of the recession, nineteen states reported a collective 49 percent increase in the number of children who were homeless (Duffield & Lovell 2008). It appears that the spike in homelessness is associated with job losses that are fueling the continued foreclosure crisis (First Focus 2010), with nearly 300,000 families receiving a foreclosure filing each month (Cramer & Black 2011). At the end of September 2009, 2.6 million homes were in foreclosure and another 1.6 million home loans were 90 days past due and headed toward foreclosure (Zandi 2009). Home foreclosures have pushed many families who own into the rental market, driving up rents in some areas by increasing the demand for housing—despite falling incomes and rising unemployment. In addition, a number of states and localities have reduced or eliminated homelessness prevention programs as a result of large state and local budget shortfalls, even as the need for these programs grows (Sard 2009). Experts anticipate that the housing market’s ongoing troubles will continue to heighten the potential for significant additional increases in homelessness (Sard 2009). Adolescent Parenthood Although adolescent pregnancy rates in the United States are at a historic low, a significant number of adolescents have unintended, often unwanted, pregnancies each year (Planned Parenthood 2006). The impact of adolescent pregnancy on parenting continues to be

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pronounced. Research consistently has shown that for the mother, adolescent childbearing is associated with lower educational achievement, an increased risk of poverty and longer-term welfare dependence, and less likelihood of marrying (Breheny & Stephens 2007; Furstenberg 2007; Hoffman 2006; National Campaign to Prevent Teen Pregnancy 2006). The children of adolescent parents often face significant health, economic, and social consequences. Research has found that the infants of adolescent mothers are 23 percent more likely to be low birth weight; they are also more likely to have childhood health problems and to be hospitalized than those born to older mothers (Alan Guttmacher Institute 2011; Martin et al. 2006; National Campaign to Prevent Teen Pregnancy 2006). Studies also have found that children of adolescent mothers are more likely to be abused or neglected than those of women who delay childbearing; they are less likely to receive proper nutrition, health care, and cognitive and social stimulation (Lounds, Borkowski, & Whitman 2006; Merskey 2009). Moreover, these children are at greater risk of social and behavioral problems and lower intellectual and academic achievement (Lounds, Borkowski, & Whitman 2006). A young father’s involvement as a parent also has been found to be crucial to children’s outcomes. Research indicates that children who grow up without fathers, when compared to children who do, may be at greater risk of poverty, experiencing violence or abuse, exhibiting aggressive behaviors, and involvement in the juvenile and criminal justice systems (Ruiz 2003). The realities that adolescent parents and their children face raise key questions about the extent to which services are available to young parents whose care for their offspring may be compromised by their own abilities. The factors that heighten the risk of foster care entry for children of adolescent parents—factors related to maturity, sound decision making, and ability to support a child—also affect efforts to reunify children in foster care with their adolescent parents.

Parental Substance Abuse Since the 1980s, parental substance abuse has increased markedly, with a significant growth in maternal drug use as a result of the crack cocaine epidemic (Freundlich 2000). The 2007 National Survey on Drug Use and Health found that 8.3 million children were living with at least one parent who was dependent on or abused alcohol or illegal drugs over the previous year (U.S. Department of Health and Human Services 2009c). Studies consistently show that children exposed to parental substance abuse or dependence are at increased risk of maltreatment and are more likely to experience physical, educational, social, and emotional challenges (Child Welfare Information Gateway 2009). Studies indicate that substance abuse is a factor in between 40 and 80 percent of the families in which child abuse or neglect has been substantiated (National Council on Child Abuse and Family Violence 2011). Research also has found that parents’ substance abuse negatively impacts family functioning (Choi & Tittle 2002). Research further confirms that when parents who abuse substances do not receive appropriate treatment, their children are more likely to remain in foster care longer as well as to reenter foster care once they have returned home (Choi & Tittle 2002; National Council on Child Abuse and Family Violence 2011). Factors That Affect Foster Care Practice As we move into the second decade of the twenty-first century, it can be expected that foster care practice will be affected by a number of factors: the evolving roles of foster parents; the increased reliance on kin as caregivers; the use of concurrent planning; the use of an expanded array of permanency options; a focus on the mental health needs of children and youth in foster care; the use of congregate care; increased foster care accountability; and the increased emphasis on the development and retention of qualified professional staff.

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Availability of Foster Parents as Resources for Children Foster families are a critical resource for children who enter foster care, with close to two hundred thousand children placed with nonrelative foster families in FY 2012 (U.S. Department of Health and Human Services 2013). Increasingly, in much of the United States, foster parents are in short supply, and child welfare agencies are struggling to develop sufficient numbers of foster families (U.S. Department of Health and Human Services 2005). Throughout the 1970s and 1980s unrelated foster families provided care for most foster children; by 2010, foster families cared for less than half (48 percent) of those in care (U.S. Department of Health and Human Services 2011a). Recruitment and retention of foster parents have long been critical issues. Broad social and economic changes, such as larger numbers of women working out of the home and an increase in single-parent families, have made the recruitment of foster parents more challenging. Additionally, although many foster parents leave fostering because they age and retire, many others leave because they are dissatisfied with their experiences as foster parents. Recent research indicates that over time the length of service of foster parents has shortened. In one study the median length of service was found to be eight to fourteen months compared to earlier studies that found median lengths of service ranging from five to eight years (U.S. Department of Health and Human Services 2005). This study, which examined foster parenting trends in three states, also found that between 47 and 62 percent of foster parents exited the foster parent role within one year of the first placement of a child in their home (U.S. Department of Health and Human Services 2005). Financial and systemic factors challenge efforts to recruit and retain foster parents. Historically, foster parents have been reimbursed at low rates for the care they provide and have been expected to subsidize children’s care with

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their own funds. In 2007 the monthly foster care reimbursement rate for children varied significantly across states, with Washington, DC reporting the highest foster care reimbursement rates ($827 for children aged two to nine, $899 for children aged sixteen) and Nebraska reporting the lowest ($222 for children aged two, $292 for children aged nine, and $352 for children aged sixteen; U.S. House of Representatives Committee on Ways and Means 2009). Given that many foster families have low to moderate incomes, the need to continuously subsidize the care of the children whom they foster can be expected to financially stress many foster families. A 2002 report by the Office of the Inspector General of the U.S. Department of Health and Human Services found that foster parents had a number of concerns that impacted their ability to continue fostering. They reported that foster care agencies placed many expectations on them, but that they were given no voice in many important decisions impacting the lives of children in their care. Foster parents also reported that caseworkers often were inaccessible and slow to respond to the needs of children and foster parents. They cited the multiple responsibilities placed on caseworkers that contributed to unmanageable workloads and high turnover; caseworkers’ workloads and turnover in turn created stresses in foster parentcaseworker relationships. Foster parents stated that the children placed with them were entering foster care with more health and behavior problems than in the past, making quality and accessible services even more important. Nonetheless, they experienced increasing difficulty in obtaining necessary support services, such as respite, child care, and dental, medical, and mental health services for the children in their care. Finally, both foster parents and caseworkers agreed that children often falsely accused foster families of abuse or neglect. Foster parents described the intrusiveness and the impact of investigations of reported abuse and neglect on their lives; a number stated that they decided

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to leave fostering because of the repercussions of false allegations made by children in their care (Office of the Inspector General 2002). These issues seriously affect foster parent retention, but they also impact recruitment. Consistently, those currently serving as foster parents have been found to be the most effective recruiters of new foster parents (Barbell & Sheikh 2000). Foster parents’ attitudes about the agency with which they are affiliated—perspectives shaped to a great extent by agency responsiveness, communication, and support— affect not only their own participation but their willingness to assist agencies in bringing new foster parents into the program. The Role of Foster Parents Historically, foster parents have been viewed as temporary caregivers for children in foster care. Children generally have been placed and removed from foster parents’ care with little regard to the latter’s rights or feelings about their charges (Dougherty 2001). In addition, agencies did not clearly define the roles that foster parents were expected to play and, to the extent that foster parents were asked to take on new responsibilities, they were often offered little training or support. Traditionally, foster parents were not considered as potential adoptive parents for the children for whom they were caring, even when the latter had bonded deeply with them. In the 1980s, however, foster parents began to be viewed as more integral to planning for the children in their care. With the emphasis on permanency, agencies began to ask foster parents to become more involved with birth parents and more frequently sought them out as prospective adoptive parents (Dougherty 2001). The past decade has seen significant developments in foster parents’ training, foster parents’ bills of rights, and the development of foster parent handbooks that clearly explain foster parents’ roles and responsibilities. Philadelphia’s Handbook for Foster Parents, for example, provides detailed information about

the day-to-day responsibilities of foster parents, including helping foster children adjust to their home, helping other children in their home adjust to a new foster child, managing financial matters, and becoming an advocate (Philadelphia Department of Human Services n.d.) A wealth of preservice training resources have been developed to more fully prepare foster parents for their roles and responsibilities (Ginther et al. 2005; National Resource Center on Permanency and Family Connections 2008; National Foster Parent Association n.d.a). At least sixteen states have enacted statements of foster parents’ rights (National Foster Parent Association n.d.b), and other states have incorporated a list of foster parents’ rights in agency policy (National Conference of State Legislatures 2002). These lists of rights address many of the concerns that foster parents have raised, including the right to be treated with respect and the right to voice grievances without fear of retaliation or harassment. Over the past decade, policy and practice have evolved to more fully include foster parents as members of children’s permanency planning teams. The Adoption and Safe Families Act of 1997 (ASFA) requires that foster parents be given notice of and an opportunity to be heard in any court review or hearing regarding a child in their care. This federally mandated right clarifies that foster parents should be valued as partners in assessing the needs of children, planning for permanency, and providing courts with key information (Center for Families, Children, and the Courts 2000). In response, many agencies have developed policies and practices that support the involvement of foster parents as partners and team members. Agencies have made efforts to change agency culture to make it possible for foster parents to play a viable role—as full team members— in assessment, service planning, and decision making. Some states have included in foster parents’ bill of rights provisions for their participation in case planning and decision-making on behalf of the child. Other states have

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enacted provisions requiring that child welfare agencies consult with foster parents regarding children’s case plans. In addition, some states’ foster parents’ bills of rights include the right to be considered as a placement option if a child formerly placed with the foster parent subsequently reenters care (National Conference of State Legislatures 2002). Increasing Reliance on Kin Recent years have seen dramatic growth in the use of kinship care (sometimes referred to as formal kinship care or relative foster care) as a resource for children served through the foster care system (U.S. House of Representatives Committee on Ways and Means 2009). In 1986, 18 percent of the children in foster care lived with relatives who were not their parents; by 2010 that percentage had grown to 26 percent of all children in care (U.S. Department of Health and Human Services 2011a). A growing body of research has documented the benefits of kinship care for children who must enter foster care (see the chapter by Hegar and Scannapeico, this volume). The critical importance of relatives as optimal caregivers for children entering foster care is recognized by the Fostering Connections to Success and Increasing Adoptions Act of 2008. This act provides that, for states to receive federal payments for foster care and adoption assistance, they are to “consider giving preference to an adult relative over a nonrelated caregiver when determining placement for a child, provided that the relative caregiver meets all relevant state child protection standards” (42 U.S.C. § 671(a)(19)). The act also requires states to exercise due diligence to: identify and provide notice to all grandparents and other adult relatives of the child (including any other adult relatives suggested by the parents) that the child has been or is being removed from the custody of his or her parents; explain the options the relative has to participate in the care and placement of the child; and describe the requirements to become a foster parent to

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the child (42 U.S.C. § 671(a)(29)). As of July 2010 approximately 41 states and Puerto Rico were giving preference or priority to relative placements by statute. Nine state statutes specifically require state agencies to make reasonable efforts to identify and locate a child’s relative when foster care is needed (Child Welfare Information Gateway 2010). As with unrelated foster parents, the past decade has seen a wealth of new resources designed specifically to support kinship caregivers. As detailed in a recent publication of the National Resource Center on Permanency and Family Connections (Dougherty 2010), a number of training programs now address the needs of kin, including those offered by the Child Welfare League of America, the Jane Addams College of Social Work, and the Center for Child and Family Programs at Eastern Michigan University (Dougherty 2010). Assessment tools have been developed to more appropriately involve kinship families in family assessment, and a number of handbooks now provide kin with key resources useful in raising their relative children (Dougherty 2010; Fostering Connections Resource Center 2010). These resources are particularly important given the characteristics of kinship caregivers, who are more likely than nonrelative caregivers to be female, African American, older, and unmarried, and have less education and income and lower socioeconomic status. While formal kinship care involves relatives caring for children in the legal custody of the state, informal kinship care refers to arrangements in which children live with a grandparent or other relative and are not under the custody of the state (Stozier & Krisman 2007). The broad and growing reach of informal kinship care is reflected in a U.S. Census Bureau report (2011) that 7.8 million children lived with at least one grandparent in 2009, a 64 percent increase since 1991, when 4.7 million children lived with a grandparent (U.S. Census Bureau 2011). Much less is known about informal kinship caregivers than formal kinship caregivers,

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but it is now recognized that, by providing services and supports for their relatives, informal kin caregivers often make it possible to avoid placing children in formal foster care. These caregivers, by virtue of age, financial and nonfinancial resources, and other factors, may face a range of stresses. A growing body of research has documented kinship caregiver stress associated with children’s problematic behavior, limited family resources, family functioning, and limited social support (Gibson 2003; Stozier & Krisman 2007). Use of Concurrent Planning for Children and Youth in Foster Care Since 1980 the primary focus in providing foster care services has been permanency planning; that is, providing services that will lead to children and youth’s exit from foster care to safe and stable families as soon as possible. To achieve that goal, many child welfare agencies have implemented concurrent planning, defined by the National Resource Center for Permanency and Family Connections (NRCPFC; 2010) as a process of working towards reunification while at the same time establishing an alternative or contingency back up plan . . . concurrent rather than sequential planning efforts to more quickly move children from the uncertainty of foster care to the security of a safe and stable permanent family. It involves a mix of family centered casework and legal strategies aimed at achieving timely reunification, while at the same time establishing a concurrent permanency plan if reunification cannot be accomplished. It is not a fast track to adoption, but to permanency.

Over the past three decades, much has been discovered about the qualities of effective concurrent planning. Research confirms that effective concurrent planning takes time (Northern California Training Academy 2009) and that ongoing parental assessment and involvement (Hudson et al. 2008) and intensive services for

parents are essential to recognizing the full benefits of concurrent planning (D’Andrade 2009). The National Resource Center on Permanency and Family Connections (2010) has identified a number of factors that are associated with successful concurrent planning: t
active extended family support as a backup to the parent; t
good communication as to what concurrent planning really means; t
all parties have ownership in a good outcome for the child; t
use of family teams; t
use of permanency timelines as a tool to help parents understand the sense of urgency; t
partnerships between birth and resource families; t
liberal parent-child visiting; and t
court support for concurrent planning. The factors that have been found to present obstacles to effective concurrent planning include high caseloads and staff turnover, lack of time, courts (including judges, citizen panels, attorneys, GALs, and CASAs) not understanding concurrent planning, lack of placement resources, and lack of meaningful parent-child visiting (National Resource Center on Permanency and Family Connections 2010). Challenges in effectively implementing concurrent planning remain. As part of the assessment of the performance of state child welfare systems, the federal Child and Family Services Reviews address the extent to which states are using concurrent planning. In its recent report, Results of the 2007 and 2008 Child and Family Service Reviews, the U.S. Children’s Bureau (2010c) noted that a principal concern regarding Permanency Outcome 1 (“Children have permanency and stability in their living situations”) was states’ “lack of effective concurrent planning (especially when goals of reunification and adoption are identified).” For those jurisdictions that were found to successfully achieve

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timely permanence, the report also noted that “effective and meaningful concurrent planning” played a key role. The Range of Permanency Alternatives Reunification continues to be the principal permanency goal for children in foster care, with about one-half of all children who exit foster care being reunified with their parents or primary caregiver. In the three most recent fiscal years, the percentage of children exiting to reunification has hovered slightly above onehalf—52 percent in FY 2008 and 51 percent in FY 2009 and FY 2010 and 2012 (U.S. Department of Health and Human Services 2009b, 2010b, 2010c, 2011a, 2013). The 1997 enactment of ASFA and the 2008 enactment of the Fostering Connections to Success and Increasing Adoptions Act have been credited with significantly increasing the number of children adopted from foster care. Since FY 2006, the percentage of exits from foster care to adoption has increased by one percentage point each year (U.S. Department of Health and Human Services 2009b, 2010b, 2010c, 2011a, 2013), with more than fifty thousand adoptions of foster children annually. In the early 2000s, guardianship with relatives was viewed as an emerging permanency option for children and youth in foster care; by 2011 it had become a fully recognized and supported permanency outcome for foster children. Guardianship has been embraced as a key alternative when reunification and adoption are not viable options because of hesitancy to change family relationships in a way that may undermine existing relationships; strong cultural resistance to the termination of parents’ rights; and the desires of the child, particularly adolescents, that adoption not be pursued (Choi & Tittle 2002). Prior to the enactment of the Fostering Connections Act, a number of states had developed subsidized guardianship programs that provided kin not only with the legal status of guardian but with financial support and access to follow-up services (Choi & Tittle 2002). The Fostering Connections Act

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gave states the option of obtaining federal reimbursement for ongoing assistance payments made on behalf of children exiting foster care to guardianship with a relative. Children receiving federal kinship guardianship assistance are now categorically eligible for Medicaid coverage. A number of states have opted to participate in the federal kinship guardianship assistance program (Fostering Connections.org 2011). ASFA revised the list of permanency goals for children originally provided in the Adoption Assistance and Child Welfare Act of 1980 and eliminated reference to long-term foster care as an option. However, this legislation also defined as a successful permanency outcome “permanent living arrangements” other than reunification or adoption, referred to as APPLA (another permanent planned living arrangement) (see Renne and Mallon, this volume). Despite this change in federal policy, fourteen years after the enactment of ASFA children in foster care continue to have long-term foster care as a permanency goal. In FY 2012, 6 percent of the children in legal custody (20,095) had “longterm foster care” as their permanency goal and another 5 percent had “emancipation” as their permanency goal (U.S. Department of Health and Human Services 2013). The Mental Health Needs of Children in Foster Care Over the past decade, increasing attention has been brought to the significant mental health problems that children in foster care experience and the need for strong collaborations between child welfare and mental health (Farmer et al. 2010; Keller, Salazar, & Courtney 2010; Landsverk et al. 2011; Simmel 2011). A study of youth in the Pacific Northwest found that 54 percent of children in foster care had one or more mental health problems compared with 25 percent of children in the general population; 25 percent of the children in legal custody suffered from post-traumatic stress disorder, twice the rate of U.S. war veterans (Pecora et al. 2005).

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Research indicates that many children enter foster care with preexisting mental health challenges. One study of almost six thousand children in foster care in Illinois found that 5 percent of the children had had at least one episode of in-patient mental health care prior to their placement in foster care (Park & Ryan 2009). In most cases the children who received inpatient psychiatric care were placed in foster care within two years of their first inpatient episode. Previous inpatient treatment was associated with greater placement instability for white children and a decreased likelihood of achieving permanency for black children (Park & Ryan 2009). Over the past several years, attention has focused on situations in which parents are required to make extremely difficult decisions about treatment when their children are experiencing severe psychiatric illnesses. In many cases the children need expensive residential treatment that is not covered by private insurers, and the family’s income is too high to qualify for Medicaid. Because of inadequate access to affordable, quality mental health services, families may be faced with placing their children in foster care to obtain the treatment services that their children need (Gilberti & Schulzinger 2000). The scope of this problem is illustrated by a study in Virginia that found that 2,008 of the 8,702 children in foster care at that time appeared to be in care to obtain treatment (Jenkins 2004). The following vignette illustrates the circumstances that may bring a child with intensive mental health treatment needs into foster care. LEXIE Lexie is thirteen and has been in therapy for seven years. He has a history of three suicide gestures; violent outbursts directed at his parents, siblings, and classmates; and, very recently, a suicide attempt. He has had three admissions to a private psychiatric hospital, including his current hospitalization following the suicide attempt. The family’s health insurance company has notified the hospital that

the coverage has been exhausted and that Hope and Carl, Lexie’s parents, must assume the costs. Both are employed, but they have no savings due to a high rent payment and debts incurred for Lexie’s previous treatment and medication costs. The couple applied for Medicaid and the Child Health Insurance Program in the past year, but their combined income makes them ineligible for assistance. The hospital has notified them that Lexie will be discharged immediately unless advance payments are received for his care. Hope and Carl have three other children; they fear for the children’s safety if Lexie returns home. Their employers have been supportive of their need to take time off to meet Lexie’s care needs, but their jobs are currently at risk should they have to take extended time off. They know from involvement in Web chat rooms that other families have used the child welfare system as a way to continue mental health services in the hospital and community. Hope and Carl decide to do what other families very reluctantly have done to get these services for their children: they tell the hospital that they will not take Lexie home. The hospital then filed a child protective services report alleging child neglect with the state child welfare agency, which resulted in a court order to place Lexie in the agency’s custody while an investigation was conducted. Lexie’s hospital costs are now covered by Medicaid. He remains in the hospital for another two weeks and is then discharged to a placement with a foster family that provides intensive treatment foster care services.

Research also suggests that children’s social and emotional well being may be negatively impacted by their experiences in foster care. Children in foster care struggle to cope with the traumatic events that brought them into foster care, the separation from their families, and the lack of certainty about what will happen to them; in many cases while children struggle with these placement experiences they are subjected to multiple placements and an inability to predict when they will see or have telephone contact with family members

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(Austin 2004; Bruskas 2008). These conditions have been described as “a hotbed for serious emotional disturbance” (Austin 2004:6). Over the past decade, psychotropic medication use in youth has increased between two and three times and polypharmacy (the use of more than one psychotropic medication at the same time) has increased between 2.5 and 8 times (Leslie et al. 2010). Children in legal custody are far more likely than children in the general population to be prescribed psychotropic medications; estimates range from 12 to 52 percent of children in custody compared to 4 percent for children generally (Leslie et al. 2010). These data underscore the importance of greater child welfare—mental health collaborations to meet the clinical needs of children in foster care appropriately. The Use of Congregate Care The past decade has seen an unparalleled focus on the number of children placed in congregate care settings (that is, group and institutional settings) and the impact of these types of placements on safety, permanence, and well-being outcomes for this group of young people. Research has verified that children and youth in foster care do not fare as well in congregate care settings on measures of safety, permanence, and well-being as do youth placed in family-based settings (Barth & Chintapalli 2009; Hyde & Kammerer 2009). The growing knowledge base has supported efforts across the country to reduce child welfare systems’ reliance on foster care and to invest savings gained from reducing the use of congregate care settings into community-based services designed to improve permanence and other outcomes for children (Annie E. Casey Foundation n.d.). This emphasis in policy and practice has resulted in a marked decline in the number of children and youth placed in these settings. In September 2001 approximately 100,000 children in foster care lived in group homes and institutional settings (U.S. Department of Health and Human Services 2003); in FY 2012 the number

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had declined by 39 percent to 62,102 children (U.S. Department of Health and Human Services 2013). That figure, nonetheless, represents a significant number of children who are either placed in group or residential settings upon their entry into legal custody because of behavioral and emotional problems or who are placed in group or residential care following repeated placement failures in family settings. Increased Accountability In 2001, the U.S. Department of Health and Human Services mandated that each state conduct periodic Child and Family Services Reviews (CFSRs) of their federally funded child welfare services, including foster care. These reviews are designed to assess each state’s performance on three key outcomes: child safety, permanence, and child well-being (U.S. House of Representatives Committee on Ways and Means 2009). In the first round of reviews, conducted from 2001 through 2004, a significant number of states neither achieved the desired outcomes nor met statewide data indicators on national standards related to the recurrence of maltreatment, maltreatment in foster care, foster care reentries, timely reunification, timely adoption, and stability of placements (see table 26.1). The second round of reviews took place from 2007 to 2010 (U.S. Department of Health and Human Services 2011b) and utilized composite outcome measures. States found to be in substantial nonconformity with the federal requirements must develop and implement a corrective action plan approved by the U.S. Department of Health and Human Services. Should the state fail to comply with the plan, the federal government may withhold federal funding as a penalty (U.S. House of Representatives Committee on Ways and Means 2009). The new federal review processes, national outcome standards, and penalties that may be assessed when states fail to provide child welfare services at an acceptable level signal increasing accountability for foster care services.

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TA B L E 2 6 . 1

Child and Family Service Reviews: First Round Results National Standard

Number of States Meeting Standard

6.1 percent (or less)

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Outcome

Statewide Data Indicator

Safety 1: children are first and foremost protected from abuse and neglect.

Recurrence of maltreatment: of all the children who were victims during the first six-month period under review, what percentage were again found to be victims of maltreatment based on a second report made within six months of the first report?

Maltreatment in foster care: of all the children living in foster care during the period under review, what percentage were found to be maltreated at the hands of a foster parent or staff member of a foster care facility?

0.57 percent (or less)

Permanency 1: children have permanence and stability in their living arrangements.

Foster care reentries: of all the children who entered foster care during the period under review, what percentage were reentering foster care within twelve months of a prior foster care episode?

Timely reunifications: of all the children who left foster care to be reunited with their parents or caretakers during the year under review, what percentage did so within twelve months of their most recent removal?

76.2 percent (or more)

19

Timely adoption: of all the children who left foster care because of adoption during the year under review, what percentage did so within twenty-four months of their most recent removal?

32.0 percent (or more)

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Stability of placements: of all children in care less than twelve months from the time of their latest removal (during the period under review), what percentage had no more than two placement settings?

86.7 percent (or more)

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28

8.6 percent (or less)

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Source: U.S. House of Representatives Committee on Ways and Means 2009.

Developing and Retaining Qualified Child Welfare Professionals Of critical importance to quality foster care practice is an adequate number of qualified professional staff. This goal, however, has been difficult to achieve because of high levels of staff turnover (Zlotnik 2005), budget-driven staff reductions, and decreases in staff supports such as training (National Association of Child Care Resources and Referral Agencies 2010).

Research has found that staff turnover negatively affects permanency outcomes for children as well as children’s safety (Flower, McDonald, & Sumski 2005; National Council on Crime and Delinquency 2006; Wagner, Johnson, & Healy 2009). As the child welfare work force contracts, social workers are unlikely to have frequent and consistent contact with birth parents, children, or foster parents or to develop and implement effective permanency plans.

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Building and retaining a quality child welfare work force has become a higher priority for the U.S. Department of Health and Human Services, which created the federally funded National Child Welfare Workforce Institute (2010). This institute has been designed to help states and tribes support child welfare leadership and improve the quality and capacity of the child welfare workforce. The institute has funded a range of workforce projects to develop, field test, revise, implement, evaluate, and disseminate an effective and comprehensive training program and model for recruiting and retaining a competent child welfare workforce. At the same time, many agencies have initiated strategies designed to decrease caseworker turnover and create “an energetic, involved and effective workforce with improved outcomes for children and families” (Bernotavicz 2006:6). However, significant challenges remain in fully integrating these efforts into agency culture and in developing data systems that allow agencies to identify and analyze problems, monitor trends, and take effective correction action to respond to workforce issues. The Future of Foster Care In the early 2000s, five principles were identified as essential to foster care’s responsiveness to children’s and families’ needs (Dougherty 2001). These principles remain equally essential in the second decade of the twenty-first century and include the following. 1. A family focus that views foster care as a service for the child’s entire family, as opposed to a service for the child or the parents only. 2. A child-centered orientation that places the needs of the individual child, including the need for safety, at the forefront of case planning. 3. The delivery of services from a communitybased perspective so that children and youth remain in contact with the important people in their lives and live in a familiar environment. 4. Developmental appropriateness, so that the care and services provided to children and

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youth are responsive to their age and physical, cognitive, behavioral, and emotional status. 5. Cultural competence, so that the cultural strengths and values of all families are respected and accommodated. As foster care practitioners look to the future, we must recognize that children’s families will always play a key role in children’s lives, irrespective of the permanency outcomes that are planned for them. The design and delivery of foster care services must take into account the importance of children’s family connections and the relationship of these connections to children’s sense of self, ability to cope with and resolve loss, and ability to form new and lasting attachments. Foster care services also must fully implement practices that ensure that children are placed with families within their own cultural groups, neighborhoods, and communities whenever possible. A community-based approach to foster care broadens the definitions of family and helping to include a variety of individuals and organizations that can assist families and children in more inclusive and often less conventional ways. Over the past decade the planning and delivery of services to children in foster care, their families, and their caregivers have incorporated important changes. Foster care policy and practice have expanded the roles of foster parents, actively engaged kin, focused more fully on permanency planning and placement outcomes, begun to more systematically address the wellbeing of children, particularly with respect to their needs for mental health services and their needs to maintain family connections, developed new foster care resources, and embraced greater levels of state and local accountability. More work remains to meet the full range of the complex needs of children and their families. As foster care looks to the future, community partners are critical to ensuring the safety and wellbeing of children and youth at the same time that permanency is being planned and achieved.

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Residential Services A Critical Link in the Continuum of Care his chapter provides a comprehensive description and a historical overview of residential services as well as a review of the empirical findings regarding the outcomes of residential services. We also profile characteristics of children and youth in residential care, highlight case studies of children who have benefited from residential services, and outline promising practices of some model residential facilities. Finally, we address the challenges that lie ahead as residential service providers continue to serve increasingly acute populations of children in an environment of decreasing financial reimbursement for services.

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Overview of Residential Services Residential services are an essential component in the continuum of child welfare services. The primary purpose of residential care is to address the unique needs of children and youth who require more intensive services than can be provided in a family setting. Either on-site or through links with community programs, residential facilities provide educational, medical, psychiatric, and clinical/mental health services as well as case management and recreation (Child Welfare League of America 2004b). Ranging in size from 4-bed group homes to institutions with 250 or more beds, residential care facilities provide varied services from emergency shelter care to secure detention. Although residential services are provided in a variety of settings, all facilities are available and

accessible on a 24-hour basis and designed to meet children’s basic needs. Residential care is a child welfare service, which can be provided under the auspices of mental health, juvenile justice, education, and/or developmental disabilities. Scope of Residential Services The primary goal of the child welfare system is to support and ensure safety, permanency, stability, and well-being for children and youth (Barth 1999). As such, child welfare professionals need to view and critically consider residential care as an essential service option. Residential care should not be viewed only as a service of last resort. Rather, residential care for children and youth should be viewed as a component of a comprehensive constellation of integrated services designed to assist and serve families. Types and Definitions of Residential Services Facilities The Child Welfare League of America’s (2004b) Standards of excellence for residential services recognizes seven types of residential care settings: 1. Supervised independent living programs [SILPs]; 2. Community-based group homes; 3. Residential treatment centers (RTCs); 4. Intensive residential treatment facilities (RTFs); 5. Emergency shelter care; 498

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6. Short-term/diagnostic reception centers (DRCs); 7. Detention and secure treatment (secure and nonsecure detention). Within these settings many facilities further specialize, providing targeted services to the following groups: pregnant and parenting teens, youth exhibiting sexually offending behaviors, sexually reactive behaviors, fire-setting behaviors, self-injurious behaviors, suicidal ideation, and mental health and/or substance abuse problems, children with fragile medical conditions, and children with serious cognitive limitations. The following definitions describe the residential services available within each setting, the features that are consistent among all residential care settings, and the unique characteristics of each setting (Child Welfare League of America 2004b): t
Supervised/Staffed apartments: small living units housing (also known as SILPs) no more than four teenagers. Apartment programs may be located within larger complexes or may be free-standing. Supervised/staffed apartments afford residents opportunities for increasing their independence and for using community resources, such as employment, health care, education, and recreation. Apartments can be fully supervised by live-in staff or by shift coverage, or they may be semi-supervised, as appropriate for the ages and service plans of the residents. t
Group homes: detached homes with twelve or fewer children in a setting that offers potential access to community resources, including employment, health care, education, and recreational opportunities. t
Residential treatment: treatment that provides a full range of therapeutic, educational, recreational, and support services by a professional interdisciplinary team. Residential treatment facilities often provide opportunities for children to be progressively more involved in

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the community; however, a full range of services are available on-site. t
Intensive residential treatment: treatment that provides more intensive and frequent therapeutic services and more intensive staffing patterns than offered by residential treatment. Provides staffing, structure, and environment to make possible more intensive child supervision and a higher degree of physical safety. There is a greater capacity to adapt and individualize service delivery. t
Emergency shelter care: short-term emergency care services to meet the basic needs for safety, food, shelter, clothing, education, and recreation. Allows access and admission on a twenty-four-hour basis. May admit children through self-referral without parental consent for periods as stipulated by state regulation and statute. May have services available on-site or may access needed services in the community. t
Short-term/Diagnostic care: care that provides more intensive services than does emergency shelter care. Admission may be planned or emergency. Diagnostic services include a time-limited assessment/diagnostic process that evaluates each child and family’s needs. t
Detention: short-term care that provides supervision to children in the custody of or detained by a juvenile justice authority. Detention facilities may include restrictive features, such as locked doors and barred windows. Minimally, services provided and available are equivalent to those provided by emergency shelters. t
Secure treatment: treatment that provides residential or intensive residential treatment in a secure facility that may include restrictive features, such as locked doors and barred windows. Although some services may be accessed in the community, the full range of services is available on-site. Provides staffing, structure, and environment to make possible intensive child supervision and a high degree of physical safety to prevent self-injury, running away, or unplanned entry from outside.

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Residential Treatment Center at Girls and Boys Town: A Model Program The residential treatment center at Girls and Boys Town implements a psychoeducational treatment model. The program combines cognitive-behavioral and educational treatment components designed to supplement and support the more traditional psychiatric and clinical modalities for children and adolescents. The RTC combines psychiatric supervision of psychotropic medication with an integrated treatment plan developed by a multidisciplinary team. The treatment incorporates individual, group, and family psychotherapy and special education. Minimal treatment components for each youth include weekly meetings with a child psychiatrist, weekly family therapy when feasible, and daily work on academic subjects. Distinctive aspects of the RTC program include a contingency-based system of managing behavior and a behaviorally specified social skills curriculum used to develop replacement skills for previously problematic behaviors. The youth practice their newly acquired social skills and self-control strategies during daily interactions initiated by direct care staff. Staff members are trained in the classroom and on the job to implement treatment goals and build therapeutic relationships. An outcome study of Girls and Boys Town RTC found that children showed improvement on Child Behavior Checklist (CBCL) scores between admission and discharge, and at follow-up on the anxious/depressed, attention problems, delinquent behavior, aggressive behavior, and internalizing, externalizing and total problems subscales (Lazelere et al. 2001). Mean scores on the Children’s Global Assessment Scale found that children moved from “major impairment of functioning in several areas and unable to function in one area” to “variable functioning with sporadic difficulties or symptoms in several, but not all, social areas (p. 181).” Upon discharge, only 9 percent of the youth moved to a more restrictive setting,

89 percent were in school, and 7 percent had graduated from high school and were working. Furthermore, caregivers reported that 76 percent of youth had a better quality of life postdischarge than they were experiencing prior to their placement in residential treatment. One key to the maintenance of positive treatment gains was utilizing several kinds of outpatient treatment after discharge. Girls and Boys Town serves as a model of what well-administered residential treatment can achieve (Lazelere et al. 2001). Childhelp USA: Caring for Young Children in the United States Childhelp USA serves boys and girls aged four to twelve (Pugh et al. 1997). At Childhelp the treatment program emphasizes structure, support, and sensitivity. With a nurturing environment, Childhelp treatment center offers a variety of psychotherapeutic programs for children, including family group, art, play, peer, animal, and individual therapy. Child-staff ratios are kept to a maximum of five children to one adult, allowing each child to receive individual attention. The structured environment consists of a behavior modification system that emphasizes positive reinforcement through all phases of daily activities, including school behavior, peer relationships, adult interactions, hygiene, and daily chores. The children live in four-bedroom cottages with three beds in each bedroom. Each child has her own bed, closet, and toiletries, which gives the children a sense of security and self-worth. The children ride bicycles, skateboards, and play a variety of community sports. The treatment center has its own ranch, with horses, chickens, and cows. The animals are used as animal therapy, to help teach children the responsibility of caring for and loving the animals. About 75 percent of the children attend elementary schools in the community and have individualized education programs. The other children attend an on-site school with the plan of mainstreaming the children to a community school.

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Historical Overview of Residential Services According to McGowan (1983), the first orphanage designed specifically for young people in the United States was the Ursuline Convent, founded in New Orleans in 1727 under the auspices of Louis XV of France. Prior to 1800, most dependent children and youth were cared for in almshouses and/or by indentured servitude, the most common pattern being that very young children were placed in public almshouses until the age of eight or nine, when they were indentured until they reached the age of majority. Bertolino and Thompson (1999) report that during the nineteenth century the establishment of prisons, juvenile reformatories, asylums, and orphanages proceeded at a rapid pace. The primary purpose of most of these institutions was rehabilitation; however, orphanages were developed solely to care for poor and homeless children. Institutions conducted rehabilitation through isolation, compliance, structure, and punishment, while also providing religious and moral teaching. In the nineteenth century 104 institutions were designed specifically for children and youth (Tiffin 1982). Institutions for children and youth during the 1820s were based on the same model as adult prisons and correctional facilities for juveniles (Levine & Levine 1970). Later in the century, cottage-style care emerged, which consisted of one female house parent responsible for supervising and caring for up to fifty children and youth at a time (McGowan 1983). In the early twentieth century a trend emerged that moved residential care for children from custodial care and rehabilitation toward residential psychotherapeutic treatment services (Bertolino & Thompson 1999). The regulation of these programs became an area of concern for many states. As a result, states developed and implemented standards for the operation of these programs. Government agencies created programs for visiting and inspecting institutions, and licensing bodies

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enforced the standards and increased control (Bertolino & Thompson 1999). Unfortunately, standards and thus the quality of care, varied greatly from state to state. Some states developed strong standards but fell short on monitoring and enforcing those standards. Other states had poor standards but good monitoring and enforcement. Unsatisfied with state efforts, child welfare professionals concluded that higher standards were needed. As a result of their advocacy, the accreditation movement of the twentieth century was born. Returning children and youth to their homes became the overarching goal. Professionals started developing new practices for assuring accurate assessments and categorizing childhood disorders, and facilities began to use standards of psychoanalytic and learning hypotheses to care for children and youth (Stein 1995). In addition, several studies indicated the harmful effects of institutional care on young people and the need to reduce the placement of children in institutional care (Child Welfare League of America 1994). In the 1930s many preventive programs were restructured into residential treatment facilities and many new treatment facilities were established (Bertolino & Thompson 1999). The concept of a therapeutic environment was introduced. Starting in the 1960s, behavior modification was introduced into residential facilities (Adler 1981). During this time a considerable amount of information was developed and written on behavioral systems, mainly by professionals in conjunction with their facility treatment modality. During the 1950s and 1960s residential care became a widely accepted means of working with children and youth with emotional disturbances. The deinstitutionalization movement in the juvenile justice and mental health fields fueled the expansion of residential services, which forced many facilities to expand their services to address the needs of a more diverse population. Providers broadened their program options by including family support,

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foster family support, counseling, individual and group therapy, family therapy, and preindependent living and life skills. Throughout this period the residential treatment center and the community-based group home were the two dominant forms of residential care (Braziel 1996). Concurrently, this period experienced an increase in community-based programs for children that were often less expensive than congregate care. These programs kept children and youth connected with their community while still providing them with the needed supervision and treatment (Rosen, Peterson, & Walsh 1980). Today, residential services are provided by public, private nonprofit and for-profit child welfare agencies and located in urban, suburban, or rural areas. Residential facilities may be campus-based, community-based, selfcontained, or secure facilities. In these settings children, youth, and their families are offered a variety of services, such as therapy, counseling, education, recreation, health, nutrition, daily living skills, pre-independent living skills, reunification services, aftercare, and advocacy (Braziel 1996). There has been a growing interest in boarding schools or residential education programs for youth in the child welfare system who need out-of-home care (Lee & Barth 2009). At the same time that there is increased interest in boarding schools or residential education programs, other residential agencies around the country are struggling financially. State public child welfare agencies are a primary funding source for residential agencies. Many state agencies have reduced the funding available for social services, including child welfare services. Thus public and private child welfare agencies are seeking new, innovative, and less costly approaches for addressing the complex needs of children, youth, and their families. This increased focus on fiscal accountability, coupled with the need to improve outcomes for children and youth, has led state and county agencies to implement initiatives that support the transformation movement of

reducing the number of children and youth placed in residential settings (Annie E. Casey Foundation 2010). The transformation movement challenges agencies to improve outcomes for children, youth, and their families by limiting and reducing the use of out-of-home and residential care services and increasing the use of less restrictive services and supports designed to meet the specific needs of children and families. While there is a direct correlation between the total number of children in out-of-home care and the number of children placed in residential care, the number of children entering residential care has decreased disproportionately. In 1999 both out-of-home and residential placements reached peak levels with 567,000 children in out-of-home care—102,782 (18 percent) of those children were placed in residential care (U.S. Department of Health and Human Services 2006). However, the Adoption and Foster Care Analysis and Reporting System (AFCARS) for fiscal year 2009 notes there were 423,773 children in out-of-home care; 65,804 (16 percent) of those children were in residential care. While the transformation movement has been credited with prompting positive developments in states, such as increasing preventative services, it may also exacerbate the problem of inadequate funding for residential care agencies. This issue is further complicated by some states implementing financial disincentives for residential care placements (Annie E. Casey Foundation 2010). Many residential care agencies are already underfunded due to the level of reimbursement for services received from the states. Residential care agencies in some states receive less than 90 percent of their actual costs from public funding sources (Child Welfare League of America 2004a). Additionally, the current methodology for establishing reimbursement rates in many states is flawed. The reimbursement rate setting system must address both direct costs, such as basic care needs, supervision, education, treatment, and reunification/reintegration services,

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as well as indirect costs such as case management, accreditation, licensing, professional development and certification, and administrative costs (Child Welfare League of America 2004b). In response to the low reimbursement rate, many residential care agencies must increase their reliance on private fund-raising and/or endowments to remain in operation and to provide quality services. The unstable and unpredictable funding stream threatens residential care agencies’ ability to maintain high quality services and the needed aftercare services for children and families. Further, some child welfare agencies are eliminating residential care services altogether. The instability of residential care services for children weakens the child welfare constellation of care and reduces the placement options available to maintain child safety and well-being. The following case vignette describes an example of reunification through the use of an array of intensive services. ADAM Adam was born to a single, fifteen-year-old mother. Adam’s grandmother became his primary caregiver. Two weeks prior to Adam’s tenth birthday, his mother married; shortly thereafter, Adam’s mother and stepfather moved to another state. Both parents decided it would be best for Adam to move with them because of his grandmother’s failing health. Before long, Adam’s stepfather became physically abusive to both Adam and his mother. Prior to the move, Adam had been an above-average student, but his grades and behavior began to deteriorate. Adam’s new teacher noticed several bruises on his arms and legs. The school immediately contacted Child Protective Services (CPS). Through an interview with Adam, the CPS worker learned that Adam’s stepfather had spanked him numerous times in recent weeks. Adam’s stepfather informed the worker that Adam had received multiple whippings for his poor school performance, and, if Adam’s poor behavior continued, the beatings would continue. Because CPS could not ensure Adam’s safety in the

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home, he was removed and placed in an emergencydiagnostic program. Adam’s caseworker requested a full assessment of Adam and his family. Adam’s assessment recommended that he be prescribed Ritalin for attention deficit/hyperactivity disorder, attend weekly individual and family therapy, and be placed in a residential treatment center. Adam’s mother and stepfather were court ordered to attend weekly family therapy and to enroll in parenting classes. Adam’s stepfather was also required to attend anger management and domestic violence groups. Because they were invested in Adam’s return home, both parents agreed to comply with the assessment recommendations. Adam’s new residential placement invited his parents to participate in the admission process and encouraged them to actively participate in Adam’s treatment. Adam’s parents were enthusiastic about his placement and were especially pleased that they could freely visit Adam and were consulted regularly regarding Adam’s treatment. The residential facility staff members were not interested in talking about what the parents had done wrong, but instead focused on addressing their needs and the challenges preventing Adam from returning home. Adam made tremendous progress both in the treatment milieu and on-site school. He found the smaller school class size less threatening and the teachers flexible. Furthermore, Adam and his parents made great strides in individual and family therapy. Adam liked having input in his treatment, service plans, and activities planning. He did well in the structured environment that allowed for some flexibility. Within three months Adam was spending every weekend at home. Both Adam and his parents continued to report positive home visits. Within nine months—after Adam’s parents successfully completed their required classes and sessions and Adam had successfully addressed the goals outlined in his treatment plan—he was discharged home from the program. Prior to Adam’s return home, the program arranged for aftercare services, which included scheduling a mentor to meet twice a week with Adam.

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Adam and his parents were extremely pleased with their accomplishments, the relationship that they established with the facility’s staff, and the thoughtful aftercare plan for the family.

Treatment Approaches and Models In the past forty years, numerous new approaches and models for altering behavior have emerged within residential facilities; however, no consensus exists regarding which approach or model is best (Bertolino & Thompson 1999). Many treatment models utilize behavior modification techniques to promote the desired behavior. Currently, point and level systems are the most common behavior modification approaches employed by residential agencies. However, some evidence suggests that point and level systems have many limitations and often do not provide residents with adequate positive personal interactions (Armstrong 1993; Buckholdt & Gubrium 1980; Durrant 1993; Fox 1994; Goldfried & Castonguay 1993; VanderVen 1993, 1995, 1999). In the past twenty years, psychotherapeutic milieu models of care have continued to evolve. This development has spurred a movement away from pathology and problemcentered viewpoints (Bertolino & Thompson 1999) toward expanded competency-centered techniques, such as solution-oriented, solution-focused, narrative, reflexive, workability, and collaborative language methods therapies (Anderson 1997; Berg 1994; de Shazer 1985, 1988; Eron & Lund 1996; Freeman & Combs 1996; Furman & Ahola 1992; Hoffman 1993; Miller, Duncan, & Hubble 1997; O’Hanlon & Weiner-Davis 1989). During the past decade this shift has encouraged the development of competency-based approaches in residential programs (Booker & Blymer 1994; Freeman, Epson, & Lopovits 1997). Durkin (1990) stated that a competency-based approach is crucial in the healthy development of children and youth, as residential care should promote normal growth and development.

Although residential services and the array of settings have changed greatly over the years (Bullard et al. 2008), a debate has emerged over the use of residential care versus family foster care (Whittaker & Maluccio 2002). Many child welfare professionals believe the main purpose of residential child welfare facilities should be to address the specific therapeutic needs of children and adolescents who are unable to live with their families or in family foster care and for whom a more intensive setting is not required. It is generally accepted that all outof-home placements should be based on a full assessment of the child and his family’s needs. However, current research indicates that optimal placement criteria are equivocal and there are no definitive guidelines for determining when a child needs out-of-home placement (Segal & Schwartz 1985). Characteristics of Children and Youth in Residential Group Care Many children living in residential group care exhibit high levels of impulsivity, aggression, truancy, inappropriate sexual behavior, delayed social development, interpersonal and academic problems, conduct disorder, and adjustment disorder (Fitzharris 1985; Preyde et al. 2009; Whittaker, Fine, & Grasso 1989; Wurtele, Wilson, & Prentice-Dunn 1983; Young, Dore, & Pappenfort 1988). Compared to the general population, children and youth in residential treatment centers are more impoverished, have more behavioral and academic problems, and have more deficits in social competencies (Wells & Whittington 1993). Perhaps most challenging is the number and severity of mental health problems presented by youth in residential treatment. Using the behavior problems index, Zill and Peterson (1989) found that children and youth residing in residential group care scored more than two standard deviations above the mean compared to those in the same age range in the general population. A study of children and youth in fifteen Illinois residential treatment facilities

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found that 80 percent of the sample met the criterion for diagnosis in at least one of the five categories on the children’s severity of psychiatric illness scale; more than 50 percent met the criteria for emotional disturbance (Lyons et al. 1998). Wells and Whittington (1993) found that 87 percent of boys and 89 percent of girls in residential treatment scored in the clinical range on the total problem behavior scale of the Child Behavior Checklist. Studies using the CBCL in Nebraska, California, and the Midwest consistently reveal mean scores in the clinical range on the delinquency, aggression, withdrawal, internalizing, externalizing, and total problems scales (Brady & Caraway 2002; Handwerk et al. 1999; Shennum, Moreno, & Caywood 2002). Children and youth in residential care often face acute mental health problems. Dale et al. (2007) found that more than one-third of the young people in 13 residential treatment facilities in New York had at least one prior psychiatric hospitalization and had exhibited suicidal behaviors or gestures. Furthermore, a study of 416 boys who entered the Children’s Village RTC in New York between 1995 and 1997 found that 19.5 percent experienced an acute psychiatric crisis at some point during their stay (Baker & Dale 2002). Youth in the child welfare system demonstrate greater social, emotional, academic, behavioral, and mental health problems than their peers in the general population, and children and youth in residential care are often the most challenged. Compared to those in treatment foster care, youth living in residential group care tend to be older (Berrick, Courtney, & Barth 1993; English 1993), predominantly male (English 1993), more likely to have been sexually abused (English 1993; National Survey of Child and Adolescent Well-Being Research Team 2002), and engaged in sexually offending behaviors (Baker et al. 2007), and to have a history of running away (English 1993) and contact with the criminal justice system (English 1993; Baker et al. 2007).

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Although English (1993) found that children and youth living in residential group care and treatment foster care have similar incidences of mental health, anger, and academic problems, another study found that those in residential group care have higher levels of mental health disorders (Baker et al. 2007). Such studies have indicated that children and youth in residential treatment centers were more likely to abuse substances, have a history of suicidal ideation and psychiatric hospitalization, and be prescribed psychotropic and antipsychotic medications compared to their peers in family foster care (Baker et al. 2007). These differences remained even when the investigators controlled for demographic and background characteristics. The evidence regarding the acuity of the behavioral and mental health problems of youth in residential treatment facilities means facilities face monumental challenges in providing care and treatment. Furthermore, evidence suggests that the youths’ presenting problems continue to grow more severe. Over the past ten years the proportion of youth entering residential treatment with mental health problems and juvenile justice backgrounds has increased dramatically. Dale and colleagues (2007) found that those entering residential treatment centers in New York in 2001 were more likely to have a history of substance abuse, psychiatric hospitalization, association with the juvenile justice system, and psychotropic medication use than their peers who entered residential care a decade before them. Outcomes of Residential Care Outcome studies of residential treatment vary widely in scope and often lack control conditions, suffering from poorly defined service units, limited samples, improper selection of outcome criteria, and improper use by practitioners (Whittaker & Pfeiffer 1994). Those studies that identify a comparison group often fail to control for the initial level of problems presented by the children and youth, making

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causality especially difficult to determine. Such gaps in research have posed a barrier to identifying best practices in residential services. These gaps are exacerbated by the relative inattention to new models of residential provision by federal agencies and private foundations compared to other types of out-of-home placement (Whittaker & Maluccio 2002). The lack of strong research findings supporting the efficacy of residential care led the U.S. General Accounting Office (1994) to observe: “Not enough is known about residential care programs to provide a clear picture of which kinds of treatment approaches work best or about the effectiveness of the treatment over [the] long term. Further, no consensus exists on which youth are best served in residential care . . . or how residential care should be combined with community-based care to serve at-risk youths over time” (p. 4). Studies of the effects of residential care have yielded mixed results. Some studies have identified positive outcomes associated with residential treatment. Using the global assessment scale, a Canadian study of forty children in a residential treatment center found that for the majority of children, functioning was severely impaired at admission, moderately impaired at discharge, and normal at one and three years postdischarge (Blackman, Eustace, & Chowdhury 1991). A study of children diagnosed with conduct disorder in residential treatment centers found that the number of concerns expressed by caregivers decreased between admission, discharge, six months, one year, and two years postdischarge (Day, Pal, & Goldberg 1994). Finally, a retrospective study of two hundred children served at group homes in the Midwest found that, as adults, 70 percent had completed high school, 27 percent had some college or vocational training, and only 14 percent were receiving public assistance. Unfortunately, 42 percent had been arrested since their discharge (Alexander & Huberty 1993). Family-centered residential treatment centers have shown considerable success. A

meta-analysis of residential care outcomes from 1990 to 2005 revealed that programs with a strong behavioral-therapeutic program and family involvement focus had the most positive short-term outcomes (Knorth, Harder, Zandberg, & Kendrick 2008). Landsman and colleagues (2001) found that youth in familycentered care had shorter lengths of stay, were more likely to return home at discharge, and had better long-term stability than youth in traditional residential treatment centers. In a similar study Hooper and colleagues (2000) found that, at six-, twelve-, eighteen-, and twenty-four-month follow-ups, 58 percent of youth discharged from a family-focused, community-oriented residential treatment program had been involved in no new illegal activity, had continued to participate in educational endeavors, and had not been moved to a more restrictive level of treatment; 90 percent of the youth accomplished two of the three aforementioned outcomes. The following case demonstrates the critical importance of family and youth involvement in determining a treatment plan. ROXANNE Roxanne was a sixteen-year-old girl who lived with her mother and her mother’s boyfriend. One afternoon, Roxanne shared with her mother that the mother’s boyfriend had been sexually molesting her for the past six months, including fondling her breasts and genitals and forcing her to have sexual intercourse. The mother’s boyfriend had threatened to hurt Roxanne if she told anyone. Roxanne’s mother confronted her boyfriend, and he denied everything. Roxanne’s mother immediately chose to believe her boyfriend and punished Roxanne for lying. Roxanne was told not to report the incident to anyone. The following day Roxanne told a close friend that her mother’s boyfriend had been sexually molesting her. Roxanne’s friend told her mother, who subsequently called the police. Roxanne was given the choice of being placed in a foster home or a group home. She decided that a group home would be her

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best option because she did not want the pressure of adjusting to the rules of a new family. Roxanne was placed in a community-based group home near her home. Roxanne’s mother attempted to contact Roxanne on several occasions following her placement and tried to influence Roxanne’s account of her story. After several failed attempts to coerce Roxanne into altering her story, Roxanne’s mother became verbally abusive. After several weeks, Roxanne’s mother stopped calling altogether. Roxanne was given the opportunity to participate in the development of her treatment plan. Roxanne decided that, because her mother was not involved in her treatment, she would work toward independent living. She also hoped to reestablish communication with her mother. Roxanne’s initial adjustment to the group home was challenging because she was not accustomed to being held accountable for her actions. Once Roxanne learned that completing her responsibilities earned her privileges, her adjustment improved. Eventually, Roxanne’s social worker convinced Roxanne’s mother to visit her. Shortly after the first visit, Roxanne’s mother agreed to participate in weekly family therapy at which Roxanne was able to express her feelings of abandonment and distrust. Two months later Roxanne’s mother apologized to Roxanne for not believing and supporting her. Roxanne continues to speak with her mother weekly and visits her when the boyfriend is out of town. Roxanne’s relationship with staff and teachers improved after she reestablished contact with her mother. Within six months Roxanne successfully addressed all her treatment plan goals. Roxanne was discharged to an independent living program where she was able to find a job, maintain a relationship with her mother, and graduate from high school. The following fall Roxanne left the program to attend college full-time.

One of the most promising studies demonstrating the efficacy of group care with young children emerged from a twenty-three-year longitudinal study from Israel. In this study Weiner and Kupermintz (2001) found that 268 children initially placed as preschoolers in well-designed

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congregate care settings, some of whom spent long periods in care before being placed in adoptive homes, functioned “adequately or well” as young adults. The finding was contrary to the researchers’ initial hypothesis and led them to conclude that “neither pre-school institutional care, nor long-term institutional care was found to be harmful for these young people in terms of normative living. . . . In fact, the majority of those who were functioning well have significantly improved since their teenage years” (p. 214). A study of 246 children at Childhelp USA found that aggressive behavior, covert conduct problems, attention deficit/hyperactivity disorder, self-destructive behavior, withdrawal/ anxiety, toileting problems, and sexual acting out were all reduced in a significant number of children at the time of discharge. Positive attitudes towards staff and responses to discipline also improved (Pugh et al. 1997). Other studies of residential care have shown less positive outcomes for children and youth. Hoagwood and Cunningham (1992) found that for emotionally disturbed children and youth aged five to eighteen, 63 percent exhibited minimal or no progress during a three-year residential treatment program. Furthermore, only 11 percent demonstrated “good” progress. Asarnow, Aoki, and Elson (1996) examined outcomes and service utilization over a three-year period following discharge from a residential treatment center in a sample of fifty-one boys with disruptive behavior disorders. They found that once a pattern of residential treatment was initiated, high rates of continuing placement and dependency continued in the immediate and long-term postdischarge period. The risk of replacement was 32 percent, 53 percent, and 59 percent by the end of the first, second, and third postdischarge years, respectively. Not all residential programs are created equal; thus treatment outcomes vary widely. Characteristics of residential treatment centers that have been correlated with long-term positive outcomes include high levels of family involvement, supervision and support from

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caring adults, a skills-focused curriculum, service coordination, development of individualized treatment plans, positive peer influences, enforcement of a strict code of discipline, a focus on building self-esteem, a family-like atmosphere, academic support, presence of community networks, a minimally stressful environment, and comprehensive discharge planning (Barth 2002; Curry 1991; Curtis, Alexander, & Lunghofer 2001; Lazelere et al. 2001; Pecora et al. 2000; U.S. General Accounting Office 1994; Vollmer 2005; Whittaker 2000). Age, gender, intelligence, length of stay, and presenting problems are all weakly correlated to outcomes (Curry 1991; Pecora et al. 2000). Other studies have found that a positive working alliance between youth and staff after three months in care related to positive psychological advances for youth and predicted lower rates of recidivism upon discharge (Florsheim et al. 2000). Substance abuse, difficulty talking with adults, no home visits, teasing others, and prior residential placement are identified risk factors of unplanned discharge from residential treatment (Sunseri 2001). Additional risk factors include prior psychiatric hospitalization, juvenile delinquent status at admission, and exhibiting serious emotional and behavioral problems during the first two months of treatment (Piotrkowski & Baker 2004). A study of thirty-seven children and youth at Edgewood Children’s Center in Missouri found that consistent family counseling resulted in a preponderance of positive outcomes for children and youth at discharge, but only discharge destination was significantly related to postdischarge outcomes (Burks 1995). Outcomes of Residential Treatment Compared to Family and Therapeutic Foster Care Most studies comparing outcomes for children and youth in family and therapeutic foster care to those in residential treatment fail to control for differences in the children and youths’ presenting problems at intake; thus findings that

treatment foster care is a more cost-effective service and produces similar or better outcomes to residential care are not surprising, given the characteristics of children and youth in residential care compared to their peers in family and therapeutic foster care. Therefore attempts to compare long-term outcomes for children and youth in residential treatment versus therapeutic foster care have produced mixed results. Lee and Thompson (2008) found that youth discharged from family-style group care were more likely to have as favorable a discharge home as youth discharged from therapeutic foster care. Two studies found no difference in the reduction of problem behaviors for children and youth in residential care versus those in therapeutic foster care (Colton 1988; Rubenstein et al. 1978). Chamberlain and Reed (1998) revealed that one year after completing either a residential treatment or a therapeutic foster care program, boys in treatment foster care were less likely to run away, had significantly fewer arrests and a greater probability of no arrests, fewer incarcerations, and were more likely to live at home or with relatives. Other studies have used personal interviews to determine the long-term outcomes of youth in residential care versus family foster care. Follow-up studies with youth who spent more than five continuous years in either family foster care or residential care found that those who lived in family foster care achieved higher levels of education; had fewer arrests or convictions; had fewer substance abuse problems; were more satisfied with their level of contact with their biological siblings; were less likely to move, live alone, be single head-of-household parents, and/or be divorced; had more close friends and greater informal support; had higher satisfaction with their income level and were more optimistic about their economic future; and generally had more positive assessments about their lives (Festinger 1983; Jones & Moses 1984). The National Survey of Child and Adolescent Well-Being (2002) found that children and youth in group care were four times as

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likely as those in family foster care, and ten times as likely as those in kinship care, to report that they do not like the people with whom they live. They were also more likely to report never seeing their biological mother or father. Barth (2002) found that, compared to children and youth in family foster care, reentry rates of individuals in residential treatment were higher and fewer aftercare services were available to ease the transition home. In an extensive review of the literature in support of a research agenda for child welfare, Meadowcroft, Tomlinson, and Chamberlain (1994) concluded that, compared to therapeutic foster care, residential care is more expensive, serves a population with similar problems, places children and youth in more restrictive settings at discharge, and produces fewer behavioral improvements. Such findings led the U.S. surgeon general to report that residential treatment has not shown substantial benefits to children and youth with mental health problems and may have adverse effects because of behavior contagion. The report concludes that for youth who manifest severe emotional or behavioral disorders the positive evidence for home- and community-based treatments contrasts sharply with the traditional forms of institutional care, which can have deleterious consequences (U.S. Department of Health and Human Services 2000). Although we have outlined a number of important studies regarding residential care (see Bullard et al. 2008), many questions remain. Several studies note the lack of adequate research on residential care compared to other child welfare services (Boyd & Einbinder 2007; Butler & McPherson 2007; Owens 2008). Pecora and colleagues (2000) suggest further research of residential care in the following areas: children and youth best served in residential settings, community transitions and maintenance of educational gains, mechanisms for family involvement, and identification of outcome indicators and program components of effective residential settings. Furthermore,

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it is imperative that residential programs be evaluated, preferably via standardized evaluation procedures that utilize consistent measurements, methodologies, and definitions. Future Directions Residential providers must emphasize the identification of best practices that lead to successful outcomes. Unfortunately, the identification of best practices is hindered by the historically negative image of group care, which stems from the long-established hierarchy of preferred out-of-home care arrangements for children and youth (Whittaker & Maluccio 2002). The hierarchy dictates that family foster care is preferred over group care when child dependency is the primary issue. The marginalized position of group care in the continuum of child welfare services has, in many ways, stifled creative interventions in the field. As Wolins (1974) states, “as professionals withdrew their approbation, the [full- and part-time group care] programs deteriorated, innovation ceased and cycles of prediction of bad results, and their fulfillment, spiraled programs downward” (p. 126). The strict hierarchy of preferred child welfare interventions not only curbs advancement of practices in residential settings but also forces children and youth who may need intensive residential services to “fail out” of a number of family foster home placements before they are admitted to group care. The history of placement disruption many children and youth carry into residential treatment increases their trauma and presents further challenges to treatment in residential settings. Furthermore, the hierarchy of services is based on the assumption that child dependency is the primary placement issue, when in reality the child welfare system is increasingly caring for children and youth with acute mental health needs that may be best served in residential settings. Residential providers and researchers need to identify placement criteria to ensure children and youth who would most benefit from

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residential services receive that level of service. Current practice wisdom suggests that residential group care is most appropriate for children and youth who need a structured program, who cannot tolerate the emotional intimacy of a therapeutic foster family, whose relationship with their biological parents may disrupt foster family efforts, who cannot form age-appropriate relationships, and whose behavioral or emotional problems significantly affect daily functioning (Dore 1994). Barth (2002) suggests that residential services may be most appropriate for children who have previously run away from foster care, youth who are destructive or engage in self-destructive behaviors, and youth who are moving back to the community from more restrictive settings. These findings, however, are only loosely based on empirical evidence; thus it is critical that more research be completed to identify youth who would most benefit from residential services. Indisputably, placements must be based on the needs of the child and her family and the level of services required to meet those needs. The placement goal should always be based on the most appropriate environment for meeting the needs of the child. Along with identifying appropriate placement criteria, funding of residential services is another critical issue facing providers today. Without adequate funding streams, residential care programs cannot provide appropriate services to ensure the safety, permanency, and well-being of the youth in their care. Children and youth in residential care have more acute needs than their peers in other out-of-home care settings. Unfortunately, most residential care facilities across the country have not been funded at the levels required to provide the intensive services needed by the children, youth, and families in their care. In most states no formal or consistent methodology is used for establishing reimbursement rates for care. Furthermore, it is rarely acknowledged that some group care costs offset expenses that would have been incurred by communities, such as the

provision of mental health and educational services. Residential care is a more costly service compared to family foster care, yet residential care is necessary to provide the best care and intervention to the most vulnerable population in the child welfare system. A number of other critical issues face residential providers. The federal government, state regulators, and licensing and accreditation bodies are increasingly emphasizing reduction and eventual elimination of the use of restraint and seclusion in facilities serving children and youth. Some studies have suggested that physical restraint and seclusion place children, youth, and staff members at risk of physical injury and death, as well as causing emotional and psychological harm (Allen 1998; National Technical Assistance Center for State Mental Health Planning 2003; U.S. General Accounting Office 1999). The importance of family involvement to children and youth in residential placements is also becoming more apparent; residential providers need to find ways to better engage families in treatment. Residential settings must embrace new models of care, such as relationship-based and trauma-sensitive treatment milieus, and abandon “management and control” models that have dominated the field in the past. Workforce recruitment and retention issues, which are central to ensuring that youth in residential settings are receiving quality and consistent care, continue to be a challenge in all areas of child welfare. Racial and ethnic disproportionality and disparity of outcomes exist within residential care (McMillen et al. 2004; Wright & Thomas 2003), and children of color remain in the child welfare system for greater lengths of stay (Advocates for Children & Youth 2008). This may be exacerbated by the fact that residential settings are often unwilling to establish specific discharge dates based on the youth’s treatment goals, resulting in discharge dates mainly being based on the youth’s designated level of care and causing extended lengths of stay for many youths (Madden et al. 2009).

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Additional research indicates that evidencebased practices (EBPs) may add to the disparity of outcomes experienced by racially and ethnically diverse youth and families who receive residential treatment services. The EBPs movement grew out of concern that many individuals were receiving ineffective services that were grounded in tradition and outdated training, rather than scientific evidence of effectiveness (Whitley 2007). Some professionals within the cultural competence movement, however, have expressed concern that the excessive attention given to the development and implementation of EBPs decreases focus on cultural difference within the service delivery system. EBPs tend to invalidate and/or exclude culturally specific interventions and traditional healing practices used in communities of color (Isaacs et al. 2005). Some may assume, because EBPs are supported by documented evidence of effectiveness with certain populations and communities, that these interventions are equally effective and applicable across ethnic populations and communities. Nevertheless, there is little documented evidence that systematically validates this assumption. Whitley (2007) suggested that EBPs should be tested among diverse populations in their local treatment settings and should be developed in a bottomup approach that included collaboration with diverse cultural groups. These and other findings suggest the current methodology for developing EBPs needs to be modified to include children, youth, and families of color (see nrcpfc, 2013). The current approach used to develop EBPs may be contributing to the level of disparities experienced by children,

youth, and families of color utilizing residential treatment and services. Development and testing of EBPs should include diverse communities of color and involve community stakeholders. Current research should infuse cultural competence in EBPs and, at the same time, create a larger evidence base for cultural competency. Additional research is needed to understand the scope and impact of the relationship between residential care and racial and ethnic disproportionality and disparity. Consequently, it is critical that the leadership and staff of residential agencies evaluate how their current policies and practices might be contributing to racial and ethnic disproportionality and disparity of outcomes. These agencies are compelled to implement revisions that will mitigate these disparities. Finally, program evaluation and empirically based continuous quality improvement need to become institutionalized components of every residential setting.

REFERENCES

Alexander, G., & Huberty, T. (1993). Caring for troubled children: The Villages’ follow-up study. Bloomington, IN: Villages of Indiana. Allen, L. (1998). Deadly Restraint. Hartford Courant. Available at http://courant.ctnow.com/projects/ restraint. Anderson, H. (1997). Conversation, language, and possibilities: A postmodern approach to therapy. New York: Basic Books.

Adler, J., ed. (1981). Fundamentals of group care: A textbook and instructional guide for child care workers. Cambridge: Balinger. Advocates For Children & Youth (2008). The Growing Toll—Non-Family Residential Care for Youth Linked to Delinquency: Costing 50 Percent More. Issue Brief—Voices for Maryland’s Children (March). Advocates for Children & Youth.

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Residential services are an essential component in the continuum of child welfare services. Upon admission, most children and youth in residential treatment exhibit challenging behaviors that require intensive intervention. Residential care providers are often able to meet the children and youths’ needs and help them achieve positive outcomes. Research regarding best practices and appropriate placement criteria will continue to strengthen the field, and adequate funding will ensure that youth in care receive the degree of intervention they require.

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Dore, M. (1994). Guidelines for placement decisionmaking. New York: Child Welfare Administration, Human Resources Administration of the City of New York. Durkin, R. (1990). Competency, relevance, and empowerment: A case for restructuring children’s programs. In J. Anglin et al. (eds.), Perspectives in professional child and youth care (pp. 231–244). New York: Haworth. Durrant, M. (1993). Residential treatment: A cooperative, competency-based approach to therapy and program design. New York: Norton. English, D. (1993). Group care/therapeutic foster care, Part III: A comparison of children currently placed in group care versus those in therapeutic foster care. Seattle: Office of Children’s Administration Research, Children, Youth and Family Services, Department of Social and Health Services. Eron, J., & Lund, T. (1996). Narrative solutions in brief therapy. New York: Guilford. Festinger, T. (1983). No one ever asked us . . . A postscript to foster care. New York: Columbia University Press. Fitzharris, T. (1985). The foster children in California: Profiles of 10,000 children in residential care. Sacramento: California Association of Services for Children. Florsheim, P., Shotorbani, S., Guest-Warnick, G., Barratt, T., & Hwang, W. (2000). Role of the working alliance in the treatment of delinquent boys in community-based programs. Journal of Clinical Child Psychology, 29, 94–107. Fox, L. (1994). The catastrophe of compliance. Journal of Child and Youth Care, 9, 13–21. Freeman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton. Freeman, J., Epson, D., & Lopovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton. Furman, B., & Ahola, T. (1992). Solution talk: Hosting therapeutic conversations. New York: Norton. Goldfried, M.., & Castonguay, L. (1993). Behavior therapy: Redefining strengths and limitations. Behavior Therapy, 24, 505–6. Handwerk, M., Lazelere, R., Soper, S., & Friman, P. (1999). Parent and child discrepancies in reporting severity of problem behaviors in three out-of-home settings. Psychological Assessment, 11, 14–23. Hoagwood, K., & Cunningham, T. (1992). Outcomes of children with emotional disorders in residential treatment. Journal of Child and Family Studies, 1, 129–40. Hoffman, L. (1993). Exchanging voices: A collaborative approach to family therapy. London: Karnac. Hooper, S., Murphy, J., Devaney, A., & Hultman, T. (2000). Ecological outcomes of adolescents in a psychoeducational residential treatment facility. American Journal of Orthopsychiatry, 70, 419–500.

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Isaacs, M., Huang, L., Hernandez, M. & Echo-Hawk, H. (2005). The road to evidence: The intersection of evidence-based practices and cultural competence in children’s mental health. Paper prepared for the National Alliance of Multiethnic Behavioral Health Associations, December, Washington D.C. Jones, M., & Moses, B. (1984). West Virginia’s former foster children: Their experiences in care and their lives as young adults. New York: Child Welfare League of America. Knorth, E., Harder, A., Zandberg, T., & Kendrick, A. J (2008). Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children & Youth Services Review, 30, 123–40. Krueger, M. (1991). Coming from the center, being there. Journal of Child and Youth Care, 5, 77–88. Landsman, M. , Groza, V., Tyler, M., & Malone, K. (2001). Outcomes of family-centered residential treatment. Child Welfare, 80, 351–79. Lazelere, R., Dinges, K., Schmidt, M., Spellman, D., Criste, T., & Connell, P. (2001). Outcomes of residential treatment: A study of adolescent clients of Girls and Boys Town. Child and Youth Care Forum, 30, 175–85. Lee, B.., & Barth, R. (2009). Residential education: An emerging resource for improving educational outcomes for youth in foster care? Children & Youth Services Review, 31, 155–60. Lee, B., & Thompson, R. (2008). Comparing outcomes for youth in treatment foster care and family-style group care. Children & Youth Services Review, 30, 746–57. Levine, M., & Levine, A. (1970). A social history of helping services: Clinical, court, school, and community. New York: Appleton-Century-Crofts. Lyons, J., Libman-Mintzer, L., Kisiel, C., & Shallcross, H. (1998). Understanding the mental health needs of children and adolescents in residential treatment. Professional Psychology: Research and Practice, 29, 582–87. McGowan, B. (2005). Historical evolution of child welfare services. In G. Mallon and P. Hess (eds.) Child welfare for the twenty-first century: A. Handbook of Practices, Policies, and programs (pp. 1 0–48). New York: Columbia University Press. McMillen, J., Scott, L., Zima, B., Ollie, M., Munson, M., & Spitznagle, E. (2004). Use of mental health services among older youth in foster care. Psychiatric Services, 811–17. Madden, E., McRoy, R., Maher, E., & Ward, K. (2009). Reintegrating youth who have severe emotional and behavioral problems. Available at www.casey.org/ Resources/Publications/pdf/AustinReintegration_ FR.pdf. Meadowcroft, P., Tomlinson, B., & Chamberlain, P. (1994). Treatment foster care services: A research agenda for child welfare. Child Welfare, 73, 565–82.

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Shennum, W., Moreno, D., & Caywood, J. (2002). Demographic differences in children’s residential treatment progress. In N. S. LeProhn (ed.), Assessing youth behavior: Using the Child Behavior Checklist in family and children’s services (pp. 112–33). Washington, DC: Child Welfare League of America. Stein, J. (1995). Residential treatment of adolescents and children: Issues, principles, and techniques. Chicago: Nelson Hall. Sunseri, P. (2001). The prediction of unplanned discharge from residential treatment. Child and Youth Care Forum, 30, 283–303. Tiffin, S. (1982). In whose best interest: Child welfare reform in the progressive era. Westport, CT: Greenwood. U.S. Department of Health and Human Services (2000). Report of the Surgeon General’s Conference on Children’s Mental Health: A national action agenda. Washington, DC: U.S. Government Printing Office. U.S. Department of Health and Human Services (2006). The AFCARS Report: Final for FY 1998 through FY 2002 Estimates as of October 2006 (12). Retrieved June 24, 2011, from www.acf.hhs.gov/programs/cb/ stats_research/afcars/tar/report12.htm. U.S. Department of Health and Human Services (2009). Child welfare outcomes 2004–2007: A Report to Congress. Retrieved June 09, 2011, from http://www.acf. hhs.gov/programs/cb/pubs/cwo04–07/cwo04–07. pdf. U.S. Department of Health and Human Services (2010). The AFCARS Report: Preliminary FY 2009 Estimates as of July 2010 (17). Retrieved June 24, 2011, from www.acf.hhs.gov/programs/cb/stats_research/ afcars/tar/report17.htm. U.S. Department of Health and Human Services (2013). The AFCARS Report #20: Final estimates for FY2012. Retrieved October 26, 2013, from http://www.acf. hhs.gov/programs/cb/stats_research/afcars/tar/ report20.htm. U.S. General Accounting Office (1994). Residential care: Some high-risk youth benefit, but more study needed. Gaithersburg, MD: U.S. General Accounting Office. U.S. General Accounting Office (1999). Mental health: Improper restraint and seclusion use places people at risk. GAO HEH-99-176. Washington, DC: U.S. General Accounting Office. VanderVen, K. (1993). Point and level systems: Do they have a place in group care milieu? R&E: Research and Evaluation in Group Care, 3, 20–23. VanderVen, K. (1995). Point and level systems: Another way to fail children and youth. Child and Youth Care Forum, 24, 345–67. VanderVen, K. (1999). Point/Counterpoint: Level & point systems. Residential Group Care Quarterly, 1, 4–6.

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Vollmer, T. (2005). Creating a peer-directed environment: An approach to making residential treatment a unique experience by using the power of peer groups. Child & Youth Care Forum, 34, 175–93. Weiner, A., & Kupermintz, H. (2001). Facing adulthood alone: The long-term impact of family break-up and infant institutions; A longitudinal study. British Journal of Social Work, 31, 213–34. Wells, K., & Whittington, D. (1993). Characteristics of youths referred to residential treatment: Implication for program design. Children and Youth Services Review, 15, 165–71. Whitley, R. (2007). Cultural competence, evidencebased medicine, and evidence-based practices. Psychiatric Services, 58, 1588–90. Whittaker, J. (2000). Reinventing residential childcare: An agenda for research and practice.. Residential Treatment for Children and Youth, 17, 13–30. Whittaker, J., Fine, D., & Grasso, A. (1989). Characteristics of adolescents and their families in residential treatment at intake: An exploratory study. In E. Balcerzak (ed.), Group care of children: Transitions toward the year 2000 (pp. 67–87). Washington, DC: Child Welfare League of America.

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Whittaker, J., & Maluccio, A. (2002). Rethinking “child placement”: A reflective essay. Social Service Review, 72, 108–32. Whittaker, J, & Pfeiffer, S. (1994). Research priorities for residential group child care. Child Welfare, 73, 583–601. Wolins, M. (1974). Successful group care: Explorations in the powerful environment. Chicago: Aldine de Gruyter. Wright, R. &. Thomas, J. (2003). Disproportionate representation: Communities of color in the domestic violence, juvenile justice, and child welfare systems. Juvenile & Family Court Journal, 54, 87–95. Wurtele, S., Wilson, D., & Prentice-Dunn, S. (1983). Characteristics of children in residential treatment programs: Findings and clinical implications. Journal of Clinical Child Psychology, 12, 137–44. Young, T., Dore, M., & Pappenfort, D. (1988). Residential group care for children considered emotionally disturbed, 1966–1981. Social Service Review, 58, 158–70. Zill, N., & Peterson, X. (1989). National longitudinal survey of youth child handbook. Columbus: Ohio Center for Human Resources Research.

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Sibling Issues

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urprising controversies arise over the meaning of the word sibling. Rooted in an archaic word for kin, sibling most literally means “little kinfolk,” and it originally included such relatives as cousins as well as brothers and sisters. With its first recorded use in 1000 C.E., it is among the oldest of English words (see the Oxford English Dictionary). In contemporary usage siblings share one or both parents by birth or adoption. However, the operational definition of siblings for research purposes has proved a challenge (Fein & Staff 1993; see also Hipple & Haflich 1993). When should research include half siblings, stepsiblings, adoptive siblings, birth siblings, or fictive siblings (children who consider themselves brothers and sisters, although not linked by birth, adoption, or marriage, as may occur in foster care or in blended cohabiting households? (See discussion in Hegar & Rosenthal 2011.) Most typically, the siblings identified in child welfare research are either full siblings or half siblings with the same mother. This occurs because child welfare agencies typically track children based on the mother’s identity, unless she is not present in the home. There is a dearth of information concerning paternal siblings, unless they reside in the household of a single father. This chapter sets the context for understanding siblings in child welfare by summarizing demographic trends and patterns involving siblings in the general population. It also provides a brief historical overview and considers how academic research at different times has focused on distinct aspects of sibling relationships. The chapter summarizes the research

literature on several topics: aspects of sibling relationships, sibling placements and their outcomes, promising approaches and programs promoting joint placement of or contact among sibs, and tools for those working with siblings to provide assessment and interventions. The chapter concludes with case studies, discussions of value-based issues, and comments on the role of sibling placements in preserving families. U.S. Demographic Patterns Involving Siblings Just as research definitions of “sibling” are problematic, startlingly little is known about the population of siblings in the United States. Reports based on census data emphasize that, as a proportion of all families, the number with four or more children has fallen steadily since 1970 (Fields & Casper 2001:6). However, for children, the likelihood of living with siblings has remained constant in recent years. According to census data, 21 percent of U.S. children under age eighteen have no co-resident siblings, 39 percent live with one sibling, 25 percent live with two sibs, and 15 percent reside with three or more (U.S. Census Bureau 2010). For each category these proportions are within 1 percent of those reported in prior decades (Fields 2003:19; Saluter 1996:36). Because of the Census Bureau’s focus on households, it is much harder to estimate how many siblings children actually have, as some siblings may live with another parent or relative, reside elsewhere (e.g., in foster care, institutions, prisons), or be adults either at home or in independent households. It can be safely 516

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assumed that many children have siblings who are not reflected in census figures because they are not co-resident minors. Just as 80 percent or more of U.S. children have siblings, so do children who are served by child welfare agencies. However, conclusive national statistics are lacking because many U.S. government documents report limited data on sibling groups. For now, the best data come from other sources. The National Adoption Information Clearinghouse estimates that 65 percent to 85 percent of foster children come from sibling groups (Corder 1999). Academic research on siblings in the child welfare system suggests that 60 percent (Welty, Geiger, & Magruder 1997) to 73 percent (Staff & Fein 1992) of U.S. foster children have siblings who also enter foster care. Many, if not most, of them are separated from some or all of their siblings in care (Drapeau, Simard, Beaudry, & Charbonneau 2000; Kosonen 1996; Maclean 1991; Shlonsky, Webster, & Needell 2003; Staff & Fein 1992; Welty, Geiger, & Magruder 1997). Based on the National Survey of Child and Adolescent Well-being, the federal government reports that the average foster home includes 0.5 siblings (substantially less than 1 sibling of the study child, including full, half, step, and adoptive relationships), while kinship foster homes are somewhat more likely to include such siblings, with an average of 0.7 (U.S. Department of Health and Human Services 2005. Societal Context of Siblings: The Role of Research For many decades, little professional or academic research was directed to any aspect of siblingship. The effect of birth order on personality development was one of the first issues to attract the attention of researchers (see Toman 1976). When relationships among siblings began to attract professional attention, the issue of rivalry became paramount (e.g., Sewall 1930). By the 1960s, adult researchers were beginning to notice that families had children whose

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relationships were interesting (e.g., Cummings & Schneider 1961). Irish (1964) explored some of the reasons this realization may have taken so long, such as the dominance of theories of personality rooted in the parent-child relationship. However, Perlman noted critically in 1967 that the word sibling still seldom appeared in the professional literature without being paired with rivalry (Perlman 1967). By the 1970s, theory and research concerning siblings began to mature. Major works about the nature and range of sibling relationships appeared over the course of a decade (e.g., Bank & Kahn 1982; Lamb & Sutton-Smith 1982; Sutton-Smith & Rosenberg 1970). Running parallel to professional attention to siblings in general has been increasing attention to siblings in families in which child abuse or neglect occurs. One emphasis has been on siblings as perpetrators of violence or abuse (e.g., Button & Gealt 2010; Kiselica & MorrillRichards 2007; Reid & Donovan 1990; Whipple & Finton 1995). Another focus has been on the perceptions of sibling placements by caseworkers (Hegar 1986; Smith 1996), foster mothers or other caregivers (James 2008; Smith 1996), and foster children (Hegar & Rosenthal 2009, 2011; Hindle 2000). Attention has also been given to assessing and maintaining the sibling relationships of foster children (Grigsby 1994; Herrick & Piccus 2005; Hindle 2007; James 2008; Pavao et al. 2007; Ryan 2002; Whelan 2003). Discussion of the assessment of sibling relationships appears later in this chapter. The balance of this review of the research concerns the growing attention given to questions surrounding placement of siblings. There has been a long-standing interest within the child welfare field in siblings who enter foster care (e.g., Berg 1957; Hurvitz 1950; Maas & Engler 1959; Theis & Goodrich 1921). However, most of the early attention to siblings in child welfare was limited to noting the problems associated with finding joint placements and to conveying practice wisdom concerning when to separate siblings in foster care.

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The first wave of research addressing sibling placement arose in Britain between 1940 and the mid-1960s (Heinicke & Westheimer 1965; Isaacs 1941; Parker 1966; Trasler 1960). These studies concerned populations of children quite different from those in foster care today—for example, children evacuated during the blitz bombings of World War II (Isaacs 1941) and children placed in short-term residential nurseries (Heinicke & Westheimer 1965). It was not until after 1970 that some foster care research in the United States addressed the issue of siblings in child placement (Aldridge & Cautley 1976; Zimmerman 1982). The findings of these and later studies are discussed in the next section. Outcomes, Risks, and Benefits Related to Sibling Placement In recent years there has been a significant increase in the number of studies that have examined sibling placement in various parts of the world. As a consequence, studies are available that examine a range of placement systems and foster care or adoption populations. Sites of studies have included Australia (TarrenSweeney and Hazell 2005), Canada (Drapeau et al. 2000; Thorpe & Swart 1992), England (Maclean 1991; Rushon et al. 2001; Wedge & Mantle 1991), the Netherlands (Boer & Spiering 1991; Boer, Versluis-den Bierman, & Verhulst 1994; Boer, Westenberg, & van Ooyen-Houben 1995), Scotland (Kosonen 1996), and the United States (Brodzinsky & Brodzinsky 1992; Hegar & Rosenthal 2009, 2011; Leathers 2005; Linares et al. 2007; Shlonsky, Webster, & Needell 2003; Smith 1998; Staff & Fein 1992; Webster et al. 2005; Welty, Geiger, & Magruder 1997; Wulczyn & Zimmerman 2005). Many of these studies are cited and compared in recent, detailed reviews of the literature (e.g., Hegar 2005; McCormick 2010; Washington 2007). Unlike the earlier period of foster care research, a growing number of studies address the ultimate questions of outcome of sibling placements. Studies that examine how sibling placements turn out tend to compare placements of siblings with those of other children, using as outcome

variables either rates of placement disruption or measures of emotional and behavioral adjustment. Although some studies compare children placed with siblings with those separated from siblings (e.g., Aldridge & Cautley 1976; Drapeau et al. 2000; Hegar & Rosenthal 2011; Smith 1998; Thorpe & Swart 1992), other studies compare sibling placements with those of children placed singly, whether or not the latter come from sibling groups (Barth et al. 1988; Boer, Versluis-den Bierman, & Verhulst 1994; Boer, Westenberg, & van Ooyen-Houben 1995; Hegar & Rosenthal 2009; Holloway 1997; Rosenthal, Schmidt, & Conner 1988; Smith et al. 2006). As discussed earlier, they also define siblings and joint placement in various ways. Considering all their differences in settings and research methods, it is interesting that studies have consistently found that disruption rates in sibling placements are either lower than (Drapeau et al. 2000; Rosenthal, Schmidt, & Conner 1988; Fein & Staff 1992; Trasler 1960) or not significantly different from nonsibling placements (Boer, Versluis-den Bierman, & Verhulst 1994; Holloway 1997; Parker 1966; Tarren-Sweeney & Hazell 2005, Wedge & Mantle 1991). When disruption does occur, it has been found to be unrelated to sibling issues (Boer & Spiering 1991). One recent study that did not focus specifically on sibling placement does report more placement changes in the case of siblings placed together (Wulczyn, Kogan, & Harden 2003). Another, which is discussed further on in the chapter, suggests that size of sibling group may be related to disrupted adoptive placements (Smith et al. 2005). Studies also have begun to examine permanency outcomes. For example, Webster and colleagues (2005) report higher reunification rates for children placed with siblings in a large California sample, and Leathers (2005) also reports improved permanency outcomes for siblings placed together. Of the studies that assess children’s behavior or emotional adjustment, several report better outcomes in sibling placements (Boer, Versluisden Bierman, & Verhulst 1994; Heinicke & Westheimer 1965; Isaacs 1941; Rushton et al. 2001;

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Smith 1998), whereas others found no significant differences for most children (Brodzinsky & Brodzinsky 1992; Hegar & Rosenthal 2011). One study has noted more behavior and school problems for siblings placed together (Thorpe & Swart 1992). Recent research shows major methodological improvements over earlier studies, many of which had relatively small sample sizes and were unable to control for many variables. However, larger samples and more sophisticated analyses have enabled several researchers to report interactions that can be difficult to understand and interpret. For example, Smith and colleagues (2006), who examined a large database of Illinois children adopted between 1995 and 2000, report an interaction between size of the sibling group and adoption disruption, such that only the largest sibling groups were less likely to disrupt when placements were shared. Tarren-Sweeney and Hazell (2005) studied 347 children aged 4 to 11 in traditional foster care and kinship care in Australia and reported that girls, but not boys, who were placed with a sibling had fewer problem behaviors. Hegar and Rosenthal (2009) report interactions involving kinship care, sibling placement, and children’s expressed satisfaction with aspects of their placements. Unfortunately, it is very difficult to sort out what some of these results may mean. Sibling Placement Programs and Promising Approaches Legal Mandates Concerning Siblings Among the earlier advocates of sibling rights in child placement situations was a social worker writing in the legal literature. Reddick (1974) argued that siblings have a right of association that should influence judges reviewing child placement decisions, a position that Shlonsky and colleagues (2005) also advance. In earlier work the author of this chapter (Hegar 1988a) reasoned that the legal profession and the helping professions approach sibling placement using different paradigms for decision making. Whereas lawyers approach the question from

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what Rappaport (1981) calls a “rights paradigm,” social workers are more inclined to apply a “needs paradigm.” Reddick’s (1974) argument about a right of association is based on the former; an example of the latter might be an agency policy mandating that the relationships among members of sibling groups be considered in making placement decisions. These concepts are discussed more fully later, in the context of value conflicts surrounding services to siblings. State legislatures and, recently, the U.S. Congress have been moving steadily to address the issue of siblings in the child welfare system, particularly of those in foster care. For the past ten years a majority of states have given some statutory attention to placement decisions affecting siblings, although their approaches vary widely (Christian 2002; Kernan 2005). A number of state laws now express a preference for joint sibling placements whenever possible (Christian 2002). On the federal level, the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110–351) includes siblings in the language concerning the “reasonable efforts” that public child welfare agencies must make to avoid unnecessary placement of children and separation of families. Implications of the inclusion of siblings in federal policy are still emerging (Gustavsson & MacEachron 2010); nrcpfc, 2013. U.S. courts have also addressed the issue of sibling placement in two contexts: class action suits against state child welfare agencies and cases of individual children separated from siblings. The history of class actions in child welfare and the vulnerability of agencies to such suits are well known (Stein 1987). Several of the prominent class actions of the past twenty years have included claims about unnecessary separation of siblings or poor service to sibling groups (e.g., Aristotle P. vs. Johnson [Illinois], Del A. vs. Edwin Edwards [Louisiana]). At least one suit, which like several others was settled by consent, concerned issues of sibling placement exclusively (Jesse E. vs. New York City Department of Social Services). Although class actions settled by consent decrees have generally required states to do more to safeguard

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and promote the ties of siblings in foster care, the most prominent case to date concerning an individual child, Adoption of Hugo (Massachusetts), ruled that there is no constitutional basis for sibling rights in child placement cases (Dillard 1999, 2002; Glaberson 1998). This case subsequently was appealed to the U.S. Supreme Court but not accepted for review, so there has been no national resolution of the question of sibling rights. Social Services Initiatives Concerning Siblings In 2002 Casey Family Agency convened and sponsored a symposium on siblings in out-ofhome care that included presentations about innovative programs designed to serve siblings involved in the child welfare system (Casey Family Programs 2002). An example is the Camp To Belong program founded by Lynn Price in Colorado. Her program allows children separated in foster care or adoption to reunite at a summer camp for sibling groups only (Camp To Belong 2011; Corder 1999; Price 2002). Foster care programs have also been designed to keep more siblings in shared placement. In Washington the Sibling House Foundation offers settings in which siblings can remain together. In New York City, where the settlement of the Jesse E. vs. New York City Department of Social Services lawsuit required a new approach to sibling placement, foster parents who accept sibling groups also receive supplemental payments and services (Corder 1999). Neighbor-to-Neighbor is a specialized foster care program, begun in Chicago by Hull House Association, that provides salaries and extra training to a professionalized cadre of foster parents who accept sibling groups (Corder 1999). This model has been expanded and copied in other communities. One example is Neighbor to Family, which has developed an evidence-based Sibling Foster Care Model (Neighbor to Family 2011). Although a recent search for updated information yielded no results, a program in Massachusetts, SibLinks, stood out because case management was

provided by the public child welfare agency rather than by a contracted nonprofit group. Sib-Links began placing sibling groups in 2001 (Alvarado 2002). It is clear that the needs of sibling groups in foster care have moved out of obscurity and now attract the attention of legislators, judges, community advocates, and public and private child welfare agencies. Assessment Tools One result of the legal impetus to place siblings together (or facilitate their relationships with one another if they are separated) has been the need for independent evaluations of children and their relationships with siblings. For example, when there is a statutory preference for placing siblings together, courts may require expert testimony to support any recommendation of separate placements. Experts, in turn, require assessment skills and tools to help evaluate sibling relationships. Many of the standard assessment procedures used in child welfare practice can be used in placement evaluations of siblings. These include observations of interactions among siblings; children’s drawings of their families, made with instructions to include whomever they wish; discussions and revelations made by children when they show the evaluator their “life books” or photo albums; nondirective play therapy assessment using doll families and other materials; and direct statements and preferences expressed by the children. Whelan (2003) has advocated using attachment theory as the basis for assessing whether siblings should be placed together, and he includes case studies illustrating this approach. Hindle also is a long-time advocate of clinical assessment of sibling relationships (Hindle 2000, 2007); nrcpfc, 2013. In addition, there are standardized assessment instruments designed to gauge the nature of individual sibling relationships, although these are relatively few. As is usually the case with new measurement tools, additional research must establish their validity, and extensive use may

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be necessary before they are widely accepted. One is the Sibling Relationship Inventory (SRI) developed by Stocker and McHale (1992), which is designed to measure the dimensions of sibling affection, hostility, and rivalry. Published studies have used the SRI with children between the ages of five and thirteen (Dunn, Slomkowski, & Beardsall 1994; Lindhout et al. 2003; Stocker & McHale 1992). One study tested its internal consistency and test-retest reliability with satisfactory results (Boer et al. 1997). Another instrument is the Social Interactions Between Siblings (SIBS) interview, first presented by Slomkowski, Wasserman, and Schaffer (1997). Although there are at least three other instrument for use with siblings, Boer and colleagues (1997) note that they have been used primarily with adolescents and young adults, and it is not clear that they would be useful in child placement decisions. They are the Sibling Inventory of Differential Experiences (Daniels & Plomin 1985), the Sibling Relationship Questionnaire (Furman & Buhrmester 1985), and the Sibling Inventory of Behavior (Hetherington & Clingempeel 1992). Value Conflict in Sibling Services: Rights Versus Needs As with kinship foster care, the issue of how best to serve siblings in child welfare is closely linked to the meaning and value of family ties (see also the chapter by Hegar and Scannapieco, this volume). Although parent-child ties have a high degree of legal protection and grandparent-child relationships have come to be recognized in many circumstances, sibling ties are only beginning to be acknowledged in law. Some of that recognition comes in the form of recent state statutes that take various approaches to siblings entering foster care and adoptive placements. As already noted, the majority of states now addresses the issue of siblings in state custody, and a number of these statutes take the form of a general preference for sibling contact and/or placement (e.g., Connecticut, Nevada, Texas; Christian 2002).

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When state statutes become more specific, they highlight the distinction that Rappaport (1981) first made between the rights paradigm and the needs paradigm. This distinction forms the basis of the value conflict discussed here. In the context of social advocacy, the distinction between rights and needs sometimes becomes blurred. Discussion of the needs of a group can slide almost unnoted into an assertion of rights. However, many rights are claims that can be legally enforced. Needs, however, may be general human requirements for life or happiness or specific individual necessities, but they are not legally protected or guaranteed. Of course, individual needs do enter into judicial deliberations of what is in a child’s best interests. In their recent statutory approaches to sibling placements, states have tended to fall along a continuum from a rights orientation, recognizing that children in foster care have enforceable claims with regard to their brothers and sisters, to a needs orientation, mandating that state agencies consider sibling relationships in making placement decisions. Toward the end of the continuum that emphasizes rights in addition to needs, California allows anyone, including children, to assert the sibling relationship in court as a possible basis for various orders, including as a basis for denying termination of parental rights if that action would interfere with a sibling relationship that outweighs the potential benefits of adoption (Christian 2002). Maryland and Massachusetts also allow children in foster care or adoption to petition for sibling visitation. The Arizona statute uses the language of rights with respect to children in foster care maintaining contact with significant others, including siblings, and with respect to court orders that address visiting in permanent guardianship cases (Arizona Revised Statutes). In both California and Louisiana there are provisions for courts to order postadoption contact between siblings. Such orders may place unusual limitations on parents’ rights to make all decisions about contact with their children.

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Although states that are beginning to confer sibling rights also incorporate the language of best interests into their statutes as the standard for judicial decision making, other states avoid the language of rights by addressing only how the sibling relationship may serve individual children. For example, Mississippi, Missouri, New Mexico, and South Carolina, among others, list the sibling relationship as one of the factors to be considered in making child welfare placement decisions (Christian 2002). Presumably, an assessment that showed a relatively insignificant sibling relationship would allow a child placement agency and juvenile court to disregard the sibling tie in placement decisions, something that would be more difficult in states that lean heavily toward the rights paradigm. Sibling Placement Case Examples THREE SIBLINGS WITH A HISTORY OF SEXUAL ABUSE Two sisters (aged thirteen and six) and their brother (aged eight) have been in agency custody for three years. They were removed for sexual abuse (See also Faller’s chapter, this volume, on this area) which was disclosed by the oldest child when it began to affect her younger siblings. Both parents were tried for the abuse and sentenced. The parents remain incarcerated, and parental rights have been terminated. For two years the children were placed together in the Ayres foster home with a couple in their fifties who have several adult children no longer living at home. This placement worked well, but the Ayres family felt too old to adopt. Plans were made for all three children to be moved to the Barnes foster/adoption home, with the goal of adoption. Beginning with the youngest, the children were moved one at a time over a period of several months. About two months after the placement of the thirteen-year-old girl, the Barnes family requested her removal. The thirteen year old had been the most seriously abused of the children, and she was in special education as a slow learner. The Barnes family’s complaint was that she set a poor example and usurped some of the parental

role with her siblings. The family had other adopted children, each younger than ten. At this point, the child welfare agency arranged for an outside evaluation and requested placement recommendations concerning all three children. The thirteen year old was returned to the Ayres foster family, who then said they wished to adopt her and her siblings. They believed strongly that the children should not be split up. The thirteen-yearold favored this plan. The Barnes family wanted to adopt the younger sister and brother. Those two, however, expressed a wish to stay with the Barnes family. The two families lived about an hour’s drive from one another, had little in common, and were angry with one another about decisions affecting the children. The Barnes family would not allow the thirteen year old to call her siblings or visit in their home. The agency had been arranging and supervising visits between the children alone, in public places like parks and bowling alleys. The children and both families were of the same race and general religious background. After a placement evaluation involving record reviews and staff interviews, interviews with the three children, observations of their interactions, and the review of such assessment tools as family drawings by each child, the placement consultant recommended placement of the three siblings with the Ayres family. At follow-up, two years later, the children had been adopted and remained together in the Ayres home. The boy had displayed some sexualized aggression and needed to be supervised closely. The adoptive parents continued to be committed to raising the three children.

THREE SIBLINGS SEPARATED BETWEEN TWO HOMES In a rural part of the country where few African Americans live, three black children came into care due to parental neglect. Their mother subsequently surrendered custody and the rights of their father were terminated. At the time (before the passage of the Multiethnic Placement Act amendments that prohibit consideration of race in child placement decisions), the agency had only two black foster

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homes, and both were too full to accept a sibling group of three. Therefore the two girls (aged five and seven) were placed in one of the homes (the Austin family), while their younger brother (aged two) was placed in a home with white parents (the Booth family) who also had two young adopted children. The Booth family, then, included three preschool children. The separated siblings had regular visits, almost always in the home of the Austin family. Meanwhile, the Austins had room in their home and asked to adopt the whole sibling group of three. They had two biological children, one in college and one in middle school. They also provided respite care for a cousin of the three siblings who was in residential care, and their life within the small African American community brought them into regular contact, at church, with the children’s biological grandmother. The placement evaluation included record reviews and staff interviews, interviews with the three children and observations of their interactions, family drawings by the school-aged children, and nondirective play with doll families (both black dolls and white dolls). The placement consultant recommended placement of the three siblings with the Austin family, where they were subsequently adopted.

A third sibling case appears as the first case discussed in the chapter concerning kinship foster care by Hegar and Scannapieco (this volume). It illustrates a situation in which separate placements might be recommended for siblings. Sibling Placement as Extended Family Preservation Although permanent shared placement of siblings has not regularly been discussed in the context of family preservation, it should be. Unfortunately, the sibling group is sometimes the only part of a foster child’s family that a child welfare agency has a chance of preserving.

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Child welfare agencies are ultimately powerless to bring about changes in the behavior and functioning of parents and other adults that might lead to family reunification, guardianship, or adoption within the extended family. However, agencies do have legal authority, in the form of temporary or permanent child custody, over the children in their care. Most often, these children belong to sibling groups over which an agency has significant decisionmaking control. One rationale for preserving the sibling subsystem whenever possible is that children have an interest in their future relationships. If siblings are not enabled to have a relationship in childhood, they will have difficulty acting as brothers and sisters in adulthood. There is both evidence from social science research and reasoning in the legal literature to support the significance of sibling relationships that stretch into the future. Legal scholars and others have repeatedly raised the issue of siblings’ rights to associate, including the right to a future that includes sibling relationships (e.g., Elstein 1999; Jones 1993; Markel 1997; Patton 2001; Patton & Latz 1994; Shlonsky et al. 2005). Unless child welfare agencies are able to help preserve sibling relationships, foster children and those who are adopted will lose parts of their family and pieces of their future. Efforts are needed at all stages of child welfare intervention to gather information about siblings, obtain and preserve their names and contact information, bring the sibling relationship to the attention of attorneys and judges, recruit and train foster parents so that more placements for siblings will be available, make thoughtful permanent placement decisions that consider the sibling relationships of children, and enable children to have relationships with brothers and sisters from whom they are separated. To do less is to fail in an important aspect of family preservation.

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Rappaport, J. (1981). In praise of paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9, 1–25. Reddick, W. H. (1974). Sibling rights in legal decisions affecting siblings. Juvenile Justice, 25, 31–38. Reid, W. J., & Donovan, T. (1990). Treating sibling violence. Family Therapy, 17, 49–59. Rosenthal, J.  A., Schmidt, D.  M., & Conner, J. (1988). Predictors of special needs adoption disruption: An exploratory study. Children and Youth Services Review, 10, 101–17. Rushton, A., Dance, C., Quinton, D., & Mayes, D. (2001). Siblings in late permanent placements. London: British Agencies for Adoption and Fostering. Ryan, E. (2002). Assessing sibling attachment in the face of placement issues. Clinical Social Work Journal, 32, 77–93. Saluter, A. F. (1996). Current population reports: Marital status and living arrangements: March 1995 (update). Washington, DC: U.S. Census Bureau. Sewall, M. (1930). Two studies of sibling rivalry: Some causes of jealousy in young children. Smith College Studies in Social Work, 1, 6–22. Shlonsky, A., Bellamy, J., Elkins, J. & Ashare, C. (2005). The other kin: Setting the course for research, policy, and practice with siblings in foster care. Children and Youth Services Review, 27, 617–716. Shlonsky, A., Webster, D., & Needell, B. (2003). The ties that bind: A cross-sectional analysis of siblings in foster care. Journal of Social Service Research, 29, 27–52. Slomkowski, C., Wasserman, G., & Schaffer, D. (1997). A new instrument of assessing sibling relationships in antisocial youth—The Social Interaction Between Siblings (SIBS) Interview. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38, 253–56. Smith, M.  C. (1996). An exploratory survey of foster mother and caseworker attitudes about sibling placement. Child Welfare, 71, 257–70. Smith, M.  C. (1998). Sibling placement in foster care: An exploration of associated concurrent preschoolaged child functioning. Children and Youth Services Review, 20, 389–412. Smith, S. L., Howard, J. A., Garnier, P. C., & Ryan, S. D. (2006). Where are we now? A post-ASFA examination of adoption disruption. Adoption Quarterly, 9, 16–44. South Carolina Code Annotated, 20–7-764 (A)–(D). Staff, I., & Fein, E. (1992). Together or separate: A study of siblings in foster care. Child Welfare, 71, 257–70. Stein, T.  J. (1987). The vulnerability of child welfare agencies to class action suits. Social Service Review, 61, 636–54. Stocker, C. M., & McHale, S. M. (1992). The nature and family correlates of preadolescents’ perceptions of their sibling relationships. Journal of Social and Personal Relationships, 9, 179–95. Sutton-Smith, B., & Rosenberg, B. G. (1970). The sibling. New York: Holt, Rinehart & Winston.

Tarren-Sweeny, M., & Hazzell, P. (2005). The mental health and socialization of siblings in care. Children and Youth Services Review, 27, 821–43. Texas Family Code, Section 162.302(e). Theis, S., & Goodrich, C. (1921). The child in the foster home. New York: New York School of Social Work. Thorpe, M. B., & Swart, G. T. (1992). Risk and protective factors affecting children in foster care: A pilot study of the role of siblings. Canadian Journal of Psychiatry, 37, 616–22. Toman, W. (1976). Family constellation (3d ed.). New York: Springer. Trasler, G. (1960). In place of parents: A study of foster care. London: Routledge & Kegan Paul. U.S. Census Bureau (2010). Table C3. Living Arrangements of Children Under 18 Years/1 and Marital Status of Parents, by Age, Sex, Race, and Hispanic Origin/2 and Selected Characteristics of the Child for All Children: 2010. Retrieved from: http://www.census.gov/ population/www/socdemo/hh-fam/cps2010.html. U.S. Department of Health and Human Services, Children’s Bureau (2003). The AFCARS Report: Preliminary FY 2001 Estimates as of March 2003. Retrieved from www.acf.hhs.gov/program/cb. U.S. Department of Health and Human Services, Administration for Children and Families (n.d.). National Survey of Child and Adolescent Well-being: 1997–2010 (NSCAW): Current Caregiver Characteristics, Table 4.7. Retrieved from http://www.acf.hhs. gov/programs/opre/abuse_neglect/nscaw/reports/ nscaw_oyfc/oyfc_chp4.html. Washington, K. (2007). Research Review: Sibling placement in foster care: a review of the evidence. Child and Family Social Work, 12, 426–33. Webster, D., Shlonsky, A., Shaw, T., Brookhart, M. A. (2005). The ties that bind II: Reunification for siblings in out-of-home care using a statistical technique for examining non-independent observations. Children and Youth Services Review, 27, 765–82. Wedge, P., & Mantle, G. (1991). Sibling groups and social work: A study of children referred for permanent substitute family placement. Aldershot: Avebury. Welty, C., Geiger, M., & Magruder, J. (1997). Sibling groups in foster care: Placement barriers and proposed solutions. Sacramento: California Department of Social Services. Whelan, D.  J. (2003). Using attachment theory when placing siblings in foster care. Child and Adolescent Social Work Journal, 20, 21–36. Whipple, E. E., & Finton, S. E. (1995). Psychological maltreatment by siblings: An unrecognized form of abuse. Child and Adolescent Social Work Journal, 12, 135–46. Wulzcyn, F., Kogan, J., & Harden B.  J. (2003). Placement stability and movement trajectories. Social Service Review, 77, 212–36. Wulczyn, F., & Zimmerman, E. (2005). Sibling placements in longitudinal perspective. Children and Youth Services Review, 27, 741–63. Zimmerman, R.  B. (1982). Foster care in retrospect. Tulane Studies in Social Welfare, 14, 1–125.

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Visits Critical to the Well-Being and Permanency of Children and Youth in Care

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requent visiting between children and youth in care and their parents is consistently associated with children’s enhanced well-being while in care, the outcomes of placement, particularly family reunification, and decreased length of stay in care. However, despite the wealth of available research and practice wisdom concerning the importance of visiting as a placement service, many children in care are not provided frequent visits with their families. A close look at state policies regulating visiting practices reveal that they vary widely, often providing no or limited guidance to those who plan and implement visits. Another indicator of the states’ insufficient attention to family visiting of children in care is the findings from the federal Child and Family Services Reviews (CFSRs). Round 1 of the CFSRs found that 20 of the 50 states neither achieved substantial conformity nor demonstrated strength in the area of “Facilitating Visitation of Children in Care with Parents and Siblings” (Children’s Bureau 2002, 2003–2004). This finding was equivalent to failure in this area for two out of five of the states. Round 2 CFSRs were completed in 2010; 52 states were reviewed and 2,079 foster care cases (Children’s Bureau 2011). On Permanency Outcome 2, “The continuity of family relationships and connections is preserved for children,” the mean state performance was 64.5 percent of desired outcomes were “substantially achieved” (Children’s Bureau 2011). Moreover, the evaluation of item 13 within Permanency Outcome 2, “Visiting parents and siblings in foster care,”

found that “stronger practice [was] noted in the area of Sibling visitation”; however, in 36 percent of States “no concerted efforts were made to ensure sufficient [sibling] visitation” (Children’s Bureau 2011). In 82 percent of states “no concerted efforts [were made] to ensure sufficient visitation with fathers”; and in 62 percent of states “no concerted efforts [were made] to ensure sufficient visitation with mothers” (Children’s Bureau 2011). It is evident that the majority of states continue to fail to ensure that children and youth in their custody have even minimally adequate visits or family time. Professionals have recently questioned the use of the terms visitation and visiting, which can be off-putting to children and family members. Smariga has clarified that “because the term visitation does not adequately describe the quality and quantity of time that families need to spend together when children are removed from the home, child welfare experts have begun using other terms, such as family time, family access, and family interaction” (2007:7). Visiting and visits will primarily be used here, with other terms cited as they have been employed in the literature. In this chapter I review research findings regarding the importance of frequent visiting to placement outcomes and the nature of the states’ visiting policies. I also identify the obstacles to achieving optimum visit arrangements for children in care and their families as well as recently developed resources to guide visiting practice. Several innovative visiting programs and resources are described. 527

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THE STILLMAN FAMILY Marty Stillman is a twenty-nine-year-old mixedrace mother of two, Bobby (aged four) and Javon (aged two). Marty, whose parents had both died when she was a teenager, longed for a family and very much wanted to have children. After several unsuccessful relationships, Marty met Pete, who was on permanent disability for a physical injury he had sustained as a child. She and her two children from previous relationships moved into Pete’s studio apartment. Unfortunately, Marty began abusing illegal substances with Pete, and this contributed to violence in their newly formed family. At various times over their three-year relationship, Pete physically abused Marty and both children. Hearing almost constant commotion coming from the small apartment, a neighbor called the state hotline for suspected child abuse. Upon investigation, the police arrested Pete, who acknowledged physically abusing the children. Citing imminent risk and safety concerns for the children, the Child Protective Services worker placed Bobby and Javon together in a family foster home located within the community. Their foster parent, Mrs. Jones, was skilled and experienced. Neither child had ever been separated from his mother; both were deeply distressed. The child welfare worker provided Marty with her cell phone number and suggested that she could begin visiting her children within seventy-two hours. After the mandated seventy-two-hour case conference was held, Marty and the child welfare staff began to develop a plan that would enable her to be reunited with her children. Marty was highly motivated to have her children returned to her care. During that first week, visits were supervised with a visiting coach present to work with Marty and her children. In the spirit of full and open disclosure, the role of the visiting coach was explained to Marty, who welcomed any intervention that would assist her in reunifying with her children. Marty visited weekly with her children and the visiting coach in the foster parent’s home. Mrs. Jones, the foster parent, was a skilled mentor in her own right and welcomed Marty into her home. She also kept Marty abreast of all events in her children’s lives and welcomed Marty to telephone her any evening before 11 P.M.

After two months, Marty had moved from the apartment she shared with Pete into another apartment. She attended a day treatment program to support her decision to abstain from alcohol and substances and made some very positive connections with staff and fellow program members. Marty was no longer seeing Pete. She was permitted to begin visits with her children in her apartment, with the visiting coach continuing to facilitate the visits. Bobby and Jovan were thrilled with their mother’s new apartment, which was located in a building with a playground. They seemed to thrive under these conditions. Marty continued to meet the goals in her plan and talked by phone with the children daily. In her words: “I am doing everything I need to do to get my kids back.” The visits were increased in length, and the visiting coach recommended that visits begin to be unsupervised. At the six-month case review, Marty and her caseworker developed a specific plan with steps to reunify her with her children. The steps included moving to overnight visits, with both the visiting coach and Mrs. Jones available by phone, and then to visits of several days. Within three months, Bobby and Jovan were able to have a two-week visit, after which they were reunified with Marty. Marty continued to work with the child welfare caseworker in the aftercare program. Mrs. Jones, who had developed a strong connection with Marty and her children, chose to continue providing support to Marty and be a part of the Stillman family system.

Why Is Visiting Important? Frequent parental visiting has consistently been found not only to benefit children and youth in care emotionally but also to affect whether and how quickly they return home. These are significant reasons for policy makers, agency administrators, and practitioners to ensure that parents are afforded every opportunity to visit with their children and, whenever possible, to address and eliminate obstacles to parents’ frequent visiting. Findings from the CFSRs cited earlier in this chapter and the research cited have led to the conclusion that “When carefully and intentionally orchestrated, parent-child visits can

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be the determining factor in safe reunification” (Freundlich 2010:16). In 1959 Maas and Engler reported the findings of the first comprehensive study of children in foster care in the United States. They reported that visiting was a variable related to discharge. In the more than fifty years since their study, other researchers also have found that parental visiting frequency is strongly associated with placement outcomes—particularly family reunification—and with length of stay in care. Children who are more frequently visited are more likely to be discharged from placement (Davis et al. 1996; Fanshel 1982; Fanshel & Shinn 1978; Lawder, Poulin, & Andrews 1985; Milner 1987; Sherman, Neuman, & Shyne 1973), to experience shorter placement time in months (Mech 1985), and to experience a successful (i.e., lasting) reunification with their families (Farmer 1996). The benefits of parental visiting reported by Davis and colleagues (1996) are particularly compelling. They report that, in a study subsample of 922 children 12 years old or younger who entered foster care in San Diego and remained in care for more than 72 hours, 66 percent of the children were reunified with their families after up to 18 months in care. Just over onethird (34 percent) had other permanency planning outcomes. In the logistic regression model predicting family reunification, “The .10 odds ratio indicates that when the mother visited as recommended the child was approximately 10 times more likely to be reunified” (Davis et al. 1996:375). These researchers conclude that “the evidence gathered by the current and other studies of the crucial importance of parental visiting speaks loudly for even stronger allocations of fiscal and professional resources to foster care practice in order to maximize the benefits inherent in parental visiting” (1996:381). In addition, visiting between children in care and their families is essential to maintaining parent-child and other family relationships and to reducing the sense of abandonment that children experience at placement (Beyer 1999; Blumenthal & Weinberg 1983; Elstein 1999;

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Fahlberg 1979; Fanshel & Shinn 1978; Haight et al. 2001; Haight, Kagle, & Black 2003; Hess 1981, 1982, 1987; Hess & Proch 1988, 1993; Kuehnle & Ellis 2002; Littner 1975; Mapp 2002; McFadden 1980; Weinstein 1960; White 1982; Wright 2000). Fanshel and Shinn (1978) have provided the greatest detail regarding the relationship between parent-child visits and children’s personal and social adjustment in care. Over a 5-year period, they examined the experiences of 624 children who entered foster care in New York City in 1966. They reported that children who were visited more frequently were rated more positively on the indexes of emotional well-being and developmental progress. For example, “highly (more frequently) visited children showed significantly greater gains in verbal IQ scores over the full five years of the study” (Fanshel & Shinn 1978:486). During certain periods, frequently visited children showed significantly greater gains in nonverbal IQ scores and emotional adjustment. In addition, frequent visiting helped predict positive changes in behaviors such as agreeableness, defiance and hostility, and emotionality and tension, and over-all positive assessment by the child’s classroom teacher (1978:486, 487). Other studies have also found a relationship between the frequency of parent-child visiting and children’s well-being while in care. Children in legal custody whose parents visit them frequently are more likely to have positive well-being ratings and to adjust well to placement than are children less frequently or never visited (Borgman 1985; Weinstein 1960). McWey, Acock, and Porter (2010) found frequent, consistent visits with a child’s mother may decrease levels of depression and externalizing problem behaviors in children in foster care. And, consistent with the findings about frequently visited children’s well-being while in care, Barth (1986, 1990), Inglehart (1994), and Dinisman et al. (2013) have reported that youth who have contact with their birth parents while in foster care have better outcomes following their exit from care than do youth who do not maintain these contacts.

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Policy Regarding Visiting of Children and Youth in Care One of the factors contributing to the frequency of scheduled visits is the agency policy regarding planned visit frequency. One study found that having in place an agency policy that specified minimum parent-child visiting frequency “resulted in the development of visiting plans that complied with the minimum standard required by the agency for visit frequency . . . Caseworkers with neither agency policy nor norms refer to their own personal guidelines regarding visit frequency” (Hess 1988:315, 323). As emphasized in the first published detailed guidelines for visiting practice: “Visiting does not occur at the whim of parents and caseworkers, independent of case goals and agency services. Visiting is a planned intervention, and the visiting plan is an essential component of the service plan. The visiting plan is based in part on the permanency goal for the child, and therefore should help achieve the goal and reflect progress toward it” (Hess & Proch 1988:11). Almost three decades ago, a study of the parent-child visiting policies of all state public agencies responsible for placement services examined the extent to which state policies outlined standards regarding visit frequency and other aspects of visiting. Although almost all states were found to have applicable policies, Hess and Proch (1986:13) reported that “the content of the policies varies widely, indicating there is no consensus on standards concerning any aspect of visiting and raising questions about how well the relationship between children in care and their parents is protected.” In 2002 this author completed a second study of states’ policies to identify whether and in what ways standards regarding visiting of children and youth in care as reflected in policy had changed (for study methodology, findings, and excerpts from responding states’ policies, see Hess 2003). Responses received from thirtyseven of the fifty states (74 percent) indicated that all responding states had written policies regarding child-family visiting. The majority of

these addressed not only parent-child visits but also visits between siblings separated while in care. This emphasis on visits between siblings placed separately reflected a change in states’ policies since the Hess and Proch 1986 policy study. (See Hegar’s chapter on sibling issues, this volume.) Thirty discrete categories of requirements and/or guidance concerning visiting between children in care, their families, and others were identified through a content analysis of the respondents’ policies. Only seven of the thirty categories, however, were addressed by one-half or more of the thirty-seven responding states’ policies: t
78.4 percent of the thirty-seven responding states addressed development of a written visiting plan. t
78.4 percent addressed documentation of the visiting plan in the child’s or youth’s case record. t
73.0 percent identified who was permitted to participate in visits with children and youth in care. t
70.3 percent addressed how frequently visits should or might occur. t
62.2 percent stipulated agency and/or caseworker responsibilities regarding visits. t
56.8 percent specified the circumstances under which visits with children and youth should or could be limited or terminated. t
54.0 percent stipulated where visits should or might occur. Many state policies lacked specificity. Moreover, when states’ policies did provide specific guidance, their requirements varied widely, frequently emphasizing different priorities and actions. To illustrate, although 70.3 percent of the responding states did “address” the frequency of visiting in their policies, the ways in which the states addressed visit frequency provided very different guidelines. Nine states recommended or required that children and youth in care be provided at least weekly visits with

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family members. In contrast, the minimum recommended or required visit frequency in four other states was only monthly. Assuming that caseworkers schedule visits as frequently as required, children and youth in the first nine states would be provided four visits per month, or forty-eight visits per year, whereas, in the other four states, children and youth would have only one visit per month, or twelve visits per year. Children in legal custody in an additional seven states are permitted visits “regularly” or “as frequently as possible,” phrases subject to a broad range of different interpretations. It is of particular concern that eleven (29.7 percent) of the states’ policies failed to address required or even recommended frequency of scheduled parent-child visits. These differences in state policies concerning visit frequency almost certainly affect the well-being of children and youth, their family relationships and connections, and their progress toward achieving permanence. Holcomb (2004:2, 7) has observed, rightly, that “visitation may be the most delicately complicated portion of a foster care plan. . . . Visits should be better tailored to the needs of the child and the skills of the family, and families should not be expected to do more than they can, nor should they be prevented from doing all they can.” Most states’ policies require that a written visiting plan for children and their families be included in the child’s or youth’s case plan and/or case record. Although the states’ policies vary with regard to what must be addressed in a child’s plan for family visits, the practice literature (e.g., Allen & Hamilton 2011; Beyer 1999; Hess & Proch 1988, 1993; Wright 2000) has consistently emphasized that such plans must address the following: visit frequency, length, location, and participants; whether visits will be supervised; supportive services to facilitate visiting, such as transportation; appropriate visiting activities; and any conditions related to visits, such as a requirement that a parent must call in advance to confirm her intention to keep a visit appointment or must refrain from using

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physical discipline during visits. Current state policies concerning family visits with children in foster care may typically be found on the Website of the state’s department that administers foster family and other placement services. In a thoughtful discussion regarding what attorneys need to know about the importance of parent-child relationships and the impact of parent-child separation, Kuehnle and Ellis (2002) have highlighted the differences regarding minimum frequency of children’s visits when they are separated from their parents due to divorce rather than due to “dependency” (child neglect and abuse). They assert, “In family court, attorneys and mental health professionals would be outraged if a child were kept from all contact with a parent for weeks, let alone months. In dependency court, why is this tolerated?” (2002:69, emphasis added). This observation is reminiscent of comments often heard from professionals familiar with both the prison and child welfare systems that persons who are incarcerated are typically permitted much more frequent visiting by family members than are children and youth in foster care. Impact of Fostering Connections Act Although the Fostering Connections to Success and Increasing Adoptions Act of 2008 (H.R. 6893/P.L. 110-351) fails to include requirements or standards concerning frequency or other aspects of parent-child visits, it does include a new Title IV-E state plan requirement that Title IV-E agencies must make reasonable efforts to place siblings who are removed from their home together in the same foster care, adoption, or guardianship placement, or facilitate visits or ongoing contacts with those that cannot be placed together, unless it is contrary to the safety or well-being of any of the siblings to do so. At least two Web sites regularly update information regarding individual states’ legislative action to enact bills related to provisions of the Fostering Connections Act: www. nrcpfc.org/fostering-connections/ and www.ncsl. org, the Web site for the National Conference of State Legislatures.

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Professional Standards for Family Visits with Children and Youth in Care In addition to the policies and legislation that provide standards concerning family visits with children and youth in care, standards for visiting practice have also been promulgated by accrediting bodies and other organizations. The Child Welfare League of America standards for family foster care services stress the importance of children’s visits with parents, siblings, kin, and friends (Child Welfare League of America 1995:48–49, 74–75). The Council on Accreditation, a not-for-profit, child- and family-service and behavioral health care accrediting organization, also has developed standards for developing and maintaining connections for children in family foster care services (Council on Accreditation 2013a,b). The council’s standards for both public agencies and private organizations require that, at a minimum, in-person contact occurs weekly between children and parents, and monthly between siblings. Supervised Visitation Network (SVN) also publishes standards and guidelines for supervised visiting policy, programs, and practice that are available online (Supervised Visitation Network 2006). Formed in 1991, the SVN is an “international membership network that establishes standards, promotes education and advances professionalism in the field of supervised visitation” (Supervised Visitation Network 2011). The network’s individual members and member organizations provide supervised visits for children whose parents are divorced, and/or for children in out-of-home care. Guidelines for Visiting Practice Since 1980, when the Adoption Assistance and Child Welfare Act emphasized reunification as the preferred permanency goal for children and youth in care, greater attention has been paid to visiting as an intervention. Although the field has been slow to develop resources to guide and support visit planning and activities, newsletter articles for agency staff and foster caregivers, videos, training curricula,

and other materials are increasingly being developed. Several illustrative resources are described in the following. State-Specific Guides The Minnesota Department of Human Services (2009) has developed resources available online (see chapter references) that address numerous visit-related topics, including benefits of family visiting, Minnesota statutes about foster care and visiting, first visits and frequency of visits, example of a visit plan and review and revision of visit plans, foster parents’ role in visits, terminating or limiting visits, and sibling visits. New Jersey’s Office of the Child Advocate has published Protecting and promoting meaningful connections (Chen 2010), also accessible online. The New Jersey Office of Child Advocacy staff conducted focus groups statewide with resource parents, law guardians, birth parents’ attorneys, volunteers with court appointed special advocates, and birth parents about their experiences and opinions on visiting policy and practices. The report incorporates findings from this process and highlights best visiting practices nationally and in New Jersey. The report presents strategies for promoting positive change in visiting practice as well as model programs. It stresses that, “done correctly, spending quality family time together reduces the child’s sense of abandonment and loss and can address feelings of guilt or mistrust related to being removed from their home. In this way, visitation promotes children’s mental and emotional health” (2010:5). Resources for Judges and Attorneys Another recently developed resource has as its intended audience judges and attorneys: Visitation with infants and toddlers in foster care: What judges and attorneys need to know (Smariga 2007). In the introduction, Smariga states: One-third of all children entering foster care are zero to three years of age, and 15 percent are babies under age one. Children are removed from their parents and placed in out-of-home care

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because a court has determined that it is not safe for them to live at home. However, children who are removed from home, particularly those who are very young, are exposed to a new danger—the emotional and developmental harm that can result from separation. Children at different stages in life react differently to separation from a parent, based primarily on their ability to understand the reasons for separation and the range and maturity of their coping strategies. The younger the child and the longer the period of uncertainty and separation from the primary caregiver, the greater the risk of harm to the child. Therefore, frequent, meaningful parent-child visits are critical for infants and toddlers in foster care. (Smariga 2007:1).

Smariga describes the development of children’s attachments and the effects of separation on young children; clarifies how visiting helps meet federal permanency planning requirements; and highlights the importance of judges’ and attorneys’ sensitivity to parents’ and children’s emotions around visitation. An “Infant Visiting Checklist for Family Court Judges” is included, as is a chart of “Developmentally Related Visit Activities” (2007:20–21, 14–15). Online Children’s Bureau Clearinghouse Child Welfare Information Gateway, found at www.childwelfare.gov, is a service of the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services. This Web site provides information services to child welfare professionals and the public as the clearinghouse for the Children’s Bureau (Administration for Children and Families n.d.). Information Gateway provides access to publications, Web site links, and online databases covering a range of topics, including parentchild visiting, sibling visiting, and visit coaching (Administration for Children and Families n.d.). A newly developed online training course, Introduction to Parent-Child Visits, has been developed in partnership with the National Resource Center on Permanency and Family

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Connections (2011a) and is accessible on the Child Welfare Information Gateway Web site. The training incorporates six lessons on maintaining parent-child and other family connections, goals of visits, the legislative background pertaining to visiting, best visiting practices, and other topics. Positive Family Visits: Guides for Birth Parents, Children, and Foster Parents Family Alternatives, a private foster care agency in Minneapolis conducted a three-year research initiative to identify best practices in family visiting in response to the growing research on the topic as well as their own experience with children living in the foster homes they serve. Wendy Wolff, a Family Alternatives staff member wrote, compiled, and piloted the original Familyconnect Guides for foster parents, younger and older children, and birth parents. Now available on a printable CD Positive family visits: guides for birth parents, children, and foster parents (Wolff 2011), each guide is a handson, practical tool designed to help reassure everyone of the importance of family visits and connections, normalize typical reactions and difficulties related to family visits, and provide strategies for communicating and working with families in a child centered way. Each booklet provides role-specific (i.e., child, foster parent, etc.) insight into the issues surrounding family visits—emotions, communication, preparation, connection, and transitions. To illustrate, the workbook is written for children ages four through eight and colorfully illustrated. It is designed for use by a caregiver(s) who would read the workbook with a child in care who is having visits. The tips for caregivers at the end of the workbook encourage those using the workbook with children to adapt the details to the child’s age, unique developmental level, and family situation. Milo Mouse, Ready Rabbit, Back and Forth Beaver, and Feelings Fox all have lived away from their families in foster care and talk about various aspects of their family time/visit experience. For example,

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Ready Rabbit shares some of the questions he had while he was living in foster care: When will I see my family? Where will I see them? Who will bring me there? What will we talk about? What can we do at our visits? How long will I stay? The workbook provides a calendar for family time/visits, explores what can go in a family time bag for the child to take to visits, examines feelings a child might have related to family time, explores an after-visit plan, provides an after-visit journal that can be written in words or drawing pictures, explores missed visits, and ends with a review of these topics. Visit Coaching Visit coaching is “based on a belief that parents can overcome anger, sadness, and other obstacles to make visits happy for their children. The program aims for interactions similar to those the family enjoyed when they were living together” (Williams with Beyer 2009). Visit planning starts with, “Imagine your child coming through the visit room door—what does he/ she want from you?” (Beyer 2004:8). In Visit Coaching: Building on Family Strengths to Meet Children’s Needs (2004), Beyer states that coaching can be provided in a variety of ways and settings, which include the following: t
Reaching agreement with the parent about the child’s needs to be met in visits, connected to the risks that brought the child into care t
Preparing parents for their child’s reactions and how to plan to give their child their full attention at each visit t
Appreciating the parent’s strengths in responding to his or her child and coaching parents to improve their skills t
Supportively reminding parents before and during the visit of how they plan to meet the particular needs of their children t
Helping parents cope with their feelings in order to visit consistently (2004:2)

Beyer addresses visit coaching principles, empowering families through visit planning, methods of visit coaching, coached visits and kinship care, coached visits to make peace with the past, and the logistics of visit coaching. Obstacles to Planning and Implementing Visiting for Children in Care As reported elsewhere in this volume, caseworker contact with parents of children in care is generally infrequent; services to support parent-child visits occur even less frequently. To illustrate, in partnership with New York City’s Administration for Children’s Services (ACS) and the Legal Aid Society Juvenile Rights Practice, Children’s Rights conducted a study that sought to “identify the barriers that may keep children in foster care [including the barriers to parent-child visiting] and to recommend concrete, viable strategies for overcoming them” (2009:3). Case records of 153 children in foster care with permanency goals of return to parent or adoption for two years or more were examined; in addition, interviews and focus groups were conducted with parents, foster parents, and caseworkers; attorneys for children, parents, and the ACS; and family court judges and referees (2009:3). Reported findings include the percentage of children who had been visited as expected by mother and by father during one year (October 1, 2007, through September 30, 2008). The minimum of biweekly visits was used as the “expected” minimum frequency in accordance with New York State Office of Children and Family Services policy that requires biweekly visits when the goal is reunification. The ACS also requires biweekly visits as the minimum parent-child visit frequency for the goals of reunification and of adoption for children who are not legally free (Children’s Rights 2009:133– 34). As cited in this report, ACS policy also states: “it is expected and recommended that more frequent contact [than the minimum required] be arranged and facilitated. Whenever possible and in the best interests of the

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child, it is recommended that visits occur on a weekly basis” (2009:134). Information found in the case records of children and youth in care (none of whom were legally free for adoption and for whom visiting was applicable), revealed that only 17 percent of children had the expected number of visits with their mothers (2009:135). Further, the study found that “54 percent of children had no visits with their mothers in more than half of their applicable [twelve] months” (2009:136). Fathers and children visited even less infrequently. Only 4 percent of the children had the expected number of visits with their fathers (2009:132). In more than six months of the twelve-month review period, 81 percent of children had no visits with their fathers (2009:137). Sixty percent of fathers and 20 percent of mothers and their children failed to have even one documented visit during the twelve-month period examined (2009:132). The specific barriers to visits with the child’s mother most frequently identified in the children’s case records include the following: t
Mother canceled/missed scheduled visit— 45 percent of children t
Lack of documented caseworker efforts to schedule visits with mother—14 percent of children t
Mother’s whereabouts unknown during part or all of review period—14 percent of children t
Foster parent canceled/missed scheduled visit—14 percent of children t
Mother incarcerated, hospitalized, or in an inpatient program—11 percent of children Other barriers to mother-child visits include mother (10 percent) or child (8 percent) refused to visit; lack of geographic proximity between mother and child (8 percent); child canceled/ missed scheduled visit (4 percent); child incarcerated, hospitalized or in inpatient program (4 percent); and child AWOL/missing for part of review period. Other information regarding

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barriers to visits with mother includes those reviewing case records were unable to determine the barrier (5 percent) and no barrier (4 percent; Children’s Rights 2009:136). The specific barriers to visits with the child’s father most frequently identified in the children’s case record include the following: t
Father’s whereabouts unknown during part or all of review period—40 percent of children t
Lack of documented caseworker efforts to schedule father-child visits—26 percent of children t
Father canceled/missed scheduled visit— 21 percent of children t
Father incarcerated, hospitalized, or in inpatient program—11 percent of children t
Father refused to visit—10 percent Other barriers to father-child visits include foster parent canceled/missed scheduled visit (8 percent), child refused to visit (5 percent), lack of geographic proximity between father and child (5 percent), child canceled/missed schedule visit (1 percent), child AWOL/missing for part of review period (1 percent), and foster parent refused to facilitate visit (1 percent). In 6 percent of the children’s cases no barrier to father-child visits was found (Children’s Rights 2009:138). Research for several decades has identified obstacles to frequent visiting. For example, caseworkers have reported that the frequency of planned visits is undermined by the lack of agency resources, “especially caseworker time to schedule and coordinate visits, supervise visits needing supervision, transport parents and children, prepare persons for visits, discuss visit reactions with parents, children, and foster parents, and record pertinent information” (Hess 1988:315). Fanshel reported (1982:67–73) that visit frequency was lowered by a parent’s low motivation, employment hours, and other child care responsibilities; the distance of parent’s home from child’s placement; the lack of funds

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for transportation or child care; and a parent’s physical or mental illness or mental retardation. Both public and voluntary agencies can identify the current local barriers to frequent visits between children and their parents, siblings, extended family, and others of significance by systematically reviewing the agency’s own visiting policies and practices. The comprehensive guide Organizational Self Study on Parent-Child and Sibling Visits (National Resource Center for Permanency and Family Connections 2011b) has been developed to assist agencies in reviewing overall agency readiness to fully support family visiting, assess administrative policies, and identify strengths and challenges in the agency’s parent-child and sibling visiting practices. Once an agency has systematically assessed its strengths, challenges, and current barriers to frequent family visiting, the actions necessary to address the identified barriers can be taken. Innovative Programs That Support Visiting In an attempt to address these obstacles and challenges, public child welfare agencies have increasingly purchased visiting services from other agencies and community service providers. Consequently, over the past decade hundreds of visiting programs have been developed throughout the country. Some have thrived and grown, while others have been discontinued, typically due to insufficient funding. (For descriptions of visiting programs and their development, see Hess et al. 1992; Hess 2000; National Resource Center for Permanency & Family Connections 2008; and Pearson & Thoennes 1997.) To illustrate the diversity and creativity of visiting programs for children in care and their families, I discuss two innovative programs. Families Together Families Together, a program of Providence Children’s Museum, was created in partnership with the Rhode Island Department of Children,

Youth, and Families (DCYF). This program provides permanency planning and therapeutic visits for parents, siblings, and extended family of children infants to age eleven who are referred to the program by their DCYF caseworker. Visit length and frequency are individually determined, but weekly one- to two-hour visits for eighteen weeks is typical. Visits occur when the museum is open to the public. Families completing the program receive a one-year children’s museum membership at no cost. Since its inception more than twenty years ago, Families Together has helped more than 2,000 families move toward permanency. In 2012 the program served 230 families with 600 children and youth. Program director Heidi Brinig, who developed and piloted the program in 1992, is very clear about Families Together’s mission: “We are committed to supporting our families by recognizing that a child’s best teacher is his or her parent or adult caregiver; by teaching parents how to support their child’s needs and strengths; and by offering families respectful, nurturing environments specifically designed for parent-child interaction. We try to bring out the best in every family we serve” (Brinig 2011). Visits are provided to children whose permanency goal is family reunification. Families Together staff members work closely with DCYF caseworkers and other team members to ensure that the visit strategies are an integral part of the comprehensive case plan and that the visiting schedule follows the children’s case plan. Families Together follows a strengthsbased, family-focused model that is grounded in the experiential learning approach used by Providence Children’s Museum. Families Together clinicians coach parents in real time as they interact with their children; they provide immediate feedback, including affirmation, suggestions, and explanations, as parents practice new skills. They also guide parents to meet their children’s needs, to set developmentally appropriate limits, and to follow through

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with consequences. Thus parents are provided hands-on experience in a stimulating, safe environment and immediate feedback as they master parenting skills. Visits may also occur at other community locations, including in the family’s home. In 2012 Families Together added a homelike setting for family healing in which some of the therapeutic family visits take place: “Nina’s House.” The Nina Foundation (Families Together 2011) purchased and renovated a Providence residence for this purpose. DFCS caseworkers also refer children whose permanency goal is adoption to Families Together for two to four preadoptive visits with potential adoptive families. Supervised sibling visits and kinship visits are also provided. Families Together also offers ninety-minute biweekly parenting groups with an active play component, team-taught by a museum educator and Families Together clinician. Participants receive the Providence Children’s Museum’s booklet Play with Your Kids! A How-to, Why-to Guide for Parents (O’Donnell n.d.). Parenting groups also function as support groups as parents learn from and support each other. Families Together consultants communicate frequently with children’s foster families and transport children, and parents when necessary, to and from visits. Consultants also meet with families and DCYF staff members, observe and participate in families’ visits in the community, and participate in administrative reviews. In addition, they are available each week to DCYF caseworkers and supervisors to assist in screening referrals, documenting visits, and developing effective visiting plans. Families Together staff members hold masters-level degrees in social work, counseling, and child development and have several years experience. They offer observations and clinical insight into the health of the parent-child relationship to caseworkers, therapists, and family court judges. Families Together collaborates with the Child Welfare Institute staff at Rhode Island College to deliver

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a visiting training series for all family service units and recently hired DCYF employees. Families Together has inspired and advised the development of other child welfare partnerships. After the program received the 2006 MetLife Foundation and Association of Children’s Museums Promising Practice Replication Award, it created a tool kit, Partnering with the Child Welfare System (Providence Children’s Museum 2007), to assist children’s museums across the country in developing similar collaborative programs. The tool kit includes information about the child welfare system, funding for child welfare services, and partnering with the child welfare system; facts about abused and neglected children and foster care; and a description of the Families Together Program, including program staffing, organizational chart, position descriptions, and budget. FAMILYConnections Reunity House Located in South Orange, East Orange, and Paterson, New Jersey, FAMILYConnections’ Reunity House Therapeutic Supervised Visitation Program has offered an innovative reunification program since April 2002 (FAMILYConnections 2009; Williams & Byer 2009). The program’s goal is to achieve safe, successful, and lasting family reunification for children in foster care and their families. Reunity House professional staff teach personal responsibility and parenting skills and facilitate parent-child bonding in a respectful, nurturing, homelike environment. The program is designed to reduce child abuse and neglect, decrease the time children spend in foster care, and strengthen families throughout New Jersey communities (FAMILYConnections 2006). Services are provided to families whose children are in out-of-home placement and have the permanency goal of reunification. The program accepts all families with that goal who are referred by caseworkers of the New Jersey Department of Children and Families’ Division of Youth and Family Services.

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Visiting services are provided in three homelike settings, including two renovated homes. All three include group meeting rooms and multiple visiting spaces, including full kitchen, dining areas, and living rooms stocked with children’s books, toys, and arts and crafts supplies for all ages. The South Orange house also has two full apartments on the second floor suitable for both daytime and overnight supervised visits. After a thorough initial assessment of the child(ren)’s and family’s strengths and needs, the Reunity House program proceeds in three phases. In each phase the amount of time a family spends together increases along with opportunities to engage in daily family living activities, such as preparing meals together. Each program phase includes meetings with children and parents to review feelings about visits, meetings with parents to review visits, discuss relevant parent issues, and plan for subsequent visits, as well as an ongoing weekly parenting skills training and support group. The program includes dedicated drivers and minivans to transport all children to and from all visits. Staff also provides linkage to a wide range of support services, including other FAMILYConnection services such as an in-house intensive outpatient program to treat drug addiction. Phase I includes weekly one-hour supervised visits and videotaping of an early visit. Videotapes are reviewed with the parents to point out strengths and identify areas for improvement. The family’s therapist participates in all family visits at Reunity House, modeling positive parenting skills and intervening if needed. After each visit, the child(ren)’s parents and the therapist discuss the visit and plan for the next visit. Phase II includes weekly two-hour supervised visits, including community outings. It is generally during this phase that families also participate in group-based Music Together (2011) classes, taught by a music consultant, and Infant Massage, taught by a certified

FAMILYConnections staff member. These components of the Reunity House model foster and enrich parent-child interaction and bonding. Visits may also be videotaped during this phase and discussed with the parents. Phase III includes weekly two-hour supervised visits, a visiting outing of up to three hours, overnight visiting, and a videotaping of a visit during the final stages for discussion and comparison to earlier videotaped visits. Parents plan the overnight visits as preparation for when the child(ren) are returned to their custody. The Reunity House model also has an aftercare phase during which staff members support children and their parents in this transition by meeting weekly with families in their homes. For the year after children return to their parents’ home, staff members provide strengthsbased in-home counseling, case management, and referrals to concrete services. Staff members also have continued contact with reunified families by telephone. “All the program components contribute to the central goal,” stresses Paula Sabreen (2011), FAMILYConnections’ executive director and the founder of the Reunity House model. (Sabreen has been executive director of FAMILYConnections since 1996.) “Program staff set high expectations on participating parents, but we also treat parents with respect and believe in their strengths. So parents see the staff as supportive partners, not punitive representatives of some bureaucratic system.” An additional measure of the program’s success with parents is that program “graduates” are providing encouragement to parents currently enrolled in Reunity House. Current parents are eager to talk with those who have been through the same experience and successfully reunified their families. According to Sabreen, “Talking with graduates who have their children back gives current parents hope and increases their buy-in to the program model” (2011).

VISITS

Further Research Important questions about visiting policies, programs, and practices remain. Haight and colleagues (2001) report interesting findings regarding parent-child interactions during visits; however, further study is needed as to the nature of the visiting situation and of parent-child interactions within the visiting situation. Additional knowledge about the factors that influence the visiting situation would assist practitioners in planning successful visits, preparing participants for visits, and assessing parent-child visiting interactions. For example, how does the location of visits (e.g., in the public child welfare agency office, foster family home, public community settings, the child’s home) affect parent-child interaction during visits, permanency goal achievement, and the timing of family reunification? How do the auspices of visit services (e.g., public child welfare agency, contractual agency, community mental health agency) affect family members’ cooperation with the visit plan? Visit frequency in combination with other visit characteristics also requires further study. To date, studies have focused on visit frequency, perhaps in part because of patterns of agency record keeping. However, a focus solely on visit frequency obscures other important differences in visit arrangements and the possible contributions of these differences to children’s permanency outcomes. For example, although the planned visit frequency may be once a week, a once-a-week visit might be limited to fifteen minutes or might extend over a weekend. Although the association of the variable of visit frequency with a range of other variables has produced significant information, other variations (e.g., visit length, location, supervision) in cases where visit frequency is the same may also be influencing permanency outcomes and not yet have been identified as such.

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Caseworkers typically determine the amount of time family members spend together while a child is in care. Further examination of multiple agency and placement factors that support or constrain caseworkers in developing and implementing visiting arrangements is essential. YYY

For some time, research findings have underscored the critical importance of family visiting to children and youth in care. However, the findings of the most recent Child and Family Services Reviews (Children’s Bureau 2011) confirmed that the majority of states continue to fall short in achieving visiting policies and practices that would support children’s and youth’s well-being in care as well as the achievement of desired permanency outcomes. Agency resources to support frequent visits, including caseworker time, are too often in short supply. Specific national standards for minimum frequency of scheduled visits between children and their parents and siblings placed separately would decrease the wide variations and inequities found in the states’ visiting policies. The requirements of the Fostering Connections Act regarding regular sibling visits when siblings are placed separately is an encouraging, but not sufficient, step toward legislated protection of children’s family relationships. There are other encouraging signs. Greater attention is being given to developing resources that support safe and quality family time for children and youth in care and their families. Creative partnerships between public child welfare agencies and community resources, such as children’s museums, are demonstrating that communities can act to strengthen, heal, and protect the often fragile families to which the majority of children and youth in care hope to return.

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REFERENCES

Administration for Children and Families (n.d.). Child Welfare Information Gateway. Retrieved October 3, 2011, from: http://www.acf.hhs.gov/programs/cb/tta/ cwig.htm. Adoption Assistance and Child Welfare Act. (1980). P.L. 96-272. Allen, M., & Hamilton, N. (2011). The visit handbook. Des Moines: Iowa Department of Human Services. Barth, R. (1986). Emancipation services for adolescents in foster care. Social Work 67, 165–71. Barth, R. (1990). On their own. Child and Adolescent Social Work, 7, 419–40. Beyer, M. (1999). Parent-child visits as an opportunity for change. Prevention Report 1. Des Moines, Iowa: National Resource Center for Family Centered Practice. Beyer, M. (2004). Visit coaching: Building on family strengths to meet children’s needs. New York: NYC Administration for Children’s Services Visiting Improvement Project. Retrieved September 14, 2011, from: http://www.martybeyer.com/page/45/102/. Blumenthal, K., & Weinberg, A. (1983). Issues concerning parental visiting of children in foster care. In M. Hardin (ed.), Foster children in the courts (pp. 372– 98). Woburn, MA: Butterworth. Borgman, B. (1985). The influence of family visiting upon boys’ behavior in a juvenile correctional institution. Child Welfare, 64, 629–38. Brinig, H. (2011). Personal communication, October 8. Chen, R. (2010). Protecting and promoting meaningful connections: The importance of quality family time in parent—child visitation. Trenton, NJ: New Jersey Office of the Child Advocate. Retrieved September 28, 2011, from http://www.acnj.org/main. asp?uri=1003&di=1592. Children’s Bureau (2002). Child and Family Services Reviews: Summary of key findings. Retrieved December 30, 2004, from http://www.acf.hhs.gov/programs/cb/cwrp/keyfindings2002.htm. Children’s Bureau (2003–2004). Child and Family Services Reviews: Summary of key findings. Retrieved December 30, 2004, from: www.acf.hhs.gov/programs/cb/cwrp/keyfindings2003.htm. Children’s Bureau (2004). Child and Family Services Reviews: Summary of key findings. Retrieved December 30, 2004, from http://www.acf.hhs.gov/programs/cb/cwrp/keyfindings2001.htm. Children’s Bureau (2011). Federal updates: Child and Family Services Reviews. Child and Family Services Reviews: FY 2007–2010 Round 2 Findings, 52 States Reviewed. Powerpoint presentation at 2011 Policy to Practice (P2P) Dialogue: Making It Work in Child Welfare, E. Sherrard and M. Thomas. Children’s Bureau (n.d.). Results of the 2007 and 2008 Child and Family Services Reviews. Retrieved September 26, 2011, from http://www.acf.hhs.gov/

programs/cb/cwmonitoring/results/agencies_ courts.pdf. Children’s Rights (2009). The long road home: A study of children stranded in New York City foster care. New York: Children’s Rights. Retrieved September 24, 2011, from http://www.childrensrights.org/policy-projects/foster-care/permanency-in-new-yorkcity-2009/2/. Child Trends (2009). About the law. Fosteringconnections.org. Retrieved October 2, 2011, from http://www.fosteringconnections.org/about_the_ law?id=0007. Child Welfare League of America (1995). Child Welfare League of America standards of excellence for family foster care services (rev. ed.). Washington, DC: Child Welfare League of America. Council on Accreditation (2013a). Standards for private organizations. Retrieved October 25, 2013, from www. coanet.org/fkc/7/. Council on Accreditation (2013b). Public agency standards. Retrieved September 26, 2011, from http:// www.coanet.org/standard/pa-fkc/7/. (access service standards, foster care). Davis, I., Landsverk, J., Newton, R., & Ganger, W. (1996). Parental visiting and foster care reunification. Children and Youth Services Review, 18, 363–382. Dinisman, T., Zeira, A., Sulimani-Aidan, Y., & Benbenishty, R. (2013). The subjective well-being of young people aging out of care. Children and Youth Services Review, 35, 1705–11. Elstein, S. (1999). Making decisions about siblings in the child welfare system. ABA Child Law Practice, 18, 115. Fahlberg, V. (1979). Attachment and separation. Lansing: Michigan Department of Social Services. Families Together (2011). Parent to Parent Programs (Summer), p. 5. FAMILYConnections (2006). Family and foster care services. Retrieved October 3, 2011, from http:// www.familyconnectionsnj.org/services-adultsandfamilies.html. FAMILYConnections (2009). Home page. Retrieved October 3, 2011, from http://www.familyconnectionsnj.org/index.html. Fanshel, D. (1982). On the road to permanency. New York: Child Welfare League of America. Fanshel, D., & Shinn, E. (1978). Children in foster care: A longitudinal investigation. New York: Columbia University Press. Farmer, E. (1996). Family reunification with high-risk children: Lessons from research. Children and Youth Services Review, 18, 287–305. Fostering Connections Resource Center (n.d.). Enacted kinship/guardianship legislation. Retrieved October 2, 2011, from Fosteringconnections.org. Freundlich, M. (2010). Legislative strategies to safely reduce the number of children in foster care. Denver, CO and

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Washington, DC: National Conference of State Legislatures. www.ncsl.org. Haight, W., Black, J., Workman, C., & Tata, L. (2001). Parent-child interaction during foster care visits: Implications for practice. Social Work, 46, 325–338. Haight, W., Kagle, J., & Black, J. (2003). Understanding and supporting parent-child relationships during foster care visits: Attachment theory and research, Social Work, 48, 195–207. Hess, P. (1981). Working with birth and foster parents. Knoxville: University of Tennessee, School of Social Work. Hess, P. (1982). Parent-child attachment concept: Crucial for permanency planning. Social Casework, 63, 46–53. Hess, P. (1987). Parental visiting of children in foster care: Current knowledge and research agenda. Children and Youth Services Review, 9, 29–50. Hess, P. (1988). Case and context: Determinants of planned visit frequency in foster family care. Child Welfare, 67, 311–26. Hess, P., ed. (1999). Enhancing visiting services: Standards, leadership, organization, and collaboration. Philadelphia: Commonwealth of Pennsylvania Department of Public Welfare. Hess, P. (2000). The history and evolution of supervised visitation. In A. Reiniger (ed.), The professionals’ handbook on providing supervised visitation (11–30). New York: New York Society for the Prevention of Cruelty to Children. Hess, P. (2003). Visiting between children in care and their families: A look at current policy. New York: National Resource Center for Permanency and Family Connections, Hunter College School of Social Work. Available at http://www.hunter.cuny.edu/socwork/ nrcfcpp/info_services/family-child-visiting.html. Hess, P., Mintun, G., Moehlman, A., & Pitts, G. (1992). Family Connection Center: An innovative visiting program. Child Welfare, 71, 77–88. Hess, P., & Proch, K. (1986). How the states regulate parent-child visiting. Public Welfare (Fall), 13–17, 46. Hess, P., & Proch, K. (1988). Family visiting of children in out-of-home care: A practical guide. Washington, DC: Child Welfare League of America. Hess, P., & Proch, K. (1993). Visiting: The heart of reunification. In B. Pine, R. Warsh, & A. Maluccio (eds.), Together again: Family reunification in foster care (pp. 119–39). Washington, DC: Child Welfare League of America. Holcomb, R. (2004). Innovative practice in foster child visitation: A review of the literature for Family Alternatives, Inc. Minneapolis: Family Alternatives. Retrieved October 2, 2011, from http://www.cehd. umn.edu/SSW/cascw/events/past_events/familyconnect.asp. Inglehart, A. (1994). Adolescents in foster care: Predicting readiness for independent living. Children and Youth Services Review, 16, 159–69.

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Kuehnle, K., & Ellis, T. (2002). The importance of parent-child relationships. What attorneys need to know about the impact of separation. Florida Bar Journal, 76, 67–70. Lawder, E., Poulin, J., & Andrews, R. (1985). 185 foster children five years after placement. Philadelphia: Research Center, Children’s Aid Society of Pennsylvania. Littner, N. (1975). The importance of the natural parents to the child in placement. Child Welfare, 54, 175–181. Maas, H., & Engler, H. (1959). Children in need of parents. New York: Columbia University Press. McFadden, E. J. (1980). Working with natural families, instructors’ manual. Ypsilanti, MI: Foster Parent Education Program. McWey, L., Acock, A., & Porter, B. (2010). The impact of continued contact with biological parents upon the mental health of children in foster care. Children and Youth Services Review, 32, 1338–45 Mapp, S. (2002). A framework for family visiting for children in long-term foster care. Families in Society, 83, 175–82. Mech, E. (1985). Parental visiting and foster placement. Child Welfare, 64, 67–72. Milner, J. (1987). An ecological perspective on duration of foster care. Child Welfare, 66, 113–123. Minnesota Department of Human Resources (2009). Child and family visitation: A practice guide to support lasting reunification and preserving family connections for children in foster care. Minneapolis: Minnesota Department of Human Resources. DHS-5552-ENG 1–09. Retrieved October 25, 2013, from http://www. dhs.state.mn.us/main/idcplg?IdcService=GET_ DYNAMIC_CONVERSION&dDocName=id_00016 4&RevisionSelectionMethod=LatestReleased. Music Together (2011). About us. Retrieved October 7, 2011, from http://www.musictogether.com/AboutUs. National Conference of State Legislators (2010a). Fostering Connections Act: 2009 Legislation. Updated May 2010. Retrieved October 2, 2011, from http:// www.ncsl.org/?TabId=16326#Legislation. National Conference of State Legislators (2010b). Fostering Connections Act: 2010 Legislation. Updated December 2010. Retrieved October 2, 2011, from http://www.ncsl.org/default.aspx?tabid=20264. National Conference of State Legislators (2011). Fostering Connections Act: 2011 Legislation. Updated September 20, 2011. Retrieved October 2, 2011, from http://www.ncsl.org/default.aspx?tabid=22222. National Resource Center for Permanency and Family Connections (2008). Programs that provide services to support family visiting of children in foster care. Retrieved September 13, 2011, from http://www. nrcpfc.org/cpt/component-five.htm. National Resource Center for Permanency and Family Connections (2011a). Introduction to parentchild visits. New York: National Resource Center for Permanency and Family Connections. Retrieved

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September 15, 2011, from http://training.childwelfare. gov/oltMain.cfm?z=z. National Resource Center for Permanency and Family Connections (2011b). Organizational self study on parent-child and sibling visits. New York: National Resource Center for Permanency and Family Connections. Retrieved September 13, 2011, from http://www.nrcpfc.org/s. O’Donnell, J. (n.d.). Play with your kids! A how-to, why-to guide for parents. Providence, RI: Providence Children’s Museum. Available in English and Spanish. Retrieved September 26, 2011, from http://www. childrenmuseum.org/pubs.asp. Pearson, J., & Thoennes, N. (1997). Supervised visitation: A portrait of programs and families. Denver, CO: Center for Policy Research. Providence Children’s Museum (n.d.) Families Together. Retrieved September 26, 2011, from http:// www.childrenmuseum.org/familiestogether.asp. Providence Children’s Museum (2007). Partnering with the child welfare system—a toolkit. Providence, RI: Providence Children’s Museum. Retrieved September 26, 2011, from http://www.childrenmuseum.org/ pubs.asp. Providence Children’s Museum (2010). Providence Children’s Museum 2010 Annual Report. Retrieved on September 26, 2011, from http://www.childrenmuseum.org/pubs.asp. Providence Children’s Museum (2011). Museum News. In Dragon Tale: The Newsletter of the Providence Children’s Museum. Retrieved September 26, 2011, from http://www.childrenmuseum.org/pubs.asp. Sabreen, P. (2011). Personal communication, October 10. Sherman, E., Neuman, R., & Shyne, A. (1973). Children adrift in foster care. New York: Child Welfare League of America.

Smariga, M. (2007). Visitation with infants and toddlers in foster care: What judges and attorneys need to know. Washington, DC: American Bar Association and Zero To Three. Supervised Visitation Network (2006). Standards for supervised visitation practice. Retrieved September 22, 2011, from www.svnetwork.net/standards.asp. Supervised Visitation Network (2011). About SVN. Retrieved September 22, 2011, from www.svnetwork. net/about.asp. Weinstein, E. (1960). The self-image of the foster child. New York: Russell Sage Foundation. White, M. (1982). Promoting parent-child visiting in foster care: Continuing involvement within a permanency planning framework. In P. Sinanoglu & A. Maluccio (eds.), Parents of children in placement: Perspectives and programs (pp. 461–75). New York: Child Welfare League of America and the University of Connecticut. Williams, M. (2008). Changing a critical practice: How can policy and practice improve visits between parents and their children in care? Children’s voice (November/ December). Retrieved September 13, 2011, from http://www.cwla.org/voice/0811changing.htm. Williams, M., & Beyer, M. (2009). Exploring options for better visiting: National and local programs develop their own best practices for visiting. Children’s voice (January/February). Retrieved September 13, 2011, from: http://www.cwla.org/voice/0901visiting.htm. Wolff, W. (2011). Positive family visits: Guides for birth parents, children and foster parents. Eugene, OR: Northwest Media Inc. Retrieved October 24, 2013, from http://www.sociallearning.com/catalog/search ;jsessionid=aYUv6iXgtpba?op=quick&phrase=posit ive+family+visits&x=13&y=8. Wright, L. (2000). Toolbox #1: Using visitation to support permanency. Washington, DC: Child Welfare League of America.

M A D E LY N F R E U N D L I C H LOIS WRIGHT

Postpermanency Services

A

lthough planning for and achieving permanency have been the focus of child welfare since the early 1980s, postpermanenc y planning—sustaining permanency—has received much less attention. The two most recent federal child welfare laws—the Adoption and Safe Families Act (ASFA) of 1997 and Fostering Connections to Success and Increasing Adoptions Act of 2008—placed additional focus on achieving permanency for children and youth in foster care. Although these laws are designed to expedite discharges of children and youth from foster care to permanency families and to accelerate planning related to termination of parental rights and adoption, they do not address sustaining permanency. Yet, there is growing acceptance that permanency is not simply a placement event, but rather a process that implicates a range of issues related to child and family well-being. Of critical importance in this process are the postpermanency service needs of children, youth, and families (birth, kinship, adoptive). That aspect of permanency—sustaining permanency through postpermanency services that address ongoing child safety and child and family well-being— is the subject under discussion here. In this chapter we present an overview of the research, theory, and values related to postpermanency, offer guiding principles for postpermanency services, and suggest how those principles translate into a coherent postpermanency services system.

Research The knowledge base related to postpermanency needs and services is better described as a patchwork of information than a coherent set of principles, policies, programs, and practices. With the implementation of federal data collection and reporting system requirements (Adoption Foster Care and Analysis Reporting System [AFCARS]), a wider range of data has become available regarding outcomes for children and youth who exit foster care (U.S. Department of Health and Human Services 2013). These data, however, are generally limited to demographic information and permanency destinations, and the data are far more complete on children and youth who achieve permanency through adoption than on children and youth who leave care through reunification, guardianship, or placement with kin. Research and other information regarding the postpermanency needs of these families remain extremely limited. Research on the postpermanency status and needs of children and youth who have been adopted and of their new families is more extensive. Research has focused on children’s histories of abuse and neglect prior to entering foster care, foster care experiences, ages at the time of adoption, and the impact of these factors on later service needs in the areas of physical health, mental health, and education (Gabbard 2010; Murphy et al. New York State Citizens’ Coalition for Children 2010; Smith 2010; Ward 2011). And a growing body of research has addressed the service needs of 543

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adoptive families (Barth & Miller 2004; Evan B. Donaldson Adoption Institute 2004; Jones & LaLiberte 2010). Barth, Gibbs, and Siebenaler (2001) summed up adoptive families’ needs for services as occurring in four areas: educational and informational services, clinical services, material services, and support networks. Research has attempted to assess adoption stability by determining the rates of adoption disruption and dissolution (see the chapter by Festinger, this volume). Disruption rates for children and youth with physical, mental health, and developmental problems have been found to range from 10 percent to 25 percent (Barth, Gibbs & Seibenaler 2001; Festinger 2005; McDonald, Propp, & Murphy 2001). The few studies that have calculated adoption dissolution rates found rates of 6.6 percent (Goerge et al. 1997) and 3.3 percent (Festinger 2002). The specific causes of adoption disruption vary in each individual circumstance, but research suggests that there are factors generally associated with adoption disruption. Studies have shown that the rate of adoption disruption increases with the child’s age at the time of the adoption (Jones & LaLiberte 2010). Other correlates are the number of placements the child experienced while in foster care, the child’s emotional and behavioral problems, and child welfare staff turnover (Barth & Miller 2004; Groza & Rosenberg 2001; Festinger 2001). Permanency through placement with relatives, particularly through guardianship arrangements, has become a permanency outcome of increasing interest (Littlewood et al. 2012). The Fostering Connections to Success and Increasing Adoptions Act provides states with an option to provide subsidies with federal support to certain relatives who assume guardianship of their relative children in foster care nrcpfc, 2012. This optional program has built on existing programs in many states in which states paid the full cost of monthly subsidies to relative guardians under certain circumstances. A significant number of children now exit foster care to guardianship arrangements with kin (16,424

children in FY 2012) or exit to “living with relatives” other than parents (19,671 children in FY 2012; U.S. Department of Health and Human Services 2013). To date, the data indicate that guardianship placements are as stable as adoption and that kinship guardianships are no more likely to disrupt than are adoptive placements (Children’s Defense Fund & Child Focus 2010). To the extent that kinship placements disrupt, research suggests that disruption is not associated with the level of relatives’ commitment to the children and youth in their care or to child maltreatment issues, but, instead, to the continued influence of biological parents; adolescents’ difficulties in adapting to life with their relatives; children and youth’s psychological and behavioral problems; relatives’ age and health limitations; and the limited information, training, and support that are made available to relatives (Merrit & Festinger 2013; TerlingWatt 2001). Historically, very little attention was paid in the kinship care literature to postpermanency services; however, as support for kinship care and relative guardianship has grown, the needs of kinship families, both while children are in foster care and following permanency, have become areas of greater focus (Pecora et al. 2009; Rudder et al. 2010; Schneiderman & Villagrana 2010). Research has documented the needs of kin guardians for services in a number of areas: respite care, child care, financial support for caregivers, and mental health services for children and youth (Child Welfare Information Gateway 2010; Cornerstone Consulting Group 2001). Kinship navigator programs are being implemented across the country to provide relatives with the information, referrals, and services they need to care for the children in their care (Wallace 2010), a process further enriched by federal grants to assist states in developing these programs. Although reunification is the preferred permanency option for children and youth in foster care, research also has been limited regarding the postreunification needs of children, youth, and families. Nonetheless, a common theme

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among states in their final reports following federal Child and Family Services Reviews is the importance of postreunification services in reducing the risk of harm to children, repeat abuse or neglect, and the return of children to foster care. A number of the states indicated in their final reports that they provide postreunification services over a period of time, ranging from three months to as long as is needed, and many described monitoring activities to support families’ participation in needed services. Among the postreunification services that states report providing are in-home services, mental health or counseling services, substance abuse services, parenting support, child care, transportation, and concrete services, such as housing and financial aid. States, however, describe a number of obstacles to successfully providing postreunification services, including the lack of service availability in all areas of the state, services not being available at the intensity or duration that families need, and the high service costs (Child Welfare Information Gateway 2011). Postreunification services have as the primary goals safety and stability, with emphasis on the prevention of the child’s reexperience of maltreatment and return to foster care (Jones & LaLiberte 2010). Federal standards under the Child and Family Services Reviews mandate that states track the percentage of children who reenter foster care within twevbe months of reunification with their families, with the expected performance being a reentry rate of 9.9 percent or lower. Data indicate that reentry rates vary significantly by state; however, the median reentry rates from 2005 through 2008 are higher than the national standard, though showing a decline from 14.8 percent in 2005 to 13.1 percent in 2008 (U.S. Department of Health and Human Services 2009). Research has identified three groups of factors associated with reentry to foster care following reunification: child characteristics, family characteristics, and child welfare administrative characteristics. Among the child

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characteristics associated with an increased risk of reentry is age, with some studies finding that pre-teens and teens have higher reentry rates (Shaw 2006; Wells, Ford, & Griesgraber 2007) and other studies finding that infants and very young children are at increased risk of return to foster care (Fluke 2005; Fuller 2005). A number of studies have found that children’s high levels of physical, mental, and behavioral health issues increase their risk of returning to foster care (Koh 2007; Wells, Ford, & Griesgraber 2007), with externalizing behaviors linked specifically to reentry (Barth 2008; Wells, Ford, & Griesgarber 2007). Research also has identified the child’s race as a risk factor, with some studies showing that African American youth are at the highest risk of reentry into legal custody (Koh 2007; Shaw 2006). Several family characteristics have been identified as correlated with an increased risk of reentry into foster care. Studies suggest that foster care reentry is associated with: parental substance abuse (Brook & McDonald 2009; Frame, Berrick, & Brodowski 2000; Shaw 2006), parental criminal history (Frame, Berrick, & Brodowski 2000), parental mental illness (Fuller 2005; Hindley, Ramchandani, & Jones 2006), insufficient parenting skills (Miller et al. 2006), and higher numbers of children in the household (Barth 2008; Fuller 2005). A consistent finding across studies is that families who became involved with child protective services as a result of neglect are at higher risk for foster care reentry (Hindley, Ramchandani, & Jones 2006; Shaw 2006; Terling 1999). Another consistent finding is that increased foster care reentry rates are associated with shorter stays in foster care, that is, stays between three and six months (Fuller 2005; Jonson-Reid 2003; Shaw 2006). Higher numbers of previous episodes of maltreatment and prior placements into foster care also appear to be associated with risk of reentry (Hindley, Ramchandani, & Jones 2006; English et al. 1999). Further, placement type is linked to reentry, with studies finding that nonkin placements are associated with a

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higher risk of return to foster care (Frame, Berrick, & Brodowski 2000; Jonson-Reid 2003; Shaw 2006), particularly placement in congregate care (Westat and Chapin Hall Center for Children 2006). Finally, placement instability while in foster care is associated with higher risk of reentry (Fuller 2005; Koh 2007; Westat and Chapin Hall Center for Children 2006). The body of research on protective factors associated with reunification success is far less developed than that on increased risks of reentry following reunification. Among the protective factors that have been identified, however, are kinship care placements (Frame, Berrick, & Brodowski 2000; Westat and Chapin Hall Center for Children 2006; Winokur, Holtan, & Valentine 2009), longer stays in foster care (Kimberlin, Anthony, & Austin 2009), and placement stability while in foster care (Koh 2007; Westat and Chapin Hall Center for Children 2006). Theoretical Considerations In addition to research, theory supports the need for postpermanency services. Although there are no generally agreed-upon best approaches, attachment theory, role theory, family systems theory, and ecological theory are particularly useful in explaining why families in each type of permanency arrangement may need a variety of postpermanency services and supports. Developmental theory will not be discussed here separately, but it is important to note the ongoing influence of the child’s developmental stage throughout the child and family’s time together, as will be described later in the chapter. Attachment theory has been most influential in the field of child welfare (e.g., Bowlby 1969, 1973; Goldstein, Freud, & Solnit 1979; O’Connor et al. 2000; Smith 2011). Given that disrupted early relationships and subsequent separations (presumed contributors to attachment difficulties) are ubiquitous in child welfare, it is understandable that attachment theory has been dominant. Parents who adopt with incomplete

knowledge of the child’s attachment history may be disappointed and frustrated with the latter’s limited ability to relate and to own the family. Often, attachment difficulties surface during adolescence, particularly when a child was adopted as an adolescent, as the parents are trying simultaneously to attach to the child and to support independence (Solomon & George 2011; Barth & Berry 1988). In terms of kinship care, attachment issues may arise as the child and family experience challenges in sorting out the child’s dual parentage and the possible discrepancies between attachments and legal authority (Steele at al. 2009). In reunification, professionals must consider how existing attachment issues were addressed during the period of separation. The mother and infant in the following scenario were fortunate in having frequent and productive visits together during the child’s time in foster care. MOIRA I was really messed up. Drugs and alcohol. Mostly alcohol. Jeremy was just a baby. I knew I couldn’t take care of him until I got straightened out, but that didn’t make it any easier. I was out of it more than I was sober during his first three months of life, so we never really got to know each other. But I was lucky, because the caseworker and the foster mom said I could visit every day as long as I was sober. At first I didn’t even know how to relate to him. They helped me learn to take care of him, and that really motivated me to stay sober. After six months they let me have him back. He likes me to hold him and he looks at me and giggles. I am gradually learning how to be Jeremy’s mom. I really appreciate his foster mom helping me, and the parent support group has been terrific.

Role theory is also well suited to explaining postpermanency familial challenges, as every coming and going leaves some family role unfulfilled, presents unfamiliar and unscripted roles, challenges an existing role structure, and requires negotiation for defining the new role structure. Roles issues may

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arise in reunified families as families face the complexities and difficulties in resuming roles and the need for renegotiations of roles when a child returns. Differences between how parents and the agency see the adoptive parents’ role can result in role conflict and ambiguity; rigid expectations regarding the role the child is to fill in the family may increase the anxiety in the parent-child relationship, particularly when the child reaches adolescence (Wells & Correira 2009). The recent practice of concurrent planning, in which reunification and another permanency goal (often adoption) are pursued simultaneously, further complicates the role of the foster parent who wishes to adopt, increasing the potential for role confusion that could strain both child and foster family loyalties (Hudson et al. 2008; National Resource Center on Permanency and Family Connections 2010). Examining kinship care in terms of role theory reveals more of the complexity of that arrangement (Dolbin-MacNab, Rodgers, & Traylor 2009). As kinship adoptions are most likely open, the issue of dual parentage must be addressed, expectations expressed, and ground rules determined (Hochman 1997; Reitz & Watson 1992), as demonstrated in the following scenario. JAMIE My daughter Jill tried to pull her life together, but she was not prepared to care for a baby and couldn’t keep off drugs. I hadn’t known how bad it was or I would have done something earlier. Her caseworker contacted me about it because they were going to terminate her rights. Jill seemed relieved when I said I would adopt Jamie, keeping it all in the family. But she doesn’t understand that I am his mother now. She still wants to make all the decisions for him and is upset when I disagree and make my own decisions. I want her to continue to come see him whenever she wants, but we really have to talk about some limits, and the final decisions are mine now. It is hard to figure out how to do this. I have needed the support of my counselor in working through these issues.

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Fundamental to all family systems thinking is the idea that individuals cannot be adequately understood outside the context of the family (immediate, extended, and historical) of which they are a part and that a problem in any part of the family reverberates throughout the system (Bowen 1978; Cheung 2008; Minuchin 1974; Sumner-Mayer 2008). Particularly important is the understanding that a child’s presenting problem may be symptomatic of a family interactional issue and thus the child is only the symptom-bearer. In reunification, boundary issues influence how readily the family accepts the child back into the home. Family subsystems may be rigid, and the new coalitions that formed in the child’s absence may freeze her out of important relationships. TEREK I was really close to my sister, Kisha. We are just one year apart and we did lot of things together. At home we played computer games and listened to music together. We were best friends. After Mom beat me so bad, I was in foster care for three months. You wouldn’t think in only three months that things could have changed so much. But they did. When I came home, Kisha was stuck like glue to our half sister, Theresa, who had moved in while I was gone. I felt like nobody even wanted me back home. I feel really lonely and depressed. I ran away once. I wish I had somebody to talk to.

Reitz and Watson (1992) describe family system scenarios in which parents adopt a child to distract from their marital difficulties, and the child, caught in the middle of marital tensions, becomes anxious and symptomatic. Kinship care presents more complicated family system issues, with boundary issues intensified and children often reflecting confusion in the family (Benedict n.d.). Much of modern ecological theory derives from the work of Bronfenbrenner (1979), who showed how the socialization that occurs between parent and child is embedded in complex systems of social networks and societal,

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cultural, and historical influences. Garbarino (1982) introduced the concept of sociocultural risk and opportunity, which challenges notions of family responsibility and independence and suggests instead that shared responsibility and interdependence are more facilitative of healthy development. When a family adopts, critical ecological issues include the sensitivity of friends and relatives and the extended family’s acceptance of the child as part of the family. In both adoption and guardianship arrangements, ecological considerations involve the availability of supports to ease family burdens and the competence of community institutions and service providers regarding permanency issues (see Fulcher, & McGladdery 2011; Pinderhughes & Harden 2005). ABBY AND MARK We thought the whole family was behind us when we decided to adopt. But when they found out that Michael was a biracial adolescent, they just kind of raised their eyebrows. My family won’t even talk about it, and I don’t think they’ll ever accept him as part of the family. Mark’s family has come around some. They are really nice to Michael and have stopped looking shocked when he brings his black friends to the house. The community? That’s another story. I never felt any support coming from the community. I feel like people are always looking at us and wondering. I know Michael can feel this and I know we have to deal with it. We just don’t know who to turn to for help.

Poverty is an important ecological consideration, and kinship care providers are more apt than nonrelative adopters to live in poverty (McDonald, Propp, & Murphy 2001). Likewise, research on reentry into care suggests that many of the challenges that reunified families face are ecological in nature, including poverty, housing problems, low positive social support, and dangerous environments (Anthony, Kimberlin, & Austin 2008; Honomichi, Hatton, & Brooks 2009). These challenges often are not addressed during the child’s stay in care.

Values and Postpermanency Services Societal and personal values lie at the heart of any consideration of postpermanency services. Important value-laden questions arise: What is society’s responsibility to invest in families through offering postpermanency services? To whom should they be offered, to what extent, with what conditions, for how long, and at whose expense? Answers to these questions are based on strongly held beliefs about child and family rights and responsibilities. Certainly the entire field of child welfare is undergirded by values and riddled with values tensions (see Moynihan & Webb 2010). As a society, we value our children and youth and accept an obligation to protect them. We also value families’ privacy, freedom from state intrusion, and responsibility to care for their own. Child protection reflects a resolution of the tension between these values—parents’ rights and responsibilities are honored until a child’s safety is brought into question, at which point the child’s rights take precedence. More recently, a child’s right to permanency also has been recognized by society, carrying state responsibility beyond ensuring safety to also include protecting ongoing nurturing relationships, as reflected in the Adoption Assistance and Child Welfare Act of 1980, the Adoption and Safe Families Act of 1997, and the Fostering Connections to Success and Increasing Adoptions Act (FCA) of 2008. Still, the strong societal belief that individual families are responsible for the welfare of their children has always made public efforts to address children and youth’s concerns problematic for U.S. political institutions, and individualism and social justice have been difficult to reconcile (Hutchison & Charlesworth 2000). There has been a growing recognition of the need for postpermanency services and the last decade has seen the extension of child welfare goals beyond child safety and permanency to include the more elusive goal of well-being. These developments signal an important shift in resolving the ongoing puzzle of reconciling

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family responsibility and the public assumption of responsibility for the welfare of children and youth. A compelling case can be made for supporting families in claiming their rights and carrying out their responsibilities toward their children in the context of societal changes (e.g., greater interdependence, multiculturalism, and economic disparities that have deepened throughout the economic crises of the 2000s), changes in the child welfare population (i.e., increasing percentages of the foster care population being, on the one hand, infants and very young children and, on the other hand, adolescents), and the current policy pressure toward permanency (ASFA and the FCA). Postpermanency services have received the greatest support in relation to adoption, and families who adopt are seen as providing a service to children, youth, and society. However, in relation to other permanency arrangements—kinship care and reunification—the issue of inequity remains, as notions of parental responsibility and deservedness come into play. Thoughtful observers must ask themselves whether society is less willing to help some families than others, to the detriment of the safety, permanency, and well-being of some children and youth. Although family privacy, sanctity, and responsibility are to be valued, serving the needs of children and youth is a higher obligation. The debate must move beyond privacy versus intrusion or family versus public responsibility and put the needs of children and youth in the forefront. Services should be connected to the individual child rather than to the postpermanency arrangement and should be extended to children and youth in need, regardless of the permanency outcome. Convergence of Research, Theory, and Values In the area of postpermanency services, it is important to articulate an underlying philosophy—based on research, theory, and values as

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previously discussed—to guide policy makers and child welfare agency staff at all levels through subsequent decision making. This umbrella philosophy can keep the process focused as a coherent postpermanency approach is designed and various aspects of postpermanency law, policy, and practice are considered. Seven principles may be considered as the elements of this umbrella philosophy: social obligation, the ideal of services following the child, permanency as an ongoing process, a developmental view of permanency, service accessibility and acceptability, service integrity, and public agency leadership. Social Obligation It would be difficult to move toward designing a coherent system of postpermanency services absent an underlying conviction that there is a social obligation to families postpermanency, whether families are reunified birth families, extended families, or adoptive families. Practitioners must promote efforts to support and strengthen these families in ways that meet their needs, thereby maximizing positive outcomes for children and youth in terms of their safety and well-being. An acceptance of social obligation also takes a longer view of outcomes for children, youth, families, and society as a whole. It recognizes the long-range consequences of failing to follow through on societal obligations in the present that are likely to impact the overall health and well-being of U.S. society. These long-range consequences include mental health challenges, substance abuse, homelessness, and incarceration. Moving into postpermanency services signals a shift for child welfare, suggesting that the social obligation is far broader than ensuring safety and that, having intervened, society continues to carry some responsibility for the outcomes for children and youth. Services Follow the Child Currently, there is inconsistent availability of postpermanency services according to the

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particular arrangement, with more services available for families who adopt and less for kinship care and reunification arrangements. Those who develop policies and programs as well as practitioners who serve families recognize the legitimacy of postpermanency services across arrangements with a focus on the child. Thus dollars and services should follow the child rather than the permanency arrangement. An approach avowing that a child who is adopted “deserves” assistance more than a child who is returned home or whose grandmother makes the decision to raise him would be very difficult to justify. Indeed, assuming that the intent of child welfare programs is to achieve good outcomes for children and youth, it would be counterproductive to exclude or minimally serve a whole class of children and youth based on their living arrangements. Optimally, programs need to incorporate approaches in which services both follow the child and provide families the resources they need to become stronger and more competent at handling their responsibilities.

Developmental View Ongoing normal developmental processes present important challenges to sustaining permanency, as every life stage presents new demands on the child, the family, and the environment. As the child and his relationship with the family develop, the postpermanency services and supports that are needed may change, both in terms of the nature and intensity of services and the types of supports. The adoption literature focuses on the normal developmental trajectory of adoptive families, with certain anticipated crises triggering the need for service (Modell 1994; Pavao 1998). However, there is little discussion of these issues for reunited and kinship families. All families, irrespective of the permanency arrangement, require the caseworker’s understanding of the developmental nature of child and family systems and the episodic family challenges these issues present. Furthermore, families should be encouraged to seek services in an environment that recognizes episodic need as normal and should be supported in doing so.

Permanency as an Ongoing Process Permanency planning must recognize that placing a child with the intent of permanency is only one step in a process that began with the agency’s first intervention and continues far beyond the child’s return home, guardianship or other placement with kin, or adoption. Postpermanency support and services are a natural extension of earlier phases of the permanency planning process. Indeed, agency choices and actions in earlier phases—including the quality of investigations, application of reasonable efforts, initial placement, availability and quality of services, use of visiting, ability to work with the courts, and interpretation of ASFA and the FCA—influence what the permanency destination will be and how the plan is implemented. Child welfare agencies are co-creators of children and youth’s permanency experiences and outcomes and thus have a continuing responsibility.

Service Accessibility/Acceptability Pre- and postpermanency services will be meaningful and supportive of positive outcomes for children, youth, and families only when they are both accessible and acceptable. Accessibility is a broad concept, covering a range of factors related to the ease of using services. It includes accessibility in many forms: financial, temporal, geographic, cultural, and psychological. Acceptability, which is closely related to psychological accessibility, refers to the users’ view of services and their comfort level with not only the nature of the services but also the ways in which services are provided. Taken together, accessibility and acceptability suggest the need for a range of services that provide options and choices (e.g., formal and informal, private and public). Without full acceptance of social responsibility for children and youth in postpermanency arrangements, implementation of accessibility

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and acceptability may be hampered by lingering views of services as a privilege rather than a right. Privilege-based views imply that social obligation ends with providing services, leaving families with the challenges of accessing them. This viewpoint runs counter to the federally mandated goals of child safety, permanency, and well-being and is inconsistent with a value of shared social responsibility for children and youth. The most important assurance of acceptability is that the voices of all families are heard fully and equally and social services are responsive to these voices. Service Integrity Service integrity refers to societal confidence that services do what they are designed to do—that they produce or contribute toward intended outcomes. In the arena of postpermanency services, it is essential that a system be in place to evaluate the impact of services and ensure service quality and effectiveness. Even when formal evaluation of services is not possible, they can still be assessed—based on theory, informal feedback, or practice wisdom—to determine whether services are effective and thus have integrity. Practitioners may need to reexamine the current processes of planning services to ensure that they include ongoing conversations with families and children about not only their needs but also service effectiveness. Examining outcomes is challenged by the inclusion of child well-being (U.S. Department of Health and Human Services n.d.) as a child welfare goal, as the concept has yet to be specifically and fully defined. Still there is a need for some combination of informal and formal processes, including standard measures of effectiveness and ways of incorporating the feedback of families and their children regarding their service experiences. Public Agency Leadership To meet the variety of child and family needs and insure service accessibility and acceptability, a system of mixed public and private, formal

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and informal services is needed. Although a public role in postpermanency services has been accepted on some level, particularly in terms of postadoption services, the issue of the extent of public involvement remains unresolved. Only with strong public leadership and resource commitment will the principles delineated here be integrated into the development and delivery of postpermanency services and support. The public agency must assume a role that includes leadership, support, and integration of services. However, the public sector cannot be the sole, nor perhaps even the major, provider of postpermanency services. Rather, the public sector’s role is to determine need and, while directly offering some services, to support and encourage private and informal services. The public agency should be viewed not so much as “leader” as “convener,” with coordinating responsibility that extends to private agencies, community-based resources, and neighborhood supports for families. Under this approach the public agency creates the framework and supports it and then, essentially, gets out of the way. A System of Postpermanency Services The translation of these seven principles into improved practice requires a coherent postpermanency service system. Two initial steps in the creation of such a system are a delineation of the components of such a system and an exploration of how these components might be implemented in light of the principles. Components of a Coherent System of Postpermanency Services Six components characterize a coherent system of postpermanency services: law, policy, programs, services, system of care, and the environmental context. Law As is the case with child welfare services in general, federal and state laws play a key role

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in shaping the nature and scope of postpermanency services. Of perhaps greatest impact is the extent to which the law recognizes the value of certain services through the allocation of public funds to support the development and provision of those services. Financial support for postpermanency services may take a variety of forms: the earmarking of funds specifically for this purpose, statutory provisions that allow state or local authorities the flexibility to use funds for services most needed by families, legal frameworks that endorse “blended” funding to meet families’ needs for cross-system services, fiscal incentives when states develop and invest in postpermanency services, inclusion of postpermanency outcomes in legally mandated evaluative reviews, and funding structures that recognize the strengths of both the formal and informal service systems. The law also defines the extent to which financial benefits may be available to families. For example, the law specifies the extent to which tax benefits are extended to all or only certain groups of families and whether ongoing financial support is available to reunified, kin, and adoptive families. Finally, and importantly, the law establishes benefits to which certain individuals are entitled and mechanisms to ensure that the rights of individuals to these benefits are protected. Policy Broader than the law, policy articulates general program parameters based on publicly stated values. Policy sets the overall course of program development and implementation at the federal and state levels, grounded on broad principles that guide planning and decision making. In the context of child welfare policy, these principles historically have focused on child safety and permanence, with recognition of, but less emphasis on, child and family well-being. Support for postpermanency services is dependent on the extent to which policy articulates a broad commitment to child safety, permanency, and child and family well-being and the

extent to which policy places priority on the development and implementation of services that extend beyond the initial achievement of permanency. Programs Programs are organized systems of service delivery that provide a set of related services to a specific population of clients or provide a single service to a broad or diverse population of clients. Postpermanency programs may take a variety of forms—ongoing programs of services provided by public and/or private child welfare agencies, special initiatives funded by federal or state governments (such as programs developed through the federal Adoption Opportunities Program or through state-funded programs to expand postadoption or postguardianship services), advocacy initiatives linking families with formal and informal resources in their communities, and foundation-supported initiatives to facilitate needed program development and implementation. To date, postpermanency programs have tended to provide a range of services (of varying scope) to a defined group of postpermanency families—most often, adoptive families; to a growing extent, to kinship families; and to a far more limited extent, to reunified families. Services Although a somewhat elusive concept to define, services may be viewed as the specific types of assistance that individuals and/or families receive in relation to identified needs. Services are extremely variable, ranging from highly formal (such as therapy for a child’s emotional problems) to highly informal (such as a parent support service that begins when families meet one another at an agency orientation and then evolves into regular get-togethers over coffee to discuss common parenting challenges). A number of service considerations arise in connection with the development of a postpermanency system: families’ eligibility for services (which is tied to a host of other factors,

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including the nature of the postpermanency arrangement), accessibility to services (which involves the cost of the services and where the services are provided), the acceptability of services (which implicates personal, social, and cultural factors), and the extent to which services actually make a difference in outcomes for families (an issue that reflects the need for evidence-based practice). Services depend on law and policy to provide the necessary financial resources, but, even when funding is available, there is no guarantee that services will be appropriately offered and provided to all families who need them. System of Care The concept of system of care, perhaps most fully developed in the field of mental health (Akin 2012; Delaiden et al. 2010; Werrbach, Withers, & Neptune 2009), encompasses a range of interconnections in the context of postpermanency services and supports. These interconnections exist: t
among the various child welfare services provided by public agencies—child protective services, family preservation, foster care, and adoption—all of which must work together to maximize positive postpermanency outcomes; t
between public and private child welfare agencies that share responsibility for planning for permanency with families and achieving positive outcomes in relation to child safety, permanency, and child and family well-being; t
between child welfare services (whether provided by public or private agencies) and other service systems that play vital roles in promoting the well-being of children, youth, and families, including the mental health, medical, and educational systems; and t
between the formal, professionalized service systems and informal (or “nontraditional”) service systems—extended family,

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friends, neighborhoods, churches, and other neighborhood supports—which families often identify as the most important and helpful resources for them. This multitiered framework for a postpermanency system of care highlights the importance of identifying all the essential partners in the development and implementation of quality postpermanency services. It also points to the need to develop effective channels of communication and other mechanisms that support strong collaboration among the key participants. Environmental Context However postpermanency services may be defined, developed, and implemented, they interact with other social and service environments. The larger social environment affects how the postpermanency needs of families are viewed. Social attitudes about children’s birth, kin, and adoptive families affect whether the public supports services for all families, irrespective of the nature of the permanency arrangement. Social and cultural values and perceptions also affect the extent to which policy (as articulated in law and in federal and state initiatives) endorses postpermanency services, programs are developed to address these needs, and resources are mobilized. A normative, developmental conceptualization of the postpermanency needs of families would impact societal understanding of the role of ongoing supports and services. In this connection, public agency leadership—with the goal of drawing together partners from many different systems and perspectives—becomes particularly critical. There also are key considerations in relation to postpermanency services in the context of specific program and service system environments. These issues include the policies of child welfare agencies (whether public or private) and other service systems that guide the provision of such services; the training of professional

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Social obligation

Services follow the child

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Families’ needs as develop-mental

Accessibility and acceptability

Integrity

Public leadership

Components Law Policy Program Services System Environment

and paraprofessional staff who provide services; staff attitudes and expectations regarding families’ needs for and responses to services, particularly as staff relate directly to families; and the physical environments in which services are provided (i.e., whether services are provided at home or at an office and the physical surroundings when services are provided outside the home). Analysis of the Principles and Components of a Coherent System of Postpermanency Services A second step in creating a coherent postpermanency service system is an exploration of each component in light of the principles of social obligation, services following the child, permanency as an ongoing process, developmental view of families’ needs, service accessibility and acceptability, service integrity, and public agency leadership. This process requires that attention be given to each individual component. However, it also requires that focus be maintained on the interaction of the various components with one another as an analysis is undertaken of 1. the current status of each component of postpermanency services, 2. where improvement is needed, and 3. the

effect of changes in one component on other components. This process is likely to be most meaningful and hold the promise of greatest benefit if there is active participation of public and private child welfare agencies staff, community representatives, and, perhaps most important, families themselves. An inclusive approach can be expected to generate more comprehensive information than would be possible if participants are limited to child welfare professionals. A broadly inclusive process is likely to serve an educational function of its own, providing participants with opportunities to enrich their own understanding of families’ postpermanency needs and achieve greater clarification of all parties’ roles, responsibilities, and potential contributions. Many approaches may be taken in the analysis of the issues that have been raised in this chapter. One approach is to use a matrix structure that guides the consideration of each component in terms of each guiding principle. The following matrix offers a guide and stimulus for the consideration of these issues. As one example of what the matrix approach might yield, policy could be considered through the lens of the “services follow the

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child” principle. This consideration might lead to a comparison of policy initiatives that promote ongoing services for children and youth who are adopted, who are placed permanently with relatives, and who are reunited with their parents. An assessment of the policies that support services for children who leave foster care to live with their birth parents and relatives—compared to policies that support adoptive families—may lead to an examination of the factors that have supported policies that favor one group of children and youth (or type of parent) over others. What factors explain the policy emphasis on adoptionrelated services as opposed to reunificationor kinship-related services? What changes would be needed to shape a more inclusive child-focused policy? What are the barriers to policies that promote postpermanency services for all children and youth, irrespective of the nature of the family arrangement? This example suggests how the matrix approach can stimulate consideration of key issues in light of both the principles and components that have been identified.

REFERENCES

Adoption and Safe Families Act. (1997). P.L. 105-89. Adoption Assistance and Child Welfare Act. (1980). P.L. 99–272. Akin, B. A., Bryson, S. A., McDonald, T., & Walker, S. (2012). Defining a target population at high risk of long-term foster care: Barriers to permanency for families of children with serious emotional disturbances. Child Welfare, 91(6), 79–102. Anthony, E., Kimberlin, S., & Austin, M. (2008). Foster care reentry: Evidence and implications. Berkeley: Bay Area Social Services Consortium. Barth, R. (2008). The move to evidence-based practice: How well does it fit child welfare services? Journal of Public Child Welfare, 2, 145–72. Barth, R., & Berry, M. (1988). Adoption and disruption: Rates, risks, and responses. Hawthorne, NY: Aldine de Gruyter. Barth, R., Gibbs, D., & Siebenaler, K. (2001). Assessing the field of post-adoption services: Family needs, program models, and evaluation issues. Washington, DC: U.S. Department of Health and Human Services.

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This chapter documents what is known about outcomes for children and youth after they have exited foster care to return to their parents, live permanently with relatives, or be adopted. It outlines the theoretical considerations that can provide a basis for postpermanency services and systems and describes the importance of delineating the values on which work in this area must proceed. It sets forth a philosophical and conceptual framework for the development of a coherent postpermanency service system, outlining seven key principles and six components of such a system. Finally, this chapter suggests a method for applying the presented information in a way that can lead to the development of effective postpermanency services and service systems. There has been a greater focus on sustaining permanency over the past decade, but more needs to be understood, developed, and documented. This chapter provides a framework for those involved in planning, delivering, and advocating for postpermanency services as they undertake this critical work.

Barth, R., & Miller, J. (2004). Building effective postadoption services: What is the empirical foundation? Family Relations, 49, 447–55. Benedict, M. (n.d.). Kin and nonkin-foster care in the context of family systems theory. Baltimore: Johns Hopkins University, Department of Maternal and Child Health. Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson. Bowlby, J. (1969). Attachment and loss, vol. 1: Attachment. London: Hogarth. Bowlby, J. (1973). Attachment and loss, vol. 2: Separation, anxiety and anger. London: Hogarth. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: Harvard University Press. Brook, J., & McDonald, T. (2009). The impact of parental substance abuse on the stability of family reunifications from foster care. Children and Youth Services Review, 31, 193–98. Cheung, M. (2008). Family systems theory. In M. Cheung & P. Leung (eds.), Multicultural practice & evaluation: A case approach to evidence-based practice (pp. 135–56). Denver: Love.

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Children’s Defense Fund & Child Focus (2010). Myths and facts related to use of the Guardianship Assistance Program. Retrieved August 15, 2011, from http:// www.fosteringconnections.org/tools/tools_analysis_ research/files/Myths-and-Facts-Related-to-Use-ofGuardianship-Assistance-Program.pdf. Child Welfare Information Gateway (2010). Kinship caregivers and the child welfare system. Retrieved August 15, 2011, from http://www.childwelfare.gov/ pubs/f_kinshi/f_kinshi.pdf. Child Welfare Information Gateway (2011). Family reunification: What the evidence shows. Retrieved August 15, 2011, from http://www.childwelfare.gov/ pubs/issue_briefs/family_reunification/family_ reunification.pdf. Cornerstone Consulting Group (2001). Guardianship: Another place called home. Houston: Cornerstone Consulting Group. Daleiden, E., Pang, D., Roberts, D., Slavin, L., & Pestle, S. (2010). Intensive home based services within a comprehensive system of care for youth. Journal of Child and Family Studies, 19, 318–25. Dolbin-MacNab, M., Rodgers, B., & Traylor, R. (2009). Bridging the generations: A retrospective examination of adults’ relationships with their kinship caregivers. Journal of Intergenerational Relationships, 7, 159–76. English, D., Marshall, D., Brummel, S. & Orme, M. (1999). Characteristics of repeated referrals to child protective services in Washington State. Child Maltreatment, 4, 297–307. Evan B. Donaldson Adoption Institute (2004). What’s working for children: A policy study of adoption stability and termination. Retrieved August 15, 2011, from http://www.adoptioninstitute.org/publications/Disruption_Report.pdf. Festinger, T. (2001). After adoption: A study of placement stability and parents’ service needs. New York: New York University, Ehrenkranz School of Social Work. Festinger, T. (2002). After adoption: Dissolution or permanence? Child Welfare, 81, 515–33. Festinger, T. (2005). Adoption disruption rates, correlates, and service needs. In G. P. Mallon & P. M. Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 452–68). New York: Columbia University Press. Fluke, J., Shusterman, G., Hollinshead, D. & Yuan, Y. (2005). Rereporting and recurrence of child maltreatment: Findings from NCANDS. Washington, DC: U.S. Department of Health and Human Services. Fostering Connections to Success and Increasing Adoptions Act of 2008. P.L. 110-352. Frame, L., Berrick, J., & Brodowski, M. (2000). Understanding reentry to out-of-home care for reunified infants. Child Welfare, 79, 339–69. Fulcher, L., & McGladdery, S. (2011). Re-examining social work roles and tasks with foster care. Child and Youth Services Review, 32, 19–38.

Fuller, T. (2005). Child safety at reunification: A casecontrol study of maltreatment recurrence following return home from substitute care. Children and Youth Services Review, 27, 1293–306. Gabbard, L. (2010). Post-adoption services for adoptive families across the life cycle: Challenges and insights. Adoption Today, 12, 22–23. Garbarino, J. (1982). Children and families in the social environment. New York: Aldine Transaction. Goerge, R., Howard, E., Yu, D., & Radomsky, S. (1997). Adoption, disruption, and displacement in the child welfare system, 1976–94. Chicago: Chapin Hall Center for Children, University of Chicago. Goldstein, J., Freud, A., & Solnit, A. (1979). Beyond the best interests of the child. New York: Free Press. Groza, V., & Rosenberg, K. (2001). Clinical and practice issues in adoption: Bridging the gap between adopted people placed as infants and as older children. Westport, CT: Bergin and Garvey. Hindley, N., Ramchandani, P., & Jones, D. (2006). Risk factors for recurrence of maltreatment: A systematic review. Archives of Diseases in Childhood, 91, 744–52. Hochman, G. (1997). Keeping the family tree intact through kinship care. Retrieved June 26, 2001, from www.calib.com/naic/pubs/f_kinshi.htm. Honomichl, R., Hatton, H., & Brooks, S. (2009). Factors, characteristics, and promising practices related to reunification and reentry: A literature review for the peer quality case review process. Davis: Northern California Training Academy, Center for Human Services, University of California Davis Extension. Hutchison, E. D., & Charlesworth, L.W. (2000). Securing the welfare of children: Policies past, present, and future. Families in Society: The Journal of Contemporary Human Services, 8, 576–95. Hudson, L., Almeida, C., Bentley, D., Brown, J., Harlin, D., &. Norris, J. (2008). Concurrent planning and beyond: Family-centered services for children in foster care. Zero to Three, 28, 47–53. Jones, M., & LaLiberte, T. (2010). Adoption disruption and dissolution report. Retrieved August 15, 2011, from http://www.cehd.umn.edu/ssw/cascw/attributes/ PDF/publications/AdoptionDissolutionReport.pdf. Jonson-Reid, M. (2003). Foster care and future risk of maltreatment. Children and Youth Services Review, 25, 271–94. Kimberlin, S., Anthony, E., & Austin, M. (2009). Reentering foster care: Trends, evidence, and implications. Children and Youth Services Review, 31, 471–81. Koh, E. (2007). Predictors of reentry into foster care. Paper presented at the Conference of the Society for Social Work and Research. Retrieved August 15, 2011, from http://sswr.confex.com/sswr/2007/techprogram/ P6705.HTM. Littlewood, K., Swanke, J. R., Strozier, A., & Kondrat, D. (2012). Measuring social support among kinship

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caregivers: Validity and reliability of the Family Support Scale. Child Welfare, 91(6), 59–78. McDonald, T., Propp, J., & Murphy, K. (2001). The post-adoption experience: Child, parent, and family predictors of family adjustment to adoption. Child Welfare, 80, 71–94. Merrit, D. H., & Festinger, T. (2013). Post adoption service need and access: Differences between international, kinship and non kinship foster care. Children and Youth Services Review, 35(12), 1913–22. Miller, K., Fisher, P., Fetrow, B., & Jordan, K. (2006). Trouble on the journey home: Reunification failures in foster care. Children and Youth Services Review, 28, 260–74. Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press. Modell, J. (1994). Kinship with stranger: Adoption and interpretation of kinship in American culture. Berkeley: University of California Press. Moynihan, S., & Webb, E. (2010). An ethical approach to resolving value conflicts in child protection. Archives of Disease in Childhood, 95, 55–58. Murphy, A. L., Van Zyl, R., Collins-Camargo, C., & Sullivan, D. (2012). Assessing systemic barriers to permanency achievement for children in out-of-home care: Development of the Child Permanency Barriers Scale. Child Welfare, 91(5), 37–72. National Resource Center for Permanency and Family Connections (2010). A web-based concurrent planning toolkit. Retrieved August 16, 2011, from http:// www.nrcpfc.org/cpt/. National Resource Center for Permanency and Family Connections (NRCPFC) (2012). Kinship Care and the Fostering Connections to Success and Increasing Adoptions Act of 2008. New York: NRCPFC. Retrieved October 26, 2013 from http://www.mrcpfc. org/toolkit/kinship/ New York State Citizens’ Coalition for Children (2010). Parents and professionals identify post adoption service needs in New York State. Ithaca: New York State Citizens’ Coalition for Children. O’Connor, C., Rutter, M., English, and the Romanian Adoptees Study Team (2000). Attachment disorder behavior following early severe deprivation: Extension and longitudinal follow-up, Journal of the American Academy of Child and Adolescent Psychiatry, 39, 703–12. Pavao, J. (1998). The family of adoption. Boston: Beacon. Pecora, P., Whittaker, J., Maluccio, A., Barth, R., DePanfilis, D., & Plotnick, R. (2009). Family reunification and kinship care. In R. Barth, A. Mallucio, R. Plotnick, J. Whittaker, & P. Pecora (eds.), The child welfare challenge: Policy, practice, and research (3rd Edition) (pp. 219–44). Somerset, NJ: Transaction. Pinderhughes, E., & Harden, B. (2005). Beyond the birth family: African American children reared by

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alternative caregivers. In V. McLoyd, N. Hill, & K. Dodge, African American family life: Ecological and cultural diversity (pp. 285–310). New York: Guilford. Reitz, M., & Watson, K. (1992). Adoption and the family system. New York: Guilford. Rudder, D., Whalen, M., Agyemang, A., & Lyskawa, J. (2010). Resource and service needs of grandparents raising grandchildren: A mixed methods survey study. Michigan Child Welfare Law Journal, 13, 2–13. Schneiderman, J., & Villagrana, M. (2010). Meeting children’s mental and physical health needs in child welfare: The importance of caregivers. Social Work in Health Care, 49, 91–108. Shaw, T. (2006). Reentry into the foster care system after reunification. Children and Youth Services Review, 28, 1375–90. Smith, S. (2010). Keeping the promise: The critical need for post-adoption services to enable children and families to succeed: Policy and practice perspective. New York: Evan B. Donaldson Adoption Institute. Smith, W. (2011). Youth leaving foster care: A developmental, relationship-based approach to practice. New York: Oxford University Press. Solomon, J., & George, C. (2011). Disorganized attachment and caregiving. New York: Guilford. Steele, M., Smith, C., Wilson, R., Raun, W., & Michaels, C. (2009). Attachment relationships and adoption outcomes. Children’s Mental Health eReview. Minneapolis: University of Minnesota. Center for Excellence in Children’s Mental Health. Sumner-Mayer, K. (2008). An integrative approach involving the biological and foster family systems. In R. Lee & J. Whiting (eds.), Foster care therapist handbook: Relational approaches to the children and their families (pp. 181–225). Arlington, VA: Child Welfare League of America. Terling, T. (1999). The efficacy of family reunification practices: Reentry rates and correlates of reentry for abused and neglected children reunited with their families. Child Abuse & Neglect, 23, 1359–70. Terling-Watt, T. (2001). Permanency in kinship care: An exploration of disruption rates and factors associated with placement disruption. Children and Youth Services Review, 23, 111–26. U.S. Department of Health and Human Services (2009). Results of the 2007 and 2008 Child and Family Services Review. Retrieved August 15, 2011, from http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/agencies_courts.pdf. U.S. Department of Health and Human Services (2011). Preliminary FY 2010 estimates as of June 2011(18). Retrieved August 15, 2011, from http://www.acf.hhs. gov/programs/cb/stats_research/afcars/tar/report18. htm. U.S. Department of Health and Human Services (2013). The AFCARS Report #20: Final estimates for FY2012,

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Retrieved October 26, 2013, from http://www.acf. hhs.gov/programs/cb/stats_research/afcars/tar/ report20.htm. U.S. Department of Health and Human Services (n.d.). Table A. Data Indicators for Child and Family Services Review. Retrieved August 16, 2011, from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/data_ indicators.htm. Wallace, G. (2010). Kinship navigators: The new child welfare system. Common Ground (New England Association of Child Welfare Commissioners and Directors), 25, 3. Ward, B. (2011). Adoptive parents’ suspicion of preadoption abuse of their adopted children and the use of support services. Indianapolis: EarlyView. Wells, M., & Correia, M. (2009). Assessments of safety and risk: Implications for reunification from out-ofhome care. Safety and Risk Assessment and Decision Making, special issue, Protecting Children, 25, 90–108.

Wells, S., Ford, K., & Griesgraber, M. (2007). Foster care case types as predictors of case outcomes. Paper presented at the Conference of the Society for Social Work and Research. Retrieved August 15, 2011, from http://sswr.confex.com/sswr/2007/techprogram/ P6991.HTM. Werrbach, G., Withers, M., & Neptune, E. (2009). Creating a system of care for children’s mental health in a Native American community. Families in Society: The Journal of Contemporary Social Services, 90, 87–95. Westat & Chapin Hall Center for Children (2006). Assessing the context of permanency and reunification in the foster care system. Retrieved August 15, 2011, from http://aspe.hhs.gov/hsp/fostercare-reunif01/. Winokur, M., Holtan, A., & Valentine, D. (2009). Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. Cochrane Database of Systematic Reviews, no. 1 (2009), art. no. CD006546.

PART IV Systemic Issues in Child Welfare Y

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Facilitating an agenda of well-being, safety, and permanency requires that child welfare systems and the professionals who work in them institutionalize safety-focused, family-centered, and community-based approaches as the foundation of service delivery. Timely, quality services require policy, fiscal, and organizational cultures that promote and encourage effective practice with and on behalf of children, youth, and families. To support the institutionalization of quality services, several components of an agency’s infrastructure, such as its mission, goals, policies, and procedures, must be aligned with current practice standards as well as federal and state policy. Consideration must also be given to: appropriate caseloads; accountability at all levels of the agency; agency staff and caregiver qualifications; preservice and ongoing training for staff and caregivers; regular staff supervision; agency partnerships with legal entities and others from the court system and with other service delivery systems serving families, children, and youth; and agency partnerships with the community and its formal and informal provider networks. Identifying the criteria and developing a process for making organizational-level decisions are complex tasks. To facilitate this process, managers are urged to familiarize themselves with child welfare practice standards, federal and state policies, and child welfare data for the state, and, where applicable, the local jurisdiction. The analysis of the data assists in identifying the needs of children and youth who most often are placed in out-of-home care, the outcomes of services provided to them, and the strengths and weaknesses of the service system. Such data are also useful in identifying the most frequently needed services, issues regarding caseload size, the nature of practice decisions by supervisors and frontline staff, child welfare workforce issues, and the need for resources for program development, training, and accountability at all levels. In addition to the systemic challenges related to increased emphasis on data collection and

analysis for service planning and accountability, child welfare in the twenty-first century requires achieving case goals within briefer specified time frames. Time Frames for Decision Making The Adoption and Safe Families Act (ASFA) (P.L. 105–89) requires that states hold the child’s first permanency hearing within twelve months, rather than eighteen months, as required in previous legislation. Moreover, it requires that states initiate or join proceedings to terminate parental rights for parents of children who have been in care for fifteen of the past twenty-two months, except in situations in which: the child is placed safely with relatives; there is a compelling reason why termination of parental right is not in the child’s best interest; or the family has not received the services that were part of the case plan. These time frames have required supervisors and frontline workers to approach their work differently, as they must move quickly to complete comprehensive child and family assessments, provide services, assist the family in connecting with other supports in the community, and evaluate progress. Achieving case goals within specified time frames requires that sufficient resources are provided for caseworker, supervisory, and other positions within the child welfare agency. In addition, specified brief time frames require individualized service plans; high-quality, comprehensive, and coordinated services and supports; and, to support such support, effective collaboration with other service providers. Collaboration with Other Service Providers: The Service Array No one agency or program has the resources or expertise to develop a comprehensive response to the needs of all families that come in contact with the child welfare system. Families served by this system typically experience complex and interrelated problems, such as child maltreatment, poverty, unemployment, poor housing,

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substance abuse, domestic violence, and mental illness. The degree to which community-based social service agencies and courts can be effective in helping children and families depends in large part on their ability to connect families with the resources available from various agencies, community-based organizations, and other formal and informal supports in the community. To achieve positive outcomes for children and families, it is essential that all components of the community work together to provide the child and family an individualized array of comprehensive, coordinated, family-centered, and community-based services and supports. An absence of collaboration and coordination of services among these agencies can undermine the efforts to create safe, stable family environments; it can also result in unnecessary and duplicated requirements and services that complicate, rather than simplify and support, family life. Collaboration of multiple services, particularly when various interdisciplinary styles are involved, is not a simple task. With resources stretched throughout the human services system and with differences in philosophy and practice approaches in various systems, collaboration can be perceived as a real challenge. However, many child welfare systems are beginning to effectively forge collaborative partnerships that acknowledge the limitations of each agency and yet find ways to work effectively together to provide the individualized services that families need. For collaboration to be successful, partnering agencies must be guided by a common vision and commitment. Therefore, the child welfare system, together with other service systems and community providers, must form partnerships that select and focus on the same goals (e.g., creating more substance-abuse resources or programs to prevent family violence), even if the mandates for and means of attaining that goal differ for each agency. Responsible parties must outline the concrete tasks and functions

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to be performed by each agency. This means that interagency agreements must be specific about the purpose of collaborative efforts (e.g., providing cross-training to the courts, mental health, substance abuse, and other service providers regarding ASFA time limits and other mandates; developing interagency referral protocols and/or contracts to provide services to families). Community partnerships must subsequently evaluate their effectiveness and identify policies and practices that would benefit from modification. Thus these partnerships will be continually evaluating and advancing efforts to ensure that families receive the most comprehensive, coordinated, individualized supports and services possible to promote safe, stable family environments. Beyond collaboration, child welfare agencies must take a leadership role to expand the network of services available at the neighborhood level, including those provided by schools, churches, health and child care centers, and other family support agencies. This requires a clear understanding of current and projected trends, of the services families need that are not yet provided in a community, and of strategies to elevate critical issues and obtain responses from agency administrators and policy makers. Agencies may also find it useful to enlist the court’s help in working with other providers. Use of the Agency’s Legal Authority In all child welfare agencies, the principles of good practice must be addressed in the context of the agency’s authority and responsibilities. All agency staff—from administrators to frontline practitioners—must recognize that they function as agents of the state’s authority and responsibility to ensure the mandated safety, permanency, and well-being of children. They also must educate other systems (e.g., employment, housing, health, mental health, substance abuse treatment, schools) involved with children and families regarding the unique authority of the child welfare agency and the requirements of federal and state legislation.

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The decision-making process in child welfare takes place in the context of deeply held but often competing social values. Society recognizes that parents have the fundamental right and responsibility to protect and nurture their children. However, when parents are unable or unwilling to do so, the public child welfare agency has the societal and legal mandate to intervene promptly to ensure the child’s safety. Most families become involved with the child welfare system involuntarily due to abuse and neglect. This nonvoluntary nature of child protective services creates special challenges for child welfare agencies. Frontline practitioners must take into account the possible existence of competing goals among different members of the system—the child or youth, the family, outof-home caregivers, the agency, and the courts. Child and Family Services Reviews Fittingly, part 4 begins with a chapter by Mitchell, Thomas, and Parker in which they examine child welfare data and the implications from two rounds of Child and Family Services Reviews (CFSRs). In 1994, prior to the enactment of ASFA, Congress directed the U.S. Department of Health and Human Services to develop regulations for reviewing state child and family service programs administered under Titles IV-B and IV-E of the Social Security Act. Dissatisfaction among states and the federal government with prior federal reviews led, at least in part, to the passage of ASFA legislation. Although prior review processes had effectively held states accountable for meeting procedural requirements associated with the foster care program, these reviews were less successful in ensuring positive outcomes for the children, youth, and families served by state child welfare agencies, especially those outside the foster care program—those children, youth, and families served by in-home family preservation and support programs. As noted by Mitchell, Thomas, and Parker in their chapter, the CFSRs examine child welfare practices at the ground level, capturing

the interactions among caseworkers, children, families, and service providers and determining the effects of those interactions on the children and families involved. The reviews stress practice and are based on the belief that, although certain policies and procedures are essential to an agency’s capacity to support positive outcomes, it is the day-to-day casework practices and the underlying values that most influence such outcomes. In addition, the CFSRs are the federal system’s primary mechanism for promoting an agenda of change and improvement in services to children and families nationally. With a focus on program improvement planning, CFSRs have provided an opportunity for states and the federal government jointly to implement reforms at a systemic level that will realize and sustain improved outcomes for children and families. Rather than seeking quick, and possibly ineffective, answers to the complex problems that weaken the responsiveness of state child welfare programs, the reviews are intended to stress thoughtful planning and the development of lasting solutions. Furthermore, CFSRs offer opportunities to frame solutions in the context of practice principles that reflect the mission and intent of federally funded child and family service programs and state-of-theart knowledge on the most effective approaches to serving children and families. Placement Stability as a Systemic Factor D’Andrade and James’s chapter focuses on placement stability. It explores a phenomenon in child welfare that might be considered the antithesis of permanence: placement instability, which occurs when children experience a series of homes or facilities while in care. Placement instability was first identified in studies examining the child welfare system in the 1950s, 1960s, and 1970s, with findings that many children and youth were “drifting” in care, often enduring multiple placements, with no actions being undertaken on their behalf to find them permanent homes. The consequences for children that are associated with placement stability,

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we believe, should cause readers to consider this subject not only as a practice issue but also as a broader systemic matter to be considered in the context of necessary child welfare reform. The problem of children and youth “drifting” in foster care is still unresolved more than a decade into the twenty-first century. According to D’Andrade and James, approximately 20–25 percent of children and youth who enter outof-home care are neither reunified with their families nor placed in other permanent homes through adoption or guardianship; for these young people, placement instability remains an ongoing concern. D’Andrade and James’s chapter describes the challenges involved with defining instability and details the evidence regarding its effects on children and youth. Promising approaches are considered along with evidence regarding their effectiveness. Placement instability potentially affects any child or youth entering out-of-home care. The next three chapters in this section address systemic issues that have been found to negatively affect specific groups of children and youth in the child welfare system and their families: children and youth of color; African American fathers; and immigrant children and youth. Foster Parent Recruitment, Development, Support, and Retention The increased emphasis on achieving permanency for children in a timely manner has prompted professionals and policy makers to find more effective ways to recruit and retain resource families for children in need of permanent homes. Increasingly, the child welfare system is relying on foster parents to fill the gap. Foster parents, rather than newly recruited adoptive parents, are serving as the most consistent and viable option for permanence for large numbers of children and youth in care. Most children separated from their families reside with licensed foster parents in familylike, community-based settings. According to the Children’s Bureau Express (Children’s Bureau 2011), 64 percent of children

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adopted from the child welfare system are adopted by their foster parents (although not necessarily the families with whom they were first placed). In some states (e.g., Virginia) almost 81 percent of all adoptions are finalized with foster parents. Not only are foster parents adopting children in their care but also, according to the National Adoption Information Clearinghouse these adoptive placements are very successful, with 94 percent remaining intact for the life of the child (Children’s Bureau 2011).Thus the promise of permanency for children and youth in the child welfare system who are unable to return to their birth parents lies in many instances with their foster parents. This reality has far-reaching practice and policy implications. One of the critical practice implications is the need to keep the pool of foster parents growing, because as foster families take on the role of adoptive parents to children in their care the pool of foster parents naturally diminishes. Foster parents have historically been viewed as temporary caregivers or, in some cases, as “babysitters” for children in foster care. Traditionally, foster parents have not been considered as potential adoptive parents for the children cared for in their homes, even when the children had deeply bonded with them. Mallon (2004:58) in his research on gay dads provided this observation about foster parents from Terry Boggis, the director of CenterKids in New York City: I think it takes a very different, almost enlightened being to be a good foster parent. You have to be willing to love them [the children] on a spiritual level, totally embracing them and accepting that you must ultimately be willing to say good-bye. In this one way, it’s a dramatically different approach to the kind of parenting most of us imagine; it’s not about claiming and owning. It’s not about saying “This child is mine.” But you have to say, “This child is a gift in my life, someone I am allowed to love and nurture and then, perhaps, let go.” All parenting is about that, really,

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but it’s a greater likelihood—a bigger risk looms larger with foster children. A foster parent may be able to adopt the child, but that is not the deal when you go into the relationship. You absolutely have to be willing to share in the role of parent, but understand that you are not, in the end, their parent. Just because you set the meals on the table and cuddle with them and read them bedtime stories does not erase the fact that they already have a mother and/ or father somewhere. I have the greatest respect for foster parents. They have to be really centered and mature to approach parenthood through that channel because they have to want the child to be reunited with his or her biological family. They have to want the parent to get to the place where he or she is able to take care of the child they are raising. People tend to enter into parenting assuming there it will be a permanent relationship. But foster parents have to say, “Until your parents are able to take care of you, I will love you like my own.” It requires a lot of maturity to tolerate that reality. You also have to be willing to see your home as a revolving door, but at the same time consider permanency planning as a possible outcome. The reconciliation with birth parents might not work out, and then the child might be freed for adoption. It is hard to sign on to both of these realities at the same time. Again, you have to be able to say, “However this goes, I am willing to attach my fate to this child’s life and do whatever is best for this child.”

In their chapter, Pasztor and McNitt provide a framework for an approach to finding and maintaining foster parents, a critical area of systemic reform. Families, Children, and the Law Ventrell’s chapter explores court systems and child welfare legislation noting how both are indispensable components of child welfare practice. Social workers, attorneys, judges, guardians ad litem, Court Appointed Special Advocates (CASA) volunteers, and others

involved in the legal and judicial system are key actors in promoting systemic child welfare reform. But without laws authorizing the agency, police, and courts to intervene on behalf of abused and neglected children, society would be powerless to protect children. Juvenile and family courts, as well as tribal and many general trial courts, have jurisdiction over cases involving child abuse and neglect. Only children who are identified in a state’s law as needing the court’s protection may become the subject of a child protection petition. Each state has its own terms and definitions related to the jurisdiction of these cases and each has its own court structure for handling such cases. The passage of ASFA expanded the role of juvenile and family courts in several ways, as elaborated throughout this volume. Although these changes have been important for improving outcomes for children, ASFA did not address the systemic challenges faced by courts in meeting these new requirements, nor did it provide additional resources to assist courts in overcoming these challenges. In his chapter on families, children, and the law, Ventrell provides a comprehensive review of the salient issues involved in family, child welfare agency, community, and legal collaboration. In the following two chapters Munson, McCarthy, and Dickinson and Potter, Hanna, and Brittain discuss the critical role supervisors and administrative staff play in ensuring that state and federal policies as well as local, regional, and federal initiatives are fully supported and that outcomes focused on safety, permanency, and well-being of children and families are achieved through the delivery of competent, individualized, and timely services. Supervisors and other administrative level staff convey the mission, policies, procedures, and resources of the organization and direct the frontline action—the points of contact with children, youth, and families. Simultaneously, these professionals communicate information from the direct practice level to upper

SYSTEMIC ISSUES IN CHILD WELFARE

management to help agency administrators plan and allocate resources. As such, effective supervision is essential to achieving quality child welfare services. Therefore, supervisory skills and ongoing training are critical to enhance supervisory capabilities in managing the practice-level staff and caseloads. Supervisors are increasingly more computer savvy and use their computer skills to access state child welfare data systems to monitor the practice-level work and individual worker performance. Understanding the data reports enables supervisors to identify outcome trends, more effectively manage frontline staff, and influence necessary changes in policies and procedures within agencies to yield better outcomes for children and their families. To achieve positive outcomes, child welfare organizations must have a vision of what they hope to achieve and a strategy to guide their practice. With competing and often changing demands, organizing this work to achieve selected outcomes can be an arduous task. There is frequently a lack of direction, agreement, or understanding as to the outcomes that the organization is working to achieve. Unfortunately there is often a contradiction between what is targeted in practice and what is targeted by administration and supervision. Similarly, the systems that have been implemented to support the staff, such as information systems and training, sometimes might appear to be focused in different directions. Research and Evaluation in Child Welfare Systems Collins-Camargo provides a rationale for and an overview of the history of child welfare research and evaluation, describing the various types of evaluation and research utilized in child welfare systems. Collins-Camargo discusses strategies for conducting research and evaluation while at the same time addressing issues associated with its complexity in child welfare settings.

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Overrepresentation of Children and Youth of Color in Foster Care Children of color, belonging to various cultural, ethnic, and racial communities (primarily African American, Hispanic, and Native American) are disproportionately represented in the child welfare system and frequently experience disparate and inequitable service provision. The overrepresentation of children of color in child welfare and other social service systems (e.g., juvenile justice) is linked to social class, economic, and other factors that must be addressed to ensure that the needs of all children are fairly and appropriately served. In her chapter on overrepresentation of children and youth of color in foster care, McRoy takes a close look at the latest statistics available from the Adoption and Foster Care Data Analysis System (U.S. Department of Health and Human Services 2013). These reveal that in 2012 56 percent of the 399,546 children in the U.S. foster care system were children of color; yet only 38 percent of all U.S. youngsters are children of color. The inverse is true for white children, who represent 61 percent of the U.S. child population and comprise only 42 percent of the children in out-of-home care. McRoy’s chapter reviews the literature on the causes and correlates of overrepresentation and presents systemic strategies for addressing this growing problem. Fatherhood There is a dearth of information on the involvement of fathers in the child welfare system. Yet every child who has a mother not only has a father but also an entire set of paternal resources. The majority of state child welfare systems have failed in their attempts to locate and involve fathers and paternal resources in meaningful ways in the lives of children and youth. Coakley’s chapter focuses on African American children who are disproportionately represented in the child welfare system and highlights narratives from in-depth interviews with five fathers. Coakley thus gives a voice to the many fathers that child welfare agencies

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and agency staff fail to engage and discusses the importance of involving fathers in the lives of children and youth. Immigrant Children, Youth, and Families Child welfare workers do not routinely identify their clients’ immigration-related needs; nor do they make referrals for immigration legal services. Although a great deal of attention is given to laws and systems governing the entrance of new immigrants into the United States, there is little coordination between federal and state policies for addressing the human service needs of these newcomers once they are here. The result is an ad hoc, patchwork approach to federal, state, and local services that can permit

REFERENCES

Children’s Bureau (2011). Changing social work in child welfare, 12 (June), 4–6. Mallon, G. (2004). Gay men choosing parenthood. New York: Columbia University Press. P.L. 105-89, Adoption and Safe Families Act. (1997). U.S. Department of Health and Human Services (2013). Preliminary FY 2010 estimates as of September, 2010.

new immigrants, especially children and youth, to fall between the cracks. In their chapter on immigrant needs, Earner, Fong, and Smolenski focus specifically on how immigration status affects permanency planning for youth in outof-home care. The different types of immigration status of children and youth in care, the importance of early identification and assessment of immigration status, and guidelines for effective intervention are highlighted. Earner, Fong, and Smolenski also provide examples of collaborative programs between public child welfare systems and community-based immigration service providers that enhance capacity to meet the permanency planning needs of this population.

(The AFCARS Report). Retrieved October 26, 2013, from www.acf.hhs.gov/programs/cb/publications/ afcars/report20.htm. U.S. Department of Health and Human Services (2013). The AFCARS Report #20: Final estimates for FY2012, Retrieved October 26, 2013, from http://www.acf. hhs.gov/programs/cb/stats_research/afcars/tar/ report20.htm.

LINDA MITCHELL M I R A N D A LY N C H T H O M A S B O N I TA PA R K E R

The Child and Family Services Reviews

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n 1994 Congress amended the Social Security Act to establish a new framework for federal monitoring of state child welfare programs. The legislative changes were driven by criticism that the prior monitoring process was focused on states’ paperwork process (i.e., did the child have a case plan?) as opposed to practice and outcomes (i.e., was the child’s permanency goal appropriate and was it achieved in a reasonable time?). The 1994 amendments mandated the U.S. Department of Health and Human Services (HHS) to establish regulations for the review of state child and family services programs receiving Titles IV-B and IV-E funding under the Social Security Act. In addition, HHS was mandated to provide states with the opportunity to implement corrective action before withholding federal funds as well as to make technical assistance available to facilitate states’ improvements (Federal Register 2000). The legislation coincided with the efforts of HHS to redesign the review procedures. HHS undertook a lengthy process to develop and field-test the new Child and Family Services Reviews (CFSRs) in fourteen states and “shaped the CFSRs around the goals of capturing the actual experiences of children and families served through state child welfare programs and evaluating programs on the basis of outcomes, rather than focusing exclusively on federal requirements pertaining to procedures and documentation” (Milner, Mitchell, & Hornsby 2005).1 It was also the intent that the CFSRs create a national movement and

discussion in several areas, including defining core elements of practice, engaging local and state stakeholders in assessing and improving systems, defining performance measures in child welfare, and establishing mechanisms for states’ continuous quality improvement. HHS believed that the reviews could become a “primary mechanism for promoting an agenda of change and improvement in services to children and families nationally” (Milner, Mitchell, & Hornsby 2005). Over the past ten years the CFSRs have not only helped HHS ensure the states’ conformity with federal requirements, but have assisted in determining “what is actually happening to children and families receiving child welfare services, and assisting States in enhancing their capacity to help children and families achieve positive outcomes” (U.S. Department of Health and Human Services, Children’s Bureau 2010, 2013). The CFSR process consists of three major components: the statewide assessment (often referred to as “State self assessment”), the on-site review, and, if applicable, a program improvement plan (PIP). States are evaluated for conformity with seven outcome areas and seven systemic factors. Conformity with the outcomes includes determining whether the state has met national data standards related to safety and permanency, which are derived from states’ data that are submitted to the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS). These national standards include 567

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t
recurrence of maltreatment t
maltreatment in foster care t
timeliness and permanency of reunification t
timeliness of adoption t
permanency for children and youth in foster care for long periods of time and t
placement stability. Systemic factors include t
statewide information system t
case review system t
quality assurance system t
staff training t
agency responsiveness to community t
service array t
foster and adoptive parent licensing, recruitment, and retention. Following the on-site review, each state is provided a final report outlining the results of the review, and the state enters into a twoyear PIP to address findings that were not in conformity. Since 2001 HHS has conducted two rounds of CFSRs that have resulted in PIPs in the fifty states, the District of Columbia, and Puerto Rico (herein referred to as “states”). Throughout the first round of reviews, HHS sought feedback on the states’ experiences and made adjustments in the process to respond to states’ concerns regarding sampling of cases to be reviewed on-site, quantitative data measures that relate to the national standards, how cases are rated, and measurement of improvement in the PIP. Following completion of the second round of on-site reviews in 2010, HHS issued a Federal Register announcement soliciting public feedback with the goal of identifying improvements to federal monitoring of child welfare Title IV-B and IV-E programs (Federal Register 2011). HHS has stated the intention to enhance the monitoring process in the future. This chapter identifies and discusses practice and system findings from the CFSRs, states’

program improvement efforts, the influence of CFSR results on HHS programming, and the ways in which the lessons learned about the CFSR process are shaping future federal accountability in child welfare. CFSR Findings As mentioned in the previous section, the CFSRs determine states’ performance in the areas of safety, permanency, and well-being, as well as the seven systemic factors.2 The measurement of each state’s performance uses information from statewide assessments, performance on the national data standards, case reviews, and stakeholder interviews. While all information collected in the CFSR process is important in examining states’ performance, the case reviews conducted by HHS and the states yield insights into the strengths and challenges of practices on the front line of child welfare. This section will discuss important findings related to the case reviews conducted across all states.3 Scope and Limitations It is important to understand that the information presented relates to the reviews conducted by HHS and states over the course of ten years. HHS never intended for the results of the reviews to be presented or used as formal research about child welfare practice; rather, the results were to be used to determine states’ functioning in accordance with federal law. While the reviews examine various practice and systemic areas, originally they were framed in light of compliance with federal requirements and family-centered practice principles. The reviews do not touch on all areas of practice or administration that are integral to child welfare, such as impact of caseloads or workforce issues related to retention of staff or supervision. Findings represent performance during the “period under review,” which is approximately eighteen months in duration, and provide a “snapshot” of performance in a sample of cases at a single point in time. This point in time varies for each state. A small number of each

T H E C H I L D A N D F A M I LY S E R V I C E S R E V I E W S TA B L E 3 1 . 1

Outcomes and Items

Safety Outcome 1: children are, first and foremost, protected from abuse and neglect (S1) Item 1: timeliness of initiating investigations of reports of child maltreatment Item 2: repeat maltreatment Safety Outcome 2: children are safely maintained in their homes whenever possible and appropriate (S2) Item 3: Services to family to protect child(ren) in home and prevent removal or reentry into foster care Item 4: Risk assessment and safety management Permanency Outcome 1: children have permanency and stability in their living situations (P1) Item 5: Foster care reentries Item 6: Stability of foster care placement Item 7: Permanency goal for child Item 8: Reunification, guardianship, or permanent placement with relatives Item 9: Adoption Item 10: Other planned permanent living arrangement (OPPLA) Permanency Outcome 2: the continuity of family relationships and connections is preserved for children (P2) Item 11: Proximity of foster care placement Item 12: Placement with siblings Item 13: Visiting parents and siblings in foster care Item 14: Preserving connections Item 15: Relative placement Item 16: Relationship of child in care with parents Well-being Outcome 1: families have enhanced capacity to provide for their children’s needs (WB1) Item 17: Needs and services of child, parents, foster parents Item 18: Child and family involvement in case planning Item 19: Caseworker visits with child Item 20: Caseworker visits with parents Well-being Outcome 2: children receive appropriate services to meet their educational needs (WB2) Item 21: Educational needs of the child Well-being Outcome 3: Children receive adequate services to meet their physical and mental health needs (WB3) Item 22: Physical health of the child Item 23: Mental/behavioral health of the child

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states’ total number of child welfare cases are reviewed (approximately fifty cases per state in Round 1; sixty-five cases per state in Round 2) and are limited to selection from three sites within each state. The small sample size allows HHS and states to conduct a more thorough review of cases during a one-week time frame. This review includes interviews of individuals involved in cases, but prevents findings from being viewed as representative of statewide or national performance or conducive to drawing statistical inferences. Finally, in response to feedback from states, HHS made changes to the CFSR process between the two rounds. These changes limited the extent to which comparisons could be made between the findings from the first and second round of reviews. Overall Themes Even with the limitations in the CFSR data, there now exists a significant amount of information on the over twenty-five hundred cases reviewed in Round 1 and three thousand cases reviewed in Round 2. As such, several themes have emerged from examination of information gathered during both rounds of the CFSRs. For instance, in both rounds states have struggled to achieve the outcome relating to children having permanency and stability in their living situations (Permanency Outcome 1) and families having enhanced capacity to provide for their children’s needs (Well-Being 1). Across all of the items rated in the CFSR, items related to Permanency Outcome 1 and Wellbeing Outcome 1 have been among the lowest performing. In the area of permanency, states have been challenged to establish timely and appropriate permanency goals and to then achieve those goals in a timely manner, particularly reunification and adoption. In addition, ratings across the states show difficulties in providing appropriate services to support independent living and arrange planned permanent living arrangements for older youth remaining in foster care, when appropriate.

In the area of Well-being Outcome 1, states show continuing challenges in assessing the needs of birth parents and providing services to them and in engaging birth parents and children in case planning. Additional continuing challenges have been identified in conducting frequent and quality worker visits with birth parents and children. In the general area of assessment, results across both rounds of CFSRs indicate that states have more success in assessing the needs of children and foster parents and providing services to meet those needs, as well as showing strengths in assessing and meeting children’s education and physical and mental health needs than other items. Despite many states’ efforts to develop a family-centered approach to practice, both rounds of CFSR results show continuing challenges in working with birth parents—particularly fathers. This disparity could be identified since the reviews assess some practices with regard to mothers versus fathers separately. Overall, the ratings are lower with regard to practices in working with fathers, including assessment of their needs and providing them with services, engaging fathers actively in case planning, conducting caseworker visits with fathers frequently and with sufficient quality to impact case planning, facilitating visiting between fathers and their children in foster care, and adequately supporting a healthy relationship between fathers and their children in foster care. Finally, themes emerged across both rounds of reviews regarding differences between cases of children who are in foster care and those who remain in their own homes. Ratings were higher in the areas of safety and well-being for children who were being served in foster care than were the safety and well-being ratings for children being served in their own homes. The following sections will highlight information from the second round of CFSRs, including the common challenges that we identified in critical areas. A content analysis was conducted on all of the final reports

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summarizing second-round review results; the analysis focused on identifying challenges that were common across the states for individual items.4 The next sections will describe these common challenges to the states’ achievement of safety, permanency, and well-being for children and youth. Safety CFSR safety outcomes address timeliness to initiate investigations of maltreatment reports, prevention of repeat maltreatment, services to prevent removal or reentry into care, and risk assessment and safety management. Across these items nationally, the percentage of cases rated a “strength” ranged from 87 percent for repeat maltreatment not occurring to 67 percent for adequate risk assessment and safety management. In looking at the cases rated for risk assessment and safety management, overall states were relatively stronger in conducting initial risk and safety assessments than in conducting ongoing risk and safety assessments. In addition, adequate safety assessments before case closure or reunification occurred in only 74 percent of applicable cases. Common challenges identified in the area of safety included the following: medium-priority reports were not consistently investigated in a timely manner (twenty-four states); effective services were not provided to families while children remained at risk in the home (seventeen states); and the agency did not consistently conduct adequate ongoing risk and/or safety assessments in the child’s home (twenty-nine states). Permanency The two CFSR permanency outcomes address a range of areas (see table 31.1). As noted previously, states have been challenged in meeting Permanency Outcome 1, particularly in areas related to establishing timely and appropriate goals and achieving those goals in a timely manner.

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Establishing a timely and appropriate permanency goal is a basic and important casework function. In addition to rating this area for every foster care case reviewed in the CFSR, reviewers were also to determine whether the state agency had filed termination of parental rights (TPR) in appropriate cases, or had instead established compelling reasons not to file TPR, in accordance with the requirements of the Adoption and Safe Families Act (ASFA) of 1997. Across the country in the second round of the CFSR, only 63 percent of the applicable cases reviewed were rated a “strength” for timely and appropriate goals and appropriate processes for filing TPR. Common challenges identified included: TPRs were often not filed on behalf of children in accordance with the requirements of ASFA (twenty-three states); the goals set for children were not established in a timely manner in many cases (forty-five states); and too frequently inappropriate goals were established for children (twenty-three states). Additional common permanency challenges included the following: t
An insufficient number of foster placements were available to meet the variety of needs of children (thirty-seven states). t
There was a lack of appropriate training for foster parents to address the needs of children (thirty-three states). t
Concurrent planning, where implemented, was not conducted consistently or effectively (twenty-seven states). t
The services available in the community were insufficient to meet identified needs to support parents in reunification (twenty-five states). t
There were delays in filing and/or finalizing TPR due in part to court continuances and appeals (twenty-five states). t
When children were going to remain in foster care, they were not always placed in permanent living arrangements with families committed to caring for them long term (twenty-four states).

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t
Children were sometimes placed in unstable foster care placements (twenty-four states). t
Children either did not receive independent living services or the services available were insufficient (twenty-two states). t
There were limited resources available to support foster parents in keeping placements stable (seventeen states). Items related to the second permanency outcome were rated stronger, in general, than those associated with Permanency Outcome 1. Overall, states’ performance was strongest in items related to placing children in proximity to their families and communities of origin, placing siblings together, and preserving children’s primary connections. Areas where the CFSR found the most need for improvement related to facilitating visiting between a child and her parents and siblings in foster care, placing children with their relatives where safe and appropriate, and making efforts to support and maintain a relationship between parents and their children in foster care. One of the major challenges for states in this area, as mentioned previously, was in engaging birth parents to support permanency, particularly fathers.

t
The agency did not make concerted efforts to involve children in case planning (fortyfour states) t
Services available in the community were insufficient to meet identified needs of children, parents, or foster parents (thirtythree states). t
The agency did not provide adequate assessments and/or services to children (twenty-five states).

Well-being The three CFSR well-being outcomes address a range of areas (see table 31.1). As noted previously, states have been challenged in meeting Well-being Outcome 1, particularly in areas related to engaging and assessing birth parents in regard to ensuring well-being. In addition to issues on engaging birth parents, some of the other common challenges identified in Wellbeing Outcome 1 include the following:

In the Round 2 CFSR, states performed better on the other well-being items related to assessing and meeting educational needs and assessing and meeting physical and mental health needs than on the well-being outcome previously discussed. Across the states, 87 percent of all applicable cases were rated a “strength” for assessing educational needs and providing services to meet those needs. It is important to note that this item is not a determination of a child’s performance in school but rather examines the child welfare agency’s attempts to assess children’s educational needs and provide services to support these needs. Across the states, 86 percent of all applicable cases were rated a strength for assessing and meeting children’s physical health needs, while 77 percent of all applicable cases were rated a strength for assessing and meeting children’s mental health needs. Similar to the education item, the physical and mental health items assess the agency’s ability to identify needs and facilitate appropriate services to meet those needs rather than determining the actual physical and mental health of the child. Some of the common challenges identified with respect to these aspects of well-being include the following:

t
The caseworker visits with children did not focus adequately on issues pertinent to case planning, service delivery, and goal attainment (fifty-two states). t
The frequency of caseworker visits was not sufficient to meet the needs of children (forty-nine states).

t
The mental/behavioral health services available were insufficient to meet identified needs (thirty-two states). t
The dental health services available were insufficient to meet identified needs due to insurance limitations and an insufficient number of providers (twenty-eight states).

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t
There were challenges in maintaining or coordinating educational services for children in foster care in part due to lack of communication between schools and child welfare agency, delays in transferring individual educational plans and credits, and delays in enrollment in new schools (twenty-four states). t
There were delays in service assessments and/or delivery due to waiting lists (eighteen states).

Program Improvement Following the completion of the statewide assessment and onsite CFSR, states are required to address areas of nonconformity by developing a PIP. Although identifying states’ practices and systemic strengths, as well as concerns, is essential to the process, “the most important aspect of the review is how States use the information to make needed program improvements” (Milner, Mitchell, & Hornsby 2005). The PIP must identify action steps and benchmarks to correct deficiencies as well as to establish measurable goals and amounts of progress. If the CFSR identified serious concerns impacting child safety, these safety issues must “receive priority in both the content and time frames of the program improvement plans and must be addressed in less than two years” (45 CFR §1355.35 (d)(2)). While action steps and benchmarks must be achieved in two years, States are afforded an additional “nonoverlapping” or “evaluative” period of one year to meet PIP measurement goals (U.S. Department of Health and Human Services, Children’s Bureau 2009). If a state fails to complete action steps and/or measurement goals in its PIP, federal funds are withheld commensurate with the level of nonconformity (45 CFR §1355.36 (e)(2)(iii)). States’ PIPs contain two specific measures used to monitor progress in improving practice. The first is an amount of improvement toward any national data standard that was not met at the time the PIP is approved; these

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data are obtained from AFCARS and NCANDS (see previous section discussing data standards). The second is an amount of improvement toward other CFSR measures not met at the time the PIP is approved. These latter items include: those related to safety; permanency items not already measured through the national standards, namely, timeliness and appropriateness of permanency goal and other planned permanent living arrangement; and well-being items related to assessment and services provided, child and family involvement in case planning, and caseworker visits with children and families. While states have varying capacities to measure progress on these items over the course of a PIP, all states use some method of qualitative case review to measure progress toward these items. In doing so, states follow HHS guidelines regarding minimal sample sizes, inclusion of the largest metropolitan area, and baseline periods for such reviews. State Approaches to Practice and Systems Improvement In the PIP process HHS provides states with wide latitude to develop strategies and goals to address the CFSR findings. Most often, states are balancing the need to address a range of issues related to both direct line practice, such as response time to abuse and neglect reports, and larger systemic concerns, such as the array of services available to families or challenges in providing quality supervision of staff. Added to this is the importance of developing or strengthening cross-systems collaborations with others who may, or may not, be focused on engaging in improvements that have impact on the ability of child welfare to achieve its goals, such as the courts, mental health agencies, and education systems. Other barriers identified by states in developing their PIPs include 1. funding and workforce constraints, including staff turnover and caseloads; 2. organizational structure, such as engaging local counties; 3. the range of competing priorities, including reform directed by litigation; and 4. instability

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or frequent changes in agency leadership (U.S. Department of Health and Human Services, Children’s Bureau 2007). Despite these challenges, states have successfully implemented a variety of strategies to address CFSR findings. Following the completion of the first round of CFSRs, HHS conducted an analysis of thirty-one approved PIPs to identify strategies across several areas of practice, including those measured by the national data standards. Several cross-cutting themes emerged from these thirty-one PIPs, including strategies targeted to 1. strengthen agency capacity, 2. strengthen professional development, 3. improve social work interventions, 4. enhance agency quality assurance, 5. expand community resources, and 6. develop stronger partnerships (U.S. Department of Health and Human Services, Children’s Bureau 2007). HHS also looked at completed PIPs to determine the range of strategies and emerging themes among states with performance above the top quartile, and those gaining the most improvement, in the national data standards.5 While states’ performance on the data standards cannot be linked to specific programmatic strategies used in the PIPs (U.S. Department of Health and Human Services, Children’s Bureau 2007), the information collected nevertheless provides the field with a summary of PIP strategies undertaken by these states to address CFSR findings in key areas of safety and permanency. Some examples of the strategies include developing new policy and conducting staff training on concurrent planning to address adoption and reunification data standards; developing data reports to track and monitor agency progress to adoption, reunification, and stability data standards; strengthening worker supervision on permanency planning to address adoption and reunification data standards; and, developing, revising, or implementing structured decision making to address the recurrence of maltreatment standard (U.S. Department of Health and Human Services, Children’s Bureau 2007).

Finally, HHS conducted in-depth interviews with twenty-two states to obtain information on contextual factors and approaches to PIP development and implementation. While a number of areas were explored in the interviews such as the level of engagement of various stakeholder groups in the states, the impact of consent decrees on PIP development and implementation, and states’ use of HHS training and technical assistance, the information that proved the most helpful was that which provided insight into states’ perspectives on the PIP and systems change. These discussions highlighted issues pertaining to states’ strengths and barriers around leadership, sustaining change, managing resources, and general impressions of successes and challenges to PIP implementation (U.S. Department of Health and Human Services, Children’s Bureau 2007). Table 31.2 outlines important issues identified on these contextual factors. It should be noted that the second round of PIPs is currently underway, and ACF is continuing to collect and analyze results. Influence of CFSR Findings at Federal and State Levels States’ performance on the CFSRs and the successes and challenges they have had in implementing change initiatives through the program improvement plans have created a distinctive source of information for various public policy makers to consider. Even with the limitations of the results data from the CFSR, the findings produce a narrative about what is working in public child welfare that builds upon the shared but sometimes largely anecdotal experience of the field. The CFSR findings also provide a different perspective than more formal research and evaluation because it is based on indicators of systemic functioning and outcomes for children and families in relation to federal child welfare requirements and widely accepted practice principles. This performance framework lends itself to the federal government, states and other interested stakeholders using CFSR

T H E C H I L D A N D F A M I LY S E R V I C E S R E V I E W S TA B L E 3 1 . 2

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PIP Strengths and Barriers Challenges

Successes

Leadership

Institutional instability PIP not integrated with consent decrees Inability to model positive attitude toward change and systems improvement Agency leadership not involved in PIP process Leadership did not support systemic change

Governor and legislature support, embracing the process to create vision for change Supported involvement and responsibility at the local level Commitment to PIP sustained through administration changes Promoted and demonstrated receptivity to change

Resources

Hiring freezes or slowdowns Increased caseloads Issues with staff retention Need to promote less experienced staff Inability to meet basic family needs

Approximately half the states overcame barriers through creative means Approximately half the states obtained restored or increased funds for PIP initiatives Some states used the PIP to leverage funds from legislature

Sustaining change

Not institutionalizing QA efforts Focus on “plan to plan” and not full implementation Not addressing need to change agency culture Not engaging stakeholders

Local and state QA systems Promoting supervisory development Use QA results at local level Open communication between administration and field Use forums and stakeholder input

Overall PIP implementation

Economic issues Unexpected complexities of implementation Lack of leadership Challenges with local counties Low morale in field Issues with data quality and QA Overreliance on training and policy as a strategy

Use data in daily practice Agency speaking in “same language” Instituted a learning organization Aligned all programs Improved supervision Trained the field on best practices Improved stakeholder collaboration

results, in combination with other information, to direct and leverage government resources to support systems change. CFSR Principles in Federal Laws The federal government has used performance issues highlighted by CFSR findings to shape federal laws that target child welfare practice. A prime example of using the results has been with regard to caseworker visits to children in foster care. HHS articulated, for the first time in the CFSRs, a clear expectation that caseworker visits to children involved in the child welfare system were to be conducted face to face and practiced in a manner that ensured that a child’s

needs for safety, permanency, and well-being were met. Specifically, the reviews included an item to assess the frequency of caseworker visits to children and the quality and substance of those visits. The expectation is that the typical pattern of visits would match the child’s needs for visits, which at a minimum would be at least monthly unless there are significant extenuating circumstances. Further, workers would conduct such visits alone with the child, separate from his caregiver or parent and in an environment conducive to discussing the child’s needs, such as the foster care placement or child’s home. Depending on the age of the child, the visit would involve an assessment or discussion

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of the child’s safety and well-being along with other pertinent information needed to accomplish the child’s permanency goals. These expectations for caseworker visits were applied in the CFSR regardless of any state’s policies or practices to the contrary for children in foster care and those receiving services in their own homes (U.S. Department of Health and Human Services, Children’s Bureau 2008). As discussed earlier, caseworker visits with children were an area of challenge for every state, a fact that HHS highlighted in its findings early in the first round of reviews (U.S. Department of Health and Human Services, Children’s Bureau 2003a, b). Further, HHS noted that there appeared to be a relationship between the frequency and quality of caseworker visits with children to states’ performance on other permanency and well-being outcomes as measured by the CFSR. Congressional hearings and a series of HHS Office of Inspector General reports released in 2005 focused on CFSR results, states’ standards for caseworker visits, and states’ ability to track whether those visits were occurring for children in foster care (U.S. Department of Health and Human Services, Office of Inspector General 2005). Further, a number of published reports and testimony before Congress by the General Accountability Office (formerly General Accounting Office), which is an independent, nonpartisan agency that works for Congress, further illustrated the workforce challenges states face that could inhibit caseworkers from fulfilling state and/or CFSR caseworker visit and case management practice expectations (U.S. General Accounting Office 2004). Many states were in the midst of implementing ways to improve caseworker visits and workforce issues in their program improvement plans when pertinent federal legislation was enacted in 2006. The Child and Family Services Improvement Act of 2006 provides an explicit statutory basis for the federal government to continue to encourage state improvements in caseworker visits and funding (Child

and Family Services Improvement Act 2006). The law cites CFSR results on caseworker visits in the rationale for the new caseworker provisions (Child and Family Services Improvement Act 2006). The law mandated that all states were to have standards for the content and frequency of caseworker visits for children in foster care, with conditions that such standards be at least monthly and focus on case planning, and services to support safety, permanency, and well-being. In addition to the policy emphasis, this legislation provided new federal funding to support caseworkers and caseworker visits and required states to be accountable for the number of these visits conducted. The law outlined fiscal consequences for states that failed to achieve progress toward visiting 90 percent of children in foster care by October 1, 2011. As a result, going into the second round of reviews, the federal government had mandates in place for states to set standards, track and report caseworker visits, and directed funds to support state attention to this foundational area of child welfare practice. Although it is not possible to make a causal association between the statutory provision on caseworker visits or the CFSRs program improvement plan process and state performance, the majority of states made progress on at least the frequency of caseworker visits to children in foster care since the 2006 legislation (Stolztfus 2011). Nonetheless, the second round of CFSRs found that there continues to be challenges in ensuring that the quality of caseworker visits addresses children’s needs. The recently enacted Child and Family Services Improvement and Innovation Act of 2011 indicates that the federal government will have a continued mandate to hold states accountable for caseworker visits through fiscal year 2016 (Child and Family Services Improvement and Innovation Act 2011). In addition to caseworker visits, a number of other federal statutory changes are in alignment with findings from the reviews and provide statutory support for a continued focus on federal monitoring of improvement. For example, the

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legislative amendments to the Court Improvement Program (CIP) and Title IV-B programs in 2006 (Stolztfus 2006) require state child welfare agencies and dependency courts to forge meaningful collaborations with one another to ease pathways to timely permanency for children. As early as 2003, state CIPs were required to implement activities under their grants that addressed court-related findings of the CFSR and were expected to give priority to legal and judicial issues identified in the CFSR PIP in making CIP fund allocations (U.S. Department of Health and Human Services, Children’s Bureau 2003b). In addition, the Fostering Connections to Success and Increasing Adoption Act of 2008 reinforces principles previously highlighted in the CFSR, such as placing children in foster care settings with their siblings and monitoring children’s health and mental health while in foster care. CFSR-Informed Technical and Training Support to States HHS has leveraged the CFSR findings to refine its training and technical assistance to support states as they reform their systems. HHS’s overall network of child welfare resources is designed to build the capacity of government agencies, courts, and other public child welfare agencies through the provision of training, technical assistance, research, and consultation on child welfare (U.S. Department of Health and Human Services, Children’s Bureau 2011a, b). HHS has a long history of funding resource centers through cooperative agreements to address a myriad of program and administrative areas central to child welfare agencies and programs, such as child protection, adoption, youth development, permanency, data and technology, organizational improvement, and legal and judicial issues. As CFSR results have emerged, HHS has worked with the resource centers as partners to mold the technical assistance offerings to be most responsive to states around the review process, findings, and program improvement work. For example, the

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national resource centers were available to review states’ assessments, final reports or PIPs and work with states to identify strengths, areas of focus, and opportunities for training and technical assistance. National resource centers also have been instrumental in providing states with assistance in engaging groups of stakeholders, clients, and communities to assess the states’ programs, review results, and design improvement initiatives. HHS’s training and technical assistance providers also have hosted peer-to-peer sharing events so that states engaged in the work of systems and practice change can learn from each other. HHS also developed new types of resources to accommodate the challenges that become more apparent due to CFSR findings and program improvement plans. For example, in reflecting on the first round of reviews, HHS noted that the implementation of some program improvement plans was hampered by the rise of unanticipated complexity in executing some strategies, challenges in relationships between state administrators and counties (if child welfare was largely county run), and issues of changing leadership and staff morale (U.S. Department of Health and Human Services, Children’s Bureau 2005). These types of difficulties spoke to the need to provide assistance that went beyond the practice-specific areas of child welfare and attend to broader and strategic issues of change management, work culture, political environment, and agency leadership. One of HHS’s responses was the development of the concept of regionally based implementation centers. The model for these centers was to provide multiyear and integrated support to states to assist them in implementing systems change rather than the more traditional training and technical assistance events and initiatives around the transfer of knowledge. These centers could work in conjunction with the entire span of national resource centers for practice and administrative expertise; make a more intensive assessment of organizational

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culture, administration, and practice within the state; and coordinate a comprehensive effort to have systems change take hold and be sustainable over the long-term (U.S. Department of Health and Human Services, Administration for Children and Families 2008). Other partners in the HHS’s training and technical assistance network have been encouraged to incorporate implementation and leadership-focused analysis and resources into their approaches. Evaluation of this newer model of assistance will be necessary to determine its impact and effectiveness for states, but it is indicative of the potential for HHS and others to address persistent barriers to reforming child welfare systems in new ways armed with performance and implementation information. A second response to the issue of workforce leadership and supervision has been to target HHS funding in several areas, such as grants for developing models of effective child welfare staff recruitment and retention training and the establishment of a national institute devoted to the child welfare workforce in 2008. The institute is focusing on workforce issues and cultivating leadership through learning academies that are devoted to the development of middle managers and supervisors. The institute also provides child welfare traineeship programs for bachelors and masters level social work students and peer networking opportunities. HHS has also strategically used the CFSR findings to drive an agenda for development of discretionary grant priorities. Examples of areas focused on include improving legal representation of children in the child welfare system, developing models of comprehensive family assessments, strengthening diligent recruitment of foster and adoptive families, improving outcomes through systems of care, impacting child welfare outcomes through engaging nonresident fathers, and improving educational stability through child welfare/ education collaboration.

CFSR as Opportunity for States The CFSRs’ influence on state child welfare agencies goes further than the need to comply with a federal monitoring process. At the very least, as a result of these reviews, states have developed an enhanced capacity to assess their strengths and areas needing improvements in specific areas of practice and systems and to design targeted change initiatives in response to such information. Many states went further than using CFSR as a catalyst for rethinking their internal analysis correction capacities and seized the review process and findings as an opportunity to engage parties instrumental to child welfare reform in their initiatives. For example, several state child welfare agencies have used the CFSR to frame discussions with and engage their state legislators on matters of performance and budget (William-Mbengue 2010). States that did this most successfully have been able to enhance their ability to open lines of communication outside of crises and garner understanding and legislative support for reform efforts. Other states have built on the CFSR and other performance information to address how they were serving various populations within their system, such as Indian children, older youth, and families in certain jurisdictions. Such states used performance information to engage those communities in a dialogue about how to be responsive to a community’s needs in a more culturally respectful, targeted, and/ or effective manner (U.S. Department of Health and Human Services, Children’s Bureau 2005). Still others have been able to use CFSR results to illustrate the need for additional collaboration with other public entities that serve children and families involved in the child welfare system, most notably with juvenile justice agencies, the courts, and health and mental health agencies. Lessons Learned When the CFSRs were officially launched in 2001, HHS intended to create a system that

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not only monitored for states’ compliance with federal requirements and examine child welfare practice at the ground level (Milner, Mitchell, & Hornsby 2005), but also encouraged states to engage in continuous quality improvement by establishing their own internal monitoring and program improvement systems. While the CFSR has not been without its own challenges and criticisms, particularly around the use of quantitative data to establish national standards and state comparisons (Wulczyn & Orlebeke 2006; Schuerman & Needell 2009), there has also been general consensus in the field that the CFSRs have been a catalyst for improved practice and child welfare reform (National Association of Public Child Welfare Administrators 2011; U.S. General Accounting Office 2004) and have contributed to establishing state and local quality assurance systems that focus supervisors and child welfare managers on outcomes (Moore 2010). As HHS prepares for modifications to the CFSRs, it is essential not only to consider feedback from states and other groups but to also learn from the experiences of other government entities in ensuring compliance and monitoring performance. Those experiences suggest that while it is important for HHS to continue its role in supporting states’ work to improve front-line practice and systems reform, it is equally important that HHS not limit or diminish accountability of states to achieve improved outcomes for children and families. Looking ahead, the following bear consideration. Comparing performance across states is an important tool for accountability in public programs and has been effective for motivating performance in many government programs, allowing “pack leaders to serve as de facto goal setters” (Metzenbaum 2003). Additionally, ranking states can identify performance leaders and allow government programs to focus on states that are falling behind and need more improvement (Metzenbaum 2006). Although comparison data cannot be used as evidence of the effectiveness of particular practices or

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programs, it can provide the field with insights about whether or not the general direction of change taken by a state should be considered by others as a promising approach for further study or replication (National Research Council 1997). Finally, it will be important for HHS to consider an overall strategy for disseminating the data in a way that is useful to states, policy makers, federal and state legislators, and the general public, and can help frame and inform critical policy debates around child and family issues (Metzenbaum 2003). Encouraging a learning environment between the federal level, states, and counties is a critical component for continuous quality improvement that “continually seeds, harvests, and re-sows the lessons of State experience” (Metzenbaum 2006). Likewise, at the state level, learning must be focused at all levels of the organization and include field staff “who must ultimately take ownership of quality efforts” (Casey & CSSP 2011). In addition, federal staff can facilitate use of data with the states in ways that foster learning, encourage honest dialogue about identified concerns, and lead to effective program improvement. Some federal programs have utilized strategies of regional office coaching and facilitating “communities of practice” among states (Metzenbaum 2003). Improvements must occur simultaneously in other systems that impact child welfare such as education, mental health, and the courts for states to realize better outcomes for children and families. While HHS has long mandated the Court Improvement Programs to address findings from the CFSRs, it is important for HHS to team with states and courts to ensure that improvements are not discrete court activities, but are strategically integrated with states’ own systems change efforts. HHS has also seen examples of innovative ways that state child welfare agencies have created buy-in from other entities to address cross-agency issues. These include inviting mental health staff to participate in quality assurance case reviews to see firsthand the importance of quality

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mental health services for children in child welfare. Finally, it is important for HHS to create collaborations at the federal level that could possibly focus on ways to establish broader accountability and incentives for other federal programs to engage in improvements that will benefit children and families being served by child welfare. “How” change is implemented is as important as “what” change is implemented. HHS has been engaged in efforts to apply implementation science to the work of improving child welfare practice and systems. Over the course of monitoring implementation of PIPs, it has become increasingly clear that state agencies are not always prepared for the magnitude of the changes, have not clearly thought through the “staging” and “phasing” of the different activities, often over-rely on policy and training strategies rather than exploring the use of other more effective means of implementation, and rarely consider issues of post-PIP sustainability (National Implementation Research Network 2011). As noted previously, HHS has funded implementation centers to provide technical assistance and establish implementation projects in state child welfare agencies; evaluations of the projects will contribute to a body of knowledge that can be applied to ongoing PIP work. State commissioners and directors administering child welfare programs must provide the vision for reform and must be actively engaged as leaders in the change process for PIPs to be successful. In addition, to be effective, leaders must ensure that PIPs are integrated into other reform efforts in the states and are not seen as “stand-alone” plans competing for priority. It has not been unusual for states to assign PIP development and monitoring to an individual in the agency with little authority to actually ensure that the PIP is implemented and to hold local offices and managers accountable for

required changes. In contrast, the most effective work has been seen in states where agency leaders actively communicate a vision for the PIP to both the state and local office staff and ensure the PIP is integrated with other reform plans, such as consent decrees. It is also important that leaders regularly engage in internal monitoring of the PIP and tracking of data toward PIP goals. YYY

The Child and Family Services Reviews have shown that the institutionalized collection and attention to performance information can better inform the development of policy, intensify supports to administrators who are engaging in systems change, and create synergies with partners critical to child welfare. With ten years of the CFSR behind us, the conversation is no longer about whether the federal government’s role is in holding state child welfare systems accountable for serving children and families well. Rather the CFSR has been a key catalyst for a national dialogue on whether the federal government, local jurisdictions, and other stakeholders are measuring salient elements, focused on the right domains of practice, employing the appropriate methodologies to understand what children and families are experiencing and how they are faring, collaborating with key system partners, and designing effective change and improvement strategies. There is additional opportunity in these performance, accountability, and reform conversations to consider whether and how we get the right information to determine whether federal and local granting mechanisms, child welfare legislation, and technical assistance resources are best aligned to support public child welfare and related social service systems in succeeding in their mission to meet the needs of children and families.

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NOTES

1. The Children’s Bureau, part of the Administration for Children and Families within the Department of Health and Human Services, is the agency that conducts the Child and Family Services Reviews. The Children’s Bureau is the governmental agency responsible for partnering with federal, state, tribal, and local agencies to support comprehensive, positive change in child welfare systems, with a focus on enhancing the lives of children and families. 2. All data cited in this section is from one source: Children’s Bureau, Federal Child and Family Services Reviews Aggregate Report (2011). 3. Round 1 CFSR occurred between 2001 and 2004. During this time, a total of 2,569 cases were reviewed across the 52 states. Case samples were selected from the largest metropolitan area in each state, in addition to two additional sites jointly selected by the states and HHS. These cases included 1,477 children in foster care as well as 1,092 cases involving children being served in home. Round 2 CFSR included a review of 3,363 cases in 52 states between 2007 and 2010. Case samples were again selected from the largest metropolitan area in each state, in addition to two additional sites. These cases included 2,079 children in foster care, as well as 1,284 cases involving children being served in home. 4. For each outcome, a challenge was considered a “common challenge” nationally if it was relevant to approximately one-third (33 percent) of the states that received an overall rating of Area Needing Improvement for that item. 5. Not all states with completed PIPs were required to address every national data standard; states only addressed those standards in which they were not in conformity at the time of the CFSR or at the time of the PIP approval. REFERENCES

Annie E. Casey Foundation & Center for the Study of Social Policy (2011). Counting is not enough— Investing in qualitative case reviews for practice improvement in child welfare. Seattle: Annie E. Casey Foundation. Child and Family Services Improvement Act of 2006. 42 USC 622 et seq. Child and Family Services Improvement and Innovation Act of 2009, H.R. 2883, 112th Congress (2011). Federal Register (2000). Title IV-E Foster Care Eligibility Reviews and Child and Family Services state plan reviews; final rule. Washington, DC: Department of Health and Human Services. Federal Register (2011). Federal monitoring of child and family service programs; request for public comment and consultation meetings. Federal Register, 76,

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April 5, 2011, p. 18677. Washington, DC: Department of Health and Human Services. Metzenbaum, S. (2003). Strategies for using state information: Measuring and improving program performance. Washington, DC: IBM Center for the Business of Government. Metzenbaum, S. (2006). Performance accountability: The five building blocks and six essential practices. Washington, DC: IBM Center for the Business of Government. Milner, J., Mitchell, L., & Hornsby, W. (2005). Child and Family Services Reviews: An agenda for changing practice. In G. Mallon & P. Hess, Child welfare for the twenty-first century (pp. 220–35). New York: Columbia University Press. Moore, T. (2010). Results-Oriented management. In M. Testa & J. Poertner (eds.), Fostering accountability: Using evidence to guide and improve child welfare policy (pp. 232–44). New York: Oxford University Press. National Association of Public Child Welfare Administrators (2011). Comments on CFSR Federal Register notice with recommendations (May). Retrieved from www.napcwa.org. National Implementation Research Network (2011). What is implementation? Retrieved from http:// www.fpg.unc.edu/~nirn/. National Research Council (1997). Assessment of performance measures for public health, substance abuse, and mental health (p. 48). Washington, DC: National Academy. Schuerman, J., & Needell, B. (2009). The CFSR composite scores: Accountability off the track. Chicago: Chapin Hall, University of Chicago. Stolztfus, E. (2006). Child welfare: The court improvement program (April 6). CRS RL33350. Washington, DC: U.S. Congressional Research Service. Stolztfus, E. (2011). Child welfare: Funding for child and family services authorized under Title IV-B of the Social Security Act (June 11). CRS R41860). Washington, DC: U.S. Congressional Research Service. Title IV-E Foster Care Eligibility Reviews and Child and Family Services Reviews final rule. Federal Register, 65, No. 16, p. 4020. U.S. Department of Health and Human Services, Administration for Children and Families (2008). Funding Announcement: Cooperative Agreements for Child Welfare Technical Assistance Implementation Centers. Retrieved from www.acf.hhs.gov/grants/ closed/HHS-2008-ACF-ACYF-CO-0058.html. U.S. Department of Health and Human Services, Children’s Bureau (2003a). ACYF-CB-Program Instruction for State Court Improvement Program. U.S. Department of Health and Human Services, Children’s Bureau (2003b). Results of the 2001 & 2002 Child and Family Service Reviews. Retrieved from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/ results/results/index.htm.

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U.S. Department of Health and Human Services, Children’s Bureau (2005) CFSR fact sheet. Retrieved from http://www.acf.hhs.gov/programs/cb/cwmonitoring/ recruit/cfsrfactsheet.htm. U.S. Department of Health and Human Services, Children’s Bureau (2006). Child and Family Services Reviews procedures manual. Retrieved from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/ tools_guide/procedures/manual.pdf. U.S. Department of Health and Human Services, Children’s Bureau (2007). 52 Program Improvement Plans—Strategies for improving child welfare services and outcomes. Retrieved from http://www.acf.hhs. gov/programs/cb/cwmonitoring/results/pip_ presentation_final/sld001.htm. U.S. Department of Health and Human Services, Children’s Bureau (2008). Child and Family Services Reviews onsite review instrument and instructions. Retrieved from http://www.acf.hhs.gov/programs/ cb/cwmonitoring/tools_guide/onsitefinal.pdf. U.S. Department of Health and Human Services, Children’s Bureau (2009). CFSR amended technical bulletin #3 (October 8). Retrieved from http:// www.acf.hhs.gov/programs/cb/cwmonitoring/ general_info/tech_bull3.htm. U.S. Department of Health and Human Services, Children’s Bureau (2011a) Federal Child and Family Services Reviews aggregate report, Round 2. Retrieved from http://www.acf.hhs.gov/programs/ cb/tta/cbttan.pdf.

U.S. Department of Health and Human Services, Children’s Bureau (2011b). The Children’s Bureau Training and Technical Assistance Network 2011 Directory. Retrieved from http://www.acf.hhs.gov/programs/ cb/tta/cbttan.pdf. U.S. Department of Health and Human Services, Children’s Bureau (2013). Reports and results of the Child and Family Services Reviews: Rounds One and Two, State by State Analysis Washington, DC: Children’s Bureau. Retrieved October 26, 2013, from http://library.childwelfare.gov/ cwig/ws/cwmd/docs/cb_web/SearchForm. U.S. Department of Health and Human Services, Office of Inspector General (2005). State standards and capacity to track frequency of caseworker visits with children in foster care. Retrieved from http://oig.hhs. gov/oei/reports/oei-04–03–00350.pdf. U.S. General Accounting Office (2004). Improved federal oversight could assist states in overcoming key challenges. Publication No. GAO-04–418T. Retrieved from www.gao.gov/cgi-bin/getrpt?GAO04–418T. William-Mbengue, N. (2010). Involving state legislators in the Child and Family Services Review. Denver: National Conference of State Legislatures. Retrieved from http://www.ncsl.org/documents/cyf/cfsr_reviews. pdf. Wulczyn, F. & Orlebeke, B. (2006). Getting what we pay for: Do expenditures align with outcomes in the child welfare system? Issue Brief 106. Chapin Hall Center for Children.

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Placement Stability

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ermanency is a central aim of the child welfare system. Federal child welfare policy emphasizes the idea that every child should have a permanent home. This chapter explores a phenomenon in child welfare that might be considered the antithesis of permanence: placement instability, which involves a problematic number or pattern of placements while a child is in foster care. Placement instability was first identified in studies examining the child welfare system in the 1950s, ’60s, and ’70s. These studies showed that many children were “drifting” in care, often enduring multiple placements, with no actions being undertaken on their behalf to find them permanent homes (Maas & Engler 1959). In spite of federal policy changes during recent decades, the problem of children experiencing multiple placements has persisted. This chapter begins by describing how placement instability has been defined and measured by scholars who study the phenomenon. It next reviews the scope of the problem and the evidence regarding its effects on children. Risk and protective factors are explored, and a number of approaches to addressing the problem are detailed along with the available evidence regarding their effectiveness. The chapter concludes with a discussion of the importance of clarity in definitions and measures, the need to better understand the relationships between risk factors and outcomes, and proposed directions for improving practice and policy interventions designed to reduce placement instability.

Defining Placement Instability While concerns about placement instability for children in foster care have been long-standing, definitions and measures of the term have varied over time and by perspective. Defining placement instability is challenging, as many have noted (James, Landsverk, & Slymen 2004a; Newton, Litrownik, & Landsverk 2000; NRCPFC 2013). This is due in part to the complexity of the phenomenon of children’s movement through care. In this section, several approaches to measuring the problem of placement instability are outlined. One understanding of placement instability assumes fewer placements are better. In this view, the more placements a child experiences the worse the problem of placement instability is considered to be. The measure associated with this definition of placement instability is the simplest, consisting of the count of the number of placements or placement changes a child in foster care has had. Many studies examining placement instability use this measure (Aarons et al. 2008; Aarons et al. 2010; Children & Family Research Center 2011; Pears & Fisher 2005a). Placement instability defined as a count of placements is simple to operationalize; it seems reasonable to have greater concern for a child with ten placements over some span of time than for a child with two placements over the same period. The count of placements is a well-accepted measure of placement instability, as it provides a reasonably good proxy for the construct of interest. Additionally, results from

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a qualitative study suggest this definition is congruent with the experience of foster children. From interviews with twenty-two young adults who had experienced multiple foster care placements during childhood, Unrau and colleagues (2010) found that most respondents felt “every move counts”—each move was perceived to be significant. These individuals thought that every placement a child experienced should be counted when defining and measuring placement instability (Unrau et al. 2010). However, there are relevant aspects of the construct of placement instability that are not captured when it is measured with a simple count of placements. Placement changes in foster care can occur for reasons that are beneficial to the child. Accordingly, placement changes should not always be considered a negative experience; a change could result in an environment better suited to the child’s needs (James 2004; Usher, Randolph & Gogan 1999; Wulcyzn 2010). Consistent with this observation, some distinguish placement disruptions from placement changes and define a disruption as “any exit [of a child] from the foster home or kinship home that was made for a negative reason” (Chamberlain et al. 2006:414). Researchers use this definition to refine the count measure by excluding changes that are planned or occur for reasons other than a disruption or a negative event. For example, in their study of predictors of the number of placement changes, Wulcyzn, Kogan, and Harden (2003) excluded moves of children in foster care due to placement in an adoptive home, being reunited with siblings, or placement in an agency-approved emergency relative home. However, whether the reasons precipitating a placement change lead to differential outcomes for the child remains unknown. Furthermore, most studies do not have data that would reveal the reasons behind a placement change, which forces researchers to aggregate the changes. Particular aspects of the child welfare placement process also complicate the measurement of placement instability. In some jurisdictions

it is common practice to use emergency shelter care, which may involve a brief placement in group care or a specialized short-term foster family home for assessment purposes. Some researchers include such placements in the overall total placement count (see Newton, Litrownik, & Landsverk 2000), while others attempt to exclude it. In their examination of predictors of placement instability, Webster, Barth, and Needell (2000) disregarded placements that occurred during a child’s first year in out-of-home care in an effort to exclude initial shelter placements. Other researchers have acknowledged that a certain number of placement moves are reasonable or to be expected (e.g., move from a shelter placement to an intended foster care placement) by creating a threshold number of placements beyond which children are believed to be experiencing placement instability. Rubin et al. (2004a) examined the relationship between placement instability and mental health service use. They created a dichotomous variable that distinguished between children who had fewer than three placements over the period of a year and those that experienced three or more placements during the same period. Another threshold measure is the required reporting element of placement stability for states in the Child and Family Services Review (CFSR) process. CFSR reviews are the means by which state child welfare programs’ performance is evaluated for conformity with federal requirements. For the purposes of the CFSR, children experiencing two or fewer placements are considered to be experiencing placement stability (U.S. Department of Health and Human Services n.d.).Unfortunately, the choice of the cutoff is somewhat arbitrary. The threshold measure of placement instability may also obscure the fact that a child with a number of placements just over the threshold may differ in substantive ways from a child with a number of placements far beyond the threshold. Another complication arises when children move back and forth between their parents’ home and foster care. Some researchers have

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developed measures of placement instability that account for this. For example, Rubin and colleagues created a dichotomous variable representing “episodic care,” reflecting experiences in which the child’s foster care spell was interrupted by a return home of at least one month (Rubin et al. 2004a). Comments by participants in Unrau’s and colleagues’ (2010) qualitative study of former foster youths’ experiences of placement moves suggest this may be appropriate. Many youth felt the return home to be another placement—another move, another adjustment, and one that also felt potentially temporary. However, the federal government instructed states to not count temporary placements or situations such as hospitalizations, trial placements in the home of a parent (trial reunification), or runaways, when making required data submissions to the Adoption and Foster Care Analysis and Reporting System (AFCARS 20; U.S. Department of Health and Human Services 2013). Note that in this review we have excluded studies that use the outcome of “permanent placement failure” or reentry to foster care from the child’s home following a trial reunification. We consider this to be a different construct than either placement instability or placement disruption, both of which focus on foster care experiences. A related but different approach is taken by researchers who study a single event of placement disruption rather than placement instability over time, examining what might cause or result from a single disruption for children in foster care. Chamberlain and colleagues for example, examined the predictors of the likelihood of a foster placement ending for a negative reason, such as behavior problems or runaway, using survival analysis (Chamberlain et al. 2006). James (2004) examined determinants of the first behaviorrelated placement change. This approach represents a different conceptual and methodological angle from which to examine questions about placement instability and change. A number of researchers have expanded the conceptualization of placement stability

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beyond a straightforward count of total placements. These authors argue that aggregating all placements obscures important variation in children’s movement through out-of-home care. To accurately depict children’s experiences in out-of-home care, methodologies need to be used that enable us to simultaneously capture multiple indicators of the placement experience, such as number of placement disruptions, total length of time in care, placement sequences, changes in level of restrictiveness of care over a series of placements, as well as length of time in care per placement episode (James, Landsverk, & Sylmen 2004). One way to do this is to consider placements patterns or trajectories. This is not a new idea; the potential importance of the pattern of placements was noted by Festinger in 1983. More recently, Usher, Randolph, and Gogan (1999), studying the first spell placement patterns of a cohort of 1,456 children in Cuyahoga County in Ohio over a 3-year period, introduced a descriptive method that captured sequences of different types of placement settings over time. Usher, Randolph, and Gogan’s (1999) study provided useful descriptive information about the movement of children across different placement types. The creation of a frequency distribution for all possible placement sequences revealed the most prominent patterns for their cohort. Wulczyn, Kogan, and Harden (2003) addressed the dimension of time in their study of placement trajectories of a New York foster care cohort of over 16,000 children. They quantitatively extracted common placement trajectories, involving the multiple dimensions of number of moves, time in care, and time patterns, using event count and mixture models. This classification strategy revealed that children with the same number of placements differed in important ways. James, Landsverk, and Slymen (2004) examined patterns of movement through care for a cohort of 450 children who were still in placement after an 18-month period across 2 dimensions—placement timing and levels of care. Using an inductive

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methodology, authors identified 4 patterns of movement—early stability (children who were in stable placements within 45 days), late stability (children who were in stable placements by between 45 days and 9 months), variable pattern (children who had at least one placement of 9 or more months, but experienced subsequent placement moves), and unstable pattern (children who experienced multiple placements, none of which were over 9 months). This method was subsequently used by Rubin et al. (2007) to study the impact of placement stability on behavioral child well-being for 729 children in foster care at least 18 months who spent less than 9 months in a residential setting. Havlicek (2010) used child welfare administrative data to retrospectively examine the entire placement histories (birth to age 17.5) of 474 foster youth who reached the age of majority in the state of Illinois, searching for patterns in their movement through the child welfare system. Patterns were identified through optimal matching and hierarchical cluster analyses. Five distinct patterns of movement were differentiated: late movers had the highest rate of movement, no predominant placement, and a high rate of unplanned moves; the community care pattern had the second-highest rate of movement, with foster care the predominant placement; the institutionalized pattern showed the next highest rate of movement, with the prevailing placement being congregate care and a high rate of unplanned moves; the early entry and settled with kin patterns were fairly stable. These studies underscore that understanding movement through care across time and placement type and knowing what factors put children on certain pathways through the child welfare system could provide guidance with regard to the needs of distinct groups of children as well as the timing of interventions. Study findings might therefore ultimately assist those who develop and monitor children’s placements to stabilize their stays in out-ofhome care and thus improve outcomes (James, Landsverk, & Slymen 2004). Clearly, there is

no single agreed-upon definition of placement instability or strategy for handling the myriad situations that complicate the placement process. In this review of the literature on placement instability, we make distinctions between the different approaches used to understand the problem—placement instability measured with a count of placements, a threshold measure, or placement patterns, and placement disruption—as we consider the magnitude of the problem, its consequences and contributing factors, and related interventions. Understanding the Scope of the Problem It is not easy to ascertain how widespread and serious the problem of placement instability is (Cross et al. 2013). In addition to applying different conceptualizations and measures of “instability,” as previously noted, most studies have relied on nonrepresentative samples, studied different subpopulations of children in care, examined different periods of time, and used different study methodologies. As a result, comparing findings of studies that examine the extent of the problem of placement stability is difficult. However, the literature does provide a general sense of the magnitude of the problem. The majority of children who are in legal custody for a relatively short period of time experience only one or two placements while in care, i.e., from entry into legal custody to discharge from legal custody. Usher, Randolph, & Gogan (1999) examined all 1,993 children who were first entries to care in an Ohio county (n = 1456) and found over 90 percent of those who left care within one year had experienced only 1 or 2 placements. Wulcyzn, Kogan, & Harden’s (2003) study of movement trajectories using children entering care in New York City similarly reported that almost 90 percent of children had only 1 placement over a 2- to 3-year period. An analysis of data from the National Survey of Child and Adolescent Well-Being (NSCAW), a prospective and nationally representative study of children and families involved with the child

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F I G U R E 3 2 . 1 . California placement stability rates 1998–2010 using CSFR measure. Needell et al. 2011; CWS/CMS 2010 Quarter 4 Extract.

welfare system, found that children experienced an average of 2 placements over 3 years (Foster, Hillemeier, & Bai 2011). However, when children remain in care for longer periods they are less likely to have such a low number of placements. Only about 50 percent of a sample of 2,653 emancipating California adolescents who had been in care for at least 18 months experienced 1 or 2 placements (Courtney & Barth 1996). In Usher’s 1999 study, just under 50 percent of children in placement for 3 to 4 years had only 1 placement. Similarly, Webster, Barth, and Needell (2000) studied the experiences of all children under the age of 6 entering care in California and still in care 8 years later; they found that about 48 percent of children in nonkin foster care had 1 or 2 placements after 8 years. Children’s placements with kin were more stable, with 71 percent still in their first or second placement. The federal government uses a threshold measure as a way to understand the magnitude of the problem of placement instability through the CFSR process. The federal CFSR measure

of placement instability combines in a composite measure three separate indicators: 1. the percentage of children in foster care for eight days to less than twelve months with two or fewer placements; 2. the percentage of children in foster care for twelve months to less than twenty-four months with two or fewer placements; and 3. the percentage of children in foster care for twenty-four months or longer with two or fewer placements. Figure 32.1 shows performance on the CSFR measures of placement stability for the state of California from 1998– 2010. According to this measure, just under 85 percent of children in care less than one year, about 62 percent of children in care one to two years, and 32 percent of children in care two or more years experience placement stability. In addition, according to the federal CFSR measure, while placement stability for children in care less than twelve months and children in care between twelve and twenty-four months has slightly improved since 2003, placement stability for children in care more than twentyfour months has been worsening (see figure

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F I G U R E 3 2 . 2 . California placement stability rates 1998–2010 using CSSR measure. Needell et al. 2011; CWS/CMS 2010 Quarter 4 Extract.

32.1). This worsening in performance appears steady and rather dramatic from 1998–2005, then slows but continues from 2005–2010. However, the federal indicator may provide an imperfect picture of placement instability. Although the three different indicators of placement stability provide some differentiation between children who are in care varying lengths of time, the distinctions are not adequate to avoid distortions of the understanding of performance on the indicator. In fact, California’s performance on placement stability has not been worsening. An alternative measure of placement stability provided via the California Child Welfare Performance Indicators project at the University of California at Berkeley calculates the percentage of children entering care during a six-month period who experience a number of placements over a specific span of time, for all children who were in care for at least that length of time (Needell et al. 2011). That is, for all children who were in care at least twelve months the indicator identifies the

number of placements each child had at exactly twelve months and provides the proportion of children who had two or fewer. This avoids the problem of combining children with different amounts of time in care in one measure. Using this measure, it can be seen that California’s performance on placement stability has been improving overall since 2002, even for children who have been in care for long periods of time (see figure 32.2), although the percentage of children actually experiencing placement stability is lower than it appears using the federal measure: About 65 percent of children have placement stability (two or fewer placements) at one year in care, and somewhat less than 50 percent of children do at two years in care.1 Researchers who seek to understand placement instability using a placement pattern approach have identified the proportion of children falling into each pattern. Pattern categories differ across most studies, making comparisons challenging. In general, however, these studies find the majority of children experience

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relatively stable placement histories. However, a small portion of children experience disturbingly unstable patterns characterized by repeated disruptions, short stays in multiple facilities and placement into increasingly restrictive levels of care. The James, Landsverk, and Slymen (2004) study of patterns of movement found 64 percent of the sample experienced the more stable placement patterns of early stability (35.6 percent) and later stability (28.6 percent). The two less stable patterns were experienced by the remaining 36 percent of children in the sample: the variable pattern (16.0 percent) and the Unstable pattern (19.8 percent). In Rubin and colleague’s (2007) study of the impact of placement stability on child behavioral well-being, using categories similar to those in the James, Landsverk, and Slymen’s (2004) study, about 70 percent of the sample were in more stable patterns of early stability (52 percent) and later stability (19 percent). Just under one-third of the children experienced an unstable pattern. Havlicek’s (2010) study found patterns suggesting higher, but variable rates of movement. About 40 percent of her sample had the relatively stable placement patterns of early entry (13.5 percent) and settled with kin (25 percent), while about 60 percent had the less stable placement patterns of late movers (28 percent), community care (25 percent), and institutionalized (16 percent). However, Havlicek’s finding of a higher rate of less stable patterns is not surprising, given that her sample included youth who had aged out of foster care. Another approach to understanding the magnitude of the problem of placement instability is to consider how often children’s placements disrupt. A study of disruption rates following a sample of 90 youth aged 2–16 referred to treatment foster care found that, overall, 25.5 percent of youth experienced a disruption over 12 months (Smith et al. 2001). As with studies using a count measure of instability, the rate appears to increase with time in care. In Leathers’s (2006) study of 179 12–13-year-old children placed in traditional foster care, just over

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half had disrupted from their placements after 5 years. Finally, it appears that placement changes tend to occur in the earlier part of the placement episode. Wulcyzn, Kogan, & Harden (2003) calculated the number of movements per child by placement interval in care, and identified that the movement rate tends to be higher earlier in the case. The number of moves per child was highest during the first six months; the rate then decreased each subsequent six-month period. James (2004) study of disruption found that the risk of a behavior-related disruption was highest during a child’s first one hundred days in care. Effects of Placement Instability Most agree that placement instability is harmful to children in foster care. When children change placements they are likely to experience rejection by a caregiver as well as loss of a familiar family and social environment and associated relationships. In addition, they must adapt to a new environment and new caregivers. It is important to note that the majority of empirical studies in this area have been cross-sectional, precluding definitive inferences about the directionality of effects. Assignment of placement instability as either independent or dependent variable has been conceptually driven and guided by different assumptions: 1. children experience placement instability because of their attributes upon entering care, and 2. placement instability causes poor outcomes. This latter hypothesis is grounded in attachment theory and argues that frequent placement changes undermine children’s ability to build stable relationships, ultimately leading to adverse outcomes in the short- and longterm (Aarons et al. 2010). In this section empirical evidence regarding the effects of placement instability on children is presented. Researchers have studied the effects of placement instability on health and developmental outcomes with mixed results. One correlational study of 214 foster youths aged 13–18 found the

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number of placements was associated with the severity of substance use involvement (at p < .06) (Aarons et al. 2008). However, other studies have not found such associations; one study of 60 maltreated children aged 3–5 placed in foster care found no association between number of placements and children’s emotional understanding (Pears & Fisher 2005a). The same investigators also found no association in bivariate analyses between number of placements and various developmental, cognitive, and neuropsychological variables, such as height and weight, memory, and language (Pears & Fisher 2005b). Several studies have examined placement instability in relation to children’s use of services targeted at health and mental health problems. Rubin et al.’s study (2004b) of 2,358 children who spent at least 9 months in foster care found that the number of placements was associated with an increased rate of emergency department use. Examining a cohort of 570 children in foster care in San Diego County, James and colleagues (2004b) determined that an increase in the number of placement changes predicted a greater rate of outpatient mental health visits. This study further found that children who experienced behavior-related placement changes received more outpatient mental health visits than children who experienced placement changes for other reasons. Follow-up analyses of the 144 children who experienced any behavior-related placement changes indicated that the rate of outpatient mental health service use almost doubled in the 90 days following the first behavior-related placement change. A study using a threshold measure of placement instability found that for a sample of 1,389 foster children aged 3–16 who underwent a psychiatric crisis screening, having 3 or more placements prior to the first psychiatric screening was associated with a greater likelihood of subsequent psychiatric services use (Park, Mandell & Lyons 2009). A child’s having 3 or more placements has also been found to be

associated with an increased likelihood of high mental health service use (Rubin et al. 2004a). As mentioned earlier, this study used a second measure of instability—episodic care—capturing reunifications and reentries into foster care—which was also found to be associated with an increased likelihood of high mental health service utilization. Placement instability also has been linked to poor educational outcomes. One study of a sample of 726 maltreated and matched nonmaltreated school-aged children in New York state linked placement instability (measured by the sum of the number of residential and unscheduled school changes for each child) to adverse academic outcomes, such as low test scores, English grades, and grade repetition (Eckenrode et al. 1995). Another found placement instability (measured by the number of placements) to be associated with academic skills delays, but without grade repetition, history of expulsion, or history of suspension, in a study of 300 foster children aged 6–12 (Zima et al. 2000). Placement instability has been associated with behavioral problems for children in care across many studies. Multiple placements were linked to juvenile delinquency filings for a sample of 4,085 10–16 year old boys in foster care in Illinois, with 2 placements increasing the odds over only 1 placement, and 3 or more placements increasing the odds again (Ryan & Testa 2005). An association between placement stability and behavior was also reported in a prospective longitudinal study of 279 youth placed in foster care. The researchers created a measure of placement stability composed of a cumulative count of the number of time points (out of 5 possible) at which the child remained with the same caregiver over the 8 years of the study; this was used as a predictor of various behavior adjustment trajectories in a multinominal logistic regression model. Placement stability was positively associated with a stable behavior adjustment trajectory (Proctor et al. 2010). However, Zima et al. (2000), using a

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count measure of placement instability, found no relationship between the number of placements and behavior problems measured by the total behavior problem scale of Achenbach’s Child Behavior Checklist (CBCL) or by classroom behavior problems measured with the Teacher-Child Rating Scale. A study using a threshold measure of instability found that adopted children with more than one placement in foster care prior to the adoption performed less well on tasks involving inhibitory controls and were perceived by their caregivers as having more oppositional behavior as measured by the CBCL than did other adopted children (Lewis et al. 2007). Another study, using a placement pattern approach, also identified a link between behavior problems and placement instability. Rubin et al. (2007) investigated whether placement instability contributed to behavior problems after 18 months for children in foster care, using a nationally representative sample of 729 foster children. Controlling for placement instability risk at case outset as predicted by child and birth parent characteristics and maltreatment history, the authors found that children with an unstable placement pattern had an increased likelihood of behavior problems. By controlling for risk of placement instability at time of placement into foster care, the authors were able to determine what increase in behavior problems was due to the placement history rather than to the initial characteristics of the child. Finally, a primary theme emerging from a qualitative study of 22 adults who experienced multiple placements in foster care was the experience of grief from the multiple losses involved in placement moves. These young adults reported withdrawing from others in response to the experience of multiple moves and subsequent difficulty in trusting others (Unrau, Seita & Putney, 2008). The traumatic effects that separation from beloved and trusted caregivers can provoke in a child were also explored by clinicians Gauthier, Fortin,and Jeliu (2004) using case studies of children involved in the child

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protective system in Canada. The painful impact of the loss of relationships, schools, belongings, and self-esteem poignantly recounted by interviewees and in case studies adds another level of understanding to our knowledge of children’s experience of placement instability. Risk and Protective Factors in Placement Instability Better understanding the factors contributing to placement instability can help us develop approaches to reduce the problem. In this section the potential contributing factors characteristics of the child, the caregiver, and the placement process are considered. Characteristics of the Child Emotional Problems A number of studies have found children with mental health or emotional problems to be more likely to experience placement instability. Barth and colleagues used data from the NSCAW study to examine predictors of placement changes for a subgroup of children, ages seven to fourteen, who scored in the clinical range on either the internalizing or externalizing scales of the CBCL (Barth et al. 2007). Using a placement count measure, depression was found to be associated with a higher number of placement changes. Similarly, a history of inpatient treatment prior to child welfare system involvement increased the likelihood of a child experiencing three or more placements while in care (although not for African American children; Park & Ryan 2009). And an identified mental health problem increased the likelihood of placement change for children in foster homes (although not for children in group homes or emergency shelters) in a study of fifty-nine hundred foster children in Rhode Island (Connell et al. 2006). Behavior Problems Studies of placement disruption have consistently found children with behavior problems, particularly externalizing behavior, to be at greater risk for

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placement instability (Chamberlain et al. 2006; Hurlburt et al. 2010; James 2004; Leathers 2006). The odds of experiencing one of the less stable placement patterns—delayed entries into stable placements (later stability), late disruptions (variable pattern), or multiple short stays in care (unstable pattern)—was found by James and colleagues (2004) to increase with foster children’s progressively higher levels of externalizing behaviors as measured by the CBCL. A few studies have considered whether there are bidirectional effects between placement movement and behavior. In Newton, Litrownik, & Landsverk’s (2000) study an entry cohort sample of 415 children aged 2–17 from one city who had been in care at least 5 months were assessed approximately 5 months after entry to care (Time 1) and again a year later (Time 2). The CBCL was used to assess internalizing, externalizing, and total behavior problems. For the entire sample, more problems were associated with more placement changes at both measurement points. This association between the number of a child’s placements and the number of a child’s problem behaviors is expected, since more difficult children are likely to move more often. In a linear regression the researchers assessed whether multiple placements in turn cause emotional and behavioral problems, using Time 2 CBCL scores as the outcome and controlling for Time 1 CBCL scores. The number of placements did have a significant negative effect on Time 2 CBCL scores, supporting the hypothesis that placement movement itself negatively affects foster children’s behavior. Further analysis found that this effect existed primarily for children with five or more placements. Bidirectional effects were further explored by Aarons et al. (2010) using a continuous count of placements and CBCL cut-off scores to measure behavior problems in a nationally representative sample of five hundred foster youth. With a series of cross-lag path analyses and data collected at three time points, the authors found evidence for both hypotheses: both external

and internal behavior problems at baseline increased the likelihood of placement changes at eighteen months, and externalizing behavior problems at eighteen months predicted placement changes by thirty-six months. Placement changes between baseline assessment and eighteen months did not affect behavior problems at eighteen months, but placement changes between eighteen and thirty-six months predicted externalizing behavior problems at thirty-six months, with some differences by gender and age. Overall, however, the effect of behavior problems on placement changes was greater and more consistent than the reverse. Gender The relationship between gender and placement instability is not clear. On one hand, a number of studies have found boys to be less likely to experience placement instability than girls; two of these studies used a placement count (Barth et al. 2007, in the nonclinical sample; Wulcyzn et al. 2003, for children in group care, placement instability measured by the log of the ratio of the number of placements to time in care); a third was a study of placement change (Connell et al. 2006). On the other hand, several studies examining placement instability by a threshold measure have found boys to be at greater risk of placement instability (Park & Ryan 2009; Webster, Barth, & Needell 2000). Gender was not associated with an increased likelihood of experiencing either a variable or unstable pattern in the James, Landsverk, and Slymen study of placement patterns (2004), nor was any effect seen in several studies of placement disruption (Chamberlain et al. 2006; James 2004; Smith et al. 2001). Ethnicity Findings related to ethnicity have been similarly equivocal. A study examining predictors of placement instability measured with a countlike dependent variable found no effect for ethnicity (Wulczyn, Kogan, & Harden 2003). Several studies using threshold measures of placement instability showed that African American children were less likely

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to experience three or more placements than were white children (Park & Ryan 2009; Webster, Barth, & Needell 2000). Ethnicity was not associated with an increased likelihood of an unstable or variable pattern in James, Landsverk, and Slymen’s placement patterns study (2004). However, Havlicek (2010) found that African American children were more likely to be in the most stable pattern, settled with kin. Studies of placement disruption have had contradictory findings. In one study of placement disruption, after controlling for externalizing behavior measured by the Children’s Symptom Inventory and “integration into the foster home” assessed with a measure developed by the author (Leathers 2006), African American children were found to be at increased risk of disruption. Several other studies found no effects for ethnicity (Chamberlain et al. 2006; Connell et al. 2006; James 2004). Age Most studies find older youth to be at greater risk of placement instability than younger children. This finding has been consistent for studies measuring placement instability as a count of placements (Barth et al. 2007; Strijker, Knorth, & Knot-Dickscheit 2008); in bivariate analyses (Wulczyn, Kogan, & Harden 2003, for children placed in foster family care); a threshold measure of three or more placements (Park & Ryan 2009; Webster, Barth, & Needell 2000); and placement patterns (James, Landsverk, & Slymen 2004). Findings regarding age from studies of placement disruption are less clear. While three studies found older age to be predictive of behavior-related placement changes (James 2004; Smith et al. 2001; Wells & Chuang 2012) for any placement change (Connell et al. 2006), no effect for age was found in two others (Chamberlain et al. 2006; Dozier & Lindheim 2006). Characteristics of the Caregiver and Placement Processes While most studies have examined children’s characteristics as predictors of placement

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instability, increasing attention is being paid to caregiver and agency characteristics. This is consistent with findings that suggest child behaviors are not the most common cause of placement changes. James’s (2004) descriptive study of 454 children entering foster care found that only 20 percent of placement changes over eighteen months were prompted by the behavior of the child; 70 percent of placement changes were due to system or administrative reasons (e.g., moving to a placement with siblings, a long term placement, or a placement with a relative); 8 percent involved problems related to the foster family; and a small percentage (2 percent) was due to conflicts with the child’s biological family. Caregiver Commitment Several studies have considered whether caregiver commitment is related to the likelihood of placement disruption. In one study, caregivers’ commitment to the child in their care (measured by an instrument developed by one of the authors) was found to be positively associated with the likelihood of the placement enduring at least two years (Dozier & Lindheim 2006). In Leathers’s (2006) prospective study of disruption, the effect of a child’s behavior problems on the likelihood of disruption diminished when integration into the foster home was controlled, suggesting that difficult behavior can be better tolerated from a child who is considered part of the family. Placement with Kin Studies have consistently found that children placed with kin experience less placement instability than children placed in nonkin foster care. Winokur and colleagues compared the number of placements of 636 foster children from one state who entered care in 2002 and stayed for at least 60 days. One group had spent at least 90 percent of their time in care with relatives, and a matched sample had spent 90 percent of their time in nonrelative foster care. Children placed primarily in kin care had fewer placements; they averaged

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1.62 placements as compared to 2.27 placements for the group of children in nonrelative foster care (Winokur et al. 2008). Other studies using countlike measures have found placement in kin care to be associated with a lower number of placements than placement in nonkin care (Foster, Hillemeier, & Bai 2011; Wulcyzn et al. 2003), as have studies of placement disruption (Chamberlain et al. 2006; Connell et al. 2006; Hurlburt et al. 2010; James 2004; Koh & Testa 2008; Price et al. 2008). In an exception to these findings, Koh and Testa (2008) examined placement instability using a threshold measure; they found that children placed with kin were not less likely to experience three or more placements within one year of care. Time in Care Time in care has been positively associated with placement instability and negatively associated with placement disruption. In a study of a cohort of 419 children 0–18 years of age entering care in the Netherlands using a count of placements (Strijker, Knorth, & Knot-Dickscheit 2008), the placement number was strongly positively correlated with time in care in a bivariate analysis. Moreover, a threshold study found that every additional month in care increased the likelihood of placement instability (measured as 3 or more placements) by 5 percent in a longitudinal study of almost 6,000 foster children aged 3–18 (Park & Ryan 2009). Conversely, several studies of placement disruption have reported that the longer a child had been in a particular placement the less likely that placement was to disrupt (Leathers 2006; Price et al. 2008; Smith et al. 2001). Multiple Placements Early in Care Multiple placements early in care have been associated with placement instability. Although, as noted earlier, Webster, Barth, & Needell’s (2000) measure of placement instability ignores the number of placements in the first year, in their analysis of predictors of placement instability they assessed whether the number of moves during the first year was associated with placement

instability. They found that children with more than one move during the first year in foster care were more likely to experience placement instability; the more moves the first year, the greater the likelihood of placement instability. Based on a study of placement disruption in a sample of 700 families in one urban area, Price and colleagues (2008) reported similar effects; the number of prior placements a child had was predictive of disruption—each additional prior placement increased the hazard by 6 percent. Group Care Finally, group care placement and placement instability have been relatively consistently linked in the empirical literature. While the directionality of the relationship remains unclear children with placement episodes in group care tend to also have experienced greater instability; this finding has been consistent whether placement instability has been measured by a count of placements (Foster, Hillemeier, & Bai 2001; Wulczyn, Kogan, & Harden 2003), or a threshold measure (Park & Ryan 2009), and whether considering placement disruption or change (Connell et al. 2006). Approaches to Reducing Placement Instability There are few interventions that specifically address the issue of placement instability and fewer still that have been empirically tested with regard to their effectiveness in doing so. In the following section we describe research on interventions that have been tested for their effectiveness in reducing placement instability or disruption in foster care and use research designs that include some kind of counterfactual control. It should be noted that there is a larger body of literature on interventions that address foster children’s behavioral problems, which may contribute to placement instability, and on the phenomenon of foster care reentry. However, in this review we include only studies that have specifically examined outcomes of either placement instability or placement disruption for children in foster care.

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Foster Parent Training One study has assessed the effectiveness of a foster parent training program on placement instability. This study examined a training program called KEEP (Keeping Foster and Kinship Parents Trained and Supported), which is based on the Multidimensional Treatment Foster Care model developed by Chamberlain and Reid. In this study, seven hundred new foster and kinship parents of foster children ages five to twelve from one urban area , who had been in care for at least thirty days, were randomly assigned to either KEEP training or usual services. KEEP training involved teaching caregivers to increase their use of positive reinforcements, use nonharsh discipline techniques, such as time-outs, consistently, and closely monitor children’s whereabouts and friends. Instructions were provided in a group format, with some at-home lessons. While there was no apparent direct effect on the likelihood of disruption for participants, the negative effect of prior placements on the likelihood of placement disruption appeared to be mitigated by program participation (Price et al. 2008). Professional Foster Parents One strategy that has been believed likely to reduce placement instability is to provide higher compensation and professional status as incentives to foster parents to encourage them to keep children (Testa & Rolock 1999). “Professional” foster parents are provided compensation and benefits based on training, experience, and merit, as well as being expected to participate as members of the agency service team (Pecora, Whittaker, Maluccio, & Barth 2000; Testa & Rolock 1999). A study comparing kin caregivers, nonkin foster parents, and two types of professional foster parents (n = 2,062)—a group compensated with a salary and a group compensated with a housing voucher—found salaried professional foster parents had the lowest disruption rate (Testa & Rolock 1999). A second study examined whether payment of an additional stipend decreased disruptions.

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Investigators randomly assigned seventy-two caregivers to receive or not receive stipends of seventy dollars; they found that caregivers receiving a stipends had a lower disruption rate after nine months, though the difference only approached statistical significance (29 percent compared to 53 percent; p < .08; Chamberlain, Moreland, & Reid 1992). WrapAround Services WrapAround is a team-based model of service provision in which individually tailored services are provided to children at risk of highlevel placement and their families. One study examined 132 children aged 7–15 placed in outof-home care and at risk of or diagnosed with emotional or behavioral problems. Fifty-four were randomly assigned to receive WrapAround Services, which included a strengths-based assessment, life-domain planning, clinical case management, and follow-up supports and services; all other children received services as usual. After 2 1/2 years, children receiving the WrapAround intervention had a decrease in their annualized rate of placement change from 3.7 prior to the intervention to 2.2 afterward. Children who did not receive the WrapAround intervention had an increase in their annualized rate of placement change from 4.1 to 4.9. The difference in the post-treatment annualized rate of placement change was statistically significant, and a repeated measures ANOVA on pre- and postintervention change rates was marginally significant (p < .08; Clark, Lee, Prange, & McDonald 1996). Court Ordered Special Advocates (CASAs) The Child Abuse Prevention and Treatment Act of 1976 mandated that all children served in the child welfare system due to abuse or neglect must have a “guardian ad litem” representing them in court. While many states use attorneys in this role, others use court-ordered special advocates (CASAs) or assign a CASA to certain children in addition to an attorney. CASA volunteers investigate the facts of a case, speak for

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children in dependency proceedings, advocate for children’s best interests, ensure services are provided, and monitor court orders to ensure compliance (Waxman, Houston, Profilet, & Sanchez 2007). Several studies have found that children who were assigned a CASA experienced fewer placements than did children to whom a CASA was not assigned (Calkins & Millar 1999; Litzenfelner 2000; Waxman et al. 2009). While two of these studies use matching techniques (Litzenfelner 2000; Waxman et al. 2009), none make use of random assignment or statistical controls. Differences between the children assigned CASAs and those not assigned CASAs could therefore be due to factors other than the assignment of a CASA. Discussion Placement instability is a problem for a sizable number of children in foster care and has been consistently found to negatively affect children’s school performance and behavioral and emotional health. A resurgence of scholarly attention has identified factors that place children at risk for placement instability and provides an emerging, though still limited, evidence base for interventions aimed at reducing placement stability. Our review of the literature concerning placement instability and placement disruption has identified a number of issues with implications for policy, practice, and research. In terms of policy, the federal CFSR measure has been criticized for failing to take into account the fact that some changes in a foster child’s placement may be positive as well as failing to incorporate movement patterns or trajectories (Wulcyzn 2010). But perhaps a greater concern with the measure is that it does not allow for accurate consideration of change over time. If the measure is not revised, this policy intervention designed to improve performance on placement instability will remain at best unhelpful; at worst, it could provide a misleading picture to agencies attempting to monitor and improve their performance. (See NRCPFC 2013).

Currently, there are a few promising models focusing on enhanced supports and training for caregivers that appear to enhance the stability of placements for the children placed in their homes. These promising programs should be encouraged. Interventions that have been successful in addressing problematic child behavior in the child welfare population, such as KEEP (Leathers et al. 2011), should be systematically studied with regard to their effect on placement stability. The majority of interventions that have been tested to date focus on avoiding placement disruption by improving caregivers’ ability to manage challenging child behavior; however, descriptive work points out that most placement changes are not related to child behavior, but rather to ensure that a child’s placement conforms to agency and system policies (James 2004), such as moving children to a placement among their siblings. While some system-related placement changes are beneficial to a child (e.g, transferring a child from a temporary setting to a permanent preadoptive foster home), others may be less so (e.g., disrupting a stable nonrelative foster care placement to place a child with a relative). However, in the absence of data on the relationship between type of disruption and its effects on children’s safety, well-being, and permanency outcomes, conclusions about the effects of various placement changes will continue to reflect practice wisdom. Based on the sheer number of placement changes that are not necessarily related to a child’s behavior problem, it may make sense for the field to focus greater attention on these kinds of placement changes and to develop interventions to reduce them. Eesearch attention to the problems of placement instability and placement disruption has greatly increased over the past decade; however, additional work is necessary. While the evolving measures of placement instability reflect our expanding understanding of the complexity of the placement process, the variation between measures challenges our ability

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to get a clear grasp of the problem—its size, effects, and risk factors. Various terms are often used interchangeably, and findings from studies using different measures are combined as if the measures were comparable. While few obvious trends have emerged from considering risk factors and problem effects separately by measure type or outcome as is done here, these could vary. For example, time in care increases the risk of placement instability when measured with a threshold measure, but is associated with a decreased likelihood of placement disruption. It may be problematic to combine these approaches when summarizing findings related to risk and protective factors and intervention effects. In many cases, study designs do not allow definitive conclusions as to whether identified “risk factors” are in fact causing placement instability; associations may be due to a reverse effect (placement instability causes the risk factor) or to a bidirectional effect. A few researchers have begun to tease these relationships apart and have found evidence of bidirectional effects in the case of behavior problems and placement instability. More research on placement instability needs to account for this possibility. Other useful questions for study regarding placement instability include the effects of placement instability on foster caregivers, on siblings and foster siblings, and on agencies in terms of time and resources. The number of spells of placement a child experiences should also be considered. Reentry to foster care is not infrequent: one study of youth emancipating from care in California found 40 percent had at least two separate spells in foster care (Needell, Brookhart, Jackman, Cucarro-Alamin, & Shlonsky 2002). Studies that do not take reentry into account in measuring placement instability may be underestimating the size and effects of this problem for a substantial number of children, particularly given the impact of the transition, as suggested by the participants in Unrau

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et al.’s (2010) qualitative study. Other qualitative research examining the effects of experiencing placement instability in foster care has suggested that measures of placement instability should be broadened. Hyde and Kammerer (2009) interviewed twenty teenagers in foster care in Massachusetts. The results emphasized the instability these youth felt from a variety of experiences and changes—not only placement changes. These authors have suggested broadening the definition of placement instability to incorporate other changes, such as changes in the worker assigned to a child; changes in service providers, such as a child’s therapist; changes in the child’s school; and changes in placement with siblings. YYY

Reducing placement instability and placement disruption for children in foster care is essential. Researchers, policy makers, and practitioners share responsibility for understanding the extent of the problem and developing and evaluating effective solutions. Important progress in understanding and addressing placement instability has been made in the past decade. We now have more sophisticated strategies for measuring the problem and a clearer sense both of the characteristics contributing to its existence as well as its consequences. However, more remains to be done. Greater conceptual clarity concerning the types of measures to be used, the risks associated with placement instability, and a more accurate focus on a range of effects is needed. The development and testing of additional interventions to reduce placement disruption as well as to reduce system-created reasons for children’s placement moves is urgently needed. Importantly, the federal measure designed to help agencies understand and monitor their progress in reducing placement instability over time should be revised so that it is reliable and valid.

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1. The discrepancy between the federal measure and the CFSR measure is likely due to changing population dynamics, possibly related to improved performance on other indicators. Over the past decade the proportion of children reunified and adopted in a timely manner has been increasing in California (Needell et al. 2011). This changes the relevant population for the third measure of placement stability, causing it to include fewer children recently not reunified or adopted within two years; it consists proportionately more then of children who have been in care for long periods. The average number of placements of the group increases not because children entering care in recent years experience more placements than children who entered care in prior years but because the underlying population making up the denominator of the indicator is shifting over time to include a disproportionate number of “longstayers” in care and these children tend to have more placements. REFERENCES

Aarons, G., Hazen, A., Leslie, L., Hough, R., Monn, A., Connelly, C., Landsverk, J., & Brown, S. (2008). Substance involvement among youths in child welfare: The role of common and unique risk factors. American Journal of Orthopsychiatry, 78, 340–49. Aarons, G., James, S., Monn, A. R., Raghavan, R., Wells, R., & Leslie, L. K. (2010). Behavior problems and placement change in a national child welfare sample: A prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 70–80. Barth, R., Lloyd, E., Green, R., James, S., Leslie, L., & Landsverk, J. (2007). Predictors of placement moves among children with and without emotional and behavioral disorders. Journal of Emotional and Behavioral Disorders. 15, 46–55. Calkins, C., & Millar, M. (1999). The effectiveness of court appointed special advocates to assist in permanency planning. Child and Adolescent Social Work Journal, 16, 37–45. Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for foster parents: Effects on retention rates and outcomes for children. Child Welfare, 71, 387–401. Chamberlain, P., Price, J., Reid, J., Landsverk, J., Fisher, P., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? Child Abuse & Neglect, 30, 409–24. Children and Family Research Center (2011). Placement stability and number of children in a foster home. Urbana, IL: Children and Family Research Center, University of Illinois at Urbana-Champaign. Clark, H., Lee, B., Prange, M., & McDonald, B. (1996). Children lost within the foster care system: Can Wraparound service strategies improve placement

outcomes? Journal of Child and Family Studies, 5, 39–54. Connell, C., Vanderploeg, J., Flaspohler, P., Katz, K., Saunders, L., & Tebes, J. (2006). Changes in placement among children in foster care: A longitudinal study of child and case influences. Social Service Review, 80, 398–418. Courtney, M., & Barth, R. (1996). Pathways of older adolescents out of foster care: Implications for independent living. Social Work, 41, 75–83. Cross, T. P., Koh, E., Rolock, N., & Eblen-Manning, J. (2013). Why Do Children Experience Multiple Placement Changes in Foster Care? Content Analysis on Reasons for Instability. Journal of Public Child Welfare, 7(1), 751–62. Dozier, M., & Lindhiem, O. (2006). This is my child: Differences among foster parents in commitment to their young children. Child Maltreatment, 11, 338–45. Eckenrode, J., Rowe, E., Laird, M., & Brathwaite, J. (1995). Mobility as a mediator of the effects of child maltreatment on academic performance. Child Development, 66, 1130–42. Festinger, T. (1983). No one ever asked us: A postscript to foster care. New York: Columbia University Press. Foster, E., Hillemeier, M., & Bai, Y. (2011). Explaining the disparity in placement instability among African-American and white children in child welfare: A Blinder-Oaxaca decomposition. Children and Youth Services Review, 33, 118–25. Gauthier, Y., Fortin, G., & Jeliu, G. (2004). Clinical application of attachment theory in permanency planning for children in foster care: The importance of continuity of care. Infant Mental Health Journal, 25, 379–96. Havlicek, J. (2010). Patterns of movement in foster care: An optimal matching analysis. Social Service Review, 84, 403–35. Hurlburt, M., Chamberlain, P., DeGarmo, D., Zhang, J., & Price, J. (2010). Advancing prediction of foster placement disruption using Brief Behavioral Screening. Child Abuse & Neglect, 34, 917–26. Hyde, J., & Kammerer, N. (2009). Adolescents’ perspectives on placement moves and congregate settings: Complex and cumulative instabilities in out-of-home care. Children and Youth Services Review, 31, 265–73. James, S. (2004). Why do foster care placements disrupt? An investigation of reasons for placement change in foster care. Social Services Review, 78, 601–27. James, S., Landsverk, J., & Slymen, D. (2004). Placement movement in out-of-home care: Patterns and predictors. Children and Youth Services Review, 26, 185–206. James, S., Landsverk, J., Slymen, D., & Leslie, L. (2004). Predictors of outpatient mental health service use— the role of foster care placement change. Mental Health Services Research, 6, 127–41. Koh, E., & Testa, M. (2008). Propensity score matching of children in kinship and nonkinship foster care:

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Do permanency outcomes still differ? Social Work Research, 32, 105–16. Leathers, S. (2006). Placement disruption and negative placement outcomes among adolescents in longterm foster care: The role of behavior problems. Child Abuse & Neglect, 30, 307–24. Leathers, S., Spielfogel, J., McMeel, L., & Atkins, M. (2011). Use of a parent management training intervention with urban foster parents: A pilot study. Children & Youth Services Review, 33, 1270–79. Lewis, E., Dozier, M., Ackerman, J., & Sepulveda-Kozakowski, S. (2007). The effect of placement instability on adopted children’s inhibitory control abilities and oppositional behavior. Developmental Psychology, 43, 1415–27. Litzenfelner, P. (2000). The effectiveness of CASAs in achieving positive outcomes for children. Child Welfare, 79, 179–93. Maas, H., & Engler, R. (1959). Children in need of parents. New York: Columbia University Press. Needell, B., Brookhart, A., Jackman, W., Cucarro-Alamin, S., & Shlonsky, A. (2002). Youth emancipated from foster care: Findings using linked administrative data. Berkeley: Center for Social Services Research. Needell, B., Webster, D., Armijo, M., Lee, S., Dawson, W., Magruder, J., Exel, M., Cuccaro-Alamin, S., Putnam-Hornstein, E., Williams, D., Simon, V., Hamilton, D., Lou, C., Peng, C., Moore, M., Jacobs, L., & King, B. (2011). Child Welfare Services Reports for California. University of California at Berkeley Center for Social Services Research Web site, CWS/CMS 2010 Quarter 4 Extract. Retrieved June 21, 2011, from http://cssr.berkeley.edu/ucb_childwelfare. Newton, R., Litrownik, A., & Landsverk, J. (2000). Children and youth in foster care: Disentangling the relationship between problem behavior and number of placements. Child Abuse and Neglect, 24, 1363–74. National Resource Center for Permanency and Family Connections (NRCPFC) (2013). Working with siblings in foster care: A web-based NRCPFC toolkit. New York: NRCPFC. Retrieved October 26, 2013, from http://www.nrcpfc.org/toolkit/sibling/. Park, J., Mandell, D., & Lyons, J.. (2009). Rates and correlates of recurrent psychiatric crisis episodes among children and adolescents in state custody. Children and Youth Services Review, 31, 1025–29. Park, J., & Ryan, J. (2009). Placement and permanency outcomes for children in out-of-home care by prior inpatient mental health treatment. Research on Social Work Practice, 19, 42–51. Pears, K., & Fisher, P. (2005a). Emotion understanding and theory of mind among maltreated children in foster care: Evidence of deficits. Development and Psychopathology, 17, 47–65. Pears, K., & Fisher, P. (2005b). Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: Associations with prior

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maltreatment and placement history. Developmental and Behavioral Pediatrics, 26, 112–22. Pecora, P., Whittaker, J., Maluccio, A. & Barth, R. (2000). The child welfare challenge: Policy, practice and research. Hawthorne, NY: Walter de Gruyter. Price, J., Chamberlain, P., Landsverk, J., Reid, J., Leve, L., & Laurent, H. (2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment, 13, 64–75. Proctor, L., Skriner, L., Roesch, S., & Litrownik, A. (2010). Trajectories of behavioral adjustment following early placement in foster care: Predicting stability and change over 8 years. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 464–73. Rubin, D. M., Alessandrini, E. A., Feudtner, C., Mandell, D. S., Localio, A. R., & Hadley, T. (2004a). Placement stability and mental health costs for children in foster care. Pediatrics, 113, 1336–41. Rubin, D., Alessandrini, E., Feudtner, C., Localio, A., & Hadley, T. (2004b). Placement changes and emergency department visits in the first year of foster care. Pediatrics, 114, 354–60. Rubin, D., O’Reilly, A., Luan, X., & Localio, A. (2007). The impact of placement stability on behavioral well-being for children in foster care. Pediatrics, 119, 336–44. Ryan, J., & Testa, M. (2005) Child maltreatment and juvenile delinquency: Investigating the role of placement and placement instability. Children and Youth Services Review. 27, 227–49. Smith, D., Stormshak, E., Chamberlain, P., & Bridges Whaley, R. (2001). Placement disruption in treatment foster care. Journal of Emotional and Behavioral Disorders, 9, 200–5. Strijker, J., Knorth, E., & Knot-Dickscheit, J. (2008). Placement history of foster children: A study of placement history and outcomes in long-term family foster care. Child Welfare, 87, 107–24. Testa, M., & Rolock, N. (1999). Professional foster care: A future worth pursuing? Child Welfare, 78, 108–24. U.S. Department of Health and Human Services, Administration of Children, Youth and Families (2003). Summary of the results of the 2001 & 2002 Child and Family Services Reviews (April). Available at http://www.acf.hhs.gov/programs/cb/cwrp /2002 cfsrresults.htm. U.S. Department of Health and Human Services (2011). AFCARS, Data elements and definitions, foster care specific elements, placements. Child Welfare Policy Manual. Section 1.2, B.7: Administration of Children, Youth and Families, Children’s Bureau. Available at http://www.acf.hhs.gov/cwpm/programs/cb/ laws_policies/laws/cwpm/policy_dsp.jsp?citID=150. U.S. Department of Health and Human Services (n.d.). Table A: Data indicators for the Child and Family Services Review. Administration of Children, Youth and Families, Children’s Bureau. Retrieved May 4, 2011,

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from http://www.acf.hhs.gov/programs/cb/cwmonitoring/data_indicators.htm Wells, R., & Chuang, E. (2012). Does formal integration between child welfare and behavioral health agencies result in improved placement stability for adolescents engaged with both systems? Child Welfare, 91(1), 9–33. Unrau, Y., Chambers R., Seita, J., & Putney, K. (2010). Defining a foster care placement move: The perspective of adults who formerly lived in multiple out-of-home placements. Families in Society, 91, 426–32. Unrau, Y. A., Seita, J., & Putney, K. (2008). Former foster youth remember multiple placement moves: A journey of loss and hope. Children and Youth Services Review, 30, 1256–66. Usher, C., Randolph, K, & Gogan, H. (1999). Placement patterns in foster care. Social Services Review, 73, 22–36. Waxman, H. C., Houston, W. R., Profilet, S. M., & Sanchez, B. (2007). The long-term effects of the Houston Child Advocates, Inc. program on children and family outcomes. Child Welfare, 88, 25–48. Webster, D., Barth, R., & Needell, B. (2000). Placement stability for children in out-of-home care: A longitudinal analysis. Child Welfare, 79, 614–32.

Wells, R., & Chuang, E. (2012). Does formal integration between child welfare and behavioral health agencies result in improved placement stability for adolescents engaged with both systems? Child Welfare, 91(1), 9–33. Whittaker, J. (2000). The future of residential group care. Child Welfare, 79, 59–74. Winokur, M. A., Crawford, G. A., Longobardi, R. C., & Valentine, P. (2008). Matched comparison of children in kinship care and foster care on child welfare outcomes. Families in Society, 89, 338–46. Wulczyn, F. (2010). Placement stability in the context of federal policy. Child Welfare 360o, Center for Advanced Studies in Child Welfare, University of Minnesota. Wulczyn, F., Kogan, J., & Harden, B. (2003). Placement stability and movement trajectories. Social Service Review, 77, 212–36. Zima, B., Bussing, R., Freeman, S., Yang, X., Belin, T., & Forness, S. (2000). Behavior problems, academic skill delays and school failure among school-aged children in foster care: Their relationship to placement characteristics. Journal of Child and Family Studies, 9, 87–103.

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Foster Parent Recruitment, Retention, Development, and Support

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ver since nineteenth-century private charities and twentieth-century government agencies assumed the responsibility of securing other parents for children whose birth parents were not able to care for them, there have been policy, program, and practice challenges over who these other parents should be. Relatives traditionally filled that role through extended family networks. In 1991 Child Welfare League of America (CWLA) named those relationships kinship care and identified it as a program area with policies and practices different from family foster care (National Commission on Family Foster Care 1991; Pasztor 2010). Child Welfare League of America (1994) differentiated between the traditional “natural bridges” that families create between generations and the newer “government created bridges” providing parents for abused and neglected children. There are legal, social, emotional, and financial differences between the inherited roles of being someone’s grandmother, mother, grandfather, father, and sibling and the acquired roles of volunteering and being selected to be foster parents. This chapter focuses only on foster parenting; it does not address kinship caregiving or kinship foster parenting (see Hegar and Scannapeico’s chapter, this volume). The chapter has the following objectives and accompanying rationales: first, it provides a historical perspective on foster parent recruitment and retention. Turnover among line staff, supervisors, managers, and administrators mitigates against institutional memories of strategies that have and have not worked over the

years. In the time it takes to raise a generation of children, agency staff on all levels—from politically appointed executive directors in the public sector to line staff in faith-based agencies—may have turned over numerous times. Further, workloads are such that agency staff members do not have the time to access research, policy papers, and other literature that informs strategies for effective recruitment and retention. Agencies have limited resources to support staff members’ access to publications, attendence at professional conferences, or even participation in webinars. Second, finding and keeping foster parents require their having a defined role in fulfilling their respective agency’s mission and vision. We can only invest in recruiting and retaining foster parents when there is consensus on what we are finding and keeping them to do. As far back as 1941, a professional journal asked, “Are foster parents more like clients, more like colleagues, or something in between?” (Hanford 1941). Many decades and a new century later, the lack of role clarity and repeated experiences of being treated with little or no respect continues to negatively impact the retention of foster parents (Behana 1987; Faith Communities for Families and Children 2003; Pasztor 1985; Pasztor & Burgess 1982; Pasztor & Wynn 1995). According to Rodger, Cummings, and Leschied (2006), negative relationships with professional staff from the agency welfare agency were linked to foster parents’ decisions to quit. This chapter provides the rationale for a role shift for foster parents from being solely 601

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caregivers providing “bed and breakfast plus two more meals” to that of a resource parent and solid team member, a team leader, and an advocate for the children in their care. Most prospective and new foster parents do not walk in the door of an agency with the competencies needed to meet the Adoption and Safe Families Act (ASFA) of 1997 goal of safety, well-being, and permanency; these competencies have to be developed and supported. Third, if communities value families as the best places for children to grow up, then they must take responsibility to develop and implement “a comprehensive, culturally responsive, community-based strategic plan” or “model of practice for resource family development and support.” This plan or model must (a) connect the role of foster parents to their agencies’ mission and vision; (b) recognize that retention and support activities must be in place before recruitment and development begins, to avoid a “revolving door” of foster parents; (c) respect the diverse strengths and needs of ethnic and sexual minority (gay, lesbian, bisexual, transgender, and questioning) children and youth; and (d) engage the public, private, and business communities in a model of practice and comprehensive action plan that uses community problem solving, appreciates diversity, and builds collaborative relationships. Policies, programs, and practices are enhanced when there is a common language. Therefore this chapter begins with the definition of family foster care that has been advanced by the National Commission on Family Foster Care (NCFFC), which was convened in 1991 by CWLA and the National Foster Parent Association (NFPA). Prior to that date, the term was foster family care. The NCFFC rearranged the words to family foster care, emphasizing that foster care takes place in a family setting. A new definition was proposed that continues to be valid today: Family foster care is an essential child welfare service option for children and parents who must

live apart while maintaining legal and, usually, affectional ties. When children and parents must be separated because of the tragedy of physical abuse, sexual abuse, neglect, maltreatment or special circumstances, family foster care provides a planned, goal-directed service in which the care of children and youth takes place in an agencyapproved family. The value of family foster care is that it can respond to the unique individual needs of infants, children, youths and their families through the strength of family living. The goal of family foster care is to provide opportunities for healing, growth, and development leading to healthier infants, children, youth, and families, with safe and nurturing relationships intended to last a lifetime. Within this definition, foster parents must have a clearly defined role with identifiable competencies and supports. (National Commission on Family Foster Care 1991:51, 39)

Back to the Future Endeavors to recruit foster parents began before there was a formal child welfare system. From the mid nineteenth century until the Great Depression of 1929, the Orphan Train movement relocated more than one hundred thousand destitute immigrant children from the streets of New York City to families in America’s heartland. Handbills announcing the arrival of yesterday’s orphan trains have been transformed into contemporary mass marketing messages on billboards, city buses, the Internet, and Wednesday’s Child television segments. Simple contracts of indenture for families selecting a child from an orphan train have given way to a complicated maze of changing laws and policies. In the 1970s foster parents had to sign documents indicating that they would not attempt to adopt children placed with them; now they are expected to participate in concurrent planning and adopt children if reunification is not possible. Some dynamics remain the same. Caseworkers, along with the media, still refer to children

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being “up for adoption,” which comes from the 150-year-old practice of placing children up on train station platforms and theater stages so they could be viewed for selection. The notion that foster parents take children for the money derives from the orphan train days when older children were selected first because they could help work the farms. The challenges of placing nineteenth-century immigrant children having Italian, Irish, and German accents and Roman Catholic religious affiliation with Protestant families in rural America have given way to new cross-cultural placements of ethnic minority children from African American, Latino, and other cultures. In the U.S. the convergence of many systemic issues has impacted foster parent recruitment and retention. Economic stresses have impacted families’ abilities to have two and even one regular paycheck. The definition of the North American family is changing to include not only the traditional heterosexual two-parent family (both married and living together without marriage) but also single parents, stepfamilies, and same gender partner families (Downs et al. 2004). Rigid gender roles and agency efforts to create the “perfect family” affect the way in which many agencies define family and make it a compelling recruitment issue. The need for foster parents mandates us to serve children, but also to recognize the value of historically underutilized groups, such as single parents, people with limited incomes, kinfolk, and gays and lesbians (Mallon 2004). The disconnect between resources and the needs of a changing and aging population affects foster parent availability. Historically, a shortage of affordable, accessible child day care has meant that prospective foster parents could not find care for their own children, much less someone else’s. Now families also struggle to find adult day care for dependent parents, sometimes for many more years than the time it takes for their children to grow up. Current foster parents may be aging themselves. Some single foster parents have never been covered

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by social security and find in their older years a struggle to maintain a subsistence standard of living. The health care crisis leaves many families underinsured or uninsured, while mental health and family support services are being dismantled. Social and economic stress, family violence, and a continuing failure to win the war on drugs take a toll on children. By the time children enter the foster care system, “much emotional—if not physical—damage has already occurred. Many children in foster care come from families that are struggling with complex and interrelated problems including mental illness, substance abuse, homelessness, domestic violence, incarceration, and HIV/AIDS” (David and Lucile Packard Foundation 2004:2). Rather than experiencing family foster care as a healing opportunity, children continue to suffer because “too often the system lets those children down” (p. 2). The David and Lucile Packard Foundation (2004) attributed this in part to “overburdened caseworkers” and foster parents who do not get the help that they need (p. 2). Kortenkamp and Ehrle (2002) documented that the caregivers of many children in foster care are themselves “aggravated” by the demands of caregiving (p. 4). As long ago as 1991, the NCFFC concluded that children with special, if not extraordinary, needs must be cared for in a therapeutic environment by foster parents who have special if not extraordinary skills. In addition to skills, foster parents also need emotional strength and system supports (Pasztor & Wynn 1995). This outcome can only be achieved when the public is concerned about the discrepancy between the number of children needing care and the number of quality fostering families available to care for them. According to Berrick, Shauffer, and Rodriguez (2011): No national census of foster parents exists. Systematic records typically are not kept at the state level to enumerate active and available foster parents. Among the jurisdictions that keep such

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records, little is known about the quality of their available caregivers. In most communities, child welfare administrators indicate that the number of foster parents cannot accommodate the children in out-of-home care, and the recruitment and retention of foster parents are generally acknowledged as especially challenging. In those communities where the number of caregivers may be high, the capabilities of available caregivers may fail to match the characteristics and needs of children needing care. (p. 272)

Further, the child welfare system is continually viewed as being in “crisis.” That is a misleading word, implying a temporary condition. Actually, the foster care system has been “in crisis” for more than two decades, indicating that the ongoing state of dysfunction has become a de facto way of doing business. Given the mandates of ASFA, bold steps must be taken to ensure that foster parents can access the resources needed for children in their care, and that they become essential members of the caregiving team (Pasztor et al. 2004). Affirming the Role of Foster Parents as Resource Families Foster parent training programs, such those developed by Eastern Michigan University and Nova University in the late 1970s and Child Welfare Institute’s Model Approach to Partnerships in Parenting (MAPP) in the 1980s, emphasized a shift in the role of foster parents from clients receiving services to service providers needing supports. These programs recognized that there must be congruence between role definition and the training required to fulfill that role. By necessity, this new focus also addressed how casework staff should interact with foster parents as their team members, partners, or collaborators. In 1991 the NCFFC outlined a strategic plan to reframe family foster care with a clear and valued role for foster parents. Infants, children, and youth placed in family foster care should

only be placed with foster parents who had the competencies and supports to meet their unique needs. Foster parents must have a collaborative role in the delivery of services, including participation in case planning, administrative reviews, and court proceedings. It was also noted that foster parents could have specialized roles, such as caring for children with HIV/ AIDS or serving as role models for parents of children in care. However, given the trauma that children endure prior to being placed in family foster care, all foster parents should be able to provide a therapeutic family experience. By the mid 1990s the role of foster parents was clarified again through the PRIDE (Parent Resources for Information, Development, and Education) Model of Practice. PRIDE was developed as a partnership between the Illinois Department of Children and Family Services and CWLA, and a broad coalition of foster and adoptive parents, public and private agency staff, educators, and foundation support. The result was a competency-based program that advanced the child welfare field by referring to both foster and adoptive parents as “resource families” (Pasztor & Wynne 1995:33). The PRIDE Model of Practice identified five competencies for resource parents based on recommendations by the National Commission on Family Foster Care: a) protecting and nurturing children; b) meeting children’s developmental needs and addressing their developmental delays; c) supporting children’s relationships with their parents and/or kin; d) connecting children to safe and nurturing relationships intended to last a lifetime; and e) working as a member of a professional team (Petras & Pasztor 2011). This Model of Practice reconceptualized recruitment and retention as development and support. The premise is that most new resource parents do not initially possess the competencies needed to work with challenging children;

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these competencies must be developed though preservice training, on-the-job experience, collaboration with skilled casework staff, and interactions with agency, other resource parents, and the community. The PRIDE Model of Practice is now used in thirty-three jurisdictions across the United States and in more than a dozen other countries. With new language of “development and support” and “resource families,” additional language can be included to affirm the role of resource parents. It is essential to eliminate the use of the phrase foster home. Typically, caseworkers, educators, administrators, and researchers refer to foster homes rather than foster families. This usage makes it easy to forget that real people with real feelings are involved in the therapeutic care of children. It is not the home that hurts or heals a child, but the individuals living there. Families are further marginalized when expressions like “screening out” and “weeding out” are used to refer to the selection process, as opposed to the strengths-based terminology of “selecting in,” as advanced by MAPP. Youth transitioning from foster care can be an effective resource for recruitment and public awareness, and they may also have strong feelings concerning child welfare language. Youth representatives on the NCFFC explained that “being removed” refers to snow or garbage, whereas they experienced the trauma of “separation” from all that was familiar. They did not like others to refer to them as a “damaged child” when discussing their needs. Efforts to change perceptions rooted in the language of child welfare will involve a shift to a strengthsbased practice. In The Strength Perspective in Social Work Practice Saleebey (2002:81–82) stated, “it will take genuine diligence on your part to begin to appreciate and utilize strengths in practice. . . . The system is against you, the language and metaphors of the system are against you.” Youths desire this change, harboring strong feelings about labels attached to foster care. “I am not a label. I am a person

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who has been labeled all my life and I’ve always fought it” (Desetta l996:155). The following provides examples of strengths-based language as opposed to “stigmatizing language” (Silverstein et al. 2004; Pasztor, Petras, & Rainey 2011). The causes of the problems in recruiting and retaining or developing and supporting resource families are well documented; adopting the multifaceted approaches outlined in our knowledge base is essential. This begins with a clear definition of the role of resource families in the delivery of family foster care services. The field has been struggling to define this role of client, colleague, or something in between for over seventy years (Anderson 1988; Hanford 1941; Maas & Engler 1959; McFadden l996; Pasztor & Burgess 1982; Pasztor & Wynne 1995). It is not effective, efficient, or ethical to recruit individuals for a position that is not established and supported in an organization. Once the parameters of the role are established and valued, the community can be engaged to find and keep resource parents who are willing and able to fulfill that role. Certainly current foster parents must be involved in that process. And while no child would probably refer to his foster parents as “resource parents,” it is the concept of their being a resource to children and families and the system that is being promoted. In the UK, for example, foster parents are known as foster carers; it is doubtful that children refer to them as “my carer.” Creating a Resource Family Development and Support Model of Practice If communities value families as the best places for children to grow up, then communities must take responsibility to develop and implement a comprehensive, culturally responsive, community-based strategic plan for the recruitment, development, support, and retention of resource parents. The support plan for retention must be in place before recruitment and development begin, to avoid a “revolving door” effect. There are ten suggested components for

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a resource family development and support model of practice. The first step is to clarify the family foster care agency or program mission and vision. While wording may be unique to each agency, mission and vision statements probably address protecting and nurturing children and strengthening families, however families are defined. The renowned poet Maya Angelou stated, “Each family is so complex as to be known and understood only in part even by its own members. Families struggle with contradictions as massive as Everest, as fluid and changing as the Mississippi River. . . . Yet when practical, the preference should be for family” (Downs et al. 2004:271). All activities under the rubric of resource family development and support must link to the agency’s mission and vision. A second critical step is to clarify the role and responsibilities of resource families within the mission/vision. The field has had a “job/ role description” for foster parent tasks dating back to the 1991 National Commission on Family Foster Care, which include a complementary list of responsibilities for their caseworker role-reciprocals (1991:15–18). It included operationalizing the five competencies for resource families listed earlier, including participating in culturally competent strengths/needs assessments of children in their care; involving children, youth, and parents to the fullest extent in their service plans; providing emotional support around grief and loss; sharing accurate information; respecting confidentiality; supporting the access of children in their care to health, mental health, and educational resources; providing appropriate discipline; and more. It is critical that agency staff and resource families develop the role, task, or job description together, and that it reflects the mission and vision of the agency and its core principles or values. The job or role or task description can most easily be framed around the five PRIDE competencies. The attraction of these competencies is that they can be stated in a

“30-second sound bite.” When someone asks a resource parent what exactly it is that they do, they can say: “I protect and nurture children. I meet their developmental needs and address their developmental delays. I support their relationships with and/or feelings about their birth families. I connect them to safe, nurturing relationships intended to last a lifetime. And I do all of these activities with pride. What do you do for children?”1 Another essential step is to conduct a resource family strength/needs assessment. Before recruitment begins, an agency should know the number and nature of resource families needed. What are the demographic needs? Will the majority of families be needed to care for infants or for adolescents? What is the need for gay and lesbian resource parents? How many families are needed for sibling groups? How many families must be fluent in a language other than English? Does the agency have a large immigrant population, especially undocumented immigrants, and, if so, do you have a task force that has made recommendations (Earner 2005)? How many resource families are needed to provide emergency shelter? Instead of placing children by chance, the goal should be to place children by choice. This means having three waiting families to choose from each time a child must be placed, so that children’s needs and resource parents’ capacities can be matched. Excellent information on matching can be found in the Field Guide for Child Welfare, Volume IV (Rycus & Hughes 1998). Some foster parents may be unhappy at having to wait. Being a member of a professional team means understanding that to have one’s wish come true to be a foster parent a child has to be abused or neglected and another family has to come apart. This is a difficult but critical concept to internalize and accept. It may be helpful to emphasize the following: being a foster or resource parent, just like being a caseworker, is a privilege, not a right, but for a child to be protected and nurtured is a right, not a privilege.

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Getting the message out is a critical next step. The purpose is to inform the general community and prospective resource families about the need for and value of resource parents. Childplacing agencies must be aware of their reputation within their communities. Distrust of the dominant culture is found within communities of color, whose children are overrepresented in out-of-home care. This has not always been the case as, in the early twentieth century, African American children were excluded from the child welfare system (Roberts 2001), living of course with kin. They have had the highest overrepresentation of all ethnic groups in foster care, followed by Native Americans. Asian American and Hispanic children tend to be underrepresented, even in states with large Latino populations. Until we can prevent the unnecessary separation of African American children from their families, finding and keeping African American resource families are critical components of a model of practice (Denby & Rindfleisch 1996). A comparison of role perceptions of white and African American resource parents found that African American resource parents were more likely than their white counterparts to facilitate relationships between children and their parents and to see themselves as contributing to the emotional development of the children in their care (Nasuti, York, & Sandell 2004). Other groups of children living in ethnic enclaves, such the Hmong in central California and children of Mideastern descent in southeastern Michigan, are appearing in foster care populations. Native American children were afforded some protection through the Indian Child Welfare Act passed in 1978, which strengthened the role of tribal governments in determining custody of Indian children. Diverse community leaders must be involved in resource parent development and support activities if the historical distrust of the formal system is to be overcome. Places of worship are often linked with a potential resource family’s willingness to foster (Cox, Buehler, & Orme

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2002). Programs such as One Church One Child make use of trusted leadership within the faith community to locate resource families. Outreach to other religious groups is essential to keep children connected to their faith-based and spiritual communities. Literature dating back more than two decades describes the health and mental health needs of abused and neglected children requiring family foster care and the challenges of serving them from the perspectives of physicians, agencies, and resource parents themselves (Pasztor et al. 2004). Helping professionals who serve at risk populations represent a possible source of resource parents with the knowledge and skills to care for special children with extraordinary needs. This group of professionals may not only provide children specialized care but may also facilitate a community dialogue on multidisciplinary delivery of services, as they have learned to work across disciplines in advocating for the needs of their clients. Multidisciplinary community teams working with resource families on behalf of young children in foster care at risk for special educational services have been successful in early identification of needs. Wraparound services for children and youth have been successful in keeping children and youth in the least restrictive community placement (Walker & Bruns 2003). One-shot recruitment activities are rarely effective; recruitment efforts need to be ongoing, consistent, and persistent (Moore, Grandpre, & Scroll 1988; Rodwell & Biggerstaff 1993; Pasztor, McNitt, & McFadden 2005). The method of communicating the need may vary from community to community, but keeping the message in the public eye on a regular basis is essential. Brochures, posters, fliers, billboards, outreach at community events, inserts in utility bills, awards banquets, and public service announcements on the radio and television are only some of the possible approaches. Having a slogan or logo helps institutionalize the message. The message should be positive and

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focus on the strengths of fostering rather than on the rescue of children. Mass marketing is needed to address the negative image of foster care held by the public in general. For every article that is written about a foster care tragedy, letters to the editor should flood the newspaper regarding positive interventions. It may be helpful to build community support for fostering by offering opportunities for volunteers—tutoring, for example—with the message “You don’t have to be a foster parent to help a child in foster care.” There can be agency-hosted Web sites, and e-mail is a means for resource parents to communicate with staff and each other. However, the digital divide must be taken into consideration for resource families who tend to be less resourced. Knowledge of demographic and census data concerning resource parents may identify community locations for recruitment. Knowing where resource parents shop and what radio stations they listen to may provide effective outreach, and ethnic media offers new opportunities for recruitment. Looking for collaborating partners outside the child welfare arena was the focus of a research project titled “Recruiting for Excellence in Foster Care: Marrying Child Welfare Research with Brand Marketing Strategies” (Berrick, Shauffer, & Rodriguez 2011). Looking for “high quality foster parents” as defined through focus groups of resource parents and caseworkers, characteristics included (a) loving and nurturing the health development of the child, (b) accepting the child as a full member of the family, (c) advocating for the needs of the child, (d) strengthening the child’s connection to the birth family, (e) valuing the role of team member, and (f) knowing when to ask for help. Using partners with marketing expertise, the project relied on six media messages focusing on the characteristics listed (p. 276–77). It was far from the historical “rescue” recruitment themes of “open your home and heart” to a waiting (and usually sadlooking) child. “Developing high-quality, rich

caregiving experiences should be a fundamental goal for all child welfare agency administrators” (p. 279). Agencies should apply licensing standards consistently and not raise the bar for families of color. The law does not allow discrimination against Euro-American families in the placement of a child of color. So, too, families of color cannot be discriminated against in setting standards for licensing, which can become a barrier to resource development. How families are treated in the process may not only set the stage for the successful completion of the licensing process but also determine how long the family remains a resource for children. The responsiveness of the agency to the recruited family and a positive approach to these families in the development process is essential (Bussiere 1995). Development and support activities must be neighborhood based, and easily accessible, using places of worship and community centers where families of color may be comfortable. Consideration of the unique needs of sexual minority children is part of resource parent development and support. The needs of gay, lesbian, bisexual, transgender, and questioning youth (GLBTQ) have only started to be addressed in the 1990s (DeCrescenzo & Mallon 2002; Mallon 1997). Similarly, there must be policy and practice attention to the development and support of gay and lesbian resource parents. Just as there is concern regarding cross-cultural or transracial placements, attention must be given to the diverse ways gay and straight resource parents may work differently with GLBTQ youth in their care. There are dynamics that must be considered when sexual minority youth are matched with resource parents of the same sexual orientation (Ramos & Pasztor 2003). Gay and lesbian communities should be approached for leadership and assistance in finding and keeping resource parents who can meet the special if not extraordinary needs of sexual minority youth . . . especially those who are at risk of

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transitioning from foster care without connections to at least one safe, nurturing adult. Both the North American Council on Adoptable Children and CWLA support policies and practices that entitle potential gay and lesbian resource families to fair and equal consideration (Mallon 2004). Once outreach begins, there must be a strategic plan to respond to inquiries. It has been documented for decades that prospective resource families often consider fostering for much more than a year before making the first inquiry call (Berrick, Shauffer, & Rodriguez 2011; Pasztor & Burgess 1982; Pasztor &Wynne 1995). Groze, McMillan, and Haines-Simeon (1993) have noted that contact with someone who has received foster care or who has fostered is related to the motivation to foster. Many times the first contact with the agency is a voice mail message. This impersonal response can be disconcerting. It is critical to have a friendly, informed, and welcoming voice on the other end of the call. Foster parent associations may be able to assist, under contract, to provide experienced mentoring resource parents who can answer calls and provide general guidance and discuss nonconfidential information. The message should be, “We are so delighted you have called our agency. Do you know we have 100 or 200 or 300 foster parents, whom we call resource parents, and we want to make you number 101, or 201, or 301! We have information to share and to ask, where would you like to start?” The purpose of having a special step to respond to inquiries is to (a) set the tone for the process of teamwork with resource families; (b) begin the process of mutual selection leading to an informed decision about the willingness, ability, and resources of both the prospective resource parents and the agency to work together; and (c) determine the next step. An information packet could be mailed or e-mailed. It should include a description of the types of children and youth in need of care and the statutory requirements to become a resource

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parent. Dougherty (2001) has explained that current resource parents can be recruiters, trainers, and mentors to new resource parents. All too often, the role that an experienced resource parent can have is not formalized by agencies. The use of the social network of experienced resource parents opens the door for targeted marketing. It should be noted that foster fathers are silent voices in the fostering experience. They are typically at work when caseworkers come to meet with the foster mother and children; they may have “behind the scenes” influence, but little overt presence. Their opinions, experiences, concerns, and influences must be acknowledged, and outreach to foster fathers can be valuable. Wilson, Fyson, and Newstone (2007) learned that 48 percent of the foster fathers with whom they connected reported that fostering was their idea. A formal message of thanks for the inquiry is essential. This should include specific information about the agency’s preparation/assessment program and when the next group of preparation/selection sessions will start. Most important, it must include a statement about the agency’s mission and vision and the role of resource parents in achieving the mission and the vision. Once prospective resource families begin the process of preservice training, or a preparation program, and the assessment process begins as well, is where support and develop overlap. Both preparation/preservice and inservice training are essential components of the development and support plan. However, most agencies provide training that is either money driven, based on available funding, or time driven, based on how many hours they believe resource parents will devote to participating. However, training is only as effective as the policy that directs it and the supervision that reinforces it (Telles-Rogers, Pasztor, & Kleinpeter 2004). Training, no matter how excellent, cannot compensate for deficits in the system.

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The following training checklist can help assess cost-effectiveness: a) Does the agency have a clearly defined role for what resource families are being trained to do? b) For what level of competence is the training designed? c) How will the training address the unique strengths and needs of ethnic and sexual minority children and resource parents? d) What is the trainers’ skill level? e) How is the training tailored for resource parents who are not comfortable with English? f) How is the training content supported by and commensurate with agency policy and practice? g) Is the training designed for adult learners? h) Is the training offered to meet some kind of training requirement, or is it thoughtfully designed as part of an agency’s strategic plan? i) Is there a match between the level at which the curriculum is written, the skill level of the trainers, and the needs of the participants? j) How will the training be evaluated, and how will the results influence ASFA outcomes? (Pasztor 2009:20). Foster parents associations can and do provide realistic training and support for both new and experienced resource parents. In fact, they should be essential partners in almost every aspect of foster parent development and support (Pasztor & McFadden 2006). It could be argued that development and support are continuously integrated. But once a resource family is certified, licensed, or approved, and children are matched and placed, the formal process of development transitions to continuous support. Research documents that there are twenty-five components to resource family retention. These were

adapted from a book about foster parent retention and recruitment (Pasztor 2009) by Fostering Families Today magazine and developed into a checklist. A critical step in any resource family development and support model of practice is having exit or transition meetings when resource families discontinue fostering. The reasons may be because of life circumstances (job transfer), adoption of children in their care; or a sad event (death of a family member, abuse of a child). This information must become an integral part of an agency’s continuous quality improvement program. Agencies need to know the number and nature of all critical incidents, accidents, and grievances related to resource families. Evaluation of practice as to what works under what circumstances is necessary. There is much conventional wisdom about how to best retain and recruit or support and develop resource families. Qualitative and quantitative research typically has not guided that wisdom. Child welfare practitioners may know better than we do, yet more data are needed. “The value of systematic training for foster parents is well-established. Foster parent training has been shown to reduce the incidence of failed placements, increase the number of desirable foster parents, and to encourage foster parents to remain licensed” (Downs et al. 2004: 351). Collaboration and advocacy is an essential component of a resource family development and support model of practice (Rosenwald & Riley 2011). Abused and neglected children requiring family foster care belong to and in their neighborhoods and communities. A neighborhood or community cannot be a place where children are harmed and then moved to a different location to be healed. Resource families are members of their neighborhoods and communities; local support is merited. Child welfare agencies, whether public, private, or faith based, must work together to identify resources and challenges within communities that promote or hinder effective fostering.

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Perceptions of the agencies, their staff, and their current resource families are key to engaging communities. According to Rhodes and colleagues (2003), family resources have been associated positively with willingness to care for special needs children. For many families these resources are depleted. Along with the pressures of family finances, it should be anticipated that resource families, like other American families, will have their share of problems with physical and mental health, parenting, and marital issues. When such problems occur, it may be difficult for families to continue fostering. State legislatures can set a tone for the importance of family foster care by creating a favorable environment for the development of resources. Positive attention by legislatures may improve the often tarnished image of foster care. The NFPA, through the Council of State Presidents, has endeavored to seek universal passage of a Foster Parent Bill of Rights. Such bills address the essential role of resource families by serving vulnerable children or participating with the state child welfare agency in the creation and implementation of relevant policies and procedures. A mass marketing message about the value of resource families is achieved when legislatures partner with foster parent associations and agencies in the passage of a Foster Parent Bill of Rights. Development and support activities are often grouped together, but they involve different strategies. As resource families are service providers (not service recipients), development and support initiatives must ensure that they are included in all aspects of service delivery (Goodman & Steinfield 2012). Resource parents must work with a wide range of professionals in their communities, such as schools, health care providers, and mental health practitioners. They have connections to civic organizations, unions, and places of worship. Those groups could be engaged strategically in the development and

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support of resource families; group members might even become resources themselves. Local and state foster parent groups and associations must be advocates in the process of developing and supporting resource families. But in practice “child welfare workers have always made the critical decisions, too often regarding birth parents as adversaries and foster parents as employees in the day-to-day work of caring for children at risk” (Omang & Bonk 1999:17). Advocacy requires a sharing of power and resources. Collaborative relationships with law enforcement and child welfare agencies concerning finger printing and timely records checks of prospective resource parents assist in the licensing process. If the family is unable to meet standards of safety set by state licensing standards, further training and development activities are not expended. Collaboration occurs when tasks are divided between child welfare agencies responsible for licensing and community organizations that partner to develop and support foster families. While there is a considerable literature on agency collaboration and interdisciplinary collaboration, the child welfare field is less informed about collaboration between individuals who are involved in the unique dynamics of family foster care. There are two dynamics that must be considered: the challenge of demographic diversity and the challenge of authority versus attachment (Pasztor, Petras, & Rainey 2011). Resource parents tend to be demographically different from caseworkers, their role reciprocal. Compared to a new child welfare caseworker, resource parents will tend to be older and more likely to be married. They also will be more likely to have children by birth and be of color. They will be less likely to have a college degree. Most of us tend not to associate with individuals who are demographically different than we are; yet, in spite of these differences, diverse groups of resource parents and caseworkers must learn to collaborate on

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a range of emotionally charged issues such as money and payments, discipline, parent-child visiting, and sexual abuse. Other conflicts arise because resource families often have attachments to children but no real authority over them. Caseworkers have authority but no deep attachment, otherwise there could be a “boundary issue.” While conflict is inherent if not inevitable, in these relationships conflict resolution training typically is not on the list of preservice and in-service training topics (Pasztor, Petras, & Rainey 2011). Once the role of the resource parent as a collaborative partner is further defined, child welfare agencies must also be respectful of the potential for conflict inherent in the agency/resource family relationship. The resource parent is not a full colleague in the traditional sense, nor is the resource parent a client. Agency administrators, along with caseworkers and their supervisors, must be cognizant and respectful of these role conflicts. Without such a commitment, the result is collab-petition (individuals who pretend to work together, but are working at cross-purposes). As communities define their needs for family foster care, the range of fostering options should be addressed. What has been termed general foster care may serve some children. Given trauma that most children entering care are reported to have experienced because of the tragedy of physical abuse, sexual abuse, and neglect, it appears that most should have access to treatment foster care, requiring resource parents with special training and skills. Research documents the effectiveness of therapeutic foster care with salaried foster parents who can file treatment plans, work with the parents of children in care, and produce measurable outcomes that contribute to program effectiveness. This form of professional foster care is promising for emotionally challenged children who increasingly comprise the foster care population. A comprehensive plan for the support and development of resource parents ultimately

hinges on their value to their communities in general and their agencies specifically. At the core is the relationship between resource parents and caseworkers. There is considerable literature on why foster parents discontinue their critical work. The lack of agency support and communication has consistently been found to be a key variable associated with foster parent discontinuance. This finding has held through all the studies dating back at least twenty years, whether the lack of support and communication is related to a child management issue, a resource challenge, a birth parent conflict, or the trauma of abuse allegations (Anderson 1988; Behana 1987; Carbino 1991; McFadden 1985; Pasztor 1985; Rodger, Cummings, & Lesheid 2006). Rodger, Cummings, and Lesheid have reported that “being an advocate, along with not being recognized as part of the professional team or having expertise, were the themes expressed most frequently by foster parents. Being recognized for this contribution and being included as an integral part of the clinical team may not only insure more cohesive and effective services, but may also be the determining factor for foster families remaining with an agency” (2006:1140). A critical component of collaboration and advocacy must focus on finding and keeping the role reciprocals of resource parents: casework staff. Resource families cannot be fully supported and developed without a comprehensive strategic plan to develop and support child welfare social workers. However, agencies suffering administrative turnover lack leadership with necessary institutional memory. Administrators without social work backgrounds in general, or child welfare expertise in particular, also may lack knowledge of salient research findings. Politicians and administrators who do not know what to do, or do not want to invest in what has been demonstrated as effective, tend to commission new studies or implement an agency reorganization. This gives the illusion of change or reform, whereas the reality is “running to keep in place,” as the

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Urban Institute’s recent report on the child welfare system was titled (Malm et al. 2001). The “Demand for Social Workers in California” study for the California legislature highlighted that, without a comprehensive, strategic plan to find and keep casework staff (or resource families), “a new generation of politicians, lawmakers, agency administrators, and educators will struggle with the same problems. Another shortage study will be commissioned, and the cycle will begin again” (Pasztor, Saint Germain, & DeCrescenzo 2003:38). It is reasonable to ask: how long will it take to develop the public will and political leadership to do the right thing and to do things right—the first time, on time, and every time—for vulnerable families involved in the tragedy of physical abuse, sexual abuse, neglect, and emotional maltreatment? (Pasztor & McCurdy 2009). YYY

The 2005 version of this chapter emphasized the principles spelled out in the National Association of Social Workers’ (NASW) Child Welfare Section Connection titled, “The Face of Adoption and Foster Care Has Changed: What About

NOTES

Authors Pasztor and McNitt recognize the thoughtful, scholarly, and creative contributions of Emily Jean McFadden to the original chapter. These have been carried over to and integrated with sections of this revised chapter. 1. The PRIDE Model of Practice operationalizes these competencies into measurable, observable behaviors. For more information on the competencies, see www.cwla.org/pride. REFERENCES

Anderson, S. (1988). Foster home retention survey: Findings from former foster parents in Bay Area counties. San Francisco: Bay Area Community Task Force on Homes for Children. Behana, N. (1987). Foster parents’ perceptions of agency support. Master’s thesis, San Diego State University, School of Family Studies and Consumer Science.

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Our Beliefs?” (King 2003:4). It offered a six-step process, adapted from Maxwell’s Thinking for a Change (1996): t
When we change our thinking, we change our beliefs. t
When we change our beliefs, we change our expectations. t
When we change our expectations, we change our attitudes. t
When we change our attitudes, we change our behaviors. t
When we change our behaviors, we change our performance. t
When we change our performance, we change our practice. Another valuable set of principles to consider in finding and keeping or developing and supporting foster parents or resource families are those promulgated by the NASW Code of Ethics (www.socialworkers.org): How are we being competent? How are we showing dignity? How are we demonstrating integrity? How are we respecting the importance of human relationships? How are we providing service? How are we advocating for social justice?

Berrick, J., Shauffer, C., & Rodriguez, J. (2011). Recruiting for excellence in foster care: Marrying child welfare research with brand marketing strategies. In E. Pasztor & B. Thomlison, eds., Journal of Public Child Welfare, special issue on Advocacy and Public Relations, 5, 271–81. Bussiere, A. (1995). A Guide to the Multiethnic Placement Act of 1994. Washington, DC: American Bar Association. Cahn, N. (2002). Race, poverty, history, adoption, and child abuse: Connections. Law & Society Review, 36, 461–90. Carbino, R. (1991). Child abuse and neglect reports in foster care: The issue of foster families and ‘false’ allegations. Child and Youth Services, 15, 233–47. Child Welfare League of America (1994.) Kinship care: A natural bridge. Washington, DC: Child Welfare League of America. Cox, M., Buehler, C., & Orme, J. (2002). Recruitment and foster family service. Journal of Sociology and Social Welfare, 29, 151–77.

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David and Lucille Packard Foundation (2004). Children, families, and foster care: Issues and ideas. Los Altos, CA: David and Lucile Packard Foundation. DeCrescenzo, T., & Mallon, G. (2002). Serving transgender youth – The role of child welfare systems. Washington, DC: Child Welfare League of America. Denby, R., & Rindfleisch, N. (1996). African American’s foster parenting experiences: research findings and implications for policy and practice. Children and Youth Services Review, 18, 523–551. Dessetta, A., ed. (1996). The heart knows something different: Teenage voices from the foster care system. New York: Persea Books, Inc. Dougherty, S. (2001). Toolbox No. 2: Expanding the role of foster parents in achieving permanency. Washington, DC: Child Welfare League of America. Downs, S. (1986). Black foster parents and agencies: Results of an eight state survey. Children and Youth Services Review, 8, 201–18. Downs, S., Moore, E., McFadden, E., Michaud, S., & Costin, L. (2004). Child welfare and family services: Policies and practice. New York: Pearson. Earner, I. (2005). Immigrant children and youth in the child welfare system: Immigration status and special needs in permanency planning. In G. Mallon & P. Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 655–65). New York: Columbia University Press Faith Communities for Families and Children (2003). Foster parent recruitment and support. Retrieved October 24, 2011, from www.usc.edu/dept/LASreligion_online/families/recruitment.html. Goodman, D., and Steinfield, F. (2012). Building Successful Resource Families: A Guide for Public Agencies. Baltimore: Annie E. Casey Foundation. Groze, V., McMillen, J. C., & Haines-Simeon, M. (1993). Foster families caring for children with HIV: A pilot study. Child and Adolescent Social Work Journal, 10, 67–87. Hanford, J. (1941). Child placement and the family agency. Social Service Review, 15, 706–11. Herczog, M., van Pagee, R., & Pasztor, E. (2001). The multinational transfer of competency-based foster parent assessment, selection, and training: A nine country case study. Child Welfare, 80, 631–44. King, G. (2003). The face of adoption and foster care has changed: What about our beliefs? In NASW Child Welfare Section Connection (July), 3–6. Washington, DC: National Association of Social Workers. Kortenkamp, K., & Ehrle, J. (2002). The well-being of children involved with the child welfare system: A national overview. Washington, DC: Urban Institute. Lutz, L. (2002). Recruitment and retention of resource families—the promise and the paradox. Seattle, WA: Casey Family Programs. Maas, H., & Engler, R. (1959). Children in need of parents. New York: Columbia University Press.

McFadden, E. (1985). Preventing abuse in family foster care. Ypsilanti MI: Eastern Michigan University. McFadden, E., & Ryan, P. (1991). Maltreatment in family foster homes: dynamics & dimensions. Child and Youth Services, 15, 209–31. Mallon, G. (1997). Basic premises, guiding principles, and competent practices for a positive youth development approach to working with gay, lesbian, and bisexual youth in out-of-home care. Child Welfare, 76, 591–610. Mallon, G. (2004). Recruiting and retaining lesbian and gay foster and adoptive parents. Washington, DC: Child Welfare League of America. Malm, K., Bess, R., Leos-Urbel, J., Geen, R., & Markowitz, T. (2001). Running to keep in place: The continuing evolution of our nation’s child welfare system. Assessing the new federalism. Occasional Paper Number 54. Washington, DC: Urban Institute. Maxwell, J. (1996). Thinking for a change. New York: Warner. Moore, B., Grandpre, M., & Scroll, B. (1988). Foster home recruitment: A marketing approach to attracting and licensing applicants. Child Welfare, 67, 147–60. National Association of Social Workers (1996). NASW code of ethics. Washington, DC: Author. National Commission on Family Foster Care (1991). A blueprint for fostering infants, children, and youths in the 1990’s. Washington, DC: Chilf Welfare League of America. Nasuti, J., York, R., & Sandell, K. (2004). Comparison of role perceptions of white and African American foster parents. Child Welfare, 83, 49–68. Omang, J., & Bonk, K. (1999). Family to family: Building bridges for child welfare with families, neighborhoods, and communities. Policy and practice of public human services, 57, 15–21. Orme, J. G., & Buehler, C. (2001). Foster family characteristics and behavioral and emotional problems of foster children: A narrative review. Family Relations 50, 3–15. Pasztor, E. (1985). Permanency planning and foster parenting: Implications for recruitment, selection, training, and retention. Children and Youth Services Review, 7, 191–206. Pasztor, E. (2004). The impact of abuse allegations on children and foster parents – Scholarly and creative activities grant. Long Beach: Department of Social Work, California State University. Pasztor, E. (2009). Confessions of a foster parent trainer. Fostering Families Today (July/August), 16–21. Special issue on foster parent training. Pasztor, E. (2010). The history of a name. Fostering Families Today (March/April), 20. Pasztor, E., & Burgess, E. (1982). Finding and keeping more foster parents. Children Today, 2, 36. Pasztor, E., Hollinger, D., Inkelas, M., & Halfon, N. (2004). Health and mental health services for

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children in family foster care: Foster parents’ perspectives. Child Welfare, 83. Pasztor, E. & McCurdy, M. (2009). When work comes home and home goes to work: Child welfare social workers as foster and adoptive parents. In E. GriseOwens & K. Lay, (eds.), Reflections: narratives of professional helping. Special issue of Inside Out: Reflections on Personal and Professional Intersections, 15, 95–105. Pasztor, E. M., McNitt, M., & McFadden, E. J. (2005). Foster parent development and support: Strategies for the twenty-first century. In G. P. Mallon & P. M. Hess (eds.), Child welfare for the 21st Century: A handbook of practices, policies, and programs (pp. 665–86). New York: Columbia University Press. Pasztor, E., & McFadden, E. (2006). Foster parent associations: Advocacy, support, empowerment. Families in Society, 87, 483–90. Pasztor, E., McNitt, M., & McFadden, E. (2005). Foster parent development and support: Strategies for the twenty-first century. In G. Mallon & P. Hess (eds.), Child welfare for the twenty-first century: A handbook of practices, policies, and programs (pp. 665–86). New York: Columbia University Press. Pasztor, E., Petras, D., & Rainey, J. (2011). Collaborating with kinship caregivers: A research to practice evidence-based training program for child welfare workers and their supervisors. Washington, DC: Child Welfare League of America. Pasztor, E., Saint-Germain, M., & DeCrescenzo, T. (2003). Demand for social workers in California. Retrieved October 23, 2011, from http://www.csus/edu/calst/ Government_Affairs/faculty_program.html. Pasztor, E., & Wynne, S. (1995). Foster parent retention and recruitment: State of the art in practice and policy. Washington, DC: Child Welfare League of America. Petras, D., & Pasztor, E., eds. (2011). The PRIDE model of practice guidebook. Washington, DC: Child Welfare League ofAmerica. Ramos, D., & Pasztor, E. (2003) Preparing heterosexual and sexual minority youth in foster care for independent living. Poster presentation at CWLA National Conference on Research in Child Welfare, Miami, November 13.

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Rhodes, K., Orme, J., & Buehler, C. (2001) A comparison of family foster parents who quit, consider quitting, and plan to continue fostering. Social Service Review, 75, 85–114. Rhodes, K., Orme, J., Cox, M., & Buehler, C. (2003). Foster family resources, psychosocial functioning, and retention. Social Work Research, 27. Roberts, D. (2001). Shattered bonds: The color of child welfare. New York: Basic Books. Rodger, S., Cummings, A., & Leschied, A. (2006). Who is caring for our most vulnerable children? The motivation to foster in child welfare. Child Abuse & Neglect, 30, 1129–42. Rodwell, M. K., & Biggerstaff, M. A. (1993). Strategies for Recruitment and Retention of Foster Families. Children and Youth Services Review, 15 (5), 403–19. Rosenwald, M., & Riley, B. (2011). A model of foster care advocacy for child welfare practitioners. In E. Pasztor & B. Thomlison, Journal of Public Child Welfare, special issue on Advocacy and Public Relations, 5, 251–70. Rycraft, J. (1994). The party isn’t over: The agency role in the retention of public child welfare caseworkers. Social Work, 39, 75–80. Rycus, J. & Hughes, R. (1998). Field guide to child welfare (vol. 4). Washington, DC. Child Welfare League of America. Saleebey, D. (2002). The strength perspective in social work practice, 3rd Ed. Boston: Allyn and Bacon. Silverstein, D., Roszia, S., Pasztor, E., & Clark, H. (2004). Adoption clinical training (ACT). Monterey, CA: Kinship Center. Telles-Rogers, T., Pasztor, E., & Kleinpeter, C. (2004) The impact of training on worker performance and retention: Perceptions of child welfare supervisors. Professional Development: The International Journal of Continuing Social Work Education, 39–49. Walker, J., & Bruns, B. (2003). Quality and fidelity in wraparound. Focal Point: A National Bulletin on Family Support and Children’s Mental Health (Fall). Wilson, K., Fyson, R. & Newstone, S. (2007). Foster fathers: Their experiences and contributions to fostering. Child & Family Social Work, 12, 22–31.

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hild welfare law and the child welfare court systems are the outgrowths of centuries of developing and defining the legal relationship between children, their families, and the government. This development reflects the views of society and lawmakers on whether and how the government ought to intervene in the private lives of children and families. The family exists in American society today as a largely autonomous social unit. It is not created by the government and, absent extraordinary circumstances, it cannot be terminated by the government. It is largely a myth that the government has broad and extensive authority to intervene into family life for the purpose of regulating the treatment of children or substituting its judgment for that of parents. To the contrary, the right to parent children as a family chooses (the right of parentage) is subject to fundamental constitutional protections. It can only be removed after a showing, by clear and convincing evidence, that a parent is unfit. And an unfitness determination can only occur following a threshold judicial finding of abuse or neglect. This is a considerable prerequisite to governmental intervention. The best interests of the child is indeed the guiding standard by which judicial placement of a child is governed. However, the government does not have authority to regulate best interests unless there is first a finding of abuse and neglect. This threshold requirement prevents the government from ever intervening into the lives of the vast majority of American families. Family autonomy is, therefore, an ideological foundation of child welfare law. Such autonomy

exists not only before the state intervenes in the family but also as a guiding principle once intervention is authorized by abuse or neglect. The federal law, as expressed in the states’ child welfare codes, requires the government to preserve the family by avoiding removal of children and by prioritizing reunification of children with the family so long as the children’s safety can be assured. The child welfare professional operates, therefore, under a special exception to the general rule of law that the government may not intervene in family matters. Without this child maltreatment exception, the child welfare professional would not be authorized to intervene and bring a matter before the court system. This is the context under which child welfare work is conducted. Incidence of Maltreatment Despite the fact that most American children and families will never be involved in the child welfare system, the number of systeminvolved children is significant. Approximately 399,546 children live in foster care. It is estimated that court action occurs in approximately 43 percent of cases, involving over 53,000 children (National Resource Center for Permanency and Family Connections 2011). In 2012 approximately 58,587 children experienced the termination of parental rights (U.S. Department of Health and Human Services 2012). The significant numbers of children involved in the child welfare system is a relatively modern condition that did not come about until the child welfare movement 616

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of the 1970s. It is instructive for the child welfare worker to understand how the current system developed. Development of Child Welfare Law and the Juvenile Court System: A Legal-Judicial Model The American child welfare system follows a legal-judicial model. This means that the rights and obligations of children, caregivers, and the government (and each of these parties’ agents) are defined by our laws and our judicial system. The juvenile courts function as the oversight authority and arbitrator of child welfare controversies. This is not necessarily true of other countries or other systems within the U.S., such as the health care system. Americans, however, tend to be rightsbased thinkers and value autonomy vis-à-vis the government, particularly where the family is concerned. The view that government needs to be checked and limited is deeply rooted in the American perspective. So it should not be surprising that Americans have viewed government involvement with family matters as a potential infringement on their rights, which must be defined by laws and managed by courts. The Adversarial Advocacy System The juvenile court dependency system, consistent with the U.S. judicial system generally, is an adversarial system where parties, typically through their lawyers, confront the court with competing interests. The adversarial system is premised on the notion that just outcomes flow from a process where competent lawyers advocate zealously for clients’ interests. The legal system is a process-based system more than it is an outcome-based system. The legal system does not presume to know what is best for parties, but rather it is committed to giving voice to competing interests in the belief that the process, not preconceived notions of the best outcome, will produce justice. The Gault decision is a powerful illustration of this

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point. Gault was a landmark Supreme Court decision that held that juveniles accused of crimes in a delinquency proceeding must be afforded many of the same due process rights as adults, such as the right to timely notification of the charges, the right to confront witnesses, the right against self-incrimination, and the right to counsel. The Gault court found that the history of the juvenile court to that point was an outcome-based system under the “benevolent intentions” approach that disregarded process in order to accomplish a preconceived end. The court concluded that children were disserved by the outcome-based system. However, the child welfare/dependency component of the juvenile court in the twentyfirst century is still specialized, with unique rules and procedures, in contrast to traditional, general jurisdiction American courts. With rare exceptions, judges, rather than juries, determine outcomes. Judges are more likely to be proactive and take a role in the process in child welfare court, by asking questions of the witness, for example. Evidentiary standards that make it difficult to admit certain evidence in general jurisdiction courts are typically loosened in child welfare court. Caseworker reports, for example, are frequently taken into account even though they would be excluded as hearsay under the law of evidence. These evidentiary rules are particularly relaxed at the dispositional phase of a child welfare proceeding. The Role and Duties of Legal Counsel An adversarial system depends on competent advocates who allow the court to appreciate individual clients’ interests and reach just outcomes. In child welfare proceedings it is imperative that each of the primary parties— the child, the parents, and the agency—has competent legal counsel. These lawyers’ basic function is to provide competent legal advocacy for their clients, just as any other lawyer would, despite the unique circumstances and procedures of the juvenile court.

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Child’s Counsel There is no conclusive constitutional authority mandating that children in child welfare cases are entitled to appointed legal representation (Haralambie 2009). There is a consensus in the child welfare policy community that children should be provided independent legal counsel because it benefits the child and the system. Lawyers for children can ensure that children’s perspectives and interests are brought to the court’s attention. Lawyers can also be instrumental in expediting cases and promoting the child’s interest in a permanent resolution. CAPTA provides that a representative, who may or may not be a lawyer, must be appointed for every child. The CAPTA representative is called a guardian ad litem (GAL), and she is required to represent the best interests of the child. States choose who will serve as a GAL and whether other representatives, such as a court appointed special advocate (CASA) or traditional (non–best interests) lawyer, will be appointed. The majority of U.S. jurisdictions appoint a lawyer to serve in the role of the GAL, while other states allow nonattorneys to fill this role (Duquette 2011). A minority of jurisdictions appoint a lawyer to serve the role of a traditional attorney rather than a GAL. Proponents of an attorney model of representation argue that otherwise the child is disadvantaged by a lack of legal advocacy. When a lawyer is appointed as a GAL, the lawyer serves in the hybrid role of legal counsel with an emphasis on the child’s best interests. The reasoning underlying this model is that children, due to their immaturity, are not capable of directing their lawyer the way an adult would. This can cause confusion and may pose ethical dilemmas. Lawyers, as a general rule, are charged with representing the wishes of the client and not substituting their own judgment about what they believe to be in their client’s best interests. Zealous advocacy of a client’s position is a cornerstone of the practice of law. The lawyer in the role

of a GAL, therefore, can face a difficult ethical dilemma when the client’s wishes conflict with the lawyer’s view of the child’s best interests. In such cases lawyers can resolve the problem by counseling the client and relying on ethical standards. Additionally, the traditional ethical obligation of keeping a client’s confidence may be more complicated when a lawyer serves as GAL. Because a GAL is required to represent a client’s best interest, the lawyer may encounter a situation where he needs to reveal something that the child told the lawyer in confidence in order to do so. The contradictions that result from placing a lawyer in the role of a GAL have been part of an omnipresent, unresolved debate in the child advocacy legal community for many years. The debate centers on the question whether lawyers for children should represent the child’s best interests or the child’s expressed wishes. There tends to be agreement that children need independent legal representation but that a traditional attorney model is not fully appropriate for children. Increased child welfare lawyer training and education, combined with the development of ethical standards and guidelines specifically adopted to dilemmas faced by lawyers who represent children, will help the lawyer for the child achieve the crucial balance between providing legal advocacy and protecting the child client. Parent Counsel Some parents retain private legal counsel to represent them, but many parents in child welfare cases are indigent and receive appointed counsel. State law determines whether, and at what stage, a lawyer is appointed to a parent. The Lassiter case provides some constitutional parameters for states in making this determination (see http://www.lawnix.com/cases/ lassiter-social-services.html for an overview). Competent legal representation of all parties, including parents, is essential to ensuring fairness throughout the process.

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Counsel for the parent serves the traditional role of a lawyer, with a duty to provide competent and zealous advocacy for her client. Because parents have a fundamental constitutional liberty interest in parenting their children, the parent attorney has a critical responsibility to the client and the system. Government Counsel Agency counsel is charged with the powerful responsibility of “prosecuting” the child welfare case. Agency counsel typically initiates the case by filing the petition. It then has the burden to prove the allegations while serving the system goals of child safety, family preservation, timeliness, and permanence. Agency counsel can typically be classified as falling into one of two general categories, or models, as defined by state law. Under the “prosecutorial model,” the attorney represents the people of the jurisdiction, just like a prosecutor in a criminal case. This means that the agency attorney has the authority and responsibility to make prosecutorial decisions in the interests of the people. These lawyers are typically the district attorney, county attorney, city attorney, or attorney general. Under the “agency attorney model,” the attorney represents the state child welfare agency and must follow the direction of the agency. Agency attorneys are typically employed by the state child welfare agency. In this model the caseworker assigned to the case serves as the voice of the agency client. This is an important distinction for the child welfare worker. Even under the “prosecutorial model,” however, the department should have a voice in the prosecution of the case. Attorneys in both the “agency attorney” and “prosecutorial” model should value the position of the agency as expressed by the caseworker. Standards of Practice State Regulatory Standards The conduct of lawyers, including the role and duties of a lawyer in relation to a specific client, are governed

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by the American Bar Association Model Rules of Professional Conduct adopted by each state. The ABA Model Rules describe a lawyer’s duties of advocacy, competence, loyalty, and confidentiality, among others. An instructive provision of the ABA Model Rules, particularly for the child’s counsel, is Rule 1.14 on “Representing a Client with Diminished Capacity.” Additional authority for the child welfare lawyer may exist in state statutes (appointment statutes), state or local court rules, or special state ethics standards or guidelines. Instructive Authority The American Bar Association has passed three sets of ethics standards for lawyers who work in child welfare. These standards are not binding authority unless they have been adopted by the state. They are the products of years of child welfare community input and collaboration and can be very instructive in handling ethical matters. The three sets of ethics standards are the ABA Standards of Practice for Lawyers Who Represent Children in Abuse and Neglect Cases (American Bar Association 1996), the ABA Standards of Practice for Lawyers Representing Child Welfare Agencies (American Bar Association 2004), and the ABA Standards of Practice for Attorneys Representing Parents in Abuse and Neglect Cases (American Bar Association 2006). The Relationship Between Social Workers and Attorneys Social workers practicing in the child welfare field are frequently forced to adapt to this attorney-driven adversarial system, which may seem needlessly complex and even contrary to the best interests of the child and the family. For example, a parent may be hostile or uncooperative because of the perception that the social worker is an opponent, or a social worker who has been assisting a struggling parent may be required to effectively testify against the parent at a termination of parental rights (Weinstein 1997). From the social worker’s perspective, the

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legal system’s emphasis on fair processes and procedural protections may seem to interfere with the ability to reach the “correct” outcome. The historical development of the juvenile court helps explain why, from a lawyer’s perspective, the adversarial system is generally superior to the alternatives. But that does not mean that social workers must act more like lawyers or that lawyers must act more like social workers. It does mean, however, that they must cooperate despite their sometimes contradictory views of what is causing the problem at hand and how best to resolve it. Commentators emphasize the need for cooperation and respect between attorneys and social workers, but there may be different ways of achieving these goals depending on the context and the personalities involved. It may be beneficial to clearly distinguish the responsibilities of each party to reduce the opportunities for conflict (Laver 2011). Yet lawyers cannot prepare effective legal arguments without understanding the facts behind the dispute, which often requires frequent and open communication with the social worker. As mentioned, attorneys are still grappling with how best to represent the interests of the child client. Social workers are often in the best position to gather information from the child and explain his perspective. They can use their abilities and experience to help the lawyer communicate with the child and understand what course of action is in the child’s best interests (American Bar Association 2006). The social worker can communicate the specific story of an individual or family in a legal system that may seem cold, impersonal, and unconcerned with the circumstances of each case. This will improve the quality of legal advocacy even if it does not bring the goals and perspectives of the attorney and the social worker into harmony. The Court Process A child welfare case proceeds through the court system in the following stages or phases, with some variation. The child welfare caseworker

must appreciate the purpose of each phase and her role in it. Good communication and preparation between the agency attorney and caseworker is especially critical in navigating these phases. Emergency Removal Hearing Cases are initiated by the filing of a petition that can either precede or follow the emergency removal of a child. Sometimes a child is not removed, but rather allowed to remain in the home. Where removal occurs, an emergency removal hearing is held. These are also called detention, shelter, or preliminary hearings, and they typically must occur within seventy-two hours of removal. These hearings are sometimes preceded by an order (usually obtained ex parte) that authorizes the removal of the child. During this phase the agency must typically prove that there is abuse or neglect, or danger of abuse or neglect, by showing probable cause or prima facie evidence (the lowest standard of proof). Adjudication Sometimes called jurisdiction, adjudication is the phase where the agency must prove, usually by a preponderance of the evidence (an intermediate standard of proof), that the child is dependent due to abuse or neglect. This is the stage that most resembles a traditional trial in terms of the calling of witnesses and presentation of evidence. The relevant issue is the conduct of the parent(s) prior to the filing of the petition. Disposition If a child is adjudicated dependent, then the court may proceed to disposition, which generally immediately follows adjudication. At this phase the agency must, typically by a preponderance of the evidence, show what is in the child’s best interests regarding the child’s current placement, the terms of contact between parent and child, and the services to be provided to parent and child.

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Case Planning While not a hearing, case planning meetings are held to produce the federally required case plan. The parents and the child are entitled to participate. Review Hearings Review hearings must be held at least every twelve months. The court determines whether the child is safe, what changes should be made to assure safety, and whether the child can be returned home. Permanency Hearings The 1997 Adoption and Safe Families Act (ASFA) mandates that a permanency hearing be held within twelve months of the time a child enters care. The purpose of a permanency hearing is to select the appropriate permanency plan for the child. Plans may include permitting the child to return home, termination and adoption, guardianship, or other permanent placements with relatives. Permanence hearings must be held at least every twelve months. If a court determines that reasonable efforts are no longer appropriate, the court must hold a permanency hearing within thirty days. Termination (TPR) TPR is a formal traditional court hearing similar to adjudication. ASFA requires states to terminate parental rights, as a general rule, when the child has been in foster care for fifteen of the most recent twenty-two months, is an infant who has been abandoned, if the parent has killed a sibling, or other egregious circumstances exist. TPR is optional where the child is in relative care, the agency shows compelling reasons why TPR is not in the child’s best interests, or the state has not provided necessary services to the family. To achieve TPR, the state must prove unfitness through failure to comply with a reunification plan by clear and convincing evidence (the highest civil standard of proof). States also typically require a showing that TPR is in a child’s best interests.

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Post-Termination Review Post-TPR review hearings are required if a child has not been immediately adopted. The court must determine that adequate services are being given to the child, a realistic placement plan is being aggressively pursued, and educational stability is ensured. Adoption Adoption or legal guardianship is the final stage of child welfare court proceedings. Courts are typically required to make findings that the child is free for adoption and that the proposed adoption is in the child’s best interests. Adoption may be seen as a proceeding outside the parameters of the child welfare case. Reform Efforts Not surprisingly given the challenges described in this chapter, there are numerous proposals to reform the child welfare court. Hardin has proposed reforms designed to ensure that all phases of the process are completed in a timely manner, that the parties are guaranteed complete and in-depth hearings, that judges and attorneys are skilled and knowledgeable, that courts and agencies coordinate their efforts, that technology is used effectively, and that all parties before the court are treated properly (Hardin 2002). Increasing the coordination between courts and agencies is likely the most relevant, and one of the most frequently cited, of these reform efforts. Some states have emphasized coordination in their program improvement plans (PIP) in response to federal Child and Family Service Reviews (CSFRs) or through their court improvement plans (CIPs; Fiermonte & Salyers 2005). Increased collaboration can be fostered through cross-disciplinary training, meetings and working groups, and sharing information so that courts are aware of the services available and agencies are aware of changing court procedures (Hardin 2002). Cooperation also has positive effects on other areas where many commentators agree that reforms are needed.

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For example, improved communication may further goals like timeliness and permanence, and attorneys and judges can become more knowledgeable through increased exposure to other aspects of the process and different perspectives. Some jurisdictions have experimented with moving toward a “One Family/ One Judge/ One Treatment Team” model, since continuity and an integrated approach is thought to improve outcomes (Flango, Flango, & Rubin 1999). Coordination between courts and agencies may have similarly positive effects even if it is not feasible to create a unified family court or ensure that the same judge hears all cases regarding a particular family. Court System Evolution The juvenile child welfare court is the product of years of evolution, yet it is far from perfect. The system arguably serves children and

REFERENCES

American Bar Association (1996). ABA standards of practice for lawyers who represent children in abuse and neglect cases. Retrieved July 27, 2011, from http:// www.americanbar.org/content/dam/aba/migrated/ family/reports_abuseneglect.authcheckdam.pdf. American Bar Association (2004). Standards of practice for lawyers representing child welfare agencies. Retrieved July 27, 2011, from http://apps.americanbar.org/child/rclji/agency-standards.pdf. American Bar Association (2006). Standards of practice for attorneys representing parents in abuse and neglect cases. Retrieved July 27, 2011, from http:// apps.americanbar.org/child/clp/ParentStds.pdf. American Bar Association (2010). Model rules of professional conduct: Rule 1.14 Client with diminished capacity. Retrieved July 27, 2011, from www.americanbar.org/groups/professional_responsibility/publications/model_rules_of_professional_conduct/ rule_1_14_client_with_diminished_capacity.html. Child Welfare Information Gateway (2011). Foster care statistics 2009. Retrieved July 25, 2011, from http:// www.childwelfare.gov/pubs/factsheets/foster.cfm. Duquette, D.N. (2011). Giving children their say in court. Washington, DC: Court Appointed Special Advocates. Duquette, D., & Haralambie, A. (2010). Representing children and youth. In D. Duquette & A. Haralambie (eds.), Child welfare law and practice: Representing

families better than it ever has in our history. Yet the system is still flawed because of a lack of resources, excessively high worker caseloads, inadequate professional compensation and professional training, and the overrepresentation of children and families of color. Poverty has been part of the child welfare system since its origins in Elizabethan England, and it is still with us. Our law has evolved, however, to provide better and fairer processes for both children and families. Reform efforts from the government and private agencies continue in the areas of professional education, training and development, system measurement, system accountability, and system reform. In addition to performing well at his job within the system, the child welfare worker can take his experiences to the policy level and be part of the history of child welfare law and the juvenile court system as it progresses.

children, parents, and state agencies in abuse, neglect and dependency cases, pp. 617–40. Denver: Bradford. Fiermonte, C., & Salyers, N. (2005). Improving outcomes together: Court and child welfare collaboration. Retrieved July 28, 2011, from http://fosteringresults. org/reports/pewreports_06–22–05_improvingout comes.pdf. Flango, C., Flango, V., & Rubin, H. (1999). How are courts coordinating family cases? Retrieved July 28, 2011 from http://contentdm.ncsconline.org/cgi-bin/ showfile.exe?CISOROOT=/famct&CISOPTR=69. Fostering Connections to Success and Increasing Adoptions Act. (2008). P.L. 110–351. Haralambie, A. (2009). Handling child custody, abuse, and adoption cases (vols. 1–3). New York: West. Hardin, M. (2002). Improving courts’ handling of child abuse and neglect cases: A list of suggested reforms. Retrieved July 28, 2001, from http://apps.americanbar. org/child/rclji/samlist.pdf. Laver, M. (2011). Agency attorneys and caseworkers: Working well together. In D.  N. Duquette & A.  H. Haralambie (eds.), Child Welfare Law and Practice: Representing Children, Parents, and State Agencies in Abuse, Neglect and Dependency Cases (pp. 565–78). Denver: Bradford. McKinney-Vento Homeless Assistance Act (1987). P.L. 100–77. National Resource Center for Permanency and Family Connections (2011). Foster care fact sheets. Retrieved

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July 25, 2011, from http://www.hunter.cuny.edu/ socwork/nrcfcpp/info_services/fact-sheets.html. U.S. Department of Health and Human Services (2009). Child maltreatment 2007. Retrieved July 25, 2011, from http://www.acf.hhs.gov/programs/cb/ pubs/cm07/. U.S. Department of Health and Human Services (2011). The AFCARS report: Preliminary FY 2010 estimates as of June 2011. Retrieved July 25, 2011, from http://www.

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acf.hhs.gov/programs/cb/stats_research/afcars/tar/ report18.htm. U.S. Department of Health and Human Services (2013). The AFCARS Report: Final estimates for FY2012. Retrieved October 26, 2013, from http://www.acf.hhs.gov/ programs/cb/stats_research/afcars/tar/report20.htm. Weinstein, J. (1997). And never the twain shall meet: The best interests of children and the adversary system. University of Miami Law Review, 52, 79–175.

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hildren, youth, and families in the child welfare system deserve the best researchinformed practice support from a professionally educated, committed, and highperforming child welfare workforce. Building a stable and effective workforce is an important goal for child welfare agencies across the country, as their service quality and effectiveness depends every day on the professionals at the front lines who provide critical services to vulnerable children and families (Farber & Munson 2010). According to the National Association of Public Child Welfare Administrators (2011:3), the “workforce is the most important and expensive resource that agencies must invest in to achieve their goals and objectives.” This chapter discusses the demographics of the current child welfare workforce as well as the evolving role of the frontline child welfare professional over the last two centuries and the historical factors that have shaped that role. The chapter also highlights long-standing workforce challenges and provides information about federal sources of support for workforce development. A number of innovations that hold great promise for strengthening the ability of the workforce to more effectively impact the lives of vulnerable children, youth, and families are also presented. Workforce Demographics The findings of various workforce studies and surveys conducted over the last ten years offer a general snapshot of frontline child welfare caseworkers in the Unites States today. The

child welfare workforce encompasses a diverse group, representing various program areas (family support and preservation, child protection, foster care, adoption, postadoption, youth development, juvenile justice), locations (public state or county, tribal, voluntary/private/nonprofit), and environments (rural, urban, suburban). Frontline child welfare workers tend to be white and female (Dolan et al. 2011; National Association of Social Workers 2004), although they are more likely to be African American if they work in urban settings (Barth et al. 2008). Nearly three-quarters are between the ages of twenty-five and forty-four (Dolan et al. 2011). The majority of caseworkers hold bachelor’s degrees (52.3 percent) or baccalaureate social work degrees (21.9 percent), while nearly 25 percent hold master’s-level degrees (Dolan et al. 2011). Frontline casework staff members earn annual salaries that range between $30,000 and $49,999 (Dolan et al. 2011). Role of the Workforce Historical Context The work of child welfare is most closely associated with the profession of social work. Both emerged at approximately the same time in the United States, at the end of the nineteenth century. The parallel development of child welfare as a career and social work as a profession has linked the two for more than a century. There is also a deeper connection that is based on the social values and beliefs that are reflected in the “work” of caring for and serving others. 624

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Child welfare practice has its roots in the juvenile justice advocacy that started in Cook County, Illinois and quickly encompassed services for the immigrant families flooding American cities during the Industrial Revolution. At the same time, social work leaders such as Jane Addams, Mary Richmond, Julia Lathrop, and Graham Taylor were beginning to build institutions that became the earliest social work organizations and education centers (National Association of Social Workers 1998). Like the child welfare workforce of today, the earliest labor force was comprised predominantly of women who valued work with an orientation toward social justice principles. For example, Mary Richmond trained lay volunteers to provide services that embodied social assistance coupled with personal and moral development. Jane Addams invited colleagues to live in the neighborhoods that were most in need and help build social networks that provided advocacy, services, and educational opportunities for immigrants and poor families. In 1903 Graham Taylor and others established the Chicago School of Civics and Philanthropy, which later became the University of Chicago School of Social Service Administration. This was followed by the launching of similar programs at Columbia University in New York City and other states in 1906 (National Association of Social Workers 1998). The Children’s Bureau was created in 1912 and headed by social worker Julia Lathrop. As a result of these roots, there has been a strong relationship between social work education and child welfare services since the beginning of the Children’s Bureau in 1912 (Briar-Lawson, McCarthy, & Dickinson, 2013). This relationship has had a significant— though varying—effect on the child welfare workforce over time. Julia Lathrop was the first director of the Department of Social Investigation at the Chicago School of Civics and Philanthropy (precursor to the School of Social Administration) (Almgren, Kemp, & Eisinger 2000). The new profession of social work participated in research projects funded

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by the Children’s Bureau and promoted the use of the social casework method in the bureau’s administration of mothers’ pensions (Machtinger 1999). In their reform agenda of mothers’ pensions, the Children’s Bureau “wanted to ensure the quality of services by requiring delivery by trained social workers” (Machtinger 1999:110). At that time social workers were trained almost exclusively by emerging schools of social work. Child welfare came to be viewed as a highly regarded social work specialty, and the leaders in the evolution and development of child welfare sought out trained social workers to comprise their workforce. Thus the preferred degree in child welfare agencies was the MSW (Child Welfare League of America 2002). This partnership was strong until the advent of the Depression, which refocused the energy of the nation on relief and recovery. Simultaneously, rapid developments in the understanding of mental illness and human behavior led to new approaches in social work practice that addressed the needs of individuals. Hence social work practice shifted from a focus on human rights and community advocacy to individual therapy designed to address psychological deficits (Kemp et al. 2001). During that time the demand for social work increased dramatically due to the return of veterans from World War II who were suffering from serious injuries and mental health needs. As a result, professionally trained social workers were called upon to work in the developing mental health system, leaving child welfare systems without much funding or visibility (McGowan 2005). In 1958, amendments to the Social Security Act mandated that states fund child protection efforts.. The War on Poverty refocused the nation on the needs of poor women and children and child welfare services became part of a constellation of services designed to keep women and children from living in destitution. Child welfare essentially disappeared from the public view until pediatricians and the media reawakened the public to the plight of children

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who were being physically abused. The term battered child syndrome was first used in 1962 as a medical diagnosis as a result of advances in X-ray technology. This new diagnosis led to increased public awareness and federal concern such that Congressional hearings were called to better understand this phenomenon, ultimately resulting in child abuse reporting laws in all states by 1967 and the first child abuse reporting systems in 1974 (Nelson 1984). As reporting laws went into effect and public awareness increased, the ever increasing numbers of reports began to illustrate the national prevalence of child abuse and neglect. This is clearly illustrated by the increase in reports of suspected maltreatment from sixty thousand in 1974 to over two million by 1990 and nearly three million in 2000—a 5,000 percent increase in twenty-six years (Myers 2008). As the need for child welfare services expanded, however, a shortage of graduate level social workers developed. In the 1950s close to 50 percent of child welfare staff were professional social workers, but by the 1980s only 26 percent had a BSW or MSW degree (Clark 2003). In their 2008 article Barth and his colleagues reported that findings from the National Survey of Child and Adolescent Well-being indicated 49 percent of child welfare workers held a nonsocial work bachelor’s degree, while 40 percent held BSW or MSW degrees. There is no continuity across states in the educational requirements for child welfare staff, despite research showing that a social work degree is a strong contributor to child welfare worker retention and improved worker competence (Fox, Miller, & Barbee 2003; Jones & Okamura 2000). Current Role As noted in the previous section, child welfare has expanded and contracted over the past century in response to social, economic, and political changes through the country. The current child welfare service framework reflects a societal belief that government has the right to

intervene in a family if parents behave in ways that put their children at risk of harm or fail to protect them from harm. Child welfare services are the intervention mechanism. How this mechanism is delivered can vary greatly, due in part to differences in systemic structure. Some child welfare systems are administered by the state, while others are supervised by the state but administered by their respective counties. Other systems are partially or fully privatized, such that child welfare services are delivered by private/not for profit agencies through contracts with the state or county. Additionally, nearly all tribes operate some form of child protection services, and many have their own tribal codes, court systems, and child welfare programs (Cross, Earle, & Simmons 2000). These diverse, frequently changing workplace environments require a flexible, welleducated workforce capable of implementing services that are value-driven, responsive to the law, and reflective of effective practice strategies. The frontline child welfare professional is responsible for translating broad federal, state, and tribal agency goals and objectives into everyday strategies and actions that result in real change in the lives of children, youth, and families. The current scope of child welfare practice focuses on t
ensuring safety for children from harm and reducing risk of future harm; t
ensuring permanence for children in safe environments; t
maximizing family engagement to develop resources in support of children and to strengthen their families; t
providing case management and intensive services to families with complex mental health, substance abuse, domestic violence, and socioeconomic challenges; t
identifying and facilitating supports that ensure the best possible outcomes for the child and family with the greatest potential for well-being.

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According to guidance put forth by the National Association of Public Child Welfare Administrators (2010), the child welfare workforce is a “fundamental but multifaceted ingredient of capacity. Some agencies rely more on specialty workers; others rely on generic workers. Some agencies include administrative tasks as part of its program staff ’s responsibilities; others limit those tasks to staff hired solely to perform administrative work” (2010:10). Regardless of the type of worker or the specific duties assigned, most child welfare professionals are expected to have or attain the following qualities, values, knowledge, and skills for competency in their work: A final factor influencing the role of the child welfare caseworker has been the emergence of a more rigorous science identifying practices that work and those that are ineffective. The child welfare workforce must be capable of modifying their work with families to reflect legislated priorities and practice guidance that are evidence informed or evidence based. As Casey Family Programs (2011:9) stated in their recent report on the role of accountability in child welfare finance reform: “If state and county child welfare systems are to be held accountable for results, then the management of caseworkers and units should be balanced between compliance with a regulatory framework and an emphasis on outcomes. Professional commitment to knowledge-based practice and to high standards of conduct should be strongly supported, and initiative should be rewarded.” Impact of the Child Welfare Workforce The importance of the child welfare workforce in the lives of children, youth, and families is frequently underscored by studies and reports that detail what happens when caseworkers are either overstressed (high caseloads) or unavailable (high turnover). There is a somewhat cyclical relationship between high turnover and high caseloads. As McKenzie, McKenzie, and Jackson (2007:4) explain, “in child and family service agencies, uncovered workloads are both

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a cause and effect of high turnover. . . . Having a high vacancy rate can lead to a chaotic and unsafe situation for supervisors, front-line staff and the children and families served.” Nationally, the average annual turnover rate is approximately 20 percent (Alliance for Children and Families et al. 2001; Alwon & Reitz 2000). In a 2005 study, turnover rates in child protective services were compared to those in other government services (22 percent versus 9 percent, respectively), clarifying that CPS turnover occurred nearly two and a half times that of other government employees (APHSA 2005). Child welfare workers in public agencies remain an average of two years on the job (National Association of Social Workers 2003); turnover rates are approximately twice as high in the private sector (Alliance for Children and Families et al. 2001; Alwon & Reitz 2000). High turnover negatively impacts worker morale and service delivery (Faller et al. 2009). When workers leave, remaining workers’ workloads increase, and their morale declines (Graef & Potter 2002). This leads to another cycle of worker turnover. Worker turnover has also been found to negatively impact children and youth, who experience more placement disruptions and longer stays while in foster care as well as increased rates of maltreatment recurrence, loss of trusting relationships and second chances (Flower, McDonald, & Sumski 2005; National Council on Crime and Delinquency 2006; Strolin, McCarthy, & Caringi 2007; Strolin-Goltzman, Kollar, & Trinkle 2009; U.S. General Accounting Office 2003a, b). These studies further clarify that attention must be given to addressing the negative impact of an unstable, ill-prepared, and/or unsupported child welfare workforce on the lives of children and families. Workforce Challenges The twenty-first century is distinguished by the ubiquitous discussions of work and the workforce across all fields and professions. Workplaces need better trained employees;

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TA B L E 3 5 . 1 Core values

Child Welfare Caseworkers: Values, Knowledge, and Skills Belief that t t t

All people have a reservoir of untapped, renewable, and expandable abilities (mental, physical, emotional, social, and spiritual) that can be used to facilitate change. Each child has a right to a permanent family. Each child and family member should be empowered to work toward his or her own needs and goals.

Commitment to t t t t t t

Using a strength-based, child-centered, family-focused practice. Assuring the safety of children in the context of their family. Practicing complete confidentiality. Ensuring accountability and an end-results orientation. Implementing quality professional practice. Continuing pursuit of knowledge and skills to effectively accomplish the mission of CPS.

Respect for t t Core knowledge

Persons of diverse racial, religious, ethnic, and cultural backgrounds, and a belief that there is strength in diversity. Each person's dignity, individuality, and right to self-determination.

Understanding of t t t t t

t

Family systems, the family's environment, the family in a historical context, diverse family structures, and concepts of family empowerment. Individual growth and development with particular attention to attachment and bonding, separation, loss, and identity development. Child abuse and neglect dynamics. Cultural diversity, the characteristics of special populations, and the implications for assessment and intervention. Continuum of placement services including the foster care system, the residential care system, kinship care, placement prevention, familial ties maintenance, family reunification, and adoption. Services including crisis intervention, parenting skills training, family counseling, conflict resolution, and individual and group counseling.

Command of t t t

Case management issues and responsibilities. Child welfare and child protection programs and models. Principles of permanency planning for children and the role of out-of-home care.

Familiarity with t t t t t t t

Special problems of poverty, oppression, and deprivation. Substance abuse issues and their effect on children and families. Dynamics of community and family violence, including partner abuse and the impact of trauma. Direct services available to children and families in the mental health, health care, substance abuse treatment, education, juvenile justice, and community systems. Wraparound services available for families through the economic security, housing, transportation, and job training systems. Legal systems related to child welfare practice. Political and advocacy processes and how they relate to funding and acquiring services.

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Core skills

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Ability to t t t t t t t t t

Identify strengths and needs and engage the family in a strengths-based assessment process. Take decisive and appropriate action when a child needs protection. Analyze complex information. Be persistent in approach to CPS work. Employ crisis intervention and early intervention services and strategies. Assess a family's readiness to change and employ appropriate strategies for increasing motivation and building the helping alliance. Function as a case manager and a team member, and collaborate with other service providers. Assess for substance abuse, domestic violence, sexual abuse, and mental illness. Work with birth families to create a permanent plan for a child in foster care, kinship care, or group care.

Aptitude for t t t t t t

Developing and maintaining professional relationships with families. Listening. Remaining flexible. Working with involuntary clients, including those who are hostile or resistant. Working with legal systems, including documentation and court testimony. Empowering the child and family to sustain gains and use family and community supports.

Expertise in t t t t

Assessing for abuse, neglect, and the safety of the child and others in the family setting. Negotiating, implementing, and evaluating the case plan with the family. Working with the family and key supports to accomplish the service agreement goals. Applying knowledge of human behavior and successful intervention methods with children and adolescents at various developmental stages.

Source: Depanfilis & Salus 2003.

turnover is an ongoing problem due to poor supervision, training, or workplace climate; there are limited numbers of people entering professional education programs; and rural communities lack workers for a range of professions such as fire departments, engineering, or medicine. Even in times of recession, when quality employees should be available and hungry for work, corporations and organizations strive to keep the best and the brightest in their workforce and struggle to recruit people with the requisite knowledge, skills, and abilities to carry out quality practices (Economist 2011). Over the last twenty years, child welfare organizations have encountered all these issues and

more, due to the complex challenges associated with endeavoring to provide tailored, supportive services to vulnerable children, youth, and families. Recruitment, Screening and Selection The recruitment, screening, and selection of candidates for child welfare positions have been hampered not only by the lack of a specific process to recruit, screen, and hire the right candidates for the right positions but also by regulations originally designed to open up jobs to wider groups of people. Civil service rules and union contracts drive child welfare workforces in twenty-seven states.1 These labor

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contracts structure recruitment and advertising, testing procedures, hiring conditions, interview protocols, and selection procedures. While originally designed to increase access to government positions for qualified applicants at a time of rampant cronyism and hiring practices based on patronage, these “protections” have ultimately resulted in contractually based, rule-bound personnel management strategies that leave few opportunities for targeted, effective recruitment and selection. In states that are not governed by civil service regulations, recruitment, screening, and selection may be more flexible. However, those doing the hiring are often not trained in the latest human resource practices, which create an effective platform for identifying and selecting the best-prepared applicants, based upon a specific set of competencies. Competencies are defined as the knowledge, skills, behaviors, personal attributes, and other characteristics associated with or predictive of superior job performance. The ability to specify those characteristics that differentiate the average worker from the exemplary worker is fundamental to any competency-based system (CPS Human Resource Services n.d.a, n.d.b). Although competency-based hiring has been shown to be more effective at selecting child welfare workers who have a stronger aptitude for the work and stay longer (Bernotavicz 2008), many jurisdictions have yet to embrace this model. Educational Preparation and Training Educational preparation and training are also necessary components to building and maintaining an effective child welfare workforce. With the continuing emphasis on assuring effective outcomes of child welfare practice, agencies must recruit new employees whose educational backgrounds prepare them well to engage in such practice and who can take advantage of core and advanced training to improve their skills. As noted earlier, research has indicated that employees with an educational

background in social work with a specialization in child welfare remain in their positions longer and practice more effectively than workers with degrees in other areas (Barbee et al. 2009; Fox, Miller, & Barbee 2003; Jones & Okamura 2000). However, since there is no consistency regarding educational requirements across states and counties, agencies often hire whomever they can find. Only a limited number of jurisdictions set specific educational requirements for employment. Like many professional organizations, child welfare agencies rely on pre- and in-service training to prepare new as well as experienced workers to carry out essential, value-driven practices. Despite significant financial investments and policies that require training before new workers are assigned caseloads, research has found a significant problem with the transfer of skills from training to practice in current training approaches (Antle et al. 2009). As a result, administrators, policy makers, and researchers are turning their attention to an expanded model, which includes innovations in curriculum development and competencies, delivery format, and training reinforcement activities (Antle et al. 2009). Caseload and Workload Even the most skilled, well-prepared workforce will struggle with providing high quality, effective casework practice if they must manage high caseloads and workloads. Since 1992 the Child Welfare League of America has identified caseload standards for different work units within child welfare; the Council on Accreditation (2008) includes similar caseload standards as a component in its accreditation review process. Despite this national guidance, most agencies do not adhere to these standards, even though recent research by McDonald and Associates (2006) stresses the cost of failing to address high caseloads and workloads. The continued debate has focused less on the reasonableness of setting standards and more on the cost implications of doing so. Unfortunately, current federal

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legislation has ignored this critical structural component that drives quality front line practice. The organizational will that is required to address workload criteria illustrates how forcefully organizational climate and culture impact the workforce. Organizational Climate and Culture Systematically examining organizational factors has deepened our understanding of their impact on front line practice (Strolin-Goltzman et al. 2008; Strolin-Goltzman, Kollar, & Trinkle 2009; Zlotnik et al. 2005). Organizational culture—the attitudes, behaviors, and values of an organization—can not only create a supportive work environment, increase staff productivity, and improve staff self-sufficiency, but also decrease staff turnover. In addition, and perhaps more important, child welfare workers’ positive perceptions of their agencies’ organizational climate has been found to be a primary predictor of increased service quality for clients and positive service outcomes (Glisson & Hemmelgarn 1998). Similarly, organizational leadership behaviors and practices can positively influence worker motivation, organizational commitment, productivity, and job satisfaction (Elpers & Westhuis 2008). Effective leadership that maximizes investments in workforce development “creates commitment, hope and confidence that the agency is able to perform at its best, consistently and over time, and in times of difficulty and crisis” (National Association of Public Child Welfare Administrators 2011:1). All too often, however, those in the child welfare workforce view their agencies as falling short of these values (Alwon & Reitz 2000a, b; Anderson & Gobeil 2002; Munson 2006; Zell 2006). Research demonstrates that public child welfare agencies are often overly hierarchical, chaotic places where power is centralized: communications follow rigid hierarchical channels, managerial styles and job descriptions are uniform, and rules and regulations direct decision making (Ambrose & Schminke 2003; Busch

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& Folaron 2005; Ellett, Ellett, & Rugutt 2003; Glisson & Hemmelgarn 1998; Mor Barak et al. 2005; Munson 2006; Smith & Donovan 2003). As a result, workers report that they are generally unaware of impending agency changes, have minimal information regarding why many decisions are made, and have few opportunities to discuss or provide input to agency decision making and policy setting (Anderson & Gobeil 2002; Gibbs 2001; Lewandowski 2003; Rhoades & Eisenberger 2002). Consequently, employee morale and performance are negatively affected by the experience that child welfare bureaucracies leave little latitude for professional discretion and independent decision making and oftentimes implement confusing, inconsistent, and unduly cumbersome policies (Alwon & Reitz 2000a; Ambrose & Schminke 2003; Anderson & Gobeil 2002; Bednar 2003; Bell, Kulkarni, & Dalton 2003; Munson 2006; Zlotnik et al. 2005). These experiences result in worker burnout, lack of satisfaction, disillusionment, isolation, fragmentation, and low morale (Munson 2006), which in turn negatively impact the quality of services to clients and organizational productivity (Ambrose & Schminke 2003; Munson 2006; Zlotnik et al. 2005). Federal Policies, Oversight, and Support for the Child Welfare Workforce A number of federal policies and supports have been developed to address these longstanding issues. Myriad national, state, and triballevel initiatives are underway to combat these workforce concerns and provide strategies for child welfare agencies as they work to build and maintain a committed, stable, and effective child welfare workforce. To prepare the workforce for child welfare services, social work education is supported by two federal programs—Title IV-B, Section 426 and Title IV-E—both of which are administered by the Children’s Bureau. A smaller federal program, Title XX, was important but financially limited during its short tenure.

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Federal Policies Supporting Child Welfare Workforce Development Title IV-B, Section 426 The federal government began providing grants to states for child welfare in 1935 through the Child Welfare Services Program, Title IV-B of the Social Security Act (Child Welfare Information Gateway 2011); states were encouraged to use this funding to support educational leave for staff to earn social work degrees. In 1962 the Title IV-B Section 426 Discretionary Training Grant Program was created to provide financial support for social work education, short-term training of child welfare staff, and curriculum development grants (U.S. General Accounting Office 1993). That source of federal support continues to be available to public and nonprofit institutions of higher learning, although the $7-million-peryear appropriation limits both the scope and the impact of the program (Zlotnik 2003). Title XX In January 1975 Title XX of the Social Security Act authorized a capped entitlement to states for providing social services. Title XX gave states flexibility to offer a wide range of services to a broad population of adults and children, including education and training services (Office of Community Services 2006). These funds, while limited, did support some training and education services for the child welfare workforce. In 1981, however, Title XX was amended to establish the Social Services Block Grant program, and funding for workforce development diminished. Title IV-E Since passage of the Child Welfare and Adoption Assistance Act of 1980 (P.L. 96-272), states have used Title IV-E entitlement training funds to support public universities to provide stipends for BSW and MSW education to current child welfare staff as well as new students preparing for child welfare positions. Title IV-E monies have also funded child welfare training for public child welfare agency staff. The Fostering Connections

to Success and Increasing Adoptions Act of 2008 (P.L. 110-351) expands financial support for the child welfare workforce, allowing Title IV-E training funds to be used to train staff in private agencies serving children receiving Title IV-E assistance and the courts as well as approved tribal agencies (Child Welfare Information Gateway 2011). Federal Monitoring for Systems Change and Workforce Development: Child and Family Services Reviews (CFSRs) While Titles IV-B and IV-E provide funding for workforce development, they do not monitor workforce programs or outcomes. The Child and Family Services Review (CFSR) process, on the other hand, does provide a link between the child welfare workforce and outcomes for children, youth, and families. Since 2000 the Children’s Bureau has conducted CFSRs in every state and territory to ensure conformity with federal child welfare requirements and to determine the outcomes for children and families who receive child welfare services. Ultimately, the goal of the CFSR reviews is to help states and territories improve their child welfare service array and delivery, and, most important, the outcomes for children, youth, and families (Children’s Bureau n.d.b). States found not to have achieved substantial conformity in all areas assessed in the CFSR (all states, DC, and Puerto Rico in the first round of reviews) are required to develop and implement program improvement plans (PIPs). Many PIP strategies that states have developed to meet CFSR conformity are related to workforce development, including training child welfare workers, supervisors, and state staff, and cross-training of staff and community partners (Children’s Bureau n.d.a). While the inclusion of workforce development strategies in states’ PIPs doesn’t confirm a significant relationship between workforce and child and family outcomes, it is significant that workforce development strategies are prominent in the PIPs (Children’s Defense Fund & Children’s Rights 2006).

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Federal Support for Workforce Development: Children’s Bureau-Funded Recruitment and Retention Projects In 2003 the Children’s Bureau provided funding support for eight projects around the country to study, develop, implement, and evaluate recruitment and retention strategies for the child welfare workforce. These five-year projects addressed the many challenges agencies faced in recruiting, screening, and selecting new workers who best fit child welfare position requirements as well as in retaining workers whose skills and abilities ensured that they served children and families most effectively over time. These projects resulted in an array of findings, tools, and other resources that have offered the field practical strategies for improving the hiring process, organizational culture, and training efforts and promoted greater investment in quality child welfare supervision, management, and leadership (Child Welfare Information Gateway & National Child Welfare Workforce Institute 2010). The Children’s Bureau’s Training and Technical Assistance Network The Children’s Bureau’s Training and Technical Assistance Network (T/TA Network) is designed to provide public and tribal child welfare agencies with information, training, technical assistance, research, and consultation on the full array of federal requirements administered by the Children’s Bureau. The T/ TA Network is also intended to support efforts to strengthen child welfare systems and achieve sustainable systemic reform yielding improved outcomes for children, youth and families. T/ TA Network members also assist public and tribal child welfare agencies in improving child welfare systems in ways that increase conformity with the outcomes and systemic factors defined in the CFSRs as well as the results of other monitoring reviews to assure the safety, permanency, and well-being of children and families (Children’s Bureau 2011).

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National Child Welfare Workforce Institute: Social Work Traineeships and Leadership Academy In 2008 the Children’s Bureau expanded its array of T/TA Network supports by funding the National Child Welfare Workforce Institute (NCWWI), using Section 426 Discretionary Funds for Child Welfare Training. Although the Children’s Bureau had directly administered traineeships since 1962, the NCWWI took on responsibility for this task in 2008. In addition, the NCWWI was assigned to recommend twelve social work program partners, subsequently administering and evaluating these professional education stipend programs through the five years of the project. These traineeships are intended to increase the knowledge and skills of individual stipend recipients, especially as these relate to leadership development; address the workforce challenges of local child welfare systems; and build the capacity of college and university social work programs to prepare students for positive, culturally competent, and productive careers in child welfare. Traineeship programs have been particularly attentive to understanding and addressing diversity within the workforce, the workforce needs of local agencies, the preparation of future child welfare leaders, systems of care principles, and the guiding principles of the federal CFSR. The pace and demand for supervisory and managerial leadership has increased exponentially in public and tribal child welfare, which must respond daily to strong interest in the implementation of evidence-based practices, systemwide changes reflected in PIPs, advocacy and input from families and other stakeholders, and multiple initiatives for reform introduced by legislators, philanthropists, community leaders, and agency executives. As a result, the NCWWI also provides child welfare middle managers and supervisors with leadership training for implementation of change. The NCWWI’s Leadership Academy is designed to develop and implement a distributive, adaptive, and inclusive child welfare

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leadership training model for middle managers (week-long, residential) and supervisors (self-paced, online). The training framework is a research-based leadership competency model, which draws upon current leadership principles and skill sets and is based on competencies in four domains: leading change, leading people, leading in context, and leading for results (National Child Welfare Workforce Institute 2010). For the Leadership Academy for Middle Managers, child welfare executives and tribal programs nominate key change leaders in middle management roles in their agencies and support their participation in a week-long residential training as well as peer networking events and small group and individual coaching. The Leadership Academy for Supervisors provides experienced child welfare supervisors with the knowledge and skills to identify, define, and implement new initiatives that align with their agencies’ program improvement plans and facilitate the delivery of high-quality front-end services. This online training of six core courses and follow-up peer networking sessions requires an average of thirty hours to complete. Supervisors may work at their own pace, coming in and out of the training as their schedules allow. Moving Forward: Innovations to Strengthen the Child Welfare Workforce In addition to the federal government’s investment in workforce development through funding opportunities and other forms of guidance and support, numerous national, state, and tribal-led initiatives have been developed and implemented to help child welfare systems build and maintain a committed, stable, and effective child welfare workforce. A number of these innovative efforts are described in detail below. Realistic Recruitment Increasingly, attention is being paid to the importance of giving prospective child welfare

workers a realistic depiction of the child welfare field, and the nature of the job and its requirements. Although the business community and the military have utilized realistic job previews (RJPs) for the past forty years, they are relatively new to the child welfare field (Faller et al 2009). RJPs can be created in multiple formats, including video, verbal presentations, job tours, and written brochures; they are designed to provide applicants with an accurate picture of the position(s) under consideration in order to strengthen their decision making about child welfare work. RJPs “include descriptions of the realities, stresses, and rewards of child welfare work and are highlighted by personal experiences and case examples described by the video participants” (Ellett et al. 2009:57). Videos have become the preferred format for child welfare agencies so that the information can be shared in multiple ways, such as DVD, streaming video, and on the Internet (Faller et al 2009). As of 2011 twelve states are using RJPs during the recruitment process.2 Although most states do not yet use RJPs specifically as tools for screening and selection of prospective applicants, applicants are increasingly being required to review RJPs before or during their job interviews (Faller et al. 2009). In a preliminary study of child welfare RJPs, outcome data provided by one state indicated that the RJP positively impacted the selection process, new hires’ job expectations, and employee retention (Faller et al. 2009). Structured Employee Screening and Selection From the agency perspective, the screening and selection process has a dual purpose: to attract the best qualified applicants to the agency and to screen out those who are not or are less qualified (Bernotavicz 2008). The literature makes clear that screening and selecting the right staff is best done through a carefully thought-out and replicable process (McKenzie, McKenzie & Jackson 2009), which a number of states have begun to implement. In Maine this process consists of a standard

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interview, fact-finding interview, and written exercise (Bernotavicz 2008). In Georgia, through a university-agency collaboration, the employee selection protocol—consisting of 1. Web-based review of written material and a RJP video, 2. Web-based self-assessment, 3. on-site assessment, and 4. assessment decision making—has been designed to “facilitate a better match between new applicants’ commitments, beliefs, and expectations and the demands of work in child welfare” (Ellett et al. 2009:51). In addition, this process is more likely to result in the selection of prospective child welfare employees that possess and demonstrate the personal knowledge, skills, abilities, and values considered minimally essential upon entry into the child welfare workforce (Ellett et al. 2009). Competency-Based Child Welfare Training and Specialized Social Work Education Within the network of the twelve federally supported traineeship stipend programs noted previously, and the range of university-agency training and educational partnerships that exist throughout the country (Zlotnik 2002), competency-based training and education programs are a strategy to ensure that prospective and current child welfare staff members have what it takes to perform their jobs effectively. It is also critical that staff members are provided wellorganized, systematic training that communicates a consistent practice model and practice standards (Rycus & Hughes 2000). For example, Maine’s competency model focuses on ten elements: interpersonal relations, self-awareness/confidence, analytic thinking, adaptability, observation skills, sense of mission, communication skills, motivation, planning and organizing, and teamwork (Bernotavicz 2008). In Ohio a “universe of child welfare competencies” identifies a range of different knowledge and skills required for various levels and types of child welfare staff; this is the driving force behind the state’s comprehensive, competency-based in-service training system

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(Ohio Child Welfare Training Program n.d.). In California’s common core curricula for child welfare staff, there are twenty-two different child welfare subject areas, each with its own set of standardized competencies (California Social Work Education Center 2011). Many schools of social work ensure that critical public child welfare competencies are incorporated into the curriculum competencies as well, in some cases even taking steps to ensure that public agency preservice training requirements are met within the school’s child welfare track (Barbee et al. 2009; National Child Welfare Workforce Institute 2010). Additionally, specialized Title-IV-E partnerships between states and universities are showing promise in preparing workers who are more skillful in providing quality practice and are retained. Subsequent training for these specially trained employees helps them develop their skills more quickly than employees who do not have this prior educational experience (Clark et al 2008). Frontline Supervision There is growing recognition of the importance of strengthening frontline child welfare supervision, given the key role of supervisors as facilitators of effective service delivery (Dickinson & Perry 2002; Hess, Kanak, & Atkins 2009; National Child Welfare Resource Center for Organizational Improvement 2007). Because supervisors interact with a number of groups (e.g., clients served by the agency, assigned line staff, organizations and individuals providing contracted services, agency administrators and managers, the financial and legal bodies under whose auspices the agency functions, resource parents and child care providers, etc.), they can be seen as key translators of the organization’s mission, vision, values, and practice both within the agency and with external partners and stakeholders (Hess, Kanak, & Atkins 2009). The tone and expectations that supervisor set in the work environment are so important that some have called them the “keepers of

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the culture” for their agencies (North Carolina Division of Social Services & the Family & Children’s Resource Program 2003). Supervisors also play a role in worker functioning and retention. According to a meta-analysis of twenty-seven articles with a combined sample of more than ten thousand workers in child welfare, social work, and mental health settings, when workers receive effective supervision they reciprocate with positive feelings and behaviors toward their positions and agencies. Empowerment, organizational citizenship behavior, job satisfaction, and retention are realized when supervisors provide tangible, work-related advice and instruction to their workers. Workers’ well-being, organizational commitment, and job satisfaction improve when they receive supervisory support of their emotional needs and job-related stressors. Finally, when workers perceive high quality interpersonal interactions with their supervisors, their sense of competence and personal accomplishment, organizational citizenship behavior, and job satisfaction improve (Mor Barak et al. 2009). Similarly, workers’ attitudes, perceptions, and retention can be significantly influenced by the skills of their supervisors. This has been demonstrated in a randomized control trial in which the workers assigned to supervisors who received training and resources in recruitment, selection, and retention knowledge and skills were 44 percent more likely to be retained two years after the intervention than workers assigned to the control group supervisors (Dickinson & Painter 2011). In addition to promising models for supervisory practice, such as strengths-based supervision, clinical supervision (Collins-Camargo et al. 2009), and family-centered supervision (North Carolina Division of Social Services & the Family & Children’s Resource Program 2003), many child welfare systems are beginning to embrace a recently released framework that identifies the elements necessary

for effective supervisory programs in child welfare: t
a clearly articulated practice philosophy and approach; t
identification of the functions and job responsibilities of child welfare supervisors (administrative, educational, supportive); t
recognition of the importance of supervisors’ ability to build and maintain relationships with their staff and others; t
mandated manageable standards for caseload size and supervisor-supervisee ratios; t
defined expectations regarding the frequency and format for supervision of staff; t
clarification of the organization’s expectations for ongoing evaluation of staff; t
support for supervisors in their roles as unit leaders and change agents by systematically including them in quality assurance activities, program evaluation, and redesign of information systems, forms, and procedures; training supervisors first for all policy and practice changes; involving them in the recruitment, selection, and training of new frontline practitioners; and frequently recognizing their own and their units’ accomplishments (Hess, Kanak, & Atkins 2009).

Peer Support Increasingly, peer-to-peer models of support have been implemented in child welfare to provide assistance to staff at all levels (caseworkers, supervisors, and managers). Although referred to by a range of different titles (such as peer networking, mentoring, coaching, teaming, consultation or supervision, learning circles, community of practice, or learning community), the underlying purpose and objectives are similar, as all involve “people exchanging information, disseminating good practices and building leadership skills to achieve a commonly-valued purpose, such as community

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change” (Backer & Kern 2010:1). Whether the interactions take place face-to-face or through the use of Web sites, teleconferences, webinars, and LISTSERVs, these semi-structured peerto-peer interactions provide opportunities for child welfare staff from different agencies across the country to connect, share ideas and resources, problem-solve, and engage in timely discussions on a variety of current child welfare issues and topics. According to a study of fourteen California communities involved in the California Endowment’s Building Healthy Communities initiative, peer networks are successful when they create a trusting environment for participants, allow for sufficient time for the peer networking activities to develop and mature, and are transparent in their operation (Backer & Kern 2010). Additionally, the evaluative findings regarding a child welfare staff mentoring program in Connecticut make clear that such mentoring programs benefit both mentors and mentees; mentees report more confidence, a larger professional network, and improved commitment to their position and agency, while mentors report higher personal satisfaction levels and a sense of purpose in their position (Strand & Bosco-Ruggiero 2008). Organizational Climate and Culture The literature supports public agency efforts to retain highly skilled, well-prepared child welfare workers by focusing on creating a positive organizational culture and becoming a supportive, active learning organization (Agbenyiga 2009; Calahane & Sites 2008; Collins-Camargo 2010; Strolin-Goltzman et al. 2008). Although organizational culture is not uniform, and the factors influencing organizational culture differ in urban, rural, and suburban agencies, all agencies can improve staff retention and effectiveness by taking steps to foster a learning and results-oriented environment. According to Austin (2008), a learning organization is an agency that creates, collects, and shares

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knowledge, synthesizing the new knowledge to enhance the agency and staff behaviors. A learning culture can be fostered by sharing information, encouraging group work, initiating peer mentoring systems, developing growth plans, and engaging in cross-training. One technique used to foster a learning culture is that of Design Teams (DTs; StrolinGoltzman 2010; Strolin-Goltzman et al. 2010). Design Teams are groups of employees that work together to solve organizational issues contributing to intentions to leave and turnover within their own agencies. Through informal focus groups and an agencywide survey, teams identify the problems that employees perceive to be the causes of turnover. The team then compiles the results and organizes these into priority areas based upon feasibility and importance. Each team follows a specific solution-focused logic model that guides them to developing solutions to the identified issues. Studies have found that DTs are correlated with a reduction in intention to leave and overall agency turnover rates; they positively affect perceptions of burnout and role clarity, job satisfaction, and agency commitment among child welfare staff (Strolin-Goltzman 2010; Strolin-Goltzman et al. 2010). Finally, to support workforce development, agencies can take steps toward fostering a results-oriented culture in which timely data drive decision making at all levels of the organization, from program improvement efforts to employee performance reviews and action plans (Moore 2002). Increasingly, child welfare systems are taking steps to create a results-oriented culture by 1. aligning individual performance expectations with organizational goals; 2. connecting performance expectations to crosscutting goals; 3. providing and routinely using performance information to track organizational priorities;

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4. requiring follow-up actions to address organizational priorities; 5. using competencies to provide a fuller assessment of performance; 6. linking pay to individual and organizational performance; 7. making meaningful distinctions in performance; 8. involving employees and stakeholders to gain ownership of performance management systems; 9. maintaining continuity during transitions (U.S. General Accounting Office 2003b:4). YYY

This chapter has documented the often unsettled path of the child welfare workforce over time, as influenced by historical events, federal policies, bureaucratic constraints, and uneven educational and training opportunities, among numerous other challenges (NCWWI 2013). The promise of a stronger, more effective child welfare workforce rests largely with innovations that must be further developed and more widely implemented, as discussed

NOTES

1. C. Perry, AFSCME, personal communication September 16, 2011. 2. C. Brittain, personal communication, August 2, 2011.

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Ohio Child Welfare Training Program (n.d.). The universe of child welfare competencies. Retrieved from http://www.ocwtp.net/Universe%20of%20Competencies.htm. Rhoades, L., & Eisenberger, R. (2002). Perceived organizational support: A review of the literature. Journal of Applied Psychology, 87, 698–714. Rycus, J., & Hughes, R. (2000). What is competencybased inservice training? Columbus, OH: Institute for Human Services. Retrieved from http://www.ocwtp. net/PDFs/WhatIsCompetencyBasedTraining.pdf Schorr, A. (2000). Comment on policy: The bleak prospect for public child welfare. Social Service Review, 74, 124–136. Smith, B., & Donovan, S. (2003). Child welfare practice in organizational and institutional context. Social Service Review, 77, 541–563. Social Work Policy Institute. (2010). High caseloads: How do they impact delivery of health and human services? Research to Practice Brief, January. Retrieved from http://www.socialworkpolicy.org/wp-content/ uploads/2010/02/r2p-cw-caseload-swpi-1–10.pdf Strand, V., & Bosco-Ruggiero, S. (2008). Initiating and sustaining a mentoring program for child welfare staff. Administration in Social Work, 34, 49–67. Strolin, J., McCarthy, M., & Caringi, J. (2007). Causes and effects of child welfare workforce turnover: Current state of knowledge and future directions. Journal of Public Child Welfare, 1, 29–52. Strolin-Goltzman, J. (2010). Improving turnover in public child welfare: Outcomes from an organizational intervention. Children and Youth Services Review, 32, 1388–1395. Strolin-Goltzman, J., Auerbach, C., McGowan, B., & McCarthy, M. (2008). The relationship between organizational characteristics and workforce turnover among rural, urban, and suburban child welfare systems. Administration in Social Work, 32, 77–91. Strolin-Goltzman, J., Kollar, S., & Trinkle, J. (2009). Listening to the voices of children in foster care: Youths

speak out about child welfare workforce turnover and selection. Social Work, 55, 47–53. Strolin-Goltzman, J., Lawrence, C., Auerbach, C., Caringi, J., Claiborne, N., Lawson, H., et al. (2010). Design Teams: A promising organizational intervention for improving turnover rates in the child welfare workforce. Child Welfare, 88, 149−168. Thomas, M. (2012). One hundred years of Children’s Bureau support to the Child Welfare Workforce. Journal of Public Child Welfare, 6(4), 357–75. U.S. General Accounting Office (1993). Foster care: Federal policy on Title IV-E share of training costs. Retrieved from http://archive.gao.gov/t2pbat5/150116. pdf. U.S. General Accounting Office (2003a). Child welfare: HHS could play a greater role in helping child welfare agencies recruit and retain staff. Retrieved from www. gao.gov/new.items/d03357.pdf. U.S. General Accounting Office (2003b). Results oriented cultures: Creating clear linkages between individual performance and organizational success. Retrieved from http://www.gao.gov/new.items/d03488.pdf. Zell, M. (2006). Child welfare workers: Who are they and how they view the child welfare system. Child Welfare, 85, 83–103. Zlotnik, J. (2002). Preparing social workers for child welfare practice: Lessons from an historical review of the literature. Journal of Health & Social Policy, 15, 5–21. Zlotnik, J. (2003). The use of Title IV-E training funds for social work education: An historical perspective. Journal of Human Behavior in the Social Environment, 7, 5–20. Zlotnik, J., DePanfilis, D., Daining, C., & Lane, M. (2005). Factors influencing retention of child welfare staff: A systematic review of research. Washington DD: Institute for the Advancement of Social Work Research. Retrieved from http://www.aecf.org/ upload/publicationfiles/hs3622h638.pdf.

C AT H RY N C . P O T T E R MICHELE HANNA C H A R M A I N E B R I T TA I N

Child Welfare Supervision

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hild welfare supervisors are central to effective child welfare practice. Their influence ranges from ensuring that families and children receive high-quality services, to ensuring that child welfare workers are well equipped to deliver that service, to ensuring, with their manager colleagues, that agencies provide the kind of culture and climate that supports effective practice. What do we know about child welfare supervisors and their roles and impact? What are the critical skills and abilities for child welfare supervision? In this chapter we present an overview of this important role in child welfare systems. Many reading this chapter may be relatively new to child welfare practice. We encourage you to think about how you will develop your supervisory and leadership abilities, because preparation for being a good supervisor begins very early in one’s career. Child welfare workers become supervisors more quickly in today’s demographic environment (American Public Human Services Association 2005),and team leadership and support is a task shared by all in a child welfare unit. Social Context for Child Welfare Supervision Why is supervision so important in child welfare? Child welfare is high-stakes work, and many workers enter the child welfare system with relatively little experience or preparation (American Public Human Services Association 2005). Child welfare is also high-stress work. The research is clear that workers and

supervisors are affected by their exposure to the traumatic experiences of children and families, including experiencing symptoms of emotional exhaustion, burnout, and secondary trauma (Pryce, Shackelford, & Pryce 2007; Regehr et al. 2002). Child welfare is complex work. Families served typically face multiple challenges in addition to child maltreatment. These include other forms of family violence, substance abuse, parental mental health concerns, and poverty (Chambers & Potter 2008; Scannapieco & Connell-Carrick 2005). For all these reasons, child welfare work requires a high level of critical thinking and use of evidence, often in environments that demand immediate action (Luongo 2007). Child welfare organizations may not always provide the full range of supports to workers, but they do give workers a supervisor, a supervisor whose role is critical to their effective practice and to their longevity in the field. Child welfare systems are bureaucracies, with all the attendant organizational facets, including a slow pace of change (Cohen & Austin 1994; Smith & Donovan 2003). Positive organizational characteristics do make a real difference in both child welfare practice and client outcomes. Glisson and Hemmelgarn (1998) found that positive organizational climate was associated with both improved services and positive outcomes for children. Similarly, Glisson and Durick (1988) found that organizational characteristics were the strongest predictors of worker commitment to the job. Yoo and Brooks (2005) found that certain organizational conditions, including the quality of supervision, 643

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are associated with avoidance of out-of-home placement for children. In one of the few strong tests of organizational interventions in child welfare, Glisson, Dukes, and Green (2006) tested an intervention that focused on supervisors that improved organizational climate and reduced worker turnover by two-thirds. Studies of worker retention and job satisfaction routinely find that child welfare workers see their team and their supervisors in a more positive light than they see the wider agency (Potter, Comstock, & Brittain 2007; Strolin, McCarthy, & Carringi 2007). Dickinson and Perry (2002) found that the worker’s perception of the level of concern held by the supervisor for her welfare predicted whether the worker stayed at the agency. Additionally, supervisor competence and support are important predictors of worker intent to stay with the organization (Landsman 2001; Nissly, Mor Barak, & Levin 2005; Potter, Comstock, & Brittain et al. 2007). Brownlee (2002) found that supervisors from low-turnover counties in Arkansas had significantly greater experience than did those from high-worker-turnover counties. Clearly child welfare supervisors occupy a central role in the child welfare organization, from both the point of view of their support for practice and their importance in creating and mediating organizational climate issues (Hess, Kanak, & Atkins 2009). A handful of small, qualitative studies have looked at the strengths and challenges associated with child welfare supervision from the perspective of the supervisors (Hanna & Potter 2012; Rushton & Nathan 1996; Schmidt 2008). The primary focus of Schmidt’s study was to explore the difference in perspectives of rural versus urban supervisors. Turnover and retention issues emerged as the primary challenge across the board. Supervisors in this study expressed frustration over the constant training of new workers. Rushton and Nathan (1996) identified the need for advanced training to help supervisors manage the different aspects of the role. These participants stated that clinical

expertise and abilities to prioritize interventions and handle risk are vital skills needed in child welfare supervision. In addition, they discussed the importance of management and organizational skills specifically related to the high emotional environment of child welfare. Hanna and Potter’s participants echoed this concern, stating that the management of their workers’ stress can be a challenge in supervision (2012). Juggling and managing personal and professional boundaries can also be a challenge in child welfare supervision (Collins-Camargo & Millar 2010; Hanna & Potter 2012; Schmidt 2008). The definition of boundaries can be particularly challenging for new supervisors who have been identified as “superworkers” prior to promotion. It can also be a challenge for rural county supervisors in situations where everyone knows everyone and there is a fishbowl effect. The Child Welfare Workforce As with the profession of social work, the child welfare workforce is made up mostly of females (72 percent; Annie E. Casey Foundation 2003; School of Public Health, University of Albany & National Association of Social Workers 2006). This trend remains true among supervisors, with some indication that men are more likely to be represented among supervisors than are women (Regehr et al. 2002). Not surprisingly, on average, supervisors tend to be older and have more experience than frontline workers (Clark, Smith, & Mathias 2009). With the turnover rate in child welfare estimated between 30–40 percent nationwide (U.S. General Accounting Office 2003), it is not surprising that the child welfare workforce is also relatively inexperienced (American Public Human Services Association 2005). For supervisors, the average tenure was found to be nine years. The turnover rate is significantly lower for supervisors, averaging about 12 percent per year (American Public Human Services Association 2005).

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The human service workforce tends to be highly motivated and committed to the work, with 97 percent reporting that they are proud of the work they do and 87 percent saying that they see their work as “very important” (Light 2003). In general, supervisors tend to express more job satisfaction than frontline workers; however, Silver, Poulin, and Manning (1997) found that the longer supervisors were on the job the less satisfied they were and the more emotionally exhausted they felt. Westbrook. Ellis, and Ellet (2006) identified a set of “committed survivors” (child welfare supervisors, administrators, and workers) who differed in some key ways from the general child welfare workforce. This group interacted with each other and with the researchers, in calm, courteous, reflective ways. These committed survivors identified several characteristics as important for longevity in child welfare organizations. COMMITTED SURVIVORS: THEIR V I E W O F E F F E C T I V E C H I L D W E L FA R E PROFESSIONALS

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Critical Skills for Child Welfare Supervisors In 2009 Potter and Brittain offered a framework for considering the range of supervisor roles and the knowledge and abilities associated with those roles. We use this framework to organize our discussion here, realizing that this summary does not do justice to the rich discussions provided by chapter authors in Child Welfare Supervision (Potter & Brittain 2009). Leadership Supervisors are, first and foremost, leaders— within their unit, with their peers, and in their organizations and communities. Anderson (2009) highlights the importance of ethical commitments in child welfare. Supervisors are balancing multiple perspectives and imperatives; an ethical framework for practice is central to success and to holding the respect of the workforce. Supervisors must also convey the sense of purpose that frames the work for their workers and their agency. This sense of vision is married to strong abilities to solve problems. Supervisors are also leaders in caring for those around them, as well as in creating the work environments that are needed for success. More will be said further on in the chapter about new leadership training opportunities and frameworks for child welfare supervisors; however, these key attributes (purpose, ethics, problem solving, and caring) are basic building blocks of supervision (see NCWWI 2013). Management Child welfare supervisors are good managers. While leadership and management are clearly related, it is important to make some distinction between them in order to integrate them effectively. Leadership supports purpose and direction, while management gets things done. East and Hanna (2009) argue that there are three primary dimensions of management in child welfare supervision. Supervisors must have strong communication and analysis skills in order to effectively define and analyze

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problems, review alternative solutions, communicate with all involved, and effect a strong decision-making process. Supervisors may or may not be involved in larger planning efforts of their organization, but they do take responsibility for their areas of focus. A good plan involves linking the vision and purpose of activities to clear goals and objectives, a strong implementation approach, and the ability to monitor results and self-correct. Supervisors who make time for planning are more effective in responding to their environment (Menefee 2001.) Project management skills involve the supervisor’s ability to effectively implement, including their ability to manage time and resources and to motivate and support members of their team. The Child Welfare Unit Supervisors must effectively lead and manage the groups of workers (units) that characterize child welfare organizations (Hanna 2009). Units may be thought of as “living systems” (Lewin 1947) in that their membership and supervisor changes over time (and, of course, units are sometimes merged, but their function continues, and often core members carry on over time. Supervisors often join the unit rather than form it; workers come and go over time. The supervisor’s ability to lead and manage the group is essential. Hanna (2009) argues that effective supervisors must understand group dynamics and group development and have skills in group management, team building, caseload management, coalition building, meeting management, and morale building. Middle Management Supervisors are middle managers in child welfare organizations (Antle, Barbee & van Zyl 2009). In this role they are responsible for communicating and implementing agency policies and procedures while also communicating the needs and expertise of those on the front lines up into the larger organization. Antle, Barbee & van Zyl (2010) discuss the importance of several key skills in middle management. Supervisors

must understand the larger organizational context, including the ability to use frameworks to analyze their organization (Netting, Kettner, & McMurtry 2007). Supervisors must have mastery of laws, policies, and data, including the ability to access, synthesize, and use internal agency data. They must have in-depth knowledge of a region and/or program area, that is, they must have the on-the-ground expertise to contribute to the larger agency discussions. As part of that expertise, supervisors must understand best practices in child welfare and actively advocate for them. As they undertake the middle management role, supervisors must hone their communication skills and vary them by audience and situation. The middle management role can be both frustrating and exciting for supervisors; those who wish to be most effective must find a way to embrace it. Working in Larger Environments Supervisors also operate beyond the immediate agency context, for example, in collaborative work with courts and contract agencies. Cahn (2009) set forth a set of critical skills for this role. Supervisors require skills in assessing external environments, including the ability to map patterns of relationships and to intervene to support the strengthening of those relationships. External relationships may range from coordinated work to collaborative work to, in rare instances, integrated work. For coordinated relationships, managing meetings, crosstraining, and interagency protocols are key. For collaborative work, we see an increase in co-location and formal liaisons, collaborative structures, and joint decision making. In fully integrated work environments, workers from both systems function as members of a single team. All require supervisors to have a range of communication, partnering, advocacy, and negotiation skills. Changing Environments Child welfare organizations are constantly transforming in response to changing policy

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and practice imperatives. Some change is reactive; some is proactive, and some is evolutionary (Cahn & Berns 2009). Whatever its nature, change requires supervisors to play a central role in implementing adaptive change initiatives (Hess, Kanak, & Atkins 2009). Cahn and Berns argue that it is important to pay attention to stages of change, including motivation, learning and implementing the new ways of thinking and acting, building mechanisms for sustaining the new practices, and recognizing and rewarding accomplishments. Supervisors are critical in these activities and also in supporting the people involved in changing their work behaviors, even as they keep the work moving forward. Diversity In Child Welfare Supervision Ortega and Mixon-Mitchell (2009) address skills for creating strong organizational climates in diverse workplaces and supervisory relationships. Effective intercultural communication requires supervisors to hone their basic communication skills and to develop strategies for reducing anxiety and opening opportunities. Understanding communication styles, patterns in the use of silence, and the effects of unequal power relationships on communication are very important. Worker Recruitment and Retention Dickinson and Comstock (2009) have honed in on the supervisory skills needed to get and keep the best workers. Effective recruitment strategies include building and implementing agency marketing strategies and expanding the pool of potential recruits through the use of mediasavvy approaches to reaching this generation of workers. Supervisors also have responsibility for effective screening and selection of child welfare staff. The use of realistic job previews (written or video introductions to the job) to help applicants screen themselves in or out has been shown to increase worker retention (Faller et al. 2009). Selection processes, such as structured interviews and work-sample tests, allow supervisors and interview teams to engage

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with applicants in real-world problem-solving activities. Retaining good workers is also critical for supervisors. Explicitly welcoming newcomers, developing deliberate socialization processes, using structured feedback and performance coaching, and supporting and rewarding all workers go a long way toward creating a retention-oriented environment. Addressing stress, burnout, and vicarious trauma among workers is also a critical supervisory role. Both prevention and intervention strategies are needed at the unit level. These include creating an organizational climate that openly acknowledges these job-related risks and monitors workloads for intensity and size; provides work environments that feel safe, comfortable, and private; ensures ongoing education about secondary trauma and concrete skills for coping; and creates ongoing opportunities for group support (Bell, Kulkarni, & Dalton 2003). Developing Worker Competence Child welfare supervisors are trainers and teachers. New and experienced workers receive training from the agency; but it is in the unit that training is transformed to action. Brittain and Potter (2009) argue that taking a developmental perspective is critical, since workers’ needs for skill development vary greatly across their career. Indeed the middle stage of development, in which workers must integrate specific skills into integrated, coherent, independent practice, is critical for the worker and the agency. The literature on worker turnover indicates that many leave before we would expect this level of integration (American Public Human Services Association 2005; U.S. General Accounting Office 2003). Therefore moving workers through the difficult transition from supported beginner to independent worker is of great importance. If they are to effectively reinforce their agency’s approach to practice, supervisors must also understand individual learning styles and the process of transferring learning from training to practice.

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Clinical Supervision in Child Welfare Supervisors report that administrative duties take much of their time; nevertheless, clinical supervision with workers remains of the utmost importance in ensuring effective child welfare practice. Ferguson (2009) discusses the process of effective clinical supervision in a child welfare setting. Supervisors set the stage for good supervision by ensuring consistent frequency and duration of structured clinical supervision. They provide a physical setting and protected time. Supervisors understand that clinical supervision parallels intervention relationships in some important ways, but does not slide into a clinical relationship with the worker. Supervisors and workers build relationships, use contracting techniques, focus on understanding and doing, and monitor results much like clinical relationships. Good clinical supervisors have a number of skills that they use in their time with workers, including effective eliciting of information, tuning in to verbal and nonverbal communication, focused listening and targeted questioning, “reaching inside silences,” using empathic skills, effectively making the demand for work, facilitative confrontation, and holding focus, among others (Shulman 1993). Managing Performance Supervisors not only teach and support effective practice, they are also responsible for managing the performance of their workers. This involves defining performance expectations, communicating those expectations clearly, monitoring performance, documenting performance, analyzing performance problems, facilitating improved performance, and ultimately disciplining those whose performance does not improve (Paul et al. 2010). These human resource management skills are not always part of supervisory preparation programs in child welfare; nevertheless, supervisors report that managing performance is a time-consuming part of their work (Hanna & Potter 2012).

Promising Practices in Child Welfare Supervision There has been increased attention to the development of the supervisory workforce over the past decade. Several Children’s Bureau–funded projects have focused directly or indirectly on improving supervision (Potter, Comstock, & Brittain 2007; Renner, Porter, & Preister 2009; Strolin, McCarthy, & Caringi 2007). The Child Welfare Implementation Centers, a Children’s Bureau–funded initiative that provides intensive training and technical assistance to states and tribes as they implement system-reform efforts, have found that many states choose to focus on strengthening supervision as part of their change initiative (e.g., Arkansas, Connecticut, Massachusetts, New Jersey, New York). Here we present a few promising approaches to strengthening supervision in child welfare. Training for Supervisors Many states have developed strong supervisor training programs. This training is often a mix of classroom, online, and on-the-job training. An example of supervisor competencies from Maine (State of Maine 2011) illustrates the identification of supervisory knowledge and skills necessary for supervisors to perform at the highest level. Maine’s training program develops specific training that addresses these performance competencies. MAINE’S SUPERVISOR COMPETENCIES

Managing Self 1. Initiative: drives for results and success. Sets high standards of performance. Pursues aggressive goals and works hard to achieve them. Displays a high level of effort and commitment to performing the work. 2. Adaptability: handles day-to-day work challenges confidently. Is willing to adjust to multiple demands, shifts in priorities, ambiguity, and rapid change. Shows resilience in the face of constraints, frustrations, or adversity. Demonstrates flexibility.

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3. Decision making: shares information and involves appropriate others in the decisionmaking process. Makes timely, logical decisions. Decisions are modified based on new information when appropriate. Takes responsibility for decisions. 4. Self-responsibility: describes and evaluates own performance in terms that reflect recognition of personal strengths and challenges. Takes responsibility for own performance and outcomes and learns from mistakes. Clarifies personal values and carries out plans for professional development to meet client and agency needs. Managing Others 5. Teamwork: contributes to organizational goals. Fosters collaboration among team members and among teams. 6. Interpersonal relations: shows respect and tolerance for each person. Relates well to others; possesses good listening skills; and demonstrates trust, sensitivity, and mutual respect. Recognizes the contribution diversity brings to job performance and creativity. 7. Delegation/follow up: assigns responsibilities. Delegates responsibility and empowers others. Removes obstacles. Allows for and contributes needed resources. Coordinates work efforts when necessary. Monitors progress. 8. Staffing: builds a strong team with complementary strengths. Forms the right structures and teams. Demonstrates leadership and holds employees accountable for safe work practices, fair employment practices, and state and federal Affirmative Action/Equal Employment Opportunity requirements. 9. Coaching and counseling: gives timely, specific feedback and helpful coaching. Adapts approach to each individual. 10. Employee development: accurately assesses strengths and developmental needs of employees. Provides challenging assignments and opportunities for development.

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Managing for Results 11. Quality focus: emphasizes the need to deliver quality services. Defines standards for quality and evaluates processes and services against those standards. 12. Planning and organizing: develops short- and long-range plans that are appropriately comprehensive, realistic, and effective in meeting goals. Integrates planning efforts across work units. Handles multiple demands and competing priorities. Manages meetings effectively. Defines and arranges activities in a logical and efficient manner. Effectively uses resources including time, money and materials. 13. Customer service: seeks feedback from internal and external customers. Anticipates customer needs and provides quality services to customers. Continuously searches for ways to increase customer satisfaction. 14. Program administration: explains relevant human services history, theory, values, and ethical considerations. Communicates the mission of the agency and its role in the child and family service system. Clarifies roles and responsibilities of participants in the child welfare system. Leading in the Organization 15. Casework supervision: explains and applies relevant federal and state statutes, rules, policies, procedures, and current practice standards related to casework. Effectively manages case assignments, case coverage, and service delivery to clients via direct caseworker supervision. Models and teaches necessary elements of assessment, decision making, case planning, and case process to staff. Structures supervisory conferences (individual and group) to review and document casework activities and caseworker performance. 16. Collaboration: builds and maintains effective working relationships with a network of systems. Appreciates the different views, expertise, and experience of other individuals and systems. Finds creative and effective ways to advocate for clients and staff. Participates con-

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structively on inter- and intra-agency work groups and activities to clarify and improve system and program functioning and service delivery. Offers support to colleagues. Relates effectively with all levels of administration inside and outside the organization. 17. Organizational leadership: applies organization and management development theory, the role of power and authority, the operation of effective organizations, and the dynamics of organization change. Develops effective collaborations both inside and out of the agency. 18. Public/community relations: communicates with the community service network. Presents a positive image to other service providers and to the community at large through use of the media, personal contacts, and presentations. Delivers presentations at public/private meetings, conferences, and workshops.

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Educational supervision, which is concerned with educating the worker for a more knowledgeable and skilled performance of tasks. t
Supportive supervision, which provides support, sustenance, and motivation to the worker to improve performance. The Kadushin model has provided the basis for a supervisory core training series developed by the Butler Institute for Families (2005) and adopted by multiple states across the country (Colorado, Georgia, Arizona, Indiana, Wisconsin). This training series consists of three modules, each three days in length, delivered once per month to allow for sufficient opportunities to apply training to the field. PUTTING THE PIECES TOGETHER: SUPERVISOR CORE TRAINING TOPICS

Communication Skills 19. Oral communications: speaks clearly and expresses self well in groups and in one-on-one conversations. Demonstrates attention to and conveys understanding of comments and questions of others. 20. Written communications: conveys information clearly and effectively through formal and informal documents. (State of Maine 2011:1–2)

Training programs for supervisors are typically composed of entry-level core or foundational training followed by ongoing professional development and in-service training. One of the most commonly used models for supervisor training is the Kadushin model, in which supervision is compared to a three-legged stool, with each component being essential to effective supervision. Kadushin (1976) articulated three key dimensions of supervision: t
Administrative supervision, which focuses on the efficient and effective delivery of services to achieve organizational goals.

Administrative Supervision Agency mission, vision, and philosophy Self-awareness Management and organizational theories Power Transitioning from peer and worker to supervisor Supervisor as advocate Supervisor as change agent Supervisor as data analyst Supervisor as recruiter Supervisor as performance monitor Educational Supervision Learning styles Orientation for new employees Stages of worker development Transfer of learning Supervisor as mentor Supervisor as practice expert Casework jeopardy Constructive feedback Coaching Understanding emotional responses Supervisor as clinical consultant Supervision land

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Supportive Supervision Supervisor as motivator Supervisor as counselor Supervisor as burnout prevention specialist Supervisor as team leader Supervisor as conflict manager Job satisfaction (Butler Institute for Families 2005:3–4.)

Core training is just one aspect of preparing supervisors for their jobs. Sufficiently preparing supervisors for their jobs requires a thorough, integrated approach. The Georgia Department of Children and Families has developed a comprehensive five-part supervisor professional development program that includes a peer-mentoring component (State of Georgia 2011). Mentoring of supervisors is an important way of preparing and supporting them. Collins-Camargo and Kelly (2007) highlight the importance of informal mentorship by supervisors in child welfare. They found that 92 percent of the supervisors in their study had been mentored, and 77 percent had actively mentored someone else. Moreover, Strand and Bosco-Ruggerio (2010) found that a formal mentoring program in Connecticut positively influences supervisors’ confidence, investment in the agency, and sense of purpose. G E O R G I A’ S S U P E R V I S O R P R O F E S S I O N A L DEVELOPMENT PROGRAM

Family-Centered Case Practice for Administrators and Supervisors This course is designed to provide management’s approach to implementing and maintaining the Family-Centered Practice Model. There are seven standards of practice that apply, including Agency Management and Leadership; Policies and Standards; Qualifications, Workload, and Professional Development of Staff; Array of Services; Information Systems; Agency Coordination Within the Community; and Quality Assurance.

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Results-Oriented Management (ROM) Online Training Designed by the University of Kansas School of Social Welfare, this course provides information on outcome measurement in child welfare and provides practical approaches to the three major factors that affect the usage of data: effective management reports, essential skills in interpreting data and taking management action, and developing a resultsoriented organizational culture. Putting the Pieces Together Classroom This nine-day supervisor core training series, Supervisory Training: Putting the Pieces Together, is divided into three three-day segments: Unit 1: Supervisor as Manager; Unit 2: Supervisor as Coach; Unit 3: Supervisor as Team Leader. This curriculum was adapted for Georgia Department of Family and Children’s Services in 2009. Supervisors attending this course must be certified in their program area. Skill Building/Mentoring A series of four units with activities related to each unit of Putting the Pieces Together, designed to enhance the transfer of learning from the classroom to the workplace. Each new supervisor is assigned a trained peer mentor who provides guidance, coaching, and monitoring for the skill building activities. Day to Day Supervision with GA SHINES, Georgia’s Statewide Automated Child Welfare Information System (SACWIS) This is a two-day hands-on training designed to provide new and veteran supervisors with basic knowledge and skills surrounding supervisory functions when using GA SHINES. Supervisors engage in a variety of interactive activities to promote understanding of their day to day role for using GA SHINES to achieve safety, permanency, and wellbeing for the children and families that we serve. (State of Georgia 2011)

Recently, the National Child Welfare Workforce Institute (NCWWI) has developed free online training in and ongoing peer support of

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leadership skills for child welfare supervisors (National Child Welfare Workforce Institute 2011a). Rather than focusing on core supervisory skills, the Leadership Academy for Supervisors focuses on supervisory leadership skills that are applied within the unit, the agency, and the community. The Leadership Academy for Supervisors is complemented by the Leadership Academy for Middle Managers, a weeklong residential training for middle managers in child welfare. Both these training curricula rest on the NCWWI Leadership Competency Framework (National Child Welfare Workforce Institute 2011b). The competency framework lays out four domains of leadership and outlines the critical competencies associated with those domains for four levels of child welfare practice (workers, supervisors, middle managers, and executives). The competency model integrates five important leadership traditions. Adaptive leadership (Heifetz & Linsky 2002) refers to a set of skills related to ways for dealing with adaptive challenges, that is, challenges that require a transformation of current behavior to address. Collaborative leadership calls the leader to focus outside the immediate area of function to the collaborative relationships that are necessary for success; distributive leadership (Spillane 2006) focuses the supervisor on multiple levels of the organization; inclusive leadership (Ryan 2006) centers the supervisor on collective processes to promote inclusion; and outcomefocused leadership describes an orientation to goals and results that is critical in today’s child welfare environment. The NCWWI framework articulates a ladder of leadership competencies related to these domains that extends from the worker level through supervision to middle and senior management. (The following box presents the competency domains and competencies for the supervisory level.) Supervisors require skills in leading change, leading people, and leading for results as well as in building collaboratives

and excelling in fundamental leadership areas. A quick look at the competencies reveals the scope of leadership skills required of all participants in an organization. N AT I O N A L C H I L D W E L F A R E W O R K F O R C E INSTITUTE: LEADERSHIP COMPETENCIES

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consensus through give and take, gains cooperation from others to obtain information and accomplish goals.

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Learning Circles Learning circles are a fresh approach to problem solving and professional development that embody the leadership traditions already discussed through a focus on collaboration, innovative thinking, and shared decision making. Fundamental to learning circles are the pursuit of knowledge and new information to address common issues affecting the learning circle membership. Learning circles consist of a group

of people who gather together to think, learn, and act on a designated topic. Typically, learning circles meet once a month and are led by a trained facilitator who is also a group member. Learning circles offer flexibility in their approach, but are typically used in two contexts in child welfare: with groups of supervisors (as in Georgia and Massachusetts ) and with units of workers with the unit supervisor as lead (as in Mississippi and the Western Workforce organizational intervention study). In the Western Workforce model in the states of Colorado, Wyoming, and the tribal sites in North Dakota, the supervisor is fully trained to act as the facilitator for her unit and jointly they address the practice- or team-functioning issues most impacting the unit. Over time, they thoroughly discuss the issue, using a semistructured approach, then develop a plan that is periodically reassessed and adapted as appropriate. In Georgia and Massachusetts, learning circles bring together groups of supervisors to address topics common to all the supervisors, while also providing collegial support and cross-fertilizing best practice approaches across geographical areas. Topics for both approaches range from secondary trauma to improving morale to promoting accountability. Learning circles use the PLAN, ACT, REFLECT, and ADAPT approach that mirrors most strategic planning and problem-solving processes (Butler Institute for Families 2010). Learning circle members design plans with solutions that address the issues most affecting their own practice to improve team or agency functioning and, ultimately, child and family outcomes. Learning circles follow a loose structure to maximize the meeting time and ensure fidelity to an approach that facilitates interaction leading to a more positive organizational culture. Cumulative in nature, learning circles may explore one topic while acting on another topic; discussion of a topic may span several meetings. A successful meeting is not measured by the development of a plan, but by the group members’ engagement in an active debate

CHILD WELFARE SUPERVISION

about the topic. Sometimes issues or problems are not so easily solved, but the act of discussion regarding the topic does move practice in a positive direction. Learning circle members may choose their own topics to discuss in their learning circles, though some agencies may designate a topic. However, how members resolve the issue under discussion and develop a plan is left up to the individual learning circle. L E A R N I N G C I R C L E T O P I C E X P L O R AT I O N QUESTIONS

Plan Phase 1. What are this team (agency’s) strengths regarding this topic? 2. What do we hope will happen by addressing this issue? 3. What is the agency policy around this issue? 4. How does this issue affect our clients? 5. What data or other performance measures inform this topic? 6. What are the challenges that we all face around this issue? 7. Where can we go to find information about this topic? 8. According to external information, what are the best ways to deal with this issue? 9. According to external information, what should we be considering? 10. What are the pros/cons to this (these) approach(es) suggested by external information? Plan Development Questions 11. What strategies can help to address this issue? 12. What supports might help with this issue? 13. What resources can we draw upon to assist with this issue? 14. What barriers might be anticipated? How can they be addressed in advance? 15. Is permission needed? Who else needs to be made aware of the plan? 16. How will we know we are successful in addressing this issue? (Butler Institute for Families 2011)

]

Perhaps you are feeling a bit overwhelmed by the range of roles and skills required to be a good child welfare supervisor. Child welfare supervision is clearly not for the fainthearted. It is, however, clearly for those who enjoy challenges, problem solving, leading and supporting others, and building effective organizations. Preparation for becoming an effective supervisor begins with becoming an effective child welfare worker—a worker who uses supervision well and who listens, observes, and learns GSPN
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welfare workers, with organizational and leadership skills, can expect to be offered the opportunity to serve as a child welfare supervisor. In so doing you will join a group of child welfare’s most important practitioners. Take a look at Gina’s case and apply some of the ideas from this chapter to your assessment of her situation as a supervisor. GINA’S STORY Gina reflects on the past year as an intake child welfare supervisor in a medium-sized urban/suburban county. What a ride it has been! So many surprises! So many challenges! Yet such a rich learning experience and fulfilling. Gina has been with this public child welfare agency for almost seven years. She had six years of experience as a worker prior to accepting her current position. Gina reports to the agency child welfare administrator (who reports to the director). Gina works in a state-supervised, county-administered child welfare system. Her county must often collaborate with other counties in the urban area; however, she knows now that the organization and cultures of these county agencies are somewhat different. Her agency is bound by many state policies, but the director reports directly to the county manager and board of commissioners. Her unit consists of seven workers who are quite diverse in terms of age, gender, ethnicity, social and economic class, and experience. Gina has drawn upon her own diversity-related skills to interact with her group and ensure that everyone feels included and appreciated. Over the past year, she has worked

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with her staff members to understand their training needs and develop plans to address these needs using agency and community training resources. An important part of her job has been managing the work flow of her unit while also attending to the unit’s organizational climate as the unit dealt with new challenges, settled in, and then geared up for more changes. Two experienced workers had an ongoing conflict, and others felt that they had to choose sides. Through creative mediation, the unit is in a relatively calm phase. At yesterday’s supervisors’ meeting, Gina learned about even more upcoming changes. A mock Child and Family Service Review will be held in three weeks, and several cases from her unit have been selected for the sample. The child welfare administrator will also be looking at outcome data by unit in order to identify units where improvements are needed. Managing with data has become a mantra for the agency. Some months ago this county was involved in a highly publicized child fatality. Though the fatality took place while the case was under the supervision of a neighboring county, it was Gina’s county that did the initial assessment and may not have adequately passed on information to the supervising county when the family moved. The report from the state agency’s investigation of the fatality will be released today. The child welfare administrator sees a new grant program that uses supervisors to lead unit learning circles as a positive response and is having

REFERENCES

American Public Human Services Association (2005). Report from the 2004 child welfare workforce survey: State agency findings. Washington, DC: American Public Human Services Association. Anderson, G. (2009). Supervisors as leaders: A critical dimension for organizational Success. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 44–60). New York: Oxford University Press. "OUMF
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the middle management role in child welfare. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 119–45). New York: Oxford University Press. Annie E. Casey Foundation (2003). The unsolved challenge of system reform: The condition of the frontline human services workforce. Baltimore: Annie E. Casey Foundation.

some difficulty hearing Gina’s fellow supervisors, who are worried about overload in their schedules. Because her newest worker has completed core training and is now eligible for a full caseload, and in light of an anticipated increase in referrals in the wake of the upcoming media attention, Gina learns that her unit can expect an increase in cases over the next week. Gina contemplates all that she’s learned and still needs to learn in order to be the best possible supervisor. She’s already taken the supervisor core foundational training and has participated in an online supervisor training, Leadership Academy for Supervisors. Next week she has a meeting with her supervisor to assess her own degree of mastery of the agency’s supervisor competencies. It turns out that her job as a supervisor is much more than she thought it would be! Reflection questions: What are the priorities that Gina juggles on a daily basis? What is her most important priority? How can Gina act as a leader at her agency? What do you think has surprised Gina the most about her job? What are the most important resources available in Gina’s work environment? What might you be most excited about in this job if you were Gina? What can Gina anticipate in the future?

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Families, Graduate School of Social Work, University of Denver. Brownlee, R. (2002). Recruitment and retention study: Supervisor survey. Little Rock: University of Arkansas, Little Rock, Midsouth. Cahn, K. (2009). The world beyond the unit. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 146–76). New York: Oxford University Press. Cahn, K., & Berns, D. (2009). Working in changing environments. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 177–202). New York: Oxford University Press. Chambers, R., & Potter, C. (2008). The match between families needs and services for high risk neglecting families. Public Child Welfare 2, 229–52. Child Welfare League of America (2002). Research roundup: Child welfare workforce. Washington, DC: Child Welfare League of America. Clark, S., Smith, R., & Mathias, C. (2009). 2008 California public child welfare workforce study report. Berkeley: California Social Work Education Center. Cohen, B., & Austin, M. (1994). Organizational learning and change in a public child welfare agency. Administration in Social Work, 18, 1–19. Collins-Camargo, C., & Kelly, M. (2007). Supervisor as informal mentor: Promoting professional development in public child welfare. Clinical Supervisor, 25, 127–46. Collins-Camargo, C., & Millar, K. (2010). The potential for a more clinical approach to child welfare supervision to promote practice and case outcomes: A qualitative study in four states. The Clinical Supervisor, 29, 164–87. Cornerstones 4 Kids (n.d.). Complete competency library. Houston, TX: Cornerstones 4 Kids. Retrieved June 26, 2009, from http://portal.cornerstones4kids. org/stuff/contentmgr/files/c715e1e22011e8eac46f c839b5f6d376/folder/competency_library_guide lines.pdf. Daniels College of Business at the University of Denver (2007). Leadership competencies. Denver: Daniels College of Business, Institute of Leadership and Organizational Performance. Dickenson, N., & Comstock, A. (2009). Getting and keeping the best people. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 220–61). New York: Oxford University Press. Dickinson, N., & Perry, R. (2002). Factors influencing the retention of specially educated public child welfare workers. Journal of Health & Social Policy, 15, 89–103. Dill, K. (2007). Impact of stressors on front-line child welfare supervisors. Clinical Supervisor, 27, 177–93. East, J., & Hanna, M. (2009). Management essentials for child welfare supervisors. In C. Potter & C. Brittain (eds.), Supervision in child welfare (pp. 61–82). New York: Oxford University Press.

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and Retention Project. Presentation to the 16th National Conference on Child Abuse and Neglect, Portland, OR. Potter, C., Comstock, A., Brittain, C. & Hanna, M. (2009). Intervening in multiple states: The Western Regional Recruitment and Retention Project. Child Welfare (Special Issue on Recruitment and Retention), 88, 165–89. Pryce, J., Shackelford, K., & Pryce, D. (2007). Educating child welfare workers about secondary traumatic stress. In J. Pryce, K. Shackelford, & D. Pryce (eds.), Secondary traumatic stress and the child welfare professional. Chicago: Lyceum. Regehr, C., Leslie, B, Howe, P., & Chou, S. (2002). An exploration of supervisors’ and managers’ responses to child welfare reform. Administration in Social Work, 26, 17–36. Renner, L., Porter, R., & Preister, S. (2009). Improving the retention of child welfare workers by strengthening skills and increasing support for supervisors. Child Welfare, 88, 109–27. Rushton, A., & Nathan, J. (1996). The supervision of child protection work. British Journal of Social Work, 26, 357–74. Ryan, J. (2006). Inclusive leadership. San Francisco: Jossey-Bass. Scannapieco, M., & Connell-Carrick, K. (2005). Understanding child maltreatment: An ecological and developmental perspective. New York: Oxford University Press. Schmidt, G. (2008). Geographic location and social work supervision in child welfare. Journal of Public Child Welfare, 2, 91–108. School of Public Health, University of Albany & National Association of Social Workers (2006). Licensed social workers in the U.S., 2004. Washington, DC: National Association of Social Workers. Shulman, L. (1993). Interactional supervision. Washington, DC: National Association of Social Workers. Silver, P., Poulin, J., & Manning, R. (1997). Surviving the bureaucracy: The predictors of job satisfaction for the public agency supervisor. Clinical Supervisor, 15, 1–20. Smith, B., & Donovan, S. (2003). Child welfare practice in organizational and institutional context. Social Service Review, 77, 541–63. Spillane, J. (2006). Distributed leadership. San Francisco: Wiley. Stalker, C., Mandell, D., Frensch, K., Harvey, C., & Wright, M. (2007). Child welfare workers who are exhausted yet satisfied with their jobs: how do they do it? Child and Family Social Work, 12, 182–91. State of Georgia (2011). Supervisor capacity-building sequence. Unpublished MS. State of Maine (2011). Supervisor academy: Supervisor competencies self-assessment. Unpublished MS. State of Maine, Office of Child and Family Services, & Maine Child Welfare Training Institute. (2005).

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Standards for supervision in child welfare. Portland: State of Maine, Office of Child and Family Services. 4USBOE
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sustaining a mentoring program for child welfare staff. Administration in Social Work, 34, 49–67. Strolin, J., McCarthy, M., & Caringi, J. (2007). Causes and effects of child welfare workforce turnover: Current state of knowledge and future direction. Journal of Public Child Welfare, 1, 29–52. U.S. Department of Health and Human Services Administration for Children and Families/Children’s Bureau and Office of the Assistant Secretary for Planning and Evaluation (2003). National study of child protective services systems and reform efforts: Findings

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on local CPS practices. Washington, DC: Government Printing Office. U.S. General Accounting Office (2003). Child welfare: HHS could play a greater role in helping child welfare agencies recruit and retain staff. Washington, DC: U.S. General Accounting Office. Westbrook, T., Ellis, J., & Ellett, A. (2006). Improving retention among public child welfare workers: What can we learn from the insights and experiences of committed survivors? Journal of Administration in Social Work, 30, 37–62. Yoo, J., & Brooks, D. (2005). The role of organizational variables in predicting service effectiveness: An analysis of a multilevel model. Research on Social Work Practice, 15, 267–77.

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here is no human services field in which it is more important that we determine how to effectively work with clients and promote positive outcomes than in child welfare. Our most vulnerable children and their families depend on us to do so. Fortunately, child welfare agencies are increasingly focused on improving their outcomes and being accountable for their practice (Weigensberg 2009; Lindsey & Schlonsky 2008). Unfortunately, the evidence base in child welfare, while growing, remains at a relatively early stage of development, particularly in the arena of practice techniques that produce the desired outcomes for children (Barth 2008). Every day child welfare practitioners struggle to address complex social problems experienced by the families they serve without sufficient evidence regarding the effectiveness of their agencies’ programs and interventions; moreover, the evidence remains insufficient regarding how best to adapt what has been found to be effective to practitioners’ own local context (Mullen, Bledsoe, & Bellamy 2008). In 2000, the Children’s Bureau created the Child and Family Services Review (CFSR) process (see the chapter by Mitchell, Thomas, and Parker, this volume) to monitor the extent to which state child welfare systems are meeting national standards for achieving safety, permanency, and well-being for the children and youth they serve as well as to monitor a number of systemic processes, such as staff training, quality assurance systems, and management information systems (MIS; U.S. Governmental Accounting Office 2004). The implementation

of the CFSRs has been a significant step forward in accountability for state systems that had formerly relied primarily on measuring outputs, such as the number of children served, rather than outcomes. During the first round of these federal reviews, none of the states was found to be in substantial conformity with all outcomes and systemic factors; therefore, the Children’s Bureau required all states to complete program improvement plans (PIPs). Implementing the PIPs has required states to better determine which programs and interventions will achieve desired outcomes, thereby better serving children and families as well as avoiding fiscal sanctions. Although evidence-based practice (EBP) has been widely discussed in the field of child welfare, some have noted that achieving EBP may be elusive in a system that has only recently begun to track outcomes for the families and children it serves (Poertner, McDonald, & Murray 2000). The need for a razor-sharp focus on providing agencies and practitioners with data on how to most effectively approach and perform their work with children and youth and their families is tremendous. Testa and Poertner (2010) advocate a resultsoriented approach to accountability in child welfare agencies. Their model includes five stages: outcomes and performance monitoring; data analysis to determine if the difference between observed and desired outcomes is of sufficient importance and magnitude to warrant a change; review of research to identify potential empirically supported alternatives; rigorous 660

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evaluation of selected interventions; and a continuous quality improvement approach to identify interventions that demonstrate promise and terminate those that do not throughout the field. This approach embraces both the implementation of evidence-supported interventions and the process of evidence-informed practice by child welfare agency administrators and frontline workers in their day-to-day work (Testa & Poertner 2010). The field has also begun to study the implementation of practice techniques and programs in order to identify what a child welfare agency must do to support its staff in implementing evidence-based practice (Fixsen et al. 2005). In addition to developing a systematic approach to selecting, implementing, and evaluating practice methods at the agency level, the field of child welfare is being challenged to infuse an overall evaluation climate that promotes sustainable outcome improvement over time, rather than focusing on specific individual projects or studies (Chaffin 2006). This chapter provides a rationale for and an overview of the history of child welfare research and evaluation, describes the various types, and discusses strategies for conducting research and evaluation while at the same time acknowledging and addressing the complexity of conducting research and evaluation in child welfare settings. This chapter is not intended to, and cannot be, a manual on conducting research. Many excellent sources exist for that purpose. Instead, this chapter will convey the breadth of recent and current research and evaluation activities in child welfare. In the human services, scientific research can be broadly classified as having three primary and often interrelated purposes: to objectively describe things, to evaluate the effectiveness of services, and to validly explain things. Descriptive research can be undertaken to better understand the characteristics and needs of clients served by a particular agency. Evaluative research helps determine whether clients’ needs are being met and their goals attained. Explanatory studies aim at uncovering the causes of psychological and social problems

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and the processes by which interventions achieve the desired outcomes, thus contributing to what is known as etiological or intervention research (Royse et al. 2001:2).This chapter attempts to hone in on research and evaluation as these relate to child welfare—a field that is simultaneously complex, changing, and critical to the well-being of our children. A Brief History of Child Welfare Research In 1909 President Roosevelt convened the first White House Conference on Dependent Children which led to creation of the US Children’s Bureau to investigate and report on infant mortality, birth rates, orphanages, juvenile courts, and other social issues—essentially a research function (Baker & Charvat 2008). A core part of the Children’s Bureau’s mission continues to be the support and funding of research designed to inform the field regarding topics of interest to child welfare practice (Mallon 2011). This federal agency invests approximately $110 million in the development and transfer of knowledge regarding child maltreatment and child welfare services through research and demonstration grants, contracts, and cooperative agreements. In recent years the Children’s Bureau has required demonstration project applicants to detail their research designs and to allocate a percentage of the project’s funding toward evaluation; the Children’s Bureau favors external evaluation and sometimes requires cooperation with a national evaluation process across a grant cluster (Brodowski et al. 2007). One of the earliest studies in the field of child welfare was conducted by Sophie van Senden Theis, How Foster Children Turn Out. In her study of 910 children who had been placed by the New York State Charities Aid Association and had reached adulthood, Theis (1924) reported fairly positive outcomes in school performance, self-support, and observance of the law. This landmark research was notable not only for its sample size and systematic approach, but also for its emphasis on outcomes for the children served.

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In 1956 the Social Work Research Section of the National Association of Social Workers (NASW) sponsored the Conference on Research in the Children’s Field, noting that little was known with respect to this field of practice and particularly emphasizing foster care and adoption. Subsequently, in 1963 the Social Work Research Section of the NASW and the Child Welfare League of America (CWLA) sponsored the Institute on Child Welfare Research to acknowledge and encourage the expansion of scholarship in child welfare and to disseminate research findings. The Institute’s sponsors published the papers presented in a compendium, The Known and Unknown in Child Welfare Research: An Appraisal (Norris & Wallace 1965). At that time, Fanshel (1965:12– 14) articulated practice questions that child welfare research needed to address: Can psychological damage to a child caused by separation from his parents be reversed through good placement experiences and through the therapeutic services provided by agencies? .  .  . What are the earmarks of a potentially good candidate for the foster parent or adoptive parent role? .  .  . All things being equal, is a child who could cope with either institutional or foster family care better off in a family home than in an institution? .  .  . Can the decision to separate children from their parents be made more rational through research on the decision-making process?

More than forty-five years later, the field is still grappling with variations of Fanshel’s questions. Such a volume could be published each decade to serve as a research agenda for the field. Baker and Charvat (2008) illustrate the impact of child welfare research on, or at times in response to, major trends in federal legislation. A similar approach is offered here. Maas and Engler’s (1959) landmark study documented foster care drift and placement instability for children and youth placed in out-of-home care. Although the study’s design has been criticized

as to child welfare research history, setting off the field’s long-term attention to permanency for children and youth. Fanshel & Shinn (1978) studied foster youth in New York City longitudinally, raising additional questions about the policies and practices related to out-of-home care placement and stability. In the Oregon Project, casework approaches designed to better achieve permanency planning for children and the adjustment of children in placement were tested (Lahti et al. 1978). These studies and growing concern regarding the number of children entering and then “languishing” in out-of-home care contributed to the passage of the Adoption Assistance and Child Welfare Act of 1980. This act mandated a process for permanency planning for children and youth once they enter foster care; it also emphasized providing reasonable efforts to prevent the removal of children from their homes as well as to promote reunification with families. In the eighties, research continued to focus on length of stay and lack of permanency for children, such as Gibson, Tracy, and DeBord’s (1984) study of the frequency of contact between families and the agency and its relationship to length of stay in care. Other significant studies examined intensive family based services (e.g., Fraser, Pecora, & Haapala 1991) to determine the degree to which such services prevented out-of-home placements and responded to the federal reasonable efforts requirement. The 1980 federal child welfare legislation further required states to develop data systems to report case-level information on children in foster care. The development of large administrative data sets enabled research advances, including multistate comparisons. The availability of administrative data in child welfare research has led to advances in statistical procedures, such as event history analysis, to examine the relationship of critical stages in time, such as a child’s early months in foster care, to the ultimate achievement of outcomes (e.g., Wulczyn & Goerge 1992). Large data sets have been made available to researchers through

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the federally funded National Data Archive on Child Abuse and Neglect established in 1988 at Cornell University. This is a repository for voluntarily contributed state-level, and in some case-level data, to a data set established as the National Child Abuse and Neglect Data System in subsequent reauthorizations of CAPTA since 1990. The Adoption and Foster Care Analysis and Reporting System, which collects case level data and was mandated by federal legislation in 1986, can also be accessed by researchers through the archive (Waldfogel 2000). More recently, with data submissions beginning in 2011, the National Youth in Transitions Database has been created to collect data on youth receiving independent living services and track outcomes into early adulthood. The publication in 1962 of The Battered Child Syndrome, which reported medical research regarding serious injuries to children (Kempe et al.), initiated the field’s expanded focus on child safety. Subsequently, the Child Abuse Prevention and Treatment Act of 1974 (CAPTA) mandated that states develop a system to track and report suspected and confirmed cases of child maltreatment. Two decades later, the Adoption and Safe Families Act of 1997 (ASFA) represented another shift in federal policy, explicitly making children’s safety a paramount concern. It also established shorter and less flexible time frames for permanency achievement, and focused attention on termination of parental rights, adoption, and kinship care. Examples of important research during this time period included Berrick and colleague’s (1998) study on the impact of levels of out-of-home care (such as foster homes or residential care) on stability, length of stay, and permanency; examination of outcomes associated with kinship versus nonkinship placements (Testa 2001); and outcomes for youth aging out of foster care (Courtney, Needell, & Wulczyn 2001). The twenty-first century has continued to yield major advances in collaborative, multisite, and longitudinal child welfare research. One example is the National Survey of Child

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and Adolescent Well-being, a longitudinal, nationally representative study on the functioning of children and families served by the child welfare system based on interviews with children, caregivers, and agency staff (Webb et al. 2010). Longitudinal Studies of Child Abuse and Neglect, a consortium of five coordinated longitudinal research studies that use some common data protocols but study very different samples of children, examines the antecedents and consequences of child maltreatment (Runyan et al. 1998). In 2001 the Children’s Bureau launched a new approach to knowledge development by funding regional quality improvement centers (QICs) in child protective services and adoption. QICs were funded by the federal agency for five years to design and manage a cluster of research and demonstration projects around a particular area of child welfare practice. Rather than the Children’s Bureau doing so, the QICs have conducted a knowledge gap analysis around a topic of interest to the field, administered a competitive application process, monitored and provided technical assistance to funded research and demonstration projects, conducted a cross-site evaluation, and engaged in dissemination activities (Brodowski et al. 2007). Following a national evaluation of this new research mechanism, in 2005 the Children’s Bureau funded the first national QIC, the Quality Improvement Center on the Privatization of Child Welfare Services. National QICs have the expanded responsibility to facilitate national information sharing on promising practices and the emerging evidence base associated with the topical area (CollinsCamargo et al. 2007). This approach to child welfare research holds promise for conducting clusters of collaborative, applied research in multiple sites focused on particular topics of interest to the field. National QICs have been able to provide intensive technical assistance and emphasize ongoing dissemination. Most recently, the development and passage of the Fostering Connections to Success and

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Increasing Adoptions Act of 2008 reflected findings from research conducted during the decade following AFSA’s implementation. This 2008 legislation emphasizes kinship care and support for maintaining family connections and achieving permanency for older youth transitioning into adulthood. Areas of Research in Child Welfare Many research questions remain, the answers to which will improve our understanding of the needs of the children, youth, and families served by the child welfare system and the ways in which we can most effectively respond to the challenges they present. Several ways have been developed to identify and categorize child welfare research topics, questions, and types. One approach was utilized in the development of A Research Agenda for Child Welfare (National Association of Public Child Welfare Administrators & the National Resource Center on Child Maltreatment 2001); this product was developed through forums in five sites across the country with 151 public child welfare administrators and university representatives. Each forum generated recommendations for child welfare research questions across five categories: practice research, program evaluation, policy research, research synthesis, and prognosis research. At the regional level, these research questions were ranked in priority; subsequently the questions were merged by a workgroup into a national agenda of 41 research questions. To illustrate, one practice question identified was: Which risk and protective factors should be targeted in screening, assessment, and intervention? A question for program evaluation included: What is the effectiveness of current cross-system collaboration efforts? In the policy area, the following question was one of those selected: How do you construct incentives in policy and funding that support desired outcomes? Research synthesis included: What is known about the relationship of staff qualifications to program outcomes? In the final category, prognosis, a

question identified was: What is the prognosis that a child will be better off with a child welfare intervention than without one? (National Association of Public Child Welfare Administrators & National Resource Center on Child Protective Services 2001). The field could benefit from the establishment of such a process to periodically examine and assess the evidence base for answering each of these questions, and research priorities revised based on emergent needs and knowledge levels. Another way of developing categories of research is by the topical focus of the research itself. One such area is research regarding the children, youth, and families served by the child welfare system. Within this broad focus are easily identified subtopics, such as the characteristics of maltreated children (e.g., Dubowitz et al. 2005); family dynamics, characteristics, and contributors to child maltreatment (e.g., Drake, Johnson-Reid, & Sapokaite 2006; Gaudin et al. 1993); and the impact of abuse and neglect on children (e.g., Briere 1992). A second critical category would be research regarding effective practice techniques, treatment, and programs. An array of examples of research in this category can be identified, such as factors associated with substantiation decisions (e.g., English et al. 2006), outcomes associated with use of kinship care (e.g., Courtney & Needell 1997), family engagement techniques (e.g., Dawson & Berry 2002), solution-based casework practice and its relationship to federal child welfare outcomes (e.g., Antle et al. 2012), outcomes of family preservation programs (e.g., Fraser, Nelson, & Rivard 1997), and the impact of services on child maltreatment recurrence (e.g., DePanfilis & Zuravin 2001). Since practice spans prevention to assessment and investigation to intervention with children and families in children’s home, when children are placed in legal custody, and postplacement as well as post-achievement of permanency, this is a vast area of research. This is a category of child welfare research in which a great deal of work must yet be done.

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Knowledge concerning the achievement of effective outcomes for children and families served by the child welfare system has a focus much broader than frontline practice, however. A third area is research regarding organizational structures and interventions in child welfare agencies and systems. Similar to the practice category, many subtopics could be included here, such as performance-based contracting with private provider agencies (McBeath & Meezan 2010), organizational culture and climate (Glisson 2007), organizational conditions promoting evidence-based practice (Franklin & Hopson 2007), quality assurance and quality improvement processes (Pecora et al. 1996), the relationship between agency characteristics such as caseload size and a history of systems change initiatives and permanency achievement (Weigensburg 2009), and clinical supervision of the front line (Collins-Camargo & Millar 2010; Leitz 2008). The field also necessarily develops knowledge about the professionals who are employed in the child welfare system. Research regarding the child welfare workforce and its development can include employee selection processes (e.g., Ellett et al. 2006), relationship between staff characteristics and child outcomes (e.g., Ryan et al. 2006), Title IV-E education programs (e.g., Coleman & Clark 2003), staff training (e.g., Sullivan et al. 2009), and worker retention (e.g., Ellett, Ellett, & Rugutt 2003; Zlotnick et al. 2005). Having found relationships between characteristics of the child welfare workforce and child and family outcomes, the field must necessarily continue to explore how to better develop and retain a competent, committed child welfare workforce. Perhaps a category of research that has been studied least, yet is of critical importance, is research regarding child welfare policy. This would include research into policy related to the role of the public and private sectors in child welfare service provision, such as themes related to planning of privatization initiatives (Flaherty, Collins-Camargo, & Lee 2007); policy

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related to multisystem collaboration, such as between child welfare and domestic violence providers (Banks et al. 2009); policy related to citizen participation in the child welfare system, such as citizen review panels (Bryan, Jones, & Lawson 2010); and the efficacy of social policy, such as the relationship between social context, social policy, and child fatalities (Douglas & McCarthy 2011). The field must continue to study practice and structures on a macro level as well as on the frontline. Promising Strategies in Child Welfare Research and Evaluation In addition to what we study, it is also important to consider how we study it. Child welfare research and evaluation can be undertaken in numerous ways, and certainly every welldesigned and implemented research study and program evaluation contributes to the field’s evidence base. However, agency-based research units, collaborative research through university/agency partnerships, and multisystem/ multisite research are strategies that show particular promise in helping us to move forward in a more coordinated and comprehensive way in child welfare research. Agency-Based Research and Program Evaluation Some child welfare agencies have established their own research units. Agency-based units and researchers can directly access a vast array of data as well as the professional expertise of agency staff to help them plan, conduct, and interpret internal research and evaluation (Baker & Charvat 2008; Lawrence et al. 2013). Internal units have implied sanction and acceptance from within the system and the support of agency administrators. These also have the ability to improve practice and policy through establishing data-driven continuous quality improvement processes within the agency. Agency-based researchers may concurrently be challenged regarding the need to maintain objectivity as well as regarding political pressures to report

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favorable findings regarding systems under fire. In addition, such units and their staff may be vulnerable to budget cuts and agency leadership changes (Collins-Camargo et al. 2011). Two examples illustrate how differently such agency-based research units may be structured. Kentucky’s Information and Quality Improvement unit, staffed by only 2.5 staff, has as its goals to build the infrastructure to support data-driven decisions, facilitate the quality improvement process to promote best practices, envision and implement statewide solutions and initiatives, and disseminate results and enhance Kentucky’s image as a high-performing child and family service delivery system.1 The unit generates outcome indicators for the child welfare agency’s PIP; performs comparative and descriptive analyses regarding all programs in the Department for Community Based Services for both standardized, periodic reports, and specialized inquiries; implements a customer satisfaction survey process; and leads the agency’s continuous quality improvement process. The unit also has conducted evaluations for a number of agency programs, such as family preservation, the multiple response system, and the centralized intake programs, and published program evaluation reports on the agency Web site. The Rhode Island Department of Children, Youth, and Families established the Data and Evaluation, Quality Assurance Unit in 2006. The data and evaluation director is a member of the agency’s senior executive team. Including the director, there are three staff members who conduct data analysis and research. In addition, the Quality Assurance and Administrative Review unit has four staff members, and there are thirty MIS staff members who manage hardware, software, data interface, and the database.2 Rhode Island’s Data and Evaluation, Quality Assurance Unit is comprised of three subareas. Management information system staff members generate approximately six hundred monitoring and quality assurance reports. These reports are regularly disseminated to

appropriate staff. This subarea also maintains a dashboard accessible to all department staff regarding safety, permanency, and well-being, including raw data specific to the user as well as aggregate reports and graphs that can be manipulated by the individual. The subarea also conducts targeted analyses, cross-sectional and longitudinal studies, such as a study of archival data regarding risks and protective factors, exits to permanency in foster care, and re-maltreatment of children following family reunification. Another subarea, the Quality Assurance and Administrative Review Unit, performs foster care and quality assurance reviews. Data and Evaluation holds regular meetings with regional offices and senior administrators to review data reports. The Data Analytic Center is a collaborative initiative with the Yale University School of Medicine and Placement Solutions to provide evaluations regarding residential service delivery, research consultation, and analysis for any of the department divisions. These two examples demonstrate how large public child welfare agencies are building their own capacity to conduct research and evaluation. Collaborative Research Through University/ Agency Partnerships Many public and private child welfare agencies rely on partnerships with universities to evaluate their programs and conduct research. Almost fifty years ago, Brieland (1965) described university social work programs as an important resource for child welfare research. Zlotnick (2010) has provided an overview of the evolution of such partnerships over time. Some are formal, such as the Child and Family Research Center at the University of Illinois at UrbanaChampaign, created by the Illinois Department of Children and Family Services (DCF) and the university social work program, and the Child Welfare Research Center at the University of California at Berkeley. Other partnership may focus on specific federally funded research and demonstration projects and/or agencyfacilitated stakeholder groups and taskforces.

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When such relationships are built with respect for and an understanding of each other’s strengths and needs, these partnerships can be very mutually beneficial. Begun and colleagues (2010) have recently described four strategies for promoting success in university-community research partnerships. These include adopting a technology exchange perspective, establishing a longitudinal approach, knowing your partners, and establishing clear contracts and budgets. The Illinois DCF has a long history of working with several universities to manage and utilize their data to improve services, including contracts with the Child and Family Research Center at the University of Illinois, Northwestern, Chapin Hall at the University of Chicago, and others. Research at individual universities can easily become siloed. The director of DCF meets regularly with researchers from these universities to be updated on individual projects and coordinate research efforts among the universities to provide comprehensive data with which the administration can make decisions.3 Collaborative research involving authentic partnerships between child welfare agencies and universities enables the study of questions that are directly relevant to real world practice, demonstrates valuing and appreciation of both researcher and practitioner expertise, and enhances rigor as well as feasibility in research design. These collaborations also serve to build evaluation capacity and an appreciation for evidence-based practice in the agency (Regeher, Stern & Schlonsky 2007). Universities can help agencies to package data in a user-friendly format that frontline staff can apply in their practice (Schoech, Basham, & Fluke 2006). The importance of the field of child welfare continuing to build and sustain long-term, committed relationships in which researchers are truly engaged in helping the system to improve and agency administrators appreciate the value faculty have to offer the system and the importance of rigorous methods to answer the agency’s questions, cannot be understated.

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The Institute for the Advancement of Social Work Research’s report on child welfare research partnerships (2008), based on interviews with over forty stakeholders, focus groups, and Web-based surveys, describes the attributes of successful university/agency research partnerships as including trusting relationships, longterm commitment, committed leadership, all collaborators experiencing benefits from the partnership, and common interests and objectives. This publication offers a detailed toolkit for developing and maintaining such partnerships. More than thirty research centers and partnerships were identified in the Institute for the Advancement of Social Work Research’s study of child welfare research partnerships (2008). Both entities can benefit from these collaborations—universities fulfill their service mission and develop opportunities for knowledge development and publication on topics that really matter to the field, while agencies gain research and statistical expertise, access to the professional literature, and a partner in addressing their challenges. Multisite/Multisystem Research One of the challenges in building the evidence base for the field of child welfare is the translation of findings from individual studies into real world settings, settings with their own unique context and characteristics. Multisite research involves multiple implementation sites with a cross-site evaluation (Sinacore & Turpin 1991). Given the vast differences across state child welfare systems, multisite research that utilizes strong comparison designs and collaborative development of research questions, methodology, and instrumentation offers very real benefits to a field that is seriously attempting to identify effective practices (Leff & Mulkern 2002; Cook et al. 2002). By measuring the influence of programmatic, agency-based, and other contextual factors in multiple sites, the evidence base for how programs may be replicated in an array of settings is strengthened (Straw & Harrell 2002). The ideal model,

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termed “negotiated, centralized evaluation” by Lawrenz and Huffman (2002), uses a participatory or collaborative research approach, led by a centralized evaluation team that manages the cross-site evaluation and comparison and facilitates support and adherence to the agreedupon study design. This is the model used by the federally funded QICs. Collaborative negotiation of common instrumentation and methodology among site evaluators helps to develop relationships across sites for collaborative problem solving and accountability to the design despite agency leadership changes and other pressures. James Bell Associates conducted a national evaluation of the original regional QICs. Four overarching findings are relevant to this discussion. First, they found that it important to establish welldefined and structured evaluation expectations and a study design to be followed by all sites. Second, implementation and evaluation should occur in tandem with an experienced evaluator involved in programmatic as well as research planning from the beginning. Third, site-specific program diversity negatively impacts on measurement and comparability, thereby losing some of the benefits for multisite research. Finally, it was found that the quality of the local and cross-site evaluations impacted the ability of QICs to contribute to the overall evidence base (Hafford et al. 2006). It will be important for our field to continue to work toward multisite methods, testing research questions in an array of child welfare settings to ensure that knowledge development and evidence regarding effective practices in the field move forward.

research projects may progress, and responsiveness to findings may occur. Institutions, including universities and public and private child welfare agencies, operate out of differing missions and perspectives and inevitably have different priorities at any given point in time. Agencies may be hesitant to open up their practices to additional scrutiny and/or increase the workload of an overburdened system with the addition of data collection and research activities. Agency-based MISs contain a large quantity of data, but relying on these for research typically provides challenges. And, researchers may want to adhere to preferred research designs that may not be easily adapted to the fast-paced, often crisis-driven child welfare environment. Luongo (2007) described how interventions developed in a research setting often fail when transferred to a real-world setting. The organizational culture of each agency varies, encompassing its own norms, values, and characteristics, such as communication flow, morale, supervision, and leadership style. Staff members have diverse characteristics, such as levels of performance and skill, attitudes, educational backgrounds, and motivation or resistance to studying one’s own practice and to change. The interaction of these variables may create situations in which new practice models that have been found to be effective in some settings may not produce the same outcomes elsewhere. These and other challenges facing child welfare research and evaluation must be identified, understood, and tackled with persistence.

Emerging Challenges and Trends in Resolution Collins-Camargo and colleagues (2011) articulate a number of challenges associated with child welfare research and evaluation. Scrutiny and external demands from the courts, media, and other systems, such as behavioral health and education and public opinion, all impact the pace at which agencies can change,

Issues Associated with Methodology RCTs and Realistic Evaluation Randomized control trials, typically considered the gold standard of intervention research, have become more frequent in child welfare. This is a very positive trend when this design is appropriate to the research questions to be answered. However, debate continues regarding the use of

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experimental methods in the human services due to the issues of feasibility, the ethics of withholding treatment to control groups, and questions regarding the appropriateness of studying complex interventions in complex settings such as child welfare (Oakley 1998). In order to address some of these concerns while making it possible for a statistically valid comparison group, the use of propensity score matching has grown as an alternative. This enables researchers to match subjects statistically on their conditional probability of group membership, which is calculated based on a number of other observed variables (Koh & Testa 2008). A broader issue, however, is the inability of interventions in clinical environments to actually approximate their potential effectiveness in real-world settings. Solomon (2002) noted that demonstration projects in child welfare rarely produce results that live up to project expectations because typical causative research designs do not take into account the ways in which large public programs are developed and implemented. Solomon advocates for a realistic approach to evaluation described by Pawson and Tilley (1997); this approach focuses not only on the intervention but also the context and the mechanism through which the intervention produces outcomes. Without this sort of approach—in which process is measured carefully in addition to outcomes— how could one realistically hope to replicate interventions in new settings? Solomon (2002) provides an excellent example of how a project in the Department of Children and Family Services in Los Angeles began with articulation of program theory (Why do we think this particular intervention will yield the results we seek? What is the predicted mechanism for how change will be promoted?), involved careful program specification (How are client social problems and characteristics logically connected to the detailed activities undertaken in the intervention, and the outcomes being sought?), and articulation of a design for the program evaluation that measured the program

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activities, contextual factors associated with the implementation, and short and long-term outcomes. Such a process is typically laid out in a logic model that lists program inputs, activities, outputs, and outcomes in a relational figure, along with the underlying assumptions associated with the problem to be addressed and the program approach, and contextual factors that may influence it. It is important to conduct both formative (process) evaluation and summative (outcome) evaluation in child welfare. We need to know not only whether an intervention strategy, such as family group conferencing, yields positive outcomes for children and families but also to understand why, how, and through what combination of activities these positive outcomes can be achieved. What sorts of supports are necessary to promote the successful implementation of an intervention? Important strides are being made in the field of research studying implementation. For example, Fixsen and colleagues (2005) have found an array of drivers of successful implementation, including staff selection, training and coaching, administrative policies and structures, and external supports. If an agency has chosen to implement a new practice model, for example, simply establishing a revised policy and conducting spray-andpray-style training of staff will not likely yield the desired practice change. The agency staff may be left wondering why an empirically supported intervention from another setting did not work for them. Another methodological issue involves the relationship between the researcher and the practitioner. To what extent is it critical that the evaluator be external to the agency? Sometimes there is a desire to avoid even the appearance of bias. Are there ways to promote objectivity in internal research? There are pros and cons to both, strengths of both external and internal research teams. This is a complex matter, but it is perhaps most important to employ strategies to maintain objectivity and welcome alternative points of view in the process.

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Participatory Methods Lawrenz & Huffman (2003) assert that there are four dimensions of evaluation quality: 1. objectivity, 2. design, 3. relationship to agency goals and context, and 4. motivation to provide data and support the evaluation effort including the frontline staff. Participation impacts all four dimensions. This involves making the intervention and the evaluation questions relevant to the field as well as realistic within the context of each different practice environment (Schwandt 2005). For example, given the role of the CFSRs and program improvement plans (PIPs) in each state’s child welfare reform efforts, research that cannot be tied directly to the federal outcomes and the areas the state is focused on improving is destined to fail—it will not be relevant to the agency goals and context at that point in time. Similar challenges will be associated with the requirements of consent decrees and court rulings that place intense expectations on child welfare agencies in some states. Researchers and evaluators hope that their efforts will be used in some way. Most, if not all, are interested in the application of what is learned in the real world so that interventions are effective—make a difference—and promote the enhanced wellbeing of our clients. A utilization-focused approach (Patton 2008) assists researchers in producing research findings that are necessary and ready to be implemented . To do so it is helpful to start the process with a clear understanding of the study’s or evaluation’s intended use by specific stakeholders such as program administrators and practitioners. In utilization-focused evaluation, administrators and practitioners are directly involved in identifying the evaluation questions to be answered and the design of the study, working with the researcher (Patton 2008). Similar strategies are referred to as participatory research. When research or evaluation users (agency programmatic and frontline staff or supervisors) have been engaged in the planning process, it stands to reason that they buy in to making use of the findings. It

is also likely that the design, by including practitioners, will have a greater likelihood of being successful within the context of how the agency functions. Agency practitioners and the researcher(s) will also more likely be able to confront and solve problems together when the inevitable challenges occur. This proved invaluable in our work with the QICs (see Collins-Camargo et al. 2011). As is common in public child welfare agencies, change is constant—the agency is not going to stand still to enable an experimental condition to be maintained for the research period: it’s not possible. When a third-party case review process that was a critical part of an evaluation of frontline supervision in the agency was terminated early on, the practitioners working with the evaluation team were well suited to help identify alternative data sources. While the agency considered implementing a new initiative that would sabotage the intervention being tested, engaged practitioners were able to advocate with administrators against contamination of the study much more effectively than were researchers. Another related hazard in child welfare research is the pressure to roll out promising programs before evaluation can be completed. The pressure to improve child welfare outcomes is tremendous. There is a push for information about new programs that have not had time to produce results or process information regarding the mechanism of how the program works in the day-to-day work of the agency. When child welfare professionals are in dire need of improved practice and outcomes, waiting for evaluation findings may be frustrating. Agencies understandably want to implement programs that look promising. It is critical to take the time needed to pilot programs and measure both short- and long-term results. The cost of implementing new programs is too great to not use evidence in decision making. Administrators and practitioners need to know “what works best for whom and in what situations” (Brodowski et al. 2007:5).

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Issues Associated With the Complexity of Families and Child Welfare Systems One of the most complex topics in our field involves the selection of outcomes and indicators to be measured. In 1989 McDonald and colleagues published Child Welfare Standards for Success, reviewing research on outcomes of child welfare services. They noted that most studies focus on case status variables such as adoption rates and maltreatment recidivism as opposed to direct measures of child wellbeing. A follow up study, published after ASFA established safety, permanency, and wellbeing as outcomes to be tracked through the CFSR process, found that approaches to measuring child safety were relatively unchanged while permanency measures had expanded to focus on kinship care and out-of-home care reentry. While the need to assess child wellbeing was recognized, there were relatively few studies that had measured it; instead studies most typically focused on indicators such as medical and dental examinations and educational progress (Poertner, McDonald, & Murray 2000). Concerns regarding current child welfare performance standards associated with the CFSRs have been raised (e.g. D’Andrade, Osterling, & Austin 2008; Courtney, Needell, & Wulczyn 2004; Testa & Poertner 2010). Courtney, Needell, and Wulczyn (2004) particularly criticize use of cross-sectional or exit cohort data due to inherent bias. Instead, they suggest an entry cohort perspective with attention to how the measures are constructed. Perhaps more important for this purpose is moving toward a system that is focused on “better understanding why states are achieving particular constellations of outcomes. It is only through the acquisition of such knowledge that child welfare systems will be able to achieve meaningful change in child and family outcomes” (Courtney, Needell, & Wulczyn 2004:1152). This being the case, the CFSR process represents a major step forward in promoting the accountability, program evaluation, and research that can

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drive system reform. The states’ efforts to meet the national standards and achieve substantial conformity on systemic factors can be an important impetus for child welfare agencies to build in greater emphasis on research and evaluation. In addition, many factors influence whether or not agencies have been and even can be effective in implementing programs. Public agencies in particular are subject to frequent budget cuts, hiring freezes, and staffing caps. Many of the outcomes child welfare agencies and contractual providers are trying to achieve are significantly impacted by decisions made by the court system and the availability of treatment resources in the community. The ability of families to achieve positive change is affected by much more than their interaction with agency workers. The dynamics and challenges faced by families served by this system are complex— substance abuse, domestic violence, poverty, and many others. There is a great deal to take into account when designing program evaluations and intervention research. Mixed Methodology Child welfare research is often most relevant when it employs both quantitative and qualitative methods. Quantitative data are unquestionably persuasive when they demonstrate whether and in what ways statistically and practically significant differences are observed between groups. Analysis of administrative data sets as well as surveys and other sources of numerical data can be very valuable. Qualitative data can be just as useful, particularly in helping to explain quantitative findings and answer questions concerning how or why something is occurring. Archival review of case records, focus groups, and interviews can also be very helpful in this regard. Such methods can help determine what should be measured quantitatively. Qualitative data also provides something that is invaluable in demonstrating research findings—real stories in the words of clients and practitioners that paint compelling pictures.

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Statistical Techniques The field has benefited greatly from developing statistical techniques that help us better understand organizational and human phenomenon. Procedures such as survival, or event history, analysis enable statistical risk modeling for outcomes related to the length of time it takes to achieve events (such as placement or reunification; Fraser et al. 1997). Hierarchical linear modeling enables us to consider the influence of variables that occur at different levels such as individual, supervisory unit, and county- or regional-level indicators. For example, when studying staff retention we may want to analyze the influence of staff characteristics as well as variables such as supervisory style, caseload, and county unemployment rates in the overall model. Structural equation modeling enables us to test relative causal relationships among an array of variables in explaining a variable we are interested in, such as child maltreatment itself. Issues Associated with Technology SACWIS and Child Welfare Data Systems Statewide Automated Child Welfare Information Systems (SACWIS) legislation was passed in 1993, funding states for enhancement of their child welfare administrative data systems (Waldfogel 2000). As of this writing, the Administration for Children and Families reports that thirty-six states have operational SACWIS systems, and eleven states have systems in development (Administration for Children and Families, n.d.a). Whether states have SACWIS or another type of MIS, state-level data systems present many challenges. Combining results from the 2007 and 2008 CFSRs, only twenty-seven states achieved substantial conformity regarding their statewide information system (Administration for Children and Families, n.d.b). Child welfare data systems often need reconciliation to reduce data entry error, yet data system staff members make easy targets for budget cuts. Haslag, Matt, & Neal (2012)

describe how movement from one MIS to another seriously hampered a state’s ability to compare child welfare data over time; the two systems could not effectively be integrated, and data from years prior to the new system looked very different than the current system data. In addition, data entry by frontline workers can be unreliable, requiring extensive procedures to clean and reconcile the data with other sources of information to ensure its validity. Elder and colleagues (2012) describe how evaluation of a new performance-based contracting system that relied on measuring and incentivizing the ability of contractors to achieve certain practice indicators, such as contact with biological families, was seriously threatened when the state brought a new MIS online that was full of bugs and did not work for months. A workaround process involving time-intensive record review of a random sample of cases had to be developed to make it possible to determine which agencies should receive the incentive and enable the program evaluation to continue. Electronic Case Records and Online Surveys Despite the challenges of large administrative data systems, technology has opened the door to new processes for data collection. In some states case records are maintained online, simplifying archival review processes. However, agencies have had to face issues related to maintaining the privacy of Web-based systems. Online surveys can be made available to research subjects, such as frontline workers, through an e-mail invitation. Responses provided do not need separate data entry but rather can be downloaded into analysis programs. However, because the systems used by different agencies vary, they can create challenges for the researcher. For example, in a current national study of private child welfare agencies, the very same hyperlinks embedded in an e-mail to provide access to a survey worked for respondents in some agencies, but not in others.

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Technology-Based Research to Practice Technological systems also can make researchbased practice information easily available to practitioners (Cannon & Kilburn 2003; Schorr & Auspos 2003). Schoech, Basham, and Fluke (2006) conducted a three-year project to promote evidence-informed decision making in a child welfare agency by making user-friendly data from the MIS available to workers; however, they do not document how the information was used or the extent to which outcomes were impacted. Resources for making the growing evidence base accessible in child welfare are increasingly available to the field. Funded by the California Department of Social Services, the California Evidence-Based Clearinghouse for Child Welfare rates programs using a scientific rating scale and has a searchable Web site around a number of topic areas. The internationally focused Campbell Collaboration prepares systematic reviews of research on education, crime and justice, and social welfare that are then available on the Web. Research in Practice is a network of partners supporting evidence-informed practice with children and families primarily in Great Britain. Some of their materials are accessible on the Web, while a vast array of literature reviews, research briefings, and other tools are available only to members. In many ways Great Britain has been ahead of the United States in child welfare research activities. In addition to these two initiatives, they have developed a series of publications entitled Messages from Research since the 1980s that synthesize current research in a manner that is easily digested and practically applied by child welfare agencies and workers. Studies are selected by an advisory group of child welfare researchers and practitioners. The most recent version, Quality Matters in Children’s Services: Messages from Research, begins with a particularly apt quote from John Hutton, then minister of state for social services, 1998: “What if this was my child? Would it be good enough for them?” (Stein 2009:13). Questions such as

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this should serve as motivators for us to diligently conduct research and evaluation in our field and place it in the hands of child welfare administrators and practitioners in a format that they can put to use in their day-to-day work with children and families. Evidence-Informed Practice in the Child Welfare Setting While conducting more research and evaluation in child welfare is an important step, an equally, if not more important step, is to get administrators and practitioners to use the information derived from such research. Many have called for research into methods of promoting critical thinking, reflective practice, and research-based decision making in social work practice (e.g., Gambrill 2000; Gibbs & Gambrill 2002; NRCPFC 2013 Rosen & Proctor 2003). It may be very useful to measure worker attitudes toward EBP; attitudes play a critical role in the achievement of organizational goals (Gioia 2007), such as achieving a child’s permanency. Translation of research findings into practice is difficult when practitioners do not believe current research is relevant (Klesges, Dzewaltowski, & Christensen 2006). This is a major obstacle that spans well beyond our field. We have discussed the strategy of engaging practitioners in identifying research questions, developing methodologies for studying them, and engaging them in the process of thinking in an evaluative manner. We encourage translation by inextricably linking practice and evaluation (Hudgins & Allen-Meares 2000; Schwandt 2005). Kukla-Acevedo and colleagues (2008) conducted a number of systems change case studies, and found that the type of data agencies collect is driven by system intent. If improved client outcomes are the goal, there must be a conceptual link between services, indicators, and outcomes that is well understood on the front line. When practitioners view the indicators as relevant, they become more engaged in reporting accurately and using the data (KuklaAcevedo et al. 2008).

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Social work must explore effective ways to integrate the more traditional EBP approach to applying rigorously generated research findings into the field of child welfare with a critically reflective approach to practice that makes use of a wide array of forms of evidence—not clinical research exclusively (Hall 2008; Plath 2006). Practice research is rapidly expanding, and technology must be used to put this information in the hands of frontline staff (Lindsey & Schlonsky 2009). The literature supports aggressively promoting evidence-informed practice with an outcomes-focused orientation (Epstein 2009) by actively engaging workers in activities to evaluate the effectiveness of their work within a learning organizational culture that integrates evaluation and data-driven decision making into daily work (Franklin & Hopson 2007). Petr (2009) advocates a multidimensional approach that examines multiple sources of knowledge and evidence, including quantitative and qualitative data as well as both client and professional perspectives, in a valuecritical analysis to identify best practices—with the ultimate goal of achieving positive outcomes for clients and overall agency performance. Fielding and colleagues have argued for “an alternative understanding of evidence-based or knowledge-guided practice that encompasses both reflective and empirical types of knowledge where the practitioners experience themselves as knowledge makers not just knowledge takers in their everyday work” (Fielding et al. 2009:164). This requires effort on the part of child welfare agencies to teach workers how to use data and support supervisors in facilitating this through a team approach to evaluating evidence and modifying practice (Austin & Claassen 2008; Lawler & Bilson 2004). It also requires that the data available to the frontline be focused on the relationship between practice activities and client outcome achievement. Cunningham and Duffee (2009) have termed this a “developmental” style of EBP in child welfare. Practitioners must first want to help

clients achieve beneficial outcomes. Agencies must make tools available to help workers use data to inform their practice, such as user-friendly databases and reports that allow practitioners to drill down to their own cases to look for trends and reports demonstrating the relationship between particular practice activities and the achievement of outcomes in their state. This would appear to have greater potential for success than an “adoption” style in which traditional empirical research findings are incorporated into programs or an externally imposed “compliance” style reporting of outcomes. A culture would then be created in which staff members learn to use data (Wulczyn 2005) and to interpret the relationship between process and outcome indicators so they can use this information to modify their own practice with clients (Aarons & Palinkas 2007). There is a role for agency-based research and university-agency partnerships in promoting such evidence-informed practice and generating research and evaluation within and for use by child welfare administrators and practitioners. Challenges and Priorities for the Next Decade Reviewing the evolution of child welfare research and evaluation over the past century and the first decade of this century clarifies the ways in which our field is gaining ground. More emphasis is being placed on scientific and statistical rigor, and studies span the many categories of topics for research and evaluation that we have discussed here. We must continue our quest to better understand, explain, and address the very complex dynamics of the families we serve as well as better understand, explain, and address the cultures and dynamics of the agencies and practitioners who serve them. And we must sustain our progress in attracting bright minds to this quest. More researchers seem to be drawn to child welfare in recent years; the child welfare track of the Council on Social

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Work Education’s annual program meeting has become one of the largest in terms of the number of abstracts submitted and ultimately accepted for presentation. It will be important for child welfare to recruit academics to engage in research partnerships with agencies in addition to collaborations in education and training activities. Finding sustainable funding for the child welfare research and evaluation efforts described in this chapter also must be a priority. While the National Institute of Health’s (NIH) funds research in health and mental health–related topics, its history of funding research in child welfare remains very limited the Children’s Bureau’s budget for funding research and evaluation pales in comparison to that of the NIH. We must become more adept at articulating the enhanced quality of social work research and the value of research in our field, not only to the families served by the system and the practitioners who serve them, but also to our communities and society as a whole. Only then will we be able to fund longer-term streams of research around related aspects of important topics over time and across settings that will enable us to make leaps in the development of our child welfare evidence base.

As a field, we must insist that our research and evaluation measure both outcomes and the implementation factors and conditions associated with their achievement in such a way that we can inform agencies not only what to implement, but how as well. We also must focus more research on the impact of child welfare organizational interventions and policy. Perhaps our greatest challenge is to shift the organizational culture in child welfare agencies toward that of a learning organization in which an evidenceinformed practice approach is ingrained in both the administrative and frontline levels. This will require that agencies make tools such as user-friendly interactive databases and access to research briefs available to supervisors and practitioners so that they can use data-driven decision making. Over fifty years ago, Kahn and Wolins (1956) made an observation that is still very relevant today: “It is less important to facilitate research operations than it is to provide an atmosphere in which problems are recognized as such, and in which a searching for answers is valued. Given such an atmosphere, research will ‘facilitate’ itself ’” (p. 331). The children, youth, and families served by the child welfare system and the professionals who devote their lives to working with them deserve no less.

NOTES

Administration for Children and Families (n.d.b). Results of the 2007 and 2008 Child and Family Services Reviews. Retrieved from http://www.acf.hhs. gov/programs/cb/cwmonitoring/results/agencies_ courts.pdf. Antle, B. F., Christensen, D. N., van Zyl, M. A., & Barbee, A. P. (2012). The impact of the Solution Based Casework (SBC) practice model on federal outcomes in public child welfare. Child Abuse and Neglect, 36, 342–53. Austin, M. J., & Claassen, J. (2008). Implementing evidence-based practice in human service organization: Preliminary lessons from the frontlines. Journal of Evidence-based Social Work, 5, 271–93. DOI: 10.1300/1394v05n01_10. Baker, A. J. L., & Charvat, B. J. (2008). Research methods in child welfare. New York: Columbia University Press.

1. Audrey Brock, personal communication May 10, 2011. 2. Colleen Caron, personal communication May 6, 2011. 3. Erwin McEwen, personal communication April 29, 2011.

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care: Do permanency outcomes still differ? Social Work Research, 32, 105–16. Kukla-Acevedo, S., Hodges, S., Ferreira, K., & Mazza, J. (2008). System of care implementation issue brief #6—Quality improvement strategies that work. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health. Lahti, J., Green, K., Emlen, A., Zendry, J., Clarkson, Q.  D., Kuehnel, M, & Casciato, J. (1978). A followup study of the Oregon Project: A summary. Portland: Portland State University Regional Research for Human Services. Lawler, J., & Bilson, A. (2004). Towards a more reflexive research aware practice: The influence and potential of professional and team culture. Social Work and Social Sciences Review, 11, 52–69. Lawrence, C. C., Strolin-Goltzman, J. J., Caringi, J. J., Claiborne, N. N., McCarthy, M. M., Butts, E. E., & O’Connell, K. K. (2013). Designing evaluations in child welfare organizations: An approach for administration. Administration in Social Work, 37(1), 3–13. Lawrenz, F., & Huffman, D. (2003). How can multisite evaluations be participatory? American Journal of Evaluation, 24, 471–82. Leff, H., & Mulkern, V. (2002). Lessons learned about science and participation from multisite evaluations. In J. Herrell & R. Straw (eds.), Conducting multiple site evaluations in real-world settings (pp. 89–100). San Francisco: Jossey-Bass. Leitz, C. A. (2008). Implementation of group supervision in child welfare: Findings from Arizona’s supervision circle project. Child Welfare, 87, 31–48. Lindsey, D., & Schlonsky, A., eds. (2008). Child welfare research: Advances for practice and policy. New York: Oxford University Press. Luongo, G. (2007). Re-thinking child welfare training models to achieve evidence-based practices. Administration in Social Work, 31, 87–96. Mallon, G. P. (2011). Maybe Sophie was right: Child welfare evaluation and research. Child welfare, 90(2), 5–9. Mass, H. S., & Engler, R. E. (1959). Children in need of parents. New York: Columbia University Press. McBeath, B., & Meezan, W. (2010). Governance in motion: Service provision and child welfare outcomes in a performance-based, managed care contracting environment. Journal of Public Administration Research and Theory, 20, 101–23. McDonald, T., Lieberman, A., Poertner, J., and Hornby, H. (1989). Child welfare standards for success. Children and Youth Services Review, 11, 319–30. Mullen, E. J., Bledsoe, S. E., & Bellamy, J. L. (2008). Implementing evidence-based social work practice. Research on Social Work Practice, 18, 325–38. Doi: 10.1177/1049731506297827. National Association of Public Child Welfare Administrators & the National Resource Center on Child Maltreatment (2001). A research agenda for public

child welfare. Retrieved from www.nrccps.org/documents/2001/pdf/Research-Agenda.pdf. National Resource Center for Permanency and Family Connections (NRCPFC) (2013). Evidence-based practices in child welfare. New York: NRCPFC. Retrieved October 26, 20131, from http://nrcpfc.org/ ebp/index.html. Norris, M., & Wallace, B., eds. (1965). The known and unknown in child welfare research: An appraisal. New York: Child Welfare League of America and the National Association of Social Workers. Oakley, A. (1998). Public policy experimentation: Lessons from America. Policy Studies, 19, 93–114. Patton, M. Q. (2008). Utilization-focused evaluation: The new century text (4th ed.). Thousand Oaks, CA: Sage. Pawson, R., & Tilley, N. (1997). Realistic evaluation. London: Sage. Pecora, P., Seelig, W. R., Zirps, F. A, & Davis, S. M. (1996). Quality improvement and evaluation in child and family services. Annapolis Junction, MD: Child Welfare League of America. Petr, C. G., ed. (2009). Multidimensional evidencebased practice: Synthesizing knowledge, research and values. New York: Routledge. Plath, D. (2006). Evidence-based practice: Current issues and future directions. Australian Social Work, 59, 56–72. Poertner, J., McDonald, T. P., and Murray, C. (2000). Child welfare outcomes revisited. Children and Youth Services Review, 22, 789–810. Regeher, C., Stern, S., & Schlonsky, A. (2007). Operationalizing evidence-based practice: The development of an institute for evidence-based social work. Research on Social Work Practice, 17, 408–16. Rosen, A., & Proctor, E., eds. (2003). Developing practice guidelines for social work intervention: Issues, methods, and research agenda. New York: Columbia University Press. Royse, D., Thyer, B. A, Padgett, D. K., & Logan, T. K. (2001). Program evaluation: An introduction (3d ed.). Belmont, CA: Brooks/Cole. Runyan, D. K., Curtis, P. A., Hunter, W. M., Black, M. M., Kotch, J. B., Bangdiwala, S., Dubowitz, H., English, D., Everson, M. D., & Landsverk, J. (1998). LONGSCAN: A consortium for longitudinal studies of maltreatment and the life course of children. Aggression and Violent Behavior, 3, 275–85. Ryan, J. P., Garnier, P., Zyphur, M., & Zhai, F. (2006). Investigating the effects of caseworker characteristics in child welfare. Children and Youth Services Review, 28, 993–1006. Schoech, D., Basham, R., & Fluke, J. (2006). A technology enhanced EBP model. Journal of Evidence-Based Social Work, 3, 55–72. Schorr, L. B., & Auspos, P. (2003). Usable information about what works: Building a broader and deeper knowledge base. Journal of Policy Analysis and Management, 22, 669–76.

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Schwandt, T. A. (2005). The centrality of practice to evaluation. American Journal of Evaluation, 26, 95–105. Sinacore, J., & Turpin, R. (1991). Multiple sites in evaluation research: A survey of organizational and methodological issues. In R. Turpin & J. Sinacore (eds.), Multisite evaluations (pp. 5–18), San Francisco: Jossey-Bass. Small, S. A; Cooney, S. M., & O’Connor, C. (2009). Evidence-informed program improvement using principles of effectiveness to enhance the quality and impact of family-based prevention programs. Family Relations: Interdisciplinary Journal of Applied Family Studies, 58, 1–13. Solomon, B. (2002). Accountability in public child welfare: Linking program theory, program specification and program evaluation. Children and Youth Services Review, 24, 385–407. Stein, M. (2009). Quality matters in children’s services: Messages from research. London: Jessica Kingsley. Straw, R. B., & Herrell, J. M. (2002). A framework for understanding and improving multisite evaluations. New Directions for Evaluation, 94, 5–15. Sullivan, D. J., Antle, B. F., Barbee, A. P., and Egbert, R. (2009). The impact of training and other variables on the preparation of the public welfare workforce. Administration in Social Work, 33, 278–96. DOI: 10.1080/0364310090298790. Testa, M. (2001). Kinship care and permanency. Journal of Social Science Research, 28, 25–43. Testa, M., & Poertner, J., eds. (2010). Fostering accountability: Using evidence to guide and improve child welfare policy. New York: Oxford University Press. Theis, S. V. S. (1924). How foster children turn out. New York: Charities Aid Association.

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U.S. General Accounting Office (2004). Child and Family Service Reviews: Better use of data and improved guidance could enhance HHS’s oversight of state performance. Report No. GAO04-333. Washington, DC: U.S. General Accounting Office. Waldfogel, J. (2000). Child welfare research: How adequate are the data? Children and Youth Services Review, 22, 705–41. Webb, M., Dowd, K., Harden, B., Landsverk, J., & Testa, M. (2010). Child welfare and child well-being. New York: Oxford University Press. Weigensberg, E. C. (2009). Child welfare agency performance: How are child, agency, and county factors related to achieving timely permanency outcomes for children in foster care? Ph.D. diss., University of North Carolina at Chapel Hill. Wulczyn, F. (2005). Monitoring the performance of the child welfare system. In Rockefeller Institute of Government (ed.). Performance management in state and local government (pp. 54–62). Albany: Rockefeller Institute of Government. Wulczyn, F., & Goerge, R. (1992). Foster care in New York and Illinois: The Challenge of rapid change. Social Service Review, 66, 278–94. Zlotnick, J. L. (2010). Fostering and sustaining university-agency partnerships. In M. Testa & J. Poertner (eds.), Fostering accountability: Using evidence to guide and improve child welfare policy (pp. 328–56). New York: Oxford University Press. Zlotnick, J., DePanfilis, D., Daining, C., & Lane, M. (2005). Retaining competent child welfare workers: Lessons from research. Washington, DC: Institute for the Advancement of Social Work Research.

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Disproportionate Representation of Children and Youth

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isproportionate representation in foster care refers to the current situation in which particular racial/ethnic groups of children are represented in foster care at a higher or lower percentage than their representation in the general population. Children of color, belonging to various cultural, ethnic, and racial communities (primarily African American, Hispanic, and Native American), are disproportionately represented in the child welfare system. Moreover, children of color frequently experience disparate and inequitable service provision. The disproportionate representation of children of color in the child welfare and other social service systems (e.g., juvenile justice) is linked to social class, economic, and other factors that must be addressed to ensure that the needs of all children are fairly and appropriately served. Some suggest that this overrepresentation of children and youth of color in the foster care system is perhaps due to disproportionate need (Bartholet et al. 2011). A close look at the latest statistics available from the Adoption and Foster Care Analysis and Reporting System (AFCARS; U.S. Department of Health and Human Services 2013) reveals that as of September 30, 2012, 56 percent of the 399,546 children in the U.S. foster care system were children of color, yet only 46.9 percent of all U.S. children were children of color (Childstats.gov 2012). The inverse is true for white children, who in 2011 represented 53.2 percent of the U.S. child population under the age of 18 (Childstats.gov 2012), yet only 42 percent (166,195) of white children were in

out-of-home care in 2012 (U.S. Department of Health and Human Services 2013). Further examination of ethnic differences among the populations of children of color reveals that African Americans and Native Americans have the highest overrepresentation of all ethnic groups in foster care. African American children make up 27 percent (109,775) of those in out-of-home care in 2011 (U.S. Department of Health and Human Services 2012), yet constitute only 14.0 percent of the U.S. population of children and youth (Childstats.gov 2013). Native American children are also overrepresented in foster care, as they make up 2 percent (8,020) of the foster care population (U.S. Department of Health and Human Services 2013) and only 1.6 percent of the U.S. child population (Childstats. gov 2012). Cross (2011) has noted that overreporting of American Indians often stems from unintended racial or cultural bias and can be a factor that leads to disproportionate representation of American Indian children in care. Asian American children tend to be underrepresented in foster care. In 2012 Asian/Pacific Islanders represented 1 percent (2,296) of the foster care population (U.S. Department of Health and Human Services 2013), but 4.7 percent of the U.S. child population (Childstats. gov 2012). Much more information is needed to fully understand these disproportionately low foster care rates. Cheung and LaChapelle (2011) have called for empirical research to explore the actual occurrence of abuse in Asian American communities and the possibility of underreporting as well as whether factors such as biases 680

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or perceptions of Asian American communities may lead to underreporting. Recent data on Latino children and youth in the child welfare system reveal several interesting trends. Nationally, in 2011 Latino children represented 23.6.7 percent of the U.S. child population (Childstats.gov 2012) and an almost equal percentage, 21 percent (84,523; U.S. Department of Health and Human Services 2013), of the foster care population. However, despite the seemingly comparable level of representation nationally, a closer look reveals that Latino children were “overrepresented in 19 states and underrepresented in 30 states in 2006” (Dettlaff 2011:122). Moreover, in some locations Latino children may be underrepresented at the state level, but overrepresented in a particular county. Dettlaff (2011) identifies several possible explanations for these trends. He suggests that this underrepresentation may be due to lower levels of maltreatment, family strengths, or protective factors that mitigate risk or to “underreporting, especially of Latino children in undocumented immigrant families, and they are therefore less likely to come to the attention of child welfare systems” (Dettlaff 2011:123). The majority of the research literature on disparities in foster care has focused on the African American population (Billingsley 1992; Billingsley & Giovannoni 1972; Chestang 1972; Derezotes, Poertner, & Testa 2005; McRoy 1994, 2004) due to their very significant overrepresentation. In this chapter I review the recent literature on the causes and correlates of disproportionality primarily within African American populations and present risk and protective factors as well as current policies and programs for addressing this problem. I conclude with a discussion of the implications for child welfare practice with children, youth, and families of color. Key Facts To gain a more complete understanding of the causes of disproportionality of children of

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color in foster care, readers should consider (see Dougherty 2003): 1. exploring whether factors such as bias and service obstacles could lead to both overrepresentation and underrepresentation of specific groups of children in the child welfare system and 2. examining not just overrepresentation or underrepresentation of children in care, but also assessing this disproportional representation at each decision point over time (Shaw et al. 2011). As Anyon (2011:242) observes, “at the national level, African American youth are overrepresented at every stage of the child welfare intervention process, and these disproportionalities grow as children move deeper into the system.” That is, not only do African American children experience disproportionately higher rates of maltreatment investigation and abuse and neglect substantiation (Fluke, Yuan, & Edwards 1999), they are also more likely to be removed from their parents and placed in foster care, more likely to stay in foster care for longer periods of time, less likely to be either returned home or adopted, and more likely to be emancipated from the child welfare system. In addition, the instability in foster children’s lives makes it difficult for them to become productive citizens as they mature. Educational delays and emotional stress are associated with both maltreatment and multiple placements. Finally, youth of color aging out of care are at high risk for depression, homelessness, and economic dependency. Review of the Literature A number of factors potentially contribute to the disproportionate representation of African American children in the foster care system, including disproportionate poverty among African Americans; vulnerable single parent households; greater visibility to authorities responsible for child maltreatment reporting; and racism and bias in reporting. Additional factors include welfare policies, lack of resources, community of residence, increasing substance abuse, and lack of community-based treatment (Bass, Shields, & Behrman 2004;

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Chipungu & Bent-Goodley 2004; Green 2002; Hill 1997). Some observers suggest that the interaction of race and class may be causing disproportionate representation in the out-of-home care system. African Americans continue to be disproportionately poor. In 2009 25.8 percent of African Americans were poor, compared to 25.3 percent of Hispanics, 9.4 percent of non-Hispanic whites, and 12.5 percent of Asians (U.S. Census Bureau 2009). According to Pelton (1989), there is a strong relationship between child abuse, neglect, and poverty. It is a wellestablished fact that most of the children in foster care come from single-parent households (Lindsey 1991; McRoy 2011a, b). Moreover, poverty rates are highest for families headed by single women. For example, in 2010 49.7 percent of black children lived with their mothers only (compared to 18.3 percent of white children; Children’s Defense Fund 2011a, b). Therefore, it is no surprise that these families would be more vulnerable. Single mothers rarely receive child support, and low wages make it very difficult to afford good child care. Further, Courtney (1998:95) has reported that “the incidence of abuse and neglect is approximately 22 times higher among families with incomes less than $15,000 per year than among families with incomes of more than $30,000 per year.” Note also that physicians and other service providers may be more likely to attribute an injury to abuse in cases of children in lowincome homes and attribute the same injury to an accident in families of higher income (Newberger et al. 1977; O’Toole, Turbett, & Nalpeka 1983). These differential attributions and labeling biases against low-income families may account for some of the relationships that have been found between poverty and abuse. Stehno (1990), acknowledging that African American children are much more likely to be poor than white children, suggests that growing depression and substance abuse of impoverished parents can also lead to neglect. In fact, according to the Child Welfare League of

America (1997), in 1995 about one million children were found to be substantiated victims of child abuse and neglect and at least 50 percent had chemically involved caregivers. Parental substance abuse is one of the leading contributors to children being removed from home and placed in care. Parental incarceration is another factor leading more children into the child welfare system. Drug and alcohol abuse are clear factors contributing to the incarceration of 80 percent of the 1.7 million men and women in prison today. In 2008 1.7 million children had at least one parent in prison, and 45 percent of these children were African American (U. S Department of Justice, Bureau of Justice Statistics 2008). Cumulative Effect: The Path to Overrepresentation in the Child Welfare System Poverty, child abuse and neglect, parental substance abuse, and parental incarceration all combine to impact the potential vulnerability of African American children. However, these factors alone do not fully explain their overrepresentation in the child welfare system. Barth (2001), Kapp, McDonald, and Diamond (2001), and others have suggested that it is important to understand disproportionality by examining a child’s path into the system, beginning with research findings of the likelihood of maltreatment of African American and white children. For example, although Fluke and colleagues (2002) found that African American, Hispanic, and Asian/Pacific Islander children have a disproportionately higher rate of maltreatment investigations than white children, several researchers (Ards, Chung, & Myers 1999; Sedlak & Schultz 2001) have reported that African American children are not at greater risk for abuse and neglect. Knott and Donovan (2010) note “after controlling for child, caregiver, household and abuse characteristics, African American children had 44 percent higher odds of foster care placement when compared with Caucasian children” (p. 679) in their secondary

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analyses of the 2005 National Child Abuse and Neglect Data System (NCANDS) on child abuse investigations in forty-eight states and DC. Further, the National Incidence Study-3 data (U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect 1996) found no statistically significant race differences in the incidence of maltreatment. These findings indicated that children of color are not at greater risk for abuse and neglect over white children and that there are no differences in the incidences of maltreatment (Ards, Chung, & Myers 1999; Sedlak & Schultz 2001). However, much controversy was raised by the analysis of the NIS-4 data, which suggested that there is a black/white maltreatment gap (Bartholet et al. 2011) and that maltreatment rates are higher among African American families. Others have questioned whether this finding in the NIS-4 analysis reflects an actual change in maltreatment rates or an issue of survey methodology (Wells 2011). A close look at differences between type of maltreatment and race has revealed that black children in low-income families may have higher rates of harm from physical abuse and white children in low-income households may be more likely to experience neglect (Wells 2011). Despite the varying findings related to incidence between groups, differences have been found in substantiation rates of abuse/neglect for African American children. Eckenrode and colleagues (1988) reported study findings that suggested child maltreatment reports are much more likely to be substantiated for African American and Hispanic children than are those for Anglo children. Using hypothetical vignettes of cases of sexual abuse, Zellman (1992) found that survey participants were more likely to believe that the law required a report to be made when children of color were described in the vignettes than when white children were described. Although some studies have found no racial differences in allegations of sexual abuse by race or ethnicity (National Center on Child Abuse

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and Neglect 1988), some have found differences in type of abuse by race. For example, Cappelleri, Eckenrode, and Powers (1993) and Jones and McCurdy (1992) found that white children were more likely to experience sexual abuse (as compared to neglect) compared to African American children. Outcome Disparities: Contemporary and Historical Analysis Not only are African American children and youth overrepresented in the child welfare system, researchers have found numerous racial inequities in service delivery. Courtney and colleagues (1996) reviewed much of the literature on disparities in service provision and found research accounts of inequities in child maltreatment reporting, child welfare service provision, kinship care, family preservation services, exit rates and length of care, placement stability, and adoption. Although a few studies they reported did not find an association with race, the majority did. They also found that most of the racial differences reported were found between African Americans and whites rather than among other racial groups. An Historical Look at Disproportionality Disproportionality, overrepresentation, and differential service delivery are not new issues in foster care. According to Lawrence-Webb (1997), under the Aid to Dependent Children program established in 1935, states could determine eligibility for receiving public assistance. Therefore, to rule out “immoral families” from receiving public welfare benefits, many states established “home suitability” and “illegitimate child” clauses. During this period, Florida removed fourteen thousand children (more than 90 percent of them were African American) from public assistance, and in 1960 twenty-three thousand children were removed from the welfare roles in Louisiana (McRoy 2004). Once children and their families were declared ineligible for public assistance, the children in these families were often labeled as

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“neglected” due to lack of financial resources and were subsequently brought before the court for child protection issues. In response, the Flemming rule, named after U.S. Department of Health, Education, and Welfare secretary Arthur Flemming, was passed in 1961, which required the provision of service interventions to families identified as being “unsuitable” (Murray & Gesireich 2004:2). Although services were to be provided, many caseworkers began to emphasize removal of the child from the home as opposed to working with the family to correct the conditions. At the time, most eligibility workers were not trained social workers and lacked the skills needed for understanding family dynamics and clinical intervention techniques (Lawrence-Webb 1997:13). Moreover, according to Lawrence-Webb (1997:14), the workers serving African American families were untrained in cultural sensitivity and held racial stereotypes of African American clients. Therefore, they were more likely to push for child removal. Once removed from their families and placed in foster care, these children were not given equal access to services. For example, in 1959 Maas and Engler reported that many African American children in foster care were in need of adoption, but were less likely to be adopted than were white children. Beginning with the 1962 amendments to the Social Security Act, which made open-ended funds available for out-of-home placements, children began to be removed from “undesirable family situations.” Jeter (1963) reported that 81 percent of children entered care because their parents were either unmarried or the children came from “broken homes, and in public agencies, the largest groups of children placed in foster care consisted of both Negro and American Indian children, 49 percent of the Negro children, and 53 percent of the American Indian children. In voluntary agencies the proportions were even higher, 57 percent and 59 percent [respectively] in foster care” (Jeter 1963:32). Jeter (1963) also found ongoing

discrimination in service provision, noting that African American children were primarily being served by public agencies; private voluntary agencies were primarily serving white children. Black children were remaining in foster care for longer periods of time than were white children, and adoption was not being offered on an equitable basis. Over the years, additional studies have documented differential service provision. In 1982 Olsen reported that white and Asian American families had the greatest chance for receiving recommendations for services and Native American families had the least chance. African American and Hispanic children were least likely to have plans for contact with their families. Barth and colleagues (1986) reported that in their study of 101 physically abused children in California, African American children were more likely than children in other racial groups to experience permanent out-of-home placement. Close (1983) and Stehno (1990) found African American children in care were more likely to remain in care longer, less likely to have visits with their families, and had fewer contacts with caseworkers. Similarly, Fein, Maluccio, and Kluger (1990) found, in their study of 779 children who had been in out-of-home care in Connecticut for at least 2 years in 1985, that white children and white foster families received more services and support than did children and foster families of color. Goerge (1990) found that, over an 8-year period, African American children in Cook County, Illinois remained in care for a median of 54 months, whereas the median length of stay for all other children was 18 months. Goerge, Wulczyn, and Harden (1994) reported significant differences in many states regarding the median duration in care between African American and white children. In California the median time in care was 30.8 months for African American children compared to 13.6 months for white children. In Illinois African Americans had a median duration of 36.5 months compared to 6.6 months for white children. In

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Michigan African Americans remained in care a median of 17.5 months, whereas white children had a median duration of 11.2 months. In Texas, although the duration of care was not as great, there was a difference of 7.3 months for whites and 9 months for African Americans. McMurtry and Gwat-Yong (1992) reported in their study of 775 foster children in Arizona that African American children were half as likely to be returned home as white children. These authors also found that African American children were 3 times as likely to be in the foster care system and that they had been in care for longer periods than the other 3 ethnic groups studied. Black children spent an average of 3 or more years in out-of-home care, whereas white and Hispanic children spent an average of 2.5 years, and other children of color, 2 years. The third group consisted of children from mixed racial backgrounds. Berrick, Barth, and Needell (1994), studying six hundred kinship foster parents and nonrelative foster parents in California, noted that white foster parents were receiving more services than were other foster parents and that kinship foster parents (mostly African American) were less likely to have been offered such services as training, respite care, and support groups than were nonrelative foster parents. Courtney (1994) found that, in California, African American children placed in kinship care went home at about half the rate of similarly placed white children. According to Courtney (1995), African American children had significantly higher reentry rates into foster care than all other children, even after controlling for the child’s age, health problems, placement history, and Aid for Families with Dependent Children program eligibility. Finally, Courtney and colleagues (1996) reported that African American children were also less likely to be adopted than white or Hispanic children. Some of the most compelling findings of service disparities were reported by Barth in 1997. In his longitudinal study of 3,873 children in California who were younger than 6 years old

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upon entry into care, it was reported that age and race had substantial independent effects on outcomes. Barth (1997:296) stated that when, “controlling for age, African American children were considerably less likely to be adopted than Anglo or Latino children. The estimated adopted/remained in care odds ratio was more than five times as great for Caucasian children as for African American children.” An African American infant had nearly the same likelihood of being adopted as a white child ages 3 to 5 years old. Also, in this California study, the odds of African American children being reunified from nonkinship foster care were one-fourth those of white children in care. Other states have reported disparities as well. For example, a study by the Minnesota Department of Human Services (2002) to the state legislature on outcomes for African American children in Minnesota’s child protection system noted significant disparities. The Minnesota Department of Human Services (2002) found that Black children are more likely to be reported as suspected victims of maltreatment by teachers, police, nurses, family members or neighbors. Additionally, after an initial screening, Black children are six times as likely as white children to be referred for a more formal investigation. Black children are nearly eight times as likely as white children to be determined victims of maltreatment. Only two in five African American families receive counseling, compared to three in five white families. If a child becomes legally free for adoption, Black children stay in care two years and three months, which is about six months longer than white children. One of the largest areas of disproportionality in Minnesota occurs in Hennepin County in which African American children represent 10 percent of the child population, yet 60 percent of the placement population.

Disparate outcomes are not only reported for African American children in the foster care system: similar patterns are found in

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the juvenile justice system. African American youth in 1997 accounted for 26 percent of those arrested, 31 percent of referrals to juvenile court, 44 percent of youth detained, 56 percent of those waived to criminal court, 40 percent sent to residential placement, and 58 percent of those admitted to state prison. Although white youth were reported as committing higher levels of weapons-possession crimes, African American youth were arrested at 2.5 times the rate of white youth for weapons offenses (Building Blocks for Youth 2000; Green 2002). Moreover, according to the Child Welfare League of America, there is a link between child abuse and later juvenile delinquency arrests. A study in Sacramento, California indicated that children reported abused and neglected were 67 times more likely to be arrested between the ages of nine and twelve than were other children (Johnson 1997). This link suggests even more dire long-term consequences for minority children because they are disproportionately represented in abused and neglected populations. Addressing Foster Care Inequities Court-Mandated Systems Improvement Over the years there has been growing concern about state child welfare systems’ failures to correct the problematic outcomes for children in out-of-home care. Children’s Rights of New York, a legal advocacy organization whose mission is to promote and protect the rights of abused and neglected children in foster care systems, has filed class action suits against at least eighteen states and other jurisdictions (Children’s Rights 2011). Six states have met all the settlement requirements and have been released from federal court oversight; cases in four states are active, prejudgment cases, and eight states have yet to meet requirements of a settlement and remain under federal court oversight. These include Wisconsin, Washington, DC, Tennessee, New Jersey, Mississippi, Michigan, Georgia, and Connecticut

(Children’s Rights 2011). For example, in 1989 Children’s Rights brought a class action complaint against the state of Connecticut stipulating: “For children who are African American and Latino, there is no system to ensure that sufficient numbers of appropriately trained, culturally sensitive, and bilingual persons exist to perform necessary evaluations and render appropriate treatment.  .  .  . Defendants have failed to provide sufficient services statewide (and particularly to non-English-speaking and African-American families) to ensure timely access to services which are necessary to ensure that reasonable efforts are and can be, made by DCYS to avert out-of home placements for all children” (Juan F. v. Rell 1989:42, 47). However, in September 2010, more than 20 years after the case was filed, a U.S. district judge stated: “children in the state’s care face unneeded delay and disruption, and continue to go without important services” (Bachetti 2011); therefore, the judge ruled that the Department of Children and Families (DCF) would remain under federal oversight (Kovner 2010). As of June 2011, Connecticut’s DCF continued to fail to fully comply with the court-ordered exit plan and remained under federal oversight (Bachetti 2011). Children’s Rights also filed a class action law suit against Governor Donald Sundquist and George Hattaway, then commissioner of the Tennessee Department of Children’s Services (DCS), for failure to protect the approximately ten thousand children dependent on DCS for care and protection. The complaint was filed specifically on behalf of BRIAN A. and eight other named plaintiffs who were in the Tennessee foster care system. According to the complaint: The Plaintiff Class includes approximately 9,000 children reported by the state to be in DCS custody who are dependent and neglected, “unruly” or were placed into custody voluntarily by their parent(s) or guardian(s). There are approximately 4,400 African-American children in DCS custody.

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The questions of law and fact raised by the claims of the named Plaintiffs are common to and typical of those raised by the claims of the putative Class members. Each named Plaintiff and each putative Class and Subclass member is in need of child welfare services, must rely on Defendants for those services, and is harmed by DCS’s systemic deficiencies. (Children’s Rights 2004)

The following charges were subsequently brought against the Tennessee DCS (Children’s Rights 2004:12): Lack of appropriate foster care placements, lack of adequate assessments, investigations and services to insure safety of children returned to home of parents or relatives. Also DCS routinely fails to provide appropriate caseworker, monitoring and supervision. Children often face abuse and neglect while in care, do not receive necessary services and treatment, and frequently spend many years moving from one inappropriate placement to another. The comptroller’s report stated, “upon entering custody, African American children are not as likely to receive adequate services crucial to achieving permanency and improving family participation.” Defendants’ criteria or methods of administering adoption and permanency services also have a discriminatory effect on AfricanAmerican foster children. Children spend years of time in care, lose much of their childhoods, move from one inadequate placement to another, lack appropriate services, are discharged at 18 without life skills, and the turnover rates for caseworkers are unmanageably high.

On July 30, 2001, a federal district judge approved the settlement reached by these parties in Tennessee. The settlement called for a technical assistance committee of five national experts in the child welfare field to assist in the implementation of the agreement, an independent monitor to determine whether the state is making reforms, a quality assurance program for statewide implementation; a system for

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receiving screening and investigating reports of child abuse and neglect, regional services to support and preserve foster children in the state’s custody, maximum limits on caseloads and number of caseworkers overseen by a single supervisor, and time periods within which children must be moved through the adoption process. The agreement also called for the state to hire an independent consultant to conduct a statewide evaluation of the Tennessee foster care program to determine whether African American children in the plaintiff class receive disparate treatment or suffer disparate impact, to assess the causes for such disparities, and recommend solutions. The Tennessee settlement is perhaps one of the most comprehensive agreements rendered in this type of case. Through court monitoring of the state’s delivery system and mandating caseload size and service outcomes, the state has been held accountable for its actions on behalf of children, youth, and families of color. YYY

Child welfare systems have a history of cultural preference and focus on the Americanization of immigrant children. The system was not designed to serve culturally and racially diverse populations. Until the 1960s, public child welfare services—and specifically, adoption services— systematically excluded African American children. Over the past four decades the population served by the public child welfare system has become increasingly diverse, and for some populations, a system that is overly inclusive. Currently, child welfare systems attempt to protect children by relying on placement with less attention to the family and community issues that make families and children of color more vulnerable. Overrepresentation and racial disparities in child welfare service provisions must be recognized and addressed in state systems. If not, it is likely that there will be more class action

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suits on behalf of African American and other children of color in care. More effective service provision can be achieved by addressing the problems of high caseloads; a shortage of experienced professional social workers, especially minority professionals (Stehno 1990); inadequate and minimally funded family preservation services; limited data and reporting capabilities; and insufficient alternatives to outof-home placements. Biased assessments may occur due to the lack of culturally competent child protective service workers who are aware of cultural differences and variations in child rearing (Leashore, Chipungu, & Everett 1991; Stehno 1982) and therefore be more likely to remove African American children from their birth families. McMurtry and Gwat-Yong (1992:47) have suggested that the nonminority staff lacking familiarity with black family norms might have been more likely to find these families dysfunctional and to view reunification as not feasible. More than twentyfive years ago, Vinokur-Kaplan and Hartman (1986) reported that 78 percent of workers and 87 percent of supervisors were white and that the majority had not received cultural competency training. To address this issue, in 2004 Bozanich and colleagues called for “Developing Cultural Competence Through Training, Assessment, Analysis, and Implementation” at the Second Annual Symposium on Fairness & Equity Issues in Child Welfare Training. Further exacerbating this issue of cultural competency among staff is the insufficient number of experienced staff in the child welfare system. According to the U.S. General Accounting Office (2003), the average tenure of a child welfare worker is less than two years. Thus inexperienced workers are responsible for large caseloads, including complex cases that have issues pertaining to child maltreatment, parental substance abuse and mental illness, domestic violence, HIV/AIDS, and numerous povertyrelated problems. Acknowledging the problem of disproportionality and the previously mentioned issues within child welfare services,

the Child Welfare League of America has committed to a number of activities to address the issue, including “engage member agencies to establish an action agenda to address this issue; present data and research; engage task forces to develop culturally competent policies, services, and practices; address workforce recruitment and retention issues to enhance diversity and cultural competence of staff; and address these issues at the national conference” (Child Welfare League of America 2003). Most important, ways must be found to help families so they are not at risk for having their children removed. Pelton (1989:52–53) has suggested that the reason for placement is that the family, frequently due to poverty, “does not have the resources to offset the impact of situational or personal problems which themselves are often caused by poverty, and the agencies have failed to provide the needed supports, such as babysitting, homemaking, day care, financial assistance, and housing assistance.” Responses to cases in which a family is at risk should include support and preservation services. Promising practices include family group conferencing, family group decision making, and other strategies that involve families and/ or youth in case planning and deciding what is right for the family. Community-based organizations that provide comprehensive wraparound services, including employment assistance, substance abuse prevention and treatment, and family-centered prevention programs, particularly those with a built-in differential response (in which more than one response to a report is possible) are essential to help keep families intact and need to be explored by child welfare systems. Another essential option for family preservation is legal guardianship. Legal guardianship permits an alternative to termination of parental rights and permits families to stay connected. (See chapter on guardianship.) Legal guardianship as a permanency goal is in many ways more concordant with many cultural and racial traditions that support the maintenance

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of strong ties with extended family. With ongoing support from states and local districts, kinship care is a placement option that has increased the likelihood that children of color will be placed with a family member. The National Association of Black Social Workers (NASW; 2003:2) has called for state and local community boards to examine the impact of class on removal rates and has challenged the “over reliance on removing children from the home, as opposed to addressing structural issues, such as poor housing, income inequity and employment discrimination against people of African ancestry, in particular, and poor people, in general.” Additionally, the association has recommended that each local child welfare agency convene a group of community members, selected by community and faith based groups, to examine disproportionality in the local child welfare system. Communities should be consulted and assisted with solving issues that impact their families. The problem of disproportionality must be addressed at the local level, with supporting federal mandates. In a similar vein, Roberts (2011) found in her study of predominantly African American Chicago neighborhoods, that in addition to concerns about differential placement rates of African American children, residents indicated that child welfare agency involvement in their neighborhood had significant negative effects on their communities. Specifically, Roberts called for agencies to partner with these vulnerable neighborhoods and target these areas for community-building initiatives and for the provision of supports and resources for families. A leader in research for child welfare issues, Casey Family Programs, took on the issue of disproportionality in 2005. With a focus on improving community capacity, educating stakeholders, and designing culturally responsive services, Casey Family Programs partnered with nine state- and four county-level jurisdictions in a collaborative effort entitled Reducing Disproportionality and Disparate Outcomes for Children and Families of Color in the Child

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Welfare System (Miller & Ward 2011). Casey Family Programs designed this methodology to help engage states and counties in change efforts that involved looking specifically at the influence of structural and institutional racism on the “dynamics of responding to families and decision making” (Miller & Ward 2011:273). On a federal level, in 2007 the U.S. Government Accountability Office was asked to analyze the factors leading to disproportionality and report to the chairman of the Committee on Ways and Means of the U.S. House of Representatives. The U.S. Government Accountability Office (2007:2) identified the following factors that have contributed to disproportionality: “Families living in poverty had greater difficulty accessing housing, mental health, and other services needed to keep families stable and children safely at home. Bias or cultural misunderstandings and distrust between child welfare decision makers and the families they serve are also viewed as contributing to children’s removal from their homes into foster care.” These findings reinforce previous research regarding disproportionality and disparate outcomes. This governmental office also found African American children were remaining in foster care longer due to difficulties in recruiting adoptive parents and due to greater reliance in the placement of African American children with relatives who were reluctant for the child welfare agency to terminate parental rights of the child’s parent in order for the relatives to adopt or who needed federal adoption subsidies in order to adopt (U.S. Government Accountability Office 2007). The study found that many states have been trying to reduce bias by “recruiting and training staff with skills who can work with people of all ethnicities, and to reduce the number of children in care by doing diligent search for relatives who might adopt, recruiting African American adoptive families, and offering subsidies for relatives seeking to adopt” (p. 2). The report also called for Health and Human Services to provide better technical assistance to states for analyzing their data on

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disproportionality and developing strategies to address this issue. The federal government as well as individual states and advocacy organizations have launched a number of initiatives to respond to some of these findings. In 2008 the Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351) was passed by the U.S. Congress in order to promote ongoing connections between children and family members and to support relative caregivers and provide adoption incentives for families. It is hoped that subsidized guardianships will lead to an increase in the availability of homes for African American children and other children of color and reduce disproportionality (Alliance for Racial Equity in Child Welfare 2009). In 2009 the Alliance for Racial Equity in Child Welfare examined strategies in eleven states to identify practices that might improve child outcomes for children in care and to specifically address disproportionality. They reported that many states are beginning to involve families and communities in developing action plans, analyzing the impact of institutional practices and policies on families of color, and collecting data and establishing benchmarks for achieving equity. For example, the Texas legislature has established a Center for the Elimination of Disproportionality and Disparities as part of the Texas Health and Human Services Commission. This center is establishing an Interagency Council for Addressing Disproportionality to examine best practices, training, availability of

funding, and outcomes of vulnerable populations in several systems, including juvenile justice, child welfare, education, mental health, and health and human services systems (see [email protected]). Most recently, in 2011 the Black Administrators in Child Welfare called for the utilization of a “racial equity lens in the development of policies, practices and procedures that are being used in agencies serving African American children” (Jackson & Jones 2011:4). They have identified specific racial equity strategy areas (i.e., innovative data, creative finance, parent and community engagement, youth-informed practice, culturally competent leadership, effective kinship services, etc.) that can be used to facilitate data-informed decision making by state and local policy makers and reduce overrepresentation (see www.blackadministrators.org). It is clear that the issue of disproportionality has increasingly been brought to the attention of state legislators and advocacy groups. However, each year disproportionately high numbers of African American children and other children of color continue to be removed from their families and communities and placed in the child welfare system, only to experience disparate outcomes. Much more research is urgently needed to identify community-based, culturally appropriate, and effective family support, preservation, prevention, and intervention programs and policies to improve outcomes for all children, youth, and families in this country.

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Alliance for Racial Equity in Child Welfare (2009). Policy actions to reduce racial disproportionality and disparities in child welfare: A scan of eleven states. Washington, DC: Center for the Study of Social Policy. Accessed at www.cssp.org. Anyon, Y. (2011). Reducing racial disparities and disproportionalities in the child welfare system: Policy perspectives about how to serve the best interests of African American youth. Children and Youth Services Review, 33, 242–53. Ards, S., Chung, C., & Myers, S. (1999). Letter to the editor. Child Abuse and Neglect, 23, 244.

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his chapter defines and discusses aspects of fatherhood with an emphasis on the importance of fathers’ involvement in the development and overall well-being of children and youth in the child welfare system. A historical perspective on the legislation concerning fathers is provided, as well as trends in various agency policies and practices to effectively identify, locate, and engage fathers to become positive and permanent parents in their children’s lives. The experiences of fathers with children and youth served by child welfare agencies are described and illustrated with excerpts of interviews from a qualitative study conducted by the author with fathers about their perceptions of agency factors that facilitate and inhibit their child welfare involvement. The chapter concludes with a discussion about the implications of father involvement for future research, practice, and public and child welfare policy. This chapter is not intended as a comprehensive review of the literature; rather, the most salient work on fathers’ involvement with the child welfare system is discussed. Who Is Considered a Father? A man who is responsible for providing paternal care to a child is considered to be a father. In our society those who assume the role of father may or may not be related to the child biologically, may or may not be the primary caregiver of the child or custodian, and may or may not reside in the same household as the child (i.e., nonresident father; Palkovitz 2002). A noncustodial father refers to a father who does not have physical custody of his child, but may

have visiting rights and be legally responsible for child support payments. In such instances, it is possible for the child’s mother, relative, or the child welfare agency to have legal custody or legal guardianship instead of the child’s father. Whether resident or nonresident, a father who has been married to the child’s mother since the child was born automatically has full legal paternal rights over his child. A paternity test is not required to establish his rights. On the other hand, an unmarried father must first establish his paternity rights through a DNA test before a court will declare him to be the legal father. Although, legally, a father is recognized as legal, biological, or adoptive, child welfare agency social workers understand that a nonrelative male might assume the role of father. For instance, a stepfather or a mother’s long-term live-in boyfriend who is the father of his and her biological children may act as the father for children in the household who are unrelated to him. Both a stepfather and a live-in boyfriend are welcome to participate in a child’s case planning meetings. However, neither has legal parental rights unless he adopts the child. Finally, a putative father is one who is presumed to be the biological father because he has been named as such by the biological mother. Child welfare agencies recognize men as the putative father until paternity is definitively established through a voluntary or courtordered DNA test for paternity. Social workers work diligently to establish paternity of children and youth and to involve fathers in case planning as swiftly as possible in order to prevent a child from entering into the foster care system, 694

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and, if the child is placed in out-of-home care, to reduce the child’s length of stay. Fathers’ Involvement Defined There has been an evolving definition of fathers’ involvement with children and youth who are at risk for placement in legal custody or who have been placed in legal custody. This definition includes important constructs relevant to the current multidisciplinary understanding about how fathers shape children’s lives. Therefore, a broad definition of fathers’ involvement for the twenty-first century is offered based on the collective contributions of previous research (Hodgins 2007). Fathers’ involvement refers to the direct and indirect involvement that a father has with his children (Lamb & Tamis-LeMonda 2004), with reciprocal emotional and behavioral dimensions and cognitive elements (Marsiglio & Cohan 2000). Af father’s involvement is likely to vary across time, developmental periods of both parents and children, and in relation to other components of the social ecology and life circumstances of the child and the child’s family (Marsiglio & Cohan 2000; Palkovitz 1997:213; Toth & Xu 1999). Fathers’ involvement occurs under many conditions and in many family contexts, depending on a father’s characteristics, such as age, race or ethnicity, and sexual orientation. As it relates to children and youth in foster care, a father’s involvement may be specifically outlined; for example, a plan may be made for a father’s visits with his children and his financial and/or or nonfinancial support of their children (Malm, Zielewski, & Chen 2008). The latter part of the definition suffices to explain what it is that fathers must do to meet child welfare agency expectations regarding fathers’ willingness and ability to promote their children’s development and overall well-being while the children are placed in safe, stable, and potentially permanent families (Coakley 2013; Saleh 2013). Men’s Conceptualization of Fatherhood The following has been helpful to researchers in understanding how fathers develop their

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foundational understanding of fathering and conceptualize themselves as fathers. According to Marsiglio (2004), men experience an abstract quest for philosophy, intentions, and vision about fathering; this quest is influenced by processes related to their individual development and gendered experiences. There are developmental and motivational components that inspire some men to not only want to produce children, but to want to nurture them as well (Marsiglio 2004). Marsiglio refers to this as fatherhood readiness, which has to do with how prepared men feel they are to become fathers. Before they become fathers, men typically base their ideas of fathering on the way their fathers parented them (Lamb 2010; Marsiglio 2004). They either want to emulate their fathers’ parenting because they admire their fathers and the way their fathers parented them, or want to parent their children differently because of negative experiences with their fathers. However, once men become fathers, their perspective on fathering and fatherhood is influenced by their distinctive, personal experience, which includes their relationships with their children and/or the children’s mothers. If fathers do not have positive examples or references for successful parenting, then they may follow their fathers’ example of poor involvement and/or a cycle of absenteeism. Men who are already fathers have visions that incorporate their children. Those who are nonresident fathers may visit and revisit their abstract visions about what kind of father they would like to be, since they are not carrying out the role that they once envisioned. Fathers can experience grief, regret, and guilt about their negative fathering experiences with their children. This may influence their future behavior as it relates to their parenting; men’s feelings about their negative fathering experience may also influence their decisions about having more children. For some men, these reflections might be the impetus for them to become more responsible fathers or family men (Marsiglio 2004). Men who assume the role of

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father to a nonbiological child (e.g., stepchild or girlfriend’s child) can also use their visions of fathering to self-evaluate and aim for selfimprovement. Taking an active role in developing and maintaining relationships with their biological and nonbiological children helps men form their identity as a father as well as their perceptions about fatherhood. The relationship between fathers and their children may deteriorate over time; fathers may choose to no longer be a part of their children’s lives. They may, however, later make efforts to reestablish their role as a father who is actively and positively involved with his child(ren) (Marsiglio 2004:223). A man also will form his identity as either a coparent or a solo parent. He might identify as a father in a good relationship with the children’s mother and jointly raise their children. Or he may identify as a father who will necessarily embrace unconventional parenting strategies as a nonresident father. These varied conceptualizations of father involvement help us understand the lives of fathers and the nuances regarding their involvement with their children (Marsiglio 2004:68). Benefits of Father Involvement Generally, fathers who are highly involved in raising their children make significant contributions that support their children’s overall development and well-being. When children have a secure, supportive, sensitive, warm, and reciprocal relationship with their father, it leads to their being well-adjusted (Lamb 2010). Research has found that involved fathers influence children’s cognitive ability, social behavior (Pruett 2000; Tamis-LeMonda & Cabrera 2002), psychological well-being (Cryer & Washington 2011), and educational achievement (Rosenberg & Wilcox, 2006; Washington 2011). Children and youth with highly involved fathers are more likely to be emotionally secure, form more secure attachments, be confident to explore their surroundings, and have better social connections with peers later in life; they also are less likely to get

in trouble at home, at school, or in their neighborhood (Gable, Crnic, & Belsky 1994; Harris & Marmer 1996; Pleck 2010; Yeung, Duncan, & Hill 2000). Some research suggests that fathers’ involvement in nurturing and playful activities with their infants is associated with their children’s high IQs and better language and cognitive capacities (Pruett 2000). Additionally, highly involved fathers’ toddlers begin school with higher levels of academic readiness; highly involved fathers’ children are more patient and deal with school stressors better than children with fathers who are less involved (Pruett 2000). Adolescents with highly involved fathers have better verbal skills, intellectual functioning, and academic achievement than youth with less involved fathers. Scope of Father Absence One of the most critical social problems that child welfare agencies and practitioners must contend with is fathers whose involvement with their children is inadequate as well as fathers who are altogether absent from their children’s lives. Father absence is a national phenomenon that refers to men who are neither a part of the family household nor contributing financially or emotionally to any aspects of childrearing. The One Hundred Billion Dollar Man is a National Fatherhood Initiative study that has investigated the impact of fathers’ absence on the well-being of children (Nock & Einolf 2008). This study found that the federal government spends $100 billion each year to sustain families when the children’s fathers are absent. The government assists families with absent fathers and who are in need through thirteen means-tested antipoverty programs and child support enforcement. These include Temporary Assistance for Needy Families (TANF), food and nutrition programs such as Women, Infants, and Children (WIC), public housing programs, Medicaid, the Earned Income Tax Credit, the State Children’s Health Insurance Plan, and child support enforcement (Nock & Einolf 2008).

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According to the Census Bureau, there are about twenty-four million children (one out of three) who grow up without their biological fathers. The impact is more profound for African American families where two out of three children are affected (Rosenberg &Wilcox 2006). Fathers who are uninvolved or absent contribute to deleterious effects on their children’s psychosocial development (Flouri 2005). Their children are more likely to live in poverty, drop out of school, and engage in risky behaviors, such as using illicit drugs, alcohol, and tobacco (Nock & Einolf 2008; Rosenberg & Wilcox 2006). Children of absent father families also use mental health services at a higher rate than children of two-parent families. Compared to their two-parent counterparts, they do not perform as well academically and have more behavior problems at school. Additionally, they are more likely to enter the juvenile justice system and more likely to be incarcerated later in life (Flouri 2005; Nock & Einolf 2008). According to a study for the Urban Institute, Malm (2003) found that in 2003 only 54 percent of children in foster care had had contact with their fathers in the past year compared to 72 percent of children in the general population (Malm 2003). The reasons for father absence can include divorce, out-of-wedlock births, and incarceration. Research shows that incarcerated fathers are more likely to lose contact with their children or passively withdraw from their lives, despite their desire for continued relationships (Center for Research on Child Well-Being 2007). There are also instances where the father is not involved because he cannot be located. The father’s identity and/or whereabouts may be unknown; the mother and father may have had conflict and consequently distanced themselves from each other or the father may be deceased. Although fathers’ personal problems may keep them from being involved in their child’s life, there are additional problems that lead to father absence for fathers whose children are in the child welfare system.

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Because in many of these families the father is often an absent parent, partner, and positive role model, there has been a tendency in permanency planning meetings not to see the father as a positive factor for reducing children’s out-of-home stays or providing permanent homes for them. This issue is of utmost concern; if fathers are not full participants in the permanency planning process, they then are deemed by the child welfare system as noncompliant, disinterested in participating in the lives of their children, and/or unsuitable as a permanent placement option, thus jeopardizing their parental rights to raise their children and preserve their family heritage. If the child welfare agency determines that a father is not now and will not become capable of safely raising their child(ren), he most likely will be asked to relinquish his parental rights or the court may order his rights terminated based on the recommendation of the child welfare agency. Obstacles to Child Welfare Involvement Fathers’ Personal Challenges Fathers’ personal challenges can serve as an obstacle to initial or ongoing involvement with their children (Coakley 2013). Fathers may have mental health, alcohol and substance abuse, or domestic violence issues that they must resolve or manage before they can be safely involved with their children. Additionally, fathers’ adherence to traditional mother/father roles in their family and their feelings of inadequacy as fathers also may influence if, how often, and in what ways they participate in various familybased programs and services. Fathers often do not participate because they are not used to talking about problems and accepting parenting suggestions from outsiders. On a deeper level it is problematic for some fathers to admit that they and their families have problems. Having to accept help from professionals makes them feel embarrassed, uncomfortable, weak, or as if they are failures. They also do not want to be scrutinized because they receive outside help for family problems (Shock & Gavazzi 2004).

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When abuse or neglect is involved, a father’s lack of involvement with programs such as Child Protective Services (CPS) and foster care has irrevocable consequences on his ability to have future contact with his children. Therefore, fathers who want to have involvement— and for whom the child welfare agency agrees that such contact is safe for the children—must successfully deal with their own issues during the time frame that is federally mandated to secure children’s permanence. Under the Adoption and Safe Families Act of 1997 (ASFA, P.L. No. 105-89), fathers risk losing their parental rights when they do not comply with case plan goals that are designed to facilitate a relatively short stay in foster care for children. The rationale behind this policy is to motivate parents to act responsibly and swiftly, removing any and all identified challenges in their lives that put children at risk so that their children can have safe, stable, permanent families. However, this policy may also encourage biased practices that promote adoption over placement with fathers. For instance, prospective adoptive parents are screened, evaluated, trained, and monitored to ensure safety and quality before social workers consider placing children in their homes. As a result, adoptive parents typically present fewer problems to deal with than do children’s birth families. In some instances this makes placement with adoptive families easier and faster, thus more conducive to achieving the twelve-month permanency plan mandated by the ASFA. In contrast, the issues that birth parents must rectify before their children can be reunited or placed with them are typically severe and often time-consuming to resolve. To illustrate, treatment and recovery for drug addiction is a lengthy process. Yet this and other serious problems typically must be resolved or sufficiently managed within twelve months in order for the agency to work toward family reunification, rather than to change the plan to be relinquishment or termination of parental rights.

Research suggests that fathers’ challenges influence social workers’ views about involving them in permanency planning efforts (O’Donnell 1999). O’Donnell (1999) conducted interviews with social workers from two child welfare agencies to assess the involvement of seventy-four African American fathers who had a total of one hundred children placed in kinship homes. The social workers reported various challenges related to their attempts to involve fathers, including that forty-nine of the seventy-four fathers (66 percent) experienced specific problems that impacted their ability to care for their children. The most common problems included drug abuse or alcoholism (55 percent), incarceration (26 percent), not cooperating with the agency (14 percent), inadequate housing (12 percent), and lack of interest in the child (12 percent). If left unresolved, such challenges are likely to threaten any relationship with their children that fathers might have expected to establish or hoped to rekindle. Mother-Father Conflict Positive relationships between mothers and fathers lead to greater child involvement from fathers (Curran 2003; Johnson 2002), not only when their children are young, but throughout their lives (Coley & Chase-Lansdale 1999). When a marriage or intimate relationship ends between a mother and father, it is important for them to maintain a cordial relationship with each other to support the children’s sense of well-being. Research has shown that children are more likely to be anxious, withdrawn, or antisocial when their fathers display anger toward their mothers or refuse to cooperate or communicate with them (Gable, Crnic, & Belsky 1994; Rosenberg & Wilcox 1996). It is imperative that fathers interact with mothers amicably because mothers are considered to be the “gatekeepers” in child rearing (Allen & Hawkins 1999; Marsiglio 2004:68). Custodial mothers have the authority to determine the overall manner in which children are raised, including the amount of contact they

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have with their non-custodial fathers. According to the Center for Research on Child WellBeing (2007), mothers’ perceptions of fathers’ trustworthiness influenced fathers’ involvement with their children. Fathers deemed untrustworthy by the children’s mother to care for their children were less engaged in activities with their children than fathers who were considered trustworthy. Additionally, to a great extent, mothers shape children’s feelings about their fathers. For example, a child’s view of his father is formed by whether or not the father is at home, as well as the context of why he is or is not at home. But, if the child witnesses the mother expressing negative or hostile feelings toward the father regarding the amount of time he spends with his child, the child will perceive those scenarios to be negative and internalize them (Marsiglio 2004). Mothers also have influence over the manner in which governmental agencies view children’s fathers. Fathers often times find themselves in predicaments where they have to explain themselves to authorities of the court, police department, or the child welfare agency because their children’s mothers have alleged—sometimes falsely—that they have perpetrated violence against them or some form of abuse on their children. They might give a false—or accurate, but retaliatory—report that they are not paying adequate child support or that they are wanted for an outstanding warrant of some kind. Fathers with presumed indiscretions will have a more difficult time convincing the court that they deserve the custodial or visiting rights they seek to have with their children. Child Welfare Agency Issues There is no doubt that the lack of fathers’ involvement with their children is largely a function of the fathers’ actions. However, when children become clients served by the child welfare system, there are institutional obstacles that also contribute to fathers’ lack of involvement in their children’s lives. Agencies’ policies

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and practices convey whether and to what degree they are open to working with fathers, and fathers form their perceptions based on agency’s responses to them. For example, O’Donnell (1999) found that social workers were unprepared to work with African American fathers because agencies were not set up to include them in a useful way during the intake, assessment, and case planning. As a result, social workers did not regularly see fathers in person or make follow-up phone calls to them; they actually had more contact with the fathers’ families than with the fathers. In another study, O’Donnell (2001) examined social services agency case records representing 132 single and multiple father households. His findings indicated that the majority of fathers (70 percent) had never participated in their children’s case planning activities, and more than two-thirds (67 percent) had never had a discussion with the social worker about obtaining custody of their children. Additionally, only 14 percent of the fathers actually participated in developing their children’s case plan goals. Similar findings were reported from another study. In their survey of 53 child welfare administrators and 1,222 caseworkers regarding 1,958 foster children, Malm, Murray, and Geen (2006) studied nonresident fathers’ involvement with child welfare agencies and their children across four different states from 2004 to 2005. Their findings show that, overall, 70 percent of caseworkers said they had received some training on how to identify, locate, or engage fathers. Few caseworkers (32 percent) reported having received training on how to refer cases to Child Support Enforcement to get assistance with locating the father. Some caseworkers reported having received training on father engagement, referring a case to Child Support Enforcement for assistance locating the father, and on father engagement or child support. Significant differences in service were found between cases involving workers who did and did not report having received training about working with fathers. Those who received

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training were more likely to share the case plan with fathers; their agencies were more likely to consider the fathers as possible placements for the children; and the fathers on their caseloads were more likely to express interest in having their children live with them. In this same study, of the 1,958 cases eligible for analysis, caseworkers reported that 1,721 (88 percent) fathers had been identified, and 1,071 (55 percent) fathers had been contacted by the caseworkers or agencies at least once. Most caseworkers (86 percent) reported asking the children’s mother how to locate fathers. Caseworkers reported that 40 percent of the mothers who were asked provided information about the fathers’ whereabouts. They also asked other caseworkers (40 percent), mothers’ relatives (33 percent), and the children (34 percent). Paternal relatives were the most helpful resources to obtain information concerning the fathers’ whereabouts; sixty percent of the time a paternal relative knew the father’s whereabouts. However, only 20 percent of caseworkers reported having utilized children’s paternal relatives as resources to locate children’s fathers. Malm, Murray, & Geen (2006) found that 72 percent of caseworkers believed that children’s well-being is enhanced when fathers are involved; they reported contacting more than 90 percent of nonresident fathers and informing them of the out-of-home placement and case plan. However, only 53 percent of children’s child welfare caseworkers believed nonresident fathers were interested in participating in the decision-making process regarding their children’s permanency. In an effort to address the disproportionate numbers of children of color in foster care (Hill 2006), Annie E. Casey partnered with a North Carolina county child welfare agency to investigate how fathers’ involvement influences children’s permanency outcomes. Coakley (2009) conducted a secondary data analysis study of 116 randomly selected case records of children from diverse racial and

ethnic backgrounds. The sample consisted of fifty-four (47 percent) CPS and sixty-two (53 percent) foster care case records. The findings showed that the majority of fathers (biological and nonbiological) did not sign the case plan to enter into an agreement to complete case plan goals. Of the nineteen who did sign the case plan, less than half (eight) actually complied with and completed the case plan goals. Children whose fathers complied with the case plan had shorter lengths of stay in foster care than the children whose fathers did not comply. When cases with father-involvement were compared with cases in which fathers were not involved, the children’s length of stay in foster care decreased by more than half (twelve months for involved fathers versus twenty-six months for uninvolved fathers). A significant relationship was also found between fathers’ compliance with the case plan and where children were placed after their discharge from foster care (Coakley 2009). Children whose fathers successfully completed case plan goals were placed more often with a parent or relative than with a nonrelative or in other types of placements: 37 percent of the children were reunited with one or both of the parents; 28 percent were placed with a relative; 23 percent were placed with a nonrelative; and 7 percent were placed in other non-specified placements that could include emancipation, run-away status, or aged out of foster care. The findings from my own and others’ research strongly suggest that enhancing child welfare agencies’ policies and practice efforts to increase fathers’ involvement, would improve children’s permanency outcomes. However, prospective research on the involvement of custodial and noncustodial fathers from the point that cases are opened to when they are closed is needed. The following excerpts from father interviews from the author’s qualitative study provide insight regarding factors that fathers perceive to facilitate and to inhibit fathers’ involvement with the child welfare agency.

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Fathers’ Perspectives and Experiences with Child Welfare Agencies Using a qualitative research design, the author interviewed fathers about what influences their involvement with a child welfare agency serving their child or the lack thereof. The study findings are organized as follows. First, for each of the two start list categories—facilitated involvement and inhibited involvement—themes from the fathers’ interviews are identified. The quotations selected from the transcribed interviews further illustrate the themes and the context. Only particularly salient excerpts from the interviews are included. What Helps Fathers Stay Involved? Eight themes emerged from fathers’ perceptions of factors that facilitated their involvement with a child welfare agency that is serving their child(ren): t
social workers’ helping skills, t
workers’ understanding and compassion, t
workers’ openness and honesty in telling fathers exactly what is expected and how to get it done, t
resources/providing assistance that helps fathers help their children, t
workers’ availabilty to meet with fathers and answer their questions, t
realistic/appropriate case plan goals, t
fathers’ confidence as a parent, and t
fathers’ mothers’ guidance and support. Seven fathers’ comments below exemplify the themes regarding the facilitation of their involvement: “They [child welfare workers] did everything that I needed done. At the time of my son’s situation they didn’t give me a hard time about me being a man and not being a woman. And I like the way they made me feel comfortable.” “I could call her at any time and tell her I needed to talk to her and . . . she put an effort. I mean, she wasn’t like somebody ‘well let me check into it, see

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if I can do it,’ she never said that. She would say ‘well let me get involved, let me get in touch with you tomorrow.’ And she .  .  . she helped me out a lot. A lot!” “The most comfortable thing about it was having that support that didn’t frown on you, you know? Having my immediate caseworker[‘s] support. Yes, she would call us at I’d say probably anywhere from two or three times a week, 8 o’clock in the morning .  .  . ‘look you need to do this, I left you some paperwork on my way home last night. That is the paperwork sitting in your mailbox. Fill that out. We’ll get this started for you. We’ll get that started for you. Let me know if there is anything you need.’ . . . I mean without a shadow of a doubt she was a lifesaver there.’’ ‘One of the best things about [the child welfare agency] is that they make you focus on your goals . . . They make you set them and they help you meet them . . . And my goal was basically to get—because I had a b.s. job—my goal was basically to get a job to where I could actually support my children—you know what I’m saying?—and things of that nature.” “They [child welfare caseworkers] make you do things sometimes that you don’t really wanna do. But when you do them, after a while you learn that, you know, you will see why they ask you to do them so. You know what I mean?” “I had to go through certain steps as far as taking classes—parenting classes—and they had to come do a home evaluation and stuff like that so I could get my son. But some of the classes, though, I did felt like, you know, why did I have to do it or whatever. . . . It wasn’t no big deal to meet her, but it was uncomfortable for me to go to different meetings and I had to take drug tests and stuff like that . . . I’m gonna do it anyway because no child should be in foster care if they got parents, you know, living or family around. You know, foster care taking care of the child is nothing like family.” [Regarding a support group he was referred to] “It’s a support group. Men talk about what can we do to help, you know, you do better with your kid. What can we do to help benefit . . . help you to be able to talk and not have problems. ’Cause it’s not easy.”

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What Hinders Fathers’ Involvement? Ten themes emerged that fathers perceived as factors that inhibited their involvement with the child welfare agency that served their child(ren). Included were workers’ negativity; dismissiveness toward father—ignores or does not value father’s presence; lack of understanding regarding father’s discipline style; unfair policies/practices; children’s mothers’ negativity and noncompliance; father’s negativity; economic difficulties/inability to find a job; jail/ criminal history; too frequent visits from social workers; and stereotypes of black men. The following are excerpts from seven fathers’ accounts about the manner in which the child welfare agency personnel (not necessarily the social worker) conducted business with them. “I’d say the most interference that we really had was when, it was the most uncomfortable situation I’d say was probably the very first time we met [the employee]—and basically she played off almost your basic stereotype—’I got a title, I gotta place, so I’m gonna be an [expletive]’ . . . excuse my language . . . ‘But, I’m gonna be an [expletive] just because I can.’” “That’s how they look at you. They see the color of your skin. People go off of stereotypes. They think that all black men are bad people because we don’t have anything good going on for us right now.” “But everybody I talk to basically looks at my wife and holds conversations with my wife, when it’s me. You know what I’m saying? I am the one who took the initiative to come here. I took the initiative, swallowed my pride, and say, ‘Hey look, I need some help.’ My wife didn’t. It was me. You know? But, I mean it’s like social services is very female-oriented. They want to help the female.” ‘It’s really a two-sided opinion ’cause on one side theirs is to do a job, which is to help out the less fortunate and to get certain opportunities to mothers and fathers that are there. . . . On the other hand, I feel a little disrespected because a lot of times, if you are sitting there with your girls and your kid, they, they are not really paying attention to you. They asking her questions . . . they didn’t see the father. I feel

a little disrespected actually. . . . Like I wasn’t even there. They really didn’t pay me any mind. They seen me, they spoke to me, and that was it. Then to go so far as to ask to see the father without . . . I mean they should have presented the question in a better way and not just say, ‘well, is he the father?’ Like every black male don’t take care of his kid when there are some out here who does. Who is there everyday, day in and day out from day one, beginning to end.” “They rather talk to my wife about me, even though I’m sitting right there beside her. They seem timid. They don’t want to talk to me directly.” “You got people in there, they look at every guy that walks in there like, OK, well he can’t take care of his family. That may not be the issue, you know, that may not be the case. I mean, just because we are at Social Services there could be other things like, you know, where I have a wife and two children at home, I work at a fast food restaurant. I mean ends don’t meet like they are supposed to. So, I mean, I go and get a little bit of help . . .” “No offense, but I think they lean more toward the mother than they do fathers on everything, just because . . . I know they carry the baby and everything, but you know you got single fathers out here that are willing to be a mother, too.” “Me, personally, I think that the majority of social services pretty much cater to the women more than the men because a lot of women show up more than men, and I’m not saying it’s because of the male ego or anything like that. I just feel that social services cater toward women more than they do men . . . and any type of service that a man looks for is very limited . . . The mother has left the house, and I’m taking care of the kids. I got full custody of ’em, and the things that I can ask for I have pretty much gotten, but I haven’t [gotten things] to the full extent like the mother of my kids have.” “Well with everything that they want me to do and require me to do, and when I try to do it, they should give me an opportunity to see my kids. . . . Any opportunity, I would like to be with them [children]. But they do not give me a choice. How many jobs are they going to require [of] me to see my kids?”

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Findings from this study identify obstacles and facilitating factors toward fathers’ involvement. The findings indicate that fathers perceive social workers as effective when they demonstrate that they can treat fathers respectfully and compassionately. However, many of these fathers feel that the child welfare policies and practices favor mothers over fathers. They do not believe that the child welfare agency considers fathers for the provisions and services they need to support their children. If fathers do not feel comfortable, respected, and valued in their interactions with the child welfare system, then they might not choose to work with social workers toward their child(ren)’s permanency (O’Donnell et al. 2005). Father Responsibility Legislation From a historical perspective, social welfare policy in the United States has been predicated on providing financial assistance to children seriously affected by poverty. Eventually, public assistance was extended to custodial parents who were at or below the poverty level. The extent to which fathers have been included in social welfare policy has entailed holding them accountable for financially supporting their children. Societal expectations for men have always been that they will assume the role as the provider and work to financially support themselves and their families (Harris & Marmer 1996). This principle plays out in the way that many public policies are designed. Men who are custodial parents typically are not eligible for the types of government assistance programs that are available to mothers with children. Instead, TANF, signed into law by President Clinton in 1996, placed emphasis on identifying the fathers of children receiving public assistance, establishing their legal paternity, and, perhaps most critically, establishing and enforcing the payment of child support orders. So, although the explicit goal is for men to act responsibly, the implicit goal is to reduce their families’ public welfare dependency (Day & Lamb 2004).

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For the past fifteen years the legislative focus has remained steadfastly on responsible fatherhood. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 generated considerable discussion about the role of divorced or unmarried low-income fathers in the lives of children. These policies have been described as emerging from a deficit model of fathers in which fathers are considered to be problematic. Therefore programs and initiatives have been developed to promote “responsible fatherhood” with those from low-income and marginalized backgrounds (Tamis-LeMonda & Cabrera 1999). Even though no association has been found between the level of socioeconomic status and parents’ love and acceptance of responsibility for their children, the government has dedicated resources and energy to educate low-income parents about their parental responsibility (Center for Family Policy and Practice 2011:1). Trends in Child Welfare Policy and Practice Several important trends in child welfare policy and practices have the potential to affect the involvement of fathers. For example, there is a renewed focus on permanency planning as stipulated in ASFA. Moreover, there is a national movement toward family group decision making, concurrent case planning, kin connections, and kin support in case planning. To date, there is no evidentiary support that these trends lead to significant results regarding identifying, locating, and engaging fathers (Malm, Murray, & Geen 2006). However, they have potential to positively influence fathers’ involvement. Strategies to Identify and Locate Fathers Research shows that, overall, the child welfare system has not done an effective job involving fathers (Malm, Murray, & Geen 2006). This is partly due to the difficulty social workers have in establishing the identity of children’s and youths’ biological fathers and attempting to locate them (Malm, Murray, & Geen 2006). Nevertheless, there are a number of efforts

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being implemented nationally that should improve child welfare agencies’ ability to identify, locate, and engage fathers. Some fathers are not involved initially because they may not know that they had fathered a child or are not aware of the issues regarding their children’s safety and care. Other fathers may not understand how their involvement could be beneficial to their children and therefore do not make themselves available to child welfare agency personnel. There has been a shift in legislation that permits agencies to strengthen their efforts to engage fathers in planning for their children’s safety, well-being, and permanence. Federal legislation now gives child welfare agencies access to records and services to locate fathers (Malm, Murray, & Geen 2006; Social Security Act). The Federal Parent Locator Service is an assembly of systems operated by the Office of Child Support Enforcement to assist states in locating noncustodial parents, putative fathers, and custodial parties for the establishment of parentage and child support and for enforcement of custody, support, and visiting orders. Various records, such as those from law enforcement, bankruptcy proceedings, credit bureaus, and putative father registries, may be accessed by social workers to locate fathers. Many public records can now be accessed online, making searches quicker and easier. Additionally, information sharing between child welfare social workers and social services benefits workers is another a strategy used by some social services agencies. There is a possibility that public aid or child support files could contain a name or address of a father or his relatives that was not disclosed during the child abuse or neglect investigation or foster care placement. Moreover, the child welfare social worker may have information about the noncustodial father or mother that would be helpful to the child support office or economic services unit. Over a decade ago, in their searches for fathers, it was commonplace for social workers to rely heavily on the use of

family and friends, the telephone directory, and newspaper ads summoning fathers to contact the child welfare agency (Malm, Murray, & Geen 2006). However, these leads frequently contained inaccurate information and, consequently, many fathers were not located. Although family and friends continue to be an invaluable resource to identify and locate fathers, with current advances in technology such as the Internet and social networking sites like Facebook (where users openly share pictures and information about their family members), child welfare agency personnel have more reliable and speedier methods to verify information regarding the whereabouts of children’s fathers that has been received from family and friends. The recent legislative focus on supporting kin caregivers, when combined with technological advances, should also assist child welfare agencies in identifying and locating children’s fathers. Even if these activities fail to result in a child’s temporary or permanent placement with her biological father, they may assist in identifying the father’s relatives, who may be potential kin caregivers for his child. Father Involvement Assessments and Interventions Assessments The nature and extent of fathers’ involvement has only recently begun to receive national attention. The social sciences have developed a method to measure family process by motherchild interaction, but father-child interaction and the construct “father’s involvement” has not received the same attention (Day & Lamb 2004). There are a number of measures used with the general population that assess fathers’ financial support, engagement, accessibility, social and emotional support, and cognitive activities like planning for their children (Pasley & Braver 2004). There are a few untested tools focusing on the levels of involvement of fathers whose children are in foster care or

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are at risk of entering the child welfare system (Coakley 2009). However, a lack of evidencedbased assessment resources exists to explore or study fathers’ involvement with the child welfare system around the needs of their children and adolescents. Interventions The Federal government and national organizations have sponsored various programs that address the critical role that fathers have in strengthening their families and successfully meeting children’s needs. In the U.S. Deficit Reduction Act of 2006, policy makers allocated one-third of the $150 million annual budget for family support to programs that promote fathers’ involvement with their children. This was noted as an unprecedented demonstration of commitment to providing father-focused services for families (Cowan et al. 2009). As a result, there are several innovative, collaborative, and comprehensive programs in the U.S. that have evaluated their effectiveness on father engagement and children’s safety, permanence, and well-being outcomes. Four such programs have been recommended as models for future program development nationwide (National Quality Improvement Center on Nonresident Fathers 2010). In Indianapolis, Indiana, the Fathers and Families Center, Indiana Department of Child Services, Indiana University School of Social Work, and community organizations are collaborating to study nonresident father engagement. One group of nonresident fathers—the control group—will participate in a twentyweek peer-led support group and are supported to obtain their GED if desired. An intervention group of nonresident fathers will receive enhanced supports to address areas identified in the fatherhood literature as barriers to father involvement. The intervention group will participate in the peer-led support group, but will also be offered legal support and advocacy letters to the courts, legal fees, transportation or reinstatement of a driver’s license, car repair,

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bus tickets, assistance in finding housing, child care, clothing, food, education, technical training, as well as mental health and other referrals. The Indiana University School of Social work will manage and evaluate the project. In the state of Washington the Fathers Engagement Project is offered by the Division of Children and Family Services, a section of the Department of Social and Health Services for the State of Washington, region 4, King County. The Division of Children and Family Services is collaborating with a local fatherhood program, the University of Washington School of Social Work, the Fatherhood Advisory Group, child welfare professionals, consumers, advocates, and decision makers in order to make systems changes that promote justice and improve outcomes for all children and families in the child welfare system. The Fathers Engagement Project offers services for nonresident fathers that include fatherhood support groups, child support management, parent involvement (visiting, parenting plans), reunification services, parenting training, and case management. University of Washington School of Social work will provide project management and evaluation. The El Paso County Department of Human Services in Colorado Springs will work with partners from various sites to develop a nonresident fathers curriculum under the auspices of the Non-Resident Fathers Supplemental Grant. The project offers a variety of services for fathers that include child support services, diligent searches for absent parents, establishing paternity, case management, mediation, dispute resolution, employment and job readiness services, father groups, tips for educational and fun activities to do with their children, parenting classes, and a dads as mentors program. The Center for Policy Research in Denver will be the evaluator of this project. Finally, the Texas Department of Family and Protective Services, Child Protective Services Division will partner with members of the Tarrant County Fatherhood Coalition to

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provide a model intervention program to nonresident fathers. The purpose of the program is to examine the influence of nonresident father involvement on the outcomes for children in Department of Family and Protective Services custody. The Tarrant County Fatherhood Coalition consists of about forty organizations that work to promote responsible fatherhood. The program will offer peer-led support groups, job resources, and job readiness information, affordable housing, financial education workshops, support in the areas of tax and financial planning, and educational and employment opportunities. Child Trends, based in Washington, DC, will establish an experimental research design for a comprehensive evaluation of this project. Future Research Aside from financial support, policy makers have not placed much value on the important contributions that fathers are capable of making toward the development and support of their children. However, because of the relatively recent federal allocations toward innovative nonresident fatherhood programs, a number of evidence-based studies have been launched to assess whether, over time, fathers are better able to successfully support their families and parent their children with temporary assistance from the government and various community organizations. Additional research is necessary, focusing on both resident and nonresident fathers of children and youth in foster care and their involvement with the child welfare system. The lack of empirical knowledge concerning fathers’ involvement with the child welfare system limits the development of evidence-based policies, programs, and practice (Courtney et al. 1996). Future prospective studies are needed to examine all dimensions of fathers’ involvement: the availability and equity of government provisions and services for fathers; training of social workers and other professionals regarding the engagement of fathers as partners in planning

and caring for their children; the assessment of father-child relationships; interventions and programs to strengthen these relationships; and social workers’ attitudes toward working with fathers. Child Welfare Agency Policy and Practice It is widely acknowledged and documented that child welfare agency policies and practices have failed to achieve engagement of fathers with the child welfare system. In order to facilitate fathers’ initial and ongoing involvement, child welfare agencies must enhance the knowledge and skills of agency staff concerning involving fathers in planning for their children and providing services to fathers whose needs and issues may differ from those of children’s mothers. In addition, child welfare agencies must assess the ways in which those serving children, including frontline staff, supervisors, resource parents, and others, may convey to fathers that they are not considered a valuable, viable resource for permanency. Specifically, comprehensive training is needed and can be implemented to help social workers: (a) learn innovative ways to identify, locate, and engage fathers as early as possible; (b) recognize the benefits of involving fathers in the permanency planning process; (c) understand the special issues that fathers experience while working with the child welfare system; (d) learn to communicate effectively with and welcome men with minority racial and ethnic backgrounds and fathers with low incomes; (e) connect fathers to services that will enhance their parenting and relationship skills; (f) link fathers with services that promote education, employment, and job skills; (g) ensure that fathers receive counseling and support services to deal with alcohol, substance abuse, and mental health issues; and (h) empower fathers to stay involved so that they can support their children during and after the period at which the child welfare agency intervenes. It is imperative that child welfare social workers understand how public policy affects

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fathering as well as the ways that father involvement can be encouraged and supported through effective case planning and intervention (Rosenberg & Wilcox 2006). While they must work quickly to identify, locate, and engage fathers, child welfare social workers also should exercise caution in their practice

to ensure that fathers do not lose their parental rights because of factors beyond their control. Fathers and their families can be allies to child welfare agencies to keep their children safe and well (Rosenberg & Wilcox 2006) regardless of fathers’ living arrangements, marital status, socioeconomic status, or other demographics.

REFERENCES

impact of father involvement on child well-being. Unpublished MS. Curran, L. (2003). Social work and fathers: Child support and fathering programs. Social Work, 48, 219–27. Curtis, C. (1996). The adoption of African-American children by Whites: A renewed conflict. Families in Society 77, 156–64. Day, R., & Lamb, M. (2004). Conceptualizing and measuring father involvement. Mahwah, NJ: Erlbaum. Dillon, D. (1994). Understanding and assessment of intragroup dynamics in family foster care: AfricanAmerican families. Child Welfare, 73, 129–37. Flouri, E. (2005). Fathering and child outcomes. West Sussex: Wiley. Gable, S., Crnic, K., & Belsky, J. (1994). Coparenting within the family system: Influences on children’s development. Family Relations, 43, 380–86. Harris, K., & Marmer, J. (1996). Poverty, paternal involvement, and adolescent well-being. Journal of Family Issues, 17, 614–40. Hill, R. (2006). Synthesis of research on disproportionality in child welfare: An update. Washington, DC: Casey—CSSP Alliance for Racial Equity in the Child Welfare System. Retrieved from http://www. caseyfamilyservices.org/pdfs/0226_CC_BobHillPaper_FINAL.pdf. Hodgins, B. (2007). Father involvement in parenting young children: A content analysis of parent education programs in British Columbia. Master’s thesis, University of Victoria, Canada. H.R. 6893—110th Congress: Fostering Connections to Success and Increasing Adoptions Act of 2008. (2008). In GovTrack.us (database of federal legislation). Retrieved from http://www.govtrack.us/congress/bill.xpd?bill=h110–6893. H.R. 2193—112th Congress: Julia Carson Responsible Fatherhood and Healthy Families Act of 2011. (2011). In GovTrack.us (database of federal legislation). Retrieved from http://www.govtrack.us/congress/ bill.xpd?bill=h112–2193&tab=summary. Johnson, W. (2002). Social work strategies for sustaining paternal involvement among unwed fathers: Insights from field research. Professional development: International Journal of Continuing Social Work Education, 4/5, 70–83.

Allen, S., & Hawkins, A. (1999). Maternal gatekeeping: Mothers’ beliefs and behaviors that inhibit greater father involvement in family work. Journal of Marriage and the Family, 61, 199–212. American Humane Society Association and Family Group Decision-Making (2010). Guidelines for Family Group Decision-Making in child welfare. Retrieved from http://www.americanhumane.org/ assets/pdfs/children/fgdm/guidelines.pdf. Casey Center for the Study for change in paternal involvement among urban African American fathers. Journal of Family Social Policy Alliance for Racial Equity unpublished report. Center for Family Policy and Practice (2011). Social Welfare Policy. Retrieved from http://www.cffpp. org/socialwelfare.html. Center for Research on Child Well-Being (2007). Fathers’ risk factors and their implications for healthy relationships and father involvement. Fragile Families Research Brief No. 37. Retrieved from http://www.fragilefamilies.princeton.edu/briefs/ResearchBrief37.pdf. Coakley, T. (2009). Fathers’ involvement with the child welfare system: A study on racial disproportionality and fathers’ perspectives on fatherhood and permanency planning. Unpublished MS. Coakley, T. (2013). An appraisal of fathers’ perspectives on fatherhood and; barriers to their child, welfare involvement. Journal of Human Behavior in the Social Environment, 23(5), 1080–91. Coley, R., & Chase-Lansdale, P. (1999). Stability and Psychology, 13, 416–35. Combs-Orme, T., & Renkert, L. (2009). Fathers and their infants: Caregiving and affection in the modern family. Journal of Human Behavior in the Social Environment, 19, 394–418. Courtney, M., Barth, R., Berrick, J., Brooks, D., Needell, B., & Park, L. (1996). Race and child welfare services: Past research and future directions. Child Welfare, 75, 99–137. Cowan, C., Cowan, P., Pruett, M., Pruett, K., & Wong, J. (2009). Promoting fathers’ engagement with children: Preventive interventions for low-income families. Journal of Marriage and Family, 71, 663–79. Cryer, Q., & Washington, T. (2011). African American children in informal kinship care: Exploring the

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Kalil, A., & Ryan, R. (2010). Mothers’ economic conditions and sources of support in fragile families. Future of Children, 20, 39–61. Lamb, M. (2010). The role of the father in child development (5th ed.). Hoboken, NJ: Wiley. Lamb, M., & Tamis-LeMonda, C. (2004). The role of the father. In M. E. Lamb (ed.), The role of the father in child development (4th ed., pp. 1–31). Hoboken, NJ: Wiley. Malm, K. (2003). Getting noncustodial dads involved in the lives of foster children. Caring for children: Facts and perspectives brief No. 3, Retrieved from http:// fatherhoodqic.org/research%20on%20non%20resident%20fathers.shtml. Malm, K., Murray, J., & Geen, R. (2006). What about the dads? Child welfare agencies’ efforts to identify, locate, and involve nonresident fathers. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Malm, K., Zielewski, E., & Chen, H. (2008). More about the dads: Exploring associations between nonresident father involvement and child welfare case outcomes. Final report for the assistant secretary for planning and evaluation. Administration for Children and Families, U.S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/hsp/08/ MoreAboutDads/index.htm. Marsiglio, W. (2004). Studying fathering trajectories: In depth interviewing and sensitizing concepts. In R. Day & M. Lamb (eds). Conceptualizing and measuring father involvement (pp. 61–82). Mahwah, NJ: Erlbaum. Marsiglio, W., & Cohen, M. (2000). Contextualizing father involvement and paternal influence: Sociological and qualitative themes. Marriage & Family Review, 29, 75–95. National Conference of State Legislatures. (2000). Connecting low-income fathers and families: A guide to practical policies. Retrieved from http://www.cga. ct.gov/coc/PDFs/fatherhood/connecting/childsupp. pdf. National Conference of State Legislatures (2008). Summary–Fostering Connections to Success and Increasing Adoptions Act. Retrieved from http:// www.ncsl.org/documents/cyf/FosteringConnectionsSummary.pdf. National Quality Improvement Center on Nonresident Fathers and the Child Welfare System. (2010). Retrieved from http://fatherhoodqic.org/. National Resource Center for Foster Care & Permanency Planning (NRCFCPP) Hunter College School of Social Work of the City University of New York (1998). Tools for permanency. Retrieved from http:// www.hunter.cuny.edu/socwork/nrcfcpp/downloads/ tools/fgdm-tool.pdf. Nock, S., & Einolf, C. (2008). The costs of father absence. National Fatherhood Initiative Report: The 100 billion

dollar man. http://www.fatherhood.org/policymakers/fatherhood-and-public-policy. North Carolina Department of Health and Human Services. (2009). NCDHHS Online manuals. 1201 Child placement services. Retrieved from http://info. dhhs.state.nc.us/olm/manuals/dss/csm-10/man/ CSs1201c6–02.htm. O’Donnell, J. (1999). Involvement of African American fathers in kinship foster care services. Social Work, 44, 428–41. O’Donnell, J. (2001). Paternal involvement in kinship care services in one-father and multiple-father families. Child Welfare, 80, 453–79. O’Donnell, J., Johnson, W., D’Aunno, L., & Thornton, H. (2005). Fathers in child welfare: Caseworkers’ perspectives. Child Welfare, 84, 387–414. Palkovitz, R. (1997). Reconstructing “involvement”: Expanding conceptualizations of men’s caring in contemporary families. In A. J. Hawkins & D. C. Dollahite (eds.), Generative fathering: Beyond deficit perspectives (pp. 200–16). Thousand Oaks, CA: Sage. Palkovitz, R. (2002). Involved fathering and child development: Advancing our understanding of good fathering. In C.  S. Tamis-LeMonda & N. Cabrera (eds.), Handbook of father involvement: Multidisciplinary perspectives (pp. 119–40). Mahwah, NJ: Erlbaum. Pasley, K., & Braver, S. (2004). Measuring father involvement in divorced, nonresident fathers. In R. D. Day and M. E. Lamb, Conceptualizing and measuring father involvement (pp. 217–40). Mahwah, NJ: Erlbaum. Pleck, J. (2010). Paternal involvement: Revised conceptualization and theoretical linkages with child outcomes. In M. Lamb (ed.), The role of fathers in child development (5th ed., pp. 58–93). Hoboken, NJ: Wiley. Pruett, K. (2000). Father-need. New York: Broadway. Public Law 105–89: Adoption and Safe Families Act (ASFA) of 1997. Retrieved from http://www.acf.hhs. gov/programs/cb/laws_policies/cblaws/public_law/ pl105_89/pl105_89.htm. Rosenberg, J.. & Wilcox, W. B. (2006 ). The importance of fathers in the healthy development of children, Washington, DC: Office on Child Abuse and Neglect, U.S. Children's Bureau. Rosenberg, J., & Wilcox, W. (2006). U.S. Dept. Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Office of Child Abuse and Neglect. Retrieved from http:// www.childwelfare.gov/pubs/usermanuals/fatherhood/chaptertwo.cfm. Saleh, M. (2013). Child welfare professionals’ experiences in engaging fathers in services. Child and Adolescent Social Work Journal, 30, 119–37. Shock, A., & Gavazzi, S. (2004). A multimethod study of father participation in family-based programming. In R. Day and M. Lamb. Conceptualizing and

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measuring father involvement (pp. 149–84). Mahwah, NJ: Erlbaum. Social Security Act. Social Security Online. Retrieved from http://www.ssa.gov/. Tamis-LeMonda, C., & Cabrera, N. (1999). Perspectives on father involvement: Research and policy. Social Policy Report, 13. Society for Research in Child Development. Tamis-LeMonda, C., & Cabrera, N., eds. (2002). Handbook of father involvement: multidisciplinary perspectives. Mahwah, NJ: Erlbaum. Toth, J., & Xu, X. (1999). Ethnic and cultural diversity in fathers’ involvement: A racial/ethnic comparison

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of African American, Hispanic, and White fathers. Youth & Society, 31, 76–99. Washington, T. (2011). An exploration of promotive factors and competence in African American children in informal kinship care. Dissertation Abstracts International Section A, 71. Retrieved from EBSCOhost. Yeung, W., Duncan, G., & Hill, M. (2000). Putting fathers back in the picture: Parental activities and children’s adult outcomes. In H. Peters, G. Peterson, S. Steinmetz, & R. Day (eds.), Fatherhood: Research, interventions and policies (pp. 97–113). New York: Hayworth.

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Immigrant Children, Youth, and Families REBECCA

Rebecca was fourteen years old when she was sent from Jamaica to live with her mother’s sister in Brooklyn, New York. Within three months of her arrival, her aunt’s live-in boyfriend began to sexually abuse her. When her aunt discovered what was going on, the fight between her and her boyfriend brought the police and child welfare authorities. Rebecca was placed in a group home where she stayed until she was discharged at the age of eighteen years. During her four years in the care of the state, she received an array of services, including independent living skills training. It was only after she left care that Rebecca discovered she was an undocumented immigrant and could not legally study, live, or work in the United States. Rebecca lost the only opportunity she had to legally change her immigration status because the foster care agency failed to make an application on her behalf while she was in their care.

Cases like Rebecca’s are not uncommon, as new immigrants, especially children and youth, continue to change the demographic face of the U.S. However, as illustrated by Rebecca’s case, mainstream institutions, such as child welfare systems, have been slow to recognize, respond to, and appropriately address the special needs of immigrant children and youth who come into their care. Child welfare workers do not routinely assess clients for immigration-related needs; nor do they make referrals for immigration legal services. The primary reason for this oversight is that although a great deal of

attention is often given to laws and systems governing the entrance of new immigrants into the United States, there is little coordination between federal and state policies for addressing the human service needs of these newcomers once they are here. The result is an ad hoc patchwork approach to federal, state, and local services that often lets new immigrants, especially children and youth, fall between the cracks. In this chapter we focus specifically on how immigration status affects permanency planning for adolescent youth in out-of-home care. The different types of immigration status of immigrant children and youth in care, early identification and assessment of immigration status, and guidelines for effective intervention are highlighted. We also describe examples of collaborative programs between public child welfare systems and community-based immigration services providers that enhance the capacity of agencies and their practitioners to meet the permanency planning needs of this population. The range of special needs presented by immigrant children and youth who come to the attention of the public child welfare system is broad and can include issues related to language and culture (Suleiman 2003), special health problems (Guendelman, Schauffler, & Pearl 2001), and educational needs (QinHilliard 2002), as well as psychosocial and mental health problems that result from migration and subsequent adjustments (James 1997). Immigration status affects the ability of all immigrants to access certain public services 710

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and benefits; however, immigrant children and youth are often eligible for specific services apart from their parents or other adult members of a household. Ignorance on the part of both service providers and immigrant families often results in many immigrant children and youth failing to receive services that are available to meet their special needs. New immigrants and their children are a fact of American life. From 1990 to 2000 more immigrants came to live in the United States than in any other historical time frame (Fix & Passel 2001). In 1970 the foreign-born population represented less than 5 percent of the total population. Current data indicate that 31 million residents in the United States are foreign born, representing roughly 11 percent of the total population. Of these, 60 percent are either legal permanent residents or naturalized citizens; refugees and asylum seekers make up another 7 percent. However, an estimated 28 percent are undocumented immigrants (U.S. Census Bureau 2001). Further complicating this demographic picture is that noncitizen households are far more likely to contain children (55 percent as against 35 percent) and that 85 percent of immigrant families with children are so-called mixed-status families—a situation in which members of the same family may include various combinations of citizens and noncitizens (e.g., undocumented parents, citizen children, undocumented siblings; Fix & Zimmerman 1999). These families present distinct challenges for child welfare service providers in the face of recent federal legislation that has sought to substantially restrict the legal and social rights of immigrants (Baum & Goldstein 2002). Immigrant policy, as distinct from immigration policy, is generally construed as the laws, regulations, and programs that affect immigrants’ access to health and human services, including preventive and primary health care, housing, job placement, counseling, and other social services programs (Siegel & Kappaz 2002; ICE 2013). Since 1996 only a categorical

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group of “qualified” immigrants has been entitled to receive assistance from federal benefits programs. With the passage of the Personal Responsibility and Work Opportunity Act, all new legal immigrants were barred for a period of five years from accessing federal meanstested benefits, including Temporary Assistance to Needy Families, Medicaid, and the Child Health Insurance program, while states were given the option of defining how far they wished to pursue these categorical distinctions for immigrants to access state aid programs. Immigrants generally not qualified for benefits include the undocumented, but also many others legally present in the United States, such as applicants for family unity or other adjustment of status categories, asylum seekers, students, visitors, and temporary workers (Siegel & Kappaz 2002). The unintended consequence of this policy has been an overall “chilling” effect that has kept many immigrant families from accessing services to which they are legally entitled, including health care for their children and food stamp programs (Fix & Zimmerman 1999). According to some studies, as a result immigrant families and their children are disproportionately poor and lack adequate health care, food, and shelter (Capps et al. 2002). Little is known about how or why immigrant children and youth come to the attention of the child welfare system or, for that matter, even the numbers of children and youth so involved (Dettlaff 2010). Anecdotal evidence, limited studies, and reports from observers suggest, however, that their numbers are increasing, especially in the long-term foster care population (Earner 2007; Lutheran Immigration and Refugee Services Rajendran & Chemtob 2010 and United States Conference of Catholic Bishops 2003). In the absence of specific data, it can be assumed that the issues that bring immigrant children and youth into contact with the child welfare system are often the same as those for their American counterparts: a combination of the normative changes that occur during childhood and adolescence and exceptional family

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and environmental stressors (Loppnow 1985). However, in the case of immigrant children and youth, the stressors may be exacerbated by experiences unique to this population that may also place them in situations where the risk for abuse and neglect is high. For example, some immigrant children and youth residing in the United States have been sent to this country by their families and are living with extended family members (Baum & Goldstein 2002; Haines 2001). In other cases, immigrant children and youth may experience being left behind in their native country with grandparents or other relatives while their parents travel to the United States to find employment. They may then be reunified many years later with parents they hardly know and find themselves in a situation of having to adjust not only to their parents and a new country, but perhaps to a new family as well, with siblings or step-siblings that are U.S. born (Kandel & Kao 2001). For immigrant children and youth who migrated with their parents, the migration experience itself, especially if it included illegal border crossings, may have been traumatic. Psychological suffering can continue and profoundly affect adjustment to the reality of life in a new country; in addition, undocumented immigrants must cope with the constant fear of being found out (James 1997). Other unique issues that place immigrant children and youth at risk may be cultural dissonance between immigrant parents and their American-raised children (Ojito 1997); disciplinary practices on the part of parents that differ from accepted standards in this country (Gopaul-McNichol 1999); language barriers (Carliner 2000); untreated mental health problems in families, including substance or alcohol abuse (Vega, Kolody, & Aguilar-Gaxiola 2001); and individual difficulties with assimilation and acculturation (Beiser et al. 2002; Rumbaut 1996). Much less is known about a growing number of disturbing cases involving immigrant children and youth who may be victims of trafficking, either with or without their families’ knowledge and complicity (Franken 2002).

Another small but growing phenomenon is that of unaccompanied minors, some of whom may be refugees, although others are often picked up by immigration officials at ports of entry with no official status (Solomon 2002). Refugee children and youth represent a very small portion of the known international population of children and adolescents identified as migrating across international borders to flee conflict, persecution, and conditions of deprivation (Bates et al. 2005; Bhabha et al. 2007; Bhabha & Schmidt 2008). In the United States most refugee children arrive with their families; a very small number are provided specialized services as an “unaccompanied refugee minor.” Largely invisible are vulnerable children and adolescents who also migrate internationally, often alone, to flee similar situations of threat (Haddal 2008a, 2008b). Their experiences stand in stark contrast as they receive little, if any, assistance or protection and may in fact be more likely to become targets of trafficking (Earner & Detlaff 2008; Earner & Smolenski 2007; Fong & Cardoso 2009; Thompson 2008). International and national policies intended to extend protections to victims of international human trafficking and to stem international smuggling conflate the reasons and means individuals may utilize to flee intolerable conditions creating greater invisibility (UNICEF 2010a, 2010b). This invisibility, especially for children and adolescents, exacerbates their risk for exploitation. A child welfare framework that focuses attention on identification and assessment of the best interests of the child may provide strategies for improving outcomes for these most vulnerable children and adolescents. Once immigrant children and youth are involved with the child welfare system, they and their families face a unique set of obstacles that may keep them in care longer and affect permanency planning outcomes. In some cases immigrant parents are unable to meet the service plan requirements for family reunification because they are ineligible, based on their immigration status, for certain federal or

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state-funded services (e.g., alcohol or substance abuse counseling, mental health services; Baum & Goldstein 2002). In other cases parents may be unfamiliar with or afraid to engage with child welfare authorities and do not understand, either because of language or cultural barriers, the consequences of their failure to comply with service plan requirements (Earner 2007). Child welfare workers may also hesitate to place immigrant children and youth in kinship care with undocumented relatives, even though the mandates of the Adoption and Safe Families Act of 1997 (P.L. 105-89) can result in permanent separation from family and kin for these children and youth in care (Wexler 2002). Finally, because of widespread unfamiliarity with immigration laws and a lack of legal resources, foster care service providers may altogether fail to address immigration status irregularities of children and youth in their care. In the case of Rebecca, adjustment of immigration status could have been facilitated through a Special Immigrant Juvenile Status application to the U.S. Citizenship and Immigration Services. Under the Immigration Act of 1990 (P.L. 101-649), immigrant children and youth in long-term foster care can become permanent residents and obtain legal resident status (a “green card”), which allows them to fully participate in society once they leave outof-home care. Definitions and Implications of Immigration Status on Service Needs and Permanency Planning A critical first step for child welfare workers in beginning to address the special needs of immigrant children and youth is learning to recognize the impact that immigration status has on an individual’s ability to function in society and to address this issue appropriately in developing service plan needs. Although most immigrant children and youth in care will receive all necessary services regardless of their status, it is important to stress that once a child leaves care the ability to achieve independent living

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can be severely curtailed by immigration status problems. Undocumented persons cannot obtain a social security card, live permanently in the United States, obtain legal employment, travel freely, receive financial aid for college, or access most forms of public benefits. Permanency planning for immigrant children and youth in foster care must therefore address their specialized need for immigration-related legal services. Immigration law is both complex and subject to change. Therefore, it is unreasonable to expect that child welfare workers will become sufficiently proficient to be able to give expert advice to children and youth in their care. However, through regular training, workers can achieve a general knowledge and familiarity with common immigration statuses and develop the ability both to assess immigration status, especially for youth in foster care, and to refer children to specialized immigration and legal resources when appropriate. Important to the issue of assessing immigration status are agency guidelines for workers to ensure that this information is protected by confidentiality protocols; many immigrants are reluctant to interact with government officials or employees for fear they will be reported. Providing both verbal and written assurances that information about immigration status is sought strictly for the purposes of identifying programs for which a family or child may be eligible would help alleviate this fear. Unfortunately, few state or local child welfare agencies have developed such handbooks or implemented guidelines for child welfare workers on these issues. Identifying the immigration status of children, especially adolescents, in foster care is necessary and should be a routine part of concurrent planning protocols. Even if children or youth are reunified with their families, those with immigration status irregularities can and should be referred to immigration-related legal services or community-based immigration advocacy organizations that are qualified to provide expert advice. Furthermore, even if

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a child is a U.S. citizen, but the worker recognizes that the family includes new immigrants, the family may benefit from such a referral. For adolescents in care there is a limited window of opportunity to file for immigration status adjustments. The sooner the process is initiated, the more likely it will be successful. Assumptions about immigration status should not be made based on a family or child’s ability or lack of ability to speak English or on the family’s ethnic background or country of origin. Documents that identify immigration status may become lost over the years, but the statuses do not expire. So, for example, although a green card, officially known as an Alien Registration Card, may be lost, or the card itself may have expired, the individual continues to be a lawful permanent resident. Child welfare caseworkers can assist individuals with the replacement of documents through the U.S. Citizen and Immigration Services (USCIS) or refer individuals to qualified immigration advocacy organizations for assistance (New York City Administration for Children’s Services 2004). The following is a brief overview of common immigration statuses that child welfare workers may encounter with children and youth in care as well as a description of how these statuses impact services. Legal permanent residents are immigrants who have been granted permission to live and work in the United States permanently; they possess a green card and have a social security number. They are still citizens of their country of origin, but can exercise most of the rights of American citizenship. One difference is that they can be deported or denied permission to reenter the country if they are convicted of certain felony crimes or other special circumstances. Under current legislation, they may be considered “qualified aliens” and be eligible for federally funded government benefits after they have had a green card for five years. This status has no implications for permanency planning. Refugees/asylees are individuals who flee their country to avoid persecution and may be

granted refugee or asylee status. The difference between a refugee and an asylee is that refugee status is conferred upon individuals while they are still outside of the United States; an asylee is an individual who is granted status after he has arrived. The Office of Refugee Resettlement, a division of the U.S. Department of Health and Human Services, is responsible for resettlement of refugees, including unaccompanied refugee minors who receive foster care and other services and benefits. Presently the Office of Refugee Resettlement contracts with voluntary agencies, primarily Lutheran Immigration and Refugee Services and the United States Conference of Catholic Bishops, to assist in locating foster care placements for refugee and asylee minors (Office of Refugee Resettlement 2002). Because of their status and the special circumstances surrounding their entrance to the United States, these individuals are entitled to certain services not otherwise available to other immigrants in foster care. They can be identified by a green card, a stamp in their passport, or a letter from the USCIS. The Office of Refugee Resettlement should be notified if individuals with this type of status are identified (New York City Administration for Children’s Services 2004). Under a collection of federal laws known generally as the Violence Against Women Act of 1994, battered immigrant spouses and/or their children can obtain legal immigrant status without the abuser’s knowledge or permission. To be eligible, the batterer must either be a legal permanent resident or a U.S. citizen. If professionals believe that a child or parent might qualify, a referral should be made for domestic violence-related legal services immediately. Each state has an Office on Violence Against Women and further information can be accessed from the National Domestic Violence Hotline (1–800–799-SAFE; U.S. Department of Justice 2003). Currently U.S. law recognizes as “trafficked persons” those individuals who can prove that they were brought across international borders

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for the purpose of forced labor or prostitution. The Victims of Trafficking and Violence Prevention Act of 2000 grants these individuals the possibility of obtaining legal permanent status if they met these criteria and agree to cooperate in criminal investigations of their traffickers. Advocates estimate that approximately fifty thousand women and children are brought each year to the United States under these circumstances (Franken 2002). Presently only ad hoc procedures are in place to address the needs of minor children who are identified as victims of trafficking, including placing them in state foster care services rather than in federal immigration detention facilities. The Office of Refugee Resettlement has been designated as the lead organization to address this situation and should be contacted if someone suspects that an individual meets the criteria of a trafficked person (Office of Refugee Resettlement 2003). Undocumented immigrants are individuals who either entered the United States unlawfully or overstayed a visa. Undocumented minors may not know their status because their parents or relatives did not inform them. Undocumented immigrants are eligible for limited services and benefits, such as Child Health Plus, emergency Medicaid, and some state-funded programs. Undocumented immigrants, especially children, may be eligible to apply for lawful immigration status and should be referred to appropriate immigration legal services as soon as possible. Undocumented immigration status has significant implications for permanency planning because of the limits it places on an individual’s ability to live independently once she leaves out-of-home care. The next section discusses immigration law relief available to undocumented minors in long-term foster care placement. Special Immigrant Juvenile Status In 1990 the Special Immigrant Juvenile Status Law (SIJS) was created and incorporated into the Immigration and Nationality Act (P.L.

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104-208). SIJS allows unmarried minors under the jurisdiction of a juvenile court who are under the age of twenty-one and deemed eligible for long-term foster care to apply to USCIS for special immigrant status and subsequently for lawful permanent residency. Certain criteria must be met: 1. the minor must qualify for longterm foster care; 2. the court must rule that family reunification is not an option; 3. the minor must remain in foster care or go on to adoption or guardianship; 4. the court must find that it is not in the best interests of the minor to be returned to their country of origin; and 5. the minor must be in care because of neglect, abuse, or abandonment (Catholic Legal Immigration Network & Immigrant Legal Resource Center 2002). SIJS proceedings are initiated by child welfare workers and consist of a twopart application, one with the juvenile court and the other with the USCIS. It is imperative that potential applicants are identified early because current USCIS regulations stipulate that the minor remain under the jurisdiction of the court until the immigration application is decided. This can take anywhere from six to thirty-six months or longer. Some states end dependency at the age of eighteen, whereas others extend it to age nineteen, especially if the minor must complete high school. Other states extend dependency to the age of twenty-one. Therefore it is critical that workers make judges aware of and advocate for the need to extend dependency as long as the SIJS application is in process. If the minor leaves care, ages out of the system, or turns twenty-one years old, the immigration application becomes moot and, regardless of the circumstances, the minor will lose this opportunity to change her immigration status. Once the SIJS application is approved, the minor can apply for lawful permanent residency. However, he will be required to meet all the requirements that apply to this status. Applicants might be denied permanent residency if they have a record of involvement with drugs or have committed certain felony crimes,

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are HIV positive, have committed visa fraud, or had previously been deported. Minors with these potential problems should be advised to consult an immigration attorney who may be able to resolve their case with special waivers (Catholic Legal Immigration Network & Immigrant Legal Resource Center 2002). Child welfare workers should explain to youth in care the benefits and risks involved prior to making an SIJS application. For some undocumented children and youth, an SIJS application might be the only route to gain lawful permanent resident status in the United States. Not only does this ensure the long-term benefit of guaranteeing an individual’s ability to live and work permanently in the United States, it also accesses a more immediate benefit: once an SIJS application is made the minor can also be granted work authorization until his case is decided. These minor children are also then protected from deportation proceedings. The greatest risk in making the SIJS application is that it alerts the USCIS to the existence of the undocumented minor in the United States. The SIJS application process is not confidential; the USCIS can use this information at a later date to initiate removal proceedings if the application is unsuccessful. Therefore it is crucial that all potential applicants are referred to appropriate and qualified legal advice prior to initiating the application process. It should be noted that, even if she is not likely to win SIJS status, a qualified legal expert may still be able to get the child legal status in some other way (Catholic Legal Immigration Network & Immigrant Legal Resource Center 2002). Finally, immigrant children and youth who apply for change of status through SIJS should also be made aware that they will not be able to use their new lawful immigration status to petition for either their original parents or siblings. A legal permanent resident can usually help her family members change their immigration status. This rule was enacted to ensure that parents who abused, neglected, or abandoned their children would not benefit from their children’s

new legal status (Catholic Legal Immigration Network & Immigrant Legal Resource Center 2002). Collaborative Endeavors Between Public Child Welfare and Immigrant Services Providers Beginning in the mid-1990s, immigrants’ rights advocates and community-based organizations serving immigrant communities began to draw attention to the systemic obstacles immigrant families, children, and youth face in negotiating mainstream social service institutions. A number of national, state, and local studies identified problems that immigrants encounter accessing health care (Hagen et al. 2003), education (Yeh & Inose 2002), legal services (Lee 2000), and mental health and social services (Vergara et al. 2003). Recommendations for change have included a public health model approach with an emphasis on prevention and well-being (i.e., better coordination of services and collaboration between providers, expanding cultural and linguistic competence, and improving outreach to immigrant communities; Cress 2003; Kullgren 2003; Taylor 2004). Advocates for social change have focused on the need to develop an agenda for action concerning immigrant policies, such as promoting social justice through legislative change, community building, and enhancing the capacity of ethnic and community-based organizations that help integrate immigrants to full participation in society (Siegel & Kappaz 2002). Scant attention has been paid to the issues and problems faced by immigrant families, children, and youth who come into contact with this system. This situation has slowly begun to change through local efforts by both immigrant and child welfare advocates (Baum & Goldstein 2002). There are two promising approaches for change. One involves cross-service training between public child welfare agencies, refugeeserving agencies, and refugee community representatives. The other illustrates the role that an advisory committee composed of consumer

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groups can play in shaping services to immigrants in the child welfare system. Bridging Refugee Youth and Children’s Services (www.BRYCS.org) is a joint project of the Lutheran Immigration and Refugee Services and the States Conference of Catholic Bishops/Migration and Refugee Services. Through funding received from the U.S. Department of Health and Human Services, Administration for Children and Families, and the Office of Refugee Resettlement, BRYCS has sought to develop a model mechanism for how public child welfare agencies, refugee services providers, and representatives of refugee communitybased organizations can inform one another about their operating structures, objectives, needs, and resources. The goal is to enhance communication and understanding between these groups and increase the effectiveness of service provision to refugee families and children. In 2000 BRYCS initiated a short-term project, Community Conversations, that consisted of focus group meetings with public child welfare officials and representatives of African refugee groups living in Seattle, Omaha, and Baltimore. These meetings explored such issues as childrearing practices, knowledge about relevant U.S. laws and the child welfare system among refugee families, as well as public child welfare officials’ concerns and questions about refugee communities and family practices. It became apparent from these conversations that there were issues and recommendations frequently raised by these groups that could be applied to all immigrant refugee communities and the child welfare system (Bridging Refugee Youth and Children’s Services 2003). Pilot programs in Atlanta, Cleveland, and St. Louis have resulted in the development of a model of cross-training, whereby an array of service providers who work with immigrant families in a given community are brought together by a lead organization to discuss how to coordinate, collaborate, and share resources to strengthen services to immigrants. The

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lead organization may either be a public child welfare agency or a community-based organization; in either case, it should be an organization with recognition in the community. Because this training is focused on refugees, participants include resettlement organizations, ethnic mutual assistance associations, community-based organizations, mainstream organizations (e.g., schools, health care providers, domestic violence programs, mental health services, substance and alcohol abuse services, adult education), and public child welfare agencies. Ideally, the final outcomes of this task force include the development of a resource manual that describes available services and identifies liaison personnel; the creation of a natural network of services providers who have an incentive to collaborate in meeting the needs of the refugee population may also result from such efforts (Bridging Refugee Youth and Children’s Services 2003). This model can be adjusted to accommodate immigrant populations other than refugees. In New York City, several media stories have documented the experiences of immigrant parents and children who were involved with the city child welfare system (Gonzalez 1999a, b; Hurley 2002). At the same time, several immigrant rights and child welfare advocates released reports attesting to the systemic barriers immigrants have faced that amount to de facto discrimination (Coalition for Asian American Children and Families 2001; Coalition for Hispanic Children and Families 2001). Pressure from immigrants’ rights and child welfare advocates prompted the New York City Administration for Children’s Service to create a special advisory group composed of consumer groups whose task was to address immigrant issues in the child welfare system. In 2003 the Commissioner’s Advisory Board Subcommittee on Immigrant Issues initiated work on developing a collaborative agenda for improving services to immigrant families, children, and youth. The group, composed of representatives of parents’ rights organizations,

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immigrants’ rights groups, child welfare advocates, legal experts, members of faith-based and ethnic-community-based organizations, and members of the public child welfare agency worked together to develop a handbook and training curriculum. The handbook, one of the few that exist in any local or state public child welfare system, identifies different types of immigration statuses child welfare workers may encounter, provides assessment guidelines, and details regulations regarding confidentiality. It also covers issues related to language access, the use of interpreters, and translation services. Training curriculum on immigrant issues specifically in relationship to child welfare services has been developed by the Immigrants and Child Welfare project in collaboration with other community-based groups; the training is now offered regularly to all child welfare workers in New York City (Earner 2007). This training, aside from providing basic information about immigration status and immigrants’ access to public benefits, also addresses the migration experience and how that affects immigrant families and their children. Both the handbook and the training guide include a community resource manual specific to immigrant family needs. YYY

The child welfare system must grow more sensitive to the special needs of immigrant families, children, and youth who get involved in services. Immigrant children and youth may be able to REFERENCES

Bates, L. Baird, D., Johnson, D., Lee, R., Luster, T., & Rehagen, C. (2005). Sudanese refugee youth in foster care: the “lost boys” in America. Child Welfare, 84, 631–48. Baum, J., & Goldstein, B. (2002) Problems facing immigrant families in the child welfare system. Testimony to the New York State Assembly Standing Committee on Children and Families and New York State Assembly Legislative Task Force on New Americans, July 11, 2002. Beiser, M., Hou, F., Hyman, I., & Tousignant, M. (2002). Poverty, family process and the mental health of

legalize their immigration status while in care and should be referred to specialized legal services in a timely manner (Dettlaff 2010). Child welfare workers should be become knowledgeable of the ways in which immigration status affects individuals’ ability to function, especially once they leave care. In addition, workers should obtain knowledge of common immigration statuses and their impact on permanency planning. Agencies can ensure that workers are trained to engage in early identification of immigration status-related needs of children and youth and, when appropriate, are prepared to routinely refer all immigrant families, children, and youth to immigration law legal services and assistance. Handbooks should also be developed that furnish policy and protocol guidelines and information about resources so that caseworkers can provide current information and referrals to immigrant families (Dettlaff & Earner 2012). Confidentiality protocols regarding information about immigration status can alleviate immigrants’ fears about interacting with government officials and employees. Immigrants present numerous challenges to the public child welfare system; however, in partnership with community-based organizations and other service providers who work with this population, it is possible to create a comprehensive continuum of care for these newcomers that addresses immigration-related issues. For immigrant children and youth in care, this is critical to ensure their future ability to live and work as independent adults in American society. immigrant children in Canada. American Journal of Public Health, 92, 220–28. Bhabha, J., Crock, M., Finch, N., & Schmidt, S. (2007). Seeking asylum alone: A comparative study: Unaccompanied and separated and refugee protection in Australia, the UK and the U.S. London: Themis. Bhabha, J., & Schmidt, S. (2008). Seeking asylum alone: Unaccompanied and separated children and refugee protection in the U.S. The Journal of the History of Childhood and Youth, 1, 126–38. Bridging Refugee Youth and Children’s Services (2003). Retrieved June 30, 2004, from www.brycs.org.

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Capps, R., Ku, L., Fix, M. E., Furgiuele, C., Passel, J. S., et al. (2002). How are immigrants faring after welfare reform? Preliminary evidence from Los Angeles and New York City. Final report. Washington, DC: Urban Institute. Carliner, G. (2000). The language ability of U.S. immigrants: Assimilation and cohort effects. International Migration Review, 34, 158–82. Catholic Legal Immigration Network & Immigrant Legal Resource Center (2002). Special immigrant juvenile status for children under juvenile court jurisdiction. June 30, 2004, from athena.ilrc.org. Coalition for Asian American Children and Families (2001). Crossing the divide: Asian American families and the child welfare system. New York: Coalition for Asian American Children and Families. Coalition for Hispanic Children and Families (2001). Building a better future for Latino families. New York: Coalition for Hispanic Children and Families. Cress, C. (2003). Making community-based learning meaningful: Faculty efforts to increase student civic engagement skills. Transformations, 1987–94. Dettlaff, A. J. (ed.) (2010). Child welfare practice with immigrant children and families [Special issue]. Journal of Public Child Welfare, 4(3). Detlaff, A., and Earner, I. (2012). Children of immigrants in the child welfare system: Characteristics, risk and maltreatment. Families in Society, 93(4), 295–313. Earner, I. (2007). Immigrant families and public child welfare: Barriers to services and approaches to change. Child Welfare, 86, 63–91. Earner, I., & Dettlaff, A. (2008). Immigrants and Refugees: The intersection of migration and child welfare. Available online: http://www.f2f.ca.gov/res/pdf/ ImmigrantsAndRefugees.pdf Earner, I., & Smolenski, C. (2007). Human trafficking: A child welfare issue. Presentation April 19 at the 16th National Conference on Child Abuse and Neglect, Portland, OR. Fix, M. E., & Passel, J. (2001). U.S. Immigration at the beginning of the 21st century. Testimony to the Subcommittee on Immigration, Committee on the Judiciary, U.S. House of Representatives, August 2, 2001. Fix, M.  E., & Zimmerman, W. (1999). All under one roof: Mixed-status families in an era of reform. Washington, DC: Urban Institute. Fong, R., & Cardoso, J. (2009). Child human trafficking victims: Challenges for the child welfare system. Journal Evaluation and Program Planning. 33, 311–16. Franken, M. (2002). Rescue and protection of trafficked victims: The experience of the Catholic Church in the United States. Address presented at Conference on 21st Century Slavery, United States Conference of Catholic Bishops, Rome, Italy, May 25–28, 2002. Gopaul-McNichol, S. A. (1999). Ethnocultural perspectives on childrearing practices in the Caribbean. International Social Work, 42, 79–86.

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Gonzalez, D. (1999a). Empty crib, full schedule in court. New York Times, (April 10), p. 23. Gonzalez, D. (1999b). Still unable to proclaim: “This is mine.” New York Times, (May 15), p. 25. Guendelman, S., Schauffler, H. H., & Pearl, M. (2001). Unfriendly shores: How immigrant children fare in the U.S. health system. Health Affairs, 20, 257–66. Haddal, C. (2008a, January 31). Unaccompanied alien children: Policies and issues. Congressional Research Service, Report RL33896. Haddal, C. (2008b, March 14). Unaccompanied refugee minors. Congressional Research Service, Report RL34414. Hagen, J., Rodriguez, N., Capps, R., & Kabiri, N. (2003). The effects of recent welfare and immigration reforms on immigrants’ access to health care. International Migration Review, 37, 444–52. Haines, D. W. (2001). Helping out: Children’s labor in ethnic businesses. International Migration Review, 35, 340–41. Hurley, K. (2002). Card me: Immigrants in foster care may finally get help getting legal. City Limits. Retrieved Month 00, 0000, from www.citylimits. org. Immigration and Customs Enforcement. (2013). Facilitating Parental Interests in the Course of Civil Immigration Enforcement Activities. Washington DC: Author. Retrieved October 27, 2013, from http:// www.ice.gov/doclib/detentionreform/pdf/parental_ interest_directive_signed.pdf. James, D.C. S. (1997). Coping with a new society: The unique psychosocial problems of immigrant youth. The Journal of School Health, 67, 98–113. Kandel, W., & Kao, G. (2001). The impact of temporary labor migration on Mexican children’s educational aspirations and performance, The International Migration Review, 35, 1205–31. Kullgren, J.  T. (2003). Restrictions on undocumented immigrants’ access to health services: The public health implications of welfare reform. American Journal of Public Health, 93, 1630–33. Lee, R. (2000). Are religiously affiliated law schools obsolete in America? The view of an outsider looking in. St. John’s Law Review, 74, 655–66. Loppnow, D.  M. (1985). Adolescents on their own. In J. Laird and A. Hartman (eds.), A handbook of child welfare. New York: Free Press. Lutheran Immigration and Refugee Services and United States Conference of Catholic Bishops (2003). Serving foreign-born foster children: A working paper and resource guide for meeting the special needs of refugee youth and children. Paper presented at the Bridging Refugee Youth and Children’s Services Roundtable, Washington, DC, July 16–19. New York City Administration for Children’s Services (2004). Immigration and language guidelines for child welfare staff. New York: New York City Administration for Children’s Services.

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Y  CONTRIBUTORS

About the Editors Gerald P. Mallon, DSW, is the Julia Lathrop Professor of Child Welfare and executive director of the National Center for Child Welfare Excellence at the Silberman School of Social Work at Hunter College in New York City. For more than thirty-eight years Dr. Mallon has been a child welfare practitioner, advocate, and researcher. He is the author or editor of twentyone books and numerous peer reviewed publications in professional journals. Dr. Mallon also serves as the senior editor of the peer-reviewed journal Child Welfare. Dr. Mallon earned his doctorate in social welfare from the City University of New York at Hunter College, his MSW from Fordham University, and his BSW from Dominican College. He has lectured extensively in the United States and internationally in Australia, Canada, Cuba, Indonesia, Ireland, and the United Kingdom. Correspondence may be sent to 2180 Third Avenue, Suite 702, New York, New York 10035 or via e-mail at gmallon@ hunter.cuny.edu. Peg McCartt Hess, PhD, is a child welfare consultant. Dr. Hess has served on the faculty of five schools of social work, most recently as professor at the University of South Carolina College of Social Work and at the Columbia University School of Social Work, New York City. For forty years, Dr. Hess has been a child welfare practitioner, supervisor, educator, advocate, and researcher. She is the author or editor of eight books and numerous peerreviewed publications in professional journals. Her most recent publications from Columbia University Press are Collaborating with Community-Based Organizations Through Consultation and Technical Assistance (2007), co-edited with Patricia Stone Motes, and Nurturing the 721

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One, Supporting the Many: The Center for Family Life in Sunset Park, Brooklyn (2003), with Brenda McGowan and Michael Botsko. Dr. Hess earned her PhD at the University of Illinois at Urbana-Champaign, School of Social Work and her MA at the University of Chicago, School of Social Service Administration. Correspondence may be sent to her via e-mail at [email protected].

Connections. She can be reached via e-mail at [email protected]. Tracey K. Burke, PhD, is associate professor at the University of Alaska at Anchorage School of Social Work. She can be reached via e-mail at [email protected].

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Lloyd Bullard, MEd, is a child welfare consultant. He can be contacted via e-mail at [email protected].

Amy Ackroyd, MSW, is an evaluation assistant and social worker with the Washington State Division of Children and Family Services.

Tanya M. Coakley, PhD, is associate professor, University of North Carolina at Greensboro Department of Social Work. She can be reached via e-mail at [email protected].

Kara Allen-Eckard, MSW, is a trainer and training coordinator at North Carolina State University Department of Social Work. She can be reached via e-mail at [email protected].

Mary Elizabeth Collins, PhD, is professor, Boston University School of Social Work. She can be reached via e-mail at [email protected].

Melissa F. Becker, MSW, is a research associate at the University of Washington School of Social Work. She can be reached via e-mail at [email protected].

Crystal Collins-Camargo, PhD, is associate professor, Raymond A. Kent School of Social Work, University of Kentucky, Louisville. She can be reached via e-mail at [email protected].

Marianne Berry, PhD, is director, Center on the Family, University of Hawaii at Manoa Honolulu, HI She can be reached via e-mail at [email protected].

Debra Conway is a child welfare consultant specializing in parent partnerships. She can be reached via e-mail at parentpartnerprogram@ yahoo.com.

Nicole Bossard, PhD, is the president of TGC Consultants and a senior consultant at the National Resource Center for Permanency and Family Connections. She can be reached via e-mail at [email protected].

Theresa Costello, MSW, is the director of the National Resource Center for Child Protective Services. She can be reached via e-mail at [email protected].

Charmaine Brittain, PhD, is senior associate Butler Institute for Families, Graduate School of Social Work University of Denver. She can be reached via e-mail at charmaine.britten@ du.edu. Angela Braxton is a consultant at the National Resource Center for Permanency and Family

Terry L. Cross, MSW, is executive director of the National Indian Child Welfare Association in Portland, Oregon. He can be reached via e-mail at [email protected]. Amy C. D’Andrade, PhD, is associate professor at San Jose State University School of Social Work. She can be reached via e-mail at amy. [email protected].

CONTRIBUTORS

Diane DePanfilis, PhD, is professor and director, Ruth H. Young Center for Families and Children at the University of Maryland School of Social Work. She can be reached via e-mail at [email protected]. Nancy Dickinson, PhD, is a clinical professor at the University of Maryland School of Social Work School and the former executive director of the Jordan Institute for Families at the School of Social Work, University of North Carolina, Chapel Hill. She can be reached via e-mail at [email protected]. Martha Morrison Dore, PhD, is research associate in psychiatry, Harvard Medical School, and director of research and evaluation, Cambridge Guidance Center/Riverside Community Care. She can be reached via e-mail at [email protected]. Ilze Earner, PhD, is associate professor at the Silberman School of Social Work at Hunter College in New York City. She can be reached via e-mail at [email protected]. Diane Elze, PhD, is associate professor at the State University of New York at Buffalo. She can be reached via e-mail at [email protected]. Kathleen Coulborn Faller, PhD, is the Marion Elizabeth Blue Professor of Children and Families, University of Michigan School of Social Work. She can be reached via e-mail at [email protected]. Trudy Festinger, DSW, is professor at the Silver School of Social Work at New York University in New York. She can be reached at trudy. [email protected]. Rowena Fong, PhD, is the Ruby Lee Piester Centennial Professor in Services to Children and Families in the School of Social Work at the University of Texas at Austin. She can be reached via e-mail at [email protected].

]

Madelyn Freundlich, MSW, JD, is a child welfare consultant. She can be reached via e-mail at [email protected]. Eileen Gambrill, PhD, is the Hutto Patterson Professor at the University of California at Berkeley School of Social Welfare. She can be reached via e-mail at [email protected]. Katherine Gaughan, MS, is implementation manager of Atlantic Coast Child Welfare Implementation Center. She can be reached via e-mail at [email protected]. Stephanie Gosteli, LCSW is clinical training coordinator at the Village for Families and Children. She can be reached via e-mail at sgosteli@ thevillageforchildren.org. Neil B. Guterman, PhD, is the Moses and Sylvia Firestone Professor and dean at the Chicago School of Social Service Administration. He can be reached via e-mail at nguterman@ uchicago.edu. Michele Hanna, PhD, is associate professor at the University of Denver Graduate School of Social Work. She can be reached via e-mail at [email protected]. Rebecca L. Hegar, PhD, is professor at the University of Texas at Arlington School of Social Work. She can be reached via e-mail at [email protected]. Leslie Doty Hollingsworth, PhD, is associate professor, University of Michigan School of Social Work, Ann Arbor. She can be reached via e-mail at [email protected]. Hui Huang is a doctoral student and research assistant with the Children and Family Research Centre. University of Illinois–Champaign. She can be reached via e-mail at [email protected]. Sigrid James, PhD, is associate professor at Loma Linda University, Department of Social

723

724

[

CONTRIBUTORS

Work and Social Ecology. She can be reached via e-mail at [email protected].

She can be reached via e-mail at mmcnitt@ dom.edu.

Kristin Kelly, JD, is an associate at American Bar Association Center on Children and the Law Legal Center for Foster Care and Education. She can be reached at Kristin.Kelly@ AmericanBar.org.

Ruth G. McRoy, PhD, is the Donahue and DiFelice Endowed Professor at the Boston College Graduate School of Social Work. She can be reached via e-mail at [email protected].

Susan P. Kemp, PhD, is Charles O. Cressey Endowed Associate Professor at the University of Washington School of Social work. She can be reached via e-mail at [email protected]. Jan McCarthy, MSW, is a child welfare and children’s mental health consultant. She can be reached via e-mail at janmccarthy@ comcast.net. Mary McCarthy, PhD, is lecturer and director, Social Work Education Consortium, and assistant dean for school advancement at the University at Albany, School of Social Welfare. She can be reached via e-mail at mccarthy@ albany.edu. Brenda McGowan, DSW, is the James R. Dumpson Professor of Family and Child Welfare at Fordham University School of Social Services. She can be reached via e-mail at brmcgowan@ fordham.edu. Sara McLean, PhD, is research project manager at the Australian Centre for Child Protection. She can be reached via e-mail at Sara.McLean@ unisa.edu.au. Kathleen McNaught, JD, is an associate at American Bar Association Center on Children and the Law Legal Center for Foster Care and Education. She can be reached at Kathleen. [email protected]. Myrna L. McNitt, ACSW, is lecturer at Dominican University Graduate School of Social Work.

Jennifer Miller, MSW, is policy adviser, National Crittenton Foundation, Portland, Oregon. She can be reached via e-mail at [email protected]. Linda Mitchell, MS, is a senior child welfare specialist, the Children’s Bureau, Administration on Children, Youth, and Families, Administration for Children and Families, Department of Health and Human Services, Washington, DC. She can be reached via e-mail at lmitchell@acf. hhs.gov. Sara Munson, MSW, is a research associate at the University at Albany, School of Social Welfare. She can be reached via e-mail at [email protected]. Larry W. Owens, PhD, is assistant professor, Western Kentucky University Department of Social Work, Bowling Green, Kentucky. He can be reached at [email protected]. Bonita Parker, PhD, is the deputy project director for the Child Welfare Review Project at JBS International. She can be reached via e-mail at [email protected]. Eileen Mayers Pasztor, DSW, is professor at the Department of Social Work, California State University, Long Beach. She can be reached via e-mail at [email protected]. Barbara A. Pine, PhD, MSW, is professor at the University of Connecticut School of Social Work. She can be reached via e-mail at Barbara. [email protected].

CONTRIBUTORS

Judy L. Postmus, PhD, is associate professor of social work and director and founder, Center on Violence Against Women and Children at Rutgers University in New Jersey. She can be reached via e-mail at [email protected]. edu. Cathryn C. Potter, PhD, is dean and professor at Rutgers University School of Social Work. She can be reached via e-mail at cpotter@rssw. utgers.edu. Jennifer Renne, JD, is adjunct professor of law; director of the National Resource Center on Legal and Judicial Issues at the American Bar Association’s Center on Children and the Law in Washington, DC. She can be reached via e-mail at [email protected]. Hilda Rivera-Rodríguez, PhD, is assistant professor at the University of Puerto Rico. She can be reached at [email protected]. Joseph P. Ryan is associate professor of University of Michigan. He can be reached via e-mail at [email protected]. Maria Scannapieco, PhD, is professor and director of the Judith Birmingham Center for Child Welfare at the University of Texas at Arlington. She can be reached via e-mail at [email protected]. Aron Shlonsky, PhD, is associate professor and the Factor-Inwentash Chair in Child Welfare at the University of Toronto School of Social Work. He can be reached via e-mail at aron. [email protected]. Carol Smolenski is executive director and cofounder of End Child Prostitution and

]

Trafficking (ECPAT)–USA. She can be reached via e-mail at mailto:[email protected]. Robin Spath, PhD, is associate professor at the University of Connecticut School of Social Work. She can be reached via e-mail at Robin. [email protected]. Karen M. Staller, PhD, JD, is associate professor, University of Michigan School of Social Work at Ann Arbor. She can be reached via e-mail at [email protected]. Janet Stotland, JD, is an associate at the American Bar Association Center on Children and the Law Legal Center for Foster Care and Education. She can be reached at JStotland@ elc-pa.org. Mark F. Testa, PhD, is the Sandra Reeves Spears and John B. Turner Distinguished Professor, University of North Carolina School of Social Work. He can be reached via e-mail at [email protected]. Miranda Lynch Thomas, MS, is the Child and Family Services Review team leader at the Children’s Bureau, U.S. Department of Health and Human Services. She can be reached via e-mail at [email protected]. Marvin Ventrell, JD, is director of Community and Alumni Relationship Harmony Foundation. He can be reached via e-mail at [email protected]. Maria Woolverton, MSW, is senior social science research analyst and coordinator for child welfare research, Office of Planning, Research and Evaluation, Administration for Children and Families. She can be reached via e-mail at [email protected].

725

Y  INDEX

AACWA, see Adoption Assistance and Child Welfare Act ABA, see American Bar Association Abbott, Grace, 19 Abuse and neglect, 121, 207–35, 290–91, 712; assessment of, 242–43, 248, 431; attachment effects, 6, 123, 129, 207, 213, 220, 493; cultural influences, 211–12; deaths caused by, 53, 54, 119, 140, 207, 208; definitions of, 33, 207, 239–40, 288–89; developmental consequences, 207–8; domestic violence association with, 210–11, 217, 312, 319–21; emotional (psychological) abuse, 95, 120, 161, 163, 166, 169, 186, 239, 240; engagement and retention in services for, 224–25; etiology of, 209–12, 226; family preservation and, 274–75; by fathers and male partners, 210, 217–18, 288–89; federal law on, 238–39, 616; Harm Standard definition of, 275; historical responses to, 16–18; incidence of, 1, 208–9, 240–47, 480, 616–17; juvenile delinquency link to, 686; legal procedures, 616; mandatory reporting laws, 32, 33, 194, 242, 320, 393, 624; maternal depression and, 215, 217; poverty as risk factor, 210, 211, 275, 482–83, 682; prevention of, 33–34, 202–3, 212–23; protective factors relevant to prevention of, 56; recurrence of, 280; reported, 1, 32, 33, 37; risk assessment, 203, 224–26, 253–55, 261–62; risk factors for, 48, 54–56, 209–12, 217–18, 224; runaway and homeless youth experiences with, 186–87; safe haven laws, 221–22; social support and self-help interventions, 219–20; substance abuse association with, 56, 209, 218–19, 305, 682; targeting and screening, 224–26, 240–41; TPR and, 428; as well-being threat, to children, 207–8, 245–46; see also Child protection; Safety

Abusive Head Trauma (AHT), 222 ACE, see Adverse childhood experiences ACF, see Administration for Children and Families Achenbach, Thomas M., 120, 126; CBCL of, 387–88, 500, 505, 591–92 ACS, see Administration for Children’s Services Actuarial decision-making models, 254–56 ADC, see Aid to Dependent Children Addams, Jane, 16, 20, 625 Add Health; see National Longitudinal Study of Adolescent Health Addiction, see Substance abuse Addiction Severity Index (ASI), 301 ADHD, see Attention-deficit/ hyperactivity disorder Adjudication, 620 Administration for Children and Families (ACF), 22, 158–59; see also Child and Family Service Reviews; Child and Family Services Plans; Children’s Bureau Administration for Children’s Services (ACS), New York City, 321, 434, 534, 718 Administrative staff, 545, 564, 627 Adolescents, 407; father’s involvement influence on, 696; in group homes, 468; health care for, 94–114; parenthood of, 483–84; permanency planning for older, 456–57; placement instability and, 593; substance abuse of, 124, 130, 475, 499, 505, 508; youth development, 468; see also Delinquent youth; Emancipation; Foster care, youths aging out of; Independent living programs; Lesbian, gay, bisexual, transgender, and questioning youth; Runaway and homeless youth Adolescents, in foster care: ASFA on needs of, 458; lifetime 727

728

[

INDEX

connections for, 456, 457, 462; permanency needs of, 456–57 Adoptees: during adolescence, 407; adoption disruptions characteristics of, 445–46, 449; African American, 25; attachment histories, 446; birth mothers’ reconnections, 417–20; children of unmarried mothers, 26, 28; children with disabilities, 32, 116, 341; gender of, 403; infants, 406; medical histories of, 406; older children, 409; racial or ethnic identities of, 411; self-concepts of, 407; siblings, 415–16, 443, 518 Adoption and Foster Care Analysis and Reporting System (AFCARS), 370n1, 567; on adoption, 401, 410; on children and youth in foster care, 339–40, 458, 543, 680; on children and youth who exit foster care, 543; on children of color in foster care, 564; on kinship foster care, 385; on Latino children in foster care, 87; on residential care, 502; on single-parent adoption, 410; on TPR, 427 Adoption and Safe Families Act (ASFA) (1997), x, xi, 7, 245, 306, 336; on adolescent needs in foster care, 458; Adoption Incentive program of, 437; adoption increases from, 489; on concurrent planning, 341; on decision making, xii, 39, 359, 431, 560; family preservation and, xi, 53, 276; on fathers, 698, 703; on foster parents, 486, 602; goals of, 39; ICWA and, 376; on juvenile and family courts, 564; key components of, 341–42; on kinship adoption, 414; on kinship foster care, 385, 396, 713; on LTFC, 459–60; mandates of, 604; older youth in care, 456, 457; passage of, 1, 336; on permanency, x, 458, 459, 460, 489, 543, 621, 663; on reasonable efforts time lines, 341, 431, 550, 621; on safety, x, 46, 53, 202, 236, 276, 663; on TPR, 571; well-being goal of, x, 46–47, 97, 105–6 Adoption Assistance and Child Welfare Act (AACWA) (1980), ix, x, 39, 336, 340, 341; on adoption disruptions, 441;

family preservation and, 53, 54, 270, 276, 358, 430, 662; federal adoption subsidies, 360; on guardianship, 356, 358; impact of, 36; on LTFC, 459–60, 489; older youth in care and, 456; on permanency planning, 437, 662; provisions, 36–37; on reasonable efforts for preservation and reunification, 54, 358, 662; on visits for reunification, 532 Adoption disruptions, 437–54; adoptees characteristics, 445–46, 449; adoptive parents characteristics associated with, 444–45; circumstances of, 448; composition of home and, 445; concerns about, 438; consequences of, 450–51; correlates of, 442, 448–49; definition of, 437; of kinship adoptions, 441; motivation and placement risk for, 446–47; practice implications, 449–50; predictors of, 442–49; rates of, 438–42, 544; research on, 544; risk factors, 409, 445; service characteristics, 447–48; of special needs adoptions, 438–40, 442–43; warning signals, 446–47 Adoption Healing, 430 Adoption home studies, 27, 405, 413, 416, 420 Adoption Incentive program, of ASFA, 437 Adoption Opportunities grants, 552 Adoption Preservation and Linkages (APAL) program, Illinois, 368 Adoptions, xiii, 5–7, 26, 697; of African Americans, 360, 442, 684, 685; attachment and, 415, 420, 444, 448; birth mothers effects from, 424; case example, 401–2, 403, 405, 408, 414–15, 416; clinical core issues of, 407–8; closed, 406, 424; customary, xiii, 360, 378, 379–80, 460; dissolutions, 409, 544; fathers’ relinquishment of children for, 697; by foster parents, 563; future of, 421; gender considerations, 403; guardianship as alternative to, 355, 357–58, 368; history of, 403–4; home study assessments, 27, 405, 413, 416, 420; of immigrants, children and youth, 603; incentives for states, 437; informal, 23; international,

402–5, 415; language in, 405–6; laws, 23, 404–5; by LGBT persons, 169, 172; number of, 437; openness, 407, 424, 434, 450; as permanency goal, 537; practice issues, 406–8; promotion of, 35, 39; search and reunion issues, 417–20; sibling, 415–16, 443, 518; single-parent, 403, 410, 414, 444; stability of, 367–68; standards, 8, 27; by stepparents, 402; subsidies, federal funding for, 36, 53, 356, 358, 360, 361, 404; tools for working in, 416–21; transracial, 27, 410–12; see also Adoptive parents; Kinship adoption; Native Americans, adoptions; Special needs adoptions Adoptive parents: characteristics associated with disruptions, 444–45; ethnic and racial diversity of, 38; LGBT persons as, 412–14; licensing of, 8–9; organizations, 32; single, 403, 410, 414, 444 AdoptUsKids, 172 Adverse childhood experiences (ACE), 208 Advisory Board on Child Abuse and Neglect, U.S., 214–15 “The Aetiology of Hysteria” (Freud), 290 AFCARS, see Adoption and Foster Care Analysis and Reporting System AFDC, see Aid to Families of Dependent Children AFDC-Foster Care (1961), 30, 356, 366 African Americans, 30, 427; adoptees, 25; adoption disruptions, 442; adoption of, 360, 684, 685; child welfare system treatment of, 25, 607, 680–84; disproportionality in foster care system, 28, 41, 54, 185, 383, 463, 511, 680, 682; family reunification and, 685; family support services and, 55; fathers, 697, 699; in foster placement, 383, 467, 680–83; history of services for, 25, 26; incarcerated parents and, 682; informal adoptions, 360; juvenile justice system disproportionality of, 680, 686; kinship care of, 14, 593, 685; length of foster care, 684, 689; orphanage exclusion of, 14; permanency, 490; poverty

INDEX

among, 681–82; reentry to foster care rates of, 545, 685; substance abuse of, 302 Age: foster care outcomes and, 685; placement instability and, 593 Agency-based research, 665–66 AHT, see Abusive Head Trauma Aid to Dependent Children (ADC), 683 Aid to Families of Dependent Children (AFDC), 685; costs of, 30–31; economic support from, 53; funding cuts, 37; history of, 26, 30–31 Alaska Natives: adoptions, 373–81; children in foster care, 339; kinship adoption of, 375, 377 Alcohol, see Substance abuse; Substance use Alcohol and Drug Abuse (AODA) Waiver Demonstration, Illinois, 303, 306 Alliance for Racial Equality in Child Welfare, 690 Almshouses, 12, 13, 14, 15, 18, 501 American Academy of Child and Adolescent Psychiatry, 127 American Academy of Pediatrics, 146; on children and youth in foster care, 95; health care standards, 100; on health care standards for out-of-home care, 98; on medical home approach, 105 American Association for Organizing Family Social Work, see Family Service Association of America American Association for the Protection of Children (1985– 1989), 289 American Bar Association (ABA): Model Rules of Professional Conduct, 619; Standards of Practice for Attorneys Representing Parents in Abuse and Neglect Cases, 619; Standards of Practice for Lawyers Representing Child Welfare Agencies, 619; Standards of Practice for Lawyers Who Represent Children in Abuse and Neglect Cases, 619 American Indians, see Native Americans American Medical Association, 127 American Psychiatric Association, 125

American Public Human Services Association (APWA), 236 American Public Welfare Association, 358 Americans with Disabilities Act, 157n6 Animal therapy, 500 Annie E. Casey Foundation, 491, 502, 700; Casey Family Services, 161, 457, 520, 627, 629; communitybased child welfare services of, 60; F2F (Family to Family) program, 41, 54, 60, 61, 325; on family support services, 54 Another planned permanent living arrangement (APPLA), xiii; advocate or guardian, 464; case example for, 455–56, 461; community-based programs, 463; definition of, 457; evaluations of, 460–64; group care placements, 463; identification in ASFA, 456, 457; mentoring, 462–63; misuse of, 457; overuse of, 456; as permanency goal, 5, 459–60, 489; process, 464–65; reasonable efforts in, 460, 461, 462; reasons for, 457, 461; respite care and, 461; temporary versus permanent, 464 AODA, see Alcohol and Drug Abuse Waiver Demonstration APAL, see Adoption Preservation and Linkages program APPLA, see Another planned permanent living arrangement APWA, see American Public Human Services Association Aristotle P. vs. Johnson, 519 Arizona: African Americans in foster care, 685; Indian Adoption program, 376 ASFA, see Adoption and Safe Families Act ASI, see Addiction Severity Index Asian Americans: child welfare services to, 339, 607, 682, 684; under-representation of children in foster care, 680; see also Racial and ethnic groups Assessments: of abuse and neglect, 242–43, 248, 431; accuracy of, 49; adoption home study, 27, 405, 413, 416, 420; during closure, 5; comprehensive, 57, 64, 109, 259, 348, 560; CPS, 242–43, 248; developmental, 118; domestic

]

violence cases, 203, 316–17, 326–27; engagement in, 47, 70; family, 48, 243, 487; family preservation, 283–84; of father’s involvement, 704–5; of foster parents, 488, 606, 609; goal of, 48; health, 97, 100–102, 108; initial, 2, 193, 241, 242–43, 249, 538; in kinship care, 388–89; of MEB disorders, 117, 119, 125–26; multidimensional, 299–300; ongoing process of, 7, 48, 244, 246; for risk and protective factors, 664; for and during service planning, 4; of sibling relationships, 416, 517, 520–22; of strengths, 8, 48, 133, 246, 606; substance abuse, 300–301, 432; tools, 108, 203, 345, 347–48, 487, 520–21; for TPR, 432–34; see also Risk assessments Association for the Treatment of Sexual Abusers (ATSA), 295 Association on American Indian Affairs, 373 ATSA, see Association for the Treatment of Sexual Abusers Attachment: abuse and neglect effects on, 6, 123, 129, 207, 213, 220, 493; adoption and, 415, 420, 444, 448; to birth parents, 446; children’s health and development and, 46, 95, 468; disorganized/disoriented, 122, 129; family reunification and, 546; by foster parents, 612; improving positive experiences of, 46, 213, 218, 409; in institutional care, 415; kinship care and, 360, 364, 366, 389, 546; MEB disorders and, 121, 181; as protective factor, 56, 123, 191; visits and, 528–29 Attachment theory, 546, 589 Attention-deficit/hyperactivity disorder (ADHD), 96, 116, 127 Attorneys: collaboration with social workers, 619–20; government or agency, 617, 619; instructive authority, 619; of parents, 617, 618–19; role and duties of, 517– 619; state regulatory standards, 619; see also Guardian ad litem Australia: PUP program, 219; Triple P program, 220–21 Basic Centers Programs, 182 Battered child syndrome, 212, 626

729

730

[

INDEX

The Battered Child Syndrome (Kempe), 663 Behavioral disorders, see Mental, emotional, and behavioral disorders Behavioral Services Institute, Tacoma, 37 Behavior Problem index, 388 Bergh, Henry, 17 Big Brother/Big Sister program, 463 Birth mothers: adoption effects, 424; children’s visits with, 527, 535; demographic patterns and, 427; depression of, abuse and neglect and, 215, 217; domestic violence of, 428–29; engagement of, 72, 73–75; fathers and, 688–89, 698–99; incarcerated, 218, 429, 535; informal assistance for, 430; loss of custody effects on, 426; mental health of, 215, 217, 427, 429; openness of adoptions effects on, 434; preplacement services for, 432; program models for, 432; reconnections with children, 417–20; resiliencies and protective factors for, 430; single parent, 26, 28, 682; substance abuse of, 37, 302, 303, 427–29; TPR effects on, 424, 427, 429–30; trauma experiences of, 432 Birth parents, 337; attachment to, 446; contact with children in foster care, 458–59; final visits for, 428, 429, 433; guardianship and, 355, 361; services for, 5; see also Fathers; Parents Bisexual youth, 163, 173 Black Administrators in Child Welfare, 690 Brace, Charles Loring, 14–15 Brain: AHT, 222; development, trauma and, 120–21; neurological consequences from abuse and neglect, 208 Brief strategic family therapy (BSFT), 130–31 Britain: adoption disruptions, 440; family support services in, 53; poverty risk factors in, 54 BSF, see Building Stronger Families program BSFT, see Brief strategic family therapy Building Stronger Families (BSF) program, 273–74

CACs, see Children’s Advocacy Centers California: on adoption disruptions, 438, 440; family risk assessment form, 265, 266; Gay and Lesbian Adolescent Social Services, 169; Homebuilders program, 271; kinship foster care in, 385, 685; on LGBTQ youth, 169; Parent Partner Program of, 60; placement stability rates, 587–88, 588; Prevention Initiative Demonstration Program, Los Angeles, 60; on tribal customary adoptions, 380 California Evidence-Based Clearinghouse for Child Welfare (CEBC), xii Campbell Collaboration database, 263, 673 Canada: on adoption disruptions, 438; family support services in, 53–54 CAPTA, see Child Abuse Prevention and Treatment Act Caregivers, see Kinship caregivers CASA, see Court Appointed Special Advocate Case management, intensive, 134 Case planning, 4, 26, 49–50, 243, 619 Caseworkers, see Child welfare workers Casey Family Services, 161, 457, 520, 627, 689; see also Annie E. Casey Foundation CASSP, see Child and Adolescent Service System Program CBCL, see Child Behavior Checklist CBT, see Cognitive-behavioral therapy CEBC, see California EvidenceBased Clearinghouse for Child Welfare Census Bureau, on child poverty rate, 123 Center for Family Connections, 432 Center for Family Life (CFL), New York City, 60 Center for Health Care Strategies, 102 Center for Medicare and Medicaid (CMS), 135–36 Center for Policy Research, Colorado, 705 Center for the Elimination of Disproportionality and Disparities, Texas, 690 CenterKids, New York City, 563–64

Centers for Disease Control and Prevention, YRBSS of, 160 CFCIP, see Chafee Foster Care Independence Program CFL, see Center for Family Life CFPP, see Community Family Partnership Program CFSMs, see Community family support meetings CFSRs, see Child and Family Service Reviews Chafee Foster Care Independence Program (CFCIP), 362; establishment of, 39–40; ETV program, 40, 153–54, 471; funds, 153, 156; provisions of, 39 Charities Aid Association, New York State, 22, 404 Charity Organization Society movement, 17, 18 Child abuse, see abuse and neglect Child Abuse Prevention and Treatment Act (CAPTA) (2000), 20, 33–35, 36, 97, 240, 291–92, 303, 663 Child abuse prevention programs: engagement and retention in services for, 224–25; federal laws for, 238–39, 616; implementation challenges, 225–26; state laws for, 239; targeting and screening for, 224–26 Child advocacy movement, 32 Child and Adolescent Service System Program (CASSP), 130, 132–33 Child and Adolescent Treatment and Preventive Intervention Research Branch, of NIMH, 127 Child and Family Research Center, 187 Child and Family Service Reviews (CFSRs), x, xi, 245, 562, 581n1; caseworker visits, 575–76; on change implementation, 580; on children’s health needs, 97; on child welfare service outcomes, 491; on concurrent planning, 488; on court improvement plans, 621; data sources, 567; on discretionary grant priorities, 578; on fathers, 570; first round results, 492, 581n3; goals of, 40; influence at federal and state levels, 574–78; -informed technical and training support to states, 577–78; learning environment encouragement, 579; legal

INDEX

mandate, 576; on mental health needs, 119; National Standard, 246; outcomes, 581n4; permanency outcomes, 569, 570, 571–72; on permanency planning, 336; PIPs, 567, 568, 573–74, 575, 580, 581n5, 621, 632, 660, 670; placement instability problem, 587; on postreunification services, 545; practice themes, 570–71; principles, for federal policies and initiatives, 575–77; regionally based implementation centers, 577; results, 568–73; safety measures, 569, 571; scope and limitations, 568, 570; state performance comparison, 579; systemic factors reviewed, 7–8, 568; on TPR, 571; on visits, 527, 528–29, 539; well-being outcomes, 46, 97, 119, 569, 570, 572–73; on youth aging out of foster care, 467 Child and Family Services Improvement Act (2006), 153, 576 Child and Family Services Improvement and Innovation Act (2011), 576 Child and Family Services Plans (CFSPs), 7, 8 Child and family teams, 72 The Child and the State (Abbott), 19 Child Behavior Checklist (CBCL), of Achenbach, 387–88, 500, 505, 591–92 Child development: abuse and neglect consequences for, 120– 21; knowledge of, as protective factor, 56 Child-focused practice, 7 Child guidance movement, 22 Childhelp USA, 500, 507 Childhood, concept of, 12 Child labor, 26, 188 Child Maltreatment annual reports 2001–2010, of HHS, 208 Child protection: family preservation versus, 38, 53; family support services for, 51, 53; as policy goal, 38 Child Protective Services (CPS), 204–5, 213, 236–52, 685; case closure, 244; case planning, 243; case process, 242; child and youth safety, 244–45; differential response, 54, 59, 62, 64, 238, 241–43, 248–49; domestic violence relationship

to, 313, 319–21; effectiveness of, 245–47; family assessment, 243; initial assessment, 242–43; intake process, 242; legal basis, 238; mission, 236; outcomes, 244–45; philosophy, 238; problems in, 247; process stages, 242; progress evaluation, 244; reforms, 247–49; safety assessment, 248; services, 244, 247; sexual abuse and, 291; system problems, 247 Children: of adolescent parents, 483–84; deaths of, 53, 54, 119, 140, 207, 208; depression in, 124, 127, 128; father’s involvement with, 695–96, 701–3; health and development, attachment and, 46, 95, 468; health care for, 94–114; psychopharmacological interventions with, 127–28; public responsibility for, 21; reconnections with birth mothers, 417–20; rights of, 32, 34; special needs, 4, 32, 134–35; state responsibility for, 19; see also Disabilities, children with; Domestic violence, children’s exposure to; Foster care, children in; Immigrants, children and youth Children in need of parents (Maas and Engler), 29 Children’s Advocacy Centers (CACs), 292–93, 295 Children’s Aid Society, 14–15, 24 Children’s Bureau, U.S., 26, 27, 32; CFSR conducting by, 581n1, 660; Child Welfare Information Gateway, 533; child welfare review by, x, xi; creation of, 625; establishment of, 20–22; on guardianship, 357; NCANDS of, 208, 246, 289, 567, 663, 683; NRCPFC of, 171, 337–38, 457, 488; NSCAW II of, 95–96; NSCAW of, 95, 119, 300, 319, 508–9, 517, 586, 626, 663; on promising child welfare services approaches, 431; on QIC knowledge development, 663; recruitment and retention projects, 633; research funding, 29, 661; standards, 29; on supervision improvement, 648; T/TA Network, 633 Children’s Defense Fund, 132 Children’s Global Assessment Scale, 500

]

Children’s Home Society movement, 15 Children’s Research Center, 253 Children’s Rights of New York, 686–87 Children’s Village RTC, in New York state, 505 Child rescue movement, 53 Child safety intervention system, 236–37 Child support, 355, 682, 694, 696, 699, 703, 705 Child Support Enforcement, 699, 704 Child trafficking, 405 Child Trends, Washington, D.C., 706 Child welfare agency, 32; accountability, 660–61; bureaucracy, 631; community responsiveness by, 8; culturally competent practice in, 90; fathers’ involvement and, 702–3; GAO on, 40–41; immigrant service providers’ collaboration with, 716–17; issues with fathers, 689–90, 699, 706–7; legal authority, 561–62; mission and vision, 606; organization and culture of, 631, 637–38; partnership with families, 70; permanency and, 550; policy by, 530; risk assessment responsibilities of, 261–62; school stability and continuity, 149 Child Welfare and Adoption Assistance Act (1980), 1 Child Welfare Implementation Centers, 648 Child Welfare Information Gateway, 533 Child Welfare Institute, Model Approach to Partnerships in Parenting, 604 Child welfare law, development of, 617 Child Welfare League of America (CWLA), 22, 27, 32, 236, 457, 487, 498–99; on abuse and delinquency arrests, 686; on caseload standards, 630; on child welfare system issues, 688; on family-centered practice, 345–46; family visits of foster children, standards for, 532; on foster care growth, 358; Fostering Transitions Project, 171–72; health care standards of, 98, 100; Institute on Child Welfare Research, 662; on kinship care, 361, 601

731

732

[

INDEX

Child welfare legislation, 662–63 Child Welfare Organizing Project (CWOP), New York City, 78 Child welfare policy, research on, 665 Child welfare services: to Asian Americans, 339, 607, 682, 684; Children’s Bureau approaches to promising, 431; outcomes, CFSRs on, 97, 119, 245–46, 467, 491, 527, 562, 567–82, 632, 671–72; outcomes in, 280; for whites, 684; see also Community-based child welfare services Child welfare system: administrative staff, 545, 564, 627; African American treatment by, 25, 607, 680–84; bureaucratization of, 19, 26, 643–44; child protection, 51; Children’s Bureau review of, x, xi; collaboration with other service providers, 1–2, 560–61; coordination with child support system, 696, 703, 704; courtmandated improvement of, 686– 87; culturally competent practice in, 89–90; decision-making in, 254–55; empowerment in, 72, 79, 389, 534; family engagement in, 70; federal role in, 20, 20–21, 25, 27, 29, 31, 34, 39, 112; forces shaping, 21; good practice elements, 7; health care challenges for children and youth, 98; health care needs of children and youth in, 94–96; Hispanic Americans in, 88, 681; imbalance of power in, 71, 75; legal authority, 561–62; legaljudicial model, 617; links across systems for health, 99–100; older children in, 408–10; parental role, 3; professionalization of, 19, 26; responsibilities of, 3; services, 2–7; staff of, 21, 27; state administration of, 626; supervisors, 564; supervisory programs, 636; systemic issues, 7–9, 560–66; tensions in, 10; on youth aging out of foster care, 472–75; see also Research in child welfare Child welfare system, history of, 11–43; from 1940 to 1960, 27–29; in 1960s, 29–33; in 1970s and 1980s, 33–37; in 1990s, 37–40; lessons from, 41; in seventeenth and eighteenth centuries, 12–13;

in nineteenth century, 13–19; social forces and, 33; in twentieth century, 19–40; in twenty-first century, 40–41 Child welfare workers: administrative, 545, 564, 627; adoption disruptions and, 447–48; challenges, 627, 629–31; civil service standards for, 22; cultural competence, 688; current role, 626–27; decision-making by, 6, 245, 486, 637–38; demographics of, 624; developing and retaining, 492– 93; development and support for, 612–13; domestic violence training, 58, 321, 323, 328–30; educational preparation, 630; family engagement by, 70; family support services and, 64; father involvement and, 699–703, 706–7; federal policies for, 631– 34; forensic interview training, 294–95; gender differences in, 644; historical context for, 624–27; impact of, 627; innovations to strengthen, 634– 38; insufficient experienced, 688; job satisfaction, 644; mentoring program, 637; nonminority staff, 688; organizational climate and culture, 631, 637–38; peer support, 636–37; recruitment and retention of, 578, 629–30, 634, 647; research access by, 601; research on, 665; retention, 644; staff turnover, 492, 601, 627, 644; supervisors, 635–36; training, 8, 432, 630; transition planning, postsecondary education support, 156; values, knowledge, skills, 628–29; visits by, 46, 529, 535, 539, 572, 575–76; workloads/ caseloads, 53, 98, 145, 235, 261, 271, 282, 319, 346, 485, 488, 560, 568, 573, 575, 601, 622, 627, 630–31, 646, 665, 687–84 China, adoptees from, 403 CIDI-SF, see Composite International Personal Interview Short Form CIP, see Court Improvement Program Civil Rights Act (1964), 30 Civil rights movement, 31, 33 Civil service regulations, 629–30 Civil service standards, for child welfare workers, 22

Clergy, sexual abuse by, 291 Client empowerment, 2, 61, 82, 279, 706 Clinical decision-making models, 254–55 Clinton, Bill, 356, 358–59, 404, 703 Clinton, Hillary Rodham, 12, 362 Closed adoptions, 406, 424 CMS, see Center for Medicare and Medicaid COA, see Council on Accreditation Cochrane Collaboration database, 263, 265 Coercive family process, 129 Cognitive-behavioral therapy (CBT), 128–29, 271, 284, 409 Cognitive interviewing, 327–28 Collaborative practice, 57; of agencies, in domestic violence, 329; family engagement and, 70 Collaborative research, 666–67 College Cost Reduction and Access Act (2008), 155 Colorado: Center for Policy Research, 705; Non-Resident Fathers Supplemental Grant, 705 Colored Orphan Asylum, New York City, 14 Commissioner’s Advisory Board Subcommittee on Immigrant Issues (2003), 716–17 Commission on Law Enforcement and the Administration of Justice, on juvenile delinquency, 180 Commission on Youth at Risk (2010), 472 Committed survivors (child welfare supervisors, administrators, and workers), 645 Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions, 117, 124 Community-based child welfare services, 60, 688; Center for Family Life (CFL), 60; EBP in, 61; ICM, 134; for immigrants, 713–14; for MEB, 130; plan or model for, 602; for youth aging out of foster care, 475 Community-based group homes, 498 Community Conversations project, of BRYCS, 716

INDEX

Community Family Partnership Program (CFPP), 61–62, 65n2 Community family support meetings (CFSMs), 59, 60–61, 62, 65n2 Community Partners, 7 Community partnerships, 7, 58, 60–61, 64 Community relations: in child welfare agency involvements, 689; in Latino family engagement, 91–92 Community resources, mental health services, 130 Complex blended families, 405–6 Composite International Personal Interview Short Form (CIDI-SF), 300, 302 Comprehensive assessments, 57, 64, 109, 259, 348, 560 Comprehensive Community Mental Health Services for Children and their Families program, 134 Comprehensive health care, 94, 100–111 Concrete supports: in family reunification, 347; family support services, 55–59; in FPS, 272, 274–75, 279, 283; in Homebuilder program, 272; as protective factor, 56 Concurrent planning, xi, 341, 488–89, 547, 713 Conference of Catholic Bishops, U.S., 291, 714, 716 Conference on Research in the Children’s Field, of NASW, 662 Conferences, see Community Family Support Meetings Confidentiality, 194; of health care information, 104; for LTBTQ youth, 165, 167; NASW code on, 393 Congregate care, 491; long-term care in, 507 Congressional Budget Office, on guardianship subsidies, 364 Congressional Research Service, 356, 481 Connecticut: court-mandated systems improvement, 686–87; Department of Children and Families class action suit, 686 Contra Costa County parent mentor program, 77–78, 81 Corporal punishment, 15, 212, 218, 318; Sweden prevention program on, 222–23

Correctional institutions, 28, 32; see also Incarcerated parents Council on Accreditation (COA): on caseload standards, 630; visits standards of, 532 Council on Social Work Education (CSWE), 674–75 Court Appointed Special Advocate (CASA) programs, 155, 595–96 Court Improvement Program (CIP), 577, 579–80 Courts: CASA programs, 155, 595–96; CFSRs on improvement plans for, 621; child sexual abuse testimony in, 292; child welfare system role, 616; civil child protection cases and, 239; drug, 306–7; health care services and, 106; mandated systems improvement, 686–87; TPR by, 427; see also Family courts; Juvenile courts Covenant House, New York City, 180 CPS, see Child Protective Services; Current Population Survey Cramer, Bud, 292 Criminalization, of sexual abuse, 292 Cross-systems services, 57–58, 99–100 CSWE, see Council on Social Work Education Cultural differences: abuse and neglect effect from, 211–12; health care implications from, 108; therapy incorporation of, 134; TPR and, 489 Culturally competent practice, 7, 57; of child welfare workers, 688; components of, 90; Latino Americans and, 89–90 Culture: of child welfare agency, 631, 637–38; family, of Native Americans, 373, 376–79; of Latino Americans, 87–88; safety, in risk assessments, 260–62 Current Population Survey (CPS), 469–70 Custodial fathers, 694, 700 Customary adoption, xiii, 360; as ASFA permanency option, 460; key definitions of, 378; legal basis for, 379–80 CWLA, see Child Welfare League of America CWLA/Lambda Legal National LGBTQ Advisory Network, 171

]

CWOP, see Child Welfare Organizing Project DASA, see Division of Alcoholism and Substance Abuse Data and Evaluation, Quality Assurance Unit, Rhode Island, 666 Data sets, 662–63 David and Lucile Packard Foundation, 603 Deaths: due to abuse and neglect, 53, 54, 119, 140, 207, 208; in residential care, 510; suicide, 168, 189, 429 Decision-making, 2, 29; actuarial/ statistical versus clinical, 254–56; ASFA on, xii, 39, 359, 431, 560; by child welfare workers, 6, 245, 486, 637–38; community-based, 377; definitional dilemmas, 255; environmental characteristics and, 254; Fostering Connections to Success and Increasing Adoptions Act (FCSIA) on, xii, 472; justice system role in, 100, 106, 522; methodological challenges, 255; in risk assessment, 203, 253–55, 262; strategies for, 253–54; time frames for, xii, 237, 337, 560; see also Family group decisionmaking Deficit Reduction Act (2006), 136, 705 Deinstitutionalization, 213, 501–2 Del A. vs. Edwin Edwards, 519 Delinquent youth, 180; abuse and neglect link to, 686; African American, 30; care of, 15–16; delinquency proceeding, 617; MEB disorders and, 118; MST model for, 273; see also Office of Juvenile Justice and Delinquency Prevention Departments of Justice and Health and Human Services, Safe Start Demonstration Project, 325 Depression: of birth mothers, abuse and neglect and, 215, 217; in children, 124, 127, 128 Design Teams (DTs), 637 Detention facilities, 499 Development, psychosocial, 96; see also Child development Developmental disabilities, 132, 498; in placements, 4, 32, 95, 150, 461 Developmental theory, 546, 550

733

734

[

INDEX

Diagnostic and Statistical Manual (DSM), 125 Diagnostic and Statistical Manual V, 124, 125, 300 Differential response (DR) systems, 54, 59, 62, 64, 238, 241–43, 248–49 Disabilities: developmental, 132, 498; learning, 150, 276; symptoms of, 111 Disabilities, children with: abuse and neglect of, 122, 276; of adoptees, 32, 116, 341; case examples, 105, 349–50, 528; education of, 124–25, 147, 151–52, 154; health care for, 105, 110; in placements, 4, 32, 95, 150, 461; in residential care, 498; respite care for parents of, 369; services for, 108, 463; social workers’ relationships with, 409 Disorganized/disoriented attachment, 122, 129 Disposition hearings, 620 Disproportionality of racial groups in foster care system: African Americans, 28, 41, 54, 185, 383, 463, 511, 680, 682; contributing factors, 681–82; efforts to address, 686–90; Hispanic Americans, 565, 680, 682; history of, 683–86; implications for practice, 687–90; lawsuits on, 686–87; Native Americans, 565, 680; outcome disparities, 683–86; research on, 682–83 Disruptions: foster care, 509; of guardianship, 368; of kinship foster care, 544; risk factors for, 409, 445; see also Adoption disruptions Dissolutions, adoption, 409, 544 Division of Alcoholism and Substance Abuse (DASA), 306 Domestic violence, xiii, 204–5, 312–33; abuse and neglect association with, 210–11, 217, 312, 319–21; assessments for, 203, 316–17, 326–27; assumptions about, 317–20; of birth mothers, 428–29; current practices, 322–25; definition of, 312–13; as family reunification obstacle, 316; gender differences in risk, 312–13; homicide, 217; hotline, 714; immigrants and, 329, 714; implications, 328–30;

interventions, 316–17, 327–28; lack of attention to perpetrator, 317; legal responses, 316–17; prevalence, 313–14; protection for immigrants, 329, 714; research on, 28, 318, 319, 328, 329; separation from abuser, 317, 319–20; service providers, 328–30; shelters, 315, 316, 319, 323, 324; substance use and abuse association with, 307–8, 328; training of child welfare workers, 58, 321, 323, 328–30 Domestic violence, children’s exposure to: assessment, 326–27; assumptions about, 317–20; consequences of, 314–16; as form of neglect, 316, 320; interventions, 316–17, 327–28; interviewing approaches, 327–28; mandatory reporting laws, 320; prevalence, 313–14; protective factors, 315–16, 318; responses to, 313–15; risk factors, 315–16, 318, 320 Domestic Violence Enhanced (DOVE) Home Visitation Project, 217 Domestic Violence Liaison (DVL) program, New Jersey, 323–24 Domestic Violence Prevention and Treatment Board, Michigan, 322 Domestic violence shelters, 315, 316, 319, 323, 324 DOVE, see Domestic Violence Enhanced DR, see Differential response Draft Riot of 1863, 14 DRCs, see Short-term/diagnostic care reception centers Drug courts, 306–7 Drugs, testing for, 301; see also Substance abuse; Substance use DSM, see Diagnostic and Statistical Manual DTs, see Design Teams DVL, see Domestic Violence Liaison program Dysregulation, 210 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, 101, 136 Early Head Start (EHS), 214, 215, 216, 217–18, 219 Early intervention services, 213; CAPTA on, 97

EBP, see Evidence-based practice Ecological theory, xi, 546, 547–48 Ecomaps, 420 ED, see Emotionally disturbed disorder Edna McConnell Clark Foundation, 37, 54 Education: of children with disabilities, 124–25, 147, 151–52, 154; IEPs and IEP team meetings, 124, 125, 150–52, 155, 157n8; laws supporting stability for children in foster care, 147–49; needs, permanency and, 145; placement instability and, 590, 681; postsecondary, 147, 152–55, 156 Educational neglect, 275 Education and Training Voucher Program (ETV), Chafee, 40, 153–54, 471 Education of All Handicapped Children Act (1977), 2, 133 EF, see Executive function Effective Intervention in Domestic Violence and Child Maltreatment Cases: Guidelines for Policy and Practice (the Greenbook), 324 EHS, see Early Head Start Electronic case records and online surveys, 672 Emancipation services for youth in foster care, 587; health care coverage after, 39, 103; legal action for, 193; as permanency goal, 457, 458, 460; transition planning before, 40 Emergency removal hearings, 620 Emergency shelter care, 3, 148, 498, 499, 584, 591, 606, 620 Emotional abuse, see Abuse and neglect Emotionally disturbed (ED) disorder, 133 Empathy, 88, 89, 91, 327 Employment: of families served by foster care, 483; of youth aging out of foster care, 470 Empowerment: in child welfare system, 72, 73, 79, 389, 534; client and family, 2, 61, 82, 279, 706; for youth aging out of foster care, 146–47, 154, 156, 475 Engagement, 152–55; abuse and neglect and, 224–25; in assessments, 47, 70; benefits, 73; with birth mothers, 72, 73–75;

INDEX

at case level, 72–73; case study, 80–81; context, 70; definition of, 72; difficulty of, 71–72; dimensions/domains of, 70–71; of families, 57, 70–85, 277, 279, 431–32; with fathers, 72, 706; goals of, 47–48; knowledge and skills needed for, 73; peer support programs for, 72–73, 76–77; resistance to, 73; in service planning, 70, 72; by social workers, 73–75; strategies for, 76, 81 Engagement of Latino families, 86–93; case study, 89; challenges and needs, 88–89; community relations, 91–92; family engagement, 91–92; knowledge base expansion, 92; practice implications, 90–92; sociodemographic overview of, 86–89 Engler, Richard, 29 English Common Law, 15, 357 English Poor Law, 12–13, 384 Environmental context, of postpermanency services, 553–54 EPSDT, see Early and Periodic Screening, Diagnosis, and Treatment Equity Project, 172 Ethical issues and value dilemmas: in client relationships, 104; confidentiality, 104, 165, 167, 194, 393; in family preservation, 284; in family reunification, 349–51; in health care, 108; in kinship foster care, 391–94; for runaway and homeless youth, 179, 193–94 Ethnicity: in foster care, 467–68, 565, 680; placement instability and, 592–93; role in kinship foster care, 392–93; see also Racial and ethnic groups Etiology of emotional and behavioral disorders in children and youth, 119–24 ETV, see Education and Training Voucher Program, Chafee Every Child Matters Education Fund, 208 Evidence-based practice (EBP), xi–xii, 660; on communitybased child welfare services, 61; fatherhood programs, 706; home visiting programs, 213–15; in mental health services, 126, 128– 31; in research in child welfare,

673–74; in residential care, 511; risk assessment and, 263–64, 264; for sexual abuse, 293–96 Executive function (EF) of the brain, 117–18, 121 Extended families preservation, 382, 395–96 F2F, see Family to Family Program Facebook, 195 Families: characteristics of, FPS and, 276–77; child welfare agency partnership with, 70; resilience and protective factors for, 123, 277; as systems change agents, 79 Families First program, Michigan, 323 Families Together program at Providence Children’s Museum (PCM), 536–37 Family Acceptance Project, 159, 168, 170 Family Alternatives, 533–34 Family and Children’s Resource Program, child welfare workers training, 432 Family and Youth Services Bureau (FYSP), 182 Family assessment, 48, 243, 487 Family-bonding model, 422 Family Builders by Adoption, 172 Family-centered practice, xi, 7, 49, 57, 688; CWLA on, 345–46; for service planning, 70, 72 Family-centered residential treatment centers, 506 Familyconnect Guides, 533 FAMILYConnections Reunity House, 537–38 Family courts, 564; GALs, 155, 595, 617–18 Family drug courts, 306–7 Family Educational Rights and Privacy Act (FERPA), 125, 148–49 Family foster care; see Kinship care; Kinship foster care Family group conferencing: key elements to, 389–90; for kinship foster care, 389–90 Family group decision-making (FGDM), 58, 59, 61, 72, 389–90, 688, 703 Family preservation, 270–87, 382; AACWA on, 53, 54, 270, 276, 358, 430, 662; AFSA and, xi, 53, 276; assessments, 283–84; child maltreatment and, 274–75;

]

child protection versus, 38, 53; definition of, 38; ethical issues and value dilemmas, 284; for extended families, 382, 395–96; interventions effectiveness, 278–81; planning process, 38; policy context for, 276; program models Homebuilders, 37, 271–72, 281–82; reasonable efforts requirements, xiii, 36, 37, 39, 54, 202, 245, 270, 271, 358, 431, 519, 531, 551, 662; as service or practice model, 271; sexual abuse and, 274; societal context, 275–76; support services for, 52 Family Preservation and Support Services Program (FPSSP), 37–38 Family preservation services (FPS): ASFA, FCSIA for, xi, 53, 276; assessment and interventions, 283–84; characteristics of families receiving, 276–77; client empowerment, 2, 61, 82, 279, 706; concrete supports in, 272, 274–75, 279, 283; context surrounding, 274–78; demand for, 270–71; effectiveness of, 278–81; family support services distinction from, 203–4; federal funding, 38; modifications and new models of, 272–73; for prevention of out-ofhome placements, 2; research limitations, 281; short-term services, 278, 279, 280, 281, 284; similarities and differences among, 273–74; social network interventions, 272; target population, 60; treatment infidelity, 281–82; for well-being, 280–81; see also Intensive family preservation services Family reunification, x, xii, xiii, 36, 685; AACWA on, 54, 358, 532, 662; as ASFA permanency option, 460; assessment tools, 345, 348; attachment and, 546; case studies, 340–41, 344, 345– 46, 349–52; concrete supports in, 347; definitions of, 340; distinction from reintegration, 340; domestic violence as obstacle to, 316; ethical issues, 349–51; family-centered practice, 345–46; family support services for, 52; family visiting of foster children and, 345, 529, 532, 536–37;

735

736

[

INDEX

Family reunification (continued) future research needs, 348–49; homeless families and, 52; immigrants and, 712–13; incarcerated parents obstacles to, 70, 342; intensive services, 345, 346–47; interventions, 342; multiple attempts, 343; new policy developments, 341–42; obstacles to, 342; as permanency goal, 4–5, 489; placement settings and, 343; postreunification services, 48, 348, 544–45, 549; poverty and, 343; protective factors for, 344, 546; racial disparities in rates, 342; reasonable efforts for, 4, 39, 202, 337, 431, 662; reentry to foster care, 481, 545; social work staff with specialized competencies, 347–48; strengths perspective, 344; in substance abuse cases, 304, 306, 308, 342; time frames for, 351, 426; visits and, 345, 529, 532, 536–37 Family Risk Model, Michigan, 255 Family Service Association of America, 22 Family support services, xii, 1, 47, 55–59, 203–4; child protection services relationship to, 51, 53; constraints and opportunities in, 63–65; funding for, 59, 64; for high-risk families, 63; history of, 53–54; interventions, 56–58; need for, 51–52; outcomes, 62–63; poverty and, 26, 30–31, 55; protective factors, 56; for reunification, 52; social marginality and exclusion, 54–55; vulnerability and protection, 54–56; see also Community family support meetings Family systems theory, 128, 408, 409, 546, 547 Family therapy, 130–32, 137–38, 345, 369, 500 Family to Family Program (F2F), 41, 54, 60, 61, 325 Family violence, see Domestic violence Farming out, 12 FAS, see Fetal alcohol syndrome Fatherhood: legislation, 694, 703–4; men’s conceptualization of, 695–96; programs, 565–66, 703–4, 706; readiness for, 695

Fatherhood Coalition, Texas, 705–6 Fathers, 484, 570, 694–709; African American, 697, 699; approaches to involving, 72, 706; assessments of involvement of, 704–5; birth mothers and, 688– 89, 698–99; case examples, 701, 702; child support payments, 694, 696, 699; child welfare agency issues with, 689–90, 699, 706–7; child welfare workers involvement with, 699–703, 706– 7; custodial, 694, 700; definition of, 694–95; ethnographic study of, 700; incarcerated, 697, 698; interventions for, 705–6; involvement with children, 695–96, 701–3; LGBT, 563–64; locating, 695, 697, 699–700, 703– 4; male partners and, abuse and neglect by, 210, 217–18, 288–89; noncustodial, 694, 700, 704; paternity establishment, 694–95; as permanency resources, 697, 698; personal challenges, 697– 98; putative, 694–95; relatives of, 699, 700; relinquishment of children for adoption, 697; research on, 706; roles of, 694; substance abuse, 218, 698; TPR, 697, 698; visits with, 527, 535, 695; see also Parents Fathers and Families Center, Indiana, 705 Fathers Engagement Project, Washington, 705 FCIA, see Foster Care Independence Act FCSIA, see Fostering Connections to Success and Increasing Adoptions Federal funding: adoption subsidies, 36, 53, 356, 358, 360, 361, 404; FPS, 38; for out-of-home placement, 64; to states, 491 Federal government: abuse and neglect law, 238–39, 616; child welfare role of, 20, 20–21, 25, 27, 29, 31, 34, 39, 112; mental health services mandates, 126–27, 133– 34; see also Children’s Bureau Federal Parent Locator Service (FPLS), 704 Federal policies and initiatives: CFSR principles for, 575–77; for child welfare workers, 631–34; for health care, 96–97; on sexual abuse, 291–93; for TPR, 430–31;

for youth aging out of foster care, 471–72 Federal TRIO programs, 155 FERPA, see Family Educational Rights and Privacy Act Fetal alcohol syndrome (FAS), 375 FGDM, see Family group decision making Final visits, at TPR, 428, 429, 433 Flemming rule, 684 Forensic interviewing, 293–95 Formal kinship care, see Kinship foster care Foster care, 543; accountability issues, 491; ACS on barriers to, 534; challenge of demographic diversity, 611; community-based approach to, 493; definition of, 602; disruptions, 509; dynamics of, 480–82; factors affecting families and children served by, 482–84; future of, 493; health clinics, 103; history of, 14–15, 602–4; increase in, 358; inequities of, 686–87; institutional care comparison to, 18; numbers in, 480; parental incarceration and, 682; placement stability, 481; racial and ethnicity, 467–68, 565, 680; standards, 8, 611; state legislature resource development, 611; therapeutic, 3, 4, 508–9, 612; types of, 3, 4; see also Foster parents; Kinship foster care Foster care, children in: adoption of, 444; birth parents contact for, 458–59; case example of, 481; concurrent planning for, xi, 341, 488–89, 547, 713; health care for, 95, 96; length of stay, 458, 481–82; meeting needs of, 458–59; mental health needs for, 489–91; mental health services for, 118–19; multiple placements for, 166, 443, 481–82, 490, 594; number of, 37, 275, 480; placements, 6, 339; placement settings, 458; reentry of, 481, 545, 597, 685; school completion rate, 469–70, 500, 506; special needs, 4, 32 Foster care, youths aging out of, 467–79; child welfare system on, 472–75; communitybased child welfare services for, 475; employment of, 470; empowerment of, 146–47, 154, 156, 475; FCSIA on, 97, 154,

INDEX

267; federal and state policies for, 471–72; high school and GED completion rates, 469–70; homelessness of, 469, 474; interventions, 476–77; life skills training, 473–74; mentors for, 462–63, 470–71, 475; number of, 467; outcomes, 469–71; poverty of, 470; program challenges, 476; race and ethnicity of, 467–68; resilience factors, 470–71; risk factors, 469–70; social support for, 470–71; societal context for, 468–69; studies of, 469–70; support needed, 468–69; see also Independent living programs Foster care drift, 356, 368, 563 Foster Care Independence Act (FCIA) (1999), 39, 153–54, 457, 471, 474 Fostering Connections to Success and Increasing Adoptions (FCSIA) Act (2008), x, xi, 1, 202, 380, 391, 392; adoption increases from, 489; adoption promotion by, 437; CFSRs and, 40; on collaboration, 105–6; on decision-making, xii, 472; on education stability, 147–48; on foster children aging out of system, 97, 154, 471–72; on guardianship assistance program, 355–56, 384, 489; guardianship subsidies, 544; on health care, 97–98; on homeless youth aging out of foster care, 474; impact of, 7; on kinship adoption, 414; on kinship care, 342, 431, 487, 663–64, 690; on permanency, 336, 543; on reasonable efforts for preservation and reunification, 431, 531, 551; on services for older youth in foster care, 459; on siblings, 519, 577; on visits of children in foster care, 531 Fostering Transitions Project, of CWLA and LLDEF, 171–72 Foster Parent Bill of Rights, 611 Foster parents: adoptions by, 563; aging and changing population of, 603; assessments, 488, 606, 609; attachment to children, 612; diversity of, 603; length of service, 485; licensing, 8–9, 608; maltreatment allegations, 612; organizations, 32, 610; professional, 595; reasons for

leaving, 485; reimbursement rates, 485; relationships with agencies and caseworkers, 485, 486–87; as resource families, 485–86, 604–12; rights of, 486; roles of, 485, 486–87, 601; support services, 485, 603, 610; as team members, 486; training, 595, 609–10 Foster parents, recruitment of, 563– 64, 601–15; collaborating partners for, 607, 610–11; communicating needs for, 607; by experienced foster parents, 609; foster fathers and, 609; history of, 486; inquiries response, 609; language for, 605; obstacles, 485; systemic issues, 485 Fourth National Incidence Study of Child Abuse and Neglect, 483 FPLS, see Federal Parent Locator Service FPS, see Family preservation services FPSSP, see Family Preservation and Support Services Program Freud, Sigmund, 291–92 Friendly visitors, 17 Fund to Parents Act (1911), 24 FYSP, see Family and Youth Services Bureau Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR-UP), 155 GALs, see Guardian ad litem GAO, see General Accounting Office GAP, see Title IV-E Guardianship Assistance Program Gault decision, 617 Gay, Lesbian and Straight Education Network (GLSEN), 163 Gay and Lesbian Adolescent Social Services, California, 169 Gay and Lesbian Advocates and Defenders (GLAD), 158 GEAR-UP, see Gaining Early Awareness and Readiness for Undergraduate Programs Gender differences: in adoption, 403; of child welfare workers/ supervisors, 644; in domestic violence risk, 312–13; placement instability and, 592; in placements, 339; for runaway and homeless youth, 184; for sexual abuse, 290 General Accounting Office (GAO), 187; on child welfare agencies,

]

40–41; on kinship foster care, 387; on substance abuse, 302 Geography of the safety net, 55 Georgia: court-mandated systems improvement, 686–87; supervisor professional development program, 651 Gerry, Elbridge T., 17 GLAD, see Gay and Lesbian Advocates and Defenders Global Initiative to End All Corporal Punishment of Children & Save the Children, Sweden (2010), 222 GLSEN, see Gay, Lesbian and Straight Education Network Goodness of fit, 451 Government Accountability Office, U.S.: on disproportionality, 689; on foster children, 95 Grants to States for Aid to Dependent Children, 26 Great Britain, see Britain Great Depression, 602, 625 Great Recession (2007), 482 Greenbook initiative, 324–25 Green card, see Legal resident status Green Chimneys Children’s Services, 169 Grief, 427–28; openness of adoptions and, 434; placement instability and, 591; Worden’s model of counseling for, 433 Group homes, 3, 499, 502, 509; adolescents in, 468; communitybased, 498; placement instability and, 594; placements in, 339 Guardian ad litem (GALs), 155, 595, 617–18 Guardianship, xiii; AACWA on, 356, 358; as adoption alternative, 355, 368; as ASFA permanency option, 460; candidates for, 360–61; debates on, 366–67; disruptions, 368; history of, 355, 357, 370; increase in, 356; legal basis, 356; natural, 357–58; permanency goal, 489; postguardianship services, 568–69; preferences for adoption over, 357–58; stability of placements, 367–68; subsidies, 355, 358, 360–67, 390–91, 544; TPR and, 358–59, 688–89; unmet needs of, 368–69 Hague Convention on Intercountry Adoption (1993), 404–5

737

738

[

INDEX

A Handbook of Child Welfare: Context, Knowledge and Practice (Laird/Hartman), ix Harm Standard definition, 275 Hartman, Ann, ix, xi Hawaii: abuse and neglect response system in, 431; Healthy Start, 213–14, 217 Health: assessments, 97, 100–102, 108; histories, 95, 101–2, 103; status of children, 94; see also Mental health Health, Education, and Welfare, Department of, 21, 30, 33 Health and Human Services, Department (HHS), U.S., 22, 182, 245, 356; Child Maltreatment annual reports 2001–2010, 208; on disproportionality, 689–90; technical adoption assistance, 39; training and technical assistance network, 577–78; see also Child and Family Service Reviews Health care, 94–114; access to, 95, 102–3; ADHD, 96, 116, 127; CFSRs on, 97; challenges to meeting needs of, 98–99; for children with disabilities, 105, 110; community-based services, 100, 103, 106, 108, 111; comprehensive, 94, 100–111; coordination of, 104–5; coverage, after emancipation, 39, 103; cultural issues, 108; data management, 103–4; developmental problems, 96; ethical issues and value dilemmas, 108; family participation, 102, 106–8; FCSIA for, 97–98; federal policies and initiatives, 96–97; foster care clinics, 103; funding, 109–10; individualized plans, 105; knowledge and skills needed, 111–13; links with other systems, 99–100, 105–6; managed care systems, 99, 110–11; medical homes, 105; monitoring, 108–9; needs, 94–96; parental consent, 110; performance outcomes, 95–96; screening and assessment, 97, 100–2, 108; services for children in foster care, 95, 96; standards and policies for, 96–97, 100, 102; training, 103, 109; youth voice, 106–8 Healthcare passports, 103–4

Health insurance, 97, 136, 223, 472; see also Medicaid Health visitor program, 213 Healthy Families Alaska, 217 Healthy Families America (HFA) initiative, 214, 215, 216, 218, 219 Healthy Start program, 218 Healy, William, 22 HELP at Home: Hawaii Early Learning Profile, 218 HFA, see Healthy Families America Initiative HHS, see Health and Human Services Higher Education Opportunity Act (2010), 155 High-risk families: family support services for, 63; risk assessment of, 264 Hispanic Americans: in child welfare system, 681; culturally competent practice and, 89–90; cultural values and assets, 87–88; culture, language of, 87; demographics of, 86–87; disproportionality in foster care system, 565, 680, 682; family support services and, 55; in foster placement, 467; length of placement, 685; LGBTQ youth, 168; religious practices of, 87; substance abuse of, 302; see also Engagement of Latino families HIV, 188, 189, 194 Hmong, 607 Home-based services, 63 Homebuilders, 37, 281–82; CBT in, 271; value statements, 272 Homelessness: of families, reunification and, 52; for families served by foster care, 483; of youth aging out of foster care, 469, 474 Homeless youth, see Runaway and homeless youth Home visitation services, 212–16, 217–19, 225–26 Home Visiting Evidence of Effectiveness (Hom VEE), xii House of Refuge, New York City, 15 Housing, family support services for, 55 IAA, see Intercountry Adoption Act ICD, see International Classification of Disease ICFC, see Indian Child and Family Consortium

ICM, see Intensive case management ICWA, see Indian Child Welfare Act IDCFC, see Illinois Department of Children and Family Services IDEA, see Individuals with Disabilities Education Act IDEIA, see Individuals with Disabilities Education Improvement Act IEP, see Individualized Education Program IEPs, see Individualized education plans IHDP, see Infant Health and Development Program Illegitimacy, 28 Illinois: AODA Waiver Demonstration, 303, 306; APAL program, 368; IFPS in, 280; on in-home services, 24; juvenile court law in, 16; juvenile justice advocacy in, 627; kinship foster care in, 385; length of placement in, 684–85; subsidized guardianship waiver demonstration, 362–64, 367, 391 Illinois Department of Children and Family Services (IDCFS), 306, 441, 666–67 ILPs, see Independent living programs Immigrants, 22, 87, 710–16; de facto discrimination of, 716; deportation, 716; domestic violence and, 329, 714; eligibility for means-tested benefits, 711, 715; legal and advocacy services for, 710; legal permanent residents, 714, 715–16; legal resident status (green cards), 713, 714; number of, 711; statuses, 710, 713–14; undocumented, 681, 711, 715 Immigrants, children and youth, 13, 566; adoption of, 603; case examples, 710; in child welfare system, 711, 712–13, 716–16; Hispanic American, 88; migration experience, 711, 712; refugees, 711, 712, 714; risk factors for abuse and neglect, 712; services for, 710–11; special immigrant status, 714; special needs of, 710, 713–14; status issues, 710–11; trafficking victims, 712, 714–15; training for working with, 91, 713, 716–17

INDEX

Immigrants and Child Welfare project, 717 Immigration Act (1990), 713 Immigration and Nationality Act, 715 Incarcerated parents, 345; family reunification obstacles, 70, 342; fathers, 697, 698; mothers, 218, 429, 535; placements of children, 279, 408, 603, 682; substance abuse cases, 307; visits, 342, 531 Indenture, 12, 13, 501 Independent living: of immigrants in foster care, 713; after kinship foster care, 387 Independent living programs (ILPs), 5; benefits of, 473; education services, 472; evaluations of, 473, 476; housing support, 474; life skills instruction, 472–73; short-comings, 473–74; youth development, 474–75; see also Chafee Foster Care Independence Program Indian Child and Family Consortium (ICFC), 376 Indian Child Welfare Act (ICWA) (1978), 373–74, 384, 392, 607; ASFA and, 376; tribal governments role, 35 Indians, see Native Americans Individualized education plans (IEPs), 124, 125 Individualized Education Program (IEP) team meetings, 150–52, 155, 157n8 Individualized services, 5, 7, 57 Individualized treatment planning, 28 Individuals with Disabilities Education Act (IDEA), 109, 111, 124, 133–34, 150, 154–55 Individuals with Disabilities Education Improvement Act (IDEIA) (2004), 124–25 Infant Health and Development Program (IHDP), 218 Infants: as adoptees, 406; African American, adoption of, 685 Informal adoptions, 360 In-home services, 2; expansion of, 23–25 Initial assessments, 2, 193, 241, 242–43, 249, 538 Innumeracy, 254 Institute for the Advancement of Social Work Research, 667 Institute on Child Welfare Research, CWLA, 662

Institutions, 18; children raised in, 415; correctional, 28, 32; downsizing of, 132; mental health, 32, 132; placements in, 35; rise of, 13–14 Intensive case management (ICM), 134 Intensive family preservation services (IFPS), 53, 60, 203–4, 270, 662; effectiveness of, 281; Homebuilders model, 37, 271–72, 281–82; substance abuse and, 279 Intensive family reunification services, 345, 346–47 Intensive home-based services, for LGBTQ youth, 170 Intensive residential treatment facilities (RTFs), 498, 499 Interagency Council for Addressing Disproportionality, Texas, 690 Intercountry Adoption Act (IAA) (2000), 404 Intercountry adoptions, 27 International adoptions, 402–5, 415 International Classification of Disease (ICD), 300 Internet, child sexual exploitation on, 288–89 Interracial adoptions, see Transracial adoptions Interventions, 7; animal therapy, 500; BSFT, 130–31; CBT, 128–29, 271, 284, 409; domestic violence, 316–17, 327–28; family preservation effectiveness, 278–81; family reunification, 342; family support services, 56–58; family therapy, 130–32, 137–38, 345, 369, 500; for fathers, 705–6; FPS, 283–84; in kinship foster care, 388–89; for LGBTQ youth, 169–70; MDFT, 130; MST, 130, 273, 281–82; PCIT, 129–30, 137, 305; play therapy, 128, 520; psychopharmacological, with children, 127–28; psychotherapy, 24, 128, 290; self-help, 219–20; social network, 272; TF-CBT, 295; for TPR, 432–34; for youths aging out of foster care, 476–77 Intrafamilial sexual abuse, 288, 291 Involuntary termination of parental rights, 424–25, 428, 432–33 Jesse E. vs. New York City Department of Social Services, 519, 520

]

JJDPA, see Juvenile Justice Delinquency and Prevention Act John H. Chafee Foster Care Independence Program; see Chafee Foster Care Independence Program Johnson, Lyndon B., 30, 180 Juan F. vs. Rell (1989), 686 Judge Baker Clinic, 22 Justice system: decision-making role of, 100, 106, 522; on health care, 100; see also Juvenile justice system Juvenile courts, 26, 29–30; adjudication, 620; adoption, 621; adversarial advocacy system, 617, 619; ASFA on, 564; case planning, 619; development of, 16, 22, 617; disposition hearings, 620; emergency removal hearings, 620; evolution of, 622; judges, 617; permanency hearings, 621; posttermination review, 621; procedures, 620–21; reform efforts, 621; review hearings, 621; SIJS process and, 715; TPR, 621 Juvenile delinquents, see Delinquent youth Juvenile Justice Delinquency and Prevention Act (JJDPA), 181 Juvenile justice system: advocacy, 625; disproportionality of African Americans, 680, 686; LGBTQ youth in, 161 Kadushin model of supervision, 650–51 Keeping Foster and Kinship Parents Trained and Supported (KEEP), 595, 596 Kennedy administration, 30 Kentucky, SBC, 58 Kin-GAP, see Kinship Guardianship Assistance program Kinship adoption, 385, 414; of Alaska Native children, 375, 377; as ASFA permanency option, 460 Kinship caregivers, 3, 37; characteristics of, 487; foster care benefits for, 356; history of, 382–83; informal, 487–88; number of placements with, 382, 685; poverty of, 383; preferences for, 414, 487; racial and ethnic groups, 383; stress of, 488; TANF for, 385

739

740

[

INDEX

Kinship foster care: of African Americans, 14, 593, 685; assessments, 388–89; attachment and, 360, 364, 366, 389, 390, 546; benefits and risks to children in, 387, 487; case examples, 394–95; challenges, 414; commitment, 593; current state of, 385–86; CWLA on, 361, 601; definition of, 383; disruptions, 544; ethical issues and value dilemmas, 391–94; as extended family preservation, 382, 395–96; family group conferencing for, 389–90; family ties importance, 392; FCSIA on, 342, 431, 487, 663–64, 690; financial aid, 37, 38; gift relationship of, 392; growth of, 37, 38, 356, 359–60, 366; healthcare services, 384; history of, 384–85; immigrants and, 713; increase in, 391; independent living after, 387; interventions, 388–89; Medicaid and, 489; mental health problems and, 387–88; number of children in, 385; outcomes, 386–88; permanency planning for children in, 385, 390–91; placement instability and, 593–94; placements in, 339; reentering, 386; reluctance to adopt, 386–87; research on, 382, 388, 391; respite care in, 369; role of race, ethnicity and religion, 392–93; role theory and, 547; screening, 388–89; services for, 414, 487; siblings in, 523; by single-parent family, 382, 383, 393, 508; societal context, 384–86; stability of placements, 414 Kinship Guardianship Assistance Program (Kin-GAP), 356, 364–65 Kinship navigator programs, 544 Laird, Joan, ix, xi Lambda Legal Defense and Education Fund (LLDEF), 158, 171–72 Lassiter case, 618–19 Lathrop, Julia, 16, 21, 625 Latinos, see Engagement of Latino families; Hispanic Americans Law, 551–52; families, children and, 564–65; federal, on abuse and neglect, 238–39, 616; mandatory

reporting, for abuse and neglect, 32, 33, 194, 242, 320, 393, 624; safe haven, for abuse and neglect, 221–22 Lawyers, see Attorneys Leadership Academy for Supervisors, 652 Learned helplessness theory, 210 Learning circles, for professional development, 654–55 Learning disabilities, 150, 276 Legal Aid Society Juvenile Rights Practice, 534 Legal authority, of child welfare agency, 616 Legal-judicial model, 617 Legal resident status (green card), 713 Legal Services for Children, Model Standards Project, 172 Lesbian, gay, bisexual, and transgendered (LGBT) persons: as adoptive parent, 412–14; fathers, 563–64; needs of, 608–9 Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth, xii, 50, 158–78; confidentiality and, 165, 167; demographic patterns of, 159–62; family reactions to comingout, 162; in foster care, 158–59, 160–63; glossary of terms, 173; identities, 159; interventions for, 169–70; juvenile justice system and, 161, 165; legal protections for, 168–69; multiple placements of, 166; peer acceptance or rejection, 158, 163; permanency planning for, 167–68; physical and mental health problems, 163–64; programs serving, 169–72; protective factors, 168; psychosocial strengths and needs, 161–62; research on problems of, 158–60; resilience of, 168; runaway and homeless, 160, 162–64, 168, 184–87; training for practice with, 158, 171–72; victims of violence, 163, 166; vulnerabilities and risk factors, 160, 164–68 LGBT, see Lesbian, gay, bisexual, and transgender persons LGBTQ, see Lesbian, gay, bisexual, transgender, and questioning youth Life books, 420, 450, 520 Life skills, 188, 473–74

Lighthouse Youth Services, 474 Lizbeth Schorr Foundation, 54 LLDEF, see Lambda Legal Defense and Education Fund Longitudinal Studies of Child Abuse and Neglect, 663 Long-term foster care (LTFC), 5, 456, 457, 458, 489; ASFA on, 459–60 LTFC, see Long-term foster care Lutheran Children and Family Services, Philadelphia, 169 Lyman School, 15–16 Maas, Henry S., 29 Maine: abuse and neglect reduction program, 431–32; supervisor training program, 648–50 Maltreatment, see Abuse and neglect Managed care systems, 99, 110–11 Management information systems (MIS), 660, 668 Mandatory reporting of abuse and neglect, 32, 33, 194, 242, 320, 393, 624 Massachusetts: almshouse care in, 18; Committee on Pauper Laws, 13; on domestic violence, 322–23; probation officers for delinquents, 16; Rise Above Foundation, 475; State Board of Charities, 18 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, 219 Maternal and Child Health Bureau, 215 McKinney-Vento Homeless Assistance Education Act, 148 MDFT, see Multidimensional family therapy MEB, see Mental, emotional, and behavioral disorders Medicaid, 36, 490, 696; coverage of youth aging out of foster care, 39, 98–99, 471; eligibility, 101; EPSDT program, 101, 136; immigrants and, 711, 715; kinship care and, 489; MEB disorders and, 135–36; use of, 110; waiver program, 135–36 Men, see Fathers; Gender differences Mental, emotional, and behavioral (MEB) disorders: assessments of, 117, 119, 125–26; attachment and, 121, 181; case studies, 115–16, 137–38, 490; for children in residential care, 490, 504–5;

INDEX

comorbidity with substance abuse, 124, 130, 307–8; delinquent youth and, 180; depression in children, 124, 127, 128; EF and, 117–18; etiology of, 117, 119–24; identification of problems, 118; legal requirements for serving children with, 126–27, 133–34; placement instability and, 590–92; prevalence of, 116, 124–25; protective factors, 123; psychotropic medications for, 127; risk factors, 118, 119, 122–23; screening, 125–26; treatments, 126–31; types, 124–25 Mental health: of birth mothers, 215, 217, 427, 429; institutions, 32; needs of children in foster care, 489–91; placement instability and, 590–92 Mental health services, 115–44; access to, 135–36; animal therapy, 500; BSFT, 130–31; CBT, 128–29, 271, 284, 295, 409; for children in foster care, 118–19; communitybased, 130; continuum of, 132; EBP in, 126, 128–31; evolution of, 131–35; family-based models, 130–31; family therapy, 130–32, 137–38, 345, 369, 500; federal mandates, 126–27, 133–34; funding, 136; ICM, 133; inpatient, 131, 136; MDFT, 130; MST, 130, 273, 281–82; needs, 119, 489–91; outpatient, 131; parent management training, 129; PCIT, 129–30, 137, 305; play therapy, 128, 520; psychopharmacological interventions, 127–28; psychotherapy, 24, 128, 290; in schools, 133–34; schools as entry point, 117; system-of-care principles, 132–33, 134; TF-CBT, 295; wraparound services, 72, 134–35, 137, 595, 607, 688 Mentoring, 56; APPLA, 462–63; child welfare workers program of, 637; of parents, 60, 77–79, 81; of supervisors, 651; supportive service model, 59–60; of youths aging out of foster care, 462–63, 470–71, 475 MEPA, see Multiethnic Placement Act Mexican Americans, see Hispanic Americans Michigan: on adoption disruptions, 438; almshouse care in, 18; on

domestic violence, 323; Families First, 323; Family Risk Model, 255; probation officers for delinquents, 16 Microsystem, 209 Midwest Evaluation of Adult Functioning of Former Foster Youth, 469, 470 MIECHV, see Maternal, Infant, and Early Childhood Home Visiting Miller vs. Yoakum, 37, 359, 369, 384 Minnesota Department of Human Services: African Americans CPS outcomes, 685; on home studies, 404; on visit guidelines, 532 MIS, see Management Information Systems Missing Children’s Assistance Act (2004), 181 Mississippi, court-mandated systems improvement, 686–87 Model Rules of Professional Conduct, ABA, 619 Model Standards Project, 172 Mothers’ pensions, 24 Motivational interviewing, 305–6 MST, see Multi-Systemic Therapy Multidimensional family therapy (MDFT), 130 Multidimensional services, 57–58 Multidisciplinary community teams, 607 Multiethnic Placement Act (MEPA) (1994), 38, 376, 392 Multiple placements, 443, 481–82, 490; of LGBTQ youth, 166; placement instability and, 594 Multisite/multisystem research, 667 Multi-Systemic Therapy (MST), 130, 273, 281–82 Museums, children’s, 536, 537, 539 MySpace, 195 NASW, see National Association of Social Workers National Adoption Information Clearinghouse, 517, 563 National Alliance to End Homelessness, 172 National Alliance to End Homelessness (2013), 184 National Association of Black Social Workers, 689 National Association of Public Child Welfare Administrators, 624 National Association of Social Workers (NASW), 613; on

]

confidentiality and child abuse reporting, 393; Social Work Research Section, 662 National Center for Lesbian Rights (NCLR), 158, 172 National Center for Prevention and Treatment of Child Abuse and Neglect, 213 National Center on Child Abuse and Neglect, 295 National Child Abuse and Neglect Data System (NCANDS), 208, 246, 289, 567, 663, 683 National Child Labor Committee, 20 National Children’s Alliance (NCA), 292–93 National Child Traumatic Stress Network (NCTSN), 295 National Child Welfare Workforce Institute (NCWWI), 493; online training on leadership skills, 651–54; Social Work Traineeships and Leadership Academy, 633–34 National Commission on Family Foster Care (NCFFC), 602; on foster parents role, 604; on foster resource family competencies, 606 National Council of Juvenile and Family Court Judges, 324 National Data Archive on Child Abuse and Neglect, 663 National Domestic Violence Hotline, 714 National Family Preservation Network, 346 National Fatherhood Initiative study, 696 National Federation of Families for Children’s Mental Health, 131 National Foster Parent Association (NFPA), 486, 602, 611 National Health and Social Life Survey, 161 National Incidence Studies (NIS), 289, 683 National Incidence Studies of Missing, Abducted, Runaway, and Thrown-away Children (NISMART-2), 184, 192 National Indian Child Welfare Association (NICWA), 376, 378 National Institute of Child Health and Human Development (NICHD), forensic interviewing protocol, 294

741

742

[

INDEX

National Institutes of Health (NIH), 295, 675 National Institute of Mental Health (NIMH): Child and Adolescent Treatment and Preventive Intervention Research Branch of, 127; on treatment models, 126 National Institute of Mental Health Epidemiological Catchment Area Program, 307 National Juvenile Defender Center, 172 National Longitudinal Study of Adolescent Health (Add Health), 160, 163, 470 National Network for Youth, 172 National Registry of EvidenceBased Programs and Practices (NREPP), xii, 130 National Research Council, 117 National Resource Center for Adoption Services, 457 National Resource Center for Child Protective Services (NRCCPS), 248 National Resource Center for Legal and Judicial Issues, 457 National Resource Center for Permanency and Family Connections (NRCPFC), 171, 337–38, 457, 488 National Resource Center for Youth Development, 457, 472 National Resource Center on Permanency and Family Connections, 487, 533 National Runaway Switchboard, 187 National Standard, CFSR, 246 National Survey of America’s Families, 123 National Survey of Child and Adolescent Well-Being (NSCAW), 95, 119, 300, 314, 319, 508–9, 517, 586, 626, 663 National Survey of Child and Adolescent Well-Being II (NSCAW II), 95–96 National Survey of Family Growth, 427 National Survey on Drug Use and Health, 484 National Urban League, 25, 27 National Violence Against Women Survey, 312 National Youth in Transitions Database, 663 Native Americans, 40; CAPTA and, 239; disproportionality in foster care system, 565, 680; family

culture of, 373, 376–79; in foster care system, 606; foster placement of, 373–74; placement decisions, 35; substance abuse of, 302 Native Americans, adoptions, 360, 373–81; case examples, 374–75; customary, 377–80; decreased number of, 374, 375; difficulty of finding adoptive homes, 375; FAS and, 375; history of, 373–74; permanency issues, 376–77; placement decisions, 373–74; placement preferences, 384; traditional, 377; trends in, 376 NCA, see National Children’s Alliance NCANDS, see National Child Abuse and Neglect Data System NCFAS, see North Carolina Family Assessment Scale NCFAS-R, see North Carolina Family Assessment Scale for Reunification NCFFC, see National Commission on Family Foster Care NCLR, see National Center for Lesbian Rights NCTSN, see National Child Traumatic Stress Network NCWWI, see National Child Welfare Workforce Institute Neglect: definition of, 240; family preservation and, 274; see also Abuse and neglect Neighbor to Family, 520 Neighbor-to-Neighbor, Chicago, 520 New Jersey: court-mandated systems improvement, 686–87; DVL program, 323–24; NJCBW in, 323; Office of the Child Advocate visit guidelines, 532; PALS program, 323 New Jersey Coalition for Battered Women (NJCBW), 323 New York City: ACS, 321, 434, 534, 718; adoption disruption study, 440; almshouse in, 18; Center for Family Life (CFL), 60; CenterKids, 563–64; Colored Orphan Asylum, 14; Covenant House, 180; CWOP, 78; Family Violence Prevention Project, 326; House of Refuge, 15; Streetworks Project, 186 New York Society for the Prevention of Cruelty to Children (NYSPCC), 17, 212 New York State: on adoption disruptions, 438; Charities

Aid Association, 22, 404, 661; Children’s Village RTC, 505; kinship guardianship assistance legislation in, 369; OCFS, 168–69, 534; OCFS, on LGBTQ youth, 168–69 New Zealand, family group conferencing in, 59 NFP, see Nurse Family Partnership NFPA, see National Foster Parent Association NICHD, see National Institute of Child Health and Human Development Nicholson vs. Scoppetta, 319, 321, 322 NICWA, see National Indian Child Welfare Association NIH, see National Institute of Health NIMH, see National Institute of Mental Health Nina Foundation, 537 NIS, see National Incidence Studies NISMART-2, see National Incidence Studies of Missing, Abducted, Runaway, and Thrown-away Children NJCBW, see New Jersey Coalition for Battered Women Noncustodial fathers, 694, 700, 704 Nonrelative adoption, 23 North American Council on Adoptable Children, 609 North Carolina: on adoption disruptions, 438; IFPS study in, 278 North Carolina Family Assessment Scale (NCFAS), 283 North Carolina Family Assessment Scale for Reunification (NCFAS-R), 347 Northwest Foster Care Alumni study, 469 NRCCPS, see National Resource Center for Child Protective Services NRCPFC, see National Resource Center for Permanency and Family Connections NREPP, see National Registry of Evidence-Based Programs and Practices NSCAW, see National Survey of Child and Adolescent Well-Being NSCAW II, see National Survey of Child and Adolescent WellBeing II Nurse Family Partnership (NFP), 215, 216, 217, 219

INDEX

Nurse Home Visitation Programs, 214 NYSPCC, see New York Society for the Prevention of Cruelty to Children Obama, Barack, 219, 223, 356 OCFS, see Office of Children and Family Services, New York State Office of Children and Family Services (OCFS), New York State: on LGBTQ youth, 168–69; visiting policy, 534 Office of Juvenile Justice and Delinquency Prevention (OJJDP), 183, 184, 186, 215, 220 Office of Refugee Resettlement, 714, 715 Office of the Child Advocate, New Jersey, 532 Office of the Inspector General, of DHHS, 485 Ohio: Don’t Shake the Baby program, 222; orphanages in, 18 OHYAC, see Out-of-Home Youth Advocacy Council OJJDP, see Office of Juvenile Justice and Delinquency Prevention Omnibus Budget Reconciliation Bill (1981), 36, 37 One Church One Child, 607 Openness, of adoptions, 407, 424, 434, 450 Operation Peace of Mind (OPM), 181 OPM, see Operation Peace of Mind Oregon Family Unity Meetings, 61 Oregon Project, 662 Organizational Self Study on ParentChild and Sibling Visits, 536 Orphans and Orphanages, 12–14, 18 Orphan Train movement, 602–3 Outcomes: age and foster care, 685; child welfare services, 280, 491; CPS, 244–45; disproportionality of racial groups in foster care system, 683–86; educational, placement instability and, 590, 681; family support services, 62–63; kinship foster care, 386–88; performance, in health care, 95–96; permanency, ix–x, 336–37, 488–89; research on, 665; residential care, 505–8; wellbeing, CFSRs on, 46, 97, 119, 569, 570, 572–73; for youths aging out of foster care, 469–71 Outdoor relief, 13, 14

Out-of-home placements, see Placements Out-of-home services, 2–7 Out-of-Home Youth Advocacy Council (OHYAC), 172 Over-representation, see Disproportionality PALS, see Peace: A Learned Solution program Parens patriae, 16 Parental consent, 110, 149, 193–94 Parental resilience, as protective factor, 56 Parental rights, termination of, see Termination of parental rights Parental substance abuse, see Substance abuse, parental Parent-child interaction therapy (PCIT), 129–30, 137, 305 Parent management training, 129 Parent Mentoring Program, 60 Parent mentors, 60, 77–79, 81 Parent Partner Program, 60 Parent Resources for Information, Development & Education (PRIDE), 604, 613n1 Parents, see Adoptive parents; Birth mothers; Fathers; Foster parents; Incarcerated parents; Kinship caregivers Parents Anonymous, 220 Parents as Teachers (PAT), 214, 215, 216, 218, 219 Parents for Children, 439 Parents Under Pressure (PUP) program, Australia, 219 Parent to Parent supportive service model, 59–60 Participatory methods of research, 670 Partnerships, between agencies and families, 70 PAT, see Parents as Teachers Paternity establishment, 694–95 Patient Protection and Affordable Care Act (2010), 97–98, 219, 223 Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act (2008), 136 PCA America, see Prevent Child Abuse America PCIT, see Parent-child interaction therapy Peace: A Learned Solution (PALS) program, 323 Peer advocacy program, 56

]

Peer support programs, for parents, 72–73, 76–77 Permanency, 245; alternatives, 489; APPLA, 5; ASFA on, x, 458, 459, 460, 489, 543, 621, 663; challenges, 571–72; education needs for, 145; family reunification as goal of, 4–5, 489; fathers as resource for, 697, 698; fathers’ involvement and, 698– 700; FCSIA on, 336, 543; lasting or binding, 365–67; as ongoing process, 550; outcomes for, ix–x, 336–37, 488–89; postpermanency support, 368–69 Permanency hearings, 621 Permanency planning, x, 336–38, 357–58; AACWA on, 437, 662; CFSRs on, 336; for children in kinship foster care, 385, 390–91; continuum, 362; emancipation, 457, 458, 460; fathers involvement in, 698–700; federal guidelines for, 366; immigrants and, 710, 712–14; in Indian child welfare, 376–77; for LGBTQ youth, 167–68; for older adolescents, 456–57 Personal problems, family support services for, 56 Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 38, 384, 703; immigrants and, 711; on kinship adoption, 414 Pew Commission on Children in Foster Care, on federal guardianship subsidies, 362 Philadelphia Association for the Care of Colored Children, 14 Physical abuse, see Abuse and neglect; Domestic violence PIPs, see Program improvement plans Placement genograms, 351, 420 Placements: demographic characteristics for, x, 339; family visits with foster children after, 4; gender differences in, 339; from incarcerated parents, 279, 408, 603, 682; preventing, 35, 36, 37; racial and ethnic differences in, 339; safe and nurturing, 3–4; service goals for, 339–40; Social Security Act on, 684; as temporary measure, 6; types of, 2–3; see also Foster care; Residential care

743

744

[

INDEX

Placements, instability of, 46, 490, 544, 562–63; caregiver and placement processes characteristics, 593–94; CFSRs on, 587; child characteristics, 591–93; definition of, 583–84; educational outcomes and, 590, 681; effects of, 589–91; extent of problem, 584–89; federal indicator of, 588; grief and, 591; group homes, 594; kinship foster care and, 593–94; MEB disorders and, 590–92; multiple placements and, 594; patterns, 583–84, 588; positive aspects of, 584–94; promising approaches, 594–96; risk and protective factors, 584–94, 597; time in care, 594 Planning: case, 4, 26, 49–50, 243, 619; concurrent, xi, 341, 488–89, 547, 713; individualized treatment, 28; residential care treatment, 506–7; service, 4, 57, 70, 72, 104; transition, 152–55, 472–73; see also Permanency planning Play therapy, 128, 520 Poorhouses, 12, 14 Postadoption permanency services, 543–44, 549 Postguardianship postpermanency services, 544, 549 Postpermanency services, 368–69; access to, 550–51; components of, 551–54, 554; financial support for, 552; philosophy of, 554–55; postadoption, 543–44, 549; postguardianship, 544, 549; postreunification, 48, 348, 544–45, 549; research on, 543–46; social obligation for, 549; systems, 551; theoretical considerations, 546–48; values issues, 548–49 Postreunification postpermanency services, 48, 348, 544–45, 549 Postsecondary education, 147, 152–55, 156 Poverty: as abuse and neglect risk factor, 210, 211, 275, 482–83, 682; affecting families and children served by foster care, 482–83, 688; among African Americans, 681–82; causes of, 17; child rate of, 123; as ecological condition, 548; family reunification and, 343; family support services and, 26,

30–31, 55; of immigrant families, 711; of kinship caregivers, 383; risk factors, in Britain, 54; of single-parent families, 123, 210, 682; urban, 53; of youth aging out of foster care, 470 Practice themes, 205; expert-based models, 71; implementation of, 661 Preadoption investigations, 23 Preferential adoptions, 360 Pregnancies: adolescent, 483–84; of unwed mothers, 26, 28 Preservation, see Family preservation; Intensive family preservation services Prevent Child Abuse America (PCA America), 214 Prevention: of abuse and neglect, 33–34, 202–3, 212–23; Sweden program on corporal punishment, 222–23; universal strategies for, 221; see also Child abuse prevention programs Prevention Initiative Demonstration Project, Los Angeles, 60 PRIDE, see Parent Resources for Information, Development & Education Primary health care, 94 Professional foster care, 612 Program improvement plans (PIPs), 567, 568, 580, 581n5, 660; state approaches to, 573–74, 621, 632, 670; strengths and barriers, 575 Progressive era, 18 Promoting Safe and Stable Families Amendments (2001), 471 Prosecutorial model, 619 Prostitution, 288, 428; trafficking and, 715; youth, 183, 188–89, 240 Protecting and promoting meaningful connections, 532 Protective factors: attachment, 56, 123, 191; for birth mothers, 430; child development knowledge, 56; for children’s exposure to domestic violence, 315–16, 318; concrete supports, 56; for family reunification, 344, 546; for LGBTQ youth, 168; for MEB disorders, 123; parental resilience, 56; for placement instability, 584–94, 597; for resilience, 123, 277; to restore family functioning, 56; for runaway and homeless youth, 191–92; social connections, 56

Protective services, see Child Protective Services Psychiatric disorders, see Mental, emotional, and behavioral disorders Psychoanalytic theory, 24 Psychopharmacological interventions with children, 127–28 Psychosocial development, 125–26 Psychotherapy, 24, 128, 290 Psychotropic medication, for children and youth, 96, 491 Public guardianship, 387 PUP, see Parents Under Pressure Putative father, 694–95 QICs; see Quality improvement centers Quality assurance systems, 8, 237 Quality improvement centers (QICs), 663, 668, 670 Racial and ethnic groups: adoptees, 411; adoptive parents, 38; delinquent youth, 30; family reunification and, 342; family support services and, 64; in foster care, 467–68, 565, 680; kinship caregivers, 383; in placements, 339; residential care, 510; sexual abuse and, 290, 683; states on, 687–88; transracial adoptions, 27, 410–12; see also African Americans; Asian Americans; Disproportionality of racial groups in foster care system; Hispanic Americans; Whites Randomized control trials (RCTs), 668–69 Reagan, Ronald, 36 Realistic job previews (RJPs), 634 Reasonable efforts: AACWA on, 54, 358, 662; in APPLA, 460, 461, 462; ASFA on, 341, 431, 550, 621; in family preservation, xiii, 36, 37, 39, 54, 202, 245, 270, 271, 358, 431, 519, 531, 551, 662; for family reunification, 4, 39, 54, 202, 337, 358, 431, 662; FCSIA on, 431, 531, 551 Recovery coaches, 306 Reentry to foster care, 481, 545, 597, 685 Reform schools, 16 Refugees, 711, 712, 714; see also Immigrants, children and youth

INDEX

Regionally based implementation centers, of CFSRs, 577–78 Rehabilitation Act (1973), 157n6 Reintegration, family, 340 Relative foster care, see Kinship foster care Reliability, 255–56 Relinquishing mothers, demographic patterns for, 427 Report of the Surgeon General’s Conference on Children’s Mental Health, 117 A Research Agenda for Child Welfare, 664 Research in child welfare, 22, 565, 660–79; on adoption disruptions, 544; agency-based, 665–66; areas of, 654–55; categories of, 664–65; challenges and trends in, 668–73; on child welfare workers, 665; child welfare workers access to, 601; collaborative research through university/agency partnerships, 666–67; on disproportionality of racial groups in foster care system, 682–83; on domestic violence, 28, 318, 319, 328, 329; EBP and, 673–74; on family reunification, 348–49; on fathers, 706; on FPS, 283; future priorities for, 674–75; history of, 661–64; on kinship foster care, 382, 388, 391; on LGBTQ youth problems, 158–60; limitations for FPS, 281; methodological issues, 668–69, 671; multisite/multisystem, 667–68; on outcomes, 665; participatory methods, 670; on postpermanency services, 543– 46; quantitative and qualitative methods, 671; RCTs and realistic evaluations, 668–69; on residential care, 509, 511; on runaway and homeless youth, 195; on sexual abuse, 290; on siblings, 516, 517–19; strategies for, 665–68; technology issues, 672–73; on visits, 535–36, 539–42 Residential care, 3, 28; AFCARS on, 502; behavior modification approaches, 500, 506; case examples, 503–4, 506–7; characteristics of children and youth in, 499, 504–5; children with disabilities in, 498; for children with MEB, 490, 504–5,

509; deaths in, 510; EBPs, 511; facility types, 498–99; family foster care compared to, 508–9; funding, 502–3, 510; future of, 509–11; history of, 501–3; number of children in, 502; outcomes, 505–8; overview of, 498; placements stability, 506; racial and ethnic disparity, 510; for rehabilitation, 501; research on, 509, 511; restraint and seclusion policy in, 510; scope, 498; services, 510; settings, 502; target populations, 505, 510; treatment approaches and models, 504; treatment planning, 506–7 Residential treatment centers (RTCs), 3, 498, 499, 502; familycentered, 506; Girls and Boys Town, 500 Resilience: of abused children, family support systems for, 47; of adoptive children, 449; child attributes for, 123; of child welfare supervisors, 654; factors, for youths aging out of foster care, 470–71; of LGBTQ youth, 168; model, Hispanic Americans and, 87; parental, 56; protective factors for, 123, 277; of runaway and homeless youth, 179, 191–92 Respite care, 41, 461; in adoptions, 448, 450; in kinship care, 369 Responsible Fatherhood Initiative, 218 Restraining orders, 320 Results-Oriented Management (ROM) online supervision training, 651 Reunification, see Family reunification Reunity House, 537–38 Review hearings, 621 Revised Conflict Tactics Scale, 326 RHMCPA, see Runaway, Homeless, and Missing Children Protection Act Rhode Island Department of Children, Youth, and Families, 536; Data and Evaluation, Quality Assurance Unit, 666 RHYA, see Runaway and Homeless Youth Act Richmond, Mary, 625 Rise Above Foundation, Massachusetts, 475 Risk Amplification Model, 190

]

Risk assessments, 253–69; abuse and neglect cases, 203, 224–26, 253–55, 261–62; barriers to, 262; California family risk assessment form, 265, 266; comprehensive, 259; concerns in, 258–59; decision-making context of, 203, 253–55, 262; EBP in, 263–64, 264; errors in, 254, 261–63; example of, 264–66; of high-risk families, 264; implementation of programs, 262–63; models, 254– 55; need for, 259–64; process, 263; reliability, 255–56; safety culture of, 260–62; statistical concerns, 256, 258; study of risk and error in, 261; tools, 257–59; validity, 255–56 Risk factors: for abuse and neglect, 48, 209–12, 224; for adoption disruptions, 409, 445; for children’s exposure to domestic violence, 315–16, 318, 320; for immigrant children abuse and neglect, 712; of LGBTQ youth, 160, 164–68; for MEB disorders, 118, 119, 122–23; for runaway and homeless youth, 186–87, 190–91; for TPR, 428–30; of youths aging out of foster care, 469–70 RJPs, see Realistic job previews Role theory, 546–47 ROM, see Results-Oriented Management Roosevelt, Franklin D., 25, 661 RTCs, see Residential treatment centers RTFs, see Intensive residential treatment facilities Runaway, Homeless, and Missing Children Protection Act (RHMCPA), 181 Runaway and homeless youth, xii, 179–99; ages of, 185; arrests of, 184, 185, 187; characteristics of, 179, 184–86; communitybased agencies for, 180–81; criminal activity, 188, 190; deinstitutionalization, 180; demographic patterns, 184–87; dropout rates, 188; ethical issues and value dilemmas, 179, 193–94; family composition and home environment, 186–87; former foster youth, 187; future research needs, 195; genders, 184; historical and societal context, 179–82; homicides of, 181;

745

746

[

INDEX

Runaway and homeless (continued) hotlines, 180; lack of life skills, 188; LGBTQ, 160, 162–64, 168, 184–87; number of, 184; physical and mental health problems, 189–90; physical and sexual abuse of, 186–87; policy responses, 179, 181; population definitions, 182–84; program effectiveness, 179, 192–94; protective factors, 191–92; public care instability, 187–92; resilience of, 179, 191–92; runaway episodes, 185, 187; safety of, 180, 181; school problems, 187–88; self-determination, 193; services for, 182, 183; sexual risk behaviors, 188–89; shelters, 116, 180, 181, 185, 187, 188, 192–95; single-parent families and, 186; status offenses, 180; substance use, 190, 194; successful, 191–92; terms used for, 182–83; vulnerabilities and risk factors, 186–87, 190–91 Runaway and Homeless Youth Act (RHYA), 181–82, 195 Runaway Youth Act (RYA) (1974), 181, 195 Rural families, family support services for, 55 Ruth Ellis Center, Detroit, 169 RYA, see Runaway Youth Act SACWIS, see Statewide Automated Child Welfare Information Systems Safe and Stable Families Program, 39 SafeCare, 215, 216, 219 Safe haven laws, 221–22 Safe Start Demonstration Projects, 325 Safety: ASFA on, x, 46, 53, 202, 236, 276, 663; Child Protective Service and, 244–45; FCSIA for, x, 46, 53; IFPS and, 280; issues of, 46; postreunification services for, 545; prevention of abuse and neglect, 33–34 SAMHSA, see Substance Abuse and Mental Health Services Administration SBC, see Solution-Based Casework SCHIP, see State Children’s Health Insurance Program Schools: children in foster care rate of completion, 469–70, 500, 506; as entry point for mental health services, 117; mental

health services in, 133–34; parental consent for records of, 149; reform, 16; runaway and homeless youth problems in, 187–88; special education, 149–52; stability and continuity, 147, 149; see also Education Screening: for abuse and neglect, 224–26, 240–41; for child abuse prevention programs, 224–26; health care, 97, 100–102, 108; kinship foster care, 388–89; for MEB disorders, 125–26 Seattle Birth to Three Program, 218 Secure treatment, 499 SEI, see Substance-Exposed Infants Select Committee of the New York State Senate, 14 Selective serotonin reuptake inhibitors (SSRIs), 128 Self-awareness, 86, 90, 93, 635, 650 Self-determination, 193 Self-help interventions, 219–20 Self-reflection, 90 Sequencing, for youth aging out of foster care, 468 Service array, 8 Service delivery, families as resource in, 70 Service planning, 4; in familycentered practice, 70, 72; health care data integration, 104; substance abuse and, 57 Services, 552–53; early developments in organization and provision of, 22–23; expansion of, 16–18; implementation of, 49–50; integrity of, 551; public funding for, 34–35; wraparound, 72, 134–35, 137, 595, 607, 688; see also Child welfare services; Community-based child welfare services; Family preservation services; Family support services; Postpermanency services Settlement House movement, 17–18 Sexual abuse, 204; adoption disruption and, 443; CACs, 292–93, 295; by clergy, 291; CPS and, 291; criminalization of, 292; definition of, 240, 268; EBP for, 293–96; family preservation and, 274; federal and state policies on, 291–93; forensic interviewing for, 293–95; gender and, 290; incidence, 289–90; intrafamilial, 288, 291; racial and ethnic differences, 290, 683; research on, 290; runaway and homeless

youth experiences of, 186–87; societal context for, 290–91; types of, 288–89; victim treatment, 295–96; see also abuse and neglect Sexual orientation, see Bisexual youth; Lesbian, gay, bisexual, transgender, and questioning youth Shaken baby syndrome, 208, 221, 222 Shelters: domestic violence, 315, 316, 319, 323, 324; emergency shelter care, 3, 148, 499, 584, 591, 606, 620; for runaway and homeless youth, 116, 180, 181, 185, 187, 188, 192–95 Sheppard-Towner Act (1921), 21 Short-term/diagnostic care reception centers (DRCs), 499 Sibling Foster Care Model, 520 Sibling House Foundation, Washington, 520 Sibling Inventory of Behavior, 521 Sibling Inventory of Differential Experiences, 521 Sibling Relationship Inventory (SRI), 521 Siblings: adoptees, 415–16, 443, 518; adoption of, 415–16, 518, 519; assessment of relationships, 416, 517, 520–22; bonds, 520–21; case examples, 522–23; definition of, 516; demographic patterns, 516–17; FCSIA on, 519, 577; in foster care, 517, 519, 520; in kinship care, 523; legal mandates concerning, 519–20; placement issues, 517–18; research on, 516, 517–19; right of association, 519, 523; rights vs. needs of, 519, 521–22; services for, 520; visits between, 5, 523, 527, 536, 537 Sib-Links, 520 SIBS, see Social Interactions Between Siblings Interview SIJS, see Special Immigrant Juvenile Status Law SILPs, see Supervised Independent Living Programs Single-parent families, 26, 28, 276, 681; adoption by, 403, 410, 414, 444; for kinship care, 382, 383, 393, 508; poverty of, 123, 210, 682; runaway youth and, 186 Slavery, 13 SMART, see Specific, measurable, achievable, realistic, and timelimited SNIP, see Social Network Intervention project

INDEX

Snowe, Olympia, 362 Social competence, visits and, 529 Social connections, as protective factor, 56 Social inequality, 54 Social Interactions Between Siblings (SIBS) Interview, 521 Social isolation: abuse and neglect and, 211; family support services for, 55–56 Social learning theory, 318 Social marginality and exclusion, 54–55 Social media, runaway and homeless youth and, 194 Social Network Intervention Project (SNIP), 220 Social networks: for father locating, 704; interventions, 272; maps, 420 Social obligation, for postpermanency services, 549 Social Security Act (1935), 53; amendments to, 31–32, 625–26; FCIA and ETV, 153–54; impact of, 25–26; on out-of-home placements, 684; passage of, 25–27; Title IV-B of, 8, 36, 153, 384, 562, 568, 631, 632; Title IV-E GAP, 355, 358, 362, 365, 366, 384–85, 387, 391; Title-IV-E Independent Living Initiative of 1986, 457, 471, 474; Title IV-E Independent Living programs, 456, 458; Title IV-E of, x, 8, 39, 40, 59, 148, 159, 306, 355, 384, 562, 631, 632; Title V of, 27, 31; Title XX of, 34, 36, 631, 632 Social support, 219–20 Social workers: family engagement by, 73–75; friendly visitors as forerunners of, 17; professional, 626; relations with children with disabilities, 409; training to work with fathers, 706; see also Child welfare workers Social work profession: criticism of, 32; development of, 27, 28 Social Work Research Section, of NASW, Conference on Research in the Children’s Field, 662 Social Work Traineeships and Leadership Academy, 633–34 Societal context: for family preservation, 275–76; for kinship foster care, 384–86; for runaway and homeless youth, 179–82; for sexual abuse, 290–91; for TPR, 428; for youths aging out of, 468–69

Society for the Prevention of Cruelty to Animals, 17 Society for the Reformation of Juvenile Delinquents, 15 Society of Friends, 14 Solution-Based Casework (SBC), 58 Somatoform disorder, 290 SOP, see Street Outreach Programs Special education: advocacy, for children in foster care, 149–50; child evaluation, 150–51; dispute resolution and enforcement, 152; IEPs and IEP team meetings, 124, 125, 150–52, 155, 157n8 Special Immigrant Juvenile Status Law (SIJS), 713, 715–16 Special needs adoptions, 424; disruptions, 438–40, 442–43; subsidies, 36, 53, 356, 358, 360, 361, 504 Special needs children: in foster care, 4, 32; schools requirements for serving, 134–35 Specialty health care, 94 Specific, measurable, achievable, realistic, and time-limited (SMART) case goals, 243 SRI, see Sibling Relationship Inventory SSRIs, see Selective serotonin reuptake inhibitors Stability of placements, see Placements, instability of Standards of Practice for Attorneys Representing Parents in Abuse and Neglect Cases, ABA, 619 Standards of Practice for Lawyers Representing Child Welfare Agencies, ABA, 619 Standards of Practice for Lawyers Who Represent Children in Abuse and Neglect Cases, ABA, 619 State Board of Charities, 18 State Children’s Health Insurance Program (SCHIP), 136, 696 State Program Improvement Plans (PIPs), 71 States: CFSR-informed technical and training support to, 577–78; child welfare review process by, x, xi, 491; child welfare systems, 21, 27, 29; child welfare systems administration, 626; on domestic violence, 322–24; federal funding to, 491; PIP approaches by, 573–74; racial disparities, 687–88; responsibility to children, 18–19

]

Statewide Automated Child Welfare Information Systems (SACWIS), 8, 651, 672 Status offenses, 180 Stepparent adoptions, 402 Street Outreach Programs (SOP), 182 Street Smart, 193 Streetworks Project, New York City, 186 Street youth, 190; see also Runaway and homeless youth Strengthening Abuse and Neglect Courts Act, 239 Strengths assessments, 8, 48, 133, 246, 606 Strengths perspective, 7, 49, 57, 191, 344 Stressful life events, 483 Stuart Foundation, 61, 65n1 Student Support Services, 155 Subsidized adoptions, 36, 53, 356, 360, 361, 368, 404 Subsidized guardianship, 355, 358, 360–67, 390–91, 544; waiver demonstration, 361–63; see also Title IV-E Guardianship Assistance Program Substance abuse, xiii, 57, 279, 299–311; in adolescence, 124, 130, 475, 499, 505, 508; assessments, 300–301, 432; definitions, 299; diagnostic instruments for, 299; domestic violence association with, 307–8, 328; drug testing, 301–2; estimating, 302–4; as family reunification obstacle, 304, 306, 308, 342; measurement strategies, 299–302; MEB disorders comorbidity with, 124, 130, 307–8; motivational interviewing and, 305–6; MST for, 130, 273, 281–82; prevalence, 302–4; of runaway and homeless youth, 190, 194; see also Substance use Substance abuse, parental, 484; of birth mothers, 37, 302, 303, 427–29; child abuse and neglect association with, 56, 209, 218–19, 305, 682; drug courts for, 306–7; effects on children, 304; family reunification issues, 304, 306, 308, 342; of fathers, 218, 698; incarceration association with, 307; placements involving, 39, 95, 303, 304; in pregnancy, 218, 303; recovery coaches for, 306; TPR and, 427; whose children are served in foster care, 204, 383, 482, 484

747

748

[

INDEX

Substance Abuse and Mental Health Services Administration (SAMHSA), xii, 295 Substance-Exposed Infants (SEI), 303 Substance use: abuse risk factors, 190; domestic violence association with, 307–8, 328; placement instability and, 590; in pregnancy, 301; see also Substance abuse Sugar daddy relationships, 189 Suicide, 168, 189, 429 Supervised Independent Living Programs (SILPs), 3, 498, 499 Supervised Visitation Network (SVN) visits standards, 532 Supervision, 643–59; clinical, in child welfare, 648; diversity in, 647; Kadushin model of, 650–51; personal and professional boundaries, 644; promising practices in, 648–56; social context for, 643–44; strengthsbased, 636; studies on, 644 Supervisors, 648–51; changing environments, 646–47; child welfare unit, 646; critical skills for, 645–48; developing working competence, 647; example, 655– 56; gender differences in, 644; job satisfaction, 645; leadership, 645; management, 645–46; mentoring of, 651; middle management, 646; performance management, 648; training in recruitment and selection, 636; turnover rate, 644; worker recruitment and retention, 647; worker relationship with, 636; on worker support and turnover, 644; working in larger environments, 646 Supportive services, see Family support services Supreme Court, U.S.: Gault decision, 617; Miller vs. Yoakum, 37, 359, 369, 384 Survival sex, 188–89 SVN, see Supervised Visitation Network Sweden, prevention of corporal punishment in, 222–23 Systemic issues: CFSRs review of, 7–8, 568; in child welfare system, 7–9, 560–66; lessons learned from CFSR reviews about, 578–80; in recruitment of foster parents, 485

Systemic risk management programs, see Risk assessments TANF, see Temporary Assistance for Needy Families Taylor, Graham, 625 Taylor, Hasseltine B., 356, 357, 360 Teacher-Child Rating Scale, 591 Technology: electronic case records and online surveys, 672; electronic health passports for children in foster care, 103; Internet, 288–89; in research, 672–73; social networks, 272, 420, 704 Teenagers, see Adolescents Temporary Assistance for Needy Families (TANF), 26–27, 38, 215, 356, 385, 696, 703, 711 Tennessee: court-mandated systems improvement, 686–87; on guardianship subsidies, 363, 364; Solution Based Casework (SBC), 58 Termination of parental rights (TPR), 8, 619, 621; assessments and interventions for, 432–34; birth mothers effects from, 424, 427, 429–30; CFSRs on, 571; cultural resistance to, 489; fathers and, 697, 698; federal and state policies for, 430–31; final visits and, 428, 429, 433; guardianship and, 358–59, 688–89; involuntary, 424–25, 428, 432–33; number of, 616; risk factors for, 428–30; societal context for, 427–28; studies overview, 425–26; tribal customary adoption and, 377, 378, 380; voluntary, 427, 435; vulnerabilities and risk factors for, 428–30 Texas: Center for the Elimination of Disproportionality and Disparities, 690; Fatherhood Coalition, 705–6 TF-CBT, see Trauma-focused cognitive behavioral therapy Therapeutic foster care, 3, 4, 508–9, 612 Thrownaway youth, 183, 184, 186, 187; see also Runaway and homeless youth Title IV-B, Social Security Act, 8, 36, 153, 562, 568; on social work education, 631, 632 Title IV-E, Social Security Act, x, 8, 39, 40, 59, 148, 159, 306, 355,

562; on social work education, 631, 632 Title IV-E Guardianship Assistance Program (GAP), 355, 358, 362, 365, 366, 384–85, 387, 391 Title-IV-E Independent Living Initiative of 1986, 457, 471, 474 Title IV-E Independent Living programs, 456, 458 Title V, part 3, Social Security Act, 27, 31 Title XX, Social Security Act, 34, 36; on social work education, 631, 632 TLOA, see Tribal Law and Order Act TLP, see Transitional Living Programs TPR, see Termination of parental rights Trafficking victims, 712 Training: for child welfare workers, 8, 432, 578, 630; domestic violence training for child welfare workers, 58, 321, 323, 328–30; forensic interview training for child welfare workers, 294–95; foster parents, 595, 609–10; health care, 103, 109; for Latino family engagement, 92; life skills, 473–74; parent management, 129; of social workers, to work with fathers, 706; of supervisors, in recruitment and selection, 636; and technical assistance network, of HHS, 577–78; for working with immigrant children and youth, 91, 713, 716–17 Training and Technical Assistance Network (T/TA Network), Children’s Bureau, 633 Transformation movement, 502 Transitional Living Programs (TLP), 182 Transitional living services, 467–79 Transition planning, 152–55, 472–73 Transracial adoptions, 27, 410–12 Trauma: Abusive Head Trauma (AHT), 222; birth mothers experiences of, 432; brain development and, 120–21; from removal, 3 Trauma-focused cognitive behavioral therapy (TF-CBT), 295 Tribal governments: CAPTA and, 239; legal basis for adoption

INDEX

laws, 379–80; permanency issues and, 376–77; placement decisions role, 35; see also Native Americans Tribal Law and Order Act (TLOA), 289 Triple P program, Australia, 220–21 T/TA Network, see Training and Technical Assistance Network U.N. Convention on the Rights of the Child, 404 Undocumented immigrants, 681, 711, 715 Uninterrupted Scholars Act (2013), 149 United Kingdom, see Britain Universal prevention strategies, 221 Urban Indian Organizations, MIECHV funding to, 219 Urban poverty, 53 Ursuline Convent, New Orleans, 13 U.S. Advisory Board on Child Abuse and Neglect, see Advisory Board on Child Abuse and Neglect, U.S. U.S. Children’s Bureau, see Children’s Bureau, U.S. U.S. Citizenship and Immigration Services (USCIS), 714 Validity, 255–56 Values: of child welfare workers, 628–29; cultural, of Hispanic Americans, 87–88; postpermanency services and, 548–49; see also Ethical issues and value dilemmas Van Arsdale, Martin Van Buren, 15 Van Theis, Sophie, 22 VAWA, see Violence Against Women Act VCIS, see Voluntary Cooperative Information System Victims of Child Abuse legislation, CACs funding by, 292 Victims of Trafficking and Violence Prevention Act (2000), 715 Violence, see Abuse and neglect; Domestic violence; Trauma Violence Against Women Act (VAWA) (1994), 714 Visiting plans, 345; agency policy for, 530; obstacles for, 534–35 Visits, 527–42; barriers to, 534–35; with birth mothers, 527, 535; case examples, 528; of children and

youth in foster care, well-being and, 458–59, 527, 529; coaching, 534; family reunification and, 345, 529, 532, 536–37; with fathers, 527, 535, 695; FCSIA impact on, 531–32; final at TPR, 428, 429, 433; guidelines for, 532–33; importance of, 528–29; with incarcerated parents, 342, 531; policy regarding children and youth in care, 530–31; positive family, 533–34; programs that support, 535–39; research, 535–36, 539–42; between siblings, 5, 523, 527, 536, 537; standards for, 532, 539; see also Child welfare workers, visits by; Home visitation services Voluntary Cooperative Information System (VCIS), 358, 370n1 Waiver program, Medicaid, 135–36 Wald, Lillian, 20 War on Poverty, 30, 31 Washington, D.C.: Child Trends, 706; court-mandated systems improvement, 686–87; foster care reimbursement rates, 485 Washington State: Behavioral Services Institute, Tacoma, 37; on birth mothers substance abuse, 302, 303; Community Family Partnership Program (CFPP), 61–62, 65n2; Division of Children and Family Services, 61; Fathers Engagement Project, 705; Homebuilders program, 37, 271–72, 281–82; Parent Mentoring Program, 60; Sibling House Foundation, 520; Solution Based Casework (SBC), 58 Welfare programs: ADC, 683; AFDC, 26, 30–31, 37, 53, 685; for dependent children, 32, 34; Medicaid, 36, 39, 98–99, 101, 110, 135–36, 471, 489, 490, 696, 711, 715; mothers’ pensions, 24; TANF, 26–27, 38, 215, 356, 385, 696, 703, 711; see also Federal funding Well-being, xii, 46–50; abuse and neglect, threat to children’s, 207–8, 245–46; ASFA, FCSIA for, x, 46–47, 97, 105–6; challenges, 572–73; congregate care effects, 491; effects of poverty on, 482–83; family visits of

]

children and youth in foster care and, 458–59, 527, 529; FPS for enhancing, 280–81; issues of, 46–47; outcomes, CFSRs on, 46, 97, 119, 569, 570, 572–73; placement instability effects on, 589–91, 595–97; see also Safety White House Conference on Children, 20, 23, 25 White House Conference on Dependent Children, 661 White House Conference on the Care of Dependent Children (1909), 53 Whites: child sexual abuse and, 683; child welfare services for, 684; history of services for, 25, 26; length of placement, 684; out-ofhome care of, 680 WIC, see Women, Infants, and Children food and nutrition program Wisconsin: court-mandated systems improvement, 686–87; on guardianship subsidies, 355, 363, 364, 365, 368, 369; on youth aging out of foster care, 469; YRBSS and, 160 Women; see Birth mothers; Domestic violence; Gender differences; Parents Women, Infants, and Children (WIC) food and nutrition program, 696 Workhouses, 15 World Health Organization, 300 Wraparound services, 72, 134–35, 137, 595, 607, 688 Yates Report, 13–14 Youth, see Adolescents; Delinquent youth; Lesbian, gay, bisexual, transgender, and questioning youth; Runaway and homeless youth Youth at Risk of Separation from the Family, 183 Youth engagement, transition planning, postsecondary education, 152–55 Youth prostitution, 183, 188, 189, 240 Youth Risk Behavior Surveillance System (YRBSS), 160, 163 Y.O.U.T.H. Training Project, 171 YRBSS, see Youth Risk Behavior Surveillance System

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