Reducing Congregate Care: Worth the Fight

Posted April 4, 2012
By the Annie E. Casey Foundation
Blog reducingcongregatecareworththefight 2012

Fif­teen-year-old Jas­mine O’Shea has been liv­ing with a fos­ter fam­i­ly in Den­ver for a year, and plans are under­way to find her an adop­tive fam­i­ly. It’s a dif­fer­ent world for the bright, intro­spec­tive girl who loves read­ing and cre­at­ing art, from abstracts to fash­ion design.

O’Shea has lived in group care facil­i­ties on and off since 2006. Her moth­er left an abu­sive mar­riage and gave up her parental rights for Jas­mine a few years lat­er, report­ing that she was aggres­sive.”
I was there too long. I didn’t get to get out in the world and see what it was like, didn’t get a chance to social­ize,” says O’Shea of her last stay in a con­gre­gate care facil­i­ty in Den­ver. By all reports, O’Shea is doing well in her fos­ter home and cau­tious­ly antic­i­pat­ing a tran­si­tion to pub­lic high school and poten­tial­ly a new adop­tive fam­i­ly. But, she says, I wasn’t pre­pared for any of it. The things nor­mal teenagers are excit­ed about, I’m ter­ri­fied of.”

Jas­mine is a youth who had been in insti­tu­tion­al care for years, and against the rec­om­men­da­tions of many pro­fes­sion­als who thought she could nev­er make it in a home-like set­ting, we got the court to agree to allow us to move her to a fos­ter home,” notes Allen Pol­lack, divi­sion direc­tor for youth ser­vices and com­mu­ni­ty impact for the Den­ver Depart­ment of Human Ser­vices. She is now on the way to being adopted—another goal many pro­fes­sion­als involved did not believe was possible.”

The Annie E. Casey Foun­da­tion has been help­ing Den­ver and the state of Col­orado forge child wel­fare reforms for sev­er­al years, first through its Fam­i­ly to Fam­i­ly ini­tia­tive, which used a team approach to help more chil­dren remain safe­ly with their fam­i­lies or in fam­i­ly set­tings, and more recent­ly through its Right­siz­ing Con­gre­gate Care” ini­tia­tive, which seeks dra­mat­ic reduc­tions in reliance on group care.

These efforts are dri­ven by a recog­ni­tion that too many chil­dren spend too much time in con­gre­gate care” set­tings, which many experts believe should be no more than a tran­si­tion­al step in mov­ing a child toward a fam­i­ly set­ting and pro­vid­ing ser­vices to ensure a suc­cess­ful out­come. Any­thing over three months tends to pro­duce worse behav­ior,” notes Pollack.

Too much time in con­gre­gate care has bad out­comes and inter­feres with the pub­lic child wel­fare system’s abil­i­ty to find a per­ma­nent rela­tion­ship for a child,” notes Suzanne Barnard, asso­ciate direc­tor of Casey’s Child Wel­fare Strat­e­gy Group. The pop­u­la­tion that needs to be in con­gre­gate care is much small­er than the pop­u­la­tion that cur­rent­ly lives there.”

Casey’s goal is to sup­port inter­ven­tions that reduce con­gre­gate care from its cur­rent lev­el of 16 per­cent of all fos­ter care place­ments nation­al­ly to about 510 per­cent in the next five years and to move those chil­dren as quick­ly as pos­si­ble toward life­long fam­i­ly con­nec­tions and per­ma­nent homes.

Casey’s Child Wel­fare Strat­e­gy Group has suc­cess­ful­ly helped child wel­fare sys­tems in Louisiana, Mary­land, Maine, New York City, and Vir­ginia to reduce reliance on con­gre­gate care. Through the Right­siz­ing Con­gre­gate Care ini­tia­tive, this work con­tin­ues in sev­er­al more sites, includ­ing Col­orado, Con­necti­cut, Delaware, and Wash­ing­ton, DC.

Tougher Road for Old­er Youth

Nation­wide, there’s been notable progress in efforts to min­i­mize the use of con­gre­gate care for younger chil­dren. In Den­ver, for exam­ple, the coun­ty con­vert­ed its Fam­i­ly Cri­sis Cen­ter, once a hold­ing sta­tion— often long term—for infants and tod­dlers removed from their homes, to serve only old­er chil­dren. We said tod­dlers and babies don’t belong there, and we had it reli­censed so no one under 12 could go there. We basi­cal­ly drew a line in the sand and said we are not going to insti­tu­tion­al­ize young kids,” says Pol­lack. The coun­ty is still work­ing to decrease the num­bers and lengths of stay in such facil­i­ties for old­er chil­dren as well. But in Den­ver and else­where, that work is slow going.

We’re in the very ear­ly stages of try­ing to fig­ure out what the research says defin­i­tive­ly” about con­gre­gate care’s impact on old­er chil­dren, notes Barnard. The Child Wel­fare Strat­e­gy Group, in con­junc­tion with the San Fran­cis­co-based Youth Law Cen­ter and Casey’s Pol­i­cy, Research, and Com­mu­ni­ca­tions Group, has com­mis­sioned a lit­er­a­ture review and is con­ven­ing child wel­fare experts, researchers, and pol­i­cy­mak­ers lat­er this year to begin devel­op­ing a research framework.

We are try­ing to get a devel­op­men­tal­ly research-informed approach to group care,” says Car­ole Shauf­fer, for­mer exec­u­tive direc­tor of the Youth Law Cen­ter and now its senior direc­tor for strate­gic initiatives.

Research has been influ­en­tial in curb­ing con­gre­gate care for younger chil­dren, begin­ning with well-doc­u­ment­ed stud­ies on the adverse effects of Roman­ian orphan­ages. A Decem­ber 2011 arti­cle in the Jour­nal of the Amer­i­can Acad­e­my of Child and Ado­les­cent Psy­chi­a­try, titled Fos­ter Care for Young Chil­dren: Why It Must Be Devel­op­men­tal­ly Informed,” cites decades of devel­op­men­tal research on the sci­ence of attach­ment” in sup­port of a focus on per­ma­nent adult connections.

Co-authored by Shauf­fer, who is an attor­ney, with Charles H. Zeanah, MD, and Mary Dozi­er, PhD, the arti­cle under­scores the impor­tance of ear­ly attach­ments to con­sis­tent, nur­tur­ing adults and says fam­i­ly, care­givers, guardians, and kin need to form com­mit­ted rela­tion­ships with young chil­dren to bol­ster their sense of secu­ri­ty and self-worth. Because such facil­i­ties are staffed by peo­ple who work in shifts, group care is the opposite—you don’t even get a full day com­mit­ment, you only get eight hours,” notes Shauffer.

The insta­bil­i­ty of shift care is def­i­nite­ly an issue. When the same per­son get­ting you up in the morn­ing is not the same per­son who sends you to bed at night, it is very dif­fi­cult for chil­dren,” notes Barnard.

While research on the impact of con­gre­gate care on old­er kids is more lim­it­ed, a recent report on ado­les­cent brain devel­op­ment by the Jim Casey Youth Oppor­tu­ni­ties Ini­tia­tive cites evi­dence that young peo­ple need car­ing one-on-one adult con­nec­tions in a real-world set­ting to learn appro­pri­ate risk-taking.

Casey wants to know: Based on what research tells us, what are some devel­op­men­tal tasks young peo­ple need to be able to com­plete to get on the right path, and if we match those up against the con­di­tions, cir­cum­stances, and poli­cies in group care, does it enable them to ful­fill those tasks?” says Shauffer.

For now, what does turn the heads of pub­lic offi­cials is out­come data. What we do know is that chil­dren removed from con­gre­gate care and tran­si­tioned into fam­i­ly set­tings tend to do bet­ter,” says Pol­lack. In con­vinc­ing courts, which can over­ride child wel­fare author­i­ties seek­ing to remove a child from con­gre­gate care, we show them how many kids we can get into a less restric­tive set­ting with­out hav­ing to go back.”

Fam­i­ly set­tings are also more cost effec­tive, and the sav­ings can be invest­ed in sup­port ser­vices. Accord­ing to Casey data, con­gre­gate care place­ments cost child wel­fare sys­tems three to five times the amount of fam­i­ly-based place­ments. In Den­ver, notes Pol­lack, the aver­age month­ly cost for con­gre­gate facil­i­ties is $7,000 a month. We can invest some of the sav­ings into wrap­ping ser­vices around a fam­i­ly and pro­vid­ing ser­vices in the home.” Pro­vid­ing such ser­vices on the front end for vul­ner­a­ble fam­i­lies can help pre­vent a child’s removal from home.

Will Light­bourne, direc­tor of California’s Depart­ment of Social Ser­vices, says such ser­vices are crit­i­cal in a pilot the state is imple­ment­ing that aims to reduce con­gre­gate care to a min­i­mal lev­el. There has to be a very con­scious strat­e­gy to look at the length of stay and out­comes and see some evi­dence that you have assessed each child’s needs for why they are in a high­er lev­el of place­ment, so that it’s clear there is a rea­son, and it’s not just because a bed is available.”

As direc­tor of social ser­vices in San­ta Clara pre­vi­ous­ly, Light­bourne led a mul­ti-year effort to con­vert a state-of-the-art, 132-bed shel­ter that often housed 180 chil­dren a night—many stay­ing for a peri­od of months— into an intake and assess­ment cen­ter. The cen­ter now places kids with rel­a­tives or in fos­ter homes with­in a 24-hour peri­od. The more this work can be informed by research, the bet­ter,” reflects Light­bourne, but that means mak­ing sure it is out there and available.”

Ensur­ing that there are alter­na­tives to group care also means recruit­ing and train­ing more fos­ter par­ents and mak­ing con­nec­tions with any fam­i­ly mem­bers and men­tors who can be part of a child’s team and offer life­long support.

Reduc­ing con­gre­gate care can pose a finan­cial threat to pri­vate providers, but forg­ing new rela­tion­ships is pos­si­ble. In Den­ver, one group of providers accused us of putting them out of busi­ness, while anoth­er took the ini­tia­tive to devel­op a con­tin­u­um of ser­vices includ­ing much less restric­tive set­tings,” notes Pol­lack. These kinds of changes are need­ed, experts say, to reduce the use of group set­tings and help more chil­dren find sup­port­ive homes.

The fam­i­ly envi­ron­ment has helped me more than the treat­ment cen­ters,” says Jas­mine O’Shea. No mat­ter how good it is, it’s just not home.”

The biggest chal­lenge is mak­ing sure there is a strong team back­ing these chil­dren. Kids need to know you believe they will be suc­cess­ful,” notes Dawn Cross­white, who coor­di­nates a Per­ma­nen­cy Round­table in Den­ver and is the senior social case­work­er who works with O’Shea.

She’s worth the fight,” says Crosswhite.

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