Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993
Child Welfare Perspective Foster Care Caseloads
The Spring 1991 issue reported that the foster care caseload in most states had increased dramatically in recent years, and that it was widely perceived that the increase was the result of the increase in births of drug-exposed infants. Richard Barth of the School of Social Welfare's Family Welfare Research Group, University of California at Berkeley, reports the following:
The number of children in foster care has continued to increase, although there are recent indications that the rate of increase for children entering foster care has slowed. According to data collected by the Voluntary Cooperative Information System (VCIS), the number of children in foster care grew from 300,000 in 1987 to 383,000 in 1989. By 1991, there were 430,000 children in foster care.13 The increasing number of children in foster care likely results from many factors, including growth in the number of entrants into the system and a slower exit rate from the system. Although no recent national data are available to document this fact, it is evident from data collection in the key states of New York, Illinois, and California.14,15
Quantifying the number of children in foster care who were drug-exposed infants is difficult. There is no national data system that collects this information. However, we do know that, in several states, many very young children are entering foster care. For example, a study of foster care in New York and Illinois found that children under the age of one are the fastest growing category of children entering foster care.14 The researchers concluded that prenatal drug exposure was a prominent reason for these placements. An influx of drug-exposed infants may also at least partly explain why, in California in 1992, 38% of the children in foster care were under the age of five, whereas in 1980, only 32% were in this age group.15Kinship Placements
In the Spring 1991 issue, Charlotte McCullough of the Child Welfare League of America, discussed four placement options for out-of-home care for children: foster care homes, kinship care, therapeutic infant shelter care programs, and orphanages. She provides this update on kinship care, in which relatives of the child serve as foster parents:
The use of kinship care placements for children in foster care continues to grow. Although there is no national database to confirm this, reports from the field indicate a trend toward increased kinship care placements across the country. Specific states have collected data documenting this trend. For example, the number of children in kinship care has surpassed the number in family foster care in Illinois, New York, and California.16,17 There are no separate data on the placement of drug-exposed infants in kinship settings, but it is likely that they are placed in kinship settings no more or less often than are other children in the foster care system.
Kinship care placements are reported to be more stable than foster care placements, that is, there is less movement of the child from one foster care home to another.18 This stability provides a clear advantage to the children in kinship care. However, their length of stay in kinship care tends to be longer than for children in other foster care settings.17 Part of the reason for the increased length of stay relates to the fact that achieving a stable placement with relatives no longer necessarily results in an exit from the foster care system. Often these relatives are provided with continued services or financial reimbursement to care for the child.
Several questions about kinship care need to be answered. Was permanency planning pursued as aggressively for these children? Is continued kinship care appropriate as a permanency plan? Is the kinship family dependent upon the financial reimbursement provided through foster care in order to continue to care for the child? Are continuing services needed as well as financial reimbursement? Is there a more effective and appropriate avenue to provide the needed funding and services outside the foster care system once it has been determined that the permanency plan is continued placement with kinship parents?
In many states, it is not unusual for mothers or even fathers with children in kinship care placement to live in the same household with the guardian-relative and the child. This raises additional questions. Are issues of protection and safety being adequately addressed? Does the kinship parent model positive parenting behavior for the biological parent? What services are offered to enhance the level of family functioning? Are the biological parents encouraged and provided the services and support they need to regain custody of their child?
The attainment of safe, nurturing, lifetime relationships is important for children in kinship care whether or not reunification with biological parents is feasible. We are wrestling with how best to assure children in kinship families a stable legal and financial status to meet their needs and to function independently of the child welfare system.Family Shared Care
Barth describes the arrangements that have developed through model projects or adaptations of existing programs to keep mothers and children together while the mother receives drug treatment and other needed services. These programs seek to achieve the goals of both child protection and family preservation.
At least five models of family living arrangements have evolved to keep parent and child together while one or both are receiving treatment: (1) residential treatment programs for children that also offer residence and treatment for parents; (2) drug and alcohol treatment programs for adults that also offer accommodations for children; (3) drug treatment programs expressly designed for mothers and children; (4) residential programs offering care for pregnant and parenting mothers (once referred to as "homes for unwed mothers," a historically strong but currently waning tradition in America); and (5) foster homes that also accept mothers, usually adolescent mothers.19
Each of these programs accomplishes the goals of child protection and family preservation in different ways. Residences dedicated for drug-involved women and their children are a rapidly increasing strategy but are funded primarily by grant funds and do not yet have an ongoing funding stream to support them. Because of significant initial expenditures needed to create such residences, as well as high staff costs, this approach to shared family care is more expensive than other approaches. Other models for family living arrangement programs, such as children's homes that also accept parents, may not require substantial additional funding to incorporate parents' services. In these instances, the usual roadblocks are administrative policies and staff reluctance to modify an existing program to incorporate parents. Perhaps the most flexible and lowest-cost format involves placement of family groups into foster care, with treatment provided in other settings.
To date, we know little about the effectiveness of each of these alternatives. We also need better plans for promoting the transition from such shared family care to independent living for the parent and child in the community. However, on the whole, these programs have shown promise and warrant additional implementation and evaluation.