Journal Issue: Children, Families, and Foster Care Volume 14 Number 1 Winter 2004
Policy and Practice Implications
The preference for reunification is rooted in American traditions that afford parents constitutionally protected rights, thus it is rather unlikely that the basic framework for child welfare policy and practice in the United States will change significantly in the years ahead. As states devise strategies to meet the needs of children, the U.S. Supreme Court's words in Quilloin v. Walcott are again instructive. The state may not "force the breakup of a natural family over the objections of the parents and their children, without some showing of unfitness and for the sole reason that to do so was thought to be in the children's best interests."37 Thus, states will continue to turn first to parents when planning a permanent home for a child who has been placed in foster care. Child welfare officials will seek out other caregiving arrangements only if the parent cannot or will not provide adequately for the child.
However, the need to identify workable strategies that reduce time in placement prior to reunification and the likelihood of reentry has never been greater. The federal Child and Family Service Reviews stress reduced time in care and lower reentry rates among other outcomes. 38 If a state fails to achieve substantial conformity with the federal standards, the public child welfare agency could face fiscal sanctions. In this last section, the discussion turns to the policy and practice implications that form the challenge ahead.
Two areas of federal policy are especially germane to efforts to improve the reunification decision-making processes in state and local child welfare agencies across the country. The first has to do with the federal Child and Family Service Reviews and the way the federal government measures reunification and reentry. The second area has to do with fiscal incentives and federal funding for child welfare services generally and foster care specifically.
Measuring State Performance
The Child and Family Service Reviews conducted by the Department of Health and Human Services (DHHS) represent a historical milestone in the federal government's efforts to better understand and monitor state child welfare programs. Unlike previous federal efforts that focused on outcomes, the newer standards are focused more squarely on performance, measured in terms directly related to the experiences of children in foster care. Thus, how long children spend in foster care prior to reunification, and reentry into foster care are important indicators of performance. The federal standards pertaining to reunification and reentry are:
- Percentage of children reunified within 12 months of latest removal,
- Percentage of children admitted in a year who reenter care within 12 months of a prior episode.
Of all the issues confronting the child welfare system at this juncture, changing the federal measurement system is quite possibly the most important. In the current plan, DHHS proposes to compare states on these indicators at two different points in time to determine whether the observed changes are consistent with better performance. Although the basic approach is sound, there are fundamental problems with the way DHHS measures performance.39 For example, the reunification standard is based on all children who have exited care (an exit cohort) through reunification. This group is useful to look at for some purposes, but this view of the foster care population excludes children still in care. Therefore, the federal standard does not measure the likelihood of reunification. Also, members of an exit cohort are a select group of foster children, different in ways directly related to system performance. For example, exit cohorts systematically favor children who leave placement after short stays. This situation leaves the impression that the amount of time children spend in foster care is much shorter than it is when measured using the experiences of all the children placed in foster care. As a result, this view can be misleading. In fact, a state's measured performance could show improvement when in actuality performance is declining. Thus, state actions and federal sanctions based on these measures could be predicated on inaccurate perceptions regarding state performance.
The second policy area currently hindering efforts within the child welfare system to improve outcomes for children in foster care has to do with how child welfare services are financed. On the positive side, federal funding for in-home services has increased in recent years.40 However, as discussed in the article by Allen and Bissell in this journal issue, a large share of federal child welfare revenue goes to support foster care programs allocated through per-diem claims that can be made only if a child is in foster care. If a child is discharged from foster care, the basis for making a federal claim disappears, along with the associated revenue. As it now stands, the harder child welfare service providers try to reduce foster care utilization from current levels—either by lowering admission rates (placement prevention), reducing time in care (earlier permanency for children), utilizing less-restrictive settings, or lowering the rate of reentry—the less federal revenue will be available to provide services, even if the changes in service utilization are predicated on the judgments of professionals who choose alternatives to foster care as a way to meet client needs.
Under the current federal funding structure, agencies have to draw primarily on state and local dollars to provide services to families outside foster care.41 Without a permanent solution to this structural dilemma, the federal government's fiscal commitment to foster children will diminish over time, as states successfully meet federal reunification standards.
Of all the child welfare services studied over the past few decades, reunification services have rarely attracted the kind of attention dedicated to other child welfare services, such as family preservation. Thus, the evidence base for successful reunification programs and practices is especially thin, even by child welfare standards. Some researchers have reported favorable results when they worked to increase collaborative relationships with parents, build family-based strengths, address concrete services, and offer aftercare services. But few clinical programs have been rigorously tested using experimental designs. In their review of reunification programs conducted for DHHS,42 researchers could find only two examples of controlled studies (studies that used randomized assignment of clients to treatment and control groups) that tested family reunification services: a study conducted in New York State and another conducted in Utah. In the Utah program, members of the treatment group received intensive services featuring skill building, assistance with concrete services, and help with family members. Families in the treatment group experienced higher reunification rates than families in the control group.43 However, this study also found that reentry into foster care for families in the treatment group approached 27%, comparable to the rate reported in Figure 6.
From a service perspective, it is also important to note that some research, however limited, shows that children in foster care sometimes fare better than their counterparts who were reunified. For example, another study followed a fairly small sample of children in San Diego, looking for well-being differences among children who went home and those who stayed in care.44 Results indicated that children who went home engaged in more risk behaviors and exhibited more behavioral problems. Because the sample is a small one from a single city, it is hard to generalize to other populations and places. Still, the findings serve to remind us to think very carefully about reunification, the process for deciding when a child is ready for reunification, and the services needed to reintegrate the child within the family and community.
Although studies of reunification services are limited, social services research more generally provides a basis for drawing observations about the features of successful programs. However, because so few tested reunification and aftercare programs exist, the tenor of the discussion leans toward promising practices whose program elements provide the basis for designing reunification services. A discussion of these promising practices follows.
Strengths-Based Family Services
Identifying, enhancing, and building family strengths into the service plan holds promise as a means of encouraging birth parent involvement, ownership, and compliance. Ideally, a family strengths perspective uses assessment tools to identify the core strengths a family possesses, such as healthy social supports; access to resources such as employment, public assistance, or child care; or a sense of their own empowerment and agency, and finds ways to incorporate them into the case plan. Family group conferencing,—bringing family members together to decide whether a child should go into placement—is another widely used familystrengths- based approach. However, these types of programs have limited utility if professionals are generally unaware of how family strengths are activated.45
Intensive Family Visitation
Most researchers agree that visits must be part of a planned process addressing the setting, preparation, and various perspectives of parents, children, foster parents, and social workers.46 One study found that children whose parents adhered to court-recommended visitation schedules were more likely to be reunified than were children whose parents had not done so. Family visitation is often viewed as the heart of family reunification. Continuing family connections when children are in care increases the likelihood of reunification and may ease the process of reintegrating a child back into a family.
Children of color, particularly African American children, are disproportionately represented in child welfare. Moreover, the data indicate that African American children are less likely to be reunified than other children. Developing culturally competent practices is a critical step in providing better services to these children and their families. Social workers must be cognizant of cultural differences in the ways families raise children and the ways family members respond to crises within the family circle, to avoid missing signs that a family is ready to bring a child home.
In addition to cultural sensitivity, administrators have to allocate resources in proportion to the needs of the children returning home, and social workers must be trained to recognize the age-specific needs of children and families waiting to be reunified. Babies and adolescents are the children most likely to enter foster care. Thus, to be effective, service programs must be geared to the unique service needs of these two populations.47
Comprehensive and Theory-Based Interventions
Scholars have found that programs that are comprehensive in nature and based on theoretically sound intervention strategies hold promise for effectively addressing the multitude of issues families and children in the child welfare system face. For example, researchers discussing the Multidimensional Treatment Foster Care (MTFC) model state that the intervention "targets multiple settings and determinants . . . is delivered in the community . . . and emphasizes the importance of the parental (or other caretaker) role in providing the youngster with consistent close supervision, limit setting, and emotional involvement and support."48 Another group of scholars assert that multisystemic therapy (MST) should take place within the natural ecology of the family and the community, with a particular focus on the ability of parents vis-Ã -vis their role as primary caretakers.49 Other programs adopt a similar approach to parents and their role within the family. Finally, MST uses a rigorous training protocol that includes orientation, booster training, on-site supervision, and integrity checks. Research indicates that thoughtful implementation of comprehensive and holistic approaches to addressing the needs of family and children in foster care can have positive effects.50
The importance of aftercare services as a component of the service continuum available to children and families is readily apparent given that more than 25% of children who are reunified later return to foster care. Concrete services such as housing assistance or respite care, as well as "soft" services such as counseling, can ease the reunification process. In addition to providing needed services, social workers can assist parents and children as they adjust to family reunification. They can help families understand, anticipate, and appropriately respond to challenges they may face in the reunification process. Generally speaking, however, federal funding for postreunification services is quite limited.51 State expenditures for aftercare services help, but most observers agree that aftercare is the least developed of the services along the child welfare continuum. Results from the National Study of Child and Adolescent Well-Being indicate that less than 60% of the counties surveyed actually mandate aftercare services.52 In most child welfare agencies, post-reunification services are at first intensive but then taper off to less-frequent contact. Yet some families may need some level of services indefinitely.