Reducing Congregate Care: Worth the Fight

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

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 5–10 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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