Assessing the Context of Permanency and Reunification in the Foster Care System

Chapter 2.
Permanency:  A Balancing Act

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Contents

  1. An Historical Review
    1. The Social History of Child Welfare
    2. Federal Legislation
  2. Current Status of Permanency and Reunification
  3. Programmatic Initiatives
    1. Tools to Expedite Reunification
    2. Special Reunification Programs
    3. System Reform
  4. Implications

References

Endnotes

1. An Historical Review

In the last few decades, foster care of children has come to be viewed as an evil. A necessary evil in some cases, but an evil nonetheless. When possible it should be avoided, since a child's birth family is viewed as the best place for the child except in extraordinary circumstances. When foster care cannot be avoided it is viewed as an arrangement that should be short term, even though it sometimes turns out to be otherwise.

So what is to be done when a child is removed from his or her family and placed in foster care? At present, answers to that question are dominated by the concept of permanency. Children should be afforded living arrangements that are nurturing and long lasting. Foster care itself is not thought of as an appropriate permanency plan, so the intention (not always accompanied by action) in most cases is to move the child into other circumstances. There are many options: reunification with parents, placement with relatives, legal guardianship by relatives or others, independent living, adoption. Not all options are available for every child, but there is usually more than one, so decisions need to be made. It is thought that the best option is to return the child home whenever that is possible, so in most cases that is the alternative that is explored first. Usually at least some work is attempted with the birth parents (or other original caretakers) directed at making return home possible. When work with the parents proves unsuccessful, we turn to other alternatives.

In this paper we develop a framework for thinking about permanency. We place particular emphasis on reunification and on the decision processes that are involved in choosing reunification or other alternatives. We begin with a brief review of the social history of child welfare in the last century and consider the legislative initiatives in various periods of that history (with particular emphasis on federal legislation). We describe the current status of permanency and reunification efforts in the states based on information gathered from several sources, and conclude with a discussion of implications of our investigation and an identification of central policy and practice issues.

1.1 The Social History of Child Welfare

The last century has seen the development of an extensive (and expensive) child welfare system in this country -- a system dominated by government (mostly state and local governments), and a service delivery system dominated by private social service agencies. The system's primary focus is on abuse and neglect of children, having been given responsibility for society's response to child maltreatment. In the last fifty years, in addition to permanency, three other concepts have dominated thinking about child welfare: the best interests of the child, reasonable efforts, and least restrictive alternative. Of these, perhaps the most central is best interests. That we should act in the best interests of children seems unassailable. The question is what constitutes the best interest of an individual child.

The answer to that question has depended on shifting views as to the origins of abuse and neglect and on the importance of the natural family in a child's development. It is generally recognized that many factors enter into child maltreatment, including parental pathology, ignorance, and other failings; disorders of relationships within the family; the social condition of the family, most notably poverty and poor housing; and broader social conditions. The extent to which maltreatment is attributed to something inside the parents, and the extent to which that something is seen as moral failing, has been one of the most significant influences on responses to child maltreatment. Joined to that issue are beliefs about the extent to which people can change and whether some external intervention can bring about that change. On the one hand, some people believe that child maltreatment arises out of personal failings that are quite unlikely to change. Others believe blaming parents is inappropriate and ineffective because in most maltreatment there is a substantial component of cause that is not the "fault" of the parents, and that people, families, and relationships can change.

Views on the importance of the birth family to the child are also central. Early in the last century, those concerned with abused and neglected children recognized the importance of the child's own family. The White House Conference on Children in 1909 said that "home life is the highest and finest product of civilization" and children should not be deprived of home life "except for urgent and compelling reasons" (Proceedings of the Conference on the Care of Dependent Children, 1909). This notion was strengthened by the idea of the parent-child bond, developed in detail by Bowlby (1952, 1969-73, 1988). It is believed that there is a special bond between child and mother that comes out of their biological relationship and is unlike other human relationships. Beyond the special bond, many advocates in child welfare believe that families inherently want to do right by their children.

But the special bond is sometimes violated and sometimes children are harmed by their parents. So are the child's best interests served by removing the child from the parents or by leaving him or her with them? The decision must balance interests in the child's safety with interests in maintaining familial bonds (Goldstein et al., 1996). If a child is removed, it is hoped that the removal will be temporary, that the problems in the family can be relieved enough to return the child home soon (or later). The reunification decision invokes the same balancing: the interest in restoring familial bonds with that of avoiding future harm to the child.(1) In deciding on whether or not to return a child home, the crucial issues are how much must the parents change and how long do we wait for that change to take place before considering other alternatives?

The history of the child welfare system has been characterized by cycles in which emphasis on these two values, maintenance of the family and safety of the child has shifted back and forth. Neither of these values are ever totally repudiated, but at any one time one appears to be dominant. And each value has advocates at any one time. Shifts in the balancing of these values are precipitated by events, changes in the political landscape, and sometimes by changes in expert opinion.

Following Bowlby's work in the early 1950s, concern with the effects of the child welfare system on children began to build. In the late 50s, the publication of Maas and Engler's Children in Need of Parents (1959) had a considerable impact on the field. This study of the situation of children in foster care in several communities showed that children often stayed in care for long periods of time, often did not visit with their natural parents, and often developed behavioral problems. The findings suggested that these children had been abandoned by their parents and neglected by the system. The results could be taken as evidence of the need for reform of the foster care system, or as evidence for the desirability of limiting foster care placement, or both.

The 1960s saw a rediscovery of child abuse with the discovery of the "battered child syndrome." Advances in xerography led to identification of injuries that were unlikely to have had accidental origin (Kempe et al., 1962; Nelson, 1984). States established child welfare agencies to investigate reports of maltreatment and take action when needed. States also enacted laws requiring professionals to report to the state agencies suspicions of abuse or neglect. The dominant concern of the child welfare system with maltreatment was established.

Due largely to increased public awareness, the number of reports of maltreatment and the number of children in substitute care grew enormously during the 1970s and 80s. The number of staff and the budgets of child welfare departments also grew, leading to concerns about costs on the part of state legislatures and the federal government. Worries about increased costs of foster care, the effects of foster care on children, and beliefs that at least some foster care placements were unnecessary led to a swinging back of the pendulum of public concern.(2) Thus was born, in the late 1970s, the "family preservation" movement, the development of policies and programs intended to prevent the placement of children in foster care. Programs designed to work with parents to avoid placement or facilitate the return home of children in foster care had been around for a long time,(3) but a new model for such work, developed by David Haapala and Jill Kinney in the early 1970s, was thought to be particularly promising (Kinney et al., 1991). Called "Homebuilders," the model called for very short term, intensive, crisis-oriented work based on cognitive-behavioral principles. Other models for family preservation were also promulgated. Early evaluations of family preservation programs, particularly Homebuilders, seemed to indicate remarkable success. Few of the families receiving such services experienced the placement of a child. As a result of such evaluations and the skilled work of advocates, led by foundations such as the Edna McConnell Clark Foundation, many states began to develop family preservation programs by the late 1980s. By the early 90s, most states were experimenting with family preservation and both the programs and philosophy of family preservation were well established as cornerstones of reform of the child welfare system.

But the early 1990s also saw the beginnings of a backlash against family preservation. Despite efforts to keep children from entering foster care, between 1987 and 1996 the number of children in the child welfare system placed in out-of-home care increased by 89.5 percent.(4) Deaths or serious harm to children living at home, whose families had previously been involved with the child welfare system were prominently displayed in the media of a number of cities. These incidents were attributed to the policy of family preservation and critics suggested that the interests of families were being allowed to supercede the best interests of children. Legislatures began to write laws affirming that safety of children must come first in making child welfare decisions. A new round of evaluations, this time more carefully designed than earlier ones, began to cast doubt on the effectiveness of family preservation in maintaining families. The research was used by critics, often inappropriately, to bolster their attacks.

By the mid-1990s interest also began to be focused on the "back end" of the system. Lengths of time in foster care had been rising and children were often moved from one placement to another, with consequent disruption of relationships critical to their development. Thus, it was thought that more work should be done with families so that more children could be returned home more quickly. The contrary view was that families should not be given unlimited opportunities to prove themselves capable of safe parenting, the child's sense of time should take precedence. Interest in alternatives such as adoption and relative guardianship grew.

At present the pendulum has swung back. Public understanding of the meaning of best interests of the child again places emphasis on the safety of the child, rather than maintenance of the birth parent and child as a family unit, both in decisions about what should be done in newly discovered cases of maltreatment and in decisions about how to proceed once a child has been placed in substitute care. Alternatives such as adoption, guardianship, and placement with relatives and non-relatives are given more weight and lengths of time before deciding on permanent plans have been reduced. More children are being adopted and fewer are returning home.(5)

1.2 Federal Legislation

It is important to put federal legislation into a proper perspective in the history of the child welfare system in the United States. Legislation largely followed trends that were already underway, rather than creating those trends, so it is a mistake to trace history solely in terms of legislation. Furthermore, child welfare is a state responsibility (often delegated to counties), so in fact there are more than fifty separate child welfare systems in this country. Child welfare laws, customary ways of dealing with family problems, characteristics of caseloads, and salience of various social problems all vary considerably from one jurisdiction to another. All of the innovations in the child welfare system in the past century began in the states, some were later embraced by the federal government. Nonetheless, federal legislation confirmed trends and contributed to them, so a complete picture of the history of child welfare must include it.

The Social Security Act. The Social Security act of 1935 included, in Title IV-B, grants to the states for child welfare services. Most of these funds were initially used for foster care but more recently they have been used for other services. In 1961, as part of the Aid to Dependent Children program, under Title IV-A of the Act, funds were provided to the states for costs of foster care for children eligible for assistance under ADC in an attempt to address barriers to placing children in foster care when their own homes were unsafe. Funding is open ended, provided under a matching grant formula. In 1980 the program was transferred to Title IV-E of the Act.

Funding for foster care under these provisions has constituted, and continues to constitute, the major contribution of the federal government to the child welfare system in this country. The openendedness of the funding has been thought by many to be a significant disincentive to reforms that might de-emphasize foster care, whether through family preservation or alternatives to foster care such as adoption.(6)

The Child Abuse Prevention and Treatment Act (CAPTA, PL 93-247). CAPTA was enacted in 1974, as a result of the heightened awareness of child abuse in the 1960s. Although states had already begun to pass mandatory reporting laws, CAPTA encouraged such laws, provided for the development of standards for responding to reports, and required maintaining records of reports. CAPTA established the National Center on Child Abuse and Neglect and provided funds to the states that adhere to the Act's provisions. The Act contributed to the development of the state child protective agencies that now constitute the core of the child welfare system.

The Adoption Assistance and Child Welfare Act (PL 96-272). Passed in 1980, this Act was a triumph of the advocates of family preservation. It required that states (as a condition of receiving federal funds for foster care expenses) exercise "reasonable efforts" to prevent the placement of children whenever possible and to encourage the return home of children removed from their parents. The Act represented an unusual melding of interests: both those concerned with the burgeoning costs of foster care to federal and state governments and those interested in affirming the importance of family life supported it. Following its passage, states continued to develop family preservation programs and the family preservation philosophy of not removing children unless absolutely necessary took hold. However, it is generally accepted that the Act was never fully implemented. The Act did not include funding for family preservation or reunification programs (there were no carrots in the Act, only the stick of reduced funding if federal guidelines were not followed) and the vague term "reasonable efforts" was never adequately defined so that it was unclear whether the intent of the Act was being followed in individual cases.

The Family Preservation and Support Provisions of the 1993 Omnibus Budget Reconciliation Act. This Act provided funds to the states for family preservation and family support (child maltreatment prevention) programs.(7) This enactment finally put federal funds behind the requirements of PL 96-272. States were required to use at least some of the funds for each of the subcategories of programs, family preservation and family support. However, there is evidence that most of the funds were allocated to family support. The Act came at the time the family preservation movement was beginning to wane.

The Adoption and Safe Families Act (ASFA). ASFA was enacted in 1997, with the waning of family preservation now well under way. It shifted federal guidance away from family preservation to again emphasize the safety of the child, a trend already evident in many jurisdictions. The Act reauthorized funding for family preservation and family support but added reunification and adoption services to the list of activities that could be supported by the funds. Other provisions of the Act limited the length of time most children could be in foster care before an alternative other than return home was pursued, encouraged "concurrent planning" (planning for both return home and other alternatives at the same time), and encouraged states to increase the number of adoptions. The Act confirmed the swing of the pendulum back to emphasis on the safety of the child.

Income Support Programs. Welfare programs have long had substantial effects on child welfare and indirectly on the child welfare system. Aid to Dependent Children (later Aid to Families of Dependent Children), enacted as part of the original Social Security Act, provided financial support for destitute children and is thought to have prevented the involvement of the child welfare system in many families. The welfare reform of 1996 (PL 104-193) eliminated AFDC, replacing it with Temporary Assistance to Needy Families. In the process, the federal entitlement to welfare assistance was replaced by block grants to states. Adults who receive assistance must engage in activities that will lead to work and the length of time on welfare is limited in most cases to a lifetime total of five years.

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2. Current Status of Permanency and Reunification

The current child welfare system is characterized by an emphasis on the safety of the child. Lengths of time before deciding on permanent plans have been reduced, and more weight is being given to permanency options such as adoption and relative placements. The current emphasis on safety and expedited permanency for children has led to new state legislation and regulation. The provisions include holding permanency hearings sooner, practicing concurrent planning, and establishing a more expedited track to filing termination of parental rights (TPR) when reunification is inappropriate. Discussions with state and local child welfare staff about permanency elicit responses about the legal responsibilities of the state to provide safety for the child, limiting the child's time in foster care by expediting the process of the child returning home or being placed in a permanent home outside the child welfare system. Emphasis is on the safety, health, and well-being of a child; and the importance of finding a solution to meet the physical and emotional needs of the child.

Child welfare staff are left to safely expedite the best permanency solution for a child within time limits, while facing the reality of family problems. With a focus on child safety and away from the family unit, there seems to be less emphasis on services to resolve parental problems necessary to maintain the family. Caseworkers must cope with difficult and chronic family problems, and often lack resources and services to adequately address family needs. Yet they must achieve the goals of safety and permanency for a child, and make decisions on where the child will be placed within the timelines set by law. As a result, time is at the forefront of permanency decisions made by caseworkers. Gone are the days when extended periods were granted to assist parents in resolving their problems in order to reunify the family. Instead, workers are pressed to expedite a family assessment and case plan for the family. However, with large caseload sizes, workers have less time to spend with families. Parents can be difficult to engage after a child is removed from the home, particularly when drug or mental health problems are an issue. If parents are apathetic and unresponsive to initial attempts for treatment, workers have little time to spend providing personal support or handholding. If parents are not able to meet case plan goals to rectify problems that brought their child into care within 15 months, they risk losing parental rights to their child. Unfortunately, substance abuse and mental health problems are not easily resolved in short time periods.

So given the time limitations to resolve permanency where does this leave reunification in the permanency continuum? The Adoption and Safe Families Act upheld requirements that reasonable efforts be made to preserve and reunify families. However, at the same time, ASFA instituted a major change in the reasonable efforts requirement by making the safety and health of the child the paramount consideration in decisions to return a child home. ASFA specifies it is not reasonable to reunify children with their parents when: 1) a court determines that a parent has committed murder or voluntary manslaughter of one child, 2) a parent commits serious bodily injury to a child, 3) a parent has subjected the child to aggravated circumstances as defined by state law, or 4) parental rights to a sibling have been involuntarily terminated. In other cases, reasonable efforts must be made within specified time limits.

Despite the changes in regulation, child welfare administrators and staff reported overwhelmingly that reunification is always the first permanency option considered for families, with very few exceptions. However, the questions remain -- to what extent is reunification seen as feasible within the time limits, and as a result, is reunification receiving true commitment by service providers? Are reunification services adequate given the new time limitations?

Many states and localities are working to institute new programs to better serve children and parents working towards reunification within the time constraints.(8) But in many agencies around the country, the reality is that staff work with constrained resources, and as a result, child well-being and permanency take priority over the focus on successfully treating parents and reunifying families.

There appears to be a broadening of the traditional notion of reunification in some states and localities. Several states and localities count permanent placement with a relative as reunification (sometimes called family reunification). It is not clear whether this trend is something new in response to shortened time requirements for permanency, or a longstanding practice for some states or localities.

Emphasis on other permanency options. With the increasing pressures to expedite permanency, states and localities are considering a number of alternative permanency options. Permanency options reported by states now include adoption, relative placement, guardianship placement, and independent living.

Many states and localities now practice some type of concurrent planning on cases. Concurrent planning is the process of planning two strategies for permanency for a child from the start of a case. This process involves a primary plan, usually a goal of reunification, and at the same time the worker plans an alternative permanency goal for the child (e.g., permanent relative placement, guardianship, or adoption) in case the primary goal is not achieved within the set timelines. Workers seek out commitments by relatives and other possible caregivers early in case the parent does not resolve his or her problems within the time limit and termination of parental rights is necessary. Planning alternative options earlier appears to be popular although in many jurisdictions this process does not take shape until after a determination has been made by the worker and supervisor that the family will not reunify. Workers mention that concurrent planning can create tension between themselves and parents, and they also find their "dual role" of simultaneously supporting family reunification and planning alternative permanency conflicting. For these reasons, and also because workers have little time for dual planning, workers may provide some preliminary planning on alternatives (contact relatives or close friends of the family) but true planning for an alternative placement is often left until it is determined reunification for a family is not feasible.

States are increasingly turning to relatives as a permanency option. In fact, relatives seem to be the main avenue to permanency when reunification is not possible. A majority of state administrators reported an increase in the use of temporary and permanent relative placements over the past few years. Relative placement may be more popular as an option because children placed with relatives are exempt from the ASFA timelines, although some state law time limitations apply to relative placements.

Placing children with relatives when a parent is unable to care for the child has been practiced among families for generations. But in the past many of these arrangements were informal kin placements outside the child welfare system. Once in the foster care system, states and localities use relatives in a variety of ways to create permanency for children including as licensed foster care placements, informal placements, legal guardians (subsidized and unsubsidized), adoption, and some local communities recognize placement with a relative as reunification. In some cases, the process of finding relative caregivers begins at the time it is suspected that a child may enter the foster care system. Identifying and relying on kin for placements early can divert children from foster care, but at the same time may also lessen the use of services necessary to alleviate problems between birth parents and their children, leaving little chance for reunification.

States prefer transferring legal custody of children in kin placements to relatives so that the child is no longer in state custody. This decreases expenditures by reducing both foster care and administrative costs. Moreover, states believe that legal custody by kin provides a more stable permanent placement for a child and reduces the chance that the child will return to foster care. To this end, many states have implemented a more stringent policy, requiring relatives to take legal custody or adopt children, if they are to remain in the relative's care. Such policies are intended to provide a more permanent home for the child and reduce the chance that the child will re-enter the foster care system. However, this policy may not be effective for permanency because relatives may not be willing to legally take a relative's child or become involved in the termination of parental rights due to the delicate nature of family relationships. Kin may also be unwilling to endure the burdensome process of adoption or may be unable to care for a child without financial support. States are working to relieve relative burdens by using mediation and financial support to address relatives' needs. Many states have recently developed guardianship programs and initiatives (subsidized and unsubsidized) to address these concerns. In addition, many states have simplified procedures for guardianship and kinship assistance, and have implemented new programs specifically to support grandparents as guardians. However, despite states' current implementation of programs to alleviate the burden placed on relatives, it is important to recognize that the changing roles of relatives have changed the child welfare system. If the trend continues, service structure, and particularly reunification services, may be affected as states and localities move to address the service needs of children and their relative caretakers.

With implementation of new timelines for permanency, adoption has been given a great deal of attention as a permanency option. Under ASFA, termination of parental rights usually takes place after a child is in foster care 15 of the most recent 22 months. Since ASFA, there has been an increase in the number of children freed for adoption in many states.

Voluntary TPR can be difficult to obtain from birth parents and more states and localities are using mediation counseling to resolve issues between parents and the agency to make the process easier for parents and their children. The voluntary relinquishment of rights is sometimes facilitated by good relationships that have developed between the foster parents and birth parents, and some agencies reported that such relationships are more often cited as leading to open adoptions, allowing the birth parents to maintain some contact with their children. However, the process can be difficult in involuntary TPR cases. With involuntary TPR, workers must document parents' lack of progress in a case and present it at a court hearing, and parents may have legal representation at these hearings and may bring witnesses to support their opposition.

ASFA established a number of incentives to states for placing children in adoptive homes, including financial assistance for states, local communities, and courts that reach targets for increased numbers of adoptions. ASFA also requires states to use cross-jurisdictional resources for adoptive and permanent placements and denies federal assistance to a state that impedes the placement of a child for adoption outside the jurisdiction.

Adoption is commanding a great deal of worker time and public money. There is a good deal of discussion about the expansion of adoption and how that has prompted the need for adoption expertise, increased adoptive services and larger adoption units, and budget changes to addressthese adoption needs. States have found it difficult to find an adequate pool of adoptive parents to meet the needs of children freed for adoption. Changes are ongoing in states focusing on recruiting an increased number of adoptive parents (to meet the increasing numbers of children waiting), using foster families as adoptive homes, broadening the geographic area for adoption home consideration, and promoting adoption through web sites. Despite these efforts, states will likely end up lacking an adequate number of adoptive homes for children in state custody, resulting in an increased number of "legal orphans" -- children whose partents' rights have been terminated but for whom no adoptive family has been identified.

Guardianship has also become a popular permanency option. Guardianship placement can mean many different things -- placement with relatives or non-relatives, subsidized or unsubsidized placement. Guardianship provides states an additional avenue to move children out of state custody. Many states have implemented some type of guardianship option and others have plans to institute guardianship soon. States are quickly realizing the benefits of guardians and are using state funds (or using federal waiver money) to institute financial support to promote guardianship placements.

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3. Programmatic Initiatives

While these alternative permanency options are receiving much attention, reunifying foster care children with their families is still the initial goal of almost every case coming into the system. Routinely, caseworkers follow basic elements of standard reunification practice including:

  1. Meet with birth parents to establish a service plan that outlines the steps they need to take for the child to return home;
  2. Provide or refer parents to services to meet goals of the service plan;
  3. Supervise visitation between parents and children;
  4. Monitor and evaluate parents' progress in remedying the problems that brought the child into care; and
  5. Based on parents' progress, make recommendations to the court to either return the child home or pursue an alternate permanency option.

In the majority of cases, these steps are still effective in returning the majority of children to their parents in a short time frame. Yet, these techniques fail other children who can languish in the system.

Some agencies have implemented intensive reunification programs within their foster care units. These programs follow these same steps but give the workers smaller caseloads and flexible funding to provide additional services to the birth family to return children home more quickly. In addition to these "regular" reunification procedures, many states and counties have adopted special reunification efforts to facilitate reunification. Balancing reunification and expedited permanency has led to the development of a number of new initiatives. These initiatives can be categorized into three broad categories: 1) tools to expedite reunification, 2) specialized reunification programs, and 3) system reform efforts.

3.1 Tools to Expedite Reunification

Interviews with state administrators suggest that the following tools are gaining popularity to facilitate and speed reunification within traditional child welfare agencies.

Family Conferencing. Family conferencing, which is also known as family group decision making, was the most commonly identified new practice that states were using to enhance reunification efforts. Family conferencing was originally developed in New Zealand in response to concerns of indigenous people that Eurocentric expert-driven models were undermining their families and tribes.(9) The family conferencing model recognizes the strengths of families and their ability to help design solutions to child and caregiver problems. This model focuses on the extended family to make plans to ensure the safety of children at risk of abuse. As used in the United States, family conferencing involves inviting extended family members, friends, and members of the family's support network such as ministers or priests, to attend a meeting at the time of initial placement to discuss the problems that have brought a child into care and what needs to be accomplished for the child to return to a safe home environment. Rather than having the caseworker serve as the expert to determine what the family needs to do, the family is encouraged to come up with plans for what needs to be done. In practice, family conferencing programs vary in the extent to which families are empowered to come up with their own solutions. In some localities, family conferencing is a means to inform families about the permanency planning process, what is expected from the family, and what the repercussions will be if problems are not remedied in a timely fashion (i.e., the termination of parental rights). In other areas, family members are expected to participate fully in the design of the intervention and service plan to provide an environment where the child can one day return home. Ideally, family conferences are used throughout the service process to evaluate progress and make new plans as necessary. Supporters of family conferencing believe that it is effective because it identifies additional supportive resources for the parent and child, helps to break down the sometimes adversarial relationship between child welfare staff and family so that all are working toward a common goal, and serves to give the family notice of the consequences of inaction on the part of the parent.

Intensive Visitation. Intensive visitation programs try to increase safe and healthy contact between parent and child to maintain a strong bond and keep the parent focused on the goal of the child's return home. In response to research identifying visitation as one of the most important factors in reunifying families, Pennsylvania created a statewide manual on visitation. The manual provides practice guidelines to counties on how to make sure parents maintain contact with their child. The process is primarily focused on systematically changing visitation policy at an agency's administrative level, and then instituting administrative oversight (at the county level) of workers. In Tennessee, the state contracted with a private provider to provide therapeutic or intensive visitation between parents and children.

Foster Parent Mentoring. Foster parent mentoring is used to develop a helping relationship between the foster parent and the birth parent so that the foster parent serves as a source of support and learning for the birth parent. Under ideal circumstances, a mentoring foster parent has regular contact with the birth parent, allows visitation in his or her home, models good parenting behavior, and serves as a means of social support for the birth parent while the child is in care and even after the child returns home. Caseworkers we interviewed felt that when foster parents were willing to work with birth parents there were positive results in terms of greater visitation and the birth parents viewing the foster parents and agency as less of a threat.

While these tools are used to help facilitate reunification, they may also facilitate a permanency plan other than reunification. Workers told us that, at times, a consequence of foster parent mentoring was the birth parent's decision to voluntarily relinquish parental rights and consent to adoption of the child by the foster parents as the birth parent felt the child would be better off with the foster parents. Similarly, one state administrator told us family conferencing can help parents realize much earlier in the process that they are not going to be able to parent their child and this expedites permanency for the child.

3.2 Special Reunification Programs

Beyond these reunification tools that are implemented in many foster care agencies, many states and counties have developed special reunification programs. These specialized programs are designed to serve families or children with particular needs, or for programs designed as an alternate approach to traditional reunification practices in foster care systems. Some of these are structured as managed care or performance contract efforts. Some emphasize concurrent planning. Others are community oriented efforts while still others make use of other approaches such as "wrap-around services" (intensive efforts to provide extensive community supports for the family) and court-based services. The concepts of permanency, time limits for making decisions, and use of community resources pervade these programs. The importance of ongoing contact between children and their parents is generally recognized, so visitation is a part of all programs directed at return home, although it is handled in various ways in different programs. In other respects, there is great variation in the ways common goals are pursued.

Specialized or innovative reunification programs can be classified into four categories:

Programs for Substance Abusing Parents. Programs for substance abusing parents focus on working with a population recognized as one of the most difficult to reunify, particularly under the constraints of the ASFA timelines. Long-term substance abuse is a difficult behavior to eradicate. Even when parents are motivated to change, repeated relapse is common before they are ultimately free of drugs. Two types of programs developed to combat substance abuse among parents are drug courts and residential treatment programs.

Drug courts represent an approach to treatment of drug abusers that includes sanctions enforced by the court. One such program is the Drug Court Recovery Project in San Diego County, California. When a custody petition is entered and the caseworker has identified substance abuse as a contributing factor to the abuse or neglect of the child, the parent is referred for inpatient or outpatient substance abuse treatment and regular drug testing. Parents' failure to comply with treatment may result in the court exercising a number of sanctions including 3-5 days in custody and/or a monetary penalty for contempt of court, and upon the third failure to comply a referral is made to the Dependency Drug Court Program. Participation in the program is voluntary and subject to the approval of the court judge. In this program, parents continue to receive treatment for substance abuse, but must make frequent court appearances to report their progress to the judge during phases of the program. Phase 1 of the Dependency Drug court requires a court appearance once a week for 90 days; phase 2 requires a court appearance once every two weeks for 90 days; and phase 3 requires a court appearance once a month for 90 days. The Dependency Drug Court hopes to encourage compliance through the heightened supervision of the court and through peer support. Parents receive praise for compliance and are given tokens for the number of days of sobriety maintained. Failure to comply results in sanctions of up to 5 days in custody or dismissal from participation and evaluation for TPR.

Another specialized approach to working with substance abusing parents is the development of residential treatment programs for drug dependent women and their children. Mothers Making a Change (MMAC) in Cobb and Douglas Counties in Georgia is a comprehensive program that includes community outreach, early intervention, family preservation and support services, and substance abuse treatment services. MMAC's services are based on a non-threatening treatment model that is family-centered, community-based, and encompasses a holistic approach to treatment. MMAC recognizes that substance abuse is usually one of many family problems, and addresses not only the addiction but education, health, housing, and employment in a holistic fashion. The program recognizes that to keep a parent and child together requires resolving the problems of the parent. Therefore, services are mother and family focused rather than child focused. The hallmark of the MMAC program is a residential substance abuse treatment service. Clients receive intensive services to conquer addiction for 90 days in the Ready to Work program at the Cobb County facility. In the second phase of the program women are transferred to the Douglas County facility, (a complex of apartments rented by the program) where they spend 9 months receiving services focused on anger management, child development, parental skills, nutrition, and education. Most women are reunified with their children during this phase. In the final phase, clients receive 6 months of aftercare focused on support to minimize the risk of relapse and on finding employment.

Programs for Children with Severe Problems. While the drug courts and residential substance abuse prevention programs target parents whose problems make them among the most difficult to reunify, other innovative programs target children whose severe problems make reunification difficult. Children with severe mental health problems who end up in the child welfare system are difficult to reunify as their parents' problems with parenting are exacerbated by the children's serious mental health needs. Finding a way to reunify children who have been institutionalized due to their mental illness is a real challenge. Wraparound services were mentioned by several states as an effective way to reunify emotionally disturbed children with their parents. Wraparound services refers to an approach whereby an extensive array of services are individualized and "wrapped around" the family unit to support their strengths and meet all their needs with respect to personal and community safety, education, emotional and physical health, family life recreation and legal issues.

Wraparound services are used by the Santa Clara County California Department of Family and Children's Services for emotionally disturbed children who have been placed -- or are at risk of being placed -- in their highest level of care residential placement facilities. Through the efforts of two wraparound programs in the county, children and their families are provided with an individualized array of program services to maintain the child in a more normalized setting outside of an institution. The program uses a team approach with a variety of specialists within the agency working with parents to make decisions about what services the family needs to keep the child within the home. A crisis line is available with program specialists on call 24 hours a day to go to the family's home to intervene as necessary. At times, as many as 12 staff members may be assigned to work with one family. Although these intensive wraparound programs are costly in terms of resources, workers report the services are successful in returning children to their homes who would otherwise stay institutionalized until they reached the age of majority.

Community Based Models. Across the country, community based models for providing foster care and reunifying families have become more prevalent. The Annie E. Casey Foundation's Family to Family Initiative is one of the more widely used community-based models. This model seeks to reform foster care systems so that 1) there is better screening of cases to determine if out-of-home placement is necessary, 2) children in institutional settings are returned to their communities, 3) foster families are used as team members to facilitate family reunification, and 4) family-centered neighborhood-based services are developed to strengthen the communities from which foster children come.

Community-based reunification programs try to recruit foster families to serve children in the communities where the children reside so that there are no unnecessary disruptions of school and peer friendships. The Lucas County Ohio Community Development Department adopted the Family to Family model to help facilitate reunification. Six neighborhood community centers have been given subcontracts from the department to provide space for family visitation, parenting classes, and family conferences. The families find the community centers more convenient and less intimidating than the Department's downtown offices. In addition to providing space for Department use, the community centers themselves are multi-service agencies that provide recreation, family counseling, health services, and after-school programs. Community advocates from the Department are linked with families shortly before a child is to return home. Their job is to provide intensive in-home services to parents and children to prepare them for the transition and to stabilize the reunified family. The community advocates introduce families to the community centers so that the community centers can serve as a resource for families once services by the community advocate end. The goal of the program is to use the community centers as a resource that troubled families can draw upon to prevent abuse and neglect and another out-of-home placement.

Family Preservation Intensive In-Home Services. A fourth widespread approach to specialized reunification services are programs that use the family preservation model of short-term intensive in-home services. Caseworkers assigned to these cases have small caseloads of 2 to 5 families, are available to the families 24 hours a day, seven days per week and go to the home to provide services to the families. Typically the families start to receive services a few weeks before the child is to return home and the services last for 8 to 12 weeks until the family is stable and the child has been reintegrated into the family. The amount of service is intensive with families typically receiving between 10 and 20 hours of services per week, depending on the families' needs.

A variation of this family preservation model is the Natural Parent Support Program which operates in central New Jersey. Like family preservation programs, the program provides home-based services to families whose children are soon to be returned home. The services are typically less intensive than family preservation services and workers work with families in their homes an average of 5 to 7 hours per week. However, families receive services for 6 months, a much longer period of time than families are usually served by family preservation programs.

The services are family-focused with an emphasis on trying to support the parents' ability to be successful parents through behavior modeling, mentoring, advocacy for school and other services, and family counseling. The program also provides concrete services such as transportation to appointments, child care, and help finding housing and employment. Workers have caseloads of five to seven families. This program occupies an important niche between family preservation programs which provide more intensive services but can only serve a few families as caseloads are limited to 2 or 3 families per worker and traditional reunification services where caseworkers have much larger caseloads and provide families with much more limited attention.

While the special reunification programs described represent different approaches to reunification and serve different populations, these programs, with the exception of the drug courts, share several elements in common. First, they are predominantly family-focused rather than child-focused or parent-focused. They stress working with the entire family to provide the support and resources necessary for the family to function effectively as a unit. Second, they develop a well delineated case plan with the parents that identifies what is necessary to return and keep children in the home. Also, there is an emphasis on active work with the parents to make sure that the goals of the case plan are met. Reunification services provided within the context of standard social service practice typically put much more of the onus on the parents to comply with the case plan and, given the size of their caseloads, can rarely provide the intensive one-on-one attention that is evidenced in these specialized programs. Third, these programs are comprehensive efforts to address a range of issues that effect the parent's ability to be a good parent. They focus on much more than remedying the problems that brought the child into the system but on making sure families are stable with respect to housing, employment, and networks of support. Fourth, services are individualized and customized to meet the unique needs of the families. Finally, these reunification programs start their intensive reunification efforts once a decision has been made to return the child. These programs help parents and children prepare for and then make the transition to home and then expend considerable time and resources to stabilize the family so that the child can remain home permanently.

3.3 Systems Reform

Today there are a number of ideas for reforming the child welfare system that compete for attention. We appear to have a rich menu of possibilities but little agreement on what to try next. Some of the current ideas include:(10)

Divided Systems. Some jurisdictions are focusing on the front end of the system and experimenting with differential responses to reports of maltreatment. Two separate processing streams are available for reports, one investigative and law enforcement oriented and the other oriented toward assessment and support of the family. The first system is available in very serious circumstances when it appears the criminal justice system should be invoked. But it is thought that most cases of maltreatment can be handled in the second system which avoids determination of blame and instead focuses on how the family might be helped to attain better functioning. Cases in the second stream avoid the "investigation" that is usually the initial response to a report of maltreatment. A differential response system is being tried in Missouri and in a few other jurisdictions.

Alterations in Financial Structure and Performance Responsibility. This approach is based on the belief that problems in the functioning of the child welfare system are the result of suboptimal relationships among responsible organizations, particularly the relationships between the public child welfare agencies and the private agencies that provide much of the service under contract with the public agencies. Hence, the approach focuses on restructuring those contracts. One motivation for this restructuring is the belief that the financing of foster care (based on open-ended federal appropriations) encourages placement in the first place and discourages termination of placement once the child is in care. Hence, we should alter the incentive structure for agencies responsible for providing foster care to encourage quicker termination of that care. This can be accomplished through managed care contracts, modeled after managed care arrangements in medical care, in which flat-rate payments are made for service to a group of children or families for a period of time, instead of payments for particular services provided. An example of such contracts is the agreement by a private agency to serve a group of children in foster care for a fixed sum. The incentive structure is thus changed through a rearrangement of the financial risks the parties undertake. If a child is in foster care for a shorter period of time than expected, the agency "makes money" while if the child is in care a longer time, the agency loses money. The incentive is to reduce the time a child is in placement. An early example of a child welfare, managed care program is HomeRebuilders in New York City.(11)

A second motivation for altering organizational relationships is the observation that traditional contracts with agencies specify the services to be delivered, rather than the outcomes to be achieved. This leads to performance contracting, in which payment and contract renewal is based on the achievement of goals defined in terms of outcomes, such as terminating placements for a certain proportion of cases covered by the contract. Illinois, together with some other jurisdictions, employs performance contracting in some of its contracts.

However, as in medical managed care, when financial incentives drive the system of care, quality of service may suffer, so mechanisms for assuring quality are often added to managed care and performance contracting. Unfortunately, in arenas such as child welfare, the measurement of quality of service is often problematic, and so it is unclear whether quality assurance programs will succeed.

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4. Implications

The overall goal of the child welfare system has always been to maintain safety and permanency for children. Historically, the path to this goal has been riddled with ambivalence. At any one time, society emphasizes either family or child. A true balance of these interests seems elusive and the result is a child welfare system constantly in tension. Any choice of emphasis results in new tension which must be managed. A comprehensive approach to addressing the needs of both children and their families remains to be found.

The current tension is the result of shortened timelines for permanency decisions. Although it is in line with the child's "sense of time,"(i.e., his or her developmental needs) it conflicts with the fact that parental change often takes longer than is permitted under the new deadlines. In turn, this has created a tension among permanency options. Reunification remains the initial goal for the majority of children entering foster care. Yet, the concept of permanency has broadened, with an emphasis on other options such as adoption, guardianship, and placement with relatives. The challenge becomes viewing the goals as a continuum rather than competing forces.

New time limits give workers permission to remove a child from foster care by finding an alternative permanent home at 15 months, if reunification is unlikely. Concurrent planning is the primary tool used to comply with the new time requirements. Concurrent planning has changed the focus and approach of case planning and decision making. It requires caseworkers to make a primary plan, usually a goal of reunification, and at the same time make plans for an alternative form of permanency. There are inherent tensions in the approach, starting with the conflict it creates around a principle of casework -- that social workers are trained to have full confidence in a client and focus on a client's ability to change. Reunification efforts require total commitment and should not be approached with the expectation of failure. Instead, a worker develops a plan for the purpose of inciting client change, while at the same time the worker develops an alternative permanency plan in case client change does not occur. There is some shaping of the concept in the field. In some locales, emphasis is placed on concurrent planning involving relatives and foster parents, and not on stranger adoptions as an alternative plan. Perhaps this makes the concurrent planning concept more acceptable. Also, many workers initially identify a "back-up" plan but do not actively pursue it until they have determined that reunification is unlikely.

Balancing permanency and child safety in shortened time frames has resulted in a variety of responses throughout the service delivery system. Greater pressure is being placed on the courts to make permanency determinations in shorter timeframes. Since the implementation of PL 96-272 in 1980, which instituted 18-month court case reviews, there have been complaints of overburdened family courts and extensive delays in case reviews. The ASFA requirements of the 12-month court case review, permanency decisions by 15 months, and the increase in TPR cases, have put additional burdens on the court system.

New emphasis on relatives as a permanency option has created tensions between those who believe that relatives are the best way to keep children within the family unit and those who believe that "the apple does not fall far from the tree." Relatives are sought to keep children out of the system, as placements once a child has been put into the system, and as alternative options to reunification. Debate about the role relatives play is complicated by who is defining permanency and whether it is considered an emotional state of being, a legal status, or a fiscal issue. No matter the perspective, relatives are an increasingly used resource and the debate over their role, the services needed to maintain a child in their custody, and the value placed upon them as resources needs to be addressed.

The shortened timeframes of ASFA have shifted from a presumption of reunification to a presumption of permanency, with reunification being a major option. As a result, there is greater emphasis on a parent's responsibility to change despite ASFA's implied expectations for reciprocal responsibilities of agencies and parents. Personal responsibility from the parent is important for successful reunification, however for family reunification to have a chance, the agency must uphold its responsibility to facilitate adequate services. Successful reunification requires addressing the problems of the parent, and that entails more than drawing up plans, setting appointments for treatment and visitation, and checking in with the parent to verify progress. Greater success in reunifying families comes when agencies and their staff work to share the responsibility with parents by assisting and supporting parent treatment and visitation, and providing adequate concrete and emotional support to bridge the gap between the parent problem and successful treatment.

This agency responsibility puts pressure on the service delivery system to develop targeted services to meet the needs of parents in a timely manner. Programs are varying the intensity of services, the length of time that services are provided, the point in a case when reunification services begin, and the extent to which post-reunification services are available to families. To target services effectively, information is needed on which services work best for which families and under which circumstances, focusing on accomplishing reunification in a time-limited period.

The priority of child welfare agencies is to provide safe and permanent environments for children. The best way to accomplish this goal is to balance the needs of children and their families. The needs often conflict, creating inherent tensions at all levels of the service delivery system. While the tensions can be frustrating and even confusing, it must be recognized that the tensions are intrinsic to the problems being addressed. The challenge is to learn to successfully manage the tensions and use them as a vehicle for positive change. New policies are creating environments that emphasize child safety. Yet, programmatic efforts are being developed to try to balance the needs of children and their families. It will be very important to track the effects of policy changes on child, family, and system outcomes. Some of the questions to be answered include: Will reunification rates drop significantly? If they do, will children be in other permanent arrangements or in legal limbo? Can concurrent planning be implemented effectively and if so, is it an effective approach for permanency? How will it impact reunification of families? And how are children faring under the many permanency options?

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References

Bowlby, John (1952). Maternal Care and Mental Health. Geneva: World Health Organizations

Bowlby, John (1969-1973). Attachment and Loss. London: Hogarth.

Bowlby, John (1988). A Secure Base: Parent-child Attachment and Healthy Human Development. New York: Basic Books.

Child Welfare League of America. Stat Book (1999). CWLA Press, Washington, D.C.

Excerpts in Robert H. Bremmer, Ed., Children and Youth in America, Vol. 2, Cambridge, MA: Harvard university Press, 1979.

Goldstein, Joseph, Albert Solnit, and Anna Freud. (1996) The Best Interests of the Child: The Least Detrimental Alternative. New York: Free Press.

Kempe, C.H., Frederic N. Silverman, Brandt T. Steele, William Droegemuller, and Henry R. Silver (1962). The Battered Child Syndrome. JAMA 181(1): 17-24.

Kinney, Jill M., David Haapala, and Charlotte Booth. (1991). Keeping Families Together: The Homebuilders Model. Hawthorne, NY: Aldine de Gruyter.

Maas, Henry S. and Richard Engler, Jr. (1959) Children in Need of Parents. New York: Columbia University Press.

Nelson, Barbara J. (1984) Making an Issue of Child Abuse. Chicago: University of Chicago Press.

Pennell, J., & Burford, G. (2000 March/April). Family Group Decision Making: Protecting Women and Children. Child Welfare, LXXIX (2), 131-158.

Wood, Katherine M. and Ludwig L. Geismar. (1989). Families at Risk: Treating the Multiproblem Family. New York: Human Sciences Press.

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Endnotes

1.  The motivation for keeping a child in his or her home and returning a removed child is sometimes put in terms of maintenance of family integrity. This view stresses the value our culture places on the privacy of the family and the right of families to determine how they want to raise their children.

2.  There was also concern at the time that the financing of the child welfare system contributed to the increase in foster care. The federal government, through provisions of the Social Security act, provides open-ended partial financing of foster care costs of the states. At the time, federal support for prevention of maltreatment or for services to avoid placement was much less available.

3.  For example, the St. Paul Family Centered project of the 1950s (Wood and Geismar, 1989).

4.  Child Welfare League of America Stat Book (1999) CWLA Press, Washington, D.C. citing American Public Welfare Association's, Characteristics of Children in Substitute and Adoptive Care: (1993). A Statistical Summary of the VCIS National Child Welfare Data Base. (1998) Washington, D.C., Child Welfare League of America.

5.  See Reunification From Foster Care in Nine States: 1990-1997, Description and Interpretation, in this reunification series.

6.  States have used some funds from the Social Services Block Grant (Title XX of the Social Security Act, passed in 1975) for child welfare, including prevention and family preservation programs.

7.  Despite the intention of the Act, most family support programs do not explicitly include maltreatment and prevention/reduction among their goals and do not target children at significant risk of maltreatment.

8.  See Section 3 of this paper for more information on reunification efforts.

9.  Pennell, J., & Burford, G. (2000 March/April). Family Group Decision Making: Protecting Women and Children. Child Welfare, LXXIX (2), 131-158.

10.  Other system reform practices not discussed here include strategies to redesign and restructure the foster care system such as those initiatives ongoing in Oregon, North Carolina, and Ohio.

11.  See the HomeRebuilders Evaluation on the World Wide Web at http://aspe.hhs.gov/hsp/NYC-HomeRebuilders99/index.htm


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