UNADOPTABLE?

Jeanine and Molly* spent their early childhood with their homeless mother. When she died they entered foster care. The sisters had been diagnosed with borderline intellectual functioning (50-70 IQ range) and little interest in adoption or guardianship. Their specialized permanency services worker was told the girls were incapable of forming any attachments and were not socialized. With counseling over time, the girls realized that a permanent family was something they wanted. They became their own best advocates, identifying several potential connections, none of whom were able to offer the sisters permanence.

A few months later, they approached a faculty member at their school and asked if she and her husband would be their guardians. The couple agreed to explore the idea. Once the frequency of the visits increased, the girls made dramatic progress. Their social worker now describes them as “talented, outgoing, and even gregarious.” They graduated from middle school on the honor roll and are getting straight A’s in high school with the support of their adoptive parents.

*names changed for confidentiality

Why does it matter?

Children are our future, a precious resource we dare not squander. Young people aging out of foster care face enormous challenges for achieving a successful adulthood. Studies show:

  • More than 1 in 5 will become homeless
  • Only half will graduate from high school
  • 1 in 4 will be incarcerated within two years of leaving foster care
  • Less than 3 percent receive college degrees
  • Youth in foster care and former foster youth comprise the majority of commercially sexually exploited children.

Permanency is possible

A decade of innovation is dispelling the myth that achieving permanent families for pre-teens and teens in foster care is beyond hope. Effective specialized youth permanency and family finding practices are now available. Pilot programs across the county have demonstrated strong permanency outcomes as well as savings to their host counties or states.

Why then do youth age out without families?

  • Far too many child welfare professionals still hold the barrier belief that these youth cannot achieve permanent families.
  • Most jurisdictions counties underutilize these best practices for the mistaken belief that they lack the financial resources or organizational capacity to provide them. In fact, the needed resources are built into the practices themselves. The cost of keeping youth in care is very high — up to $118,000 annually per youth in California. As specialized youth permanency programs move youth from foster care to permanent families, significant savings are achieved. These savings more than cover the cost of the services – often in the same year permanency services are provided.

Families NOW Youth Permanency Solutions

  • Dissemination of specialized youth permanency practice innovations
  • Dissemination of Families NOW’s youth permanency funding methodology
  • Calculation of savings through specialized permanency services for specific states, counties, and/or programs
  • Consultation on strategies for communicating fiscal savings and advocacy for implementation and expansion of specialized permanency services
  • Consultation to counties initiating specialized permanency services
  • Sponsorship of AB 519 (California) to create a statutory definition of child-centered specialized permanency services and require those services before children are deemed unadoptable and placing them in long-term foster care (APPLA), as well as requiring those services to fulfill the new fed law for intensive and ongoing efforts to place APPLA youth into permanent families.

Funding Youth Permanence

Strategic Spending to Reduce Costs and Improve Outcomes

optical illusion vace facesKeeping children and youth in foster care is very expensive. Best practice specialized youth permanency services are one-time costs that improve lives while saving county, state, and federal dollars. These savings can be documented and strategically reinvested to sustain and expand effective youth permanency practice.

Our Youth Permanency Funding Methodology is both elegantly simple and frustratingly complex. The simplicity is rooted in shifting the way we look at funding, not unlike the picture here. Is it a vase or two faces?

Why simple?

  • The financial cost of keeping children in foster care is high, in California up to $118,000 per youth for every year the child remains in care in placement costs alone, plus additional costs for social workers, administration, mental health services and more.
  • The costs for picking up the pieces from our poor outcomes for these youth as they enter adulthood are likewise daunting, a high rate of homelessness, incarceration, substance abuse, early pregnancies, low rates of employment and education; and perhaps most sadly, high rates of entry into foster care of their own children.
  • Moving a child from a high cost foster placement into an adoptive or guardianship family generates big savings and better outcomes for the youth.

Why complex?

  • Categorical funding: The savings accrue as net county (or state or fed) savings, not necessarily as savings to discrete departments. This means that child welfare cannot implement this methodology alone.
  • Shifting funding streams: The nation as a whole is working to shift away from funding streams that create a fiscal disincentive to permanence to ones that create fiscal incentives. Until this process settles it will remain hard for jurisdictions to sort out the accrued savings.
  • Complex authorization systems to access applicable funding: In counties where the methodology is being used it was implemented based on the recommendation of either the board of supervisors or the director of the Health and Human Services Agency, both of whom are responsible for the bottom line fiscal outcomes of multiple departments.
  • Deeply entrenched but outdated beliefs, including the beliefs that older children and youth do not want families, that it is not possible to find families for them, and that effective youth permanency services are too expensive.

We know how to get better outcomes for our children and youth.  And we know that it costs less to do it right than do it wrong. Do we not have a moral and fiscal imperative to do it right?

Youth Permanency Practice

AA mom and teen boy_60170329Effective youth permanency practice is youth-specific and requires small caseloads, significant involvement of the youth, and a whatever-it-takes attitude. These practices often include a public/private agency partnership utilizing the unique strengths of each sector. Typical components of youth permanency practice include:

  • In-depth review of case file
  • Family-finding / identifying potential connections. This includes relationship building and mending
  • Building a trusting relationship with the youth
  • Assessment of youth’s strengths, challenges, readiness for adoption or other forms of permanence, etc.
  • Network building / engaging caring adults in planning for the teen, both professional and social supports
  • Individualized recruitment plan
  • Preparation of permanent family to assure they are adequately prepared to meet the needs of the youth
  • Post placement support

Clinically Enhanced – Youth Permanency Practice

teen boy on steps_scaled down for giving edgeSince many of the permanency needs of youth in foster care are clinical in nature, permanency practices can be enhanced through Medicaid (Medi-Cal) reimbursable mental health services for youth who meet medical necessity criteria.

  • Federal Financial Participation (FFP) for 100% of children in foster care vs significantly lower FFP for IV-E Foster Care
  • Low or no share of cost for local jurisdictions

Even more important than the funding is the ability to improve permanency outcomes by adding enriched clinical components to the permanency services. Clinically-enhanced youth permanency practice utilizes a clinical team to take many of the components of standard youth permanency practice to a deeper clinical treatment level to address complex trauma issues and facilitate the development of attachment security including:

  • Creating safety, self-regulation, and self-reflection
  • Traumatic experience integration
  • Relational engagement and positive affect enhancement using a family-centered model
  • Understanding their past, realizing their present situation, and to developing  plans for the future
  • Building sense of empowerment and mastery over their situation and their life by nurturing the youth participation and decision making in their  case plan and work
  • Providing individual, family, collateral and group therapy
  • Case management and rehabilitation services
  • Educating and supporting the youth and the families that they live with on the issues of complex trauma and core permanency issues.

Keeping the Promise of Permanence AB 519

Foster Care was designed as a temporary safe haven for children for children whose parents do not have the ability to keep them safe. Youth permanency expert Bob Lewis reminds us of the promise we make to the children:

To every child we take into care we make a promise. We promise to restore them to a healthier, more stable, more secure, safer family than the one from whom we removed them, either their original family or one who will share parenting with that family. No one can exempt us from that promise and none of the children or youth have forgotten that promise not matter how sure they may feel that it will not be fulfilled.

Child-Centered Specialized Permanency Services

Families NOW, in partnership with the California Association of Adoption Agencies, has crafted this definition of robust specialized permanency services to guide the inclusion of such services in emerging child welfare practice and policy.

Families NOW recommends requiring services meeting this definition be provided prior to children being deemed “unadoptable” or giving a permanency plan of long-term foster care or another planned permanent living arrangement (APPLA). We also recommend that the definition be used to meet the federal requirement for documentation for intensive and ongoing services to place children with permanency plans for APPLA). This is addressed in our 2015 California AB 519 legislation.

See Robert George, Employment Outcomes for Youth Aging Out of Foster Care (Chapin Hall Center for Children, 2002);
See also Mark Courtney and Darcy Hughes, Young Adults in the Foster Care System as Adolescents (unpublished paper, 2003); Marian Busey et al, Transition from Foster Care: A State by State Database Overview, Technical Report (Annie E. Casey Foundation, 2000); R. Cook, E. Fleishchman, and V. Grimes, A National Evaluation of Title IV-E Foster Care Independent Living Programs for Youth in Fostercare: Phase 2, Final Report Volume 1 (Westat 1991).