Moving the Work Forward: Best Practices to Support Kinship Families ABA Kinship Preconference

1. Moving the Work Forward: Best Practices to Support Kinship Families ABA Kinship Preconference Thursday, July 23, 2015

2. The highlights: children do best in families

3. OVERVIEW • What the research says • Policies to increase the odds that children are cared for in families • Have we arrived at a tipping point? • Aligning child welfare financing with what we know works

4. WHAT THE RESEARCH SAYS

5. RESEARCH: CHILDREN DO BEST IN FAMILIES • Healthy attachments with a parent figure are necessary for children of all ages and help to reduce problem behaviors and interpersonal difficulties. • Child-sensitive exercise of adult authority is critical to healthy development. • Group placement is not an appropriate living arrangement, and is never substitute for a family environment. • There is no demonstrable therapeutic necessity for group placement to be used as a long-term living arrangement. • Group placement may cause psychological harm even in typically developing children. • Even children who have never experienced secure attachments can develop them in appropriate family settings. SOURCE: Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association

6. RESEARCH: CHILDREN DO BEST IN FAMILIES • “Child development theory, federal legislation and best practice confirm what we know intuitively – children should be placed in settings that are developmentally appropriate and least restrictive.” • “Stays in congregate care should be based on the specialized behavioral and mental health needs or clinical disabilities of children. It should be used only for as long as is needed to stabilize the child or youth so they can return to a family-like setting.” SOURCE: U.S. Department of Health and Human Services, Children’s Bureau

7. MANY CHIILDREN INVOLVED WITH CHILD WELFARE AGENCIES ARE SEPARATED FROM FAMILY • 57,000 young people – or about 1 in 7 children in foster care – in the United States are not living with a family. • For teens in the system, the ratio jumps to 1 in 3. • 1 in 5 children in foster care will experience a non-family placement at some point during their time in the child welfare system. SOURCE: Child Trends analysis of 2013 AFCARS data

8. ENORMOUS state VARIATION DEMONSTRATES THAT PLACEMENT practices and not children’s needs dictate likelihood of being cared for in a family Source: Annie E. Casey Foundation Child Welfare Strategy Group analysis completed using AFCARS 2013 data

9. SIGNIFICANT evidence that children are unnecessarily separated from family • 30% of teens are placed in foster care solely due to their behavior • 40% of children in group placements have no clinical needs (DSM, behavior, medical) • Most children who do experience group placement do so as their first placement • Foster parents (kin and non-kin) effectively care for the same types of children placed in group homes • Average length of time in group placements (8-9 months) is much longer than what the research suggests is effective • Listen to the voice of youth and providers

10. WHY ARE CHILDREN Unnecessarily SEPARATED FROM FAMILY? • Lack of understanding/appreciation for the critical role of family in healing, resiliency • Belief that there are not families willing to take older youth who have suffered trauma • Lack of investment in alternatives

11. KIDS AND STATE BUDGETS PAY A TREMENDOUS PRICE WHEN KIDS ARE UNNECESSARILY PLACED IN INSTITUTIONS • Short-term • Safety, permanency, well-being • Stability • Maintain sibling connections • Long-term • Educational outcomes • Employment • Future arrests • Gains made in group placements are seldom maintained after youth return to their communities. • Financial cost of poor decision-making

12. High quality Residential treatment is an essential, lifesaving component of the service continuum • Treatment, not a place to grow up • Capacity/expertise to meet children referred • Involve families in treatment • Short-term • Customized • Clear plan for transition back to family

13. POLICIES TO INCREASE THE ODDS THAT CHILDREN ARE CARED FOR IN FAMILIES

14. smart policies strengthen and sustain BEST practice

15. INCREASING THE ODDS THAT CHILDREN ARE CARED FOR IN FAMILIES

16. EXPAND THE SERVICE ARRAY • Partner with Medicaid agencies to ensure adequate support by the behavioral health system • Encourage private providers to shift their business models • Invest in high-quality residential treatment, hold residential providers accountable for treatment outcomes

17. RECRUIT, STRENGTHEN AND RETAIN MORE RELATIVE AND FOSTER FAMILIES • Eliminate barriers to the immediate placement of children with appropriate relatives. • Reform foster home licensing standards in accordance with new national standards. • Require dedicated foster parent support caseworkers with capped caseloads. • Require agencies to maintain and update census of foster homes, including how the capacity of those homes meets the needs of children requiring placement.

18. SUPPORT DECISION MAKING THAT ENSURES LEAST-RESTRICTIVE PLACEMENTS • Require validated assessments of children’s needs before placement in non-family settings and ensure providers have capacity to meet documented needs. • Make kinship placements the default and require justification for non-kin placements. • Require high-level approval before a child or youth is placed in group or institutional setting. • Increase monitoring of children placed in non-family settings. • Restrict the use of non-family settings, including shelters, for young children.

19. Have we arrived at a tipping point? • Research demonstrating the importance of family • Innovative public and private agency efforts to support families (birth, kin, and foster) • Evidence-based programs that promote effective parenting of children who have been traumatized, have behavioral reactions • Enormous bi-partisan political momentum • Understanding of the relationship between previously siloed issues – kinship care, family foster care, youth diversion, effective residential treatment

20. ALIGNING FEDERAL FINANCING WITH WHAT WORKS

21. Overview of child welfare financing • Federal funding provides approximately half of all dollars spent on child welfare • There is significant variation in type and level of spending by states • Federal funding sources are structured in a variety of ways, including capped allocations and entitlement programs • Some federal funding sources are specifically allocated for child welfare services, while others fund a wide variety of programs

22. Child welfare systems rely on multiple funding sources, including federal, state and, sometimes, local funds Total Federal Spending = $12.7 billion State/Local Spending = $15.5 billion SFY 2012 Data

23. Multiple federal funding sources assist states in responding to child abuse and neglect Total Federal Spending = $12.7 billion State/Local Spending = $15.4 billion

24. Title IV-E is the backbone of federal child welfare funding • Title IV-E was created by the Adoption Assistance and Child Welfare Act of 1980 • Title IV-E accounted for 23% of all child welfare expenditures in SFY 2012 • Tribal child welfare programs have access to Title IV-E funds through: • Tribal-state agreements, or • Directly from the federal government, a new option introduced by the Fostering Connections to Success and Increasing Adoptions Act of 2008 Title IV-E 51% $6.5 billion

25. For eligible clients, Title IV-E reimburses states for a variety of services and costs • Children in out-of-home care are eligible if they: • Would have been considered “needy” in the home from which they were removed (based on 1996 measures from the Aid to Families with Dependent Children (AFDC) program), • Entered care through a judicial determination or voluntary placement, and • Are placed in a licensed or approved foster care placement • Candidates for foster care • “imminent” or “serious” risk of entry into foster care (as evidenced by agency making “reasonable efforts” to prevent removal) • Reimbursable costs include: • The cost of board and care • The cost of case management for IV-E eligible children (in-home and out-of-home) • All IV-E administrative and IT costs, including training, to support the IV-E program • Adoption and guardianship subsidies, and the costs of administering the subsidy programs • Independent living services for youth aging out of foster care, and education and training funds (Chafee Foster Care Independence Program, and Education Training Vouchers)

26. Federal IV-E reimbursement rates vary by purpose • IV-E pays for: • 50-83% of the cost of board and care at the Federal Medical Assistance Percentage (FMAP) • 50% of the cost of administration and case management for the portion of kids who are IV-E eligible • 75% of the cost of training for staff and providers for allowable activities for the portion of kids who are IV-E eligible • 80% of the cost of the Chafee Foster Care Independence Program

27. Existing structure makes it difficult for states to design and maintain effective child welfare systems • Declining federal investment • Competition for federal resources among systems that support various needy populations (SSBG, TANF, Medicaid) • Federal investments are not aligned with what works best • Largest federal funding source, Title IV-E, is inflexible • Accountability for outcomes is not adequate • States are required to have elaborate “litigation prevention devices” – separate state plans for CAPTA, IV-E, IV-B, IV-D, TANF, Medicaid, SSBG

28. Percentage of children in foster care reimbursed by Title IV-E declining

29. CBO estimates that spending on foster care payments will decline by another 45% over the next ten years

30. Declining IV-E eligibility is just part of the problem • We spend more than $200 million/year just on eligibility determination • Does Congress really only care about abused and neglected children if they come from poor families? • Collecting information necessary to determine eligibility hampers the ability of caseworkers to develop a therapeutic relationship

31. Title IV-B funding is also declining

32. SSBG is at risk

33. The federal-state partnership has shifted, placing greater pressure on state budgets Percent of Total Spending from Federal vs. State & Local Sources

34. The likelihood of Congressional action appears to be greater than it has ever been • One of a narrow set of issues where bi-partisanship is possible • Significant bi-partisan staff-level interest in financing reformand fairly deep knowledge among primary players • Growing consensus on principles for reform • End of Title IV-E waiver authority • Potential for budget reconciliation that includes child welfare financing reforms • President’s 2016 budget requestincludes modest legislative proposals that could achieve consensus

35. Areas of agreement and disagreement Disagreement • How to realign resources: • Flexibility • Investments in underfunded services • Fiscal Incentives • Willingness to rethink the entitlement • Politics of making a deal on resource levels Agreement • Delinking AFDC is critical • Realignment of resources is needed to achieve better outcomes • Greater accountability for outcomes is necessary [concerns about long-term foster care and group placements] • SSBG is dead or on life support • TANF is vulnerable • Medicaid is underutilized

36. Q&Aand DISCUSSION

37. Rob Geen, Director of Policy Reform & AdvocacyAnnie E Casey Foundationrgeen@aecf.org