Co-director, Columbia University Institute for Child and Family Policy
... Let me begin, of course, by welcoming our FRONTLINE colleagues, our Fred Friendly Seminars friends and colleagues, friends and colleagues from the Institute for Child and Family Policy, the School of Social Work, and the child welfare field generally.
Our focus today is on children, especially the most vulnerable children, and the system that's supposed to protect them against harm. ... We hear repeatedly that the child protection services system is in crisis, as is the child welfare system generally. Recently, once again, The New York Times has been full of articles on what's wrong with the system. Children are killed, children are horribly injured, children disappear and are lost, and often this happens despite the local child welfare agencies' prior knowledge of abuse and severe neglect.
Although abuse may occur in foster care or residential care, most occurs in the child's own family, the institution that's assumed to be safest for children. For context, let me give you a few national numbers to give you some perspective on the national scene:
In the year 2000, 3 million reports of child abuse and neglect were made to protective service agencies throughout the country. About two-thirds of these reports were screened in as warranting investigation, and one-third of those that were investigated were substantiated, that is, the children were found to be maltreated. Most of the substantiated cases involved neglect, and almost all the remainder of course were abuse, largely physical abuse.
The most vulnerable children are the youngest; infants and children under one year of age accounted for close to half of the child deaths and 85 percent of the fatalities were children who were younger than six. In 85 percent percent of the cases, the victims were abused by a parent or parents. And, for about one-fifth of the cases, removal from home and placement in foster care was the intervention of choice. About half of these children were placed in foster family homes.
According to [National Clearinghouse on Child Abuse and Neglect] data, about 565,000 children were in foster care in 2001, and 28 percent of these were under six. The children in foster care are disproportionately poor, disproportionately black, disproportionately likely to remain in foster care for more than a year, and the system is costly and there are increasing difficulties in recruiting foster parents.
Since the passage of the Adoption and Safe Families Act in 1997, there's been increasing attention paid to the performance of the child welfare system and how well the system is meeting the needs of the children it's designed to serve.
The conventional definition of the system problems are: inadequate resources, both money and services; inadequate numbers of staff; inadequately trained staff; and badly informed judges. Across the nation, efforts are under way to reform child protective services to better meet the dual goals of protecting children and preserving families. These reform efforts are varied, but one common focus is to change frontline practice in protective services and partner agencies to more effectively engage families. A second focus is on system change.
The first panel will bring together experts who've had experience with protective service reform efforts around the country, and particularly with efforts to change frontline practice. The second panel will focus on the impact of the 1997 legislation, the Adoption and Safe Families Act.
So now, let's see what our experts have to say about how to do better by these most vulnerable children, and I turn it over to Kathryn Conroy, who will chair the next session.
Assistant dean, Columbia University School of Social Work
... I'm delighted to give you our first panelist, Zeinab Chahine, deputy commissioner of the New York City Administration for Children's Services (ACS).
Deputy commissioner, New York City ACS
Thank you, good morning. Seven years ago, with the tragic death of Elisa Izquierdo at the hands of her mother, this tragedy exposed a deeply flawed child welfare system in New York City. The [child protective service (CPS)] system was overwhelmed, poorly managed, poorly resourced, staff lacked basic qualifications, training, supervision, and support, lack of accountability and manageable workloads, non-compliance with state and federal mandates. The case practice with families and children was poor, and coordination among service providers was minimal.
As Dr. Kamerman stated earlier, the situation here in New York City was similar in many situations across the country with CPS. With the creation of the Administration for Children's Services in New York City, the child protection system has come a long way since 1996. The reforms implemented by ACS in the past several years have strengthened child protective services tremendously, but the efforts are ongoing and must continue.
It took strong visionary leadership, political will, infusion of necessary resources and help from national experts, advisory groups, and the active participation and collaboration of all parties interested in the welfare of children in New York City. ACS developed a comprehensive reform plan aimed at transforming child welfare services. I will highlight some of the initiatives that I believe had the most impact on reforming the system.
First and foremost, ACS focused on improving staff qualifications, training, and development. ACS instituted enhanced educational qualification and hiring requirements for caseworkers and supervisors, and new civil service titles specifically for child protective staff and child welfare staff. It increased salaries, instituted merit-based promotions and raises, and [a master's of social work (MSW)] scholarship program for staff. It also enhanced and expanded training, and is currently implementing a new skill-based family strengths comprehensive training for all staff.
The second major area of improvement involved strengthening infrastructure. ACS recognized that administrative supports impacted the ability of frontline staff to fulfill the agency's mission. Basic resources and equipment, such as computers, fax machines, and file cabinets were provided the staff, [along with] interpretation and translation services, so that CPS staff can better communicate with families.
The third major improvement involved management of workload and compliance. Attention was paid to filling vacancies so that the number of new reports assigned to an average CPS worker was manageable.
ACS managed the movement of cases from CPS to other parts of the system and eliminated bottlenecks and prohibited the shuffling of cases back and forth between divisions so that the families did not fall through the cracks. This resulted in a more streamlined and more focused CPS operation. CPS workers were free to focus on child protection. As a result, CPS staff now maintain an 11 to 13 cases on average, down from 26 in 1996.
New York was so out of compliance with state mandates in completing investigations timely that in 1996, over 30,000 investigations were overdue. ACS launched an effort to bring New York City into compliance by using a set of management reports that really describe performance for each of the levels of staff from caseworkers to supervisors to managers to directors. And now, ACS has the highest compliance in New York State of timely completions of investigations and safety assessments.
With these basic reforms in place, ACS focused on enhancing quality case practice. The next major step was for ACS to develop standards and guidelines for CPS practice. Caseworkers, supervisors, and managers were not clear about outcomes they were expected to achieve. They were operating based on a collection of outdated policies and procedures. For CPS, a case practice guide detailing the requirements for interviews, assessments of safety and risk, and service planning and service referral was developed. The guide shifted practice basically away from the narrow focus on investigations of allegations to a more comprehensive assessment, not just for the purposes of determining whether abuse or neglect actually happened, but rather for the purposes of determining safety and risk in developing interventions that best protect the children.
All levels of staff, including supervisors and managers, receive six days of training on quality case practice. Most importantly, all levels of staff train together to reinforce the expectations that caseworkers, supervisors, and managers are all responsible for improving case practice.
A critical part of the quality case practice improvement involved enhanced supervision and management of frontline practice. ACS established multilevel supervisory and managerial reviews consistent with case practice requirements. Whereas, in the past, supervisors held on-the-spot conferences with workers whenever there was a crisis, now supervisors and managers are required to review cases and to hold conferences with staff at particular timeframes throughout the process.
Several program innovations were also implemented. For example, in 1998, ACS, the district attorneys, and the police department established instant response teams. The instant response established procedures for joint investigations and coordination between ACS and law enforcement on severe child abuse and neglect cases. One of the objectives was to protect children from abusive maltreatment by ensuring that we gather evidence in a timely, effective, and coordinated manner, and, where appropriate, removing the alleged perpetrator from the home instead of the child.
Another objective was to minimize the trauma to the children involved in the investigation by minimizing the repetitive interviews and examinations and getting a multidisciplinary team together to interview the child in a child-friendly setting, such as child advocacy centers. In 2002, over 4,000 reports were handled through the instant response team.
Within the larger framework of its neighborhood-based initiative, ACS realigned its services along community district lines. CPS staff were assigned by community districts geographically. The goal was to more effectively engage families and communities in the protection of children. Neighborhood networks were established in many communities. Efforts are currently under way to further integrate CPS into the neighborhood networks. Since over 60 percent of children coming into foster care come from 18 community districts in New York City, ACS is working with the neighborhood networks to better address the needs of these communities.
Given the prevalence and overlap of substance abuse, domestic violence, and mental health issues with CPS, ACS established 12 clinical consultation teams, each composed of a substance abuse, domestic violence, and a mental health specialist to be stationed in the CPS field offices. The teams provide consultation, training, and support to CPS staff around assessment and service needs of families on the CPS caseloads.
ACS also set out to increase reliance by CPS on preventive services directly provided through the Family Preservation Program and its court-ordered supervision program, but also mainly through its contracted preventive providers in the community. New York City-contracted preventive providers have always been community-based and were not driven by CPS referrals. In contracts with other jurisdictions where families must enter the child welfare system to access support services, ACS preventive service programs provide services to families in the communities regardless of whether they were referred by CPS. However, in recent years, there's been an increase in reliance on preventive services by CPS. Over half the referrals now come actually from CPS through these community providers and we're working more closely with them to engage these families in preventive services.
The increased reliance on preventive services has had a dramatic impact. For the first time, there are more children receiving preventive services in New York City than foster care services. There are over 29,000 children receiving preventive services, compared to 26,000 children in out-of-home foster care. Admissions into foster care have dropped from over 13,000 in 1997 to a little over 8,000 in 2002.
For those children where foster care is the only option, ACS developed various strategies to improve outcomes and achieve permanency. Placement principles were developed to highlight the temporary nature of foster care and the urgency to create permanent, loving homes. ACS has made kinship and neighborhood placements a priority. Several initiatives focus on recruitment of resource parents in the neighborhoods, increasing partnering with parents and resource parents, and improving visiting plans. ACS examined the placement process and created guidelines to reduce trauma to children being placed.
Finally, ACS implemented a continuum of family team conferences aimed at effectively engaging families and their supports in the planning and decision-making process.
In conclusion, through these and other initiatives, ACS has improved and is continuing to improve frontline practice. Some of the outcomes indicate that the system is heading in the right direction. The foster care population is down from over 40,000 children in 1997 to 26,000 in 2002. Although more work is needed to continue to improve CPS in New York, it's evident from the New York City experience that reform is possible when there is political will, strong management with a clear plan of action, commitment to frontline practice and necessary supports and resources. Thank you.
Ms. Conroy: Thank you. Our next panelist is John Mattingly, senior program associate at the Annie E. Casey Foundation.
Senior program associate, Annie E. Casey Foundation
... I expect and hope to make a few simple straightforward observations about my experience over the last 25, 30 years in child welfare, and I apologize for the oversimplicity, but I hope that the messages are clearest that way. Really, about four comments and a couple of stories.
First of all, those of us who have been doing this work in public child welfare for many, many years know as well as, probably better than, anyone else the simple fact that we need to do better than we are doing. We need to do better. Too many children are coming into care without adequate support to their family to stay together safely. Too many brothers and sisters are being split from one another when they have to come into care. Too many kids are staying too long without a permanent safe family. Too few families are getting immediate help to reunify safely. We need to do better in this business than we are doing today.
The good news is that systems all across the country, including New York City's, which I have had the privilege of providing some support, advice, and consultation to as a member of the Special Child Welfare Advisory Panel, and I have to say that what you heard from Zeinab is 20 percent of the enormous amount of work and accomplishments that have gone on here in New York City in the past seven years.
[Systems like the one in] New York City, systems like Louisville's and Birmingham's, systems like Illinois's, systems like Allegheny County, Pittsburgh, Hennepin County, Minnesota, all across the country are in fact doing better. We know that, because they're achieving much better outcomes for children and families -- fewer children removed, less long lengths of stay, fewer children split from their own community, placed in their own community when they must be placed. That's happening all across the country, and that is very good news we should not avoid paying attention to.
The bad news about it is that with all of that work and effort and all of the success, we are not where we want to be, and it really is heartbreaking, mind-bending work that needs to be done to accomplish these improvements. There is no quick fix; there is no free lunch. There is just hard, difficult, tough work.
Unfortunately, there are in too few places the kind of political will that was shown here in New York to stick by the long term and see to it that we didn't just jump for political reasons from one leader to another, with one following another every 18 months, deep down in the bowels of the Department of Human Resources, because we want to keep the child welfare system at great distance from the political process, because it's so dangerous, because children do die.
It takes work on the part of the media to pay attention to the big story as opposed to the story about the child death today; to pay attention to the story about the young people in systems, especially in the big cities around this country, who get placed in group care, or don't get any care at all, because we don't have families for older kids, and who spend their entire youth in a public child welfare system with the state as a parent. That's a story that we need to pay more attention to, but it doesn't bleed, so it doesn't lead around the country.
So change takes those sorts of things all across, from the depth of knowledge, understanding, and technical ability on the part of leaders like Zeinab and Commissioner [William] Bell, right down to the political leadership and the media attention focused on the big issues rather than the hot issues. It takes a lot. This is very difficult work.
Thirdly, the bad news is it's fragile. We've seen around the country in communities that have made these major reforms that when political leadership changes, we have to have a new approach; we have to have somebody selling the future way to go about doing this. And the next thing you know, they've adopted one of the simple, free approaches: What we need is more adoption, what we need is more family preservation, what we need is privatization, what we need is, is, is. And, in point of fact, what we need is long-term attention to these human systems to support their functioning the way they need to do, and to hold them accountable for functioning the way that they need to do.
Second point I'd like to make is, today, this morning, as we stand here, there are thousands, perhaps tens of thousands of oftentimes young people out in the streets of our cities trying to make life or death decisions for families and for children. Too frequently they are not supported the way they need to be. They're not trained; they're not supervised the way they need to be. And they are the true heroes of all of this talk that we'll be doing today, because by and large they're doing good work. And, in many cases, they are doing great work.
How many of us today could go out into a family that we have had no contact with before and make a critical judgment about whether the children in that family are safe, and, at the same time, try to engage that family in the need to change some of its behavior in order to support the safety of their children in the future. And, at the same time, make judgments about what risk we are facing here and what the future will be for the children if we remove them -- too frequently not good -- and what the future will be if we can find the right supports for that family. This is tough work, it's not simple, it is not easy, and creating human systems that can do it is really tough.
Third point. There are two areas that need attention and two areas of great need within these systems if we're going to do better, as we need to do. And it is the separating out of them, one from the other, and the creation of an ideological battle over which is more important than the other that kills us in this business. It hurts us desperately and deeply, and the politicians and the media play a critical role in oversimplifying and setting apart these issues as separate. They are usually talked about as safety versus well-being and permanence. They're talked about as family preservation versus adoption. When, in point of fact, children are being harmed by the actions or inactions of their caretakers around this country today, and once that has happened to a certain level of need, we have to assess that harm, we have to intervene to support the family to be safe in the future, and we have to go about removing children who can't stay safely at home in a way that does the least harm to them by keeping them close to their friends, by keeping them in their school, by keeping them in touch with the school crossing guard who made the original report for these youngsters. All of that stuff is at the heart of the safety work that we need to do.
But children in the care and custody of the public child welfare system need to be cared for in such a way that they are with a strong, capable family in their own neighborhood, that that family is linked to the birth family to provide ongoing resources and to keep the connection between the birth family and the children. And we have to find and support those caregivers who can help us move the children home safely or help us move the children to permanence with those caregivers or other caregivers, and that's the well-being and permanence part of this work. You can't separate one from the other.
In my view, you can't overemphasize one from the other, because in point of fact, as many of you in the audience know quite well, the question is not whether some children need to be removed from their family for their own safety, and other children need to remain home safely with their families. The question is how you can decide at what point to go from one decision to another, and that again requires the creation of these human systems that can distinguish between the policy and this particular case, and how a policy and practice fits within that schema.
So, briefly, what does it take to get all of this right? From my experience around the country, well, it's a series of things that I don't have time to go into at any great length, but it's the linkage of policy, good, strong policy that gives people a sense of direction, linked to management and organizational structures within the public system that flow from the policy and reinforce it.
If you believe children should be placed in their own community and not deprived of their friends, we have to put in place a structure by which, as in New York, we contract out services to see to it that the private agencies under contract place children in their own neighborhoods.
And the final linkage is to good practice. And it's when practice on the frontline, which you'll hear more about, and management structure and organizational systems link to good policy that change really results in better outcomes for children and families.
In addition to that, we need to pay more attention to decision-making. We need to focus more on caregivers and, Lord knows, we need to focus much more on building partnerships between our work and the communities and neighborhoods in which children live today.
And it's that lack of connection with local communities and their leaders that has also left us oftentimes struggling, trying to figure out what the best decision is, because we don't know enough about the communities we are working in.
I'll have to leave my stories until later, but thank you very much.
Ms. Conroy: Thank you very much, John. Our third panelist is Gail Nayowith, executive director of Citizens' Committee for Children of New York, and chair of the New York City Child Welfare Advisory Panel.
Executive director, Citizens' Committee for Children of New York
I just want to say a couple of things contextually. First of all, once again, New York City is a laboratory for reform in services for children and families, and I want to just give two examples to make that point. It is a little boosterism on my part, because my work is in New York City, but I do want to say that there are very important things happening here for kids and families, and there's a lot to be learned about what can be accomplished in a very large city with 2 million children.
The example of the disaster of 9/11 and the development of innovative mental health approaches for children and families is a case in point, as is the example at ACS around child welfare reform. So for those of you who are not familiar with what's going on here, I would urge you to take out your microscopes and spend a little time here. It's really very well worth the effort.
The focus on child protective service reform basically presumes that nothing works, and it starts from a premise that new child protection models can be implemented that will produce better results for children and families, and not only that it'll produce better results, but that these results are actually guaranteed. We know from experience that CPS reform, when done properly, does work. The ACS example, as Commissioner Chahine mentioned, which started with CPS reform, was successful in large part because it was implemented as part of an overall child welfare system reform effort.
Real reform is impossible without the availability of substantial new resources and political support provided to the child welfare department over time and at the same time. Superimposing new child protection models on old sclerotic CPS infrastructures has not, ever, and nor will it ever work. CPS cannot be funded or viewed as a stand-alone service, nor can CPS reforms alone improve outcomes for children and families.
Basically, when I talk about CPS, I describe it to people as the children's 911. It creates a special public safety response for children, and the goal of the investigation is to assure child safety, as well as family engagement, although I'm going to talk about why that's complicated later. But CPS should not be the front door or the only door to family support and treatment services. That's the problem; that's the fundamental problem with the CPS conception that we hold very dear.
There are CPS reform proposals that are being debated all over the country that posit a new vision for CPS services that can both protect children and preserve families. In New York, there's an active and vigorous debate over a dual-track CPS model that, in my view, has gotten more political attention than is warranted, given the child safety failures of the dual-track experiments under way in other jurisdictions, and, in our case, the failure to fund this new way of providing services to children and families. Good idea, no money, not going to work.
This doesn't mean, and I want to be clear, that CPS reforms are impossible. It just means that as a matter of public policy and public investment, we have to resist the lure of the magic bullet and really hold out for substantial improvements in practice, funding, and staffing that are directly linked to family support and treatment services for parents and children in communities where they live.
I want to argue, too, that articulating the success of CPS services as one that better protects children and also preserves families requires a complex understanding of the dual role of CPS and child welfare services, and at this point, in this very simplified ... public dialogue, the discussion about CPS is very confused. The policy-making conversation is very muddy, and it makes it hard to recruit staff and provide training.
It also creates a lot of confusion around the issue of family engagement. I also think -- apropos of the later panel -- that ASFA codifies this confusion because it requires concurrent planning where two tracks are occurring simultaneously. You have a CPS investigation of the abuse and neglect incident that's supposed to aid in the preparation of the legal case to terminate parental rights, and at the same time try to engage a family around their strengths and their needs and create a path to reunification or adoption or independent living for their children. We all do this for a living and we don't understand it. It's hard to imagine how somebody faced with a situation that John described -- going into a home to make a very critical decision in a short period of time -- and then doing this work can actually make sense out of a very complicated piece of legislation that's also in itself, I think, inherently confusing.
The lack of specificity around guaranteed access to and availability of family support, preventive, and treatment services is the biggest problem that we face in child welfare. My point that I guess I want to make is that the national crisis in child welfare is only one part CPS. It's also in large part about the conditions of care provided to children who are placed, and the significant lack of treatment defined by me, my short list, as health and mental health and substance abuse or behavioral health services, preventive services, and support services for children and families in the communities where they live.
It's also about the state failure to supervise children in care and finance access to services for families who are the subject of CPS investigations and assessments. I want to make a point. The point, for me, is not just about the failure to protect. The point, for me, is also about the failure to invest. The responsibility for child protective service reform is not only at the frontline, it's also in the state houses, in the executive branch, and in the legislatures all over this country.
If you go back and you look at the relationship between the money and what actually happens on the ground, I'm sorry, but follow the money. Anybody knows it. It's a very basic business concept. In the human services, we don't think about it; we think that magic and good interpersonal skills and training are going to do it all, but I have to tell you, without money you cannot help children. It either has to be a worthwhile investment to make sure that kids are safe and that families are preserved or supported, or it's not going to work at all. Good intentions require money.
So as I said, it's not just about the failure to protect, it's also about the failure to invest, and I frankly believe that the executives and the legislative branches in governments all over this country have to be held responsible for their failure to help support child welfare services. It's very key. Of course, I'm an advocate, what else would I say? But I have to tell you, that's just my experience. And when that political will, as exemplified by large checks and consistent support financially in budgets is there, you actually will see results.
Back to the family engagement issue. It's also my view in looking at what's going on around the country that CPS investigations or assessments -- if you're a dual-tracker, call it assessments, whatever you want -- have to occur for every child abuse and neglect case that is suspected. The cases have to be looked at. Every child has to be accounted for, interviewed in person in a timely fashion, and family needs have to be assessed.
Families have to have immediate access to support services, preventive services, and treatment services. But also, again, to restate my point, independent of, prior to, and unrelated to a CPS investigation, [these services] should also be the available array of services for families, in addition to foster care placement, as a consequence of the investigation. Real family engagement means that services have to be available when, where, and how families need them, and how families want them. CPS investigations must be conducted in a way that's respectful of families, in a way that engages parents in decision-making and helps them to take steps to ameliorate risk and help make plans for the child's return, adoption, or so forth.
We believe that CPS investigations can be handled with sensitivity to family concerns, and in particular the need to preserve family connections, but that a key to improving family engagement practice in CPS is to view the CPS intervention as a potential way to prevent placement.
At the same time, it's naíve to think that a CPS investigation is either the correct means or the best place to engage families. I don't think we should say that it's the right way to engage families. None of us would really be all that happy if somebody knocked on our door to talk to us about what was going on in our house with our children, no matter how high their threat was. So let's just say it doesn't create a good basis for a relationship, which is basically what family engagement is. It's naŚve to think that it's the best place to engage families. So in the context of CPS reform, family engagement might require a sort of a different way of thinking about it and a different approach. It has to allow the CPS worker to think about child safety first and foremost, but it also has to create a structured venue for ongoing discussion and collaborative planning between the CPS worker, the family members and others. The New York City model is illustrative here. I think it's useful, building in family team conferences and sort of structured ways of engaging. That in and of itself is a very big job.
The goal really is for families to engage around service planning for their children and around service planning for themselves. And it's also the first place to begin to talk about permanency. I could go on for much longer, but I think I'll stop.
Ms. Conroy: Thank you. Our next panelist, Paul Vincent, director of the Child Welfare Policy and Practice Group.
Director, Child Welfare Policy and Practice Group
... I'm going to talk about two things, which will seem exaggerated in their prominence, and I don't mean to suggest they're exclusive of other change strategies, but it does reflect the priority we give frontline practice as an entry point for change.
One of them is that systems are changed one child and family at a time. Regardless of the structural supports that have to be present, and they are substantial, ultimately that's where systems change, and a key mechanism is changing the practice of workers one worker at a time.
Reform language is sort of epidemic in this country. Every time you pick up a newspaper, there's some new strategy or some new pronouncement about a response to a tragedy. Things don't seem to change. You see one jurisdiction after another one, initiative after another, where there is yet a new tragedy that gets publicized. Often, those are sort of unfairly portrayed as representative of actual practice in the system, but they still get great prominence.
I think it's fair to ask, what else does it take? In some jurisdictions, we do spend more money, we have new policies, we replace people, we have new services. ... [But] in states that are struggling, the indicators often don't change a lot. And so, what's missing from the formula for changing systems when those events don't occur? In my opinion, what's missing is the absence of a bottom-up strategy in addition to the essential top-down strategy, and what I'm going to talk about is the bottom-up strategy. ...
If I can tell you one bit of history, ... in another life more honorable than my current consulting role, I ran Alabama's child welfare system during a period of class-action litigation that really transformed the system. It happened largely because the focus of the reform was on frontline practice, which, frankly, weren't the changes I would have assumed would have been made when we first began to think about settling the case. If we had more workers and more residential treatment programs, and clearer policy and better training, the content of which I couldn't describe to you, things would be better. And ultimately, that was not at all what we did to begin with. ...
One experience that's driven our strong opinions as an organization about the power of practice is ... when we work in systems -- and we're working in around 10 states around the country -- we do practice. We model practice for trainers and supervisors so that they can see it done well. I do less of that than our real experts do, so I'm not speaking of myself. But we actually model, for example, the facilitation of family team conferences so people can see them done, even though they may have been in training. So we see a lot of families and we see a lot of frontline practice.
Part of the Alabama reform involved the development of what is the predecessor of the federal [Child and Family Services Review (CSFR)] process, an intensely qualitative examination of representative number of cases to determine how the system is performing. It would involve two days of interviewing all the parties in each case that was sampled, making a professional appraisal about outcomes at that point in the case and the quality of the system's performance. And as an organization, we probably reviewed a thousand cases in the last six years in 10 states.
So we've seen a lot of practice and we've seen enough that we see trends about what works for families that I'm happy to say is pretty consistent with what the field thinks works for the families. This is what we find that makes casework practice successful:
Developing trusting relationships with families. Gail was certainly talking about engagement. What we see when we talk to families is they sense disdain from caseworkers. It's pretty common that we can't separate our concern that children be safe from our judgment about parents as people. The saying "people are more than the worst thing they've ever done" applies here. There are ways to engage families without giving them permission to harm their children, to treat them respectfully in the process, and to demonstrate some genuine concern about what's going on in the family. When that happens, we see families more engaged in the intervention process. It's also a teachable skill that we don't do a very good job of when we're implementing reforms.
Like all of us, families are much more committed to plans they have a role in designing. It seems like common sense. We've looked at a thousand permanency plans in these reviews and the percentage of cases where the family had a meaningful role in designing the plan is minuscule. Often, you don't even find the parents' signature on the plan; rarely do you see any influence from the parent. So parents who perceive themselves as being treated with disdain, who have no role in what's happening to them will often comply. And often that's referenced as a strength in the case plan: "Family is compliant." As soon as you close that case, nothing's changed, and those are the families that come back into systems over and over and over again, because they just want you gone.
Assessments need to go beyond symptoms. Most of our assessments are very service-driven and symptom-based. What works for families are assessments that really get at the underlying conditions in the family. What's the underlying need that's producing the behavior that's triggered the system's intervention? If you can't figure that out and respond with supports and services that relate to the need, either the family's not going to change or the family's going to pretend to change until you get out of their lives, and you're not going to have the right kind of outcomes for kids and families. You're not going to have safe kids and often you're not going to have permanence.
Plans are not individualized. We have a running joke [about] trying to guess what the plan's going to say when we first begin looking at cases: Go to parenting classes. If there were a smart entrepreneur who marketed nationally a chain of parenting classes, you could make a fortune. Every parent gets a parenting class. That's the need that gets identified, when actually a parenting class is a service, it's not a need at all. Counseling, everybody gets counseling. Appropriately, many parents get substance abuse intervention, but often sort of the wrong match for their needs. So services are not individualized, but when they are, when they're matched to needs, we see outcomes on the other end of the case begin to change.
Let me just give you a case example of an assessment issue that was very powerful. We were facilitating a team meeting for one of the community partnership sites -- this was in Jacksonville -- of a mom that was described as withdrawn, limited, uninvolved with her kids. This was an ongoing CPS case. To my discredit, since we had not met her at that point, I wondered if maybe she had a developmental disability, and I actually asked the family preservation worker quickly before she showed up, what are her strengths, what's going well? And this FPS worker said, "I can't think of any."
So mom comes in, appropriately parents these two young children throughout the meeting and, to make a long story short, in an environment that brief where she was treated respectfully and listened to, finally acknowledged to us that the reason she seemed to be listless and the reason her toddler was in the crib all day long was that she had epilepsy, which no one knew, and that she had cut her dosage by two-thirds because she didn't like the effects of the medication. ... Reframing the parenting skills issues, the child was in a crib because she didn't want the child to wander off if she happened to be unconscious.
The intervention, which had been parenting and a lot of warnings, completely changed once people understood what was going on in that family. And while it doesn't always happen in one magic moment of a family team meeting, it is great example of how treating parents differently and thinking differently about practice can change outcomes on a case.
Coordination issues seem obvious. We often have a lot of providers in families. Often they don't know what other people are doing, and when people talk to each other, which is one of the great values of the family conferencing process, shared information often produces a much more accurate intervention.
My other case story is we were doing a review in another state where they were about to permit unsupervised visiting with this mentally ill mom. In interviewing the mom and the mom's therapist, we found that she was picking up men on the weekend and bringing them back to her apartment. But because the standard for returning the kids was a clean U.A., they were on the verge of sending this 12-year-old girl home, which would have been an enormous safety issue. All these people had to do was talk to each other.
I guess the answer to this is, what is the answer to this? What do you do to install this practice? The things we would suggest is to decide what practice you want, to formalize a framework of practice, some sort of model of practice that everybody understands. Systems often don't do that. You get one overlaid initiative after another that provides really no integral description of what practice should be.
You can't just train new workers. Assuming you have great skill-based training, most of it applies to new workers. The majority of the practice culture has never had it. And what we normally hear when workers come back from this great pilot training is, supervisors say "We don't do that here," [and] it never happens. You have to find a strategy to retrain your work force. If you don't, you're just sort of nibbling around the edges of change.
Mentoring is a critical issue. People have to see good practice done, and so there has to be a way to develop the coaching skills of the supervisory staff.
And last, although this isn't last, all of our resources continued to be tied up in categorical services. If you have a needs-based system where you individualize responses to kids and families, you have to have more than parenting classes, counseling classes, and substance abuse treatment. The worker has to have the ability to get something new, even if it has to be created. That was one of the benefits of the litigation in Alabama, it gave us the power to take money away from people who weren't providing the right services and put it in the hands of workers so they could craft individual services.
That's a snapshot of a look at reform around frontline practice issues. I'll stop now. Thank you.
Ms. Conroy: Thank you, Paul. Our final panelist this morning is Professor Brenda McGowan, professor of child and family welfare at Columbia University School of Social Work, and she'll make some closing comments in terms of the panelists that you've heard so far.
Professor, Columbia University School of Social Work
... There's a lot of questions and issues I'd like to pick up on. One just early one I think I want to relate also to Commissioner Bell's op-ed piece in the [New York] Times yesterday [Jan. 21, 2003], as well as Zeinab's comments, all the important forces for change in the city and what's been accomplished. The one thing that wasn't mentioned until we got to Alabama was the role of court class-action suits, and it seems to me that did have an important role in precipitating some of the political will, and I'd be interested in people's views on that.
I think another theme that people have been talking on, alluding to, is the need for looking much more closely at what's going on on the frontline, the demands, the need for empathy, really, for the workers. One thing that worries me a lot is the reliance on training. Like, what is it, six days now of intensive training? I can't believe six days is enough. Somebody raised the question earlier, how many of us could go in and do a good assessment today in a family and find out what's really going on? And there's an awful lot of education in this room; it would go way past the six days.
I think we've got to think how to do the modeling. A particular issue, I guess, is how do we get people with more training in better supervisory roles. I've just been involved in a little study with ACS folks who got their masters degrees in social work and have gone back to the agency, and it's wonderful to listen to what they say they've learned. Just a couple of quotes:
"The MSW is empowering in helping me understand the need to work with families from a strength perspective while still fitting the agency scheme."
"The degree helps in learning not to be judgmental. My focus with clients is more detailed, more focused on stabilization of family, modification of behavior, rather than just protection of children."
The program made a tremendous difference in evaluating decision-making, but the supervision does not change. The big theme that came through is, they feel ready to make more individualized decisions; they're making more comprehensive assessments. But they're caught. And I don't know how one changes that; I'm not an administrator. But it seems to me a real dilemma is, how do we create some space for the frontline practice folks to be able to make professional decisions, more thoughtful individualized decisions? While I realize there's still the need to control, to protect, because of the public nature of the system, we have to find a way to create some autonomy for people that have the expertise.
Also, nobody mentioned it, but I think a big issue for me has been the turnover. That's diminishing, but with child protective workers, I think one reason is this lack of feeling professional. So I'd like to see some discussion on that.
Clearly, another big theme that came up is around the need for more attention to the early family support services, early intervention. I think we probably could have discussion about dual-track. I have a different view from Gail. Jane Waldfogel's done a lot of work on that, so you can hear from that later, but it seems to me that probably is a way to help us move to struggle with some of the ideological battles that clearly are part of what's so difficult with the system, and I think what's so difficult for the workers, for the frontline practitioners trying to change, and to know which way to function, to try and think they're doing the right thing. ...
I left Children's Defense Fund in 1976 to come teach at Columbia, and I remember thinking the first article I was going to write was, "Why is Child Welfare so Hard to Reform?" I have never written that article. I realize it was a great title, but I didn't know the answer. Hopefully we're getting to some answers on it.
Ms. Conroy: The floor is open for questions. There's a mike.
» Joe Semidei
Committee for Hispanic Children and Families
The commissioner mentioned that entry to child welfare is largely contained to 18 neighborhoods. Given that fact, I want to go back to Gail's comment about investing, because there seems to be an overlap of class, race, and poor neighborhoods. What type of investments will be appropriate to build up the community that give those families the supports they need? ...
Ms. Nayowith: I think part of it, Joe, is what's the reason for the report. Are there housing problems? Clearly, housing is an important issue in a big urban area. It's all over the country, even in the suburbs, the cost of housing is bankrupting poor families. No matter how much work is going on and how much money the families are struggling to earn, it's not enough to really take care of all their obligations.
So there are a number of concrete issues that are beyond the scope of the child welfare system, which have to be addressed also, which are basic safety nets, right, whether it's housing or access to food and other kinds of things that are indicators of poverty and create stresses in families. But then there are personal issues that the parents have, too, whether it's substance abuse, or whether it's access to mental health services, or if there are developmental delays.
So the reason for the report and the findings from an appropriate assessment in particular neighborhoods will point up very glaring gaps in the availability of supports for these families. Again, some of them are concrete, as in housing, which I know is a big issue all over the city here, and there are other things that are also in very short supply. So there is a question of strategic investment in neighborhoods that I think really has to be addressed.
ACS Deputy Commissioner Chahine: I'd like to add that the stresses of poverty and specifically the issues that we really deal with in these neighborhoods are related to substance abuse, mental health, domestic violence -- all issues that we know are impacting heavily on the children who are coming into the foster care system. So the strategy has to really be comprehensive to address the needs of these families, to provide more supports so that early on we can be able to detect when the family is being stressed and to support them with different services and different strategies that would really help to keep these children in the homes.
So it takes all of the community really working together, figuring out its resources, and accessing some addition resourcing, like housing, which is really a great problem for children and families in New York.
Mr. Semidei: ... It's always struck me that our system is a triage system and is pathologically driven. So a poor woman who is trying to care for her family has very little resources. The minute she does some abuse, then the social worker will knock on the door. And it seems that the investment that they do on poor women, a non-pathological approach to helping poor women would be helpful. But there's no political support for that, but that would be something that advocacy might want to start building up.
Foster Youth Advocate
I'm an ex-foster kid and I don't get a chance to talk to people who actually have this much ability to change things, so I wanted to make a comment. I listen to you guys and I hear a lot about the structure and about the organization and about the foster parents and about the birth parents, but what I don't see is a lot of representation from the youth themselves. What I would like to recommend is I think that youth leadership panels really need to happen across the country. I think that voices of the kids as they get out of the system are very important and need to be tied absolutely to all of these changes that you're talking about. What Paul was saying, where the top is making all the decisions, and the bottom, the very bottom of it is the kids. So that was the comment that I wanted to make: Bring the youth in as much as possible and start from there.
Ms. Conroy: Apropos of that, I also teach children and family services at school, as does Brenda, and I require all my students to read Foster Care Youth United, which is a newsletter of kids in foster care in New York City right now. So if you don't know that, really check it out. It's an excellent, excellent resource, and the only place that I know of where your point is even addressed, where the kids get to have a chance. So thank you very much. Anyone else want to comment on that? Other questions from the floor? Mark?
Chapin Hall Center for Children
I agree with what pretty much everyone said in terms of what I would consider as sort of common-sense solutions to the problems. We should talk to the families, we should talk to extended families, we should deal with folks in their communities. I think all of that is good, and the fact that we're not doing that is troubling.
But I guess I'm a little less optimistic that in many cases we actually do know exactly what to do. I think this is an example, the issue of youth in the foster care system leaving the foster care system. We spent well over a billion dollars of federal and state money on programs that were supposed to help youth transition out of out-of-home care. There's no evidence, frankly, that those programs work. I know that because it's an area that I do work in.
There's a whole lot of common sense about what you should do to help youth, but if you start thinking down and you really look at the circumstances of these youth in particular, it gets a lot more complicated than that. I guess the question I have for anybody who wants to answer it is, at the ground level, do we really know what works? Do we know what we need to do to get a worker, for example, to know how to do those assessments? Let's say they do the assessments and they need substance abuse treatment; do we actually know the effectiveness of the substance abuse treatment resources we have? ... I think that's a real challenge for our field. ...
Mr. Vincent: I'm not sure this is fully responsive. I particularly agree with your concern about youth and care. My own feeling, and this is somewhat exaggerated but not completely, is I don't have much confidence in programs. Kids and families are so different. While you do need the capacity to respond to large numbers, which requires some structure and commonality, the only thing I've seen really work for kids -- and I'm talking about youth in this case -- is being able to involve the youngster in decisions about his or her own life, preferably with the other family or informal supports as a part of it, and craft an intervention that's based on those unique issues.
I think that's been one of the major flaws in independent living services in this country: They're programmatic. You get trained in budgeting, you're taught how to pay rent, how to cook a meal, how to open a bank account -- the more fundamental issues people wrestle with in adolescence. ... So other kinds of issues about their own developmental experiences we don't deal with because there's not a good programmatic fit.
I think systems have to find a way to go to where kids are and develop a response that's unique to their current environment. That's difficult to do because you can't do it with just a new program. I think the dollar resources could be used that flexibly, but systems don't function that way around the country.
Mr. Mattingly: Boy, do I agree with that. And also, Mark, I think it's fundamentally true that we don't know what works from hard, fast results produced and analyzed. I have a strong sense from the field and from having supported successful efforts the kinds of things that need to happen. ... What you have to do is help a young person develop the systems of support with adults and caring people in the community to make better life choices, and to get support during the next crisis, whether we're there or not. That's a lot more complicated. And that's why we haven't seen it happen as much as the setting-up of these programs that don't really engage the kids.
However, let me be clear: I know that there are systems in place around the country that are not focused on programs but focused on helping children and youth and their families stay connected, and that are available during crises, and that keep kids from getting caught up in this system so that they don't have a group home spot and an independent living program they're supposed to go to, and that's all they've got. We know that that works. Can I prove it today or tomorrow? No.
We also know from our work in places all around the country now that we go into the "deep end of the system" and talk to young people about what they need to get their life going, and we help them around the country, in places like Alabama, get the help that they need and take responsibility for their future and stay connected with people, and that works as well.
All of that is the non-silver bullet, non-programmatic pay attention to the individual within a broader system that supports individuals' needs rather than program needs. ...
Chapin Hall Center for Children
... A couple themes, particularly in Paul and John's remarks, deal with the issue of defining things in terms of needs as opposed to defining things in terms of programs or what you're willing to purchase. That is not well represented in the language of policy vis-›-vis the issues that John was raising about the need for an overarching policy structure that supports decision-making in terms of continuous flow of activity. How do we as a nation develop public policy that is needs-responsive or defined in terms of needs, as opposed to the kinds of language that we usually find -- such as independent living services, or services for young children, or permanency -- [that are] ideological and programmatic content. ... How do we get to that place in this country?
Ms. Nayowith: I think the issue is a fundamental failure in really conceptualizing child welfare services in the context of a whole array of other services and supports for families. I guess it's my view, and I haven't really talked about this out loud before, so here it is, the idea really that the child welfare system is a self-contained system that has to provide investigations, and assessments, and foster care placement, and mental health services, and independent living services, is sort of counterintuitive, really, in terms of the healthy development of a child in the life of a family. It doesn't make sense. You don't really learn how to be a parent in a class; you don't really learn how to be independent in a class. You can develop some skills, but it's all about practice, right? We know that from our first jobs, we know that from managing money, we know that in the way that we interact with our family members.
I might also say psychologically the idea that somehow the child welfare system as the parent is the right person to impart this information to the adolescent is slightly bizarre. And I might suggest that there is a lesson to be learned about what happens in the youth services community around youth development and what we do know that works in engaging young people in making good decisions for themselves about the future.
So there are other things that can be done. The policy conversations happen in committees. The policy conversations happen with experts. Everybody's siloed, everybody's categorical, everybody's an expert in their area. The whole child and the whole family require a different approach.
I want to say apropos of Mark's point, there are some things actually that people know work. From a behavioral health point of view, there are evidence-based practices and substance abuse treatment and mental health treatment for children and families that have been proven effective through research that works. We don't pay for it anywhere in the country, but in fact the research is there. The bridge to policy and the bridge to financing doesn't exist.
Similarly, in the youth services area, there is a raft of things that we know actually work for young people in communities, which we don't pay for either because there's no way in a policy conversation that is committee-based and expert-based and siloed to really create some kind of an approach that doesn't just create a plethora of programs in a child welfare system that can really perform those services. ...
Ms. McGowan: One of the things that I struggle with [is that] there are a lot of things that don't work [and] there are some things that work more on the individual level; probably we can point out the successes of some programs. But something happens in child welfare where that's the focus. We don't know how to cure cancer; we don't know how to cure AIDS. People are still getting resources, being allowed to try things individually. Somehow in child welfare, programs are imposed on staff and people are not given the resources or the autonomy to make decisions, to say, "Let me try this way. That's not going to work for that kid coming out of foster care. I've got to go this other way."
And I don't know how to change that from a policy arena at all, to go to your point, Fred, but it seems to me that we have to fight somehow to give people more control so that we don't have people trying to make decisions by committee and then imposing the program on them.
Mr. Vincent: I can give you one example from personal experience that's been replicated in a couple of states we've worked in in varying degrees. In the Alabama reform, ... the settlement agreement was a practice framework. It wasn't a bunch of rules and procedures; it was about 30 best practice principles that we were held accountable to. The challenge became, how do you design a system that functions this way? ...
We didn't have the dollars for many new services and workers, which was sort of my first instinct. The first thing we had to do was at least make the workforce we had competent. So we spent many of our new dollars retraining everyone who worked there in groups of counties each year. Everybody from the newest line worker to the most seasoned supervisor or child welfare administrator went through this eight-week skill-based competency curriculum and had an opportunity to practice real skills and be coached on them by very skilled practitioners who were the trainers.
That sounds like sort of full employment for social work trainers, but that was the only way to push the concept of needs-based services down to the practice level. Workers were taught to write needs statements. They were taught to assess for underlying conditions. The QA system looked at that. We didn't just monitor whether they'd responded within four days; we looked at the quality of their work through this mechanism that became the CFSR.
All the new dollars we had went to our localities in flexible, de-categorized dollars. For a small county, for example, they might have $4 million to $5 million in non-committed dollars they could use to create their own individual system of care in that county, and over time, moved dollars out of categorical contracts so that if they weren't compatible with what the locality needed, they could be changed. Now, some systems had more flexibility than we did.
So it was a very decentralized system, and most of the state office attention was built on practice capacity-building -- coaching and mentoring at the practice level. And so there was sort of the message from the top that practice mattered and needs-based practice was the theme. There were policies and procedures, financially and otherwise, to support it. In fact, every kid had to have an individualized service plan. None of them had it when we started. To get at the flexible dollars, you had to have created an individualized service plan through a series of family meetings. That was a policy piece.
Then sort of on the bottom of the system, the QA system paid attention to practice. As the saying goes, you get what you inspect, not what you expect. I think as messy and cumbersome as that is, if you really want to push needs-based practice to the bottom line, you have to do those kinds of things. You can't just tinker.
ACS Deputy Commissioner Chahine: I think when we think of families and their multiple needs, and we at the same time think of workers and individual decisions, the piece here is not to have only our focus [be] on improving the competence of individual workers and individual supervisors, although that's really very important, but to think in terms of really bringing the resources and the supports into this child protection system so that the decisions that are being made are not being made individually or in isolation, and to involve the families and the supports in the decision-making process. So that the approach to really figuring out what is best can only happen in this context, where we are bringing the people who are actually impacted by the issues that they're struggling, so that it changes the approach of all of us really coming together to try to figure out what's the best approach here, not, rather, leaving it up to individual workers and individual supervisors. I think that's really our best hope in terms of bringing all of us together and to change things for families.