Dying for the wrong reasons

Children who go into foster care should be there for the right reasons and expect safety, nurturance and support as they struggle with what can only be thought of as one of the most difficult transitions that children can face. They are leaving the home that represents their known base of life - the one with parents and siblings - and going to a place that is unknown with people who are strangers. Who of us can conceive how challenging that must be (unless of course we have been there).

I have met success stories from foster care in my practice and with my students in university. They have shared personal insights into how foster care saved their lives. This is how it is supposed to work. Yet it doesn't always.

A report just published in Oregon looking into foster care raises some serious concerns that echo struggles with foster care elsewhere. Here is an interesting first recommendation:

"A foster care certifier carries a case load of 55 homes. In addition to certifying these homes, they are also recruiting, training, monitoring, supporting and placement matching. These roles require very different skill sets and cannot be effectively accomplished by one person. Certifiers, who often carry the same case load for several years, run the risk of becoming enmeshed with the foster parent because of the
relational aspect of the job."

Well - relationships are what social work is about so let's not criticize workers for doing that. But the point is fascinating - work is complex and at times, workers who are generalists may be faced with specialist challenges. Child proetction systems often don't like specialists because of the extra costs that can go with such roles.

Their second recommendation should look familiar to almost all child protection systems: A scarcity of foster homes in Oregon drives compromise, and certification violations may be overlooked due to the need for homes." Scarcity can lead to overloading homes, expecting foster parents to manage complex kids that they may not be qualified to handle or holding children in placements that are inappropriate while efforts are made to find a foster home.

Critics of child welfare will, of course, also note that children are being brought into care who should not be. With other supports, they argue, children could be maintained in their homes with family that may not be perfect but can be good enough. Critics will also argue that children are being brought into care because of poverty as opposed to real child protection concerns. That is a big discussion but one that our profession is not having widely enough. There is no doubt that poverty creates significant pressures in families and the majority of families in such situations do not abuse or neglect their children. But equally, there is little doubt that the poor are over represented in child protection cases.

The critics will further argue that if proper efforts are made to address these socio-economic conditions, fewer children would come into care thus easing caselods, improving the opportunities for more effective casework with families that truly are in need of protection and reducing the demands on foster care resulting in safer, better homes.

The Oregon study raised one very disturbing issue that has been seen in so many tragic cases - the lack of effective communication between professionals. This has been so widely discussed in child death reviews in the United States, Canada, the United Kingdom and other countries that it is distressing to see it again. The Oregon study notes, "Through the examination of two sensitive case reviews released in October 2009, as
well as a random sampling of “closed at screening” files, the FCST found that the lack of communication among DHS staff and/or foster parents contributed to the initial and long term abuse of children in foster care." They also state, "There is no ability for cross county information sharing which would allow foster care providers to move to other counties without the new county office having knowledge of their history of allegations." This is a broad systemic issue that is negatively affecting children.

In my own practice, I have seen it. For example, a person doing a parenting capacity assessment will deliver a report with striong concerns only to find that the children were returned to the parents without the assessor being told while the assessor was writing their report; assessors raise serious worries about the safety of a family but never hear from the case worker.

Systemically, these types of concerns that are so broadly reported are often a refelction of high caseloads, demanding systemic pressures and complex cases that leave workers scrambling from crisis to crisis. As a profession, we need to be willing to take steps to alter the systems that keep recreating the the kinds of circumstances where these problems will keep occuring otherwise.

The Oregon report can be found at http://www.oregon.gov/DHS/abuse/publications/children/fcst-final-report.pdf?ga=t

While I am not often in agreement with the comments of the National Coalition for Child Protection Reform (a US based organziation)their viewpoints on some of these issues merits hearing as part of the wider discussion. In response to a recent news report, they have offered some food for thought. See their report at http://www.nccpr.org/reports/censoredinmilwaukee.pdf

In a related idea about the impact of neglect, abuse, foster care, readers might want to look at the new book Born for love: Why empathy is essential and endangered by Maia Szalavitz and Bruce Perry, M.D. In particular, the chapter on resilience which includes reference to the very powerful Adverse Childhood Experiences study (see acestudy.org). They are the authors of another remarkable book, The boy who was raised a dog.