Making Child Welfare Work

Forging New Partnerships to Protect Children and Sustain Families

After his parents divorced, 8-year-old "RC" was taken into the state's custody. He was sent to a series of psychiatric institutions, even though he was not diagnosed with any serious emotional problems. He spent much of his time in locked isolation rooms, heavily drugged. RC's father protested this treatment and was promptly barred from visiting his son. A year and a half later, after a lawsuit was filed on RC's behalf, the state's child welfare agency returned RC, offering no assistance to either the boy or his father.

A new book tells the story of RC's lawsuit and how its settlement produced the first bottom-up statewide reform of a child welfare system in the United States. Making Child Welfare Work describes the collaboration among public officials and Bazelon Center lawyers and experts that has rededicated Alabama's child welfare bureaucracy to focus on the people it was created to serve—children like RC and their families.

The results of the unique county-by-county staged reform are as compelling as the story of how it happened. From 1991 to 1995, when the number of children in foster care nationally rose by 12 percent, Alabama's foster care census fell by 22 percent, even though fewer than half of the counties had started the reform. Children's stay in care dropped from an average of 438 days to less than 100.

Now, seven years after the R.C. settlement, the new system is in full operation for two thirds of the state's population. Changes in policy and contracting are driven by local practice. Child welfare workers and their supervisors take pride in engaging families and building on their strengths to meet children's needs effectively. Families report satisfaction about the quality of services and their relationships with caseworkers. Foster families and other providers view themselves as part of a team working together to support families and children.

Some of the children, parents, foster parents and case workers help us tell the story with dramatic examples in the narrative of Making Child Welfare Work. The introduction is excerpted below.

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Background: The Human Cost Of Systemic Problems In Child Welfare

The child protective services and foster care system in the United States grew out of efforts by early religious and charitable organizations to serve orphans and "rescue" children from abusive or neglectful families. Today's federally supported foster care system was created under the Social Security Act of 1935 as a last-resort attempt to protect children at risk of serious harm at home. The law obligated states to assume temporary custody of children whose parents were unable or unwilling to care for them.

By the early 1990s almost half a million children were in the custody of state child welfare systems and the U.S. Department of Health and Human Services estimated that at least one of every 10 babies born in poor urban areas in the '90s would be placed in foster care.¹ Children with emotional or behavioral disorders made up 40 percent of the child welfare population and few resources were available for any type of treatment or support services.²

The steady increase in foster care placements is very troubling. Most children are deeply traumatized when they are separated from their families. Even when their family environment has been dangerous or unhealthy, studies have shown that a child often experiences separation from a primary caregiver as a threat to survival.³

Shirley I., who lived in Children's Harbor, a campus of group homes, asked the agency's director to send her story to the judge to be read at the September 1991 fairness hearing. Things that was Wrong in My Foster Home 1. I was whipped with just about anything. I was whipped with a bullwhip, switches off of plum trees, and a extension cord. 2. I was locked out of the house one night and I stayed out until that morning. 3. My foster parents had a farm and they would keep us out of school to do some of the work like chopping around cane and getting it ready to make syrup. 4. When I was little, about from 9 to 11, I use to get tied in a chair so I can take my whipping because I always would run. She whipped my sister on the tongue, because she brought in a little switch to get a whipping with. 5. My foster parent would slap me. She slapped me one day because she thought I had lied on her husband. I wished I could have stayed with my parents instead of being in a foster home. I was abused in my foster home by my foster farther. It started when I was about 10 or 11 until the day I left. I think if I was with my parents none of this would have happened. Me, my sister and brother could have been together with a mother and father like all the normal kids. My father has died and I did not get a chance to tell him that I love him and that I forgive him for not having his children, and that I still think he was a great dad. While I was in my foster home I didn't get to see him and my mother much. I don't like being in different homes and foster home. I would like to be with my mother. I don't want her to die without being able to live with her and get to know her more, and to catch up on the times at we missed as a mother and daughter. I don't think from what I hear that I needed to be in a foster home. D.H.R. could have gave my mother and father a chance before they took us away. My sister and brother want [to] stand and say what happen and I think it's wrong, what happened in that foster home. I have flashbacks and it bothers me to talk about, it bothers me at night when I need to go to sleep. I can't go to sleep at night and then I get tired and can't do my work in school. I think about what happen a lot and I know I never said that I want this to happen to me and I never ask that it would. All I really want now is to be saved, ask God to take control of my life and to help me know that one day I won't be having these dreams. Then I hope to live with my mother. I think she has done better. I don't really like it here. I just want to be with my mother and if I can't I would at least like to live near her. I want to get to know my family more than I do. While I'm in and out of places like this it is harder for me to see my mother. I had a hard life but somewhere along the road God is going to really help me. Love, Someone Special. (Back to text)

A child is removed from home with an implied assumption that the state will be able to provide the safety and stability the family was unable to give. Yet the child welfare system itself often falls short of providing either safety or stability. In a letter to a judge, Shirley I, an Alabama girl, reflects the multiple problems with today's child welfare system: abuse by some foster parents, a child's anguish at being separated from siblings, the lack of support services for parents, and the trauma of the child's loss of contact with her family while in foster care.

Lack of stability is particularly serious. "K, a 17-year-old Alabama boy in foster care for nine years, described himself as a "basketball," dribbled from one relative to another and shuttled between 11 different custodial facilities, shelters and hospitals. When K was 10, child welfare staff wrote a plan that envisioned his remaining in an institution until 18.⁴ Despite all this "care" at state expense, K never received treatment for his visual, hearing and learning problems, or counseling for the emotional issues he struggled with as a result of all the different placements.

Advocacy for Reform

Except when a child's death makes headlines, the children in foster care are easy to ignore. They are too young to have a political voice, their parents are portrayed as unloving or abusive, their caseworkers are overwhelmed and the state agencies responsible for their care face constant financial pressures and negative public opinion. By the late 1980s, advocates began bringing these children to the forefront of America's conscience and addressing system-caused harm aggressively.

One tool they used was system-reform litigation. Leading the charge was the American Civil Liberties Union's Children's Rights Project, bringing cases to enforce the Adoption Assistance and Child Welfare Act, requiring that states make "reasonable efforts" to prevent unnecessary removal of children from their homes and, when they were removed, to reunite them with their biological families or find permanent adoptive homes for them. Most of these complex class actions had only modest success. Unlike the case known as Willie M., brought by the Youth Law Center and local advocates, which developed a comprehensive system of care for children with serious emotional disturbance in North Carolina's custody,⁵ they did not address the emotional disorders that affect such a large proportion of children in foster care. And most spent years battling the inertia of entrenched bureaucracies, producing at best lowered caseloads.

In 1988, lawyers with the Bazelon Center for Mental Health Law and other human-rights advocates in Alabama saw an opportunity to build on the Willie M. approach. They developed a litigation strategy modeled on the landmark cases that were reforming mental health systems to shift power from the state child welfare system to the community, creating a new kind of system from the bottom up. What bottom-up means is that the structure of the system and the way it responds are not defined at bureaucratic conference tables but at the point of service, the consumer—in this situation, the children and their families.

Child Welfare in Alabama

The Alabama Department of Human Resources (DHR) operates a typical state system for child protective services and foster care. As it is collectively called, this child and family services system responds to about 30,000 reports of child abuse and neglect every year, about half of them with some foundation. In 1988, some 4,600 children were in the department's care at any one time.

Alabama's system reflected all the problems seen nationally: huge backlogs of uninvestigated child abuse and neglect reports, children languishing for years in foster care and children with serious emotional problems on long waiting lists for treatment, often ultimately provided in institutional settings far from their homes. The bureaucratic structure had grown rigid, drifting from its purpose and stifling the creativity of its workers and administrators.

This was the impetus for the class-action lawsuit called R.C. v. Hornsby, brought by the Bazelon Center, the American Civil Liberties Union of Alabama and the Southern Poverty Law Center. The R.C. case never went to trial, however. In a landmark 1991 settlement, the plaintiffs' lawyers and the state agreed to a set of values and principles for total reform of Alabama's child welfare system. Working in concert, with the help of leading national experts in children's mental health servcices, they began an extraordinary county-by-county implementation strategy. As a result, at a time when child welfare systems across the United States face a chorus of criticism for failing either to protect children or to preserve families, many of Alabama's counties have made remarkable progress in doing both.

Fixing a Bicycle While Riding It

How has Alabama achieved so much more real improvement in engaging families and meeting children's needs than other child welfare reforms? It is the first reform to be driven not by procedural requirements but by the principles of good practice. The outcome measure in each case is not a federally mandated time frame, a court-ordered service plan or a referral for services; it is meeting the child's needs for stability and family integrity, by whatever means it takes.

Partnership is the key principle—between DHR workers, families, foster parents, communities and the providers of all the services a child and family need. This means that county offices, instead of listing children's and families' deficits and assigning them whatever service is available, define a child's and family's strengths and needs and design services case-by-case. When all involved agree—family members, the foster family, other providers, the worker and, when old enough, the child—on what a child needs, and undertake to do whatever is necessary to meet those needs, more intensive services are provided that result in shorter stays and in foster care placements and adoptions that do not break down.

Because the reform reflects a new model and not simply compliance with existing standards, consultation and training have been critical to its success. Workers and providers receive training and then have continuing access to help in applying the new way of thinking to their own cases. Even with such assistance, however, designing services specific to each child and family calls for new and creative thinking and takes more effort at the front end. "Fixing a bike while riding it" was how state and county child welfare staff sometimes described the R.C. change process.

At the outset, neither the counties nor the state office had an instruction book for fixing the bicycle. Instead, the players invented the reform as it went along. As more and more workers enthusiastically changed their practice, all the activities of the county office changed, from foster-parent recruitment to intake to personnel. And as the strengths/needs-based service philosophy was applied locally, county offices integrated the improvements in their management, casework and relationships with providers. Finally—and rather gradually—state-office infrastructure evolved to support it. Now workers, families and providers have such a strong personal investment in the success of the new approach that they are the first line of defense against any drift into bureaucratic stagnation.

Although the result of a lawsuit, the R.C. reform is in many ways not an adversarial model. One of the reasons the reform effort succeeded is because DHR's leadership was strongly committed to the guiding principles laid out in the consent decree. The director of Alabama's child welfare system, Paul Vincent, received a national award from his peers for his stewardship of the reform effort.

The reform also benefited from the principal role played by the plaintiffs' attorneys in mapping implementation strategy and from their ongoing work of monitoring and assisting the implementation itself. They worked with parents, providers, courts, other stakeholders and the media to build broad-based community support for the plan. And, when political or other obstacles arose, the public-interest lawyers pressured the state to adhere to the consent decree by threatening—and on several occasions pursuing—renewed litigation.

The R.C. reform is not without problems. Children in some of Alabama's largest population areas, have a disproportionately high rate of truancy and teenage pregnancy relative to children who are not in foster care. The DHR offices in these counties have had to cope with a mix of poverty, substance abuse and emotional disturbance in both parents and children. Communities and families there were less involved than in other counties and case workers were overwhelmed. However, with intensive advocacy by the plaintiffs' attorneys and the flexibility fostered by the R.C decree, innovative approaches have started to show success in these counties.

The political climate has always been a factor in implementing the R.C. decree—as it is in advancing any systemic reform. Several years into the process it took a negative turn. In 1995, Governor Fob James took office. In March 1996, he appointed a new DHR commissioner, Martha Nachman, who shared his bias against judicial solutions. The collaborative reform spirit that had prevailed under Commissioner Andy Hornsby and his successors faded quickly.

While professing a commitment to comply with the R.C. decree, Nachman began to dismantle much of the infrastructure that supported the reform effort. When she imposed a hiring freeze that would have left too few workers for children's safety in two urban counties, the plaintiffs' attorneys obtained a court order to increase staffing in these counties. In July 1996, she asked the court to vacate the R.C. decree or at least modify it by narrowing the plaintiff class, asserting that DHR's commitment to family preservation was unsafe for children. On June 16, 1997, the court denied Nachman's motion in a sternly worded 53-page order. The judge suggested that her motion, filed six years after the settlement, was based only on a shift in the political winds." His opinion was upheld on appeal.

Even more dramatic than the judge's order, however, was the county DHR directors' response to Nachman's disdain for the reform. At their annual meeting in early 1997, they unanimously voted "no confidence" in her leadership and management of the state bureaucracy. The new philosophy had taken hold at the point where it matters—the point of interaction between the system and the families it was established to serve.

In recent years a significant backlash against family preservation has developed around the country. Opponents incorrectly characterize it as supportive of leaving children with their families no matter what the risk. The press—in Alabama, as elsewhere—has exploited each report of injury due to possible neglect or abuse, blaming the family preservation movement. But the Alabama counties implementing the R.C. reform have consistently emphasized the need to protect a child's safety as workers and supervisors learn new ways to attend to the child's attachment to family. As a result, children who could not safely live with their families can still maintain ties to them, supported through letters or visits that help the child settle into another permanent home. This simultaneous focus on safety and recognition of the child's attachment needs is a complex skill, as yet found in few other child welfare systems. The changes in child welfare practice fostered by the R.C. litigation hold new promise for preserving the family connections of children at risk everywhere and lay the groundwork for their healthy futures.

Notes

¹"Proposal to Preserve the Family," Associated Press, The Wenatchee Daily World, May 24, 1993. Back to text.

²Mental Health Law Project (now Bazelon Center for Mental Health Law), The R.C. Case: Creating a New System of Care for Children, 1991. Back to text.

³Firman, C., On Families, Foster Care, and the Prawning Industry, Family Resource Coalition Report, No. 2, 1993. Back to text.

⁴From Alabama case record review by plaintiffs' experts, 1989. Back to text.

⁵For an overview of the case, see Soler, M. And Warboys, L., Services for Violent and Severely Disturbed Children: The Willie M. Litigation, in Dicker, S. (ed.), Stepping Stones: Successful Advocacy for Children, Foundation for Child Development, 1990. Back to text.