[Senate Hearing 108-304]
[From the U.S. Government Publishing Office]
DISTRICT OF COLUMBIA APPROPRIATIONS FOR FISCAL YEAR 2004
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WEDNESDAY, MAY 14, 2003
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10 a.m., in room SD-138, Dirksen
Senate Office Building, Hon. Mike DeWine (chairman) presiding.
Present: Senators DeWine and Landrieu.
NONDEPARTMENTAL WITNESSES
STATEMENT OF SISTER ANN PATRICK CONRAD, ASSOCIATE
PROFESSOR, NATIONAL CATHOLIC SCHOOL OF
SOCIAL SERVICE, THE CATHOLIC UNIVERSITY OF
AMERICA
OPENING STATEMENT OF SENATOR MIKE DEWINE
Senator DeWine. Good morning. The hearing will come to
order. Today we begin the subcommittee's second hearing within
6 weeks regarding the foster care system in the District of
Columbia. On April 2 we heard testimony that revealed a number
of serious problems and shortcomings with the District's Child
and Family Services Agency.
It is imperative that CFSA address these problems and
protect the lives of this city's children. Clearly, the
paramount reason for exposing CFSA's failures is to discover
ways to make lives better for the most vulnerable and precious
of citizens, our children. That's why today's hearing will
focus on ways that this subcommittee can target resources
towards new initiatives aimed at improving the foster care
system in the District of Columbia.
Before we hear from today's panel, I think some of the
points that were raised at our earlier hearing bear repeating,
so briefly: First, the General Accounting Office has determined
that CFSA is not meeting the official requirements of the
Adoption and Safe Families Act. This law, which I helped pass
and get signed into law in November of 1997, includes a number
of very specific provisions. It requires States to change
policies and practices, of course also the District of
Columbia, to better promote children's safety and adoption, or
other permanency options.
In fact since this law has been in effect, adoptions have
increased by nearly 40 percent nationwide. But, according to
the GAO, CFSA is not meeting the important requirements of the
Adoption and Safe Families Act.
Another troubling finding that the GAO testified about is
the District's inability to track its children in foster care.
In fact, data is not even available for 70 percent of the
District's children in foster care. This is true even though
the District has invested resources in a new automated
information system that has been operational now for over 3
years. How can we track these children and determine their
well-being if they are not even entered into an automated
system, or certainly not fully entered into that system?
In addition, the chairman of the National Association of
the Council for Children testified that children wait weeks or
months before a foster care placement is available. Some more
of the children are waiting at group homes or overnight at CFSA
offices. They are often placed in whatever home has a vacancy,
irrespective of the needs of that particular child or the
preference of the family.
With the findings from last month's hearing as our
backdrop, I will now turn to today's panel. These witnesses
will describe their experiences with CFSA and will provide
ideas about ways that we can better protect our children.
Tragically, most children in this system have been traumatized
by neglect and/or abuse. Then add separation from their
caregivers. We should see to it that they do not experience
additional, and I might say avoidable traumas, because of a
failed foster care system. I look forward to hearing our
witnesses describe ways that we can work together to fix this
system.
Witnesses will be limited to 5 minutes for oral remarks;
however, we do have your written statements in front of us,
which will be made a part of the record. Let me just say that
the 5-minute rule we have, but we will be a little lenient in
regard to that, as we have some excellent witnesses and are
very anxious to hear your testimony.
Let me introduce the entire panel and then we will begin to
hear from all of you. Judith Sandalow is executive director of
the Children's Law Center. The Children's Law Center is a
nonprofit organization that provides free legal services to
children, their families, and foster and kinship caregivers in
the District of Columbia. We welcome you and thank you very
much for being with us.
Marilyn Egerton is the deputy director of the Foster and
Adoptive Parents Advocacy Center. This center assists foster,
kinship, and adoptive parents in the District of Columbia
secure supportive services. Thank you very much for being a
witness.
Sister Ann Patrick Conrad is an associate professor with
the National Catholic School of Social Service at The Catholic
University. NCSS is one of the top 20 schools of social service
in the Nation. Currently, 3,500 NCSS alumni are serving in the
fields of child welfare, mental health, social policy, social
justice and social work education. Sister, thank you for
joining us.
Jacqueline Bowens is the vice president for Government and
Public Affairs at Children's Hospital, and is also joined by
Dr. Joseph Wright, who is the medical director for Advocacy and
Community Affairs at the hospital. Children's is the only
hospital in the area dedicated exclusively to children's
health. The hospital currently runs the DC KIDS program, which
provides comprehensive healthcare services for children in D.C.
foster care. We thank both of you for joining us here this
morning.
Damian Miller is a 20-year-old student at Hampton
University. He has been in and out of D.C. foster care most of
his life, having lived in a total of, I believe, seven foster
and group homes. Damian has accepted an internship at the State
Department this summer. Damian, thank you very much for being
with us today.
In no particular order, we will start with--Sister, do you
want to start first, and we will just go from right to left?
Sister Conrad. Thank you.
Senator DeWine and members of the subcommittee, I want to
thank you for the opportunity to provide testimony about some
options that I feel are available to the subcommittee to
enhance services in the District. I speak as a former dean of
the School of Social Service, as an experienced health and
family service worker, as the chair of the board of Catholic
Charities of the Archdiocese of Washington, and also as a board
member of the Council on Accreditation of Child and Family
Services in New York.
I want to commend the members of the subcommittee for your
interest in the children of the District. It can really be said
that the mark of a truly compassionate civilization is the way
we treat our least fortunate, and so clearly, the children of
the District in need of substitute families through foster care
and adoption are among the persons who should be considered as
part of this group, whom we sometimes refer to as the real
human resources for the future.
Most recently, as I'm sure many have had the opportunity to
speak and talk with persons who have been in foster care and
adoption, I know we are going to have this opportunity today,
but one of the things that I think we want to be very aware of
is that the potential of persons who are in care is something
that we want to capture as a society and to grow and to
develop. I have had the opportunity to review the hearings of
the April meeting and I find that certainly the road to change
for the District has been a slow and arduous path, but one of
the things that is a serious and grave concern today is that
childhood is a very short experience, and it leaves a lasting
imprint, and this is particularly true for disadvantaged
children.
So for this reason, it is urgent that the future path be
directed toward quality service, and the point that I want to
make strongly is sustainability of the services, lest any child
be lost in the system.
At the School of Social Service we have worked over the
years to provide a sound curriculum in the field of child
welfare, and many of our students do go into this field. We
have also joined with our social work education colleagues in
this metropolitan area in providing continuing education and
ongoing training for social workers who are already in the
field.
A point that I want to make is that what our graduates and
what our students often find is that although they come into
child welfare with a real passion to meet the needs of children
and their families they serve, and they are deeply interested
in the clinical well-being of the children, very often what
they experience is that the responsibilities sometimes of
excessive documentation, support services, transportation,
crisis intervention, leave them little time to engage in some
of the really best practices that we attempt to teach them in
the School of Social Service. So this makes a real tension for
them.
Some feel that there is actually minimal or no public
recognition for a job well done, yet at the same time they have
a tremendous fear of the sense of sensationalism in the public
arena with little or no shared responsibility when deficiencies
do arise. So a major point, I think a major recommendation that
I think that we can do in the future is to truly affirm the
positive examples of competent foster care and adoption
services and to provide ways that there is public recognition
for our child welfare workers. I think this is a very basic.
At the same time, speaking from my experience with the
Catholic Charities of the Archdiocese of Washington, we've sat
down in the past couple of days and we have had telephone
conferences as late as yesterday. As I'm sure you know,
Catholic Charities in the Archdiocese is one of the largest
nonprofit providers, service providers in the District, and the
Charities contract with CFSA for foster homes for children,
many of which become adoptive homes, and also for independent
living services for young men and women, as well as for teenage
mothers and their children.
For the most part, the staff reports that their working
relationship with CFSA has improved tremendously over the
years. Now you have to remember that we're talking about people
that remember the days when the District did not make its
payments for foster care parents and when all of our budgets
had such tremendous deficits that we began to say, can we
really contract with the District. So with that perspective in
mind and with the perspective in mind that staff had often
tremendous problems in communication and in collaboration with
CFSA, what they find now is that CFSA, they feel is very
appropriately demanding an increased accountability. For
example, with case plans that require identified goals, service
plans for children and families, and timelines to be made
available.
But as was brought out in the earlier testimony, the data
system, the basic data system is often down, or just not
available to their use. And what they're finding is that it's
only very recently that they've been able to get a real
technological responsiveness in this regard. But I want to make
the point that that responsiveness does seem to be coming.
The other point that seemed to be very, very important in
my talking with the staff is that in the amount of change that
has taken place in CFSA, there are, as one would expect,
infrastructure disruptions. But what has been happening more
recently that they do find helpful is the strengthening in
communications. There are now monthly meetings that allow CFSA
to provide information, and also that allow the contractors to
be able to ask questions as they need them.
A point of major concern, and I know it was discussed
before but I wanted to reiterate, the fact that it's taking as
long as 90 days to complete the licensing of foster homes and
this, the staff finds very, very difficult in them being able
to move children into a care system.
Based on all of this then, I think it's important that we
recognize that foster care was initially developed in our
country as a response to children who were orphaned either as a
result of a mother's death, accident, a father's dying in the
war, physical health problems. The children were generally,
they were fairly healthy and well adjusted experiences, and
they could fit into foster homes much more readily.
However, the current situation is not the case. Children
now come into foster care because of abuse, family violence,
community violence, drug situations, substance abuse, many
other problems. So the children who come are already
traumatized. As was pointed out, what we find is that in many
ways the health care, the mental health care in the District,
all of the social workers described the mental health care,
what we find is that the mental health services that really
could deal with the trauma that the children experience are
particularly overwhelmed in the District. And so a second
recommendation that we feel, and I think much more work could
be done on this to flush it out even more fully, is that the
District really needs to develop specialized mental health
services, staffed by professionals who are experienced in
meeting the special and differential needs of young and older
children who are in need of care.
Many of the judges, as you know, order mental health
evaluations, and yet, sometimes the staff available or the
services available leave children on a waiting list, they tell
me, for as long as a month. Now this is not acceptable in
trauma situations.
So in the older days of foster care, we had such things as
the child guidance clinic or the child mental health clinic,
that was truly tied in specifically with foster care and
adoption, and understood those services in a special way. This
seems to be very imperative for the District to move much more
rapidly and strongly in this direction.
The final area that I want to point out is that some gains
have been made during the period from child welfare
receivership and beyond. We can identify a number of directors
who each have made their own contribution. Yet at the same
time, we know for any system when there is frequent and rapid
change, it's very possible to move to a burnout or what many of
the social work professionals are calling today, the mental
health professionals are referring to as compassion fatigue.
What I would like to bring to our attention is the fact
that it becomes very, very important to think about the future
of the services and to begin to talk about the fact that across
the country, many agencies have moved into the area of
accreditation. I served and have been involved in the
development of the Council on Accreditation of Family and Child
Services for a number of years, and we have been very strong
advocates that the D.C. metropolitan area move into this
accreditation process.
If you're not familiar with this particular process, it was
formed in 1977 at a time when the Child Welfare League of
America, the Family Services of America, and a number of the
church-sponsored or faith-based organizations were really
experiencing a tremendous desire to begin to set standards for
child welfare organizations. At the current time, COA, the
Council on Accreditation, accredits more than 1,400 public and
private organizations that serve children and families. And the
advantage of this is that this is a national organization that
sets national goals, it readily updates the standards for child
care, and they hold accountable in an objective way the staff
from an administrative point of view, as well as from a
services point of view.
Most organizations that move into the process, it's a stage
process, that requires first an application process, a self
study and the self study in itself has the organizations look
very carefully at their own processes, what needs to be done,
how do they have strong quality assurance programs. And these
are monitored, and there are standards set for how this can
happen. My recommendation is that the District move into this
accreditation process and that they contract with service
providers who are also accredited. This is happening across the
country. Many States and local jurisdictions are given a
timeframe by which they require that the agencies that they
work with have some form of accreditation, and have moved in
that area.
To the best of my knowledge, only three agencies in the
District have been accredited by this process. These are the
Family and Child Services of Washington, Lutheran Social
Services of the National Capital Area, and Progressive Life
Center. And currently, Catholic Charities is in this process
and will move toward it.
We feel that the advantage of an accreditation process for
the District is that it will assure that all CFSA children and
families receive confident and holistic care based on regularly
updated standards regardless of who the service provider is. It
would certify that CFSA and provider agencies adhere to highest
standard of management practices regardless of administration
or staff turnover.
PREPARED STATEMENT
Several years ago at Catholic University, the National
Association of Social Workers sponsored a conference on child
welfare and at this time there was some of the early moves to
move away from the formal receivership. At that time the
receiver who was in office at that point in 1998 committed
herself to moving toward an accreditation process and to
contracting with accredited organizations. Unfortunately, it's
my understanding----
Senator DeWine. Excuse me, Sister. You are way over time.
I'm liberal, but not that liberal.
Sister Conrad. Thank you. Much more is in the written
material.
[The statement follows:]
Prepared Statement of Sr. Ann Patrick Conrad
Senator DeWine and Members of the Subcommittee, I thank you for the
opportunity to provide testimony about the options available to the
Subcommittee to enhance child and family services in the District of
Columbia. I speak as an experienced child and family service social
worker; as former Dean of the National Catholic School of Social
Service (NCSSS), The Catholic University of America; as current
Chairperson of the Board of Directors of Catholic Charities of the
Archdiocese of Washington; and as a member of the Board of Directors of
the Council on Accreditation of Child and Family Services, New York. I
want to commend the members of the Subcommittee on your interest in and
commitment to the children and families of the District of Columbia who
are vulnerable and in need of our special support and concern. It can
be said that the mark of a truly compassionate civilization is the way
we treat those who are least fortunate. Clearly, the District children
in need of substitute families through foster care and adoption are
among the persons who should be considered as part of this group and
whom we sometimes refer to as the human resources of the future.
Most recently I had the opportunity to meet the family of a former
Catholic Charities' foster child who was later adopted by his foster
family. They reminisced over their experience of foster care and
adoption, pointing out how very proud they are of their adopted son,
now a married adult and father of a growing family. He completed his
education, served in the Gulf War and currently serves as a career
Federal civil servant. This family continues to sustain a close and
supportive relationship with each other that benefits not only the
immediate family members and their offspring but also the community in
which they live. In many ways, this is an exemplar of the outcomes that
quality professional child and family service can produce when a social
service agency, foster families, and the community work together.
I have had the opportunity to review former testimony provided to
the Subcommittee in your April hearings and have followed the various
transitions in the District of Columbia Child and Family Service Agency
since the LaShawn Order. There is no question that the path to change
over the subsequent years has been slow and arduous. However, the
experience of childhood is short and leaves a lasting imprint--
particularly so for our Nation's poor and disadvantaged children. For
this reason, it is urgent that the future path be directed toward
quality service and sustainability, lest any child be lost in the
system. Therefore, my comments are directed to these ends: quality
service and sustainability.
Our School of Social Service at Catholic University has had a
continual interest in the welfare of children and have worked to
provide a sound curriculum in child and family service that prepares
social workers to pursue careers in the complex and changing field of
Child Welfare. We have also joined with our social work education
colleagues in the Washington Metropolitan area to provide training and
continuing education for social workers in this field. It has been our
experience that child abuse, family violence, and the drug culture are
among the many social phenomena that require heroic efforts on the part
of today's caseworkers and case managers. Many have a real passion to
meet the needs of the children and families whom they serve and are
deeply interested in the clinical well-being of the children. Yet the
responsibilities of extensive documentation and support services such
as transportation, crisis intervention and the like leave them hard
pressed to find the time to engage in best practices. Some feel that
there is minimal to no public recognition for a job well done, yet they
fear extensive sensationalism in the public arena with little or no
shared responsibility when there are deficiencies. As a start, we need
to affirm positive examples of competent foster care and adoption
services and to provide public recognition for our child welfare
workers.
As you most likely know, Catholic Charities of the Archdiocese of
Washington is among the largest private non-profit social service
providers in the District. Our financial audit shows that 85 cents of
every dollar goes into client service. The agency contracts with the
Child and Family Service Agency (CFSA) to provide Foster Home Care for
children--many of which become Adoptive homes--and Independent Living
Services for young men and women as well as teenage mothers and their
children. For the most part, staff report that their working
relationship with CFSA is good and mutually supportive and that
increased accountability to CFSA is being appropriately demanded. An
example is that case plans which contain identified goals, service
plans for children and families, and time lines are to be made
available in a timely manner through the automated FACES data base.
Unfortunately, the system has been frequently ``down'' and it is only
recently that workers are experiencing greater responsiveness to their
difficulties in this regard. They describe other infrastructure
disruptions such as lack of information about whom to contact for
particular types of needs, but note that they are encouraged by CFSA to
report these problems when they occur. To address the issues and
strengthen communication, CFSA holds monthly provider meetings which
allow agencies the opportunity to raise issues and concerns as well as
to provide a vehicle for CFSA to transmit necessary information to the
service agencies. Additionally, Charities staff find that the process
of licensing of foster homes has been lengthy--taking as long as 90
days to complete, because CFSA has been short of staff to carry out the
review process. These concerns are not new and have been discussed in
previous hearings. In summary, the Catholic Charities staff find that
communication and coordination with CFSA are in transition from a
crisis orientation to a more consistent working relationship.
It is important to recognize that foster care was initially
developed in an earlier century as a response to children who were
orphaned as a result of a mother's death in childbirth, the father's
death in a war, or caretaker deaths from pneumonia, tuberculosis,
polio, accidents, etc. The children were generally healthy, adjusted
children who fit easily into a family where the mother was at home and
the father was the sole breadwinner. This is not the case today!
Children of this century come into foster care as a result of physical
or sexual abuse, domestic violence, community violence, substance
abuse, severe neglect, abandonment, and other social problems. These
children are frequently not healthy, happy children who simply need a
home. They are traumatized children in need of many more supports. They
are traumatized first by the neglect and/or abuse they have
experienced; then by separation from the primary caretaker; again by
placement with strangers; and yet again by re-placement for troubled
behavior when the initial placement threatens to disrupt. Too often,
our child care system ignores the initial mental health stresses and
compounds them with further forms of trauma such as movement from one
home to another, often more harmful than the initial trauma. Although
judges frequently order psychiatric evaluations in emergencies, the
services are described by social workers as ``overwhelmed'' and so
backed-up that foster children can be a month or longer on the waiting
list.
Compliance with current Federal Law (the Adoption and Safe Families
Act) requires that children be returned to families or placed for
adoption within a year. While basically sound in terms of permanency
planning, this requirement places intense psychological stress on
children and on the child care system. We need to make the assumption,
then, that long waiting periods for mental health care are unacceptable
and need to be remediated. The District needs to develop a specialized
mental health service staffed by professionals who are experienced in
meeting the special and differential needs of young and older children
who are in our care.
Finally, and very importantly, there is the issue of strengthening
and sustaining the gains that have been made. We need to recognize that
during the period of the Child Welfare Receivership and beyond there
have been at least five directors whom I can identify. At NCSSS, we
reached out and collaborated with them all. Each brought important
gifts and talents to the table and in his and her own way moved the
system along. However, with each change there was ambiguity and
disruption for the workers, the children, the families and the
community as the environment and expectations changed. While a certain
amount of challenge is useful for any system, continual transitions can
lead to burnout and what is known today as ``compassion fatigue.'' Over
the years, I and several of my colleagues have been involved in the
development and work of the Council on Accreditation of Family and
Child Services (COA) and have been strong advocates that the foster
care and adoptions services in the Metropolitan area and the agencies
with whom they contract engage in this process. We see this as a way of
stabilizing the gains that have been made while at the same time
placing the responsibility for long-term oversight in the hands of
experienced professionals.
The Council on Accreditation was founded in 1977 through the
combined efforts of the Child Welfare League of America, the Family
Service Association of America as well as Jewish Family Services,
Catholic Charities U.S.A., Lutheran Family Services and other
experienced family and child serving agencies. Their purpose was to
promote standards of care based on best practices that could be used
across the United States and Canada. Today, more than 1,400 public and
private organizations serving over six million individuals, children
and families are accredited. With its recent international thrust,
family and child care agencies in the Philippines and other
underdeveloped countries struggling for financial and human resources
have become interested in the process. They see accreditation as a way
of sustaining the transformative efforts they have undertaken. COA
provides standards for agency administration as well as for service
provision in 60 unique service areas. The process includes four basic
phases: First, an application is submitted by the applying
organization. Eligibility criteria require that the organization
provide at least one of the services for which COA has accreditation
standards; that it be in operation for at least one year at the time of
the on-site review; that it hold all applicable licenses or
certifications required to operate; and that it demonstrate sufficient
autonomy and independence to permit review as a separate entity.
Second, a self study is completed which addresses all areas of
organizational management as well as service standards. During the self
study, the agency undergoes a systematic quality improvement process
and strives to demonstrate to COA and to the peer review team that it
is in compliance with all standards. The self-study process takes
between four and eight months and involves participatory self-study and
change where needed. Next, a site visit is made by a team of peer
reviewers knowledgeable and experienced in the accreditation process.
In the final phase, an accreditation decision is made by the COA
Accreditation Commission. Most organizations complete the entire
accreditation process within 12 months but an organization facing an
internally or externally imposed deadline may opt for an accelerated
time line.
To the best of my knowledge, only three agencies in the District
have been accredited. These are Family and Child Services of
Washington, Lutheran Social Services of the National Capital Area, and
Progressive Life Center. Currently, Catholic Charities of the
Archdiocese of Washington is in the final stages of the process. This
means that although they may be in compliance with current legal
requirements, neither CFSA nor many of its contractor agencies have
been systematically evaluated against national standards of best
practice.
You may already be aware that at a conference on child welfare held
at Catholic University in 1998 sponsored by the Metropolitan Chapter of
the National Association of Social Workers and co-chaired by Dean
Richard English of Howard University School of Social Work and myself,
a former CFSA Receiver committed her administration to work toward
accreditation. Some staff work in this regard was begun. Unfortunately,
it has been my understanding that work toward compliance with the law
eventually took precedence and I am not aware that accreditation has
been pursued since that time.
However, in light of the continual and increasingly complex
challenges to competent and responsible child welfare today--the
challenges of physical and sexual abuse, domestic and community
violence, substance abuse, etc.--and in spite of the strides that have
been made through receivership and beyond, it is imperative that an
objective and experienced system of oversight such as that provided by
the Council on Accreditation be required for the District of Columbia
which holds CFSA and its contractors to clear and measurable national
standards within a three to four year time line. This provision will
serve the District of Columbia by:
--Assuring that all CFSA children and families receive competent and
holistic care based on regularly updated standards, regardless
of service provider;
--Certifying that CFSA and provider agencies adhere to high standards
of management practices regardless of administration and staff
turnover;
--Providing a work environment that is safe and supportive of on-
going professional development for all staff; and,
--Ensuring that on-going oversight of the child and family services
of the District is carried out by an experienced and committed
professional organization, thus reducing the amount of time and
direct action needed by government officials such as Congress
and the Appropriations Committee.
Failure of the Appropriations Committee to act in this regard and
to provide the needed resources could compromise the future progress
and sustainability needed to meet today's child welfare challenges. The
District of Columbia needs and deserves to be on a par with national
standards of foster care and adoption as well as other child and family
services.
Thank you for the opportunity to address this very important
issue--the future of our vulnerable and neglected children in the
District of Columbia. With appropriate resources and systems, they,
like the former foster child I described earlier, can and will become
an integral part of our human resources of the future.
Senator DeWine. Thank you. Miss Egerton. You're next. We
have been joined by Senator Landrieu.
STATEMENT OF MARILYN R. EGERTON, DEPUTY DIRECTOR,
FOSTER & ADOPTIVE PARENT ADVOCACY CENTER
Ms. Egerton. Good morning, Senators. My name is Marilyn
Egerton. I am a D.C. foster kinship and adoptive parent. In
addition, I am the deputy director of the Foster and Adoptive
Parent Advocacy Center, commonly known as FAPAC. We are very
appreciative of your inclusion of foster parents' voices into
these hearings and thank you for inviting us to participate and
to share our experiences with the reform efforts of the D.C.
child welfare system.
In the 12 years that my husband and I have been foster
parents, we have fostered over 25 children, had well over 50
social workers, and I have been active as a member of foster
parent leadership through three changes in administration.
I would like to start my testimony by pointing out some of
the positive changes that have happened during this
administration. These changes include the successful closure of
the respite center in the CFSA building. This was a place where
children were living, often for days at a time, while placement
workers tried to find a home for them. As additional success,
the majority of these children are going into individual foster
homes as opposed to congregate care facilities.
Also at the insistence of the foster parent leadership, a
CFSA mandate requiring all staff to give the name and number of
their supervisor on their outgoing voice mail message enables
us to immediately go up the chain of command when we cannot
reach our social workers. This is a huge accomplishment for us.
We've worked very hard and very long to get it.
Third, the accessibility of upper level management to both
the foster parent leadership and the individual foster parents
has been extremely commendable.
Fourth, the development of a new placement information
packet through a joint effort of foster parents and staff to
address a serious issue of the lack of information given when
children are placed in their homes. The packet has been
developed and when CFSA workers actually begin using them, this
will be another major improvement.
Fifth, the introduction of disruption conferences, which
utilize clinical expertise to try to prevent disruptions.
And sixth, principal deputy director Leticia Lacomba's
creation of joint working groups of foster parents and staff to
revise and impact policy and practice guidelines.
Despite the good intentions and real improvement we have
seen, the tasks ahead for CFSA regarding its foster parent
community are still great. There are many areas in which the
support and services we receive are inadequate to meet the
needs of our children. These areas include, one, the need for
the infrastructure of CFS to improve to accommodate the changes
being made at the upper level. As a result of this process,
problem resolution often goes around in circles. Hours that
could be appropriately spent parenting are often spent in
frustrating efforts to seek problem resolution.
Second, the reliance on social workers for routine tests
that could be accomplished by administrative support like
looking up a Medicaid number or Social Security number. Quite
frankly, I'm perplexed that the agency does not utilize
administrative support for these clerical tasks within the
social work unit, freeing the social workers to actually
practice social work.
Third, although the responsiveness and inclusiveness of the
upper level has been real and significant, the attitudes of
true partnership have not yet reached the front line. Workers
often invalidate our experience and when it comes to the right
to make a decision, they exclude, ignore and/or rebuff the
foster parent's input.
For all the children currently living in my home, I have
been invited to participate in a total of one administrative
review, at which parenting plans and progress are to be
discussed. We have been assured very recently that the
technological and logistical barriers to notification have been
resolved and that consistent notification of administrative
review will now be implemented. We hope to see evidence of this
in the immediate future and we trust that our notification of
court reviews will be next.
Fourth, the inability of social workers to consistently
access resources both within CFSA and from the community. We
recommend that social workers receive training in this area.
Fifth, the lack of sufficient numbers of infant daycare
slots in the District of Columbia. It is an issue and it is a
barrier to particularly working families fostering infants in
the city.
Sixth, the lack of quality and timely mental health
services. Our children are wounded. Many have suffered
emotional and sometimes physical abuse and all have suffered
much loss by the mere fact that they have been torn away from
everything that they are familiar with. It is outrageous that
their mental health needs have been addressed in such an
inadequate manner. We do not know the answer, I don't know what
it is, but it is a problem that is so paramount that it cannot
go unaddressed. And just to say that we understand that the
mental health, Department of Mental Health has control over the
mental health stuff, but we don't think it's enough for the
agency to just say okay, that's their responsibility. And much
like special ed, it may fall on the DCPS, but if our children
are not getting what they need from those agencies, then we
feel it is the responsibility of CFSA to find a way to get it
for them.
Seventh, the lack of adequate Medicaid numbers and cards,
this creates barriers to health care for our children.
Eighth, the lack of an operating medical consent to treat
policy leaves us as well as the hospitals confused about who
can sign for what treatments.
And ninth, the lack of availability of and access to
respite care. All parents need a break from their children at
some time. Biological parents have the option of sending their
children to spend a weekend with their relatives or family
friends, or to visit a classmate for the weekend. As foster
parents, we don't have that option unless those parents can
meet many criteria, including obtaining all the clearances that
we as foster parents have to obtain.
This puts us in a very tough position. Not only are we
asked to parent without significant breaks, we are parenting
children who often have serious issues. And I can say that I
know placements that have disrupted, I have experienced
personally a placement disruption in my home because of a lack
of respite care. And when I requested respite for a child who
was having very severe emotional and mental health issues, I
was told respite did not exist, but I know of foster parents
who get it. But I was told it was unavailable and did not
exist.
And so, the crisis in my home escalated to a point where
the placement disrupted and that child was moved to what is
called a therapeutic home, where once a month--where in a
therapeutic home they receive respite every other weekend, they
get in-home counseling, they have a staff available around the
clock. Needless to say, CFSA is paying exorbitant amounts of
money to have this child parented in that home when all I asked
for was respite once a month, and then he would not have been
torn away from his brothers, who are still with me, and he
would not have had the experience of yet another move and an
introduction into yet another family.
I believe that many seeds have been planted under this
administration which can lead to very positive change for
foster families at CFSA, but many have not yet blossomed into
actual day-to-day improvement. Responsiveness, accessibility
and inclusiveness of the upper level's response to foster
parents have been real and beyond rhetoric. However, we have
much further to go with the infrastructure in CFSA to implement
the philosophy of the upper levels for the principles of best
practice.
PREPARED STATEMENT
In closing, we do think that the agency is on the right
path. We believe that. However, we must acknowledge and support
the necessity for them to develop an infrastructure that will
facilitate the kinds of changes essential for our children to
receive the care that they deserve. I appreciate the
opportunity to speak to foster parent concerns at this hearing
as an individual foster parent as well as the deputy director
of FAPAC. I will continue to be available to assist in system
reform in any way that I can, and to work with CFSA to develop
its partnership with this foster parent community. Thank you,
Senator.
[The statement follows:]
Prepared Statement of Marilyn Egerton
Good morning. My name is Marilyn Egerton, and I am a D.C. foster,
kinship and adoptive parent. In addition, I am the Deputy Director of
the Foster & Adoptive Parent Advocacy Center, commonly known as FAPAC,
an organization that assists foster, kinship and adoptive parents of
children in the D.C. child welfare system to secure services and help
to create system change.
We are very appreciative of your inclusion of foster parent voices
into these hearings and thank you for inviting us to participate and to
share our experiences with the reform efforts of the D.C. child welfare
system.
In the 12 years that my husband and I have been foster parents, we
have fostered over 25 children, had well over 50 social workers, and I
have been active as a member of the foster parent leadership through 3
changes in administrations. Currently living in my home are my foster
grandson, the infant son of one of my older boys who has ``aged out''
of the system, my foster teenage son and my three adopted school aged
children. In addition, we continue to parent four young adults who we
raised in foster care. They have aged out of the system and now live
nearby and although they no longer live in our home they are still very
much a part of the family. With this perspective of history, I feel
qualified to discuss changes we are currently experiencing under the
administration of the Director, Olivia Golden, and the Principal Deputy
Director, Leticia Lacomba.
Although everyone agrees that there is still a tremendous amount of
work to be done at CFSA, I think it only fair to point out some of the
positive changes that have happened during this administration which
have brought, and have the potential to bring many more, significant
changes in the lives of children in the D.C. child welfare system and
their foster/kin/adoptive families.
Over the last two years, this administration and staff in
partnership with the foster parent community has been able to close
down the respite center that was located on the first floor of the CFSA
building. This was a place where children were living, often for days
at a time, while placement workers tried to find a home for them. Can
you imagine being a child who was just recently removed from all that
is familiar to you--your family, your friends and your community? Only
to spend those crucial first few days sleeping in an office building
and not in the comfort and safety of the loving home and arms of foster
parents trained and willing to help them through this most difficult
time. This is a very personal issue for me. As a member of Foster
Parents United for Support and Change, a local foster parent support
group, I worked very hard to combat this situation. In previous years
and during previous administrations, at the end of our monthly
meetings, members who had vacancies in their homes would go down to the
respite center to see if there were any children we could take home who
were sleeping at the agency. It was tragic and poignant to see children
of all ages who could not be placed anywhere else living for days in an
office building. To have lessened the need for this center so much so,
that it could be eliminated all together is quite an achievement. When
we add to this the fact that not only are children being placed without
having to spend the night at CFSA, but that most children are being
placed in actual homes with loving foster and kinship families, and not
in congregate care, it is clear to us that this in an amazing
accomplishment.
Another major problem we have had for years and years has been the
lack of accessibility of our social workers, supervisors and
administrators. In fact, it was so bad that many foster parents were
convinced that once caller ID went into the agency, their calls were
actually being screened out by workers. At the request of foster
parents, CFSA has mandated that each staff member have an outgoing
voice message that reflects the name and number of their supervisor so
that if we cannot reach our worker we can immediately go up the chain
of command. This may sound like a small innocuous change to many, but
I, like most foster parents whom I know, have been in situations with
my own children over the years when I have called and left many
messages for my children's social worker(s) to request vital
information like a Medicaid number, options for therapy for my
child(ren), shot records or daycare requests. And, because I didn't
know who the social worker's supervisor was, or I didn't know the
supervisor's number, my only options were to sit and wait days and
sometimes weeks for a social worker to get back to me or for my husband
or me to take a day off of work and go down to CFSA and act ugly until
someone helped us. Having this information readily available on the
outgoing voicemail message has been very helpful for those situations
in which accessing services are contingent upon the ability to reach
our workers in an expedient fashion. In addition, the accessibility of
upper level management's to both foster parent leadership and
individual foster parents has been extremely commendable.
Another extremely serious problem we have had absolutely forever
has been the lack of information given to foster parents about the
children we are taking into our homes. Children have historically been
placed without our being told imperative medical, psychological, and
behavioral information, because that information was not communicated
intra-agency to the placement workers. Imagine being a foster parent
who takes a child into your home and finds out that the child sets
fires, but you were not told. Because of this, children were often
placed into homes that were not prepared for them, and the placements
broke apart, or as we say, ``disrupted.'' In the last few months foster
parents and staff have worked together on the development of a new
``Placement Information Package''. The agency has promised to uphold
the expectation that all relevant information available to the agency
will be passed onto foster parents through this package so they can
make appropriate decisions about placements in their homes. When CFSA
workers actually begin using them, this will be another major
improvement.
In these last years, as a member of the foster parent leadership, I
have spent much time at CFSA. My current experience is that there is
active and diligent work being done towards improvement and reform.
Staff, administration and foster parent leadership have put in many
hours working on systemic issues. Foster parents have experienced
significantly improved appreciation and inclusion from the upper level
and a more acute consciousness of what we need to care for our
children. We have seen much more energy spent on trying to address the
issues of multiple placements, such as the introduction of Disruption
conferences, which utilize clinical expertise to try to prevent the
disruption of placements. We hope that these clinical interventions
will be increased to include wrap-around services that will permit a
``traditional'' foster parent to maintain a child they love in their
home instead of having to transfer them to a much more expensive higher
end therapeutic home to get services, as has been the case. We
specifically recognize Clinical Services Administration, under Dr.
Roque Gerald, for work in these areas.
One of the major issues for the District of Columbia's foster
parents, and indeed nationwide, is the lack of inclusion in decision-
making. This decision-making exclusion is two-fold and includes
decisions about the individual children in your home as well as
decisions about agency policy, regulation and practice. Nationwide,
this lack of inclusion is sited as one of the major reasons that foster
parents quit fostering. When a system can not retain its foster
parents, any recruitment efforts, no matter how successful, are like
recruiting into a bucket that has a hole in the bottom.
To address the concern about lack of inclusion into agency policy
and practice, Ms. Leticia Lacomba, Principle Deputy Director, began to
work directly with joint working groups of foster parents and staff to
revise and impact policy and practice guidelines. Involving foster
parents in true partnership with staff and administration in this way
has been a tremendous step forward and we want to acknowledge her for
this accomplishment.
Unfortunately, inclusion into the professional team for the
children in our home has not been yet achieved, and will be discussed
as we move into the discussion of the many challenges still ahead.
Despite the good intentions and real improvement we have seen, the
tasks ahead for CFSA regarding its foster parent community are still
great. There are many areas in which the support and services we
receive are inadequate to meet the needs of our children.
Although we applaud the accessibility of the upper level
administration to its foster parent community, many of the issues
brought up to that level should have been resolved at lower and middle
levels. What we see is that the infrastructure of CFSA has not yet
improved to accommodate the changes being made at the upper level. As a
result, balls are still always dropping on the lower and middle levels,
problem resolution often goes around in circles, and the person who
needs help gets bounced from one staff or unit to another. In addition,
units themselves are often out of alignment with each other in the
information they give to our families and in the processes they create.
This causes much confusion to anyone trying to access services. Hours
more appropriately spent parenting is spent in frustrating efforts to
seek problem resolution. It is our recommendation that communication
between units as well as internal to units be acknowledged as important
job functions of program administrators and time be allotted for this
purpose.
Another infrastructure issue I would like to comment on is the
reliance on social workers for routine tasks that could be accomplished
by administrative support staff. When foster parents have to call
social workers for something as simple as a birth certificate number,
they may have to call over and over to reach a worker. This in turn
clogs up the worker's voice mail which may make them less accessible to
others. I can not tell you the countless times that I have had to call
a social worker to get a social security number for one of my children.
Quite frankly I am perplexed that the agency does not utilize
administrative support for these clerical tasks within the social work
unit, freeing the social workers to actually practice social work. It
is our recommendation that CFSA assign one administrative assistant per
(X) number of social workers for this purpose.
In addition, although the responsiveness and inclusiveness of the
upper level has been real and significant, the attitudes of true
partnership have not yet reached the front lines. Many of the District
of Columbia's foster parents have been operating as caseworkers
themselves for years, handling all on their own the daunting tasks of
finding resources for their children. Many have had no regular visits
from workers, no phone calls, no help, no after hours support at all,
and as such stand alone. Despite that, workers often invalidate that
experience and when it comes to the right to make decisions, exclude,
ignore and/or rebuff the foster parent's input.
It is this inclusiveness into case planning for the children in our
homes that is seriously lacking. In my own experience, for all the
children currently living in my home, I have been invited to
participate in a total of ONE administrative review, at which
permanency plans and progress are to be discussed. Since these reviews
are supposed to be happening every six months, either they are not
happening at all or they are happening without my presence, input or
feedback. In my ENTIRE experience as a foster parent, I have never been
informed about a court hearing from my social workers, although I
regularly attend due to notification from our children's GAL's. The
agency is out of compliance with The Adoption and Safe Families Act
(ASFA) on both of these forms of notification. We have been assured
very recently that the technological and logistical barriers to
notification have been resolved and that consistent notification of
Administrative Reviews will now be implemented. We hope to report back
to you on the successful intervention of this assurance. We trust that
our notifications of court reviews will be next.
There is much work ahead to address the complicated issues of real
partnership between line workers and foster parents. We acknowledge
that the agency has taken a first step by inviting us to participate in
the training that new workers receive. I am personally very excited
about the possibility of participating in these trainings. I think it
is vital to a successful working relationship that the worker have a
real understanding of how what s/he does or says may effect the foster
parent's ability to open up to them and trust them, thus impacting the
quality of care our children receive. It is imperative that social
workers understand that they must give foster parents the same respect
that they give the other professionals involved in the care and
treatment of our children. We are the ones who are caring for these
children day in and day out. Although I am very excited about these
trainings, it is my hope that this is just the beginning. It is my hope
that we will get to the point where we can expand this training to
allow us to work also with those social workers who have been around
for a while. After all, it was a veteran social worker with many years
of experience who told my husband and me that we were too strict with
my 17-year-old son when we put him on restriction for constantly acting
out in school and having multiple suspensions. She recommended that he
go into independent living. When we objected, saying that we had been
parenting him since he was 11 years old and that we were 100 percent
sure that he was not mature enough to handle the freedom that comes
with an independent living program, she pushed for it and got it
anyway. From the moment he entered the program my son went on a
downward spiral that landed him in a psychiatric facility. There it was
determined that he needed a more structured environment and we were
asked if he could come back home to us. Although this particular
incident occurred under a previous administration, lack of input into
decisions about our children still continues. I feel this is a good
example of the danger that can happen to our children when decisions
are made by people who see them at the most once a month, and often
much less, without taking into serious consideration the input of those
of us who are parenting them every day.
I think that it would be beneficial if we also recommend that
social workers be given more training on how to access resources, both
within CFSA itself and from the community. Access to resources remains
a big problem for us. There is a lot of inconsistency in this area.
Securing resources often depends upon the knowledge, workload and
sometimes even personal feelings of your workers. A strong example of
this lack of resource consistency is day care. Foster parents who live
in the District of Columbia are entitled to day care services through
the Office of Early Childhood Development. However, some workers can
access it fast, some have to be taught by their foster parents or GAL's
how to access it at all, and in fact one private agency has told their
families that day care is not even available! Again this is a personal
issue for me. My foster grandson was placed with us at the ripe old age
of two months old and in spite of many, many phone calls and inquiries
from both my husband and me, our little Jay was seventeen months old
before daycare was secured. Had it not been for the untiring help of
family and friends, as well as compassion and flexibility of my
husband's and my employers we would not have been able to continue to
parent this child who has known us as his grandparents since the day he
was born.
One resource is so very absent from the fabric of this city that it
demands separate mention of its own. That resource is quality and
timely mental health services. Our children are wounded; many have
suffered emotional and sometimes physical abuse and all have suffered
much loss. It is outrageous that their mental health needs have been
addressed in such an inadequate manner. We do not know the answer,
however, this problem is so paramount that it cannot go unaddressed.
Another huge issue for us is Medicaid. Medicaid numbers may not be
given to us until our child has been in our home for weeks or months.
This creates a very serious situation when we need prescriptions
filled. In addition, our numbers often become inactive, creating the
inability to access services. Many of us have been at doctor's offices
or pharmacies when the numbers have become inactive and we have had to
leave without the services we need for our children. In addition, the
lack of an operating Medical Consent to Treat Policy leaves us as well
as the hospitals confused about who needs to sign for what treatments.
We have been trying to get the agency to develop and implement a
medical consent policy for over a year and a half, but to our knowledge
there has been no significant progress made. This is of utmost urgency
to us, because sooner or later a child will die because of the
confusion surrounding what foster parents can or cannot consent to.
Another issue for foster parents is the lack of availability of
respite care. All parents need a break from parenting sometimes.
Biological parents have the option of sending to their child(ren) to
spend the weekend with a relative or family friend, or to visit with a
classmate at his/her home. As foster parents, we don't have that option
unless those persons can meet many criteria, including obtaining all
the clearances that foster parents are required. This puts us in a very
tough position. Not only are we asked to parent without significant
breaks, we are parenting children who often have serious issues. Can
you imagine all of a sudden the number of children in your family
increasing by four? It happened to me three years ago. I got a call
about a sibling group of four boys, ages 6, 8, 10, and 12. This was
quite an undertaking as I am sure you can imagine. As delightful as the
boys were, we began to notice almost immediately that one of our
children had some pretty severe emotional problems and we began to seek
out help for him. When it was all said and done he was diagnosed with
severe depression and intermittent explosive disorder. It took about a
year and a half for him to be diagnosed and for the doctors to
determine the proper medications in the proper doses to help stabilize
him. During that time our home was in constant turmoil with crisis
after crisis involving him, while we were still trying to effectively
parent his three siblings and my adopted daughter. When we asked for
respite once a month so that we could regroup and be better able to
parent our children we were told that respite was not available. The
situation escalated to the point that the placement disrupted and he
was placed in a ``Therapeutic'' home where the city not only pays
significantly more for his care, but the therapeutic foster parents get
respite every other weekend. This was very traumatic for all of us. He
was not only separated from us, but also from his siblings who had been
the only constant in his life. Mine is not the only story. Many foster
parents can tell of situations where they feel access to respite would
have enabled them to continue fostering a child rather than having the
placement disrupt. I really believe that respite can be a big part of
decreasing the number of disruptions as well as increasing foster
parent retention. And a foster parent who is happy and wants to remain
a foster parent is more likely to actively recruit other potential
foster parents for the agency. Providing respite for foster parents is
a win/win situation for all involved.
In conclusion, I believe that we are seeing many seeds which have
been planted under this administration which will lead to very positive
change for foster families at CFSA, but many of those seeds have not
yet blossomed into actual day-to-day improvement. There is still a
great deal of work to do. Responsiveness, accessibility and
inclusiveness of the upper level to its foster parents have been real
and beyond rhetoric, as demonstrated by the cutting edge partnership
lead by Ms. Lacomba. We have come very far in these ways. However, we
have much farther to go before the infrastructure of CFSA supports and
implement the philosophy of the upper level or the principles of best
practice. To summarize, some specific areas we need to see improvement
in are:
--After hours crisis intervention for foster families outside of the
general hotline;
--Quality and timely mental health evaluations and therapy;
--Consistently active Medicaid numbers and cards;
--Easily and consistently accessible emergency and planned respite
care for foster parents;
--Timely day care;
--Operating Medical consent to treat policy;
--Increased team building efforts between social workers and foster
parents as well as between birth parents and foster parents;
--Training of all social work staff on resource availability;
--Strengthening communication between units so that information given
to families is both accurate and consistent;
--Clear and consistent systems for problem resolution which free up
foster parents to spend our time and energy parenting our
children instead of going around in circles fighting for
services.
Again, in closing we do believe that the agency is on the right
path, but we must acknowledge the great need for them to develop an
infrastructure that will allow for the kinds of changes necessary to
give our children the care they deserve. I appreciate the opportunity
to speak to foster parent concerns at this hearing. As an individual
foster parent as well as the Deputy Director of FAPAC I will continue
to be available to assist in system reform in any way I can, and to
work with CFSA to develop its path of partnership with its foster
parent community.
Senator DeWine. Thank you very much. Ms. Sandalow.
STATEMENT OF JUDITH SANDALOW, EXECUTIVE DIRECTOR,
CHILDREN'S LAW CENTER
Ms. Sandalow. Good morning, Senator DeWine, Senator
Landrieu. Thank you for giving me the opportunity to speak
today about the solutions to problems facing abused and
neglected children in the District of Columbia.
As you know, the Children's Law Center helps at-risk
children in the District of Columbia find safe and permanent
homes, and the education, health and social services they need
to flourish, and provides comprehensive legal services to
children, their families and foster, kinship and adoptive
parents. My testimony today is focused on remedies that involve
the Child and Family Services Agency, and that can be
accomplished with targeted and specific Federal funding.
The first days in foster care often determine the outcome
of a child's life. When a child is injured in a car accident,
an ambulance rushes the child to a hospital where a team of
doctors and nurses drop everything to save that child's life.
We all recognize that without this extraordinary effort, a
child could die or be permanently disabled. That same urgency
and those same resources should attend to the removal of
adduced and neglected children from their homes.
In fact, every day in the District of Columbia, children
are permanently scarred because we don't treat these first days
in foster care as an emergency. What is right for children is
also right for the D.C. budget. Early and intensive
intervention on behalf of children will speed reunification and
it will speed adoption and it will prevent the financial and
human costs of increased homelessness, incarceration and
welfare dependence that is found among adults who spend their
childhoods in foster care.
I propose that Congress fund a pilot project within CFSA to
provide early and intensive intervention for children as soon
as abuse or neglect is reported. What you might ask, should
such an emergency team do? On the first day that a child is
removed from her home, an emergency team of social workers
should be interviewing the child, their siblings, their
parents, their neighbors, to find the nearest relative, a
person who is appropriate to be a temporary caregiver while
that family is restored. The emergency team should have access
to a flexible fund to buy beds, clothes and if necessary, food,
to ensure their relative can bring a child into their home
immediately.
One of our clients, a grandmother, has been waiting 45 days
for benefits, while CFSA will not provide emergency funding for
her to feed the grandchildren who she has taken into her home
on an emergency case basis. The emergency team should provide
drug treatment, homemaker services, parenting classes
immediately for children and families so they can be reunified.
All of these tasks and many more that I highlight in my written
testimony, must be done within the very first few days that a
child is removed from her home.
Just as we staff the emergency room 24 hours a day and we
would never consider closing it after business hours, we must
have a child welfare emergency team 24 hours a day. Where a
child is removed from her family, she needs an opportunity to
visit her brothers and sisters and her parents in order to
enhance the chance of reunification, but also to help her with
that transition as she moves away from her birth family. But
last week, a social worker said in open court at the District
of Columbia's Family Court to a mother who was begging to see
her children, that she and her children could only visit
together 1 hour a week, and the reason that she gave was
because CFSA didn't have the resources to staff a visitation
center for longer hours that would provide more frequent
visits.
Can we really tell a child that she can't see her brothers,
sisters and parents more than 1 hour a week because she has to
give other little children the chance to see their families?
Get in line, little girl, behind all the other children who
need to see their families. I urge the committee to appropriate
funds to CFSA to build and staff visitation centers in the
community.
Each center should be staffed by a social worker trained to
work with parents on their parenting skills. And most important
of all, the center should be open in the evenings and on
weekends so that children don't have to miss school to see
their families, and that parents can maintain employment so
that they can bring the children back to live with them.
Forty percent of all foster children in the District of
Columbia are teenagers. Despite this staggering figure,
unfortunately, CFSA has a woefully inadequate program to help
teenagers prepare for adulthood. Today I would like to focus on
one particular issue, which is helping teenagers find jobs, and
that may be important to me because I am the parent of teenage
boys who came to me out of the foster care system when they
were in their preteen years, and I know how important it is for
their development that they be able to find jobs. In part, they
will have me as a safety net but other foster children won't
have that kind of safety net.
How is it that CFSA can help teenagers find jobs and give
them the jobs skills necessary to make them productive
citizens? One very simple option is to partner with local
businesses to provide a job coach just like they do for
developmentally disabled adults, to ease that new foster child
into a job. I am confident that there are corporations in this
city that would partner with CFSA. I understand that in
California they reserve a certain number of government jobs for
foster children entering the system to help them meet that
transition. Well, they're part of our government family, so
they save some jobs for them. Those are both very simple
solutions, I think.
But no matter how many programs are available or what
philosophy there is in the child welfare system, the quality of
the individual social worker is successful to the successful
system.
Senator DeWine has introduced legislation to provide loan
forgiveness for lawyers and social workers who serve children.
The Children's Law Center strongly supports this legislation
and believes that it will increase the pool of highly qualified
lawyers and social workers.
Talented well-trained social workers, frequent family
visits and early intervention won't help children if there are
no services to help children heal, to rehabilitate parents and
to support families. The District of Columbia has an extremely
limited number of mental health providers. There are very few
drug treatment beds. Homemaker and intensive in-home services
are almost nonexistent. CFSA should be clamoring at your door
asking for the funding to provide these services. They should
have a comprehensive plan for developing and funding service
providers.
Although I applaud their recent efforts to evaluate the
quality of service providers, and I understand that they are
vigorously evaluating the outcomes of the service providers
that they do have, I am disturbed by their silence regarding
increasing the availability of services.
PREPARED STATEMENT
A foster child is by law in the legal custody of the
government. The government therefore has the right and the
responsibility to parent that foster child, to meet the needs
of every child as if she were our own child. I thank each of
you in particular for taking that responsibility seriously, and
for calling for supporting measures that will give every foster
child the promise of a safe and loving home.
[The statement follows:]
Prepared Statement of Judith Sandalow
Good morning, Chairperson DeWine, Senator Landrieu and members of
the Committee. My name is Judith Sandalow, and I am the Executive
Director of The Children's Law Center here in Washington, DC. The
Children's Law Center helps at-risk children in the District of
Columbia find safe, permanent homes and the education, health and
social services they need to flourish by providing comprehensive legal
services to children, their families and foster, kinship and adoptive
parents.
Thank you for the opportunity to speak with you today about
solutions to the problems facing abused and neglected children in the
District of Columbia. At The Children's Law Center, we serve as the
voice for many children. They share their fears and their hopes with
us. Because the solutions I propose today are informed by these
children and their experiences, I would like to start by sharing with
you some of their stories.
Sam, Tony and Terry were removed from their mother's home on a
Friday evening and placed in a temporary group home. The very next day
their aunt came to court and offered to have them live with her.
Understandably, she did not have three beds in her home, nor did she
have the money to pay for them. The CFSA social worker told the judge
it would take three weeks to buy beds for the aunt and, until then,
suggested that the boys stay in a group home. Only because The
Children's Law Center purchased beds for the boys that afternoon were
they able to be with their family and avoid spending three weeks in a
group home.
Seven-year-old DeMarco and nine-year-old Shawn were taken from
their mother's home by the D.C. Child and Family Services Agency when
it was discovered that their mother physically abused them. Despite the
fact that Shawn and DeMarco have a loving and capable grandmother, CFSA
put Shawn and DeMarco in a foster home. Only after their grandmother
contacted The Children's Law Center were the children allowed to see
their grandmother and, with more advocacy by The Children's Law Center,
were the children allowed to live with her. The CFSA social worker
admitted that she had not interviewed the children to find out if they
had relatives nearby. DeMarco and Shawn spent a month living with
strangers during the most traumatic moment of their lives, when they
could have been with the grandmother they had known and loved all their
lives.
Federal assistance can have an important, direct and measurable
impact on the District of Columbia's abused and neglected children. My
testimony is focused on remedies involving the Child and Family
Services Agency that will make a difference to Shawn, DeMarco, Sam,
Tony and Terry and that can be accomplished with targeted and specific
funding.
early and intensive intervention
When a child is injured in a car accident, medical personnel have
no qualms about stopping traffic to get an ambulance to the scene. A
helicopter or an ambulance rushes the child to the hospital where a
team of doctors and nurses drop everything to save a child's life or
prevent permanent disability. A social worker contacts the parents,
provides counseling and helps the family plan for the child's
convalescence. We all recognize that without this extraordinary effort,
a child will die or be permanently disabled.
The same urgency and the same resources should attend the removal
of abused and neglected children from their homes. In fact, every day
in the District of Columbia children are permanently scarred and
irrevocably deprived of their childhoods, their emotional well-being
and their chance to become productive citizens because we do not treat
these first moments, these first days in foster care as an emergency.
What is right for children is also right for the D.C. budget. Early
and intensive intervention on behalf of children will speed
reunification and adoption, will reduce the number of children who
languish in foster care at great cost to our city and will prevent the
financial and human cost of increased homelessness, incarceration and
welfare dependence that are found among adults who spent their
childhoods in foster care.
I propose that Congress fund a pilot project within CFSA to provide
early and intensive intervention for children as soon as abuse or
neglect is reported.
What would such an emergency team do? There are three things that
must be accomplished quickly: (1) find the best home for the child as
fast as possible; (2) provide services and support to the child to
repair the damage caused by abuse and to reduce the trauma of being
separated from her family; and (3) provide the entire family with the
services necessary to reunify them.
How would an emergency team accomplish these goals?
--On the day a child is removed from her home, social workers should
interview the child, his or her siblings, neighbors and
relatives to find an appropriate temporary caregiver for the
child. Frequently, grandparents, aunts, uncles and cousins
don't learn that a child is in foster care for weeks or months.
--Quickly conduct criminal records checks, review the child abuse
registry and do a home study of the caregiver's home so that
the child can move in immediately.
--Have access to a flexible fund to buy beds, clothes and if
necessary food to ensure that a relative can bring a child into
her home immediately, without forcing the child to stay--scared
and alone--in a group home or foster home while the relative
finds the money to prepare her home.
--Convene a meeting of the child's family within 24 or 48 after
removal to see what resources the extended family can provide.
Often, family members can step in to assist an overwhelmed
parent, can arrange visits in their home for the child or can
even bring a child to live with them while the parent is in
recovery.
--Provide transportation to the child's home school, so that she is
not further traumatized by having to adjust to a new school and
a new home at the same time.
--Gather medical records from the child's pediatrician and area
hospitals to ensure that medical treatment and medication are
not disrupted.
--Provide drug treatment, homemaker services, parenting classes and
other services a birth parent needs so that a child can be
safely reunited with her parents.
--Do thorough medical and mental health assessments of children and
provide mental health services to assist children during this
traumatic time.
--Arrange for a child to talk on the phone with brothers, sisters and
other family members during the initial, traumatic hours and
days after removal.
--Provide transportation for frequent visits between children, their
siblings and important family members to reduce the trauma of
removal and maintain the familial bonds in preparation for
reunification.
All of these tasks must be done within the first few days after a
child is removed from her home. Just as we staff an emergency room
around the clock and not only during business hours, we must staff a
child welfare emergency team 24 hours a day.
maintaining family ties through visitation
In 1989, when the ACLU was preparing to file a class action lawsuit
against the District of Columbia to address the needs of abused and
neglected children, they interviewed local child advocates. One of
these advocates who had worked with neglected children for years and
was a founding member of The Children's Law Center, asked for only one
thing. She said, ``if you can get family visits for foster children so
that they can visit their brothers and sisters and their parents and if
you can get those visits to happen on weekends and in the evenings so
that children don't have to miss school to visit their families, then I
will believe that your lawsuit made a difference.''
Fourteen years later, this simple wish has not been granted.
Fourteen years later--in fact just last week--a social worker said in
open court to a mother who was begging to see her children that she and
her children could only visit together one hour each week because CFSA
didn't have the resources or the staff to have longer or more frequent
visits.
Can we really tell a child that she can't see her brothers, sister
and parents more than one hour a week because she has to give other
children the chance to see their families?
I urge the committee to appropriate funds to the Child and Family
Services Agency to build and staff visitation centers in the community
so that children can see their brothers, sisters and parents as often
as is necessary for them to maintain their family bonds.
Today, just like 14 years ago, foster children visit with their
parents in partially furnished offices--artificial environments that
are a far cry from the apartments and houses in which families usually
interact.
I envision visitation centers that feel like a real apartment, with
a living room that has games, books, a television and a radio. I
picture a kitchen or at least a microwave oven, so that parents could
show their love the way most parents do--by cooking a meal for their
children. I imagine children playing in the center's backyard, a
backyard that has a swing set and a basketball hoop. With an
opportunity to visit in this home-like setting, parents could work on
parenting skills and children could enjoy their brothers and sisters.
Each center should be staffed by a social worker trained to work
with parents on their parenting skills. Most important of all, the
centers should be open in the evenings and on weekends so that children
do not have to miss school and parents can maintain their employment.
preparing teen foster children for adulthood
Forty percent of all foster children in the District of Columbia
are teenagers. Despite this staggering figure and the additional
Federal funding that has been made available by the Chafee Act, CFSA
has a woefully inadequate program to help teenagers prepare for
adulthood. Today, I would like to focus on addressing one particularly
important issue--helping teenagers find and hold jobs.
CFSA social workers do not help teen find work, they do not help
teens fill out job applications and they certainly do not create job
opportunities for teenagers.
How can CFSA help teenagers learn the basic job skills necessary to
make them productive citizens? CFSA need look no further than their
back door for a solution. The See Forever Foundation, started by David
Domenici, son of Senator Pete Domenici, and by James Forman, Jr., owns
several businesses that are run by teenagers, including a catering
business and a print shop. The teenagers handle all aspects of the
business, from marketing, to accounting to preparing and delivering the
product.
A business run by foster children would give these young people the
training they need to become successful and independent adults.
A simpler option that might help more teens more quickly would be
for CFSA to partner with local businesses to guarantee that there were
jobs available to teen foster children. If CFSA hired a job coach who
worked with teens during their first weeks on the job--in a manner
similar to job coaches for developmentally disabled adults--I believe
that many employers would commit to hiring foster children.
There are many other areas in which CFSA fails teen foster
children. I am pleased to announce that beginning this Fall, The
Children's Law Center will be able to devote more of its resources to
advocating for teens. Because of the generosity of the Equal Justice
Works Foundation and the Public Welfare Foundation, we have hired a
lawyer who will help to train social workers and other child advocates
about strategies for helping teen foster children make the transition
to independence and adulthood.
retaining and training capable social workers
No matter how many programs are available or what philosophy
governs a child welfare agency, the quality of the individual social
workers is critical to a successful system. The April 2003 report by
the GAO on the challenges confronting child welfare workers supports
the observations of The Children's Law Center's staff. Repeatedly, the
best social workers tell us that they are leaving CFSA because they
have extraordinary administrative burdens with no secretarial support,
that their caseloads are so high that they are worried about making
mistakes that will jeopardize children's safety and health and that the
quality of supervision they receive is extremely poor.
CFSA Director Olivia Golden testified before this committee just
last month that she was working to reduce caseloads for social workers.
Reducing caseloads by hiring high quality social workers must continue
to be a top priority for Ms. Golden. She must also focus on retaining
and training social workers. This committee may be able to assist Ms.
Golden by proposing legislation and targeting funding toward
initiatives that will increase social worker retention.
Senator DeWine has introduced legislation to provide loan
forgiveness to lawyers who represent children. The Children's Law
Center strongly supports this legislation and believes it will increase
the pool of highly qualified lawyers who serve children. Similar
legislation to provide loan forgiveness to child welfare workers would
help ease the financial burden on these dedicated individuals.
I also urge the Committee to consider providing funds to CFSA
targeted toward providing administrative support to the social workers
who work directly with children and families. Social workers spend a
tremendous amount of time completing paperwork. As recently as last
Fall, social workers were required to fill out requests in triplicate
to renew each child's Medicaid eligibility. In addition, social workers
have little assistance in transporting foster children to evaluations,
doctors' appointments, family visits and therapy.
services for children and families
Talented, well-trained social workers, frequent family visits and
early intervention won't help children if there are no services to help
children heal, to rehabilitate parents and to support families. The
District of Columbia has an extremely limited number of mental health
providers. There are very few drug treatment beds. Homemaker and
intensive in-home services are almost non-existent. CFSA should be
clamoring at your door, asking for more funding to provide these
services. They should have a comprehensive plan for developing and
funding service providers. Although I applaud their recent efforts to
evaluate the quality of service providers, I am disturbed by their
silence regarding increasing the availability of services.
The short-term cost of providing services may be great, but the
long-term benefit in personal and financial savings is extraordinary.
For one D.C. family, it made all the difference. After the death of his
wife, a father of three children was extremely depressed. He managed to
hold down a full-time job, get dinner on the table and was available to
his children every evening after work. For some reason, however, he
couldn't manage to get the children dressed and ready for school in the
morning and so the children missed school frequently. Rather than
provide limited early morning homemaker services, CFSA sought to remove
the children from his home. Only after the father's lawyer intervened
did CFSA agree to provide services to the family. Obviously, the
emotional and financial cost of splitting up this family pales in
comparison to the short-term cost of helping them through this crisis.
The Children's Law Center receives dozens of calls each year from
relative caregivers and foster parents who want to keep a child in
their home, but cannot handle the extreme behavioral and emotional
needs of their child without assistance that CFSA refuses to provide.
One foster mother called The Children's Law Center distraught because
she had been trying to get services for her foster children for months.
At the end of her rope, she had asked the social worker to remove the
children unless CFSA gave her some in-home support and respite care.
Three days later, she couldn't bear to hear them crying on the phone.
The children had been with her for a year, called her Mommy, and were
begging to come back to her. She wanted them home, but needed in-home
mental health services to address their extreme behavioral problems.
Only after intervention by The Children's Law Center were the services
provided and the children returned to the foster mother they had come
to love.
conclusion
A foster child is, by law, in the legal custody of the government.
The government, therefore, has the legal right and responsibility to
parent that foster child. To me, this means that we must treat every
foster child as if she or he is our own child.
Thank you for taking that responsibility seriously and for calling
for and supporting measures that will give every foster child the
promise of a safe, permanent and loving home.
Senator DeWine. Thank you very much, very helpful. Miss
Bowens.
STATEMENTS OF:
JACQUELINE BOWENS, VICE PRESIDENT FOR GOVERNMENT AND PUBLIC
AFFAIRS, CHILDREN'S NATIONAL MEDICAL CENTER
DR. JOSEPH WRIGHT, MEDICAL DIRECTOR FOR ADVOCACY AND COMMUNITY
AFFAIRS, CHILDREN'S NATIONAL MEDICAL CENTER
Ms. Bowens. Good morning, Senator DeWine and Senator
Landrieu. Thank you very much for providing us with this
opportunity to address the committee today about our role in
caring for children in Washington, DC's foster care system. I'm
Jacqueline Bowens, Vice President of Government and Public
Affairs at Children's Hospital, and joining me this morning is
Dr. Joseph Wright, who is the medical director of Advocacy and
Community Affairs, as well as the medical director of the DC
KIDS program. I'm going to spend a quick few moments giving you
some background on the DC KIDS program, and turn it over to Dr.
Wright to speak to some of the challenges we face in our vision
for the future.
The District of Columbia Kids Integrated Delivery System,
DC KIDS, is a collaborative effort between CFSA and Children's
Hospital to provide comprehensive health care services to the
children in foster care in the District of Columbia. The
arrangement allows for this vulnerable population of children
to be evaluated and treated in a child-friendly pediatrics
specific environment and provides for support, information and
navigation of the complex systems of care for foster parents
and their foster children. There is no paper work to complete
and no cost to the foster parents of child. All children under
the age of 21 and under the care of CFSA living with a foster
family or in a group home are eligible for enrollment in the
program.
The agreement between CFSA and Children's Hospital provides
coordination of ongoing healthcare services for children in
foster care. First a child is brought to Children's DC KIDS
assessment center for an initial screening before their first
foster family placement. This initial screening is done by
dedicated staff who complete a medical portfolio on each child
before certifying that they are healthy enough for placement to
a foster home. In addition, each time that a child's placement
is disrupted, they return to Children's for a new assessment
before being sent to their new placement.
The child is enrolled in DC KIDS at the time of the initial
assessment. Within 10 days, the DC KIDS program arranges for a
comprehensive physical examination and a mental health
evaluation to identify necessary services for the child and
family. These may include early and periodic screening,
diagnosis and treatment of illnesses, inpatient specialty care,
and prescription services. From that point forward, the DC KIDS
staff assists the foster families in navigating the complex
health care system to provide for ongoing treatment for their
foster child, everything from scheduling and confirming
appointments to arrangement of transportation for specialty and
follow-up services. The DC KIDS outreach coordinators are
available to educate foster parents, social workers, in-service
providers.
We are again, very proud of the relationship that we've had
in the DC KIDS program, and I'd like to just quickly talk about
some of our successes since taking on the program. We each feel
that we've come a long way since our first days on the job with
DC KIDS. We have increased enrollment by over 400 percent. When
we first assumed the program, there were less than 1,000
children actively enrolled in the program; now we care for over
4,000. Since May 2001, we have had 3,053 children come through
our assessment center, and 1,870 children have returned for
visits due to a disruption in their placement.
We're also proud of the new technology we've developed to
make the process easier for social workers. We provide computer
terminals for the social workers on-site with all their
required forms online and readily accessible to them. This way
they can make productive use of their time while waiting for
their child's medical assessment to be completed. And we get
the information we need to accurately enroll the children in
the program. We work very hard to minimize the time that the
social worker spends on this process, reaching our goal of 90
percent or more of the cases triaged in less than 2 hours by
July 2002.
Also, upon our assumption of the program, Children's also
requested the creation of a new system to provide foster
families with the prescriptions and other pharmaceutical items
they needed in order to care for their children once they left
our care. Working with CFSA, we developed a new electronic
prescription pad that creates a voucher that is now accepted at
a network of pharmacies throughout the city, allowing families
to have 24-hour access to prescription services.
These are just a few of our achievements with the program.
At this point I would like to turn it over to Dr. Wright, who
can address some of the challenges and our vision for the
future.
STATEMENT OF DR. JOSEPH WRIGHT
Dr. Wright. Again, Senator, we would like to thank you for
allowing us to testify this morning. Jackie has already told
you about some of the successes that we have achieved in the
first almost 2 years of involvement with this program and I
will address some of the specific challenges that we face.
One that you have heard repeatedly this morning is in the
area of mental health. This is a struggle citywide due to the
lack of capacity for mental health services. There are simply
not enough providers, beds and programs to adequately serve the
children in this region, and not just the kids enrolled in DC
KIDS, but for all children. As you might imagine, the DC KIDS
population is especially vulnerable in this area. More than 50
percent of these children require some type of mental or
behavioral health intervention, and most on a ongoing basis.
Children's Hospital has a 12-bed inpatient psychiatric unit
which cannot absorb all the needs of this population. Further,
our facilities are not equipped with the quiet rooms and
restraints necessary to primarily treat severely mentally ill
and out of control patients. As a result, we have tried to
establish partnerships and collaborations with other community
providers to whom we can refer DC KIDS when we are unable to
primarily provide services. In this regard we serve as the
coordination point, managing the care that these children
require.
The same situation exists with dental services. There is a
nationwide shortage of pediatric dentists and we feel the
shortage in the District as well. Many of the DC KIDS requiring
dental care are children with special health care needs and
must be seen by dentists who are appropriately trained. In
order to address this problem, Children's has purchased half
the time of two pediatric dentists who work at Sharpe and Mamie
D. Lee, the District's two public schools dedicated to the
special needs population. These dentists are dedicated to
provide dental services to our DC KIDS population. While this
arrangement has helped, it is insufficient.
Let me address briefly court-ordered mental treatment.
Children's works hand-in-hand with the judges in the Family
Court to ensure appropriate health care services are provided
to this vulnerable population. However, there are no better
advocates for these children than the judges. Their
sensitivities to these children's needs demand their strict
attention, which they provide. However, a growing concern for
our institution and the DC KIDS program is the amount and
nature of court-ordered medical treatment that we are
experiencing.
As cases are adjudicated, specific medical treatment or
therapy is frequently ordered without any physician
consultation. As the medical provider for these children, we
are forced to comply with the court order even if it is
medically inappropriate. Unfortunately, such court-ordered
referrals are continuing to grow. From October 2002 to April
2003, the number of court-ordered outpatient referrals grew
from 10 percent of our referrals to nearly 20 percent. We have
begun to educate the judges about the difficulty of these very
specific orders for medical care, but we have a long ways to
go.
Now, I want to make it very clear. We realize that the
judges are passionate advocates for these children. In the best
interests of these most vulnerable kids in our population, we
simply feel that it is our obligation to help educate all
involved in their care, including the Family Court, about the
best ways to work together.
Lastly, an internal challenge that we face is the
appointment no-show rate. In some areas, this is as high as 50
percent. Even though we coordinate transportation services for
these families, it does not help. This results in a negative
domino effect. Children are not getting necessary care,
frustrated physicians who block out sessions to treat DC KIDS
only to have none of them show. The problem is then compounded
by other needy children in the community who may be waiting
several weeks for an appointment.
Now at Children's Hospital we continuously strive to make
things better, and I would be remiss if we didn't offer some
ideas and potential solutions for the problems that I have
identified. Jackie has already alluded to our ideas in the area
of information technology and we envision an assessment program
that will be a model for the rest of the country. This
assessment process will build on the foundation already
established.
The first step will be complete integration of the CFSA
computer system with our system in the DC KIDS program.
Currently, as we enroll children at the time of their initial
assessment, this often occurs before CFSA has confirmed
placement. As a result, it requires a DC KIDS staff member to
contact the social worker or CFSA to locate the child in order
to make their follow-up appointments. This causes a tremendous
bottleneck in waiting for the address and contact information.
If we were fully integrated with the CFSA system, we could
simply log on to the child's file and see the placement
immediately after it is entered into the system by the social
worker. This would save immeasurable time.
We also envision a program that makes health care for
foster children as accessible as possible to the foster family.
Transportation is one of the biggest barriers for our foster
families, and we know that it contributes substantially to the
aforementioned no-show rate. We believe that if we owned a DC
KIDS shuttle and driver that were dedicated solely to providing
transportation to foster families and children for their
appointments, more foster children would receive their care in
a timely manner.
I have already mentioned our dental facilities. Currently
we do not have the facilities or space to cover all the needs
of children at Children's Hospital. We are land-locked and do
not have room for expansion. Our vision for the future,
however, includes a system of community-based partners to
provide all services needed by the DC KIDS children. We are
making strides towards that goal with the recent awarding of a
State innovations grant from the Department of Health and Human
Services that we will be implementing in conjunction with the
D.C. Department of Health to develop state-of-the-art
community-based dental programs at the District's two special
needs schools.
Lastly and clearly the most difficult clinical element in
managing the DC KIDS program is the mental health capacity
issue. The number of patients seeking acute care for mental
health problems has exploded at our institution over the past 2
years. The volume for such crisis has more than tripled since
the closure of the emergency psychiatric facility on the campus
of D.C. General in 2001.
Because of the aforementioned physical limitations at our
institution, we know that we must develop partnerships with
other community providers, but there are some things that can
be done immediately as well. For example, we are planning new
programs to operate a mental health urgent care center at
Children's Hospital in the evenings and on the weekends. We
believe this will help alleviate some of the strain that is
being felt by our emergency department. We believe this mental
health urgent care center will help to redirect patients
currently occupying beds in the ER that are needed for children
with medical and surgical emergencies.
Our proposal is currently being considered by the D.C.
Department of Mental Health and they have agreed to provide
funding for a psychiatric social worker. However, ideally,
funding is needed to support three social workers, a security
guard, a disposition staff, and one full-time position in order
to properly support such a program. Above all, the DC KIDS
population needs stability. What is best for these children is
a comprehensive health system that addresses their emotional,
medical and educational needs.
PREPARED STATEMENT
It is critical that they involve stable foster families and
consistency among providers when they seek this treatment.
Children that face disruption in placement as well as
fragmented medical care will have their baseline problems
further compromised.
I would like to thank you for the opportunity to testify
and will be happy to answer questions at the end of the panel.
[The statement follows:]
Prepared Statement of Jacqueline D. Bowens and Dr. Joseph Wright
Mr. Chairman, thank you very much for the opportunity to address
the committee today about our role in caring for the children in
Washington, DC's foster care system. I am Jacqueline D. Bowens, Vice
President of Government and Public Affairs at Children's Hospital.
Joining me today is Dr. Joseph Wright, who is the Medical Director of
Advocacy and Community Affairs, as well as the Medical Director of the
DC KIDS program.
background on children's hospital
Children's Hospital is a 279-bed pediatric inpatient facility
located in the District of Columbia. For over 130 years, we have served
as the only provider dedicated exclusively to the care of infants,
children, and adolescents in this region. It is our mission to be
preeminent in providing health care services that enhance the well-
being of children regionally, nationally, and internationally.
The Children's system includes a network of five primary care
health centers located throughout the city, and a number of
pediatrician practices throughout the region, providing stable medical
homes for thousands of children. We also operate numerous regional
outpatient specialty centers in Maryland and Virginia, providing access
to high quality specialty care right in the communities that we serve.
We are proud to be the region's only Level I pediatric trauma center.
Children's Hospital serves as the Department of Pediatrics for
George Washington University medical school, and runs a highly-
respected pediatric residency program, providing education and
experience to the next generation of pediatricians, pediatric
specialists, and pediatric researchers. We also conduct significant
research within Children's Research Institute, with funds from the
National Institutes of Health, the Health Resources Services
Administration, the Department of Defense, and countless private
funders. Our researchers have received national recognition for recent
breakthroughs including identification of the gene associated with
matasticizing brain tumors, and discoveries related to muscle
development for muscular dystrophy patients.
Recently Children's Hospital was named as one of the nation's ``Top
Ten'' pediatric institutions in the country by Child Magazine, based on
stringent quality and outcomes measures. Our Hemotology/Oncology
program was ranked fourth in the nation. We are the only such facility
in the region to receive this honor.
Locally, we also work in collaboration with the District of
Columbia Department of Health to operate the District's School Health
program, employing all the school nurses in the public schools,
including 21 charter schools. And we are very proud of our affiliation
with the District's Child and Family Services Agency (CFSA), in which
we work in conjunction to operate the medical program for children in
foster care called DC KIDS.
background on the dc kids program
The District of Columbia Kids Integrated Delivery System (DC KIDS),
is a collaborative effort between CFSA and Children's Hospital to
provide comprehensive health care services to the children in foster
care in the District of Columbia.
The DC KIDS program was first established by CFSA as a medical
management model. The initial contract went to the former Public
Benefits Corporation and DC General Hospital. Prior to the closure of
DC General Hospital and the PBC in early 2001, CFSA approached
Children's to absorb the program on an emergency basis ``as is,'' with
the intent of eventually establishing a more formal long-term
relationship--which we did. Children's assumed the DC KIDS program on
May 1, 2001 after a rapid transition. Our current agreement runs
through December 31, 2003.
The arrangement allows for this vulnerable population of children
to be evaluated and treated in a child friendly, pediatric-specific
environment. It provides each child with a continuous and coordinated
system of services. DC KIDS supports, informs and navigates the complex
systems of care for foster parents and their foster children. There is
no paperwork to complete, and no cost to the foster parent or child.
All children under 21 years of age and under the care of CFSA, living
with a foster family or in a group home, are eligible for enrollment in
the program.
The agreement between CFSA and Children's Hospital provides
coordination of ongoing health care services for children in foster
care. First, a child is brought to the Children's DC KIDS assessment
center for an initial assessment, before their first foster family
placement. This initial screening is done by dedicated staff who
complete a medical protocol on each child before certifying that they
are healthy enough for placement into a foster home. In addition, each
time that a child's placement is disrupted, they return to the
Children's for a new assessment before being sent to their new
placement.
The child is enrolled in DC KIDS at the time of the initial
assessment. Within 10 days, the DC KIDS program will arrange for a
comprehensive and thorough physical examination and a behavioral/mental
health evaluation. Once completed, necessary services for the child and
family are identifed, such as:
--early and periodic screening
--diagnosis and treatment of illnesses
--dental services
--immunizations
--eye care
--hearing services
--mental health services
--substance abuse services
--developmental services
--in-home services
--inpatient and specialty care
--prescription services
From that point forward, DC KIDS assists the foster families in
navigating the complex health care system to provide for ongoing
treatment for their foster child. The DC KIDS team schedules and
confirms appointments, and arranges for families to receive care at the
Children's Health Center and therapists located in close proximity to
their neighborhoods. When that is not possible, the staff arranges for
transportation--this occurs most often for specialty and follow-up
services. DC KIDS outreach coordinators are available to educate foster
parents, social workers and service providers by answering questions
about enrollment and eligibility.
our successes
Increased Enrollment
We at Children's Hospital feel that we have come a long way since
our first days on the job with DC KIDS. We have increased enrollment by
over 400 percent. When we first assumed the program, there were less
than 1,000 children actively enrolled in the program--we now care for
over 4,000. Since May 2001 we have had 3,053 children come through our
assessment center, and 1,870 children have returned for visits due to a
disruption in their placement.
Enhanced Technology
We are proud of the new technology we have developed to make the
process easier for the social workers. We provide a computer terminal
for the social workers on site, with all their required forms on line.
This way they can make productive use of their time while waiting for
the child's medical assessment to be completed, and we get the
information we need to accurately enroll the children in the program.
We have worked very hard to minimize the time that the social worker
spends in this process, reaching our goal of 90 percent or more of the
cases triaged in less than 2 hours by July, 2002.
Pharmacy Vouchers
Upon our assumption of the program, Children's also requested the
creation of a new system to provide foster families with the
prescriptions and other pharmaceutical items they needed in order to
care for these children once they left our care. Working with CFSA, we
created a new electronic prescription pad that creates a ``voucher''
that is now accepted at a network of pharmacies throughout the city--
allowing our foster families to receive both prescription and over-the-
counter products for their new foster child.
dc kids challenges
While we are very proud of these achievements, we acknowledge that
there is so much more that needs to be done to overcome the challenges
that Children's, CFSA, and the entire system faces.
Mental Health
One challenge that is a struggle city-wide is the lack of capacity
for mental health services. There simply are not enough providers,
beds, services and programs to adequately serve the children of this
region--not just children enrolled in DC KIDS, but for all children.
The DC KIDS population is a very vulnerable one. More than 50
percent of these children require some type of mental or behavioral
health service, most on an ongoing basis. Children's Hospital has a 12
bed inpatient psychiatric unit, which cannot absorb all of the needs of
this population. Children's Hospital does not have the facilities such
as quiet rooms and restraints that are needed to treat the severely
mentally ill; patients needing that type of care must be treated
elsewhere. As a result, we have tried to establish partnerships and
collaborations with other community providers to refer our DC KIDS
population when we are unable. We serve as the coordination point,
because we simply cannot provide all of the services needed. More of
this collaboration needs to be done.
Dental Services
The same situation exists with dental services. There is a nation-
wide shortage of pediatric dentists, and we feel that shortage in the
District as well. Many of the DC KIDS that need specialized dental care
are ``special needs'' children, and must be seen by a dentist that is
appropriately trained. In order to address this problem, Children's has
purchased half the time of two pediatric dentists who work at two of
the District's special needs schools. These dentists are dedicated to
provide dental services to our DC KIDS population. While this
arrangement has helped, it is insufficient.
One recent strategy has developed with the award of $450,000 in
funding from the Department of HHS, through a State Innovations Grant
to the District of Columbia. The District was one of five states to
receive this grant, which is intended to spur states into finding new
and innovative ways to improve access to health care. Children's
partnered with the DC Department of Health to create a program with two
state-of-the-art dental clinics in schools for children with special
health care needs. The centers will use telemedicine tools to link
patients with pediatric dentists and hygienists. This will allow us to
focus on the provision of dental services to the most vulnerable
children, a population which includes many foster children. It is one
step towards a comprehensive ongoing strategy in this area.
Focus on Young Children
Another challenge that Children's faces with this population is the
orientation of our facility primarily on younger children, as the only
acute care facility solely dedicated to pediatrics in this region.
Although we are licensed to treat patients up to age 21, and do so, we
have met challenges in providing for the unique needs of the older DC
KIDS population. As with mental health, to meet this challenge, we have
had to build partnerships and collaborations with outside community
providers, serving as the coordinator of those services instead of the
primary provider.
Court-ordered Medical Treatment
Children's works hand-in-hand with the judges and the Family Court
to assure appropriate health care services are provided to this
vulnerable population. There are no better advocates for these children
than the judges. Their sensitivities to these children's needs demand
their strict attention, which they provide. But a growing concern for
our institution and the DC KIDS program is the amount and nature of
court-ordered medical treatment. As these cases get adjudicated, often
times a specific medical treatment or therapy will be ordered without
any physician consultation. As the medical provider for these children,
we are forced to comply with a court order, even if it is medically
inappropriate for the child. Our physicians have great difficulty in
treating a child in a manner they feel in unnecessary, regardless of
whether the court has ordered it or not. For example:
--It is common to receive an order to admit child for an inpatient
psychiatric stay for a specified number of days. The child may
not need to be admitted for that period of time--they may be
appropriately released in half the time. But because of the
order, the child may be required to remain in the inpatient
psychiatric unit for the full number of days prescribed in the
court order. These types of social admissions are not always in
the best interest of the child.
--Another example is a court order for occupational therapy within 14
days. But an occupational therapist cannot treat a child
without a physician's order. So DC KIDS must first arrange a
visit with a physician for an evaluation before an appropriate
occupational therapist can be scheduled. It is usually
extremely difficult to accomplish this within the short time
frame usually ordered by the courts.
Unfortunately, such court-ordered referrals are continuing to grow.
From October, 2002 to April, 2003, the number of court-ordered
outpatient referrals grew from about 10 percent of our load to nearly
20 percent. We have begun to educate the judges about the difficulty of
these very specific orders for medical care, but we have a long way to
go.
We want to make it very clear--the judges are passionate advocates
for these children. They demand the very best of service and care, with
the children as their number one priority. Our task is to educate CFSA,
the judges and the Family Court, social workers and families about the
best ways to work together.
Transportation Problems
Another internal challenge we have with this population is the high
rate of ``no-shows'' we encounter. We make every effort to expedite and
facilitate appropriate medical care for these very vulnerable and needy
children--but it is to no avail if the foster family does not bring
them to their appointments. Even though we coordinate transportation
services for them, it often does not help. The result is a negative
domino effect: children, who are not getting necessary medical care;
frustrated physicians, who block out entire days or afternoons to treat
this population, only to have none of their appointments show up; and
other needy children in the community who may be waiting several weeks
for an appointment. We've got to find a better way.
our vision for the future
At Children's Hospital we continually strive to make things better.
We have ideas and solutions for which we are searching for ways to
implement.
Information Integration
We envision an assessment program that could be a model for the
rest of the country. This assessment process would build on the
foundation we have created. The first step would be complete
integration with the CFSA computer system.
Right now, when we enroll the children at the time of their initial
assessment, often this is before CFSA has confirmed their family
placement. This requires a DC KIDS staff member to contact the social
worker or CFSA to locate the child in order to make their follow-up
appointments and comply with the 10-day window to complete the physical
and mental health assessment. Waiting for address and contact
information creates a major bottleneck in the system. If we were fully
integrated with the CFSA system, we could simply log into the child's
file and see the placement immediately after it is entered into the
system by the social worker. It would save immeasurable time.
In addition, integration would eliminate duplication of effort.
Right now, we keep the medical records and CFSA keeps the complete
record. The medical information gets entered in at Children's, and then
has to be manually re-entered into the CFSA system. Placement
information gets entered into the CFSA file, and then has to be
manually re-entered into the medical record. There is a lot of
exchanging of information and data that could be completely eliminated
if the two systems were integrated.
Dedicated Transportation Service
We also can envision a program that makes health care for foster
children as easy and convenient as possible for the foster family.
Transportation is one of the biggest barriers for our foster families,
and we know that it contributes substantially to our ``no-show'' rate.
If a foster parent is unable to get the foster child to a scheduled
appointment, it is a delay in care for that child. Although the DC KIDS
program helps make transportation arrangements, it is an ongoing
problem. We believe that if we owned a DC KIDS shuttle and driver that
was dedicated solely to providing free transportation for foster
families and children to their medical appointments, more foster
children would receive their care in a more timely manner.
Education and Training
We also believe there would be great benefit and improvement of the
system if there were opportunities for outreach and education--to
families, to judges, to social workers, and other partners who touch
the lives of these children. Annual training for all these groups, we
are certain, would go a long way.
Mental Health Models
One of the most difficult pieces of this is the mental health
capacity issue. Because of our physical limitations at our institution,
we know that we must develop partnerships with other community
providers. But there are some things that could be done immediately as
well. For example, we are planning to pilot a new program to operate a
mental health urgent care center at Children's Hospital for nights and
weekends. It would be housed in the outpatient psychiatric department
as a mental health urgent care center in the off hours. We believe this
will help alleviate some of the strain that is being felt by our
emergency room. When St. Elizabeth's closed, we were told to anticipate
an increase of about 10 percent in our emergency room. Instead,
emergency room visits for mental health crisis have tripled in the last
ten months. We believe this mental health urgent care center will help
to redirect patients that are currently occupying medical/surgical beds
in the emergency room that are needed for children with physical
issues. Our proposal is currently being considered by the DC Department
of Mental Health, and they have agreed to provide funding for one
social worker. But the rest we are scraping together for this pilot, to
see whether or not it would be beneficial for the patients and for the
facility. Ideally we need funding for three social workers, a security
officer, a disposition staffer, and one full-time physician to operate
an ideal program.
We also would support the expansion of the DC Department of Mental
Health 24-hour access help line and mobile teams. This would allow
patients to contact DMH directly, and receive care right in their
community. Not every child needs to come to the hospital--they do now
because that is the only place they know to get services. But expansion
of community services like the mobile teams could be very helpful.
Another component that is lacking for the DC KIDS population is a
day treatment program. Often a child is not in need of hospitalization,
but they also need more structure and care than weekly therapy. A day
treatment program is a structured ``in-between'' step that could be
very valuable for those children who are in between hospitalization and
less rigorous treatment they can receive in the community.
Above all, the DC KIDS population needs stability. They come to us
with developmental issues, and problems with attachment and trust. What
is best for this kind of vulnerable population is a comprehensive
mental health system that addresses their emotional, medical, and
educational needs. It is critical to have the involvement of stable
foster families, and consistency with the providers that they see for
treatment. Those children that face disruption in their placement,
coupled with fragmented care that shuffles them from provider to
provider, only worsens their problems with attachment and trust.
Stability is key.
Children's hopes to utilize current research that suggests more
targeted cognitive behavior psychotherapy, carefully re-evaluated every
3-4 months, will lead to better outcomes--better resilience, better
social skills, and better adjustment in the future.
Dental Care
Our current facilities will not cover all the dental needs of the
children. We are land-locked, and have no room for expansion. Our
vision of the future of dental services includes a system of community
based partnerships to provide all the services needed by DC KIDS
children.
Thank you very much for the opportunity to testify before you
today. We are very proud of our efforts in caring for this vulnerable
population, and look forward to even greater successes with the DC KIDS
program in the future.
We would be happy to answer any questions you may have.
Senator DeWine. Doctor, thank you very much. Mr. Miller.
STATEMENT OF DAMIAN MILLER, STUDENT, HAMPTON UNIVERSITY
Mr. Miller. Good morning, Senator Landrieu and Senator
DeWine, and distinguished guests, for the privilege of allowing
me to address the committee on concerns that I have and things
that need to be improved, as well as the positives of the D.C.
foster care program. First, let me say, my name is Damian
Miller. I am a rising senior at Hampton University. I have been
part of the D.C. foster care program since the age of 7 on and
off. I have had a very unique experience, to say the least,
with some positives and some negative things.
First, let me focus on the areas that I feel need
improvement, starting, I would like to say that I think the
training for many parents should be more intense and with this
training, I think that there should be an emphasis on treating
the kids like they are part of the family. I know in many homes
that I have been in, I found that things like family picnics,
we were not included in. Also, other youths of my age were not
included in things like that, simple things like allowing the
kids to play with other kids in the house and use the
refrigerator, and just do things that are part of the family. I
think that is definitely essential and a part of making them
feel like they are in the family and that you really care about
them.
Also, I think that the training should encourage the
parents to attend PTA meetings and reward you for good behavior
and, you know, academic achievement. I feel that I was always
punished when I did bad, but when I came home with good grades,
I wasn't rewarded, and I think that with any child, you should
definitely reward them, you know, not just always hound them,
and I think that should be an important part of the training.
Also, I think it's important that we rid the system of
parents that are in it for the money. I think that there are
many parents that I have been with that I feel are definitely
in the system, you know, for a check. And even good foster
parents, I remember being in good foster homes, and I would
have good parents, but the fact that the agency would allow
them to bring in three or four extra kids, they were doing a
good job with me but when you brought in three or four other
kids, I mean, can they really handle that? And it definitely,
you know, played a negative effect on my placement with them.
I think that workers should make sure that the funds are
actually used for the kids. A lot of the clothing allowances
and things of that nature, I missed out on, and other youth
that were in the home with me, they didn't receive adequate
funds to go clothing shopping, an allowance, you know, and
teaching them good economics, that wasn't something that was
taught to me in these homes. And I think social workers should
really go out of their way to make sure that these funds are
really being used to better the youth and not just for the
parents.
And part of that, I think that there should be a limit on
how many kids that a person can get, and not just based upon
home size. Just because they have four bedrooms, you know,
doesn't mean that they should have four or five or six kids. It
should be based upon, you know, are they working well with two
kids, you know, should you put this third kid in. I think that
that's something that should be looked at and not just the size
of the house.
Also, I think that recordkeeping is something that's very
important, and I know one of the panelists touched on that.
Social Security cards, birth certificates and things of that
nature, I cannot tell the committee how many times I have tried
to apply for summer jobs and things of that nature, and a
simple copy of my Social Security card could not be found or a
birth certificate or things of that nature. I think vital
recordkeeping is essential and definitely something that needs
to be improved within CFSA.
I think that one thing that should be expanded is family
visitation time. Agencies like For Love of Children provide
once-a-month time when foster kids are allowed to see their
parents. I think that that's a very positive thing and I think
that should be expanded to all agencies, because as Senator
Hillary Clinton's book says, it takes a village to raise a
child, and I think their families should be included in that
village.
I think that helping better the relationship with the
families is definitely a must. I think that these sessions were
always great to me because I would meet uncles and cousins that
were coming, encouraging me with better grades, and like I
said, I think the visitation thing is very important and should
be expanded.
The positive areas that I think should be expanded and the
great improvement I have seen, programs like CFSA's Keys for
Life has been extremely positive for me. In this program youth
are encouraged to excel academically and given money to pursue
a higher education. Like I said, it has been a very positive
experience, and in fact I would call it the most positive out
of my years in the D.C. foster care system. It has given me an
unbelievable opportunity to attend college and definitely
encouraged me along with many other youths to better ourselves
and our future.
The first semester at Hampton University during my freshman
year I didn't do so well, and Keys for Life really stayed on me
and kept me focused to better myself, and since then, I'm a
rising senior now and I have been on the dean's list ever
since. So programs like Keys for Life are definitely essential
and a great way to help youth.
I think that one thing I have seen improvement in over the
years is that social workers today are not as swamped with
caseloads like they used to be when I first came into the
system. It was very hard to even talk to my social worker, but
now that's something that has improved and I think that it's
critical that it improves even more, because when you have a
social worker that's not swamped with caseload, they can give
the youth individualized attention which definitely is always a
positive.
And I think something that's also important is mentors. I
have had mentors over my years in CFSA and they have helped me
a great deal, and I think that should be something that should
be mandatory for all youth if possible, that they be given a
mentor or someone to look up to and provide guidance to them.
And also, lastly, I would like to mention programs like the
Orphan Foundation. Providing internships on Capitol Hill for
youth this summer, CFSA will be providing internships because
of the Orphan Foundation, and programs like that are positive.
Thank you for allowing me to come and testify.
Senator Landrieu [presiding]. Thanks to all the panelists
today for coming here and presenting well-put-together
presentations, and for concentrating on some of the positive
efforts that are being made, and still being forthright in
pointing out some of the weaknesses that still need to be
addressed.
Senator DeWine will be back with us. He had to make a
quorum for another committee, but he does have questions, so I
will take the first round and he will be back shortly.
Damian, just start with you. For the record, if you can
remember, how many foster care placements and social workers
have you had since the age of 7?
Mr. Miller. Sure. Approximately nine placements and maybe
eight to nine social workers also.
Senator Landrieu. Okay. I wanted to get it on the record
and I want to thank Damian for being here and sharing his
experience and his commitment to advocate for the 9,000
children or so that are within the universe of this discussion
this morning, and as well as the 500,000 children in the
country today that are in the foster care system. Without
leaders like Damian, we would have an even harder time trying
to figure out some of the solutions. Obviously one of the goals
of our work is to try to achieve one placement, at the most two
per child and one social worker for each child, to give him or
her the consistency over time. There will be turnover, so one
is not always going to be possible, but that ideally would be
our goal, one case worker, one placement, one judge, one
permanency plan, and that is what I would like us to keep in
mind as we think about Damian's future and how hard he has
worked and how much he has achieved under these difficult
circumstances.
Senator DeWine and I are very pleased to be part of the
agencies and offices that will be offering internships. Damian,
I might specifically request you, since I have met you now, but
we are not supposed to pick our young people for the summer.
But both Senator DeWine and I look forward, given our
experience this last summer, of having these interns come into
our office.
Let me ask just a couple of questions. One, there are so
many, but one I would like to pursue is this seemingly model
that's developing here with Children's Hospital. Ms. Sandalow,
I think the car accident analogy that you referred to is an
excellent one. We would not leave a family involved in a car
wreck on the highway and not give them immediate attention.
This is exactly the same kind of thing that happens when there
is basically a breakdown or a wreck in a family, and that
emergency care, the first 24 to 48 hours is crucial for the
health and development of either that group of individuals or
one individual that has been the victim of such an accident. It
seems as though we're developing a fairly good model here with
Children's Hospital and with DC KIDS to do that early
evaluation.
My question is, you were saying that you have seen 4,000
children. I think there are 9,000 in the universe. Am I looking
at the right number? What is preventing, or what is stopping
the system or slowing it down for all the children that are
removed from the home to get to this evaluation center where a
lot of wonderfully good things could be done in the first 24 or
48 hours? Medical records could be compiled, an evaluation
could be conducted, a social worker or case worker could make a
fairly quick assessment of the appropriate temporary placement,
preferably a kinship placement, which is what we always like to
reach to, a kinship placement or a neighbor, until an
appropriate maybe interim placement can be made, and then the
work begins to try to move that child either back to
reunification with the family, or on to a permanent adoption.
In the new Federal law it refers to temporary foster care of no
more than 18 months.
So let's talk about what might be a barrier for setting
that as a model, maybe Miss Bowens and all of you could
comment. Is that the model we're trying to achieve, and what
are the barriers?
Dr. Wright. Let me just start by saying the point of entry
for children into the DC KIDS program is either an initial or a
change of placement, so that the universe of children who are
in stable homes and represent perhaps the 5,000 that represents
the gap between the 4,000 that we have enrolled and the
universe of children, are not accessible to us through the DC
KIDS model. However, let me also say that the full universe of
children in foster care is a population in which we are very
interested and would very much like to access those children
for the purposes of some of the things that Damian has
validated for us, which is very encouraging to see, to hear,
that we're interested in education, we're very much interested
in mentorship and working with the families in the foster care
system, the entire foster care system and not just the ones
that enter into the DC KIDS program because there has been a
change in placement.
And one of the barriers that I alluded to in my testimony
was from the standpoint of information technology, we have
access only to the kids in the DC KIDS database, and there is
not an interface there.
Senator Landrieu. Thank you for your clarification. Did I
understand you correctly that after the initial placement that
every child that has come into the D.C. system has to be
evaluated at your center?
Ms. Bowens. No. We only have access to the children since
we assumed the program, and that would only be under the
assumption that they were still in the homes that they were in
when they first came into our care. Any children that have been
enrolled prior to, we don't have access. The bottom line is
that we don't have the information on the foster care family.
What would be great is actually to have the list of all the
foster care families, so that we could outreach to them and
provide them with information and education about DC KIDS. For
example, issues about Medicaid numbers and things like that,
many of the families are not even aware that the program
exists. So if we had access to them and were able to educate
them, some of the things that were mentioned earlier probably
could be minimized.
Senator Landrieu. I may be misunderstanding, maybe I heard
the testimony wrong, but I'm trying to determine when the car
accident occurs, are the children in the car accident brought
to you?
Ms. Bowens. No.
Senator Landrieu. That's what I'm trying to figure out. I
thought you testified that was an early initial evaluation.
Ms. Bowens. No. When children first go to CFSA, then CFSA
will bring, the social worker will bring children to Children's
Hospital for an initial assessment.
Senator Landrieu. Right, an initial assessment sometime
after that car accident.
Ms. Bowens. Yes, exactly. I'm sorry. Very, very quickly,
within 24 hours, those children will come in for an initial
assessment. We don't have any idea of where they're going, it's
just kind of the social worker is there with them, we'll do an
initial assessment just to make sure that they are healthy
enough to be placed. We then work diligently to work with CFSA
to find out where those families are then located, so that we
can provide their follow-up primary care visit and a mental
health evaluation.
Senator Landrieu. But in that stop, do you do a
comprehensive evaluation of the child's general situation so
that you could provide foster parents with some meaningful
information about a general initial evaluation of their
physical health, maybe some of their initial experiences, the
reasons they were--you know, a packet that would be helpful to
what Mrs. Egerton said about having some information as a child
comes into a foster care home, do you provide this information?
Ms. Bowens. We don't, we would love to. I mean, we have
actually reached out to the agency, because many of our
physicians get extremely frustrated because the children come
in, we have no medical record information, no background
information, so we are not poised right now to be able to do
that, because like many of the other panelists have said, we're
chasing after information to be able to make those appropriate
assessments. But our initial assessments when they first come
in, again under that label of assessment, are to just make sure
that the child is healthy enough to be placed, and then we
provide the follow-up comprehensive evaluation. But then the
struggle there is, we don't have the requisite information.
Senator Landrieu. It's a very limited evaluation of the
child.
Ms. Bowens. The initial, that's correct.
Senator Landrieu. Ms. Sandalow, would you like to comment,
or Miss Egerton, if we could help develop this system, would
that be helpful? We want to create systems that are simple,
streamlined and work, and not add any other bureaucratic
layers. Can you comment on that system as it exists today and
what you would like to see?
Ms. Egerton. Well, that actually happens prior to the child
being placed with me. It would be divine, and we have been
fighting for a very long time to get adequate information on
our children when they come to us. The realities though, in all
fairness to CFSA, is that they're chasing down the information
as well. When they go into a home to take a child out in the
middle of the night and the parent is in opposition, the parent
isn't standing there saying, well, wait a minute, let me get
you the Social Security card and Medicaid card. That doesn't
happen, and so CFSA is chasing the information down also.
The evaluation happens before the child is placed with me,
so I really can't speak to the evaluation itself, but we would
like a situation where they go to that evaluation and from that
evaluation come to us with a full medical screening, with a
mental health evaluation, with all of the pertinent medical and
mental health information available to us, absolutely. And if
we can figure out a way to do that, that would be beautiful.
Ms. Sandalow. But we need the combination of the medical/
mental health screening. We need adequate social worker
resources at the very beginning to pull that together. The
Foster and Adoptive Parents Advocacy Center, which I'm proud to
be on the board of, has done an extraordinary job in their
efforts to put together the concept of a placement passport,
which would carry that information. If a child comes to your
home who is HIV-positive, we want to know so we can give
adequate medication. That has been a struggle.
So there is a medical and mental health piece that comes,
but there are also things as simple as has the child been in
the system before. It is common for a child to be returned home
and then he will come to you 2 years later and you are not told
that. My own children have been in and out of care twice. It
took 2 years for me to figure that out, until they were
emotionally able to unlock that. I didn't learn it from CFSA.
Those kinds of records could be pulled in.
And I think most important is to focus CFSA on adequate
social worker resources in the first few days, to pull together
family. We had a case recently where we represented a child who
had been living half-time with her father in a normal split
custody situation and CFSA did not know that there was a father
involved. And we figured it out and we had to tell them. So
here's a child who could have moved straight to her father, and
it took an outsider to tell. So that kind of intensive
interview of the family members and the neighbors, and a family
caucus, it is a model being used around the country.
Senator Landrieu. I would like to follow that up for a
minute. I know Senator DeWine has questions, but I think this
is a very important component to obtain this initial placement
assessment by getting the general information from family and
neighbors, so an accurate assessment can be made. The hospitals
need this, the foster care parents need this, and the judges
need this information eventually so that they can make good
determinations for the children.
Could we comment about what exists now? Is there any model
in the District of that group social worker intensive
evaluation? If so, where is it working? If not, how could this
committee help to get that initial assessment, which I think,
that and the technology piece are the two things that we
perhaps could be most helpful with.
Ms. Sandalow. I think that the funding assets should go to
CFSA as a targeted type of project. I shared my testimony with
a few people who--yesterday, who said this emergency team,
shouldn't that be true for every child? And you'd think that
the goal would be for CFSA to be given some pilot money to
develop it internally, because obviously our hope is, if it
works, if they can make it work and they have the funds to do
it, that they can expand that even more for all the kids.
I don't think it's happening in any of the private agencies
right now. Our structure is that when a child comes into the
system, it is CFSA who touches them first. So I think that they
need to be focused on that job.
Senator Landrieu. Let's take one minute, if you would, to
describe in 30 seconds what this team would look like. How many
people would be on it, would there be a team leader? Does
anybody have a comment?
Ms. Sandalow. I'm a lawyer, so I don't think I'm the expert
you want, but it is--I can tell you what we do. In essence, we
step in and act like what we call the SWAT team that we're
hoping to, and we do it ourselves. And we have one lawyer
working tirelessly around the clock. I think two or three
social workers. The important thing is passing the information
on. That needs to happen. And you can go to hospitals after
hours and get medical records, we can coordinate that. What
we're talking about is a team of social workers who have the
time as well as, and I think this is very important, flexible
funding.
I think you mentioned, Senator, we should try to place
children with relatives. Most of the relatives are not well
off, they can't absorb extra children in their home without
some assistance. Grandmothers who may be on SSI are wonderful
caregivers, but they need some flexible funds to ease the
transition. So it needs to be social workers with access to
some flexible funds, access to the resources of Children's
Hospital.
Senator Landrieu. Mr. Chairman, could I ask one more
question, and I want each of you to comment for the record. Do
you think it would be a wise policy for us to try to put these
evaluation teams together for the first initial assessment with
the medical evaluation coming as close to an assessment as
possible, more comprehensive than just the physical well-being
of the child to, if we could identify a relative or neighbor,
to make an emergency 30-day placement based on the
recommendation of at least two certified social workers, if
that would be the best, for at least 30 days until we can find
a more--not to say more appropriate, that may have been a very
appropriate placement, but a certified foster home, assuming
none of these relatives have been certified for foster care,
most of the neighbors are not certified for foster care. But
yet, they may be the best short-term placement for these
children until a more--and I want an answer yes or no, a short
comment, because this is a big issue in trying to loosen up, if
you want to use the word loosen up, but make a greater pool of
placement opportunities that would help to ease this traumatic
time for a child. Or should we stick to the policy of you can't
place a child unless they're a certified family? Sister.
Sister Conrad. I would certainly support the idea of as
much flexibility as possible. The one area that strikes me
immediately in your question is the notion of neighbor, and in
many cases this would seem to be appropriate. However, if the
child is being removed from a dangerous situation, if we're
talking about the neighbor next door or down the street, we may
simply be endangering the neighbor as well as the child
themselves. And so in a very broad sense, yes, but with that
notion, that our concern is safety in care, that perhaps a
neighbor would be much further away than down the street.
Senator Landrieu. Miss Egerton?
Ms. Egerton. I actually have to agree with that. I think
that's a real concern for--that's a real concern for foster
parents. Even trying to keep children in their same
neighborhood, if the child or children have been pulled out of
very dangerous situations, and those parents can see that child
going back and forth to that particular home, it can be an
issue.
I think that there needs to be some room left for
flexibility. It sounds wonderful, right off the top it sounds
like a wonderful thing, but you would put the agency in a
position of monitoring unlicensed homes if you do that, which
brings in a whole other dynamic. And as a foster parent, I
would say it isn't always a bad thing for that emergency
placement to come to me. The reality is, I raised six kids to
adulthood who came to me as emergency placements who were only
supposed to stay with me 4 weeks, and they stayed with me from
11 or 12 years old to adulthood. I have one who came in at 17
and was only supposed to stay a month, who stayed until he aged
out.
So, they called me not specifically because I could, you
know, everything matched up or this was the child I wanted, or
I matched the needs of the child, or because I would be able to
answer the phone in the middle of the night. So it's not always
a horrible thing either. I just think there definitely needs to
be some room for flexibility.
Ms. Sandalow. Unequivocally yes, with the additional
problem that the District of Columbia has, which is a lot of
those people live in Maryland, so anything that we can do to
address the problem, because many of our extended families are
in Maryland.
Ms. Bowens. Not to be redundant, but I agree. I think that
that would be great, but I think we do have to retain the
flexibility because emergencies will happen and we don't want
to have a situation where we again have a backlog of children
waiting while we search out neighborhoods and families, and so
there will be that ongoing need for emergency placement. So I
think what ultimately the other panelists have said as well,
but again, we need flexibility.
Dr. Wright. Just to echo the flexibility mantra, but I
would also like to address your question about the composition.
I think that you have alluded to the fact that any such team
would need to be multidisciplinary, because these children and
families present with a multitude of issues, and the model that
I alluded to in regard to emergency or urgent mental health
assessment is one that suggests the need for several
disciplines to be involved and a point of contact.
Mr. Miller. I do agree with the rest of the panelists. I
feel that if you can place a child in an emergency placement
with a relative, that would be great, but that relative should
not be in that community, and they should be--like you talked
to about the economic burden, maybe grandparents are not able
to support an extra child and things of that nature. So I think
that if it's possible and reasonable, I think we should work to
do that, because that would ease the transition.
Senator Landrieu. Was there a relative you could have been
placed with?
Mr. Miller. I think that with economic help, I think that
that would have been definitely possible, and it would have
eased my transition to be with relatives.
Senator Landrieu. Would you have liked that?
Mr. Miller. Yes, I would have, Senator. I very definitely
would have.
Senator Landrieu. Thank you, Mr. Chairman.
Senator DeWine [presiding]. Let me apologize to all of you.
I had to attend another hearing actually, we call it a Senate
markup, we were moving a poison control bill that we passed out
of committee just a few minutes ago. So that's where I was and
now I'm back, so I may ask some of the same questions that
Senator Landrieu asked, because I obviously did not hear some
of your answers.
I would like to get into an area that I know has been
covered a little bit, and that is the question of Children's
Hospital contract between, a medical contract between
Children's Hospital and CFSA, and make sure I understand the
nature of that contract.
How do you deal with a child that has a chronic medical
problem such as, let's say asthma, and how do you know that kid
has asthma, for example? How does that child get in to you? In
other words, you know, we know that asthma is a preventable
problem, and unless that child ends up in your emergency room,
asthma is something that you try to keep he or she out of your
emergency room, and if it's something that's severe enough,
you're dealing with every day, that child is taking medication
every day. How do you know that child who maybe has been in the
system for a long time, how do you reach out and get that kid
in so that kid is being seen by your specialists or whoever he
needs to be seen by?
Dr. Wright. Well again, I will reiterate that the point of
entry into our system only occurs with initial placement or
change of placement. So provided that that has occurred, we as
part of our screening do inquire about the presentation of
chronic illness. And actually as we speak, we are developing a
pilot program for the DC KIDS program within which we have
identified a physician who would specifically work with those
children who have complex medical conditions. In other words,
this individual would be the primary physician for that cohort
of children who have asthma as an example, or who might have
any host of medical conditions that are actually more
predominant in this population than in the population at large.
This individual, as I said, we are piloting this right now, and
this individual would be identified as the follow-up physician
from the point of assessment, and then be involved in the care
of--the ongoing care of that child through specialty care or
whatever care the child needs. But we are sensitive and
recognize that that is an issue and a problem that we want to
identify as early on as possible, and that's the reason why we
are instituting this pilot program right now.
Senator DeWine. But the big picture is that you have--how
many children do you currently have, what I would call open
case files?
Dr. Wright. Four thousand, five hundred that are enrolled
in the DC KIDS program.
Senator DeWine. Those are foster children.
Dr. Wright. That's right.
Senator DeWine. And that's out of a total of how many kids
that are in the foster care program?
Dr. Wright. I believe we heard this morning that the
universe is somewhere between 8,000 and 9,000.
Senator DeWine. Okay. So instantly we know that we have a
problem, right? I know I'm repeating what has been said, but to
me this is a real problem.
Ms. Goode. No.
Senator DeWine. Okay. We do have a problem or we don't have
a problem. Who's saying we don't have a problem?
Senator Landrieu. They're saying they don't have that
number.
Senator DeWine. Okay, step up to the microphone and
identify yourself for the record please.
Ms. Goode. Good morning, Senator.
Senator DeWine. Good morning.
Ms. Goode. I am Brenda Goode, Public Information Officer
for Child and Family Services. Let's help get these numbers
straight. There are 3,200 paid placements in foster care.
Ms. Sandalow. But many more children under the supervision
of the Court.
Ms. Goode. That's correct, but 3,200 paid foster care
placements and about 8,000 children in the system total. So, a
number of those children are being monitored in their homes
with their parents.
Senator DeWine. Well now, what does all that mean?
Ms. Goode. Eight thousand children in the system, of which
3,200 are paid foster care placements. And then we have the
remainder of the kids who are being monitored at home with
their parents.
Ms. Sandalow. But other kids are placed with kinship
caregivers.
Senator Landrieu. It would be very helpful if you all could
give us for the record today, I would appreciate this,
literally just a record of the universe, okay? Because we need
to have those numbers.
Senator DeWine. Well, I'm getting apples and oranges now.
The point is, the public policy issue is how many, as a matter
of public policy, should we be providing medical care for.
Isn't that the public policy issue?
Ms. Bowens. All of them.
Senator DeWine. All of what universe? I'm getting an 8,000
number or a 3,200 number?
Ms. Goode. Right, the 8,000 is the entire universe of
children that we have cases open on at the current time, but
3,200 is the number who are placed in foster care. So right
now, DC KIDS only serves our children who are in foster care.
Ms. Bowens. But we also serve the children who are under
the jurisdiction of child protection as well, so we serve both.
Ms. Goode. All right. So you serve all the court-involved
kids.
Ms. Bowens. Correct.
Ms. Goode. We have a number of kids in the system for other
cases in court.
Ms. Sandalow. I understand from the Family Court that it's
slightly over 5,000 children who are court involved.
Senator DeWine. That includes the foster kids?
Ms. Sandalow. That includes children in foster care and it
includes children who are still, there's an open court case but
they may have returned home to their parents or whatever but
they didn't close the Court's involvement, and the children who
are with relative caregivers who are not licensed paid
providers.
Senator DeWine. So, are we all agreeing that that's the
universe, that as a matter of public policy, the District of
Columbia has agreed that we want to take care of their health
needs?
Ms. Sandalow. Most of the children----
Senator DeWine. Hold on. I want to get her. Since you
represent the CFSA, would you like to answer that?
Ms. Goode. What was the question?
Senator DeWine. My question is, do we agree as a matter of
public policy, CFSA had said that that is the number that you
want to provide medical care for, and that is 5,000, whatever
the figure was.
Ms. Goode. Yes. But we also provide Medicaid services for
other kids, so that if you're not part of DC KIDS or not court-
involved, we still provide medical services for the families
who are involved with us.
Senator DeWine. But if I have a 5,000 figure, and what's
the figure, 5,000 what?
Ms. Goode. Five thousand court-involved kids.
Senator DeWine. Five thousand court-involved kids, and
you've got, the hospital has open files for how many?
Ms. Bowens. About 4,000 children year to date, we have been
tracking and following.
Senator DeWine. All right. So we are missing a thousand. Do
you agree with that?
Senator Landrieu. One of the issues, Mr. Chairman, is that
they only have files for kids that have had a change in their
placement.
Ms. Bowens. And since we took over the program, there are
many more children----
Senator Landrieu. They're not really lost, it's just that
they didn't come into the system because they are in a stable
place now, but I understand that your enrollment in DC KIDS is
about 4,000; is that correct?
Ms. Bowens. That is correct. We only track those children
who have had an initial placement or a change since 2001
basically, so any children who may have been in a home for
many, many years and did not have to come for an initial
assessment through us would not necessarily be in the program.
Now we've done some significant outreach working with the
agency to bring more in, but there is obviously a large group
of folks we do not have access to.
Senator DeWine. And I'm not finding fault with Children's.
Ms. Bowens. I understand that.
Senator DeWine. All I'm simply saying is, does that mean
that those children are not getting medical care?
Ms. Bowens. No, it does not mean that.
Senator DeWine. What does it mean?
Ms. Bowens. It means that we are not coordinating all of
their health care services and they then are left to kind of
navigate on their own. So the foster family may have to work to
get the Medicaid card, to schedule appointments. We are able to
kind of fully manage the care for these children.
Senator DeWine. Let me ask it this way then.
Ms. Bowens. Okay.
Senator DeWine. Would we all agree as a matter of public
policy that it would be better if those thousand were picked
up?
Ms. Bowens. Yes, and I think the agency would agree with
that as well.
Senator DeWine. Well, let me ask the agency. Does the
agency agree with that?
Ms. Goode. Yes.
Senator DeWine. Okay. Then why can't we get it done?
Ms. Goode. You're asking me--you started out by saying that
you didn't understand the contract between CFSA----
Senator DeWine. Yeah, and now I'm asking a different
question. Can you answer that question?
Ms. Goode. I know that's a contracting issue, and I don't
know the answer off the top of my head.
Senator DeWine. I'm not sure it is a contracting issue.
Ms. Bowens. No, it's not a contracting issue. Part of the
issue is that we need to do a better job of outreaching and
accessing the families, and being able to educate them that the
service is available to them. I mean, that is the largest
obstacle.
Senator DeWine. Well, my only point is, if we have decided,
you have decided that this is a good way to provide medical
care and you're doing it for four-fifths of these kids, why
don't you figure out a way to do it for the other fifth of
these kids? That's all I'm saying. I didn't devise the system,
I didn't say it was the best system, but it seems to me as an
outside lay person, you as the experts decide it is the best
system, and it seems to me it is the best system, it looks like
we have the experts here who are doing it, and why do you just
say we've got a fifth of these kids and we're just not going to
worry about them? And it seems to me, I worry about them. I
don't get it, why don't you worry about them?
Ms. Goode. And I simply don't know the answer off the top
of my head.
Senator DeWine. My only point is why?
Ms. Goode. I will be happy to take that message back.
Senator DeWine. Thank you. If these are the best folks that
we've got, and I think it's good you have a contract with them,
and I just think if we get the rest of these kids in the system
so they can get kind of the holistic approach to health care,
and we know it's good and it's particularly good with kids, and
we can get prevention in there and get somebody paying
attention to them, that's the way we want to treat these kids,
and if we're missing some of them, we want to get them into the
system. That's all.
Let me turn to Miss Egerton, if I could, and you made some
interesting comments, and I appreciate the fact that you said
that things are getting better. And I think that was, you put
it in perspective and I think those of us who can be critical
up here need to understand that, so I appreciate you saying
that.
But I am intrigued by some of the things you said, and I
want to read from your written testimony. You say, social
workers often invalidate our experience, and when it comes to
the right to make decisions, exclude, ignore and/or rebuff the
foster parent's input. I wonder given your vast experience, if
you can give me an example. And obviously, don't use names, and
obviously don't use anything that we could tie them to any one
person, but could you give me an example?
Ms. Egerton. I could give you some examples. One major
example is the fact that there is supposed to be these
administrative reviews that happen every 6 months, and in my
history of fostering, I think I have been to 2 or 3, in 12
years. And even, you know, as much as things have gotten better
over time, even recently, I have not been invited to an
administrative review.
Senator DeWine. Why is that, do you think? You know the
system as well as anybody.
Ms. Egerton. I know the system pretty well and I am not
sure if that is because they are not happening or if that is
because they are happening without me; either way it's a
travesty.
Another example, a very personal example would be, I have a
son who at 17 was having some very serious behavioral issues in
school, and we were putting him on restriction. And so his
social worker came in, and this is a child who I have been
parenting since he was 11 years old, who had been in 8 homes in
the 18 months prior to coming to me and was only supposed to be
there for a couple of days while they got a residential
placement for him, and he ended up there. And he's my baby
today, and he's aged out.
But he at 17 years old went through some serious stuff, and
his social worker just came in and said we were too strict, and
that he should be in an independent living program, he didn't
need the kind of restrictions we were putting on him. And I
said you cannot do that, he is not mature enough to cope with
the independent living programs that we have out there. And she
fought me, she won, she got him into the independent living
program. The moment he went in there, he went on a downward
spiral, he ended up in a psychiatric facility for an extended
amount of time. And when they did release him from that
facility, they would not release him back into an independent
living program. They called us and asked us if he could be
released back to us, and we would not take him back because of
the structure--or if we would not take him back, then they
weren't going to release him until they found a setting with
the kind of structure that he needed.
Senator DeWine. Well, at least they learned.
Ms. Egerton. But the fight was put up by the social worker
who did not see my son even once a month, okay? And I was
parenting him every single day.
Senator DeWine. So you had all your years of experience.
Ms. Egerton. And my husband and I were saying you cannot do
this, you cannot do this. We asked them for certain supports
for him. My son went down to his social worker, sat at her desk
and asked for certain support and said okay, I have some real
problems and I know it, and I have to get it together, and the
solution that they came up with was to put him in independent
living in spite of our protests.
And I think that that example, though I will point out that
that particular example did not happen under this
administration, it is a classic example of how absolutely
dangerous it can be to ignore the input of the person who is
parenting these children every day all day.
Senator DeWine. I think that's a great summary. I mean,
it's a scary thing. You also tell us that although this
incident occurred under a previous administration, the lack of
input in decisions about our children still continues.
Ms. Egerton. Absolutely.
Senator DeWine. And that's even more frightening. Why do
you think that is?
Ms. Egerton. In my position as an employee of FAPAC, and
also as an active member of a local foster parent support
group, I interact with a lot of foster parents going through a
lot of issues and they are brought to me constantly. Foster
parents will tell me that a particular child is therapeutic and
they need more services for this child, and they have a social
worker telling them that child is not therapeutic, you don't
know what you're talking about, we're just going to take the
child away from you. I can't tell you how many foster parents I
have had call me with that issue where the social worker just
absolutely rebuffs what they say their child needs, and they
feel that very often the social worker's personal feelings are
involved and that the social workers sometimes make judgments
about the underlying motivation for a foster parent requesting
more services for their child, yet you know, ultimately that
foster parent is just working toward a larger check.
And let me say that I have worked with some fabulous social
workers, so this is not a blanket statement to say that all
CFSA social workers are lousy, it's not that at all. I have had
some social workers use some of their skills to get me calmed
down in some situations, so my hat's off to them, there are
some wonderful ones. But there are still some social workers
out there who are not accepting the fact that we do know what
we're talking about and that when we say our children need
certain services, the answer is not to decide that you just
want to put yourself in a position to get more money for that
child. The answer is to hear what I have to say and to act on
getting those services for those children.
Senator DeWine. Do you think that sometimes the problem is
that they don't have those services?
Ms. Egerton. I think absolutely, I think sometimes the
problem is the services are not available, but I also think
that sometimes the problem is that the social worker doesn't
know that the services are available or have access to those
services for my child. I have been in situations where I have
known about services that would help my child and the social
worker did not, and I had to school that social worker. And I
know lots of foster parents, particularly those who have been
it a long time, who have been in that situation.
Senator DeWine. Mary?
Senator Landrieu. Is there an annual evaluation of foster
parents that is conducted by CFSA?
Ms. Egerton. We have to get recertified every year and we
have a support group that used to be called monitors, the
terminology for a support worker assigned to us who visits us
periodically throughout the year and regularly at yearly
intervals takes us through the motions of getting recertified,
so we go through all the clearances again and the medical
evaluations, we go through a stack of paper work discussing
what we can and cannot do.
Senator Landrieu. You have been through this evaluation
now, and as one of our outstanding foster parents, what would
you recommend to either streamline that process and make
everybody, save everybody a lot of time, but also get the job
accomplished? Because what we want, I think, the purpose is to
identify the foster parents who are doing a very good job and
recommend that they be continued, and then to eliminate those
that are not doing a good job. So, I don't know if you would
know how many foster parents are eliminated each year.
Ms. Egerton. I don't know.
Senator Landrieu. If anybody in the audience knows, I would
like to know, if possible, how many foster families are
eliminated every year through that evaluation process. And Ms.
Egerton, what would you recommend, one or two or three things
that could be done differently that would make that process
work better for you, better for the system, that you would like
to share with us?
Ms. Egerton. Wow, that's a good question. I think that for
one, if there were more consistent and regular interaction
between the social workers or the support workers and the
foster parents, it may be a lot easier for the workers to know
what kind of job we're doing. I think that maybe, you know--I'm
not really sure, honestly I'm not sure. I think that it would
probably be a good thing if we had some kind of evaluation
where they talk to us about our strengths and weaknesses, and
we talk to them about our strengths and weaknesses.
As it stands, we do, we are required to do a certain amount
of training all year, 15 hours of training throughout the year,
but what does not happen is nobody sits down with me and says
okay, here is what we see as your strengths, here are what we
see as your weaknesses, what do you think about that, what
training can we get.
Senator Landrieu. In all of your years of foster care, no
one has sat down and done that?
Ms. Egerton. No.
Senator Landrieu. And when they evaluate you as a foster
parent, do they focus on your parenting skills, your
relationship with the children, or do you find that their
evaluation is concerned more about, you know, the home, the
physical environment, or your recordkeeping capabilities, and
what kind of records you are required to show them year after
year after year?
Ms. Egerton. They very seldom come to my house, truthfully.
When I was trained I was told that I was required to keep a
list of the children who come into my home who are placed with
me, when they are placed, and their social worker. We are
encouraged to give social workers copies of children's report
cards, copies of health evaluations, although we don't get
written copies of health evaluations, just so you all know. And
any, you know, any other printed information we get, we are
encouraged to give our children's social workers copies of
that. I keep copies of it all. I keep a file on my children. I
don't know that I have ever been told beyond that list that I'm
supposed to.
Senator Landrieu. Have you had the same monitor every year?
Ms. Egerton. I had the same monitor for a very long time
and I recently, I think the last 2 years, I got a different
one.
Senator Landrieu. Can somebody in the audience tell me how
many monitors we have? We have 3,000 foster homes; how many
monitors do we have?
Ms. Sandalow. But I think it's important, Senator, that
CFSA does not monitor Maryland homes, that Maryland monitors
Maryland homes, and I think 60 percent of our children are in
Maryland homes.
Senator Landrieu. Of these 3,000 homes, for just homes
where D.C. children reside, how many of them are in the
District?
A Voice From Audience. About 250 homes.
Senator Landrieu. Only 250 homes are in the District of
Columbia, and the rest of the homes of those 3,000 are either
in Maryland or Virginia?
A Voice From Audience. No, we don't have 3,000 homes. I
will have to get back to you with accurate numbers.
Senator Landrieu. Mr. Chairman, I'm going to have to have
these numbers to do any of this work.
Senator DeWine. You will.
Senator Landrieu. Mr. Chairman, before this meeting is
over, someone has to take responsibility to provide at least to
me and to my staff an accurate accounting of the universe of
what children we're talking about. We would really like to
help, but we're having a very difficult time, and I don't want
to take the time in a public meeting, but in 24 hours I have to
have on my desk what the universe of the 8,000 children under
the jurisdiction of CFSA is, and I'm going to ask them to give
me this universe. How many children are under the jurisdiction
of the courts, how many do you have that aren't under the
jurisdiction of the courts? How many that are under the
jurisdiction of the courts are living in traditional homes, how
many are living in group homes, how many are living in
therapeutic homes, I think those are the three categories, and
if there's a fourth one, please add that. And of those homes,
where are the homes? Are they in the District of Columbia, are
they in Maryland, are they in Virginia?
And we need these numbers before we can sign off on--the
chairman and I agree that we spend--at least I spend half of my
time trying to figure out that's not the number, that's not the
number, and I'm tired of doing that. I want to focus on the
solutions to the problems. So being able to provide an accurate
list of that would be very illuminating to me, to begin with,
and I'm getting very different information. So with that said,
I have to have that in 24 hours, but this has been very
helpful.
One of the things we want to do is recruit more foster
parents in the District of Columbia. This is a major problem
that has been identified, and while I, and I think the chairman
believes that we have want to have regional cooperation, if
there are children who can be well placed in Maryland, we don't
want to deprive them of the opportunities to have placements
with relatives or good parenting homes just because they happen
to live outside the concentrated and very artificial district
that was created for totally other purposes, for the benefit of
the Nation, so we should not hold children responsible for
that, but to improve foster care to what some experienced
foster care parents do, and we could recruit more, do better
evaluations, et cetera, et cetera.
Ms. Egerton. I think that, if I can just say this, that if
we could retain more of our foster parents, your recruitment
efforts would be----
Senator Landrieu. Less than a third.
Ms. Egerton. Absolutely, because we would actively recruit.
Right now today, I have to say, I'm a little more willing to
recruit today than I have been in years. And I for a long time
absolutely refused to, and not only absolutely refused to
recruit, but had made up in my mind, when the children I was
fostering aged out, I was quitting, because the system was so
horrible and because I felt so unsupported and unappreciated.
As we see CFSA begin to give us the tools to do the things that
we need to quality parent our children, we will recruit for
you. I am a District of Columbia resident, have been my entire
life, I'm one of those few native Washingtonians, and I would
recruit. And I would guarantee that the people I bring in would
be just like me and would be great foster parents.
Senator Landrieu. That's what we want to hear.
Ms. Egerton. But you have to take care of some of the
issues that we are fighting. We must have care for our kids, we
must have adequate healthcare for our children, we must be at
the decisionmaking table for our children, and when those
things happen, we will go out and recruit.
ADDITIONAL SUBMITTED STATEMENTS
[Clerk's Note.--Additional submitted statements were
received by the subcommittee and are included here as part of
the formal hearing record. The statements follow:]
Prepared Statement of Senator Paul Strauss
Chairman DeWine, Senator Landrieu, and others on this subcommittee,
as the United States Senator for the District of Columbia I wish to
express my support for this Committee's examination of the D.C. Foster
Care System. The foster children of the District of Columbia deserve
quality care and service, services that can only be provided with your
support.
I respect the positions of all of the witnesses that are here today
and acknowledge the testimony they have given. When faced with the
challenge of reforming the Child and Family Services Agency not only
did they step up to make the changes necessary, they did so to the best
of their ability. However, it is the continuing need for change that
brings us here today.
Though we are all United States citizens, the residents of the
District of Columbia are not afforded the same rights as their
neighboring States. Therefore, we must rely on Congress to provide
needed support to the D.C. Foster Care System. Ideally, the District of
Columbia should not have to look to Congress for supervision. This is
just another example of the injustice the American citizens residing in
the District must suffer. While we will continue to fight to achieve
full rights as celebrated by those in surrounding areas, I urge you to
consider the needs of our D.C. Foster Care System as you would any
issue that affects your own constituents, including respect for local
sovereignty.
All Americans must care about all American children. However, we
must acknowledge the fact that to Ohio and Louisiana constituents the
D.C. Foster Care system is not a high priority. For that reason I
appreciate this committee taking the time to hear the needs of the
District of Columbia's Child and Family Services Agency. We must come
together and make effective judgments based on the needs of this
community, and despite the inconvenience of having to go through
Congress to make decisions about District spending, we welcome your
input on matters that affect the interests of our children.
Over the months since the end of Federal Court Receivership, the
District has made substantial progress in reforming Child welfare and
meeting the Federal Courts expectations. The witnesses who testified
here today, not only provided suggestions for improvement but also
justification to those suggestions. Several key issues must be taken
into consideration. The development of a team of social workers whose
primary goal is assessment and placement and an in-depth focus on
permanent one-time placements are essential. Additionally an extension
of the DC KIDS program as well as increased communication between
foster parents and social workers are resources that should not be
denied to the children of the foster care system.
In many foster care cases, the Child and Family Services Agency has
to make quick emergency placements. Often these placements are
disruptive to the child and the foster family. At times placements are
not available which can result in the child staying in group or intake
homes. Ideally, the Child and Family Services Agency would have the
funding available to create a team of social workers whose primary goal
is assessment and placement. This team of social workers would be able
to investigate different placements quickly in order to find the one
most suited to the child's needs. Kinship or extended family placements
can be more readily taken advantage of. In order to ease the transition
into a new home flexible funding would also be available for emergency
supplies such as beds, food, and clothes. These resources are
fundamental in ensuring that the foster child receives the best care
within the first few days of transitioning from the biological home to
the foster home.
Furthermore, the Child and Family Services Agency has a commitment
to ensuring that children grow up in permanent homes. These homes are a
necessary step in encouraging a healthy and normal lifestyle. They
should have the means to devote more time in keeping siblings together
and placing foster children with family members. Attention should be
focused on one permanent placement rather than moving children from
home to home. Foster children are taken from a traumatic home-life and
have to work to build trusting relationships with a new family only to
have to start all over again. The focus should be on finding the best
placement, not just on placement as quickly as possible.
The Children's National Medical Center already has a strong
foundation for quality health care being providing to the District's
foster children. With its DC KIDS program, foster children who have
recently been placed in foster homes are given premium health care.
However, the DC KIDS program does not help those kids who were placed
in foster care prior to 2001. The need to be able to reach those
children is great. With the development of the FACES program, a
computerized database of all foster children, medical records and
medical histories can be easily accessible to health professionals and
social workers. Often foster parents, social workers and medical staff
do not have adequate records that are needed for the care of the child.
The DC KIDS program should be more integrated with the FACES database.
This would not only enhance the DC KIDS program but would increase the
reliability of the Child and Family Services Agency. The foster
children of the District would receive quality care and there would be
accurate medical histories and data on record for the children in the
system.
The Child and Family Services Agency's commitment to bringing up
the services standard for all children can be met if the communication
between its social workers and foster parents was at a more productive
level. Currently social workers are overloaded with cases and are not
able to visit the children on a regular basis. They can not provide
important information, such as programs and opportunities, that the
foster parent and child can take advantage of because there is no time.
An increase in staff would not only solve administrative headaches but
could also lessen the workload on current social workers. Face-to-face
meetings should be arranged between social workers and foster parents
so that some sort of feedback session can be accomplished. Policy
changes frequently are not told to foster parents or even social
workers. These administrative hiccups need to end. Only with the
available resources can the Child and Family Services Agency become a
valuable asset to our community.
Senator Landrieu as you stated we would not leave a child involved
in a car wreck stranded without emergency care. So why do we continue
to leave the District's foster children stranded in this equally
critical time? The answer is a lack of resources. The District Foster
Care Services Agency must be given the resources it needs to take care
of foster children. Most children are taken from a hostile environment,
homes that can be both physically and mentally abusive. We need to do
all we can to ensure the next home is one that will promote a healthy
lifestyle so children of the next generation will not go through the
same vicious cycle. The Child and Family Services Agency has a deep
commitment to strong management and maximization of the quality of
care. They have dealt with strained relations among agencies,
increasing permanency placements, and have built a foundation of an
improving organization. Adequate resources are a critical part of
maintaining this momentum. The Child and Family Services Agency is on
the right path and as long as we continue to improve, the organization
will become a better place. Again I would like to thank Chairman
DeWine, Senator Landrieu, members of the subcommittee for listening to
the needs of the Child and Family Services Agency. I would also like to
thank the witnesses who gave testimony effectively expressing the
requirements necessary to care for the District's foster children. I
trust the members of this subcommittee will go out of their way to
ensure they have all the information that is required for this tough
decision. I look forward to further hearings on this topic and am happy
answer any questions. In closing, let me thank Ms. Adrianne Goffigan of
my staff, for her valuable assistance in preparing this testimony.
______
Prepared Statement of CASA of the District of Columbia
Children being abused, neglected or not receiving mandated services
while under court ordered supervision is an unacceptable crisis. When
children become lost in the system that was put in place to protect
them, the abuse of these children becomes an overwhelming tragedy. CASA
of DC, Court Appointed Special Advocates of the District of Columbia is
a nationally accredited program to ensure that no child gets lost in
the system. CASA of DC's mission is to recruit, train and supervise
volunteers from diverse cultural and ethnic backgrounds to assist the
court in protecting the best interests of abused and neglected children
by advocating for a safe and permanent home for every child. Our
mission is to provide stability and hope to abused and neglected
children by being a powerful voice in their lives. By matching trained
community volunteers with children under court supervision, we can
ensure that the needs and best interests of the foster children in the
District of Columbia are met and can improve the decision-making
ability of judges in the Family Court system by providing an
independent evaluation that is geared to the best interest of the
child.
CASA of DC, Court Appointed Special Advocates for children of the
District of Columbia is the ONLY accredited CASA program operating in
the District of Columbia. Not only is the program the only program
recognized and supported by the National CASA Association, the program
receives technical and financial support from National CASA. In order
to make CASA of DC the showcase program for the Nation, the program was
designed from the bottom-up to ensure strict compliance with the
National Standards established by Judge David Soukup in 1977. In 1990
with the inclusion of the CASA Program in the Victims of Child Abuse
Act, Congress affirmed the use of volunteers in the otherwise closed
juvenile court systems and made provisions for the growth of the CASA
volunteer movement nationwide. CASA of DC is also recognized and
supported by foundations such as the Freddie Mac Foundation, the Gannet
Foundation and Microsoft.
Because the Metro D.C. area is unique, CASA of DC is working in
collaboration with CASA programs both in Maryland and Virginia and have
formed a working group entitled ``METRO DC CASA COLLABORATIVE''. The
purpose of the group is to work together to address the problems of the
Metropolitan area in the areas of abuse and neglect. In addressing the
regional issues of child abuse and neglect, the Metro DC CASA
Collaborative is working to ensure that no child falls between the
cracks because of jurisdictional issues.
In the District of Columbia, the Child and Family Services Agency,
[CFSA] was removed from six years of Federal receivership established
by the U.S. District Court in 1995 under the LaShawn A. v. Williams
decree. However, social workers continue to carry large case loads and
do not have time to provide the detailed, one-on-one attention that
every child in the dependency system deserves. The office remains
understaffed and children are not receiving the much needed services
once they enter the system. Children continue to have multiple
placements, few visits from the social worker and even fewer sibling
visitations. Additionally, court orders are often times not
implemented. Children in the system spend a median of 3\1/2\ years in
foster care. Thirty-two percent of the children spend from 4-9 years in
foster care.
Under a court ordered plan by Federal Court under the LaShawn
decree, CFSA must meet specific performance measures including:
--Compliance with ASFA ( Adoption and Safe Families Act).
--Increased visitation: Increase the number of visits children
receive from their social worker. (As of 2/2003, children in
foster care were only visited monthly by their social worker in
one-third of the cases).
--Reduce the numbers of placements.
--Children should be placed in the least restrictive environment.
CASA programs fill the void left by an overburdened system. Social
workers and attorneys carrying large caseloads. In this jurisdiction
there remains a high staff turnover rate, so caseworker effectiveness
remains low. Because of budget cuts and low salaries, many
jurisdictions face serious difficulties in recruiting qualified
motivated caseworkers. We continue to see child welfare workers who are
overworked, have less time, and are doing a less effective job for
children.
A CASA advocate will only carry one case at a time and advocate for
all children in that family.
The CASA program, historically has proven to be able to:
--Reduce the number of children in foster care.
--Reduce the amount of time a children remain in foster care.
--Ensures that court orders are implemented so that the child
receives medical, mental and educational services.
In the District of Columbia, approximately 1,500 new abuse and
neglect cases are brought before the Family Court each year. This
compounds the number of children already in the system which is
approximately 4,000. The goal of the CASA of DC program is to have a
trained CASA advocate for every child in the system. Each volunteer
advocate represents one family representing approximately 1-3 children
per family ranging from birth to 18 years of age.
Why volunteers? CASA of DC trained and certified volunteers act as
a multiplier for professional program supervisors. Volunteers work on
only one case at a time. This one on one ability provides closer
monitoring than can be cost effectively provided directly by
professional staff. CASA volunteers focus gives them the ability to see
and do more on behalf of the children that they represent. CASA of DC
volunteers receive extensive, ongoing training and close supervision
from the professional program staff. By the very nature of their
``volunteerism'' they empower themselves through their commitment of
time and energy. They stay with the case from beginning to end and
serve the program an average of 30 months.
Volunteers are also independent of bureaucratic constraints that
often keep those employed by our local institutions playing by rules
that frequently are too rigid or outdated to serve the best interest of
the children in foster care. Certainly CASA volunteers do not work in a
vacuum. It takes the strong support and guidance of local program staff
to facilitate their work. Careful screening, training, supervision, and
retention are essential to assure high quality volunteer advocacy.
Although paid staff play an integral role in the coordination and
management of the program, the traditional role of staff does not
include routinely working cases. The CASA Advocate will have closer and
more consistent contact with the children than the social worker or the
attorney. Another reason to have CASA advocates is its cost-
effectiveness. It is certainly more cost-effective to have one staff
person coordinating 30 volunteers serving 75 children as opposed to one
staff person carrying 25 cases with 60 children. Still, cost-
effectiveness is only a small component of our commitment to the use of
volunteers.
Volunteers bring a much needed outside perspective to our court and
child welfare systems. Their lack of past experience in the system not
only brings a fresh perspective to what we do, it opens our doors to
the community and helps raise public awareness of the plight of our
community's abused and neglected children.
To a child, having a volunteer working for them can make all the
difference. Hundreds of children across the country have been moved
when understanding the notion, ``you don't get paid to do this?'' It
shows to them the level of concern and commitment being made by the
volunteer. No, it's not part of their ``job.'' Volunteers are ordinary
citizens, doing extraordinary work for children, and along the way
bringing such passion, dedication, and effort to their work. In the
period from January, 2003-March, 2003, over 463 volunteer hours were
given to the children of our community. The significant achievements by
the advocates for the children represented includes but is not limited
to:
--Finding and retaining proper school assignment,
--Obtaining clothing,
--Obtaining school supplies,
--Locating tutoring services,
--Requesting child support and follow up with court and family,
--Ensuring dental appointment completed,
--Helping with housing,
--Monitoring the appropriate placements,
--Helping parents locate substance abuse program,
--Requesting an IEP in compliance with court orders,
--Assisting in locating summer camps,
--Ensuring medical and dental appointments are kept,
--Assisting in preventing the expulsion of a child,
--Locating therapy for the children,
--Informing the court regarding improper group home facility,
--Locating Saturday classes,
--Locating dance school,
--Locating GED classes,
--Locating independent living skills programs,
--Locating vocational training programs,
--Locating summer programs,
--Locating mentoring programs,
--Locating after school care, and
--Locating a more compatible foster placement.
In 1988, CSR, Inc., under contract with the U.S. Department of
Health and Human Services, published the results of a study entitled,
National Evaluation of Guardians Ad Litem [CASA] in Child Abuse or
Neglect Judicial Proceedings. After analyzing five types of CASA models
the study found that:
``CASA volunteers are excellent investigators and mediators, remain
involved in the case and fight for what they think is right for the
child.'' The study concluded, ``We give the CASA models our highest
recommendation.''
As advocates for children, there are no phrases such as ``it cannot
be done'' because when it is in the best interest of that child, our
volunteers will zealously advocate for those interests no matter what
barriers come before them. There is a story about a man who was walking
on the beach and saw hundreds of starfishes dying on the sand so he
began to throw them into the sea one starfish at a time. Another man
was walking and saw the man's futile attempts to save the starfish when
he said to the man, ``You will never save them all.'' The man replied,
``Oh, but it does matter even if I save one starfish.'' And so, the
CASA program will continue to make a difference, one child at a time.
We thank the committee for allowing us to submit this written
testimony.
______
Prepared Statement of the Council for Court Excellence
The Council for Court Excellence (``CCE'') is an independent,
nonprofit, nonpartisan organization dedicated to improving the
administration of justice in the local and Federal courts and related
agencies in the Washington metropolitan area. While the Council for
Court Excellence is proud to have a number of judges among its active
and dedicated board members, it is important to note that no judicial
members of the Council participated in the preparation of this
testimony.
For more than 3 years, CCE has been privileged to work with the key
public agencies in the D.C. child welfare system--the Family Court of
the D.C. Superior Court, the Child and Family Services Agency
(``CFSA''), the Office of Corporation Counsel (``OCC'')--and others, to
reform the city's child welfare system so that every abused or
neglected child in the District of Columbia has a safe and permanent
home within the time frame established by the Federal and D.C. Adoption
and Safe Families Acts (``ASFA''). To assist the agencies in meeting
these goals, CCE has been tracking and measuring progress in child
abuse and neglect cases filed since February 1, 2000, the date the city
began implementing ASFA. In October 2002, we were pleased to issue a
public report summarizing the many early successes of the D.C. child
welfare system reform effort. This statement is intended to explain how
far the system reform effort has come and how much further there is to
go.
where we were
When CCE began its work with the agency leaders in late 1999, CFSA
was under Federal court receivership, relations among the agencies were
strained, and there was little awareness of ASFA's permanency
requirements. As reported on July 15, 1999, by the Federal court-
appointed Monitor of CFSA:
``Significant interagency issues remain unresolved . . .
Relationships between CFSA, the Office of Corporation Counsel, and the
Superior Court also remain problematic; each agency is highly critical
of the other's failings. OCC currently is understaffed to meet the need
for timely processing of abuse and neglect and termination of parental
rights petitions and CFSA's staffing and practice problems contribute
to friction between the agencies. The structure and resources available
in the Family division of the Superior Court make it difficult for the
court to provide timely legal action for children and families. (1998
Assessment of the Process of the District of Columbia's Child and
Family Services Agency in Meeting the Requirements of LaShawn A. v.
Williams, Center for the Study of Social Policy, July 15, 1999).''
where we are
Structural Improvements
There has been dramatic improvement since those early days. Perhaps
the most dramatic of improvements is CFSA's emergence from receivership
and establishment as a cabinet-level agency of the District of
Columbia. Other important structural reforms are: 1) the selection of a
new agency director, Dr. Olivia Golden, and a new management team; 2)
the agency's assumption of responsibility for child abuse cases in
addition to child neglect cases; 3) the publication of licensing
regulations for foster and group homes; and 4) the increased used and
usefulness of the agency's FACES data system.
Improvement in Agency Relations
There also is a new spirit of collaboration and cooperation among
agency leaders. CCE facilitates monthly ``Child Welfare Leadership Team
Meetings'' among the agency leaders, i.e., Dr. Olivia Golden, CFSA
director; Judge Lee Satterfield, Presiding Judge of the Family Court;
and Arabella Teal, Interim Corporation Counsel; and many others
including the leaders of the Department of Mental Health, the
Department of Human Services, D.C. Public Schools, etc. As trust and
communication among these leaders has grown, these meetings have become
more and more productive with team members identifying multi-agency
issues and setting-up work groups to address them.
For example, the enormous task of transferring to the Family Court
over 3,500 child abuse and neglect cases that were pending before
judges assigned to divisions outside the Family Court was accomplished
by a work group consisting of CFSA, the Family Court, the Department of
Mental Health, and OCC. Together they identified cases appropriate for
transfer and closure, and they prioritized the sequence for transfers.
In addition, CFSA is a member of several of the Family Court's multi-
agency committees on Family Court Act implementation. CFSA also is a
member of the Family Court's Training Committee which is organizing
monthly and annual interdisciplinary training sessions for judges,
social workers, and lawyers. It also is one of several agencies with an
on-site service representative in the Family Court's Service Center.
In addition to the monthly Child Welfare Leadership Team Meetings,
Judge Satterfield and CFSA director Dr. Golden meet on a regular basis
to discuss issues affecting both agencies. Together they worked out a
schedule that would allow social workers to spend more time with their
clients and less time in court. Relations between CFSA and the Family
Court are perhaps the best they have ever been.
Relations between CFSA and OCC have improved significantly. OCC
attorneys and CFSA social workers are now co-located at the offices of
the agency so that they may work more closely together in preparing
child abuse and neglect cases for court. What is more, OCC attorneys
are providing CFSA with legal representation in cases from filing of
the abuse/neglect petition through the permanency hearing stage. Before
the city made the commitment to increase OCC staffing, CFSA social
workers were represented only through the trial and disposition stages
of a child abuse and neglect case.
improvement in asfa compliance and measuring asfa compliance
The agency leaders have made steady measurable progress in
complying with ASFA and they are keenly aware of the need to track case
data to measure ASFA compliance. One of ASFA's most important
requirements is that a permanency hearing be held within 14 months (425
days) of a child's removal from home to decide the child's permanency
goal, i.e., reunification with family, adoption, or guardianship, and
set a timetable for achieving it. Data collected by CCE for cases filed
since 2000, shows significant and growing improvement with ASFA's
permanency hearing requirement:
COMPLIANCE WITH 425-DAY PERMANENCY HEARING DEADLINE \1\
[For Children Removed from the Home] \2\
------------------------------------------------------------------------
Compliance Rate
Year Cases Filed (percent)
------------------------------------------------------------------------
2000.......................................... 32
2001.......................................... 43
2002.......................................... \3\ [54]
------------------------------------------------------------------------
\1\ CCE's data is calculated through the third quarter of 2002 only. The
Court took over the responsibility of data tracking from CCE in the
fourth quarter of 2002.
\2\ 80 percent of children in abuse and neglect cases filed in the past
three years were removed from their homes. Thus, this data reflects
approximately 80 percent of child abuse and neglect cases filed in
each of these years.
\3\ We obtained this 2002 figure from the Family Court's first annual
report filed with Congress on March 31, 2003. The Court's permanency
hearing compliance rates for 2000 and 2001 were significantly higher
than CCE's. This 2002 compliance rate appears reasonable and more
reliable.
Data from the past three years also shows that the length of time
from filing of the abuse/neglect petition to trial or a stipulation has
decreased consistently. Indeed, data reported by the Court in its
Annual Report shows that the city is now in compliance with the trial
deadline established by D.C. ASFA, i.e., 105 days from filing of the
petition. The city also has made consistent progress in reducing the
amount of time from filing to disposition--the court proceeding focused
on remedying the conditions of abuse or neglect determined by trial or
stipulation to be true.
Through its FACES automated data system, CFSA has been successful
at compiling additional types of information that are relevant to
permanency. It tracks the number of entries into and exits out of
foster care, the reasons for exiting care, and the permanency goals of
children in care. It also tracks information on legal action toward
adoption and finalized adoptions. In an effort to improve communication
with the Family Court, CFSA has developed a function within FACES to
access information on the dates, times, and locations of court hearings
on child abuse and neglect cases. CFSA also is able to scan abuse and
neglect court orders into its FACES system. In addition, CFSA is one of
the most frequent users of JUSTIS, the District of Columbia's criminal
justice information system, which can be used, among other things, to
locate missing parents.
where we are headed
Much additional information is needed to properly monitor
compliance with ASFA. Because cases filed prior to 2000 are a large
part of the child abuse and neglect caseload, the city must obtain
permanency hearing information for these cases as it has done for cases
filed since 2000. Also, the city needs information on how many children
actually achieve permanency each year and how long it takes them to
achieve it. Indeed, the city should know how long it takes children to
achieve permanency for each permanency goal, i.e., reunification with
family, adoption, or guardianship. In addition, it will need
information on the rate of children re-entering the child welfare
system after the original petition is closed. This information is
essential to understanding and resolving the problems that delay
permanency.
Both CFSA and the Family Court are working to improve their
individual automated information systems so that they can access
information that will enable them to implement as well as monitor
compliance with ASFA. The Court's new automated system is expected to
be in place by July 2003. CFSA is revising its monthly data monitoring
as part of is plan to implement the final order in the LaShawn lawsuit.
In addition, the D.C. Mayor is working to create an automated system
that will integrate the individual systems of the Family Court, CFSA,
and the other child welfare agencies.
conclusion
While there is much more work to be done, the D.C. child welfare
system is on the road to reform. It is headed in the right direction
and is moving at a quick pace. We have witnessed extraordinary
commitment of the city's child welfare system leaders, including Dr.
Golden, over the more than three years we have been involved in their
work. We can now document improving performance trends, which make us
optimistic that in the future the city's abused and neglected children
will be better protected, better served, and will spend less time in
foster care.
We have attached a copy of the Council for Court Excellence's
District of Columbia Child Welfare System Reform Progress Report to
this statement.
______
Prepared Statement of Kate Deshler Gould, Esq., National Association of
Counsel for Children, Washington, DC Chapter
My name is Kate Gould. I am an attorney and a mediator. I am one of
about 250 attorneys who are appointed by D.C. Superior Court to
represent children, parents and caretakers in child welfare cases. I
have been doing this work since 1994 and have represented many children
in the foster care system over the years. In my work I interact daily
with the Child and Family Services Agency and advocate regularly for
children in the foster care system.
suggestion for improvement
I would like to share my perspective and some ideas for a plan that
could help to shorten the length of time children are in care and cut
down on multiple placements and failed adoptive placements. My
organization, the local chapter of the National Association of Counsel
for Children, is proposing the formation of a new type of mental health
clinic dedicated to the needs of foster children. It would serve the
children from the point of the traumatic removal through the closure of
the case, if necessary. It would be a resource for the child to work
together therapeutically to support reunification with the biological
family, as well as to promote stabilization of foster and adoptive
placements. It would save money in the long run by helping to stabilize
children and families sooner, enabling successful case closure at an
earlier date. Such a program is needed to replace the existing
patchwork system of delay, insufficient services and poor quality
services.
problems with current system
In order to present the proposed solutions, I first need to
describe the problems with the current system. The Child and Family
Services Agency uses a program called DC KIDS for all its medical
referrals, including mental health referrals. I have heard few
complaints about the medical functions of DC KIDS. The mental health
services provided by DC KIDS are another story.
Referrals for mental health services do not run smoothly. I have
cases where there are very long delays before a therapist is
identified. In one case, it took two months to identify a therapist.
After another two months had passed, I learned that therapy had not
begun because the therapist had met once with the children to do an
assessment, had to write a report, which then had to be reviewed by DC
KIDS in order for services to be set up. In this case, not only had
therapy been court ordered months before, but had also been recommended
in psychiatric and psychological assessment reports. I was calling and
threatening court action. The requirement for the therapist to assess
and report only served to delay the onset of badly needed services. I
worry about what the time frame would have been like without my
advocacy.
In another recent instance, a child for whom I serve as Guardian ad
Litem told me that in order to reschedule her therapy appointment, she
would have to contact DC KIDS. I checked with the social worker and was
informed that DC KIDS does indeed do the scheduling for psychotherapy.
This is an unnecessary encumbrance.
traumatized children benefit from mental health services
Psychotherapeutic services are not routinely offered as part of the
services to the children removed, and yet, are universally needed. As
the Guardian ad Litem, I routinely ask for court orders to provide
these services. I have even been in the position of having to file a
motion in order for therapy to be provided to a very needy child. These
are not services that should have to be court-ordered in order to
occur.
Children who are in foster care or placed with relatives frequently
exhibit many signs of emotional disturbance. They may be aggressive,
oppositional, anxious, very needy, and they frequently have low self-
esteem. The reasons are obvious. They have been removed from their
parent and their home. They may have been traumatized by physical,
sexual or mental abuse or neglect that has precipitated the removal.
Next, they are nearly always traumatized by the removal itself. I have
never had a child removed from his or her parent, no matter how
deplorable the abuse or the conditions of the home, who did not
desperately want to return to the parent. Further, because of their own
behaviors as a result of all this trauma, these children can be hard to
live with and frequently do things such as steal or damage property
which make them unwelcome in the foster home. Consequently, we see the
additional trauma of multiple placements. Sadly, some children never
recover from this trauma and spiral down into a life of residential
treatment or juvenile delinquency.
mental health services reduce placement disruption
If a child removed from his or her parent were guaranteed the
services of a licensed psychotherapist as soon as the case comes in, we
would have a better prognosis for adjustment to the foster home or
relative's home, making placement disruption less likely.
There are other critical points when availability of good mental
health services is crucial. Many children come into the system with a
background that suggests the possibility of developmental delays or
educational problems. The patchwork of services that now exists
provides uneven quality of psychiatric, psychological and psycho
educational reports. These almost routinely have to be court ordered in
order to occur, and very often there is delay in obtaining these
services and the necessary reports. This information is essential to
getting the help that these children need in order to address the
problems that may be identified.
Good mental health services are particularly needed upon removal
from the home and for the adjustment period of about the first 90 days.
In order to effectuate reunification of the child with the biological
parent, family therapy may play an important role. If efforts toward
reunification with the biological family are exhausted and the goal is
made adoption, the child will need support and therapy to help to
process feelings of grief and loss. Another critical point is when a
pre-adoptive family is identified, and the child and family need help
to establish trust, and to bond.
mental health services ease adjustment in adoption placement
I have had several cases where a pre-adoptive placement failed. It
is very sad to see a child removed from the home that all had hoped
would be that child's permanent family at last. In these cases, as
Guardian ad Litem, I have advocated for family therapy and supportive
services that simply did not exist. Child and Family Services certainly
does not have a program that routinely provides the kind of support a
family would truly need to adopt an emotionally fragile child from
foster care. In these sad cases of mine, the families have told me they
felt that they were left hanging with very little support to face this
enormous adjustment.
a clinic model would improve quality and availability of services
Even if DC KIDS were to improve its service model, another problem
exists. Well-qualified psychotherapists are not now widely available
for foster children in the District of Columbia. There is frequent
turnover among therapists, just as with social workers. I have had
instances in my cases of therapists not showing up for scheduled
appointments, dropping out of sight without a final session to give
closure for the child, and failing to return telephone messages from
the Guardian ad Litem or social worker. While in some of my cases, I
have had excellent therapists who helped the child tremendously, in
general the agencies which currently provide mental health services to
foster children in the District of Columbia are doing an inadequate
job.
The Agency's position is that they are limited for the most part to
providers who will accept what D.C. Medical Assistance pays. D.C.
Medical Assistance pays a very low rate, and as a result, we find rapid
turnover, and poorly qualified therapists. Licensed psychotherapists
who will accept payment from D.C. Medicaid are very hard to find.
Frequently after long waits for identification of a therapist, a child
is assigned an intern. The problem with interns is that they are on the
job for a short term, usually only a period of three or four months.
Part of the therapeutic process involves trusting and building a
relationship with the therapist. Children with behavioral difficulties
resulting from neglect, removal and multiple placements frequently are
diagnosed with attachment disorder, or at least have issues with
attachment. This means that they reject others so they will not suffer
rejection, which leads to huge behavioral problems in the foster home,
at school, and with peers. The last thing most foster children need is
a therapist who will leave after a short period of time.
separate medical services from mental health services
DC KIDS should separate out the mental health function from the
provision of medical services to the foster children, and a new agency
should be formed or contracted with to provide comprehensive mental
health services to the foster children of the District of Columbia. It
should have psychotherapists on staff who are licensed and well-trained
to work with children and families. Funds should be allocated to cover
salaries that are reasonable, which means significantly more than the
amount paid by D.C. Medicaid.
conclusion: a mental health clinic would be cost-effective
If funds for this purpose were reallocated from another function,
it would be cost-effective. A comprehensive mental health program for
foster children would save money by reducing the length of time spent
in foster care, and reducing the need for expensive services such as
residential treatment.
I appreciate your consideration of my suggestions.
SUBCOMMITTEE RECESS
Senator DeWine. We'll end on that very positive note. Thank
you very much for your commitment to the children, and we thank
all of you for what you do for kids. We will continue to hold
hearings on our foster care system, this was the second and we
will have more in the future. Thank you.
[Whereupon, at 11:27 a.m., Wednesday, May 14, the
subcommittee was recessed, to reconvene subject to the call of
the Chair.]