Foster Care: Agencies Face Challenges Securing Stable Homes for Children
of Substance Abusers (Letter Report, 09/30/1998, GAO/HEHS-98-182).

The number of children in foster care has nearly doubled since the
mid-1980s, and today about half a million children are in the foster
care system. The mid-1980s also marked the onset of the crack cocaine
epidemic. More recently, the use of other hard drugs, such as
methamphetamines and heroin, has been on the rise in some parts of the
country. Research suggests that the escalating use of hard drugs has
contributed to the growth in the foster care population, but little is
known about the effect that parental substance abuse has on how and when
children leave the system. Members of Congress have raised concern that
children whose parents are drug addicts or alcoholics may languish in
foster care for years before being placed in a safe, permanent home.
This report discusses (1) the extent and characteristics of parental
substance abuse among foster care cases, (2) the difficulties foster
agencies face in making timely permanency decisions for foster children
with substance-abusing parents, and (3) initiatives to achieve timely
permanency outcomes for foster children with substance-abusing parents.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-98-182
     TITLE:  Foster Care: Agencies Face Challenges Securing Stable
	     Homes for Children of Substance Abusers
      DATE:  09/30/1998
   SUBJECT:  Foster children
	     Interagency relations
	     Drug abuse
	     Drug treatment
	     Alcohol or drug abuse problems
	     Child custody
	     Child adoption
	     Parents
	     Alcohol abuse
	     Rehabilitation programs
IDENTIFIER:  Los Angeles County (CA)
	     Cook County (IL)
	     Orleans Parish (LA)
	     Illinois
	     California

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GAO/HEHS-98-182

Cover
================================================================ COVER

Report to the Chairman, Committee on Finance, U.S.  Senate

September 1998

FOSTER CARE - AGENCIES FACE
CHALLENGES SECURING STABLE HOMES
FOR CHILDREN OF SUBSTANCE ABUSERS

GAO/HEHS-98-182

Drug Abuse and Foster Care

(105827)

Abbreviations
=============================================================== ABBREV

  AFCARS - Adoption and Foster Care Analysis and Reporting System
  CASA - Court Appointed Special Advocate
  CSAT - Center for Substance Abuse Treatment
  CWLA - Child Welfare League of America
  DATOS - Drug Abuse Treatment Outcome Study
  DRA - Delegated Relative Authority
  FAS - fetal alcohol syndrome
  GPRA - Government Performance and Results Act
  HHS - Department of Health and Human Services
  LSD - lysergic acid diethylamide
  NIDA - National Institute on Drug Abuse
  OFR - Options For Recovery
  PCP - phencyclidine hydrochloride
  ProjectSAFE - Substance and Alcohol-Free Environment Project
  SIDS - sudden infant death syndrome
  TPR - termination of parental rights

Letter
=============================================================== LETTER

B-276627

September 30, 1998

The Honorable William V.  Roth, Jr.
Chairman, Committee on Finance
United States Senate

Dear Mr.  Roth:

Our nation's foster care population has nearly doubled since the
mid-1980s, leading to dramatic increases in federal foster care
expenditures.  Today, about half a million children are in foster
care,\1 and many of them have been in the system for years.  The
mid-1980s also marked the onset of the crack-cocaine epidemic.  More
recently, the use of other hard drugs such as methamphetamines and
heroin has been on the rise in some parts of the country.  Research
suggests that the escalating use of hard drugs has contributed to the
growth in the foster care population.  While we know that children
often enter foster care because of neglect associated with parental
substance abuse, little information exists on the effect parental
substance abuse has on how and when children leave the system.
Because of concerns about children languishing in foster care, the
Congress recently enacted legislation that places a greater emphasis
on adoptions for children who cannot be safely returned to their
parents in a timely manner.\2

Because of your concern that children whose parents abuse drugs or
alcohol may remain in foster care for long periods of time before
they are placed in a safe, permanent home, you asked us to provide
information on (1) the extent and characteristics of parental
substance abuse among foster care cases, (2) the difficulties foster
agencies face in making timely permanency decisions for foster
children with substance abusing parents, and (3) initiatives that
address reunifying families or achieving other permanency outcomes in
a timely manner for foster children whose parents are substance
abusers.

Data on the extent and characteristics of parental substance abuse
among foster care cases are limited.  To obtain such information, we
developed and administered a questionnaire that was completed by
caseworkers for random samples of foster care cases in California and
Illinois that were in the system as of June 1, 1997, and had been in
continuously since at least March 1, 1997.  Together, these two
states account for about one-quarter of the nation's foster care
population.  To provide information about the difficulties foster
care agencies might have making timely permanency decisions for
foster care cases involving parental substance abuse, we conducted
case studies of foster care programs in Los Angeles County,
California; Cook County, Illinois; and Orleans Parish, Louisiana.  We
focused on these three urban counties because they have large foster
care caseloads and large populations of substance abusers.  We
selected these particular counties because they provide a geographic
mix and have foster care laws or initiatives that address parental
substance abuse and permanency decisionmaking.  In each of our case
study locations, we interviewed foster care program and policy
officials, caseworkers, dependency court judges and attorneys, and
drug treatment providers.  At each location, we also reviewed the
files for a small number of foster care cases with different
outcomes, each involving parental substance abuse.  We conducted our
fieldwork in compliance with generally accepted government auditing
standards between April 1997 and June 1998.  Our scope and
methodology are discussed further in appendix I.  Appendix II
contains the questionnaire that we used to collect data on the extent
and characteristics of parental substance abuse among foster care
cases, and appendix III contains the survey results.

--------------------
\1 The term "foster care" in this report refers to all types of
out-of-home foster care for children to protect them from abuse and
neglect at home.  These placements include family homes (both
relative and nonrelative), private for-profit or nonprofit child care
facilities, or public child care institutions.  In Illinois, all of
these placements together are referred to as "substitute care."

\2 The Adoption and Safe Families Act of 1997 (P.L.  105-89) was
enacted on November 19, 1997.

   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

On the basis of our survey, we estimate that about two-thirds of all
foster children in both California and Illinois, or about 84,600
children combined, had at least one parent who abused drugs or
alcohol, and most had been doing so for at least 5 years.  Most of
these parents abused one or more hard drugs such as cocaine,
methamphetamines, and heroin.  Substance abusers often abandon or
neglect their children because their primary focus is obtaining and
using drugs or alcohol.  They also place their children's safety and
well-being at risk when they buy drugs or engage in other criminal
activity to support their drug habit.  Recovery from drug and alcohol
addiction is generally a difficult and lifelong process that may
involve periods of relapse.

Parental substance abuse makes it more difficult to make timely
decisions that protect foster children and provide them with stable
homes.  Foster care agencies face difficulties in helping parents
enter drug or alcohol treatment programs.  In addition, foster care
agencies and treatment providers may not always be adequately linked,
and as a consequence, close monitoring of parents' progress in
treatment does not always occur.  Finally, foster care agencies also
face several challenges when trying to quickly achieve adoption or
guardianship in these cases after family reunification efforts have
failed.

To accommodate children's need for timely permanency decisions, some
locations have launched highly collaborative initiatives, involving
drug treatment providers and sometimes the courts and other
organizations, to help parents obtain treatment for their addictions
and to closely monitor their progress in treatment.  In addition to
maximizing the prospects for reunification, these initiatives may
produce the detailed information about parents' progress in treatment
that judges need to make timely permanency decisions.  Some locations
are undertaking other efforts to better enable foster care agencies
to quickly achieve other permanency outcomes for children who cannot
be safely returned to their parents in a timely manner.  While not
designed specifically for foster care cases involving parental
substance abuse, such efforts may be useful in these cases.  For
example, concurrent planning is being used to reduce the time it
takes to achieve permanency by simultaneously working to reunify the
family and planning for some other permanency outcome should family
reunification efforts fail.  Some locations are also implementing
programs to encourage relatives of children in foster care to adopt
or become the legal guardians of these children.

   BACKGROUND
------------------------------------------------------------ Letter :2

Foster care laws and regulations have historically emphasized the
importance of both reunifying families and achieving permanency for
children in a timely manner.  Permanency outcomes from foster care
include family reunification, adoption, and legal guardianship.\3 The
Congress recently enacted legislation that places a greater emphasis
on adoption when foster children cannot be safely returned to their
parents in a timely manner.  Failing to secure a safe, permanent home
for foster children before they reach age 18--sometimes referred to
as aging out of the foster care system--can have damaging
consequences for their emotional stability and future
self-sufficiency.\4

Although federal law requires states to make "reasonable efforts" to
reunify foster children with their parents,\5 neither federal laws
nor regulations clearly define "reasonable efforts."\6 At a minimum,
the law does require states to develop a case plan with a permanency
goal.  When family reunification is the goal, the case plan must
describe the services--such as drug or alcohol treatment, counseling,
or parenting classes--that will be provided to help parents rectify
the problems or conditions that led to their children entering foster
care.  In order to evaluate the progress that parents have made in
complying with their case plan requirements, states are required to
hold court or administrative reviews every 6 months.  They also must
hold permanency planning hearings at which the judge must determine
whether to continue family reunification efforts or begin to pursue
some other permanency goal, such as adoption or guardianship.  In
determining if and when to end efforts to reunify the family, foster
care agencies and the courts must balance the goals of reunifying
children with their parents and meeting children's need for timely
permanency.

The Adoption and Safe Families Act of 1997 (P.L.  105-89) emphasizes
that a child's health and safety are of paramount concern by
specifying situations in which states do not have to make reasonable
efforts to reunify the family before parental rights can be
terminated.\7 This law also stresses the importance of securing safe,
permanent homes for children in a timely manner by (1) requiring
states to file a petition to terminate parental rights (TPR) if the
child has been in foster care for at least 15 of the most recent 22
months,\8 (2) shortening from 18 to 12 months the time period within
which a permanency planning hearing must be held,\9 and (3) providing
incentive payments to states for increasing the number of foster
children who are adopted.  This law also authorizes funds for
time-limited family reunification efforts.\10

Currently, data on foster care outcomes--including family
reunification rates--and length of stay in foster care are
limited.\11 A longitudinal study of foster care outcomes in
California found that, while 44 percent of children who entered
foster care in 1990 as infants were reunified with their families
within 4 years, 37 percent were still in care after 4 years.\12 This
study also showed that foster care outcomes vary by placement type,
age at entry, and ethnicity.  Data on how parental substance abuse
may affect the length of time children spend in foster care and their
outcomes are particularly limited.  However, Illinois reported that
the percentage of foster children who were reunified with their
families dropped between 1990 and 1995, which foster care agency
officials attribute to the "epidemic level of parental drug
abuse."\13 Parental substance abuse may also result in children
re-entering foster care.  The California study cited above found that
among those who were reunified with their families, 28 percent
re-entered foster care within 3 years.  This study found that
parental substance abuse was particularly common among cases in which
children had re-entered foster care.

Research suggests that children who spend long periods of time in
foster care, or age out of the system before a permanency outcome has
been achieved, may have emotional, behavioral, or educational
problems that can adversely affect their future well-being and
self-sufficiency.  A study of the title IV-E foster care independent
living program, which assists children in their transition from
foster care to self-sufficiency, found that about 2-1/2 to 4 years
after aging out of the system, 46 percent of foster children had not
completed high school; 38 percent had not held a job for longer than
1 year; 25 percent had been homeless for at least 1 night; and 60
percent of those who were female had given birth to a child.
Furthermore, 40 percent had been on public assistance, incarcerated,
or a cost to the community in some other way.\14

The Department of Health and Human Services (HHS) is responsible for
the management and oversight of federal programs providing services
to foster children.  HHS issues federal foster care regulations,
monitors states' compliance with them, and administers federal
funding.  Federal foster care funds are authorized under title IV-E
of the Social Security Act of 1935.  Title IV-E is an uncapped
entitlement program that reimburses states for a portion of the
maintenance cost for foster children whose parents meet federal
eligibility criteria related to their income level.  Federal
expenditures for the administration and maintenance of children
eligible for title IV-E funding increased from about $546 million in
1985 to an estimated $3.3 billion in 1997.  States and counties must
bear the full cost for maintaining foster children who are not
eligible for title IV-E funding.\15

Children are exiting foster care at a slower rate than they are
entering.  As a result, the foster care population nationwide has
nearly doubled since the mid-1980s, increasing from about 276,000 in
1985 to about 500,000 in 1997.  Following the advent of crack-cocaine
in the mid-1980s, cocaine use increased dramatically and reached
alarming proportions by the end of the 1980s.  Research indicates
that the "crack epidemic" may have contributed to the increase in
foster care caseloads.  We reported that, in 1991, nearly two-thirds
of foster children 36 months of age or younger in Los Angeles County,
New York City, and Philadelphia County combined were known to have
been prenatally exposed to drugs or alcohol.  Most of them were
exposed to cocaine.\16 Although research indicates that the number of
new crack-cocaine users is declining, chronic use among parents of
foster children is still common.

While crack-cocaine use is declining, the use of other hard drugs is
on the rise.  Methamphetamine use has been growing, particularly in
the West and Southwest, and there is a resurgence of heroin use
throughout much of the country.  Heroin's growing popularity may stem
from its sharply increased availability; decreased cost; and higher
purity level, in a form that does not need to be injected.  Both
crystallized methamphetamines and crack-cocaine are inexpensive,
smokable drugs that produce immediate and intense highs and increased
alertness.

In March 1998, we reported that major studies have shown that drug
treatment is beneficial, although concerns about the validity of
self-reported data suggest that the degree of success may be
overstated.\17 Nonetheless, substantial numbers of clients do report
reductions in drug use and criminal activity following treatment.
Research also indicates that those who remain in treatment for longer
periods generally have better treatment outcomes.  Methadone
maintenance has been shown to be the most effective approach for
treating heroin abuse.  Research on the best treatment approach or
setting for other groups of drug abusers, however, is less
definitive.  To date, there is no effective pharmacological treatment
for cocaine abuse, but studies have shown that several
cognitive-behavioral treatment approaches show promise for treating
cocaine addiction.  Little is known about the effectiveness of
treating methamphetamine addiction.

--------------------
\3 A legal guardian is someone who assumes legal responsibility for
the care of a child.  Parental rights do not have to be terminated in
order to establish a legal guardianship.

\4 Services to help these young adults become self-sufficient are
sometimes provided until they are 21 years of age.

\5 The Adoption Assistance and Child Welfare Act of 1980 (P.L.
96-272).

\6 The lack of a specific definition of "reasonable efforts" has been
a source of controversy, and allegations that the state has failed to
meet the reasonable efforts requirement have been used as grounds for
contesting permanency decisions.

\7 These include cases in which a parent has committed murder or
voluntary manslaughter or in which parental rights for another child
have already been involuntarily terminated.  This provision may also
apply, at the state's discretion, in cases of abandonment, torture,
chronic abuse, or sexual abuse.

\8 Exemptions from this requirement are allowed if (1) the child is
placed with a relative; (2) reasonable efforts to reunite the family
have not been made; or (3) there is a compelling reason, documented
in the case file, indicating why it would not be in the best interest
of the child to terminate parental rights at that time.

\9 While a permanency decision is not required at the time of the
initial permanency planning hearing, states are expected to submit a
permanency plan for the child at this hearing, for the judge's
approval.  The plan should reflect whether the permanency goal for
this child is family reunification or some other permanency outcome,
such as adoption or guardianship.

\10 These monies are available only during the 15-month period that
begins on the date the child is considered to have entered foster
care.

\11 The Department of Health and Human Services' (HHS) Adoption and
Foster Care Analysis and Reporting System (AFCARS), which is in the
early stages of implementation, requires states to report detailed,
case-specific information.  In the future, information on how
parental substance abuse affects the length of time children remain
in foster care and case outcomes may be available through this
database.  HHS will be using AFCARS data to track foster care
agencies' progress in meeting HHS program goals under the Government
Performance and Results Act (GPRA).

\12 Barbara Needell, Ph.D., "Permanence for Children Entering Foster
Care as Infants." Family Welfare Research Group, Child Welfare
Research Center, School of Social Welfare, University of California
at Berkeley.

\13 Child Protective and Child Welfare Services Fact Book, FY 1995,
Illinois Department of Children and Family Services, December 1996.

\14 A National Evaluation of Title IV-E Foster Care Independent
Living Program for Youth:  Phase II Final Report, Vols.  I and II
(Rockville, Md.:  Westat, Inc., 1991).

\15 The proportion of foster children who are eligible for federal
IV-E funding has increased from about 40 percent in 1985 to about 50
percent in 1997.

\16 Foster Care:  Parental Drug Abuse Has Alarming Impact on Young
Children (GAO/HEHS-94-89, Apr.  4, 1994).

\17 Drug Abuse:  Research Shows Treatment Is Effective, but Benefits
May Be Overstated (GAO/HEHS-98-72, Mar.  27, 1998).

   PARENTAL SUBSTANCE ABUSE IS
   PREVALENT AMONG FOSTER CARE
   CASES AND MAKES REUNIFYING
   FAMILIES EXTREMELY DIFFICULT
------------------------------------------------------------ Letter :3

According to our survey, most children in foster care in California
and Illinois had at least one parent with a serious and long-standing
substance abuse problem that makes recovery extremely difficult.
Most of these parents had been abusing drugs or alcohol for 5 years
or more.  About two-thirds of these parents had used one or more hard
drugs such as cocaine, heroin, or methamphetamines.  These hard drugs
are highly addictive and debilitating and can greatly diminish the
ability to parent.  These substance-abusing parents often neglect
their children because their primary focus is obtaining and using
drugs.  In addition, substance abusers often engage in criminal
activity that can threaten the safety and well-being of their
children.  Recovery from drug and alcohol addiction depends on many
factors, such as the substance abuser's readiness for recovery, and
relapse is common.

      PARENTAL SUBSTANCE ABUSE IS
      INVOLVED IN MOST FOSTER CARE
      CASES
---------------------------------------------------------- Letter :3.1

On the basis of the results of our survey, we estimate that about 65
percent of the foster children in California and 74 percent in
Illinois, or about 84,600 children combined, had at least one parent
who was required to undergo drug or alcohol treatment as part of the
case plan for family reunification.  (See fig.  1.) In about 40
percent of these cases in each state the father was required to
undergo drug or alcohol treatment, while the mother was required to
undergo treatment in over 90 percent of these cases in each state.
In about one-third of the cases involving parental substance abuse in
each state, either the father was deceased or his whereabouts were
unknown.  As a result, the mother was usually the focus of the foster
care agency's family reunification efforts.  Caseworkers in our case
study locations explained that fathers whose whereabouts are unknown
may not even be aware they have children in the foster care system;
and even if they are aware, they may never have been involved in the
care of their children.

   Figure 1:  Foster Care Cases in
   Which a Parent Was Required to
   Undergo Treatment for Drug or
   Alcohol Abuse

   (See figure in printed
   edition.)

Notes:  Percentages may not total 100 because of rounding.  About 30
percent of the fathers and less than 4 percent of the mothers in each
state were deceased or their whereabouts were unknown.  See also
tables III.1 and III.2 in app.  III.

Source:  GAO survey of open foster care cases in California and
Illinois.