March/April 2009 Issue

Fixing Foster Care — 5 Strategies for Change
By Nadine M. Hasenecz
Social Work Today
Vol. 9 No. 2 P. 30

There are more than enough horror stories about social workers discovering children who’ve been abused or neglected within the foster care system or—perhaps worse yet—reports of social workers who knew of abuse or neglect and failed to address or report it. The investigations will go on, and the details of these tragedies will be dissected.

But is there hope for change, and if so, what important strategies must be implemented? Social Work Today consulted foster care experts and, noting the recurring themes among their varied suggestions, gleaned the following five strategies for change.

1. Strengthen Families of Origin
A strategy experts firmly believe and urge as the first step before proceeding to other options in foster care is the need to strengthen families of origin. “I can’t underscore enough the urgency of getting focused on family work,” says Carol Wilson Spigner, MSW, DSW, the Kenneth L. M. Pray distinguished professor at the University of Pennsylvania School of Social Policy & Practice in Philadelphia and one of 16 individuals who served on the Pew Commission on Children in Foster Care, a nonpartisan group founded in May 2003 to recommend ways to improve outcomes for children in the foster care system.

It’s a mistake to separate the development of children from families, notes Tricia B. Bent-Goodley, PhD, MSW, LICSW-C, a professor and the chair of the Macro (Policy, Community, and Administrative Practice) Sequence at the Howard University School of Social Work in Washington, DC. She specifically points to the need to focus on maintaining the family of origin, suggesting that better funding for prevention would be a good start. Prevention has been proven effective, she stresses, even though comparatively foster care and adoption have traditionally been funded at higher rates.

Echoing Bent-Goodley on the funding irony is Sarah B. Greenblatt, ACSW, director of New Haven, CT-headquartered Casey Family Services’ Casey Center for Effective Child Welfare Practice, which is the direct services agency of the Annie E. Casey Foundation. “The way that the federal government has funded services has made it more possible for states to get funding for placement services than for family-strengthening services,” Greenblatt says.

“We must help to develop and sustain families who really want their children,” says Bent-Goodley, who coauthored “Meeting the Challenges of Contemporary Foster Care,” an article posted on The Future of Children, a Web site collaboration of The Woodrow Wilson School of Public and International Affairs at Princeton University and The Brookings Institution.

Furthermore, Greenblatt draws attention to the legalities of family-preservation matters. She notes that the law requires that every reasonable effort be made to preserve and strengthen a family while solving family problems that put a child at risk. “If a child needs to be placed in foster care, the reasonable-effort mandate is to reunify them in 12 to 15 months,” she says.

All social workers who have discussed family preservation and reunification stress that keeping a child in or returning a child to an abusive family situation is never an option. Preservation and reunification should not be pursued at all costs, they note, and are acceptable only when a child’s safety and well-being are ensured.

Greenblatt sees promise in strategies that bring nonabusive birth parents to the table and offer them a voice, even when a child does not remain in their care. “States are beginning to work inclusively with families by inviting them to planning meetings, decision-making meetings, and including them in mediation processes to determine who else could care for these children if parents can’t,” she says. “It’s limiting the role of the state, unless there’s absolutely no one else.

 “We [the foster care system] used to say, ‘Well, they don’t have any family, so we’ll keep them in foster care until they’re 18 and teach them how to become independent adults,’” she continues. “But children learn in families, not in independent living classes.”

2. Support Case Workers
Another priority is the support, development, and nurturing of case workers who serve in the foster care system. “We must pay attention to how we train and supervise the workforce,” says Spigner. “A good portion [of the workforce] on the front line across the country doesn’t have professional training. We ask them to make tough decisions. We ask them to go into circumstances where they can’t predict what’s going to happen.”

Bent-Goodley uses an analogy to elaborate on the circumstances encountered in social work and the quick thinking required. “What I tell my students is that what we [case workers] do is equally aligned to going into surgery,” she says. “A surgeon may go into surgery and find something different than what’s expected. You may get into a home and find something different there. It changes your response, and you have to come up with a new strategy.”

And when it comes to supervising case work, the experts make a distinction between what’s effective and what isn’t. “What tends to happen,” Bent-Goodley says, “is that supervision is focused on ‘Did you write your progress notes?’” When involved in a case that’s outside his or her area of strength—for example, the legal system—the social worker should be asked what types of support he or she requires, she says.

Experts also express the need to establish national competencies for mental health care providers working in foster care, postadoption, and related arenas. “We must build the capacity of the mental health care community to help these children. We don’t have the breadth and depth of mental health care providers in communities who can help,” says Debbie B. Riley, MS, executive director of the Washington, DC, metro area-based Center for Adoption Support and Education (C.A.S.E.), who is currently leading a national initiative to set standards of competencies. “You tend to have kids with the most complex needs being seen by the least experienced mental health care providers.”

Riley partially blames a fiscally driven mental health care system with inequitable service reimbursement rates. She explains that a less experienced clinician is more likely than an experienced clinician to accept a lower reimbursement.

“It’s necessary that there be competent treatment providers who understand what the foster care system experience has been for children and the techniques needed to be able to help those children,” echoes Greenblatt. “Competencies are needed to help services popping up around the country so that they know there’s a body of tested practice that they can ground their training around.”

For case workers, Bent-Goodley advocates for holistic, flexible, family-friendly support, not only for those affected by secondary trauma, but also for those simply struggling to balance work with their family lives. “Another key piece is respecting the fact that staff have families,” she says. “It can be such a paradox that they’re out having to work to save other kids, but they can’t make a commitment to pick up their own child from school.”

During her days as a child welfare agency administrator, Bent-Goodley implemented and witnessed firsthand the positive effects of “rejuvenation days,” in which a staff member could take a day off from work to relax and clear his or her head. “It helped in creating an environment where it was less stressful. There was a feeling that people were supportive and that management understands,” she says. “It required more of me, but I saw that it was more positive in that people were willing to do more because they were supported.”

Ultimately, she says, her creative work policies positively impacted not only workers but also clients. “We need to have a child welfare entity that’s willing to develop or implement these policies to test and see if it improves their child welfare outcomes,” she says. “People need to see the evaluative data.”

3. Educate the Public
A coordinated effort of professional organizations and schools of social work is needed to help the public understand the complexity of the foster care arena, maintains Bent-Goodley. “The public may hear one side of what’s happening,” she says, “and may not understand that we were looking at one issue, but when we came in [to the home or the situation], there were multiple issues, some of which we can’t control but are still responsible for.”

High-profile cases and negative media coverage give social work a bad name, Bent-Goodley says. Noting that the past year has been tough for child welfare in the Washington, DC, area, she says she has seen the lives of social workers turned upside down, even when they have no direct involvement in a particular case. “It’s so hard to encourage students to pursue social work when they can pick up The Washington Post and read the names of people [social workers], even though in the end, they are vindicated by the courts,” she says.

One way to help stem negative media coverage is to consult with those who interface with the media, such as public officials and politicians, about what is and is not acceptable to say about a particular case, especially when the case remains under investigation. “We need to start with educating them and getting the rules down about what is appropriate and inappropriate to discuss,” she says.

Another way to fight the stigma associated with foster care is to educate the public. Created by C.A.S.E. originally for use with adopted children, the W.I.S.E. Up! Power Book was recently adapted for use by children in foster care. It’s a workbook that empowers children and teens, helps them deal with obtrusive and offensive questions about their situation, and, ultimately, can help questioners develop a greater understanding not only about a particular child but also about foster care in general.

The book allows a child to decide on and practice responses to various scenarios. “For example, a teacher may ask a child, ‘Why didn’t you turn in your field trip permission slip?’ Does the child say, ‘My [social] worker’s on vacation’? Or someone might say, ‘I heard all foster children are sexually abused,’” Riley says. “A classmate might ask, ‘Who is that person that takes you out of the lunch room every day?’”

Each letter from the acronym in the book’s title represents an option that a child can choose to follow: “W” is for “Walk away or ignore what is said or heard”; “I” is for “It’s private, and I don’t have to answer it”; “S” is for “Share something about my personal story”; and “E” is for “Educate others about foster families.”

4. Help Children Deal With Unresolved Grief and Loss
Children languishing in foster care is not the problem that it used to be, thanks in part to the Adoption and Safe Families Act of 1997, which mandates the onset of permanency planning as soon as a child enters foster care. However, a drawback of swift placement has been that the long-term mental health care needs of this population are not being met. “As we’re moving children faster into adoption,” Riley says, “we’re not sticking around long enough to help them.”

Riley points specifically to unresolved grief and loss as a unique mental health care challenge of children in foster care and one that should be addressed by the system as a primary concern. “The kids are separated from their first families, separated from their friends, separated from schools, and separated from communities. They’re placed into new and different settings,” she says. “Nowhere along the journey do we spend time in helping children work through those significant losses in their lives.” She adds that the physical and sexual abuse experienced by some children in foster care is also a type of loss.

The grief experienced by a child who is removed from the care of a living parent is trickier to handle than the grief experienced by a child whose parent has died. Put simply, the child in foster care is unable to move forward. “It’s different than any other loss because of the ambiguity of the loss; it’s ambiguous in that there isn’t finality. With death, there’s finality,” Riley says. “In foster care, children carry with them this hope that they will be reunited with the birth family. It’s hard to grieve something that you can’t yet have closure with.”

Compounding the problem of unresolved grief and loss is the fact that children grieve differently than adults and often employ unhealthy coping strategies. “Children express grief behaviorally. They’re not just going to say, ‘I’m feeling depressed today because I’m thinking about my birth mother.’” Riley says. “They might act out in the classroom and get sent to the principal’s office, and nobody understands why.”

Inexperience regarding the complex and unique needs of a child in foster care, combined with inadequate reimbursement for mental health care services as mentioned previously, can lead to a tendency to misdiagnose and overmedicate children in the foster care system, cautions Riley. “It’s too easy to medicate a child for depression but not really get underneath as to why they’re depressed,” she says. “We have to be much more cautious about using psychotropic medications.”

Furthermore, the education of foster parents is paramount, as an overwhelmed foster family can mean that the foster parents end up relinquishing a child. “Foster parents need to know not to blame these kids when they have problems,” says Greenblatt. “At 17, 16, 12, they may still be working through what 8 year olds are working through.”

Continuing support is necessary as the child ages. As their thought processes change, middle and high school-aged children may begin viewing their origins in a different way, and episodes of acting out may increase. “As children get older, issues tend to resurface,” says Riley. “Families who adopt from foster care are seeking services five to seven years after finalization.”

5. Guide Children in Building Connections
When children feel anxiety about what’s going to happen to them and who’s going to be there for them—in essence, when they feel they don’t belong—it’s of the utmost importance to guide them in building connections. “Children tend to do better in their well-being—intellectual, emotional, social, health, and mental health—when they have connections,” says Greenblatt. For individuals in foster care to feel connected to the world as they grow into adults, they must first know from where and whom they came.

Whenever possible, an open relationship with the family of origin is encouraged so that children know about heredity, genetics, and how they became who they are. “We must make sure that children are not pulled from families unnecessarily and that we don’t cut them off from families just because those families put them into foster care,” Greenblatt says.

Encouraging significant nonfamily relationships can also be effective for a child’s well-being. Years ago, Riley says, C.A.S.E. developed LifeLines, a project to help children in foster care consider relationships with people with whom they’ve been connected at various times in their lives. “It could be their favorite teacher, coach, counselor, or third foster parent,” she says. “We want to show them that not everything is a loss. We help them to see that there are people in their lives that still care or can become more active in their lives.”

This connection-building process is an area where children need guidance, Riley cautions. “We must help the child to see it. The child may not have thought of that person as a strong connection,” she says.

Building relationships and connections is a strategy whose effectiveness cannot be denied. Says Greenblatt: “You just see a child all of sudden relax because they know they’re not alone.”

— Nadine M. Hasenecz is a Bethlehem, PA-based freelance writer.