About three years ago I wrote an article published by The Imprint entitled “California’s Continuum of Care Reform – Will It Produce as Promised?”
So has it?
The goal of the Continuum of Care Reform (CCR) was to reduce group home placements by shifting foster youth to family-based services. There have been some modest accomplishments, but from my perspective, there is a long way to go to really achieve success.
The reforms have had some positive outcomes. First, California has seen a reduction in group home placements by about one-third since 2011. Second, all private providers are now required to be nationally accredited, creating a consistent, high bar for program evaluation, fidelity and monitoring. I believe the standards of accreditation requirements should also apply to counties providing direct services.
And finally, CCR implemented a standardized Child Family Team process for assessment, case planning and monitoring activities, basically eliminating unilateral decision-making. This process is definitely a best practice for youth and their families.
Unfortunately, CCR has also spent hundreds of millions of dollars creating a huge, unwieldy state bureaucracy, which is far from efficient or effective. For example, millions of dollars have been wasted to determine what assessment tools to use, when the state had already reliably used one for years, the Child and Adolescent Needs and Strengths (CANS). Millions more was spent developing the “Level Of Care” (LOC) rating system for assessing and placing foster children. Today, the LOC system has not been fully implemented, it is not a scientifically validated instrument, and nobody working in the field likes it – counties and providers alike.
Probably one of the most egregious misuses of CCR funding, nearly $200 million, has been for the Foster Parent Recruitment, Retention, and Support (FPRRS) program. It was a great idea, but went solely to the counties and not to the private providers. FPRRS should have been used to help create more Intensive Services Foster Care (ISFC) families to step down kids from group homes or serve as an alternative to group home placement.
ISFC is almost exclusively provided by private foster family agencies with few counties delivering the service, and basic county level foster parents are not equipped, or properly supported to work with very challenging behaviors. Consequently, we have a serious shortage of Intensive Services Foster Care-approved families, and no evidence that FPRRS funding had any impact on meeting this critical need.
But here is where CCR has really fallen short. Yes, there are fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care such as the Transitional Housing Placement Program, or basic-level foster care. Reality check: we still do not have a “reformed” foster care system that is effectively and uniformly serving foster children and youth. We still do not have critical services in place.
We have a substantial population of foster youth being under-served, creating real challenges at the county level. The need for my agency’s Transitional Housing Placement Program is soaring but the failure rate is higher than ever, without the financial ability to provide the services required. More salient, in the past year, my agency has had more than 160 incidents of putting children and youth with very disturbing behaviors in motel or hospital beds with 24/7 awake staff because the county had no other place for them: no group homes, no out-of-state placements, and no foster homes either.
Another glaring gap in CCR is that there was no accommodation for very disturbed, behaviorally challenging youth who need to be in “secure” psychiatric facilities. The accredited congregate care providers are not accepting these kids, or they are discharging them prematurely. Last month at the California Alliance conference, provider after provider gave testimony to state officials about youth who were unmanageable, assaultive and a risk to themselves or others. One large group care provider in the Los Angeles area is not continuing with its short-term therapeutic residential program because local law enforcement does not have the capacity to respond to the number of incidents which regularly occur at the congregate-care facility.
For CCR to really succeed, and I believe it can, there needs to be a far greater state investment. Allocate the funds to really develop Intensive Services Foster Care as a viable alternative to group care. Pay providers rates that cover their costs. Develop a rate structure for “professional” foster parents that will allow someone to be a full-time, therapeutic caregiver. Create a statewide system to serve severely emotionally disturbed youth in a secure setting.
And most importantly, begin investing in early intervention and prevention services to prevent the need for children and youth to go into foster care in the first place.
Jim Roberts is the CEO and founder of the San Luis Obispo-based Family Care Network and a 43-year veteran of human services.