In 2023, many child welfare agencies could face a public shaming, an organizational meltdown, or both, when it comes to young people in out-of-home care whose behavior is especially challenging.
I’ve spent time in at least a few states this year and no one seems to have identified the secret to manage this growing problem. Scores of kids are spending time in unlicensed homes, unregulated environments or places that are just not appropriate for their level of need. There is a great deal of hand-wringing, but honestly, this is our own form of institutional neglect. We have been kicking this issue down the road for several years, changing the conversation but not our behavior. In our present situation, self-reflection on how we’ve mismanaged this journey is as important a step as the destination.
The notion that things will improve significantly, without a radical change in our approach, is naive. We are caught in an undertow of circumstances that do not appear to be abating. COVID-19 has exacerbated the problems of hiring and retaining qualified staff; meanwhile, many states are forced to connect foster youth with a stretched-thin behavioral health system that has lost therapeutic options as nonprofit providers gradually withdrew from the scene.
We now have scores of younger children and teens floating in no-man’s land, many living in situations that reinforce the message that they are not valued. For the ones who survive this, the meaning and the memories will be astonishing.
This problem does not lend itself to a New Year’s resolution where we commit to doing better. Nor is setting an aspirational percentage goal of reduction in the number of children who have this same experience. We’re past that.
Some potential for improvement lies with the Qualified Residential Treatment Programs (QRTP) component of the Family First Prevention Services Act. But the successful development and implementation of QRTPs requires an unprecedented level of collaboration, attention to readiness, a substantial pool of willing providers who feel confidence in the public partners, a genuine place for consumer voice, and a trained and well-paid workforce.
That could all take time and in the interim, we are barely treading water. Caseworkers regularly spend their time transporting kids to temporary sites, with young people figuratively, literally and emotionally lost once they arrive there.
For almost three decades, advocates, philanthropists, the federal government, clinicians and researchers have warned us that group care is not a therapeutic, safe or healing experience for most kids. They’ve encouraged us to find alternatives to placement, work more closely with families and utilize intensive, wraparound services in the youngster’s own home and community. Others have demonized all group care and advocated for a reduction or freezing of any resources going to residential care providers. A number of experts have espoused an expanded use of therapeutic foster home settings or professional foster parents. Through all of this, group care providers lose their confidence and competence in expanding and innovating because the future looks uncertain.
Meanwhile, we’ve insisted on finding the ideal policies and practices, refusing to accept the reality that these are kids whose lives flow with a wide range of behaviors and reactions as they struggle to make sense of negligent or abusive adult caregiving. On occasion, their behaviors pose a threat to themselves and others, and the availability of family settings that can address those extreme reactions is limited. Because we have done such a poor job of multidisciplinary, community-based prevention, we reach these kids when it is too late. What if we dropped our need to have one right answer and agreed that there might be a few reasonable approaches?
Our system has coughed up a hairball of theories and policies that are more likely to fit our political perspectives and ideological convictions than what is realistically best for kids and their families. It’s a form of social service vertigo resulting in kids who act out aggressively or fall deeper into a depression that will last a lifetime. We continue these conversations as if there is a solitary path toward achieving what is the perfect solution for all kids; the “perfect” here being the enemy of good. In the meantime, kids move from one crisis to another.
After all these years of circular pontification, what’s the result? We still don’t have enough thorough, comprehensive and effective prevention services, especially for chronic neglect, for kids and families that include community partners. A better effort to prevent foster care or to support reunification would have kept many of the youth sleeping in offices from ever finding themselves in such a dystopia.
We don’t have enough team members to staff these programs, nor enough qualified to understand and treat those families experiencing toxic combinations of generational trauma, poverty, racism and hopelessness. Many of our staff have found a better life working at Costco or Amazon.
I’m thinking that there must be more effective, practical and compassionate approaches to supporting this relatively low number but high-need group of young people who require an extraordinary amount of deep-end resources. We owe it to these kids and families to get smarter and more decisive.
How can we glean a few lessons from our partners in related health and human service settings? What can business leaders tell us about how they manage big investments for small populations and how to scale up the right level of reward? Who from outside of our arena can shed a fresh light on these issues?
I’m hoping we move on this quickly because when January 1, 2023, 12:01 a.m. arrives, there will be kids in agency waiting rooms or in hotels or in unlicensed homes. If they are still there in 2024, someone really should call the hotline and report all of us.
Other news outlets don’t cover child welfare and juvenile justice like we do.
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