One Size Does Not Fit All in Child Welfare Reform
There is no sadder day in America than when a single child experiences abuse or neglect in his or her family. The experience of abuse and neglect and the events that follow often needlessly tear families apart and negatively influence the trajectory of that child’s life.Unfortunately, for too many children, the response of our current child protection system is often too little, too late and the current deep-end federal financing of the system exacerbates this problem. Yet with increasing knowledge, we know that we can successfully intervene earlier and more effectively to keep children with their families or place them with relatives or unrelated foster parents so they can continue to live in a family setting. Most abuse and neglect in America is neglect, and if we intervene earlier and more successfully, we can correct the trajectory of a child’s life.
We all want children to have their behavioral health needs met in the community while they live in a family setting, whether that is with their birth family of foster family. And there are times a child only needs a brief stay in quality residential treatment to stabilize and return home. But just like a child with cancer needs hospitalization, without artificial time limits, there will always be children who need residential treatment. Their ability to access it should be based on comprehensive assessment, sound clinical judgement, and demonstrated progress. Without it, how can we expect them to get healthy and move on with their lives? Failing this, we will see these youth struggle, further decompensate in their communities, or end up in inpatient psychiatric hospitals. True parity does not treat mental and behavioral health differently than physical health. We don’t micromanage hospitalization for acute care needs of children in foster care, so why would we micromanage which children need quality treatment interventions, what they get, and for how long?
We need to understand to get from where we are today to where we want to get to go will require us to have more flexible federal financing that allows states to create more home and community-based behavioral health services and family supports, find more relatives for kids, recruit and support more foster families, and modernize child protection systems for the 21st century. These include working with today’s quality residential providers to right size their bed capacities and reposition their immense expertise for a home and community-based system of care.
I agree that the vast majority of children and youth who come to the attention of child protection can be provided the stability and treatment they require while remaining with in a quality and supported family setting. But, we must recognize that each child has unique needs, some children do require more intensive treatment, and child welfare cases are rarely simple. There can be no one-size-fits-all policy.
We need to do a better job of strengthening families before child protective services is ever called. When it is, we need to provide the services and supports that keep our children safe and cared for in their homes. We also need to confront the reality that too many children of color are being removed from their homes and placed in residential settings without convincing clinical reasons of why these decisions are deemed necessary. Addressing these considerations will allow us to use residential treatment for its intended purposes—as a critical, evidence-based behavioral health intervention for the children who most need it.
As a nation we have long focused on treating the symptoms of our child welfare challenges rather than the root causes. We need a plan that focuses on comprehensive system reform and aligns the regulatory and fiscal realities to ensure that child welfare agencies have the tools, resources, and flexibility to act in the best interest of the children whose lives we are impacting. A plan that is not driven by a very limited scope of policy mandates but rather one that offers incentives for doing the right thing and provides flexibility with measurable accountability across the key partners necessary for success so that child-specific decisions can be made to preserve and strengthen families and achieve lasting safety, permanency, and improved well-being for all children who are served by the child welfare system. We have been talking about this long enough, let’s get it done