Stop the Merry-Go-Round

Sweeping changes are urgently needed in today's foster care system

Magazine Issue
July/August 2005
Stop the Merry-Go-Round

It’s the tragic irony of America’s foster care system that children enter it because they’re believed to have endured abuse or neglect at the hands of their parents, then, in the system designed to protect and care for them, they’re moved from home to home, school to school, caseworker to caseworker, and therapist to therapist. Instead of the stability they so need, the system offers what amounts to planned impermanence, leaving them isolated, disconnected, and vulnerable to further abuse and neglect, sometimes at the hands of foster parents.

Now two new reports are making clear the long-term cost of so much indifference and instability. The first report, from Casey Family Programs, finds that foster care “alumni” now in their twenties and early thirties are suffering from staggering rates of post-traumatic stress disorder (PTSD) and other mental health problems; high rates of unemployment, homelessness, and poverty; and low rates of college and vocational school completion. The other report, from the University of Chicago’s Chapin Hall Center for Children, finds that teenagers leaving foster care at 18, a requirement in most states, are ill-prepared to fend for themselves and have a tough time finding jobs, paying for housing and food, and securing medical care–a tougher time than their peers living in states that allow foster children to stay in the system until they’re 21.

“These findings are a wake-up call to the nation,” says Ruth Massinga, president and CEO of Casey Family Programs, a Seattle-based foundation that serves foster children and studies the foster care system. For the Casey report, researcher Peter Pecora and his colleagues reviewed case records of 659 foster care alumni in Washington State and Oregon and interviewed 479 of them. They found that only 20 percent of these young adults, now aged 20 to 33, were doing well–with a good education, good job, and decent income. Most were faring poorly, especially in terms of their mental health:

– More than 54 percent had had clinical levels of at least one mental disorder during the 12 months prior to their interview, and 20 percent had had three or more mental health problems.

– Some 25 percent had suffered from PTSD in the previous 12 months, a rate more than double that of war veterans, and more than six times that of the general population.

–  Rates of depression, anxiety disorders, and drug dependence were all at least double those of people of the same age in the general population.

The picture painted by the Casey and Chapin Hall reports is that of a system that’s largely failing its vulnerable charges. The young adults in the Casey study had an average of 6.5 home placements each as foster children–many were moved far more often–and 33 percent experienced additional maltreatment at the hands of an adult while in the system. “Add that all up and perhaps we shouldn’t be surprised by the high prevalence of mental health disorders,” Pecora says.

Robert, an 18-year-old who spent seven years in the foster care system and left last year at 17, puts it less diplomatically. “The system’s completely screwed up,” he says. “The system’s set up for failure.”

During his years in foster care, Robert stayed in more homes and had more caseworkers than he can remember. In just four years in San Mateo County, California, he had more than 10 different caseworkers. “My caseworker changed every two or three months,” he remembers. “I always had a new one. I didn’t know who they were, and they knew nothing about me.”

So what can be done about the seemingly intractable problems of this large, complicated system? How can the mental health problems of children in foster care better be served? The first step, says Paul Vincent, former director of family and children’s services for the State of Alabama, is to do less harm. During the years Vincent ran Alabama’s child welfare system from 1989 to 1996, his agency was a defendant in a class-action lawsuit that, among other charges, alleged that “children’s mental health needs weren’t met, and the system often made mental health problems worse,” he says.

To settle the lawsuit, Alabama agreed to make sweeping changes in its foster care system, including smaller caseloads, improved training of caseworkers so they could better evaluate the needs of families and children, greater involvement of a child’s extended family, less use of group placements, fewer moves for children, and quicker return of children to their parents’ home. Therapeutic foster care was established for the first time–and in family, not group, settings–by providing special training and greater compensation for therapeutic foster parents. Intensive in-home services were made available to birth parents and foster parents to help them manage children with serious behavioral or emotional problems.

But the biggest change was that fewer kids were removed from their homes in the first place: in the course of five years, the number of children in out-of-home placement dropped by more than 25 percent. These changes cost money, but not as much as might be assumed. “By reducing the number of kids in the system, we could divert more resources and devote them to additional home-based services,” Vincent says.

These changes made Alabama a national model of system reform, says Richard Wexler, executive director of the advocacy group National Coalition for Child Protection Reform. For him, the most significant change was the drop in foster care placements. “The only way to fix foster care is to have less of it,” he states.

Wexler contends that many children are unnecessarily removed from the homes of parents whose main offense is poverty. Foster care may step in, for example, when a mother, afraid she’ll be fired from her job, leaves her children alone for one day when her babysitter can’t come, or when a family loses its housing and ends up on the street. “These kinds of cases are far more common than the horror stories of brutally abusive or hopelessly addicted parents,” Wexler says. He argues that, according to some recent studies, “about 30 percent of America’s foster children could be returned home right now if their birth parents simply had decent housing.”

A few other states and cities, including New York City and Illinois, have made changes in their foster care programs similar to Alabama’s. But first, both went through what Wexler calls a “foster care panic,” when a child who’d been reported to the foster care system was brutally beaten or killed. New York and Illinois authorities initially responded to these tragedies by removing more children from their parents’ custody, but were eventually challenged in court and pressed to enact reforms. The most telling result of New York City’s reforms was a drop in the foster care population, from 41,000 children in 1996 to 19,000 today.

Such sweeping changes and major reductions in foster care placements are the goal of progressive reformers like Wexler and the public interest lawyers who are his closest allies. But while they pursue these big-picture changes, some therapists are trying to make a difference in the lives of individual foster children.

A few years ago, San Francisco psychologist Toni Heineman got concerned about one of the many ways the child welfare system causes instability and pain in the lives of foster children: having them receive therapy from interns who rotate every 9 to 12 months. Just as a child forms an attachment with a therapist, he or she is once again abandoned.

To address this problem, Heineman and a group of colleagues formed the Children’s Psychotherapy Project, which recruits therapists to donate one hour a week to work with one foster child indefinitely. Their guiding principle is simple: “One child, one therapist, for as long as it takes.” From its start in San Francisco, the group has spawned chapters in 12 counties around the country, recruited 100 therapists, and served about 200 children.

Heineman hopes that the attention now being focused on the foster care system will someday lead to big policy changes, like those in Alabama or New York. In the meantime, she’s working to help as many children as possible. “Maybe soon we’ll make a difference in the lives of 400 children,” she says. “Over time, it adds up and has an impact on the system, as people begin to think about the importance of long-term relationships in the lives of these children.”

Rob Waters

Rob Waters is the former editor of the men’s health channel at WebMD and a former contributing editor to the Psychotherapy Networker.