Statement of Mary Nelson, Administrator, Division of Child and Family Services, Iowa Department of Human Services

Testimony Before the Subcommittee on Income Security and Family Support
of the House Committee on Ways and Means

May 15, 2007

Good morning, Chairman McDermott, Congressman Weller, and members of the subcommittee.  I am Mary Nelson, administrator of the Division of Child and Family Services for the Iowa Department of Human Services. In this position, I have responsibility for program and policy in child protection, foster care, permanency, and adoptions as well as child care regulation, juvenile institutions, delinquency programs, dependent adult protection, teen pregnancy prevention, child abuse prevention and family support and the interstate compacts for children, juveniles and medical assistance and adoption. I am also a current member of the National Association of Public Child Welfare Administrators (NAPCWA), an affiliate of the American Public Human Services Association (APHSA), and am here today in that capacity as well. APHSA is a nonprofit, bipartisan organization representing state and local human service professionals for over 76 years. NAPCWA, created as an affiliate in 1983, works to enhance and improve public policy and administration of services for children, youth, and families. As the only organization devoted solely to representing administrators of state and local public child welfare agencies, NAPCWA brings an informed view of the problems facing families today to the forefront of child welfare policy.

I appreciate the opportunity to testify before this subcommittee about the challenges facing the public child welfare system in serving children and families who have come to our attention. With over three decades of experience with the Iowa Department of Human Services, beginning as a caseworker, I have seen, experienced and worked to address the many challenges the child welfare system has and continues to face.

BACKGROUND

APHSA members appreciate the Subcommittee’s attention to one of our nation’s most critical and heart wrenching struggles – what we can and should be doing to improve the lives of children who are at-risk of being or have been abused and neglected.  The latest data released by the federal government indicate that in 2005, an estimated 899,000 children were found to be victims in this country.  The child welfare system serves as the safety net for these children and works to improve their life circumstances and outcomes. 

Core Work of the Child Welfare System – A Skilled and Supported Workforce

Child welfare professionals courageously work in one of the most challenging professions in this country. The jobs performed by caseworkers have become more complicated as the challenges faced by families in the child welfare system have become increasingly complex. An enormous responsibility is placed in the hands of caseworkers as they are expected to perform multiple interventions and make judgments that have the power to change a child’s life. Their findings can determine whether a child is kept safe or put at risk. The connection that caseworker can make is greatly impacted by the competencies they can acquire and build through effective training, available tools including the array of services to which they can link families and on-going support.  This subcommittee acknowledged this core element of child welfare work in the recent reauthorization of the Promoting Safe and Stable Families program with the requirement for monthly visits in ninety percent of foster care cases.  States agree with the importance of face-to-face visits as is demonstrated by requirements in many state child welfare policies and in the results of the first round of the Child and Family Services Reviews (CFSRs) where both visits with children and with parents were strongly associated with a decreased risk of harm to the child; improved permanency and enhanced child well-being.  However, the resources needed to meet this goal have not been sufficient given that less than 25% of states received a rating of strength on the worker visits items in the CFSRs.

Additionally, child welfare supervisors play a vital role in providing support, skill building, and professional development to caseworkers. Supervisors are coaches, mentors, and evaluators responsible for the quality of services children and families receive. A supported, skilled, and stable workforce is crucial in child welfare practice given the tremendous impact caseworkers can have on helping vulnerable children and families overcome difficult life circumstances. Training, workload, risk of violence, supervision, and turnover present great challenges to providing the needed workforce supports in this field. However, there is the opportunity to build on the level of motivation and the level of dedication among the child welfare workforce which are incredible assets that can contribute to meaningful and sustained improvements. A key to improving the workload for caseworkers is to ensure access to other human service systems that can help provide the services needed by children and families.  

Iowa’s Challenges

The issue of an adequate workforce of frontline child welfare caseworkers is one of the most significant challenges we face in Iowa in terms of meeting the requirement for monthly visits.  In our first CFSR, we found that we were only meeting that requirement with ten percent of the children and 23% of families we served.  We worked diligently in our Program Improvement Plan to reduce the workload of our frontline child welfare staff in order to make improvements in this area.  Although not where we want to be ultimately, I'm pleased to say that we are now doing monthly visits with just over 50% of the children we serve.  I'm also pleased to say that we are seeing the positive results of this effort in terms of improved relationships with children and families, workers being better prepared for Court, and better outcomes.  Our staff are also reporting higher satisfaction in being able to spend more time directly working with children and families. 

Iowa has also struggled with having an adequate number of trained supervisors.  As noted, frontline supervisors play an essential role as expert consultants to our frontline staff as they make the critical decisions expected of them.  We have been fortunate to receive two federal grants focused on recruiting, training and retaining child welfare supervisors.  As a result, we have been able to strengthen the skills of our supervisors as coaches and mentors.  We've also been fortunate to receive funding from our state Legislature to hire additional supervisors. 

Despite the progress we’ve made to date, we do not currently have the staff complement to reach 100% of the children we serve.  New flexibility in the use of federal funds to support these frontline staff – caseworkers and supervisors – would help us to continue to make progress to reach this goal.

Cross-system Collaborations

The child welfare system cannot do its work in isolation because we cannot address the complex needs of children and families, and achieve improved outcomes for children and families alone.  Cross system collaboration is critical both in terms of addressing the multiple needs of at-risk families in order to prevent abuse and neglect, and in terms of addressing the complex needs of the children and families that come to the attention of the child welfare system.  Child protection is often the final safety net for many of the children and families that were not "caught" in time by other systems, such as mental health, housing, public health, or education.  By working together, child welfare and other systems can strengthen families and prevent the need for child welfare system involvement.

For those children and families that do come to the attention of the child welfare system, cross-system collaboration is necessary to address the multiple challenges these families face, as well as the trauma of family violence.  The Children's Bureau’s CFSR findings indicated that in 86% of states, key services for parents are lacking (e.g., substance abuse assessment and treatment, child care, respite care, transportation, domestic violence services, home-based services, housing, and post-reunification services).  Addressing these issues is often integral to reunification and the ability of a family to care properly for its children. Collaboration and partnerships must be developed and continued with all of the critical agencies that can provide services to children and families who have come to the attention of the child welfare system. The system has increasingly been contending with crosscutting challenges impacting the lives of children and families including unmet medical and mental health needs, educational challenges, substance abuse, housing challenges for both families and older youth exiting foster care, and domestic violence. 

Obstacles to truly connecting the supports these families need remain today.  The items

that were least likely to be rated as a strength on the CFSRs pertained to assessing and meeting service needs and meeting children’s mental health needs.  Waiting lists for services, particularly substance abuse treatment services, were found in 69% of states.  The funding provided in the reauthorization of the Promoting Safe and Stable Families program for substance abuse partnership is a step in the right direction, however, not all states will receive grants to enhance their capacity to address this issue.  Numerous families that come to the attention of child protection have unmet mental health needs. Private health insurance limitations, an inadequate supply of services, and limited resources have all impacted the access to mental health services for both children and parents.  This concern is reinforced by the findings in the CFSR that in 71% of states there is a lack of mental health services for children, and in 77% of states the number of dentists/doctors willing to accept Medicaid is not sufficient to meet the need.  Recent limitations on the ability of states to use Medicaid Targeted Case Management funds and upcoming changes to the Medicaid Rehabilitation Option will greatly diminish the federal government’s role in partnering with states to meet the on-going health and mental health needs that must be addressed to improve outcomes for children and families involved with the child welfare system.

We have seen cases where the lack of adequate housing can lead to overcrowded conditions that cause high levels of stress and can ultimately lead to the maltreatment of a child.  Educational outcomes for children in foster care are lower than those of the general population.  Simplification of records transfers and access to wrap around educational services to ensure foster children don’t fall behind in school during placement moves is critical.  We will look to opportunities to address these issues in the Congressional reauthorizations of the McKinney-Vento Homeless Assistance and the No Child Left Behind Acts. 

These examples serve to highlight how systems must work together to better address the varied needs of families and how the federal government must continue to be a true partner in ensuring these services reach the children and families most in need.  Although the CFSR findings indicated that less than one-half of the states achieved substantial conformity with the systemic factor of service array, it also showed that more than one-half of the states were found to be effective in individualizing services to meet the unique needs of children and families.  If these systems can be brought together to enrich the array of services available, child welfare systems have shown that they do have the ability to connect children and families to the supports they need.

Iowa’s Challenges

With respect to our experience in Iowa, I want to focus on the challenge of ensuring that children in foster care have their educational needs met.  Our youth council, Elevate, which is made up of current and former foster care youth, has identified educational issues as the number one issue they want to address in the upcoming year.  Based on a study done through Chapin Hall, we found that over one-third of children that "aged out" of foster care in Iowa have had 5 or more school changes, nearly half reported having spent at least some of their educational experience in special education, 18% missed at least one month of school due to foster care change, and over half could not read at a 7th grade level. About a third had repeated a grade, and more than two-thirds had received out-of-school suspensions.  While Iowa's CFSR final report indicated we were making appropriate efforts to assess and address children's educational needs, we can and must do better than the Chapin Hall findings.  In an effort to turn these outcomes around, the Iowa Departments of Human Services and Education have signed a Memorandum of Agreement identifying a set of concrete steps we will take to address these issues.  In 2006, the DHS also used state funds to implement the Preparation for Adult Living (PAL) program, which provides continued support to youth that "age out" of foster care that are continuing their education or working.  Iowa has also taken advantage of the Medicaid option for youth that age out of care.  And, this year, the Legislature appropriated additional state funds for a post-secondary education tuition waiver program that will supplement the Chafee Education and Training vouchers. Support from Congress can help states address these and other cross-system collaborations.

Another important area where cross-system collaboration plays a key role is prevention of abuse and neglect.  In Iowa, we have implemented an initiative, Community Partnerships for Protecting Children, that brings together child welfare, substance abuse, mental health, housing, education, public health, corrections, the faith community, businesses, and local neighborhoods to work together to develop neighborhood based supports that address the multiple needs of vulnerable children and families. 

Supporting (Birth, Foster, Kin and Adoptive) Families

The child welfare system cannot succeed without the partnership with all of the families who care for abused and neglected children – birth families, foster families, kin, and adoptive families.  A state or local system cannot provide the nurture and care that these families can provide, with the necessary supports and services from the child welfare system. The CFSRs showed that a key challenge for many states is having a sufficient number and type of placement options to ensure that a child’s out-of-home placement is based on appropriateness rather than availability.  Once those placements are found, they must all receive the supports needed for the children in their care. 

The majority (54%) of children in foster care were reunified with their families in 2005.  In these instances, child welfare systems may have met the challenges of providing the family with the necessary services to improve their lives to a point of warranting reunification.  However, states currently lack the resources necessary to provide continued services and supports to ensure children don’t re-enter the foster care system.  Reunification cannot be the end goal; rather, the focus must be on keeping children with their families whether it be prior to a removal or after a reunification.  The Children’s Bureau’s analysis of the CFSRs indicated that more than 60% of child welfare agencies were not able to provide sufficient and/or adequate post reunification services and only half were able to meet the national standard for re-entry into foster care.

Recruiting and retaining foster parents, particularly for older youth and children with special needs, poses an on-going challenge for child welfare systems.  It is not always an easy decision for families to take on the important work of caring for children who have experienced difficult home situations.  They must be commended and supported for the incredible role they’ve agreed to fulfill. 

Relatives and other caretakers known to the child often step in when a home is needed for a child who has come to the attention of the child welfare system.  These caretakers, often grandparents, do not necessarily have the resources to provide the care needed for children who have been removed from their homes.  Child welfare systems face the challenge of a declining federal role, given federal regulatory definitions and recent legislative changes, in providing the resources needed by relatives.  Child welfare systems also struggle with providing supports to kin and kith who are willing to provide children with permanency thorough guardianship.  The federal role in supporting this permanency option is currently lacking. 

In 2005, over 51,323 children were adopted from foster care. Adoptive families are essential for children who are unable to return to their family of origin.  However, on-going supports are necessary for these families as well in order to ensure they can continue to care for the children they’ve taken into their family.  Post-adoption supports through the adoption assistance program continue to decline as the Title IV-E eligibility link to 1996 standards erodes over time.  While more federal support is needed for post-adoption services, there currently is no federal support for any of the other post-permanency options that can also lead to positive outcomes for children such as guardianship and reunification.  

Iowa’s Challenges

In Iowa, almost forty percent of foster care placements are with relatives.  Many of these relative caretakers, however, choose not to become licensed as foster parents.  As a result, even though they have met the same safety standards as licensed foster parents (e.g., child abuse and criminal record checks, and home inspections and studies); they are not eligible for federal financial support through Title IV-E.  In Iowa, we also now have more children in subsidized adoption than we do in foster care placements, in fact, almost fifty percent more.  Thankfully, the vast majority of these benefit from federal support through Title IV-E.  Due to the link to 1996 eligibility standards, however, that percentage is declining.

Historically, Iowa has had few families able to provide permanency through guardianship, in part, due to the lack of federal support through Title IV-E.  Recently, Iowa received one of the last Title IV-E waivers for subsidized guardianship.  We began our program in February of this year, and look forward to being able to offer post-guardianship support through this program.  While we are grateful to have this opportunity, offering this program through a waiver means that only some children can benefit since we must maintain a "control" group that cannot receive a subsidy.  Including guardianship subsidy within Title IV-E would mean that all eligible children for whom another permanency option is not possible could achieve permanency through guardianship.  This is especially important for older youth in care who might otherwise "age out" of foster care with no permanent family connections. 

Lastly, I want to note that in Iowa, as is true nationally, well over half of the children that exit foster care are reunited with their families.  Providing post-permanency support for birth families is critical to maintaining these placements, just as it is with adoption and guardianship.  While Iowa has made significant improvement in reducing our foster care re-entry rate from twenty-two percent three years ago to ten percent, we still need to do a better job of supporting children and families after they leave care.

Disproportionality

The issue of disproportionality in child welfare has received the attention of child welfare administrators across the nation.  The scope of the issue includes differing experiences and/or outcomes for children in the child welfare system based in some part on racial or ethnic factors.  Child welfare agencies are struggling to identify effective strategies that accurately identify where disproportionality is manifested within public child welfare systems and to positively impact outcomes by addressing issues at the individual and systemic levels.

Although the federal government found no relationship in the first round of the CFSRs between the percentage of white children in the state’s foster care sample and the state’s ratings for the outcomes, there were indications in the analyses that African American children and Alaska Native/American Indian children were more likely to be in the foster care case sample than in the in-home case sample. It is our understanding that Congress has begun to pay attention to this issue with Representative Rangel requesting a GAO study.  We look forward to discussing this challenge further once that study is released.

Iowa’s Challenges

In Iowa, the Department of Human Services identified disproportionality and disparate outcomes in child welfare as a critical issue in our recent redesign of our child welfare system.  As a result, we have implemented two demonstration projects - one in Sioux City focused on Native American children and families, and one in Des Moines focused on African American children and families.  Both projects focus on expanding community based culturally competent services, improving family engagement, and cross-systems collaboration.  Although progress is slow, in both cases we are seeing improvements in our work and in outcomes for children and families.  In fact, Sioux City was recently recognized by the Center for Community Partnerships in Child Welfare as one of 10 jurisdictions to watch in terms of addressing this issue.

CONCLUSION

The challenges outlined in my testimony are but a few of the many in a system that impacts every aspect of a child and family’s life.  Given that my testimony before you today is not considerably different from the one I presented in January 2004 and that the Government Accountability Office recently reported the long-standing challenges the system continues to face, we must do something drastically different in this country about child welfare.  Addressing only the challenges I’ve outlined in this testimony simply is not sufficient.  Abused and neglected children deserve a comprehensive approach to improving their lives. 

For the past several years, various national groups have come to Congress asking for reform of the federal child welfare financing structure; each with their individual recommendations for reform.  Though there was a good deal of overlap in the reform proposals, it may not have appeared as if there was consensus.  Therefore, APHSA joined with a group of national organizations that worked for more than one year to develop recommendations in order to come to Congress with one voice in asking for help in meeting the on-going challenges faced by child welfare systems throughout this county.  The recommendations outline changes needed to ensure access to broad range of services and supports – including prevention, treatment and post-permanency and other services – for children who have come to the attention of the child welfare system.  Today, APHSA, the American Federation of State, County and Municipal Employees; Catholic Charities USA; the Center for Law and Social Policy; the Child Welfare League of America; the Children’s Defense Fund; the National Child Abuse Coalition; and Voices for America’s Children, propose recommendations that cover three primary areas of reform:

1.      Guaranteeing services, supports and safe homes for every child who is at-risk of being or has been abused or neglected by strengthening the federal-state child welfare partnership by amending the federal Title IV-E statute to do the following without converting any of the Title IV-E to a block grant

2.      Promoting program effectiveness

3.      Enhancing accountability

Although several bills have been introduced in this Congress that would address some of the challenges facing the child welfare system, comprehensive reform is necessary to make a significant impact.  We urge the Subcommittee and Congress to adopt our joint recommendations in order to keep children safe and in nurturing families.  The details of our recommendations are attached to my testimony and available on the press table. 

NAPCWA’s vision for child welfare is a society where children are free from abuse and neglect and live in safe, stable, permanent families—where children and families have needed supports and can help themselves. When children are at risk and come to the attention of the public agency, the agency can provide services and supports to them and their families to mitigate their problems and prevent them from being removed from their families and communities. When children must come into care, the agency can address children and family needs expeditiously and enable a safe reunification or, where that is not possible, find an alternative permanent placement expeditiously, while assuring their well-being in the interim. It is a vision where the child welfare system has the capacity to improve outcomes for children and families, and the federal government and states are equal partners in serving all children in all parts of the system.

Thank you for the opportunity to testify. I would be pleased to respond to any questions you may have.