| 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.
CHALLENGES
I
must start off with saying that the challenges are great. I have been asked to discuss the top
four to five challenges facing
public child welfare systems. The
challenges I will outline today are those we face in the state of
Iowa, but are also similar
to those encountered by other states. As
someone who has worked in this field for more than three decades, I have seen
the federal role in funding for the system decline, while oversight has
increased. And it might surprise some to
learn that fewer than fifty percent of the children in child welfare are
supported with a federal dollar. States,
including
Iowa,
have picked up the responsibility to fund the needs of these children and that
trend is clearly not sustainable.
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.
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