<DOC>
[109 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:25855.wais]
S. Hrg. 109-262
FUNDING FOR FEDERAL FOSTER CARE INITIATIVES IN THE DISTRICT OF COLUMBIA
=======================================================================
HEARING
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
SPECIAL HEARING
MARCH 10, 2005--WASHINGTON, DC
__________
Printed for the use of the Committee on Appropriations
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COMMITTEE ON APPROPRIATIONS
THAD COCHRAN, Mississippi, Chairman
TED STEVENS, Alaska ROBERT C. BYRD, West Virginia
ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii
PETE V. DOMENICI, New Mexico PATRICK J. LEAHY, Vermont
CHRISTOPHER S. BOND, Missouri TOM HARKIN, Iowa
MITCH McCONNELL, Kentucky BARBARA A. MIKULSKI, Maryland
CONRAD BURNS, Montana HARRY REID, Nevada
RICHARD C. SHELBY, Alabama HERB KOHL, Wisconsin
JUDD GREGG, New Hampshire PATTY MURRAY, Washington
ROBERT F. BENNETT, Utah BYRON L. DORGAN, North Dakota
LARRY CRAIG, Idaho DIANNE FEINSTEIN, California
KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois
MIKE DeWINE, Ohio TIM JOHNSON, South Dakota
SAM BROWNBACK, Kansas MARY L. LANDRIEU, Louisiana
WAYNE ALLARD, Colorado
J. Keith Kennedy, Staff Director
Terrence E. Sauvain, Minority Staff Director
------
Subcommittee on the District of Columbia
SAM BROWNBACK, Kansas, Chairman
MIKE DeWINE, Ohio MARY L. LANDRIEU, Louisiana
WAYNE ALLARD, Colorado RICHARD J. DURBIN, Illinois
THAD COCHRAN, Mississippi (ex ROBERT C. BYRD, West Virginia (ex
officio) officio)
Professional Staff
Mary Dietrich
Emily Brunini
Kate Eltrich (Minority)
C O N T E N T S
----------
Page
Opening Statement of Senator Mike DeWine......................... 1
Statement of Senator Mary L. Landrieu............................ 3
Prepared Statement of........................................ 4
Prepared Statement of Senator Thad Cochran....................... 7
Statement of Brenda Donald Walker, Director, Child and Family
Services Agency, District of Columbia.......................... 7
Prepared Statement of........................................ 9
Statement of Martha Knisley, Director, Department of Mental
Health, District of Columbia................................... 16
Prepared Statement of........................................ 18
Statement of Hon. Lee F. Satterfield, Presiding Judge, Family
Court, D.C. Superior Court..................................... 22
Prepared Statement of........................................ 24
Statement of Judith Meltzer, Deputy Director, Center for the
Study of Social Policy......................................... 25
Prepared Statement of........................................ 28
Statement of Marilyn Egerton, Deputy Director, Foster and
Adoptive Parent Advocacy Center................................ 30
Prepared Statement of........................................ 32
Letter From The Drenk Center..................................... 39
Prepared Statement of Youth Villages............................. 43
Prepared Statement of First Home Care............................ 44
FUNDING FOR FEDERAL FOSTER CARE INITIATIVES IN THE DISTRICT OF COLUMBIA
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THURSDAY, MARCH 10, 2005
U.S. Senate,
Subcommittee on the District of Columbia,
Committee on Appropriations,
Washington, DC.
The subcommittee met at 3:30 p.m., in room SD-192, Dirksen
Senate Office Building, Hon. Mike DeWine (chairman) presiding.
Present: Senators DeWine, Allard, and Landrieu.
opening statement of senator mike de wine
Senator DeWine. We made it. We apologize. We had four
straight votes, so we apologize. Thank you all for waiting.
The subcommittee today will focus on the progress that the
Child and Family Services Agency (CFSA) has made in protecting
the lives of the children in the District of Columbia's foster
care system.
The simple fact is that every child in foster care, whether
it's a child here in the District or in Cincinnati or New
Orleans or anywhere in America, deserves to live in a safe,
stable, loving, and permanent home, with loving and caring
adults. All children certainly deserve that. But,
unfortunately, too many children are not getting what they
deserve in this country.
Over 10 years ago, the District's child welfare system was
considered among the worst in our Nation. In 1989, the American
Civil Liberties Union filed a class-action lawsuit, LaShawn A.
v. Barry, against the city, arguing that the District was
failing to protect neglected and abused children. In 1991, the
case went to trial, where the court ultimately found the
District liable.
Following this decision, the parties involved in the case
developed a remedial action plan. The court used this plan as
the basis for its modified final order, which required the
District to correct the vast deficiencies in its child welfare
system.
By 1995, however, little had changed, prompting U.S.
District Judge Thomas P. Hogan to install a receiver to oversee
the system and appoint a court monitor to review the District's
performance.
On June 15, 2001, the receivership ended, and
responsibility was transferred to a newly established Cabinet-
level Child and Family Services Agency. The order terminating
the receivership created a probationary period that would end
when the District demonstrated progress on a series of
performance indicators.
Two years ago, this subcommittee held a series of hearings
to shed light on the many and varied problems with the
District's foster care system and to explore ways that the
Federal Government, through funding provided by this
subcommittee, could improve the failed system. Through our
hearings and reviews, we found that there were several critical
needs that, if addressed, could go a long way toward improving
the lives of thousands of children in the District of Columbia
foster care system and help expedite their placement in stable,
loving homes.
To that end, we have provided nearly $20 million over the
past 2 years to address those needs, which include the
following:
One, intensive early intervention. This means that when a
child comes into care, he or she is treated as an emergency
situation. Just as hospitals triage medical trauma, the
District's Child and Family Services Agency could do the same
for the emotional trauma facing children who are brought into
its care. The earlier a child is stabilized, the better his or
her chances of avoiding long-term damage. We intended that a
flexible fund be established that could be used to purchase
beds, clothing, other items to help a relative bring a child
into his or her home immediately without forcing the child to
stay in a group home or foster home.
Second, early mental health evaluations and timely mental
health services for all children in foster care. The committee
has provided funds for the District's Department of Mental
Health to ensure that all children receive timely mental health
assessments upon entering foster care, that all mental health
assessment reports be provided to the court in a timely
fashion, and that all children receive mental health services
immediately after the court orders those services.
We heard testimony from the D.C. Family Court that, in most
child abuse and neglect cases where mental health services have
been ordered, there have been long delays in providing those
services to the child and/or the family. It had often taken up
to 6 to 8 weeks, or longer, to complete an evaluation, and up
to 60 days after the evaluation before the mental health
services were provided, even in serious cases. I hope that we
will hear from our witnesses today that those times have been
dramatically shortened.
Number three, recruitment and retention of qualified social
workers. This subcommittee provided funds for the repayment of
student loans for social workers at the Child and Family
Services Agency in the hopes of recruiting and keeping
qualified social workers. It's no surprise that the higher the
caseload for a social worker, the lower the quality of service
to each of those children. The District, like many cities, has
suffered from the high turnover rate of social workers.
Clearly, the relatively low pay and difficult working
conditions of social workers has resulted in a child-welfare
workforce crisis. We have taken a big step to encourage more
workers to enter the child-welfare workforce by funding student
loan repayment which will aid in the retention and improvement
of conditions for the District's social workers.
Number four, recruitment and retention of foster parents.
This subcommittee also provided funds to recruit and retain
foster parents. The Children and Family Services Agency had
experienced difficulties recruiting and retaining an adequate
number of appropriate qualified foster parents. One reason for
this had been the lack of available respite care for foster
parents. Foster parents do not have the same opportunities for
respite care as biological parents. The funds we have provided
have helped with emergency respite, planned respite, and
ongoing regularly scheduled respite. This is critical to
provide foster parents the rest that they need to continue to
stay on as foster parents. I am hoping that our witnesses can
give us a progress report on the use of these funds.
Number five, improved computer tracking of all children in
foster care. We have also provided funds so that the agency
could move the current client-service system to a Web-based
architecture and provide laptop computers to all CFSA social
workers. The subcommittee had heard testimony from the
Government Accountability Office that CFSA's database lacked
many active foster care cases, and that the system was often
down. In addition, social workers did not have access to the
database via laptop computers. Social workers often had to
return to the office, sometimes late at night, to enter data on
children in care. We planned that some of the funding would
allow the agency to purchase laptop computers for social
workers so that they could be able to enter data from offsite
locations, such as the courthouse or the child's home.
As chairman of this subcommittee, my paramount goal has
been to help the District of Columbia improve its foster care
system. I view this as my most important priority, and hope
that city leaders also will continue to place the highest
priority on this goal. I believe that we have established a
unique partnership in the area of foster care improvement. I am
eager to hear what fruits our efforts are now bearing.
As usual, witnesses will be limited to 5 minutes for their
oral remarks to allow ample time for questions and answers.
Written statements will be included in the record.
Now let me turn to Senator Landrieu, who has been my great
partner in this effort and who again will be joining me as the
ranking member.
Senator Landrieu.
STATEMENT OF SENATOR MARY L. LANDRIEU
Senator Landrieu. Thank you, Mr. Chairman. And thank you
for that excellent opening statement. I want to join you in
that priority for the improvement and strengthening of our
foster care system, and agree wholeheartedly with your
designation as our lead issue. And I'm proud that we've started
our hearings, Mr. Chairman, first on this important issue of
foster care, because I look before me and see many partners in
that effort.
I'm going to try to keep my remarks very brief, because I
know we have been delayed by unexpected votes, but I do have a
few things that I'd just like to cover very briefly.
One, Mr. Chairman and panelists, great cities, like great
nations, are not built on roads and infrastructure and tall
buildings, alone. In fact, their foundations rest on families.
If families are not healthy and strong and economically
independent, the communities they live in are not, either.
It has been my honor to work with this chairman and with
many of you to strengthen and to honor our families and to
protect children. And I hope that we will continue to make
progress.
I'd also like to take this opportunity, before we begin
with this panel, though, to restate that I hope that, as this
year unfolds, we can continue our focus on the reform and
strengthening of our public school system, which is also a
critical foundation to building a great and vibrant city.
In addition, no matter how strong our family support system
is, no matter how strong our public school system is, if the
city itself, in which these systems, if you will, rest, has a
structural, real, and significant financial imbalance, whatever
reforms that we can make couldn't last very long without the
adequate funding, as well as good management necessary to keep
them going. So I'm hoping that we'll continue, as this year
unfolds, to focus on the structural imbalance, as the GAO study
that we reviewed last year would indicate we should.
I'll submit the rest of my remarks to the record, and also
some written facts about the numbers of children, broken down
in ways that some of the panelists in their testimony provided
for us, and submit these so that we can just have a benchmark
of how many children are in foster care, in-home and out, how
many are a certain age, how many adoptions, how many
terminations of parental rights, what is the backlog, so we can
get benchmarks and really see that we are making progress.
PREPARED STATEMENT
So, Mr. Chairman, thank you again. I'm going to be able to
stay for just a few minutes, and, unfortunately, I'm going to
have to slip out a little early.
[The statement follows:]
Prepared Statement of Senator Mary L. Landrieu
Great cities, Mr. Chairman, like great nations, are not built on
roads alone, their foundations rest on families. If the families are
not strong, the communities they live in cannot be. It has been my
honor, Mr. Chairman, to work with you to focus this committee on
preserving families and protecting children. I hope the fact that we
chose to hold our very first hearing of the 109th Congress on a system
that aims to serve families says a lot about how important we feel this
issue is to the future of the District.
Before I share some of my thoughts on the issue at hand, I would
like to take this opportunity to suggest other areas for this committee
to focus on this year. As you well know, the primary purpose of the
D.C. subcommittee is to ensure the immediate and long term economic
health of the District. There are many ways we can do that. We can
continue our work to correct what GAO has identified as a structural
imbalance between the cost of providing city services and their ability
to take in revenue. But at the same time, we must focus on other tools
for bringing greater prosperity and long term stability to the
District. Cities that have good public schools, safe communities and
strong families are cities that have strong economies. If we focus
ourselves on providing these things in the District, we will go a long
way toward the economic independence the city needs and deserves.
I think we have come a long way toward reforming public education
in the District. One of the driving forces behind this change has been
the charter schools. In the District, charter school students now make
up 20 percent of the public school population, some 16,500 students.
When people ask me why I support charter schools, I tell them it is
because I believe in public education. I firmly believe that if we work
to modernize the system of delivery for public education, allow greater
opportunities for innovation and hold schools accountable for results,
then we can provide a high quality public education for every child in
America. One size does not fit all, and if we give our parents choices,
they will choose what is best for their child.
Until now, the focus of the charter school movement has been to
increase the quantity of charter schools. But if we expect this to be
more than a movement, we must shift our focus from quantity to quality.
As the Washington Post put it, ``The District's experiment with charter
schools has proved hugely popular with parents, but the schools vary
widely in quality and have yet to demonstrate that they are doing
better than the city's regular public schools in raising student
achievement.''
I am encouraged by the D.C. Board of Education's proposal to issue
a short moratorium on issuing more charters. I think this indicates
that they are not going to try and do more; they are going to try and
do better. I hope that this committee will use its resources to help
support all public schools, both charter and non-charter, to do better
by their children.
Our focus today is on the investments made in the D.C. Foster Care
system. I would like to thank Chairman DeWine for his ongoing
leadership on issues such as these. In our first year on D.C. as
chairman and ranking member we worked together to pass the Family Court
Act which created a new standard for how children and their families
are to be treated in the courts--one family one judge. The courts have
implemented this standard, hired new staff and created a separate
family-friendly space in the courthouse in order to better serve the
most vulnerable population. I want to recognize the strong leadership
of Chief Judge Rufus King and the tremendous dedication of his Family
Court Chief Judge Lee Satterfield and deputy Judge Anita Josey-Herring;
thank you for being here today.
We have shepherded the Child and Family Services Agency in their
transition from receivership to improving services and outcomes for
children. CFSA was put under a court-ordered Receivership in 1995, as a
result of findings by the court in a 1991 civil action brought on
behalf of LaShawn A. and other children in the foster care system. In
2001 CFSA became a D.C. agency and has been working to meet the goals
of the Modified Final Order, local and Federal mandates, primarily the
Adoption and Safe Families Act. I am pleased to see such remarkable
progress in establishing a management structure to implement the
specific reforms necessary; I look forward to hearing more today.
What made the Adoption and Safe Families Act so historic had little
to do with the programs it created or the funding it provide. In 1997,
for the first time, we as a Congress acknowledged that above all
things; children need permanent, safe, and loving homes. We dedicated
ourselves and the systems we help fund to putting the well being of
children ahead of all other considerations. This change of mind has
resulted in 56,000 children going from the halls of the system into the
arms of a loving parent.
By most accounts, this law was a success and yet, there are still
barriers that stand in the way of children finding homes. The same can
be said about the District. In March 2001, Senator DeWine and I held
our very first hearing and many of you or your predecessors were here
with us. At that time Judith Meltzer, the Court Monitor of the
Receivership, who joins us again today, outlined four broad categories
of issues the system faces: the lack of a clearly defined child welfare
policy by the city; inadequate system capacity, options, and supports
for children and families; fiscal insufficiency in several of the
agencies involved in child welfare activities; and the failure of
multiple agencies to work together to support children and families.
Four years later we are here to revisit these issues. Highlights of
improvements are: the number of young children in congregate care
longer than 30 days has been reduced from 99 young children in 2001 to
5 young children as of the end of 2004. Adoptions are increasing every
year, from 273 in 2001 to 384 in 2004. However, there remain some
serious areas in which CFSA must improve in order to be in compliance
with Federal laws and the LaShawn order.
This committee has always encouraged collaboration among various
agencies in the city which provide services to children. While I
understand there are improvements in information sharing between the
Public Schools and CFSA, I remain very concerned with how well children
under the care of CFSA are performing in school. We need to be sure
that the people in the field understand that one of the areas they
should be gauging a child's success and well being in is education. I
have often thought that a residential school, such as the SEED School
in D.C. would offer an opportunity for a safe home paired with a
rigorous and supportive educational environment. I would be interested
to hear the witnesses' thoughts on the educational outcomes for
children in foster care and what some immediate strategies for
improvement are.
The city is still not addressing the great needs of 43 percent of
children in out-of-home foster care--those who are age 14 older. These
are the children who could ``age out'' in a matter of months or short
years and will be lost to the involvement of these committed
individuals and the services their agencies can bring to bear. I urge
CFSA and the Department of Mental Health to focus quickly and
creatively on older children before it is too late.
My final point relates to two issues which the court and CFSA must
work closely on. The first is the backlog of filing Termination of
Parental Rights (TPR); I understand the D.C. Attorney General and CFSA
undertook a review and determined 453 children need goal changes or
TPRs. The Adoption and Safe Families Act requires that if child has
been in care 15 of the last 22 months the court must initiate TPR
proceedings. I would like to hear what specific action CFSA will take
to clear this backlog. Second, I understand the D.C. Council changed
the requirement for the court to hold an initial hearing from 24 hours
to 72 hours. I can see this may alleviate the court schedule and allow
for CFSA to conduct early intervention. However, I would like to know
what services are being provided to children in care during this time?
The first few hours and days when a child is removed from the home are
critical.
We are so grateful that there are dedicated individuals working to
provide safe and permanent homes to children in the District of
Columbia--thank you for taking the time to be here today. I look
forward to your testimony and our continued partnership to improve the
lives of children in care and those we successfully help into a
permanent safe home.
BASIC FACTS ABOUT THE DISTRICT'S CHILD WELFARE SYSTEM AS OF 12/31/04
------------------------------------------------------------------------
Number
------------------------------------------------------------------------
Total Number of Children (in Foster Care plus Under 5,800
Supervision)...........................................
Number of Children in Foster Care....................... \1\ 2,633
Number of In-home family cases under Protective \2\ 3,167
Supervision............................................
Demographic Profile of Children in Foster Care:
Female (percent).................................... 49
Male (percent)...................................... 51
African American (percent).......................... 94
Age: \3\
Under 1 year (percent).............................. 5
Age 2-3 (percent)................................... 7
Age 4-5 (percent)................................... 5
Age 6-13 (percent).................................. 41
Age 14-21 (percent)................................. 43
Entries and Exits in Foster Care (January 2004 to
December 2004):
Number of children in Foster Care as of 2004........ 2,941
===============
Entries:
New Entries..................................... 694
Re-entries...................................... 186
---------------
Total Entries................................. 880
===============
Exits:
Adoption........................................ 383
Guardianship.................................... 268
Living with relatives........................... 135
Aging Out (Emancipation)........................ 187
Reunification................................... 287
Placement/Custody by Other District Agency...... 19
Fatality........................................ 8
Other........................................... 12
---------------
Total Exits................................... 1,299
===============
Number in children in Foster Care (on 12/31/ 2,633
2004)........................................
Percent change (percent)...................... -10.5
------------------------------------------------------------------------
\1\ Includes 1,857 children where CFSA is primary case manager and 776
children where private agency workers are primary case managers (via
CFSA contract). Includes 556 children in kinship foster homes; 1,507
children in non-kinship foster homes; 184 children in group homes; 196
children in independent living programs; 152 children in residential
treatment and 38 children in other placements ( e.g. juvenile
corrections, substance abuse treatment etc.).
\2\ 3,167 children are under supervision in 1,541 families.
\3\ Adds up to 101 percent due to rounding.
SOURCE: CFSA FACES.
Note.--CFSA reports that discrepancy of 111 children between entrances
and exits due to in-process placements and newly processed placement
changes.
PREPARED STATEMENT OF SENATOR THAD COCHRAN
Senator DeWine. That's all good information the
subcommittee would like. Thank you very much. Before we start,
I would like to insert the statement of Senator Cochran into
the record.
[The statement follows:]
Prepared Statement of Senator Thad Cochran
Mr. Chairman, I am pleased you are having this hearing, and
I look forward to working with the committee and the District
of Columbia on issues of importance to our Nation's capital.
I want to also thank Senator DeWine for his leadership as
chairman of this subcommittee. It is my hope that this panel
will give us guidance in making informed decisions regarding
the quality of life of the children placed in the District's
foster care system.
Senator DeWine. Let me introduce, very quickly, our panel.
Ms. Brenda Donald Walker is a Director with the District of
Columbia's Child and Family Services Agency. We welcome you.
The Honorable Lee Satterfield is the presiding Judge of the
D.C. Family Court. Judge, thank you very much for joining us.
We appreciate it very much. Judith Meltzer is the Court-
appointed monitor for the Child and Family Services Agency. Ms.
Marilyn Egerton is the Deputy Director of the Foster and
Adoptive Family Advocacy Center. And Ms. Martha Knisley is the
Director of the District of Columbia's Department of Mental
Health.
Let me take an extra moment here to point out, Ms. Knisley
is a former Buckeye. She spent 21 years as a Deputy Director
and then Director of the Ohio Department of Mental Health. Many
of her family live in southern Ohio, and she is also an alumnus
of the Ohio State University.
And so, we thank all of you for joining us.
Senator Landrieu. Bragging, bragging, bragging.
Senator DeWine. Well, we have to get that in. I'm sure
Louisiana will be represented here shortly. So Ms. Walker,
would you like to start?
STATEMENT OF BRENDA DONALD WALKER, DIRECTOR, CHILD AND
FAMILY SERVICES AGENCY, DISTRICT OF
COLUMBIA
Ms. Walker. Thank you. Good afternoon, Senators DeWine and
Landrieu.
I am Brenda Donald Walker, Director of the D.C. Child and
Family Services Agency. Thank you for your interest in child
welfare in the Nation's Capital and for the opportunity to
highlight our progress.
When CFSA, our agency, appeared before this subcommittee 2
years ago, I was then Chief of Staff to CFSA's former Director,
Olivia Golden. Dr. Golden left CFSA in April 2004, and Mayor
Anthony Williams appointed me to build on the foundation laid
in the 3 years post-receivership. All of us wanted a smooth
leadership transition that would preserve the fast pace of
reform, and we made that happen.
Child welfare in the District has changed in the past 2
years. Abused and neglected children and troubled families in
the District have never had a stronger safety net than they do
today. But are we there yet? No.
Our court-ordered implementation plan approved in May 2003
allows nearly 4 years to achieve rigorous performance
benchmarks. We are now at the halfway point, and we'll need
every moment of the remaining time to get totally there.
Two years ago, we had 8,325 children on our caseload.
Today, that number has dropped to 5,791, a 30-percent decline.
At the end of last month, 54 percent were at home with their
parents, and 46 percent were in out-of-home placements.
Children we serve are overwhelmingly African-American and
evenly divided between males and females. The largest
percentage is older children, ages 12 to 17, followed closely
by a sizeable group of 6 to 11 year olds. Seventy-five percent
of our foster care children are in family settings, with about
20 percent in kinship care.
To paint an overall picture of CFSA's progress to date, my
written testimony highlights just nine performance indicators
representative of the hundreds we track. CFSA has been
successful on three of the nine. We're making steady
incremental progress on four. And we're still struggling to
improve and maintain performance on two. Thus, you have a bell
curve that illustrates our current status quite accurately--
outstanding achievement in some key areas; adoptions; almost no
young children in congregate care; measurable progress in many
areas, such as case plans, visits to children in foster care,
and licensing of foster homes; and yet several problems
resulting in insufficient progress in a few important areas,
such as investigations and in-home visits.
As an example, in fiscal year 2004 we moved an all-time
high of 919 children out of foster care and into permanent
homes through reunification, guardianship, or adoption, and we
currently only have four children under six in congregate care.
At the same time, we continue to have a persistent backlog of
investigations not completed within 30 days, and we are not
visiting our in-home children as frequently as we should. Yet
we are light-years ahead of where we have been, and we are
still moving in the right direction.
In that regard, CFSA has put to good use the fiscal year
2004 special appropriation of $9 million for early
intervention, flexible funds for kinship licensing, student
loan repayments for social workers, and technology
improvements. The core of our early intervention strategy is
the new family team meeting (FTM) initiative, which gives
families a strong voice in making decisions.
In January, we began conducting FTMs before all removals.
We have held 47 family team meetings involving 85 children so
far. Other jurisdictions using FTMs have experienced fewer
children entering care, and significant reductions in placement
disruptions. We anticipate similar outcomes in the District. In
April, we will use family team meetings for all placement
changes--or prior to any placement changes.
Flexible funds facilitate licensing family members willing
to care for children who otherwise would go into traditional
foster homes or congregate care. Between March 2004 and the end
of the fiscal year, we spent approximately $234,000 to support
99 families in meeting licensing standards.
Within the 7 months available to plan and launch the
student loan repayment program, 147, or about half, of our
social workers applied for a total obligation of a little over
$2.2 million out of the $3 million allocation. While it will be
at least 2 years before we know whether this is an effective
retention strategy, we do believe it will increase social
workers' tenure in the District.
Finally, CFSA is using $3 million to convert our FACES
automated management information system to a Web-based
platform, and we've just completed that first stage. In
addition, we are replacing social workers' personal computers
with laptops so that they can, as you mentioned, Senator
DeWine, be able to enter and retrieve client information in the
field.
Thanks, in part, to your support, CFSA is moving toward
becoming a model for the Nation. At the same time, we have a
great deal of work still ahead. I am especially concerned about
the large number of older youths growing up in the District in
foster care, a legacy of past failure to focus on permanence.
CFSA must redress that failure and give these young people the
same quality start in life we give our own children. We must
also do more to prevent younger children from growing up in the
system.
Of CFSA's $235 million budget, only about 5 percent, about
$12 million, is for early intervention and prevention services.
We need more flexibility to shift resources to address critical
front-end and back-end issues, such as lack of affordable
housing that undermines family efforts to stay together or
reunite, post-adoption services, after-care programs for youth,
for young adults who are aging out of foster care, including
affordable housing and other support.
We hope you will be interested in discussing potential next
steps in building the safety net for the District's abused and
neglected children.
PREPARED STATEMENT
Thank you so much for your interest in these children and
families, and for your support.
Senator DeWine. Good. Very concise, very good. Thank you
very much.
[The statement follows:]
Prepared Statement of Brenda Donald Walker
Good afternoon, Senator DeWine, Senator Landrieu, and members of
the District of Columbia Subcommittee of the Senate Appropriations
Committee. I am Brenda Donald Walker, director of the D.C. Child and
Family Services Agency (CFSA). Thank you for this opportunity to report
on the progress of child welfare reform in the Nation's Capital. In
addition, I am eager to tell you about initiatives you funded via the
special Congressional appropriation, for which we are grateful.
It was exactly two years ago that CFSA last appeared before this
subcommittee. At that time, I was chief of staff to CFSA's former
director Olivia Golden. Dr. Golden left CFSA in April 2004, and upon
her recommendation, Mayor Anthony Williams appointed me to build on the
foundation she established in the three years post-receivership. All of
us wanted a leadership transition that would preserve the fast pace of
our reform agenda. In practice, we had the least disruptive leadership
transition in agency history and more than maintained the rapid
evolution underway at CFSA.
Performance Highlights
Public child protection in the District has changed significantly
since CFSA testified here in March 2003. To anticipate some overall
questions you may have * * *. Have we passed major milestones in
solidifying our foundation and improving performance in key areas? Yes.
Are we seeing evidence of better outcomes for more children and
families? Yes. Are we demonstrating that the District Government can
deliver critical services after six years of Receivership? Yes. Abused
and neglected children and troubled families in the District have never
had a stronger safety net than they do today. But are we ``there yet?''
No. Our court-ordered Final Implementation Plan approved in May 2003,
allows nearly four years to achieve rigorous performance standards. We
are now almost at the halfway point and will need every moment of the
remaining time--as well as continued hard work, political will, and
community support--to ``get there.''
As numerous other cities have learned from experience, urban child
welfare reform is a long, challenging progress. The only way to succeed
is to use each accomplishment as a platform for tackling the many
critical requirements still ahead.
Children and Families
I want to provide a brief overview of how things stand at CFSA
today, beginning with the most important element: the children we
serve. Two years ago, we had 8,325 children on our caseload. Today,
that number has dropped to 5,791 children--a 30 percent decline. We
have gotten much better at achieving permanence for children, as I'll
explain in a moment, and because caseworkers are no longer overwhelmed,
they close cases instead of allowing them to languish.
CHILDREN CFSA SERVES
------------------------------------------------------------------------
March 31, 2003 February 28,
------------------ 2005
-----------------
Number Percent Number Percent
------------------------------------------------------------------------
In home:
Court........................... 1,330 26 785 25
No court........................ 3,700 74 2,328 75
-----------------------------------
Total in-home................. 5,030 60 3,113 54
===================================
Out of home:
Court........................... 3,262 99 2,607 97
No court........................ 33 1 71 3
-----------------------------------
Toal out of home.............. 3,295 40 2,678 46
===================================
Total children................ 8,325 ....... 5,791 .......
===================================
Goals of children in out-of-home
placement:
Reunification................... 614 19 513 19
Adoption........................ 1,289 39 770 29
Guardianship.................... 124 4 445 17
Ind. Living, APPLA.............. 1,268 38 800 30
Other........................... ....... ....... 150 5
-----------------------------------
Total......................... 3,295 ....... 2,678 .......
------------------------------------------------------------------------
Source: CFSA FACES.
The children we serve continue to be overwhelmingly African-
American and evenly divided between males and females. The largest
percentage is older children, ages 12 to 17, followed closely by a
sizeable group of six- to 11-year-olds. At the end of last month, 3,113
children--or 54 percent--were at home with their parents, and 2,678--or
46 percent--were in out-of-home placement.
At the same time, a growing proportion of our caseload is composed
of clients with serious, difficult, and expensive issues--such as
children with multiple disabilities. We are also serving many large
families struggling with a host of challenges. In December 2003, our
first needs assessment study (which we will now conduct every two
years) showed that the typical CFSA client family is a single mother,
average age 31, with four children under age 18 in the home. Among
adult clients in the sample: 96 percent were unmarried; 73 percent were
unemployed outside the home; 52 percent had not graduated from high
school; and fully 25 percent were homeless or living in a shelter
before becoming involved with CFSA.
Child protective cases in the District have always been complex,
and that is truer today than ever before.
Sample Performance Indicators
With an overall caseload decline of nearly one-third and a larger
cadre of case-carrying social workers, CFSA has made significant
strides in meeting the long-standing challenge of reducing individual
caseloads to manageable levels. Based on standards in the LaShawn
order, caseloads may not exceed 1:12 in Investigations, 1:17 for
families, 1:20 for children in foster care, and 1:12 for children with
the goal of adoption. Today, average caseloads at CFSA are currently
1:15 in Investigations, 1:17 for children in families and in foster
care, and 1:10 for children with the goal of adoption.
To paint an overall picture of where CFSA stands today, I want to
highlight nine performance indicators representative of the hundreds we
track regularly. Our court-ordered Final Implementation Plan mandates
these performance measures, but that's not the point. The point is that
meeting these standards is critical to providing the diligent, quality
service abused and neglected children need and deserve. Of the nine
performance indicators I'll discuss briefly, CFSA has been very
successful on three; is making steady, incremental progress on four;
and is struggling to improve and maintain performance on two. Thus, you
have a Bell curve that illustrates our current status quite accurately:
Outstanding achievement in some key areas; measurable progress in many
areas; and stubborn problems resulting in insufficient progress in a
few areas.
Strong Performance.--At the front end of the Bell curve, strong
performance at CFSA stands out in: reducing the number of young
children in congregate care, conducting timely Administrative Reviews,
and increasing adoptions. These important indictors cut to the heart of
what children need to thrive--namely, nurturing family settings and
stability.
In 2001, when the Court Monitor prepared baseline data for CFSA, we
had 99 children under age six who had been in congregate care for more
than 30 days. Today, we have just five children under age six who have
been in congregate care for 30 days. The District has made a huge leap
forward in placing younger children in the family settings that do so
much more for their healthy emotional development.
Semi-annual Administrative Reviews ensure movement of children
toward permanence with all due speed. CFSA has more than doubled the
percentage of cases with current Administrative Reviews--from 43
percent in 2001 to 93 percent at the end of December. Each month, we
move closer to the goal of 100 percent and expect to meet it within the
next few months. Our in-house Quality Improvement Administration
schedules and facilitates these reviews, evaluates the status of case
plans in advance, and follows up with social workers to ensure prompt
attention to action items.
Deliberate focus on permanence has led to a large increase in
adoptions. Family Court finalized adoption of 273 children in 2001. In
2004, adoptions jumped 41 percent to a total of 384. Add the 273
children who achieved guardianship and 262 reunified with their
families, and the result is 919 children who left foster care for
permanent homes last year. Speedier permanence for more children
accounts for a significant portion of the decline in our overall
caseload, as it should.
Steady Progress.--At the top of the Bell curve are numerous areas
in which CFSA is making steady, incremental progress. Four stand out:
Developing case plans for foster care cases; developing case plans for
family and kinship cases; making monthly visits to children in foster
care; and licensing foster homes.
A case plan is the critical roadmap to safety; services; and
permanence through reunification, guardianship, or adoption. In 2001,
only 25 percent of CFSA foster care cases had case plans. By the end of
December 2004, that number had jumped to 85 percent--still short of our
95 percent goal but closing in rapidly. For family and kinship cases,
only a shameful 9 percent had case plans in 2001. Today, 69 percent
have case plans--also short of the goal but a seven-fold increase
headed in the right direction.
Regular visits by social workers to monitor foster children are one
of the strongest safety features in public child protection. From an
abysmal two percent of foster children receiving a monthly visit in
2001, 78 percent had a monthly visit in December 2004. That's a
dramatic 39-fold increase. We are continuing to push to meet the goal
of 90 percent.
Licensing standards for foster homes are an important safety and
quality measure for children. CFSA has worked diligently to achieve
licensing despite barriers, such as long-time placement of children
with kin before the District required licensing. In some cases, long-
standing court orders for monthly foster-care payments to unlicensed
relatives exacerbate procrastination in fulfilling licensing
requirements. Nonetheless, CFSA has more than doubled the percentage of
children placed in licensed foster homes--from about a third in 2001 to
just over two-thirds today. We move closer to the goal of 95 percent
each week.
Corrective Action.--Finally, at the end of the Bell curve, CFSA has
some areas undergoing strenuous corrective action. In June 2004, our
semi-annual Quality Assurance Report listed 11 methods CFSA is using to
drive performance improvement, such as intensive, short-term work
groups; training; staffing up; developing tools to facilitate
investigative and case decision making; and input from outside experts.
Over the past eight months, we have initiated several additional
approaches.
Both Mayor Anthony Williams and I are serious about making CFSA a
first-class child welfare agency that consistently performs well in
every key area. Regular management reports keep me fully aware of where
performance is lagging, and I have put managers on notice that
turnarounds in these areas are their highest priority.
From an unacceptable backlog of 807 child abuse investigations not
completed within 30 days in 2001, CFSA had reduced the current backlog
by 61 percent to 311 at the end of 2004. This is still too high. Late
last summer, I hired an experienced manager to head Intake &
Investigations. She is now working to streamline and improve an
essential function that had never been properly organized since CFSA
assumed responsibility for abuse as well as neglect investigations. I
have devoted extensive resources and other support to this critical
gateway to child protection and will do whatever else is necessary to
bring investigative performance up to standards.
Regular social worker visits to monitor children's safety and well
being are the essence of child welfare. I am deeply concerned that
reducing caseloads to more manageable levels has not yet translated
into regular visits to children living at home. Make no mistake: More
children at home are now receiving more regular visits from CFSA social
workers than ever before. When the Court Monitor established a baseline
for this measure in October 2002, only 11 percent of children at home
received a monthly visit. In December 2004, 68 percent received a
monthly visit. While that's a six-fold increase, it's not enough. CFSA
Program Operations has identified barriers to visits and is working to
overcome them. I have made continued, diligent focus on this essential
element of casework one of the agency's top priorities.
Update on Fiscal Year 2004 Special Appropriation
Of the $14 million special appropriation you generously awarded to
the District in fiscal year 2004, CFSA received $9 million for early
intervention, flexible funds for kinship licensing, student loan
repayments for social workers, and technology improvements. When
Congress approved the fiscal year 2004 appropriation in February 2004,
we immediately began developing and succeeded in launching several new
initiatives.
Early Intervention
The core of our early intervention strategy is the new Family Team
Meeting (FTM) initiative, which ensures families have a strong voice in
decisions about removing a children or changing their placement. In
fiscal year 2004, we executed a contract for FTM training from noted
national experts, hired the FTM team, and established the flexible fund
component of the program.
The program began as a pilot from September through December for
selected high-risk cases. We began conducting FTMs before all removals
in January 2005, and beginning next month, we will hold an FTM before
all placement changes. While it is too early to draw conclusions about
the long-term effectiveness of FTMs in the District, we have developed
a tracking system to follow the progress of FTM participants. For
example, we know that of the 11 children whose families participated in
Family Team Meetings last September, two remained at home, four were
returned to their father, and five were placed with relatives. So far
in 2005, we have held 47 FTMs for 85 children. Other jurisdictions that
have used Family Team Meetings for some time have typically experienced
fewer children entering care and significant reductions in placement
disruptions. We anticipate similar outcomes for the children and
families we serve.
Emergency Support Fund
Flexible funds facilitate licensing of family members willing to
care for children who would otherwise go into traditional foster homes
or congregate care. We are using flexible funds for home repairs or
renovations, furniture, medical exams, and lead paint removal--all to
help relatives meet foster home licensing standards.
We also use the funds to underwrite room-and-board payments to
kinship homes with short-term temporary licenses, which are ineligible
for federal reimbursement. Between March 2004 and the end of the fiscal
year, we spent approximately $234,000 from the flexible fund to support
about 99 families in meeting licensing standards.
Social Worker Student Loan Repayment
Nearly every child welfare agency in the nation struggles with the
challenge of reducing high social worker turnover. Repaying all or a
portion of student loans is an experiment to determine whether this
incentive will keep social workers on the job longer.
Under our demonstration project, case-carrying social workers who
have worked for CFSA or one of our contracted providers for at least
two years and who agree to stay an additional two years were eligible
for generous loan repayments between $10,000 and $18,000. Within the
seven months available to plan and launch the program, 147 social
workers applied for a total obligation of $2.2 million out of the $3
million allocation. We also budgeted $250,000 for administration,
documentation, and evaluation. While it will be at least two years
before we know whether this is an effective retention strategy, we
believe it will encourage qualified and motivated social workers to
extend their tenure in the District.
Technology Improvement
Three million dollars allocated to upgrade technology for social
workers has two primary purposes: conversion of our FACES automated
management information system from a server- to a web-based platform
and purchase of laptop computers so social workers can access FACES in
the field. In fiscal year 2004, we awarded contracts to establish the
web-based system and to purchase almost 250 laptop computers. We are
now phasing in FACES.net over 18 months.
Even at this early stage, we are already seeing results. Under a
portion of the project known as the provider web, all our contracted
child placing agencies now have real-time access to FACES. This allows
them to update placement changes promptly, which, in turn, helps CFSA
resolve long-standing payment challenges. At the end of this month,
CFSA Information Systems will begin replacing social worker personal
computers with laptops. By the end of 2005, social workers will be able
to enter and retrieve client information in the field. Among many
benefits, we hope this will improve CFSA's ability to claim federal
revenue. We are set to forge ahead in that arena since this past
January, CFSA's FACES system joined an elite group of only eight other
``states'' that have achieved State-Administered Child Welfare
Information System--or SACWIS--approval from the U.S. Department of
Health and Human Services.
Mental Health Services
Director Martha Knisley of the District's Department of Mental
Health is here today to report on use of their special appropriation to
develop new mental health services for foster children. Without
stealing her thunder, I will just say we have long needed the expanded
range of mental health treatment options DMH is now able to provide.
Family instability, abuse and neglect, removal from home, multiple
placements, and other factors too often leave some child victims with
serious emotional and behavioral issues. They deserve expert, caring
treatment, and we're delighted to have these new, high-quality services
available.
Looking Ahead
Thanks in large part to your support and commitment to improving
child protection in the District, we are moving toward becoming a model
for the nation. At the same time, we have great deal of work still
ahead. I am especially concerned about the large number of older youth
growing up in care in the District, a sad legacy from past failure to
focus on permanence. Over the next five years or more, CFSA must do
everything possible to redress that failure and give these young people
the same quality start in life we give our own birth children. In
addition, we must do more to prevent younger children in our care from
growing up in the system.
Of CFSA's $235 million budget, we can use only five percent (or
approximately $12 million) for early intervention and preventive
services. We really need more flexibility to shift resources to address
critical front- and back-end issues such as: The lack of affordable
housing that too often undermines family efforts to stay together or
reunite; post-adoption services, especially for families who adopt
older youth; and after-care programs for young adults who have aged out
of foster care, including affordable housing and other supports.
We hope you will be interested in discussing potential next steps
in building the viable safety net for the District's abused and
neglected children and troubled families. As always, thank you for your
caring interest in these children and families and for your support.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
STATEMENT OF MARTHA KNISLEY, DIRECTOR, DEPARTMENT OF
MENTAL HEALTH, DISTRICT OF COLUMBIA
Senator DeWine. Ms. Knisley.
Ms. Knisley. Good afternoon, Senator DeWine and
subcommittee staff.
I am Martha Knisley, Director of the D.C. Department of
Mental Health. Thank you for this opportunity to share with you
the status of the service delivery, mental health services
delivery to the children, youth, and families in the D.C.
foster care and child welfare system.
It's always good to see a fellow Southern Ohioan. I think
the last time I was, I said that to you, and not very many
people, outside of you and I, would understand what that means.
Senator DeWine. We understand.
Ms. Knisley. On behalf of all of our employees, the
District children and youth and families, our heartfelt
appreciation for your vision and your support to ensure
evidenced-base mental health services are now becoming
available to children and their families with the greatest
needs.
Mayor Anthony Williams has devoted himself to a long-range
effort to improve services to children in foster care, starting
with his commitment to end the receiverships for both of our
departments, simultaneously. He reasoned that the faster our
two agencies came out of receivership, the faster we would be
able to deliver necessary services to begin helping people, and
especially children, improve their lives. He did this, because
he, personally, wanted to take the responsibility for these two
fragile groups of individuals. At his urging, our two agencies
began meeting to develop a long-term plan wherein the
Department would begin to take--Department of Mental Health--
would begin to take responsibility for providing and arranging
for mental health services for children, under the supervision
of the Child and Family Services Agency. Because of his
commitment and the joint efforts with the Child and Family
Services Agency, we began to carve out both a long-term plan
that addresses the areas of most critical needs for foster
children, their parents, and children's birth parents, where
appropriate.
The $3.9 million provided to the Department of Mental
Health from this subcommittee in 2004, and $1.25 million for
2005, has spurred this development of an array of services to
meet those urgent needs that would have not happened this fast
without your remarkable commitment to the Nation's Capital and
with Mayor Williams' foresight.
When we speak of the fragility of children's lives,
especially those in the child welfare system, and also the
juvenile justice system, where we're also beginning to work
furiously as part of our mission, we are talking about
disruption of family, frequent change of residence, and the
resulting emotional trauma. Our role, as the Department of
Mental Health, is to help build, or rebuild, the resilience
within these children, youth, and families so they can go
forward.
Studies are very clear, the mental health status of
children involved in child welfare indicates that they're 3 to
10 times more likely to have mental health problems than
children not in the child welfare system. The trauma of
separation, multiple placements, and transitions often
exacerbates children's mental health program--problems.
The resources provided by this subcommittee have allowed us
to take aggressive action to strengthen accessibility,
timeliness, and quality of mental health services. We're
significantly expanding our capacity for screening and
assessments, as you've requested, building a cadre of providers
to provide timely, appropriate, and cutting-edge mental health
services, and to expand the capacity of our agencies to
increase their knowledge and expertise in a wide variety of--
array of service interventions.
We had two primary goals: reduce the backlog of court-
ordered evaluations, and to begin to build an infrastructure
for evidence-based mental health services, timely services for
foster care children.
We began immediately, contracting with 10 new forensic
psychologists and three new board-certified children's
psychiatrists, to--for our evaluations. We've significantly
reduced the wait time for psychiatric evaluations, from 3
months to 3 weeks, and psychological examinations from 2 months
to less than 3 weeks--actually, at one point in time, down to 1
week. It's beginning to creep back up some. And, in part,
that's because we've had a 44 percent increase in the number of
requests for evaluations in 2004; and already this year, a 41
percent increase. So we need to place more individuals, and we
are doing that, to do the psychological and psychiatric
examinations.
In addition to that, this gave us an opportunity to
establish a clinical rotation with Children's Hospital to train
child psychiatrists in forensic child psychiatry. It is--if we
are going to do this, we're going to have to have the
expertise.
We also have been contracted for three new major cutting-
edge services: mobile response and stabilization services,
multi-systemic therapy, and intensive in-home and community-
based services. With multi-systemic therapy, this year we are
going to be able to serve 96 youths in this cutting-edge
service, and already we've taken 27 youths into the program.
And the intensive community-based services, again, we began in
January, we've already taken 36 youths. And I just talked to
our mobile crisis team, who are here with us today, and they
had five calls for mobile crisis last week.
I will not finish my testimony, but submit it in writing,
but one of the projects that we're doing this summer is
inviting one of the national leading groups in trauma to help
support our clinicians in what they call ``cognitive behavioral
therapy,'' so that we can increase our capacity to serve
children and youth.
I'd like to end by talking about two children for just a
second, a 14-year-old girl, who was referred to our MST team
last week because of removal from her home. We began--our team
began working with her mother on implementing consistent
structure and supervision at home, and increasing communication
between home and school. She hasn't missed a day of school, she
hasn't gotten into any fights, and she hasn't run away.
In addition, a 12-year-old youngster who's in and out of
State residential treatment facilities. He's been there for 4
years. He's coming home at the end of March.
PREPARED STATEMENT
That's what it's all about. We thank you, again, very, very
much. Our three new providers are here with me today, and I
will be submitting their testimony for the record, as well.
Senator DeWine. Ms. Knisley, thank you very much.
[The statement follows:]
Prepared Statement of Martha B. Knisley
INTRODUCTION
Good afternoon, Senator DeWine, members of the District of Columbia
Subcommittee and staff. I am Martha B. Knisley, Director of the D.C.
Department of Mental Health. Thank you for this opportunity to share
with you the status of the service delivery to children, youth and
families in the D.C. foster care/child welfare system.
On behalf of all DMH employees, and District children, youth and
families, our heartfelt appreciation for your vision and support to
ensure evidence-based mental health services now are available to those
with the greatest need.
Mayor Anthony Williams has devoted himself to a long-range effort
to improve services to children in foster care, starting with his
commitment to end the Department of Mental Health and Child and Family
Services Agency receiverships that were in place when he took office.
He reasoned that the faster our two agencies came out of
receivership, the faster we would be able to deliver necessary services
to begin helping people improve their lives.
At Mayor Williams' urging, our two agencies began meeting to
develop a long-term plan wherein the DMH would begin to take
responsibility for providing and arranging for mental health services
for children under the supervision of the CFSA.
Because of this commitment and our joint efforts to identify how
this cooperation could work to the benefit of children, youth and
foster families, CFSA, the LaShawn Court Monitor and advocates
identified mental health services as key areas for improvements in
their deliberations with you and District leaders.
Hence, in the summer of 2003, we began meeting to carve out both a
long-term plan that addresses the areas of most critical need for
foster children, their foster parents and the children's birth parents,
where appropriate.
The $3.9 million provided in fiscal year 2004, and $1.25 million in
fiscal year 2005 have spurred development of an array of services to
meet those urgent needs that would not have happened this fast without
your remarkable commitment to the Nation's Capital and Mayor Williams'
foresight.
BUILDING THE SYSTEM OF CARE
The District is committed to building a comprehensive, state-of-
the-art system of care for mental health service that meets the needs
of the children, youth, and families of the District.
When we speak of the fragility of children's lives, especially
those in the child welfare system, the foster care system or the
juvenile justice system, we are talking about disruption of family,
frequent change of residence and the resulting emotional trauma. Our
role is to build resilience within these children, youth and families
so they can go forward.
Studies profiling the mental health status of children involved in
child welfare indicate that children in foster care are three to ten
times more likely to have mental health problems than children on
welfare. The trauma of separation, multiple placements, and transitions
once children are involved in the foster care system often exacerbate
mental health problems in children and families.
These issues are frequently compounded by a lack of appropriate,
quality mental health services, by long waits for assessment and
treatment, and by a system that has not been organized or funded to
meet the particular needs of children, youth, and families that are
experiencing a high level of stress. These factors further jeopardize
children's placement in permanent and loving homes.
The resources provided by the Committee have allowed us to take
aggressive action to strengthen the accessibility, timeliness, and
quality of mental health services to children and families to:
--Significantly expand our capacity for screening and assessments for
children in foster care.
--Build an array of providers with the ability to provide timely,
appropriate and even cutting edge mental health services to
children in foster care, focusing on services that have been
shown by research evidence to be successful.
--Significantly expand the treatment capacity of agencies and
clinicians by increasing their knowledge and expertise in a
wide array of service interventions.
HOW DMH IS MAKING A DIFFERENCE
Many children and youth in foster care are living with the
emotional distress of uncertainty, violence and lack of control over
their own lives. They are at greater risk of becoming part of the
juvenile justice system; therefore, any delay in identifying and
providing the mental health services and supports they need prolongs
their suffering.
We have two goals: (1) reduce the backlog of court-ordered
evaluations of foster care children's mental health needs; and (2)
create a new infrastructure of evidence-based mental health services to
be available to foster care children.
DMH moved quickly with CFSA and community partners to meet these
goals.
DMH immediately increased its capacity for screening and
assessments by:
--Contracting with 10 additional child forensic psychologists,
including one who is a neuro-psychologist.
--Contracting with three additional Board Certified Child
Psychiatrists.
--Hiring one additional social worker to assist in handling increased
neglect referrals, serves as the Mayor's Liaison Officer to the
Family Court, and works with juvenile and domestic relations
referrals.
The results included:
--Reduced wait time for psychiatric exams from three months to three
weeks by the end of the 2004 fiscal year. Demand has increased
and so has our wait time in the past two months. We will add
resources to the extent possible to reduce the wait again to
three weeks or less.
--Reduced wait time for psychological exams from two months to less
than three weeks, but again we are experiencing a higher demand
and will need to add resources to meet this need if the demand
continues to rise.
--Established a supervisory clinical rotation with Children's
Hospital to train child psychiatrists in forensic child
psychiatry, with two staff serving in pending faculty
positions. The supervisory faculty psychiatrist also has
received his board certification in addiction.
--Increased capacity to work with individuals representing diverse
cultures and who speak languages other than English: One
psychologist speaks Arabic.; two psychologists speak Spanish;
one psychologist speaks French; and one psychiatrist speaks
Spanish.
--Meanwhile, the number of assessments conducted in fiscal year 2004
represents a 44 percent over fiscal year 2003 and has increased
by 41 percent in the first five months of fiscal year 2005 over
the same time period in fiscal year 2004.
Our second goal became a reality January 24, 2005 when our three
new services--Multi-systemic Therapy, Intensive Home- and Community-
Based Services, and Mobile Response and Stabilization Services--came on
line.
While it is too early to begin calculating the effects of these
services, nevertheless, having them in place furthers our effort to
create a comprehensive network of services. I also want to point out
that more than 82 percent of these funds or $2.8 million has been
allocated for direct services to children, youth and families. I will
describe these services briefly:
Across the country where Multi-Systemic Therapy (MST) has been
implemented successfully, youth are half as likely to be re-arrested,
and they have reductions in arrests for violent and substance-related
crimes. Additionally, they have improved family relations. This service
focuses on preventing older children and teens from entering
residential treatment and allowing others to return from residential
treatment to less restrictive, more family-like settings.
These funds allow for the treatment of 96 youths, ages 10 to 17,
with complex behavioral issues, for upward of six months. Qualified,
experienced therapists will visit the youth at least three times per
week in the community where they live, whether at home, in foster
homes, or in local group homes. Therapists will also be on call around
the clock in case of emergencies involving their clients. This service
will focus on preventing older children and teens from entering
residential treatment and allowing others to return from residential
treatment to less restrictive, more family-like settings. MST has
admitted 27 consumers and two are awaiting assessments.
Intensive Home- and Community-Based Services (IHCBS) will allow for
the in-home treatment of 72-90 youth and families during the first
year. This provider already is working at maximum capacity with 36
youth. Qualified, experienced counselors will work with children with
serious emotional disturbance and behavioral problems in their homes
several times per week. This service is designed to help families
resolve serious issues and prevent removal of children from the home.
Mobile Response and Stabilization Services (MRSS) will allow
parents, foster and pre-adoptive parents, kinship caregivers, and group
care providers to access emergency assistance from qualified
professionals for children and youth, ages 5 to 21 years old,
displaying extreme behavior but not requiring hospitalization.
Professionals can stay on site to provide emergency response for up to
72 hours. On a case-by-case basis, they can also develop eight-week
stabilization plans. This service is designed to help reduce placement
disruptions for children and teens with emotional and behavioral
issues.
Caregivers of children and youth involved with the District's child
welfare system can reach this service through DMH's 24-hour Access
HelpLine. While the capacity of these services is initially limited,
they mark the beginning of a more comprehensive and nuanced approach to
meeting the mental health needs of children, youth, and families within
the local child welfare system.
HOW DMH IS EXPANDING CLINICAL CAPACITY
DMH is significantly expanding the treatment capacity of agencies
and clinicians by increasing their knowledge and expertise in a wide
array of service interventions. The following training opportunities
have been or are being offered:
--The National Council for Community Behavioral Healthcare (NCCBH)
provided technical assistance to nine child serving agencies
and provided community support training to twenty-six staff.
--The American Academy of Child and Adolescent Psychiatry provided
CALOCUS training to child-serving agencies working with CFSA
children.
--DMH has contracted with another provider to offer another 30 hours
of community-support training to up to nine agencies and staff.
--DMH has contracted with National Association of State Mental Health
Program Directors and National Child Trauma Stress Network to
assess the treatment capacity of agencies to deliver quality
services to youth who have experienced or who are experiencing
trauma.
THE TRAUMA LEARNING COLLABORATIVE PROJECT
DMH has allocated $228,515 of the congressional appropriation to
support a Learning Collaborative Project focusing on the practice of
evidence-based cognitive behavioral therapy for clinicians serving DC
foster care children and youth.
The major focus of the project is an in-depth training in Abuse
Focused Cognitive Behavioral Therapy, a treatment model that has
received support from several randomized clinical trails and has been
adapted specifically for use with children in child protection and
foster care systems.
The project will be initiated this month with a baseline assessment
that will use a combination of tools and oral interviews to identify
current knowledge and use of evidence-based practices, current therapy
procedures, and identify attitudes and potential barriers to adoption
of evidence-based practices.
Experts from the Center for Child and Family Health (CCFH) in
Durham, North Carolina, a learning collaborative for maltreated and
traumatized children and adolescents, will facilitate. CCFH is a
collaborative undertaking by the University of North Carolina at Chapel
Hill, North Carolina Central University, Duke University and Child and
Parent Support Services, a nonprofit corporation, and has been
designated as a community practice site in the Substance Abuse and
Mental Health Service Administration (SAMHSA)-funded National Child
Traumatic Stress Network, whose mission is to raise the standard of
care and improve access to services for traumatized children, their
families and communities throughout the United States. The National
Association of State Mental Health Authorities (NASMHD) serves as DMH's
primary contractor for the project. NASMHPD will provide technical
assistance to DMH concerning system change with respect to integration
and replication of best practices.
Learning sessions are scheduled at the Gallaudet University Kellogg
Conference Center April 28-29, June 9-10 and August 12, 2005. Between
sessions clinicians will receive regular consultation via conference
calls with the training faculty. Each clinician will receive a toolkit
that includes a treatment manual and resources related to the practice
of best practices in trauma treatment.
DMH has invited 57 child and youth-serving clinicians from the
Department of Mental Health's community system of care to participate
in the project and clinical program administrators from Child and
Family Services and the Department of Mental Health's School Mental
Health Program and CINGS System of Care Project will also participate.
The project will culminate by the close of fiscal year 2005 with a
final report that will include an evaluation assessing program change
(from the baseline) and recommendations for ongoing implementation of
evidence-based practices across the DMH child and youth-serving system
of care.
PROJECTING INTO THE FUTURE
DMH is committed to sustaining the gains made thus far. We are
creating the means for providing the three services as part of our
Mental Health Rehabilitation Services system, which will allow the
three aforementioned services to be reimbursed in part by Medicaid. We
are encouraged that the services we have put in place will reduce out
of home treatment costs and will carefully monitor outcomes overtime.
We have two concerns however for the future. One is the level of
need and whether the current level of resources and Medicaid
reimbursement, which requires a 70 percent local match is sufficient to
meet the service needs of foster care children and their families.
Secondly we continue to see escalating requests for formal psychiatric
and psychological assessments. We are monitoring this demand closely.
In conclusion, Senator DeWine and Subcommittee members, I would
like to again express my appreciation for your support. I will be happy
to answer your questions.
STATEMENT OF HON. LEE F. SATTERFIELD, PRESIDING JUDGE,
FAMILY COURT, D.C. SUPERIOR COURT
Senator DeWine. Judge, thank you very much for coming. We
appreciate it.
Judge Satterfield. Thank you. Good afternoon, Chairman
DeWine and the subcommittee members and staff.
I want to thank you for inviting me to testify at this
hearing about the foster care in the District of Columbia. I'm
pleased to report to you that, with the support and the
leadership of this subcommittee and Congress and the work of
CFSA, the Department of Mental Health, the courts, and other
stakeholders in the District of Columbia who are interested in
the welfare of our children, we continue to make significant
progress in achieving permanency for our children.
In 2004, as we will report to you in our annual report
that's due later this month, the Family Court has increased the
number of dispositions in cases involving abused and neglected
children and guardianship cases and adoption cases and in
termination of parental rights motions. What this means is that
more children are achieving permanency in safe, loving homes in
2004 than they were even in 2003.
I'm going to focus my testimony on the termination of
parental rights, because I remember being here, at a
subcommittee meeting once before, where you expressed some
great concerns about how we were doing in that area. So, I want
to report to you that I believe we are making encouraging
progress in that area.
I'll talk briefly about the foster care initiatives and
about the assessment center to tell you how we think that the
money that was put into those initiatives by the Congress will
benefit the children in the District of Columbia.
Over the past year, there has been an increased urgency
among CFSA, the District of Columbia Office of Attorney
General, and the Family Court to remove, when appropriate, the
legal barriers that are sometimes the obstacles to children's
chances of being adopted by a loving family. The Office of
Attorney General and CFSA are engaged in an initiative to
increase the number of filings and termination of parental
rights motions in Family Court. In fact, just yesterday I
received a briefing from them as to how they were reviewing the
cases, how they plan to go forward increasing the numbers.
The Family Court judicial officers have participated in
additional training in anticipation of receiving more filings,
as we have recently, and as we will in the future. And we've
done training on the importance of moving these cases forward
expeditiously as possible.
As part of the training, we have members of CFSA come speak
to the judges about CFSA's efforts to recruit pre-adoptive
families and the positive impact that legally ``free'' children
would have on their recruitment efforts.
I have established a Family Court policy that TPR motions,
termination of parental rights motions, should be considered a
priority when there is no related adoption proceedings. As we
have indicated in the past, when there is a related adoption
proceeding, generally the parental rights are terminated during
the course of those proceedings.
Finally, the Family Court, the Office of Attorney General,
and CFSA, with the significant assistance of the Center for
Study of Social Policy, Ms. Meltzer, as well as the Council for
Court Excellence, are in the process of finalizing a discussion
paper and recommendations about when it's appropriate to begin
a TPR proceeding and when there are compelling reasons not to.
This effort began in our child welfare leadership team
meetings, and it is designed to guard against overuse of the
provision of the law that allows for a determination of
compelling reasons not to begin termination of parental rights
proceedings. These recommendations will include criteria for
making such a determination.
I might add that we plan to do that also in the area of
alternative planned living arrangements to make sure that we're
not making the decision too soon about a child aging out of the
system so that we will be on the same page in the criteria with
respect to that. That has already started in Ms. Meltzer's
office.
On to the new foster care initiatives. I remember, again,
testifying a few years ago, when the court was submitting its
transition plan, and I remember Senator Landrieu's raising of
the issue of family team meetings. While I think the agency
wasn't at that hearing, they must have heard her, because they
started that process this year, and we are very pleased and
encouraged by that process. It's designed to bring all family
members and other interested people together to discuss the
needs of children and to create a plan for each child's safety
and permanency.
As the court, our role in that initial process is to
appoint guardians ad litem to attend these meetings. I've
spoken to a few of the guardians ad litem that have attended
these meetings recently, and they speak very highly about the
substance that's coming out of the meetings and the plans that
are coming out of the meetings. So, that makes us very
optimistic that these meetings are going to help decrease the
time it takes to achieve permanency. As Director Donald Walker
indicated, that will reduce the amount of placements of
children, thereby, reducing the risk of trauma to our children.
These meetings will enable us to make better decisions with
respect to the relatives, when we need to go to a relative
placement, and help us to make them sooner, at the beginning of
the case, and not in the middle of the case. So often in the
past, relatives would appear then and the whole plan had to
start all over because of that.
The other programs that are in collaboration with DMH and
CFSA programs, we think, too, will benefit the children of the
District of Columbia, and we thank you for the money that
you've put into those programs to impact those programs.
I've spoken to a couple of attorneys about the difference
that some of those programs have made already, particularly
with respect to a child not being removed from the home because
of the programs.
And, finally, the assessments. The money, the Federal
dollars, provided to DMH has made a significant difference the
past year in substantially decreasing the time to obtain
evaluation of the child or the parent. The quality of the
mental health evaluations are excellent. We just hope that that
will continue, in terms of the decrease in the time to get the
assessment that is so important to how we provide services to
our children.
PREPARED STATEMENT
So I thank you for the opportunity to testify.
Senator DeWine. Good, Judge, thank you very much.
[The statement follows:]
Prepared Statement of Judge Lee F. Satterfield
Chairman DeWine, Senator Landrieu, Subcommittee Members, thank you
for inviting me to testify at this hearing about foster care in the
District of Columbia. I am pleased to state that due to the support of
Congress and the work of the D.C. Child and Family Services Agency
(CFSA), the Department of Mental Health (DMH), the courts and all of
other stakeholders interested in the welfare of our abused and
neglected children in this city, we continue to make significant
progress in achieving permanency for our children. In 2004, the Family
Court increased the number of dispositions in cases involving abused
and neglected children, in guardianship cases, in adoption cases, and
in termination of parental rights motions.
My testimony will focus on three areas that I believe will be
invaluable to our continued progress: (1) a joint initiative to
increase the number of termination of parental rights motions filed and
resolved in court; (2) new programs implemented by CFSA and DMH and the
intended impact on the lives of our abused and neglected children; and
(3) the DMH Assessment Center, the primary center for evaluating the
mental health needs of our abused and neglected children.
Most of these areas are directly impacted by the federal dollars
provided by the leadership of this committee. I hope they will continue
to make a positive impact in the District of Columbia foster care
system.
Termination of Parental Rights
Over the past year, there has been an increased urgency among CFSA,
the District of Columbia Office of Attorney General (OAG) and the
Family Court to remove--when appropriate--the legal barriers that are
sometimes obstacles to a child's chances of being adopted by a loving
family. The OAG and CFSA are engaged in an initiative to increase the
number of TPR filings in Family Court. The Family Court judicial
officers have participated in additional training on the management of
TPR proceedings and the importance of moving these cases forward as
expeditiously as possible. As part of the training, CFSA adoption
recruitment workers spoke to the judges about CFSA's efforts to recruit
pre-adoptive families and the positive impact that legally ``free''
children would have on their recruitment efforts. I have established a
Family Court policy that TPR motions should be considered a priority
when there are no related adoption proceedings. As we have indicated in
the past, when there is a related adoption proceeding, generally, the
parental rights are terminated during the course of those proceedings.
Finally, the Family Court, the OAG and CFSA, with significant
assistance from the Center for the Study of Social Policy, are in the
process of finalizing a Discussion Paper with recommendations about
when it is appropriate to begin a TPR proceeding and when there are
compelling reasons not to begin TPR proceedings. This effort began in
our Child Welfare Leadership Team, comprised of representatives from
CFSA, DMH, OAG, the Council for Court Excellence, and the Center for
the Study of Social Policy. It is designed to guard against over use of
the provision of law that allows for a determination of compelling
reasons not to begin TPR proceedings. The recommendations will include
criteria for making such a determination.
New Foster Care Initiatives
Family Team Meetings
CFSA has begun to conduct Family Team Meetings before the court
proceedings are initiated in cases involving abused or neglected
children. These meetings, which use federal funding, are designed to
bring all family members and other interested people together to
discuss the needs of the children and to create a plan for each child's
safety and permanency. The Family Court judges appoint guardians ad
litem to attend these meetings. The Family Court is very optimistic
about these meetings. We expect that, in many cases, when the court
proceeding begins, plans for the safety of the child and for achieving
permanency will have been established and will be presented to the
judge at the initial hearing. These meetings will decrease the amount
of time it takes to achieve permanency because relatives can be
identified earlier in the process. The relatives serve a useful purpose
in that they are available to assist the parents in absolving the
neglect issues and are available as potential permanent placement
resources.
Multisystemic Therapy
This DMH/CFSA program, which is federally funded, targets youth
ages 10-17 who are currently in or returning from residential
treatment. Therapeutic services will be provided to youth in foster
care with histories of violence, drug abuse, and school failure.
Intensive Home and Community Based Services
This DMH/CFSA program, also funded with federal dollars, will
provide intensive home focused services to children and youth who are
seriously emotionally disturbed or behaviorally disordered, and the
support teams will be available 24 hours a day, 7 days each week.
Mobile Response and Stabilization Services
This federally funded DMH/CFSA program will provide mobile crisis
support to foster youth and their biological and foster families.
Each of these new programs came online earlier this year following
an intensive preparation period that involved, among other things,
presentations to the Family Court judges. While it is too early to
report on the long-term impact of such programs on the lives of our
abused and neglected children and their families and foster parents,
the judges are very encouraged that such programs will positively
impact the well being of the children we protect in the court system.
Assessment Center
The DMH Assessment Center plays a vital role in the Family Court's
ability to protect children and strengthen families. Federal dollars
provided to DMH have made a significant difference in the past year,
substantially decreasing the time to obtain an evaluation of a child or
his or her parent. Judges report that the quality of mental health
evaluations prepared by the Assessment Center is excellent. Recently,
however, there has been some disruption in service due to a failure to
pay Assessment Center doctors. This problem is of concern, and Chief
Judge King has met with the Director of DMH to ensure that the
disruption is minimal and that a backlog of referrals for assessments
does not develop.
Conclusion
There is always more that can be done to ensure safety and obtain
permanency for our abused and neglected children, and the Family Court
is committed to using the best practices in managing the cases
involving those children. We will continue to work with CFSA, DMH and
other District agencies and organizations that serve children and
families. We are currently in the process of preparing our annual
report to Congress in which will elaborate on the 2004 Family Court
activity that affected cases of families and children in Family Court.
As in years past, this report will be filed in a timely fashion, on or
before March 31, 2005.
Thank you for this opportunity to testify and for the support this
subcommittee has provided the Family Court to enable us to ensure that
abused and neglected children in the District of Columbia find
permanent loving homes more quickly.
Senator DeWine. Ms. Meltzer.
STATEMENT OF JUDITH MELTZER, DEPUTY DIRECTOR, CENTER
FOR THE STUDY OF SOCIAL POLICY
Ms. Meltzer. Thank you, Chairman DeWine, for this
opportunity.
I'm the Deputy Director of the Center for the Study of
Social Policy, and we serve as the independent court-appointed
monitor under LaShawn A. v. Williams. Under that litigation,
the District is working toward the goals set forth in the
Federal court implementation plan which was approved by Judge
Hogan in May 2003.
The implementation plan lays out strategies that the
District has agreed to take to improve its child welfare
system, and it sets measurable targets for improvement on
performance and outcomes between June 2003 and December 2006.
As you have heard from the previous people who have just
testified, the District's Child and Family Service Agency today
is a far different and far better functioning agency than it
has been in the past. The quality of its leadership, the level
of commitment, the collaboration among the stakeholders in the
District is better than it's ever been. And over the past 3
years, there's been progressive and measurable improvement in
many areas. In addition, the system as a whole, and CFSA in
particular, is increasingly able and willing to hold itself
accountable and be held accountable for results.
This last year has been one of considerable gain, and there
are enumerable examples of success. Overall, our assessment of
progress continues to be positive, although compliance with
specific performance benchmarks, while moving in the moving in
the right direction, is not meeting established targets in many
areas. Full compliance within 2 years is going to be a reach,
but we do believe that it is possible.
Many of the District's recent accomplishments have
benefitted from the special investments of your subcommittee,
and I want to thank you and echo the thanks of others here for
that. The additional Federal funds and the purposes for which
each appropriation has been focused have provided both the
impetus and support for critical strategic reforms. There have
been many accomplishments, many related to the specific
appropriations that you've made. I'm not going to repeat them
now; they're all in my written testimony.
What I want to talk about, though, is the things that I
think could benefit from some help in the future. And I'm going
to turn to that now.
I think there are four areas where I think the subcommittee
can make additional investments to stimulate and reinforce
desired results.
Number one is meeting the needs of older youth in foster
care. The District's foster care population is unusually and
heavily weighted toward teenagers. In fact, most of the
children in foster care are very young. In the District, 43
percent of the children in care, as of the end of December,
were age 14 and over. As Ms. Donald Walker said, this is the
legacy of a system that was broken for 10 to 12 years. The
agency has a responsibility to make sure, however, that when a
child leaves foster care at age 21, they have the necessary
relationships, skills, and support to survive and succeed in
life. This is appropriately a priority area of focus with CFSA,
and they're currently preparing a comprehensive plan based on
best practices.
The Congress can assist this important effort by providing
funds for innovative service strategies, particularly for
housing and job support for teens and for efforts to connect
them with lifelong support from caring adults in their
community.
Number two would be--is expanding the availability of post-
adoption and post-permanency mental health and other support.
Again, you've heard that the District is doing a much better
job at moving children to permanency through adoption and
guardianship. They now have an equally important responsibility
to provide post-adoption and post-permanency support. Without
this help, foster and adoptive families will become reluctant
to become the permanent guardians or to adopt.
The LaShawn order and implementation plan require the
agency to offer these kinds of services. But, so far, they have
been minimally available. Funding to expand access to--by
adoptive families and permanent guardians to the special-ed
mental health services that has been recently made available to
foster families would be an important step in this direction.
Number three is improving educational outcomes for children
in foster care. Research confirms that children in foster care
are at very high risk of educational failure due to experiences
prior to coming into foster care, whether it's exposure to
prenatal drugs and substance abuse or separation issues from
their birth families, and, while in foster care, for example,
due to multiple moves while in placements, and sometimes the
lack of consistent educational services.
Social work staffs do not typically pay close enough
attention to the educational needs of children in foster care,
and school systems are usually unaware or uninvolved in the
educational progress of these children. Congress can help focus
on this issue by providing funding for joint work between CFSA
and the local school system, to better identify, assess, and
track education needs and progress, and to support strategies
for appropriate educational advocacy.
One proposal is to establish educational passports for
children in foster care so that information on their
educational strengths, needs, and progress is easily
transferred.
My last recommendation is that--regarding screening
assessments and early intervention with very young children.
Again, infants and toddlers who come to the attention of the
child welfare system or enter foster care are at high risk for
developmental delays, resulting in their lack of readiness to
enter and succeed in school.
At the same time, once these children are known to the
child welfare system, there are important opportunities to
assess their developmental progress, improve parents'
understanding of child development, link families to high-
quality child development programs, and ensure the provision of
early intervention services where needed and appropriate. I
speak a little bit more about this in my written testimony.
PREPARED STATEMENT
In closing, I thank the subcommittee for their ongoing
interest and oversight. Your support must remain strong if the
District is to be successful in meeting the requirements of the
LaShawn implementation plan and, more importantly, if it can
sustain a system with high-quality performance long after
LaShawn goes away.
Thank you.
Senator DeWine. Great, thank you very much.
[The statement follows:]
Prepared Statement of Judith Meltzer
Thank you Chairman DeWine, Senator Landrieu and other members of
the Subcommittee on the District of Columbia of the Appropriations
Committee for this opportunity to update you on recent progress of the
District of Columbia's child welfare system. My name is Judith Meltzer,
and I am Deputy Director of the Center for the Study of Social Policy
in Washington, DC. The Center for the Study of Social Policy is the
independent court-appointed Monitor under the LaShawn A. v. Willliams
litigation. The District of Columbia is working towards the goals set
forth in the Federal Court Implementation Plan, which was approved by
the U.S. District Court in May 2003. The Implementation Plan lays out
the strategies that the District has agreed to take to improve its
child welfare system and sets measurable targets for improvement on
performance and outcomes between June 2003 and December 31, 2006.
The District's Child and Family Services Agency (CFSA) today is a
far different and far better functioning agency than it has been in the
past. The quality of its leadership and the level of commitment and
expertise of staff at all levels and in all areas is better than it has
ever been and continues to grow. Over the past three years, progressive
and measurable improvements towards creating an agency that understands
and carries out its mission to protect children and preserve families
have been made. CFSA is increasingly able and willing to hold itself
accountable and to be held accountable by outside entities for results.
While the Child and Family Services Agency (CFSA) is the primary
agency in District government responsible for child welfare services,
its success in serving children and families depends also on the
effective functioning of other District agencies including the
Department of Mental Health, the Addiction Prevention and Recovery
Administration, the Office of the Attorney General and the Family
Court.
This last year has been one of considerable gain for the District's
child welfare system and there are numerous examples of success that
can and should be highlighted. Overall our assessment of progress
continues to be positive although compliance with performance
benchmarks, while mostly moving in the right direction, is not meeting
established targets in many areas. Full compliance with the outcomes of
the Implementation Plan is expected within the next two years, and
significant strides in many performance areas will be needed for the
Agency to meet this deadline. However, we continue to believe that the
compliance for outcomes can be met by the end of 2006 or early 2007.
Many of the District's recent accomplishments in child welfare
reform have benefited from the special investments of your
Subcommittee. The additional federal funds and the purposes for which
each appropriation has been focused provided both impetus and support
for critical strategic reforms that have moved the system forward.
There have been many accomplishments this year, but I wish to highlight
the following:
--CFSA's ability to hire qualified social workers and retain them has
significantly improved over prior years. The workforce is more
stable, resulting in a continued overall decline in worker's
caseloads. The caseload level is approaching the levels both
required by the Implementation Plan and where workers can be
expected to consistently provide high quality service to
families. The special federal appropriation to establish a
social work loan repayment program is important not only for
the District of Columbia, but if successful, can provide a
national model for addressing child welfare workforce
recruitment and retention.
--CFSA has an ambitious training plan to upgrade the practice skills
of workers. Importantly, they have begun implementing an
approach to practice based on principles of family engagement.
CFSA recently launched a ``Family Team Meeting'' (FTM)
initiative that is based on best practice evidence and seeks to
involve family, extended family, community support and
professionals in joint work to assess family strengths and
needs, and develop and carry out plans for children's safety
and permanency. This work also has benefited from the early
intervention appropriation by the Congress, which pays for the
training and salaries of FTM facilitators and flexible funding
for services. If successfully implemented, the use of family
team meetings should mean that more children can safely remain
or safely return to their families.
--Collaborative work with the Family Court continues to be
strengthened, and the joint CFSA/Family Court work to resolve
social work and legal barriers that for many years have kept
children lingering in foster care without permanency is moving
forward. More children than ever before were provided permanent
homes this year though adoption and guardianship (over 600
children) and there is a clear and strong commitment from the
Family Court, the Office of the Attorney General and CFSA to
take appropriate and needed actions on the approximately 500
children still in foster care who need legal permanency.
--The cooperative work between CFSA and the Department of Mental
Health is beginning to pay off. Again, with Congressional
support, there are now new mental health resources available
for assessment of children's needs, crisis stabilization
services and a range of in-home and other supportive therapies.
More work is needed as the District's mental health system
builds its capacity and quality, but there is real progress
here.
--CFSA's commitment to quality practice improvement is increasingly
evident in the quality and accuracy of its performance data and
its use of data to assess performance, identify problems and
track progress. CFSA has also launched an effort to routinely
assess the quality of their practice through a rigorous Quality
Service Review (QSR) approach that has been successfully used
in many states to support and propel continuous practice
improvement.
--After a difficult and much delayed process, CFSA has renegotiated
new contracts for congregate and family-based care with almost
all of its service providers. These contracts include clear
performance expectations and are the first step in a multi-year
process to implement a performance-based contracting system.
This means that future decisions about contracted services can
be determined by each agency's objective performance and
results.
--CFSA is working towards the full development of web-based access to
its management information system. This is another initiative
that has benefited from federal investment. Contracted agencies
that provide CFSA with foster families are now able to enter
placement data through the web-based system thereby improving
the tracking and timeliness of information, and the accuracy of
reimbursement for their foster care services. It is expected
that by December 2005, the contract agencies will be able to
enter into the web-based system all case management data
related to families and children.
Many of these improvements have been made possible through generous
appropriations by the United States Congress and with support from the
Mayor and the Council of the District of Columbia. Without Congress'
foresight, understanding of the needed reforms and commitment to
children and families, these changes would not have been possible.
However, despite real and measurable improvements, the District
still has a long road to travel if it is to become the model child
welfare system that we all desire. Problems remain in timely and high
quality investigations of child abuse and neglect; in work to safely
maintain and support children with their families and in their
communities; and to make sure that all of the children in foster care,
including the children who have been in foster care for many years, are
helped to secure permanent homes with loving families.
In looking ahead to the next few years, there are four areas where
I think the Subcommittee can make additional investments to stimulate
and reinforce desired results. They include:
Meeting the needs of older youth in foster care
The District's foster care population is unusually and heavily
weighted toward teenagers. Forty-three percent (43 percent) of the
children in out-of-home care as of December 31, 2004 were age 14 or
over. This is the legacy of a system that was broken for too long and
allowed many young children to grow up in foster care. It creates
particular challenges for developing the correct range of placements
suitable for adolescents, and the services and supports teenagers need
to grow into successful young adults. The Agency has a responsibility
to make sure that when a child leaves foster care at age 21, they have
the necessary relationships, skills and supports to survive and succeed
in life. This is appropriately a priority area of focus for CFSA this
year. They are preparing a comprehensive plan based on best practices
in supporting adolescents and their successful transition from foster
care. The Congress can assist this important effort by providing funds
for innovative service strategies, particularly in housing and job
supports for teens, and in efforts to connect them to lifelong supports
from caring adults and their community.
Expanding the availability of post-adoption and post-permanency mental
health and other support
The District child welfare system, like other systems across the
country, has done a better job recently at helping children to find
adoptive homes and permanency through subsidized guardianship; they now
have an equally important responsibility to provide post-adoption and
post-permanency supports to these children and families. Without this
help, foster and adoptive families will become reluctant to become
permanent guardians or to adopt, thus threatening the stability of
children's placements. The LaShawn Order and Implementation Plan
require the Agency to offer and provide post-adoption supports but
efforts to date have been minimal. Funding for comprehensive post-
permanency supports is urgently needed, and this is another high
priority area for CFSA this year. In addition, funding to expand access
by adoptive families and permanent guardians to the specialized mental
health services recently made available for foster families is
important to meet the needs of children as they adjust to new families.
Improving educational outcomes for children in foster care
Research confirms that children in foster care are at very high
risk of educational failure due to experiences prior to their
involvement with the child welfare system (for example, exposure to
prenatal drugs and substance use, separation from birth families) and
while in foster care (for example, multiple moves, lack of consistent
educational services). Social work staff, both in the District of
Columbia and across the nation, do not typically pay close attention to
the educational needs of children in foster care, and school systems
are usually unaware or uninvolved in the educational progress of these
children. Congress can help focus on this issue by providing funding
for joint work between CFSA and local school systems to better
identify, assess and track the educational needs and progress of
children in foster care and to support strategies for appropriate
educational advocacy and educational support services for children. One
proposal is to establish educational ``passports'' for children in
foster care so that information on their educational strengths, needs
and progress is easily transferred if their placements change, as they
frequently do, or when they are unified with birth families or
relatives.
Screening, assessment and early intervention with very young children
Infants and young toddlers who come to the attention of child
welfare systems and/or enter foster care are at high risk for
developmental delays, resulting in their lack of readiness to enter and
succeed in school. At the same time, once these children are known to
the child welfare system, there are important opportunities to assess
their developmental progress, improve parent's understanding of child
development, link families to high quality child development programs,
and ensure the provision of early intervention services, where needed
and appropriate. Quality early care and education programs can also
provide important supplemental support to families facing difficult
circumstances; help build parental resiliency, provide knowledge and
other resources and assist parents with parenting skills and child
development knowledge. While CFSA helps foster families secure child
care as a support for working caregivers, there has not been a focus or
joint work with the District's Office of Early Childhood to assure that
high quality, developmentally appropriate programs are available and
provided for all high risk infants and toddlers. Adequate funding is
one barrier that hampers efforts to address this issue, and
congressional funding for increased access to enriched early care and
education programs would make an important contribution. In addition,
the Keeping Children and Safe Families Act of 2003 requires the
development of provisions and procedures for the referral to early
intervention services funded under Part C of the Individuals with
Disabilities Act of any child under the age of 3 who is involved in a
substantiated case of abuse or neglect. Again, adequate funding for
cross-staff training and interagency collaboration for early needed
intervention services has been a barrier to ensuring that all children
in the District of Columbia who need these services get them--in time
to make a difference.
In closing, I thank the Subcommittee for their ongoing oversight of
child welfare performance in the District of Columbia. This support
must remain strong if the District is to be successful in meeting the
requirements of the LaShawn Implementation Plan, and sustain a system
with high quality performance for the District's children and families
long after the LaShawn Order goes away. Thank you and I will be glad to
answer questions.
Senator DeWine. Ms. Egerton.
STATEMENT OF MARILYN EGERTON, DEPUTY DIRECTOR, FOSTER
AND ADOPTIVE PARENT ADVOCACY CENTER
Ms. Egerton. Good afternoon, Chairman DeWine, Senator
Landrieu, in her absence.
My name is Marilyn Egerton, and I'm the Deputy Director of
the Foster and Adoptive Parent Advocacy Center, commonly known
as FAPAC. I've been a D.C. foster and adoptive parent for over
13 years. I'd like to thank you for the opportunity to testify
for the needs of the District's most vulnerable children.
I'm here today to report on the impact of the new
initiatives that the District has developed for our children
due to the generosity of the financial resources that came from
this subcommittee. I must admit that the first time we came
before you, we were a bit overwhelmed at being asked to
testify. We never expected that the testimony of our small
organization would have any impact on a congressional
committee. But you listened, and we are touched and extremely
grateful to you for providing our children with the
opportunities brought to the District by these appropriations.
The funding that came from this committee has been
instrumental in developing new, unique, and exciting
initiatives for the children in D.C.'s child welfare system.
Our closest involvement in the new programs has been with the
Metropolitan Washington Council of Governments, or COG, toward
the development of the new respite program. COG has succeeded
in establishing this program to meet the needs of our families.
I would like to identify some of the key elements of the
program. The new respite program utilizes respite families,
who, although they are trained by COG and become fully licensed
foster parents, they provide this service as volunteers. COG
chose this model of volunteer families so that the program
would be affordable and sustainable into the future.
After COG trains the families in the 30-hour pre-service
training program, all families become licensed in their
respective jurisdictions. To recruit families for respite and
for foster care, COG has attended 10 major recruitment
activities, had 11 presentations to churches and businesses,
and distributed over 50,000 brochures and flyers through
newspaper inserts.
COG has held three weekend-long training sessions. Thirty
families have been trained, and five are fully licensed. The
others are awaiting their clearance approvals. A major barrier
to expedient licensing is the 3 to 4 month wait for FBI
clearances. COG is working with the local FBI field office to
try to reduce the waiting time.
Due to the timeframe required to establish all the
components to this program, and the challenges in getting
people licensed, overnight placements have just begun. Forty-
five children from ages 1\1/2\ to 17 years old are currently
approved to receive respite services.
Another unique component of the respite program is the
daytime respite enrichment project. Many families who do not
feel comfortable leaving their children overnight for respite
prefer the ability to have daytime opportunities for a break.
Our challenge is for our blended families, those families
who have both foster and adoptive children. We are hearing of a
great need from our adoptive families to also receive respite
services, and are working to identify a means to meet these
needs.
Although we have not been as hands-on in our involvement
with the other initiatives, we do want to share our
observations about their progress and potential for our
families. We are excited about the development of the family
team meetings. As foster parents, many of us have seen, up
front--have seen, up front, the damage done when the system
does not make an effort to involve the birth families of our
children when they first come into care. We support the
identification of family members who can be potential resources
for our children up front and in the beginning. And we believe
that the work of assessing family members as resources must
start immediately.
From the start, both CFSA and DMH have been inclusive of
foster-parent input into the development of the mental health
initiatives. We think that the Mobile Crisis Access Units,
specifically, will have a significant impact on the stability
and well-being of our families. We know that mental health
crisis without crisis intervention can lead to placement
disruption. We have already heard from a few families who have
used this service, and the good word is spreading.
However, as with the respite program, when we announce
these programs, we are receiving reactions of dismay from
members of our community who are post-adoption and post-
guardianship. The special needs of their children do not
disappear with the signing of the final adoption and
guardianship decrees, but many of their services disappear.
Advocates and service providers in the District of Columbia
must come together to find ways to drastically increase the
range of services offered to families post-adoption and post-
guardianship.
In closing, I want to, again, offer our gratefulness to
you, Senator DeWine and to the other members of the
subcommittee, for the opportunities you've brought to the
children and foster families of the District of Columbia. Your
financial resources and support for the work that has been done
has helped us to all turn a significant corner toward greater
improvement in our system.
PREPARED STATEMENT
Continued funding for these crucial services is vital in
ensuring that these programs get fully institutionalized into
the framework of services available to our families.
Thank you.
Senator DeWine. Ms. Egerton, thank you very much.
[The statement follows:]
Prepared Statement of Marilyn Egerton
Good afternoon, Chairman DeWine, Senator Landrieu, and other
members of the Committee. My name is Marilyn Egerton and I am the
Deputy Director of the Foster & Adoptive Parent Advocacy Center,
commonly known as FAPAC. I have been a D.C.foster and adoptive parent
for over 13 years. Thank you for the opportunity to testify for the
needs of the District's most vulnerable children.
I am here today to report on the impact of the new initiatives that
the District has developed for our children due to the generosity of
the financial resources that came from this committee.
I must admit that the first time we came before you, we were a bit
overwhelmed at being asked to testify. As a small and relatively young
advocacy organization, we were not sure what we could offer you in the
way of meaningful testimony that would help you to assess the needs of
our children and families. So we did what we know best, and spoke our
truth. What was amazing to us was that you listened. We never expected
that the testimony of our small organization would have any impact on a
Congressional committee. We were touched in your trust in our
testimony. On behalf of D.C.'s foster families, we are extremely
grateful to you for providing our children with the opportunities
brought to the District by this appropriation.
The funding that came from this committee has been instrumental in
developing new, unique and exciting initiatives for children in the
District's child welfare system. The Mental Health programs, the Family
Team Meetings and the Respite Project all bring services to our
children and families that will have the potential to change the
landscape for our families in deep and meaningful ways.
Our closest involvement in the new programs has been with the
Metropolitan Washington Council of Governments, or COG, towards the
development of the new Respite Program. When we came before you in 2003
we stated that the lack of respite was a serious barrier for our
families. Today we can report that since March 24, 2004 when the
federal funding was received, COG has succeeded in establishing a new
respite program to meet the needs of our families. Although based upon
research in other jurisdictions, this program has unique components
specific to the needs and requirements of the District of Columbia. I
compliment both COG and Child and Family Services Agency, or CFSA, for
the many hours of work together to establish a program which meets the
needs of families, the needs of the agency, and the need for a model
that can become financially sustainable into the future. To these ends
I will identify some of the key elements of this new program:
--The new respite program utilizes respite families, who although
they are fully trained by COG and become licensed the same as
other foster parents, they provide this service as volunteers.
COG chose this model of volunteer families so that the program
would be affordable and sustainable into the future. CFSA felt
strongly that for the best safety of our children, all families
should be fully licensed foster families. This component is
unique from the model used in some other jurisdictions.
--After COG trains the families in the 30-hour pre-service training
program, all families become licensed in their respective
jurisdictions. CFSA licenses the D.C. families and appropriate
Maryland and Virginia agencies license the Maryland and
Virginia families, with CFSA approval of all families before
children are placed.
--To recruit families for respite and for foster care, COG has
attended 10 major recruitment activities, had 11 presentations
to churches and businesses and distributed over 50,000
brochures and flyers as newspaper inserts.
--COG has held three week-end long training sessions. Thirty families
have been trained and five are fully licensed. The others are
awaiting their clearance approvals. A major barrier to
expedient licensing is the three to four month wait for FBI
clearances. This is a major barrier for recruitment and
licensing throughout the metropolitan area, not just for this
project. COG is working with the Washington field office of the
FBI to see if there is anything that could be done to reduce
this waiting period.
--Due to the time frame required to establish all the components to
this program and the challenges in getting people licensed,
overnight placements have just begun. Forty-five children from
the ages of 1.5-17 years are currently approved to receive
respite services.
--We have a foster parent community that has never had consistent
respite available. As a result, part of the task has been to
educate our community about the availability and the
application process. To best inform the foster parent community
of these services, COG has been holding informational meetings
with families as well as with social workers as well as sending
out written information. Social workers are a key component. If
respite is to meet its potential as an intervention for
retention and prevention of disruption, social workers need to
be continually aware of this service and inform their families
of its availability.
--Another unique component of the respite program is the daytime
respite/enrichment project. Many families who do not feel
comfortable leaving their children overnight for respite prefer
the ability to have daytime opportunities for a break. FAPAC
has developed relationships with four fully licensed community
enrichment programs, with two more pending, for our children to
have day-long enrichment opportunities on weekends using the
federal funding to voucher our children into these programs.
These are not segregated settings for children in foster care,
but rather community programs which have expanded to embrace
our families. So far 11 families have used daytime respite and
almost 30 more families are in the approval process by their
agencies.
--The interest in respite is growing weekly as word gets out in the
foster parent community.
--One challenge is for our ``blended'' families, those families who
have both foster and adoptive children. Since these respite
programs are specific to children in foster care, those
families who also have adoptive children hesitate to break up
their children for respite placements. We are hearing of a
great need from our adoptive families to also receive respite
services, and are working to identify means to meet these
needs.
Although we have not been as ``hands on'' in our involvement with
the other initiatives, we do want to share our observations about their
progress and potential for our families. We are excited about the
development of the Family Team Meetings. As foster parents, many of us
have seen up front the damage done when the system does not make an
effort to involve the birth families of our children when they first
come into care. We have many foster families who report that over the
years they actually had to encourage social workers to find birth
families and set up visits. Also, when birth families are not involved
from the beginning, transitioning to pre-adoptive status is risky for
our foster families. There is always the potential and often the
reality of family members coming into the picture years later, when the
bonds of attachment between child and foster family are deep and
substantial, and then contested situations occur. We support the
identification of family members who can be potential resources for our
children up front and in the beginning, and we believe that the work of
assessing family members as resources must start immediately. We look
forward to social work practice shifting to accommodate the changes
that can be brought by these Family Team Meetings.
As we stated in our previous testimony, D.C.'s foster parents have
cried out for years for quality mental health services for their
children. Our children suffer many losses and wounds that make the need
for quality mental health a crucial aspect of their healing. Through
their partnership on these initiatives, CFSA and the Department of
Mental Health (DMH) have come closer than we have ever seen before in
developing a plan to meet these needs. We have been impressed with the
extensive work, thought and planning from both CFSA and DMH that went
into these initiatives.
From the start, both CFSA and DMH have been inclusive of foster
parent input into the development of these initiatives. Both CFSA and
DMH staff come out on evenings and weekends to train groups of foster
parents about these programs. The response of our community has been
extremely positive upon hearing about these new opportunities.
We think that the Mobile Crisis Access Unit specifically will have
a significant impact on the stability and well-being of our families.
We know that mental health crisis without crisis intervention can lead
to placement disruption. Our families are not used to getting help in
crisis. We believe that this service can have the potential to turn
around this paradigm and help to empower foster parents to feel
comfortable moving through those crises with their children. We have
already heard from a few families who have used this service, and good
word is spreading!
However, as with the respite program, when we announce these
programs, we are receiving reactions of dismay from members of our
community who are post adoption and post guardianship. The special
needs of their children do not disappear with the signing of the final
adoption or guardianship decrees, but many of their services disappear.
Advocates and service providers in the District of Columbia must come
together to find ways to drastically increase the range of services
offered to families post adoption and post guardianship.
In closing, we want to again offer our gratefulness to you, Senator
DeWine, and to the other members of this committee, for the
opportunities you have brought to the children and foster families of
the District of Columbia. Your financial resources and support for the
work that has to be done has helped us to all turn a significant corner
towards greater improvement in our system. Continued funding for these
crucial services is vital to insuring that these programs get fully
institutionalized into the framework of services available to our
families.
Thank you.
Senator DeWine. I think I saw Eleanor Holmes Norton come
in. I want to thank you for coming. We're always delighted to
see you here. Thank you very much.
We're going to have another vote shortly, and I'm not going
to hold this group, so when that vote occurs, we'll end the
hearing. So that means we have a condensed period of time. So
what that means is, we're going to have some written questions
for you all to help our subcommittee.
Testimony has been great. Very, very helpful.
Ms. Meltzer had four different suggestions. I wonder if I
could ask the rest of the panel to comment on those four
priorities. This subcommittee is here to help you all, and--but
we have limited resources, and--you know, we don't know exactly
how limited those resources are going to be, but we know
they're going to be limited. And so, we will hope to continue
to do some of the things that we've already started. We hope to
do some additional things. And so, I just wanted to know if I
can get some comments on maybe the four things that she talked
about.
And some of you had already mentioned several of them,
anyway, but she gave some of the latter testimony, so it's on
my mind.
Ms. Walker. Great. Thank you, Mr. Chairman. We certainly
concur with the recommendations, and I think the one theme that
you heard threaded throughout was the need for post-adoption
support services. And we would really like to come together and
talk about what some of those services would be. And there's
definitely a need. As our population----
Senator DeWine. And post-permanency, I think she said, too.
Ms. Walker. And post- --exactly--for guardianship. We're at
the point, I think, within the next year, where our caseload is
likely to cross, in terms of the number of children who have
been adopted or who are in guardianship, and the number in
care. We currently have a little over 2,000 children for whom
we are still providing subsidies, either guardianships or
adoption subsidies, and a little under 2,700 children in foster
care. And as we get more aggressive and better at moving
children to permanence quicker, we certainly are going to
cross. And that's a very good thing.
But, clearly, as we have many older children in the system,
which, again, Ms. Meltzer mentioned, and I did, as well, we are
still trying to find permanence for those young people, and
they tend to have higher needs, because many of them have been
in foster care for a long time. And if we're to encourage
foster parents or adoptive parents to take these young people
into their families permanently, we certainly need to be able
to offer the kinds of support that they'll need in order to be
successful. We certainly support that.
The educational needs are clearly there. Judge Satterfield
and I have made an outreach to the new public school--D.C.
Public School Superintendent, and with Marty Knisley, so that
we can form a team and talk about the kinds of strategies and
supports needed for our children. So I think we're very
consistent in our recommendations of what's needed.
Additionally, CFSA put in your packets our housing white
paper. And we've had some conversations with Senator Landrieu
about the need for housing. We have a number of children in our
system who are ready to be reunified with their families, and
housing is the only barrier. There's no reason that children
should be in foster care strictly because of housing. And we
want to move very quickly. We're going to use some of the money
that we got this year, the local money, to try to move those
families off of the waiting lists and reunify them with their
children. And we think that will have a tremendous impact.
Senator DeWine. Do you want to comment at any more length
about this older population, the 43 percent that's over 14?
Ms. Walker. Definitely. As I said, most of them have been
there a long time. They have very special needs. I have pulled
together a subcommittee--we have several judges and other
people who have experience with older youth or--and some who
have even grown up in foster care--so that we can have a real
strategic focus.
I think we have a lot of resources. And if you look at what
the best practices recommend, in terms of what older children
need as they age out, they need to be re-engaged in the
community, they need to have a network of ongoing support, they
need to be successful in school, and hopefully encouraged and
supported to go to college. We do those things. I just think we
have not been as strategic as we need to be. We're just
skimming the surface.
So we're bringing everybody together to look--take a top-
down look at all of the programs and services that we do offer,
and help us to figure out how we can be more successful.
Planning earlier is certainly a key. Making sure that children
who are in foster homes are supported and do not have a lot of
placement disruptions is very, very important. And encouraging
more children to go to college, to have mentors so that when
they graduate from college they have real experiences and those
connections. We're doing a lot of that. I think we've got to go
deeper.
And I'm just so encouraged that now everybody is really
focused on the older youth. And we will come back with a
strategic plan, that Judy Meltzer mentioned, very shortly.
Senator DeWine. How shortly?
Ms. Walker. We're within the next 30 to 45 days. I mean,
I'm on a fast track for this, because these children cannot
wait.
Senator DeWine. We're anxious to take a look at it.
Ms. Walker. Right. Thank you.
Senator DeWine. Ms. Knisley.
Ms. Knisley. I just want to echo. And let me start with the
aging-out youth. There are some--actually, some very
interesting best practices where the mental health services
would not change, in terms of the provider, at the magic age.
Because if you've established that relationship, we would like
to continue with the clinicians, the case workers, right
through until age 23, 24, 25, while the youth is getting
stabilized.
As a matter of fact, one of those programs actually is
operating in Columbus, another one in Rhode Island, where
there's much better success if you can keep your mental health
services stabilized through that period. And we know, talking
to many youth who have become homeless in the District, that
we've--we became familiar with after they had come through the
system, that if we could have just stayed with them, as
clinicians--and we're more than ready to assist with our new
providers in staying with youth and not just cutting them off
at the so-called ``age of majority.'' So I think that that's
one thing that we can offer with the aging-out youth.
Ms. Donald Walker and I have actually also been talking
about housing. The Department of Mental Health, because of our
adult population, particularly working with people who are
homeless or disabled, people who need affordable housing, we
have an affordable housing strategy already going in the
District. We actually even talked today, and we've talked
several times before, about joining forces on making certain
that if a family needs a home and we have--we can help with
that by combining our housing dollars with supports from CFSA,
then we can make some of those homes available that would make
reunification possible. So, yes, we can help there.
Education, I can't tell you enough about. In the District,
one of our biggest challenges is that we're still placing more
children into special education in a month for emotional
problems than the State of Maryland does in 1 year. And we know
that a lot of children are going to special education for--with
emotional problems because we haven't given our classroom
teachers and the school counselors all the tools that they need
to reduce the barriers to learning.
We're now in 29 schools with an exemplary school-based
mental health program. And the Mayor has asked me for a plan to
take that program citywide. The results are phenomenal when we
can actually get in there and get to work. And we can target
those youth who are in the foster care system, who are at the
risk or are being identified as children that we could pay
particular attention to in the schools that we're in. So
we're--we would be more than happy to participate. And it--I
just can't say enough about what we need to do in our schools.
The most--the second most problematic thing about educating
our youth is, once you go into special ed, the chance that you
are ever going to graduate from high school is almost zero.
It's just not going to happen, because there's no hope. Our
children are losing hope, and they're dropping out.
Senator DeWine. But, just so I understand, the reason
that--and you said this earlier, you talked about the
tremendous increase in the--the other part of that was, in your
first testimony, I wrote down here, you talked about the
increase in the request for evaluations.
Ms. Knisley. That's correct.
Senator DeWine. So why is all this going on? Tell me again?
Ms. Knisley. I think that what's going on is that we have a
number of youngsters who are either traumatized because of the
disruption in their home, or are--failure to reach them in some
way. And then they're presenting, then, after-the-fact, for an
evaluation, after something's already happened.
Senator DeWine. Okay, but why is that number so
dramatically going up, though?
Ms. Knisley. That number is so dramatically going up--is
because when children are identified in the child welfare
system, and when--begin to take a look at what's going on with
the family, the case workers and the judges are saying,
``There's a real problem here with this child's behavior that
we need to take a look at.'' And we're saying that what you're
seeing with children's behavior sometimes is masking depression
and hopelessness.
Senator DeWine. I won't belabor the point, but why wasn't
the--why weren't you seeing those numbers 3 years ago, or 2
years ago? You said there's been a spike.
Ms. Knisley. I believe partly because of better
identification.
Senator DeWine. Okay, that's fine.
Ms. Knisley. Yeah, I think----
Senator DeWine. We're doing a better job identifying them.
Ms. Knisley. I think--you know, it's hard to tell whether
it was better identification or more problems. And my
colleagues here could----
Judge Satterfield. Well, I have an answer to the spike----
Senator DeWine. Right. And I want to keep moving, because--
--
Judge Satterfield. Okay.
Senator DeWine [continuing]. We're going to get the bell
here in a second.
Judge Satterfield. All right.
Senator DeWine. And I want to make sure that anybody else
who has a comment for this subcommittee has an opportunity to
do so.
Ms. Knisley. Let me make one more comment----
Senator DeWine. Okay.
Ms. Knisley [continuing]. If I can, on post-adoption. If
there were some mental health services that could be offered so
that we can make adoption possible and say to those potential
adoptive parents, ``We'll stay with you,'' that will make a
difference.
Judge Satterfield. Part of the reason for the spike in
referrals with DMH is that before you put the Federal dollars
into enhancing that assessment center, we were going elsewhere,
using other providers for those services. But the assessment
center always provided quality service; they just had to
increase the capacity. So the spike is in their referrals to
DMH, although there were other providers doing that.
I'm only going to comment on the older children, because I
think that's so important, because if we don't do something to
continue to focus on that, they're going to come through the
juvenile court system and, obviously, the criminal court
system. We're doing some things now in Family Court, having
what we call benchmark permanency hearings in which all the
stakeholders--mental health and other agencies--come together
to try and provide a plan. You can do some simple things.
We actually have an expert on this in our court, and that's
a judge who aged out of the foster care system, Judge Pamela
Gray. She'll tell you that you can do some of the simplest
things, identifying someone in that child's life that's
important to him. It was her foster parent who she saw, and she
was able to rely on, after she aged out of the system. We like
to put her out there, because we like to tell the community,
``Look what you're missing out on. You could have a judge for a
daughter if you had adopted this child.'' But she tells us, you
can do some simple things, just like that. We all have support
when we leave college and when we come out of high school. We
have to identify those kind of people while they're in our
system.
Senator DeWine. All right. Anybody else?
Ms. Egerton. I'd just like to----
Senator DeWine. Sure.
Ms. Egerton [continuing]. Add to just the importance of
the--both the services for older children and the post-
permanency services. The lack of services, post-permanency, is
a very, very real barrier for families. And as a family that
decided not to adopt a child because we would lose services,
and even with, you know, the stipends continuing--because the
child was considered special needs, even with that stipend, my
husband and I were not going to be able to afford a $36,000 a
year school. So, as a family, we had to sit down with this
child and try to make sure he understood that we loved him as
much as we loved him, but that it wasn't the best decision, for
him, for us to adopt him. And that's a difficult position to be
in. And if there were a way for us to still access that service
for our child, we would absolutely have adopted him. And he
would have come out of foster care, you know--he came to us at
11, and he wouldn't----
Senator DeWine. Good point.
Ms. Egerton [continuing]. Have had to age out.
Senator DeWine. Good point.
Well, good. I thank you all very much. This has been very
instructive. We will follow up with you, maybe with formal
questions, but probably more actually with phone calls, which
is a lot faster and easier for you and easier for us.
ADDITIONAL SUBMITTED STATEMENTS
The subcommittee has received some additional statements
that we will include in the record.
[The statements follows:]
Letter From The Drenk Center
March 10, 2005.
Senator DeWine,
Chairman, Dirksen Senate Office Building, 100 Constitution Avenue,
Northeast, Rm. 192, Washington, DC 20510.
Honorable Senator DeWine: The Drenk Center would like to thank you,
the U.S. Committee on Appropriation, Members of D.C. Subcommittee and
staff for the opportunity to provide community crisis mobile response
services to the children currently apart of the foster care system who
may be residing in the District of Columbia, Prince Georges County,
Maryland and/or Fairfax or Alexandria, Virginia.
While we are a new operation here in the District of Columbia, we
have extensive experience in assisting foster care and the general
youth culture of the state of New Jersey with remaining in their
respective placements and/or homes. In the attach data we have provide
our current data, statistical support with outcomes as we have
experienced in New Jersey and expect to so provide here in the
District.
Again, thank you all for this opportunity.
Sincerely,
Katherine Gee, M.S.W.,
Program Director, DC CMRSS.
THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER
AGENCY DESCRIPTION
The Lester A. Drenk Behavioral Health Center (The Drenk Center) is
a private, non-profit organization headquartered in Hainesport, New
Jersey, that provides a wide range of behavioral health services. The
Drenk Center was founded by former Superior Court Judge Lester A.
Drenk. As a judge who often dealt with juvenile delinquents, Judge
Drenk saw a need for counseling services to address the needs of
juveniles and their families. The organization was founded as The
Burlington County Guidance Center in January 1955 and was later renamed
in honor of Judge Drenk. The agency is currently celebrating its 50th
year of providing exceptional and continuous service.
The Drenk Center's mission is ``partnering with people to provide
accessible mental health & social services that will improve our
communities.''
Our goals, as outlined in our agency's strategic plan, are:
--To continuously improve: Accessibility to service; customer service
and consumer satisfaction; the agency's visibility in the
community; and the agency's financial stability by diversifying
funding sources.
--Enhance staff skills to maximize value to the community.
--Expand community partnerships.
Since its inception, The Drenk Center has experienced tremendous
growth and has become a leader in behavioral health programming
throughout Southern New Jersey. The Drenk Center's services reach all 7
southern New Jersey counties and the District of Columbia. The agency
currently has eight sites that are located throughout Burlington
County, Cape May County, Cumberland County and one in the District of
Columbia, serving over 8,700 people annually. Our staff of well-
trained, experienced professionals focuses on partnering with consumers
to help consumers reach their goals. We strive to be creative and
innovative in how we offer services to make treatment as accessible as
possible for consumers to connect with us. Services are available 24
hours a day, every day of the year.
The agency is licensed as a Mental Health Provider by the New
Jersey Division of Mental Health Services, and is licensed by the
Division of Youth and Family Services to provide foster care. The Drenk
Center is proudly accredited by the Joint Commission on the
Accreditation of Healthcare Organizations (JCAHO).
The Drenk Center's services include:
--Emergency Services;
--Youth Residential Services;
--Wrap-around services for children/youth in their natural
environment;
--Outpatient Services (individual, family, couples and group
therapy);
--Psychiatric Services (evaluations and medication monitoring);
--Adult and Residential Case Management Services;
--Project for Assistance in Transition from Homelessness;
--Supportive Housing Program (housing and case management for adults
who have a mental illness);
--Crisis House (short-term residence for adults who have a mental
illness and are experiencing crisis);
--School-Based Services; and
--The Drenk Center serves persons of all economic levels, all ethnic
backgrounds, and all educational backgrounds. A large number of
our consumers are economically and educationally disadvantaged.
The Drenk Center has a variety of programs some of which are
entirely grant funded and some which ask for consumer contribution in
terms of payment. At no time do we turn anyone away because of
inability to pay. We will always work with consumers to put treatment
needs first and then working out a financial arrangement that is
acceptable to the consumer. We see people from all income levels and
work with all major insurance providers including Medicaid, Medicare
and managed care plans.
Mobile Response and Stabilization Services (MRSS) are offered in
Burlington, Atlantic, Cape May, Cumberland, Salem and Gloucester
Counties in New Jersey and the District of Columbia. MRSS provides time
limited crisis intervention to children and youth exhibiting emotional
or behavioral disturbances that threaten to disrupt current living
arrangements. The MRSS is family oriented, using an individualized
approach focusing on strengths. Trained response workers diffuse crises
at the site of the crisis for up to 72 hours. They also work with the
youth and family caregivers to develop an individual crisis plan for
the stabilization of each crisis and ensure that stabilization services
are delivered in the home for up to eight weeks. Response workers
intervene within one hour from time of referral. Response workers also
work with the youth and family caregivers to develop community based
support systems that will remain in place after the crisis has been
diffused and the stabilization intervention ends. Through our
experiences we have had to deal with several cultural issues in
delivering crisis stabilization and in home stabilization services.
From as simple as the consumer requesting a specific cultural, or sex
or age preference of an in-home provider to ensuring we have providers
that are linguistically and culturally competent. The demographics for
our MRSS over the past three years are as follows: Caucasian--50
percent, Black--48 percent, Am. Ind.--0 percent, Asian--0 percent,
Pacific Islander--0 percent, Hispanic--2 percent.
Collectively the MRSS programs have served 2,034 children and youth
with emotional and behavioral disturbances since the inception of
services in December 2002. The following chart identifies the types of
behaviors that are identified that required a crisis intervention.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
DC CHILDREN'S MOBILE RESPONSE AND STABILIZATION SYSTEM (DC CMRSS)
What is the DC Children's Mobile Response Stabilization System?
The concept of the Children's Mobile Response and Stabilization
System is based on the Children's Initiative Reform Agenda, which is
grounded in the belief that children/adolescents have the greatest
opportunity for normal, healthy development when ties to the community
and family are maintained. The following are three identified concepts
that the program is driven upon.
--Strategies used to achieve these goals and assist in maintaining
the system includes child-centered, strength-based processes
that cross all life domains.
--Ties to the family are of the utmost importance, any assistance to
the child/adolescent is family-focused and friendly to assure
that their needs and goals are an integral part of any planning
or implementation process.
--All interventions are community based and culturally sensitive
while working collaboratively with other child-serving systems.
--Provides time limited crisis intervention for D.C. foster children
and youth who are exhibiting emotional or behavioral
disturbances that threaten to disrupt their current foster care
placement.
--DC Children's Mobile Response System is family oriented, using an
individualized approach and focuses on strengths and needs.
What does the DC Mobile Response Stabilization System do?
The basics functions of the program are divided into two
components, Response and Stabilization. The following include the
Response function of the program:
--DC CMRSS is a support team providing interventions to assist
children/adolescents with emotional and behavioral
disturbances. Our goal is to help youth manage their response
to life stressors in an appropriate manner that would
facilitate them in maintaining their present living
arrangement.
--DC CMRSS operates 24-hours a day. We provide face-to-face in-
community response and stabilization services. There is a 72-
hour response period used to de-escalate a child in crisis and
up to 8-week period of in-community stabilization
interventions.
--During the response phase a crisis assessment is completed and the
level of intervention is determined. A safety plan is developed
prior to the response worker leaving the consumer's home and
within 24 hours an individualized crisis plan (ICP) is
developed. It is through the ICP that the level of
intervention(s) is determined and authorized. All interventions
are in-community and focus on the areas that precipitated the
crisis response call.
The following include the Stabilization function of the program:
--The stabilization phase of the program can start within the first
twenty-four hours and last up to eight weeks. In-community
individual, family, and behavioral assistance interventions are
provided to assist the youth to strengthen coping skills and to
obtain unmet needs, in order to improve the youth's ability to
remain in their current placement. Interventions maybe provided
by masters and/or bachelors level clinicians. Prior to
discharge, the youth and his/her family are connected to
resources that support the youth remaining where he/she is and
assist the youth with working on long-term needs.
--DC CMRSS recognizes that sometimes youth and their caregivers may
need a ``cooling off'' period, and it is at that time, DC CMRSS
can access a stabilization bed for up to seven days. This is
done only in an emergent situation and with the agreement that
the youth may return to his/her current living arrangement.
Success Case No 1:
IDENTIFYING INFORMATION:
Consumer is an African American female, age 15 who currently
resides in the home of foster parent, along with foster parent's
daughter, 17 year old female. The family resides in the North East
section of Washington, DC, reportedly has a history of depression, and
has been in the current placement for 30 days.
IDENTIFYING PROBLEM:
This case was referred to DCMRSS by the Access Help Line on 2/4/05.
Consumer was missing from placement 3-4 days refusing to return to the
foster parent home. Response Worker arranged meeting with Social
Worker, foster parent and foster parent's biological daughter.
PROBLEM: Foster child refused to return home as she over heard
foster sister speaking about her on the telephone with friends.
Consumer was offended and left the home.
RESOLUTION: All parties agreed to meet as CFSA, Foster parent's
daughter apologized to consumer, and they made up and went home.
Safety Plan developed and in-home stabilization services are being
received by the family on a weekly basis.
Success Case No 2:
IDENTIFYING INFORMATION
African American female, age 14 resides in Clinton, MD for past
seven (7) months. Return placement of consumer after several foster
home and residential placements. Child was 10 when lived with family
for a short period. Consumer's history included runaway, physical and
verbal abusive behavior, fire setting, medication overdose and verbal
threats towards foster mother. Client is diagnosed as having ADHD,
major depression, and post-traumatic stress disorder. As a result of
her current diagnosis, she is receiving Risperdal (1mg) and Concentra
(36mg) for treatment
IDENTIFYING PROBLEM:
This case was referred to DCMRSS by the Access Help Line on 3/1/05.
Consumer was exhibiting out of control behavior, being physical and
verbally abusive towards her foster mother and refusing to take her
medications. Foster Parent felt consumer was a threat to self and
others and parent requesting removal from home.
PROBLEM: Foster Parent requesting removal of child from home.
RESOLUTION: After several hours of intensive one on one with
consumer, jointly with foster parent and consumer, response worker was
able to resolve the crisis at hand. Intensive intervention lasted four
(4) hours. Safety plan developed, and the family agreed to receive in-
home stabilization services. The case was referred to our stabilization
unit for intensive services on a weekly basis.
______
Prepared Statement of Youth Villages
We would first like to thank Senators DeWine and Landrieu, as well
as the Committee for their commitment to improving the quality and
availability of mental health services to children and families in the
District of Columbia. Your vision in seeking empirically-based
treatment practices for the youth and families involved in the
District's foster care system is commendable. We, at Youth Villages,
are honored to have been chosen to provide Multisystemic Therapy to
these families as part of this initiative.
Multisystemic Therapy (MST) is an evidence-based model that is the
result of over twenty years of research. MST is a community based
approach to treatment. We work with children and families in their
natural environments--home, school, and neighborhood--to address
problem behaviors where they are actually occurring. In this model, the
environmental factors in a client's life--family, peers, school, and
community--are key components of treatment. We provide intensive
services that include at least three in-home sessions per week as well
as 24/7 on-call availability for crisis intervention and support. In
addition, MST utilizes a highly structured model of supervision to
insure high quality of service and model adherence. This is an
essential component as a recently completed transportability study
found that outcomes were directly related to model adherence. Youth
Villages has been providing this service in a variety of settings for
the past ten years and is currently the largest provider of MST
services in the world. In this time, what we have found is that MST is
incredibly effective in addressing issues such as runaway, truancy,
substance use, and other delinquent behaviors with youth and families
who have been deemed ``tough to treat'' by other treatment modalities.
MST as a treatment model has been highlighted as effective by the
Surgeon General and the National Institutes of Health. At one year
post-discharge, Youth Villages' outcome data shows a success rate of
70-85 percent depending on the population served.
Although we have only been providing services for a short period of
time in the District, we are already beginning to see some successes
with our cases. We would like to briefly share two of these with you
today. The first is a 14-year-old female who was referred to our
program due to runaway, truancy and physical aggression. She was at
risk of removal from her home and possible placement in foster care. We
began working with her mother on implementing consistent structure and
supervision at home and increased communication between home and
school. In the past three weeks, she has been attending school daily,
has not gotten into any physical fights, and has not runaway. Her
mother reports feeling better equipped to handle her behavior and the
chances of disruption have been greatly reduced. The second case is a
12-year-old male who has been in an out of state residential treatment
facility for the past four years. One of the barriers to bringing him
back home was some reluctance on the part of his family to take him in
due to their concerns about his behaviors. Since we have been involved,
his paternal aunt has agreed to allow him to return to her home, in
large part, due to the level of support that MST will be able to
provide. We have begun working intensively with her on preparing for
this and will continue to work with the family through the transition.
He is scheduled to return home at the end of March.
We have found that major system reforms can be achieved by
increasing services that both reunify and stabilize families. Services
grounded in science with strong outcome measurement practices will
ultimately reduce family involvement in both the child welfare and
legal systems. By increasing family responsibility, long-term foster
care placements and related expenses can be reduced. Fewer children
will remain in the foster care system and more children will remain
successfully with their families. These are the results that we expect
to replicate on a broader scale in the District of Columbia.
______
Prepared Statement of First Home Care
Dear U.S. Senate Committee on Appropriations, District of Columbia
Subcommittee--Senator DeWine, and members of the District of Columbia
Subcommittee and staff: Thank you for the privilege of standing before
you to express gratitude and appreciation for changing the course of
history in the lives of families struggling with their children's
mental health issues. It is with great honor and pride that First Home
Care, a Core Service Agency, has accepted the challenge to establish
the District of Columbia's first Intensive Home and Community-Based
Services program. As a frontline Core Service Agency, we are serving
the mental health needs of hundreds of youths and families. We are
aware of the overwhelming needs and cries for supportive and
preventative services that can empower families to effectively manage
their own challenges and maintain stability in their homes, schools and
communities. Thanks to the listening ears and devoted hearts of our
Congressional leaders, the cries of these families are being heard and
their needs are being met.
First Home Care's Intensive Home and Community-Based Services
program is designed to intervene in family crises and prevent the need
for out-of-home placements into foster care, psychiatric hospitals or
residential treatment facilities. The program transitions and monitors
youths returning from out-of-home placements to their long term family
placements. Each family is assigned a trained case manager who uses a
strengths-based approach to address the specific needs of each family.
The program has an oncall component and provides 24/7 crisis
intervention and stabilization. The families are trained to implement
preventative and proactive parenting skills and behavior/crisis
management strategies designed to reinforce parental effectiveness in
the home, school and community.
The Intensive Home and Community-Based Services program is
appropriate for CFSA children/youths between the ages of 6-21, who have
been identified as having an emotional or behavioral disturbance. They
must be residents of the District of Columbia, and at risk for being
removed from their families or long term placements.
Families of children with mental health needs are being helped at
this very moment. Children who have been recognized as ``extremely
difficult to manage'' in their homes, school and communities are being
constructively engaged, encouraged, supported, monitored and
successfully redirected. Mothers, fathers, grandmothers, aunts, uncles,
and foster parents who were at the brink of surrendering their troubled
loved ones to be removed from their homes are now receiving the long
awaited support and training they've needed to successfully manage
them.
A particular grandmother and father in this community thank you,
U.S. Senate Committee on Appropriations, District of Columbia
Subcommittee--Senator DeWine, and members of the District of Columbia
Subcommittee and staff, for allocating the funds to make it possible
for them to nurture and support their special needs child at home.
Until such services were in place, they were heartbroken and torn over
the fact that their grandson/son would have to grow up and be reared in
a strange environment by strangers. Thanks to all of you, a single
mother who suffers from her own mental health issues and a terminal
illness, is finding courage to rise up out of her deep depression and
to take control of her four children's lives and prepare them for their
futures. She was overwhelmed by their special needs as well as her own
and had given up. It's heartwarming to see her sparkling smile as she
successfully implements her duties as their mother. She is establishing
routines, and setting limits and seeing improvement in her children's
behavior. The children's school attendance and performance are
improving. She simply needed a program like Intensive Home and
Community-Based Services to acknowledge her strengths, provide support
and training to get her moving in the right direction. Without these
services, her children might have been immediately removed from her
home and placed in foster care.
There are many more ``thank yous'' awaiting you, U.S. Senate
Committee on Appropriations, District of Columbia Subcommittee--Senator
DeWine, and members of the District of Columbia Subcommittee and staff,
and even more ``thank yous'' to come from the hearts and lips of the
struggling families you have helped us reach by allocating funds for
these much needed services.
CONCLUSION OF HEARING
Senator DeWine. And we appreciate it. We look forward to
working with all of you. You've been very helpful. And we hope
we can be helpful to you to continue to do the great work that
you're doing. So thank you very much.
[Whereupon, at 4:25 p.m., Thursday, March 10, the hearing
was concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]