To provide an array of perspectives on the future direction of foster care, we asked experts across various disciplines and backgrounds to respond to this question: “How can the child welfare system be improved to better support families and promote the healthy development of children in foster care?”  Susan H. Badeau's response follows.

My husband and I first became foster parents in 1982. In the 20 years since then, we have fostered more than 50 children and teens, adopting 20 children along the way. At the same time, in my career as a child welfare caseworker, I was involved in placement decisions for hundreds of children and their biological, foster, and adoptive families. With those experiences in mind, I would argue that a conversation about improving the system should begin with a discussion of guiding principles. If policymakers and practitioners at the federal, state, and community level were to agree to a basic set of guiding principles, multiple strategies to serve children and families would emerge and would likely be successful. As a way of beginning this conversation, I propose six key principles.

1. Do no harm
Any policy discussion or shift in practice should begin with a strong commitment to ensuring that no child or family will be worse off after intervention than they were before. No one works in child welfare with a goal of hurting children. Yet the cumulative effect of the patchwork approach to child welfare policy and practice is that children and families are often hurt more by the system than they were by the circumstances that brought them to the system in the first place.

One of our first foster care experiences was with a teenage boy, “Jerry.” When he arrived in our home at the age of 14, he was desperately behind in school, severely depressed, and addicted to sniffing glue, paint, and other chemicals. We eventually learned that Jerry had been a “healthy, normal” six-month-old when he was removed from the care of his developmentally disabled mother, ostensibly because of neglect. In the ensuing years, Jerry experienced 17 foster care moves, and was physically and sexually abused in at least 3 of these placements. During the same period, his mother, despondent over the loss of her son, became depressed and lost her job. She received no supportive services, and, as a result of chronic unemployment and homelessness, eventually became a prostitute. Throughout his teenage years, Jerry was involved in escalating criminal activities, and he is in prison today. Jerry and his mother were clearly harmed more by the system's intervention than by the “neglect” that first brought Jerry to the attention of child welfare workers.

Children who have spent time in foster care have negative outcomes in numerous areas, including physical and mental health, educational achievement, and social development. Although some of these outcomes can be attributed to factors that were present before a child came into contact with the child welfare system, prolonged foster care, particularly involving multiple placements, undoubtedly contributes to the negative outcomes.

2. Focus on the whole child, in context
Policy and practice must be structured to serve children within the context of families and communities. The structure should provide opportunities and incentives for multiple systems — including health, mental health, education, employment and income support, and justice as well as child welfare — to collaborate on behalf of children before, during, and after their involvement with foster care. Although some strides have been made, serious gaps exist. For example, children in foster care are entitled to receive health and mental health care services through Medicaid, but no policy initiative ensures continuity of health care coverage for children who return home after a period in foster care. Services that “wrap around” both the child and the family should be a high priority in discussions regarding improvements in the child welfare system.

Recently the media have presented heart-wrenching stories of children with mental health challenges being placed into state custody for foster care because their families concluded that this was the only way to secure a mental health diagnosis and ongoing treatment. Early in our experience as foster parents, “Kyle,” a cute but “wild” 11-year-old, was placed in our home. Kyle's parents had become increasingly unable to cope with his erratic and challenging behavior, and after several years of frustration, they decided to place him in foster care. Within six months, we obtained a mental health assessment for Kyle and he began treatment, which included medication. Nine months after entering foster care, he was stable enough to return home. Upon leaving foster care, however, he lost his Medicaid coverage. His parents could not afford both therapy and the medication for Kyle. Within a few months, he had deteriorated to the point where he was returned to foster care.

3. Uphold connections to family and other significant relationships
Children need constancy, connectedness, and a sense of belonging to thrive, as detailed in the article by Jones Harden. Even when a child clearly will not be well served by returning home, and no relatives are available to provide a permanent home for the child, children must be allowed to maintain the connections that have been significant in their lives. Sibling relationships, in particular, should be carefully preserved in all but the most extreme circumstances. Our oldest six children are siblings who had been separated and scattered across a large state for several years while in foster care. When we adopted them, they had to move across the country to join our family. Someone asked the 17-year-old why he wanted to uproot himself in the middle of his junior year in high school and move 3,000 miles away to start over. “To be reunited with my siblings,” he replied, “it is worth it.”

Adoptions that incorporate a degree of openness, allowing a child to maintain some contact with parents and other relatives, should become the norm. Paternal as well as maternal family connections should be explored and honored. After more than 15 years of separation from her birth father, one of our daughters, “Betty,” recently got to know not only him, but also her half siblings, aunts, uncles, and cousins on his side of the family. We learned that her birth father's family had never been considered as a resource when Betty entered foster care as a young child. Clearly, many family members could have been either a placement or resource for her. Instead, she bounced around between seven foster and group home placements.

Families and children themselves should determine who is significant in a child's life; child welfare agencies should take steps to ensure that both sides of a child's family are contacted when a foster care placement is imminent. Instead of viewing “lasting versus binding” as competing concepts, as described in the article by Testa in this journal issue, we should think about ways to provide children with family connections that are both lasting and binding. A legally binding relationship with a relative (as in a permanent legal guardianship) or an adoptive family does not eliminate the need for a child to continue to have lasting connections with other important people in his or her life, including siblings, birth family members, and former foster families.

4. Consider the child's developmental needs, timetable, and lifetime needs
Remember how far away summer vacation seemed at the beginning of a new school year when you were a child? Interventions for children and their families must respect and account for children's timetables. Too often, child welfare policies and practices take a “one-size-fits-all” approach. Instead, service delivery should look entirely different for infants, toddlers, school-age children, and adolescents. During our tenure as foster parents, my husband and I cared for an equal number of infants and adolescents. One thing that constantly amazed me was how similar the case plans looked, whether for a medically fragile baby or a college-bound teen. In particular, “parenting classes” for the birth parents were the same for everyone, regardless of whether they were the parents of infants, adolescents, children with developmental or mental health challenges, or children with relatively normal cognitive capabilities.

In addition, although foster care is meant to be shortlived and temporary, it must be cognizant of children's lifelong needs. Child welfare policy and practice must not only focus on the immediate health and safety of children in care, but also lay the foundation for healthy adult lives. Children eventually grow up, and as most of us can attest, they will continue to need family, supportive relationships, and healthy environments as adults.

5. Culturally respectful approaches, not unequal treatment
Principles 2 and 3 above, if implemented with honesty and integrity, will result in culturally respectful and competent practices involving a child's family, kin, and community in every aspect of their experience with the child welfare system. As noted in the article by Wulczyn in this journal issue, significant differences are seen in the quality of care and outcomes for children in the child welfare system depending on their race and ethnicity. This is clearly unacceptable. Yet, in an effort to ensure that such disparities are erased, we must not ignore the significance of racial, ethnic, and religious factors in children's development and long-term wellbeing. For example, one of our foster sons was better served by moving to another state, where he could be placed with an Orthodox Jewish family, similar to his family of origin. Other children are best served by remaining in the neighborhood and school system they are most familiar with. Child welfare policy needs to account for, embrace, and encourage respect for cultural differences while ensuring fairness and equality in expected outcomes for all children.

6. Outcomes-based approaches should not eliminate innovation
Given the sufficiency of data and research in the field of child welfare, we can legitimately expect to see evidence that programs and support services will be effective before investing in them. However, the focus on outcomes should not be used as a limiting factor discouraging our best thinkers from stretching toward even better opportunities and outcomes for all children and families. To serve the best interests of children, families, and communities, we should provide professional environments that encourage social work staff and researchers to innovate and take the risks needed to make continued improvements in the system. In our family, when four siblings we later adopted first came into foster care, kinship placements and subsidized guardianship were relatively new approaches. Had the child welfare agency been encouraged to be creative and innovative, social workers there might have considered a guardianship placement with the children's cousin, a schoolteacher with a stable home environment who cared a great deal about them. However, because this was an “untested” approach, agency staff did not explore it, and the children lost an opportunity to remain permanently connected to their family of origin. After multiple foster care placements, they landed in our family, and over the years we were able to reestablish this tie to their birth family.

Unfortunately, lack of public will remains a serious barrier to making genuine improvements in the care of vulnerable children in our society. Transforming the child welfare system, in the ways in which I have suggested will require a groundswell of public interest in and support for these children and families.
 

This feature: Children, Families, and Foster Care, Vol. 14, No. 1, Winter 2004.
From The Future of Children, a publication of the David and Lucile Packard Foundation.