Reducing Congregate Care Placements: Strategies for Judges and Attorneys

September 6, 2018

In a 2017 survey by Child Focus, 80% of attorneys and 76% of judges agreed with the following statement: “Children in foster care should only be placed in non-family settings (shelters, group care, residential treatment) when such placements are therapeutically or medically necessary.”[1] So what role can attorneys and judges play to make this vision a reality? In the following article, Judge Kim Berkeley Clark shares actions she has taken to reduce congregate care placements by 60% in five years in her community.

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A teen girl with severe mental health needs enters Judge Kim Berkeley Clark’s court in Pittsburgh, PA for a review hearing. She had previously been adjudicated dependent and placed for three months in a residential treatment facility, where she gradually progressed. In the past, the placement recommendation would have been continued congregate care. Not today. After extensive efforts to identify the girl’s family and supportive connections, her caseworker found an aunt able to help.

Judge Clark orders preplacement visitation with the aunt, starting at the residential treatment facility and gradually moving to offsite day visits then overnight visits. She also asks the child welfare agency to arrange meetings with the residential treatment facility to help the aunt understand the girl’s needs and what services and supports she will need. As a kinship caregiver, the aunt will become licensed through the agency and eligible for subsidies in line with foster caregivers.

With regular court oversight to monitor progress at the residential treatment facility, the girl continues improving while establishing a closer relationship with her aunt. The caseworker and a counselor at the residential treatment facility have taught the aunt about the girl’s medication regimen, how to keep her on track through regular psychiatric appointments with a local provider contracted by the agency, and strategies and supports to help her assimilate into school and the community.

After three months, Judge Clark orders the girl’s transition to placement with her aunt. The girl responds well to the home environment with a family member, in-home supports, regular counseling, medication management, and integration into a public school and community activities. However, she has some behavioral issues in the aunt’s home. After running away and engaging in some negative activity, a decision is made to return her to residential placement through juvenile probation with a goal to reunify her with her aunt. Another potential foster home with a family friend has been identified if it doesn't work out with the aunt.

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In Allegheny County, Pennsylvania, where Judge Clark has presided over the Family Division of the Fifth Judicial District of Pennsylvania for 21 years, the Office of Children, Youth and Families (OCYF) has a goal of no children in congregate care. With a current 5% congregate care placement rate, the goal is in sight yet there’s still work to do. “[W]e still think that congregate care number is too high,” said Judge Clark, “but we’re working on it.” (State congregate care placement rates vary significantly. In federal fiscal year 2014 the national average was 14%, ranging from a low of 5% to a high of 31%.[2])

Reducing reliance on congregate care for children in Allegheny County is rooted in the growing awareness that placements in group homes and residential treatment facilities lead to poor outcomes for children. Allegheny County has set out to change these outcomes by ensuring congregate care is only used for children with severe mental health or substance abuse treatment needs. From 2012 to 2017, the number of children in congregate care settings declined by 60%.[3] Judge Clark shared steps she and Allegheny County have taken and strategies for judges and attorneys to reduce reliance on congregate care.

Clearly define when congregate care is appropriate.

A narrow population of children and youth are placed in congregate care in Allegheny County. “The only kids where I think there’s a legitimate reason to send them to congregate care are those with such extreme mental health needs requiring a hospital bed or those with high addiction issues who need residential drug treatment,” said Judge Clark. An example is a youth IV-heroin user who would benefit from longer-term residential treatment to recover. A child with severe mental health issues/concerns who is engaging in harmful behaviors, such as suicidal ideation or aggression towards their family, would also require a hospital setting to provide mental health treatment and regulate medication.

Engage family when a child is placed in congregate care.

Involving the child’s parent and extended family helps support the child and strengthens permanency planning. For dependent children placed directly in congregate care, the court and agency actively look for the child’s family supports. “We do a lot of family finding and are constantly updating connections and supportive adults for a young person,” said Judge Clark. This is critical to identify potential placements and supports for children who will transition from congregate care to a kinship or foster placement, and for youth old enough to transition from foster care to independent living.

Sometimes a child living at home or in foster or kinship care may end up in congregate care because of serious behavioral issues requiring a high level of care. “The goal is clearly to go back home or to be placed in kinship or foster care,” said Judge Clark. “The idea is for the family to visit them in placement, engage with the treatment teams at the facility, and engage with family therapy when recommended,” she said. Home visits with the parent or kin caregiver and services to help the child return home or to a kinship or foster placement are essential. Sibling visitation is also arranged to help maintain sibling ties.

Efforts address barriers to family involvement. For example, the agency provides parents and family members transportation to facilities for visits and some congregate care providers arrange transportation for parents as part of their contracts to allow them to visit the child and join family therapy and other services. If a parent’s own issues prevent the parent from visiting the child, the court and agency work to try to limit any negative impact on the child. Congregate care facilities are also discouraged from making visits with family a reward or punishment for a child’s good or bad behavior.

Increase kinship placements.

A focus on increasing kinship care placements is key to Allegheny County’s success. Currently 70% of dependent children who have been removed from their families are in kinship care (well above the national average of 14% in federal fiscal year 2014[4]). Many children placed with kin can avoid congregate care when services and supports are in place that allow the child to work on challenges and make progress while in kinship care. “Wherever possible that you can put services in the home to prevent [congregate care] placement, that’s the best-case scenario,” said Judge Clark.

Kin caregivers in Allegheny County are licensed and paid in line with foster caregivers. Judge Clark explained that in the past it was assumed relatives had a duty to care for kin. The reality was a single parent with limited financial resources, or a married couple with three kids of their own, could not take in nieces and nephews without financial and other supports. The OCYF director recognized this and committed to supporting kinship care by paying and training kin caregivers. A separate agency was created to provide counseling and emotional support for kin caregivers, and arrange respite care. These supports attract and retain kin providers and ensure children benefit while in kinship care.

Visit congregate care facilities to evaluate them firsthand.

Judge Clark visits congregate care facilities where children are placed to see and learn how they operate. She asks: Would I want my child to be here? and If I were a kid, would I want to be here? “If the answer to that is no, then that’s a big issue,” she said.

Staff quality is also important when evaluating facilities. Staff quality indicators include training, longevity, and ability to build relationships with children and provide them opportunities and experiences they may not have gotten at home.

Studying child outcome data helps identify programs that are working well, not just making a good appearance. Judge Clark recalls visiting congregate care facilities when she was a new judge that were beautiful and looked like college campuses with a lot going on,” she said. “But when you looked at outcomes, they weren’t good and you had to ask why?” In contrast, other facilities that appeared stark had data showing successful outcomes, such as helping youth stabilize and address their mental health or drug issues, transition from congregate care to a more family-like placement or independent living, and join community activities. “Don’t be afraid to look at the data,” said Judge Clark.

Talk to children in congregate care to learn what works.

Judge Clark makes a point to hear from children in congregate care about their needs and experiences. For kids who are doing well, she wants to know what worked for them. For children who have been in more than one facility and done poorly in one but great in another, she finds out why. Was it the staff, physical aspects of the facility, quality of services received, ability to make children feel safe and respected, ability to provide experiences that kids might not otherwise receive, ability to help kids develop achievable goals? “Listening to what the kids have to say and seeing with your own eyes where you’re sending them is hugely important,” said Judge Clark.

Set high quality standards for congregate care providers.

When OCYF set a goal of no children in congregate care, a shift occurred in the quality and types of services congregate care providers were expected to offer. “We met with providers and said we want you to do something different,” said Judge Clark. For the court and agency to continue sending children to them, they were asked to increase supervision, improve facility quality and safety, provide community-based services, and give children normal experiences, such as attending public school, joining extracurricular activities, getting jobs, dating and engaging in social activities, and learning to drive.

Some providers stepped up to the plate, while others closed. Outcomes improved for those facilities that changed. Children received tailored services and supports that helped them stabilize their mental health or addiction issues so they could transition to family-based placements. They also received services to address trauma histories, gain life skills, build self-esteem and self-worth, integrate into the community, and experience normal activities.

Judge Clark cited a residential provider for girls in downtown Pittsburgh that started incorporating empowerment strategies for girls, trauma therapy, and community-based services. Girls get bus passes to attend public school like other children. There is a mother-baby program for teen parents that provides a safe environment to raise a child and learn how to parent. Its convenient location in the city also makes it easy to access some of the best services available in the county. Another provider in a more remote location serving a highly impoverished population started providing opportunities for vocational and employment training.

Routinely monitor congregate care placements.

Regular court oversight when a child is in congregate care helps ensure the child’s needs are being met, the child is progressing, and a transition plan is in place. Questions Judge Clark asks at review hearings include:

  • What are you doing to get this child out of this group home to go home or into foster or kinship care?

  • What are you doing to meet the needs of this child in congregate care and make life more normal?

  • Is there anything the child wants?

“We want to make sure with this population that they’re moving toward being discharged from congregate care to a foster care home or kinship care,” said Judge Clark. While dependency cases in Allegheny County are reviewed every three months, congregate care placements often receive more frequent attention. “We might be reviewing every 30 days or so to make sure we have our eyes on it,” she said. This keeps people on their toes and ensures expectations are being met.

Judicial oversight of congregate care placements is especially critical now because sections of the Family First Prevention Services Act (FFPSA), which become effective in October 2019, will limit federal financial support for congregate care placements. The provisions call on judges to play a critical role determining the need for residential placement and monitoring such placements regularly during the case. For example, a qualified individual must assess the child’s placement in a residential facility within 30 days and a judge must review that assessment within 60 days to ensure residential placement is appropriate and meets the child’s needs in a way that a family foster home cannot. A shortage or lack of foster family homes will not be considered an acceptable reason for residential placement. Judge Clark said Pennsylvania is starting to discuss the provisions, how they mesh with existing practice, and implementation issues at their state judges’ roundtables.

Don’t give permission for congregate care.

An ah-ha moment came for Judge Clark when the OCYF director told her: If you don’t want us to put kids in congregate care then don’t give us permission. The caseworkers can only do what you give them permission to do. Judge Clark said she realized congregate care was sometimes the easiest out for them. “When I stopped giving them permission, guess what, they were able to find other placements for kids,” she said. She started giving permission just for kinship or foster care. Aside from cases where the child’s needs clearly warranted congregate care, she only changed her position when thorough efforts to identify a kin or foster placement were unsuccessful.

Plan to transition children from congregate care.

Transitioning to a family-based placement is the goal for most children in congregate care. “We really don’t want kids to languish in a group home,” said Judge Clark. “If they have to go, it should be for a clearly defined purpose and for a short period of time until we can move them home, to foster or kinship care, or living on their own.”

Judge Clark helps transition children to kinship or foster care by arranging preplacement visitation with the prospective caregiver. This approach allows the child and caregiver to build a relationship gradually. It starts with the caregiver going to the facility to meet the child and facility staff to get a full picture of the child’s needs. Visits progress by allowing the caregiver to take the child off-grounds for day visits, followed by overnight visits. Once a bonded relationship forms, the child and family are ready for placement. This process takes two-to-three months for some children, longer for others. “The benefit is it usually lasts,” said Judge Clark. “It is a slow process on the front end but it can create a better chance of permanence.”

For older youth, age 17 or 18, who don’t want to go to a foster or kinship home, Judge Clark honors their wishes and moves them toward independent living. Family supports and positive adult connections are critical in this process. By law in Pennsylvania judges must get the first and last name of at least one supportive person during transition planning for older youth. Judge Clark tries to get three names and ensures youth have strong, positive relationships with these adults.

 

Innovative efforts in Allegheny County and Judge Clark’s court ensure congregate care is reserved for children who truly need it. An emphasis on safe, high-quality congregate care facilities that meet children’s needs and help them progress and move toward less-restrictive, family-based placements ensure it is a short-term solution.

 

Claire Chiamulera, legal editor, ABA Center on Children and the Law, is the editor of CLP Today.

 

This article is one in a series on innovative court approaches to address pressing child welfare issues. Funding for this article was provided by the U.S. Department of Justice Office of Juvenile Justice and Delinquency Prevention through Award #2015-CT-BX-K001 to the National Council of Juvenile and Family Court Judges. Points of view or opinions expressed are those of the contributors and do not necessarily represent the official position or policies of the funder or the National Council of Juvenile and Family Court Judges. 

 

Resources

Every Kid Deserves a Family: Safely Reducing Reliance on Group Home Placements for Children in the Child Welfare System - A Judicial Toolkit

Toolkit for judges, attorneys, and advocates to guide decisions that ensure the least-restrictive and most family-like placements possible for each child under court jurisdiction.

Youth in Congregate Care Settings

Information packet highlighting the use of congregate care in child welfare, highlights of research about outcomes for youth placed in congregate care, and select resources.

Kids Count Policy Report: Every Child Needs a Family

This Annie E. Casey Foundation report highlights placement trends for children in the child welfare system, emphasizes the need for family and normal experiences, and includes practice recommendations.

 

Endnotes

[1] Annie E. Casey Foundation. Survey Results: Judges’, Attorneys’ and CASAs’ Perspectives on Non-Family Placements (PowerPoint presentation), June 2017.

[2] National Center for State Courts. "Non-Family Placements: What We Know." Reducing Reliance on Non-Family Placements: A Judicial Toolkit.

[3] “Allegheny County Out-of-Home Placement Care Types, 2012-2017.”(PowerPoint slide). Citing KIDS Report Portal data; point-in-time counts on 12/31 of each year. Extracted on 5/17/2018 by ACDHS-DARE

[4] Child Trends. State Child Welfare Policy Database: Foster Care Facts FFY 2014, United States.

 

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