NCSL State Legislative Report
Analysis of State Actions on Important Issues
Returning Home From Foster Care: What Policymakers Need to Know
By Steve Christian
December 2001
Volume 26, Number 12
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 State Legislative Reports Table of Contents
Since at least 1980, reunification with family has been the preferred permanency outcome for children in foster care. This preference is expressed in law, regulation and policy at both the state and federal levels. Underlying this preference are a number of legal, clinical and administrative concerns. First, reunification is considered to be in a child's best interest because it preserves parental and sibling attachments that are important to child development and identity formation. Second, it recognizes the constitutional right of birth parents to custody of their children absent a finding of parental unfitness. Finally, reunification generally is less expensive than other permanency options such as adoption, guardianship and long-term foster care, which often involve an ongoing financial commitment from the child welfare system. As a result of the preference for reunification, roughly 60 percent of foster children return to their families of origin (see figure 1).
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Figure 1 is not available online. Please contact the author for a copy or view the Adobe Acrobat version.
Notwithstanding that most foster children eventually go home to their families, policymakers, researchers and practitioners have paid relatively little attention to what happens to children after they return home from care. Funding for reunification services is limited at both the state and federal levels. As a result, child welfare agencies in many jurisdictions do not have the resources to adequately prepare families for reunification, stabilize them afterwards and prevent foster care re-entry. Less than 60 percent of the local child welfare agencies surveyed as part of the National Study of Child and Adolescent Well-Being sponsored by the U.S. Department of Health and Human Services reported that they mandate or recommend post-reunification services. In addition, many child welfare agencies do little at the time of reunification to assess the possibility of emerging threats to a child's safety and well-being or to connect families with sources of ongoing support within their communities. As a result of all these factors, children sometimes remain in foster care longer than they need to or are returned home to families in which the problems that led to placement have not been resolved.
Why Should Legislators Care?
There are a number of reasons why state policymakers should be concerned about the well-being of foster children who are reunified with their families. Approximately 20 percent of such children eventually re-enter care within six years because of further maltreatment. The following recent changes in federal law and policy will likely require states to invest in additional resources to lower their rates of foster care re-entry.
- First, the federal Child and Family Service Review process is assessing the performance of state child welfare systems, including the number of children who re-enter foster care within a 12-month period. In FY 1998, 10 percent of the children who entered foster care had a prior foster care episode within the preceding 12 months. The national standard that states now will be expected to meet is 8.6 percent.
- Second, recent changes in federal law and regulation that are intended to shorten children's stays in foster care may place reunified children at greater risk of re-entry. Parents who are struggling with difficult problems such as substance abuse, domestic violence or mental health issues need time to stabilize their lives. Research has shown that shorter stays in foster care are correlated with higher rates of re-entry to care.
Even children who do not return to care after reunification may be at risk for poor outcomes. An article in the July 2001 issue of Pediatrics found that, compared to children who remained in foster care, children who returned home demonstrated significantly poorer behavioral and life course outcomes-including more arrests, school dropouts, lower grades, substance use, delinquency and adolescent pregnancy-six years after foster care entry. The authors state that "the study's findings strongly caution us against presuming that children who return to live with their birth parents have achieved positive outcomes."1
What Can Be Done to Ensure the Safety, Permanency and Well-Being of Children Who Reunify?
Researchers are only beginning to understand the characteristics of children and families that are correlated with re-entry to foster care. Below are a few key findings from recent research.
The following children are most at risk of re-entering foster care:
- African-American children
- Children initially placed for reasons of neglect (children who are neglected are 44 percent more likely to experience recurrence of maltreatment than are physically abused children)
- Children with serious medical and/or behavioral problems
- Children who were in foster care less than 90 days
The following family characteristics are associated with re-entry to foster care:
- History of involvement with child protective services
- Isolation and lack of social support
- Substance abuse
- Low parental competence and/or denial of parenting problems
Currently, limited research exists on what works to promote successful reunification and to prevent re-entry to foster care. Many family reunification programs are quite new and have yet to be evaluated. Some programs and approaches, however, have shown promise.
Intensive Family Reunification Services
Services originally designed to prevent out-of-home placement in the first place have shown some promise in keeping children at home after reunification from foster care. The essential elements of intensive family reunification services include a flexible combination of home-based clinical and concrete services such as drug treatment or assistance with housing, an emphasis on family strengths, low caseloads, service intensity, time-limited intervention, and efforts to connect families with ongoing supports. Some child welfare agencies are developing promising models that include a period of pre-reunification preparation, intensive services following reunification and an extended period of monitoring. Preliminary studies have shown that intensive family reunification services can pay off in terms of increased family stability.
- A study in Utah examined the effect of intensive, in-home services for a period of 90 days, beginning approximately two weeks prior to reunification. At the conclusion of the service period, 93 percent of the families assigned to the treatment group were reunified, compared to 28 percent of families in the control group. At the end of 12 months, more than 75 percent of the children in the experimental group were still at home, compared to 49 percent of children in the control group.2 Differences between the groups were maintained over a six-year follow-up period.3
- Another study in Virginia examined the effect of a service mix consisting of intensive family preservation services, visits by the birth family while the child was in care, contact between birth and foster families, increased agency support for foster families and specialized foster family training. One year after reunification, 91 percent of the reunified children were still living with their families.4
Sources of federal funding for intensive reunification services include Title IV-B of the Social Security Act, which provides funds for family preservation and reunification; TANF; the Social Services Block Grant; and targeted case management under Medicaid. A number of states have obtained waiver authority to use Title IV-E foster care funds for intensive services designed to expedite permanency, including reunification, and to reduce the number of foster care re-entries.
Shared Family Care
Another strategy to support families during the reunification process is shared family care, in which the parent and the child live in the home of a mentor for a period of four to 12 months. Shared family care is used to address a variety of needs, including prevention of traditional foster placement and transition from residential drug treatment or homelessness to independent living. Approximately 30 percent of clients in shared family care are referred by child welfare agencies for purposes of reunification from foster care. In these cases, shared family care is intended to provide a safe and stable environment in which parent and child may make the transition from separation to complete reunification. The mentor helps the parent to develop necessary parenting, household and life skills and monitors the safety and well-being of her children. Case managers support both mentors and their clients with regular visits, crisis intervention and referral to community resources. In the United States, shared family care programs exist in Philadelphia, St. Paul, Milwaukee, Colorado Springs, San Francisco and Contra Costa County, California.
Outcome data on shared family care are limited but appear to indicate that children from families that have successfully completed a program are less likely to re-enter the child welfare system than are children in regular foster care or children from families that do not complete shared family care. Of the 33 children from families that completed shared family care in California before May 2000, five (15 percent) had re-entered foster care as of May 2001, compared to 44 percent of children from families that did not complete the program.
The costs associated with shared family care are higher than those for basic foster care. Proponents, however, point out that families that graduate from shared family care are more stable and less likely to require intervention by child welfare agencies, making the program cost-effective over the long term. The average monthly cost for a parent with two small children in shared family care is $1,725, including case management costs. The average placement duration is about 6.5 months, for a total cost of $11,212. This amount is considerably higher than basic foster care, but lower than the amount typically paid for therapeutic foster care for children with serious medical, emotional or behavioral problems.
Shared family care programs are funded from a variety of sources. The primary source of federal funding is under Title IV-B. TANF funds and Social Services Block Grant funds also may be used. Title IV-E foster care funds may be used for eligible teen parents who are placed in care along with their children. California has obtained waiver authority to use Title IV-E funds for the care of adult-headed families. Some state and local child welfare, substance abuse and homeless programs also finance shared family care for their clients. Finally, some programs are using private foundation funds to support planning, start-up and evaluation and to provide ancillary services.
More information about shared family care may obtained from the Abandoned Infants Assistance Resource Center, http://ist-socrates.berkeley.edu/~aiarc/projects/projects.htm.
Reauthorization of the Promoting Safe and Stable Families Program
The Promoting Safe and Stable Families Program, created by Title IV-B, Subpart 2 of the Social Security Act, provides 75 percent federal matching funds for a number of child welfare services, including time-limited family reunification services. These services are defined as 1) individual, group and family counseling; 2) inpatient, residential, or outpatient substance abuse treatment; 3) mental health services; 4) assistance to address domestic violence; 5) temporary child care and therapeutic services, including crisis nurseries; and 6) transportation to and from any of these services. The program funds services for only 15 months after a child enters foster care. The program was authorized through fiscal year 2001. As of November, 2001, Congress was still considering bills that would reauthorize and increase funding for the program, but that would make such funding discretionary, rather than mandatory.
Conclusion
Given the current emphasis on shortening children's stays in foster care and reducing the rate of recurrence of maltreatment and re-entry to care, states need to do more to ensure the safety, permanency and well-being of children who return home from foster care. The available research underscores the need for more intensive services to support families before and after reunification. Recent research raises another important issue: Should the child welfare system alone be expected to ensure the long-term well-being of children who return home from foster care? The families of these children typically struggle with a host of issues-including poverty, substance abuse, domestic violence and social isolation-that place reunified children at risk for poor developmental outcomes, even if they manage to avoid further involvement with child welfare. An important goal of reunification should be to connect families with long-term support from a variety of community-based sources. Policymakers can play an important role in ensuring that these supports are available to children and their families, even after the end of their involvement with the foster care system.
Notes
1. Heather Taussig, Robert Clyman and John Landsverk, "Children Who Return Home From Foster Care: A 6-Year Prospective Study of Behavioral Health Outcomes in Adolescence," Pediatrics 108, no. 1 (July 2001).
2. Elaine Walton, et al., "In-Home Family-Focused Reunification: An Experimental Study," Child Welfare LXXII, no. 5 (Sept.-Oct. 1993): 473-487.
3. Elaine Walton, "In-Home Family-Focused Reunification: A Six-Year Follow-Up of a Successful Experiment," Social Work Research 22, no. 4 (Dec. 1998): 205-214.
4. James Gillespie, Barbara Byrne and Lynda Workman, "An Intensive Reunification Program for Children in Foster Care," Child and Adolescent Social Work Journal 12, no. 3 (June 1995): 213-228.
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