The Child Welfare Placement Continuum: What's Best for Children?

11/3/2019

Ideally, a child at risk of abuse or neglect can remain with his or her birth family and receive in-home services designed to strengthen and support the family, as long as there are no safety concerns and the family is willing to participate in services.

Most children who come to the attention of the child welfare system remain at home, receiving a variety of services to protect and support the family. Research indicates that a safe, stable family environment is important for children’s health and well-being. 

According to the 2014 In-Home Services in Child Welfare, Child Welfare Information Gateway, “Removing children from their families is disruptive and traumatic and can have long-lasting, negative effects. There are a number of stressors for a child that are associated with removal and can add to the initial trauma of maltreatment, including dealing with the substantiation of abuse and/or neglect findings and having to cope with parental loss (Schneider & Phares, 2005).”

Keeping children with family also allows them to remain in the same school and community with consistent access to teachers, neighbors, extended kin, friends, faith groups, coaches, sports teams and others that can provide critical support for children’s sound mental and emotional health.

The Family First Prevention Services Act of 2018 gives territories, and tribes with an approved Title IV-E plan the option to use these funds for prevention services that would allow “candidates for foster care” to stay with their parents or relatives. States will be reimbursed for prevention services for up to 12 months. A written, trauma-informed prevention plan must be created, and services will need to be evidence-based. The purpose of the Act is to provide enhanced support to children and families and prevent foster care placements through the provision of mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, and kinship navigator services.

 

 

 

 

 

 

 

However, if a child must be removed from home due to child abuse or neglect, research and federal legislation (42 U.S.C 675(5)) supports the notion that a child should be placed in the least restrictive, most family-like environment available. Additionally, Title IV-E of the Social Security Act requires that states “consider giving preference to an adult relative over a nonrelated caregiver when determining placement for a child, provided that the relative caregiver meets all relevant State child protection standards.”

If a child cannot be placed with a relative, states place children with foster families which are intended to be temporary placements until a permanent placement—such as reunification with birth family, legal guardianship or adoption—can be found. While a child is in foster care, the child attends school, the child’s family receives services and the permanency goal for most of these children is reunification with the child’s birth family.

States will also place children and youth into group or congregate care for a variety of reasons including a need for specialized services, so they can receive necessary emotional and behavioral health services in a setting that includes intensive supervision.

For more on the continuum of child welfare placements see Every Kid Needs a Family: Kids Count Policy Report and NCSL's Family First Prevention Services Act.

Placement with Birth Family: Family Preservation and Reunification

In 2017, 674,000 children experienced maltreatment in the form of abuse or neglect. Nearly 75 percent were victims of neglect, including medical neglect. The other 25 percent were victims of either physical, sexual abuse or other.

According to the Child Welfare Information Gateway, laws in all states and territories require child welfare agencies to make reasonable efforts to preserve or reunify (if the child has already been removed) the child with his/her family. For children that have been removed from home, safe reunification with the birth family is the key goal. Services used in both family preservation and reunification may include family therapy, parenting education, substance abuse treatment, home visiting and other supports designed to make the home safe and improve the capacity of the family to provide appropriate and stable care for their children. States vary in their definitions of “reasonable efforts” sufficient to satisfy this requirement. Federal law, starting with the Adoption Assistance and Child Welfare Act of 1980, also requires state agencies to demonstrate reasonable efforts. However, in some instances it is not appropriate or in the best interest of the child to seek reunification. The Adoption and Safe Families Act of 1997 provides a list of instances where reasonable efforts, which are valid in all states and territories, are not required, They include:

  1. The parent has subjected the child to aggravated circumstances (defined in state law, which may include but need not be limited to abandonment, torture, chronic abuse, and sexual abuse).
  2. The parent has
    1. Committed murder of another child of the parent.
    2. Committed voluntary manslaughter of another child of the parent.
    3. Aided or abetted, attempted, conspired, or solicited to commit such a murder or voluntary manslaughter.
    4. Committed a felony assault that results in serious bodily injury to the child or another child of the parent.
    5. The parental rights of the parent to a sibling have been terminated involuntarily.

Several states have also identified other instances where reasonable efforts are not required. For more on that check out the Child Welfare Information Gateway’s Reasonable Efforts to Preserve or Reunify Families and Achieve Permanency for Children and Family Reunification: What the Evidence Shows.

Placement with Relatives: Kinship Care

If a child must be removed from the home, placement with kin is considered the least restrictive placement option. This may include a relative, close or distant, or what is known as fictive kin. Fictive kin is a person not related to a child by blood or marriage but who has a significant and positive relationship with a child; this person may be a godparent, neighbor or family friend.

Nearly 3 million children are cared for by relatives other than their parents in the United States. Child welfare agencies in many states rely on extended families, primarily grandparents, to provide homes for children who cannot safely remain with their parents.

Kinship Care

Relatives care for 32 percent of children in foster care— or about 139,000 children—according to the Adoption and Foster Care Analysis and Reporting System.

Kinship care placements generally fall into three categories:

  • Informal kinship care where the child’s parent/s and kinship caregiver come to an agreement that the relative will take physical custody of the child for a period of time. The right to make decisions regarding the child remains with the parent, however.
  • Involuntary kinship care where the child welfare agency places the child with the kinship caregiver but does not take the child into state custody.
  • Formal kinship care is the most like foster care, where the child is taken into state custody and placed with a relative (who is a licensed caregiver) instead of a non-relative foster family home. In this arrangement, the state retains the right to make legal decisions on behalf of the child, just as they would with other foster children, but the kinship caregiver retains physical custody of the child; parental rights are not terminated

In formal kinship care, states may offer kinship guardianship assistance payments to caregivers. In 35 states and the District of Columbia, a kinship guardian may be eligible to receive federally funded title IV-E relative guardianship assistance if the child has been removed from his or her home through a voluntary placement agreement or court order; the child is eligible for title IV-E foster care maintenance payments and has lived with the kinship guardian for at least 6 months; and, being returned home or being adopted are not options for the child.

At least 33 states and the District of Columbia provide state guardianship assistance payments on behalf of the child if they are not eligible for the federal Title IV-E guardianship assistance payments and meet certain other criteria.

See NCSL’s Supporting Relative Caregivers page for more on medical consent and school enrollment, relative notification, subsidized guardianships and kinship care legislation. More information is also available in the Child Welfare Information Gateway’s Kinship Guardianship as a Permanency Option and Placement of Children with Relatives.

Placement with Foster Care Families

If a relative is not available, or is unwilling to care for the child, federal law requires the child to be placed in foster care and specifies that foster care is intended to be temporary. Foster family homes may provide the next best, most family-like setting.

Number in foster care on September 30, 2018 .......... 437, 283

Number who entered foster care in FY 2018 .............. 262,956

Number who exited foster care in FY 2018............... 250,103

Data from The AFCARS Report, August 2019

Non-Relative Foster Families

Of the more than 400,000 children in foster care at any given time, approximately 46 percent, or 198,753 children, are placed in a foster family home with a non-relative.

Recruitment and Retention

States struggle with recruitment and retention of foster families as well as providing services to foster families once a child is placed with them. In response to the recruitment and retention struggle, Nebraska’s Department of Health and Human Services, Division of Children and Family Services created a 2015-2019 Foster and Adoptive Parent Recruitment and Retention Plan. The plan details existing strengths and challenges as well as goals and strategies for moving forward. See the National Resource Center for Diligent Recruitment at AdoptUSKids publication Enhance Recruitment and Retention Practices. See also the Annie E. Casey Foundation's Children Need Amazing Parents (CHAMPS) campaign which lists six policy priorities for supporting foster parents:

  • Strengthen relationships between birth and foster parents. 
  • Implement data-informed recruitment and retention efforts.
  • Engage foster parents in decision-making.
  • Provide timely access to trusted, dedicated staff and peer support to foster parents.
  • Prioritize placements with family members and other family connections.
  • Ensure timely access to physical and mental health services.

Reasonable and Prudent Parenting Standard

In an effort to support children and youth in foster care, especially older youth facing the transition out of foster care, and to encourage the development of the most family-like settings for children in out-of-home care, the federal Preventing Sex Trafficking and Strengthening Families Act of 2014 requires states to establish and define a “reasonable and prudent parenting standard.” That, along with state initiatives to create foster parent and foster child bill of rights, are examples of strides that states are taking to ensure that children who cannot stay at home are placed in the least restrictive, and most family-like setting.

So far, 24 states and D.C. have established a reasonable and prudent parenting standard that allows foster parents to make decisions on behalf of the children, particularly when it comes to extracurricular activities, in a way most similar to that of the child’s birth parent. In addition to the reasonable and prudent parenting standard, 17 states have enacted foster child and foster parent bill of rights laws to further support and strengthen foster care. See NCSL’s Foster Care Bill of Rights for a look at how states have enacted these provisions; also see NCSL’s searchable, online Child Welfare Enacted Legislation Database for ways states are supporting foster care.

Treatment Foster Care

Treatment foster care (TFC) combines elements of family foster care and residential treatment centers. TFC allows children in out-of-home care to be in a family-like setting while receiving clinical treatment for severe mental, behavioral and emotional health needs. TFC foster parents are specially trained to care for children with heightened medical needs.

Placement into Residential Treatment, Group Home or Congregate Care

Just over 400,000 American children live in foster care, and some 47,000 reside in group homes, residential treatment facilities, psychiatric institutions’ and emergency shelters. This type of placement—called “congregate care”—may be beneficial for children who require short-term supervision and structure because their behavior may be dangerous.

However, many officials believe that children who don’t need that type of intense supervision are still in these group placements—depending on the state, between 5 percent and 32 percent—making it harder to find them permanent homes and costing state governments three to five times more than family foster care.

A recent federal analysis of Adoption and Foster Care Analysis (AFCARS) data revealed important information about children and youth placed in congregate care settings in the U.S.  The number of children placed in congregate care dropped between 2004 and 2013 from 18 percent to 14 percent. However, children who were placed in a congregate care setting during their time in foster care were more likely to have been removed from the home for “child behavioral problems” compared to other children in foster care and were shown to have been in foster care an average of seven months longer than those children who never experienced congregate care.

The Family First Prevention Services Act of 2018 now has important new requirements for congregate care placements. This includes a limit of two weeks on federal payments for placements that are not foster homes or qualified residential treatment programs. This rule takes effect Oct. 1, 2019. Exceptions include the following circumstances:

  • Juvenile justice system (states may not incarcerate more juveniles under this provision).
  • Prenatal, postpartum or parenting support for teen moms.
  • A supervised setting for children 18 or older.
  • High-quality residential activities for youth that have been victims of trafficking or are at risk of it.
  • States may delay the implementation of this part of the legislation for two years, but if they choose to do so they will delay funding for prevention services for the same length of time.

For a setting to be designated as a qualified residential treatment program, it must meet the following qualifications:

  • Licensed by at least one of the following:
    • The Commission on Accreditation of Rehabilitation Facilities.
    • Joint Commission on Accreditation of Healthcare Organizations.
    • Council on Accreditation.
  • Utilizes a trauma-informed treatment model.
  • Must be staffed by a registered or licensed nursing staff that:
    • Provide care within the scope of their practice as defined by state law.
    • Are on-site according to the treatment model.
    • Are available 24 hours a day and seven days a week.
  • Be inclusive of family members in the treatment process if possible, and documents the extent of their involvement.
  • Offer at least six months of support after discharge.
  • Within 30 days of a youth being placed in a qualified residential treatment program, an age-appropriate and evidence-based review must be performed to determine if a qualified residential treatment program is the best fit for them.
  • The court must approve or disapprove the placement within 60 days and continue to demonstrate at each status review that the placement is beneficial to the youth. The state must also show that progress is being made in preparing a child to be placed with a family, in a foster family home or with an adoptive parent.

For more, see NCSL's Family First Prevention Services Act, NCSL’s Finding a Way Home article in State Legislatures Magazine and NCSL’s Congregate Care, Residential Treatment and Group Home State Legislative Enactments 2009-2013.

This information was adapted from “A National Look at the Use of Congregate Care in Child Welfare,” a product of the Children’s Bureau.

About This NCSL Project

The Denver-based child welfare project staff focuses on state policy, tracking legislation and providing research and policy analysis, consultation, and technical assistance specifically geared to the legislative audience. Denver staff can be reached at (303) 364-7700 or childwelfare@ncsl.org.

NCSL staff in Washington, D.C. track and analyze federal legislation and policy and represent state legislatures on child welfare issues before Congress and the Administration. Staff in D.C. can be reached at (202) 624-5400 or cyf-info@ncsl.org.

Additional Resources