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​New Child Welfare Law Will Help Keep Families Together

Valerie Borum Smith, MD, FAAP
July 23, 2018

At 15, Ashley* entered foster care for the first time. Since she was a young child, her mother had struggled with depression. Without access to mental health treatment, her mother’s condition worsened significantly over the year leading up to Ashley and her three younger siblings entering care.

As depression prevented her mother from adequately caring for her children and home, Ashley demonstrated her strength and bravery by helping to fill in the gaps. Every morning she would make sure her younger brother and sisters got dressed and made it to the school bus with their backpacks. Each afternoon she would help them with their homework, and every evening she would read them books and tuck them into bed. Her identity was firmly grounded in her role as caretaker and protector for her siblings.

Eventually, the crippling depression that Ashley’s mother suffered became so deep that she was unable to provide a safe home for her children. That’s when Ashley and her siblings were brought into foster care.

Ashley’s younger siblings were placed in a foster home, but there were no foster families willing to take four children, including an adolescent. So, Ashley was placed in an emergency shelter--separated from her brother and sisters now, in addition to her mother. The trauma of this separation and the uncertainty of whether her brother and sisters were safe weighed heavily on Ashley, and she began to struggle with her own depression.

After three weeks in the emergency shelter with no mental health support services and no clear plan for reunification with her siblings, Ashley reached her breaking point and tried to hang herself in the shelter’s bathroom. The shelter staff, untrained in identifying signs of trauma, depression, and anxiety, had not recognized that she was in crisis.

#AAPvoices blogger Dr. @ValerieBSmith describes how a new child welfare law could have helped a patient whose mother had debilitating depression. The girl was so distressed at being placed in care apart from her brother and sisters that she attempted suicide.

Ashley is alive today because another child happened to walk into the room in time to get help. We can’t expect vulnerable children to count on that kind of serendipity; they need systems and services that meet their needs and provide for the best possible outcomes. 

 

The Family First Prevention Services Act, a new federal law enacted in February 2018, will help transform our child welfare system to better serve children like Ashley. At every step of Ashley’s journey, Family First policies could have made a significant difference in her family’s fate.

Family First could have provided mental health services for Ashley’s mother, for example, potentially avoiding the need for her children to enter foster care. Family First will allow states for the first time to utilize federal dollars previously restricted to paying for foster care to also provide prevention services for families with children at risk.


These services include substance use disorder treatment, mental health services, and in-home parenting supports. By providing evidence-based services to caregivers and children, Family First can reduce the number of children entering foster care and safely keep families together.


By transitioning how the federal government provides foster care funding, Family First also ensures that a child is placed in the setting that will most appropriately meet his or her needs throughout a stay in foster care. We know that the vast majority of children are best served in family-based settings. Unfortunately, many children like Ashley are placed in group homes or residential facilities not because they need specialized care, but because it is the most convenient placement for the state.


"The trauma of this separation and the uncertainty of whether her brother and sisters were safe weighed heavily on Ashley, and she began to struggle with her own depression. After three weeks in the emergency shelter with no mental health support services and no clear plan for reunification with her siblings, Ashley reached her breaking point and tried to hang herself in the shelter’s bathroom."

 

Under Family First, federal foster care dollars for group care placements exceeding 14 days must meet fall within one of several categories of quality placement settings: a residential family-based substance use treatment program serving parents and children together; specialized programs serving pregnant and parenting teens; treatment programs serving victims of sex trafficking; independent living placements for children 18 and older; and Qualified Residential Treatment Programs.

A Qualified Residential Treatment Program will have to meet basic quality standards, such as accreditation and licensing, use of a trauma-informed treatment model, the presence of nursing and clinical staff in accordance with that treatment model, and the provision of support services for six months after the child leaves the program. In addition. the law also requires that the courts regularly review the appropriateness of a child’s placement with the goal of transitioning to a family setting as soon as possible.


Our foster care system plays a pivotal role in the lives of children like Ashley and so many others. In 2016 alone, 273,000 children entered the child welfare system in the United States. These numbers are only expected to rise, according to a recent Health and Human Services report, with the ongoing opioid epidemic devastating families.

With its child- and family-focused principles of prevention, family preservation, appropriate placement, can and quality residential treatment services, Family First promises to help ensure the child welfare system can keep kids safe without adding additional traumas to families.


*The patient's name has been changed to protect her privacy.

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.

About the Author



Valerie Borum Smith, MD, FAAP, a member of the American Academy of Pediatrics and the Texas Pediatric Society, is a pediatrician at St. Paul Children's Clinic in Tyler, Texas. She is on Twitter @ValerieBSmithMD. This post is based on an article first published in the Dallas Morning News.