Tanzina Vega:

Over the past few years, the foster care system in the state of Oregon has been in crisis. When the state is unable to place foster care children in stable housing, it sometimes houses children in hotels, motels, and even offices.

Hillary Borrud:

The offices where the kids were being housed in some cases were actually the offices where the caseworkers are trying to do their work. And then that would mean a case worker or a couple of case workers would need to stay overnight, earning overtime and being away from their families, to care for these children.

Tanzina Vega:

That is ...

Hillary Borrud:

Hillary Borrud. I'm the state politics and government reporter for The Oregonian newspaper in Portland, Oregon.

Tanzina Vega:

So Hillary told us that when advocates sued Oregon to end this practice, the state began using an approach that was at times even more drastic.

Hillary Borrud:

They turned increasingly to institutional or congregate care, basically group homes or larger facilities for these children they had a hard time housing. And in some cases, those were even state juvenile jails that had been converted into treatment centers.

Tanzina Vega:

Congregate care is supposed to mean a supervised group home or institutional setting. But in Oregon, hundreds of children were sent to these juvenile centers. And in some cases, they faced prison-like conditions.

Hillary Borrud:

You can't avoid the fact that these were built or designed as jails. The kids are staying in rooms that look kind of like cells. And then one of these facilities, in subsequent reporting I found out, this particular facility was basically conditioning access to tampons for girls on good behavior. They had access to sanitary pads, but if they wanted to earn tampons, they needed to rack up some good behavior points.

Tanzina Vega:

Oregon isn't the only state where kids in foster care face these conditions. West Virginia has also used juvenile detention centers. And both states have faced lawsuits over the treatment of children in their care. The federal government attempted to address this problem back in 2018 when Congress passed the Family First Prevention Services Act. And it went into effect this past October and it's meant to dramatically change the way congregate care is used across the country.

John Kelly:

So before a Family First took effect, there was no limit to the length of time that a child could stay in a congregate care placement with federal money continuing to flow. Now under the Family First Act, the limit is two weeks.

Tanzina Vega:

That's John Kelly, editor in chief at the Chronicle of Social Change.

John Kelly:

So as a result, states and local governments are really going to have to think through whether they intend to take more of the financial responsibility of paying for congregate care on or think through new options for the children that they have been putting into to those homes.

Tanzina Vega:

I spoke to John about why so many children have ended up in congregate care over the years and the effect it's had on their lives.

John Kelly:

Generally, congregate care consists of largely older youths in foster care, as well as youths with very acute behavioral needs. And the sort of criticism of congregate care use is that it is often a placement of last resort as opposed to a placement of need, so that these kids are ending up there not because people feel that congregate care is the best option for them. As much as the systems are having a hard time finding a foster home or a relative placement that people generally agree are more suitable.

Tanzina Vega:

So do the reasons that children end up in this type of care range from state to state or is it pretty much the same across the board?

John Kelly:

There are certainly states that use congregate care more often than others for very young children. I believe South Carolina, as part of their settlement in a class action lawsuit over child welfare services, is one that has committed to try and lower its use of congregate care for very young children. So the use of congregate care for older kids and for kids with high needs, that is a pretty nationwide pattern. Now, the use of congregate care in terms of quantity, we have kind of crunched the federal numbers and found that, interestingly, while the number of kids in foster care in total in the country has gone up in recent years, basically from 2012 up until about 2017, the number of kids in congregate care has actually declined. But that is not an airtight story across the country. There's 20 states that, between 2011 and 2017, saw an increase in the number of kids who are in congregate care. And of those 20 states, 10 of them saw an increase of 20% or more. New Hampshire really stood out as the one that basically almost tripled during that time.

Tanzina Vega:

So across the board, John, you said we're seeing a decrease nationwide, but then there are certain states that are seeing an uptick. What's leading to that uptick in those States?

John Kelly:

One likely factor is that as they've seen the number of kids in foster care in general rise, they have been challenged to find foster homes or appropriate relative options for some of those children and that they are resorting to congregate care, especially for the older youth coming into foster care.

Tanzina Vega:

Does this have anything to do with the opioid crisis that we've been hearing about for the past couple of years? Does it have anything to do with the income inequality that we see exacerbated in this country today?

John Kelly:

The federal government, in putting out their annual data on foster care, has kind of closely tied the increase in recent years with a growing number of cases where substance abuse by the parent is kind of an indicated reason for removal. I certainly think there is some connection to the opioid crisis. I don't think it's just a complete tight fitting narrative that that's the case in all states. We have spoken to officials in some states where meth is still the big driver, in their opinion, of substance abuse related cases where kids come into care.

Tanzina Vega:

Let's talk a little bit about what these facilities are like. What are the conditions for children who are housed there? We mentioned there are hotels, juvenile detention centers. What are these places look like, generally?

John Kelly:

You know, the traditional options that are kind of quantified as congregate care are group homes. And these are generally buildings where there'll be multiple bedrooms to house somewhere around seven to twelve children generally, again, of older age. And they'll be surrounded with youth workers or counselors and social workers who are staffing that place. The other option within congregate care is called institutions. And that ranges pretty widely from residential facilities all the way to a more secure psychiatric facility.

Tanzina Vega:

A lot of these children, we said, are experiencing mental health challenges in addition to just being caught up in the system, in the foster care system, which in itself can be traumatic. When these children end up in these congregate care units, what types of services should they expect or should they be getting?

John Kelly:

Well, what any foster youth should be getting is a meaningful connection to permanent adults that are in their life. They should be getting any sort of mental health needs and health needs filled, and they should be getting a stable attempt at education. Now, I don't think that that's the case in every state and every situation when it comes to congregate care. And I think that Congress really heard that when they held hearings in the past decade, from youth who had experienced their placement in congregate care. And they heard from youths who really felt like they were treated somewhat like inmates in group homes. And again, that's not the case in all of them. But I think that there are a lot of youth who feel that the normalcy of being a teen or being an adolescent is really hard when you're living in a house where maybe the cabinets are locked at night or the fridge is locked at night and your motion, your movements within the house are controlled.

Tanzina Vega:

What are the long term effects on children who were in congregate care facilities in terms of their access to education? You mentioned that that might be lacking, in terms of their long term mental health?

John Kelly:

Well, I would say that this is an area that is ripe for research exploration because there's very little in the way of robust research on outcomes, actual outcomes associated with time in congregate care. We know there was a, I think it was in 2014, a very large meta analysis or a review of all the research that found that when you're looking at youth's perception of care and their internal and external behaviors, that youth who were placed with family homes, family foster homes, fared better. There was a small study in California, 2014, that found that youth who were placed in congregate care were more likely to drop out and less likely to graduate. They tested below, in some subjects, youth who were placed with foster families. And then I think a 2008 study that found that youth who had spent time in congregate care were about two and a half times more likely to be arrested. And that was in a large undisclosed urban county. When Congress went to limit federal funding for congregate care, the hearings and what they got out of that was more emotional and moral than it was based on research.

Tanzina Vega:

Is there anything positive we can say about congregate care?

John Kelly:

Oh, well, I mean, I think that there are certainly congregate care providers in this country who do a very good job and are able to demonstrate results. Congregate care should be a brief intervention in a child's life. We should not hope for any child to be in a group home or an institution for a long time. It should be an option that we use either to manage crisis or because the system is in crisis and is just in a shortage of homes. But it should not be something for a long time. And I think there are a lot of providers in that community, Children's Village comes to mind in New York, who really believe that to be their role. We want these children to be back in their community, either with their parents or with another family quickly.

Tanzina Vega:

There are children, in some cases, who run away from these institutions, which is, I don't think it's surprising. But are you seeing an increase in that? And if so, what happens to those kids?

John Kelly:

We haven't seen any national trend on increase in runaways that I'm aware of. What I can tell you, though, for sure is that it becomes a huge intermixing of child welfare and juvenile justice in a lot of places because in an attempt to locate these children, sometimes it's technically a status offense to run away if a court has ordered you not to. So we have seen that come up in New York City recently, as well as in other systems where the act of actually running away can become criminalized or kind of count against the kid in that way.

Tanzina Vega:

Do these kids understand that? I mean, it feels like these are children who are dealing with a lot already. And in addition to the burden of mental health issues, are they even aware? Do they have appropriate representation when a court is telling them whether or not this is an offense?

John Kelly:

That's a great question. I'm quite certain that youth are not up on like all of the different truancy and status offense laws, but I think that they are afforded an attorney if their case actually ends up in a juvenile court. Whether or not when they make the decision to run away from placement, any of that's in their mind, I'm sure that's a case by case basis based on what kids are cognizant of. But I think it's fair to say that if they're making the decision to run away from a placement, they've already decided that this isn't somewhere they want to be.

Tanzina Vega:

Who's paying for this?

John Kelly:

Generally, foster care is paid for, to some extent, in a cost split between state and local governments and the federal government. There is an entitlement, a federal entitlement, called Title IV-E, through which states receive sort of a matched amount of money for youth whose parents basically meet an income test. And so billions come out of the federal government every year to help states pay for foster care placements and for adoption subsidies, as well. But I would say the lion's share of the money is state and local taxpayer dollars. Generally, congregate care is provided by either nonprofits or private providers who contract with those states and local governments.

Tanzina Vega:

There are a number of lawsuits, John, that have been filed against states for housing children in places like temporary shelters and out of state for-profit facilities. There's been one lawsuit most recently in West Virginia. Where do these lawsuits stand and what's the end goal here? Is it to shut down these facilities?

John Kelly:

I think it's not to shut them down as much as it is to force systems to use congregate care for a very limited set of purposes and not essentially what's being accused in a lot of these states where there's lawsuits in play are that you're warehousing kids, you don't have enough foster parents to handle the number of kids that you are removing from parents, and that you are resorting to these congregate care options not necessarily because it's the best thing for a child, but because it's all you have to offer. And so I think that that's the goal a lot of times with the class action lawsuits, which do vary from state to state in terms of what the relief is that they seek.

Tanzina Vega:

Back in December, we actually spoke with Judge Ernestine Gray in New Orleans who has drastically lowered the number of children in foster care just across the board in her jurisdiction. But when we talk about doing that, John, does that mean that these children are being placed with families? Does it mean that something else is happening?

John Kelly:

Well, Judge Gray definitely has made headlines as a longtime veteran knowledgeable judge who has stepped up and really forced systems to make a strong case for even taking the child into foster care. You know, we've been talking about what do you do after they have been removed? Where do they go then? But really, the easiest way to lower the number of kids in any foster care placement is to just not take them into foster care in the first place.

John Kelly:

And the other side of the coin when it came to the Family First Act was trying to provide more federal resources to help states do just that. The other part of Family First is that, for the first time, you can use that federal entitlement we talked about, Title IV-E, to provide services to families that are aimed at preventing the use of foster care in certain child welfare cases. So the situation is then deemed serious enough that there needs to be intervention. But with services provided and paid for in part by the federal government, they would be able to keep the family unit together while they worked through it. And that can look either like an actual parent stays with the child through whether it's substance abuse treatment or a mental health intervention or in home parenting classes and assistance, or it can mean the use of relying on relatives to maybe temporarily care for a child outside the foster care realm but sort of like temporarily while services are being administered to a parent.

Tanzina Vega:

John Kelly is the editor in chief at the Chronicle of Social Change. John, thanks so much for joining us.

John Kelly:

Thanks for having me.

 

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