by Cris Beam
Rudy Estrada, the lawyer who now works for Legal Aid but had been hired by ACS in 2007 as the first LGBTQ coordinator, likened the fee structure in child welfare to that in health care. “It’s like an HMO, fee for service; everything is being contracted out. There are these elaborate formulas that are used to figure out how much each agency will get from the city each month based on how many kids and which kind of beds, so they’re running all these numbers constantly,” Estrada said. “Half of what ACS is doing is counting those beans.”
Forty-nine states and the cities within them are counting those same beans, zapping away critical hours and manpower while kids languish in care. But one state recently challenged the model, with results that suggest it might show the way for a better system.
In 2006, the state of Florida struck a bargain: it would become the first state in the nation to drop the per diem pay structure in exchange for a flat sum from the feds of around $140 million a year for five years. The risk they were taking was this: if there were to be a sudden surge in the foster care rolls, they wouldn’t have the per diem/per child pay structure to weather it; they’d have to make do with their capped income. But the benefit would be all the extra time and energy their workers would have—freed from the burden of filing what were, essentially, overly complicated payment requests. They’d have the time to ask questions of a kid like Dominique and track down her past connections, rather than racing to assign her the next open bed. And more than that, the plan was to focus this energy on neighborhood-based preventive programs, so fewer kids would need foster care at all.
Alan Abramowitz was the state director for family safety for Florida’s Department of Children and Families (he’s now the executive director of Guardian Ad Litem). He’s a big man, bald and plainspoken, with a hearty laugh. He’s known in house as “the firefighter.” I met him at a conference in New York in early 2009 and spoke to him on the phone some months later; he said the wild risk they took was paying off.
“We’re still removing the extreme cases,” Abramowitz said, claiming that they’d reduced removals by 29 percent in the last two years. Many people, including Abramowitz and other officials in Florida, did see the per diem pay structure as a perverse incentive to bring kids into care, and to keep them there as a way to meet their budgets. Without that incentive, Abramowitz said, “we’re able to put millions of dollars into the front end, into home services, which is far less expensive so you end up serving far more children.”
While the idea of a flat sum, called a “waiver,” has been kicked around by child advocates for years, Abramowitz says the idea was especially embraced by the then head of the state’s child welfare department, Bob Butterworth. The first thing Butterworth did when he took office, Abramowitz said, was interview kids who had aged out of foster care at eighteen. “These kids said they would have rather been abused at home with their parents than abused by the state. We realize now that the outcomes for children in foster care are going to be worse than if they had stayed in the home,” Abramowitz said. “Even if there was some neglect.”
And decisions about which kids get to stay home are far too subjective and random for Abramowitz’s taste. While Abramowitz was working in Palm Beach County, he compared removal rates between his sets of investigation teams. He found that the most experienced investigators removed 4 percent of their kids, and the least experienced removed 18 percent. “The biggest decision in a child’s life wasn’t based on the kind of abuse they were exposed to, but whichever investigator they were assigned to,” Abramowitz said. “And we assign our caseworkers randomly.”
So now, he says, with Florida’s increased spending flexibility, investigators can allot more time to the nuances of each individual family. “If it’s a substance abuse case, talk to a substance abuse expert; if it’s a poverty case, there are a lot of poverty people you can bring to the table,” Abramowitz said. “Before you make the decision to remove, there are a lot of experts you can involve, a lot of services you can look at.”
In Florida, county employees still handle the initial investigation, but everything else has essentially been privatized. Abramowitz said his agency has reached out to community-based organizations that were already in place—drug rehab centers, domestic violence agencies, child care centers, prenatal care organizations, and so on—and let them contract with the state. They also let private “lead agencies” take over all the kids in foster care, handling all the case management—from initial placement to adoption—everything, in fact, except for the initial abuse investigation. The overall philosophy, he said, is this: “We believe the state can’t raise a child very well, but the community can.”
The trouble with buzzwords like community, and the privatization it connotes, is that every community is different. The state may be a bureaucracy, but it’s big and public and, in theory, it treats everyone the same. Private agencies (even if they’re nonprofits, governed by outside boards as they are in Florida) can raise their own money and thereby range widely in terms of quality or breadth. And dropping the fee-for-service model can also mean dropping accountability or tracking measures for each individual child. Critics of privatization in child welfare—and there are many—argue that although there may be a kind of perverse incentive to retain kids in foster care to retain the day rates they incur, when you change to a flat rate there is the disincentive to provide higher-quality, expensive services. In other words, when you’re handed a flat sum (rather than a budget that changes every month based on changing client numbers), you’ll tend to run the least expensive programs. You’ll also target the broadest common denominator, and kids with specialized needs will fall off the map.
Privatization is a strange word, lacking clear definition in child welfare. Sometimes it’s used to signify Florida’s choice: swapping out the fee-for-service model for a flat, nonnegotiable sum. But this isn’t really the privatization part of Florida’s radical overhaul. The funding shift is called a waiver, and five other states—California, Indiana, Illinois, Ohio, and Oregon—have accepted waivers too, though on a smaller scale, in select counties. Privatization, in its strictest definition, is when the government seeks competition from private bidders to perform government activities. And this has been happening in foster care since its inception.
In New York City, for instance. Foster care in New York was founded on the private religious institutions and charities that took in foundlings and orphans and destitute kids, and although ACS still oversees all the kids who come into care, it contracts out all of the actual housing provisions, foster parent recruitment, and so on, to private nonprofits. Eighty percent of all states do this—it’s nothing new. What is new, perhaps, is the growing trend toward outsourcing more of the big-picture thinking and action in child welfare. The state of Kansas, for example, now uses private agencies for all aspects of its child welfare, including investigations and child removals—trumping even Florida in terms of government involvement. And, as more states and counties experiment with the waiver system, and thus have flexible funds at their disposal, they may look even more to the private agencies for broader, or more creative, or more business-oriented services.
It’s hard to tell, exactly, how the dual and sometimes intersecting trends toward privatization and waivers will pan out, but they seem to signify the beginnings of systemic change. Casey Family Programs, a national organization that provides child welfare services in five states and conducts major nonpartisan research on foster care as a whole, advocates the waiver system. Casey’s goal is to reduce foster care by half by 2020, so to them, tying funding to children who have been removed is entirely counterintuitive. Waivers allow states and agencies to spend their money as they choose—on more front-end support, say. Florida, on the whole, seems to be doing well with its choices. The secretary of Florida’s Department of Children and Families, and one of the key waiver advocates, was appointed head of child welfare at the national level. And shortly thereafter, President Obama signed an act allowing more
states to apply for waivers, lasting through 2016. Florida applied for another five-year waiver.
Even still, one county that adopted the waiver option has garnered deep reproach. Los Angeles County, which shifted to the waiver payment in July 2007 and cut the number of kids in foster care by 23 percent in nearly three years, was criticized in a scathing series of articles in the Los Angeles Times. The reporters claimed Child Services didn’t share vital information across agencies or follow policy and noted that deaths from abuse or neglect went from eighteen in 2008 to twenty-six in 2009, and they questioned whether the waiver system, and a renewed focus on family reunification, contributed to the increase.
But there were critics of the critics, who claimed the data wasn’t contextualized, that publishing wrenching tales of child fatalities instigates agency panic and unnecessary removals from other, safer homes. Amid the furor, the county transferred the director to another job.
I lived in Los Angeles in 1998. That was when I took in Christina, and the system made me send her to a group home for sex offenders because they had nowhere else to put her. I met caseworkers and foster parents and kids in that city who had the same demoralizing experience of their system as people do anywhere else. I’m hopeful about waivers, because a change in money can mean a change in philosophy, it can mean some freedom of movement, it can open the windows for new ideas to circulate in. But I know the windows are still housed in an old, tired building, so change will take time. The federal administration for children’s services basically said the same thing in a 2011 report—claiming that the first round of waiver states and counties looked hopeful—but the experiment needed to go on longer to really tell. A main problem, so far, in using the waivers to try new approaches is recruiting and training qualified staff.
In the first year of the waiver, LA’s child services spent $5.9 million on 2,400 new tablet computers for its social workers, so they could carry case files with them and access information about a family remotely when they did investigations. Armed with more knowledge, investigators could make more nuanced decisions or find resources for families on-site. But the department purchased only four hundred wireless cards, so mostly the social workers left their computers sitting on their desks.
10
Homespun
FOSTER KIDS WHO LIVE in places without waivers, which is to say most of the country, know about the day rates they incur. Fatimah, the sixteen-year-old track star with the SpongeBob necklace, calculated her value that way.
By the time she arrived at the Greens’, just a month after Chanel and Tonya, Fatimah knew she had one thing going for her: she came with a good price. She knew she would qualify for the high monthly payments from the government, post-adoption, because she was “special needs.” In the state of New York, a “special needs” child is one who hasn’t been adopted within six months of becoming available, is part of a sibling group, is over eight and part of an overrepresented minority group, or is of any race and over the age of ten. Fatimah hit three out of four. In addition to the $6,000 one-time adoption incentive her new parents would receive, they would garner $678 a month to take care of her, plus a $62 monthly clothing allowance. Fatimah thought, after she met and eventually grew to love the Greens, that this cash would be the carrot to get her wish.
Although many foster kids say that even adoptive parents are in it for the money, in reality, outside of the one-time adoption incentive payment (which was initiated under ASFA in 1997), the government’s monthly payments for an adopted child are roughly the same as for a foster child. Each state has its own complex rate system, depending on where you live and what physical, developmental, or psychological problems your child might suffer, and each prospective parent can petition for extra stipends before an adoption is finalized. In the Greens’ case, the kids aren’t wanting for much; it’s clear by the abundance of new sneakers and iPods and video games, as well as Bruce’s forty-hour work week, that Bruce and Allyson aren’t hoarding government money for themselves.
Maybe Fatimah leaned on the financial aspect of the arrangement with the Greens as a defense: if they didn’t end up wanting her, even after the adoption they’d promised, at least they’d get her money. Or maybe she had to construct them as paid caretakers because Fatimah believed, unconsciously, that one day she might return to her “real” mother. That business wasn’t over; that wound hadn’t healed.
Rudy Estrada, the lawyer at ACS and Legal Aid, told me once, “They always come back.” Foster children are sometimes called “orphans of the living,” and it’s a particularly apt designation: they’ve been abandoned in some fundamental way, and yet the biological bond is very much alive. Even if their parents’ rights were terminated long ago. Even if they want, desperately, to be adopted by somebody else.
On June 17, 2008, two months shy of her seventeenth birthday, Fatimah and Bruce and Allyson stood before a Queens family court judge. In the car ride over, Fatimah listened to the song called “Officially Missing You,” by Tamia. She was a little nervous: the night before, she and Bruce had had an argument over nothing, probably because of the tension. Fatimah was the first foster child (aside from Charles, who was already a biological nephew) to get adopted. The fight from the night before was quickly swept aside; Allyson woke her up that morning with tears in her eyes.
“I cried,” Allyson said, making breakfast for Allen and Anthony about a month after the adoption was finalized. “The job of being a mom is never-ending. You understand? I could be a mother to every child but when the moment came, it felt like ‘Wow. This really happened. Now I am really a mom and she belongs to me.’ It’s a beautiful thing.”
Fatimah sat on one of the kitchen stools, toying with the SpongeBob charm on her necklace and describing the judge. “He was like sixty-five. And he said to me everybody was five before. Everybody was ten before. Everybody was fifteen. And he said we all have our own experiences. And we all have that childhood but we have to learn how to be a child and also, you know, be mature. Right, Ma?”
Allyson nodded her assent. Baby Anthony had just spit up on the floor and she was busy rinsing out a rag. Fatimah continued. “I guess to me it meant I got to learn how to not take everything serious and like just relax and just let things flow easy inside. I’m a child but I can’t relive my childhood obviously. I need to grow up.”
After the judge’s speech, Fatimah said, everybody signed some papers and the judge officially presented her with her new last name. She also added a name of her own, the middle name Imani, because she liked the sound of it, and because she wanted to do something strictly for herself and outside the bonds of family on that day.
Fatimah couldn’t feel much, she said, at least not right away. “I was just looking around like wow. I don’t know, I can’t explain it,” Fatimah said, shaking her head as though trying to jiggle the words out. “I don’t know—it just felt—it felt regular. It didn’t feel like permanency.”
“But then the next day you couldn’t sleep the night,” Allyson reminded her.
Fatimah nodded. “Yeah, I was like walking around all night. Because I was so shocked,” she said. “I remember one day, I was about to leave one of my homes. I was staring out the window with my 3D glasses, and I was like, I wonder if I’m ever going to be adopted? I thought that I was never going to get adopted because I always heard stories about kids that go astray. I just can’t believe it; I really can’t believe it.”
Fatimah knew she’d have to come up with a new title for her memoir, Until November, about her twenty-one foster homes. The original adoption date had been November 2007, but like so many things in family court, the date got pushed back. So far, she’d settled on To the End of June. She planned to open the book with the scene of the adoption and then go back to her first memory, of hitting a piñata, and wanting candy but getting a whistle. Then she’d move chronologically through all her foster homes until she ended up where she started the book, in the courtroom with the Greens.
Fatimah said a
central theme to her book, and her life, was going back to all of her foster parents and asking them that ever-present “why” question. She’d already done it with a handful of them. “I want to ask them why they kicked me out. And I want them to feel bad,” Fatimah explained. “I’ll just be like, ‘Remember the time you sent me here, or remember this, remember that?’ Because they should be ashamed. How you put a child in care but then you’re the abuser?”
So far, Fatimah said of her former foster parents, “they always deny it.” A foster mom who called Fatimah greedy screamed with joy when she saw her, and then wanted to hug her and catch up on the last ten years. A lady with an all-yellow house didn’t remember punishing her foster kids by stepping on their hands, but, Fatimah said, the sheer act of facing these women down was enough. “It made me stop hating them,” she said. “I’m not even mad at them anymore.”
Fatimah hadn’t asked her biological mother any fundamental “whys” and didn’t feel the need; her mom, she said, was just “whack.” Fatimah told me she didn’t care what her mother felt or thought, but in the next breath she said she wished her mom could have mustered a reaction to the adoption. When Fatimah called to tell her about it, she said her mom sounded blasé. “She just said, ‘Oh, congratulations. How are you?’ She acted all fake,” Fatimah said. “I wanted her to be jealous, because she should have been doing her job.”
