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The Backgrounder
Herítage Foundation
1045
10.
The Heritage Foundation 214 Massachusetts Avenue, N.E. Washington, D.C. 20002-4999 546-4400 Telex:440235
The Cultural Policy Studies Project
July 27, 1995
R-wing interesting but
WHY SERIOUS WELFARE REFORM MUST
INCLUDE SERIOUS ADOPTION REFORM
INTRODUCTION
W
ith the national out-of-wedlock birthrate heading toward 40 percent by the year
2000, and 50 percent around the year 2012, lawmakers are concerned about the increase
in abused and neglected children which likely will accompany this disturbing trend.
There now are close to 500,000 children in the foster care system, I but only about
50,000 are cleared for adoption each year. Because of bureaucratic obstacles, many of
these children cannot find a permanent, loving home. 2
The comprehensive House welfare reform bill (H.R. 4, the Personal Responsibility
Act) tries to address this problem by rewarding states for reducing their out-of-wedlock
birthrate without resorting to abortion. But another way is to increase early adoptions of
neglected children. During the congressional debate, some Members balked at trying to
reduce the illegitimacy rate, fearing they might appear harsh or uncaring toward the
young unwed mother and her child. For these lawmakers and others with similar appre-
hensions, adoption is a solution that is kind to both mother and child. Its advantage is
well documented: a better life.
The House-passed tax reform bill (H.R. 1215) also encourages adoption. To help de-
fray the significant costs involved, a couple whose income is below $60,000 receives a
$5,000 tax credit. This credit is reduced gradually for couples with incomes between
like
$60,000 and $100,000 and phased out at incomes above $100,000. While significant,
1 In FY 1992, a total of 659,000 children were in or passed through substitute care (foster care and specialized homes for
foster children) during the year. The 421,000 children in substitute care at the beginning of the year had grown to 442,000
at the end of the year. From American Public Welfare Association, Voluntary Cooperative Information System (VCIS)
Research Notes No. 9, August 1993.
2 For an excellent overview of the anti-adoption bias in government agencies, see Conna Craig, "What I Need Is a Mom,"
Policy Review, Summer 1995, pp. 41-49.
Note Nothing written here is to be construed as necessarily reflecting the views of The Heritage Foundation or as an attempt
to
aid
or
passage of any bill before Congress
Chart 2
Unwed Births Are Increasing for Women Under 20
100%
80
Married Births
60
Unwed Births
40
20
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
Source: U.S. Bureau of the Census. Current Population Survey. 1991.
Hold hearings on the Clinton Administration's blocking of a very effective drug test-
ing and treatment program for cocaine-addicted pregnant mothers. If necessary, pass
legislation to reverse the Administration's action.
Issue annual report cards on the rate of adoption in each state.
Require federally funded family planning services to provide clear and accurate in-
formation on the benefits of adoption to all out-of-wedlock teenage mothers.
Make it easy for all churches, particularly black churches that serve the poor, to affili-
ate with adoption agencies and become involved in the adoption process as outreach
to prospective adopting parents.
Ensure the civil rights of all children in foster care and modify the Multi-Ethnic
Placement Act to prohibit any use of race or ethnicity to deny or delay the placement
of a child for foster care or adoption.
Change the Indian Child Welfare Act to curtail the reach of Indian Nation law over
those who have emigrated from those communities and societies.
Reject the language in the U.N. Charter on the Rights of the Child.
What the states should do:
Privatize adoption services.
Change the way public welfare agencies are financed so that they are obliged to con-
tract for all public adoptions.
3
Chart 3
Adoptions Are Decreasing:
Especially for Women Under 20
80%
Adoption as Share of Unwed Births
70%
Of Births to 15-19 Year-olds
60%
50%
40%
30%
Of All Births
Incomplete Data
20%
10%
1960
1965
1970
1975
1980
1985
Source: The Adoption Factbook, National Committee for Adoption, June 1989.
adopted, with formal adoptions dropping by almost 50 percent: from 89,000 in 1970 to a
fairly constant 50,000 annually throughout the 1980s and into the 1990s. 3
The National Council for Adoption estimates that of the 50,000 children adopted annu-
ally, 25,000 are healthy children under age two, 10,000 are healthy children over age
two, and 15,000 are children with "special needs" (the social work term of art for chil-
dren considered difficult to place because of their age, physical or mental condition, race
or ethnicity, or need to be placed with siblings). 4 About one-third of these adoptions are
arranged by government-funded and government-managed public agencies, some by con-
tract with private agencies. Another one-third are arranged by private, mostly nonprofit
agencies, and the rest are contracted outside of agency auspices, mostly through lawyers
in private practice. International adoptions accounted for an additional 8,000 adoptions
during 1994.
Adoption fell out of favor among social workers during the 1970s, even as single par-
enthood and abortion became more widespread. Advocates of government-sponsored so-
cial programs argued that increases in welfare would make it possible for unmarried
3
This number does not include informal adoptions by relatives that frequently take place within families-something
extended families have always done for other members in need.
4
However, the term often causes initial resistance or apprehension on the part of potential adopting parents, who may fear
having enormous burdens placed upon them. Many experts complain of the unnecessary and inordinate use of the term by
state workers, the consequence frequently being the loss of a home for the child.
5
ents can be located and rehabilitated. A 1993 General Accounting Office report showed
that 10,000 infants were being boarded in hospitals for no medical reason. Less than 40
percent of the boarder babies-and none of the abandoned babies-were expected to
leave in the care of their parents.
The average total cost of caring for these babies in hospital after their medical treat-
ment is almost $13,000. 17 Nonetheless, only 2.5 percent of the boarder babies and 6 per-
cent of the abandoned infants were expected to go into adoptive placements. 18 The vast
majority of these children will spend years in and out of the foster care system while the
biological mother attempts to get her life together. 19
Federal efforts to deal with this have been small and swamped by the size of the prob-
lem. 20 When Representative Harris Fawell (R-IL) introduced the At-Birth Abandoned In-
fants Act (H.R. 2936) last year to help move abandoned babies out of the system and into
permanent adoptive homes, the child welfare establishment lobbied against it, arguing
that creating a two-tiered system-a fast track for new-born abandoned babies and a
slower, less responsive one for older children-was unfair. 21 The bill was not enacted.
WHY ADOPTION SHOULD BE ENCOURAGED
Benefits for Children
Adopted children do as well as or better than their non-adopted counterparts, accord-
ing to a 1994 study by the Search Institute, a Minneapolis-based public policy research
organization specializing in questions of concern to states and cities. 22 This study, the
largest examination of adopted adolescents yet undertaken, concludes that:
Teens who were adopted at birth are more likely than children born into intact
families to live with two parents in a middle-class family. 23
Adopted children score higher than their middle-class counterparts on indica-
24
tors of school performance, social competency, optimism, and volunteerism.
multiple serious problems.
17 HHS/ASPE Report, p. ii.
18 "Report to Congress: National Estimates on the Number of Boarder Babies, the Cost of Their Care, and the Number of
Abandoned Infants," U.S. General Accounting Office, August 1993; hereinafter cited as GAO Report.
19 Most boarder babies are cases of neglect of a severity which easily would justify termination of the parental rights of the
mother. However, "family preservation" guidelines (as opposed to the best interests of the child) lead to prolonged and
frequently futile efforts at maternal reform.
20 GAO Report, op. cit.
21 The opponents, the Child Welfare League of America and the American Public Welfare Association, also argued that the
child's first right is to his biological family, not to care and nurturance, and that family preservation services must first be
attempted with the mother-even if she had abandoned her baby.
22 Peter L. Benson. Anu R. Shorma, and Eugene C. Roehlkepartain, Growing Up Adopted-A Portrait of Adolescents and
Their Families (Minneapolis: Search Institute, June 1994).
23 This finding illustrates the power of early adoption and the need to reform agency practices which keep children in
prolonged foster care during their early infancy, when they are highly adoptable.
24 Benson et al., Growing Up Adopted.
7
Enjoy a quality of home environment superior to all the other groups; 32
Have superior access to health care compared to all the other groups; 33
Enjoy health similar to that of children of intact families and superior to that of
the other two groups; and
Do better in educational attainment than single-parent children and children
34
raised by grandparents.
When compared with those adopted later, born outside of marriage and raised by the
single mother, or raised in an intact family, children who are adopted in infancy:
Repeat grades less often than any other group;
See mental health professionals less than all other groups, except children of in-
tact families;
Have better health status than all other groups;
Have a better standing in their school classes than all other groups, except chil-
dren raised in intact families; and
Have fewer behavior problems than all other groups, except children raised in
intact families.
Benefits for Mothers Who Give Up Children for Adoption
Significantly, teenage mothers who choose adoption also do better than mothers who
choose to be single parents.
They have higher educational aspirations, are more likely to finish school, and
less likely to live in poverty and receive public assistance than mothers who
keep their children.
They delay marriage longer and are more likely to marry eventually.
They are more likely to be employed 12 months after the birth and less likely to
repeat out-of-wedlock pregnancy.
They are no more likely to suffer negative psychological consequences, such as
35
depression, than are mothers who rear children as single parents.
32 As measured by regular bedtime, use of seatbelts, and absence of an adult smoker in the household.
33 As measured by insurance coverage, dental visits, and regular provider of sick care.
34 As measured by rank in class, repeating a grade, or being suspended.
35 Steven D. McLaughlin, Diane L. Manninen, and Linda D. Winges, "Do Adolescents Who Relinquish Their Children Fare
Better or Worse Than Those Who Raise Them?" Family Planning Perspectives, Alan Guttmacher Institute,
January-February 1988.
9
spond to the gifts of the family, and a general lack of support to bring couples success-
fully through the adoption process. 41
THE BARRIERS TO ADOPTION
Although adoption meets the interests of the needy child better than any other option,
Elizabeth Bartholet of Harvard Law School concludes that "our adoption system has
failed to live up to even its own limited vision Laws and policies that are supposed to
protect children have created barriers to adoption that function effectively to prevent
these children from getting the kind of protection they most need 'a loving, nurturing and
permanent home. .,,42
The legal system often resolves cases in ways that trouble many Americans. In two
widely publicized recent cases, for example, children were wrested from their adoptive
parents on the basis of biological ties. Baby Jessica was given to her biological father,
who had failed to support two previous children, and Baby Richard was given to his bio-
logical father, with whom he had never lived, instead of being allowed to remain with
the adoptive family which had nurtured him from birth for three years. In both cases, the
overriding "biological ties" of the fathers prevailed over the needs of their children.
Several barriers make it very difficult for many families to adopt children.
BARRIER #1: Anti-Adoption Bias in Pregnancy Counseling
Only 1 percent of women who experience an "unwanted pregnancy" choose adop-
tion for their children. 43 A University of Illinois study explains some of the causes:
Some 40 percent of individuals in a variety of settings (health, family plan-
ning, social services, and adoption agencies) who identify themselves as
"pregnancy counselors" do not even raise the issue of adoption with pregnant
clients.
An additional 40 percent provide inaccurate or incomplete information to cli-
ents.
By contrast, 38 percent of the clients whose counselors offered adoption went
on to choose adoption. 44
Congress's efforts to require adoption information and counseling in one federally
funded program providing services to pregnant women have met with resistance from
family planning professionals. For instance, the Adolescent Family Life Act45 was
41 Personal communication from Mary Beth Styles, Vice President for Professional Practice, National Council for Adoption,
summing up the complaints of parents to NCFA.
42 Elizabeth Bartholet, Family Bonds: Adoption and the Politics of Parenting (Boston: Houghton Mifflin, 1993); quoted in
Judith D. Vincent, "Reforming Adoption: Putting Children First," Center of the American Experiment, Minneapolis,
March 1995, p. 2.
43 National Committee for Adoption, Unmarried Parents Today, p. 66.
44 Edmund V. Mech, paper on "Orientations of Pregnancy Counselors Toward Adoption," University of Illinois, 1984.
45 Part of the Omnibus Budget Reconciliation Act, P.L. 97-35, August 13, 1981.
11
A study by John Schuerman and his colleagues at the University of Chicago found
that the "Family First" program did not realize even its central goal: preventing the re-
moval
of children. 49 Neither did it protect children from further abuse. There is evi-
dence that some families continue to abuse their children even during the period of in-
tensive state intervention. 50 By contrast, there is strong evidence that children do bet-
ter when left in foster care than when they are returned to abusive families. 51 This evi-
dence leads to a simple and commonsense conclusion: children need a permanent
home to which they can belong. For children at serious risk, an adoptive home is their
best chance for real permanence.
Some child advocates challenge the principle of applying the "family preservation"
approach in all cases. At a 1994 conference sponsored by the National Council for
Adoption at Boys Town, Nebraska, Dr. Richard Gelles of the University of Rhode Is-
land, a pre-eminent child abuse researcher and an early and optimistic supporter of
family preservation programs, presented the following paraphrased views on these
practices in light of recent evaluation data:
There are a now a number of studies of children who were returned home
only to be abused again or even killed. These studies show dramatically
that some abusive parents cannot be rehabilitated. 52 In these cases the
appropriate care of such a child is to terminate the parents' rights as
quickly as possible and place the child with a permanent caring adoptive
family.
The Boys Town conference highlighted the central problem of family preservation
services. The first logical step should be to assess whether the child should be removed
immediately and whether the parents are likely to benefit from support services. In-
stead, family preservation services are assumed to be the best first treatment. Though
these services are activated because of abuse to the child-sometimes very severe
abuse-they must fail before the child can be protected from the abusing family.
The foster care system is the aggregate network of parents who work for state and lo-
cal social service agencies by taking abandoned, abused, or neglected children into
their homes. They receive a set amount each month with which to feed, clothe, and nur-
ture these children. Foster parents try to function as substitute parents. Prudently, they
are admonished not to expect that placement will be permanent. However, from among
the couples who take on this work come many who would like to adopt, particularly as
they get to know these children and their lack of prospects for a happy and safe life in
their families of origin.
49 John Schuerman, Tina Rzepnicki, and Julia Little, Putting Families First (New York: Aldine DeGruyter, 1994).
50 Mary Elizabeth Seader, "Do Services to Preserve the Family Place Children at Unnecessary Risk?" in Eileen Gambrill and
Theodore J. Stein, eds., Controversial Issues in Child Welfare (New York: Allyn and Bacon, 1994).
51 Carol Statuto Bevan, "In Search of a New Child Welfare Paradigm"; unpublished paper presented at Boys Town
conference on Child Protection: Old Problem, New Paradigm, May 20-22, 1994.
52 Richard J. Gelles, "The Doctrine of Family Reunification: Child Protection or Risk?"; paper presented at Boys Town.
conference on Child Protection: Old Problem, New Paradigm, May 20-22, 1994.
13
Courts could
Chart 5
separate those
children more
decisively and
Related Adoptions: 1956-1986
quickly from
Related Adoptions
100,000
parents unlikely
90,000
to reform or
80,000
benefit from
70,000
Incomplete Data
family preserva-
60,000
tion services.
50,000
40,000
Children in dan-
30,000
ger of severe
20,000
abuse would be
10,000
separated more
quickly and ex-
1960
1965
1970
1975
1980
1985
pertly from their
Source: The Adopson Factbook, National Committee for Adoption, June 1989.
families and
made available for adoption.
Social workers involved in helping the more tractable parents would be free to
pursue that work with much less likelihood of endangering the child.
Local government agencies could turn to the adoption services of nonprofit
agencies much more quickly and frequently. Private agencies do not have the
immense burden of child protective services and related policing requirements
that public agencies have. Their mission is to recruit and prepare adoptive fami-
lies, and they tend to have great expertise in this work.
BARRIER #4: Unsatisfactory Protection of Confidentiality
State adoption laws generally guarantee the confidentiality of the identity of the
mother, the inviolability of the internal intimacy and harmony of the adoptive family,
and the peaceful development of the adopted child.
In adoption law and philosophy, there has arisen a view which parallels the modern
revisionist view of marriage and parenthood embodied in "no-fault" divorce. New rela-
tionships between parent and child are imagined, and a new type of contract is forged
between parents. Open adoption is akin to no-fault divorce, and the "birth parents"
take on the role of the visiting parent who has not yielded up all his rights to the child,
particularly rights of visitation and vacations together. The adoptive parents are bound
not just to their adopted child, but also to the birth parents and must facilitate the con-
tinuing relationship between the child and his birth parents. This form of open adop-
tion exists in Oregon from birth and in Indiana for children over two years of age.
Open adoption provides no seal of confidentiality regarding the identity of the birth
parents, the adopting parents, and the child. It essentially blends birth families with
adopting families, directly undermining the creation of a permanent new family for a
child. The professional literature shows a frequent confusion of roles when the birth
family continues a relationship with the child. This also interferes with parent and child
15
Adoption and many of its affiliated private adoption agencies have challenged the
vagueness of the legislative proposals which do not assure confidentiality. They also
have questioned the need to federalize a state issue.
BARRIER #5: Unknown, Uninvolved, or Unmarried Fathers
Another major barrier for unmarried women considering adoption for their children
is the need to obtain the consent of uninvolved fathers. Fortunately the Supreme Court,
in a series of opinions, 63 has clarified and restricted the rights of uninvolved, unmar-
ried fathers. According to current federal law, these rights correspond to the effort the
father has made to establish a relationship with his child. The unmarried father who is
unknown, is uninvolved, or has otherwise demonstrated no responsibility or interest in
the child may not be entitled to the same consideration as an involved and responsible
unmarried father. Federal courts have ruled consistently⁶⁴ that ignorance of a preg-
nancy is no excuse for uninvolvement, because the father was present at conception
and could have followed through to assure adequate care for the child.
A growing trend in state legislatures, upheld by the Supreme Court in Lehr V. Robert-
son, 65 is the establishment of father registries which make the father responsible for as-
serting his parental rights. The registry usually requires the father to file a paternity ac-
tion within 30 days of the child's birth. This will result in his being notified of a pend-
ing adoption. He then will have an opportunity to demonstrate that he has tried to es-
tablish a relationship with the child and to take responsibility, for the child's care. If he
fails to meet any of these requirements, he forfeits his rights to contest the adoption of
the child, and the adoption can proceed. While many conservatives think an absent un-
married father should never be an obstacle to adoption, this procedure at least frees the
mothers to place children without registered fathers for adoption.
The House welfare bill requires paternity establishment at birth for all fathers. This
is a major step in the right direction. Fears that efforts to locate unknown, unmarried fa-
thers will slow down, and possibly stop, adoption are unfounded. If the mother is not
seeking AFDC support (and she will not if she is placing her child for adoption), she
will not need to identify the father. Simultaneously, the putative father registry protects
the due process rights of all fathers. Those who do not register, however, cannot bene-
fit from the protection it would have given them.
BARRIER #6: Race of the Child and Adoptive Parents
Two forms of racial discrimination take place within adoption: against adoptive par-
ents and against children waiting to be adopted. Potential black parents lose the chance
to give their love to needy children of their own race. Black children in foster care are
deprived of new parents and a stronger foundation in life, in addition to being exposed
to the risks of retarded social and intellectual development. Both forms of discrimina-
63 Stanley V. State of Illinois, 405 U.S. 645 (1972); Caban V. Mohammed, 447 U.S. 380 (1979); and Lehr V. Robertson, 463
U.S. 248 (1983).
64 National Council for Adoption, "Putative Fathers' Rights," 1992.
65 Lehr V. Robertson, 463 U.S. 248 (1983).
17
moved. At this point, in addition to having suffered even more, the child is older and
more difficult to place.
Given these figures, public welfare agencies are a major source of neglect of young
black children. The bias against adopting early, when the child is most adoptable, feeds
the foster care system and ensures a larger clientele for public agencies. The present sys-
tem of financing foster care and not financing adoptions perversely rewards this form of
government neglect.
Black Families and Adoption
There is evidence that blacks adopt at a much higher rate than whites if one controls
for family structure, income, and age of parents. 70 A 1983 Department of Health and Hu-
man Services study 71 put these comparable rates at:
7 adoptions per 10,000 black families for all black families;
2 adoptions per 10,000 white families for all white families; and
2 adoptions per 10,000 Hispanic families for all Hispanic families.
Controlling for age of parents (below 55), family income (above poverty level), and
family structure (intact families), the rates change to:
18 adoptions per 10,000 black families within the range;
4 adoptions per 10,000 white families within the range; and
3 adoptions per 10,000 Hispanic families within the range.
These figures convey the reality of much higher adoption rates among blacks than
among whites or Hispanics for children in public welfare agencies who are available for
72
adoption.
To meet the needs of all children within their own racial communities by placing them
in couple-headed families above poverty, the same study suggests that the response rate
among black families would have to be far higher than it is. It would need to approach 44
per 10,000 families for blacks, compared with 6 per 10,000 families for whites and 6 per
10,000 families for Hispanics. This would require an enormous increase in the rates of
adoption by blacks and Hispanics. Richard Barth of the School of Social Welfare at the
University of California at Berkeley sums up the conclusions to which these data lead:
The growth of African-American adoptions have increased by 92% in the
last 5 years and Hispanic adoptions by 80%. The growth of African
American adoptions would have to grow four times faster than that during
the next five years in order to give African American children parity of
70 There are no ongoing survey data which sample for adoption rates. This makes the estimation of incidence and rates spotty
over time and more difficult to estimate accurately.
71 Charles P. Gershenson, "Community Response to Children Free for Adoption," Child Welfare Research Notes No. 3,
Children's Bureau, Administration for Children. Youth and Families, March 1984.
72 However, if blacks are serving at a rate much higher than their presence in the nation, then the issue of bias against blacks
either does not hold up or, at a minimum, is more complex.
19
Chart 6
Barriers to Adoption: Both Children
and Couples Must Wait
Children in
Couples Waiting
Foster Care
Barriers to Adoption
to Adopt
Teen Counseling Bias
Foster Care System
About
Confusion of Social Service Roles
50,000
500,000
Waiting for
Confidentiality
Race
2,000,000
Adoption
Uninvolved Fathers
Actual Adoptions
50,000
Sources: The Adoption Factbook National Committee for Adoption, June 1989; NCFA Memos.
tion prevented the adoption of a white child by a black couple who had fostered the child
since birth.
In 1984, liberal black columnist Carl T. Rowan argued against the "abominable notion
that race must be the dominant factor in deciding who can deliver loving care and protec-
tion to a child." Rowan equated the position of black social workers who support only in-
race adoption with a 1954 statement by a segregationist Mississippi editor that "every
child has the right to be educated among children and by teachers of the same racial back-
ground.
Furthermore, according to professor Rita Simon, sociologist at the American
University and expert in transracial adoption, "The data in our studies and indeed in all
the studies that have been done show that transracial adoptions serve the children's best
80
interests.
Still, opposition to transracial adoption is strong. When former Senator Howard
Metzenbaum (D-OH) steered S. 1224 through Congress in 1993, he did so to outlaw ob-
stacles similar to the above restrictions that exist in most states. But the Clinton Admini-
stration, which supports race matching, succeeded in changing the legislation so that lack,
78 Press release, "Institute for Justice Challenges Barriers to Interracial Adoption," April 13, 1995.
79 Carl T. Rowan, "Should Whites Adopt Blacks?" The Washington Post, July 13, 1984. p. A19; quoted in Rita J. Simon and
Howard Alstein, Transracial Adoptees and Their Families (New York: Praeger, 1994), p. 7.
80 Rita Simon, "Serving the Children's Best Interest," Interrace Magazine, August/September 1994, pp. 40-42.
21
Adoption is a national resource that should be encouraged and expanded by govern-
ment where possible. The federal government should undertake a public relations cam-
paign, targeted to girls under the age of 18 who have conceived out of wedlock, on the
benefits of adoption. In addition, Congress should:
1) Enact a means-tested, fully refundable, inflation-adjusted tax credit of up to
$5,000 for non-recurring adoption expenses.
The House-passed tax bill (H.R. 1215) provides a non-refundable tax credit of up
to $5,000 for adoption costs for those with incomes up to $60,000, gradually phased
out for those with incomes between $60,000 and $100,000.
Congress permits a tax deduction for the medical costs of fertility treatment (typi-
cally between $35,000 and $50,000 for testing, test tube conception, and deep freeze,
development, and discard). The average revenue loss for such treatment is about
$8,000. Some corporate health plans, the costs of which are fully excludable from
employees' taxable income, also cover fertility treatment. By contrast, the Treasury
would gain financially from a one-time $5,000 tax credit that encouraged parents to
assume the total cost of caring 85 for foster children-each of whom now costs taxpay
ers over $13,000 each year.
This tax credit should be fully refundable (including against Social Security taxes)
so that poorer parents who adopt a child receive the same level of support as those
who earn more and have larger tax liabilities. The object is to encourage and support
those who want to adopt. Being less generous with poorer parents (and more black
parents are poor compared to white parents) is unwise because it reduces the incen-
tive to adopt.
2) Hold hearings on the Clinton Administration's blocking of an effective drug
testing and treatment program for cocaine-addicted pregnant mothers. If nec-
essary, pass legislation to reverse the Administration's action.
The high incidence of serious child abuse among drug-addicted mothers inflicts
pain and damage on cocaine-addicted babies. With some 350,000 children affected
each year, there is an obvious need for a change in federal law to permit the testing of
mothers suspected of cocaine addiction. These babies are at high risk for foster care
and for severe damage to their health and development.
South Carolina Attorney General Charles Molony Condon ran a successful pro-
gram of testing, mandated treatment, or a jail sentence if the mother refused treat-
ment. The result was dramatic: the incidence of cocaine-addicted mothers fell from
24 per month in Charleston to five or six per month. 86 The Clinton Administration,
however, called the program punitive and racially discriminatory and threatened to
cut off all federal reimbursements to the hospital involved, effectively threatening to
85 According to the House Ways and Means Committee's 1994 Green Book on federal entitlement programs and DHHS/ACF
data on federal payments to the states for foster care services, the total federal share of foster care payments for 1994 was
$1,971,273,000 for 244,473 children, and the average of the federal share of the individual state's foster care bills is 60.88
percent.
86 Charles Molony Condon, "Clinton's Cocaine Babies," Policy Review, Spring 1995, pp. 12-15.
23
6) Ensure the civil rights of all children in foster care and modify the Multi-Ethnic
Placement Act to prohibit clearly the use or consideration of race or ethnicity
in denying or delaying the placement of a child for foster care or adoption.
The fundamental principle behind all civil rights is equality of rights and equal
treatment under law. A young child without a family cries out for as quick a placing
as possible within a caring family, so that his long-term human potential may not be
thwarted at critical early stages of development. The "personness" of that child is infi-
nitely more important than his or her "blackness," "Indianness," "Hispanicness," or
"Asianness." In cases where parents of similar ethnic background are unavailable
within, say, a 90-day period, then those who are available and willing to adopt should
be united with the child, both for the child's benefit and for the good of society.
Those who are anxious to have the children of a community adopted within that
community must ensure a sufficient supply of parents wanting to adopt. The onus is
on the community and ought not to be placed on the waiting child. To help assure a
pool of parents, Congress should work with states to streamline and simplify adop-
tion procedures in minority communities.
Many opportunities for developing a pool of waiting parents are available. The net-
work of minority churches is extensive. By linking with private adoption agencies,
these churches can help respond to the needs of minority children awaiting adoption.
Many other ethnic organizations can be harnessed to bring the pool of minority adopt-
ing parents up to the level needed. The press could carry public service announce-
ments in minority communities. Minority fraternities and sororities also could play
an important role. These and similar community efforts would raise public conscious-
ness about adoption.
7) Change the Indian Child Welfare Act to curtail the reach of Indian Nation law
over those who have emigrated from those communities and societies.
While fully respecting the right of Indian nations to regulate adoptions within their
territories, and while fully respecting the rights of all Indian parents giving up their
children for adoption to request that the Indian nations take these children for adop-
tion, Congress ought to change civil rights law so that the rights of Indian or part-In-
dian parents living outside the nations' territories are upheld.
Under current law, a child with as little as one sixty-fourth Indian ancestry may be
under the control of that Indian tribe for adoption, no matter where the child lives.
While the number may be modest, the principle of "personness" again is paramount.
Just as a foreign-born American citizen is not subject to the adoption laws of his
country of origin, an Indian who has chosen freely to leave the Indian nation and to
marry someone outside it should no longer be subject to its laws.
8) Reject the language in the U.N. Charter on the Rights of the Child.
This charter could preclude adoptions for millions of children over time and deny
U.S. couples the option of adopting foreign children. The unsigned U.N. Charter on
the Rights of the Child may come before Congress in the near future for ratification.
In the current draft, international adoption is declared to be a last option, after the
home country has exhausted its search.
25
To encourage adoption, states should:
1) Privatize adoption services.
Private adoption services are more efficient and more effective than state agencies
where adoption is concerned, as illustrated by the track record of Detroit's Homes for
Black Children. They are accountable to a board of directors, while state agencies are
not. Private organizations may be sued, which increases their accountability to the
children and parents they serve. By contrast, state agencies often cannot be sued. Fur-
thermore, people are more inclined to donate money, time, services, and goods to a
private adoption agency than to pay taxes for government agencies.
2) Change the way public welfare agencies are financed.
Public welfare agencies dealing with children receive more money to keep children
in foster care than they do to clear them for adoption. States should make the alloca-
tion of Title IVE monies to these agencies contingent on their record in making final
determinations on the future status of children within 12 months of entering foster
care. Those not returning to their families must be adopted within three months or
handed over to a private agency for adoption.
3) Establish separate units at the county level to assist the courts in making
speedy and appropriate judgments.
These units should make the initial decision whether to terminate the rights of the
parent and bring the process to court or return the child to his family. All babies un-
der 12 months of age coming into the protective custody of a public welfare agency
should be processed through the termination unit as a matter of course. A great many
such children should be placed for adoption quickly. This in turn would prevent the
buildup of a large number of children in foster care - children who grow more and
more difficult to place with each passing year, as the significant drop in the percent-
age of older children who get adopted clearly indicates.
4) Maintain special Medicaid coverage for all special-needs adopted children.
This makes it possible for many middle and low-income families to adopt a sick
child they would not be able to care for without Medicaid support. It makes sense for
government to provide this support, for the special-needs child in foster care will cost
the government even more.
5) Remove obstacles to transracial adoptions.
While working to increase the pool of minority parents and to enhance the flow of
prequalified and ready-to-adopt minority parents, states should continue the practice
of transracial adoption when no same-race parents are available. When the child be-
comes ready for adoption, his need is immediate and acute. Minority community
groups can monitor the pool of prescreened, qualified minority parents for all the rele-
vant categories of children: older children, older male children, sibling groups of chil-
dren, medically needy children.
In addition to the issues involved in ending discrimination against black children
waiting to be adopted and against black couples waiting to adopt, there is much else
to be done by the states.
27
10) Enact legislation requiring of public social service agencies the same licensing
standards and requirements as those now imposed on private adoption agen-
cies.
Just as Congress has passed a law (H.R. 1 and S. 2) to subject itself to the same
regulations it imposes on the rest of the country, all state agencies involved in adop-
tions ought to be subject to the same reporting and regulatory oversight as adoption
agencies are. This reform will likely have the speedy effect of reducing these regula-
tions to the bare minimum needed for the good of the child.
11) Mandate drug testing of pregnant mothers suspected of drug abuse, particu-
larly cocaine abuse.
Because of the high incidence of serious child abuse among drug-addicted moth-
ers, because of the pain and damage done to cocaine-addicted babies, and because
this condition now affects 350,000 children a year, states should push for a federal
law permitting the drug testing of mothers suspected of cocaine addiction so that hos-
pitals may participate in such programs without being threatened with a cutoff of fed-
eral funds as happened in the South Carolina case discussed above.
Children born to drug-addicted mothers are at risk for a host of difficulties and
abuses: lower birth weight, physical abuse, and not getting the affectionate nurturing
critical for early attachment formation and its concomitant long-range benefits,
among them the formation of a solid conscience and the ability to relate well with
others. Given these risks to the child, the requirement of drug testing when cocaine or
crack cocaine ingestion is suspected is an appropriate protection.
12) Prohibit the removal of a child who is eligible for adoption from foster parents
who are willing to adopt the child, except when the child is being returned to
the legal parents. Enact legislation to permit foster parents to initiate adoption
proceedings.
If the parents are deemed by the agency as suitable for fostering the child, they
should qualify automatically as suitable for adopting the child. Today, many foster
parents are willing to adopt the children they have fostered once they become avail-
able for adoption. However, mainly because of the effective prohibition of transracial
adoptions, these parents frequently are denied the chance to adopt the children who
have become attached to them. These couples should have the right to adopt the child
once the courts have decided he may be adopted. If child welfare agencies have not
made this possible within six months of the court decision, foster parents ought to be
granted the standing in law to sue the adoption agency and initiate adoption proceed-
ings.
13) Enact laws requiring child welfare agencies to initiate adoption proceedings
for any child who has been abandoned by his parents for six months.
This rule should apply for any child in out-of-home care for six months whose par-
ent has not engaged in meaningful interaction with the child during that period. Due
process in the courts will protect the rights of parents barred from contact with their
children due to very unusual circumstances. However, a child left alone for six
months is a child without a dedicated parent.
29
Jen - F41.
BRIEFING BOOK MEMO
-Diana
April 30, 1996
8:30 - 9:30 a.m.
Carol Rasco's office
FROM:
Diana Fortuna
SUBJECT:
HHS Child Welfare Waivers
PARTICIPANTS:
HHS: Mary Jo Bane, Olivia Golden, Carol Williams, John Monahan;
White House: Ken Apfel and Lester Cash, OMB; Lawton Jordan,
Intergovernmental; also invited are Jen Klein and Bruce Reed
PURPOSE:
To learn about HHS's review of 13 pending child welfare waivers and
its process for awarding the statutory limit of 10 waivers. Attached are
HHS's briefing materials.
AGENDA:
HHS will walk us through what they have been doing, and we should
raise any questions we may have.
BACKGROUND:
In 1994, Congress created a new special waiver authority for HHS to
allow up to 10 states to conduct cost-neutral demonstrations. After
HHS issued guidance to states on this last year, 14 states sent in
applications last fall. (Minnesota has since dropped out.) They are
Oregon, Delaware, DC, North Carolina, Georgia, Ohio, New York,
Indiana, Illinois, California, Michigan, West Virginia, and Maryland.
Florida wants to apply even though the deadline has passed.
HHS expects to award Delaware the first waiver within the next few
weeks; Illinois and Indiana are fairly far along. HHS is attempting to
discourage West Virginia about its application.
The most common thing that states have proposed to do is shift dollars
from foster care to family preservation, on the theory that the
investment will pay off in terms of foster care dollars saved in the long
run. Other ideas include "subsidized guardianship", a new status in
between foster care and adoption; managed care (New York and Ohio);
block grants (Michigan and California); and tying funding to outcomes
(North Carolina).
2
ISSUES:
HHS is considering approving fewer than 10 of the 13 applications
received, because they are not certain that 10 merit approval. The
alternative they are considering is to accept 6-8 and then solicit
proposals for a second round.
OMB may have a problem with several of the states, which did not
propose to use random assignment for evaluation purposes.
QUESTIONS FOR CONSIDERATION:
What policies should HHS test? Are we taking full advantage of this
opportunity?
How will HHS handle the requests for block grants?
What is an appropriate way to test managed care? (This has been
controversial in New York, where the Mayor has been accused to using
managed care to cut reimbursement. HHS appears interested in Ohio's
application, however.)
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SERVICES
DEPARTMENT OF HEALTH & HUMAN SERVICES
MAIN
ADMINISTRATION FOR CHILDREN AND FAMILIES
Office of the Assistant Secretary, Suite 600
370 L'Enfant Promenade, S.W.
Washington, D.C. 20447
April 29, 1996
TO:
Carol H. Rasco
Assistant to the President
for Domestic Policy
FROM:
Assistant Secretary
for Children and Families
SUBJECT: Child Welfare Waivers -- Briefing
BACKGROUND - CHILD WELFARE WAIVERS
On October 31, 1994, the President signed Public Law 103-432
which, among other things, authorized the Secretary of HHS to
permit as many as ten States to conduct child welfare
demonstration projects by making most provisions of Parts B and E
of title IV of the Social Security Act subject to waiver. These
are the sections of the Act which govern foster care, adoption
assistance, independent living, child welfare services, and
family preservation and support.
Child welfare waivers are required by statute to be cost neutral,
to be consistent with the purposes of the basic child welfare
legislation, and to have an independent evaluation. Certain
protections for children in foster care and their families may
not be waived, and eligibility for benefits may not be impaired.
The waivers are limited to five years.
The purposes of the waivers include testing State-designed
approaches to reforming child welfare services, encouraging
innovation, and gaining experience with alternative methods of
funding and administering child welfare services. The lessons of
these demonstration projects are expected to be beneficial for
other States, other social services programs, and national
policymakers.
Fourteen States submitted waiver proposals in response to a
formal Announcement which appeared in the Federal Register on
June 15, 1995. One State has since withdrawn from consideration.
The waiver proposals involve a number of themes, among them:
-
using title IV-E funds for services and for prevention,
rather than for out-of-home care;
-
providing subsidies for guardianships for certain
children now in long-term foster care;
-2-
-
encouraging kinship placements;
-
adapting managed care techniques to the provision of
child welfare services;
-
devolving child welfare responsibility and decision-
making from the State to a county or local level; and
-
developing more community-based services for children
and families, and more family-like and community-based
placement capacity for children.
The States under consideration are California, Delaware, the
District of Columbia, Georgia, Illinois, Indiana, Maryland,
Michigan, New York, North Carolina, Ohio, Oregon and West
Virginia. One State, Minnesota, dropped out. Summaries of the
fourteen proposals were published for public comment in the
Federal Register of September 7, 1995.
We have received over 50 comments from the public in response to
our publication in the Federal Register of summaries of the State
proposals. Commentors included advocates, foster parents, and
county officials. The Children's Bureau conducted a series of
initial conference calls with all of the States, for a
preliminary discussion of the proposals and to gather additional
information. Following that, Issue Papers were developed for
each State, which outline matters the Department wishes to
discuss in more detail. States are invited to set their own
timeframes for responding to the Issue Papers, and for scheduling
follow-up discussions. The table at Tab A shows the status of
Issue Papers and State responses.
It is not yet known whether ten of these thirteen pending
proposals will be approved. Sixteen other States have indicated
some degree of interest in a child welfare waiver demonstration
project.
In California, the Los Angeles County Department of Children's
Services has written to the White House expressing strong
disagreement with the State's proposal to devolve child welfare
responsibility (both programmatic and fiscal) to the counties.
California is presently revising its proposal, partly in response
to the Department's Issue Paper, which identified the local
concerns.
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Child welfare waivers will not involve the level of dollars that
are involved in AFDC and Medicaid waivers, nor will they, in most
cases, affect nearly as many children or families.
THE BROADER CHILD WELFARE REFORM CONTEXT
The child welfare system is experiencing considerable stress, and
the need for change is broadly recognized. States need federal
support in their efforts to reform the way in which services are
designed and delivered. The Department's goal is to create a
service delivery approach that is focused on safety, permanency
and the well being of children; that is family focused and
provides a continuum of services; and that is inclusive in the
planning and delivery of services.
Tn addition to waivers, other key strategies in moving child
welfare reform forward are:
-
the development of an outcomes focus for child welfare
systems;
-
reactivating the joint planning process with States
through implementation of Family Preservation and
Support logiclation;
-
revising the Department's approach to monitoring, to
stress outcomes, self-assessment, federal/State
partnership and program improvement;
-
development of an adoption strategic plan to increase
the focus on permanency;
-
working with courts to improve the timeliness and
quality of decision making; and
-
improving the collection and use of data through
support of advanced technology.
DISCUSSION
These waivers provide the Department with the capacity to enter
into active partnership with some States to implement and
evaluate promising alternatives, and to test new approaches to
child welfare practice and administration.
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The child welfare waiver proposals raise a number of substantive
issues, among them:
-
HOW to assure protection of children and quality of
services;
-
How to guarantee that children and families are not
deprived of services to which they are entitled;
-
HOW to handle the waiver proposals where systems are
especially fragile (DC) or challenged (NY);
-
HOW to handle evaluations of statewide projects; and
-
How to assure cost neutrality, especially if it is
necessary to rely on projections of State entitlements.
The first child welfare waiver proposal which will be ready for
approval is Delaware's. Draft Waiver Terms and Conditions are
now being reviewed by Delaware officials. Delaware is proposing
two separate child welfare demonstration projects: one statewide
component to test the use of substance abuse counseling and
treatment for parents as a means of reducing or removing the need
to place children in foster care; and a limited component (up to
10 children) that would test assisted guardianship for certain
children in foster care who cannot be placed for adoption.
Way I Bare
Mary Jo Bane
Attachments:
Tab A - Statutory Authority
Tab B - Waiver Announcement - Federal Register, June 15, 1995
Tab C - Summary of Proposals Received - Federal Register,
September 7, 1995
Tab D - Status of child Welfare Waivers - Table
CC: Kevin Thurm
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Tab A
HR5252, portion thereof
SEC. 208. DEMONSTRATION PROJECTS.
Part A of title XI (42 U.S.C. 1301-1320b-13) is amended by
inserting after section 1128B the following:
'demonetration projects
'`Sec. 1129. (a) In General. The Secretary may authorize not more
than 10 States to conduct demonstration projects pursuant to this
section which the Secretary finds are likely to promote the objectives
of part B or E of title IV.
(b) Waiver Authority. The Secretary may waive compliance with
any requirement of part. R or E of title IV which (if applied) would
prevent a State from carrying out a demonstration project under this
section or prevent the State from effectively achieving the purpose of
such a project, except that the Scoretary may not waive--
(1) any provision of section 427 (as in effect before
April 1, 1996), section 422(h) (9) (as in effect after such
date), or section 479; or
(2) any provision of such part E. to the extent that the
waiver would impair the ontitlement of any qualified child or
family to benefits under a State plan approved under such part
E.
(c) Treatment as Program Expenditures. For purposes of parts B
and E of title IV, the Secretary shall consider the expenditures of any
State to conduct a demonstration project under this section to be
expenditures under subpart 1 or 2 of such part B, or under such part E,
as the State may elect.
(d) Duration of Demonstration.- demonstration project under
this section may be conducted for not more than 5 years.
(c) Application. Any State cooking to conduct a dcmonotration
project under this section shall submit to the Secretary an
application, in such form as the Secretary may require, which
includes--
(1) a description of the proposed project, the geographic
area in which the proposed project would be conducted, the
children or families who would be served by the proposed
project, and the services which would be provided by the
proposed project (which shall provide, where appropriate, for
random assignment of children and families to groups served
under the project and to control groups);
(2) a statement of the period during which the proposed
project would he conducted;
(3) a discussion of the benefits that are expected from
the proposed project (compared to a continuation of activities
under the approved plan or plano of the State),
(4) an estimate of the costs or savings of the proposed
project;
(5) a statement of program requirements for which waivers
would be needed to permit the proposed project to De conducted;
(6) a description of the proposed evaluation design; and
(7) such additional information as the Secretary may
require.
(f) Evaluations: Report.--Each State authorized to conduct a
demonstration project under this section shall--
(1) obtain an evaluation by an independent contractor of
the effectiveness of the project, using an cvaluation design
approved by the secretary which provides for--
(A) comparison of methods of service delivery
under the project, and such methods under a State plan
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-2-
or plans, with respect to efficiency, economy, and any
other appropriate mcasures of program management;
(B) comparison of outcomes for children and
families (and groups of children and families) under
the project, and such outcomes under a State plan or
plans, for purposes of assessing the effectiveness of
the project in achieving program goals, and
(C) any other information that the Secretary may
require; and
(2) provide interim and final evaluation reports to the
Secretary, at such times and in such manner as the Secretary
may require.
(g) Cost Neutrality. The Secretary may not authorize à State LO
conduct a demonstration project under this section unless the Secretary
determines that the total amount of Federal funds that will be expended
under (or by reason of) the project over its approved term (or such
portion thereof or other period as the Secretary may find appropriate)
will not exceed the amount of such funds that would be expended by the
State under the State plans approved under parts B and E of title IV if
the project were not conducted
P.03
Child Welfare Waivers -- STATUS As of: Apr. 12, 1996
ISSUE PAPERS
DECISION PROCESS
In HHS/
Sent to
State
Dis-
Terms &
Approval
State
OMB Rev.
State
Response
cussion
Cond'ns
Package
DE
X
X
in
held 2/28
in State being
review
assembled
IL
X
X
in
held 4/12
NY
X
X
NC
X
X
WV
X
IN
X
X
in
held 3/20
in State
review
CA
X
will reply
in Apr.
OH
X
X
in
held 4/2
being
drafted
MI
X
X
in, in draft
***
GA
X
DC
X
MD
X
X
OR
X
X
in
held 3/18
partial
APR-18-1996 10:37
draft in
ACF review
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Appendix I
This is a list of program ideas that have been suggested by States or
others in response to the Department's requests for suggestions. They are
listed only as a means of outlining, for States interested in proposing a
child walfare waiver demonstration project, the broad range of possible
demonstrations that the Department would consider. Whether these sample ideas
would be cost-neutral would depend, of course, on how a state proposes to
implement them. Similarly, the method of implementation could affect whether
a waiver demonstration project would meet the statutory requirement that it
not "impair the entitlement of any qualified child or family to benefits under
a State" title IV-E Plan.
This list should not be regarded as limiting a State in any way in
conceiving demonstration ideas.
To meet the need for specialized foster care, and to reduce the
amount spent on institutional care, train AFDC recipients or other
low income persons to be professional, paid foster parents for
specialized foster home placements; ensure appropriate licensing
and possibly provide housing subsidies or homeownership assistance
to assure the stability of the specialized foster home ao 2 long-
term resource.
Broaden the use of title IV-E to fund services for children, their
parents, and [oster families, and LU fund preventive services IUI
families at. risk, with the expectation that total time in out-of-
home care would be reduced, and in some cases foster placements
could be avoided.
Provide better services at lower cost by, where appropriate,
returning children, especially adolescents, from out-of-State
institutional placements. Such a demonstration might include both
foster care youth and youth who are in the juvenile justice
system. The expectation is that placing them in community-based
specialized family foster homes, or community-based group homes,
will reduce the total time in out-of-home care.
Provide subsidized guardianship or other arrangements which would
allow children to etay or be placed in a familial setting that is
more cost-effective than continuing them in foster care.
For older adolescents in independent living, allow title IV-F
funds to be used for the cost of an apartment for a period of time
before the youth leaves foster care. and a short period
thereafter, to achieve more stable placemente for youth.
Expand the availability of in-home respite care for foster
families, with the expectation that administrative costs,
including the costs of recruiting foster families, will be
controlled, and more stable placements will result in shortened
stays in out-of-home care.
Provide State-funded parental visitation for parents whose
children are in institutional care, including the costs of
telephone calls, transportation, and other expenses associated
with maintaining or improving contact. The expectation is that
more contact between parents/families and children in care can
shorten stays in institutional placements.
Enter into agreements with private providers to test a managed
care concept, with clearly specified and mcaourable outcomes to bc
achieved for each family, at a fixed cost negotiated in advance,
with the expectation that fiscal incentives would produce a better
result with no increase in cost.
Enter into agreements with Indian Tribes to permit full access to
all aspects of title IV-E funding, with the expectation that
services for tribal children and families will improve, while
State costs of providing or managing those services will decline.
Where court processes are unduly delaying adoptions, enter into
agreements with courts to fund adoption-related work as if it were
an administrative cost under title IV-E, with the expectation that
the courts would then be able to speed adoptions, producing
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-2-
permanency for children earlier, and reducing foster care and case
management costs.
Seek a waiver of some provision( (B) of title IV-A (AFDC), possibly
in combination with a title IV-E or IV-B waiver, which might help
achieve child welfare objectives. For example, a waiver which
allowed a State to continue AFDC payments (in whole or in part)
for a period of time, for a family from which the children had
been removed, but where reunification is the goal and the loss of
AFDC benefits would likely result in homelessness, thus
frustrating reunification efforts.
APR-18-1996 10:38
P.04
Tab D
Delaware Child Welfare Waiver Demonstration Project
The proposal has two essential components aimed at ensuring
permanency for children. The first component employs a multi-
disciplinary team composed of treatment social workers and
substance abuse counselors. The second component will support
children who are placed in supported guardianship is transferred
in situations where adoption is not possible and an identified
family has made a long-term commitment to the child.
The State has seen a rise in the number of children entering
foster care over the last 3 years, due largely to parental
substance abuse. Through the use of multi-disciplinary teams,
treatment will be provided to families experiencing both
substance abuse and child abuse and neglect, thus providing
services to children who would otherwise be entering foster care.
Title IV-E funds normally used for foster care will be directed
to pay for the cost of treatment services.
The goal of the demonstration project is to prevent or delay
entry of children into foster care or reduce the time in out-of-
home care in 50% of the families receiving services under the
project.
The State premise is that the multi-disciplinary treatment
project would improve the quality of services provided to
families receiving services and improve outcomes for children
under its protection. It has been extremely difficult for the
State to provide effective services to families with active
addiction. Social workers spend a great deal of time trying to
connect families with substance abuse agencies, only to have the
treatment agency discharge clients because of lack of commitment
to treatment. Substance abuse counselors would have the
expertise to more accurately assess the seriousness of the
problem, make referrals to the most appropriate service and
agency, help the social worker confront the family's denial of
the problem, assist the social worker in court intervention when
necessary and where able, reduce the impact of parental addiction
on children.
Under the supportive guardianship component, the State will
utilize title IV-E funds to provide financial subsidies in
support of children who are placed in guardianship in situations
where adoption is not possible and an identified family has made
a long-term commitment to the child. Adding guardianship to the
permanency continuum which includes adoption and long-term foster
care broadens the options available to children and families.
Guardianship will enable the family to assume the parental role
without ongoing agency oversight but the family will have the
ability to return to the agency for services as needed. The
P.05
APR-18-1996 10:38
***
-2-
child's case will be removed from the foster care review system,
saving time and money for the family, the agency, and the court
system. The State contends this change will better serve the
children and youth involved. Children and caretaking guardians
will be freed of the burdensome State review system and the
degree of intrusiveness currently existing. They will receive
ongoing financial assistance and other services will be available
as needed. Children who are older and/or positively connected to
parents or kin will be able to maintain those birth ties.
Guardianship will not replace adoption where it is appropriate.
Long-term foster care placement with agreement will remain an
option where guardianship is not possible.
APR-18-1996 10:38
***
P.06
TAB B
[SUMMARIES OF STATE CHILD WELFARE WAIVER PROPOSALS,
AS PUBLISHED IN THE FEDERAL REGISTER FOR COMMENT 9-7-95]
STATE: CALIFORNIA
DESCRIPTION: California proposes to extend, and broaden to
include the use of federal funds, a planned State Partnership
Demonstration Project that will provide direct funding to
counties for the implementation of child welfare services.
Participating counties would receive from the State a single
allocation of funds for family and children's services, rather
than using categorical funding streams.
The project would enhance the counties' abilities: to meet
families' needs more comprehensively; to increase the focus on
outcomes; to provide additional in-home services which will
result in less need for out of home care; and to contain costs.
The State anticipates that enhanced flexibility in the use of
federal funds, reduced administrative requirements and a new
"outcome-oriented oversight role" will improve outcomes for
children and families, including more effective prevention
services that will reduce the need for out of home care. The
State is particularly interested in promoting a whole family
foster care program and long term options for children in kinship
care.
The State proposes, potentially, to waive a large number of
statutory (and regulatory) provisions, which would be based on
negotiations among federal, State and local child welfare
services officials regarding specific local waiver proposals.
For each of many statutory provisions, the state proposes
conditionally to "request waiver of this section to the extent
necessary to implement the proposed demonstration project."
Statutory items include certain title IV-E State plan
requirements, title IV-E income eligibility requirements,
statutory definitions (including definitions of eligible
facilities), requirements regarding adoption assistance payments,
required statistical reports, and Independent Living Program
eligibility requirements. Regulatory items proposed for waiver
include limitation on the sources of state match, cost allocation
plan requirements, general grant administration requirements,
fiscal regulations, the State allotment determination formula,
payment review and facility licensing standards, and regulations
regarding the withholding of federal funds.
CONTACT PERSON: Marjorie Kelly, Deputy Director
Children and Families Services Division
California Department of Social Services
744 P Street M.S. 19073
Sacramento, CA 95814
(916) 657-2614, (916) 653-1695 (FAX)
APR-18-1996 10:39
***
P.08
STATE: DISTRICT OF COLUMBIA
DESCRIPTION: The District of Columbia proposes to develop a
community-based therapeutic model of services to serve as an
alternative to placing children in more restrictive institutional
settings, as well as providing a transitional bridge for those
children returning to the community upon discharge from
institutional care.
The flexible use of title IV-E and IV-B funds would allow for the
development and provision of a community-based model of
therapeutic services to prevent foster home and institutional
placement and would increase inter/intra agency and multi-system
coordination of services.
The demonstration project would include the use of a "managed
care" approach through the use of rate setting procedures to
include articulated caps, and a system to provide comprehensive
multi-system social and support services. The community-based
therapeutic approach would include specialized emergency foster
care homes; shared family care; in-home treatment; use of
professional surrogate parents; and substance abuse treatment
services.
The District of Columbia proposes title IV-E waivers to allow
payment for services, and to permit the support of alternatives
to foster home and institutional placement through use of a rate-
setting process to be established under the demonstration
project.
CONTACT PERSON: Ricardo Lyles
Acting Administrator
Family Services Administration
District of Columbia Department of
Human Services
609 H Street, N.E.
Washington, D.C. 20002
(202) 724-8756
(202) 727-9460 (FAX)
3
APR-18-1996 10:39
***
P.09
STATE: GEORGIA
DESCRIPTION: Georgia proposes to use title IV-E funds to fund
preventive and supportive services for children and families at
risk, to eliminate the need for placement or reduce the time a
child spends in out of home care. Additionally, Georgia seeks to
place children in neighborhood settings; provide specialized
living arrangements for adolescents, and obtain special adoption
assistance to expedite the placement of children into adoptive
homes.
The benefits for this demonstration project include removing
systems barriers, decreasing or avoiding the amount of time a
child spends in out of home care, providing more stable
placements, expanding preventive and family support service
systems and increasing adoptive placements by making resources
available to adoptive families that otherwise would not qualify.
The services to be provided under the demonstration project
include family support and prevention services, expansion of
kinship care, and community placement services.
Georgia proposes to expand title IV-E coverage to include
placement prevention and reunification services. The State also
wishes to waive some provisions of title IV-E eligibility
determination when a child comes into custody, provide a special
waiver to provide adoption assistance to pay for the purchase of
services to expedite adoptive placement, and provide funds for
adoptive parents for one-time expenses related to the placement
of a specific child in the home. Georgia also seeks a waiver to
permit title IV-E funds to support a kinship care assistance
subsidy, and a waiver of some provisions of title IV-A to allow
families whose children are in foster care to continue receiving
food stamps, when reunification is expected to occur within 180
days.
CONTACT PERSON: Doris Walker
Foster Care Unit Chief
Georgia Department of Human Resources
Division of Family and Children Services
Two Peachtree Street, N.W., Suite 12-300
Atlanta, GA 30303-3180
(404) 657-3458
(404) 657-3415 (FAX)
4
P.10
APR-18-1996 10:40
***
STATE: ILLINOIS
DESCRIPTION: Illinois is proposing a subsidized private
guardianship as a permanency planning option which would meet the
needs of the long-term kinship care population, in order to
reduce the number of children in long-term foster care and to
reduce the number of disrupted placements.
Illinois seeks to improve permanency outcomes for children in
healthy kinship care arrangements in cases where reunification
and adoption are not possible. The demonstration project would
reduce government intrusion in family life while creating support
and clinical management systems which minimize risk through
annual reviews of subsidized private guardianship and continuous
promotion of adoption options.
Illinois would provide a subsidized private guardianship program
(which parallels the adoption subsidy program) for a random group
of eligible caregivers.
The State proposes a waiver of title IV-E to permit withholding
subsidized guardianship from a randomly selected control group; a
waiver of certain provisions of the Adoption Assistance Program
to authorize subsidized guardianship for children who meet the
eligibility requirements of Section 673 and additional
requirements set by the State, in order to authorize payment of
nonrecurring guardianship expenses, and for guardianship
assistance payments for children; a waiver of eligibility
requirements to limit assistance to special needs children; a
waiver that would permit federal financial participation in
amounts expended as guardianship support payments pursuant to
guardianship assistance agreements; and a waiver to authorize
federal financial participation in amounts expended on training
and administration for the subsidized guardianship program and a
waiver of the provision defining "adoption agreement" to allow
that term to include "guardianship assistance agreement."
CONTACT PERSON: Joe Loftus
Executive Deputy Director
Illinois Department of Children and
and Family Services
100 West Randolph, 6th Floor
Chicago, IL 60601
(312) 814-8741
(312) 814-6859 (FAX)
5
APR-18-1996 10:40
***
P.11
STATE: INDIANA
DESCRIPTION: Indiana proposes to divert per diem funds from
restrictive (primarily institutional) placements to more
community-based services in order to create more home-based in-
state placements for children, placements which would be more
supportive of family unity.
The effort would result in fewer high cost, out of state child
placements; fewer removals from home, and earlier reunification;
improved family functioning; expeditious adoptions; timely
transitions to independent living; and improved outcomes for
children.
Indiana would modify existing interagency agreements between the
Division of Family and Children Services and juvenile court
judges to include community partners such as mental health,
education and the Step Ahead Council. The local office of Family
and Children Services, the county probation office, community
mental health center or the school corporation seeking placement
of a child would convene a meeting of partners to develop
alternatives to restrictive placement.
Indiana proposes to waive title IV-E to permit payment of
proposed services: even when a child has not been judicially
removed from the home; in order to prevent the placement of a
child in out of home care; and for the child in substitute care
who is not categorically eligible for title IV-E foster care.
CONTACT PERSON: James Hmurovich
Director
Division of Family and Children
Family and Services Administration
Room W392, Government Center south
402 West Randolph Street
Indianapolis, IN 46204
(317) 232-4705
(317) 232-4490 (FAX)
6
P.12
APR-18-1996 10:40
***
STATE: MARYLAND
DESCRIPTION: Maryland proposes to add federal guardianship
assistance as a permanency planning option which would more
closely meet the needs of the kinship care population.
This effort would result in reduced average length of stay in out
of home placement for children; increased stability for children,
and empowerment/support for the caretaking family.
Under this demonstration project in order to be eligible a child
would have to be committed to the local department of social
services as a child in need of assistance and to have been in a
successful out of home placement with the prospective guardian
for a minimum of six months. Reunification and adoption would
have to be appropriately ruled out as permanency planning
options. Resources for the child (SSI, Social Security
Survivor's Benefits, etc.) would be transferred to the guardian
and deducted from the subsidy. Prospective guardians would be
required to sign a guardianship agreement which would require
annual renewal.
CONTACT PERSON: Fern Blake
Maryland Department of Human Resources
311 West Saratoga Street
Baltimore, MD 21201-3521
(410) 767-7269
(410) 333-0099 (FAX)
7
APR-18-1996 10:40
***
P.13
STATE: MICHIGAN
DESCRIPTION: Michigan proposes to increase its emphasis on
family preservation and family support services and decrease the
need for and reliance on out of home care by using title IV-E
funds to provide services.
The effort would result in controlled growth of title IV-E
maintenance expenditures; greater collaboration among federally-
funded programs; increased ability to provide services for
families; and decreased reliance on out of home care.
Michigan is proposing to treat title IV-E maintenance payments
(other than those for adoption subsidy) as a capped entitlement.
The State is proposing to use the funds for service provision, in
some cases augmenting funds now being expended under title IV-B
Subpart 1 (Child Welfare Services) and Subpart 2 (Family
Preservation and Support). The funds would be used to expand
grants to local communities and to implement family preservation
and support services more quickly.
Michigan is proposing to waive those provisions of title IV-E
which restrict States from expending these funds for the
provision of services. Michigan excludes title IV-E adoption
assistance from its waiver proposal.
CONTACT PERSON: David Berns
Director
Office of Children's Services
Michigan Department of Social Services
235 South Grand Avenue
P. O. Box 30037
Lansing, MI 48909
(517) 335-6159
(517) 241-7047 (FAX)
8
APR-18-1996 10:41
***
P.15
STATE: NEW YORK
DESCRIPTION: New York proposes to use a managed care approach to
child welfare services to recapture revenue for reinvestment in
preventive and aftercare services in local communities.
The benefits of this effort would be an accelerated decline in
the foster care population; an increase in the level of services;
and a reduction in the length of stay in foster care.
New York proposes to apply the principles of managed care to its
foster care and adoption assistance programs by identifying
preset payments for a range of services for a specified
population over a predetermined period of time (capitated
payments) and adjusting treatment regimens in light of outcomes
so that the client receives the necessary services to continue to
make progress toward the stated goals of intervention (care
management). The State also proposes to increase the
availability of child welfare services so that pre-placement
preventive and aftercare services can be intensified.
New York proposes to waive: title IV-E requirements regarding the
eligibility of children and of foster care facilities; the
definition of "special needs" for which title IV-E funds may be
used; the circumstances under which these funds may be claimed;
and certain requirements concerning title IV-E administration and
training.
CONTACT PERSON: Fred Wulczyn
Office of Family and Children Services
Division of Services and Community Development
New York State Department of Social Services
40 North Pearl Street
Albany, NY 12243-0001
(518) 486-3431
(518) 474-9004 (FAX)
10
APR-18-1996 10:41
***
P.16
STATE: NORTH CAROLINA
DESCRIPTION: North Carolina proposes outcome-based management of
foster care, in which foster care funding is tied to specific
outcomes related to diverting children from foster care whenever
possible and moving quickly to achieve permanence for children.
The benefits from this demonstration effort would: link funding
and outcomes and measure the effect on service delivery system
performance; demonstrate and evaluate the effectiveness of a
comprehensive outcome-based approach; decrease the amount of time
children spend in foster care, reduce the number of new entries
into foster care, and promote collaborative planning and
coordination of services with several other initiatives currently
underway in the State.
The proposed demonstration effort has two parts. Part I is
designed to encourage the development of effective community-
based reunification, adoption and aftercare services. Part II is
designed to achieve a paradigm shift that allows local programs
to move resources from treatment to prevention.
The waiver requests the use of title IV-E foster care funds on
behalf of children not presently eligible: to allow local social
service agencies to use a capitated rate structure with
incentives for achieving specified outcomes; to allow local
social service agencies to contract with public, private non-
profit and private for profit entities as needed to develop an
effective community network of services; and to allow
participating agencies to reinvest savings realized from
performance excellence in child welfare services.
CONTACT PERSON: Chuck Harris
North Carolina Department of Human Resources
Division of Social Services
325 Salisbury Street
Raleigh, NC 27603
(919) 733-9467
(919) 715-0024 (FAX)
11
APR-18-1996 10:41
***
P.17
STATE: OHIO
DESCRIPTION: Ohio proposes to reduce child removals and/or time
of children in placement and associated costs through the use of
managed care technology to provide a broader array of services to
children and their families.
The benefits of this effort would include decreasing placement
costs, increasing the level and quality of services;
strengthening local partnerships; and expediting the permanency
planning process.
The proposed demonstration effort represents a partnership
between public children's service agencies (PCSAs), the Ohio
Department of Human Services (ODHS), and managed care entities
(MCE). Decision making and risk will be shared among the PCSAs,
ODHS and the MCE. ODHS's role is that of coordinator,
facilitator and provider of training and technical assistance.
The PCSAs' role is primarily as purchasers of services, and they
may or may not provide all the direct service functions
themselves. The MCE will be responsible for administrative and
management functions, medical/clinical reviews, utilization
management and service authorization, developing and operating a
management information system, developing contracts with
providers and payers, and consumer satisfaction-related duties.
The current system of services will continue but with managed
care options being considered at decision making points. A
policy consortium will be created to develop and implement policy
and practices that support permanency planning and provide
guidance to the local PCSAs. The terms and conditions developed
by the Consortium will bind the provider agencies to uniformly
implement the agreed upon practice criteria and to ensure
consistency for evaluation purposes across the waiver sites.
Ohio proposes to waive a number of title IV-E provisions that
relate to restrictions on child eligibility, and prohibitions on
the use of title IV-E funds for the provision of services.
CONTACT PERSON: Isaac Palmer
Deputy Director
Office of Child Care and Family Services
Ohio Department of Human Services
30 East Broad Street
Columbus, OH 43266-0423
(614) 466-1213
(614) 466-9247 (FAX)
12
APR-18-1996 10:42
***
P.18
STATE: OREGON
DESCRIPTION: Oregon proposes to use title IV-E funds for
services including but not limited to prevention and support
services, protective services, crisis intervention and
reunification services. The State also proposes to develop a
kinship foster care rate that would be individually determined
based on the needs of the child.
The demonstration project would provide flexible funding for
abused and neglected children and their families and/or
caregivers to receive individual services, regardless of where
the chid is placed. Specific outcomes expected would include
decreasing the length of foster care placement, increasing the
number of children remaining safely in their homes, increasing
the use of relative caretakers for children who must be placed
out of the home, having more appropriate foster care resources
and better utilization of community resources.
The proposed demonstration project would provide support to
biological, foster and kinship caretakers through a myriad of
services. The State proposes to shift toward a statewide system
of in-home care services delivery, insure a match between the
child's needs and the skill of the caretakers, establish
mechanisms that will refocus the out of home care systems and
move closer to implementation of a "first placement/only
placement" objective for children who are unable to remain with
their parent (s).
Oregon proposes to waive those provisions of title IV-E: that
require a State to make foster care maintenance payments; that
require that foster care maintenance payments be made only on
behalf of a child who resides in a foster family home or a child
care institution; and that concern the conditions for federal
reimbursement for voluntary placements.
CONTACT PERSON: Richard Schoonover
State Office of Services for
Children and Families
Oregon Department of Human Resources
500 Summer Street, NE
Salem, OR 98310-1017
(503) 945-6882
(503) 328-3800 (FAX)
13
APR-18-1996 10:42
***
P.19
STATE: WEST VIRGINIA
DESCRIPTION: West Virginia will create a comprehensive,
decentralized, specialized system to determine a child's
potential eligibility for all funding resources for child welfare
programs.
The proposed system would maximize the State's child welfare
funds by identifying and accessing additional financial resources
available to children in care. The new system would emphasize
parental obligation and encourage parental participation.
A resource development unit will be created to identify, pursue
and produce accurate claims for all sources of funds to which a
child in care may be entitled, e.g., child support, SSI, Black
Lung, Railroad Retirement, third party medical, SSA, Veterans's
Benefits and titles IV-A, IV-B and IV-E.
West Virginia is requesting a waiver of the title IV-E limit of
fifty percent for Federal Financial Participation in a State's
administrative costs.
CONTACT PERSON: Mary Jarrett
West Virginia Department of Health and
Human Resources
Office of Social Services
Bldg. 6, Room B-850
State Capitol Complex
Charleston, WV 25305
(304) 558-7980
(304) 558-8800 (FAX)
14
TOTAL P.19