February 2020Vol. 21, No. 1Continuum or Continuation? A Choice of Conscience

Written by Jerry Milner and David Kelly

Most headlines and public discourse in child welfare orbit around two highly emotive topics: child fatalities and foster home scarcity. Both topics are incredibly important and warrant thoughtful attention. Unfortunately, thoughtfulness in media coverage and public discourse is rare. Seldom, if ever, do stories, discourse, and the policies they so often drive get to the underlying causes of family vulnerability and child maltreatment. Most stories highlight the most tragic and egregious occurrences and saddest stories. Sensationalism leads to blame and a deep desire to assign culpability. Political posturing ensues, data are disregarded, and knee-jerk reactions rule the day.  

This type of coverage and way of talking and thinking about child maltreatment, foster care, and fatalities have perpetuated the very problems they seek to improve. The most typical ways of speaking and thinking about these challenging issues is inertia feeding, leads far too often to doubling down on measures that have not proven effective, and leave us stuck in a highly reactionary way of being.

Groups have organized around these topics, industries have been built, lobbyists have been deployed, and stakes have been intractably driven into the ground. A panoply of panels, blue-ribbon reports, and studies have been conducted on child fatalities over decades, most commissioned after a high-profile fatality or several fatalities. The recommendations from such efforts are predictable; consistent; and, typically, call for better data sharing between family-serving agencies, lower caseloads, more frequent caseworker contact, enhanced fatality review efforts, and better interagency collaboration and coordination. Calls for more accountability, transparency, and greater resources also abound. 

With foster homes, the issue is always one of supply not meeting demand. Recruiting and maintaining high-quality foster homes is a perennial problem.

Both issues arouse emotions and activate well-intended caring people that want to help. This is commendable, appreciated, and necessary. However, as a field and society, we must guard against allowing tragedy and emotion to cause us to slip into a "child rescue" mentality.  We must not make judgements about worthy and unworthy parents, apply subjective standards from our own life experiences to families of different means and diverse cultures, and believe that taking more children into foster care where clear safety concerns have not been articulated will be beneficial to those children.

With both issues, the song largely remains the same. Yet, we stay the course with only minor adjustments. All the while, fatalities continue; cries for more beds resound; and the child welfare system remains funded primarily as a trauma-response unit as opposed to a well-being, trauma prevention, and, when needed, healing system. As discourse continues to spin, the next generation of trauma is occurring and disparities harden.

In recent years, much of the field's discourse and policy has centered on how science can help address some of the issues that leave families vulnerable to child maltreatment. This is useful. There is a clear need to understand what types of clinical interventions work best with which populations and to make them available. The Family First Prevention Services Act (FFPSA) will be helpful in these ways and serve as a vehicle for preventing foster care placement in certain circumstances. For some families, such services will help them stabilize a mental health issue, enter recovery, and/or gain new parenting skills.  That there is a new way to pay for some of these services is a big deal. It fills a needed band of the prevention continuum, but we have to recognize that families need more, and sooner.

We have to believe that families deserve more. We have to recognize that a glaring and dangerous gap in our system persists a gap that makes fatalities more likely and leaves us in perpetual need for more foster homes. Our current funding structure, even with the helpful additions of the FFPSA prevention services funding stream, leaves a gulf unattended; It does not provide for primary prevention.

If we are truly serious as a field and a society about preventing child fatalities and having enough foster homes, we must go to the root causes of both. We must directly address the conditions that leave families vulnerable. This requires a national commitment to a full continuum of prevention services.

We believe incredibly strongly that robust primary prevention networks that operate at the community level can finally allow us to make progress on preventing child fatalities and curbing the foster home demand-and-supply conundrum.

To do so, we must think beyond clinical walls and interventions and hone in on efforts to strengthen communities. To do so, we will need to invest in community resources, community programming, and community-based services that provide basic supports and build protective factors. We have to see the value and importance in ensuring that families have a place to go where they are not afraid to ask for help. We have to ensure that there are places that parents look forward to going to connect with peers and to access opportunities for their children and for themselves. We have to organize community supports around what we know about the social determinants of health, and we have to act on what we know about the importance of supporting parents of infants, babies, and very young children the population that is most at risk of fatality and most likely to require placement.

Until we do these things with clear intention, there is cause to question just how serious we are as a nation about preventing child fatalities. If we do not do these things, we will always have a foster care demand-and-supply problem. "Getting tough" on vulnerable parents and getting tough on child protection agencies is not going to solve the problem if they do not have what they need to provide or benefit from primary prevention services.

As a nation, we appear unable or unwilling to invest in and create a full prevention continuum.

We appear to be content at limiting the ways that child welfare agencies can help. We remain limited to waiting to help families until children are at imminent risk of entering foster care, which means something bad has likely already happened. It means addiction is already present, or that certain protective factors have eroded. It means that neglect has likely already occurred. It means we are waiting for trauma to occur before making help available in nonthreatening ways. It prevents us from addressing root causes and working to address normal challenges that most families experience in unobtrusive ways. When families do not have such support, normal challenges can escalate into crisis, and crisis can cascade into catastrophe.

Historically and now, precious little effort has been made or possible to address such questions from a federal child welfare funding perspective. As a nation, we remain committed to allowing trauma to occur, often compounding it through late-in-the-game intrusive intervention and then paying great sums to attempt to fix it.

For nearly 3 years, we have been attempting to knock the system out of its orbit so that we can move together with a broad range of partners in a more proactive, equitable, and humane path. For as long as it has existed, the system has revolved around crisis instead of trying to prevent it. To create that path, we must commit to robust primary prevention efforts as part of a full prevention continuum. Doing so will build on FFPSA and fill our largest and most dangerous gap.

No one is happy with our progress in preventing fatalities or reducing the need for foster homes, despite the best efforts of a committed workforce. The questions for everyone who cares about children and families are clear:

• Are we comfortable continuing as we are and have been? 
• Does this approach square with our values and our beliefs of what is right, most helpful, and just? 
• Does the current system align with our sense of purpose?
• Does it allow us to help and serve in the ways we would like to serve and know families need?

We have heard clearly from dedicated, caring, and deeply committed child welfare professionals across the country that the answer is a resounding "no" to each. We have heard from parents and youth with lived experience around the country that the answer is a resounding "no" to each. The field and those served by it clearly recognize the need for a full prevention continuum; they want to be a part of cocreating it. There are caring professionals and parents all over the country who love their children and know this is what it will take to reduce the risk of maltreatment, prevent child fatalities, and lessen the need for foster homes. It is time for statute and funding to catch up with what so many caring individuals, dedicated professionals, and communities know we need.

We can continue to admire the problems and mourn the consequent results. We can continue to cast blame, dig in, and perpetuate the circular conversation of the past several decades in child welfare. Or, we can demand and create a full prevention continuum that will strengthen families, strengthen communities, and prevent trauma and tragedy long before risk of either exists.

The work is not done. We need a full prevention continuum.