The Transformation of a Once-Helping Institution

The reporting crusade wrought other consequences as well. With the increase in reports came significant increases in staffing, budgets, and investigations. Lindsey (1994) argues that the news media has a central role in mediating information and forming public opinion. He notes that child abuse today represents a situation nearly identical to that of the "faddish hysteria" of the missing children scare of the early 1980s, during which the ranks of missing children swelled to an estimated 1.5 million per year. Anyone who questioned the reported facts and figures was suspect of lacking compassion for the plight of threatened children. It was not until 1985 that a Pulitzer prize-winning story in the Denver Post finally debunked the issue. Using FBI statistics, the newspaper reported that the number of child abductions was not 1,500,000 but 67. Over time, Harper's would come to refer to the missing children rage as a "national myth," and the New Republic would observe: "In a decade, that means that 15 million children have gone through the doughnut hole into the anti-world." Lindsey (1994, p. 163) concludes:

Looking back now, we smile that such inflated statistics received public acceptance. Yet, child abuse represents a nearly identical situation. When even one child dies from abuse, the child welfare system comes under immediate scrutiny. How was this allowed to happen, the public demands? How many other children are being clubbed to death in their cribs? Are we wasting our money on these bungling child welfare bureaucrats? Over the last two decades, such questions have transformed child welfare agencies from benevolent, helping organizations into a quasi-legal investigative, accusatory, protective services system.

Indeed, the press played a major role in the transformation, as the public's perception of child abuse is one largely based on sensationalized news accounts of relatively infrequent occurrences of extreme brutality some children endure at the hands of parents and other caretakers. Benjamin Wolf (1991), an attorney with the American Civil Liberties Union who filed a landmark suit against the Illinois Department of Children and Family Services, responded to such sensationalized coverage as provided by the Chicago Tribune:

Incredibly, there is another side which often is at least as bad and is rarely reported by the media. Those are the tragic situations in which children are needlessly removed from their homes or not reunited with their families when more appropriate, less expensive services would keep the family together.

"The cases that grab headlines and the attention of columnists are of course the ones in which the unrehabilitated parent regains custody only to inflict injury again," writes Wolf. "But by not telling about the often silent suffering of perhaps thousands of children who could be reunited with their families with just a little bit of help, we all reinforce an atmosphere in which case workers will be forced needlessly to shatter families contrary to the best interests of the children."

But it is not only the public's perception which is in need of realignment. As the Washington State Institute for Public Policy explains:

Most people, especially allied professionals in law enforcement, prosecution, and medicine, tend to imagine cases of severe child abuse when they think of child protective services. Allegations of severe child maltreatment, however, actually represent the minority of reports (Wilson, Vincent, & Lake, 1996).

John Hagedorn (1995, p. 36) describes the transformation of a once-helping institution to one in which a more conservative post-sixties era saw most federal social service dollars "going to create an expensive, punitively-inclined child protection apparatus which was to take over Departments of Social Services." Even the traditional discretion given social workers has since been altered from discretionary services to the discretion of whether to take a family to court or do nothing. Social service bureaucracies grew or sustained themselves by adapting to the ideology of child protection, "which in effect meant investigating child abuse and placing kids out of their homes." The tendency within social work toward investigations and child removal has been strengthened by changes over the past few decades in the structure of social service bureaucracies. The expansion of "social services" in the 1970s, argues Hagedorn, "had little correlation to improved services for children and families. Rather the chief beneficiaries have been urban social service bureaucracies, who have used the funds to adapt to a punitive climate, expanding their capacity to investigate poor families and remove children from their homes."

Billingsley and Giovannoni (1972) note that, as of 1971, there was no program in the United States to provide for children because they are children or because they are in need. Two forces-bureaucratization and professionalism-have sharpened the placement focus of child welfare and widened the separation between child welfare services and services to children in their homes. The gradual recognition of public responsibility for the poor was accompanied by a similar shift to public services in child welfare, with the effect of increasing the size of public child welfare operations. Privately administered agencies also grew as public money was increasingly made available to them. Bureaucratization was an inevitable consequence of these increases in size, and when the large bureaucracies came into being, they were simply superimposed on an already disarticulated system. This newly-bureaucratized system, they write, was anything but child focused, rather:

Agencies are funded on a basis of the functions they perform, and within the agencies, functions are still further subdivided. In short; services have been organized by function; they have not been organized with children in mind. This rigid division of labor has had negative consequences for children and their families (Billingsley & Giovannoni, 1972, p. 65).

As public bureaucracies grew, sociologists (Perrow 1979; Selznick, 1949, 1957) began to notice that they had taken on a life of their own. The principle goal or "mission" of such bureaucracies typically becomes one primarily of survival and expansion, or as Perrow (1979) points out: "The major message is that the organization has sold out its goals in order to survive or grow" (p. 182). Hence, bureaucracies such as social welfare are "permanently failing institutions (Meyer & Zucker, 1989, p. 19).

True to the bureaucratic mold, state and county child welfare agencies have long diverted the funds intended to reduce or prevent the inappropriate placement of children in foster care to promote their own survival and expansion. Meezen (1983) notes that, while federal funds for the maintenance of children in foster care have historically been unlimited, moneys that could have been used to provide in-home services have been appropriated at levels far below that authorized by Congress. And, many of those funds appropriated by the states for in-home services have historically been diverted instead to foster care.

A recent study conducted by the conservative Pacific Research Institute for Public Policy would bear this out (Matlick, 1997). The Institute found that "the child welfare system has squandered the resources it has been given and effectively worsened the problems it set out to solve." Over the course of 15 years and the expenditure of $10 billion, the plight of California's children has worsened. Notes the report: "Despite the emphasis placed on permanency, the California child welfare system continues to fail the children it was intended to help. In the last decade, it has grown into an enormous, self-perpetuating bureaucracy that exacerbates the very problems it is supposed to solve." These problems are attributable to "structural aspects of the child welfare system that reward both county agencies and child caregivers for keeping children in the system," the Institute found. "While the fiscal and economic costs of this are enormously high, the real cost is incurred by the children who are deprived of a healthy family by a system that puts its own welfare above theirs," the report concludes.

The bureaucratic imperative for expansion and survival has long been documented in California. The 1992-93 Santa Clara County grand jury closely examined the funding mechanisms that drive foster care placements and reported:

The Grand Jury heard from staff members of the DFCS and others outside the department that the department puts too much money into "back-end services," i.e., therapists and attorneys, and not enough money into "front-end" or basic services. The county does not receive as much in federal funds for "front-end" services, which could help solve the problems causing family inadequacies, as it receives for out-of-home placements or foster care services. In other words, the agency benefits, financially, from placing children in foster homes.

The report ominously concludes: "The Grand Jury did not see clear and convincing evidence that the foster care system operates with the best interest of the child in mind. It did find that the interest of the child often took a back seat to the interest of others."

A brief examination of how agencies benefit financially from out-of-home placement is in order, for as Kenneth A. Visser, Director of Family Preservation in the Michigan Department of Social Services explained to a Congressional Committee in 1991: "The current system of financing rewards us for foster care placement" (Committee on Ways and Means, 1991). More to the point, as Joseph R. Pisani, speaking on behalf of the National Conference of State Legislators explained: "You are paying us to do the wrong thing, and providing us with federal disincentives to do the right thing" (Committee on Ways and Means, 1979).

Child protection agencies are typically funded through a combination of state and county funds which cover the mundane costs of office space, salaries, furniture, telephone service, and other such operational expenses. It is the federal funds disbursed as "reimbursements" or "matching rates" under Title IV-E (45 CFR l356.60(c)(3)) to child protection agencies which provide the primary financial incentives favoring placement over the provision of preventive services. The Federal matching rate for foster care maintenance payments for a given state is tied to the state's Medicaid matching rate, which averages about 57% nationally and can range from 50% to 83%. States may also claim open-ended Federal matching at a rate of 50% for their child placement services and administrative costs. States also may claim open-ended Federal matching at a rate of 75% to train personnel employed by the state or by local agencies administering the program and to train foster and adoptive parents (Committee on Ways and Means, 1994, 1996).

These incentives are significant. The General Accounting Office (1995) notes that in 1993, nearly $1.3 billion Federal dollars went to foster care maintenance, while an additional $1.1 billion in reimbursements went to states for foster care related "administrative activities." The Congressional Budget Office estimates that by 2001, federal costs will rise to $4.8 billion with caseloads of federally assisted foster care children increasing by almost 26% (General Accounting Office, 1997). The best estimate currently available of the total of all annual expenditures on foster care services nationwide is in the range of $12 billion dollars (Craig & Herbert, 1997). Adding to the financial incentives favoring child removal and placement is an estimated additional $2.9 billion which is annually expended on child abuse and neglect related investigations (National Conference of State Legislatures, 1997).

Federal regulations (Administration for Children, Youth and Families, 1987) provide the following examples of allowable child placement services and administrative costs for the foster care program: referral to services, preparation for and participation in judicial determinations, placement of the child, development of the case plan, case reviews, case management and supervision, recruitment and licensing of foster homes and institutions, rate setting, and a proportionate share of agency overhead. Significantly, a child who has been identified as a potential "candidate" for placement into foster care may trigger reimbursements to the agency for these administrative costs regardless of whether or not the child had actually entered foster care, and these reimbursements to the agency may continue so long as the child remains a potential candidate for entry. Once the determination is made that a child is no longer a "candidate" for entry into care these reimbursements stop. Hence, there exists a clear financial incentive to agencies to maintain a case as open.

Conversely, costs which are not reimbursable under Title IV-E include those costs incurred for social services which provide treatment to the child and the child's family or foster family to remedy personal problems, behavior, or home conditions. Some examples of such non-reimbursable services would include physical or mental examinations, counseling, homemaker or housing services, and services to assist in preventing placement and reuniting families.

While declining to attribute to state-level administrative decision making the relationship between the Title IV-E eligibility of children and their length of stay in foster care, researchers from the Chapin Hall Center for Children at the University of Chicago point out that Title IV-E-eligible children in Illinois experienced a 50% slower rate of reunification that ineligible children. They voiced what they described as an "initial thought" that Title IV-E eligibility might influence state child welfare administrators to serve eligible children differently because of the availability of federal reimbursements (Testa & Goerge, 1988). Their suspicion merits further exploration, for federal funding is open ended; once the state appropriates revenues for child welfare, the federal match is essentially demand driven and therefore guaranteed. Such arrangements create enormous incentives for states to maximize the amount of money that can be extracted from the federal government. By the 1990s, incentives accompanying federal matching funds were clearly influencing child welfare practices (Costin, Karger, & Stoesz, 1996).

Many child welfare agencies today employ a formula described in industry jargon as the "penetration rate," which is described as the ratio of Title IV-E-eligible to ineligible children in foster care. The industry standard is that of maintaining a minimum ratio of 50% of the foster care population as eligible under Title IV-E in order for the program to be considered as well administered from a fiscal standpoint (Sharp, 1996).

In many states, the Medicaid matching rate to which the Title IV-E funding is tied is itself ever-outwardly-expanding as state and agency administrators artificially inflate Medicaid costs by passing on operating costs associated with the administration of their respective child welfare, foster care and juvenile justice systems to the Medicaid program. In expressing concern over the potential impacts of block granting on his state, Texas Comptroller of Public Accounts John Sharp (1996) suggests that agencies such as the Texas Department of Protective and Regulatory Services (DPRS) and the Health and Human Services Commission should shift their reimbursement claims from block grants to programs that still offer open-ended matching funds, such as Title IV-E and Medicaid, as: "By shifting their claims, [state agencies] can obtain more federal reimbursement to cover both their direct costs-such as employee salaries-and indirect costs-such as rent and janitorial services." Sharp also points out that, while DPRS was claiming reimbursement for some family assistance services by charging costs to the Emergency Assistance program, the agency should similarly shift those claims to Medicaid so the agency can receive additional federal funds.

Medicaid is one of many programs to which state and county agencies often charge their operating expenses using what have been described as "illusory approaches" in shifting their costs to the federal government (General Accounting Office, 1994) and as "creative financing mechanisms to leverage additional federal dollars" (General Accounting Office, 1995b, 1998; see also e.g. Office of the Inspector General, U.S. Department of Health and Human Services, 1994a, 1994b, 1994c, 1996, 1996b, 1996c, 1996d, 1997, 1998). The Emergency Assistance Program (EA) referenced by the Texas Comptroller is one such program which has enriched state and agency coffers. The Department of Health and Human Services Office of Inspector General (1995a) reports that several states have diverted EA funds, which are intended to provide short-term relief to families facing short-term financial crisis, to other programs. Notes the Inspector General: "The EA expenditures are escalating at a rapid pace due mainly to three types of costs, juvenile justice, foster care, and child welfare services."

According to the report, the State of New York diverted more than half of its claim for Emergency Assistance, over $230 million, to offset "administrative costs" for child protective services workers in Fiscal Year 1994. The state projected that the total of its foster care costs shifted to EA to be $107 million during Fiscal Years 1995-96. California has taken an even more creative approach to maximizing federal revenue. The state first set the income standard for eligibility for EA at 200% of the median income level for a family-of-four, an income of $92,800. When that failed to produce the desired federal revenue, the state amended its definition of a family unit to a family-of-one effective late September of 1994. Notes the Inspector General: "As such, the income of only the child facing the emergency is currently measured against the $92,800." Colorado has taken a similar approach, setting the family income requirements for EA at $75,000 a year. Why such high income limits for a program intended to provide short-term emergency relief to those in need? The Inspector General explains: "As a result of lengthening EA eligibility periods, defining emergencies broadly, and setting high income limits for determining eligibility, states amended their respective EA Programs to shift state funded long-term services to the EA Program, thereby maximizing Federal revenue." All of these funds are in addition to the Federal Foster Care funds being received by the states under Title IV-E and from other sources.

There appear to be few limits to the ingenuity employed by some agency administrators in their efforts to promote bureaucratic expansion and survival. In Illinois, for example, at least 20% of a $4.6 million fund known as the Foster Care Initiative was used to pay bills for security guards, temporary secretaries, bottled water, accounting fees, trash collection, equipment, furniture, utility bills, and office rent, according to state records. Nearly all of the payments were authorized by Sue Suter, the former director of the Department of Children and Family Services. Suter resigned in August of 1992 because, she said, she didn't have enough money to carry out the court-ordered reforms instituted by an ACLU lawsuit. Those reforms included finding more foster parents and providing them with training. "This agency has a history of taking funds intended for foster parents and children, and, through one ruse or another, using it to support the bureaucracy," said Benjamin Wolf, the ACLU attorney who instituted the legal action (Novak, 1993).

The situation in Illinois is not an aberration. In 1994, the state of New York settled a claim, paying out $27 million to the federal government for 12 years of overbilling it for job training programs. According to the Justice Department, the federal funds were intended for training workers who run social services programs such as Medicaid and foster care. Instead, the state's Department of Social Services used the money to hire janitors at Buffalo State College and to buy computers and fax machines. The overbilling netted New York state $14 million over 12 years, according to Justice Department spokesman Joe Krovisky (Associated Press, 1994).

The second amended civil complaint in the case, a copy of which is in my possession, alleged that contractors Cornell University, the State University of New York at Albany, Brockport and Central, The City Colleges of New York, Unisys Corporation, Motivational Systems, Inc., Child Welfare Institute, Inc., Jeffrey L. Bass Associates, Inc., and the Institute of Child Mental Health, Inc., "knowingly engaged in collusive bidding contrary to federal statutes and regulations," and that "the contractors submitted knowingly inflated budgets and vouchers for payment, the State and the defendant individuals knowingly approved such budgets and vouchers, and the State knowingly paid such vouchers, all knowingly contrary to federal statutes and regulations. The State then knowingly submitted false claims, statements and reports, and knowingly made false and concealing records, to cause the United States to approve and pay money to the State grant programs." The settling defendants included The New York State Department of Social Services, the Office of Human Resource Development, the State Universities of New York (SUNY) at Albany and Brockport, SUNY Central Administration, the Research Foundation of SUNY, the State University College at Buffalo, the City University of New York, and NYSDSS employees Robert Donahue, Robert Hagstrom, Carol Polnak, Carol DeCosmo and Will Zwink (U.S. Department of Justice, 1994).

Access to federal funds is not straightforward. Complications such as the need to determine AFDC and SSI eligibility at the time of child removal in order to qualify for the higher 75% federal matching rate arise. Under such circumstances, "the enterprising state child welfare administrator would have to acquire technical capacity rivaling 'Star Wars' in order to optimize federal revenue" (Costin, Karger, & Stoesz, 1996, p. 154). It should come as no surprise, then, that several private firms primarily composed of enterprising former state Title IV-E and IV-B administrators have sprung up to aid child protection agencies in the maximization of federal revenue on a fee contingent basis. Firms such as Maximus, Inc., Motivational Systems, Inc., and Andersen Consulting, Inc., among some others, currently offer the service. A copy of the state of Arkansas' contract with Maximus in my possession includes among its exhibits "Preliminary Workplans" for increasing recoveries for child welfare costs under Title IV-E, increasing recoveries for child welfare-related day care services under Title IV-E, recovering maintenance costs of state wards being served in private residential treatment centers under Title IV-E, increasing recoveries for residential and other community-based youth services under Title IV-E and Medicaid, increasing recoveries for DCFS case management costs under Medicaid, recovering juvenile probation and case management services under Medicaid, and, to be sure, a Preliminary Workplan "for increasing recoveries for administrative costs under IV-E, and Medicaid."

Recent reform measures threaten to make matters worse. Pelton (1997) explains that welfare reform, the Personal Responsibility and Work Opportunity Act of 1996, is likely to contribute to increased child removal, not so much because of the considerable likelihood that cuts in family-support programs will deepen child and family poverty, but because the Act, not surprisingly, protects the funding of substitute care under Title IV-E. Pelton explains: "Perversely, although meeting pre-1996 AFDC eligibility requirements will no longer insure a child's eligibility for welfare assistance in a parent's home, it will continue to qualify the child for federal foster care assistance in someone else's home" (emphasis in original).

It is difficult to be optimistic about the possibility of a popular call from among the larger population for the systemwide reform which is so desperately needed, for as Meezen (1983, p. 18) points out:

In addition to fiscal disincentives that have deterred the development of in-home services, social attitudes have also mitigated against keeping children at home. Institutional racism, negative attitudes toward the poor, and a fear of life-styles different from those of mainstream America have all allowed society to condemn the parents and remove the child rather than provide the supports necessary to maintain family integrity.

David Tobis (1998) argues that it must be understood that bureaucratic survival and expansion in and of themselves are not the only forces driving child welfare policy, suggesting that child welfare agencies may play a greater role in our society than they are frequently credited with:

The problem, I fear, is far greater than merely the self-interest of bureaucrats. The child welfare bureaucracy in our society has functions other than protecting the well-being of children. In its own minor league it promotes the interests of the politicians and bureaucrats at upper levels who put them in power, and supports the political and economic prejudices and forces that govern our policy. It functions as one of the many means used in our society to marginalize and control potentially disruptive subpopulations, and to instill fear and self-blame among impoverished people, so they will worry that if they seek more aggressively remedies for their difficulties their children, their apartment, or their increasingly diminished welfare benefits will be taken from them.

I am aware of one documented instance in which the threat of child removal was used in an effort to crush political dissent. In Concord, New Hampshire, outraged Clamshell Alliance organizers called a news conference at the gates of the Seabrook nuclear plant charging that Seabrook police had threatened to seize children from protesters and place them in foster care should they be arrested during a planned anti-nuclear demonstration. While police denied the claim, Associated Press reporters managed to track one such call to a Division for Children and Youth Services caseworker (Associated Press, 1989).

 

 
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