HEARING ON IMPROVING PROGRAMS DESIGNED
TO PROTECT AT‑RISK YOUTH
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
June 16, 2011
Printed for the use of the Committee on Ways and Means
COMMITTEE ON WAYS AND MEANS
ADRIAN SMITH, Nebraska
LLOYD DOGGETT, Texas
JIM MCDERMOTT, Washington
JOHN LEWIS, Georgia
JOSEPH CROWLEY, New York
JON TRAUB, Staff Director
C O N T E N T S
The Honorable Dennis R. “Denny” Rehberg, a Representative from the State of Montana
The Honorable Karen R. Bass, a Representative from the State of California
The Honorable Bryan Samuels, Commissioner, Administration on Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services
Patricia R. Wilson, Commissioner, Department for Community Based Services, Kentucky Cabinet for Health and Family Services
Lelia Baum Hopper, Director, Court Improvement Program, Supreme Court of Virginia
Tracy Wareing, Executive Director, American Public Human Services Association
John Sciamanna, Director, Policy and Government Affairs, Child Welfare, American Humane Society
Steve Yager, Deputy Director, Children’s Services Administration, Michigan Department of Human Services
HEARING ON IMPROVING PROGRAMS DESIGNE
TO PROTECT AT‑RISK YOUTH
U.S. House of Representatives,
Committee on Ways and Means,
The subcommittee met, pursuant to notice, at 9:02 a.m. in Room B‑318, Rayburn House Office Building, Hon. Geoff Davis [chairman of the subcommittee] presiding.
[The advisory of the hearing follows:]
*Chairman Davis. Good morning. Before we begin the opening statement, I would like to note that our line‑up on the Republican side has changed a bit, due to Mr. Heller’s move over to the United States Senate, and his departure from the People’s House. Today I would like to welcome Tom Reed from New York, both to the subcommittee and to the committee, for his first hearing. Thanks for joining us; we look forward to your perspective. He replaces Mr. Smith of Nebraska, who now becomes a distinguished alumnus of our subcommittee.
In today’s hearing we are going to review several programs under our jurisdiction that are designed to help ensure the safety and well‑being of children at risk of abuse and neglect. The majority of federal child welfare spending is used to reimburse states for supporting and overseeing children while they are in foster care.
However, the two programs we will focus on today, the Child Welfare Services program and the Promoting Safe and Stable Families program, are designed to prevent the need for foster care in the first place, as well as to help foster children return home safely or be placed with adoptive parents as soon as possible.
These two programs were last authorized in 2006, and both expire at the end of the fiscal year. The 2006 reauthorization made significant changes, such as requiring that foster children be visited at least once per month, ensuring that states consult with medical providers in assessing the health of foster youth, and helping states better address caretaker substance abuse issues.
The purpose of our hearing today is to review the effects of those changes, and to consider other changes that may be needed to promote the well‑being of children at risk of abuse and neglect. While we will primarily focus on these two programs, we should also draw attention to the patchwork way in which child welfare programs currently operate.
In our prior hearing on the program duplication, I noted that this subcommittee has jurisdiction over nine different child welfare programs, each with different purposes, spending requirements, and funding mechanisms. We need to ensure that these programs help and do not hinder states’ efforts to serve families in need. We also must make sure we understand how this taxpayer money is used, and whether it is achieving its intended purpose.
Amazingly, until 2006, there was no requirement that states report how they actually spend child welfare service program funds. In other words, for that program’s first 70 years, the public had no way of knowing how this money was spent, and this is not a way to run a government.
I look forward to hearing from our witnesses this morning on what we have learned from the recent changes to these programs, as well as what we can do to ensure more children remain safely in their own homes. Joining us today will be a mix of experts from Congress, the administration, states, and outside groups. We look forward to all of their testimony.
And I particularly want to single out one group that is not represented here today, possibly in the room, but one that my wife and I have long affiliation with, and that is CASA. I have done a lot of work through the years ‑‑ really, over the last 25 years ‑‑ with families on the edge, and particularly our years of affiliation with CASA have been a great blessing. And I appreciate not only CASA’s contribution, but all of the advocates, and especially the front‑line volunteers and folks that are working directly with children, with the families, trying to bring stability and order.
Without objection, each Member will have the opportunity to submit a written statement and have it included in the record at this point. And now I would like to recognize our distinguished ranking member from Texas, my friend, Mr. Doggett.
*Mr. Doggett. Well, thank you, Mr. Chairman. We share a similar interest in CASA. I have worked with several of the groups in the central Texas area, and they do outstanding work with able volunteers, as well as some of the other groups that are represented here this morning. And I am hopeful that we share not only that interest, but an interest in seeing that we put every taxpayer dollar to the most effective and efficient use possible to provide some of our most vulnerable children the services that they need.
As you have noted, the funding for the Child Welfare Services program and the Promoting Safe and Stable Families program will expire ‑‑ the authorization for it ‑‑ at the end of September, unless we take action to renew them. These programs have been renewed, and have enjoyed bipartisan support in the past. And I hope that we can work together to extend and improve these services.
The Child Welfare Services and the Promoting Safe and Stable Families initiatives provide about $700 million to the states this year for early intervention and family services designed to help our most at‑risk families. These funds are a critical part of the efforts to ensure that children are raised safely in their homes. And when that is not possible, to find a permanent home with a relative or an adoptive family.
In my home state of Texas, the Promoting Safe and Stable Families program has provided funds to help children in my home town in Travis County that are affected by substance abuse in the home. This program has enabled our county to develop a flexible, comprehensive continuum of services that is aimed at promoting recovery, and ensuring that children have a safe home free of drug addiction and abuse.
We know that an investment in front‑end services not only saves lives, but also can reduce the long‑term cost of removing a child from a family home and placing them in foster care. We have seen in Texas how mindless budget cutting can hurt these same children. In Texas there was a proposal in the State Legislature that would have the effect of cutting services to prevent child abuse and neglect by almost half in the current legislature. And legislatures across the country, whether through the pressures of budgets or indifference, are faced with similar kind of cuts. That is why what we do here is especially important this year.
I am troubled that the original Republican budget resolution considered earlier this year in the House would have cut the Social Services Block Grant program by $1.7 billion to the states, eliminating grants that would jeopardize protective services for almost 2 million at‑risk children.
Mr. Chairman, our committee does have a history of working together on these issues, and I look forward to cooperating and working with you and other members of the committee. I am pleased we have a couple of colleagues here to offer us insight, along with the experts from the field on this today. And I am sure it will be a productive hearing. Thank you.
*Chairman Davis. Thank you very much, Mr. Doggett. Before we move on to our testimony, I would like to remind our witnesses on both panels that oral statements are going to be limited to five minutes. However, without objection, all of the written testimony will be made part of the permanent record.
On our first panel we will be hearing from two of our distinguished colleagues. First, the Honorable Denny Rehberg, my friend from Montana since I have been in the Congress, and the Honorable Karen Bass, who is joining us from California, a long‑time advocate on these issues.
Mr. Rehberg, please proceed with your testimony.
STATEMENT OF HON. DENNIS R. “DENNY” REHBERG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MONTANA
*Mr. Rehberg. Thank you, Mr. Chairman. And I appear today not only on my own behalf, and as the representative of the State of Montana, as the chairman of the appropriations subcommittee, called labor, health and human services, and education.
I have got a long history of interest in these issues, and have been in many of your states, both as a Shriner and as a national vice president of the Montana and national Muscular Dystrophy Association, as well as having co‑founded and co‑chaired the Baby Caucus with Rosa DeLauro, for the specific purposes of looking for areas of interest to keep families together, and the struggles that are placed in their way for doing that.
I also want to thank you for the opportunity to talk about an issue that is of great importance to me in my home state of Montana, that of addressing the methamphetamine crisis, and the importance of family‑based drug prevention treatment.
Much of my activity in Montana meth is as a result of an individual by the name of Tom Sibel. He had owned Sibel Systems, eventually sold to Oracle, and he personally has put, at the last count that I was aware of, in the public‑private partnership $60 million of his own money to create meth projects in states like Arizona, Colorado, Georgia, Hawaii, Idaho, Illinois, Montana, and Wyoming. And those of you who represent those states would recognize the Georgia meth, Montana meth, Arizona meth project.
All rural areas of our nation have struggled with the devastation caused by rampant meth use, and Montana has been no exception. I have long supported the efforts of organizations that are in the forefront of drug prevention and treatment efforts in our states. In Montana, we do have the Montana meth project, an organization that does outstanding work conducting research and running statewide multi‑media public awareness campaigns aimed at significantly reducing first‑time meth use.
The meth project’s campaign of preventing kids from using meth, not even once, has led to a dramatic shift in the perception of meth use, and led to a 33 percent decrease in teen use of meth between 2007 and 2009. The meth project’s campaigns have also led to more frequent parent‑child communications about the dangers of meth, an important component of educating kids on the dangers of this addictive drug from a young age.
While I think we have come a long way in improving efforts to combat drug use in the first place, I think we can still improve in the way we provide treatment for those who are struggling with substance abuse issues. I strongly advocated for family‑based meth treatment, an approach which dramatically increases the effectiveness of long‑term recovery, employment, and educational enrollment. This kind of treatment yields consistently positive outcomes in child well‑being, family stability, and lower recidivism rates. Family‑based treatment centers provide essential needs for the entire family, including children, rather than just the parent.
I appreciate the fact that 2006 reauthorization of the child welfare programs under this committee’s jurisdiction provided dedicated funds for states to work with parents and caregivers with meth and other substance abuse issues. And I am especially thankful that two of those grants went to Montana organizations.
The bottom line? Families provide the best support systems, so making family the center of addiction treatment whenever possible just makes common sense.
The purpose of today’s hearing is to evaluate how key pieces of our nation’s child welfare system are working. I hope that, as you develop and delve into the specific programs under your jurisdiction, like the Promoting Safe and Stable Families program, that are designed to address child safety and stability of families face substance abuse uses, you will focus on opportunities for family‑based prevention and treatment whenever possible. My hope is that one day I will be able to report that meth addiction is no longer an issue in rural America.
Until then, I thank the committee for the opportunity to share my perspective, and for ‑‑ and its time on this incredibly important issue for families and communities elsewhere. Thank you, Mr. Chairman.
*Chairman Davis. Thank you, Mr. Rehberg, for your testimony on this critical issue, also a big issue in the Commonwealth of Kentucky right now.
Ms. Bass? You could give your testimony.
[The statement of Mr. Rehberg follows:]
STATEMENT OF HON. KAREN R. BASS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA
*Ms. Bass. Yes. Good morning, Chairman Davis and Ranking Member Doggett. Thank you for the opportunity to testify here before the committee today. I appreciated hearing your testimony about the meth problem.
Actually, I became involved in the child welfare issue about 20 years ago. I started an organization in Los Angeles that was addressing the crack cocaine crisis which, if we look at both of those drug epidemics, it was certainly when we had a spike in child welfare cases. And, frankly, it is one of the key policy areas that I hope to work on while I am in Congress.
In California, we have made enormous strides with reforming our child welfare system. In 1999, there were 140,000 children and youth that were removed from homes in California and placed in foster care. Today they are 57,000. In Los Angeles County there were 55,000 children removed from their homes, and today there are 15,000.
But the fact remains that there is certainly still enormous work to do to improve our system to help at‑risk children and families prevent entry into foster care. By providing help to families to prevent the spiral into abuse and neglect, we would avoid the substantial cost of foster care, avoiding the trauma of removal, and help families stay together.
To the contrary, the current child welfare system, the primary focus is on families that have already been identified with child abuse or neglect issues. This ends up with families being separated, children in foster care, costly efforts at reunification, and a system that has more failures than successes. The fact that title IV‑E funding cannot be used for prevention or post‑reunification services has created a significant challenge to achieve better safety outcomes and finding permanent homes for children.
However, in jurisdictions like Los Angeles County, some of these challenges have been mitigated because of the availability of Title IV‑E flexibility. Funding waivers allows the county to implement prevention strategies outside of funding constraints and dollars chiefly tied to out‑of‑home removal.
Given the limited number of IV‑E waivers, the Promoting Safe and Stable Families, PSSF, funding is essentially the only resource currently available that can finance support services to families. These funds can be used to provide a continuum of services that support families that have entered the child welfare system and are working towards reunification, as well as expanding efforts to prevent families from entering the system, or diverting them when they have been identified. But we know that PSSF funding is not sufficient to provide the amount of services necessary to truly affect change in existing structure.
I wanted to mention a couple of promising practices that the committee, I am sure, is aware of, but I think should be highlighted at this point in time. We know that there is many examples of programs that have been successful, and certainly my colleague mentioned a couple.
One promising practice is the differential response framework, which offers a broad set of strategies for working with families at the first signs of trouble, based on their level of need or risk that is identified. Differential response is an evidence‑based approach to prevent child abuse and neglect by ensuring child safety through expanding the ability of child welfare agencies to respond to reports of child maltreatment.
Because of the effectiveness of the model, in California there is an effort to expand this response to families that are at risk of being involved in the system because of issues such as substance abuse, mental health, and domestic violence.
Another one is up‑front assessments. In 2004 Los Angeles County Department of Children and Family Services implemented a pilot program to address the high number of children in foster care. Point of engagement is a process that attempts to engage the family as soon as possible after the referral to the department in order to assess the family and provide services that allow the family to avoid child detainment all together.
I want to give an example. There is a program in Los Angeles County called Shields for Families, and this is a program that was started at the height of the crack cocaine epidemic. I sat through one of the point of engagement responses that was done where the family members sat around and identified what the weaknesses, what the strengths were, and how to intervene in this situation. And I think it is an example of where they have been able to reduce the number of children that are in the system, all together.
In conclusion, I would ask my colleagues to consider, of course, that prevention ‑‑ an ounce of prevention, we all know, is certainly worth a pound of cure. As we work to reauthorize the Promoting Safe and Stable Families Act, these tried and proven community strategies are not only effective, but cost effective. And I encourage you to use prevention and early intervention models such as the ones adopted in LA County and Shields to inform your decision‑making.
Thank you for the opportunity to give testimony today.
*Chairman Davis. Thank you very much. I would like to thank both Mr. Rehberg and Ms. Bass for investing time to come in and share their insights. Does anyone have any questions from our colleagues?
*Mr. McDermott. Mr. Chairman, I want to commend you on getting the appropriator here, so that he can get an early buy‑in on our authorization.
*Chairman Davis. I appreciate the gentleman’s perspective. It begs the fellowship ‑‑
*Mr. Rehberg. It ‑‑
*Chairman Davis. ‑‑ of the Appropriations and Ways and Means Committee, since the ratifying of the Constitution.
*Mr. Rehberg. Mr. Chairman, in response, I knew I was probably being set up by being here, so ‑‑
*Mr. Rehberg. ‑‑ duly noted.
*Chairman Davis. Great. Thank you both very much. And that concludes our first panel.
*Chairman Davis. For our second panel, we will be hearing from the Honorable Bryan Samuels, commissioner of the administration on Children, Youth, and Families, Administration for Children and Families, from the United States Department of Health and Human Services.
Mr. Samuels, please proceed with your testimony.
[The statement of Ms. Bass follows:]
STATEMENT OF BRYAN SAMUELS, COMMISSIONER, ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, ADMINISTRATION FOR CHILDREN AND FAMILIES, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
*Mr. Samuels. Great, thank you. Good morning, everyone. Chairman Davis, Ranking Member Doggett, members of the subcommittee, I appreciate the opportunity to speak to you today.
Title IV‑B is an essential program in the child welfare system. The work of Congress over the last 14 years has made a huge difference in the lives of children. Today there are 25 percent fewer children in foster care, 14.5 percent less are entering care, and 7.5 percent more children are exiting care. And over the last 14 years we have seen an increase of 57 percent in the number of adoptions achieved through foster care.
I was the child welfare director in the State of Illinois from 2003 to 2007. The children of Illinois benefitted greatly from the reforms that Congress made. Today, Illinois has 65 percent fewer children in out‑of‑home care than they did just 14 years ago. However, my state struggled to meet the social and emotional needs of children, both in out‑of‑home care and in in‑home care.
In order for us to meet the needs of children in the foster care system, we need a strategy that is more trauma‑informed and developmentally focused. In my experience, the four categories of Safe and Stable Families are the right ones. Children and families are served well by family preservation, family support, reunification, and adoption.
I have seen the value of consistent case worker visitation, particularly the value it has for ensuring safety. In 2010 nearly 75 percent of children were visited by their case worker each month. We expect these improvements to continue, and we will monitor them through the child and family services review.
The federal investment in meth also was a critical area of focus as the earlier panel discussed. We have seen declines in meth, overall, nationally. In Illinois we had a great fear that meth would be the crack cocaine epidemic for the 1990s. I am glad to report that, during my tenure, that did not occur, and that the number of children entering foster care because of meth declined. That said, not every community has benefitted from a reduction in meth use.
More importantly, a recent study of children reared in homes where meth was used showed that they had substantially higher rates of post traumatic stress disorder (PTSD), and were exposed to multiple experiences of trauma and violence. Given the impact that trauma has on children and their development, we recommend, through the reauthorization of title IV‑B, that you focus resources on improving the social and emotional well‑being of children.
In Illinois, 25 percent of children entering care had an elevated level of traumatic stress that warranted professional intervention. Child welfare research clearly shows that focusing on trauma could have a significant impact on the long‑term well‑being of children. Children who are exposed to trauma have learning and language difficulties, and they do poorer in school. Trauma creates disturbed attachment, aggressive behavior, loss of regulation in areas of sleep, food, and self‑care, feelings of self‑hate, and chronic ineffectiveness.
The data for older children in foster care have a diagnosis of mental illness shows that 14 percent of them are diagnosed with PTSD, 20 percent with attention deficit hyperactivity disorder (ADHD), 27 percent with major depression, and 47 percent with conduct disorder or oppositional defiance at some point in their life.
Moreover, children who are diagnosed with a mental illness are prescribed psychotropic medications at substantially higher rates than the general public. Child welfare directors are gravely concerned about this issue. There is an emerging consensus that non‑medical‑based interventions, such as cognitive behavior therapy, behavioral management, and family skills training are needed, sometimes in addition to psychotropic medications.
As a child welfare director, meeting the social and emotional needs of children in foster care was my biggest challenge. Today I believe that that is still the biggest challenge across the country in child welfare. I urge the committee to take into consideration the social and emotional needs of children as you make your decisions, going forward. Thank you.
[The statement of Mr. Samuels follows:]
*Chairman Davis. Thank you very much, Mr. Samuels. Now we will turn to questions. First, I would like to ask you a question related to streamlining administrative requirements.
In April 2011, your agency announced it was reviewing the Child and Family Service Review process, which is how states are held accountable for the operation of their child welfare programs, including the two programs we are focusing on today. This announcement noted that you would consult with various stakeholders, consider changes to make sure that the reviews make sense, and really help states to make kids safe.
Several states we have spoken with have told us ‑‑ and I think our expert panel later this morning will address this ‑‑ that the many different child welfare reviews, audits, and plans have become a very large bureaucratic burden on the states. Now, your own testimony on page 24 mentions your goal to “reduce costly and unnecessary administrative requirements,” and hopefully integrating and streamlining the process to get same critical data.
What is your agency doing to make sure that federal oversight is useful, and that it holds states accountable for things we care about, and that it doesn’t divert state resources from helping children at risk of abuse and neglect?
In addition, what else is the Agency doing to streamline the way child welfare programs are managed? And I was wondering if you can consolidate some of the many audits and other administrative requirements.
*Mr. Samuels. I will start with the child and family service review (CFSR). As you know, that is a regulatory process, by which we monitor the overall activities of child welfare systems across the country. We are in the middle of soliciting comment on that review process.
Without violating the basic communications around the regulatory process, I can share that we are focused on three areas in looking at how to improve the child and family service review.
The first is around the methodology. It is both cumbersome and at times inappropriately used. We are trying to make sure that the strategies of reviewing data, reviewing case files, and reviewing the performance of states, are methodologically sound.
Second, we are concerned that the CFSR focuses on too many issues. As a result, state agencies are not clear about the most important issues. We would hope to reduce the focal points for the CFSR so that states are comfortable in being held accountable, and do the work required.
And third, we think it is important to be accountable. Sanctions are one way of encouraging accountability. We think there are probably others, and we are actively reviewing all possible examples of oversight that move beyond just sanctioning states.
We think by doing those three things, and doing those in the context of very active public involvement, we can create a system of review that is refined, targeted, and holds states appropriately accountable for their obligation under federal law.
*Chairman Davis. I appreciate you sharing that. We will look forward to working with you more on that. One concern that I have, having seen both in health care and a number of other issues related to this, that every hour filling out paperwork or redundant reports by front‑line personnel is one less hour they are actually spending doing their job, and it has a rather constricting effect on capacity for service delivery.
Are there things that Congress can do to limit this fragmentation, and the administrative complexity, while making sure states achieve the performance goals that are laid out for them by the Agency?
*Mr. Samuels. I think there are a couple of things that could be done. First, I think there is great value in accountability. As you know, part of the President’s proposal for 2012 was an increase of $250 million, specifically targeting improving the overall performance of states and, secondly, making investments in three specific areas. I am going to focus on the accountability issue.
Under the proposal, we would elevate the expectation around performance, using a set of factors, outcome and quality measures, that states would be held accountable for on an annual basis.
As you know, the child and family service review occurs on a three‑year cycle, with about two years in between one round and the next. So, in terms of accountability, the child and family service review occurs in states once every five years. We think that should be elevated. The measures ought to be reviewed on a more regular basis. Our proposal would be to do a targeted review of states on an annual basis, and then use the CFSR to really drill down on the limited number of outcomes where states aren’t performing well.
We think continued quality improvement is absolutely essential, and we that it should be an annual, and not every five years.
*Chairman Davis. Okay, thank you. Mr. Doggett?
*Mr. Doggett. Thank you very much. Thank you for your testimony and your important work.
There is something of a tension between our desire to give maximum flexibility for innovation and creativity and adapting these services, and our need to get accountability and ensure that these monies are being spent in the way that the federal law intends. And I don’t think ‑‑ I know this is true in my state ‑‑ we can always assume that, left without any accountability, that the state will get the job done correctly and in the most effective way, any more than we would assume we can do without accountability in other areas.
Let me focus in on promoting safe and stable families, and the Administration’s proposal to incorporate an incentive‑based structure there to address the social, emotion, and health‑care needs of children. Why is it necessary to create a separate model to address these issues?
*Mr. Samuels. When you look at the current use of title IV‑B, both subpart I and subpart II, there is a limited amount of funding that actually goes into service interventions that specifically address the social and emotional needs of children in foster care.
Again, I think it is important to recognize that maltreatment has a significant impact on a child’s ability to function. In many instances, the impact of maltreatment doesn’t rise to the level of a mental health diagnosis. Today, if you don’t have a mental health diagnosis, states have a limited pool of funds to be able to address your needs.
Trauma is a great example. Traumatic stress in a child has really significant impact. Child trauma is not, in and of itself, a diagnosis. Therefore, most children who would be served in a strategy to address their trauma would have to be served through funding other than Medicaid. It is our belief that there are insufficient funds to drive quality of service improvements needed to achieve good outcomes.
I gave you the example of what we did in the state of Illinois, when I was a child welfare director. I was concerned about the developmental issues that children had in foster care, and their trauma. So we introduced an integrated assessment on the front end of every child within 45 days of entering care. It was a comprehensive review. We were able to know, from the very beginning, what they needed.
In addition, we trained our case workers and our foster parents to recognize signs of trauma, and to address them. And we expanded three evidence‑based strategies across all age groups, so that we could address those needs. I can tell you 6 years ago that cost me more than $30 million.
*Mr. Doggett. You used somewhat clinical terms. But if I understand what you are saying, if you have a child who has been beat up, and beat up a number of times, but they are not to the point that a psychiatrist or other health care worker diagnoses their having a mental limitation or diagnosis, then there is some services you cannot provide to them that would prevent them from getting to that more critical level.
*Mr. Samuels. I think that is right. I think what we know from the literature and the science is that there are interventions that make a huge difference. We introduced, three of them in the child welfare system while I was director in Illinois.
I even had the opportunity to introduce two of them in the Chicago public schools, when I was the chief of staff there. We had a rash of student deaths. Over a two‑year period of time we had over 500 children who were shot, and 85 that were killed, and there were lots of young people who were showing up to school every day, clearly demonstrating signs of traumatic distress.
We were able to introduce two group‑based trauma interventions that were evidence‑based into schools throughout the city, because we knew that that was going to be the most effective way to reduce anxiety, to reduce stress, and to get better performance from children who were extremely vulnerable.
*Mr. Doggett. You mentioned a $250 million increase in your proposal. It is difficult here these days to avoid a $250 million or more decrease. Why do you need the $250 million increase? What will you do with it? What would be done with that money?
*Mr. Samuels. The President’s $250 million performance-incentive proposal has 2 components to it. The first one, which is critical, is that states would actually have to perform better than they perform today to receive any of the funds. So this would be a performance‑based distribution. So states would have to, using historical data, improve on an annual basis against themselves.
We are not comparing one state to another, we are comparing states to their historical performance. And what we would be saying is states that demonstrate better performance, receive additional funds so that they can continue to invest in their system. States that don’t improve would not have access to those funds. So it would be a performance‑based strategy.
In addition to that, there are a range of services that states currently cannot provide. We identify three areas. I will name them very quickly.
*Chairman Davis. If you could do that in one sentence, that will be helpful.
*Mr. Samuels. One, social and emotional well‑being; two, post‑permanency services – children from adopted foster care face a struggle long after they leave out of home care and achieve permanency; and third, reducing the number of children who age out of the system. We think if you can move upstream, target those children earlier, we can reduce the sad and troubling effects of a child aging out.
*Mr. Doggett. Thank you so much.
*Chairman Davis. Thank you. Mr. Paulsen?
*Mr. Paulsen. Thank you, Mr. Chairman, and thank you, Mr. Samuels. It is pleasant to hear your passion. Based on your experience, that sounds like some very troubling and difficult situations dealing with children that you are trying to protect and give a good chance in the future.
I just have a question because, you know, the last reauthorization was several years ago. And, as we learned in the opening testimony, and as I am just learning as a new member of this subcommittee, some of the provisions of the law required the visits of at least 90 percent of foster children each month. And we have seen the data, that almost all the states have certainly improved in this measure, and no doubt as a result of this requirement and the money specifically provided to help with these visits now.
But if you look across these states, it sounds like there is a wide variation of how they are actually performing, ranging from, like, a low of 18 percent all the way up to 96 percent of kids that are actually being visited each month.
What is your agency actually doing to help all the states meet the goals for the targeted 90 percent standard? Is there a penalty? You talked about sanctions earlier. Is there a penalty if you don’t hit the 90 percent standard? Are you recommending one, specifically?
*Mr. Samuels. Under the statute, there is a penalty. States that don’t meet their goals are subject to a penalty. Goals are established on an annual basis.
However, states can invest their own dollars back into the system in a way that allows them to forego the penalty. I know of only one state that actually had to pay their penalty.
But let me make two quick points ‑‑
*Mr. Paulsen. And what is the penalty?
*Mr. Samuels. The penalty is between one and five percent of their allocation within the Safe and Stable Families allotment.
You see across the country dramatic changes. There are some states that were in the single digits, in terms of the number of children that they visited. And today, 4 years later, you see them in the 70 and 80 percent.
My experience is that if you shine a light on an issue, and you tell people that you are actually going to track them and hold them accountable, most people step up. That is certainly the case in child welfare. We think the child and family service review is the appropriate place to monitor ongoing improvement. States know we are watching them, and they have demonstrated that they are going to put the resources in place.
I would welcome the opportunity to come back to Congress on a regular basis and report to you the progress that is being made. I think there is little doubt that states have figured out how to do this, and as long as we hold their feet to the fire, I think they will continue to do that.
*Mr. Paulsen. And let me ask you this, too, because you were just testifying just a little bit ago about the increased request for additional funds ‑‑
*Mr. Samuels. That is right.
*Mr. Paulsen. ‑‑ of 200‑some million dollars. And, you know, in a tough budget environment, obviously ‑‑
*Mr. Samuels. It is.
*Mr. Paulsen. ‑‑ you have got to justify that. But what about the thought of just with existing funds going to that performance‑based, you know, with level funding, or changes in funding structure, going to the performance‑based model just in itself?
*Mr. Samuels. I think part of that would require congressional action.
The work that we have been doing around looking at incentives, and particularly the indicators that we would track, suggest that there are opportunities to introduce such a system within the child and family service review. The downside is simply that we do not have funding to support state reinvestments. It is my experience that, to get better, you have to invest in your infrastructure.
Today, if you get better with your infrastructure, you produce greater rates of permanency. The results are that you have fewer children in care, and therefore, you get less support, federally. We need funding for states to invest in their infrastructure, so that the quality progress that they have already made, can be continued. And the services that they have in place that are producing good results can remain in place.
*Mr. Paulsen. Well, Mr. Chairman, I know, as we look at this reauthorization, that is one of our challenges, obviously, is that reform always costs money. And I think we are going to have to look at ways of how we are going to bring forward reform, knowing we are in tough budget situations to have those resources available.
*Chairman Davis. I agree. So much of this is going to be addressing the process and the overhead that is driven by that.
The chair now recognizes Mr. Reed from New York.
*Mr. Reed. Thank you, Chairman. Appreciate it. Thank you, Mr. Samuels, for your testimony today.
I want to follow up on your point that there would be a need for an act of Congress to implement this performance‑based review. What act of Congress are you exactly looking for, or could that ‑‑ be recommending to us to pursue, if we want to implement ‑‑
*Mr. Samuels. In the context of the $250 million we proposed in the Fiscal Year 2012 budget, funding would be available to address state performance. They could earn the money if they performed well. If they did not perform well, they earn no money, but we do not take money from them.
*Mr. Reed. That is the additional $250 million?
*Mr. Samuels. That is correct. If the suggestion is that we ought to implement the performance‑based standards by themselves, we could do that. But we could not take any further action against states than what Congress has already given us the authority to do.
I think it would be difficult, in this context, to both say we are going to elevate these new performance standards to drive states, but without new authority and new money through which you are able to do that.
I appreciate the need to hold them accountable. Congress has given us authority to do that.
*Chairman Davis. Would the gentleman suspend for a second?
Could we either ask the folks in the hallway to be quiet, or close the door, one or the other?
*Mr. Samuels. So, let me answer the question a different way.
*Mr. Reed. Yes, please.
*Mr. Samuels. As a former child welfare director, I felt absolutely confident that the Federal Government was using all of its authority to hold me accountable. And I think, today, we are.
So, if you want to push states beyond where they are at today, you either need additional resources, or you need additional authority.
*Mr. Reed. Well, I guess what I am trying to say, Mr. Samuels, is I associate myself with the comments from Mr. Paulsen, in that the performance‑based mechanism that you are recommending with the additional $250 million of additional authorization makes sense to me. And as my colleague indicated, these are difficult fiscal times, and the likelihood of getting that type of ‑‑
*Mr. Samuels. Absolutely.
*Mr. Reed. ‑‑ increased funding is probably going to be slim to none, in my opinion. But taking the concept of what you are recommending as a good performance‑based strategy to ‑‑ the expenditure of these funds, I would encourage the administration to continue to pursue that. And if there is anything you need from Congress in order to make sure you have the authority to do that with the existing funding levels that you have, please know that we would be very supportive or interested in those efforts.
I would like also to ask ‑‑ you had indicated there was a penalty, a financial penalty to states, when they didn’t meet their 90 percent visitation levels for foster care. And then you ‑‑ in your testimony you had indicated something ‑‑ you are only aware of one state that actually paid the penalty, and states have been able to avoid that penalty by engaging in some sort of practice. Could you illustrate to me a little bit further as to what you are referring to for those states that avoid the penalty?
*Mr. Samuels. Sure.
*Mr. Reed. What are they doing, and how are they doing it?
*Mr. Samuels. Currently, the way a state could avoid paying the penalty is simply by raising their level of match. Most states match at a rate much higher than required. States are spending more money than they are obligated to spend under federal law. As a result, states just demonstrate that they are actually spending more money –- and are able to avoid the penalty.
So, it is simply a mechanism where states are putting out more money than they are claiming. Because of that, when they do run into trouble, they simply put up more money, and they are able to avoid the penalty.
*Mr. Reed. Okay. So what they are essentially doing is allocating more money from their own coffers to avoid paying the Federal Government the penalty ‑‑
*Mr. Samuels. That is correct.
*Mr. Reed. ‑‑ that is being assessed by the Federal Government.
*Mr. Samuels. That is correct. So it is not that they are avoiding the penalty, per se, they are simply raising the rate at which they are demonstrating to the Federal Government that they are meeting the need.
*Mr. Reed. Very good. I yield back. Thank you. Thank you, Mr. Chairman.
*Chairman Davis. Thank you, and the chair now recognizes Mr. McDermott from Washington.
*Mr. McDermott. Thank you, Mr. Chairman, for having this hearing. And, Mr. Samuels, I want to go to your experience before you got in the Federal Government, when you were in Illinois, and talk to you about the training of the workers, the front‑line workers, how long it takes, how much you spend, what you try and teach them.
And the second part of that is many of these kids are ‑‑ it is suggested that they be put on pharmaceuticals for a variety of behavioral problems. Who makes the decision about whether the child is put on those pharmaceuticals? Is it the parent, the foster parent, or is the worker who authorizes ‑‑ in other words, where is the ‑‑
*Mr. Samuels. Sure.
*Mr. McDermott. ‑‑ informed consent? If it is my child, and I take my child to a physician, the physician says the child needs pharmaceuticals, I authorize it and take the responsibility. Where does the responsibility lie for the putting of kids on pharmaceuticals?
*Mr. Samuels. Sure. Currently, states are basically responsible for determining who has the capacity and the authority to consent.
*Mr. McDermott. There is no national standard ‑‑
*Mr. Samuels. There is no national standard on who has the authority to sign off on psychotropics.
In Illinois, the case worker can sign off on a psychotropic.
*Mr. McDermott. Can?
*Mr. Samuels. Yes. However, every prescription is reviewed by an independent contractor. So, a case worker could go into a doctor and a determination could be made that a child needs a psychotropic. They can sign off on that. But then they have to submit both the diagnosis, as well as the prescription, to a review process. Through that review process, if we determine that there is an inappropriate use of psychotropics, we can intervene, and we can intervene with a doctor who has the authority and the clinical expertise to do so.
We are also, at least in Illinois, were able to monitor children as long as they are on a psychotropic. So we have the ability to know when they started and when they stopped. That is important, because it is sometimes the case that a child will go to one physician, and as a result, get a psychotropic and go to a different physician at a different time and receive a second prescription. Those may have interaction effects.
In Illinois, we were able to track every psychotropic that the child is on to assure that there is no interaction effect. We could monitor issues around the unintended consequences of psychotropics. There are side effects to almost every drug. And so, being able to monitor and make sure that the prescription and the amount does not have a side effect that creates concern was also part of the system.
And ultimately, what we had is a system where every child had a guardian in Illinois. And that guardian can intervene if they believe that psychotropics are inappropriate or ineffective for the child that they are representing.
*Mr. McDermott. Now, how long does it take to train a front‑line worker? You take a young woman or man out of college, they have had maybe a social work ‑‑ at best a social work degree, or maybe a history degree or something else, and they take a job at the Department of Health and Human Services of the state of Illinois. How long does it take you to bring them up to the point where they can operate independently?
*Mr. Samuels. In the state of Illinois, a worker would go through about a two‑month set of training. After that two months they would then be paired with an experienced case worker. Through that case worker, their progress would be monitored over the next six months. And during that six months, there are intermittent circumstances where we bring them in for additional training.
The experience in Illinois is that if you load up all the training up front in a classroom setting, and young people do not have the chance to practice and figure out where their strengths and weaknesses are, then you do not get the kinds of impact that you want, in terms of clinical competency and understanding of policies and programs.
*Mr. McDermott. So, the case load starts at two months ‑‑
*Mr. Samuels. That is right.
*Mr. McDermott. ‑‑ after that first sort of educational block ‑‑
*Mr. Samuels. That is right.
*Mr. McDermott. Then you put them with actual patients?
*Mr. Samuels. That is right. It varies from state to state. So each state has their own training program for front‑line workers. Now ‑‑
*Mr. McDermott. Now you have moved up to this federal level. Do we need a national standard that emulates Illinois or something similar? Or ‑‑
*Mr. Samuels. So the position that I would take on that is that what we need is a national standard around the competencies that front line workers need to be effective in child welfare, more than we need a standard that says, “Every state has to train every worker in the exact same way.” But we ought to have a standard, and every state ought to meet that standard.
*Chairman Davis. Thank you very much. The gentleman’s time has expired. Mr. Berg?
*Mr. Berg. Thank you, Mr. Chairman. Mr. Samuels, again, I want to thank you for your passion, and also your experience, really, from the ground up. I don’t really care how big a school district is, 85 deaths a year just astounds me.
But, you know, on the last reauthorization we required states to report how they are spending this money for the first time. And I am a big believer from learning from our past. What have we learned from that reporting on the states since the last reauthorization on how they spent their money? And what are the ‑‑ again, I look at the states as the laboratory. What are the effective things that have come out of that?
*Mr. Samuels. To be honest, as a part of the last reauthorization, there was an increased effort to have states report. So, prior to the reauthorization, the standard was states had to submit a plan that said how they would spend the money. Today they also have to submit a plan about how they actually spent the money.
That is the progress. We don’t just have this kind of general understanding of what they said they would spend it on; they come back and actually have to report what they did spend the money on.
*Mr. Berg. Well, just so I am clear, so have any of those states given us that second part on how they spent the money?
*Mr. Samuels. They have.
*Mr. Berg. And then what have we done with that? I mean is there a matrix or measurement? Are we ‑‑
*Mr. Samuels. Primarily what happens with that information is that it is reviewed to make sure that states are using funds appropriately. We are looking at how they actually spend the money in accordance with the authority, to make sure that states aren’t inappropriately moving money from one part of the budget to the other, one service to the other.
*Mr. Berg. So, really, it is a ‑‑ is it appropriate, not whether it is an effective ‑‑
*Mr. Samuels. That is right, yes.
*Mr. Berg. So I guess I am assuming that people are honest with these expenditures, and I think we have to, obviously, have accountability, I mean, if we are going to get this turned around.
So, maybe that is my other question. Do we have measures for each state? I mean I see some matrixes that you are using. Do we have measures, so we can evaluate a state?
*Mr. Samuels. We do have measures. Again, those measures and requirements are part of the child and family service review. And, as a result of that, we look at those measures every five years.
*Mr. Berg. Okay. What I would like to see is, if you would, bring a chart that would show each state.
*Mr. Samuels. Yes.
*Mr. Berg. And on those things that you are measuring ‑‑
*Mr. Samuels. Sure.
*Mr. Berg. ‑‑ so we can look at each state and understand.
The other question ‑‑ I appreciate what you are saying, in terms of having accountability, asking states to improve from the prior year, and only would receive money if they do improve. You know, having said that, I think there is a certain level that we ought to expect. And if we have one state that is at the absolute bottom, making zero effort, and we have another state that is really doing outstanding service, you know, I would hate to see the state that is doing outstanding service receive nothing, not any incentive, and the state at the bottom just making a casual effort that gets them up one step and then another step and another step.
And so, I just want to ‑‑ you don’t need to respond to that, I would just like to make that noted, that, again, as you are taking about that money, we cannot forget that people are out there doing a great job, and we need to support those.
The final question I had really related to ‑‑ we talked about the penalty, the one five percent ‑‑ again, it is ‑‑ states are smart. I am kind of disappointed that they are getting around this. So my question to you is, how are we going to fix this? I mean, truly, if we want them to do what we feel is going to help kids, what is our stick, or how are we going to improve that stick to hold them accountable?
*Mr. Samuels. I am hesitant to make a proposal today. I certainly would be willing to go back and consider that question and give you a more complete answer. What I can say today is simply that in a 4‑year period of time, you have had about 40 percent of them meeting their visitation requirements to now close to 75 percent. Even though they are not actually paying a penalty, states are making substantial progress towards that 90 percent standard.
I would be glad to come back with you to make a proposal. But the data clearly demonstrates that, even under the current system, progress is being made, and I think it is reasonable to assume that if we keep the light shining on this, states will get to that 90 percent, and they will get to it in the near term.
*Mr. Berg. Thank you. I will yield back.
*Chairman Davis. Thank you. The chair now recognizes Dr. Price from Georgia.
*Dr. Price. Thank you, Mr. Chairman. Thank you, Mr. Samuels, for your work.
Serving four terms in the state legislature in Georgia, we have had some significant challenges in our state. And everyone hurts sincerely when kids fall through the cracks. And it seems that, often times, kids do. So I commend you for the work that you are doing.
As a physician, my gut tells me that often times in these situations we are treating the symptoms and not the disease. So I want to address two specific areas of maybe not getting at the right area. One is the issue of waste within the system itself. Have you identified ‑‑ with all the programs that are charged under your charge and elsewhere within the Federal Government, have you identified any redundancies in charge or in mission of specific programs that might be streamlined and better utilized, the limited resources that we have?
*Mr. Samuels. We are currently going through an internal review process for that exact purpose. As you know, the President put out a memo outlining the need to both look at reducing unnecessary activities, at the same time making sure that there are accountability standards. We are actually going through a review process now, and the general public has also been invited to identify areas where they think we could reduce administrative burden or increase accountability. I would love to be able to come back to you in a couple of months and share what we have learned through that review, and additional steps that we might take.
*Dr. Price. So your time line is a couple months on that report?
*Mr. Samuels. I think that is correct, yes.
*Dr. Price. And are you ‑‑ you are pulling in the public. Are you pulling in state individuals who are ‑‑ have identified ‑‑
*Mr. Samuels. That is correct. I mean the ‑‑ a public notice has been ‑‑ a federal notice has been put out. So folks are actively engaged in reviewing those, and making recommendations. We have also reached out to all of the interest groups here, to make sure that they know that they can submit ideas that they have about reducing the burden of administrative cost.
And so, we are beginning to see that information come in. But I haven’t had an opportunity to review it, and would love to be able to come back to you and tell you more, once we have been able to analyze that information.
*Dr. Price. I look forward to seeing that. The other issue I want to touch on is ‑‑ specifically, is the root cause of the challenge that we have in this country. As I say, often times we are treating the symptoms when we identify a kid at risk, a child that has been abused. We come in and try as best we can to help the child get through that situation.
What is your agency ‑‑ what are you doing to work with other areas of the Federal Government? Or are you working to identify the root cause of the challenges that kids have out there? And what are we doing to try to address that issue?
*Mr. Samuels. I cannot say that we are currently engaged in a process that is looking at root cause. What I can say that we are engaged in is a process of looking at the intersections between federal policies across each department.
So, we have been working closely with the Department of Education to see whether there are things that we can do different in order to get better educational outcomes for children in foster care. We have been working with SAMHSA and others to see if there is science on mental health services that we could learn from and integrate into the system.
What we have tried to do is to work closely with our sister agencies to get smarter about the most effective strategies for intervening appropriately, both to prevent as well as to deal with maltreatment. But our focus is really on getting better outcomes for kids and families, as opposed to drilling down on root cause.
*Dr. Price. Is there any entity within the Federal Government that is looking at root cause, do you know?
*Mr. Samuels. I would have no way of knowing.
*Dr. Price. Wouldn’t it be more wise for us, as a society, to, instead of just ‑‑ instead of concentrating on treatment of the challenge when it arises, to try to prevent it from happening in the first place?
*Mr. Samuels. I think most would agree that prevention has a critical role ‑‑ it reduces the long‑term burden that occurs with the development of a mental illness, or a problem from a health perspective.
While in theory, I can agree with you, I cannot, at this point, tell you that there is a way of getting at the root cause the way you describe it. I am not sure that there is a process currently in place, specifically, to do that.
*Dr. Price. Thank you. Thank you, Mr. Chairman.
*Chairman Davis. Thank you. The chair now recognizes Ms. Black from Tennessee.
*Ms. Black. Thank you, Mr. Chairman, and thank you, Mr. Samuels, for being here today. This is an area that is certainly near and dear to my heart, serving in the Tennessee state legislature. We have dealt with issues about helping our at‑risk children.
And so, I want to follow up ‑‑ and almost a thread ‑‑ with the last three representatives asking questions about looking at prevention, root cause, evidence base. And those are probably words that those back in Tennessee were so sick of hearing me say that, that they were fed up with my asking those questions. But what I will say is that we finally, after 10 years, saw some real results. And I am very proud to say that we are, in your testimony, noted here about one of our programs.
I want to say that there are good programs out there. And I would encourage the Department to look at those that do prevention. And I am going to lift one up, a nurse family partnership, where we know that if we take these children and put them ‑‑ or take these young mothers and put them with people that can mentor them at the very beginning, that we see good parenting skills, healthy children, and a lot of great outcomes.
So, I would encourage us to take a look in that area, and to start saying, “What can we do on the prevention side, so that we don’t have to treat these children for many, many, many years for things that are poor outcomes in their homes.” So ‑‑
*Mr. Samuels. Within the administration we can point out a number of areas where prevention and evidence base has been combined.
Certainly the home visiting initiative that is in its first year ‑‑ it is $100 million, next year it is almost $250 million ‑‑ specifically targeting the prevention of the kinds of problems you have described. I think the home visiting is a good example.
There is also considerable money invested in teen pregnancy prevention. In the child welfare system we have been working with agencies to introduce home visiting related to reducing abuse and neglect, which I think moves in the right direction. And we are currently spending some of our discretionary dollars to introduce evidence based trauma informed practice as a means of getting at some of those programs you described.
*Ms. Black. Okay, so let me go to ‑‑ I know I have limited time ‑‑ let me go to my next piece on this, is that you do lift up in your testimony, in the PSSF program, where there are a number of states that you recognize for programs that they have initiated. And I know that one here in North Dakota specifically is an evidence‑based program.
*Mr. Samuels. Yes.
*Ms. Black. How are you using what is happening in incubators back in these states to be able to help other states to make sure that what we are using is evidence‑based? Because what I have found in our state is that we spent a lot of money on programs that people said, “Oh, they are nice and they are good,” but there was not a measurement tool.
And that may be where I think that we come in, from the federal level, in whatever the states are doing, to lead them more toward evidence‑based programs, as opposed to spending money on things that maybe, oh, they feel good, or somebody says they work, but we cannot measure them.
So, number one, is what are you doing to use what comes to you from other states that is evidence‑based and working to get that out, nationwide?
And then, do you do anything to hold states accountable for the money that is spent in saying how is it evidence‑based, are you measuring your programs ‑‑ not directing them on what they necessarily have to do, because they are incubators, I understand that, but to at least say, “Whatever you are doing, you are spending the money on, you have to show that there are results on the other side that are measurable.”
*Mr. Samuels. I would respond in two ways. One is that we certainly have integrated the evidence‑based standard into much of the discretionary grants that we are currently making. There were evidence‑based programs that were funded in the 2010 cycle. We would anticipate funding additional ones in the 2011 cycle.
To date, child welfare agencies have not been held accountable for how they choose to spend money. They have been held accountable for whether that money produced outcomes that we care about in child welfare. So, I think it is hard to say that today we are holding them accountable for using evidence-based practices. What we are saying is you ought to be using whatever strategies are most effective at getting to the outcomes that you are being held accountable for.
So, it is a slightly nuanced answer. We are not requiring evidence-based practices, but we are telling them that, “We are going to hold you accountable,” and we are trying to drive them in a direction of selecting and identifying evidence‑based programs.
We have also tried to elevate the presence of evidence‑based strategies in a number of initiatives we are engaged in. Again, I point to trauma as one example, and the mental health services as another example where we have been demonstrating to states that evidence base can advance their cause.
*Chairman Davis. Thank you very much. The gentlewoman’s time has expired. And last, but not least, the chair recognizes Ms. Bass from California.
*Ms. Bass. Thank you. Well, first of all, Mr. Chair, thank you for allowing me to ask questions, given that I am not in this committee.
But I just wanted to ask you briefly about what is going on in states. Coming from California, a state that is in a terrible economic crisis like so many others, you talked about how states are meeting their targets, in terms of requirements, that the Federal Government places. Do you find ‑‑ are you seeing anywhere, given the economic crisis in the individual states, that they are going backwards?
And also, are states cutting back on their match?
*Mr. Samuels. I am unaware of any instance in which the states are cutting back on their match. We would be glad to go back and take a closer look at that if you would like, but I am not aware of any instances where that is occurring.
I think certainly we can read about all of the reductions that are being made in state after state, and we have concerns around particularly case work ratios. We are concerned that with fewer workers doing those visits, meeting their obligations are harder to achieve. But at this point we don’t have any evidence that we can specifically point at that says that, as a result of cuts, states are unable to meet their obligation.
But again, our responsibility is to monitor that on a regular basis. We are trying to do that. And if we were to find that states, as a result of cuts, aren’t meeting expectations, aren’t meeting requirements, we would engage with those states and make clear to them what their federal obligation is, and how we would hold them accountable if they fail to meet their obligation.
*Ms. Bass. Thank you.
*Chairman Davis. Thank you very much for investing the time, Mr. Samuels, coming here today to share with us. We are looking forward to working with you in continuing this dialogue to structure a reauthorization that addresses efficiency in process, but most of all works to help get to the root causes and protect kids out there on the front lines.
If Members have additional questions, they will submit them to you in writing. And we would appreciate your responses back to the committee also, for the record.
This concludes our second panel, and thank you very much, again.
*Mr. Samuels. Thank you.
*Chairman Davis. I appreciate everybody coming for the third panel, and also your patience, and also grateful to the powers that be that no votes have been called in the midst of this. I think we are going to be able to complete this without interruption on this critical subject.
We are going to have five distinguished panelists. For me, in particular, it is very exciting to have our own long‑serving front‑line leader, Patricia Wilson, the commissioner of the Department of Community‑Based Services from the Kentucky Cabinet of Family and Human Services. And most important to me in her extensive background is not the long list of accolades or administrative leadership positions that she had, it was her many, many years of front‑line experience that brings a unique perspective to the work that she is doing now in helping children in the Commonwealth. I appreciate your being here very much.
We also have: Lelia Baum Hopper, director of the Court Improvement Program for the Supreme Court of Virginia ‑‑ thank you for being with us; Tracy Wareing, the executive director of the American Public Human Services Association; John Sciamanna, director of policy and government affairs, child welfare, at the American Humane Association; and Steve Yager, director of the Children’s Services Administration from the Michigan Department of Human Services.
Ms. Wilson, please proceed with your testimony.
STATEMENT OF PATRICIA R. WILSON, COMMISSIONER, DEPARTMENT FOR COMMUNITY BASED SERVICES, KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES
*Ms. Wilson. Thank you, Chairman Davis, ranking member, members of the subcommittee. Thank you so much for this opportunity to talk to you this morning about programs that are of supreme importance to our nation’s children. I am honored to speak with you about these two programs that are so critically important to our nation’s children: Child Welfare Services and Promoting Safe and Stable Families. In Kentucky alone, approximately 50,000 children are touched annually by these two programs.
Most of my comments this morning are going to focus on the three key aspects that were in the last reauthorization: the monthly case worker visits, the regional partnership grants, and working with parents with substance abuse issues.
First, the monthly case worker visits. As Chairman Davis noted, I am a former front‑line worker and supervisor, something I am very, very proud of. I applaud Congress for setting the benchmark that every child in foster care should be seen every month. Nothing is more important to those children to have that contact with the individuals who know their case, who know their families, who know what is happening. It is also essential, as we move those children toward permanency.
However, I would like to note that the method of calculating that performance is of concern to just not only my state, but to others. The current calculation is child‑based, meaning that any missed visit to a child within a 12‑month period negates all the visits that were made to that child. An alternative that could be considered would be looking at every visit counting as an event, in and of itself. And states would be given credit for all the visits that are made to children. States should be held accountable. Sanction is an acceptable means of correcting poor performance. But we also believe that states should be recognized for the performance that they do make
Funding to support the case worker visits is much needed to help off‑set the rising cost of transportation. Again, in a rural state such as ours, where children are sometimes placed a distance from their home in order to receive the treatment they need, the mileage that our staff incur traveling to and from those visits is costly for the state, and we appreciate the extra compensation to address that.
The second aspect, improving outcomes for children with substance‑abusing parents or caregivers. Last year in Kentucky, 60 percent of the children in substantiated reports of child abuse or neglect were found to have families exhibiting substance abuse issues. It is a tremendous problem in our state.
I do want to highlight, though, the positive impact of one of the regional partnership grants that Kentucky was fortunate to receive. Martin County, in rural Appalachia, has just over 12,000 residents in the entire county. But it leads Kentucky in the percent of the child population in substantiated reports of child abuse and neglect. Approximately 6‑1/2 children out of every 100 children in that county were found to have substantiated reports. That compares to 1‑1/2 children per 100 in the rest of the state. Half of those children were ages six or younger. Substance abuse by the parent was a driving force in the majority of those cases.
Prior to the regional partnership grant, there was one substance abuse counselor in the entire county who provided one day of outpatient service per week. There was a four‑month waiting period to even receive one hour of service per week. There were no support groups.
With the grant, we were able to replicate a ‑‑ our START program. This program pairs highly‑trained parent mentors with specially‑trained child protective service workers to provide intensive case work services to the families, partners with substance abuse treatment professionals to ensure quick access to treatment, and partners with the court to identify options for child safety and permanency.
In the two‑plus years of operation, the county has developed intensive outpatient services that are available four days and several nights per week. There are now 9 weekly 12‑step meetings and a Families Anonymous meeting. There is a support group. And, very importantly, transportation is able to be provided to those individuals who need help in either accessing services, or ‑‑ we have found through our evaluation accompanying the individual to the first four appointments with their substance abuse counselor is one of the most effective means of keeping them in treatment.
To date, more than 40 percent of the parents served, most of whom are young marrieds are in their 20s, and have among them more than 100 children, have been able to become sober and maintain their children safely at home. Over time, we believe the success rate in Martin County will equal that of the 67 percent success rate that we have in the other 3 counties where this program exists.
Finally, the coordination of health care needs with children. We have entered into a cooperative agreement with our commission on children for special health care needs to address those needs of children in foster care by deploying registered nurses across the state. A larger issue, though, as Commissioner Samuels noted, is the use of psychotropic medicines.
We have concerns that children who are taking multiple psychotropic meds may not have regular psychiatric consultation, that those medications may be prescribed by someone other than a child psychiatrist, and that there are children who are receiving benefit of that that could also benefit from alternative methods of behavior management.
In closing, I would offer a general comment about the 20 percent distribution, the interpretation across the 4 broad categories in Safe and Stable Families.
*Chairman Davis. If you could, sum up quickly, please ‑‑
*Ms. Wilson. Yes, sir.
*Chairman Davis. ‑‑ your time has expired.
*Ms. Wilson. With 15 years plus of experience, and data to support the assertion, states are finding there is a need to rebalance the funding within the service needs of families. Allowing states more latitude in determining the distribution of that allotment would provide increased opportunity to fully actualize the goals of Safe and Stable Families.
Chairman Davis, members of the subcommittee, we appreciate your support, we appreciate your concern for children and families.
We urge reauthorization, and I thank you for the opportunity to present the views.
[The statement of Ms. Wilson follows:]
*Chairman Davis. Thank you very much.
STATEMENT OF LELIA BAUM HOPPER, DIRECTOR, COURT IMPROVEMENT PROGRAM, SUPREME COURT OF VIRGINIA
*Ms. Hopper. Good morning, Chairman Davis, members of the committee. Thanks for the opportunity to discuss funding by the Virginia Court System of court improvement program funding. My name is Lelia Hopper, and I am director of the court improvement program in the administrative office of the courts, under the Supreme Court of Virginia. I have worked with the court improvement program since it was first authorized by Congress, and grants were made available in 1994.
The challenge for court improvement programs is to sustain the considerable energy that it takes on the part of the judiciary and professionals who carry out the reforms daily that you all have instituted. Today, excellent court practice requires that we go beyond the basics. Since 2006, when the new CIP grants for training and data collection and analysis were made available, we have been able to substantially improve upon and energize early system reform efforts.
Training grant funds since 2006, including those planned through the end of this grant year, have enabled Virginia’s court improvement program to support 123 local and state training events, with more than 12,000 participants. We have also provided funding for juvenile court judges, attorneys, child dependency mediators, staff for CASA programs to attend 13 national educational events that have enhanced their skills. The large majority of these individuals would not have benefitted from these educational opportunities without CIP funding support.
In Virginia, many juvenile court judges provide leadership in their communities to provide ‑‑ to improve child dependency court processes on a multi‑disciplinary basis. Their involvement is supported by the best practice court program, instituted by my office in 2002, and substantially supported in the past 5 years with training grant funds.
Today there are 37 active court teams, which account for 60 percent of Virginia’s foster care caseload. These teams have committed ‑‑ have contributed to a 27 percent decrease in the number of children in foster care in Virginia over the past 3 years. This reduction has been accomplished as a part of a transformation of Virginia’s children’s services system, of which the courts have been an integral part.
The data grant. Our office produces 10 court performance measurement reports, utilizing case information that is entered by court staff into the juvenile case management system. In 2010 we began development of these reports into web‑based formats, making them more interactive and user friendly. We will complete this project this September.
In 2008, we began making analyses of local juvenile court performance measures available to the courts. This analysis process is initiated by the presiding juvenile court judge, includes a written report, a meeting, and recommendations to improve court practice. To date, we have completed 15 of these court analyses.
An interface between the courts and the state department of social services is something we have been working on for quite a while. Both of our agencies recognize that an interface would improve the ability of the courts and social services to process paperwork and make timely decisions for children in foster care. And we are scheduled to begin implementation of the first phase at the end of this year.
Finally, we also have available online to our judges ‑‑ and it is only to judges ‑‑ something called the active foster care children report. It is updated daily and provides a snapshot of children in foster care identified by locality. It includes demographic information, foster care placement information, funding resources, and critical hearing dates. Prior to this electronic transmission, we could only provide this information twice a year in a hard copy to the courts.
Mr. Chairman and members of the subcommittee, Virginia and the other court improvement programs across the country are effectively utilizing the court funds that you have provided to improve court practice. And we believe we are making a measurable difference for families and children who are under the jurisdiction of the court system.
Thank you for your time.
[The statement of Ms. Hopper follows:]
*Chairman Davis. And thank you very much for your good work in Virginia.
*Ms. Hopper. Thank you.
*Chairman Davis. Ms. Wareing?
STATEMENT OF TRACY WAREING, EXECUTIVE DIRECTOR, AMERICAN PUBLIC HUMAN SERVICES ASSOCIATION
*Ms. Wareing. Good morning, Chairman Davis and members of the subcommittee. I am Tracy Wareing, executive director of the American Public Human Services Association. And thank you so much for the opportunity to testify today regarding the promoting Safe and Stable Family and Child Welfare Service programs. And it is an honor to be sitting here with such a distinguished panel, as well.
The American Public Human Services Association is a non‑profit organization whose membership includes the nation’s top government human service executives from across each of the states, the District of Columbia, as well as hundreds of human service directors at the local ‑‑ at the county level. We happen to also house nine affiliate organizations, including the National Association of Public Child Welfare Administrators, and I speak on their behalf today, as well. We are a bipartisan organization whose ideas and direction come from the open exchange and deliberation of the expertise of our members, two of which are on this panel, as well.
This morning I would like to address the importance of prevention of child maltreatment, and the support of front‑end services for children and families at risk, and then share two recommendations with you for revisions, as you consider reauthorization.
As you know, Promoting Safe and Stable Families is one of the few federal funding streams that supports services aimed at preventing children from coming into out‑of‑home care. In 2009, states reported PSSF funding as the single largest source of funding for preventative services, covering nearly 30 percent of children receiving preventative services, nationwide.
Over the past five years, states have successfully reduced the number of children in foster care by more than 20 percent, as you heard from Mr. Samuels. In that same time period, the national repeat maltreatment rate also declined. By promoting community‑based family support, family preservation, reunification services, and adoption support, PSSF has played a critical role in helping states alleviate situations that might otherwise lead to children being placed in foster care, due to abuse or neglect, or staying in care too long.
We also appreciate the substance abuse and methamphetamine grants that were made available to states. These grants have been helping states to offer an array of services to address the specific needs of these families, and use a range of strategies too prevent and treat substance abuse. As you consider reauthorization of these programs, we want to acknowledge the importance of these to the states, and urge that you continue them.
However, I think, as we have heard today, the bulk of federal funding for child welfare is directed toward out‑of‑home care, and it comes from a patchwork of funding streams, and it is not directed to prevention. The overall allocation of title IV‑E funds, compared with title IV‑B funds, is about $10 of out‑of‑home care funding for each dollar of in‑home funding. We urge this committee to address comprehensive child welfare finance reform, and recommend increasing support for preventative and supportive services in directing federal resources toward the front end, to improve the outcomes of children and families.
While our members support the need for flexibility to deliver on an array of services that are responsive to the special needs of their community, they also understand the role of the Federal Government in ensuring federal dollars are spent wisely and correctly, and that the outcomes we all desire are met. As our members continuously improve their internal processes, they have also worked to develop practical recommendations on streamlining federal accountability measures under IV‑B and IV‑E, and have offered ideas to the administration around that.
But the methodologies for monitoring and measuring must be related to the outcomes we all desire to see. To that end, as you consider reauthorization of Promoting Safe and Stable Families, we recommend: one, relaxation of what is sometimes referred to as the 20 percent rule, which essentially requires equitable spending across the four categories of PSSF funding. That spending restriction is too rigid.
Just to give you one example, California has shared with us that many of their smaller counties, some of which may perform no more than a few adoptions a month, struggle with utilizing the 20 percent spending requirement on the adoption promotion and support services. In those communities, the funds would be better directed to community‑based family support and preservation.
Additionally, a colleague on the panel here mentioned the methodology for calculating monthly case worker visits of a child. Our members are deeply committed to the best practice of timely, effective, and regular case worker visits, and the role they place in ensuring safety and facilitating reunification and permanency. But the fact is, the current methodology is flawed. A case worker could, in fact, see a child 20 times a year, but if 1 month was missed, that case and those visits are not counted.
My written statement provides specific recommendations that our members believe will result in a much more accurate picture of the diligent efforts being made. And let me emphasize this is about methodology, not intent. Our members fully support the benchmarks set by the 2006 reauthorization.
With that, I thank you so much for the opportunity to be here. We urge reauthorization of Promoting Safe and Stable families and Child Welfare Services programs, and would welcome questions. Thank you.
[The statement of Ms. Wareing follows:]
*Chairman Davis. Thank you.
STATEMENT OF JOHN SCIAMANNA, DIRECTOR, POLICY AND GOVERNMENT AFFAIRS, CHILD WELFARE, AMERICAN HUMANE ASSOCIATION
*Mr. Sciamanna. Thank you, Chairman Davis and members of the subcommittee.
Since 1877, the American Humane Association has been a national leader in developing cutting edge initiatives to prevent and respond to child abuse and neglect. Our work in research, family group decision‑making, differential response, and father engagement are a few examples of our efforts to strengthen families, children, and communities.
Let me talk briefly about some of the important services under PSSF. Reunification services. Once a child has been reunified, access to after‑care is limited, since title E funds provides for support only when a child is in foster care.
This week we co‑hosted a briefing on Capitol Hill focusing on reunification. The compelling stories of the families who were there who were reunified with their children provided strong evidence that we could do so much more in this area. In 2009, 276,000 children left foster care and 51 percent were reunified with their parents, we feel we can do much more in this area.
One of our recommendations is that if we can’t enact a comprehensive finance reform this year, then we should extend title IV‑E entitlement funds to services for reunification, allowing dollars to address the only permanency option not currently funded under IV‑E.
We also recommend that the current 15‑month restriction under Promoting Safe and Stable Families be removed, since we would like the dollars to follow the children home into the family.
Adoption services. This subcommittee was key to enactment of the Fostering Connections to Success, and Increasing Adoptions Act. That started us towards a comprehensive reform of the finance system by eliminating the link to AFDC for adoption assistance.
We are increasing the number of adoptions annually, and have made great success in the last decade. But for a small percentage of these families, there is a need for post‑adoption services, as Commissioner Samuels mentioned today. Recently a coalition led by Voice for Adoption held a Capitol Hill briefing, with one of the recommendations being that there be specific funding to address these post‑adoption services, so that states can establish an infrastructure.
We recommend that the definition of adoption services under Promoting Safe and Stable Families be examined to see whether or not we could direct more dollars toward post‑adoption services.
We also suggest that when Congress created the de‑link, that they directed states to reinvest dollars, maintenance of effort into Child Welfare Services. Congress may want to look at directing those dollars, as some adoption groups have advocated, toward post‑adoption services as a way to provide a steady source of funding.
Family support and family preservation are two very critical services. We certainly hope that they will continue to be categories in this area. There has been some consideration in the past about whether or not these categories should be collapsed. But we think that they, the four services, address four distinct families.
The big challenge for all of this funding is that in recent years, when this committee has increased mandatory funding, appropriators have sometimes used it as a rational to decrease the discretionary piece of this program.
The need for substance abuse services. We would echo a lot of the comments that have been heard here today. There is growing evidence about the importance and the effectiveness of comprehensive family treatment. We would suggest, however, that the specification toward methamphetamine be broadened, since there are a range of substance abuse issues and problems, depending on the locality and the part of the country, and grants should be based on the most effective strategies.
Workforce development you have also heard a great deal about. Case load visits are important. But, as you have heard, there are some problems with the data collection. We need to work on that. What we don’t want is a system where we are just checking off visits. Instead, we will need to encourage quality visits. We have done a number of workforce studies for states to help them with that, to establish quality visits.
We think if the funding cannot be increased, we need to design a workforce strategy. Perhaps Congress should look at some sort of a race to the top that would allow some states to invest and ‑‑ provide strategies that could develop a child welfare workforce development plan over several years.
Court improvement. I won’t go into great detail here, because you have heard about the effectiveness of that. So we certainly hope that Congress will keep ‑‑ and, if at all possible ‑‑ increase funding.
We also want to emphasize that recently we released a report with several organizations about maltreated infants and toddlers. They are the biggest population coming into contacted with the child welfare system. We think there needs to be greater focus on this population, not to the exclusion of other populations, but perhaps we can, in the oversight or in the IV‑B‑1 plan, outline what states are doing to address this vulnerable population.
Finally, in my closing comments, let me just say that if Congress cannot complete finance reform in this session, that they look at different ways to extend current funding in IV-E, whether it is to reunification services, or to doing some up‑front services, such as differential response, an approach several of the states represented here today are implementing.
In closing, we appreciate the efforts of this subcommittee and others to pursue these matters in what has always been a bipartisan and bicameral way. As some of the members of this committee have pointed out in the past, children in foster care and child protective services are, in fact, our responsibility. And we need to make sure that we are their good parents until they find permanent families.
[The statement of Mr. Sciamanna follows:]
*Chairman Davis. Thank you very much.
STATEMENT OF STEVE YAGER, DEPUTY DIRECTOR, CHILDREN’S SERVICES ADMINISTRATION, MICHIGAN DEPARTMENT OF HUMAN SERVICES
*Mr. Yager. Good morning, Chairman Davis and members of the committee. Thank you for inviting me today to testify on child welfare reauthorization, specifically the Child Welfare Services program and the Promoting Safe and Stable Families.
Today I want to hit three areas, as my colleagues have covered a couple of other areas. I want to touch on case worker visits, data infrastructure, and audits.
Case worker visit funding is essential, and it has had positive impact on the children in Michigan. Michigan has seen a rate of case worker visits improved dramatically through the use of funding. Our base line in 2007 showed 14 percent of case workers actually achieving monthly visits with each child. In 2010 that rate increased to more than 70 percent.
We continue to aggressively pursue training for public and private case workers, courts, in foster and resource families, so not only will our rate of visitation improve to 90 percent by the end of fiscal year 2011, but also our quality will improve.
Reauthorization and extension of the case worker visit funding will support our initiatives to continue improvement in the rate and the quality of home visits. I would concur with our colleagues regarding the method of determining compliance for that. It is a concern that I would share with them.
As for substance abuse services, Michigan sees this as a continued need, as has already been stated, and we strongly support reauthorization of that funding.
Data‑driven decision‑making. Michigan’s data‑driven decision‑making initiative began out of necessity. Our goal has been to provide central administration and local office management and staff with the reports necessary to increase positive outcomes for the children and families served in children’s protective services, foster care, adoption, licensing, and juvenile justice programs. Our philosophy is to provide the field with data reports so they have the knowledge needed to manage the workforce proactively, and focus on key areas of practice that have been shown to increase child safety permanence and well‑being.
In addition, the data reports provide central administration executives with the ability to review county performance, and the same areas of practice across the board.
Now, for a minute I would like to speak a little bit about audited processes. Michigan recommends that all federal processes be streamlined and linked, so the frequent intrusions and required corrective action plans resulting from the myriad reporting and review requirements are eliminated.
For a state like ours that is also operating under federal court consent decree, writing the reports, measuring data in subtle but different manners for each process and then participating in federal reviews, program enhancement activities, leaves us with little time to work on implementing meaningful change.
From 2008 to 2010, Michigan underwent a title IV‑E review, child and family services review, statewide assessment and on‑site review, the CFSR program improvement plan, the title IV‑E departmental appeals board litigation, the children’s rights lawsuit, and SACWIS on‑site review, and other reviews of the public assistance side of the department. We do not object to oversight, but to the increasingly seemingly constant nature of that oversight.
Michigan wants strong accountability in the operation of child welfare programs, but these divergent reviews and monitoring processes are too numerous to be value added, particularly to the staff responsible to providing services to families.
Michigan recommends that current federal review and planning processes for the child family services review and the child family services plan be blended into integrated and coordinated state planning processes. The proposal proffered by the American Public Human Services Association and the National Association of Public Child Welfare Administrators establishes both the manner in which this could occur, and the rationale for coordination. The proposal recommends a modified CFSR target of no more than three key practice areas. The state would be held accountable for its efforts to achieve sustainable improvement in those targeted areas.
Assessment data and continuous quality improvement activities form the basis of these activities. The proposal would employ qualitative data from the state’s case review system, giving the review a real‑time value, instead of the historical data profiles employed in the current CFSR process.
Under a coordinated plan, the states could more readily adapt to changes in funding, legislative focus, program operation, and external influences, essentially becoming more nimble in response to these changes. Currently, the two‑year PIP period is counterintuitive to how child welfare really operates. Renegotiation is required for these modifications.
With respect to the commonality of data, we agree that national data standards need to be established. However, the child family services review data profile and measurement processes confuse external stakeholders, case workers, other agency partners, and the consumer community, including the legislature and press. This confusion often unjustly contributes to public disdain for our work, and impacts staff morale.
States should have more control over their individual processes. Michigan recommends using longitudinal data to assess our performance. This data modeling has a higher degree of reliability and we are able to move more quickly to assess the impact of changes in our policies and processes.
Another key component is ‑‑
*Chairman Davis. If you could, sum up quickly, Mr. Yager.
*Mr. Yager. We need an external review process, and we have that in Michigan. Blending the external with our internal processes will improve the review system.
We believe the children’s bureau, through technical assistance, can enable us to develop a more effective state‑based system and would satisfy federal review.
Thank you for your time today. I appreciate this opportunity. I want to encourage you to reauthorize the Safe and Stable Families.
[The statement of Mr. Yager follows:]
*Chairman Davis. Thank you. Foster care is a shared system between the Federal Government and the states. I would like to start with Ms. Wareing. Given the 20 percent decline in the foster care caseload in the last 5 years, are states spending less, in terms of state dollars, on foster care and related programs?
*Ms. Wareing. Well, I actually don’t ‑‑ Mr. Chairman, I think that they are spending less on foster care. I think that they have tried to redirect some of their dollars to in‑home services, because there is not the federal support at that level. So, trying to work on things where you are promoting children being safe, but before they come into the child welfare system, and that requires a large amount of state funding in order to do that because there are limited ‑‑ only, really, the title IV‑B funds are available to support those types of programs.
*Chairman Davis. I noted a suggestion in your statement, as well as by others on the panel today, that there should be more flexibility in how federal foster care and other funds are spent, including for services. Are states leading by example and devoting any state foster care dollars no longer needed specifically for foster care to services to prevent foster care, placements, and otherwise assist families?
*Ms. Wareing. From my experience ‑‑ and I would certainly welcome colleagues who are closer to the ground ‑‑ but yes, I think that is where states have tried to put their resources into programs that allow children to either not come into care or get home quickly. But that ‑‑ you know, that has required a very concerted effort, and it does require resources around those prevention programs in order to make that happen.
*Chairman Davis. Ms. Wilson, would you like to comment, from a Kentucky perspective?
*Ms. Wilson. From a Kentucky perspective, we are actually spending as much or more money on foster care, the difference being that the total expenditure base may not be rising more, but the federal support is declining. So we are spending more state dollars.
We are taking, though, both Safe and Stable Families dollars and any other state‑appropriated monies that we can redirect into preventative services. We wholeheartedly would like to see the number of children in foster care reduced by a greater proportion than what it is.
*Chairman Davis. Thank you. I would like to open a question up for the panel overall, just in my limited time. Earlier in the hearing we heard Mr. Samuels’s ideas about streamlining. He talked about oversight streamlining, limiting measures of performance, the way the annual audits were approached. I would like to open it up for the panel on your thoughts on the proposal, on his ideas.
*Ms. Wareing. Mr. Chairman?
*Chairman Davis. And then we will go to Mr. Yager next.
*Ms. Wareing. Thank you. I would echo ‑‑ first I would say that, on behalf of the American Public Human Services Association, we would acknowledge that Mr. Samuels and his staff have been very open to participation from the states. They have asked and reached out directly to state administrators and deeper to ‑‑ for ideas about how to streamline the process.
Our recommendations ‑‑ and we have formal recommendations that we would be happy to share with this committee ‑‑ would really bring together what are, in effect right now, planning, and then a review process, and then a monitoring process, and then a come back in and monitor again, into one seamless review process that would exist under the CFSR.
*Chairman Davis. Thank you. Mr. Yager?
*Mr. Yager. I would support what Mr. Samuels had said. I think that’s a great approach.
I think there needs to be a fundamental shift away from multiple on‑site reviews, often looking at the same cases at different points in time, to looking at the state’s quality assurance system, encouraging a robust state quality assurance system that possibly could be certified by the Federal Government. They could then go into information out of the state’s own system, as opposed to duplicating reviews across multiple counties.
*Chairman Davis. Mr. Sciamanna?
*Mr. Sciamanna. Yes, and we would agree that there is a need to do some reform for some oversight.
One that especially is based more on outcomes for children ‑‑ actually, this committee was, I think, instrumental in the Fostering Connections, in that you started to look at some of those outcomes in other areas, in terms of health planning, in terms of educational outcomes.
And so, being able to kind of track that, and obviously also what is done at the front end, I think would be important ‑‑ what we would like to see is a partnership more between the states and the Federal Government, so that that oversight and plan improvements can be jointly developed and implemented.
*Chairman Davis. I appreciate that. One of the things that we have started to work on in this subcommittee with an earlier piece of legislation ‑‑ hope to see follow through every one of the entitlement reauthorizations ‑‑ is data standardization and data integration that would allow us to bring the Federal Government into the 21st century, and move away from the old Cobalt‑based programs of the 1960s and 1970s, make it more like the private sector, in terms of both data accuracy, but significantly reduce improper payments and, frankly, pushing redundant measurement programs out on you from the different agencies, so we can drill down and get that data, and hopefully have a more proactive partnership.
With that, I would like to recognize the gentleman from Minnesota, Mr. Paulsen, for five minutes.
*Mr. Paulsen. Thank you, Mr. Chairman. I will just ask a question of Ms. Wareing. You mentioned ‑‑ at the end of your testimony you talked about one‑fifth of the SSBG funding, about 340 million of it, was devoted to prevention. I just noticed at the end of your testimony. Can you provide some additional background on that program, just for the record?
I guess I am kind of interested in knowing what states spend that $340 million specifically on that you said is devoted to prevention. Like what type of prevention services, with at least some description of what those services do, or what they are.
*Ms. Wareing. Mr. Chairman and Congressman Paulsen, let me try to broad‑brush, and if there are more specific information that we could detail you, provide for you with how states specifically spend that money, we are happy to do that research.
But SSBG funding is the second‑largest funding source for prevention activities, next to Promoting Safe and Stable Families for states. And they are able to leverage those dollars and really direct them to community‑based services that are really designed much more on the prevention side of supporting families and ‑‑ in the hopes that we are able to keep children safe and families well.
And so, they could be things like some of the same kind of things that you might see in Promoting Safe and Stable Families. It could be community supports, it could be home visitation. It could be neighborhood parenting types of classes, and those types of things. You know, many of them, I think, are evidence‑based ‑‑ some of the questions that Congresswoman Black had talked about, in terms of ensuring that sort of ‑‑ that the dollars are actually going to programs that work.
But I would also say there are very few programs that have the kind of flexibility where you can leverage other dollars. And that is really what SSBG provides. It allows funds that may not be sufficient for a particular community to really be ‑‑ to give you that extra push that you really need.
*Mr. Paulsen. Is there a way to identify, like, how many families or people are actually served by this spending on prevention services, to get down to that type of data? Can you drive down to that?
*Ms. Wareing. Mr. Paulsen, I don’t know, off the top of my head, but I would certainly be willing to look at that.
*Mr. Paulsen. Or even what the average amount, for instance, per family or per person is, you know, allocated or is a part of that, just to ‑‑ that would be helpful data, I think, as we are kind of looking at the ‑‑ sort of the prioritization or the benefits of some of these programs, because you did note that in the testimony.
*Ms. Wareing. Yes, absolutely. And it is incredibly helpful funding. I would say it is designed to be flexible funding. And so I am not sure, off the top of my head, how precise they can go to the dollars spent per family, but we will certainly look at that for you.
*Mr. Paulsen. Please, Mr. ‑‑
*Mr. Sciamanna. Just in regard to the social services block grant, there has been a series of surveys of states conducted by Child Trends most recently, and Urban Institute every two years, asking states what they spend on child welfare services. And SSBG has pretty consistently been around ‑‑ I think it’s 20 percent of the federal funding that states invest.
It varies by the 50 states. It will be about 300 million in the child protective services, nationally, but may also supplement what states do in terms of foster care, adoption assistance and support, and for youth. So there is a range of services that it does provide. But it has been a very critical component of the child welfare funding system.
*Mr. Paulsen. Thank you, Mr. Chairman. I yield back.
*Chairman Davis. Thank you. The chair recognizes Mr. Reed for five minutes.
*Mr. Reed. Thank you, Mr. Chairman. I am hearing kind of a consistent theme here from the panel and from testimony that is coming across. Essentially, what I am hearing is that we need less auditing, more streamline reporting requirements to the federal level.
But I would note that when I read the testimony I see some successes. I see 27 percent less kids in foster care, I see 20 percent over the last 5 years kids in foster care. So, does it not beg the question ‑‑ I would be interested in the panel’s response to ‑‑ we have to be doing something right. And that has ‑‑ we heard Mr. Samuels’s testimony as to previously the requirement on the states was to give us a plan, and now it is give us a plan and then give us an accounting of how you spent the money.
So, my gut tells me that that change in philosophy of accountability, it seems to be ‑‑ being implemented in this area. It seems to be working. So, is there any disagreement with that philosophy from anyone on the panel?
*Mr. Reed. Okay. So when we recommend less auditing, less accountability, if you would, from the states to the Federal Government, how do we maintain the successes by removing that accountability provision? Mr. Sciamanna?
*Mr. Sciamanna. I guess it is not less accountability, but refining it. I think the child family service reviews were an important act by Congress in 1994. And I think even some of the states will say ‑‑ they may have problems with what the current process is, but it did engage a number of stakeholders. So I think the question is more about a refinement of that process, and what is the most efficient way to oversee the states.
So, I think that is more of the debate, because certainly a number of advocacy groups and states will have different ideas, but we do need to have that oversight, because we should be doing a lot more for a lot of these families.
*Mr. Reed. Okay. Mr. Yager?
*Mr. Yager. And certainly we would agree with that. The accountability is important. That is not something that we want to shy away from. What we would suggest is that ‑‑ is how they hold states accountable is what makes a difference.
If they come in and do multiple reviews, looking at same sets of cases, requiring a lot of our staff to focus a lot of time, and then write independent corrective action plans for each of those reviews, versus looking at the state’s own data system and encouraging a robust data system that can be relied upon to prevent them from coming in at multiple points, they could rely on our data, supplement that with some coordinated efforts on site, and then produce their reports ‑‑
*Mr. Reed. Well, that is good to hear. So no one is really objecting to the accountability.
*Mr. Yager. No, sir.
*Mr. Reed. It is just a matter of getting the information streamlined.
*Mr. Yager. Yes, sir.
*Mr. Reed. And I am interested ‑‑ and there is a lot of testimony in here ‑‑ about prevention, preventative action. And that, in my gut, makes sense.
I note the court improvement program, Ms. Hopper. You indicated that the court improvement program contributed to the success in Virginia. Can you tell me exactly concrete examples of what programs, what preventative measures you took to accomplish that?
*Ms. Hopper. Well, the courts, of course, don’t deliver programs. But they monitor the cases as they come in. And I think one of the critical components in the work that has been done in Virginia is the collaboration across all of the child serving agencies.
One of the mantras in Virginia is that it is not just social services that is responsible for these children; they are the community’s children. And you need to bring together the schools, mental health agency, the health department with Medicaid. All of those agencies need to be at the table in supporting local departments of social services who hold custody of children in foster care, and are held ‑‑ frankly, all of them need to be held accountable for delivering whatever the support is that the child and the family need to get them out of foster care, or get them to some other permanent placement.
So, to some degree, prevention occurs when you are able to engage all of those agencies right at the beginning of the entry of the family into care. And one of the things that the courts in Virginia have done ‑‑ and I think is also a hallmark of other court improvement programs across the country ‑‑ is that the court is sort of a disinterested party, has the ability to provide the leadership to pull them all together and say, “Yes, I may make the final decision, as the judge, but I need to know that you all are all at the table supporting the family, and ultimately the agency, if they have ‑‑ if the court has to put the child in care in resolving these problems.”
So, that kind of collaboration, which is supported by the child and family services review ‑‑ but it has got to be more than a federally‑directed effort. It has really got to be a locally‑supported effort to be effective.
*Mr. Reed. I know my time has expired. I appreciate the testimony, Ms. Wareing. And I did note in your testimony there was a study of the nurse initiative out of Elmira, New York, which is in my district. I will be reaching out to them to find out how that program is continuing to work. So I appreciate that.
Thank you, Mr. Chairman, I yield back.
*Chairman Davis. Thank you. Mr. McDermott?
*Mr. McDermott. Thank you, Mr. Chairman. I received some information from a project in the State of Washington. So I want to put mine into the record. The Pierce County Alliance got a regional partnership grant from HHS to administer a promoting safe and family services programs like the one we are discussing this morning. It is called the Amphetamine Family Services Partnership. And it really is another example ‑‑ and I think all of these, it would be nice if we could get them all ‑‑ and I ask unanimous consent to put in the record a letter from Dr. Terry Schmidt‑Wayland along with the evaluation of the program in the State of Washington.
*Chairman Davis. Without objection.
*Chairman Davis. I think there are a number of very good practices that are out there, and the question is whether we have enough money to go further.
I would say both to Mr. Reed and Ms. Black that the visiting nurse business was in the Accountable Care Act. Some of us put this in as a part of the whole of the revamp of the health care act.
I would say also, Mr. Chairman, one thing that I wish we had up here ‑‑ we have got these wonderful people who run these programs, but I think this audience is filled with people who have actually experienced it.
I happen to know one of them sitting here was taken out of her home when she was 12 years old, when her mother was sent to prison, and her mother was sent to prison and 8 kids were taken into the system. They ‑‑ when she came out of prison, she was deported, although she had a green card. She was deported, leaving eight kids here, in the United States. So this young woman went through six or seven homes, and then aged out, and managed to get herself through college at the University of ‑‑ or Washington State University, and is an intern in my office.
I would like to hear from you. those of you who are state directors, particularly. What are the problems of the interaction of the legal system of taking the parent away and locking them up, and leaving the kid in a set of foster homes?
Because one of the issues that we had here on this sheet of paper which I sent around to everybody, which is how much money we are spending, you look down here, “Mentoring children of prisoners.” There is nothing.
And I would like to hear from you what the problems are that you see in that particular genre of case, where you have taken the kid away and put the parent into prison. You said you had lots of it in Kentucky. Here is your opening.
*Ms. Wilson. Thank you. I think one of the greatest concerns we have is, particularly with young children, breaking that bond between a parent and a child, and how we facilitate trying to do visits between children with their parents, when parents are incarcerated. That is certainly something that we struggle with.
The other issue, then too, is ‑‑
*Mr. McDermott. Is that because the distance to the state prison, or is it the reluctance of the foster parent to take the child, or ‑‑
*Ms. Wilson. It is a combination of factors. It is distance. It is just the sheer logistics of getting children their prescribed times for visits.
One of the avenues that we have taken to try to work with this is we have an organization called Prevent Child Abuse Kentucky that actually goes into one or two of our federal prisons and conducts classes with parents to prepare them for changes in their children. Because the other problem that we see is that when parents are released, their children are not the children they were when they left. And to help that parent be educated about effective parenting, but also about stages in development of children, so that when they are reunited they are better prepared to deal with the challenges before them that their children will bring.
*Mr. McDermott. What do you find in Virginia and Michigan?
*Ms. Hopper. With regard to incarcerated parents and their children? I was just sitting here thinking one of ‑‑ the only authority in Virginia in the district courts for bringing prisoner ‑‑ we’re talking district courts, where these cases are handled ‑‑ for bringing prisoners to court, as opposed to circuit courts, is actually in the juvenile court with parents who are incarcerated, and are before the court in child dependency cases. And our legislature gave us that authority.
And so, we actually encourage the courts to bring parents to court when they are having foster care review hearings or permanency planning hearings about their children.
But the reality of it is, Congressman, that if you are going to take a child to a prison to visit their parents, the visitor situation is often not very good. It can be very stressful for a child. It can be tough to be in that kind of an environment. You need training for the people who take them, to help them make judgements about what happened to the child while they were there, and when they come back. And often these parents are there for a very long time.
*Chairman Davis. Thank you. The gentleman’s time has expired. I would echo your sentiments, having been a prison volunteer for eight‑and‑a‑half years in the Kentucky Corrections cabinet. That is a fairly traumatic experience for a child, especially if they have got some history that they are carrying in there.
The chair recognizes Mr. Berg for five minutes.
*Mr. Berg. Thank you. One of the most difficult things, I think, in this whole process is the unintended consequences, where you sit around and you ‑‑ it is probably no more evident than what you are dealing with, trying to figure out the best way to help these kids, and yet at the end of the day, the practicality of it, it sometimes has the opposite effect.
And so, I just kind of wanted to expand on this. You know, I have ‑‑ you know, the President has reduced the funding in half for this prison program. Is anyone familiar with ‑‑ you know, I have heard it said that actually it is kind of detrimental to some of these children, because you are establishing a short‑term relationship, and then you are kind of pulling that away. Is there anyone on the panel familiar with that, and could explain that position, if you will?
*Mr. Sciamanna. I think ‑‑ yes, what I read on one of the mentoring programs ‑‑ at least the HHS justification ‑‑ was that their evidence seemed to be that a lot of these mentoringships were ending within six months, and I think a significant percentage within three months. And the concern is that, when that happens, then you reinforce the sense of abandonment.
So, I think it is ‑‑ at least in one of the programs they talked about better focusing some of the funding. So I ‑‑ you know, I don’t’ know. You would have to ask the department exactly the details in this program. But I think that is one of the concerns that sometimes exists in some of these efforts.
*Mr. Berg. And from my perspective, I just really believe that unless you measure things you can’t manage them. And too often we are putting money and putting new programs, and they just continue on without anyone really saying, “Hey, wait a minute,” you know, “that king doesn’t have any clothes on,” or, “It’s not working, and how can we” ‑‑ which kind of bring up my other passion, and that is really people at the state level, you know, giving them the flexibility to know what works and what doesn’t work, and allowing them to make those changes.
And so, I guess, Ms. Wareing, we talked a little bit about, I guess what ‑‑ I would like to ask you about the waivers, and you know, how you see that as a ‑‑ I think you support that, but explain how you see that working. And we did pass a bill here at the end of May to encourage the waivers, and I was wondering if your organization was supportive of that, and maybe you can explain how that will help.
*Ms. Wareing. Sure. We are absolutely supportive of the expansion, essentially, of what had been the title IV‑E waivers, as I think other folks have mentioned here, as my colleague at the end of the table, Mr. Yager, mentioned, the ‑‑ you know, the ability to use the IV‑E dollars in a way that is beyond the just bringing kids into foster care. It is really the idea of what child welfare finance reform, in a more comprehensive way, is driving at.
It allows states to meet the goals we have said they need to meet, and be accountable to those goals, but fit it to what their community needs are, and communities are different, and states are different. And, you know, the ability to do that and take ‑‑ in a very difficult fiscal time for all of us, be able to be flexible with those dollars and use them as smartly as possible, we fully support that.
We also fully support examining child welfare finance as a whole. But a huge step would be to expand the ability of the waivers to reach many more states for an extended period of time.
*Mr. Berg. I will yield back. Thank you.
*Chairman Davis. I thank the gentleman. And now the chair recognizes Ms. Black from Tennessee.
*Ms. Black. Thank you, Mr. Chair. And I want to follow up on the questioning that Congressman Berg just completed, and that is the sharing of the information, the good information, because you all have ‑‑ those of you at the state level, you have very good stories about what has worked in your state. And certainly that is something that should be shared with others.
At the same time, Ms. Wareing, I appreciate the fact that each community, each state, may be different in its own complexion, and why it is so important to give that flexibility and allow something to incubate at a state that may really be very successful.
I would like to hear from each of you, whether you are at the state level or an organizational level, how that information that may be a good piece from some place else that is doing a good job ‑‑ how do you get that information? How is that shared?
And we will start with you, Ms. Wilson. I mean, I like a number of the things that are in your testimony, and I am going to be calling the people that I know back at our state, and talking to them a little bit about that. But how would you both share what you have done successfully, and then also hear what other people are doing?
*Ms. Wilson. Certainly. And I know some of the people in your state, and we would be happy to talk with them.
We have two avenues, actually, of both receiving and giving information. One of those is, both through HHS, through ACF, and through organizations like APHSA, they are invaluable when we have the opportunity to share, either via conference calls, to share at conferences, make presentations about specific programs. And so, in return, we both provide that information and we get that information.
I think all of us ‑‑ a common theme that has been expressed this morning ‑‑ I think if you were to look at each of the 50 states individually, what you would find is that one of the things that the CFSRs did above all else was really push states to be succinct in their data collection, to target that data, and then to use that data. And I think that is the key, is using the data to inform the practices.
So, we look to our national organizations to help us get the word out. We look to those organizations also to make states aware of practices, promising practices, as well as we do ACF, and to share that information among the states.
*Ms. Black. Thank you. Ms. Hopper?
*Ms. Hopper. The court improvement programs, of course, are significantly focused on court processes and relationships with communities.
And the National Council of Juvenile and Family Court Judges, through their permanency planning for children department, is a terrific resource for us. And they cultivate judges across the country with particular expertise ‑‑ many of them come from your states ‑‑ that are available to us to use in our states to call on as resources.
The National Center for State Courts is also a terrific resource.
And then, the national resource centers that are funded through HHS, the Center on Legal and Judicial Issues and the Child Protection Center are two that we are currently using on training on child safety.
So, the national resource technical assistance that is available probably ‑‑ I look at it a little bit differently than the executive branch does, but they help to pull together best practices, and people who are really on the cutting edge of these issues. And we rely on them heavily to know what is going on across the country.
*Ms. Black. Do you think other states are relying on them, as well?
*Ms. Hopper. Oh, yes, ma’am. I do believe they are.
*Ms. Black. Okay. Great, great. Ms. Wareing?
*Ms. Wareing. I would just add ‑‑ and Pat so eloquently talked about the way that the associations really play a role. But, you know, there is a lot of people in this room, many people, who come to work every day thinking about the ways in which we can better serve, have better, healthier lives for our children and families.
And part of what I think has happened in recent years that is remarkable in a way that has allowed really good things to happen ‑‑ and if we didn’t say this, I think other people on the panel would agree ‑‑ Promoting Safe and Stable Families, and including some of the things that happened in the last reauthorization were very helpful. So, you know, that, I think, is an important thing to leave the panel with.
But there is a real shared governance and leadership that exists across national organizations, at all levels of state and local government. And those are the ‑‑ the more we can make that a dynamic relationship, as opposed to a linear relationship, that is the way that things get shared.
*Ms. Black. Thank you.
*Mr. Sciamanna. Yes. Actually, I hope American Humane Association is part of the solution. We do have a research department, based in our Denver office, and we either partner with states or localities, as they implement these practices. Or we do research around specific programs or practices, differential response.
Something that actually the state of Tennessee is implementing, it is the way you design your child protective services system. But there was extensive work, and it is ongoing work, in terms of the state of Minnesota and their progress, where they have had control groups findings on the results of differential response, how it has really helped families.
So, in our case, what we have done is we have gone into states like Ohio and now New York, and we help them implement it on a county‑by‑county basis. But it is research‑based, and it is similar to what we are also doing, in terms of the fatherhood outreach, through fathers with children in child welfare. There is a research component.
*Mr. Yager. I would quickly add that the ACF hosts conferences, and those conferences are very available to us. They are often funded for us, and we are able to go and share information. But I would also add that there is child welfare list servs where we can get on in real time and talk with our colleagues across the country and share information back and forth about what works and what doesn’t work.
*Ms. Black. Thank you very much.
*Chairman Davis. I thank the gentlewoman, and I want to personally thank each of our witnesses who have come in today, taken the time to ‑‑ some come from far away, knowing you have got a day job waiting for you that is accumulating demands while you are here with us.
We look forward to working with you closely in the future. Any additional input that you would like to have, certainly we are very open to that and want to craft the most efficient and proactive reauthorization possible.
And if Members have additional questions, they will submit them to you in writing. What we would ask is that you submit your answers also the committee, just so we can insert them in the official record, so everyone will have access.
And thank you all again. And, with that, the committee stands adjourned.
[Whereupon, at 11:12 a.m., the subcommittee was adjourned.]
SUBMISSIONS FOR THE RECORD
Child Welfare League of America
Conference of Chief Justices, Conferences of State Court Administrators
Cook Inlet Tribal Council
Dave Thomas Foundation for Adoption
Embrace Waiting Children, Inc.
Evan B. Donaldson Adoption Institute
Family Design Resource, Inc.
Zero to Three, National Center for Infants, Toddlers, and Families
National Association of Social Workers
National Committee of Grandparents for Children’s Rights
National Family Preservation Network
North American Council on Adoptable Children
Northwest Adoption Exchange and Oregon Post Adoption Resources Center
NYS Citizens’ Coalition for Children
Research on Vulnerable Families
The Adoption Exchange
The National Mentoring Partnership
Voice for Adoption