Putting the Kids First: A Child Welfare System That Works

There are more than three million reports of child abuse and neglect each year in the United States.¹ Deaths from child maltreatment are on the rise, reaching almost 2,000 in 2020, and nearly 440,000 children are in the foster care system.² These numbers are driven largely by our drug crisis, which shows no signs of abating.³

Almost every state in the country reports a shortage of licensed foster homes. In Texas and Washington, hundreds of kids have been sleeping in offices.⁴ Illinois’s head of child welfare has been held in contempt of court for keeping foster kids in utility closets.⁵

The coronavirus pandemic and the lockdowns that started in March 2020 made the child welfare situation in the US much worse. With children missing school and regular pediatrician appointments, early signs of abuse and neglect went unnoticed. Many child welfare workers actually stopped visiting at-risk children (thanks partly to agitation by public-sector unions), and some states even furloughed part of their workforce due to budget constraints. Unsurprisingly, the incidence of severe abuse and neglect cases showing up in emergency rooms tripled nationally during the pandemic.⁶

Although the states run child welfare agencies, the federal government contributes slightly less than half the roughly $30 billion per year spent in this area.⁷ The federal government funds everything from foster care training and adoption to frontline child protection and prevention services for families at risk of having their children removed. The evidence suggests state agencies and family courts are not only performing poorly but also violating federal laws that govern how to handle foster care cases.

The Children’s Bureau at the Administration for Children and Families (ACF) of the US Department of Health and Human Services (HHS) regularly investigates the states’ performance on numerous measures. In the latest round of Child and Family Service Reviews, covering 2015–18, the Children’s Bureau found that only four states achieved substantial conformity with the bureau’s most important measure: “Children are, first and foremost, protected from abuse and neglect.”⁸ Indeed, a significant portion (more than one-third in 2019) of fatalities and near fatalities due to maltreatment occur among children whose families have already been investigated by child welfare agencies.⁹

A recent report from Kentucky found that of the 208 suspicious child deaths in fiscal year 2021 (which represented a 22 percent increase in cases of suspected abuse-related deaths from the previous year), 73 were in families the child welfare agency had already investigated.¹⁰ In New York City alone, between 2008 and 2018, the number of child deaths in families that had been previously reported to and investigated by the city’s Administration for Children’s Services increased from 49 to 59.¹¹

In Pennsylvania, a report on 2014–16 found that “of the 220 substantiated fatality and near fatality incidents, nearly two-thirds (64%) of the children and/or families were involved with the county children and youth agency prior to or at the time of the incident.” Moreover, of “the 140 children and/or families known to the agency, 58 [cases] were open at the time of the incident.”¹² Child welfare officials know these kids are in unsafe situations, but, regrettably, policies are leaving them there.

Increasingly, the evidence shows that child welfare agencies and family courts are much more concerned with adults’ needs and sensibilities than children’s safety. Reform must come from many different corners of this field, but Congress can play an important role in this effort.

Federal funds given to the states must include safeguards and accountability measures to ensure that children are safe, that they do not languish in the foster care system longer than necessary, and that quality foster homes and, if necessary, institutions are available to care for children when they cannot live with a family. Reform will require using the latest data and technology available to us, training social workers to understand which children are at risk and why, and cleaning up our family court system to ensure it operates on the timelines of children, not bureaucrats.

Diagnosing the Problem

A variety of factors cause poor outcomes in the field of child welfare—many stemming from well-intentioned policies that nevertheless harm children.

Misplaced Efforts to Reduce Foster Care Placements. One reason for our situation is that states are desperately trying to reduce the number of children in foster care. On its face, this seems like a great idea. But foster care placement is an insufficient measure of children’s safety; officials can drive that number up and down depending on their decisions about children’s safety at home. The real test of whether the child welfare system is working is the numbers on child maltreatment and child fatalities. And those should worry us.

If officials are concerned only with driving down the number of kids in foster care, they risk leaving kids in unsafe family situations, and serious maltreatment becomes a bigger problem. In Maine, for instance, the number of children experiencing maltreatment jumped 30 percent from 2015 to 2019, while the number of children in foster care grew by only 12 percent.¹³ This suggests pressure was placed on child welfare workers to leave kids in their homes. Unfortunately, the percentage of children in Maine with a recurrence of maltreatment within six months of exiting foster care almost doubled between 2015 and 2019.

The pressure to reduce the number of kids in foster care comes mostly from the political left, whose priorities for child welfare are misplaced. Like so many of our political debates these days, this one has been reduced to a conversation about racial disparities.

True, the parents of black children are more likely to be investigated for allegations of child abuse and neglect. Their cases are also more likely to be substantiated.¹⁴ And black children are more likely to wind up in foster care. But there is little evidence that these numbers stem from racial bias. If they do, then why isn’t the rate of Hispanic children placed into foster care higher than their percentage in the population? And why, in large cities like New York, are most of the agency’s caseworkers actually black or Hispanic?¹⁵

More likely, more black children are in foster care because they are twice as likely to suffer from maltreatment and three times as likely to die from maltreatment as their white peers are. (Child maltreatment–related fatalities among black children rose 17 percent just from 2019 to 2020.)¹⁶ Child abuse highly correlates with family structure. Children living with a mother and nonrelative male are 11 times as likely to suffer abuse as are those living with two married biological parents.¹⁷ Family structure is not distributed evenly across racial groups in this country. According to data from Child Trends, in 2014, 69 percent of all births to black women occurred outside marriage, compared with only 28 percent of all births to white women.¹⁸

If these arguments about racial disparities sound familiar, that is because the movement to abolish foster care has modeled itself on the movement to defund the police. Just as activists discuss racial disparities in arrests and incarcerations without considering racial disparities in crimes, they discuss racial disparities in foster care without considering the reasons for removal. Just as good policing should benefit the most vulnerable communities, good decisions in the child welfare system should help the most at-risk kids. But activists, caseworkers, and family court judges would rather hide racial disparities and make the spreadsheets come out even than rescue children of any race from dangerous situations.

Failure to Appreciate the Root Causes of Child Maltreatment. In many child welfare agencies, including at the highest levels, workers assume that kids who are removed from their families weren’t really in danger and that most of the families involved with child welfare simply can’t afford to properly care for their children.¹⁹ By this logic, advocates believe that if government expanded housing vouchers, food stamps, free childcare, and other safety-net programs, child welfare problems would solve themselves.

Unfortunately, the statistics belie this theory. At least 40 percent of kids in foster care are removed from their homes because of parental substance abuse, but most experts say the number is closer to 80 percent.²⁰ Drug use, alcohol use, and co-occurring mental illnesses prevent many parents from properly caring for young children, no matter how robust the safety-net supports available to them are.

Emphasis on Prevention. In recent years, Democratic and Republican administrations have focused on prevention. According to David Kelly, a key official at the federal Children’s Bureau, child welfare agencies are too focused on rescuing children; they should instead be strengthening communities. “We need to let go of the system that was designed to rescue children, and construct a system that’s designed to promote health and well-being for all families.”²¹ However, this goal is expansive enough to intrude on the lives of families that do not need the government’s help and narrow enough to fail children who are most at risk.

For instance, Congress passed the Family First Prevention Services Act in 2018 partly to focus the child welfare system more on prevention.²² The act was supposed to divert money toward prevention services and away from congregate care. But as a careful review of the ACF’s clearinghouse shows, few services effectively prevent maltreatment in families that have already harmed children.²³ Even prevention services that show promise do not even distantly work for all families. In fact, the act implicitly acknowledges that prevention services will not keep children safe in their homes, because it also funds informal placements with relatives.

Conservatives must maintain that child welfare agencies cannot fix racial disparities and end poverty; rather, agencies should ensure individual children’s safety.

This mission begins at first contact with a child. Child welfare agencies do a terrible job of determining which kids are at high risk. New developments in data analytics could go a long way toward fixing this problem. A pilot program implemented in Allegheny County, Pennsylvania, and Douglas County, Colorado, allows child abuse hotline operators who receive reports of child abuse and neglect to see a risk score for the families involved to determine how urgently someone needs to investigate.²⁴

Child welfare agencies have information about many of the families reported to them; they simply fail to use it properly. Officials know whether a child has recently missed school repeatedly, a recently released prisoner has listed that child’s home as an address, the child’s family has failed to access food stamps and other material supports, and the family has previously been reported for abuse and neglect. Risk scores, which prove much more accurate than the gut instincts of hotline operators and even abuse investigators, do not determine whether abuse and neglect actually took place, but they allow investigators to triage cases in an overwhelmed system. Incentivizing states to develop programs with predictive risk modeling would help bring our child welfare system into the 21st century.

We have other important pieces of information about vulnerable children that we don’t use or discover until too late. Five states have adopted birth match programs, which alert child protective services when a baby is born to a mother who has already killed another child or lost her parental rights because of severe child abuse. Policymakers should encourage other states to use this system—which is similar to a sexual abuse registry—so investigators can intervene as soon as possible to ensure a child’s safety. Legislators may also consider creating a national registry of child maltreatment cases, as serial abusers often cross state lines.

Workforce Problems. The child welfare workforce also has significant deficits. Far too often, it attracts people who lack other professional options, fail to understand the job, and lack the skills to carry out their responsibilities successfully. Agencies compound the problem by offering investigators little training, little reason—financial or otherwise—to remain in the profession, and no career ladder for those who show promise.

The problems plaguing the profession are evident in the turnover rates for investigators, which are extraordinary: A Casey Family Programs report estimates that the average annual turnover rate at US child welfare agencies is approximately 30 percent, with individual agency rates reaching up to 65 percent.²⁵ As Sarah Font of Pennsylvania State University notes, staff turnover costs agencies “both financially, through recruitment and training costs, and qualitatively, through having an inexperienced workforce, staff shortages and discontinuity in the relationship between caseworkers and families.”²⁶

Frontline child protective workers might be better recruited from among law enforcement trainees than among social work trainees. The federal government’s training dollars for states in Title IV-E go almost exclusively toward university social work programs, but they should be flexible enough to cover training in criminal justice programs as well.

Even with better workforce training, problems would remain in the child welfare system. Some of child welfare caseworkers’ poor decisions have little to do with insufficient training and resources. Rather, ideology is guiding these decisions. State and local leaders have told child welfare professionals to reduce racial disparities in the system. Thus, agency heads and even some family court judges are making it much more difficult to remove black children from their homes, even when there are clear safety concerns.

For instance, a recent investigation by the Los Angeles Times and the University of California, Berkeley, into the 2019 death of 4-year-old Noah Cuatro didn’t identify caseworker workload as a major contributing factor. The Los Angeles County Department of Children and Family Services didn’t have too many kids to handle. Rather, the agency’s “less adversarial approach” to parents was to blame.²⁷ When one caseworker wanted to remove Noah from his family shortly before his death, she was accused of racial insensitivity, and the boy stayed put.

Reforms to Improve the Child Welfare System

If we are serious about improving outcomes for the country’s most vulnerable children, we should consider a number of changes.

Reduce the Time Kids Spend in Foster Care. Family preservation remains an important goal for the child welfare system. States should remember that removing a child from home is a temporary measure. According to the Adoption and Safe Families Act (ASFA) of 1997, states should move to terminate parental rights if children have been in foster care for 15 of the past 22 months.²⁸ In the nation as a whole, 69 percent of kids in the foster care system exit, or parental rights are terminated, after 18 months, and 24 percent exit between 18 and 36 months. Only 7 percent of kids in the system stay beyond 36 months.²⁹

In some states the numbers are drastically worse. In Illinois, for example, almost 30 percent of kids in the system stay longer than 36 months. Foster care should be temporary; kids should not be left to languish indefinitely. The challenge of reducing time in foster care even extends to young children. Almost a quarter of kids who entered the Illinois system before they turned age 5 remained in care longer than 48 months.³⁰

This excessive time in foster care not only increases the trauma kids experience—including from the multiple placements they may experience during that time—but also makes them less likely to be adopted as they age. The federal government should reward states that achieve the timelines the ASFA laid out. Congress has begun moving to repeal these timelines altogether, but we should understand that the legislation has helped tens of thousands of children find permanent, safe, and loving homes since it was passed in 1997. We don’t want to turn back the clock.

The child welfare system should offer parents the opportunity to rehabilitate, such as through addiction programs, parenting classes, and anger management classes. Although these programs often prove ineffective, parents should have access to them as soon as their cases begin. Delays in accessing these services often lengthen children’s stays in foster care. Again, policymakers should ensure states make this process timely for the sake of parents, but especially of kids.

Our child welfare system’s longest delays often result from inefficient family court operations. It is not uncommon for children under age 3 to wait six months between hearings. This inefficiency has real effects—not just slowing the process down but, more importantly, harming children.

“Children have a very different sense of time than adults,” the National Council of Juvenile and Family Court Judges declared in guidelines published in 2016. “Short periods of time for adults seem interminable for children, and extended periods of uncertainty exacerbate childhood anxiety.”³¹ Even some small pot of funds incentivizing states to adopt a “right to a speedy trial” statute in their family court provisions could greatly improve vulnerable children’s lives.

Policymakers should emphasize reducing the time younger kids spend in the child welfare system. The ASFA timelines are maximums, not minimums. In other words, when parents clearly cannot rehabilitate, officials need not drag matters out for children.

Some states, such as Arizona, have adopted shorter timelines for cases when children have been born substance-exposed. If parents have not shown progress toward kicking addiction within the first year after such a birth, the state can move to sever parental rights.³²

ASFA also specifies that in “aggravated circumstances” the courts can move more quickly.

• The definition of aggravated circumstances may include, but is not limited to, abandonment, torture, chronic abuse, and sexual abuse.
• The parent committed murder of another child of the parent.
• The parent aided or abetted, attempted, conspired, or solicited to commit such a murder or voluntary manslaughter.³³

Lawmakers might be amazed to see how many of these circumstances states do not consider grounds for immediately terminating parental rights.

Take sexual abuse, for instance. Although no mechanism exists to track whether children are reunified with a non-offending parent or returned to a home with their abuser, several states clearly pursue reunification between children and their sexually abusive parents. For example, some states bypass reunification efforts only after removing the child twice due to sexual abuse.³⁴

In Pennsylvania, where state law allows courts to waive family preservation and reunification requirements in cases of child sexual abuse, reunification efforts sometimes proceed anyway.³⁵ In fact, Pennsylvania has a training protocol for how social workers should place kids back with the family members who have sexually abused them.³⁶

“Family Reunification and Case Closure in Child Sexual Abuse Cases,” published by the Pennsylvania Child Welfare Resource Center, includes provisions for overnight visits and seems to require other family members to supervise the abuser. Advice includes putting locks on bathroom and bedroom doors and ensuring the abuser remains clothed unless in the bathroom or their own bedroom. It then notes: “If he needs to leave the bedroom during the night he should awaken his wife (girlfriend) and inform her of what he is doing.”³⁷

Americans who are rightly outraged about the ways various large and trusted institutions in this country (from the Catholic Church to USA Gymnastics) have covered up chronic sexual abuse might be shocked to know that many states keep children with their abusers, as long as those abusers are parents or other relatives. ASFA was not intended to keep children in danger.

Increase the Number of Foster Families. What about the kids who are already in the foster care system? It is clear from the number of children without placements across the country that we simply don’t have enough homes for the children who need foster care. Given how foster parents in this country are often treated—as little more than glorified babysitters—it’s not surprising.

Prospective foster parents who call their state agencies to volunteer often never hear back. Training is held at inconvenient times and locations. Foster parents are not told about important problems—such as a child’s history of sexual abuse—when kids are dropped off. It’s no wonder half of foster parents quit within the first year.³⁸

The Family First Prevention Services Act provided modest funding to incentivize states to recruit more and better foster parents, but many states don’t even report how many foster parents they have. Their counts are often outdated and inaccurate. How can policymakers in Washington know whether any progress has occurred?

Faith-based foster agencies do much of the heavy lifting in this space, working with states to recruit, train, and support foster parents. Numerous agencies are trying to use anonymized data on which foster parent demographics succeed most so they can target those groups in marketing efforts. The federal government should encourage states to partner with these agencies to share data on how many foster homes are open, what areas need more homes, and which groups are doing the best job.

Most importantly, Congress should protect faith-based foster agencies from activists who are trying to shut them down. Some foster agencies work only with parents who share their faith, for example. Since Catholic Social Services does not work with same-sex couples, the city of Philadelphia, Pennsylvania, ended its foster care contract with the organization. But in June 2021, the Supreme Court ruled in Fulton v. City of Philadelphia that Philadelphia’s decision was unconstitutional because the city’s nondiscrimination ordinance “burdened [the agency’s] religious exercise by forcing it either to curtail its mission or to certify same-sex couples as foster parents in violation of its religious beliefs.”³⁹

Apparently, this message was not clear to some. At least 10 cases regarding faith-based foster and adoption agencies’ ability to operate are now pending in lower courts, some filed since the Supreme Court decision came down. Facing Foster Care in Alaska v. US Department of Health and Human Services—which Lambda Legal filed in January 2021—demands that the federal government refuse to work with foster agencies that don’t serve every foster parent in the state.

Nothing seems to deter advocacy groups from trying to drum faith-based agencies out of business. Recently, Alaska reported such a severe shortage of foster homes that children are sleeping in state offices.⁴⁰ Three thousand children are in the system, but only 650 homes are licensed to take a child. Under such circumstances, shouldn’t the foster care system take an all-hands-on-deck approach?

This type of crisis highlights the importance of ending the back-and-forth at HHS over whether the federal government should restrict faith-based organizations’ use of federal funds. Congress should demand to know why, after the Supreme Court has already ruled on this issue, HHS still refuses to settle these lawsuits and allow agencies with clear religious missions to operate at their fullest potential. As a letter to the HHS secretary from Sens. Mitt Romney (R-UT) and Mike Lee (R-UT) recently put it, “HHS should be welcoming child welfare providers, not excluding them. Children are too important to be pawns in political games.”⁴¹

Recognize the Role for Congregate Care. We must realize that even if policies mitigated the shortage of families willing to foster children in their homes and led to an influx of foster families, some vulnerable children would still have behavioral and mental health problems that need residential care. While policy circles, academia, and even private philanthropy have become unwilling to support congregate care, the alternative for these children, especially older youth, is much worse.

Thousands of foster kids across the country sleep in offices and hotels each night because no family is willing to care for them. These young people may be violent and mentally ill, and they may have substance abuse problems and even criminal records. Some are even sex trafficking victims. Pushing them into one home after another, only to be rejected by families with noble intentions but insufficient resources and experience to care for them safely, punishes these children further.

In the second half of the 20th century, congregate care settings for foster kids developed a reputation for being uncaring, if not abusive, as reports surfaced of neglectful group homes and administrators who seemed to care only about the money they could gain from serving vulnerable kids. Today, of the 425,000 children in the foster care system, only about 55,000 reside in institutional settings.⁴² A third of those in institutions spend fewer than 60 days there, and their average age is 14.⁴³

The Family First Prevention Services Act, which was passed in 2018, attempted to reduce congregate care by restricting federal reimbursements to states for certain kinds of group-home care (for example, care centers without a 24-7 medical staff).⁴⁴ Another regulation, known as the Institutions for Mental Diseases (IMD) exclusion, prohibits using Medicaid for care provided to most patients in mental health residential treatment facilities larger than 16 beds. The exclusion was part of the large-scale deinstitutionalization efforts in the 1970s. But now it may apply to foster children who have serious mental health challenges.

The labor shortage hasn’t helped, and two heads of congregate care centers in California recently told me they are losing staff to federal centers housing migrant children, which pay employees significantly more. This is to say nothing of the rising costs of running a residential care program. Insurance rates have skyrocketed, and the possibility of lawsuits makes these programs prohibitively expensive.⁴⁵ Far from the stereotype that congregate care is just a way for agencies to make money, many agencies must use their other services to supplement their congregate care budgets.

To preserve the option of residential care for children whose needs are too great for foster families to meet, Congress should pass an exception to the IMD exclusion for children in the foster care system. Children are better off in a home setting in most cases, of course, but kids who have experienced enormous trauma should have as many options as possible.

Conclusion

A crucial piece of the US safety net is the child welfare system and its ability to care for the country’s most vulnerable children. From the earliest reports of child abuse and neglect to the decisions about where to place foster children who need safe, loving, permanent homes, the child welfare system in the US is failing.

The federal government should incentivize states to improve family court systems and stick to the timelines for children in foster care that federal law has already laid out. We should hold all families, no matter their race, to the same standards for how they treat children. We should not leave black children in unsafe situations simply to reduce the visibility of disparities.

The federal government, through HHS, should reward states for partnering with nonprofit groups—particularly faith-based organizations, which are on the cutting edge of efforts to recruit, train, and support quality foster parents. And the federal government should require states to provide better data on child maltreatment and foster care.

Although prevention strategies are an important part of child welfare, foster homes will always be needed. Policymakers should reward states for ensuring that each child who enters the system has multiple options for placement, no matter their level of need. America’s most vulnerable kids deserve nothing less.