1991-92 San Diego County Grand Jury - Report 7, The Crisis in Foster Care

8/9/2019 1991-92 San Diego County Grand Jury - Report 7, The Crisis in Foster Care

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THE CRISIS IN FOSTER CARE

REPORT NO. 7

A Report by the

1991-92 San Diego County Grand Jury

June 29, 1992


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THE CRISIS IN FOSTER CARE

INTRODUCTION

This special report by the 1991-1992 Grand Jury amplifies

earlier reports on the foster parent process in San DiegoCounty. The 1988-1989 "Children in Crisis" report of the Grand

Jury spoke to the looming crisis in foster care. The 1989-1990

Grand Jury made eleven recommendations regarding foster care.

These recommendations were unheeded and few improvements were

made.

Foster parents play an integral role in the juvenile

dependency system. The commitment to children of the majority

of these parents is extraordinary. This report is not, and

should not be interpreted as critical of the services provided

by selfless individuals and families who have opened their homesand hearts to children in need of protection.

The 1991-1992 Grand Jury in its report "Families in Crisis"

made findings that some foster parents are not effective checks

in the dependency process because they are co-opted by the

Department of Social Services; that good foster parents are lost

because of the treatment they receive at the hands of some

caseworkers at the Department of Social Services; and, that the

Department must discourage foster parents from viewing foster

care as a first step in an adoption plan, especially where

babies and toddlers are concerned.

The statewide Little Hoover Commission report on foster

care and its consequences to children was released in April,

1992 as a follow-up of to its l987 study. The findings of that

report are significant and deserving of careful study. The

Commission found that every $1 spent on family preservation

saved $3 in long term costs. It estimated that between 35% and

70% of foster children should never have been removed from their

parental homes. It strongly recommended a reassessment of front

end diversion funding to avoid pulling children who can be

safely kept at home.

The Commission found a disturbingly disproportionate number

of ethnic minority children in foster placement. For example

40% of all California foster children are African-American

(compared to a 6.3% overall African-American population) with an

inadequate availability of African-American foster family homes

or group homes. Causes for this were attributed to include

racism and insufficient recruitment. In addition, ethnic

minority children who are placed with relatives may be adversely

affected because of an inequitable financial support rate


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structure that does not generally allow relatives to receive as

much financial support as non-relative foster parents. This

situation affects a great many ethnic minority children because

they are placed with relatives at a much higher rate than are

white children.

The study further found that the future of those in the

foster care system is bleak. Forty-five percent of runawayyouths have been in foster care and many foster children grow up

poorly educated, in poverty, suffering from drug and alcohol

abuse, and in trouble with the law. While recognizing that

those children coming into foster care are already a troubled

class, these statistics remain disturbing indicators that foster

care generally is not breaking the cycle many of these children

are locked in. These children need the very best society has to

offer and are being shortchanged by a system which does not

provide sufficient training, support services, screening, and

reimbursement to foster parents.1

An additional serious problem which requires consideration

is the provision of foster care to teenagers. Many of these

children have difficulties adjusting to foster care and as a

result may suffer multiple unsuccessful placements. The AWOL

problem in this age group is significant. Many of the children

run away from placement only to run to the receiving home.

There is some evidence that this group of children could be

better served in cottage style residential facilities in the

community or close by in rural settings. While this concept

brings with it a host of other problems, it may meet the needs

of those children who can not adjust to a foster familysituation or ever to being returned to their natural family. A

lack of societal commitment has led to children in general being

more troubled; foster care children generally suffer from

multiple problems which contribute to ever greater adjustment

problems.

Foster care funding is primarily from federal grants. Last

year San Diego County spent over 70 million dollars on foster

care. Almost all of that was reimbursed by federal and state

funds. As of a few months ago the County is now expected to

contribute 60% of the portion paid by the state. It is expectedthat this additional cost to the County will cause a closer look

at placement decisions. The intentions of open-ended foster

care funding was to ensure that all children would receive the

level of care they needed. This has had the unfortunate result

of encouraging out of home placement and higher levels of care

than may be needed. It is hoped that the increase in the level

of County responsibility will not discourage expenditure of

funds when needed.

1 Mending our Broken Children: Restructuring Foster Care in California, Little HooverCommission, April, l992.


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The cost of foster care has escalated dramatically in the

past several years. Unfortunately, this open-ended funding

stream may have been partially responsible for excessive

placement of children in foster care.

Foster care has evolved into a highly developed "cottage

industry" with a strong political voice. While the majority offoster parents are well motivated, it is important to remember

that there can be a strong element of self-interest in the

foster care provider positions on dependency issues.

This report on foster care is intended to share with the

community, general and specific, findings on problems in foster

care. The problems are many and solutions will be difficult.

Only by acknowledging the existence of these problems can

curative steps begin. The Grand Jury has divided the range of

problems into three categories: Foster Placement Problems,

Problems of Training and Status, and Problems of the System.Our recommendations for change make up the final portion of this

report.

FOSTER PLACEMENT PROBLEMS

The Grand Jury has identified five problems caused by some

foster parents. Although many foster parents are truly

dedicated contributors to child welfare, too many are in the

business of making money by renting their homes to the

dependency system. These problem foster parents cheat the

system and short-change the foster children.

Foster placement as a precursor to adoption.

The Grand Jury interviewed attorneys, physicians,

specialists in child development, caseworkers2 and investigators,

all of whom work with foster children, in an effort to discover

foster care problems and to arrive at solutions. While these

experts routinely praised the many excellent foster parents who

are motivated by love for mistreated or neglected children, they

acknowledged that many foster parents are motivated by money,

supplementing, and at times being the entire family budget, by"taking in" foster children . However, by all accounts, the

most troublesome problem for the system is foster parents

2In earlier reports the Grand Jury has used the term "social worker" to describe employees of theDepartment of Social Services. However, the term "social worker" denotes a person who hasachieved the Masters Degree status in the social work curriculum or who is licensed as a socialworker. Many departmental employees who work on cases are not "social workers" by thisdefinition. (See San Diego County Juvenile Justice Commission Case Review Report, p.1.). Inthis report the Grand Jury uses the word case worker to denote that general class of departmentalemployees who perform case work.


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screening children for the "right" one to adopt.

Those foster parents who hope to adopt may "sift" through a

number of children until they find the one they want. An

example of this type is the case of Baby Girl R. Baby Girl R.'s

counsel informed the Jury that the foster mother admitted that

she was holding her foster care license only until the family

found a "baby sister." This mother takes emergency care (shortterm, up to 45 days) placement, only, so that the family can

"check out" a number of children. The Hispanic natural mother

of Baby Girl G. who was placed in this home has tried to visit

her baby in the foster home, but the foster mother frustrates

the visitation efforts and instructs the caseworker not to

transport the mother to the foster home. (The birth mother does

not have transportation of her own.) The result is predictable

and recurrent. The child, "who looks white" according to the

foster mother, will bond to the foster parents without knowing

her real mother. The natural mother will fail at her

reunification plan because she does not fulfill the visitationrequirement. The child will be "freed" for adoption, and the

family will have its "baby sister."

In another strikingly similar situation with a bizarre

twist, the foster parents believed the foster child is "too

white to be Hispanic", and have therefore changed the baby's

name to an English one, as part of the process of making this

child a permanent part of the family.

Many children need to be adopted because their parents have

abandoned them, or because the parents have forfeited theirparental rights through neglect or abuse and failure to comply

with the requirement for reunification during an 18-month

reunification period. These children should be adopted.

However, these children tend to be beyond infant years, the age

when children are the most attractive for adoption. The process

that the Grand Jury finds unacceptable is the placement of

infants or small children whose parents are still attempting to

reunite with foster parents hoping to adopt. This creates an

irreconcilable conflict. These foster parents frustrate

visitation and lie to the caseworker about the parents'

behavior, hoping that the caseworker will promote the foster

parent's view to the court, hastening the day when the court

frees the child for adoption.

Many natural parents in this situation have difficulty

communicating their plight to others because of language

barriers or because they are afraid to complain about "official"

conduct until it is too late. AB 243 was written into the

Welfare & Institutions Code short clock for reunification.

Bureaucracies respond slowly to complaints as this clock keeps

ticking.


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Only vigorous advocacy by the attorneys for the natural

parents, and more careful screening to discover the genuine

intentions of foster parent applicants can solve this problem.

Certainly the Department must immediately cease promoting foster

parenting as a precursor to adoption.

Treatment of the foster child as compared to treatment of the

biologic or adopted child.

Foster parents are expected to create an atmosphere as

nurturing as possible for foster children. Although foster

children older than infants or toddlers know that they are not

in their own home, they need to believe that they are being

treated fairly. Because they miss their parents and their real

home, they must adjust to their new surroundings, especially to

the new children with whom they live___the biologic or adopted

children of the foster family.

That adaptation is impossible if they are treated

differently from the other children in the home. Many

caseworkers and investigators report that some foster families

treat foster children differently than the other children in the

home. The Grand Jury was given some of the following examples

by minor's counsel and caseworkers:

o foster children given different (cheaper) food than

the other children;

o foster children given access to only limited areas of

the home;

o foster children given only very cheap clothing, or

poor condition hand-me-down clothing from the other children;

o no photos, schoolwork, awards or other mementos of the

foster children are permitted to be displayed in the home, even

in long-term placements;

o physical discipline of foster children by foster

parents in spite of such discipline being forbidden by

Department of Social Services rules;

o foster children being forbidden to watch television

with the rest of the family or being forbidden to open the

refrigerator;

o foster children being excluded from vacations with the

rest of the family.


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This disparate treatment can only single-out, mark, and even

destroy the foster child. Caseworkers report that they fear

raising the issue of these abuses to higher levels in the

department because of the constant shortage of foster homes.

Therefore, complaints other than of the most serious kind are

discouraged.

This fear is widespread and recurs in discussion of problemfoster homes: A poor quality foster home is better than the

risk of no foster home. The Grand Jury decries this attitude.

Poor quality foster homes have no place in the system.

Fortunately, the current leadership of the Department and Child

Protective Services is in full agreement with the Jury's concern.

Improper attempts to obtain higher rates.

Foster parents are paid monthly rates to care for foster

children. As an example, a foster family currently receives

$354.00 per month for a child up to four years of age and$484.00 per month for a child from 5 to 18 years old. Clothing

allowances are in addition to these amounts.3 These amounts are

not taxable income.

If a foster child requires special care, then special care

rates of up to $1,000 per month (including the basic rate) are

available at the discretion of the caseworker and his or her

supervisor.

The Jury has several concerns with the funding of foster

care. First, many of the children in foster care are therebecause of poverty. Their natural parents are unable to take

care of them on AFDC. The amount received on AFDC is little

more than half that received by foster parents. Foster parents

are not supposed to be making a profit from fostering and so it

is assumed that the amount received by a foster parent is what

the state reasonably expects it to cost to have a child in the

home. This is logically inconsistent. Why should it cost a

foster parent almost twice what it costs a natural parent?

Nonetheless, the Little Hoover Commission and Grand Jury

testimony indicate that it would save money in the long run toincrease the amount paid to foster parents and to obtain a

higher quality professional cadre of foster parents. The state

pays approximately $6500 to support a child in a foster family

compared to more than $32,500 to place him in a group home.

Children who are placed in bad, abusive, ar inadequate foster

homes are more likely to need eventual placement in the higher-

priced group home.

The Grand Jury has received reports that some foster

3Children's Services Special Notice , #67-90, p. 2.


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parents improperly claim that a child needs special care in

order to increase the amount of money coming into the home. The

Department of Social Services considers behavioral or medical

problems and "minor and/or temporary conditions"4 as potentially

justifying the payment of extra funds to the foster family.

Caseworkers, investigators and attorneys believe that some

foster parents routinely complain of behavioral problems, insist

that those behavioral problems require mental health therapy and

then seek additional funds for regular transportation to the

therapist and special care needs. These claimed behavioral

problems are subjective and are not capable of being confirmed

by objective tests.

In fact, Department of Social Services policy authorizes

the payment of special care rates for "children exhibiting

behavior problems" for which documentation has not yet been

provided.5

The Grand Jury suggests that foster parent claims of

behavioral problems in foster children not previously identified

as having the problems should be carefully investigated.

Improper use of controlling medications.

Treatment for some behavioral and allied medical problems

is through the use of medications which control the child's

nervous system and mental processes. These medications range

from mild depressants and hypnotics to strong psychotropic

drugs. In the mental health, social service and foster carecommunities these nostrums are referred to by the apparently

innocuous name "meds."

When obtained and used inappropriately, meds become a way

of making a child quiet, withdrawn, and apparently trouble-free.

Meds are often the physician's way of treating behavioral

problems. However, if the physician receives incorrect

information about a child's behavior, it is possible that

medications could be prescribed for a child who does not need

them. As will be noted in a later section on medical care of

foster children, the lack of money for medical treatment, thefinancial pressures on medical providers and a generalized lack

of medical records for foster children all contribute to make it

possible for unscrupulous foster parents to obtain medication

(and special care payments) for children who do not need to be

medicated.

The Grand Jury recommends that the Department of Social

4Children's Services Special Notice , #1-89, p. 2.5Children's Services Special Notice , #1-89, p. 2.


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Services set up a system to record and inspect the kind of care

by foster family (including medical requests) so that abuses can

be substantiated. Thereby, inappropriate foster families can be

removed from the opportunity to further harm these unfortunate

children. The Grand Jury further recommends that parents be

kept fully informed of all medical treatment received by

dependent children. The Grand Jury further recommends that

parents be kept fully informed of all medical treatment receivedby dependent children.

Sabotage of reunification efforts.

An intent to adopt by the foster parent is not the only

problem which occurs with reunification plans. Caseworkers,

investigators and attorneys who contributed their experiences to

the Jury told of foster parents who interfere with reunification

for a variety of other reasons.

o Some foster parents find the conduct of the naturalparent so unacceptable that the foster parent pronounces a

personal judgment that prevents the natural parent from ever

being able to reunify with the child. This kind of attitude,

although understandable, limits the court's ability to promote

reunification, and also acts against the birth parents' right to

learn from mistakes and to change their conduct.

o Some foster parents become antagonistic to the birth

parents because of controversies that arise during foster care.

Often, parents of dependent children are from other cultures, or

have communication difficulties, or are so nervous and upsetover losing their children that they act inappropriately. An

angry foster parent can exaggerate the negatives and forget to

describe the positives when reporting to the caseworker. The

caseworker then becomes a reporter of inaccurate information

which creates a biased record to the court.

o Some foster parents are not sympathetic to the

philosophy that parents have a right to reunify. These foster

parents may put roadblocks in the way of natural parent contact

with their children. When contact and visits do not take place,

caseworkers and judges are less likely to approve reunification.

o Many foster parents are economically far better off

than the natural parents. The natural parents may feel

embarrassed and inadequate faced with this disparity. This may

impact the ability of the parents to visit at the home of the

foster parents.

The existence of these problems makes it especially important

that recruitment of foster parents, their training, and all of

their caseworker contact stress the professional aspect of


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foster parenting. Foster parents must have a measured,

rational, and sympathetic approach to parents. They must

understand that reunification, not separation, is the goal of

the dependency system.

PROBLEMS OF TRAINING AND STATUS

By the accounts of witnesses who addressed these topics,foster parents do not receive sufficient training, and their

good work in the system is not appreciated. This has led to a

failure to keep many good foster parents. Although there are

many reasons, mostly historic and financial, for this state of

affairs, it must be changed. The alternative will be further

suffering by foster children and their natural families, and a

continuation of the difficult task of finding and keeping good

foster parents.

Insufficient training especially in the area of child

development.

The Department of Social Services attempts to train foster

parents in their role as temporary, substitute parents. That

training needs to be expanded in both breadth and content.

When faced with this proposition, caseworkers respond that

the system cannot put too many demands on the foster parents or

it will lose them. The Grand Jury sympathizes with the

difficulties in recruiting good foster parents but believes that

appropriate training and psychological screening will attract,

not put off, the best foster parents. With this training andscreening should follow increased status and respect within the

system.

A physician who specializes in child developmental medical

problems in San Diego County, and who treats foster children as

a major part of her practice is astonished at the lack of

knowledge displayed by foster parents in dealing with problems

of child development. Child development is a branch of medical

science which has found that unrecognized and untreated

developmental problems will have lifelong affects for that

child. Since foster parents, by definition, raise foster

children who are the most unfortunate of society's charges,

foster parents must receive intensive training in child

development.

The Grand Jury suggests that the Department of Social

Services must unite with child developmental medical experts in

this county to design a training program that will teach foster

parents how to recognize developmental problems and to arm those

foster parents as advocates to demand appropriate diagnosis and

treatment for children with such problems.


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Failure to co-opt foster parents.

In an ideal system, the foster parent would become the eyes

and ears of the caseworker, providing constant up-dates on the

status of the child and the child's interaction with the natural

family.

However, because of the unfortunate inability to attract

only the best foster parents, because so many foster parents are

motivated by money, and because some foster parents are not

trained sufficiently in their role, many caseworkers do not view

foster parents as reliable informants, devoted to the welfare of

the children.

As a result, this minority of inappropriate foster parents

have poisoned the well for the majority of foster parents who

seek to do a good job. These good foster parents are further

hampered by non-communicative caseworkers who have formed a badimpression of all foster parents based on the poor performance

of the few.

In spite of the bad experiences, caseworkers ought to be

encouraged to expect the best from foster parents and to report

those foster parents who perform in a sub-standard fashion.

In short, discouraged social workers have low expectations

of, and little respect for, many foster parents. Such an

expectation is self-fulfilling, causing foster parents to lose

hope of real cooperation. The self-defeating spiral must bestopped. As an institution, only the Department of Social

Services can stop it. The following observations suggest how

severe this problem has become.

Neglect and abuse of foster parents.

Investigators and attorneys have provided many examples of

foster parents who tried to give crucial information to

caseworkers but were met with disbelief and inaction.

An example involved Louis R. whose mother is in prison.

When Louis was six, he was placed with his long-term foster

mother. After two years in foster care Louis had worsening

behavior problems, was running away, and was causing serious

problems in the foster home. Louis had five caseworkers in two

years, and the last of them, newly assigned to the case, would

not honor the foster mother's requests for "a break." Instead

of providing respite care, the caseworker removed Louis from the

foster home, wasting two years of hard work by the foster mother

in building a relationship with Louis. Louis has to adjust to a

new foster home, missed long-term foster mother, and the system


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lost an effective foster parent.

A number of caseworkers act inappropriately toward foster

parents. The effect of the inappropriate behavior is to destroy

the self-image of foster parents, and to cause foster parents to

resign.

Bobby J.'s foster mother had noticed recent behavior

changes by Bobby's parents. Over the preceding six months the

parents had increased their visits with Bobby, had called him

almost daily, and were improving their financial circumstances.

Bobby was responding strongly to this increased attention. The

foster mother reported these changes which she called "dramatic"

to the caseworker. In response, the caseworker spoke

disparagingly of the birth parents. The foster mother began to

believe that the social worker had "written off" the natural

parents.

The foster mother asked the caseworker if the foster mother

could report directly to the court. The caseworker responded

that "foster parents have no part in the decision making

process." Absolutely frustrated, the foster mother planned to

resign her license, but sought help from an outside agency that

found a way to communicate the foster mother's beliefs to the

court which, in turn told the Department of Social Services of

the changed circumstances. This case ended well for the natural

mother and child because of the foster mother's perseverance in

spite of the Department.

Foster parents report that they receive a new foster child

in this way: a caseworker calls and says that (s)he is bringing

Johnny over. Johnny arrives with a small bag. He is frightened

and upset. The caseworker handles the introduction and then

takes the foster parent aside for a ten-minute presentation of

Johnny's status. The foster parent asks for medical and

educational records, but they are not available, yet. The

caseworker leaves.

Caseworkers are reluctant to share much information with

the foster parents for fear of frightening the foster parents,

sharing confidential information, or poisoning the foster

parents' conception of the natural parents. These are valid

concerns.

However, the foster parent received none of the information

needed to help Johnny adjust and to spot behavioral clues that

Johnny is having problems of a particular kind.

Many foster parents report that they obtain insufficient


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information. Often, caseworkers are afraid to share information

with foster parents for fear of making inappropriate

disclosures. There is a distinct need to convene a task force

of psychologists, attorneys, caseworkers, natural parents,

foster parents and educators to devise a protocol for the

appropriate sharing of information with foster parents.

PROBLEMS OF THE SYSTEM

The following problems in foster care are systemic. They

involve funding, cultural identity issues, agency organization,

interaction with other bureaucracies, the despair of the medical

profession, and the system's orientation toward emergencies as a

guiding and limiting force.

These problems run deep and wide, and they share a common

denominator: inadequacies in funding. The Jury describes these

systemic problems, even with the knowledge that solutions are

difficult and that budgets are strained to the breaking point.

Foster care funding in conflict with reunification goals.

The Jury has several concerns with the funding of foster

care. First, many of the children in foster care are there

because of poverty. Their natural parents are unable to take

care of them on AFDC. The amount received on AFDC is

considerably less than that received by the foster parents.

Foster parents are not supposed to be making a profit from

foster parenting and so it is assumed that the amount received

by a foster parent is what the state reasonably expects it tocost to have a child in the home. However, is it logical for

the government to pay more for foster care than it pays to

support children in the home of the natural parents?

The Little Hoover Commission found, and Grand Jury

testimony indicates, that it would save money in the long run to

increase the amount paid to foster parents to obtain a higher

quality professional cadre of foster parents. The state pays

approximately $6500 to support a child in a foster family

compared to more than $32,500 to place a child in a group home.

Children who are placed in abusive or inadequate foster homes

are much more likely to need eventual placement in the higher

priced group home.

Inadequate foster care homes.

The dependency system in San Diego County needs to place

approximately 180 children per month.6 Some of these placements

6In May, 1992, Juvenile Court received new petitions on 188 children. Most of these childrenrequired at least temporary placement. There are thousands of children in out-of-homeplacement at all times. Children come into placement at a faster rate than others leave.


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can be made with relatives. Some of the children can be placed,

on a monitored basis, with their own families. The rest must be

placed in foster care. The struggle to find new foster homes is

constant.

In addition to new cases, placements changes further burden

the system. Foster families have emergencies, so respite care

or other foster homes must be found for the foster family'sfoster children. A foster family may no longer be able to cope

with a particularly troubled child, so a new placement must be

found.

For many reasons children from cultures other than the

dominant culture are placed outside their homes at a rate far in

excess of their population.7 "Families in Crisis" made

suggestions to help reduce this problem by establishing cultural

competency as a mandate of the Department. This is currently

happening and hopefully will result in a reduction in the

overall percentages of minorities in foster care.

In other words there are too few foster homes in general,

and there are critically too few foster homes for children from

diverse cultures. The recruitment of foster homes which match

the dependent child's culture of origin has become a high

priority of the Department.

Professionals who gave information to the Grand Jury

believe that there has been an insufficient effort by the

Department of Social Services to recruit foster parents from

diverse cultures. This failing is seen as specially pronouncedin the failure to recruit Hispanic foster homes. At least one

member of the departmental unit assigned to recruit Hispanic

foster homes is a person who is a monolingual English speaker.

The lack of foster homes and arbitrary rules separate siblings.

The Department of Social Services uses a system which

categorizes foster homes to meet specific needs which commonly

recur:

o

ESCU (Emergency Shelter Care Unit) homes take childrenon a short term basis for up to 45 days.

o Short term foster homes take children who will

probably be in placement for more than 45 days, but less than

long term foster care.

7Twenty-three percent of the children placed out of home by the Department of Social Servicesare African-American while only seven percent of all children in San Diego County are ofAfrican-American. Report of the Placement and Evaluation Committee, San Diego CountyCommission on Children and Youth, April, 1992.


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o Long term foster care homes expect to have the foster

child for an extended period of time. (Long term foster care is

an alternative for children who cannot be reunited with their

birth family, and for whom an adoption is not a possibility.

o Medically-fragile homes are homes where the parents

have specialized experience or training that makes them capable

of caring for children with special medical problems.8

Using this category chart it is easy to see that if children in

the same birth family have different needs, they will be placed

in different foster homes, thereby separating the siblings. But

the problem is even more complicated.

Some foster homes (and foster homes' licenses) have

limitations on the number of children they can take. Some

foster homes take only children of one gender. Some foster

homes take only children of certain ages. In many cases these

specifications may be appropriate. However when there isinsufficient flexibility in foster home opportunities, siblings

are separated because of (1) special needs of some children in

the family, (2) age differences between the children, (3) gender

differences, or (4) the number of children in the family needing

placement.

Once siblings are separated, the child has lost the last

vestiges of his or her natural family. The only hope for that

child to remain in contact with this family is through regular

visitation.

The lack of foster homes and the same arbitrary rules are

"terrible for kids and pernicious for infants".

Physicians who provided information to the Grand Jury are

motivated to help these most unfortunate children in spite of

slim financial rewards. They are appalled by the effect that

foster care has on their young patients. Reporting physicians

see the constant shifts from emergency shelter care to short

term care to long term care as destructive to their patients'

mental and physical health.

A pediatrician cited a common experience in her practice.

A child has health problems and is placed in a medically fragile

home. After a period of adjustment caused by the change in

placement, the child begins to respond to the love and care

provided by the foster parent. The child's medical condition

improves. The child begins to bond to the foster parent. The

8Medically fragile homes should not be confused with "F.F.A. Homes." F.F.A. homes are fosterhomes which are selected and supervised by Community Based Organizations which contractwith the County to provide certain types of specialized foster care. F.F.A. homes are not coveredin this report.


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child is cured, or the condition stabilizes. The caseworker

must then move the child to another foster home because this

child no longer needs specialized care and another child does.

The first child must now deal with yet another rejection and the

loss of a loved one.

Physicians see these changes in placement as doubly hard

for infants. Whereas some older children may be able to adjustto constant changes of homes, infants cannot. Nothing in their

experience prepares them for losing their mother and being

shifted from one stranger to another. A physician treating

foster children stated, "these constant placement changes are

terrible for kids and pernicious for infants."

The crisis in visitation.

One of the worst features of the separation of families

into foster homes are the difficulties with visitation. In

calling this particular problem a crisis, the Grand Juryconsidered these facts:

o Most dependent families are very poor and do not have

transportation of their own.

o With some exceptions, travelling throughout San Diego

County by public transportation is problematic, at best.

o Foster families have very difficult schedules, added

to normal family activities are the special needs and time

demands created by caring for the foster children.

o The Department of Social Services has very few case

aides available to assist with transportation.

o The parceling of multiple children to different foster

homes geometrically increases the problems with visitation for

both parents and siblings.

o One of the prime indicators in favor of family

reunification is the frequency of visits. The rule is:

"Families that visit often get reunified; families that don't

visit lose their children."

o Some foster parents try to keep visits from happening.

o Some caseworkers are not helpful in arranging

visitation.

o Foster homes are often not located in the same part of

the County as the parents' home.


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o San Diego County is as large as the states of

Connecticut and Vermont, combined.

The solution to part of this problem is clear and is

presently being addressed by leadership in the Department and by

Task Forces studying this problem; it lies in a change of

priorities by the Department of Social Services in selecting

foster homes. The highest priority in the dependency systemmust be the reunification of families so long as reunification

can be accomplished with safety for the children. Departmental

priorities must reflect this mission. Top priorities one and

two in the selection of foster homes must be:

o Selecting a foster home that will allow the children

in the dependent family to live together; and

o Select a foster home which is located as closely as

possible to the home of the parents of the foster children.

Educational problems resulting from foster-care placement.

While children are in foster care their education often

suffers enormously. Part of this educational setback is caused

by the child's need to adjust to a new school. Given the

frequency of foster home changes in a typical case, it is not

unusual for a dependent child to change schools two or three

times per year.

Schools can be slow to transfer records. Sometimes a child

in foster care is changed to a third school before the recordsfrom the first school arrive at the second school.

This problem is magnified for the children who need special

educational services. A child who is in Special Education in

his original school may not be identified as having special

needs for some time after placement in a second school. While

the child's Individualized Education Plan (I.E.P.) should travel

with the child, professional testimony indicates this is not the

norm. Experts in the area of Special Education testified that

special needs children are far more likely to have multiple

changes in placement. "Families in Crisis" made specific

recommendations in this area. It is an unfortunate fact that

many dependent children need special educational services

because of conditions attending the child's birth, because of

injuries resulting from abuse, and because of the twin emotional

traumas caused by the conditions of dependency and the constant

changing of homes and schools.

If an I.E.P. testing is arranged at one school and the

child is moved before the procedure is completed, the child must

start the process again at the new school. Even if testing is

completed and an individualized plan is adopted, a change in


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schools will mean that the provision of special education

services called for by the plan is delayed. According to

information received from an advocate for special educational

services, these services are difficult to obtain if the student

remains in the same school system at all times. If a student

moves frequently between school systems, these services are

almost impossible to provide.

The Grand Jury suggests that the Juvenile Justice

Commission address the problems of transfer of records and the

provision of special educational services where dependent

children are involved.

Health care threats.

As in all of our society, the reliable and affordable

provision of medical services to dependent children is becoming

more problematic. Fewer medical service providers accept

payment at the level which the Department of Social Servicessubsidizes. Most physicians and psychologists no longer accept

cases which pay at the Medi-Cal rate.9 For example, only one

medical clinic in the North County area takes Medi-Cal patients.

This economic dilemma forces foster parents to fight to

have their foster children seen at clinics. Once the foster

parent is able to have the foster child seen by a physician, the

assessment process is slowed by the lack of medical records.

Some foster children new to the system do not have medical

records because their natural family either did not obtain

treatment, or the records were lost. Some foster children whohave been in the system do not have medical records because

those records did not transfer when the child changed from one

foster home to another.

The Medical Passport is an attempt to rectify this problem

and, properly implemented, would help. However, as reported in

"Families in Crisis", the Passport to be effective must be kept

up to date with accurate information.

The Department of Social Services reports that it is

constantly improving this transfer of documents. Physicianscontinue to report that, whatever the reason, they do not

receive medical records for many/most foster children.

This dual situation of a declining number of medical

providers and missing medical records is one of the most

troubling parts of the dependency system and should be monitored

on an ongoing basis by the Juvenile Justice Commission.

9Medi-Cal pays the physician $12.00 for a complete assessment. At that rate, even a charitablephysician in a non-clinic setting can afford to do no more than one assessment per week in theopinion of the physicians who informed the Grand Jury.


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Inadequate preparation for transition between homes.

Child development experts informed the Grand Jury that one

of the most destructive aspects of the foster care system is the

failure of caseworkers adequately to prepare the foster child

who is about to be moved to a new foster home. Incremental

damage is done by any change in homes, but the failure toprepare the child compounds the damage.

Caseworkers respond that they do not have time enough to

prepare children. They cite high caseloads and the emergency

nature of many changes of placement.

The Grand Jury believes that the "emergency excuse" has

permeated the Department of Social Services and that caseworkers

are not expected to make adequate provision for change of

placement.

The Grand Jury calls for the formation of a task force made

up of child psychologists, child advocates, caseworkers and

their supervisors who will establish minimum standards for the

child's preparation for change of placement in every instance.

Failure to close bad foster homes.

One feature of the foster care system was cited by all of

the physicians, psychologists, attorneys and investigators who

supplied information to the Grand Jury: the Department of

Social Services mechanism to close sub-standard foster homes isinadequate.

Physicians, especially, cited examples of foster parents

who failed to feed foster children, who made the children wear

shabby and dirty clothing, and who constantly missed medical

appointments. The foster children were pulled from the home,

but new children would be sent with the same result. These

physicians stated that they had difficulty finding a person

willing to take their complaints and that these homes continued

to house foster children.

Attorneys and investigators also reported difficulty in

having the Department deal systematically and quickly with

complaints about foster homes.

CONCLUSIONS

Foster care will always be an essential part of the

juvenile dependency system. Most foster-care parents fulfill

their roles with selfless commitment to children as their

primary motivation. Some foster parents are motivated by


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financial gain; others are using foster parenting as a path to

obtaining a child for adoption.

Family preservation is the goal of the juvenile dependency

system. In some cases children will never be able to reunify

with their natural families. However, placement of the child

during dependency intervention must not become a part of the

problem in reunification.

General societal problems have impacted the provision of

educational and medical services to all poor children. Children

in foster care are further impacted by frequent changes in

placement.

A disproportionate number of minority children are in

foster-care placement. There has been an inadequate

identification of minority foster-care providers. Relative-

placement reimbursement is less than is provided to unrelated

foster-care providers. This impacts the ability of somerelatives to provide foster care. In San Diego County this

situation is receiving priority attention.

RECOMMENDATIONS

The Grand Jury recommends that the Department of Social

Services:

#92/133: Insure that foster care is not used as a path to

adoption.

#92/134: Explore use of an assessment predictor to screen

prospective foster parents which will identify those who are

seeking to adopt infantS or toddlerS. Develop a psychological

screening procedure for prospective foster parents.

#92/135: Explore legislation to professionalize foster parents

with higher pay and better training.

#92/136: Develop a system to report differential treatment of

foster children in relation to families' biological or adopted

children.

#92/137: Monitor requests for special care payments and for

behavior controlling drugs on a foster home by foster home

basis. Supervisory monitoring of these requests should be

tightened and requests approved only when there is medical

evidence establishing the condition.

#92/138: Enhance training of foster parents with more time

given to teaching the rights and difficulties of natural parents

and the facilitation of reunification.


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#92/139: Recruit assistance from the San Diego County

Commission on Children and Youth Child Development Competency

Task Force to assist in the creation of a training program in

the recognition of developmental problems and in the advocacy of

diagnosis and treatment. Request that this Committee provide a

protocol for the minimum standards required to prepare children

to deal with changes in placement.

#92/140: Provide necessary training to all caseworker staff on

the importance of implementing and reinforcing adherence to

existing protocol for the sharing of appropriate case-specific

information with foster parents.

#92/141: Convene a task force or identify a suitable existing

body of foster parents, community leaders, caseworkers,

reunified parents, and representatives of all of San Diego's

many cultures to develop strategies to attract foster homes

within the diverse community in numbers proportional to the

children from each culture who are in out-of-home placement.

#92/142: Adjust priorities in the selection of foster homes.

These priorities should include selection of homes which allow

siblings to remain together, selection of homes within close

physical proximity to the homes of the parents of disabled

children, and selection of ethnically, culturally, and

linguistically consistent foster home.

#92/143: Request that the San Diego Commission on Children and

Youth establish a task force made up of representatives of the

school systems, foster parents, special education advocates,specialized psychologists, and departmental representatives to

forge a protocol on the transfer of the educational records of

dependent children and on testing for and provision of special

educational services for dependent children.

#92/144: Provide a second "hotline" to be available to service

providers, attorneys and investigators specifically for

complaints about foster homes. Those complaints should be

passed immediately to the internal collection and investigation

system which should be set up in response to Recommendation #137.

SI-HSS2

Documents

1991-92 San Diego County Grand Jury - Report 7, The Crisis in Foster Care