Category Archives: General

Days of Congressional Action Before November Dwindles

With Congress returning after the July 4th holiday break, the number of days left to legislate is dwindling to less than 30 actual days. The House is scheduled to be in session for 28 more days before the November election while the Senate (being less specific) is likely to be in for a similar number of days. Both houses will return on Monday and Tuesday and both will break for the August summer recess by at least August 1, and return the week after Labor Day on September 8.

The House is likely to take up the “PREVENT SEX TRAFFICKING AND STRENGTHENING FAMILIES ACT” a bipartisan/bicameral bill that would reauthorize the Adoption Incentive fund, (and extend it to subsidized guardianships), allow for current year funding of Family Connections Grants (they expired last October 1), directs state child welfare agencies to implement screening and other actions on victims of sex trafficking, and requires several additional reviews and actions in regard to youth in foster care 14 and older. Assuming that legislation is not delayed by interests wanting to add additional provisions and requirements and is adopted this week, the outlook for action on a number of human service needs and programs is limited.

The Senate has been unable to move any of the twelve appropriations bills while the House has passed four: Commerce-Justice-State, Legislative Branch, Military Construction, Transportation-HUD. Senator Barbara Mikulski (D-MD) Chair of the Senate Appropriations committee summed up her frustration recently when she was quoted as saying, “What I’m turning over is that right here in this body is that underneath every rock is another rock and then we take those rocks and throw them at each other.” The lack of progress means there will have to be another continuing resolution for October 1, for at least parts of the government and most certainly for the Department of Health and Human Services, in addition the list of hoped-for reauthorizations include the annual stand-bys of; the Elementary and Secondary Education Act (ESEA), the Transportation Act (highway fund) joined by the hoped-for: the Higher Education Act, the Child Care and Development Block Grant (CCDBG), the Runaway and Homeless Youth Act, Juvenile Justice and Delinquency Prevention Act (JJDPA), Temporary Assistance for Needy Families (TANF), and several others. In some cases (TANF, Transportation) Congress will have to provide some temporary extension on October 1, for the others an omnibus appropriations bill will fund the programs under an expired law.

House-Senate Committees OK Adoption-Family Connection-Youth Bill

On Thursday, June 26, the House Ways and Means Committee and the Senate Finance Committee announced an agreement on legislation to reauthorize the adoption incentives fund, the Family Connections grants, and to provide changes in state requirements regarding youth in foster care. This includes new requirements to screen child victims of sex trafficking. The legislation, “the Preventing Sex Trafficking and Strengthening Families Act” is actually a combination of a few Senate and House bills dealing with the reauthorization of the Adoption Incentive Fund and bills dealing with youth in care and needed changes to child support. The plan is that the House of Representatives will take the legislation up when the Congress returns next week with the Senate to follow shortly.

Perhaps the most immediate impact of the bill is that it will extend the Family Connections grants for one year. The grants provide support for up to three years to develop and expand kinship navigator programs, to assist in Family Group Decision Making (FGDM), family finding programs, and to provide drug treatment to child welfare families. While advocates had hoped for a three-year extension the committees only agreed to one year of funding at this point. It is significant because some of the grantees would’ve lost current year funding if this bill had not been agreed to (assuming it is enacted). A number of organizations, including the Child Welfare League of America, were working to get a continuation.

The parts of the legislation that extend the adoption incentive fund, extend it for three years. The incentive fund, first enacted as part of the Adoption and Safe Families Act (ASFA), provides incentive funds to each state if they increase the number of their adoptions from foster care. The new language adjusts the incentives in several significant ways, for the first time a kinship incentive bonus is provided for states that place children into subsidized guardianships. Additionally it adjust the targeting to include an additional adolescent age of children from ages 9 to 14, a group that has been more of a challenge. Finally it phases in a rate-based bonus instead of the current strategy which is has been based on the number of increased adoptions. Under the new provision states that have a smaller pool because they have reduced the number of foster children could be awarded more funding because they are increasing their rate of adoptions.

In regard to trafficking, which continues to get extensive Washington DC attention, the child welfare agencies are now directed to come up with a strategy that works across a number of different state agencies to identify and document children who have been victims of sex trafficking. In addition there are new requirements as far as reporting children when they go missing from foster care. Currently some states may not have a specific policy with some children not reported when they go missing or run from foster care. The law also mandates studies by HHS and the creation of a new commission in regard to sex trafficking that could include up to 21 members.

A second piece in the bill requires a new standard for foster care and foster parents called the prudent parent standard. This is an attempt to strengthen definitions and training for foster parents so they can make more flexible decisions in regard to activities for foster youth. Over the past two years Congress has heard testimony about some of the difficulties that youth in foster care may face in terms of normal activities such as high school sports, dating or other extracurricular activities. The new language is an attempt to address that issue. There are also new restrictions on the use of another planned permanency living arrangement what is sometimes referred to by advocates as “APPLA”. This is an attempt to prevent child welfare agencies from classifying children in care in a status that may mean no effort is being made to place them into a family or other permanent setting. There will be new court review requirements on states regarding youth and more active engagement of youth in care. Children age 14 and older are to be more fully involved in the development of their own plan and their own transition. To this point such participation has started at the age of 16.

The bill mandates states to provide youth leaving foster care with a number of important information pieces such as Social Security cards, birth certificates, identification cards as well as health records.

The legislation amends federal child support requirements to align with international child-support practices.

Finally and perhaps most significant the language once again attempts to tighten the requirements for states to reinvest any savings they realize as a result of the adoption assistance program expansion that was the result of the 2008 enactment of the Fostering Connections to Success Act. States are realizing a savings as the federal government expands its coverage for special-needs adoptions. The original bill directed states to take any savings and reinvest those funds into child welfare services but to this point HHS has been reluctant to implement the provisions. The new language is much more specific to both HHS and states directing HHS to come up with a formula to calculate the savings from the expanded adoption assistance and reinvest funds with a specific allocation for post adoption, post kinship and reunification services. If the actual savings come to fruition it could represent several hundred million dollars a year in additional state child welfare spending.

Commission on Child Fatalities Holds First Of Series of State Hearings Monday

The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) will hold the first of a series of local hearings starting today. The hearings will allow the Commission to examine the range of issues that have been raised so far. The first meeting is in San Antonio, TX followed by a hearing on July 10, in Tampa, FL and a third hearing on August 28 in Detroit, MI. Additional hearings may be held in the fall of this year. The meeting details for the San Antonio meeting is , Monday, June 2, 2014, from 1:00–5:30 p.m. CDT, and Tuesday, June 3, 2014, from 8:30 a.m.–1:00 p.m. CDT, held at the University of Texas at San Antonio, Downtown Campus, 501 W. César E. Chávez Blvd., Southwest Room, Durango Building 1.124, San Antonio, TX 78207. Although late, it may still be possible to register to phone in at https://www.surveymonkey.com/s/5WLJYWH. A call-in number is available upon registration. The first day will be dedicated to actions and policies in the state of Texas and will include policy and practice presentations from various Texas-based presenters including comments by commission-sponsor, Congressman Lloyd Doggett (D-TX). Tuesday will focus more attention on national policy and perspectives.

The state of Texas has had the highest number of child deaths in each of the past five years with 215 child fatalities in 2012 according to the 2012 Child Maltreatment report. According to rates, the fatalities rate at 3.08 per 100,000 children ranks the state lower than New Mexico, Colorado, Idaho, Louisiana, Florida and Arkansas with the last two states at approximately four and a half child deaths per 100,000.

The Commission is expected to have a website up and running by this week which should include tools to submit comments. You can also send comments via the mail to: Commission to Eliminate Child Abuse and Neglect Fatalities, c/o General Services Administration, Agency Liaison Division, 1800 F St., NW, Room 7003D, Washington DC 20006.

According to the enabling legislation, the commission’s work includes an examination of best practices in preventing child and youth fatalities that are caused due to negligence, neglect, or a failure to exercise proper care; the effectiveness of federal, state, and local policies and systems aimed at collecting accurate and uniform data on child fatalities; the current barriers to preventing fatalities from child abuse and neglect, how to improve child welfare outcomes; trends in demographic and other risk factors that are predictive of or correlated with child maltreatment, such as age of the child, child behavior, family structure, parental stress, and poverty; methods of prioritizing child abuse and neglect; and methods of improving data collection and utilization, such as increasing interoperability among state and local and other data systems.

House Hearing On Psychotropic Medication In Foster Care

On Thursday, May 29, the House Subcommittee on Human Resources of the Ways and Means Committee focused additional attention on the issue of the over-use of psychotropic medication for children in foster care. The hearing coincided with the annual “Shadow Day” a House event that arranges to have youth in or formerly in foster care to follow their member of Congress for the day. The issue of over-medication has attracted increasing attention over the past several years with a series of GAO reports, congressional hearings and a new Obama Administration proposal that would target the over medication issue through a coordinated incentive fund with Medicaid and the Children’s Bureau.

Witnesses before the panel included: Joo Yeun Chang, Associate Commissioner of the Children’s Bureau, Dawna Zender Hovenier, The Mockingbird Society, Phil McGraw, Talk Show Host, Dr. Phil, Michael Naylor, Associate Professor of Psychiatry, University of Illinois at Chicago, and Stephen Lord, Director, Forensic Audits and Investigative Services, Government Accountability Office. The star power of Dr Phil helped to draw a big hearing crowd including several of the foster youth as well as several members of the Subcommittee. The consensus was that there is an over-reliance on the use of medication and an agreement that much of it occurs due to a lack of proper health care screening for children and youth in foster care and then a lack of access to proper therapies for patients. As a result, the over-use of medication becomes a fall-back positions in many instances.
Commissioner Chang, highlighted the need for the Administration’s proposal based on current practice which fails to provide the needed therapies and screening for children in foster care. She said, “The existing strong evidence-base in the area of trauma-informed psychosocial interventions warrants a large initial investment to expand access to effective interventions. The ACF proposal for $250 million over five years would fund infrastructure and capacity building, while the CMS investment of $500 million over five years would provide incentive payments to states that demonstrate measured improvement.”

Ms Hovenier discussed her experiences in foster care and what led to her medical treatment and the overuse of psychotropic medications. She testified that she “was ordered into the psychiatric hospital after my social worker told the court I had Borderline Personality Disorder, Major Depressive Disorder and suicidal ideation. I was forced to take strong doses of psychiatric medications and told I could probably never live on my own. Only my CASA and the man who became my father agreed with me that I didn’t need the drugs. The seven months I was locked up and forced to take drugs against my will felt like being in jail.” Ms Hovenier also suggested that youth in care have a right to request a second medical opinion regarding their care.

Dr Phil repeated some of his remarks delivered earlier that afternoon before a luncheon of foster youth and members of Congress when he said, “Prescription psychotropic drugs can change and even save lives, but when it comes to these vulnerable children, these drugs are too often misused as ‘chemical straight jackets.’ This is a haphazard attempt to simply control and suppress undesirable behavior, rather than treat, nurture and develop these treasured young people.” He said it would be wrong to pour more money into the same system but that investment into a system that would provide better health care would be worthwhile and that we had to make a greater effort at supporting these children including making a better effort at reunification.

Michael Naylor, discussed some of the recent efforts and successes of the state of Illinois to monitor and reduce the overuse of medication for the foster care population in the state. Dr Naylor said, “The Illinois model of providing consent for psychotropic medications for foster children and monitoring the use of these medications is widely regarded as a pioneer and leader in this arena and has received considerable attention…a well-designed and implemented medication consent and oversight program that provides effective longitudinal oversight of a youth’s care and monitoring of prescribing patterns can improve the continuity and quality and increase the cost-effectiveness of care provided to foster children.” The GAO witness reiterated some of the findings of last week’s GAO report.

Dr Phil also indicated that he had signed onto a letter signed by more than 100 organizations in support of the Administration’s budget request for the joint ACF-Medicaid proposal.