Category Archives: Older Youth

Child Welfare’s Million Dollar Problem

There is essentially an unwritten rule for child welfare programs in Washington, D.C.: expanded funding must be “paid for” through cuts to other areas of the budget—usually child welfare itself.  This has been true even in times of budget surplus. On Tuesday, April 29 this requirement was on full display. The House Committee on Ways and Means came together to adopt seven different bills. All but one addressed the tax code by extending certain business-related tax deductions. The first bill to come to a vote, the Preventing Sex Trafficking and Improving Opportunities for Youth in Foster Care Act (H.R. 4058),  was the only bill that did not address the tax code. The other difference between H.R. 4058 and the six others: at least some of its costs had to be offset.

The six tax bills cost approximately $310 billion over ten years.  They are a series of complex bills with one supporting business research spending and the others dealing with businesses accounting for income such as interest and royalties.  Some of these business breaks have drawn the ire of critics who see them not as job-creators but as tax shelters for corporations with flexibility in where they report their income. The Committee approved the six tax bills without any requirement that they be paid for. Furthermore, the Committee did not demand that these tax deductions offer any evidence-base of proven job creation.  Rigorous evaluation of the kind constantly called for in human service and found in the federal home visiting, teen-pregnancy prevention, and similar programs was not required, and still the tax bills costing hundreds of billions of dollars were approved by the Committee without an offset.

However, the child welfare bill was modified predominantly because one section was projected to cost approximately $1 million per year. H.R. 4058 proposes several changes and requirements on state child welfare agencies in dealing with youth, particularly those who are victims or potential victims of sex trafficking. The removed section would have mandated that state child welfare agencies provide young people exiting foster care with a Social Security card, birth certificate, health information and in some cases, a bank account: essential documents, particularly for a young person without a family. This provision was a modification of more expansive Senate legislation that includes requirements for all youth in foster care to receive bank accounts and driver’s licenses.  With input from more than 150 public and advocacy comments, the Ways and Means Subcommittee on Human Resources had crafted H.R. 4058 with the narrowed requirements to account for concerns surrounding bank account fees and co-signing requirements and special challenges for requiring driver’s licenses in urban areas where cars may not be accessible, available or necessary via a foster parent. The narrowed provision, though essential for young people aging out of foster care, was pulled from the bill.

As a result, division arose during the course of the Committee debate despite the fact the legislation is a bipartisan bill.  Democrats, led by the Subcommittee Ranking Member  Lloyd Doggett (D-TX), questioned the provision’s removal and argued that it was simply because of the $1 million per year score calculation by the Congressional Budget Office. There was a back-and-forth between the two parties as to whether that was the complete reason why the section was removed and whether the minority party had been fully informed. It was acknowledged that the minority party was asked to propose an offset and Doggett did offer a committee amendment but withdrew it before the vote. At the end of the discussion there was some agreement through Committee Chairman David Camp (R-MI) that there would be an effort to put a similar provision back in the bill.  However, he did not commit to a straight restoration and the bill passed the Committee without the provision.

Tuesday’s Committee hearing clearly frames the constant challenge for child welfare. The $310 billion for the six tax bills is smaller than the so-called “tax extenders package” Congress may act on this year, yet it still dwarfs what will be spent in almost all of child welfare spending over the next ten years.  Under the current structure, child welfare spending (including Titles IV-B and IV-E of the Social Security Act) is likely to be less than $80 billion over the next ten years. Regardless of budget circumstance, child welfare faces a requirement that costs be offset while other budget areas, even in the same Congressional Committee, do not.

Is Foster Care Really the Supply Chain for Domestic Sex Trafficking?

On Tuesday, April 8, the Center for American Progress sponsored a forum: “Combating Sex Trafficking of Minors in the U.S.” The panel included Senator Amy Klobuchar, (D-MN); Malika Saada Saar, Executive Director, Human Rights Project for Girls; and John Temple, Attorney-in-Charge, New York County District Attorney’s Office Human Trafficking Program.

Much of the discussion was by Senator Amy Klobuchar (D-MN) regarding legislation she is sponsoring, S.1733, “The Stop Exploitation Through Trafficking Act.” The legislation would encourage changes by law enforcement in the way they address domestic sex trafficking and sexual exploitation, specifically as it impacts minors. Key provisions of the legislation require states to treat minors who engage in a commercial sex act as a victim. It discourages the prosecution of victims for the crime of prostitution by creating “safe harbor” laws that would apply to minors. In addition it encourages the diversion of victims to child protection services and directs the U.S. Justice Department to develop a national strategy.

The discussion after the Senator’s remarks returned to a familiar theme heard many times in Washington, D.C. in the past two years. That discussion focused on the child welfare system with foster care receiving the primary blame for domestic sexual exploitation (a large part of trafficking involves international victims). At one point panelist Malika Sada Saar indicated that 80 to 90 percent of the children who are victims of sexual trafficking come from foster care and that “foster care is the supply chain for sexual trafficking victims.” Claims similar to this have been retold countless times in numerous briefings and discussions in Washington, D.C. The narrative portrays a child welfare system that takes children into care and turns them into victims of sexual trafficking. But is this really an actuate portrayal?


So, what do we know?

First, the statistics often cited in support of the child welfare-only explanation:

  • Of 88 child victims of sex trafficking in the state of Connecticut, 86 were “child welfare involved.”
  • In 2012, 56 of 72 commercially sexually exploited girls in an Los Angeles-based court program were “child-welfare involved.” Fifty-eight percent of these 72 kids were in foster care.
  • In 2007, New York City identified 2,250 child victims of trafficking. Seventy-five percent of those experienced “some contact with the child welfare system,” mostly in the context of abuse and neglect proceedings.
  • In Alameda County, CA, 41 percent of 267 victims in 2011-2012 were kids in foster care.

But there is additional information and research that paints a broader picture of this complex problem—a problem that started to get more national attention only as recently as 2000 with the passage of the Trafficking Victims Protection Act (TVPA, P.L. 106-386). The emphasis of the child welfare-only explanation ignores the population of homeless and runaway youth who are not necessarily the same children in foster care—currently the foster care population is just under 400,000 children with 254,000 entering foster care and 241,000 exiting care in 2012. According to HHS data,

  • Every day, approximately 1.3 million runaway, throwaway, and homeless youth live on the streets of America.
  • Children, both boys and girls, are solicited for sex, on average, within 72 hours of being on the street.
  • Approximately 55 percent of street girls engage in formal prostitution; 75 percent of those work for a pimp. About one in five of these children becomes entangled in nationally organized crime networks and is forced to travel far from home and isolated from friends and family.
  • A girl will first become a victim of prostitution between the ages of 12 and 14, on average.

The child welfare-only explanation also ignores other factors that influence victimization, especially children who have been victims of sexual abuse. A 1994 National Institute of Justice report states that, “minors who were sexually abused were 28 times more likely to be arrested for prostitution at some point in their lives than minors who were not sexually abused.” It is often assumed that all children who are victims of sexual abuse are part of the child welfare system, but they are not. Typically less than ten percent of the approximate 700,000 children substantiated for child maltreatment annually are substantiated for reasons of sexual abuse (as opposed to physical abuse or neglect).

The Urban Institute recently released a U.S. Justice Department funded report, “Estimating the Size and Structure of the Underground Commercial Sex Economy in Eight Major US Cities.” The report looked at both the perpetrators (pimps) and the victims.

  • Seventy-eight percent of victims were woman, nearly 20 percent were transgender, and nearly 3 percent were male.
  • In some instances a person may have begun their lives in sexual exploitation as young as 11 and as old as 39. Seventy-eight percent started between the ages of 15 through 27 and 11 percent began before the age of 15.
  • The report indicates that, “Sex workers first started trading sex on the street for a wide variety of reasons, including economic need; homelessness; the encouragement of family members, friends, and acquaintances; a desire for social and emotional acceptance; as a natural continuation of other forms of commercial sex work, such as stripping and dancing and to support substance use. For many, a combination of these reasons served as the impetus to begin trading sex.”

A 2009 U.S. Department of Health and Human Services (HHS) funded literature review, “Human Trafficking into and within the United States: A Review of the Literature,” found the key factors that influence victimization include, age, poverty, sexual abuse, family substance/physical abuse, individual substance abuse, learning disabilities, loss of parent/caregiver, runaway/throwaway, and sexual identity issues. The National Institute of Justice also points to the role of substance abuse, “Multiple studies suggest that girls involved in prostitution are more likely to come from homes where addiction was present. For example, one study of 222 women in Chicago involved in prostitution found 83 percent had grown up in a home where one or both parents were involved in substance abuse. Further, prostituted girls are more likely to have witnessed domestic violence in their home; specifically, girls are likely to have seen their mother beaten by an intimate partner.” Substantive studies also highlight methods of recruitment that include solicitation by boyfriends, friends, and  family members across a range of locations that include the street, juvenile justice facilities, shopping malls, schools, shelters, group homes, and the internet.

One point does seem to be clear from the recent Washington debate, there are few treatment options for victims and there are on-going debates on what that treatment should be, including residential, lock-down, and home-based. During last week’s panel discussion, John Temple from New York City discussed that city’s efforts to address trafficking of girls and boys. He indicated that within New York City, a city of 8.3 million people, there are only “about 20 to 25 beds that were available for treatment” for children victimized by sexual traffickers. There are differences in the number of beds available, but a national survey last year by an Illinois-based group funded by the U.S. Justice Department found 33 residential programs totaling 682 beds. The treatment needed is complex and has to address factors such as trauma bond, underlying issues like substance abuse, trauma from previous sexual abuse and other trauma such as exposure to violence. Ironically the call for more treatment via child welfare comes up against a backdrop of current child welfare reform debates and discussions that are increasing calling for caps, restrictions and limitations on the use of residential care.

The HHS review of literature determined that when it comes to treatment key needs include,

  • Emergency Services:  safety, housing, and food/clothing and
  • Short-term and Long-term Services: legal assistance, intensive case management, medical care, alcohol and substance abuse counseling/treatment, mental health counseling, life skills training, education, job training/employment, and family reunification.

The problem with the current debate.

The problem regarding much of the recent debate that focuses solely on child welfare is that it ignores all of the other sources of sexual exploitation. It suggests a solution can be carried out by simply amending child welfare law and that child welfare can address the problem without any additional funding.

Recent proposals ignore the need to address the front end whereby child maltreatment, including sexual abuse, may plant the seeds for future victimization. These proposals also discount the need to address all youth in care so that none transition to the streets. Proposals that would simply mandate new directives without the resources create a “zero-sum game.” The same child welfare agencies will have to use the same dollars to expand care (and under some proposals expand child welfare services up to age 25). Advocates within the child welfare community know we are not doing enough to serve infants and toddlers, that far too many youth (over 24,000 in 2012) leave foster care not because we found them a family but because they grew too old to stay in care, and that we have over 100,000 children and youth officially listed as waiting to be adopted.

In regard to sexual trafficking the Administration has started to recognize the need for greater effort regarding the domestic side of sexual and human trafficking but from a more comprehensive approach. The proposed FY 2015 budget includes an increase of $8 million to $10 million to expand services for domestic victims of human trafficking. The January FY 2014 appropriations created a small $2 million initiative that will provide competitive grants to pilot projects by state, local, and tribal governments, or non-profit organizations that can work with trafficking victims or work with at-risk populations including runaway or homeless youth or those who have experienced intimate partner violence, sexual abuse, or other forms of maltreatment. The proposed focus will include intensive case management services to facilitate follow-up care, such as access to mental and behavioral health services, and information and referral to public benefits and other services. Grantees will be expected to coordinate services between entities that encounter trafficking victims including police, hospitals, culturally specific community based organizations, sexual violence organizations, community mental health agencies, and immigrant service providers. Demonstrations will target areas with high rates of domestic trafficking.

The Urban Institute study discussed strategies: “Cities and counties should address sex trafficking as a complex problem that requires a system wide response, and schools, law enforcement, and social service agencies must work collaboratively to combat sex trafficking in their communities. Prevention campaigns must ensure that both boys and girls are educated about the role of force, fraud, coercion, and exploitation in sex trafficking. Public schools should implement awareness campaigns. Local law enforcement should present in schools and share stories related to real cases, as well as encourage student outreach and reporting to law enforcement officials. Increasing the awareness of school officials will also help them identify at-risk or involved youth. Cross-training of local school officials and teachers and awareness raising within the schools will encourage the active involvement of school authorities in detecting possible cases of sex trafficking.”

What is needed in dealing with sexual exploitation is a comprehensive strategy whereby child welfare plays a role. What is needed in child welfare are improvements and resources that make sure all victims of abuse are treated, all children find permanent families, and no young person ages out without a family and a future. Child welfare has to be a part of any comprehensive solution to domestic sex trafficking, but the suggestion that it is the solution (and the blame) is at best off the mark. At worse, it is potentially harmful to children and youth who are in care as the last best hope when other systems—public, private and familial—have failed.

Senate Finance Committee Adopts Bill on Adoption Incentives, Trafficking

On Thursday, December 12, the Senate Finance Committee passed the “Supporting At-Risk Children Act of 2013.” The legislation bundled together a reauthorization of the adoption incentives fund, new legislative language to address domestic sex trafficking through child welfare, and provisions that deal with child support collection including provisions to address international treaties.

The adoption incentives fund requirements differ from a bipartisan House bill (HR 3205) in how it allocates funds for the placement of children from foster care into adoptive families. Both bills now provide an award for kinship care placements although the Senate provides a higher award than the House bill. In addition the Senate creates a broader definition of kinship care placements. The House bill also creates an additional category of children 14 and older. Both bills require greater accountability of state savings that is being realized by states as federal adoption assistance is expanded each year due to the Fostering Connections to Success Act (PL 110-351) of 2008. The Senate directs states to spend the savings on more specific categories of services. Both bills extend the Family Connections Grants which currently funds kinship navigator programs, residential drug treatment, family finding services and family group decision making services although the Senate removes the requirement that at least $5 million of the $15 million in annual funds go toward the navigator programs. Both bills extend the law by three years.

In regard to the issue of sex trafficking of children from the child welfare system, the bill creates a number of new requirements on state screening, data reporting and services to youth although these requirements are not accompanied by any additional funding. Policies and procedures would have to be in place to screen, identify and determine services for victims of trafficking for youth up to age of 21 (or at state option to age 26). It defines sex trafficking consistent with federal law that deals with international victims.

The bill also addresses young people in foster care who are in what is generally viewed as long term foster care. These are young people who may be classified as under “another planned permanent living arrangement” (APPLA). Under the legislation no youth 16 or under could be considered “APPLA” and similar to the bill (S. 1518) introduced earlier this year by Senator Orin Hatch, new requirements would be placed on the courts and states for increased hearings. States would have to give the courts greater accounting of what the agency has done to place young people into adoptive, kinship or birth families.

Also similar to the Hatch bill it would create a definition in law for a “prudent parent” standard. Each child would have to have someone in a foster home or residential facility that could meet these standards. Each child in foster care or a facility would have to have such a person (which could include a foster parent) to make decisions regarding various activities a child in foster care could participate in. This is an attempt to assure that foster children are not denied access to activities and items such as driver’s licenses, attending high school dances, and other activities sometimes restricted due to being in a foster care placement. The bill would also require that a child 14 and older be directly involved in their case planning (currently required of youth 16 and older). The legislation also requires a bill of rights provided to youth 14 or older who are in foster care, kinship care or adopted and would specify in law that anyone 14 or older who exits foster care have a birth certificate, Social Security card, drivers’ license, and a bank account (unless the child decides not to have a bank account). Failure to do this will require a reduction in a state’s reimbursement under Title IV-E.

The legislation requires that when a child runs from foster care they be reported within 24 hours to the National Crime Information Center and to the National Center for Missing and Exploited Children. States would also have to report through AFCARS the number of children in foster care who have been identified as victims of sex trafficking. The bill creates numerous requirements on HHS and creates an advisory committee on trafficking.

The legislation also makes a number of changes to the child support system not necessarily related to the child welfare system. There is one requirement for states to pass along child support collected from absent parents to youths in foster care.

The House legislation that deals with the reauthorization of the adoption incentive fund passed the House on October 28. Current law rewards states for an increase in the overall adoptions ($4000 per child), special needs adoptions ($4000) and older child adoptions—considered a child age 9 or older ($8000). In the last reauthorization a $1000 incentive was included for states that experienced an increase in their adoption rate. This part of the award was only provided to states if the funding did not run out after the other categories were provided.

The House bill would:

-Extend the authorization of the program through FY 2016 (aligning its next reauthorization with that of the Title IV-B programs)—Same as the Senate

-Add a $1000 award for placements with legal guardians (mirroring certain requirements under Title IV-E)—Different from the Senate

-Phase in awards based on improvements in the rate of adoptions and guardianships instead actual increases in numbers—Different from the Senate

-Provide a $2000 award for overall adoptions, $4000 for children aged nine through 13, $8000 for a new category of youth aged 14 and older—Different from the Senate which does not include 14-year olds as a separate category

-It requires states to calculate savings resulting from the gradual delinking and increased federal support for adoption assistance. HHS is to create the formula or work with states to develop a calculation and states have to document how they are reinvesting these funds beyond what they currently spend under Title IV-B and Title IV-E programs­-Some similarity to the Senate although the Senate requires various reinvestment requirements of the savings

-Extends the Family Connects Grants at their annual $15 million a year—Similar to the Senate although the Senate no longer requires at least $5 million a year for Kinship Navigator programs.

-Enacts a fix to current guardianship law that will allow a child to receive continued support when there is successor guardian due to death or incapacity –Same as Senate

The next steps will be for the Senate to adopt this measure (likely by voice vote/unanimous consent) then there will be a negotiation with the House Ways and Means Committee members and staff to work out differences. That is likely sometime in January.

John Sciamanna

CMS Issues Final Rule on the ACA and Foster Care

On July 5th, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing provisions of the Affordable Care Act (ACA) including Medicaid and Children’s Health Insurance Program (CHIP) eligibility, benefits, and enrollment rules. While the final rule does not cover all of the topics in the proposed rule issued in February, it does focus on the changes that are most needed to implement the changes made by ACA starting in 2014. Additionally, it addresses key provisions deemed critical to former foster youth and children and youth currently in care.

The final rule clarifies that former foster children are already a population that is eligible to be determined presumptively eligible (the rule does not extend to current foster youth as they are already Medicaid eligible and don’t need to be determined presumptively eligible). The rule also clarifies that individuals under age 21 will continue to receive Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) services either through the Alternative Benefit Plan (ABP) or as additional coverage that supplements the ABP. The final rule makes clear that CMS does not have statutory authority to require states to provide EPSDT services beyond age 21, but acknowledges that states have the flexibility to design and offer voluntary enrollment in an ABP targeted to former foster care children that provides a more comprehensive array of health coverage than is provided through the regular state plan.

Despite recommendations that former foster youth be exempt from premiums and cost sharing, the final rule explains that while there are populations upon which states may not wish to impose cost sharing, there was no clear basis to support a federally-mandated exemption. The rule does state that agencies may not impose premiums or cost sharing on children receiving child welfare services under title IV-B as well as children in foster care and individuals receiving benefits under title IV-E, regardless of age.

One key issue not addressed in this rule that remains of concern to child welfare advocates has to do with state of residency of former foster youth. The ACA requires that in order for an individual to be eligible under this category, the individual would have to have been in foster care under the responsibility of “the state” and be enrolled in Medicaid under “the state plan” or an 1115 demonstration. Under the proposed rule, CMS interprets the requirement as meaning that the individual was in foster care and enrolled in Medicaid in the same state in which coverage under this eligibility group is sought. CMS does propose giving states the option to cover individuals under this group who were in foster care and Medicaid in any state at the age of 18 or at the point of aging out. However the proposed rule does not require states to cover former foster youth who were in care and enrolled in Medicaid in any state at the time the individual reached age 18 (19, 20, or 21), as advocates had hoped.