In January, a Cook County judge issued an order holding the director of the Illinois Department of Children and Family Services in contempt of court for allegedly violating children’s rights. The judge found that a 17-year-old boy in the foster-care system had languished in a psychiatric hospital since September because the agency had nowhere to place him. This followed similar incidences, including one in which a 13-year-old boy was forced to sleep in a utility room before being placed in a temporary shelter, where he remained for almost four months.
Such stories are not unusual. States across the country lack appropriate placement options, including group homes, residential-treatment facilities, and other institutional settings, for kids in foster care who suffer from behavioral and mental-health challenges and cannot live with a family — either temporarily or permanently. The use of such settings for children who are orphans or whose parents cannot or will not care for them has decreased steadily in the past few decades amid reports of neglect and abuse at several facilities. Today, of the 425,000 children in the foster-care system nationwide, only about 55,000 reside in institutional settings — a significant drop since the early 2000s.
What’s become increasingly apparent, however, is that the movement to halt such placements has gone too far. Good congregate-care facilities are available across the United States, but there are far too few of them. In recent decades, foundations played a significant role in reducing placements of foster children in these settings. Now, they should consider supporting efforts to expand them.
Good Intentions
Philanthropy’s focus on significantly limiting institutional placements for kids was fueled by good intentions. In the middle of the 20th century, orphanages were much more common, and the idea of a nonrelative foster family was largely unknown. But as more support was made available to impoverished families, the focus switched to keeping kids at home or with foster families. At the same time, congregate-care facilities for foster kids developed a reputation for being uncaring, money-making operations. The idea took hold both in the halls of government and among philanthropy leaders that they should shrink to almost nothing.
In 2003, New York’s Administration for Children’s Services asked the Annie E. Casey Foundation to help reduce the number of teenagers placed in congregate-care facilities, eventually decreasing the number by 47 percent from 2002 to 2008. Casey also partnered with Maine, Virginia, and other states on similar efforts, which included promoting policies that would make congregate care less financially feasible for state and local governments. Other grant makers, such as the Conrad Hilton and Redlich Horwitz foundations, joined in, working to expand foster-care placements while minimizing congregate-care options.
These efforts have flourished at the federal level as well. The Family First Prevention Services Act, which passed in 2018, restricted federal reimbursements to states for certain kinds of group-home care, such as those that lacked round-the-clock medical staff. Large-scale deinstitutionalization efforts in the 1970s resulted in a prohibition against the use of Medicaid for care provided to most patients in mental-health residential-treatment facilities larger than 16 beds — a regulation that could soon apply to foster children who have serious mental-health challenges unless Congress passes a law excluding such facilities from the rule.
All these factors have left struggling foster kids with few places to go. Last summer more than 416 children were in unlicensed placements in Texas — many sleeping in child-welfare offices and supervised overnight by caseworkers or former law-enforcement agents. During that same period, a judge in Washington ordered the state to stop housing kids in offices. But, as the local NBC affiliate reported, “It’s not clear where [the state’s Department of Children, Youth, and Families] will house foster youth without placements once they stop using hotels and state offices as an option.”
The obvious answer is to create more quality congregate-care facilities. But few are willing to go that route. Ronald Richter, former head of New York City’s Administration for Children’s Services, told me in an interview that “there is genuine concern that if you have residential systems available, people are not responsible enough to use them appropriately.”
But Richter, who is now the head of JCCA, formerly the Jewish Child Care Association, a residential program for mostly foster youths, says that this assumption ignores reality. Back in the 1990s, New York had 50,000 kids in foster care, with a third of them in residential treatment. Today, there are fewer than 8,000 in foster care, thanks to more use of placements with relatives or family friends and in-home services for families at risk, and less than 9 percent in residential treatment. The city has demonstrated it does not need to rely on residential care for more than a small minority of the foster population. But that minority of the population, including kids who have experienced severe trauma or have major mental-health or intellectual disabilities, desperately need such care, and very few adults are qualified to provide it in their homes.
Regular news reports about congregate-care horror stories have certainly contributed to the lack of philanthropic support. This month, staff at a Texas group home that is supposed to help foster children who are victims of sex trafficking were accused of physical and sexual abuse, and, in at least one instance, of trafficking the girls themselves.
Listen to Effective Nonprofit Leaders
Unfortunately, such instances make it harder for those doing effective work to make their case. Grant makers, however, need to start listening to to success stories as well. Utah Youth Villages, for example, uses what’s known as the Teaching Family Model, one of the few evidence-based programs that help kids with behavioral problems develop the skills to live in a real home. Most of the nonprofit’s facilities are small cottages of eight or 10 kids who are cared for by married treatment providers who live with them. The idea is to mimic life in a family as much as possible. Programs like this deserve greater philanthropic support and should be copied across the country.
Philanthropy has an important role to play in improving residential care for the children and adolescents who have no alternatives. That includes supporting more research on the best ways to rehabilitate kids in group settings so that they can be reunited with their families or go on to be adopted or successfully transition into adulthood. Staff at these facilities are also often underpaid and undertrained. Clinical experts should be available to work with staff and develop programs specific to the needs of this vulnerable population. And employees deserve better pay for this difficult but critical work.
While funding operating expenses is often low on the list of philanthropic priorities, it is vital to running strong congregate-care programs. That includes maintaining physical facilities. Even the best-run residential-care campuses struggle with upkeep in the face of minimal government or philanthropic funding. But philanthropists should consider how living in rundown facilities affects residents. Supporting capital improvements is one concrete step grant makers can take to help these kids feel valued.
As Richter notes, “In all the years that we’ve been talking about eliminating residential care, kids have been living in residential care.” Starving facilities of the money they need to operate while children still need to live in them is clearly not the answer.
