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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
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 Diego
County. 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 homes
and 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
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 runaway
youths 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 family
situation 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 expected
that 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 Hoover
Commission, April, l992.
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 of
foster 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 the
Department of Social Services. However, the term "social worker" denotes a person who has
achieved the Masters Degree status in the social work curriculum or who is licensed as a social
worker. Many departmental employees who work on cases are not "social workers" by this
definition. (See San Diego County Juvenile Justice Commission Case Review Report, p.1.). In
this report the Grand Jury uses the word case worker to denote that general class of departmental
employees who perform case work.
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 (short
term, 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 visitation
requirement. 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 their
parental 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.
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.
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 problem


foster 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 there
because 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 to
increase 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.
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 care
communities 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, the
financial 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.
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 received
by 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 natural


parent 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 upset
over 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
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 and
screening 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.
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 bad
impression 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 be
stopped. 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
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


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 to
cost 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 children
required at least temporary placement. There are thousands of children in out-of-home
placement at all times. Children come into placement at a faster rate than others leave.
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's
foster 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 pronounced
in 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 children


on 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 Services
are African-American while only seven percent of all children in San Diego County are of
African-American. Report of the Placement and Evaluation Committee, San Diego County
Commission on Children and Youth, April, 1992.
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 is
insufficient 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 foster
homes which are selected and supervised by Community Based Organizations which contract
with the County to provide certain types of specialized foster care. F.F.A. homes are not covered
in this report.
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 adjust
to 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 Jury
considered 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.
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 system
must 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 records
from 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
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 Services
subsidizes. 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 who
have 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. Physicians
continue 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 charitable
physician in a non-clinic setting can afford to do no more than one assessment per week in the
opinion of the physicians who informed the Grand Jury.
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 to
prepare 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 is
inadequate.

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
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 some
relatives 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.
#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