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Improving Service to Children: Building on Success and Delivering Challenges

bryan samuelsBryan Samuels, Commissioner, Administration on Children, Youth and Families, Administration for Children and Families, US Department of Health and Human Services

Summary: The author offers an overview of his efforts to improve child welfare outcomes, shares good news about reductions in the number of children in foster care, and explains ways in which child welfare–system stakeholders and advocates can focus system efforts on child well-being.

A few months ago, the child welfare field got some good news: for the sixth consecutive year, the number of children in foster care declined, leaving us with just over 400,000 children in foster care on September 30, 2011. This represents a reduction of almost 30 percent over the last decade. Still, we have a long way to go in developing a system that truly meets the needs of the children, youth and families who come to the attention of child welfare. As the commissioner of the Administration on Children, Youth and Families (ACYF), my goal has been to build on our successes while challenging the field to do what it takes to meaningfully improve the odds for this vulnerable population.

Prior to the Adoption and Safe Families Act (ASFA), the number of children in foster care was skyrocketing. Child welfare systems were given a mandate to focus on achieving permanency through reunification, adoption or guardianship for the 559,000 children in foster care. Since then, we have learned how to support families and keep more children safely in their homes, and we have moved greater numbers of young people in foster care to permanency faster. Fifteen years ago, we didn’t know everything we could and would do to reduce the size of the foster care system, but collaboration, experimentation and a singular focus yielded great successes.

During my three years in Washington DC, I have aimed to expand the child welfare system’s focus on simply getting smaller to include getting better at meeting the needs of the children and families it serves. Children who experience maltreatment, whether or not they come into foster care, often have significant social and emotional challenges, and these needs can negatively impact on short- and long-term well-being. We can go a long way towards improving these outcomes by facilitating children’s healing and recovery and promoting social and emotional well-being.

At ACYF, we have identified a several key components of this work, including: (1) screening, functional assessment and progress monitoring; (2) scaling up evidence-based interventions while de-scaling practices that aren’t achieving results; and (3) continuous quality improvement. Our efforts over the last three years aim to embed these components into the ongoing work of child welfare systems.

Facilitating healing and recovery for children and their families who come to the attention of child welfare requires collaboration across systems, and courts play an essential role. Judges, attorneys, court-appointed special advocates and guardians ad litem advocate and make decisions on behalf of children in foster care. Judges can focus efforts on well-being by asking meaningful questions about children’s social and emotional needs, and building them into every hearing. Persistently asking about children’s well-being and ensuring that services are matched to meet specific needs may make all the difference for young people and their families. Courts and agencies can also work together to identify and advocate for the community resources and array of services most appropriate for their populations.

Collaboration between courts and child welfare can be instrumental in ensuring safe, appropriate, and effective use of psychotropic medication for children and youth in foster care. High rates of medication use among this population are evidence of the profound impact of maltreatment on the mental and behavioral health of children, as well as the scarcity of non-pharmaceutical alternatives to treatment. Over the past eighteen months, ACYF has been working with agencies across the Department of Health and Human Services (HHS) to support states in strengthening oversight and monitoring of psychotropic medications for children and youth in foster care within the context of promoting social and emotional well-being. This includes encouraging the development of a more comprehensive service array that includes evidence-based psychosocial treatments as first-line or concurrent treatments for mental health disorders and trauma. In many jurisdictions, courts are involved in determining the course of treatment for children in foster care, including, in some cases, providing informed consent for medication use. For this reason, the judiciary ought to be involved when states and localities work to ensure responsible use of psychotropic medication and development of an effective service array.

There are several exemplary collaborations between courts and child welfare systems that improve the well-being of vulnerable children, youth, and families. For instance, Zero to Three’s Safe Babies Court Teams Project has been able to achieve positive outcomes for young children while effecting broader systems change. Judicial leadership and a multi-disciplinary team approach that includes court personnel are critical components of this and other promising approaches.

Additional strategies that courts may use to promote social and emotional well-being include:

  • Working with child welfare agencies to ensure that trauma and mental health screenings occur
  • Sharing data from ongoing assessments to monitor whether children’s social-emotional, mental and behavioral health are improving over time
  • Working with child welfare caseworkers to match children with evidence-based interventions that meet needs identified in assessments. Courts can also use aggregated data from assessments and other sources to better understand the effectiveness of the system and inform program improvements.

Partnerships between courts and child welfare agencies have been critical in child welfare progress to date, and have great potential to promote social and emotional well-being for children. Both child welfare agencies and courts must build capacity to ensure that children receive more effective and evidence-based screening, assessment and treatment. With shared goals and consistent communication, each system, along with the others that support children, youth and families, can evolve in complementary ways.

When ASFA was passed, we didn’t know all we could do to increase permanency and reduce the number of children in foster care. Today, we don’t know everything that works to improve the social and emotional well-being of children who experience maltreatment. Just as our committed, collaborative efforts pushed us to understand what children need to stay safely at home or move quickly to permanency, a shared focus on promoting well-being will allow us to significantly improve outcomes for our nation’s most vulnerable children. Thank you for all you do to achieve this worthy goal.

For more information about ACYF’s priority to promote social and emotional well-being, read ACYF-CB-IM-12-05: Promoting Social and Emotional Well-Being for Children and Youth Receiving Child Welfare Services.

Other useful resources specific to psychotropic medication use among children and youth in foster care include:

Author biography:

Bryan Samuels is the Commissioner of the Administration on Children,Youth and Families (ACYF) within the U.S. Department of Health and Human Services.

Prior to joining the Administration, Samuels served as chief of staff for Chicago Public Schools from 2007-2009, playing a leadership role in managing the operations of the third largest school system in the nation. From 2003 to 2007, Samuels served as the director of the Illinois Department of Children and Family Services (DCFS), the third largest child welfare system in the country.

At ACYF, Commissioner Samuels has made the social and emotional well-being of vulnerable children and youth his top priority. He is aligning policies and funding to support healing and recovery for children and youth who have experienced trauma, with an emphasis on increasing access to evidence-based interventions. Under his leadership, ACYF is leading a department-wide initiative to strengthen management of psychotropic medications for children in foster care and expand the use of effective interventions.

The US Department of Justice has supported CASA advocacy since 1985 through its Office of Juvenile Justice and Delinquency Prevention.
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