Comptroller investigates foster care
"They are everybody's children, and nobody's children. They are the forgotten children in the Texas foster care system." Texas Comptroller Carole Keeton Strayhorn's foreboding words open a new report by the Texas Comptroller's office, Forgotten Children.
Forgotten Children is the result of a Comptroller investigation of Texas foster care and the state agency primarily responsible for it, the Department of Family and Protective Services--an agency better known by its pre-February 2004 name, the Texas Department of Protective and Regulatory Services (DPRS).
The study was prompted by numerous published accounts alleging fraud and abusive conditions in the state foster care system. Forgotten Children confirmed many of these findings and revealed other troubling issues.
"I am appalled at the conditions too many of our foster children must endure," Strayhorn said. "I challenge any defender of the current system to put their child or their grandchild in some of the places I've seen for one day, much less for a lifetime.
"I want this report to give these kids a voice--and open some eyes," Strayhorn said.
Among the report's findings:
- many children have been neglected and abused in foster care, some by their caregivers and some by other children;
- many children spend their time in foster care being shuttled among many all-too-temporary "homes";
- many children with special needs, such as the medically fragile and those with mental retardation, do not receive the services they need;
- some "therapeutic" camps offer deplorable living conditions and are not held to the same standards as other facilities;
- many foster children receive disturbing amounts of mind-altering psychotropic drugs with little or no accountability; and
- some facilities routinely mix potentially dangerous children, such as sexual offenders and those with violent criminal records, with foster children who may become new victims.
Of course, many Texas foster children receive high-quality care.
"Some of them find homes with caring foster parents or in treatment centers with experienced and caring providers--but some do not," said Strayhorn.
And even the best families and providers are hampered by the system. Texas foster care has, for instance, state-run and privately contracted elements. The state-run side of the system, which accounts for just more than a quarter of all days of foster care delivered, consists of foster families and group homes that contract directly with DPRS. The much larger private side consists of state-licensed residential facilities and child-placing agencies that recruit and train foster families.
Since DPRS holds primary responsibility for enforcing licensing standards, the dual system in effect requires the agency to regulate itself, a clear conflict of interest.
"We must end the current system that has the fox guarding the hen house," Strayhorn said. "We cannot tolerate a system where regulators regulate themselves."
The system also provides perverse financial incentives. Caregivers can make more money by keeping children in expensive and restrictive placements than by helping them return to their birth homes or become adopted.
Furthermore, caregivers receive the same rates for each service level regardless of the quality of the services and facilities they provide. A facility that invests in comfortable, inviting facilities receives no more per child than one that barely meets minimum licensing standards.
A lack of adequate oversight, moreover, has allowed some caregivers to "game" the system, using state and federal tax dollars to purchase services from allied companies they themselves own.
Forgotten Children offers a number of proposals to ensure the safety of Texas foster children while improving the care and cost-effectiveness of the services they receive. These recommendations could increase federal foster care funding by $21.3 million annually, while allowing DPRS to redirect nearly $109 million into the oversight of foster care from 2005 to 2009.
Improving the quality of care
The Comptroller's report recommends eliminating DPRS' dual system for foster care. This would allow the agency to focus its efforts on its all-important role of guaranteeing the safety of foster children.
This step, which should be phased in over three years, would make private child-placing agencies responsible for recruiting and contracting with foster families and supplying caseworkers to monitor the care they provide.
DPRS should use the phase-in period to strengthen its licensing and contracting standards. In particular, contracts with child-placing agencies and residential treatment centers should be revised to stress measurable positive outcomes.
Innovative funding techniques outlined in Forgotten Children could be used to improve foster care.
Several proposals would increase federal funding. They include amending the state's Medicaid Plan to take advantage of federal funding for rehabilitative services; drawing additional funding for preplacement services; and assisting foster caregivers in obtaining Medicaid reimbursement for their services. And federal dollars could be used to prevent the unnecessary institutionalization of foster children with special needs.
Forgotten Children recommends steps to ensure accountability in foster care. Caseworkers should be subject to formal documentation requirements for all required visits with their charges.
All caregiver contracts should include stiff conflict-of-interest provisions. And DPRS' current practice of allowing providers to reject or eject foster children from their care should end by 2008.
The report also recommends that the Texas Department of Health and local health departments assume responsibility for health inspections of all foster care residential facilities.
Ensuring health and safety
Mixing children who have violent tendencies or histories of sexual assault with other foster children should end immediately. DPRS should track and report all cases involving child-on-child abuse and investigate such complaints thoroughly.
FBI criminal checks should be obtained for all caregivers working directly with children before they begin work. These caregivers should be subjected to drug testing, and DPRS should consider psychological testing as well.
Forgotten Children also recommends that the state's Health and Human Services Commission (HHSC) form a review team to investigate the use of psychotropic medication on foster children.
Providing a brighter future
Finally, the report notes that foster children's problems seldom end when they grow up; they are prone to homelessness, drug abuse and other problems.
Forgotten Children recommends that DPRS and HHSC seek additional federal funding to help foster youths thrive in the adult world. Similarly, DPRS should work with local work force development boards to expand the services available to foster teens. Another proposal recommends that DPRS work with volunteer and advocacy organizations to create a Foster Grandma and Grandpa program that recruits seniors to provide foster children with mentoring and emotional support.