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THE STATE OF AMERICA'S CHILDREN YEARBOOK 1998 are likely to be born substance-exposed. Barth cited a study ofCalifornia foster care cases where parental substance abuse was suspected: of 1,576 newborns brought into care in 1995,60 percent already had at least one sibling in the foster care system; about 25 percent had three or more. In a 1997 paper for the Executive Session on Child Protection, Sid Gardner and Nancy Young at Children and Family Futures in Irvine, California, also documented the importance of providing services to mothers with substance abuse problems. They cited data indicating that a small number of women who abused alcohol or other drugs while pregnant accounted for 41 percent of child protective service referrals and out-of-home placements in the state of Washington. Gardner and Young described staff training, case assessment, and service initiatives in Delaware, Washington, and Sacramento County, California, aimed at building bridges between child protective service agencies and substance abuse treatment providers. Children exposed to domestic violence. Children in families where domestic violence occurs are at significant risk of being abused. A 1995 review of domestic violence research cited by the American Humane Association revealed that between one-third to one-half of children exposed to domestic violence are direct victims. Many more-up to 87 percent by some reports-witness the abuse. Child protection agencies are now giving more attention to these problems. Community partners in Cedar Rapids, Iowa, identified distinct overlaps between incidents of child and spousal abuse, which helped the community refocus its energies on this area. The Family Violence Prevention Fund in San Francisco has developed a training curriculum for child protection staff and is working with child protection agencies, domestic violence advocates, and shelter programs to encourage increased collaboration. Massachusetts, Michigan, and Washington state train child protection workers to recognize and address domestic violence; they also sensitize the staff of domestic violence shelters to children's needs. Focusing on Outcomes .thOugh improvements are being made, the failmgs of the systems set up to protect children ~ emain deeply troubling. These concerns have focused attention on holding child protection agencies more accountable for what happens to the children and families they serve. The new Adoption and Safe Families Act requires the secretary of HHS, in consultation with public officials and child welfare advocates, to establish outcome measures for assessing how well states protect children and a system for rating state performance on these outcomes. An armual progress report is required beginning May I, 1999, in which the secretary must inform Congress how each state is doing and how it might improve. HHS also must develop a performance-based incentive system for providing federal child welfare payments to states. This "outcome-based" accountability is also a part of the reforms sought as state child welfare agencies begin to apply the principles of managed care, or privatization, to their work. The Child Welfare League ofAmerica found that 31 ofthe 50 state child welfare agencies surveyed in 1997 are incorporating at least some of these principles into the current management, financing, or delivery of at least some of their child welfare services. This may mean, for example, "capitated" payments, whereby the state prepays a fixed amount per child for a range of services and the managing agency then is responsible for providing the needed services, either directly or through subcontractors. The agency may retain unspent portions of these capitated payments, but it also must absorb excess costs. Kansas, which has probably gone furthest in privatizing its services, is holding providers accountable for achieving specific outcomes in family preservation, foster family and group care, and adoption. The contract agencies are paid a set dollar amount per child or per family, tied to their achieving certain outcomes for their caseloads. Most states are beginning more slowly with pilot programs that include some managed care. 72 CHI L D R EN' S D E F ESE F D
'-- C~H,;,.;I L D R E NAN D F A MIL I E SIN C R I S I S --' HHS is funding such demonstration projects in Michigan, New York, North Carolina, Ohio, and Oregon. The Protect Ohio project, for example, which will involve no more than 20 counties initially, uses funds currently invested in foster care to develop community-based services to keep children safer and help families resolve problems. As foster care costs decline because of the availability ofmore preventive services, counties will be able to reinvest these dollars in other child welfare services. The project will be evaluated on the basis of improved outcomes for children and families. Although privatization and managed care in child welfare are appealing in theory, too often they are proposed simply as part of a larger plan to contain costs. The resources to achieve outcomes and measure progress are not provided. The challenge in any outcome-based system is to defme the desired outcomes, find ways to achieve them, and establish ways to measure and track progress consistently across agencies, across cases within the same agency, and over time. In Kansas, for example, the lack ofa comprehensive data system is one of the barriers to effective privatization of its activities. An Exciting Local Initiative Mer a full year of planning, Louisville, Kentucky, launched its Community Partnership for rotecting Children in 1997. With funding from the Edna McConnell Clark Foundation and technical assistance from the Washington, D.C. based Center for the Study of Social Policy, Louisville is starting to shift responsibility for child protection from a single public agency to a partnership ofagencies, community centers, schools, neighborhoods, and families. Kentucky and Louisville had already experimented with many reforms in the areas of family support, child welfare, and children's mental health services. In the early 1990s a statewide education initiative required the creation of family resource centers for elementary school students and youth service centers for high school students in most school districts. The Jefferson County Family Court sought creative new ways to mediate cases and secure appropriate services for families in need. At the same time, Louisville developed the concept of "A Neighborhood Place," where services for children and families would be centralized in one place in some of the city's most vulnerable neighborhoods. Managed with help from parents and community members, these sites bring together staff and services from various public agencies, including health and human services, mental health, social insurance, child protection, employment, education, and law enforcement. In September 1995 Kentucky Youth Advocates (KYA) chronicled the child protection crisis in a report titled Above and Beyond. It described hundreds of calls to a statewide hotline KYA set up after the death ofa child under agency supervision, and made a strong case that child welfare workers were overburdened and unable to keep children safe. Funds for better training and more staff resulted, and publicity about the hotline fmdings also helped mobilize the community to act. The Community Partnership for Protecting Children grew both out of Louisville's earlier reform efforts and out of the community's desire to take charge and find better ways to safeguard children from abuse and neglect. The project exemplifies the importance of commitment, communication, and time in building true partnerships to protect children. Its activities have focused on Neighborhood Place Ujima, housed in a multiservice center. A major challenge during the planning stage was overcoming the mistrust among people in the neighborhood, the child protective services agency, and other government agencies. Trust developed as participants created a common vision and agenda and clarified their respective roles, responsibilities, and authority. Participants now see the partnership as "a covenant ofarms linking everyone together in the belief that childhood is a sacred time and that safety is the promise our community makes to its children and families." The planning phase also involved much struggle to set objectives for partnership activity and benchmarks for evaluating pro- CHI L D R EN'S D E FEN S E F U D 73
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About CDF he Children's Defense Fun
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Copyright © 1998 by Children's Def
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Acknowledgments Susanne Martinez, d
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THE STATE OF AMERICA'S CHILDREN YEA
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