Better support means better outcomes: William C. Bell speaks at a Congressional subcommittee on improving foster care

Casey Family Programs President and CEO William C. Bell testifies at a Congressional subcommittee on improving foster care.


Mr. Chairman and members of the Subcommittee, thank you for inviting me to share Casey Family Programs’ perspective on how to improve child protective services and on reauthorizing the Promoting Safe and Stable Families (PSSF) program.

I am William C. Bell, president and chief executive officer of Casey Family Programs, the nation’s largest operating foundation serving the needs of children in foster care for over 40 years.

Before sharing some experiences and recommendations, I want to take the opportunity to commend the Subcommittee on Human Resources for the leadership you have shown over the years in the broad areas of child welfare, child protection, foster care and adoption assistance.

As we move toward a more comprehensive and targeted approach to helping foster youth transition to adult success, I ask each of you to continue the focused and passionate leadership that results in improvements across jurisdictions for foster children in the areas of mental health, education, and employment, with the ultimate outcome of significantly reducing the number of children in America’s foster care system.

Without your continued leadership on a policy level, without your voice on behalf of these children, our ability to significantly alter this nation’s child welfare landscape — for the good of abused and neglected children — will be hindered.

In the past 40 years, Casey Family Programs focused its efforts and funding on permanency and transition issues to help prepare children for long-term success.

That emphasis continues, but with a much sharper focus. Casey Family Programs is now marshaling our investments, our staff and our collective expertise on a strategy we call “2020.” Simply put, 2020 is both a point in time — 15 years from now — and a benchmark from which this nation can measure significant changes and progress within our child welfare system and our communities.

We also see the 2020 benchmark as a critically important reminder to us of the consequences we face as a nation if nothing changes over the next 15 years for our most vulnerable children.

Consider the following. If nothing changes in our child welfare system between the years of 2006 and 2020:

  • Nearly 14 million more children will be abused and neglected.
  • More than 22,500 children will die of abuse and neglect, the majority before they reach their fifth birthday.
  • Nine million more children will experience foster care.
  • And more than 300,000 children will age out of foster care without adequate supports to successfully transition to adulthood.

These numbers — and the negative impact they represent to so many young lives — are unacceptable.

Over the next 15 years, Casey will invest $1.67 billion in our 2020 strategy to improve the lives of children in foster care and ensure successful transition to adult life. Through Casey’s commitment, and by partnering with a wide range of national and local child-serving organizations, political and civic leaders, and many others, our investment and solutions will focus on the following:

  • Reducing the number of children in foster care, and reinvesting the savings: On any given day in America, more than 500,000 children live in foster care. We believe we can reduce that number by 50 percent by the year 2020. We must then efficiently reinvest what we save to support vulnerable children at a federal, state and local level, and through public-private partnerships with organizations like Casey Family Programs.
  • Education: Increasing significantly the high school graduation rates for youth in care and the number of youth who earn two- or four-year vocational or college degrees.
  • Employment: Increasing the successful employment experience for youth while in care and after they have transitioned out of care.
  • Mental health care: Improving mental health access for children in foster care and, ultimately, decreasing the number of youth who suffer mental health disorders; and increasing the number of youth through Medicaid coverage, up to age 25.

Why does Casey Family Programs make this commitment of funds and agency resources? We are troubled by what the data currently tell us:

  • The number of children who are confirmed as victims of abuse and neglect is still nearly 900,000 every year.
  • Children of color continue to be over-represented in our child welfare and juvenile justice systems. Approximately 6 out of every 10 children in foster care in America is a child of color. We appreciate the leadership of Congressman Rangel in having the Government Accountability Office open a formal review into why children of color are overrepresented in the nation’s child welfare system, which Casey Family Programs requested in our testimony last year before this Subcommittee.
  • Youth aging out of foster care continue to struggle to build productive, successful adult lives, many without health care coverage or educational opportunity. As many as half do not complete high school. While about 20 percent pursue a vocational or college education, only about 3 percent actually complete a degree.
  • The ratio of children-to-caseworker continues to be too high in many jurisdictions across the country. High turnover and training needs hinder our states’ ability to ensure successful outcome measures for children in care.

So action is essential.

Every year in our country, more than 20,000 youth in foster care turn 18 and leave the system, often with little or no financial and family support. If we are to be successful on behalf of these children, we must find a way to provide them with lifelong connections with caring and supportive adults, who can help them transition to the workforce, achieve their higher education goals, and deal with the issues of life when they happen.

We must put in place comprehensive policies rooted in permanency and reinforced by adequate funding, training, and essential relational and physical supports for children and youth in care. Without such policies and supports, we know from our research that a high percentage of these youth will suffer negative outcomes.

For example, in 2005, Casey Family Programs published its Northwest Alumni Study, which examined outcomes for 659 adults, ages 20 to 33, who had been placed in care between 1988 and 1998.

While the study documented many success stories, other results we saw were disturbing, particularly when examining issues regarding how foster youth transition to adulthood. The study showed that foster care alumni – in far greater proportion than the general population – suffered serious mental health issues, were far less likely to pursue and attain a college degree, and experienced difficult employment and financial situations that often led to unemployment, homelessness and a lack of health insurance and medical benefits.

More specifically, the Northwest Alumni Study reported that one in four foster care alumni suffered from Post Traumatic Stress Disorder — more than twice the rate for U.S. war veterans; one-third had household incomes at or below the poverty line, and more than one in five experienced homelessness after leaving care.

Taken individually, any one of these areas could hinder a young adult’s efforts to build a successful life. But when taken together, they present a nearly impossible set of obstacles for far too many foster youth. If we continue to fail to help this population enjoy the American dream, we will not just be failing them, but we will be failing the future of our communities in which they begin and live out their lives as adults.

But we are not here today to talk about failing. We are here to talk about making the health and well-being of our most vulnerable children our No. 1 priority, and continuing to create and fund solutions that change the way America cares for this population.

I want to focus the remainder of my testimony today on what Casey Family Programs believes are the critical areas of emphasis for improving outcomes for children in foster care, and providing specific recommendations to the Subcommittee regarding ongoing federal funding commitments that support vulnerable children, youth and families.

Specifically, Casey Family Programs will focus on the following areas as part of our strategy to significantly improve the lives of children in foster care by the year 2020:

One path we know, without question, that can transform a young life is education. We know that many foster youth struggle mightily to finish high school, much less move on to vocational schooling or college-level degrees. One of my greatest concerns is that, if nothing changes in the next 15 years, current data tell us that only 9,000 of those 300,000 young people who will age out of foster care by the year 2020 can expect to earn a college degree.

A strong majority — 70 percent — of teens in the foster care system have a desire to attend college. A recent study of 1,500 foster care youth in Casey Family Programs showed that nearly half attended some college, demonstrating that these youth will take advantage of opportunities for education when provided. But the reality is, as indicated through our Northwest Alumni Study, very few (3 percent) complete either vocational training or a college degree.

The California Assembly Select Committee on Foster Care has taken a step in this direction with proposed legislation to provide former foster youth with a comprehensive package of educational services and supports, based on a model program developed in partnership with the philanthropic community.

We must create better support and funding for allowing foster youth to remain with family placements beyond the age of 18, which encourages the development of lifelong relationships with foster parents and other supportive adults, and gives these youth longer-term housing solutions during difficult times, or times when they are completing high school GED programs, and vocational or college coursework.

In addition, we must support programs that combine financial aid, housing and a variety of services and supports to ensure post-secondary education success. Specifically, we recommend requiring the Advisory Committee on Student Financial Assistance to provide recommendations for expanding access to youth in foster care — and those in kinship care — to federal financial aid. In addition, we also strongly encourage the TRIO and GEAR UP programs to make those youth in foster care and transitioning out of care a priority.

Youth aging out of foster care are often underemployed with low incomes. New strategies supporting employment of transitioning youth combine traditional employment and training programs with necessary support services, such as counseling, peer support, child care and transportation assistance.

Youth in care with minimal or no job experience may benefit from collaborations that blend social services with workforce development. We can and should do a better job of connecting foster care youth to these programs, and we need to start in the early teen years, so young people have developmentally appropriate opportunities to systematically develop a strong work ethic and skills. The more preparation and training young people receive through education and pre-employment skills development, the better equipped they will be to achieve economic success.

There are excellent examples across this country of public-private partnerships and programs that are providing critically important transition services to youth in care and those who have emancipated from the foster care system. By pooling resources among public agencies, community and non-profit organizations and the philanthropic community, we are bringing more and more support to these young people at a time in their lives when they need it the most. But the needs of these youth continue to out-run the resources currently provided, so we ask the Subcommittee to continue supporting and encouraging these types of integrated programs and efforts in our communities.

I think it is particularly critical to highlight the mental health needs of this vulnerable population. Casey’s Northwest Alumni Study found that, compared to the general population, a disproportionate number of alumni (54 percent) suffered mental health disorders, especially post-traumatic stress disorder (PTSD), major depression, social phobia, panic syndrome, and generalized anxiety. In fact, we found the proportion of foster care youth with post-traumatic stress disorder to be double that of U.S. war veterans.

If nothing else, this statistic should serve to remind us of the significant challenges these children face when they enter our system, and provide significant incentive for us to ensure they have a healthy transition to adulthood.

Many youth, as they emancipate, enter jobs that do not provide health insurance or pay sufficient wages to allow them to purchase coverage independently. In addition, there is a national shortage of qualified providers who can help young people with the often unique developmental, mental health and substance abuse issues some foster youth may face when transitioning from care.

Overall, children in foster care often suffer from poor health and have much higher rates of chronic physical disabilities, birth defects, developmental delays and serious emotional and behavioral problems than children from the same socioeconomic background who are not in out-of-home care. Although current federal cuts have provided additional challenges on this front, it is vital that federal policies give states the flexibility to connect youth leaving foster care to existing health programs such as Medicaid. Casey believes health care coverage through Medicaid, especially for mental health, needs to be available to these youth up to age 25.

Simply put, caseloads in many jurisdictions across the country are too high.

It is a documented fact that dangerously high caseloads severely jeopardize the health and well-being of the children in our care, and prevent front-line caseworkers from focusing on the highest-priority needs regarding permanence and transition for youth.

During my tenure with New York City’s Administration for Children’s Services, I had the opportunity to help design a series of reforms that significantly reduced the number of children in foster care, and the number of new admissions into foster care, and began to show improvements in the quality of service exchanges with children and families.

We defined as one of the critical and necessary elements of this reform process the investing in our workforce to improve the quality of the front-line supervision and caseworkers.

We knew that staff could not be expected to adequately fulfill their responsibilities if they were not trained properly, did not receive appropriate supervision, did not have appropriate staffing support and resources, or if they were constantly afraid that their decisions would not be supported by ACS and New York City leadership.

In short, how we support our front-line caseworkers is both a resource issue and a cultural issue within our child welfare departments. We are either providing our caseworkers with the resources and training they need – in addition to the confidence and backing they need to do their best work – or we’re failing them and the children we place in their care.

I would also like to share several critical foundational components that I believe must be in place in order for significant change and improvement to occur in our child welfare system over the next 15 years:

Number One:
There must be a commitment of the political will necessary to sustain change. The child welfare system must have the consistent, powerful and focused leadership of the chief politician (whether it is the governor, a county elected official or the mayor) in order to keep driving improvements forward. Child welfare must be treated with the same level of support and attention as police, fire and education.

Number Two:
There must be competent executive and mid-level leadership. If you want to improve outcomes on the front lines of our child welfare system, those in leadership positions must have the experience and expertise to ensure that strategies and vision can be translated into action.

Number Three:
There must be a clear plan of action and clearly articulated principles and standards to guide the work. Everyone — from the top of the organization to the front-line caseworkers — must have a clear understanding of the plan, processes and desired outcomes. This creates a culture of trust, of consistency, of action and, most importantly, of accountability.

Number Four:
There must be a reasonable and continuous investment in front-line supervision and front-line caseworkers. There must be a culture of support and success created with the people who are responsible on a daily basis for the health and well-being of the children in foster care. These front-line supervisors and caseworkers must know that they have the confidence and backing of leadership in doing their work.

Number Five:
We must develop and demand strong cross-systems partnerships. Child welfare systems cannot do this work alone. The system must work in tandem — with local communities, law enforcement, education, community-based organizations, philanthropic organizations and others — to build comprehensive programs that improve the lives of children in foster care.

Number Six:
We must create and enforce data-driven accountability, and publicly report on our outcomes. We must have accurate systems to measure child welfare outcomes and hold us accountable for improving the lives of children in foster care.

Number Seven:
We need time.

Systems don’t improve overnight. We need time to get the right people in place, time to get the right resources aligned, time to test and make sure that we have the right systems and processes in place, time to form the right partnerships and collaborations, and time to see what is and isn’t working.

To make the improvements we are discussing here toward better outcomes for children, the federal government needs to make reasonable and continuous investments in the range of child protective services it funds, and to retain a leading partnership role with the states and organizations such as Casey Family Programs.

Over time, this Subcommittee and the Administration can foster the statutory links and collaborative efforts among legislative jurisdictions and federal agencies that are necessary to create the comprehensive strategy and steps to permanency that we propose for foster youth transitioning to adulthood.

That is much easier said than done, but leadership from this Subcommittee and the Administration — along with other key policymakers at the state, federal and local levels — will continue to set the tone of the discussion and dialogue around how we care for the vulnerable children in this country.

Meanwhile, we strongly support your efforts to keep stable and flexible funding options for the states to operate foster care and child welfare services. Capping or reducing funds now available to the states would slow their progress in improving outcomes and putting in place longer-term, comprehensive programs and systems. And it is important to begin now to improve funding for prevention and family services, which can include more flexibility in use of funding streams.

Casey recommends that the foster care entitlement be continued and that more flexibility be added, particularly to assist relative (or kinship) caregivers and subsidized guardians, and to improve resources for preventive services to families. Specifically, our recommendations include the following:

  • Preserve the Title IV-E entitlement funding structure.
  • States’ open-ended entitlement to administrative funds should also be maintained.
  • Title IV-E funds should be made available to children requiring services in their homes to help prevent out-of-home placements.
  • Title IV-E funding eligibility should be adjusted for inflation. The federal eligibility link tied to AFDC eligibility as of 1996 is outdated and burdensome to administer because children may need protection regardless of the financial circumstances of their biological family.
  • Title IV-E funds should be made available to all children removed from their homes, including those placed with relative caregivers and in subsidized guardianships.

The recent reversal of the Rosales v. Thompson court decision denying states IV-E reimbursement for children being cared for by relatives highlights the need to remove artificial eligibility criteria for federal assistance to neglected and abused children removed from their homes. By maintaining and supporting extended-family connections, we are creating opportunities for permanency for far more children than are currently available through adoption.

  • State child welfare systems should continue to be accountable for meeting federal standards ensuring child safety and well-being.
  • State child welfare systems should be provided adequate resources to meet those standards. Federal administrative and training funds are necessary for states to provide a stable and well-trained workforce, the most critical resource in child welfare services.
  • Mental health and rehabilitative services for the child welfare population should be explicitly authorized under Medicaid and State Child Health Insurance Program (SCHIP).
  • Twenty-one years of age should be established for all states as the minimum age for youth to emancipate from care, allowing extended program funding and supports.
  • Health care and mental health benefits for youth transitioning from foster care should be extended up to age 25.
  • Title IV-B Child welfare services funds should be significantly increased, to help states serve children within their family and community, and diminish incentives for removal of a child to foster care. Casey Family Programs supports increasing the entitlement authorization by at least $40 million.
  • Chafee Program: The Administration needs to implement the data collection and state performance assessment processes that were authorized in the 1999 legislation. This program is the most critical resource for assisting youth aging out of foster care, and it is significantly under-utilized.

Improving the lives of children in foster care is a long-term process that can only be accomplished through partnership and collaboration, with both public and private investment, and federal and state alignment.

When leadership, systems and investment are aligned, so many other positive pieces fall into place – such as cross-system support and sharing, accountability and data reporting, funding efficiency, systems innovation and, most importantly, improvement in the outcomes for our children.

Yes, we strongly support reauthorizing the Promoting Safe and Stable Families (PSSF) program, and providing sufficient funding. This is consistent with Casey Family Programs’ focus on reducing the overall number of children in foster care, and reinvesting the savings to ensure positive outcomes for America’s most vulnerable children.

But parallel to that we must have leadership — the kind that this Subcommittee continues to model for Congress, the Administration and our states.

I’d like to conclude my testimony today with remarks from a foster care alumnus that continue to provide for me a laser focus on improving the lives of abused and neglected children in this country.

What this young man said was this: He doesn’t believe in the resilience of youth as our solution, he believes in you and me. He believes in our commitment to children in our communities, and he believes in our ability to make positive change happen for children in foster care.

He said our children don’t belong to our federal or state governments, they belong to you and me. And most important of all, he said, referring to himself and all children in foster care: “We are all your children, and we need all of you to help.”

And then he made one request — when it comes to children in foster care, he said, we must apply the “Standard of Your Own Children.” And that standard is this:

“If it’s good enough for your own children, then it’s good enough for any vulnerable child in America.”

I urge each of us here today to apply that standard as we move forward with improvements in America’s child welfare system. If it is not good enough for our children or the children of our family members, then it is not good enough for any vulnerable child in this country.

I want to again thank Mr. Chairman and the Subcommittee members for the invitation to offer my remarks today. Casey Family Programs looks forward to continuing to work with each of you to make the health and well-being of our most vulnerable children our No. 1 priority.