With Family First Act implementation underway, editorials and articles proliferate, many articulating nervousness among residential providers. With their revenue models under attack, some institutions are fighting back in the press and in the halls of statehouses to defend child welfare models that can be frightening, backward and protectionist of ineffective practice.
While short-term residential placement is a necessary part of the continuum of care for some high-needs children in foster care, it is never an effective long-term solution. Children in foster care need the same things that our own children need: someone willing and able to give them unconditional belonging.
The research is clear: Children do best when placed with well-supported foster and kinship families. When we provide these families with the financial and therapeutic support they need to care for children with complex needs, they are more effective for the long term.
In a small number of cases, children may need a time-limited, emergency-room-like stay in a residential treatment center to stabilize and keep them and others safe while their families or foster family receive support to provide the nurturing environment they require. But for far too long, too many have argued that children exhibiting pain-based behaviors must be institutionalized and segregated from communities and family, and they are just flat-out wrong.
The state in which we work — New York — is in need of policy and system improvements, but of an entirely different nature than other states’. The challenge we face is that some regions in New York place children in foster care in residential facilities at a rate twice the national average, at a high cost to children, families and taxpayers.
We believe that the cause of the problem is that these N.Y. regions and their foster care providers were complacent. They had significant residential capacity. Instead of developing and investing in the foster and kinship families that children so desperately need, they defaulted to placing children in those institutional beds. Despite the best intentions, residential care became a convenient destination and not an efficacious emergency room for children.
Fortunately in New York, public and private child welfare leaders have begun the hard work to turn around our child welfare system to prioritize family preservation, engagement and family-based care. This transformation is accelerated by the 2018 federal Family First Prevention Services Act, which limits reimbursement for residential care and incentivizes family preservation and kinship care.
In 2019, the state launched a transition fund to support counties as they transform to become more family-centered, and Gov. Andrew Cuomo announced in his 2020 State of the State address that New York would implement a Kin-First Firewall policy to ensure children in foster care are placed with kin relatives and family friends. We applaud our public leaders for their proactive stance and our private leaders for their willingness to change.
We will always need residential facilities: safe places with strong clinical skills and the deeply caring staff who do very difficult work with our most vulnerable children. But, these residential providers must change from a destination where children are kept for years to be an emergency room where treatment is defined, efficacious and the commitment to finding and supporting family is the primary priority.
Because relationships heal, institutions do not.
Sarah Kroon Chiles is the executive director of the Redlich Horwitz Foundation.