It’s time to start asking hard questions about treatment foster care near you

Across the country, the number of kids in need of foster care is soaring.

Some states, like Illinois and Arizona, have seen their foster care population rise nearly 50 percent in the last six years, and numbers are creeping up across the board — spurred in large part by the country’s simmering opioid epidemic.

Most of the kids taken into state custody end up in standard foster homes, managed by state child welfare agencies. But some are put into what’s called treatment foster care, an opaque realm of foster care reserved for highly traumatized children. Unlike traditional, state-run foster care, treatment foster care (called therapeutic foster care in some states) is managed and overseen entirely by for-profit and nonprofit companies.

On the surface, the idea makes sense: some kids have higher needs than a regular foster home can handle, so the best thing to do is put them in specialized homes, managed by behavioral health companies with expertise in dealing with things like PTSD or, sometimes, violent or sexually aggressive behavior.

But the quality — and safety — of treatment foster programs varies widely from state to state.

There is no national definition of treatment foster care, and no federal standards for the services treatment foster care programs provide to kids.

“There’s confusion in the states about the quality standards that should be assured,” in large part because of that lack of federal guidance, said Laura Boyd, a policy director at the Family Focused Treatment Association, a nonprofit that represents treatment foster care programs.

Take New Mexico for example. That state doesn’t require treatment foster care companies to be accredited or to use evidence-based treatment models, which, critics say, means kids who get placed in treatment foster care most often don’t get the mental health services they need.

It also means that many kids are put into treatment foster care who shouldn’t be there —especially teenagers, who are disproportionately placed in treatment programs for behavior not uncommon for their age, like smoking pot or sneaking out at night with friends.

Ezra Spitzer, director of the Albuquerque-based foster care advocacy nonprofit NMCAN, calls this “creating a clinical diagnosis for teenagerhood.” He estimates that 80 percent of teens in New Mexico’s system are placed in treatment foster care programs, oftentimes run by companies with histories of safety lapses and legal problems. It’s not supposed to be that high — the share of kids placed in treatment programs should be a small portion of the overall foster population.

Inappropriate placements in a strict, tightly-regulated treatment foster home environment can cause some teens to act out more, often landing them in residential treatment centers or even juvenile detention, Spitzer says.

Oversight is a problem too: New Mexico only has one state employee in charge of monitoring the state’s 11 treatment foster care companies. That’s led to chronic safety violations, and in some cases, serious child abuse within treatment foster homes.

On the other hand, West Virginia, a state with a smaller population and with a similar surge in foster care cases fueled by addiction, has beefed up its treatment foster care monitoring division with four specialists, and has given foster care companies access to its database of child abuse and law enforcement investigations to help them better screen foster parent applicants.

Other states have taken similar steps to protect kids. Utah is currently working on reforms to their treatment foster care system. Oklahoma has developed strong guidelines on treatment foster care quality and has boosted its budget for foster care, even as other programs face cuts.

But even in those states that have taken steps to improve their child welfare system, many challenges remain. It’s fertile ground for reporters — journalists who dig into to treatment foster care in their area are likely to find an interesting story.

The Administration for Children and Families, a division of HHS, maintains some data and research about foster care. But since treatment foster care is run by private companies, records on those programs can be tricky to find. States do maintain some level of oversight, and documents such as compliance reviews and complaints should be available through a public records request to your state’s child welfare agency.

The Consortium for Children, a nonprofit from San Rafael, California, provides assistance to states throughout the country and can be a good source for reporters looking into foster care companies. States contract them to train foster placement workers and they audit states’ home study programs. Most of their state-specific documents aren’t public but they may be able to help you figure out which documents to request from the state you’re exploring.

Most states require treatment foster care companies to undergo an audit every year or two as a condition of their license renewal. Requesting the most recent state audits of treatment foster care companies can be a good place to start looking into what problems exists, and which companies are performing especially badly on safety measures.

In New Mexico, I was able to use those audits to reveal widespread and chronic noncompliance with safety protocols by treatment foster care companies. Those same documents also showed that, despite knowing about the safety issues, state child welfare authorities were renewing the licenses of even the most problematic companies. It was the first time a media spotlight had been shone on these programs. Chances are that reporters who investigate treatment foster care in in their state will be the first to scrutinize their local programs too.

[Photo by Petra Bensted via Flickr.]