A Foster-Care Tragedy Worthy of Dickens

Los Angeles has a foster-care system driven by what is available, not what is needed. Children receive too few services too late. Thousands are shuttled to ineffective and expensive institutional care. They are poorly monitored, with no consistent, individualized care. Not surprisingly, many deteriorate in county care, populating our jails, homeless shelters and mental wards after they “age out” of a failed system. Many never overcome the effects of the abuse or neglect they have suffered.

At a time when funds for children’s services are ever more scarce, we are paying more for less in terms of healthy outcomes. Millions of federal dollars are at risk because of our inability to meet reasonable guidelines for stable placements--through family reunification, adoption or long-term foster care. More important, the children whom the system is intended to protect are being irreparably harmed.

This is not a problem that can be solved simply by changing the person at the top, as L.A. County has done twice in recent years. It requires a philosophical change at all levels--from a system based on what services are available to a system based on earlier intervention and individualized needs.

A suit will be filed today on behalf of foster children put at risk by a failed system. It will demand a wider array of mental health services available under Medi-Cal; multidisciplinary assessments of the needs of each child based on all relevant information; continuity in services and plans for each child; and the development of services and providers to ensure that no child will be rejected.

MacLaren Children’s Center in El Monte, the county’s emergency shelter for abused and neglected children, is an apt symbol of our failed system. Designated a short-term shelter, it has become instead the county’s warehouse for the unwanted. Once a home for wayward girls, it retains its foreboding atmosphere. Such control as exists--in many instances, poor management has led to children being abused, often by other residents--is prison-like.

Some MacLaren residents languish for months beyond the ostensible 30-day limit. Many more are constantly “recycled” as foster homes reject them, adding to the trauma that brought the children to the county’s care. One plaintiff, removed from her home as a result of sexual and physical abuse by her stepfather, was moved by the county 28 times between the ages of 9 and 13. Another is in a locked facility because of the healthy impulse to find a better life elsewhere. In less than three years, she was moved 25 times.

When Dickensian stories like these are related to the uninformed, they are greeted with incredulity. It is often assumed that lack of resources must be the problem. Of course, no one desires these rootless sojourns through impersonal care. And our society could, no doubt, better invest in the needs of its children. But lack of money is not at the root of these problems.

Inertia and lack of accountability are the culprits. The county has become increasingly defensive about releasing cost estimates.

According to a recently released Los Angeles Grand Jury report, however, costs during the 2001-2002 fiscal year at MacLaren approximated $757 per day for each child--more than $276,000 per year. Group-care facilities, recognized as contrary to the interests of most children, were estimated to cost about $33,000 annually per child five years ago. By contrast, children at risk who can be assisted without removal from the home cost less than $5,000 a year, and foster home and kinship placements less than $10,000 a year.

Medi-Cal, through the early and periodic screening, diagnosis and treatment program and other federal programs, can pay for many of the intensive services that children need. True case management would ensure the effective use of such services to enable children to remain in--or quickly return to--their homes, be freed for adoption or settled in long-term foster care.

The county recognizes the penny-wise, pound-foolish nature of the system. In addition to grand jury reports, state audits, independent evaluations and testimony before the Board of Supervisors, it brought its own expert in to evaluate and make recommendations in 1998.

Dr. Robert F. Cole, an independent expert nationally recognized for his work with disturbed children, centered his recommendations on an “integrated delivery system,” such as “wrap-around” care, that would coordinate services and deliver them in a family-like environment, or the child’s home, whenever possible.

A successfully tested method, the wrap-around concept is used in other counties in California and in other states, where it has reduced cost and improved the outcomes of children in foster care. The goal is for caseworkers, therapists, health providers and schools to work together to ensure children prompt and stable placements and the early development of a long-term plan to see children reunited with their families, adopted or placed in long-term foster care.

Two years after his initial report, Cole praised the county for being poised to implement coordinated services for foster children. But in that time, the county had contracted with only two providers for wrap-around care, serving two children each. Although additional foster care providers have been found since 2000, wrap-around care and other types of intensive care are virtually unavailable in a system providing services to more than 50,000 children a year, with slightly less than 38,000 in county custody. Half of those in custody are estimated to have serious emotional problems. Those problems will become increasingly difficult and expensive to treat if effective care is not provided.

The U.S. Supreme Court has held that due process under the Constitution requires the government to protect from harm any child it takes into its custody.

The Constitution is violated when children deteriorate in county care or are subjected to policies--such as 25 different placements in less than three years--that no disinterested professional would countenance. Federal Medicaid laws are broken when needed medical services for children are not provided.

The lawsuit to be filed today will ask the court to cut the knot of inertia and hold accountable the county and the state officials responsible for oversight.