Lutheran Services America

Tuesday, April 9, 2013

Washington, D.C.

Lutheran Services America

Good afternoon. Thank you, Sam.

I have known Sam for many years and am very familiar with the wonderful work that Lutheran Services provides in Child Welfare and Human Services.

Every day in Florida, while I was Secretary at the Department of Children and Families, we depended on Lutheran Services to provide professional, compassionate care to so many children and adults whose lives were disrupted in a number of ways, and for that I have always been grateful.

But when disaster strikes, that’s when you really get a sense of who your friends are.

The tragic earthquake that struck Haiti in January 2010 is one of those times.

The federal government, in essence, deputized the DCF in Florida to handle to repatriation of Haitian Americans living there.

With little time to prepare for such a large scale operation, that had never been done before, Sam Sipes and Lutheran Services stepped up and helped us respond to the needs of more 27,000 Haitian Americans, their dependents and more than 700 medical evacuees.

Sam, I can’t thank you and Lutheran Services enough.

But that was large-scale human tragedy. Most of your work, day-in and day-out, is helping individuals cope with personal or family traumas and tragedies.

Whether it’s providing hope and a future to a child who’s been abused or neglected, or a family in need of the strengthening support services so many of your agencies provide,  our work is not glamorous.

But, it is essential and ultimately very rewarding.

That is what draws us to this work in the first place. And we follow a long line of dedicated professionals, clinicians, and researchers all committed to making child welfare in this country better.

Child Welfare has a long history in this country.

Court cases and laws governing child welfare in North America date back to the late 1600s and were patterned after laws in England.

It wasn’t until the 1820s, though, that states began to enact laws that would allow children to be removed from abusive or neglectful parents.

In 1912, the Children’s Bureau was created to help manage the federal government’s role in Child Welfare. The Children’s Bureau still exists today and is part of the Administration for Children and Families.

In the 1930s, President Franklin Roosevelt’s New Deal architects included was also during this time that states began to enact child welfare and child protection laws in the Social Security Act.

I provide this abbreviated history to make this point: In all of that time, the focus was almost entirely on the safety of abused children, and as the Social Security Act put it, to provide for “neglected and dependent children in danger of becoming delinquent.”

So, you see, for several hundred years, the focus of child welfare was on safety and preventing delinquency.

It wasn’t until after the passage of CAPTA in the mid 1970s, that the focus of child welfare policy and practitioners began to really focus on permanency. And in that time, we’ve come a long way.

Between 2002 and 2011, the number of children in foster care declined nearly 24 percent.

The system went from a daily average of 523,000 children in care during that time to 401,000.

During that same time, the victimization rate of children and youth, the rate of abuse, if you will, declined from 12.3 incidents for 1,000 in 2002 to 9.1 per 1,000 in 2011.

In other words, once we began to focus on Safety AND Permanency, we really began to see the effects of the dual approach and they have been dramatic.

In the last 20 or so years, we’ve tinkered with and improved tremendously our approach to both.

And, I’m proud to say, some of the most significant developments in Child Welfare have come during President Obama’s administration.
In the last 10 years, most of us have focused on how to improve the services and interventions we provide abused and neglected children.

As a result, we have come to a much deeper and better understanding of the profoundly negative impact of trauma…especially multiple traumas that often lead to toxic stress levels.

Through our focus on trauma-informed care, children who enter the system today have the best chance they’ve ever had to succeed in life, despite the trauma they’ve suffered.

And with the policy and practice developments related to adopting children who cannot be safely reunified with their  parents, permanency, and in particular adoption, has improved in terms of time and professionalism.

So, if you’re looking at the big picture, we’re really starting to get safety and permanency right.

For the past decade or so, it has been a casual, implicit assumption that increased or enhanced well-being for the children we serve would follow naturally from these twin pillars of modern child welfare.

And, to a large extent it has. A child who is safer and who achieves permanency quicker is naturally better off than one who hasn’t.

However, that’s not entirely what well-being is about.

When we began the Title IV-E waiver as a grand experiment in allowing states or counties maximum flexibility to achieve safety and permanency, we started to see some really innovative approaches to family strengthening and child resiliency.

We learned so much about trauma that we realized it wasn’t enough to implicitly expect well-being to flow from safety and permanency. 

We had to make well-being an explicit goal, creating a third pillar of child welfare.

The abused or neglected child has suffered so much that we must provide better support and services steeped in evidence and refinement to address these very complex issues.

One of the most important things we learned during the initial IV-E waiver stages is that they work. So, we are continuing them.

Instead of saying to grantees, states and counties, that you must find ways to reduce out-of-home placements where safety is not the issue, that you must move children to permanency more quickly, though we still want and insist on those things, we are saying to them, focus on well-being too.

What does that mean in practice?

It means better screening tools and it means more screenings.

But don’t worry, we are not saying to the states you must do this and you’re on your own when it comes to development and funding.

We’ve worked closely with the Centers for Medicare and Medicaid Services so that states can fully leverage the EPSDT (Early Periodic Screening, Diagnosis and Treatment) benefits to help pay for these costs.

These screenings are important because very often when a child is brought into the system he or she is assessed based on their behavior at that moment.

Tell me, how do you think you would have been assessed shortly after being removed from your parents?

Children in these situations exhibit a whole range of concerning behaviors from violent acting out to near catatonic withdrawal.

In the past, these behaviors may have elicited a psychiatric diagnoses and the child would’ve been prescribed powerful psychotropic medications.

But the effects of trauma can subside, leaving the child chained to these medications for years. That’s why Early and Periodic testing is so important.

We’ve worked very hard and smart to bring clearer guidelines to the prescribing and monitoring of psychotropics in the child welfare community.

These new protocols were developed with the input and participation of all 50 states and several territories.

There’s a great deal of work going on to improve child well-being and there’s more in the planning and implementation stages.

The Title IV-E demonstration projects have provided so many important breakthroughs that we are truly in the golden age of child welfare improvement.

In fiscal year 2012, ACF granted waivers to nine states and currently we are working with 10 more. (Nine previous states are Arkansas, Colorado, Illinois, Massachusetts, Mississippi, Pennsylvania, Utah, Washington, Wisconsin).

We hope to finalize agreements with all 10 in September. (The states are: The District of Columbia, Hawaii, Idaho, Montana, Nebraska, New Jersey, New York, Oregon, Rhode Island, and Tennessee).

As these waiver states generate new ideas and new approaches, we are busy testing them to determine whether they really do deliver better outcomes, the ones that do then become part of the evidence-based interventions that ACF will support and provide technical assistance on for other interested states.

What we’re working on right now in the new waiver states is how to respond to trauma with Trauma-Focused Cognitive Behavior Therapy, Multi-systemic Family Therapy and Parent Child Interaction Therapy.

Our interventions and services must take a holistic approach to the family. They can’t be focused solely on the child.

Those are just the highlights, but you can see that there is quite a bit going on to improve child safety, permanency and well-being.

The private agencies that we work with, that states work with, agencies such as Lutheran Services, are critical to the development of new services and therapies.

The feedback we get back from the clinical community is crucial to how we develop evidence-based interventions and treatments for trauma.

For many, many years now, states have relied on private providers to provide services on their behalf. I don’t see that model changing… only growing and getting better.

I thank you for your commitment to children and I look forward to continuing our important work together.

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