National Organization of State Associations for Children
March 16, 2012
It’s a pleasure to speak with you today. I want to thank NOSAC for bringing together this dedicated group of leaders.
I see this as a great opportunity to hear from child advocates across the United States.
For those of you who might not be familiar with ACF, let me give you a quick overview of my agency:
ACF is a $60 billion dollar operation that encompasses everything after the “and” in Health and Human Services.
Our mission is to improve the social and economic well-being of the most at-risk Americans—the poor, the young, the disabled, and the displaced.
We are the 21st century incarnation of many of the old 60’s War on Poverty programs, plus more.
Our programs affect people from the cradle to the coffin and are the underpinning of the social safety net.
ACF helps those whose voices are otherwise unheard and who struggle to achieve the American dream.
People like:
Infants and toddlers in Head Start
Kids in child care
Foster and adoptive children and families
Newly arrived refugees from many lands
People with developmental disabilities
Native American tribal governments
Families needing child support
Adults and teens who want skills training and a good job
People who want to learn to save their money for the future
Low income families who can’t afford heat in the winter
And many more
WAIVERS
Next month, one of the cornerstones of my agency — The Children’s Bureau — celebrates its centennial. One hundred years ago, President William Howard Taft launched an agency with a $25,000 dollar budget to try and lower maternal and infant mortality rates and deal with issues of child labor and juvenile delinquency.
Today, that agency has an $8 billion dollar budget. Its reason for being is to create better lives for at-risk children and families by cooperating with local, state and tribal partners like you.
We’re glad that there have been significant improvements in the child welfare system, even though we realize there’s still a long way to go.
For example, in the last 14 years, the foster care caseload shrank 25 percent --from 559,000 to a little over 400,000.
Every state except Arizona has fewer kids in care than they had in 2006. Some, like Hawaii, have seen dramatic decreases.
A part of that improvement is because fewer kids are coming in the front door of the system. When we’re talking about child welfare, an ounce of prevention is worth a ton of cure.
But there’s a catch 22 for states built in to the system—a catch that penalizes prevention and counterproductively rewards removing kids from homes.
The problem is that under existing federal law, if a state or county safely reduces out-of-home care—which is obviously what we want--then federal funding goes down. Under ordinary conditions, money is tied to caseload.
The IV-E waivers that we’ve been granting for years give states a chance to try out other approaches to reducing their caseloads of kids in care without losing money.
Under the waivers, if out-of-home caseloads and costs decrease, the state retains federal funding. That money can be invested to help children while they stay at home, or for reunification, or for services to help children move more quickly toward permanency if reunification is not realistic.
The waivers reward achievement, not failure. They make flexibility and local determination possible. No more “one size fits all.”
I speak from my experience in Florida.
The waiver allowed us to safely reduce the number of children in out-of-home care by 37 percent. That’s 10,000 more children in permanent homes instead of state care.
The waiver also let us provide services to the whole family, not just the child. So it took us less time to reunify the family and fewer children came back into care.
Understand though-- the waiver is not a panacea.
It must be combined with well-informed leadership and a willingness to do things in a new and better way.
Implemented correctly, it is a powerful tool that can make positive reform in child welfare more likely to happen and more likely to have the desired result.
Waivers offer the opportunity to provide an array of flexible approaches, such as:
o Intensive in-home services,
o Integration of substance abuse, mental health and domestic violence treatment into child welfare
o Using foster parents as mentors to biological parents, toward the goal of eventual reunification and
o Intensively recruiting and training potential foster parents.
When you provide more effective prevention and intervention services like these, more children who can safely remain in the home will do so. But they will still get oversight and intervention to help make sure that home is a safe place.
When you provide more effective reunification services, families that are capable of caring for their children have the support they need to get their kids back.
When you safely reduce the amount of out-of-home care, you can focus on improving the quality of the foster homes for the children who really must be in care.
Still, I know some of you have concerns about pursuing a waiver. Some people still fear that waivers will undermine the entitlement of children to IV-E funds.
I can assure you that it will not.
Congress was worried about this too, so they put a specific restriction into law. The Secretary of HHS has broad authority to waive provisions of Title IV-B or Title IV-E, but the Secretary cannot do anything to reduce entitlement under IV-E.
I assure you that the Secretary and I are committed to maintaining the entitlement nature of Title IV-E.
HUMAN TRAFFICKING
Another issue in which we are deeply involved is raising awareness of domestic human trafficking, a modern form of slavery.
HHS is tackling this problem in a variety of ways:
The Department supports the National Human Trafficking Resource Center’s 24-hr, toll-free hotline.
In Fiscal Year 2011, the hotline received over 16,000 calls—a 43% increase from the previous fiscal year. Of this total, 752 cases resulted in a direct report to law enforcement— a 51% increase from the previous fiscal year.
HHS’ domestic violence programs may serve trafficking victims within the context of existing services. Currently, HHS supports State Domestic Violence Coalitions in each State and Territory—some of which are involved in State-level coordination of services and advocacy for both domestic and foreign victims of trafficking.
ACF’s Office of Refugee Resettlement is responsible for raising public awareness of this problem and of the services available for victims.
Our Office of Runaway and Homeless Youth supports over 400 community-based organizations serving runaway and homeless youth—who, in turn, may also be subject to sex trafficking and commercial sexual exploitation.
One of ACF’s most important strategic initiatives for the rest of the year is to expand technical assistance about how to fight trafficking to involved stakeholders and regional offices.
ACF also approved the establishment of an internal workgroup to better integrate services for trafficking victims.
In addition, we plan to strengthen our collaboration with other agencies inside and outside of government to defeat trafficking.
AFFORDABLE CARE ACT
It’s been more than two years since the President signed one of the most historic pieces of legislation in our history, one that was a century in the making—the Affordable Care Act.
The law’s provisions have been slowly rolling out—amid some controversy, to be sure.
But there are some parts of the law that should be without controversy—and that’s their effect on families and children.
Let me give you just a few highlights of changes that are already taking place:
o Under the new patient’s bill of rights, insurance companies can’t deny coverage to children because of a preexisting condition like asthma or diabetes. They can’t cancel coverage for a sick child when the insurer finds a mistake on your paperwork. These abuses used to be legal.
o Young adults under the age of 26 can now stay on their parents’ health plans. As of today, there at least 2.5 million young people who are benefitting from this provision of the law.
o In many cases now, children can get preventive services for free. Services like:
Routine well baby and well child visits
Routine vaccinations
Oral and vision care…and more
o In many states, more families can now qualify for the Child Health Insurance Program.
o The law also established a new home visiting program for mothers of infants to provide them the support and information they need to give their children the best start in life.
o And it set up the Health Professions Opportunity grant program, to train folks with low incomes for promising careers in the booming field of health care.
In the realm of children and families, the ACA has so far been a great success.
2013 BUDGET PROPOSALS
In a time of austerity, ACF’s programs fared relatively well in the President’s 2013 budget request.
For example, the Budget continues the President’s commitment to early learners by:
o increasing investments in Head Start and Early Head Start and
o dedicating an additional $825 million to child care, including funds to help low income families get child care and improve program quality.
The budget also reaffirms our emphasis on responding to the needs of America's most vulnerable families.
o It invests in child support enforcement in ways that help families become self-sufficient and help fathers assume appropriate responsibility for their children. And it doesn’t just focus on fathers--these approaches recognize that children do better when both parents are involved in their upbringing.
o The budget proposes to improve the child welfare system by building on practices that we know are effective
o And it lays out a variety of strategic, targeted investments to improve services for children and families.
Finally, the budget responds to the President's call for a government that is accountable and transparent, with a significant emphasis on tough performance standards and close monitoring.
PSYCHOTROPIC DRUGS
Another issue at the top of our agenda is the safe use of psychotropic drugs in children in foster care. We share this concern with our sister agencies, the Centers for Medicare and Medicaid Services and the Substance Abuse and Mental Health Services.
This year we’re offering expanded opportunities to States and territories to strengthen their systems of prescribing and monitoring the use and effectiveness of such drugs among children in care.
We’ve urged State directors of child welfare, Medicaid, and mental health to develop action plans for addressing this issue.
We recognize that these systems struggle to achieve positive outcomes for the children in their care who have complex social-emotional, behavioral, and mental health problems.
Children in foster care represent only three percent of children covered by Medicaid. Yet a study of pharmacy claims in 16 States showed that foster children enrolled in Medicaid were prescribed antipsychotic medications at nearly nine times the rate of other children receiving Medicaid.
We don’t deny that medications can be essential. However, we must strengthen our oversight of their use and overuse in order to responsibly treat children in the foster care system.
It is absolutely essential that we enhance our efforts to make sure that psychotropic meds are prescribed only when needed and in the quantity needed, not to keep kids quiet or to divert attention from other situations that could be causing problems—like bullying or abuse.
The Fostering Connections to Success and Increasing Adoptions Act of 2008 should help. It requires States to strengthen medical oversight and expand access to medical care for children in the child welfare system.
The purpose of these requirements is to ensure that children in foster care receive high-quality, coordinated medical services, including appropriate medication, even as their placements change.
The law’s provisions offer States the opportunity to address some of the issues related to psychotropic prescription oversight for children in foster care.
TRAUMA-INFORMED CARE
The Child and Family Services Improvement and Innovation Act of 2011 (Public Law 112-34) includes new language concerning the social-emotional and mental health of maltreated children.
States’ five year plans must now include details about how they will address the emotional trauma that comes with maltreatment and removal from home. The plans must also describe how states will monitor the use of psychotropics.
State Medicaid/CHIP agencies and mental health authorities play a significant role in providing access to quality mental health services for kids in care.
Therefore, we strongly encourage these agencies to collaborate in any efforts to improve these kids’ health.
We stand ready to assist you in any way we can.
Now I think I’ve talked enough. I’m eager to take your questions.