The highest-needs children in America's foster care system will go to bed tonight in jail despite not facing criminal charges. Luckier kids will be assigned a budget hotel room. Others will wedge a cot or inflatable mattress between cubicles or beside a conference table. This is what it means to be a foster kid with complex behavioral, mental, and physical needs in a funding and regulatory climate that leaves state child welfare agencies with no good options.
Something has gone wrong in a child's life for them to enter the foster system. People closest to them or circumstances sometimes beyond anyone's control let them down. For me, it was an alcoholic mother and a volatile procession of would-be stepfather figures. But my story isn't unique, and many are far more harrowing, like the three young children who police delivered to my foster family after their father murdered their mother before turning the gun on himself.
Child development science holds that children succeed best in family environments instead of institutions. However, this near-universal shift toward deinstitutionalization has strained child welfare agencies' placement capacity, particularly for older children and those with complex traumas or health challenges.
The pandemic heightened these challenges through staffing shortages, inflation, government revenue shortfalls, and widespread hesitancy among foster families to house new children over disease transmission concerns. Consequently, the pool of willing foster families cratered while the U.S. shed congregate care capacity without developing alternative pipelines. Recent federal restrictions didn't help, either.
As horrible abuses in congregant settings were exposed, confusion among federal lawmakers about the varying modes of group care led to sweeping limitations and prohibitions. The 2018 Family First Prevention Services Act (FFPSA) imposed new restrictions on federal reimbursement for congregate care that did not meet narrow eligibility requirements. The statute led many facilities to restrict their capacity to continue qualifying for Medicaid reimbursement.
These new restrictions on congregate care programs caused huge placement bottlenecks in the states.
At least two dozen states and the District of Columbia have already housed foster care children in offices, hotels, emergency rooms, detention centers, and homeless shelters because of the inability to secure appropriate alternative placements. On any given night, hundreds and potentially thousands of high-need foster care kids live in wildly inappropriate settings that fail to provide the essential support and stability that these youth need and crave.
We don't have precise national data on the number of children exposed to this risk because foster care hoteling is the dirty open secret of child welfare. Most states only concede they engage in the practice due to litigation or media investigation.
Many children have emotional and mental needs greater than the system can serve, even through therapeutic foster placements. Foster families lack both the medical training and time to provide the professional care that the highest-need youth in the system require. Often, these kids need psychotropic intervention and the sort of round-the-clock care that's only possible in a congregant or psychiatric residential treatment facility.
For years, the federal government has ignored its responsibility to these children, allowing too many to fall through regulatory cracks in the system. Owning that failure starts with amending FFPSA to allow reimbursement eligibility for congregant care programs serving youth with confirmed behavioral health diagnoses and significantly increasing federal investment in alternative care models that meet the complex needs of children in the system.
The immense emotional trauma that foster care children shoulder is magnified by constantly shuttling them from lifeless conference rooms and cubicle farms to astringent hospital rooms and frightening jail cells. That's no life, and it's no wonder that many have had emotional and behavioral health problems worsen in the care of their government.
Easing the historic placement backlog is a complex challenge, and it'll include getting kids out of the system who don't need to be in it anymore and back with their families. But it will also require the feds to allow states to route the highest-need children into professional therapeutic environments to receive the care and attention they deserve.
Congress helped create this problem, and now they must fix it—unless they're willing to offer up their cushy offices as makeshift bedrooms for our highest-needs kids.
Rick Jackson is a businessman and philanthropist who spent six years in Georgia's foster care system after running away from a broken home. He serves as the founder and chief executive officer of Jackson Healthcare, one of the largest health care staffing agencies in the United States.
The views expressed in this article are the writer's own.
Uncommon Knowledge
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