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A White

Paper on Foster

Care in Colorado

November 2002
Introduction[1]

During the federal fiscal year 2000, 13,045 Colorado children spent at least a portion of the year in a foster care home.[2] Colorado’s foster care system is complex. The Colorado Department of Human Services (CDHS) is responsible for supervision of the counties in the provision of child welfare services that include children in out-of-home placements, but it is at the county level that child protection services take place.  These services may result in the removal and out-of-home placement of children in foster care homes. 

The need for foster care homes is greater than counties alone can meet through their recruitment efforts.  Thus many of Colorado’s 64 counties have privatized a portion of their foster care, contracting with one or more of the 60+ private Child Placement Agencies (CPAs), that recruit, train and supervise additional foster homes.[3]  CDHS licenses and monitors CPAs, which recruit and certify foster homes. County-recruited foster homes are certified and monitored by individual county departments of social services.   

            There are approximately 1,489 county-certified foster family homes and approximately 1,794 state-certified CPA foster family homes in Colorado.[4]  Counties also place children in relative and kinship care homes when available.[5]  Thus about 49% of the children in foster care reside in foster family homes recruited and supervised by CPAs while the remaining 51% reside in county-recruited and supervised foster family homes and kinship placements.   

In August 2002, the State Auditor’s Office released its Foster Care Program Department of Human Services Performance Audit, which included findings and recommendations, a review of financial activities of selected CPAs, examination of cost of care, and suggestions for redesigning and improving Colorado’s foster care program. The State Auditor’s Office is authorized by statute to audit only state agencies.  Thus its authority extends only to the State Department of Human Services and state-licensed foster care providers.  The State Auditor is not authorized to audit counties or county-supervised foster care homes absent a special request. Furthermore, the audit focused on only 10 of the 60 private CPAs licensed by CDHS.  Among those reviewed were four CPAs against which the state had taken negative licensing actions in 1999.[6]   

            Colorado’s costs for foster care maintenance and CPA expenditures were $60,075,738 in fiscal year 2000.[7]  A Foster Care Interim Committee was created in 2000 to study the foster care system and propose legislative and regulatory changes necessary to improve the system.  Valuable human and financial resources have been committed to examine and improve the foster care system in Colorado.  A complete understanding of the history and mechanics of this complex system is necessary in order to make informed decisions regarding changes that stand to impact thousands of vulnerable children, state and county agencies and finances, and providers of child welfare services.

Who Are These Children?

            Children in foster care homes generally fall into one of four or five categories based their needs.  Some counties use a level of care system that corresponds to the complexity of the child’s physical, mental, emotional and medical care needs.  Foster parent payments and CPA provider rates in these counties are then directly correlated to the levels and increase accordingly.  Appendix A of this paper contains profiles of children and examples of the various levels of care.

History of Foster Care in Colorado

Prior to 1970, private child placement agencies, such as Catholic Charities, provided only cradle care and adoption services.  Foster care was then available solely through county-recruited foster homes.  In the mid-1970s, a movement arose to move children with developmental disabilities, e.g., mental retardation, out of institutional settings and into the community.  This spawned a request by the state and counties for proposals from agencies and individuals willing to serve children with developmental disabilities.  In response to this request, private child placement agencies expanded their services and recruitment efforts to meet the needs of this population.  Between 1975 and 1980, the state began using the Medicaid dollars available to children with developmental disabilities to pay a monthly stipend to foster parents, establishing the first private foster care rate. 

In the early 1980s, the state expanded its request for foster care services to include therapeutic services[8] to children in foster care and to families in order to serve children at risk of out-of-home placement.  Counties once again privatized many of these services by contracting with CPAs to provide therapeutic services.

In 1994, a class action lawsuit was filed against the state on behalf of children in foster care who claimed to be “increasingly at risk because the system charged by law with protecting them routinely abdicates its charge and abandons these most vulnerable citizens to a dangerously underfunded and inadequately managed bureaucracy.”[9] This suit was settled by a detailed 51-page Settlement Agreement.

In 1996, the General Assembly, in partial response to the lawsuit, passed HB 96-1180, which established a process for counties to contract with CPAs so that the “State would be able to improve its responsiveness to the needs of children who are placed out of their homes.”  Counties were permitted to participate in pilot programs to utilize and evaluate CPAs for foster home and group home care.  Following the conclusion of the pilot program in 1997, the counties were to submit data to the Colorado Department of Human Services.  The Department, in turn, submitted its compiled report evaluating the use of CPAs to the Joint Budget Committee, the House Health Environment Welfare and Institutions (HEWI) Committee, and the Senate Health, Education Children and Families (HECF) Committee.   

Colorado’s current foster care system is funded from several sources.  Some of these sources are federal, such as Medicaid Act Title IV-E dollars.  Other sources include child welfare funding at the state and county levels. Rates paid to CPAs are based on a formula using two criteria: an administrative services rate and an administrative maintenance rate.  The administrative services rate includes the monthly stipend to foster parents, the cost of treatment, and case management of treatment services.  The administrative maintenance rate encompasses traditional overhead costs, e.g., rent, staff salaries, utilities, and expenses related to licensing requirements.  These rates were reduced by 10% in 1997 and remain the same today. Nonprofit best practice and efficiency standards cap administrative plus fundraising costs at between 25% and 40% of expenses.[10] 

There are significant differences between the manner in which county foster care costs are calculated and reported and the manner in which private CPA foster care costs are calculated and reported.  Since 1997, counties have received a block grant from CDHS out of which they must fund all child welfare activities and services.  It is thus difficult to conduct a direct comparison of county and CPA costs.  See Appendices B and C which detail differences between county and CPA foster care services and costs.  These charts also address concerns regarding cost comparisons and comparable activities, as raised in Audit Report Recommendation No. 17, and clarify CPA administrative costs.

            During the 2001 legislative session, the General Assembly passed several foster care reform measures.  CDHS then adopted rules, many of them applicable only to CPAs, including such requirements as annual submission of an independent audit, completion of additional departmental audit documents, modifications in licensing requirements, upgraded staff credentials, and changes in staffing patterns.    Due to the delay inherent in the rulemaking process and the fact that most nonprofit CPAs follow the calendar year as their fiscal year (the state uses a July-June fiscal year), complete compliance with these mandates had not been achieved prior to the State audit.

How the System Works

            Colorado’s foster care system provides temporary and long-term care for children who are placed outside of their homes for protection purposes or because they are in conflict with their families or communities.  The goal of foster care is to provide a safe, stable placement for the physical and mental well-being of a child during the development and implementation of a permanent plan.  Most children in foster care have experienced some form of abuse or neglect, although some children enter the system upon the death or serious illness of a parent or guardian. 

            Children typically enter the foster care system through either a court proceeding or private voluntary placement.  Before a child can be placed outside of the home by a court, the county department of social services must investigate a complaint of abuse or neglect and determine that the filing of a petition for dependency and neglect of the child is warranted.  Children in imminent danger may be removed from the home by the county for up to 72 hours prior to a formal court hearing.  The court conducts a hearing during which evidence is presented.  The judge then makes an initial determination regarding out-of-home placement based upon the best interests of the child.  When a court places a child outside the home, it vests legal custody of the child in the county department of social services.  The court must then order the development of a treatment plan and must periodically review the case with the goal being either the return of the child to the home or the implementation of an alternative permanency plan within 12 months. 

The county department of social services is responsible for placing the child in an appropriate environment, whether that is in a foster home, a group home or some other type of residential facility.   If a foster home is appropriate, the county has the option of placing the child in a county-recruited and supervised foster home or referring the child to a private CPA, which in turn identifies a suitable foster home for the child. 

            County foster homes are recruited, licensed and monitored by the county department of social services.  CPA foster homes are recruited and certified by the CPA, but are licensed and monitored by CDHS.  When counties place children in county-supervised foster homes, the county retains the case management responsibilities for the child.   When the child is placed in a CPA foster home, the CPA provides the majority of the case management services.[11]

Prior to a CPA referral, the county develops a profile of the child to determine the services the child will likely require in foster care. Upon receipt of the referral, CPAs generally review and assess the child’s needs, build services around those needs and document services in a written plan.  Before the child’s actual physical placement in the foster home, CPAs meet with the foster parents to discuss the structure of the home, the expectations of the foster parents, the child’s needs, and the extent of involvement, if any, with the child’s biological family.  Within one to two weeks of the child’s physical placement, medical and dental appointments are scheduled, and school enrollments are made by the CPA.

Regulation of Foster Homes

            All family foster care homes, whether county recruited or CPA recruited, must comply with Colorado’s “Rules Regulating Foster Care Homes” and the “General Rules for Child Care Facilities.”  In addition to these rules, CPAs must comply with the state’s 50-page “Rules and Regulations for Child Placement Agencies,” which include oversight of CPA operations, a variety of requirements related to licensing, staff credentials, personnel and staffing levels, documentation, financial reporting and submission to random, unannounced inspections. 

CPAs Enhance Colorado’s Foster Care

            Child placement agencies play a vital role in caring for Colorado’s abused and neglected children and enhance the ability of Colorado to care for its most vulnerable children.  CPAs increase the availability and quality of child welfare services because they:

• Provide placement for one-half of Colorado’s foster children
  
• Provide choices of placements for Colorado counties
  
• Offer options for families seeking to become foster families
  
• Provide non-governmental options for kinship care and foster care for those families wishing to join a private agency
  
• Can increase resources through nonprofit CPAs partnering with communities in volunteerism and philanthropy
  
• Provide individualized, consumer-friendly, 24-hour support services to the child and foster family
  
• Contribute to the child’s multidisciplinary team to oversee correct placement and permanency planning
  
• Help to advocate for the best interests of the child
  
• Can provide non-adversarial treatment and case management for biological parents and family members

·         Provide community-based placements

·         Work closely with county administrators to eliminate duplicate functions

·         Have positively impacted the number of adoptions statewide

·         Offer step-down placements and services for children leaving residential facilities

·         Offer an important placement in the needed continuum of care

·         Provide emergency and after-hours placements

·         Provide in-home services to families

·         Match the strengths of the foster home to the child’s needs and

·         Provide specific ethnic placements.

County and CPA foster care homes together provide essential services to children in out-of-home placements and their families.   CPAs provide additional flexibility in the child welfare system. For example, CPAs worked with El Paso county administrators to eliminate duplication of functions, with CPAs providing case management, recruitment and retention of foster and adoptive families.  Other benefits of CPA services include the development of sibling foster home care and an increase in adoptions statewide. 

Response to Selected Audit Recommendations

CPAs recognize the importance of the Foster Care Audit and appreciate the recommendations of the committee.  Their overriding concern is the safety and well-being of children in foster care.  As part of a larger system, CPAs understand the need to collaborate and follow the standards set forth in legislation and regulations.  CAFCA responds to recommendations that relate directly to its CPA practices in Appendix D

Summary

  Child Placement Agencies are an essential private partner in the collaborative process of meeting the needs of Colorado children who require out-of-home placement.  Historically, CPAs have served those children with the greatest medical, physical, mental, emotional and behavioral needs.  They constitute a viable alternative for counties needing to place children and for potential foster parents who wish to parent these children outside of the traditional social services structure. 

APPENDIX A

PROFILES OF CHILDREN AND GENERAL LEVELS OF CARE USED BY SOME COUNTIES

Level 0

A Level 0 child is developmentally on target, has only basic food, clothing, shelter and parenting needs, and requires no physical, medical or mental health services aside from routine well-child care.  The child’s case management needs are similarly minimal. 

Toby[12]

Toby is 6 weeks old and was relinquished by his birth mother, a nineteen year old college student.  He is a healthy baby who ranks in the 60^th percentile for both weight and height.  He sleeps through the night, smiles and is developmentally on target.

  Level 1

A Level 1 child has some needs in addition to those of a Level 0 child.  A child at this level would require a minimum of 4 hours of therapy (group and/or individual) per month, but no more than 5 hours.  These additional needs would require the CPA to make 2-3 contacts (by telephone or in person) with the foster family per month or only a low level of case management services.

Tommy

Tommy was abandoned by his mother shortly after birth.  He initially had difficulty sleeping through the night and is still restless and wakeful many nights.  Although he eats well, Tommy is underweight.  He understands when spoken to but doesn’t talk very much.  Tommy, now two,  still wears diapers. He follows his foster siblings around the house and calls his foster mother “mom.”   

Level 2

A child identified as being at Level 2 requires no fewer than 5-8 hours of individual therapy and 4 hours of group therapy per month.   Occasional crisis intervention, weekly foster parent support and once or twice monthly face-to-face contact with the child and family would be required at this level, falling into the category of a moderate level of case management services.

 Karly

Karly is nine years old and came into the custody of Social Services because her birth mother constantly left her alone in the motel room where they lived.  Karly shows depressive-like behavior, sometimes purges following meals, and sucks her thumb when nervous. She has had very little dental care and her foster mom will complete numerous dental appointments to fill cavities. 

Karly attends fourth grade and, as a special education student, has an Individual Education Program (IEP). Her foster mom has observed a possible hearing deficiency and has noticed some signs of memory problems.  Karly needs speech therapy and a mental health evaluation.

Her foster mom makes sure that Karly attends twice weekly visits at Social Services with her uncle and birthmother, a long-time prostitute.  These family visits are traumatic for Karly, who had uncontrollable crying following the most recent visit.  Karly’s foster mother is required to participate in twice monthly therapy sessions and is involved in daily scheduling and monitoring, in-home therapy activities and crisis management.  Karly needs consistent structure, daily routine around hygiene, support in behavior management, assistance with schoolwork and monitoring of medication.

Level 3

At Level 3, a child needs regularly scheduled, weekly multiple-session therapy, which may include family therapy for 8-12 hours per month, and the involvement of multiple therapists. On-going crisis intervention and face-to-face contact with the child and family a minimum of once per week is required, necessitating a high level of case management services. 

Jillian

Jillian is an extremely energetic 11-year-old.  She is in her third foster home.  She was infected with lice when she initially came into this home and has a history of sexual behaviors that she reports were encouraged by her birth mother. Jillian has reported auditory and visual hallucinations.  She is very emotional and has fits of crying.  She is aggressive, has difficulty controlling angry, has destructive behaviors and is verbally abusive.  She must be supervised closely around other children.  Jillian has witnessed extreme violence and is a victim of sexual abuse.  Her birthparents were recently involved in another domestic violence incident resulting in the birth mother’s hospitalization and the birth dad’s incarceration.  Parental rights were recently terminated, and Jillian struggles with feeling “dumped.”  Jillian takes Paxil, an antidepressant, and Respirdol, for her aggressive behaviors.  A psychological evaluation has now been requested to review the Post Traumatic Stress Disorder diagnosis. 

Level 4

Level 4 services are provided to a child who is moving from a residential treatment center setting to therapeutic foster care, or has complex, chronic medical needs.  A child at this level has all of the needs of a child at level 3, plus face-to-face contact at least 2-3 times weekly.  Discharge planning participation and coordination of therapeutic services is essential. Case management services at this level are consequently extremely high. 

Amanda (Medical Needs)

Amanda was placed in foster care at 15 months of age.  She was born premature with short-gut syndrome and was taken from her birth mom because of medical neglect.  She has been with the same CPA foster family for six years.   

  Amanda is now seven years old now and wants desperately to be like all the other kids at school.  That is very difficult because she has a Broviac catheter that dispenses constant nutrition and medication directly into her heart.  It is worn in a backpack and its beeping is a constant reminder of serious medical issues.  The backpack is heavy and causes sores on Amanda’s shoulders.  She has a degenerative condition that is causing gradual blindness.  Amanda is fitted every three weeks for new glasses and is learning Braille.  The helmet she wears during school recess protects her from a fall or bump that might cause a detached retina.  She has started to tantrum frequently, especially about being “hooked up” to her machine.  She wears diapers and has little control over her bowels. Amanda receives speech, occupational and physical therapy.  She has had numerous surgeries and is stressed by pain, weakness, frequent medical appointments, surgery, intrusive diagnostic procedures, examinations and constant handling.  Despite it all, she is very social and well liked by her peers.

  Amanda requires care virtually 24 hours a day, every day of the week.  Her foster mom constantly watches for fever and blockages in gastric tubes.  Amanda requires nine hours daily of monitored intravenous total parenteral nutrition (TPN) feeding, so her foster mom hooks up the system at night and often sleeps in the room with Amanda.  Amanda is transported at least once a week to Children’s Hospital for eye and gastric follow-up appointments.  Because she is sensitive to smoke, heat, pollutants, etc., the family deals with constant respiratory complications.

Brandi (Step-Down Needs)

Children in custody of county Social Services and who have successfully completed treatment in a Residential Treatment Center are sometimes transitioned back into foster care as a “step-down” placement.  Brandi, who has a history of sexual abuse and drug abuse, is one of those children. Her birth dad has never been involved in her life, and her birth mom is a recovering addict.  Brandi has poor boundaries and extremely low self-esteem.  At seventeen, she is promiscuous and is identified by local law enforcement as a known prostitute.

Brandi’s foster mother must constantly supervise her whereabouts.  Foster mom is constantly in touch with the school and participates in weekly therapy with Brandi.  There are numerous court hearings for Brandi and her foster mother, as the seventeen-year-old is on probation for auto and petty theft.  Brandi does not respond to rules, lies frequently and is manipulative.  She receives therapy in a day treatment academic and therapeutic program where she has constant  supervision, receives therapeutic intervention from staff and where she is required to focus on life skills rather than academics.

Brandi has run away from numerous previous foster homes and has recently run away from her current foster home during the night.  As a result, the county worker has requested installation of a monitor above Brandi’s bedroom door. 

                                                               

APPENDIX B

COMPARISON OF COUNTY AND CAFCA[13] CPA FOSTER CARE SERVICES

APPENDIX C

COMPARISON OF COUNTY AND CAFCA CPA FOSTER CARE EXPENSES & REIMBURSEMENTS[18]