Group Homes

Recommendations 7

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  The Board of Supervisors should study ways for Probation and DCFS to develop and evaluate up to 5 pilot projects designed to prevent and reduce the number of new dependents and wards in the system. The standard approaches to prevention are general public education and intervention in high-risk homes (when they can be identified). Successful prevention strategies in both delinquency and dependence cases is likely to require a multi-faceted approach. The Board has previously provided funding to the Service Integration Board (SIB) and some projects are underway in the District Attorney, CAO, and other departmental offices to mitigate some of the factors that effect the generation of new cases. Both Probation and DCFS need to study how to best accomplish this priority and participate effectively in the important integration efforts. The purpose of this recommendation is to challenge the Departments to experiment with and propose new ideas.128 Such innovation should be accomplished by bringing together multidisciplinary teams from within and outside the Departments to develop new prevention strategies on a pilot basis. Relevant nonprofit organizations, community groups, academicians, and professional consultants should also be involved. The pilot projects should include a strong evaluation component with assessments at the end of two years; at which time, the County determines the level of success of the pilots and the viability for sustaining or replicating these pilots elsewhere. The County should undertake at least 5 pilots to increase the chances of developing and implementing effective solutions quickly. One of the key parts of the effort, led by the County Auditor-Controller, should be the development of an estimate of what an average child entering the system costs. The estimate should include all potential cost components, including: a) lost productivity over a life-time as a result of a negative life trajectory and b) the explicit “out of pocket” costs while these children are in the child welfare, juvenile justice, and possibly adult justice and welfare systems. This estimate will help the Board make its “investment in prevention” decision once the pilots identify the most effective prevention strategies.
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  Probation and DCFS should develop more sophisticated approaches to evaluate, monitor, and measure success. The Departments should establish holistic evaluation approaches that consider both quantitative and qualitative components.
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  DCFS should implement new treatment models that are evidence-based and proven to be successful.
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  Develop a system of associated urgent care clinics where patients can be directed, rather than utilizing emergency rooms. 2006-2007 County of Los Angeles Civil Grand Jury 137 TABLE OF CONTENTS PREFACE....................................................................................................................................140 I EXECUTIVE SUMMARY ……………………………………...............……………141 II. HISTORY AND BACKGROUND......................................................................................144 III. PURPOSE.............................................................................................................................154 IV. INVESTIGATION...............................................................................................................155 V. FINDINGS...........................................................................................................................156 VI. RECOMMENDATIONS.................................................................................................... VII. CONCLUSIONS..................................................................................................................187 APPENDICES A – Acronyms.......................................................................................................................190 B – Quantitative Fact-Finding and Analysis C – Group Home Quantitative Findings D – Qualitative Fact-Finding: Site Visits and Interviews E – References 2006-2007 County of Los Angeles Civil Grand Jury 138 TRIPLE JEOPARDY: ABANDONED, NEGLECTED, AND ABUSED CHILDREN OF LOS ANGELES COUNTY PREFACE This investigation by the 2006-2007 Civil Grand Jury (CGJ) revealed that a review of group homes was not a simple matter. The term “group home,” though commonly used, has many different interpretations due to the range of services and quality of care provided, from minimal to comprehensive. The CGJ has redefined the term “group homes” and refers to them as “congregate-care facilities” (see diagram below). Moreover, the authorities concerned with the care of children who are the County’s wards and dependents differ dramatically in their judgments of these congregate-care facilities. The range of quality of care provided varies from truly excellent to abysmal. This situation is compounded by the fact that State funding levels for congregate-care facilities have not changed in many years. This affects the ability to hire qualified staff, establish reasonable staffing ratios, provide aftercare services, and deliver other programs necessary to provide quality services. Beyond the complex evaluation of these facilities lie the uneven, conflicting, and inconsistent efforts made by the Department of Children & Family Services (DCFS) and Probation Department. These Departments manage their assigned children’s cases, including their initial placement, monitoring and tracking them over time, and developing their exit plans (e.g., end-result reporting and outcomes). The State licenses congregate-care facilities. It has established a Rate Classification System (RCL) assigning the level of “residential-based services” provided in the facility. It is the County’s responsibility, however, to guarantee the quality of care provided. This report includes information from on-site visits made by the CGJ to a selected sampling of congregate-care facilities. It explores the changes that DCFS and Probation should be making to improve the quality of care provided and asks the questions: Which of these facilities are inappropriate for placement? Which of these facilities are underutilized? CHILDREN’S PLACE OF RESIDENCE IN-HOME/ CONGREGATE-CARE LOCK-DOWN FOSTER FAMILY RE-UNIFICATION FACILITIES FACILITY Least Most Restrictive Restrictive HOME FACILITY RESIDENTIAL-BASED FACILITIES • Small (<10 beds) • Campus-like settings • Stand alone • Multi-faceted agencies, which include campus-like settings and other services • Multi-faceted agencies with central administrative facility and multiple home facilities • Agency-operated with multiple residential facilities 2006-2007 County of Los Angeles Civil Grand Jury 139 I – EXECUTIVE SUMMARY Jackie’s Story Jackie, a thirteen year old girl was removed from her heroin-addicted birth mother at age 4 after she and her brother were sexually abused by her mother’s boyfriend and slapped and beaten by her mother as a means of discipline. In the first foster home, she suffered more abuse. In the second foster home over a nine year period, she became defiant, suspended from school for fighting, ran away and ended up in a temporary homeless shelter on skid row. In the current residential based facility, she has been found to be intelligent although guarded, has low self esteem, and displays inappropriate affect, unrealistic fear, excessive guilt, anger, mood swings, and depression. She has been described as delusional, suicidal with bizarre thinking, paranoid, and depressed, and self-destructive. She was not on psychotropic medication and was listed as "non compliant”. One medical examination indicated that she was “mentally retarded”, yet another psychological evaluation indicated “cognitive ability - high average”. Although she has a 2.94 grade average (in 9th grade) and wants to be a nurse, she has an inability to focus on her studies. She had formed an attachment to her former foster mother where her brother resides, and reunification is being pursued. CGJ 2006-2007 encountered this case during a site visit. As a result of this case, complaints to the Ombudsman, the Auditor-Controller’s reports, and the findings of previous CGJ reports, the 2006-2007 CGJ decided to investigate the use of congregate care for children in the child welfare and juvenile justice systems. Much of the previous literature refers to “group homes” as an all encompassing category, which does not reflect the breadth of congregate-care facilities and services rendered. The effects of congregate-care settings are confounded with type of facility, quality of facility and staff, staffing levels, severity of problems of children placed, prior placements, services rendered, and other variables. In the County of Los Angeles, children in the juvenile justice system are called wards assigned to the Probation Department; they can be placed in lock-up in camps or Juvenile Hall or in congregate-care settings, typically group homes. Only a few are assigned to live at home or with relatives. A variety of options is available to children, called dependents, in the child welfare system under the DCFS. Dependents are generally placed at home, with relatives, with foster families, or at congregate-care facilities. Probation views congregate-care facilities as less restrictive and a preferred option compared to the two lock-up options. DCFS views congregate- care facilities as the least preferred option for placement of their children. DCFS and Probation are currently using 238 group homes that are licensed by the State of California. The group homes range in size from 5 to 143 beds. The State license determines the monthly fees paid based on the level and type of services provided. The fees range from $2,589 to $6,371 per child per month. DCFS and Probation have approximately 1,500 dependents and 1,300 wards respectively placed in group homes, representing 4% and 23 % of the 38,000 and 5,700 children in the two systems. Within the broad category of congregate-care facilities, the CGJ has developed its own classifications: Residential-based facilities 2006-2007 County of Los Angeles Civil Grand Jury 140 Campus-like settings with a range of services – treatment centers, schools, and transitional programs Multi-faceted agencies, which include campus-like settings and foster family services, adoption services, and residential facilities Multi-faceted agencies with central administrative facility and multiple group home facilities Agency-operated with multiple residential facilities Stand-alone, small group facilities (<10 beds) The trend in the literature and emerging best practices indicate the reliance on group homes should be curtailed. The implication is that group homes are inferior to placement in a foster home because of a lack of a parental authority figure on a 24/7 basis. Dependents and wards need continuity, unconditional love, emotional support, and boundaries needed by children to thrive. The group home environment makes the transition more complicated when a child is reunified with his/her family. In contrast, within the CGJ’s classifications, the CGJ found differences in practice: With appropriate placement, children needing RCL-6 through RCL-10 residential-based services can do well in stand-alone, small group facilities. A number of residential-based facilities have remarkable success with the children in their care. Some had particularly impressive transition programs that provide job and housing support when a child emancipates or ages out of the system. They help them to become young, responsible adults with a solid foothold in the community. Because congregate-care facilities are only a component of a larger system of care for dependents and wards, the investigation’s conclusions go beyond group homes and address systems, organizational, and program issues in the Departments. Specifically: New prevention programs with specific reduction goals are required to staunch the flow of children entering the systems. The Departments, in addition to evaluating the intermediate effectiveness of specific programs, need to follow up on children after they leave the systems and collect longitudinal data to measure the real impact of the systems on a child’s life trajectory. The information systems need to be improved, automated, and integrated to ensure that accessible and comprehensive information is maintained on each child. Team decision-making, involving all the caregivers involved with the child, and where confidential information can be shared, should be the norm to ensure optimal decisions are made for the child. Stability and continuity is important for a child’s well-being. Both systems need to minimize the turnover of Children Social Workers (CSWs); DCFS must reduce the number of placements of their dependents. The Departments should set goals of one case worker throughout the child’s stay in the system and one placement per child. An organizational review is needed to address the current staffing levels in both Departments. New and more realistic case ratios are required and should be related to the complexity of 2006-2007 County of Los Angeles Civil Grand Jury 141 the cases assigned. A higher-level position of case manager should be considered for the more complex cases. The development of new systems, technology, and equipment that provide better information in real time should be part of the review. To support the stability goals, a new comprehensive placement assessment protocol is needed to ensure that each child is: a) assigned a CSW or Deputy Probation Officer (DPO), who are trained caseworkers with the appropriate skills, and b) then placed appropriately. More foster families need to be recruited and new classes of highly trained foster family caregivers are required to reduce the number of children inappropriately placed in congregate-care facilities. Children should not be placed in congregate-care facilities if the facilities are not able to provide high quality, comprehensive services. Improved educational strategies are needed to help many of the children achieve at or above their grade levels and improve their life trajectory. To avoid potentially negative peer influences, DCFS dependents and Probation wards should never be assigned to the same group facility. Some congregate-care facilities raise significant funds in the community to support and enrich their programs and services but overall most are under-funded, given the services they are required to provide. Wraparound Services – that provide supports to families to prevent children from being removed and supports after they are returned or permanently placed elsewhere – are valuable but the efficacy of delegating this to a third-party is questionable because of fragmentation and coordination problems. There is little contact and sharing of information between congregate-care facilities and other care providers or across County departments. Annual forums for sharing successful programs, best practices, and strategies could lead to improved system-wide performance. Children entering both systems are still in their formative years. Many are damaged and vulnerable. Program and system improvements are needed to help more of them attain better life trajectories than they face when they enter the child welfare or juvenile justice systems. The current goals are excellent: a) achievement of permanent placement, including reuniting with parents as fast as possible, and b) placement in the least restrictive accommodation. These goals need to be tempered by practical considerations and the needs of the child. An early removal that negatively disrupts the child’s schooling for instance should be avoided. Despite the current views and best practice research, there will likely always be a subset of children who cannot or should not be placed permanently with their family or relatives. These children thrive better in a comprehensive structured program offered by some of the larger congregate-care facilities that provide care in campus settings. Wards who have been entangled in gangs and children who have substance abuse problems are two examples. This CGJ investigation makes recommendations to: a) ensure the placement of children in congregate-care facilities is appropriate; b) improve their care and potential life trajectories; and c) maintain and improve the support of those congregate-care facilities who are currently successful with the children they are assigned. 2006-2007 County of Los Angeles Civil Grand Jury 142 II – HISTORY AND BACKGROUND NATIONAL TRENDS IN RESIDENTIAL CARE The Child Welfare League of America (CWLA) defines Residential-Based Services (RBS) as: Resident group care encompasses a broad array of services for children with pronounced special needs. Residential services are highly flexible and provide for varying lengths of stay, based on the client’s needs. Lengths of stay may range from a short respite due to tense family situations, to long-term therapy for problems such as drug or alcohol addiction. Although long-term stays in family-like community-based group homes best serve some children’s individual needs, residential group care is usually a temporary placement. Many children in residential care have emotional or physical conditions that require intensive, on-site therapy[;] others receive services from day treatment programs in their communities. Residential care programs are highly flexible and are designed to meet each child’s individual needs.80 RBS can involve a broad array of residential options for children living out-of-home, including half-way homes, campus-based homes, emergency shelters, self-contained settings, and staff- secured settings.81 Child welfare systems attempt to work with children and families in the least restrictive environment (e.g., biological, kinship, or foster family home). When such environments are unavailable or insufficient in meeting the needs of individuals, child welfare systems place dependents into more restrictive settings. Current laws and policies require that children be placed in the least restrictive setting to meet their needs. Relatives or kin are given priority in placement decisions wherever possible. Other family settings include family foster care. Placement priorities are to keep the child: 1) In the home if they are not endangered 2) With relatives 3) In a foster family 4) In congregate-care facilities In some cases, children entering out-of-home care are temporarily placed into an emergency foster care setting, which may be either a family, or a group setting. Of the 500,000 dependents in foster care in the United States, approximately 20% live in a group home or other residential institution.82 Within the social service continuum of care, congregate- care facilities are less restrictive than in-patient psychiatric clinics and juvenile detention centers, but more restrictive than foster family care.83 In all instances, the continuum is building blocks toward reunification with one’s family if possible. Child Welfare League of America (CWLA): Child Welfare, Residential Group: www.cwla.org/programs/groupcare/groupcareaboutpage.htm 81 Curtis, Alexander, & Lunghofer, 2001, CWLA, 2005. Administration for Children and Families, 2003; Jonson-Reid & Barth, 2000a, 2000b. Handwerk, Friman, Mott, & Stairs, 1998. 2006-2007 County of Los Angeles Civil Grand Jury 143 Group facilities are used in a variety of social service settings, including child welfare, mental health, and juvenile justice. Group facilities tend to be: Smaller than other residential facilities, consisting of a medium-size homes capable of housing between 8 and 12 adolescents in a community-based setting Staff secured as opposed to a locked facility Staffed with employees who work 24 hours/day Reliant on the public schools to educate their assigned children Group homes are one of the most expensive placements options for child welfare systems, given the staffing ratios. In 2000, 43% of all substitute care dollars in the State of California were associated with group home placements.84 Because the majority of children never enter a congregate-care setting, and the lengths of stay within these settings is significantly shorter than traditional foster family placements, the high costs and overall proportion of the budget allocated to such placements requires that agencies assess the viability of such placements. Children in group homes stay an average of 10 to 20 months.85 Children from California group homes and foster homes have the lowest median lengths of stay (12 and 13 months, respectively), in comparison with California treatment foster care and kinship care, which have the highest medians (25 and 20 months, respectively).86 Characteristics of Children Served In Congregate-Care Settings Across the nation, approximately 20% of child welfare placement cases enter congregate-care settings because some dependents are better suited to enter such facilities or no other placement options are available. As compared to traditional or specialized foster care homes, children living in congregate-care settings are more likely to be: older, male, minority, experiencing a range of socio-emotional and behavioral problems, and previously involved with the juvenile justice system.87 Congregate-Care Placements A healthy debate exists regarding the effectiveness of congregate-care settings. Central to this debate is the issue of peer groups and the socialization of adolescents living in congregate-care settings. Those supportive of congregate-care placements argue that youth can be influenced by positive peer behaviors. Those advocating the termination of such placements argue that congregate-care institutions generally serve high-risk children in close confines, thus, increasing the chances for reinforcing negative attitudes, values, and beliefs. A chart summarizing studies of the positive and negative effects of residential group settings is on the following page. CA Department of Social Services Research and Development Division (RADD), 2001. CA RADD, 2001. Chamberlain (1998). Berrick, Courtney, & Barth, 1993; Curtis et al., 2001; Knapp, Baines, Bryson, & Lewis, 1987; Mech, Ludy-Dobson, & Hulseman, 1994. 2006-2007 County of Los Angeles Civil Grand Jury 144 Residential Group Care Settings Positive Effects Negative Effects A number of studies have identified positive • In a well-publicized study,92 peer group outcomes: interventions might increase adolescent behavior problems and negative life outcomes in adulthood. ● A study of children diagnosed with conduct disorder in residential care – caregivers’ • On the basis of two experimental studies, the high- concerns decreased between admission and risk youth, compared with low-risk youth, were discharge and six months, one year, and two particularly vulnerable to peer aggregations. years after post-discharge.88 • In part, the potential problems associated with ● A retrospective study of 200 children served in group home placements stem from the ties that group homes in the Midwest – as adults, 70% are often severed between group home youth and had completed high school, 27% had some other more positive role models (peers and college or vocational training, and 14% received adults). public assistance.89 • Group homes often cut juveniles off from their ● A Canadian study of 40 children in resident care non-delinquent and pro-social peers and keep – the majority of the children were functioning them with youth who often are delinquent or have at severely impaired levels at admissions, emotional and behavioral problems (including moderately impaired at discharge, and normal conduct disorders and Attention- one- to three-years post-discharge.90 Deficit/Hyperactivity Disorder (ADHD) in a congregated setting for 24 hours a day.93 A specific clinical model – positive peer culture (PPC) – for youth in the juvenile corrections system • Group care is not safe, does not promote healthy and housed in residential settings found that:91 development, is not stable, exceeds the cost of other types of care, and is not cost efficient.94 • Juveniles are capable of establishing and reinforcing socially acceptable behaviors. • Children from group care report seeing family members less than children in kinship care, are • Juveniles not only take responsibility for their less likely to be reunified, and are more likely to behaviors, but for the behaviors of the entire return to group care, especially children aged 6 to group. 12.95 • Decisions regarding the progression of treatment • As compared with children in specialized foster (e.g., recreational rewards, level movements, care, adolescents living in group care are more family visitation) are made collectively. likely to suffer from extreme behavioral and • As a group, juveniles learn to trust, respect, and social adjustment difficulties, including sexual take responsibility for the actions of others; acting out, developmental disabilities, suicidal norms can be established that not only extinguish ideation and attempts, self-induced injuries, anti-social conduct, but more importantly 88 Day, Pal, & Goldberg, 1994, cited in CWLA Position Statement on Resident Services, pp. 1-2. Alexander & Huberty, 1993, cited in CWLA Position Statement on Resident Services, pp. 2. Blackman, Eustace, & Chowdhury, 1991, cited in CWLA Position Statement on Resident Services, p. 1. Vorrath and Brentro, 1985. Dishion et al., 1999. Osgood & Briddell, 2006. Barth, 2002. Barth, 2002; Wulczyn, Hislop, & Goerge, 2001. 2006-2007 County of Los Angeles Civil Grand Jury 145 Residential Group Care Settings Positive Effects Negative Effects reinforce pro-social attitudes, beliefs, and eating disorders, substance abuse, and behaviors. aggression.96 • Children in group care have fewer opportunities to practice real life tasks.97 • Children in group homes also have more academic problems. Compared with youth in family foster care, dependents in group homes received mostly C or below grades in school, have truancy problems, enroll in remedial classes, and attain lower levels of education.98 Considerable evidence suggests that: a) group care programs increase the likelihood of negative outcomes, and b) detaining children in congregate residential settings may exacerbate delinquency through exposure to deviant peers. Mitigating Factors. The effects of placements may vary by individual, that is, an interaction may exist between congregate-care placements and the characteristics of the individual. The negative effects of living in congregate care is likely to be a function of: Self-identity and influence of other factors (e.g., the developmental status of the child, the interactions of the other children who live there, and the context in which the intervention is provided). Children who are firmly grounded in their identity may be more likely to resist peer temptation. Defiant influences and tendencies (e.g., level of deviance a peer has upon entrance into a facility, the number of deviant peers present, and the length and amount of deviant peer exposure). A child who is moderately deviant may be more susceptible to become involved in delinquent friendships. Educational problems may be more prevalent for those in group care because of children’s limited opportunity for individual development and involvement in extra-curricular activities, which help to promote well-being and self-confidence. Group home facilities may also impede learning and studying because of resource shortages (e.g., lack of adequate study areas and staff to help with homework). Unfortunately little is known about which youth are most likely to succeed in congregate-care programs. To date, no evaluations exist that focus specifically on PPC models within the context of the child welfare system. Few studies have looked at factors which contribute to resilience among young people in congregate care facilities. Resilience is defined as an individual’s ability to cope in a successful manner in adverse circumstances. This skill is not a psychological trait, rather it is a set of protective factors and risks that modify the individual’s response to the 96 Berrick et al., 1993. Barth, 2002. Berrick et al., 1993; Festinger, 1983; Knapp et al., 1987; Mech et al., 1994. 2006-2007 County of Los Angeles Civil Grand Jury 146 situation and occur at critical transition points99. Resilient children in out-of- home care had: 1) high quality relationships with caregivers and friends, 2) received consistent encouragement and support to foster self esteem, and 3) experienced interventions which strengthened social abilities and social connections100 . Emancipated foster youth who were successful in attending a four- year college experienced stable school attendance, a challenging high school curriculum, considerable social support, and participation in prosocial organizations and groups. However, these youth still experienced financial difficulties, psychological distress, and a lack of health insurance and access to health services101.
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  Years 7,769 20.5 73 5.3
• R14-15

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  Years 4,670 12.3 431 31.2
• R16-17

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  Years 4,576 12.0 813 59.0 18 Years and Older 1,930 5.1 61 4.5 Age Total 37,979 100.0 1,378 100.0 Ethnicity Hispanic 19,347 50.9 804 58.3 African-American 12,039 31.7 432 31.3 2006-2007 County of Los Angeles Civil Grand Jury 150