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Adolescent Permanency Jennifer Renne Kathleen McNaught Andrea Khoury Joanne Brown.

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1 Adolescent Permanency Jennifer Renne Kathleen McNaught Andrea Khoury Joanne Brown

2 Statistics About Youth in Foster Care AFCARS data, as of March 2003, indicates that there are: 542,000 children and youth in foster care Youth ages 11 years and up account for 49% (260,457) 60% of the children and youth in care are children and youth of color African American - 38% Latino children - 17% Native American youth Immigrant population Race/Ethnicity

3 Placement settings for all children/youth in care were: Preadoptive homes (4%) Relative foster family home (24%) Non-relative foster family home (48%) Group home (8%) Institution (10%) SILP programs (1%) Runaway youth (2%) Trial discharge to their families (3%)

4 Permanency Goals 44% of the total had a goal of reunification 22% had a goal of adoption Despite the fact that it was stricken from the ASFA statute, 8% (n=45,792) of these children and youth had a goal of Long Term Foster Care 6% or 33,309 youth had a goal of emancipation.

5 Profile of Youth Aging Out 18 years old 3 or more years in care Multiple Placements Multiple workers Not likely to have completed education May have health or mental health needs likely to return to bio-family

6 Describe the Terms PermanenceAdolescence

7 Describe the Terms Permanence –Durability –Solidity –Immovability –Eternalness Adolescence –Exploration –Risk Taking –Mood Swings –Transition

8 Defining Permanency Permanency planning involves a mix of: Family-centered Youth-focused Culturally relevant Philosophies, program components and practice strategies. All designed to help children and youth live in families that offer continuity of relationships with a nurturing parent(s) or caretakers coupled with the opportunity to establish lifetime relationships (Maluccio and Fein, 1993)

9 The Concept of Permanency for Youth The concept of permanence is often not clear-cut for adolescents in foster care; permanency can be ambiguous. Adolescence is by definition a time of transformation, growth, and change (physically, intellectually, morally, spiritually, socially, and emotionally). Developmentally, adolescents are struggling to identify who they are and as a parallel process they are also developing their own unique worldview. The primary developmental tasks are identity transformation and establishing independence. Within a backdrop of distrust of adults, reluctance to accept advice, and resentment of adult authority.

10 The Concept of Permanency for Youth Developmentally, adolescents are separating from adults and trying to determine their own identities, their own values, make their own decisions, and ultimately create separation from their families. As teens struggle through this separation, they are scared. The fear is masked in a rebelliousness that is often viewed negatively by adults. The rebellion usually is a rejection of anything adults view as valuable. This is part of the challenge experienced in working with any teenager.

11 The Concept of Permanency for Youth Adolescents tend to operate in the realm of concrete thinking and permanence is, at best, an abstract idea. How a teen feels about their current situation will influence their decisions. For many foster youth, previous experiences clue them in to the fact that some families are not permanent. Permanency goals can be viewed as abstractions in themselves by youth who may view them as constructs being developed by adults and agencies. This is especially true when youth are not involved in the direct planning of their own permanency goals.

12 Adolescent Development Youth in care have more difficulty than average, and this period is tumultuous even for youth not in care. Internal Struggles. While balancing a need for security and nurturing independence, many youth experience low self esteem, reinforced by labelling such as “problem child” or “at risk youth.” The most important thing: the behavior of youth is about them and their new development, not about others. Context. All teens need similar reinforcements (stability, caring adults, strong peers), but each child is different, too. Experiences in the welfare system shape their world view as do gender, race, religion, etc. Validating this allows healthy development.

13 Case Study Discuss the important facts. What reasonable efforts could have been put into place to prevent removal? Was there a least restrictive alternative? Discuss grandmother’s role in the case. What are the permanency issues with Stephen? Should TPR be discussed? Concurrent planning? Is visitation sufficient?

14 Family Centered Casework and Legal Strategies Which Support Permanency Targeted and appropriate efforts to ensure safety, achieve permanence, and strengthen family and youth well-being. Reasonable efforts to prevent unnecessary placement in out-of-home care when safety can be assured. Appropriate, least restrictive out-of-home placements within family, culture, and community – with comprehensive family and youth assessments, written case plans, goal-oriented practice, and concurrent permanency plans encouraged. Reasonable efforts to reunify families and maintain family connections and continuity in young people’s relationships when safety can be assured.

15 Filing of termination of the parental rights petition at 15 months out of the last 22 months in placement – when in best interests of the youth and when exceptions do not apply. Collaborative case activity – partnerships among birth parents, foster parents, the youth, agency staff, court and legal staff, and community service providers. Frequent and high quality parent-child visiting Timely case reviews, permanency hearings, and decision-making about where youth will grow up – based on the young person’s sense of time. Family Centered Casework and Legal Strategies Which Support Permanency

16 Essential Elements to this Process Family-Centered and strengths/needs based practice Service delivery which is community based Cultural competency and respect for diversity Open and inclusive practice, with full disclosure to parents and youth Non-adversarial approaches to problem solving and service delivery Concurrent rather than sequential consideration of all permanency options

17 Barriers to Youth Permanency Barrier #1: Permanency planning for adolescents is not a priority. There is limited understanding of, and lack of, training for staff regarding permanency planning for adolescents. Barrier #2: Sequential case management, rather than concurrent planning, continues to be the dominant method of practice. Barrier #3: There is a dearth of permanent families available for older youth. Barrier #4: Family members and others significant to the adolescent (fictive kin) often have limited involvement in the permanency planning process. Barrier #5: Programmatic and fiscal support for pre- and post- placement support services have been insufficient to achieve permanency.

18 Pathways to Permanency for Youth Youth are reunified safely with their parents or relatives Youth are adopted by relatives or other families Youth permanently reside with relatives or other families as legal guardians Youth are connected to permanent resources via fictive kinship or customary adoption networks Youth are safely placed in another planned alternative permanent living arrangement which is closely reviewed for appropriateness every six months

19 Working with Adolescents It is incumbent upon adults who have a relationship with the young person to help them to consider the option of lifetime connections by helping to reframe the initial “NO!” into a “Yes” or “I’ll think about it.” It may initially help the young person to review their past connections and experiences to help put their thoughts and feelings into context. Helping youth to play an active role in their own planning and assisting them in developing a promising pathway to permanency that will be lifelong and sustaining can be a challenge, but it is not an unattainable goal. Helping youth to consider permanency and lifetime- connectedness only becomes possible when adults who work with young people are committed to facilitating the identification of connections in their lives.

20 CIRCLE OF CONNECTIONS

21 Case Study Relevant Facts What would a discussion for permanency sound like? Should we continue to explore reunification? Who are the people in Stephen’s life that should be considered for permanency? What efforts should the agency be making with Stephen? What services should be investigated to achieve permanency?

22 Working with Adolescents Who cared for you when your parents could not? Who paid attention to you, looked out for you, cared about what happened to you? With whom have you shared holidays and/or special occasions? Who do you like? Feel good about? Enjoy being with? Admire? Look up to? Want to be like someday? Who believes in you? Stands up for you? Compliments or praises you? Appreciates you? Who can you count on? Who would you call at 2:00 a.m. if you were in trouble? Wanted to share good news? Bad news?

23 Working with Adolescents Who are the three people in your life with whom you have the best relationship? Would it help to review where you have lived in the past? To help you recall important adults in your life? To whom have you felt connected in the past? Who from the past or present do you want to stay connected to? How? Why? How are you feeling about this process? What memories, fears, and anxieties is it stirring up?

24 Communication Techniques Do not take it personally Ask non-accusatory questions Be careful with “why” questions – instead, ask “what happened?” to avoid making the youth defensive Ask open-ended questions Avoid making judgments, assumptions Be careful about the language you use Meet the foster youth half way – explain things Encourage open dialogue – be responsive

25 Involving Youth in Permanency Efforts Youth must be involved in the process and must have input Many youth want to be adopted, even if they initially say no Youth need to be involved in recruitment efforts Youth need to be able to identify persons with whom they feel they have connections Youth need to work with professionals who understand them and enjoy working with them Models of Permanency Options for Older Adolescents in the U.S.- me for resources, examples of specific programs

26 What Else Can You Do to locate permanency resources? Carefully review the case record. Review the youth’s entire case record in search of anyone who has done anything that could be construed as an expression of concern for them, including former foster parents, former neighbors or parents of friends, members of their extended families (aunts, uncles, cousins, older siblings), teachers, coaches, guidance counselors, group home staff, or independent living staff. Given that some youth have been in care for prolonged periods of time, case records can have many volumes. The entire record, all volumes, should be explored in an effort to uncover clues about possible connection both past and present. Third party reviewers can be helpful in the process of uncovering these possible connections as case workers who have been assigned the case may inadvertently miss connections that may be more visible to a fresh eye.

27 Carefully Look at Foster Parents and Others Known to the Youth Interview the young person’s current and former foster parents, as well as group home staff and child care staff to determine who the youth currently has connections to: who does the young person get telephone calls from? Who has the young person had a special relationship in the past? Who visits the young person and whom does the young person visit? Has the young person formed a bond with any group home or child care staff that might turn into a permanent connection?

28 Provide Information About Adoption to Youth and Family Engage the youth, his or her parents (if the youth is not currently freed for adoption) and foster parents or prospective adoptive parents in a discussion about shared parenting and ongoing contacts with members of the youth’s birth family after the adoption. Youth and parents need help understanding that although a termination of parental rights ends the rights of the birth parents to petition the court for visits or other contacts with their child, ad TPR does not prevent the young person from visiting or contacting members of his or her birth family.

29 Supporting Permanency for Older Adolescents Through Positive Youth Development Approaches Mentoring Life Books Person-Centered Planning Family Group Conferencing Digital Storytelling Appreciative Inquiry Family-to-Family Approaches Youth Empowerment Approaches.

30 Title IV-E and ASFA Reasonable Efforts to Finalize Permanency Plan- new tool for advocates The ILP should be a “written description of the programs and services which will help such a child prepare for the transition from foster care to independent living.” Education Physical and mental health care Housing Formation of relationships with caring adults Understanding of community resources, public benefits, and services Daily living skills Permanency linked to well-being – education, health CFSRs

31 Case Study Discuss relevant facts. What should the permanency plan be? Concurrent plan?

32 ASFA as it applies to transitioning youth out of foster care Another Planned Permanent Living Arrangement (APPLA) Versus: –Long-Term Foster Care –Group Care / Residential Treatment –Independent Living –Emancipation (fill in state) Law Compelling Reasons Reasonable Efforts Concurrent Planning

33 Permanency Options Under Adoption and Safe Families Act Return to the Parent Adoption Legal Guardianship Permanent Placement with a Fit and Willing Relative * Another Planned Permanent Living Arrangement (APPLA) (*must document compelling reason)

34 Compelling Reasons 2 different provisions: 1.The agency determines it has a “compelling reason” not to file a termination petition for child who has been in care “15 of the last 22 months.” 2. “Compelling reason” why “another planned permanent living arrangement” is being selected as a permanency option.

35 What is an “APPLA?” ASFA defines the term as “any permanent living arrangement not enumerated in the statute.” 42 U.S.C. 475(5)(C) “Planned” means the arrangement is intended, designed, considered, premeditated, or deliberate “Permanent” means enduring, lasting, or stable Includes: –physical placement of the child –quality of care –supervision –nurture

36 What is an “APPLA”? Permanency goal for the child The objective is to craft the most stable, secure arrangement possible Permanency includes something more than merely meeting the child’s immediate physical, educational, social, and mental health needs Key to the child’s future happiness and success is the development of relationships with members of the child’s family and communities

37 Permanency Options Under (fill in state) Law example here is Virginia § Return custody to prior family Custody to relative other than prior family Terminate parental rights (Adoption) *Permanent Foster Care *Services to achieve independent living status for child 16 and over *Another Planned Permanent Living Arrangement (Residential Care) (* must document compelling reason)

38 Permanency Options Under (fill in state) Law example here is Virginia (continued) In Virginia these permanency options are all considered APPLA for federal purposes and must be documented with compelling reasons: Permanent Foster Care Services to achieve independent living status for child 16 and over Another Planned Permanent Living Arrangement (Residential Care)

39 Long-Term Foster Care / Permanent Foster Care Group Care / Residential Treatment Independent Living Emancipation

40 Use of Long-Term Foster Care –The statute struck the term “long-term foster care.” –The preamble to the regulations further explains: “Far too many children are given the permanency goal of long-term foster care, which is not a permanent living situation for a child.”65 Fed. Reg –LTF/C is not stable, may disrupt often, leading to frequent moves for the child and instability.

41 What about Group Care/Residential Treatment? Rarely is group care a living arrangement that is planned and permanent –Consider group care a step towards achieving the child’s permanency plan of adoption, reunification, etc., not a goal. –Group care should not be considered an APPLA, if the child’s release from group care is reasonably likely during the child’s minority. –Group care as an APPLA should require clear evidence that the young person will not be able to function in a family setting before reaching adulthood.

42 Independent Living –Consider Independent Living a set of services, not a permanency goal. –Requirement under IV-E for family case plans to include ILPs “where appropriate for youth ages 16 and older.” A written description of the programs and services which will help such a child prepare for the transition from f/c to independent living. –IL services should meet the child’s physical, psychological, emotional, educational needs –Job skills –Education –Safe housing –Connections to family, i.e. siblings, caring adults –Peer connections –Cultural identity –Understanding of Community Resources, Public Benefits, and Services

43 CONCURRENT PLANNING Reasonable Efforts to finalize an alternate permanency plan APPLA and : Reunification? Adoption? Relative Placement?

44 Second required R/E finding under ASFA. Judicial finding - whether the agency provided reasonable efforts to finalize the permanency plan. Within 12 months of the child’s entry into foster care and every 12 months thereafter. A negative, late, insufficient or missing finding means the agency is ineligible for IV-E dollars until the court makes a positive finding. The finding must be detailed and child specific. Frame this as a “reasonable efforts” issue APPLA: R/E to Finalize the Permanency Plan

45 Reasonable Efforts Inquiry  Have other permanency options been fully considered and ruled out for valid reasons?  Have compelling reasons been reviewed at each and every permanency hearing and at each review to determine whether a more preferred permanency option is possible?  What efforts has the agency made to identify and recruit a permanent placement for the child?  Has the agency considered the parents? Relatives? Current and former caretakers? Mentors, coaches, teachers, counselors, or employers?  Have we asked the child about preferences or ideas for placement options?  Is this placement the best way to meet child’s needs?

46 Reasonable Efforts Inquiry  Is the proposed plan actually a “permanent living arrangement?”  What support structures are being put in place?  Mentoring  Community based programs  Does the adolescent have any special needs, and what services is the agency providing?  What efforts has the agency made to assess the safety, quality, and stability of the APPLA?

47 The Chafee Act Background Information Signed December 14, 1999 Title I: Foster Care Independence Program – Independent Living Title I Subtitle C: Medicaid for ages General Accounting Office: “… as a group, [children in foster care] are sicker than homeless children and children living in the poorest sections of inner cities.” Usually they lost Medicaid when exiting Foster Care

48 FCIA and the Chafee Program Purposes. To identify youth likely to remain in foster care, and help them: Transition out of the system Get education, and services for employment Prepare for post-secondary education Have personal and emotional support Get Life-skills education and support Have vouchers for education available First 5 purposes were part of original 1999 act; 6 th purpose added in 2002 created ETV program.

49 Requirements of the State Youth must be involved in designing their own program. Allow youth up to $10,000 in savings. (previous cap at $1000) foster and adoptive parents, group home workers, & case managers Use federal dollars for training foster parents, foster and adoptive parents, group home workers, & case managers about adolescents and independent living. Provide services for youth with disabilities. Make benefits and services available to Native American youth in the same way they are available to other youth.

50 Other Chafee Issues Increases funding for independent living services - $140 million Increases funding for independent living services - $140 million Concurrent planning: independent living services & permanency planning Concurrent planning: independent living services & permanency planning Services to include personal and emotional support, i.e. mentors Services to include personal and emotional support, i.e. mentors Increased accountability: outcome measures Increased accountability: outcome measures Collaboration with private and public sector Collaboration with private and public sector

51 Parameters for States Wide discretion States can use up to 30% of their Chafee money to provide room and board for youth who have aged out of foster care after turning 18 and are under 21. Some states elect to use the whole 30% for housing, while others use less. States have the option to extend the Medicaid coverage of youth in foster care until age 21. Only a few states have elected to use this particular Medicaid extension option, but a number of others provide alternative avenues for extending health care coverage.

52 Services the State can provide Not exhaustive list of services. Assistance in obtaining a high school diploma or GED Career exploration, training, job placement, retention Training in daily living skills, finances Substance abuse prevention Preventive health activities Education Training and employment services Preparation for postsecondary training and education Mentors and interactions with adults

53 Expanded Medicaid Eligibility –New optional Medicaid eligibility group for youth who are or were in foster care at their 18 th birthday –States can limit this group through one or more of (look up state law) : An income or resource test – cannot be more restrictive than for the State’s low-income families with children eligible, A maximum age – through 18 or 19 years, for example, rather than 21. (Utah currently at 19, subcommittee of Governor’s Task Force considering extending to 21) Foster Care status – only to children who were eligible for maintenance payments or independent living services under IV-E.

54 The Importance of Medicaid Eligibility –Entitles youth to the full Medicaid package Includes the Early Periodic Screening, Diagnostic, and Treatment Program (EPSDT) When EPSDT identifies a physical or mental condition, the young person is eligible for all additional diagnostic, treatment, and follow-up services allowed under the Medicaid Program that are medically necessary The young person is eligible even if they are not specified in the State’s Medicaid plan.

55 The Importance of Medicaid Eligibility Entitles youth to the full Medicaid package Includes the Early Periodic Screening, Diagnostic, and Treatment Program (EPSDT) When EPSDT identifies a physical or mental condition, the young person is eligible for all additional diagnostic, treatment, and follow-up services allowed under the Medicaid Program that are medically necessary The young person is eligible even if they are not specified in the State’s Medicaid plan.

56 Medicaid State Match –States are responsible for the non-Federal share The Federal Medical Assistance Package (FMAP) is from 50 to 76.8% The FMAP percentage is the same one applied to Federal funding under Federal Foster Care and Adoption Assistance Programs (FFCAAPs).

57 Medicaid State Match –Sources for States’ matching funds States usually rely on State general funds Some allow other public entities to Medicaid financing Child welfare agencies may contribute through an intergovernmental transfer to the State or local Medicaid agency under its administrative control State funds appropriated for child welfare may be used Federal funds may not be used for matching unless they are authorized by Federal law for matching use.

58 Medicaid Plan Amendment Approval –State Medicaid agency must prepare an amendment to its State Medicaid Plan Add the eligibility group of youth to be covered State may submit the plan at any time to its Health Care Financing Administration (HCFA) Regional Office for approval Effective the first day of the quarter submitted to HCFA in approvable form HCFA Regional Office staff are available to provide technical assistance –States are strongly encouraged to elect this new Medicaid option to ensure that children transitioning from foster care get the physical and mental health care they need

59 Education and Training Vouchers For two and four year universities, vocational training programs, and job training programs. Wide discretion as to who receives an ETV voucher, how much it is worth, and what costs qualify. Federal law allows up to $5000 per year or the cost of attendance, whichever is less. States have similar latitude in plan design under the ETV program as the other Chafee programs. States decide the best method of distribution including application forms and criteria. 20% match by the state, 80% by federal funds.

60 Education and Training Vouchers Also under the Chafee Act, but with separate funding. Some eligibility criteria are different. Youth who meet their state’s eligibility requirements for Chafee services will qualify for ETVs. Two exceptions: Youth receiving ETVs, in some form of higher education at age 21, and making satisfactory progress, can continue through 23. Older youth who were adopted out of foster care after they turned 16 may also receive ETVs if they are continuing post-secondary education after turning 18. They can also continue through age 23.

61 Learning About, Implementing Chafee –Youth Advocates should work to educate them about their new rights to independent living and health services Youth and court-appointed attorneys should work together to help youth learn about the FCIA and to access appropriate services Encourage and support youth’s efforts to be heard in the implementation process via, but not limited to: –Formal meetings with their assigned caseworkers to develop their own independent living plans –Participation on state youth advisory boards State-specific brochures, websites on Chafee for youth

62 Learning About, Implementing Chafee –Youth Who Have Already Exited Foster Care Learning about FCIA (Chafee) can be more problematic Effective outreach to these youth is essential If these youth are aggrieved of agency decisions denying or limiting them benefits, they should: –contact their local legal services offices to see whether they can provide representation –Even if these programs cannot provide services, their staff may be able to refer youth to: »local pro bono programs, »law school clinics, or »attorneys who can represent youth free of charge. –Youth who exited foster care might contact the attorneys who represented them in their dependency court cases, who may be willing to represent them or refer them to other legal resources.

63 The Role Courts Can Play –Juvenile and Family Court judges can be instrumental role in the FCIA and ensuring that youth have access to appropriate, comprehensive independent living services and health care In the late 1980’s, the federal Adoption Assistance and Child Welfare Act of 1980 (AACWA) was amended, requiring a finding regarding specific services needed for any child 16 and over transitioning from foster care A youth’s case plan must include a written description of these programs and services The amendment’s intent was to make case plans specific enough for implementation and encourage early planning ASFA and the FCIA do not change the above provisions.

64 The Role Courts Can Play –In many states, the court’s authority to rule on youth’s cases extends to age 21. In others, it extends to 18 or 19. –Judges can monitor the provision of services to youth, ensuring that agency services are not prematurely terminated –Advocates should support state legislation that will authorize juvenile and family courts to maintain jurisdiction over the cases of youth leaving foster care up to age 21.

65 The Role Courts Can Play –Those working with transitioning youth should make sure that youth’s commitment or custody to the child welfare agency is not prematurely terminated. –Under the FCIA, termination of agency commitment or custody before their 18th birthdays will deprive them of eligibility for independent living and Medicaid benefits –Education of all parties involved, including and especially the youth themselves, is essential.

66 Adolescent Well-Being - Education Education is a critical building block to finding employment, affording adequate housing, and obtaining needed health care. A national study from 1991 reported only 48% of youth aging out had graduated high school. A 2003 study of FC youth referred to IL classes from one Midwestern county showed: 73% had been suspended at least once since the seventh grade, 16% had been expelled; 29% had physical fights with students; 63% had experienced at least one midyear school change since seventh grade 58% had failed a class in the last year. However, 70% wanted to attend college.

67 Adolescent Well-Being - Education Major Issues – Secondary Education Mobility/Lack of School Stability Lack of an advocate Determining Appropriate Education Decision Maker Quality schools and education services Access to Records Special Education Drop out vs. GED vs. High School diploma School Discipline Issues Lack of post-secondary planning/transitioning

68 Adolescent Well-Being - Education Major Issues – Post-Secondary Education Exposure to Options Decision making about educational future Supports throughout decision and entrance process Financial supports throughout education experience Ongoing emotional support education experience

69 Education -- Critical Federal Laws Foster Care Independence Act (not exhaustive) Secondary education Assistance in obtaining a high school diploma, career exploration, vocational training, job placement and retention Assistance in receiving the education, training, and services necessary to obtain employment Post-Secondary education Prepare for and enter postsecondary training and education institutions

70 Education -- Critical Federal Laws McKinney-Vento Act “Homeless” youth receive free, appropriate education. Removes obstacles delaying or preventing access, like residency, record, guardianship requirements, and lack of transportation. All school districts must have a liaison. Includes youth “awaiting foster care placement.” Applies to some youth in foster care & some who have aged out and haven’t finished high school. The youth or their advocate must contact the McKinney-Vento liaison for the school district they attend to gain enrollment.

71 Education -- Critical Federal Laws No Child Left Behind (NCLB) Youth attending schools that have been designated “in need of improvement” for two consecutive years must be able to attend better schools. The schools provide transportation. Youth attending schools designated as “persistently dangerous” or who have been the victim of a crime at school, have a right to transfer. Youth attending schools that have been designated “in need of improvement” for three of the four previous years must be offered supplemental education services at the school system’s expense.

72 Education -- Critical Federal Laws Individuals with Disabilities Education Act (IDEA) See “Special Considerations for Youth with Disabilities” in Chapter IV. Section 504 of the Rehabilitation Act/Americans With Disabilities Act See “Special considerations for Youth with Disabilities” in Chapter IV.

73 Education Discipline: There are minimum due process protections that schools must afford students accused of school violations resulting in short-term (under 10 day) suspensions: Notification of violation Opportunity to refute charges Explanation of evidence relied upon Schools may have additional procedures for these short-term suspensions, including some limited appeal process to a higher-level administrator within the system.

74 Education Financing for Higher Education Federal Pell grants, Stafford Loans, and state financial aid are based on financial need. Scholarship programs aimed at youth formerly in foster care at the state and national level. A number of states have tuition waiver programs for youth aging out of care Education and Training Vouchers Tips for Attorneys and Judges (p. 24) Questions to Ask Youth (p. 25)

75 Health Children in foster care are at higher risk for health- related problems than the general population. Access to Services and Records: A longitudinal study of foster youth in Wisconsin found that only 15% of the youth were assisted in obtaining their medical records and 11% were helped getting health insurance before discharged months after discharge, 62% felt “not very well prepared” or “somewhat prepared” to obtain their own health information. 47% still in foster care reported mental health services, but only 21% reported them months after discharge.

76 Health Importance of Access to Services and Records: A high level of quality medical service requires continuity of care. Doctors must be able to access a patient’s complete medical history in order to fully address patients’ medical needs. Medical histories also help diagnose, and treat chronic or worsening conditions. Many children in foster care have been unable to establish a “medical home” where information about health diagnosis and services can be gathered and stored.

77 Health - Federal Programs and Services Foster Care Independence Act Medicaid Extension This is the Chafee Act’s Medicaid provision, discussed earlier.

78 Health - Federal Programs and Services Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Qualifying children should be provided with periodic screening, vision, dental, and hearing services provided in the state’s plan States are required to cover all medically necessary services regardless of whether the state plan covers them. States are also required to do outreach to eligible youth and their families. EPSDT is funded through a state’s Medicaid program.

79 Health - Federal Programs and Services Medical Record Requests and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Covered entities must protect individually identifiable health information, and child welfare agencies could be considered “covered.” Unless there is a federal or state exception, child welfare agencies must keep private the medical information regarding the children in their care. This can be difficult for agencies since they often make medical decisions and consenting for minors. Once a child ages out of care, he or she can control access to personal health information.

80 Health - Federal Programs and Services State Children’s Health Insurance Program – SCHIP The federal government extended health care coverage to age 19 for youth whose family income is 200% of the poverty level or less. While youth under age 19 meet their state’s specific income guidelines, they can qualify If the state used SCHIP funds to expand Medicaid, can’t have different version for some recipients. If the state created or expanded existing state insurance, the version can be different. Tips (p. 31) Questions to Ask Youth (p. 31)

81 Confidentiality - child welfare advocates need information: To inform foster and adoptive placements of children’s health issues To investigate child abuse and neglect To help court decide whether a child is endangered and must be placed To develop good case plans for families To decide whether to provide reunification services to parents

82 More HIPAA (Health) Covered entity cannot use/disclose individually identifiable health information Exceptions: –To protect patient from abuse/neglect –For treatment purposes –Pursuant to court order –Authorization from patient

83 More FERPA (Education) Parents must have access to their children educational records; to others, parental consent is required –Exceptions: May disclose if emergency and knowledge of information is necessary to protect health/safety of student May disclose pursuant to a judicial order or lawfully issued subpoena Regulations define parent: a natural parent, guardian, individual acting as parent in absence of parent

84 CAPTA Reports and records made and maintained pursuant to the purposes of CAPTA shall only be made available to: –Subject of report –Gov’t entities or agent carrying out its duty to protect children from abuse/neglect –Citizen review panels –Fatality review panels –Grand jury/court if information is necessary for determination of an issue before the court –Other entities identified by state statute

85 AACWA In order for a state to receive federal funds under AACWA, it must demonstrate that it restricts the use of or disclosure of information to purposes directly connected with –Administration of the state plan –Any investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of such plan Available medical and educational information about the child must be shared with foster parents and child caring facilities

86 KCFSA CAPTA amendments; take effect June 24, 2004 Mandatory sharing of CPS information to public agencies (& agents) needing it to protect kids Promote CPS linkages & referrals for physical, developmental, and mental health needs of children (suggests need for HIPAA guidance) Continuity, coordination and collaboration between the child welfare and juvenile justice systems Collaboration & cross-training with substance abuse, health, domestic violence, and other agencies Congress stated its intent that if abuse and neglect court cases are open to the public, state CAPTA grant eligibility is not adversely affected

87 Housing Children in foster care sometimes leave the system without basic independent living skills, unresolved issues surrounding their removal from their parents, alcohol/substance abuse, lack of adult support networks, no income source, and/or insufficient education. Each of these issues can affect a youth’s ability to obtain and maintain appropriate housing.

88 Housing Major Issues: Affordability Availability/Safety Sustainability Addiction Returning to Inappropriate Family Environments

89 Housing Realities Two important facts about housing programs: First, the goal for most federal and state programs is to provide short-term housing while giving educational assistance, job training, life-skills training, and others. There are other ways. Many youth leaving care may be more creative. They may live with family, former foster parents, a friend’s parents, coach, or employer. Since judges and attorneys link youth to services and resources before and often after they turn 18, these non-traditional resources should not be overlooked. For some youth, these alternative choices provide a better safety net than traditional housing options discussed below.

90 Housing – Critical Federal Programs Title IV-E Foster Care Funding States may use their Title IV-E funds to create a variety of programs addressing housing needs specific to older youth under 18. States have been creative in addressing this need, for example, by providing supervised independent living programs for older youth to create an environment similar to that of living on their own while maintaining the child welfare safety net. States cannot use Chafee dollars for housing programs for youth under the age of 18.

91 Housing – Critical Federal Programs The Foster Care Independence Act (FCIA) (Chafee) Allows each state to spend up to 30% of the Chafee dollars on housing for youth ages 18 to 21. Housing may also be covered under Chafee’s ETV program as education-related expenses. Texas – specifies 30% of Chafee funds for “aftercare room and board.” Illinois - housing and counseling services, start-up and supplemental money for up to 12 months A foster child emancipated from foster care before 18th birthday is not eligible for any housing under FCIA. This applies even to runaway youth, so be sure not to close the youth’s case until after 18.

92 Housing – Critical Federal Programs Transitional Living Program (TLP) under the Runaway and Homeless Youth Act Longer-term supportive housing for up to 18 months. May include job, life-skills training, basic education and GED classes, on-site health care. “homeless” means ages who cannot live with a relative and have no other safe place to go. a social worker, homeless shelter, doctor, or legal advocate can refer youth. Most programs also allow for self-referrals The National Resource Center for Youth Development maintains a listing of TLP programs organized by region. Over 150.

93 Housing – Critical Federal Programs Housing Choice Vouchers (Section 8) Three major requirements: 18 years old or older. Employed or have a steady stream of income. Must be “very low income,” not exceeding 80% of the median income for the area. The recipient pays 1/3 of his or her salary for rent. If other people are benefiting from the voucher, then it may be revoked. Everyone must be listed on the application, and must be “family.” Although this may include cousins, grandparents and nieces, this does not include friends and acquaintances.

94 Housing – Critical Federal Programs Family Unification Program (FUP) Uncertainty in HUD’s finances affects FUPs funding. A protection for families in danger of losing children due inadequate housing. In 2000, coverage extended to youth aging out, or who left foster care after their 16 th birthday. Not currently funded, but it was for two years. Allows access to special Section 8 vouchers. Most have no time limit, but FUPs are 18 months or less. FUP also requires the agency referring the youth to the program to be responsible for their aftercare

95 Housing – Critical Federal Programs Supportive Housing Program (SHP) / McKinney-Vento Act Must be homeless before housing assistance Youth no longer in foster care, who ran away, or left their foster parents or group home may qualify HUD awards funds as annual competitive grants can be used on a variety of services in the state: emergency shelter, supportive housing programs, financial help to those who received eviction notices Tips (p. 47) Questions (p. 48)

96 Other Areas of Focus Employment (p. 33) FCIA Workforce Investment Act Job Corps Americorps Conservation Corps U.S. Military Tips and Questions (p. 40) Youth with Disabilities (p. 50), Teen Parents (p. 63) State Information for Older Youth in FC (p. 68) In the Courtroom, Guides for Easy Referral (p. 70)

97 PERMANENCE FOR YOUNG PEOPLE BREAKTHROUGH SERIES COLLABORATIVE

98 Philosophy All policies, programs, practices, services and supports to achieve and support permanence for young people should be developed and implemented in ways that: –Are driven by the young people themselves, recognizing that young people are the best source of information about their own strengths and needs and are leaders of and full partners in all decision-making and planning for their futures –Begin at first placement. Planning for permanency is initiated immediately, and all efforts are made to place a young person with one stable permanent family when out-of-home placement is needed.

99 Philosophy –Acknowledge and demonstrate that permanence includes: a stable, healthy and lasting living situation within the context of a family relationship that includes at least one committed adult; reliable, consistent and healthy connections with siblings, birth parents, extended family and a network of other significant adults; and education and/or employment, life skills, supports and services. –Recognize that every young person is entitled to a permanent family relationship, demonstrate that the agency is committed to achieving that goal, and include multiple systems and the community at large in the effort to identify and support such relationships.

100 Philosophy –Honor the cultural, racial, ethnic, linguistic, and religious/spiritual backgrounds of young people and their families and respect differences in sexual orientation. –Recognize the strengths and resilience of young people, their families, and other significant adults and take a strengths-based approach to working with them. –Ensure that services and supports are provided in ways that are fair, responsive, and accountable to young people and do not stigmatize them, their families or their caregivers.

101 Components –Empower young people through information, support, and skills (including independent living skills) to be fully involved in directing their own permanency planning and decision-making. Communication with young people is honest, direct and respects them as true partners, and young people are provided with opportunities to develop communications skills that enable them to take on the partnership role. Agencies place young people in positions where they are in charge of driving discussions and options and they receive training, preparation, services and support from child welfare agencies, multiple systems and the community at large to do so. Staff are trained and supported in using specialized permanency planning skills that assist young people in addressing their fears, feelings, family issues, hopes, dreams, and aspirations. Staff value, support, and provide opportunities for young people to advocate for themselves, and young people receive preparation that enables them to acquire the skills necessary to do so.

102 Components –Empower a wide range of individuals to participate in permanency planning, including family, tribal members, past, present and future caregivers, other adults who are significant to the young person, other systems with whom young people are involved, and other community members. Communication with young people is honest, direct and respects them as true partners, and young people are provided with opportunities to develop communications skills that enable them to take on the partnership role.

103 Components –Consider, explore and implement a full range of permanency options in a timely and continuous way. –From the beginning, continuously and concurrently employ a comprehensive range of recruitment options. –From the beginning of placement, provide services and supports to continuously ensure that young people and their families have every opportunity to achieve and maintain physical, emotional, and legal permanence.

104 Components –Agencies collaborate with other systems that serve children, young people, and families to engage children, youth, and families as true partners and to provide services, support and opportunities during and after placement.

105 Key Measures (Evaluating progress on improving the way they achieve and maintain permanence for young people) –Legal Permanence –Youth-Defined Permanence –Placement Stability –Content of Meetings –Training and Education –Making Connections –Available Potential Resource Families

106 Legal Permanence Increase in the number and percentage of young people who achieve legal family permanence through reunification, adoption, customary adoption, or guardianship (by race and ethnicity) Youth-Defined Permanence Increase in the number and percentage of young people who leave out of home care feeling that they have the optimal level of family belonging and membership based on their vision and definition of permanence. Placement Stability Decrease in the number and percentage of young people in non-family settings, e.g. institutional and group home settings.

107 Content of Meetings Increase in the number and percentage of young people who report that they actively participate in their own case planning and decision-making and that their wishes are respected Making Connections Increase in the number and percentage of young people who maintain connections with their birth parents, siblings, extended family members and other significant adults in their lives

108 Training and Education –Increase in preparation, training, education, and or support that is provided about permanence for young people to key constituency groups such as: Young people, families and extended families Agency staff Courts Tribal courts Attorneys CASA workers Schools Probation officers Community providers Other key partners as determined by the young people or the Department

109 Available Potential Resource Families –Increase in the number and percentage of resource families (foster, adoptive, kinship families) who have a demonstrated knowledge of, commitment to, and concern for young people and can parent young people with the unique needs, characteristics, and issues represented in the population

110 Cell Changes – Growth and Pruning Gray and white matter undergo extensive changes well past puberty! Structural changes at adolescence may explain the timing of schizophrenia and bipolar disorder. Wild conduct is actually not just hormones, but a combination of hormones and a “paucity of the cognitive controls needed for mature behavior” New research on adolescent brain development – Findings of Dr. Geidd and Others (cite)

111 Cell Changes – Growth and Pruning 1st wave of brain cell changes: proliferation of cells between the third and sixth month after conception, then pruning before birth. 2 nd growth wave Giedd discovered occurs in late childhood and the critical pruning period is in the late teens. This period alters the number of connections between cells, rather than cell number itself. Connections decrease in number till the early 20s. Meanwhile, the white matter that shields the connections thickens, making transmissions faster. Most scientists believe that pruning is guided by genetics and by “use-it or lose-it” So, the most used synapses survive, and how you spend your time may be critical.

112 Brain Development Development goes in stages, from back to front, from most “primitive” to most modern. Last: prefrontal cortex – planning, setting priorities, organizing thoughts, suppressing impulses, weighing consequences of actions. So, bad decisions can come from teens lacking the part of the brain that makes them more “responsible” rather than from hormones.

113 Emotion Recognition Tested adults vs. youths in recognizing the emotions behind facial expressions Adults rely on the frontal area, and make few mistakes. Kids under 14, however, rely on the amygdala and make more mistakes, especially in identifying fear as anger, confusion, or sadness. This may explain why children see anger and hostility where it does not exist.

114 Hormones, Brain Dev., and Risk-Taking In addition to testosterone and estrogen, adrenal sex hormones are produced, exerting direct influence on seratonin and other neurochemicals that regulate mood and excitability, and are especially active in the limbic system, the emotional center. “Adolescents actively look for experiences to create intense feelings”. They have an appetite for thrills via the hormone-brain interaction, perhaps evolved in order to promote exploration and nest-leaving. This is amplified by the incompleteness of the brain regions that curb risky behavior

115 Risk Assessment Adults versus teens deciding when it is safe to run a yellow light. Both are safe when alone. Teens take more risks when with friends, versus when they are tested alone (those over 20 don’t) Suggests our focus on education is not efficient use of resources Most teen crimes are committed by packs of kids. Risk-taking tendencies, rather than peer pressure, may propel them to drugs and alcohol. It may be that risk-taking tendencies of individuals feed off of each other when those youths are in a group.

116 Hormones and Brain Dev. Rapid changes in dopamine-rich areas of the brain may also make youth more vulnerable to drugs and alcohol. Dopamine is particularly active in teens. The nucleus accumbens, which directs motivation to seek rewards, is also immature in teens. This may push youth towards more exciting, and/or less effortful, activities. A good way to get a kid off alcohol would be to stress immediate, tangible results, like being kicked off of a sports team, rather than a bad future. Sleep: it takes longer for melatonin, the sleep- inducing chemical, to rise in teens than in youngsters and adults.

117 Hormones and Brain Dev. “For social and biological reasons teens have increased difficulty making mature decisions and understanding the consequences of their actions.” Comment: It is important to understand the challenges facing young people, and assist them to make responsible choices about their future, but never to disregard their point of view and their decisions.

118 Helping teens develop in healthy ways pour on praise and physical affection stay involved in their life reasoning improves – adapt parenting to reflect increased abilities promote independence set limits, but keep them fair and reasonable and be able to articulate the “why” of your decisions

119 Checklist of Law/Policy Issues to be Considered Extend court jurisdiction post-18 (mandate/option?) Create I.L. court hearings (i.e. benchmark hearings- DC & IL) Meaningful youth participation Appointment/role of lawyer/GAL for post-18 youth Maximum age of jurisdiction/aid Effective use of up-to-21 Medicaid extension Re-entry into care and/or services post-18 Social Security $ access Training for adoptive & foster parents, group home & case managers Require education & job case management services Mandate data collection pursuant to Chafee/ outcome measurement Provide things adults need (I.D.s, bank account, etc.) No exit without meaningful adult connections (supports for bio family?) No homeless aged-out kids More $ for housing support

120 Retention of Juvenile Court Dependency Jurisdiction to 21 ABA 2002– Urged Congress and state legislatures to enact laws that provide youth in foster care full access, up to 21, to independent and transitional living services and health care Also urged extension of jurisdiction of dependency courts over youth transitioning from foster care until age 21, when appropriate (e.g., youth consents), to ensure they have access to the court, and to legal and social services through the court ABA pledged to help ensure youth transitioning out of care have access to competent counsel to advocate for necessary services & safeguards

121 What Are the Variations in Extending Court Jurisdiction? Half of states provide post-18 jurisdiction Of top 8 states in foster care population size (45% of all U.S. kids in care), 6 (CA, IL, MI, NY, OH, PA) allow post-18 court jurisdiction Extend to complete high school Extend due to youth’s disability/special needs A rare variation is to mandate continuing jurisdiction (e.g., if in child’s best interests) Court jurisdiction versus continuing agency services Don’t dismiss until certain outcomes achieved

122 Center for the Study of Social Policy: One of 20 State Measures to Enhance Children’s Futures Center for the Study of Social Policy, “Twenty State Policies to Enhance States’ Prosperity and Create Bright Futures for America’s Children, Families and Communities” (January 2006) Measure 20: Statutorily authorizing that foster youth remain, post-18, under the oversight of the juvenile court (23 states plus D.C.) Only states that clearly say jurisdiction must end at 18: FL, GA, ID, IA, KY, NM, NC, UT Chapin Hall research: Better outcomes for former youth in foster care if they remain in care after age 18

123 Checklist of Law/Policy Issues to be Considered Extend court jurisdiction post-18 (mandate/option?) Create I.L. court hearings (i.e. benchmark hearings- DC & IL) Meaningful youth participation Appointment/role of lawyer/GAL for post-18 youth Maximum age of jurisdiction/aid Effective use of up-to-21 Medicaid extension Re-entry into care and/or services post-18 Social Security $ access Training for adoptive & foster parents, group home & case managers Require education & job case management services Mandate data collection pursuant to Chafee/ outcome measurement Provide things adults need (I.D.s, bank account, etc.) No exit without meaningful adult connections (supports for bio family?) No homeless aged-out kids More $ for housing support

124 Retention of Juvenile Court Dependency Jurisdiction to 21 ABA 2002– Urged Congress and state legislatures to enact laws that provide youth in foster care full access, up to 21, to independent and transitional living services and health care Also urged extension of jurisdiction of dependency courts over youth transitioning from foster care until age 21, when appropriate (e.g., youth consents), to ensure they have access to the court, and to legal and social services through the court ABA pledged to help ensure youth transitioning out of care have access to competent counsel to advocate for necessary services & safeguards

125 What Are the Variations in Extending Court Jurisdiction? Half of states provide post-18 jurisdiction Of top 8 states in foster care population size (45% of all U.S. kids in care), 6 (CA, IL, MI, NY, OH, PA) allow post-18 court jurisdiction Extend to complete high school Extend due to youth’s disability/special needs A rare variation is to mandate continuing jurisdiction (e.g., if in child’s best interests) Court jurisdiction versus continuing agency services Don’t dismiss until certain outcomes achieved

126 Center for the Study of Social Policy: One of 20 State Measures to Enhance Children’s Futures Center for the Study of Social Policy, “Twenty State Policies to Enhance States’ Prosperity and Create Bright Futures for America’s Children, Families and Communities” (January 2006) Measure 20: Statutorily authorizing that foster youth remain, post-18, under the oversight of the juvenile court (23 states plus D.C.) Only states that clearly say jurisdiction must end at 18: FL, GA, ID, IA, KY, NM, NC, UT Chapin Hall research: Better outcomes for former youth in foster care if they remain in care after age 18

127 Seen and Heard: Youth Involvement in Court Hearings Policies of National Judicial And Bar Associations ABA Standards of Representation NACC (National Association of Counsel for Children) NCJFCJ - Resource Guidelines PEW Commission – recommends courts ensure meaningful particiaption from parents & children UNLV Recommendations: Child Advocacy and Justice 10 Years after Fordham

128 Child and Family Services Improvement Act of 2006 (Title IV-B of the SSA reauthorizing the Promoting Safe and Stable Families) New federal law requires “procedural safeguards to be applied to assure that in any permanency hearing held with respect to the child, including any hearing regarding the transition of the child from foster care to independent living, the court... consults, in an age-appropriate manner, with the child regarding the proposed permanency or transition plan for the child” “The federal government recognizes the importance of a youth’s voice in planning for her future. Judges are the final gatekeepers when a youth is leaving the care and security of foster care to begin a life without that support. Judges should see it as their responsibility to ensure that the youth has the skills and the support system as they enter into adulthood.”

129 Benefits of Youth Participation in Court Process Sense of Control (youth may be experiencing lack of control over placement, school, friends, etc) Understanding the Process (versus having attorney or caseworker explain what happened) Empowerment/ Participation Critical Information for the Court Engage youth in problem solving at all levels, including court

130 Reunification after TPR Only one state has specific statute allowing a TPR to be undone (California) CA legislation- Welfare and Institutions Code Section (i)(2), effective 1/1/06 Oklahoma is working on drafting legislation to undo TPR’s -purpose of undoing the TPR? -reinstate parental rights If not provided for in state law, possible strategies to achieve result: 1) Allow parent to adopt the child, going through the ordinary adoption channels (homestudy, etc) 2) Without undoing TPR, grant custody back to bio parent

131 Resources Improving Outcomes for Older Youth: What Lawyers and Judges Need to Know. McNaught, Kathleen and Lauren Onkeles. Resource Center on Youth Development and ABA Center on Children and the Law Download version at Making it Permanent: Reasonable Efforts to Finalize Permanency Plans for Foster Children Cecilia Fiermonte and Jennifer Renne Health Care for Teens: A Judge’s Guide Karen Eileen Howze Achieving Permanency for Adolescents in Foster Care: A Guide for Legal Professionals.” Andrea Khoury and Mark Hardin, editors.

132 Contact Information Jennifer Renne, Kathleen McNaught, Andrea Khoury, National Child Welfare RC on Legal and Judicial Issues ABA Center on Children and the Law th Street, NW Washington, DC


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