Recently, I interviewed the Annie E. Casey Foundation's CEO and President Dr. Patrick McCarthy: a respected foundation and philanthropic leader, with expertise in the area of children and family well-being. To date, the Annie E. Casey Foundation has invested billions of dollars in improving and innovating the foster care and child welfare systems. I was interested in learning from Dr. Patrick McCarthy how he thinks about innovating the child welfare system because throughout his tenure at the Casey Foundation, he has led efforts to improve human services practices and policies that can make a difference for the nation's most vulnerable kids and families. Here's a snippet of our interview:
Marquis Cabrera: What are some consistent and persistent pain points you see in the current foster care/child welfare system?
Dr. Patrick McCarthy: The toughest decision a child welfare worker can make comes with investigating abuse or neglect. It's extremely difficult to make that call: Do we intervene? Do you leave a child in a home, or do you remove a child? It's a pain point that on the one hand, there is tension between protecting child's safety, and on the other hand, the removal of a child from a parent is a traumatic event that can have lifelong consequences and set off experiences that will have an indelible impact on the child. If you're a manager or supervisor, this is the decision that keeps you up at night.
When the first call comes in, the child protection decision-making initiative begins. There are folks who are experts on how humans make decisions. How do emergency room folks and firefighters and police officers make decisions under stress? Can we take what we know from how these folks make decisions and apply it to child welfare? We all make decisions by telling a story. We pay more attention to those things that inform and reinforce story versus things that contradict stories. Doctors miss signs because they constructed a story. We learned that we're less likely to do that if multiple people are involved.
If you do decide to remove child, how do you match an intervention to the needs of the individual child or family? Too often in too many systems, the resources are not available to meet sufficient needs. A particular intervention is not available in a certain geographical location where the child is, or the right amount of information isn't available to know what the needs are. As a result, we may over-intervene, which may put children in settings that can do harm. There is a tendency to over rely on group placement; children that don't meet a profile are nevertheless put in residential treatment and left there because of the problem with poorly matching a child's needs to resources available. Matching of resources is definitely a pain point.
Helping frontline workers to make better decisions is also difficult. Our workers don't have sufficient information to make good decisions. They don't even have the tools to think about how to make a decision. Too often, work is done individually instead of as a team, which can create big gaps. Even if the family is known [to the system], an individual worker may not know how to best help that family because treatment plans or previous allegations are not available to the day-to-day worker, especially when out in the field.
Marquis Cabrera: What is the foundation doing to improve the aforementioned pain points?
Dr. Patrick McCarthy: We believe a bad system will trump a good program every single time. While we recognize the importance and effectiveness of evidence-based programs in helping people, we have to adjust how the system itself functions in order to make better decisions and do things more effectively. Then how do you marry that with evidence-based programs? One of our major investments is intensive strategic consulting: Casey staff and Casey consultants go into states and large cities for eighteen months to three years to identify a set of system reforms.
We believe, except in specific circumstances, that most children can be most appropriately served in a kinship or foster setting. We'll help the system figure out processes and figure out the high rates of group care. The proportion of kids in group or congregate care varies from state to state, but range from a low of 5% to a high of 30% in some states. There's a difference in child welfare policy in some states that leads to those decisions. We look at practice and financial incentives, and do this jointly with states, to reduce reliance on congregate care.
Marquis Cabrera: What is the Annie E. Casey Foundation doing to advance innovation in the child welfare space? Can you give me 2 or 3 initiatives that you're working on?
Dr. Patrick McCarthy: Through our consulting work, we learned how to use an intensive [practice] model to develop tools that other folks could use. Our models of practice are built from consulting work. We believe: Every child deserves a family. We attempt to help state foster care systems and kinship care systems decrease tendencies to put kids in group care. [Many states] haven't put resources into the foster care system or building a strong kinship care system; instead they rely on group homes. Most of the kids that leave foster care when they reach 18 to 21 entered as teenagers. The reason they entered is because of teenage behavior. For example, a child adopted at 8 years old starts acting up at 14-15, and extended family says that it's more than they signed up for. We have prototyped and come up with ways to develop mechanisms less likely to push kids into foster care.
We supported the development of Casebook - a child welfare information system for workers on the frontline when out in the field. It's cloud-based and very intuitive.
We are funding a tool that supports matching the child's needs with resources that will be effective for them: Kids Insight's Treatment Outcomes Package. What kinds of behaviors does the child see? What kinds of therapeutic interventions work? If you do this with whole systems, workers could see the whole pattern of problems and look at the resources. This will help determine things like if there are problems with substances or a lot of anxiety.
There are 25,000 children that age out of foster care space each year. The Jim Casey Youth Opportunities Initiative focuses on this. It was separate, but now it's part of the Foundation: present in seventeen states working with private sectors, nonprofits, young people. It is creating opportunities in jobs, education, skill development, and asset development. We have increased funding and focus in this area - not just in child welfare, but also a program called LEAP (Learn and Earn to Achieve Potential) for youth ages 14-25. We're making progress on improving child welfare.
Marquis Cabrera: Do you have a big idea on how foundations can partner with governments better to improve child welfare outcomes?
Dr. Patrick McCarthy: We have a lot of faith and good experience with our consulting model. A lot of foundations should be willing to work with government to provide resources that they don't have. Private industry can bring in private resources. Bring in McKinsey or Anderson and look at the system and improve it because the system doesn't have flexible money to do so.
We are learning about things like brain development, trauma, and toxic stress that can help workers to understand behavior and emotional states of children in their care. I think foundations can help make connections between science and day-to-day decisions.
Most people who don't know the child welfare system assume it's a completely public-run system. They don't recognize that child welfare systems contract with private providers for services. In the past, we were focused on public child welfare - a small group of providers who make the transition from group care to community based and family care sources - not non-profit providers. They can be a resource to other providers.
Bring a few young people together. We have discovered that the one of the most powerful pieces to improving the system is asking young people how they feel and what they need, as well as giving them a voice in the process. We value that young people have a lot of offer here - "Nothing about us without us."