SELECT COMMITTEE ON CHILDREN

JOINT FAVORABLE REPORT

SPONSORS OF BILL:

The Select Committee on Children

REASONS FOR BILL:

To limit children under the age of 6, or sibling groups with a child under the age of six, from being placed by DCF in congregate care facilities unless necessary for health reasons.

For Proposed Substitute Bill 981 (as contained in LCO No. 4198): The effective date is made July 1, 2012 rather than October 1, 2011.

Amendment A: In line 9, after “(2)” insert “the commissioner deems it necessary to assess whether” In line 12, strike “be” In line 13, strike “placed” and insert “remain” in lieu thereof. In line 14, strike “prior to” and insert “not later than seventy-two hours after” in lieu thereof. In line 16, after “group” insert “, or provides evidence to the court that such child's health needs can only be met in a child care facility”

RESPONSE FROM ADMINISTRATION/AGENCY:

Department of Children and Families: Supports the intent of the bill but is concerned that the appropriate alternate resources need to be in place before they could implement this change. “In most cases, congregate care is not appropriate for young children but there are examples of quality programs in Connecticut effectively serving a younger population. The department is committed to working with the proponents of this legislation to ensure the needs of the children in our care are appropriately addressed in an age-appropriate manner.

Jeanne Milstein, Child Advocate: Supports this bill. Research on congregate care placements indicate that congregate care facilities are unnecessarily restrictive to children who do not have behavioral health problems, and are no more successful than foster home placements are at keeping siblings placed together. When these congregate care placements are prolonged they can often prove detrimental to the cognitive, social, and emotional development of children. Young children who have experienced trauma, neglect or abuse need a primary caregiver that they can identify as an attachment figure. Shift workers are no substitute for a primary attachment figure.

Carolyn Signorelli, Chief Child Protection Attorney: Supports this bill. Research has documented that congregate care at any age does not achieve the goals the child welfare system espouses and dos not enhance outcomes for young children. Applying the principles of Results based Accountability to placing young children in a congregate care setting, CT's Safe Homes should no longer be considered an acceptable placement option for children under 6. They do not enhance outcomes as far as permanency and they cost more than care in family based settings. The funds saved on reducing the use of Safe Homes should be transitioned to services to provide for children's safety and well-being in family settings, whether with their biological family or with a necessary substitute family.”

NATURE AND SOURCES OF SUPPORT:

Charles H. Zeanah, M.D, Vice Chair for Child and Adolescent Psychiatry, Tulane University School of Medicine: “The reasons why group care is so harmful is so harmful to young children is because they need loving care from a relative small number of caregiving adults. Only through substantial and regular (daily) interactions with caregivers can young children form attachments to adult caregivers. The rotating shifts of congregate care staff limit children's opportunities to form healthy and robust attachments”

Joan Kaufman, Ph.D., Associate Professor of Psyciatry, Department of Psychiatry, Yale University School of Medicine: “Using SAFE home placements for routine initial placements is not cost effective. It costs the state on average $10,000-$15,000 more in placement expenditures for each child initially placed in a SAFE Home program instead of in a family care setting.” The research data is unanimous – congregate care placements for young children, especially prolonged, are detrimental to cognitive, social and emotional development.

Victor Groza, Ph.D., Grace F. Brody Professor of Parent- Child Studies, Case Western Reserve University: “When children don't have primary caregivers, serious consequences can follow them throughout life. Some children become unable to form specific attachments- they can't connect.” Others face other mental and social consequences. Insecurities from a lack of primary caregivers can lead to children have a difficult time in school, with friends, and forming connections with other people.

Deborah A. Frank, M.D, Professor of Pediatrics, Boston University School of Medicine: “When removal from relatives is unavoidable because of serious maltreatment, infants and younger children should be provided with long-term, family-based care. Housing infants and young children in institutions instead of with families goes against over a hundred years of consensus among physicians and child welfare specialists. ”Simply put, infants, toddlers or preschoolers without severe behavioral health needs do not belong in institutions.”

Katherine Rosenblum, Ph. D., Clinical Assist. Professor of Psychiatry, University of Michigan: “An important recent study using rigorous experimental design demonstrated that children previously placed in congregate care settings who were subsequently moved to foster homes showed significant improvements across a number of important developmental domains (e.g., Smyke et al, 2010).” There are reasons to believe that DCF will continue to institutionalize abused and neglected children unless expressly prohibited.

Sarah Healy Eagen, Director of the Child Abuse Project, Center for Children's

Advocacy: The amount of money it costs to maintain a child in group residential care for two months could fund family support services for a year. “The federal adoption and safe families act and its corresponding regulations provide that states must ensure they are meeting children's needs for 'safety permanency and well-being'.” “According to performance ratings from Rounds 1 and 2 of the 2008 CFSR, Connecticut did not achieve substantial conformity in several key child welfare outcome measures including: 1) making diligent efforts to locate and assess relatives as potential placement resources for children, and 2) assessing the needs of, and providing services to parents, foster parents and children.”

Jamey Bell, JD, Jake Siegel, and Alexandra Dufresne, J.D, Connecticut Voices for Children: “Congregate care is developmentally inappropriate for young children.” They are also more expensive than alternative family placements. Several other states have already taken positive action toward limiting the use of congregate care for children under 6.

NATURE AND SOURCES OF OPPOSITION:

Representative Lile R. Gibbons, 155^th District: “My main concern with this proposed legislation is that it removes the ability from the professionals to make a decision on placement of a young child and puts that authority in the hands of the courts.” “My other concern with this proposed legislation is the placement of children who have a sibling under six who cannot be in congregate care.” “It's better to have these children safe and together than in a place where none is possible” There are certain instances where congregate care facilities, like Kids in Crisis, would be beneficial for a short period of time, rather than attempting to find temporary familial like settings.

Dr. Harry Adamakos, Ph. D.,Clinical Psychologist, Kids in Crisis: “The investment of a relatively brief period of time in such [congregate] care (even if by multiple caregivers) poses no adverse affect on the children it serves. This is because of the intense and multiple services that these programs provide to children who ultimately have a great need to have a successful, stable placement, whether that be with their biological families or with foster families.”

Alison Loop, Pediatric Nurse Practitioner, Kids in Crisis: Many children come into Kids in Crisis in terrible condition where only trained professionals are able to help them. Foster parents are not equipped nor have the medical skills necessary to treat the children. If they are placed in a home without medical attention there are serious developmental and physical implications.

Michael Lazarus, DMD, Volunteer Dentist, Kids in Crisis: “Only properly trained health care personnel, working in concert with consultants are capable of assessing the immediate needs of these kids. Foster parents, no matter how well intended, cannot.”

Shari L. Shapiro, Executive Director, Kids in Crisis: “The proposed legislation states that a child under the age of six or a sibling group with a child under the age of six can only be placed in “congregate care” if the child has severe health needs. Yet, a child's true medical and mental health condition is rarely known at the time of removal. Placing a child at an emergency shelter such as Kids in Crisis ensures that a comprehensive physical exam can be done by our onsite Nurse Practitioner within 48 hours.”

Nancy Rosen, Former Member of the Board of Directors, Kids in Crisis: “Foster homes do not have the resources or ability to provide the quality or depth of emergency assessments to identify serious medical and psycho-social conditions. Short term emergency care, however, does have these resources.” “Safe homes, like Kids in Crisis, are designed to responde to a child in crisis 24 hours a day.”

Debra Carlucci, Board of Directors, Kids in Crisis: “Kids in crisis is a 24 hour emergency shelter for children ages 0-17. The 'campus' of kids in crisis consists of two home-like settings. Children arrive in the midst of crisis- neglect, homelessness, abuse and abandonment.” Children are provided a safe haven with trained professionals and are given counseling and care that is vital before being placed in a private home.

Carol Greenberg, LMFT, Kids in Crisis : “It would be ideal if every child has a safe, nurturing home but as we all know this does not exist. It would be ideal if there were enough safe, nurturing foster homes where children and their siblings can live together on a temporary basis but as we know this does not exist.”

Joanne Mortimer, M.S, Prime Care Behavioral Health Services, Kids in Crisis: “At an emergency shelter facility, such as Kids in Crisis, there is a structured, well-coordinated network of services dedicated to that mission. Siblings CAN remain together as a 'family' and are provided immediate care.”

Stuart D. Adelberg, President of the Greenwich United Way: “I would agree that the state would be well served by additional foster families but in the current environment it is far better to make use of an exceptional agency with the capacity to provide professional, compassionate and loving care for our youngest children, that to place these children even farther away from their homes, families and communities in less than ideal circumstances.”

Jon Clemens, Policy Specialist at Connecticut Association of Nonprofits: “Furthermore, barring young children from congregate care will have a negative impact on foster care. The foster care system's capacity of available homes is already stretched thin. Emergency placements, instances where a provider must match a foster family and a child immediately are becoming more and more the norm as placement in Safe homes have been discouraged.” Foster parents are not being as matched as appropriately as they would be if there were no immediacy.

Cheryl Smith, The Children's Center of Hamden: “Overtime, safe home programs have continued to be able to serve sibling groups. In the last year, through the re-procurement process, safe home programs have changed in order to provide specific, short term services focused on stabilizing and transitioning children home or to foster homes.” Parents are also being included through different programs aimed at enforcing parenting skills and incorporating them into the entire treatment process.

Mary Ellen Hass- Family & Children's Agency: “To unilaterally deny access to congregate care for children under six will be dooming some children to the fate of multiple foster home disruptions as well as using up skilled foster parents who have much to offer children placed in their care.” “For some of these children, short term congregate care is such a resource and should be used as the first step in the continuum of care to help them heal from the devastating effects of child maltreatment.”

Jill Bicks, Executive Director, Child Advocates of CT: “It is in a child's best interest to receive treatment and care close to home. It is more likely that the child will maintain existing relationships and benefit from established connections that local community providers have with one another. These connections are crucial to the children's short and long-term stability and success.” “Research shows that a significant number of babies in foster care do not receive even the basic healthcare such as immunizations. Thus, placement in a high quality facility can actually be beneficial for very young children, if they are provided with essential physical and developmental health assessments and treatment.”

Jeremy J. Smith, Program Director of Dare Family Services Therapeutic Foster Care Program: “… I believe the use of congregate care in general as being the most appropriate and necessary treatment venue for a certain small portion of the population with the most severe needs. We again must be careful not to make foster care, which I am a major proponent, the only or primary solution without understanding its capacity or the capacity of the families who are courageous enough to open their homes to it… Many of these children need stabilization or short term treatment to ready them for a successful experience in foster care.”

Laurie Reisman, LCSW, Family Services of Greater Waterbury: “Do all children under the age of six need Congregate Care, no. But don't separate siblings. The damage from abuse and neglect is so awful, and to separate them is so much more devastating. This does not need to be law. Instead, concentrate on Best Practices for DCF. As a parent and provider, I tell you if this becomes law, it will rip families apart…Today [congregate care] is kind, family oriented, and works with more permanent places for our children.”