What Janet Hutchinson and her colleagues are doing here in Pittsburgh is part of one of the most encouraging trends in American foster care. They are changing the aim and structure of the agency that aids this former steel city's troubled children. They are working to keep as many children as possible from having to be taken into foster care, instead of trying to aid them once they are in foster placement.
The agency provides services that center on the fundamental needs of families. It helps them, promptly and intensively, to deal with their underlying problems. Nationally, most children are considered for foster placement because of parental child abuse or neglect; eliminating the causes of family stress can end abuse.
For the past decade or more, most social work programs around the United States have offered too little help to families when they had the greatest need. Often they get only an hour a month. That's not enough to solve family problems, experts say. It results in caseworkers having a crushing number of seemingly never-ending cases, which impedes their ability to help.
Ms. Hutchinson is three months into her new job as deputy director of the Allegheny County Children and Youth Services, which serves Pittsburgh. From her office overlooking the Allegheny River, she is putting into practice what she's been preaching around the United States for a decade as a consultant.
She says she ``wanted to simplify the agency structure and uncomplicate the treatment structure.'' She means the agency will have far fewer internal compartments. From now on each family has one caseworker to help with all its requirements; no one in need will be shunted from person to person. Formerly Hutchinson was director of the National Resource Center on Family Based Services, at the University of Iowa.
Hutchinson is ``a leader in the nation'' in providing family-oriented services, says Jane Burnley, associate commissioner for the Children's Bureau of the US Department of Health and Human Services.
Most experts agree with Hutchinson's view that the best foster care system is one that keeps as many children as possible out of foster care. Prevention is ``the only real way you can go,'' insists Rep. George Miller (D) of California, Congress's ranking expert on foster care and children's issues. A 1980 federal law on child welfare required that states, as a condition of receiving federal funds, to try to keep children with their natural families and out of foster care.
Around the US there are a number of programs that many experts say are showing that prevention is the most promising way of giving long-term help to children - and, not so incidentally, to their parents.
One is Philadelphia's much-praised SCAN, which stands for the Supportive Child and Adult Network. It provides up to two years of multifaceted help for families in crisis - intensive at first, then diminishing as families become more able to stand on their own feet. SCAN is widely praised for its successes.
Another program, much imitated, is Homebuilders, which originated some 13 years ago in Tacoma, Wash. Its approach has spread nationwide because it has served as a training ground for staff members from other communities. Like Pittsburgh and Philadelphia's SCAN, Homebuilders provides whatever intensive aid is required to a family in such crisis that it is in danger of having its children taken to foster homes. This month Homebuilders began the process of installing a small program in New York City's deteriorated Bronx borough.
Homebuilders's programs work with families for four or five weeks as a rule, says Peter Forsythe, director of children's programs for the Edna McConnell Clark Foundation, which has funded several Homebuilders-type programs. He says that well over 90 percent of families helped by Homebuilders are rated successes: Children remain safely with their parents; families stay together and are able to function much better than before.
``This is an important addition'' to the kinds of social services more generally available to troubled families and children, Mr. Forsythe says. ``It is a service of last resort [that] should be used with families where all other things have failed.''
Several experts speak highly of the role that Forsythe and the Clark Foundation have played in encouraging the spread of innovative foster care prevention ideas, such as Homebuilders. ``Almost all foster care reform,'' says Douglas Besharov, ``happened because of Peter Forsythe and the Edna McConnell Clark Foundation. ... It's the classic example of a little bit of private money leveraging a lot of federal money.'' Mr. Besharov is a resident scholar at the American Enterprise Institute and was the first director of the National Center for Child Abuse and Neglect.
In Maryland, preliminary results indicate that a new prevention program there is succeeding. It, too, features intensive assistance to families for up to 90 days. Early evaluations show that only two of 838 children have had to be removed from their families to foster homes.
Across America other programs, often small in numbers of families treated, also report success.
If further study shows that these successes continue over the long term, the American child welfare system will then need to find out how to transfer the approaches used in these often modest-size experimental programs in private agencies into full-scale programs in public agencies that aid all persons in need. In some communities, Pittsburgh is one, that broadening is under way: Hutchinson's agency serves all Pittsburgh.
Some specialists are concerned that the 1980 law may unintentionally encourage the retention of children in family homes that really are not safe. Peggy Higgins is the supervisor of Child Protective Services for the Charles County, Md., Department of Social Services. In general she strongly supports the concept of retaining children with their parents when possible instead of putting them in foster care. But she says the current system is tilted too far in that direction. ``We should not make it so hard,'' she says, ``to say that a child should be taken out of the home. ... I don't think that the first thing [on the form] should be about efforts to prevent placement. The first thing on the form should be: What are the problems? And what are the family's strengths?''
Besharov cautions that the reports of success from less-expensive programs ought to be independently checked; he suspects that only expensive programs, many of them residential, will work. He questions whether shorter and less-expensive programs will succeed over the long haul: ``What if they don't work, and it takes a $30,000 to $40,000 [per family] remedial program? Then what do you do? ... If this is what it really costs to fix the problem, then we really have some fundamental decisions to make.''
One way or another American society will pay the bill, warns Blanche Bernstein, former human resources administrator for New York City. She did two foster care studies in that city, one in 1955, the other in 1972; both accurately forecast how the city's foster care needs would change a decade later.
Dr. Bernstein, who has a PhD in economics, estimates that it will probably cost American taxpayers $10 billion to $20 billion to provide enough effective early intervention to troubled families and their troubled children to help them solve their problems.
What if American society refuses to spend the money? ``We'll all be in trouble,'' she says, especially in big cities with large nunbers of families that are poor, on welfare, and in chaos. ``There will be a decrease in the civility of this society'' with an increasing gap in the socioeconomic status of minorities and the remainder of American society.
If that comes about, she sees a need for more prisons, as Americans who felt left out of society's progress took their frustrations out on the rest of society. ``And we'll have a decline in the capabilities of the work force,'' even as the US struggles to combat international competitors.
Bernstein's final warning: ``If we don't pay now, we will pay a lot more later.''
Second in a series. The first article ran yesterday. Next: A new approach for many children already in foster care.