Kansas Pioneers a Solution to Child-Welfare Woes
TOPEKA, KAN. — Lovely and Sasha are part of a bold experiment to help America's abused and neglected children.
Sitting on a comfortable sofa with her arm around her little sister, 10-year-old Lovely speaks softly about four miserable years in foster care.
There were the jealous siblings who dumped a brew of Tabasco sauce, vinegar, and water over her face as she slept. And the shoes that didn't match. She remembers one Christmas, when her foster mother "smacked" her for not wearing a coat and took away her presents.
It was so bad, Lovely says, that she sometimes longed for home - an eastern Kansas ghetto where her drug-addicted mother abandoned her and four siblings for days.
If not for Kansas' concerted efforts to improve its beleaguered child-welfare system, Lovely and her sister would almost certainly still be languishing in foster care, instead of living with a caring adoptive family.
This spring, Kansas became the first state in the country to privatize its child-welfare system, contracting out all adoption, foster-care, and family-preservation services to private agencies. The primary goal of the reform is to cut the time abused or neglected children spend outside of permanent homes.
The pioneering Kansas reforms have already shown signs of success. Since privatization was phased in beginning last July, the rate of adoptions has increased, more siblings have stayed together, and the number of moves by children in foster care has dropped.
And with nearly half a million American children now living in foster care - double the number in the 1980s - many other states with troubled child-welfare systems are carefully watching Kansas as they consider similar reforms, experts say.
Some 30 states, including Massachusetts and Ohio, "either have or will have within a year a pilot, demonstration, or statewide managed-care approach to child-welfare services," says Charlotte McCullough, director of the Managed Care Institute for the Child Welfare League of America, citing an April survey.
Ms. McCullough predicts that the trend toward managed care - which often incorporates elements of privatization, increased accountability, and risk-sharing - is here to stay.
In Kansas, supporters and critics agree that many hurdles remain and that it's too early to gauge whether the privatization will succeed. Still, most involved in the reform say it's an improvement over the top-down bureaucracy it replaced.
Created in the 1970s, the SRS evolved by the 1990s into a huge, highly compartmentalized and cautious bureaucracy, according to a 1995 case study of the organization. Over its lifetime, the foster-care system became "seriously flawed," the study says. A 20 percent increase in the number of foster children in Kansas between 1987 and the early 1990s added to the strain on case workers, who each handled as many as 60 to 80 children. In an atmosphere of crisis management, accountability was lacking, it said.
In Kansas, as in 26 other states to date, problems within the child-welfare system led to lawsuits, as social workers failed to cope with the burgeoning number of cases of child abuse and neglect.
In 1993, Kansas settled a 1990 lawsuit brought by the American Civil Liberties Union by agreeing to make improvements. Since then, however, the SRS has failed every one of the five legislative audits of its performance, says Rene Netherton, a Topeka lawyer who filed the original suit.
As pressure to reform mounted, Gov. Bill Graves (R), himself an adoptive parent, approved a radical plan whereby private agencies would bid for contracts to take over child-welfare services.
The transition to privatization took only 18 months. In all, the state awarded contracts worth $68 million and serving more than 6,600 children and their families. Private, nonprofit agencies assumed control of family preservation in July 1996, of adoption in October 1996, and of foster care in February 1997.
Under privatization, the incentives of the old system are turned on their heads. Most important, by paying private agencies a set, one-time "capitated" rate of about $13,000 for each child or family served, the state has created a powerful motive for the agencies to move the children rapidly into permanent homes. Under the former fee-for-service system, agencies gained more from keeping beds filled.
Moreover, the state contracts link these per-child payments to high standards of care and accountability. SRS retains responsibility for monitoring the contracts and investigating abuse and neglect. "We hope to have a good balance so that we move kids quickly to permanency, but not so fast that it's unsafe or will not last," says Marilyn Jacobson, deputy commissioner of children and family services at SRS.
Strolling through his new, corporate-gray Topeka office, Bob Hartman, executive director of the private Kansas Children's Service League, says his organization intends to improve foster care in several ways: by reducing caseloads to give children and families more personal care, by placing children closer to home, and by determining more quickly whether reintegration with the birth family or adoption should be the child's main goal.
"The capitated rates are very powerful motivators to prevent us from letting the child sit in the corner. That clock is ticking for us," says Mr. Hartman, whose group was one of three winning state foster-care contracts totalling $60 million.
CRITICS of the new system worry that such financial constraints could lead private agencies to limit care to the most troubled - and costly - foster children.
"For about 30 percent of the kids, long-term foster care is the best option, and those kids' needs will not be served by this new system," says Rick Spano, director of Trinity Episcopal Foster Home in Lawrence, Kan.
In addition, several foster parents interviewed said privatization has created confusion and in some cases limited their choices of who to care for and how, leading dozens of foster families to drop out. "Overall, this system is not an improvement," says Marion Wilson, a foster parent in Winfield, Kan.
Yet if the gains in foster care are less certain so far, progress in adoption is more apparent. As Lovely and Sasha flop into the lap of their adoptive mother, Cynthia Harris, this haven of a home in a newly built subdivision an hour's drive west of Topeka demonstrates one of the clearest success stories of the Kansas reforms.
HOW LOVELY AND SASHA CAME TO BE ADOPTED
After Lutheran Social Services (LSS) won the adoption contract from the state last October, it joined with a dozen adoption agencies and launched a major media campaign to boost the profiles of Lovely, Sasha, and 400 other Kansas children legally free for adoption.
"Before [privatization], these kids were not in the public eye at all. They were invisible," says Kelley Carpenter of Kansas Families for Kids, an agency that recruits adoptive parents.
Ms. Carpenter organized photo shoots and TV and radio interviews for the children. Color posters of the youths, labeled with the words "Wanted: Families," went up in supermarkets and banks. Flyers appeared in church bulletins. All contained a toll-free phone number to call about adopting.
Ms. Harris called about Lovely and Sasha after seeing them on television and getting copies of their photos. "Those pictures just touched my heart. There was no stopping then," she says.