Prevalence, experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements
Introduction
The public child welfare system is responsible for protecting children from abuse and neglect at the hands of their parents or other caregivers. While generally children enter child welfare through a court order, some children are voluntarily placed in the child welfare system by their family, using a mechanism known as a voluntary placement agreement. In these cases, child welfare agencies become legal custodians of the child until court and medical providers determine that the child can be returned to the family home. For the duration of these voluntary agreements, the same state and federal programs that cover children who enter child welfare involuntarily become the custodians of the voluntarily-placed-child's placement, care, and supervision. If a child is placed into state care, then foster care, Medicaid, and/or special education funds can be used to cover the costs of their care (Brennon and Lynch, 2008, National Alliance on Mental Illness-Minnesota, 2009). The parameters and regulations of voluntary placements vary from state to state; in some cases, legal custody relinquishment occurs at the same time, in others parents retain legal custody but give up physical custody in order to place their child (Bringewatt and Gershoff, 2010, Friesen et al., 2003). This study examines the connection between a child's removal manner from their family of origin and experience in the child welfare system. What are the differences in the experiences and characteristics of children who enter the child welfare system through a voluntary placement?
A voluntary foster care placement (sometimes referred to as a voluntary placement agreement) is an agreement, entered into without court involvement, between a state or county child welfare agency and a child's parents to place a child into out-of-home placement. Title IV-E of the Social Security Act says that states can enter into voluntary agreements with a child's parents or legal guardians, where that child is placed into foster care through a mutual, time-limited agreement of no longer than 180 days without a judicial determination (Administration for Children and Families, 2016a, Gruttadaro, 2014). It is not necessary for parents to relinquish custody of their child in order to enter into a voluntary placement agreement, nor are the court oversights and timelines of other child welfare legislation automatically invoked during this time frame (Gruttadaro, 2014). Each state may develop their own voluntary foster care agreements guidelines and legislation, and there is a great deal of variation at this time among states (Friesen et al., 2003, United States General Accounting Office, 2003, National Alliance on Mental Illness-Minnesota, 2009). A 2003 report from the U.S. General Accounting Office stated that in 2001, over 12,700 children were placed in either child welfare or juvenile justice setting by their parents, through a voluntary placement agreement, in order to access mental health services (United States General Accounting Office, 2003). In their 2003 publication, Friesen and colleagues identified previous studies that stated that between 23% and 25% of families of children who had an emotional disturbance had been advised to relinquish custody for the purpose of obtaining services. A 1991 survey of state child-serving agencies (Cohen, Harris, Gottlieb, & Best, 1991) found that 28 of 45 states had at least one agency that used custody transfer to obtain treatment for children with serious mental health problems. Giliberti and Schulzinger (2000) reported that practice occurs in at least half of the states.
In the early 2000s there was a national advocacy effort to separate legal custody relinquishment from voluntary placement agreements (Bazelon Center for Mental Health Law and the Federation of F, Giliberti and Schulzinger, 2000, Friesen et al., 2003). Advocates worked to prohibit the requirement that parents relinquish custody of their children to child welfare agencies in order for them to receive mental health care. Some states adopted new guidelines around voluntary placements at this time (Bazelon Center for Mental Health Law and the Federation of F, Friesen et al., 2003), others chose other types of interventions to support families of children with disabilities (for example, expansion of community based services, or adoption or adaptation of Medicaid waiver programs), and others did not make changes. Eleven states (Connecticut, Colorado, Idaho, Iowa, Maine, Maine, North Dakota, Oregon, Rhode Island, Vermont, and Wisconsin) have enacted laws that prohibit child welfare agencies from requiring parents to relinquish custody to access services for their children with a mental health disability (Gruttadaro, 2014). Other states' laws specify the intended use for a voluntary placement agreement, for example specifying that they are intended to help families access treatments. For example, Minnesota's Child in Voluntary Foster Care for Treatment law (Minnesota Statute 260D) specifies that a child who is placed in voluntary foster care is still in the legal custody of their parents, with the parents maintaining ongoing responsibility for most decision-making and parental rights and responsibilities. The child welfare agency takes on financial responsibility for the child's treatment needs (perhaps in conjunction with Medical Assistance or other revenue streams), in addition to legal authority for placement, supervision, and care; however, the parents retain legal custody of their child (National Alliance on Mental Illness-Minnesota, 2009).
Previous studies have found that families who voluntarily relinquish care of their child report that they are experiencing high support and medical needs, psychological and financial distress, and difficulties in accessing respite care, and other needed supports, often related to the child's disability diagnosis (including but not limited to physical, emotional, intellectual, or learning disabilities) (Nankervis, Roswewarne, & Vassos, 2011). More specifically, families identify financial constraints in accessing reimbursements for services, legal liability concerns on the part of the state, resource scarcity, or a preference for limiting parental involvement in children's treatment on the part of treatment providers as reasons they entered into a voluntary foster care placement agreement (Cohen et al., 1993, United States General Accounting Office, 2003). Because many children with disabilities require ongoing, specialized services, parents face ongoing, complex, and long-term challenges in financing their children's care, leading to accumulation of financial and emotional stress (Crettenden et al., 2014, Semansky and Koyangi, 2003). Parents have identified challenges in finding services for their children who have multiple disability diagnoses, or a concurrent substance abuse and disability diagnosis (United States General Accounting Office, 2003). Families of children with significant disabilities have also reported challenges in maintaining jobs, experiencing psychological challenges, and balancing their family with the economic concerns presented in connecting their child with needed care (Crettenden et al., 2014, Nankervis et al., 2011).
There are a number of public sources of support for children with complex health and social service needs and their families - special education, rehabilitation services, Social Security, Medicaid and State Children's Health Insurance programs, and children's mental health programs, just to name a few (Gruttadaro, 2014, Koppelman, 2005, National Alliance on Mental Illness-Minnesota, 2009). However, families may encounter resource scarcity, conflicting eligibility requirements, or other barriers to accessing these services (Bullock, 2005, Cohen et al., 1993). The combination of financial limitations, lack of or long waits for community-based services, differing eligibility requirements, and concerns about the impact on their other children all were reported as reasons for initiating a voluntary placement (United States General Accounting Office, 2003). Indeed, Friesen et al. (2003) state that “The fundamental reason for transferring custody from the family to the state is financial; the practice has grown up as a way of gaining access to Title IV-E (foster care) funds, Title XIX (Medicaid) funds, special education funds, and other sources of financial support for out-of-home treatment.” (p. 40).
There are very few studies of voluntary foster care placement - either descriptive or explanatory (Cohen et al., 1991, Cohen et al., 1993, Friesen et al., 2003, United States General Accounting Office, 2003, Giliberti and Schulzinger, 2000, University of Washington Center for Disability Policy and R), and those that exist are over a decade out of date at this point in time. Additionally, the previous studies are focused either on policy and agency regulation of voluntary placements (Cohen et al., 1991, Cohen et al., 1993, Friesen et al., 2003), gather data through surveys of agencies that provide voluntary foster care services (United States General Accounting Office, 2003, Giliberti and Schulzinger, 2000), or are an evaluation of a single voluntary placement program (University of Washington Center for Disability Policy and Research, 2001). For example, two previous studies indicated that while where is not formal tracking, survey data gathered from child welfare and juvenile justice providers indicates that approximately a quarter of families who have a child with a diagnosis of significant emotional disabilities report being advised to relinquish custody of their child to obtain services (Friesen et al., 2003, Giliberti and Schulzinger, 2000). The University of Washington's 2001 evaluation of the Voluntary Placement Program offered through the state's Division of Developmental Disabilities found that parents of children with developmental disabilities, when offered an option of receiving out-of-home services for their child without the requirement to relinquish custody were more satisfied with the services that both they and their child received. This supports other studies that suggest that custody relinquishment has negative implications for both families and children (Friesen et al., 2003, United States General Accounting Office, 2003). None of the existing studies used administrative data to examine the prevalence and practice of voluntary foster care placements, nor do they provide analysis of the experience of children and youth who are placed in voluntary placement. Thus, very little is known about the current prevalence, practice, or impacts of this manner of foster care placement. This exploratory study uses a national dataset to examine the following research questions:
- 1.
What is the prevalence of the use of voluntary foster care placements?
- 2.
What are the characteristics of children and youth who are placed in foster care through a voluntary placement?
- 3.
What are the removal reasons most closely associated with a voluntary foster care placement?
- 4.
What are the experiences of children who are placed in foster care through a voluntary placement? Specifically, what types of settings are they placed in, how long are their placements, how stable are their placements, and how are they discharged?
Section snippets
Methods
This cross-sectional, exploratory study uses data from Children's Bureau Adoption and Foster Care Statistics (AFCARS) for foster youth. These data are drawn from all 50 states, the District of Columbia, and Puerto Rico. AFCARS includes case-level data on all foster youth in the custody of state's child protective services. AFCARS foster care files contain data that are collected by states and then reported annually to the Children's Bureau. Variables include child demographics, stays in foster
Prevalence and characteristics of children and youth in voluntary placements
AFCARS identifies three methods of removal or types of placement agreements - a voluntary removal, court-ordered removal, or not yet determined. In 2013, 95.4% of cases (611,580) were removed due to court order. Of the remaining cases, 3.4% (21,966) were voluntarily removed, and the remainder (7873; 1.2%) were reported as not yet determined. Youth who entered placement through a voluntary removal were, in many ways, demographically similar to children who entered due to a court order. The
Discussion and implications
The data reported upon in this paper provide an overview of the prevalence and characteristics of children and youth who are placed in voluntary foster care. While it is significantly less common than a court-ordered placement, more than 21,000 children entered foster care through a voluntary placement agreement in 2013. Children who were placed in foster care voluntarily were more likely to have a disability diagnosis, more likely to be Asian or Hispanic, and were older at their entry into
Conclusion
The findings from this study suggest, although comparatively rare, voluntary foster care agreements still impacted over 20,000 children in 2013. Thus, there is a need to learn more about their use and how children who enter child welfare through a voluntary foster care agreement and their families can be best supported. The practice of voluntary foster care placements does not appear to line up with the statutory guidelines for voluntary placements; specifically, they appear to be longer in
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2023, Children and Youth Services ReviewThe rights of the child in voluntary care in Ireland: A call for reform in law, policy and practice
2021, Children and Youth Services ReviewCitation Excerpt :Thus, as will be explored further below, reforms which address these issues could also help to mitigate the risk of discriminatory resourcing of care placements. The limited extant literature prior to the Voluntary Care in Ireland Study suggested that there were a number of areas worthy of further research in voluntary care, with one of those being the rights of the child and to what extent these were being protected (Corbett, 2018; Hill, 2017; Korpinen & Pösö, 2020; Shannon, 2018). The data from this study agrees with previous suggestions that voluntary care can bring certain advantages from a children’s rights perspective; but at the same time, the views and experiences of social work and legal professionals substantiate concerns around safeguarding children’s rights in the loosely regulated Irish system and confirm the need for reform in Ireland.
From care to education and employment: A meta-analysis
2018, Children and Youth Services ReviewCitation Excerpt :If we had analyzed young people entering the system, it would have been different, since children entering care are often suffering from post-traumatic stress disorder. On the other hand, it should be underlined that not all children in care have suffered child maltreatment (Brown & Bailey-Etta, 2018; Hill, 2017; Nadan, Spilsbury, & Korbin, 2015). Finally, their stay in out-of-home-care may have served to protect and compensate them, fostering their resilience and leading them to experience protective factors during their development that have moderated the effects of adversity (Masten, 2001), facilitated by a suitably stable environment.
Voluntary placements in child welfare: A comparative analysis of state statutes
2018, Children and Youth Services ReviewCitation Excerpt :Though extended care is, by nature, voluntary, it is outside the scope of this study and is distinct from the voluntary placement described in federal guidelines. Hill (2017) found differences between voluntarily placed youth and court-ordered youth, particularly in terms of age, ethnicity, reason for placement, placement length, placement type, and style of discharge. For example, children placed via a voluntary placement agreement were more likely to have a disability, to be placed in supervised independent living or group homes rather than foster homes, and to leave the foster care system by emancipation, running away, or going to a different agency (Hill, 2017).
Medical complexity and placement outcomes for children in foster care
2017, Children and Youth Services ReviewThe role of Medicaid home and community-based service policies in organizing and financing care for children with severe emotional disturbance
2017, Children and Youth Services ReviewCitation Excerpt :Given that 30 to 40% of youth with complex behavioral health needs are privately insured or uninsured (Mark & Buck, 2006), many do not receive care due to cost barriers (Rowan et al., 2013). Because much expensive specialty mental health care is not paid for by private insurance—and the household income of many families is too high to qualify them for Medicaid or the shrinking array of safety net mental health services—some families turn to the child welfare or juvenile justice system to obtain Medicaid coverage for their children, sometimes relinquishing custody of their child in this process (Cohen, Harris, Gottlieb, & Best, 1991; Friesen et al., 2003; Hill, 2017; Ireys, Pires, & Lee, 2006). In 2003, the General Accounting Office reported that over 12,000 children in 19 states were transferred into State custody when families were desperate to obtain mental health services for their child and had either maxed out their private insurance plans, found that they do not qualify for public insurance, or that local safety net programs had no openings for new clients.