Who has the authority to define "permanency?"

How the System Defines Permanency
A recent round table of experts, convened by Casey Family Services and the Annie E. Casey Foundation, defined permanency as:

“Having an enduring family relationship that:
- is safe and meant to last a lifetime
- offers the legal rights and social status of full family membership
- provides for all levels of a young person’s development
- assures lifelong connections to extended family, siblings, other significant adults, family history and traditions, race and ethnicity, culture, religion and language.”

These are lofty goals. It’s almost as if a group of people who emerged from a “normal” family looked at everything that they personally had, and said, “Yes, we want foster care youth to have that.” So, they set that as the standard, after taking upon themselves the responsibility to define what that standard is…

Is it realistic? Is it attainable? I don’t know. As a former foster care youth, I found my first “family” in my peers while living in a college dorm. But I did not have the legal rights of full family membership until I was married in 2001.

How Youth Define Permanency
It's important to note that young people in foster care define permanency very differently. When the Urban Institute and the California Youth Connection facilitated focus groups of foster youth to ask them about this issue:

- Some youth referred to permanency as a physical or concrete entity. They said things like: “Staying in one place” and “Not having to move” and “A place to stay until you age out.”

- Other young people said, “No, it’s more than a place to live. It’s a feeling of connection.” They defined permanency as an emotional commitment from other people.

One young man described the concept of permanency as being like a permanent marker; he said, “If you draw on the paper, that mark ain’t going nowhere. The paper may go somewhere or it could be picked up, but the mark ain’t going nowhere.”

That is a great visual. Think about the people who have made an indelible mark upon your life. Not all of them were connected to you by blood, birth or legal contract.

Whose Permanency Is It, Anyway?
Now, I am going to suggest something radical here… I believe that the “experts” and the “professionals” should allow the input of foster care youth and alumni to influence how they measure success in the area of permanency.

What do youth say about adoption, guardianship, reunification with their biological family, independent living programs and aging out of foster care?

During a youth panel at the 2006 Casey It's My Life conference:

1.) Young people differentiated between biological or legal family and chosen family

2.) Youth said that they needed an entire network of connections, and not just one person

3.) Young people didn't want to be viewed as a "failure" if they aged out of the system without being adopted

4.) Teenagers in foster care expressed their need for independence and independent living skills

There Is No “One-Size-Fits-All” Approach To Foster Care
The experiences of young people differ according to the situation. Some find happiness through reuniting with their biological families. Others report being taken advantage of by ‘predatory parents.’

Here are some legitimate fears that young people in foster care express:

1. “Do you just want to close my case, or am I really safe now?” Many young people fear becoming a ‘closed case.’ The rate of re-entry into the foster care system after an initial attempt at reunification is high.

2. “Aren’t I too old for adoption?” Teenagers in United States foster care report that they have learned from past experience that most foster parents are not eager to take teenagers into their homes. They also report their fears that, by being adopted, they might lose access to independent living classes, college tuition assistance and medical insurance.

3. “Why should I take the risk of adoption by a stranger?” One of the horrors of foster care is its unpredictability. Teenagers who have grown up in the system often know what to expect from independent living programs. They anticipate having some power and control over their personal living situation.

Young people interviewed by the Urban Institute said that when they were placed in a group home or foster home, they had opportunities to leave if they did not like it – but “once you are adopted, you are stuck.”

Broadening Our Definition of Permanency
We live in a pluralistic society, where the word ‘family’ can be defined in many ways. Perhaps the definition of permanency from that roundtable was more than just lofty… maybe it was limiting, too.

I would ask the experts: "Is it a nuclear family that we are trying to accomplish, and is anything less a failure? Are we engaging in partisan politics? Or are we trying to lay a foundation that will lead to lifelong emotional resiliency?"

Foster care alumni often report finding their first experience of “permanency” through friendships and mentoring relationships. A FosterClub intern from Michigan reported finding permanency through her involvement with the Jim Casey Youth Opportunities Initiative, which she described as being an ‘emotional parent’ in her life.

The way I see it, the choice is simple: We can keep defining what permanency should look like for a young person and forcing it upon them. Or we can listen to the young people themselves.

Because for a researcher, this is an outcome. For a staff person, this might be a job performance issue. But for a young person in foster care, this is their life.

Sources:
Chambers, K., et al. Foster Youth’s Views of Adoption and Permanency. Urban Institute, Child Welfare Research Program, January 2008.
Research Roundtable: Convening on Youth Permanence, Sept. 12-13, 2006.
Sanchez, Reina M. Youth Perspectives on Permanency, California Youth Connection, California Permanency for Youth, 2004.

Foster youth recommendations in my state

An organization in my state is working to establish a statewide foster youth advocacy group.

The director of this organization was first inspired by California Youth Connection. She and I met earlier this year with two members of her staff.

Foster youth involved in this program are given opportunities to describe their experiences to children's services staff, judges and youth advocates.

Here are some of the recommendations they have made on how to change the system...

Having their voice heard in court
Current foster youth report that they want to be able to speak to the judge personally about their case. They want to be present when a move is being considered or custodial decisions are being made. They desire meaningful interaction with the CASA or guardian ad-litem who is representing them in court.

Any adult would want to meet with his / her lawyer before a trial.

Sharing their insights regarding placements, including reunification
Foster youth want to be able to contact their caseworker directly. Meetings regarding the possiblity of reunification should include youth, biological parents, foster parents and caseworker.

Foster youth want the homes in which they are placed to be safe.
They recommended that foster parents participate in training, meet strict qualifications and be evaluated on an ongoing basis. They also recommended that foster parents be observed actually interacting with youth before being granted a license.

Continuity of care with therapist
Maintaining the same therapist, regardless of placement, builds trust and gives youth time to work through emotional issues. (Caseworkers and foster parents should also receive more training in the emotional challenges faced by foster youth).

Normalcy and preparation to transition out of foster care
- Placement with siblings, or regular contact with siblings
- Able to spend the night with a friend from school, if foster parent gives permission
- Freedom to participate in extra curricular activities
- Able to get a driver's license*

Foster youth asked for opportunities to engage in real-life experience, such as how to obtain housing, access public transportation and manage a checking account.

Drugging Foster Children

If I hadn't read these articles, I (a former foster child) would have thought that drugging foster children was an urban legend.

It is the stuff of a science fiction novel:
-States such as Texas, Florida and Minnesota discover an alarming number of foster youth on behavior-altering drugs.

-California state regulations provide financial incentive for group home staff to request and administer psychotropic drugs to children in their care -- because rates are based on mental-health treatment services per child.

-A seventeen-year old foster child in California is threatened that if she doesn't take the drugs she was prescribed, she will not receive transitional housing.

Unfortunately, all these things are happening - and it is time for them to stop.

Medicating wounds, rather than healing them
Medications have their place in helping members of society. But foster youth who experience grief, fear and sadness are simply displaying normal reactions to their living situations.

Consider this scenario:
Girl's mother dies - Girl feels sad - Staff recommends Zoloft - Group home receives more money.

What's wrong with this picture? It creates a system that is ripe for abuse.

In Texas, 12,000 foster youth received psychotropic drugs in 2004. Each child averaged 21 psychotropic drug prescriptions a year.

In Massachusetts, two-thirds of 17-year-old foster children have recieved inpatient or outpatient medical treatment (as opposed to only 37% in Illinois, Iowa and Wisconsin). State Representative Marie Parente believes that state reimbursement checks from the federal government might be a financial incentive to misdiagnose and overmedicate foster children.

In California, the use of drugs remains unchecked and unregulated. The California Psychiatric Assocation blocked the passing of a 2004 bill by then-Senator Mountjoy to analyze the administration of drugs to children in foster care.

Judges approving dosages
According to the California rules of court, Rule 1432.5: "Once a child is declared a dependent child of the court and is removed from the custody of parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medicine to the child."

Is the judge now considered a medical expert? Does he or she even meet the child in question? Often, all that judge has to go by are the reports handed in by social workers and group home staff.

In 1999, when Governor Gray Davis gave final approval to the law requiring judges to sign off on medication requests, many juvenile judges said that they didn't know much about medications, nor the doctors prescribing them.

One judge reported that he simply trusted that the 'doctor knows best.' While Los Angeles Juvenile Court had the funding to screen requests through the county's medical health unit, other judges lacked the money for such a review.

Also, according to California rules of court: "In emergency situations, psychotropic medications may be administered to a dependent with or without court authorization..."

This is both disturbing and vague.

What constitutes an emergency situation? Is it only that the child is sad, and the group home will recieve more money? California group homes receive anywhere between $2000 and $6000 per foster youth, depending on what medications they are on, according to Jennifer Rodriguez, legal representative for the California Youth Connection.

Foster youth are not informed of their right to refuse medication. Foster youth reported being punished for refusal by losing privilges and threatened that they will be evicted from the group home.

Risks of overmedicating
Attorney Andrea Moore, of Florida, is currently representing several children who began lactating after taking antipsychotics .

One of her clients is also a twelve-year-old whose heart condition was exacerbated by the Geodon she had been prescribed. According to Moore, the doctor who prescribed Geodon did not even have the child's medical history. The drug's label clearly states that patients with heart problems shouldn't take it.

Actions being taken in California:
-Assembly members Noreeen Evans and Karen Bass, both members of the Select Committee on Foster Care, have requested a public hearing in August, focusing on medication, foster care and the lack of communication (and accountability).

-Attorney General Bill Lockyer is investigating the amount of tax dollars being spent to overmedicate foster youth.

-State Comptroller Steve Westly has called upon Governor Schwartznegger to take immediate action on this issue "in order to ensure that no one profits by forcing kids to take mind-altering drugs."

Nationwide concern
Paul Vincent, of the Child Welfare and Policy Group, believes that the number of foster children being prescribed antipsychotics has risen over the past few years.

Children as young as four-years-old are being prescribed antipsychotics. And, who is doing the prescribing? Vincent says, "They aren't even psychiatrists or counselors. I have considerable worry over the accuracy of these diagnoses."

According to USA Today:
-There was a 77% increase in Med-Cal prescription claims in California between 2001-2005.

-Illinois had a 39% increase betwen 2003-2005.

-In Florida, the number of Medicaid children taking antidepressants jumped from 9,500 to 17, 000 over the past five years.

Sources:
For foster kids, oversight of prescriptions is scarce. USA TODAY. McLean, Va.:May 2, 2006. p. D2

Hayasaki, Erika. Teens speak out about foster care; Thirty young people attend a summit at Occidental College to tell policymakers about problems they face and suggest some solutions. Los Angeles Times Los Angeles, Calif.:Jun 6, 2006. p. B2

To our children's defense. San Francisco Chronicle San Francisco, Calif.:Jun 14, 2006. p. B8

Vascellero, Jessica. Prevalence of drugs for DSS wards questioned. Boston Globe Boston, Mass.:Aug 9, 2004. p. B1

Weber, Tracy. California and the west: Foster children on medication get protections; Health: Davis signs measure to prevent youths in state care from getting improper or unmonitored doses of psychiatric drugs. Los Angeles Times Los Angeles, Calif.:Sep 30, 1999. p. 3