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The Texas “Freedom to Serve Children Act”, passed by the Texas Senate on May 22 and sent to Governor Abbot for approval, allows publicly-funded foster care and adoption agencies to refuse to place children with non-Christian, unmarried or gay prospective parents due to religious objections. This legislation, along with a similar bill passed in South Dakota in March, rather than protecting children in foster care puts first the needs and wants of a specific group of adults and undermines the safety and well-being of all children involved in the child welfare system. This legislation specifically targets lesbian, gay, bisexual, transgender, queer (LGBTQ) and gender expansive communities as well as prospective foster and adoptive parents who are single parents, non-Christian couples such as Jews, Muslims and interfaith couples.

When children and youth enter the child welfare system, the state child welfare agency has a responsibility to ensure that they are safe, placed in the least-restrictive, most family-like settings possible and supported in their development and well-being. When children and youth cannot reunify with their parent(s), all efforts are to be made to find and support a positive permanent relationship with another parent or caregiver. Already, child welfare systems across the country struggle to identify and maintain enough loving and supportive foster and adoptive homes and each year more than 20,000 young people “age-out” of foster care without ever being placed in a family or permanent home. Allowing publicly-funded agencies to prevent safe, loving and caring individuals and families from becoming foster and adoptive parents directly contradicts the mandates of the child welfare system and will have very real and harmful effects on all children in the child welfare system.

Further, we know that LGBTQ and gender expansive youth are overrepresented in the child welfare system and are disproportionally youth of color.  Many of these youth have entered foster care because they were rejected by their families due to their sexual orientation or gender identity. This legislation sends a clear and powerful message that the public agencies charged with protecting youth who have been rejected by their families will further repeat that trauma and validate such rejection by not supporting or affirming their identities. This rejection and additional traumatization directly contradicts all that we know is considered good parenting, including the results of scientific studies showing that children raised by same sex couples experience healthy outcomes. It also discounts the fact that foster and adoptive parents of all religions have demonstrated the ability and commitment to provide loving and affirming homes to all children regardless of their religious affiliation.

Research shows that young people who identify as LGBTQ or who are gender expansive are more likely than their heterosexual, cisgender peers to experience multiple foster placements, be moved from their first placement at the request of the caregiver or foster family and be placed in congregate care settings. As many as one out of every four LGBTQ youth in a congregate care setting will exit care without achieving permanency. Young people who age out of care without achieving positive permanency are more likely to experience housing instability and homelessness, face poor educational outcomes and become involved with the criminal justice system. The cost to our families, communities and our country continue to mount with this kind of discriminatory legislation.

These outcomes are far from inevitable and many states and communities are moving forward to explicitly affirm and support LGBTQ and gender expansive families, youth and communities. To thrive, we know that all young people involved in child welfare need:

  1. safe and affirming placements in the most family-like settings possible
  2. safe schools and communities
  3.  appropriate medical and behavioral health care
  4. connections to family and supportive social networks;
  5.  external connections and support transitioning from care; and
  6.  connections to aftercare services.

Across the country, many communities, schools and allies, including those with deeply held religious beliefs are putting in place policies and practices that affirm and support LGBTQ and gender expansive children, youth and families. In addition to the 19 states and many local jurisdictions that have non-discrimination policies that include and protect LGBTQ and gender expansive youth, we have seen many recent positive pieces of state legislation:

  • Connecticut House Bill 6695, signed into law in May, 2017, bans conversion therapy
  • Illinois enacted enhanced Department of Children and Family Services procedures in May, 2017 that increase mandatory training for anyone working with LGBTQ youth and clarifies protections for transgender and gender expansive children in care
  • Nevada AB99, which was signed into law in April 2017, mandates training for working with LGBTQ youth, respecting a young person’s gender identity and placing LGBTQ and gender expansive young people in accepting homes

Policy makers, child welfare system leaders and practitioners must remain committed to their mission and mandate to achieve permanence, safety and well-being for all system-involved children and continue to advocate against discriminatory legislative proposals. Promoting safety and affirmation is critical to ensuring healthy identity development and positive outcomes for LGBTQ and gender expansive young people. We must ensure that all young people involved in child welfare are recognized, engaged, affirmed and loved to achieve well-being. This is best achieved through their in permanent loving, affirming families that we know exist across all faiths, sexual orientations, gender identities and family configurations.

This legislation and other similar efforts, such as the rescindment of federal guidance supporting transgender youth’s safety and well-being in school settings, undermine the safety and well-being of LGBTQ and gender expansive communities. CSSP promotes promising policies and practices that support the well-being of all children, youth and families. This legislation and similar proposals affirmatively hurts children, youth and families and runs counter to evidence and best practice in the field.  We call upon advocates and policymakers across the country to proactively work to protect all children and youth in foster care and reject such legislation and any other similar efforts.

For more information about policies that support LGBTQ and gender expansive youth in child welfare, please see our recent report, “Out of the Shadows: Supporting LGBTQ Youth in Child Welfare through Cross-System Collaboration.”

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Rosalynd Erney is a policy analyst at CSSP.

In 2011, in response to the troubling outcomes of young people in and exiting foster care, the Center for the Study of Social Policy (CSSP) assembled recent research on resilience, positive youth development, neuroscience and trauma to examine how all youth, and specifically youth involved in public systems such as child welfare and juvenile justice, can be supported in ways that advance healthy development and build upon young people’s strengths. The result is a framework called Youth Thrive™, which identifies five protective and promotive factors that help mitigate risk and build youth well-being. The Youth Thrive™ framework is currently implemented in seven states and jurisdictions across the country. These child welfare and juvenile justice public agencies have adopted the Youth Thrive™ Framework and are using it as a lens to revise their policies and programming. For more information on the Youth Thrive™ protective and promotive factors, please visit: http://www.cssp.org/reform/child-welfare/youththrive

Recently, CSSP received requests from judges and other court partners to develop a guide on how to use the framework in the context of family court proceedings. The Youth Thrive™ Tip Sheet for Family Court Partners is designed to guide conversations about the five protective and promotive factors among partners in preparation for and during family court proceedings. It provides an introductory summary to the Youth Thrive™ framework for judges, guardians ad litem, lawyers, parents, CASA workers, agency workers and youth. The purpose of the tip sheets, which are divided by role, is to actively promote the building of the Youth Thrive™ protective and promotive factors by providing sample questions that can be posed to youth, parents, professionals and other colleagues to ensure that young people receive the services and opportunities they need to thrive.

Read and download the tip sheet here.

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Martha Raimon is a senior associate at CSSP.

In the Footsteps of Giants

  ·   By Robert Sege, MD, PhD, FAAP

Each of us is the product of our own experiences, and those who molded our personal and professional lives. This Memorial Day weekend, I found myself in the midst of encounters with my own role models in pediatrics. On Sunday, I saw T. Berry Brazelton, the kind and brilliant pediatrician whose books captured the imagination of parents in the late 20th century. Although he is now 99 years old, Berry walked in with a huge smile on his face, and promptly engaged in conversation with an eleven-year-old girl who wants to become a pediatrician.

Later this week, I will head up to Vermont for a celebration of the life of Paula Duncan, the guiding force (and I do mean force) behind the movement in pediatrics to move beyond screening for risk to assessing the positive in children and families, and partnering with parents to grow these assets.

These two leading lights amplify the themes that children need more than protection from adversity, they also need safe places to live, learn and play and to experience connection and support from the adults and peers who shape their worlds.

With the support of Casey Family Programs, I led a group of early childhood experts to produce a new report, Balancing Adverse Childhood Experiences with HOPE (Health Outcomes of Positive Experiences). This report pulls together results from four separate population surveys. We learned that adults who recalled warm, nurturing relationships with their families and communities became healthier adults, even if they had multiple adversities in childhood.

While policymakers struggle to improve screening for risk and adversity, US parents and other adults already get it: children’s brains grow and develop in response to all their experiences, both adverse and positive. According to a 2016 population survey conducted by yougov.com and reported for the first time in the HOPE report, there is wide consensus among American adults of all ethnicities about the importance of positive parenting practices, and the political will to move forward in supporting families.

HOPE complements other new approaches to supporting child development and preventing abuse and neglect. Looked at through the lens of the social-ecological model, they all fit: The CDC advocates policies that support families through its Essentials for Childhood initiative. CSSP’s Strengthening Families approach emphasizes the centrality of the family in the lives of children, and articulates a set of protective factors that families need to thrive. HOPE completes this triad by demonstrating that protective factors operate through affecting children’s experiences.

The HOPE report provides more data and background for an approach that balances concerns about trauma and adversity with one that promotes the development of healthy resilient children who have had the positive experiences we all need. Although the report and the information within it is new, my own relationships with my mentors – Paula Duncan and T. Berry Brazelton – remind me that we are in fact only adding to a solid foundation of understanding.

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Dr. Robert Sege, MD, PhD, FAAP, is a practicing pediatrician, the Chief Medical Officer at Health Resources in Action, and a Senior Fellow at CSSP. 

The Center for the Study of Social Policy (CSSP) is excited to welcome Donna Cohen Ross as Associate Director, with responsibility for leading CSSP’s work related to Young Children and their Families. Donna has devoted her career to reducing poverty and improving access to public benefits for low-income children and families.

“Donna brings a wealth of experience and skills to CSSP, with depth in health policy finance, leading national policy campaigns, taking work to scale and bridging the worlds of health, early learning and nutrition,” said Frank Farrow, CSSP’s Director.

“Donna brings a wealth of experience and skills to CSSP, with depth in health policy finance, leading national policy campaigns, taking work to scale and bridging the worlds of health, early learning and nutrition,” said Frank Farrow, CSSP’s Director.

Donna comes to CSSP from Health Management Associates, where she focused on helping children’s programs — including maternal and child home visiting, early literacy and pediatric care programs — obtain support from Medicaid. From 2010 to 2015, Donna served as a Senior Policy Advisor and the Director of Enrollment Initiatives in the Center for Medicaid and CHIP Services (CMCS) at the U.S. Dept. of Health and Human Services. There she crafted guidance that helped jump-start Medicaid enrollment under the Affordable Care Act for individuals participating in the SNAP Program. She also directed Connecting Kids to Coverage, the first-ever federal outreach campaign to find and enroll children eligible for Medicaid and CHIP. Prior to that experience, Donna led the outreach division at the Center for Budget and Policy Priorities for 17 years.

Donna also brings to CSSP a background in other issues of importance to children and families, having worked early in her career with the Association for Children of New Jersey, the Community Food Bank of New Jersey and the Newark Preschool Council.

As Donna joins the Center, Amy Fine, who previously led the Young Children and their Families team, will continue to move CSSP’s work forward as a Senior Fellow based in San Francisco.  She will focus on CSSP’s work in California and on new initiatives across the organization.

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Viet Tran is a communications mananger at CSSP. 

The Congressional Budget Office’s (CBO) report on the House-passed version of the American Health Care Act (AHCA), released on May 24, 2017, highlights the ways in which the bill jeopardizes recent gains made in health care coverage, which is a foundation for healthy development and well-being. As CSSP mentioned in a previous blog post, American Health Care Act (AHCA) Passes the House: A Significant Step-back in Health Care Coverage and Advancement in Health Equity, on May 4, 2017, the House voted along party lines to pass the American Health Care Act (AHCA), by a narrow margin of 217 – 213, before the amended bill had the opportunity to be scored by the Congressional Budget Office (CBO). In order to garner enough votes amongst House Republicans, the bill included an amendment crafted by Representatives Mark Meadows (R - NC) of the conservative Freedom Caucus and Tom MacArthur (R - NJ) of the moderate Tuesday Group allowing states to request waivers of essential health benefits and of “community rating” requirements. These harmful waivers would enable insurance providers to: 

  • roll back nationwide standards that require plans to cover services like emergency services, mental health and substance use treatment
  • discriminate against individuals based on their medical history by increasing their insurance premiums;
  • charge women more than men for health coverage as they would have to pay more for plans that include maternity coverage; and
  • re-impose annual and lifetime limits on coverage. 

The CBO report estimates that the bill would lead to the loss of coverage for approximately 23 million people by 2026 – disproportionately impacting children and families of color, low-income children and families and those facing significant barriers to coverage such as those with pre-existing conditions and those who use mental health services or are in need of substance use treatment.

The CBO report estimates that the bill would lead to the loss of coverage for approximately 23 million people by 2026 – disproportionately impacting children and families of color, low-income children and families and those facing significant barriers to coverage such as those with pre-existing conditions and those who use mental health services or are in need of substance use treatment. The AHCA would also effectively end the Medicaid expansion (currently in effect in 31 states and Washington D.C.) as well as reduce individuals’ and families’ access to health care services, weakening coverage or making it less affordable. As amended, the AHCA would allow insurance providers to exclude basic services such as maternity coverage, substance use or mental health treatment or prescription drugs, leaving many people with pre-existing conditions unable to find the coverage they need at any price. Specifically, the CBO report estimates extremely high premiums for those with pre-existing conditions - essentially creating yet another barrier for these individuals to access necessary health care services. The $8 billion (along with a required state contribution) set aside in the bill to help cover those who fall into a high-risk pool also falls significantly short of eliminating the bill’s funding deficits or solving the other problems it creates for people with pre-existing conditions. 

Changes to Medicaid would also devastate state budgets, forcing them to cover the $834 billion spending gap or make difficult decisions regarding who qualifies for the program – potentially pitting vulnerable groups against each other. These changes will also reduce child welfare, juvenile justice and education spending and services – all of which now effectively leverage Medicaid dollars to promote healthy development and well-being for children and youth. Specifically, the AHCA: 

  • Ends federal match funding for all who qualify for Medicaid – effectively converting Medicaid from an open-ended entitlement program to a block grant or per-capita cap;
  • Does not allow states to expand Medicaid coverage to uninsured adults after 2018;
  • Allows states to determine what qualifies as an “essential health benefit;" and 
  • Increases premiums for individuals based on breaks in coverage.  

Currently, ninety-five percent of children in the United States have health coverage – a historic high – thanks in large part to the Affordable Care Act (ACA), Medicaid and the Children’s Health Insurance Program (CHIP). More than 11 million low income adults are also benefitting from expanded Medicaid under the ACA. This progress is threatened however, by continued attempts to dismantle the current structure of providing health care to Americans through efforts such as the AHCA and President Trump’s FY 2018 budget proposal (released yesterday), which includes an additional $616 billion cut to the Medicaid program and CHIP. 

When parents are able to access health care coverage and treatment, it not only strengthens their capacity to promote their child’s development, but increases rates of coverage and treatment services for their children. Legislators have the ability to promote positive health and well-being outcomes for children, families and communities in an equitable manner. But by failing to meaningfully invest in policies and programs that have the ability to reduce systemic barriers to success, they instead create disparate outcomes for children, families and communities of color. As the Senate considers this piece of legislation within the coming month, CSSP urges legislators to reject this harmful proposal and any other damaging attempt to dismantle the current structure of providing health care to Americans. 

For more information on how the current structure of Medicaid promotes well-being and healthy outcomes for children and families and the dangers of altering the funding structure of the program, download and read recent CSSP briefs: 

We will continue to issue policy briefs, statements and blogs in response to attacks on equity, basic rights and well-being. These are continually evolving issues, and our analysis and specific recommendations will change as we learn new information. Please continue to follow us on social media (@CtrSocialPolicy and fb.com/ctrsocialpolicy) and visit our website at www.cssp.org

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Rhiannon Reeves is a policy analyst at CSSP.

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