When she was 15 years old, Danielle Gibson and her two younger siblings left their home in Mingo County for their first of four foster homes. Though there were bright spots during the siblings’ years in the foster care system, Gibson says they also were emotionally abused.
“There were so many horrible people I came across in care that were so good at convincing people they had their hearts in the right place,” said Gibson, now 24.
Gibson’s experience helped cement a career path that she’s pursuing through a West Virginia program that helps former foster kids pay for college. But that time in the foster care system has had consequences, too. Beyond the abuse, she said, the instability was partly what led her siblings to drop out of school — one college and the other high school.
Nationwide, researchers have found time in the foster care system can have lasting effects on kids. Foster children are at a significantly higher risk of developing mental and physical health problems than those who haven’t been in the system — challenges West Virginia kids are already more likely to confront compared with their peers elsewhere.
As the number of children in the state’s custody keeps growing — it’s increased 71% in the last decade — child welfare agencies keep turning to a familiar concept: figuring out what they can do to keep kids out of the system in the first place.
West Virginia has tried this type of prevention work over the years, but programs and kids have suffered without sustained focus and funding. While some of the programs have been successful, many have fallen victim to budget cuts and changing federal support. And even if the programs are up and running, there are long waiting lists, and they rarely operate in every county.
The stakes couldn’t be higher.
“We’re talking about lost generations,” said Beth Cook, a social worker in Logan County who used to work for the West Virginia Department of Health and Human Resources. “We’re talking about the future economy of the state.”
Finding success, losing funding
Under the best circumstances, prevention programs require foresight and planning. And in an agency like DHHR, already struggling with staff shortages and lots of kids, it’s “nearly impossible,” according to a report the agency published in 2019.
It hasn’t always been like this.
From 1990 to 1996, when Gaston Caperton was governor, kids’ issues generally received “more collective, thoughtful consideration, and strategic planning,” said Kelli Caseman of the nonprofit Think Kids.
“Unfortunately, in hindsight, they didn’t robustly evaluate the programs or interventions, and they didn’t keep a repository of data collections or reports,” Caseman said. “It seems, since that time, we keep repeating similar programming and strategies, and stopping them when the funding runs out.”
In the late 1990s, that’s what happened to a truancy program. DHHR funded hundreds of social workers across the state to help kids who were habitually missing school. Truancy can lead to juvenile court referrals, which can mean a child can wind up in the foster care system.
And this concentrated focus, with more than $9 million in federal grants, worked. According to Steve Tuck, CEO of the Children’s Home Society of West Virginia, the number of truant children entering the foster care system went down.
Five years later, the grants ran out and the specialized social workers, employed by agencies like Tuck’s, were laid off. A commission formed to study how to continue the program, and Tuck said some county school systems felt it was so beneficial, they used local money to keep it afloat. But money was tight and they eventually had to cut the programs too.
“It was before its time,” Tuck said of the program, some elements of which reemerged years later as part of a truancy diversion program under Gov. Earl Ray Tomblin.
Then, there was Project Homecoming. The program, which operated in the late 1980s and early 1990s, was designed to provide services to kids at home to avoid sending them to treatment facilities, especially outside West Virginia. The program was modeled after a similar one in Florida, said Sue Hage, a former DHHR deputy commissioner.
It’s hard to find evidence today that the program ever existed, but Hage said it worked.
“We saw success,” Hage said, noting that some of the practices implemented under the program continued well after it ended. But when federal grant money ran out, the state couldn’t sustain it.
Finding ways to keep foster children with complex mental health needs from entering group homes for treatment has dogged DHHR for decades. Years after Project Homecoming ended, West Virginia became among the states with the highest percentages of foster kids in group homes and treatment facilities in the country. In 2014, leaders unveiled Safe at Home: a project with a similar concept.
Among its goals, the $32.4 million program aims to reduce the number of kids entering foster care, improve academics and school attendance in at-risk teenagers, and move West Virginia away from leaning too heavily on institutions or group homes. The U.S. Department of Justice investigated the state and criticized its reliance on these “congregate care” settings.
Through Safe at Home, a team of informal and formal care providers, from a neighbor who watches the kids to a licensed therapist, develop a unique plan to help kids avoid foster care and get social services in their home communities, said Lisa McCullen, who ran the program before she retired. Therapists providing mental health services might come to the child’s home, for instance, instead of the child getting the same treatment in an out-of-state facility.
According to an outside evaluation, the program has been successful in helping kids transition home and stay out of group homes; it’s been less successful in preventing kids from entering the system in the first place.
Disparities in access
But while on paper Safe at Home operates in all of West Virginia’s 55 counties, service providers may not consistently be available.
West Virginia’s topography can make providing services difficult. Regina Short, a former social worker from McDowell County, said providers coming from a county or two over eventually realize they don’t want to travel the windy, rural roads, a trip that can quickly eat up a whole work day. She left her social work job in June 2020 and now is teaching middle school in another county.
“You might have [the program] six weeks, and they would quit showing up,” she said, referring to Safe at Home offerings in McDowell. “I had kids that truly needed those services, but they would just disappear.”
“That service coming to the home was truly a way to put them back on track. The system is failing these kids.”
She said Logan County, where she also worked, had similar problems retaining services.
Indeed, the outside evaluation found that some providers “reported driving over an hour to support youth and their families who live in remote areas.”
Providing services while making a decent living can be impractical in some areas with long travel times, said Sam Hickman, who retired last month as director of the West Virginia chapter of the National Association of Social Workers. A spokeswoman for DHHR noted generally that “workforce capacity is the greatest challenge statewide, and it’s especially challenging in more rural counties.”
The conversation about prevention has been propelled in part by a new child welfare law that took effect in 2019. Under it, the federal government won’t pay for more than two weeks at a group home, except in certain circumstances. Instead, funding will go to cover services like parenting education and mental health support, “in an effort to keep families together.”
But even this new, focused funding doesn’t mean the services will be available to all who need it.
DHHR says the state has three prevention programs up and running: Mountain State Healthy Families, Parents as Teachers and Functional Family Therapy. But they have either not been well-funded or have long wait lists, which the state acknowledges.
The Parents as Teachers program, which the federal government recommends, provides free, in-home education and support for parents to learn about child development. It’s available in 41 West Virginia counties and Jessica Holstein, a DHHR spokeswoman, says 11 of those counties have wait lists.
The state also wants to expand another in-home parent education program, Healthy Families, which is located in a handful of counties in West Virginia.
“Both programs have the infrastructure to expand services with additional home visitation staff to meet increased needs,” the state’s prevention plan says, and have “demonstrated positive outcomes for West Virginia’s families and children.”
Holstein added: “Limited funding prohibits complete coverage in all counties.”
West Virginia has seen promising results with Functional Family Therapy, another accredited program used in other states. One of the therapists based in the Eastern Panhandle, Abigayle Koller, said the model works because it is “relentless.”
“We’re not the Band-Aid approach to the gunshot issue,” she said.
If the family isn’t home when a session is scheduled, Koller will sit outside in her car and wait for them to show up. The organization where she works, the National Youth Advocate Program, has served more than 100 West Virginia families. Eighty-three of these families have finished all three phases of treatment.
“We believe that kids can be treated best in their home communities,” Koller said. “I think the state is really committed to keeping kids at home.”
But even with a proven track record, funding is still an issue. Functional Family Therapy is funded through a $1 million yearly stipend from the West Virginia Legislature. But between training and administrative costs, this wasn’t enough money to expand beyond a few providers, according to the prevention plan.
“Funding has been the primary issue for [the program] not being available statewide,” the state’s prevention plan says.
Because of the funding crunch, West Virginia has only one Functional Therapy Team working in nine counties — all in the Northern and Eastern panhandles, and the north-central part of the state. They are soon planning to expand into Cabell and Wood counties.
The state said explicitly in its prevention plan that it would ask lawmakers to fund an expansion of the therapy and in-home visitation programs during the 2021 legislative session.
But the agency didn’t include the ask in its budget request. Holstein blamed the coronavirus pandemic and a delay in getting federal approval for how the state will pay for the prevention programs. In the meantime, they’re using some money allocated in 2020.
The patchwork funding of these programs might cause delays in getting them up and running for children across all of West Virginia’s counties. But child welfare experts say keeping kids out of the system is paramount.
Kathy Szafran, who heads the Aetna affiliate managing foster kids’ health matters, said there just aren’t enough services in many West Virginia communities to keep kids at home.
But ultimately, she says the solution to keeping kids out of the foster care system is contingent on investing in this type of treatment and care, rather than building more residential facilities.
“We don’t need any more residential facilities,” Szafran said. “We need smaller, specialized facilities, with smaller numbers of kids with intensive treatment — treatment not housing. And then we need services in the communities to keep kids either in foster care … or in their home communities with relatives or their families.”
This series was produced in part with support from The GroundTruth Project. Click here to read the other stories in the series.