Reform in the Hills: Reducing Congregate Care in Upstate New York

Syracuse University Hill in New York at dawn.

Five years ago, the leaders of Onondaga County, New York — home to nearly half a million people, the city of Syracuse, and hills, lakes, rivers — saw an opportunity. The number of children placed in foster care had dropped to a little more than 200 from the nearly 900 placed in the system in the late 1990s. The county’s child welfare system even had a tidy budget surplus of a few million dollars.

That was the good news. But the county also had high rates of so-called congregate care, a type of foster care placement that includes group homes and other institutional options.

In recent years, the poor outcomes for the young people living in such settings has brought policymakers, advocates and other child welfare professionals to a consensus that the system should stop relying so heavily on them. With that in mind, earlier this year, Congress passed the sweeping Family First Prevention Services Act, which included tight restrictions on federal reimbursements to local systems like Onondaga for the care of children placed in most group facilities.

More than 30 percent of Onondaga County foster youth lived in these types of settings, as opposed to with foster families or close relatives — three times the rate in New York City, and five percentage points higher than the state average. So the county decided to use its budget surplus with three aims in mind: increasing foster placements with kin, decreasing placements in congregate care and hiring more child protective staff.

Last year’s data suggest that Onondaga’s plan is paying off. Only 27 percent of youth in care were in congregate care, a five-year low.

Meanwhile, 60 youth were placed with relatives, according to county child welfare director Jim Czarniak. Before last year, he said, only one or two relative placements were made. In addition, 77 percent of cases reviewed by a newly formed triage team had been placed in approved kinship homes.

The complicated and at-times tense restructuring of child welfare services that Onondaga has managed puts it in a stronger position to benefit from Family First, which, in addition to clipping congregate care reimbursements, offers new federal funds for services aimed at preventing children from entering foster care.

“This is pretty extraordinary – by examining their own data, the county was able to make a practice change that not only resulted in savings, but will also result in better outcomes for the children and young people it serves,” said Kari Siddiqui, a senior policy analyst for the Schuyler Center for Analysis and Advocacy, an Albany-based nonprofit group that advocates for low-income youth and families.

The process began with a restructuring of child services at the top in the early 2010s.

All child welfare services, as well as juvenile probation, detention, mental health and school-based initiatives, were moved into the county’s new Department of Children and Family Services. Agreements were signed with the probation department to allow the new DCFS to do the work. All financial personnel were pulled out of their individual departments and moved into the administrative office.

Crucially, child welfare could be presented separate from the other, much larger social services it used to be grouped with on county budgets that elected officials reviewed.

“If you have this gigantic department of social services and you take down the foster care count and saved $2 million, that pales next to the bill for Medicaid,” said Ann Rooney, deputy county executive for Human Services. “But we’ve been successfully able to make the argument to the county legislature, ‘Look at what we’re doing in foster care — it’s so much cheaper and better for the child,’ if you’re looking at kinship options, much lower levels of care than institutions.

“They can zero-in now on this foster care count that wasn’t tied to this gigantic department.”

The reorganization prompted the county’s former health commissioner, Dr. Cynthia Morrow, to quit her job out of concerns that health outcomes would suffer if its services “for mothers and children” were moved under the department that investigates child abuse.

Local newspapers featured comments from doctors worried about expanded surveillance of families by the Department of Social Services. “The word ‘DSS’ strikes fear in families. Period,” said Dr. Michelle Bode, a neonatologist at the Regional Neonatal Intensive Care Unit at Crouse Hospital, in Syracuse, to the Syracuse New Times.

Dr. Thomas R. Welch, medical director at Upstate Golisano Children’s Hospital, called the plan “breathtakingly stupid.”

“It’s about owning your budget. It’s not ‘your kid’ or ‘my kid,‘ between child welfare and probation departments — now it’s both,” said Czarniak, who has been invited by the state to speak at conferences with other counties about the reorganization and the focus they’ve put on reforms.

The restructuring was followed by philosophical changes in the county’s child welfare system. Leadership began giving directives to frontline staff to prioritize kin placements. And, in a new policy, all placements in congregate care required director-level approval from Czarniak.

To support the effort, the Redlich Horwitz Foundation chipped in $150,000 divided over two years, helping fund staff for new triage teams and to expand the county’s capacity to find families for kids. One of the largest foster care agencies in the region, Hillside Family of Agencies, was given a subcontract for improved training and certification for close relatives who take in foster children.

These shifts do not appear to have impacted child safety. Onondaga County ranks relatively high among New York’s safest counties, by one closely monitored metric: recurrence of child abuse or neglect. The percentage of children who were abused or neglected within 12 months of a first report to the county was right around 15 percent in 2015. That was a four-year low, and better than the statewide average. (Though New York generally has a higher recurrence rate than the rest of the country, maltreatment definitions differ by region, making comparisons hard.)

“If you don’t have [good safety statistics], and there’s a tragedy involving a child, you’ll have a political firestorm that consumes everything else,” Czarniak said.

Altogether, the changes in Onondaga County have received positive reviews from influential stakeholders statewide.

“It will take time, but Onondaga is on the right path,” said Jeremy Kohomban, CEO of Children’s Village, who pointed out that the county’s multi-year plan to safely reduce residential placement, while increasing foster and kin family placement, is similar to what New York City did over a decade ago.

“It is not easy to break from the tradition of residential care, especially when it comes to serving the poor, native and children of color who are overrepresented in our system,” added Kohomban, who years ago oversaw Children’s Village’s transformation from a mostly residential provider to one that mostly provides community-based services now. “There seems to be a cohesive vision between the county executive and child welfare department leadership. The willingness to acknowledge that residential care, while critically important, is not a solution, requires strong political support. Children need permanent families, no institution can replace family.”

Congress echoed that sentiment in its recent passage of the Family First Prevention Services Act, which limits states to two weeks of federal dollars for placements in group homes and other residential centers, with some notable exceptions for youth with significant health issues.

The change is causing anxiety in Albany — New York and California were two states most vocal in their opposition to Family First before its passage. But Czarniak said Onondaga County’s child welfare team is looking forward to the change.

“Like every other system, the evolution is toward home-based care. We have to have the resources behind it,” Czarniak said.


If you are interested in reading more about federal child welfare and juvenile justice policy, read our annual special issue “Kids on the Hill: A Special Issue on Child Welfare Policy” by clicking here!


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Michael Fitzgerald
About Michael Fitzgerald 74 Articles
Northeast Editor for The Chronicle of Social Change. Follow me on Twitter: @mchlftzgrld