New Study Shows Tennessee Has Transformed System to Keep Children with Families and Out of Institutions

State Reform Efforts Provide Valuable Lessons for Child Welfare Systems Nationwide

NASHVILLE – Over the last several years, Tennessee’s focused effort to increase the number of children in foster care living with families rather than inappropriately in institutions — such as shelters, group homes, and residential treatment centers — has not only had a positive impact on children and families across the state, but could serve as a model of child welfare case practice nationwide, according to a new report by the national advocacy group Children’s Rights.

Today’s study, titled What Works in Child Welfare Reform: Reducing Reliance on Congregate Care in Tennessee (PDF), reports that the state’s Department of Children’s Services (DCS) has greatly improved its ability to reserve institutional care only for youth with severe mental and behavioral health needs, and now the vast majority of children in foster care live with relatives or foster families. The report also outlines specific ways other jurisdictions can emulate DCS’s success.

Eleven years since Children’s Rights first filed the class action lawsuit, now known as Brian A. v. Haslam, spurring a comprehensive reform on behalf of Tennessee’s abused and neglected children in state custody, only nine percent of all children in state custody in Tennessee are living in an institution — a dramatic drop from the shocking 22 percent placed in congregate care settings at the time the suit was filed in 2000.

“Tennessee has demonstrated the amazing results that can come from strong leadership, adequate resources, and an unwavering commitment to reform,” said Marcia Robinson Lowry, executive director of Children’s Rights. “We are hopeful that DCS can sustain these remarkable achievements and successfully address the challenges that still lie ahead. But the true measure of reform will be whether it is able to have a lasting impact on children and families not only today, but for years to come.”

According to the What Works study, Tennessee was able to achieve such a substantial decline in the use of congregate care by taking a number of critical steps over the last several years. Among the most important of those steps was the appointment of strong leadership, namely former Commissioner Viola Miller, who brought a vast knowledge of child welfare practice and an aggressive commitment to implementing a top-to-bottom culture change within the department.

Miller’s oversight of Tennessee’s reform effort played a vital role in achieving positive results for children in state care. According to one DCS Regional Administrator:

When Commissioner Miller started, we really started putting a lot more thought and care into finding a placement that was actually going to meet the child’s needs. Before [Commissioner Miller] there just wasn’t as much of a sense [or] care about their experience in foster care. It was more about availability and just kind of making sure that we had somewhere that was safe versus somewhere that was also meeting their well-being needs, that was also warm and caring and more of a family setting.

In addition to the importance of strong leadership, the report points to several other transformative policy, practice, and infrastructure changes that were critical to DCS’s success, such as:

  • Recruiting foster families for targeted populations and closing institutions. While the state still has work to do to recruit and maintain enough foster and adoptive parents for all children in foster care, DCS has refocused its efforts to recruit family foster homes specifically for children with special needs and teenagers, populations that were often overrepresented in institutions. Additionally, the state closed or stopped contracting with a number of institutions, including the Tennessee Preparatory School, a public facility that housed about 300 youth — many of whom were able to return home safely to their parents.
  • Building a collaborative approach to reform. DCS recognized that the state child welfare agency could not successfully implement reform alone. Therefore, it instituted a number of new policies to bring families, private providers, and other professionals to the table to generate more family-based placements for children in foster care. For example, DCS developed a new case practice model that employs child and family team meetings — case planning meetings that comprise not only the children and their parents, but also other family members, foster parents, caseworkers, attorneys, service providers, and others working with the child and family. DCSalso created specialized units and collaborative stakeholder meetings, creating a forum for public agency staff, private providers, and community members to discuss children’s placement needs and to brainstorm strategies for fulfilling them.
  • Prioritizing a functional child welfare data tracking system. Prior to the lawsuit, DCS had an inadequate data tracking system, making it difficult for workers to know where children were placed on any given day — let alone match individual children with placements that could meet their needs. Tennessee has since implemented a new data system that facilitates better placement matches and tracks children’s progress. The new system also allows DCS to monitor systemic placement trends and identify areas for improvement more quickly.
  • Changing the state’s relationship with private providers through performance-based and other contracting models. DCS revised its contracts with private service providers to create new incentives to achieve positive results for children. For example, in implementing a performance-based contracting system, the department now holds private service providers to achieving outcomes directly related to the safety, permanency, and well-being of the children in their care.

While there are many factors that contribute to positive outcomes for children, the child welfare stakeholders interviewed in the What Works study noted that placing children with families whenever possible makes it far more likely that they will find a permanent home, whether it be back with their birth parents or with new adoptive families.

Since DCS committed to reducing its reliance on congregate care, many other positive trends have emerged for children in Tennessee, such as children spending less time in foster care. Data also suggest that DCS’s attention to youth’s safety, well-being, and education has improved, a theme echoed by the study’s participants.

Although the state has achieved great success in reducing its reliance on congregate care, the state still has much work ahead before it can successfully exit federal court oversight. DCS must improve its ability to find permanent homes for children who have been in foster care for more than two years, develop better services for older youth in foster care before they leave state custody, and, as mentioned above, bolster its efforts to recruit and retain foster families statewide.

“Through their willingness to fully dedicate themselves to reform and adopting a more open, nimble approach, Tennessee is a model for creating meaningful change for abused and neglected children,” said Lowry. “While challenges still remain, this report gives us hope that these positive trends will continue and that the children and families of Tennessee have only seen the beginning results of this reform effort.”

Filed in 2000 by Children’s Rights and co-counsel on behalf of all children in state custody (currently 6,000 children), the Brian A. lawsuit charged Tennessee’s mismanaged child welfare system with violating children’s constitutional rights and causing them irreparable physical and emotional harm. Co-counsel includes a team of Tennessee attorneys including David Raybin of Hollins, Raybin & Weissman and Jacqueline Dixon of Weatherly, McNally & Dixon in Nashville; Richard Fields in Memphis; Robert Louis Hutton of Glankler Brown in Memphis; and Wade Davies of Ritchie, Fels & Dillard in Knoxville.

Children’s Rights and state officials negotiated a settlement agreement in 2001 mandating system-wide reform, but it initially yielded few results, prompting Children’s Rights to file a contempt motion against the state in 2003. A new agreement was reached and new DCS leadership was put in place, along with a requirement for DCS to work with a technical assistance committee composed of national experts to meet the requirements of the reform plan.

To read What Works in Child Welfare Reform: Reducing Reliance on Congregate Care in Tennessee and find out more about Children’s Rights’ child welfare reform efforts in Tennessee and nationwide, please visit www.childrensrights.org/congregatecare.