Bringing Data to Life

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association. 

For many lawyers and social service advocates, social science research and statistical data is not only foreign territory but also daunting. Despite this, social science research and data can serve as a sophisticated tool in child welfare cases for many reasons.

• Research provides incontrovertible facts that cannot be ignored by a fact finder or the child welfare agency.
• Although it may be uncomfortable to dabble in this realm, social science research and data generally support our goals in parent representation.
• Lawyers and social service advocates’ awareness of data trends and ongoing research can help craft novel court arguments or out-of-court strategies in child welfare cases.

This article shares useful resources for locating child welfare data and then briefly reviews research in four child welfare domains with guidance on leveraging that research in cases.

Locating Child Welfare Data and Research

Not all research and data are created equally. There are many types of research studies and many types of data collections that fuel those study results. Thus, the quality of any individual study will differ. Although double-blind research methods are typically seen as the gold standard in scientific research, social science topics like child welfare also lend themselves well to sociological research methods and pure data analysis, like longitudinal AFCARS data for example.

In general, look for studies that have larger sample sizes, so that generalizations about the study can be made more easily to the general population, including your case. When researching a certain topic, ensure that you’re looking at a comprehensive list of studies, not just one individual study that supports your point in a larger body of research that may contradict that point. In addition to primary research, meta-analyses, or those studies which review multiple studies, are very helpful in sorting out patterns in child welfare issues. In trying to locate quality research and data, many reliable open access resources share the latest child welfare data and research. For example:

• Adoption and Foster Care Analysis and Reporting System (AFCARS)^[1] – A rich source of state-level data on all children in foster care. It includes data on demographics of foster children and foster and adoptive parents, number of removal episodes for a child, number of placements in the current removal episode, and current placement settings.
  
  
• Child Welfare Information Gateway[2] - Includes a large publication library and free listserv subscriptions that deliver updates about new research findings and data.
  
  
• Child Welfare Agency Data - State child welfare agencies also routinely publish quarterly or fiscal year data about their agencies’ service population, placement settings and availability, and number of children in care by specific demographic characteristics. If you cannot find this data online at the agency website, try using a public records request to the agency as these are typically predrafted reports available to the legislature and larger public.
  
  
• Open source research search sites, such as Google Scholar and ResearchGate, allow practitioners to search for specific research and data.
  
  
• Listservs - Many local practitioners have listservs that share new research findings or data. For example, in Massachusetts, the agency in charge of overseeing indigent representation, the Committee for Public Counsel Services (CPCS), maintains secure listservs and newsletters for various areas of indigent representation.
  
  

Debriefing the Data: Four Child Welfare Domains

Debriefing Data on Racial and Ethnic Disparities

Racial and ethnic bias is common in the child welfare system given the wide discretion and many subjective judgments that are made daily. When coupled with high caseloads, shortcuts may be sought that decrease the intellectual and physical demands of each case; this can lead to stereotypes and bias that substitute for more sophisticated individualized judgements. For decades, research has documented racial disparities at each stage of the child welfare case: acceptance of a case for investigation, substantiation of alleged maltreatment, placement in out-of-home care, length of time in placement, and time to reunification.[3] Research also makes clear that racial disparities in the child welfare system are not due to poverty alone, but are related to caseworker assessment of risk.[4]

Data on racial and ethnic disparities can also help child welfare attorneys and social service advocates move their own work on racial and ethnic disparities from “window work” (observing others) to “mirror work” (reflecting on how you/your role perpetuates racial and ethnic bias). Indeed, social science research even breaks down a day in court to show how routine court procedures and practices marginalize clients of color.[5]

Leveraging the research. To leverage this data in our own cases, practitioners can raise awareness of bias and reduce it by:

1. Working with local attorneys/bar associations to implement judicial bench cards such as the one from the National Council of Juvenile and Family Court Judges.[6] This bench card has been published since 2010 and at least one study on its efficacy shows that judges who implemented the bench card engaged in statistically significant increases in discussion, both quality and quantity, about the individualized family before making any decision.[7] Bench card use was also associated with a statistically significant increase in the percentage of children who were reunified with the charged parent at the initial hearing, statistically significant increase in the number of family placements at the initial hearing and even more at the adjudication phase.[8] Since we know that racial disparities exist at every decision point in the child welfare system, working to implement bench cards that tackle these decision points, especially the NCJFCJ bench card with proven results in key areas of racial disparity, is one significant way we decrease reliance on stereotypical decision making to move towards conscious individualized family decisions.
   
   
2. Changing the narrative in the courtroom to address structural barriers, emphasize the positive, and ensure all parties have a voice in court. For example, raise larger structural barriers to completing tasks required by the court or child welfare agency, such as lack of reliable transportation to visits and appointments or waitlists for therapists and other services. When parents do not accomplish these tasks, it is too easy, but fundamentally flawed, to blame the parents and suggest that they are disinterested or refusing to engage when larger structural issues often prevent parents from accomplishing these tasks.
   
   It is equally important to emphasize the positive in the case. While the limited time each family spends before the court is an invitation to merely sum up the problems the family continues to face, it’s not a complete picture of how much the parent is doing. So, it is not enough to have the court hear how the parent missed two visits, but rather that the parent attended four visits and rescheduled the missed two visits for a time in the future.
   
   Finally, while it may seem counterintuitive to our training as lawyers, we should be prepping our parent clients to have their voices heard each time their case is in court. This practice not only allows the judge to hear concerns directly from the parent, it better aligns with the procedural fairness and therapeutic jurisprudence research theories[9] to addressing bias.
   
   
3. Locating family/kinship resources if the child cannot return home immediately and advocating for equal service provision as if the child was in foster care. Not only does this have an immediate and individualized effect on the statistics of racial disparities in out-of-home placements and children of color languishing in the foster system, this will impact the larger picture of racial and ethnic disparities. Indeed, when large numbers of children of color are removed from their communities and placed into state custody, the entire community’s collective ability to identify and address institutionalized racism through greater empowerment is gutted because the state strips that community of its future: the children. When it comes to our representation of parents of color, placing the child in family or kinship placement preserves familial bonds and keeps the child in the local community. It also strengthens the community factors that protect our parent clients’ identities, cultural background, and ability to organize for change. And perhaps, most importantly, once a kinship provider is identified, fight to make sure the family, both the parent and the child, receives as many services as if the child were in the formal foster care system.
   
   
4. File motions specifically identifying the racial disparity in child welfare issues and linking the data on disparity to reasonable efforts. It’s the first step in correcting agency blind-spots and educating the court about how its decisions impact the larger disparities in child welfare.
   
   

Debriefing the Data on Evidence-Based Service Planning

Although terms may differ from state to state, all states require child welfare agencies to create a list of tasks a parent must complete to reunify with a child whom the state agency has removed from the parent’s care. While federal legislation like the Adoption and Safe Families Act (AFSA)[10] originally envisioned engaging parents and families in effective reunification services within swift decision-making timeframes, growing misunderstandings about service planning has resulted in plans that look more like grocery lists than thoughtful targeted approaches to reunification. Indeed, data on service planning confirms that on average, parents are asked to complete 7.5 different services on their reunification service plans.[11] Even more alarming, research confirms that completing tasks on a service plan requires an average of 22 to 26 hours per week.[12]  For example:

• Substance abuse treatment takes approximately nine hours per week for six months.
• Looking and applying for jobs can take five hours per week for six months.
• Case management and meetings can take five hours per week for the duration of the case.
• Parenting classes take an additional two hours per week, often for several months.
• Other services such as therapy or domestic violence counseling can take an additional one to four hours for several months.[13]
  
  

Social science research shows a substantial portion of services are boilerplate services resulting in 35% of parents getting services for problems they don’t have.[14] Research also shows that intensive or higher number of services do not consistently correlate with quicker reunification or lower re-entry.

Leveraging the research. Leveraging existing research allows us to argue that fewer, evidence-based services targeted to the parent’s needs may be needed to help the parent succeed.[15] Other ways to leverage this data in our caseloads include:

1. Changing the narrative around service planning and being more visual about the burden of service plans. As attorneys for parents, we should be vocal against “everything except the kitchen sink” boilerplate service plans for our clients and instead insist on only services that are evidence-based and time-limited. Sometimes, the child welfare agency or the court do not really understand just how much work being involved in the child welfare system is for parents. We should be changing the narrative to show how burdensome compliance with service plans actually is for parent clients. Do this by making a visual, such as a calendar, that vividly illustrates every action the parent took on the case -- phone calls, appointments, and visits. These visuals help others who do not have the lived experience understand the tremendous amount of work the parent is doing to reunify with the child.
   
2. Hiring your own social work expert to find culturally competent and evidence-based services for your client. Your own social work expert will likely know whether programs are evidence-based or not and can follow up directly with clinical terminology that attorneys are not often familiar with.
   
3. Being a vocal advocate when drafting service plans and demanding the plans factor in research and data. While the child welfare agency will often only refer parents to services that they have a contract for, that does not necessarily align with any given parent’s needs or with reasonable efforts. Instead, use the drafting of service plans as an opportunity to inject services that are actually research based and tailored to your parent client’s needs, not just the agency’s referral list. Advocate for efficacy over volume of services, create solid benchmarks around discontinuation, insist on triaging issues so that basic needs are met before adding cumbersome ancillary services, and focus the agency on parsimony—requiring the smallest number of services to achieve safety (or some other goal) and then stepping up the services if needed. This approach has the collateral benefit of decreasing the length of waitlists, as not all families are referred to the same boilerplate services at the same time if that service is not a priority need for a family.
   
4. Link service planning to the larger discussion on reasonable efforts in child welfare cases in the courtroom. Too often, the mandate for child welfare agencies to provide reasonable efforts toward the goal of reunification translates to service plans which are “everything except the kitchen sink.” However, reasonable efforts in our cases means taking the time to assess this family and identify the minimal amount of services to stabilize them. Boilerplate service plans are not reasonable and the effort required to produce boilerplate service plans falls far below the reasonable efforts benchmark. Finally, when those things aren’t happening, bring the agency into court. File a motion to compel their reasonable efforts and show their abuse of discretion in providing boilerplate service plans to reunify the family.  Your client will be judged on the ability to complete service plan tasks, so the child welfare agency should be judged on its ability to identify appropriate services.

Debriefing the Data on Parent-Child Contact

Research on parent-child contact consistently shows visitation is at the heart of reunification. It is well documented that visitation is essential for a child’s well-being and fundamental to timely reunification and permanency, maintaining family relationships, and sustaining cultural connections.[16] Longstanding data confirms that children in foster care who are visited frequently exhibit less behavioral problems than children who are visited monthly or less. These children also show less anxiety or depression than children whose parents’ visits are either infrequent or nonexistent.[17] Guidelines on parent-child contact recommend visits never be used as a reward or punishment. Rather, visits are clinically necessary to promote parent-child well-being and are legally consistent with a parent and child’s fundamental rights.[18]

Leveraging the research. When leveraging data to increase meaningful parent-child contact, consider:

1. Drafting motions for parenting time that cite research and include proposed orders. Drafting these types of motions alert the court that current standard visitation practices are not in line with current scientific and sociological research about child-well-being. Further, including a proposed order allows your parent client to weigh-in as to their schedule in advance to ensure the parent can attend any additional visitation that the court allows.
   
2. Challenging standard visitation practices. Instead of one-hour supervised visitation per week per family, argue for increased time and that unsupervised visitation should be the starting point in each case. The child welfare agency should have the burden to show the court that expanded unsupervised visitation is not in a specific child’s best interest. While this may seem lofty, it is entirely appropriate to put the burden on the child welfare agency to deviate from longstanding research about well-being, as cited above. This is already how visitation is handled in Georgia[19] and illustrates a promising practice for addressing this issue legislatively and in motion practice.
   
   
3. Using your state’s family court (divorce) parenting time guidelines broken down by age group as a framework for requests and orders. These two courts deal with very similar subject matter (children) but currently allot parenting time very differently. While many times, a family’s visitation schedule in the child welfare court is determined by a child welfare worker’s schedule, the probate court routinely determines duration and frequency of visitation according to the developmental needs of the child. For example, in Massachusetts many parents entangled in the juvenile (child welfare/dependency) court are only allotted one hour per week with their child. In contrast, with the support of the chief justice of the probate and family court, model parenting time plans in the probate court offer visitation with the noncustodial parent ranging from several times weekly, including caregiving functions like feeding and bathing, to overnights.[20]
   
   Although the child welfare agency may argue with using probate and family court visitation schedules in the child welfare case because there are allegations of unfitness, that does not address the central issue of child well-being. Parental visitation is not a reward for a fit parent, it’s a necessary component of child well-being and mental health. We can change the narrative of visitation patterns by shifting the focus to how parent visitation supports the child’s well-being. Thus, if a parent’s fitness is truly at issue (versus an unsafe/unclean home), then parenting time may have to be supervised, but it should never be diminished or deviate substantially from model parenting plans in the probate court simply because of allegations of parental unfitness.
   
   
4. Making reasonable efforts arguments at each stage of the proceedings.[21] Independent of state laws, federal law makes funds to child welfare agencies contingent on providing reasonable efforts, not just at the start of a case, but throughout the duration of the case and even into the permanency plan for the child. To bolster reasonable efforts arguments, consider asking the child welfare agency for its list of potential services/service providers.[22] Then, research which of these are evidence-based and considered effective. This information can help the judge better understand whether the agency’s efforts were reasonable at each state of the proceedings.
   
   
5. Hiring a social work expert to help make clinical arguments about the need for parent-child contact. One avenue may be documenting the need for frequent and meaningful visitation in the clinical terms of the child’s developmental needs.
   
   

Debriefing the Data on Harm of Removal

Often, the larger narrative of foster care focuses on the benefits of providing children stable substitute care environments not the negative effects of child welfare system involvement. An increasing body of research addresses this imbalance.[23] For example, recent pediatric research has shown children in foster care are seven times as likely to experience depression,[24] five times as likely to experience anxiety,[25] and six times as likely to exhibit behavioral problems than the general population.[26] While there is an argument that these behavioral differences may result from the parenting that led to the placement of the child in foster care, an increasing body of research has carefully parsed out the data to eliminate certain child and household characteristics, and this data points to the concerning effects of foster care placement on mental health.[27] The harmful effects of removal extend well past the behavioral realm. Indeed, youth in foster care have an unemployment rate between 47% and 69% (compared to 10% of youth in the general population),[28] have a disproportionate likelihood of chronic criminal offending,[29] and have a higher BMI (body mass index) than non-foster care youth.[30] The data even documents that children in “marginal” homes have better employment, delinquency, and teen motherhood outcomes when they remain at home versus being placed in foster care.[31]

Leveraging the research. When leveraging the data on the harm of removal, consider:

1. Hiring a social work or forensic expert to disentangle the effects of foster placement on a child’s behavior. It is key not to let a child’s emotional, behavioral, educational, or physical health concerns after placement reflect on the parents. Consider also asking the child welfare agency to grant permission (or ask the court for an order) for the parent to receive the medical and educational records of the child while in foster care to monitor any negative effects of foster care on the child.[32]
   
2. Assisting in service plan drafting to prevent long-term harm from child welfare system involvement. Consider including requirements for the child welfare agency to include the parent in any medical appointments and school meetings, or minimally for access to those providers and their records.
   
3. Filing motions specifically identifying the harm of removal and linking those harmful effects to reasonable efforts. The Children’s Rights Litigation Committee of the American Bar Association Section of Litigation recently launched an online tool that helps lawyers incorporate research on harm of removal and separation from parents into their litigation efforts.[33]
   
4. Supporting parent ally and former foster youth movements in your community to lend voice and support to our clients. Child welfare system involvement can be lonely and ostracizing. People’s lived experiences and extrication from this system can be a powerful support for those currently involved in the system and can help them identify and successfully manage the harm of removal early.    
   
5. Participating in non-court system reforms to change the narrative of the foster care system to reflect the traumatic realities of system involvement.

Conclusion

The dominant narrative in our society paints foster care and child welfare system involvement as positive and helpful. However, foster care failings and the long-term harm of child welfare agency involvement is rarely discussed. This narrative must be changed to better reflect many families’ experiences with a system that can strip families of their cultural identities, their natural caretaking abilities, their critical bonding time, and their fundamental right to family integrity. Lawyers for parents and social service advocates can use social science data and research as an innovative and irrefutable ally in the fight for our clients’ fundamental rights. From using different practices in negotiating service plans, to rethinking practices in court for parents of color, and filing motions that force the child welfare agency and court to weigh structural barriers and failings of the current system, data and research are vital legal tools in parent representation.

Cristina F. Freitas, partner, Freitas & Freitas, LLP, Lowell, Massachusetts.

Debbie F. Freitas, partner, Freitas & Freitas, LLP, Lowell, Massachusetts.

Michael Heard, managing social worker, Washington State Office of Public Defense, Parents Representation Program, Olympia, WA.

Alexandra G. Roark, supervising staff attorney, Trial Panel Support Unit, Children and Family Law division, Committee for Public Counsel Services, Boston, MA.

Endnotes

[1] U.S. Children’s Bureau, Office of the Administration for Children and Families. Adoption and Foster Care Analysis and Reporting System (AFCARS). <https://www.acf.hhs.gov/cb/research-data-technology/reporting-systems/afcars>

[2] Child Welfare Information Gateway: https://www.childwelfare.gov/

[3] Dettlaff, Alan J. et al. “Disentangling Substantiation: The Influence of Race, Income, and Risk on the Substantiation Decision in Child Welfare.” Children and Youth Services Review 33, 2011, 1630–1637. <https://pdfs.semanticscholar.org/55f9/f76d476e94c18a1d71ecf930e949df496de8.pdf>; See also Fluke, J. D. et al.  “Disproportionate Representation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization.” Children and Youth Services Review 25, 2003, 359–373 (racial disparities exist at initial reports of maltreatment stage) <https://psycnet.apa.org/record/2003-00869-001>; Zuravin, S., J. Orme, & R. Hegar, R. “Disposition of Child Physical Abuse Reports: Review of the Literature and Test of a Predictive Model.” Children and Youth Services Review 17, 1995, 547–566 (disparities in acceptance for investigation stage) < https://www.semanticscholar.org/paper/Disposition-of-child-physical-abuse-reports%3A-Review-Zuravin-Orme/7d5d4508d2d662039f3994af32b82baf3b69a62f>; Rolock, N., & M. Testa, (2005). “Indicated Child Abuse and Neglect Reports: Is the Investigation Process Racially Biased?” In D. Derezotes (Ed.), Race Matters in Child Welfare: The Overrepresentation of African American Children in the System, 2005, 119–130. Washington, DC: CWLA Press (disparities at the substantiation of alleged maltreatment stage) < https://repositories.lib.utexas.edu/bitstream/handle/2152/15376/casey_disparities_childwelfare.pdf?sequence=5>; Rivaux, S. L. et al. “The Intersection of Race, Poverty, and Risk: Understanding the Decision to Provide Services to Clients and to Remove Children.” Child Welfare 87, 2008 151–168 (disparities at the home removal stage). <https://www.researchgate.net/profile/Donald_Baumann2/publication/23440538_The_Intersection_of_Race_Poverty_and_Risk_Understanding_the_Decision_to_Provide_Services_to_Clients_and_to_Remove_Children/links/565a0cb908aeafc2aac50350.pdf>; and Hill, R. B. (2005). “The Role of Race in Parental Reunification.” In D. Derezotes, J. Poertner, & M. Testa (Eds.), Race Matters in Child Welfare: The Overrepresentation of African American Children in the System, 2005, 215–230. Washington, DC: CWLA Press. <http://www.citizenreviewpanelsny.org/documents/disproportionality_paper_bob_hill.pdf> (disparities at the exit out of care stage).

[4] Ibid.

[5] Lens, Vicki. “Judging the Other: The Intersection of Race, Gender, and Class in Family Court.” Family Court Review 57(1), January 2019, 72-87. <https://onlinelibrary.wiley.com/doi/full/10.1111/fcre.12397>

[6] Miller, Nancy B. and Candice L. Maze. “Right from the Start: The Courts Catalyzing Change (CCC) Preliminary Protective Hearing Benchcard, A Tool for Judicial Decision-making,” 2010. 

[7] Bickett, Mari Kay and Nancy B. Miller. Right from the Start: The CCC Preliminary Protective Hearing Benchcard Study Report, Testing a Tool for Judicial Decision-Making. National Council of Juvenile and Family Court Judges. <https://www.ncjfcj.org/publications/right-from-the-start-the-courts-catalyzing-change-preliminary-protective-hearing-benchcard-study-report-testing-a-tool-for-judicial-decision-making/>

[8] Ibid.

[9] Lens, Vicki. “Judging the Other: The Intersection of Race, Gender, and Class in Family Court.” Family Court Review 57(1), January 2019, 72-87. <https://onlinelibrary.wiley.com/doi/full/10.1111/fcre.12397>

[10] See a review of AFSA priorities and timelines at Child and Family Services Reviews Information Portal:  <https://training.cfsrportal.acf.hhs.gov/section-2-understanding-child-welfare-system/2999>

[11] D'Andrade, Amy C. and Ruth M. Chambers. “Parental Problems, Case Plan Requirements, and Service Targeting in Child Welfare Reunification.” Children and Youth Services Review 34(10), October 2012, 2131-2138. <https://scholarworks.sjsu.edu/cgi/viewcontent.cgi?article=1009&context=social_work_pub>

[12] Brook, Jody and Thomas P. McDonald. “Evaluating the Effects of Comprehensive Substance Abuse Intervention on Successful Reunification.” Research on Social Work Practice 17(6), 2007, 664-673. <http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.535.7888&rep=rep1&type=pdf>

[13] Ibid.

[14] See D’Andre and Chambers, 2012.

[15] Berliner, Lucy  et al. “Report of the APSAC Task Force on Evidence-Based Service Planning Guidelines for Child Welfare.” Child Maltreatment 20(1), 2015, 6-16. <http://depts.washington.edu/risemh/wordpress/wp-content/uploads/2018/08/Report-of-the-APSAC-task-force-on-evidence-based-service-planning-guidelines-for-child-welfare.pdf>

[16] See Texas Department of Family and Protective Services. Texas Child and Family Visitation Best Practice Guide, 2015. <https://www.dfps.state.tx.us/Child_Protection/State_Care/documents/Visitation_Best_Practice_Guide.pdf>

[17] Cantos, Arthur L,  Leonard T. Gries & Vikki Slis. “Behavioral Correlates of Parental Visiting during Family Foster Care.” Child Welfare 76(2), Mar/Apr 1997, 309-29. <https://search.proquest.com/openview/d0927118e73764b20b8c1a17fd5855b7/1?pq-origsite=gscholar&cbl=40853>

[18] See Texas Department of Family and Protective Services, 2015.

[19] Georgia Juvenile Court Dependency Statute, O.C.G.A.§15-11-112 (2016), <https://law.justia.com/codes/georgia/2016/title-15/chapter-11/article-3/part-1/section-15-11-112/>

[20] Massachusetts Chapter of the Association of Family and Conciliation, Planning for Shared Parenting: A Guide for Parents Living Apart, uploaded 2016. <https://www.mass.gov/files/documents/2016/08/tx/afccsharedparenting.pdf>; Massachusetts Model Parenting Plans Task Force, Designing a Plan in the Best Interest of Your Child: Information You Should Consider. < https://www.mass.gov/files/documents/2017/09/01/parentingplan.pdf>

[21] Judge Leonard Edwards (ret.). “Overcoming Barriers to Making Reasonable Efforts Findings.” ABA Child Law Practice Today, January 29, 2019. <https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/january---december-2019/overcoming-barriers-to-making-meaningful-reasonable-efforts-find/>; Milner, Jerry  and David Kelly, “Reasonable Efforts as Prevention,” ABA Child Law Practice Today, November 5, 2018. <https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/january-december-2018/reasonable-efforts-as-prevention/>

[22] Edwards, Judge Leonard (ret.). “Overcoming Barriers to Making Reasonable Efforts Findings.” ABA Child Law Practice Today, January 29, 2019. <https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/january---december-2019/overcoming-barriers-to-making-meaningful-reasonable-efforts-find/>

[23] Liebmann, Theo. “What’s Missing from Foster Care Reform?: The Need for Comprehensive, Realistic, and Compassionate Removal Standards.” Hamline Journal of Public Law & Policy 28, 2006, 141.

[24] Turney, Kristin & Christopher Wildeman. “Mental and Physical Health of Children in Foster Care.” Pediatrics 138(5), 2016, 1. <https://pediatrics.aappublications.org/content/pediatrics/138/5/e20161118.full.pdf>

[25] Ibid.

[26] Ibid.

[27] Ibid.

[28] The Annie E. Casey Foundation, 2017.

[29] Yang, Jennifer, Evan C. McCuish, & Raymond R. Corrado. “Foster Care Beyond Placement: Offending Outcomes in Emerging Adulthood.” Journal of Criminal Justice 53, 2017, 46. <https://www.sciencedirect.com/science/article/pii/S0047235217302684>

[30] Ramseyer Winter, Virginia, Katie Massey Combs & Michaella Ward. "An Investigation of the Association Between Foster Care, Body Image, and BMI: A Propensity Score Analysis." Children and Youth Services Review, 84(C), 2018, 82-85. <https://ideas.repec.org/a/eee/cysrev/v84y2018icp82-85.html>

[31] Doyle, Joseph, J. Jr. "Child Protection and Child Outcomes: Measuring the Effects of Foster Care." American Economic Review 97(5), 2007, 1583-1610. <https://www.aeaweb.org/articles?id=10.1257/aer.97.5.1583>

[32] Many states already have statutes in place in the context of divorce litigation that gives non-custodial parents the statutory right to access the medical and educational records of their children. See Mass. Gen. Laws c. 208 section 31 (“The entry of an order or judgment relative to the custody of minor children shall not negate or impede the ability of the non-custodial parent to have access to the academic, medical, hospital or other health records of the child, as he would have had if the custody order or judgment had not been entered…”). These statutes can be easily used to craft potential orders for access if the child welfare agency will not grant a parent permission to access the child’s providers which the child is in foster care. Further, access to this information is crucial to reunification as the parent must be fully aware of the child’s needs to be able to meet them successfully.

[33] For additional research and citations, see ABA Children’s Rights Litigation Committee. “Trauma Caused by Separation of Children from Parents: A Tool to Help Lawyers” May 2019. https://www.americanbar.org/groups/litigation/committees/childrens-rights/trauma-caused-by-separation-of-children-from-parents/