By developing a more successful and cost-effective model for finding permanent homes for the most-difficult-to-place in care, Amelia Franck Meyer is proving that the key to fixing the U.S. foster care system is to break the cycle of disruption and trauma it too often perpetuates.
The New Idea
Amelia is guiding a comprehensive turnaround of the U.S. foster care system, effectively reimagining the central approach from one that is reactive in nature to one that proactively meets the needs of youth and breaks the cycle of multiple placements and trauma. There is already widespread agreement that conditions in the U.S. foster care system are appalling. Amelia’s insight is that foster care as currently set up doesn’t solve but actually perpetuates the problem, effectively creating a downward spiral of trauma. Amelia can deliver this tough assessment and actually find allies and win support because she has proven that despite the grim reality, there is hope with a new and more effective approach, and that the new model can be embraced and spread through the existing system, not via an outside or foreign fix that narrowly defines everyone in the current foster care system as the problem and thus further disempowers them.
Amelia has first had to prove that the current priorities and approach in foster care exacerbate the trauma young people face by breaking that cycle with the hardest-to-place young people. Over the last five years she has proven that her approach is nearly twice as successful in finding permanent homes for foster children, is more cost effective, and is safer for everyone involved. She is now championing a new operational model built around the central values of permanence and wellbeing and that is relevant for the whole foster care field. Her overall approach fundamentally restructures foster care agencies by changing how they are organized, where funding is directed, and – most importantly – the very definition of success. Hierarchical bureaucracies inside placement agencies are replaced with highly collaborative teams and an organizational culture where staff are expected to problem solve, seek additional learning, and support their colleagues through the inevitable difficulties. The shift from an overprotective emphasis on physical safety to wider one on wellbeing and from quick fixes to more lasting permanence has reduced trauma, improved permanency rates, and contributed to wider wellbeing among caseworkers and young people in the foster care system.
Amelia has not only been able to prove that it is possible to break the downward spiral of repeated placement, trauma, and disruption (with the hardest-to-place youth, no less), but has simultaneously demonstrated that a higher success rate results in major costs savings that more than cover the initial upfront investment of time and resources in this approach. Amelia’s model is now flourishing in Minnesota and Wisconsin and, through partnerships with state agencies and with national funders, is rapidly spreading to Texas and the District of Columbia. She anticipates expansions into Colorado and Georgia in 2016. Her approach is regarded by many in the field as a new paradigm for high-quality, proactive, youth-centered care that creates a promising pathway for foster youth “at risk of aging out of care with no one.” Although her focus is currently only on the foster care system, Amelia also sees applications for her model in the criminal justice, education and other systems that serve youth.
Everyone experiences and manages trauma differently, but unsupported children and young people are particularly ill equipped to cope with major traumas. They often lack the developmental skills to process or articulate their grief on their own. Instead, they act out, often through aggression, and get stuck in a vicious cycle: withdrawing emotionally or having violent outbursts, which drive away potential support. This loss and loneliness then further exacerbates the trauma. Over time, young people lose the ability to connect with and trust others.
Sadly, children in foster care in the U.S. have experienced exceptionally high levels of trauma but find themselves in a system that is ill-prepared to help them emerge from their grief and – in fact – all too often exacerbates their trauma. This is because, much like an emergency room, the foster care system uses a triage strategy to treat acute symptoms without ever getting to the underlying causes, relying largely on medication, treatment, and movements from placement to placement as problems occur. Indeed, it’s not atypical for a child who has been in the foster care system for 5-10 years to have had 20-50 foster home placements, each replacement representing an unsuccessful (‘unsafe’) match. The economic and emotional costs of this approach are enormous. The direct cost for each of these young people ranges from $150,000-$250,000 per year in placement services, not to mention the costs of courts, social workers, medications, or healthcare. Older youth who have gone through dozens of placements and are at risk of “aging out” with no one are the hardest to place and are most costly to the system.
Despite its price tag, the current system is also remarkably ineffective. In 2012, more than 23,000 youth aged out of the foster care system in the United States. One year later, nearly 40% of this population was homeless, nearly 60% of young men had been convicted of a crime, and just 48% were employed. Fifty percent of the youth who had aged out were involved in substance abuse. Seventy-five percent of young women and 33% of young men who age out of foster care receive government benefits for basic needs. The social costs of public assistance, incarceration, and lost wages over the lifetime of the young adults who “age out” of foster care without a permanent family are estimated to be $8 billion each year.
Though there’s widespread acknowledgement that this system is failing too many children, policies and funding mechanisms governing the foster care system are highly restricted and controlled by bureaucratic systems that leave little room for innovation or problem-solving. Instead, these systems are narrowly focused on safety and crisis control. Many of the professional case workers feel powerless to help foster youth out of this cycle. Staff in child welfare agencies have high rates of “secondary trauma” which is caused by seeing the harm the system is doing to the young people with whom they work. The number of case workers a young person is a leading indicator of how quickly that youth will achieve permanence; given the high staff turnover, the current national average is three different case workers per child per year. Not only do staff departures add to young peoples’ tally of broken bonds, but high turnover contributes to a culture of low accountability to the young people in foster care. In addition, much information about a young person’s history is lost when staff turnover, adding to the challenge of finding permanent placement.
For the last five years, Amelia has been blazing a path for wider reforms of the U.S. foster care system by taking on the profession’s most daunting challenge: finding permanent homes for the “hardest-to-place” young people about to “age out” of the system. Amelia’s central belief – informed by life experience and over a decade working in the foster care space – is that the cycle of trauma that the system perpetuates must be broken, and that this requires a reordering of the foster care system’s priorities, an overhaul of internal processes, and a shift in culture. While trauma is endemic among all foster youth, by starting with the population that the current system is most visibly failing, Amelia has been able to make a compelling case that it is possible – more affordable and more effective – to address the roots of trauma and find permanent homes.
To shift from a reactive system centered on protecting physical safety at all costs to one that values wellbeing, connections, and healing, Amelia starts by surrounding a young person with healthy role models, caring adults, and unconditional love. Rebuilding these connections is the first step in healing the relational trauma youth have experienced. Staff teams at Alia help foster youth build their own support networks by doing an exhaustive search for adults who care about them. Starting with asking the youth themselves, staff often find more than 50 adults who are willing to be part of a care circle for a young person. These can be relatives who had lost touch with a young person once he or she entered foster care, former teachers, bus drivers, or neighbors, or any other caring adult who is willing to show the young person that he or she is valued. The search and assembly of teams is a critical first step in the healing process. (Ninety three percent of the young people in Amelia’s program reported an increase in the total number of individuals they are connected to from intake to discharge.) Everyone, from the therapists and social workers on the staff team to the foster parents, bus drivers, or biological relatives on the young person’s team commit to being part of a young person’s permanency plan and helping the young person connect and reconnect with other caring adults. These commitments range from once-a-month trips to the movies or other social outings to daily or weekly tutoring sessions. And not surprisingly, it is from within this circle that Alia youth end up finding their permanent new homes.
Rather than starting a new organization that would run the risk of being disregarded as exceptional, Amelia has demonstrated this new approach by taking leadership of Alia Innovations with the expressed goal of transforming it and – in so doing – championing a new model for effective placement. For government-contracted placement agencies, the shift from reactive to proactive amounts to a complete organizational restructuring. In place of hierarchical bureaucracies, Amelia helps agencies create a more fluid structure of collaborative teams resembling the Mayo Clinic’s silo-busting model of cooperative care delivery. The teams at Alia are composed of program staff with diverse areas of expertise paired with the teams of support described above, together with other social workers, child psychologists, and more, each of whom takes collective ownership over a child’s well-being and that prioritizes ending the cycle of trauma. Case teams are highly sensitive, for example, to preventing regular turnover between youth and their primary case managers, and compared to the national average of three different case workers per child per year, the majority of young people in Amelia’s model have the same case worker throughout.
As Amelia now helps other agencies across the country understand and adopt the new youth-centered collaborative approach, she draws from a deep well of experience. One of the key learnings, for example, is that staff must address their own trauma and “secondary trauma” first in order to consistently model the connected, supported environment they intend to help youth build in their own lives. Staff are given time to take care of themselves by relying on the same modalities they are referring youth to, such as yoga and acupuncture. In place of “sick days” staff are given “well-being days” and are encouraged to continually process the challenges inherent in their roles. Because staff in this model are so highly supported – individually and as part of teams – they are able to take much greater risks than typical foster care staff. For example, honesty and transparency are central tenants to how staff work with youth. Rather than the standard practice of keeping the truth from young people in an effort to “protect” them – shielding them, for example, from disappointing updates about birth parents – case workers share painful news with confidence that the young person, with support from her teams, will process her emotions and build deeper connections and trust with her adult allies. Such changes reflect a more fundamental shift in the very culture within foster agencies, which helps agency staff feel altogether differently about the work they are doing and its significance on young people’s lives.
These same principles are also applied to foster homes, which are re-named “healing homes.” Healing home families are highly supported and are taught to be guided by a deep sense of empathy. Reversing the typical punitive response to youth acting out their trauma, healing home families are taught how to build on their connection to young people when their behaviors become aggressive. Families are not only highly trained, but are fully supported by Parent Coaches who are on call at all times to help work through a crisis together. Rather than isolate and punish youth for their behaviors after they have occurred, healing homes give young people opportunities to find attachment in new ways, such as selecting and caring for a pet. Parent Coaches play an integral role in helping families work with youth, and the data reflects their value. For example, at initial intake 24% of families said they had the support they needed to effectively parent their children, as compared to 94% at discharge. 22% said at intake that they had the skills needed to be an effective parent, compared to 72% at discharge. 76% of parents said they felt good about how things were going with their youth at the time of discharge, as opposed to the 17% at intake. As more teams gain more experience and insights, the extensive toolkit of activities, case studies, and ideas for helping youth process their trauma grows more complete.
Over time, virtually every adult in the young person’s life is trained in how to support them as they process their grief and take control of their future. In this child-centered model, as young people begin to trust and value the caring adults they have invited into their lives, they are given the power to make real decisions around their own care. They choose the pace of their grief work and even hire (or, if need be, fire) their case workers and support team.
Amelia’s approach has proven highly effective. Organizations that have adopted her model have transformed how they work with both the hardest to place youth and their general populations. Compared to the national average of +/- 38% permanent placement (though adoption or returning home), youth in Amelia’s model find permanent homes more than 60% of the time, on average, and have seen placement rates as high as 70%. The commitment to valuing stability – and limiting the number of traumatic replacements – is evident; 97% of youth have placement stability and remain in a single foster home. Nationally, youth are typically placed three times before finding permanence.
The youth who are referred to Intensive Permanence Services (IPS) are often living in residential treatment facilities which generally cost the public between $150,000-$250,000 per year. IPS costs, which are in addition to the housing costs, are about $20,000 per youth per year, with an 18-24 month timeframe. With 50% of these youth exiting Intensive Permanence Services to a permanent living situation with a caregiver, the cost savings are enormous. For every youth who exits care, the public is saved a minimum of $150,000 per year, which can be shifted to cover the upfront cost of another 7 youth going through the I.P.S. program.
Amelia’s work is increasingly well known throughout the foster care system and demand for her solution is high. In an effort to meet that demand, Amelia has developed a three-part strategy. First, Amelia prioritizes directly sharing how she changed the organizational framework. She developed a 480-hour, two-year intensive training and transition model that facilitates a restructuring of staff, relationships, mindsets, and tools. This model essentially recreates the transformation Alia underwent, and multiple in-person training days with a senior staff member from Alia throughout the first year, as well as regular team calls. Ultimately, after two years of training and coaching, the transition is complete: government-contracted organizations that run the U.S. foster care system are able to creatively respond to the needs of the children in their care. Currently, 269 county agencies—including every county in Texas and the District of Columbia— are engaged in the training process to adopt the new model. Having entire states adopt Amelia’s model has meant she’s been able to take advantage of economies of scale; hundreds of people attend each of her ongoing trainings across the country.
In addition to the agency-driven transition program, since many of the foster care system’s systemic challenges are reinforced by heavily restricted funding, Amelia understands that shifting the thinking—and, ultimately, the flow of funds— at this level is necessary to changing the overall system. In addition to the strong business case for making changes at the individual organization level, Amelia has already partnered with Casey Family Programs, a major funder and field leader with a presence in all fifty states. CFP has had Amelia present her methodology to representatives around the country, and has been a committed partner in bringing this shift to scale. Along with CFP, Amelia is working with public sector leaders at the federal, state, and county levels to show the enormous cost savings achieved by her model.
Finally, with an understanding that the type of change Amelia is envisioning necessitates an entirely new way of thinking about organizational development, Amelia sees academic institutions as key to ensuring new graduates are prepared to lead the organizations of the future. An initial partnership with the University of Minnesota is underway, which will result in a Certificate Program for transforming child welfare organizations. With this first partnership as a model, she is seeking to spread this thinking across academia and has co-authored the leading resource in this emerging field: a book titled Creating a Permanence Driven Organization: A Guidebook for Change in Child Welfare.
With national impact as Amelia’s core focus today, Amelia is in the process of starting a new organization that is focused solely on spreading this model to new systems. The new organization will have an initial budget of $1.25 million and five staff members. It will remain closely linked with Alia Innovations. Alia, with its more local direct-service focus and its team of 45 people (supported by an annual operating budget of $4.5M), will continue to serve as the “laboratory” for refining and improving the model. Alia was recently awarded the $500,000 “Bush Prize” for this model from the Midwest-based Bush Foundation. In addition, Amelia was personally awarded a $100,000 Bush Fellowship to further her own leadership and learning. Seizing on the momentum she’s built, Amelia has already raised some of the initial start-up budget and has cultivated a strong nationally experienced Board of Directors for the new organization, with a diversity of experience scaling successful models.
Amelia’s deep sense of empathy is rooted in growing up surrounded by trauma and violence. She saw the effects of domestic violence and poverty in her close friends, and was highly influenced by the effects of her own father’s unhealed childhood trauma. As a survivor of abuse, her father was unable to live the life he wanted to. It was the empathy born out of her father’s experiences that led Amelia to care so deeply for children who are unprotected from the adults around them.
From a young age, Amelia possessed the ability to entrepreneur change. She saw herself as a problem solver and others often identified her as a natural leader. She has dozens of examples of taking initiative as a young person and throughout her career. In elementary school, she formed a drama club where she went on to write the play, create all the props, recruit members, direct, and perform in the play. In junior high, she formed a cheerleading squad, organized numerous fundraising events to buy uniforms, and led the squad in practicing and performing. In high school, she was the only student in her school to apply for and go on a study abroad program. Her friends from her time in Cyprus became a window into a larger world, and she kept the group connected upon return.
While managing a set of group homes early in her career, Amelia experimented with the most effective ways to change outcomes for youth living in care. When the rules for kids were increased or punitive consequences harshened, behavior did not change. When positive behavior was rewarded, she saw a small shift. When she began to work more closely with staff to empower them to create solutions, she saw the most significant behavior changes the agency had experienced in its history. She began to rely on this strategy across the group homes, encouraging creative ideas for solving problems that arose. She began getting more practice in empowering others, and saw the tremendous results this yielded.
When Amelia joined Alia Innovations, she was hungry to put her experiences in the group homes to work on a bigger system. In her interview to join as CEO, she made it clear to the board that she would join the organization only if they understood that, starting with Alia, she was going to transform foster care.
Although Amelia knew that it would be more difficult to work in the existing entrenched, bureaucratic foster care system, she chose this path rather than creating a new parallel structure. She had faith in the hundreds of people she had met in child welfare and saw that the existing system was full of well-intentioned people who just needed support and tools to change outcomes for young people.