Doreen Chapman, Damon Thompson, & Madelyn Freundlich
Permanency planning for adolescent mothers in foster care and their children is an underdeveloped area of child welfare practice. Casey Family Services, the direct service agency of the Annie E. Casey Foundation, developed a permanency planning model to create permanent families for youth in foster care with various treatment needs. The agency¡¯s Baltimore division implemented the model with adolescent parents in foster care through a careful application of replication principles and through adaptation at both a programmatic and organizational level. The agency¡¯s model was adapted to better serve young mothers and their children. This adaptation yields significant knowledge regarding enhancing outcomes for this vulnerable population.
Adolescent mothers in foster care and their children represent a unique population that child welfare systems generally have not served well (Manlove, et al., 2011). Despite the growing body of literature that has outlined the service and relationship needs of pregnant and parenting teens in care, foster care programming in general and permanency planning in particular have lagged behind for these young people. Casey Family Services, the direct service agency of the Annie E. Casey Foundation in New England, developed a permanency planning model, the Lifelong Families Model (LFM), to create permanent families for youth in foster care with various treatment needs. The agency¡¯s Baltimore Division implemented the LFM specifically for adolescent parents in foster care through a revision of its Parent Child Foster Care program (PCFC). This implementation involved a careful application of replication principles and attention to the need for adaptation at both a programmatic and organizational level. The knowledge acquired from this implementation helps inform the understanding of permanency planning model adaptation in the context of child welfare service delivery to young mothers and their children.
Adolescent women in foster care are at greater risk for pregnancy than adolescent women in the general population (Svoboda, et al., 2012). A study in Washington state found that 29 percent of young women in foster care had been pregnant at some point and 11 percent of males in foster care had contributed to a pregnancy (Allen, 2005). A study in the Midwest found that one-third of girls in a foster care sample had been pregnant by age 17 and that 19-year-old youth with foster care histories were more than twice as likely to have at least one child compared to their peers in a nationally representative sample (Courtney, Terao, & Bost, 2004).
As with all adolescent mothers, teen mothers in foster care lack many of the personal resources that they need to be effective parents (Holub et al., 2007). Adolescent mothers in foster care, however, also lack direct, day-to-day access to supportive relatives who can model and encourage appropriate parenting behaviors (Budd, Holdsworth & HoganBruen, 2006). Young mothers in foster care are at a heightened risk for emotional distress and tend to be less prepared to parent than their non-foster care peers (Holub et al., 2007). In particular, they face significant challenges in transitioning successfully to adulthood. In one study, 40 percent of youth in foster care with one child and 58 percent of youth in foster care with two or more children reported that being pregnant or parenting interfered with their ability to live independently. Pregnancy and parenting doubled the risk of dropping out of school and heightened the risk of unemployment for youth in foster care (Leathers & Testa, 2002).
Evidence supports the importance of providing pregnant and parenting teens in foster care with caring adult relationships, supporting the young mother¡¯s healthy relationships with her family (including the baby¡¯s father and his peers), and providing services that support the young mother in developing parenting and relationship skills (Manlove, et al., 2011). Foster care programming for this population, however, has lagged behind and efforts to engage pregnant and parenting teens in planning for legal family permanency have been extremely limited. Case planning is often undermined by continuing disruptions in young parents¡¯ living situations when foster care programs are not equipped to serve young mothers and their children.
The absence of attention to permanency planning for adolescent parents and their children in foster care likely reflects certain assumptions about this vulnerable population. Not uncommonly, child welfare staff assume that these young people, poised to age out of foster care and live on their own, will reject efforts to safely reunite them with their parents or extended family members, or efforts to find new families for them through adoption or legal guardianship (Child Welfare Information Gateway, 2006). Child welfare staff may assume that neither these young parents¡¯ families of origin nor other families will be interested in legally integrating young parents and their children into their families (Child Welfare Information Gateway, 2006). In replicating and adapting the LFM with young parents in foster care, the Baltimore Division countered these assumptions, actively engaged young parents in foster care in permanency planning, and created permanent families for many young parents.
The Casey Family Services¡¯ Lifelong Families Model
The Casey Family Services¡¯ LFM is a collaborative approach to permanency planning for youth in foster care or at risk of entering the foster care system. The model is comprised of five components: permanency teaming, permanency-focused case management, permanency preparation, permanent family identification and engagement, and permanency support planning. Underlying the LFM are five key principles: a sense of urgency in creating the necessary momentum to ensure a youth¡¯s timely exit to permanency, advocacy to ensure that young people leave foster care with safe, legally permanent parents, concurrent planning to ensure that each young person has a primary parent and a back-up parent who are able and willing to provide safe parenting and a legal family relationship, increasing the responsibilities of permanent parents in all aspects of parenting and decision-making while decreasing the responsibilities of the agency, and a trauma focus that ensures that staff, family members, and other significant adults in the youth¡¯s life understand the impact of trauma on the development, behavior, and relationships of youth.
Beginning in 2005, Casey Family Services implemented the LFM with non-parenting youth in foster care in a number of its service division offices. Research on the LFM began to establish an evidence base for the LFM with these youth. Survey-based process evaluations indicated that youth, family members, and professionals were satisfied with the intervention (89 percent), reported progress toward achieving permanency as a result of the teaming process (88 percent), and believed that the permanency plans developed through the teaming process promoted the best legal arrangements for youth (94 percent) (Casey Family Services, 2012). After the implementation of the LFM, greater percentages of youth in Casey Family Services exited foster care to a legally permanent family on an annual basis (27 % in 2005, 46% in 2006, 56% in 2007, 54% in 2008, 64% in 2009, 58% in 2010, and 59% in 2011). Furthermore, higher percentages of youth achieved legal family permanence within 18 months of beginning services with the agency (from 15% in 2005 to 65% in 2011)(Casey Family Services, 2012).
The Lifelong Families Model and the Parent Child Foster Care Program
As Casey Family Services implemented the LFM in other divisions, the Baltimore Division of Casey Family Services (CFS/Baltimore) began to explore how the LFM¡¯s principles and components as implemented with non-parenting youth could be replicated and possibly adapted to serve young parents and their children in foster care. This exploration coincided with CFS/Baltimore¡¯s collaboration with the Maryland Department of Human Resources (MDHR) in 2005 to establish a Parent Child Foster Care Program (PCFC) to serve mothers, ages 12 to 21, and their infants, pregnant young women in foster care, and adolescent mothers whose children were placed with separate foster families and for whom reunification was the permanency goal.
The PCFC was designed to respond to the pressing needs of young parents in Baltimore City, a community marked by poor educational outcomes, high youth unemployment, high rates of poverty, and high adolescent birth rates (US Census Bureau, 2010; Robert Wood Johnson Foundation, 2010). Its child maltreatment rates are among the highest in the state of Maryland, and more than half of the children and youth in foster care in Maryland (56 percent) are from Baltimore City (MDHR, 2011). The PCFC was designed with awareness and recognition of the following psycho-social risk factors that were in play for many of the young people being placed in Baltimore City: physical, sexual, and emotional abuse; neglect; and witnessing and experiencing domestic violence. These psycho-social risk factors often resulted in symptoms of post-traumatic distress, complex trauma, depression, and other mental health disorders.
As CFS/Baltimore considered revising the PCFC to more closely comply with the LFM being implemented in other Casey service divisions, it was aware that adolescent parents in foster care share many of the above characteristics of the general foster care youth population for which the LFM was proving to be successful. However, they also have unique needs: Young parents often enter foster care without a dependable family or viable social networks and have limited skills in utilizing supports for themselves and their children (Becker & Barth, 2000).
Young parents in foster care are impacted by trauma exposure while simultaneously being expected to assume significant adult responsibilities as new parents well before they have completed the tasks of adolescence. In addition, their new parenting roles may have further distanced them from their families of origin and peer support. Despite these challenges, young parents in foster care are responsible for planning for themselves and their children in the short- and long-term.
Replication and Adaptation of the Lifelong Families Model
While incorporating the LFM into the PCFC for adolescent parents and their children in foster care, CFS/Baltimore was confronted with replication and adaptation challenges. Replication has been defined as the process of re-implementing an established program in a new context in a way that maintains fidelity to core goals, activities, delivery techniques, intensity, and duration of the original program model (Card, Solomon, & Cunningham, 2011). Adaptation has been defined as making a program model more suitable for a population without compromising or removing core components (Lezin, Smith & Taylor, n.d.). Borrowing from the scientific literature on program adaptation, CFS/Baltimore used a three-step framework to implement permanency planning into the PCFC using the LFM. CFS/Baltimore (1) identified the core components that should be preserved when the LFM was adapted for pregnant and parenting youth, (2) identified and categorized mismatches between the LFM and the new population context of young parents in foster care, and (3) implemented the necessary adaptations to the LFM (see Bell, et al., 2007).
CFS/Baltimore developed a revised PCFC that met the required standards as defined by the replication and adaptation literature in that CFS/Baltimore defined the priority population, the long-term goals, the mid- and short-term objectives, and the program components, and demonstrated how these elements were linked (see Card, et al., 2001). The revised PCFC identified the key goal as supporting and providing services to young mothers in order to help them access the resources and social supports needed to become nurturing parents and successfully transition to adulthood. The principal program assumption was identified as: ¡°Strong relationships and a safe home environment are a necessary context for the healthy development of life and parenting skills¡± (Casey Family Services, 2012). Examination of the original PCFC led CFS/Baltimore to determine that it strongly addressed safety and well being for the young parent and child, but did not place a necessary focus on permanency planning. This conclusion supported CFS/Baltimore¡¯s decision to revise the PCFC to be fully consistent with the LFM. CFS/Baltimore carefully reviewed the five core components of the LFM, i.e., those elements of the intervention that the broader agency determined were responsible for its effectiveness via quantitative and qualitative research (Solomon, et al., 2006). The LFM¡¯s five core components ¨C permanency teaming, permanency-focused case management, permanency preparation, permanent family identification and engagement, and permanency support planning ¨C created an interrelated set of activities and strategies that CFS/Baltimore determined to be essential to preserve in the implementation of the LFM with pregnant and parenting young people.
CFS/Baltimore identified and described mismatches between the LFM and permanency services for adolescent parents and their children. Research indicates that mismatches can occur in program goals or objectives, characteristics of the priority population, or characteristics of the community in which the program is being implemented (Castro, Barrero, & Martinez, 2004). Mismatches were not found with respect to program goals or objectives that prioritize legal family permanency for all young people in foster care. However, special attention in the adaptive implementation of the LFM was required in terms of the characteristics of the priority population and the community. The following unique needs were identified for this population and community: (1) the need to focus on permanency planning with the young parent to achieve legal family permanence for her and her child while simultaneously planning for the preservation of the family unit of mother, child, and, whenever possible, father; (2) the need to recognize the legal status of the parent with respect to full decision-making rights over the care and custody of her child in the absence of a court order that restricts the parent¡¯s custody of the child; (3) the need to actively engage the father (whenever possible) as a resource, permanency team member, and recipient of child welfare services; and (4) the critical implications of culture and race in the predominantly African American community of Baltimore City, which differed from the predominately white populations of other service divisions. The authors did not consider these population and community characteristics as problematic mismatches, but rather as critical guides to casework practices that ensured the customized delivery of the LFM to a new population of young people.
The implementation of the revised PCFC required some adaptations of the LFM¡¯s five core components, specifically, Permanency Teaming and Permanent Family Identification and Engagement. Importantly, the LFM guided CFS/Baltimore in significantly adapting its original PCFC to focus more aggressively on creating permanent family relationships in addition to achieving safety and emotional, social, and educational well being for the parent and the child. With the implementation of the LFM¡¯s Permanency Teaming and Permanent Family Identification and Engagement components, a team was formed for each young parent that was comprised of the young parent herself, the child¡¯s father whenever possible, other family members, other caring adults, service providers, and community representatives¡ªall of whom were committed to ensuring that the young person left foster care, entered a legally permanent family, and was well prepared for adulthood. Developing the active engagement of the children¡¯s fathers as critical family members was a crucial adaptation. The PCFC social workers explored the young mothers¡¯ thoughts and feelings about their relationships with their children¡¯s fathers, supported the identified young men in strengthening their relationships with their children and the young mothers, and encouraged the children¡¯s fathers to actively participate as members of the young mothers¡¯ permanency teams. For example, one child¡¯s father agreed to watch their baby when the teen mother was at work in the evenings. This allowed the father time to bond with his child and strengthen his parenting skills. In another case, the baby¡¯s father provided a trusted voice of reason and was the only person on the permanency team whom the teen mother would listen to when issues of leaving the foster home for long periods of time without permission and not following the curfew set by the foster parent needed to be addressed. The young father helped the teen mother recognize how her behavior jeopardized her placement and the other benefits of the program. In some cases when the program staff had successfully engaged the fathers as part of the permanency team, the fathers also agreed to participate in couple¡¯s therapy, which proved beneficial in addressing trauma issues that manifested in many couples¡¯ relationship. Further considering the role of the teen father and his permanency planning needs is another potential area for future research.
The LFM¡¯s Permanency-Focused Case Management component focused on the development and maintenance of young parents¡¯ safe and nurturing relationships with highly trained and supported foster parents who were committed to being the young persons¡¯ first and last foster care placement until she left care to a permanent family. CFS/Baltimore deepened the LFM practices with foster parents by placing more emphasis on the role of the young mother¡¯s foster family in providing a stable and safe home, setting expectations and boundaries for acceptable behavior, and modeling and encouraging appropriate parenting behavior. In order to ensure that foster parents were equipped to play the multiple roles essential for positive outcomes for young parents and their children, CFS/Baltimore refined the qualities of foster families that would be recruited. CFS/Baltimore defined the sought-after qualifications as: a willingness and ability to work with birth families; an ability to actively engage and participate in the permanency teaming process and to help the young mother reach her permanency goal; an ability to act as a teacher, a role model, and a mentor for young mothers in order to help them develop appropriate parenting behaviors and to reinforce parenting skills; a tolerance of challenging adolescent behaviors; an acceptance of young parents¡¯ religions and cultures; an ability to work with community resources; availability and flexibility for weekly home visits; and an ability to encourage and support the young mother¡¯s educational and vocational pursuits.
Through the LFM¡¯s Permanency-Focused Case Management component, social workers provided services to support the young parent in actively engaging in planning for herself and her child, and to connect the young parent with mental health, general health, and reproductive health services. These services were provided to meet the young parent¡¯s and the child¡¯s safety, permanency, and well being needs. Two professional staff members were available to serve each young mother and child: a licensed social worker, who focused on achieving legal family permanence, and a family support specialist, who focused on the young person¡¯s preparation for adulthood, the young person¡¯s parenting skills, and the child¡¯s well being.
Through the teaming process and casework services, young parents received Permanency Preparation to leave foster care and to enter permanent families through safe reunification with their birth families or through connections to new families via adoption or legal guardianship. Reunification with birth families proved to be the most successful option. The program¡¯s ability to engage the birth family and the removal of concrete barriers were critical components of the process. Collaboration with the local Department of Social Services assisted with determining strategies to address concrete barriers in a timely fashion. A trauma-focused approach in therapy sessions helped the birth family address some of the issues that initially brought the youth into foster care and strained the parent-child relationship.
Through implementation of the LFM¡¯s Permanency Support Planning component, the young parent and other team members were actively engaged in planning for the safety, well being, and permanency stability of the young parent and her child after they had exited from foster care. Young mothers, for example, who were attending center-based therapy, were able to continue therapy for three months following their exit from foster care in order to sustain the gains that they had made while they were in foster care. Additionally, when the permanency team determined that a young parent would be obtaining her own apartment, the permanency team would identify members to assist with concrete resources, such as acquiring furniture, household items, etc. The program, in collaboration with the Department of Social Services, also contributed funds to offset moving costs, such as rental deposits. The social workers linked the young mothers to services within their community and the permanency team identified members who remained sources of support to the young mothers and their children after they exited from foster care.
Model Adaptation and Preliminary Outcomes
The primary long-term outcome of the PCFC¡¯s implementation of the LFM was that numerous young parents and their children were connected to permanent families. Two secondary long-term outcomes also occurred: The young parents improved their parenting skills and improved their life skills in preparation for adulthood.
From 2008 to 2012, the PCFC served 72 young women and 77 children. As of October 31, 2012, the PCFC served only 16 young mothers and their 18 children, a significantly smaller census, which was necessitated by the Annie E. Casey Foundation¡¯s decision to shift to a grant-making strategy and close Casey Family Services as of December 31, 2012. The majority of the 72 young women were 18 years old or older (88 percent; n=14). The median length of young mothers¡¯ stays in foster care prior to entering the PCFC was eight years, while the median length of young mothers¡¯ stays in the PCFC was 11 months. Due to the limited number of programs in Baltimore city that serve young mothers, the authors view the ending of the PCFC as a significant loss to the Department of Human Resources. Casey Family Services was the only program that served young mothers through a permanency framework. On January 1, 2013, the Pressley Ridge Treatment Foster Care program in Baltimore, Maryland assumed the Casey Family Services contract to provide parent-child foster care. This program has stated its intention to incorporate the permanency focus of the LFM into its services for young parents in foster care.
Only two of the 72 young mothers (3 percent) who participated in the PCFC were involved with substantiated reports of child maltreatment that resulted in the removal of their children from their custody. In one case, the children were returned to the mother after the provision of supportive services to ensure the children¡¯s safety. In the other case, the child remained in foster care (one percent). This rate of foster care entry is substantially lower than rates of foster care entry based on a mother¡¯s age as reported in the literature (ranging from 13.5 percent for mothers under the age of 15 to 23.1 percent for mothers who are 18 or 19 years old) (Schuyler Center for Policy and Analysis, 2008). There were no substantiated allegations of abuse or neglect against any of the foster parents of the young mothers.
Well Being Outcomes
From the inception of the program through September 2012, 56 young mothers were discharged from the PCFC and 66 percent of those mothers were enrolled in or had completed an educational program. The authors cannot draw statistically significant conclusions about the educational impact of the PCFC on participants compared to non-participants due to the absence of public agency educational data. The PCFC¡¯s data, however, is favorable in comparison to other studies (Burley & Halpern, 2001; California Child Welfare Co-Investment Partnership, 2011) that have found low levels of educational participation and completion among young people in foster care. One study in Illinois found that fewer than half of pregnant or parenting youth in foster care had a high school diploma or GED when they exited from foster care (Dworsky & DeCoursey, 2009).
Three-quarters of the PCFC¡¯s participants (76 percent) entered the program with state-determined goals of long-term foster care or independent living. Despite this high percentage of participants with non-family-permanency goals, close to one-third of the 56 young mothers and their children who were discharged from the PCFC (31 percent) left care to permanent families or with lifelong connections to significant adults who were committed to being a part of these young mothers¡¯ lives. These outcomes must be viewed in the context of the complex issues that these young women face, including exposure to parental substance abuse, domestic violence, family dysfunction, family rejection, and the absence of opportunities for healthy attachments. These complex factors may help explain why many young women in the PCFC struggled despite the services that were provided to them.
CFS/Baltimore¡¯s investment in the PCFC and its adaptation of the LFM for this population yielded positive results for a historically underserved population in the Baltimore community. The program drew attention to young women and their children who had been largely invisible in child welfare practice and it provided youth with access to previously unavailable services. A growing number of young women were referred annually to the PCFC, which indicated the need for specialized foster care and permanency planning services for this population. During these four years of program implementation, CFS/Baltimore reached the following conclusions:
1. There exists a need for a broad array of services that center on achieving permanency. With the implementation of the LFM within the PCFC, CFS/Baltimore expanded its focus (which was initially limited to young mothers¡¯ safety and well being needs) to include a wide range of permanency-focused services. The program achieved positive permanency outcomes for a relatively high number of young parents (31 percent). When the program closed, sufficient data had not been collected to demonstrate the impact of broadening the service array.
2. Preparing and supporting foster families is crucial. CFS/Baltimore worked closely with foster parents to prepare them for the unique experience of parenting young women who are parents themselves. CFS/Baltimore¡¯s training and resources for foster families became increasingly specialized in order to assist families in understanding and responding to the complex needs of young mothers and their children.
3. Continuing to improve the PCFC is vital and further research is necessary. Through the adaptation of the LFM, CFS/Baltimore strengthened the PCFC as the agency responded to the evolving needs of the young mothers and children referred to the agency. The PCFC examined its programmatic strengths and challenges, and, in particular, identified the challenges involved with engaging young fathers and with engaging the subpopulation of young mothers who had limited motivation to plan for and make changes in their lives as young adults and as parents.
As agencies consider implementing programs that serve young mothers and their children in foster care, it is essential that they fully incorporate the goals of safety, well being, and permanence. The adaptive implementation of the LFM was critical to the PCFC¡¯s achievement of permanency outcomes for young mothers and their children. The multi-step replication and adaptation process provided a strong foundation for the use of this permanency planning model, and improved service delivery and outcomes for a vulnerable population that often lacks permanency planning services.
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The authors wish to acknowledge Dr. Eliot Brenner, Casey Family Services, Dr. Kantahyanee W. Murray, University of Maryland School of Social Work, and Dr. Heidi Melz, James Bell and Associates, for their assistance in the preparation of this article.
About the Authors
Doreen Chapman earned her BA from Syracuse University where she majored in Social Work and also completed her MSW at Syracuse University with a specialization in Human Service Administration. Doreen has a longtime commitment to children and youth in foster care through her current role in the Child Welfare Strategy Group at the Annie E. Casey Foundation where she is working with public child welfare agencies on system reform. Doreen¡¯s prior roles include director of Casey Family Services Maryland Division and Vice President of Permanency and Family Stabilization services at the Village for Families and Children in Hartford, Connecticut. She also held numerous positions at the Connecticut Department of Children and Families, which concluded with her position as the Statewide Director of Foster Care and Adoption. Doreen can be reached at email@example.com.
Damon Thompson received his undergraduate education from North Carolina Central University where he majored in Public Administration (BS) and Morgan State University (BSW). He earned his MSW from the University of Maryland with a specialization in clinical social work. Damon¡¯s career has focused on serving youth in various environments, including outpatient mental health, special education, private practice for adolescent males in group homes, and foster care treatment programs. He joined Casey Family Services in 2007 with the goal of starting the Parent-Child Foster Care program ensuring that it was in alignment with a full commitment to permanency. In his current position as Program Manager with Pressley Ridge, Damon continues to advance his permanency agenda while working with teenage mothers in foster care. Damon can be reached at DEThompson@pressleyridge.org.
Madelyn Freundlich is an adjunct professor at the Silberman School of Social Work at Hunter College, where she teaches Child Welfare and the Law. Madelyn received her professional education from Louisiana State University (MSW), the University of North Carolina (MPH), the University of Houston (JD), and Georgetown University (LLM). She specializes in child welfare practice and policy with a particular focus on foster care and adoption. Madelyn has written extensively on program, practice, and legal issues in child welfare. She is currently a private consultant who works with national organizations and foundations on child welfare reform efforts. Madelyn can be reached at firstname.lastname@example.org.