Attachment--and loss.

Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health:

Racial residential segregation: A fundamental cause of racial disparities in health

Higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death. Other racial/ethnic minority populations also have elevated disease risk for some health conditions. This paper considers the complex ways in which race and socioeconomic status (SES) combine to affect health. SES accounts for much of the observed racial disparities in health. Nonetheless, racial differences often persist even at “equivalent” levels of SES. Racism is an added burden for nondominant populations. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health by restricting socioeconomic opportunities and mobility. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.

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Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination

All Our Kin: Strategies for Survival in a Black Community. C. B. Stack. New York: Harper & Row. 1974. Carol Stack wrote one of the most powerful books of the last half century about African American families. The book's power derived from its focus on the stories and the lives of persons who were struggling to manage with limited resources and who had evolved seamless methods of survival and coping strategies. Stack was not content to view the problems of impoverished African American families from an outside perspective, as had been done in the past, but chose instead to present her work from the view of the participants. She presented a sensitive view of families that has not been duplicated to this day. Stack put specific emphasis on being accepted by the families before she began interviewing them. She and her son took a long time to be accepted by the families as they gradually became participants in the day-to-day lives of the "Flats." She was sensitive to the patterns of interactions among the networks of family and friends that would have been overlooked by almost any other researcher or method of observation. The book showed how a person from another racial and economic group was able, with skill, to become an intimate part of the experience and the lives of very poor families. Her anthropological approach stands in sharp contrast to the countless attempts of others to quickly go in and pull out slices of families' lives with a preexisting conceptual framework. The African American families of the Flats were presented as they were, not from a White academic theoretical perspective that was not based on reality. Stack made many observations that allowed one to see the intricate workings of the families that "outsiders" had not been documented before. Participants were allowed to make observations about their own families' patterns of interaction and to uncover truths of family functioning based on the reality of their lives. Important data on these second-generation urban dwellers are presented in such a calm manner that one could overlook their significance to the field. The impact of the economic pressures on the men and women in the African American community show how persons can have mainstream values but are prevented from achieving them because of the lack of employment and economic security within the community. In response to the reality, Stack found that African Americans have cooperated to produce an adaptive strategy of exchanging goods and trading resources, as well as offering child care or temporary fosterage. Kinship boundaries were more elastic than they were in more affluent families because these individuals immersed themselves in a domestic network of kinfolk and fictive kin, or those who became as kin. The participants in Stack's study moved around and had loyalties to more than one household grouping at a time, making their family networks unlike the "household" structures of most American families. These networks were diffused over several kin-based households that changed frequently. The usual method of arbitrarily specifying widely accepted definitions of the family as nuclear or matrilocal may block one from seeing the world as it exists in very poor communities. Stack's observations refuted the "culture of poverty" position that had seen African Americans as having no culture or totally negative qualities of family disorganization, personal disorganization, and fatalism. Unfortunately, too many current writings on African Americans still take these same positions. The views may be the result of ignorance, naivete, or complex levels of racism that insidiously make their way into present family literature. Stack continued to reflect on the poverty of the participants' situations. By doing so, she avoided another position that is all too common-assumption that all African American families are the same, regardless of their levels of poverty or affluence. …

All Our Kin: Strategies for Survival in a Black Community

This article describes efforts under way in Illinois to improve permanency outcomes for children in formal kinship care Between June 1986 and June 1995, the number of children in the state's home-of-relative program increased sevenfold Administrative and judicial changes in the 1990s contributed to a permanency planning crisis, as reflected in declining discharge rates The Illinois Department of Children and Family Services (IDCFS) developed a special permanency planning status-Delegated Relative Authority (DRA)-for children in secure and stable family foster care with relatives This article presents findings from 1,116 assessments of children in formal kinship care that tested the feasibility of the DRA option The growth of foster care by relatives who are formally recognized by the child welfare system as foster parents (hereinafter referred to as formal kinship care) poses special challenges to the usual assumptions and practices of permanency planning Because the dynamics of care by kin differ from those of care by persons unrelated to a child, and because placement takes on another meaning when children are entrusted to grandparents, aunts, and uncles instead of foster parents unknown to them, it is important that child welfare authorities develop new pathways for moving children out of public custody into private family care Some of these pathways can be carved out from existing policies by altering the rules under which government seeks to regulate formal kinship placements Others will have to be developed anew by qualifying legal arrangements besides adoption for public subsidy For any of these changes to be ultimately successful, it will be necessary for society to reach a new consensus on an acceptable division between public and family responsibilities in the upbringing of minors who cannot live with their parents Attaining this consensus becomes especially urgent given the impending changes in federal support of families with dependent children This article describes efforts under way in Illinois to improve permanency outcomes for children in long-term formal kinship care Illinois was the source of the original class-action suit that culminated in the US Supreme Court ruling in Miller v Youakim [1979], which concluded that kinship was an unacceptable basis under federal law for discriminating among licensed family foster care providers It was among the first states to legislate preference for formal kinship placements and to modify family foster home licensing standards to accommodate the influx of state wards into paid relative care Currently, Illinois is the site of some of the most comprehensive and sharply contested changes being made in the way states coordinate public assistance benefits with child welfare services and exercise protective authority over children in informal as well as formal kinship care After providing background on recent trends in formal kinship care in Illinois and several other large states, this article presents results from the Relative Caregiver Social Assessment (RCSA) study that the Illinois Department of Children and Family Services (IDCFS) sponsored in 1993 One purpose of the study was to test the feasibility of implementing a new permanency planning status, which IDCFS labeled Delegated Relative Authority (DRA) The status reduces casework services and administration to a minimum and delegates additional authority to relatives to make decisions on behalf of children in state custody without first receiving clearance from IDCFS The assessment found that workers recommended DRA for almost one in four children (24%) in long-term formal kinship care Quite unexpectedly, the assessments also revealed that a sizeable fraction of caregivers were willing to consider adopting the children in their care-a finding that runs contrary to the widespread notion that caregivers are unwilling to adopt their own kin [Rowe et al 1984; Thornton 1991] Workers recommended kinship adoption for an additional 21% of children in the study …

Permanency Planning Options for Children in Formal Kinship Care.

"Eloquently attests to the fact that teenage parenthood is a complex, multi-dimensional problem defying single-focused, easy solutions    A 'must read' for program planners and policymakers"DDBernice Weissbourd, Family Focus "Bound to be of great value in the reconsideration of public policy toward teenage pregnancy in the United States"DDRobert H Bremner, Professor Emeritus, Ohio State University "A very impressive collection of essays    intelligent, balanced, and imaginative"DDJoel F Handler, School of Law, UCLA Teenage parenthood has been a newsworthy issue since the 1970s The "epidemic of kids having children" led to demands for increased sex education and access to contraceptives Despite major public and private efforts, rates of teenage pregnancy have not fallen significantly since the '70s In fact, rates of teenage births have recently begun to rise This lack of progress plus startling new evidence about the health and developmental consequences of early parenthood have touched off a fresh round of debate on the problem: Is teenage parenthood simply accidental or an intended alternative for disadvantaged teens who see no advantage in delaying childbirth? Do infant survival rates depend more on socioeconomic conditions than on the age of the mother? Do teen mothers necessarily end up with less education and more poverty than older mothers with the same socioeconomic background? The contributors to this interdisciplinary volume reexamine the assumptions underlying conventional approaches to teenage pregnancy prevention and reassess how the growing problem of early parenthood ought to be addressed in the coming decade They consider the problem of early parenthood within the larger social context of prolonged transition from adolescence to independent adulthood in post-industrial society They also look at how the institutional contexts of early parenthood differ historically, cross-nationally (in Korea and Sweden), and by class, race, and age in the United States This collection of essays helps to clarify the interrelated problems of teenage pregnancy, single parenthood, and welfare dependency, and sharpens the focus of pregnancy prevention and family support policies for the 1990s

Early parenthood and coming of age in the 1990s

Fostering Accountability presents a model of child welfare decision making that holds public officials answerable for the integrity and validity of the actions they take on behalf of the children and families in their care. It operationalizes the concept of results-oriented accountability, which demands that administrators and practitioners show valid evidence of their success in improving child and family outcomes, not merely demonstrate mechanical procedural compliance. Drawing on the experiences of directors, staff, and evaluators, this timely and practical book describes the emergence of results-oriented accountability in child welfare with a special focus on the editors' role in establishing a university-agency research partnership under a federal consent decree. Chapters elaborate on the five successive stages of the results-oriented accountability framework-outcomes monitoring, data analysis, research review, evaluation, and quality improvement-and provide examples of applications of each stage for agency managers. By refocusing the emphasis on developing policies based on agency data, instead of purely reactive approaches that grasp at solutions and often fall short, Fostering Accountability guides administrators in monitoring outcomes, using evidence to select interventions to enhance results, and applying management strategies to evaluate and improve these efforts. The result is a pragmatic implementation guide for administrators seeking to bring safety, stability, continuity, permanence, and well-being to the lives of abused and neglected children in the United States.

Fostering Accountability: Using Evidence to Guide and Improve Child Welfare Policy

This article presents third-year findings from the Illinois Subsidized Guardianship Waiver Demonstration. The study blends an experimental design to test the efficacy of the intervention with an observational component to assess the generalizability of the experimental findings. Three inferences were drawn from the study: (1) subsidized guardianship significantly boosted permanence under conditions of controlled experimentation; (2) the selection of subsidized guardianship may be even greater under ordinary conditions of service delivery; and (3) the stability of kinship and foster home placements was unaffected by the availability of subsidized guardianship as a supplementary permanency option to adoption. Key words: experimental design; kinship care; permanence; subsidized guardianship ********** It has been 65 years since Taylor (1935) introduced the field to the concept of private guardianship as a child welfare resource. More than 30 years have elapsed since she first called for a federal demonstration to test the benefits and costs of providing financial subsidies to families who assume private guardianship of dependent and neglected children (Taylor, 1966). In the succeeding three decades, scholars and advocates have echoed her basic recommendations (Appelberg, 1970; Leashore, 1984-85; Williams, 1991). Finally these calls have been heeded. During the past five years, the U.S. Department of Health and Human Services (DHHS) has granted waivers to eight states to mount demonstrations in the use of Title IV-E funds to finance subsidized guardianship programs for foster children who otherwise would have remained in public custody. The purpose of this article is to present findings from the third year of one of the largest of these federal waiver demonstrations--the Illinois Subsidized Guardianship Waiver Demonstration. Since its inception in May 1997, Illinois courts have transferred (as of June 30, 2000) almost 5,000 foster children from public custody to the private guardianship of relatives and foster parents. To evaluate the efficacy of this intervention, the Office of the Research Director of the Illinois Department of Children and Family Services (IDCFS) designed a random assignment field experiment that the department implemented in three evaluation sites across the state. This study compared the experimental and control groups to test whether the availability of subsidized guardianship significantly improved the legal permanence and stability of placements with relatives and foster parents. To assess the generalizability of the experimental findings, IDCFS secured permission to offer subsidized guardianship in locations outside the evaluation sites. The addition of this observational component provides a check on the reproducibility of the results when subsidized guardianship is offered under more typical conditions than a controlled experiment. By combining the strengths of both field experimentation and naturalistic observation, this study provides empirical evidence of the internal and the external validity of the efficacy of subsidized guardianship as a permanency option. BACKGROUND The reason that subsidized guardianship appears to be an idea whose time has finally come has largely to do with the growth of kinship foster care (American Bar Association, 1999; Child Welfare League of America, 1994; National Council of State Human Services Administrators, 1997). As of 1998 kinship care accounted for approximately one-third of all children in the formal foster care system nationwide (DHHS, 2000). Although research shows that kinship foster care is as safe as (Garnier & Poertner, 2000) and often more stable than licensed foster care (Scannapieco, Hegar, & McAlpine, 1997; Testa, 2001), there are advantages to both families and the state from converting these temporary foster placements into legally permanent homes (Leashore, 1984-85; Williams, 1991). …

Mark F. Testa

Papers

Permanency Planning Options for Children in Formal Kinship Care.

Early parenthood and coming of age in the 1990s

Fostering Accountability: Using Evidence to Guide and Improve Child Welfare Policy

Subsidized guardianship: Testing an idea whose time has finally come

Conditions of risk for substitute care