Mindfully Positioning in Revolutionary Times

By Kevin A. Campbell, Published US Children's Bureau Express November 2020

“Revolutionary times call for revolutions, not patching." — William Beverage

We live in an extraordinary time. Never before in the work of child protection have we been able to access the ideas and stories of so many people speaking out about children's safety and the importance of families' well-being. Thoughts and counter ideas appear every day on countless platforms. People from across the country are asking hard questions and having courageous conversations. It seems that we are at a precipice; this building energy and movement must be expressed, but how and, more importantly, whom will it help or hurt?

Looking forward to long-promised reforms is both exciting and frustrating. It can provide a welcome distraction from confronting underlying structural and institutional fractures. However, we cannot safely build a promising future on a foundation that cannot support it or, worse, directly conflicts with the concepts, biological truths, and the design itself.

Several revolutions have been underway in recent decades; these require our unflinching attention and action to make measurable progress. Young people, parents, and former youth in care have been more vocal about their experiences than ever before. We cannot meet this revolutionary moment without listening to and acting on their wisdom based on lived experience. We have long accepted narratives about them that resulted in the present-day foster care and adoption systems. These service traditions remain in deep conflict with the perspective young people, parents, communities, and tribes have been providing for decades.

People affected by social service programs tell us they face tremendous difficulties. They tell researchers they value services that support them and their families to live socially, environmentally, and economically secure lives. They say to be a part of just and dignity-filled experiences, they must be seen for their abilities and listened to for their plans for building and living a good life. They say that services must be in service to them; they do not exist to be in service to government or government contractors or be supplanted by substitute families. They say historical relationships of power between governments, agencies, professionals, youth, and parents must change. The foundational change required is to place youth, families, communities, and tribes and their capabilities—not industry-created models and services at the center of the design, practice, and oversight.

Another revolution has been underway in the biological sciences, neuroscience, and genomic science. The resulting scientific consensus simply cannot continue to be ignored by child protection agencies, their contractors, and courts in the United States. This new science provides a foundational understanding of how health is built for better or worse over a lifetime. A useful application of science can be found in the statement, "Our biology is our biography." The places we live, the relationships we have, and the experiences we undergo as we develop, live, work, learn, and play directly affect our lifelong health, mental health, and even the length and quality of our lives.

This concept provides an opportunity to view its urgent implications for the impact on children's lifelong physical and mental health of being placed in or raised in foster or institutional care. Because of research, we can do better than imagine its impact. A very large recent longitudinal study involving hundreds of thousands of persons raised by systems in the United Kingdom shows that 85 percent of persons who had out-of-home care experiences as children and adolescents developed chronic (incurable) physical and mental health conditions 30 years after leaving care. The same studies show that being placed with a relative reduced that risk by half. Finally, the studies revealed a result that stands as a staggering counternarrative to the entire theory of change in child protection. The best life course health and mental health outcomes for children involved with the child welfare system happened with those young people who could stay with at least one parent rather than being removed and placed in foster care or with a relative. Only 21 percent of these children grew up to suffer from chronic illness as adults 30 years later.

Science points to another required foundational change; we must fix child protection's broken relationship with the word "evidence." The evidence needed to build and sustain a just and health-promoting approach to children's safety and families' well-being will come from bedrock truths about human health and flourishing, not industry-made models. The emerging worldwide scientific consensus is clear; operating a foster care system makes its own contributions to distress and disease across the life course. Kinship care provides the best alternative to substitute care for children who cannot live safely with a parent. Children who can remain with a parent have the best long-term health and mental health outcomes. Institutions for children are disruptive to childhood development and harmful to health. We must continue the process of closing them.

The United Nations' Special Rapporteur on physical and mental health rights has called for a global paradigm shift on mental health. Dr. Dainius Puras described mental health policies and services as being in crisis—"not a crisis of chemical imbalances, but of power imbalances." He says member nations have constructed systems and institutions that embody social inequities within vulnerable persons and groups by holding those most affected by inequality and racism responsible for the social and health problems that severely impact their lives. Governments have continued to invest in institutions and programs that offer medicalized treatments and criminalization as remedies instead of deconstructing intentional inequities and the deliberate policies and programs that sustain them.

We know that most (60.8 percent) family separations carried out by child protection, police, and courts in the United States happen due to neglect, resulting from health and behavioral health effects caused by unrelenting parental stress. The primary cause of this parental stress is economic, social, and neighborhood-based inequality. Foster care and adoption will never be a just remedy or cure for socially constructed hardships and their effects on American families.

A required foundational change—America never had a foster care crisis in child protection but rather a family engagement crisis. It is time to take this seriously and build funding, enforceable timelines, and policy commitments to address underlying economic and racial inequalities while investing in families' ability to stay together. When families cannot remain safely together, we must support them to remain at the table, central to the process where they and their community can construct livable solutions to the challenges that most affect their lives.

Revolutionary times call for revolutions. We must mindfully position ourselves and any resulting reforms in response to the critical feedback and ideas of those on the receiving end of child protection services. There can be no successful and valued reform without confronting the underlying power structures that shape the government and citizens' relationships and the ultimate ability to collaborate rather than be in the court in a protracted existential conflict.

One last revolutionary thought—I might call it a starting point for rethinking the quality of justice. Until we build a child protection system where every American family would welcome help like that from a medic on the battlefield, firefighter, or nurse, we will continue to walk in shoes too small for us.

"Respect your future self who will know what you do not know." — Jennifer Michael Hecht, Stay: A History of Suicide and the Philosophies Against It