Every week on our regular episodes of shift shift Blum, I get to interview people whose lives are very different from mine. And we talk about how each has navigated the twists and turns inherent in transformation. But I wonder what's universal about how people change? What are the common threads, the connective tissue, I tend to look at change through the lens of my own experience, for the most part, the artists life. Lucky for us, my curiosity is shared by the CO creator of shift shift bloom. Dr. John Lyons, luminary and author in the field of clinical psychology and systems change, who better to help me unpack all the questions that fill my mind when the interviews are over. I'm Kristen Cerelli, and you're listening to shift shift bloom, T calm takeaways, my conversation with Dr. John Lyons about a recent interview.
I'm back in the studio with Dr. John Lyons. And we are here today with a very special bonus episode, where instead of talking about the interview subject, the interviewee we are going to talk about the child welfare system. So welcome, John.
John Lyons 1:31
Thank you. It's good to be here. So good to see you. How are you?
Kristen Cerelli 1:35
I'm doing well. We are we are in the middle of this fabulously compelling two part episode with Juliana Barton. And we're not going to talk about it until both episodes air. So you had this great idea to talk about child welfare today. And I think it's a really important subject. So I'm glad that you brought that to the table.
John Lyons 2:01
Yeah, I thought that her story is quite compelling. And I'm looking forward to the second half of it. But I think to contextualize it in terms of out of the job offer system work might help the listeners understand our story a little bit more.
Kristen Cerelli 2:16
Yeah, why don't we start right there. Tell me, tell me. Can you tell me a little bit about the history of child welfare in this country?
John Lyons 2:23
th the Social Security Act of:
Kristen Cerelli 4:15
That's great. That's really concise. And it makes a lot of sense. I don't think a lot of people think about just how those, each of those pieces connect to the next thing that agriculture having lots of kids moving into the city,
John Lyons 4:31
it literally took decades for families to reconfigure their goals, but basically having kid to something that's more consistent with urban living, and then you've seen, of course, in urban settings, you know, the number of kids people have, it's continued to shrink because it's a there's less value out there. Also, the role of children in our country has changed, right? Yes, they're less of commodities and more has representations of artists of their parents, right. And so you know, they're for their parents aspirations, in some ways, rather than somebody to help milk the cows and make sure that pigs are fed and feel is plowed, and all those things that you have to take care of in the farm.
Kristen Cerelli 5:13
So you just mentioned that there are some federal federal regulations, but mostly child welfare is run state to state. How is the whole system supposed to work? If there even is such a thing as?
John Lyons 5:29
That's a great question. So the way it's supposed to work is that if somebody suspects there's abuse or neglect, then that would trigger an investigation. So that would be a call to a job offer professional. And they would come in and do an assessment. Now this is where it starts to vary. For instance, in Florida, the assessments of abuse and neglect are done by the sheriff's the County Sheriff's Department. Whereas in other states, there's actually people who work for the state child welfare authority who do the investigation. So those investigations, a lot of variation and how it's actually done. But essentially, it's to look for abuse and neglect and make a decision. Is this family, this community living situation sufficiently safe for the child to stay there?
Kristen Cerelli 6:16
Do you as a professional in this field have a strong opinion? I'm surprised to learn in Florida, it's the sheriff's office, just because with all of the news recently about how the police are overburdened with things that they aren't really expert in. I just wonder if you think, is there a best practice that should be followed?
John Lyons 6:42
r thing that's happened since:
Kristen Cerelli 7:53
Wow. Can you tell me a little
John Lyons 7:55
bit what happens then. So just to complete the story of how that system is designed, intended to work, so once there's a determination of is there abuse or neglect, and there's a decision either remove or not remove most systems, most states have some things that they can do to help families to try and prevent this from becoming something that's so that they side is not sufficiently dangerous to remove, that are the things that we can do to prevent a future removal. So those are prevention kinds of services, diversion kind of services, whatever want to call it, so those exist, they're variable state to state, but they do exist. Or if they decide to remove them, that's when they enter foster care. And the first stage of foster care is a decision about where to place the child and different states and different kinds of strategies to do that. The goal is to try to find a family home as quickly as possible. Lots of States tried to emphasize family, and they haven't guardianship kinds of laws and rules to facilitate that. Other states use, you know, paid foster parents, models and stuff. That's pretty much the foundation foster care is the foundation of the child welfare system. There are some federal guidelines encourage permanency. So permanency The goal is to try and achieve permanency in 12 months, which means finding someplace where that person that child that youth can stay, you know, so far, I would say it's sort of like an in air quotes, because you know, none of us actually have continent, right. And so that's sort of a, but it's the idea of cannot you find a place where the child can actually grow up so that there's a hope that that would be their permanent home. So that's the goal. So if Foster, it doesn't work out, so if the needs of the child are too great for a foster parent to handle and some of these foster some of these foster parents, by the way, are absolute saints. I mean, these are unbelievably good people. Some of them were just in it for the business, but many of them really, really committed Good people, you might be shocked at the number of child welfare caseworkers who also work as foster parents because they love the kids to hell. And they end up saying, hey, I want to raise you. So wow, adopting him and so forth. So there's there's really angels who work in the system. But the system doesn't work all that well. Sadly, because of the design of it. But the people in it sometimes are really special people.
I've only ever met. Yeah, I think I've only ever met those really special people, I'm happy to say I have several friends who have been foster parents foster into adoption. Talk to some people who are on both ends of the system. And it's pretty remarkable what they're willing to do is is getting a kid to a family member is that is that kinship care is that what that's referred to, as do you know, statistically, like how successful that is? Usually it is,
that's actually a scammer, and lonely immersed in, in Chicago, this dog, whatever to work on that and but there's also others around the country. Kinship Care is actually all the evidence suggests it's more desirable than than a non relative foster care, that I'm fond of saying Blood is thicker than pretty rad, so that if you have somebody who has a relational connection with you, your commitment to them is going to be stronger. So for instance, one of the things we see in our research is that relative foster carers will tolerate a greater level of behavioral emotional challenges, more difficult behavior, than will regular foster here. So a paid foster parent on average, that's not saying all pay foster parents, they pass rates on average, tend to, they tend to prefer babies, and they tend to prefer kids who don't have significant like oppositional behavior, sexualized behavior, or those kinds of acting out kind of behaviors, which are really difficult to manage, and really scary, if you're a parent. And that's where that's where congregate care comes in, is for the kids that cannot be managed. This is, you know, if you build it, it will, they will come right. So there's a Field of Dreams phenomenon. So the more beds you have in congregate care, the more likely there will be pressure to fill those beds. And so if you have a system that struggles with identifying foster homes, but has a significant number of beds in their current care system, the naturally kids can tend to go there even not having it but behavioral emotional needs that rise to the level of not being able to live in a foster home. And so that's particularly true of teenagers, that you as you mentioned, actually, in the first half of Joanna's interview, is that if you're a foster parent, I mean, which do you want a baby or an adolescent? Who's in your face? You know, give me a map? A heartbeat. But think about that, right? I mean, it's much rather have a baby than somebody who's really challenging. Somebody who has trauma trigger somebody who is ready to transition and you have to kind of help them. So it's a it's a buyers market as a farmer, so foster parents can take who they want, which makes perfect sense, right? I mean, they're doing a favor, and they're not paid very much. So you can't really make a living off of being an entrepreneur. So what does the challenge particularly for youth having a sufficient quantity of home, so that's why you tend to get youth either going into group homes or going into relatives or friends of friends of friends, you know, parents of friends also happens for you?
Are there statistics? I'm sure there are I don't know if you know them on, like, let's say how many children who need foster care? What percentage of them are lucky enough to go into kinship care?
I don't know. Moving on. It's a moving target because kinship parents become a priority. So there's been a lot of efforts around the country, I don't know the number, there's 420,000 kids each year in some form of foster care. I don't know the percentages of how many are in kinship care, and so forth. I do know that that it's increasing, because people are seeing the value of that. And they've had to overcome some barriers. Because historically, governments don't like to pay families to take care of their own kids, right. And so you have to find strategies to create the opportunity for child welfare systems and set of eyes, aunts and uncles and grandparents and raise kids. So that's, I mean, there's a lot of that happening. Outside of the formal child welfare system, right. Grandparents are major, major players in childbirth, particularly in poorer parts of our culture because if you're a single parent and you work, you're not homeless, right, you have to work. And so if you're paid, really, you might have to work two or three jobs in order to pay the rent and get food on the table and that kind of stuff. And so having grandma, in the animals to raise kids makes an enormous amount of sense, right. And so you'd have these kinds of complex environments that are just a part of growing up. In certain aspects of our culture, or areas. You've seen a
lot like your this is your field. I won't talk about Giuliana, but talking about adolescents in foster care congregate care homes. In particular, do you see a path towards making it better either making congregate care better? Or I don't want to say incentivizing but making the idea of fostering a teenager more appealing somehow. I mean, what can be done about that? It's are there things that can be done? I think
there are I think, actually, and we've actually found that there are some circumstances, particularly for older teenagers, older youth, young adults, that actually they might be better off in a group home than in a family environment, if that family environment isn't embracing. And so particularly for kids who are struggling with what we call attachment, that of forming relationships, particularly with parental figures, I mean, if you've had really poor role models, as Bernal figures, sometimes, you don't really want to have a relationship with somebody who's in that role. If you've been abused, if you've been neglected, if you've been treated like dirt, by people who were supposed to be your parent figures, then you might not really want to try that again. And that's perfectly true for 16 and 17 year olds who are almost there, right, they can see the finish line are almost done with his childhood business. And so it probably for those kinds of kids who really don't want to endure trying to fake a parent parental type relationship, they probably are better off in a group home kind of environment, and they, but it has to be a healthy environment. Right. So I mean, our basic strategy, which we do this repeatedly, is taking people have problems and putting them together with other people who have problems. That can be a problem in and of itself, right? Because there's these contagion effects, and so forth. So you really have to have some good strong leadership in the group homes, to establish a healthy culture, you have to have rules, you have to follow the rules. But at the same time, it can't be too draconian, right, because as you probably remember, from your own adolescence, Adolescence is the time where you begin to shift from just following parents rules and exploring and making your own mistakes by trying to figure out what your own personal rules. And so that's a little bit of a challenge and Groupon kinds of environment. So you do have to have some pretty interpersonally talented people to be to staff group homes to make it work.
How How old? Generally speaking, I know what state to state things are different. How old does the child need to be? Before they would be considered able to go into a congregate care situation?
Oh, that's a great question. When we fight this battle, constantly, and across the country, there is no real age. Right? So there are six year old to go to Congress here. My personal belief is that's not a very good idea. I think that sexuals are tiny, right? You should be able to handle behavioral problems with a six year old if you use your language and have some basic concept of ABA and so forth. Vitamins. That's not. So anyway. So when you start getting bigger, I mean, there's some 12 year olds are going to be six for 300 pounds, right? And so it becomes harder, because you don't have that, right. You don't have the ability to be physically stronger than them not that you're going to physically fight them, that you're even going to touch them in that way, but just the power differential because of science matters. Yeah, so I think but you know, there's a real debate. So there are most places allow the admission of children under 12 into Congress. There's not a huge percent, but we're talking maybe between eight and 10% of all kids encountered below tones. So I would like to see a world where that was not encouraged. And that would actually be a rare exception. that aspiration.
Other than that, what is the successful congregate care home look like? Like? What? What makes? What might make one run really well, in terms of organizational structure and leadership?
Yeah, I think having people who are trauma informed, that makes a difference, right, it makes a difference. Trauma Informed is really important, because, number one, all kids and child welfare have experienced at least some trauma, and many of them have, have experienced a great deal of trauma, either repetitively or model. And so for instance, you could have an adolescent who's not listening to you when you're lecturing. And you could look at them and say, You're not listening to me, you have to listen to me, you stop not paying attention, right? Because you're thinking they're being passive aggressive. If they've been traumatized, they actually might be dissociating, and they and if they're passive aggressive, you have to get in their face, right, you have to get the them to be actively aggressive, so that you can sort it out. If they're dissociating, you need to take a step back, you need to take a step back, because they can't actually interact with you until they come back from where they went. Because one of the things that kids do when they've been traumatized is to remove themselves from the situation by going off in their heads to someplace else. And that's called dissociation. I mean, I'm being a little bit close. But that's called dissociation that that happens. And then that becomes a real problem, because you really have to give kids safety and space. Whereas another example, if you had a kid, and you walk by their bedroom door, and you see they had kicked off their covers, you might go in and cover them back up and give him a kiss. If that child had been raped repeatedly by a caregiver in the middle of the night, you would never ever, ever do that. Because that you what you should do is build a safe and set a sanctuary for their bedroom, that they're safe in their bedroom, so that they can we learn how to sleep without being fearful that somebody is going to rape them. So those are the kinds of there's all sorts of different things that being trauma informed means in terms of how you interact with kids, I think that's the single most important thing is being able to not take things personally to be able to see behavior in the light of people's trauma history and to not think of it as misbehavior, but think about it. So because what happens, for instance, is one of the things that people have discovered is that having experiences of traumatic events in your life, as a child, it causes changes in brain function. And where it changes the brain function is the amygdala. And the amygdala is a regulatory function down at the bottom of your, of your brain. And some kids who are traumatized have dysregulated. And so they have dysregulated emotions, and so they can be all over the place emotionally, right and in a short period of time. Or they can be you know, hair trainers, right, just haircare. So they're hyper vigilant, they're dysregulated. And so teaching kids how to reregulate themselves is really what you need to do, you can do it actually, and you can rehabilitate your amygdala so that you are regain your capacity to regulate your emotions. You see, the same thing with stroke victims and with a head injury, folks, is that they lose the ability. And you can relearn how to say you'll see stroke, people without strokes, depending on the stroke, they might just suddenly start crying, right. And that's because their amygdala is just out deregulated. So you just have to teach teach your brain how to reregulate the effect. So which is easy to say and hard to do, but it's do
this is really done by a skill based techniques
that are designed for trauma informed care, you don't have to sit down and talk about your trauma, which is the other thing is like, people sometimes fall into the mental health view of it. And let's, you know, let's sounds like you've been traumatized kind of sounds like you're angry. How does that that kind of stuff that may not be helpful, right? It probably is helpful not to spend a lot of time talking about the trauma, and more time learning skills, you know, mindfulness kind of skills, those kinds of things, so that you can help yourself we regulate.
I have a dumb question, which is are all congregate care homes run by licensed clinical social workers or people with social work background?
It depends, right? So the group homes which are small, you know, typically four to eight kids in a house in a community and Those kids tend to go to Community Schools and so forth that live with four to eight other kids. And there's either a house parent, you know, and some of those are like mom and pop. So a couple opens our house to make it a group. All right, so you can do that you can record yourself, get through the regulations, and so forth and do that. There are also you know, companies that do group homes, there's also Groupon. So there's, you know, like Boystown has a is a very large agency that provides Groupon and also other forms of car. So there's, there's a bunch of different models. And oftentimes, the smaller the organization, but less sophisticated the approach, but a lot of them have kind of, you know, like Parent Teacher kind of models of, of how the staff interact with the youth and that kind of stuff. So some are quite good. And some of them are not so good. You know, the way I describe all systems is you've got pockets of excellence, and piles of crap, and a whole lot of stuff. Right? And so what makes the news is the piles of crap, but there are pockets of excellence, but a large number of people are good enough.
Okay, tell me about what tell me about what the relationship is between tea calm, and child welfare.
So we do a lot of work around the country and a large number of child welfare systems are beginning to use our approach. So so what we do with them is teach them how to do consensus based assessment program, because one of the big challenges of child welfare is it started out as a police investigation, and it evolved into a child, a social worker, a social work intervention. So So particularly for this, so actually, in some ways, that's why the Florida model is bad, horrible, because, you know, if the investigation is by the police, then when the social workers come in, and they're not seen as part of that investigation, it's separated. In most systems where it's all the same organization, there's this pivot that the system has to make from saying, you know, we have decided you're an inadequate parent, we've removed your kids to, what are we going to do to help you so that you can have your kids back. And that's an easy thing to say, and an extremely difficult thing to actually pull off. And so our approach is really one of the strategies that you can use to help with that pivot. So it basically empowers the biological family as experts in the story of their own children. So they get to participate in child family teams, and so forth. So that you can come to a consensus understanding, we're all on the same page, this is what's going on, this is what we need to figure out how to address. And if we can do this, then everybody can live their best lives, and you don't have to have the government involved in your life. So that's basically our approach. And so we've had quite a bit of success. And in the early implementation, we have some places have been added for a while and some places that are very new to it, but the plays of the banana for a while they actually have been able to improve their system in a slow but steady fashion, with oftentimes inter under a lawsuit. So because now there's lots of things bad that happened in child welfare, and there are advocacy groups that say stage to get things fixed. And so we're oftentimes one of those fixes. So that actually pretty well, we've gotten a number of states ready out of lawsuits by helping them improve. And the way you get out of a lawsuit is you make your system better for kids and families, and then you get a loss. And it's very straightforward.
Fairly straightforward. But it must be really gratifying to see your work implemented in that way and have real effect on humans and families.
I don't have trouble getting up in the morning to go to work. So I like I do. I feel privileged to have a voice in the process of
this has been so educational, not just for me, but I think for a lot of people listening who probably just think about foster care in a way that's like, Oh, I saw a movie about this. You know, in 1980, I saw an after school special about a foster kid and don't don't really stop to think about what's really going on and what the challenges are, and just the whole topic in general.
Let me circle back to something we started talking about when I mentioned 1936. And that historical context. There are folks that are so there's enormous racial disparities and child welfare is probably the system that has the greatest amount of racial disparity. And that disparity is that African American kids are removed at far higher rates relative to the population than any other kids to the point that some people feel Like the system is designed somewhat from a white supremacy perspective, right? And if you read books like Dr. Ross's book from Rochester, she writes things she told it's called abusive policies. And she makes that case that the expansion of the definition of trauma of abuse and neglect, back in the 60s and 70s, which was used expand funding came from a fundamentally white suburban perspective. And so everything got that made in the trauma. And it actually has had this incredibly unintended consequence on poor communities, which are predominantly communities of color, since poverty and race is very highly correlated in the United States because of historical discrimination. And some people say it doesn't exist, but it clearly does. And that's the driver, right? And so it's, it's a bit of a problem. It's becoming a name again, Michael Ross Arese, to abuse it policies in the book.
It sounds really good. It's powerful.
And I've really talks about that movement and the political. So they felt like they couldn't get the Act passed, or Walter Mondale let it unless they made it about Super lightly, that if he made it about poor people, but Congress wouldn't pass it, so and so they made it and the way they ended up structuring it was one that hadn't very unintended, negative consequences for poor people. So if you see what happens in child welfare, it's not abuse and neglect, it's abuse and neglect, in poor communities, because rich people can hire lawyers, and they can hire help, and so forth. And so you see a very, very differential justice. So, so the racial disparity is probably a poverty disparity, but the vast majority of kids, and we're talking like 80%, are, are because of neglect. And typically, it's a combination of, of substance use and poverty. And that creates a living situation that is seen as unsafe for the child. And then. So the parent is a single parent and is absent because they're using, but the problem is that they sometimes are absent because they're working, and they got nobody, no daycare, and so forth, and so forth. So it's a bit of a challenge. So
yeah, you leave us I think, on the note that it's daunting. And also it's everything is related. Like, I think what we're seeing now in our culture really is, everything is related. And what can you you can't look away from anything because it's, it's related to something else that you do care about, in a way, you know.
And I honestly think we're in a better position than we've ever been, as much as we've got very loud voices that are clearly racist. I think that's better, because at least it's out there. It's always been there. It has always been there. But at least it's now out there. And we know it's there. And we know who it is because they're actually saying it. And I get that gives us a chance to address it in a way that's not possible if it's secret. And if it's all encoded, if it's all in the background, so I'm actually hopeful and optimistic that we have as a culture of the ability to figure this out and create an equitable society. I think it's all the work, but I think it's
yeah, you're you're no stranger to hard work and you have a great team around you. And it's always a learning experience to spend time with you. So thank you for sharing your vast knowledge on this subject. I know we only touched on a little bit but we'll put some great things in the show notes. If they're interested in learning
more pleasure chatting with you as always,
I'll talk to you soon take care.
shift shift Bloom is made possible in part by the prayed Foundation, a nonprofit organization committed to improving the well being of all through the use of personalized timely interventions and provider of online training in the T comm. Tools. T calm is transformational collaborative outcomes management, a comprehensive framework for improving the effectiveness of helping systems through Person Centered Care online at prayed foundation.org and AT T comma conversations.org. And by the Center for Innovation in Population Health at the University of Kentucky online at IP h.uk y.edu.
Shift Shift Bloom is a podcast examining how people change, why they change, and how they sustain the changes that are most important to them in their everyday lives. Our guests consider themselves change makers, change embracers and change resistors — we’re all somewhere on that spectrum at different times in our lives, aren’t we? Conversations with host Kristen Cerelli explore the impact of mindset, personality, life circumstances, communities of support and sources of inspiration on the process of transformation. Illuminating how change can be both deeply personal and profoundly universal is the show's guiding principle.
Shift Shift Bloom is produced by host Kristen Cerelli and audio engineer Timothy Fall at ActuallyQuiteNice, a full-service media studio. They develop the show in collaboration with Dr. John Lyons, Director of both The Center for Innovation in Population Health at The University of Kentucky, and The Praed Foundation, which supports the development and dissemination of systems improvement strategies called Transformational Collaborative Outcomes Management, or TCOM. Online at https://praedfoundation.org, https://tcomconversations.org and https://iph.uky.edu.
Season One new regular episodes drop every Monday from February 14 to April 18, 2022, and are accompanied by "TCOM Takeaways" -- special in-depth discussions between Dr. John Lyons and Kristen Cerelli, that extract common themes, ongoing questions and powerful insights on the topic of transformation. It's safe to say there's no formula for navigating change, but John and Kristen will keep looking for and articulating the universal tenets of the process.
Host Kristen Cerelli created Shift Shift Bloom in collaboration with Dr. John Lyons of the Center for Innovation in Population Health at the University of Kentucky. She's also an actor, singer-songwriter and performance coach.
John S. Lyons, Ph.D. is the Directory of the Center for Innovation in Population Health and a Professor of Health Management. He is a luminary in mental health policy and practice, and the original developer of TCOM and its associated tools and approaches.
Audio producer and engineer Timothy Fall is a writer, actor and multimedia creator alongside Kristen Cerelli at ActuallyQuiteNice Studios, where they make podcasts and films and music and dinner.