Inside America's critical shortage of foster care homes

The U.S. foster care system is broken.

"We are in a massive crisis," Serita Cox, CEO and co-founder of the nonprofit iFoster, says. "And that crisis means that we have kids living in a casino or living in an office building or living in juvenile hall when they’ve done nothing."

There's a critical shortage of foster homes. More than half of all states saw a significant decline in licensed foster homes last year. Some states saw cuts as high as 61%. There are many reasons behind the decline. One of the main factors: new foster parents don't stay in the system.

"You could be getting all of these wonderful foster parents in, but if you're losing 50% of them in their first year ... it's basically a sieve," Cox says.

Today, On Point: The crisis in American foster care.

Serita Cox, CEO and co-founder of the nonprofit iFoster, the largest nationwide virtual network for children, families and organizations within the foster care system.

John DeGarmo, foster care advocate who's been a foster and adoptive parent of more than 60 children since 2001.

Brittany Yates, Jewell Harris, Enrique, and Glenda Wright, former foster youth.

Mikaila Reinhardt, a former foster child and now family recruitment specialist for the Children’s Home Society of North Carolina.

John Connery, the director of recruitment at the South Carolina Youth Advocate Program.

Part I

MEGHNA CHAKRABARTI: This is On Point. I'm Meghna Chakrabarti. The U.S. foster care system is broken. The number of licensed foster homes dropped last year in more than half of states, and in some states the drop was profound. For example, South Carolina lost more than 61% of its available foster homes last year. Meanwhile, more children continue to enter the child welfare system.

The shortages have forced several states to seek temporary shelter for children wherever it's available, including casino hotels, emergency rooms, retirement homes, and even former juvenile detention facilities. The Covid pandemic pushed the crisis out into the open, but it has been brewing for years.

Jewell Harris is 24 and lives in Ohio. She’s been in and out of the foster care system since she was three years old. She aged out. Enrique lives in California. He went into foster care when he was 11. He’s 25 now and has also aged out of the system. Glenda Wright is in Kentucky. She’s 27, and first entered the foster care system when she was two. She often received kinship care from her grandmother, but her grandmother died when Glenda was 13. She's also aged out of the system.

This is what they experienced.

JEWELL HARRIS: I was probably like 13 years old, and we'd spend hours upon hours inside of the actual children's services agency. So in that lobby you'd see a bunch of different kids with a bunch of trash bags just sitting there and waiting and waiting. Then you get out of school and it's like, "Oh no, you can't go back there, you have some — the caseworker's there to pick you up and you have to go to the agency."

They have completely packed up all your things in trash bags. You don't know what they left, what they missed, or what they decided to disregard or discard, and that in itself was very demeaning. You lose your sense of autonomy. You feel like you don't have any control over your life.

ENRIQUE: There was times where I've had to stay at the command post, which is in downtown L.A. and it's like a big DCFS office, kind of, where when you're unhoused, they place you there. There's been times where I got removed from one group home and I had to stay at the command post basically for almost a week until they found me something new.

I got hospitalized one time and they made me stay in the hospital for almost a week longer than I should have been just because they were trying to find me a new placement as well. A lot of times they move people around and they don't have a set plan, so they'll move you out of your house, but they don't even have a home for you to go to. It's inhumane to be honest. Especially for a kid, you know, it's very traumatic.

GLENDA WRIGHT: My grandmother had just passed away. That's a significant loss. It's basically like my mother just passed away. And instead of thinking therapeutically, like, "Okay, these kids are always together. They need to stay together. And they need to be in a home-like environment as they kind of try to work through their grandmother dying." They decided that it would be better to put us in institutional care.

So what that looked like was me and my brothers getting split up by gender. So again, I just had my grandmother's death. It's the same night. I remember being in the room and laying on the bunk bed and just crying my eyes out. And I didn't have my built-in support of my siblings, and so we were in that place for too long, first off, but really long, I don't really remember exactly how long. But to me, in that moment, it felt like months. It felt like years.

I know what's best for me, even if my age says that I don't. And so really just implementing youth feedback, both post-system and pre-system is really important.

CHAKRABARTI: That was Jewell Harris of Ohio, Enrique in California and Glenda Wright in Kentucky.

Serita Cox is the CEO and co-founder of the nonprofit iFoster, the largest national virtual network for children, families, and organizations within the foster care system. And she joins us today from Lake Tahoe, California.

Serita, welcome to On Point.

SERITA COX: Hello Meghna, and thank you so much for having me.

CHAKRABARTI: So we've only recently, I think more broadly have heard of this sort of precipitous crisis in the foster care system. But as we just heard from Enrique, Glenda, and Jewell, this has been going on for years. I mean, would you describe the current shortage of foster homes as different or more acute than it was before?

COX: I think it's happening nationwide at a level that we haven't seen necessarily before all at once, due to Covid. So Covid kind of put a spotlight on it. But this situation has been going on for a long, long time. You know, Jewell, Glenda and Enrique, you mentioned their ages now and they're talking about a decade ago and what they were going through. So yes, this has been a problem for a long time that just seems to have come to this massive head that the public is becoming aware of because of Covid.

CHAKRABARTI: Okay. I'd like to spend a few minutes talking about the lengths that several different states and social service agencies in those states have had to go to in order to find places for children to stay who are in the foster system. I mean, for example, in California where you are, there are stories of children who have had to sleep in cots in former juvenile detention centers. Do you know more about that?

COX: That's correct. That's in Sacramento. It was investigated and the bottom line is, there were — and there are — no foster homes or kinship homes available for these children. And so it is the only facility they could find. It would be that or maybe office space at Department of Children and Family Services headquarters. Or it would be homelessness. That is the crisis. There are no beds.

CHAKRABARTI: Mm. Homelessness, even though these children are supposed to be in the care of the state?

COX: Correct. And homelessness does occur. I believe Enrique talked about that, that even while you're in care, it does not mean that you're guaranteed to be with a family, to be in a safe placement.

CHAKRABARTI: Okay. There are a couple of other other examples I want to go through just to really drive this point home about how dire the situation is. In Nevada, children have been housed in casino hotel rooms where state workers watched over them while they were waiting for foster beds to open. You're — I'm sure you're aware of that as well, right?

COX: Exactly. You know, at least it was a hotel. (LAUGHS) And you have to see the grim humor in it. But yes, that's happening there, too. Especially in the more rural areas, there aren't foster families, there aren't kinship families in which to place them.

CHAKRABARTI: Yeah. And I'm seeing here that in the, in the Nevada case, KFF News, or formerly Kaiser Health News, has reported that in one Nevada County there were — in Elko County, Nevada, it's a rural but geographically large county, there were 12 foster beds in the entire county. Just 12. And they were all full.

And then in North Carolina, there were 11,000 youth in the North Carolina foster care system. Just prior to the pandemic, there were 7,100 licensed foster families in the state, but by 2022, the number had dropped below 5,500. And that led to a number of children having to stay, for example, another thing we've been reading about — and Enrique mentioned this — for extended stays in the hospital. Not because they needed medical care anymore, but simply because there was no place for them to go, Serita.

COX: Yes, that does happen. And let's be clear, it's not necessarily a hospital for physical care. In many times, it's a mental health facility. And you can imagine the trauma as a young person or a child being held in a medical health institution — or a mental health institution when you really don't need to be there.

CHAKRABARTI: I see.

COX: So this is a massive issue, and you can just imagine the trauma that is impacting on these children. They're already traumatized. They've been removed from their family due to abuse or violence or neglect. They were removed for a reason and they're being further re-traumatized by not being placed in a safe family environment for whatever temporary time they're gonna be in foster care. Instead, they're in offices, they're in casinos, they're in defunct juvenile holds that aren't even being used as juvenile holds anymore. You know, it is a crisis.

CHAKRABARTI: Mm-hmm. Well, the North Carolina Department of Health and Human Services responded to an inquiry from Queen City News who did some local reporting on this. And the NC DHHS said that they were aware of at least 50 children statewide who were waiting in emergency departments — like, living in the emergency room. Because of the fact that those particular children were waiting to be admitted into either a setting that could address their complex needs, their mental health needs — that would be inpatient or residential — or a foster home that was supported by behavioral health and other services in the community. And those foster homes simply did not exist in adequate numbers.

So when we come back, Serita, I wanna talk a little bit more about the impact that Covid has had on this already ongoing problem and really what the dynamics are that are causing this crisis. So today we're talking about a crisis in the U.S. foster care system and the dramatic drop in foster homes for children to go to. And we'll have more when we come back.

Part II

CHAKRABARTI: Today, we're taking a look at a problem that the Covid pandemic helped to burst out into the open, and that is the dramatic drop in foster homes, in licensed foster homes in more than half of U.S. states. A drop that means that children in many of these states are bounced from home to home, or sometimes housed in inappropriate situations.

And we're trying to understand what's driving not only the recent drop in foster homes, but the longer term challenges that state child services departments are facing. And Serita Cox joins us today. She's CEO of the nonprofit iFoster, which is the largest virtual network for children, families and organizations in the foster care system.

Now, Serita, the fact that Covid made a bad situation worse is unfortunately a familiar refrain in so many aspects of American life. So I wanna just go back to what the bad situation even was before Covid. Because I'm reading that there's sort of a multifaceted set of problems here, and the first of all is that for quite some time, states have had a very difficult time in retaining new foster families. Can you tell me why that is and how bad the retention rate is?

COX: Yes. So the retention rate, you know, about 50% of new foster parents last only a year or less. So you've got this huge outflow. And by the way, it takes — it can take almost a year to get licensed to be a foster parent. So they've gone through all this investment and then they leave.

And some of the endemic issues as to why this is — why we're seeing this. Well, we went out and asked the community. We run something called the Voice of the Community Survey. We just finished our second annual one. And about 3,000 caregivers from across the country — about 7,000 transition-age youth, caregivers and frontline workers — have responded.

And what the caregivers had to say is they really, they don't feel valued. Now, remember, caregivers don't get paid. They volunteer. And they don't feel valued. They don't feel that they're seen as anything but a bed and a driver, driving kids to their visitations or their doctor's appointments or to school or whatever.

They don't feel respected. They don't get the training and support they need. They're not sure how to access the resources that their children need or where to get them. And quite frankly, the stipend that they do get, which is supposed to invest in the child, is insufficient to meet the needs of that child.

CHAKRABARTI: Mm.

COX: And so when you add all of that up — and this feeling of they're already volunteering and they feel like they're not even a valued member of the team, their voice isn't heard in decision making around the future of that child even though they are principally responsible for the life of that child, for the majority of the time that that child's in care — you can see how things can fester and it becomes a very — nobody wants to be part of something like this.

CHAKRABARTI: Right. Okay. So not enough support for families who wish to be foster families. We will come back to that in a couple of minutes. But caseworkers themselves, I'm seeing, are feeling very overworked and burning out. Do you have some, some data or stories around that?

COX: Yes. There, too. You can see the same. I believe the turnover rate, depends on the state, is between 30 to 50%, on frontline workers. These are the ones that are, are out there in the field. So there, too, huge caseloads — far exceeding what the state or federal guidelines suggest should be their caseloads. Not only that, but their caseloads are moving and switching all the time.

To give you a case example, in L.A. County, cases are done by — social workers are given a region that they operate in. So as kids move placements — as you heard Enrique and Jewell and Glenda talk about moving placements — and they move in and out of a social worker's area, that social worker may have a steady state of cases, but the actual case keeps changing because the children keep changing. So you can just imagine the — how can they possibly keep up? And they're under incredible pressure, too, because there's not enough homes. How do you think a social worker feels keeping a kid in their office?

CHAKRABARTI: Mm-hmm. Mm.

COX: It's heartbreaking.

CHAKRABARTI: Yeah. Well, you know, we reached out to several states that are experiencing these critical shortages of foster homes. And several of them, a couple of them, did give back to us with statements.

One of them is Maryland. And according to at least one data set in 2000 — between 2021 to 2022, Maryland lost 38% of its available, or number of licensed foster homes in the state. And the state of Maryland responded to our inquiry with quite a long statement, but a portion of it says that currently there are 3,911 children and teens in foster care. And as of just this week, there are 2,640 licensed active resource homes in Maryland. And they gave us a couple of reasons about why that number has fluctuated in the past few years.

And they point to what seems like an administrative reason — that over the course of 2019 to 2021, the statement says, Maryland developed and launched the new child, juvenile and adult management system to better support DHS Child Welfare and Adult Services employees. And during the transition period to this new management system, they discovered, and have since corrected, programming issues with migrating the data from the state's old system to the new one, which resulted in some closed resource homes being reopened in the system inadvertently.

Now, what do you take from that, Serita?

COX: A lot of bureaucratic information. (LAUGHS)

CHAKRABARTI: (LAUGHS) Yes. Yes.

COX: Um...I...yeah, it's a mess.

CHAKRABARTI: Mm-hmm.

COX: I mean, how do you not know which of your families — and this just goes to what caregivers are saying — they're so low on the totem pole for being supported that an administrative error could turn off families.

CHAKRABARTI: Mm-hmm.

COX: It just underscores the value that is being placed on these caregivers who arguably are the biggest — from a child-centric point of view — they are the most important piece of the child welfare system.

CHAKRABARTI: Yeah. There's another piece of this that I wanted to get your impressions on. Because, again, thinking about the reporting that's come out of Nevada and some of — the tremendously acute need, especially in some of Nevada's rural counties.

Officials there, again, told Kaiser Health News that what made the available number of foster families shrink dramatically there was actually larger problems in the community: higher poverty rates, greater geographical distances to services or even between communities, very limited infrastructure, fewer social workers in all. So the community itself was struggling, which meant that the number of foster families, even if they had the desire to do so, simply couldn't. They couldn't support bringing another child into their home, even temporarily. So it's like a reflection of bigger challenges in American life, don't you think?

COX: Absolutely. Absolutely. Especially if you have built a system upon the backs of volunteers. What other system of care that do we have in the United States that is so dependent on volunteers? In healthcare, we have home health workers, we have senior care, we have pre-K and childcare. All of those do not rely upon volunteers yet, the child welfare system does.

And where are the majority of children coming into the foster care system from? Well, again, if we go back to the surveys we've been doing, 78% of frontline workers said that the number one reason that drove children into the foster care system in the first place was poverty.

CHAKRABARTI: Mm-hmm.

COX: So that means that children are coming from communities like you just described about Elko. You know, poor communities, communities that are already struggling. And now we are saying as a child welfare system, we are flipping over to that exact same community and saying, "Yeah, you're struggling, but we're looking for volunteers. Will you sign up and take another child into your home?"

CHAKRABARTI: Mm.

COX: "Oh, and P.S., by the way, we're not gonna give you a stipend that's gonna cover everything that that child completely needs. Nor are we going to be able to give you all the supports and resources and everything else that you need because we ourselves are, you know, we don't have enough social workers, we're under stress, we don't have the capability to do that. And perhaps we don't value you that way either."

CHAKRABARTI: Right. We're gonna hear from a foster parent in just one minute here, but Serita I had one more question for you. Because you said "volunteer" multiple times. But then you also mentioned, correctly, that stipends are paid to foster families who do care for children in the system.

Now those stipends, monthly stipends can vary wildly, right? I mean, I'm seeing as low as $200 a month in Utah to $1000 a month in California. But you're still making the argument that that is an inadequate amount to care for the children that the foster parents are, foster families are taking in?

COX: Yes. And to be clear, foster parents aren't paid like a professional, right? And that's one thing caregivers have suggested is what if this was to be more of a profession? And we can talk about that.

But this stipend is somewhat of a compensation for the bed, for the roof over their head. And for the consumption of items that that child needs, whether it's clothing, food, being driven to and from school or visitations or programming, you know, things like that. So when you think about it's not a lot. It does go up based on the complexity of the trauma and the case  that they are licensed to be able to have.

So a family who is trained and can handle very severe traumatic cases — children who have been sexually abused, children who have disabilities, children with severe mental health issues — obviously you need someone much more trained.

CHAKRABARTI: Mm-hmm.

COX: And they need much more supports than a child who doesn't need that. So that's why you see these varying in differences. But is it paid like one would see a home health worker being paid or a senior care worker being paid, or a childcare worker being paid? No.

CHAKRABARTI: Mm-hmm.

COX: It is not. And maybe that's why it's not valued.

CHAKRABARTI: Okay. Okay, well, Serita Cox, hang on here for just a minute because I wanna bring in  the voice of someone who is a foster parent.

John DeGarmo joins us from Monticello, Georgia. He's been a foster parent and adoptive parent of 60 plus children since 2001. He's also a foster care expert and advocate, and the director of the Foster Care Institute. John DeGarmo, welcome to you.

JOHN DEGARMO: Thank you so very much.

CHAKRABARTI: Can you take a minute first to talk about how many kids you fostered, their age ranges when you started?

DEGARMO: Oh, absolutely. Thank you for asking. Started roughly 20 years ago, we've had over 60 plus children. We've had children as young as 27 hours of age and as old as 18 years of age. We averaged roughly nine children at a time. Several times, we had as many as 11 children at the same time, including seven in diapers. And there's a reason behind that.

You know, we've been talking about the shortage of foster parents and at the Foster Care Institute, we did a deep study on why that was. But you know, in our area, there are simply not enough foster homes, and we have been asked several times to take well over the limit.

CHAKRABARTI: Well over the limit. I read that at one point in time, during one Christmas, were there 23 kids that came into your care?

DEGARMO: (LAUGHS) Well, we had 23 children. It was actually 2020, the year of Covid. We opened up our house to a lot of our former kids that came through our home, and we had 23 kids join us during that holiday season that were in foster care in our home at one time. You know, in our home, there's no label, there's no biological or adoptive or foster. They're all of our children. We love them equally.

CHAKRABARTI: Okay, so these, these were children that you had cared for before who came in for Christmas, the Christmas of Covid. Okay. Point taken. I appreciate that clarification. What, um, what drew you to become a foster parent in the first place?

DEGARMO: Well, there's a few reasons, and thanks for asking. Initially, my wife's from Australia and our child died in Australia from a condition called anencephaly. And my wife was in labor for 92 hours and I had a lot of anger at that time.

And then years later, we moved back to the United States and I was teaching in a rural system in Georgia. And two things hit me: The fact that many kids are coming through my high school classroom in this rural area that had issues of attendance issues of behavior, issues of academics. And I noticed a lot of it was stemming from their household environment.

And second of all, in this small rural county was a very, very large human trafficking ring led by a gentleman by the name of Dr. Malachi York. He was not a doctor, but that was his alias. He's now in jail for bringing over a thousand children over the state lines of Georgia for child sex trafficking. And so I asked my wife, you know, we lost our first child. We have three healthy children at that point. How can we help other kids? And that led to the journey and adventure of foster parenting.

CHAKRABARTI: Wow. Well, I'm very sorry to hear about your first child but I'm grateful that you're joining us today, John. If you hang on for just a minute, I wanna talk a lot more about the realities of being a foster parent and what can be done to change the system so that the number of foster homes can grow in this country to meet the needs of children in the system. So we'll have a lot more when we come back.

Part III

CHAKRABARTI: Today, we're talking about the crisis in the foster care system that's really burst out into the open because over the last couple of years, at least half — I should actually say more than half — of U.S. states have experienced a dramatic drop in the number of licensed foster homes in each of these various states.

And today we're exploring why and what can be done about it. Serita Cox joins us. She's CEO and founder of the nonprofit iFoster. And John DeGarmo is with us as well. He's been a foster parent since 2001 and is the director of the Foster Care Institute.  I just wanna hear for a moment from another person who was formerly in the foster care system.

Because we talked a few minutes ago about the fact that half of foster parents don't last a single year — or they exit the system as available foster families after just one year. And one of the things that means immediately is that children get bounced around from home to home. And that was the case for 25-year-old Mikaila Reinhardt of North Carolina. She entered the foster care system when she was nine due to drug abuse and trafficking in her biological home. And since then, she's been in more than 15 foster homes.

MIKAILA REINHARDT: I've had to sit down and actually write out like, the people I've lived with, like all of their names. And it's crazy because I had this list in front of me for like a week and I would just be like, "Oh, I forgot this person. Oh, I forgot this person." And so when I ended up coming to peace with like, everyone I had wrote down, I had wrote down 23 different families who had cared for me during the time I was in foster care.

And so I ended up in over seven different schools before I graduated. And I lived about two hours away at one point from, you know, like my community or the people that I'd known since like, elementary school. And a lot of my friends would say, you know, "One day you would just go missing and nobody knew where you were."

That was exactly how it was. Like, my friends, one day I'd be at school and the next day my friends would never see me again and I would never see them again until years later. It's quite an experience to wrap your mind around, being a child in foster care. It's a tornado constantly. Your life is a tornado.

CHAKRABARTI: Now, Mikaila says she's glad that she was initially removed from her mother's home. She does know it wasn't safe for her there. But the instability that she experienced afterwards really took a toll on her and she doesn't want other children to have to go through that, which is why today she's a family recruitment specialist for the Children's Home Society of North Carolina.

John, I'm wondering if I can ask you about what the — you think the primary challenges are for families in their first year of wanting to foster children? What those challenges are and whether or not in the training period that they go through with various states, if they're really adequately prepared for them by the child services that, that train the families?

DEGARMO: No, that's a fantastic question. You know, I recognized within 20 minutes of my first placement that I was not ready for the two children placed in my home. My wife and I thought we were ready, but we recognized within the first 20 minutes that wasn't the case. And that's the case for so many foster parents.

You know, we did a study, at the Foster Care Institute, and we asked over 5,000 foster parents, what's the number one reason why you are quitting after roughly 18 months? And by far, the response was foster parents felt that they did not get the help they needed during times of burnout, stress. During times of secondary traumatic stress, known as compassion fatigue, during times of feelings of grief and loss when a child leaves. They felt they weren't getting the support from their caseworkers. In truth, caseworkers are overworked, overwhelmed, under-resourced, under-supported, understaffed, and underpaid. And as we discussed here earlier, they quit as well.

So it's a very challenging time. And then during Covid, what I was hearing from foster parents was, when the child was removed — when we closed the schools down and the child was placed back into the foster care home, they were no longer getting their support services they needed in school because they were, on average, 18 months behind academically with issues of behavior and academics.

They were no longer getting their professional therapy or counseling services that they desperately needed. They were no longer getting in-person visitation services, and their anxiety levels were through the roof.

Well, foster parents were telling me, "Dr. John, I'm not a teacher. I can't help these kids with their academics. I'm not a therapist or counselor. I can't do visitations online five days a week." And their anxiety levels are through the roof. And that's one of the reasons why we lost so many good foster parents during 2020 and 2021. They just weren't getting the help they needed, and the children were in their homes 24 hours a day without any sort of help.

CHAKRABARTI: Ah. Okay. Serita Cox, you know, one might think, well, perhaps the community around where these foster families live could step up more, right? I mean, offers to babysit, carpooling, you know, assistance with laundry, whatever it takes. You know, the things that friends and neighbors do for each other on an everyday basis.

But I am reading — and please correct me if I'm wrong — that in some states, like for example, if a foster parent just needed a little bit of a break from things and wanted to have a babysitter come in and look after the kids, that that babysitter would also have to be certified as a person who's able to give foster care by that state and so that maybe reduced the options that the foster parent has? Do I have that right or am I mistaken there?

COX: No, you are correct. It depends state by state, county by county. But yes, you can't just have, let's say, a teenage babysitter come over. It's what you'll hear termed as "respite care," caregivers being asked for respite care. (DOG BARKING) My apologies. My dog's barking.

CHAKRABARTI: That's okay.  I'll let you take care — (DOG BARKING) I'll let you take care of that for a second. (LAUGHS) I'll give you a respite from the radio program for just a second and I'll turn back to John.

John, did you wanna fill in more on that, are there limitations on the kinds of assistance that a foster family can seek while they're caring for the children in their homes?

DEGARMO: That is correct. And my wife and I actually went six years without a date because we could not find somebody who was licensed through the child welfare agency for a respite care. There was no respite families available for us. We could not get a babysitter at that time. And that's true. That's one of the challenges that foster parents face.

And, you know, you mentioned about the community, there's — you know, not everybody can be a foster parent. To me, it's the hardest thing I've done. It's been the most rewarding thing I've done. But it's a challenging lifestyle. But everybody can help a child in crisis and a foster family in some way. You know, when you have roughly 465,000 children in foster care, that means there's a child in crisis in every single community in our nation.

CHAKRABARTI: Mm. Well, let me just play another bit of tape here because I wanna move now towards talking a little bit about, not just sort of local solutions that we need to turn to in order to improve this situation, but maybe even statewide and at the federal level.

So we spoke with John Connery. He's the director of recruitment at the South Carolina Youth Advocate Program. It's a nonprofit that helps place foster children with families. And recall, South Carolina has had that 60% drop in available foster homes from 2021 to 2022.

Now, John's group has been around for more than 30 years. They've had some families who've been fostering kids with them for that entire time. And they also have more than 100 families who've been fostering with them for at least 10 years. And the reason why John says they have a more remarkable retention rate is that these families feel supported.

JOHN CONNERY: We do everything possible to support the families and the children they're fostering as much as possible, so these folks feel like they've got --they're part of the professional team and they have the support necessary to do what they're doing to take care of these foster kids. We have two mental health clinics that we operate. We have offices around the state and one in Columbia and one in Charleston.

We have psychiatrists, licensed therapists. We do telehealth with the families and kids so they don't have to travel if they live, you know, too far away, somewhere else in the state. We have no answering machines. So if a family needs us at two o'clock in the morning and they call, they get a live person and get connected to the staff person that's assigned to that family. So that's a big part of, of our operation is the support that we provide.

CHAKRABARTI: So that's John Connery in South Carolina. Serita Cox, how might we get more of the kind of services that John and his group provide to families into more states?

COX: I think what John just described is fantastic and is exactly what's needed. But let's be frank that that costs money. And I think a replication of that in other states would be wonderful and needed. But what is that investment going to take to enable that when what we're dealing with, where we are right now is we're bleeding, not just on the caregiver side, but on the social worker side as well?

And so if we are having the churn on the social worker side, they're overburdened, how do we get to a state that he described where you could have live help 24 hours a day? You could be so de-stressed that you could actually take on whatever is coming at you in terms of better supporting what caregivers need? Thinking far enough ahead to say, yes, let's put in place telehealth so people don't need to travel? What are the policies and procedures we need to put in in our county and our state to enable that?

CHAKRABARTI: Mm-hmm.

COX: So I think it's a fantastic idea, but it needs plans and implementations and funding.

CHAKRABARTI: Right. So, again, we reached out to several states for comment. I read a statement from Maryland before, and California also sent us a really long statement describing all the investments --

COX: (LAUGHS)

CHAKRABARTI: You're laughing, but they described all the investments they say they've made to improve the foster care system there.

And it seems there's quite a bit of money that goes along with it. $43 million to counties through what they call the Complex Care Capacity Building system. $18 million in ongoing funding to support urgent needs for youth with complex needs. $61 million to counties and programs for a program called the Children's Crisis Continuum Pilot. $224 million to support implementation of prevention plans. And $2.2 billion in facility infrastructure through the Behavioral Health Continuum Infrastructure Program. That's just some of what California says it's invested.

Now, very briefly, Serita, that's a lot of money --

COX: Yes.

CHAKRABARTI: But are you, are you saying that perhaps it's not all going to the right places?

COX: Yes. So yes, you're right. That is a lot — that's a staggering sum. Now let's also be clear: California has more kids in foster care than the next five states combined. We have somewhere around closing in, close — somewhere between 50 and 60,000 children in foster care on any given day.

I think the bigger issue or the macro issue — and you heard the young people at the beginning of the segment talk about this — is the child welfare system is not child-centric. It's not built around the child. And I think this is why you're hearing from caregivers that they're not getting the support. You're hearing from the youth themselves that if the system itself was structured to be more child-centric, maybe where money flows would look different.

CHAKRABARTI: Okay. So that's an excellent --

COX: Was that helpful?

CHAKRABARTI: Yeah, that's an excellent point because it takes my mind back to something you said earlier, right? That many of these children obviously need to be removed from their homes because they are in dangerous situations, but a lot of them end up getting removed from their homes, not because anything is going wrong with the families themselves but because of poverty.

So on that point, I wanna hear from one more young person who's been in the foster care system. This is Brittany Yates. She's 24 now. She's from Kentucky. She spent nine years in and out of the foster care system, starting when she was 12. And she says her mother worked two jobs but still struggled to provide for her three children. There was no abuse, neglect, or drug abuse in the home. The family was simply poor.

BRITTANY YATES: I ended up couch surfing for about eight months before they found me and moved me an hour away and threw me into foster care. That placement was shut down very quickly for drug abuse, and I was moved into another house that had seven other children in a two bedroom, one bathroom home. It ended up getting shut down for physical and sexual abuse.

I bounced around to about 17 different homes through my time in foster care. And I feel like the services offered to my foster parents a monthly stipend to get her clothes, to get her toiletries. Here's reimbursement for gas mileage, you know, taking her to and from doctor's appointments — that should have been offered to my mother so I wouldn't have to get removed, and then that would've saved me a literal lifetime of trauma.

CHAKRABARTI: John, we've only got a minute left here, but this is such a compelling and important point to discuss. Do you think that there's a case to be made that for many families, instead of removing the child from the home, that the stipend that would've gone to a foster home could potentially go to the parents who are struggling just to make ends meet?

DEGARMO: Absolutely. Two of the three I've adopted are third generation foster care, which means their parents and grandparents were also in the system and they never got the help they needed when they were children. We're facing the real pandemic, I believe now, is mental health for our children. 70% increase in teenage suicide attempts in girls. Teenage depression. Teenage anxiety.

These children need support. These families need support before they're removed from their families. It's a very traumatic experience, being removed from home and being placed into a foster care home. Foster parents can provide tremendous stability, structure, consistency, unconditional love, but it's a time of trauma and anxiety being placed into my home because I'm a stranger.

CHAKRABARTI: Mm. Well, so we've heard this hour, making the system more child-centric, providing significantly more supports to foster families, and of course, doing something about the underlying poverty that makes life so challenging for so many parents and children in this country.

Well, John DeGarmo, director of the Foster Care Institute, who's been fostering children since 2001. Thank you so much for joining us, John.

DEGARMO: Thank you.

CHAKRABARTI: And Serita Cox, CEO and co-founder of the nonprofit iFoster. Serita, I'm very grateful you could join us. Thank you.

COX: Thank you so much.