Adoption Legislation U.S./North Carolina

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Adoption and/or Foster Care Legislation - North Carolina: Part One

North Carolina administers foster care and adoptions through the Department of Health and Human Services in conjunction with county agencies and licensed private agencies. Children in North Carolina can stay in foster care up to the age of 21 and have additional social services available to them. The North Carolina General Assembly has proposed some changes to the foster care and adoption system in the past year but so far not passed any bills related to these programs.

Insight #1: Public and Private Groups Involved in Foster Care and Adoptions

  • Foster care and adoptions in North Carolina are administered by the state's Department of Health and Human Services, in the division of Child Welfare Services.
  • The state office works very closely with county Department of Social Services offices to support foster care and adoption.
  • Private adoption and foster services are allowed in North Carolina, though these groups must be licensed by the state.

Insight #2: Age Requirements in Foster Care and Adoptions in North Carolina

  • Anyone over 21 can apply to be a foster parent in North Carolina. Foster parents must be licensed and go through training though.
  • Children up to the age of 21 can be enrolled in foster care homes or participate in the NC LINKS program. Not all states have moved to supporting children in foster care through the age of 21, though North Carolina has.
  • Foster children in North Carolina are covered by Medicaid up to the age of 26, assuming they were enrolled in foster care at the age of 18.

Insight #3: Proposed Legislation on Foster Care and Adoption in the North Carolina General Assembly

  • The North Carolina General Assembly and Governor have not yet managed to pass a budget, so proposed reimbursement increases (H 850) for foster care have not occurred.
  • One bill (H 826) was proposed to fund trauma screening in all children entering foster care over the age of four; it did not make it out of committee.
  • Another bill proposed in the General Assembly in 2019 (H 918) would have allowed speedier adoptions for foster parents; it was sent back to committee. This bill caused controversy with parental rights advocates as it would have made it harder for parents to regain custody of their biological children who were surrendered to foster care.
  • Other proposed bills related to foster care and adoption were designed to streamline and clean up processes in the Department of Health and Human Services.

Research Strategy

We first used the University of North Carolina at Chapel Hill's School of Government's Legislative Reporting Service to find information on the topics of "foster care" and "adoption" in the most recent North Carolina General Assembly session. We reviewed these individual bills and listed the main findings from them. For the policy side, we also reviewed the North Carolina Department of Health and Human Services website, as that government agency is responsible for administering the foster care and statewide adoption programs. Credible news sources for the state of North Carolina were also reviewed to provide opinions and background on proposed legislation.
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Adoption and/or Foster Care Legislation - North Carolina: Part Two

Three insights into foster care legislation and public policy in North Carolina include the effects of Rylan's Law (SL 2017-41), the effects of a new federal law on North Carolina's social services policies, and the effects of opioid addiction on North Carolina's foster care placements.

Insight #1: Rylan's Law Effects

  • Rylan's Law, Session Law 2017-41, required five changes to North Carolina's social services and child welfare programs. The changes are being introduced over a five-year period beginning in 2017:
(1) An independent assessment by a third-party organization had to be conducted to evaluate the current system in North Carolina. The assessment was conducted and plans for reform were formulated.
(2) New recommendations were developed for improving state supervision of the county-administered social services system by means of a system of regional state offices, and are being implemented.
(3) Effective July 1, 2018, all 100 county departments of social services were required to enter into annual performance agreements with [Department of Health and Human Services] DHHS for all social services programs (excluding Medicaid).
(4) The North Carolina General Assembly created the Child Well-being and Transformation Council to promote a coordinated approach to services to improve outcomes for children. The council had their initial meeting in December 2018. The council will advise county and regional departments.
(5) Some of the state's counties considered entering into agreements to create regional departments of social services, combining the resources of more than one county to improve the delivery of social services.

Insight #2: Effects of a New Federal Law on North Carolina's Foster Care System

  • The Family First Prevention Services Act (FFPSA) passed by Congress in 2018 had important effects on North Carolina's provision of social services for foster care and adoption programs.
  • The most important provisions of the FFPSA for North Carolina are the prevention services and limitations on funding for congregate care. North Carolina may continue to cover costs related to foster care and adoption assistance. But North Carolina may also choose to extend federal (IV-E) reimbursement to cover certain expenditures and services related to PREVENTING foster care placements.
  • FFPSA encourages states to try to keep families together by allowing the states to pay for "evidence-based mental health, substance abuse and parenting services to keep children safely with their families" rather than removing children from the home and putting them in foster care.
  • FFPSA also includes provisions to limit IV-E (federally reimbursed) foster care spending for children in congregate care settings "to the first two weeks of placement, unless the child/youth has certain specified permissible needs that necessitate a group placement." "Congregate care" is placement of a child into a structured setting such as a group home, residential treatment center, or other institution.

Insight #3: Opioid Addiction-Driven Increases in Foster Care Placements

  • The director of a nonprofit child advocacy group, NC Child, believes that substance abuse, and specifically opioid abuse, is the cause of many foster care placements of children in North Carolina.
  • The opioid epidemic is driving this crisis to a new level in our state. … Closing the health insurance coverage gap won’t end the opioid crisis, but [it could] help thousands of uninsured parents get the treatment they need to keep their families together," NC Child research director Whitney Tucker stated.
  • Tucker collected data indicating that over "16,500 North Carolina children were in Department of Social Services custody in 2017, with substance abuse cited as a factor in nearly 40 percent of those placements."
  • The advocacy group supports portions of a bill introduced in the North Carolina General Assembly. The bill, HB 662, would expand Medicaid coverage in the state to those families earning "133 percent of the federal poverty limit and close the coverage gap."
  • NC Child's report contends that "expanding Medicaid eligibility in the state would benefit parents with substance abuse problems and, by extension, their children, providing greater access to treatment programs." This could reduce the number of out-of-home placements of children.
  • Unfortunately, HB 662 also includes a work requirement for recipients. The NC Child report argues that a work requirement would be “an unnecessary bureaucratic hurdle for families in need of lifesaving insurance coverage.” Individuals with substance abuse problems often cannot stay employed because of their addictive illness.
  • HB 662 was reintroduced in the 2019 legislative session and incorporated into another bill, HB 655. The bill is supported by the North Carolina Medical Society and the North Carolina Health Association. Republican legislators oppose it because it includes an expansion of Medicaid funding.
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Adoption and/or Foster Care Legislation - United States: Part One

Modern adoption in the United States is regulated at the federal level by the Child Abuse Prevention and Treatment Act, but most policies are mandated at state level. Insights into the history of CAPTA, commonalities in adoption policies among states, LGBT adoptions, and the current costs of adoption in the United States are outlined below.

Legislative History of Adoption: CAPTA

  • Introduced in 1974, the Child Abuse Prevention and Treatment Act (CAPTA) requires federal agencies to issue or amend policies regarding adoptions and foster care. CAPTA has consistently strengthened government policies to assist in the adoption and foster care programs in the United States.
  • Laws issued by CAPTA prompt reactive laws and implementation of new or revised policies from states.
  • Provisions of CAPTA address placement of children who come from abusive families, children with special needs, children of parents suffering from addiction, as well as efforts to prevent racial or economic discrimination in the placement process.
  • CAPTA also establishes tax credits for states and adoptive parents who follow certain guidelines around discrimination and allows the enforcement of fines for states that fail to meet discrimination and other federal standards.

Common State Law Principles

  • All states adhere to certain principles regarding adoption in the United States. These include the transfer of parental rights and responsibilities from biological parents to adoptive parents.
  • Adoptions must be carried out with the consent of the child's biological parents.
  • A state's ultimate responsibility regarding adoptions are to represent the best interest of child.
  • Confidentiality is a key principle of adoptions in the legal system.
  • States hold the principle that adoptions are permanent, and that the new parents are permanently guardians of the adopted child.

Laws Regarding LGBTQ Rights and Adoption

  • Currently in the United States, over 16,000 gay and lesbian couples have adopted 22,000 children.
  • Due to federal mandates, same-sex couples in every state can petition for adoption. Some states require proof of the couple's legally recognized relationship in the form of a civil union, marriage, or other legal binding.
  • The city of Philadelphia stopped using an adoption agency, Catholic Social Services, to place children for adoption due to the agency's policy against placing children in homes with same-sex couples.
  • Philadelphia's Court of Appeals unanimously voted against the agency as it did not conform to the city's nondiscrimination policies. The Supreme Court will take on the case.

Adoption Costs

  • In the United States, all adoptions must be finalized in a court in the United States. The cost to prepare documentation for court is anywhere from $500 to $2,000. The cost for legal representation, such as a lawyer, may range from $2,500 to $12,000.
  • Using the public foster care system, adoption costs are $0-$2,500.
  • Using a lawyer to complete the adoption process costs $15,000-$40,000, which covers the medical expenses of birth, lawyers for both biological and adoptive parents, court fees, home studies, and other associated expenses.
  • Adopting through an agency costs $20,000-$45,000 to cover organizational costs, legal expenses, and medical bills.

Research Strategy

First, research was done to get an overview of the history of adoption in the United States. After garnering the general history, further insights were chosen based on recent news articles regarding adoption policies and the foster care system in the United States.
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Adoption and/or Foster Care Legislation - United States: Part Two

Intercountry adoptions are heavily regulated by Federal law. Some deem the Family First Prevention Services Act as one regulation that has the potential to change how the foster care system works in the U.S. Meanwhile, the Multiethnic Placement Act was established to address how ethnicity affects the adoption and foster care system.

Intercountry Adoption

  • Intercountry adoptions are complicated and may be challenging to navigate. Prospective American parents hoping to adopt foreign children must observe Federal laws, state laws, Conventions, and the laws of the child’s country of origin.
  • In the U.S., these adoptions are handled by the U.S. Citizenship and Immigration Services (USCIS), which is part of the Department of Homeland Security. The USCIS will determine if parents are eligible to bring an adopted child into the country and if the child is eligible to be adopted.
  • The requirements change according to the country of origin, but there are some minimal standards that parents must meet to be eligible under the Federal law, regardless of the child's nationality: If the prospective parent is unmarried, he or she must be at least 25 years old and a U.S. citizen; if it is a couple, one of the parents must be a U.S. citizen, and the other must be either a citizen or in legal status in the U.S.; and prospective parents must go to the process of determining if they are suitable to adopt, including criminal background checks, fingerprinting, and a home study. If the parent qualifies to adopt under Federal law, they must then meet their home state’s requirements.

The Hague Convention

  • The Hague Convention is an international agreement to safeguard intercountry adoption established in 1993. The U.S. signed the Convention in 1994, and it is in full force since 2008. It applies to all U.S. citizens adopting children who are residents in countries that are part of the Convention.
  • The Convention establishes requirements for the process and the children. There are five primary elements to the adoptee classification, besides country-specific requirements:
  • 1. The child must be under 16 at the time the prospective parents fill the Form I-800. The I-800 form is a "Petition to Classify Convention Adoptee as an Immediate Relative," and it is filled with the USCSI.
  • 2. The parents must be a married couple or unmarried U.S. citizen that the USCIS has found suitable and eligible to adopt (the previous minimal standards apply here).
  • 3. The Central Authority of the country of origin has determined that the child is eligible for the adoption, and proposed an adoption placement that has been accepted. At this point, the child must not have been adopted or been placed in the custody of the prospective parents.
  • 4. The child's birth parents or legal custodians have freely expressed their consent in written form, irrevocably consenting to the termination of their legal relationship with the child and agreeing to the child's emigration and adoption.
  • 5. If the child's last legal custodians were two living birth parents who signed the irrevocable consent to adoption, those parents must be incapable of providing proper care for the child.
  • Typically, when the requirements are met, the USCSI provisionally approves the Form I-800. The consular officer at the U.S. Embassy or Consulate will send an Article 5/17 letter to Central Authority in the child's country of origin, stating that the parents are suitable and eligible to adopt and that the child is eligible to enter and reside in the U.S. As a result, the court is allowed to grant a full and final adoption or custody order.
  • After the adoption is completed, the Embassy will complete the final adjudication of the petition. Considering there are no obstacles, the consular officer issues the final approval of the Form I-800 petition, issuing either a Hague Adoption Certificate or Hague Custody Certificate, and the child receives an immigrant visa.
  • In Convention adoptions, before the final adoption, the USCIS determines whether a child appears eligible to immigrate to the U.S. as a "Convention adoptee." A U.S. consular officer also defines whether the child appears to satisfy the criteria for visa eligibility before the adoption is finalized in the country of origin. This will allow the prospective adoptive parents to know ahead of time whether the child seems to be eligible to enter the United States. The procedure varies according to the country of origin.
  • The U.S. Intercountry Adoption Act of 2000 (IAA) requires the Department of State to verify every adoption in the U.S. completed under the Convention, ensuring it complies with the Convention, the IAA, and the country's regulations.

Immigration and Nationality Act (INA)

  • Under the Immigration and Nationality Act (INA), children from non-Convention countries must meet the definition of orphan to be adopted and immigrate to the U.S. Prospective adoptive parents must file a Form I-600 (Petition to Classify Orphan as an Immediate Relative) with a USCIS to finalize the immigration process for a child from a non-Convention country.
  • Like adoptions that fall in The Hague Convention, to immigrate a child as an orphan, the parents must meet the same requirements to be eligible. To qualify as an orphan under the INA, the child must at least meet the following requirements (others may apply according to the case/country):
  • 1. The child must be under 16 years old, or under 18 years old if they have a sibling under the age of 16 who has been adopted or will be adopted by the same parents, at the time the Form I-600 petition is filed.
  • 2. The child must either have no parents due to "death or disappearance of, abandonment or desertion by, or separation or loss from, both parents" or have a sole parent who is incapable of caring properly for the child and has given its irrevocably written consent for emigration and adoption.
  • 3. The prospective adoptive parents must complete the final adoption in the country of origin or obtain legal custody of the child for emigration and adoption in the U.S.
  • 4. The child must be adopted by a married U.S. citizen (or unmarried citizen at least 25 years old), with the intent of "forming a bona fide parent/child relationship."
  • The Bureau of Consular Affairs warns prospective parents that not all children in orphanages or children’s homes are adoptable and that there are many variables from country to country, including the Pre-Adoption Immigration Review program, which may affect the order in which the adoption process occurs.

Adoption Agencies and Intercountry Adoptions

  • Not all adoption agencies can handle Hague adoptions. Only adoption service providers that have been approved or accredited on a Federal level may offer certain services for Convention adoptions. The Intercountry Adoption Accreditation and Maintenance Entity (IAAME) evaluates the agencies using “uniform standards that work to ensure professional and ethical practices.
  • The accreditation regulations went into effect on April 1, 2008. Initially, the regulations were only applied to Convention cases, but in 2013, President Obama signed the Intercountry Adoption Universal Accreditation Act of 2012 (UAA), which mandated that the accreditation provisions of the Intercountry Adoption Act (IAA) apply to “orphan” cases subject to INA.
  • Organizations and individuals must be accredited, approved, supervised, or exempt, to provide any of the following services:
  • 1. Identifying the child for adoption and arranging the adoption.
  • 2. Securing the consent to termination of parental rights and adoption.
  • 3. Performing background studies on the child and prospective parents, and reporting on such studies, making a non-judicial determination of the parent's ability to care for the child and proper placement.
  • 4. Monitoring after the child has been placed with the adoptive family until the final adoption.
  • 5. Assuming custody of the child and providing childcare or other social services when necessary if there is a disruption before the final adoption.
  • The agencies are required to itemize and disclose, in writing, the fees and estimated expenses associated with the adoption from a Convention Country before the process begins. Outside of the estimated fees, the adoption service provider is only allowed to charge for unforeseen expenses under specific circumstances.
  • Important to note that U.S. accreditation is not an automatic permission to provide adoption services in other countries of origin. Some countries may insist the adoption services are handled by governmental authorities instead of agencies, for example. Other countries may have their own laws and requirements.

Multiethnic Placement Act

  • Enacted in 1994 and modified in 1996, the Multiethnic Placement Act (MEPA) is the first Federal law to address the issues of race in adoption by prohibiting agencies that received federal funds to deny transracial adoptions based on race.
  • The law intends to decrease the length of time that the child has to wait to be adopted, to facilitate the recruitment and retention of foster and adoptive parents, and to eliminate discrimination based on race, color, or national origin.
  • To achieve these goals, the MEPA has three basic provisions:
  • 1. States and entities involved in foster care and adoption placements that receive any federal financial assistance are prohibited from delaying or denying a child's foster care or adoptive placement based on the child's or parent's race, color, or national origin.
  • 2. It is prohibited to deny individuals the opportunity to become a foster or adoptive parent based on race, color or nationality.
  • 3. States must recruit foster and adoptive parents who reflect the diversity of the children in the state who need placement to remain eligible to receive federal assistance.
  • All state and county child welfare agencies that receive federal title IV-E and title IV-B funds are subjected to MEPA. Private and public agencies that receive federal funds from any source directly or through sub grant from a state, county, or another agency are also subject to the act.

Family First Prevention Services Act

  • Signed by President Trump in 2018, the Family First Prevention Services Act aims to diminish the number of children entering foster care by providing substance abuse treatments, mental health services, among others.
  • Before the Act, states could use federal Title IV-E funds, which is the primary source of federal funding for foster care, only after the child has entered foster care. As of October 2019, states have the option to claim federal reimbursement for approved prevention services designed to let children stay with their parents, including evidence-based in-home parenting training, and mental health and substance abuse treatment.
  • The Act also seeks to reduce the use of congregate or group care for children by limiting federal funds. With limited exceptions, states will not receive reimbursement from the federal government for children placed in group settings for more than two weeks. This means that existing IV-E funding for children and youth in group settings will be limited to the "first two weeks of placement unless the child/youth has particular specified permissible needs that necessitate a group placement."
  • Qualified residential treatment programs must use the trauma-informed model and employ registered or licensed nursing staff. The child must be formally evaluated within 30 days to determine if family members can meet their needs.
  • Institutions that are exempt from the two-week limitation are usually limited to 12-month placements. Additionally, to be eligible for federal reimbursement, the Act generally limits the number of children allowed in a foster home to six.
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Adoption and/or Foster Care Policy Issues - United States: Part One

While child rights advocates and government officials have made great strides in finding safe homes for children in need of care, debates about the process for doing so abound in the United States. Currently, the issues of adoption discrimination, birth parent rights, and Native American adoption have evoked controversy across the country. Equally contentious is the debate about family reunification versus placement in the foster care system.

Discriminatory Adoption Laws

  • Throughout the U.S., lawmakers and child advocates strive to balance the rights of prospective adoptive and foster parents, the belief systems and mission statements of private agencies, and the desperate need for children to find safe homes.
  • Across the country, states have enacted laws that protect the rights of adoption and foster care agencies to place children in care situations that are aligned with the agency's religious values.
  • Currently, discriminatory adoption and foster care laws exist in North Dakota, South Dakota, Michigan, Kansas, Oklahoma, Texas, Mississippi, Tennessee, Alabama, South Carolina, and Virginia. Discriminatory Bills are currently pending in Colorado, Iowa, Missouri, Georgia, and Massachusetts. The states of Oregon, California, Wisconsin, Washington, D.C., Delaware, New York, Maryland, and Rhode Island have laws that prohibit discrimination against LGBTQ parents seeking to adopt or provide foster care.
  • Senator Paul Rose of Tennessee, a proponent of laws that protect the rights of the agencies, believes that organizations should not be required to "participate in a child placement" if doing so would conflict with that agency's written policies or "religious or moral convictions."
  • One adoption agency in Michigan with a religious mission said that it would be impossible for their staff to grant a written certification for an unmarried or same-sex couple. This would not only put their funding from religious donors in jeopardy, but would completely disavow the basis of their organization.
  • Opponents argue that the laws allow agencies to legally disregard qualified prospective families seeking to adopt or foster. Despite this "license to discriminate," the agencies would still receive funding from the government. They also argue that the laws prevent at-risk children from being placed more quickly into a loving home. LGBTQ children are particularly at risk of being placed in a home that does not understand or support their emotional struggles. The Tennessee Equality Project, an LGBTQ advocacy group, has opposed such bills in its state.

Birth Parent Rights

  • The Preserving Family Bonds Act in New York, currently vetoed by Governor Cuomo, would allow judges to order that an adoptive child must remain in contact with a biological parent when the situation is advantageous to the child. The order ignores the rights and feelings of the adoptive parent and the children. Currently in New York, judges are not allowed to grant any contact after parent’s rights have been terminated. The legislation was passionately debated and the issue is still being argued at the national level.
  • Child welfare workers support the legislation, as they believe that children benefit from continued contact with biological parents. They indicate that 95 percent of infant adoptions are open. They also claim that numerous studies indicate that open adoption is beneficial to children, who are less inclined to misdirect blame and harbor resentment towards their adoptive parents. They also argue that there is a distinct advantage for adopted children to know about family and medical history.
  • Jeremy Kohomban, President and Chief Executive of the Children’s Village, a nonprofit foster care agency, is also a proponent of such legislation. He worries that biological parents whose parental rights have been terminated are usually black, and that family courts have an obligation to consider the impact of adoption and foster care decisions on black families.
  • Bill Baccaglini, President and Chief Executive of the New York Foundling, a nonprofit foster care agency, opposed the bill. He argued that the law did not protect the rights of adoptive parents, who are also experiencing an emotionally tumultuous time. He also questioned the safety of the adoptive families when angry biological parents have access to them.
  • David Hansell, Commissioner of the New York City Administration for Children’s Services, the agency which oversees foster care and adoption in New York, said that the law could "hamper the recruitment" of potential foster and adoptive parents. This would cause children to remain in foster care even longer.

Native American at-risk Children

  • The Indian Child Welfare Act (ICWA) of 1978 is a federal law that oversees the removal and placement of American Indian children in the state's custody. ICWA gives tribes legal authority in child welfare cases and determines the required criteria for foster and adoptive homes. As such, ICWA prefers to place Indian children with relatives or other Indian families. The justification for the law was a set of studies that revealed that one third of Native American children had been removed from their homes by non-tribal public and private agencies. Most children were then placed in foster and adoptive homes without a Native American present, often far from their homes. Many lost touch with their own families and were abused.
  • A debate about the law gained national attention in 2019 when a Texas judge, U.S. District Judge Reed O'Connor, ruled that ICWA illegally gave Native American families "preferential treatment" in adoption cases for Native American children. He stated that they were afforded preferential treatment because of their race, which violates the Fifth Amendment's "equal protection guarantee."
  • Proponents of Judge O'Connor's ruling against ICWA include non-Native American families who have tried to adopt American Indian children. Several lawsuits against ICWA, many of which were prompted by such families, have focused on questions of race, tribal sovereignty and the role of the federal government in the lives of Native Americans. One lawyer who represented a family challenging ICWA informed the court that a child was physically torn out of the adoptive parents' arms because they were not Native American. The states of Louisiana and Indiana have joined Texas in challenging the law.
  • Native American activists oppose the Judge's ruling. They fear that the judge's ruling may jeopardize Native American children, who are at an increased risk of being removed from their families (as compared to non-Native American children). Dan Lewerenz and Erin Dougherty Lynch, attorneys with the Native American Rights Fund, have indicated that if the ruling is upheld, decades of legal precedent regarding tribal sovereignty is in jeopardy.

Foster Care: Reunification or Placement

  • The emphasis on reunification of families has been debated on a national level, but a recent investigation in New York City brought this issue to the forefront of foster care policy discussions. The Department of Investigation in New York City released a report in 2018 that exposed that many children who have been removed from their homes are later abused by their parents during visitation or trial home stays. As a result of the report, the Department of Investigation issued 12 recommendations for corrective action to the New York Administration for Children’s Services.
  • The report indicates that in 2016 and 2017, about 1,100 foster children were maltreated after placement, usually by a biological parent. Foster parents were the perpetrators in only 19 percent of these incidents. One third of cases in which children were removed from their home involved a parent with a substance abuse addiction problem. Some analysts believe that child protection agencies appear to tolerate this situation because of their bias towards family reunification.
  • Jeremy Kohomban, President and CEO of the Children’s Village, a foster child advocacy organization and Ron Haskins, Co-Director of the Center on Children and Families at Brookings, oppose the recommendations issued by the Administration. They argue that once children are removed from their homes, a new placement will not ensure proper childhood development or safety. They also contend that children placed in foster care are usually from poor minority backgrounds who are likely to age out of the foster care system. They believe that reunification reduces the risk of negative outcomes.
  • James Dwyer, Professor of Law at William and Mary, argues that safety should take precedence over keeping African-American families together.
  • The Family First Prevention Services Act (FFPSA), was enacted into law in February 2018. This legislation allows states to use federal funds to provide mental health and substance abuse support, parenting skills programs, and support for caregivers to at-risk families. The hope is that this support will prevent the need for foster care placements at all, thus bringing this debate to a close.

Research Strategy

In order to complete this research, we reviewed state and federal legislation regarding foster care and adoption. We then reviewed a variety of articles written by advocacy groups and consulted national news sources to determine which policies have been the most contentious in recent months. While local and state policies often served as the impetus for debates on adoption and foster care, it should be noted that these issues inevitably become contested on a national level.
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Adoption and/or Foster Care Policy Issues - United States: Part Two

Four additional adoption or foster care policy issues in the US are access to birth certificates before of age, privatization, support for youth aging out of care and abuse in the system. All of these issues concern the US as a whole rather than any specific state or area.

Access to Birth Certificates

  • To date, there is actual no legal precedent across the US for gaining access to one's records, even after age 18.
  • However, there is debate over maintaining the privacy of the birth parents. For decades, states and adoption agencies assumed perpetual confidentially by sealing records permanently. In several states, adoptees have to petition the court (an expensive, long process) to gain access to their records. Only nine states recognize the right to unrestricted access to an original birth certificate.
  • The NACAC (North American Council on Adoptable Children) believes adoptees should be able to access their personal records, though their policy statement is that this should be at the age of "majority or legal emancipation".
  • Some thought leaders feel that being able to access to information about oneself is a fundamental human right.
  • One alternative would be mutual consent registries, where if everyone consents, information can be accessed sooner.
  • Some parties feel that an adoptee's right to access their birth certificate even before the age of 18 should be examined.


  • The NACAC understands that private agencies are a necessary part of the adoption and foster care process. However, they are concerned that this process can diminish the public responsibility towards foster children.
  • There is concern that children's best interests could be sacrificed for financial gain or efficiency.
  • A recent Congressional review confirmed this is already happening. Several companies are accused of cutting corners to enhance profits.
  • States lack sufficient oversight capabilities in order to catch these actions before it's too late.
  • The debate comes from states feeling they need to privatize to cut costs and reform their systems.

Support for Youth Aging Out of Care

  • As children "age out", e.g. reach the age of majority (usually 18 but sometimes 21), they no longer have official placement with a foster family.
  • Children suddenly left without that support network are vulnerable to homelessness, unemployment, criminal behavior and more.
  • The debate is that government should be providing transitory services to give ongoing support.
  • While the U.S. Fostering Connections to Success and Increasing Adoptions Act of 2008 did increase the opportunities for states to support some children until the age of 21, the NACAC believes policy should be expanded to support all foster care youth until 21. They also demand additional funding, healthcare coverage, support services, tuition waiver programs and other services that can support older foster care youth.
  • It is not so much that there is a debate about this issue, but that governments have responded that they do not have adequate funds to offer all the support services called for.


  • The foster system is vulnerable to allegations of abuse. Therefore, it is imperative that allegations are investigated thoroughly, families should be instructed on how to avoid abuse, and youth should be informed on how to keep themselves safe.
  • Studies show that children in foster care are much more likely to be abused. More than half of sex trafficking victims in the US came from foster homes.
  • It can be difficult for agencies to balance potential long-term harm by removing the child(ren) versus risk of harm from abuse or neglect.
  • The NACAC feels that foster placements should generally be preserved, preferring to remove the offender (if an isolated person) if possible.
  • Focus for Health wants stricter protocols in place to deal with this issue. This includes stricter screening and more extensive measures to combat and prosecute abuse.
  • Some officials, however, deny there is a problem. One state official recent told Iowa state legislators that only 1 in 333 foster care kids had been abused. These figures came from internal DHS reviews rather than independent assessments.


From Part 01
  • "limit who may advertise for the adoption of a minor child to: a county department of social services, a child-placing agency listed by the Department of Health and Human Services in this state, or an attorney licensed to practice in this state."
From Part 02
  • "Child welfare systems across the nation are at a pivotal point of change as a result of the Family First Prevention Services Act. The change is even more significant in North Carolina, as we have state-initiated system reform efforts underway as result of Rylan’s Law."
  • " laws require significant shifts in fiscal, administrative and programmatic functions in child welfare services. More information about Family First and Rylan’s Law can be found "
  • "The Family First Prevention Services Act passed in Feb. 2018, and is the most sweeping legislation to impact federal child welfare financing and programs in decades. Family First has many provisions, but the primary ones are prevention services and limitations on funding for congregate care. This law continues to allow states to cover costs related to foster care and adoption assistance, however, states may opt to extend federal (IV-E) reimbursement to cover certain expenditures and services related to preventing foster care placements. This includes evidence-based mental health, substance abuse and parenting services to keep children safely with their families. "
  • "Family First also includes provisions that will limit IV-E foster care spending for children in congregate care settings. This means that existing IV-E funding for children and youth in group settings will be limited to the first two weeks of placement, unless the child/youth has certain specified permissible needs that necessitate a group placement."
  • " North Carolina has opted to extend implementation of both provisions through Sept. 2021, allowing adequate time to plan and implement services that are specific to the needs of children and families in North Carolina."
  • "Ultimately, this work will result in the creation of a prevention services plan that will allow more children to safely stay in their homes while their families receive services to prevent children from being removed in to foster care."
  • "Rylan’s Law,enacted in July 2017, governs a legislatively required, statewide reformationofNorth Carolina’s social services and child welfare programs. Recent federal and statewide reviews have identified troubling gaps and flaws in North Carolina’s child welfare system that places children’s safety at risk. Additionally, more accountability and oversight are needed for County Departments of Social Services to produce better performance and outcomes. By March 1, 2020, Rylan’s Law requiresregional offices that provide closer, more direct, regional supervision and support to County Departments ofSocial Services. Each County Department of Social Services will be part of a region of counties, and state-level DSS staff will monitor and support these regions. "
  • "Rylan’s Law provides North Carolina with a blueprint for how we can collectively transform our child welfare system and speaks to the systemic changes that are needed in the oversight of child welfare services to improve outcomes for families and children served. "
  • "Rylan’s Law provides a blueprint to create statewide capacity to protect children and promote safe and stable families, while incorporating evidence-based, trauma-informed, and culturally competent practices. Transforming the child welfare system is necessary to better ensure the safety, permanency, and well-being of children and families. The child welfare system evaluations concluded that counties require improvement in areas such as providing services to families that prevent child removals, increasing efforts to achieve permanency, and supporting the child welfare workforce. "
  • "There are five key components of Rylan’s Law. The requirement of an independent assessment by a third-party organization to evaluate our current system. develop recommendations for improving state supervision of the county-administered social services system via a system of regional state offices. Effective July 1, 2018, Rylan’s Law requires all 100 county departments of social services to enter into an annual performance agreement with DHHS for all social services programs, excluding Medicaid. To promote a more coordinated approach to services that will help improve outcomes for children, the General Assembly created the Child Well-being and Transformation Council. The council had their initial meeting in December 2018. Rylan’s Law gives counties the option to create regional departments of social services. This gives counties the flexibility to combine resources and improve the provision of social services among more than one county."
  • "Congregate care is a placement setting that consists of 24-hour supervision for children in highly structured settings such as group homes, childcare institutions, residential treatment facilities, or maternity homes. Such settings must be a licensed or approved home or facility that can take in 7-12 children, as seen in group homes, or 12 or more children, as seen in institutions.[1] Fourteen is the average age of children who enter into congregate care."
  • "“Substance use disorder is a tragic disease that can tear apart families and leave children without stable, nurturing homes,” said Whitney Tucker, research director at NC Child and the report’s author. “The opioid epidemic is driving this crisis to a new level in our state. … Closing the health insurance coverage gap won’t end the opioid crisis, but it’s a powerful strategy that we can implement immediately to help thousands of uninsured parents get the treatment they need to keep their families together.”"
  • "NC Child compiled data showing that between 2007 and 2017, there was a 13 percent increase in cases in which parental substance abuse factored into out-of-home placements for children."
  • "More than 16,500 North Carolina children were in Department of Social Services custody in 2017, with substance abuse cited as a factor in nearly 40 percent of those placements, according to NC Child. Within the past two decades, the amount of time children in foster care typically spend in such placements increased from typically less than a year in 2000 to 15 months in 2016, with the median rising to 17 months for children younger than 6."
  • "The report argues that expanding Medicaid eligibility in the state would benefit parents with substance abuse problems and, by extension, their children, providing greater access to treatment programs."
  • "The report’s authors supported HB662, a proposed North Carolina law that would expand Medicaid in the state under a program called “Carolina Cares.” That program would expand Medicaid coverage in the state to those earning 133 percent of the federal poverty limit and close the coverage gap."
  • "The Carolina Cares program also includes a work requirement for recipients, which the NC Child report argues would be “an unnecessary bureaucratic hurdle for families in need of lifesaving insurance coverage.”"
  • "A person addicted to powerful painkillers or illicit drugs like heroin or meth will at some point find it difficult to maintain their responsibilities. A hallmark of addiction is that it disrupts a person’s life in what are often profoundly serious ways."
  • "People addicted to drugs or alcohol might find it difficult to get to work on time or manage their moods and irritability. Without treatment, addiction is a progressive and chronic disease. In time, it can impact a person’s job performance to the point that job loss becomes inevitable."
  • "The Carolina Cares Medicaid expansion legislation was reintroduced Tuesday with the expectation of covering at least 543,000 North Carolinians, according to bill sponsors. The legislation contained in House Bill 655 is now titled NC Health Care for Working Families."
  • "Medicaid serves 2.14 million North Carolinians, representing about 21 percent of the state population. About 1.6 million will be enrolled in managed care under a federal waiver."
  • "The proposed legislation retains two controversial elements: a work requirement for some Medicaid recipients between ages 19 and 64; and an assessment for health care systems and prepaid health plans (PHP) to pay for the state’s 10 percent share of additional administrative costs. Healthcare systems and PHPs would pay $758 million annually. The federal government would pick up the remaining 90 percent."
  • "The 2017 version of the bill, House Bill 662, received bipartisan backing — reluctantly by some Democrats — as a potential moderate initial step toward expanding state Medicaid. The bill, however, stalled in committee because of lack of GOP leadership support."
  • "The N.C. Healthcare Association said it supports HB655 “as a common-sense option” to close the coverage gap and increase affordable access to health insurance for working individuals and families in North Carolina.”"
  • "The N.C. Medical Society said the legislation “is the right thing to do for hard-working, low-income North Carolina families who need access to care. We hope the General Assembly will take this up sooner rather than later.”"
  • "Only one in every six individuals treated in a hospital emergency department for an opioid overdose has regular access to primary care or lack health insurance coverage, Murphy said. Of those who survive the overdose, Murphy said the reality is that the five out of six who don’t have accesses to care will not pursue or receive treatment and may overdose again."