Faces of Public Health: Dave Roberts, San Diego County Supervisor

May 30, 2014, 1:39 PM

May is Foster Care Awareness Month, an observance aimed at focusing attention on the 400,000 children in foster care, many of whom often are bounced from home to home only to age out of the system at 18 without community or family ties. A report from the General Accounting Office (GAO) released yesterday found that 42 states reported that they face major challenges placing large sibling groups in foster care, 38 states face challenges placing foster students near their most recent school and 31 reported they face challenges providing appropriate housing after a child in foster care ages out of the system.

A second GAO report released this week found that children in foster care group homes were twice as likely to be given psychotropic drugs than children in foster homes, and children in foster care were more likely to be given the drugs than children in the general community. Many of the drugs have serious side effects—including suicidal thoughts—and require oversight by guardians and doctors. However, but often children in foster care—particularly in group homes—who are taking psychotropic drugs are not well monitored. The GAO recommended that the U.S. Department of Health and Human Services (HHS) provide improved guidance to state Medicaid, child-welfare and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through Managed Care Organizations.

Dave Roberts and Family Pictured: Dave Roberts with his family

Child advocates say much more needs to be done to effectively place foster children in safe, nurturing homes, as well as to support foster families in adopting children and creating permanent homes and families. NewPublicHealth recently spoke with Dave Roberts, a county supervisor in San Diego, who together with his husband is raising five adopted children, ages 5 to 18, who started their lives with the family as foster children. Roberts has been a health policy advisor to Presidents Bush and Obama and played a key role in developing Tricare, the health insurance system of the U.S. Department of Defense.

NewPublicHealth: What drew you and your husband to consider having foster children grow up in your home?

Dave Roberts: We left Washington, D.C., where we had been living, and moved to San Diego where my husband is from and the first year we were here we went to the Del Mar Fair and the county had a booth there advertising their foster to adopt program. And so we signed up for the program and went through the process, and Robert [almost 19 and planning to enter the U.S. Air Force in the fall] was our first child. He was four going on five when he came to live with us. 

NPH: Some of your children are biological siblings?

Roberts: Three of them have the same mother, two of them have the same father, and then we did temporarily have one other sibling, but that sibling is back with the birth mother now, which is a good thing. She’s really trying hard.

We also had Robert’s sister live with us for 18 months, but she had to be put into a treatment-oriented program because of the abuse that she had endured prior to coming to our home.

The same week she left our home the county called and said “great news, we have another kid for you.” That’s Alex, who is our sports child. He’s now 13 years old and is in 8th grade and just loves baseball—he plays on two different baseball teams. And so he was our second.

Then Julian was our third, and Julian is the first of the three that are related. Julian had been with us for 18 months and then one day the county called and said that Julian’s mother has met all her requirements and he can now go back home to live with her. We didn’t agree, we had court-ordered weekly foster visits with the birth mom, and we just knew she was not telling the county the truth and so we refused to return Julian. We retained an attorney, we filed for de facto parenting status, we went to court and that led to us going to what’s called a team decision-making meeting where the mom broke down and admitted she was lying and that having Julian stay with us was in the child’s best interest. So we adopted Julian and then two months later the judge called a status hearing on the birth mom and said that the other two children should also be removed for abuse and neglect. They came to live with us too and we adopted them: Joe and Natalie. We have now adopted all five and are the parents of four boys and one girl.

NPH: What are the pivotal things, both as a parent and as a policy maker, that you have learned about foster care?

Roberts: First of all, just being a parent you quickly learn that the world is not about you any longer and things that you used to think were important— like is your hair combed, is your bed made, is your business suit perfect—you learn quickly that those things don’t matter. It’s more like are the kids fed and clothed, are the kids at school on time, have they done their homework? So your priorities just completely change. And my older brother was adopted, so adoption is very common in our family.

Even before I became a supervisor we became very involved in an organization here in San Diego called North County Adoptive Parents Association. We host their annual pool party at our house, where all the families and kids get together, which is a great, great event. From the policy perspective, my frustration has been that in foster care and adoption the pendulum seems to swing back and forth. That has frustrated me because, in my opinion, the pendulum has swung way too far in the wrong direction to the point that now governmental agencies are supposed to do almost anything to keep a biological family together, and I don’t think that’s in the best interest of the children always.

When we first got involved in the process 19 years ago, the county had between 5,000 and 6,000 kids a year in the system here in San Diego County. We now have less than 3,000 kids a year in the system. And there are so many reasons now why you cannot remove a child from a biological situation, which I think is causing irreparable harm to children, and I think that the sooner kids can be moved into forever loving families, the better off everybody is going to be. Recently in D.C. at a meeting for the National Association of Counties, we were briefed on current issues and one item was a study on why kids in foster care are overmedicated on psychotropic drugs. My next meeting happened to be with the White House Office of Intergovernmental Affairs, and I told them they were missing the forest for the trees, that they shouldn’t be studying why kids are overmedicated, but instead study why this pendulum has swung so far that by the time kids eventually get into foster care, they then have to be medicated because so much damage has been done to them. I was really pleased with the White House response, which was a request for information.

There are so many reasons kids who are not brought into foster care. For example, it’s no longer mandatory that a child be removed because the parents are using drugs, which just blows my mind, and it’s situations like that that I just find frustrating because my whole goal has been to keep the best interests of the children at the heart of what we’re trying to do. In San Diego County I found a great partner for this work in supervisor Greg Cox, who has been a champion of foster and adoption.

NPH: What are you doing in San Diego?

Roberts: One of the things that we did was create the exceptional family member program. Historically we have 50 kids at any time in the system who are extremely hard to place. We set up this program to look at alternative family situations, including older couples, singles, same-sex couples—people that really would like to start a family but hadn’t for whatever reason. And we’ve gotten a majority of these extremely hard to place children—whether they’ve got physical or mental health challenges or large sibling groups—with families, so that program’s been quite successful. We also set up an ombudsman program for both foster care and adoption—an objective third party to consider requests of the county and the foster parents and avoid going to court to resolve what is in the best interests of the child.

We’ve also had a series of hearings around the county to ask current and former foster parents what works and what doesn’t work. One of the things that doesn’t work is that we stovepipe foster care and we stovepipe adoption. We want to meld those two together so that it really works seamlessly. so if you get fingerprinted for foster care, you don’t have to get re-fingerprinted for adoption. It is things like that that we’re working on to really enhance the overall situation for foster parents and for adoptive parents, and really trying to make it for efficient of the whole system. Again, the whole purpose is to keep the child’s best interests in mind.

NPH: What guidance would you offer to both prospective parents and policy makers on foster care and adoption?

Roberts: I really think each child is unique. In Robert’s case, he started off with a very rough situation and we’re just so proud of him. He became an Eagle Scout in February and he graduated from high school and now he’s chosen to go into the military. I bet one day we’ll see him in elected office.

What kids are looking for is love, is consistency, they’re looking for boundaries so that they know what their boundaries are in life.

NPH: What’s next for you with respect to foster care in San Diego?

Roberts: The community hearings are completed and the staff is going to bring a package of recommendations to the board in the next few months.

This commentary originally appeared on the RWJF New Public Health blog.