I have provided a home to a teenager mother and her baby; a sibling group of five, ranging in ages from 1 to 5; delinquent girls, sexually abused girls, infants born drug addicted, physically abused children, emotionally abused children, and children who have been developmentally delayed. I also have my own personal experience in the foster care system in New York, having grown up in numerous foster homes from the time I was 9 months until I was 18. My last foster family is very much a part of my life, although I have been reunited with my biological parents.

In addition to my experiences as a foster child and foster parent, I hold a bachelor's degree in human resources management and I am a licensed practical nurse. I say this only because I have various perspectives in the foster care system, having been a foster child and now being a foster mother.

I have been a foster parent for 15 years and the children who are entering the foster care system are very difficult children, more difficult than they were 15 years ago. For example, adolescents entering care today tend to be more angry; they exhibit more difficult behaviors; they have low self-esteem and street-wise attitudes that make them appear to be incorrigible, but they are not. We have recently seen drug-addicted babies entering foster care. I have drug-addicted babies in my home. These babies are hard to live with because they are constantly irritable; they have breathing problems; they are nonresponsive to normal handling; they are developmentally delayed; constantly crying; they are more aggressive when they are toddlers; they are more active, restless and destructive.

I have a theory that some of the children that we are seeing in the school systems today who are presenting problems in the schools, in the community, and in their families may be babies who were born drug-addicted but were not identified at birth. So these children are presenting problems now.

I would like to list the major suggestions for improving foster care. Mine was for Delaware, but I think it should be for everywhere. I think there should be a more professional attitude taken toward our foster parents. I mean after all we are the ones who have to live with these children on a day-to-day basis. And I think that our opinion and what we feel as a part of the case plan for the children who come into care is very important. I think foster parents should be encouraged to take an active role in the planning of the child's care.

We need more respite. I think respite is very good for foster parents but is a preventive medicine for children before they come into care because if some of the parents had respite care there may be no reason for placement, because foster parents do not have adequate respite care when the children come into foster care, there is disruptive in placement. So you do not have prevention.

Foster parents are like any other parents, they get tired sometimes and they need some way to have their children away from them for, you know, a little period of time. If they cannot have that, you usually end up having children who are taken out of the home.

I think training. When I became a foster parent I wanted to be a foster parent because I was in foster care. And there was a love of

children. But children who come into care today need more than just love. They need people who are trained to handle and take care of the special needs that are required. So I think that additional training for foster parents is required and is needed.

I think there should be improved access to resources for foster parents. I have five foster children in my home and I have two of my own children; and I would like to be able to provide for these children who I take into care, the same type of care that I give to my own children. I am not financially able to send all of my children off to camp-whether it is basketball camp or swimming lessons or what have you. I think that we should have advocates for foster parents who go out and find the resources that foster parents need to take care of the children.

As I said before, we are like any other parent. Sometimes we become foster parents because we love children, but we are not aware of the resources that are available to the children. And if we had someone who was an advocate for foster parents who could go out and find these resources, these scholarships that may be available to foster children for camps, that we would be able to give better care.

I would like to see the independent living program expanded to offer a less structured program for the adolescents. When children come into care, especially when they are 16, they need to be prepared for independent living. And because there is a double standard, as a foster parent I am more reluctant to take a child into care if they are 16 and they do not want to go to school and the law says they do not have to go to school. So I am more reluctant to take this child into my home than I am a child who is in school. And sometimes the child needs it even more.

So I think that an overall improvement of the foster care system is what every State needs. But in order to encourage more foster parents to stay as foster parents and to become foster parents that we need things like respite care and we need improved resources for the foster parents and for the children.

The CHAIRMAN. Now you have at the present time, what, five foster children with you plus your own two children?

Mrs. SCOTT. Five foster. Yes.

The CHAIRMAN. And you receive some compensation, obviously, for taking care of the five. Do you have anyone assisting you in caring for those children or do you try to do that all by yourself?

Mrs. SCOTT. Well I have been a foster parent for a long time so I know how to use the resources. I have a girl scout troop. [Laughter.]

The CHAIRMAN. You have a girl scout troop?

Mrs. SCOTT. Yes.

Mr. HAYWARD. And her husband is there also.

Mrs. SCOTT. And my husband. He had to say that. My husband, okay, if you say. But the babies, I get a lot of help from my foster

The CHAIRMAN. You have all the children working at their own particular tasks, I suppose-

Mrs. SCOTT. Yes.

The CHAIRMAN [continuing]. To contribute to the overall effort?

Secretary Hayward, when you talk about an 83-percent increase over 3 years in California, then the other increases you have told me about, how much of that do you think is a maybe more careful determination of what Mrs. Scott was saying, of whether or not there has been drug abuse.

Are we doing a better job of discerning that or is it that there is just that much more increase in the use of crack?

Mr. HAYWARD. I truly believe that it is a major increase in the usage and abuse of a lot of elicit drugs which has caused the number of additional referrals into the foster care system. As some of the earlier comments were made, we are many times dealing with a portion of the population who is identified through various clinics and through service providers who deal with a segment of the population. But I also agree that there is a larger proportion of the population that is generally not identified who are also out there who require services that we often do not get referrals on. The CHAIRMAN. When you go through some of these hospitals and you look at the border babies you see a child no larger than your fist and you think about the quality of life of that child. Those are some terrible moral problems. What else do you think we can do to try to turn this situation around? Specifically, what kind of services do you think we need?

Mr. HAYWARD. There are a number of services; and a number of those have been talked about today, which have proven to be very effective. One of the major ones is, first of all, doing more in the preventative end. Having a system that will provide services to pregnant women up front without the menace over their heads that the child is going to be taken away.

One of the things that has happened over time is that the child welfare system has really changed. It is no longer the system of last resort. It is turned to as the system of first resort because there are a number of other programs that no longer exist or they are also so overwhelmed that they cannot provide services. So you have the child welfare system as being the front door for many, many services.

Therefore, pregnant women do not come forward if they feel they are at the point where they would like to receive some service if it is to a protective agency or a threat of referral to the protective agency is there, such that when the child is born if they do want to take care of the child, the child is going to be taken away. That is, I think, one of the major policy issues that we have to figure out how we are going to resolve.

If we are going to follow a line of family preservation that children grow best in families, in their natural families, and we are going to do what we can to keep those families together, you take one tact. If the tact is, any drug-abusing mother has abused that child because of the use of that drug, then you take a very different tact. So I think what we have to do is determine which tact we are going to take. Then I think some of the solutions will be much easier.

But right now we have a number of different philosophies out there on how you deal with these families and children; and, therefore, you have systems clashing with each other. But you definitely need services that are going to be on the preventive end. Secretary

Sullivan raised his bill for the $698,000 that was spent for a child in a neo-natal clinic. That is just about 95 percent of what our whole State of Delaware's prevention money for drug-free schools was for a year for the State.

The CHAIRMAN. Mrs. Scott, you told us about the need for loving care in your own experience as a foster child and the continuing concern and commitment to it. And you have had your own children, and then you have had other children, some that have been subjected to drug abuse and some that have not, I assume.

Other than pride in your own children, tell me what major differences you see in one that has had drug abuse and one that has not.

Mrs. SCOTT. Well I had two babies in my home at the same time that were of the same age, one was substance abuse and one was not. Developmentally, this child was way behind. At first it was low birth weight because she only weighed 1 pound and 12 ounces at birth. And she was in the hospital for 3 months before she was discharged. Coming out of the hospital at 3 months, it was just like being an infant just born and she developed along those lines, always being 6 months behind-raising her head, sitting up. Very irritable, crying all the time. And sometimes almost like a failure to thrive baby. The baby was constantly whining, constantly eating, never getting enough. Sometimes not wanting to be held and being very nonresponsive to attention until she was about a year old.

At that time she became very attentive, but only to the two primary caretakers. The baby is out of my home now, but I see the baby constantly. And right now she is the same, like there is 5 days difference between the baby that I still have. Very aggressive, very hyper. But yet on the learning end, nowhere near the baby that is in my home that is the same age, not talking yet.

The CHAIRMAN. And the problem is not that they are 6 months behind, they lag further and further and further behind as they go along.

Mrs. SCOTT. Yes.

The CHAIRMAN. Thank you very much for your testimonies.
Mr. HAYWARD. Thank you, sir.

Mrs. SCOTT. Thank you.

The CHAIRMAN. Our next panel, Dr. Maureen Montgomery, assistant clinical professor of pediatrics at the Children's Hospital in Buffalo, NY; Margaret McGoldrick is vice president for health affairs and acting hospital director, Hahnemann University Hospital, Philadelphia; and Mr. Sherman McCoy, the chief operating officer of the Harlem Hospital Center, New York, NY.

Dr. Montgomery, if you would proceed please?

STATEMENT OF MAUREEN E. MONTGOMERY, M.D., ASSISTANT CLINICAL PROFESSOR OF PEDIATRICS AND CO-COORDINATOR, INFANTS OF SUBSTANCE ABUSING MOTHERS (ISAM) CLINIC, CHILDREN'S HOSPITAL OF BUFFALO, TESTIFYING ON BEHALF OF THE AMERICAN ACADEMY OF PEDIATRICS, BUFFALO, NY Dr. MONTGOMERY. Thank you, Mr. Chairman. I am Dr. Maureen Montgomery from the Children's Hospital in Buffalo; and I am

here today representing the Academy of Pediatrics, and I think personally more representative of my own clinic at the Children's Hospital of Buffalo, which is a clinic dedicated to the care of children and their mothers who have been using drugs while they were pregnant.

So my focus is a little bit different than some of the other speakers today because my first contact with these mothers is when they have delivered their children. I have no contact with the mothers prior to their delivery.

There are a few points I wanted to make ahead of my prepared statement that have come up as we have been listening to speakers this morning. And if you don't mind, I would just like to say a couple of things.

The first is that I think the issue here is poverty. I think drug abuse is added onto the issues of poverty, but I don't think we can address this issue and expect families in poverty to simply give up a drug, whether it is alcohol, cocaine or any other drug without replacing it with something else. I think over the years people in poverty have been expected to go along with the traditional treatment plans and then in the end they still have poverty and no goals, and no future, and things haven't changed.

Second, I would like to mention that I think the availability of care-that is to say Medicaid services, WIC services, et ceterabeing available and people being eligible for them does not translate into people getting them.

Third, the long-term outcome for these children is just beginning to be recognized. As people this morning have already mentioned, the school systems, the criminal justice systems, our social services systems will be paying the price for these children long after we, as pediatricians, have finished seeing them.

Fourth, crack cocaine is an addiction that is not like any other addiction that we know about. There is no alternative drug to take the place of crack. I have had mothers come to me and say they will go for methadone treatment just to try to get off crack. It doesn't work.

So those are the four things that I think need to be said ahead of time before I start. My clinic is about 8 months old. We have about 80 patients in Buffalo. We are not in an intercity of high predominance, but we are sort of a midwestern city and we are seeing the problem here. The patients that I see are all Medicaid eligible patients, mostly intercity patients, and their mothers.

Our emphasis in beginning this clinic under a maternal child health grant that was funded through a Healthy Tomorrow's program in conjunction with the Academy of Pediatrics last year was to keep families together. I do not think the foster care system can handle or is ready for the numbers of children we are talking about.

In addition, we recognize that child abuse is a significant possibility in some of these families. So we have to keep in mind that our primary goal is to protect the children. Thirdly, we have to intervene as early as possible with these children to make any impact on their development and if they don't come to care and don't get seen they will not be helped.