Therapeutic residential care: A necessary option for foster youth with greater needs

Photo by kat wilcox on Pexels.com

The tide of opinion in the U.S. child welfare arena has been turning against institutional settings for foster youth for some time. A spate of reports of child abuse and improper disciplinary techniques in residential facilities for young people has intensified calls for the elimination of residential care as an option for foster youth. But as all who are intimately involved in the child welfare world know, therapeutic residential care is a critical part of the continuum of services that must be available for foster youth.

Media investigations have targeted abusive behavior by staff at poor-quality residential facilities around the country, with a spotlight on a for-profit company called Sequel. Concern and outrage reached a fever pitch when a 16-year-old boy died at a Sequel home in Michigan after being restrained for 12 minutes. The Imprint and the Texas Observer co-published a harrowing account of Residential Treatment Centers (RTC’s) in Texas, documenting horrific instances of abuse at multiple centers around the state.

Unfortunately, some commentators, like the author of the report on Texas RTC’s, are using reports of abuse and violence to support ending all residential care rather than getting rid of bad providers. These critics of residential care miss two basic points. First, there are children who, for a variety of reasons, are not having their needs met in a family setting. These are the children who bounce from foster home to foster home, spend nights in agency offices or hotels, or even end up sleeping in cars with their caseworkers. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. These children need treatment delivered in a residential setting before they can function safely and thrive in a family setting.

Perhaps some of these youths could heal and thrive in a home with professional therapeutic foster parents, an option which is gaining increasing popularity. These foster parents are highly-trained and paid to take care of children with complex needs full-time. This is an option that deserves more attention but its growth is probably limited by both the lack of willing and qualified candidates and the expense.

Residential care abolitionists also miss the importance of quality. Residential programs can range from outright abusive to very high quality and highly successful in achieving positive outcomes for their clients. In an op-ed in The Imprint, Dana Dorn and Kari Sisson of the Association of Children’s Residential Centers explain that “High-quality residential interventions have the ability to change lives for the better and are a critical part of the continuum of behavioral health services. They have well-trained and supported staff who provide individualized, trauma-informed, youth-guided, family-driven care in environments that are safe, welcoming and encourage healthy relationships.” The authors stress that providers who are incompetent or “prioritize profits” over people should not be allowed to stay in business.

Opponents of residential care often use faulty reasoning to make their point. They often state that children who attend residential care have worse outcomes than those in family care without explaining that it is the most traumatized, troubled kids with complex histories who are placed in residential facilities. Those children would be expected to have worse outcomes than their peers because they have often had the worst past experiences by the time they finally have access to treatment.

The State of Washington provides a cautionary tale of what can happen when residential care in a state almost disappears. Budget pressures stemming from the 2008 recession dovetailed with the growing sentiment against residential options, as described in an excellent article in The Imprint by Elizabeth Amon. Between 2009 and 2019, over 200 residential beds in 13 locations disappeared. Unfortunately, the state lacks enough appropriate placements for youth with psychiatric, behavioral and developmental needs. These young people end up staying overnight in offices, emergency one-night foster homes, hotels, and cars–or sent to out-of-state facilities including some operated by Sequel. Not only are these arrangements anti-therapeutic, but they are extremely expensive, as Amon points out.

In Texas, where the Imprint focused on the poor quality of many RTC’s, child welfare administrators are worried about the declining number of residential centers. Every year, at least one RTC stops contracting with the state due to inadequate reimbursement, which means they cannot pay workers enough to retain them. As a result, the number of Texas foster children sleeping in offices and hotels spiked last year, according to an article in the Austin American-Statesman. These were mainly teenagers with trauma histories and/or significant behavioral and mental health issues, according to a state official.

In New Mexico, the Department of Children, Youth and Families (CYFD) contracts with ten residential treatment centers in the state, but that is not enough to care for all the foster youth who need therapeutic residential care, as the Secretary told the Santa Fe New Mexican. As a result New Mexico still sends children to out-of-state facilities. The Secretary has requested more funding for additional therapeutic residential care resources.

In Maryland, the Baltimore Sun and WYPR reported last February that dozens of children were spending weeks or even months in psychiatric units of hospitals without a medical reason because social workers had nowhere else to place them. Often these children were placed in psychiatric units after experiencing a crisis in a foster home. Most of these children are not ready to move to a foster home upon discharge and need a higher level of supervision and therapeutic care. But there are waitlists for the roughly 350 spots at Maryland residential treatment facilities, and for out-of-state facilities as well. These long hospital stays are destructive and traumatic to the children as well as extremely expensive.

Last January, I wrote about similar problems in Oregon, New York, California, and Illinois. Residential critics miss the point. If states don’t have quality residential facilities, or any residential facilities at all, they will send their kids to facilities run by operators like Sequel, put them up in offices, hotels, temporary placements or cars, or leave them in hospitals. That’s why only three out of 40 states and territories sending children to Sequel facilities have severed ties with the company, despite its awful track record.

Those who oppose all residential care for foster youths are blind to the challenging problems of some foster youth, the life-changing potential of quality therapeutic residential care and the vast differences between high and low-quality residential facilities. We need to make sure quality residential services are well funded and regulated to keep children out of offices, hotel rooms, abusive or out-of-state facilities, and hospitals. Legislators at all levels of government must recognize the need for adequate funding of this crucial service necessary to heal the wounds of our most fragile foster youth.

“Upending child welfare” means devaluing Black children’s lives

Image; University of Houston/Center for study of Social Policy

In the wake of the killing of George Floyd by police, expressions of outrage from around the country and calls for police reform were soon followed by calls for completely abolishing police forces. It did not take long before a chorus of cries were launched to eliminate child welfare as we know it as well. Child welfare was described as yet another system that controls and punishes people of color. Yet, these calls disregard the suffering of Black children who are abused and neglected; it also ignores the evidence on the reasons for Black families’ high level of involvement in child welfare.

The call for the abolition of child welfare did not come out of the blue after George Floyd’s death. It is the direct descendant of a movement that began around 2004, when a coalition of foundations, nonprofits, and academics formed around the idea that the “disproportionate” representation of Black children in child welfare stemmed from a racist system.[1] This coalition launched a well-funded campaign to reduce the representation of black children in child welfare and especially foster care. They issued reports, held conferences, and provided training and technical assistance to help states analyze their disproportionality problems. The movement seemed to run out of steam afternew research (described below) debunked their major thesis, but it regained strength in the wake of the Black Lives Matter movement, and came roaring to the forefront after George Floyd’s killing.

One of the leaders in the earlier coalition, the Center for the Study of Social Policy, has joined with the Graduate College of Social Work at the University of Houston to launch a movement entitled upEND, with the aim of ending child welfare as we know it. Several representatives of upEND have published an article in the Journal of Public Child Welfare which attempts to explain their thesis. The upEND argument relies on two assertions: that the high rate of Black child and family representation in the child welfare system is due to racism within the system, and that this high rate of representation harms Black children and families. Unfortunately, these assertions are largely wrong, as I explain below.

ASSERTION ONE: The difference in Black vs. white involvement in the child welfare system are due to a racist child welfare system.[2]

There is no disagreement about the truth of upEND’s statement that Black children and families are more likely to be involved in child welfare than White children and families. In its article, upEND cites studies concluding that Black children are more likely to be reported to child abuse hotlines, more likely to be investigated, more likely to be found to be maltreated, and more likely to be placed in foster care. The ultimate result is that of this chain of disparities at each phase of the child welfare pathway is that in 2018, black children represented 14% of the total child population but 23% of all kids in foster care.

However, the real controversy (although buried in the upEND article) is about the reasons for this disparity. Is it due to a racist child welfare system, as upEND and its allies posit, or due to a difference in the underlying rate of child abuse and neglect among Black versus White families? Data suggest it is the latter. Of course, it is difficult to measure child maltreatment, which makes this question hard to answer. Although the U.S. Children’s Bureau collects annual data on official reports of child maltreatment and agency dispositions of these reports, these numbers leave out unreported maltreatment and may reflect erroneous determinations by investigators. To provide a better estimate, the Bureau periodically conducts National Incidence Studies (NIS) of child abuse and neglect. These studies are designed to estimate more accurately the incidence of child maltreatment in the United States by using community professionals to report on the actual cases of maltreatment that they have seen during the reporting period.

According to the most recent national incidence study, NIS-4, conducted in 2010 on data collected in a year spanning 2005 and 2006, Black children were almost twice as likely to be abused or neglected as white children. It estimated that 24.0 of every 1,000 black children experienced maltreatment severe enough to cause harm in the study year as compared to 12.6 per 1,000 white children.[3] There is other research evidence that Black and White maltreatment rates differ, including studies finding that black children have higher rates of preventable injury deaths; and “evidence that other predictors or markers of maltreatment are higher for black children, including maternal arrest rates, traumatic brain injury rates, parent self-reported maltreatment rates, intentional injury rates, and homicide rates.” A study published in the journal Pediatrics in 2017 concluded that the child abuse fatality rate for children aged four and under was 8.0 per 100,000 African-American children, compared with 2.7 per 100,000 white children.

A conference convened in 2011 by Harvard, Chapin Hall at the University of Chicago, the National Council of Juvenile and Family Court Judges and the National Court Appointed Special Advocates, brought together leading scholars on child welfare and race from around the country. A research brief summarizing the conference concluded that “there is a significant black/white maltreatment gap, one that roughly parallels the gap in official maltreatment reports. This evidence contradicts the belief that black children are included at high rates in the child welfare system because of bias.” One speaker noted that “African American children are at least as likely to be underserved as overserved” by current child removal rates. The authors of the brief suggested that the higher rate of maltreatment of Black children stems from the history of slavery and racism, which led to higher poverty and concentration in impoverished neighborhoods characterized by crime, substance abuse, unemployment, and limited community services. As Randall Kennedy of Harvard Law School put it, “given the history of race and racism, given the deplorable conditions suffered disproportionately by black families—conditions that produce high rates of substance abuse and other self-destructive behavior—it would be surprising if black children did not have higher rates of contact with the child welfare system than white children.”

In her important book, Spare the Kids: Why Whupping Children Won’t Save Black America, Stacey Patton has added to this narrative by linking the legacy of slavery to current patterns of discipline by Black parents. Introduced to whipping by White slaveholders, Black parents adopted a similar practice to train their children to be docile workers and avoid worse punishments from their masters. Even today, Patton contends, some Black parents justify “whupping” their children as the only way to prevent them from being shot or locked up.

In other words, there is a strong argument that disproportionality is rooted in racism. But It’s not a racist child welfare system that results in disproportional representation of black children in the child welfare system. Rather, it is the our country’s history of slavery and continuing oppression of our Black citizens that has created the difference in child maltreatment which in turn resulted in disproportional representation of Black and White children in child welfare.

ASSERTION TWO: The disparity between Black and White representation in child welfare systems causes “pervasive and persistent harm” to Black children and families. 

The next pillar of upEND’s argument is that differences in child welfare involvement cause harm to Black children and families. The authors emphasize the placement of Black children in foster care, stating that “the act of forcible separation of children from their parents is the source of significant and lifelong trauma.” It is first worth noting that most children involved with child welfare are not separated from their families. Nationally, more children receive in-home services than are removed to foster care.[3] Moreover, it is not always clear that separation from parents is traumatic for a child. A child’s reaction to placement depends on the child’s age, the quality of the attachment with the parent, the type of environment from which the child is removed, and the way the placement is handled, according to Vera Fahlberg’s authoritative book, A Child’s Journey through Placement. A child who has been emotionally neglected and has no connection to the parent may have “almost no reaction” to the placement, Fahlberg points out. Moreover “if a child is actually fearful of his living environment, he may not react as adversely to the separation. Indeed, relief is occasionally observed.” And even if the child is traumatized by separation from abusive or neglectful parents, that child may still benefit from being removed from that environment.

There is an extensive literature on the harmful and often lifelong consequences of abuse and neglect. These can include impaired brain development, health problems; diminished executive functioning and cognitive skills; poor mental and emotional health; attachment disorders and social difficulties; post traumatic stress; unhealthy sexual practices; juvenile delinquency; alcohol and other drug use; and intergenerational transmission of maltreatment, as described in an issue brief from the Children’s Bureau. The specific outcomes for each child depend on “the child’s age and developmental status at the time of maltreatment, the type, frequency, duration, and severity of the maltreatment, and the relationship between the child and the perpetrator,” according to the Bureau.

Advocates of upending child welfare often point out that most children are removed for neglect rather than abuse, and they suggest that neglect is synonymous with poverty. But the actual prevalence of neglect versus abuse is unknown. One must remember that there may be several types of abuse and neglect in one family but the investigator may not be able to substantiate all of them. There may very well be abuse in a family where only neglect was substantiated. Moreover, the kind of neglect that leads to child welfare involvement is often serious or chronic and is not at all synonymous with poverty. Chronic neglect can lead to serious cognitive and social difficulties, chronic disease, and difficulties in emotion regulation similar to the effects of trauma, as discussed in another brief from the Children’s Bureau. Moreover, chronic neglect often “opens the door” for physical or sexual abuse by a mother’s male partner.

Even though child maltreatment can cause lifetime harm to its victims, one might still believe with upEND that the treatment (child welfare services) is worse than the disease, at least for Black children. To address this contention, Richard Barth and other well-known child welfare scholars recently published a review of the literature entitled Outcomes following child welfare services: what are they and do they differ for Black children? They reviewed more than 50 rigorous studies of outcomes following a child welfare intervention and found “very little reason to believe that children’s outcomes are worsened by participation in child welfare services.” They noted that the vast majority of children received short-term services, with only a fraction placed in foster care. Based on their analysis, they found that child welfare in general results in improved outcomes in the areas of safety and education for both White and Black children and generally neutral effects on health, mental health and behavioral outcomes. Moreover, they concluded that child welfare may protect Black children in particular against some future harms as early death, transitions to juvenile services (for girls), and early childbearing.  The authors found no evidence that Black children are doing worse than other children as a consequence of system involvement. Perhaps most important, the researchers found that Black parents and youth, like their White peers, are generally positive about their experience with child welfare. (Most interesting were the two surveys of 21-year-olds that found about two-thirds saying that they were lucky to have been placed in foster care.)

It is very sad that the measurable benefits of child welfare on children’s outcomes are so modest. This may be a consequence of the poor quality of services that are generally provided to many children and their parents. Far from the intensive parenting and enrichment that abuse and neglect victims need, many foster children and youth receive benign neglect at best and outright abuse at worst. As I have written based on my experience, many foster homes provide little nurturing and attention. The system is particularly unsuccessful for older youth with behavioral problems, who are often moved from home to home, placed in residential programs which vary from highly therapeutic to abusive, or spend nights in agencies and hotels, as described in an excellent blog post by Dee Wilson. Moreover, the services provided to children and families by other systems, like mental health and drug treatment, are often low-quality and plagued by waiting lists and provider turnover.

upEND’s policy prescription

In order to end racial disproportionality and its harmful effects, upEND proposes “the abolition of the child welfare system as we know it.” While the exact meaning of this phrase is not specified, the writers make it very clear that abolition means “that the forcible and involuntary separation of children from their parents is no longer viewed as an acceptable form of intervention.” To bolster their proposal, the authors contend that for Black families in America, forced family separation has its roots in the dehumanizing system of slavery.

The historical connection of child removal to racism and slavery is not clear. White children were removed from their families by child welfare agencies long before Black children. Dorothy Roberts, who herself has called for the abolition of child welfare, traces the intellectual roots of child removal to the early progressives around the turn of the twentieth century, who tried to address poverty by placing poor immigrant children in orphanages or sending them to work on rural farms. As Roberts describes in her famous book, Shattered Bonds: the Color of Child Welfare, “black families were virtually excluded from openly segregated child welfare services until the end of World War II.” When public agencies began to take over child welfare from private agencies, they started to turn their attention to Black children. But the disproportionality took some years to appear, according to statistics cited by Roberts. So it is hard to understand the logic of the claim that the practice of child removal by child welfare is rooted in racism.

While not clear on exactly what shape the new child welfare system (if any) would take, upEND states that it will replace the current child welfare system with “community-based supports for the care and well-being of children that are designed by and for families and communities…” The authors call for a broad range of policies including: creating and expanding critical safety net programs and affordable housing; expanding the use of informal care and supports for kin care providers; ending the use of congregate care placements; strengthening the efforts states must make to prevent foster care placement; and eliminating “arbitrary timelines” to terminate parental rights.

The authors do not explain how they would respond to maltreatment of children whose parents are not capable of protecting them, or who have seriously harmed them. As a member of the District of Columbia’s Child Fatality Review Panel, I have learned about many deaths of children whose families had long histories of contact with the city’s child welfare system. These families were the subject of numerous calls to the child abuse hotline for physical abuse, school absenteeism, children left alone, parents under the influence of drugs or alcohol or both–often multiple types of abuse and neglect for the same family. Some of these calls were set aside as not worth investigating, in some cases child protective services found no cause for intervention, and in some cases the intervention was not enough. Whether the child was accidentally crushed as an infant while sleeping with a parent on drugs or alcohol, beaten to death by a parent or the mother’s boyfriend, or shot as a teenager by a member of a rival crew after years of unresolved problems in the home, these children were abandoned by the system that was set up to protect them. upEND’s prescriptions would likely result in more such deaths, even more serious injuries and damage to children, and much more suffering.

As upEND proposes, we need to address the the unconscionable inequality and poverty that affects a disproportionate number of Black families by creating a true safety net and making affordable safe housing available to everyone. To add to their list, we also need to reform policing and criminal justice to eliminate a huge source of stress on Black families. But we cannot wait to protect children until present inequities and the impacts of past ones are eliminated. We should develop programs specifically aimed at preventing abuse and neglect among high-risk families of any race as soon as a child is born, such as Pennsylvania’s new Hello Baby program. Another promising approach is to provide high quality early childhood education accompanied by family support to all infants who are at risk of maltreatment. And as we work toward eliminating child abuse and neglect before they occur, we must continue to respond to children who are currently being maltreated. We must improve the accuracy of this response by eliminating any racial or other biases that result in false positive or negative findings of maltreatment. For example, the use of predictive risk modeling to screen hotline calls has been shown to reduce the disparity between the case opening rates between Black and White children.

As Barth and his colleagues put it, not responding to maltreatment of Black children is a “violation of children’s essential rights.” If we accept upEND’s prescription for eliminating differences in child welfare representation between Black and White children, we will subordinate the rights of children for safety, security and love to the rights of parents to complete autonomy in childrearing. For those who say Black Lives Matter, the this is a sad lack of concern for Black children’s lives.

[1]: The term “disproportionate” or “disproportionality” refer to the fact that a higher proportion of Black children are involved in child welfare relative to White children. In general I prefer to use a more neutral term, such as black children’s “higher level of involvement” or “representation” in child welfare.

[2]: I have taken the. liberty of formulating these assertions to reflect the actual pillars of upEND’s argument. As stated in the article, it appears that their first pillar is that there are racial disparities. But there is no disagreement about that. The authors gloss over the reasons for these disparities, which is the actual point of disagreement between the child welfare abolitionists and others.

[3]:Black children were also nearly twice as likely to experience maltreatment as defined by the more inclusive “endangerment standard.” This broader concept of maltreatment affected 49.6 per 1,000 Black children as compared to 28.6 per 1,000 White children.

[4] According to the Children’s Bureau’s most recent Child Maltreatment report, less than half of the maltreatment victims who received services in Fiscal Year 2018 (146,706 out of 391,661) were placed in foster care. Unfortunately, we do not have these data by race.

Hello Baby: Innovative child maltreatment prevention program launches in Allegheny Co., PA

On September 21, 2020, the Allegheny County (Pennsylvania) Department of Human Services (DHS) began rolling out a “first of its kind” parenting initiative called Hello Baby. The program aims to support and strengthen families of newborns who are at risk of abuse and neglect, so as to prevent the occurrence of maltreatment rather than responding after it occurs. This new program is an innovative approach that attempts to avoid the flaws of many other programs that aim to prevent child maltreatment.

Hello Baby is a “voluntary program for parents of new babies, designed to strengthen families, improve children’s outcomes, and maximize child and family well-being, safety and security.” As described in a Frequently Asked Questions document and a Methodology Report on the Allegheny County Analytics website (which contains. many other relevant documents as well), the program combines a universal entry point with differentiated services in a three-tiered approach, as described below:

  • Universal Tier: Services available to all new parents in the county include a “warmline,” the Hello Baby website, and a texting service staffed by volunteers to answer questions about newborns and parenting issues.
  • Family Support Tier: Families with “moderate needs” will be served through the existing network of 27 Family Centers located around the county. These families will have access to the rich array of services offered by these centers, including home visiting, family support, and child care subsidies.
  • Priority Tier: Families with the most complex needs are offered the support of a two-person team employed by Healthy Start Pittsburgh, which was selected through a Request for Proposals. The teams are made up of a family engagement specialist, who functions as a peer counselor, and a social worker who plays the role of case manager. In the pandemic environment, they will meet with families both virtually and in home visits. These teams work with families to learn about their needs, connect them to resources, and provide wraparound assistance, which will be available until the child turns three years old. This wraparound assistance can include concrete goods, transportation assistance, and connections to community resources. The priority tier model is based on the COACH Model of the Camden Coalition, a behavior change intervention for people with complex needs.

Every new mother in the county receives information about the program through her birthing hospital, OB/GYN, or pediatrician and may receive an initial visit from a nurse to talk about the program in more detail. A few weeks later, each family receives a postcard informing them of the universally available services and giving them the opportunity to opt out of further contact. Families with moderate and higher levels of need who have not opted out of services will be contacted by the Family Centers or two-person teams, respectively.

The placement of newborns into three different risk groups will be based on a predictive risk model (PRM), another unique part of this program. The model is designed to identify the families with the highest likelihood of having a child removed to foster care before the age of three. The model uses data already available from birth records, child protective services, homeless services, and justice system records to calculate a risk level for each child. Model development was led by Rhema Vaithianathan and Emily Putnam-Hornstein, along with the data science team based at the Centre for Social Data Analytics (Auckland University of Technology, NZ). Vaithianathan and Putnam-Hornstein are world leaders on the use of PRM in child welfare, and they have been working with Allegheny DHS since developing the county’s child abuse hotline screening tool in 2015. While most Priority Tier slots will be filled through PRM, some slots will be reserved for parents who request intensive support or those referred by clinical providers.

The program planners made extensive efforts to address potential concerns about privacy, coercion to participate, or involvement with child protective services (CPS). Hello Baby is not connected to CPS. The risk scores will not be shared beyond program staff, used after the initial screening, kept on file, or used for any child welfare purpose. No family will be reported to CPS for refusing to participate in the program. DHS estimates that 40 percent of the families assigned to the most intensive service tier will already be involved with child welfare. These families will be eligible for the program except when safety issues are so grave that the baby is removed right after birth by CPS. If the family agrees, Hello Baby staff can work directly with the child welfare caseworker to make sure the family receives the best services to meet their needs.

The FAQ document cites several reasons for the development of Hello Baby. For one, agency leaders recognized that the county was rich in programmatic resources but that the resources were not reaching those who needed them both. Second, they realized that the historical practice of targeting high-poverty areas for prevention efforts (like the county’s Family Centers) leaves out many families in need because the root causes of child maltreatment (such as substance abuse, mental illness and intimate partner violence) cut across economic lines. Finally, even within a community with a Family Center, evidence suggests that those who need it most may not access the services.

The focus on ages 0 to 3 was chosen because infants and children are most at risk of serious abuse and neglect–and most likely to die of such maltreatment. Almost 80 percent of Allegheny County children who suffered fatalities connected with abuse or neglect were under the age of three. And half of them were unknown to the child welfare system, which means that there had been no earlier opportunity to protect the child.

According to an account on the county’s DHS website, Allegheny’s child welfare leaders began thinking about a child maltreatment prevention program using a tiered approach supported by predictive risk modeling (PRM) in 2015, when they were developing the Allegheny Family Screening Tool (AFST) for screening hotline calls to determine their relative risk level. If they could use PRM to screen child maltreatment reports, DHS leaders asked, would there be a way for them to use these methods to reach families “BEFORE they reach the breaking point?”

The fact that Allegheny County DHS is already using PRM to screen hotline calls is a testament to the vision and courage of its leadership. Few other jurisdictions have implemented PRM in child welfare in part because of the controversy surrounding the use of an algorithm in decisions about case opening.[1] But DHS Director Marc Cherna is one of the longest-serving human services directors, having served in the position since 1997 and has won nationwide recognition for his innovative initiatives. He was was the first director of DHS, a mega-agency that was the outcome of a merger between several discrete departments. As described in a case study, Cherna took the opportunity to create a “data warehouse” integrating information from the formerly separate agencies. This integrated database in turn provided the opportunity to improve decision-making using PRM. In response to a Request for Proposals, DHS chose the team led by Vaithianathan and Putnam-Hornstein to develop the AFST and later the Hello Baby tool as well.

Hello Baby is the outcome of many years of research and planning by DHS leadership working together with community members, according to the FAQ document. The process included an extensive literature review focused on how to engage and retain families with intensive and complex needs. In addition to the internal literature review, DHS commissioned two independent ethical reviews. The developers also met with families receiving services, service providers, clinical experts, judges, Family Court advocates, peer support agencies, national experts, local funders; and civil liberties, civil rights and social justice organizations to identify service gaps and concerns. Finally they conducted case reviews with social workers and child development experts in order to understand the population they were seeking to reach.

Hello Baby was launched on September 1, 2020 and is being piloted at a subset of sites before being rolled out statewide after a year. DHS anticipates providing Priority Tier service to five percent of families with new babies or about 650 families per year when the program is fully implemented. The County has contracted with two respected social science research institutes–Chapin Hall and the Urban Institute–to conduct process and impact evaluations of Hello Baby.

As Vaithianathan and Putnam-Hornstein explain in their methodology document, we know very little about what works, and for whom, to prevent child maltreatment. Therefore, new approaches are needed. Hello Baby’s combination of universality and targeting is appealing based on logic. As DHS. explains in an implementation brief provided to Child Welfare Monitor, universal services have many benefits, like reduced stigma, wider reach and no need for eligibility requirements. But when resources are limited, services are stretched thinly across many families. Families with the greatest needs may not get the intensity of services they need, while families with lesser needs may receive support disproportionate to their needs. Hello Baby addresses this problem with its tiered service array.

DHS has undertaken an elaborate process to protect privacy and self-determination and prevent the use of risk scores in any context other than assigning families to Hello Baby tiers. However it must be recognized that there is a tradeoff between parental self-determination and protecting children. Prior research indicates that it is difficult to engage the highest-risk families in voluntary services. By ruling out the possibility of reporting these families to CPS, DHS may be condemning some children to years of neglect, abuse, injury, or even death. We hope that DHS will collect and report on the number, risk scores, and future maltreatment reports, of those who decline to participate in order to assess the extent of this problem.

We congratulate Allegheny County for the implementation of Hello Baby. The lack of attention to the rollout by prominent child welfare organizations, thought leaders and media is surprising. We hope that child welfare leaders are are paying attention to this important initiative and thinking about options for similar programs.

[1]: Much of the controversy around PRM centers on fears that it will exacerbate racial disparities in child welfare decision making. But an evaluation of the AFST has suggested that it has reduced, rather than increased, racial disparities in the rate of case opening between White and Black children, thus assuaging fears that it would increase such disparities.

Maryland child custody committee recommends specialized judges for custody cases involving child abuse or domestic violence

Prince McLeod Rams and Hera McLeod: Fauquier.com

Hera McLeod did everything she could to protect her baby son from a father who she said had attempted to suffocate her when she was pregnant, raped her 19 year-old sister and was a suspect in killings of his mother and the mother of his other child. But it was not enough The judge in her custody case accepted her ex-husband’s favorable evaluation by a school counselor who was not certified to evaluate adults. In contrast, he did not accept a police report regarding the father’s abuse of another child in Virginia in the absence of the arresting officer. On his fifth unsupervised visit, paramedics responding to a 911 call found 15-month-old Prince naked, wet and not breathing at Rams’ home. Joaquin Rams is serving a life sentence for drowning his son.

Prince’s case is not unique. Around the country there has been a growing awareness that family courts are failing to protect children in custody cases where there is domestic violence or child abuse. Parents who attempt to protect their children from abusive ex-partners (often known as “protective parents”) are labeled as alienators or “high conflict” and often penalized and their warnings disregarded, as discussed in an earlier post by Child Welfare Monitor. The results can be tragic. The Center for Judicial Excellence has documented 758 children murdered by a divorcing or separating parent since 2008. We have no idea how many children are ordered into some type of unsupervised contact with an abusive parent: this number was estimated at 58,000 in 2008. While murder is an extreme result of bad custody decisions, the devastating results on surviving children of being left with an abuser are incalculable.

Anne Hoyer directs the State of Maryland’s Safe at Home Address Confidentiality Program for domestic violence survivors. From talking to the women she served, Hoyer became more and more concerned about how often she was hearing about judges awarding custody of children to their abusers. She worked with State Senator Susan Lee to draft legislation setting up a workgroup to study child custody court proceedings involving child abuse or domestic violence.

The legislation took effect in 2019 and the workgroup began meeting in June of that year. Chaired by the Secretary of State, who has jurisdiction over the Safe at Home program, the workgroup included four legislators, 12 other members with expertise on domestic violence, child abuse or child custody, and one parent with personal Family Court experience. On September 15, 2020, the workgroup issued its final report. It contains a summary of its findings as well as 24 recommendations designed to improve the performance of Maryland’s Family Court in protecting children involved in custody cases involving abuse or domestic violence.

The workgroup acknowledged the difficulty of making custody decisions in cases where domestic violence or child abuse are present. Abused children, domestic violence victims, and domestic abusers may all behave in counterintuitive ways. An abusive parent may make a better impression on the court than the protective parent; an abused child may deny the abuse and demonstrate attachment to the abusive parent. As a result, protective parents may be labeled as unreasonable, vindictive, or attempting to “alienate” their child from the abusive parent. Ms. McLeod described trying to abide by the advice of attorneys to express her desire that her son have a healthy relationship with his father while at the same time convincing the court that her husband was dangerous–an almost impossible tightrope to walk. The workgroup also noted that abusive parents with greater financial means often use litigation to assert continued control over protective parents and can use their superior resources to buy better representation in the court case and impose burdensome costs on protective parents.

The workgroup also expressed its concern about the widespread acceptance by courts of parental alienation claims against protective parents–a national problem. Specifically, a child’s fear or hostility toward a parent accused of being abusive by the other parent is attributed to the latter’s attempt to “alienate” the child from the other parent. The workgroup heard from Joan Meier, whose massive study on this issue has drawn much attention. Meier presented her results that indicate when a father claims alienation, the court’s likelihood of believing a mother’s abuse claim is dramatically reduced.

Professor Meier’s results also supported the conclusion that courts are now biased against mothers– in contrast to the anti-father bias that used to be prevalent in family court. For example she found that when fathers alleged that mothers were alienators, they took custody 44 percent of the time. Mothers who alleged that fathers were alienators took custody only 28 percent of the time. Fathers who were proven to have committed child physical abuse still took custody 25 percent of the time; mothers proven to have committed physical abuse were never granted custody. Experts cited additional evidence of gender bias in custody cases. Dr. Daniel Saunders presented a survey of 200 judges and 465 custody evaluators showed the prevalence of sexist myths, such as that mothers often accuse fathers falsely of domestic violence, that lead to recommendations likely to harm domestic violence victims and their children. Deborah Epstein, the Co-Director of the Domestic Violence Clinic at George Washington University Law School shared observations from many years of experience in DC Superior Court documenting routine disbelief of women’s claims of domestic abuse. (Summaries of all the presentations are provided at the end of the workgroup’s report).

Two of the most important workgroup recommendations, according to Hoyer, address judicial training and specialization. The workgroup recommended that the judiciary, in consultation with domestic violence and child. advocacy organizations, develop an ongoing training program for judges who preside over custody cases that involve child abuse or domestic violence. A judge would be required to receive at least 60 hours of training before presiding over such a case and to pursue at least 10 hours of such training every two years to continue hearing these cases. The workgroup also recommended a list of topics to be covered in the initial training, including: the impact of adverse childhood experiences on children and variations in how children respond to trauma; limitations in Child Protective Services responses to allegations and the fact that abuse may have occurred even if an investigation did not substantiate it; the impact of exposure to domestic violence on children; the effects of bias on custody decision-making; the history of parental alienation theory and its inappropriate use in child custody cases; and tools to assess children’s credibility in court.

Considering the impractically of training all circuit court judges this deeply in these issues, the workgroup recommended that a limited number of judges be specially trained to handle custody cases in which child abuse or domestic violence have been alleged or established. Moreover, the Judiciary must ensure that such cases are assigned only to Judges with this specialized training.

The workgroup made many other recommendations, including several that would change statutory language to better account for child abuse and domestic violence, impose more stringent qualifications and requirements for other professionals (lawyers and custody evaluators) involved in custody cases, and give parties access to needed resources without financial hardship. But according to Hoyer, “establishing a corps of judges who want to do this work and giving them the tools to do it is the essential foundation that will pave the way for future changes.” For example, fully-trained and specialized judges will be less likely to accept evaluations that are inadequate or performed by unqualified people.

Legislators and other workgroup members will be meeting in the weeks ahead to translate some of the recommendations into legislation to be introduced during the upcoming legislative session. Maryland’s workgroup is the first of its kind in the nation and Hoyer has received questions from many other states. Child Welfare Monitor hopes that other states will follow Maryland’s example and initiate the process for making our troubled family courts safe for children.

Child protection in the time of Covid-19: what we know and what we can do

Every year when school resumes after summer vacation, child welfare agencies brace themselves for an onslaught of reports as teachers see children after the entire summer and flood hotlines with reports of suspected abuse or neglect.  Earlier in the year, many officials and advocates expressed concern that this fall would see any even greater surge of calls than usual and that child welfare agencies would be overwhelmed. But as more and more schools and systems opted for a virtual opening this year, policymakers and advocates began to worry about the opposite problem–a continued dearth of reports to child abuse hotlines and a continued fear that children are suffering unseen.

A chorus of media reports from all over the country last spring documented drastic drops in calls to child abuse hotlines following school closures due to the coronavirus pandemic. As Child Welfare Monitor reported, almost every state reported declines in hotline calls last spring, with calls dropping often by half and sometimes by as much as 70 percent since schools shut their doors. A survey of children’s advocacy centers, which work with victims of physical and sexual abuse nationwide, found a 21 percent drop in the number of children served in January through June of 2020 compared to the same period in 2019; the drop would probably be much greater if only March through June were considered.

The loss of reports from schools was the primary explanation for the drops in reports of child maltreatment. And indeed the shift to online education delivered a double-whammy to any attempts at child protection. For children who did attend virtually, it was harder for teacher to see signs of trouble, like bruises or hunger. And many students who did did not show up for virtual education regularly or at all. The New York Times heard from many teachers around the country that fewer than half of their students were participating in online education. The School Superintendent in Los Angeles has reported that only 60 percent of students participated daily in online learning last spring. A child’s failure to participate may reflect the lack of a dedicated computer or internet access, difficulties in accessing platforms, a child too busy watching siblings or even working, or lack of engagement in virtual education.  Whatever the explanation for their absence, these children were not being seen by teachers, counselors or other school staff, often the ones who notice red flags. Other reporters, like doctors and extended family members, were also less likely to see children under the Covid-19 quarantine. 

More detailed data from Allegheny County Pennsylvania and two Colorado counties (shared in a webinar from Mathematica Policy Research) and from Maine (shared in a Child Welfare League of America webinar) shed some light on changes in reporting trends in the last school year and what they might mean.  The number of calls to child abuse hotlines (also called reports or referrals), as compared to the previous year, fell dramatically in all three states. The decline in reports was especially marked among teachers and other school staff such as counselors. In all the jurisdictions  the lower-risk referrals tended to drop off the most. In the data for Colorado and Allegheny County, where predictive risk modeling is used to screen hotline calls,  the average risk scores of the children being referred rose, suggesting that the lower-risk referrals tended to drop off more than the higher risk referrals. Maine officials found that reports were generally more severe and that they were getting fewer reports that were screened out as inappropriate or because there were multiple reports from the same family. Participants in both webinars suggested that in normal times schools make too many unnecessary reports for minor issues, and that many of these reports were being suppressed by the school closures.

It is encouraging that less serious referrals are more likely to be dropped than more serious ones, but it is equally clear that higher-risk referrals are being lost as well. Another important indicator is the percentage of referrals that result in a substantiation–or a finding that abuse or neglect has occurred. If the missing referrals were mainly frivolous,  we would expect a big increase in the percentage of reports that was substantiated. That did not occur in at least one state–Michigan–spurring its child welfare director to design an initiative discussed below. Unfortunately, substantiation data on a national level for last spring will not be available for another year from the federal government. 

At the same time that reports dropped, many child advocates have expressed fear that child maltreatment has actually increased. Based on past research, family violence increases in times of natural or economic disasters, probably in large part due to parental stress. In addition to the stress imposed by job loss and health concerns, parents who are cooped up in close quarters for months with their children may be more prone to respond with violence. And parents who need to work despite school closures may leave their children uncared for or with caregivers who are unprepared.

Despite these reasons to suspect that child maltreatment may be increasing, we do not have any national data to confirm or deny it. Data from individual hospitals in various locations around the country has been cited to demonstrate that cases of severe child abuse are increasing. Hospitals around the country have reported increases in serious injuries and even deaths compared to previous years. Reports of such excessive child abuse injuries and deaths have come from hospitals in Fort Worth, Texas, Orlando, Florida, Colorado Springs, Colorado, Washington, DC, and Pennsylvania. But without systematic data from hospitals, we really cannot know if this represents a national trend.

Last Spring, child advocates worried about the unseen children who would have to wait until schools reopened after the summer to have their situation discovered. But as more and more districts abandoned plans to open school buildings, it became clear that the anticipated onslaught of hotline calls would not occur in these jurisdictions. What can be done to ensure that children are safe? Several different approaches have been tried or suggested.

Public awareness campaigns: Some jurisdictions have instituted publicity campaigns encouraging members of the community to  report child abuse and neglect. For example,  the New Jersey Department of Children and Families launched a ‘Social Distancing Shouldn’t Mean Social Isolation’ campaign to raise awareness about child abuse, domestic violence and other dangers facing residents while homebound. It include a flyer about warning signs of child abuse as well as a more general resource that includes telephone numbers for the child abuse, domestic violence, mental health, and other hotlines. In a Call to Action for State Governors, CHILD USA, a national think tank focused on child protection, suggests that Governors should add to all their COVID updates a reference to the need for all adults to be alert for signs of abuse and neglect, along with how to reach the child abuse hotline.

Providing new guidance to traditional reporters: Some agencies have created new resources to share with educators and other traditional reporters of child abuse and neglect.  Maine issued guidance for educators, medical personnel, and community members to help them identify warning signs of child abuse and neglect in a time of virtual education.  CHILD USA released a useful list of Tips for Teachers on Child Welfare and Online Safety during COVID-19 which suggests questions for teachers to ask that are targeted at elementary, middle and high school students. The questions focus on food, physical safety and online safety. The document also includes tips on what to look for in the home environment as perceived through a computer screen. The Zero Abuse Project has published Responding to Child Abuse During a Pandemic: 25 Tips for MDT’s, which provides tips that might be useful for child welfare agencies as well. The authors included some valuable advice, such as a reminder to teachers that abuse has been shown to increase after a child receives a bad report card. They suggest that teachers. contact parents in advance of giving out a bad grade, promise to follow up (with the hope of defusing any violence) and call authorities if parents indicate a plan to punish the child physically,.

Reaching Out to Nontraditional Reporters: Some child advocates like family violence researcher Andrew Campbell have urged states to reach out to nontraditional reporters, such as postal workers, garbage collectors, and home repair agencies, who are continuing to see children as they move through homes and neighborhoods. A simple postcard listing the warning signs of child maltreatment and the phone number of the child abuse hotline could be distributed to businesses and agencies employing such workers. Animal protection agencies are another potential community partner for child welfare agencies, as Campbell also suggests. Animal control officers could be trained and enlisted to check up on the wellbeing of humans as well as animals in homes where animal abuse has been reported.

School Based Approaches: Schools have a critical role to play in ensuring that children can be protected in a time of virtual schooling. Districts must make sure that all students have access to a computer and high-speed internet service. It is critical that they adopt a policy of checking in with all students they have not been able to reach for a specified period of time, whether a day or a week.  Clearly this is easier said than done in schools serving largely disadvantaged populations. Media outlets have reported on the herculean efforts of dedicated school staff who have spent months trying to locate students who were missing from virtual education. Schools can also provide training to their teachers in how to spot red flags in virtual meetings, as Pueblo County Colorado has done. Schools should also consider adding to their virtual platforms an option for children to indicate that they are in trouble at home and need help. 

Reaching out to at-risk families known to the system: Noticing the precipitous fall in calls to the hotline without a corresponding rise in substantiation rates, Michigan’s child welfare director JooYeun Chang feared  that some children in need were “simply invisible,” as she explained to the editor of The Imprint. Before the pandemic arrived, the agency had commissioned an assessment from Chapin-Hall, a child welfare think-tank, which had identified 14,000 families that had been involved with the agency and had a high risk of children entering foster care without receiving additional preventive services. About 1,000 child protection workers freed up by the decline in hotline calls were assigned to reach out to these families to find out if they needed any type of assistance. Data provided to Child Welfare Monitor indicate that workers spoke with 8,267 of the 14,162 families on the list, and 80 percent of the families received a text, email, or mailing. Workers provided general support, information and referrals. Many parents expressed great appreciation for the calls; some conversations lasted 45 to 90 minutes. One worker was able to contact a cash assistance worker and rectify the erroneous closing of a case, another provided referrals to a father struggling with physical and mental health problems who thanked the worker several times just for listening. The agency is now reaching out to another 10,000 families that were investigated since the Covid-19 shutdowns began.

Inspired by Michigan, Allegheny County, Pennsylvania DHS is using staff and community partners to connect with higher-risk families involved in child welfare cases that closed six months earlier, to check in and find out whether they need help with food, housing or other services. Checking in with families to offer assistance is not designed to identify ongoing abuse or neglect. However, it may reduce the probability of child maltreatment recurrence by helping families meet concrete needs for food, clothing and shelter and even by offering them a friendly ear and reducing their social isolation.

Investing in Prevention: Interest in preventing child maltreatment before it occurs as was already growing before the Covid-19 pandemic. The drop in CPS reports under virtual schooling has led to even more interest in prevention.  Particularly relevant are secondary prevention approaches, which target families that are at risk of child maltreatment. Michigan DHHS under Jooyeun Chang is working on a new pilot that will be run by a nonprofit in two of the five Detroit zip codes from which the bulk of Detroit’s foster youth were removed. The program will target 400 families (chosen based on the previous calls), who will each receive a peer counselor with similar “lived experience” and a benefits navigator, who will connect the family to needed resources in the community. Combining peer counseling and benefits navigation is an innovative approach that may enhance the value of each of these components when provided together. In addition to the peer navigators, group activities will provide needed information and help participants build their social networks.

The Allegheny County (Pennsylvania) Department of Human Services (DHS) is launching the Hello Baby prevention program in partnership with local Healthy Start and Family Centers. The program, which is voluntary and not affiliated with child protective services, is an interesting hybrid of universal and targeted prevention. It will be offered to all families with a new baby but will offer three levels of services to families depending on how they score based on a predictive risk model using integrated data from multiple sources. The families with the most profound needs will be offered intensive services through Healthy Start Pittsburgh while others will be welcomed to their neighborhood Family Center and/or offered a variety of web-based and “warmline” supports and resources. While the program has not yet launched officially, DHS has soft-launched in some communities with a high density of vulnerable families.

The approaches outlined above fall into two broad categories: initiatives to enhance detection and reporting of child abuse and neglect and those designed to prevent it. These approaches are often supported by different groups in the child welfare space. However, both approaches are valid and important. We cannot go back in time and prevent the abuse and neglect that are already occurring, so we must have a robust system of reporting and investigation to find the children who need protection. On the other hand, to the extent that we can prevent future abuse and neglect before it starts, the benefits would be enormous.

 

America loses champion for a child-centered child welfare system

GellesRichard Gelles, one of the nation’s leading child welfare experts, died late in June of brain cancer, as reported by the Chronicle of Social ChangeGelles’ death deprives the nation of one of its leading child welfare scholars, and one of the few remaining spokespersons for a child centered approach to child welfare.

Richard Gelles played an important role in the passage of the Adoption and Safe Families Act (ASFA) of 1996 through the publication of  The Book of David: How Preserving Families Can Cost Children’s Lives. This book told the  story of a 15-month old boy who was murdered by his abusive mother. David’s parents had an open child welfare case when he was born, due to their severe abuse of his sister Marie when she was six weeks old that left her with lifelong disabilities.  While Marie was still in foster care, the parents were reported to the child abuse hotline twice for abusing David. In closing their investigation without removing David or opening a case, agency workers ignored two huge red flags–the grievous injury to six-week-old Marie and the failure by her parents to comply with the agency’s reunification plan, resulting in the termination of their parental rights to their daughter. Three and a half months after the case was closed, David was dead.

According to Gelles, David’s death could be traced to the doctrine requiring that agencies make “reasonable efforts” to keep or reunite abused and neglected children with their parents. Without any definition or timeframe, efforts to keep children like David with their birth parents often cross the line separating reasonable from unreasonable. Gelles argued that David’s death could also be traced to “the larger ideology behind ‘reasonable efforts,’ ‘the sacrosanct belief that children always (or nearly always) are better off with their biological parents.”

In his testimony at a 1995 Congressional hearing, Gelles argued that the current obsession with family preservation should be replaced for a “child centered child welfare system” where abused and neglected children would longer remain for years in abusive homes, nor would they languish for years in foster care. Instead, the goal of a child-centered child welfare system would be “to terminate parental rights, when appropriate, quickly enough so that (1) children are not permanently harmed, physically or psychologically, and {2) make children available for adoption earlier enough in their lives so that they are ‘adoptable.'”

Gelles’ perspective was incorporated into several changes made by ASFA, as described by  former Hill staffer Cassie Statuto Bevan in an Urban Institute compilation on ASFA ten years after its passage. The requirement for “reasonable efforts” was moderated by requiring that such efforts must maintain the child’s health and safety as the “paramount concern.” Moreover, a  deadline was placed on reunification efforts, requiring a state to file for termination of parental rights after a child had been in foster care for 15 of the previous 22 months. ASFA also allowed states to bypass reasonable efforts altogether in extraordinary cases, such as when parents have committed a felony assault resulting in serious injury to the child or another child–clearly an exception that could have been applied in David’s case.

While it appears that ASFA has resulted in shorter stays in foster care as Gelles hoped, the impact of the provisions designed to protect children from dangerous parents appears to have been less than their authors hoped. Agencies make frequent use allowable exceptions to the 15-month time limit for termination of parental rights and rarely use the provisions that allow them to forego reunification plans. In order to make the system more child-centered, these provisions should be strengthened. Unfortunately, we seem to be going in the opposite direction.

There is a groundswell of attacks against ASFA,  with critics claiming that 15 months is not enough time for with problems like drug addiction to address them, especially if services are not immediately available. Some critics even denounce the law as racist because they say it penalizes black parents, ignoring the needs of black children for safety and permanency. Contrary to the child-centered perspective Gelles promoted, these advocates prioritize parents’ rights over children’s needs to be placed in a loving home quickly enough to avoid permanent damage and early enough in their lives to be likely to be adopted.

In The Book of David and in his testimony, Gelles also criticized the investment of a billion dollars in unproven “intensive family preservation programs” to keep families together. These new programs, such as the well-publicized Homebuilders, were intensive, short term, crisis intervention services designed to address parental behaviors that are putting their children at risk. Gelles pointed out that there was no research evidence to support the success of intensive family preservation programs at preventing foster care placements, let alone keeping children safe–which was not even evaluated. And from a theoretical perspective, Gelles pointed out that intensive family preservation programs would be effective for only those families with a low level of risk and a high level of readiness to change. To assume that these services could work for all maltreating families was unrealistic. 

Sadly, the same programs that were supported without evidence in the 1980’s are being supported again with more baseless claims of research support. As reported in a recent post, Homebuilders is once again being promoted as effective in keeping families together, although the research is no more convincing than that of the 1980s. Recently Homebuilders was approved as a best practice that can be funded by the Family First Act, based on only two studies. One of the studies focused on a program that did not follow the Homebuilders model and worked only to reunify families already separated by foster care—not prevent foster care placement which is the main purpose of Family first. The second was a study of Homebuilders family preservation programs and according to its authors failed to demonstrate any favorable program impacts. 

Why invest in a program that has failed to document success over several decades of research? The renewed push for family preservation has once again taken over the child welfare world. With the passage of the Family First Act, allowing billions in funding for programs that keep families together, there is a desperate need for programs to spend that money on. The federal clearinghouse established to approve programs for this purpose has demonstrated that its standards for calling a program “well-supported by the evidence” are low indeed. And that is not surprising, since there are few such programs that have been shown to be effective in helping abusive and neglectful parents change longstanding and often intergenerational patterns. And so the story starts again.

As we face increased backlash against ASFA and increased incentives to spend billions of dollars on unproven family preservation programs, Richard Gelles’ keen analysis and advocacy for children will be greatly missed.

 

 

Schools and agencies should reach out to at-risk children before schools close

COVID reportingThe COVID-19 pandemic is having a disastrous effect on the systems designed to protect children from abuse and neglect, as discussed in an earlier post. With children being isolated from teachers and others who might report suspicions of maltreatment, a  drastic decline in calls to child protection hotlines has been reported nationwide. This decline calls for equally drastic measures to identify at-risk children before schools close for the academic year.

The Covid-19 pandemic and resulting economic crisis has given rise to widespread fears of increasing child abuse and neglect, as well as domestic violence. The stress imposed by job and income loss, unmet basic needs, school closures, and fear of sickness all are likely to lead to increases in child abuse and neglect. Older children who are too young to care for siblings safely may be nevertheless left in charge. Research suggests that child abuse increases during natural and economic disasters and the current crisis combines both.

Reports from emergency rooms suggest that the fears about increased child abuse are warranted. Hospitals in Texas, Florida, Philadelphia, Maryland and Washington DC have reported more children coming to emergency rooms with serious child abuse injuries, such as head trauma and fractures, that require hospitalization. A spokeswoman for the American College of Emergency Physicians told the Washington Post that members “nationwide have reported treating more serious injuries in a week than they are used to seeing in a month.”

At the same time as abuse and neglect appear to be increasing, social distancing is separating children from the professionals and others who might notice abuse or neglect and report it to authorities. As a result, calls to child abuse hotlines around the country have dropped drastically since the national lockdowns began. Child Welfare Monitor has collected reports of drops in the number of hotline calls from 37 states and the District of Columbia, most of which are reporting decreases of 50 percent or more.

The drop in child abuse and neglect reports is not a surprise. The largest source of such reports is education staff, who made 21 percent of such reports around the nation in 2018 according to federal data. With schools closed, some children are in contact with their teachers  through video apps, where signs of abuse or neglect are harder to spot than in person. But that is the best case. Not all schools are using video applications to run virtual classrooms (known as “synchronous” education) and relying instead on “asynchronous” teaching methods where teachers record lessons and post assignments, which students in turn email or upload.

Whatever the nature of online education, many children are participating sporadically or not at all. The New York Times heard from many teachers around the country that fewer than half of their students were participating. Not surprisingly, participation has been lowest in schools with many low-income students, who often lack access to computers and the internet. These are the same students who are most likely to be victims of abuse or neglect. Many systems, in conjunction with internet providers, have distributed computers and made free internet available to families that lacked these resources but it is not clear how successful these efforts have been in bridging the digital divide.

Despite the reduced access to students, many teachers are making special efforts to monitor their most vulnerable students.  The Washington Post reported on a teacher in Virginia who added a pop-up prompt to her power-points asking children how they are feeling on a scale from red (awful) to orange to yellow to blue (perfect). Staffers for Danville County Virginia public schools who are delivering meals to students try to take the opportunity to engage with families and lay eyes on the children.  Teachers are still making reports to hotlines, although certainly these reports are fewer in number. For example, as reported in Child Welfare Monitor DC, teachers made 30 percent of the 897 hotline calls received by the Child and Family Services Agency between March 16 and April 18 of this year, as compared to 52 percent of 2,356 hotline calls during the same period of 2019.

Aside from teachers and education personnel, other important reporting sources also have less access to children during this crisis situation. This includes medical personnel, who are seeing few children for routine appointments, as well as friends, family members, and neighbors.

Once schools close for the summer, the best opportunity to identify children at risk of maltreatment will be gone. Therefore, we urge schools and child welfare agencies to work together to identify these children before schools close for the summer.  School personnel could  make efforts to reach all students who has not been in regular contact with their teachers via telephone, text, email, or other means available.  Any student that they cannot reach even after several tries using more than one method could be referred to child protective services to be contacted through a home visit if necessary.

One official who has seen the need for action has been Sheriff Alex Villanueva of Los Angeles County, which has seen a 50% decline in calls to its child maltreatment hotline since the lockdown began. The county has been the site of numerous deaths of children known to the Department of Child and Family Services (DCFS), including the death of Gabriel Fernandez, which was the subject of a widely viewed documentary. Stating that “We do not want another Gabriel Fernandez,” Villanueva announced a plan to have patrol officers check up on high-risk children who  have not been in contact with their schools. Apparently the Sheriff was planning to reach out to schools reminding them of their mandatory reporting duties and announcing that deputies would be available to do welfare checks on children for whom schools express concern.

The Sheriff’s plan was rejected by DCFS on the grounds that sending uniformed officers to check on families without a specific allegation of abuse or neglect would only exacerbate their stress and not necessarily improve safety for children, as DCFS Director Bobby Cagle told the Los Angeles TimesChild Welfare Monitor agrees that police officers might not be the most appropriate professionals to do these welfare checks.  But instead of rejecting the idea of reaching out to these children and their families, DCFS could have worked with the schools to identify and reach out to these students, as suggested above.

Extraordinary times call for extraordinary measures. While child welfare agencies would not normally consider sending out workers to check on children with no specific allegation of abuse or neglect, it is crucial that we take advantage of the quickly disappearing window of opportunity to reach children that have not been in regular touch with their teachers during the societal lockdown. Child welfare agencies should work with schools to identify these children before schools close, leaving abused and neglected children completely at the mercy of their caregivers.

 

 

 

 

 

 

Impact of coronavirus on child welfare: a one-sided federal view

afScreen Shot 2020-04-18 at 12.58.40 PM.pngThe coronavirus is affecting every aspects of the child welfare system and its ability to achieve its three major goals–safety, permanency and well-being. In our last post, Child Welfare Monitor discussed the threat posed by social distancing to the safety of abused and neglected children who are not involved with the child welfare system. For children in the system, especially those who are in foster care, the disruptions posed by the response to the coronavirus pandemic pose a great threat to their hopes for permanency. Two top officials of the federal Children’s Bureau have expressed great concern about the effects of the crisis on permanency and their hopes that the states will prioritize family reunification both during and after the period of social distancing. Unfortunately, their formulation of the issue reveals a one-sided analysis of the problem. Moreover, they seem to have no interest in the safety of children trapped in their homes with abusive or neglectful parents.

Federal officials have rightly expressed their concern that the coronavirus pandemic will extend some children’s stays in foster care. There are three major reasons this might happen, as described in an excellent article in the Chronicle of Social Change. Services to parents, such as mental health, drug treatment, and parenting skills programs, are threatened by the pandemic. Some may have shifted to virtual services, but not all parents have the technological wherewithal to participate. Other services might not be provided at all. Secondly, reunifications must be ordered by a court, and courts have been drastically affected by the crisis. Most court buildings are closed; many are conducting virtual hearings but only for hearings deemed essential and able to be conducted virtually.

Third and perhaps most important, most visits between children in foster care and their parents have become virtual, conducted through apps like Facetime or Skype. But virtual visits are difficult with infants and young children, and for older children they cannot substitute for extended visits. Moreover, virtual visitation does not allow the normal progression from shorter and supervised visits to longer unsupervised ones, culminating in reunification as parents are able to prove that they can manage the children for extended periods of time.

The timelines written into law by the Adoption and Safe Families Act (AFSA) could result in termination of the rights of parents who through no fault of their own were unable to comply with their court-ordered case plans. These timelines require that a state must file a petition for Termination of Parental Rights (TPR) if a child has been in foster care for 15 of the last 22 months, with certain exceptions. If these timelines were strictly interpreted, the COVID-19 crisis could result in the termination of many parents’ rights because they would have been unable to complete services or demonstrate appropriate parenting skills by the end of the 15 months.

It must be noted, however, that the ASFA timelines are often honored more in the breach than in the observance even in normal times. The law allows them to be exceeded if there are “compelling reasons” to determine that TPR is not in the best interests of the child. Under these auspices, many parents have been given much more time to work toward reunification. As a social worker in the District of Columbia, this writer saw numerous cases in which children were reunified with their families after much more than 15 months in foster care.

Last week, the Chronicle of Social Change published an impassioned column by Jerry Milner, associate commissioner of the U.S. Children’s Bureau and his special assistant, David Kelly. Milner and Kelly argue that the virus itself should not be a reason to keep parents and children apart.

Despite our strong preference that all measures be taken to continue in-person family time for children in foster care and their parents and siblings, there will undoubtedly be instances where such family time is not provided. In some instances that may be appropriate due to the presence of the virus in the resource family home or home of the parent. In many more instances, there will be no known safety threat.

It appears that Milner and Kelly are advocating for in-person visits whenever there is no virus in the home of the foster family or birth parent. Governor Brian Kemp of Georgia became the focus of ridicule when he claimed on April 1 to have just discovered that as much as 25 percent of those with coronavirus might have no symptoms but still transmit the virus to others. Perhaps Milner and Kelly not yet learned about that finding. Moreover, one wonders what they would suggest if their recommendation resulted in the wholesale desertion of foster parents afraid of the risks of exposing the children in their custody to one or more family members each week.

Down the road, when families begin to bump up against their ASFA time limits, Milner and Kelly urge states to make use of the statutory exception allowing them not to file for TPR if there is a compelling reason to believe such filing would not be in the best interests of the child. That may be a reasonable prescription in many cases, considering how often this justification is used even in normal times. However, Milner and Kelly go on to anticipate attempts by unnamed nefarious forces to “use the crisis to serve their own interests or those of their constituencies. There will be those whose implicit or even explicit biases are drawn out into the light.” Thus, Milner and Kelly continue the practice of calling anyone who prioritizes the rights of children over those of their parents as racist, as Child Welfare Monitor pointed out in an earlier post.

Milner and Kelly take the opportunity to argue against the ASFA permanency timeline, arguing that it was “more the result of negotiation than what we know about the importance of parent-child relationships, recovery and trauma.” Yes, the ASFA timeline was the result of political forces, but in the opposite way from that claimed by Milner and Kelly. The earlier drafts of AFSA contained shorter timelines for younger children based on what we know about child development. These shorter timelines were eliminated because they would have made the bill impossible to pass.  Milner and Kelly warn that “child development and bonding will be used in arguments not to return children to their parents and to expedite adoptions in instances where families did not have a fair chance.” By denying the importance of bonding instead of acknowledging there is a conflict between two important values, Milner and Kelly betray that their position is based on ideology, not analysis.

Despite their misguided recommendations and hyperbolic statements, Milner and Kelly are right about the threat to timely permanency posed by social distancing and its effects. But they ignore that the social distancing imposed by the coronavirus is having a very different effect on children who have been abused and neglected but are not involved with the foster care system. Although there are strong reasons to believe that abuse and neglect are increasing, reports to child abuse hotlines are down as much as 50 percent around the country because children are not seeing the adults who usually report concerns about child maltreatment, especially school and medical personnel.  This crisis has drawn considerable media attention, as Child Welfare Monitor has described, and states and nonprofits have taken action to publicize the signs of child abuse and urge teachers who see children online and other workers who see children in person to be alert for the signs and ready to report to child protective services hotlines. But even during Child Abuse Prevention Month, Milner and Kelly have nothing to say about this issue and have issued no guidance for states and counties.  It is obvious that their minds are elsewhere.

Two of the major goals of child welfare–safety and permanency–are often in conflict. It takes wise leadership to navigate the narrow channel between endangering and separating them from the parents they love. Sadly, we are not blessed with such leadership on the federal level in these troubled times.

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When social distancing can kill: child protection during a pandemic


NJbridgethegapSocial distancing is essential to break the back of  the coronavirus pandemic. But for children who are at risk of abuse and neglect, social distancing means social isolation and the loss of any hope of rescue from their desperate circumstances. It is important for child welfare agencies to reach out to the general public and those workers still seeing children with special messages about warning signs of maltreatment and how to get help.

For children living in abusive or neglectful homes, the pandemic is a perfect storm. On one hand, abuse and neglect are likely to increase due to parental stress and more time spent together in close quarters due to social distancing. Research suggests that child abuse increases in times of economic or natural disasters.

At the same time as families are under increased stress and spending more time together, children are not being seen by mandated reporters, especially teachers and school staff.  One in five reports comes from education personnel, according to the most recent federal data; hence the annual summer falloff in reports and the uptick every October. Today, almost every school building in the country is closed. While many schools are conducting online classes, the New York Times has reported that fewer than half of students are participating in some schools. Absence from virtual classrooms seems to be especially high in schools with many low-income students, who often lack access to computers and the internet. Some students and parents have completely fallen out of touch with their schools. And these are precisely the students who are more likely to be abused or neglected.

Reports about declines in hotline calls have appeared from almost every state, with calls in dropping by as much as 70 percent since schools shut their doors.1 School closures cannot explain this entire decline. Clearly other possible abuse reporters, such as law enforcement, health personnel, neighbors, and family members are seeing less of children as well.

At the same time, there is reason to think that child abuse is increasing during the pandemic.  A three-year-old Fort Worth boy who died from “severe child abuse” on Easter morning was the third child in less than a month to die at Cook Children’s Hospital, according to the hospital. Since March 13, eight children have been admitted to the hospital for severe child abuse and three have died. The hospital normally sees six child abuse deaths in an entire year. The Arnold Palmer Children’s Hospital in Orlando, has seen a spike in child abuse cases. According to the medical director, the hospital normally sees one or two trauma cases a month. But in the last few weeks, eight children were brought to the hospital with severe injuries due to abuse. At Children’s National Medical Center in Washington DC, 86 percent of children coming to the Emergency Room with injuries suggesting child abuse between March 15 and April 20 had to be hospitalized compared to 50 percent in the same period of last year.

Ironically, April is Child Abuse Prevention month, when government and nonprofit agencies work to increase public awareness about child abuse and neglect and the need to report it. Unfortunately, a recent study casts doubt on the effectiveness of public education efforts to date. A nationwide survey conducted during the pandemic found that a large majority of Americans are not willing to report excessive physical punishment to the police or CPS. The New York Society for the Prevention of Cruelty to Children (NYSPCC)  surveyed 1,004 adults nationwide on March 27 to 29, in the midst of the crisis. They found that only 19% of adults say they are “very likely” to report a parent who is “excessively spanking or physically punishing their child” to child protective services. Only 36 percent of adults say they are very likely to contact the police if they see a stranger doing the same thing. Among the reasons given for their unwillingness to report, 68 percent of respondents cite that it might make things worse for the child, 35 percent cite the risk to their own family, and 30 percent say it is “none of my business.”

These survey results, with or without a pandemic, are frightening.  As Mary Pulido of NYSPCC puts it, “If what you see in public is enough to even make you think about calling the authorities, think of what that child could be enduring at home, behind closed doors.” But these results should not be surprising to those who are aware of past cases of egregious child abuse which were not reported despite obvious red flags.  For example, the media has reported on the failure of family and neighbors to report major concerns about treatment of the 13 Turpin children, who were imprisoned, starved, and physically abused by their parents over many years. 

What we know about the reluctance of people to report their concerns about children’s treatment suggests the need for a much more concerted effort for the long-term. Such an effort should be led by the federal government and implemented at the state and local levels. It should aim to increase knowledge of the signs of child abuse and neglect and convince citizens that it is their obligation to report, as described in an earlier post. Such a campaign would be more powerful if all citizens were required to report when they fear that a child is being harmed.

For this time of pandemic, we cannot hope for an immediate sea-change in attitudes, but governments can integrate messaging about child abuse and neglect into their communications with the public about the pandemic. Special efforts should be made to encourage teachers who are interacting with students online and other essential workers who have contact with children and families. Sadly, the federal Children’s Bureau has not issued any guidance to states and and counties resources and suggestions for how to do this. Such leadership has been left to state and local governments and nonprofits.

In a Call to Action for State Governors, CHILD USA, a national think tank focused on child protection, suggests that Governors should add to all their COVID updates a reference to the need for all adults to be alert for signs of abuse and neglect, along with how to reach the child abuse hotline. Special campaigns such as  #bridgethegap in New Jersey, may be helpful as well. As shown in the poster above, the public is reminded that “It IS your business. Everyone in New Jersey is a mandated reporter.” Readers should reach out to their government executives to urge them to incorporate such messages into their communications with the public. 

Special materials targeted to teachers and other staff may be helpful as well. New Jersey has produced a special message for education personnel asking them to “try to get ‘eyes on’ every child at least once a week.” Maine’s Office of Child and Family Services, in partnership with the Department of Education, has also issued guidance for educators, health care providers and community members for spotting and responding to signs of child maltreatment.

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CHILD USA has issued a list of Tips for Teachers on Child Welfare and Online Safety during COVID-19. This helpful document lists questions to ask students at the elementary, middle, and high school levels to assess their physical safety, online safety, and whether they are getting enough to eat. It also lists key items for teachers to look for when seeing their students online, such as the appearance of the student and the home, and things that the student might say.  And it suggests special efforts to monitor students with issues with drug abuse, mental illness or domestic abuse in their families. All child welfare agencies should ensure that their local school systems distribute this checklist to their teachers.

The document from CHILD USA does not say what teachers should do when they are unable to reach a child and their family, which is probably the case for many of the children most at-risk of maltreatment. Jurisdictions should consider the possibility of treating the inability to reach a child and family after several tries over several days as grounds for a teacher to call the child abuse hotline.

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States and counties might also try to enlist the only people who are seeing children regularly other than their immediate families–grocery and pharmacy workers and mail carriers. A representative of the Allegheny County Department of Children Youth and Families told a reporter that the agency “plans to pivot its awareness campaign” to focus on these workers. They plan to make sure the workers get the message that “if you see something, say something.” A grassroots campaign run by former child welfare workers in Arizona is also trying to contact the people who are still seeing children, including grocery workers, delivery services, and food banks.

As Angelina Jolie wrote in Time Magazine, “We were underprepared for this moment because we have yet to take the protection of children seriously enough as a society.” This is a major problem which needs to be addressed for the long term, so that next time there is a crisis, we will have a society that is ready to keep its children safe in spite of physical isolation.

This post is being updated daily during the coronavirus crisis include new information.

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Homebuilders program, never proven effective for family preservation, approved regardless by Title IV-E Clearinghouse

Screen Shot 2020-04-06 at 5.48.54 PMThe federal Title IV-E Prevention Services Clearinghouse recently approved Homebuilders, a well-known family preservation program, for Title IV-E funding, giving it the highest rating of “well-supported.” This decision is sure to be lauded by many child welfare administrators looking for more program choices, including those in the fourteen states where it is currently being used as of 2018. Unfortunately, the Clearinghouse decision does not appear to be justified by the research it cites. Of the two studies cited as the basis of the rating, one worked to reunify rather than preserve families; the other study concluded that Homebuilders was not effective in preserving families.

As many readers know, the Family First Prevention Services Act expanded the use of Title IV-E funds, which were formerly used only for foster care, to pay for evidence-based practices to prevent the placement of children in foster care. “In-Home Parent Skill-based” services were one of the three groups of services authorized, and Homebuilders has been frequently cited as a likely member of this category. To be approved for funding, each practice must be approved by the Prevention Services Clearinghouse, which was also created by the Act, with a rating of “promising,” “supported” or “well-supported.” The Act establishes criteria for meeting each of these standards.

In order to be rated as “well-supported,” a practice must be shown to be superior to an “appropriate comparison practice using conventional standards of statistical significance” as demonstrated by improvements in “important child and parent outcomes, such as mental health, substance abuse and child safety and well-being.” This must be established by at least two studies that were determined by an independent review to be “well-designed and well-executed,” used random assignment or a quasi-experimental design, and “were carried out in a usual care or practice setting,” and at least one of which established a sustained effect lasting at least a year.

Homebuilders is the best-known family preservation program. Developed in 1974 by the Institute for Family Development, it provides “intensive, in-home crisis intervention, counseling, and life-skills education for families who have children at imminent risk of placement in state-funded care.” Its goal is to “prevent…unnecessary out-of-home placement … through intensive, on-site intervention, and to teach families new problem-solving skills to prevent future crises.”

In the 1980s and early 1990s, a movement in support of Homebuilders and other Intensive Family Preservation Services (IFPS) spread throughout the child welfare world, spearheaded by wealthy foundations and advocacy groups, as described by Richard Gelles in his influential text, The Book of David: How Preserving Families Can Cost Children’s Lives. This movement resulted in a rapid expansion of these programs around the country, culminating in federal legislation allocating $1 billion to these programs nationwide. However, a major study authorized by Congress and conducted between 1994 and 2002 cast doubt on the effectiveness of these programs at keeping children safe and reducing foster care placements. In recent years, that study seems to have been forgotten. Indeed it is common for supporters to express the belief that “research shows Homebuilders has been well-supported for decades,” as one advocate told the Chronicle of Social Change.

Therefore there were no expressions of surprise or consternation that the clearinghouse gave Homebuilders its highest rating as a “well-supported practice.” In its narrative, the Clearinghouse explains that Homebuilders meets the criteria laid out in the Family First Act for that rating. Specifically, “at least two studies with non-overlapping samples carried out in usual care or practice settings achieved a rating of moderate or high on design and execution and demonstrated favorable effects in a target outcome domain. At least one of the studies demonstrated a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome.”

The clearinghouse reviewed 17 studies for possible relevance to  the Homebuilders program. Of these studies, only three were determined eligible for inclusion as evidence of Homebuilders’ effectiveness. The others were ruled out because they were done before 1990, were not relevant, or did not meet basic quality standards. Of those three studies, two were determined to meet the clearinghouse design for “moderate” or “high” support of the causal evidence, and both met the “moderate” rather than the “high” standard. So  the Clearinghouse based its recommendation on two studies only–the minimum required for Clearinghouse approval–both of which the lowest acceptable standard for support of the evidence.

For each of these two studies, the Clearinghouse separated out each individual effect found at each site and date, resulting in separate listings for the same effect at different follow-up times and sites if the project had multiple sites. At the end of this process, the Clearinghouse cited 10 instances of “no effect” on child safety across the two programs, confirming what was already well-known. For child permanency, there were seven favorable outcomes, two unfavorable outcomes, and 13 findings of no effect. For adult well-being, they found one favorable effect, 14 instances of no effect, and no unfavorable effects. Despite the preponderance of findings that Homebuilders had no effect, the eight  favorable outcomes were enough to give Homebuilders the coveted rating of well-supported.”

The aggregate data is already underwhelming but it becomes worse when considering that seven of the eight favorable effects came from one study, which should not have been included at all in the review. That study, described by Elaine Walton and others in reports published between 1993 and 1998, assessed an intensive family reunification program provided in Utah. The study involved 110 families divided between the program and control groups. There were many things that made this program a strange prototype for Homebuilders. First, the program was aimed at reunification of children in foster care with their families, not the prevention of foster care placement. While Homebuilders can be used for reunification as well as for family preservation, it is known predominantly as a family preservation program.  Similarly, while Title IV-E funds can be used for family reunification programs as well as family preservation (if a state chooses to define children existing foster care as “foster care candidates”) Family First has been described by its supporters almost exclusively as an initiative to prevent the placement of children in foster care.

A program that is successful in family reunification may not be successful for family preservation. A family facing the possible removal of a child is in a very different situation from a family with a child already in foster care. Children in the Walton study had been in out-of-home placements from one to 88 months, with an average of one year. Most of the parents had presumably already participated in court-ordered services such as therapy, drug treatment and parenting classes.

Further undermining the relevance of the Walton study is that it was not a study of the Homebuilders program. The model described by Walton et al, called Family Reunification Services (FRS) by the authors,  departed from Homebuilders in many respects. Services were less intensive and longer in duration. Workers spent an average of about three hours per week in direct contact with the families, and this contact could last up to 90 days. This is a very different model from Homebuilders, which typically provides at least 40 hours of face-to-face services or about seven to ten hours a week, over a period of only four to six weeks.  It is hard to understand how the Clearinghouse could use this study of a non-Homebuilders reunification program to affirm the success of Homebuilders in general.  Yet, the Clearinghouse drew six or seven of its eight or nine favorable results from this study.[^1]

The second study cited by the Clearinghouse was conducted by three well-known research firms, Westat, Chapin Hall, and James Bell & Associates. This was a congressionally mandated evaluation that was intended to overcome shortcomings of previous studies. It included three family preservation program sites using the Homebuilders model, although the Clearinghouse cites only the studies from New Jersey (343 families) and Kentucky (442 families).  The researchers studied one family reunification program in New York, but the Clearinghouse did not review that portion of the study.

In reviewing the Homebuilders family preservation program sites in the three states,  the Westat researchers found no impact on child safety or foster care placement. The researchers concluded that their results were consistent with other studies that “have failed to produce evidence that family preservation programs with varying approaches to service have placement prevention effects or have more than minimal benefits in improved family or child functioning.”

Not surprisingly, the Clearinghouse found only one “favorable effect” from the Westat study. That effect was not on child safety or permanency but on adult well-being. They found a favorable impact on adult (not child) receipt of WIC program benefits at the Kentucky site immediately after program participation–not surprisingly as one would hope the Homebuilders caseworker helped families sign up for WIC. This is a very weak hook upon which to hang a “well-supported” rating.

The authors of the Westat study suggest that “The extent to which the intensive, short-term, crisis approach fits the needs of child welfare clients should be reexamined. The lives of these families are often full of difficulties—externally imposed and internally generated—such that their problems are better characterized as chronic, rather than 24 crisis. Short-term, intensive services may be useful for families with chronic difficulties, but those services are unlikely to solve, or make much of a dent in the underlying problems. Of course, the hope is family preservation programs will be able to connect families with on-going services to treat more chronic problems. But, that appears to happen far less than needed.”

In sum, the Clearinghouse based its rating on Homebuilders on two studies of two different programs. One of the programs did not follow the Homebuilders model and worked only to reunify families already separated by foster care. The second was a study of Homebuilders family preservation programs and according to its authors failed to demonstrate any favorable program impacts. The clearinghouse found only one favorable effect from this study, and it pertained to adult well-being. It is hard to believe that any reasonable person would conclude that these two studies together provide “strong support” that Homebuilders is effective in meeting the goals of Family First.

The flaws in the Clearinghouse approach to Homebuilders raise issues that are broader than the effectiveness of this one program. While the Act’s criteria for approval of a program are often described as “rigorous,” the Homebuilders result show that they are anything but that. Requiring only two studies to show favorable results regardless of the number of studies that show no impact; reporting that two studies have found favorable effects even though the one relevant study had only one minor favorable effect that its authors did not mention in their conclusion; allowing the use of data from an evaluation of one program to support the effectiveness of another program; rating a program as “well-supported” without specifying the specific outcomes that it has been shown to achieve — all of these connote a lack of rigor. Regarding the last point in particular, if a program is found to work for only one goal (such as family reunification and not family preservation) the Clearinghouse should approve it only for that goal.

The initial wave of Homebuilders expansion was spurred by an onslaught of non-scientific “evaluations” funded by foundations intent on demonstrating its effectiveness, as Richard Gelles describes in his book cited above. Sadly, the same type of advocacy-based analysis was used to support the passage of Family First.  Supporters of the Act repeatedly stated that we know what works to preserve families and we just need to fund it.  Yet Child Welfare Monitor has found few or no programs with strong evidence of large favorable effects. It is likely that other practices approved by the Clearinghouse have equally skimpy support.

This post was updated on April 16, 2020 after the Clearinghouse responded to Child Welfare Monitor’s question, submitted on April 2, requesting an explanation on apparent internal inconsistencies in its table about favorable program effects for Homebuilders.

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