Opioid Crisis Part 1: New federal report shows child welfare impact

After more than a decade of decreasing, the national foster care caseload rose by 10% between 2012 and 2016. Many public officials and commentators have blamed this increase on parental substance use, especially due to to the opioid crisis, but evidence has been lacking on the national level to support this conjecture. A new report from the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services provides new evidence linking substance abuse with increasing foster care caseloads. It also highlights the daunting challenges facing those professionals at the interface of child welfare and substance abuse in hard-hit areas, and highlights the urgency of helping them meet these challenges..

The ASPE researchers obtained data on drug overdose deaths and hospitalizations and child welfare indicators for all of the counties in the US. They conducted quantitative analysis and statistical modeling to assess the relationship between substance abuse and child welfare. They also conducted interviews and focus groups with child welfare administrators and practitioners, substance use treatment administrators and practitioners, judges and other legal professionals, law enforcement officials, and other service providers who work with families affected by substance abuse in counties that are being hard-hit by the opioid crisis. Their key findings include:

Caseloads: There is a correlation between the severity of a county’s drug crisis and the burden on its child welfare system. The researchers found that when related factors are controlled, counties with higher rates of overdose deaths and drug hospitalizations had higher child welfare reports, substantiations, and foster care entries.
Nature of Cases: The researchers also found that higher rates of substance abuse overdoses corresponded to more “complex and severe child welfare cases,” as measured by a greater proportion of children with maltreatment reports that were removed from their homes. Substance abusing parents have multiple issues including domestic violence, mental illness and extensive history of trauma. Professionals in hard-hit areas described great difficulty in reunifying families due to the multigenerational nature of the epidemic (reducing the availability of kin caregivers) as well as the weakening and loss of community institutions including churches over time.
Treatment Challenges: Several major challenges affect agencies’ ability to get treatment for substance-abusing parents. These include cursory and delayed assessments resulting in treatment delays; misconceptions about Medication Assisted Treatment (MAT), which has been found to be the most effective treatment for opioid use disorder; and lack of treatment options matching parents’ needs, including family-friendly treatment options.
Systemic Barriers: Agencies are struggling to meet families’ needs due to multiple systemic factors including inadequate staffing leading to unmanageable caseloads, shortages of foster homes, and difficulty coordinating between systems and states (in the many counties that border other states).

This study has many policy implications. Unfortunately, all of them involve the need for increased financial resources both within the child welfare system and beyond it. The nation’s supply of effective drug treatment needs a major boost. Child welfare systems need financial help to improve assessments, hire new staff and train all staff on substance abuse and treatment, and increase the availability of high quality placement options for the children affected by the substance abuse crisis.

Treatment. More treatment programs are needed to meet the needs of parents involved with child welfare. In particularly, the study documented shortages of MAT and family-friendly treatment options. Clearly the opioid crisis is much broader than its impact on child welfare and requires a much broader response. In a full-page editorial on April 22, the New York Times stated that Congress has taken only “baby steps” so far in addressing this crisis by appropriating only a few billion dollars over the past few years. The Times quotes Andrew Kolodny, co-director of opioid policy research at Brandeis University, that “at least $6 billion a year is needed for 10 years to set up a nationwide network of clinics and doctors to provide treatment with medicines like buprenorphine and methadone.” Supporters of the recently–passed Family First and Prevention Services Act, which allows Title IV-E foster care funds to be used for drug treatment and other services to keep families together, have exaggerated its potential to help parents obtain treatment. If the treatment slots do not exist, money to purchase treatment won’t help. Moreover, many or most parents involved with child welfare already have Medicaid or other insurance that could pay for treatment if it existed.
Assessment. It is crucial that parents involved with child welfare receive thorough assessments of their substance abuse and other needs. The lack of proper assessments is a also problem for parents and systems not affected by the opioid crisis. A change in the standards of child welfare practice requiring a thorough assessment, conducted by a licensed professional, for each parent with a child in foster care, is necessary. Of course this would require additional funding.
Training. Lack of knowledge among professionals about the efficacy of different treatment options can prevent parents from obtaining the most effective treatment. Child welfare and court staff need training in substance abuse and treatment options just as they need training in mental health, domestic violence, and other issues facing many of their clients.
Staffing. In areas that are overwhelmed by cases due to the substance abuse crises, staff shortages lead to burnout, which in turn leads to more departures and increased shortages. These staff shortages are dangerous to children and to staff themselves and should not be allowed to continue.
Foster placements. More placements are clearly needed in some hard-hit areas, but it is not likely that enough traditional foster homes can be found, especially in light of the widespread nature of the substance abuse epidemic in some of these areas. That’s why we may need to look at new placement options, including family-style group homes and professional foster homes for four to six children, including large sibling groups.

The new study from ASPE has received a shocking lack of attention. It adds new, more rigorously collected evidence to the avalanche of media reports that have documented the impact of the substance abuse crisis on children and families. So far, the nation has not responded to this crisis with the urgency it demands. We will pay a high cost in the future–in broken families and damaged children–if we don’t provide the needed resources now.

An Overlooked Approach to Child Maltreatment Prevention

April is child abuse prevention month, and many organizations are offering recommendations on how to prevent child maltreatment. Typically these recommendations do not include one approach that may promise the most success–prevention of teenage, unplanned and closely spaced pregnancies.

Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy (now Power to Decide) gave a lecture in December 2015 that brought home this unfortunate omission. She reported being struck by “the total absence of pregnancy planning, spacing and prevention in virtually all discussions of how to improve overall child and family well being.” As she put it, many groups concentrate on services after the child is born, but “rarely do they mention the time when decisions are made about when with whom and under what circumstances to become pregnant or cause a pregnancy.”

There is no lack of research on the connection between pregnancy timing and child maltreatment. There is a strong association between child maltreatment and the mother’s age at the birth of the child. California researchers Emily Putnam-Hornstein and Barbara Needell found that babies born to mothers who were under 20 were twice as likely to be reported to child protective services (CPS) by the child’s fifth birthday as those born to mothers 30 or older. Among children referred to CPS by age five, almost 18 percent were born to a teenage mother and 50 percent were born to a mother younger than 25. Among children with no CPS contact, only 8 percent were teen births and 30 percent were born to a mother under 25.

There is also strong evidence that family size and child spacing are correlated with child maltreatment. Putnam-Hornstein and Needell found that children who fell third or higher in the birth order were more than twice as likely to be the subject of a report as first children. Moreover, a large study published in 2013 found that women who gave birth to another child within 24 months of the previous child were 80 percent more likely to have a substantiated CPS report.

And research suggest that the interaction between birth order and maternal age creates the highest risk for a child maltreatment fatality. A study using linked birth and death certificates for all births in the U.S. between 1983 and 1991 found that the most important risk factors for infant homicide were a second or subsequent infant born to a mother less than 17 years old. These infants had 11 times the risk of being killed compared with a first infant born to a mother 25 years old or older. A second or subsequent infant born to 17 to 19-year-old mother had nine times the homicide risk of the first infant born to the older mother.

And setting the research aside for a moment, anyone who has worked for or with CPS, or in foster care, knows the prevalence of larger families with closely-spaced children in the system, often with a mother that started childbearing as a teen. The same pattern has been observed among families that experience a child fatality.¹

It is truly unfortunate that the number of children in families that are involved in child welfare is not among the data required to be reported to the federal government by states. It is highly plausible that if these data were collected we would see a big difference.

If it is not the lack of research, why do supporters of child maltreatment prevention fail to include family planning and contraception in their suggestions? In part, Sarah Brown says of child advocates in general, it may be that they simply don’t think of it. But in large part, says Brown, it is because they fear getting in trouble and becoming mired in controversy about abortion or sex outside marriage. In addition to the issues raised by Brown, it is likely that others avoid this topic because of the shameful legacy of past attempts to control the population of minority groups.

But people who care about the future of African American children should not allow this racist history to prevent thinking clearly about what is best going forward. There are few if any policies that could be more helpful to the future of black children and the elimination of racial disproportionality in foster care placement than ensuring that black women have access to the most effective methods of contraception so that they can determine their own futures.

Family planning and contraception need to be included in the discussion about child maltreatment prevention. We have made great progress in teen pregnancy prevention. The teen birth rate has fallen dramatically from 59.9 per thousand in 1990 to 24.2 per thousand in 2014. While research suggests that reality TV shows and the last economic recession contributed to the decline in teenage pregnancy, better information about preventing pregnancy and the availability of more effective methods have doubtless contributed to the drastic decline.

The Colorado Family Planning Initiative, initiated with the help of a private funder, improved access to highly effective methods of contraception by training public health providers, supporting family planning clinics and removing the barriers to obtaining Long Acting Reversible Contraceptives (LARC’s). As a result of this initiative, the state’s teen birth and abortion rates were cut in half in just five years, with big financial savings to the state. Because younger mothers are so much more likely to abuse or neglect their children, this initiative should yield lower maltreatment rates now and into the future.

Upstream USA, a nonprofit organization, hopes to expand the Colorado program nationwide, starting with Delaware. Delaware’s Contraceptive Access Now (CAN) is a partnership between Upstream and the State of Delaware to decrease the incidence of unintended pregnancy. CAN works to ensure that all women get same-day access to all methods of birth control, free or at a nominal cost. They are also working to eliminate administrative and reimbursement barriers so that women can access LARC’s immediately after giving birth, taking advantage of a crucial opportunity to provide this critically important service.

Imagine if these initiatives could be expanded nationwide, combined with a public information campaign to explain the benefits of planning, spacing and timing pregnancy for both children and their parents.

Few child welfare experts have noted the link between family planning and child welfare. One of the few is Judge Patricia Martin of Illinois, a member of the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF). Martin included teen pregnancy prevention, especially in high-poverty neighborhoods and among youth in foster care, as one of the recommendations in her dissenting report.

Family planning experts also rarely if ever mention the potential of their programs to reduce child maltreatment. The more immediate benefits of increased opportunities for women and reduction in taxpayer funding for cash assistance and other services are more than enough to justify spending on helping women plan their childbearing.

The link between child abuse prevention and family planning is clear. I hope that the word will spread and that child welfare advocates and family planning advocates can work together for increased resources to help young people plan their childbearing based on their readiness to be parents.

Testimony of Dr. Angela Diaz, CECANF, August 6-7, 2015), https://slideblast.com/cecanf-nyc-meeting-transcriptfinal_59767e8e1723ddc0e0eedc5d.html ↩

Educated: A Must-Read for all Child Advocates

Educated, the new memoir by Tara Westover, deserves to be read by anyone who is concerned about child abuse and neglect. Born in 1986, Westover tells her story of being raised with her six siblings by a paranoid, bipolar survivalist father and her mother, a midwife and herbalist, in a Mormon community at the foot of a mountain in Idaho.

Westover had no birth certificate until the age of nine. Her parents did not remember her birthday and had to obtain her christening and baptism certificates from Salt Lake City. She had no medical records because she had never seen a doctor or nurse. She got her first vaccinations at the age of 22. Westover never went to school until she entered college at the age of 17. She spent her summers bottling peaches and her winters working in her father’s junkyard.

Westover’s mother initially attempted to teach her children at home, but by the time Tara reached school age any pretense of home education was gone. One of her brothers taught her to read, but that’s where her education ended. Instead of going to school, Tara became a member of her father’s junkyard crew. On her first day, he threw a steel cylinder into a sorting bin, unaware that she was in the way, hitting her in the stomach. On another occasion he ordered her to get into a bin filled with 2,000 pounds of iron. He then used a massive forklift to raise the bin 25 feet in the air with her in it. She was impaled by an iron spike and thrown some 20 feet to the ground. With a wide gash in her leg her father sent her home so her mother could stop the bleeding with home remedies.

Doctors and hospitals were avoided as tools of Satan, even though the family had an unusual number of severe injuries due to their lifestyle. Westover’s mother suffered a traumatic brain injury when her brother fell asleep at the wheel driving through the night from Arizona. (No member of the family wore seatbelts.) In another overnight driving accident, Tara blacked out and her neck was “frozen” for a month. Her seventeen year old brother received third-degree burns to his leg when he spilled gasoline drained from cars on his jeans, and later lit a cutting torch. Ten-year-old Tara treated him by immersing his leg in a trash can filled of water. His parents debrided the burns with a scalpel and treated his fever and agony with ice and herbs. When Tara had tonsillitis, her father directed her to stand outside with her mouth open for 30 minutes each day.

Westover’s brother “Shawn” (a pseudonym) began to abuse her when she was about 15. When she refused his commands or otherwise displeased him, he would drag her by the hair to the toilet, dunk her head, and twist her wrist until she apologized, breaking it one one occasion. and calling her a whore. This went on for a decade. She later found that he had done the same to her older sister. Westover’s mother witnessed the abuse but later sided with her father in refusing to accept Tara’s account. “Shawn” eventually went on to inflict similar treatment on his wife. Westover is currently estranged from her parents and some of her siblings because she confronted them about her brother’s violence and abuse.

Tara’s older brother Tyler (to whom the book is dedicated), who had been in school before his father withdrew his older children, had escaped to college and encouraged her to follow the same route. He told her about the ACT test, showed her how to access the internet, and completed her application to Brigham Young University (BYU) for her. Tara taught herself algebra and grammar and scored high enough to gain admittance to BYU.

BYU was a new world for Westover. In one of her first lectures on Western art, she asked what the Holocaust was and her teacher and classmates thought she was making an inappropriate joke. Although initially lost and bewildered, her passion for learning enabled her to excel despite having to work multiple jobs to pay for her schooling. Westover graduated from BYU magna cum laude in 2008, receiving “the most outstanding undergraduate” award from the history department. She won a prestigious fellowship to Cambridge University, where she earned her PhD in intellectual history and political thought at the age of 27.

Educated highlights two of the issues that were most recently raised by the Hart and Turpin cases–homeschooling risks and failure to report maltreatment.

Homeschooling. “Homeschooling” for Tara was first and foremost educational neglect. She was given no formal education and was reliant on a few old textbooks to try to teach herself. It was only her exceptional ability and desire to learn that allowed her to make up for lost ground in college or beyond. “Homeschooling” allowed her to be exploited as a child laborer during school hours, In addition, it deprived her of contact with professionals who might have questioned her various injuries from work and from her brother’s abuse and reported them to the authorities.

Failure to report maltreatment: As in the cases of the Harts and Turpins, nobody reported this family to CPS, even though many family members and residents of their town were aware of the dangerous conditions and educational and medical neglect, if not the abuse, to which these children were subject. Westover’s paternal grandmother argued passionately with her son against his choices to avoid school and medical care. Many members of the community had worked for Westover’s father, been injured and quit or were fired. They were well aware that the children were being forced to work under these conditions instead of going to school. The family attended Mormon church weekly with nearly everyone in the town, and it is inconceivable that other members were unaware of the children’s situation. Westover got to know others in the community by participating in musical theater. She reports that people in the community “reached out to her,” but she never spoke to a social worker or any other person who could really help.

Why did nobody report? The same reluctance to interfere and fear of reprisal that influenced neighbors and family of other maltreated children like the Harts and Turpins probably played a role in this case. But the culture of this particular rural, Mormon community likely made reporting to a government agency unthinkable. Many residents may not even have known that there was an agency to receive such reports. Unfortunately, this type of community is more likely that others to harbor more families living off the grid and failing to meet their children’s fundamental needs.

The key question in the end is this: What, if anything, could be done to save Tara and her siblings from the extreme neglect they all suffered as well as the abuse endured by Tara and her sister? Two possibilities come to mind.

Regulate Homeschooling: There is very little regulation of homeschooling in Idaho,. The state requires that parents who homeschool must provide instruction in “subjects commonly and usually taught in the public schools of Idaho.” However, there are no requirements regarding notification of the relevant authorities, parent qualification, instruction time, bookkeeping, or assessment requirements. The Coalition for Responsible Home Education, an advocacy group made up of homeschool alumni, recommends that parents be required to provide annual notification of homeschooling, and maintain academic records for each child; students’ academic progress should be evaluated and reported annually and failure to make adequate progress should result in intervention; homeschooled children should meet the same medical and immunization requirements as children who attend public schools; and students should be assessed annually by mandatory reporters. These measures might have protected Westover’s older siblings after they were withdrawn from school. However, someone would have to report the four younger children’s existence to the educational authorities to trigger these protections. Thus, reporting–either to educational or child welfare authorities–becomes crucial

Encourage Mandatory Reporting: To prevent future cases like that of the Hart children, I have recommended universal mandatory reporting accompanied by a robust public information campaign to inform adults about the signs of maltreatment and the obligation to report any reasonable suspicion of maltreatment. But in a small Mormon community like the one where Westover grew up, this many not be enough. Perhaps states like Iowa and Utah could enlist the Mormon church to help promote the message about the importance of reporting abuse and neglect, including educational neglect.

Most people who read Tara Westover’s memoir will marvel at how she managed to escape her deadly background and become an academic superstar and successful writer. But not all children have the strength and gifts Tara had, and she paid a high price in suffering and lifelong scars. So I hope people will also think about how to save future Tara Westovers. It takes a caring community to protect a child whose family is a source of danger instead of protection.

How to prevent more Hart cases

In my last post, I discussed the tragic case of the six children adopted by Jennifer and Sarah Hart. The entire family is presumed dead in the crash of their SUV off a cliff in California on March 26. Multiple system gaps resulted in the failure to rescue these children before their tragic death. Below are some suggestions for filling these gaps so that children do not continue to suffer and die in abusive homes.

Improve Vetting of Potential Adoptive Families. States that are desperate to find adoptive parents for large sibling groups or other children with special needs should not overlook obvious red flags. Clearly a past investigation for abuse of an adopted child–as in the Hart case– should have resulted in serious reconsideration of their application to adopt the sibling group that was currently living with them for a trial period. But the home study process should also be sophisticated enough to identify more subtle problems. These might include parents with a “white savior” complex who are adopting for the wrong reasons and are not suited to parent traumatized children.
Monitor adoption subsidy recipients. The Harts received almost $2,000 a month in adoption subsidies, but the children were never monitored to ensure that all was well. All agencies paying adoption subsidies should verify periodically that the children are alive and well and still living in the adoptive home. Submission of an annual doctor visit report, and/or an annual visit by a social worker could be used for such verification. There has been little support in the past for monitoring families receiving adoption subsidies, on the grounds that adoptive families should be treated the same as biological families. But the addition of money to the arrangement modifies the picture. Adoptive families sign contracts with the state, which could include a requirement that they cooperate with monitoring. When taxpayers are financing the care of our most vulnerable children until they reach adulthood, they should demand that the well-being of these children be regularly monitored.
Regulate homeschooling. The Harts removed all their children from school after their child abuse case closed in Minnesota. The Coalition for Responsible Home Education (CRHE), an advocacy group for homeschooled children, recommends barring from homeschooling parents convicted of child abuse, sexual offenses, or other crimes that would disqualify them from employment as a school teacher. CRHE also recommends flagging other at-risk children (such as those with a history of CPS involvement) for additional monitoring and support and requiring an annual assessment of each homeschooled child by a mandatory reporter. Unfortunately, the powerful homeschool lobby has beaten back attempts to impose such requirements in many states. But the climate may be changing, with a raft of horrific cases around the country (most recently the Turpins) resulting in proposals to require regulation.
Adopt universal mandatory reporting and educate the public about reporting child maltreatment. If a friend who witnessed abuse by the Hart parents in 2013 or their Washington neighbors had reported their disconcerting observations earlier, the children’s lives might have been saved. Eighteen states already require all adults to report suspected child abuse; the rest impose this requirement only on specified professional groups. All states should adopt universal mandatory reporting, but more importantly they should inform their residents about the signs of child maltreatment and the need to report. Public information campaigns should emphasize that the reporter need not have proof that there is maltreatment before making a report. As one child advocate puts it, “a reasonable suspicion that a child is at risk” warrants a call to the child abuse hotline. Better safe than sorry.
Require interstate information sharing. When Oregon and Washington received reports about the Harts, they had no way of knowing that abuse had already been documented in Minnesota. Perhaps they would have tried harder to see the family after their first attempt failed. Hotline staff need to have access to out-of-state records as soon as they receive a report, because the existence of a previous history may add urgency and credence to the new allegation. Minimally, states should be required to participate in an interstate network to share data in their child abuse registries. This was recommended by 2017 Congressional intern Tonisha Hora, who along with her sister suffered ten years of severe abuse before she was rescued by CPS.
Make investigations more child-friendly. A family friend who reported that the Harts deprived their children of food as punishment was told that CPS could not verify the allegation because the children had apparently been coached to lie. We need to rectify the pro-parent bias that allows many true allegations of abuse to be unsubstantiated or even not accepted for investigation. Investigators must be required to interview children before they can be “coached” by parents. If children appear to be coached, the case should be kept open until enough information is gathered to ensure they are safe.

The Hart children can be seen as victims of a “perfect storm”–adoption by unqualified parents, home schooling, neighbors who failed to report, history not shared between states, and inadequate investigations. But it only takes one system failure to kill a child or scar one for life. All of these systemic gaps must be addressed, so that all children can have a real childhood and grow to be happy, productive adults.

Multiple System Failures Allowed Hart Children to Die

On March 26, an SUV filled carrying a family plunged off a cliff. The car belonged to Jennifer and Sarah Hart. Their bodies, and those of three of their children, were found on the scene. Three children are still missing although another body found in the ocean may be one of the children. Initial coverage focused on the fact that the family consisted of two white mothers and six adopted black children. The family had had an earlier brush with fame when one of the boys was in a viral photograph hugging a police officer at a Ferguson protest.

As the days passed, disturbing details came to light. Days before the crash, Washington Child Protective Services (CPS) had opened an investigation of the family after a neighbor called the child abuse hotline. We eventually learned the family had a history of abuse reports. Then we learned that the crash appeared intentional, and probably triggered by the CPS report.

With each new discovery, we learned of another systemic failure to protect these vulnerable children. The Hart case brings together several common themes found in many cases of severe child maltreatment. Each of these themes highlights a different gap in the system that is supposed to protect our children.

Adoption: All six Hart children were adopted from foster care in Texas: three in 2006 and the next three in 2009. It is not that being adopted makes children more likely to be abused. Indeed, one Dutch study indicated adopted children were less likely to be abused than children growing up in their biological families. However, anecdotal evidence suggests that adopted children are overrepresented among children who are severely abused or neglected, at least in homeschool settings. Many of these cases involve common elements, including locking children up in a room, withholding food, and isolating the child by homeschooling or other means, all of which were present in this case. One possible explanation for this pattern focuses on the traumatic backgrounds of many adoptive children, which may lead to behaviors that adoptive parents are not prepared to deal with. While they may start out with good intentions, they end up resorting to punitive and eventually abusive parenting to control the undesired behaviors.

Writer Stacey Patton has described a “white savior attitude” among some white parents who adopt black children from the U.S. or abroad. These parents “wear their transracial adoption as a status symbol.” These adoptive parents often post on social media about their extraordinary efforts to deal with their children’s emotional and intellectual challenges that they attribute to the deficiencies of their birth parents.” The Harts fit this pattern. According to the Oregonian, the Harts often said their children suffered a multitude of early childhood behavioral and developmental issues that made parenting a challenge. Jennifer Hart also polished her image as an ideal mom who gave her underprivileged children a beautiful life. She frequently posted on Facebook portraying an idyllic family life full of trips, celebrations, community service, and events like the Ferguson rally in which Devonte sported a sign offering “Free Hugs.” When adoption is all about the parents, and the children become part of their public image, a bad outcome is not surprising.

There is reason for concern about the vetting process the Harts received when adopting the children. The Hart kids were among the 300 to 400 Texas children adopted each year by out of state foster parents, often because they are harder to place because they are in large sibling groups or have special needs. The Harts would have been vetted by a Minnesota agency, which would have submitted their home study to Texas for approval. After a child visit, the children would have probably moved in with the Harts for a six-month trial period. A Texas agency spokesman told the San Antonio Express-News that during the trial period for out-of-state adoptions, the out-of-state agency would be monitoring the family and reporting back to Texas. But in September 2008, probably during the trial period for the second adoption, Hannah Hart was asked about a bruise in her arm. She reported that her mother hit her with a belt. Police and social services interviewed the mothers, who denied the beating and said she had fallen down the stairs. Nevertheless, the second adoption went through. We need to know whether Texas was informed of this investigation.

Once the adoption was finalized, there was nobody monitoring the Hart children, even though Texas continued to pay for their care. The San Antonio Express-News reports that Jennifer Hart received nearly $1,900 per month in adoption subsidies from the State of Texas. The paper estimates that she collected a total of $270,000 from the state for caring for the six children during the time they lived with her. Unfortunately, children who receive adoption subsidies are not monitored to ensure that they are being properly cared for, are still in the home, or are even alive. Such monitoring has not been imposed even in the wake of cases in which adoptive parents like Renee Bowman and Edward and Linda Bryant have fraudulently collected adoption subsidies after killing–or allegedly killing–their children.

Home Schooling. On April 11, 2011, Sarah Hart made a plea agreement a week after pleading guilty to physical abuse of a six year old child. The next day, all six children were removed from school, never to attend again. The Harts joined a long line of abusive parents that removed their children from school after a brush with CPS. The notorious Turpin family, who gained worldwide attention this winter when one of their 13 malnourished children escaped confinement in their home, who also liked to dress their children in matching tee shirts. As the Coalition for Responsible Home Education points out, Pennsylvania is the only state that bars convicted child abusers from homeschooling, and then only if the conviction is in the past five years. No state has any mechanism to identify cases where parents remove a child from school after a child protective services case is closed, or after a series of child abuse allegations.

Failure to report: At a festival in Oregon, the Oregonian reports that one acquaintance observed the mothers become enraged after she brought Devonte and Sierra back to her parents from a day out, bearing food. Sarah Hart grabbed Sierra’s arm, inflicting a bruise that lasted for days, and both mothers chastised her for “being selfish” and not sharing. Sierra told the woman that she often got in trouble for talking to people her mothers did not know. But the neighbor did not report the disturbing incident. The Hart family’s neighbors in Washington, Dana and Bruce DeKalb, told reporters that they had suspected that something was not right in the Hart household. A few months after the Harts moved to Washington, the DeKalbs reported that Hannah Hart came to their door at 1:30 AM. She had jumped out of a second-story window and ran through bushes to their home, begging them to protect her from her abusive parents. The neighbors noted that she was missing her front teeth and appeared to be about seven years old, although she was twelve. The other children also appeared small and thin when the family came over the next morning.

The DeKalbs told the Washington Post that they considered calling CPS but “tried to overlook the incident.” In the next eight months, the DeKalbs saw Devonte doing chores but never saw the other children outside. About a week before the crash, Devonte began coming to the DeKalbs’ house requesting food and saying that his parents had been withholding food as punishment. The visits escalated from daily to three times a day. It was only after a week of such visits that they finally called CPS, setting in motion the the escape attempt that ended in the fatal crash.The DeKalbs’ hesitation echoes that of the Turpins’ neighbors, who never reported the many red flags they saw.

Lack of Data Sharing Between States: Court records indicate that Minnesota’s child protection agency had at least two interactions with the Hart family before they left the state. In 2008, Hannah reported that her mother hit her with a belt, as described above, resulting in an investigation by police and CPS. In 2010, six-year-old Abigail’s teacher found her with bruises covering much of her stomach and back. Abigail told police and a social worker that Jennifer Hart hit her repeatedly with a closed fist and submerged her head underwater. She also said that Jennifer Hart withheld food as punishment. Sarah Hart (not Jennifer) was eventually arrested, pled guilty to misdemeanor domestic violence, and received a suspended jail sentence and a year of probation.

But this information never found its way to Oregon, where CPS was unable to confirm a report from a family friend that the Harts were punishing the children by withholding food and using “controlling emotional abuse.” The Harts then moved to Washington, where CPS would not have known that the parents had a history with their counterparts in other states. There is no national child welfare database that a state can check to determine if a family has history in another state. If Oregon had wanted to check with Minnesota, it might have taken months and the state might have refused access to the data unless the parents gave consent.

Biased Investigative Process: As mentioned above, Oregon CPS was unable to substantiate a report from a family friend that the Harts were punishing the children by withholding food and emotionally abusing them. CPS interviewed the children but told the friend that it appeared they had been “coached” to lie, so there was no evidence to substantiate the allegation. The question is, why were the parents given enough warning that the children could be coached? This is only one example of how the system is biased toward parents’ rights over children’s safety.

Multiple systemic gaps allowed the abuse of the Hart children to continue until it culminated in the deaths of the entire family. A variety of policy changes are needed to address the gaps highlighted by this tragic case. I will discuss these in my next post.

Why Kansas let Adrian and Evan die

Image: kansascity.com

Image: cbsnews.com

Dianne Keech, a former Kansas child welfare official and currently a child safety consultant, was asked by the Wichita Eagle and Fox News to analyze case files regarding the highly-publicized deaths of Adrian Jones and Evan Brewer. I asked Ms. Keech to prepare a guest blog post about the factors contributing to the deaths of Evan and Adrian. She prepared a ten-page document, which you can access here. Below, I highlight some of her conclusions.

Calls to the Kansas child abuse hotline began when Adrian Jones was only a few months old. There were 15 screened-in reports for Adrian before he was six years old. Out of 15 reports in total that KCF investigated, Keech found that there was only one substantiated allegation of abuse, and that was based on an investigation by law enforcement. After Adrian was removed from his mother’s custody due to lack of supervision and placed with his father and stepmother, calls alleged that there were guns all over the house, that the stepmother was high on drugs, that Adrian had numerous physical injuries, that he was being choked by his father and stepmother, and that he was beaten until he bled. Adrian’s father and stepmother consistently denied every allegation and the agency did nothing to verify their stories. Adrian’s body was found in a livestock pen on November 20, 2015. It had been fed to pigs that were bought for this purpose. It was later found that Adrian’s father and stepmother had meticulously documented his abuse through photos and videos. They are serving life terms for his murder.

DCF received six separate reports of abuse of little Evan Brewer between July 2016 (when he was two years old) and May 2017. These reports involved methamphetamine abuse by the mother, domestic violence, and physical abuse of Evan. Only three of these reports were assigned for investigation and none were substantiated. In the last two months of Evan’s life, the agency received two reports of near-fatal abuse, one alleging that he hit his head and became unconscious in the bathtub and the other alleging that his mother’s boyfriend choked Evan and then revived him. The first of these reports received no response for six days and the investigator apparently accepted the mother’s claim that the child was out of state. The investigator of the second report also never laid eyes on Evan. On September 22, a landlord found Evan’s body encased in concrete on his property. Horrific photos and videos documented Evan’s months of torture by his mother and her boyfriend. His mother and her boyfriend have been charged with first-degree murder.

Looking at Root Problems

Keech believes that there are three root problems that led to Adrian and Evan’s deaths: a dangerous ideology, the pernicious influence of a well-heeled foundation, and faulty outcome measures used by the federal government. These are discussed in order below.

Dangerous Ideology: Signs of Safety is a child protection practice framework that was never officially adopted by Kansas. But Keech alleges that its philosophy has permeated all aspects of child welfare practice in the state. The Signs of Safety framework, according to its manual, seeks to avoid “paternalism,” which “occurs whenever the professional adopts the position that they know what is wrong in the lives of client families and they know what the solutions are to those problems.” Signs of safety links paternalism with the concept of subjective truth, citing “the paternalistic impulse to establish the truth of any given situation.” According to Keech, this implication that all truth is subjective means that investigating “facts” is a worthless task. Workers are encouraged to “engage” parents, not investigate them. Keech gives numerous examples of how this practice approach left Evan and Adrian vulnerable to further abuse. When Adrian’s younger sister was brought to the hospital with seizures, she was diagnosed with a subdural head trauma that was non-accidental. But when Adrian’s stepmother insisted that Adrian inflicted the injury with a curtain rod, DCF believed her and did not substantiate the allegation–not even finding her neglectful for letting the child be hurt. When DCF received a report that Evan’s mother was using methamphetamine and blowing marijuana in his face, they accepted her denials and closed the case with no drug test required.

Along with a new practice framework, Kansas adopted a new definition of safety. As in many other states, safety in Kansas has been redefined as the absence of “imminent danger.” This is in contrast to “risk,” which connotes future danger to the child. As a result, children can be paradoxically found to be at high risk of future harm but safe–which happened twice with Adrian. (He was found to be at “moderate” risk three times.) As long as a child is deemed “safe,” the child cannot be removed from home. The decoupling of risk from safety explains why both Adrian and Evan were found to be “safe” 18 times in total, when they were anything but. This is a common situation in many other states. “Risk,” on the other hand, triggers an offer of services, which can be refused, which is what Adrian’s father and stepmother did when he was found to be at risk. I’ve written about the case of Yonatan Aguilar in California, who was found four times to be at high risk of future maltreatment but “safe.” His parents refused services. He spent the last three years of his life locked in a closet until he died.

Pernicious Influence: Casey Family Programs is a financial behemoth with total assets of $2.2 billion. Its mission is to “provide and improve, and ultimately prevent the need for, foster care.'”Over a decade ago, Casey set a goal of reducing foster care by 50% by the year 2020. Casey works in all 50 states, the District of Columbia, two territories and more than a dozen tribal nations. It provides financial and technical assistance to state and local agencies to support its vision. It conducts research, develops publications, provides testimony to promote its views to public officials around the country. As Keech puts it, “There is not a corner of child welfare in the United States where Casey is not a highly influential presence.” Keech has experienced firsthand Casey’s efforts to pressure Kansas to reduce its foster care rolls. At a meeting in that Keech attended in 2015, Casey used “peer pressure” to “shame one region for having a higher foster care placement rate. Casey adopted and promoted the Signs of Safety approach discussed above.

Faulty Federal Outcome Measures: The Child and Family Services Review (CFSR) is an intense federal review of the entire child welfare system. If a state does not pass the review (and no state has passed, to date) then the state must agree with the federal government on a Program Improvement Plan (PIP) or lose funding. Keech feels that the federal reviews can be manipulated by states to improve their outcomes at a cost to child safety. For example, one of the two measures of child safety is timely initiation of investigations. When a hotline screens out a report (as was done three times with Evan) or a case manager fails to report a new allegation (which was done three times while Adrian had an open services case) the agency does not need to worry about timely initiation of an investigation. Another CFSR outcome is “reduce recurrence of child abuse and neglect, ” which is measured by calculating the percentage of children with a substantiated finding of maltreatment who have another substantiated finding within 12 months of the initial finding. This outcome can be improved by failing to investigate reports, or investigating them but failing to substantiate. Only one of the allegations involving Adrian was substantiated; three of the allegations involving Evan were not even investigated and the other three were not substantiated. By not substantiating allegations, Kansas reduces its recurrence rate.

The factors that Keech discusses are not unique to Kansas and are occurring around the country, in states including most of America’s children. All of these states should consider Keech’s recommendations for protecting Kansas’ children from the fate of Adrian and Evan. Most importantly, states need to prioritize the safety of children over and above any other consideration. The primary goal of child welfare must be the protection of children, not reducing entries to foster care. The artificial division between risk and safety should be eliminated and risk should be allowed to inform safety decisions. States must treat substance abuse, domestic violence, criminal activity, mental health issues, and parental history of maltreatment, as real threats to child safety. Workers must be empowered and required to gather all of the information needed to determine the truth of allegations, not rely on adults’ self-serving denials. And they must be allowed–and required–to request out of home placement when there is no other way to protect a child.

Childhood trauma: Let’s invest in prevention as well as treatment

Oprah childhood trauma — Image: jsonline.com

In the past decade, the world has discovered trauma. More and more “trauma-informed” models of care have been developed, and more and more institutions and government agencies have adopted these models, making a lot of money for their developers. Awareness of trauma and trauma-informed care took a big leap with its discovery by Oprah Winfrey, who highlighted in a 60 Minutes segment the adoption of the approach by her home town of Milwaukee.

Recognizing the impacts of trauma on human development and incorporating this knowledge into education, social services and other areas is important. But I wish we could devote as much attention to preventing trauma as we do to treating its effects.

Oprah’s story started with the case of Alisha Fox. She was removed from her mother at the age of one and placed in foster care. At the age of four, she was placed with her father, “a sometimes construction worker prone to heavy marijuana use and violent bouts of depression, “according to an article in the Milwaukee Journal-Sentinel which inspired Oprah’s story. For the next ten years, Alisha endured sexual abuse by her father. By the time she revealed the abuse and was removed from her father, she had a full-blown case of Post Traumatic Stress Disorder (PTSD).

Whether Alisha’s trauma could have been prevented is not clear. The child welfare system may have erred in placing her with a deeply troubled and drug-abusing father. Alisha told the Journal Sentinel that she covered up the abuse until age 14. It is common for abused children not to report their abuse. One can’t help but wonder if there were warning signs that were disregarded. There is more awareness now of the signs of child sexual abuse than there was when Alisha was a child. So we just don’t know if Alisha’s years of trauma could have been cut short or if other children in her situation can nowadays be protected better than she was.

But we do know that many other children are abused for years while numerous red flags are disregarded. Nobody called the authorities about the 13 Turpin children as they were beaten, starved and chained for years in two states, even though family and neighbors in two states noted numerous warning signs. Texas neighbors considered reporting but had seen Turpin with a gun and feared “repercussions.” California neighbors perceived a peculiar and private family but claimed not to draw the conclusion that abuse was occurring.

Other traumatized children are reported numerous times but the system never intervenes to help them. We we often hear about these children only after they die. Evan Brewer was killed by his mother’s boyfriend after the Kansas child welfare agency had received eight reports that Evan was living in a home of chronic meth users and that the mother’s boyfriend was choking him until he blacked out. For every Evan Brewer who is finally killed, there must be many more Alisha Roths, who escape after years of suffering. Or like Congressional intern Tonisha Hora who wrote:

At 14 years old, my twin sister and I were removed from a kinship care placement and put in foster care after experiencing severe physical and verbal abuse for ten years…Child Protective Services often visited our home, sometimes multiple times a year, after they received reports from neighbors and teachers who we often asked for food to keep from being hungry or saw our bruises. We were scared children who wanted to run away every day in hopes of escaping. We were aware of how the system continued to fail us by never removing us from our home when they should have. To us, the signs were obvious, yet CPS workers always left us there. The abuse worsened after every CPS visit. That was the problem: they always left without us. Every time. For ten years.

There are things we can do to save the Alishas, Tonishas and Evans of this world before they end up with PTSD or die. We need universal mandatory reporting accompanied by a massive public education campaign about the signs of child abuse and the duty to report even a suspicion of maltreatment. We need enough funding to ensure that CPS workers are qualified and have time to make good decisions. And we need to ensure that the current bias by agencies around the country toward preserving and reunifying families does not go too far and leave children to suffer in silence.

It is great that cities, states and the federal government are investing in trauma-informed care. Lets hope that with the help of citizen input, they soon decide to allocate equal resources to save traumatized children before they suffer as long as Alisha did.