Abusive parents are using homeschooling to avoid detection

Hart family
Photo: Associated Press

On April 25, 2018, Connecticut’s Office of the Child Advocate (OCA) issued a stunning report. Using data from six school districts, OCA found that over a third of children removed from school to be homeschooled lived in families that had been reported at least once for abuse or neglect. This is the first publicly released data to suggest the extent to which homeschooling may serve as a vehicle for abusive parents to isolate their children from scrutiny by other adults.

The Child Advocate’s report was a follow-up to its investigation of the tragic death of Matthew Tirado.  On February 14, 2017 , Matthew died of homicide from prolonged child abuse and neglect by his mother. While Matthew was never formally withdrawn from school (though he had not attended for a year), OCA found that his mother was able to withdraw his sister from school after numerous reports by the school district alleging abuse and neglect in the home.

To determine whether other children from families that were the subject of child abuse allegations were withdrawn from school, OCA collected data from six Connecticut school districts, the Hartford District where the Tirados lived and five other districts selected for their diversity. Their analysis showed that over three school years, 2013-2016, 380 students were withdrawn from the six districts to be homeschooled. Of those students, an astonishing 138 (or 36%)  lived in families that were the subject of at least one prior accepted report of abuse or neglect. Most of these families had multiple prior reports, ranging from two to 30 reports. 11% of the withdrawn children belonged to families with four reports or more.

Executive Director Rachel Coleman of the Coalition for Responsible Home Education (CRHE) is not surprised by this percentage. She cites an unpublished study conducted in another state, which produced similar results. Coleman also cites the groundbreaking study of torture as a form of child abuse by Barbara Knox and colleagues. Of the school-aged victims they studied, 47% had been removed from school under the pretext of “homeschooling,” although no education was taking place in these homes. According to the researchers, this “homeschooling” “appears to have been designed to further isolate the child and typically occurred after closure of a previously opened CPS case.”

Like the parents in Connecticut and those studied by Knox, Jennifer and Sarah Hart removed their six children from school as soon as Minnesota CPS closed their last case in 2011. The school had made six reports concerning food deprivation and physical punishment, two of which resulted in findings of abuse. With their withdrawal from school, the children had lost their best advocates. They continued to endure starvation and cruel discipline until their deaths in 2018.

The OCA report suggests that “homeschooling is used to conceal abuse more frequently than has been commonly thought,” as Rachel Coleman puts it. With 1.7 million children being homeschooled today, it is possible that hundreds of thousands are living in abusive situations.

Abusive parents must not be allowed to withdraw their children from school on the pretext of homeschooling them. Legislators must act to require schools to report all withdrawals for the purpose of homeschooling to Child Protective Services (CPS) to be cross-checked for previous reports. Parents with at least one substantiated abuse or neglect report should not be allowed to homeschool. Parents who have been the subject of an unsubstantiated report could be allowed to homeschool, subject to frequent monitoring by the school district or CPS.

The powerful homeschool lobby will object to any such regulation of homeschooling. In California, a massive outcry from homeschooling parents killed a very modest bill to require annual fire inspections of all home schools, prompted by the Turpin case.  The Home School Legal Defense Association has stated that “abuse is horrible and must never be tolerated. But imposing regulations that treat all home-schooling families like criminals is unjust.” Nobody is suggesting that homeschooling parents be treated as criminals. Rather, they should be treated a little more like schools.

“Steady March Toward Child Fatality Prevention” leaves Many Endangered Children Unprotected

sad child
Image: socialworkhelper.com

In an April 26 Opinion piece in the Chronicle of Social Change, Teri Covington congratulated the child welfare establishment for a “steady march toward child fatality prevention,” citing new developments on the federal, state and local levels. Earlier that week, new details came out about a case involving six child abuse fatalities that had transfixed the nation. But any mention of the Hart case–or how we can address fatalities and near-fatalities from chronic and severe child abuse–was conspicuously missing from the article and the briefing conducted by Covington’s group on the same day.

On April 23, newspapers across the country carried new headlines about Jennifer and Sarah Hart and their six adoptive children, who drove off a California cliff to their deaths in March. The new information, released by the State of Oregon Department of Human Services (DHS), revealed that DHS knew of the Hart parents’ extensive CPS history in Minnesota and had convincing evidence of maltreatment in Oregon but was still unable to determine that abuse had occurred.

The Hart case may have been unusual in the sheer number of system failures involved, but none of the specific features of the case is unusual. In January, the 13 Turpin children who were saved from death by abuse and starvation by the extraordinary bravery of one child. Within the past year, we’ve learned about Brook Stagles in New York, Evan Brewer in Kansas, and many other children who were allowed to suffer ongoing torture and abuse because of failures of the community and the systems designed to protect them. And those are only the cases that made the headlines. We will never know how many other children have suffered and perhaps died of chronic and severe abuse without ever being discovered.

In the article and briefing, Ms. Covington cited a number of actions by federal, state, or local governments that fulfill one or more of the 100 recommendations of Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF). First and foremost according to Covington was the passage of the Family First and Prevention Services Act (FFPSA), which she hailed as a “seismic change,” because it makes resources available for the first time for services to prevent children who have already been abused or neglected from entering foster care. It’s hard to see how the passage of FFPSA could help victims of chronic and severe child abuse. The view that virtually no abused child should enter foster care may be one reason why many abused children are eventually killed by their parents. Moreover, it is hard to see how FFPSA will make the kind of difference expected by its advocates, since states are already funding the same services through funding streams like Medicaid and TANF.

Covington also mentioned the addition of $60 million in CAPTA funds in the current fiscal year for safe plans of care for drug-exposed infants as “another major federal improvement.” This is a good step that might aid in early identification of some children at risk of abuse, but it is a drop in the bucket compared to the need.

Several state and local initiatives mentioned by Covington are steps in the right direction to identifying victims of chronic and severe child abuse. These include the introduction of predictive analytics, improved data sharing between agencies, and more interagency planning and action.

However, conspicuously missing from Covington’s narrative are a set of major reforms that need to occur if we are to avoid more tragedies due to severe and chronic abuse. Some of these reforms are listed below:

  1. Improve vetting of potential adoptive parents. Jennifer and Sarah Hart arranged the adoption of their children through a Texas agency that reportedly put together adoptions against the wishes of the child welfare agency. Moreover, the second set of children was adopted even though the parents had already been investigated for abusing one of the first set. Agencies must not let their desperate search for homes for children considered to be hard to adopt lead them to disregard the future outcomes for these children.
  2. Monitor children whose parents receive adoption subsidies. Given the disproportionate number of serious cases of child maltreatment among adopted children and a valid state interest in the well-being of children supported by the state, parents receiving adoption subsidies should be required to document annually the child’s well-being through a social worker or doctor visit.
  3. Monitor homeschoolers and ban homeschooling by known child abusers. It is all too frequent for parents who have been substantiated for child abuse to withdraw their children from school as soon as their case is closed and they are no longer under the supervision of the child welfare agency. Parents with a record of abuse should not be allowed to homeschool their children. In addition, since homeschooled children appear to figure disproportionately in serious cases of abuse, all homeschooled children should have at least annual contact with a mandatory child abuse reporter such as a teacher, doctor or social worker.
  4. Adopt and promote universal mandatory reporting. Only 18 states and Puerto Rico require all adults to report suspected child abuse or neglect; most states require only certain professionals to do so. And even in the universal reporting states states (including Texas, where neighbors did not report the numerous red flags surrounding the Turpin family), it is unlikely that people know or observe the law. It should be mandatory for all adults to report any reasonable suspicion that a child is being maltreated and this duty should be promoted through a massive public information campaign.
  5. Demand greater accountability from mandatory reporters, as CECANF recommended. Incredibly, an Oregon pediatrician who saw the Hart children at the request of DHS reported that she had “no concern” that five out of six were so small and thin that their weights and heights did not even appear on the growth charts for children their age. CECANF recommended that mandatory reporting training and competency should be a requirement for licensure when applicable. Licensees and their agencies should be responsible for maintaining and refreshing their competency. And doctors who fail to fulfill their responsibilities should lose their licenses.
  6. Revamp investigations. Agencies need to separate the determination of whether abuse has occurred (which can be difficult when frightened children are coached to lie) from the decision to protect vulnerable children. Furthermore the definition of “safety” needs to be changed in many states. Often, a child deemed to be at high risk can be simultaneously labeled as “safe.” Thorough investigations also require manageable caseloads, which in turn require sufficient funding, which is not available in many states.
  7. Interstate registry: In child maltreatment death cases like that of Adrian Jones, parents have been able to escape detection by moving to another state. States should be required to participate in an interstate registry of child maltreatment reports and findings. This was recommended by foster care alumna and 2017 Congressional intern Tonisha Hora, who along with her sister suffered ten years of severe abuse before she was rescued by CPS.
  8. Reform in-home child welfare services so that meaningful services are provided and feedback is obtained from providers about parents’ progress. No case should be closed unless a state obtains credible testimony from service providers, the children and other professionals who know the family that parental behaviors have changed. Again, this require manageable caseloads and adequate funding.

Why were none of these proposals mentioned in the article and briefing? The most direct cause is that only one of these proposals (holding mandatory reporters accountable) was recommended (in part) by CECANF. But that just begs the question of why they were not among the CECANF recommendations.  There are three reasons I can identify:

  1. More children die of neglect than abuse. Of the children who were reported to the federal government who died of maltreatment in 2016, 75% suffered neglect and 44% suffered abuse either exclusively or in combination with another maltreatment type. At the briefing, a speaker from the Virginia Department of Social Services stated that unsafe sleep was the primary driver of child fatalities in Virginia, so the department was concentrating its fatality prevention work on safe sleep. Of course we should promote safe sleep, but we can’t ignore those children who die of severe and chronic child abuse because they are fewer in number.
  2. Many of these measures would draw intense political opposition for ideological reasons or because they would require increased spending. Homeschooling parents and adoptive parents have been adamantly opposed to any monitoring of their children. Doctors would virulently oppose greater penalties for malfeasance. Beefing up child welfare systems would cost money and systems around the country are struggling to obtain enough funds to meet increasing needs.
  3. The narrative currently embraced by the child welfare establishment is that all parents want the best for their children and that all children do best with their parents, no matter how abusive or neglectful. Perhaps that is why there has been so little response to the Hart tragedy and similar tragedies from the agencies responsible for protecting children.

The child welfare establishment needs to recognize that there are some parents to whom the prevalent rosy attitude simply does not apply. Ms. Covington opened her article by stating that deaths of children from abuse and neglect increased by more than 7 percent from 2015 to 2016. We don’t know how many of these deaths stemmed from severe and chronic child abuse. If there is such a thing as “a fate worse than death,” then years of torture by the people who are supposed to protect you qualifies. As you are reading this, how many children are being deprived of food, chained to their beds, or being beaten? One is too many, and political barriers should not be allowed to prevent action.

Despite DHS Statement, Little Change Apparent in Oregon Child Protection Practice Since Hart Case

Policies and Procedures binders in the office. Stationery on a wooden shelf
Image: Oregon.gov

In a cover letter accompanying the records of its interactions with the Hart family–the six children and their adoptive parents who are all presumed dead after their van drove off a cliff on –the Oregon Department of Human Services (DHS) tacitly acknowledged that it botched an opportunity to rescue the six children from years of suffering and a tragic death. DHS also suggested that such a catastrophic error would not happen today because policy and practice have changed. But available evidence raises questions about whether vulnerable children are any safer in Oregon today than they were in 2013.

The released records show that DHS knew that Jennifer and Sarah Hart had been reported for child abuse six times in Minnesota and two of these reports had been confirmed. Sarah Hart had even pleaded guilty to misdemeanor abuse charges and was placed on probation. At least two women who knew the family reported the Hart withheld food from their children and used excessively harsh punishments. Nevertheless, DHS closed its investigation after concluding it was unable to determine that there was abuse in the home.

Since the time of the Harts’ assessment, according to the cover letter, “DHS has shifted practice from incident-based investigations to comprehensive safety assessments” and Oregon has “greatly increased efforts to provide ongoing training…on Oregon’s Safety Model (OSM).” A quick search showed that OSM, in comparison with the previous practice model, indeed was a step toward protecting vulnerable children. Instead of being dependent on confirming the specific allegations of abuse, the decision to act would now be based on the present safety of the children.

But the recent audit of child welfare in Oregon reveals that the OSM was actually rolled out in 2006–and was in place long before the Hart investigation. Unfortunately, it was never fully implemented because of inadequate training and opposition from administrators and staff. There seems to have been a new push to implement the model fully at about the same time as the Harts were being investigated in 2013. But statewide effort to retrain workers in the model was halted in 2014 and the resources reallocated to training in a new model, Differential Response. That model was in turn dropped but training in the OSM never resumed. Managers were still resistant it in 2017, when the audit was conducted.

Moreover, the DHS website shows that the new push to train staff in the Oregon safety model is still in its early stages. In a description of a project called Fidelity to the Oregon Safety Model Part 2, DHS states that “Some caseworkers and supervisors know and use the model well but other caseworkers and supervisors do not.” The website goes on to say that while online training is available, the agency needs more trainings, as well as coaching and quality assurance, to make sure the model is used “consistently.” (And this is a model that has been on the books since 2006!) The project aims to “create new training so that all staff understand and use the Oregon Safety Model and use it correctly.”

The timeline for the Fidelity to the Oregon Safety Model Project Part 2 is dated April 2018. According to the timeline, the project began in “March – May 2017” with the hiring of a project manager. In the intervening year, according to the timeline, the agency has created a work team, developed a project scope, held a kickoff meeting, developed a project plan, developed a scope of work for a consultant, finalized deliverables, assigned tasks and set timelines. It looks like the “active work” begins in August 2018 and the training will not begin until February 2019! So Oregon’s new statewide effort to train staff in the Oregon Safety model does not appear to have begun. Who knows whether this effort too will be dropped before it is implemented, and how effective the training will be if it is actually put into place?

But one part of the OSM seems to have been in use already, despite DHS’s claim that it was not. The DHS letter claimed that things would be different today because “case workers are trained to assess factors that contribute to a child’s vulnerability such as isolation (sic). Children who have no outsiders observing them are considered ‘highly vulnerable’ under the [Oregon Safety] Model and this factor must be considered…when making child safety decisions.” The Hart records show that DHS investigators were already assessing for vulnerability. In a section called “Vulnerability,” the investigator reported that “The children are completely dependent on their caregivers and do not have contact with any mandatory reporters, as they are home schooled.” Despite this understanding, the investigators opted to close the case without protective action.

DHS appears to be manipulating its reporting of the facts in order to suggest that its child welfare system has been reformed to prevent future catastrophic errors. But the recent audit and the case files themselves suggests this is not the case. The subtitle of the audit, “chronic management failures and high caseloads jeopardize the safety of some of the state’s most vulnerable children,” provides further reasons to doubt the capacity of DHS to protect the state’s most vulnerable children.

New Details on Harts Reveal Oregon Knew Children Were at Risk–but Left them in Abusive Home

Hart family
Image: cbsnews.com

In a previous post about the tragic story of the Hart family I listed multiple system failures that allowed the children to remain in an abusive home for years. In response to a public records request from multiple media outlets, the Oregon Department of Human Services released records from Child Protective Services (CPS) and police investigations of the Hart family. These records show that Oregon had extensive information about the children’s situation but still did not act to protect them.

The Hart family had reportedly lived in Oregon for just three months when a family friend called Oregon DHS to report that she was worried about the children after an incident at her home on June 28, 2013. The Harts were staying with the caller and she ordered pizza. Jennifer Hart gave each child, ranging in age from 8 to 15, one slice of pizza and some water. But in the morning, all the pizza was gone. Hart became angry. She stated that none of the children would be eating breakfast as none confessed to eating the pizza. All six children were made lie on an air mattress with sleeping masks on their faces for five hours as punishment. The caller said that the children had appeared to get taller, but not gain weight, over the 5 to 7 years since their adoption. The caller also indicated that the Harts had been investigated in Minnesota for withholding food from the children. The Harts pulled the children from school after the investigation but the caller doubted there was any education going on. Instead, Jennifer Hart took the children across the country for weeks attending music festivals and frequently had them pose as a happy family for Facebook.  The caller stated that the children were terrified of Jennifer Hart, their primary caregiver. Sarah was outside the home working during the day, but her loyalty was totally with Jennifer.

Because of missing pages in the Oregon record, we do not know the date of this report or how much time elapsed before DHS received a second report on July 18, 2013. An anonymous caller reported that the six Hart children appeared malnourished. The caller provided a Minnesota license plate number which enabled the hotline screener to identify Jennifer and Sarah Hart. The screener contacted Minnesota’s child welfare agency and quickly learned that the Harts had adopted their six children from Texas. A Minnesota social worker told the Oregon screener that Texas “seems to do a lot of adoptions through [a now defunct local agency}, even when the child welfare office has not approved the placement.”

The Oregon screener learned that Minnesota had received six separate abuse and neglect allegations against the Harts in 2010 and 2011, all of which came from the school regarding Abigail or Hannah Hart.  Three of the allegations involved physical abuse. and three involved food deprivation. On November 15, 2010, the school reported that six-year-old Abigail had “bruising on her stomach area from her sternum to waistband, and bruising on her back from mid-back to upper buttocks.” Abigail reported that Jennifer Hart beat her, but it was Sarah who said she was responsible for the marks. The beating reportedly resulted from a penny found in Abigail’s pocket, which her parents thought was stolen. The Harts “agreed to in-home therapy, parenting and counseling, and a variety of skill building activities.”

There is no information about whether the Harts really participated in these services, but a report came in the next month  (December) that Hannah had a bruise she attributed to Jennifer Hart, saying that Jennifer hit her “all the time.” Two reports came in January, one saying that Hannah had been asking classmates for food.  The final report stated that Hannah reported to the school nurse that she was hungry. During the investigation, the children reported being deprived of food as a form of discipline. As part of an assessment, six-year-old Abigail, who reportedly looked like she was two, was taken to the doctor, who “said she is just small, and being adopted, we don’t know their bio family history.” The Minnesota worker reported that when the parents were asked about the children’s hunger and their complaints about withholding food, they said the children were adopted, were “high risk kids,” and had food issues. The allegation apparently was confirmed and the Harts participated in services (perhaps the same services that were ordered pursuant to the November 15 report) but no information is provided about those services and whether the children were assessed to be safe before case closure. When that case was closed, and the services were “concluded” the family pulled their children out of school and eventually left the state for Oregon.

The Minnesota social worker told the Oregon screener that the problem was “these women look normal.” They knew what to tell professionals about special needs, adoption and food issues, to get them to “assign the problem to the children” rather than the parents. The Minnesota worker also understood that the children were at particular risk because “without any regular or consistent academic or medical oversight” and without reviews from the State of Texas, the children risked “falling through the cracks.”

After the Oregon screener spoke to the Minnesota staff, the case was approved for investigation by CPS. A CPS worker tried unsuccessfully to visit the family and found out eventually that the children were traveling with Jennifer Hart. Two Oregon CPS workers finally interviewed the parents and children on August 26, 2013–over a month after the report was received.  All of the children appeared small, but their mothers reported that they had  been small when they were adopted. Hannah Hart, 11 at the time, had no front teeth and the parents stated she had knocked them out in a fall and had to wait another year for dental work. All six children denied that they had been abused. According to the investigative report, “the children provided near identical answers to all questions asked.” For example, they all reported that they were punished by being required to meditate for five minutes. “All of the children, except Devonte, were very reserved, and showed little emotion or animation,” according to the CPS worker’s report. The investigator also observed  that the children looked at Jen Hart for permission to answer a question. The investigator was clearly not fooled by the identical answers. She later told one of the callers that the children had clearly been coached on what to say. Nevertheless, the children’s failure to report the abuse, even though it was characteristic of abused children who fear their caregivers, may have sealed their doom.

One of the family friends interviewed by CPS stated that Jennifer Hart viewed the children as “animals” when they came to her, and herself as their savior. The Harts displayed this “savior” mentality in their descriptions of the children when they were adopted. For example, they reported that when they adopted Devonte at the age of six, he could say only two words, both of which were expletives. They reported that he did not know where his fingers and toes were and was violent. They reported that Abigail was diagnosed as “borderline mentally retarded” at the age of two but had made “great strides” since that time. And they reported that Jeremiah was labelled “globally delayed” and possibly autistic, and could not even use a fork, but was currently functioning normally. As described in my earlier post, this exaggerated emphasis on the children as defective and the parents as saviors fits the pattern of the “white savior” as described by writer Stacey Patton.

The Harts agreed to a CPS request to take the children to a doctor to evaluate their weight. The doctor faxed the children’s growth charts to DHS along with a letter indicating “no concerns” even though five of the six children were so small that their heights and weights were not listed on growth charts for their age. The social worker was curious enough about this lack of concern that she spoke to the doctor, who , like the doctor in Minnesota, explained that she had no previous data or records for the children, and apparently therefore had no basis for concern.

The case was closed on December 26 with a disposition of “unable to determine, which means that there are some indications of child abuse or neglect, but there is insufficient information to conclude that there is reasonable cause to believe that child abuse or neglect occurred.” It was concluded that all of the children were “safe.” Nevertheless, in the section related “Vulnerability,” the investigator indicated that the children “are completely dependent on their caregivers and do not have regular contact with any mandatory reporters, as they are home schooled.”

The Hart case brings together many different barriers to our ability to protect abused children not just in Minnesota, Oregon and Washington but all over the country. In my post, How to Prevent More Hart Cases,  I identified a number of policy areas where change is needed in many or all states and localities, to save children like the Harts. In all of these areas, policy and practice needs to be changed in order to shift away from the current extreme focus on parental rights to a more balanced approach which gives child protection equal or greater emphasis. Here is an updated version of the list based on the new information from Oregon:

  1. Improve Vetting of Potential Adoptive Families. The new information from Minnesota adds more evidence that improved vetting is necessary, at least in some states. The second set of children were adopted despite the fact that the parents were investigated for abuse of one of the first set of children. Moreover, Minnesota staff told Oregon DHS staff that Texas arranged many adoptions through a particular agency, even when not supported by Minnesota’s child welfare agency. We need to know more about how adoptions could be organized against the wishes of the child welfare agency in the adoptive child’s state, and whether such adoptions continue to occur.
  2. Monitor adoption subsidy recipients. The new information confirms that the Harts received almost $2,000 a month in adoption subsidies–money that clearly enabled them to live. 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.
  3. Regulate homeschooling. The Minnesota records confirmed that the Harts removed all their children from school after their child abuse case was 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.
  4. Adopt universal mandatory reporting and educate the public about reporting child maltreatment. The new information does not change the fact that the Harts’ neighbors in Washington witnessed clear indicators of maltreatment months before the family went off a cliff. If they had reported their observations earlier, the children might have been saved. However, Minnesota and Oregon reporters were more conscientious, and the children were failed by CPS; hence the next recommendation.
  5. Revamp the investigative process. We have seen that social workers in Minnesota and Oregon had a very clear idea of the dynamics of the Hart household, and how the parents manipulated professionals to shift all blame to the children. Nevertheless they were not able to act on this knowledge to protect the children. There are several reasons that arise from the characteristics of child protective services in most or all states. First, action such as opening an in-home case or removing a child is contingent on the abuse allegation being confirmed. But that is very difficult to do, especially when children deny the abuse, as abused children often do. It is likely that many actual cases of abuse are not substantiated. Research has found little or no difference in future reports of maltreatment of children who were the subject of substantiated or unsubstantiated reports.  We need to move away from substantiation as a trigger for action to protect children.  Another problem is the bizarre distinction between risk and safety which is made in most or all CPS systems. That children could be labeled “safe” even when  at risk, as happened in Oregon, is obviously ridiculous. This false distinction has contributed to the deaths of Adrian Jones in Kansas, Yonatan Aguilar in California, and doubtless hundreds of other children around the country.
  6. Establish stricter criteria for case closure. In Minnesota, one or two cases were opened and the Harts were required to participate in services. We know in retrospect that none of the services worked to change the Harts’ parenting style. It appears that the parents continued their pattern of abuse and food deprivation while the services were being provided. State and local agencies need to revise their criteria for case closure to make sure that they are not leaving the children in the same unsafe situation they were in before the case opened. Agencies must be required to do a rigorous assessment of the children’s safety, which includes checking in with all service providers as well as the children and other professionals who have contact with them.
  7. Encourage doctors to err in the direction of protecting children. The similar response from doctors in Minnesota and Oregon to these malnourished children (saying that they don’t know if there is a reason for concern because lack of historical data) suggests a pattern of reluctance by medical professionals even to express concern that abuse or neglect may be occurring. For a doctor to say that he or she has no concerns because of the lack of information is backwards. Pediatricians need to express concern until given reason to believe otherwise. The American Academy of Pediatrics should issue guidance to this effect, but this needs to be followed up by consequences for doctors who fail to protect their patients

In my earlier post, I recommended interstate information sharing as a way to prevent future Hart cases.The new information reveals that Oregon DHS was able to obtain information about the Harts’ abuse record almost as soon as they began their investigation. The State of Washington found out about the Harts only three days before the fatal event, so information sharing was unlikely an issue. Thus, a failure of information sharing appears not to have been a major factor in this case, even if it has played a role in other cases where abusive families moved from state to state. One of the family friends who reported the abuse of the Hart children has launched a petition campaign for an national child abuse registry. This proposal deserves support and might save many children in the future, even if it would not have helped the Hart children.

On April 26, I attended a briefing on Capitol Hill about “Innovations and Opportunities to End Child Maltreatment Fatalities.” None of the measures suggested above were mentioned, even though they are responses to system breakdowns that have occurred again and again in child maltreatment fatality cases. Until we are willing to address the current imbalance between the rights of parents and those of their children, children will continue to suffer and die just like the Harts.

 

 

 

Opioid Crisis: New federal report shows child welfare impact

opioid crisis
Image: Youth Today

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

LARCs
Image: Policy Lab

 

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.

Educated: A Must-Read for all Child Advocates

EducatedEducated, 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.