No, family separations are not all the same

There is an old political adage that you should “never let a crisis go to waste,” meaning that a crisis can awaken public interest and create an opportunity to advance policies that might otherwise be unachievable.

President Franklin D. Roosevelt, for instance, was able to pass much of his New Deal – including a dramatic expansion of the country’s social safety net via the Social Security Act – in the wake of the Great Depression with the American economy in shambles and the American public desperate for government support.

Unfortunately, in a cruel twist of irony, some child advocates are now using the devastation wrought by the Trump administration’s separation of children from their parents at the U.S.-Mexico border to advance arguments undermining a key part of the Social Security Act – support for children who cannot be cared for in their own homes.

Several weeks ago, Sherry Lachman, the executive director of Foster America, authored a Time essay suggesting “family separation is not just a problem at the border.” In this piece, Lachman bizarrely equates the separations at the border with removals of U.S. children from their homes by child protective services, suggesting even the latter are “inherently toxic.”

And last week, Vivek Sankaran associated the two systems, misleadingly citing statements in an opinion piece that were made about the border separations to attack child removals by child protective services – without disclosing that these statements actually referred to the latter rather than the former. Sankaran quotes Dr. Charles Nelson, professor of pediatrics at Harvard, as follows: “[T]here is so much research on [child removal] that if people paid attention at all to the science, they would never do this.”

Finding it hard to believe that a distinguished Harvard professor would suggest that children should never be removed into foster care, we contacted Dr. Nelson, who explained that his words were taken out of context, as he was referring to separations at the U.S.-Mexico border and not the removal of children from abusive or neglectful homes. Dr. Nelson agreed that any comparison of the two systems is misconceived, noting: “It is inappropriate to compare children experiencing forced separations from their parents in the context of migration to children removed from parental care due to maltreatment (abuse, neglect).”

The separation of children from their parents at the U.S.-Mexico border was an ill-conceived policy that arose from the desire to discourage migration. Rather than being aimed at protecting children, this policy was adopted despite the obvious fact that it would be extremely harmful to them.

The child welfare system, on the other hand, was created to protect children from harm inflicted by their own parents or guardians. It is a sad fact that some homes are dangerous to their own children. Forty-nine states reported 1,700 child fatalities due to abuse or neglect in 2016, and there is wide consensus that this is likely an under count. We don’t know how many more are severely injured but survive; it is doubtless much higher.

And deaths and severe injuries are only the tip of the iceberg. There is extensive literature on the lifelong consequences of child abuse and neglect. These include chronic health conditions, impaired brain development, poor mental and emotional health, social difficulties, juvenile delinquency and adult criminality, alcohol and drug abuse, and an increased likelihood of abusing one’s own children.

Moreover, foster care is a rarely-used intervention by CPS. Most systems try hard to keep children at home by providing services to the parents to help remedy the conditions that caused the maltreatment. In 2016, according to federal data, agencies placed slightly over 200,000 children involved in maltreatment investigations in foster care and provided other post-investigation services to about 1.1 million children and families.

Yes, removing children from their parents is often traumatic to the child. But it goes without saying that in some terrible home situations, the damage to a child of staying in the current home would be greater than the damage caused by removal.

As Dr. Nelson puts it:

Of course we would like to see the biological parents be successful in changing the family dynamics and preserving the parent-child relationship but if that is impossible, and the harms to the child continue, then the child should be removed from the home, either temporarily, if the home situation can be remedied, or permanently.

But, it is of utmost importance to act with alacrity – I think in many cases children are left for far too long in their biological homes and by the time they are placed into foster care or adoptive care, they may be irreparably harmed.

Setting aside the vastly different reasons for, and targets of, family separations at the border and child removals by child protective services, there are huge differences between the two sets of policies. Cathy Senderling-McDonald recently wrote an instructive and comprehensive summary of the distinctions, outlining the vast differences in living conditions, objectives, legal structure and oversight.

Using the suffering of parents and children at the border to denigrate foster care is not merely an illogical comparison, it is a harmful one that can result in suffering, lifelong damage, and even death to children. Moreover, it is offensive to those professionals who have devoted their lives to protecting children, and to the children who have suffered and died for lack of such protection.

Let us be clear: we want to prevent children from being removed from their parents whenever it is safe and appropriate to do so.

But let us be equally clear: until we eliminate serious child maltreatment and endangerment from every home, there will always be a need for foster care to keep kids safe. To pretend otherwise is naïve, dangerous and irresponsible.

This op-ed was published in the Chronicle of Social Change on September 6, 2018. I wrote it with Sean Hughes, the director of government relations for the consulting firm Social Change Partners.

Abuse death of Anthony Avalos after 16 reports: the public needs to know why

On June 21, the suffering ended for ten-year-old Anthony Avalos when his tortured body finally succumbed to years of abuse. The ten year old had severe head injuries and cigarette burns all over his body when his mother found him unresponsive and called 911. Anthony died the next morning. Despite sixteen reports to the Los Angeles Department of Child and Family Services (DCFS) or the police, the agencies tasked with protecting Anthony never rescued him from the adults that had abused him for years. Without a new law requiring public disclosure of the details of such cases, the public will never know how Anthony’s peril was missed or what changes are needed to protect future children from his horrible fate.

School administrators, a teacher, a counselor, family members and others called police or the child abuse hotline at least 16 times since 2013 to report abuse of Anthony or one of his six siblings, as revealed in a devastating article by respected investigative reporter Garrett Therolf published by the Los Angeles Times. DCFS received twelve reports between 2013 and 2015, according to its director, Bobby Cagle.

According to these reports, “Anthony or his six siblings were denied food and water, sexually abused, beaten and bruised, dangled upside-down from a staircase, forced to crouch for hours, locked in small spaces with no access to the bathroom, forced to fight each other, and forced to eat from the trash.”

Most of the allegations concerned Anthony. Among the alleged abusers were his mother, Heather Barron, her boyfriend, Karim Leiva, and another family member who was left in charge of the children and was accused of sexual abuse.

According to the sources, only some of the investigations resulted in a finding of child abuse. And even when abuse was found, the children were only once placed with an uncle and aunt, from whom they were soon removed and brought back to their mother over protests from the relatives, according to the aunt. She reports that she started making calls to DCFS in 2015 when she noticed injuries the children said were inflicted by Leiva.

Anthony’s father, a Mexican citizen, reported that Anthony asked to live with him but his mother refused. Aware that Anthony was being treated badly, he repeatedly gave case workers his contact information in Mexico. But he never heard back.

Instead of placing Anthony with his father or aunt and uncle, DCFS workers opened at least two cases to help Anthony’s mother improve her parenting while the children remained in the home. But these cases where closed without any resolution of the safety threat to these vulnerable children.

These horror stories of deaths of children after multiple serious allegations to police and child welfare agencies never seem to end. The first step in preventing more tragedies is to conduct a detailed case review to identify the critical decision points where an opportunity was missed. It is likely that DCFS has already begun such an internal review. But it will be shared only with the county Board of Supervisors, which will hold it close.

This state secrecy is not unique to Los Angeles. Only a few states provide for the release of information about agency interactions with children who died of abuse or neglect. Texas’ Office of Child Safety posts reviews of fatalities but only when a child died of abuse or neglect during an open case. Florida requires an immediate investigation of a child’s death if the family was involved with CPS in the past year and posts the review if the child was found to have died of abuse or neglect. In Washington, the Children’s Administration (CA) conducts a review (by experts with no prior involvement in the case) when the death or near-fatality of a child was suspected to be caused by child abuse or neglect, and the child had any history with the CA at the time of death or in the year prior. These reviews must be completed within 180 days and posted on the agency’s website.

The Washington legislation, which requires reviews for families having history with child welfare within the past two years, is the broadest and most useful requirement. However, the universe of cases covered should be increased to include families that had contact with the child welfare agency within the past five years at a minimum. The last report on Anthony’s family was made in April 2016, more than two years before Anthony’s death, according to a statement by Bobby Cagle, the DCFS Director. After the sixth abuse report concerning Yonatan Aguilar (also in Los Angeles County), Yonatan was locked in a closed for over four years until he was found dead in 2016.

Reviews should also be required for cases of children who suffer severe injuries due to abuse or neglect as well as cases of chronic severe maltreatment that was allowed to continue despite reports to CPS. These would include another Los Angeles County case recently in the news when a jury awarded $45 billion to a girl who suffered two years of sexual abuse after child welfare workers left her in a home with an a accused molester. We need to know how these errors happen as well.

A requirement that all states conduct and post such reviews of children who died should also be added as an amendment to the Child Abuse Prevention and Treatment Act, which is expected to be reauthorized in 2018. When an agency egregiously abdicates its responsibility to protect children, the public must know how and why it happened. Only then can they hold their government accountable for making the changes necessary to prevent such tragedies in the future.

This post was updated on July 27, 2018.

Child Welfare Myths: Indian Child Welfare Act Protects Indian Children

Spearskids — Veronica and Hayley Spears: Traverse City Record-Eagle

Fourteen-year-old Veronica Spears, her twelve-year-old sister Hayley and their fifteen-year-old brother have been living with their foster parents Tim and Anne Dorn for nine years. Valerie and Haylie want to be adopted by the Dorns and have set up a Facebook page to tell their story. Yet, an Indian tribe has asked a tribal judge to move them in with a foster parent they have met twice.

The Trump Administration’s policy of separating children from their parents created such an uproar around the country and the world that the Administration was forced to back down. Yet, a law that is almost uniformly supported by liberal politicians and activists has for years been ripping children away from the only parents they ever knew. I am referring to the Indian Child Welfare Act (ICWA).

Congress passed ICWA in 1978 to alleviate a national crisis, the wholesale separation of Indian children from their families. But in attempting to right a wrong, Congress created a new threat to the safety and well-being of Indian children. It established a weaker set of protections for Native American children than for other American children and subordinated their best interest to that of the tribe.

The problem with ICWA begins with how it defines an “Indian child.” Any child who is either a member of an Indian tribe or is eligible for membership in a tribe, and is the biological child of a tribe member, is considered an Indian child. While some tribes require a certain percentage of Indian ancestry, others (like the nation’s largest tribe, the Cherokees) will accept those with any amount of Indian blood.

There is no requirement that the child or parent has any connections to the tribe or its culture. That’s how tribes end up deciding the fate of children whose Native American ancestry is less than two percent and those who have no social or cultural connection to a tribe. Veronica and Haley Spears, for example, are less than half native, did not grow up in the native culture and only became members of the tribe until their mother enrolled them after they were removed from her care.

ICWA gives Indian tribal courts jurisdiction over child custody cases involving Indian children living on a reservation. For other Indian children, the state court is required to transfer the case to the tribal court if either parent, or the child’s Indian custodian, requests it. If the case remains in the state court, the tribe also has the right to intervene at any time in the proceedings, and can request transfer to tribal court.

That’s what happened to Lauryn Whiteshield and her sister. The Spirit Lake Sioux Tribe invoked their powers under ICWA to remove them from a non-Indian foster family and place them with their grandfather and his wife, despite her long history of child neglect. On November 26, 2013, a the grandfather’s wife was sentenced to 30 years in prison for throwing Lauryn down an embankment and killing her.

ICWA requires a higher standard of proof to remove an Indian child or terminate the rights of an Indian parent. An agency requesting that an Indian child be placed in foster care or adoption must prove that “active efforts” were made to prevent the breakup of the family. This standard is more difficult to meet than the “reasonable efforts” required for all children under Title IV-E of the Social Security Act. This makes it more likely that Indian children will be left in dangerous homes.

If the court orders a foster care or adoption placement, ICWA establishes an order of preferences, with a member of the child’s extended family being the first choice for both foster care and adoption. For an adoption, the second choice if a member of the extended family is unavailable is other members of the child’s tribe and the third choice is other family members. This makes it easy for tribes to take children away from foster families like the Spears that may have raised them from infancy and want to adopt them.

ICWA is often used to override the preferences of one or both parents about who will raise their child. In 1985, twin babies were born to Choctaw parents living on a Mississippi reservation. The parents drove 200 miles to give birth, hoping to escape tribal court jurisdiction, and chose a non-Indian adoptive family. The tribe brought the case to the Supreme Court, which upheld the jurisdiction of the tribal court. Ultimately, the tribe returned the babies to the adoptive family chosen by the parents. But the tribe’s right to overrule parents on custody for their children continues in effect.

ICWA has no respect for the importance of bonding between child and caregiver and the trauma imposed by separating children from their parents. In the Spears case, the appellate court that sent the case to tribal court ruled that neither the best interests of the children nor the time the children have been with their current caregivers is relevant to the decision to transfer a case to tribal court.

Guidelines issued by the Bureau of Indian Affairs under the Obama Administration dispelled any doubt about whether the child’s best interests should play a role in Indian child welfare proceedings. They state that courts should not “conduct an independent analysis of the best interests of the child” in making decisions about foster care or adoptive placements, because placement in an Indian home is presumed to be in an Indian child’s best interests.

In my last post I wrote about the disparity between black and white placement rates in foster care. People who consider themselves advocates for black children in Minnesota are proposing legislation that would require “active efforts” to keep black children with their parents and reunify them, over and above what must be done for other children. This term is clearly drawn from ICWA, and like ICWA, the Minnesota legislation subordinates the interests of children to their “tribe” or race.

The Goldwater Institute in 2015 filed a class-action suit in Arizona (A.D. vs. Washburn) that “challenges the constitutionality of ICWA requirements that make the best interests of an Indian child less important than the desires of an Indian tribe when deciding foster care or adoption placements.” Unfortunately, a federal judge dismissed the case in 2017 for lack of standing, without ruling on the constitutionality of ICWA. A three-judge panel is now considering the Goldwater Institute’s appeal of that ruling.

The tragic results of ICWA show what happens when we treat people as part of racial groups rather than individuals. Instead of protecting Indian children, ICWA subordinates their interests to that of the tribe and deprives them of the same protections that are given to their peers who do not have Indian blood.

Child Welfare Myths: Black/White Disproportionality in Child Welfare is due to Racist Child Welfare System

According to federal data, black children were 13.8 percent of the total child population in the United States in 2014. Yet, they constituted 22.6 percent of those identified as victims of maltreatment, and 24.3 percent of the children in foster care. In Minnesota, the disparities appear to be even greater. Citing these disparities, two legislators have proposed the Minnesota African American Preservation Act.

The Act would create an “African American Child Well-being Department” within the Department of Human Services to receive notification of all cases involving African-American children and “directly oversee, review, and consult on case plans and services” offered to these children. It would also create an African American Child Welfare Oversight Council. Similar to the Indian Child Welfare Act, it would set a higher bar for removing African American children from their homes than white children and require greater efforts to reunify children once removed from their families.

The bill’s sponsors argue that racial disparities in child welfare are caused by differential treatment of minority families in terms of how allegations of maltreatment are investigated, resolved, and responded to. This is belief, which was supported by early research, has become accepted by the child welfare establishment.

The idea of racial bias in child welfare found support in the first two National Incidence Studies of Child Abuse and Neglect, which were published in the 1980s and 1990s. These studies, which attempt to count all episodes of abuse and neglect rather than just those that are reported and substantiated, suggested that there was no difference in black and white child maltreatment rates. The study authors suggested that black families received differential treatment by child welfare systems, resulting in their over-representation in these systems.

Starting about 2004, a coalition of foundations, nonprofits, and academics formed around the idea that this disproportional representation of black children in child welfare stemmed from a racist system. This coalition launched a well-funded campaign to reduce the representation of black children in child welfare and especially foster care. They issued reports, held conferences, and provided training and technical assistance to help states analyze their disproportionality problems.

As a result of this work, agencies around the country have adopted strategies like staff retraining, creating special administrative structures to advance racial equity, and special data collection efforts. As a social worker in the District of Columbia, I was subjected to multiple, often poor-quality trainings that tried to help me discover my hidden biases so that they would not affect my treatment of families.

The fact that child welfare workers in many jurisdictions are disproportionately African American has not influenced the consensus in favor of such strategies, as pointed out in an excellent article by Naomi Schaefer Riley. When I pointed out in a training class that most District of Columbia child welfare social workers were African-American, I was told that did not matter, as Black social workers could be as racist as white ones.

But a cascade of new research has cast grave doubts on the accepted theory of disproportionality. The third (larger and more rigorous) National Incidence Study published in 2010 estimated that black child maltreatment rates are almost twice as high than those of whites. Further analysis showed that this difference was present in the earlier study, but due to small sample sizes, the differences were not statistically significant and hence not reported.

A conference, convened in 2011 by Harvard, Chapin Hall at the University of Chicago, the National Council of Juvenile and Family Court Judges and the National Court Appointed Special Advocates, brought together leading scholars on child welfare and race in front of an audience of child welfare leaders from around the country. A research brief summarizing the conference that was published by Chapin Hall concluded that “there is a significant black/white maltreatment gap, one that roughly parallels the gap in official maltreatment reports. This evidence contradicts the belief that black children are included at high rates in the child welfare system because of bias.”

The brief’s authors based their conclusions on the National Incidence Study as well as other empirical work reinforcing the conclusion that child maltreatment rates are significantly higher for black children. They suggested that the higher rate of maltreatment among African-Americans stems from the history of slavery and racism, which led to higher poverty and concentration in impoverished neighborhoods characterized by crime, substance abuse, unemployment, and limited community services.

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

The researchers concluded that trying to reduce racial bias in the system is not the way to address the inequity between blacks and whites in child welfare. Instead, we need to address the underlying social conditions. And until we can do that, we need to protect children, both by preventing maltreatment and by providing appropriate protective services.

Since the Harvard conference, the evidence continues to accumulate that black and white maltreatment rates differ. A recent study published in the journal Pediatrics concluded that the child abuse fatality rate for children aged four and under was 8.0 per thousand African-American children, compared with 2.7 per 100,000 white children.

Unfortunately, many child welfare agencies, advocates, and legislators, including the sponsors of the Minnesota legislation, are either unaware of, or do not want to recognize, the new consensus among researchers. As The Los Angeles Times put it:

“Many left the [Harvard/Chapin Hall] conference believing that any caseworker bias against black families accounted for only a small portion of the disparity in foster care rates … Yet, Los Angeles County officials pressed forward with programs that assumed that racial bias was a significant cause for the high rate of [foster care placement] of black children.”

As I have written in the past, Native American children have been victimized by a similar type of reasoning. The Indian Child Welfare Act has been responsible for separating Indian children from loving foster families and placing them with relatives they do not know. On some occasions, these relatives have hurt or killed them.

This focus on reducing alleged systemic bias may do more harm than simply wasting child welfare resources on bureaucracy and training. If black children are more likely to be maltreated, equalizing black and white representation in the child welfare system would leave many black children in danger of years of suffering or even death. As Naomi Schaefer Riley put it, “No it’s not racist to save minority children’s lives.”

Family Separation at the Border: The Ultimate Anti-Child Policy

immigration-impact-sue-family-border-1024x683 — Image: Iimmigrationimpact.com

Child Welfare Monitor has not yet addressed the current crisis of family separations at the border because it generally focuses on the child welfare systems run by the states and counties. But for a blog with child welfare in its name and a mission of supporting a child-centered policy, this omission is no longer tenable. Below we attempt to answer some frequently asked questions and provide links to further information.

What is the cause of the upsurge in family separations at the border? The separations resulted from a policy change by the Trump Administration. On May 7 Attorney General Jeff Sessions announced that the government would criminally prosecute anyone who crosses the border illegally, including those stating that they are seeking asylum. As explained in more detail by the New York Times and Vox.com, families that arrived here illegally were traditionally placed in immigration detention centers and brought before immigration courts. Sending parents to jail rather than immigration facilities requires the separation of parents from their children, who cannot be housed in jail with their parents.

How did the Trump Administration decide to separate children from their families? The New York Times discusses the evolution of the new policy in an article published on June 16. In an attempt to stem the flow of unauthorized arrivals, the Obama Administration vastly increased the detention of immigrant families, opening new facilities near the border where families were held while their cases were being considered. But courts ruled that children could not be detained indefinitely and would have to be released within strict time limits. In 2016 a court ruling held that this applied to families as well. As a result of this ruling, families were being released to await processing of their cases in a policy dubbed “catch and release” by the Trump Administration, which was determined to put an end to this policy. It considered but initially discarded the idea of separating children from their parents after remarks by John Kelly suggesting this policy touched off a swift backlash. But Trump advisor Stephen Miller never gave up on the idea. And when border crossings took a sharp upward turn in May, his boss agreed to give it a try.

How many children have been separated from their parents under the new policy implemented by the Trump Administration? The Department of Homeland Security (DHS) reported on June 15 that 1,995 minors have been separated from their families at the border between April 19 and May 31.

What happens to the children? After being separated from their parents, these children are being designated as unaccompanied minors and placed in the custody of the Office of Refugee Resettlement (ORR), which is part of the Department of Health and Human Services. ORR’s child-caring system is overwhelmed. Its facilities were 95% full by June 7 mostly with children who arrived without their parents. A hastily-constructed “tent city” in the port of entry of Tornillo TX was housing 100 unaccompanied minors by June 15, only a day after the administration announced the location. Almost 200 unaccompanied children are being held in old warehouse in South Texas, confined in cages created by metal fencing, according to the Chicago Tribune. Reporters observed one cage holding 20 children. One advocate told reporters she met with a teenager who had been taking care of a traumatized four-year-old for three days. She also reported observing facility staff scold a group of five year olds for running around in their cage where there are no toys or books. The head of the American Academy of Pediatrics told Tribune reporters about observing a toddler in a 60-bed facility who had been taken from her mother the night before. She was crying uncontrollably and pounding her fists but the staff were not allowed to pick her up and comfort her.

The New York Times reported that the Administration on May 10 issued a call for proposals from “shelter care providers including group homes and transitional foster care” to accommodate an expected surge of separated children. One agency, Bethany Christian Services, is providing foster placements for about 100 migrant children in Massachusetts and Michigan and was planning to expand into other states in response to the proposal. The Times visited one of the children sent to Michigan, a five-year-old boy who was separated from his father after arriving in El Paso from Mexico late in May. The child was put on a flight to Michigan, and placed in a Bethany Christian Services foster home. The little boy came with a trash bag filled with dirty clothes and two sketches of his family. The first few nights he cried himself to sleep Then the crying turned to “just moaning and moaning” according to his foster mother. For the first two days the little boy would not shower or change his clothes. According to the article the little boy was sleeping with the sketches under his pillow and asking every day when he would see his father.

What is the age of the children who are being separated from their parents? A homeland security official told the New York Times that the administration had “drawn a bright line” against removing babies from their parents because the government cannot appropriately care for them. But the official would not provide a specific age below which children would not be separated from their parents. Bethany officials told the Times that the agency had taken charge of an 18-month-old girl who had been separated from her parents. A three-year-old boy taken from his mother at the border cried inconsolably all the way to Michigan and for the first few days at his foster home. He has now bonded with his foster mother ensuring another traumatic separation is in his future.

What is the impact on children of the new policy? The American Academy of Pediatrics (AAP) stated in a letter to the Administration that the fear and stress the children will experience due to the separations, in the absence of the significant adults in their lives, can harm their developing brains and their short and long-term health . “We ask you to put children first and not exacerbate their suffering by the additional trauma of being separated from their parents,” entreated the pediatricians.

The New York Times reports that even within the Trump Administration there is considerable unease about the policy of separating families at the border. Even the President recognizes the distasteful nature of the family separations, which is why he has falsely tried to blame it on Democrats. Child Welfare Monitor urges its readers to join the AAP, the UN High Commissioner for Human Rights, Laura Bush, and other child advocates and people of conscience in telling the Administration to put an end to this cruel and inhumane policy that can have lifelong effects on the development of thousands of children.

Opioid Crisis: Removing Infants from Mothers on Medication Assisted Treatment is Misguided

An NPR story (New Hampshire Mothers Struggling with Opioid Addiction Fight to Keep their Children) aired on June 2, 2018, introduced us to Jillian Broomstein, a New Hampshire mother whose two-week-old infant was removed from her by the state’s child welfare agency. Broomstein was on methodone to combat her addiction to heroin and it was working. She had not taken heroin for months.

Methadone is one of the two medications that is used in Medication Assisted Treatment (MAT) for Opioid Use Disorder. MAT is “the use of medications in combination with counseling and behavioral therapies to provide a whole patient approach to the treatment of substance use disorders.” The medications commonly used to treat opioid addiction in pregnant women include methadone and buprenorphine.

Research has shown that MAT is the most effective treatment for opioid use disorder, at least doubling the rates of abstinence from opioids compared with treatments that use a placebo or no medication. MAT has been recognized by the World Health Organization as the most effective treatment for opioid use disorder. Moreover, MAT is the treatment the American College of Obstetricians and Gynecologists (ACOG) recommends for pregnant women with opioid use disorder.

Concerns about MAT for pregnant women arise from the fact that their infants may experience neonatal abstinence syndrome. But as the lead author of the ACOG guidance states, “Concern about medication-assisted treatment must be weighed against the negative effects of ongoing misuse of opioids, which can be much more detrimental to mom and baby.” MAT increases adherence to prenatal care and drug treatment and reduces the risk of pregnancy complications. Abrupt withdrawal from opiates or safer substitutes means a mother is more likely to relapse, thus making it less likely that she can reunify with her child. Neonatal abstinence syndrome, on the other hand, is treatable and does not appear to have lasting effects.

Bias against MAT among professionals working with substance-abusing families has been documented often. An excellent federal study, discussed in an earlier post, found that MAT is not always understood or accepted by child welfare professionals, judges or even in the substance abuse treatment community. One reason for such bias may be that many professionals have past experience with other types of drugs such as cocaine and methamphetamine, for which MAT is not available

Information on state policies regarding reporting, investigation, and placement of infants exposed to methadone and buphrenorphine is not readily available. A report from the Substance Abuse and Mental Health Administration suggests that New Hampshire is not alone, indicating that child welfare agencies “may use a positive toxicology result for methadone or buprenorphine at birth as a presumptive cause for child removal.”

In some states, on the other hand, these cases may not even be reported or investigated. Pennsylvania law requires reporting only if the drug is illegal, although individual hospitals may choose to report other cases. In Massachusetts, for example, the Department of Children and Family Services can screen out a report involving a substance-exposed newborn if the only substance affecting the newborn was methadone, buprenorphine or naltrexone and if the substance was used as part of a treatment program.

But do we know that methadone and buprenorphine are consistent with safe parenting? Unfortunately, there seems to be no research evidence on this question. We do know that with stable dosing, methadone and buphrenorphine does not cause the euphoric “high” associated with heroin and prescription painkillers.

Removing infants from their mothers who are participating in MAT has many negative consequence. It disrupts the critical attachment process between infant and mother. It may lead discouraged mothers to go cold turkey in order to get their children back. This may lead to relapse and permanent loss of the children.

Instead of automatic removal of the children, new mothers on MAT should be supervised by CPS for at least six months to ensure that they are capable of safe parenting. During that period they should receive intensive services akin to those provided by Kentucky’s Sobriety Treatment and Recovery Teams (START), a program that has been in municipalities in New York, Indiana, Georgia and North Carolina. Each family is paired with a specially-trained CPS worker and a mentor who is in long-term recovery. Caseloads are limited and each family receives weekly visits from both the CPS worker and the mentor for the first 60 days. START has been rated as a promising practice by the California Evidence-Based Clearinghouse for Child Welfare.

Most states, particularly those ravaged by the opioid epidemic, are reporting critical shortages of foster homes. Preventing unnecessary foster care placements, in addition to the obvious benefits for parent-child attachment and long-term sobriety of the parent, will allow these homes to be available for children who really need them.

Texas children adopted out-of-state: what happens when the push for adoptions goes too far?

Photos: nightlight.org

Photo: Associated Press

On May 24, 2018, the Chronicle of Social Change published “Bigger in Texas: Number of Adoptions and Parents Who Lose Their Rights.” Reporter Christie Renick points out that Texas has received 15% of the federal adoption incentives that have been given out since the program began in 1998. According to federal data, Texas has about seven percent of the foster children in America, so it has received over twice its share of adoption incentives based on foster care population.

So what is Texas doing differently from other states? Renick suggests that it is a combination of the state’s aggressive push to terminate parental rights along with an emphasis on placing kids with kin. But Renick does not address another factor that may contribute to Texas’ adoption success. And that is the number of Texas children who are adopted by families in other states. Texas is exporting many of its unwanted children.

Child advocates became aware of this issue in the wake of the violent death of Jennifer and Sarah Hart and most likely all six of their adopted children when their car drove off a California cliff on March 26, 2018. We soon learned that Jennifer and Sarah Hart were living in Minnesota when they adopted their six children from the Texas foster care system. Three of the siblings were adopted in 2006 from Colorado County, Texas and another set of three in 2009 from Harris County, which includes Houston.

Oregon’s release of files from a 2013 investigation following the family’s move to Oregon provided limited information about these adoptions. An employee of the Department of Human Services (DHS) in Douglas County, Minnesota told an Oregon investigator that “the State of Texas works with this Permanent Family Resource Center…Texas seems to do a number of adoptions through this agency, even when the Child Welfare Office has not supported the placement.”

The Minnesota employee’s comment was somewhat misleading because the Minnesota child welfare agency does not approve adoptions of children from another state. Instead, the Texas Department of Family and Protective Services (DFPS) requires that out-of-state homes be approved for adoption by “agencies licensed or certified to approve adoptive home studies in the state where the home is located.” Apparently the Permanent Family Resource Center (PFRC) was such a licensed agency.

An internet search provides skimpy information about PFRC, which dissolved early in 2012. According to a 2008 article in the Fergus Falls Journal, PFRC was founded by Maryjane Westra and Kristy Ringuette in 2000 with a focus on placing children from foster care with permanent adoptive parents. PFRC’s archived website and its Twitter page are still online. Eerily, its Twitter avatar is a photograph of Markis and Devonte Hart. The internet archives contain a document with profiles of families approved to adopt children, including Jennifer and Sarah Hart, pictured with Markis, Hannah and Abigail, the first set of siblings they adopted. The Harts were described as a “fun, active family” that was “eager to open their hearts and their home to adopted children.”

PFRC emphasized its openness to all potential adoptive families. Westra told the reporter that in forming the agency, “they wanted to expand the range of adoptive families to include those that had the will but needed a little help along the way.” On its Frequently Asked Questions page, PFRC said that it “wants successful families and are not interested in ‘weeding people out.’ A home study is your opportunity to speak about your strengths so the best possible match is made.” “We can always use families. You don’t have to be a perfect family, there is no perfect family,” Westra told the Fergus Falls Journal.

And PFRC was as good as their word. The agency apparently approved the Harts for adopting the second sibling set even though five months before the adoption was finalized, Hannah came to school with a bruised arm and said that Jennifer had hit her with a belt, resulting in a police report and an investigation by Douglas County Social Services. It is not clear if PFRC knew of the incident. But it probably happened during the trial period for the second adoption, during which the agency should have been very carefully monitoring how the family was adjusting to the second set of three siblings.

The addition of three children aged three or under could have precipitated great stress for a family that already had three young children aged about 10, 6 and 5. But PFRC staff and adoptive families often adopted large numbers of closely-spaced children. Westra cited a family that adopted a twelve-year-old and two toddlers. Three years later, they returned and adopted six more children. “It’s heartwarming when that happens,” Westra told the reporter. Of the 16 families approved to adopt, three already had 5 children and four (including the Harts) had three children. Claudia Fletcher, an adoption worker for PFRC, has 12 adopted children and writes about her life in a blog entitled Never a Dull Moment: my Journey as a Foster and Adoptive parent….12 Kids in 12 Years.

The appropriateness of larger families for adoption is a controversial issue. There is strong evidence that child maltreatment increases with family size and more closely spaced children. Having more children, and children closer together in age, can result in increased stress. Moreover, many adopted children, especially those who are older than infancy, need even more attention than other children their age. It is clear from discussions on adoption websites that mainstream adoption agencies are often reluctant to work with larger families. Clearly, PFRC did not have a problem with large families becoming even larger through adoption.

The scanty information about PFRC raises many questions. Was the home study process for the Harts flawed? Were there signals that could have been picked up by a more sophisticated and critical staff? Are there other children adopted through PFRC who are languishing in abusive homes? Are there other agencies around the country that are not interested in “weeding families out?” Adoptions records are sealed, so we probably won’t ever know the answers to most of these questions.

Child advocates told KPRC Houston’s Syan Rhodes that the Hart children’s fate was the result of “a state desperate to remove kids from the system.” And Texas is not the only state where this desperation may lead to adoptions that should never have taken place. States are graded by the federal government as well as outside groups on the size of their foster care caseloads and the time it takes to achieve permanency. Getting children off the rolls also saves money that would be spent on case management and other services and vacates desperately needed foster homes. And then there are of course the federal incentives from which Texas has benefited so consistently.

There were 5,413 adoptions consummated in Texas in 2017. According to Houston’s KPRC, 320 of these children were adopted out of state. That’s a lot of kids to worry about every year.

We don’t want kids to languish in foster care, but we don’t want to adopt them out to abusers. So what is the answer? Keep children at home with support if it is safe, place them with relatives if appropriate, but recognize that aging out of foster care would have been a better fate than what the Hart children suffered.

This article was modified on June 4, 2017 at 5:30 PM in response to a correction issued by KFRC Houston regarding the number of adoptions by out-of-state families. The number that was originally attributed to the Houston area was actually statewide.