The Family First Prevention Services Act Act was widely hailed as allowing for the first time the use of federal Title IV-E child welfare funds for services to prevent a child’s placement in foster care. Unfortunately, the law has been interpreted in a way that has almost negated this central purpose of Family First. Thanks to a technical-sounding determination about Title IV-E’s place in the hierarchy of programs as payers for services, Title IV-E funds are now unavailable to beef up services that are eligible for funding from other programs.
Before implementation of Family First on October 1, 2019, federal matching funds under Title IV-E of the Social Security Act could be used only to match state spending on foster care. Advocates of Family First and its predecessors argued that providing Title IV-E funds for foster care and not services to prevent it encouraged jurisdictions to place children in foster care rather than helping their parents address their problems and keep their children at home. As I argued in an earlier post, this was a false narrative that disregarded the fact states were already working with families in their homes using other funds, such as Medicaid, maternal and child health programs, and others.
But the advocates won and Family First was passed. It allowed federal Title IV-E matching funds to be used for evidence-based practices (EBP’s) in the categories of “in home parent skill-based programs,” mental health, and drug treatment programs that meet criteria for being “evidence-based” as defined by the Act. These are all considered to be “prevention services” because they are aimed at preventing placement of children in foster care. (Funds can also be spent on kinship navigator programs to help kin who agree to take custody of children temporarily while their parents pursue services.) The Act also created a clearinghouse of programs from which states can choose. The clearinghouse has so far approved nine programs for inclusion and is in the process of considering 21 more.
But the contents of the clearinghouse have much less impact in light of decisions made by Congress and the Children’s Bureau, as explained in a useful webinar from the Chronicle of Social Change. As a result of these decisions, Title IV-E became in effect the “payer of last resort” for the foster care prevention services authorized under the Act .
It would be difficult to overestimate the magnitude of this decision to make Title IV-E the payer of last resort for foster care prevention services. Many of the services that are already included in the clearinghouse or being reviewed now are covered by Medicaid or paid for by other programs in many states. This means that states with more generous Medicaid plans (those covering more people and/or more services) and more participation in other federal programs have less opportunity to use Title IV-E funds for foster care prevention services.
Consider the District of Columbia, which has a generous Medicaid program in terms of whom and what it covers. In my five years as a child welfare social worker in the District, I don’t remember a parent who was not eligible for Medicaid. The District was the first jurisdiction to submit a Family First plan and the first to have its plan approved, but it’s hard to understand the District’s eagerness to make the transition. In its plan, the District’s Child and Family Services Agency (CFSA) indicates that of the seven services in its plan that are currently deemed allowable by Title IV-E, six are funded through other federal sources–Medicaid and the Maternal, Infant, and Early Childhood Home Visiting Program. Therefore, CFSA will be claiming Title IV-E funds for only one allowable evidence-based program–Parents as Teachers (PAT).
So here is the irony. Family First was supposed to revolutionize child welfare by allowing federal foster care funds to be used for family preservation or foster care prevention, whatever one chooses to call it. Never mind that states have been using Medicaid and other funds for this purpose for many years. And now it turns out that with Title IV-E as a payer of last resort, many states will continue to provide these services with other funds. Family First will make little difference except adding a new layer of bureaucracy: states will now have to include these services in their prevention plans even if they are not funded by Title IV-E!
Things are actually worse under Family First for the 27 states that had waivers under Title IV-E. Under the waivers, states were able to use Title IV-E funds in combination with other funds to expand and improve services–an option not available to them now.
It gets even worse. Under Family First, states must spend at least 50% of their Title IV-E prevention funds on practices defined as “well supported” as defined by the Act. It looks like payments made by Medicaid won’t count toward the 50%, so states will need to find enough “well-supported” practices that are not covered by Medicaid in order to meet this requirement, which may cause great difficulty.
Title IV-E’s status as payer of last resort also appears to prevent Title IV-E from paying a provider who does not accept Medicaid for an EBP that is allowed under Medicaid. It is widely known that low Medicaid reimbursement rates restrict the quality and quantity of mental health services available to Medicaid participants. Both jurisdictions where I have served as a foster care social worker, Maryland and the District of Columbia, use their own funds to pay for top-notch providers who don’t accept Medicaid. In both jurisdictions and I suspect many others, children with the most complex mental health needs are enrolled with one of these high-quality providers rather than left to the mercy of the Medicaid-funded agencies, with their long waits for service and high turnover. We rarely or never paid for mental health services to parents but isn’t that just what Family First should allow jurisdictions to do? Where, otherwise, is the revolution in child welfare that Family First was supposed to bring about?
Title IV-E as payer of last resort means that very little will change, except perhaps in some states with very narrow Medicaid programs and little categorical federal funding. To have any hope of fulfilling its promise to keep families together, Family First should be amended to allow Title IV-E to supplement Medicaid and other funding to provide critically needed services to parents.
“Faith,” an 18-year-old high school senior that I know, has already missed four days of school without ever being sick. You see, Faith is in foster care and lives in a group home. She missed one day for a morning court hearing and one day for a morning clinic appointment. Both days, Faith was brought back to her group home because nobody had time to take to her school in Maryland, which she was attending before being returned to foster care from a failed guardianship. Another missed day was for a 12:30 clinic appointment. The logical solution would be to schedule her appointments after school, but that is impossible because the group home staff are busy picking up six girls from six different schools in different parts of the city or Maryland suburbs. Faith is a senior and has to pass every one of her classes in order to graduate this June. She failed a class last year due to excessive absences, but none of many adults involved in her case seems to be making the connection between going to school and graduating.
When it comes to missing school, Faith would probably not be any better off in a foster home. As a foster care social worker for five years I learned that the paraprofessional family support workers who took our clients to all of their appointments (because their foster parents refused to take time off from work) always scheduled these appointments during school hours. That’s because these workers were busy after school transporting children to visits with their parents.
I remember hearing about another social worker’s client, who was failing in school. This young lady had recently come into foster care after years of neglect and had more than a dozen cavities. In a school meeting to find out why she was failing, school staff informed the social worker that the missed class time was making it difficult for this young woman to complete her assignments. Apparently, scheduling visits out of school time had never been considered.
So I was not surprised that Faith’s appointments were scheduled during school hours and that nobody was available to take her back to school in Maryland, resulting in her missing a full day of school for each. Never mind that the Mayor of the District of Columbia has a campaign against school absenteeism entitled Every Day Counts, citing facts like “Missing just two days a month can put students at risk of academic failure.” I wish Faith’s social worker and group home staff knew that. And I wish the Mayor knew that another part of her government was sabotaging this campaign among the very students most at risk of failure.
In addition to staff constraints due to resource limits, one reason for this widespread disregard of the value of school attendance is an attitude shared by many social workers, foster parents, group home staff, and foster youth themselves, that absence from school is fine as long as it is excused. After all, schools must call Child Protective Services when a student has a certain number of unexcused absences. Excused absences don’t seem to matter, regardless of the reason for the excuse. Nobody at school asks if the child had to miss a whole day due to a 30-minute medical appointment. And I have seen at least one case when a parent who was at risk of having her child removed due to neglect was encouraged to go to school and retroactively excuse all her child’s absences.
I know this problem is not unique to the District of Columbia. In Kentucky, the Lexington Herald-Leader published an excellent article about foster children’s educational disadvantages. Education officials told the reporter that “foster children are too often pulled out of the classroom for various meetings, appointments, and discussions linked to their status as a foster child, sometimes including visits from social workers or guardians ad litem.”
The problem of system-induced absenteeism among foster youth likely exists around the country, and I hope to hear from readers with examples. So it is not surprising that studies suggest that children in foster care are about twice as likely to be absent from school as other students. This higher absenteeism rate is probably just one among many reasons why educational outcomes for foster youth are so much worse than for the general population. Nationally, only 65% of foster youth complete high school by the age of 21, compared with 86% among all youth aged 18-24. Estimates of the number of foster care alumni who attain a bachelor’s degree range from 3% to 11% compared with 32.5% for the general population.
Of course absenteeism that is not caused by the foster care system itself is also a large problem, especially among older foster youth. That is another, more complex issue that is related to the long history of trauma and school failure as well as inadequate placements. But the system itself should not be contributing the absenteeism for students who want to attend and do well in school. There should not be a trade-off between health care and education.
So what can be done to ensure that foster youth are not kept out of school by the foster care system? Child welfare agency leaders must establish from the top that being in school every day is a priority. Agency policy should be that all court hearings, appointments, and meetings take place outside school hours unless there is a documented reason this cannot happen.
Observance of this policy can be monitored only through data sharing between the child welfare agency and the school system. A very helpful fact sheet from the Legal Center for Foster Care and Education provides information about what some jurisdictions are doing to address school absenteeism among foster youth, including data sharing. Jurisdictions should follow the example of Allegheny County PA, where child welfare social workers are able to easily access education data, including attendance. (See Roadmap for Foster Care and Education Data Linkages for more information about how to address the barriers to such linkages.)
Every child welfare agency should have one or more education liaisons for each school or group of schools who have access to all school data including attendance data and reasons for absence if possible. These liaisons should monitor these data and contact social workers as soon as there is evidence of excessive absenteeism. Kids in School Rule! is a collaborative program between Cincinnati Public Schools and the Hamilton County Department of Job and Family Services. It includes child welfare-based education specialists who have access to real-time data to alert them when a child is absent so that they can intervene quickly.
Clearly, many students in foster care are attending school more regularly than before they were removed from their homes. But when the system removes children, it must not to continue the neglectful parenting that may have brought them into the system in the first place. Foster care should be a time for youth to make up for past disadvantages, rather than fall further behind.
On May 5, New York City firefighters were called to a horrible scene. A three-year-old girl had been locked in a car and the doors had been chained shut. Then the car was set on fire. As reported by the New York Times, the perpetrator had weekend visitation rights with his three-year-old daughter Autumn. Less than two weeks before, Autumn’s mother wrote to the family court in charge of her custody case, that Pereira was “losing a grip on reality and I honestly feel my child is in danger while in his care.” The court did not intervene.
This terrible case is not an aberration. The Center for Judicial Excellence (CJE) has compiled data on 707 children who have been murdered by a divorcing or separating parent since 2008. CJE has documented 98 cases during that time period in which a child was killed by a parent or parental figure after the family court allowed them unsupervised contact with the child despite being warned that the perpetrator posed a risk to the child. But this is likely only the tip of the iceberg as there is no agency that records these cases.
A four-month investigation by Gillian Friedman in the Deseret News found that in many cases family courts are failing to protect children, allowing unsupervised visits or even custody to abusive parents. These decisions are resulting in physical and sexual child abuse and sometimes homicide.
Why would family courts put a child in danger by allowing unsupervised contact with a dangerous parent? One reason, experts told Friedman, is that judges and custody evaluators hired by courts often do not believe the claims of danger from the other parent who is trying to protect the child. As the director of CJE told Friedman, “In custody proceedings, family courts often see a parent’s allegation of child abuse as no more than a tactic to undermine the other parent’s custodial rights to the child — and therefore not a credible accusation.” Several of the mothers interviewed by Friedman reported that their attorneys told them not to allege abuse for fear that these allegations would lead to an adverse custody ruling.
Disbelief of the protective parent is not the only possible factor that causes courts to make decisions that put children in danger. Experts told Friedman that evidence of child abuse is often not conclusive and courts are reluctant to bar a parent from access to a child unless the evidence of past abuse is airtight. Moreover, many judges are overwhelmed. They may see as many as 20 cases a day and may have to make a decision after spending no more than 20 minutes on a case.
Finally, judges may be prioritizing parental rights over child safety and well-being. Even if a judge believes that a parent has been abusive, family court professionals told Friedman that it is very hard to get a judge to deny visitation to a parent. Instead, they will require the abuser to engage in treatment or counseling, while maintaining visitation.
Judges may also think a child is safe with a parent who has abused the other parent but not the child. But placing a child with a parent who has a record of domestic abuse may be dangerous even if that parent had not hurt a child. That’s because the parent may harm the child in order to punish the other parent.
Both mothers and fathers can abuse and kill their children. But domestic violence victim advocates like Joan Meier cite evidence that women are in a disadvantage when alleging abuse in the context of a custody dispute, in part due to the influence of inaccurate beliefs about “parental alienation,” which I described in an earlier post. The “alienation” concept can be used by either parent to connote that the other parent is poisoning the child’s mind against them and has often resulted in the placement of children against their will with a parent that they allege abused them–more often than not, the father.
But fathers’ advocates claim that that family courts are prejudiced against fathers. It seems clear that judicial attitudes have changed over time. As described in a useful article published in 2011 by San Francisco Weekly, family courts were traditionally biased against fathers, believing that children belonged with their mothers. However, as divorce became more common, advocacy by fathers’ rights group has led to the acceptance that children’s time should be split as evenly as possible between parents. While it seems clear that child safety should trump any considerations of equity between mom and dad, it seems that some judges do not agree.
The problem of placing parents’ rights over safety should be familiar to readers of Child Welfare Monitor from our many columns about child welfare agencies and family court judges accepting risks to child safety and well-being in order to keep families together or reunite them. In our experience with such cases. the court and the child welfare agency usually agree about the primacy of parents and the need for children to remain or be reunified with their parents. There are occasional disagreements. Child Welfare Monitor will never forget tearfully trying to convince a judge that my six-year old client would do better with a foster parent who had loved her for two year than with a mother who could not think of one good thing to say about her–to no avail. But in these custody cases it is the protective parent whose pleas to keep the child safe are being disregarded.
Thankfully, there is a growing recognition that family courts are failing to protect children in custody cases, with sometimes tragic results. Last year, Congress passed a resolution stating that “child safety is the first priority of custody and visitation adjudications, “and that courts should resolve safety risk and family violence claims first, before assessing other factors that may affect a child’s best interests. The resolution makes several recommendations to states for improving their court processes, including setting standards for evidence presented in custody proceedings and for the professionals who are accepted as experts.
In 2019, the Governor of Maryland signed a bill requiring the formation of a new workgroup, the first of its kind, to study child custody court proceedings involving child abuse or domestic violence allegations and make recommendations about “incorporating the latest science regarding the safety and well-being of children and other victims of domestic violence.”
It is important for child advocates to become involved with this issue, which has generally been the province of mainly domestic violence advocates. Child advocates around the country should push for legislation like that passed in Maryland to establish commissions to study this issue and make recommendations about how the family courts can be improved to ensure the safety of children involved in custody litigation.
The passage of the Family First Prevention Services Act (FFPSA) was greeted with joy and celebration when it passed as part of the Bipartisan Budget Act of 2018. “The Family First Prevention Services Act will change the lives of children in foster care,” crowed the Annie E. Casey Foundation. The new law “will change foster care as we know it,” raved the Pew Charitable Trusts. But the Act took effect on October 1 to little fanfare. Based on contacts with all the states, the Chronicle of Social Change expects only 14 states and the District of Columbia to implement the Act and 36 to delay implementation for up to two years as allowed by the law. But as of two weeks before implementation, only four states had submitted the plan required in order to implement the Act.
An Act with Many Flaws
FFPSA has been revealed (as some knew all along) as a messy and poorly written piece of legislation. It starts with a misnomer. What the Act calls “prevention services” (“in-home parent skill-based,” mental health, and drug treatment programs for parents who have already been found to have abused or neglected their children) are aimed at prevention of foster care, not of child abuse and neglect before they occur. To most experts, these would be considered to be “intervention” and not “prevention” services. But beyond this misnomer, the legislation has multiple flaws which means it may create more problems than it solves. Among these issues, covered in detail in a recent webinar from California’s Alliance for Children’s Rights and an article in Governing, are the following:
Lack of new funding: FFPSA was designed to be budget neutral, redirecting funds toward foster care prevention services from congregate care and a delay of an expansion in adoption assistance. The Congressional Budget Office has estimated that FFPSA will actually result in a $66 million reduction in federal spending over a ten-year-period. This comes on the heels of 20 years of federal disinvestment in foster care, leaving jurisdictions struggling to maintain reasonable caseloads and services. Some states are anticipating crippling losses of of funds due to the loss of their Title IV-E waiver programs, which expire at the end of the year and were far more generous and less restrictive than FFPSA. For example, California anticipates the loss of $320 million in federal funding when the waiver ends, forcing service reductions in some of its largest counties. New York will lose support for a program that hired more social workers and supervisors and has been credited with allowing youth to leave foster care earlier.
Requirement that 50% of funding be spent on “well-supported” programs. FFPSA requires that 50% of funding be spent on programs that meet a rigorous set of criteria to be defined as “well-supported.” But so far, the clearinghouse created for the purpose of this provision has designated only six programs as “well-supported”: three mental health programs, three home visiting programs, and no drug treatment programs. Some states may prefer to adopt or expand in other similar programs that are not on the list. Therefore there has been a chorus of proposals that this provision be eliminated or delayed.
Interaction with Medicaid: Each state’s Medicaid program covers a different set of services, but many of the services meeting FFPSA criteria, especially mental health and substance abuse treatment, are already funded by Medicaid in most cases. Allowing Title IV-E to supplement Medicaid funds might have helped improve the quantity and quality of services available. But in its guidance on implementing the legislation, the Children’s Bureau specified Title IV-E as the payer of last resort for these services. That means that Medicaid must pay first before Title IV-E can be billed. Thus, in states with more generous Medicaid programs, the law will greatly expand the services available to families. Moreover, it appears, based on the federal government’s answer to one state’s question, that programs paid for by Medicaid may not count toward the 50% of programs that must be “well-supported,” leaving states that use Medicaid to fund these programs in a difficult situation.
Restrictions on congregate care: One of the two main purposes of FFPSA was to restrict congregate care, which is basically any placement that is not a foster home. To do so, FFPSA cuts off funding after two weeks for any placement that is not a foster home, with four exceptions. Three of these are programs for special populations and the fourth is a new category called a Quality Residential Treatment Programs (QRTP)–a new category created by FFPSA. QRTP’s must meet numerous requirements, such as accreditation, 24-hour nurse coverage, and a “trauma-informed” approach. Moreover, a child must be assessed by a “qualified individual” as needing placement in a QRTP and that decision must be approved by the family court. Furthermore, a youth may not remain in a QRTP for more than 12 consecutive months without written approval from the head of the agency. As Child Welfare Monitor has discussed elsewhere, there is concern that some group homes will have trouble meeting the FFPSA criteria. Group homes are closing around the country due to insufficient funding and state-level policy changes. Many states have desperate shortages of foster homes, and closing group homes at the same time will worsen their placement crises. Furthermore many young people, especially those with more issues, may need more than 12 months in a group home and may lose all their gains if transferred prematurely to a foster home. There is also a problem with Medicaid and QRTP’s, as it appears they will fall into a category of “Institutions for Mental Diseases” that are not payable by Medicaid.
Kinship Diversion: FFPSA creates an avenue for prevention of foster care by placing a child with relatives (often called kinship diversion) while the parents receive prevention services for up to 12 months. If reunification with the parents never happens, there is no requirement that the children be placed formally with the relatives, or that the relatives receive any assistance either financially or with services. They would be forced to rely on Temporary Assistance for Needy Families (TANF), which is much less generous than foster care payments, and to make do with any services they can find in the community. There is concern that FFPSA may encourage states and counties to use kinship diversion rather than licensing relatives as foster parents, thus entitling them to more services and assistance and ensuring that the agency does not lose track of the children.
How a bad bill was born
The passage of FFPSA was the outcome of many years of advocacy, under the mantra of “child welfare finance reform.” So how did such a flawed bill pass after so many years of proposals and discussions? The answer includes a truncated legislative process, an insistence on budget neutrality, and a false narrative promoted by a wealthy group of organizations.
This call for finance reform was based on the idea that, as expressed by one of its primary proponents, Casey Family Programs, in a white paper published in 2010:
…the major federal funding source for foster care, Title IV-E, primarily pays for maintaining eligible children in licensed foster care, rather than providing services for families before and after contact with the child welfare system. The fact that no IV-E funding can be used for prevention or post-reunification services has created a significant challenge to achieving better safety and permanency outcomes for children.
This statement was literally true. Before implementation of FFPSA, Title IV-E funds were not available for services provided to families to help them avoid placement of their children in foster care. But plenty of other funds were available to cover these services. We’ve already mentioned that Medicaid currently pays for many or most of the services that will be provided under FFPSA, with the specifics depending on the state. Other funding sources included Title IV-B, TANF, Social Services Block Grant, and CAPTA funds.
Moreover, Title IV-E does not cover all foster care costs. The federal government reimburses states for 50 to 75% of the cost of foster care payments, depending on the state. But only 38% of foster children were eligible for federal reimbursement under Title IV-E in 2016, down from an estimated 54% in 1999. The reason for this decline is an antiquated provision (often called the “Title IV-E lookback”) that links Title IV-E eligibility to eligibility for Aid to Families with Dependent Children, a welfare program that ended in 1996. Anything calling itself finance reform should have addressed this senseless linkage, but the framers did not.
So, between the availability of other funds and the fact that states had to pay a large share of foster care costs themselves, it is hard to accept the narrative that states had an incentive to place children in care rather than provide services to their families to keep them at home. And indeed states have for years been providing in-home services to help families avoid foster care. According to federal data, 1,332,254 children received in-home or family preservation services in FY 2017 compared to only 201,680 children who received foster care services. So the argument for “finance reform” is simply a red herring.
The idea that a foster home is almost always better than a group home or residential placement is behind the other major part of FFPSA, the strict restrictions on funding for congregate care. But this narrative ignores the fact that there are not enough foster parents, especially those who are willing, loving and gifted enough to care for older and more troubled young people. Perhaps some supporters think that these foster parents will suddenly appear once group homes disappear. But this kind of wishful thinking failed when the mental hospitals closed in the 1960’s and the promised community mental health services did not appear, and there is no reason to think it will be more accurate this time around.
So how did a false narrative gain such a large following and become accepted as the truth? This idea has been supported by a powerful coalition of organizations led by Casey Family Programs, author of the white paper quoted above. Casey’s assets totaled $2.2 billion at the end of 2018 and it spent $111 million that year in pursuit of its goals, which include “safely reducing the need for foster care by 50 percent by the year 2020.” Casey has relentlessly promoted this narrative through publications, testimony, and assistance to jurisdictions that agree to implement its agenda.
As mentioned above, FFPSA does not add resources to the system but instead redirects them from congregate care and adoption assistance to services designed to keep families together. Much of the savings will come from states taking on the full cost of group home placements that they cannot avoid. The Congressional Budget Office estimates that about 70% of the children residing in group home placements (other than residential treatment programs) would become ineligible for Title IV-E funding in 2020. So the cost of funding this placements will be shifted to states and counties that are often already struggling to fund these necessary placements. Moreover, the continuation of the TItle IV-E “lookback” means that the federal share of foster care funding will continue to decrease.
Much of the blame for the Act’s budget neutrality goes to Casey and its fellow advocates, who have been uninterested in increasing resources for foster care. As longtime Hill staffer Sean Hughes points out, “…Congressional staffers will tell you that child welfare advocates are perhaps the only group of federal advocates that consistently decline to even ask for new resources.” According to Hughes, these advocates have been unwilling to increase resources for foster care because of their bias toward family preservation. (Remember Casey’s goal of reducing foster care by 50% by 2020). They apparently hope that “starving the foster care beast” might result in fewer foster care placements, whether or not children might be left in unsafe situations. The framers wanted a budget neutral bill, and the advocates were happy to accept it in order to reallocate resources away from foster care (through the continuation of the “lookback” and the restrictions on group homes) toward family preservation.
Lack of review
Aside from a pair of hearings that were orchestrated by the bill’s sponsors to support their vision for the legislation, there were no hearings or floor debate on the Family First Act after it was introduced in 2016. In 2017, it passed the House by voice vote, and its Senate sponsors failed to get it passed. In 2018, after failing twice to attach it to larger bills without hearings of debate, the sponsors succeeded at the eleventh hour in getting it attached to the budget act. Young people whose lives were saved by group homes were never able to tell their stories. The technical problems with Medicaid eligibility were never discussed and may not have even been noticed until long after passage.
A bill called the Family First Transition Act has been introduced to ease the transition to the new legislation. It would delay for two years the implementation of the 50% “well-supported” requirement for services reimbursement, provide a small amount of transition funding to help states implement the Act, and provide temporary grants to jurisdictions with expiring waivers to make up for a portion of their loss under FFFPSA. However, none of these temporary fixes would cure this fundamentally flawed bill, the inevitable result of a false narrative, inadequate funding, and a truncated legislative process.
This post was updated on November 7, 2019, to specify that the Children’s Bureau made the determination that Title IV-E would be the payer of last resort for prevention services to foster care candidates. This designation of Title IV-E as payer of last resort was not made in the Act itself.
On July 5, the parents of four-year-old Noah Cuatro called 911, saying their son had drowned in the pool at their apartment complex. But Noah did not look like a drowning victim, and the sheriff is investigating his death. Noah’s family had been under the supervision of the Department of Children and Family Services (DCFS). The eagerly awaited report on the Noah Cuatro investigation has appeared after a long delay, and OCP in the person of Judge Michael Nash (Ret.) has exonerated DCFS from responsibility for Noah’s death. This is not surprising given the similar results of OCP’s Anthony Avalos investigation, which Child Welfare Monitor addressed in our last post.
The flaws in this latest report are so glaring that they are evident even to readers without access to Noah’s case file. The report describes a child who may have been wrongly sent back to his parents, and an agency that failed to protect him after he was sent home. But Nash limited the scope of the investigation to DCFS’s failure to carry out an order to remove Noah from his parents. “Given what is currently known, the primary issue in this case from a systemic perspective focuses on the removal order,” Nash states. He defines three questions, all of which involve the removal order. Was it appropriate? Should it have been issued? Should it have been executed? Nash concludes that the order was inappropriate, the judge was correct (nevertheless in issuing it), and the decision not to execute it was correct. End of story.
But the decision to confine his conclusions to the removal order disregards a much larger issue. Here is a family that was under DCFS supervision since the reunification of Noah and his parents in November 2018. A child under supervision by DCFS died in unexplained circumstances in the Antelope Valley of Los Angeles County. Sound familiar? Think of Gabriel Fernandez in 2013. Think of Anthony Avalos, who had been under court supervision for years but was left unprotected for over a year until he died in 2018. Had there been no removal order at all, this case would have raised serious questions.
A Story of a Troubled Family
Let us step back and look at the history, as summarized by Nash. In August 2014, shortly after Noah’s birth, he and his sister were placed in foster care with their maternal great-grandmother as a result of DCFS finding that their mother had fractured the skull of her own infant sibling, and that their father was abusing marijuana. They were returned to their parents in May 2015 based on dismissal of the allegations in the original petition for removal.
Noah and his sister were removed again in November 2016 (although his sister was returned over the objections of DCFS) due to DCFS finding that Noah had been diagnosed with “failure to thrive,” developmental delay, and congenital hypertonia, and that he was medically neglected by his parents, who failed to take him to eight scheduled appointments. Noah was originally placed in an unrelated foster home and was then placed with his maternal great grandparents in August 2017.
In November 2018, the court ordered Noah returned home to his parents over the objections of DCFS. As is common practice in Los Angeles and around the country, Noah was placed under court supervision after being reunified with his parents. The court ordered DCFS to make unannounced visits and set up a visitation schedule for Noah’s maternal great-grandparents and also ordered that Noah and his parents participate in Parent Child Interaction Therapy (PCIT) to help improve their bond. The next judicial review was scheduled for May 9.
Between Noah’s return to his parents in November 2018 and his death in July 2019 the following occurred:
The parents did not enroll in PCIT or put Noah in preschool–which would have been another set of eyes on the child. Noah had only one visit with his maternal grandmother.
On her February 28 visit the caseworker supervising the family’s case (referred to as a “CS-CSW” without clarification by Nash) described Noah as lethargic and advised his parents to take him to the doctor. They did not follow his advice, waiting for Noah’s well-child visit on March 7, where Noah was diagnosed with an ear infection and prescribed medication.
On April 17, 2019, the hotline received a call (almost certainly from Noah’s maternal great-grandmother) stating that he appeared “thinner, intimidated, and scared.” The caller alleged that Noah suffered from night terrors and said his “butt hurt” and that his father hits and curses at him. The family’s caseworker was informed of the report and went to see Noah. She noted a bruise on his back and a scab on his forearm. He denied all the allegations and agreed with his mother that he had fallen off a bunkbed. The caseworker suspected he had been coached.
On April 18, the caseworker made a report to the hotline and an investigative worker met with the family. She took Noah for a forensic exam on April 19. Noah denied any abuse and the examiner concluded that the injury could have occurred as Noah and his mother reported. On May 9, the investigator met with the family’s prior caseworker. The latter said she “always had concerns for Noah, was opposed to his return home, and felt that the parents are habitual liars who present well.” She also expressed doubts about the bonding between Noah and his parents and concerns that he was targeted by them for abuse among their other children. Nevertheless, the referral was closed on May 9 or shortly thereafter with a finding of “inconclusive.”
On May 13, the investigative worker advised the current caseworker that the allegations could not be verified, but the caseworker indicated that she was working on a petition to the court for permission to remove Noah due to concerns about the compliance and honesty of the parents. On May 15, the caseworker submitted the removal petition to the court and it was signed the same day.
On May 15, the maternal grandmother called the hotline alleging that Noah’s maternal aunt reported his father beat his mother in front of the children and sometimes threw them in the street. She also reported that Noah spent the night at an aunt’s home and woke up screaming in the middle of the night. He also told the maternal uncle that his “butt hurt” and the uncle told the aunt that Noah was being sexually abused. This referral was assigned to the same investigative worker. When the investigator saw the family on May 20, the parents and Noah denied all the allegations and Noah even denied staying over with his aunt. The mother also denied being pregnant–a fact that becomes significant later.
On May 22, a case conference including the Assistant Regional Administrator agreed not to execute the removal order while the investigation was underway. They agreed to facilitate a meeting with the family. “Unsuccessful attempts were made through July 5” to schedule this meeting, according to Nash.
On June 6, the mother, who had denied pregnancy on May 20, gave birth. At the hospital she initially denied the baby was hers, claimed she was artificially inseminated as a surrogate, but that she did not know she was pregnant. Hospital staff reported that the mother had no prenatal care and they were concerned about her mental health. Nevertheless the baby was discharged with her parents.
On June 13, the investigator, in consultation with her supervisor, decided to add Noah’s three siblings to the family’s case because of “concerns for Mother’s mental health and her ability to comply with court orders.”
On June 18, according to redacted documents that have since disappeared from the internet, an automated assessment found the risk to Noah to be “very high” and the caseworker noted “current concerns for the mother’s mental health,” as cited by the Chronicle of Social Change.
On June 19, the investigation begun on May 15 was closed. The allegation of general neglect by the mother was substantiated and the allegation of abuse by the father was found inconclusive.
On June 28 the investigative worker saw all the children and reported Noah to be in good spirits. (Note: It is unusual for an investigative worker to visit 9 days after an investigation is closed. Perhaps this is an error and the visit was by the caseworker).
On July 5, Noah was hospitalized after his parents said they found him in the pool at their apartment complex. The county sheriff stated that Noah had signs of trauma that were not consistent with drowning, and an investigation is ongoing. Noah died on July 6.
This history raises serious questions aside from the question of why the removal order was not implemented, which is all that Nash addressed. This family was under supervision by the the court, with DCFS responsible for monitoring the family. The family’s caseworker was concerned enough about Noah’s safety to file a 26-page request for a removal order from court. If the agency later decided to shelve the order, what was done to ensure Noah’s safety? Between the decision not to carry out the court order on May 22 and Noah’s hospitalization on July 5, Nash does not list any visits to Noah by the caseworker who was supposed to be supervising the case. Unusually, the investigative worker was recorded as visiting them one more time on June 28, after the investigation was closed. If that was the only visit to Noah in six weeks, this is evidence of serious negligence, especially in light of the fact that the family’s caseworker thought his situation was bad enough to require a removal. Moreover, the investigator had added the other children to the case on June 13 due to concerns about the mother. Other than gross negligence, the only possible explanation for the lack of visits noted is that there were visits but Nash was not given access to the notes. That possibility is concerning; also concerning is the fact that Nash apparently did not notice the gap and ask for any missing notes.
More questions abound. Information from the hospital after the birth of the new baby was very concerning as to the mother’s lack of veracity and her mental health. Yet, this did not seem to change the outcome of the still-open investigation or result in more intensive supervision of the family. Why not? Why is there no report on the court hearing that was supposed to take place on May 9? Moreover, how could an agency make “unsuccessful attempts” to schedule a family meeting for six weeks without raising the stakes? The agency had recently had a removal order for Noah. Did they try to involve the court? Why is the family’s former caseworker now a “Human Services Aide,” which appears to be a demotion?
Perhaps Nash is right in his narrow conclusion that a removal was not warranted on May 15 when the order was granted. But it is impossible to assess this conclusion without seeing the text of the removal petition or the judge’s order. Note that DCFS was against returning Noah to his parents in the first place and was overruled by the judge in the case. Nash’s report does not provide any of the reasons why DCFS opposed the reunification. (It would be interesting to see these reasons and also learn whether they were restated in the petition requesting the removal order.) One would think that if the same team was in place when new concerns were raised, they would have been very happy to implement the removal order when they finally received it. We need to know if the team was the same and if so, why it changed.
We will have to wait for the release of the full case file to know the answers to these questions. It is not clear why Judge Nash authored such a faulty report. Perhaps it was a deliberate attempt to whitewash DCFS; perhaps DCFS administrators provided incomplete or misleading information; or maybe Judge Nash simply failed to appreciate the questions raised by the information he received. It is ironic that OCP exonerated the agency for Anthony Avilas‘s death because unlike the family of Gabriel Fernandez, Anthony’s family was not under agency supervision at the time of his death. But in addressing Noah Cuatro’s death while under agency supervision and in light of numerous red flags, OCP has exonerated DCFS, giving the agency a free pass for losing a child it was supposed to protect. It seems that the agency cannot go wrong in the eyes of Judge Nash.
In July 2018, ten-year-old Anthony Avalos arrived at the Emergency Room with fatal bleeding in his brain. His emaciated and battered body succumbed the next day to years of deprivation and abuse. For four years, the Los Angeles Department of Children and Family Services (DCFS) had received 13 reports on suspected abuse of Anthony and his siblings. For part of that period, his family was actually under the supervision of DCFS.
Many commentators saw parallels between Anthony’s death and that of Gabriel Fernandez in 2013 in the same town of Palmdale, in the Antelope Valley section of Los Angeles County. Gabriel was tortured to death by his mother and stepfather after multiple reports to DCFS failed to result in his rescue from this lethal home.
But based on its review of the family’s case file, Los Angeles County’s Office of Child Protection (OCP) concluded that Anthony’s case was “very different” from Gabriel’s. OCP concluded that it could not say that Anthony might still be alive today if the agency had done things differently. In justifying this conclusion, OCP stressed that the family was not under DCFS supervision at the time of Anthony’s death and that it had been over a year since the last report was made to the child abuse hotline concerning the family.
But in his devastating article, The horrific death of Anthony Avalos and the many missed chances to save him, investigative reporter Garrett Therolf shows that DCFS had many opportunities to save Anthony. It also reveals striking connections between Anthony’s case and Gabriel’s. The same private agency counselor had worked with both boys, and had been questioned in court about Gabriel. A caseworker who had been disciplined for his errors in the Fernandez case actually supervised the social worker who managed Anthony’s case.
Garrett Therolf was kind enough to share the DCFS case file with Child Welfare Monitor. In reviewing the file, we were struck by the many red flags that DCFS ignored and the crucial points where the agency could have intensified the surveillance of the family or removed the children to safety. In this post, we highlight our own observations from the case file, complemented by key information obtained from other sources (such as interviews and grand jury transcripts) by Therolf.
The First Calls: 2013 and 2014
Anthony Avalos first came to the attention of DCFS in February 2013, when he was only four years old and reported that his grandfather sexually abused him. The agency substantiated the abuse but did not set up any ongoing monitoring, relying on his mother, Heather Barron, to keep his grandfather away from him.
In May 2014 the family came to the attention of DCFS again when a caller alleged that Barron, who had four children at the time, was hitting the children with hoses and belts and locking them in their rooms for hours. An allegation of neglect (but not abuse) was substantiated. Barron agreed to the opening of a voluntary case, which was open from May 20, 2014 to December 4, 2014. A social worker named Mark Millman was assigned to manage the case.
Under DCFS Supervision: June-December 2014
In June, 2014 a PhD. psychologist who evaluated Barron concluded that she “appeared to have poor parenting skills as shown by her lack of patience towards her two children that displayed energetic behavior….At this time…. the assessor believes that her capacity to provide suitable care for her children is severely limited by her poor parenting skills, poor judgment, and denial and lack of awareness of her mental health issues.” The evaluator recommended a variety of services for Barron. She refused to participate in individual therapy–probably the most essential. But there is no indication that case manager Millman even read the report, let alone followed up to see if the services were provided or successfully completed. Barron did participate in in-home services to improve her parenting skills, which were provided by an agency called the Children’s Center of the Antelope Valley.
Once services got under way, reports from the provider were not encouraging. A July 2014 progress report from the Children’s Center indicated that Barron was “having a difficult time maintaining her composure when the children misbehave.” In its August 2014 report, the agency reported that Barron was overwhelmed. The agency case manager recommended therapy for Ms. Barron but she again refused saying she was not interested in talking about the past.
On October 9, 2014, a counselor at the Children’s Center called the hotline with concerns about the family. The counselor had tried to discuss her concerns with Millman but he seemed to “blow it off.” She reported that Barron, who had recently given birth to a fifth child, was “ very aggressive and angry and showed no nurturing to any of her children, even the infant.” She reported that she observed Barron yanking one child by the arm, yanking her daughter’s hair while brushing it, and calling the children names like “punk” and “bitch.”
The social worker assigned to investigate the new allegations was not concerned. He observed that Barron and her children were ”interacting positively” and “that mother and children had secure attachment as seen by their interaction.” Barron’s admission that she hit the children with a belt and used hot sauce to punish them for talking back did not seem to bother him. It appears that he was influenced heavily by Millman, who expressed no concern for the family. He reported that Ms. Barron “has her hands full and is doing her best….…She does cuss and yell but [is] doing all she can to provide appropriate care.”
The automated risk assessment performed as part of every investigation showed a high risk of abuse and neglect and recommended promotion to a court case. The investigator overrode this recommendation, stating that the children were already involved in a voluntary case and getting services. And somehow, despite the mother’s own admission, the investigator closed the referral as “inconclusive” for physical abuse, as well as emotional abuse and general neglect.
Another Children’s Center therapist called DCFS on November 5, 2014, alleging she overheard one child say “She’s bad because she whips our ass.” The caller said that Barron continued to get frustrated easily. She quoted Barron as telling one of the children, ‘Don’t think, because she is here, I won’t whip your ass.’” This referral was “evaluated out” with no explanation.
Case Closed: December 2014
The voluntary case was closed on December 4, 2014 with the following comments: “The mother has been compliant with services and receptive to outside resources. Although the family has received two new referrals, the allegations were assessed unfounded/ inconclusive. Mother has agreed to continuing counseling for the children.” The agency arranged for the family to receive this counseling through a new agency, Hathaway Sycamores Counseling. There was no indication that the mother had made any progress in addressing her parenting issues. Nor was there a rationale given for directing the counseling toward the children rather than the mother.
Hathaway-Sycamores was the same agency that worked with Gabriel Fernandez, as mentioned above. As Therolf reveals, Anthony was even assigned to the same counselor, Barbara Dixon, who worked with Gabriel. Dixon testified in court that she had observed extensive injuries to Gabriel but did not report them to the hotline, despite being a mandatory reporter. The fact that she still had her job is mind-boggling. According to Therolf, “her case notes show that she counseled [Gabriel] to listen to his mother more attentively and to finish his homework.”
Kareen Leiva Enters the Picture: 2015
As Therolf describes, Barron met Kareem Leiva in 2015 and began a relationship that would last several years and result in Barron’s seventh child. Within months, the father of Anthony’s two-year-old brother reported to police that Leiva was abusing his son. There was no DCFS investigation but DCFS did open a court case involving that child and his parents, resulting in regular visits to the home by a social worker, Mindy Wrasse.
On June 12, 2015, the same father went to the police again after an agency-supervised visit with his son, reporting that his son had bruises on his arm and face. The social worker observing the visit had confirmed the bruising and reported that the child repeatedly said “Mommy is mean” during the visit. The father reported that the child seemed to have bruises at every visit. Ms. Barron reported the two-year-old fell in the shower, and the toddler reportedly confirmed the report. A two-year-old’s ability to confirm this verbally–and to take a shower on his own–shows suspicious precocity for his age. Despite the other siblings giving two different accounts of the bruising, the referral was ruled unfounded on the grounds that all of the children had similar stories. Additionally, the risk of maltreatment was found to be high and the recommendation was to promote to a case. But this recommendation was overriden because there was already an open case involving the two-year-old and his mother. That case closed in October 2016, leaving no DCFS personnel in contact with the family.
The Children Beg for Help: September 2015
On September 18, 2015, the hotline received a call, revealed by Therolf to be from the principal of Anthony’s school, recounting disturbing reports by Anthony of his treatment at home. A similar call came in from a sheriff’s deputy the next day. According to Therolf’s investigation, the children were visiting their uncle, David Barron, and told him about the horrific treatment they received from Barron and her boyfriend, Karim Leiva. David Barron refused to allow his sister to pick up the children and called the police instead. Anthony and his two oldest siblings described to the deputy who responded a litany of horrific punishments by Barron and Leiva. They reported Barron made them. squat against the wall for long periods of time, a torture she called the “Captain’s Chair.” They also described beatings, food deprivation, being locked in their rooms, and Leiva’s hanging Anthony’s brother from the stairs.
When the DCFS investigator met with Anthony, he told her “Heather is my old mom. This is my new house. I am part of the Barron family now. I’m never going to see Heather again. She locks us up in our rooms and makes us starving.”
But sadly, the agency that was responsible for Anthony’s safety did not allow him to stay in his safe “new home.” The investigator spoke with three staff members of Hathaway-Sycamores, the agency providing home-based services to the mother. The three reported that they were “constantly in the home” and that the mother did not hit the children. They said the children did not seem frightened, never talked of abuse, and there were no locks on the doors. The contrast with the reports of the Children’s Center a year earlier is striking. Given what came out after Anthony’s death, it is clear that the providers from the Children’s Center were much more discerning. Or perhaps Hathaway-Sycamores was in the grips of an ideology that values family preservation over child safety–a belief system that has led to many other children being abandoned to a horrible fate. In any case, it is incredible that DCFS was still using this agency after its role in Gabriel’s death.
Heartbreakingly, Ms. Barron was allowed to take the children home from her brother’s house. Not surprisingly, they recanted all the allegations once deprived of the protection of their aunt and uncle. Instead, they said their aunt and uncle told them to make these allegations. The wholesale retraction is suspicious because of the similarity and unusual nature of the allegations and the young age of the children, as well as the number of previous reports of abuse. It doesn’t take a genius to realize that the children may have been frightened into recanting their allegations. But the investigator decided that the aunt and uncle were manipulating the children and had instigated the allegations. (Therolf reports that she was new to the job and testified in court that she was unaware that survivors of abuse often retract their accounts.). The allegations were found to be “inconclusive “and the referral was closed with a disposition of “situation stabilized.”
One last chance of rescue missed: April 2016
On April 28, 2016, DCFS received another report, which Therolf learned came from a domestic violence center staffer who was working with Barron. Two of Anthony’s brothers had bruises on their faces. Barron said they had been in a fight, but the boys told the reporter that Karim Leiva made them fight each other. They also reported being locked in their rooms and deprived of food for long periods of time. Barron stated that Leiva had not been in the home since the previous September. In interviews with the investigator, Anthony, his sister, and the five year-old brother all denied the allegations. Anthony and his sister denied that Leiva was in the house or even that they knew him–a denial which should have raised serious concerns to the investigator. Wrasse, the social worker who was monitoring the open case involving Anthony’s brother, said the children definitely knew who Leiva was–and she thought he was coming regularly to the house. The investigator of the previous report also declared definitely that the children knew Leiva.
Despite all these inconsistencies, the allegations were all judged “unfounded” or “inconclusive,” and the disposition was “situation stabilized.” The risk assessment showed a high risk of abuse or neglect and a recommendation to “promote” the case. But the recommendation was disregarded because there was already a social worker on the scene–the same worker who was sure Leiva was coming into the home regularly. Her involvement ended in October 16, and then the children were totally on their own.
There were no more allegations until it was too late for Anthony. At some point, Ms. Barron cut ties with her brother and sister-in–law and moved Anthony to a school that did not know his history. Nobody was left to protect him. It is nevertheless surprising that no reports came from the children’s schools–a fact that deserves further investigation. According to Therolf, Anthony’s teacher noticed that he was “often nervous about something.” Such nervousness is not normal and should have triggered a response. But that is an issue for another post.
June 2018: Anthony’s suffering ends
Anthony’s fate was sealed when he told his his mother that he liked boys and girls. Leiva overheard this conversation. The following night, his siblings later reported, Leiva picked up Anthony by his feet and slammed his head on the floor repeatedly. The next morning, Barron called 911, saying Anthony had fallen. He was taken to the hospital and died the next day.
Anthony’s siblings initially denied any abuse, but as soon as they were questioned by an expert forensic interviewer, they revealed all the horrors that were occurring in the home. As punishment for minor transgressions, they were made to kneel on rice with weights in their hands, were kept awake all night (with water thrown into their faces by Barron or Leiva if they fell asleep), and were whipped with a belt or extension cord on the buttocks or soles of their feet. Anthony was singled out of special punishment. Leiva would pick him up by the feet and slam him on the floor head-first, as he did the night before Anthony died. By dying, Anthony saved his siblings from this nightmare home. They were removed from the home Barron and Leiva , who have been charged with first-degree murder for Anthony’s death.
DCFS had many chances to save Anthony but it wasted them all. This gifted, sensitive, and loving child was condemned to years of suffering ending only with his death. OCP was set up to protect children in the wake of Gabriel Fernandez’s death. It’s sad that this office ended up basically whitewashing Anthony’s. Now we are waiting for their report on why four-year-old Noah Cuatro was killed when DCFS disregarded an order to remove him from his home. Based on the Avalos report, the chances of a thorough investigation by OCP are slim.
When a child is found to be seriously or fatally abused, the perpetrator is often found to be a male caregiver. But a new study using data from pediatric emergency rooms provides powerful evidence of the correlation between caregiver characteristics and the likelihood of abuse.
The new study is the first to compare caregiver features among children with injuries due to abuse to those with accidental injuries. The article was published in the Journal of Pediatrics, and a summary is available online on the Science Dailywebsite. The authors used data on 1615 children under four who were brought to a pediatric emergency department. Overall, 75% of the injuries were classified as accidents, 24% as abuse and 2% as indeterminate.
The differences between the likelihood of abuse versus accident among different groups of caregivers are striking. Abuse was determined to be the cause of injury to only 10% of the children for whom a female was the only caregiver at the time of injury and fully 58% of children who were with a male caregiver when injured. There was a big difference between fathers and boyfriends however; an “alarmingly high” 94% of the children who were alone with the mother’s boyfriend at the time of injury were determined to be abused, as compared to “only” 49% of injured children who were with their fathers at the time of injury.
Analysis of the 83 cases of severe injury (including fatalities) provided even stronger evidence of the connection between male caregivers and abuse. The authors found that “nearly all cases of severe injury in which fathers and boyfriends were present involved abuse, and for fatalities, the fathers and boyfriends were most commonly present as lone caregivers. Mothers were rarely present alone when severe abusive injuries occurred.”
Among female caregivers, one group was more likely associated with injuries and that was babysitters. Fully 34% of the children left alone with babysitters were found to be victims of abuse
The researchers point to several policy implications of their study. First, they highlight the importance of asking who was caring for the child at the time of injury as part of the investigation to determine whether an injury is the result of abuse. Second, they call for abuse-prevention strategies to focus on male caregivers and female babysitters. (Currently, such programs, like shaken baby education, often focus on mothers.)
But the authors do not mention another policy implication that is equally important. Ensuring that all low-income children have access to high-quality early care and education (ECE) is a logical implication of the study.
As I have written in an earlier post, there are many pathways by which ECE can prevent maltreatment. Free, high quality ECE would provide mothers with an alternative to leaving their children with caregivers who are unsuitable to the task–be it boyfriends, fathers, or babysitters. ECE has other child welfare benefits as well. Staff who are trained as mandatory reporters ensures that more adults will be seeing the child and able to report on any warning signs of maltreatment. Quality ECE programs that involve the parents can also improve child safety by teaching parents about child development, appropriate expectations, and good disciplinary practices. They may also connect parents with needed supports and resources in the community and help them feel less isolated and stressed.
Of course the benefits of ECE extend far beyond child welfare in the narrow sense. We are worried about school readiness for low-income children and we know that much of brain development occurs between the ages of 0 and 3. That’s why quality ECE has been such a priority for the early childhood community. But child welfare policymakers have not yet caught onto the importance of ECE as a means of preventing child maltreatment.
An excellent issue brief from the Administration on Children and Families recommends improving access to ECE for families that are already involved with child welfare. That is a great proposal, but the child welfare field is beginning to focus on prevention rather than only treatment. We must explore ways to provide access to ECE among children who are at risk of child abuse and neglect. Expanding access to subsidized child care among lower-income families, because income is so highly correlated with child maltreatment, would be a good beginning.
Prevention is the word of the day in child welfare. A key part of prevention is making sure children spend their time with caregivers who will not harm them.