To Prevent Further Tragedies, Require Immediate Fatality Reviews

On November 6, 2016, Trinity Jabore was born in the District of Columbia with marijuana in her system and weighing less than five pounds. On December 25 of the same year, Trinity’s lifeless body was taken to the morgue. A pathologist determined that Trinity’s brief life had been one of suffering. She weighed less than her birthweight, she had multiple fractured ribs, and she died from consuming water that had been mixed with condensed milk.

Soon the Washington Post learned that the District’s Child and Family Services Agency (CFSA) had received multiple calls reporting neglect of other children born to Trinity’s parents. The final call occurred early in the month of her death. A teacher reported that her brother had showed up in school with a bruise under his left eye and stated that his mother had punched him because he “wasn’t listening.” Three weeks later, the investigators had talked to the brother but had not managed to contact his parents. They were still “trying to make contact” when Trinity died.

Trinity’s story is unfortunately very familiar. I have written about the deaths of Zymere Perkins in New York and Yonatan Aguilar in Los Angeles. A recent series published in the Fayetteville Observer revealed that more than 120 North Carolina children have died within a year of a child maltreatment report. Each of these deaths is the tip of the iceberg of system failure. We have no idea how many children are suffering in toxic homes as you read this column. Tonisha Hora was left in an abusive home for ten years despite repeated calls to CPS about her plight and that of her sister.

The first response to Trinity Jabore’s death should have been for an independent panel to conduct a comprehensive review of her parents’ prior contacts with the child welfare system to determine how she was left unprotected . This review should have been conducted immediately and included recommendations to prevent such tragedies in the future.

Unfortunately, Trinity has been dead for 9 months and no such review has been released. Like other jurisdictions, the District of Columbia has a Child Fatality Review Committee, upon which I serve. But I have been disappointed by the long lag times and lack of thoroughness of these reviews.

The Committee is about to issue its annual report, which will contain reviews of deaths that occurred between 2012 and 2015. It takes some months for the panel to receive notice of child deaths and all the relevant information including pathology reports. Because the panel is understaffed, there is a further delay after cases are received. The District of Columbia Auditor recently found that the percentage of child deaths reviewed by the CFRC has been declining as the panel’s budget has been cut drastically. Similar issues plague other child fatality review teams, such as the one in North Carolina.

There is another problem with child fatality review panels as a mechanism for reviewing systems’ failure to identify children at risk. In about half the states, these teams review all child fatalities, not just those that are due to child maltreatment, or those of children known to child welfare agencies. The District’s panel reviews all fatalities of young people aged 18 and younger, including all premature infants, gun violence victims, children with terminal illnesses, and accident victims. It does not review the actual files but brief summaries provided by overworked CFRC staff. And Trinity’s death will be mentioned only briefly in an annual report devoted to all of the child deaths that were reviewed in the same year.

An internal CFSA review has probably already occurred, but the public will not know about it for some time. It was in April 2017 that the agency released its review of child deaths occurring in 2014 and 2015. Moreover, Trinity’s death will be folded into a report on all deaths of children known to CFSA within four years of their death–a total of 30 deaths in 2015.

The death of a child known to the system should be treated like a plane crash or the loss of the space shuttle Challenger. It should be reviewed immediately and exhaustively by experts of the highest caliber. The point is not to allocate guilt or punishment but to change policies or practices to save children in the future.

In the State of Washington, the Children’s Administration (CA) conducts a review 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 CA (including a hotline report that was not investigated) at the time of death, or in the year prior. The review committee is made up of individuals with no prior involvement with the case, and typically includes CA staff, ombudsman staff, and community professionals selected from diverse disciplines with expertise relevant to the case. The review committee has full access to all records and files relevant to the review. The agency must release review results within 180 days following the fatality, unless granted an extension by the Governor.

These reports are subject to public disclosure and must be posted on the Department’s website. The Department is authorized to redact confidential information contained in these reports. In order to promote accountability and the consistent implementation of recommendations, the state’s family and children’s ombudsman is required to issue an annual report to the Legislature that includes an update on the implementation of recommendations issued by fatality review committees.

Every state or other relevant jurisdiction should follow Washington’s example and require a thorough, immediate independent review of all all cases of children children who die, are seriously injured or disappear (as in the case of Relisha Rudd in the district of Columbia) when there is a family history with CPS. This should be a requirement for federal funding.

No more children should suffer because of agency incompetence, extreme family preservation ideology or underfunding. Let us take the first step and ensure all of these terrible cases are investigated immediately and acted upon fast.

The Real Benefit of Child Welfare Waivers: Eliminating Title IV-E Eligibility Determination

I’ve never been a huge fan of the Title IV-E waivers that 28 jurisdictions have obtained from the federal government to allow states to develop innovative programs to address federal child welfare goals. Maybe it’s because the one in my own jurisdiction, the District of Columbia, is currently being redesigned because the services it funded were underutilized at the same time as many system-involved families received little help.

Around the country, most states are funding the same set of programs, few if any of which can document impressive effects despite being billed as “evidence-based.” Moreover, in its most recent report on child welfare financing, Child Trends found that only nine percent of waiver funds were used for purposes not traditionally reimbursable under Title IV-E.

But when reading an article about Florida I suddenly realized why the loss of the waivers could be disastrous for many child welfare systems and the children they serve. If Florida’s waiver expires, the Deputy Commissioner of Florida’s Department of Children and Families is worried about the state having to return to determining the Title IV-E eligibility of individual children.

For those who are not versed in the arcane details of child welfare finance, let me explain. States receive partial federal reimbursement for Title IV-E foster care expenditures only for children who would have been eligible for Aid to Families with Dependent Children (AFDC), a welfare program which ended in 1996. To obtain their share of federal funding, states are forced to devote considerable resources to determine this eligibility for every child–a calculation which serves no other purpose.

Of course there has been inflation since 1996, so the proportion of children eligible for Title IV-E funding decreased from 67% in 2000 to under 50% in 2017. This means that every year states and counties are paying a higher proportion of foster care costs compared to the federal government.

Determining eligibility for foster care based on income makes no sense. A state or county pays for foster care even for youths who are not eligible for financial assistance based on poverty. If a child of Donald Trump or Bill Gates came into foster care, the state would pay. So federal reimbursement should not depend on the income of the parents.

I have not seen any estimate of how many people perform the soul-deadening task of determining Title IV-E eligibility, or how much governments spend on this useless exercise. That money would be much better spent on services to children in a desperately underfunded child welfare system.

Most states with waivers have been exempted from Title IV-E eligibility determination. To ensure that the projects are cost-neutral, the federal government established a cap on federal funding for each jurisdiction rather than reimbursing them on a per-child basis. These jurisdictions have been able to stop determining Title IV-E eligibility for kids entering foster care.

States should not need a waiver in order to avoid wasting human and financial resources to determine foster children’s eligibility for a defunct welfare program. Yet, advocates have been silent on this issue. There are several child welfare bills awaiting consideration by the 115th Congress in 2018. Unfortunately, none of them would eliminate the criteria for Title IV-E eligibility, not even the “Family First Act,” which has been billed as child welfare finance reform.

In his brilliant column, The Two Billion Dollar Question: Why Haven’t We De-Linked?, Sean Hughes tried to explain the reasons for this silence. He argues that “the focus seems to have shifted almost exclusively toward preventing entry into foster care, with little advocacy being devoted to actually improving the continuum of care for children in out-of-home care.” Shockingly, he reports that advocates have often told him that they would not want more funding for foster care even if they could get it.

It is hard to believe that people calling themselves child advocates could turn their backs on the heartbreaking needs of children in foster care by staying silent on the Title IV-E eligibility limits. Children in foster care need great foster parents who live near their homes and schools of origin, and who might be attracted by the offer of housing in supportive communities of foster parents. They need caseworkers who have the time to assemble and coordinate the multiple services they require. They need cutting-edge trauma-informed mental health services from top providers, not the low-end providers who often choose to participate in Medicaid. They need music lessons, art and dance classes, and driver’s education.

In light of the dwindling supply of good foster parents and the recent increase in the foster care rolls, large sibling groups and harder-to-place foster youths need high-quality boarding schools where sibling can be kept together, needed services can be provided in one place and where behavioral challenges can be addressed in a safe and non-traumatizing way.

Eliminating Title IV-E eligibility determination would be a good first step to providing all the enhanced services that foster kids need and deserve, and stopping the waste of desperately needed resources on eligibility determination.

Putting the Child Back in Child Welfare

It was the dead kids who inspired me to leave my comfortable, well-paid job as a researcher and become a child welfare social worker. Kids like Adrian Jones, Zymere Perkins and Yonatan Aguilar, who were killed by their parents after months or years of abuse.

The dead kids were out of their misery. But I couldn’t stop thinking about all the other kids living in fear of the next beating, watching child protective services (CPS) workers leave after accepting the mother’s or stepfather’s explanation of their bruises, and facing the now-angrier adult eager to punish them.

So I went back to school and added a Masters in Social Work to my Masters in Public Policy from Princeton and my B.A. in Sociology from Harvard. I was thrilled to be accepted as a CPS trainee at the District of Columbia’s Child and Family Services Agency (CFSA).

But my CFSA trainer told us we were not there to save children. I learned that the family, not the child, was at the center of child welfare policy. Our business was to find the strengths in each family.

We learned that “safety” meant simply the absence of “imminent danger.” A child could be “safe” but at high risk of abuse or neglect in the future. Such children should remain at home with monitoring and supervision by the agency, but since this is usually voluntary, the family can refuse to participate.

I later learned that even if the family agrees to participate, these in-home cases often closed quickly with little evidence of reduced risk to the child. I also learned of cases around the country, such as that of Yonatan Aguilar, in which these high-risk but “safe”kids died from abuse.

I never ended up being a CPS worker. I ended up instead in a private agency that provided foster care and case management to D.C. children.

Working in foster care, I learned even more about how the child is not the center of child welfare practice. Compliance with requirements, meeting benchmarks and saving money were much more important than helping children.

Assuring that a child had her physical exam on time, her two visits with the social worker within the month, her “Youth Transition Plan” every six months was paramount. But no problem if I did not have enough time to explore summer camp options, or talk to a teacher or therapist, because there was no benchmark for that.

These benchmarks could have perverse results, like the time I had to take a client for an extra physical because her placement had changed its designation from “respite,” so it was treated as a new placement. Working 60 hours a week to see my clients’ needs met, I could ill afford the time.

I learned that the field adheres to simple, feel-good policy reforms that just happen to save money and often have perverse effects on kids. Non-family residential placements are anathema in the current climate. But many excellent group homes and residential schools are far more nurturing than some of the uncaring foster homes I’ve seen.

Because of the virtual elimination of group homes in the District, social workers have to repeatedly find new placements for traumatized teens whose behavior results in repeated rejection by foster families in search of easy money with no behavior problems.

It is also accepted as gospel that children must achieve “permanency” rather than aging out of care. To increase the numbers of “permanent placements,” and reduce the number of kids aging out, workers often urge youth to accept adoption or guardianship with foster parents, relatives, or other available adults, even if they are uncaring or inappropriate. Never mind that some youth might do better staying in foster care until 21 and benefiting from continued case management and services, rather than being at the mercy of paid guardians who may divert their subsidies for their own purposes.

Once a child is off the foster care rolls, there is no mechanism to ensure that the “permanent” placement works out. And with subsidies being paid to adoptive parents and guardians, there is reason for concern. Of course, the results are not usually as catastrophic as the murder of two girls by the woman who adopted them from D.C. foster care, who collected subsidies while their bodies remained in her refrigerator.

In my experience in child welfare, I’ve learned that too many things take precedence over the welfare of children.To share what I’ve learned, I’ve blogged for two years as part of The Chronicle of Social Change blogger co-op. Those postings can be found here. With the end of the co-op, I am continuing my blog under the new title of Child Welfare Watch. I hope you will follow me as I continue to comment on child welfare developments from a child-centered perspective.

An earlier version of this column was published in the Chronicle of Social Change on September 21, 2017.