Therapeutic residential care: A necessary option for foster youth with greater needs

Photo by kat wilcox on Pexels.com

The tide of opinion in the U.S. child welfare arena has been turning against institutional settings for foster youth for some time. A spate of reports of child abuse and improper disciplinary techniques in residential facilities for young people has intensified calls for the elimination of residential care as an option for foster youth. But as all who are intimately involved in the child welfare world know, therapeutic residential care is a critical part of the continuum of services that must be available for foster youth.

Media investigations have targeted abusive behavior by staff at poor-quality residential facilities around the country, with a spotlight on a for-profit company called Sequel. Concern and outrage reached a fever pitch when a 16-year-old boy died at a Sequel home in Michigan after being restrained for 12 minutes. The Imprint and the Texas Observer co-published a harrowing account of Residential Treatment Centers (RTC’s) in Texas, documenting horrific instances of abuse at multiple centers around the state.

Unfortunately, some commentators, like the author of the report on Texas RTC’s, are using reports of abuse and violence to support ending all residential care rather than getting rid of bad providers. These critics of residential care miss two basic points. First, there are children who, for a variety of reasons, are not having their needs met in a family setting. These are the children who bounce from foster home to foster home, spend nights in agency offices or hotels, or even end up sleeping in cars with their caseworkers. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. These children need treatment delivered in a residential setting before they can function safely and thrive in a family setting.

Perhaps some of these youths could heal and thrive in a home with professional therapeutic foster parents, an option which is gaining increasing popularity. These foster parents are highly-trained and paid to take care of children with complex needs full-time. This is an option that deserves more attention but its growth is probably limited by both the lack of willing and qualified candidates and the expense.

Residential care abolitionists also miss the importance of quality. Residential programs can range from outright abusive to very high quality and highly successful in achieving positive outcomes for their clients. In an op-ed in The Imprint, Dana Dorn and Kari Sisson of the Association of Children’s Residential Centers explain that “High-quality residential interventions have the ability to change lives for the better and are a critical part of the continuum of behavioral health services. They have well-trained and supported staff who provide individualized, trauma-informed, youth-guided, family-driven care in environments that are safe, welcoming and encourage healthy relationships.” The authors stress that providers who are incompetent or “prioritize profits” over people should not be allowed to stay in business.

Opponents of residential care often use faulty reasoning to make their point. They often state that children who attend residential care have worse outcomes than those in family care without explaining that it is the most traumatized, troubled kids with complex histories who are placed in residential facilities. Those children would be expected to have worse outcomes than their peers because they have often had the worst past experiences by the time they finally have access to treatment.

The State of Washington provides a cautionary tale of what can happen when residential care in a state almost disappears. Budget pressures stemming from the 2008 recession dovetailed with the growing sentiment against residential options, as described in an excellent article in The Imprint by Elizabeth Amon. Between 2009 and 2019, over 200 residential beds in 13 locations disappeared. Unfortunately, the state lacks enough appropriate placements for youth with psychiatric, behavioral and developmental needs. These young people end up staying overnight in offices, emergency one-night foster homes, hotels, and cars–or sent to out-of-state facilities including some operated by Sequel. Not only are these arrangements anti-therapeutic, but they are extremely expensive, as Amon points out.

In Texas, where the Imprint focused on the poor quality of many RTC’s, child welfare administrators are worried about the declining number of residential centers. Every year, at least one RTC stops contracting with the state due to inadequate reimbursement, which means they cannot pay workers enough to retain them. As a result, the number of Texas foster children sleeping in offices and hotels spiked last year, according to an article in the Austin American-Statesman. These were mainly teenagers with trauma histories and/or significant behavioral and mental health issues, according to a state official.

In New Mexico, the Department of Children, Youth and Families (CYFD) contracts with ten residential treatment centers in the state, but that is not enough to care for all the foster youth who need therapeutic residential care, as the Secretary told the Santa Fe New Mexican. As a result New Mexico still sends children to out-of-state facilities. The Secretary has requested more funding for additional therapeutic residential care resources.

In Maryland, the Baltimore Sun and WYPR reported last February that dozens of children were spending weeks or even months in psychiatric units of hospitals without a medical reason because social workers had nowhere else to place them. Often these children were placed in psychiatric units after experiencing a crisis in a foster home. Most of these children are not ready to move to a foster home upon discharge and need a higher level of supervision and therapeutic care. But there are waitlists for the roughly 350 spots at Maryland residential treatment facilities, and for out-of-state facilities as well. These long hospital stays are destructive and traumatic to the children as well as extremely expensive.

Last January, I wrote about similar problems in Oregon, New York, California, and Illinois. Residential critics miss the point. If states don’t have quality residential facilities, or any residential facilities at all, they will send their kids to facilities run by operators like Sequel, put them up in offices, hotels, temporary placements or cars, or leave them in hospitals. That’s why only three out of 40 states and territories sending children to Sequel facilities have severed ties with the company, despite its awful track record.

Those who oppose all residential care for foster youths are blind to the challenging problems of some foster youth, the life-changing potential of quality therapeutic residential care and the vast differences between high and low-quality residential facilities. We need to make sure quality residential services are well funded and regulated to keep children out of offices, hotel rooms, abusive or out-of-state facilities, and hospitals. Legislators at all levels of government must recognize the need for adequate funding of this crucial service necessary to heal the wounds of our most fragile foster youth.

“Upending child welfare” means devaluing Black children’s lives

Image; University of Houston/Center for study of Social Policy

In the wake of the killing of George Floyd by police, expressions of outrage from around the country and calls for police reform were soon followed by calls for completely abolishing police forces. It did not take long before a chorus of cries were launched to eliminate child welfare as we know it as well. Child welfare was described as yet another system that controls and punishes people of color. Yet, these calls disregard the suffering of Black children who are abused and neglected; it also ignores the evidence on the reasons for Black families’ high level of involvement in child welfare.

The call for the abolition of child welfare did not come out of the blue after George Floyd’s death. It is the direct descendant of a movement that began around 2004, when a coalition of foundations, nonprofits, and academics formed around the idea that the “disproportionate” representation of Black children in child welfare stemmed from a racist system.[1] 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. The movement seemed to run out of steam afternew research (described below) debunked their major thesis, but it regained strength in the wake of the Black Lives Matter movement, and came roaring to the forefront after George Floyd’s killing.

One of the leaders in the earlier coalition, the Center for the Study of Social Policy, has joined with the Graduate College of Social Work at the University of Houston to launch a movement entitled upEND, with the aim of ending child welfare as we know it. Several representatives of upEND have published an article in the Journal of Public Child Welfare which attempts to explain their thesis. The upEND argument relies on two assertions: that the high rate of Black child and family representation in the child welfare system is due to racism within the system, and that this high rate of representation harms Black children and families. Unfortunately, these assertions are largely wrong, as I explain below.

ASSERTION ONE: The difference in Black vs. white involvement in the child welfare system are due to a racist child welfare system.[2]

There is no disagreement about the truth of upEND’s statement that Black children and families are more likely to be involved in child welfare than White children and families. In its article, upEND cites studies concluding that Black children are more likely to be reported to child abuse hotlines, more likely to be investigated, more likely to be found to be maltreated, and more likely to be placed in foster care. The ultimate result is that of this chain of disparities at each phase of the child welfare pathway is that in 2018, black children represented 14% of the total child population but 23% of all kids in foster care.

However, the real controversy (although buried in the upEND article) is about the reasons for this disparity. Is it due to a racist child welfare system, as upEND and its allies posit, or due to a difference in the underlying rate of child abuse and neglect among Black versus White families? Data suggest it is the latter. Of course, it is difficult to measure child maltreatment, which makes this question hard to answer. Although the U.S. Children’s Bureau collects annual data on official reports of child maltreatment and agency dispositions of these reports, these numbers leave out unreported maltreatment and may reflect erroneous determinations by investigators. To provide a better estimate, the Bureau periodically conducts National Incidence Studies (NIS) of child abuse and neglect. These studies are designed to estimate more accurately the incidence of child maltreatment in the United States by using community professionals to report on the actual cases of maltreatment that they have seen during the reporting period.

According to the most recent national incidence study, NIS-4, conducted in 2010 on data collected in a year spanning 2005 and 2006, Black children were almost twice as likely to be abused or neglected as white children. It estimated that 24.0 of every 1,000 black children experienced maltreatment severe enough to cause harm in the study year as compared to 12.6 per 1,000 white children.[3] There is other research evidence that Black and White maltreatment rates differ, including studies finding that black children have higher rates of preventable injury deaths; and “evidence that other predictors or markers of maltreatment are higher for black children, including maternal arrest rates, traumatic brain injury rates, parent self-reported maltreatment rates, intentional injury rates, and homicide rates.” A study published in the journal Pediatrics in 2017 concluded that the child abuse fatality rate for children aged four and under was 8.0 per 100,000 African-American children, compared with 2.7 per 100,000 white children.

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 from around the country. A research brief summarizing the conference 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.” One speaker noted that “African American children are at least as likely to be underserved as overserved” by current child removal rates. The authors of the brief suggested that the higher rate of maltreatment of Black children 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. As Randall Kennedy of Harvard Law School put it, “given the history of race and racism, given the deplorable conditions suffered disproportionately by black families—conditions that produce high rates of substance abuse and other self-destructive behavior—it would be surprising if black children did not have higher rates of contact with the child welfare system than white children.”

In her important book, Spare the Kids: Why Whupping Children Won’t Save Black America, Stacey Patton has added to this narrative by linking the legacy of slavery to current patterns of discipline by Black parents. Introduced to whipping by White slaveholders, Black parents adopted a similar practice to train their children to be docile workers and avoid worse punishments from their masters. Even today, Patton contends, some Black parents justify “whupping” their children as the only way to prevent them from being shot or locked up.

In other words, there is a strong argument that 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 our country’s history of slavery and continuing oppression of our Black citizens that has created the difference in child maltreatment which in turn resulted in disproportional representation of Black and White children in child welfare.

ASSERTION TWO: The disparity between Black and White representation in child welfare systems causes “pervasive and persistent harm” to Black children and families. 

The next pillar of upEND’s argument is that differences in child welfare involvement cause harm to Black children and families. The authors emphasize the placement of Black children in foster care, stating that “the act of forcible separation of children from their parents is the source of significant and lifelong trauma.” It is first worth noting that most children involved with child welfare are not separated from their families. Nationally, more children receive in-home services than are removed to foster care.[3] Moreover, it is not always clear that separation from parents is traumatic for a child. A child’s reaction to placement depends on the child’s age, the quality of the attachment with the parent, the type of environment from which the child is removed, and the way the placement is handled, according to Vera Fahlberg’s authoritative book, A Child’s Journey through Placement. A child who has been emotionally neglected and has no connection to the parent may have “almost no reaction” to the placement, Fahlberg points out. Moreover “if a child is actually fearful of his living environment, he may not react as adversely to the separation. Indeed, relief is occasionally observed.” And even if the child is traumatized by separation from abusive or neglectful parents, that child may still benefit from being removed from that environment.

There is an extensive literature on the harmful and often lifelong consequences of abuse and neglect. These can include impaired brain development, health problems; diminished executive functioning and cognitive skills; poor mental and emotional health; attachment disorders and social difficulties; post traumatic stress; unhealthy sexual practices; juvenile delinquency; alcohol and other drug use; and intergenerational transmission of maltreatment, as described in an issue brief from the Children’s Bureau. The specific outcomes for each child depend on “the child’s age and developmental status at the time of maltreatment, the type, frequency, duration, and severity of the maltreatment, and the relationship between the child and the perpetrator,” according to the Bureau.

Advocates of upending child welfare often point out that most children are removed for neglect rather than abuse, and they suggest that neglect is synonymous with poverty. But the actual prevalence of neglect versus abuse is unknown. One must remember that there may be several types of abuse and neglect in one family but the investigator may not be able to substantiate all of them. There may very well be abuse in a family where only neglect was substantiated. Moreover, the kind of neglect that leads to child welfare involvement is often serious or chronic and is not at all synonymous with poverty. Chronic neglect can lead to serious cognitive and social difficulties, chronic disease, and difficulties in emotion regulation similar to the effects of trauma, as discussed in another brief from the Children’s Bureau. Moreover, chronic neglect often “opens the door” for physical or sexual abuse by a mother’s male partner.

Even though child maltreatment can cause lifetime harm to its victims, one might still believe with upEND that the treatment (child welfare services) is worse than the disease, at least for Black children. To address this contention, Richard Barth and other well-known child welfare scholars recently published a review of the literature entitled Outcomes following child welfare services: what are they and do they differ for Black children? They reviewed more than 50 rigorous studies of outcomes following a child welfare intervention and found “very little reason to believe that children’s outcomes are worsened by participation in child welfare services.” They noted that the vast majority of children received short-term services, with only a fraction placed in foster care. Based on their analysis, they found that child welfare in general results in improved outcomes in the areas of safety and education for both White and Black children and generally neutral effects on health, mental health and behavioral outcomes. Moreover, they concluded that child welfare may protect Black children in particular against some future harms as early death, transitions to juvenile services (for girls), and early childbearing.  The authors found no evidence that Black children are doing worse than other children as a consequence of system involvement. Perhaps most important, the researchers found that Black parents and youth, like their White peers, are generally positive about their experience with child welfare. (Most interesting were the two surveys of 21-year-olds that found about two-thirds saying that they were lucky to have been placed in foster care.)

It is very sad that the measurable benefits of child welfare on children’s outcomes are so modest. This may be a consequence of the poor quality of services that are generally provided to many children and their parents. Far from the intensive parenting and enrichment that abuse and neglect victims need, many foster children and youth receive benign neglect at best and outright abuse at worst. As I have written based on my experience, many foster homes provide little nurturing and attention. The system is particularly unsuccessful for older youth with behavioral problems, who are often moved from home to home, placed in residential programs which vary from highly therapeutic to abusive, or spend nights in agencies and hotels, as described in an excellent blog post by Dee Wilson. Moreover, the services provided to children and families by other systems, like mental health and drug treatment, are often low-quality and plagued by waiting lists and provider turnover.

upEND’s policy prescription

In order to end racial disproportionality and its harmful effects, upEND proposes “the abolition of the child welfare system as we know it.” While the exact meaning of this phrase is not specified, the writers make it very clear that abolition means “that the forcible and involuntary separation of children from their parents is no longer viewed as an acceptable form of intervention.” To bolster their proposal, the authors contend that for Black families in America, forced family separation has its roots in the dehumanizing system of slavery.

The historical connection of child removal to racism and slavery is not clear. White children were removed from their families by child welfare agencies long before Black children. Dorothy Roberts, who herself has called for the abolition of child welfare, traces the intellectual roots of child removal to the early progressives around the turn of the twentieth century, who tried to address poverty by placing poor immigrant children in orphanages or sending them to work on rural farms. As Roberts describes in her famous book, Shattered Bonds: the Color of Child Welfare, “black families were virtually excluded from openly segregated child welfare services until the end of World War II.” When public agencies began to take over child welfare from private agencies, they started to turn their attention to Black children. But the disproportionality took some years to appear, according to statistics cited by Roberts. So it is hard to understand the logic of the claim that the practice of child removal by child welfare is rooted in racism.

While not clear on exactly what shape the new child welfare system (if any) would take, upEND states that it will replace the current child welfare system with “community-based supports for the care and well-being of children that are designed by and for families and communities…” The authors call for a broad range of policies including: creating and expanding critical safety net programs and affordable housing; expanding the use of informal care and supports for kin care providers; ending the use of congregate care placements; strengthening the efforts states must make to prevent foster care placement; and eliminating “arbitrary timelines” to terminate parental rights.

The authors do not explain how they would respond to maltreatment of children whose parents are not capable of protecting them, or who have seriously harmed them. As a member of the District of Columbia’s Child Fatality Review Panel, I have learned about many deaths of children whose families had long histories of contact with the city’s child welfare system. These families were the subject of numerous calls to the child abuse hotline for physical abuse, school absenteeism, children left alone, parents under the influence of drugs or alcohol or both–often multiple types of abuse and neglect for the same family. Some of these calls were set aside as not worth investigating, in some cases child protective services found no cause for intervention, and in some cases the intervention was not enough. Whether the child was accidentally crushed as an infant while sleeping with a parent on drugs or alcohol, beaten to death by a parent or the mother’s boyfriend, or shot as a teenager by a member of a rival crew after years of unresolved problems in the home, these children were abandoned by the system that was set up to protect them. upEND’s prescriptions would likely result in more such deaths, even more serious injuries and damage to children, and much more suffering.

As upEND proposes, we need to address the the unconscionable inequality and poverty that affects a disproportionate number of Black families by creating a true safety net and making affordable safe housing available to everyone. To add to their list, we also need to reform policing and criminal justice to eliminate a huge source of stress on Black families. But we cannot wait to protect children until present inequities and the impacts of past ones are eliminated. We should develop programs specifically aimed at preventing abuse and neglect among high-risk families of any race as soon as a child is born, such as Pennsylvania’s new Hello Baby program. Another promising approach is to provide high quality early childhood education accompanied by family support to all infants who are at risk of maltreatment. And as we work toward eliminating child abuse and neglect before they occur, we must continue to respond to children who are currently being maltreated. We must improve the accuracy of this response by eliminating any racial or other biases that result in false positive or negative findings of maltreatment. For example, the use of predictive risk modeling to screen hotline calls has been shown to reduce the disparity between the case opening rates between Black and White children.

As Barth and his colleagues put it, not responding to maltreatment of Black children is a “violation of children’s essential rights.” If we accept upEND’s prescription for eliminating differences in child welfare representation between Black and White children, we will subordinate the rights of children for safety, security and love to the rights of parents to complete autonomy in childrearing. For those who say Black Lives Matter, the this is a sad lack of concern for Black children’s lives.

[1]: The term “disproportionate” or “disproportionality” refer to the fact that a higher proportion of Black children are involved in child welfare relative to White children. In general I prefer to use a more neutral term, such as black children’s “higher level of involvement” or “representation” in child welfare.

[2]: I have taken the. liberty of formulating these assertions to reflect the actual pillars of upEND’s argument. As stated in the article, it appears that their first pillar is that there are racial disparities. But there is no disagreement about that. The authors gloss over the reasons for these disparities, which is the actual point of disagreement between the child welfare abolitionists and others.

[3]:Black children were also nearly twice as likely to experience maltreatment as defined by the more inclusive “endangerment standard.” This broader concept of maltreatment affected 49.6 per 1,000 Black children as compared to 28.6 per 1,000 White children.

[4] According to the Children’s Bureau’s most recent Child Maltreatment report, less than half of the maltreatment victims who received services in Fiscal Year 2018 (146,706 out of 391,661) were placed in foster care. Unfortunately, we do not have these data by race.

Maryland child custody committee recommends specialized judges for custody cases involving child abuse or domestic violence

Prince McLeod Rams and Hera McLeod: Fauquier.com

Hera McLeod did everything she could to protect her baby son from a father who she said had attempted to suffocate her when she was pregnant, raped her 19 year-old sister and was a suspect in killings of his mother and the mother of his other child. But it was not enough The judge in her custody case accepted her ex-husband’s favorable evaluation by a school counselor who was not certified to evaluate adults. In contrast, he did not accept a police report regarding the father’s abuse of another child in Virginia in the absence of the arresting officer. On his fifth unsupervised visit, paramedics responding to a 911 call found 15-month-old Prince naked, wet and not breathing at Rams’ home. Joaquin Rams is serving a life sentence for drowning his son.

Prince’s case is not unique. Around the country there has been a growing awareness that family courts are failing to protect children in custody cases where there is domestic violence or child abuse. Parents who attempt to protect their children from abusive ex-partners (often known as “protective parents”) are labeled as alienators or “high conflict” and often penalized and their warnings disregarded, as discussed in an earlier post by Child Welfare Monitor. The results can be tragic. The Center for Judicial Excellence has documented 758 children murdered by a divorcing or separating parent since 2008. We have no idea how many children are ordered into some type of unsupervised contact with an abusive parent: this number was estimated at 58,000 in 2008. While murder is an extreme result of bad custody decisions, the devastating results on surviving children of being left with an abuser are incalculable.

Anne Hoyer directs the State of Maryland’s Safe at Home Address Confidentiality Program for domestic violence survivors. From talking to the women she served, Hoyer became more and more concerned about how often she was hearing about judges awarding custody of children to their abusers. She worked with State Senator Susan Lee to draft legislation setting up a workgroup to study child custody court proceedings involving child abuse or domestic violence.

The legislation took effect in 2019 and the workgroup began meeting in June of that year. Chaired by the Secretary of State, who has jurisdiction over the Safe at Home program, the workgroup included four legislators, 12 other members with expertise on domestic violence, child abuse or child custody, and one parent with personal Family Court experience. On September 15, 2020, the workgroup issued its final report. It contains a summary of its findings as well as 24 recommendations designed to improve the performance of Maryland’s Family Court in protecting children involved in custody cases involving abuse or domestic violence.

The workgroup acknowledged the difficulty of making custody decisions in cases where domestic violence or child abuse are present. Abused children, domestic violence victims, and domestic abusers may all behave in counterintuitive ways. An abusive parent may make a better impression on the court than the protective parent; an abused child may deny the abuse and demonstrate attachment to the abusive parent. As a result, protective parents may be labeled as unreasonable, vindictive, or attempting to “alienate” their child from the abusive parent. Ms. McLeod described trying to abide by the advice of attorneys to express her desire that her son have a healthy relationship with his father while at the same time convincing the court that her husband was dangerous–an almost impossible tightrope to walk. The workgroup also noted that abusive parents with greater financial means often use litigation to assert continued control over protective parents and can use their superior resources to buy better representation in the court case and impose burdensome costs on protective parents.

The workgroup also expressed its concern about the widespread acceptance by courts of parental alienation claims against protective parents–a national problem. Specifically, a child’s fear or hostility toward a parent accused of being abusive by the other parent is attributed to the latter’s attempt to “alienate” the child from the other parent. The workgroup heard from Joan Meier, whose massive study on this issue has drawn much attention. Meier presented her results that indicate when a father claims alienation, the court’s likelihood of believing a mother’s abuse claim is dramatically reduced.

Professor Meier’s results also supported the conclusion that courts are now biased against mothers– in contrast to the anti-father bias that used to be prevalent in family court. For example she found that when fathers alleged that mothers were alienators, they took custody 44 percent of the time. Mothers who alleged that fathers were alienators took custody only 28 percent of the time. Fathers who were proven to have committed child physical abuse still took custody 25 percent of the time; mothers proven to have committed physical abuse were never granted custody. Experts cited additional evidence of gender bias in custody cases. Dr. Daniel Saunders presented a survey of 200 judges and 465 custody evaluators showed the prevalence of sexist myths, such as that mothers often accuse fathers falsely of domestic violence, that lead to recommendations likely to harm domestic violence victims and their children. Deborah Epstein, the Co-Director of the Domestic Violence Clinic at George Washington University Law School shared observations from many years of experience in DC Superior Court documenting routine disbelief of women’s claims of domestic abuse. (Summaries of all the presentations are provided at the end of the workgroup’s report).

Two of the most important workgroup recommendations, according to Hoyer, address judicial training and specialization. The workgroup recommended that the judiciary, in consultation with domestic violence and child. advocacy organizations, develop an ongoing training program for judges who preside over custody cases that involve child abuse or domestic violence. A judge would be required to receive at least 60 hours of training before presiding over such a case and to pursue at least 10 hours of such training every two years to continue hearing these cases. The workgroup also recommended a list of topics to be covered in the initial training, including: the impact of adverse childhood experiences on children and variations in how children respond to trauma; limitations in Child Protective Services responses to allegations and the fact that abuse may have occurred even if an investigation did not substantiate it; the impact of exposure to domestic violence on children; the effects of bias on custody decision-making; the history of parental alienation theory and its inappropriate use in child custody cases; and tools to assess children’s credibility in court.

Considering the impractically of training all circuit court judges this deeply in these issues, the workgroup recommended that a limited number of judges be specially trained to handle custody cases in which child abuse or domestic violence have been alleged or established. Moreover, the Judiciary must ensure that such cases are assigned only to Judges with this specialized training.

The workgroup made many other recommendations, including several that would change statutory language to better account for child abuse and domestic violence, impose more stringent qualifications and requirements for other professionals (lawyers and custody evaluators) involved in custody cases, and give parties access to needed resources without financial hardship. But according to Hoyer, “establishing a corps of judges who want to do this work and giving them the tools to do it is the essential foundation that will pave the way for future changes.” For example, fully-trained and specialized judges will be less likely to accept evaluations that are inadequate or performed by unqualified people.

Legislators and other workgroup members will be meeting in the weeks ahead to translate some of the recommendations into legislation to be introduced during the upcoming legislative session. Maryland’s workgroup is the first of its kind in the nation and Hoyer has received questions from many other states. Child Welfare Monitor hopes that other states will follow Maryland’s example and initiate the process for making our troubled family courts safe for children.

America loses champion for a child-centered child welfare system

GellesRichard Gelles, one of the nation’s leading child welfare experts, died late in June of brain cancer, as reported by the Chronicle of Social ChangeGelles’ death deprives the nation of one of its leading child welfare scholars, and one of the few remaining spokespersons for a child centered approach to child welfare.

Richard Gelles played an important role in the passage of the Adoption and Safe Families Act (ASFA) of 1996 through the publication of  The Book of David: How Preserving Families Can Cost Children’s Lives. This book told the  story of a 15-month old boy who was murdered by his abusive mother. David’s parents had an open child welfare case when he was born, due to their severe abuse of his sister Marie when she was six weeks old that left her with lifelong disabilities.  While Marie was still in foster care, the parents were reported to the child abuse hotline twice for abusing David. In closing their investigation without removing David or opening a case, agency workers ignored two huge red flags–the grievous injury to six-week-old Marie and the failure by her parents to comply with the agency’s reunification plan, resulting in the termination of their parental rights to their daughter. Three and a half months after the case was closed, David was dead.

According to Gelles, David’s death could be traced to the doctrine requiring that agencies make “reasonable efforts” to keep or reunite abused and neglected children with their parents. Without any definition or timeframe, efforts to keep children like David with their birth parents often cross the line separating reasonable from unreasonable. Gelles argued that David’s death could also be traced to “the larger ideology behind ‘reasonable efforts,’ ‘the sacrosanct belief that children always (or nearly always) are better off with their biological parents.”

In his testimony at a 1995 Congressional hearing, Gelles argued that the current obsession with family preservation should be replaced for a “child centered child welfare system” where abused and neglected children would longer remain for years in abusive homes, nor would they languish for years in foster care. Instead, the goal of a child-centered child welfare system would be “to terminate parental rights, when appropriate, quickly enough so that (1) children are not permanently harmed, physically or psychologically, and {2) make children available for adoption earlier enough in their lives so that they are ‘adoptable.'”

Gelles’ perspective was incorporated into several changes made by ASFA, as described by  former Hill staffer Cassie Statuto Bevan in an Urban Institute compilation on ASFA ten years after its passage. The requirement for “reasonable efforts” was moderated by requiring that such efforts must maintain the child’s health and safety as the “paramount concern.” Moreover, a  deadline was placed on reunification efforts, requiring a state to file for termination of parental rights after a child had been in foster care for 15 of the previous 22 months. ASFA also allowed states to bypass reasonable efforts altogether in extraordinary cases, such as when parents have committed a felony assault resulting in serious injury to the child or another child–clearly an exception that could have been applied in David’s case.

While it appears that ASFA has resulted in shorter stays in foster care as Gelles hoped, the impact of the provisions designed to protect children from dangerous parents appears to have been less than their authors hoped. Agencies make frequent use allowable exceptions to the 15-month time limit for termination of parental rights and rarely use the provisions that allow them to forego reunification plans. In order to make the system more child-centered, these provisions should be strengthened. Unfortunately, we seem to be going in the opposite direction.

There is a groundswell of attacks against ASFA,  with critics claiming that 15 months is not enough time for with problems like drug addiction to address them, especially if services are not immediately available. Some critics even denounce the law as racist because they say it penalizes black parents, ignoring the needs of black children for safety and permanency. Contrary to the child-centered perspective Gelles promoted, these advocates prioritize parents’ rights over children’s needs to be placed in a loving home quickly enough to avoid permanent damage and early enough in their lives to be likely to be adopted.

In The Book of David and in his testimony, Gelles also criticized the investment of a billion dollars in unproven “intensive family preservation programs” to keep families together. These new programs, such as the well-publicized Homebuilders, were intensive, short term, crisis intervention services designed to address parental behaviors that are putting their children at risk. Gelles pointed out that there was no research evidence to support the success of intensive family preservation programs at preventing foster care placements, let alone keeping children safe–which was not even evaluated. And from a theoretical perspective, Gelles pointed out that intensive family preservation programs would be effective for only those families with a low level of risk and a high level of readiness to change. To assume that these services could work for all maltreating families was unrealistic. 

Sadly, the same programs that were supported without evidence in the 1980’s are being supported again with more baseless claims of research support. As reported in a recent post, Homebuilders is once again being promoted as effective in keeping families together, although the research is no more convincing than that of the 1980s. Recently Homebuilders was approved as a best practice that can be funded by the Family First Act, based on only two studies. One of the studies focused on a program that did not follow the Homebuilders model and worked only to reunify families already separated by foster care—not prevent foster care placement which is the main purpose of Family first. The second was a study of Homebuilders family preservation programs and according to its authors failed to demonstrate any favorable program impacts. 

Why invest in a program that has failed to document success over several decades of research? The renewed push for family preservation has once again taken over the child welfare world. With the passage of the Family First Act, allowing billions in funding for programs that keep families together, there is a desperate need for programs to spend that money on. The federal clearinghouse established to approve programs for this purpose has demonstrated that its standards for calling a program “well-supported by the evidence” are low indeed. And that is not surprising, since there are few such programs that have been shown to be effective in helping abusive and neglectful parents change longstanding and often intergenerational patterns. And so the story starts again.

As we face increased backlash against ASFA and increased incentives to spend billions of dollars on unproven family preservation programs, Richard Gelles’ keen analysis and advocacy for children will be greatly missed.

 

 

Schools and agencies should reach out to at-risk children before schools close

COVID reportingThe COVID-19 pandemic is having a disastrous effect on the systems designed to protect children from abuse and neglect, as discussed in an earlier post. With children being isolated from teachers and others who might report suspicions of maltreatment, a  drastic decline in calls to child protection hotlines has been reported nationwide. This decline calls for equally drastic measures to identify at-risk children before schools close for the academic year.

The Covid-19 pandemic and resulting economic crisis has given rise to widespread fears of increasing child abuse and neglect, as well as domestic violence. The stress imposed by job and income loss, unmet basic needs, school closures, and fear of sickness all are likely to lead to increases in child abuse and neglect. Older children who are too young to care for siblings safely may be nevertheless left in charge. Research suggests that child abuse increases during natural and economic disasters and the current crisis combines both.

Reports from emergency rooms suggest that the fears about increased child abuse are warranted. Hospitals in Texas, Florida, Philadelphia, Maryland and Washington DC have reported more children coming to emergency rooms with serious child abuse injuries, such as head trauma and fractures, that require hospitalization. A spokeswoman for the American College of Emergency Physicians told the Washington Post that members “nationwide have reported treating more serious injuries in a week than they are used to seeing in a month.”

At the same time as abuse and neglect appear to be increasing, social distancing is separating children from the professionals and others who might notice abuse or neglect and report it to authorities. As a result, calls to child abuse hotlines around the country have dropped drastically since the national lockdowns began. Child Welfare Monitor has collected reports of drops in the number of hotline calls from 37 states and the District of Columbia, most of which are reporting decreases of 50 percent or more.

The drop in child abuse and neglect reports is not a surprise. The largest source of such reports is education staff, who made 21 percent of such reports around the nation in 2018 according to federal data. With schools closed, some children are in contact with their teachers  through video apps, where signs of abuse or neglect are harder to spot than in person. But that is the best case. Not all schools are using video applications to run virtual classrooms (known as “synchronous” education) and relying instead on “asynchronous” teaching methods where teachers record lessons and post assignments, which students in turn email or upload.

Whatever the nature of online education, many children are participating sporadically or not at all. The New York Times heard from many teachers around the country that fewer than half of their students were participating. Not surprisingly, participation has been lowest in schools with many low-income students, who often lack access to computers and the internet. These are the same students who are most likely to be victims of abuse or neglect. Many systems, in conjunction with internet providers, have distributed computers and made free internet available to families that lacked these resources but it is not clear how successful these efforts have been in bridging the digital divide.

Despite the reduced access to students, many teachers are making special efforts to monitor their most vulnerable students.  The Washington Post reported on a teacher in Virginia who added a pop-up prompt to her power-points asking children how they are feeling on a scale from red (awful) to orange to yellow to blue (perfect). Staffers for Danville County Virginia public schools who are delivering meals to students try to take the opportunity to engage with families and lay eyes on the children.  Teachers are still making reports to hotlines, although certainly these reports are fewer in number. For example, as reported in Child Welfare Monitor DC, teachers made 30 percent of the 897 hotline calls received by the Child and Family Services Agency between March 16 and April 18 of this year, as compared to 52 percent of 2,356 hotline calls during the same period of 2019.

Aside from teachers and education personnel, other important reporting sources also have less access to children during this crisis situation. This includes medical personnel, who are seeing few children for routine appointments, as well as friends, family members, and neighbors.

Once schools close for the summer, the best opportunity to identify children at risk of maltreatment will be gone. Therefore, we urge schools and child welfare agencies to work together to identify these children before schools close for the summer.  School personnel could  make efforts to reach all students who has not been in regular contact with their teachers via telephone, text, email, or other means available.  Any student that they cannot reach even after several tries using more than one method could be referred to child protective services to be contacted through a home visit if necessary.

One official who has seen the need for action has been Sheriff Alex Villanueva of Los Angeles County, which has seen a 50% decline in calls to its child maltreatment hotline since the lockdown began. The county has been the site of numerous deaths of children known to the Department of Child and Family Services (DCFS), including the death of Gabriel Fernandez, which was the subject of a widely viewed documentary. Stating that “We do not want another Gabriel Fernandez,” Villanueva announced a plan to have patrol officers check up on high-risk children who  have not been in contact with their schools. Apparently the Sheriff was planning to reach out to schools reminding them of their mandatory reporting duties and announcing that deputies would be available to do welfare checks on children for whom schools express concern.

The Sheriff’s plan was rejected by DCFS on the grounds that sending uniformed officers to check on families without a specific allegation of abuse or neglect would only exacerbate their stress and not necessarily improve safety for children, as DCFS Director Bobby Cagle told the Los Angeles TimesChild Welfare Monitor agrees that police officers might not be the most appropriate professionals to do these welfare checks.  But instead of rejecting the idea of reaching out to these children and their families, DCFS could have worked with the schools to identify and reach out to these students, as suggested above.

Extraordinary times call for extraordinary measures. While child welfare agencies would not normally consider sending out workers to check on children with no specific allegation of abuse or neglect, it is crucial that we take advantage of the quickly disappearing window of opportunity to reach children that have not been in regular touch with their teachers during the societal lockdown. Child welfare agencies should work with schools to identify these children before schools close, leaving abused and neglected children completely at the mercy of their caregivers.

 

 

 

 

 

 

Impact of coronavirus on child welfare: a one-sided federal view

afScreen Shot 2020-04-18 at 12.58.40 PM.pngThe coronavirus is affecting every aspects of the child welfare system and its ability to achieve its three major goals–safety, permanency and well-being. In our last post, Child Welfare Monitor discussed the threat posed by social distancing to the safety of abused and neglected children who are not involved with the child welfare system. For children in the system, especially those who are in foster care, the disruptions posed by the response to the coronavirus pandemic pose a great threat to their hopes for permanency. Two top officials of the federal Children’s Bureau have expressed great concern about the effects of the crisis on permanency and their hopes that the states will prioritize family reunification both during and after the period of social distancing. Unfortunately, their formulation of the issue reveals a one-sided analysis of the problem. Moreover, they seem to have no interest in the safety of children trapped in their homes with abusive or neglectful parents.

Federal officials have rightly expressed their concern that the coronavirus pandemic will extend some children’s stays in foster care. There are three major reasons this might happen, as described in an excellent article in the Chronicle of Social Change. Services to parents, such as mental health, drug treatment, and parenting skills programs, are threatened by the pandemic. Some may have shifted to virtual services, but not all parents have the technological wherewithal to participate. Other services might not be provided at all. Secondly, reunifications must be ordered by a court, and courts have been drastically affected by the crisis. Most court buildings are closed; many are conducting virtual hearings but only for hearings deemed essential and able to be conducted virtually.

Third and perhaps most important, most visits between children in foster care and their parents have become virtual, conducted through apps like Facetime or Skype. But virtual visits are difficult with infants and young children, and for older children they cannot substitute for extended visits. Moreover, virtual visitation does not allow the normal progression from shorter and supervised visits to longer unsupervised ones, culminating in reunification as parents are able to prove that they can manage the children for extended periods of time.

The timelines written into law by the Adoption and Safe Families Act (AFSA) could result in termination of the rights of parents who through no fault of their own were unable to comply with their court-ordered case plans. These timelines require that a state must file a petition for Termination of Parental Rights (TPR) if a child has been in foster care for 15 of the last 22 months, with certain exceptions. If these timelines were strictly interpreted, the COVID-19 crisis could result in the termination of many parents’ rights because they would have been unable to complete services or demonstrate appropriate parenting skills by the end of the 15 months.

It must be noted, however, that the ASFA timelines are often honored more in the breach than in the observance even in normal times. The law allows them to be exceeded if there are “compelling reasons” to determine that TPR is not in the best interests of the child. Under these auspices, many parents have been given much more time to work toward reunification. As a social worker in the District of Columbia, this writer saw numerous cases in which children were reunified with their families after much more than 15 months in foster care.

Last week, the Chronicle of Social Change published an impassioned column by Jerry Milner, associate commissioner of the U.S. Children’s Bureau and his special assistant, David Kelly. Milner and Kelly argue that the virus itself should not be a reason to keep parents and children apart.

Despite our strong preference that all measures be taken to continue in-person family time for children in foster care and their parents and siblings, there will undoubtedly be instances where such family time is not provided. In some instances that may be appropriate due to the presence of the virus in the resource family home or home of the parent. In many more instances, there will be no known safety threat.

It appears that Milner and Kelly are advocating for in-person visits whenever there is no virus in the home of the foster family or birth parent. Governor Brian Kemp of Georgia became the focus of ridicule when he claimed on April 1 to have just discovered that as much as 25 percent of those with coronavirus might have no symptoms but still transmit the virus to others. Perhaps Milner and Kelly not yet learned about that finding. Moreover, one wonders what they would suggest if their recommendation resulted in the wholesale desertion of foster parents afraid of the risks of exposing the children in their custody to one or more family members each week.

Down the road, when families begin to bump up against their ASFA time limits, Milner and Kelly urge states to make use of the statutory exception allowing them not to file for TPR if there is a compelling reason to believe such filing would not be in the best interests of the child. That may be a reasonable prescription in many cases, considering how often this justification is used even in normal times. However, Milner and Kelly go on to anticipate attempts by unnamed nefarious forces to “use the crisis to serve their own interests or those of their constituencies. There will be those whose implicit or even explicit biases are drawn out into the light.” Thus, Milner and Kelly continue the practice of calling anyone who prioritizes the rights of children over those of their parents as racist, as Child Welfare Monitor pointed out in an earlier post.

Milner and Kelly take the opportunity to argue against the ASFA permanency timeline, arguing that it was “more the result of negotiation than what we know about the importance of parent-child relationships, recovery and trauma.” Yes, the ASFA timeline was the result of political forces, but in the opposite way from that claimed by Milner and Kelly. The earlier drafts of AFSA contained shorter timelines for younger children based on what we know about child development. These shorter timelines were eliminated because they would have made the bill impossible to pass.  Milner and Kelly warn that “child development and bonding will be used in arguments not to return children to their parents and to expedite adoptions in instances where families did not have a fair chance.” By denying the importance of bonding instead of acknowledging there is a conflict between two important values, Milner and Kelly betray that their position is based on ideology, not analysis.

Despite their misguided recommendations and hyperbolic statements, Milner and Kelly are right about the threat to timely permanency posed by social distancing and its effects. But they ignore that the social distancing imposed by the coronavirus is having a very different effect on children who have been abused and neglected but are not involved with the foster care system. Although there are strong reasons to believe that abuse and neglect are increasing, reports to child abuse hotlines are down as much as 50 percent around the country because children are not seeing the adults who usually report concerns about child maltreatment, especially school and medical personnel.  This crisis has drawn considerable media attention, as Child Welfare Monitor has described, and states and nonprofits have taken action to publicize the signs of child abuse and urge teachers who see children online and other workers who see children in person to be alert for the signs and ready to report to child protective services hotlines. But even during Child Abuse Prevention Month, Milner and Kelly have nothing to say about this issue and have issued no guidance for states and counties.  It is obvious that their minds are elsewhere.

Two of the major goals of child welfare–safety and permanency–are often in conflict. It takes wise leadership to navigate the narrow channel between endangering and separating them from the parents they love. Sadly, we are not blessed with such leadership on the federal level in these troubled times.

Enter your email address to follow this blog and receive notifications of new posts by email.

When social distancing can kill: child protection during a pandemic


NJbridgethegapSocial distancing is essential to break the back of  the coronavirus pandemic. But for children who are at risk of abuse and neglect, social distancing means social isolation and the loss of any hope of rescue from their desperate circumstances. It is important for child welfare agencies to reach out to the general public and those workers still seeing children with special messages about warning signs of maltreatment and how to get help.

For children living in abusive or neglectful homes, the pandemic is a perfect storm. On one hand, abuse and neglect are likely to increase due to parental stress and more time spent together in close quarters due to social distancing. Research suggests that child abuse increases in times of economic or natural disasters.

At the same time as families are under increased stress and spending more time together, children are not being seen by mandated reporters, especially teachers and school staff.  One in five reports comes from education personnel, according to the most recent federal data; hence the annual summer falloff in reports and the uptick every October. Today, almost every school building in the country is closed. While many schools are conducting online classes, the New York Times has reported that fewer than half of students are participating in some schools. Absence from virtual classrooms seems to be especially high in schools with many low-income students, who often lack access to computers and the internet. Some students and parents have completely fallen out of touch with their schools. And these are precisely the students who are more likely to be abused or neglected.

Reports about declines in hotline calls have appeared from almost every state, with calls in dropping by as much as 70 percent since schools shut their doors.1 School closures cannot explain this entire decline. Clearly other possible abuse reporters, such as law enforcement, health personnel, neighbors, and family members are seeing less of children as well.

At the same time, there is reason to think that child abuse is increasing during the pandemic.  A three-year-old Fort Worth boy who died from “severe child abuse” on Easter morning was the third child in less than a month to die at Cook Children’s Hospital, according to the hospital. Since March 13, eight children have been admitted to the hospital for severe child abuse and three have died. The hospital normally sees six child abuse deaths in an entire year. The Arnold Palmer Children’s Hospital in Orlando, has seen a spike in child abuse cases. According to the medical director, the hospital normally sees one or two trauma cases a month. But in the last few weeks, eight children were brought to the hospital with severe injuries due to abuse. At Children’s National Medical Center in Washington DC, 86 percent of children coming to the Emergency Room with injuries suggesting child abuse between March 15 and April 20 had to be hospitalized compared to 50 percent in the same period of last year.

Ironically, April is Child Abuse Prevention month, when government and nonprofit agencies work to increase public awareness about child abuse and neglect and the need to report it. Unfortunately, a recent study casts doubt on the effectiveness of public education efforts to date. A nationwide survey conducted during the pandemic found that a large majority of Americans are not willing to report excessive physical punishment to the police or CPS. The New York Society for the Prevention of Cruelty to Children (NYSPCC)  surveyed 1,004 adults nationwide on March 27 to 29, in the midst of the crisis. They found that only 19% of adults say they are “very likely” to report a parent who is “excessively spanking or physically punishing their child” to child protective services. Only 36 percent of adults say they are very likely to contact the police if they see a stranger doing the same thing. Among the reasons given for their unwillingness to report, 68 percent of respondents cite that it might make things worse for the child, 35 percent cite the risk to their own family, and 30 percent say it is “none of my business.”

These survey results, with or without a pandemic, are frightening.  As Mary Pulido of NYSPCC puts it, “If what you see in public is enough to even make you think about calling the authorities, think of what that child could be enduring at home, behind closed doors.” But these results should not be surprising to those who are aware of past cases of egregious child abuse which were not reported despite obvious red flags.  For example, the media has reported on the failure of family and neighbors to report major concerns about treatment of the 13 Turpin children, who were imprisoned, starved, and physically abused by their parents over many years. 

What we know about the reluctance of people to report their concerns about children’s treatment suggests the need for a much more concerted effort for the long-term. Such an effort should be led by the federal government and implemented at the state and local levels. It should aim to increase knowledge of the signs of child abuse and neglect and convince citizens that it is their obligation to report, as described in an earlier post. Such a campaign would be more powerful if all citizens were required to report when they fear that a child is being harmed.

For this time of pandemic, we cannot hope for an immediate sea-change in attitudes, but governments can integrate messaging about child abuse and neglect into their communications with the public about the pandemic. Special efforts should be made to encourage teachers who are interacting with students online and other essential workers who have contact with children and families. Sadly, the federal Children’s Bureau has not issued any guidance to states and and counties resources and suggestions for how to do this. Such leadership has been left to state and local governments and nonprofits.

In a Call to Action for State Governors, CHILD USA, a national think tank focused on child protection, suggests that Governors should add to all their COVID updates a reference to the need for all adults to be alert for signs of abuse and neglect, along with how to reach the child abuse hotline. Special campaigns such as  #bridgethegap in New Jersey, may be helpful as well. As shown in the poster above, the public is reminded that “It IS your business. Everyone in New Jersey is a mandated reporter.” Readers should reach out to their government executives to urge them to incorporate such messages into their communications with the public. 

Special materials targeted to teachers and other staff may be helpful as well. New Jersey has produced a special message for education personnel asking them to “try to get ‘eyes on’ every child at least once a week.” Maine’s Office of Child and Family Services, in partnership with the Department of Education, has also issued guidance for educators, health care providers and community members for spotting and responding to signs of child maltreatment.

Screen Shot 2020-04-13 at 1.41.21 PM

CHILD USA has issued a list of Tips for Teachers on Child Welfare and Online Safety during COVID-19. This helpful document lists questions to ask students at the elementary, middle, and high school levels to assess their physical safety, online safety, and whether they are getting enough to eat. It also lists key items for teachers to look for when seeing their students online, such as the appearance of the student and the home, and things that the student might say.  And it suggests special efforts to monitor students with issues with drug abuse, mental illness or domestic abuse in their families. All child welfare agencies should ensure that their local school systems distribute this checklist to their teachers.

The document from CHILD USA does not say what teachers should do when they are unable to reach a child and their family, which is probably the case for many of the children most at-risk of maltreatment. Jurisdictions should consider the possibility of treating the inability to reach a child and family after several tries over several days as grounds for a teacher to call the child abuse hotline.

teachersCOVID

States and counties might also try to enlist the only people who are seeing children regularly other than their immediate families–grocery and pharmacy workers and mail carriers. A representative of the Allegheny County Department of Children Youth and Families told a reporter that the agency “plans to pivot its awareness campaign” to focus on these workers. They plan to make sure the workers get the message that “if you see something, say something.” A grassroots campaign run by former child welfare workers in Arizona is also trying to contact the people who are still seeing children, including grocery workers, delivery services, and food banks.

As Angelina Jolie wrote in Time Magazine, “We were underprepared for this moment because we have yet to take the protection of children seriously enough as a society.” This is a major problem which needs to be addressed for the long term, so that next time there is a crisis, we will have a society that is ready to keep its children safe in spite of physical isolation.

This post is being updated daily during the coronavirus crisis include new information.

Enter your email address to follow this blog and receive notifications of new posts by email.

 

Homebuilders program, never proven effective for family preservation, approved regardless by Title IV-E Clearinghouse

Screen Shot 2020-04-06 at 5.48.54 PMThe federal Title IV-E Prevention Services Clearinghouse recently approved Homebuilders, a well-known family preservation program, for Title IV-E funding, giving it the highest rating of “well-supported.” This decision is sure to be lauded by many child welfare administrators looking for more program choices, including those in the fourteen states where it is currently being used as of 2018. Unfortunately, the Clearinghouse decision does not appear to be justified by the research it cites. Of the two studies cited as the basis of the rating, one worked to reunify rather than preserve families; the other study concluded that Homebuilders was not effective in preserving families.

As many readers know, the Family First Prevention Services Act expanded the use of Title IV-E funds, which were formerly used only for foster care, to pay for evidence-based practices to prevent the placement of children in foster care. “In-Home Parent Skill-based” services were one of the three groups of services authorized, and Homebuilders has been frequently cited as a likely member of this category. To be approved for funding, each practice must be approved by the Prevention Services Clearinghouse, which was also created by the Act, with a rating of “promising,” “supported” or “well-supported.” The Act establishes criteria for meeting each of these standards.

In order to be rated as “well-supported,” a practice must be shown to be superior to an “appropriate comparison practice using conventional standards of statistical significance” as demonstrated by improvements in “important child and parent outcomes, such as mental health, substance abuse and child safety and well-being.” This must be established by at least two studies that were determined by an independent review to be “well-designed and well-executed,” used random assignment or a quasi-experimental design, and “were carried out in a usual care or practice setting,” and at least one of which established a sustained effect lasting at least a year.

Homebuilders is the best-known family preservation program. Developed in 1974 by the Institute for Family Development, it provides “intensive, in-home crisis intervention, counseling, and life-skills education for families who have children at imminent risk of placement in state-funded care.” Its goal is to “prevent…unnecessary out-of-home placement … through intensive, on-site intervention, and to teach families new problem-solving skills to prevent future crises.”

In the 1980s and early 1990s, a movement in support of Homebuilders and other Intensive Family Preservation Services (IFPS) spread throughout the child welfare world, spearheaded by wealthy foundations and advocacy groups, as described by Richard Gelles in his influential text, The Book of David: How Preserving Families Can Cost Children’s Lives. This movement resulted in a rapid expansion of these programs around the country, culminating in federal legislation allocating $1 billion to these programs nationwide. However, a major study authorized by Congress and conducted between 1994 and 2002 cast doubt on the effectiveness of these programs at keeping children safe and reducing foster care placements. In recent years, that study seems to have been forgotten. Indeed it is common for supporters to express the belief that “research shows Homebuilders has been well-supported for decades,” as one advocate told the Chronicle of Social Change.

Therefore there were no expressions of surprise or consternation that the clearinghouse gave Homebuilders its highest rating as a “well-supported practice.” In its narrative, the Clearinghouse explains that Homebuilders meets the criteria laid out in the Family First Act for that rating. Specifically, “at least two studies with non-overlapping samples carried out in usual care or practice settings achieved a rating of moderate or high on design and execution and demonstrated favorable effects in a target outcome domain. At least one of the studies demonstrated a sustained favorable effect of at least 12 months beyond the end of treatment on at least one target outcome.”

The clearinghouse reviewed 17 studies for possible relevance to  the Homebuilders program. Of these studies, only three were determined eligible for inclusion as evidence of Homebuilders’ effectiveness. The others were ruled out because they were done before 1990, were not relevant, or did not meet basic quality standards. Of those three studies, two were determined to meet the clearinghouse design for “moderate” or “high” support of the causal evidence, and both met the “moderate” rather than the “high” standard. So  the Clearinghouse based its recommendation on two studies only–the minimum required for Clearinghouse approval–both of which the lowest acceptable standard for support of the evidence.

For each of these two studies, the Clearinghouse separated out each individual effect found at each site and date, resulting in separate listings for the same effect at different follow-up times and sites if the project had multiple sites. At the end of this process, the Clearinghouse cited 10 instances of “no effect” on child safety across the two programs, confirming what was already well-known. For child permanency, there were seven favorable outcomes, two unfavorable outcomes, and 13 findings of no effect. For adult well-being, they found one favorable effect, 14 instances of no effect, and no unfavorable effects. Despite the preponderance of findings that Homebuilders had no effect, the eight  favorable outcomes were enough to give Homebuilders the coveted rating of well-supported.”

The aggregate data is already underwhelming but it becomes worse when considering that seven of the eight favorable effects came from one study, which should not have been included at all in the review. That study, described by Elaine Walton and others in reports published between 1993 and 1998, assessed an intensive family reunification program provided in Utah. The study involved 110 families divided between the program and control groups. There were many things that made this program a strange prototype for Homebuilders. First, the program was aimed at reunification of children in foster care with their families, not the prevention of foster care placement. While Homebuilders can be used for reunification as well as for family preservation, it is known predominantly as a family preservation program.  Similarly, while Title IV-E funds can be used for family reunification programs as well as family preservation (if a state chooses to define children existing foster care as “foster care candidates”) Family First has been described by its supporters almost exclusively as an initiative to prevent the placement of children in foster care.

A program that is successful in family reunification may not be successful for family preservation. A family facing the possible removal of a child is in a very different situation from a family with a child already in foster care. Children in the Walton study had been in out-of-home placements from one to 88 months, with an average of one year. Most of the parents had presumably already participated in court-ordered services such as therapy, drug treatment and parenting classes.

Further undermining the relevance of the Walton study is that it was not a study of the Homebuilders program. The model described by Walton et al, called Family Reunification Services (FRS) by the authors,  departed from Homebuilders in many respects. Services were less intensive and longer in duration. Workers spent an average of about three hours per week in direct contact with the families, and this contact could last up to 90 days. This is a very different model from Homebuilders, which typically provides at least 40 hours of face-to-face services or about seven to ten hours a week, over a period of only four to six weeks.  It is hard to understand how the Clearinghouse could use this study of a non-Homebuilders reunification program to affirm the success of Homebuilders in general.  Yet, the Clearinghouse drew six or seven of its eight or nine favorable results from this study.[^1]

The second study cited by the Clearinghouse was conducted by three well-known research firms, Westat, Chapin Hall, and James Bell & Associates. This was a congressionally mandated evaluation that was intended to overcome shortcomings of previous studies. It included three family preservation program sites using the Homebuilders model, although the Clearinghouse cites only the studies from New Jersey (343 families) and Kentucky (442 families).  The researchers studied one family reunification program in New York, but the Clearinghouse did not review that portion of the study.

In reviewing the Homebuilders family preservation program sites in the three states,  the Westat researchers found no impact on child safety or foster care placement. The researchers concluded that their results were consistent with other studies that “have failed to produce evidence that family preservation programs with varying approaches to service have placement prevention effects or have more than minimal benefits in improved family or child functioning.”

Not surprisingly, the Clearinghouse found only one “favorable effect” from the Westat study. That effect was not on child safety or permanency but on adult well-being. They found a favorable impact on adult (not child) receipt of WIC program benefits at the Kentucky site immediately after program participation–not surprisingly as one would hope the Homebuilders caseworker helped families sign up for WIC. This is a very weak hook upon which to hang a “well-supported” rating.

The authors of the Westat study suggest that “The extent to which the intensive, short-term, crisis approach fits the needs of child welfare clients should be reexamined. The lives of these families are often full of difficulties—externally imposed and internally generated—such that their problems are better characterized as chronic, rather than 24 crisis. Short-term, intensive services may be useful for families with chronic difficulties, but those services are unlikely to solve, or make much of a dent in the underlying problems. Of course, the hope is family preservation programs will be able to connect families with on-going services to treat more chronic problems. But, that appears to happen far less than needed.”

In sum, the Clearinghouse based its rating on Homebuilders on two studies of two different programs. One of the programs did not follow the Homebuilders model and worked only to reunify families already separated by foster care. The second was a study of Homebuilders family preservation programs and according to its authors failed to demonstrate any favorable program impacts. The clearinghouse found only one favorable effect from this study, and it pertained to adult well-being. It is hard to believe that any reasonable person would conclude that these two studies together provide “strong support” that Homebuilders is effective in meeting the goals of Family First.

The flaws in the Clearinghouse approach to Homebuilders raise issues that are broader than the effectiveness of this one program. While the Act’s criteria for approval of a program are often described as “rigorous,” the Homebuilders result show that they are anything but that. Requiring only two studies to show favorable results regardless of the number of studies that show no impact; reporting that two studies have found favorable effects even though the one relevant study had only one minor favorable effect that its authors did not mention in their conclusion; allowing the use of data from an evaluation of one program to support the effectiveness of another program; rating a program as “well-supported” without specifying the specific outcomes that it has been shown to achieve — all of these connote a lack of rigor. Regarding the last point in particular, if a program is found to work for only one goal (such as family reunification and not family preservation) the Clearinghouse should approve it only for that goal.

The initial wave of Homebuilders expansion was spurred by an onslaught of non-scientific “evaluations” funded by foundations intent on demonstrating its effectiveness, as Richard Gelles describes in his book cited above. Sadly, the same type of advocacy-based analysis was used to support the passage of Family First.  Supporters of the Act repeatedly stated that we know what works to preserve families and we just need to fund it.  Yet Child Welfare Monitor has found few or no programs with strong evidence of large favorable effects. It is likely that other practices approved by the Clearinghouse have equally skimpy support.

This post was updated on April 16, 2020 after the Clearinghouse responded to Child Welfare Monitor’s question, submitted on April 2, requesting an explanation on apparent internal inconsistencies in its table about favorable program effects for Homebuilders.

Enter your email address to follow this blog and receive notifications of new posts by email.

When school is safer than home: school closures, home schooling and child abuse

takoda collins house
Takoda Collins’ home: WDTN.com

Among the many frightening consequences of the coronavirus epidemic is one that has received little attention from the media. The loss of school as a safe place and school staff as a second set of eyes on children means an  increase in unreported child abuse and neglect. For home-schooled children, however, this vulnerability is the normal state of affairs.

School closures have a double-edged effect on child maltreatment. First, children are spending more hours with their parents without the respite that the school day affords to both.  Second, these children are isolated from teachers and other school staff who might have noticed bruises or other signs of trauma. According to the latest federal data, one-fifth of calls to child abuse hotlines come from school staff, making education personnel the largest single report source. School staff are such important reporters of suspected child maltreatment that reports to child abuse hotlines typically go down every summer and increase when students return to school. During the coronavirus epidemic, we have already learned of drastic reductions in calls to the child abuse hotline in Los Angeles, Connecticut and Georgia.

As we worry about the impact of school closings on both child abuse and its reporting, it is important to note that one population of children never benefits from the protective role of schools. About 1.8 million children, or 3.4 percent of the school-aged population, were homeschooled in America in 2012, the most recent year for which data are available. Clearly most of their parents are not abusive and want to provide the best education for their children, often at great personal sacrifice.

Nevertheless, for a small proportion of these children, homeschooling provides an opportunity for their abusive parents to prevent their abuse from being detected. The Coalition for Responsible Home Education has collected 456 cases of severe or fatal child abuse in homeschool settings. Many of the families had a history of past child abuse reports and child protective services (CPS) involvement. All too often, the homeschooling began after the closure of a CPS case.

Connecticut’s Office of the Child Advocate, in a stunning report, revealed that 36% of the students withdrawn from six districts to be homeschooled between 2013 and 2016 lived in families that had least one prior accepted report of child abuse or neglect. The majority of these families had multiple prior reports. In a landmark 2014 study of child torture cases by pediatricians from five medical centers, 29 percent of the school-aged children studied were not allowed to attend school while another 47 percent were removed from school under the pretext of homeschooling, typically after the closure of a CPS case.

From time to time, an egregious case of abuse of a homeschool child makes headlines and and leads to public calls for monitoring or regulation of homeschooling families. One tragic example was the death of ten-year-old Takoda Collins, in Dayton, Ohio on December 13, 2019. Takoda was tortured, raped and murdered by his father. School officials stated that school staff reported their concerns over Takoda’s safety 17 times over several years.  It was only days after the last report that Takoda’s father pulled him out of school under the pretence of homeschooling.

As Takoda’s art teacher told the Dayton Daily News, “I think his father just got tired of us calling him and calling Children Services because people had been calling for years.”  Now Dayton teachers are asking their legislators to require some scrutiny for children who are pulled out of school after they have been the subject of abuse reports.

Raylee Browning died on December 26, 2018 in West Virginia of sepsis after drinking from the toilet after being deprived of water for three days. When Raylee died, she had bruising, burns and lacerations and a torn rectum. She had been removed from school after multiple reports by school staff expressing their concerns about physical abuse and starvation.  H.B. 4440, sponsored by Del. Shawn Flaherty, would prevent parents from withdrawing a child from school to homeschool them when there is a pending child abuse or neglect investigation, and when a parent has been convicted of domestic violence or child abuse or neglect.

The Coalition for Responsible Home Education, an organization that works to protect homeschooled children from educational neglect and maltreatment, has three recommendations to protect home-schooled children from abuse:

  • Forbid homeschooling by parents who have been previously convicted of any offense that would disqualify them from teaching or volunteering in a public school. Only Pennsylvania currently has such a provision.
  • Flag at risk children–such as those with a history of child-abuse reports–for additional protections and supports.
  • Require that homeschooled students have contact with mandatory reporters once a  year.

Sadly, such laws are often proposed in the wake of egregious cases but fail in the legislature due to vociferous opposition from the homeschool lobby. In Ohio, the death by abuse of another homeschooled boy led to introduction of  Teddy’s Law, which would have required annual interviews of homeschooled children and their parents with social workers, checks to see if homeschool applicants had pending investigations, and delays or denials of permission to homeschool under some circumstances. The bill produced a national outcry from homeschool advocates, including death threats to the sponsors. After entire nation was rocked by the rescue of the 13 Turpin children in California from their imprisonment in a house of horrors that was registered as a home school, two bills to institute protections for homeschooled children failed as well. Similar attempts to protect children after deaths, near-deaths and egregious abuse of homeschooled children failed in Iowa and Kentucky and doubtless many other jurisdictions.

As described in the Washington Post Magazine, the Home School Legal Defense Association is one of Washington’s most effective lobbying groups  – and the current political climate  is in their favor. State homeschooling advocates are vocal as well. The Homeschool Legal Defense Fund is fighting Raylee’s Law and calls it “unconstitutional, un-American, and unnecessary.”

The school closures will eventually end, and we can only hope that the repercussions will not be dire for many children. When they do end, let us not forget those children who remain isolated even after COVID-19 is a bad memory. All children must be protected from maltreatment, even if their parents elect to school them at home.

 

Kinship Diversion: A parallel system of foster care

KinshipDiversion
Image: WAMU.org

The development of a system of informal kinship care that is parallel to the foster care system has recently begun to receive attention among academics, advocates and policymakers. This second system includes relatives who are caring for children under an informal arrangement facilitated by child welfare agencies through a practice called kinship diversion. This system has been called America’s Hidden Foster Care System by Josh Gupta-Kagan, Associate Professor of Law at the University of South Carolina.  Because most states don’t collect data on this practice, we don’t know how many children are affected, but it appears to be the most prevalent placement for children investigated by child protective services (CPS) agencies and greatly dwarfs kinship care within in the foster care system.

An issue brief from the research organization ChildTrends states that there is no agreement on the definition of kinship diversion, but in general it refers to a situation where a child welfare agency decides a child cannot be safe in a home due to abuse or neglect. But instead of taking custody of the child and requesting court approval for this move, the agency facilitates the transfer of custody to a relative outside the foster care system. This transfer is often effected through a “safety plan” or agreement between the parents, the agency, and the relative to keep the children safe. Whether stated or implied, parents know that failure to agree to the plan may result in the removal of their child and court involvement. According to Marla Spindel of the DC Kincare Alliance, sometimes the agency transfers custody of a child without the agreement of the parent, and only the agreement of the kinship caregiver.

The only national data on the prevalence of kinship diversion appears to come from a study of children who had contact with child welfare services within a fifteen-month period starting in February 2008. The researcher, Wendy Walsh, found that informal kinship care was the most common out-of-home placement for children found to be abused or neglected, accounting for almost half of children placed out of home. But these data are over ten years old. The limited data suggest that states are using kinship diversion in many more cases than they are licensing kin as foster parents. According to the most recent national data, 32 percent of children in formal foster care were in a relative home as of September 30, 2018. Gupta-Kagan cites a number of more recent studies in individual states that suggest kinship diversion is being used “with roughly the same frequency” as formal foster care overall–including relative and non-relative caregivers.

Newer data on kinship diversion are greatly needed. ChildTrends used a social worker survey to estimate the rates of kinship diversion in “several” unnamed jurisdictions. The researchers reported that “[I]n some jurisdictions, for every [ten] children entering foster care, an additional [seven] were diverted, while in others there was an equal split—for every child entering foster care, another child was diverted.” Without knowing how many and what jurisdictions were studied, and whether these were the highest and lowest ratios, it is hard to know how to interpret these data.

In addition to information about the extent of kinship diversion, we know little to nothing about how informal kinship care arrangements initiated through kinship diversion differ from foster care. Among the questions raised by ChildTrends are: Do kinship caregivers undergo a background check? Are services and supports provided and to whom? How do the services and supports differ from those provided in foster care? How long do diversion arrangements last? In their studies of three jurisdictions, ChildTrends found that agencies usually initiated background checks but often failed to complete them; an official case is not always opened; and services and supports to children, parents and caregivers are “inconsistently provided” and differ by jurisdiction. The “greatest disparity in supports” was that diversion caregivers do not receive foster care stipends and usually have to rely on welfare assistance to support the children.

As Gupta-Kagan points out, kinship diversion has raised various concerns both ends of the child welfare ideological spectrum. Those who are concerned about parents’ rights worry about the state removing children without due process protections for their parents. Moreover, unlike with foster care, there is no requirement that the agency make reasonable efforts toward reunification or develop case plans prescribing what parents must do to get their children back. Those who are concerned about children’s safety and well-being worry that kin caregivers may return the children to their parent at any time, regardless of safety, or may allow unsupervised visits with dangerous parents. Child advocates also worry that there is no permanency for these children as they move back and forth between parents and caregivers. Moreover, informal kinship caregivers may not receive the same level of screening as potential foster parents. These caregivers and the children they raise do not usually receive the same supports as they would in foster care, including stipends, case management, and mental health, drug treatment and parenting services. If not granted custody in court, these caregivers have no legal rights to obtain medical care, enroll children in school, or approve services, and a parent can come back and take custody of the child at any time. 

Some stakeholders support kinship diversion because they think it is always better to keep children out of state custody and allow families to decide their own futures. In the jurisdictions that it studied, ChildTrends found a wide variety in opinion among stakeholders but widespread agreement (over 90 percent) in favor of kinship diversion among agency social workers in five states.

Gupta argues that the “hidden foster care system” enabled by kinship diversion is “likely growing and it is certainly becoming institutionalized through federal funding incentives, new federal funding which strengthen those incentives, and state policies which seek to codify the practice.” As Gupta points out, there is a strong financial incentive for states and other jurisdictions to use informal kinship care. They avoid expensive foster care payments as well as the expenses of case management and other services to children in foster care and their families. Gupta argues that the new Family First Act further incentives kinship diversion by allowing funding for services to children and their parents for a year or more while they remain in an informal kinship placement.

Gupta fails to mention another incentive for kinship diversion–reducing the foster care rolls–which has become increasingly viewed as a favorable outcome and even (somewhat paradoxically) as a goal of child welfare systems. For example, one of the four pillars by which the District of Columbia’s child welfare agency measures its performance is Narrowing the Front Door, or reducing entries into foster care. Casey Family Programs, the two-billion dollar private foundation with an oversize influence on child welfare policy around the county, still proclaims (somewhat anachronistically) on its website that one of its four primary goals is to “Safely reduce the need for foster care by 50 percent by the year 2020.”

Some kinship diversion critics, like Gupta-Kagan, argue for more regulation of the practice to require appointment of attorneys for parents, impose a maximum length of time for safety plans that change custody, and allow parents to seek court review of safety plans.  Others, like Marla Spindel of DC Kincare Alliance, believe that kinship diversion as currently practiced is both harmful and illegal under state and federal law.

There is a case to be made for an outright prohibition on kinship diversion to eliminate the possibility that an abused or neglected child be returned to the parents before a professional can assess that the child is safe. Custody changes involving CPS would have to take place through an official removal subject to court approval, leading to formal foster care, or through a time-limited Voluntary Placement Agreement (VPA, which is allowed by federal and state law). A VPA can be used to place a child with a relative for a limited time period (such as 90 or 180 days) with the requirement that court proceedings be brought if reunification with the birth parent is not achievable in that timespan.

DC Kincare Alliance (DKA) and the law firm Ropes & Gray has filed an unprecedented federal lawsuit against kinship diversion in the District of Columbia. The lawsuit was filed on behalf of three relative caregivers and  three children they are raising. DKA argues that CFSA is violating the federal Social Security Act and several DC laws by using kinship diversion instead of removing these children formally and licensing their caregivers as foster parents. The case seeks a court ruling that kinship diversion is illegal and an order prohibiting CFSA from engaging in this practice. It also seeks damages for lost foster care payments “and other injuries.”

As policymakers debate restrictions on kinship diversion, not time should be lost in learning all we can about the extent and nature of the practice today. At a minimum, as proposed by Gupta, states should be required to track every case of kinship diversion to provide information about the total number of cases, the safety and well-being of the children, how long they remain in these arrangements, and how cases are resolved. We also need to know the policies and practices that states are following in terms of clearances, supports, monitoring, and other ways the arrangements may differ from foster care. The hidden foster care system must be brought out of the darkness and into the light of day.