Their names were Rashid Bryant and Julissia Battles). She was seven years old and he had lived for only 22 months. He lived in Opa-Locka, Florida, and she lived in the Bronx. They were both taken into state care at birth. Julissia had a life of safety and love with her grandmother, occasionally punctuated by disturbing visits with her mother, until the age of six, when she was dropped off for a visit that ended in her death. Rashid knew 14 months of safety and care starting at birth, before the months of torture began. An inexplicable drive to reunify families, regardless of the lack of change in the parent’ ability to care for their children, is behind both of these tragic stories.
The 694 days of Rashid Bryant
By the time Rashid Bryant was born, on December 13, 2018, his parents were already known to the Florida Department of Children and Families, according to Carol Miller of the Miami Herald, whose articles from May 10 and July 8 are the basis of this account. Rashid’s parents, Jabora Deris and Christopher Bryant of Opa-Locka, had first come to the attention of the Florida Department of Children and Families (DCF) in 2013 and were reported at least 16 times to DCF. The allegations included parental drug abuse, physical injury, domestic violence, and inadequate supervision of their many children. The reports alleged that Deris smoked marijuana with her older children, that most of her children did not to school, that her home had no running water and that the children were hungry and losing weight. An allegation that Bryant had thrown one of his children into a car when escaping from police finally resulted in court-ordered in-home supervision of this family by DCF. When Deris and her newest child tested positive for marijuana, all of the children were removed but were soon returned to the family in August 2018.
By that time, Deris and Bryant had eight children including two younger than two and a hotline report said that the couple were leaving a 15-year-old in charge of several younger siblings, including a two-year-old who was seen outside naked. In October and November 2018, DCF received seven new reports, including drug abuse, inadequate supervision and “environmental hazards.” The couple’s children were taken into custody around Nov. 22, 2018 and were placed with relatives and foster parents. Less than a month later, their ninth child, Rashid, was born and was immediately taken into state care.
The 14 months from his birth in December 13, 2018 until his return “home” on February 2 may have been the only time that Rashid received the love and care he deserved. But the system had reunification on its mind. By August 2019 the parents were given unsupervised visitation, which was revoked after they suddenly moved without notifying the court, but was restarted again in January 2020. That same month, a supervisor with a private case management agency handling the case for the state of Florida stated that conditions for the children’s return had been met. But records reviewed by the Herald show that DCF did not agree, stating that “This determination was not supported, given that the reason for removal had not been remedied.”
On February 28, 2020 14-month-old Rashid and three brothers were returned to their mother by the court, despite the fact that DCF had asked the judge to return the children gradually, starting with one older child. According to agency records reviewed by the Herald, the children were sent home without supportive services to assist the mother with her four young children. As if that were not enough, the judge also saw fit to give “liberal, unsupervised visitation” to Deris with her other five children.
About a month later, Deris’ tenth child was born, to the “complete surprise” of caseworkers, who reported that she had denied in court that she was pregnant. Three weeks after the birth of her tenth child, the judge saw fit to return her remaining four children, leaving the new mother with the custody of ten children including five that were younger than five years old. Oversight of Rashid and the three brothers sent home with him ended in August of 2020, and all monitoring of the family end by October of that year at the judge’s order.
We don’t know when Rashid’s suffering began. We do know that he injured his leg around June 2020, but his mother waited two days to seek medical help, leaving the hospital with Rashid after refusing to allow an X-Rray. It appears Rashid spent the last five months of his life mostly in bed. At a June 22 pool party at the house of an aunt, Rashid and his father never left the car, according to the aunt. When she tried to pick him up from his car seat, she reported that Rashid began to cry. She never saw him again. Rashid’s maternal grandfather, who frequently visited the home, reported not seeing Rashid for about two months. (Why these family members did nothing in view of these red flags is another question.) Rashid’s brother, then 16, told police that he noticed something wrong with Rashid’s leg two months before he died because the little boy cringed and cried when it was touched. The teen described another incident where Rashid vomited all over his bed and then lay still and shaking with his legs up in the air. The teen could not remember if his mother sought medical attention after either of these incidents. After that incident, reported the teen, Rashid could not move his right arm. Four days before he died, a sister saw Rashid vomit after eating. She reported that the right side of his body appeared limp and his eyes were moving in different directions.
On November 6, 2020, two weeks after DCF closed the case on the family by court order, Rashid was dead. He had lived 694 days. The arrest warrant said that Rashid had suffered two seizures in the month before his death but his mother had never bothered to take him to a pediatrician. On the morning of Rashid fatal seizure, Deris called her sister saying he was unresponsive and “foaming from his nose and mouth.” Her sister told her to take him to the hospital. Deris did call for an ambulance–83 minutes later.
The Medical Examiner reported that in the months before his death Rashid had suffered two cracks to his skull — one healing, the other fresh. He also had a healing rib fracture and a recently broken leg. The cause of Rashid’s death was “complications of acute and chronic blunt force injuries.” The contributory cause was “parental neglect.” Deris and Bryant were arrested within a week of Rashid’s death and are awaiting trial on manslaughter and aggravated child abuse.
But somehow, DCF has not decided whether Rashid died of abuse or neglect–so they refuse to release the case files that they are required to release by law when a child dies of abuse or neglect by a caregiver . That requirement is in a state law that was passed requiring such revelations in the wake of the Miami Herald’s publication in 2014 of, Innocents Lost, detailing the deaths of about 500 children after DCF involvement. The Herald has filed suit against DCF and has been joined in the suit by a dozen media companies and advocacy groups.
Julissia Batties: from home to hell
On August 10, police and medics were summoned to the 10th-floor Bronx apartment where Julissia Batties lived with her mother, Navasia Jones, her 17-year-old half-brother, and one-year-old brother, as reported by the New York Times and many other media. Her mother gave inconsistent accounts to the police but it appears that after finding Julissia “vomiting and urinating on herself” at 5am, she waited three hours, and went to the store and the bank, before she called for emergency services shortly after 8:00 AM. Julissia was pronounced dead shortly after 9am. Julissia’s 17-year-old half-brother later told police that he had punched Julissia in the face eight times that morning because he thought she had taken some snacks. But those were not the injuries that killed Julissia. The medical examiner found injuries all over her body. On Friday her death was ruled a homicide caused by blunt force trauma to the abdomen. There have been no arrests so far.
Records show that Julissia’s mother had a long history of involvement with ACS and police. In 2013, the year before Julissia was born, Jones lost custody of her four older children. When Julissia was born in April 2014, she was immediately removed from her mother’s custody and placed with her paternal grandmother, Yolanda Davis. A family court judge initially granted Jones’ motion for custody of the new baby, but ACS appealed, and the appeals court stayed enforcement of the custody transfer pending their decision on the appeal. In 2015, the appellate court agreed with ACS, stating that “the mother had failed to address or acknowledge the circumstances that led to the removal of the child.” The court stated that although the mother complied with the services required by her case plan, “she was still prone to unpredictable emotional outbursts, even during visits with the children, and she was easily provoked and agitated. Indeed, the case planner testified that she had not seen any improvement in the mother’s conduct even after the mother participated in the mandated services.” The court concluded that “until the mother is able to successfully address and acknowledge the circumstances that led to the removal of the other children, we cannot agree that the return of the subject child to the mother’s custody, even with the safeguards imposed by the Family Court, would not present an imminent risk to the subject child’s life or health.” Wise words indeed. Julissia remained with her grandmother, Yolanda Davis, until being returned to her mother on March 2020, when she was almost six years old.
It appears that the COVID-19 pandemic had some role in the transformation of a weekend visit into a custody change that resulted in a child’s death. Davis told a local TV station, PIX-11, that a caseworker told her the visit had been extended due to the pandemic, and the extension never ended. Sources told the New York Post that the mother was officially granted custody in June 2021, though the circumstances are unclear. The decision to return Julissia to her mother appears to have been made at the recommendation of SCO Family of Services, a foster care nonprofit that was managing the case for ACS. After the first month or so, Julissia was not even granted visits with her grandmother, which would have been a much-needed respite and could have saved her, had the grandmother seen or reported injuries or other concerns. The New York Daily News reported that in May 2020, Davis was denied visits with Julissia because she had allowed the child to see her own father, Davis’ son. The motivation behind denying a child visits with the only parent she had known for six years are truly hard to understand.
There were many indications that all was not well in Navasia Jones’ household in the months before Julissia’s death. A neighbor told the Times that “there was always a lot of commotion, always yelling, always screaming” in the apartment. As recently as August 6, his girlfriend had called authorities to report that Julissia had a black eye. The neighbor told the Times that he had spoken to police and ACS staff about the family several times. Police reported to the Times that officers had filed at least nine domestic abuse reports on the family and responded to five reports of a person needing medical attention.
The decision to send Julissia home with her mother after six years apart is particularly strange because the Adoption and Safe Families Act of 1997 (ASFA) requires that a state must file for termination of parental rights after a child has spent 15 of the last 22 months in foster care. The requirement was written into law because children were languishing for years in foster care without a plan for permanency. It was recognized that children need permanency and stability and it is hard to understand why ACS and its contractor would want to move a thriving child from the grandmother who had parented her from birth to age six.
Much needs to be clarified to understand how this child was returned to the family that would kill her. ACS and SCO have declined to comment on the case, citing confidentiality. ACS did issue a statement that “its top priority is protecting the safety and wellbeing of all children in New York City.” But it is clear that other priorities took a front seat in Julissia’s case.
Factors Contributing to lethal reunifications
What explains the adamant determination on the part of some agency personnel and judges to return children to biological parents who have shown no sign of changing the behaviors that caused the system to remove them in the first place? To some extent, it reflects an ideology–one that is becoming increasingly dominant in the nation– that is committed to family preservation and family reunification at almost any cost. Child welfare is known for pendulum shifts in the emphasis on child safety as opposed to family preservation and reunification, but the latter is clearly in the ascendant right now. Extreme deference to this ideology can blind agency employees and judges to what is right in front of their faces: the failure of a parent to change the behaviors and attitudes that resulted in the initial removal of a child.
The obsession with family reunification at all costs can be encoded into social worker evaluations. In Tennessee, a recent survey of social workers suggests that they are being judged by whether they close cases in a timely manner, regardless of child safety. As one worker put it, “Children are returned home or exiting custody to relatives quickly to lower the number of cases without regard to whether the children will be truly safe and the parents ready to parent again.”
The current emphasis on family preservation and reunification is often justified as a way to ratify racial imbalances in child welfare involvement. A growing movement urges drastically scaling down or eliminating current child welfare services on the grounds that the overrepresentation of Black children in care compared to White children is a consequence of racism. Supporters call for elimination of the “disproportionality” between removals of Black and White children from their parents, while disregarding higher rates of poverty and historical trauma that result in more child maltreatment among Black families. To say that Black children need to stay with, or return to, abusive parents in order to equalize the percentages of White and Black children in care is to devalue children and reduce them to nothing more than their race, a strange position for an anti-racist movement to take. As described in a document entitled How we endUP: A Future without Family Policing, parts of this movement are fighting for repeal of ASFA, which would eliminate timelines and encourage jurisdictions to reunify children with their birth parents years after they had established parental bonds with other caregivers, such as grandmothers or former foster parents.
Racial considerations are not the only factor driving systems to support reunification at all calls. Lethal reunifications occur in states like Maine, where 88 percent of the children in foster care are White. Maine’s Office of the Child Advocate recently reported that the state’s child welfare system continues to struggle to make good decisions around two critical points–the initial safety assessment of a child and the finding that it is safe to reunify the child with her parents. In its review of seven cases closed through reunification, the OCA found multiple incidents where children were sent home with insufficient evidence that they would be safe. In one case, the parents had not been visited for a year-and-a-half despite the fact that home conditions were a reason for the original removal. In another case, providers were not contacted or given the information they needed to treat the issues that had resulted in the removal. In another case, the parent “failed to understand or agree to the reasons the children entered custody, but this was not considered significant.” In yet another case, the trial home placement started too soon and the parent never completed required substance abuse treatment. The child was sent home two months after the parent had a positive toxicology screen.
In responding to the criticisms of Maine’s OCA, OCFS admitted that “staff have been challenged with the current workload based on the increase in the number of calls, assessments, and children in care.” It is clear that insufficient of resources lead to excessive caseloads around the country, endangering children. In Tennesseee, for example, while caseloads are not allowed to exceed an average of 20 (a very high number in the experience of this former social worker) data obtained by the Tennessee Lookout, indicated that 30% of caseworkers had caseloads of more than 20, and that many had 30, 40 or even 50 cases. Insufficient funding often means low pay and a difficulty in attracting people with the education and critical thinking skills required for the job. High caseloads and poor pay lead to high turnover, resulting in a loss of institutional memory about specific cases that may drag on for years, such as those discussed here. In turn, high turnover leads to high caseloads as social workers have to pick up cases from those who leave. Such factors may or may not have contributed to the deaths of Rashid and Julissia; they have certainly contributed to other child deaths around the country. Most taxpayers don’t want to think about these systems or fund them; it is easy to avoid reading about the consequences when they occur.
And cost considerations drive reunifications in another way as well. Reunifications save money for cash-strapped child welfare systems. Once a child is sent home and the case is closed, the jurisdiction incurs no more expenditures for foster care. If the child is instead placed in guardianship or adoption with a relative or foster parent, the jurisdiction may end up paying a monthly stipend to the caregiver until the child turns 21. Of course, many relatives who step up to the plate like Julissia’s grandmother are not paid, due to the same budget concerns. giving rise to the current outcry and debate around hidden foster care.
Family court problems contribute to lethal reunifications as well. Rashid’s death appears to be primarily due to a judge who insisted against agency protests on the return of nine children in the space of two months, during which the mother also gave birth to a tenth child. The information available suggests that Florida DCF staff proposed a much slower reunification process. We don’t know what influenced the judge’s decision, but we do know that family courts are overwhelmed and in crisis, resulting too often in the deaths of children in both custody and child protection cases. These courts are inundated with cases, judges often lack the training they need, delays are all too frequent and were worsened by the pandemic. Judges rarely see consequences for decisions that lead to an innocent child’s death, and I have never heard of a judge being removed for the death of a child that was placed in a lethal home against all the evidence. The judge who sent Rashid to his death probably continues to endanger other children daily. This judge must be named, punished, removed and never again allowed to send children to their deaths.
The degree to which the pandemic contributed to Julissia’s and Rashid’s deaths is impossible to estimate. Julissia’s irregular reunification was justified to her grandmother on the grounds of the pandemic. Both Rashid and Julissia should have been visited regularly at least monthly once they were placed with their original families, depending on state regulations. Visits to Rashid should have occurred until the judge terminated them in August, well after the leg injury that left him bedridden, and he should have also been seen in the visits to his siblings that terminated in October. Even if the case managers were visiting (virtually or in real life) only the four children whose cases had not been closed, they should have had the curiosity to ask about little Rashid. For Julissia, there should have been visits throughout her 16 months in hell. Were these visits conducted at all, virtually, or in person? What information was gathered at these visits? This information that must be revealed.
This is not my first post about a lethal reunification in Florida. In January 2019, I wrote about Jordan Belliveau, who was murdered by his mother eight months after being reunified with her, even while a agency in Pinellas County was still monitoring the family. A caseworker for the agency and later resigned told News Channel Eight that the system “puts far too much weight on reuniting kids with unfit parents and makes it nearly impossible for caseworkers to terminate parental rights.” It does not appear that the state learned from Jordan’s death.
I could have written about other lethal reunifications in New Mexico, Ohio, and elsewhere. But I often resist writing about the deaths of a specific child or children known to the system that was supposed to protect them. There are so many reports of such cases, and they are only the tip of the iceberg. Why choose one and not another? I cried for Rashid but I did not write about him until I read about Julissia. Then I knew that I had to write about both, because they represent so many others whose names we will never know. Some of these children’s names may never be known to the general public because there was no outraged grandmother to speak out, no determination of the cause of death, no charges by police, or no alert reporter to reads a crime report and ask questions. But others are unknown because they are suffering in silence and darkness. Because death is not the worst thing that can happen to a child whose life is one of unremitting pain.
Around the country, there is a lack of appropriate placements for the most traumatized and hard-to-place foster youth–a shortage that has reached crisis proportions in many states, including Texas, Washington, and Illinois. These children are spending days, weeks or even months in offices and hotels or languishing in inpatient psychiatric units where there is no semblance of normal life. These young people have been damaged by our negligence and now deteriorate daily without the treatment they need and deserve. Unfortunately, recent federal legislation is likely to worsen the crisis by withdrawing federal funding for children placed in some of the best therapeutic residential settings.
An unforeseen consequence of the much-heralded Family First Prevention Services Act (FFPSA) of 2018 may exacerbate the shortage of therapeutic placements in many states. FFPSA had twin goals: to shift resources from foster care to family preservation, and within foster care, to shift resources from congregate care settings (anything other than a foster home) to foster homes. However, the framers of the act did recognize that some children need more intensive care than a foster home can provide, and for them FFPSA defined a new category of placement called a Quality Residential Treatment Program (QRTP). QRTP’s must have a trauma-informed treatment model, involve families, be accredited by an approved organization, and provide at least six months of aftercare. A child can be placed in a QRTP only if a qualified professional determines that the child’s needs cannot be met in a foster home, and the placement must be approved by a judge. Other than specialized settings for teen parents, children who have been sex-trafficked, and supervised independent living settings for foster youths aged 18 and older, QRTP’s are the only non-family placements that can be funded under FFPSA.
Unfortunately, in creating QRTP’s, Congress unintentionally created a conflict with a provision of the Medicaid law that may sharply limit the number of children who can benefit from this new category of therapeutic placement. The problem is that federal Title IV-E foster care funding pays for room and board, but not the costs of medical, dental, behavioral and mental health care for children in foster care. States generally extend Medicaid to all foster youths, allowing the program to cover those costs. But the “IMD exclusion,” a provision included in the original 1965 legislation creating the Medicaid program, prohibits federal Medicaid dollars to be used to pay for any care or services to anyone under 65 who is a patient in an “institution for mental diseases” except for in-patient psychiatric services provided to children under 21. An Institution for Mental Diseases (IMD), as defined by Section 1905(i) of the Social Security Act, is a “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases including medical attention, nursing care, and related services.” (For more on the IMD exclusion, see Fact Sheets by the Legal Action Center and the Training and Advocacy Support Center.)
This “IMD exclusion” reflects the sentiment at the time of Medicaid’s creation in 1965 against the large public institutions where the mentally ill were warehoused at the time. The provision was a driving force behind the transformation of public mental health care from an inpatient to an outpatient model, often known as “deinstitutionalization.” But now, many high-quality therapeutic residential programs have more than 16 beds distributed between separate units or cottages on one campus, and in many states these are exactly the facilities that qualify to be licensed as QRTP’s. Without a legislative fix, QRTP’s of over 16 beds may be considered IMD’s and children placed there will not be eligible for federal Medicaid funding for any of their care, including medical, dental, behavioral and mental health services, whether delivered inside or outside the residential program. States will then have to pay the entire costs of all care for foster children placed in these settings.
Decisions as to whether a facility is an IMD are made on a facility by facility basis based on federal law, regulations and guidance. But the definitions of IMD’s and QRTP’s, as well as the guidance provided by the Center for Medicare and Medicaid Services (CMS) in the State Medicaid Manual section 4390 on how to determine if a facility is an IMD, suggests that QRTP’s are likely to be considered IMD’s. When California wrote to CMS arguing that its “short-term residential treatment programs” (which they were hoping to designate as QRTP’s) should not be considered IMD’s, CMS responded that it was “unable to provide California the blanket assurance requested that STRTPs are not IMDs.” While a state Medicaid agency can elect not to consider a facility to be an IMD, CMS can essentially overrule these decisions by requiring a state to review the status of these facilities based on its guidance.
Even before the current crisis over QRTP’s, the IMD exclusion had resulted in the loss of Medicaid coverage for foster children living in therapeutic residential facilities in at least two states. For years, Minnesota was using residential programs that would have met the definition of QRTP’s as an alternative to, or a step down from psychiatric hospitalization. But, as reported by theStar-Tribune, after a review ordered by federal officials, 11 treatment centers with a total of 580 beds lost about $4.5 million in federal Medicaid funding–a cost that had to be picked up by counties. Utah went through an “IMD sweep” in 2010, which resulted in its replacing most of its residential treatment centers serving children in foster care with facilities having less than 16 beds.
The Association of Children’s Residential and Community Services (ACRC) has been contacting states to find out how they are dealing with the IMD/QRTP issue. They found that states fall into several groups:
Some states are not concerned about the IMD problem because they are not planning to implement QRTP’s. Some already rely on facilities that are exempt from the IMD exclusion (Psychiatric Residential Treatment Facilities or facilities with fewer than 16 beds) or will use state funds to pay for children placed in residential care.
Some states are proceeding on the hope that their QRTP’s will not be declared to be IMD’s even if they have more than 16 beds. This includes six states where all of the programs that have been approved as QRTP’s have more than 16 beds.
Some states are discussing whether to limit the size of their QRTP’s but have not yet decided whether to do so. In many of these states, the majority of the potential QRTP’s have more than 16 beds–or the majority of the QRTP beds are in facilities with more than 16 beds.
Some states are trying workarounds to avoid the IMD designation. Two states have decided to separately license cottages that are on the same campus, which enables them to use the bed count for the individual cottage rather than the entire facility, thus potentially avoiding an IMD designation. Another state has classified all residential facilities as serving youth at risk of sex trafficking, one of the allowable uses of congregate care. Whether these workarounds will be accepted by CMS or the Administration for Children and Families (in the case of the latter state) remains to be seen.
Colorado has decided to limit its QRTP’s to 16 beds or less, and a FAQ document from the Colorado Department of Human Services provides an interesting case study in how one state has tried to address the QRTP issue. Hoping to find a way to license its existing residential facilities as QRTP’s, Colorado’s Medicaid and child welfare agencies worked together to analyze the federal IMD criteria and its application to QRTP’s. These agencies “explored every possible argument that would allow Colorado to confidently move forward with QRTPs without risking an IMD designation.” But ultimately they agreed that the only way to avoid the designation was to reimburse only QRTP’s with 16 beds or less. Currently almost all of Colorado’s residential facilities that could have been designated as QRTP’s have more than 16 beds. Instead of creating smaller programs, the state is planning to serve fewer children in residential facilities. The question is whether they will have appropriate options for those children who have been determined to need therapeutic residential care. There is considerable concern that they will not.
Without legislation exempting QRTP’s from the IMD exclusion, states will be faced with the choice of paying the full costs of care for children in therapeutic residential care or scrapping their current facilities and starting from scratch. Vulnerable children may end up in greater numbers in hotels, offices, and hospital beds or bouncing between foster homes that are not equipped to care for them.
According to ACRC, there is no evidence that residential programs with 16 beds or less produce better outcomes than programs with a higher capacity. As a matter of fact, there are reasons to think that a larger campus would be able to offer more services (like therapeutic riding or other specialized therapeutic modalities) that would not be possible to offer on a smaller campus. It is also possible that the IMD/QRTP conflict might result in more foster youth receiving a higher level of care through Psychiatric Residential Treatment Facilities (PRTF’s). These are facilities that deliver an inpatient level of care outside a hospital and they are not considered IMD’s. They are exempted from the IMD exclusion and Medicaid can pay all costs for these facilities, including room and board. So FFPSA might have the perverse result of having more children in a more restrictive, less homelike setting.
On July 23, ACRC sent a letter to the House and Senate leadership asking them to pass legislation by October 1, 2021, exempting Qualified Residential Treatment Programs (QRTPs) from the Institution for Mental Diseases (IMD) exclusion. In the letter, ACRC argues that that “without the exemption for QRTPs, thousands of children in foster care who are vulnerable will be pushed into more restrictive placements, non-therapeutic shelters, unlicensed or unstable settings, or they will bounce from placement to placement without addressing their true needs – which is opposite the intent of the FFPSA.” So far, about 540 organizations have signed onto the letter, and more signatures are coming in daily.
Many groups concerned with the mentally ill have long been advocating for an end to the IMD exclusion altogether, arguing that it is behind the nationwide shortage of psychiatric beds. Rep. Grace Napolitano, Democrat from California, has introduced a bill (H.R. 2611) to eliminate it. CMS and ACF during the Trump Administration also proposed eliminating the exclusion specifically for QRTP’s in its budget for 2021. There are strong arguments for eliminating this exclusion, but the urgency of the QRTP problem requires immediate action, rather than waiting to change a policy that has lasted 50 years.
Unfortunately, there is opposition to lifting the IMD restriction among powerful and wealthy advocates whose ideology appears to blind them to the reality facing our most vulnerable children. William Bell of Casey Family Programs, the nation’s most influential child welfare funder and a leading force behind the Family First Act, urged Congress in testimony to “stand firm” in resisting modifications to the IMD rule. In the real world, where staff work face-to-face with wounded children, the picture looks very different.
The IMD exclusion for QRTP’s threatens to eliminate one of the most promising avenues to address the desperate shortage of therapeutic residential placements for foster youth that already exists in many states. On the state level, legislators must open their hearts and their minds to the pleas of those who are on the front lines caring for our most troubled children. They must increase funding for the therapeutic residential programs the most vulnerable foster youth so desperately need. Congress must help by exempting QRTP’s from the IMD exclusion, enabling the federal government to ensure access to therapeutic residential care–and ensure that the legislation they authored and passed can actually be implemented by states.
Wishful thinking is a very human pattern of thought that can even be functional at times. Thanks to wishful thinking, a placebo can actually cure an illness. Great ideas can gain support even if we don’t know they will succeed. But when wishful thinking is used to distort available data to support a given theory or policy, it becomes a problem. Such is the case with “race-blind” removals. The story of how this simple concept became viewed as a solution to the disproportional share of Black children in foster care, in relationship to their share of the general population, is a case study in the misuse of data to promote a particular viewpoint.
As reported in The Imprint and the Los Angeles Times, the Los Angeles Board of Supervisors has voted to support a project testing “race-blind removal” or “blind removal” of children into foster care. Blind removal was pioneered in Nassau County, New York in 2011 and “discovered” (as they describe it) by a team of researchers headed by Jessica Pryce of Florida State University, who were investigating the practices of two counties that were credited by New York’s Office of Child and Family Services (OCFS) with reducing racial disparities. Before the inception of blind removal, county investigative workers were presenting cases to a committee made up of supervisors, managers, and an attorney before a child could be removed and placed in foster care. Under blind removals, the members of this committee were no longer given information that might give a clue as to the race of the child and family. According to an email from a county official, the information that is withheld includes race, ethnicity, first and last names, addresses, the location of the reporter if that reflects the community where the child lives, and any other information (such as socioeconomic status or receipt of government benefits) that is not deemed to affect safety or risk.
Nassau County adopted the blind removal policy as a way to address its high rate of racial disproportionality in foster care, with Black children being much more likely to be removed and placed in foster care than White children. According to data provided by New York State, Black children were over 14 times more likely than White children to be placed in foster care in Nassau County in 2010. The blind removals policy is based on the belief that implicit racial biases affect the decision to remove a child and that removing this information from the process will remove the bias.
Unless there is strong evidence in support of such a program, one might worry about a practice that relies on people who know so little about a family. One might wonder if such a meeting is the best use of time for overburdened social workers and supervisors. Perhaps it would be better to make sure investigators have enough time to interview everyone who might be able to give them information about the family under consideration rather than burden them with another meeting. And what about emergency situations, where a child cannot be safely left in the home? An article in Children’s Bureau Express documents concerns from social workers who fear that blind removals would make it harder to do their jobs for these and other reasons. Another concern is whether race-blind removals might provide more of an opportunity for investigative workers to express any racial bias they have, since they control the information that is presented to the committee.
But if blind removal truly does cause a significant reduction in racial disparities, perhaps it is worth implementing despite the costs. And if one can believe a TED Talk by Jessica Pryce that has been viewed 1.3 million times, the practice has been spectacularly successful. According to Pryce, “In 2011 57 percent of the kids going into foster care were black, but after five years of blind removals, that is down to 21 percent.” (At which point the audience broke into applause). Such a simple idea and such a huge impact! Casey Family Programs, the nation’s most influential child welfare funder, highlighted this program in an article on its website, stating without providing numbers that “within five years, the number of Black children removed from their families was reduced considerably, representing the most significant decrease in racial disproportionality within the county system ever.” New York State was so excited that it required all counties to develop a blind removal process effective October 14, 2020, offering a strikingly vague and yet broad description of what information must be kept from the committee: “all demographic and identifiable information (race, gender, language needs, zip code, etc. sic)).” Several other jurisdictions have expressed interest, including Los Angeles County, which is proceeding with its pilot.
Such a great result should be documented and the data made available to the public and researchers, preferably online, so it is surprising that Pryce was unwilling or unable to provide the source of the percentages at the heart of her popular talk. Instead, she referred me to the data team at Nassau County, who did not respond, nor did did the Commissioner’s Office. Nor was Casey Family Programs able or willing to provide the document referenced in their footnote to their statement about the program’s stellar results. Happily, I was able to obtain data from the New York State Office of Child and Family Services showing the percentage of children removed into foster care who were Black every year from 2009 to 2020. Those percentages are shown in Chart One.
The first fact that emerges from the New York data is that Jessica Pryce’s percentages were not accurate. The 57 percent (56.7 percent) that she cites as the percentage of Black children removed in 2011 was actually the percentage of Black children removed in 2010. As for the 2016 data (the endpoint of the five-year-period cited by Pryce), 37.1 percent of the children removed in 2016 were Black, rather than 21 percent cited by Pryce–rather a large difference. There was a sharp increase in the Black share of children removed, from 45.2 percent in 2009 to 56.7 percent in 2010, the year before the program was implemented. With the implementation of blind removals, the percentage of children removed who were Black declined for two years to 45.5 percent in 2012, then rose for two years to 57.4 percent in 2014, fell to its all-time low of 37.1 percent in 2016, then rose to 49.7 percent in 2018, dipping slightly back to 45.1 percent in 2019, then popping back up to 49.5 percent in 2020–higher than it was in 2009 before the program was implemented. With such large fluctuations from year to year, as well as changes in direction, it is hard to imagine drawing any conclusions from the difference between any particular two years.
It is also important to note that the total number of children placed in foster care in Nassau County dropped precipitously from 429 in 2009 to 91 in 2020, as shown in Chart 2. This drastic drop in removals of Black and other children means that there was a lot more going on than the effort to make removals race-blind; cutting removals by three-quarters requires major changes in policy and/or practice. So it is hard to attribute any change with confidence to the race-blind policy. It also means that the numbers of children removed became smaller and smaller, resulting in a larger margin of error.
OCFS also provided data on Nassau County’s “Black Admissions Disparity Rate.” This rate, which New York State collects for all its counties, is defined as the “ratio of unique Black children admitted to foster care per 1000 Black children under 18 relative to comparable rate for White children.” According to OCFS, the disparity rate for foster care admissions went down from 14.30 (meaning Black children were 14 times more likely to be removed than White children) in 2010 to 12.60 in 2020. But it fluctuated to a surprising degree (between 24.4 and 6.16 between 2011 and 2019) that is not consistent with the percentages shown above and casts doubt on the correctness of the ratios provided. Assuming the 2020 ratio is correct, Nassau County currently has the highest disparity in foster care placement for Black children in the entire state. According to its ranking of counties based on this ratio, Nassau County was at the bottom in 2020 of all counties listed* with its disparity rate of 12.6, compared with 3.34 for the state as a whole. Hardly a role model for New York or the nation! Now this doesn’t mean we should blame Nassau County’s child welfare system for its abysmal disparity ranking. Other factors are probably behind that large disparity compared to other counties, such as the socioeconomic status of the Black and White populations in a given county. Which raises the question, how much can we expect blind removals to change racial disparities in foster care?
New York State recognizes the weaknesses of its data but focuses on the positive overall trend between 2010 and 2020. As John Craig of OCFS put it in his email to Child Welfare Monitor, “While Nassau County has seen fluctuations in the rate of Black children entering care over the past 10 years, overall, the trend has been very positive. OCFS commends Nassau County for recognizing the disproportionality of children of color in the child welfare system and implementing this innovative approach.”
Despite OCFS’ valiant attempt to portray Nassau County’s data as “very positive,” the data do not provide a strong justification for expanding the program. While the Black percentage of children taken into foster care in 2020 was 49 percent compared to 57 percent in 2019, there were changes in both directions in the years between those two dates, and the 49 percent was actually higher than the Black percentage in 2009, two years before program implementation. There is reason to wonder whether New York, Los Angeles and others were really concerned about what the data showed. Instead, they may have proceeded in part based on the inherent logic of the approach, which addresses racial disparities directly in a way that is appealing to those who seek a relatively simple solution. Most importantly, they wanted it to work, so they decided that it did, regardless of the highly equivocal findings.
It would be wonderful if we had easy solutions to racial disparities in child welfare, but evidence suggests that higher reporting, investigation and removal rates among Black children stem from their greater needs, rather than bias among social workers. LA County would be better off studying how to make CPS decisions more accurate rather than imposing a cumbersome and unproven hurdle on social workers trying to protect endangered children.
* Certain counties were excluded because of very small number of Black children or Black children taken into foster care.
There is much confusion around child neglect. Opponents of the current child welfare system are fond of stating that most children reported to child protective services (CPS) are suffering from neglect, not abuse, that neglect is synonymous with poverty, and therefore that children are commonly being removed from home because of poverty. While neglect is clearly related to poverty, the facts suggest that the removal of children due to poverty alone is rare. To know more about this most common form of maltreatment, it is necessary to collect more specific data on the types of child neglect that are found when a neglect allegation is substantiated. Nevertheless, child welfare must recognize the important role of poverty in promoting child neglect and the role of poverty alleviation programs in child neglect prevention.
A useful way to distinguish between abuse and neglect of children is that abuse is generally an act of commission, while neglect is an act of omission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect (failure to provide for basic physical needs), medical neglect, inadequate supervision, emotional neglect, and educational neglect. Some states include exemptions for certain types of neglect, like religious exemptions for medical neglect. Twelve states and the District of Columbia exclude financial ability to provide for a child from the definition of neglect.
How true are common statements about neglect?
A number of statements about neglect are are frequently made in support of various views and proposals. These are discussed below.
The national child welfare system was established to address abuse, not neglect. This is absolutely true. The discovery of “battered child syndrome” by Henry Kempe at the University of Colorado led to the passage of child protection laws in every state within a few years. On the federal level, the Child Abuse Prevention and Treatment Act (CAPTA), which established the federal role in supporting and monitoring these systems, was also focused on abuse rather than neglect. According to an oft-quoted book about the history of CAPTA, Democrats feared that President Nixon might veto CAPTA if it was viewed as an anti-poverty program, so they took pains to reiterate that child maltreatment could happen to anybody, regardless of socioeconomic status. As a result, the responses to child maltreatment focused on mental health and parent education services rather than economic supports. In his essay, Poverty, Neglect and Cultural Denial, child welfare commentator Dee Wilson recalls that when he began working as a CPS social worker in the 1970’s, all his training focused on battered children. Yet, in his work he encountered battered babies and toddlers maybe “once or twice annually out of 100 to 150 assigned cases.” Instead, he received both in Colorado and later in Washington “a steady diet of reports of child neglect and, to a lesser extent, reports of excessive punishment of children with minor injuries that did not require medical attention.” Academic literature has contributed to the problem by failing to distinguish between abuse and neglect.
Neglect is the main reason for children’s involvement with child welfare. This is also a true statement. According to the latest data collected from the states and published in Child Maltreatment 2019, three-quarters (74.9 percent) of the 656,000 children found to be victims of maltreatment in 2019, were found to be neglected, 17.5 percent were physically abused, 9.3 percent were sexually abused, and 6.8 percent were “other.” Some children were found to be victims of both neglect and another maltreatment type. These percentages should not be viewed as an exact representation of the relative importance of different types of maltreatment. As Font and Maguire-Jack point out, investigators do not have to substantiate every allegation to justify intervention. So If there is more than one type of maltreatment in the home, investigators may not substantiate all of the different types. Thus a child found to be a victim of neglect only may actually have suffered abuse as well. Comparison of substantiation data with other sources, as shown in Font and Maguire-Jack’s table listed below. suggests that “substantiations are likely to grossly understate all forms of child maltreatment, but especially physical abuse.” So neglect does appear to be more common than abuse as a reason for child welfare involvement, but abuse may be be present in a higher fraction of cases than the percentages indicate.
Child neglect is strongly related to poverty. This is also true. Research demonstrates that poverty is a major risk factor for child neglect. According to the most recent National Incidence Study of Child Abuse and Neglect, children in low socioeconomic status households experienced maltreatment at five times the rate of other children. Studies have also demonstrated that providing economic supports for families (through programs like tax credits, passing on child support, food assistance, and child care subsidies) have direct effects on child maltreatment. We do not know exactly how poverty affects child neglect but in an excellent article in a journal issue devoted to child maltreatment Feely et al provide a useful way to think about it. They posit that the inverse of neglect is what they call “safe and consistent care or SCC,” which they define as “to provide safe, consistent supervision and constantly provide for children’s basic needs.” As they describe, time and money are two core resources a family needs to provide SCC. For a poor parent, it may be very difficult to provide acceptable levels of time and money simultaneously. So a poor parent might have to choose between going to work and letting the children be unsupervised or inappropriately supervised, or losing their job and letting their children go hungry.
Most parents found to be neglectful are actually just poor. The confusion of poverty with neglect is a trope that is cited again and again by those who advocate restricting government intervention in maltreating families. For example, Jerry Millner and David Keller, the former Associate Commissioner of the Children’s Bureau and his special assistant, have written that It’s time to stop confusing poverty with neglect. They claim that many children become involved with child welfare only because their parents are poor. For example, children might be taken into care because a parent gets evicted or cannot afford childcare and leaves them alone. Despite the popularity of this belief, the evidence does not support it. It is clear that most poor parents do not neglect their children. They find a way to provide safe and consistent care, whether it means extensive research on community resources, creative use of existing supports, or delaying the next birth until adequate resources are available to care for the children they already have. Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction, beginning with mood disorders such as depression and PTSD,” which often lead to substance abuse as a method of self-medication.
The most serious cases of neglect are often chronic. Chronic child neglect can be defined as “a parent or caregiver’s ongoing, serious pattern of deprivation of a child’s basic physical, developmental and/or emotional needs for healthy growth and development.” Chronic neglect by a single mother often opens the door for physical or sexual abuse by her boyfriend. Children who have experienced chronic neglect may suffer “serious cognitive and social deficits because of the….lack of responsive parent-to-child interaction that is essential for healthy child development.” Chronic neglect can have effects similar to trauma, such as difficulties with emotion regulation.
Many child neglect reports are frivolous and unnecessary, cluttering up the system and making it harder to identify serious maltreatment. Many critics of mandatory reporting and CPS cite a study estimating that 37.4 percent of all U.S. children (and 53 percent of Black children) experience a CPS investigation by the age of 18. Some argue that many of these reports are the consequence of a racist system that ensnares too many poor and Black families. Some are supporting bills to end anonymous mandatory reporting in New York and Texas. Another, smaller set of reports has drawn attention, as described by Naomi Schaefer Riley in her article, Reforming Child Neglect Laws. These reports target stable, functional middle class families that have chosen to give their children more independence than many other parents in their geographic and demographic stratum. The case of the Meitiv children, who were picked up by police while walking a mile to their home in Silver Spring, Maryland and became the subject of not one but two CPS cases, drew publicity around the country.
It is clear that some reports coming into hotlines do not warrant investigation, but we do not know what proportion. Annual data submitted by states and compiled in the Child Maltreatment 2019 report shows that that 45.5 percent of referrals (for all kinds of maltreatment) in 2019 were screened out. And of all children receiving an investigation or alternative response, only 18.9 percent were found to be victims of maltreatment. However, research suggests that the likelihood of another report, a substantiated report, or a foster care placement is the same for a child who is the subject of a substantiated versus an unsubstantiated report. Chances are that many of the children with unsubstantiated reports were previously the subject of substantiated reports, or will be the subject of such reports later. Moreover, as Font and Maguire-Jack point out, “it seems unavoidable that some number of non-maltreated children will be reported to CPS if mandatory reporters are acting appropriately.” After all, they are told that they do not need to be sure the maltreatment is occurring, but to leave that decision to CPS. Changing that guidance, in my opinion, would be dangerous to children.
Should neglect be treated differently from abuse?
Even if neglect is not “just poverty,” some commentators argue that it should be treated differently from abuse. Two former directors of large child welfare systems, Tom Morton and Jess McDonald, argue that because child protective services were designed around abuse rather than neglect, they were patterned after the criminal justice system and treat all maltreatment as antisocial behavior. Morton and McDonald argue that because neglect is an act of omission rather than commission, it should be treated differently, The response to neglect should occur in a “public health framework” outside the current child protection system.
I do not agree that we need a separate system to deal with neglect. As I have discussed, many neglected children are also victims of abuse, whether or not it is substantiated by authorities, and neglect by one caregiver can pave the way for abuse by another. We already have a criminal justice system that addresses criminal abuse and neglect separately from the child welfare system. While the effect may seem punitive, the goal of CPS is to make children safe, not punish parents. Both abuse and neglect make a child unsafe, and the first mission of child welfare is to ensure child safety. Splitting this mission into two is probably not be the best way to promote children’s safety.
Even if we do not need a separate system to deal with neglect, we need to recognize the importance of anti-poverty strategies to help families provide safe and consistent care and prevent child neglect. Prevention has become a major priority of child welfare leaders and thinkers, so this is a good time to talk about incorporating poverty alleviation into child maltreatment prevention. In this new vision, as Feely et al propose and as I have discussed in an earlier post, child maltreatment (especially neglect) prevention should not be the responsibility of child welfare agencies alone. This responsibility should be shared by all the agencies responsible for alleviating poverty. The new initiatives proposed by the Biden Administration for child tax credits, universal pre-kindergarten and expanded child care assistance should be a good beginning.
Is it time to drop the term “neglect”?
In an article in The Imprint, Rebecca Masterson of Gen Justice argues correctly that the term “child neglect” has become almost meaningless because it is used so broadly and so deceptively as a symptom of poverty. Masterson argues that “neglect” needs to be replaced by more specific terms, such as abandonment or refusal of medical care. I do not agree that the term neglect should be dropped. Just as “child abuse” is an umbrella term that includes physical abuse, sexual abuse, and emotional abuse, “neglect” has value as an umbrella term that refers to acts of omission that harm children, in contrast to abuse, which is an act of commission. It makes sense to have these umbrella categories.
But the umbrella categories of “abuse” and “neglect” should not be put in the same list of categories as the specific acts (or lack thereof) underneath the umbrellas. Unfortunately, state and local data systems often list “neglect” as a category along with other more specific terms for types of neglect. This results in bizarre analyses where “neglect” is often described as the most common category of child maltreatment–more common than its subcategories–as if anything else is possible! Just as social workers do not have to check off “abuse” as well as “physical abuse,” in their agency database, they should not be asked to check off “neglect,” as well as specific types of neglect. In order to fix this problem everywhere, and to make sure we have comparable data from all states, the federal government should mandate that all states use the same subcategories of abuse and neglect, and that “abuse” and “neglect” not be among the specific categories.
In devising these alternative categories, we also must be careful to avoid confounding neglect with conditions that may cause it, such as substance abuse and mental illness. These are contributing factors that should be noted in databases and shared with the federal government but are not in themselves forms of neglect. And indeed, in some jurisdictions, like the District of Columbia, substance abuse is not considered neglect unless it is considered to impair parenting.
Child neglect is the most common form of child maltreatment, yet it received little attention in the first decades of the modern child welfare system. It took a long time for child welfare scholars and leaders to recognize the importance of neglect. Unfortunately now that they have recognized its importance, many leaders are using this new knowledge in order to support their proposals to upend child welfare in ways that may be harmful to neglected children. This misuse of the concept of neglect can be addressed by requiring that child welfare agencies collect uniform data on the types of neglect that are being found. That being said, it is important for child welfare leaders to understand the importance of poverty alleviation strategies in preventing maltreatment in general and to recognize that this job does not belong to the child welfare system.
I have been trying to avoid writing more posts about children failed by state systems that exist to protect them. No matter how many reports are written, these fatalities continue to occur with devastating regularity, and I’m not sure if my posts do any good. But despite my resolution to avoid such stories, I feel compelled to write about David Almond, a fourteen-year-old boy with Autism Spectrum Disorder who died of abuse and neglect on October 21, 2020. I have to write about David for many reasons, including the sheer number of red flags that were disregarded by child welfare, schools and courts in his case; the light his death sheds on risks to children with special needs, and what it shows about the peril posed to abuse victims by the quarantines due to COVID-19.
The Massachusetts Office of Child Advocate (OCA) issued a scathing report in March that revealed “multiple missed opportunities for prevention and intervention prior to the death of David Almond and the discovery of the serious physical and emotional injuries to his brothers.” David’s family was under the supervision or monitoring of the Department of Children and Families (DCF), the juvenile court, the education system and many service providers at the time of David’s death. Reading OCA’s account of the family’s involvement with DCF alone, it is hard to comprehend the many misguided actions and missed opportunities that allowed David to be returned to a family patently unable to care for him and then to deteriorate physically and emotionally over a period of seven months, culminating in his death. The attachment to this blog lays out the sad chronology assembled by OCA, which I summarize more briefly below..
David, Michael and Noah Almond were triplets born in February, 2006 in Syracuse, NY and diagnosed with Autism Spectrum Disorder at the age of about two. Between 2006 and 2013, the triplets were removed from their parents three times by the New York State Office of Children and Family Services (OCFS) due to substance abuse, mental illness, “deplorable living conditions,” medical neglect, inadequate supervision, and “a general lack of basic care.” After working toward termination of the parents’ rights, OCFS inexplicably shifted gears and a New York Family Court awarded full custody of the boys, now aged ten, to Almond, who was living in Massachusetts, in September 2016.
Upon receiving custody, Almond moved the boys to the one-bedroom apartment in Fall River, Massachusetts, which he shared with his partner, Jaclyn Coleman, and his mother, Ann Shadburn. Almond had been removed as a child from Shadburn, whose parental rights to all her children had been terminated due to abuse and neglect. Almond and Coleman were both in DCF custody for part of their childhoods due to abuse and neglect, mental illness, physical violence, and substance abuse. By August 2017, Coleman had a new baby (Aiden) and three reports had already come into Masachusetts’ child abuse hotline concerning the family.
In October 2017, all four children were removed from Almond and Coleman because of abuse and neglect, parental substance abuse, unsanitary home conditions, medical neglect, and the triplets’ excessive absences from school. In the words of OCA, “This was the fourth time in the triplets’ young lives that they were removed from Mr. Almond for the identical pattern of abuse and neglect.” But four strikes was not enough. The parents agreed to a plan requiring them to engage in therapy to address longstanding substance abuse and mental health issues, submit to random drug tests, participate in family therapy with the triplets, complete psychological evaluations, and complete parenting classes. Aiden was placed in foster care and the triplets were eventually placed in a residential facility specializing in autism spectrum disorder and intellectual disability.
While the triplets thrived in their residential facility, Coleman and Almond displayed minimal compliance with their plans, and the children’s permanency goal was changed to adoption in January 2019. But in July 2019, the children’s goal was changed back to reunification based on the parents’ improved compliance with their case plan, and Aiden was returned home the next day. This occurred, as OCA put it, “despite Mr. Almond’s failure to engage with therapy, despite Ms. Coleman’s limited engagement with therapy, and despite the lack of any documentation of any change in Mr. Almond and Ms. Coleman’s ability to parent, specifically their ability to parent children with special needs.” OCA attributes this decision mainly to a parenting evaluation conducted by a contractor that did not adequately assess the caregivers’ ability to care for the children.
In December 2019, DCF Fall River area office management decided to begin the reunification process for the triplets. This decision was made despite concerns raised by the family support provider and the case management team (social worker and supervisor) that the parents were canceling appointments, and more generally regarding their ability to care for the triplets. Management set a target date of January 2020 for the reunification. They disregarded requests for a delay from the case management team, the residential facility and the boys’ school. These requests were based in part on the need of children for a slower transition given the children’s disability, the logic of waiting until June to eliminate an extra change of school, the limited engagement the parents had demonstrated with services, the difficulties inherent in having seven people in a one-bedroom apartment, and the threat of eviction by the landlord if the boys returned home.
As the reunification date grew nearer, Almond and Coleman canceled scheduled visits with the boys, canceled appointments with the parenting support provider, and failed to take steps to secure larger housing. During the first day visit of the boys to the home on January 10, 2020, Coleman stated that reunification was moving too fast and that the family was not yet ready for overnight visits because the apartment was too small. At the first overnight visit on February 7, Almond and Coleman reported that Noah became aggressive, and he was returned to his facility that night. After this home visit, Noah refused to return to the apartment and was allowed to remain at his residential facility. The goal of reunifying him with his parents was dropped. This young autistic boy’s self-advocacy may have saved his life.
On February 11, 2020, the residential care facility took the “extraordinary” step of sending DCF a letter opposing the reunification of David and Michael with Almond and Coleman, citing the inadequate physical environment of the home to meet the children’s therapeutic needs; the fact the parents were facing eviction; and the need for a slower, more appropriate transition plan. The reunification was delayed, but by one month only. The case management team referred the family for Applied Behavioral Analysis (ABA) Services, an evidence-based approach used in both the residential program and school that the boys attended. This service was considered essential for a successful reunification, but there was a waiting list of at least six months for ABA services. Instead of delaying the reunification, DCF chose to secure “continuum services” for the family even though these services targeted one child only (Michael) and were not a substitute for ABA’s services, which are specific to the needs of autistic children.
David and Michael were returned to Almond and Coleman on March 13, 2020, barely two months after their first day visit. Four days after the reunification, the state’s COVID-19 restrictions went into effect. Starting within days of the boys’ return home and continuing until David’s death, OCA states that Almond and Coleman “deliberately avoided contact with the DCF case management team, the Fall River Public Schools, the continuum service provider, and the parenting support service provider.” They often claimed to have phone or internet access issues that prevented them from responding or being on video. When offered help in dealing with these issues, they refused or provided conflicting information.
Between March and September 2020, the case management team conducted monthly virtual visits with the family and received many communications from providers and schools. During this period, the team missed multiple red flags and opportunities to prevent the tragedy that eventually occurred. The team disregarded evidence from their own virtual visits, such as Coleman’s berating of David for his alleged behavior and her coaching of the boys to provide the desired responses to the case manager’s questions. But they never sought to interview David and Michael outside the presence of the adults. Exactly two months before David’s death, DCF received received a new CPS report about conditions in the home and substance abuse by Coleman and Almond. But the case management team accepted Coleman’s attribution of the report to a malicious neighbor and did not request drug tests for Coleman and Almond.
The team ignored concerning reports from providers and schools. These included the termination of services by the parenting services provider due to Coleman and Almond’s failure to engage with services; consistent reports from the continuum services provider that Coleman refused to allow them to speak to Michael, the targeted child for these services, and were resistant to the support and the strategies offered to address the boys’ behaviors; and David was never allowed to see the therapist obtained by DCF. DCF heard from Fall River Public Schools that Coleman and Almond refused the Chromebooks offered by the school in May but never submitted the paper packets they had chosen to complete instead. Instead, DCF learned that that the boys were not logging into school in the fall semester (a report Coleman denied, as she was logging into the schools’ electronic attendance system to falsely mark the boys “present.” ). They learned that David had missed his physical in July and two subsequently scheduled appointments.
David’s school, despite making multiple concerning reports to DCF case management, also missed many chances to save David. In one striking example, a school attendance officer came to drop off Chromebooks for David and Michael only 20 days before David was found dead. Coleman met the officer outside, refusing him entry in the apartment, and the offer did not attempt to see the boys. Apparently he was there solely to drop off the devices and not to see David or discuss with this family his lack of engagement with school since the previous March.If that officer had seen David and noticed his physical state, David might be alive today.
On the morning of October 21, 2020, emergency medical personnel responded to a 911 call regarding David; he was bruised, emaciated, and not breathing. He was transported to Charlton Memorial Hospital and pronounced deceased. Michael was found emaciated but responsive, and Aiden was well nourished and appeared physically unharmed. Substances believed to be heroin and fentanyl were found in the apartment. Michael and Aiden were immediately removed from Almond and Coleman, who are in jail and facing criminal charges.
OCA found that DCF missed multiple opportunities to protect David and his brothers. DCF gathered insufficient information from service providers and failed to analyze the information they did get; underestimated the impact of Almond and Coleman’s substance use; failed to recognize that Almond and Coleman were using access to technology as a tactic to avoid participation in services for themselves and their children; misinterpreted the “successful” reunification of Aiden (a non-disabled child) as a predictor of a successful reunification for the triplets; disregarded the triplets’ need for a gradual transition to the home; failed to secure the recommended essential services for David and Michael to be stable and successful at home; made David responsible for his own physical safety rather than teaching him to distinguish between appropriate and inappropriate interactions how to to communicate concerns to a trusted adult; and failed to adequately identify and adjust to the complications imposed by the COVID-19 pandemic.
OCA found that DCF management failed to understand that the physical environment of the home, a small one-bedroom apartment, did not meet the needs of the triplets. This is despite hearing this concern from the DCF case management team, Almond, Coleman, Almond’s legal counsel, legal counsel for David and Michael, and several provider agencies. Incredibly, it appears that DCF management interpreted concerns from the various professionals as “an inappropriate consideration of the family’s financial means.” They seem to have disregarded the importance of physical space in the therapeutic management of autistic children and also the fact that Coleman and Almond seemed uninterested in finding a larger apartment and provided multiple excuses for not following up on housing applications.
As OCA states, “It is widely recognized that in times of crisis and economic stress there is an increase in child abuse and neglect.” Yet, OCA found that DCF did not treat the COVID-19 pandemic as a cause for reevaluation of the appropriateness of David and Michael’s reunification and did not consider the implications of the pandemic for the safety or well-being of the children. DCF seemed oblivious of Coleman and Almond’s use of the pandemic to isolate the children. Bizarrely, DCF case management staff urged school staff not to hold Coleman accountable for David and Michael’s complete absence from school, arguing that the problem was lack of technology access in the home. Case management staff also advised Coleman repeatedly to contact the school to explain that technology was the barrier to David and Michael’s participation, in order to prevent the school from filing a child neglect report against her.
Amazingly, DCF did not categorize David and Michael as high-risk children to receive in-person home visits during COVID-19. DCF appeared not to understand that that the boys’ disability, the long history of abuse and neglect in this family, the caregivers’ avoidance of contact with providers, and their reports about David’s behaviors, injuries and illnesses were all signs of children at risk. Moreover, the DCF administration has not issued statewide guidance that provides DCF personnel instructions about how to assess safety and risk during virtual home visits.
And perhaps most shockingly, DCF missed the deterioration in David’s physical and emotional state between March 13, 2020, and his death on October 21. The residential program and school where David lived and studied until March 2020 described him as having good social interaction skills, as being communicative, as having no significant behavioral issues or self-injurious behaviors, as having no aggression toward others and as having the ability to take care of his own activities of daily living. Yet within weeks of reunification Coleman was reporting that David was noncompliant, aggressive, harmed himself, and needed assistance with activities like toileting. During virtual home visits with DCF, David was always quiet and minimally communicative, while Coleman often berated and shamed him for behaviors and defiance. The case management team accepted her account and disregarded the conflict with his observed behavior and past accounts. David was a healthy weight when he left residential care. At his death, David had lost approximately 60 pounds from his last recorded weight in December 2019. It is hard to understand how anyone could have missed such a drastic change, even through a video screen.
OCA found that the Juvenile Court, including the attorney for David and Michael, did not serve as a check on the many egregious decisions of DCF. Instead, perhaps because they all agreed to return the boys home, the court and attorneys relied too heavily on DCF to determine the direction of the case. They accepted DCF’s interpretation of Aiden’s “successful” reunification as an indication of the likelihood of a similar outcome for the triplets, disregarding the differences between Aiden and the autistic triplets; failed to require a submission of a realistic reunification plan despite the judge’s statement that such a plan would be needed; accepted DCF’s narrative of the triplets’ “successful” reunification even though court reports contained information from service providers about the family’s failure to participate in services; disregarded multiple concerns about the small size of the family’s apartment and the stress it caused, based on the apparent belief that it was inappropriate to consider inadequate housing as a barrier to reunification; and never requested an analysis of the effects of the COVID-19 pandemic on the family’s ability to care for these high-needs children.
The education system’s failure of David and Michael was almost as egregious and shocking as that of DCF and the court. OCA found that the state Department of Elementary and Secondary Education (DESE) did not have the resources to monitor the provision of a free and appropriate public education in real time by local school districts during the COVID-19 pandemic. Despite their policy of prioritizing high-risk students for in-person learning, DESE “allowed families to choose the fully remote option for any reason and without a stated reason. In fact, districts were instructed not to counsel families of high risk students to choose in-person learning even if the district felt that remote learning would not be successful for a particular student.” DESE did not set higher standards for monitoring or support for high-risk students, such as those with disabilities and those involved with DFS, regardless of their choice of learning option. DESE issued no guidance to school staff on how to recognize abuse and neglect in a virtual environment. Nor did they address mandatory reporting of attendance issues until January 2021.
In addition to the failures of DESE, Fall River Public Schools (FRPS) missed multiple opportunities to save David. The shift to remote learning, coinciding exactly with the transfer of David and Michael to FRPS, meant that David was never seen by, or spoken to, by any school employee from March 2020 to the time of his death in October 2020. To their credit, school staff made numerous attempts to communicate with the parents and resolve alleged technology problems. Yet, David and Michael’s teachers never attempted to make contact with the boys directly via telephone. While they raised concerns about the boys’ lack of participation to the DCF case management team, school staff never elevated this concern by filing a neglect or truancy report. Moreover, FRPS set no attendance or participation requirements, and David was incredibly promoted to high school after being completely disengaged from his school since being transferred there in March. DESE and FRPS guidance for the fall 2020 concerning attendance tracking, contact, and grading never filtered down to school staff, perhaps preventing an intervention in the last month of David’s life.
There was another entity that could have intervened to raise concerns about the safety of the children, and that was the Massachusetts Probation Service (MPS). Massachusetts children in child welfare cases are assigned a probation officer whose role is to verify compliance with court orders, report to the court on the status of these orders and monitor the well-being of the children. The officer in this case had regular contact with the family and seemed to have a much more clear-eyed view of their problems than did DCF, which did not act on his expressed concerns. However, he did have a worrisome conversation with Coleman only days before David’s death in which she reported on the deterioration of both boys, that they had regressed to wearing adult diapers, that David was picking at his skin causing sores and bleeding, and that Michael had to be hospitalized for self-injury. The officer could have brought these concerns to the attention of the court before the next hearing but did not do so–possibly due to a culture discouraging such communications–and missing the last opportunity to save David.
Several questions remain even after the comprehensive review by OCA. First, what explains the New York Court’s decision to reunify the triplets with their father after taking steps toward terminating his rights? It is very concerning that OCA was not able to obtain this information in its review of court data. A court decision like this would have to be documented and would presumably been based on recommendations from Onondaga County (NY)’s Office of Children and Family Services (OCFS). It is not clear whether OCA requested documents from OCFS, and whether such a request was refused. It is necessary to understand what occasioned this about-face by New York. One cannot help wondering if the agency realized the boys would not be adopted was trying to avoid the expense of caring for the boys into adulthood.
OCA was also unable to explain the DCF area management’s unwillingness to reconsider the appropriateness of the reunification plan in the face of objections from their case management team and almost everyone else involved. OCA states that there was no pressure from the Juvenile Court, Almond, Coleman, their attorneys, nor the children’s attorney to rush a transition home. DCF administration also confirmed during this investigation that there were adequate funds in the Fall River Area Office’s budget to continue the triplets residential placement. Once again, as in New York, one has to wonder whether, despite the existence of “adequate funds” for the boys’ placement, there was in fact pressure on the local DCF office to return the boys due to the financial costs of their placement. Such budget concerns might have explained the unseemly rush to reunify despite the unavailability of a crucial service and adequate housing and the clear logic of waiting until the triplets completed their educational program in June 2020.
It is hard to avoid speculating about whether Almond and his paramour actually wanted custody of David and Michael. It appears that Almond and Coleman wanted Aiden back (not surprising as he was Coleman’s son and not disabled) and that is why they began to cooperate somewhat with services after an initial period of total noncompliance. There is no evidence that the couple were pushing for the return of the triplets and many indications that they tried to delay it as long as possible. Canceling visits to the boys and appointments with providers and failing to take steps to find a larger apartment could all be taken as signs of reluctance to receive the boys at home. Caring for triplets with autism plus a baby is not easy for anyone, it is hard to imagine a troubled couple like this one doing it, especially without the help that was recommended by the expert.
There is no excuse for the sheer inhumanity displayed in this household. Nevertheless, the case does call to mind the reports that are coming from all parts of the country regarding our national failure to help parents care for their mentally ill or developmentally disabled children–a crisis that is leading good parents to consider relinquishing custody of their children in order to obtain the services they need. It is possible that Almond and Coleman (not being good parents in the least) were trying hard to relinquish custody but were unsuccessful in unloading their unwanted triplets onto New York and Massachusetts. The eagerness of agency management to shed this burden and the reluctance of Almond and Coleman to take it on made for a toxic mix that killed David Almond, and left both of his brothers with lifelong wounds.
The OCA report contains many pages of recommendations for DCF, which include improving supervision, reviewing and revamping agency policies on contacts with collaterals, clients with disabilities, reunification; revamping the safety assessment process; setting standards for when and how virtual visits can be conducted, establishing a robust quality assurance system with additional monitoring at critical decision-points in a case and for higher-risk cases, and creating a “culture of continuous learning” where the “identification and correction of errors, miscalculations, or misinterpretations is encouraged and commended.” Many more recommendations targeted the juvenile court, the Probation Services, and the public schools.
While this report is unique due in its exploration of the complications due to the COVID-19 pandemic, we have seen too many similar reports from all of the country over many years. Most recently, Maine’s child welfare ombudsman found that the system continues to struggle with making an informed decision about whether to send a child home from foster care and whether to end agency supervision of reunified children. In a review of 82 cases closed in the past year, they found 20 cases where reunification practices were at issue.
Commonwealth Magazine notes that OCA conducted comprehensive investigations in 2013 and 2015, following three high-profile child deaths. Since 2015, the Legislature and Gov. Charlie Baker’s administration have increased funding for DCF by more than $200 million, added more than 650 positions, reduced caseloads, and introduced numerous reforms. Yet, Fall River State Representative Carole Fiola pointed out that many of the same patterns of agency malfunction were found in the earlier reports. This is indeed discouraging. Perhaps stronger measures are required.
A “three strikes law” for abuse and neglect might be one such stronger measure. Perhaps parents should not be given another chance after three or more removals. And this question brings up the role of ideology, especially as it might be expressed by managers who are unfamiliar with the actual details of the case. In the current child welfare climate, it often seems that parents can do no wrong. As noted repeatedly in the this case, there was too little focus on the problems that brought the children into care, and too little assessment of whether these problems were truly solved before the children were returned. This may not be atypical or surprising, given the current emphasis on family preservation and “strength-based” approaches to working with families, which ask social workers to minimize problems and find strengths wherever they can. There is certainly value in this perspective as a corrective to an earlier focus exclusively on problems, but taken too far it can be deadly.
The reluctance of the agency, lawyers and court personnel to consider housing adequacy as a prerequisite to reunification was another dysfunctional intrusion by ideology into case practice. Today’s dominant narrative asserts that children are being removed from families due to poverty that is being couched as neglect by intrusive child protective services systems. Poverty should not be a reason for removal nor should it be a barrier to reunification. But this case was not so simple. Almond and Coleman took no steps to apply for larger housing, despite being offered many opportunities to do so. It is possible that their reluctance to apply stemmed to their hope that they would not be saddled with the three boys. But the reigning narrative may have blinded agency management, court and lawyers to this concerning lack of action by the boys’ father and his paramour.
David’s case warns us to beware of the blanket statements often pushed by the child welfare establishment. It is often accepted as common knowledge that children do best with their family of origin, that in rare cases where children cannot remain at home the best placement is a relative (like Ann Shadburn?), and that congregate care is always the worst placement for children. None of these “truths” were correct for David and his brothers. Perhaps David’s story will lead some leaders and commentators to ask themselves what a home really is, and to understand that it is the presence of love, not the type of setting, that matters to a child.
“It is tempting to characterize this case as resulting from a ‘perfect storm,'” says the OCA, while not expressing an opinion on whether that is an apt characterization. The “perfect storm” explanation is often used by governments to argue against placing significant weight on individual cases, no matter how egregious. “A system should not be judged by one case, no matter how sad or sensational,” said Joette Katz, Commissioner of Connecticut Department of Children and Families (DCF) as reported by the Hartford Courant. Katz was talking about the death of Matthew Tirado, an autistic 17-year-old, on February 14, 2017 from prolonged abuse and neglect by his mother. Matthew had been known to Connecticut’s Department of Children and Families since the age of five, as revealed by a heartbreaking report from Connecticut’s Office of the Child Advocate. Yes, A System Should be Judged by One Case was my answer to Katz. If David’s death was the outcome of a perfect storm, it was also the tip of the iceberg. If professionals are capable of making the kind of mistakes they made over and over again in this case, similar mistakes are obviously occurring in other cases. For every David Almond or Matthew Tirado, there must be many other children left in abusive and neglectful homes who never come to our attention because they are not actually killed albeit suffer lifetime damage. But the cost in current suffering and future damage is incalculable.
Certainly the COVID-19 pandemic was a large part of the “perfect storm” leading to David’s death. Thankfully, the pandemic appears to be easing and schools should be open full time next fall. However many jurisdictions plan to retain a virtual option next fall. OCA expressed concern that even though an in-person option was offered to the boys in Fall 2020, parents were allowed to choose virtual education without any stated reason and even if the district felt that remote learning would not be successful for a particular student. OCA made many recommendations for improving the oversight of children in virtual education but did not make a recommendation that addressed this finding. It is my view that jurisdictions should establish guidelines for approval of virtual education for each student and require a waiver for any student whose guardians request virtual education for reasons that are not included in these guidelines. Many advocates for children and domestic violence victims, such as Andrew Campbell, have warned from the outset of the pandemic of the dangers facing people who locked in with abusers. David’s case showed how right they were and that planning for future emergencies needs to include better provisions for such vulnerable people, including school-aged children.
COVID-19 will end, but I will continue to write about the Davids, the Matthews and all of the children who are failed by the agencies that exist to protect them. I will continue to write about them until we learn to value our children more than money or ideology, and until we decide as a nation that children will no longer be collateral damage in the pursuit of other goals, whether pandemic containment, “family preservation,” or budget savings.
Attachment: Chronology of the case of David Almond, from the Office of the Child Advocate Report
February, 2006: David, Michael and Noah Almond were born in Syracuse, NY to Sarah and John Almond, as described in OCA’ s devastating report. The triplets were all diagnosed with Autism Spectrum Disorder at the age of about two.
2006 to 2013: the triplets were removed from their parents three times by the New York State Office of Children and Family Services (OCFS) due to substance abuse, mental illness, “deplorable living conditions,” medical neglect, inadequate supervision, and “a general lack of basic care.” Their mother had no contact with them after the final removal, and their father moved to Massachusetts. OCFS began steps to terminate the parents’ rights to the boys, but never completed the process.
September 2016: A New York Family Court awarded full custody of the boys to Almond, who was living in Massachusetts, in September 2016, after years of minimal or no contact. Almond moved the boys to the one-bedroom apartment in Fall River, Massachusetts, which he shared with his partner, Jaclyn Coleman, and his mother, Ann Shadburn. All three had a history of abuse and neglect as a victim or perpetrator. Shadburn’s parental rights to all of her children, including John Almond, had been terminated. Almond and Coleman were both in DCF custody for part of their childhoods due to abuse and neglect, mental illness, physical violence, and substance abuse.
June 2017: The first two abuse or neglect reports were called into the Massachusetts hotline concerning the children. Another report came in that August, citing Coleman’s substance abuse and questions about the parents’ ability to meet the needs of their newborn son, Aiden, as well as of the triplets.
October 2017: All four children were removed from Almond and Coleman because of abuse and neglect, parental substance abuse, unsanitary home conditions, medical neglect, and the triplets’ excessive absences from school. In the words of OCA, “This was the fourth time in the triplets’ young lives that they were removed from Mr. Almond for the identical pattern of abuse and neglect.” But four strikes was not enough. The parents agreed to a plan requiring them to engage in therapy to address longstanding substance abuse and mental health issues, submit to random drug tests, participate in family therapy with the triplets, complete psychological evaluations, and complete parenting classes. Aiden was placed in foster care and the triplets were eventually placed in a residential facility specializing in autism spectrum disorder and intellectual disability.
January 2019: While the triplets thrived in their residential facility, Coleman and Almond displayed minimal compliance with their plans, and the children’s permanency goal was changed to adoption.
July 2019; the goal for all of the children was changed back to reunification after reports that Coleman and Almond’s compliance with their plans had improved, and Aiden was returned home the next day. This occurred, as OCA put it, “despite Mr. Almond’s failure to engage with therapy, despite Ms. Coleman’s limited engagement with therapy, and despite the lack of any documentation of any change in Mr. Almond and Ms. Coleman’s ability to parent, specifically their ability to parent children with special needs.” OCA attributes this decision mainly to a parenting evaluation conducted by a contractor that did not adequately assess the caregivers’ ability to care for the children.
December 2019: DCF management decided to begin the reunification process for the triplets. This decision was made despite concerns raised by the family support provider and the case management team (social worker and supervisor). DCF management set a target date of January 2020 for the reunification. They disregarded independent requests for a delay from the case management team, the residential facility and the boys’ school.
January 10, 2020. The boys had their first day visit to the home and Coleman stated that reunification was moving too fast and that the family was not yet ready for overnight visits because the apartment was too small.
February 7, 2020: At the first overnight visit on February 7, Almond and Coleman reported that Noah became aggressive, resulting in a physical altercation. As a result, Noah was returned to his facility that night. After this home visit, Noah refused to return to the apartment and was allowed to remain at his residential facility. The goal of reunifying him with his parents was dropped.
February 11, 2020: The congregate care provider took the “extraordinary” step of sending DCF a letter opposing the reunification of David and Michael with Almond and Coleman, citing the inadequate physical environment of the home to meet the children’s therapeutic needs; the fact the parents were facing eviction; and the need for a slower, more appropriate transition plan. The reunification was delayed, but by one month only.
March 13, 2020: David and Michael were returned to Almond and Coleman, barely two months after their first day visit, while remaining in the legal custody of DCF. Four days after the reunification, the state’s COVID-19 restrictions went into effect.
April 2020: At the monthly virtual DCF visit Ms. Coleman reported that there were no concerns regarding the children’s behaviors and the children had access to a laptop for the purposes of schooling. The DCF case management team did not recognize that Ms. Coleman provided contradictory information to the continuum service provider.
May, 2020: Ms. Coleman rescheduled a DCF virtual home visit supposedly due to technology access issues. During this phone call, Ms. Coleman reported to the DCF case management team that David was vomiting from having too many snacks and was lying in his own vomit. The DCF case management team did not follow up with Ms. Coleman about how David was feeling or the possibility that David could be sick another reason. When the virtual home visit happened ten days later, Coleman took a “strong and controlling role in the communication between the DCF case management team and the children.” She prompted the children to provide specific answers to the DCF case management team questions. In the same month, the parenting support service provider cancelled the service with Almond and Coleman due to their lack of engagement with the service. Also in May, the school offered Chromebooks to David and Michael. This offer was turned down by Coleman in favor of having the boys complete paper packets. But paper packets were never submitted for either of the boys, and the school took no action.
June 2020, the continuum service provider shared with DCF Coleman’s report that Almond physically restrained David due to David’s aggression and that David was completing his chores, which included scrubbing the floor with a toothbrush. Later in the month, the continuum service provider informed DCF that Ms. Coleman reported being fearful that David and Michael would both attack her at the same time and that David refused to take his medication. The provider reported that Coleman refused an outdoor visit and was not using the provider’s emergency service line that they repeatedly urged her to use.
June 2020: In the monthly virtual DCF visit, Coleman tried to stop the boys from answering a question about whether they wanted to visit with their brother Noah, whom they had not seen since March. OCA believes that “Ms. Coleman intentionally prevented David and Michael from virtually visiting with Noah to isolate them from Noah and isolate them from the congregate care program staff that knew them well and might have identified concerns.”
June 17, 2020: A foster care review panel was held and reviewers found that “Mr. Almond and Ms. Coleman were meeting the needs of the children and participating in the continuum services. According to OCA, “It is unclear if the foster care review panel was aware that the parenting support service provider closed the case in May due to a lack of responsiveness from Mr. Almond and Ms. Coleman, and it was unclear also if the panel knew of the continuum service provider’s description of the challenges facing the family.”
July 17, 2020: The Court returned legal custody to Almond despite the lack of improvement in his and Coleman’s participation in services and no change in Coleman’s description of the boys’ behavioral challenges . Almond was not present at the hearing. On the same day Coleman refused both an outdoor and an indoor visit. According to OCA, “The DCF case management team did not observe the children, the home, or Mr. Almond or Ms. Coleman between June 19, 2020 and July 17, 2020 when David and Michael were legally returned to Mr. Almond’s care.”
July 22, 2020: At the monthly DCF virtual visit, Coleman berated David in front of the case management team for his behavior. When Michael contradicted Coleman’ account of David’s behavior, she said he was “making her look like a liar.” But at no point did the case managers seek to interview David or Michael outside Ms. Coleman’s presence.
August 2020: The continuum service provider informed the DCF case management team that Ms. Coleman had reported David scratched his collar bone until it had become raw. The DCF case management team did not follow-up with Almond or Coleman about this injury. The continuum service provider also expressed that the family was not fully engaging with the service and that the children needed Applied Behavioral Analysis (ABA) services.
August 21, 2020: DCF received a report about conditions in the home and substance abuse by Coleman and Almond. The case management team conducted a virtual home visit three days later. Coleman attributed the report to a malicious neighbor and denied the substance abuse. The team accepted her self-report and did not request drug tests for Coleman and Almond. Coleman attributed a bandage on David’s nose to self-injury and when David was asked, he followed Coleman’s prompting to corroborate her account. As OCA points out, the team neither considered the significance of self-injury as a sign of distress nor considered the possibility of parental violence as the cause of the injury.
September 14, 2020: On September 14, 2020, Michael was brought to an out-of-state hospital emergency department for an injury that Coleman reported was self-inflicted. Michael was admitted for overnight observation and discharged home the next day. This injury was not reported to DCF.
September 25, 2020: The DCF case management team had its last virtual home visit with the family. Ms. Coleman described David as having behavioral issues, and David refused to speak. Between September 20, 2020 and October 3, 2020, the family canceled or did not attend all their scheduled appointments with the continuum service provider.
On October 1, 2020, a school attendance officer came to drop off Chromebooks for David and Michael. Coleman met the officer outside and he did not attempt to see the boys as he was there solely to drop off the devices and not to see David or discuss with this family his lack of engagement with school since the previous March.If that person had seen David and noticed his physical state, David might be alive today. Twice in October, a teacher contacted DCF to report that the boys were not logging into school. The OCF team contacted Coleman, who denied that report.
October: The DCF case management team was made aware that David’s individual therapist had only been successful in contacting the family one time since August. Ms. Coleman told the case management team why that therapist was not appropriate for David.
October 5 and October 14, 2020: A teacher from Fall River Public Schools contacted the DCF case management team and reported that David and Michael were not logging into school virtually. The DCF case management team contacted Ms. Coleman, who denied this report and reported both David and Michael were attending school virtually
On October 7, 2020, the team learned that David had missed his physical in July and two subsequently scheduled appointments. A case review was held on October 14, 2020. Almond and Coleman did not attend. The review panel “inexplicably found that Mr. Almond and Ms. Coleman were meeting all the children’s needs in the home. This determination was made despite concerns regarding the family’s lack of consistent engagement and utilization of services, that David and Michael had not attended school or received any special education services since their reunification in March, and despite Ms. Coleman’s reports of David engaging in serious self-injurious behaviors.”
October 14, 2020: Another foster care review meeting was held in the absence of Almond and Coleman. In OCA’s words, “The foster care review panel inexplicably found that Mr. Almond and Ms. Coleman were meeting all the children’s needs in the home. This determination was made despite concerns regarding the family’s lack of consistent engagement and utilization of services, that David and Michael had not attended school or received any special education services since their reunification in March, and despite Ms. Coleman’s reports of David engaging in serious self-injurious behaviors.”
October 21, 2020: Emergency medical personnel responded to a 911 call regarding David; he was bruised, emaciated, and not breathing. He was transported to Charlton Memorial Hospital and pronounced deceased. Michael was found emaciated but responsive, and Aiden was well nourished and appeared physically unharmed. Substances believed to be heroin and fentanyl were found in the apartment. Michael and Aiden were immediately removed from Almond and Coleman, who are in jail and facing criminal charges.
It is always disheartening when people take advantage of a tragedy to support their own views or interests, even when the facts don’t support it. The tragic death of Ma’Khia Briant is an example of this tendency. As soon as it was disclosed that Ma’Khia was in foster care, advocates and pundits began to argue that her death is “indicative of deeper problems in the foster care system,” as the Washington Post put it. That the case illustrates problems with foster care cannot be denied–but most of the damage to Ma’Khia clearly occurred before her placement in foster care.
For the few who have not heard, 16-year-old Ma’Khia Bryant was shot to death by a police officer in Columbus Ohio who was responding to a 911 call from her younger sister saying that “grown girls” were attempting to fight and stab them. Officer Nicholas Reardon found Ma’Khia swinging a knife while pinning a 22-year-old woman against a car. He fired four shots, striking Ma’Khia, who died shortly thereafter.
When it became known that Ma’Khia was in foster care, many foster parents and advocates raised serious concerns about how the system contributed to her death. Noting that teens should not be unsupervised in a foster home, experts interviewed by the Washington Post raised concerns about the low standards for foster parents who care for Ohio teens, which some tied to the scarcity of foster parents willing to care for teens.
As a social worker in the District of Columbia, I had a very similar experience. Many foster parents refused to take in teens. As a result, it appeared that the standards to become a foster parent for teens were minimal. Many of the foster parents who cared for my teen clients in DC foster care provided little more than room and board, not the loving care these children needed. Few had ever visited the child’s school, doctor, or therapist. They were typically not home during the day, as foster parents are not paid enough to forego full-time work. Moreover, as in Ohio, foster parents who have enough room were often landed with several teens, each with a history of trauma–a recipe for conflict.
Another way the system failed Ma’Khia may have been by failing to help her grandmother, Jeanene Hammonds, retain custody of Ma’Khia and her sister, who spent their first 16 months in foster care living with her. But when her landlord threatened to evict her for having too many people in the house, the Children’s Services social worker had no solution other than telling her to drop the girls off at the agency, according to what Hammonds told the New York Times. If the agency had licensed her as a foster parent, she could have moved to a larger apartment. But information from case files quoted by both the Times and the DIspatch suggests that the agency believed Hammonds was not meeting the girls’ needs or making sure they received needed therapy. I cannot assess the truth of either the grandmother or the agency’s statements, but I can say that as a social worker I was often frustrated by my inability to help relatives obtain housing needed to obtain custody of children in foster care.
Some advocates are using Ma’Khia’s death to ask for needed changes in the system, like a crisis response team, better training for foster parents, and more help for relatives willing to take custody of children in foster care. They should also be advocating for better options for troubled teens in foster care. These teens need either professional foster parents who are paid to be home all day and and trained to work with traumatized teens or high-quality, trauma-informed residential facilities where they receive the therapeutic care that they need before graduating to a less restrictive setting.
Less responsible or informed advocates are using this tragedy to argue for the abolition of foster care. The Washington Post quotes Hana Abdur-Rahim of the Black Abolitionist Collective of Ohio, who said that“a lot of times people’s children get taken away because they can’t afford to take care of them, or they don’t have proper housing….So if we had more resources, children would not get taken away from their families.”
Abdur-Rahim’s statement embodies the popular trope that what child welfare systems call “neglect” is really poverty, and that children are being removed due to poverty alone. Anyone who has been a social worker in child welfare will tell you that removals for poverty alone are quite rare; that neglect usually involves some combination of drug abuse, alcohol abuse, mental illness, disorganization and family violence; and, in any case, that chronic neglect can be more damaging to a growing child than abuse.
It is not surprising that Ma’Khia’s mother, Paula Bryant, would not say why her daughter was removed in the first place. The Columbus Dispatch has reported that Ma’Khia, her younger sister, and two brothers were removed from Bryant in March 2018, after police responded to an “incident” at a residence. Police reported the four children were unsupervised and made allegations of abuse against their mother and an older sibling. A neighbor who spoke to the New York Times says she can still remember the fights between Bryant and her daughters, stating that “the girls ran out of the house terrified, and were hanging out in the backyard screaming while the mom was yelling at them.” Children’s Services already knew of the family due to repeated complaints that the two youngest children were absent from school. And in February 2017, according to the Times, Bryant brought her four children to Children’s Services saying she could no longer handle them. The grandmother, Ms. Hammond, told the Times that it was difficult having the four Bryant children because “they came from a lot of dysfunction.”
Aside from this historical information, the behavior of Ma’Khia and her sister provides evidence of their traumatic history. According to the Post and the Times accounts, Ma’Khia’s sister Ja’Niah told police officers she called to the home 23 days before Ma’Kiah’s death that she would to “kill someone” unless she was placed in another home. Ma’Khia was killed while threatening someone with a knife, and Ja’Niah told the Times that Ma’Khia was triggered when the one of the older women spit toward her family. To anyone familiar with foster youth, these statements and behaviors suggest girls who were traumatized not by foster care itself but by a long history of neglect and violence in their home.
Children’s Services was trying to help Ms. Bryant get her children back but in court filings obtained by the Columbus Dispatch the agency reported that the mother “repeatedly failed to comply with the plan, which included mental health counseling, or even to consistently show up for scheduled visitations with Ma’Khia and her sister.” Court reports also indicate that the father did not respond to outreach by the court or agency. In December 2019, Children’s Services asked the court to suspend the mother’s visitation because of “emotionally damaging” interactions between her and her daughters, according to the Dispatch. And in January 2020 the agency filed a motion seeking permanent custody of the girls. Court action was delayed by the COVID-19 pandemic and was still pending at the time of Ma’Khia’s death.
Ma’Khia’s mother, father and grandmother are now united in calling for an investigation of Ohio’s foster care system in the wake of her death. It is depressing but not surprising that the mother who abused and neglected Ma’Kiah and the father who would not engage with Children’s Services are now blaming the foster care system for her death.
None of this exonerates the foster care system for the unacceptable quality of the care Ma’Khia was apparently receiving at the foster home where she was killed. When society removes a traumatized child from an unsafe home, it adds one more trauma to that child’s history. It owes that child more than an environment only slightly better than what she was removed from. A good system might have saved Ma’Khia from the trajectory she was on when she was removed. To that extent, a struggling foster care system, and ultimately our society’s indifference to these most vulnerable children, bears some responsibility for Ma’Khia’s death.
To argue that foster care should not exist is to say that children should be allowed to grow up in homes characterized by chronic violence, abuse and neglect. As Lily Cunningham, a mental health counselor, told the Washington Post, “The question always is Why is this child or family in foster care? But the right question should be: What can we be doing now to enhance the lives of children in foster care?” Foster care should be improved so that it can become a place of healing, from which children can return to families that have done the work needed to get their children back.
This post was edited on May 8, 2021 to incorporate new information shared by the New York Times.
A growing chorus of voices is calling for a shift of resources away from responding to child abuse and neglect toward preventing its occurrence. Interest is coalescing around a newer idea that would combine universal reach with a response that is targeted based on a family’s risk, sometimes called targeted universalism. Several jurisdictions are already implementing initiatives based on this approach. Governments interested in adopting such a system need to resolve a number of questions concerning the system’s entry point, goals, lead agency, program content, and how to attract and retain the families that are most at risk. But the idea of targeted universalism is worth pursuing as it combines the advantages of both approaches.
The new focus on prevention should not be confused with the changes made by the Family First “Prevention” Services Act of 2018, which allows funds under Title IV-E of the Social Security Act to be be diverted from foster care to services to help keep children with their families. Despite its name, Family First funds can be used only for services to families in which abuse or neglect has already occurred. Such services are generally considered treatment, not prevention, although public health specialists refer to them as “tertiary prevention,” which mean preventing the recurrence of a problem. But this is not the meaning of prevention to the layperson, and the placement of “prevention” in the title of the act continues to cause confusion.
Preventing a problem, if possible, is certainly preferable to addressing it after it appears. As child maltreatment prevention expert Deborah Daro states in an issue of The Future of Children devoted to universal approaches to promoting healthy development, doctors don’t send away patients with precancerous cells and tell them to come back when they have Stage 4 cancer. Yet, that is exactly what we do in child welfare. As Daro points out, “our public response lacks an adequate early assessment when people become parents, and we often offer the appropriate level of assistance only after a parent fails to meet expectations or a child is harmed.” For this reason, many child welfare thought leaders like Daro are calling for a new emphasis on preventing maltreatment before it occurs.
The consensus on prevention still leaves the question of how much to invest in universal approaches (known as primary prevention) as opposed to “secondary prevention” approaches that target families who are deemed to be at risk. Secondary prevention has a lot going for it. Targeting a program to those who need it most can be justified on grounds of efficiency. Why spend money reaching people who do not need help? But investing only in secondary prevention has drawbacks, as described by Kenneth Dodge and Benjamin Goodman in the Future of Children issue referenced above. Even the lowest-risk groups have some risk of child maltreatment. And because they are much larger than the high-risk groups, they may account for most cases of maltreatment. Moreover, interventions with targeted groups rarely reach a high proportion of that population, and thus cannot have a detectable impact on the problem overall. Finally, targeted programs are often stigmatized and not politically popular, leading to lower funding–and less participation by targeted groups.
Dodge and Goodman point out that a debate over universal vs. targeted approaches played out when public schooling was first discussed in the United States. Some advocates argued that middle and upper class families could pay for their children to be educated, and that confining public education to the poor would save taxpayers money. Of course the proponents of universalism won out. Even though affluent families continue to be able to buy a more expensive education through higher property taxes and access to private school, one can only imagine the sorry state of our public education system if at been confined to the poor.
As Dodge and Goodman point out, not all universal programs must provide the same services for everyone, and they cite pediatric care as analogy. All children are seen for well-child visits, during which pediatricians screen them for conditions that might warrant services from specialists, and refer them accordingly. Therefore, they argue that “the best strategy may be to embed targeted interventions in a universal strategy that reaches the entire population while offering intensive interventions for targeted subgroups.” This approach, which they call “targeted universalism,” involves screening all families at a single point in time, such as the birth of a child, identifying the family’s risks and needs, and connecting them with community resources for addressing those risks and needs.
This is the approach that they embedded in the Family Connects Program, starting with a home visit fro a nurse. Nurse home visiting is a popular platform for a universal program, and there is a lot of precedent for a universal nurse home visiting program. Universal nurse home visiting is used by many European countries, where it is part of a comprehensive maternal and child health system, and is also used in other parts of the world. Perhaps the best developed application of this approach in the United States is Family Connects, which Dodge and his team at Duke University initiated in Durham, North Carolina in 2008 as Durham Connects. The model is now being implemented in over two dozen communities around the country, and Oregon is rolling it out statewide. Family Connects aims to reach every family giving birth in a community, assess the parents to determine their risks and needs, and refer them to appropriate services. The program rests on three “pillars:” home visiting, community alignment and data and monitoring, as described by Dodge and Goodman.
The first pillar is home visiting by a trained public health nurse who visits the family in the hospital to welcome the baby and offer a free home visit when the baby is about three weeks old. During the home visit, the nurse uses a structured clinical interview to assess risk in 12 key domains that predict adverse outcomes among children. At the end of the interview, the nurse works with the family to develop a plan of action which may include follow-up visits, phone calls, or contact with external agencies. With parental consent, this plan is shared with the baby’s pediatrician and the mother’s primary care provider. Four weeks later, a program staff member calls the family to check on their progress and determine if the referrals were successful. If the family has not succeeded in making the connection, the program either helps the family try again or makes another referral.
The second pillar, called community alignment, is a compilation of community resources available to families at birth, including targeted home visiting programs, early care and education, and mental health. This directory is available in electronic for for nurses to use on their visits. The third pillar is an electronic data system that documents each family’s assessment, referrals, and connections with community agencies. These records, scrubbed of identifying information, are aggregated to provide information about each agency and on a community level to identify gaps between needs and services. To contain costs, Family Connects is limited to seven contacts (phone calls and visits) over the course of 12 weeks. Dodge and Goodman report that the cost of Family Connects ranges from $500 to $700 per family.
Family Connects has been evaluated with two randomized controlled trials (RCT’s) in Durham, NC and one field study in four rural counties in the state. Eighty percent of the intervention families in the first trial scheduled a visit and 86 percent completed it, for a total “completion rate” of 69 percent. In the second trial, the percentages were 77 percent scheduled and 84 percent completed for a total of 64 percent. The first and second RCT’s found 49 and 52 percent of families respectively to have moderate needs, 46 and 42 percent to have serious needs requiring referral to a community resource, and one percent with a crisis needing immediate intervention. Of the families referred to a community agency, 79 percent and 83 percent reported they had followed through and made the connection. In the first RCT, researchers found that intervention infants had 39 percent fewer referrals to Child Protective Services (CPS) than did the control infants by the age of 60 months, controlling for demographic risk factors, as well as a 33 percent decrease in emergency room use.
Nurse home visiting is not the only possible platform on which to base a targeted universal program, Other options for locating a universal service include pediatric practices. There are two different models based in pediatrician’s offices that have shown promise for preventing child maltreatment–SEEK and Healthy Steps. SEEK trains pediatric primary care providers (PCP’s) to use a questionnaire to assess for a specific set of risk factors. The PCP initially addresses identified risk factors and refers the parent to community resources, ideally with the help of a behavioral health professional. Healthy Steps, as described by Valado and coauthors in The Future of Children, functions as a targeted universal model with three tiers. All families receive screenings and access to a child development support line. Second-tier families receive short-term consultations, along with referrals, additional guidance and resources. Families classified in the highest-risk tier receive “a series of team-based well child visits incorporating a Healthy Steps specialist.”
Models based in pediatric practices have had some promising results. A study testing SEEK with a high-risk sample of patients from a pediatric primary clinic in Baltimore found a “striking” 31 percent reduction in CPS reports. The other SEEK study focused on a low-risk population and there were not enough cases of maltreatment to find impacts on abuse and neglect; however, the study found a lower rate of physical punishment and psychological maltreatment reported by participating mothers. A multisite evaluation of Healthy Steps, as described by Velado et al, showed similar effects, such as a 33 percent reduction in the use of severe physical discipline in the intervention group vs the comparison group when the child was 30-33 months of age. The philanthropic partnership Blue Meridian Partners has chosen Healthy Steps as one of five models to receive large grants to help bring them to a national scale as a potential solution to poverty and lack of economic mobility.
Neither of these primary care-based models has been used universally throughout a jurisdiction. Moreover, pediatric care based models have less reach than models based on the birth hospital. Almost all babies are born in hospitals, but fewer infants attend their regularly scheduled well-baby visits. But according to the National Survey of Children’s Health for 2019, only an estimated 89 percent of children aged 0 to five had experienced one or more preventive care visit in the past year. While hopefully the percentage is greater for infants, it is probably less than the nearly 100% who are born in hospitals.
Many questions must be answered in developing a “targeted universal” child maltreatment prevention system.
What should the entry point be, and should there be more than one? Having all families enter the program through the same portal (be it the GYN practice, birth hospital, or pediatrician’s office) would avoid overlap and inefficiency. Choosing the system that meets parents earliest–the OB-GYN office–would allow programs to make a difference at a crucial time but would also miss the children who get little or no prenatal care. The founders of Family Connects chose to use the birthing hospital because it covers the most families, even though they are missing the chance to address problems that begin prenatally. Combining two or more portals may increase a program’s reach and the opportunity to coordinate and extend services. In Guildford County, NC, Healthy Steps is being integrated with Family Connects. Michael Wald, in a forthcoming article in the Handbook of Child Maltreatment, proposes a prevention system that starts with OB-GYN’s and WIC programs in the prenatal stage and continues with universal services at birth through pediatricians, home visitors and family resource centers. All of these entry points in turn would refer families to targeted services. Using more than one portal requires linkages and procedures for hand-off or collaboration, adding complexity to the system, but increases potential coverage.
What should the goals of the system be? A basic question is whether the system would be framed as a child maltreatment prevention system or something broader. It is hard to separate the goal of preventing maltreatment from that of promoting healthy child development, and indeed most of the programs discussed above have broader goals. The mission of Family Connects is “to increase child well-being by bridging the gap between parent needs and community resources.” Healthy Steps has the goal of “promoting the health, well-being and school readiness of babies and toddlers.” Clearly it is hard to separate the goals of child maltreatment prevention and the promotion of child well-being and healthy development.
What should the lead agency be? A key question about universal prevention is which system should take the lead. Child welfare leaders like Jerry Milner, head of the Children’s Bureau under the Trump Administration, have expressed the desire to expand the role of child welfare to include primary prevention. But if the goal is the broader enhancement of child development, and if the main providers of universal services are health professionals rather than social workers, another agency like public health may be a more appropriate home. Moreover, the child welfare system is already overburdened and underfunded. The work of investigating existing abuse and neglect (which will never be totally eliminated), helping parents and children heal, and making sure children have a safe environment to thrive either temporarily or permanently, is work enough for this beleaguered system. It is interesting that many modern child welfare leaders are so discontented with their primary mission that they are crying out to take on prevention. Perhaps the answer lies in the current political climate, which disparages child protective services and foster care, rather than recognizing the crucial role these services play in protecting children from harm,
What should the targeted services be? Michael Wald raises the question of whether a limited set of evidence-based models should be supported as part of a prevention system or whether jurisdictions should be given free rein in program selection. There are arguments for both, but it may be more practical to allow local jurisdictions to choose their own programs, especially since most “evidence-based” programs have only modest effects. But there are many reasons to advocate that every family found to be high-risk receive early care and education (ECE) interventions such as Early Head Start and Educare, which reduce child maltreatment risks in so many different ways, as I argued in an earlier post. The proposed Child Care for Working Families Act should help make such quality programs more available around the country.
How can we engage the highest-risk families? This is perhaps the thorniest question of all. All of the existing and proposed programs discussed above are voluntary, and voluntary programs never succeed in involving all eligible families. Moreover, it is often hardestto enroll and retain the highest-risk families in parenting support programs. We have already seen that Durham Connects provided a home visit to only 69% and 64% of eligible families in its two RCT’s. And considering that only 79 percent and 83 percent accessed the recommended services, the actual completion rate goes down further. In a study of Durham Connects, the researchers found that parents with a higher risk based on demographic factors like age and income were more likely to agree to a home visit but less likely to follow through. They also found that infant health risk, as measured by low birth rate, birth complications, and medical diagnoses, was associated with lower levels of both initial engagement and follow-through. An HHS issue brief suggests many ways to improve a program’s performance in enrolling and engaging families in home visiting programs. Not listed is the idea of including a peer mentor in the program model, which is embedded in some newer initiatives like Hello Baby and the Detroit Prevention Project. But the fact remains that a voluntary program will leave some children unprotected until they are actually harmed by abuse or neglect. Yet, it is clear that a mandatory child abuse prevention program will not be accepted in the U.S–just look at the debate over the COVID vaccine. We can hope that If a universal, voluntary prevention program is adopted, it will gradually gain in acceptance by high-risk and low-risk parents alike as a valuable benefit. In case that does not occur, we must record identifying information about the parents who do not accept the initial offer to participate and and follow up on future outcomes for their children in order to assess the efficacy of the program at preventing maltreatment among the highest-risk groups. Moreover, CPS must have access to this information when they receive a new report on a family.
Can the system be funded by cutting child welfare budgets? Congress has an unfortunate history of cutting funds to unpopular programs prematurely with the hope of achieving savings by a new approach, rather than waiting for a new approach to yield savings. One could mention mental health deinstitutionalization but a closer analogy might be the Family First Act’s moving money away from congregate care toward family preservation services, before states have the foster homes to replace these facilities, thereby simply shifting the cost of such facilities to states. We hope that establishing a robust system of prevention may well eventually result in a reduction of calls to Child Protective Services and in the need for foster care and in-home services. But we cannot reduce funding for traditional child welfare unless and until this effect has occurred, as Brett Drake argued in in a webinar recently conducted by the American Academy of Political and Social Science (AAPSS) in conjunction with their 2020 volume on child maltreatment. Even then it may make sense to retain current funding as the system is currently stretched thin.
What about anti-poverty programs? Adopting a system of targeted universalism to prevent child maltreatment does not directly address poverty, a prime risk factor for abuse and neglect, as discussed in my last post. Targeted universal programs will not change the level of welfare benefits or housing availability. However, it is important to remember that most poor families do not neglect their children, as University of Maryland’s Brenda Jones-Harden mentioned in the AAPSS webinar. Those families that are functioning well will find a way to get the resources they need to care for their children, and the supportive services provided through targeted universalism may help the others do the same. But at the same time, prevention advocates should fight to improve economic supports so that no child is deprived of what he or she needs to grow up into a healthy and functioning adult. Some of the new programs already passed or under discussion under the Biden Administration and the new Congress, such as the expanded child tax credit and the Child Care for Working Families Act, will help make targeted interventions more effective by addressing some of the poverty-related risk factors that cannot be addressed by targeted programs.
There is a growing consensus in the child welfare world that we must focus on prevention of abuse and neglect, and there is an increasing interest in using the approach of targeted universalism. The current historic expansions of the safety net will provide the perfect backdrop for such an initiative by addressing the economic risk factors for child abuse and neglect. With the motivation to build a better society in the wake of the pandemic, the time may be right to develop a universal, targeted system to prevent child maltreatment and allow every child the conditions for optimal development.
April is Child Abuse Prevention Month, the blue pinwheels are on view around the country, and the obligatory emails and tweets are urging people to recognize the month with Facebook frames and Zoom backgrounds. And in the past year or so, prevention has become the word of the day in child welfare. This year, the House of Representatives has passed the Stronger CAPTA Act, which would raise the authorization for prevention services to match that of treatment services. CAPTA provides funds to state child welfare agencies for child abuse prevention, investigation and treatment programs. However when it comes to prevention, child welfare agencies are only a small part of the answer. Preventing child maltreatment requires the involvement of many other sectors of the government and society. It is important for prevention advocates to understand this and to work with other child advocates to support these programs.
In searching for guidance in how to view child abuse and neglect prevention, I came across an excellent 2016 publication from the Centers for Disease Control (CDC). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities provides “a select list of strategies ….based upon what we know about risk and protective factors as well as empirical evidence on whether they have been shown to affect child abuse and neglect.” The CDC cites a number of risk factors researchers have found to be associated with the perpetration of child abuse or neglect, including young parental age, single parenthood, large number of dependent children, low parental income, parental substance abuse, parental mental health issues, parental history of abuse or neglect, social isolation, family disorganization, parenting stress, intimate partner violence, poor parent-child relationships, community violence, and concentrated neighborhood disadvantage. In addition, children who are younger and have special needs are more at risk of suffering maltreatment. Protective factors include supportive family environments and social networks, and probably other factors like parental employment, adequate housing, and access to health and social services.
Considering risk and protective factors leads to a broader conception of child abuse prevention than the one promoted by federal, state and local child welfare agencies. The CDC report lays out five strategies, all of which contain approaches that have demonstrated success in preventing child maltreatment. I have added a new strategy to CDC’s list and made some other smaller changes which are explained in notes. My modified list of strategies and approaches is summarized in the table below.
Preventing Child Abuse and Neglect
Strengthen economic supports to families
-Strengthening household financial security -Family-friendly work policies
Encourage pregnancy planning, spacing and prevention*
-Increased availability of long acting contraceptives -Public engagement and education campaigns
Change social norms to support parents and positive parenting
-Public engagement and education campaigns -Legislative approaches to reduce corporal punishment
Provide quality care and education early in life
-Preschool enrichment with family engagement -Improved quality through licensing and accreditation
Provide parenting support to at-risk parents**
-Early childhood home visitation -Other parenting skills and relationship interventions -Enhanced case management plus peer engagement*** -Enhanced primary care to address maltreatment risks****
Intervene in maltreating families to lessen harms and prevent future risk
-Behavioral parent training programs -Treatment to lessen harms of abuse and neglect exposure -Treatment to prevent problem behavior and violence
**Strategy and approach titles modified by Child Welfare Monitor
***Approach added by Child Welfare Monitor
****Approach moved from following strategy by Child Welfare Monitor
As the CDC points out, the strategies address different levels, from the individual to the societal. The first four operate on the community or societal level and the CDC hypothesizes that they are most likely to have a “broad public health impact on child abuse and neglect.” The last two strategies operate on the family and individual level and would have a narrower impact focusing on targeted populations.
Strengthen Economic Support to Families: Low parental income is one of the major risk factors for child maltreatment, as documented by multiple studies cited by the CDC. Economic insecurity leads to maltreatment, presumably by making it more difficult to meet children’s needs and provide quality childcare and by increasing parental stress and depression, both risk factors for child abuse and neglect. Approaches to strengthening economic support for families could include both improving economic assistance to low-income families and intervening to support family-friendly work policies like livable wages, paid leave, and flexible and consistent scheduling. The CDC cites studies of several economic support programs for which research has demonstrated a direct effect on child abuse and neglect or associated risk factors. Perhaps the expanded 2021 child tax credit will have such an effect.
Encourage Pregnancy Planning, Spacing and Prevention: The CDC report identified young parental age and large number of dependent children as risk factors for abuse and neglect, but it did not propose a strategy to address those risk factors. But as I have written before, there are strategies to address these risk factors and they should be considered. One approach would be to expand access to long acting removable contraceptives (LARC’s). A statewide campaign to increase availability of LARC’s in Colorado resulted in a halving of the teen birth rate in five years. Another approach would be public information campaigns to inform people of the dangers of early and closely spaced childbearing and the advantages to both parents and children of pregnancy planning and spacing. Research indicate that such campaigns can change people’s health-related behavior, as in the case of smoking cessation and HIV prevention.
Change social norms to support positive parenting. As the CDC points out, norms about how we discipline our children are especially important to child abuse prevention. An analysis of 50 years of research found that spanking leads to more defiance, and increased antisocial behavior, aggression, mental health problems and cognitive difficulties. A recent study found that the percentage of parents who reported spanking a child in the previous year dropped from 50 percent in 1993 to 35 percent in 2017. Yet corporal punishment remains popular in some communities. While corporal punishment is not necessarily child abuse, it can lead to physical abuse when the parent loses control or goes too far. The CDC recommends both public education campaigns and legislative strategies to reduce the use of corporal punishment. The report cites successful public education campaigns regarding other parenting behaviors, such as emotional abuse. It also cites international studies indicating that bans on corporal punishment were successful at decreasing overall rates of corporal punishment.
Provide quality care and education early in life. Early care and education (ECE) is a particularly appealing child maltreatment prevention strategy because there are so many pathways by which it can operate to reduce child maltreatment. Quality ECE reduces parental stress, exposes the child to mandatory reporters, and reduces the time spent in an abusive or neglectful home or with an unrelated adult–often the perpetrator of severe or fatal child abuse. ECE approaches with a family engagement component may prevent maltreatment by training parents in positive discipline approaches. Approaches to providing ECE could include expanding government support to programs that combine childcare with educational enrichment and parent involvement and improving standards to increase quality. Studies suggest that childcare programs that include parent involvement are effective in preventing child maltreatment. A 15-year follow up of Child Parent Centers found that children who participated for one to two years had a 52 percent reduction in substantiated child abuse and neglect.
Provide parenting support to at-risk parents. Intervening directly with a targeted population of parents to address risk factors for child maltreatment is perhaps the most popular approach to child maltreatment prevention because it has a clear connection with child maltreatment and often falls under the jurisdiction of child welfare agencies. Such approaches include home visiting programs as well as interventions based in doctor’s offices, preschools, school or mental health clinics. These programs vary in their models and the risk factors they address. Many of these programs focus parent education and training, based upon the assumption that poor parenting skills and ineffective discipline practices can lead to maltreatment. Some interventions focus on the parent-child relationship since poor parent-child relationships are a risk factor for child maltreatment. Many of the home visiting programs include a case management component to help parents set goals for their own lives and access needed services, thus addressing risk factors like substance abuse, mental illness, and parental stress. Home visiting interventions like Nurse Family Partnership, SafeCare and Child First and parent training programs like Incredible Years and Triple P have been found to have small to moderate effects on maltreatment and related risk factors. Another approach is to use the pediatrician’s office to identify families at risk of abuse or neglect, address these risk factors at regular visits, and provide information and referrals. Both SEEK and Healthy Steps are examples of this approach that have had some promising results but needs more evaluation. A new generation of programs, as yet unproven, is connecting at risk families with both a case manager and a family engagement specialist who provides peer support. Examples of that approach include the intensive tier of Allegheny County PA’s Hello Baby program and the Detroit Prevention Project.
Intervene in maltreating families to lessen harms and prevent future risk. In this category, CDC places therapeutic programs that seek to limit the damage caused by prior maltreatment. Such programs are often known as tertiary prevention and aim at preventing further abuse and neglect or healing victims so that they do not proceed to abuse the next generation. The CDC divides these programs into three approaches. One approach is “behavioral parent training programs,” like Parent Child Interaction Therapy. Also included in this approach are SafeCare and Incredible Years, which are also in the secondary prevention category. Another approach is treatment for children and families to lessen the harms caused by abuse or neglect, such as Trauma-Focused Cognitive Behavioral Therapy. And the final approach suggested is treatment to prevent problem behavior and later involvement in violence, which includes programs such as Multisystemic Therapy. All of these programs have shown some impact on maltreatment or associated risk factors.
Of the six strategies discussed above, only the last two generally fall under jurisdiction of child welfare agencies–and and even those are often delivered by public health or behavioral health agencies or pediatricians’ offices. But the other four strategies are often not mentioned in discussions of child maltreatment prevention simply because the latter is considered to be the province of child welfare agencies. It is not surprising that the responsibility for preventing child maltreatment is often attributed to the agencies responsible for identifying and treating it. But as described above, the range of risk and protective factors is much larger than what child welfare agencies have the capacity or mandate to address. CDC suggests that public health agencies are well-suited to take the lead in developing community-wide prevention strategies that bring in the other systems that need to be involved.
It took a public health agency to articulate the broad scope of risk factors that lead to child abuse and neglect and the need for a broad spectrum of approaches to address it. Let us hope that public health agencies on the national, state and local levels can take the lead in pushing for a full spectrum of strategies that deserves the name of child maltreatment prevention.
In 1998, something extraordinary happened in San Diego County. Galvanized by the heartbreaking stories of local foster youth who were disgorged at the age of 18 from a system that never gave them the tools to thrive, the community came together to create a place where foster youth could prepare for happy and productive futures. In 2001, the San Pasqual Academy (SPA) opened as a result of this unique moment of community solidarity and altruism. Twenty years and over 400 graduates later, SPA is on the chopping block because of federal and state legislation that eliminates any funding for placements that are not standard foster homes, unless they are providing temporary intensive treatment for severe mental health conditions.
The story of SPA began in 1998 when James R. Millikan, the presiding judge of the San Diego Juvenile Court, arranged for a group of foster youths to speak to the County Board of Supervisors, as described in a moving video. It was a transformational moment for many of the listeners, who were essentially unaware of the plight of older foster youth. Supervisors were riveted by young foster care alumni, who described surviving as many 30 placements and being discharged to the streets at the age of 18, with no supports or tools for success. This magic moment resulted in the creation of SPA.
In a rare moment of collaboration by multiple agencies and community leaders, SPA was developed with the support of Judge Milliken, the County Board of Supervisors, the Child Welfare Director, the Office of Education, as well as attorneys, social workers, healthcare providers, educators, law enforcement, foster youth, and other community members. They found a disused boarding school for sale on 238 acres, refurbished it, and opened it in September 2001. The goal was to “provide a safe, stable and caring environment” where youth [could] work toward their high school diplomas, prepare for college and/or a vocation, and develop independent living skills.” The Academy was “designed to be a place its students can call home, providing stable relationships needed for development of social skills and future relationships during their student experience at the Academy and beyond.”
SPA services can be classified into four categories: residential, education, work readiness and child welfare.
Residential: The residential component is run by New Alternatives, Inc., a private nonprofit. Youths live in family-style homes with house parents for up to eight children per cottage. “Foster grandparents,” who live on campus for reduced rent, mentor, tutor and engage students in hobbies and activities. An on-campus health and wellness center provides comprehensive health care, including mental health. Housing and supportive services are also available to Academy alumni for up to 24 months. (Twelve alumni are living on campus right now, taking advantage of this crucial safety net in the midst of a pandemic.)
Education: The onsite high school program is operated by the County Office of Education. After-school activities include student government, athletics, yearbook, and dances.
Work Readiness: Provided by the San Diego Workforce Partnership, services include tutoring, career counseling, job training, internships, employment, vocational electives, and assistance in creating resumes and portfolios.
Child Welfare: Social workers from the County Department of Health and Human Services (DHHS) onsite provide case management, services and advocacy.
The resources provided to SPA students are enhanced by the support of Friends of San Pasqual Academy, a dedicated group of community members who provide additional financial support and volunteer work. Friends’ support pays for special events, school supplies, and personal items, all designed to give students a “normal high school experience.” The Friends raise money for maintenance and upgrades to the cottages, the pool and other parts of the facility. They have leveraged outside resources to help SPA. The San Diego Chargers helped build the football field and the Padres built the softball field for SPA.
SPA truly embodies the definition of wraparound services, and the research shows that it works. To assess the effectiveness of the SPA model, New Directions commissioned a ten-year research study that followed 478 SPA alumni, including all youth who attended the academy between February 2001 and June 2011 and left the program between July 2002 and July 2012. The results were summarized in an article titled “Comprehensive residential education: a promising model for emerging adults in foster care,” which was published in Children and Youth Services Review. The findings were impressive. As the authors put it, “Foster youth who participated in the Academy until they were 18 years old or older attained high school diplomas or GEDs at rates far above state and national standards for foster youth. Of the youth who were at least 18 years old when discharged from the Academy, 92% of them graduated with a high school diploma or GED, which greatly exceeds Californias high school graduation/GED rates for foster youth of 45% and for the general population of California youth of 79%….In fact, we are not aware of any other program serving foster youth in the United States…with such high rates of high school diploma/GED completion.”
The evaluators concluded that “the Academy provided its alumni with safety, significant relationships with adults, and well-being that exceed state and national standards for foster youth. Those youth who attended the Academy for longer periods of time through their 18th birthday and participated in extracurricular activities had the most positive outcomes, including safe housing, employment, access to healthcare, attainment of a high school diploma or GED, and attendance at institutions of higher education. The Academy appears to provide a stable, comprehensive residential education program that helps foster youth successfully emerge into adulthood.” A preliminary draft of a follow-up study focusing on current students and alumni is equally glowing.
In addition to the spectacular evaluation mentioned above, SPA has been the subject of several other flattering reports. Five San Diego County “grand juries” (groups appointed by Superior Court judges to investigate, evaluate, and report on the actions of local government) and four county Juvenile Justice Commissions have issued glowing reports on SPA. The most recent report, by the group meeting from 2016-2017, lamented the fact that SPA was operating at only 50 percent of its capacity of 184 students. The Grand Jury recommended that SPA be fully utilized to make full use of its life-saving potential. San Diego’s Juvenile Justice Commission has also issued multiple flattering reports on SPA. In its most recent report, issued in 2018, the commission stated that “SPA continues to be a model facility delivering essentially full service, wrap around services in a residential setting to foster youth.”
Despite the overwhelming evidence of SPA’s life-changing impact, the number of children at SPA declined from 139 in April 2011 to 69 as of February 1, 2021. The most important reason for declining referrals appears to have been the decline in support by child welfare leaders for what is often called “congregate care,” usually meaning any type of setting other than a foster home. This change in mindset was created in large part through influence of two wealthy organizations started by the same family, Casey Family Programs and the Annie E. Casey Foundation, that have used their financial resources to produce reports like Every Kid Needs a Family, lobby legislators, and provide free consultation with states. With the help of the “Casey Alliance,” a new narrative has been created that that all “congregate care” settings are prison-like institutions and any family home is better than a group setting for almost every child.
The change in mindset eventually resulted in legislative changes. California’s Continuum of Care Act, passed in 2015. ended the placement of foster youth in group settings except to provide short term therapeutic care. Thanks to SPA’s known track record and strong support, pilot program was authorized to allow SPA to operate through December 2021. But passage by the U.S. Congress of the the Family First Prevention Services Act (FFPSA) sealed SPA’s fate. Like Continuum of Care, FFPSA essentially eliminated federal funding for placement in settings other than foster homes except for short-term placements for youth who assessed to have a diagnosis that requires a level of care that a family cannot provide. With the implementation of FFPSA scheduled for October, the California Department of Social Services (CDSS) decided to advance the date of SPA’s closure to avoid having to use state funds to maintain it until December. In an undated letter, CDAA informed San Diego County DHHS that SPA must close by October.
Both Continuum of Care and FFPSA were based on the belief that children almost always do better in families than in other, more institutional settings. But as we have written, supporters often misuse data and research to support this belief. Research generally shows children in group care having poorer outcomes than those in foster care. But these studies do not account for the fact that children placed in group care generally have much more severe issues, which is why they were placed in group care in the first place. Moreover, supporters of “a family for every child” fail to define the concept of a family. The cottages at SPA and many other residential facilities offer a family setting, with house parents who play the parental role, as one house parent eloquently described in the video cited above. SPA homes are much more like families than many foster homes, where the foster parent has little interaction with the youth and provides little besides room and board. In fact, the residential component of SPA could be called “enhanced foster care” more accurately than congregate care.
And that raises the related concept of quality, which the reformers ignored. Quality matters much more than the type of setting. It is likely that most parents whose child had to leave home, would prefer a high-quality group setting (even if not family-style) for their children than a low-quality family setting. Anyone who has worked in foster care will know the difficulty of obtaining high-quality settings for older foster youth. Due to the scarcity of foster families, especially those willing to accept older youth, few jurisdictions can afford to be choosy enough about whom they accept and retain. What they do get more often than not are foster homes that provide little beyond room and board (and often those are barely adequate), foster parents who never set foot in the child’s school, refuse to take them to the doctor and the therapist, and quickly return difficult youths to the agency–resulting in multiple placements for each foster youth. Moreover, in my experience as a foster care social worker in the District of Columbia, few of my high school age clients participated in extracurricular activities because foster parents were unwilling to pick them up late from school or take them to weekend games, performances or other activities. Yet, engagement in after-school activities is linked with higher academic performance and college attendance, better health, and fewer problem behaviors.
Opponents of group care also ignore the problem of sibling separation. Many children placed in traditional foster homes are separated from one or more siblings because foster families do not have room for sibling groups. As I argued in Sibling Separation: An Unintended Consequence of the Family First Act, family-style group homes like those provided by SPA have been an important vehicle for keeping siblings together. In addition to providing a home for sibling groups of high school age, SPA accepts siblings of current students who are of middle-school age, allowing them to live at SPA and attend school in the community. The importance of siblings to foster children is such that even some congregate care opponents admit that it is better to place siblings together in congregate care than to separate them into different foster homes.
It is important to note that the restrictions on group care in FFPSA had another purpose aside from the alleged benefits to foster care. Restricting group care, which is more expensive than foster care, was necessary to free up federal funds to pay for the expansion of funding for services to prevent the placement of children in foster care. In other words, to find the money to preserve families, Congress took it away from services to the children who will have to be removed when family preservation fails. As long-time Congressional staffer and child welfare consultant Sean Hughes wrote in the Imprint, the focus among child welfare advocates seems to have shifted almost exclusively toward preventing entry into foster care, with little advocacy being devoted to actually improving the continuum of care for children in out-of-home care.
Current students, alumni and supporters of SPA were stunned by the CDSS letter. A petition on Change.org has obtained almost 11,000 signatures so far. Supporters of SPA have created a Facebook page and deluged public officials with letters and telephone calls. Reverend Shane Harris, the President and founder of the People’s Association of Justice Advocates, says SPA changed his life and gave him a safe place to grow up and is fighting to keep it open. One alumna is quoted on the Save San Pasqual Facebook page as follows: “I really loved living at SPA. I got to create relationships, a family and a strong support system. I also became stable by living here. I was able to attend school and catch up from how behind I was. I succeeded in sports and found outlets to deal with emotions. I couldn’t live in foster homes because the families wouldn’t treat me like their own.” Simone Hibbs-Monroe, valedictorian of the class of 2009 told KUSI News that “SPA has been a community safe haven and the only solution for many foster youth and a dedicated home for many alumni of foster care… “It’s an opportunity for children to feel normal. We are able to play sports, get jobs, have pep rallies, have our first proms, get our drivers’ licenses …..these are all the things that the caring community of San Pasqual offers its youth and its alumni….Often people [say] it takes a village to raise a child. That is San Pasqual Academy.”
Current and former staff have joined the call to save SPA. SPA’s Clinical Director, Rex Sheridan, wrote as follows in an eloquent letter to the County Supervisors and San Diego’s DHHS leadership team. “During my career in mental health and youth services, two decades of which has been in San Diego County, I have had contact with and worked in many different settings dedicated to meet the needs of our most vulnerable youth populations; yet none could even remotely be compared to what is offered at SPA. That is why I have now spent a third of my life committed to and working to develop this program because of first-hand experience witnessing lives transformed, hearts opened back up after years of disconnection, wounds healed after lifetimes of abuse and trauma, siblings reunited after separation, goals reimagined out of hopelessness, skills and knowledge crafted and nurtured out of feelings of incompetence, and new identities and possibilities replacing desperation and fragmentation. And if you think that those experiences sound overstated or dramatic, then you haven’t had the privilege of attending games where youth are cheered for the first time in their lives, one of our talent shows where they perform an original song, or a college road trip where they get to visit universities all over the state and envision a new possibility that was never previously imagined.”
What can be done to save SPA? The state and the county must adopt a stop-gap solution to keep SPA running as they work to permanently amend state law to create a category of residential schools that is eligible for reimbursement. On the federal level, advocates are already working on legislation to amend FFPSA to add residential campuses with family style homes as a placement option. We will share more information as it becomes available.
The proposed closure of SPA is a victory of ideology and greed over humanity and common sense. We need more, not fewer San Pasqual Academies. Rather than shutting it down, the state and county should be ensuring that it is at capacity and boasting that within their borders lies the most effective foster care program in the country.
Foster Parents Needed As COVID-19 Pandemic Strains Families is a typical headline these days, as illustrated in an article from Illinois. The pandemic has imposed new impediments to recruiting and retaining foster parents, including fears of exposure to COVID-19, loss of employment and income, and concerns about supervising virtual schooling. But these issues do not seem to be affecting New Jersey, where prospective foster parents are told that they are not needed, thank you very much! While the state credits its efforts at child abuse prevention and family preservation for its lack of need for foster parents, the explanation seems to lie elsewhere. Over the course of five years, the state has cut in half its rate of confirming allegations of abuse and neglect–resulting in a similar fall in the number of children entering foster care. This is a big change, and one that demands explanation in order to ensure that the agency is continuing to fulfill its mission of ensuring children’s safety in New Jersey.
Would-be New Jersey foster parents who click on “Be A Foster Parent” on the website of the Department of Children and Families (DCF) are greeted with the following message: “Thank you for your interest in becoming a resource parent to children and youth in state care. Due to the COVID19 Pandemic and its impact on operations, DCF has suspended all new inquiry submissions at this time. Please continue to check our website for any updates.” This is an odd message indeed, as it seems to imply that the pandemic has made recruitment and licensing impossible. But agencies around the country have adapted quickly to move vetting and training online in order to enable new foster parents to enter the pipeline. Not so New Jersey.
When we asked DCF why foster parents are being turned away, we received the following reply from DCF Communications Director Jason Butkowski. “[W]e did experience a 19.17% reduction in out-of-home placements from 2019 to 2020. This is attributable both to New Jersey’s statewide prevention network and our ongoing work to preserve families and keep children and parents together in their homes while receiving services.”
Interestingly, a message sent earlier to prospective foster parents gave a different answer. In May, 2020, would-be foster parents received a message saying, “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements,” as quoted in an article by Naomi Schaefer Riley. We asked Mr. Butkowski which explanation was more accurate–prevention and family preservation or kinship placements–but received no answer.
So what is going on in New Jersey? Certainly, foster care numbers have been decreasing. According to the data portal maintained by Rutgers University, annual entries to foster care fell from 5,504 in 2013 to 2,525 in 2019, as shown in the chart below. The rate of decrease in foster care entries became even steeper between 2018 and 2019, with a decrease of 23.7 percent in the number of entries in that one year alone. The total number of children in foster care dropped from a high of 7,775 in May 2014 to 4,463 in February 2020–before the pandemic closures occurred. So what could be causing this drastic decline in foster care placements and caseloads?
One possibility might be a decline in child abuse and neglect, which Butkowski is implicitly assuming by attributing part of the fall in foster care cases to DCF’s “statewide prevention network.” In that case, one might expect reports to child abuse hotlines to decline significantly. But according to monthly state reports, calls to child abuse hotlines hardly changed between 2014 and 2019, decreasing very slightly from 165,458 to 164,417. Of course we cannot be sure that reports are an accurate measure of child maltreatment; but one might expect a significant reduction in hotline calls if a large reduction in maltreatment were occurring.
DCF’s Butkowski also credited the agency’s work to “keep children and parents together in their homes while receiving services” as a reason for declining foster care entries. It is true that most substantiations of abuse or neglect do not result in foster care. Instead, DCF works with many families in their homes to help them avoid future maltreatment. But DCF has been emphasizing in-home services for years. Of all the children who were under DCF supervision in foster care or in-home services, the percentage receiving in-home services rather than foster care was 84.7 percent in May 2014 and 90 percent in February 2020. So children were somewhat more likely to receive in-home services in 2020 than in 2014, but the difference was small and not likely to explain the big fall in the foster care rolls.
So with hotline calls basically unchanged, and only a slight increase in the emphasis on in-home services, how did New Jersey manage to reduce its foster care entries by almost half in six years? One can think of the child welfare process as a funnel, starting with referrals, the child welfare term for hotline calls. As we discussed, those have fallen only slightly. Only some referrals are screened-in and accepted for investigation; many are rerouted or receive no action because hotline workers determine that they do not concern abuse or neglect. But a reduction in screened-in referrals is not part of the explanation for New Jersey’s drop in foster care placements. New Jersey reported that 60,934 referrals were screened in in FFY 2019, compared with 59,151 in FFY 2013–a slight increase.
The next step in the child welfare funnel is investigation, and here the count shifts from the number of referrals to the number of children. According to data submitted to New Jersey to the Administration for Children and Families (ACF) and published in Child Maltreatment 2019, the number of children receiving an investigation in New Jersey increased slightly from Federal Fiscal Year (FFY 2015) to FFY 2019–from 74,546 to 78,741. However there was a stunning drop in the proportion of these children who were found to be abused or neglected (known as “substantiation” in the child welfare world). In FFY 2015, 13.0 percent of the children who received investigations (or 9,689 children) were found to be abused or neglected. In FFY 2019, only 6.5 percent of the children receiving investigations (5,132 children) were found to be victims of maltreatment. In other words, among the children who were involved in investigations, the proportion who were found to be maltreated dropped by half. Similarly, the number of children found to be maltreatment victims dropped by 47 percent. (This is very similar to the 44.6 percent decrease in foster care entries between those years shown in the Rutgers data portal cited above).
It turns out that aside from Pennsylvania, which is not comparable to other states because it does not report on most neglect allegations, New Jersey had the lowest rate of substantiation per 1,000 children of all the states in FFY 2019. Only 2.6 children per 1,000 were found to be maltreated, compared to a national rate of 8.8 children per 1,000. In FFY 2015, this rate was 4.9 per 1,000 children in New Jersey–almost twice as high.
How did the number and percent of children found to be victims of child maltreatment drop so much in New Jersey over a four-year period, despite little decline in hotline calls? We asked DCF this question but received no reply. In the notes it submitted to ACF with its 2019 data, DCF acknowledged a decrease in the number of substantiated victims of maltreatment and stated that this is consistent with a continued trend–but provides no explanation. Perhaps policy or practice has changed to make it more difficult to substantiate abuse or neglect, through a change in definitions or in the standard of proof, or perhaps in training or agency culture. But such a change was not mentioned either by Butkowski or in DCF’s submission to ACF.
Let us revisit DCF’s previous message to foster parents saying that “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements.” This is an interesting statement because it implies that these kinship placements are not through the foster care system. It is important to understand that children can be placed with relatives in two ways. A child can be found to be a victim of maltreatment and placed with a relative, who becomes licensed as a foster parent. In New Jersey, 1,619 foster children (or 41 percent of the 3,951 children in foster care) were living with licensed kinship foster parents in November 2020. But these children are included in the state’s count of children in foster care, so they cannot account for the caseload drop. DCF must have been referring to something else.
Perhaps DCF’s earlier message to foster parents referred to the agency’s increasing use of a practice called “kinship diversion.” As described in an issue brief from ChildTrends, kinship diversion is a practice that occurs during an investigation or an in-home case when social workers determine that a child cannot remain safely with the parents or guardians. Instead of taking custody of a child, the agency facilitates placing the child with a relative. If this occurs in the context of an investigation, kinship diversion may result in a finding of “unsubstantiated” even when abuse or neglect has occurred, on the grounds that the child is now safe with the relative. We have no idea how widespread this practice is in New Jersey or nationwide since neither New Jersey nor other states report the number of these cases. However, the system of informal kinship care created by diversion has been called America’s hidden foster care system and nationwide it appears to dwarf the provision of kinship care within the foster care system.
There are many concerns about kinship diversion, as described in an earlier post: caregivers may not be vetted or held to the same standards as foster parents; they and the children they are caring for do not receive case management and services; they do not receive a foster care stipend and may have to depend on much-lower public assistance payments; there is nothing preventing caregivers giving children back to the parents without any assurance of safety; and parents are not guaranteed the due process rights and help with reunification that come with having their children in foster care. Because of the various concerns around kinship diversion, litigation has been filed in several states challenging this practice.
There is one other possible explanation that comes to mind for DCF’s foster parent surplus–dropping foster care rolls due to the COVID-19 pandemic. We removed data from the time of the pandemic from the above discussion to avoid confounding its effects with those of policy and practice changes but we need to ascertain whether the pandemic’s impact on calls to the hotline has affected entries into foster care. As in most states, hotline calls in New Jersey fell sharply in the aftermath of school closures and other pandemic measures. The number of child maltreatment referrals between March (the onset of school closures and quarantines) and November 2020 (the last month for which data are available on the DCF website) was 98,306, compared to 131,344 in the same period of 2019–a drop of 25 percent, based on monthly reports from DCF. It is likely that fewer calls from teachers now teaching virtually were a major factor behind this drop in hotline calls.
Entries into foster care also fell sharply in the wake of the pandemic. Foster care entries dropped from 1,949 in March through November 2019 to only 1,211 in the same months of 2020–a drop of 37.9 percent–which may have reflected in part the reduction in hotline calls and in part the continuing decrease in foster care entries that we have described. But the number of children in care did not drop nearly as much as entries into care. Between February and November 2020, the total number of youth in care decreased only 11 percent from 4,463 to 3,951. This drop is surprisingly low–in fact it is less than the decrease in the foster care caseload during the same months of 2019 (16.1 percent). The small size of this caseload decline reflects the fact that foster care exits dropped even more than foster care entries. Exits from foster care dropped from 2,754 in March through November 2019 to 1,661 in the same months of 2020. That is a drop of over 1,093, when the drop in foster care entries was “only” 738. As a result, it appears that the number of children in foster care was higher, rather than lower, due to the pandemic. Therefore, it does not appear that the pandemic contributed to the decline in demand for foster parents.
One might expect to hear expressions of concern, or at least interest, in the recent precipitous drop in the number and rate of substantiations and in the foster care caseload from the court-ordered monitor charged with ensuring that New Jersey’s child welfare system is fulfilling its mission of protecting children. Since 2006 New Jersey has been operating under a settlement agreement in a lawsuit filed in 1999. The Court Monitor is Judith Meltzer, Executive Director of the Center for the Study of Social Policy (CSSP). In its most recent report, CSSP praised DCF for maintaining its progress toward meeting all the benchmarks required to exit the lawsuit, despite the challenges posed by COVID-19. Ironically, the report mentions DCF’s progress in “Prioritizing Safety.” The report does not mention the precipitous drop in foster care entries or substantiations before the pandemic or the fact that the state is turning away prospective foster parents.
New Jersey may be the first state to have stopped accepting applications for foster parents, and the reasons cited by DCF do not seem to explain this unusual event. Careful study of DCF data shows that the rate at which allegations of abuse or neglect are substantiated has been cut in half, and that there has been a similar reduction in entries into foster care. This cut in the substantiation rate could be due to policy or practice changes making it harder to confirm child maltreatment or it could be due to an increased tendency to place children with relatives without establishing officially that maltreatment has occurred. Without an adequate explanation from the state, the extent to which either of these factors is driving these trends is unknown. It is imperative to know the explanation of this trend to ensure that DCF’s new policies and practices are not compromising its mission of keeping children safe.
: Reasons for this drop in foster care exits may include court shutdowns and delays and suspension of services parents need to complete their reunification plans.