America loses champion for a child-centered child welfare system

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

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

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

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

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

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

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

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

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

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

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

 

 

When social distancing can kill: child protection during a pandemic


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Child Maltreatment 2018: Almost one in 100 children found to be maltreated, but great variation among states and populations

The federal Children’s Bureau (CB) has released its annual Child Maltreatment report, containing data provided by the states from Federal Fiscal Year 2018.  The high rate of maltreatment victimization and the contrasting numbers and rates between states and populations are two of the major takeaways of the report. A common theme across the report is that differences between states and populations and over time can reflect differences in levels of maltreatment,  policy or practice, or even how states collect data.

CB’s annual maltreatment reports use data from the National Child Abuse and Neglect Data System (NCANDS),  which is a federal effort that collects and analyzes child welfare data provided voluntarily by the states plus the District of Columbia and Puerto Rico. The data follow children and families from referrals to reports, dispositions and services. One of the most helpful resources is exhibit 2, reproduced below, a flow chart that follows families and children through the process from referral to services. (All tables in this post are reproduced from the report).

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Referrals and Reports

During FY 2018, states reported receiving a total of 4.3 million “referrals” (calls to a hotline or other communications alleging abuse or neglect) regarding approximately 7.8 million children.  The number of referrals per 1,000 children varied wildly between states, from a low of 15.7 in Hawaii to a high of 167.9 in Vermont.  The different referral rates between states may reflect different levels of knowledge about and comfort with child maltreatment reporting, different rates of underlying maltreatment, or even different state practices in defining the term “referrals.” Vermont explains that its high referral rate is the result of its practice of treating all calls to the child abuse hotline as referrals.

The rate of referrals has increased from 50 per 1,000 children in 2014 to 58.5 referrals per 1,000 children in 2018. Differences over time within a state may due to changes in state policy or practice or events in a particular state. For example, Alabama reported that it implemented online mandatory reporter training in 2014, resulting in an increase in referrals. Rhode Island reported a large increase in referrals due to the public trial of a school official for failure to report child abuse, resulting in more than a doubling of hotline calls from school staff.

A referral may be screened in or out by the child welfare agency depending on whether it meets agency criteria. Referrals may be screened out because they do not meet the definition of child abuse and neglect, there is inadequate information, or for other reasons. Screened-in referrals are called “reports” and receive a traditional CPS investigation or an “alternative response” (often called an “assessment”) in states that have two-track or “differential response systems.” These alternative responses, usually reserved for the less serious cases, do not result in an allegation of abuse or neglect but rather are aimed at connecting families with services they might need. Of the 4.3 million referrals, states screened in 2.4 million for an investigation or assessment. The rate of screened-in referrals (known as “reports”) has increased from 29.1 per 1,000 children in 2014 to 32.5  in 2018. The highest number of reports came from education personnel (20.5%), legal and law enforcement personnel (18.7%), and social services personnel (10.7%). Parents, other relatives, friends and neighbors submit the remaining reports.

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Substantiations

A total of 3.5 million children received an investigation or alternative response, and states found approximately 678,000 (16.8%) to be victims of child maltreatment; in other words the allegation was “substantiated.” Another 14% received an alternative response rather than an investigation, which meant there was no determination of whether maltreatment occurred. Reports involving 56.3% of these children were unsubstantiated, which meant there was not sufficient evidence to conclude that maltreatment took place.

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The 678,000 children who were found to be victims of maltreatment equates to a national rate of 9.2  victims per thousand children in the population, or almost one out of every 100 children. This rate varies greatly by state, from 2.7 in Washington 1 to 23.5 in Kentucky. A lower child victimization rate might reflect less child maltreatment or a system less likely to respond to existing maltreatment or that makes greater use of differential response. Kentucky had the highest proportion of children found to be victims (23.5 per 1000 children or over one in every 50 children) followed by West Virginia, Rhode Island, Massachusetts and Michigan. The ongoing crisis involving opioid and methamphetamine addiction has been blamed for an increase in maltreatment in many states. And indeed, all of the states with the highest rates have been hard-hit by the opioid epidemic and had among the highest opioid overdose death rates in the country in 2017.

The national proportion of children found to be victims of maltreatment has fluctuated since 2014, increasing slightly between 2014 and 2018 from 9.1 to 9.2 per thousand. This small national increase masks large changes in the numbers of victims in certain states, from a 50% decrease in Georgia to a 216% increase in Montana. In their written submissions, the states attribute these diverse trends to changes in child welfare law, policy and practice as well as increases in parental drug abuse and even severe weather events such as Hurricane Maria in Puerto Rico.2  Georgia reports a policy change that resulted in a large increase the proportion of cases assigned to the alternative response track, perhaps one reason for the decrease in substantiations. Montana has experienced a surge in children entering foster care due to parental drug abuse, especially methamphetamine, which probably contributed to the increase in children found to be victims.

The disparity in the proportion of children found to be maltreatment victims across states is consistent with the belief that there is no foolproof method of assessing the truth of an allegation and that substantiation may not be a very good indicator of whether maltreatment has taken place. Research has found little or no difference in future reports of maltreatment of children who were the subject of substantiated or unsubstantiated reports

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Victim Demographics

The proportion of children found to be victims of maltreatment decreases as age increases. The rate of substantiated victimization for babies under a year old is 26.7 per thousand. This rate falls to 11.8 percent for children aged one to two and decreases gradually as age increases. This age effect reflects the greater fragility and helplessness of younger children and also the fact that they are less likely to spend time away from their parents (the primary maltreaters). That is one reason why many child advocates support making early care and education available to all children at risk for maltreatment and particularly to those already involved with the child welfare system.

Screen Shot 2020-01-31 at 9.30.35 AMThe rate of children found to be victims of maltreatment  varies considerably between racial and ethnic groups. The highest rate is for Native American or Alaska Native children, who were found to be victims at a rate of 15.2 per thousand, followed by African-American children, with a rate of 14 per thousand, compared to  8.2 per thousand for White children,  and 1.6 per thousand for Asian children. It is 8.1 per thousand for Hispanic children, who can be of any race. The higher rate of substantiated victimization among African-American and Native American children is a subject of controversy. Some believe it reflects greater tendency of African-American and Native parents to be reported to CPS and later substantiated as perpetrators due to racism. But these differences might also reflect a greater poverty rate for Black and Native children, or cultural factors, such as a preference for corporal punishment in the Black community, or substance abuse in the Native American community.

Maltreatment Types

Neglect continues to be the predominant type of maltreatment. The data shows 60.8% of children were found to be victims of neglect only, 10.7% victims of physical abuse only, and 7.0% to be sexually abused only, with 15.5% suffering from multiple types of maltreatment, mostly commonly neglect and physical abuse. It is important to understand that a given child may be found to have suffered one type of maltreatment when other types are also present. For example, abuse can be hard to substantiate when the parent and child give contradictory accounts, or the child recants, and such children may be substantiated for neglect only when abuse is also present.

For the first time, 18 states reported on victims of sex trafficking. These states reported a total of 339 victims. While one case would be too much, it is encouraging that the scope of the problem is so small compared to other types of maltreatment. This suggests that sex trafficking as a type of child maltreatment is much less widespread than one might have thought given the amount of attention recently attached to this topic through legislation, training, and policy.

There is wide variation among states in the prevalence of different types of substantiated maltreatment. Some of this variation may be due to real underlying differences in parental behavior and some may be due to varying laws, policies and practices. Of particular interest are the states that have much higher percentages of abuse than the national average. While nationally only 10.7% of victims are found to have experienced abuse only, that percentage was 55.3% in Vermont, 48.2% in Alabama, and 39.7% in Pennsylvania. It is known that corporal punishment, which may escalate to abuse, is more popular in Southern states, like Tennessee and Alabama. Vermont’s  and Pennsylvania’s high rates of abuse may be due to the assignment of many less-serious cases to an alternative track where there is no disposition (in Vermont) or the disposition is not reported (in Pennsylvania).3 Alabamans are aware of their state’s high abuse rate, which was covered in an excellent story by Al.com that cites the state’s acceptance of corporal punishment as one underlying factor.

Substance Abuse

For the FY 2018 report, the researchers analyzed three years of data on the presence of alcohol or drug abuse among caregivers. They found that the national percentage of substantiated victims with a caregiver identified as a drug abuser was 30.7%  in 2018. Alcohol as a caregiver risk factor was 12.3%. Both of these percentages increased slightly from 2016. As is often the case, there was an astonishing diversity among states, ranging from 2.2% to 45.5% for alcohol abuse, and from 3.1% to 61.5% for drug abuse. This diversity, especially the very low rates in some states,  raises concerns about whether they are accurately capturing these factors.

Perpetrators

The data show that 90.7% of the victims were maltreated by one or both of their parents. That includes nearly 40% who were maltreated by their mother acting alone and 21.5% by their father acting alone. Relatives (4.7%) and unmarried partners of parents (2.8%) are the largest remaining categories of maltreaters.

Fatalities

There is no standard, mandatory system for reporting child abuse and neglect deaths and it is often extremely difficult to determine where a death was caused by abuse or neglect rather than natural causes. Based on data from all states except Massachusetts, the researchers estimated that 1,770 children died from abuse or neglect in 2018, which is a rate of 2.39 per 100,000 children in the population. That is an 11.3% increase over the estimate for 2014 but this change may reflect data quality rather than a real change in maltreatment deaths. State rates range from 0 (Nebraska) to 6.6 (Arkansas) per 100,000 children but it is hard to know how much of the variation reflects differences in capturing actual child fatality rates.  NCANDS maltreatment data are generally viewed as underestimates because, among other factors, many maltreatment fatalities may be unknown to any system or impossible to prove and some states do not report on deaths of children not known to the Child Protective Services Agency.  In contrast, the Commission on Child Abuse and Neglect Fatalities reported that the most recent National Incidence Study (where data is collected directly by ACF) reported 2,400 deaths compared to 1,530 deaths in the Child Maltreatment report for a similar period. The  CAPTA reauthorization bill which was passed by the House would require the Secretary of the Department of Health and Human Services establish uniform standards for the tracking and reporting of child fatalities and near-fatalities related to maltreatment.  This requirement is badly needed.

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Like child maltreatment itself, child maltreatment fatalities are more likely occur to the youngest children. Infants under one year old were the most likely to die, at a rate of 22.77 per 100,000. The rate decreases to 6.3 per 100,000 one-year-olds and continues to fall with age. Nearly half of the children who died were younger than one and 70.6% were younger than three. This illustrates again why it is so important to ensure that all children at risk of severe abuse or neglect must be in early care or education.

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The child fatality rate for African American children (5.8 per 100,000 children)  is over 2.8 times the rates for White children. Mixed-race children had the second highest rate of 3.2, followed by Native American children at 3.12. As discussed above, we do not understand these disparities. They could be due to cultural factors, economic factors, racism in reporting and substantiation, or other factors. The child maltreatment fatality rate for Black children is more than twice that for White children (5.48 vs. 1.94 per 100,000). This is an even greater disparity than  the difference in child maltreatment rates (14.2 per 1000 for black children vs. 8.2 per 1000 for white children).   Perhaps many Black parents’ embrace of corporal punishment, as described by author Stacey Patton in her important book, Spare the Kids, while not much different in terms of overall percentages from that of White parents, countenances more severe discipline than among other racial and ethnic groups. These disparate child maltreatment death rates should give pause to those self-described anti-racists who want to equalize the rates of investigations, substantiations, and child removals of Black and White children. Such a policy would very likely lead to increased deaths of Black children–hardly an outcome they should welcome.

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Of the children who died from maltreatment in 2018, 72.8 percent suffered neglect and 46.1 percent suffered physical abuse, including some children who suffered more than one type of maltreatment. Eighty percent of the deaths were caused by parents or caregivers acting alone or with other individuals. Based on reports from 24 states, 20.3% of the children who died had received family preservation services in the previous five years. And 2.5%  had been reunified with their families in the previous five years after being removed.

Services

Approximately 1.3 million children (a duplicated count4) received services at home or in foster care as the result of an investigation or alternative response. This includes 60.7% of the children who were found to be victims of maltreatment and 20.9 percent of the non-victims. It is concerning that such a low percentage of the victims received services. But not every state reports data for every in-home service (especially those provided by other agencies or contractors), so the actual proportion receiving services other than foster care may be higher. Sadly, according to reports from 26 states, only 21.9% of the victims received court-appointed representatives.

About a fifth of the children found to be maltreatment victims (22.5%) and 1.9% of those not found to be victims5 were placed in foster care. It is worth noting that less than half of the maltreatment victims who received services (146,706 out of 391,661) were placed in foster care. The others received family preservation services while remaining at home. Many news reporters and child welfare commentators have incorrectly suggested that no services other than foster care were available to abused or neglected children before the implementation of the Family First Prevention Services Act. This data shows the incorrectness of that assumption.

Infants with prenatal substance exposure

For FFY 2018, States were required  to report for the first time on infants exposed prenatally to drugs and alcohol. Forty-five states reported that they had been informed of 27,709 infants born exposed to substances. Nearly 88% of these infants were screened in as appropriate for an investigation or alternative response. It is somewhat concerning that the others were not, given the possible serious effects of prenatal and postnatal substance abuse.  Of those screened in, 75.5% had a caregiver identified as a drug abuser, 11.7% had a caregiver identified as a drug and alcohol abuse, and less than one percent had a caregiver identified as abusing alcohol only. The 24,342 children who were screened in in 42 states constituted a shockingly high 10.8 percent of children under one in those states. Of the screened in reports, 68.3 percent were substantiated as victims or abuse or neglect. Nine percent received an alternative response and nine percent were unsubstantiated. The report’s authors caution against comparing states because this was the first year of reporting.  The wild disparity between states in the proportions identified suggests they are right to be cautious and that the national figures have a wide margin of error as a result.

The Child Abuse Prevention and Treatment Act (CAPTA) as amended by the Comprehensive Addiction and Recovery Act (CARA) in 2016,  requires that all infants “affected by a substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder” receive a “plan of safe care…addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver.” Thirteen responding states reported that 64% of infants with prenatal substance exposure had a plan of safe care. A separate CAPTA provision requires states to report how many infants had a “referral to appropriate services,” and fourteen states reported that only 42.6% of infants had such a referral. The difference between these two percentages is due to California, which provided data on referrals and not plans of safe care. Only 12.7% of California’s substance-exposed infants had referrals to appropriate services. Since the California’s population is larger, and the percentage receiving referrals was low, the overall percentage was reduced significantly by adding California but the two percentages were the same in the other responding states.

Plans of safe care and referrals are voluntary and do not mean much unless they are followed by the families, providers, and agencies. It would be better to know how many of these infants received foster care and other services after an investigation or family assessment. That would probably require opening a services case for all these families. Congress should consider requiring this, as it would be the only way to follow up on what services these families actually receive.

The fact that almost one in 100 children is found to be a victim of child maltreatment should be of concern to all child advocates, especially because it is likely that many other victims were never reported or found to be victimized. It is hard to interpret comparative data between states, populations, and years because of the difficulty in disentangling the amount of actual maltreatment given the variety of  policies and practices in how it is defined and reported. Analysis of the report suggests changes in CAPTA that would make it more useful. For example, Congress should to set uniform standards for reporting child maltreatment fatalities by passing the CAPTA reauthorization bill in 2020. And the new version of CAPTA should be further strengthened to replace the plans of state care with a more substantial response to infant substance exposure.

 

 

 

 

 

 


  1. Pennsylvania’s victimization rate was actually the lowest at 1.8% but this low rate reflects the state’s unusual child protective services structure. Allegations that do not concern abuse or specific very serious types of neglect are labeled as General Protective Services and not counted as referrals or reports for federal reporting. 
  2. Puerto Rico had a 43% decline in children found to be maltreatment victims between 2014 and 2018. The territory’s commentary explains that its child population was already decreasing due to emigration even before Hurricane Maria struck in October 2017 and then further declined due to emigration. 
  3. Vermont’s extremely high abuse rate rate may be due to the fact that about 40% of its cases are assigned to the alternative response track, which does not result in a disposition, and another sizeable group are assigned to a pathway outside CPS, called family assessment. The cases assigned to these alternative tracks are expected to be less serious and more likely to involve neglect rather than abuse. A similar phenomenon likely occurs in Pennsylvania where most neglect allegation are assigned to General Protective Services and not reported to the federal government. 
  4. Individual children were counted more than once if they were involved in more than one CPS case. 
  5. Many of these children were probably siblings of children who were found to be victims of maltreatment. 

Illinois’ Intact Family Services: What happens when family preservation trumps child safety?

ChapinHallIllinois’ child welfare services to families that are allowed to keep their children have major systemic flaws that put children at risk. Most importantly, there is extreme reluctance to remove children from their homes and place them in foster care. Those are the findings of a review from Chapin Hall at the University of Chicago that was commissioned by the Governor in the wake of several deaths of children whose families were being supervised by the state.

This report follows an earlier one, discussed in a  previous post,  by the Inspector General (OIG) for the Illinois Department of Children and Family Services (DCFS) stating that child safety and well-being are no longer priorities for the agency.  One problem area identified in that report was Intact Family Services, which are the services provided to families in order to prevent further abuse or neglect without removing the child. OIG’s 2018 annual report included an eight-year retrospective on the deaths of children in Intact Family Services cases, which concluded that in many of these cases the children remained in danger during the life of the case due to violence in their homes, when DCFS should have either removed the children or at least sought court involvement to enforce participation in services,

Increasingly, child welfare systems around the country have been relying on services to intact families (often called in-home or intact family services) in order to avoid placing children into foster care. In 2017, according to federal data, only 15% of children who received services after an investigation or assessment were placed in foster care; the other 85% were provided with services in their homes. These services may become even more predominant with implementation of the Family First Prevention Services Act, which allows federal Title IV-E funds to reimburse jurisdictions for the cost of such services.

It is important for child welfare agencies to be able to work with families that remain intact. This allows the agency to monitor the children’s safety and avoid the trauma of placement in foster care while working to ameliorate the conditions that might lead to a foster care placement. But agencies must be cognizant that not every family can be helped this way, keep a close watch what is going on in the home, and be ready to remove children when necessary to ensure their safety. The deaths of children who have received Intact Family Services in Illinois have raised questions about whether the agency is accomplishing these tasks.

In Illinois, Intact Family Services (referred to below as “Intact”)  are provided mostly by private agencies under contract with DCFS. The Chapin Hall  report found systemic issues that create barriers to effectively serving intact families.

Avoiding foster care placement: Perhaps the most important issue observed by the researchers was the high priority that Illinois places on avoiding placement of children in foster care. As a result of many years of such efforts, Illinois now has the lowest rate of child removal in the country. Intact staff expressed the belief that “recommendations to remove children based on case complexity, severity, or chronicity will not be heard by the Division of Child Protection (DCP) or the Court.” As a result, Intact supervisors are reluctant to reject referrals of families even when they believe a family cannot be served safely in the home.  They are also reluctant to elevate cases for supervisory review when they have not been able to engage a high risk family.

Supervisory Misalignment: In the past, negotiations between DCP and Intact over the appropriateness of a referral occurred on a supervisor-to-supervisor level, allowing Intact to push back against unsuitable referrals. An administrative realignment that placed investigators and Intact under different administrations eliminated this ability of Intact to contest inappropriate referrals. According to the researchers, this resulted in the opening of Intact cases for families with “extensive histories of physical abuse” that Intact staff believed they could not serve effectively.

High Risk Case Closures:  Intact service agencies are expected to work with a family for six months and then close the case with no further involvement by DCFS. The researchers learned that there was no clear pathway for intact staff to express concerns when they been unable to engage a family. As a result, some providers told the researcher that they may simply close the case when a family will not engage.

Staffing Issues: Caseload, capacity and turnover.  The researchers found that DCP investigators are overwhelmed with their high caseloads and are desperate to make referrals to Intact to get families off their caseload as soon as possible. The prescribed caseload limit of 15 cases per worker is very hard to manage, and some workers carry even more cases. Moreover, DCP workers tend to stop managing safety plans and assessments as soon as a referral is made to Intact, which leaves children in limbo until services begin. For their part, Intact workers’ caseloads are often over the prescribed limits and are not adjusted for travel time or case complexity. Moreover, the difficulty of their clientele makes the current caseload of 10:1 difficult to manage. High turnover among Intact workers, investigators and other staff can also contribute to the information gaps and knowledge deficits mentioned below.

Role Confusion: DCP workers and Intact workers seem to have different views of the role of the DCP worker, according to the researchers. DCP workers view their role as making and justifying the decisions about whether to substantiate the referral and remove the child. However, the Intact Family Services policy calls upon them to engage the family and transmit all necessary information to the Intact staff. Cultural differences between the two sets of workers compound the problems.

Information Gaps: Because of the role ambiguity mentioned above, investigators often fail to pass on crucial information to Intact workers. Yet, these workers often cannot access investigators notes or key features of the case history. Moreover Chapin Hall’s reviews of the two recent deaths of toddlers in intact cases found that much of the family’s history was inaccessible because cases were expunged or purged. DCFS expunges most unsubstantiated reports and shreds investigators files and appears to be more aggressive about such expungements than most other states, according to a previous DCFS Director, George Sheldon.

Service Gaps: The researchers also mentioned gaps in service availability, especially long waiting lists for substance abuse prevention, which make it very difficult to engage families as well as providers.

The authors made a number of recommendations for addressing these problems they identified.  These include:

  • Work with courts and State’s attorneys to refine the criteria for child removal in complex and chronic family cases;
  • Develop and refine protocol for closing Intact cases;
  • Direct attention to cases at greatest risk for severe harm; revisit the use of predictive models which should be transparent, based on broad input and be supported by ethical safeguards’
  • Clarify goals and expectations across staff roles;
  • Utilize evidence-based approaches to preventive case work;
  • Improve the quality of supervision;
  • Adjust the preventive services offered through Intact to meet the needs of the population;
  • Restructure Intact Services to address the supervisory mismatch with DCP; and
  • Redesign the assessment and intake process to reduce redundant information, improve accuracy or assessments to support decision-making and improve communication across child serving systems.

We would have liked to see a recommendation to modify Illinois’ policy of expunging and purging all unsubstantiated investigations. At a hearing in May, 2017, the DCFS Director, George Sheldon, expressed his support for allowing DCFS to keep records of all investigations, even if they are unsubstantiated. Research suggests that it is very difficult to make accurate decisions about whether maltreatment has occurred; moreover, unsubstantiated reports are as good as substantiated ones in predicting future maltreatment. Examples of children killed after families have had multiple unsubstantiated reports have been observed all over the country.

This report should be a must-read for all child welfare agencies.  Children in many states have died of abuse or neglect after intact cases have been opened for their families. (Think about Zymere Perkins in New York or Anthony Avalos and Gabriel Fernandez in Los Angeles.) Many of the issues identified by the Chapin-Hall report may have contributed to these deaths as well, particularly the extreme avoidance of child removals that has condemned so many innocent children to death ever since the widespread push to reduce the foster care rolls, supported by a coalition of wealthy and powerful foundations and advocacy groups.

 

Inspector General: Child safety and well-being no longer priorities for Illinois Department of Child and Family Services

SemajCrosby
Semaj Crosby: wtvr.com

DCFS has lost focus on ensuring the safety and well-being of children as a priority. This is evidenced by several recent cases and the clear lack of attention to assuring children and families receive adequate, thorough, and timely responses and needed services. Investigators, caseworkers and supervisors are unmanaged, and unsupported. Children are dying, children are being left lingering in care, children are being left in in psychiatric hospitals beyond medical necessity causing them to lose hope. This is not just unacceptable it is HARMFUL

That startling statement was made by the Acting Inspector General (IG) for Illinois Department of Children and Families to News Channel 20 about its most recent annual report. During FY 2018, the Office of Inspector General (OIG) reviewed 97 deaths and one serious injury of children whose families were involved in the child welfare system within the preceding 12 months. Of the 98 families involved, at least 52 were the subject of of a completed child abuse or neglect investigation during the previous 12 months; fully 37 of these investigations failed to find any abuse or neglect and were closed without any action to protect the child. Twelve of the 98 families were the subject of an open investigation when the child died, eight were involved in an open family service case, and three had had a family case closed within a year of the death. (See the full count of deaths by case status at the bottom of this article.)

Not all of the deaths or serious injuries can be attributed to DCFS failure to protect a child. Twenty-seven deaths were ruled natural; most of the children involved had serious medical issues. Some of the deaths (including most the 16 youths in foster care)1 were sadly due to violence, car accidents, drug abuse by older youths and other circumstances not under the Department’s control. Heartbreakingly, two older teens in foster care died of abuse that was inflicted on them as infants and left them medically compromised.

However, many of the case reviews suggest DCFS missed danger signs and opportunities to save vulnerable children. Thirteen children were killed by a parent, step parent, parent’s paramour, another relative or unknown perpetrator within a year of an open investigation or service case.  These children were beaten, starved, stabbed, and shot to death. The cause of 23 deaths of children in families that recently interacted with DCFS is still undetermined; many are currently being investigated. Most of these children were infants; many of the deaths appeared to be linked to unsafe sleep practices and at least four raised concerns of abuse. The deaths of 24 children with an open or recently open case were classified as accidental. Fourteen of these deaths were attributed to asphyxia, suffocation, or sleep related causes; there were also two accidental drownings, an accidental hanging, and an accidental shooting of a three-year-old by an 11-year-old, as described below.

 The OIG completed “full investigations” of four cases  that have drawn extensive media attention:

  • Seventeen-month-old Semaj Crosby was found dead under a couch in her home 30 hours after being reported missing. There was both an open in-home case and a pending child protection investigation of the family at the time Semaj was reported missing. The family had been the subject of 11 investigations during the two years before her death. The mother received SSI for cognitive delays but was never assessed to determine her ability to keep her children safe. Semaj’s seven-year-old brother was psychiatrically hospitalized three times for threatening to kill himself during the time the family’s case was open. A family service caseworker visited the home the day before the toddler was reported missing, and a child protection investigator had been to the house the day the report was made. No immediate safety concerns were reported by this investigator, even though the health department deemed the apartment uninhabitable after the body was found. Criminal and child neglect investigations are pending.
  • Four-year-old Manual Aguilar was killed, apparently  starved to death, and his body was burned post-mortem. Four years before his death, Manual and his three siblings were removed  from their mother’s custody after she left the three older children in a car overnight at temperatures hovering around freezing, while Manual was left in a stranger’s care. The children were returned home a year before Manual’s death despite the mother’s failure to progress in therapy and an unfounded investigation stemming from bruises to one child that his older siblings reported were inflicted by the mother during an overnight visit. Five months before Manual’s death, the two older siblings texted to their former foster parent that their mother was beating them, but the investigation was unfounded when they recanted. The mother has been charged with murder.
  • A daycare center reported that a two-and-a-half-year-old appeared to have cigarette burns on both hands. The reporter also said the child’s face had been swollen on two prior occasions, and an unknown male accompanying the mother was seen to hit the child across the face a week before. The investigator closed the case without investigating adequately either the child’s burns or the family’s allegation that they occurred at the daycare. Two days following the investigation’s closure, the child experienced cardiac arrest and died four days later. The autopsy concluded that the manner of death was undetermined and suspicious, but a child protection investigation did not find evidence to find anyone responsible for the death.
  • An eleven-year-old girl accidentally shot her three-year-old brother in the head while playing at home. This child survived and and this appears to be the only non-fatal case reviewed. The parents had left four of their children, of which the eleven-year-old was the oldest, at home alone.  The father had eight drug convictions and had been arrested multiple times for physically assaulting the mother. The investigation of the shooting was the eleventh investigation of this family since 2008. One investigation had occurred when the father barricaded himself in the home with the mother, who was eight months pregnant, and the screaming and crying children. The children’s eight-year-old sibling was in residential care in the custody of DCFS at the time of the shooting and the agency was required to monitor the at-home siblings as well. Nevertheless no visits by case managers to the home were documented in the 45 months before the shooting with one exception. A case manager attempted to visit the home 21 days before the shooting but was not allowed in. . 

The acting Inspector General told a reporter that understaffing may have contributed to the state’s inability to prevent child deaths. Following the death of Semaj Crosby, the OIG investigated a media report that child protection workers in the local office were offered incentives for early case closure. The IG found that while Semaj’s family was involved with DCFS, the entire region was understaffed (at times as low as 66% of staff needed), resulting in excessive caseloads for investigators. In December 2016, the field office administrator offered a $100 gift card to the investigator who could close the most cases in January. The IG found similar incentive programs for early case closure around the state.

The OIG also found that “a large contributing factor to the caseload problem was that the previous director had several management initiatives that seemed to take priority” over any attempt to redistribute caseloads. One of these initiatives, Rapid Safety Feedback, received some media attention last year. DCFS awarded a multimillion-dollar contract to two out-of-state firms using a “propriety algorithm to identify cases most likely to result in death or serious injury.” There were concerns that this contract was one of several no-bid contracts given to a circle of former associates of the previous director, as described by the Chicago Tribune. The contract was terminated after 25 to 50 percent of cases were flagged as having a a greater than 90% probability of death or serious injury in the next two years, alarming and overwhelming social workers. At the same time, the algorithm failed to predict the death of Semaj Crosby and other children who were killed while under supervision by DCFS. 

The OIG report identified two areas of “chronic misfeasance,” or conduct that is lawful but inappropriate or incorrect. One of these areas is “intact family services,” which is DCFS-speak for the services provided to families to prevent further abuse or neglect without removing the child. OIG’s 2018 annual report included an eight-year retrospective on the deaths of children in intact family services cases. The OIG concluded that in many of these cases the children remained in danger during the life of the case due to violence in their homes, when DCFS should have either removed the children or at least sought court involvement to enforce participation in services.

A second area of “chronic misfeasance” identified in the 2019 report which has also drawn media coverage is the practice of leaving foster children in psychiatric hospitals “beyond medical necessity,” or after they are stable enough to be cared for outside that setting because there is no appropriate placement. OIG reported that the number of such episodes increased from 273 in FY 2017 to 329 in 2018. “The availability of community-based services and resources for youth with significant mental and behavioral needs continues to be at crisis levels.”

The OIG’s overall conclusion–that child safety and well-being are no longer priorities for DCFS–is sobering. But even more alarming is the fact that this description could be applied to many or even most other states.  Although we don’t have numbers for most states, every year brings stories from around the country of children killed after long histories of contact with child welfare authorities. Twenty-seven percent of the fatality cases analyzed by the Administration on Children and Families for its Child Maltreatment report had at least one Child Protective Services contact within the past three years.  State child welfare agencies tend to hide behind strict privacy protections in order to avoid releasing information on child protection failures, even though the case information could be released without including the names of the families involved. As a member of the District of Columbia’s Child Fatality Review Commission, I hear at almost every monthly meeting about one or more children who died after the family was called to the attention of CPS multiple times. And yet, I am not allowed to share any information about these cases with anyone, including legislators.

At least in Illinois, thanks to the DCFS Inspector General, the public and its elected representatives are given the opportunity to learn about failures to protect children while in the custody of their parents as well as those the custody of DCFS. This information helps make the case for change. The OIG report was the subject of a hearing in Springfield. The Governor has already requested an increase of more than $70 million for 126 new staff and technology upgrades.

Unfortunately, most states do not have an independent agency like the Illinois OIG to look out for children who are served by the agency both at home and in care. In a report issued on April 4, 2018, the National Council of State Legislators found that only 11 states have “an independent and autonomous agencies with oversight specific to child welfare,” although they seem to have missed Illinois. All states need such an autonomous agency. Somebody needs to reveal the truth about how we fail our most vulnerable children–and what it would take to do better.

Number of Child Deaths by Case Status from OIG Report

Case Status*                                                    Number of deaths or serious injuries

Pending Investigation at time of child’s death………………………………………………………12

Unfounded Investigation** within a year of child’s death……………………………………37

“Indicated” Investigation*** within a year of child’s death…………………………………..15

Youth in care………………………………………………………………………………………………………………16

Open Placement/Split custody****……………………………………………………………………………..3

Open Intact Case*****………………………………………………………………………………………………….8

Closed Intact Case within a year of child’s death……………………………………………………….3

Child of Youth in Care……………………………………………………………………………………………………1

Child Welfare Services Referral (no allegation of abuse or neglect)………………………….2

Preventive services to assist family but not as result of indicated investigation………1

Total……………………………………………………………………………………………………………………………….98

*When more than one reason existed for the OIG investigation, the death was categorized based on “primary reason.”

**An investigation in which the agency was unable to verify that abuse or neglect occurred. 

***An investigation in which abuse or neglect by the parent was found to have occurred.

****Child was in home with siblings in foster care

****A case in which the family was receiving services while the child remained in the home. 


  1. Of the 16 children who died while in foster care, a 14-year-old and an 18-year-old died of gunshots by unrelated perpetrators, two died as a consequence of abuse by their parents in infancy, three were infants in care of relatives and cause of death was undetermined for two and suffocation for one, two died of methadone or opioid intoxication, one 18-year-old died in a car accident and five died of natural causes. 

 

Sibling Separation: An Unintended Consequence of the Family First Act?

siblings.pngI recently read a book that should be a must-read for all involved in child welfare policy. In Etched in Sand, Regina Calcaterra tells of being left at the age of eleven to care for her two younger siblings while her mother disappeared for weeks at a time. When she was home, her mother savagely beat the children. Chronically malnourished and living in fear, Calcaterra was responsible for feeding, clothing, and protecting her younger siblings–and making sure they looked clean and well-fed so as not to draw the attention of the authorities who might place them in foster care.

Despite her horrific childhood, the goal of Regina and her older siblings, as she said in an interview for Youtube TV, “was to never to be picked up by the authorities because when the authorities found out how we were living, they would separate us.” When Regina was finally unable to satisfactorily explain the results of a savage beating, the children were indeed taken into care and separated.

No maltreated children should have to hide their plight in order to avoid separation from each other. Yet, this is undoubtedly the situation facing many children even while you read this. I myself know two girls who, for fear of being separated, remained for two years with an uncaring guardian who diverted her guardianship stipend to her own needs. The girls only recently broke the silence, and were removed from this toxic home.

Sibling relationships are known to be critically important in emotional development in childhood and beyond, as documented in a useful publication from the Child Welfare Information Gateway. In abusive and neglectful families, sibling relationships can be even more important as siblings support each other through adverse circumstances.

Keeping siblings together in foster care provides an important element of continuity for children who have already suffered a traumatic removal from the home they had known. As the the brief cited above puts it, “For children entering care, being with their brothers and sisters promotes a sense of safety and well-being, and being separated from them can trigger grief and anxiety.” Some studies have reported poorer outcomes for children separated from their siblings in foster care.

We don’t know how many siblings are separated in foster care. Older studies indicate that a large proportion of foster children were separated from at least some of their siblings, but the proportions varied by location. Current, national data are not available.

In most cases siblings are separated for no other reason than the lack of foster homes that can accommodate siblings, especially larger sibling groups. There is a nationwide shortage of foster parents, but foster parents who are able to take more than two siblings are even more scarce.

In some states, like North Carolina and Florida, family-style group homes have been an important vehicle for keeping siblings together.  Many of these homes, such as Crossnore School and Children’s Home in North Carolina and A Kid’s Place in Florida provide highly enriched services to their residents with the help of public and private philanthropic funding. These homes often use a family-style model based on houseparents that mimics a family home. Group homes are serving sibling groups in many other states, including CaliforniaTexas and New York.

Unfortunately, the recently passed Family First Prevention Services Act (FFPSA) threatens these important havens for sibling groups and may result in mass separations of siblings. That’s because FFPSA eliminates federal funding for placement of children in congregate-care settings such as group homes beyond two weeks, unless an assessment shows that a child’s needs cannot be met with family members or in a foster family home. Moreover, group facilities must meet criteria as “Qualified Residential Treatment Programs” designed to meet the needs of “children with serious emotional or behavioral disorders.”

FFPSA is based on the widely-held belief in child welfare circles that most children do better in a family than in another type of setting. However, experts such as Dave Bundy, President and CEO of the Children’s Home Society of America, believe that it is better to keep siblings together in congregate care than to split them up among separate foster homes.

Moreover, many legislators and executives pressing for closing group homes have much more than children’s best interests at heart. The greater cost of congregate care has clearly contributed to its growing unpopularity and to the bipartisan support of FFPSA. But these comparisons are often deceptive.  Facilities like  Crossnore and the Florida Sheriffs Youth Ranches provide therapists, case managers, after-school activities, and other services, such as therapeutic riding. Moreover, they bring in substantial private funding in addition to state support. And no matter how expensive they are, they cannot cost more than keeping children in hotels and offices when there are no homes for them, which is happening around the country.

Siblings have already been separated due to the policies against congregate care that have already taken hold in some states. From 2006 to 2015, Sonoma County Children’s Village was a haven for 24 foster children, including sibling groups, who  lived in four homes staffed by “village parents,” with surrogate grandparents living in onsite apartments. But after California began to limit group home placements for children requiring high levels of care, the village had to close.  Sixteen children, including a group of seven siblings, had to leave. The children were devastated. They sent out appeals to the likes of Barack Obama and Taylor Swift, but to no avail.

There is another approach to housing large sibling groups which in practice looks very similar to family-style group homes. Some child welfare agencies contract with private agencies, such as Neighbor to Family in Florida and Georgia, that provide homes where siblings can live together in foster care. Some of these programs actually provide larger houses in clusters or “neighborhoods” to foster parents willing to care for large sibling groups but who don’t have the space. This clustering provides the added benefit of community support and shared facilities for recreation and other activities. Such programs include the SOS Children’s Villages in Illinois and Florida. New homes are currently being built in locations around the country including Oklahoma,  and Southwest Florida. However these programs are too few and far between to make a dent on the national problem of sibling separation in foster care.

Perhaps all the group homes that keep siblings together could eventually be replaced by family foster homes with housing provided by public and private agencies. The feasibility of this approach would have to be investigated; it might be even harder to find good foster parents than it is to find good houseparents, because the latter generally have a schedule that allows time off to return to their own residences, while being replaced by a substitute couple. In any case, such a transition would take years to accomplish and could not occur in the short period preceding the implementation of the FFPSA provisions, which go into effect on October 1, 2019. States can apply for a two-year delay in implementing these provisions but then they must forego the opportunity to received federal matching funds for services to prevent foster care placements. (For a detailed explanation, see the “Cliffs’ Notes on Family First” from the Chronicle of Social Change.)

The sponsors and supporters of FFPSA likely had no idea that sibling separation might be a consequence of their legislation. Once they understand what they have done, I hope they will consider amending FFPSA to make  congregate care allowable for sibling groups and provide a new funding stream to encourage jurisdictions to build foster home communities where siblings can thrive together.

 

Child Welfare Myths: Foster Care Is Worse than Remaining Home

removed kids
Image: Fox 26 Houston

As a field, child welfare seems to be particularly vulnerable to myths and misconceptions, which are often backed up by inaccurate interpretations of research. Unfortunately, these myths and misconceptions, when promoted by powerful and wealthy advocates, can be perpetuated and enshrined into policy.  This is the beginning of an occasional series in which I attempt to deconstruct some of the most common myths. We start with one of the most common and potentially destructive–the myth that children left with their families always do better than they would if placed in foster care.

This myth was recently exhibited in all its glory by the Arizona Star as part of a major series on child welfare in that state. Here is how reporter Emily Bregel describes a frequently quoted study.

Research indicates that children left with their own troubled families fare better than those brought into the foster care system. A 2007 study found children whose families were investigated for abuse and neglect but remained home were less likely to become teenage parents or juvenile delinquents than similarly abused children who were removed from home. Those left at home were also more likely to have jobs as young adults, compared with children of similar backgrounds who were put in foster care.

This oft-misquoted study was published by Massachusetts Institute of Technology’s Joseph Doyle in 2007. Doyle’s study has been used relentlessly–and often inappropriately–by advocates of reducing foster care placements. Doyle used a creative method to estimate the effects of foster care on Illinois children ages 5 to 15 who were receiving welfare and who were investigated for maltreatment for the first time between July 1, 1990 and June 31, 1991. He compared long-term outcomes (delinquency, teen motherhood, and employment)  for the children assigned to investigators with higher removal rates to outcomes for those assigned to investigators with lower removal rates.

By comparing the outcomes for the two groups, Doyle could estimate the effects of being placed in foster care for children who were on the margin of placement–those who might have been placed by one investigator and not by another. For those children, Doyle found large differences favoring those children who were not removed from their homes. Doyle’s results say nothing about the children whose cases were unambiguous and who would have been placed (or not placed) regardless of the investigator.1

Obviously, we cannot do a controlled experiment in which the same child is both placed and not placed in foster care to get at the true difference that it makes in children’s lives. Perhaps the best we can do is ask the children themselves. Researchers at the University of Chicago’s ChapinHall research center surveyed 727 sixteen and seventeen year olds who had in foster care in California for at least six months. When asked about their treatment by their parents or other caregivers before entering foster care, 36% reported that they were hit hard with a fist, kicked or slapped; 32.4% reported that a caregiver threw or pushed them; 28.4% reported missing school to do chores or care for a family member; 28.3% reported having to go without things they needed because the parent’s paycheck was spent on “adult interests,” 26.4% reported that their caregiver beat them up; and 24.9% reported that their caregiver failed to protect them from harm by someone else. A shocking 29.7% reported sexual molestation and 20.7% reported rape. Horribly, 18.6% reported that their caregiver tried to choke, smother or strangle them and 16.9% reported being locked in a closet or room for several hours or longer.

When asked about characteristics of the parent or caregiver they lived with before entering foster care, 48.8% reported inadequate parenting skills, 49.7% a criminal record, 48.3% drug abuse, 48.8 alcohol abuse, 33% reported that a caregiver was abused by or abused a spouse or partner and 25.6% said a caregiver had mental illness. In addition, a total of 56.9% reported that they either agreed, strongly agreed or very strongly agreed with the statement, “All in all I was lucky to be placed in the foster care system,” while only 17.6% disagreed.

The California survey suggests that more often than not, foster care is an improvement over families where children are unsafe, fearful, hungry, unsupervised, or unloved. However, I have learned from my own experience as a social worker that, while some children make the miraculous journey from hell to heaven when they are placed in the best foster homes, many foster homes are only slightly less chaotic and more nurturing than the homes from which the children have been plucked. The beatings, rapes, and hunger may be over but many children and youth continue to be neglected emotionally, educationally, and in other ways in foster care. When combined with the trauma caused by separation from family, it is not surprising that young people whose home lives were on the border between acceptable and unacceptable to an investigator may do worse in foster care than they would have done at home.

Neglect of children in foster care is inexcusable: these children need more than the usual nurturing in order to make up for the trauma and deprivation they may have already suffered in their birth homes. That’s why we need to increase the number of children placed with kin as well as other alternatives to traditional foster care, such as residential schools and hybrid arrangements that combine features of foster and group homes. But what we don’t need to do is abandon children in homes where they are not safe.

The misuse of Doyle’s article has supported the ideas that it is always better to reduce the number of children in foster care and that reduced care numbers are a prima facie indicator of improvement. It has led to many systems, like that of my home town of Washington DC, using reduction of foster care numbers as an outcome in itself–independent of trends in actual maltreatment. Using foster care reduction as an indicator of success fails to recognize that some placements are needed to keep children safe. It also means that jurisdiction, like New York City for example, may be claiming partial credit for the results of gentrification.

The misuse of research and data, especially when translated into policy, should disturb everyone regardless of their feelings about the particular issue. Doyle’s research suggests that when the case for removal is marginal, the default option might be to keep the child at home–with supervision and services by the state. It does not suggest that removal of a child from home is always the wrong decision or that programs should be rated solely on the ability to cut foster care rolls.


  1. Another problem with making inferences from Doyle’s study about foster care today is the age of his data, which are from 1990 and 1991. Child welfare culture and practices have changed greatly since that time and the relevance of research from 25 years ago is questionable. 

New book debunks prevailing child welfare myths

After the Cradle FallsA new book by two leading child welfare researchers aims to elucidate the complex world of child welfare for the general public and policymakers.  In After the Cradle Falls, Melissa Jonson-Reid and Brett Drake of Washington University provide a useful primer for the child welfare field. While they may be overly optimistic in assuming that a lay audience will pick up this book, it will certainly be useful for policymakers, journalists, students and advocates who want a general overview of child abuse and neglect, child welfare systems, and proposals for change.

Jonson-Reid and Drake make a particularly valuable contribution by highlighting myths and common misconceptions that are rife in the child welfare field. Among the common myths they debunk are the following:

  • “Neglect” is just another word for poverty, and parents become embroiled with Child Protective Services just because they are poor. Johnson-Reid and Blake explain that while poverty increases the risk of neglect, most parents who are poor do not neglect their children. Neglect is much more serious than a missed dental appointment or a messy house. Some neglect cases are extremely severe, even fatal. But even less severe cases can result in devastating lifetime consequences on brain development and the ability to form relationships.
  • Racial disproportionality in child welfare involvement is caused by racist decision-making by Child Protective Services (CPS). There is no dispute that African-American children are overrepresented in child welfare services and foster care compared to their share of the population. But Jonson-Reid and Drake conclude that “it is hard to find current empirical data that suggest that widespread bias within today’s CPS system is a significant driver of current disproportionality.” It would have helped if they had included the key research finding that actually debunked the myth about racism and disproportionality. As I have explained elsewhere, research has conclusively shown that higher Black representation in the child welfare system reflects higher rates of maltreatment in African-American families. This Black/White maltreatment gap may in turn reflect the relationship between race and poverty, as Jonson-Reid and Drake suggest.
  • State and local agencies have an incentive to take more kids into foster care. This trope was mentioned over and over again by supporters of the Family First and Prevention Services Act (FFPSA), which was signed into law on February 9, 2018. Jonson-Reid and Drake rightly give it short shrift. They explain that states are required to make “reasonable efforts” to keep children with their families and can be sanctioned by the federal government if they fail to document that they have made such efforts.  The authors could have cited some other key evidence against this myth.  For example, only about half of children in foster care are eligible for federal foster care support under Title IV-E of the Social Security Act and the federal government pays only part (50 to 83% depending on the state) of the cost. States and localities spent about $8 billion on foster care in FY 2014, 47% of their total child welfare spending, so it is hard to understand how they could have an incentive to place children in foster care. Moreover, states have access to other federal funds for services to intact families, such as TANF, Title IV-B, and the Social Services Block Grant.
  • Child welfare systems should prevent abuse and neglect. As the authors point out, child welfare systems (which they refer to as CPS, a term that I prefer to reserve for the investigation function only) have no truly preventative role. They are charged with responding to abuse and neglect after they have already occurred. This common misconception is particularly important in relation to the recent debate on FFPSA. Despite its name, the Act does not fund prevention; rather it funds treatment, or services to parents who have already maltreated their children. Obscuring the distinction between prevention and treatment prevents an honest and clear-headed debate about the appropriate allocation of resources between these purposes.
  • Child welfare is a broken system: Jonson-Reid and Drake argue that rather than being broken, the child welfare system has never been completed. They compare it to a fire department that will will send out a fire truck only 60% of the time, and often after the house has been consumed by flames. When a truck does respond, the firefighters may have minimal training in firefighting. A firefighter might show up without a truck and will have to wait until a truck with water is found. An injured person, instead of being taken into a hospital, may be placed in the home of someone who has no idea what treatment they need.
  • Child welfare can be fixed in a cost-neutral manner. Jonson-Reid and Drake point out that reform efforts (such as privatization or differential response) have often aimed to do more with less or the same amount of resources and have thus either done harm or failed to make a difference. They argue that any real improvement would raise costs but but could result in big long-run savings. They point out that we spend only $30 billion a year on child welfare when the long-term costs of child maltreatment have been estimated at $250 to $500 billion for each year’s cohort of victims.

The last myth is particularly poignant in view of the recent passage of FFPSA. It expands the use of federal Title IV-E funds to  services to parents at risk of losing their children  to foster care. But it  finances some of this new spending by taking money from other key functions of child welfare. like congregate care placements (necessary both for therapeutic reasons and to make up for the foster parent shortage), and foster care payments to kin, who will now not be allowed these payments if the parent is receiving federally-funded services.

Jonson-Reid and Drake end with an extensive list of suggestions for changing programming, policy and law. These include primary (or universal) prevention such as poverty reduction and educating parents about positive parenting, systemic improvements to child welfare (such as completing the system), and improving and expanding treatment for children and families. The list is somewhat overwhelming, but gives policymakers and advocates many options for where to start addressing this massive and complex problem.

After the Cradle Falls is a realistic and informed discussion of child welfare. It will be a useful resource to those who are open minded enough to accept the conclusions of science and common sense even when they conflict with the facile platitudes of ideologues, which have all too often had a disproportionate influence on policy and practice.

 

Yes, A System Should be Judged by One Case

Katia Tirado
Image: Hartford Courant

“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) Katz’ words were reported by the Hartford Courant.

Katz was referring to the case of Matthew Tirado. Matthew, a 17-year-old diagnosed with Autism and Intellectual Disability, died on February 14, 2017 from prolonged abuse and neglect by his mother.  As revealed by a heartbreaking  report from Connecticut’s Office of the Child Advocate (OCA), Matthew had been known to DCF for 11 years, since he was five years old. Yet, DCF missed several opportunities to save Matthew, who was nonverbal and could not speak for himself. Matthew’s interactions with DCF included:

  • In December 2005, when Matthew was six years old, his school called DCF to report that Matthew had missed more than 30 days of school since the school year began, . DCF investigated and found neglect but later closed the case after Matthew’s attendance briefly improved.
  • In December 2006, the school again contacted DCF to report that Matthew had missed over 50 days of school. DCF closed the case six weeks later without finding neglect. Matthew’s mother told DCF that her mother was moving in to help her care for the children. This should have been a red flag because agency files documented Matthew’s grandmother’s  long history of involvement with DCF, alcohol abuse and mental illness. But repeated risk assessments erroneously noted that Matthew’s mother had no history of being abused or neglected as a child.
  • In 2009, school officials again called CPS stating that Matthew came to school with bruising on his face that was covered up with makeup. School officials also reported contacting Ms. Tirado on other occasions regarding bruises, which she responded were inflicted by Matthew’s two-year-old sister.  Matthew’s mother denied abusing him and the case was closed before requested medical records arrived.
  • In October, 2014, Hartford Public Schools (HPS) reported that Matthew’s sister, a first-grader, showed signs of physical abuse and reported that her mother hit her. She told school staff that Matthew was also hit, but he was not seen or assessed.
  • In November 2014, HPS reported to DCF that Matthew was not enrolled in school and may not have been in school for a long time. In fact, Matthew had hardly attended school since 2012.  DCF found Ms. TIrado to be neglectful and abusive and opened a case on the family for supervision by the agency.
  • Matthew attended less than 100 days of school between June 2012 and his death in February 2017. HPS made five reports to DCF between October 2014 and May 2016. about the children’s failure to attend school.  After March 2016, Ms. Tirado refused to allow DCF access to her children. In July, DCS iled a neglect petition with the Juvenile Court.
  • The Court held six hearings on the case between July and December 2016 but Ms. Tirado never appeared. In December 2016 DCS asked the court to terminate the case. No orders were sought to compel Ms. Tirado to produce the children, permit visitation of Matthew’s sister in school, or to remove the children, even though there was legal justification for any of these actions. Unbelievably, after a failed attempt to compel Ms. Tirado to come to court, the court accepted DCS’ request to close the case. DCS closed its own case on the family in January 2017.

After Matthew’s death, the Hartford Courant reported that Commissioner Katz shockingly told legislators that “As horrible as this may sound, there comes a point where you have to make a determination that you have done all that you can legally do. There are 15,000 cases and only so many social workers.”

The Commissioner also said that a system should not be judged based on one case. It’s an old refrain. But is it true? I don’t think so. There are many reasons why a system should be judged by one case.

First, we are not talking about one bad decision. A child suffered for as long as 11 years and agency social workers missed multiple opportunities to protect him. His sister fared a little better since she survived but will probably bear lifetime scars. This is more than a one-time event.

Secondly, for each “worst case, “we don’t know how many children suffer for years and don’t die while the system ignores repeated red flags.  At least Matthew is out of his misery. The others are still suffering. We may never know their names.

I’m tired of agency heads who tell us not to judge the system by the worst cases. Lets bury this trope once and for all. A system should be judged–above all–by the worst cases. For each of these cases represents many more children whose daily suffering will lead to lifetime emotional educational and physical damage.