Opioid Crisis: Removing Infants from Mothers on Medication Assisted Treatment is Misguided

MAT
Image: drugabuse.gov

An NPR story (New Hampshire Mothers Struggling with Opioid Addiction Fight to Keep their Children) aired on June 2, 2018, introduced us to Jillian Broomstein, a New Hampshire mother whose two-week-old infant was removed from her by the state’s child welfare agency. Broomstein was on methodone to combat her addiction to heroin and it was working. She had not taken heroin for months.

Methadone is one of the two medications that is used in Medication Assisted Treatment (MAT) for Opioid Use Disorder.  MAT is “the use of medications in combination with counseling and behavioral therapies to provide a whole patient approach to the treatment of substance use disorders.” The medications commonly used to treat opioid addiction in pregnant women include methadone and buprenorphine.

Research has shown that MAT is the most effective treatment for opioid use disorder, at least doubling the rates of abstinence from opioids compared with treatments that use a placebo or no medication. MAT has been recognized by the World Health Organization as the most effective treatment for opioid use disorder. Moreover, MAT is the treatment the American College of Obstetricians and Gynecologists (ACOG) recommends for pregnant women with opioid use disorder.

Concerns about MAT for pregnant women arise from the fact that their infants may experience neonatal abstinence syndrome. But as the lead author of the ACOG guidance states, “Concern about medication-assisted treatment must be weighed against the negative effects of ongoing misuse of opioids, which can be much more detrimental to mom and baby.” MAT increases adherence to prenatal care and drug treatment and reduces the risk of pregnancy complications. Abrupt withdrawal from opiates or safer substitutes means a mother is more likely to relapse, thus making it less likely that she can reunify with her child. Neonatal abstinence syndrome, on the other hand, is treatable and does not appear to have lasting effects.

Bias against MAT among professionals working with substance-abusing families has been documented often. An excellent federal study, discussed in an earlier post, found that MAT is not always understood or accepted by child welfare professionals, judges or even in the substance abuse treatment community. One reason for such bias may be that many professionals have past experience with other types of drugs such as cocaine and methamphetamine, for which MAT is not available

Information on state policies regarding reporting, investigation, and placement of infants exposed to methadone and buphrenorphine is not readily available. A report from the Substance Abuse and Mental Health Administration suggests that New Hampshire is not alone, indicating that child welfare agencies “may use a positive toxicology result for methadone or buprenorphine at birth as a presumptive cause for child removal.”

In some states, on the other hand, these cases may not even be reported or investigated. Pennsylvania law requires reporting only if the drug is illegal, although individual hospitals may choose to report other cases. In Massachusetts, for example, the Department of Children and Family Services can screen out a report involving a substance-exposed newborn if the only substance affecting the newborn was methadone, buprenorphine or naltrexone and if the substance was used as part of a treatment program.

But do we know that methadone and buprenorphine are consistent with safe parenting? Unfortunately, there seems to be  no research evidence on this question. We do know that with stable dosing, methadone and buphrenorphine does not cause the euphoric “high” associated with heroin and prescription painkillers.

Removing infants from their mothers who are participating in MAT has many negative consequence. It disrupts the critical attachment process between infant and mother. It may lead discouraged mothers to go cold turkey in order to get their children back. This may lead to relapse and permanent loss of the children.

Instead of automatic removal of the children, new mothers on MAT should be supervised by CPS for at least six months to ensure that they are capable of safe parenting. During that period they should receive intensive services akin to those provided by Kentucky’s Sobriety Treatment and Recovery Teams (START), a program that has been in municipalities in New York, Indiana, Georgia and North Carolina. Each family is paired with a specially-trained CPS worker and a mentor who is in long-term recovery. Caseloads are limited and each family receives weekly visits from both the CPS worker and the mentor for the first 60 days. START has been rated as a promising practice by the California Evidence-Based Clearinghouse for Child Welfare.

Most states, particularly those ravaged by the opioid epidemic, are reporting critical shortages of foster homes. Preventing unnecessary foster care placements, in addition to the obvious benefits for parent-child attachment and long-term sobriety of the parent, will allow these homes to be available for children who really need them.

Abusive parents are using homeschooling to avoid detection

Hart family
Photo: Associated Press

On April 25, 2018, Connecticut’s Office of the Child Advocate (OCA) issued a stunning report. Using data from six school districts, OCA found that over a third of children removed from school to be homeschooled lived in families that had been reported at least once for abuse or neglect. This is the first publicly released data to suggest the extent to which homeschooling may serve as a vehicle for abusive parents to isolate their children from scrutiny by other adults.

The Child Advocate’s report was a follow-up to its investigation of the tragic death of Matthew Tirado.  On February 14, 2017 , Matthew died of homicide from prolonged child abuse and neglect by his mother. While Matthew was never formally withdrawn from school (though he had not attended for a year), OCA found that his mother was able to withdraw his sister from school after numerous reports by the school district alleging abuse and neglect in the home.

To determine whether other children from families that were the subject of child abuse allegations were withdrawn from school, OCA collected data from six Connecticut school districts, the Hartford District where the Tirados lived and five other districts selected for their diversity. Their analysis showed that over three school years, 2013-2016, 380 students were withdrawn from the six districts to be homeschooled. Of those students, an astonishing 138 (or 36%)  lived in families that were the subject of at least one prior accepted report of abuse or neglect. Most of these families had multiple prior reports, ranging from two to 30 reports. 11% of the withdrawn children belonged to families with four reports or more.

Executive Director Rachel Coleman of the Coalition for Responsible Home Education (CRHE) is not surprised by this percentage. She cites an unpublished study conducted in another state, which produced similar results. Coleman also cites the groundbreaking study of torture as a form of child abuse by Barbara Knox and colleagues. Of the school-aged victims they studied, 47% had been removed from school under the pretext of “homeschooling,” although no education was taking place in these homes. According to the researchers, this “homeschooling” “appears to have been designed to further isolate the child and typically occurred after closure of a previously opened CPS case.”

Like the parents in Connecticut and those studied by Knox, Jennifer and Sarah Hart removed their six children from school as soon as Minnesota CPS closed their last case in 2011. The school had made six reports concerning food deprivation and physical punishment, two of which resulted in findings of abuse. With their withdrawal from school, the children had lost their best advocates. They continued to endure starvation and cruel discipline until their deaths in 2018.

The OCA report suggests that “homeschooling is used to conceal abuse more frequently than has been commonly thought,” as Rachel Coleman puts it. With 1.7 million children being homeschooled today, it is possible that hundreds of thousands are living in abusive situations.

Abusive parents must not be allowed to withdraw their children from school on the pretext of homeschooling them. Legislators must act to require schools to report all withdrawals for the purpose of homeschooling to Child Protective Services (CPS) to be cross-checked for previous reports. Parents with at least one substantiated abuse or neglect report should not be allowed to homeschool. Parents who have been the subject of an unsubstantiated report could be allowed to homeschool, subject to frequent monitoring by the school district or CPS.

The powerful homeschool lobby will object to any such regulation of homeschooling. In California, a massive outcry from homeschooling parents killed a very modest bill to require annual fire inspections of all home schools, prompted by the Turpin case.  The Home School Legal Defense Association has stated that “abuse is horrible and must never be tolerated. But imposing regulations that treat all home-schooling families like criminals is unjust.” Nobody is suggesting that homeschooling parents be treated as criminals. Rather, they should be treated a little more like schools.

“Steady March Toward Child Fatality Prevention” leaves Many Endangered Children Unprotected

sad child
Image: socialworkhelper.com

In an April 26 Opinion piece in the Chronicle of Social Change, Teri Covington congratulated the child welfare establishment for a “steady march toward child fatality prevention,” citing new developments on the federal, state and local levels. Earlier that week, new details came out about a case involving six child abuse fatalities that had transfixed the nation. But any mention of the Hart case–or how we can address fatalities and near-fatalities from chronic and severe child abuse–was conspicuously missing from the article and the briefing conducted by Covington’s group on the same day.

On April 23, newspapers across the country carried new headlines about Jennifer and Sarah Hart and their six adoptive children, who drove off a California cliff to their deaths in March. The new information, released by the State of Oregon Department of Human Services (DHS), revealed that DHS knew of the Hart parents’ extensive CPS history in Minnesota and had convincing evidence of maltreatment in Oregon but was still unable to determine that abuse had occurred.

The Hart case may have been unusual in the sheer number of system failures involved, but none of the specific features of the case is unusual. In January, the 13 Turpin children who were saved from death by abuse and starvation by the extraordinary bravery of one child. Within the past year, we’ve learned about Brook Stagles in New York, Evan Brewer in Kansas, and many other children who were allowed to suffer ongoing torture and abuse because of failures of the community and the systems designed to protect them. And those are only the cases that made the headlines. We will never know how many other children have suffered and perhaps died of chronic and severe abuse without ever being discovered.

In the article and briefing, Ms. Covington cited a number of actions by federal, state, or local governments that fulfill one or more of the 100 recommendations of Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF). First and foremost according to Covington was the passage of the Family First and Prevention Services Act (FFPSA), which she hailed as a “seismic change,” because it makes resources available for the first time for services to prevent children who have already been abused or neglected from entering foster care. It’s hard to see how the passage of FFPSA could help victims of chronic and severe child abuse. The view that virtually no abused child should enter foster care may be one reason why many abused children are eventually killed by their parents. Moreover, it is hard to see how FFPSA will make the kind of difference expected by its advocates, since states are already funding the same services through funding streams like Medicaid and TANF.

Covington also mentioned the addition of $60 million in CAPTA funds in the current fiscal year for safe plans of care for drug-exposed infants as “another major federal improvement.” This is a good step that might aid in early identification of some children at risk of abuse, but it is a drop in the bucket compared to the need.

Several state and local initiatives mentioned by Covington are steps in the right direction to identifying victims of chronic and severe child abuse. These include the introduction of predictive analytics, improved data sharing between agencies, and more interagency planning and action.

However, conspicuously missing from Covington’s narrative are a set of major reforms that need to occur if we are to avoid more tragedies due to severe and chronic abuse. Some of these reforms are listed below:

  1. Improve vetting of potential adoptive parents. Jennifer and Sarah Hart arranged the adoption of their children through a Texas agency that reportedly put together adoptions against the wishes of the child welfare agency. Moreover, the second set of children was adopted even though the parents had already been investigated for abusing one of the first set. Agencies must not let their desperate search for homes for children considered to be hard to adopt lead them to disregard the future outcomes for these children.
  2. Monitor children whose parents receive adoption subsidies. Given the disproportionate number of serious cases of child maltreatment among adopted children and a valid state interest in the well-being of children supported by the state, parents receiving adoption subsidies should be required to document annually the child’s well-being through a social worker or doctor visit.
  3. Monitor homeschoolers and ban homeschooling by known child abusers. It is all too frequent for parents who have been substantiated for child abuse to withdraw their children from school as soon as their case is closed and they are no longer under the supervision of the child welfare agency. Parents with a record of abuse should not be allowed to homeschool their children. In addition, since homeschooled children appear to figure disproportionately in serious cases of abuse, all homeschooled children should have at least annual contact with a mandatory child abuse reporter such as a teacher, doctor or social worker.
  4. Adopt and promote universal mandatory reporting. Only 18 states and Puerto Rico require all adults to report suspected child abuse or neglect; most states require only certain professionals to do so. And even in the universal reporting states states (including Texas, where neighbors did not report the numerous red flags surrounding the Turpin family), it is unlikely that people know or observe the law. It should be mandatory for all adults to report any reasonable suspicion that a child is being maltreated and this duty should be promoted through a massive public information campaign.
  5. Demand greater accountability from mandatory reporters, as CECANF recommended. Incredibly, an Oregon pediatrician who saw the Hart children at the request of DHS reported that she had “no concern” that five out of six were so small and thin that their weights and heights did not even appear on the growth charts for children their age. CECANF recommended that mandatory reporting training and competency should be a requirement for licensure when applicable. Licensees and their agencies should be responsible for maintaining and refreshing their competency. And doctors who fail to fulfill their responsibilities should lose their licenses.
  6. Revamp investigations. Agencies need to separate the determination of whether abuse has occurred (which can be difficult when frightened children are coached to lie) from the decision to protect vulnerable children. Furthermore the definition of “safety” needs to be changed in many states. Often, a child deemed to be at high risk can be simultaneously labeled as “safe.” Thorough investigations also require manageable caseloads, which in turn require sufficient funding, which is not available in many states.
  7. Interstate registry: In child maltreatment death cases like that of Adrian Jones, parents have been able to escape detection by moving to another state. States should be required to participate in an interstate registry of child maltreatment reports and findings. This was recommended by foster care alumna and 2017 Congressional intern Tonisha Hora, who along with her sister suffered ten years of severe abuse before she was rescued by CPS.
  8. Reform in-home child welfare services so that meaningful services are provided and feedback is obtained from providers about parents’ progress. No case should be closed unless a state obtains credible testimony from service providers, the children and other professionals who know the family that parental behaviors have changed. Again, this require manageable caseloads and adequate funding.

Why were none of these proposals mentioned in the article and briefing? The most direct cause is that only one of these proposals (holding mandatory reporters accountable) was recommended (in part) by CECANF. But that just begs the question of why they were not among the CECANF recommendations.  There are three reasons I can identify:

  1. More children die of neglect than abuse. Of the children who were reported to the federal government who died of maltreatment in 2016, 75% suffered neglect and 44% suffered abuse either exclusively or in combination with another maltreatment type. At the briefing, a speaker from the Virginia Department of Social Services stated that unsafe sleep was the primary driver of child fatalities in Virginia, so the department was concentrating its fatality prevention work on safe sleep. Of course we should promote safe sleep, but we can’t ignore those children who die of severe and chronic child abuse because they are fewer in number.
  2. Many of these measures would draw intense political opposition for ideological reasons or because they would require increased spending. Homeschooling parents and adoptive parents have been adamantly opposed to any monitoring of their children. Doctors would virulently oppose greater penalties for malfeasance. Beefing up child welfare systems would cost money and systems around the country are struggling to obtain enough funds to meet increasing needs.
  3. The narrative currently embraced by the child welfare establishment is that all parents want the best for their children and that all children do best with their parents, no matter how abusive or neglectful. Perhaps that is why there has been so little response to the Hart tragedy and similar tragedies from the agencies responsible for protecting children.

The child welfare establishment needs to recognize that there are some parents to whom the prevalent rosy attitude simply does not apply. Ms. Covington opened her article by stating that deaths of children from abuse and neglect increased by more than 7 percent from 2015 to 2016. We don’t know how many of these deaths stemmed from severe and chronic child abuse. If there is such a thing as “a fate worse than death,” then years of torture by the people who are supposed to protect you qualifies. As you are reading this, how many children are being deprived of food, chained to their beds, or being beaten? One is too many, and political barriers should not be allowed to prevent action.

How to prevent more Hart cases

Hart family
Image: katu.com

In my last post, I discussed the tragic case of the six children adopted by Jennifer and Sarah Hart. The entire family is presumed dead in the crash of their SUV off a cliff in California on March 26. Multiple system gaps resulted in the failure to rescue these children before their tragic death. Below are some suggestions for filling these gaps so that children do not continue to suffer and die in abusive homes.

  1. Improve Vetting of Potential Adoptive Families. States that are desperate to find adoptive parents for large sibling groups or other children with special needs should not overlook obvious red flags. Clearly a past investigation for abuse of an adopted child–as in the Hart case– should have resulted in serious reconsideration of their application to adopt the sibling group that was currently living with them for a trial period. But the home study process should also be sophisticated enough to identify more subtle problems. These might include parents with a “white savior” complex who are adopting for the wrong reasons and are not suited to parent traumatized children.
  2. Monitor adoption subsidy recipients. The Harts received almost $2,000 a month in adoption subsidies, but the children were never monitored to ensure that all was well. All agencies paying adoption subsidies should verify periodically that the children are alive and well and still living in the adoptive home.  Submission of an annual doctor visit report, and/or an annual visit by a social worker could be used for such verification. There has been little support in the past for monitoring families receiving adoption subsidies, on the grounds that adoptive families should be treated the same as biological families. But the addition of money to the arrangement modifies the picture. Adoptive families sign contracts with the state, which could include a requirement that they cooperate with monitoring. When taxpayers are financing the care of our most vulnerable children until they reach adulthood, they should demand that the well-being of these children be regularly monitored.
  3. Regulate homeschooling. The Harts removed all their children from school after their child abuse case closed in Minnesota. The Coalition for Responsible Home Education (CRHE), an advocacy group for homeschooled children, recommends barring from homeschooling parents convicted of child abuse, sexual offenses, or other crimes that would disqualify them from employment as a school teacher. CRHE also recommends flagging other at-risk children (such as those with a history of CPS involvement) for additional monitoring and support and requiring an annual assessment of each homeschooled child by a mandatory reporter.  Unfortunately, the powerful homeschool lobby has beaten back attempts to impose such requirements in many states. But the climate may be changing, with a raft of horrific cases around the country (most recently the Turpins) resulting in proposals to require regulation.
  4. Adopt universal mandatory reporting and educate the public about reporting child maltreatment. If a friend who witnessed abuse by the Hart parents in 2013 or their Washington neighbors had reported their disconcerting observations earlier, the children’s lives might have been saved.  Eighteen states already require all adults to report suspected child abuse; the rest impose this requirement only on specified professional groups. All states should adopt universal mandatory reporting, but more importantly they should inform their residents about the signs of child maltreatment and the need to report. Public information campaigns should emphasize that the reporter need not have proof that there is maltreatment before making a report. As one child advocate puts it, “a reasonable suspicion that a child is at risk” warrants a call to the child abuse hotline. Better safe than sorry.
  5. Make investigations more child-friendly. A family friend who reported that the Harts deprived their children of food as punishment was told that CPS could not verify the allegation because the children had apparently been coached to lie. We need to rectify the pro-parent bias that allows many true allegations of abuse to be unsubstantiated or even not accepted for investigation. Investigators must be required to interview children before they can be “coached” by parents. If children appear to be coached, the case should be kept open until enough information is gathered to ensure they are safe.

The Hart children can be seen as victims of a “perfect storm”–adoption by unqualified parents, home schooling, neighbors who failed to report, history not shared between states, and inadequate investigations.  But it only takes one system failure to kill a child or scar one for life. All of these systemic gaps must be addressed, so that all children can have a real childhood and grow to be happy, productive adults.

 

 

Multiple System Failures Allowed Hart Children to Die

Hart family
Photo: Associated Press

On March 26, an SUV filled carrying a family plunged off a cliff. The car belonged to Jennifer and Sarah Hart. Their bodies, and those of three of their children, were found on the scene. Three children are still missing although another body found in the ocean may be one of the children. Initial coverage focused on the fact that the family consisted of two white mothers and six adopted black children. The family had had an earlier brush with fame when one of the boys was in a viral photograph hugging a police officer at a Ferguson protest.

As the days passed, disturbing details came to light. Days before the crash, Washington Child Protective Services (CPS) had opened an investigation of the family after a neighbor called the child abuse hotline. We eventually learned the family had a history of abuse reports. Then we learned that the crash appeared intentional, and probably triggered by the CPS report.

With each new discovery, we learned of another systemic failure to protect these vulnerable children. The Hart case brings together several common themes found in many cases of severe child maltreatment. Each of these themes highlights a different gap in the system that is supposed to protect our children.

Adoption: All six Hart children were adopted from foster care in Texas: three in 2006 and the next three in 2009. It is not that being adopted makes children more likely to be abused.  Indeed, one Dutch study indicated adopted children were less likely to be abused than children growing up in their biological families. However, anecdotal evidence suggests that adopted children are overrepresented among children who are severely abused or neglected, at least in homeschool settings. Many of these cases involve common elements, including locking children up in a room, withholding food, and isolating the child by homeschooling or other means, all of which were present in this case. One possible explanation for this pattern focuses on the traumatic backgrounds of many adoptive children, which may lead to behaviors that adoptive parents are not prepared to deal with. While they may start out with good intentions, they end up resorting to punitive and eventually abusive parenting to control the undesired behaviors.

Writer Stacey Patton has described a “white savior attitude” among some white parents who adopt black children from the U.S. or abroad. These parents “wear their transracial adoption as a status symbol.” These adoptive parents often post on social media about their extraordinary efforts to deal with their children’s emotional and intellectual challenges that they attribute to the deficiencies of their birth parents.” The Harts fit this pattern. According to the Oregonian, the Harts often said their children suffered a multitude of early childhood behavioral and developmental issues that made parenting a challenge.  Jennifer Hart also polished her image as an ideal mom who gave her underprivileged children a beautiful life. She frequently posted on Facebook portraying an idyllic family life full of trips, celebrations, community service, and events like the Ferguson rally in which Devonte sported a sign offering “Free Hugs.” When adoption is all about the parents, and the children become part of their public image, a bad outcome is not surprising.

There is reason for concern about the vetting process the Harts received when adopting the children. The Hart kids were among the 300 to 400 Texas children adopted each year by out of state foster parents, often because they are harder to place because they are in large sibling groups or have special needs. The Harts would have been vetted by a Minnesota agency, which would have submitted their home study to Texas for approval. After a child visit, the children would have probably moved in with the Harts for a six-month trial period. A Texas agency spokesman told the San Antonio Express-News that during the trial period for out-of-state adoptions, the out-of-state agency would be monitoring the family and reporting back to Texas. But in September 2008, probably during the trial period for the second adoption, Hannah Hart was asked about a bruise in her arm. She reported that her mother hit her with a belt. Police and social services interviewed the mothers, who denied the beating and said she had fallen down the stairs. Nevertheless, the second adoption went through. We need to know whether Texas was informed of this investigation.

Once the adoption was finalized, there was nobody monitoring the Hart children, even though Texas continued to pay for their care. The San Antonio Express-News reports that Jennifer Hart received nearly $1,900 per month in adoption subsidies from the State of Texas. The paper estimates that she collected a total of $270,000 from the state for caring for the six children during the time they lived with her. Unfortunately, children who receive adoption subsidies are not monitored to ensure that they are being properly cared for, are still in the home, or are even alive. Such monitoring has not been imposed even in the wake of cases in which adoptive parents like Renee Bowman and Edward and Linda Bryant have fraudulently collected adoption subsidies after killing–or allegedly killing–their children.

Home Schooling. On April 11, 2011, Sarah Hart made a plea agreement a week after pleading guilty to physical abuse of a six year old child. The next day, all six children were removed from school, never to attend again. The Harts joined a long line of abusive parents that removed their children from school after a brush with CPS. The notorious Turpin family, who gained worldwide attention this winter when one of their 13 malnourished children escaped confinement in their home, who also liked to dress their children in matching tee shirts. As the Coalition for Responsible Home Education points out, Pennsylvania is the only state that bars convicted child abusers from homeschooling, and then only if the conviction is in the past five years. No state has any mechanism to identify cases where parents remove a child from school after a child protective services case is closed, or after a series of child abuse allegations.

Failure to report: At a festival in Oregon, the Oregonian reports that one acquaintance observed the mothers become enraged after she brought Devonte and Sierra back to her parents from a day out, bearing food.  Sarah Hart grabbed Sierra’s arm, inflicting a bruise that lasted for days, and both mothers chastised her for “being selfish” and not sharing. Sierra told the woman that she often got in trouble for talking to people her mothers did not know. But the neighbor did not report the disturbing incident. The Hart family’s neighbors in Washington, Dana and Bruce DeKalb, told reporters that they had suspected that something was not right in the Hart household.  A few months after the Harts moved to Washington, the DeKalbs reported that Hannah Hart came to their door at 1:30 AM. She had jumped out of a second-story window and ran through bushes to their home, begging them to protect her from her abusive parents. The neighbors noted that she was missing her front teeth and appeared to be about seven years old, although she was twelve. The other children also appeared small and thin when the family came over the next morning.

The DeKalbs told the Washington Post that they considered calling CPS but “tried to overlook the incident.” In the next eight months, the DeKalbs saw Devonte doing chores but never saw the other children outside.  About a week before the crash,  Devonte began coming to the DeKalbs’ house requesting food and saying that his parents had been withholding food as punishment.  The visits escalated from daily to three times a day. It was only after a week of such visits that they finally called CPS, setting in motion the the escape attempt that ended in the fatal crash.The DeKalbs’ hesitation echoes that of the Turpins’ neighbors, who never reported the many red flags they saw.

Biased Investigative Process: As mentioned above, Oregon CPS was unable to substantiate a report from a family friend that the Harts were punishing the children by withholding food and emotionally abusing them. CPS interviewed the children but told the friend that it appeared they had been “coached” to lie, so there was no evidence to substantiate the allegation. The question is, why were the parents given enough warning that the children could be coached? This is only one example of how the system is biased toward parents’ rights over children’s safety.

Multiple systemic gaps allowed the abuse of the Hart children to continue until it culminated in the deaths of the entire family. A variety of policy changes are needed to address the gaps highlighted by this tragic case. I will discuss these in my next post.

 

 

 

 

Why Kansas let Adrian and Evan die

 

Dianne Keech, a former Kansas child welfare official and currently a child safety consultant, was asked by the Wichita Eagle and Fox News to analyze case files regarding the highly-publicized deaths of Adrian Jones and Evan Brewer.  I asked Ms. Keech to prepare a guest blog post about the factors contributing to the deaths of Evan and Adrian. She prepared a ten-page document, which you can access here. Below, I highlight some of her conclusions. 

Calls to the Kansas child abuse hotline began when Adrian Jones was only a few months old. There were 15 screened-in reports for Adrian before he was six years old. Out of 15 reports in total that KCF investigated, Keech found that there was only one substantiated allegation of abuse, and that was based on an investigation by law enforcement.  After Adrian was removed from his mother’s custody due to lack of supervision and placed with his father and stepmother, calls alleged that there were guns all over the house, that the stepmother was high on drugs, that Adrian had numerous physical injuries, that he was being choked by his father and stepmother, and that he was beaten until he bled.  Adrian’s father and stepmother consistently denied every allegation and the agency did nothing to verify their stories.  Adrian’s body was found in a livestock pen on November 20, 2015. It had been fed to pigs that were bought for this purpose. It was later found that Adrian’s father and stepmother had meticulously documented his abuse through photos and videos. They are serving life terms for his murder.

DCF received six separate reports of abuse of little Evan Brewer between July 2016 (when he was two years old) and May 2017. These reports involved methamphetamine abuse by the mother, domestic violence, and physical abuse of Evan. Only three of these reports were assigned for investigation and none were substantiated.  In the last two months of Evan’s life, the agency received two reports of near-fatal abuse, one alleging that he hit his head and became unconscious in the bathtub and the other alleging that his mother’s boyfriend choked Evan and then revived him. The first of these reports received no response for six days and the investigator apparently accepted the mother’s claim that the child was out of state. The investigator of the second report also never laid eyes on Evan.  On September 22, a landlord found Evan’s body encased in concrete on his property. Horrific photos and videos documented Evan’s months of torture by his mother and her boyfriend. His mother and her boyfriend have been charged with first-degree murder. 

Looking at Root Problems

Keech believes that there are three root problems that led to Adrian and Evan’s deaths: a dangerous ideology, the pernicious influence of a well-heeled foundation, and faulty outcome measures used by the federal government. These are discussed in order below.

Dangerous Ideology: Signs of Safety is a child protection practice framework that was never officially adopted by Kansas. But Keech alleges that its philosophy has permeated all aspects of child welfare practice in the state. The Signs of Safety framework, according to its manual, seeks to avoid “paternalism,” which “occurs whenever the professional adopts the position that they know what is wrong in the lives of client families and they know what the solutions are to those problems.” Signs of safety links paternalism with the concept of subjective truth, citing  “the paternalistic impulse to establish the truth of any given situation.” According to Keech, this implication that all truth is subjective  means that investigating “facts” is a worthless task.  Workers are encouraged to “engage” parents, not investigate them.  Keech gives numerous examples of how this practice approach left Evan and Adrian vulnerable to further abuse. When Adrian’s younger sister was brought to the hospital with seizures, she was diagnosed with a subdural head trauma that was non-accidental. But when Adrian’s stepmother insisted that Adrian inflicted the injury with a curtain rod, DCF believed her and did not substantiate the allegation–not even finding her neglectful for letting the child be hurt. When DCF received a report that Evan’s mother was using methamphetamine and blowing marijuana in his face, they accepted her denials and closed the case with no drug test required.

Along with a new practice framework, Kansas adopted a new definition of safety. As in many other states, safety in Kansas has been redefined as the absence of “imminent danger.” This is in contrast to “risk,” which connotes future danger to the child. As a result, children can be paradoxically found to be at high risk of future harm but safe–which happened twice with Adrian. (He was found to be at “moderate” risk three times.) As long as a child is deemed “safe,” the child cannot be removed from home. The decoupling of risk from safety explains why both Adrian and Evan were found to be “safe” 18 times in total, when they were anything but. This is a common situation in many other states. “Risk,” on the other hand, triggers an offer of services, which can be refused, which is what Adrian’s father and stepmother did when he was found to be at risk. I’ve written about the case of Yonatan Aguilar in California, who was found four times to be at high risk of future maltreatment but “safe.” His parents refused services. He spent the last three years of his life locked in a closet until he died.

Pernicious Influence: Casey Family Programs is a financial behemoth with total assets of $2.2 billion. Its mission is to “provide and improve, and ultimately prevent the need for, foster care.'”Over a decade ago, Casey set a goal of reducing foster care by 50% by the year 2020.  Casey works in all 50 states, the District of Columbia, two territories and more than a dozen tribal nations.  It provides financial and technical assistance to state and local agencies to support its vision. It conducts research, develops publications, provides testimony to promote its views to public officials around the country.  As Keech puts it, “There is not a corner of child welfare in the United States where Casey is not a highly influential presence.” Keech has experienced firsthand Casey’s efforts to pressure Kansas to reduce its foster care rolls.  At a meeting in that Keech attended in 2015, Casey used “peer pressure” to “shame one region for having a higher foster care placement rate.  Casey adopted and promoted the Signs of Safety approach discussed above.

Faulty Federal Outcome Measures: The Child and Family Services Review (CFSR) is an intense federal review of the entire child welfare system.  If a state does not pass the review (and no state has passed, to date) then the state must agree with the federal government on a Program Improvement Plan (PIP) or lose funding. Keech feels that the federal reviews can be manipulated by states to improve their outcomes at a cost to child safety.  For example, one of the two measures of child safety is timely initiation of investigations. When a hotline screens out a report (as was done three times with Evan)  or a case manager fails to report a new allegation (which was done three times while Adrian had an open services case) the agency does not need to worry about timely initiation of an investigation. Another CFSR outcome is “reduce recurrence of child abuse and neglect, ” which is measured by calculating the percentage of children with a substantiated finding of maltreatment who have another substantiated finding within 12 months of the initial finding. This outcome can be improved by failing to investigate reports, or investigating them but failing to substantiate. Only one of the allegations involving Adrian was substantiated; three of the allegations involving Evan were not even investigated and the other three were not substantiated. By not substantiating allegations, Kansas reduces its recurrence rate. 

The factors that Keech discusses are not unique to Kansas and are occurring around the country, in states including most of America’s children. All of these states should consider Keech’s recommendations for protecting Kansas’ children from the fate of Adrian and Evan.  Most importantly, states need to prioritize the safety of children over and above any other consideration.   The primary goal of child welfare must be the protection of children, not reducing entries to foster care. The artificial division between risk and safety should be eliminated and risk should be allowed to inform safety decisions. States must treat substance abuse, domestic violence, criminal activity, mental health issues, and parental history of maltreatment, as real  threats to child safety. Workers must be empowered and required to gather all of the information needed to determine the truth of allegations, not rely on adults’ self-serving denials. And they must be allowed–and required–to request out of home placement when there is no other way to protect a child.  

 

 

Childhood trauma: Let’s invest in prevention as well as treatment

Oprah childhood trauma
Image: jsonline.com

In the past decade, the world has discovered trauma. More and more “trauma-informed” models of care have been developed, and more and more institutions and government agencies have adopted these models, making a lot of money for their developers. Awareness of trauma and trauma-informed care took a big leap with its discovery by Oprah Winfrey, who highlighted in a 60 Minutes segment the adoption of the approach by her home town of Milwaukee.

Recognizing the impacts of trauma on human development and incorporating this knowledge into education, social services and other areas is important. But I wish we could devote as much attention to preventing trauma as we do to treating its effects.

Oprah’s story started with the case of Alisha Fox. She was removed from her mother at the age of one and placed in foster care. At the age of four, she was placed with her father, “a sometimes construction worker prone to heavy marijuana use and violent bouts of depression, “according to an article in the Milwaukee Journal-Sentinel which inspired Oprah’s story.  For the next ten years, Alisha endured sexual abuse by her father. By the time she revealed the abuse and was removed from her father, she had a full-blown case of Post Traumatic Stress Disorder (PTSD).

Whether Alisha’s trauma could  have been prevented is not clear. The child welfare system may have erred in placing her with a deeply troubled and drug-abusing father. Alisha told the Journal Sentinel that she covered up the abuse until age 14. It is common for abused children not to report their abuse. One can’t help but wonder if there were warning signs that were disregarded. There is more awareness now of the signs of child sexual abuse than there was when Alisha was a child. So we just don’t know if Alisha’s years of trauma could have been cut short or if other children in her situation can nowadays be protected better than she was.

But we do know that many other children are abused for years while numerous red flags are disregarded. Nobody called the authorities about the 13 Turpin children as they were beaten, starved and chained for years in two states, even though family and neighbors in two states noted numerous warning signs. Texas neighbors considered reporting but had seen Turpin with a gun and feared “repercussions.” California neighbors perceived a peculiar and private family but claimed not to draw the conclusion that abuse was occurring.

Other traumatized children are reported numerous times but the system never intervenes to help them. We we often hear about these children only after they die.  Evan Brewer was killed by his mother’s boyfriend after the Kansas child welfare agency had received eight reports that Evan was living in a home of chronic meth users and that the mother’s boyfriend was choking him until he blacked out. For every Evan Brewer who is finally killed, there must be many more Alisha Roths, who escape after years of suffering. Or like Congressional intern Tonisha Hora who wrote:

At 14 years old, my twin sister and I were removed from a kinship care placement and put in foster care after experiencing severe physical and verbal abuse for ten years…Child Protective Services often visited our home, sometimes multiple times a year, after they received reports from neighbors and teachers who we often asked for food to keep from being hungry or saw our bruises. We were scared children who wanted to run away every day in hopes of escaping. We were aware of how the system continued to fail us by never removing us from our home when they should have. To us, the signs were obvious, yet CPS workers always left us there. The abuse worsened after every CPS visit. That was the problem: they always left without us. Every time. For ten years.

There are things we can do to save the Alishas, Tonishas and Evans of this world before they end up with PTSD or die. We need universal mandatory reporting accompanied by a massive public education campaign about the signs of child abuse and the duty to report even a suspicion of maltreatment. We need enough funding to ensure that CPS workers are qualified and have time to make good decisions. And we need to ensure that the current bias by agencies around the country toward  preserving and reunifying families does not go too far and leave children to suffer in silence.

It is great that cities, states and the federal government are investing in trauma-informed care. Lets hope that with the help of citizen input, they soon decide to allocate equal resources to save traumatized children before they suffer as long as Alisha did.