The Trials of Gabriel Fernandez: an all-too familiar story

TrialsofGabrielFernandez
Image: Facebook.com

On February 26, Netflix released a heartbreaking series, The Trials of Gabriel Fernandez.  Directed by Ben Knappenberger, the series centers on  the horrific death of an eight-year-old boy in the Antelope Value of California on May 24, 2013. Gabriel Fernandez died after eight months of torture by his mother and her boyfriend. Despite repeated reports to the child abuse hotline and the Sheriff’s Office, multiple investigations, and even an open family services case, there was no rescue for Gabriel. It was only after his death that the story of his last eight months and the inexplicable failure of the police and social services were revealed.

I wrote about Gabriel’s story in November 2018 in a post entitled, Why No One Saved Gabriel Fernandez. But The Trials of Gabriel Fernandez uses the power of video to bring the case alive in a way that is difficult to do in writing. The unusually calm voice of a mother tells a 911 operator her son is not breathing. An ambulance flies through the late-night streets, carrying an eight-year-old who had been resuscitated by the EMT’s and again in the ambulance and will stop breathing twice more in the ER. A little boy with injuries to almost every part of his small body, which will, in spite of all the heroic efforts by doctors and nurses to save him, finally shut down.

So begins The Trials of Gabriel Fernandez. In six excruciating but riveting episodes, The Trials tells the story of the Los Angeles Times investigation into Gabriel’s life and death, the trials of his murderers, and the unsuccessful attempt to hold accountable those professionals who failed him. Times reporter Garrett Therolf recounts learning of the eight-year-old’s death in a crime blog and wondering about the circumstances, being faced with self-protective wall secrecy and stonewalling imposed by the Los Angeles County Department of Children and Family Services (DCFS) and hearing from  a whistleblower who risked his job to reveal the truth. The prosecutor wheels into court the shockingly small cabinet where Gabriel spent his nights bound and gagged. Isaurro Aguirre sits impassive as a parade of witnesses describe the sweetness of Gabriel and the unspeakable nature of his injuries. Gabriel’s teacher fights back tears as she tells how she contacted CPS every time Gabriel arrived in school with increasingly bizarre and severe injuries. The partner of Gabriel’s uncle tells of the three-day-old infant they took home from the hospital because his mother did not want him, his growth into a joyful four-year-old, who was then raised by his grandparents for the next four years until he was returned to his mother for the welfare money. A bewildered social worker sheds tears of fear for her own future, claiming she had no idea anything was wrong in Gabriel’s home.

I identified two major systemic issues that could have been behind DCFS’ failure to rescue Gabriel. One of these issues–the focus on family preservation at all costs–was addressed in the documentary. The other issue–that of resources–was not. As Garrett Therolf put it in a brilliant article in The Atlantic, child welfare requires a balancing act between child safety and family preservation. Finding this difficult balance requires a highly trained workforce with the resources to carry out a thorough investigation in every case.” Overworked, undertrained, and underpaid social workers simply cannot do it.

Gabriel’s case was far from unique, as the documentary made clear. Two weeks after Isaurro Aguirre was sentenced to death for his murder of Gabriel, and Pearl Hernandez was sentenced to life without parole after taking a plea deal to avoid the death penalty, another little boy was dead of abuse in the Antelope Valley. Ten-year-old Anthony Avilas was allegedly killed by his mother and her boyfriend. His torture and abuse appeared to be motivated at least in part by homophobia, as in Gabriel’s case. And there was a long history of interactions with authorities with no help forthcoming for Anthony. Soon enough news arrived that a four year old named Noah Cuatro had died under similar circumstances in the Antelope Valley. Around California, over 150 children who were known to DCFS have died of abuse or neglect since Gabriel died, as reported in the documentary.

But this is not a California story alone. These cases happen all over the country. The Commission on Child Abuse and Neglect Fatalities estimated that a third to a half of the child maltreatment fatalities around the country involved families known to Child Protective Services. I write have written about some of these children whose cases made it to the mass media: Zymere Perkins in New York City,;Matthew Tirado in Connecticut; Adrian Jones and Evan Brewer in Kansas; the six Hart children in Minnesota, Oregon and Washington; Jordan Belliveau in Florida; and most recently Thomas Valva in New York. All were the subject of reports and investigations, and sometimes service cases, but all were allowed to die at the hands of murderous caretakers.

The power of video to bring about public awareness is truly awe-inspiring. Normally my posts are read mainly by academics, child advocates, and child welfare professionals. On February 27, I started to notice some unusual traffic on my blog. Between February 27 and the early morning of March, my posts on Gabriel, Anthony, Noah and other children failed by the state had been viewed over 2000 times. If only the public could keep up this level of interest –perhaps even follow my blog–and insist on adequate funding and an end to the wall of secrecy around child welfare services, we might be able to save the next Gabriel Fernandez.

 

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.  

 

 

Why The Child Welfare Establishment May Not Want to Know About Child Torture

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Image: CNN

The Child Welfare League of America (CWLA), one of America’s most venerable child welfare organizations, issued its weekly update on January 21 with something conspicuously missing.  “Last Week in Child Welfare, January 14 -21” contained updates on Mississippi’s lack of representation for families involved with child welfare, a recent report from New Jersey’s court monitor, and an opinion piece in the Indiana star about Indiana’s struggles with opioid abuse and its impact on the foster care system.

You would never know that on January 14, a starving seventeen-year-old escaped from a house of horrors where she and her twelve siblings were being starved, beaten, chained to beds, and kept prisoner. The teenager told police that her parents would kill her if her escape plan failed. During the week after the children’s rescue, public and press around the country and indeed the world were fixated on this story, trying to understand why it could happen and what could be done to prevent similar occurrences in the future. But this event apparently did not figure in CWLA’s “week in child welfare.”

One might think that an organization with a self-described mission “to advance policies, best practices and collaborative strategies that result in better outcomes for children, youth and families that are vulnerable” would be concerned that 13 children were allowed to suffer for so many years. You’d think that they would be putting out information  about the warning signs of child abuse and neglect and an admonition to make the call that might save a life. But you’d be wrong.

CWLA is part of what I think of as the child welfare establishment–the group that dominates the national conversation around child welfare. These organizations’ resources have enabled them to dominate the national conversation around child welfare by funding materials, conferences, and technical assistance to state and local child welfare agencies.  Since the 1970s, this group has been preoccupied with keeping families together and children out of foster care–with scant concern about the costs to kids in families that are so dysfunctional and dangerous that foster care is clearly a better alternative

Like the other members of the child welfare establishment, CWLA believes that “children fare better in their own homes compared to children in foster care who have been similarly maltreated, suggesting that social services should promote therapy, education, and treatments to increase family stability instead of relying on removals. ”

Of course child removals should should be minimized unless absolutely necessary, but it is difficult to imagine that parents like the Turpins could be helped through “therapy, education, and treatment” to love and nurture their children. The child welfare establishment appears not to want to believe in the existence of such parents who are so bad as to be beyond rehabilitation.

The child welfare establishment also fears that publicizing cases like that of the Turpins will result in a flood of calls to child abuse hotlines, resulting in the type of “foster care panic” that sometime occurs after a tragic case. Perhaps they would rather not encourage members of the public to report suspicions of child abuse that might save children in the future, because they believe such reports must increase the foster care rolls.

Of course we don’t want the public making frivolous, malicious, or fallacious reports. Nor do we want investigators responding to tragic events by sweeping kids up into foster care who don’t need to be there. In some cases, we can help children by monitoring their situation and providing services to their parents without removing the children. But in other cases, the children can only be protected by removing them from their toxic families.

The desire to avoid publicizing extreme cases of abuse and neglect might also explain why the child welfare establishment was not part of the coalition that supported the establishment of the Commission the Eliminate Child Abuse and Neglect Fatalities. And it might explain why, as I wrote in an earlier post, child deaths and other tragedies that are missed by CPS are often followed by the comment from system administrators that “systems should not be judged by one case.”

During the week the Turpins were uncovered, CWLA thought it was more important to cite an op-ed piece that criticized Indiana’s highly respected former child welfare commissioner, who resigned with warnings that children would die if more funding was not provided. CWLA assured readers that “Even infants who have been exposed to narcotics fare better when they are kept with their mothers, assuming the mother has access to government resources and drug treatments.”

Unfortunately, the child welfare establishment’s obsession with keeping kids out of foster care may be condemning more children to suffering, physical and emotional injury, and death at the hands of their own parents.

This post was updated on January 29, 2017.

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Turpin Case Shows Risks of Not Monitoring Home Schools

TurpinsIt seems that the whole country is talking about the Turpin family. Thirteen children and young adults were found imprisoned and emaciated in their home in Riverside County and California on January 14 after a seventeen-year-old escaped and called the police.

Reporters and politicians soon focused on one salient aspect of this family. The children were being ostensibly homeschooled under a provision of California law that allows parents to designate their homes as a private school by simply filing an affidavit. These “schools” are not monitored or inspected aside from an annual fire inspection.

I have already written about Natalie Finn. starved to death by her adoptive parents Adrian Jones, tortured to death by his mother and stepfather, and a little girl in Kentucky who was rescued at the last minute from a similar fate. All were ostensibly home-schooled, although little schooling was going on in these toxic homes.

Homeschooling is increasing in popularity in the United States. About 3.3 percent of the school-aged population was homeschooled in America in 2016. This is nearly double the percentage tin 1999. Clearly most of their parents are not abusive and want to provide the best education for their children, often at great personal sacrifice.

But available evidence suggests that the most severe cases of abuse and neglect, often fatal, tend to involve homeschooling.  A study by Barbara Knox of the University of Wisconsin found that 47% of a sample of children tortured by their parents had been withdrawn from school and an additional 29% had never been enrolled.

.The Coalition for Responsible Home Education (CRHE) has collected nearly 400 cases of severe or fatal child abuse in homeschool settings that it identified from public records that mentioned home schooling as a factor. Even based on this incomplete database, CRHE estimates that homeschooled children are more likely to die of abuse or neglect than children of the same age overall.

Many of  the severe and fatal homeschooling abuse cases that CRHE has collected share ugly details with the Turpin case. More than 40% of these cases involved some form of imprisonment. These children were chained to their beds, kept in cages, or locked in rooms for years. More than 45% of these cases involve food deprivation.

The linkage between home schooling and severe child abuse is not totally surprising. As Rachel Coleman and Kathryn Brightbill of CRHE point out in an op-ed piece for the Los Angeles Times, children who are in school cannot be isolated and locked away. They cannot easily be starved to death as school staff would notice and they would have access to food. And they are required to have an annual physical exam.

Of course children who attend school are abused and neglected too. But attending school exposes them to teachers and other staff. School staff submit more child abuse reports than any other group. Education personnel submitted 18.4% of the child maltreatment reports that received an investigation or alternative response in 2015, the most recent year for which the information is available

In order to prevent more cases like the Turpins, CRHE recommends requiring that homeschooled children receive annual education assessments and physical examinations. This would provide two opportunities for each child to be seen by a mandatory reporter.

State Assemblyman Jose Martinez, who represents the town where the Turpins live, has already expressed his concern about the lack of oversight of private and home schools and his intent to explore introducing legislation to mandate some type of oversight.

But homeschooling advocates are opposed to any regulations on homeschooling. The President of the powerful Home School Legal Defense Association (HSLDA) asked a reporter for Reuters, “Should all the innocent home-school families, who do a great job, … be intruded upon because of this family?” he said. “I think the answer is no.”

HSLDA is one of Washington’s most effective lobbying groups, according to the Washington Post Magazine. State groups have also been able to scuttle attempts to regulate homeschooling in response to child abuse deaths in Florida,  Iowa and Kentucky.

It is hard to understand why responsible homeschooling parents and their advocates would object to such minor requirements as requiring an annual doctor’s visit and educational assessment. State legislators should set aside their fears of backlash from extremist advocates and assume that most voters will support protecting children.