Child protection in the time of Covid-19: what we know and what we can do

Every year when school resumes after summer vacation, child welfare agencies brace themselves for an onslaught of reports as teachers see children after the entire summer and flood hotlines with reports of suspected abuse or neglect.  Earlier in the year, many officials and advocates expressed concern that this fall would see any even greater surge of calls than usual and that child welfare agencies would be overwhelmed. But as more and more schools and systems opted for a virtual opening this year, policymakers and advocates began to worry about the opposite problem–a continued dearth of reports to child abuse hotlines and a continued fear that children are suffering unseen.

A chorus of media reports from all over the country last spring documented drastic drops in calls to child abuse hotlines following school closures due to the coronavirus pandemic. As Child Welfare Monitor reported, almost every state reported declines in hotline calls last spring, with calls dropping often by half and sometimes by as much as 70 percent since schools shut their doors. A survey of children’s advocacy centers, which work with victims of physical and sexual abuse nationwide, found a 21 percent drop in the number of children served in January through June of 2020 compared to the same period in 2019; the drop would probably be much greater if only March through June were considered.

The loss of reports from schools was the primary explanation for the drops in reports of child maltreatment. And indeed the shift to online education delivered a double-whammy to any attempts at child protection. For children who did attend virtually, it was harder for teacher to see signs of trouble, like bruises or hunger. And many students who did did not show up for virtual education regularly or at all. The New York Times heard from many teachers around the country that fewer than half of their students were participating in online education. The School Superintendent in Los Angeles has reported that only 60 percent of students participated daily in online learning last spring. A child’s failure to participate may reflect the lack of a dedicated computer or internet access, difficulties in accessing platforms, a child too busy watching siblings or even working, or lack of engagement in virtual education.  Whatever the explanation for their absence, these children were not being seen by teachers, counselors or other school staff, often the ones who notice red flags. Other reporters, like doctors and extended family members, were also less likely to see children under the Covid-19 quarantine. 

More detailed data from Allegheny County Pennsylvania and two Colorado counties (shared in a webinar from Mathematica Policy Research) and from Maine (shared in a Child Welfare League of America webinar) shed some light on changes in reporting trends in the last school year and what they might mean.  The number of calls to child abuse hotlines (also called reports or referrals), as compared to the previous year, fell dramatically in all three states. The decline in reports was especially marked among teachers and other school staff such as counselors. In all the jurisdictions  the lower-risk referrals tended to drop off the most. In the data for Colorado and Allegheny County, where predictive risk modeling is used to screen hotline calls,  the average risk scores of the children being referred rose, suggesting that the lower-risk referrals tended to drop off more than the higher risk referrals. Maine officials found that reports were generally more severe and that they were getting fewer reports that were screened out as inappropriate or because there were multiple reports from the same family. Participants in both webinars suggested that in normal times schools make too many unnecessary reports for minor issues, and that many of these reports were being suppressed by the school closures.

It is encouraging that less serious referrals are more likely to be dropped than more serious ones, but it is equally clear that higher-risk referrals are being lost as well. Another important indicator is the percentage of referrals that result in a substantiation–or a finding that abuse or neglect has occurred. If the missing referrals were mainly frivolous,  we would expect a big increase in the percentage of reports that was substantiated. That did not occur in at least one state–Michigan–spurring its child welfare director to design an initiative discussed below. Unfortunately, substantiation data on a national level for last spring will not be available for another year from the federal government. 

At the same time that reports dropped, many child advocates have expressed fear that child maltreatment has actually increased. Based on past research, family violence increases in times of natural or economic disasters, probably in large part due to parental stress. In addition to the stress imposed by job loss and health concerns, parents who are cooped up in close quarters for months with their children may be more prone to respond with violence. And parents who need to work despite school closures may leave their children uncared for or with caregivers who are unprepared.

Despite these reasons to suspect that child maltreatment may be increasing, we do not have any national data to confirm or deny it. Data from individual hospitals in various locations around the country has been cited to demonstrate that cases of severe child abuse are increasing. Hospitals around the country have reported increases in serious injuries and even deaths compared to previous years. Reports of such excessive child abuse injuries and deaths have come from hospitals in Fort Worth, Texas, Orlando, Florida, Colorado Springs, Colorado, Washington, DC, and Pennsylvania. But without systematic data from hospitals, we really cannot know if this represents a national trend.

Last Spring, child advocates worried about the unseen children who would have to wait until schools reopened after the summer to have their situation discovered. But as more and more districts abandoned plans to open school buildings, it became clear that the anticipated onslaught of hotline calls would not occur in these jurisdictions. What can be done to ensure that children are safe? Several different approaches have been tried or suggested.

Public awareness campaigns: Some jurisdictions have instituted publicity campaigns encouraging members of the community to  report child abuse and neglect. For example,  the New Jersey Department of Children and Families launched a ‘Social Distancing Shouldn’t Mean Social Isolation’ campaign to raise awareness about child abuse, domestic violence and other dangers facing residents while homebound. It include a flyer about warning signs of child abuse as well as a more general resource that includes telephone numbers for the child abuse, domestic violence, mental health, and other hotlines. 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.

Providing new guidance to traditional reporters: Some agencies have created new resources to share with educators and other traditional reporters of child abuse and neglect.  Maine issued guidance for educators, medical personnel, and community members to help them identify warning signs of child abuse and neglect in a time of virtual education.  CHILD USA released a useful list of Tips for Teachers on Child Welfare and Online Safety during COVID-19 which suggests questions for teachers to ask that are targeted at elementary, middle and high school students. The questions focus on food, physical safety and online safety. The document also includes tips on what to look for in the home environment as perceived through a computer screen. The Zero Abuse Project has published Responding to Child Abuse During a Pandemic: 25 Tips for MDT’s, which provides tips that might be useful for child welfare agencies as well. The authors included some valuable advice, such as a reminder to teachers that abuse has been shown to increase after a child receives a bad report card. They suggest that teachers. contact parents in advance of giving out a bad grade, promise to follow up (with the hope of defusing any violence) and call authorities if parents indicate a plan to punish the child physically,.

Reaching Out to Nontraditional Reporters: Some child advocates like family violence researcher Andrew Campbell have urged states to reach out to nontraditional reporters, such as postal workers, garbage collectors, and home repair agencies, who are continuing to see children as they move through homes and neighborhoods. A simple postcard listing the warning signs of child maltreatment and the phone number of the child abuse hotline could be distributed to businesses and agencies employing such workers. Animal protection agencies are another potential community partner for child welfare agencies, as Campbell also suggests. Animal control officers could be trained and enlisted to check up on the wellbeing of humans as well as animals in homes where animal abuse has been reported.

School Based Approaches: Schools have a critical role to play in ensuring that children can be protected in a time of virtual schooling. Districts must make sure that all students have access to a computer and high-speed internet service. It is critical that they adopt a policy of checking in with all students they have not been able to reach for a specified period of time, whether a day or a week.  Clearly this is easier said than done in schools serving largely disadvantaged populations. Media outlets have reported on the herculean efforts of dedicated school staff who have spent months trying to locate students who were missing from virtual education. Schools can also provide training to their teachers in how to spot red flags in virtual meetings, as Pueblo County Colorado has done. Schools should also consider adding to their virtual platforms an option for children to indicate that they are in trouble at home and need help. 

Reaching out to at-risk families known to the system: Noticing the precipitous fall in calls to the hotline without a corresponding rise in substantiation rates, Michigan’s child welfare director JooYeun Chang feared  that some children in need were “simply invisible,” as she explained to the editor of The Imprint. Before the pandemic arrived, the agency had commissioned an assessment from Chapin-Hall, a child welfare think-tank, which had identified 14,000 families that had been involved with the agency and had a high risk of children entering foster care without receiving additional preventive services. About 1,000 child protection workers freed up by the decline in hotline calls were assigned to reach out to these families to find out if they needed any type of assistance. Data provided to Child Welfare Monitor indicate that workers spoke with 8,267 of the 14,162 families on the list, and 80 percent of the families received a text, email, or mailing. Workers provided general support, information and referrals. Many parents expressed great appreciation for the calls; some conversations lasted 45 to 90 minutes. One worker was able to contact a cash assistance worker and rectify the erroneous closing of a case, another provided referrals to a father struggling with physical and mental health problems who thanked the worker several times just for listening. The agency is now reaching out to another 10,000 families that were investigated since the Covid-19 shutdowns began.

Inspired by Michigan, Allegheny County, Pennsylvania DHS is using staff and community partners to connect with higher-risk families involved in child welfare cases that closed six months earlier, to check in and find out whether they need help with food, housing or other services. Checking in with families to offer assistance is not designed to identify ongoing abuse or neglect. However, it may reduce the probability of child maltreatment recurrence by helping families meet concrete needs for food, clothing and shelter and even by offering them a friendly ear and reducing their social isolation.

Investing in Prevention: Interest in preventing child maltreatment before it occurs as was already growing before the Covid-19 pandemic. The drop in CPS reports under virtual schooling has led to even more interest in prevention.  Particularly relevant are secondary prevention approaches, which target families that are at risk of child maltreatment. Michigan DHHS under Jooyeun Chang is working on a new pilot that will be run by a nonprofit in two of the five Detroit zip codes from which the bulk of Detroit’s foster youth were removed. The program will target 400 families (chosen based on the previous calls), who will each receive a peer counselor with similar “lived experience” and a benefits navigator, who will connect the family to needed resources in the community. Combining peer counseling and benefits navigation is an innovative approach that may enhance the value of each of these components when provided together. In addition to the peer navigators, group activities will provide needed information and help participants build their social networks.

The Allegheny County (Pennsylvania) Department of Human Services (DHS) is launching the Hello Baby prevention program in partnership with local Healthy Start and Family Centers. The program, which is voluntary and not affiliated with child protective services, is an interesting hybrid of universal and targeted prevention. It will be offered to all families with a new baby but will offer three levels of services to families depending on how they score based on a predictive risk model using integrated data from multiple sources. The families with the most profound needs will be offered intensive services through Healthy Start Pittsburgh while others will be welcomed to their neighborhood Family Center and/or offered a variety of web-based and “warmline” supports and resources. While the program has not yet launched officially, DHS has soft-launched in some communities with a high density of vulnerable families.

The approaches outlined above fall into two broad categories: initiatives to enhance detection and reporting of child abuse and neglect and those designed to prevent it. These approaches are often supported by different groups in the child welfare space. However, both approaches are valid and important. We cannot go back in time and prevent the abuse and neglect that are already occurring, so we must have a robust system of reporting and investigation to find the children who need protection. On the other hand, to the extent that we can prevent future abuse and neglect before it starts, the benefits would be enormous.

 

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.

 

 

Around the country, states face shortage of foster homes for youth with greater needs

Red Rock Canyon
Image: Salt Lake Tribune

Around the country, young people in foster care–especially those with greater needs– are being housed in facilities not designed for them because appropriate placements are not available. Children who are already traumatized by abuse or neglect are being warehoused in agency offices, hotels, emergency shelters, out-of-state facilities, and even detention centers, resulting in further harm to these most vulnerable children and high present and future costs for taxpayers.

Many youth in foster care have serious emotional and behavioral issues. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. Around the country, these youths are being placed in inappropriate settings because the right ones are not available.

  • In the letter accompanying his annual budget request, The head of Washington‘s Department of Children Youth and Families has acknowledged the scarcity of “therapeutic group home and facility-based placements for children with severe behavioral issues that don’t enable them to be successful in private foster homes.” As a result, he states, children are being placed in foster homes that are unequipped to handle them, resulting in further damage to the child and often a loss of the foster parent to the system. The lack of appropriate placements also led to over 2000 instances last year of children staying overnight in a hotel or office accompanied by a caseworker; and “excessive use of expensive one-night placements at extraordinary cost and detriment to the child.”
  • In 2016, the discovery that some Oregon children were sleeping in hotels or offices due to a lack of other options resulted in a public outcry and a class action lawsuit. In response, the state drastically reduced its practice of sending foster kids to hotels. But at the same time, according to an investigation by Oregon Public Broadcasting (OPB), the state began sending more foster kids requiring a higher level of care to out-of-state residential treatment facilities.  The majority of these children were housed in facilities run by one for-profit company called Sequel, as reported by OPB in a second installment of its investigation. After reports of abuse and neglect by staff resulted in the closure of five Sequel Facilities, Oregon began bringing its children home. There are now 30 children (down from 84 in February 2019) at out-of-state facilities, all of them run by Sequel, according to OPB.
  • Texas has projected that by 2021 it will have only 90% of the foster homes or other facilities it needs for youths with “specialized” or “intensive” needs (including 24-hour supervision from specially trained caregivers. ) And in some regions of the state the shortages will be much more severe, meaning that children will have to be sent far away if a spot can be found at all..
  • Illinois has had a longstanding problem of children being left in psychiatric hospitals after they have been cleared for release, a practice labeled as  “Beyond Medical Necessity (BMN). The Inspector General for the Department of Children and Family Services has reported that there were approximately 308 episodes of BMN during FY 2019 involving 297 individual youths. Such long stays in such an inappropriate setting result in further damage to children’s mental health. Moreover, the state cannot receive Medicaid reimbursement for such hospitalizations, leaving the state to foot the bill. In FY 2019, children left in psychiatric hospitals BMN ranged in age from 3 or 4 to 19 or 20 with the largest number being between 14 and 16. In FY 2019, 94 youths were hospitalized between 31 and 60 days and 154 youths were hospitalized from 61 to 120 days. The longest BMN hospitalization involved a fifteen-year-old who was hospitalized for 279 days.
  • As I discussed in an earlier post, an alarming report last March indicated that New York City children with behavior problems or mental illness were staying for months at an intake center where they are supposed to be no longer than a few hours until a real placement can be arranged. Instead they were staying as long as a year in this center, where social worker have described an atmosphere of chaos, violence, weapons in plain sight, feces-smeared walls, overcrowding and “a dangerous mix of babies and young children with special needs living alongside troubled teens and even adults straight out of jail.”
  • In my own jurisdiction of the District of Columbia. a special hearing was recently held in a longstanding class action case to discuss the current placement crisis. The Judge, referring to a letter that is not available to the public, reported that 31 children, including seven children between eight and ten years old, experienced a total of 60 overnight stays at the Child and Family Services Agency between April and November of 2019. All of these children had challenging behaviors that excluded them from existing placements. The agency director acknowledged that the District needs more therapeutic placements (either in family or group settings) for these children. The District is in the process of developing some new therapeutic placements but it is not clear that they will be enough to meet the need.

As many are already beginning to do, states must expand their array of placements for the young people with the most serious needs. There is increased interest in developing a cadre of highly trained professional foster parents for whom caring for hard-to-place youths is a full-time job. This may be the best option for many children, but these programs, where they exist, are very small both due to cost and to a small pool of people willing to take on this difficult job. So there will still be a need for more therapeutic group settings. In states including California and Florida there have even been calls for secure therapeutic settings to be established for the most disturbed youths. Child welfare agencies should coordinate with other agencies serving the same youths. such as developmental disabilities, mental health, and juvenile justice agencies, to develop a continuum of appropriate residential placements for all the youths who need them.

Leaders from Washington State to Washington, DC have already begun increasing budgets for therapeutic options including professional foster care and therapeutic group homes. But unfortunately the task of expanding the placement array to accommodate foster youth with greater needs will be made more challenging due to the new Family First Prevention Services Act. This Act was based on a false narrative that nearly all children can succeed in foster homes and that congregate (or non-family) care is always harmful to youth. Believers in this narrative combined with legislators who supported the law because it would reduce government spending. Family First makes it more difficult to place children in congregate care facilities and requires these facilities to meet a number of criteria, such as accreditation, a trauma-informed model, and 24-hour nursing staff in order to be eligible for funding under Title IV-E.

California is one indicator of what might happen under Family First because it is deep into a similar state-level reform called Continuum of Care. So far, many group homes have been closed or have been denied a license to care for foster kids. One veteran service provider in California writes that “there are fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care.” Family First will result in a replication of the California situation around the nation. At a time when we need more therapeutic facilities, Congress has made it more difficult for those in existence to continue and for new ones to be established.

As in many other areas, America has been penny-wise and pound-foolish in its reluctance to spend money on therapeutic placements for the most damaged young people in the foster care system. The new federal funding framework makes it even more difficult to fund the placements that the hardest to place children need. Let’s hope that states recognize that failing to provide therapeutic placements for these most fragile children now will only result in much greater costs later.

 

 

Family First Act: no funding for important drug treatment and mental health services

Family First ActPassage of the Family First Prevention Services Act as part of the Bipartisan Budget Act early in 2018 was hailed as a game changer in child welfare.  For the first time, according to the celebrants, Title IV-E funds could be used to pay for services to keep families intact rather than place children in foster care. But the more we learn about Family First and how it is being implemented, the less cause for celebration there seems to be. In my last post, I discussed the problems caused by the decision to make Title IV-E the payer of last resort for foster care prevention services. In this post, I discuss the surprising omission of important mental health and drug treatment programs from the list of programs that have been approved or proposed to be paid for under Family First. The paucity of useful programs in the clearinghouse certainly will detract from the utility of Family First in preventing foster care placements.

In expanding the use of federal IV-matching funds beyond foster care through Family First, Congress wanted “to provide enhanced support to children and families and prevent foster care placements through the provisions of mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, and kinship navigator services.” Family First allowed federal Title IV-E matching funds to be used for programs in these categories that meet criteria for being “evidence-based” as defined by the Act.

The categories  of mental health, drug treatment and parenting programs make sense in light of what we know about why children come into foster care. Anyone who has worked in foster care knows that parental drug abuse and mental illness are two of the major circumstances behind child removals, while a third major factor, domestic violence, was inexplicably left out of the Act. The inclusion of parenting programs makes sense because abuse in particular is often related to parents’ lack of knowledge about child development and appropriate disciplinary practices.

Family First established a Title IV-E Prevention Services Clearinghouse, which is being developed under contract by Abt Associates, to review and approve programs for reimbursement using Title IV-E foster care prevention funds. So far, the clearinghouse has approved nine programs for inclusion and is in the process of considering 21 more. A careful look at the programs that are included, under review, and not on either list raises some questions.

Take substance abuse treatment, the most common single factor behind child removals according to federal AFCARS data, which indicates that drug abuse was a factor in 36% of the child removals that took place in Fiscal Year 2018. The opioid crisis, often cited as a reason to pass Family First, seems to have peaked in most areas but is still wreaking havoc in many states and their foster care systems. Medication-assisted treatment is often called the “gold standard” for treating opioid addiction and is vastly underutilized. But strangely that Abt Associates chose to include in the clearinghouse only Methadone Maintenance Therapy and not the newer buprenorphine treatment, which is not even on the list of programs to be considered for clearinghouse listing.  According to the National Institute on Drug abuse, “Methadone and buprenorphine are equally effective at reducing opioid use.” And there are reasons to prefer the newer medication. As the federal Substance Abuse and Mental Health Administration (SAMHSA) states, unlike methadone treatment, “which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.”

Let’s turn to mental health. It is clear that mental illness is the major factor behind many removals into foster care. AFCARS data indicate that 14% of child removals are associated with a “caregiver’s inability to cope,” but that percentage sounds small to this former social worker. It is likely that many more removals where other factors (like child abuse and substance abuse) are cited are also related to parental mental illness. Parents suffering from untreated depression, bipolar disorder, post-traumatic stress disorder (PTSD), and other mental health disorders often have difficulty providing appropriate care to their children. So it is not surprising that mental health was included as a category of services to prevent foster care under Family First.

What is surprising is the nature of the services that have been chosen so far. The clearinghouse has approved four mental health programs: Functional Family Therapy, Multisystemic Therapy, Parent Child Interaction Therapy, and Trauma-Focused Cognitive Behavior Therapy. All of these programs are geared at addressing the issues of children–not their parents. It is very odd that the clearinghouse did not include any services to address common mental disorders, such as depression and PTSD, that afflict many parents who come to the attention of child welfare agencies. After all. the California Evidence-Based Clearinghouse for Child Welfare (CEBC), the leading repository of evidence practices in child welfare, lists nine programs meeting Family First criteria as well supported, supported or promising  for treating depression and 11 programs meeting those criteria for trauma treatment for adults. Even odder, among the six mental health programs being considered for inclusion in the Title IV-E clearinghouse, only one (Interpersonal psychotherapy) could be used to treat adults although there is also a version for adolescents and the clearinghouse does not specify which one is under review.

Among the evidence based practices included in the CEBC and not included or under review by the Title IV-E clearinghouse are some well-established programs known to be effective, such as Cognitive Behavioral Therapy for adult depression and  Mindfulness Based Cognitive Therapy.  Both of these have the top rating of “well-supported” from CEBC for treatment of depression in adults. Another mindfulness-based treatment called Mindfulness Based Stress Reduction is becoming increasingly popular and supported by research for treatment of depression and anxiety. Because it is not generally covered by insurance, using Family First funds could make this treatment available to parents who could not otherwise get it. Eye Movement Desensitization and Reprocessing (EMDR), a popular trauma treatment, is also given the top rating from the California clearinghouse and not included or being reviewed by its Title IV-E counterpart.

On the other hand, the inclusion of two out of three “in-home parent skill based” programs in the Title IV-E Clearinghouse is somewhat surprising. The inclusion of Healthy Families America (HFA) raises questions because it has not yet been able to demonstrate an impact on the prevention of child abuse and neglect. There is one study with a promising result but this study was criticized by CEBC due to a very small sample size, limitation to one region, reliance on parent self-report and other factors. CEBC gave HFA as a rating of “4” (“evidence fails to demonstrate effect”) for the prevention of child abuse and neglect.

Another home visiting program, Nurse Family Partnership (NFP), has limited potential to prevent foster care among the Title IV-E eligible population. NFP is the only home visiting program given the top rating for prevention of child abuse and neglect by the CEBC; however it is approved only for first-time teenage mothers. It cannot by definition be used to prevent a recurrence of abuse or neglect. NFP can be provided under Family First in jurisdictions, like the District of Columbia, that have defined all children of teens in foster care as foster care candidates. But it is not applicable to most families eligible for prevention services under Title IV-E.

In sum, the list of programs that have been cleared by the Title IV-E clearinghouse as well as those that are being reviewed contains some disconcerting omissions and surprising entries. While some of the most exciting and promising mental health and drug treatment programs are not included, some home visiting programs with very limited applicability to the purposes of the Act have been included. When added to the decision to make Medicaid the payer of last resort, these decisions by the clearinghouse make the utility of Family First as a vehicle of foster care prevention even more dubious. Those who agree should join me in requesting that the Title IV-E Clearinghouse review and approve some of the effective practices mentioned in this post.

 

 

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.

 

Strong and Thriving Families: The Unreal World of the Children’s Bureau

NCCANThe 21st National Conference on Child abuse and Neglect (NCCAN) sponsored by the Children’s Bureau of the U.S. Department of Human Services (HHS) took place in Washington DC from April 24-26, 2019, and  there could be no better window onto the child welfare zeitgeist. NCCAN’s defining spirit was perfectly embodied in the conference theme, Strong and Thriving Families. But the main takeaway for this blogger was how far the field has strayed from its central and defining mission–protecting children.

From the first words booming out of the speaker in the hotel ballroom, the conference plenary sessions focused relentlessly on a two-part message. First, the worst thing to do for abused and neglected children is to remove them from their families and we should stop doing it right now. Second, child welfare should focus on primary prevention–preventing child maltreatment before it occurs.

Removing abused and neglected children from their families is the worst thing you can do to them. That was the main message delivered by plenary speaker Amelia Franck Meyer, one of PEOPLE Magazine’s 25 Women Changing the World. Meyer made extensive use of the animal kingdom to make her points about the mother-child relationship. She started with baby ducks imprinting onto their mothers and went on to mother bears.  When one of own children is not having their needs met at school, Meyer says she will stop at nothing to ensure that the little one’s needs are met. And that’s why all kids need their mother, she explained, because your mother “always has your back.”

“Mama bear” would not be the best term to describe many of the mothers I saw as a foster care social worker, or the ones whose children’s deaths I have been reviewing as part of the District of Columbia’s Child Fatality Review Committee. The moms who expose their babies to brain-damaging substances in utero, sleep through the night aided by drugs or alcohol while their infants die, can’t be bothered to bring their children to school for 30 days in a semester, leave them in the care of volatile boyfriends, or inflict bruises and cuts are hardly mama bears. And, despite what we may want to believe, some children need to be rescued from such mothers.

Meyer also told us that we should not think of children as individuals but as part of families, which sounds a bit like a return to an earlier century. And of course she did not forget to the modern trope that child welfare is not about saving children from their families but rather about helping families protect their children.

In his closing plenary session, Children’s Bureau Chief Jerry Milner urged us to stop using the term “birth parent,” “which undermines the singular parent-child relationship.” That term helps separate the idea of procreation from that of nurturing–something that Milner clearly does not want to do. We also can’t talk about “dysfunctional” families, according to Milner. If only not talking about them would make them function well!

Milner urged participants to picture a different type of child welfare system, where “families are given what they need to thrive, not just survive.” In an interview with the Chronicle of Social Change, Milner suggested that what families need to prevent maltreatment includes “parenting education and support, community-based substance abuse prevention and treatment services, ready access to needed medical and mental health services and trauma-informed services to help parents heal from their adverse experiences.”

Milner did not mention child care, housing, or increased cash assistance–services that many would argue poor families need to thrive. But that’s not surprising given that he’s a member of the Trump Administration. Even expanding access to parenting classes, drug treatment and mental health services does not sound like an administration priority–unless the funds come from reprogramming current spending, which seems to be what Milner has in mind. By his own report, he tells child welfare officials who are afraid of adding a new set of primary prevention functions to their current overwhelming mandate that they should do it instead of what they are already doing, not in addition to it! Apparently he believes that cutting funds for CPS investigations and foster care would provide ample funding for primary prevention.

So what’s wrong with all this? Isn’t primary prevention the most logical approach to any social ill?  Unfortunately, there are a few problems with making it the only approach:

  • We don’t know much about what works to prevent child abuse and neglect. The most touted programs involve home visiting, and we don’t have a lot of evidence that they work to prevent child abuse and neglect. The California Evidence Based Clearinghouse for Child Welfare (CEBC) has rated only one home visiting program as “well-supported” by the research evidence as a means of preventing child maltreatment, and that program (Nurse Family Partnership) is limited to first-time low-income mothers. CEBC rates only one program (SafeCare) as “supported by the research evidence” as a program to prevent child maltreatment. And all of these programs have been strictly voluntary–which leaves out the families that are most dangerous to their children.
  • Many primary prevention programs don’t belong in the child welfare agency. Mental health and drug treatment serve a broader clientele than parents involved in child welfare and are generally provided by different agencies. And while Milner was careful not to mention housing, child care, or cash welfare, these don’t belong under the jurisdiction of child welfare agencies either.
  • Even if we had a better idea about what worked, we might reduce maltreatment but not eliminate it. We would need a method of investigating possible occurrences and protecting (even sometimes rescuing) the children at risk. It’s like saying we need to shut down hospitals. Of course we want to prevent gun violence, car accidents, cancer, and outbreaks of preventable infections diseases. But we certainly need to have hospitals available in case we fail.

Given NCCAN’s focus on primary prevention, it is not surprising that the Family First and Prevention Services Act received almost no mention throughout the conference, even though it is the biggest change to federal child welfare legislation in two decades and takes effect in October–and federal guidance is woefully lacking. Jerry Milner has already said that Family First is only the first step toward transforming child welfare. What he really wants is a block grant that would allow states to shift funding from CPS, foster care, and family preservation to primary prevention. And that could result in further starvation of CPS,  foster care and in-home services (which need more funding, not less) in the name of a mission that should be carried out by other agencies.

On Monday, conference participants returned to the real world, where media outlets in Illinois and nationwide were reporting on five-year-old AJ Freund, who was beaten to death on April 15. His parents, who reported his disappearance three days later and tearfully attended a vigil shortly thereafter, have been charged with his murder. As the Chicago Tribune put it,

Witnesses in all corners of AJ’s life saw signs of abuse or neglect. A doctor, neighbors, police and others knew or suspected that much was amiss over the years. Many of them sounded alarms that were recorded by the courts and the Illinois Department of Children and Family Services, which once again finds itself struggling to explain why a child on its watch is now dead….Yet AJ, who was born with opioids in his system, was left to live in a filthy house of horrors where it appears he was hurt again and again.

And if Jerry Milner and Amelia Franck Meyer have their way, many more AJ’s will suffer and die without anyone to rescue them. Because they believe that child welfare agencies should not be in the business of rescuing children.

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. 

 

Yet another child abandoned by another state: Two-year-old Jordan Belliveau dead at his mother’s hands in Florida

Juliet Warren (left) with her foster child, Jordan Belliveau. The 2-year-old toddler went missing for more than two days and was then found dead late Tuesday. His 21-year-old mother, Charisse Stinson, now faces a charge of first-degree murder in the death of her child. [Photo Courtesy the Warren Family]
Jordan Belliveau, Jr. with his foster mother: Tampa Bay Times
On September 4, 2018, the body of two-year-old Jordan Belliveau was found in a wooded area in Largo, Florida. Two days before, his mother Charisse Stinson told police she was assaulted by a stranger and that her son was missing when she recovered consciousness. She later admitted that she had fabricated this account and in fact had caused the injuries that caused Jordan’s death.

Jordan had been removed from his parents in October 2016 and reunited with Stinson in May 2018. At the time of his death, Jordan was under court-ordered “protective supervision” by a nonprofit agency under subcontract with the Florida Department of Children and Families (DCF). There was also an open investigation of allegations of ongoing domestic violence between Stinson and Jordan’s father, Jordan Belliveau, Sr. DCF convened a special review team to determine why Jordan killed despite being under supervision by the system that was supposed to protect him. The team’s report was issued earlier this month.

To understand the case, one must grasp the particularly fragmented nature of child welfare in Pinellas County, Florida, in which three crucial functions usually vested in one agency are split between three different agencies. The Sheriff’s Department handles child abuse investigations, a private agency called Directions for Living manages in-home service cases under contract with Eckerd Connects, which in turn has a contract with DCF, and the State Attorney’s Office represents DCF in court.

The first call concerning Jordan and his parents came in to the child abuse hotline on October 2016, when Jordan was three months old. Jordan and his parents were living in the home of his paternal grandmother, and the caller was concerned about drugs, gang activity and firearms in the home. The allegations were verified and an emergency hearing was called. Ms. Stinson was ordered to relocate immediately and was referred to a program providing housing and support services to young mothers. However, she  refused to cooperate with the program and was rejected. A second hearing was convened on the same day (November 1, 2016) and Jordan was placed in foster care. In order to get Jordan back, the parents had to comply with a case plan which required each of them to obtain stable housing and income, comply with a “biopsychosocial assessment,” and follow the recommendations of the assessment. Ms. Stinson was also required to obtain counseling.

In January 2017, Jordan was placed with the foster family that would keep him until he was returned to his mother 16 months later. It was in this home, as his foster mother reported in a heartbreaking statement after his death, Jordan learned to roll, crawl, walk and talk and flourished in a supportive community of church members, foster families, and Coast Guard families.

While Jordan was thriving in foster care, an escalating series of violent incidents was reported between his parents. Each parent was in turn arrested for violence against the other but each case was dropped because the other parent did not press charges. Despite these incidents, Ms. Stinson was granted unsupervised visits with her son starting June 18, 2017. During the first unsupervised visit, Ms. Stinson allowed Mr. Belliveau to attend despite the fact that his visits were still required to be supervised. At this visit, which took place at a Burger King, members of a rival gang arrived and a fight ensued. Holding Jordan in her arms, Ms. Stinson struck at a woman who was fighting with Mr.Belliveau. Attempting to hit back, the woman hit Jordan in the mouth, inflicting lacerations. This incident was reported to the child abuse hotline, along with allegations that Mr. Belliveau was selling cocaine and marijuana from their home and that both parents used these drugs. Both parents refused to be tested for drugs. The investigation concluded with a finding of inadequate supervision and failure to protect Jordan by both parents.

In the next court hearing on the family case, the magistrate in charge of the case was not informed that this was a gang-related incident, that Ms. Stinson was involved, or that Jordan was injured. There was no mention of the  need to screen both parents for drug use.

According to Florida statute, DCF was required to file a petition for termination of parental rights within 60 days of November 1, 2017, when Jordan had been in foster care for 12 months. Yet no such petition was filed. At the hearing on January 8, 2018, the court found “compelling reason not to consider termination” because Ms.  Stinson was “partially compliant” with her case plan tasks because she had completed an assessment and was wrongly reported to be in counseling.

During a court hearing on April 23, 2018, Ms. Stinson’s attorney reported that she had completed the counseling mandated by her case plan, but no documentation was provided. As a matter of fact, Ms. Stinson had been terminated from counseling for the second time a week before the hearing. The Guardian ad Litem (GAL appointed to represent Jordan’s interests in court) objected to reunification because there was no documentation that Stinson was going to counseling and it appears that the case management agency objected as well. Without requiring documentation,  Magistrate Jennifer Sue Paullin ordered reunification and gave all parties 20 days to object based on new information. No objection was filed.

The court order, obtained by the Tampa Bay Times, states: “No evidence was presented to show that the circumstances that caused the out-of-home placement have not been remedied to the extent that the return of the child to the mother’s care with an in-home safety plan … will not be detrimental to the child’s safety.”.

On April 25, 2018, in anticipation of Jordan’s return to Ms. Stinson, the latter was referred to an in-home reunification program that provided twice-weekly visits from a licensed clinician. Ms. Stinson missed three or her five scheduled visits prior to reunification, which went ahead as scheduled on May 21, 2018. She missed seven of 11 visits following reunification and was unsuccessfully discharged from the program due to failure to participate

In a court hearing on June 11, 2018,  the court granted reunification to Mr. Belliveau, allowing him to join the family. Ms. Stinson had already missed several appointments with the clinician but the case management agency and government attorney reported that both parents were compliant with services.

On July 14, 2018, police responded to the parents’ residence to find Ms. Stinson bleeding and bruised and reporting that she had been punched by Belliveau. Mr. Belliveau was arrested after threatening to kill Ms. Stinson and “a lot of ….cops.” The child abuse hotline was not notified of this incident until three weeks later, on August 4. Despite the escalating violence and threats, the ensuing investigation did not find Jordan to be in danger warranting removal, but it was still open at the time of Jordan’s death.

On August 17, 2018, the agency filed an amended case plan with the court, including domestic violence services for Belliveau (as a perpetrator) and Ms. Stinson (as a victim). On August 24, Ms. Stinson refused to allow the GAL into the house. The investigator contacted the case manager for the first time on August 29, more than three weeks after the investigation began. The case manager said she normally visited once a week but admitted that he sometimes had trouble  reaching Ms. Stinson. On August 31, the case manager completed a home visit and explained to the parents that they needed to participate in services in order to retain custody of Jordan. Less than 24 hours later, Ms. Stinson reported Jordan missing.

Charisse Stinson has been charged with first degree murder for hitting Jordan, causing him to hit his head and have a seizure. Police report she did not seek medical treatment immediately and Jordan died. She then allegedly dumped his body in a wooded area and lied to police about a stranger kidnapping him, resulting in an Amber Alert and days of searching before Jordan’s body was found.

The special review team made six findings about the system’s  failures to save Jordan:.

  1. The decision to reunify Jordan with his parents was apparently driven by the parents’ perceived compliance to case plan tasks rather than behavioral change. Case decisions were solely based on addressing the reasons Jordan came into care. which related to gang and drug activity in the home where he was living. Although other concerns came to light during the life of the case, like substance abuse, domestic violence and mental health issues among the parents, these factors were not added to the case plan or considered in the decision to reunify Jordan with his parents. Ms. Stinson herself requested anger management training during a meeting in 2016 but this was never included in her case plan or provided. Moreover the court was kept in the dark about many of these concerns. “On multiple occasions, Ms. Stinson provided false information to the court,” which the case management agency and government attorney did not correct.
  2. Following Jordan’s reunification with his parents, staff failed to follow policy and procedures to ensure child well-being, such as making weekly visits. Moreover, they did not notify the court or take any action based on the mother’s lack of compliance with post-reunification services.
  3. When a new report was made to CPS, the investigator “failed to identify the active …threats occurring within the household that were significant, immediate, and clearly observable.” These included: ongoing and escalating violence between the parents, the father’s threat to kill the mother, and his gang membership and access to weapons, among others. In a major understatement, the Special Review Team opined that “Given the circumstances, a modification of Justin’s placement should have been considered.”
  4. There was a “noted lack of communication and collaboration” between investigative staff located in the Sheriff’s Department and case management staff during the August 2018 child abuse investigation. The investigator did not talk to the case manager for over three weeks after opening the investigation.
  5. There was a failure of communication and collaboration between all of the different entities involved in the case. There was a “lack of diligence in conducting multidisciplinary staffings at critical junctures of the case.” Neither the case management agency nor the state attorney provided accurate information to counter the false information provided by the mother to the court. Unbelievably, the case manager attended court hearings with no information about the mother’s participation in counseling, which was provided by the same agency.
  6. Assessments of both parents failed to consider the history and information provided by the parents and resulted in treatment plans that were ineffective to address behavioral change.

The review team did a good job of isolating the specific system failures that occurred in Jordan’s case but was not as successful identifying the systemic problems behind these failures. In this writer’s opinion, three major systemic factors contributed to the failure to protect Jordan:

  1. Lack of coordination and communication between agencies. This was the factor emphasized by the review team, which suggested that this issue was limited to Pinellas County. State Senator Lauren Book castigated the team for for this implication, arguing in a statement that the issue of “siloed communication” goes beyond the county and even beyond child welfare itself, citing the errors that predated the shooting at Marjorie Stoneman Douglas High School.
  2. Inadequate funding of child welfare services, leading to high caseloads and staff turnover.  The review team gave an offhand mention to the difficulty caused by high caseloads and turnover, both of which can be traced to inadequate funding but treated it as a given, rather than a problem to be rectified.
  3. The overemphasis on family reunification. In Florida and around the country, family reunification has been emphasized to the degree that children are often placed at risk. The Tampa Bay Times highlighted this  problem in its editorial entitled, Another child dead, another state failure. The death of a child following reunification is not a new story in Florida or around the country. If Florida law had been followed, Jordan’s parents’ rights should have been terminated before he was ever returned to them. A case manager who left Directions for Living shortly before Justin’s death told Florida’s News Channel 8 that the system “puts far too much weight on reuniting kids with unfit parents and makes it nearly impossible for caseworkers to terminate parental rights.” When asked why workers did not remove Jordan, she replied, “We are on quotas and we are told, ‘If there is any way to keep this kid in home do it.”

What is to be done to prevent future deaths like Jordan’s? It must begin, as the Tampa Bay Times editorial board asserts, with holding those involved accountable. This applies particularly to the magistrate on the case, who should have given the child rather than the parents the benefit of the doubt and held up reunification until she heard from the mother’s counselor. Second, child welfare must be funded adequately so that its staff are well-qualified and able to devote the time to handle cases correctly. Third, the silos must be broken down through improved policies and procedures that mandate data sharing and collaboration, but only adequate funding to enable reasonable caseloads will allow this to happen.

Finally, Florida and other states must rectify the balance between a child’s safety and the value of family reunification. Agencies must recognize that some parents who are suffering from the consequences of intergenerational trauma and dysfunction cannot change–at least within a timeline that is appropriate for a developing child.  This decision must be made early, with the input of qualified staff, high-quality evaluations, and laws and policies that put the child first.

As Justin’s foster parents put it, “Ultimately, we hope that our painful loss will result (in) a fundamental re-examination of the entire system, of how foster care works, of the reunification process. Jordan deserves that, and the other children in the system deserve that.”

Charisse Stinson is awaiting trial on charges of first degree murder and lying to police. She gave birth to another child in December and Belliveau has been determined to be the father. Both parents have filed court documents requesting the child be handed over to Belliveau, who has been arrested twice since Jordan’s death.

 

 

 

 

Caring about Children Isn’t Racist

Well, it happened. After a lifetime of service to poor and maltreated children, I’ve been accused of racism. I knew it would happen eventually. I couldn’t keep saying with impunity that children shouldn’t be collateral damage in an attempt to avoid “punishing” parents who happen to be members of a minority group.

It was a prominent critic of government intervention to protect children who noticed an op-ed that I wrote for the Chronicle of Social Change in August 2017 and demanded a retraction.

In the offending piece, I critiqued an article in the New York Times entitled Foster Care as Punishment: The New Reality of Jane Crow. In my rebuttal, entitled Foster Care as Punishment? A Case of Biased Reporting by the New York Times, I attempted to highlight the naivete of the reporters, who accepted the statement of a birth mother that she splurged on brand-name diapers for her baby as an indicator of her fitness as a mother.

As the authors put it, “Maisha Joefield thought she was getting by pretty well as a young single mother in Brooklyn, splurging on her daughter, Deja, even though money was tight. When Deja was a baby, she bought her Luvs instead of generic diapers when she could.” The authors went on to describe the night when an exhausted Ms. Joefeld put Deja to bed and “plopped into the bath with earphones on.” Ms. Joefeld was indeed tired. Deja was placed in foster care after she was found wandering the streets of Queens at midnight after trying and failing to rouse her mother.

I thought the authors’ concept of good mothering seemed to be a little backwards, as it prioritized spending on brand names over being available to respond to a small child at any time of the day or night. So I wrote, “It is odd to me that the authors seem to consider splurging on brand-name diapers, sneakers, or apparel to be an indicator of good motherhood.”

Little did I know the firestorm I was launching. The authors had said nothing about sneakers or apparel, but I grouped them with diapers, because I was making a general point about some parents’ undue preoccupation with brand names. And those words were a trigger to to those advocates of family preservation under all circumstances who are always looking for a chance to cry racism.

In an email I received 15 months after publication of my op-ed, the Publisher of the Chronicle of Social Change told me that the Chronicle would be publishing a publisher’s note concerning my use of “racially charged language” and asked me whether I wanted to submit a statement that he would consider including.

What the Chronicle eventually published was called An Apology for a Regrettable Chronicle Op-Ed. In it the publisher and Editor state that “the trope of a low-income mom buying children designer clothes, at the expense of spending on more critical family needs, does exist as a crude and often racial stereotype.” They apologize for their “poor judgement” in allowing “a callous dismissal of a young single mother’s very human efforts to do right by her daughter” to stand.  They deleted my piece from their website. And they did not publish my statement that I had sent to the publisher at his request. Here is what I said:

This statement [about brand-named diapers, clothing and shoes] was based not on racism but on my experience as a social worker in foster care. It was not unusual for birth parents to complain when foster parents dressed their kids in clothes that were not stylish or (God forbid) handed down. It was also not uncommon for them to splurge on high-end apparel or athletic shoes, or talk about splurging on them, in visits to their children. All of these behaviors together made a big impression on me. That some parents who had subjected their children to abuse or neglect seemed to care passionately about the brand of diapers, clothing or shoes their child wore seemed contradictory and illustrated a fundamental problem with their parenting.

I expressed my feelings most clearly in an adoption hearing that I will never forget. One of my favorite foster parents, an African-American woman I will call “Ms. Brown,” had petitioned to adopt “Ronald,” a little boy whom she had loved and cared for as her own for several years. “Ronald’s” father, a drug user who often showed up to visits with his son high or exploded with rage during visits, often requiring a police presence, was fighting the adoption tooth and nail with the help of his very aggressive lawyer. Through the lawyer, the father raised the issue that “Ronald” was often dressed in what seemed to be hand me downs or cheap clothes. The Judge asked for my opinion and I gave it to her. I told her how this father resembled many other birth parents, who are more concerned with the newness and style of their children’s clothes than with the safety, security and most importantly love provided by the foster parent. For me, the father’s question illustrated his inability to understand what matters to a child (love and security) and what doesn’t (brand names.)  The judge cut me off, admonishing me sharply for my editorial comments. But I hope she understood. She eventually approved the adoption. I recently saw “Ronald,” and he is thriving with “Ms. Brown.”

Because I worked in the District of Columbia, most of my clients (parents and children) were African-American. If I had worked in Maine or Indiana, I have no doubt that I would have seen some of the same patterns among white parents. Perhaps it is an issue of class [to some extent]. But I think most of all it reflects parents who have not grown up sufficiently themselves to understand that their children are not dolls to be dressed up in a way that reflects well on parents and that they need love, not brand-name diapers or fancy clothes. No, my words were not racist. They were about what matters for children, and what doesn’t. Children should be at the heart of this debate, not racial groups.

Readers who have worked with abusive and neglectful parents as social workers, therapists, or in other capacities will recognize the phenomenon I describe here. The fact that neither the New York Times journalists nor the publisher of the Chronicle (who was clearly puzzled by where my reference came from if not racism) understood this shows their distance from the people they are writing about. Nor do they understand that many healthy and mature parents of all races, such as the foster parent I called “Ms. Brown,” are completely unconcerned with brand names.

I have written before, and will write again, about what has been called “the liberal dilemma of child welfare reform.” Many of my fellow liberals seem to be reluctant to “punish” parents whose problems in parenting stem from poverty and racism by taking away their children or even monitoring and offering services to these families. The whole idea of “punishing” parents, which was used in the title of the Times article, reveals the emphasis on parents’ rights over child safety. But if we succumb to this attitude, we may be condemning poor and minority children to years of suffering and even death. Is that really the anti-racist position?

Some of these who advocate family preservation at any cost are eager to describe any criticism of an African-American parent as racist. They use the fear of being called racist to suppress expressions of alternative viewpoints. As a child of Holocaust survivors, I am well aware of what can happen when fear paralyzes free speech. I was sad to see the Chronicle respond so pusillanimously the demand that I be silenced.

 

 

 

Why No One Saved Gabriel Fernandez

Gabriel Fernandez
Image: LATimes.com

On September 13, 2018, a Los Angeles County judge denied a motion to dismiss felony child abuse and falsification of records charges against four former child welfare caseworkers in the 2013 death of ten-year-old Gabriel Fernandez.  The charges, filed in 2016, marked the first time Los Angeles caseworkers were criminally charged for misconduct connected with their work, and is one of only a few similar cases nationwide.

If Gabriel’s case is one of the few child deaths to result in prosecution of state workers, the egregious nature of the state’s failure explains why. A brilliant article by investigative reporter Garret Therolf shows that for seventh months, evidence of Gabriel’s abuse steadily accumulated. Yet again and again, the Los Angeles Department of Child and Family Services (DCFS) failed to intervene. Some of the worst errors are listed below.

  • Gabriel’s mother had been the subject of at least four calls to the child abuse hotline, had abandoned one child, and had lost custody of a son a year older than Gabriel. Yet, this record was never reviewed by workers investigating multiple reports of suspicious injuries to Gabriel.
  • Each time investigators came to the home, they interviewed Gabriel and his siblings with his mother in the room, against agency policy and common sense. And each time they did so, he recanted his previous statements. Even after he came to school with his face full of bruises from being shot by his mother with a BB gun, he recanted and told the investigator the injuries were from playing tag with his siblings. In the face of visible evidence, the investigators repeatedly chose to believe the repeated recantations
  • Investigators never spoke with neighbors or school personnel (other than the teacher who reported the abuse) but according to Therolf the abuse was known widely among school staff.
  • A computer program had found Gabriel to be at “very high risk” of abuse, requiring that the case be “promoted,” usually involving asking a court to require services or foster care. But the investigator, backed up by her supervisor, referred Gabriel’s mother to voluntary family services. Gabriel’s mother Pearl Fernandez withdrew from these services after three visits.
  • During the brief period of voluntary services, Gabriel wrote several notes saying he wanted to kill himself. Gabriel’s therapist informed the caseworker and supervisor, but they took no action.
  • The therapist had grown concerned that Gabriel was being abused, but her supervisor told her not to call the hotline so as not to jeopardize the mother’s participation in the voluntary case.
  • After three visits, Pearl Fernandez asked for her voluntary case to be closed. The caseworker accepted her decision, stating that there were no safety or risk factors for the children. Contrary to policy, her supervisor signed off on the case closure without reading the file.
  • After the case was closed, a security guard at the welfare office saw Gabriel covered with cigarette burns and other marks and being yelled at by his mother. The called DCFS twice and got lost in the automated system. The 911 operator gave him the non emergency line, which he called. He was later told that a sheriff’s deputy had gone to the home and seen nothing wrong.
  • Gabriel’s teacher, who had lost hope of any rescue from DCFS, called the DCFS investigator one more time late in April when Gabriel showed up looking worse than she had ever seen him. One eye was blood-red, skin was peeling off his forehead, and other marks were on his face, neck and ear. Her call was never returned. Gabriel had only about a month left to live.

Investigators later learned that during the weeks before his death, Gabriel  was spending days and nights locked in a cabinet with a sock in his mouth, hands tied, a bandanna over his face, and handcuffs on his ankles. His solitude was interrupted by vicious beatings and torture sessions in which his siblings were required to participate. On May 22, Pearl and Aguirre tortured Gabriel a final time with a BB gun, pepper spray, coat hangers and a baseball bat. When they finally called 911, paramedics found two skull fractures, broken ribs, several teeth knocked out, BB gun pellet marks, cigarette burns on his feet and genitals, a skinned neck, and cat feces in his throat.

Therolf poses a key question regarding Gabriel’s death: “Was [the] failure …to protect Gabriel an isolated one—the fault of four employees so careless and neglectful that they allowed a child to suffer despite a series of glaring warning signs? Or was it a systemic one, the result of a department so ill-equipped to safeguard children that tragedies were bound to happen?”

While Therolf does not actually answer the question, his report offers a number of key findings and insights that point strongly in the direction of systemic factors as the prime contributors to the failure to protect Gabriel. Therolf found that many of the errors made by investigators, such as failure to interview children alone or to speak with witnesses outside the family, were prevalent in Los Angeles County. Sadly, many of the same failures were evident in the very recent case of Anthony Avalos, also in Los Angeles. And we also see similar failures , and in cases around the country, including Kansas, New York, and Oregon.

The systemic factors that cause these failures fall into two major categories–resource constraints and ideological factors.

Resource Constraints

Child welfare involves a balancing act between too much intervention  or “erring on the side of child safety” as Therolf puts it and too little or “erring on the side of family preservation.”  Striking this critical balance requires a combination of  knowledge, skill, and time. In other words, as Therolf puts it, “it requires a highly trained workforce with the resources to carry out a thorough investigation in every case.” Therolf rightly contends that most agencies don’t have these resources. One has only to read the constant stream of news reports of overwhelming caseloads and poor training of child welfare workers around the country. All of this reflects the unwillingness of taxpayers and legislatures to provide what is needed to protect children. Inadequate funds mean caseloads are too high and salaries are too low, both resulting in low standards for caseworkers.

More funding and could buy both lower caseloads and higher salaries, which are necessary to obtain more qualified investigative workers. After reading so many similar stories, and recalling my own rudimentary training as a Child Protective Services (CPS) worker I am beginning to think that ultimately CPS Investigation should be a specialty in Masters in Social Work Programs. Students would learn advanced interviewing skills and how to assess the truthfulness of children and adults rather than, for example, believing children when they recant allegations with their parents in the room.  Alternatively, CPS Investigations could be folded into the growing field of Forensic Social Work. In any case, a Masters-level specialization could be required in order to be a CPS worker, also adding a needed level of prestige to an important, difficult and hard-to-fill  job.

Ideological Constraints

Inadequate resources might result in a random distribution of agency errors between those that involve too much intervention and those that involve too little. But the dominance of a particular ideology may skew the errors in one direction or another. And Garrett Therolf alludes to the rise of an ideology prioritizing family preservation nationwide and particularly in California during the years preceding Gabriel’s death. This ideology contributed to the decline in foster care numbers around the nation and particularly in Los Angeles, where Therolf reports the number of children in foster care fell from about 50,000 in 1998 to 19,000 in 2013. Much of this decline occurred during the tenure of DCFS administrator David Sanders, who later went on to lead Casey Family Programs, a foundation worth over two billion that has played an outsize role in national child welfare policy. The same year that Sanders took over at Casey, it declared a new goal to reduce the number of children in foster care by half by 2020.

Therolf was right to point a finger at Casey Family Programs. In my post about the death of two children by child abuse in Kansas, I wrote about how Casey leverages its massive wealth to affect policy directly, bypassing the voting public. It provides financial and technical assistance to state and local agencies, conducts research, develops publications, and provides testimony to promote its views to public officials around the country. Through its wealth in an underfunded field, Casey has been able to directly influence policy at the federal, state, and local levels.

Therolf points out that opinions on child welfare often cut across traditional political groupings. While Casey tends to support progressive causes, its emphasis on family preservation is often shared by conservatives who desire to reduce the government’s incursions on parental authority and at the same time to reduce spending. Working together, Casey and the George W.  Bush administration created a waiver policy that allowed child welfare agencies to direct unused foster care funds toward family preservation services–a policy change which created an incentive to reduce the use of foster care. Therolf links this incentive to the drastic decline in the Los Angeles County foster care rolls between 1998 and 2013, stating that “When Gabriel came to the attention of DCFS, the chances of an abused child being placed in foster care were “lower than they’d been in many years.”

Perhaps all of the factors that led up to Gabriel’s death can be summed up by a striking statement by the supervisor on Gabriel’s case, who is currently standing trial in Gabriel’s death. He told Therolf that he had  “concluded long ago that some of the children who depended on the department would inevitably be injured, if not killed.” He expressed frustration that administration and the public expected him to prevent all such deaths. This is not an acceptable attitude. It is true that a child welfare agency cannot prevent deaths among children who are unknown to the agency. But to expect that children will die under the agency’s watch–that is a low expectation indeed. We must do better by our most vulnerable children.