Kinship is More than just Blood

Jamie Law has fostered 28 children. But she says her fostering days are over.

In April 2013, she picked up a two-day-old baby from the hospital. A year and a half later, she and her husband signed paperwork to adopt him. Shortly after he turned two years old, the Idaho Department of Health and Welfare placed him with an aunt that he had never seen.

Idaho is not the only state where children are routinely removed from foster parents with whom they are bonded and want to adopt them, in order to be placed with strangers who happen to be related to them by blood. Readers who follow Meghan Walbert’s heartbreakingblog have been reading along as her foster son “Blue-Jay” became progressively more attached to her family.

Now, almost 10 months after Blue-Jay was placed in her home at the age of three, a relative is within weeks of being licensed as his caregiver. It took Blue-Jay the better part a week to calm down after Walbert spent a night away from home. Now she is worried about how he will react to a permanent separation.

Separation from a parent or long-term caregiver is always traumatic for a child. If the child then forms a bond with a new family and is subsequently separated from that family, further trauma will result, even if the child is returned to the parent. But if the child is placed with yet another stranger, the trauma is likely to be even greater. And there may be lifelong effects on the child’s ability to love and trust others.

One of the major goals of the Adoption and Safe Families Act of 1997 was to speed up the achievement of permanency so that children would not have to go through repeated separations or continued limbo. If a child has been in care for 15 out of the last 22 months, the state is required to file for termination of parental rights.

But there is no such deadline for relatives to come forward. Even if the state files for termination of parental rights after a year, it may take as long as another year for an adoption to be concluded. If a relative comes forward during that time period, the child may be moved after two years or more with the foster/adoptive family.

As I have seen in my own experience, relatives often do not come forward as soon as a child comes into care because they hope the parent will be able to get the child back. They often wait until the child’s goal has been changed to adoption. But this additional disruption can be harmful to the child.

Idaho’s foster parents want to do something about this. A new organization, Idaho Foster Care Reform, has earned over 1,500 likes on Facebook since February 5, and similar stories have been pouring in. Forty foster parents and former foster children packed a committee hearing on February 12 to tell their stories.

Idaho legislators have already introduced a bill that would require the agency to locate and contact relatives within 30 days of a child’s removal. The relatives would be informed that they have 45 days to volunteer as a placement resource for the child. Thanks to the passion of the Idaho foster parent group, the legislation is on a fast track for consideration.

The Idaho legislation is a good start. Also needed around the country are ways to expedite the licensing of relatives to care for children both within and between states. Even if relatives come forward right away, it may take months to get licensed—months in which the child may bond with the foster family. Many states have provisional licenses for kin, so that children can be placed with them while they gather the documentation for a permanent license.

The District of Columbia now tries to license relatives (including an immediate fingerprint check) on the same day the child is removed. Not all relatives can be cleared so quickly, but it does mean that some children are spared the pain of multiple disruptions.

When the relative lives in another state, the licensing process often takes as long as six months. Legislation has been introduced to automate this process so that social workers no longer have to photocopy documents and submit them on paper through a succession of offices. Congress should pass this law, Modernizing the Interstate Placement of Children in Foster Care Act, immediately.

No effort should be spared to place children in care with appropriate relatives quickly. But after a child has bonded with his current caregivers, blood should not trump the bond formed by months of daily loving care. Children who have already been abused or neglected by parents should not be abused by the state as well.

This column was published in the Chronicle of Social Change on February 23, 2016.

Therapeutic Child Care: An Underused Tool in Family Preservation and Foster Care

We know that chronic abuse and neglect can interrupt a young child’s brain development and result in developmental delays and behavioral problems. We also know that early intervention can mitigate the consequences of early adversity.

Yet we are investing almost nothing in early childhood programs to mitigate the effects of abuse and neglect for young children.

When an abused or neglected infant, toddler or preschooler is removed from home, he or she is often placed in child care for up to 12 hours a day within a day or two of being placed with a foster family. And, at least in the District of Columbia, all that is required is that the provider be licensed and available.

For children who are found to be abused or neglected but are kept at home, states are emphasizing therapy or parenting skills training for the parents. But rarely do they invest in early childhood programs designed to mitigate the past and ongoing effects of the adversity these children are experiencing.

Seattle’s Childhaven program is one of few programs that provide therapeutic child care for children who have experienced abuse or neglect. The program provides therapeutic day care for infants, toddlers and preschoolers who have experienced trauma. At the same time, it teaches parents the skills to break the cycle of child abuse and neglect.

A study of children who started at Childhaven between 1980 and 1982 found strong positive effects twelve years later. They were six times less likely to have committed a violent crime and two-and-a-half times less likely to use drugs. Moreover, they used 50 percent less public benefits.

Children are referred to Childhaven by child welfare services agencies, drug treatment services, public health, and welfare departments. Some are at risk of being removed from abusive or neglected homes; others have already been removed and are in foster care.

The children receive individualized, therapeutic care for six hours per day, including two healthy meals and a snack. Highly trained and experienced staff and low child-teacher ratios–3:1 for children up to two years of age and 5:1 for children aged three to five–means that staff can implement an individual treatment plan for each child.

The program achieves its therapeutic effect through consistency, structured routine, attentive listening, the opportunity for children to make their own choices, and clear limits and boundaries. Transportation is provided daily by the teachers—on a rotating basis—which allows daily check-ins with the parents.

“Childhaven is basically a trauma therapy center disguised as a day care facility, so children can have a happy, fun place to come,” Childhaven CEO Maria Wilcox told the Seattle Times.

Program staff work with parents and children together to coach parents in appropriate interactions with their children. This occurs at the center, where parents are encouraged to visit as often as they like, and where staff can model and coach parents in playing with their children. It also occurs during monthly home visits.

Childhaven offers periodic parent support group meetings to discuss issues of interest to parents. It also offers four different evidence-based parent skill-building programs for parents who are willing and able to participate.

It is easy to see why states are not investing in therapeutic child care programs. The average cost of Childhaven is $36,720 per child, per year. But remember that government money is already being spent on child care for children in foster care as well as children of low-income working mothers. And states are beginning to invest in pre-K for four-year-olds as well—money that could be funneled into therapeutic programs for children who need them.

Moreover, the cost of continuing to ignore this opportunity to help traumatized children before they enter school means continuing to incur future costs in terms of crime, drug abuse, mental illness, and public assistance.

I hope that private funders—including the new Blue Meridian Partners initiative recently covered by The Chronicle — will consider replicating this program including a randomized controlled trial to include a cost-benefit analysis. This approach may be expensive, but doing without will ultimately cost more.

This column was published in the Chronicle of Social Change on February 16, 2016.

No Risk in Trying New Approaches to Finding Children Most in Danger

In my last column, I discussed the new approaches to identify and target high-risk families for special attention in child welfare. Los Angeles and Allegheny County, Penn., as well as New Zealand are working on risk assessment algorithms. Rapid Safety Feedback (RSF), which has been implemented in Florida and is being adapted to other states, targets for special attention families with characteristics associated with high risk to children.

It is my opinion that these new approaches to protecting children have demonstrated their potential and deserve to be put into practice. In particular, the results of Project AURA in Los Angeles demonstrate that risk assessment algorithms can be a powerful tool.

As I described in my last column, AURA did an impressive job of predicting future harm to children based on child and family characteristics. Among families that had at least one previous referral, the 1 percent of referrals with the highest risk scores had 57 percent of the deaths and serious injuries.

Targeting the top 10 percent of referrals for special treatment would have identified 76 percent of the cases where a serious event would occur within the next six months. Targeting the top 20 percent would have identified 83 percent of the serious events. That is a lot of children saved from death or serious injury.

The power of AURA stems from its ability to access data from other systems and translate many factors into a single score. Among the factors that contributed most to the likelihood of a future AURA event were a previous referral within six months, parental history of narcotics treatment, age (younger) of the child, and previous substantiated allegations of abuse and neglect.

Some have expressed concerns that like medical tests, AURA produced a significant number of “false positives.” For example, among 1 percent of referrals with the highest risk scores, about 30 percent had AURA events within 6 months and the other 70 percent did not. However, some of these families had a critical event outside the 6-month period measured by AURA.

Moreover, comparing a high AURA risk score to a finding that cancer is present or absent is misleading. A high AURA score is more like a finding that one has a genetic marker for cancer and needs to be monitored. There is no harm and probably a lot of good in targeting high-risk families for extra services. Of course agencies should not remove children from their families based on a high risk score alone because that removal could be very harmful to the child and family.

The RSF tool being used for in-home cases in Florida and now being replicated in several states for CPS is a different type of instrument. Rather than calculating a risk score for each child, it targets cases with proven risk factors for special attention. The lack of child deaths in Hillsborough County in-home cases in the three years since implementation (compared to nine in the three years before) is certainly suggestive, though there is no proof that RSF is behind the drop in deaths.

But RSF has not yet been used with investigations and it has not been assessed, as was AURA, to show whether it would target the cases in which deaths or injuries would occur. This needs to be done before conclusions can be made about its effectiveness compared to AURA and similar tools.

Opponents of the new risk assessment tools argue that they might lead to more children of color being removed from their homes. But as Emily Putnam-Hornstein, one of the leading experts on child maltreatment data, noted in a forum covered by the The Chronicle, social workers making these decisions have their own biases. An objective tool should decrease bias, not increase it.

Moreover, there is a more fundamental problem with the racial profiling argument. There is strong evidence that tools like AURA can identify children who are in danger of death or injury. Opponents of the approach need to ask themselves whether they would prefer to see children of color die or face severe abuse rather than be protected at home or removed from a dangerous situation.

Surprisingly, the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) does not appear to have heard about the encouraging results of the AURA study or another set of positive results in New Zealand. CECANF is wrapping up its deliberations and completing work on its final report, and based on remarks at the last meeting, appears to have concluded that predictive analytics is not yet ready for the big time. It would be a shame if the commission misses an opportunity to educate the public and policymakers about this promising tool.

This column was published in the Chronicle of Social Change on February 9, 2016.

New Strategies Long Overdue on Measuring Child Welfare Risk

As The Chronicle of Social Change has been reporting over the past two years, various jurisdictions have been exploring new tools to focus the attention of child welfare systems on the children most at risk of subsequent abuse or neglect. The mainstream media has begun to notice, as demonstrated by CNBC’s recent report on Los Angeles’ contract with software company SAS to develop such a tool for its child welfare system.

These new approaches generally rely on predictive analytics, which means using patterns in data to predict future outcomes. Despite the recent media coverage, there is still some confusion about what is meant by this term, how it differs from current approaches like Structured Decision Making (SDM), and the distinctions between the various new approaches.

To understand these new approaches, it is important to understand how child protective services (CPS) works now. I can describe the process in the District of Columbia, where I once served as a caseworker.

CPS workers in the District use checklists to interview children, parents, teachers, and others about an allegation of abuse and neglect. They generally rely on the verbal answers to these questions, although they do receive access to data from schools and public assistance agencies.

The District of Columbia, like jurisdictions in over 20 states, uses an SDM tool to help social workers decide how to proceed at the conclusion of an investigation. Social workers fill out checklists on the computer. SDM assigns points to each risk factor, such as “primary caregiver has historic or current drug or alcohol problem.”

Based on the worker’s checkoffs, the software spits out a recommendation to remove the child or keep her at home.

SDM has at least two major flaws. First, it can be manipulated to recommend the action that the social worker wants to take. Second, it does not obtain any new data but simply uses what the social worker plugs in. That’s why in my experience in D.C., SDM was treated as a meaningless form to be filled out, not as a tool for making decisions.

A new set of predictive tools, known as predictive analytics, is being developed for governments in Los Angeles, Allegheny County, Pennsylvania, and New Zealand. These tools are designed to produce a numeric risk score for each child assessed. A high risk score would target the child and family for special attention, which might include intensive services and monitoring.

Unlike SDM, predictive analytics tools access data directly from other systems rather than relying on self-report from parents and caregivers. These systems might include mental health, substance abuse treatment and criminal justice, among others. Clearly, the information obtained this way would be more accurate than simply asking the parent or caregiver, who has to rely on memory and might have an incentive to withhold information.

Los Angeles County’s Department of Child and Family Services has contracted with software giant SAS to develop a risk assessment tool called AURA. As described by The Chronicle, SAS identified child deaths, near fatalities and severe injuries (called “AURA events”) in 2011-2012 among children referred to CPS within six months of these events.

Programmers then developed an algorithm that calculated the risk of an AURA event in the six months following a referral based on the characteristics of the children and their families. The predictive power of the algorithm was tested against child abuse reports in 2013 (data that was not used to develop the algorithm.)

AURA proved to be a powerful tool for predicting deaths and serious injuries to children. Among those cases that had at least one referral before the current one, the 1 percent of referrals with the highest AURA scores experienced 57 percent of the AURA events. The 20 percent of referrals with the highest risk accounted for 83 percent of total AURA events.

Florida has chosen to use a different approach. It is using a tool called Rapid Safety Feedback(RSF), developed by a nonprofit called Eckerd Kids for Hillsborough County, which had experienced nine deaths among children in open cases receiving services at home over three years.

Rather than a risk assessment algorithm, RSF is a quality assurance tool that is used to target a set of high-risk cases for special treatment and review. RSF targets cases with characteristics associated with a high probability of serious injury or death to a child.

In Florida, RSF is used only for families with in-home cases. Cases designated high-risk are reviewed quarterly to make sure workers are using specific practices that have been shown to increase child safety.

According to Eckerd, there have been no maltreatment-related deaths of children in open cases in Hillsborough County since implementation of RSF in January 2013. Several states are working with Eckerd to adapt and implement RSF in their child welfare investigations.

The new tools discussed above are in their infancy in child welfare. It is important for policymakers and advocates to understand the nature of the tools that are available and the differences between them before making decisions about which if any to support.

This column was published in the Chronicle of Social Change on February 3, 2016.

Families First Act Disregards Foster Care Shortage, Need for Some Group Homes

Congress appears to be on the right track with child welfare reform, as evidenced by a summary of the new Families First Act, which may soon be marked up by the Senate Finance Committee. The centerpiece of the legislation is the expansion of Title IV-E to provide preventive services to assist children in danger of being placed in foster care.

With the passage of this legislation, federal funding will support keeping children at home as much as it does foster care. It is a change that almost everyone seems to support.

The other major part of the legislation, however, is not without controversy. That is the part that seeks to eliminate most federal support for foster care group homes.

The legislation eliminates funding for placements that are not foster family homes after two weeks, with three exceptions: Qualified Residential Treatment Programs (QRTP’s), facilities for pregnant and parenting teens, and independent living arrangements.

The definition of QRTP has not been released, but it appears that Congress has in mind the types of arrangements that are currently known as residential treatment programs, which are large institutions where clients attend school and receive mental health treatment.

I have several concerns with this provision.

First, the bill fails to recognize the need for a continuum of care depending on the child’s needs. Such a continuum should include family foster care, therapeutic foster care, therapeutic community group homes and residential treatment centers. A child who leaves residential treatment is not necessarily ready for a foster family, and a child who can’t function in a family may not need a residential treatment program. What’s missing from the options provided by the new bill are therapeutic group homes, such as those operated by Boys Town, using the evidence-based Teaching Family model.

Secondly, the bill contains no provisions to increase the supply of high-quality foster care to meet the needs of all the children who will need to be accommodated when group homes close down. Today, there is a critical foster care shortage around the country, with children staying in offices, hotels and emergency shelters because foster homes are not available to them.

To make matters worse, many existing foster homes provide care that is neglectful or even abusive. As a former social worker with District of Columbia foster children, I have writtenabout neglectful foster parents. There was the foster parent who hadn’t been to her foster child’s school in more than a year, and refused to pick her up even when she was vomiting. There was the foster parent who refused to go to a meeting at her foster child’s school, saying, “If I cared I would go, but I don’t care.”

I asked my agency to close these homes, but the request was not granted. With the shortage of foster homes, agencies are reluctant to close homes that are anything short of abusive. And even in the case of abusive homes, we have all heard the stories of children who have been killed or injured in foster care.

Sometimes, as in the case of two-year-old Laila Marie Daniel in Georgia, it turns out that agency staff disregarded multiple reports of trouble in the home. I’m sure that the critical shortage of foster parents is part of the explanation.

Abusive and neglectful foster homes need to be closed, but they must be replaced and added to with a new source of high quality foster homes. How can this be done? The only way is to pay foster parents enough so that one foster parent in each home can stay home with the children, thus attracting a completely new source of foster parents.

In an earlier column, I wrote about the SOS Children’s Villages in Illinois and Florida. They not only pay foster parents a salary but provide houses large enough for six children. The provision of housing is particularly important in order to attract foster parents to cities with high housing costs, where many foster kids live.

Paying foster parents a full-time salary is an expensive proposition. But this expense can be offset by recruiting foster couples (either married couples or two single people living together as house parents) to care for five or six children. By locating them in communities like those provided by SOS Children’s Villages or the Mockingbird Society, foster parents can be empowered to help each other, and services to the children can be provided on site.

It would be irresponsible for Congress to pass the Families First Act without provisions for a therapeutic option between foster homes and residential treatment and for increasing the supply of quality foster care. The Senate Finance Committee should modify its bill by adding a provision for short-term therapeutic group homes and by providing new funding and incentives to encourage states to improve the quantity and quality of their foster homes.

This column was published in the Chronicle of Social Change on January 27, 2016.