Child Maltreatment Prevention Should Start Before Conception

April is Child Abuse Prevention Month, and the recent report from the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) urges the nation to stop waiting for a child to be maltreated before intervening with services and supports.

But when talking about child abuse prevention, CECANF and most others miss one of the most crucial opportunities: before a child is even conceived.

Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy, gave a lecture last December that made this point forcefully. She reports being struck by “the total absence of pregnancy planning, spacing and prevention in virtually all discussions of how to improve overall child and family well being …” As she put it, many groups concentrate on services after the child is born, but rarely do they mention the time when decisions about whether and when it should take place.

There is no lack of research on the connection between pregnancy timing and child maltreatment. There is a strong association between child maltreatment and the mother’s age at the birth of the child. California researchers Emily Putnam-Hornstein and Barbara Needell found that babies born to mothers who were under 20 were twice as likely to be reported to child protective services (CPS) by the child’s fifth birthday as those born to mothers 30 or older.

Among children referred to CPS by age five, almost 18 percent were born to a teenage mother and 50 percent were born to a mother younger than 25. Among children with no CPS contact, only 8 percent were teen births and 30 percent were born to a mother under 25.

There is also strong evidence that family size and child spacing are correlated with child maltreatment. Putnam-Hornstein and Needell found that children who fell third or higher in the birth order were more than twice as likely to be the subject of a report as first children. Moreover, a large study published in 2013 found that women who gave birth to another child within 24 months of the previous child were 80 percent more likely to have a substantiated CPS report.

And setting the research aside for a moment: Anyone who has worked for or with CPS, or in foster care, knows the prevalence of larger families with closely-spaced children in the system.

So if it is not the lack of research, why do supporters of child maltreatment prevention usually fail to include family planning and contraception in their suggestions? In part, Sarah Brown says of child advocates in general, it may be that they simply don’t think of it. But in large part, says Brown, it is because they fear getting in trouble and becoming mired in controversy. In addition to the fear of bringing abortion into the discussion, this discussion makes many people uncomfortable because of fears of conjuring up past attempts to control the population of poor or minority groups.

But family planning and contraception need to be included in the child maltreatment discussion. We know so little about what works after birth to prevent child maltreatment, but we have made great progress in teen pregnancy prevention. Many factors, including economic recession, MTV shows, and fear of HIV may have contributed to the decline in teen pregnancy and parenthood.

But public and private initiatives to provide education and availability of effective contraception have probably played a part as well. Imagine if we could expand that work to focus on young adult women as well. Imagine a public health campaign explaining the benefits of planning, spacing and timing pregnancy to prospective mothers “so that your children can be healthier and have a better chance in life.”

CECANF Commissioner Judge Patricia Martin is to be commended for including teen pregnancy prevention, especially in high-poverty neighborhoods and among youth in foster care, as one of the recommendations in her dissenting report. She stresses the inclusion of young men in these efforts. It is too bad the main report did not include this recommendation.

This column was published in the Chronicle of Social Change on April 26, 2016.

Starving the Foster Care Beast Hurts Only the Children

In his brilliant column of April 5, Sean Hughes explains why 20 years after the federal Aid to Families with Dependent Children (AFDC) was replaced, states still have to document a child’s AFDC eligibility in order to receive federal reimbursement for foster care. This Title IV-E “lookback” has potentially cost state and local child welfare systems billions of dollars over the past two decades.

According to Hughes, advocates have been reluctant to push for eliminating the lookback for fear of encouraging placement in foster care. As Hughes put it, “the focus seems to have shifted almost exclusively toward preventing entry into foster care, with little advocacy being devoted to actually improving the continuum of care for children in out-of-home care.”

At first, it was hard for me to believe that people who call themselves child advocates would stop caring about kids as soon as they are removed from their homes. Government-hating Reagan Republicans invented the term “starving the beast” to describe the strategy of cutting taxes to force government to shrink. But child advocates withholding money from children in foster care?

But then I read Richard Wexler’s column. According to Wexler, the Title IV-E “lookback” is the only restraint on the “runaway train” that is foster care, which rampages through poor communities, “ripping” children from their families. The only way to restrain this train is to cap the funding, even if that means the kids who are removed are essentially warehoused in the cheapest placements with the worst mental health services, education and services to their parents.

Wexler supports his argument by pointing out that rates of child removal vary greatly by state. Iowa “tears apart” families at a rate four times higher than Illinois, and it is unlikely that a difference in child maltreatment rates explains this. I totally agree. Clearly, there is no easily-applied objective standard for removals. Iowa is probably too ready to remove children; Illinois may be too reluctant.

There is a delicate balance in child protection. Some children who are not removed end up dying of abuse or neglect. Federal and state policies have often followed a cyclical pattern. Outcry about child deaths has led to more aggressive removal policies, while complaints about unnecessary removals have led to an emphasis on family preservation.

The CalYOUTH data cited by Hughes shows that 57 percent of the youths surveyed agreed that they were “lucky” to be placed in foster care versus 18 percent who disagreed. That information suggests that at least from the children’s point of view, the majority of removals in California were warranted at that time. That jibes with what I saw as a social worker in the District of Columbia.

In her recent column published by The Chronicle, Mary Callahan suggests that Maine was overly eager to remove kids when she was a foster parent over a decade ago. But things may have changed since that time. The general trend in the past decade has been toward keeping children at home whenever possible, and falling foster care caseloads around the country have been the result.

Regardless of whether too many or too few children are being removed from their homes, an obsolete funding formula is not an appropriate way to prevent unnecessary removals. There is no evidence that changing the federal reimbursement rate would have any effect on the number of removals in any state. The idea that states would respond to the increased reimbursement rate by increasing removals just does not ring true to me.

Hughes argues that eliminating the lookback might make foster care cheaper for a state or county than family preservation programs, for which the state would pick up the full tab. But this whole discussion is taking place in the context of a broader financing reform in which IV-E funds would be allowed to be spent on family preservation, thereby eliminating that problem.

Moreover, the scenario envisioned by Hughes – “the lookback simply ending” and resulting in more federal funds for foster care – is unlikely in this budgetary climate. As some have proposed, Congress would probably lower the reimbursement rate or find other ways to reduce the federal costs of expanding the entitlement.

So what could jurisdictions do with more federal funds? First of all, they could address the critical shortage of quality foster homes by professionalizing foster care or creating foster care communities that provide housing to foster parents. They could implement promising models like Neighbor to Family that keep siblings together. They could create quality residential options, such as North Carolina’s Crossnore School, which graduates at least 95 percent of its seniors every year. They could provide therapeutic child care and improve mental health services.

Foster kids deserve the best homes, therapists, medical care and education, not the cut-rate care most are getting now.

This column was published in the Chronicle of Social Change on April 18, 2016.

Pay Foster Parents to Stay Home with Infants, Not Put Them in Daycare

On April 1 in The Chronicle, Jeremy Loudenback reported on a California budget proposal that would allocate $31 million to provide emergency child care vouchers to foster parentscaring for children ages 0 to 3. Based on my experience as a social worker for foster children in the District of Columbia, I would recommend moving in the opposite direction and using the funds to pay foster parents for staying home with younger children.

To illustrate the need for infant child care, Loudenbeck spoke to a couple who took in a newborn. They were unable to find a spot in a child care center and had to hire a nanny. The couple spent between $400 and $500 per week for child care, compared to their foster care stipend of only $688 per month.

Loudenback’s example raises questions about the policy. It is generally accepted that new parents should take some leave to bond with the baby, cope with sleep deprivation, and adjust to a new lifestyle. The federal Family and Medical Leave Act guarantees 12 weeks for unpaid leave for eligible employees after the birth or adoption of a child or the placement of a child in foster care.

Perhaps a prospective foster parent who expects to put an infant into full-time childcare should reconsider her intention on fostering. Moreover, foster parents need to be available to care for sick babies and take them to frequent doctors’ appointments; something that is hard to do when working full-time.

The economics of paying for infant care plus foster care are also questionable. Californiacurrently pays up to $1,292 per month for subsidized child care for infants and toddlers aged 0-2, which dwarfs the $688 foster care stipend. Talk about the tail wagging the dog!

But what’s better for the children? A major study of child care impacts found no difference between children who were cared for exclusively by their mothers and those who were also cared for by others. There were some modest negative impacts on behavior for those who spent many hours in child care.

Sheila Kuehl, the county supervisor who authored the current plan, says it will help in foster parent recruitment. I’d be willing to bet that Los Angeles could find more than enough foster parents for infants if they added $1,192 to the $688 foster parent stipend, for a total of $1,880 per month.

Loundenback mentions the situation of relative caregivers, who may have only a few hours notice that a child is being placed in foster care. An emergency child care voucher for these relatives does make sense. We cannot expect them to quit their jobs in order to care for a relative who might be with them temporarily.

Perhaps the best option is to limit the emergency child care vouchers to relatives. Or the state to offer the choice between a child care voucher and a higher stipend for non-relatives who wish to stay home with foster children between zero and three.

The current plan would allow foster parents to use the new vouchers for licensed or unlicensed settings, and adds no provisions for ensuring quality. This is short-sighted. Many young children enter foster care already behind developmentally due to neglect or abuse. Except for newborns and very young infants, most are traumatized by their removal and perhaps by the conditions that caused the removal.

The concept of trauma-informed schools is sweeping the nation, but the concept of trauma-informed child care does not seem to have advanced beyond Seattle’s Childhaven program. Kuehl’s proposal pays lip service to the concept of trauma-informed care by “making trauma-informed training available to providers,” but does not apparently require such training or the use of any particular practices.

In addition to being trauma-informed, child care for foster children should be developmentally appropriate and enriching. If California is going to allocate funds specifically for child care for the youngest foster children, only high-quality, trauma-informed and developmentally appropriate programs should be funded.

I hope that the California legislature will modify the proposal currently before it so that foster parents who want to stay home with babies and toddlers instead of sending them to child care can be paid to do so. In addition, the proposal should be modified to ensure that when the state pays for child care, it is both licensed and designed to meet the needs of young children in foster care.

This column was published in the Chronicle of Social Change on April 11, 2016.

Plenty of Blame to Go Around for Traumatic Removal of Six-Year-Old from Longtime Home

On March 21, six-year-old Alexandria P. (“Lexi”) was carried screaming away from the home where she had lived for two-thirds of her life. This traumatic removal has drawn attention around the world to the negative consequences of the Indian Child Welfare Act (ICWA). But careful study shows that ICWA is only part of the story.

Seventeen-month-old Lexi was removed from her father in 2010 when he was jailed for auto theft and selling stolen auto parts, according to Indian Country Today. Her mother had a long history of substance abuse, and had lost custody of at least six other children. Lexi’s father initially denied any Indian heritage but his mother alerted the court to his membership in the Choctaw tribe. The court found that ICWA applied, and the tribe was brought into the case.

By October 2011, the “R” family in Utah had expressed an interest in adopting Lexi. The family is very loosely related to her father; Ms. R’s uncle is Lexi’s paternal step-grandfather. The R’s now have custody of Lexi’s half-sister, according to the Children’s Law Center, which represents Lexi in court.

The tribe decided to keep Lexi in foster care in Los Angeles, so that her father could visit as he tried to reunite with her. But if reunification failed, the R’s would be its choice to adopt Lexi, in accordance with the preference for family embodied in ICWA.

Lexi lived in two foster homes before she was placed with Rusty and Summer Page at the age of two in December 2011. According to testimony before the California Court of Appeal, within a few months she had bonded with the entire family and considered the Pages to be her parents and their children to be her siblings.

Lexi’s father stopped visiting, and indicated in September 2012 that he no longer wanted custody. The Pages expressed their interest in adopting Lexie, but were told that the tribe had selected the R’s as Lexi’s adoptive parents. The Los Angeles Department of Children and Family Services (DCFS), Lexi’s attorney, and her father all agreed with this plan. So the Pages hired their own lawyer and challenged the plan.

On July 13, 2013, the court began a hearing that spanned five days over the course of three months. The court reached its decision on December 9, 2013, almost five months after the trial began. The court decided that the Pages did not have good cause to prevent Lexie’s placement in Utah but granted their petition to keep Lexie in their home, pending appeal.

On August 15, 2014, the appeals court ruled that the Pages did have good cause to challenge the adoption, and sent the case back to the original court.

One year and seven months later, the original court issued its decision. Lexie was going to Utah.

There is more than enough blame to go around here.

ICWA gave jurisdiction over a child who was 1/64 Choctaw to a tribe that her father did not even know he belonged to. This goes well beyond the purpose of the act, which was designed to stop the wholesale removal of Indian children from their families and tribes.

DCFS and Lexi’s attorney supported the tribe’s decision, and might have made the same choice in the absence of ICWA. A definition of family which prioritizes the ties of blood and even marriage over the realities of bonding and attachment may not be in the best interests of children, as I discussed in an earlier column.

The Children’s Law Center reports that Lexi’s half-sister is also with the R’s. Lexi never lived with this half-sister. She has three foster siblings with whom she has lived for four years.

In my opinion as a former child welfare social worker, DCFS did not manage the case in accordance with best practice and state law. When a state wants to place a child in another state, it must formally request that the second state evaluate the proposed guardians, a process that can take six months or longer.

DCFS waited until reunification failed before filing this request, even though California law calls for “concurrent planning” in such cases. By the time the approval was received, the Pages were able to claim “de facto parenthood” and delay the placement.

But the foster parents also bear considerable responsibility for Lexi’s suffering. If they had not challenged the decision of the agency and the tribe, Lexi could have been placed with the R’s years ago and the trauma of her transition would have been much less.

Finally, the greatest share of blame belongs to a legal system that ignores a child’s sense of time, and to the politicians that refuse to provide the funding that would enable the courts to act with more urgency. It has been over four years since the Pages filed their first motion. Lexi has now spent over two-thirds of her life with the same family. Removing her from them is truly abuse by the state.

This column was published in the Chronicle of Social Change on March 29, 2016.

To Improve Child Welfare, Let Social Workers do Social Work

March is National Social Work month, and there will be a lot of talk about the importance of social workers. But for all of the praise heaped on the profession, there sure seems to be a lack of support for people willing to do the job.

In Texas, one-sixth of new caseworkers quits within six months. In Florida, case worker turnover averaged 37 percent in 2014.

I know first-hand the reasons for high social worker turnover in child welfare. I abandoned an easier and better-paying career to become a child welfare social worker in the District of Columbia. I lasted almost five years before giving up in exhaustion and despair.

At first, I loved my job. I loved the feeling of making a difference in children’s lives. I loved trying to find the right services to meet the needs of the children and their birth parents. I loved teaming with teachers and service providers to help my kids and parents achieve their goals. I was thrilled when I was able to find a family friend or relative who could provide a permanent home for a child.

Every day I came to work with a long to-do list. But I never knew if all my plans would be derailed by one of the frequent crises that characterize foster care. A foster parent was fed up with a defiant teenager and wanted her out today. A client said she wanted to die and had to be taken to the hospital, where we would wait for seven hours. A client was sick and the foster parent couldn’t pick her up. The best foster parents do the emergency pickups and doctor visits, but the foster parent shortage means that agencies tolerate those who do little but provide room and board.

A huge part of my job involved driving. Some of my clients lived as far as 30 miles–over an hour’s drive in the congested Washington D.C. metro area–from the office. One was 90 miles away, just under the 100-mile limit so that I was still required to visit him twice a month.

When foster parents said they could not, and our overworked paraprofessionals were unavailable, I had to take my clients to the doctor, dentist, therapist, and for family visits. I spent as much as 10 hours a week driving and I logged as many as 300 miles per month. I don’t see how it makes sense for a person with a master’s degree in social work to serve as a paid driver.

Finally, there was the endless list of useless things I had to do to meet process-oriented standards that only detracted from helping my clients. In the District of Columbia, all children need a case plan every six months. All children over the age of 14 need a different Youth Transition Plan every six months. All children in therapeutic foster care need a separate treatment plan every six months. All of these plans must follow prescribed formats which make them impossible to consolidate with each other, difficult to use and not very useful in my work with clients.

All children must be visited twice a month, or four times a month when they are in a new setting. On average, I saw my clients more than required. But the need to do a second monthly visit with a client who is thriving instead of a third visit with one who is struggling just makes no sense.

All clients have to receive a health screening every time they change foster homes, even for respite placement for a week. Some clients end up being screened four times in a month!

Things were at their worst whenever one of my colleagues left the job. I would then get two or three more cases and things became totally out of control. For the next two to three months, until a replacement was hired and trained, proactive case management took a back seat to crisis management, and the stress became almost unbearable.

I received a lot of praise from supervisors, attorneys, and judges because my clients got the services they needed and my cases actually moved toward permanency. But after five years, I could no longer maintain the brutal pace and the constant stress.

For most child welfare social workers in D.C., and I would guess around the country, there are simply not enough hours in a day to do the work that matters plus the work that is required. Too many hours have to be spent doing things that others should do, or things that just sound good and don’t really help the clients.

If we want to keep social workers on the job and helping their clients, we must eliminate meaningless requirements, hire more paraprofessionals to do the driving, and ensure that foster parents do their jobs.

This column was published in the Chronicle of Social Change on March 2, 2016.

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.