Family Planning Can Help Curb Maltreatment Mortality

In my previous column, I quoted Sarah Brown, founder of the National Campaign to Prevent Teen and Unplanned Pregnancy, who said that groups focusing on child and family well-being rarely propose interventions that begin before conception.

Nowhere is this more true than in the field of child welfare. So it is not surprising that the draft recommendations of the Committee to Eliminate Child Abuse and Neglect Fatalities (CECANF) do not include family planning.

But anyone who has worked with children in foster care knows that more of these youth come from larger, closely spaced sibling groups than one would expect in the general population. Indeed, research shows a strong relationship between larger families and child maltreatment.

A study of the 2002 birth cohort in California showed that babies born to mothers who already had two or more children were more than twice as likely to have CPS contact than firstborn babies.

Using earlier data from California, Barbara Needell and Richard Barth found that 59 percent of infants entering foster care between 1989 and 1994 were the third or later child born to their mother, compared to only 29 percent of the general population of infants.

Federal data from the Fourth National Incidence Study of Child Abuse and Neglect shows that one in 48 children in households with four or more children were likely to suffer abuse or neglect. This is double the rate of children in households with two children, which had the lowest rate.

Unfortunately, we don’t know what proportion of child fatalities come from large families. But at least one expert has noticed a pattern. Angela Diaz, who directs New York’s Mount Sinai Adolescent Health Center, testified that during her tenure on a panel that reviewed child fatalities in New York City, the mother of the dead child often had had a child in adolescence, followed by more children in short order.

The correlation between larger families and child maltreatment is not surprising. Parents of larger families undergo more stress due to both the difficulty of supervising more children and the financial burden.

Financial strain can also lead to neglect in the form of lack of supervision when the parent must work, inadequate housing, etc. Moreover, both child maltreatment and larger families may be related to underlying social factors such as poverty and low education levels.

Of course, many people raise large families with no difficulties, and many adults from large families treasure their upbringing and their strong support system. In the past, larger families were more practical for all income levels.

Today, I’d submit that a very large family is financially risky to most adults without a serious cash reserve or income in the top percentile. For parents already involved with child welfare, especially those struggling to make ends meet, it is hard to dispute the benefits of postponing further children.

In the last few years, advances in contraception have led to the availability of Long Acting Reversible Contraceptives (LARCs). But the availability of LARCs and knowledge of their safety and efficacy have not yet caught up.

As I recommended in an earlier column, system-involved mothers could be offered the opportunity to get a LARC immediately. Judges, attorneys and social workers could provide information about LARCs and explain the importance of avoiding further births as a mother tries to regain her children and get the agency out of her life.

CECANF should add to its recommendations that future data collection about child deaths include family size. But the correlation between family size and child maltreatment is compelling enough for immediate action. CECANF should suggest that states explore the possibility of integrating pregnancy prevention with child welfare services.

On a policy level, it is time to discuss ways to limit childbearing by women who lack the financial means to handle more kids. A grant program might even be created in order to encourage states to experiment with different approaches.

Such proposals are difficult to bring up in America, thanks in part to our country’s shameful history of attempting to restrict childbearing by women of color through means including forced sterilization and the promotion of birth control methods like Norplant. But the welfare of children should take precedence over the reluctance to offend adults.

This column was published in the Chronicle of Social Change on December 16, 2015.

Teen Pregnancy Prevention: An Overlooked Weapon Against Child Maltreatment Fatalities

The Commission for the Elimination of Child Abuse and Neglect Fatalities (CECANF) has developed a long list of draft recommendations. One overarching recommendation is to “ensure access to high-quality prevention and intervention services for children and families at risk.”

Many prevention services are mentioned, but one was left out in my opinion: services to prevent teen and unplanned pregnancies.

It is not surprising that pregnancy prevention was not often recommended to CECANF as a strategy to prevent child abuse and neglect fatalities, and that this recommendation did not make its way into CECANF’s draft.

As National Campaign to Prevent Teen Pregnancy co-founder Sarah Brown recently pointed out, groups that focus on child and family well-being rarely propose interventions that begin before conception of a child. CECANF could begin to rectify this omission by including teen pregnancy prevention in its recommendations for reducing child abuse and neglect fatalities.

In her testimony before CECANF, Angela Diaz, director of New York’s Mount Sinai Adolescent Health Center, discussed the connection between teenage parenthood and child maltreatment fatalities. In serving for many years on a child fatality review panel, she noticed that in many of these cases, the mother began childbearing in adolescence, and had more closely spaced children thereafter.

Dr. Diaz cited a national study of deaths of infants born between 1983 and 1991, which showed that “childbearing at an early age was strongly associated with infant homicide, particularly if the mother had given birth previously.”

A second or subsequent infant born to a mother younger than 17 years old was 11 times more likely to be a homicide victim than the first child of a mother 25 or older. A second or subsequent infant born to a mother age 17 to 19 was over nine times more likely to be a homicide victim.

Based on her observations and the research, Dr. Diaz recommended ensuring that adolescents have access to comprehensive sexuality education and reliable family planning methods. I hope the Commission will add this to its recommendations.

It is true that teen pregnancy has been decreasing rapidly. But there were still 249,067 birthsto teenage girls in the United States in 2014, or 24 births for every 1,000 girls. Estimates from 2013 data show that 11 percent of adolescent girls in the United States will give birth by their 20th  birthday.

And rates are still higher among Blacks and Hispanics, girls in poor neighborhoods, and teenagers in foster care. Nearly one third of teenage girls in foster care have at least one child.

Most teens in foster care have been abused or neglected, which makes them statistically more likely to abuse or neglect their children. A large study in California found that 40 percent of children born to teen mothers involved in the child welfare system will be reported for child abuse by age five.

We need to know what proportion of child fatalities involve children who were born when their mothers were teens, as well as those born to mothers who began having kids as teenagers. CECANF should recommend that Congress require the collection of these data.

Even without knowing the proportion of child maltreatment deaths occurring to children of teen mothers, we already know that teen motherhood is a risk factor for child abuse and neglect. CECANF should recommend increased emphasis on teen pregnancy prevention, especially for young women in high poverty areas and those in foster care.

The Commission should recommend that all teens, especially those at higher risk of pregnancy, have access to contraceptive methods and education. Clinics in low income areas and those serving youth in foster care and juvenile justice should provide the full array of contraceptive options including the long-lasting methods that are most effective, along with education and counseling.

Special attention should be devoted to preventing a second birth to a teenage mother by ensuring that she is provided with a contraceptive method at the time of the first birth. The federal Teen Pregnancy Prevention Program, which has been under attack in Congress, should be fully funded or expanded.

 This column was published in the Chronicle of Social Change on December 9, 2015.

Birth Match, Tool to Prevent Abuse and Neglect, Slow to Spread in U.S.

The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) has heard from experts and stakeholders around the country and has prepared a draft of its recommendations. Among them is the suggestion that states expand a practice called “birth match,” which can identify at birth children who are at risk of child abuse and neglect.

This recommendation should be highlighted and strengthened.

Richard Barth, a highly regarded child welfare scholar, discussed Maryland’s birth match law in testimony during a CECANF hearing in July of 2014. This law was adopted after several children were killed by parents whose parental rights had been terminated for previous children.

Infants born to parents with a prior termination of parental rights (TPR) are not an insignificant group. Barth found that they made up over 10 percent of entries into foster care in Maryland in 2013.

Maryland’s law requires that birth records be matched against a list of parents who had their parental rights terminated within the last five years due to abuse or neglect. The families thus identified receive a visit from a social worker to assess for safety and risk to the infant.

States have a choice in how to intervene with the families they identify through birth match. In Maryland, these families receive a visit from a social worker to assess the family. If the parent refuses the visit, a case can be opened “only if abuse or neglect is suspected.”

Michigan is more aggressive in dealing with high-risk families. Identification of these families results in the opening of a case unless there is a waiver. That seems a more effective way to ensure a child’s safety than allowing families to opt out of the screening.

Identifying only parents with prior TPRs is a very conservative strategy that does not even capture all parents who lost a child permanently due to abuse or neglect. To identify all of those parents, a state would have to include parents who lost a child to guardianship as well as adoption.

To target a broader swath of parents at risk of harming a child, a state could identify all parents who had a prior finding of child abuse or neglect or a child placed in foster care. It could also target teenage mothers who themselves were victims of child abuse and neglect. One study found that 40 percent of children of California teen mothers who were found to be the victims of abuse or neglect as children will be reported for child maltreatment by age five.

Birth records could also be matched with data other than child welfare administrative records. A groundbreaking study of all 2002 births in California shows that “objective data collected at birth can be used to identify those children in a given birth cohort who are at greatest risk of future CPS contact.”

Among the most important risk factors were a mother’s low education level, a mother’s young age, three or more children in the family, and for U.S. born mothers, Medicaid coverage of the birth.

Despite the promise of this approach, few systems have embraced it. Barth told CECANF that “virtually all states have the option to share birth records with child welfare agencies,” but very few states do; to his knowledge, the only states that do are Minnesota, Maryland and Michigan.

According to Barth, the main obstacle to implementing birth match in other states is the reluctance to trigger CPS involvement with families that may not be maltreating their children.

Clearly, it would be distressing for a family to be contacted by CPS when they have not done anything wrong. And by no means am I suggesting that all, or even most, of the parents identified through birth match are incapable of caring for a child.

However, the opportunity to save a child from serious abuse or neglect should take precedence over the inconvenience to families of undergoing an assessment.

We need more research on birth match programs to identify the outcomes of intervening early in families identified as high-risk. How many families are identified and what is the result? Do child fatalities decrease after the adoption of such a policy?

CECANF’s recommendation that states “expand birth match programs such as those operated in Michigan” should be strengthened and elevated to the federal level. The commission might recommend that the federal government establish a pilot program providing grants to states that adopt and evaluate birth match programs.

Information from this pilot could be used to develop a federal requirement for all the states to match birth and child welfare records.

This column was published in the Chronicle of Social Change on November 30, 2015.

Too Often, Parental Rights Trump Kids' Best Interest

It is National Adoption Month, and I’m remembering the four adoptions that I oversaw in my five years as a foster care social worker. These were among the happiest occasions in my child welfare career.

What could be better than seeing a child who had been abused or neglected permanently united with a family that had already proven their love and nurturance by fostering?

But I’m also remembering the adoptions that did not happen, despite the fact that they were clearly in the best interests of the children. Because the system too blindly favors biological parents, the interests of the children and their future prospects took a back seat.

“Tamara” came into care at the age of two when her mother was arrested for hitting and knocking her down at a CVS. After two years in foster care, Tamara was totally bonded to her foster family.

Despite months of individual and family therapy and parenting training, Tamara’s mother had not developed an attachment to her. She was unable to state anything she liked about Tamara, a lively, bubbly child.

In a court-ordered bonding study, knowing she was being observed, Tamara’s mother was unresponsive to Tamara’s attempts to get a reaction to her drawing. The parenting counselor who had worked with Tamara and her mother agreed with the bonding study: Tamara’s mother just was not attached to her.

Unfortunately, the judge did not agree. The government attorney and I were nearly in tears as we tried to explain the type of nurturing that children need for healthy development. All he saw was that Tamara’s mother had followed the court’s orders, such as participating in therapy and parenting training.

It did not matter that these services had not worked to make her a better parent. I had to return Tamara to her mother.

Then there was Davon. His extremely nurturing foster parents, a married couple with grown children, brought him up from the time that his mother abandoned him at the age of 3 months until past his second birthday.

In the foster home, Davon basked in an atmosphere of love, order and intellectual stimulation. But then, his mother named the real father, who had not known of Davon’s existence.

The 19-year-old father, jobless and a high school dropout, wanted to bring up his son. He had not abused or neglected Davon. Nevertheless, it was clear that Davon would do better with his foster parents. 

I left the job before I would have had the sad task of removing Davon from the only home he remembered. But I later heard from his attorney, who had opposed the move, that she had serious concerns about his emotional and intellectual development in the somewhat chaotic home to which he was transplanted.

I’ve been reading Meghan Walbert’s Foster Parent Diary in the New York Times. For seven months, she and her husband have fostered “Blue-Jay,” who came to their home at the age of three. Through her blog, we see a fearful child gradually settling in to the family.

We read about Blue-Jay’s anguish after his birth parents tell him on a visit that he is coming “home.” “I don’t want to live in a different house. I want to live in this house with this family,” he wails.

We see him becoming afraid of new places and new people, for fear that he will be taken away. How long this limbo will last is anybody’s guess.

The problem is, as Elizabeth Bartholet of Harvard Law School puts it, that the child welfare system puts parents’ rights ahead of the rights of the child. But laws are not the whole problem. District of Columbia law allows for a child to be adopted against a parent’s consent if it is in the child’s best interests. But courts will generally not waive a parent’s right to consent if the parent has complied with court orders or, as in the case of Davon’s father, was not guilty of abuse or neglect.

Federal law was changed in 1997 to require that the government move to terminate parental rights if a child has been in foster care 15 out of the most recent 22 months. But even after the government moves for termination, it can take a year or more before an adoption is finalized.

During that time parents can continue to press for reunification, a father can appear, or a relative can be found who is given priority because of the blood relationship. In the meantime, some children will become more bonded to foster and adoptive families, making the separation even more harmful.

Accumulating research findings show how important it is for a child to have a loving, consistent, responsive caregiver. Caregiver-child interactions shape the developing brain. Loving and appropriate responses to the child’s cries, gestures, and early speech are necessary for the child’s physical, mental and emotional health.

I hope that our increasing knowledge about early childhood brain development will eventually lead to a change in practice that puts the best interests of children at the heart of child welfare and allows for many more joyful adoption days in the future.

This column was published in the Chronicle of Social Change on November 23, 2015.

Short-Term Emergency Shelters Better than Uncertain Alternatives

Oklahoma is closing its emergency shelters for foster children pursuant to a settlement in a class action suit. As of October 20, the Oklahoma City shelter was down to one child, and the Tulsa shelter was to be closed by the end of the calendar year.

The Oklahoma shelters were supposed to serve as emergency intake facilities for children after they had been removed from their homes. But children were reportedly spending months at these shelters when foster homes could not be found for them. As part of a major class action suit, the state agreed to close these shelters.

The move to close Oklahoma’s emergency shelters is part of a general movement to eliminate institutional settings for foster children. Emergency shelters have gone out of style as research has suggested that institutions are bad for children.

In addition, states have reported that emergency shelters worsen their performance on the “placement stability” standard, which is one of the standards by which states are measured as part of the Child and Family Services Review (CFSR) process.

Now, in many jurisdictions like the District of Columbia, children are placed immediately into foster homes, even in the middle of the night. This approach is considered the best for children. But I have my doubts.

In my last job as a foster care social worker with a private agency in the District of Columbia, one of my duties was to be on-call overnight for a week at time. The main function of an on-call social worker was to receive emergency placement calls. In my last on-call week, I was woken up four times by calls between 2:00 and 4:00 a.m.

Here’s how it worked. I’d be woken by the call from the equally groggy on-call placement worker. I’d be told that a child or sibling group needed to be placed, given minimal information about them, and would then have to call all of our foster homes with vacancies. Depending on the age and sex of the children, there might be one possibility or as many as five or six.

Some of the foster parents did not answer their telephones in the middle of the night. The kids would go to the first one who did and who was willing to take them. Given the randomness of that process, my grogginess, and the very limited information provided about the children, the chance of placing the child with the best possible home was not great. Moreover, a sibling group could be split up if the one foster parent who could take them all did not answer the telephone.

I often thought, “How much better it would be if the kids could stay at an emergency shelter/assessment facility for one or two nights, while we contacted available foster parents and determined who might be the best match?” During that time, medical and mental health professionals could assess the children and determine whether they had special needs that should be taken into account. Special efforts could be made to place sibling groups together.

Emergency shelters or assessment centers should not be used as a long-term placement for children in foster care, as was was apparently happening in Oklahoma. But that can be addressed by limiting the amount of time that children can stay in such facilities rather than eliminating them.

Jurisdictions should consider the value of establishing or reinstating assessment centers where children can stay up to 72 hours while they are matched with an appropriate foster home. In order to encourage states to support foster care assessment centers, the federal government should change its measure of placement stability so that placements in emergency shelters and assessment centers are not included.

Children entering foster care need a proper assessment before they can be placed in the most appropriate home. This might be the best way to avoid future displacements as children who had been placed in poorly suited homes—or without their siblings—move to a better-matched home.

This column was published in the Chronicle of Social Change on November 3, 2015.

Real Experts Say Keep Group Homes Open

The anti-group home juggernaut continues to roll along. The Governor of California has signed legislation that aims to drastically reduce the number of foster children placed in group homes by turning them into short-term placements for up to 6 months.

On the federal level Senator Orrin Hatch, has announced his attention to work with other Senators to develop legislation reducing reliance on group homes for youth in foster care.

In last week’s column, I wrote about the folly of restricting group homes when family foster homes are in short supply. Today, I cite the real experts—young people who have thrived in group homes, often in contrast to their foster home experience.

Below are a few examples.

Sunday Koffron Taylor, a former foster child and current foster parent, is now the vice president of the Michigan Chapter of Foster Care Alumni of America. She questions the constant call that every child should be in a family:

The reality is that there are not enough qualified or willing foster homes for older children. I am the beneficiary of the group care system and I have noticed when talking to other foster care alumni that those of us who spent the majority of our time in group settings suffered far less mental and emotional abuse then our counterparts who are placed in foster homes. …Time would be more wisely spent improving group care, rather than attempting to coerce and cajole the unwilling and unprepared foster parent into accepting the care of children whose needs they are not equipped or willing to meet.

Eric Barrus, currently a student at Brigham Youth University, participated in the Congressional Coalition on Adoption Institute (CCAI)’s summer internship program. Eric bounced from home to home until he found stability and love at an independent family group home called Open Gate Ranch, which serves up to eight boys at one time.

The family running “The Ranch” have adopted six of their residents (including Eric) over the 20 years that they have operated the home. In his policy report for CCAI, Eric proposed that family-style group homes be placed in a different category from group homes operated by shift staff and be a preferred option for older boys in foster care.

Another former CCAI intern, Thomas McRae, Jr., entered foster care at the age of 11. He lived in 22 foster homes, suffering abuse, neglect, and multiple changes of school and neighborhood. He reacted with anger and aggression, leading to further disruption as foster parents refused to keep him.

After his last altercation with a foster parent, he ended up in a Boys Town family-style group home. He was supposed to stay only a few days, but his attorney fought for a longer placement, and he ended up there for 8 months. Of his house parents, Thomas states:

They were so inspiring, so motivating. They taught me what it means to have a mother and a father. They taught me patience and kindness. Had it not been for them, I would not be the man I am today.

Thomas is already a seasoned public speaker and will graduate from Cheyney University next spring with a degree in psychology.

These experiences illustrate that group homes not, in and of themselves a problem. As a sector of the child welfare continuum, however, it has come to be defined by its worst members. These are often larger and are known for their rigid “level” systems in which even the most basic “privileges” can be taken away.

The “foster home sector” could easily be viewed through the same lens, but it’s not. There are foster parents who have never been to their child’s school, never taken them to the doctor, and don’t buy them more than the minimal clothing. There are even abusive and neglectful foster parents. But nobody is talking about shutting down all foster homes, or limiting the amount of time a child can stay in a home.

Could the higher cost of group homes have something to do with this discrepancy? Group homes cost more than foster homes, although the ratio of costs varies by jurisdiction and type of home. But the higher cost of group homes might explain why some conservative legislators, like Sen. Charles Grassley (R-Iowa), are so keen on restricting group homes.

The child welfare field should take the advice of Sunday Taylor and improve group homes, rather than eliminating them or establishing arbitrary time limits. Improved standards and accountability for group homes can improve their quality.

And let’s do more research on the effectiveness of different types of group care compared to foster care for different populations. The one study that compares similar group and treatment foster homes following the same treatment model shows that family-style group homes produced better outcomes.

Let’s make sure we know what works before we make it any harder to place youth in homes that could mean the difference between a successful life and a future in prison or on the streets.

This column was published in the Chronicle of Social Change in October 28, 2015.

Curbing Congregate Care Plus Foster Care Shortage Equals Bad Policy

Rarely have I seen a greater disconnect between policy and reality than what is occurring in California’s foster care system.

On October 11, Governor Jerry Brown signed legislation that drastically reduces the number of children placed in group homes and the length of time they spend in such placements.

Four days later, the Los Angeles Daily News reported that there is an “urgent need” for foster parents in the San Fernando Valley. Yet nobody in the executive or legislative branch seems to be connecting these two facts. What is going on?

Under the new legislation, all group homes will be replaced by “Short Term Residential Treatment Centers.” These centers will be licensed only to provide short-term intensive treatment for children who are determined in need of such an intervention.

Stays at these centers will be limited to six months. Longer stays will have to be authorized by senior child welfare officials.

The new legislation is based on the increasing belief that “congregate care is detrimental to the development and well-being of youth in foster care.” Yet, as I wrotein an earlier column, the research behind this assertion is far from conclusive. Especially when it comes to older youth with more serious therapeutic needs, group care may be more appropriate. For larger sibling groups that cannot be accommodated in a single home, a group home may also be a preferable option.

A loving, caring family is of course the best option for many children. However, as I discussed in another column, many foster homes do not provide this type of nurturing environment. Some are neglectful or even abusive, and many are simply providing room and board.

There are also not enough foster homes, good, bad or in-between. So even if any foster home is better than any group home, most jurisdictions just don’t have enough foster homes.

The Daily News reported on October 15 that the Los Angeles County Department of Children and Family Services is holding a special event to recruit “urgently needed” foster parents. Because of the shortage of foster homes, there has been a surge in the number of children admitted to the County’s welcome centers, short-term shelters for children for whom there is no foster home available.

These centers are allowed to keep children for only 24 hours but the Los Angeles Timesreported that this rule was violated 800 times in the last year.

The underlying cause of the crisis is the collapse in the supply of foster homes in Los Angeles County. As reported by the Times, the number of beds in homes of foster parents who are unrelated to foster youth has dropped from 22,000 to 9,000 since the year 2000.

Social workers make up to 100 calls to place one child. What is going to happen when the closing of group homes creates an even greater demand for foster homes?

The supporters of the new California legislation understand that they will need to recruit more foster homes in order for the new regime to succeed. The new law will provide more money to recruit, retain and support foster families.

But unless this money will be enough to buy homes for foster parents in expensive areas like Los Angeles County, or to provide salaries so foster parents do not have to work outside the home, I doubt this effort will be successful.

The rush to close group homes during a foster parent shortage is not a California phenomenon. It is happening all over the country behind the child welfare establishment rallying cry, “Every child needs a family.” In the District of Columbia, children are being sent as many as 30 miles or an hour by car away from the District for lack of foster homes, while group home beds have been cut back.

When there are not enough foster homes, closing group homes does not make sense. Instead, we should create group homes that are as family-like and nurturing as possible. There are many group homes that already meet their residents’ needs for love and caring much more than many foster homes.

Next week, I will share the views of some of the real experts about group homes: young people who have lived in them.

This column was published in the Chronicle of Social Change on October 20, 2015.