Preventing Repeat Pregnancies Among System-Involved Moms

Last week, I wrote about the need to address teen pregnancy among youth in foster care. This week, I focus on repeat pregnancies among mothers who are already involved with the child welfare system. This includes mothers with children in foster care and those who are being supervised by the child welfare agency due to abuse or neglect.

Among the saddest news for me as a social worker in the District of Columbia’s foster care system was to hear that a mother whose child was in my caseload was pregnant again. There was the teenage mother, herself in foster care, who was not visiting her son consistently or complying with court orders. Still a teenager, she got pregnant again, perhaps in the hope of keeping this child.

There was the mother struggling against her addiction to crack cocaine. Her first three children were living with her own mother, but she could take no more. One or two were with the father. The sixth was with a foster parent who was trying to adopt him. And now she was pregnant with the seventh.

Some of these women continue to give birth and to have the children removed, over and over. I have witnessed mothers who were drug addicts, selling sex for drugs, and others who were trying to cement a relationship with a new man or replace the children who were taken away.

But we have no idea of what proportion of the caseload they account for because this data is not collected. The federal government does not even require the states to collect data on how many children each mother in the system has had. We have no idea how many mothers with a child in foster care get pregnant again or how many of these children end up in foster care as well.

This is a very sensitive subject. It would not be acceptable to most people if judges ordered mothers to use contraception and told them that another birth would reduce their chances of getting their children back. But there are meaningful steps that could be taken without depriving women of their rights to self-determination.

Mothers could be encouraged to use Long Acting Reversible Contraceptives (LARCs). As I wrote last week, many primary care clinics do not provide access to LARCs, and they should be made available at clinics that take Medicaid patients and uninsured patients and training provided to staff in how to insert them.

While a court couldn’t order mothers to use LARCs, it could offer a financial incentive to mothers who agree to have a LARC inserted. It could be a sizeable incentive, considering the cost that the birth of a child to most of these mothers saves in welfare, Medicaid, or foster care payments.

Perhaps many readers would object to this attempt to influence a woman’s reproductive decisions. But I’m guessing that those who are directly involved in caring for these children would agree with me.

One of my clients, a three-year old girl, was born to a drug-addicted mother who abandoned her at the District of Columbia’s family homeless shelter. The maternal grandmother was raising the first two children but was exhausted and ill, so her sister stepped up to the plate. She and her husband created a wonderful home for the little girl, but they were still hoping that mom would come back one day clean and sober so they could have the retirement they had dreamed of.

Then came the dreaded news that mom was pregnant again. A cousin in Texas agreed to take the next newborn. But she was also on her way to D.C., to track down mom in the streets and persuade her to get her tubes tied. There was nobody else to take another child, and this was not a family that allows its children to be taken in by strangers.

I don’t know if the cousin succeeded in her mission. But I hope she did.

This column was published in the Chronicle of Social Change on September 29, 2015.

Long-Term Contraception Has Great Potential to Help Foster Teens

When a teenager in foster care gets pregnant, the child welfare system has failed. The barriers to future education and employment for these young people are bad enough without the added burden of a baby. And of course, the risk of bad outcomes (including abuse, neglect and placement in foster care) are high for babies born to teen mothers.

Unfortunately, teenagers in foster care are much more likely to become pregnant than other teens. According to data compiled by the National Campaign to Prevent Teen and Unplanned Pregnancy, nearly half of teenage girls in foster care are pregnant by age 19, compared to 27 percent of all teenage girls. (Fatherhood data, sadly, is not available.)

It is not surprising that teens in foster care are more likely to get pregnant. Researchindicates that teens in foster care are about twice as likely to be sexually active as teens not in foster care. Girls in foster care are much less likely to use contraception than their peers who are not in care. Risky behavior by teens in care is probably related to their adverse childhood experiences  and the fact that they have fewer protective factors, like attachment to a caregiver.

Some teen pregnancies are intentional, and these may be more likely among young people in foster care. For some, a baby may provide the unconditional love and attachment that some teens in foster care have never experienced. For others, the opportunity to get an independent living apartment may be an incentive for pregnancy where such opportunities are available.

Even if they don’t want to get pregnant, teens are likely to conceive by accident if they don’t use effective methods of birth control. Methods that must be taken each day or used each time (like a condom) are not very reliable for teens. Because foster children move frequently, a method that requires repeat medical visits is not practical for them.

The availability of Long Acting Reversible Contraceptives (LARCs), such as an interuterine device (IUD) or a birth control implant, offers an opportunity to reduce pregnancy among teens in foster care. LARCs are safe and easy to use, and they last from five to ten years.

Unfortunately, LARCs are still not widely known or understood among teens, adults and even health care professionals. Problems with earlier versions of the IUD and contraceptive implant contribute to an impression that these methods are not safe. Teenagers and even clinicians continue to express concerns about LARCs, often based on myths and misconceptions.

Secondly, foster youth are not likely to be offered LARCs in most systems. Many foster care teens get their care at primary care clinics that take Medicaid. Research shows that primary care clinics are less likely to offer LARCs than are clinics focused on reproductive health care.

A few places are starting to see the value of long-term protection. The Colorado Initiative to Reduce Unintended Pregnancy made LARCs free and widely available. The initiative began in 2009; since then, the state’s birth rate among teens ages 15 to 19 has dropped from 37.7 per thousand to 25.4 per thousand.

When it comes to foster youth in particular, Los Angeles is setting an example for other jurisdictions.  As recently reported in the Chronicle, a new program there provides LARCs to foster youth and those at risk of entering into foster care in all of the “medical hubs” affiliated with the county’s Department of Health Services. Staff at these clinics are being trained in inserting the devices.

Jurisdictions should follow Los Angeles’ example and make LARC’s available to all teens in foster care. In addition, agencies should train foster parents, group home staff, and social workers to provide accurate information about the effectiveness of LARC’s and other birth control methods.

Contraception and education alone do not provide the solution to the problem of births to foster care teens. Research indicates that youth who received more monitoring by their caregivers were less likely to be sexually active, and more frequent use of contraception was likely among youth who reported feeling connected to their caregivers.

But as I have written in previous columns, many teens in foster care do not receive adequate attention or monitoring and do not have strong relationships with their caregivers. We need to find a way to replace these bad foster homes, be it with professional foster homes orfamily-style group homes.

Preventing pregnancy among teens in foster care should be a top priority for all child welfare systems. Teens in foster care need to complete their educations and defer childbearing until they are in a better position to support a child economically and emotionally. Unfortunately, Congress may be close to cutting resources for teen pregnancy prevention and family planning.

We can only hope that state leaders see the problems of teen pregnancy first-hand, and will be smart enough to ensure that prevention services to teens in foster care and other at-risk teens are increased, not decreased.

This column was published in the Chronicle of Social Change on September 22, 2015.

Out-of-County Placements Tax Kids and Workers Alike

The Chronicle’s series on out-of-county placements for foster youth provided excellent examples of the problems caused by placing foster children out of county or far away from home. In the District of Columbia, where I worked as a social worker with foster children, over half of foster youth are placed in the Maryland suburbs.

California seems to be unique in having data about out-of-county placements. However, while nationwide data are not available, this is likely a national issue. As far back as 1999, child welfare scholar Mark Testa discussed the lack of foster homes in the cities and the placement of urban children in suburban foster homes.

Working with D.C. children who lived with Maryland foster families, I saw firsthand the problems with having foster youth in another jurisdiction. Child welfare agencies are now required to keep children in their home school unless it is not in their interests to do so. As I discussed in an earlier column, these young people are often forced to use special van services, which means that they cannot participate in extracurricular activities since drivers are not available after normal school hours.

Moreover, travel times are often lengthy as drivers might have several children in different jurisdictions on one route. Faraway schools means that it is difficult for children to see friends after school or participate in evening or weekend activities.

Long distances from children’s families also cause big problems. Young people usually visit with their families weekly, and this means lots of time in the car for kids and staff– a waste of everybody’s time. Overwhelmed social workers often have to do the driving, detracting from other important duties.

I was confused by Judge Henry’s column asserting that the burden is on parents to travel long distances to visits. In the jurisdictions with which I am familiar, visitation takes place at the agency, the parent’s home, or in the community at a location convenient to the parent.

Finding mental health services in another jurisdiction can also be problematic, as TheChronicle series points out. Because the District has so many children in the Maryland suburbs, mental health services are available there, but frequent moves mean that children have to change therapists or endure commutes of more than an hour each way to mental health services.

Long commutes to school, family visits and therapy are major inconveniences for kids, who should be using the time for schoolwork, activities and fun. Along with long drives for social workers to required home visits, they also impose a financial cost on agencies, which must pay for transportation. And having master’s degree-holding social workers spending hours every week driving hardly seems a good use of taxpayers’ money.

The Chronicle’s series raises the question of how to address the out-of-county placement dilemma. As I argued in a previous post, we need to move kids back to their jurisdictions. But it is unrealistic to expect that a new supply of foster parents will miraculously appear without some redefinition of the foster care concept.

Agencies might consider a model of the government owning the home and paying foster parents as employees to live there and provide full-time care to the children. As I stated in an earlier column, we need to pay foster parents as professionals in order to solve the foster parent shortage and attract the kind of nurturing families that are required for this demanding job.

For teenagers, we might consider family-style group homes of up to eight children such as those endorsed by foster care alumnus and congressional intern Eric Barrus. Due to the high cost of land in many cities, agencies might have to acquire land or facilities for this purpose or help nonprofits like Boys Town to do so.

In addition to bringing children back to their own jurisdiction, these models would have the virtue of making it possible for one member of a two-parent family to be a full-time foster parent. As both the foster parent and the CASA Director interviewed by The Chronicle in Part Five of the series stated, foster parenting should be a full-time job in view of the intense needs of most foster children, not just those labeled as “therapeutic.”

These solutions sound expensive. However, let’s not forget the costs of transporting children to schools, family visits, court hearings and therapists out of county, as well as the cost of masters-level social workers driving hours to get to home visits and doing some of the client transportation.

Compared with these current costs, providing professional foster care in county may not be so expensive. And the benefits to children would be great.

This column was published in the Chronicle of Social Change on September 15, 2015.

Too Often in Foster Care, Kids' Privacy Rights Used to Protect Agencies

The privacy rights of children and their families caught up in the child welfare system should be protected. But all too often, they are used to shield agencies from questions about their actions.

In my last column, I wrote about Ashley Rhodes-Courter and her efforts to find out the truth about the death of a foster child who was briefly in her care. The story of a child welfare system trying to suppress information about the death of a child is unfortunately all too common.

But a recent story from upstate New York illustrates an agency hiding behind privacy rights at the expense of a living child. A 13-year-old in Warren County, New York, is being kept in foster care so that the child welfare agency can keep secret the circumstances under which she was allowed to stay with a heroin addict and convicted felon who was unrelated to her.

The child in this case had been in the system most of her life. She was living with her maternal grandmother, but they were not getting along. A crisis was reached on July 4, when the grandmother called police and the girl threatened to run away.

The next day, the girl was picked up by a family friend, Shannon Dickinson. The sheriff’s office told the Glens Falls Post-Star that Dickinson was a known heroin addict who overdosed last December after injecting heroin while driving. He is also a twice-convicted felon and a paraplegic as a result of a failed suicide attempt decades ago.

According to the Post-Star, the Warren County Department of Social Services (DSS) approved the placement with Dickinson. Because he was a family friend and the maternal grandmother approved the placement, she could be placed in his home as a “kinship placement” and a background check did not have to be done before she was placed.  The child remained with him until July 30, when she reported that he had sexually abused her the night before. DSS then placed the girl in foster care. They later stated that they were not aware that the paternal grandmother had custodial rights.

On August 26, the paternal grandmother came to court to request custody of her granddaughter and get her out of foster care. Judge Jeffrey Wait told her attorney to file a motion. But he could not schedule a hearing on that motion because of a DSS appeal of his ruling about closing the court.

DSS wants the courtroom to be closed for further hearings. The judge has refused this request twice. But DSS announced its intention to appeal his decision, so the judge stated that he would schedule no more court dates at this time.

In the meantime, the 13-year-old remains in foster care with strangers. The agency claims that it wants the courtroom closed to protect the girl’s privacy. But the judge noted that the press has not reported her name nor the names of any family members. And according to a reporter who was there, the child’s court-appointed guardian urged the court to allow the case to go ahead.

On September 2, the Glens Falls Post-Star ran a hard-hitting editorial stating that DSS has “made the girl’s welfare secondary to their own interest in keeping details of this case secret.”

All of my information comes from the Post-Star, and the press can sometimes be an accomplice in blaming individuals when systemic problems are at fault. That is one reason why agencies are so preoccupied with protecting themselves.

I know how hard it is to be a social worker in the child welfare system, especially working with children old enough to run away. I once allowed an 18-year-old client under agency supervision to stay with a family member after her father kicked her out. There were some concerns about the family member’s home but I knew my client would run away if I placed her in foster care with a stranger.

Another family member, who was mentally ill, came over and got in a fight with my client, seriously injuring her. If God forbid my client had been killed, this could have been portrayed as my negligence, rather than choosing the option that appeared the least unsafe.

The press can be unfair and uninformed. But the answer for agencies is not in sacrificing their client’s interests to protect themselves. This is simply unethical.

We will not be able to improve policy or practice unless we know why things go wrong. Since the agency does not seem to be open to explaining and fixing its own problems, the public needs to be informed, so that those who truly care about children can step in to prevent similar problems in the future. 

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

Foster Parent, Facing Ultimatum, Chooses Not to be Silenced

In my last column for The Chronicle, I reviewed Three Little Words by Ashley Rhodes-Courter, who triumphed after a harrowing 10 years in foster care. Her second memoir,Three More Words, documents her life since leaving her adoptive home for college.

Rhodes-Courter is now a popular speaker with a Master’s degree in social work. And until this year, she was a dedicated foster parent for the State of Florida who had taken 20 children in crisis into her home.

Her drive to speak out against the problems in her state’s child welfare system have cost her the ability to help improve it. She chose not to be silenced by a state-sponsored ultimatum to clam up about the death of a child she once cared for.

Last February, Rhodes-Courter was horrified to read that one of her former foster children had been beaten to death by a schizophrenic uncle. Jenica Randazzo had been with the Courters less than a month before she was placed with a family that was planning to adopt her. But Rhodes-Courter learned that after Jenica had left her home, the plan for Jenica had changed.

Jenica and her siblings had been sent back to the grandparents’ home from which they had been removed in 2012 because they were deemed to be in “substantial and immediate danger.” Also living in the home was Jenica’s uncle, Jason Rios, who has been diagnosed with paranoid schizophrenia.

On February 7, Rios killed his mother and Jenica with a tire iron. His father stopped him after he had hit Jenica’s 7-year-old sister and had his arm raised to hit her again.

Executives with Eckerd Community Alternatives, the lead agency providing child welfare services in the Tampa Bay area, reviewed the case and concluded “there were no indications that could have predicted this tragic outcome.”

But Jason Rios’ mental health issues were not noted by Eckerd or the Florida Department of Children and Families (DCF), even though he lived in the home. His parents never told caseworkers that he was committed to a psychiatric institution three times because of behavior that could be a threat to himself or others. The third time was only two or three months before he killed Jenica, when she and her siblings were already living in the home.

Jenica’s team appeared to be focusing on a non-relative adoption for Jenica until the private agency handling her case closed, according to an investigation by the Tampa Bay Times. The previous team had concerns about the grandparents’ ability to handle the children.

But everything changed when that agency closed and Jenica had a new case manager and therapist. Suddenly, the focus was on returning the children to their grandparents, against the recommendations of her court-appointed volunteer guardian.

DCF could have requested a Critical Incident Rapid Response Team report to clarify all of the unresolved questions in order to avoid further tragedies, but the agency declined to do so. Rhodes-Courter and her husband did not accept the agency’s refusal to take responsibility.

They decided to speak out, posting about the case on Facebook and eventually speaking to the media.

“Someone needs to demand answers for Jenica. I don’t want the truth of what happened to remain buried with her body,” said Rhodes-Courter.

Rhodes-Courter notes officials with Carlton Manor — the case management agency assigned to Jenica when her original agency closed — lost no time in contacting her and her husband and advising them to stop speaking to the media. Eventually they demanded that the Courters sign a document admitting they had violated confidentiality and pledging to stop speaking out.

Failure to sign the contract, Rhodes-Courter was told, would be grounds for closing her home to new foster care placements.

According to the Courters’ attorney, her clients did not breach any confidentiality statutes. But the Courters decided to surrender their license rather than stop speaking out or risk having their license formally revoked, which could prevent their fostering or adopting in the future.

The fact that an agency was willing to jettison a dedicated foster family to cover itself is emblematic of the problems plaguing child welfare in this country. The over-use of confidentiality to hide agency negligence is common as well.

Being a great foster parent requires being passionate. But when it comes to government, passion can be your downfall if its directed at something that will get leaders in trouble.

In this case, Rhodes-Courter’s passion for a better Florida child welfare system cost the state a dedicated foster family.

NOTE ON SOURCES: I learned about Ashley Rhodes-Courter’s fight to get justice for Jenica from an article published by the Children’s Campaign of Florida. Rhodes-Courter also has her own “Justice for Jenica” page, which provides links to various media accounts. I found the detailed articles by the Tampa Bay Times and the Bradenton Herald to be particularly helpful.

This column first appeared in the Chronicle of Social Change on September 1, 2015.

Three Little Words: A Must-Read for Child Welfare Professionals

The odds seemed to be stacked against Ashley Rhodes Carter. Born to a teenage mother in Florida in 1985 and removed from her mother at the age of three, she spent ten years in 14 different homes, surviving abuse, neglect, and separation from her brother.

But Ashley defeated the odds. Adopted at the age of 12, Ashley completed high school, went to college on a full scholarship, and obtained a master’s in social work. In 2008, Ashley published Three Little Words, chronicling her harrowing journey through the child welfare system and her eventual adoption by a family whose loving care enabled her to blossom into an accomplished and successful adult.

I just discovered this book, which is surprisingly classified as Young Adult. ButThree Little Words should be required reading for any child welfare professional. Ashley’s story illustrates some ways that things have improved and some ways they haven’t, and casts light on debates that are still raging.

Unhelpful Front End

Ashley and her brother were removed from their mother after she was arrested for writing a bad check. She was cleared and released in six days, but the children were not returned. Ashley’s mother was told she needed to provide for her children, but her applications for financial assistance and food stamps were denied because she did not have custody of them at the time.

Today, almost 30 years after Ashley’s removal, the field places a high priority on keeping kids at home and getting them back home as soon as possible with agency assistance. Nevertheless, children often stay in foster care long after they could be returned if the right help was available. Perhaps new legislation introduced by Sen. Ron Wyden (D-Ore.) to change the financing of child welfare will help. It will give states the flexibility to use federal foster care funds on preventive services to keep kids at home.

But changes also need to be made in the culture of child welfare agencies and government agencies that interact with low-income people. Just last weekend, the New York Times carried the story of a woman who left her baby with a friend in the domestic violence shelter where they were living in order to purchase diapers after the official curfew. When she returned, the police were taking her baby away. She spent two weeks in jail and lost her shelter spot. Five months later, she was still fighting to get her child back.

Languishing in Foster Care

Ashley’s mother also had a problem with drugs and alcohol. Perhaps she would have received more help today, but she did not take advantage of the opportunities available at the time. She did not make herself available for visits and was often in jail. Despite that disinterest, Ashley was in foster care for over five years before her mother’s rights were terminated and she was freed for adoption.

Federal legislation passed in 1996 attempted to prevent children languishing in foster care for years. It requires agencies to initiate the termination of parents’ rights for children who have been in care for 15 of the last 22 months, with certain exceptions. This has certainly improved the chances for many children like Ashley to achieve permanency. However, in my experience in the District of Columbia, judges often did not cooperate with attempts to terminate parental rights, insisting that parents be given additional months or even years to regain their kids.

Safety vs. Well-Being

After Ashley had been in four different foster homes, she and her brother found a loving home with her grandfather and his common-law wife in South Carolina. But the children were eventually sent back to Florida to live with strangers. Ashley was never able to find out why they were sent back. There were apparently safety concerns regarding her grandfather’s lifestyle but Ashley felt that this was beside the point.

“It seemed logical to me that Luke and I would be safest with someone who actually loved us,” she writes in Three Little Words.

The conflict between safety and well-being for foster children still plagues the system today. There are no easy answers, but social workers need to understand the importance of a loving home to a child’s well-being and healthy development.

Bad Foster Homes

If safety really was the concern in the removal of Ashley from her relatives, the system truly failed when she was placed in the nightmarish home of the Moss family. In the Moss home, the husband stood by while his wife punished the children by pouring hot sauce in their mouths, requiring them to run and squat, dragging them by the hair, and in Ashley’s case, pushing her face into her own vomit.

The Mosses were investigated three times, but the charges were never substantiated because their word was taken over that of the children. It was only years later that Ms. Moss was arrested for abuse and neglect of children she adopted.

When she obtained their file, Ashley learned that the staff who originally licensed them had overlooked numerous red flags that should have prevented their being licensed at all. The file was full of praise for their great work as foster parents even as negative reports were ignored.

Horror stories like this exist but more common are the people who foster for the money and provide little more than room and board. This type of neglect may be less traumatic than horrific abuse, but it can be very harmful to children who need special attention.

The perennial shortage of foster parents means that agencies are extremely unlikely to fire bad ones. And one reason for this shortage is that the government is unwilling to spend the money it takes to pay for professional, full-time foster parents or family-style group homes. Which brings us to the next point…

Benefits of Group Homes

After many foster homes, Ashley was placed in a group home, where she stayed until she was adopted. Ashley’s tale makes clear the drawbacks of group homes: the institutional celebration of holidays, the lack of normalcy, and worst of all, the transience of staff.

But Ashley grew and matured in this home, and formed a close relationship with two staff members, who became lifelong connections. It seems clear that she got better care in the group home than she did in many of her foster homes. It was only in the group home that she found stability and relationships with caring adults, as well as the therapeutic services she needed. From the group home, she was adopted at the age of 12 by the Courter family, whose love and support enabled her to fulfill her great potential.

An Attorney for Every Child

Ashley’s book illustrates the necessity that every foster child have an advocate in court. It was only after a volunteer Guardian Ad Litem was appointed that the government moved to terminate her mother’s rights.

The only way to make sure that every child has an advocate is to mandate that an attorney be appointed for every child in foster care. A 2008 report indicates that 31 states plus the District of Columbia mandated the appointment of an attorney. The other states—including Florida–need to follow suit. The appointment of an advocate should be a right, not a privilege. It may even save money if it leads to children exiting foster care sooner.

Ashley Rhodes-Courter went on to become a motivational speaker, author, foster parent, adoptive parent, and birth mother. She chronicles these experiences in her new memoir, Three More Words, just published this year.

This column was published in the Chronicle of Social Change on August 25, 2015.