Wednesday, September 21, 2016

Supervisors Are Right to Push L.A. County on Replacing SDM

On Sept. 17, Daniel Heimpel reported in this publication on a motion by two members of the Los Angeles Board of Supervisors that would require Los Angeles’ child protection agency to re-evaluate how it addresses risk. This comes in the wake of the death of eleven-year-old Yonatan Aguilar, whose family was the subject of six prior CPS reports, according to records reviewed by the Los Angeles Times.
Four times, Yonatan was found to be at high risk of maltreatment, but the county never even opened a case.
Opinion_Feature_ImageThe Supervisors are correct to question the effectiveness of the Structured Decision Making (SDM) protocol that Los Angeles and many other jurisdictions use to guide decision making in cases of child maltreatment. SDM, described as an “actuarial model” of risk assessment, is a series of questionnaires to be used at different phases of a case to determine the risk level for a child in a given situation. The social worker checks off the appropriate boxes, and the instrument spits out a risk level which is supposed to inform the decision about how to proceed.
SDM has been criticized for various reasons, including the fact that it is easy for social workers to manipulate in order to generate the recommendations they want. As child welfare researcher Emily Putnam-Hornstein pointed out to the Commission to Eliminate Child Abuse and Neglect Fatalities, many workers manipulate the tools because they think their clinical judgment is superior.
And they are probably right. SDM tools simplify complex clinical data into multiple-choice questions and do not add any data to what the social worker puts in.
A new generation of risk assessment tools, usually referred to as “predictive analytics,” is on the brink of replacing outdated actuarial assessments like SDM. Los Angeles has been at the forefront of developing the new tools. It contracted with software behemoth SAS to develop apredictive analytics algorithm, called AURA, that attempted to identify which children referred to CPS would be the victims of severe maltreatment.
In a column published on Feb. 3, I wrote about the spectacular success of the AURA demonstration. Among those families with at least one CPS referral prior to the current one, flagging the top 10 percent of referrals that earned the highest AURA scores would have predicted 171 critical incidents, which amounts to 76 percent of the deaths and severe injuries to children, according to the Project AURA Final Report.
One of the sources of AURA’s power is that it draws from other sources of data that CPS investigators often cannot access or don’t have time to search fully, such as the mental health, public health and criminal justice systems. Without this data, workers must rely on a parent’s answers to questions about their mental health, substance abuse or criminal history.
But progress on implementing AURA seems to have stalled since a contentious public meeting in July of 2015. DCFS staff quoted in Heimpel’s article do not seem to understand the revolutionary nature of the AURA tool. Acknowledging that AURA predicted more than two-thirds of the county’s critical incidents, DCFS Public Affairs Director Armand Montiel stressed that it also identified 3,829 “false positives,” or cases in which there was no critical incident.
But Montiel missed the point. Children who are abused or neglected, but don’t die or “only” nearly die, are not “false positives.” We don’t know how these children have fared since they were identified by AURA, but I certainly hope that Montiel did not intend to say that we don’t need to protect children from any maltreatment that does not result in severe injury or death.
Nevertheless, Montiel is correct that AURA cannot tell for sure if a child will be a victim of severe maltreatment and that it cannot replace a good investigation. Clinical judgment should always trump the result of any algorithm. But as Putnam-Hornstein suggests, when a predictive algorithm identifies a case as high-risk, an extra layer of review can be put into place, or two workers can be sent out on a case, to make sure it is getting the scrutiny it deserves.
There is some irony in the case that prompted the motion. The SDM tool did correctly classify Yonatan as being at high risk, but workers disregarded the finding. Having a better tool is not enough to protect children. The tool needs to have teeth, not to replace clinical judgment but at least to require a higher level of review when a child is identified as high-risk.

This column was published in the Chronicle of Social Change on September 20, 2016.

Friday, September 9, 2016

Congress Should Not Kill Lifesaving Options for Foster Youth

Jamal* is a teenager in foster care whom I met through an organization pairing Washington D.C. foster youth with volunteer mentors..
He is a spirited young man who bounced through five foster homes in less than a year due to his defiant behavior. When I met him, Jamal had ended up at a Boys Town family-style group home and was finally happy, stable and doing well.
If the supporters of the Family First Prevention Services Act have their way, the option of a supportive group home will no longer be available to most young people in foster care who cannot thrive in a family setting. Federal dollars will not be available to help states pay for group home placements beyond two weeks without a special assessment and court hearing, and the facility must be accredited by a specified agency and meet other criteria that may be burdensome and expensive.
The bill’s sponsors and supporters often cite a belief that most children do best in family settings.
Yet, this is not always the case. Jamal is not the only young person who needed a group home to find the support and nurturing he needed.
Lorenzo Mauldin, a linebacker with the New York Jets, was shuttled from home to home due to his mood swings and violent behavior, the legacy of a traumatic childhood. He credits the house parents from his Atlanta group home for the fact that he is playing football and not on the streets or in prison today like his mother.
Thomas McCrae 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. Thomas finally ended up in family-style group home, where he stayed eight months with the intercession of his attorney to let him stay longer. Thomas credits his house parents for his becoming “the man I am today.” He went on to college and a summer internship in the U.S. Congress.
As a social worker in the District of Columbia, I saw older youth boomerang from home to home after being ejected from each home due to behavioral problems. With few group homes available, the only choice was to find yet another foster home that they had not yet been expelled from. Unfortunately, many of these homes were little more than boarding houses, providing barely adequate food and shelter and no nurturing or emotional support.
Even if the bill’s authors were correct that all group homes should be closed, closing them before appropriate foster homes exist to take their place is foolhardy at best. States around the country are reporting foster home shortages, with children having to stay in offices until they can be placed. The hardest to place are older youth with behavioral problems. With group homes closed, this problem will only worsen.
The attempt to close group homes without providing an alternative is eerily reminiscent of the closure of institutions for the mentally ill in the 1960s. These hospitals were supposed to be replaced with community health services that were never funded. We are still reaping the consequences with the abundance of mentally ill people sleeping on the streets of America’s cities.
It is clear that there is something else behind the draconian prohibition on group settings beyond a concern about children. Legislators want the savings from eliminating these options to offset the increased costs imposed by the expansion of Title IV-E to include preventive services. As a matter of fact, they did such a good job of cutting costs that theCongressional Budget Office has estimated that the Family First Act will actually save money.
The two states with the largest numbers of children in foster care – New York and California– oppose the Family First Act. Together, these states represent 19 percent of the children in foster care in the United States. The State of Washington has expressed its opposition to the bill as well. The head of Texas’ child welfare agency said the Family First Act could worsen the state’s “already worrisome shortage of foster care beds” in an article in The Dallas Morning News.
The Family First Act is on the right track with its other major provision in allowing foster care funds to be spent on preventive services to keep families together, although there areconcerns about the way the act does this. But this important reform should not be achieved at the expense of a life-saving option for some of our most wounded children.
Moreover, the Family First Act does not address the aspect of foster care financing that most needs reform—the so-called AFDC “lookback” for children in foster care. Currently the federal government pays a share of foster care costs only for those children who would have qualified for the defunct Aid to Families with Dependent Children (cash welfare) program, which was replaced by Temporary Assistance for Needy Families in 1996. This ridiculous standard requires states to spend millions of dollars annually determining eligibility for a defunct program — money they could spend helping children.
Aside from a pair of hearings that were orchestrated by the bill’s sponsors to support their vision for the legislation, there have been no hearings or floor debate on the Family First Act. It passed the House by voice vote, and its Senate sponsors tried to get it through without a vote before going on summer recess. They failed, thanks to courageous Senators who cared about children enough to resist pressure from the powerful coalition supporting the bill.
The Senate will be considering the bill again this September and now has a chance to get it right by amending the bill to ensure that we will not be leaving our most traumatized youth out in the cold.
* The young man’s name was changed to protect his anonymity.
This article was published in the Chronicle of Social Change on August 31, 2016.

Group Home Closure Eliminates Key Option for Most Challenging Foster Youth

I was sad to read in the Chicago Tribune that yet another well-respected institution is closing its doors to foster children as a consequence of the current belief that a loveless foster family is better than a caring residential placement. This time, the casualty is Maryville Academy, which has been serving children and families since 1882. About 70 boys and girls will be moved out of Maryville facilities into foster care by June 30.
Currently, Maryville provides homelike residential settings for boys and girls aged 13 to 20 on one campus in Chicago, and two in nearby suburbs. All of of the campuses serve boys or girls with a history of childhood trauma and mental illness. In some of the homes, clients must have an intellectual disability as well. There is one home that serves pregnant teens.
There are 35 reviews on Maryville’s Facebook page, all or most from former clients, with an average of 4.5 out of 5.0 stars. According to one former resident:
I think MVA was the best thing that happen[ed] to me….I became the man most of my staff thought I would be.
Reports Dennis, from the class of ’65:
I spent 3rd grade through 8th grade there. It was, more than likely, a life-saver.
These two reviews are typical of the testimonials to be found on Facebook.
So why close such a lifesaving program? Child welfare is a business marked by trend. Right now, residential care is out and family foster care is in. Maryville’s executive director reported in a recent statement that Illinois’ Department of Child and Family Services (DCFS) has decided to reduce funding for residential care by $23 million in the upcoming fiscal year.
Maryville has been picking up an increasing share of the costs of residential care as DCFS has reduced its subsidy, and the agency has decided to eliminate these programs.
The problem is that states all over the country, including Illinois, are reporting foster parent shortages. And, as I have written before, many existing foster families are not providing the love, nurturing and supervision that these youth need.
It’s hard to believe that Illinois, like other states, is moving to close residential programs before recruiting the quality foster homes needed to accommodate the children who will be left homeless. But the common belief that residential care is more expensive than foster care makes closing residential care an irresistible option for both sides of the aisle.
Yet it is not clear that all residential care is more expensive than foster care. DCFS’ draft implementation plan, mandated by the court in its ongoing class action lawsuit, calls for a pilot Therapeutic Foster Care (TFC) program as an alternative for children now being served in programs like Maryville.
At least one parent in each TFC home would not be allowed to work outside the home, and no more than two children can be placed in each home. There is no information about costs, but providing a payment to foster parents who care for two or fewer children may not be any cheaper than residential care.
Moreover, many programs like Maryville have a large base of private donors. During the last 10 years, Maryville reports that it has invested $33 million in donated funds in its residential programs because of declining government funding. By losing Maryville, Illinois is losing access to these funds, which enriched services for foster youth.
The DCFS plan calls for a “minimum of 40 youth” to be placed in contracted TFC homes in three counties by the end of the first year of operation (which has not started yet). But the closure of Maryville alone will leave about 70 boys and girls (all qualified for TFC) homeless by June 30. There is something wrong with this picture.
The Illinois story is being repeated all over the country. Residential facilities are closing nationwide with no notion of where the children will go. Many will probably bounce in and out of foster families that are not trained or willing to keep traumatized youth with behavioral problems.
And now Congress is considering following suit by restricting residential care. A nation that failed to learn from the deinstitutionalization of the mentally ill population in the 1960s may be on its way to creating a new class of foster youth with no place to go.
This column was published in the Chronicle of Social Change on June 6, 2012.

Kin and Faith: The Right Ways to Grow a Foster Home Supply

May is Foster Care Month, and it is a great time to sing the praises of the many wonderful foster parents who are changing children’s lives every day. As a social worker in Washington, D.C.’s child welfare system until a year ago, I came across several of these super foster parents. Many, though not all, of these foster parents were church members who felt called to share their love with children who needed it.
These great foster parents had several things in common. Most importantly, they treated their foster kids as their own children. They took them to the doctor, school meetings and parental visits, rather than asking overwhelmed social workers to perform these functions. They participated in the children’s therapy, the only way it can possibly work. The children accompanied them on family vacations, and became part of their extended families.
Many of these stellar foster parents worked closely with the birth parents, and offered to be a continuing resource to these families once the children returned home. But if reunification did not work out, many of them were ready to step in as adoptive parents.
Unfortunately, for every super foster parent, there was more than one who rarely or never visited the child’s school or talked to teachers, refused to take the child to medical or therapy appointments or even pick them up from school when sick, and avoided meeting the birth parents. These people were fostering for one reason only: the money that helps pay their monthly bills.
Why did these bad foster parents keep their licenses? The answer is simple. Foster parents were, and are, in short supply. That may explain the occasional stories about abusive foster parents who keep their licenses despite frequent complaints until they actually kill or injure a child.
With the foster care population increasing, the reluctance to fire bad foster parents will only increase. In the meantime, the harm to the children from these loveless placements may last a lifetime, and we will all pay the costs.
A recent briefing, co-sponsored by Fostering Media Connections, which publishes The Chronicle of Social Change, and the Congressional Coalition on Adoption Institute, convinced me that these bad foster parents can be replaced. The increasing need for foster care can be met through kinship care and church-based recruitment programs.
Kinship placements provide a number of advantages. Relatives or family friends (also considered to be kin) may have a previous relationship with the child, thus lessening the trauma to the child. They are likely to be more invested in continuing the relationship with the parent and facilitating reunification. And they are more likely to be available as permanent caregivers if reunification fails.
In Allegheny County (home of Pittsburgh), Penn., 55 percent of foster youth are in kinship care, as opposed to 29 percent nationwide according to data from 2014. How does Allegheny do it? As described in The Chronicle of Social Change, Allegheny’s child welfare agency contracts with A Second Chance, a nonprofit that handles 95 percent of the county’s relative caregiver placements.
A Second Chance leaves no stone unturned in helping relatives get licensed. It provides financial assistance if necessary, and then provides the continued wraparound support they need to successfully foster the children until reunification or permanency can be achieved.
Not all jurisdictions will be able to place more than half of foster children with kin as easily as Allegheny County, where housing is not a problem. In my experience in the District of Columbia, housing was one of the biggest obstacles for relatives wishing to care for children in foster care. Jurisdictions may have to get creative in enabling relatives to take custody of foster children, particularly large sibling groups.
For example, why not buy or build an apartment building or neighborhood of large homes to shelter large sibling groups? These homes could be offered rent-free or at below-market rents to relatives or non-relative caregivers who otherwise could not take in these siblings. These “foster care neighborhoods” would allow families to help each other out, and activities and services to be provided on site.
The forum also highlighted the work of Project 1.27, which works with the State of Colorado to recruit and train foster parents through churches around the state. The Colorado project has trained over 800 foster families since its creation in 2004.
Affiliated organizations are springing up around the country, including DC127, which was recently profiled in The Chronicle. Foster parents recruited through these projects are motivated by their faith to love and shelter children who need a family.
Despite the foster parent shortage, we need to remember that we are looking for more than a place to put kids. We are looking for the love and commitment to permanency that are best provided by kin or those very special unrelated foster parents who can often be found through church-based recruitment programs.
This column was published in the Chronicle of Social Change on May 18, 2016. 

The Liberal Dilemma in Child Welfare Reform

I’ve always considered myself to be a liberal, and a left-leaning one at that. As a liberal, I believe that government has the ability and the obligation to protect all of its citizens from suffering.
I believe this obligation is particularly strong when it comes to children, both because they are not able to protect themselves and because their suffering may compromise their physical, emotional and intellectual development.
But even before entering the field of child welfare, I had an inkling that the dominant voices in child welfare reform, though liberal, did not agree with me in prioritizing the protection of children. I learned that some of the most prominent child advocacy organizations actually place a higher priority on keeping families together than on ending the suffering of maltreated children.
I’ve puzzled over this seeming paradox for a long time. Now, a recent issue of the William and Mary Bill of Rights Journal has helped me understand it. In March 2015, a group of scholars got together to discuss “The Liberal Dilemma in Child Welfare Reform.” Papers based on these talks, along with a discussion by Daniel Heimpel, publisher of The Chronicle of Social Change, are included in the March issue of the Journal.
All of the participants in the symposium agreed that America’s child welfare system is parent-centered rather than child-centered. We bend over backwards to keep children in their homes, even when their lives are in danger. The result, as the Commission to Eliminate Child Abuse and Neglect Fatalities report suggests, is that at least half of the families of children who die from maltreatment were previously known to CPS agencies.
In the 1990s, the majority in Congress was convinced that the bias toward family preservation had gone too far. Laws were passed to rectify the balance and ensure that children could be removed from unsafe situations. But as symposium participant Cassie Bevan explained, these laws have not been fully implemented because of opposition to this approach by child welfare agencies and judges.
Elizabeth Bartholet, director of the Child Advocacy Program at Harvard Law School, wrote about a “corrupt policy-research merger whereby programs chosen on the basis of ideology are then supported by research designed not to test, but instead to prove, the programs’ efficacy.” For example, the extreme emphasis on family preservation in the 1980s was bolstered by evaluations of these short-term programs that were later shown to be flawed.
Of course, children should be kept at home or returned there if there are services that can be put in place to address the threats to their safety. But anyone who has worked in the child welfare system knows that many of these parents have deep-seated mental health and substance abuse issues that cannot be resolved within the time frame required by law and a child’s need for permanency.
The symposium participants disagreed about where the parent-centered emphasis in our child welfare system comes from. But several participants, including Bartholet and William and Mary Professor James Dwyer, agreed that it stems from the nexus between poverty, racism and child maltreatment. Liberals are reluctant to further penalize parents whose problems in parenting ultimately stem from poverty and racism by taking away their children.
I believe that society has a deep moral responsibility to put an end to poverty and racism. But in the meantime, true liberals cannot advocate holding abused and neglected children hostage in homes where they are suffering and cannot thrive. A child suffering from maltreatment should not be penalized by having to remain there because of being poor or black. Leaving such a child in such a home when services to correct the problems are not provided or do not exist will only prolong the cycle of poverty-related abuse and neglect into the next generation.
This column was published in the Chronicle of Social Change on June 15, 2016.