No place for the children: a therapeutic group home closes while foster children sleep in hotels and offices

In my last post, I wrote about Washington State’s critical shortage of foster parents, which is r

esulting in children staying in offices, hotels, and by-the-night foster homes. One of my suggestions was to reinvest in quality group care settings. Unfortunately, the state (along with most of the country) is moving in the opposite direction.

KUOW, Seattle’s public radio station, recently  reported on the closure of a group home that provided therapeutic care to  foster children with “severe behavioral problems and emotional needs.” At the Ruth Dykeman Children’s Center in Burien, Washington 15 children lived in lakeside cottages supervised by staff members, with nurses and psychologists on call.

Unfortunately, foster care ideology has changed and now any family setting seems to be considered better than any  group  setting, regardless of the needs of the child and the quality of the placement. The fact that group settings are more expensive than foster family homes might have something to do with this new bias.

Unfortunately, the type of children that were housed at Dykeman don’t do well in family foster care. Children with behavioral problems and emotional needs tend to bounce from one foster home to another, their behavioral problems worsening with each move.

Nevertheless, group homes have been shuttered around the country. In Washington  state, according to Investigate West, “stagnant reimbursement rates have forced many facilities that contract with the state to reduce capacity or shutter altogether.”

The CEO of Navos, the mental health nonprofit running the Dykeman home, told KUOW that ending the contract for foster care was a source of great anguish to the leadership. But it was not financially sustainable. The nonprofit had been paying more than half the cost of running the home for years.

The Dykeman Center is not closing, but it is now off-limits for foster kids. It will now serve long-term inpatient psychiatric care, which is reimbursed at two to three times the rate, according to KUOW.

Now, the fragile children from the Dykeman Center will be competing with less troubled but still vulnerable foster youth for the dwindling supply of foster homes. Some may bounce from home to home, perhaps spending nights in hotels or pay-by-the-night foster homes where they have to be dropped off late in the evening and picked up early in the morning. Some have already been sent out of state, according to KUOW.

This post has been posted on my new wordpress website at https://childwelfarewatchblog.wordpress.com/2017/10/30/no-place-for-the-children-a-therapeutic-group-home-closes-while-foster-children-sleep-in-hotels-and-offices/ In the future, I will no longer be using this blogging platform, so please subscribe to my blog at the new site. 

Announcing a New Title and Platform for My Bog

From June 2015 through September 2017 I was able to use my membership in the Blogger Co-Op at the Chronicle of Social Change to provide a professional format and increased readership for my Fostering Reform blog. With the closure of the blogger co-op, I soon realized that Google's "blogspot" blogging platform had some flaws as the sole platform for my blog and that I needed to move my blog to a more modern platform, eventually settling on Wordpress.com.  It was also a good time to change the name of the blog from Fostering Reform, which connotes an exclusive focus on foster care, to a title with a broader connotation--Child Welfare Watch.

Starting immediately, my renamed blog will move to its new location, where you can find my newest post, No place for the children: A therapeutic group home closes while foster children sleep in hotels and offices. Simultaneously, I am changing the name of my Facebook page to Child Welfare Watch and my Twitter username to childwelfarewatch. I hope that all of my wonderful readers will continue to read and share my postings so that we can build a movement to put the child back in child welfare. I know my readership will continue to grow and I hope that eventually Child Welfare Watch will be bigger than just Marie Cohen but instead will be an organization with members and staff. Together  we can change the conversation around child welfare to reflect reality, rather than feel-good, money-saving theories about what works for abused and neglected kids.

$600 for Overnight Foster Care? Time to Consider the alternatives

Washington State’s Children’s Administration (CA) is desperate. In order to avoid lodging abused and neglected children in hotel rooms or agency offices, it has increased to $600 per night the amount it is willing to pay foster parents to keep children in their homes for one night in emergency short-term situations, according to the independent news organization InvestigateWest.

Washington’s placement crisis is being driven by a large decrease in the number of available foster homes combined with an increase in the foster care population that coincides with a ballooning heroin and opioid addiction epidemic.

But even $600 overnight fees cannot generate an adequate supply of beds for Washington’s foster children. The state reported a total of 236 hotel stays in August 2017, at the remarkable cost of about $2,100 per night including the cost of paying two social workers and sometimes a security guard to supervise the children.

Washington may be an unique in paying $600 per night, but the same combination of increasing foster care caseloads and decreasing or stagnant supply of foster parents can be found in most parts of the country. Governing Magazine reports that 35 states saw an increase in their foster care caseloads between 2012 and 2015.

Reports of children being housed in offices and hotels have come from California, Texas, Oregon, Kansas, and Georgia, Tennessee, and Washington DC. Children newly entering the system, and those with behavioral issues who are repeatedly kicked out of foster homes, seem to bear the ones most affected.

In addition to the incredible waste of government funds, the warehousing of already traumatized young people in temporary and non-therapeutic environments is the antithesis of the therapeutic care they need.

Another casualty of the desperate need for foster parents may be the reluctance to revoke the licenses of neglectful foster parents. In my five years as a social worker, I begged my agency not to renew the licenses of foster parents who refused to take their children to the doctor, never met their therapists and never visited their schools, even to pick them up when they were sick. I never got my way.

The recent congressional investigation of the for-profit MENTOR foster care agency illustrates the worst-case scenario of foster parents who killed the children who had been entrusted to their care. While severe maltreatment by foster parents is extremely rare, the continued licensing of unacceptable foster parents reflects in part the desperate need for their services.

We cannot rely on traditional foster care to solve a placement crisis of this magnitude. Alternatives must be considered, particularly for new entrants to the system and older and more challenging youths.  

For children who have just been removed from their homes, the answer is clear. Temporary assessment centers need to be reinstated as the first step for children entering foster care. In the last few decades, many states closed their emergency shelters and assessment centers in the belief that institutional settings are bad for children.

The elimination of shelters and assessment centers resulted in the phenomenon of middle-of-the night placements that I described in a previous column. This system results in an almost random assignment of child to home based on who answers the phone at 3:00 AM. This is no way to match a child with the most appropriate placement.

For children older than elementary school age, particularly those with more challenging behaviors, we need to consider an array of alternatives to traditional foster care. Some of these options are on the border of family foster care and group care.

On the family side, these include programs in which professional parents receive a salary for caring for foster kids. To make professional foster care economically feasible, foster homes must be larger and serve anywhere between four and eight children. I have written about several such programs. These include Neighbor to Family, which provides professional foster care to sibling groups in the same home.  

Some of these programs provide housing to foster parents in “foster care communities” which provide the added benefit of community support and programmatic  resources on site. These include SOS Children’s Villages in Illinois and Florida, and  Pepper’s Ranch in Oklahoma,

On the other side of the artificial foster home/group home divide are group homes that are structured like families, with live-in houseparents. These include Boys Town, homes following the Teaching Family model, the Florida Sheriffs Youth Ranches, and many others.

Residential schools, such as the Crossnore School in North Carolina or San Pasqual Academy in Escondido, CA, also have many advantages. Students live in cottages run by house parents and benefit from enriched educational opportunities, extracurricular activities, and medical and mental health services.

All of these programs have the added benefit of keeping larger sibling groups together, a major and often unrealized goal in child welfare. San Pasqual Academy, which provides only high school on campus, will even accept middle-school-age siblings to live in its residences and attend community schools until they are promoted to high school.

Child welfare leaders at all levels need to begin a conversation about alternatives to standard family foster care. Many of these models are more expensive than traditional foster care. But considering the short-term and long-term costs of temporarily housing foster children in offices and hotels for days or weeks at a time, the money would be well-spent.

To Prevent Further Tragedies, Require Immediate Fatality Reviews for Children Known to System

On November 6, 2016, Trinity Jabore was born in the District of Columbia with marijuana in her system and weighing less than five pounds. On December 25 of the same year, Trinity’s lifeless body was taken to the morgue. A pathologist determined that Trinity’s brief life had been one of suffering. She weighed less than her birthweight, she had multiple fractured ribs, and she died from consuming water that had been mixed with condensed milk.

Soon the Washington Post learned that the District’s Child and Family Services  Agency (CFSA) had received multiple calls reporting neglect of other children born to Trinity’s parents. The final call occurred early in the month of her death. A teacher reported that her brother had showed up in school with a bruise under his left eye and stated that his mother had punched him because he “wasn’t listening.” Three weeks later, the investigators had talked to the brother but had not managed to contact his parents. They were still “trying to make contact” when Trinity died.

Trinity’s story is unfortunately very familiar. I have written about the deaths of Zymere Perkins in New York and Yonatan Aguilar in Los Angeles. A recent series published in the Fayetteville Observer revealed that more than 120 North Carolina children have died within a year of a child maltreatment report.  Each of these deaths is the tip of the iceberg of system failure. We have no idea how many children are suffering in toxic homes as you read this column. Tonisha Hora was left in an abusive home for ten years despite repeated calls to CPS about her plight and that of her sister.

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The first response to Trinity Jabore’s death should have been for an independent panel to conduct a comprehensive review of her parents’ prior contacts with the child welfare system to determine how she was left unprotected . This review should have been conducted immediately and included recommendations to prevent such tragedies in the future.

Unfortunately, Trinity has been dead for 9 months and no such review has been released. Like other jurisdictions, the District of Columbia has a Child Fatality Review Committee, upon which I serve. But I have been disappointed by the long lag times and lack of thoroughness of these reviews.

The Committee is about to issue its annual report, which will contain reviews of deaths that occurred between 2012 and 2015. It takes some months for the panel to receive notice of child deaths and all the relevant information including pathology reports. Because the panel is understaffed, there is a further delay after cases are received. The District of Columbia Auditor recently found that the percentage of child deaths reviewed by the CFRC has been declining as the panel’s budget has been cut drastically. Similar issues plague other child fatality review teams, such as the one in North Carolina.

There is another problem with child fatality review panels as a mechanism for reviewing systems’ failure to identify children at risk. In about half the states, these teams review all child fatalities, not just those that are due to child maltreatment, or those of children known to child welfare agencies. The District’s panel reviews all fatalities of young people aged 18 and younger, including all premature infants, gun violence victims, children with terminal illnesses, and accident victims. It does not review the actual files but brief summaries provided by overworked CFRC staff. And Trinity’s death will be mentioned only briefly in an annual report devoted to all of the child deaths that were reviewed in the same year.

An internal CFSA review has probably already occurred, but the public will not know about it for some time. It was  in April 2017 that the agency released its review of child deaths occurring in 2014 and 2015. Moreover, Trinity’s death will  be folded into a report on all deaths of children known to CFSA within four years of their death--a total of 30 deaths in 2015..  

The death of a child known to the system should be treated like a plane crash or the loss of the space shuttle Challenger. It should be reviewed immediately and exhaustively by experts of the highest caliber. The point is not to allocate guilt or punishment but to change policies or practices to save children in the future..

In the State of Washington, the Children’s Administration (CA) conducts a review when the death or near-fatality of a child was suspected to be caused by child abuse or neglect, and the child had any history with CA (including a hotline report that was not investigated) at the time of death, or in the year prior.  The review committee is made up of individuals with no prior involvement with the case, and typically includes CA staff, ombudsman staff, and community professionals selected from diverse disciplines with expertise relevant to the case. The review committee has full access to all records and files relevant to the review. The agency must release review results within 180 days following the fatality, unless granted an extension by the Governor.

These reports are subject to public disclosure and must be posted on the Department’s website. The Department is authorized to redact confidential information contained in these reports.  In order to promote accountability and the consistent implementation of recommendations, the state’s family and children’s ombudsman is required to issue an annual report to the Legislature that includes an update on the implementation of recommendations issued by fatality review committees

Every state or other relevant jurisdiction should follow Washington’s example and require a thorough, immediate independent review of all all cases of children children who die, are seriously injured or disappear (as in the case of Relisha Rudd in the district of Columbia) when there is a family history with CPS. This should be a requirement for federal funding.

No more children should suffer because of agency incompetence, extreme family preservation ideology or underfunding. Let us take the first step and ensure all of these terrible cases are investigated immediately and acted upon fast.

In Memory of My Son, Michael Benjamin Cohen, March 25, 1992-September, 2017

Last Tuesday morning, September 26, I was planning to put the finishing touches on a new blog post and publish it. But at 6:00 AM, my husband came stumbling into our bedroom. He told me our 25-year-old son, a sparkling presence in the world, was found dead in his temporary lodgings in Berkeley, California.

Our son, Michael Cohen, was a graduate student in computer science at the Massachusetts Institute of Technology, who had a semester-long research fellowship at Berkeley. After not being able to reach him all weekend, we contacted his academic advisor, who went to his rental apartment. Unable to get in, his advisor contacted the police, who broke in and found our son dead. We are still awaiting lab tests, but there is reason to suspect that Michael was suffering from undiagnosed Type I diabetes. He had been sick all week, but told people he was getting better. At some point, he slipped into a coma and died.

It is really hard to get up in the morning now. What keeps me going that my husband, my daughter, my two elderly cats, and my dearest friends would suffer if I followed my son out of this life. Equally important is my mission to help abused and neglected children.

When I think of  my treasured son who knew nothing but love, it is even more heartbreaking to think of all the children who even at this minute are being physically or emotionally abused or neglected, and even murdered, by their parents or guardians. It is heartbreaking to think of agencies that are so concerned with the rights of parents, or so overwhelmed due to underfunding, that they leave these children in dangerous and toxic homes. And it is unbearable to think of the children who have been removed from their families and placed in uncaring families or institutions that continue to abuse or neglect them.

I know that I must go on writing this blog. I must continue participating in the District of Columbia’s Citizen Review Panel on child abuse and neglect and its Child Fatality Review Committee.

I must do it in honor of  Adrian Jones, whose body was fed to the pigs by the father and stepmother who killed him, and who was the subject of multiple CPS reports in two states before he died. I must do it in honor of Natalie Finn, who died of starvation at her adoptive home, isolated from help because she was “home-schooled.” I must do it for all of the other children who continue to suffer and die because the state fails in its duty to protect them.

I must do it in honor of my son, Michael Benjamin Cohen, whose energy and passion for the things he cared about never let up, even while his body was breaking down.

Parents and guardians, hug your children. Don’t think that they have a self-preservation instinct just because they are 25. If they live alone, tell them that you need to hear from them every 24 hours or you will send someone to their dwelling or call the police. Like the deaths of Adrian Jones and Natalie Finn and so many others, Michael’s death was eminently preventable. And for the rest of my life, I will suffer the consequences.