Sunday, March 25, 2007

A New York Daily News series gets results -- 32 years later

Many people familiar with NCCPR know that I used to be a reporter, and it was my reporting on child welfare that led me first to write a book on the topic (Wounded Innocents, (Prometheus Books: 1990, 1995) and then into advocacy. And some journalists know that I covered my first child welfare story as a journalism student in 1976.

What I have not had occasion to mention before is one of the things that got me so interested in the topic: A May, 1975 five-part series in the New York Daily News, the first installment of which ran under the headline “Big Money, Little Victims.”

The series was full of genuinely shocking revelations about New York City children trapped in foster care and the sometimes-appalling conditions in which they lived. But that wasn’t new. What set this series apart was how reporters William Heffernan and Stewart Ain connected the dots, and traced the problems back to financial incentives - specifically the fact that private agencies which, then as now, handle almost all foster care in New York City, were paid for every day they kept a child in their “care.” Send the child home, or get the child adopted, and the money stopped.

Among the findings:

● “…[M]any private [child welfare] agencies regularly deny thousands of children the chance of finding permanent homes so that they can continue to collect millions of dollars each year in city child support payments.”

●“…[C]hildren … have become the lifeblood of these private agencies, which thrive on the millions of dollars the city pumps into them each year. These agencies systematically keep the children in their jurisdiction so that a constant level of government funding is maintained.”

The series documented how children were held in foster care needlessly, with no help for birth families and no moves to get them adopted. It documented the enormous power of the private agencies with their blue-chip boards of directors filled with prominent members of the city’s business, civic and religious elite, and how they effectively ran child welfare in New York with almost unlimited power and no accountability – a perfect example of what the late Jack Newfield called “the permanent government.”

The series documented the role of financial incentives in telling detail, complete with at least one “smoking memo” in which an agency acknowledged that it preferred collecting per diems day after day to the one-time flat fee which existed at the time for getting a child adopted.

I still think this series is the second thing anyone interested in learning about child welfare in New York should read – right after they finish New York Times reporter Nina Bernstein’s magnificent book The Lost Children of Wilder (Pantheon: 2001).

From time to time since 1975, another revelation would surface, like the deposition in a 1990 lawsuit in which a social worker said that “I have been advised by a foster-care agency caseworker that her facility has imposed a three-month moratorium on discharges, because it was not receiving sufficient referrals to fill its beds.”

And from time to time, the city would try to change the per diem system, only to have pilot projects scrapped by the power of the private agencies and their onetime opponent-turned-ally, Marcia Lowry of Children’s Rights Inc.

But in all the time since “Big Money, Little Victims,” no newspaper I know of, in New York City or elsewhere, ever again zeroed in on the crucial issue of financial incentives.

There is nothing more important in child welfare reform than changing financial incentives. When I offered 35 recommendations for change in my book, number one was: Change the financial incentives. In fact, on any “top ten” list, changing financial incentives should be one through nine.

Now, at last, New York City is trying again. According to a story in Thursday’s New York Times, The Administration for Children’s Services plans to replace per diem reimbursement with a formula giving private agencies a flat amount based on what they’re getting now. The agencies would get far more flexibility concerning how to spend that money, so they could use more of it to help families get their children back, and to help foster families take care of children who otherwise would have to go into group homes and institutions – options that are both more expensive and far worse for children. The agencies also would estimate the cost savings from reducing the use of those group homes and institutions, and ACS would pass those savings on to the agencies to use to bolster services. ACS says that means that for most agencies, their budgets would increase 15 to 20 percent in the first year they join the program.

In addition, ACS will revamp the way private agencies are monitored, stationing specially-trained city workers at the agencies both to see how those agencies really perform and to help them do their jobs better.

That Times story alludes briefly to the fact that Illinois saw success through changing financial incentives. Here’s what happened: The foster care population statewide fell from more than 50,000 in 1997 to under 17,000 today. Independent court-appointed monitors (put in place because of a consent decree) found that as foster care plummeted, child safety improved.

It’s a bold, courageous move for any child welfare agency, but especially for an agency that has been under as much pressure as ACS. And it is another indication that for all its failings in how it responded to the death of Nixzmary Brown and other tragedies, failings I’ll discuss next week, ACS remains far better than most of its big-city counterparts. (The current ACS Commissioner, John Mattingly, formerly worked for the Annie E. Casey Foundation, which helps to fund NCCPR).

Indeed, it is easier to implement a change like this when the number of children taken from their parents is falling. In New York City it is rising. That ACS is moving ahead with this reform also makes me hope they feel the surge in removals has peaked.

But this change won’t come easily.

Hell hath no fury like an agency denied its per diems. And the scare tactics already have begun. Not that anyone is saying no to changing financial incentives. As usual, they’re trying to “yes, but…” it to death.

Marcia Lowry, who once was a leader in making systems more progressive and now leads efforts to hold them back, raises the specter that agencies won’t take more difficult children. But there is just as much incentive to try to avoid such cases under a per diem system – there’s even a name for it, “creaming,” as in skimming the cream. And ACS has made creaming more difficult than it used to be.

The head of the trade association for the city’s private agencies already is hinting darkly that under this system his agencies might feel pressured to return children home too soon.

How odd. In all the decades that they’ve operated under a per diem system these same agencies have insisted that money never, ever affects their decisions, and they never would even think of holding onto a child for too long. In fact, New York’s existing system for monitoring agencies penalizes them if too many children they return home have to come back into foster care. And, if anything, the new monitoring system is likely to reduce errors in all directions.

So here’s what to expect:

If they can’t stop the new system, the private agencies will lie low for a year or so, and then start a whispering campaign. They’ll blame every death of a child “known to the system” on how they supposedly were pressured to return that child home too soon.

They will base this smear campaign on the assumption that reporters and the public have very short memories. They’ll assume that everyone will forget that the number of such deaths hit a record of 45 in 2006. That’s up 50 percent over 2005 – and of course that was before any change in the per diem system.

Even such a large change over just one year can be a fluke. But I can’t see how one can have it both ways – either fatalities tell you something about overall system performance, or they don’t. (It’s not so much ACS that wants to have it both ways as it is a certain large, influential news organization).

The deaths “come at a time when” the city is taking away significantly more children than the previous year, which, one would think might “raise questions about” all those additional removals, but that’s another story — one I’ll get to next week.

Oh, and to William Heffernan, who now is a novelist, and Stewart Ain, now at The Jewish Week – congratulations. Looks like that series finally got results.

Sunday, March 18, 2007

One place where the news about child welfare is, mostly, good

That place is Maine, and nobody would have said that just six years ago.

Back in 2000, a little girl named Logan Marr was taken from her mother, Christy. Christy had some problems, but she had never harmed Logan nor had she allowed anyone else to harm her. Mostly, Christy’s problem was, she was poor.

Logan may have been abused in her first foster home. After that, Logan and her sister, Bailey, were moved to the home of Sally Schofield, herself a former caseworker for the child welfare agency.

In her searing account of the case, Logan’s Truth, award-winning independent journalist Terilyn Simpson published a letter that Christy wrote to Logan’s new foster mother:

Dear Sally,
My name is Christy. I'm Logan and Bailey's Mom. I'm writing this so you can know and understand my children. I thought I would let you know their likes and dislikes.
Logan - she likes butterflies, pizza (what kid doesn't?), flavored noodles, pitted black olives (she likes to put them on her fingers), white cheese, grape soda, Babes in Toyland (her favorite movie) the Cartoon Arthur. Logan's dislikes - peas, fish sticks, going to bed early, not picking out her clothes. Bailey's likes - her brown teddy bear blanket (she takes it everywhere, including visits), dry cereal, pitted black olives, cheese, eggs, cooked carrots.
Bailey's dislikes - having her poopie diaper changed (if you haven't noticed), someone taking her pacifier, fish sticks, someone feeding her (she likes to do it herself). Please ask [caseworker] Allison Peters what the kids are allergic to.
I don't blame you for not wanting me to know who you are, I will respect that. Regardless of what you have heard or read, I love my little ladies with all my heart. I have never hit, spanked or put my hands on my girls. I do respect my children. I'm not saying you would or wouldn't, but Please don't hit or hurt my children. The girls have already been through enough they don't need the added stress in their life.
Every night I look up at the sky about 7:45pm and say goodnight to my girls. In closing, I want to thank you for taking the time to read this. Please tell the girls before they go to bed I love them and give them a big hug and kiss. Thanks again!

A few months later, Logan was dead.

Sally Schofield was convicted of taking Logan down to the basement and tying her to a high chair with 42 feet of duct tape. She died of asphyxiation. Logan’s story was told on the PBS series Frontline.

A month before she died, Logan could be heard on home video during a supervised visit complaining that her foster mother hurt her. Nothing was done. Indeed, at one point, the caseworker who was supposed to be supervising the placement sent an e-mail to Sally Schofield gloating about the prospect of terminating parental rights, so Logan could live with Schofield forever.

But I said this would be, mostly, a good news story.

At first the response to the death of Logan Marr was what it usually is when a child dies in foster care: The press focused on issues like whether there were enough visits by caseworkers to foster homes, were the licensing standards good enough, were background checks adequate, etc. Those are reasonable questions, and it’s understandable that they are the first to pop into people’s heads.

But whether a system will reform in the wake of a foster-care tragedy depends on whether journalists move on to the real problems. In Maine, that meant confronting a culture of child removal embedded in the child welfare agency. At the time Logan died, the proportion of children trapped in foster care in Maine was among the highest in the nation. But Maine was never the child abuse capital of America.

NCCPR began raising these questions – and the state’s newspapers began pursuing them. Two legislative committees held hearings, and one of them produced some good recommendations. An independent office of child welfare ombudsman was created, under the auspices of a leading state child advocacy group, the Maine Children’s Alliance.

At about the same time, a very good foster parent got fed up. Mary Callahan kept finding that the children placed with her could have remained in their own homes if only the birth parents had gotten the kind of aid she received as a foster parent. Already a published author, she decided to write a book about her experiences. It’s called Memoirs of a Baby Stealer (Pinewoods Press, 2003). She organized the Maine Alliance for DHS Accountability and Reform, a grassroots organization that demanded systemic change.

A new governor listened. Governor John Baldacci saw immediately what the problems were. He brought in new leadership. When a committee was formed to reorganize the human services agency, each member of the group found a copy of Callahan’s book at her or his place at the table. Her presentation to the committee is on NCCPR’s website.

A lot more committee work, and much frustration followed. Callahan describes it in an op ed column for the Bangor Daily News.

But the change has been remarkable and, by child welfare standards, remarkably swift.

● Since 2001, the number of children in foster care has dropped by one-third and the number of children taken from their homes each year is down 30 percent. More than a thousand children have been spared needless confinement to foster care.

● When children must be taken, far more are placed with extended family, which is better for children’s well-being and safer than what should properly be called “stranger care.”

● The proportion of children trapped in the worst form of care, institutions and group homes, has dropped from 28 percent to 18 percent.

● The independent child welfare ombudsman has found that the reduction in substitute care has come with no compromise of safety. He strongly supports the reforms.

There still is a long way to go. For example, that reduction in the proportion of children in group homes and institutions is a reduction from a rate that was 50 percent above the national average to a rate no worse than the national average. But the national average is, itself, too high.

And for some people, praising reform in Maine is like rubbing salt into a wound - -these are the people for whom reform came too late, or those it still hasn’t reached. Because every system still makes mistakes, in both directions. Every system leaves some children in dangerous homes and every system takes some children needlessly. What sets apart reformed systems, like Maine’s, is that the mistakes occur less often.

But what is good for vulnerable children can be bad for the industry that has grown up around them. With group homes closing and staff losing their jobs, the people running such places have launched a campaign of fear and smear, arguing that the pendulum has swung too far away from institutionalizing children.

In fact, as noted above, Maine has simply reduced the proportion of children in group homes and institutions from more than 50 percent above the national average to the national average, an average which is, itself, too high. If anything, the pendulum hasn’t swung far enough.

The most offensive argument from the group home industry is an unctuous claim that while they supposedly care only about children, the state allegedly is interested only in money. This from an industry scarfing up an average of $134,000 per child per year, paid on a per diem basis. The longer they hold onto a child, the more money they make.

Much has been said about the addiction problem in child welfare. But as I’ve noted before on this blog, the biggest addiction problem in child welfare is not substance-abusing parents, though that problem is serious and real. The biggest addiction problem is powerful, well-connected child welfare agencies that are addicted to their per-diem payments. And they are putting their addiction ahead of the children.

Six years ago, when NCCPR first criticized child welfare in Maine, the old leadership replied that Maine is a leader in human services. That’s true. Maine always has been in the forefront of helping its most vulnerable citizens, often setting an example for the nation. At the time, child welfare was a glaring exception.

On January 31, the sixth anniversary of the death of Logan Marr, NCCPR was able to add Maine to our short list of best practices around the country, Eleven Ways to do Child Welfare Right. Because now, thanks to the concerted efforts of state leaders, and the people of Maine, the state has a child welfare agency that is worthy of the state it serves.

I can’t believe anyone is going to let the selfishness of a few group home providers undo all that progress.

Thursday, March 15, 2007

What are they smoking in Texas?

Perhaps you saw the videotape: Two boys, ages two and four, forced to smoke marijuana while their 17-year-old uncle who gave them the pot, and two other teenagers laughed – and recorded the entire scene. The uncle and the other teens are under arrest – and the children are in foster care.

Had the 17-year-old been the children’s father, and their only custodial parent, that would have been justified. The harm of foster care is likely to be less than the harm of leaving the children with someone who engages in calculated acts of cruelty.

But he was the children’s uncle -- and the children already had been made safe from him when he was arrested. According to the Fort Worth Star-Telegram, which seems to be ahead of everyone else on this part of the story, the boys’ mother says she was napping in another room when it happened, and was shocked at what her brother did.

One can imagine any number of reasons for the mother taking a nap, ranging from scenarios that would make her equally irresponsible to the possibility that she was sleeping because she worked a night-shift job to make ends meet and it never occurred to her that her 17-year-old brother would do something like this.

So what should be the “default” position while Texas authorities figure this out?

● We know that children of this age almost always love their mothers and are tremendously attached to them.

­● We know that when they are taken from their mothers there is no way to explain why; to them it might as well be a kidnapping.

● We know that they may well feel that they have done something wrong and now they are being punished.

● We know that they may recover from the trauma, or they may suffer from it forever.

● We know that Texas child protective services placed the children with total strangers, unable – or unwilling – immediately to find a relative to cushion the blow. (The agency says it’s looking for a relative now.)

We know all that harm is likely before we even get to little details like the likelihood the children will wind up bounced from foster home to foster home or the risk of abuse in foster care itself (probably about one in three nationally, one can only imagine the rate in Texas, which has been the scene of one scandal after another over abuse in foster care).

The risks on the other side:

● Even with her brother out of the house we don’t know if the children’s mother knew how irresponsible and cruel he was. So would she leave the children with some other unsuitable caretaker? Or did she really know what was going on and not care? Has this happened before?

No actual evidence has been produced to support any such speculation – but that’s still how CPS works.

So what alternative could CPS have used?

How about an Intensive Family Preservation Services (IFPS) intervention, in which a worker would be in that home several hours a day several days a week for up to six weeks? That doesn’t eliminate the alleged risks, but it significantly reduces them. These programs have a far better track record for safety than foster care. So then you need to weigh the relative risks: The well-known harm of foster care to the risk, even absent any known evidence, that the mother would be irresponsible when the IFPS worker wasn’t around.

In a rational system, the IFPS intervention should win hands down. In fact, for a child welfare agency to expose young children to all the known harm of foster care on these grounds, one has to ask: What are they smoking?

But, of course, this is the Texas system, one of the more chaotic in the nation, and one that is in the midst of its second foster-care panic since 1999. For details, see NCCPR’s report on Texas Child Welfare. (Although in fairness to Texas authorities, most systems would have the same take-the-child-and-run response to a high-profile case like this, not because it protects children, but because it protects the people who take away the children, who would have been painting targets on their backs had they done anything else).

But hey, at least the Texas Legislature has its priorities straight. On the same day this story was getting lots of play on cable news, Texas State Sen. Bob Durell was introducing a bill to restore the right of foster parents of severely emotionally disturbed children to keep guns in their homes. After all, it would be a tragedy if Dick Cheney were to retire to Texas only to discover he couldn’t be a foster parent.