Sunday, August 17, 2008

Unfinished business in Florida

Late last month on this Blog I praised the work of Bob Butterworth who just left the job of Secretary of the Florida Department of Children and Families. He began a transformation of what was once one of the worst child welfare systems in the nation, including the first significant reduction in entries into foster care in a decade.

    But even as Florida newspapers were filled with stories about Butterworth's last day and the naming of his interim successor, George Sheldon, a small story in a small newspaper , Hernando Today, illustrated how much more needs to be done, not only in Florida, but almost everywhere.

    It was one of those barely-more-than-a-police-blotter items about a young mother who fell asleep one afternoon and didn't know her three-year-old had managed to open a deadbolt lock and get out the front door of their house, something he apparently had done at least once before. He was found in the front yard wearing only a diaper. Someone called the police. They found a home "in disarray with piles of dirty dishes and bottles of medication and toxic household cleaners within easy access of the child." The three-year-old and his infant brother were taken away, and the mother was criminally charged.

    There is some risk in pointing out this case. If there is an "advocates handbook" out there, it probably says one should point out only cases in which the alleged victim is pure as the driven snow; what I've come to call a "60 Minutes-class victim."

    But those cases are at one end of a continuum, with the horror story cases of sadistic brutes who torture their children at the other. Most of what child welfare agency workers see falls in between – like this case. And that means the success of any effort to fix DCF, and almost every other child welfare agency in the country, will rise or fall on how cases like this one are handled.

    I imagine a lot of people will share the sentiment of the first person to comment on the Hernando Today website, "Chris 100602" who wrote:

The saddest part of this story is that they will give this bright young child right back to this sad excuse for a mother, and she will quash and smother anything he may have been able to accomplish in his life if given half the chance.

Indeed, that is almost certainly the first reaction among a lot of DCF workers, including whoever decided to take these children in the first place. And that makes it a perfect example of flunking the "balance of harms" test.

We all can see the risk in leaving these children at home: Teen mother, messy home, dangers in easy reach.

    But no one involved in the case saw the dangers of removal: The fact that this three-year-old is now probably terrified about never seeing the mother he loves again; the fact that the terror may well be compounded by guilt; a belief that he is being punished, why else would they have taken mommy away? The fact that this fear and guilt may cripple the child emotionally for life. The fact that if the foster care drags on long enough there is a one-in-three chance he'll actually be abused in foster care itself.

    As for the infant, also taken, I often have cited a major medical center study of Florida infants born with cocaine in their systems, one group placed in foster care, one group left with mothers able to care for them. Even for these infants, those left with birth mothers did better. For the foster children, the separation from their mothers was more toxic than the cocaine. (No that doesn't mean you can just leave children with addicts, it does mean drug treatment for the mother almost always is a better first choice than foster care for the child). There is no allegation of drug use in this case. So imagine how much the infant in this case is suffering now. (The story doesn't say exactly where the children are. If they're with extended family that cushions the blow, but harm still is done.)

    And remember that study of 15,000 typical cases – the one that found that, on average, the children left in their own homes, even with little or no help, did better than those placed in foster care? This is precisely the kind of case that the study examined – a typical, everyday, "in-between" case. If anything, many of those 15,000 cases probably were worse. So while Chris100602 probably reflects public opinion, I know 15,000 children who probably would like to take issue with her, if they could. Still another study found that only one in five foster-care alumni does well in later life. So, no, foster care doesn't give a child "half the chance" to accomplish anything in life – it's more like one-fifth of a chance.

    And then there's the second comment. The person posting this comment claims to be the mother's big sister. She says she tried to help her sister to no avail, and ultimately called DCF to turn in her sister a couple of weeks earlier. But, she says, DCF didn't do anything then.

Let's assume that's all true. That only further illustrates how DCF got it wrong. If it's all true, this is a classic example of a child welfare agency believing there are only two options, "all" or "nothing" – that is, take away the children or close the door and go away.

    Depending on what DCF found on that first report, there might well have been plenty of cause to offer help. That help could have included partnering with the sister – helping the big sister find and provide concrete help to her younger sister (assuming the relationship hadn't soured too much as a result of the call to DCF).

    And when DCF came back the second time? There was nothing wrong that couldn't have been solved with a locksmith and some housekeeping help. Then do some in-home help and monitoring. Send in someone to teach the mother, but not with a wagging finger and a lot of theory. Send in someone who also would provide concrete help – roughly the equivalent of one of those "nurse home visitor" interventions that the child welfare establishment loves. (Done right, it really is an excellent program). I don't think this case even rises to the level where something more intense, like Intensive Family Preservation Services is necessary.

    Why bother doing all this? For those who care only about money, it will cost less than foster care. For those who care about children, it will leave those children far better off than they probably are now – terrified and guilt ridden somewhere in foster care. This kind of intervention is the kind that would really give these children that "half a chance" that Chriss100602 naively believes you get from foster care.