Thursday, July 29, 2010

Foster care finance reform: The charge of the “Yes, but…” brigade

During his opening statement at a Congressional subcommittee hearing on child welfare finance reform this morning, the Secretary of the Florida Department of Children and Families spoke about a meeting he had with fifteen former foster children. He said it was those former foster children who convinced him of the need for Florida's current reforms:

Child after child after child told me I would have rather stayed at home and dealt with the issues in that home than gone into a foster care system where I was moved from home to home and school to school.

Today, children are far more likely to be able to stay in their own homes in Florida because of its highlysuccessful waiver from federal funding rules. The waiver lets Florida spend about $140 million a year in federal funds normally reserved for foster care on better options as well. The result has been a significant reduction in entries into care and, according to independent evaluations, improved safety outcomes

But for the rest of the 90 minute hearing, almost everyone else who spoke forgot about those young people, as they sought to "yes, but…" to death any plan to let other states do what Florida has done. The Florida wavier itself expires in 2011 if it's not extended by the Department of Health and Human Services.

Among those joining the "Yes, but…" brigade was the chairman of the subcommittee holding the hearings, Rep. Jim McDermott, (D-Washington).

At the start of the hearing, McDermott announced he would introduce legislation to restore HHS' authority to grant a limited number of new waivers. He spent the rest of the hearing wringing his hands over his own bill. Over and over he expressed the classic fear of the foster care-industrial complex: Somehow or other this means we don't get as much money. He obsessed over the possibility that states might use the waivers to cut child welfare spending and use savings from putting fewer children into foster care on other government services.

Suppose, he argued, a state was spending $100 to keep a child in foster care and could spend only $40 to keep that child safely in his own home. What's to stop a state from diverting the other $60 to highway construction or something else besides child welfare. (This is my recollection of the hypothetical, his figures and examples of other spending may have been a little different).

Even assuming that were possible (and for reasons discussed below, it is not) that still would be an improvement over the status quo. That's because the $40 intervention – keeping the child safely in his own home – almost always would produce better results for the child than the $100 intervention: foster care. Yet this is virtually incomprehensible to McDermott and other of my fellow liberals who can't conceive of something being better if it doesn't involve spending more money.

Part of the problem is that too many of us on the left are stuck in a 1960s mindset, in which letting states make decisions meant segregation forever and enlightened policy – from the New Deal to the civil rights laws to the Great Society – came only from the federal government. The irony is that now this mindset is perpetuating one of the worst civil rights violations of the 21st Century, the needless confiscation of poor, minority children from their parents. And we're thwarting states who want to do better. We're never going to win the war of ideas with the right until we get it through our heads that it's no longer 1968.

But in any event, what McDermott fears can't happen under child welfare waivers like the one in Florida. Indeed, over and over, Sheldon and another witness – one from McDermott's home state – tried to explain that in the real world of child welfare, the opposite was the case.


Sheldon explained how the Florida waiver had a strong "maintenance of effort" provision which required that the state maintain its own level of funding for child welfare. He talked about how DCF had, indeed, taken hits in other areas, but not child welfare, because the waiver would not allow it. So any savings from reducing foster care in Florida had to go into further improvements in child welfare services.

In contrast, State Rep. Ruth Kagi (D-Washington) expressed her enormous frustration at the fact that, now that Washington State finally was reducing its foster care numbers, that state was being penalized for it financially. Since Washington State gets its foster care money the old fashioned way, as an open-ended entitlement, it can't keep the savings from reducing foster care – the money never even gets to Washington State. As a result, they're having enormous problems trying to spend on services to keep children out of care.

She cited an example:

I was with a caseworker in Vancouver a few months ago, who had been with a young mom with a baby, and the risk, she felt, was high, but she wanted to get a public health nurse in there to support the mom, and felt that would make the difference. She was unable to get a public health nurse. So she took the child, and placed the child in foster care.

So to sum up:

Florida: Has waiver – CAN'T cut child welfare

Washington State: No waiver – CAN cut child welfare.

Somehow, this didn't seem to sink in.

And no wonder, given the comments from some of the other witnesses.

For starters there was Fred Wulczyn, from the home of advocacy "scholarship" the Chapin Hall Center for Children. He hemmed and hawed about what evaluations showed, suggesting that only the evaluations of waivers involving subsidized guardianship really produced outstanding results. He dismissed the comprehensive evaluations of Florida's waiver because they're not yet "final."


This is a perfect example of the double standards that plague child welfare scholarship: We've known about the dreadful failure of foster care and institutions for a century – that should be "final" enough. Yet these interventions are allowed to scarf up almost all the money because alternatives haven't dotted every i and crossed every t on their "final" evaluations.

Even more galling, of course, are Chapin Hall's own double standards. Wulczyn's "Yes, butting…" of prevention waivers comes only weeks after his colleague Deborah Daro co-authored a letter passionately urging President Obama to fund certain "home visiting" programs that have a lot less evidence of success than the Florida waiver. And Daro failed to disclose in the letter that one of these programs, Healthy Families America, is a program she helped to develop when she was at Prevent Child Abuse America.

In the same vein, one of the programs Rep. Kagi rightly praised, and wants to expand is the original Intensive Family Preservation Services program, Homebuilders, a program which has an outstanding evidence base proving effectiveness, but which probably would be dead by now had some of the advocacy-scholars at Chapin Hall had their way. (In fairness to Wulczyn, while I believe he applies the wrong standard when comparing innovation to the status-quo, he's been consistent and honorable in his own evaluation work.)

But the leader of the Charge of the "Yes, but…" Brigade was Rutledge Q. Hutson, who has ping-ponged between the Center for Law and Social Policy, where she works now, and the Children's Defense Fund, a group whose slogan should be "no dollar left behind."

For starters, Hutson offered up a favorite scare number from those whose 19th Century counterparts proudly called themselves "child savers" – the one about how, in 40 percent of cases in which investigators "substantiate" maltreatment, the family received no "services." This, of course, conjures up images of parents beating, raping and torturing their children as caseworkers check the "substantiated" box on a form and walk away.

Far more likely, the overwhelming majority of these cases are situations in which no "help" from the government was required. They may be cases in which the worker only checked the "substantiated" box because she was afraid to do otherwise if something later went wrong – in some states you're supposed to check this box even when there is more evidence of innocence. Or they may be situations in which a mother rushed to a toddler twin crying in one room, and the other twin hurt himself while unattended for those few minutes. Or a young child unlatches the back door and wanders away for a few minutes – and by the time the child protective services worker arrives to "investigate" the parents have put a better lock on the door, etc. etc.

In a classic example of the narrow range of ideas that characterizes the child savers, Hutson insisted that waivers can't possibly work until an entire array of alternative services is in place and ready to go before even one child is kept out of foster care. She suggested this even as Florida's experience proves this simply isn't so. It doesn't take that long to bolster basic prevention and family preservation. And Hutson's thesis assumes that every child in foster care needed to be there in the absence of "services." In fact, there are foster children who never should have been taken away at all – and the savings from keeping them out of foster care can be used immediately to bolster prevention and family preservation.

Hutson also erred in claiming we don't know what happens to children not taken into the system under waivers. On the contrary, Florida's waiver evaluation measures the proportion of children with substantiated allegations of maltreatment who are maltreated again within six months – and that figure has improved under the waiver.

But the fact that Rutledge Q. Hutson ignores the research of others is not nearly as disturbing as the fact that she's ignored the research of – Rutledge Q. Hutson. In 2003, Hutson wrote a report on the dramatic improvements in the county-run child welfare system in El Paso County, Colorado. Absolutely vital to making that work was the fact that a visionary leader of that system, David Berns, took full advantage of the flexibility in state aid provided by Colorado to the counties – in fact, he pushed the envelope as far as it would go in mixing and matching those funds, adopting a "better to apologize afterwards than ask permission beforehand" approach.

But today, Hutson spent most of her time effectively seeking to put obstacles in the way of the next Dave Berns to come along and try to transform child welfare in a county or a state.

All of those in the "Yes, but…" brigade kept saying that waivers are no substitute for comprehensive reform of child welfare finance in general. That's true – but the vision of reform the "Yes, but…" brigade is pushing would add a lot of new spending and do almost nothing to encourage shifting that spending from foster care to better alternatives. Indeed, under some scenarios, things could get even worse. Details are in our report on child welfare financing.

And, as Rep. Kagi pointed out toward the end of the hearing, in a tone that suggested some exasperation: There is no consensus on what "comprehensive reform" should look like – so at least states that want to move ahead should get a chance through waivers.

Reporting to Congress on the foster care waiver that saved Florida


A subcommittee of the House Ways and Means Committee is scheduled to hold a public hearing starting at 10:00am today on waivers from rules that limit the use of huge amounts of federal money only to warehousing children in foster care. Witnesses include the Secretary of the Florida Department of Children and Families, George Sheldon, who will testify about the enormous success Florida has had with its waiver, which allows the state to use up to about $140 million per year that otherwise would be restricted to foster care on better alternatives as well.

The waivers will be expiring soon – extending them is vital to the continued success of Florida in transforming its child welfare system from one of the nation's worst into an emerging national leader.

The home page for the hearing includes a link to live coverage on the web. But I doubt the cameras will be focusing much on the audience. Too bad. Virtually every organization wedded to the child welfare status quo will have someone in the room, and they'll all be thinking about how to kill the waivers without actually saying that's what they're doing. Expect a lot of written statements for the record filled with comments about how "we favor flexibility but…" "the waivers are promising, however…," or "we strongly support alternatives to foster care, as long as…"

That's how the nation's foster care-industrial complex always tries to kill reform. Never say "no." Just, "yes, but…" it to death.

In fact, extending the waivers isn't nearly enough. Congress should authorize HHS to make Florida-style waivers quickly and easily available to any state or county that wants one. Even then, relatively few child welfare leaders are likely to have the courage – the classic profile in cowardice being Michigan, which actually accepted a Florida-style waiver and then turned it down at the last minute. But at least if such waivers were readily available those with the vision to transform their child welfare systems will have the financial incentives from the federal government on their side, instead of getting in the way.

For details on child welfare financing and the full context for today's hearing, see NCCPR's report, You Get What You Pay For.

Monday, July 26, 2010

Foster care tragedy in Michigan. Again.

First there was Ricky Holland, taken by the Michigan Department of Human Services from an overwhelmed, impoverished mother, only to die in the foster home DHS workers thought was perfect for him.

Then there was Johnny Dragomir, taken from his mother when she asked DHS for help after losing her job as a factory worker in Dearborn. As Detroit television station WXYZ reported, DHS placed him in a group home where he starved to death.

And now there is Emily Meno.

DHS never claimed Emily's mother beat her, or tortured her or sexually abused her. Her only "crime" was to be overwhelmed and maybe suffering from a mild mental impairment. Thousands of mothers just like her have raised happy, healthy children when agencies provide those mothers with the basic help they need.

There was a time when Michigan probably would have done that. More than 20 years ago, Michigan was a national leader in using safe, proven alternatives to foster care. But ever since the mid-1990s, Michigan has embraced a take-the-child-and-run approach to child welfare. Occasional efforts to change that have been thwarted, time and time again, by the state's enormously-powerful private agencies, paid for every day they hold children in foster care.

So budgets for basic help that almost certainly could have kept Emily safely with her mother have been slashed. And no, the cuts are not required because of Michigan's budget crisis. Even as these programs were cut, DHS lavished rate increases on providers of what is both the worst form of care for children and the most expensive, institutionalization in so-called "residential treatment centers" and other latter-day orphanages.

Other funds have been diverted to a foster care worker and child abuse investigator hiring binge in order to meet the terms of a consent decree between DHS and the group that so arrogantly calls itself "Children's Rights" (CR).

The consent decree requires DHS to cut caseloads. But that can be done by putting more money into alternatives to taking children in the first place, instead of wasting the money hiring more workers to take away even more children, which will leave Michigan with the same lousy system only bigger.

Indeed, the latest report from the independent monitor overseeing the consent decree shows that the cuts in prevention and family preservation violate the decree. Yet while CR has been more than willing to go back to court to enforce its decrees in other states, and especially enthused about rushing into court to block Georgia and Tennessee from doing more to keep families together, CR apparently hasn't lifted a finger to stop the family preservation cuts in Michigan.

When birth parents really can't care for their children, the next best placement almost always is with a relative. Study after study has found that "kinship" foster care is more stable, better for children's well-being and, most important, safer than what should properly be called "stranger care."

Here, too, Michigan used to be a leader. As long as the home of a grandparent or other relative met basic health and safety standards, Michigan would place the child there – without forcing the grandparent to comply with ten single-spaced pages of hypertechnical requirements needed to become formally "licensed." Many of these requirements involve middle-class creature comforts, so it's relatively easy for middle-class strangers to meet them, but hard for impoverished relatives.

But licensing is an obsession with CR, a group that believes there is no problem that another piece of red tape or another layer of bureaucracy can't solve. So the consent decree put an end to Michigan's sensible approach to kinship care. As a result, hundreds of Michigan children have been expelled from the homes of loving relatives, and it is harder to relatives to gain custody of children taken from their parents in the first place.

That may explain why Emily Meno wound up in exactly the kind of foster home CR likes best: The home of a duly-licensed stranger, overseen by a respected private agency. Ricky Holland's foster and adoptive home, and Johnny Dragomir's group home also were licensed.

A jury ultimately will decide the guilt or innocence of the licensed stranger who cared for Emily Meno. But this much we already know: Emily Meno is one more child "protected to death" and "licensed to death" by the Michigan Department of Human Services and a consent decree it never should have signed.

If Emily Meno's death is to have any meaning, DHS should have the common decency to restore funding for prevention and family preservation, and go back into court to demand changes to those parts of the decree that launched the war against Michigan's grandparents.

Friday, July 23, 2010

Attn. CR: If you REALLY want to curb abuse in Georgia foster care, stop trying to shovel so many children into it

The group that so arrogantly calls itself Children's Rights is now declaring itself officially outraged at an increase in abuse in foster care in metropolitan Atlanta, where CR has a consent decree.

They're even threatening to take the state back into court (in contrast to Michigan where CR meekly accepts that state's cuts in prevention and family preservation in order to fund more foster care workers and rate increases for institutions).

And even in Georgia itself, CR still doesn't get that you can't have it both ways: You can't whine about abuse in foster care in Georgia while trying to undermine every effort to keep more children out of foster care in Georgia. As noted in this previous post, CR is trying to undermine Georgia's differential response program, which has a proven record of reducing entries into foster care and improving child safety.

To CR, trying to shovel more children into the same system you condemn as rife with abuse makes perfect sense. No doubt they would argue that even as you overload the system with more children who don't need to be there, you supposedly prevent the abuse with more licensing paperwork, background checks, etc. etc. This is why I've said the people at CR are like the clerk you least want to see when you finally make it to the front of the line at the DMV. CR thinks every problem can be fixed with another form to fill out, another box to check off or some other bureaucratic answer.

More than 150 years of experience in child welfare tells us that, when it comes to foster care, this doesn't work. And the more you overload a foster care system with children who don't need to be there, as CR now seems hell-bent on doing in Georgia, the greater the risk of abuse in foster care.

The only way to fix foster care is to have less of it.

Meanwhile, CR's lousy consent decree in Michigan may have contributed to another tragedy in that state. That story Monday.

Wednesday, July 21, 2010

UPDATED JULY 21: Foster care in Rhode Island: The child warehousing capital of America

PROVIDENCE, RHODE ISLAND (JULY 20): Today NCCPR released a comprehensive report on child welfare in Rhode Island. The full report, press release and other documents all are available on our website here. Among the key findings:

Rhode Island takes away children at one of the highest rates in America, a rate 80 percent above the national average and nearly double and triple the rates of states widely-recognized as doing a better job of keeping children safe.

Rhode Island is the child warehousing capital of America, trapping children in the worst form of care, group homes and institutions, at a rate more than double the national average.

Rhode Island exports an astounding proportion of its institutionalized children across the country – out of state, out of mind. Representatives of the child welfare agency, the Department of Children Youth and Families, visit them only once every three months if they're in a nearby state – and only once every six months if they've been warehoused far away. (DCYF did not explain why institutions need to be checked less often, and the Rhode Island children in them need even fewer visits if they are farther away.)

Two children are institutionalized nearly a thousand miles from Rhode Island in an institution run by a national chain that was the subject of a scathing report in December 2006, alleging substandard care. DCYF did not even know about this report until NCCPR called it to their attention.

In addition to doing enormous harm to the children, all this wastes huge amounts of taxpayer money. Rhode Island spends on child welfare at one of the highest rates in the Nation, a rate more than two-and-a-half times the national average.

Although DCYF is being sued by the group that so arrogantly calls itself "Children's Rights" the lawsuit is not likely to do much good – and might even do harm. That's because of CR's depressing track record of ignoring the problem of wrongful removal, and sometimes making it worse.

The only good news in all this: Because Rhode Island already is spending so much, and getting so little, it is possible to comprehensively reform the system without spending more money.

The Providence Journal has two excellent stories on the report, available here and here and WPRO Radio has a story here

Most interesting has been the response from DCYF. For well over a day after seeing the report they would say nothing. Then, finally, they told the Journal, in effect: Look at the bright side. We used to be even worse!

Thursday, July 15, 2010

Does Chapin Hall want YOU (investigated for child abuse)?

In the previous post to this Blog, I said that home visiting programs like the Nurse Family Partnership or Healthy Families America have such strong support in the child welfare community that they should be called "goody-two-shoes prevention." The people whose 19th Century counterparts proudly called themselves "child savers" like these programs because they enormously expand the scope of intervention into families. Advocates of family preservation like them because the intervention is voluntary, and such programs really can be helpful.

Almost the only dissenters are a few on the political right who see it as a way to impose government child-rearing standards and take away children when the parents don't comply. Absurd, of course – except for the fact that every once in awhile, someone from the mainstream of American child saving says something to fuel those very fears.


A little over a decade ago, for example, one of the most zealous crusaders against family preservation, Elizabeth Bartholet, suggested making home visiting programs like Healthy Families America mandatory – specifically for what she described as their "surveillance" value. Under Bartholet's spy-in-every-living-room scheme, parents would be required to admit the visitors and the visitors required to turn in any parent who falls short of Bartholet's standards for child rearing. Bartholet, a self-proclaimed liberal, explains that this "would simply provide society with a realistic means of enforcing" child maltreatment laws.

Which brings me to Dr. Deborah Daro, advocate-turned-"scholar."

In the previous post to this Blog, I discussed the extremist agenda of the group now called Prevent Child Abuse America when Daro was the group's "research director." Daro now is a "research fellow" at the Chapin Hall Center for Children, a place which claims to be a center of objective scholarship but I would argue has a checkered record in that regard.

Last February, Daro wrote an Issue Brief discussing the most recent National Incidence Study of child maltreatment (NIS-4). In addition to taking the findings of the study out of context (our own analysis is available here), toward the end of the Brief, Daro offers her own four-point plan for exactly what government should do in response to the data. Point three calls for "Universal assessments of all new parents that carry the dual mission of assessing parental capacity to provide for a child's safety, and linking families with services commensurate with their needs."

But Daro is remarkably vague about what this means. Does "universal" mean every new parent must be assessed, or has the opportunity to be assessed? If it's the latter, what happens to the parent who says no – does that make her automatically suspect? Who does these assessments? Are they also mandated reporters of child abuse? Before "volunteering," how much is the parent told about the risk of letting someone who may be a mandated reporter of child abuse into the home to "assess" her "capacity to provide for a child's safety"? The brief article doesn't say.

Daro's other writing, including a much longer article about a variety of prevention strategies, doesn't answer these questions either. That article suggests that what Daro has in mind is what they're trying to implement in Durham, North Carolina, as part of something called the Durham Family Initiative. The goal is to get a home visitor into the home of every newborn, apparently within 48 hours of the mother's discharge from the hospital. The visitor would complete "the standard risk assessment protocol" and do a "comprehensive psychosocial assessment." The goal is to "expand coverage to the families of newborns that are not now offered or do not accept these visits" [emphasis added].


Once again this remarkably vague description (especially for "scholarly" writing) is all the reader gets about how the process works. So we don't know if the visitor is a mandated reporter of child abuse and what happens if, after knocking on the door, the new parent tells the visitor to go away.

And even if this is purely voluntary, there is a huge difference between stopping by to offer help and stopping by with "the standard risk assessment protocol" to assess "parental capacity to provide for a child's safety" – both of which sound remarkably like what Child Protective Services workers do after they've received a report alleging maltreatment.

Of course Daro couches all this in the language of help. The point of the process, she writes is to "ensure that the family is linked to a medical provider and that any immediate needs identified though the risk assessment are addressed through an appropriate service referral."

And I'm sure Daro would argue that family preservation advocates should favor this approach, since, if it gets families "services" and prevents maltreatment, no one will report them and their children won't be taken away. But that assumes the assessment instrument is strictly objective and all these friendly "home visitors" can check their prejudices at the door. We've learned through the failure of Structured Decision Making, a similar set of assessment tools used by CPS workers that was found by this excellent study to be permeated with racial and class bias, just how dangerous "help" can be when the prerequisite for getting it is submitting to a "comprehensive psychosocial assessment." And the failure of the CASA program illustrates the danger of letting overwhelmingly white middle-class strangers pass judgment on overwhelmingly poor disproportionately minority families.

In short, what Daro is talking about is sending what are likely to be overwhelmingly white, middle-class professionals into homes they can identify with, and a whole lot of homes they can't – the homes of poor, minority families, in a way that may be voluntary in name only, even when these families have not even been accused of maltreating their children.

In other words, a spy in every living room.

And, indeed, if point three of Daro's agenda was the velvet glove, point four is the iron fist: "Creating child welfare systems that have the capacity to work with parents who require mandatory intervention to insure their child's safety and the willingness to remove children in those cases in which parents are either unwilling or unable to change." As if somehow we don't have that already.


So does this mean the critics on the right were right about home visiting programs?

I don't think so. These programs have been around for a long time. I'm aware of no evidence linking them to increased removals of children from their homes – and there is evidence, with varying degrees of strength depending on the program – linking them to better outcomes for children. I don't think an entire program should be condemned because a few extremists want to pervert it.

But there also is an obligation on the part of mainstream supporters of these programs, like the Children's Defense Fund, the Child Welfare League of America and, especially, Prevent Child Abuse America, to take the initiative and speak out, loudly, against the extremists in their midst. They need to say that they won't tolerate having the program distorted the way people like Bartholet and Daro suggest.

And I haven't heard that yet.


The other question here is why does a "scholar" have an advocacy agenda? According to the recent Youth Today story on evidenced-based evaluation of youth service programs:

Mark Dynarski, vice president and director of the Center for Improving Research Evidence at the research company Mathematica, said a researcher must be neutral in carrying out any study, "very transparent" about the methodology of the evaluation, and then should step out of the way and "let the debate ensue." Even if there are significant findings, researchers "don't want to be over strong" in reporting them, Dynarski said. "Over-strong discussions are a kind of advocacy." Researchers must "stay in the line of science and let the policymakers pick up from there."

But at Chapin Hall, it seems, the line between advocate and scholar can be blurry – sometimes it's even indistinguishable. And that makes the "scholarship" suspect.

Monday, July 12, 2010

Evaluating alternatives to foster care: The advocate in scholar’s clothing

The lead story in the current issue of Youth Today is about how to measure the success or failure of programs serving youth in an "evidence based" world. Should programs be funded only if they can prove their success based on the same kind of "Randomized Controlled Trials" (RCTs) used to test medicines? Or are there so many more variables in human services programs than in pills that a lot of very successful programs, and those who benefit from them, would lose out?

It's an important debate, and one which probably calls for a "middle ground" answer, in which there is a reasonable standard of proof of effectiveness short of RCTs. But that's not the main topic here today. Today's primary topics are double standards, hypocrisy and failure to disclose at least the appearance of conflict-of-interest.

The issues arise in a letter cited in a sidebar at the end of the Youth Today story. The letter, available here, was sent to President Obama by four "scholars." The issue is funding for "home visiting" programs, in which someone from a government or private agency visits new mothers to offer help with child rearing. These are, in fact, useful programs, though exactly how useful is open to debate. And they are purely voluntary – we really are talking about help here, not investigations. (Though as I'll discuss in a future post, at least one "scholar" may want to change that.)

Because these programs widen the net of intervention into families – in some cases, potentially, to every new mother in the country - and do absolutely nothing to threaten the child welfare status quo, they are enormously popular in America's child welfare establishment. Since almost no one is opposed, I call them "goody-two-shoes prevention."

But not all of these programs have been proven equally effective. The strongest evidence, by far, supports one particular model, the Nurse Family Partnership program in which, as the name implies, the home visitors are nurses.

There is less evidence behind other programs, including what is probably the best known, "Healthy Families America," a project of a group called Prevent Child Abuse America.

President Obama originally proposed a big increase in funding for home visiting – but only for the Nurse Home Visitor model because it has the strongest evidence base.

The four scholars urged him to fund programs like Healthy Families America as well. Their position has some merit (and the Obama Administration ultimately came up with what appears to be a reasonable compromise). It is, in fact, far harder to apply the Randomized Controlled Trial model to evaluating social programs, and relying only on that model can be a serious mistake, something that Lisbeth Schorr, senior Fellow at the Center for the Study of Social Policy and Lecturer in Social Medicine at Harvard, discusses in several articles on her website. Her absence from the Youth Today story is an unfortunate omission. (About 14 years ago, I assisted Prof. Schorr with the editing of one of her books, and was paid for the work.)

In addition, though there are many excellent scholars studying child welfare, the field is so loaded with bias in favor of taking away children, and so poorly self-policed, that a lot of good programs probably would be strangled if a pure medical model were applied now.


The letter from the four "scholars" proves the point – though not in the way they had intended.

One of the "scholars" is one Dr. Deborah Daro, a "research fellow" at the Chapin Hall Center for Children at the University of Chicago.

But before she was Deborah Daro, scholar, she was Deborah Daro, advocate – serving as "research director" of the group now called Prevent Child Abuse America (PCAA) at a time when the group took a variety of extremist positions. These included everything from fanning the flames of the 1980s "mass molestation" and satanic ritual abuse witchhunts (relying in part on a psychiatrist who later would have his license suspended for two years on grounds of "dishonorable, unethical and unprofessional conduct") to publishing a special Spider Man comic book – still in print - that can't help but leave young children with the impression that they should turn in their parents if they get a spanking.

At Daro's PCAA, poverty had nothing to do with neglect – ever. A PCAA pamphlet declared that "the heart of the problem always is an emotional lacking in the parents" for which the solution is "re-education." [Emphasis added.]

Indeed, Daro's mentor, PCAA's first executive director, Ann Cohn Donnelly, seemingly relished rubbing salt in the wounds of parents who lost their children to foster care because they couldn't afford adequate housing or had to leave their children home alone to keep their jobs.

Said Donnelly: "There are a tremendously large number of people in this country who have little or no money who do not neglect their children. When parents neglect their children and are of low income, it is not sufficient to say they are excused because they have no money."

The sheer cruelty of the comment aside, it also is the equivalent of saying that, because there are a tremendously large number of smokers who don't get lung cancer, smoking has nothing to do with lung cancer.

Daro's own work at this time included a 1988 letter she wrote to The Wall Street Journal hyping the numbers in a federal report on child abuse issued at the time, the second "National Incidence Study" known as NIS-2.

She cited a part of the study which found that, in Daro's words: "Nine percent of the cases determined to be unfounded by Child Protective Service workers did indeed involve mistreatment that involved significant harm to the child."

But Daro left out the fact that, using the same criterion, the same study found that from 27 percent to 61 percent of the cases CPS workers "substantiated" should have been unfounded. In other words, caseworkers were two to six times more likely to mistakenly "substantiate" a case than to mistakenly label one "unfounded."

That information is in the same document, on the same page, in the same table as the information Daro chose to include in her letter – yet she left that part out.

And she didn't do it just once. She took the same information out of context in the same way in a report issued in 1992.

In short, the PCAA of Donnelly and Daro was the epitome of 19th Century "child saving" 100 years after it should have been extinct.

And Daro is still at it. When the fourth National Incidence Study (NIS-4) was released earlier this year and showed a significant decline in child abuse, Daro tried as hard to minimize the findings as she tried to hype NIS-2 more than two decades ago. (Our own analysis of NIS-4 is available here; see especially how our analysis of the study's findings on "neglect" differs from Daro's.).


But not everything PCCA did was harmful. They came up with a promising strategy for helping new mothers, thereby reducing child abuse. They called it "Healthy Families America." In the years since, HFA has become a huge part of PCCA's agenda. One could argue that PCCA, and those who created the program, have staked their reputations on it.

One of those people was Deborah Daro. In fact, when interviewed for a book, Daro declared that "In cooperation with my colleagues at Prevent Child Abuse America, we developed Healthy Families America."

But that little detail isn't in the letter to President Obama. Nowhere in the letter is there any disclosure of the fact that what Deborah Daro really is saying boils down to: Mr. President, please make an exception and lower the standards of evidence for the program I helped to invent.

This doesn't make the request invalid. Nor was it wrong for Daro to make the request. The problem is the absence of the kind of basic disclosure expected in other fields. For example, leading medical journals expect that if a study purporting to prove the effectiveness of a drug was paid for by the company that invented the drug, this fact will be disclosed.

The other problem with Daro's position is that she appears to be selective about which programs deserve this kind of consideration.

Daro led a Chapin Hall team that evaluated a promising child welfare innovation called Community Partnerships for Child Protection. This innovation long has been listed among NCCPR's Ways to do Child Welfare Right.
(The evaluation was published in 2005. Five years earlier, NCCPR received general operating funds from the Edna McConnell Clark Foundation, which created the Community Partnerships initiative.)

Did I say Chapin Hall evaluated the initiative? Savaged is more like it. The evaluation set an impossibly high standard for what the program sites had to do to prove success.

The Chapin Hall team essentially wrote off Community Partnerships despite the fact that, at three of four sites, there was significantly greater improvement in reducing child abuse at the partnership sites than in the surrounding communities, using the measure chosen by Chapin Hall itself. But these data were buried in charts in an appendix. The overall message was "community partnerships don't work" and that's the message picked up, understandably, by reporters writing about the study.

At one of the Community Partnership sites, St. Louis, there also were very large reductions in entries into foster care. But for Community Partnerships, Daro decided one site was not enough. In contrast, in her letter, Daro cites evidence of healthier births from just one of scores of Healthy Families America sites as sufficient reason for a big federal investment in the program.

In short, the evidence for the success of Community Partnerships is as least as strong as the evidence for Healthy Families America. And given that the whole approach of Community Partnerships – including working to cushion the blows of poverty and extending a helping hand instead of a wagging finger - is the opposite of that advocated by PCAA when Daro was their research director, it's fair to ask if Daro should have recused herself from any involvement in the Community Partnership evaluation.


This kind of issue is nothing new for Chapin Hall. They similarly stacked the deck against Intensive Family Preservation Services (IFPS) – but in that instance, other researchers did more careful studies proving its effectiveness. Indeed, in its comprehensive survey of what passes the "evidence-based" test and what doesn't, the Washington State Institute for Public Policy rates IFPS programs that follow the model of the original such program, Homebuilders, among the relatively few interventions that is truly an evidence-based success. Their detailed evaluation is available here. But Chapin Hall's hatchet job set back the field for years. (For details see NCCPR Issue Paper #11).

And it was a leading "scholar" at Chapin Hall who led an effort to punish a researcher for disclosing the very fact that child welfare scholarship is riddled with bias in favor of "child saving" interventions, something discussed in detail in this previous post to the Blog.

Now, don't get me wrong. I can't wait for the field to be fully ready for evidence-based evaluation, and for funders to act on the results. We already know that, when that day comes the government will cut off all funding for residential treatment centers (RTCs) and parking place "shelters," the CASA program will disappear, and there will be vastly less foster care, since none of these programs has real evidence of success, and they've all got significant evidence of failure.

But that's the whole problem with the debate over evidence-based funding. What evidence-based really means is: If you want to challenge the child welfare status-quo you'd better be able to dot every i and cross every t on a huge pile of randomized controlled trials. If, on the other hand, you just want to conduct business as usual and shovel children into substitute care – no evidence is required.

Or, to put it another way, the findings from the RCTs are no match for the clout of the RTCs.

LATER THIS WEEK: Does Chapin Hall want YOU (investigated for child abuse)?

Tuesday, July 6, 2010

Foster care in Texas: The solution to the problem of hellholes is NOT more hellholes

If news accounts of a public hearing before Texas lawmakers last week are to be believed, this month's "What was she thinking???" award should go to Anne Heiligenstein, Commissioner of the Texas Department of Family and Protective Services.

The hearing was all part of a ritual that unfolds every few years in Texas. It starts, one imagines, with an editor at some big Texas newspaper saying: "Hey, nobody's done the series exposing abuses at Texas Residential Treatment Centers for awhile – is it our turn?" Or, if the newspapers miss a turn, a politician will do it.

So in 2002 it was the Dallas Morning News, in 2004 it was the former Texas State Comptroller, and this year it was the Houston Chronicle and an online news site.

Of course, the ritual is not complete without legislators declaring themselves shocked and outraged by the same things that shocked and outraged them in previous years, and holding a hearing.

Heiligenstein's testimony started out well enough. She focused on the fact that many Texas children are sent to RTCs far from home. It does indeed compound the trauma of substitute care to send a child to the other end of a very large state – separating the child from siblings – and everyone else loving and familiar – and making it hard for parents to visit. This is doubly true when what they get at the other end of the state is a form of "care" that is a grade-A certified failure: Residential Treatment.

But the solution to this is not to build a whole bunch of brand new failed institutions closer to where children live. And the solution is not giving the people running these failed institutions a rate increase, because paying them $96 to $374-per-day-per-child to leave them no better, and sometimes worse, somehow just isn't enough.

Yet these are among the things Commissioner Heiligenstein says she wants to do.

Is Heiligenstein waiting for a third review of the scholarly literature before she believes residential treatment is a failure – were the first two not enough? Does she need more than one former head of the Child Welfare League of America, the giant trade association that includes many RTCs, to admit that they can't "show success"? (Details and citations are available here).

At least 80 percent of the children now warehoused in Texas RTCs almost certainly could be cared for in their own homes and foster homes – provided even a fraction of the money wasted on the RTCs was spent instead on Wraparound programs, which bring whatever those families need to help the children right into the home.

And yes, it does work on the children RTCs love to describe, falsely, as unable to cope with living in a home. For a great example, listen to the "father of Wraparound," Karl Dennis, describe such a case on a video available in a link from this previous post.

Heiligenstein did have at least one genuinely good idea. She proposed changing a system in Texas that also exists in many other states, in which the sicker the child the more a caregiver gets paid. She points out that this gives caregivers no financial incentive to help children get better. Actually, it's worse than that. It means there is an incentive to pretend children are worse than they are – and that can contribute to the misuse and overuse of psychiatric medications.

But if Heiligenstein mentioned the even bigger financial incentive problem – paying RTCs for every day they hold the child in their "care," it was not mentioned in news accounts.

Almost as bad as what Heiligenstein doesn't seem to know is the hypocrisy of the legislators. This time, it seems, they acted shocked – shocked! - that children sometimes are abused at RTCs. They say they're furious that they had to learn about the latest examples from news organizations.

And why, exactly did this upset them so? Surely not because they'd actually respond this time in some way more useful than their response to the last expose, or the one before that. So I have to assume the outrage has something to do with their feeling they missed out on a chance to issue a press release.