Sunday, December 20, 2015

Child welfare in Arkansas: The Legislature is not helping

Last of three parts

If little John or Jane from Little Rock isn't in class today,
a child abuse investigator may be at the door tomorrow.
The previous two posts about Arkansas child welfare deal with the failures of Gov. Asa Hutchinson and the State Division of Children and Family Services.  But while the governor has been leading the state backwards, the legislature has been no help.

Consider the issue of “educational neglect.”  This is how we began a blog post on thisissue in 2010:

Late [in 2009] the highly-regarded Vera Institute of Justice, based in New York, issued a report  on one of the seedier back alleys of child welfare: "Educational Neglect." The majority of states, wisely, don't even include such cases in the mandate of their child welfare agencies. Unfortunately, New York, is not one of them. There, educational neglect reports serve one primary function: They're a lever schools can use to force parents to do what they want – like, for instance, not demand too much in the way of special education for their kids, or not complain about school safety.
Here are some highlights from the Vera Institute study, which focused on New York State but applies to any state that still lets CPS investigate "educational neglect":
● Overwhelmingly, these are low-risk cases, and it's idiotic to waste the time of child protective services dealing with them. (While that may be obvious, they've got an actual case reading, from Orange County, to prove it.) In addition to wasting the time of CPS workers, sending a CPS worker to the door only makes the family defensive and makes it harder to solve whatever problem may be causing absenteeism.
● The notion that educational neglect is the "tip of the iceberg," a sign of some other, deeper problem, (the primary excuse for CPS investigating such cases), is nonsense. Generally, "educational neglect" is the tip of nothing except some kind of school problem, often one that is not the parent's fault.

So guess what the Arkansas Legislature did this year: It passed a law expanding the jurisdiction of the state Division of Children and Family Services to include educational neglect.  The rationale: Exactly the “tip of the iceberg” assumptions that the Vera Institute study found were wrong.

This is a bad idea in any state.  It’s even dumber in Arkansas, where one of the key problems identified in a report from child welfare expert Paul Vincent (a report commissioned by the state itself) is impossibly high caseloads.

The other issue concerns cases where DCFS does not remove the child, but demands that the family meet certain conditions to keep the child in the home.  In most states, these “safety plans” are used in low-risk cases, and are agreed to by the agency and the family.

The Arkansas Legislature has decided, however, that in Arkansas, every single one of these plans is going to have to be accompanied by a formal charge of abuse or neglect and approved by the court.

According to Vincent’s report:

Regardless of the merits of the Act, it will undoubtedly increase the DCFS workload, including administrative tasks and time in court. It is also likely to increase the number of children placed in foster care.

But there’s more – and it says a lot about the mindset both of DCFS and some in the court system, Vincent writes: 
It is likely that this bill was introduced because of doubts on the part of some stakeholders that DCFS could assure child safety without court oversight. Some legal stakeholders criticized a DCFS practice which they called coercive placements, meaning that DCFS would threaten removal unless the caregiver placed the child with another family member, for example, … 
OK, let me interrupt here.  When I first read this, I thought: Good.  The courts have discovered that DCFS is unfairly strong-arming parents into placing the child into what is foster care in all but name.  This also raises questions about how many times DCFS does this but doesn’t officially report the placement as an entry into foster care, something discussed on this blog here.  So it’s possible the real rate of removal in Arkansas is much higher than the official figures reported to the federal government.

But now, let me allow Vincent to finish his thought (I've put the portion I left out above in bold): 
Some legal stakeholders criticized a DCFS practice which they called coercive placements, meaning that DCFS would threaten removal unless the caregiver placed the child with another family member, for example, without properly reviewing the alternative caregiver’s suitability or petitioning the court.
In other words, these “legal stakeholders” were just fine with DCFS strong-arming the parents – but, in keeping with the profound bias against kinship care that permeates the state, they just didn’t like where the child went after the parents were strong-armed.

Saturday, December 19, 2015

Donald Trump and the child savers: It's not a band, but they sing the same song

Photo by Gage Skidmore

This post originally appeared at the Chronicle of Social Change

Last month, author and political commentator Jeff Greenfield wrote an essay for Politico on the politics of fear – and how Donald Trump exploits it.  He wrote:

History teaches us lessons of what can happen when genuine public fears are co-opted by the demagogues, fear-mongers and over-reactors. There was a reason to fear crime in the 1960s and 1970s, because violent crime in America was increasing by leaps and bounds, but that didn’t mean the only response [had to be] four decades of over-incarceration, driven by politicians’ fears of looking soft on crime. There was a reason to fear a Soviet espionage network looking for military secrets during a Cold War waged in the shadow of countless nuclear weapons, but that didn’t require McCarthyism as a response.There was a reason to fear where Al Qaeda might strike next after 19 men with box cutters killed 3,000 people in the heart of two great cities, but that didn’t mean we had to invade Iraq.

Let me add one to Greenfield’s list: There is a reason to fear that a small number of parents are brutally abusive and will do terrible things to innocent children if they are not stopped.  But that doesn’t mean we needed to create a system that puts millions of children through frightening investigations every year, and casts thousands of them into a chaotic system of foster care, traumatizing some of them for life. 

Yet that’s what we’ve done. Some of the same people who probably are horrified by Donald Trump seem to have no problem using his tactics in the fight against child abuse.

Case in point: Suppose someone tried to set up a role-playing exercise concerning international relations. But every Muslim character was a terrorist and they all said things like “death to America” and “kill the infidels.”  The furor at this blatant bigotry would be enormous.

Yet a column in the Chronicle of Social Changrecently sang the praises of a role-playing exercise about foster care in an article that begins with the script for those taking the role of birth parent:

The birth parent leans in and whispers horrific things to her child.“I don’t want you.”“I can’t protect you.”“Don’t tell anyone our family secret.”

Everyone playing a birth parent is instructed to “choose an addiction” – since, of course, every parent who loses a child to foster care must be an addict. 

In fact, the problem of drug abuse, like the problem of child abuse, is serious and real. But both also have been subjected to enormous hype, and inflated figures.

Where in this role-playing exercise are the birth parents who lost their children because their poverty was confused with neglect? Where are the mothers who were beaten by their husbands and then had their children taken away because they “allowed” the children to “witness domestic violence”?   And where are the ones who lost their children because of a false positive drug test, or whose “drug problem” consists of smoking marijuana?

This same role-playing exercise features only “enlightened foster parents.”  There are many of these.  But since multiple studies have found abuse in one-quarter to one-third of foster homes, they can’t all be enlightened.

And where are the caseworkers who immediately jump to conclusions about families because they are poor, and especially if they are poor and African-American?  has shown that to be a common problem.

Yet this exercise in stigma and stereotyping not only isn’t condemned, it is honored. The guy who came up with it, David White, won and “Angels in Adoption” award.

Donald Trump would be proud.

Or suppose Donald Trump were asked which states were doing the best job at solving a social problem. Suppose he replied that it’s complicated, “but I will tell you the states that do the best overall are the ones that have smaller, whiter populations” [emphasis added].

Even Trump never actually said that - but Michael Petit did, when asked which states are best at preventing child abuse. He’s the founder of the group that calls itself Every Child Matters, and he said it at a Congressional hearing. 

And then there is this, from a former social worker for the Washington, D.C. child welfare agency. She laments the fact that a judge would not let foster parents adopt a child, and instead awarded custody to

The 19-year-old father, jobless and a high school dropout. … He had not abused or neglected Davon. Nevertheless, it was clear that Davon would do better with his foster parents. 

In other words, why do we need actual maltreatment to take away a child forever? And why help a birth father with employment and child-rearing?  Let’s have a society in which mostly white, middle-class caseworkers descend upon impoverished communities and take black children from parents because they would be “better off” elsewhere! 

Perhaps she should send the idea to the Trump campaign. I’m sure they’d love it.

None of this is new. In the 19th Century, Protestant Minister Charles Loring Brace snatched away the children of poor Catholic immigrants whose parents he deemed genetically inferior and threw them onto “orphan trains” even though many were not orphans.  Brace knew how to whip up a crowd with scare stories. 

Other child savers, as they proudly called themselves, hid their agenda of fear and loathing of the immigrant poor – and their efforts to confiscate their children -- behind horror stories of brutally beaten children, complete with “before” and “after” pictures for the media.

They, and their latter-day counterparts, could be Donald Trump’s role models.

If there is a difference between Donald Trump and today’s child savers it is this: The child savers mean well.  They want to help children and they really believe their “solutions” will work. 

But Greenfield wrote something else in his Politico column on the politics of fear:

The dilemma, of course, is that in every one of these examples, the lunge toward useless, or foolish, or dangerous, or deplorable responses seems almost built into the political system.

In child welfare, we have a system that subjects millions to needless investigations, traumatizes thousands with needless foster care – and still overlooks children in real danger.

Useless, foolish, dangerous and deplorable seems like a pretty good description of that system. If we’re ever going to change that, America’s latter-day child savers need to stop playing the Trump card.

More about the impact of Trump-style paranoia, and the implications for child welfare, in this post. 

Thursday, December 17, 2015

Child welfare in Arkansas: Asa Hutchinson and the faith-BIASED orphanage

Second of three parts

The previous post to this blog described how Arkansas Gov. Asa Hutchinson commissioned a good report about the failings of child welfare in Arkansas – and then proceeded to ignore one of its most important recommendations.  The report, issued in July, found that Arkansas could go a long way toward ending a “shortage” of placements if it would just end the bias against kinship care – foster care provided by grandparents and other relatives.  Indeed, Arkansas makes far less use of this option than neighboring states.

In contrast, Arkansas badly overuses the worst form of care – group homes and institutions, in other words, latter-day orphanages.  The child welfare euphemism is “congregate care.” As the report notes:  “There is considerable evidence that children do better in family-based settings than congregate settings.”

That is an understatement.  It takes three single-spaced pages just to list the citations for some of the studies showing the harm of congregate care.  In addition, no matter how well-meaning the founders may be, orphanages have an unnerving tendency to go bad.  Orphanages are institutions for the poor, and institutions for the poor almost always are poor institutions.

None of the standard excuses for these places stands up to scrutiny.  They do not make children’s lives more stable, they do not help siblings, and often, they doom children to languish in substitute care.

Vincent’s report goes on to suggest that Arkansas adopt a series of guiding principles for its child welfare system including:

Placements should be made in the least restrictive, most normalized setting responsive to the child’s needs. Children should not be placed in congregate settings unless that environment is the only setting in which needed services can be provided [emphasis in original].

Five months later, the governor issued a statement touting “progress” in fixing foster care.  The statement said not a word about increasing kinship care.  Instead it touted the opening of new orphanages.  He even released the statement at a dedication ceremony for one of them, a place called Maggie House.

One thing you can say about Maggie House – it doesn’t try to hide its true nature.

Most of the time, modern orphanages try to do just that.  “How can you call us an institution?” the people who run them say.  “We have ‘cottages’ and beautiful grounds.  
But no matter what it may look like, a building that houses large numbers of children, most of them strangers to each other, to be cared for by paid staff hired to dispense indiscriminate pseudo-love to whoever walks in the door – staff that, at best, are  likely to change every year or two - is not a home. It's a dormitory. And a collection of dormitories is an orphanage.

Children are not fooled by pretty grounds and immaculate “cottages.” They know the difference between “homelike” and home. An orphanage is an orphanage is an orphanage. The new ones just come complete with Potemkin Village façades.

At Maggie House, it looks like they’ve pretty well dispensed with the façade.  It’s one building, a former nursing home.  The “cottages” are just different parts of the same building.  Have a look around.  Why place children with grandma when they can be at a place like this, right?

Also, although Maggie House is run by a group calling itself Free Will Baptist Ministries, exercising free will may be difficult for those residents whose religious beliefs don’t precisely match those of the people who run the place.  On their website, before they say almost anything else, the people running Maggie House say this: 
At Family Ministries’ Maggie House, we strive to create a Christian family atmosphere. In addition, we will teach the Word of God as the rule of life. Every child is given the opportunity to accept Christ as their personal Savior. Given the circumstances of many of these children, it is of upmost importance that we share the love of Christ with them. We find that most of them have never been taken to church, owned their own Bible, or had the opportunity to learn about Christ.  
That sounds more faith biased than faith-based.

One can only imagine how the governor would respond if a local mosque decided to build an orphanage for foster children because “we find that most of them have never been taken to a mosque, owned their own Quran, or had the opportunity to learn about Allah.” 

What happens to an LGBT youth placed at Maggie House? 

What about a teenager who wants access to contraception?

But the most important question remains: Why does Arkansas keep opening new institutions of any kind to warehouse children, instead of concentrating on keeping children out of the system and, when children must be taken, placing more of them with  relatives?

In part three: How the Arkansas Legislature made things worse

Wednesday, December 16, 2015

Child welfare and terrorism: Lessons from the paranoia in Los Angeles

                                                                                     Photo by John Picken
Over at the Chronicle of Social Change, I have a blog post called “Donald Trump and the Child Savers: Not a Band But They Sing the Same Song.”  It’s about how people in child welfare, many of whom abhor Trump, use his tactics to whip up hysteria over child abuse and scare us into supporting policies that lead to the widespread, needless removal of children from their homes.  This does terrible harm to the children needlessly taken.  It also steals time and resources from finding children in real danger.

Anyone who lives in a poor neighborhood knows this, of course.  The threat that Child Protective Services (CPS) will confuse family poverty with neglect is a constant, nagging fear.  It dates all the way back to the 19th Century when Societies for the Prevention of Cruelty to Children – who disguised an agenda of hatred and fear for the immigrant poor with lofty rhetoric about saving the children – were known in poor neighborhoods simply as “The Cruelty.”

Yesterday, the rest of America got a small taste of how much disruption can be caused when we give in to the Trump-style paranoia that has long dominated the child welfare system.  It happened in Los Angeles, when one crude hoax email led to the shutdown of the entire Los Angeles Unified School District – the nation’s second largest.  The only system that’s bigger, the one in New York City, got a nearly identical email.  They knew a hoax when they saw one, and decided not to overreact.

By the time Los Angeles officials made their decision, many students were on their way to school, or already there.  According to The New York Times:

The decision [In Los Angeles] threw the lives of millions of people — students, parents, teachers — into disarray and sent a wave of concern across an already tense region. “If they sent an alert, I never received it,” said Christine Clarke, who showed up at Hollywood High School looking frantically for her son after hearing the news on the radio. Parents scrambled for last-minute day care or called in sick at work, …

And that may be the least of it.  Police inspected more than 1,500 school sites before the search finally was called off.  How much real crime was missed while all those police officers were chasing down a hoax?

It could have been even worse.  How many very young children could have been left unsupervised, or gotten lost, in the chaos as parents tried to change plans and find them?  In short, the response to the hoax caused more danger to the children than the hoax.

The mentality on display in Los Angeles is the mentality that pervades child welfare.  It’s why caseworkers barge into the lives of more than three million children every year, sometimes based on little more than an anonymous call to a child protective hotline – and 80 percent of the reports are falseAs caseworkers spin their wheels on false reports and trivial cases, children in real danger are overlooked.

The mentality of those defending the response in Los Angeles is strikingly like the mentality that dominates child welfare.  Again from the Times:

[Rep. Brad] Sherman said elements of the message did not appear credible, including the number of potential attackers and the claim that they had access to nerve gas. ([New York City Police Commissioner William] Bratton … suggested that the writer might have been inspired by recent episodes of “Homeland,” with its plotline of a sarin gas attack on Berlin.) The message was signed by a male Arabic-appearing name, Mr. Sherman said, but added: “The word ‘Allah’ appears several times in the email, but once it’s not capitalized. A devout Muslim or an extremist Muslim would probably be more careful about typing the world Allah.”
But then Sherman says:
The author appeared knowledgeable about the structure of the Los Angeles Unified School District, referring to the system by its full name, which added to the concern, Mr. Sherman said. “Just because parts of the email are false doesn’t mean it’s all false,” he said [emphasis added].
Classic.  I’m reminded of the CPS caseworker who told me that even if someone is harassing a family with false reports, workers should keep right on going out and investigating the family time after time after time because of “the cry wolf example.”
There’s still another parallel.  Some have said, in effect, of course New York and Los Angeles responded differently – L.A. is near San Bernardino.  (Whereas New York, of course, has had no experience with terrorism.)
In child welfare, agencies are more likely to take the child and run if a high profile child abuse death is in theheadlines.
Or maybe it’s partly cultural.  Even when rates of child poverty are factored in, Los Angeles County takes away children at more than double the rate of New York City.  There is no evidence that Los Angeles children are twice as safe as their New York City counterparts.
There is one difference though.  When CPS agencies behave this way the stakes are a lot higher.  A child abuse investigation is not a benign act.  Having a stranger come to the door – or your school – pull you aside and ask questions about the most intimate aspects of your life can be an enormously traumatic experience for a child; and the younger the child the greater the trauma.  It can leave lifelong emotional scars.
Even worse, when the allegation is physical abuse – and, sometimes, even when it’s not - the investigation often is accompanied by a stripsearch by a caseworker or a doctor looking for bruises.  If anyone else did that it would be sexual abuse.  And if the allegation is sexual abuse, the medical exam can be a lot more traumatic.
Indeed, try to imagine the terror for a young child, suddenly taken from family by strangers, often including police.  She goes to a strange hospital, where doctors and nurses she’s never met before perform the most intimate possible examination.

All this is before we even reach the harm of panicky caseworkers using flimsy allegations to throw children needlessly into foster care.

Some will read this and say: But what if there really had been a terrorist attack and the school officials had ignored the warning?

Well, everyone involved would have been fired, we know that.  In contrast, no one will be held accountable for the chaos caused by the overreaction – once again, the parallel to child welfare is perfect.

But we also should know this: Life comes with risk.  Every time we get into a car we run the risk that a drunk driver is heading toward us in the next lane.  Every time we go for a swim we risk drowning.  But trying to take every last bit of risk out of our lives not only debilitates our psyches – it also, paradoxically, puts us all at more risk. 

Tuesday, December 15, 2015

NCCPR op-ed at A new epidemic of hype won’t help ‘drug-dependent’ infants

Every few years we are told about a new “drug plague” in which the drug use of pregnant women supposedly dooms their children – unless, of course, we take the children away. The media said it about crack, and they were wrong. They said it about methamphetamines and they were wrong. Now there’s a new epidemic of hype around pregnant women who use drugs both legal and illegal, from heroin to prescription painkillers. Those stories are wrong, too. ...

Whenever we try to take a swing at “bad mothers” the blow lands on the children. We know there are better answers — and if we really care about the children, we’ll turn to those answers instead. 

Read the full column on the Reuters opinion page here.

Sunday, December 13, 2015

Child welfare in Arkansas: Full-speed backwards

First of three parts

Give Arkansas Gov. Asa Hutchinson credit for this much: When he called in a consultant to examine the dismal condition of child welfare in his state, he chose well: He chose the Child Welfare Policy and Practice Group, headed by Paul Vincent, who led the transformation of the child welfare system in Alabama into, relatively speaking, a national model.

Arkansas Gov.
Asa Hutshinson
In a report about Arkansas issued in July, Vincent found a system so short of places to put children that some were sleeping in offices or moving to a different placement every night. 

Among the key reasons: A deep-seated hostility to kinship care – placing children with relatives instead of strangers.

Read all about that hostility, and what it does to children in this excellent story from Arkansas Times - including a case in which one relative after another was turned down, and the children wound up placed in the care of a stranger who adopted them - and abused them.

Only 14 percent of Arkansas children are placed with relatives.  The average for surrounding states is nearly double – 25 percent.  Many other states that do better still.  If Arkansas simply performed as well on kinship care as its neighbors, a large part of the “shortage” of placements would be over.  In contrast, Arkansas has the worst record among these states for using the worst form of care – group homes and institutions – latter-day orphanages.

(Of course, it also would help if Arkansas reduced its rate of child removal to the rate of, say Alabama.  As of 2014, the rate of removal in Arkansas was nearly 80 percent higher than Alabama and there are indications the gap may have widened since then.)

Consultants try to use gentle language when writing about the agencies that hire them, but it’s clear from Vincent’s report that there is a strong bias against grandparents in the state Division of Child and Family Services and the courts.

Study after study has shown kinship care to be more humane, more stable and, most important, safer than what should properly be called “stranger care” – see this report, and this one.  Nevertheless, Vincent found

DCFS  staff and stakeholders identified a number of factors limiting the use of relatives. Attitudes toward the suitability of relatives as caregivers on the part of some staff, judges and other legal partners were frequently mentioned as a barrier. This negative view seems to be most prominent among those who view some extended families as sharing a common lack of caregiving capacities.

And now we learn that not only does this bias remain, it goes all the way to the top.

At a legislative hearing this month, grandparents spoke of stepping forward to try to take in their grandchildren, only to be stymied at every turn by DCFS.  The agency director, Cecile Blucker responded first with stonewalling, then with bigotry.

Blucker said the situation is complicated. By law, she said she could not comment on the people who made their cases to lawmakers or comment on any specific case.  "Only one side of the story can be told and only one side of the facts can be told," she told lawmakers.

If such a law exists in Arkansas, it almost certainly exists only because DCFS wants it, so the agency can hide its blunders behind “confidentiality.”  If you really feel hamstrung, Ms. Blucker, ask the legislature to repeal any such law.

If she means the federal government would object if she told the agency’s side of the story, then she needs to explain how it is that at least four states have laws specifically allowing their own child welfare agencies to comment on cases when they have been disclosed by another party – and none has been sanctioned.

But then it got worse.  Again, according to the story:

Generally speaking, [Blucker] said, grandparents can be complicit when they see abuse and sometimes cannot adequately keep their grandchildren safe from the grandchildren's parents.

In other words, “the apple doesn’t fall far from the tree.” That is precisely the claim that’s been debunked by all those studies.  Or, as one of the nation’s leading experts on kinship care, Prof. Mark Testa of the University of North Carolina, put it: “Fortunately, trees have many branches.”

In poor communities all over America there are parents who have waged a battle for decades to save  their  children   from poverty, despair, and the lure of the streets.  They have been forced to call upon reservoirs of strength that most of us can only imagine. Is the mother who won the battle with three children and lost it with a fourth to be denigrated and discarded when she comes forward to take in that fourth child’s children?  Cecile Blucker seems to think so.

And the bias may go even higher.  In a statement released Dec. 1, touting “progress” in fixing foster care, Gov. Hutchinson said not one word about boosting kinship care.

Even worse: He made his remarks at the dedication of a brand new orphanage.

More on that in the next post about Arkansas.

Monday, December 7, 2015

NCCPR op-ed in Youth Today: Attention Child Savers: Your Double Standards Are Showing

They’re following the script to the letter in Minnesota.

Act 1: A newspaper reports on the horrifying death of a child “known-to-the-system.”
Act 2: The ritual sacrifice of the agency chief.
Act 3: The naming of the OBRC — Obligatory Blue-Ribbon Commission.
Act 4: The invocation of the swinging pendulum. The OBRC declares that “Minnesota’s child protection system has moved from one end of the spectrum to the other since 1999,” and now supposedly puts too much emphasis on family preservation.
The report is seized upon by those who want to tear apart more families — those whose 19th-century counterparts proudly called themselves “child savers” — as part of an ongoing effort to discredit one of the few large-scale efforts to avoid needless foster care: differential response.
There’s just one problem. The pendulum never actually swung.

Read the full post in Youth Today

Friday, December 4, 2015

Child welfare in California: A fix that recognizes “The GEICO principle"

Second of two parts

The previous post to this blog discussed an outstanding series of stories by Karen de Sa of the Bay Area News Group concerning the needless drugging of foster children, particularly those consigned to group homes and institutions.

There is a predictable pattern to what follows this kind of journalism – a response that isn’t nearly as good as the reporting.  There are declarations of outrage from politicians, public hearings and/or creation of an OBRC (Obligatory Blue-Ribbon Commission), and then some sort of legislation.

Sometimes, the legislation actually makes things worse – that’s usually what happens when the topic is child abuse deaths, for example, or in cases like the Jerry Sandusky sex abuse scandal at Penn State.  When it’s a topic such as children harmed in substitute care, the responses generally don’t do harm, but they don’t usually do much good either.  Typically they involve adding an extra layer of “review” and an extra form to fill out.

In fact, California tried that the last time the doping up of foster children in group homes and institutions was exposed – by the Los Angeles Times in 1998.  The next year the state enacted a law requiring juvenile courts to approve the prescriptions, with reviews every six months

But as the presiding judge of the Los Angeles Juvenile Court until last year, Michael Nash, told de Sa, that didn’t work too well:

A juvenile court authorizes each prescription, but the forms the courts use often lack critical details and a doctor’s expertise is rarely questioned. Nash, the Los Angeles judge, acknowledges the resulting challenges — even in Los Angeles, where mental health experts now review all applications for prescriptions and in 2013 officials created protocols to curb prescribing of multiple psych meds.
“The last time I looked around, there aren’t too many psychiatrists or psychologists on the bench,” the judge said. “So how in the heck are we able to make good decisions about these meds?”

This time around, it’s not clear if a lot of the solutions will be much better – indeed, the original proposals were weakened after lobbying by the group home industry and groups representing doctors.   

So it’s no wonder that Nash, for one, is cautious, telling de Sa:

"These bills are a step in the right direction for foster children in California who are being administered psych meds," he wrote in an email. "However, they are not a panacea and do not relieve anyone who is involved with foster children from giving them any less attention than they would give their own children."

But there is one exception. The exception actually is part of a plan unrelated to the other bills.  Indeed, it had been in development even before the news stories.

It should come as a shock to no one that the speed with which a caregiver will rush to demand that a child be medicated is inversely related to the extent that the caregiver gives a damn about that child.  So the rate of drugging in group homes and institutions in California is more than double the rate in foster homes.  In Florida, where the former leadership of the Department of Children and Families made it a mission to curb drugging foster kids, they broke down the data further and found that when children were placed in kinship foster homes with grandparents and other relatives, they were far less likely to be drugged than when they were placed with strangers – even when the strangers were foster parents.  (And, as in California, the rate of drugging was highest in group homes and institutions.)

As I’ve said before on this blog It's not hard to figure out why: Grandparents and other relatives are more likely to love these children, and so will tolerate more difficult behavior before demanding a prescription. That's just one indication that the best solution to the misuse and overuse of meds on foster children is not a new law – it's grandma; or, better yet, keeping more children out of the system in the first place.

Of course the group home industry has a different take.  They blame the kids.  By the time they get to us, they claim, the children are simply so troubled we have no choice but to drug them and drug them and then drug them some more.

But de Sa’s series shows that there are better options for these children.  See especially part four, in which she tells the story of a doctor at one institution who found that the kids didn’t need all those meds.  And check out the video below, in which Karl Dennis, who founded the nation’s first Wraparound program describes exactly the kind of youth the group home industry would write off as hopeless, and how Wraparound got him safely back home – without meds:

So, what is the plan California has to deal with this – the one that just might work?

A new law, set to take effect in January, is supposed to drastically curb the number of children put into group homes, and set strict limits on how long they stay.  In theory, most children won’t be allowed to stay more than six months, and, supposedly, the standards for the new institutions will be so high that many existing group homes will have to close.  The very name group home will be abandoned, to be replaced by a new category, “Short Term Residential Treatment Center” (STRTC).

The sponsor of the new law, Assemblyman Mark Stone told de Sa:

One of the biggest impacts that we're going to have on reducing the use of psychotropic drugs is getting kids out of group homes," said Stone. "Put a kid in a family, and that family is much, much less likely to resort to chemical restraints. It gets kids into situations where there is a commitment to their future."

In other words, Stone is applying what might be called the GEICO principle. To paraphrase the insurance company’s commercials: When you’re a group home you dope up the kids to keep 'em docile.  It’s what you do.

So the best way to stop overmedicating all those kids is to keep them out of group homes in the first place. 

But there are some problems with this plan.

For starters, the plan depends heavily on increasing the supply of foster parents – instead of taking the better approach: working to reduce the demand for foster parents, by doing much more to keep children out of foster care in the first place.  Get the children who don’t need to be in any form of foster care back into their own homes, and there will be plenty of good, safe family foster homes for the children now warehoused in group homes and institutions.

California has made real progress in reducing entries into care in recent years.  But Los Angeles County, for example, which has about one-third of the state’s foster care population takes away children at more than double the rate of New York City and more than triple the rate of metropolitan Chicago.

In addition, the bill seems to rely heavily on “accreditation” to ensure that the newly renamed STRTCs will do a decent job.  But in child welfare, accreditation is a sham.

But at least this law recognizes that you won’t solve the drugging-in-group-homes problem until you solve the group homes problem.  The law suggests some recognition of the fact that, in the overwhelming majority of cases, when you’re a family, you love your children.

It’s what you do.

Thursday, December 3, 2015

Child welfare in California: The state finally may bring the group home industry under control

That’s largely because of some great journalism from the Bay Area News Group

First of two parts

About 20 years ago, the staff at a California residential treatment center then known as EMQ Children and Family Services had a crisis of conscience or, as the trade journal Youth Today put it “a collective epiphany.”

They were caring for 130 emotionally disturbed or mentally ill children in their residential treatment facilities in San Jose and its suburbs, at a cost of about $90,000 a year for each child. These children often arrived at EMQ angry, depressed, suicidal or combative. When they left 18 months later, some were even worse.
“We kept saying, ‘There’s got to be a better way to deal with these high-end kids,’” recalls [then-CEO Jerry] Doyle.
They found that better way – providing Wraparound services to children and families in their own homes or foster homes.  The agency is now called EMQ Families First.
But they faced one huge obstacle along the way, what Doyle called California’s “group home industry” - which fought efforts to have California fund Wraparound.
Though EMQ succeeded, it remains an exception, and the group home industry remains powerful.  But now, at last, the state may be about to bring that industry under control.  Legislation that takes effect in January is intended to drastically curb the use of group homes and congregate care.
For that, Californians can thank a very good reporter and an astute legislator.
The reporter is Karen de Sa of the Bay Area News Group and its flagship paper, the San Jose Mercury News.
Last year, she wrote both a newspaper series and a video documentary called Drugging our Kidsabout the misuse and overuse of psychiatric medication on foster children.
Others have done good work on this topic (follow the links in this post for examples), but no other series I’ve seen has marshalled data, told the human stories, and tied it all together so well.
It’s hard to single out any one part as most importantThere’s the overview, which found that nearly a quarter of California foster children age 12 and over are on psychiatric medicines – and in group homes it’s more than 50 percent.  The series makes clear that a lot of the drugging has nothing to do with helping the kids, it’s just an easy way to keep them docile and easy to control.
Part three documents the wining and dining of doctors who prescribe psychiatric medications (along with assorted other payments) – with what appears to be a special effort to target doctors who treat foster children.  The doctors insist this has absolutely no influence on them.  So apparently America’s drug companies are the world’s dumbest marketers, since they’re wasting a huge amount of money on efforts that have absolutely no effect.
But perhaps most compelling is part four, called Finding Yolanda
Yolanda Vasquez’s mother was homeless and mentally ill.  The story says nothing about the mother abusing Yolanda.  That, of course, raises the question of whether she ever needed to be taken away at all.  Once taken, the moves didn’t stop.  She was moved 50 times before she was 13.
Chemical torture would not be too strong a term for what Yolanda endured after the state became her parent and made her take ten pills a day.  de Sa writes:
After a decade in California foster care, Yolanda had become so medicated with psychiatric drugs, she practically lost the ability to speak.
“I would cry day and night, beat myself up,” she said, looking back, “and all I wanted was somebody to listen and understand and hear what I had to say.” …
Yolanda often expresses herself in metaphors. She described adults medicating her to control her, like a remote-control car. On the drugs she felt like a caged bird, a lab rat, like she was in a box that someone wound tape around and around, trapping her inside. 
[Then], she said, “somebody found the scissors.”
That somebody was Dr. Edmund Levin, who became medical director for two of the “cottages” at an institution known as the Lincoln Child Center two months after Yolanda arrived.  Levin was no crusader.  But, de Sa writes:
The “magnitude and the exaggeration of the dosages” startled him, Levin recalled. “I was blown away by the apparent irrational use of medications.” One patient’s dose of sedatives was so high, the child was hallucinating, seeing “monstrous” spiders on the ceiling. … Levin concluded that the “institutional culture” at Lincoln “favored a quick and easy, and low-cost way of dealing with kids’ problems.”
But ultimately, he persuaded the staff to go along with an experiment: Slowly reduce the number and the dosage of the meds and find better ways to deal with children’s behavior problems. 

It worked.  The use of psychotropic medication dropped by 80 percent and ten of 16 children on whom it was tried were taken off the drugs entirely.  Yolanda was one of them.  She got her life back.

Levin published the results in a peer reviewed journal, de Sa reports:

“The overwhelming majority of children do no worse and most do considerably better entirely off or at doses of psychotropic medication significantly lower,” he wrote.
 But then we come to what I found to be the most disturbing revelation in the entire series – even worse, in some ways, than the statistics, the marketing and even the horrors the children endured.

It’s the response to this stunning success from Levin’s boss.
“It’s important to say that Ed Levin was a bit of an extremist,” said psychologist Lesleigh Franklin, who led the therapy team at Lincoln.
Franklin said while she admires Levin and his work on many levels — and concedes that some of the children benefited greatly — the tapering trials in his housing units at times went too far.

“Considering the children that we were treating, I don’t think what was being tried was appropriate,” she said. “There were kids at Lincoln that if they were not on meds, I don’t even want to think about what things would have been like.”

This is, of course, the standard party line from the group home industry:  Oh, we’d like to take them off meds, but the kids are just too damaged, there’s just no alternative. 
That’s bad enough when they refuse to even try an alternative.  But Franklin said this after the experiment was over, after it succeeded. 
This is a bit like saying “It is absolutely impossible to create a machine in which human beings can fly” – after watching the Wright Brothers’ first flight.
And of course it is only in the upside-down, inside-out, tops-turvy, down-the-rabbit-hole world of child welfare that the person who wants to get the kids off the meds is the “extremist.”
Whenever people who run group homes or institutions prattle on about how alternatives need to be “evidence-based” keep in mind how Franklin reacted when the evidence didn’t go her way.
That’s why stopping the torture of children like Yolanda – again, that’s my word, but read the series and see if you think it’s too strong – is going to require drastic measures.
Fortunately, California might be about to implement one such measure.

That story tomorrow.