Sunday, October 29, 2017

Yes, you CAN reduce foster care – even in Ohio

Two counties embrace family preservation, one by “[taking] to heart” NCCPR recommendations.

In 2006, NCCPR released a report on child welfare in Ohio, with a particular focus on Butler County, just north of Cincinnati.  Ohio is one of the states in which individual counties run child welfare agencies.

Last week, a story in the Dayton Daily News about deaths of children previously known to those agencies all the way back to 2009 included this:

After the 2006 death of Marcus Fiesel, a Middletown boy who was bound and left in a closet by his foster parents, Butler County was the subject of a scathing report by [NCCPR], which said the system is too quick to yank children out of troubled homes and place them in foster care, where they may not get the same level of supervision. 
Butler County took many of the report’s recommendations to heart and has seen success in the years since, according to Butler County Job and Family Services Director Bill Morrison. 
The county has achieved a 20 percent reduction in removals and did not have a child death from abuse or neglect post-reunification in the years examined by this newspaper.

Butler was not alone.  Montgomery County, which includes Dayton, reduced needless foster care by embracing “differential response” an approach found to be safe by 25 of the 26 studies to examine it.  Montgomery County had the same excellent results as Butler concerning fatalities.

 Learning from an earlier “drug plague”

What makes these results all the more notable is that they come from Ohio which is, we are told in one news story after another, the “epicenter” of the latest “drug plague” – the opioid epidemic.

So how did foster care go down in these counties when it is going up elsewhere in Ohio? 

Perhaps these counties learned from an earlier drug plague, “crack cocaine.”

University of Florida researchers studied two groups of children born with cocaine in their systems; one group was placed in foster care, another left with birth mothers able to care for them.  After six months, the babies were tested using all the usual measures of infant development: rolling over, sitting up, reaching out.  Typically, the children left with their birth mothers did better.  For the foster children, the separation from their mothers was more toxic than the cocaine.

Similarly, consider what The New York Times found when it looked at the best way to treat infants born with opioids in their systems. According to the Times

a growing body of evidence suggests that what these babies need is what has been taken away: a mother.  Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care.
“Mom is a powerful treatment,” said Dr. Matthew Grossman, a pediatric hospitalist at Yale-New Haven Children’s Hospital who has studied the care of opioid-dependent babies.
It is extremely difficult to take a swing at so-called “bad mothers” without the blow landing on their children. That doesn’t mean we can simply leave children with hopelessly addicted parents.  But it does mean that in most cases, drug treatment for the mother is a better option than foster care for the child. 

Butler and Montgomery Counties also seem to have done something else: They took a long, hard look at all the cases that did not involve drug abuse to see if those children really needed to be torn from everyone they know and love.

A caution about how results are measured

The results concerning fatalities do have to be looked at with caution.  Indeed, I have long argued that you can’t judge child safety simply by looking at fatality numbers. That is for a reason for which we all should be grateful.

Though each is among the worst imaginable tragedies, let us be grateful that the number of such tragedies is low enough to rise or fall due to random chance.  A child returned to his home in Montgomery County could die tomorrow. If that happens, you may be sure those wedded to a take-the-child-and-run approach to child welfare will rush to scapegoat differential response.

So it’s not changes in the number of fatalities that prove you can’t have child safety without family preservation.  It’s a much larger “evidence base”:

●The reason we know differential response is safe is not because no child returned to his own home has died in Montgomery County since 2009. It’s because of all those studies.

●The reason we know Intensive Family Preservation Services is safe and effective is because of all the studies that prove it.

●The reason we know that rebuilding systems to emphasize safe, proven approaches to keeping families together works is because independent court-appointed monitors have found that it works, as, for example, in Alabama. (A member of NCCPR’s volunteer board of directors brought the lawsuit that led to the Alabama reforms.)

●The reason we know lower rates of removal can improve child safety is because of places such as New York City. In New York, key safety indicators  - the rate at which children “known to the system” were reabused and the rate of foster-care recidivism (children returned from foster care who had to be placed again) - improved when the city reduced needless removals of children.

That’s why other Ohio counties should be learning from Butler and Montgomery. And that’s why take-the-child-and-run does not have to be child welfare’s knee-jerk response to every new problem, or even to every new drug plague.