Another baby killed in DC: another set of unanswered questions

On November 16, I wrote about Gabriel Eason, who was beaten to death around April 1, 2020 by one of the adults who was caring for him. Gabriel was not the first child to be killed by abuse in this awful year. Eleven-month-old Makenzie Anderson was brought to the hospital on February 6, 2020 already dead of physical abuse. Ten months later, her mother was charged with first degree murder in Makenzie’s death. We know even less about how Makenzie fell between the cracks than we do about Gabriel. We know that other residents of the hotel shelter where she lived were aware that the baby was in danger. But we don’t know whether they notified the Child and Family Services Agency (CFSA), which is responsible for investigating reports of child abuse and neglect, nor how the agency responded to any reports it may have received. CFSA and the Department of Human Services (DHS) refused to release any of this information based on confidentiality requirements–requirements which protect the agencies but deprive the public and its representatives of the information needed to protect children better in the future.

We learned about Makenzie’s death back in February 2020 from media reports, including a column from Petula Dvorak in the Washington Post, which discussed the stressful conditions at the Quality Inn as possible contributors to Makenzie’s death. Then there was a long silence as the pandemic descended and MPD built a case, culminating in the filing of charges against Makenzie’s mother on December 1, 2020. According to a police affidavit filed in court, Makenzie’s mother Tyra Anderson brought the baby to Children’s National Medical Center (CNMC) on February 6, claiming she had fallen off the bed on or about February 3 and began to have episodes of shaking. The baby was pronounced dead and the police were called. Anderson told police that Makenzie had fallen before, “sometimes striking her head” as the affidavit put it. Anderson stated that the day after her fall the side of Makenzie’s head was “soft like jello” and that she could no longer hold herself up or stand on her own. The day after that, the baby was gasping for breath, and a day later Anderson found her cold to the touch upon waking up in the morning. On none of these days did Anderson seek medical care for the child, telling the police that she was “scared.”

Anderson told the police that she had been diagnosed with anxiety and panic attacks and “possibly bipolar disorder, but later stated that she wasn’t sure about the bipolar diagnosis,” according to the affidavit. The officer noted that Anderson stated that she “took pills” that morning and “seemed fixated on getting her medications after [her child] was pronounced dead.” Anderson talked about Makenzie’s happy disposition and bright smile. But she also referred to Makenzie as “greedy and lazy.” When asked to explain, she stated “because that’s all she do is eat and sit around.” The police later spoke to Makenzie’s father. He stated that the 11-month-old had previous fallen from a bed on “three or four occasions” but he thought Anderson was a “good mother.”

Video footage from numerous cameras around the hotel showed Makenzie alive and alert most recently on February 1, although her mother and 20-month sibling appeared many times in the next few days. On February 3, Anderson is seen carrying Makenzie, whose head was hanging limply on her mother’s shoulder, to her father’s car along with the 20-month-old. On February 4, Anderson exited the vehicle with a limp baby on her shoulder, accompanied by the 20-month old. Later that day, a witness observed Makenzie in the hotel room sitting in a walker. She had a bump on her head and was leaning to one side, whimpering and shaking. She reported that Anderson kept pushing the baby back up, telling her to “lift her head up.” On February 5, footage shows Anderson and the 20-month-old in the cafeteria and on the way to the father’s car, but no sign of Makenzie. Later that day, images show Anderson carrying her limp body, completely covered in a pink blanket, to the father’s car before arriving at CNMC. Video from the hospital shows Anderson “calmly” walking into the main entrance of the hospital with the pink bundle. Desperate attempts to revive the baby were unsuccessful and she was pronounced dead by hospital staff.

At no time in the surveillance video from the hotel between February 1 and February 6 did Anderson appear to be distressed or frightened, according to the police affidavit. Police later learned that Anderson had not allowed housekeeping staff to enter or clean her room on February 5. A social worker who worked with Anderson told police that they spoke about her housing needs on the morning of February 6, but that she did not mention that her child was hurt or needed medical help.

An autopsy revealed that Makenzie had “multiple acute contusions to the face and head,” acute skull fractures, a laceration to the [tissue behind the upper lip], a laceration inside the left ear, pulmonary edema, and hemorrhaging in the bilateral optic nerve sleeve.” The Medical Examiner ruled the cause of death to be Blunt Force to the Head and the manner of death to be Homicide. The affidavit alleges that “the DEFENDANT intentionally inflicted the decedent’s injuries and/or failed to seek immediate medical treatment which created a grave risk of harm to [Makenzie], and which ultimately led to the decedent’s death.”

Three days after Makenzie’s death, her paternal grandmother went to court to request custody of her two siblings. At an emergency hearing, she testified that she had cared for the older child for her entire life and for the younger child for most of hers. She reported that Anderson was incarcerated in Alexandria, Virginia from April to November 2019, when she reclaimed her younger two children. So it appears that Anderson cared for Makenzie for only a fraction of her very short life. The judge granted sole legal custody to the paternal grandmother on the grounds that “the children are in danger from their mother who killed their 11-month old sibling on February 6, 2020.”

When a child dies of abuse or neglect, child advocates want to know whether the death was preventable. Were there opportunities for agencies to intervene? Only with this knowledge can one determine if and how the system failed and how to fix it. We know of one government agency that was involved with Makenzie’s family, and that was DHS. The family was staying at the Quality Inn, which at the time was serving as an “overflow shelter” for families for whom there was no room at the main family shelter at DC General–now closed as well. If DHS staff had been required to lay eyes on Makenzie daily, she might have been saved. But instead, as reported by Dvorak, the staff did “bed checks” at 10pm daily when Makenzie was quietly lying in her bed–dead or alive. Ironically, these bed checks were instituted to prevent future cases like that of Relisha Rudd, whose disappearance from the DC General shelter in the company of a janitor raised no alarms and who has never been found.

One question that needs an answer is whether the hotel shelter staff complied with their responsibility to report any suspicion that Anderson was abusing or neglecting her children. All staff members were mandatory reporters of child abuse and neglect and were trained at least once a year in that requirement, according to DHS. There were 25 staff members serving the 110 families who were living at the shelter as of January 15, according to DHS. This included licensed mental health professionals, case managers, and supervisors. Each family had a case manager that was required to meet with the family weekly.

It is hard to imagine that none of these staff members knew that Makenzie and her sister were in peril. In a December article, Petula Dvorak reported that other residents of the Quality Inn knew that Makenzie was in danger. Family members contacted MPD during its investigation with reports of the mother and father taking drugs like Ecstasy, PCP and Percocet together. We know that Makenzie’s father had been barred from the Quality Inn after a domestic incident with Anderson on January 15, 2020. This was not the first incidence of domestic violence between them. Court documents show that Tyra Anderson went to court three times in 2015 and 2016 to seek protection orders from Makenzie’s father, saying that he punched, kicked and tried to strangle her and also kicked in her front door and damaged her apartment. He also filed for protection against her once in 2015. Court documents also show that Anderson’s mother was raising an older son of hers, who was born in 2009. At the time Tyler was born, Anderson was a teenager and asked her mother to raise him. The grandmother testified in court that the father had been incarcerated during most of the child’s life and Anderson had been intermittently incarcerated and rarely visited her son. As mentioned above, Anderson was incarcerated again soon after Makenzie’s birth, with the three children going to their paternal grandmother this time, only to be reclaimed by their mother only two to three months before Makenzie’s death.

All of these facts suggest a troubled family, and one that definitely came to the attention of shelter staff due to the domestic violence that occurred only two to three weeks before Makenzie’s death. A DHS official told this writer that she was not allowed to disclose whether any staff made reports to the CFSA hotline about this family. Nor do we know if any family members or friends may have reported concerns about the family, since CFSA refused to comment as well. Without knowing if CFSA received any reports, we cannot know if the agency fulfilled its obligations to investigate and make accurate findings.

This is not acceptable. In Florida, an immediate investigation by a Critical Incident Rapid Response Team is required for any child death reported to the Department of Children and Families (DCF) if any child in the family was “the subject of a verified report of suspected abuse or neglect” during the previous year. The investigation must be initiated no longer than two days after the case is reported and a preliminary report must be submitted within a month. The team must undertake “a root-cause analysis that …attributes responsibility for both direct and latent causes for the death or other incident, including ….specific acts or omissions resulting from either error or a violation of procedures.” The team’s report must be made available on DCF’s website, with confidential information redacted. A similar law exists in the State of Washington, where the Children’s Administration (CA) conducts a review when the death or near-fatality of a child was suspected to be caused by child abuse or neglect, and the child had any history with CA in the year prior to death. These reports must be completed within 180 days of the fatality and must be posted on the Department’s website with confidential information redacted.

Ironically, this writer is one of the few people who will eventually find out whether DHS staff reported Makenzie’s mother to CFSA and how CFSA responded. That is because I serve on the District’s Infant Mortality Review Committee, which will be responsible for reviewing the case after Anderson’s trial is over. Unfortunately, I will not be allowed to share what I learn with anybody, even members of the legislature, without risking a $1,000 fine and expulsion from the committee, as I discussed in my post about the death of Gabriel Eason. So the public will never know the answer to these questions, unless the Council takes action to allow the disclosure of this type of information.

With our limited knowledge of how the system failed little Makenzie, there is only one recommendation (No. 1 below) that we can make about how to protect future Makenzies. Two other recommendations would ensure the release of sufficient information about child maltreatment fatalities to enable a fuller set of recommendations to be made. Here is what we recommend:

Homeless shelter staff should be required to set eyes on each resident child daily, or in the case of a child said to be staying temporarily with a friend or relative, verify that the child is alive and well.
When a child dies of abuse or neglect, any history with any government agency that should have been concerned with the safety of the child (such as the child welfare agency, the homeless services agency, and the youth services agency) should be made available to the public.
The DC Council should change the broad prohibition on sharing any information from a meeting to allow attendees to share any information that does not identify individuals by name.

As in the case of Gabriel, there is not one picture of 11-month-old Makenzie to be found online. Did she ever know a moment of love? Was her life full of fear and pain, or was she a victim of an adult’s sudden snap? Why did nobody help her before it was too late? The DC Council should pass legislation requiring that the public be notified about what the government knew and what it did about children like Makenzie and Gabriel. We owe it to them and to all the children who could be saved by such knowledge.

Hotline calls, investigations, substantiations, and services still gravely suppressed by pandemic

In August, I wrote about the drastic decline in reports to CFSA’s hotline, investigations, and substantiated abuse and neglect allegations in the wake of the Covid-19 emergency, which closed schools and resulted in increased social isolation for children. CFSA has released data from June through October 2020, and the same trends are continuing. Reports, investigations, substantiations, and in-home case openings are down drastically. Foster care entries have decreased as well, but that drop seems to have occurred mainly before the pandemic. With plans for reopening schools up in the air, it is long past time to worry about the children who are not being seen in school or child care and to find alternative ways to reach them until schools and childcare centers are fully open. Moreover, these frightening data lend support to those calling for schools to reopen soon–especially for children of elementary-school age or younger, who are incapable or less capable of seeking help.

In the District, Mayor Muriel Bowser declared a public health emergency on March 11, 2020 and schools closed for in-person classes on March 13. After a two-week spring break, online learning began on March 24 and the stay-at-home order went into effect on April 1. Online learning ended on May 29, nearly a month early, and the same day that the District entered Phase One of reopening. Schools started on a virtual basis again on August 31. In its public-facing Dashboard, CFSA posts data for each quarter 45 days after the quarter ended. The data for the July through September quarter were posted on November 13, 2020. Using this data, we compared the numbers of reports, investigations, dispositions, in-home case openings and foster care placements since the pandemic with the numbers during the same months of 2019.

Reports to the Hotline

Hotline calls are generally a family’s first contact with CFSA and thus the earliest indicator of the effects of the pandemic. Figure 1 shows the number of hotline reports per month in FY 2019 and 2020. In FY 2019, the number of reports increased every month until May, dropped to a much lower level in July and August when schools were closed, and then bounced up in September with the opening of schools. The pandemic year of 2020 looked very different. The number of calls fell from February to March with the closure of schools, followed by a much larger drop in April, with the number of calls staying fairly flat until a modest rise in September with the opening of school. It’s as if summer vacation started in March, with a slight increase of reports when school started again.

Comparing the months across years shows that in January and February 2020, before the pandemic shutdown began, there were actually more hotline calls than there were in the same months of 2019, suggesting that the year would have seen increased reports if not for the pandemic. But in every month of the pandemic, the number of hotline calls in 2020 was considerably less than its counterpart in 2019. (The actual numbers are provided in Table 2 at the bottom of this post.) The biggest year-to-year differences were in April and May 2020, after the pandemic emergency began, when calls were down by 64 percent and 67 percent respectively over the same months in the previous year. In July and August, the differences between 2019 and 2020 were less drastic, which is to be expected because schools are normally closed during the summer months. But still reports were down by nearly a quarter in both July and August 2020 from the previous year. The total number of hotline calls received between March and September (roughly the period affected by covid-19) fell from 14,245 in 2019 to 9,780 in FY 2020, a decrease of 31 percent.

It is likely that the school closures were a major reason for the drop in hotline reports. Many schools, especially in the poorest areas, struggled to engage many of their students in distance learning last spring; some students were missing for the entire quarter. In addition, signs of maltreatment may be harder for teachers to observe online, although a virtual platform does allow them to observe incidents in the home that might otherwise go unreported. Moreover, DCPS closed several weeks early, offering not even virtual education in June. The lower level of reports even in the summer months may be due to families being more isolated due to the pandemic, spending less time with friends, neighbors, and extended family members who might report suspected abuse or neglect, as well as putting off visits to doctors, another common reporting source.

While monthly data on reporting source are not available, annual data shown in Table 1 support the hypothesis that a decline in reports from school personnel was a major factor behind the fall in reports overall. In 2019, presumably a fairly “normal” year, school and childcare personnel made 42.9 percent of all reports to the hotline. This is larger than the national percentage of 21 percent for these groups in FY 2018, probably because the District requires schools to report to the hotline all students who have more than 10 unexcused absences during a school year. These data show that these groups made a smaller share of reports in the recently completed Fiscal Year 2020 (in which more than half of the school year was virtual) than in FY 2019. In FY 2019, childcare and school personnel made 7,704 reports, which was 43 percent of all reports to the hotline. But in 2020 they made only 5,006 reports, which was only 36 percent of all reports. Counselors, therapists and social workers also made fewer reports in FY 2020, probably reflecting services that were suspended and or transitioned to a virtual platform. Their reports dropped from 2,342 to 1,702, or 13 percent of reports, which was not a large percentage change. On the other hand, law enforcement and medical personnel made an increased number and share of reports. Law enforcement personnel made 1,938 reports in 2020, a slight increase over the 1,891 reports they made in FY 2019. Their share of total reports increased from about 11 percent to 14 percent of all reports. Medical personnel made 965 reports in FY 2020, a big increase from the 866 reports they made the previous year, and their share of reports increased from five to seven percent. Friends and neighbors made fewer reports, but these reports were a slightly higher fraction–about 14 percent) of those received. Clearly no group could make up for the missing reports from teachers, so the total number of reports for the year was 14,046, down from 17,960 in 2019. The increasing number and share of reports due to law enforcement and medical personnel reflects their status as essential workers who have continued to see District residents in person. There have been anecdotal reports from many areas that maltreatment cases that do come to the attention of child welfare tend to be more severe; this may reflect the increased role of these reporters, who are more likely to see children who are seriously injured, and the reduced role of teachers, who are often said to report concerns that do not rise to the level of abuse or neglect.

Table 1: Hotline Reports by Source, 2019 and 2020

Reports accepted for investigation

A hotline call can be screened out as not meeting the requirements for an investigation, referred to another agency, or accepted for investigation. The number and percentage of reports accepted for investigation is shown below in Table 2. The percentage of hotline calls accepted was higher each month during the pandemic period (especially in May and June) than in that same month of the previous year. This pattern suggests that the reports made during the lockdown tended to be more serious, with the less serious reports less likely to be made. Such a trend has been observed in other jurisdictions where data have been analyzed in more depth, as reported in my national blog, Child Welfare Monitor. As mentioned above, some commentators have suggested that teachers in particular make many reports that do not merit investigation. Virtual schooling may have screened out some of this “noise.” CFSA data provide evidence for a small winnowing effect but one that was far from enough to make up for the drastic drop in the number of reports.

Table 2: Hotline Calls Accepted for Investigation

Completed and Substantiated Investigations

In addition to the number of calls accepted for investigation each month, CFSA also reports on the number of investigations completed each month. This is a different number because investigations can take a month or sometimes even longer to complete. So we can expect a time lag in observing the effects of the pandemic on the number of investigations completed. Also there is a small number of investigations that are not completed, as explained on the dashboard. These of course are included as part of total, but not completed, investigations.

Figure 2 shows a similar pattern of differences in completed investigations as shown in Figure 1 for reports, with the time lag delaying the effect by a month. In 2019, completed investigations mostly increased from January through June and then fell through September. In the pandemic year of 2020, the number of completed investigations fell precipitously in April and May, with the onset of the pandemic, drifted slightly upward through August, and fell slightly in September.

Turning to the numbers, in the pre–pandemic months of January and February 2020, the number of investigations was 24 percent and 36 percent higher than it was in January and February 2019. (Table 2 below the text shows the numbers and percentage changes.) It appears that the agency was on track to have more reports and investigations in 2020 than in 2019, if not for the pandemic. Completed investigations fell in April but it is not until May that the number of investigations completed in FY 2020 dropped below that of FY 2019. Once the number of investigations began to fall, however, it dropped like a stone. In May, only 230 investigations were completed compared to 565 in 2019–a drop of 59 percent. There were 56 percent fewer investigations completed in June 2020 than in June 2019. The gap between FY 2019 and FY 2020 lessened in July but was still large at 39 percent, reflecting the fact that many of these investigations would have begun in the first half of June, when school was still in session in 2019 but not 2020. It was only in August and September that the year-to-year difference declined to 21 percent and 18 percent respectively, reflecting the time lag between reports and completed investigations. It is worth noting that the year-to-year difference was still significant even in those months. This presumably reflects the continuing suppression of hotline reports during the summer of the pandemic. The total number of investigations completed between April and September (roughly the period affected by covid-19) fell from 2,716 in 2019 to 1,787 in FY 2020. That was a decrease of 25 percent–somewhat less than the difference in reports, reflecting the fact that a higher fraction of reports was investigated in 2020.

An investigation can have several possible results. It can result in a finding of “inconclusive,” meaning the evidence is insufficient to prove maltreatment despite some indications it occurred; “unfounded,” which means “there was not sufficient evidence to conclude or suspect child maltreatment has occurred,” or “substantiated,” indicating that the evidence supports the allegation of maltreatment. (See the CFSA Data Dashboard for the full definitions of these terms as well as of “incomplete investigations.”) As shown in Figure 3, the monthly trends and yearly differences were very similar to those for investigations in general. The total number of substantiated investigations for April through September dropped from 643 in FY 2019 to 420 in FY 2020, a decrease of 35 percent. The percentage of investigations that was substantiated during that period stayed almost exactly the same from year to year at approximately 24 percent.

In-home cases opened

When an abuse or neglect allegation is substantiated, several things may happen, depending on the perceived level of risk to the child or children in the home. The agency may take no action, refer the family to a community-based collaborative, open an in-home case, or place the child or children in foster care. As Figure 4 shows, there was a drastic drop in in-home cases opened between March and April, coinciding with the closing of schools and the pandemic emergency. Case openings dropped 48 percent in April, 54 percent in May and 74 percent in June compared with the previous fiscal year.[2] Data were not available for the quarter ending September 30, 2020. Presumably the trend in new case openings reflects in large part the trend in substantiated allegations; the patterns appear similar but not identical in the two measures. The total number of in-home cases opened in the pandemic months of March to June dropped from 533 in March-June 2019 to 267 in the same months of 2020–a decrease of 50.0 percent.

Source: CFSA Data Dashboard, available at https://cfsa.dc.gov/service/cfsa-data-dashboard
Note: In-Home Data not available for July-September 2020

Foster Care Entries

It is not surprising that hotline calls, investigations, and substantiations all declined in the wake of the pandemic and associated closures. The big surprise is that foster care entries do not display the same pattern. There was a big drop in foster care entries in February 2020–before the pandemic closures hit. Foster care entries actually rose in March, April and May of 2020 before dropping sharply in June and a bit more in September. True, monthly entries into foster care were always lower in 2020 than in 2019, though only by one child during the month of July. The total number of children placed in foster care declined from 193 in March through September of 2019 to 119 in March through September of 2020.

But the big decrease in foster care entries appears to have occurred before the onset of the pandemic, as Figure 6 shows. The number of entries into foster care was falling throughout FY 2019, aside from slight rises in May and August. There was actually somewhat of a rebound in the spring pandemic quarter, while the summer quarter entries fell back to the January-March levels.

The downward trend in foster care placements that began before the pandemic may have been due to policy or practice changes. As we mentioned in an earlier post, the data suggest that there was a renewed push to “narrow the front door” of foster care starting in the third quarter of Fiscal Year 2019. As we reported then, CFSA’s Communications Director indicated that the fall in foster care entries reflected CFSA’s “continued commitment to keep children out of foster care by supporting families in their homes.” Of course, we do not know if placements would have been higher in the absence of the pandemic; perhaps the school closures and pandemic orders did suppress foster care entries somewhat. But clearly, the pandemic has had a more obvious effect on the opening of in-home cases, resulting in a big decrease in in-home case openings. This makes sense if we assume that CFSA had become more likely before the pandemic to open in-home cases in lieu of foster care cases.

Exits from Foster Care

Commentators around the country have expressed concern that covid-19 would create delays in the achievement of permanency for foster youth. Family reunifications could be delayed by court closures, cancellation of in-person parent-child visits and increased difficulty facing parents needing to complete services in order to reunify with their children. Court delays could also hamper exits from foster care due to adoption and guardianship. The monthly data in Figure 7 show that fewer children did exit foster care every month from March to September, especially in May and June, than in the same months in 2019. The difference between years declined in July and August and almost disappeared by September, so perhaps the agency and court were able to clear the backlog. The total number of children exiting foster care declined from 261 during the period from March through September 2019 to 178 in the same months of 2020, a difference of 83 children or 32 percent. A small part of the reduction is due to the City Council’s decision to allow older youth to stay in foster care instead of aging out during pandemic. There were 27 exits by emancipation in the third and fourth quarters of FY 2019 and only 10 in the second half of FY 2020. But this difference does not account for most of the drop in foster care exits during the pandemic period.

Figure 8 shows the trends in total foster care caseload over time, which reflects both entries and exits. The total number of children in foster care on the last day of Fiscal Year 2020 was 695, compared to 798 on September 30, 2019, for a decrease of 13 percent. This reflects a total of 217 entries and 321 exits during the year. [1] (The percentage declines are listed in Table 7 at the bottom of this post). Combining Dashboard data with previously published data shows that the number of children in foster care on the last day of the fiscal year has declined every year since FY 2012. However, the 13 percent fall during 2020 was greater than in any other year since FY 2014. It appears that this decline happened mostly before the pandemic. Comparing data from March to September of 2019 and 2020 shows that 74 fewer children entered foster care and 68 fewer children exited it, suggesting that the pandemic had little effect on the total foster care caseload.

Conclusion

The release of fourth-quarter FY 2020 data on CFSA’s data dashboard shows a continuation of the trends that were displayed in the second-quarter data released in August. The pandemic and its associated closures had the expected downward effect on calls to the child abuse hotline, investigations, substantiated maltreatment reports, and in-home case openings. What was not expected was that although foster care entries fell in FY 2020, most of that fall occurred before the pandemic and appeared to be due to other factors, such as policy and practice changes. It appears that by suppressing reports and investigations, the pandemic probably suppressed the opening of in-home cases more than it reduced removals into foster care. But in any case, it resulted in a loss of protective services for children. Child Welfare Monitor DC has long been urging CFSA to do more to reach the children who may be suffering behind closed doors through means like working with schools to track down no-shows, launching a public awareness campaign about child abuse and neglect, educating non traditional reporters to spot signs of abuse and neglect, and reaching out to at-risk families known to the system. These ideas are discussed in my national blog, Child Welfare Monitor. With no clear plan for reopening schools, it is hoped that CFSA will now make this their top priority. Moreover, the data are sobering enough to support a return to school soon for children of elementary school age or younger as soon as possible because school is such a crucial safety net for abused and neglected children.

[1] The total is 694 rather than 695, which presumably reflects a small inconsistency in counting of entries and exits.

[2] There was an anomaly in the in-home case data that casts some doubt on the accuracy of the case opening numbers. We are awaiting clarification from CFSA.

Additional Tables

Table 2: CFSA Hotline Reports by Month, FY 2019 and FY 2020

Table 3: Investigations by Month, FY 2019 and FY 2020

Table 4: In-Home Cases Opened by Month

Note: Data not available for July-September 2020

Table 5: Foster Care Entries by Month

Table 6: Foster Care Exits by Month, FY 2019 and FY 2020

Figure 7: Children in Foster Care on Last Day of Fiscal Year

Another child, known to police and CPS, dead of abuse in DC

His name was Gabriel Eason. His story is achingly familiar. A young child dead at the hands of those who should have been caring for him in the District of Columbia. A family that was investigated by both police and child protective services, who were apparently unable to confirm the multiple incidences of past abuse. An agency more concerned about parents’ rights than children’s safety and hiding behind confidentiality laws to protect itself.

On October 9, 2019, an unnamed childcare center called the Child and Family Services Agency (CFSA) child abuse hotline to report that two-year-old Gabriel Easton had an unexplained injury, according an affidavit provided to DC Superior Court by the Metropolitan Police Department (MPD) and summarized in a Washington Post article. On October 16, 2019 CFSA and Metropolitan Police Department (MPD) investigators went to the home of Ta’Jeanna Eason and Antonio Turner in Northeast Washington to initiate an investigation. By March 2020, detectives had determined that there was not enough evidence to prove or disprove the allegation of abuse and closed the case. Two weeks later, police called to the home found EMT’s unsuccessfully trying to revive two-year-old Gabriel.

An autopsy showed old and new injuries to Gabriel’s body, including swelling of the head and brain, abrasions and contusions to the head and torso; lacerations of the kidney and liver; injuries to the. heart and vena cava; cuts on the face and neck; blunt trauma to the genitals; and 36 rib fractures, six of which were healing and believed to have happened in an earlier incident. The medical examiner reported that Gabriel appeared to have been punched, kicked, slapped, or hit with an object on his right flank and punched or hit in the chest. She concluded that the main cause of death was significant head and abdominal trauma.

Both of Gabriel’s siblings had experienced physical trauma. The three-year-old was admitted to the Intensive Care Unit with life-threatening injuries including a fractured rib and a lacerated liver. There was evidence of old and new injuries. A child abuse pediatrician determined the injuries were due to blunt force trauma equivalent to being involved in a multiple-vehicle accident or falling from a twenty-story building. The liver lacerations were inflicted within two days of the child’s presentation at the hospital. The 11-year-old was found with a healing black eye and older injuries. Both surviving boys have been placed in foster care.

Gabriel’s older brother, age 11, told police that he was required to clean the house, do the laundry, and change his siblings’ diapers at night while the adults slept. If a diaper was wet in the morning he would be beaten. He disclosed that Turner had previously hit him in the eye, on the chest, and with a belt. He reported that his mother hit him with her hands, her fists, and a belt. The 11-year-old stated his mother did not recognize that “the marks and bruising rampage” started when Turner arrived, and that Turner would beat his younger brothers when his mother was not around or not in a position to hear the abuse. When she noticed the injuries, she blamed her oldest son instead.

Turner admitted to police he routinely used physical force to punish his partner’s children. He reported punching the 11-year-old in the face to “teach him a lesson.” He also admitted that he beat the boy up once, giving him a “teenager whooping.” He reported that he “went to his body, like my father did me” during that incident. Turner also said that he hit the 11-year-old in the head and kicked him in the body when he found the boys playing with one of his metal weights the day before Gabriel’s death.

Eason, the boys’ mother, repeatedly blamed the 11-year-old for the injuries to Gabriel, telling the police on the murder scene that he was evil. Eason later told police that she started to notice bruises on Gabriel after she met Turner, but later concluded they were inflicted by the 11-year-old. But the child abuse pediatrician who examined and treated the three-year-old stated that neither his injuries nor Gabriel’s could have been caused by a child weighing 80 pounds.

The police concluded that Eason and Turner “collectively and chronically inflicted injury upon the three children who lived with them, including two-year-old [Gabriel], who died at their hands. They did this this both by abusing the children and failing to obtain medical attention for the injuries.” Police charged both defendants with First Degree Cruelty to Children and Felony Murder.

There is a system to protect children like Gabriel and his brothers. It starts with the requirement that professionals who work with children report all suspected abuse to CFSA’s hotline. It appears that the staff of Gabriel’s day care center did not fulfill their mandatory reporting duties as established by District law, failing to report four suspicious injuries to Gabriel. On May 22, 2019, a teacher saw Gabriel with a black eye. When asked the cause of the injury, Eason told the teacher a brother hit him with a boxing glove. The same teacher found injuries on Gabriel’s back in June. The mother said she did not know what caused the marks. In August 2019, Gabriel showed up with another black eye. The center director told police she did not report the August incident because Eason had an explanation for the injury (Gabriel had fallen and hit his eye on a toy) and produced a doctor’s note indicating Gabriel had been cleared to return to day care. (Receiving medical clearance from a doctor to return to day care should not be a reason not to report suspected abuse.) A staff member saw bruises on Gabriel’s face and ears on October 7, 2019. Eason wrote and signed a note saying the injuries came from playing roughly with siblings. On October 9, Gabriel had bruises on his ears, which his mother could not explain. That is when the center finally called the CFSA hotline. It should not have taken five suspicious injuries before a report was made. It is not clear whether the staff were sufficiently trained in mandatory reporting, especially the principle that all suspected abuse must be reported.

Doctors are also mandatory reporters of child abuse and neglect. We know that Gabriel received a doctor’s note clearing him to return to school after his black eye in August, 2019. MPD found that Eason had taken Gabriel to Prince George’s County Hospital on August 30. He was diagnosed with a black eye and eye abrasions. According to notes from the medical record, Eason claimed she was on her computer while the “father” was watching the kids. At some point Gabriel was playing in the closet and Turner said he had to get Gabriel out because the doors were off the track. Gabriel fell asleep on the couch and woke up crying but Eason did not see an injury. Nevertheless, she gave him Benadryl because she thought he might be having an allergy attack. She claimed she did not see child abuse by the “father,” suggesting she was asked that question. She also declined a CT-scan because she did not want Gabriel sedated or exposed to radiation. Eason’s explanation of the injury seems incoherent and self-contradictory, and a mother’s response that she did not suspect abuse by her partner should be expected and not necessarily credited. Eason’s refusal of a CT scan might be unremarkable if the doctor did not recommend it–but we don’t have that information. If there were any concerns about Eason’s explanation or behavior, the hospital should have made a report to the CFSA hotline just to be safe, but we do not know if this happened.

The next known contact with medical personnel occurred on January 28, 2020, when Turner called 911 and Gabriel was taken to Children’s National Medical Center (CNMC) with a severe laceration to his forehead. Turner claimed Gabriel fell off the bed while the 11-year-old was watching him, at Turner’s request. Doctors diagnosed Gabriel with a “complex” seven-centimeter laceration with concern for facial nerve laceration, as well as a concussion. To a layperson like this author, such a laceration sounds quite unusual from falling off a bed unless Gabriel somehow fell onto a sharp object, which would raise serious concerns about the home’s safety. Moreover, Turner’s statement that he had asked an 11-year-old to “watch” a two-year-old should have been concerning. We do not know if the emergency room doctor had good reason to call the hotline or if in fact a call was made. We can only speculate about whether a call could have saved Gabriel.

MPD also has a role in protecting children, but its duty is primarily to investigate crimes, arrest offenders, and charge them in court. There is no point in charging people when the charges will not hold up in court. Therefore, it is not clear that MPD made any errors in investigating the October report from the day care center. It is understandable that MPD did not find evidence of abuse that could support a criminal charge. The injury that was actually investigated did not appear serious and did not require medical attention. Eason lied about her own use of corporal punishment and the 11-year-old, undoubtedly terrified to tell the truth, reported that his mother did not use physical discipline. More importantly, there is nothing about Turner in the summary of MPD’s first investigation; it is not clear whether whether MPD or the child care staff knew of Turner’s existence. Whether MPD should have uncovered his presence is a question we cannot answer at the moment.

The responsibility to assess the validity of an abuse allegation and ensure safety for the child is with CFSA, not MPD. Rather than investigating allegations to determine whether charges should be presented in court, CFSA decides whether or not to confirm, or “substantiate” allegations. Investigators must substantiate an allegation when it is “supported by credible evidence and is not against the weight of the evidence.” Therefore, CFSA may substantiate an abuse allegation when MPD does not find evidence to make criminal charges. The call from Gabriel’s childcare went to CFSA and it is not clear how MPD got involved. Perhaps CFSA asked MPD to accompany the investigator on the initial visit to the home, but we have no information what CFSA itself did. The only mention of CFSA action in the MPD complaint is that “On October 18, 2019, CFSA filed a report with MPD about the October 9, 2019 incident.” CFSA’s Communications Director told the Post she could not comment on CFSA’s interactions with the family, citing local and national confidentiality laws. So we don’t know if CFSA delegated the entire investigation to MPD, which would be unusual, or if CFSA conducted its own investigation. If CFSA did investigate, we do not know the quality, results, or findings of the investigation, or any further actions by the agency.

Not knowing these facts is unacceptable when a child is dead of abuse. The taxpayers pay the cost of maintaining an agency to investigate complaints of child maltreatment and make arrangements to ensure that the children are safe. We have a right to know if it did its job. If the problems are systemic, we need to fix them. If one or more individuals made errors, they need to be held accountable.

CFSA’s conduct in this case will be reviewed in by at least two bodies, but the results will not be available to the public. An internal CFSA fatality review committee will review the agency’s conduct to determine whether there were opportunities to save Gabriel. It will make a public report, but that report will not include details about the agency’s response to individual cases. The District’s Child Fatality Review Committee will review the case as well. I have served on this committee for over three years. Unfortunately, the committee will not have the opportunity to review Gabriel’s case until Eason and Turner have been sentenced or acquitted. When that day comes, we might have less than an hour to review the case, unless a longer time is allotted as it was on one occasion during my tenure when a high-profile case was being discussed. The document we read will not include the names of Gabriel and his family members, referring to him as “the decedent.” Undoubtedly, I’ll be able to identify Gabriel’s case from the description. But if I call him by his name instead of “the decedent,” as I have done in the past, I will be chastised and possibly punished for violating confidentiality. I will be able to read summaries of the family’s interaction with MPD, CFSA, and other agencies with which they had contact. Although I won’t see the full case files, I may get at least partial answers to my questions about how the case was handled. But I won’t be able to share what I learn with anybody outside the meeting even without including any names. If I do, I will be subject to a fine of up to $1,000. The panel may make recommendations, which will be shared in its annual report. But there will be no case study included in the report. Information about individual cases in these reports is statistical only.

This is not an acceptable state of affairs. As a first step, the law regarding the Child Fatality Review Committee should be changed to allow members to share information about how District agencies respond to reports of abuse and neglect. Secondly, the D.C. Council must require that all deaths from abuse or neglect, and all deaths of any child whose family has been the subject of an earlier child abuse report, be reviewed by experts. This review should be made public with names (such as those of the surviving brothers) redacted when necessary. This review could be done by a special multidisciplinary team staffed by the child welfare agency as in Washington State or by a neutral agency like Illinois’ Office of the Inspector General for DCFS or the Office of the Child Advocate in Rhode Island. I prefer the neutral agency so that the agency that failed the child is not involved in the review. That is why I support including child fatality review in the bailiwick of the proposed child protection ombudsperson under legislation that is currently being marked up.

In the absence of any information about CFSA’s response to the initial call from Gabriel’s child care center, we cannot know why Gabriel’s suffering was not discovered in time to save him. But I cannot help placing some responsibility on a mindset that values parents’ rights above child safety. This orientation is becoming even stronger, with a growing chorus of groups arguing that child welfare as we know it should be abolished. According to some of these organizations, like a new movement called upEND, removing a child from home is always traumatic and never recommended. (See my recent post for discussion of this movement.) I wonder what the folks at upEND would make of what the 11-year-old told the interviewers at the Child Advocacy Center after he was finally liberated from his hellish home. He told them that he felt safe in his foster home. In contrast, he said his own home felt like a “death trap.” Would they say he was traumatized by his removal and not by his home life? Would they say that Gabriel is better off dead than in foster care?

Gabriel’s case also supports the importance of childcare and school in protecting children. The police affidavit states that Gabriel and his three-year-old brother did not attend childcare for most of February and all of March. Ironically, this was not related to the closure of the childcare center in March due to the coronavirus pandemic. Instead, Turner told police that Eason was not able to get the children to the center because she was pregnant with his child–a baby that died shortly after birth. It is reasonable to wonder if Gabriel might have been saved had he been attending childcare in the days before his death. Perhaps another report would have been made and this time this house of horrors would have been seen for what it was. There has been much talk about how school closings due to Covid-19 mean that children are no longer seen by adults who might spot and report signs of abuse or neglect. While the pandemic did not apparently contribute to Gabriel’s death, the circumstances show the importance of of keeping childcare centers and schools open, especially for children at risk of maltreatment.

I searched the internet in vain for a photo of little Gabriel Eason. Perhaps nobody loved him enough to take a photo. There have been no vigils or demonstrations about his death. But for those who care about children, forgetting Gabriel is not possible. Let us remember him by holding accountable those who let him die, and learning why the system failed him so badly, so that such failure can be prevented in the future.

CFSA’s Internal Child Fatality Report leaves out more than half of dead children known to system

On September 10, 2020, the Child and Family Services Agency (CFSA) released its internal child fatality review report for 2019. This report raises many issues and concerns. Some relate to the scope and coverage of the report. Others concern the cause and manner of death, the existence of families with repeated CFSA involvement that nevertheless have a child death, the predominance of large families as a correlate of child deaths, and the suggestion that unrelated adults in the home may have perpetrated a child fatality.

Child fatality review is an important way for an agency to assess the quality of its work. CFSA states in the report that “the fatality review process is one of CFSA’s strategies for examining and strengthening child protective performance. It provides the Agency with specific information that helps to address areas in need of improvement and to identify any systemic factors that require citywide attention–all with the goal of reducing preventable child deaths.” But the goal of child fatality review should be broader than reducing child deaths. Child fatalities should be seen as the tip of the child welfare iceberg. For every child who dies, there may be many others who are left in abusive or neglectful homes with no monitoring or support.

There are two child fatality review reports issued in the District. The District of Columbia’s Child Fatality Review Committee (CFRC) is located in the Office of the Chief Medical Examiner. CFRC reviews all deaths regardless of cause of all District residents from birth through 18 years, as well as the deaths of youths aged 19 to 21 who were known to child welfare within four years of the fatal event or those known to intellectual and disability services or juvenile justice programs within two years of the fatal event. Each year CFRC reports on all the fatalities reviewed in that year, but these fatalities could have occurred in any previous year. In the most recent report, on 104 cases reviewed in 2018, the deaths reviewed were from 2014 through 2018.

CFSA’s internal child fatality review reports are based on information gathered by the CFSA’s Child Fatality Review (CFR) unit and recommendations developed by the agency’s Internal Child Fatality Committee (ICFR). These reports focus on a smaller subset of child fatalities–all known fatalities of children whose families were known to CFSA within five years of the child’s death. In the past, the report included all fatalities reviewed in each calendar year. As stated in last year’s internal fatality review report, which has been removed from the CFSA website: “Historically, every CFR annual report has also included review data outside of the calendar year, depending on when the CFR Unit received notification of a child’s death. For [Calendar Year] 2018, reviews included fatalities from years 2015 to 2018.” However, the new report, includes only those fatalities that occurred during 2019. This is only 13 of the 33 fatalities the Committee reviewed during 2019, as the agency explains in a footnote. The other 20 fatalities reviewed occurred in previous years and will therefore never be included in a CFSA child fatality report unless the previous practice of including deaths from previous years is reinstated.

Cause and Manner of Death

Of the 12 fatalities for which cause and manner were known, the causes were equally divided between maltreatment, natural causes, non-abuse homicides, and accidents.

The cause of death was abuse or neglect by a caregiver for three of the children who died in 2019, 25 percent of the 12 children whose cause of death was known. All of these children were under the age of three. For two of these children the cause of death was abuse by blunt force trauma. The other child died of fentanyl poisoning due to neglect.
Of the 12 children with a known cause of death, three (or 25 percent, died of natural causes. Two of these were children between one and five years old, while the third was a young adult over 18.
Non-abuse homicides accounted for 25 percent of the fatalities in CY 2019. All of the victims were males living in Ward 8. One was aged 11, another was 16, and the third was 20.
All three accidental deaths were infant fatalities and all involved unsafe sleeping arrangements.

Demographic Characteristics

The children who died disproportionately resided in Ward 8 (seven children), Ward 7 (four children), Ward 5 (one child), and Maryland (one child). All of the children who died were African-American. None of these facts are surprising since they reflect the demographics of CFSA’s clients. Most of the children were living at home at the time of the fatality, except two that were living with relatives. All of the children who died had siblings. Nine of the decedents (about 69 percent) had three or more siblings; seven (54 percent) of them had four or more siblings, and four had six or more siblings. Many of the siblings were half-siblings. Twelve of the 13 decedents had at least one-half sibling.

Source: CFSA, Child Fatalities: Statistics, Observations, and Recommendations, 2019, page 6.

CFSA History

Over three quarters of the decedent’s families (10 families) had an open case or investigation within five years of the fatality. The other three families had one or more screened-out referrals only.

Six families had four or more reports to CFSA within five years of the child fatality. Nine families had two or more reports.
Eight families had at least one CPS investigation; of these families, one had a total of 10 investigations, another had seven investigations and two had five investigations.
All of these investigated families had at least one substantiated allegation of abuse or neglect. Most substantiations were for neglect; the neglect categories with the most substantiations were inadequate supervision and caregiver incapacity. There were two substantiations for physical abuse and two for “mental abuse.”
Of the eight families that had a CPS investigation, Family Assessment, or case closed within five years of the fatality, the time between investigation or case closure and the fatality ranged from four to 13 months.

*Source: CFSA, Child Fatalities: Statistics, Observations, and Recommendations, 2019*, page 14. The frequency of CFSA involvement refers to the number of hotline reports received.

Four of the 13 decedents’ families (31 percent) were involved with CFSA at the time of the child’s death. All of these families had open Permanency (foster care) cases. According to additional information provided by the agency, one of these children, a three-year-old, was in foster care with a relative. Her death was classified as an abuse homicide due to blunt force injuries, but it was not known if the injuries were caused by the relative or another adult in the home. Another decedent, a 17-year-old male, had run away from foster care and been missing for 17 days when he was shot to death. The other two decedents were living at home at the time of their deaths: one was an accidental death (asphyxia due to unsafe sleep) and the other decedent’s manner of death was undetermined. According to additional information provided by the agency, in both of these cases the non-custodial parent lived in a different household and had an open permanency case for the decedent’s half-sibling.

CFSA’s Recommendations

CFSA’s Internal Child Fatality Review Committee (ICFR) makes recommendations based on the information it reviews; these recommendations are approved by the Agency Director. There were surprisingly few recommendations based on 2019’s child fatalities. One of them calls for the agency to “ensure that practitioners identify and evaluate all adults living (or potentially living) in the same home as a child in foster care.” CFSA’s Communications Director told Child Welfare Monitor DC that a three-year-old decedent in kinship care died of blunt force trauma that may have been inflicted by an adult that was living in the home. Based on the recommendation, we can assume that adult was not evaluated as part of the foster care licensing process. During my tenure as a social worker in foster care, foster parents (including kin caregivers) not informing their licensing agencies of adults living in the home was a common concern. Often this information is purposely kept from social workers because the adult (often a boyfriend) has a criminal or child abuse record that would prevent the home from being licensed. To address this problem, CFSA plans to have supervisors “continue to work with social workers to identify adults who live in or spend significant time in the home and ensure all adults are evaluated.”

Analysis

This report raises many issues and concerns. These include the exclusion of 20 cases from years prior to 2019, the many children who died of causes that might have been prevented by CFSA, the deaths of children in families with long histories of CFSA involvement, the large size of many decedents’ families, and the possible role of an uncleared adults in the home in a child fatality.

Scope and Coverage of Report: While the ICFR Committee reviewed 33 fatalities during 2019, the report covers only those 13 fatalities that actually occurred in 2019; all of the other 20 occurred in prior years, mostly 2017 and 2018. Unless CFSA returns to its earlier practice of including all fatalities reviewed in a calendar year in that year’s report, these 20 fatalities will never be covered in a future report. This is the first year the ICFR left out all deaths that did not occur in the same year as they were reviewed. Like the citywide Child Fatality Review Committee, until this year the ICFR reported on all of the fatalities it reviewed in a calendar year–not just the ones that occurred in the same year they were reviewed. Leaving out more than half of the fatalities of children known to CFSA in its annual fatality report every year deprives the public, policymakers and stakeholders of crucial information that, if acted upon, could help prevent fatalities and harm to children in the future.

Lack of Case Detail: The lack of detail on the individual cases is a major problem in making sense out of the information provided in this report. Statistical data on such a small number of cases is of limited utility, but knowing the history of CFSA involvement in each case would enable readers to pinpoint the opportunities that may have been missed to prevent the fatality and lessons for the future. The public should know such details, as long as personal information redacted. Some states, like Texas, Florida, and Washington are required to post fatality reviews for children who died of abuse or neglect following involvement with the child welfare agency, as described by Child Welfare Monitor. Detailed fatality case studies on child deaths with agency involvement (without identifying information) are provided in other jurisdictions by independent agencies like the Office of the Child Advocate in Rhode Island and Connecticut and the Inspector General for the child welfare agency. Legislation to establish an independent Ombudsperson for CFSA was introduced in 2019 by Councilmember Brianne Nadeau. Such fatality reports were not included in her original legislation, which was never put to a vote, but could be added to the next version.

Cause of death and preventability: The cause and manner of death were known in 12 of the 13 cases and were distributed evenly between four categories–natural causes, accidents, abuse homicides, and non-abuse homicides. The deaths from natural causes were very likely not preventable by CFSA action. Deaths in the other three categories, however, could possibly been prevented if CFSA had responded differently to these families when they came to the agency’s attention. Clearly the fatalities from abuse or neglect raise the question of whether CFSA terminated its involvement without ensuring that the maltreatment that led to the initial allegation had ended. Accidental deaths can reflect neglect. For example, all of the accidental deaths in this report reflected unsafe sleep practices..

Preventability of non-abuse homicides: We don’t know the details on the tragic deaths of an 11-year-old, a 16-year-old and a 20-year-old of non-abuse homicide. Was the youngest victim (most likely an innocent bystander and possibly the case that appeared in media reports in June 2019) exposed to violence because of the lifestyles of the adults who were caring for him? Were the two older youth themselves involved in violence and criminal activities, as is the case for many young victims of violence? Three of the families were involved with the Department of Youth Rehabilitation Services (DYRS), suggesting that one child (perhaps not the decedent) in those families was involved in illegal activities. I spent five years working as a social worker in foster care and almost four years serving on the citywide Child Fatality Review Committee. In this work I have seen numerous examples of young people who became involved in crime and violence after growing up in families that were repeatedly involved in child welfare due to drug activity, domestic violence, mental illness, and abusive or neglectful parenting. Cases were opened and closed, and children were in and out of foster care, but none of these interventions resulted in any substantial change in parental behavior. Perhaps some of these tragic deaths could have been prevented if better, more intensive and long-lasting services had been provided to the parents, or if the children had been removed from these homes after their parents failed to take advantage of offered services.

Families with Repeated CFSA Involvement: It is clear from the extensive history of some of these families with CFSA that the agency is failing to identify some children who are in danger in their homes. Some investigations may fail to identify the family’s most severe problems; some cases may be opened for foster care or in-home services but may close before the parents succeed in changing their behaviors. CFSA requires a “4+ staffing” for all families that have four or more allegations with the last report occurring within the past 12 months. There was concern in previous years that families with child fatalities had more than four allegations but there was no documentation of a 4+ staffing. As a result, ICFR in 2018 recommended that the agency “make 4+ staffings more consistent,” a recommendation that was reported as “complete” in this year’s report. CFSA reports that five of the families with a child fatality in 2019 were eligible for a 4+ staffing. Of these families, four were documented as receiving such a staffing, but there was no explanatory documentation for the family that did not receive one. If the agency is indeed more consistently holding these meetings, it may be time to evaluate their effectiveness.

Unknown adults in a kinship home: Information provided by CFSA indicates that one of the abuse homicides was perpetrated in a kinship home and that it is not clear whether the perpetrator was the relative or another adult in the home. Evidence suggests that many abuse homicides are perpetrated by other adults living in the home, particularly nonparent partners, as described in Within Our Reach, the report of the Commission to Eliminate Child Abuse and Neglect Fatalities.

Large families: There is considerable evidence that the deceased children tended to come from larger families. Not only did 70 percent of the decedents have three or more siblings but more than half of the decedents had four or more siblings. The average number of children in a family is only 1.9 in the United States. Large numbers as well as close spacing of children are correlated with more abuse and neglect. Many of these mothers started having children as teenagers. Often, the medical providers used by low-income women lack access to the more modern, effective modes of contraception such as Long Acting Reversible Contraceptives (LARC’s) at all, or require a second visit to obtain these methods.

Recommendations

Cover all fatalities reviewed: CFSA should return to its previous practice of covering all deaths of children known to CFSA within five years–not just those that took place in the year of review. This would probably at least double the number of cases included, providing a much larger basis for making conclusions.
Provide detailed case studies by a neutral party: The public needs to have access to a detailed case study of each fatality in a family with which CFSA had recent involvement. Such a case study would include a chronology of agency involvement and a description of touchpoints where the agency could have done something different and perhaps averted the death. This is particularly important for legislators, who might want to take action to avert future deaths, and for members of the media, who are often the ones that make the public aware of gaping holes in our child safety net. Ideally, such an analysis would be performed by a neutral party, such as the child welfare ombudsman’s office that was proposed last year.
Pay attention to those with repeated CFSA reports: CFSA should assess the nature of the 4+ staffings to determine whether they are having any impact on families with multiple allegations, whether the current guidance for such meetings needs to be changed, and whether other measures should be implemented to ensure that families with repeated allegations get more attention.
Evaluate all adults in the home: The IFRC suggested that the agency “ensure that practitioners identify and evaluate all adults living (or potentially living) in the same home as a child in foster care.” To implement this recommendation, the report states that CFSA plans to have supervisors “continue to work with social workers to identify adults who live in or spend significant time in the home and ensure all adults are evaluated.” More specific guidance may be needed for supervisors and workers as to how to identify such adults.
Increase access to effective birth control methods: The large size of many decedents’ families highlights the need for policies to increase access to modern, effective and long-acting birth control options for all women in the District. Some of the saddest moments in my life as a foster care social worker came from hearing that a mother struggling to get her existing children back from foster care was pregnant again. Clearly expanding access to family planning is in the bailiwick of the Department of Health (DOH) rather than CFSA. However, even in the absence of DOH initiatives, CFSA could collaborate with DOH to ensure that the parents involved in cases have access to effective contraception as soon as their cases are opened and are educated about the deleterious effects of close child spacing and large families, and that family planning is included in case plans.

Studying fatalities among children known to a child welfare agency is an important way to find out how well an agency does its job of protecting children and to suggest changes to protect children better in the future. CFSA’s review of a limited number of child fatalities (probably less than half) among children known to CFSA in FY 2019 suggest that the agency could have done more to identify and protect some children in danger. And for every dead child, several more may be suffering from abuse and neglect that will poison their future. Leaving out over half of the children whose deaths were reviewed in 2019 just because they died in previous years is an unnecessary loss of information that could be crucial in saving lives in the future. And without a detailed study of each case, it is impossible for legislators and members of the public to evaluate whether CFSA did all that it could to prevent these deaths and protect the many other children in these homes.

This post was modified on October 15, 2020 to incorporate new information provided by CFSA on the families of decedents who had open permanency cases as well as to modify a statement regarding the scope and coverage of the report.

More efforts needed to encourage child abuse reporting during pandemic

Social distancing is essential to break the back of the coronavirus pandemic. But for children who are at risk of abuse and neglect, social distancing can mean being cut off from the people who might see and report their situation. The District’s Child and Family Services Agency (CFSA), like other agencies around the country, has recognized the problem. However, its response should be strengthened in order to check in with isolated children before schools close on May 29.

All DC public schools (DCPS) and public charter schools closed on March 16. Public schools resumed on March 24 and charter schools on various dates with instruction taking place by distance learning. Distance learning will continue until DCPS schools close on May 29, weeks before the regular closing date. Each public charter school is selecting its own end-of-year closing date.

We do not know how many children are logging on but we know there are problems. The coronavirus crisis has highlighted the digital divide that already affected the District. This divide coincides with discrepancies in income, parental education, time and many other resources affecting children. DCPS estimates that 30% of its students lack a computer and/or access to the internet at home. As the Washington Post has reported, schools, nonprofits and activists have been trying to fill the gap but have not reached all the children who need help getting connected with their schools.

The results of the digital divide are clear. The Washington Teachers’ Union surveyed its teachers in April and received responses from about half of all teachers, as reported in the Washington Post. Of the respondents, 57 percent said that less than half of their students were participating in virtual education. Not surprisingly, teachers at richer and more selective schools reported strong attendance in remote education. DCPS Chancellor Lewis Ferebee told the Post that “Ninety-six percent of our students have engaged in some way….And those are the key words here: ‘in some way.’ . . . Instead of logging into a learning session, a student may be doing virtual meetings with a counselor or a school psychologist.” But we have no idea how much contact those 96 percent of students have had with their schools. Was it one virtual contact or ongoing contact? Without knowing the quality or frequency of the contact, this figure is not very helpful, except to raise extreme concerns about the four percent of students who have had no contact with their schools since the shutdown.

Unfortunately, many of the children without computers and internet are also the most at risk for abuse and neglect due to poverty, parental drug abuse, domestic violence, or parental mental illness. Taking these children out of school cuts them off from the main group of professionals on whom we rely to report their concerns about child abuse and neglect to child welfare agencies.

Hotline data show the impact of this loss of contact. CFSA reports that between March 16 and April 18 of 2020, it received 897 hotline calls, with 30 percent coming from school personnel. During the same period last year, the agency received 2,356 hotline calls, with 52 percent coming from school personnel, according to CFSA Communications Director Kera Tyler. Clearly both the number and proportion of calls coming from schools have declined greatly, but so has the number of calls coming from other sources. This is not surprising since other major reporters, like medical personnel and extended family members, are also less likely to see children during this period of social distancing.

At the same time as hotline calls have drastically decreased, severe child abuse appears to be increasing. The Washington Post reports that “the overall number of children referred to Children’s National Medical Center with child abuse concerns has dropped. But the cases coming in are more severe than usual: From March 15 through April 20 of last year, about 50 percent of the children had injuries serious enough to be hospitalized. This year, 86 percent did. During the same period last year, about 34 percent of children had head trauma, fractures, or injuries in multiple areas of the body. This year, that number jumped to 71 percent. Last year, 3 percent of the children referred for child abuse died. This year, 10 percent died.” While teachers are unable to reach a student, serious injury or death is the worst-case scenario but they also worry about children being hurt, going hungry, and suffering other types of abuse or neglect.

On April 13, 2020, CFSA issued new guidance to educators who are concerned about their inability to contact some students. The guidelines create a dichotomy. between “contact concerns” and “safety concerns.” For children of any age for whom there are safety concerns, educators are directed to call the CPS hotline. For children aged 0-4 and 14-18 for whom there are “contact concerns,” educators are also directed to call the hotline.

But for children aged 5-13, there is a different procedure for when a school “determines it has not had sufficient contact with a student, and there is no evidence the student has engaged in distance learning.” In such cases, schools are directed to attempt to reach the student’s friends and emergency contacts and to use calls and postcards to contact the student and family members. After ten days of such efforts, schools that have been unsuccessful in reaching a student are instructed to complete a reporting form to CFSA. The guidance warns that any “report that does not document full contact efforts will be denied by CFSA and sent back to the reporting school.” (According to CFSA’s Ms. Tyler, these specific reporting requirements for children aged five to 13 derive from the law that requires reporting of unexcused absences for students in this age group and also from a concern that parents play a more important role in facilitating contact with school than for older children).

In view of the large decline in reports from teachers, one might worry that CFSA seems more concerned with restricting reports from teachers than encouraging them. When we raised this concern with Ms. Tyler, she stressed that the “most important piece of the guidance to note is that if educators have safety concerns for a child of any age, it is mandatory to report those concerns to the hotline.” When the concern is educational, the guidance encourages teachers to use different approaches to reaching students before engaging the hotline.

However, distinguishing between contact concerns and safety concerns is difficult in this time of social isolation. Lack of contact prevents the identification of safety concerns, and long-term lack of contact (when teachers have tried to reach students and their families by phone, email or mail) suggests a child may be in danger. The early closing of schools on May 29 of this year will leave children without even virtual conduct with the most important group of mandatory reporters. CFSA and DCPS should consider new guidance encouraging school staff to report on all students for whom contact has been a concern since the schools reopened in March. This should include all students with whom the schools have not been in touch since school reopened (the four percent mentioned by the Chancellor) as well as any students with whom there has been little or no recent contact and for whom teachers have reason to feel concern. Such guidance should request that schools reach out to these students and their families and to report to the hotline when such efforts have been unsuccessful.

CFSA has been making efforts to encourage other professionals to report. The agency has reached out to agencies like the Metropolitan Police Department and community organizations like the Healthy Families and Thriving Communities collaboratives to serve as “an additional set of eyes and ears” on children. CFSA has asked Child Welfare Monitor DC to share the following message: To help keep children safe during this time, it is imperative for neighbors, family members, and essential workers who still see children to be extra vigilant. CFSA is operating through the pandemic, and our hotline accepts calls 24 hours a day, seven days a week. Please call 202-671-SAFE[7233] to report child abuse or neglect.

CFSA could be more aggressive in sharing this message. The agency could work with the Mayor to incorporate messaging about child abuse and neglect reporting into her daily press briefings. The agency could try to reach the workers who are still seeing children and families by providing materials to grocery stores, pharmacies, post offices, and food banks to share with their employees informing them of the signs of abuse and neglect and how to report them.

As we approach the end of the school year, the emphasis should shift from setting limits on CPS calls to encouraging educators to reach out to all children and families with whom they have had little or no contact. It is a time for schools and CFSA to team up to check on our most vulnerable children before the the school year ends and the opportunity is lost. And it is also time for CFSA to look for other workers outside schools to take on the role of protectors of our children.

This post was updated on May 13, 2020 to incorporate information from a Washington Post report about school participation during the pandemic.

Want a national perspective? Check out our national blog, Child Welfare Monitor.

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CFSA’s Oversight Responses: What can we learn?

Screen Shot 2020-02-26 at 10.08.48 AM Every year, the DC Council’s Committee on Human Services, currently chaired by Councilwoman Brianne Nadeau, submits a series of detailed oversight questions to the Child and Family Services Agency (CFSA). These questions focus on many aspects of the agency’s operations and policy. The lengthy responses, available on the DC Council website, are some of the most interesting and detailed information that the agency releases during the year. This post attempts to highlight some of the more revealing responses, as well as providing some comparisons with the previous year’s oversight responses.

Child Protective Services

Hotline Calls: The number of calls to CFSA’s child abuse and neglect hotline increased from 26,602 in FY 2018 to 28,561 in FY 2019. The highest number of calls (594) concerned educational neglect (usually student absences from school), followed by physical abuse (428), substance abuse (407), inadequate supervision (343), and domestic violence (248). The agency screened out 11,768 of these calls, or 41%, compared to 35% of the slightly smaller number of calls in FY 2018.

Assessments and Investigations: CFSA eliminated its Family Assessment track as of April 1, 2019, so that all screened-in Hotline calls, other than some infant positive toxicology reports , receive an investigation. The total number of investigations increased from 4193 to 4788, which reflects the elimination of Family Assessment. The total number of investigations substantiated increased slightly from 1127 to 1204–which was a smaller percentage of investigations than in the previous year. The top factors leading to substantiation in 2018 and 2019 were substance abuse (in almost 25 percent of the cases), educational neglect (21 percent), physical abuse (19 percent), inadequate supervision (19 percent), domestic violence (15 percent) and caregiver incapacity due to incarceration., hospitalization, or physical or mental incapacity (11 percent). Substance abuse was the top factor in both years, but the order of the next five factors differed.

Educational Neglect Allegations: Because of the increase in allegations of educational neglect, CFSA is piloting a new approach to these allegations in collaboration with DCPS. A specialized unit has been created and is being piloted at two schools in order to provide early intervention services.

Sex Trafficking: Sex trafficking has been a hot topic in child welfare for the past decade or so after it became known that children in foster care are at particular risk. The Committee asked numerous detailed questions about sex trafficking and CFSA’s response. Unfortunately it requested only the top ten factors accounting for substantiation of allegations to the hotline–and sex trafficking was not one of the top ten. In order to know the number of substantiated sex trafficking allegations, the committee could ask for the numbers of substantiated allegations for all categories, not just the top ten. Without knowing how many sex trafficking cases were substantiated, we do know that the number of cases must have been less than the 49 substantiated for general neglect, the lowest number listed out of the top ten factors accounting for substantiation.

Worker Caseloads: The current plan to exit the LaShawn court case requires that 90 percent of investigators and social workers will have caseloads less than or equal to 12′ no individual investigator shall have a caseload greater than 15 cases, reflecting generally accepted caseload standards. In response to the Committee’s question about the average caseload per worker, CFSA provided the average caseload for each individual investigator rather than the entire investigative workforce. For a better picture, the Committee could request that the agency provide the average caseload for all investigators. It is encouraging to note, however, that the highest average caseload for any investigator in FY 2019 was 10.21 although there were many “instances” when a worker had a caseload of 13-15 and one “instance” when a worker had a caseload of 16 or more. The concept of “instance” is hard to interpret as it could reflect one minute or a year. The Committee could instead request the median number of days with a higher caseload for all investigators.

Newborns with Positive Toxicology: CFSA changed its policy in 2017 to require that all positive toxicology reports for newborns be screened in to make contact with the family and determine whether an investigation needs to be conducted. The number of hotline calls received regarding newborn positive toxicology in FY 2019 was 233, almost exactly the same number as the previous year but the response appears to have been more extensive. Of these 233 calls, 87 percent resulted in an in-home wellness visit by nursing staff (compared to 56 percent in FY 2019), 69 percent resulted in an investigation (compared to 30 percent in FY 2019) and 12 (five percent) resulted in removal of a child (data not provided for FY 2019).

Child Removals: CFSA removed a total of 360 children from their homes in FY 2018 and 378 in FY 2019. The most common reasons for removal were neglect (unspecified, 84 percent), physical abuse (13 percent), parental drug abuse (nine percent), and “caregiver ill/unable to cope” (7.5 percent).

In-Home Services

Cases Opened: In F’Y 2019, 618 cases were assigned to the In-Home Administration. ¹ Of these cases, 69 percent resulted from a finding of abuse, 26 percent from neglect, five percent from sexual abuse, and less than one percent from allegations of sex trafficking (three cases) and child fatality (three cases). A total of 662 in-home cases closed in 2019, slightly more than the number that opened.

Case Closures: The the reasons for closure of in-home cases that CFSA provided are confusing, and Chairperson Nadeau asked about these during the hearing. Half of the cases closed because “child welfare services not needed,” a category whose meaning is unclear. Another 126 closed because “services/service plan not completed.” Still another 89 closed because of “completion of treatment plan.” It is hard to understand how that differs from “service plan completed.” Four cases closed for “client’s failure to co-operate.” Since in-home cases by definition involve high risk to children, this is somewhat disconcerting. The Council might want to ask what happened to the families in these cases. Were the children removed, or simply left in their risky situations without monitoring? Was a risk assessment done before case closure? CFSA and the Court monitor have agreed that court involvement (through community papering) should be considered for noncooperative parents with in-home cases. It is also significant that 38 of the families moved out of the District. A reasonable conjecture would be that many moved to Maryland. There have been child fatality cases around the country involving families with in-home cases moving between states (or even lying that they were moving out of state) and avoiding further supervision by CPS. The Council could ask CFSA whether they verify such moves and inform the receiving state of these families.

Services to In-home families: Families with in-home cases develop a case plan with their social workers that outlines the services they need to complete in order to close their cases. Among the services most frequently included are mental health services, drug treatment, parenting skills training, and domestic violence interventions. As the Citizen Review Panel pointed out in a recent report, many many parents with in-home cases who need mental health services in order to comply with their case plans, as well as many of their children, struggle to obtain timely quality services in light of long waiting times and high provider turnover. In response to the committee’s question about what the agency is doing to ensure these families get the services they need, CFSA stated that “In-Home families access mental health services through DBH” and that the two agencies work collaboratively to address families’ needs. It is clear that CFSA understands the deficiencies in DBH services because it has opened an in-house mental health unit to serve children in foster care and plans to expand these services to their families. That leaves the larger group of parents and children with in-home cases out in the cold. Unfortunately, the Family First Act, which was supposed to fund services to prevent children entering foster care, does not allow federal Title IV-E funds to pay for services which can be funded by Medicaid, ruling out most mental health programs in the District for Title IV-E funding..

Family First Act: Under the Family First Act, CFSA can now spend federal Title IV-E funds, formerly confined to foster care, for in-home services that have been included in the federal Title IV-E Prevention Services Clearinghouse. As discussed in the oversight hearing, CFSA expects only $80,000 in revenue from Family First because there was only one program in the clearinghouse at the time CFSA developed its Family First Plan–Parents as Teachers–that CFSA chose to provide and that was not already sufficiently funded using other sources. However, Motivational Interviewing and Healthy Families America have been added to the clearinghouse since CFSA submitted its plan, and CFSA stated that it hopes to draw down federal funding for these programs.

Foster Care

Placement instability: Frequent placement changes continued to be a problem in 2019. About 51 percent of children had one placement episode in FY 2019; another 27 percent experienced two episodes, 16 percent experienced three to four episodes and seven percent had five or more. The percentages were fairly similar in FY 2018, with slightly more experiencing one or more than five episodes. As described by witnesses at the oversight hearing, it is often the children with behavioral problems and disabilities who bounce from placement to placement because foster parents are unable to handle their issues.

Overnight stays at CFSA and emergency placements: As discussed at the oversight hearing, more children stayed overnight at the agency in FY 2019 than in FY 2018. This number increased from 13 youths in FY 2018 to 31 in FY 2019. According to CFSA’s responses, the factors behind these overnight stays included placement disruptions occurring late at night or early in the morning, lack of psychiatric options such as sub-acute psychiatric programs and partial hospitalization programs, youth brought back to the agency by foster parents, and youths refusing to leave the building for an offered placement. The number of youths staying in an emergency, short-term, or otherwise temporary placement while awaiting a long-term placement also increased from 79 in FY 2019 to 100 in 2020.

Placement Capacity: Placement capacity has increased greatly from 758 beds as of September 30, 2018 to 941 at the time of the oversight responses–presumably January 2020. Not surprisingly, given the decline in the foster care population, the number of vacant beds increased from 66 in January 2019 to 327 in January 2020. This huge increase in vacancies at a time when children are staying overnight in the CFSA building as described below illustrates that the problem in the District is not the number of foster homes but the lack of placements for harder-to-place children.

Expanding Placement Capacity: In order to expand the placement array, CFSA in FY 2019 added two Stabilization Observation Assessment Respite (“SOAR”) professional foster homes with a total of four beds, to serve high-needs children; entered into a contract with Children’s Choice to provide intensive foster care to 36 children, secured six additional congregate care beds for children with Autism Spectrum Disorder, and added six additional behavioral/therapeutic beds in a new group home run by the Children’s Guild. The agency expressed the hopes that these new resources will reduce stays in offices and emergency placements and also hopes to increase placements with kin.

Kinship Care; Twenty-eight percent of children in out-of-home care were in kinship homes on the last day of FY 2019 (up from 26% in FY 2018), as compared to a national average of 32 percent. To explain this difference, CFSA cited the stricter licensing requirements in Maryland, where many relatives live, as well as the lack of affordable housing in the District. More use of kinship diversion to place children with relatives outside of the foster care system could account for a jurisdiction’s lower-than-average percentage of foster parents who are kin. However, neither CFSA nor most other jurisdictions collect the data that would allow comparison of the frequency of the practice.

Assistance to relative caregivers outside foster care: In FY 2019, 521 families with 822 children were served by the Grandparent Caregiver program, up from 513 families with 798 children in FY 2018. The average benefit received in FY 2019 was $1,145 per month. The Close Relative Caregiver program was established in FY 2019 and currently serves 12 caregivers and 22 children, who are expected to receive an average of $553 per child per month. CFSA started its Kinship Navigator Program in the last quarter of FY 2019 and includes a helpline, enrichment events for families, flex funds for one-time or short-term needs, and educational groups, which are slated to begin later in FY 2020.

Group Homes: The number of group home beds decreased from 71 as of January 15, 2019 to 67 as of January 15, 2020 despite CFSA’s opening two new group homes for children with special needs. There were 17 vacant group home beds, as compared to 14 the previous year. In an email responding to my questions, CFSA’s Intergovernmental Affairs Liaison Yolanda McKinley explained that the decrease stemmed from the decline in foster care caseloads and the continuing move away from congregate care as a placement option for most youths.

Mental Health Services: The new in-house mental health unit appears to have reduced the time it takes for children newly placed in foster care to access needed mental health services. Children receiving services from the Department of Behavioral Health (DBH) waited an average of 75 days between mental health screening at CFSA and intake and the actual receipt of services. Children served by the in-house mental health unit waited an average of 35 days. Seventy-three children were served by the unit in FY 2019. Unfortunately, CFSA answered the question about length of service, type of service, and transition to an external provider with a table that provides a separate row for each of the 73 children receiving services. The Committee might want to request aggregate data about length of service to get a better overall picture. For those children who completed services, the average length of service ranged from seven to 399 days. Six children, all of whom received at least 259 days of services at CFSA, transitioned to another provider after completing service at CFSA.

Psychiatric hospitalization: A total of 118 children in foster care had an episode of psychiatric hospitalization in FY 2019, compared to 122 in 201, according to Director Brenda Donald, who corrected in her oral testimony an error in the oversight answers for FY 2018.

Educational Performance: The abysmal educational performance of DC youths in foster care is no surprise and not different from that other jurisdictions around the country. Only five percent of third through eighth graders and two percent of those in grades nine through twelve met or exceeded expectations for their grade in mathematics. In reading, the percentage meeting or exceeding expectations was 12 percent for grades 3-8 and five percent for grades 9-12. In its oversight responses, CFSA rightly points out that there are many factors behind this abysmal school performance, most of which predated children’s placement in foster care. These include cognitive or other disabilities, periods of missed schooling, mental health concerns, and trauma histories. But while all foster youth should receive intensive supports to help reduce the deficits they bring into foster care, my experience as a foster care social worker and mentor has revealed that the system often instead imposes new disadvantages. These can include foster parents who take little interest in the child’s education (especially Maryland foster parents when the child attends a DC school), long commutes to keep children in their original school (which may result in a child missing a whole day of school for a doctor’s appointment), and system-induced absences for court hearings, meetings, and medical appointments scheduled during school hours for the convenience of staff who must take them to these appointments.

The number of students receiving tutoring went down from 285 in 2018 to 209 in 2019. CFSA’s Yolanda McKinley explained in her email that the agency conducted a comprehensive review of service utilization and terminated tutoring services for students with a “poor history of utilization,” those who had completed their educational goals, and those who had exited foster care.

The number of youths receiving mentoring services declined from 172 to 118 during Fiscal Year 2019. In her email, McKinley explained that CFSA has changed its referral guidelines so that youth who are nearing reunification with their families are not referred to contracted mentoring services through BEST Kids. They also removed from the mentorship rolls young people who were not actually participating in mentoring services. According to McKinley’s email, “[T]he lower FY19 number accurately represents youth who are actively engaged in mentoring services.”

School stability transportation: CFSA paid a total of $1,310,966 , or $99 per youth per day, to transport 199 foster youth living in Maryland to their original schools in the District. In addition to the high costs, these transportation arrangements may require children to spend two to three hours on the road daily and deprive them of the opportunity to participate in extracurricular activities. There is no debate that it would be better to place children in foster homes that are near their schools. CFSA is already investing heavily in foster parent recruitment in the District but perhaps future efforts could be targeted around the schools and neighborhoods that send the largest number of children to foster care. Trying to recruit families and teachers from schools and churches close to these schools might be a good approach. In view of the large numerical surplus of foster homes, CFSA might want to consider closing some Maryland foster homes in order to increase the ratio of DC to Maryland homes.

High School Performance and Graduation: CFSA had access to grade point average information for only 84 of the 186 youths enrolled in high school during the 2018-2019 school year. These GPA’s ranged from a low of 0 to a high of 4.42, with a median of 1.61. The high school graduation rate for the last academic year was 73 percent, which was calculated by dividing the number of youth who graduated from the 12^th grade or earned a GED by the end of the school year by the number of foster youth who were in the 12^th grade or a GED program ² at the beginning of the year.

College: Thirty-six young people were enrolled at a four-year college in Fall 2019, and 11 were enrolled in a two-year college. These figures are similar to those from the previous year. Eight young people received a Bachelor’s degree in the 2018-2019 school year and no youths achieved an associate’s degree in that year. CFSA reports that 19 youths dropped out of college in FY 2019.

Older Youth Issues

Program changes: YV LifeSet is a new grant-funded program that has replaced Career Pathways. There were 49 youths involved in YVLifeset as of January 2020, compared to 113 in Career Pathways in 2019. Eighteen youths were enrolled in vocational programs in FY 2019, compared to 35 in 2018. It is possible that the reduction is due to the end of the Career Pathways program.

Independent Living: In January 2019, there were 10 beds in Independent Living Programs (ILP’s) in CFSA’s system, of which 5 were vacant. By January 2020, all of these beds had been eliminated. In its oversight responses, CFSA explained that it no longer offers ILP’s due to “underutilization.” Last year’s oversight responses clarify the meaning of this term. In its 2018 responses, CFSA described its conclusion that youths placed in ILP’s who have not demonstrated their maturity have struggled after aging out. In 2018, CFSA revised its policy by requiring youths to demonstrated readiness by having a high school diploma, being engaged in employment, education or training and having a savings account in order to move into an ILP. In tandem with this policy change, CFSA reduced the number of ILP slots from 20 to 10 by eliminating one of the two ILP programs. CFSA reported that only three young people moved into an ILP after the new policy and there were only five youths total in the one ILP at the end of the fiscal year. This appears to be the “underutilization” that resulted in closure of the remaining program in FY 2019.

Aging Out: CFSA answered that 45 out of 49 youths had stable housing at the time they aged out of foster care in FY 2019. However, a witness from the Children’s Law Center stated at the oversight hearing that “the agency improperly defines transitional housing, college dorms, staying with friends, and DDS placements as ‘stable living arrangements.”’ If those arrangements are considered unstable, 32 out of the 49 youths who aged out were in unstable housing.

Permanency

The number of adoptions finalized remained nearly the same–98 in FY 2019 and 101 in FY 2019. There was an average of 14 months between filing of the adoption petition and finalization of the adoption, up from 10 months in FY 2018. The number of guardianships finalized declined from 64 to 40 with an average of 19 months between placement in a home and finalization of the guardianship, down from 39 months in FY 2018. The Committee did not ask similar questions about reunification.

Fatal Incidents

CFSA reported that eight children and youth died while in CFSA care in FY 2019. Four children were in foster care, three had open In-Home Cases and one had an open Family assessment or investigation at the time of death. I view these numbers as very distressing and I hope that the Council requests further information about them. It could be that some of these children were medically fragile and that their deaths were not due to maltreatment of any type. Such basic information as the cause of death is necessary for the Committee to make sense of this information.

Conclusion: CFSA’s answers to the oversight questions of the DC Council’s Human Services Committee provide a trove of useful information. A continued reduction in the number of children in foster care, an increase in stays in agency offices and emergency placement, a large surplus of foster care beds along with continued need for more placements for hard-to-place youth, expansion of the placement array in response to this problem, successful implementation of a mental health unit to serve foster youth, the elimination of independent living programs, and high number of fatalities among system-involved children are among the results that stand out. Child Welfare Monitor DC was able to obtain corrections for some responses from CFSA that did not appear to make sense. Nevertheless, some responses were unclear or delivered in a format that is difficult to use. The Council might want to seek clarification in these cases and modify its questions next year in order to obtain information that is more useful in its effort to oversee and support CFSA’s important work.

There are no comparable data for FY 2018 because of a change in the data collected. ↩
This number was incorrectly reported as 32 instead of 26 in the oversight responses, according to the clarifying email by CFSA. ↩

The CFSA Performance Oversight Hearing: Progress and Problems

Screen Shot 2020-02-17 at 3.32.03 PM The annual oversight hearing on the Child and Family Services Agency took place on February 12, 2020. The hearing lasted over six hours and covered a wide variety of topics and perspectives. The testimony painted a mixed picture of considerable progress along with continuing concern about major issues including the availability of placements meeting the needs of some of the more difficult-to-serve clients. Much of the testimony centered around CFSA’s responses to the committee’s oversight questions that were submitted in advance. These are a very useful resource that can be compared from year to year. Readers can watch the hearing here.

Widespread Praise for CFSA: The last to testify, CFSA director Brenda Donald heralded a year of accomplishment, including planning and getting approval for a five-year Title IV-E Prevention Plan under the new Family First Prevention Services Act, creating the local Families First DC program, reducing the scope of monitoring under the LaShawn class action lawsuit, settling its new arrangement for delivering foster care, fully implementing its in-house mental health unit, and gearing up for new child welfare information system. As she pointed out, CFSA is currently considered to be a national leader in child welfare. Many other witnesses also praised CFSA for these accomplishments or others.
Foster Care Numbers: Contrary to national trends, the number of youth in foster care continued to fall in the District since a year ago. Director Donald testified that there were only 796 children in care at the end of 2019 and 1357 were being served in their homes. Reunifications increased from 197 in 2018 to 227 in FY 2019 and the number of children aging out of care fell from 63 to 53. CFSA expects further declines because of the emphasis on front-end prevention, according to Director Donald, as well the agency’s continuing efforts to reduce the length of stay in foster care. Donald did not mention the movement of low-income families into Maryland due to rising rents in the District, which may be an even more important factor behind the continued declines at a time when the national foster care total has been rising.
LaShawn Exit Plan: Court Monitor Judy Meltzer of the Center for the Study of Social Policy reported that CFSA and CSSP have agreed on a revised exit plan in the 30-year-old LaShawn vs. Bowser class action lawsuit. The new plan removes 56 of the exit standards; 23 remain to be achieved. As part of the revised plan, CFSA committed to adding several types of placements and it has already satisfied most of these commitments, as described below.
Lack of appropriate placements: CFSA continues to struggle with a lack of placements for the young people with the most serious disabilities and behavioral problems, as described in testimony from CSSP’s Meltzer and witnesses from the Children’s Law Center (CLC). As a result, 31 children spent a total of 60 nights at the agency between April and November 2019. The number of children staying overnight more than doubled between FY 2018 and 2019, as Aubrey Edwards-Luce of the Children’s Law Center pointed out in her valuable written testimony. The number of children staying at the Sasha Bruce emergency shelter also more than doubled. About 100, or one in every eight children, had stayed in an emergency shelter or respite home in FY 2019. Moreover, about 22% of children in care had three or more placements, the same number as the previous year, which suggests a lack of appropriate placements for some children.
Additions to Placement Array: CFSA has made some progress in expanding the array of placements that can accommodate children with more severe problems. The agency has contracted with Children’s Choice for 36 therapeutic foster homes for youth with intensive needs; added two “Stabilization Observation Assessment Respite (SOAR) professional foster homes, with a total of four beds, to serve high-needs children; secured six congregate care placements for children with autistic spectrum disorders, and added six additional behavioral therapeutic congregate care placements.
Foster Parent Retention and Supports: Judith Sandalow of the Children’s Law Center urged CFSA to focus on retention as well as recruitment of foster families by improving its support for foster parents. Margie Chalofsky of the Foster and Adoptive Parent Advocacy Center (FAPAC) suggested several improvements to foster parent supports, including on-call and timely crisis support, which has not been consistently available through the current resources; more therapy for foster youth; and a mechanism for foster parents to evaluate social workers. Interestingly, Cheryl Brissett Chapman of the National Center for Children and Families gave a dissenting position on retention, arguing that foster parents need to take a break after two therapeutic youths. She also reminded listeners that many foster homes are lost when foster parents adopt the youths in their care and that should not be considered a problem.
Education and Employment: Data on education and employment outcomes cited by Aubrey Edwards-Luce from CFSA’s oversight responses continues to be very concerning, although the high school graduation rate among CFSA foster youth actually increased from 67% in FY 2018 to 73% in FY 2019, based on corrected data submitted later by CFSA. The Grade Point Average (GPA) of the 84 (out of 186) high-school aged children in care for whom this figure was available was only 1.69. Nearly 10% of high school students in CFSA care dropped out in FY 2019. And nine of the 40 foster youth who enrolled in college in FY 2019 dropped out, based on corrected data from CFSA. Moreover, less than half the young people enrolled in vocational programs completed them.
Youth aging out: Edwards-Luce pointed out that CFSA’s data on living arrangements of youth aging out of care are deceptive. CFSA reported that only four of the 49 youths who aged out of foster care in FY 2019 exited to unstable housing situations, which it defines being homeless, in a shelter, or incarcerated. However, CLC believes that “the agency improperly defines transitional housing, college dorms, staying with friends, and DDS placements as “stable living arrangements.” If those arrangements are considered unstable, 32 out of the 49 youths who aged out were in unstable housing.
Office of Youth Empowerment: CFSA touted its status as the first public agency to be awarded a three-year $10 million grant fromYouth Villages to implement the evidence-based and much-praised YV LifeSet program. But CLC’s Edwards-Bruce expressed concern about the elimination of OYE’s Career Pathways program, which served 113 youths in FY 2019, and its replacement by the LIfeSet Program, which served only 49 youths in the firsts quarter of FY 2020. According to CFSA’s Annual Progress and Services Report, YV Lifeset requires participant buy-in, and youths who do not wish to participate will receive similar services to those provided under Career Pathways. Moreover, there is some reason for concern that the LifeSet funding may be supplanting rather than supplementing local funds, as discussed below.
Aftercare: In her very enlightening oral and written testimony, Marcia Huff of the Young Women’s Project described her experience running CFSA’s aftercare program in a contract that lasted from 2017 to 2019. In a nutshell, Huff found that “the vast majority of the youth we worked with were unprepared to succeed when they emancipated from care at age 21.” Among the depressing data she cited about the young people entering her program: 51% were unemployed; 9% were employed 15 hours or less; and only 20% were employed full-time; 31 out of 75 were homeless or couch surfing; 32% were in temporary housing, and only 9% were in permanent housing with a long-term voucher or rent that was sustainable based on employment; 56% had one or more children; 27% needed help managing marijuana or other drugs; 58% had unresolved mental health issues that interfered with progress in employment and housing; 17% had no GED or high school diploma; and 36% had no bank or deposit account of any kind. Lack of housing was a major obstacle to engagement with the program and progress toward goals and kept many participants in a state of crisis. Lack of child care was a huge obstacle for parenting youth. Huff’s testimony, which should be essential reading for anyone who cares about foster youth, recommended first and foremost that the agency needs to “start young and go deep” to prepare youth for life after care because “by the time they are 20 it is nearly too late and it is extremely hard to turn things around.”
Youth Services Reprogramming: Human Services Committee Chair Brianne Nadeau asked about the reprogramming of $449,782 allocated for teen youth services to support for the court monitor in LaShawn, which was not included in the FY 2019 budget. Donald testified that this money was saved by bringing youth aftercare in-house, without any loss of service capacity. If true, this would point to an appalling inflation of the contract price, which seems unlikely. This writer cannot help wondering whether this money may have instead been replaced by the grant to implement YVLifeSet and hopes Chairwoman Nadeau will look into that possibility.
Kinship Care: Several witnesses celebrated the new Close Relative Caregiver Subsidy, including Donte Massey, whose testimony last yea sparked the creation of this program. Massey reported that the program is helping him raise his younger siblings. Stephanie McClellan of the DC Kincare Alliance asked the Council to remove the requirement that a caregiver must wait six month to receive the subsidy. This results in an actual eight-month rate which is a hardship for cash-strapped caregivers. She also asked the Council to consider emergency funding to eliminate the current waiting list. The longstanding Grandparent Caregiver Subsidy also received praise from caregiver Vernita Grimes, who credited program staff with providing emotional and moral, as well as financial, support .
Social Worker Support: Wayne Enoch, president of the union local representing 400 workers at CFSA, expressed his members’ concern about worker safety from attacks by clients, even in the office. The union is seeking for a “viable health and safety committee” to work with management on a long-term solution to this problem. Worker turnover is a concern for CFSA. Social workers complain about work-life balance, support from supervisors, and micromanagement rather than pay and promotions. Despite the problems, Enoch hailed Brenda Donald for her commitment to workers’ well-being and to working with the union through the Labor Management Partnership Council. He noted that CFSA has appointed a Wellness Coordinator to boost well-being among its workers. He said that other agencies should follow CFSA’s example of labor-management cooperation.
Latino Families: Isabelle Suero-Stackl of the Latin American Youth Center (LAYC) argued that CFSA is not meeting the needs of the Latin American community. Although LAYC has a contract to deliver foster care including case management to Latino families, all of these families are initially managed by CFSA, and most are served directly by CFSA. Moreover, in-home services to all families are provided by CFSA, which may be a problem for a family that does not speak English. Instead, Suero-Stackl recommended that CFSA should assign all Latino families to LAYC as soon as they come into in-home or out-of-home care.
Changing nature of foster youth: Both Director Donald and Dr. Cheryl Brissett Chapman of the National Center of Children and Families (NCCF) cited changes in foster youth. They are seeing more young children with aggressive behaviors than in the past. Dr Chapman of NCCF, which manages all of the Maryland foster homes that house about half of the District’s foster youth. had some interesting observations from a long career in child welfare. Unlike the “parentified” children seen in the crack epidemic, who acted as parents to their own parents and their siblings, many of today’s children coming into care are accustomed to be treated by their parents as peers. When they come into foster care, they are not ready to treat foster parents respectfully as adults, and many older, veteran foster parents cannot cope with disrespectful behavior. Surprisingly, placement disruptions are most frequent for children aged 9 through 12, and it is this disrespect that is causing many of the disruptions.
CFSA Mental Health Unit: the new mental health unit to provide initial services to youth coming into care seems to have be achieving its goals of allowing CFSA to screen and evaluate children more quickly and get them into therapy sooner. This unit works with children for six to nine months. Donald testified that CFSA has issued a contract for ongoing mental health services for some children with specialized needs and to serve some parents.
Child Protective Services: The number of substantiated investigations went up slightly in FY 2019, as did the number of removals, which Deputy CFSA Director Robert Matthews suggested might be due to the elimination of Family Assessment as an alternative response to investigation. He also mentioned that the quality of investigations is improving as indicated by the agency’s Quality Service reviews. However, one representative of a charter school raised concerns about the quality of CFSA responses to reports alleging child abuse and neglect. In his written testimony, Christopher Nace of the DC International School mentioned two families that were the subject of repeated and serious reports to CFSA, none of which resulted in actions that protected the children. In the case of the first child, staff reported concerns ranging from sexualized language and behaviors, physical abuse, educational neglect and sex trafficking. none of which resulted in any change in the child’s situation. In the other case, school personnel reported concerns about a family 11 times between 2016 and 2020 on issues including domestic violence witnessed by school staff, children being left alone all night, alcohol and drug abuse in the home, children being driven to school by intoxicated parents, concerns about drug distribution, physical abuse that left bruises; and fights in which weapons were drawn and students were kicked out of the house. Nace recommended that CPS investigations should take into account past allegations as well as the present one and that CFSA should collaborate more extensively with schools and other agencies involved in the lives of children and consider adding regular “check-ins.”
Families First DC: The Committee heard from many of the organizations that have received grants to start Family Success Centers under Families First DC, CFSA’s new primary prevention initiative. The grantees have been chosen and given money for a year of planning. The centers are to launch early in Fiscal Year 2021.All of the grantees praised the support of CFSA and the provision of a year to plan their programs with input from community residents. Grantees expressed their excitement about this program.
Transparency and Responsiveness: After last year’s hearing, where representatives of several organizations lamented a decline in transparency and community involvement by CFSA, both the Children’s Law Center and the Foster and Adoptive Parent Advisory Council (FAPAC) noted that CFSA had become more open and responsive to feedback from advocates and foster parents in the last year.
Ombudsman Proposal: Several witnesses, including Aubrey-Luce of CLC, reiterate the need to move forward the proposal of establishing an independent Ombudsperson for CFSA in order to spur the needed improvements.

This year’s oversight testimony highlighted agency’s ability under the leadership of Brenda Donald to accomplish major initiatives. Of more doubt to this writer is how many of these initiatives actually improve children’s lives. Some of the most important testimony highlighted the major problems that still plague the District’s foster care system, especially the lack of appropriate placements for the hardest to serve children and the lack of effective approaches to enhancing education and employment outcomes for foster youth. As I have written before, CFSA’s vaunted success in getting the first Family First plan approved is of limited utility given the extreme limitations on services available for funding. However, CFSA responded in an email to this writer that “CFSA’s implementation of Family First//// is not designed to produce immediate results. ” Instead, “Family First has created the momentum for the District to look at our referral pipelines, assess the systems we have in place to ensure referral connections are made timely and, have targeted conversations to determine if we have the right services available to meet children and their families’ needs.”

The abysmal outcomes for older foster youth and those who have aged out (while consistent with those around the country) indicate that there is much room for improvement. And the transfer of $450,000 in services to older youth in order to pay for the court monitor’s oversight is particularly concerning considering the great needs of these youth. However, some of the new initiatives, such as the addition of new placements for children with greater needs, the creation of in-house mental health services, and the establishment of Family Success Centers are likely to make life better for children in CFSA care and in the community.

Director Donald’s concluded by expressing her gratitude to the Mayor for supporting CFSA in its request for funding for its new initiatives. She did not however, point out that parents and youths involved with CFSA rely on other systems, like behavioral health and child care, in order to achieve their goals. Many parents rely on mental health and drug treatment services provided by the Department of Behavioral Health (DBH) to get their children back or keep their children at home–and these services are characterized by waiting lists, high turnover, and insufficient capacity. CFSA has attempted to compensate for DBH deficiencies by creating its own mental health unit for children in care, and is expanding that unit to serve their parents as well, but parents and children with in-home cases will still be relying on services funded by DBH. Youth who have aged out need these services as well, including help in managing their use of marijuana and other drugs, as mentioned in testimony by the Young Women’s Project. Parents with in-home and out-of-home cases, as well as parenting youth in foster care and aging out, all struggle to find and pay for child care. In order to ensure that CFSA can achieve its goals, the generosity of the Mayor must extend to other systems as well.

This post was updated on February 25, 2020 to incorporate corrections and comments from CFSA.

CFSA’s “Family First” Plan shows limits of new law

PuttingfamiliesfirstDC On October 29, 2019, the Child and Family Services Agency (CFSA) became the first child welfare agency to have its Title IV-E Prevention Plan approved by the federal Administration on Children and Families (ACF). This plan, called Putting Families First in DC, describes how CFSA plans to implement the Family First Prevention Services Act (“Family First”). .While it is encouraging that the District was successful in gaining federal support for its plan, it is disheartening that there will be very little expansion of services under this new legislation, and that Family First will have no impact on the shortage of critically needed mental health services for parents.

Family First widened the population of children and families that can be served under Title IV-E of the Social Security Act from children in foster care to children who are “candidates for foster care” and their families. A “candidate for foster care” is defined as a child who is identified in the jurisdiction’s prevention plan is being at “imminent risk of entering foster care” but who can remain safely at home or in a kinship placement if services are provided. Each state sets its own definition of a candidate for foster care in its Title IV-E plan. CFSA has chosen a fairly broad definition, which includes many types of families that have been investigated by CFSA after an allegation of child abuse or neglect

Most interestingly, CFSA has chosen to include as “candidates for foster care” children of pregnant or parenting youth who are in foster care or have left foster care within five years. The inclusion of these families is particularly significant because it allows services to families in which abuse or neglect has not taken place. Rather than preventing the recurrence of abuse or neglect (known as “tertiary prevention”) this extends the use of Title IV-E funds to preventing the first occurrence to a high-risk population (known as “secondary prevention”). This represents a more “upstream” approach, which many experts and child welfare leaders have long been arguing deserves more support.

However, the effects of this expansion of the eligible population are drastically constrained by the severe limitation on what services can be provided under Family First. The Family First Act extends the use of Title IV-E funds to services designed to prevent placement of children in foster care. Three categories of services are allowed: “in-home parent skill-based services,” mental health services, and drug treatment. (“Navigation” services to kin who are caring for children are also covered). So far, so good. But when specific services are considered, things become complicated.

As I described in earlier posts, the decision of Congress to make Medicaid the payer of last resort rules out using Title IV-E to fund many mental health and drug treatment programs that are crucial to keeping families together safely. And Congress’ decision to limit reimbursement to programs that are included in a Title IV-E Prevention Services Clearinghouse rule out support for many promising and supported programs that jurisdictions are already using or might want to use to support their struggling families.

Through a Program Instruction, ACF recently gave states an option to claim “transitional payments” for services that have not yet been approved by the clearinghouse, by conducting an “independent systematic review” of such services. But the funding will be cut off if the Clearinghouse decides not to approve the service, and it is not clear if any states will use this option. The District of Columbia has elected not to do so. As a result, after all the hoopla, the District is claiming only one evidence-based prevention service for funding under Family First! That is the Parents as Teachers (PAT) home visiting program, which is already being provided by the DC Department of Health using federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds. CFSA will be using local dollars, matched by federal Title IV-E funds, to add slots to this program to meet the needs of its foster care candidates and their parents.

It is worth noting that the evidence on PAT’s potential to prevent child maltreatment or its recurrence not very compelling. The California Clearinghouse for Evidence Based Practices in Child Welfare (CEBC, the leading organization of its kind) rates it as only “promising” (not “supported” or “well supported”) on primary prevention and does not even rate it on prevention of maltreatment reduction. Since the CEBC rated the program, a new study was released testing the potential of PAT to reduce maltreatment among parents who already have been found neglectful or abusive. The study found no overall effect, though they did find that there was a reduction in maltreatment reports for parents who were not depressed and did not have a significant history with Child Protective Services–in other words, the easiest-to -treat minority of the population of parents involved with CPS.

It is also strange that CFSA has not adopted the home visiting program that has shown the strongest evidence by far of preventing child abuse and neglect. That is the Nurse Family Partnership (NFP) , which is the only program to have been given a rating of 1 (“Well Supported by Research Evidence”) by the CEBC for the prevention of child abuse and neglect. NFP is designed for first time teenage mothers only; it would be a natural for teen parents in foster care and other teen parents citywide. It is a shame that DC’s Department of Health has not chosen to invest in this program and that CFSA has followed suit.

It is likely that CFSA will eventually receive Title IV-E support for a second service. Motivational Interviewing (MI) was approved by the Title IVE Prevention Services Clearinghouse after CFSA had already submitted its plan. MI is a method of counseling to facilitate behavior change, especially regarding substance abuse. It is typically delivered over one to three sessions. However, CFSA has included Motivational Interviewing in its plan as a “cross-cutting” program rather than a program addressing substance abuse. The agency states that it intends to use MI as a “core component” of its case management model, rather than a two-or-three-session freestanding program. Brenda Donald, CFSA’s director, told the Chronicle of Social Change that she expected to be able to claim IV-E reimbursement for case management once it was added to the clearinghouse. Other jurisdictions are moving in the same direction, according to the Chronicle.

CFSA included in its Family First Plan other programs eligible for Title IV-E funding but is not planning to claim federal funds for these programs because they are already supported by federal funds. Also included are several services that have not yet been approved for Family First funding and are supported by Medicaid or local dollars. It’s a large array of programs, none of which will be supported by Title IV-E funds except PAT and perhaps MI.

So under Family First, Title IV-E dollars are being used to expand one home visiting program in the District and perhaps can be used to match funds spent on case management if CFSA succeeds in making the case that the use of the MI approach makes case management reimbursable. In the meantime, District parents with children at risk of foster care placement are desperately seeking needed services, especially mental health services to treat their mental disorders, such as depression and Post Traumatic Stress Syndrome (PTSD) that contribute to child abuse and neglect. As recently reported by the District of Columbia’s Citizen Review Panel (CRP), there is such a shortage of basic mental health services for parents that social workers are doing therapy themselves and also trying to substitute alternative services that may not be as effective, such as telemedicine or yoga. Lack of appropriate mental health services and long waiting lists were major themes of CFSA’s 2019 Quality Service Review, as reported by the CRP. Poor quality of Medicaid-funded services and rapid turnover of providers are also problems that plague CFSA-involved parents and their social workers.

What a difference Family First could have made if its funds could be used to augment the supply of Medicaid-funded basic mental health services such as medication management, individual and group therapy! How many families could be strengthened if the Clearinghouse had included, or was considering, newer and exciting evidence-based mental health services like EMDR and Mindfulness Based Stress Reduction that may not be covered by Medicaid! Without federal help through Family First, parents involved with CFSA continue to wait for services they need to parent their children safely.

Another problem for CFSA lurks down the road. As CFSA describes in its plan, the law requires that 50% of IV-E spending be for practices that are “well-supported” as defined by the Act. But most of the “well-supported” practices that CFSA is using are funded by Medicaid in the District. If the Medicaid-funded programs cannot be counted as part of CFSA’s total Family First expenditures (which ACF has suggested will be the case), CFSA will not be able to show that it is spending 50% on “well-supported” practices. Congress has already passed the Family First Transition Act, which delays implementation of this requirement to 2024, with a requirement that by 2022 states have to show 50% of practices as “supported” or “well supported.” But what will happen then? The Chronicle voices the hope that more practices would have made it to the well-supported list by that time. We shall see.

With all the fanfare around Family First and CFSA’s large investment of time in developing this plan, it seems clear that the agency is gaining few resources in return for the large burden of showing compliance with Family First. It’s ironic that CFSA must provide extensive documentation to ACF regarding services that are getting no funds under the act. CFSA and other jurisdictions should press for amendments that make Family First more likely to achieve its objective of supporting parents to improve their parenting and keep their children safely at home.

Washington Post on foster care: old tropes and false narratives

: Image: Washington Post

A note to readers: This first substantive post on Child Welfare Monitor DC is unusual because it focuses on national, not local issues. However, it is important for a local blog to comment on the coverage offered by our local newspaper of record, the Washington Post, and that is why this piece is included in this blog.

Foster care has finally made it to the front page of the Washington Post, and a sad story it is. The story highlights the growing crisis in many states due to the increase in drug addiction bringing in its wake a cascade of child removals into foster care, outstripping the supply of foster homes and other placement. The problems outlined in the article are real and urgent, but the analysis and prescriptions offered in the article and subsequent editorial reveal the authors’ lack of understanding of the issues, which results in the repetition of false narratives and common misleading tropes.

The Post‘s front-page article focused on a growing crisis caused by increased drug addiction among parents, especially the opioid crisis. The author, Emily Wax Thibodeaux, zeroed in on West Virginia, one of the epicenters of the crisis. She introduced us to Arther Yoho, a young man who spent more than two years in a detention center because there was no foster parent available to take him in. Locked up with 27 juveniles with criminal convictions, Arther was failed by the system that was supposed to protect him.

Thibodeaux reports that other desperate states are using emergency shelters, hotels and out-of-state institutions to house youth for whom there is no foster family home available. This is tragic and true, and I wrote about it in a recent post, although the placement of foster youth in detention centers along with criminally charged youth may be unique to West Virginia with its cataclysmic foster care crisis. Thibodeaux reports Oregon’s use of refurbished detention centers to house foster youth, which is certainly not ideal but is quite different from housing them with juvenile offenders. In any case, Thibodeaux is right to point out that many young people in foster care are being placed in inappropriate (and often harmful) placements because appropriate ones are not available.

However, Thibodeaux takes an unwarranted conceptual leap by linking the placement of children in inappropriate facilities to states’ use of congregate care, a term used to connote placements that are not families. These include what are generally known as group homes, as well as residential treatment centers, which are part of the accepted continuum of care for foster youth. While detention centers are never appropriate for foster youth who have not been charged with a crime, group homes and residential treatment centers may be the appropriate placement, often for a limited time, for some youths in foster care. These are the young people who cannot be maintained in a regular foster home because of their defiant, violent, or self-destructive behavior. Many of these children might be able to “step down” to foster care after spending time at a therapeutic residential facility. It is possible that some of these young people could be helped in a professional therapeutic foster home staffed by salaried and trained foster parents, an approach that is gaining increasing interest, but programs so far are few and small and not likely to meet the need for therapeutic placements.

Thibodeaux cites the common trope that “Compared with foster children living with families, those housed in congregate care settings are more likely to drop out of high school, commit crimes and develop mental health problems.” That is very true. But it is a matter of correlation, not causation. It is the younger and less damaged children who end up in foster homes in the first place. Not surprisingly, they are likely to have better outcomes. Concluding that congregate care causes the negative outcomes may well be akin to concluding that fire trucks cause fire damage since buildings that have been visited by fire trucks are far more likely than typical buildings to have sustained fire damage. We don’t have a body of research on what happens to children with similar risk factors who spend time in foster homes compared to those who spend the same amount of time in group homes.

Thibodeaux appears to be unaware that some of the states with the lowest proportions of children in congregate care are those that are struggling the most with inappropriate placements. Washington and Oregon are among the states with the highest proportions of foster children placed in families as opposed to congregate care facilities, according to federal data cited in a recent report from the Annie E. Casey Foundation. Both states have been the subject of disturbing media reports that foster youth are staying in hotels, offices and substandard and abusive out-of-state facilities. That’s not surprising, since appropriate options are not available. In Washington, ten years of group home closures led to the current crisis. The director of Washington’s child welfare agency has requested funding to expand the capacity of therapeutic group home beds to accommodate the children who are now staying in hotels and offices. The director of Oregon’s agency has cited a reduced number of treatment beds as a cause of children being sent to substandard and abusive out-of-state facilities.

By implying that all congregate care placements are inappropriate, Thibodeaux lays the groundwork for false conclusions about policy. Rather than saying that states need to beef up their therapeutic options, whether they are professionally-trained therapeutic foster parents or therapeutic group homes or residential treatment centers, Thibodeaux suggests that the new Family First Prevention Services Act, which makes it more difficult to obtain federal reimbursement for congregate care stays, may solve the problem.

Actually, the Family First Act may well make things worse. By making it harder to license therapeutic group homes, there is reason to fear that Family First will exacerbate the placement crisis. This has already happened when group homes closed in in jurisdictions like Oregon, Washington, New York City, and Baltimore. In California, the closure of group homes due to their Continuum of Care “reform” (a predecessor of the Family First Act) has resulted in, according to one veteran service provider, “fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care.”

The Washington Post followed Thibodeaux’ article with an editorial, “The Crisis in Foster Care,” which repeated and further distorted some of Thibodeaux’s questionable statements. Where Thibodeaux reported that 71% of foster children aged 12 to 17 are in congregate care placements in West Virginia (a high number to be sure), the editorial page erroneously stated that seven in ten of all foster children are in such foster care placements. That is a huge difference as older children are much more likely to be in such placements.

The opinion writers go on to repeat Thibodeaux’ misleading statement from the Casey Foundation about children in group homes doing worse than those in foster homes. However, they also cite discouraging outcome data about children growing up with foster parents. Because both options seem bad, the opinion writers suggest that “the least-bad option for many children” may be staying or reuniting with their parents, “unless there is abuse in the home. “They go on to cite one of the most persistent tropes of all that child protective services workers “often remove minors from neglectful parents who, while a far cry from being good caregivers, may still be better than group homes.”

The trope that child neglect is “less than ideal parenting” is belied by some of the stories that have come out of West Virginia and other states in the throes of the opioid crisis. We’ve all heard the stories: infants born addicted to drugs to mothers unable to care for them, children who lost their parents and even their extended families due to opioid overdoses, children abandoned at home without food while parents seek drugs, children strapped in cars while their parents get high, babies and toddlers who ingest heroin, alcohol or meth; children whose parents are incarcerated due to substance abuse or dealing; and more. This is not “imperfect parenting” but something much worse. Living with an addicted parent is has a host of negative consequences that may be lifelong and is in itself considered an Adverse Childhood Experience (ACE).

One article from the Seattle Times documents the impact of the drastic increase in infants born addicted to drugs when they reach school age. “[The lives of children who grow up with drug-abusing parents are marked frequently by the presence of police, the constant fear of a mother or father’s incarceration and the likelihood of sudden death by overdose — all traumas shown to impede brain development and learning.”

To add insult to injury, the Post did not even seek to find out what is happening in its own back yard. Only two weeks before Thibodeaux’s article, a hearing was held in the 30-year-old LaShawn class action case to discuss the current placement crisis in the District of Columbia. The Judge referred to a letter from the court monitor that 31 children, including seven children between eight and ten years old, experienced a total of 60 overnight stays at the Child and Family Services Agency between April and November of 2019. All of these children had challenging behaviors that excluded them from existing placements. The agency director acknowledged that the District needs more therapeutic placements (either in family or group settings) for these children. The District is in the process of developing a new group home and “a couple of” professional foster parents. The District is a small jurisdiction and its crisis is dwarfed by that of West Virginia, but its 60 office stays deserved a mention in our hometown paper.

The Washington Post‘s treatment of foster care illustrates the consequences of letting reporting and editorial staff without subject matter expertise tackle a complex subject like foster care. Repeating false narratives and tropes from alleged authorities is easy and saves time. But it does not help readers to understand what is wrong and what is needed and on the contrary leads them to look for “solutions” that may make things worse.