[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
FAILURE TO PROTECT CHILD SAFETY
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RESOURCES
of the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
JUNE 17, 2004
__________
Serial No. 108-61
__________
Printed for the use of the Committee on Ways and Means
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99-679 WASHINGTON : 2005
_________________________________________________________________
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COMMITTEE ON WAYS AND MEANS
BILL THOMAS, California, Chairman
PHILIP M. CRANE, Illinois CHARLES B. RANGEL, New York
E. CLAY SHAW, JR., Florida FORTNEY PETE STARK, California
NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California
AMO HOUGHTON, New York SANDER M. LEVIN, Michigan
WALLY HERGER, California BENJAMIN L. CARDIN, Maryland
JIM MCCRERY, Louisiana JIM MCDERMOTT, Washington
DAVE CAMP, Michigan GERALD D. KLECZKA, Wisconsin
JIM RAMSTAD, Minnesota JOHN LEWIS, Georgia
JIM NUSSLE, Iowa RICHARD E. NEAL, Massachusetts
SAM JOHNSON, Texas MICHAEL R. MCNULTY, New York
JENNIFER DUNN, Washington WILLIAM J. JEFFERSON, Louisiana
MAC COLLINS, Georgia JOHN S. TANNER, Tennessee
ROB PORTMAN, Ohio XAVIER BECERRA, California
PHIL ENGLISH, Pennsylvania LLOYD DOGGETT, Texas
J.D. HAYWORTH, Arizona EARL POMEROY, North Dakota
JERRY WELLER, Illinois MAX SANDLIN, Texas
KENNY C. HULSHOF, Missouri STEPHANIE TUBBS JONES, Ohio
SCOTT MCINNIS, Colorado
RON LEWIS, Kentucky
MARK FOLEY, Florida
KEVIN BRADY, Texas
PAUL RYAN, Wisconsin
ERIC CANTOR, Virginia
Allison H. Giles, Chief of Staff
Janice Mays, Minority Chief Counsel
______
SUBCOMMITTEE ON HUMAN RESOURCES
WALLY HERGER, California, Chairman
NANCY L. JOHNSON, Connecticut BENJAMIN L. CARDIN, Maryland
SCOTT MCINNIS, Colorado FORTNEY PETE STARK, California
JIM MCCRERY, Louisiana SANDER M. LEVIN, Michigan
DAVE CAMP, Michigan JIM MCDERMOTT, Washington
PHIL ENGLISH, Pennsylvania CHARLES B. RANGEL, New York
RON LEWIS, Kentucky
ERIC CANTOR, Virginia
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
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C O N T E N T S
__________
Page
Advisory of June 10, 2004, announcing the hearing................ 2
WITNESSES
Maryland Department of Human Resources, Hon. Christopher J.
McCabe......................................................... 7
Baltimore City Department of Social Services, Floyd R. Blair..... 10
Baltimore City Health Department, Peter Beilenson................ 17
University of Maryland, School of Social Work, Center for
Families, Diane DePanfilis..................................... 22
SUBMISSIONS FOR THE RECORD
Cook, Theresa S., Santa Clara, CA, statement..................... 42
Fight Crime: Invest in Kids, statement........................... 47
Justice for Children, Eileen King, letter........................ 50
Zero to Three: National Center for Infants, Toddlers and
Families, Matthew E. Melmed, statement......................... 51
FAILURE TO PROTECT CHILD SAFETY
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THURSDAY, JUNE 17, 2004
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Human Resources,
Washington, DC.
The Subcommittee met, pursuant to notice, at 4:00 p.m., in
room B-318, Rayburn House Office Building, Hon. Wally Herger
(Chairman of the Subcommittee) presiding.
[The advisory announcing the hearing follows:]
ADVISORY
FROM THE
COMMITTEE
ON WAYS
AND
MEANS
SUBCOMMITTEE ON HUMAN RESOURCES
CONTACT: (202) 225-1025
FOR IMMEDIATE RELEASE
June 10, 2004
Herger Announces Hearing on
Failure to Protect Child Safety
Congressman Wally Herger (R-CA), Chairman, Subcommittee on Human
Resources of the Committee on Ways and Means, today announced that the
Subcommittee will hold a hearing on a recent failure to protect child
safety. The hearing will take place on Thursday, June 17, 2004, in room
B-318 Rayburn House Office Building, beginning at 4:00 p.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only.
Witnesses will include State and local officials and outside experts
familiar with the child welfare system in Baltimore, Maryland.
BACKGROUND:
News accounts have documented events leading to the recent death of
twin infant girls in Baltimore, Maryland. These newborns were released
to their mother, a foster care runaway previously involved with child
welfare authorities. The circumstances of this tragedy have prompted
numerous questions that highlight broader child welfare policy
concerns: How well do government officials track children in their care
and individuals previously in contact with child welfare authorities?
Are child abuse cases reported and investigated promptly to ensure
child safety? Are government agencies working together effectively to
protect vulnerable children?
Federal taxpayers provided States with more than $7 billion in 2003
to promote safety, permanency, and well-being of children in or at risk
of needing foster care. A significant share of these Federal funds
support administrative costs, including systems and salaries dedicated
to monitoring the well-being of children under the care of birth,
foster, and adoptive parents. In recent months, the Subcommittee on
Human Resources has held a series of hearings on another high-profile
case involving a failure to protect children in New Jersey, as well as
reporting and oversight issues that reflect on broader program trends
and concerns in child welfare.
In announcing the hearing, Chairman Herger stated, ``This
incredibly sad situation highlights once again that the current child
welfare system is ill-equipped to protect children. Such failures to
ensure the safety of children are unacceptable. Federal taxpayers pay
billions of dollars each year for systems and salaries designed to
prevent such tragedies from happening. This hearing will examine the
circumstances of this case to better inform policymakers about steps we
should consider taking to better protect children.''
FOCUS OF THE HEARING:
This hearing will focus on (1) the facts of a recent child welfare
case in which twin infants died in Baltimore, Maryland; and (2) the
implications of this case for efforts to improve the child welfare
system.
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Chairman HERGER. Today's hearing focuses on a child welfare
tragedy, the death of twin infant girls in Baltimore last
month. I want to thank Mr. Cardin for suggesting this hearing
as a continuation of our review of how child welfare systems
are failing to protect children. Our purpose this afternoon is
to understand what happened in this case so we do all we can to
keep it from happening again in Baltimore and elsewhere. We
welcome our guests from the State of Maryland and the city of
Baltimore child welfare agencies. We also are pleased to be
joined by the Baltimore City Commissioner of Health, who will
discuss issues raised by the death of these 1-month-old girls.
Finally, we welcome another expert and long-time observer of
child welfare issues in Maryland who will place this case in
context for us.
This Subcommittee has held several hearings recently to
investigate the Nation's child welfare programs. We explored a
disturbing case involving four adopted boys in New Jersey who
were starved in their home, we reviewed Federal and State
oversight measures designed to determine if local officials are
doing all that is necessary to protect children, and we heard
about Federal reviews of State child welfare programs.
Unfortunately, what we learned was that not one State has
passed their review.
Tragedies such as this case can happen in any neighborhood.
Regretfully, the evidence we have seen shows that abuse cases,
such as the one before us today, have occurred in every State.
Since November, this Subcommittee has heard testimony from more
than 30 individuals. We have received numerous e-mails, phone
calls, and submissions for the record that highlight problems
and concerns. What we have learned is that the current system
is ill-equipped to protect vulnerable children.
The case we will examine today highlights where life-and-
death decisions are made for these children, in homes, offices,
courts, and hospitals across the country. With one more call,
one more question, or one more background check, two little
girls in Baltimore might be alive. We owe it to them and the
other children who die each year to understand what went wrong
so we can work with local officials to prevent such tragedies
from happening again. No policy is or will be perfect, but we
can all agree that what is occurring today in our country's
child welfare programs is simply unacceptable and must change.
Without objection, each Member will have the opportunity to
submit a written statement and have it included in the record
at this point. Mr. Cardin, would you like to make an opening
statement?
[The opening statement of Chairman Herger follows:]
Opening Statement of The Honorable Wally Herger, Chairman, and a
Representative from the State of California
Today's hearing focuses on a child welfare tragedy--the death of
twin infant girls in Baltimore last month. I want to thank Mr. Cardin
for suggesting this hearing as a continuation of our review of how
child welfare systems are failing to protect children.
Our purpose this afternoon is to understand what happened in this
case, so we do all we can to keep it from happening again in Baltimore
and elsewhere.
We welcome our guests from the state of Maryland and City of
Baltimore child welfare agencies. We also are pleased to be joined by
Baltimore's health commissioner who will discuss issues raised by the
death of these one-month old girls. Finally, we welcome another expert
and long-time observer of child welfare issues in Maryland, who will
place this case in context for us.
This subcommittee has held several hearings recently to investigate
the nation's child welfare programs.
We explored a disturbing case involving four adopted boys
in New Jersey who were starved in their home.
We reviewed federal and state oversight measures designed
to determine if local officials are doing all that is necessary to
protect children.
And we heard about federal reviews of state child welfare
programs. Unfortunately, what we learned was that not one state has
passed their review.
Tragedies such as this case can happen in any neighborhood--
regretfully, the evidence we've seen shows that abuse cases such as the
one before us today have occurred in every state.
Since November, this Subcommittee has heard testimony from more
than 30 individuals. We've received numerous emails, phone calls, and
submissions for the record that highlight problems and concerns. What
we've learned is the current system is ill-equipped to protect
vulnerable children.
The case we will examine today highlights where life and death
decisions are made for these children--in homes, offices, courts, and
hospitals across the country. With one more phone call, one more
question, or one more background check, two little girls in Baltimore
might still be alive.
We owe it to them and the other children who die each year to
understand what went wrong, so we can work with local officials to
prevent such tragedies from happening again.
No policy is or will be perfect. But we can all agree that what is
occurring today in our country's child welfare programs is simply
unacceptable, and must change.
Mr. CARDIN. Thank you, Mr. Chairman. First, let me thank
you for calling this hearing so quickly in response to the
shocking events that took place in Baltimore. I thank you for
your continued commitment on this subject. As you pointed out,
this is not the first hearing we have held in regards to the
child welfare system. We have had several. The problems we see
in Baltimore are not just in Baltimore, they are throughout the
entire Nation. I thank you very much for your continued
commitment and the commitment of this Subcommittee regarding
the welfare of our children, our most vulnerable children that
are in the child welfare system.
This hearing is being called because of the tragic loss of
the death of twins in Baltimore, the Swann twins, that
illustrate a system that is clearly failing the very children
whom it is designed to protect. When we talk about the twins'
case, I am not interested in accusations or political
maneuvering. The safety of vulnerable children in our society
is just too important, and we need to have answers as to what
we can do to protect these children. I expect to hear today
from our witnesses clear and concise suggestions on how to
prevent such tragedies in the future. In short, we want
results.
Mrs. Johnson, at one of our prior hearings, expressed, I
think, the frustration of our Subcommittee; that we want to
protect these children, and we want to find out how we can do
it. We know we have to change our system, and we want specific
recommendations. Only one thing is more tragic and more
horrific than a child being beaten to death, and that is when
the deadly abuse occurs after a variety of warnings signs that
should have told us that there was a problem and we should have
prevented this.
That is exactly what happened in Baltimore. On May 11, 1-
month-old twin girls died after having their skulls and ribs
fractured after being severely malnourished. The 17-year-old
mother of these children, Sierra Swann, was a foster care
runaway with a known drug problem who had another daughter
recently removed from her custody because of a confirmed case
of abuse and neglect, and yet she was still allowed to leave
the hospital with twins after a hospital caseworker contacted
the Department of Social Services (DSS) to inquire as to
whether there was an open case or whether there was a concern
for the mother.
There were all types of signs that this mother had
problems, and the hospital worker did what she thought was
right in contacting the DSS. Social Services indicated that
there was no open case with the agency. As a result, the mother
left the hospital for a vacant basement with no electricity or
running water. I don't know how many more signs could have been
given that we had a problem here, and yet the children were
lost because we did not respond.
Mr. Chairman, legally the parents of a child in foster care
is the State. We are the parents. We are the ones who have
responsibility, and we failed in that responsibility. As a
result of failing a responsibility for our child, our
grandchildren died. It is unacceptable. Unfortunately, this is
not an isolated incident in Baltimore. For example, a year and
a half ago a 2-month-old baby was beaten to death by a mother
with a psychiatric problem who was still on probation for
abusing her first son. This tragedy occurred after Child
Protective Services (CPS) was informed that the baby was in
danger because its mother was failing to take her medication.
Our past hearings, press reports from around the country,
and Federal review of every State child welfare system suggests
that Baltimore is not alone in failing to adequately protect
their children. In fact, as you pointed out, Mr. Chairman, not
one State in the Nation has passed all of the child well-being
standards assessed by the Federal review process.
Unfortunately, my own State of Maryland has failed in the seven
measures that we use for child safety. That, obviously, is
totally unacceptable. It is time, in fact it is past time, for
action. We must take steps now to make sure that what happened
in Baltimore never again happens anywhere in the Nation.
We need to do more at the Federal level, and, Mr. Chairman,
I am encouraged by our discussions as we are looking at
legislation in order to modernize the Federal child welfare
issues, and I am hoping that we can pass some legislation at
the Federal level in order to help our States, and if a few
foundations come up with recommendations, we are going to look
at that, but regardless what we do at the Federal level,
immediate steps must be taken by our States to protect our
children.
Therefore, I reiterate my request from the beginning. We
want to know what can be done at the State level to protect our
children today. I hope and expect the DSS will implement the
necessary reforms quickly in order to protect our children. The
lives of our children literally are on the line, and the cost
of inaction is way too high. I look forward to hearing our
witnesses in an effort that we make sure this never happens
again.
Chairman HERGER. Thank you, Mr. Cardin. Before we move to
our testimony, I want to remind our witnesses to limit their
oral statements to 5 minutes. However, without objection, all
of the written testimony will be made a part of the permanent
record. This afternoon we will be hearing from Christopher
McCabe, Secretary of the Maryland Department of Human Resources
(DHR); Floyd Blair, Interim Director of the Baltimore City DSS;
Dr. Peter Beilenson, Baltimore City Commissioner of Health, who
is also the son of a former Member of Congress from my home
State of California, Tony Beilenson; and Dr. Diane DePanfilis,
Co-Director of the Center For Families at the University of
Maryland School of Social Work. Mr. McCabe to testify.
STATEMENT OF HON. CHRISTOPHER J. MCCABE, SECRETARY, MARYLAND
DEPARTMENT OF HUMAN RESOURCES, BALTIMORE, MARYLAND
Mr. MCCABE. Thank you, Mr. Chairman and Congressman Cardin,
Congressman Camp, and Members and staff of the Subcommittee.
Thank you for the opportunity to be with you again and to share
perspectives on Maryland's child welfare challenges together
with this very distinguished panel. We at the State level rely
on partners to assist us in protecting children. Indeed, our
work often begins after a child is referred to us from schools,
hospitals, churches, or law enforcement in the community. We
are then responsible to investigate these cases and take all
appropriate actions.
Governor Ehrlich and I are grateful for your interest in
support of human service issues and for the funding that is
appropriated by Congress for these purposes. These issues are
not glamorous, but are at times literally, as Congressman
Cardin said, a matter of life or death. Just 1 month ago, I
testified before you regarding the Child and Family Services
Review (CFSR) process. Since then Maryland has received the
final report from the Federal Government. The study found that
Maryland was in substantial conformity with Federal standards
in some areas, but did not meet Federal standards in others.
The DHR has formed six Committees made up of agency employees
and outside advocates to recommend a program improvement plan
to meet Federal standards.
While the CFSR provides our State and every State a
baseline from which to make systemic improvements in the
practice of child welfare, on a daily basis our local agencies
still face the stress of critical and difficult cases that test
the capability of protecting children in at-risk situations.
One of those such cases occurred in Baltimore City in May of
2004, which is also the subject of this afternoon's hearing. It
has also been the subject of much angst within our local and
central offices on what actions might have been done
differently not just by our local agency, but a number of the
partners in child protection. We do not do it alone. The Sierra
Swann case is both sad and tragic. While limited under law
regarding what can be said related to an ongoing criminal case,
I can say that Sierra Swann was known by our local DSS in
Baltimore City. Her case file alone measures 5 inches. News
accounts revealed some but not all the pertinent history of the
case.
Sierra Swann was a teenage runaway from a Baltimore City
foster family. Her status as a runaway made the challenge of
keeping a safety net for her only more difficult. In my
observations, it is not uncommon that teenagers who have been
in foster care for many years run away from the system that
purportedly is there to help them. The majority of these
individuals come back to their foster homes because they learn
that the alternatives that they are facing are not acceptable.
Sierra chose not to take this course.
When this case became known, we acted aggressively to
determine what indeed had happened both internally, as far as
the department's response, and externally with the hospital and
within the community. Very specific changes are being made as a
result of our investigation. I will let Director Blair speak
about specifics, but I can tell you that one of the changes we
are immediately making is in the way critical communication is
received and handled. Not only are we providing intensive
training for our internal workers on how to field these child
protective calls, and when to refer them to experts or up the
chain, we will be working with sister agencies and community
partners, again, schools, hospitals, churches, to explain our
processes. In addition, the department has delivered a package
of safety-related proposals, legislative proposals, that I will
be sharing with Governor Ehrlich in the weeks ahead for
possible legislative action in the 2005 legislative session in
the Maryland General Assembly.
One systemic improvement that we are very aggressively
trying to implement involves better and more timely information
technology. A key component of improving information sharing is
to bring our automated child welfare computer system, MD
CHESSIE, to the desk of each child welfare worker in the city
and across the State. You all help provide the funding for that
system. Immediately after becoming Secretary of the department,
I recognized our current child welfare computer system is
minimally adequate and largely disjointed. Currently, among
Maryland's 24 local jurisdictions, there are several partially
automated child welfare tracking systems, none of which
communicate across platforms. Though some of these systems are
adequate for local needs, the major problem is they are not
standardized statewide, and our largest jurisdictions, in
particular Baltimore City, struggle most with this disparity.
Maryland's statewide automated child welfare information
system (SACWIS) is still 2 years away, but we are committed to
an early release of the child intake module. I'll repeat, are
committed to the early release of the child intake module, and
Baltimore City will be one of those jurisdictions. Other
workers, their supervisors, and our executive staff deserve
this 21st century tool to do their difficult jobs. The central
offices and Baltimore City DSS are learning from the Sierra
Swann case, as we do endeavor in each case. As we implement
changes to fill gaps in our own system, we would expect our
partners in child protection, hospitals, public health
department, and others, to evaluate their own processes and to
do the same. In turn, we all need to communicate with each
other of our respective improvement plans.
In conclusion, will the improvements I have just mentioned
and those that Mr. Blair will outline prevent the future deaths
of children in cases similar to Sierra Swann's children? I
cannot make that guarantee. Will it help reduce the likelihood
that an incident like this will happen in the future? I believe
so, and I am committed to doing what I can to do so. Thank you
for your time and attention to this very serious matter, and I
am prepared to answer your questions at the appropriate time.
Thank you, Mr. Chairman.
[The prepared statement of Mr. McCabe follows:]
Statement of The Honorable Christopher J. McCabe, Secretary, Maryland
Department of Human Resources, Baltimore, Maryland
Dear Mr. Chairman and Members of the Committee:
Just one month ago, I testified before you regarding the child and
family services review process. Since then, Maryland has received the
final report by the federal government.
The study found that Maryland was in substantial conformity with
federal standards in training its workers, responding to the community,
and licensing, recruiting and retaining foster and adoptive parents.
However, our State did not meet federal standards in several other
categories, including an adequate statewide information technology
system for child welfare and the number of children in foster care
reunited with their parents.
The Department of Human Resources has formed six committees, made
up of agency employees and outside advocates, to recommend a program
improvement plan to meet federal standards.
While the child and family services review provides our state--and
every state--a baseline from which to make systemic improvements in the
practice of child welfare, on a daily basis, our local agencies still
face the stress of critical and difficult cases that test the
capability of protecting children in an at risk situation.
One of those such cases occurred in Baltimore City in May 2004,
which is the subject of this afternoon's hearing. It has also been the
subject of much angst within our local and central offices on what
actions might have been done differently, not just by our local agency,
but a number of ``partners'' in child protection.
The Sierra Swann case is sad and tragic. While I am limited under
law regarding what can be said related to an ongoing criminal case, I
can say that Sierra Swann was known by our local Department of Social
Services in Baltimore City. Her case file alone measures five inches.
As news accounts revealed, Sierra was a teenage runaway from a
foster family, licensed by the Department of Social Services, which
made the challenge of keeping a safety net for her only more difficult.
When this case became known, we acted aggressively to determine
what indeed had happened both internally as far as the Department's
response and externally with the hospital and within the community.
Very specific changes will be made as a result of our investigation,
some of which were in process, but due to this tragedy, were suddenly
propelled to a new level of intensity.
I will let Director Blair speak about specifics but I can tell you
one of the changes we have made immediately is in the way incoming
calls are handled. Not only are we training internal workers on how to
take calls and when to refer them to the experts, but we will be
working with sister agencies and community partners--schools,
hospitals, churches--to explain our process.
We all have to be partners, working together as effectively as
possible. The job is tough enough already and if we are not working
together, tragic things like this can happen, as it does in other
states.
One systemic improvement involves better and more timely
communication. This is an ever present goal of the Administration. A
key component of that improved communication is to bring our automated
child welfare computer system, MD CHESSIE, to the desk of our child
welfare workers.
Immediately after becoming Secretary of the Department, I
recognized our current child welfare computer system as inadequate and
disjointed. Currently, among the 24 local jurisdictions there are
several partially automated child welfare tracking systems, none of
which communicate across platforms. All DHR child welfare systems are
predominantly paper based. Though some of these systems are adequate,
the major problem is that they are not standardized statewide. Our
larger jurisdictions struggle the most with this disparity.
Governor Ehrlich, Lieutenant Governor Steele, and I have made
demonstrable and substantial commitments to providing Baltimore City
Department of Social Services with the leadership, structure, and
resources to effectively and efficiently serve the most vulnerable
citizens of Baltimore City. We do this in the context of a statewide
human services system in need of additional staffing resources and
training needs, to mention a few.
In Baltimore City, we are committed that any reform we undertake
will be data-driven and research-based, family--focused and strength-
based, as well as based on interagency coordination.
Perhaps a little history is helpful in understanding the magnitude
of these commitments.
Soon after I was appointed Secretary, it became apparent
that the Baltimore City Department was struggling under a great many
management challenges.
BCDSS had been operated under a federal consent decree,
lj vs. Massinga, since 1989.
Sixty to sixty-five percent of our total client needs for
the entire state reside within the boarders of Baltimore City. The
sheer size of the need in Baltimore has a disproportional impact on
Maryland's success or failure.
For example, the overall span of control for its director was
enormous:
The local agency employs approximately 2,400 staff
members.
It manages 22 facilities spread across the city, touching
nearly every community.
The agency has high caseloads in its many programs,
serving families literally from cradle to grave.
Some facilities were found below par in terms of
cleanliness and healthfulness.
Equipment needs were manifest, with communication
seriously impaired from an aging telephone system that frequently
failed at various sites and did not even provide many staff members
with voice mail. A significant number of staff members were without
computers and thus without e-mail or internet access to do their work.
With Governor Ehrlich's support and that of the Maryland General
Assembly, the Department of Human Resources undertook an extensive
investment of time, funds, personnel and other resources to bring
Baltimore City Department of Social Services into the twenty-first
century.
With four million dollars committed by the legislature,
we are implementing a full upgrade of the outdated analog telephone
system with a digital system, which on completion will provide voice
mail throughout the 22 BCDSS work sites, as well as conferencing and
transfer capability.
We installed one thousand computers previously ordered
but never delivered to staff.
We invested significant resources in performing or
negotiating with our landlords overdue repairs and renovations of
facilities that were not providing a suitable work environment.
We are investing in replacement of aging and
nonfunctioning basic equipment staff members need to do their jobs,
like copiers and printers.
And most important, we have added fifty new state
employees. Thirty-five of them are in child welfare to help make
caseloads manageable at ninety percent of CWLA standards.
In addition to these immediate steps, however, we began a careful
and critical examination in the child welfare system. We determined
that, while no one model in its entirety seemed appropriate for
BaltimoreCity, we needed to transform Baltimore City Department of
Social Services to provide:
Seamless service delivery (i.e., one-stop shops),
An interdisciplinary team approach,
Focus on Baltimore's communities,
Strong interagency collaboration, and
Data-driven and outcomes-based service delivery.
We are instituting a regional service delivery system co-locating
services that serve the same clients so that they can find a variety of
needed services across the hall rather than across town.
Thank you again for the opportunity to provide these updates. Mr.
Blair will provide additional details.
Chairman HERGER. Thank you, Secretary McCabe. Now, Director
Blair to testify.
STATEMENT OF FLOYD R. BLAIR, INTERIM DIRECTOR, BALTIMORE CITY
DEPARTMENT OF SOCIAL SERVICES, BALTIMORE, MARYLAND
Mr. BLAIR. Good afternoon, Mr. Chairman and Members of the
Committee. I am Floyd R. Blair, Interim Director of the
Baltimore City DSS, the largest social services agency in
Maryland. I am honored and pleased to speak before you today
and provide an update about current progress on child welfare
services in Baltimore City and improvements to its service
delivery system. Baltimore is a wonderful city, yet at times it
is a violent place. Unfortunately, this is not uncommon in
large urban areas. Families in urban areas frequently face a
multitude of issues: violence, substance abuse, mental health
issues, high unemployment, and a lack of family and community
resources. Given this environment, children are often at risk,
even in danger, while in the care of their own parents. It is a
heart-wrenching for our workers to get a call to remove a child
from a home where abuse and severe neglect compromise that
child's safety and security. The home the child has known as
his or hers, that safe place, in fact, is not, and out of
necessity the child is uprooted, the family torn apart. On the
average, our workers remove about 100 children per month from
their families in Baltimore City.
When a child dies, it is a tragedy, and it is unacceptable.
We have undertaken a serious, comprehensive review of the
Sierra Swann case, reviewing not only the immediate
circumstances of the case that eventually ended in the tragic
deaths of the twins, but also a review of the case involving
this teen mother since she first came to the attention of the
department. Both processes are equally important to the
continued improvement of our current system.
I will explain some of the facts we have found in our
investigation. Prior to public reports, there was a previous
report of child abuse against Ms. Swann. An older child had
been removed from her care in October 2003. Once a child is
removed from a parent's home and placed into foster care, that
protective service case is considered closed, not active. It
becomes an active foster care case and continues to be
monitored by the foster care caseworker. It was also reported
that Ms. Swann was a runaway from the State foster care system
with an outstanding warrant for her to return to foster care.
Ms. Swann, already in labor, was taken to Johns Hopkins
Hospital, where she delivered twins. A Johns Hopkins social
worker attending to Ms. Swann called the number normally used
by internal DSS staff and asked the clerk if Ms. Swann had an
active child abuse case. After checking the appropriate data
screen, the clerk answered no, which was an accurate answer.
The social worker from the hospital did not ask any further
questions about prior cases regarding Sierra Swann. This call
was made to a clerk, not a screener. A screener is trained to
go beyond the question that was initially asked by the person
from Johns Hopkins.
When someone calls in to report suspected abuse or neglect,
our screen unit takes the call. It is our standard operating
procedure to do an intensive review of all such calls. Based on
our review of the Swann case, we are implementing not only some
immediate plans, but also systemic changes which have become
part of our overall improvement plan, a copy of which you
should have before you entitled, The Baltimore City DSS
Systemic Improvements.
In the Swann case, we developed an action plan, and some of
these are the key actions: all calls reporting maltreatment are
now routed through a central number where trained screeners can
access all available information on a case. We are implementing
a written protocol for all staff who take outside calls,
detailing how and when to refer appropriate calls to the
appropriate staff who can give comprehensive information to
qualified verified callers. We are implementing a runaway risk
alert feature on all screens. We have a priority list of cases
needing response within 1 hour. Today, staff have initiated
contact with our outside partners through written and verbal
directives detailing our processes, educating our partners,
hospitals, schools, et cetera, on the current and future
protocol and procedures. We plan to convene face-to-face
training with our community partners to reinforce our
processes. We have added staff to our screening unit to ensure
calls are answered timely and properly. On July 1st, we are
enhancing our 24-hour, 7-day-per-week CPS hotline. Twenty
positions have been added to work nights, weekends, and
holidays. We need all of our advocates, community resources,
public officials, neighbors, experts in the health care system,
school systems, everyone to create a positive partnership to
help us ensure that services are provided through a
coordinated, unified system, so that a tragedy like this never
happens again. I want to thank you for the time.
[The prepared statement of Mr. Blair follows:]
Statement of Floyd Blair, Interim Director, Baltimore City Department
of Social Services, Baltimore, Maryland
Good afternoon, Mr. Chairman and members of the
committee. I am Floyd R. Blair, Interim Director of the Baltimore City
Department of Social Services (BCDSS), the largest social services
agency of the Maryland Department of Human Resources (DHR). I am
honored and pleased to speak before you today to provide an update
about our current progress on ensuring child safety and improving child
welfare service delivery in Baltimore city.
When speaking to parents about children, a famous
children's television personality, Mr. Fred Rogers, said: ``the roots
of a child's ability to cope and thrive, regardless of circumstance,
lie in that child's having at least a small, safe place . . . (an
apartment? A room? A lap?) Where, in the companionship of a loving
person, that child could discover that he or she is lovable and capable
of loving in return.''
This quote sums up for me, the fact that the most
important aspect of a child's life is the security of a safe place.
When children enter our care it is our priority to provide that safe
place for those that have been abused or neglected.
Specifically, I will be briefing you on a recent child
welfare case you indicate is of special concern.
Protecting children who are in the care of social
services is one of the primary responsibilities of this administration.
Governor Ehrlich, Secretary McCabe and I are committed to
improving services in Baltimore city. Baltimore is a wonderful city,
yet at times it is a violent place. Unfortunately, this is not uncommon
in large urban areas.
Families in urban areas frequently face a multitude of
issues--violence, substance abuse, mental health issues, high
unemployment and a lack of family and community resources. Given this
environment, children are often at risk, even in danger while in the
care of their own parents.
Once the local department is involved with a family, we
have an opportunity to begin to help that family address many of these
difficult issues. Our staff work tirelessly under very strenuous
conditions with limited resources, to try to make a difference in the
lives of these citizens.
I cannot say to you that all our workers are always
giving 150%--I don't think anyone in management can say that with
assurance. But what I can say is that these exceptionally dedicated men
and women save lives every day. In fact, the final report of the recent
federal child and family services review indicates that on its safety
outcome 1, ensuring that children are first and foremost protected from
abuse and neglect, the outcome was determined to be substantially
achieved in 100% of Baltimore city cases reviewed.
It is heart-wrenching for our workers to get a call to
remove a child from a home where abuse and severe neglect compromise
that child's safety and security--the home that child has known as his/
her ``safe place'' in fact isn't--and out of necessity, the child is
uprooted, the family torn apart.
Our staff are trained to make those tough decisions--to
remove a child from his/her parent's home when it is determined to be
in the child's best interest.
On average, our workers remove about 100 children per
month from their families in Baltimore city.
When a child dies it is a tragedy--and even more so when
the department has previously intervened in an attempt to stabilize the
family.
Federal and state laws place certain restrictions on the
department concerning case confidentiality. While this of course
protects the families and children involved, it also limits what we
might like to say to those who share our concern, particularly
following a child fatality.
Given the importance of recent events, I will share as
much as I can in an effort to assure you that BCDSS and DHR have
undertaken a serious, comprehensive review of the Sierra Swann case,
reviewing not only the immediate circumstances of the events that
eventually ended in the tragic deaths of the twins, but also the case
involving this teen mother since she first came to the attention of the
department. Both processes are equally important to the continued
improvement of our current system.
To better understand our role, the role of the hospital
and others involved, we tracked the chronology of events in this case.
It is important for us first to identify any gaps in service or
procedure so that we may prescribe the proper remedies.
I will explain some of the facts we found in our
investigation.
Prior to public reports, there was a previous report of
child abuse against ms. Swann. An older child had been removed from her
care in October 2003.
Once a child is removed from a parent's home and placed
into foster care, that protective service case is considered closed--
not active.
It was also reported that ms. Swann was a runaway from
the state foster care system with an outstanding warrant for her to
return to foster care.
Ms. Swann, already in labor, was taken to Johns Hopkins
hospital, where she delivered twins.
The Johns Hopkins social worker attending to Ms. Swann,
called a number normally used by internal DSS staff, and asked a clerk
if ms. Swann had an ``active'' or ``open'' child abuse case. After
checking the appropriate data screen, the clerk answered ``no'', which
was an accurate answer. As I previously stated, once a child is removed
from the parent's care and placed in foster care, the case is closed--
and not active.
The social worker from Hopkins did not ask any further
questions about prior cases regarding Sierra Swann. This call was made
to a clerk, not a screener. A screener is trained to go beyond the
question asked.
It was recently reported that sierra was charged, along
with live-in boyfriend, Nathaniel Broadway, with the murder of their
newborn twins.
I would like to describe some of the standard operating
procedures we follow after a fatality so you will know what DHR and
BCDSS have done to address incidents surrounding the Swann case in
particular.
When someone calls in to report suspected abuse or
neglect, our screening unit takes the call. It is our standard
operating procedure to do an intensive review of all such calls.
Based on our review of the Swann/Broadway case, we are
implementing not only some immediate plans, but also systemic changes
which have become part of our overall improvement plan--a copy of which
is attached as ``document a:BCDSS systemic improvements.''
BCDSS has begun to initiate process improvements. I wish
I could say we always do everything right. It is frustrating that
change is slow even when we put forth our best efforts. But we are
making progress.
In the Swann case, we completed a risk analysis and
developed an action plan of systemic issues that we agree need to be
addressed. They are:
1. Implementation of a centralized number--all calls reporting
maltreatment will go through a central number where trained
screeners can access all available information on a case;
2. Development of a written protocol--any general staff who
take outside calls will be trained in how and when to refer
calls to appropriate staff who can give comprehensive
information to qualified/verified callers;
3. Initiation of an alert feature--we will initiate runaway/
high risk alerts on all screens;
4. Revision of priority list of cases needing response within
1 hour to elevate the most urgent;
5. Education of partners (hospitals/schools etc.) On protocol,
procedures; and
6. Addition of staff in screening units to ensure calls are
answered timely and properly.
We need all of our advocates, community resources, public
officials, neighbors, experts in the health care system, school
systems--everyone--to create positive partnerships--to help us ensure
that services are provided through a coordinated, unified system.
I met recently with charlie cooper, administrator for the
citizens review board in Maryland. We discussed the combined
recommendations that the child protection panels, the city child
fatality review team, and citizens review board for Baltimore city have
made for improvements to our agency.
We have shared that information with internal BCDSS work
groups which will be making recommendations for the redesign of our
service delivery system.
We are open to an ongoing dialogue with all stakeholders
as we continue this process.
We have incorporated some of the plans that a work group
headed by Baltimore's health commissioner, Dr. Peter Beilenson,
recommended--some I am pleased to say we had already identified in our
internal workgroups. Others are under consideration.
Our BCDSS mission is:
To protect vulnerable children and adults,
To preserve families, and
To promote self sufficiency
In support of our mission, here is what we are doing now:
1. On July 1st we will enhance our 24 hours--7 days per week
child protection service hotline.
2. Twenty positions will be added to work nights, weekends,
and holidays.
3. A family preservation component will be initiated in the
same unit to help children stay in their homes and keep
families together when it is safe to do so.
4. We have added sixty new positions to our family investment
and family services programs through the support of Governor
Ehrlich and Secretary McCabe.
5. Caseload ratios will significantly decrease in our family
services program (1:20) when all positions are filled.
6. All family services staff have been issued personal digital
assistant equipment to assist our workers in the field with
proper reporting and follow up.
We will continue to seek creative ways to work smarter
and more efficiently with the resources that we have. It is our plan
for the city's department of social services to be more user-friendly
and full-service oriented.
We can make a difference in the lives of Baltimore's most
vulnerable families and children by working in a coordinated fashion
with our community partners and sister agencies.
Thank you for your commitment, involvement, and support
as we move forward on this journey to excellence.
__________
DOCUMENT A: Baltimore City Department of Social Services
Systemic Improvements
------------------------------------------------------------------------
Persons
Problem/Barrier Action Steps Responsible Target Dates
------------------------------------------------------------------------
1) Multiple Immediate:
Contact All A.Towns, July 1, 2004
Numbers calls regarding L. Williams
CPS child
Intake maltreatment go
Central to 410-361-2235.
Intake (Family Decisions of what
Support) constitutes abuse
Adult or neglect are
Services the statutory
Informa responsibility of
tion and Referral the Department.
Inform
callers that
their information
is accepted for
investigation (if
screened in) and
that they will
receive
acknowledgement
letter with
assigned worker's
name
For 3-5 L. Williams, July 15, 2004
days, have M. Gordon
clerical staff
who answer 410-
361-4033, keep a October 1, 2004
log of calls for
information, data
to assist in how
to cease the
inappropriate use
of that number
Longer term:
Seek A. Towns, October 1, 2004
guidance from L. Williams
Legal to develop
guidelines for
appropriate use
of the 4033
number
Incorpo
rate in design of
new phone system
to be operational
10/01/04
Determi
ne feasibility of
establishing a
central ``call
center'' for all
calls
------------------------------------------------------------------------
2) Two Data Immediate:
Systems
(Client Continu L. Williams Current
Information e current and Staff
System and practice of
SADIE) clearing both
systems on new
referrals for
investigation
Informa July 15, 2004
tion to be given
out from either
system to be
determined after
protocol (in 1
above) developed
Longer Term:
MD DHR/OTHS 2006
CHESSIE will
provide complete
data search
(including CIS
information)
------------------------------------------------------------------------
3) No easily Immediate:
useable alert Determi C. Henry, July 1, 2004
system for high ne feasibility of A. Towns,
risk situation using cross- Holmes A.
(runaways, child bureau (that is,
abductions, etc) all programs
including Family
Investment) alert
procedure
developed by CPI
Team
Determi A. Holmes July 1, 2004
ne feasibility of
using either CIS
or SADIE for
alerts
Longer Term:
MD DHR/OTHS 2006
CHESSIE has alert
functionality
------------------------------------------------------------------------
4) Priority Immediate:
Protocol needs Review J. Smith, July 15, 2004
refining to and revise the L. Williams
better identify list and
cases needing definitions to
immediate appropriately
response identify those
cases needing 1
hour response
------------------------------------------------------------------------
5) Limited Immediate:
services provided Continu F. Blair, July 1, 2004
outside of the e plans for C. Henry,
``normal'' implementation of A. Towns,
workday (that is, Extended Hours L. Williams,
8-5,M-F) PLUS (full A. Cobb
service Intake,
including Family
Preservation
services) 24/7
Insure A. Holmes Aug. 2004
case data
availability for
after-hours
decision-making
------------------------------------------------------------------------
6) Partnerships Immediate:
need renewal for Develop J. Smith, July 1, 2004
better schedule to meet L. Williams
collaboration with partners to
re-iterate
commitment to
collaboration
Longer Term:
Plan L. Williams August 1, 2004
with them for
regular follow-up
to keep the
communication
open
------------------------------------------------------------------------
7) Training for Immediate:
staff and Develop J. Smith, L. July 15, 2004
educational training plan for Williams,
awareness for all staff TSD
stakeholders
needs to be
updated
Educate L. Williams August 1-15, 2004
stakeholders in and Staff
protocols that
affect them
Longer Term:
Build L. Williams September 1, 2004
in regular and Staff
updates
------------------------------------------------------------------------
8) Staffing is not Immediate:
sufficient 4 new E. Seale, July 1, 2004
PINS added to C. Henry,
Screening
Additio A. Towns, June 15, 2004
nal needs to be L. Williams
identified
Replace C. McCabe, July 1, 2004
ment staffing F. Blair
plan needed for
those positions
where the
incumbents are
transferring to
Extended Hours
Longer Term:
Continu On-going
e to evaluate
needs as well as
necessary
staffing or
workload shifts
as program
improvements are
made
------------------------------------------------------------------------
9) Case review Immediate:
process needs to Continu C. Henry, On-going
continue e to use the A. Towns
Quick Response Public
Team staffings to Information
evaluate case
work and identify
gaps
Longer Term:
Evaluat C. Henry, Oct. 2004
e the Quality A. Cobb,
Assurance process A. Towns
for changes to
improve
effectiveness
------------------------------------------------------------------------
Chairman HERGER. Thank you, Director Blair. Dr. Beilenson
to testify.
STATEMENT OF PETER BEILENSON, COMMISSIONER, BALTIMORE CITY
HEALTH DEPARTMENT
Dr. BEILENSON. Thank you, Mr. Chairman, and fellow
Californian; and Mr. Cardin, fellow Marylander; and, Mr.
McDermott, good to see you again, sir; Mr. Camp and staff. I am
the City Health Commissioner, and so people have been asking
why am I involved with this, the answer to that I will get to
briefly, but I was Chair of a Committee that made
recommendations, specific recommendations, on how to improve
the child protective system both in Baltimore and in the State.
We got to that point because I am Chair of the Child Fatality
Review Committee in Baltimore. By statute, the health officer
of each county is required to Chair the Child Fatality Review
Committee. That Committee is charged with reviewing cases of
unexpected childhood deaths and looking for themes and ways
that can change those sort of things.
In Baltimore City, there are three major causes of
unexpected childhood death: one, sudden unexplained death in
infancy. A lot of that was due to co-sleeping cases with
parents. We made public education and press conferences to let
parents know about trying to avoid that. Second, were juvenile
homicides. We set up a project, and Congressman Cardin has
probably heard of it, called Operation Safe Kids, where we
intensively case-manage the kids that are most at risk for
shooting or being shot. The third major cause of unexpected
childhood death are child abuse cases. There are two basic
patterns of child abuse death cases in the city and, I would
presume, around the country as well. Pattern number one: kid is
neglected or abused. I will use mom, but it can be obviously
mom or dad. Temporarily removed from the family, returned to
mom, inappropriately we believe. Kid is killed by mom. I will
talk about the recommendations we made for that pattern.
The second pattern, the one of the Swann case, is kid
abused or neglected so severely that they are permanently
removed from the family. As you heard from Mr. Blair, CPS
closes the case; closes the case because there is no child to
protect anymore, and those moms go on, almost inevitably,
because they are all at reproductive age, to have another child
within several months or a year or 2 years. As is the case
here, it was actually a few months after the permanent removal.
No one is following that mom from CPS. So, they are not offered
contraceptive services, they are not offered mental health
services, substance abuse services. That mom has another child
who is at tremendous risk for neglect or abuse and is killed.
So we, in January, made recommendations that were forwarded
to the State and to the city DSS on concrete things that we can
do, we think, most of which are cost-neutral. Most of these do
not cost money. I have attached them to my testimony. I am not
going to go through all of them. I am only to go through a few
that I thought might have some implication on a national level,
or were so directly related to this case that I wanted to
mention them.
First of all, improving the CPS Call Center. It has not
changed. I am now, thanks to press coverage, getting a lot of
calls from people who are reporting to me child abuse cases. I,
in fact, called Baltimore County DSS, not us, a different DSS,
and happened to know in a case that was reported to me that
there had been five previous children removed, case closed,
case closed, case closed, case closed; no services offered. A
new kid has been born to this mom. There is now worry of abuse
or neglect from the community. I call in and am only told by
the person who answers the correct hotline, the correct
hotline, because I did call the correct hotline, they did not
tell me there had been previous cases. So, that had not
changed.
We think, in terms of the temporarily removed kids, very
specific team approaches need to be made. Team approach
decisions need to be made as to when to return a kid. Far too
many cases, and Congressman Cardin didn't mention the litany of
cases that we have had of temporarily removed kids that are
then returned to mom because they simply had parenting classes;
because one social worker and, potentially, a supervisor made a
decision to return the kid to mom, when there is all evidence
to the contrary that that child should be returned to the mom.
A team approach, multidisciplinary, should be instituted. I
know it is talked about, but it is rarely done.
One of the biggest problems is there is a lack of
caseworkers because, and, therefore, too high caseloads,
because funding is a problem. You have to streamline the
process by which caseworkers go to court. I don't know if the
Congressman has been to juvenile court in Baltimore City, but
it is chaotic, to say the very least. An immense amount of time
is wasted by caseworkers just waiting around for cases that
often just get postponed. Similarly, to keep judges involved
and keep cases followed, just like you want to keep CPS
involved with cases, it should be a one-judge, one-family
setup. That has nothing to do with DSS or DHR, but it is
something the court should be looking at.
Finally, as you can probably guess from my comments, it is,
I would say, insane, it makes no sense, that when the child has
been permanently removed from a family, that CPS case should
not be closed. In fact, it should be stepped up, the kind of
coverage for that family that needs to go forward. Last two
points, confidentiality laws need to be revisited. I will be
happy to take questions on that. Second, it has to be what is
in the child's best interest, not reunification for any reason.
As Congressman Cardin knows, I am a dad. I have four kids.
Being a father is one of the very most important things in my
life, and preserving family is crucial. However, there are some
cases where you should not reunite a family because it is
simply not in the child's best interest. Thank you.
[The prepared statement of Dr. Beilenson follows:]
Statement of Peter Beilenson, M.D., Baltimore City Commissioner of
Health, Baltimore, Maryland
Good afternoon, Chairman Herger and members of the Subcommittee. I
am Baltimore City's Commissioner of Health, have held this position for
12 years, and have been appointed by two mayors. Since our Health
Department is most often associated with health service delivery, many
have asked why I am involving myself in the reform of social service
systems. It is my experience as chair of Baltimore City's Child
Fatality Review Team that brings me here today, and it is the pattern
of child abuse deaths that leads me to advocate for swift systemic
changes to our Child and Protective Services. Unfortunately, the
terrible deaths of two infants at the hands of their parents have
brought this advocacy to the forefront.
The Child Fatality Review Team (CFR) is a multi-agency, multi-
disciplinary team that reviews unexpected deaths (those not occurring
in a hospital) of infants and children through age 17. The purpose of
the team is to review all pertinent information on a specific case and
come up with recommendations on how future deaths could be prevented.
The team meets once per month and reviews over 100 cases per year.
During recent years, as chair of the local CFR, three major causes
of unexpected death in children have emerged. First, SIDS and SUDI
(Sudden Infant Death Syndrome and Sudden Unexpected Death in Infants)
occur repeatedly. In response to this, we held several press events to
address adults co-sleeping with their babies, which can lead to
suffocation. A second main cause is juvenile shootings, especially as
related to the drug trade. Our Health Department has pioneered
Operation Safe Kids, a program designed to protect our city's youth
that are most at-risk for shooting or being shot. Finally, we have
reviewed countless child abuse deaths. The majority of these deaths
fall in two categories. One--the Child and Protective Services had
removed a child temporarily from a parent's care due to abuse and
neglect and then the child was returned to that parent and killed. Or
two--after a parent had a child permanently removed previously from
their home due abuse or neglect, the parent had another child, which s/
he then abused and killed.
To respond to these common patterns of child abuse deaths, with the
Mayor's encouragement, we formed an interdisciplinary task force, the
Child Welfare Reform Committee, to examine this flawed system and to
draft recommendations for improvement. Composed of eight local leaders
from medical, therapeutic, advocacy, law enforcement, and judicial
sectors, this committee represents decades of experience with the local
child welfare system.
Rather than the protracted processes that frequently plague
longstanding commissions and committees, the Child Welfare Reform
Committee held two targeted meetings. In meetings in November and
December of 2003, we pointedly asked and answered, ``Where are the gaps
in our city's Child and Protective Services and what measures will
close those gaps?''
In January of this year, I submitted to the Mayor the Committee's
recommendations for system reform. The briefing memomorandum included
recommendations that impact upon a part of the process as well as
recommendations that affect the system globally. The recommendations
were then forwarded to the State Department of Human Resources, which
oversees Child and Protective Services, and were widely covered by the
press.
Four months subsequent to the Committee's recommendations, the
horrific death of two infant twins at the hands of their parents
shocked the entire region. Factors of poverty, mental health, and
substance abuse played a role in the atrocity, but what is worse--and
unfortunately not at all new to the citizens of Baltimore--is the fact
that Maryland's safety net for victims of abuse and neglect failed
these babies miserably. A case review shows many warning signals--
namely, a runaway teenage mother whose previous child was permanently
removed from her care because of abuse. Sadly, it took the Broadway
twins' case to prove the pertinence of our recommendations.
Speaking to you today about the system's recurring failure to
protect children, I would like to share with you a selection of the
Child Welfare Reform Committee's recommendations--those that
particularly relate to this case. Implementation of these ideas would
likely have impacted the outcomes in this most recent tragedy.
``Improve effectiveness of CPS call center by increasing training
and staffing.'' When called, had the worker not simply commented that
there was no open case but actually looked at the record, when Johns
Hopkins Hospital called they would have been notified that, in fact,
there was a closed case for severe abuse and neglect, but there was
also an open foster care runaway case, which would have unquestionably
resulted in immediate appropriate referral of the case to Child and
Protective Services.
``Staff Johns Hopkins Hospital 24 hours per day, 7 days per week.''
Had there been a worker on-site, the Hopkins social worker would have
had a direct contact to the Department of Social Services. We recommend
this service for this facility because it is the primary medical center
for children suspected to be victims of child abuse.
``Equip CPS offices with adequate information technology.'' It may
not be fair to completely blame the telephone operator. If adequate
information technology had been available, the intricacies of the case
may have been available on his/her computer screen.
Most salient of all, in January, we recommended that the system
``Design measures to protect future children of a parent who has been
convicted of [or otherwise implicated in] abusing previous children.''
This idea is so completely logical; it almost defies explanation. We
often speak of preventive care for high-risk populations. A new child
in the care of those who have a history of abuse is undoubtedly at the
highest risk of all, yet, incredibly, it is exactly those cases that
are permanently closed and the abusive parent is basically free to have
additional children without any services or follow-up to help prevent
abuse of these new children--exactly as occurred in the Broadway twins'
case.
It is unrealistic to believe that the Baltimore City Department of
Social Services and Child Protective Services can change overnight.
Undoubtedly, they have an uphill battle where fiscal and human
resources limitations are consistent obstacles. However, a review of
these recommendations shows that the vast majority of the suggestions
are cost neutral, simply requiring a redistribution of resources or a
revised mindset.
Recently, we have begun to hear from the State's Secretary for
Human Resources and the Director of Baltimore City's Department of
Social Services. Frankly, I have been disappointed by the vague
responses to our recommendations and the middling willingness to
redress the gaps in operations, policy, and strategy of this CPS
system. There is also a terrible lack of urgency in addressing these
gaps.
I fear that the State is in danger of talking about this issue ad
nauseum without institutions actually changing. The case of Emunnea and
Emonney Broadway is one that will never fail to stir emotion. It is my
hope that as legislators and leaders our emotions will be stirred to
mandate State involvement in any family where children have been
previously removed.
Thank you for your time and devotion to these issues.
__________
Child Welfare Reform Committee Recommendations
Dr. Peter Beilenson, Chair
Recommendations: The recommendations listed are concrete steps to
begin reform for this agency in crisis. The Committee's recommendations
include ``Process Recommendations'' which include reforms for
reporting, responding, decision-making, placement, and ongoing
services. ``Global Recommendations'' include overall systemic and
philosophical changes.
Process Recommendations
Reporting
Improve effectiveness of CPS call center by increasing
training and staffing. Committee members found wait-times for calls to
report abuse or neglect to be over 30 minutes at times and conducted by
unprofessional operators.
Responding
Staff Johns Hopkins Hospital 24 hours per day, 7 days per
week. These facilities are the primary medical centers for children
suspected to be victims of child abuse. A large proportion of incidents
occur on nights and weekends, and while the hospitals' pediatric
emergency departments are open 24 hours a day, 7 days a week, there is
not a DSS worker to seek care for the child at these hours. Currently,
an abused or neglected child may sit in the emergency room alone hours
waiting for DSS attention.
Implement on-call system to respond to child abuse crises
at other hospitals. Should another hospital identify an injury or
condition outside of business hours, DSS should be able to send a
worker on-call.
Decision-Making
Stat-like roundtable prior to court hearing should allow
more thoughtful, informed decision-making. An interdisciplinary review
of case files, reminiscent of our KidStat process, would prepare
involved parties for court day and hold DSS caseworkers accountable. We
hope that this collaborative approach will decrease the likelihood of a
child being returned to a dangerous home at the discretion of just one
caseworker.
Triage process needed to identify cases that should be
presented for roundtable discussion. With over 7,500 BaltimoreCity
children in out-of-home placements it would be neither feasible nor
necessary to bring every case to a roundtable review. Triage must
assure that only cases that require discussion be considered in this
formal way.
Streamline process of scheduling workers to be in court.
Caseworkers' time in court, though essential, detracts from case
management and time with children. DSS, similar to other court-
appearing agencies (i.e. Police), should thoughtfully schedule
appearances.
Institute ``one judge, one family'' approach in
scheduling CINA proceedings. Since CINA cases involve a sequence of
hearings and court involvement, which can extend over the length of a
child's life as a minor, assigning one judge to all of a child's or all
of a family's court affairs is a logical measure. More informed,
consistent judicial decision-making should result if the same judge or
master were to hear all proceedings related to a particular child or
family. Furthermore, the courts would save time because the judge
should already know the background of the case. ``One judge, one
family'' should also prevent court decisions that may place a DSS child
in harm's way. Jurisdictions all over the country have instituted this
measure.
Placement
Increasing foster care parent recruitment. The low number
of foster parents in comparison to the number of children needing out-
of-home care, contributes to overcrowded and suboptimal placements.
Check criminal background and child abuse registry. While
potential foster care/adoptive parents and guardians not related to the
child receive extensive criminal background checks. However, family
members who are providing kinship care do not receive background
checks. All out-of-home placements should experience the same level
investigation as foster applicants, including an application for
guardianship.I
nclude mental health history in application for foster
care and guardianship. In an effort to better place children, it should
be required that all foster care and guardianship applicants include
their mental health history in the application. The current uneven
screening of guardians was a factor in recent high-profile deaths.
Ongoing Services
Utilize a high standards approach in order to achieve
100% of required services for children in out-of-home care. As a
response to the October 2003 legislative audit, which showed that DSS
was not meeting bench marks for ongoing services, the Department should
be guided to assure that 100% of children in out-of-home care:
receive recommended therapy
have monthly face-to-face meetings with DSS worker
receive annual well-child exam
receive required annual dental exams
are enrolled in school
have their caregivers contacted monthly by DSS have
their homes/facilities subjected to annual health and safety
inspections
Institute a case file checklist procedure to assure
children's receipt of these services.L Placing a checklist in
caseworker's files should allow caseworkers and supervisors to best
keep track of these services. As the Department increasingly employs
information technology, this type of checklist recordkeeping may be
computerized as well.
Global Recommendations
Recruit more trained social workers as opposed to current
human service workers. A small proportion of caseworkers are actually
trained social workers presumably due to the high stress and workload
of the position.
Equip CPS offices with adequate information technology.
Technological capacity at Baltimore City DSS can hinder productivity.
Change emphasis from ``family preservation'' to ``child
protection.'' Though ``child protective'' in name, CPS has historically
taken a turn toward keeping family intact--often in instances that do
children more harm than good.
Revisit confidentiality laws; consider allowing the
release of case files following child fatality. Revealing the
information like the caseworker's name upon a child's fatality could be
a tremendous source of accountability in DSS.
Design measures to protect future children of a parent
who has been convicted of abusing of previous children. Currently,
there are no measures in place to supervise a convicted child-abusing
parent who has goes on to have more children. The Child Fatality Review
Team has seen multiple deaths as a result of this abusive pattern.
Redefining child's best interest. Over time, the court's
definition of a ``child's best interest'' has strayed from true
consideration of the health and safety of the child. Future legislation
may be necessary to guide this philosophical change.
Chairman HERGER. Thank you, Dr. Beilenson. Dr. DePanfilis
to testify.
STATEMENT OF DIANE DEPANFILIS, CO-DIRECTOR, CENTER FOR
FAMILIES, SCHOOL OF SOCIAL WORK, UNIVERSITY OF MARYLAND,
BALTIMORE, MARYLAND
Dr. DEPANFILIS. Okay. Thank you, Mr. Chairman and other
Members of the Subcommittee. I speak to you today as a social
worker with over 30 years of experience in child abuse and
neglect issues, currently as a researcher and educator at the
University of Maryland's School of Social Work. What can we
learn from this tragic situation which we have already heard
the details about from our other witnesses? I offer three
suggestions: first, I believe it is time for a paradigm shift
in the way our child protection service systems are designed.
Second, I emphasize the importance of working across
disciplines and community systems, which reinforces what Dr.
Beilenson just emphasized also. Third, I emphasize the
importance of using evidence-based practices, using what we
know has a greater chance of working to deal with this complex
problem of child abuse and neglect.
I need to emphasize that none of these points are new
ideas, and I think that we have known much more than we have
applied over the years, if we sort of trace the chronology from
the first enactment of the Child Abuse Prevention and Treatment
Act (CAPTA) (P.L. 93-247). My written testimony elaborates on
all these points in much more detail, but I am just going to
highlight a couple of those in the oral testimony. It is my
opinion that one of the principal failures to respond to
protect these two infants, or any other children that might be
classified as at risk of child abuse and neglect, is because
our system is designed to respond only to the most serious
cases. Our definition of child abuse and neglect requires there
to be an act or omission that results in harm or serious threat
of harm. In this case, the facts are unclear how much of that
was actually reported, actual harm at that point in time. So,
without pointing fingers, and without dwelling on that, I think
we really need to take a look at whether or not that type of
revolving door makes the most sense given where we are today.
My research, as well as other research, have suggested that
families may be reported for child maltreatment as many as 25
times over 5 years. That was research where I followed families
over 5 years in Baltimore City. The system continues to screen
out, investigate, and serve the same families over and over
again, and we often fail to stop this pattern that continues
sometimes for generations. It is no wonder that this particular
case record is 5 inches thick, and I think we see many, many,
many other situations similarly.
Despite the fact that research indicates that when you have
a chance to help a family the first time they are known to some
system, we tend to fail to respond to families until situations
are seriously complex, perhaps fatal, and, therefore, the
chance of success is not great. I have an analogy in my written
testimony to try to highlight the importance here, suggesting
that if you detected a cyst that you would worry might be
cancer, it would be the same thing as being told you have to
wait to get medical treatment until the possibility of cure is
almost nonexistent. I think that is the picture that we have in
today's child protection system.
In my opinion, protecting children seems to occur more by
chance than through a system that is structured to respond
differentially based on the safety needs of families and of
children. I do think there has been some movement in some
States to change this picture, and it is called the System of
Differential Response. In the States that are trying a new
reform of the child welfare system, systems are redesigned to
deliver quality supportive services the first time there is a
red flag, and instead of waiting for children to experience
serious and sometimes fatal injuries from neglect and abuse,
there is a triage system where community agencies can work
together to respond differentially to those needs. The second
point that I emphasize is the importance of interdisciplinary
efforts, which you have already heard about, so I will not go
forward on that. The third thing that I was asked to discuss is
the importance of using evidence-based practices in our
response to child abuse and neglect. Child abuse and neglect
does not happen in the same way in all situations. It is a
complex problem that really requires complex solutions, and I
think we need to use the evidence and the research that helps
us understand what works best in certain situations.
The Office on Child Abuse and Neglect presented the results
of the Emerging Practices in the Prevention of Child Abuse and
Neglect Project, which was initiated to try to identify some of
these effective programs, and in the context of that work, our
Family Connections Program in West Baltimore was highlighted as
one of the programs that was deemed demonstrated effective. The
results that we are pleased to report about in this project,
which was quite small, reaching out to families before they
were known to child abuse and neglect, suggested that over a
short period of time, families could be helped to increase
protective factors related to parenting attitudes, parent
competence, social support; decrease known risk factors for
child abuse and neglect, like depression and parenting stress,
and life stress; and improve safety, both physical care,
psychological care; and the prevention of child abuse and
neglect known to CPS agencies.
In summary, I think if we want to prevent future fatalities
due to child abuse and neglect, we really need to drastically
reform the way our community systems are structured. We need to
look at this promising effort called differential response, or
other ways to get responses to families before serious or fatal
injuries occur. We need to work more effectively together using
evidence-based practice strategies. Thank you. I would be happy
to answer any questions.
[The prepared statement of Dr. DePanfilis follows:]
Statement of Diane DePanfilis, Ph.D., Co-Director, Center for Families,
University of Maryland, School of Social Work, Baltimore, Maryland
Mr. Chairman and members of the subcommittee, my name is Diane
DePanfilis. I am an Associate Professor, Director of the Institute for
Human Services Policy, and Co-Director of the Center for Families at
the University Of Maryland School Of Social Work. I have more than
thirty years of experience in the child protection field as a social
worker, supervisor, administrator, national consultant, and researcher.
I am the co-author of Child Protective Services: A guide for
caseworkers \1\ published by the Department of Health & Human Services
(HHS), Children's Bureau, co-editor of the Handbook for Child
Protection Practice,\2\ and a former President of the Board of
Directors of the American Professional Society on the Abuse of
Children. Last year, I conducted an important study on the
investigatory practices of reported child abuse and neglect in out-of-
home care in the state of New Jersey in collaboration with Children's
Rights, Inc. I have been a consultant with the state of California and
other states as they undertake efforts to reform their child protection
systems and I am on an advisory committee for the University of
Chicago's Chapin Hall Center for Children related to a study of the
impact of some of these reforms. I am also currently collaborating with
the Institute for the Advancement of Social Work Research with support
from the Annie E. Casey Foundation on a study of the effectiveness of
practices to retain professionally prepared social workers in public
child welfare.
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\1\ DePanfilis, D., & Salus, M. (2003). Child Protective Services:
A guide for caseworkers. Washington, D.C.: U.S. Department of Health
and Human Services, Administration on Children and Families,
Administration for Children, Youth, and Families, Children's Bureau,
Office on Child Abuse and Neglect.
\2\ Dubowitz, H., & DePanfilis, D. (Eds.). (2000). Handbook for
child protection practice. Thousand Oaks, CA: Sage.
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Thank you for inviting me to present my views on the safety of
children following the tragic death of two infants in Baltimore. I
commend you and the committee for undertaking a series of hearings on
the safety of maltreated children in this country. Today, I speak to
you based on my research and experience with child protection systems
in Baltimore. I have studied: (1) the recurrences of child maltreatment
in Baltimore in collaboration with the Baltimore City Department of
Social Services; (2) screening practices regarding child abuse and
neglect reporting in Baltimore and other jurisdictions in collaboration
with the Maryland Department of Human Resources and the State Council
on Child Abuse and Neglect; and (3) the efficacy of a promising
preventive intervention in West Baltimore called Family Connections. My
views are based on my experiences as a social worker and researcher and
I do not formally represent any group.
What can we learn from this tragic situation in which two young
lives were lost? I offer three related suggestions. First I believe
that it is time for a paradigm shift in the way our child protection
systems are designed. Second, I emphasize the importance of working
across disciplines and community systems. Third, I emphasize the
importance of using evidence-based practices to respond to the complex
problem of child abuse and neglect. These are not new ideas.
Too Little Too Late: Time For a Paradigm Shift
Our current laws our designed for the public child protection
system to respond when there is a reason to believe that a child has
already been harmed or is at serious risk of harm. Only a very small
percentage of the children and families with maltreatment or risks of
maltreatment actually receive help. Over ten years ago, the Federal
Advisory Board on Child Abuse and Neglect declared that the child
protection system was in a State of Emergency.\3\ The state of
emergency continues.
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\3\ U.S. Advisory Board on Child Abuse and Neglect. (1993).
Neighbors helping neighbors: A new national strategy for the protection
of children. Washington, DC: Department of Health and Human Services,
Administration for Children and Families.
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Let's begin with the call to CPS. CPS workers are charged with
screening reports of child abuse and neglect according to definitions
in state laws.\4\ If the alleged concerns do not meet the state
definition of child maltreatment, workers make appropriate decisions by
not accepting reports for investigation. The Child Abuse Prevention and
Treatment Act (CAPTA) sets the standards for a state definition of
child abuse and neglect. The term ``child abuse and neglect'' means, at
a minimum, any recent act or failure to act on the part of a parent or
caretaker, which results in death, serious physical or emotional harm,
sexual abuse or exploitation, or an act or failure to act which
presents an imminent risk of serious harm.\5\
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\4\ Wells (2000). How do I decide whether ot accept a report for a
child protective services investigation? In H. Dubowitz & D. DePanfilis
(Eds.), Handbook for child protection practice (pp. 3-6), Thousand
Oaks, CA: Sage.
\5\ U.S. DHHS, Administration for Children and Families,
Administration on Children, Youth, and Families, Children's Bureau,
Office on Child Abuse and Neglect (2003). The Child Abuse Prevention
and Treatment Act including Adoption Opportunities and the Abandoned
Infants Assistance Act, as amended by the Keeping Children and Families
Safe Act of 2003. Washington, DC: Author. Retrieved June 6, 2004 at
http://nccanch.acf.hhs.gov/general/legal/federal/index.cfm.
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While I am not familiar with the ``facts'' of the Baltimore City
case other than what I have read in the Baltimore Sun, I'm not sure
that a report that alleged that a mother who was known to social
services as a foster care runaway from whom a previous child had been
taken away because of abuse and neglect \6\ would constitute an
imminent risk of serious harm.
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\6\ Klein, A. (2004, May 24) Officials seeking better safeguards to
protect children from abuse. Baltimore Sun, 2b.
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It is my opinion that the failure to respond to protect these
children is not the failure of the CPS agency, but a failure of our
state laws that dictate that children need to be harmed or at imminent
risk of harm before someone in the community responds.
What do we know about screening practices in Maryland? In 2001, a
collaborative research team reviewed all screened out reports of child
abuse and neglect in Maryland for one month. Reviewers, including
University researchers and state policy analysts, determined that most
(83%) of the screening decisions made that month were consistent with
state policies.\7\ Of the 5,023 referrals received by 24 local CPS
jurisdictions in the study month, an average of 36% of referrals was
screened out. The proportion of referrals screened out significantly
differed between jurisdictions ranging from 62.5% to 5.6%. Larger
jurisdictions tended to screen out fewer referrals (29.8% in
BaltimoreCity; 25.7% in Prince George's County) than the state average
(36%). These variations are consistent with screening practices
nationally. Screening rates vary substantially between states from a
low of 1.7% in Alabama to a high of 72.3% in Maine.\8\
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\7\ DePanfilis, D. (2003). Report of the Research Committee to the
State Council on Child Abuse and Neglect. Baltimore: Author.
\8\ US DHHS, Administration for Children and Families,
Administration on Children, Youth, and Families (2004). Child
maltreatment 2002: Reports from the states to the national Child Abuse
and Neglect Data System. Washington, DC: U.S. Government Printing
Office. Retrieved June 3, 2004 at www.acf.hhs.gov/programs/cb/
publications/cmreports.htm.
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It is my opinion that assessing the safety of children occurs
inconsistently between local and state jurisdictions. Society should
not wait until a child has experienced a serious or fatal injury before
responding to referrals of concern about children at risk of
maltreatment. Our community systems must be available to respond to all
families at risk for child maltreatment.
For some families, the child protection system is like a revolving
door. My research, as well as research, by others has found that
families may be reported for child maltreatment as many as 25 times in
five years.\9\ The system continues to screen out, investigate, and/or
serve the same families over and over again as we often fail to stop a
pattern that sometimes continues for generations. Despite the fact that
research also indicates that we have a chance to alter this picture if
families can be helped the first time someone recognizes a problem, our
systems too often get involved too late. We are serving only the tip of
the iceberg and waiting too long to offer help that has any chance of
success. Imagine detecting a cyst that has a chance of being diagnosed
as cancer but being told you can't access medical care until the
chances of recovery are almost nonexistent.
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\9\ DePanfilis, D., & Zuravin, S. J. (2002). The effect of services
on the recurrence of child maltreatment. Child Abuse and Neglect, 26,
187-205; DePanfilis, D., & Zuravin, S. J. (2001). Assessing risk to
determine the need for services. Children and Youth Services Review,
23, 3-20; DePanfilis, D., & Zuravin, S. J. (1999). Predicting child
maltreatment recurrences during treatment. Child Abuse and Neglect, 23
(8), 729-743; DePanfilis, D., & Zuravin, S. J. (1999). Epidemiology of
child maltreatment recurrences. Social Services Review, 73, 218-239;
DePanfilis, D., & Zuravin, S. J. (1998). Rates, patterns, and frequency
of child maltreatment recurrences among public CPS families. Child
Maltreatment, 3, 27-42.
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It is my opinion that as a society we must develop new strategies
for early detection and response to families at risk for child
maltreatment.
In 2002, state CPS agencies received 2.6 million referrals alleging
maltreatment related to 4.5 million children.\10\ Of the referrals
accepted as a report and investigated, more than half of the reports
(60.4%) led to a finding of unsubstantiated suggesting that sufficient
evidence of child abuse or neglect was not found by the CPS worker. In
contrast, an estimated 896,000 children were determined to be victims
of child abuse or neglect in 2002 based on determining that a report
was substantiated or indicated. There is growing consensus that the
legalistic process of reporting, investigating, and substantiating or
unsubstantiating does not lead to the protection of children.\11\ While
some reports that are unsubstantiated may not require a community
response, it is likely that at least some of these reports represent
children and families who could benefit from family support or other
community services that may prevent child abuse or neglect in the
future.
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\10\ US DHHS (2004).
\11\ Drake, B. (1996). Unraveling unsubstantiated. Child
Maltreatment, 1 (3), 261-271; Melton, G. B. (2003, October). Mandated
reporting: A policy without a reason. Commentary prepared for a virtual
discussion sponsored by the International Society for Prevention of
Child Abuse and Neglect.
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In the current system, most reports of child abuse and neglect do
not result in services to prevent the occurrence or recurrence of child
maltreatment (DHHS, 2004). Think of a funnel. Extrapolating from
national reporting data, consider the following scenario. Out of every
100 reports of child abuse and neglect, 67.1 are screened in for an
investigation. Of those 67 reports, 20 (30.3%) are substantiated or
indicated. Of those, 11.8 children may receive a service response
beyond an investigation of the report. The deaths of these infants in
Baltimore is an example of a tragic situation that may have been
screened out from receiving the benefit of a safety assessment.
It is my opinion that protecting children seems to occur more by
chance than through a system that is structured to respond
differentially based on the safety needs of children and families.
The beginnings of a paradigm shift. As others \12\ have asserted,
the system designed to protect children is not working. In 1990, the
U.S. Advisory Committee made a most compelling argument that we
ignored. The most serious shortcoming of the nation's system of
intervention on behalf of children is that it depends upon a reporting
and response process that has punitive connotations and requires
massive resources dedicated to the investigation of allegations. State
and County child welfare programs have not been designed to get
immediate help to families based on voluntary requests for assistance.
As a result, it has become far easier to pick up the telephone to
report one's neighbor for child abuse than it is for that neighbor to
pick up the telephone and receive help before the abuse happens.\13\
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\12\ See for example, Waldfogel, J. (1998). Rethinking the paradigm
for child protection. The Future of Children Protecting Children from
Abuse and Neglect, 8 (1) 104-119.
\13\ U.S. Advisory Board on Child Abuse and Neglect (1990). Child
abuse and neglect: Critical first steps in response to a national
emergency. Washington, DC: Author.
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It is time to consider that there must be a better way. During the
past 10 years, there has been a growing consensus that states and
communities need to change the way they protect children, and many
states have taken the charge to make the protection of children a
community responsibility. One type of reform to child protection
systems has been implemented: differential response. These newly
designed differential response systems provide non-adversarial,
flexible responses to individual family circumstances. Systems are
redesigned to deliver quality supportive services the first time red
flags are identified instead of waiting for children to experience
serious and sometimes fatal injuries from neglect or abuse. Community
agencies, in partnership with child protective services, work to triage
services so that together the community can help families meet the
basic needs of their children and keep them safe. A national study of
child welfare reforms \14\ identified twenty states that offer one or
more alternatives to the traditional CPS investigative response. While
it is not yet clear whether these efforts will yield better outcomes
for children, some early evaluation results are promising.\15\ States
have reported improvements in child safety and child and family well-
being compared to families served through traditional services.
Previous testimony before this subcommittee by Tom Birch on behalf of
the National Child Abuse Coalition (2004) has already outlined
information about the costs of not investing in prevention and early
intervention.
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\14\ U.S. Department of Health and Human Services, Office of the
Assistant Secretary for Planning and Evaluation and Administration for
Children and Families, Administration on Children, Youth and Families,
Children's Bureau (2003). National Study of Child Protective Services
Systems and Reform Efforts Review of State CPS Policy. Washington, DC:
Author. Retrieved June 6, 2004 at http://aspe.hhs.gov/hsp/cps-status03/
state-policy03/.
\15\ Institute of Applied Research. (1998, January). Missouri child
protection services family assessment and response demonstration impact
evaluation: Digest of findings and conclusions. St. Louis, MO: Author.
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Working Together Across Systems
Protecting children is a community responsibility. This statement
has been emphasized since the enactment of CAPTA in the 70s. For
example, the current edition of one of the federal government's user
manuals suggests that all relevant professionals must be aware of their
role in child protection and the unique knowledge and skills they bring
to their community's prevention and intervention efforts. They must
also understand the roles, responsibilities, and expertise of other
professionals.\16\ All practitioners must also have sufficient
competence and time to perform the roles they are assigned. Federal and
state governments have invested considerable resources to require
multidisciplinary teams and state coordinating bodies to collaborate in
broad efforts to protect children. Unfortunately, these requirements do
not always ensure that all professionals and organizations will work
together on a daily basis. And there are some disagreements about how
these multidisciplinary teams really should work.\17\ Child abuse and
neglect is a complex problem that requires interdisciplinary efforts.
That means we must work together, not side by side. The tragic case of
the twins in Baltimore is an example of serious failures in multiple
systems. Pointing fingers and blaming each other will not prevent
future failures. Coming together and developing ways to work together
on a daily basis will keep children safe. This is not a situation of
not knowing how. It means we must have the will to make it happen. In
Baltimore, Secretary McCabe and Director Blair, other witnesses here
today, have already taken steps to bring groups together. We must
tackle the serious barriers to keeping children safe as new protocols
and procedures are established to prevent future avoidable tragedies.
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\16\ Goldman, J. & Salus, M. (2003). A coordinated response to
child abuse and neglect the foundation for practice. Washington, DC:
US DHHS, ACF, ACYF, Children's Bureau, Office on Child Abuse
Institute of Applied Research. (2003, February). Minnesota
alternative response evaluation second annual report: Executive
summary. St. Louis, MO: Author; Texas Department of Protective and
Regulatory Services. (1999). Flexible response evaluation. Austin, TX:
Author; VirginiaDepartment of Social Services. (1999). Final report on
the multiple response system for Child Protective Services in Virginia.
Richmond, VA: Author.
\17\ Wilson, C. & McGrath, P. (2004, Spring). In search of a new
model for coordinated urban child abuse investigations. APSAC Advisor,
16 (2), 5-10.
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Evidence-Based Practices
Since child neglect and abuse are rooted in multiple and
interacting intrapersonal, interpersonal, and environmental factors, no
one intervention or treatment is expected to be effective in all
situations.\18\ Even though research on what works to prevent and
respond to child maltreatment is limited, recent reviews of
intervention and treatment effectiveness have identified some core
elements.\19\ As we reassess the field's response to child abuse and
neglect, it is incumbent that we employ methods to prevent and respond
to child abuse and neglect which have some evidence that they are
effective in reducing the risk of child maltreatment.
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\18\ National Research Council (1993). Understanding child abuse
and neglect. Washington, DC: National Academy Press.
\19\ Becker, J.V., Alpert, J. L, BigFoot, D. S., Bonner, B. L.,
Geddie, L. F., Henggeler, S. W., Kaufman, K. L., & Walker, C. E.
(1995). Empirical research on child abuse treatment: Report by the
child abuse and neglect treatment working group, American Psychological
Association. Journal of Clinical Child Psychology, 24, 23-46; Corcoran,
J. (2000). Family interventions with child physical abuse and neglect:
A critical review. Children and Youth Services Review, 22, 563-591;
DePanfilis, D. (1999). Intervening with families when children are
neglected. In: H. Dubowitz (Ed.). Neglected children (pp. 211-236).
Newbury Park, C: Sage; Kluger, M. P. Alexander, G., Curtis, P. A.
(2000). What works in child welfare. Washington, DC: Child Welfare
League of America; Oates, R. K., & Bross, D. C. (1995). What have we
learned about treating child physical abuse? A literature review of the
last decade. Child Abuse & Neglect, 19, 463-473; Thomlison, B. (2003).
Characteristics of evidence-based child maltreatment interventions.
Child Welfare, 82, 541-569; Wolfe, D. A. (1994). The role of
intervention and treatment services in the prevention of child abuse
and neglect. In G. B. Melton & F. D. Barry (Eds.), Protecting children
from abuse and neglect foundations for a new national strategy (pp.
224-303). New York: Guilford; Wolfe, D.A., & Wekerle, C. (1993).
Treatment strategies for child physical abuse and neglect: A critical
progress report. Clinical Psychology Review, 13, 473-500.
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In 2003, the Office on Child Abuse and Neglect (OCAN) presented the
results of the Emerging Practices in the Prevention of Child Abuse and
Neglect project, which was initiated to identify effective and
innovative programs in child abuse and neglect prevention around the
nation. In partnership with the prevention community, OCAN implemented
this review to elevate understanding of prevention programs and
initiatives, and to share information on emerging and promising
practices with the field.\20\
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\20\ U.S. Department of Health and Human Services [U.S.DHHS].
(2003). Emerging practices in the prevention of child abuse and
neglect. Washington, D.C.: Author.
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In coming here today, I was asked to speak briefly about a program
called Family Connections in West Baltimore, which was deemed
``demonstrated effective'' by the OCAN initiative. Family Connections
received this designation because the Advisory Group determined that
the program had undergone rigorous evaluation using an experimental
design with random assignment, and the results demonstrated positive
outcomes for participants.
Family Connections is a multi-faceted, community-based service
program that works with families in the context of their neighborhoods
to help them meet the basic needs of their children and reduce the risk
of child neglect. The program was developed by the University Of
Maryland School Of Social Work in collaboration with the School of
Medicine and the Department of Pediatrics. It was launched through a
federal demonstration project funded in 1996 and has since been
supported by a combination of federal, state, private foundation, and
other sources. The mission of Family Connections is to enhance the
safety and well-being of children and families by combining education
of graduate social work interns, services to families in the West
Baltimore Empowerment Zone, and research about the process and outcomes
of the intervention. Our goal is to reach families and to prevent the
need for a formal child protective services intervention.
The program was designed to specifically target factors known to
increase the risk of child neglect. The choice to focus on the
prevention of neglect came out of research on the recurrence of child
abuse and neglect in Baltimore. The program operates from an ecological
developmental framework using Bronfenbrenner's \21\ theory of social
ecology as the primary theoretical foundation. Child neglect is thought
to evolve when risk factors related to the child, caregivers, family
system, and environment challenge the capacity of caregivers and
broader systems to meet the basic needs of children. Family Connections
uses a home-based, family-centered model of practice consistent with
other home-based, tailored intervention approaches.\22\ Nine practice
principles guide FC interventions: community outreach; individualized
family assessment; tailored interventions; helping alliance;
empowerment approaches; strengths perspective; cultural competence;
developmental appropriateness; and outcome-driven service plans.\23\
Individualized intervention is geared to increase protective factors
and decrease risk factors.
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\21\ Bronfenbrenner, U. (1979). The ecology of human development:
Experiments by design and nature. Cambridge, MA: Harvard University
Press.
\22\ Dunst, C.J., Trivette, C.M. and Deal, A.G. (1988). Enabling
and empowering families: Principles and guidelines for practice.
Cambridge, MA; Brookline Books; Kinney, J., Strand K., Hagerup M., &
Bruner C. (1994). Beyond the buzzwords: Key principles in effective
frontline practice. Falls Church, VA: NCSI Information Clearinghouse.
\23\ DePanfilis, D., Glazer-Semmel, E., Farr, M., & Ferretto, G.
(1999). Family Connections intervention manual. Baltimore: University
of Maryland, Baltimore. Retrieved June 15, 2004 from http://
www.family.umaryland.edu.
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The core components of Family Connections include: (1) emergency
assistance; (2) home-based family intervention (family assessment,
outcome driven service plans, individual and family counseling); (3)
service coordination with referrals targeted toward risk (e.g.,
substance abuse treatment) and protective factors (e.g., mentoring
program); and (4) multi-family supportive recreational activities.
Research supported through the demonstration project illustrates
positive improvements for children, caregivers, and families.\24\ The
sample included 154 families (473 children) in a poor, urban
neighborhood, who met risk criteria for child neglect, and who were
randomly assigned to receive either a 3--or 9-month intervention. Self-
report and CPS data were collected prior to, at the end of, and six-
months post intervention. Observational assessments were made at the
beginning and the end of the intervention. Data were analyzed using
analyses of variance (ANOVA) with repeated measures. Results for the
entire sample indicated:
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\24\ DePanfilis, D. (2002). Helping families prevent neglect final
report. Study funded by the U.S. Department of Health and Human
Services, Children's Bureau 1996-2002 (Grant Number 90CA1580).
Baltimore, MD: University of MarylandSchool of Social Work. Retrieved
June 15, 2004 at http://www.family.umaryland.edu; DePanfilis, D., &
Dubowitz, H. (Submitted for peer review, January 2004). Family
Connections: Preventing child neglect--promoting well-being and safety.
enhanced protective factors (parenting attitudes,
parenting competence, social support);
diminished risk factors (parental depressive symptoms,
parenting stress, life stress);
improved child safety (physical and psychological care of
children); and
strengthened child well-being (decreased externalizing
and internalizing behavior).
The nine-month intervention was more effective in certain areas
compared to the three-month intervention (e.g., fewer caregiver
depressive symptoms, fewer child behavior problems). Prior to Family
Connections' intervention, CPS had received 274 reports of child abuse
or neglect related to 87 of the 154 families (56.5%) in this sample.
Fifty-nine (38.3%) of these reports were indicated. While Family
Connections was providing intervention, twenty-four CPS reports were
made related to seventeen families (11% of 154 families), and 12 of
these were indicated. Six months following the closure of intervention,
searches on 139 families found that there had been eleven reports made
to CPS. (Fifteen families had less than six months follow-up time and
were not included in the search). Five of the fifteen reports were for
three-month families and six were for nine-month families. Of these 11
reports, five of them were indicated (four for three-month families and
one for nine-month families). The low number of reports overall
precluded tests of significance between groups. Family Connections
appears to be a promising model for preventing neglect and enhancing
children's safety and well-being. Limitations of this original project
are now being addressed through the replication of this program in 8
sites. The Office on Child Abuse and Neglect has funded one replication
in Baltimore which is targeting grandparents raising grandchildren.
Other projects are funded in California (2 programs); Michigan; Texas
(2 programs); West Virginia; and Tennessee. Further information about
this program may be found at the Family Connections' web site at http:/
/www.family.umaryland.edu
A workshop on the program will also be presented at the U.S.
Department of Health and Human Services, Administration for Children
and Families, Children's Bureau sponsored Biennial Child Welfare
Conference: Focus on Evidence Based Practice being held on June 29th,
2004 at the Marriott Wardman Park Hotel in Washington, D.C. This
national conference will provide training experiences and best practice
models in child welfare as well as many opportunities for collaboration
and partnership building. It is expected to bring together 500
participants across the spectrum of child welfare. The participants
will include state child welfare directors, policy makers, judicial
representatives, federal, state and local agencies, community-based
organizations, faith-based organizations, advocacy groups, direct
service providers, related associations, and other partners in the
field.
Lessons Learned
In summary, I firmly believe that if we want to prevent future
fatalities due to child abuse and neglect, we need to drastically
reform the way our communities are structured to respond to families
who may be at risk for child abuse and neglect. Governments ought to
facilitate the development of community environments that by their
nature provide family support and that ensure watchfulness for
children. Help--and, if necessary, monitoring and control--ought to be
built into primary community settings in a manner that minimizes
intrusions on privacy and that improves the everyday quality of life
for children and families, whatever their vulnerability and needs.\25\
One such promising method for accomplishing this goal may be to reform
child protection systems to differentially respond to children and
families. We must also practice working together systematically on a
daily basis.
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\25\ Melton, 2003, p. 9.
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Finally, more attention needs to be paid to testing strategies to
prevent and intervene so that we more efficiently use the limited
resources available to dedicate to this major social problem. Despite
gains in evaluating the effectiveness of interventions in the past ten
years, we do not yet completely understand what interventions work with
whom and under what conditions. Federal and state support for research
on the effectiveness of child maltreatment related prevention and
intervention efforts are limited. If we want to invest in programs that
work to help children and families achieve safety and well-being, we
must undertake rigorous studies on the efficacy and effectiveness of
different program models.
Thank you for an opportunity to express my opinions about what we
may learn from this tragic situation in Baltimore.
Chairman HERGER. Thank you very much. The gentleman from
Michigan, Mr. Camp to inquire.
Mr. CAMP. Thank you, Mr. Chairman. Dr. Beilenson, it seems
to me that the hospital had an obligation to do more than
simply place a phone call to a clerk. You had a single parent
coming in with twins and low birth weight. All the red flags
went off that this person should not have been just simply sent
home. Can you just tell me a little bit about why the hospital
did not do more?
Dr. BEILENSON. Yes. I actually know about the case. I am
just the City Health Commissioner, I don't work at Johns
Hopkins, but I actually do know the case, and I have also said
in the press that I think the Secretary and Mr. Blair have kind
of taken too much of the heat; that not only did Johns Hopkins
make that call, they actually knew, and the referral form that
was eventually sent did have on it that they knew a permanent
removal had occurred. So, I do think it was incumbent on Johns
Hopkins staff to have gone ahead and called CPS, even though
they were told by the clerk that there was no open case.
Mr. CAMP. So, they had other knowledge?
Dr. BEILENSON. They did have other knowledge. So, that is
why it shouldn't have happened. That is why one of the
recommendations I didn't mention, because it was very specific
to the case, is Johns Hopkins, and you wouldn't know this, but
Johns Hopkins happens to see the vast majority of physical
child abuse cases in the city. So, we recommended not a hotline
extended hours, but 24-hour, 7-day-a-week coverage at Johns
Hopkins. So, a CPS person could have been there and just been
called upstairs.
Mr. CAMP. From what I have seen in press reports, the
circumstances of the mother coming in indicated no prenatal
care.
Dr. BEILENSON. Delivered in a sweat pant.
Mr. CAMP. I think there were other issues. I appreciate
your comments on reunification. This clearly was not a
reunification case. I think the Adoption and Safe Families Act
(P.L. 105-89) really does give the authority to the judges to
make the decisions that need to be made, but it is interesting
to hear that your experience is they are not doing that. So, we
may have to take a look at that in another issue.
Secretary McCabe, it seems to me that this whole
legislative or legal point that the State cannot act on a
presumption that the same parent will abuse a child later, I
know other States have different laws. For example, in
Michigan, a subject can incorporate by reference what has
happened to one child to other children later. It seems to me
there should be a legislative change there to correct that. I
know other States do that, and I am surprised, frankly, that
Maryland does not have the ability to do that.
Mr. MCCABE. We will certainly look at that. We want to
learn from this. I think differential response that the doctor
talked about points to that, and we will do that, Congressman.
If I can also, I talked a little about partners in this, and I
think it is important to also make a point that judges
ultimately have the discretion and the authority to determine
what custody is for a particular child. We spend a lot of time,
our social workers, working with judges. Hence, they, in our
State, very much believe in reunification, as we do as a
department. Whenever possible we want to reunify. In fact, we
are mandated by law to try to reunify to the extent we can. So,
we will certainly look at that.
Mr. CAMP. I understand, but I am really looking at the
point at where files are closed, particularly after one child
may be removed. If one child has been removed, and then a later
child is born, there is a fairly high indication there may be
problems again. I know other States account for that, and the
evidence in the previous file can come in in a judge's
determination. The other point I wanted to ask you about is
when you testified before us in May, you said that the
Baltimore City DSS had been operating under a Federal consent
decree since 1989, and the local agency is obligated to make
systemic improvements in their programs. Obviously, there have
been problems in the Baltimore welfare system for some time. I
wondered if you could tell us more about why the consent decree
was put in place, and what it means today; what improvements
does it require; and how are these paid for? A little
background on that, please.
Mr. MCCABE. Sure. In 1989, the Federal courts established,
in LJ v. Massinga, which was a class suit by plaintiffs'
attorneys, that the Baltimore City DSS would be operating under
this Federal consent decree. Others could probably comment even
more knowledgeably than I can, but I think it was because there
were children in foster care that had been lingering there, and
there did not seem to be any significant improvement in trying
to find permanency for kids in foster care.
As a result of that Federal consent decree, we are now
required to measure our progress in a report every 6 months to
plaintiffs' attorneys, these are pro bono attorneys who are
doing this, about progress against several measurable
standards. I have to admit to you all that I think for many
years it was a kind of a pro forma exercise, where we
internally recognized we had to do this report, but we had not
been committed, as much as I think we should be, to making
improvements so that someday we could qualify to get out from
under this Federal consent decree. I have made a commitment
with the plaintiffs' attorneys to do everything I could to make
changes so that we could qualify for coming out from underneath
that. The systemic issues that they reference in that are still
very much in play, and we are trying to do something about it.
Mr. CAMP. There have been some comments about the
technology here, and if there had been better technology. Under
the Maryland system, even if the technology was perfect, they
would not have told the hospital that there was a case, because
it was closed. So, all the technology in the world wouldn't fix
that. I think you have a legal problem there. I noticed in your
written testimony you mentioned 1,000 computers had been
ordered but never delivered. Can you tell me about that and the
reason for that delay?
Mr. MCCABE. Sure, Congressman. Well, when I came on board,
and I think Mr. Blair can confirm this in his shorter time at
the helm, we recognized that the conditions in which our
workers operated, particularly our frontline workers, was just
unacceptable. So, we committed, I committed and the Governor
committed, to doing everything we could to make sure that those
tools were available to them. So, now every caseworker, believe
it or not, has a computer on their desk. We are finally getting
a phone system that you and I have enjoyed for years. We are
finally getting our workers those tools, and that is a good
thing.
Specifically, I talked about MD CHESSIE, which is our
SACWIS system. I don't want to oversell the technology. Any
technology is only as good as it can be if people who are using
it either understand it or understand the value of it.
Otherwise, it is just that, it is technology. So, we are very
much committed to training our workers to use it. The more
information the better. The MD CHESSIE system, when fully
implemented, will have all the relevant case information,
including placement opportunities open, where we can actually
place a child, at the fingerpoint of the person operating the
computer. That simply does not exist, and it just compounds the
difficulty our caseworkers have.
Mr. CAMP. Thank you, Mr. Chairman.
Chairman HERGER. The gentleman's time has expired. The
gentleman from Maryland, Mr. Cardin to inquire.
Mr. CARDIN. Thank you very much, Mr. Chairman. I want to
ask a few questions about the Swann case to find out what
happened, but also to see whether we have made changes in our
system so that what happened in the Swann case will not happen
again.
The first point is you have a young teenager who is a
runaway from foster care, becomes pregnant. She has a child.
The child is taken away from this young teenager because of
abuse and put in foster care. You have a big folder, You said,
4 or 5 inches thick. Why wasn't she put into foster care or the
juvenile system, or why wasn't there any services provided to
her after she had abused her child? You had to take the child
away, and she is still a foster child herself. We have a
responsibility. So, why wasn't there any services provided,
either through foster care or the juvenile justice system, if
need be, so she is not on her own on the streets? Question
number one. Have we taken steps to make sure that doesn't
happen again in another case that might be looming?
Mr. BLAIR. Congressman Cardin, yes, she was in foster care.
She was on runaway status, meaning that she had left her foster
care parent which is provided by the State and the services we
would be providing for her. She had run away from us, and we
were making strenuous attempts to find out where she was. We
did not know she was living in an abandoned building, and we
did not know she was pregnant.
Once a case is closed, in a sense, the child is transferred
to an active foster care case, where he or she will receive the
supportive services from our agency; so she was receiving
services. For whatever reason, which I don't know and can't
comment on now, she ran away from us. She ran away from the
foster home, and we were trying to find where she was. We had
no idea she was living in an abandoned building and no idea she
was pregnant. It was brought to our attention only after this
case was brought to our attention, sir.
Mr. CARDIN. My real question said, when she had her first
child and the first child was taken away, why didn't then more
intense services, if she had a child while she was in foster
care, and she abused that child, it seems to me that is a
signal that intense intervention is necessary, and it is our
responsibility for intense intervention, and just putting her
back into a foster care situation that couldn't supervise
doesn't seem like it is a safe alternative for either Ms. Swann
or society, and it proved to be that way.
Mr. MCCABE. Can I comment, just to clarify a little about
our internal processes? The question the Johns Hopkins worker
asked our clerical staff, which was, was there an open child
abuse case or child abuse case, and the answer was no. When an
investigation occurs, and then an action is taken, we may
remove a child, within our own system we close the
investigation. That, however, doesn't mean that there is not an
active foster care case. So, we are not only providing for the
child, the well-being in a new foster home, our caseworker, the
foster worker, also has a dual responsibility to help the
foster worker.
Mr. CARDIN. I think I understand that point, but I think
Dr. Beilenson's point is that this is a real big flag going up,
and we need to provide intense services. The case should not be
closed from the point of view of service after you take a child
away from an abusive parent, particularly if that parent is
your responsibility under the foster care system.
Mr. MCCABE. We were continuing to provide services. Now, I
agree with Dr. Beilenson, the level of service that we can
provide a caseworker, to both a child who is in care as well as
the teenage mom, probably they do the best they can with the
tools they have got.
Mr. CARDIN. I want to give Dr. Beilenson a chance at that,
but the second point, and I want to make sure time doesn't run
out, is that Johns Hopkins evidently had a telephone number to
call. It is an internal number. I don't know who gave them the
number to call, and I am not trying to say Johns Hopkins
shouldn't have done a better job in the case, but it seems to
me if Johns Hopkins has an internal number to call in the DSS,
and you are calling from a hospital as far as children being
sent home with a parent, that number should have connected to a
person that could have given them the right information. Again,
I am not trying to place blame here, but have we made the
corrections now so that if a hospital contacts the DSS they can
know for sure whether there is an open case with a mother
before letting that child go home with that mother?
Mr. BLAIR. The answer is yes, sir. For several years prior
to me coming on board, this back-door number had existed
basically based on workers who worked for the department who
moved on to other employment, such as Johns Hopkins and other
hospitals, and they utilized this number just to get simple
information, not to actually report an issue of abuse. So, the
worker was calling a number that she knew she would get cursory
information. She did not suspect abuse. That is why she didn't
call the correct number, which is the CPS hotline. Presently
that number has been shut down.
Mr. CARDIN. Mr. Chairman, with your patience, a question to
Dr. Beilenson. Do you have a comfort level today that we have
in place in Baltimore information in the delivery rooms of our
hospitals, particularly Johns Hopkins, which is the largest,
you said, for potential child abuse cases, so that if the
hospital in good faith is trying to get information, they can
get information? Number two, are you confident that if you have
a foster parent who delivered a child after they had another
one taken away from them, that there is something in place that
ensures that the foster child is going to get adequate
services?
Dr. BEILENSON. No.
Mr. CARDIN. Thank you, Mr. Chairman.
Chairman HERGER. I thank the gentleman. The gentleman from
Louisiana, Mr. McCrery to inquire.
Mr. MCCRERY. I have no questions at this time, Mr.
Chairman.
Chairman HERGER. The gentleman from Washington, Mr.
McDermott to inquire. Does the gentleman from Washington have a
question?
Mr. MCDERMOTT. Yes, Mr. Chairman. I am interested in
hearing from the witnesses whether they think the Federal
Government has any role in this? Do you need Federal standards?
Do you want Federal standards? Do you want us to stay out and
just ship the money, or what is your view? We have been having
hearings on this stuff for the last couple of years. We heard
about New Jersey, and we have a big report here from the GAO,
and we get all this stuff, but we never write any legislation.
So, I am kind of wondering what the point is. Are you here
asking or think we ought to do something?
Mr. MCCABE. If I may, Congressman, I served 11 years in the
Maryland Senate, and when an incident occurs, it, rightfully
so, creates a lot of visibility and usually action. It should.
We need to take urgent steps to make a fix, and we are planning
to do that in Maryland. However, the CFSR demonstrate that we
just can't make a quick fix in all cases. We have got a real
long-term systemic weakness in our system in Maryland, as
usually most other States do. The Federal Government absolutely
has a role, not just by shipping money to us, and we are very
grateful for that; we rely on it significantly. Two out of
every $3 which funds Maryland's DHR comes from the Federal
Government. So, we absolutely need that partnership.
A hearing like this, frankly, brings all of us to this
table and really requires us to listen to each other. That is
something that doesn't always happen. As Dr. DePanfilis
mentioned, we all work in our own little tunnels sometimes. I
spoke with Dr. Beilenson about the three of us meeting next
week to talk about what the health department does with our
department and how we can better work together. So, in terms of
Federal standards and legislation, I think the CFSR is that
Federal role that you indicated is so important. We have to
provide a program improvement plan which will incorporate this,
or we risk a significant penalty.
Mr. MCDERMOTT. Has any State ever been penalized? Have you
ever been penalized?
Mr. MCCABE. We just received ours, and to the best of my
knowledge that hasn't occurred. Our expectation, and I think
the expectation of the Federal Government, is we will get a
plan in 90 days to them that is workable and doable.
Mr. MCDERMOTT. So, you don't think there is any real
positive thing that the Congress could do in this? It is
already in place, and it is really up to you guys at the local
level? Or you folks, because it is men and women.
Mr. MCCABE. Congressman McDermott, Congressman Cardin, I
know the Committee is aware of the Pew Foundation on Foster
Care, and one of the things we all talked about is the need for
intensive services before abuse happens. Right now there is an
incentive really because we get money only after we take a
child out of care. The recommendations that will be before you
indicate that States need more flexibility for the moneys they
receive so they can provide some of those up front services
that Dr. Beilenson and others have talked about. That is a big,
long process, and that is in your hands; that flexibility for
the use of Federal funds would be helpful.
Mr. MCDERMOTT. Any of the others of you?
Mr. BLAIR. As a local director, the Secretary is correct.
We are receiving children who have multiple problems. Their
lives are shattered long before they encounter a local DSS
office, across the country, not just in Baltimore. Times have
changed. Times are more difficult. So, clearly being able to
utilize funding to create more preventive services to help
children before they enter the stream.
We are looking at a local DSS where we basically have a
safety net out trying to catch as many as we can, but they have
been abused or neglected long before they encounter our agency.
So, any assistance from the Federal Government that would allow
the State, which means local DSS, to create sort of these out-
of-the-box type of collaboratives with the health department
and others, and education and housing and all these other
things that are important to the children before they come in
contact with DSS, would be most appreciative, sir.
Dr. BEILENSON. I will just be blunt. I think that by far
the most important thing you are doing is holding these
oversight hearings, because, with all due respect to the
Secretary, who is a very decent, caring guy, who really does
care about these issues, what has happened in the past when a
bad case occurs, at least in Baltimore, is press, all these
guys from Baltimore, cover it for 2 or 3 days; DSS hunkers
down, waits for the wave to crash over their heads, public
outcry to die down, and nothing ever really changes.
We made these recommendations to the Secretary and the head
of DSS back in January. As Congressman Cardin knows, being the
former Speaker of the House of Delegates, it was done to get
there before the legislative session in case legislation had to
change. I don't think Federal legislation is necessary, with
one exception: confidentiality. I can't ever get from our own
people whether it is State law or Federal law that affects
releasing information, but I really believe in transparent
government. This is part of transparent government. Too many
times people fall back on, we can't release the details of this
case. Even fatal cases. I don't understand the confidentiality
of fatal cases actually. I have never understood that. We
cannot discuss them.
There is no way you are going to solve problems or change
the system unless confidentiality, and I am all for
confidentiality. I don't want my medical records divulged, but
that is not what we are really talking about here. This is to
protect kids, and you keep falling back on confidentiality. So,
if there is any one issue that the Federal Government, and I
don't know specifically where the confidentiality issue lays,
Federal or State. That might be something you can be involved
in. This oversight is making a difference because these
recommendations are getting a lot of coverage now.
Dr. DEPANFILIS. I would like to offer a possible alternate,
but somewhat complementary, view, and that has to do with the
way that our Federal and State systems are designed to respond
after the fact. So, the guidance that the CAPTA sets up, which
sets the standards for child abuse and neglect reporting laws
at the State level, has a very narrow definition of child abuse
and neglect. It is only when those omissions or acts create
harm for children, or a serious risk of imminent harm for
children, are our current systems able to respond. That, in
combination with the funding issues, where much more support is
provided after the fact, when there is a need to remove
children, which comes out of Title IV-E funding, we end up with
this pattern of spending all our resources to serve the same
families at the high end, at the deep end, this revolving door.
So, I think we really need to look in this country at a
total new system and quit taking the easy road, with these
small solutions, and really look much more deeply. Maybe the
whole thinking was faulty to begin with, to think you could
take a legalistic response to such a complex problem. We know
that prevention works in many other fields of practice, if you
look at medicine and others. We need to look at prevention with
respect to child abuse and neglect.
Mr. MCDERMOTT. It seems to me, Mr. Chairman, and I realize
my time is up, but I think we spend $700 million on prevention
and about $7 billion on treating the results of the problem.
That seems like that is somewhat of an imbalance, and maybe it
is something we really ought to look at in terms of what we do
with our money. I think it is a suggestion that this
Subcommittee could have an impact on.
Chairman HERGER. The time has expired, and I have been very
generous with the time, because certainly this issue is
critically important to the young people, to the children of
this Nation. I again mention that the purpose for this hearing
is to bring to light the challenges, the problems that we have
out there. This Subcommittee is looking at coming forward with
legislation. We have just had recently the Pew Foundation study
that has come out. I am working with Ranking Member Cardin,
along with Mrs. Johnson, Mr. Camp and others, to come up with
legislation where, hopefully, we will be going out of our way
to address these problems that we are seeing coming forth that
are, again, not just unique to Baltimore or Maryland, but we
see tragically all too often taking place in our other 49
States as well. Mr. McCabe, if I could ask you, who, if anyone,
is responsible for determining whether a new mother, especially
a teenaged mother, is fit to take a child home from the
hospital?
Mr. MCCABE. Ultimately, the way our process works. Oh,
excuse me, in terms of who makes that determination whether a
child should be released after birth in a hospital?
Chairman HERGER. Yes, and do the hospitals release
newborns, for example, to mothers who live on the streets; to
mothers who live in homeless shelters? Maybe Director Blair, or
anyone else.
Mr. MCCABE. This is where Dr. Beilenson is saying everybody
has to work together to determine what makes a rightful plan.
Ultimately, judges in Maryland, in our juvenile system, have a
role where we make recommendations to them on the disposition
of children. So, if there were someone clearly at risk and
there was history of it, I think that we do have a role to
advise and recommend what the proper disposition is. As this
case illustrates, in real time, two children were born in a
hospital setting and calls were made. My view is that the right
additional questions were not asked and that all parties had
some role in failure here.
Chairman HERGER. Anyone else have a comment?
Dr. DEPANFILIS. Basically, I think what you are talking
about is, a child is born, there is an assessment of the
capacity of that parent to provide adequately for that child
when the child leaves the hospital with the parent. If that
person, that team in the hospital, has reason to believe that
the child will be maltreated, according to the definition in
State law, they may make a report of child abuse and neglect.
In this case, it would be a risk of child abuse and neglect.
So, it depends how convincing of an argument that person
making the call can make to suggest that the conditions that
they are aware of would create a significant risk of serious
imminent harm when that child leaves the hospital. So, if the
parent has been noncommunicative about the information, about
their plan, if there is a history of substance abuse, if there
is enough, if there is a good enough assessment done at the
hospital, then you should be able to make a convincing case,
such as in this case. It doesn't sound like that happened. So,
it doesn't sound like the call was actually made to report the
suspicion of child abuse and neglect, and that is why it fell,
in this case, through the cracks.
Mr. CARDIN. Would you yield, just so I can clarify that? If
the assessment is made that there is a risk here, the call is
made to the DSS; the child, the baby, would normally be
released within a very short period of time, 2 days. So, you
are saying that the DSS would be contacted by the hospital, and
then DSS would then come out and make an on-the-spot
investigation? That would be the normal process that would be
used?
Mr. BLAIR. Yes, sir. As a Director, I have done that with
my workers. I have gone to CPS and taken a call, and we
followed through on an investigation, myself as Director, just
to see what the process is myself, so you make decisions. You
are making it in real time, and that is exactly what happens.
Mr. CARDIN. So, it is your agency's judgment, and you said
there were 100 cases that you act on, on abuse, a month in
Baltimore City?
Mr. BLAIR. Correct.
Mr. CARDIN. How many of these are made in this type of
circumstance at the hospital?
Mr. BLAIR. That number I can't say. I can only say that,
over the year of 2003, we had over 13,000 phone calls of people
making allegations of abuse in 2003. I don't know how many came
exactly from the hospital, but I can get that information to
you, sir.
Mr. CARDIN. Thank you.
Chairman HERGER. Thank you. The gentleman from California,
Mr. Stark, to inquire.
Mr. STARK. Thank you, Mr. Chairman. I am just trying to see
if I can focus here, Mr. Blair, on how the system works in
Baltimore City. You have a ratio of 17.5, I see here, of
caseloads per worker. Now, is that just for this chart I am
looking at, is child protective foster care, adoptions and
whatever SFC is? Is that the 17.5, or is this caseload for all
families who would come to the attention of your department?
Mr. BLAIR. I believe that is our foster care ratio.
Mr. STARK. That is just foster care.
Mr. BLAIR. I believe that is what that is.
Mr. STARK. You have a Family Preservation Program?
Mr. BLAIR. Yes, sir, we do.
Mr. STARK. Give me an idea, if I were to suggest to you
that if all Temporary Assistance for Needy Families (TANF)
beneficiaries that had children, what would be, what would you
guess the caseload to social workers would be? If you lumped
all of these, all of your clients together, what are you
operating on in your department in terms of caseload? Make a
guess.
Mr. MCCABE. We have approximately a little over 70,000
temporary cash-assistance customers in Baltimore City, excuse
me, Statewide, and of that, a number of them single only, the
child is a temporary cash assistance client. I don't have that,
those numbers.
Mr. STARK. Hundreds?
Mr. MCCABE. I am not sure if I understand the question.
Mr. STARK. Well, how many? All of these people have to be
supervised somewhere or another, minimally, if they are not in
any immediate danger, but they have to be assigned to a
professional, I would presume, a caseworker. I am trying to get
your caseload here, as you say, for foster care and other
services is about 17.5 cases to the social worker. I am trying
to get, if you take all of your TANF clients and others in your
DSS program, what is the overall caseload?
Mr. BLAIR. The persons on TANF are receiving temporary
assistance, temporary aid. So, most of them, more than likely
some of them have active foster care cases. So, what happens?
Mr. STARK. They do not come under Family Preservation?
Mr. MCCABE. No. What they do, we have within our system in
Baltimore City, as across the State, we have separate
eligibility workers who work with those clients. They are
different and distinct from the people who provide these social
services to child welfare.
Mr. STARK. Is there, do they interface a lot?
Mr. MCCABE. They should interface a lot better. We have
information.
Mr. STARK. The idea of Family Preservation is that there is
housing and food and poverty and transportation and child
abuse, and foster care gets to be a very small number, but my
suspicion is that not, it happens in Alameda County,
California, is that you are closer to individuals supervising a
hundred cases. That means you get to look at somebody in their
surroundings to see whether there is a house or whether there
is assistance and parenting needed once every 3 months as
opposed to more often. I am just trying to get, in terms of the
resources that we might offer, I am just trying to see how
pressed you are for additional resources.
Mr. BLAIR. As a local DSS director, we always welcome any
type of resources.
Mr. STARK. What do you pay a starting caseworker in the
child protective? What does a child protective caseworker get
as a starting salary? After they graduate from Dr. DePanfili's
program, what do you pay them?
Dr. DEPANFILIS. First of all, I need to say that most
workers in Maryland are not social workers. They have other
training.
Mr. STARK. Good training?
Dr. DEPANFILIS. They have other education.
Mr. STARK. Is there a training standard?
Dr. DEPANFILIS. I really don't know. I know that there is a
training certification that occurs for all. If they have
graduated with their masters in social work, they start at
around $33,000.
Mr. STARK. If they teach in the public school and teach in
third grade, what do they start with?
Mr. MCCABE. I would suspect higher than that in Baltimore
City, without a masters degree.
Mr. STARK. I guess what I am concerned about is that, this
is a concern that I have across the country, that we have
awfully minimal standards for people who are charged with
observing families who probably don't rise to the level of
incipient abuse, but if they are not trained, they are not
going to spot it. They are trained to add up the numbers and
say, ``You don't qualify for food stamps any more.'' It is not
that that isn't a job that needs to be done, but if we cannot
somehow raise the professional level of your undergraduates and
if Mr. Blair can't demand a bachelors degree or some intern
training of a couple of months rather than a 10-hour
indoctrination course, I think we just miss a lot of cases.
That, I am just concerned that we are not doing that. I don't
know how, I know you are limited in the resources you have. I
think that is something, Mr. Chairman, that we could do more as
we do these programs and not only just by the money we provide,
for instance, in TANF for the training, but we are impacting
these communities who have to put into operation the plans that
we create. I don't know how we get more generous, but I think
we have to be. Thank you.
Chairman HERGER. I thank the gentleman from California. Dr.
DePanfilis, could you identify for us some of the factors known
to increase the risk of child neglect? Are child welfare
systems in the United States currently designed to identify
those factors and respond with assistance?
Dr. DEPANFILIS. Yes. First of all, let me say that each
case, each family situation is different. The things that have
been shown in research to increase the likelihood that the
basic needs of children are not met, which is one broad
definition of neglect, substance abuse, domestic violence,
mental health problems of the parents, I would say would be the
primary ones. Then you have social isolation, having no one to
turn to, lots of stress, high relationship between poverty and
meeting the basic needs of your children, but it doesn't mean,
most poor people don't support their families. In spite of
that, they can still adequately care for their children. So,
poverty alone usually does not result in neglect. Poverty puts
you in neighborhoods where you have poor housing, where you
have poor educational opportunities, lots of high rates of
crime and other violence, which then makes the neighborhoods
unsafe.
So, I would say those are the core factors that relate to
neglect specifically, and neglect is the primary reason that
most families are referred to the child welfare system, and
those in my own research on the recurrence of child abuse and
neglect. Neglect circumstances are the most likely to come back
over and over and over again because we failed to respond
effectively the first time we become aware of a family who is
under stress and is having challenges to meet the basic needs
of their children.
Chairman HERGER. Are there any Federal policies that you
feel that we might come up with that might more actively
encourage States to target these families with these factors to
prevent abuse from happening?
Dr. DEPANFILIS. Well, I think the whole emphasis, both
within the CAPTA and also the way we allocate our resources
under Title IV-E all put an emphasis on after the fact. I
think, especially in cases around neglect, this isn't like a
one-time thing usually. It is not like an event occurs today
and that is it. It is this chronology of omissions in care that
sort of mount up and, in the life of a child, mean a great deal
to their opportunities or lack of opportunities to succeed in
any part of their life. So, I think we really need to go
backward, I think, and look at, where are we going to put the
minimal resources we have? I think we should change that ratio.
Chairman HERGER. Well, I would like to thank you. I would
like to thank each member of our panel.
Mr. CARDIN. Could I make one quick comment? Appreciate
that. Just one quick comment. First, I want to first point out,
I think the suggestion that you are now talking more among
yourselves is very helpful. If these hearings help facilitate
that then that, in and of itself, is important. I am glad to
see that you are all trying to get as much expertise as
possible to deal with this issue. I just would be bold enough
to make just two suggestions that I think have come out of this
hearing. One, it seems to me that, I understand Baltimore City
has approximately 500 confirmed cases of abuse or neglect a
month, of which, 100 results in the child actually being taken
out of the family, from the information that I got from
Secretary McCabe.
That is a tough assignment. I understand that. I would just
suggest that, number one, in the hospital itself we could be
doing a better job with children who are born there. I think, I
know Dr. Beilenson has made some recommendations here, but it
seems to me that we should be able to assist the hospital in
carrying out its very tough responsibility, to get DSS involved
before a child is allowed to come home. It seems to me we
should have better guidelines to help the hospital get the
information from DSS or report the information to DSS in order
to make the appropriate evaluation.
The second point I would suggest is that, when we have a
child in foster care who is a very tough assignment, such as
Ms. Swann, we should have some type of way of putting a high
priority to provide services to that individual. Again, it may
not be appropriate within foster care. We might have to go
beyond foster care. We should be able to put a high priority on
that type of a case. We should be able to identify that. Once
again, Mr. Chairman, I want to thank you very much for
permitting this hearing so that we could try to understand what
happened in Baltimore and use that not only to help people in
our jurisdiction but to use it as a way to try to get national
involvement to try to help our children.
Mr. MCDERMOTT. Can I ask another question of them?
Chairman HERGER. Very briefly.
Mr. MCDERMOTT. My question is this: if neglect of children
is the major reason that you pick kids up, to what extent are,
or are you yet seeing any impact? Or do you anticipate impact
from the lessening of the availability of Section 8 vouchers
and, therefore, the loss of housing, so that people start
living in their cars and that kind of thing?
Dr. DEPANFILIS. I think, in Baltimore in particular, I
think we are all sort of nodding our head. The housing, both
the quality of housing and the quality of housing at an
affordable price, high content of lead in the poor housing,
high density of people within four walls, all of those things
are major issues and have a big impact on how adequately
parents can care for their children.
Mr. MCDERMOTT. Thank you.
Chairman HERGER. Again, I want to thank each of our panel
members for appearing before us on this very difficult issue to
discuss this tragic case. I look forward to continuing to work
with all of you to ensure that States are doing all that is
necessary to protect children from abuse and neglect. With
that, the hearing stands adjourned.
[Whereupon, at 5:15 p.m., the hearing was adjourned.]
[Submissions for the record follow:]
Statement of Theresa S. Cook, Santa Clara, California
I am a Mother who has lost a son to the Department of Children and
Family Services not only because of a ``system that is broken'' but
because ``the system is corrupt''. There are NO changes possible for
Children in the System until you remove the problems from which they
are rooted. The root to all and mainly to this evil is the people who
currently run the programs. The Best Interest has somehow gotten lost
and greed has taken over. These people are given bonuses for every
adoption, tax deductions, awards, not to mention what is paid under the
table and much more. One who denies any of this to be truth is not only
lying to themselves but disgustingly; they also lie to the children. I
know first hand because my son was lied to and I was lied about. The
record is set up against me and it's all-fraudulent. Time and time
again, I continue to present my case to committees just like this one
and time and time again I am ignored. I have the evidence to prove the
lies yet; no one wants to take the time to see them. I am just one
voice in a crowd of many who keep screaming out for help and are not
being heard. Change is on the horizon, we have heard this for many
years now and nothing has changed. Only the order of the words seems
different. Before you make change, you must fix the problem. Get the
criminals out of their positions, appoint ``watchdog'' citizen panels
to review the cases, RETURN the children and as you witness the
reunions, the looks of the parents who will never get their child home
because of death, the scars so many have suffered from and the sigh of
relief at a mother who holds her child after thinking she would never
ever see him again, take those moments into consideration when deciding
what changes you have to make. The answers are there as they have been
all along. Any one of you who can't look at the number of children
being removed, the number of children not being returned should have
some concern why those numbers are so high. KEEPING FAMILIES TOGETHER
IS SUPPOSED TO BE THE GOAL HERE. Why then are so many children not
going home? How many more children will it take to slip through the
cracks before you realize the truth? This is Tragedy that could be so
easily prevented if that were the true intensions at stake.
Comments on Testimony
Having had experience with the System and becoming an Advocate for
other parents who are suffering as I am without my child, I would like
to comment on the testimonies taken on June 17, 2004.
A. To The Honorable Wally Herger;
1. You stated that the purpose of this hearing was to understand
what happened in the Baltimore case so it could prevent it from
happening again.
Your Honor, when will it be a reality to all of you that sitting
down to talk about it will not solve the problem? You ``explored'' the
case of the starving children in NJ; you have reviewed federal and
state oversight measures, and even heard about each and every state
FAILING the Federal Reviews. This is not the first year they have
failed; this is one of many years it failed. And every year new changes
are going to be made and every year, more children are taken and every
year more children die and every year, this committee sits down to talk
about it. The tragedy of a family being torn apart for ever, the death
of a child who's left in a strangers home to die alone, the bruises and
the scars other children have and are suffering from tonight and the
silent cries of children for their mothers and the mothers for their
children whisper in the wind each night as the world lays down to
sleep. Children are being physically dragged from their families,
beaten, molested, killed all the while they are lied to and drugged and
moved from place to place. They lose their identities, their rights and
the very core of who they really are.
Stopping the tragedies takes more then sitting down, it takes
action and it takes immediate action in order to attempt to prevent the
next from happening. True, no policy is perfect but it's the people who
have the power to implement them that are to blame here. They take the
polices and manipulate them to their own benefit and that's where
change must occur.
B. Floyd Blair;
2. Ask any family who has been involved with the system if the
Department addressed the families' difficult issues in any other way
but to use them against them in court? Limited resources are not the
issue. The resources exist and many of them good ones. The problem is
with the Social Worker who is under pressure of a Director who looking
to make brownie points with members of the Board of Supervisors or
someone else in position. Most social workers don't care what the
families issues are, they are just out to get the child put somewhere
and the last place they consider is to return them home. You will see
in my own personal story how well the Social Worker helped my family.
Social Workers do give 150% and that's in making sure the child never
returns home.
Heart wrenching is when a parent busts their rear end to get their
child back and a social worker recommends termination of rights because
of lies. Heart wrenching is having a 6-year-old boy tell his mom that
he will promise to come home when he gets big and to not move so he can
find her. Heart wrenching is when the birthdays, Xmas, Mother's Day,
Father's Day etc. roll on by each year and there's an empty void
because someone very special is missing.
The statistics will show, if taken honestly and they aren't, that
most of the children who die in the homes of their parents are children
who have been abused for years or most of their lives. They are
``damaged'' in the eyes of the Department and would be harder to place
if they were to be removed. So, they are left behind. During a
termination of rights hearing, features, ``adorable-adoptable'', always
describe the child. Children are described at the Reunification trials
as to having severe mental health issues that will only be aggravated
more if returned home but shortly after while in the.26 hearing, this
mental health issue will diminish and the child is deemed adoptable.
We have proof in the county where I live in that paperwork is
changed and altered by Officials. They even get to keep tier job when
the paperwork is exposed. Money embezzled from someone amounts to jail
time for a ``citizen'' yet, if a county or state employs you, you are
not even held accountable. That is what happens in Santa Clara County
and I'm sure it happens elsewhere too.
C. To Peter Beilenson;
3. Your recommendations are logical and unfortunately have
``suppose ably'' already been implemented but still they hold too many
gaps. What about foster parents who adopt or take in several children,
like the NJ case? What about the unlicensed social worker? Many of them
are. What about the social workers having to produce evidence to prove
their statements not just allow hearsay to be admitted. What about a
Judge who gives the perpetrator of domestic violence custody even
though classes was never completed? What about the social workers
accountability for NOT following the mandates as they are written.
You spoke about the three major causes of childhood deaths; SIDS
(adults co-sleeping with infants mentioned), Juvenile shootings and a)
CPS having removed a child and returned it only to be killed by the
parents b) one child removed and another killed later. Be realistic
with your studies. California has the largest amount of children taken
into custody by CPS. Experts here say that out of the 75,000 children
taken up to 50% could have been left home. DCFS comes into contact with
nearly 180,000 children each year. That's five-fold and its doubled in
the nation. More then 660 children have died since 1991 and more then
160 were homicide victims. Go onto the website ``Forgotten Children''
you'll see the horror these children are suffering in the hands of CPS.
There are many, too many other websites filled with these inexcusable
and preventive deaths.
There have been numerous lawsuits settled that involve CPS.
Hundreds of parents are stepping forward and begging for help from our
Government to get their children back because of the injustices CPS is
inflicting upon us all. Yet, you refuse to hear the truths and continue
to point fingers at the parents. That is just the easy way out of a
very bad situation in which it appears that each and everyone of you A)
Just don't care B) profit from it in one way or another or C) are just
too naive to understand about it.
It is frustrating to try and understand why you would state that
you are disappointed in the vague responses to your recommendations to
the State's Secretary for Human Resources and the Director of
Baltimore's DCFS. Doesn't that non-willingness of participation ring a
bell for you? What will it take to get you to see why you are not
getting prompt responses? And what do you intend on doing about the
lack of concern on their part?
Before making any future recommendations, I would suggest looking
at the reality of what is happening here and while you face it deal
with it accordingly. For instance, December 2, 3003, President Bush
signed the so-called ``Adoption Promotion Act''. This signature
expanded an existing adoption bounty program. The bounty encourages
states to tear children from their families-especially easy-to-adopt
infants. Even if the adoptive parents decide to give children back,
states keep their bounties and toss them into slipshod placements which
are even more likely to fail. Fewer foster parents are willing to adopt
then promised yet, termination of rights has increased. Between 1997-
2001, 92,000 parental rights were terminated. A generation of ``legal
orphans''. In 2002, 3000,000 were taken from their parents with
termination of rights taken. I know, my child was one of those
children. Children are trapped in foster care each and everyday and the
end results are needless.
D. To The Honorable Christopher J. McCabe,
The only comment needed here is that it is very strange how your
explanation of the Departments situation and plans just so happens to
be the same as every other Social Services Department in the country's
explanation. I am beginning to believe that is something one would
learn in a Social Services 101 Class.
E. To Diane DePanfilis,
``Family Connection'' is also a program that was implemented here
in Santa Clara County. Problem is the program hasn't benefited any
parent or child that I know of. The County Officials have once again
formed another committee to ``aid families'' and no results have taken
place. I can say that it is more likely then not that the Federal
Funding was received and probably spent elsewhere as Federal money is
easily obtainable resulting in very little progression for the safety
of the children. Has anyone thought to recommend that any Federal money
given should be only spent on those that produce positive results?
Positive results meaning families stay together and family issues
resolved. Positive results meaning fewer children removed and fewer
children abused and killed. Positive results are having a truly abused
child's life saved. One who's importance would normally slip through
the cracks because the focus is on taking a child whose parent is
willing to make changes and whose willing to do whatever it takes to
get their child home to them.
We already have the ``Working together across systems'' going on
here in Santa Clara County. It consists of a team of *A Superior Court
Judge and/or Commissioner, *CountyCounsel, *A Social Worker, *A
District Attorney, * Juvenile Dependency Attorney, *A therapist and *a
psychologist. As a team, they all work together to promote the negative
issues of the family over a limited period of time thus resulting in
the termination of parental rights for adoption of the child.
These ``known professionals'' need only the ``evidence of hearsay''
to establish their case against the parents. The parents are greatly
involved in each and every case as this team demands completion of the
case plan. Parents are told after complete ion that it wasn't good
enough or that they didn't learn enough or that time had run out. Might
I add that a greater number of these ``so-called professionals'' are
not even licensed. The ones that are were only required to take
training courses which ran 4 to 6 hours each.
IN RE: JOHN C.
March 13, 2000, my son John, three years old at the time was taken
into custody after a 911 call. I had argued with my two older boys
about a relapse I had. Having been in treatment and diagnosis with Bi-
Polar Disorder, I was suddenly caught in the middle of a nasty divorce,
insurance cut off and no medication. The only thing I knew was to self-
medicate. I was not happy with that decision and to prove to the kids I
didn't want to continue using, I dialed 911. Thinking I would end up at
the county hospital, I soon realized I was headed to jail and John to
the Shelter. Previously, four other children had been removed and I had
never been offered any kind of treatment plan. Two other children went
to live with their Dad but the Courts recommended I do drug treatment
at my own expense and I had no income at the time. My two children were
taken by their Dad out of state where he has held them away from me for
over 11 years now.
I was told by the first Social Worker that if I completed my case
plan, my son would be returned home. I was put into intensive
programming dealing with ``dual Diagnosis'' and I successfully
completed each and every class I went to. I obtained employment and
worked with other addicts, built a strong support group and continue to
maintain my sobriety and contacts with my sponsor who is my best
friend. I complied with everything. I struggled with dealing with my
ex-husband and his family who did everything to keep me from regaining
custody. There were phone calls made to the social worker several
times, which were made out of complete vindictiveness. The social
worker (SW # 4) admitted to never investigating these allegations. She
merely wrote reports to the Judge and submitted the allegations as
facts. She lied and manipulated my son away from me over a period of
2\1/2\ years. I was accused of telling my son to lie--accused of having
``diluted'' tests'', burning my son with a cigarette intentionally
amongst other things. A social worker from the DA's office put the
icing on the cake with the cigarette burn. One burn which he had no
doctors report on, no visits were stopped and my son was not removed at
the time he says he saw the burn. Amazingly, on the witness stand this
``so-called expert'' admitted to seeing a burn and then he stated he
never saw it. Out of five Judges who sat on my case, one described me
as being a MBPS Mom. Despite numerous letters from my doctor, the Court
and the social worker made their own diagnosis and said that the people
that were with me on a daily basis (who never witnessed any of the
allegations I have described) were incredible. My rights were
terminated on September 20, 2002. It had been 6 months that I had seen
my son as they had terminated my visitation in May 2002.
My son and I were very closely bonded. He was the sparkle of my eye
and I was a very good mother to him. I never let him down until the
Department stepped into our lives. Once involved, they made sure I
failed my son in every way and told him I was the cause of the failure.
He would beg for me to let him stay at my house. He cried when I had to
take him back to his Aunt's house and told me I didn't' love him. This
result after a perfect weekend we had spent doing things together and
with other family members. The system literally tore my son and I apart
with their lies. I have proof to each and every lie they told and I
have shown several entities, including this committee the documents,
yet I am unheard and my son is to this day, somewhere out there. I have
no idea if he is even alive. If he is being abused, if he is happy,
sad, has a home, a bed . . . I have no idea and the unknowing is pure
torture.
Your system and the people who run it should be abolished. You
people have got to do the right thing and bring our children home. I
don't mean to round table discuss this matter but to put it into action
immediately. ``Let our children go.'' Where have you heard those words
before? Each and every day, each and every hour, each and every minute
that goes by with no immediate action taken on your part is a crime and
a lack of concern to humanity on your part. Too many children are being
taken, why can't you understand that there is a serious violation being
committed against the families of America and even other nations if
that were to be sized properly. What is happening is not just a matter
of a case or two. It's a matter of millions of cases and it's a greater
chance that if this keeps going many, many more children will go
unprotected as the billion-dollar industry of stealing and selling
children is kept alive.
There are many parents like myself who realized their mistakes and
sought help. This has to amount for something other then the loss of
our children. In today's society, drug addicts are frowned upon and
treated as if they can never make changes. Investigations are done and
the results are ``Looking into the family history and the social
workers notes''. We obliviously all know that cycles of family history
can be broken and that the programs work for those who want to work
them. If it is true that drug addicts can not change then why are so
many federal tax dollars being ``wasted'' on the programs? The truth is
that the programs are working and the results are showing. So, the
question now shifts to the Juvenile Dependency system. Unlicensed
social workers are being allowed to opionate to a judge without even
following state mandates. There is no room to err on the part of a
parent but the social workers are not obligated to accountability on
anything they do. The sickest part of the whole situation is that they
know it and they will take advantage of it.
The social worker in my case told me exactly what the Judge was
going to rule on 6 months before the trial and she had already informed
my son that he was never going to see his mom again. Another social
worker told my son that he was going to be getting ``proper parents''.
This is a child who was never abused, who was close to both parents
even though my ex and I did not get along, we both were bonded to our
son. This child was the focus and center of attention at all times and
no matter what, his needs always came first. Yet, the social worker
told me I was an ``unfit mother.'' When I got upset over that remark,
she informed the Judge that I was ``maniaced and spinning out of
control''.
When the opinion of the Sixth District Court Appeals came out, I
was appalled. The facts of the case were incorrect. They didn't even
mention testimony and documented proof that those facts were proven
wrong during the termination of rights trial, instead they focused on a
previous trial. Termination of Reunification was a complete sham.
Represented by a ``public defender'', my rights were certainly not
protected in the course of the trial. They brought in statements that
were not true and my attorney did nothing to protect my interest. She
even told me after the trial that there was no reason to appeal because
I had nothing to appeal about. I found out months later that the entire
contents of the trial was appeal able and had I appealed I probably
would have had my son returned to me today. The Justices sure made
comment to the fact that I did not appeal the trial, but never
mentioned as to why that occurred.
I want my son back and I want him back now. I have patiently waited
for two years now for people like this committee to take action and do
what needs to be done. In LA County, they are returning children as
they have admitted the wrong of the department. Here in my county, the
Board of Supervisors continues to shuffle the blame. Over the past two
years or so, the County has been exposed in the following:
1. Juvenile Hall Officials were busted for physically abusing the
kids in custody. ``Counselors'', better known as Police Officers were
using excessive force on these kids resulting in bruises and broken
bones. In CYA, they had cages they put the kids into. This abuse has
been reported for years and has been ignored until recently. Many cases
of abuse could have bee prevented had the voices been heard. To date,
nothing has been mentioned about the reprimand of the officers. Child
abuse is a crime and a felony at that. I wonder why it's not being
imposed in these cases?
2. The Children's Shelter investigation results were horrifying.
Especially since my son spent a considerable amount of time there
during the reporting period. He was 3 and 5, having been placed back
into the system by my ex-sister in law after my visits were terminated.
She didn't raise her own son due to mental illness and had no
intensions of raising mine. Her goal was to show me that she had the
power as she put it, to stop me from getting my son back. She proved it
all right at my son's expense. She and the ex brother in law are now
divorced and she has moved out of the state. The investigation of the
shelter produced many abuses. Children were restrained and locked into
a closet like room until they calmed down. We have discovered that the
children are rugged. Thorizione and Adavent are given to little
children to keep them calm and zombie like. Drugs and prostitution were
exposed. Molestations. The Feds told the County that no child under the
age of 6 is to be left at the shelter overnight. Only for the amount of
processing time. It was discovered that this was not honored and that
several children remained there for several days under the age of five.
One six-year-old girl was molested by a thirteen yr old boy. This was
exposed with the next that occurred in this county.
3. Following the Shelter report, a Civil Grand Jury began
investigating our complaints against the Department of Social Services.
They spoke to the Ombudsman's office. What they discovered soon made
local news as the Director of that office was making 200, 0000.00 from
the county for services and she spent the majority of her time in Costa
Rica. She fired the two whistleblowers that exposed more of the
evidence and documents against the Department's Director and the
Children's Shelter. The Director-altered documents which detailed the
molestation of the little girl. Altered documents were also submitted
to the Board and there were other documents submitted altered. Thus,
the final reports were not true. Turns out the Chairman of the Children
and Family Service Committee knew about the Ombudsman's Office and so
did the Director. A going quay party was thrown for her when she first
left. Those that attended were people in position in the County. End
results of that scene were that the County fired the Director of the
Ombudsman's Office and denied knowing anything more about it. The
Director who altered documents still continues in her position and the
Board members are acting as if it never happened and that what happened
was innocent and done for good cause and our DA is turning his head the
other way. The local NAACP Office who opened the can of worms by
allowing the parents to hold an open forum with County Welfare
Officials present has announced that no civil rights were violated,
(The Civil Grand Jury is supposed to file a report stating that there
has been violations) and he has reneged on each and every promise made
to the parents who spoke at that forum. Inside scoop is that the
Chairman of the Committee has told the NAACP to ``get the parents off
his back''.
Having spoken to an FBI agent in our County about the corruption,
she stated that they knew that there was a lot of money here being
passed but that they didn't know how it was ``going from hand to
pocket''. She asked me if I knew anything and although I have been
privy to some things, I told her no. That was because she told me that
even if I had all the facts about the money, it would not change the
status of my case as what they are doing is ``legalized kidnapping''. I
would have to prove fraud.
In Black Law's Dictionary, F-R-A-U-D is defined over several pages
starting with this; ``An intentional perversion of truth for the
purpose of inducing another in reliance upon to part with something
valuable thing belonging to him or to surrender legal right. A false
representation of a matter of fact, whether by words or by conduct by
false or misleading allegations, or by concealment of that which should
have been disclosed, which deceives and is intended to deceive another
so that he shall act upon it to his legal injury/ Anything calculated
to deceive, whether by a single act or combination, or by suppression
of truth. Or suggestion of what is false, whether it be by direct
falsehood, by innuendo, by speech or silence, word of mouth, or look or
gesture.''
Fraud is what has happened in my case and in several millions of
cases all across the USA. California is the worst. I do believe that
this problem can be fixed if it's truly the intent of your discussions.
If you are truly concerned about the safety of these children then you
MUST take immediate action. Return my son and other children who have
the right to be where they belong. Stop the overflow of the foster care
and you will then have enough fostering places for those children who
clearly do need the help like the twins that brought you all together.
For too many years, the system has been on the ``hot seat'' and
vowing to make changes for the ``Best Interest'' of the children. The
results prove that the System is failing our children. Time has come to
look into other solutions. Such as doing the right ways by returning
children, removing those who are being paid to do nothing but make more
excuses every time another child dies, let the people work for the
system and the system for them. You can figure the rest out. After all,
that's your job.
My space is limited and trying to submit my evidence in 10 pages is
impossible. I truly believe that the System knows that you people will
not look into lengthy exhibits and that's why they drag the situation
out. Think about it. We are dealing with a highly intelligent group of
people who like living in the high life and will do it at the expense
of a child. The proof is there. The question is ``How many more
children is your Committee willing to let die before you decide to take
action?'' Tell the children yourself, how many of them will NOT be with
their parents. Face the end result of the child who has been raised by
the system and yet cannot get a grip on life and how to deal with it.
There are too many wrongs here and no rights. Make the way clear.
I am available for further information if you need it. Thanks for
your time and patience. Have a good day.
Statement of Fight Crime: Invest in Kids
Mr. Chairman and Members of the Subcommittee:
Thank you for the opportunity to submit this written testimony. My
name is Sanford Newman, and I am the President of Fight Crime: Invest
in Kids, an anti-crime group of more than 2,000 police chiefs,
sheriffs, prosecutors and victims of violence from across the country
who have come together to take a hard-nosed look at what the research
says works to keep kids from becoming criminals. In considering how to
reduce child abuse and neglect tragedies, such as that of Sierra
Swann's children, the Subcommittee faces a formidable and very
important task. I hope my testimony will help this Subcommittee make
choices that will prevent child abuse and neglect, and reduce crime now
and in the future.
The members of Fight Crime: Invest in Kids, on the front lines of
fighting crime, know that that there is no substitute for tough law
enforcement. However, once a child has become a victim of child abuse
and neglect, a jail term for the offender cannot replace the innocence
or the life that is lost.
On May 11, 2004, Emonney and Emunnea Broadway became yet another
national tragedy. Both girls, only a month old, were found dead--
victims of child abuse and neglect. The situation that led to Emonney
and Emunnea's deaths is unfortunately not a rare occurrence in our
nation. In 2002, the latest year for which data is available, the
Department of Health and Human Services reported that 896,000 children
were victims of abuse and neglect, and 1,400 children died. Of these
1,400 children, 41% died before reaching their first birthday. And over
half of the children who die from abuse or neglect were previously
unknown to child protective services.
Child abuse and neglect is itself often a crime, and it also
produces a cycle of violence whereby victims of child abuse and neglect
grow up to become perpetrators of violence. Sierra Swann, a foster
child, was a victim of child abuse and/or neglect herself. While most
victimized children will not commit violent crimes later in life, being
abused or neglected sharply increases the risk that children will
emerge as violent criminals in their adulthood. When that happens, many
thousands of additional innocent people become victims. The best
available research indicates that each year 35,000 additional violent
criminals and more than 250 murderers will emerge as adults who would
never have become violent criminals if not for the abuse and neglect
they suffered as children. But this fact need not become a reality if
we invest in programs--such as in-home parent coaching--that are proven
to reduce child abuse and neglect.
Research has shown that providing in-home parent coaching to at-
risk moms like Sierra Swann can dramatically reduce child abuse and
neglect. For example, rigorous research published in the Journal of the
American Medical Association, shows that children of mothers left out
of the Nurse Family Partnership program (NFP)--an in-home parent
coaching program through which trained nurses visit single, poor,
first-time young mothers during and after pregnancy--had five times as
many substantiated reports of child abuse and neglect as the mothers
who participated.
[GRAPHIC] [TIFF OMITTED] 99679A.001
A fifteen year follow up study of NFP participants showed that
mothers in the program had only one-third as many arrests, and their
children had half as many arrests compared to those who received no
services.
[GRAPHIC] [TIFF OMITTED] 99679A.002
In another study, the Healthy Start program in Hawaii (which is the
basis for the nationwide Healthy Families in-home parent coaching
program) succeeded in reducing severe abuse and neglect through in-home
parent coaching. In at-risk families that received parent-coaching,
only 2 in 1,000 children were hospitalized for child abuse and neglect
compared to 13 in 1,000 children from similar at-risk families not
receiving parent coaching. In other words, failing to provide high-risk
families with in-home parent coaching makes the children six times more
likely to be hospitalized for abuse and neglect.
Currently, only 12,000 eligible mothers are being served by NFP.
The Healthy Families program serves only 50,000 families. Other in-home
coaching programs combined still leave at least 500,000 at-risk mothers
in need of in-home parent coaching. Providing in-home parent coaching
to all at-risk mothers, like Sierra Swann, means tragedies--such as the
death of Emonney and Emunnea Broadway--are far less likely to happen.
The Sierra Swann case highlights a nationwide problem that, if not
properly addressed, can lead to more crime and even death. However, the
tragedy does not end there. Child abuse and neglect costs America
upwards of $80 billion a year. Two-thirds of that is in crime costs
alone. A study by RAND concluded that the Nurse Family Partnership
program saved taxpayers four dollars for every dollar spent on the
program and paid for itself by the time the kids were three years old.
In an era of soaring budget deficits, we can no longer afford NOT to
make the needed investment to support a nationwide in-home parent
coaching effort that would serve nearly a million at-risk mothers
across the country.
One word of caution: the President, in his Fiscal Year 2005 budget,
suggested changing the Title IV-E foster care entitlement into a state
option capped grant, in order to free up more funds for prevention
services, such as in-home parent coaching. While well-intentioned, we
are concerned that implementation of such a proposal would likely be
counter-productive, and endanger children, because: (1) there are no
guarantees that under the state option grant ``flexible funding'' plan
proposed by the Administration, states will actually use the money on
child abuse prevention services (and, historically, only small
percentages of mixed-use funding pools tend to go to prevention--the
vast majority tends to go to addressing the needs of children already
in the system, also currently underfunded); and (2) there is inadequate
protection for children who have been abused or neglected and need
foster care--especially if there is a sudden upsurge in cases, as there
was during the crack/cocaine epidemic in the late `80s and early `90s.
In his Fiscal Year 2005 budget, the President also proposed
increasing the Promoting Safe and Stable Families Program and the Child
Abuse Prevention and Treatment Act--the two primary federal investments
specifically addressing child abuse and neglect prevention.
Congressional passage of the President's proposed increases would be an
excellent first step. However, even the President's proposed increases
would leave hundreds of thousands of America's most vulnerable children
without the services they need.
Law enforcement leaders know that one of the best ways to reduce
future crime is to invest in programs that prevent child abuse and
neglect. Furthermore, studies have shown that in-home parent coaching
is effective at preventing child abuse and neglect. It is time for
Congress to get tough on crime by providing the resources needed to
support in-home parent coaching for all at-risk mothers.
Justice for Children
Washington, DC 20005
July 1, 2004
Chairman Wally Herger
Subcommittee on Human Resources
Committee on Ways and Means
1102 LHOB
Washington, DC 20515
Dear Representative Herger and Members of the Subcommittee:
We commend your initiative in calling this hearing on behalf of
Maryland's children, spurred by the tragic death of two children in
Baltimore City.
Justice For Children, a national child advocacy organization, is
composed of concerned citizens who share the belief that our community
must act together to protect abused and neglected children from further
abuse and to defend every child's right to grow up in a safe and loving
environment. Justice For Children works together with Children's
Protective Services and other such agencies for the welfare of these
children, and, when appropriate, intervenes on behalf of children in
court or agency actions that have the potential to compound the harmful
effects of the abuse they have already suffered.
Since our founding in Houston, Texas in May 1987, Justice For
Children's accomplishments have been nationally recognized. Our
achievements have been featured on ABC's Prime Time Live, on the ABC
Prime-Time documentary ``Crimes Against Children,'' a PBS documentary
entitled ``Boy Crying, Baby Crying,'' and on Good Morning America,
Donahue, and HBO. In our effort to expand our commitment to serve as an
advocate for all abused children, Justice For Children now has chapters
in Arizona and the District of Columbia.
Our mission is to raise the consciousness of our society about the
failure of our governmental agencies to protect victims of child abuse,
to provide legal advocacy for abused children and to develop and
implement, on a collaborative basis where possible, a full range of
solutions that enhance the quality of life for these children. We
accomplish this mission through intensive case advocacy, providing pro
bono counsel for children or the protecting parent, court watch, filing
friend of the court briefs in selected appellate cases, a community
resource hotline, referrals and community presentations. Our public
policy recommendations are based on hands-on expertise with abused
children whose cases that have fallen through the cracks.
Since the founding of our Washington, D.C. Chapter in 2000, many
cases of ``system failure'' involving abused children in Maryland have
been referred to our office for advocacy.
One of the first cases that came to our attention was that of
little Collin Horridge. In 2000, when he was nearly one-and-a-half
years old, Collin's mother brought him and his older sister from Texas
to live in St. Mary's County, Maryland. She shared a house with a male
friend with children of his own.
Collin's father, Eric Horridge, worried about Erica and especially
Collin: their mother had been abusive to him in the past. When Mr.
Horridge remembers that when called to speak with the children, he
sometimes heard her hitting Collin on his head--once using the phone
receiver. Another time he recalls hearing a crash and then the baby's
screams after Collin's high chair was tipped over.
Mr. Horridge has phone records documenting his futile attempts to
get St. Mary's Co. Department of Social Services (``DSS'') to intervene
and protect Collin. After many calls, DSS sent a caseworker out to the
house as a ``courtesy'' to what they obviously thought was a
``disgruntled'' ex-boyfriend.
The caseworker gave Collin a cursory check and noted bruising
around his eye and on his forehead. She reported that this 19-month-old
baby stated: ``I fell on my toy.'' She never bothered to lift his shirt
or remove clothing to look at his tummy, buttocks, back or legs.
Shortly thereafter, Mr. Horridge was informed by DSS that they had
closed Collin's case and that he should just stop calling them.
Two weeks later, Mr. Horridge received a telephone call: his son
was dead. Collin had massive internal injuries as well as over forty-
four old or new wounds and bruises on his small body, according to the
medical examiner's report. His nose was broken and hanging over to the
side of his face. A large footprint on his abdomen resulted when the
mother's friend stepped on him with his full weight of 185 lbs. for
five seconds--an attempt to ``resuscitate'' the baby as he testified at
trial (he was tried and acquitted twice).
St. Mary's County released Collin's body to his mother even though
she was at that time charged with contributing to his death. She
immediately cremated his body--effectively doing away with state's
evidence--and to this day she has possession of his ashes. To this
date, no one has been held accountable for Collin's brutal death.
Jervis Finney, Chief Counsel for Maryland Governor Robert Erlich,
confirmed in writing that Collin's death has never been investigated by
Maryland Fatality Review Board or by any other state agency.
At hand of our extensive experience with cases of system failure in
Maryland as well as in many other states, we have come to recognize the
patterns and weaknesses that allow children to fall through the cracks.
I am attaching a document created by the Arizona Chapter of Justice
For Children called ``Eleven Components of an Effective Child
Protection System.'' I hope you find them of interest as you continue
to hold hearings on the failings of the child welfare system in
America.
Once again, we thank you for your understanding of the urgent need
for systemic changes to protect Maryland's children and all children in
America!
Respectfully submitted,
Eileen King
Regional Director
Statement of Matthew E. Melmed, Zero to Three: National Center for
Infants, Toddlers and Families
Mr. Chairman and Members of the Subcommittee:
I am pleased to submit the following testimony on the safety of
very young children in foster care on behalf of ZERO TO THREE. My name
is Matthew Melmed. For the last 9 years I have been the Executive
Director of ZERO TO THREE. ZERO TO THREE is a national non-profit
organization that has worked to advance the healthy development of
America's babies and toddlers for over twenty-five years. I would like
to start by thanking the Subcommittee for all of their work to ensure
that our nation's infants are safe. I commend you and the Committee for
holding hearings on the safety of maltreated children in this country.
The tragic Baltimore case on which your hearing focuses today
raises concerns not only about the problems of adolescents growing up
in the child welfare system, but also about the particular
vulnerability of very young children and the intergenerational nature
of abuse and neglect. I know that you have received very able testimony
on the subject of older children in the system. I would like to address
the effects of abuse and neglect on infants and toddlers and offer
recommendations for your consideration as you look at systemic changes
to the way in which states address child welfare. I also would like to
describe a promising approach, Court Teams for Change, that helps
improve the well-being of maltreated infants and toddlers and their
families and seeks to break the intergenerational transmission of abuse
and neglect.
We know from the science of early childhood development that
infancy and toddlerhood are times of intense intellectual
engagement.\1\ A child's first years set the stage for all that
follows. During this time--a remarkable 36 months--the brain undergoes
its most dramatic development, and children acquire the ability to
think, speak, learn, and reason. In fact, by age three, roughly 85
percent of the brain's core structure is formed.\2\ Future development
in key domains--social, emotional, and cognitive--is based on the
experiences and relationships formed during these critical years.
---------------------------------------------------------------------------
\1\ Shonkoff, J., & Phillips, D. (Eds.). (2000). From neurons to
neighborhoods: The science of early childhood development. Washington,
DC: National Academy Press.
\2\ Bruner, C., Goldberg, J. and Kot, V. (1999). The ABC's of early
childhood: Trends, information and evidence for use in developing an
early childhood system of care and education. A joint publication of
Iowa Kids Count and the Iowa Forum for Children and Families.
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Portrait of Very Young Children in Foster Care
Infants are the fastest growing category of children entering
foster care in the United States.\3\ They comprise the largest cohort
of young children in care--accounting for 1 in 5 admissions.\4\ Twenty-
one percent of all children in foster care were admitted prior to their
first birthday and 45 percent of all infant placements occurred within
30 days of the child's birth.\5\
---------------------------------------------------------------------------
\3\ Dicker, S., Gordon, E., Knitzer, J. (2001) Improving the odds
for the healthy development of young children in foster care. New York:
National Center for Children in Poverty.
\4\ Ibid.
\5\ Wulczyn, F., Hislop, K., & Harden, B (2002). The placement of
infants in foster care. Infant Mental Health Journal, 23(5), 454-475;
Oser, C. & Cohen, J. (2002). America's babies: The ZERO TO THREE Policy
Center data book. Washington, DC: ZERO OT THREE Press.
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Once they have been removed from their homes and placed in foster
care, infants and toddlers are more likely than older children to be
abused and neglected and to stay in foster care longer.\6\ Half of all
babies who enter foster care before they are three months old spend 31
months or longer in placement i and they are less likely to
be reunified with their parents. Thirty-six percent of infants who
enter care between birth and three months of age are reunified with
their parents compared to 56 percent of infants who enter care at 10-12
months of age.\7\
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\6\ Wulczyn, F. & Hislop,K. (2002). Babies in foster care: The
numbers call for attention. ZERO TO THREE Journal, (22) 4, 14-15.
\7\ Ibid.
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Developmental Impact of Child Abuse and Neglect on Very Young Children
The developmental impact of child abuse and neglect is greatest
among the very young. Infants and toddlers are extremely vulnerable to
the effects of maltreatment. Its impact on their emotional,
developmental and physical health can have life-long implications if
not properly addressed. Research shows that young children who have
experienced physical abuse have lower social competence, show less
empathy, have difficulty recognizing others' emotions, are more likely
to be insecurely attached to their parents, and have deficits in IQ
scores, language ability, and school performance.\8\ Without
intervention, by the time these children reach school age, they will
also likely be at risk for social problems and learning deficits.
Compounding the problem, one third of the individuals who were abused
and neglected as children can be expected to abuse their own
children.\9\
---------------------------------------------------------------------------
\8\ Shonkoff, J., & Phillips, D. (Eds.). (2000). From neurons to
neighborhoods: The science of early childhood development. Washington,
DC: National Academy Press.
\9\ National Research Council. (1993). Understanding child abuse
and neglect. p. 223.
---------------------------------------------------------------------------
According to one longitudinal study, being abused or neglected as a
child increased the likelihood of arrest as a juvenile by 59 percent,
as an adult by 28 percent, and for a violent crime by 30 percent.\10\
Abused and neglected children are also more likely to have mental
health concerns (suicide attempts and posttraumatic stress disorder);
educational problems (extremely low IQ scores and reading ability);
occupational difficulties (high rates of unemployment and employment in
low-level service jobs); and public health and safety issues
(prostitution in males and females and alcohol problems in
females).\11\ However, research confirms that the early years present
an unparalleled window of opportunity to effectively intervene with at-
risk children. And intervening in the early years can lead to
significant cost savings over time through reductions in child abuse
and neglect, criminal behavior, welfare dependence, and substance
abuse. It is critical that child well-being be the first priority in
all child welfare cases.
---------------------------------------------------------------------------
\10\ Widom, C., & Maxfield, M. (2001). An update on the ``Cycle of
Violence'', Research in Brief, Washington, DC: U.S. Department of
Justice, Office of Justice Programs, National Institute of Justice.
\11\ Ibid.
Promoting the Health and Well-Being of Infants and Toddlers:
Infant-Toddler Court Teams
I am going to briefly describe one approach that offers promise by
building on the existing collaborative approach of the National Council
of Juvenile and Family Court Judges Model Courts and the expertise of
ZERO TO THREE: National Center for Infants, Toddlers and Families in
translating the science of early childhood into resources for parents,
professionals and policymakers. Multidisciplinary Court Teams, with a
specific focus on the needs of infants and toddlers, could be a vehicle
for implementing ZERO TO THREE's policy recommendations, described
below. By partnering legal expertise with the science of early
childhood development, these Court Teams could work to raise awareness,
increase knowledge and skills, and change practice and policy regarding
the needs of infants, toddlers, and their families involved in the
judicial system.
This model envisions Court Teams co-led by a judge and in infant
mental health/child development expert in partnership with key
community stakeholders who serve the very youngest children, including
community leaders, Court Appointed Special Advocate, and guardians ad
litem. By bringing together the knowledge and skills from the judicial
system with the training and expertise of the child development field,
this collaborative, coordinated model has the potential to promote
child well-being by improving systems, services and funding.
This Infant-Toddler Court Team model is based on the pioneering
work of Judge Cindy Lederman and Dr. Joy Osofsky who have partnered to
develop a groundbreaking effort to address the well-being of infants
and toddlers involved in the Miami-Dade Juvenile Court. In this court,
all infants, toddlers and mothers receive screening and assessment
services. All babies are screened for developmental delays and referred
for services. A parent-infant therapeutic intervention is available to
a select number of mothers. An Early Head Start Program connected to
the court is the nation's first designed specifically to meet the needs
of maltreated children.
One factor that makes the Court Teams approach relevant to the
Baltimore case is the intergenerational nature of many abuse and
neglect cases. Judge Lederman was motivated to develop this approach
after observing children who had come into her court as victims of
abuse and return later as abusive parents. They were unable to be good
parents because they had never been adequately parented themselves. A
major goal of the Court Teams project is to break this cycle of abuse
by giving these young mothers the skills they need to understand and
respond to their infants and toddlers in a positive way.
Research is confirming the effectiveness of the approach used in
the Miami-Dade Juvenile Court. Three years of data in the Miami-Dade
Juvenile Court show substantial gains in improving parental
sensitivity, child and parent interaction, and behavioral and emotional
parental and child responsiveness. The children showed significant
improvements in enthusiasm, persistence, positive affect and a
reduction of depression, anger, withdrawal and irritability. There have
been no further acts of abuse or neglect, and 100 percent of infants
were reunified with their families.
One promising intergenerational success story that emerged from the
Miami-Dade Juvenile Court is that of Katrina. Katrina was removed from
her home for the first time at the age of 10 for chronic emotional
neglect. She remained in care for a year and then returned home. Almost
two years later, Katrina was removed again. She was found to be dirty
and begging for good and her home was identified by police as a
frequent site of drug related activities. Katrina went to live with an
aunt while her younger siblings were placed in foster care. Katrina
became a child mother. She was living in foster care with her own baby;
however, at the age of 14 months, her baby was removed from her care.
She did not understand why her baby couldn't live with her and was
unable to care for him. Because she was still under the jurisdiction of
the court as a dependent child, the court would see her on a regular
basis. The court seemed to think she had the capacity and desire to
accept services and work with the court in order to have her baby
return to her care. Six months after her baby was removed, she was
served with a petition for termination of parental rights. The court
begged her to go back to school and to agree to live in a foster home,
she agreed. She enrolled in school and in parenting classes and
continued to have visitation with her baby. In addition, she was
receiving individual counseling.
Katrina and her son Charles (now 2 years, 11 months) appeared for
an evaluation. Charles was found to be within the extremely low range
of functioning. During the play session, there was minimal play
interaction between Katrina and her son. Katrina appeared unable to
allow Charles to explore and initiate himself. Charles' day care
teacher expressed frustration with Charles' aggressive behavior. She
stated that he is active and hits and bites other children. Charles was
referred to an early intervention program operated by the school for a
full evaluation for adequate pre-school placement and services. He was
also referred to the Miami Juvenile Court Early Head Start Program. In
addition, Charles and Katrina began dyadic therapy initiated by the
court through its IMHPP program. Katrina continues to come to court and
is lauded for her accomplishments. She is actively involved in school,
maintains a B average and wants to become a chef. Reunification with
Charles appears to be imminent.
ZERO TO THREE's Policy Recommendations
1. Prevent multiple placements for infants and toddlers in foster care.
In the first year of life, babies need to have the opportunity to
develop a close, trusting relationship or attachment with one special
person. The ability to attach to a significant caretaker is one of the
most important emotional milestones a baby needs to achieve in order to
become a child who is trusting, confident, and able to regulate their
own stress and distress. Babies form strong attachments and rely on
their parents for security and comfort. For babies in foster care,
forming this secure attachment is difficult. When a baby is removed
from home, or never has the chance to ``bond'' with a parent (e.g. when
a baby is placed in foster care immediately after birth), the baby is
not able to form an attachment or an emotional connection to a parent/
caretaker. Multiple foster care placements present a host of traumas
for very young children. When a baby faces a change in placement,
fragile new relationships with foster parents are severed reinforcing
feelings of abandonment and distrust. Babies grieve when their
relationships are disrupted and this sadness adversely effects their
development. Children who have experienced abuse or neglect have an
even greater need for sensitive, caring and stable relationships. In
order to prevent placement disruption, foster parents need sufficient
support and training. They may need assistance in how to read the
infants' emotional cues as they are often unclear, to understand the
importance of attachment and how to develop an emotional connection to
the child, to understand how the infants' prior experience,
particularly maltreatment and placement experiences, have affected
them, and to adapt their own parenting styles to meet the unique needs
of these vulnerable young children.\12\ All placement decisions should
focus on promoting security and continuity for infants and toddlers in
out-of-home care.
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\12\ Clyman, R., Harden, J., & Little, C. (2002). ``Assessment,
intervention and research with infants in out-of-home placement.''
Infant Mental Health Journal, 23(5), 435-453.
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2. Use evidence based models to prevent child abuse and neglect.
Abuse and neglect during the first years can have serious
consequences on later developmental outcomes. Research shows that young
children who have experienced physical abuse have lower social
competence, show less empathy for others, have difficulty recognizing
others' emotions, are more likely to be insecurely attached to their
parents, and have elevated rates of aggression, apparent even in
toddlers. They have been found to have deficits in IQ scores, language
ability, and school performance. In addition, young children who are
victims of physical abuse may experience psychosomatic disorders,
anxiety, fears, sleep disruption, excessive crying, and school
problems. By the time these children reach school age, they will be at
risk for social problems and learning deficits. Compounding the
problem, one-third of the individuals who were abused and neglected as
children, without intervention, can be expected to abuse their own
children.\13\ Research on model programs reveals that well-designed
services with explicitly defined goals can be effective in changing
parenting practices and influencing parent-child interactions.\14\ It
is clear, therefore, that prevention is a critical strategy for
protecting at-risk babies and their families.
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\13\ National Research Council. (1993). Understanding child abuse
and neglect. p. 223.
\14\ Shonkoff, J., & Phillips, D. (Eds.). (2000). From neurons to
neighborhoods: The science of early childhood development. Washington,
DC: National Academy Press.
3. Assure comprehensive, developmentally Appropriate Health Care for
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infants and toddlers in foster care.
Nearly 40 percent of young children in foster care are born low
birthweight, premature, or both, two factors that increase their
likelihood of medical problems and developmental delay.\15\ They are
more likely to have fragile health and disabilities and far less likely
to receive services that address their needs.\16\ More than half of
these children suffer from serious health problems, including elevated
lead blood-levels, and chronic diseases such as asthma.\17\ Sadly, a
significant percentage of children in foster care do not receive even
basic health care, such as immunizations, dental services, hearing and
vision screening, and testing for exposure to lead and communicable
diseases.
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\15\ Halfon, N.; Mendonca, A.; & Berkowitz, G. (1995) ``Health
status of children in foster care: The experience of the Center for the
Vulnerable Child.'' Archives of Pediatric and Adolescent Medicine,
149(4), 386-391.
\16\ Dicker, S., Gordon, E., & Knitzer, J. (2001). Improving the
odds for the healthy development of young children in foster care. New
York: National Center for Children in Poverty. Oser, C. and Cohen, J.
(2003). Improving early intervention: Using what we know about infants
and toddlers with disabilities to reauthorize Part C of IDEA.
Washington, DC: ZERO TO THREE Policy Center.
\17\ Halfon, N.; Mendonca, A.; & Berkowitz, G. (1995) ``Health
status of children in foster care: The experience of the Center for the
Vulnerable Child.'' Archives of Pediatric and Adolescent Medicine,
149(4), 386-391.
4. Ensure access of infants and toddlers referred to child protective
services to the Early Intervention Program (``Part C'') of the
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federal Individuals with Disabilities Education Act (IDEA).
Infants and toddlers in foster care are more likely to have fragile
health and disabilities and are far less likely to receive services
that address their needs.\18\ They may show signs of delays in language
acquisition, cognition and behavior. In fact, infants and toddlers in
foster care have rates of developmental delay approximately 4 to 5
times that found among children in the general population.\19\
Therefore, there must be a strong connection between the child welfare/
child protection systems and Part C to ensure early access to services
will provide significant benefits to children. The National Research
Council/Institute of Medicine recommends that infants and toddlers who
are referred to a protective services agency for evaluation of
suspected abuse or neglect be automatically referred for a
developmental-behavioral screening under Part C.\20\
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\18\ Dicker, S., Gordon, E., Knitzer, J. (2001) Improving the odds
for the healthy development of young children in foster care. New
York: National Center for Children in Poverty.
\19\ Dicker, S. & Gordon, E. (2000). Connecting healthy development
and permanency: A pivotal role for child welfare professionals.
Permanency Planning Today, 1(1) 12-15.
\20\ Shonkoff, J., & Phillips, D. (Eds.). (2000). From neurons to
neighborhoods: The science of early childhood development. Washington,
DC: National Academy Press.
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A provision of The ``Keeping Children and Families Safe Act of
2003'' that amended the Child Abuse Prevention and Treatment Act
(CAPTA) (PL 108-36) requires that each state develop ``provisions and
procedures for referral of a child under the age of 3 who is involved
in a substantiated case of child abuse or neglect to early intervention
services funded under Part C of the Individuals with Disabilities
Education Act (IDEA) (section 106(b)(2)(A)(xxi)).'' Although this new
requirement is a step in the right direction, states will face new
challenges in trying to ensure that the Part C system is able to
respond to these new referrals. Impacts will vary substantially from
state to state because of significant differences among states' Part C
systems. In some states, very large increases in workload for providers
of Part C evaluation, assessment and intervention services are likely
as a result of this legislation. In all states, a need to enhance the
capacity of the Part C system to respond to social-emotional and
behavioral problems (early childhood mental health) is likely. And in
most or all states, the cost of responding to this federal mandate will
be a problem, given very tight state budgets, unless the federal
government significantly increases funding for Part C.
5. Assure early childhood mental health assessment and access to early
childhood mental health services for babies and toddlers in
foster care.
Early childhood mental health is the capacity of the child from
birth to age 5 to experience, regulate and express emotions; form close
and secure interpersonal relationships; and explore the environment and
learn. Early childhood mental health is synonymous with healthy social
and emotional development. Because maltreatment and repeated and often
traumatic separation from caregivers may place infants and toddlers in
foster care at risk for mental health disorders, mental health supports
for babies in foster care, their birth families, and their foster care
families is critical. Untreated mental health disorders in early
childhood can have disastrous effects on children's functioning and
future outcomes.
There is an enormous disconnect between what we know about very
young children and their mental health, and what we do for very young
children in the child welfare system. Over the past 20 years, much has
been learned about the mental health of young children in foster care
and how to provide early childhood mental health services. However,
this knowledge has not reached the child welfare system. Early
childhood mental health expertise, providers, and services for infants
and toddlers in the child welfare system as well as in other systems
(Part C early intervention, child care, Early Head Start) is non-
existent and the need is severe! In addition to improving mental health
aspects of the child welfare system, training for mental health and
other early childhood providers is needed. It is critical that early
childhood providers understand not only the unique needs of infants and
toddlers, but also, the unique needs of very young children who have
been victims of abuse/neglect and who have been separated from their
families. These early childhood mental health services should be
integrated and delivered via early learning experiences at home, in
center-based programs, or both. Federal and State policy must support
early identification, screening and evaluation of emotional
development, improving the service array for diagnosis, treatment and
prevention of early mental health problems, and increasing mental
health supports for parents and foster parents in the existing child
welfare system and other systems that serve these children.
6. Ensure that infants and toddlers in foster care have access to
quality early care and learning experiences.
Infancy and toddlerhood are times of intense growth and development
in all areas, including rapid changes in motor development, cognition,
and emotions.\21\ All babies and toddlers need positive early learning
experiences to foster their intellectual, social and emotional
development and to lay the foundation for later school success. Infants
and toddlers who have been abused or neglected, and are at increased
risk for adverse outcomes as a result, need additional supports to
promote their healthy growth and development. Quality early learning
experiences can provide very young children in foster care the
opportunity to form secure attachments with teachers and/or child care
providers who can provide consistent, positive environments. Early
childhood training programs that promote small groups, continuity, and
individualized care, such as the Program for Infant Toddler Caregivers
(PITC), can help young children who have been abused and neglected
develop these essential early relationships. These early relationships
are associated with adaptive social development.\22\
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\21\ Lederman, C., Osofsky, J., & Katz, L. (2001). When the bough
breaks the cradle will fall: Promoting the health and well being of
infants and toddlers in juvenile court. Juvenile and Family Court
Journal, (52)4, 33-37.
\22\ Lederman, C., Osofsky, J., & Katz, L. (2001). When the bough
breaks the cradle will fall: Promoting the health and well being of
infants and toddlers in juvenile court. Juvenile and Family Court
Journal, (52)4, 33-37.
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High-quality early care and education programs can also support
foster, kinship, and biological parents by directing them to other
support systems, providing information, and connecting them with other
parents that they may turn to for advice and support.\23\ Comprehensive
early childhood programs, such as Early Head Start, that combine home
visitation, comprehensive services and technical assistance, can
provide the specialized services that very young children in the child
welfare system need. In addition, therapeutic child care programs that
address issues faced by abused and neglected children, such as
attachment disorders and depression, can ensure that these young
children are receiving specialized treatment and attention.
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\23\ Dicker, S., Gordon, E., & Knitzer, J. (2001). Improving the
odds for the healthy development of young children in foster care. New
York: National Center for Children in Poverty.
7. Ensure developmentally appropriate visitation practices for infants
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and toddlers in foster care.
One of the major challenges faced by young children in foster care
is maintaining attachment relationships with their parents. In order
for young children in foster care to maintain attachment relationships
with their biological parents, parental visitation schedules are
developed by the social worker in conjunction with the court and the
biological parents. Foster parents are expected to cooperate with the
child's visitation plan to help with transportation to and from the
visits. Current visitation practices usually consist of brief
encounters that occur anywhere from once a month to once or twice a
week. For very young children, infrequent visits are not enough to
establish and maintain a healthy parent-child relationship. Infants and
toddlers build strong attachments to their biological parents through
frequent and extended contact. One month in the life of a baby is an
eternity. Visits should occur frequently, in a safe setting that is
comfortable for both parent and child, and should last long enough for
a positive relationship to develop and strengthen. For very young
children, visits with parents can be upsetting and disruptive to their
development.
8. Assure ongoing adoption services and supports for adoptive families.
Adoptive parents often face significant challenges in the day-to-
day parenting of very young children. Foster children who have been
adopted tend to have challenging behaviors and emotional issues as well
as medical conditions that may impact their development--often due to a
history of maltreatment and extended stays in foster care. Adoptive
families facing this kind of stress are at increased risk of adoption
failure--referred to as disruption before an adoption is legalized and
as dissolution after an adoption has been finalized.\24\ Services and
supports for the family prior to, during, and after the adoption can
help to stabilize and preserve adoptive placements and can help in
recruiting adoptive parents.\25\ The assurance of the availability of
services and supports after adoption has been found to play a critical
role in many potential adoptive parents' decisions to move forward with
the adoption of a child in foster care.\26\ These supports may also
reduce the likelihood of adoption disruption and are cost-effective as
they help prevent the child from reentering foster care.
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\24\ National Conference of State Legislatures. (2002). Post-
Adoption Services: Issues for Legislators. Retrieved February 26 from
http://www.ncsl.org/programs/cyf/PASI.htm.
\25\ Casey Family Services. (2001). Strengthening Families and
Communities: An Approach to Post-Adoption Services. Casey Family
Services.
\26\ Ibid.
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Conclusion
We must ensure that infants in the child welfare system are healthy
and safe. During the first years of life, children rapidly develop
foundational capabilities--cognitive, social and emotional--on which
subsequent development builds. The amazing growth that takes place in
the first three years of life creates vulnerability and promise for all
children. These years are even more important for maltreated infants
and toddlers. We know from the science of early childhood development
what infants and toddlers need for healthy social, emotional and
cognitive development. We also know that infants and toddlers in the
child welfare system are at great risk for poor outcomes. We must
continue to seek support for services and programs that ensure that our
nation's youngest and most vulnerable children are safe and that
promote and improve their emotional, social, cognitive and physical
health and development.
It is simply unacceptable that we wait until the safety of very
young children is put at-risk before proper investments are made to
address their needs. We cannot wait for an infant in the child welfare
system to die before we provide states with adequate funds to ensure
the safety, permanence and well-being of children in or at risk of
needing foster care. Policies and funding must be directed to
preventing harm to maltreated young children. I urge the Subcommittee
to make the investment to ensure that the current ill-equipped child
welfare system receives adequate funding to better protect our nation's
most vulnerable children.
Thank you for your time and for your commitment to our nation's at-
risk infants and toddlers.