[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
``THE HEROIN EPIDEMIC AND PARENTAL
SUBSTANCE ABUSE: USING EVIDENCE AND
DATA TO PROTECT KIDS FROM HARM''
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HUMAN RESOURCES
OF THE
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
MAY 18, 2016
__________
Serial No. 114-HR10
__________
Printed for the use of the Committee on Ways and Means
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COMMITTEE ON WAYS AND MEANS
KEVIN BRADY, Texas, Chairman
SAM JOHNSON, Texas SANDER M. LEVIN, Michigan
DEVIN NUNES, California CHARLES B. RANGEL, New York
PATRICK J. TIBERI, Ohio JIM MCDERMOTT, Washington
DAVID G. REICHERT, Washington JOHN LEWIS, Georgia
CHARLES W. BOUSTANY, JR., Louisiana RICHARD E. NEAL, Massachusetts
PETER J. ROSKAM, Illinois XAVIER BECERRA, California
TOM PRICE, Georgia LLOYD DOGGETT, Texas
VERN BUCHANAN, Florida MIKE THOMPSON, California
ADRIAN SMITH, Nebraska JOHN B. LARSON, Connecticut
LYNN JENKINS, Kansas EARL BLUMENAUER, Oregon
ERIK PAULSEN, Minnesota RON KIND, Wisconsin
KENNY MARCHANT, Texas BILL PASCRELL, JR., New Jersey
DIANE BLACK, Tennessee JOSEPH CROWLEY, New York
TOM REED, New York DANNY DAVIS, Illinois
TODD YOUNG, Indiana LINDA SANCHEZ, California
MIKE KELLY, Pennsylvania
JIM RENACCI, Ohio
PAT MEEHAN, Pennsylvania
KRISTI NOEM, South Dakota
GEORGE HOLDING, North Carolina
JASON SMITH, Missouri
ROBERT J. DOLD, Illinois
TOM RICE, South Carolina
David Stewart, Staff Director
Nick Gwyn, Minority Chief of Staff
______
SUBCOMMITTEE ON HUMAN RESOURCES
VERN BUCHANAN, Florida, Chairman
KRISTI NOEM, South Dakota LLOYD DOGGETT, Texas
JASON SMITH, Missouri JOHN LEWIS, Georgia
ROBERT J. DOLD, Illinois JOSEPH CROWLEY, New York
TOM RICE, South Carolina DANNY DAVIS, Illinois
TOM REED, New York
DAVID G. REICHERT, Washington
C O N T E N T S
__________
Page
Advisory of May 18, 2016 announcing the hearing.................. 2
WITNESSES
Panel One
The Honorable Karen Bass, a Representative in Congress from the
State of California............................................ 7
The Honorable Tom Marino, a Representative in Congress from the
State of Pennsylvania.......................................... 6
Panel Two
.................................................................
Katherine Barillas, Director, Child Welfare Policy, One Voice
Texas.......................................................... 33
Hector Glynn, Vice President for Programs, The Village for
Families & Children............................................ 28
Bryan Lindert, Senior Quality Director, Eckerd Kids.............. 42
Tina M. Willauer, MPA, Director, Sobriety Treatment and Recovery
Teams (START), Kentucky Department for Community Based
Services, Kentucky Cabinet for Health and Family Services, and
Consultant, Children and Family Futures........................ 9
SUBMISSIONS FOR THE RECORD
American Academy of Pediatrics................................... 90
Children's Hospital of Wisconsin................................. 98
Donna Butts...................................................... 101
New York State Office of Children and Family Services............ 107
SHIELDS for Families............................................. 110
The American Congress of Obstetricians and Gynecologists......... 120
The Premier Healthcare Alliance.................................. 122
``THE HEROIN EPIDEMIC AND PARENTAL
SUBSTANCE ABUSE: USING EVIDENCE AND
DATA TO PROTECT KIDS FROM HARM''
----------
WEDNESDAY, MAY 18, 2016
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Human Resources,
Washington, DC.
The Subcommittee met, pursuant to call, at 2:06 p.m., in
Room 1100, Longworth House Office Building, Hon. Vern Buchanan
[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) 225-3625
FOR IMMEDIATE RELEASE
Wednesday, May 11, 2016
No. HR-10
Buchanan Announces Human Resources
Subcommittee Hearing on ``The Heroin Epidemic
and Parental Substance Abuse: Using Evidence
and Data to Protect Kids from Harm''
House Human Resources Subcommittee Chairman Vern Buchanan (R-FL),
announced today that the Subcommittee will hold a hearing entitled
``The Heroin Epidemic and Parental Substance Abuse: Using Evidence and
Data to Protect Kids from Harm'' on Wednesday, May 18, 2016, at 2:00
p.m. in room 1100 of the Longworth House Office Building. At the
hearing, Members will examine the effectiveness of programs designed to
address parental substance abuse and protect children from harm.
Members also will explore State efforts to better use data to identify
and serve children most at risk due to parental substance abuse, and
the impact of the substance abuse epidemic on the child welfare system.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only. However,
any individual or organization not scheduled for an oral appearance may
submit a written statement for consideration by the Committee and for
inclusion in the printed record of the hearing.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Any person(s) and/or organization(s) wishing to submit
written comments for the hearing record must follow the appropriate
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which you would like to make a submission, and click on the link
entitled, ``Click here to provide a submission for the record.'' Once
you have followed the online instructions, submit all requested
information. ATTACH your submission as a Word document, in compliance
with the formatting requirements listed below, by the close of business
on Wednesday, June 1, 2016. For questions, or if you encounter
technical problems, please call (202) 225-3625 or (202) 225-2610.
FORMATTING REQUIREMENTS:
The Committee relies on electronic submissions for printing the
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Note: All Committee advisories and news releases are available
online at
http://www.waysandmeans.house.gov/.
Chairman BUCHANAN. The Subcommittee will come to order.
Welcome to the Ways and Means Subcommittee on Human
Resources hearing on ``The Heroin Epidemic and Parental
Substance Abuse: Using Evidence and Data to Protect Kids from
Harm.'' Welcome to today's hearing on how the heroin epidemic
and more general parental substance abuse is hurting our
Nation's children and how we can use evidence and data to
protect more of them from harm.
The heroin epidemic is a growing crisis affecting children
and families across the country and it is reaching into our
local communities. In 2014, according to the Centers for
Disease Control and Prevention, more Americans died from drug
overdose than car accidents, and over 60 percent of those
deaths were from heroin, painkillers, and other opioids.
In Florida, we know all too well of the consequences. We
started to address this epidemic years ago by reducing access
to opioids and decreasing their supply. Now that it is cheaper,
and just as potent, heroin has taken over. Heroin overdose in
Florida increased by 900 percent 2010 to 2014--900 percent.
Unfortunately, the epicenter for the Florida crisis is in my
own district, Manatee County, where more people died from
heroin overdose per capita than in any other Florida county in
2014.
We have been talking about the issues of opioid addiction
more broadly these last 2 weeks here in Congress, and I have
been championing a comprehensive approach to provide more
education, prevention, treatment programs to those in need. I
was pleased to see a legislative solution, the Comprehensive
Opioid Abuse Reduction Act of 2016, pass the House last week.
The Senate has passed a similar bill, and I hope we can quickly
resolve our differences so we can help more families
immediately.
While we have made great progress, there is one area that
deserves further attention: The impact parental substance abuse
has on families. This crisis has a serious impact on our
children, especially those who come in from foster care because
of parental drug abuse. According to the data and news reports,
parental drug abuse is a leading factor in why children enter
foster care facilities. And multiple States have cited opiate,
heroin, and other substance abuse as a major reason for the
increase in foster care.
Caseloads and Federal data support this view. In fiscal
year 2014, more than 25 percent of those children found to be
victims of abuse and neglect had caregivers with drug abuse
problems. Thankfully, many States, including Florida, are
leading the effort to combat this crisis.
Today, we will learn about some of these approaches,
including ways to serve families at home or in other settings
so children can remain safely with their parents or more
quickly return home if they must enter foster care. Florida and
other States are also using data gleaned from prior child
welfare cases to reform their responses to new cases, allowing
them to more quickly and effectively respond to prevent tragic
consequences.
In addition to those State efforts, the Senate Finance
Committee has developed a draft proposal to shift foster care
funding into services that will help prevent abuse and neglect.
These reforms will encourage States to support programs that
better address parental substance abuse and other issues, as
well as implement programs that have proven their effectiveness
in addressing the needs of parents and their children.
Today's hearing will help us take a closer look at the
Senate's proposal and help in moving bipartisan, bicameral
legislation. We have taken positive steps forward in the House
to address the opioid crisis and substance abuse. Now it is
time to turn to the kids that need our help as well.
I look forward to hearing more about these efforts today
and discussing how we can work together on a bipartisan effort
to protect more children from harm, because strong families
make for a strong community.
I now yield to the distinguished gentleman, the Ranking
Member, Mr. Doggett, for the purposes of an opening statement.
Mr. DOGGETT. Thank you so much, Mr. Chairman, for your
interest in this matter and for holding today's hearing.
As I see it, this hearing is addressing one aspect of a
critical problem. It is addressing the question that I think
represents a failure by this Congress and by one State after
another to deal effectively with child abuse.
Within the past month, on one of the front pages of the San
Antonio Express-News, there was a report: ``Kids who were bound
constantly want food.'' Officers rescued a boy, 4, who was tied
by his ankle with a dog chain in the yard at his home. His
sister, 3, had her hands tied with a leash above her head, her
arm broken in two places. Authorities said the two had been
physically abused for at least 2 weeks. ``They constantly want
food,'' said their attorney ad litem.
Just a few miles up the road and only a few days apart, a
little girl, 1 year old, sexually abused by her mother's
boyfriend, along with her sister, she was killed by the
physical abuse that she suffered.
And only a few days before that, a young student at the
University of Texas was murdered by a child who had been
physically abused himself, was in the foster system, but had
run away from it.
Time after time, not only in Texas, but across the country,
we see the price that is being paid for our failure to deal
effectively with child abuse. And because our courts have also
seen it, this is an emerging crisis.
In my home State of Texas, the situation for severely
abused and neglected children is so bad that a Federal court in
Texas has declared the system unconstitutional, as was done
previously in the State of Mississippi, as has occurred in
challenges in one State after another.
In her ruling Judge Jack wrote, ``Years of abuse, neglect,
and shuttling between inappropriate placements across the State
has created a population that cannot contribute to society and
proves a continued strain on the government through welfare,
incarceration, or otherwise.''
Certainly the problem with opioids, drug abuse, is a very
big factor, from talking to people in the field who deal with
this issue every day in Texas.
And it is great that some legislation was passed last week
concerning that aspect of the problem. There is only one major
concern about that and about what we are not doing on child
abuse here, and that is that talking about it, passing changes
without approving necessary resources to get to the problem,
where caseworkers for child protective services are
underskilled and overburdened with cases, just talking about it
and not putting the resources out there to deal with and to
prevent these tragedies and moving our resources so that they
focus on prevention, not just responding after one of these
horrible events occurs, and not just lurching from one tragedy
to another, that is what this Congress ought to be focused on.
Senator Wyden and I have introduced legislation to try to
change the focus to prevention. Our first speakers today, who
have worked on child abuse, have raised many of these concerns.
A scaled-down version of that legislation Senator Wyden and I
introduced has been circulated now in draft form. There is
agreement about some of the things that need to be done. There
is certainly bipartisan agreement in this Committee about the
importance of doing something.
The issue is: Are we willing to put our money where our
mouth is? Just reorganizing the deck chairs on the Titanic by
moving some money from one part of child abuse to another will
not get the job done. Our States need to do more, but we can in
this Congress provide resources and provide an incentive to the
States, particularly those that are under court order like
Texas and Mississippi and the other States that are likely to
be under court order when their cases are finished, provide
them an incentive to do right by these children.
We won't stop all child abuse, of course, but we can
prevent some of these tragedies by applying the resources we
have within our ability to provide and work together to address
these kinds of concerns, back up and encourage the States, and
get the resources we need to reduce the level of child abuse.
And I yield back.
Chairman BUCHANAN. Without objection, other Members'
opening statements will be made part of the record.
On our first panel this afternoon we will be hearing from
two of our distinguished colleagues, the Honorable Tom Marino
of Pennsylvania and the Honorable Karen Bass of California.
Mr. Marino, please proceed with your testimony.
STATEMENT OF THE HON. TOM MARINO, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF PENNSYLVANIA
Mr. MARINO. Good afternoon, and thank you, Chairman
Buchanan and Ranking Member Doggett and the Members of the
Subcommittee, for giving us the opportunity to testify on an
issue that is important to both of us.
It is abundantly clear that our Nation is facing a
substance abuse epidemic. Unfortunately, one group that we fail
to mention as being affected are the children who have been
placed in foster care because their parents' have become
addicted to drugs and alcohol.
Over 400,000 American children are in foster care. In my
home State of Pennsylvania alone, approximately 15,000 children
reside in foster care. As a former State and Federal
prosecutor, I have seen firsthand how substance abuse directly
affects children, and I have seen my share of children on slabs
in morgues.
Many of the people I had been tasked with prosecuting were
parents whose children ended up in foster care. This was done
with the hopes that following treatment, these offenders could
become parents again.
This is not always the case. Many of the individuals who
enter treatment programs find that their necessary care is cut
short due to gaps in healthcare insurance and they are unable
to afford additional treatment.
We recognize that substance abuse is a serious disease that
requires serious treatment. Nevertheless, there is a great void
in the way that our current health system treats substance
abuse. In most cases, the only treatment available to those
affected is short-term intervention like detoxification.
To adequately treat those who suffer from substance abuse,
we must provide serious long-term treatment. Those addicted
must have the ability to be treated by specialists and receive
proper medications.
In this current environment, we are doing a disservice to
those who require treatment. Many addicts are ineffectively
treated. Although one may leave treatment and be ``cured'' by
some standards, more often than not one ends up behind bars or
in another futile program because their first attempt failed.
The question remains: What can we do to ensure that those
who require help get the proper treatment and are reunited with
their children?
One treatment option I have advocated for years would be
placing nondealer, nonviolent drug abusers in a secured
hospital-type setting under the constant care of health
professionals. Once the person agrees to plead guilty to
possession, he or she will be placed in an intensive treatment
program until experts determine that they should be released
under intense supervision. If this is accomplished, then the
charges are dropped against that person. The charges are only
filed to have an incentive for that person to enter the
hospital/prison, if you want to call it that.
In an effort to keep them in touch with their children, we
can offer them the chance to continue to visit with and
eventually care for their children as they undergo treatment.
This is a massive project. Not only are we dealing with trying
to cure the drug addict, but we are trying to keep a family
together.
And it is going to take a lot of money. The Feds are going
to have to be involved in this, the States are going to have to
be involved with this, the local child welfare agencies are
going to have to be involved with this. This isn't just one
entity that is going to take care of this.
Initially, we would have to separate them. But hopefully,
after they have been cleared by medical professionals, one can
regain custody of their children while still receiving
treatment in the facility. This treatment option may offer a
better chance for addicts to finally be cured and have a normal
life, but also their children have a normal life.
As with any disease, there is no one-size-fits-all approach
to substance abuse treatment. Some people respond to treatment
in different ways, and for most it takes a very long time.
Congress must continue to address the current drug crisis and
keep searching for better ways to treat addicts and tend to
foster children.
We must also continue to protect the children of parents
who are suffering from substance abuse. Placing these children
in foster care is necessary. However, in the instances where we
can keep the families together, it remains an important key to
curing drug addiction.
With that, I yield back.
Chairman BUCHANAN. Thank you, Mr. Marino.
Ms. Bass, please proceed with your testimony.
STATEMENT OF THE HON. KAREN BASS, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF CALIFORNIA
Ms. BASS. Thank you, Chairman Buchanan, Ranking Member
Doggett, and Members of the Subcommittee. Thank you for the
opportunity to give remarks to you today.
Tom Marino and I serve as two of four Co-Chairs of the
Congressional Caucus on Foster Youth and have been very much
involved in this issue.
This is a critical time in our country, and from my
perspective we actually have an opportunity to learn from the
last drug epidemic--crack cocaine in the 1980s and 1990s.
I can assume that many of you were not in Congress during
those years. I was in Los Angeles serving as a member of the
faculty at the USC Medical School and I spent several years
working in the emergency room in LA County.
Our response during those years to the crack cocaine
epidemic was one of outrage and anger. We were angry at people
who were addicted, and we were particularly outraged at women
and mothers who suffered from addiction and neglected their
babies, and even abandoned their babies in the hospital after
delivery.
We passed laws that eventually led to an 800 percent
increase in the incarceration rate for women, and the number of
children removed from home and placed into foster care
skyrocketed. At the height of the epidemic, there were over
40,000 children in foster care in Los Angeles County alone.
Today that number has been reduced by over 50 percent.
The crack cocaine epidemic and advances in science led to
today's understanding that addiction is a brain disease. One of
the characteristics of addiction, unfortunately, is relapse.
And so far in the latest epidemic we are not hearing cries for
incarceration. I do worry, however, that those cries might
still be coming.
So far we seem to be approaching the opioid epidemic and
addiction differently. Just as science advanced our
understanding of addiction, research has certainly advanced our
understanding about how to handle families that are in crisis.
We know the majority of children in foster care are removed
from home because of neglect, and we know that that neglect is
secondary to addiction, mental illness, or both, dual
diagnosis.
We know that removing a child from home is traumatic for
the child regardless of the circumstances. We certainly know
that there are times we absolutely must remove a child for
their safety. However, we have also learned that families can
benefit tremendously when services like drug treatment are
provided in a fashion that allows families to remain intact.
I agree with my colleague, Mr. Marino, that you need to
have a variety of approaches. There is no one-size-fits-all. I
want to suggest a couple of programs, some of which I believe
you are going to hear from today.
Members of this Committee passed legislation allowing
States to apply for IV-E waivers to use Federal funds in
developing evidence-based programs to see if the number of
children in care can be safely reduced and outcomes can be
improved. Many States have used the funds to target parents
with substance abuse disorders. Kentucky and Maine are
implementing a program known as START, Sobriety Treatment and
Recovery Teams. I know you will hear from them directly in the
next panel. Oklahoma connects parents to substance abuse
services. San Francisco has a program called Family Link that
includes both residential and outpatient substance abuse
treatment services.
In LA County, SHIELDS for Families has created a
therapeutic community where entire families live in an
apartment community. In the last 5 years, more than 81 percent
of the participants have completed all phases of the program,
which can last up to a year, and maintained their sobriety and
kept their families intact. This program has saved LA County
millions of dollars that would have been spent placing children
in foster care.
The legislation this Committee passed allowing States to
apply for title IV-E waivers is set to expire in 3 years, 2019.
After years of implementing programs, States and counties have
developed many evidence-based practices that have successfully
and safely reduced the number of children in care or improved
outcomes. So now is the time to consider implementing Federal
finance reform.
I believe this Committee will soon be discussing the Family
Stability and Kinship Care Act that will provide flexibility in
the use of title IV-E dollars. If and when this Committee does
consider the legislation, I would hope that substance abuse
will be up front and center.
When people suffer from addiction, sometimes they have to
hit rock bottom before they face the reality of their disease.
Sometimes rock bottom results in them losing their children.
Many times women refuse treatment because they don't want to
leave their children and enter a program. Then their addiction
spirals so far out of control the government has to intervene.
I come before you today out of concern for the individuals
and families that have lost everything. So if they had
insurance, they lost it, and if they lost their jobs their
families cannot afford expensive drug treatment programs.
So we as a society have a choice. We can incarcerate them
when they begin criminal behavior to support their addiction.
We can remove their children and place them in foster care.
Both choices cost the Federal Government billions of dollars
and in too many cases result in the government supporting the
individual their entire life when they end up in prison. Or we
could look at how we increase funding to SAMHSA for community-
based drug treatment services.
Thank you.
Chairman BUCHANAN. Thank you, Ms. Bass.
Do any of the Subcommittee Members have questions for our
colleagues on the panel?
If there are no further questions, then you are free to go,
and I want to thank you for testifying before the Subcommittee
today. Thank you very much.
Ms. BASS. Thank you.
Chairman BUCHANAN. Now we will move on to our second panel.
On the second panel this afternoon we will be hearing from four
experts: Ms. Tina Willauer, Director for Sobriety Treatment and
Recovery Teams, START, of the Kentucky Department for Community
Based Services with the Kentucky Cabinet for Health and Family
Services; Mr. Hector Glynn, Vice President for Pro-
grams, The Village for Families & Children;
Ms. Katherine Barillas, Director of Child Welfare Policy for
One Voice Texas; and Mr. Bryan Lindert, Senior Quality Director
for Eckerd Kids.
We will begin with you, Ms. Willauer, whenever you are
ready.
STATEMENT OF TINA M. WILLAUER, MPA, DIRECTOR, SOBRIETY
TREATMENT AND RECOVERY TEAMS (START), KENTUCKY DEPARTMENT FOR
COMMUNITY BASED SERVICES, KENTUCKY CABINET FOR HEALTH AND
FAMILY SERVICES, AND CONSULTANT, CHILDREN AND FAMILY FUTURES
Ms. WILLAUER. Thank you, Chairman Buchanan, Ranking Member
Doggett, and Members of the Subcommittee. Thank you so much for
conducting this hearing on our Nation's opioid crisis and the
effects of parental substance use disorders on our Nation's
child welfare system. I am honored to talk with you today about
Kentucky's efforts over the last 10 years to address these very
issues. And in my career of 25 years in child protective
services, this has been my dedication. So thank you.
The good news is that we know a lot more today about what
works with families in this population. There are good programs
all across this country that really save money and have
improved outcomes. I am going to talk to you today about the
Sobriety Treatment and Recovery Team, or START, program that
has been implemented in Kentucky, and I have three primary
points today.
First of all, START has better outcomes for children and
families than standard CPS.
Number two, strategies that work for families include
collaboration across systems, intensive work, quick access to
substance use disorder treatment, shared decisionmaking, peer
supports, and a nonpunitive approach, among other strategies.
Number three, the current opioid epidemic reinforces that
the most important policy issue in child welfare right now is
changing the financing model to prevent foster care placements
whenever safe and possible and taking the programs that work to
scale by using the lessons of prior Federal investments.
So why did Kentucky invest in START? Well, in 2006 we had a
terrible opioid epidemic going on with prescription drugs in
Kentucky. And at that time, 80 percent of the children in
Kentucky's foster care system were there because a parent had a
substance use problem. So this was a real crisis and an
opportunity for our State to invest in a program that works.
So what is START? START is a child welfare-led program that
helps parents achieve recovery, and it keeps children in the
home when safe and possible. START serves CPS-involved families
with a substance-exposed infant or young children. And in START
we address addiction as a brain disorder because we know that
it affects the whole family and it requires treatment.
So in START we pair specially trained CPS social workers
with family mentors, and family mentors are persons in long-
term recovery from addiction who actually had a CPS case in
their past. They are now stable and in recovery, and they help
new parents engage in treatment.
Together, that worker and mentor dyad serves families, a
very small caseload of families, and they intervene very
quickly upon the CPS report, right away. Kind of maximizing on
that window of crisis, we partner with substance use treatment
providers, and parents can get into treatment from START within
48 hours.
So creatively working with families, giving quick access to
treatment, and providing wraparound supports can allow us to
leave some children in the home safely while the whole family
gets treatment.
So at the same time that we were implementing START in
Kentucky, Kentucky was lucky enough to be awarded with two RPG
grants, in 2007 and 2012, and it was just the right initiative
at just the right time. The reason is because we receive a lot
of technical assistance and there was a real push for rigorous
program evaluation that allowed us to study START.
With RPG support, we have now produced four peer-reviewed
journal articles, and START is now listed in the California's
Evidence-Based Clearinghouse for Child Welfare as a program
with promising evidence.
The work isn't done, however. We continue to build START
in Kentucky. And we are building on the evidence. We are actu-
ally expanding the program in Louisville, Kentucky, under the
title
IV-E waiver program.
So what did we learn? START serves the top highest risk
cases in the entire State, but the mothers in START achieve
double the sobriety rates of those moms who didn't receive
START services, children in START were 50 percent less likely
to enter foster care, and at case closure, over 75 percent of
the children served by START were actually reunified with their
biological parent or they remained there in the home the whole
time.
Because of our low rate of recurrence of maltreatment, very
few children ever reenter foster care, and for every dollar
spent on START, we save the Commonwealth of Kentucky $2.22 just
in the avoidance of foster care cost alone.
So in closing, I can't think of a better time in the midst
of this opioid crisis to better protect children and families
with substance use disorders. START has more than a decade of
study behind it as to what works. We know what works now. And I
am thankful for the IV-E waiver program, as well as the RPG
program.
But we now must move from demonstration projects to system-
wide reform, meeting the problem at the scale of need. So
really at this point, we would like to move the financing of
child welfare so the family can remain intact, and receive
services. And what we know is preventing kids from entering
foster care not only saves money, but it reduces trauma to
children and families.
Thank you so much.
[The prepared statement of Ms. Willauer follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman BUCHANAN. Thank you, Ms. Willauer.
Mr. Glynn, please proceed with your testimony.
STATEMENT OF HECTOR GLYNN, VICE PRESIDENT
FOR PROGRAMS, THE VILLAGE FOR FAMILIES & CHILDREN
Mr. GLYNN. Committee Members, thank you for the honor of
being here. My name is Hector Glynn. I work with The Village
for Families & Children in Hartford, Connecticut. We are a
large nonprofit provider for the area.
We are part of the National Traumatic Stress Network, which
has allowed us to expand our expertise in evidence-based models
and treatment, to include models such as eye desensitization
and reprocessing, child-parent psychotherapy, modular approach
to therapy for children with anxiety, depression, trauma, and
conduct problems, and trauma-focused cognitive-behavioral
therapy.
But today I am here to talk about a truly unique program
called FBR, Family-Based Recovery. In Connecticut almost half
of the foster care placements for children under 3 have at
their core an issue of substance abuse.
So in 2006, the Connecticut child welfare agency, the
Department for Children and Families, brought together Yale and
Johns Hopkins to develop a new approach in dealing with this
crisis. It was really focused on the idea that most parents
really have a strong desire and drive to be good parents and
that that could be the motivating factor to changing their
behaviors.
So FBR combines treatment of substance abuse using a
reinforcements-based treatment and a child connection
adaptation type of approach, which helps to motivate and
control the desires.
When FBR started in 2006, it quickly got expanded to 10
regions throughout the State of Connecticut. When we looked at
the outcomes in this model, it is really about transforming the
system, because what we asked the child welfare agency to do is
keep families together, even though there was evidence and
proof of substance abuse.
So these families, we go in three times a week at a minimum
to provide both the child-parent psychotherapy together and the
substance abuse treatment, and we are testing for substance use
at least three times. This type of monitoring helps to create a
shared risk profile between us, the providers, and the child
welfare agency and the parents and constantly gives feedback on
how they are doing.
Since 2007, 564 caregivers have been in the program; 51
percent of these clients have had positive tests in the first
week, and that rate drastically drops down to, like, 14 percent
by the time they are being discharged. Eighty percent of the
families that we are working with are intact when we are
discharging them from the program, and it really shows the
strength.
And this isn't just about the program that The Village
offers. It is a program of network. The model was developed out
of Yale. It is an evidence-based model. And for our
terminology, that means there is a higher level of monitoring
to fidelity. Yale comes in and reviews our tapes of how we are
doing within sessions. They look at our substance abuse logs.
They look at the connections and the types of work that we do.
And that is really what is crucial. It is about what does work
versus just providing services.
So for us at The Village, 62 percent abstained from drugs
or alcohol 30 days prior to their discharge, and 88 percent of
the families were intact at the point of our discharge. But the
network continues to be extremely strong. And like I said,
there are 10 others that are involved within there.
The substance abuse, they have tested thousands of parents,
and only 8.2 percent of the families have had ongoing relapses
in which they needed a higher level of care or newer levels of
treatment.
We really do believe that this is a model that builds upon
the strengths of what parents can do and what families can do.
And this type of approach, along with case management to help
support the poverty and other factors that make it difficult
for families to stop using drugs, is the way to--at least one
approach--to dealing with this crisis.
Thank you.
[The prepared statement of Mr. Glynn follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman BUCHANAN. Thank you, Mr. Glynn.
I would like to advise Members that a series of votes has
been called. I anticipate this series of votes to last about 30
minutes.
I would ask the Members to return to the hearing as quickly as
possible from voting. This hearing will stand adjourned subject
to the--oh, recess, recess, okay--subject to the call of the
Chair.
[Recess.]
Chairman BUCHANAN. The Committee will come to order.
I recognize Ms. Barillas for 5 minutes.
STATEMENT OF KATHERINE BARILLAS,
DIRECTOR, CHILD WELFARE POLICY, ONE VOICE TEXAS
Ms. BARILLAS. Good afternoon, Chairman Buchanan, Mr.
Doggett, and Members. My name is Dr. Katherine Barillas, and I
am Director of Child Welfare Policy at One Voice Texas, a
health and human services advocacy organization. Thank you for
the opportunity to testify today.
As you heard from Mr. Doggett, our child welfare system in
Texas is in crisis. And let me say this is a crisis of
resources, where the needs of children in the child welfare
system far outpaces the State, Federal, and local resources
currently allocated.
Substance use, almost 80 percent of the cases in the foster
care system, has a profound impact on resources, just as it did
when I was an investigator for Child Protective Services back
in the late 1990s. What I have observed over my 20-year career
is that we often do not get to these families and children soon
enough.
One of the reasons it is so critical to ensure cases
involving substance abuse receive expedited services is the
impact that being separated from a parent can have,
particularly on a very young child. Women and Children
Residential Services is one specialized program that promotes
parent-child bonding. This program allows mothers to stay with
their children while the former is in inpatient treatment.
Despite the benefits implied with this model, it does face
challenges, one of which is judges are seldom willing to put
children in treatment, so to speak. There is also a myth that
women can't focus on their treatment if their children are
there ``bothering'' them. The truth is that when women enter
programs with their children they are able to work on parenting
and try out improved techniques under supervision and modeling.
Unfortunately, providers of this program are scarce. Part
of the challenge is funding, which would be somewhat alleviated
if States had the option of using title IV-E funding to pay for
these services and were able to draw down Federal foster care
match for the children when they are living with their parent
who is receiving treatment.
Another area where we must direct resources is kinship
caregivers, particularly those caring for children not yet in
foster care. These are fairly stable living arrangements with
the right resources, but without them they can easily break
apart.
Texas provides financial benefits to informal arrangements
when a child is in conservatorship but not to parental child
safety placements. A PCSP in Texas is basically an arrangement
between CPS, a parent, and a relative caregiver to prevent a
child from coming into foster care. These are short-term
placements used to alleviate risk so parents can address issues
in the home relatively quickly.
PCSPs are sometimes used in cases where parents are
struggling with substance abuse, but time is limited in these
cases--not a good match unless time and family-based safety
services are extended, with strong support to the kinship
caregiver.
The research is clear that children in kinship placements
have better outcomes than their peers in foster care. So
imagine outcomes for those children who age out of the system.
These youth face far worse than their peers in terms of lower
rates of high school graduation and college attendance, higher
rates of homelessness, substance abuse, and mental health
problems.
These young people have a desire and the ability to be
independent, but without the appropriate preparation they can
easily become the next generation of drug users and parents in
the CPS system.
Recommendations for this population include transition
living services being extended up until youth are 23 years old
and the time limit on family unification vouchers being
extended past 18 months to 2 years to meet standard lease
requirements and give youth time to attain stability in their
lives.
For kinship, we need Congress to direct resources such as
monthly payments and reimbursements at these placements, which
keep children out of the very expensive and detrimental foster
care system, and to allow payments to kinship families to be
used to draw down IV-E dollars.
Congress also needs to ensure that title IV-E coverage can
be used for more than just out-of-home care in order to address
substance abuse issues early. We also need to support the
expansion of IV-B funds and a time extension around family-
based safety services and family reunification.
We also need States to have guidance regarding the
importance of family treatment programs and visitation and the
promotion of women and children's programs as a vital treatment
option for women with young children.
Thank you.
[The prepared statement of Ms. Barillas follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman BUCHANAN. Thank you, Ms. Barillas.
Mr. Lindert, please proceed with your testimony.
STATEMENT OF BRYAN LINDERT,
SENIOR QUALITY DIRECTOR, ECKERD KIDS
Mr. LINDERT. Chairman Buchanan, Ranking Member Doggett, and
Subcommittee Members, thank you for the opportunity to address
the Committee on the use of data to keep children known to the
child welfare system safe.
My name is Bryan Lindert, and I am the Senior Quality
Director at Eckerd Kids, a nonprofit provider of services to
children and youth operating in 20 States and the District of
Columbia. We also manage the largest privately operated child
welfare system in the country, serving more than 6,000 children
and youth in Tampa Bay.
The number-one reason children enter the system is for
maltreatment from a substance-abusing parent. The aim of my
testimony is threefold: To describe how Eckerd Kids ended a
tragic pattern of homicides that occurred prior to Eckerd's
involvement; to explain how that success has led to
partnerships with five States to prevent future abuse
fatalities; and to explore the implications of our approach to
other child welfare challenges, including a potential improved
response to repeat maltreatment due to substance abuse.
Our work developing a priority tool called Eckerd Rapid
Safety Feedback was recently featured in the final report of
the bipartisan Commission to Eliminate Child Abuse and Neglect
Fatalities released in March of this year. To understand why,
we must explain why Eckerd Kids was selected to manage the
child welfare system in Hillsborough County beginning in July
of 2012.
This occurred after that community experienced an
unprecedented nine child deaths from maltreatment in less than
3 years. These cases were not co-sleeping deaths or the result
of inadequate supervision. Instead, they were intentional
inflicted injuries, including one child thrown out of a moving
car on the interstate. Worse still, they occurred under the
open jurisdiction of the court.
In Hillsborough, as in other jurisdictions around the
country, the Department of Children and Families reviewed these
cases and came to a frustrating conclusion: The fatalities kept
happening to children with similar risk factors and lapses in
casework. A more proactive approach was needed.
Therefore, in addition to the review of the nine child
deaths, Eckerd Kids conducted a 100-percent review of the 1,500
open child welfare cases in the county. From this review,
critical case practice issues were identified that, when
completed to standard, could reduce the probability of
preventable serious injury or death. Among these case practices
were quality safety planning, quality supervisory reviews, and
the quality and frequency of home visits.
Now that Eckerd knew what to look for, the next step was to
determine which cases needed to be prioritized for review. So
Eckerd Kids secured a technology partner that specializes in
predictive analytics, Mindshare Technology, to identify the
cases most like the prior fatalities on incoming cases in
realtime. Cases that were prioritized had multiple common
factors, such as a child under the age of 3, a paramour in the
home, intergenerational abuse, and history of substance abuse.
Eckerd Kids then reviewed these cases against the practices
identified with better safety outcomes and conducted coaching
sessions with the frontline staff when deficits were
identified.
The results have been promising. In Hillsborough, there
were no maltreatment fatalities in the 3-year period following
implementation of the program in the population served by
Eckerd. Critical case practices also improved an average of 22
percent. As a result, Eckerd Kids and Mindshare are now working
with Oklahoma, Maine, Alaska, Illinois, and Connecticut.
Regardless of the jurisdiction, the problem needs the same
ingredients for success. These include: A narrowly defined
challenge the jurisdiction is trying to solve, such as the
prevention of a fatality to a child with prior abuse reports;
daily access to the State Automated Child Welfare Information
System, allowing for predictions that continuously improve and
update as new data is entered; access to quality assurance
reviews assessing case practice; and experienced staff to
review the identified cases for the key safety practices and
provide coaching to the field.
In closing, it is important to note that we are not
advocating decisions made by machines. What is needed is a
second set of eyes to ensure we are doing our best casework and
positive outcomes for the children and families in our care.
Therefore, we are advocating that data and coaching
together provide a support for those men and women working with
families to help them focus attention where it is needed most.
I know from past experience as an investigator and supervisor
in the field I would have appreciated the help.
Mr. Chairman and Members of the Subcommittee, thank you
again for the opportunity. I will present my testimony in full
for the record and look forward to answering any questions.
[The prepared statement of Mr. Lindert follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman BUCHANAN. Thank you, Mr. Lindert.
I want to thank all of you for excellent testimony.
We will now proceed to the portion of the hearing that is
the questions-and-answers session.
Mr. Lindert, in your testimony, you talked about the
thorough review your organization undertook of child welfare
cases in Hillsborough County in Florida. As you began handling
child welfare cases, you noticed that you found a pattern, you
noticed certain common features, such as parental substance
abuse, that were correlated with serious injuries or death.
I know you have been working with other States to do the
same things, but, from my understanding, you were the first in
this area to really work in this area.
Should other counties be doing the sort of review of data
to help them better understand the cases of abuse and neglect,
from your viewpoint?
Mr. LINDERT. From our view, yes. We are actively searching
for additional partners to work with and additional
jurisdictions to work with beyond the initial five.
It was also one of the recommendations of the Commission to
Eliminate Child Abuse and Neglect Fatalities, which is
Recommendation 2.1, that other States and other jurisdictions
take a look at all of these cases in the same vein.
Chairman BUCHANAN. When you look at data, what type of data
are you looking at? When you say review of data, what----
Mr. LINDERT. So we are looking at factors that are
demographics, such as the age of the child involved in the
case, but we are also looking at system factors, such as the
number of police reports that have been received on an
individual family.
Chairman BUCHANAN. Why do you find, when you go into these
other States, that many States aren't taking advantage of the
data or best practices or the idea of continuous improvement?
What is your sense of why they are not taking advantage of
that?
Mr. LINDERT. My sense is that this is a new area of work.
Until recently, we didn't have the technology to take our eyes
out of the rearview mirror and put them on the dashboard. We
can now, if there is new information learned on a case, adjust
what we think the risk level of that case is based upon the new
information that is received right when it happens. Until
recently, we weren't able to do that. So this is a new
opportunity.
But I think the broader issue is probably this. Anytime
there is a tragedy, there is an intense focus, and rightly so,
on that tragedy that occurs, but it tends to be episodic in
nature rather than taking the long view. And I think the
recommendations of the Commission are that we must take the
long view so that we understand these patterns better, rather
than making policy or decisions based on an individual case.
Chairman BUCHANAN. The other thing you mentioned, at least
I understood, is the way you operate is a private-public
partnership. Tell me how that works and why that works.
Mr. LINDERT. So, in Florida, the child welfare system is
called the community-based care system. In each community, a
nonprofit provider partners with the Department of Children and
Families in order to provide the child welfare services that
are received. We operate all services once a child is removed
from their home up to the time that they are adopted or have
independent living services and even post-adoption support.
So we manage all of those services through the same
partnerships that would be required of any State agency or
county agency if they were operating the child welfare system.
Chairman BUCHANAN. Thank you.
I now recognize the distinguished Ranking Member for any
questions that he might have.
Mr. DOGGETT. Well, thank you, Mr. Chairman.
And each of you provided valuable testimony.
Ms. Willauer, I am just reviewing again your written
testimony, knowing you couldn't give it all here, but what
strikes me as being very important is your comment there on
page 15 that there are hundreds of unserved families in
Kentucky and the START sites are unable to take all the
referrals due to full caseloads. And then you say: ``It is time
to take the lessons of all of the prior Federal investments of
these families and move them to scale by providing the States
with funds and technical assistance needed to reform their
systems.''
Basically, you have a good approach. It is evidence-based.
You can show how it has been effective. Haven't you been doing
this in some parts of Kentucky now for over two decades?
Ms. WILLAUER. Yes. Actually, Kentucky implemented START in
2007, but it came out of Ohio. It was operating in Cleveland,
Ohio, from 1997 for about a decade and a half also----
Mr. DOGGETT. You still can't cover all of the State----
Ms. WILLAUER. No.
Mr. DOGGETT [continuing]. Because you don't have adequate
resources to cover all of it.
Ms. WILLAUER. Well, that is true. And I can tell you that
in Louisville, Kentucky, for example, for every family we
served, we had to turn away two that had the same exact needs.
So we have pockets of excellence in Kentucky and across the
Nation, but nothing is to scale.
Mr. DOGGETT. And, Ms. Barillas, in Texas, I believe the
same IV-E waiver program that she is talking about only covers
one county, only Houston.
Tell me about, from your perspective, what additional
resources will be necessary in Texas to comply with this
Federal court order declaring the system a failure and
unconstitutional to meet the needs of these children and their
families.
Ms. BARILLAS. Well, it is definitely a resource issue.
Three particular things that the lawsuit mentioned was a lack
of oversight of facilities, which was leading to children being
sexually abused; caseworkers lapsing in their duties--in fact,
one particular report said caseworkers were only able to spend
26 percent of their time with children and families, so the
majority of their time was spent on paperwork and more
administrative duties; and then youth transitioning out of
care. This young man who is accused of the UT student's murder
is a prime example. He was 17 and a runaway. He had no
particular mental health treatment, no transitioning services
to help prepare him for adulthood. And we see that happening
too often.
So, certainly, more oversight of our facilities; not just
more caseworkers but well-trained caseworkers; and we need a
tremendous amount of resources to help our youth actually age
out, be independent, and be free of that system.
Mr. DOGGETT. So, in Texas, only about one-fourth of the
time that these caseworkers have their child protective
services is actually about reaching out to troubling situations
like the ones that I described and others have described.
Ms. BARILLAS. Yes, sir.
Mr. DOGGETT. And you have an immense turnover of these
caseworkers. They come in, the pay is low, they are cycled
through the system, and then you have someone new.
And in Texas also, we far exceeded the recommended load for
these caseworkers, sometimes by really tremendous amounts, so
that we hear when a child is found chained or a child is found
abused that Child Protective Services didn't do its job, and in
some cases it did not, but in some cases we are loading up
those caseworkers with a load that is so big that they can't
possibly do their job.
Ms. BARILLAS. Well, there are certain priority cases where
caseworkers haven't been out at all for weeks up to months,
especially in Dallas. We have had a crisis in that area, where
caseworkers are leaving in droves, and because of all the poor
media attention, they are having a lot of trouble hiring
anybody. So one of the things they have done, our Health and
Human Services commissioner has indicated he wants to remove
the 4-year degree requirement and reduce training hours, which,
to me, is a very dangerous and explosive combination.
Mr. DOGGETT. Would all of you agree that, knowing we have
limited resources here also that we will be able to focus on
this problem, that looking at IV-E and prevention moneys, if we
have to prioritize, that that is a good place to focus our
attention?
Ms. BARILLAS. Yes, sir.
Ms. WILLAUER. Yes, sir.
Mr. DOGGETT. Mr. Glynn.
Mr. GLYNN. Yes, sir.
Mr. DOGGETT. And Mr. Lindert.
Mr. LINDERT. Yes.
Mr. DOGGETT. Thank you very much for your testimony.
Thank you, Mr. Chairman.
Chairman BUCHANAN. I now recognize Mr. Reichert.
Mr. REICHERT. Thank you, Mr. Chairman.
I want to start out a little philosophical, I guess, with a
quote from President Adams that kind of goes to the point that
Mr. Doggett was making in his opening statement. We can pass
all the laws we want to pass, but this is just a portion of a
quote, where he says, ``Our Constitution was made only for a
moral and religious people. It is wholly inadequate to the
government of any other.''
And so, you know, as we talk about parents who are chaining
their children and locking them in closets and taking their
life, where is this society headed? Where are we? The fabric of
our society is disintegrating and falling apart, and so where
is it left? It is left in the hands of people like all of you.
And thank you so much for all the hard work that you do. My
daughter was a caseworker, and I know from her experience. You
don't know me, but my experience was in law enforcement for 33
years, so I get this from having had to call CPS, I have had to
take children out of their homes.
I ran away from home when I was a senior in high school. I
was one of those kids at 16 years old who left my home because
of domestic violence, because of alcoholism, and but for the
grace of God, you know, here I am today to be in this position
to help you.
I have so many things that I want to say, I hardly know
where to begin. Just the 33 years alone should tell you what I
have seen and where I have been. I was the lead detective on
the Green River serial murderer case. In that case, that person
took over 60 lives. Those young girls on the street were
addicts. They were abused at home. They ran away from home,
looking for somebody to care for them. They were abused on the
street. Then they were abused by the judicial system and
victimized over and over and over.
And so we have to start where the problem, you know, really
begins, and that is at the family. And that is where we really
have to focus in order to prevent those kids from getting into
that position where--the young man you spoke about, and me as a
16-year-old leaving home and fortunately not falling into that
pathway.
My daughter and her husband also adopted two drug-addicted
babies from an organization called the Pediatric Interim Care
Center in Kent. My grandson, who is now 13, was adopted at 3
months, and was a meth-addicted baby. My granddaughter, who is
now 12, was a crack cocaine and heroin-addicted baby.
PICC, keeping their statistics--a review of 140 infants
discharged by PICC in 2013 and 2014 found only 8 of those
infants who had changed their placements--only 8 out of 140 had
changed placements, and the majority of those infants had moved
from a parent to a relative or a relative to a parent again,
those 8. So, you know, that is one of the success stories in
our neck of the woods. And you have success stories too.
I only have a minute and a half left here. I am really
excited about what PICC does and about the blessing that Emma
and Briar have brought to our family. And what happened there
was the visitation between the parents--I have been to PICC,
and those drug-addicted parents come in, they rock the babies,
they hold the babies. They try to get off drugs. Sometimes they
can, sometimes they can't. Sometimes the babies have to be sent
to foster care, and then sometimes, guess what, they have to be
adopted. And, in our case, we have just been blessed.
I am curious to know if any of you have programs like PICC
in your State. I will stop talking, because otherwise you won't
be able to answer the question.
I am just passionate about this. You know, PICC, they take
the babies from the hospital, because the hospitals don't have
the time to withdraw them, right? So they take the babies, and
they get them off drugs. And then they work with the parents,
and they work--no? Yes?
Ms. BARILLAS. In Houston, we have a facility called Santa
Maria Hostel, and they actually are one of these women and
children residential services that I spoke of, and they work
with both the children and the parents. But that early
attachment and bonding is so critical to their----
Mr. REICHERT. Yeah.
Ms. BARILLAS [continuing]. Brain development, that that is
why they want to keep mom and baby together. And so----
Mr. REICHERT. Yep.
Ms. BARILLAS [continuing]. That has been very successful in
Houston.
Mr. REICHERT. Good. Maybe we can share some information
back and forth and----
Ms. BARILLAS. Sure.
Mr. REICHERT [continuing]. Make the programs better.
Mr. LINDERT. I would reiterate those comments for Florida.
We also partner with a number of providers of that nature, and
would reiterate all the comments made.
Mr. REICHERT. I yield back. Thank you, Mr. Chairman.
Chairman BUCHANAN. Thank you.
I now recognize Mr. Davis for 5 minutes.
Mr. DAVIS. Thank you, Mr. Chairman. I commend you and
Ranking Member Doggett for holding this hearing today.
One of my top priorities on this Subcommittee is
modernizing our approach to families and child welfare affected
by parental substance abuse. For months, I have worked with
experts to draft a bill that does just this. My bill amends the
current Regional Partnership Grants both to focus the grants on
what the research shows works and to scale up these grants to
the State level.
I will introduce this evidence-based approach this month in
honor of National Foster Care Month. We need to update our laws
to reflect the decade of research, and I look forward to
continuing to work with the Chair and Ranking Member to advance
these reforms.
Although I have championed evidence-based policy, I must
raise concern from experts about whether we have the data
infrastructure and research base necessary for large-scale
implementation of predictive analytics.
And I request permission, Mr. Chairman, to submit for the
record this dissenting report of the Honorable Judge Patricia
Martin, a Commissioner on the Commission to Eliminate Child
Abuse and Neglect Fatalities.
[The submission of The Honorable Danny Davis follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. DAVIS. Judge Martin is a national expert on child
welfare whom I have known for decades, and if she has concerns,
then I think our Subcommittee should give serious consideration
to them.
Ms. Willauer, given that timely access to treatment is
related to child welfare reunification outcomes, can you tell
us more about how you achieve quick access to services? And
what are your recommendations to make this type of quick access
available in more States and communities?
Ms. WILLAUER. Thank you for that question. I think it is
the key to child welfare reform, quick access to parental
substance use treatment.
So I think that there are a couple things. We need
resources. We need treatment providers. Sometimes there is a 3-
to 6-month waiting list in Kentucky, for example.
So, again, I think that I would reiterate what you are
saying, and that is, for example, Regional Partnership Grants,
taking them to a State level, providing States with the
resources to be able to develop those resources so that
individuals--so all families can get them. Right now, only
pockets of families can get those resources. So it is critical.
Mr. DAVIS. Thank you.
Your testimony also emphasized the necessity to include
fathers in family treatment, noting that this policy evolved
over time. Can you expand on the importance of focusing on
fathers in your program?
Ms. WILLAUER. Absolutely. Addiction affects the whole
family, including moms, dads, kids, extended family. And if we
do not include the fathers, then you are not holistically
addressing the situation. We should include them in treatment,
in decisionmaking. We should look at their families for support
for placement for children. And we should look for gender-
specific treatments for those dads.
Mr. DAVIS. Thank you very much.
Dr. Barillas, several of the other witnesses have described
their promising approaches to address parental substance abuse
and keep children safe. Are these interventions expensive in
the short term?
Ms. BARILLAS. Evidence-based practice can be expensive in
the short term. It requires fidelity to a model, which requires
specific elements and training. It also requires evaluation,
and I have found that a lot of times, when programs are funded,
they are not funded for that evaluation piece. But in the long
run, as you can hear from the various witnesses, these programs
have a major impact and save us money.
Mr. DAVIS. So we follow the trend that an ounce of
prevention is worth much more than a pound of cure----
Ms. BARILLAS. Yes, sir.
Mr. DAVIS [continuing]. If we provide it early on.
Ms. BARILLAS. Absolutely.
Mr. DAVIS. Thank you very much.
And, Mr. Chairman, I yield back.
Chairman BUCHANAN. Thank you.
I now recognize Mr. Reed for 5 minutes.
Mr. REED. Well, thank you, Mr. Chairman.
And thank you to the panel for your testimony. And each and
every one of you has a great story, a great piece of
information to help us on this issue.
So what I really want to get into is to ask you, on the
day-to-day perspective of a frontline worker dealing with this
issue, dealing with the people that are involved, we are trying
to get to prevention. That seems to be a common theme that we
are all testifying to in the remarks.
So, as we go down the path to prevention, what is the
existing culture with those frontline workers in regards to
prevention? Is it something they promote? Is it something they
are committed to? Or are they more focused on the back end,
dealing with the situation after the crisis has gone on?
Would anyone like to answer?
Ms. WILLAUER. I will speak to that. I was a frontline
worker for 7 years.
I just think the frontline workers are overwhelmed. The
caseloads are huge. They don't have the resources they need to
do their work. It is not that they don't want to do prevention.
They don't want to remove these children from the home. But
sometimes, when your caseload is 30 families and you have
nowhere to send parents to treatment, sometimes you feel like
foster care might be a safer way to go, when we know that is
not necessarily true.
Mr. REED. Any other input?
Mr. Glynn.
Mr. GLYNN. My organization works with 8,000 families at any
given point, but this program here is the one that keeps me up
at night. And it is the same for the child welfare agencies.
What we are asking is for a greater risk tolerance, right?
We are asking that they keep babies, 0- to 3-year-olds, with
parents who have an active substance abuse issue.
And so the model that will have to be adapted is one of
shared risk, one in which we are in the home very often, three,
four, five times a week, where we are on call 24/7. And we
share that information with the child welfare workers. And,
together, we have to make those decisions about is it safe and,
when it is not, how do we remove the children.
Mr. REED. Okay. So that is great. So what you are
envisioning is your organization picking up that risk on the
front end--or sharing that risk with the child welfare system
workers going forward.
Now, that being said, how do you then--we measure the
success of that preventive measure that you are advocating for
on the front end with your organization. What is the
measurement that you would offer us as a guide in that culture?
Mr. GLYNN. I think, one, it should be placement; did the
children stay within their biological or natural placement.
And, two, for us, it is those tox screens. You know, how clean
are the parents? Do they remain clean during periods of
treatment, and what does it look like going out after?
Mr. REED. Okay.
And then from the child welfare workers' perspective,
because some folks in D.C. think the ultimate solution is just
more resources, more resources, and if you keep funding at
higher and higher levels, you will cure this problem. One of
the things I have experienced here in the time I have been
here, since 2010, is often that is not the best solution, nor
will it lead to a solution. So what you have to do is
reallocate the resources.
So, from a child welfare workers' reactive perspective,
moving to a prevention, what things are they focusing on now on
the front line that you would say is probably not the best use
of resources and could be allocated more toward the front end
to the prevention side of the equation?
Ms. Barillas, do you have any----
Ms. BARILLAS. Making----
Mr. REED. Or is every dollar being 100-percent efficiently
deployed?
Ms. BARILLAS. No, no, I would not argue that. But what I
would say is, you know, in the study we did in Texas, where we
found that 26 percent of a caseworker's time is the only time
they are spending with children and families because they are
busy filling out 5 million forms----
Mr. REED. Amen.
Ms. BARILLAS [continuing]. Most of which are repetitive--
you know, I know you all know nothing about that kind of
paperwork--you know, instead of----
Mr. REED. And why are they filling out so many forms? What
is causing that, from the frontline workers' perspective?
Ms. BARILLAS. It is caused by policy decisions that are
made at the State level that are sending--we have this great
idea, we are going to do structured decisionmaking, and we have
this great idea, we are going to change visitation and make you
fill out a form, and as part of that policymaking process there
is no consideration of what implementation is actually going to
look like on the front line.
Mr. REED. So is that a fair piece of input that I hear from
you? When we move to the prevention side, make sure we don't
duplicate that kind of administrative bureaucratic problem when
we go to the prevention side?
Ms. BARILLAS. Oh, absolutely.
Mr. REED. And what would be the one reform or requirement
or provision that we could put into that shift in policy that
would accomplish that to the most successful end?
Ms. BARILLAS. Well, as I mentioned, considering in the
implementation what is going to happen in the implementation
process. There is a lot of this that can be done electronically
or a lot that is already included in paperwork caseworkers
have. They are literally duplicating the same information on
five different forms.
Mr. REED. So data streamlined and data----
Ms. BARILLAS. Absolutely.
Mr. REED. I appreciate that.
And I am out of time. With that, I yield back.
Chairman BUCHANAN. Thank you.
I now recognize Mrs. Black for 5 minutes.
Mrs. BLACK. Thank you, Mr. Chairman. I want to thank you as
a non-Committee Member for allowing me to sit on this Committee
and also be able to ask questions.
Gosh, I don't know where to begin, just like the other
Members of this Committee. This is such a big issue.
But where I do want to start--and if we could just walk
down the line with this. Help me to understand how you come to
know that someone needs assistance. Where do you get that first
contact to say, we need to go and visit this family and become
a part of helping them to turn the situation around?
Ms. Willauer, how about you?
Ms. WILLAUER. Yep. In the START program, families come to
our attention after a report to the child welfare agency
regarding some abuse or neglect. START gets involved right
after that.
Mrs. BLACK. Okay.
Mr. Glynn.
Mr. GLYNN. The same is true for us.
Mrs. BLACK. Okay.
Ms. Barillas.
Ms. BARILLAS. In prevention, a lot of it is other service
providers. So when families are receiving services from WIC or
somewhere else and it is noticed that they need assistance,
they will be referred to a prevention program.
Mrs. BLACK. Okay.
Mr. Lindert.
Mr. LINDERT. In our case in Florida, the families come to
our attention as a result, primarily, of removal from their
parents. However----
Mrs. BLACK. Primarily? I am sorry, I didn't catch that.
Mr. LINDERT. Removal from their parents.
Mrs. BLACK. Removal from their parents.
Mr. LINDERT. In some cases, it is also to serve the
families in-home prior to removal.
Mrs. BLACK. Okay.
Mr. LINDERT. And in the other States where we are working,
typically it is a result of a hotline call that has been made
to the State's health welfare agency.
Mrs. BLACK. Okay.
So, again, going down the line, tell me what percentage of
these moms that you come in contact with, what percentage of
them are either single mothers or of a divorce, where they may
have been married and no longer are.
Ms. WILLAUER. I don't have numbers on that, but I can tell
you it depends on the region of the State.
Mrs. BLACK. Okay.
Ms. WILLAUER. And we do have a lot of single-headed
households. But I can follow up with you.
Mrs. BLACK. Okay.
Mr. Glynn.
Mr. GLYNN. It would be an estimate, but it would be in the
high 70 to 80 percent----
Mrs. BLACK. Okay. A high percentage.
Ms. Barillas.
Ms. BARILLAS. I would say the same, although I don't have
the specific numbers right now.
Mrs. BLACK. Sure.
Mr. Lindert.
Mr. LINDERT. It is the same for me.
Mrs. BLACK. Okay.
So here is--I want to go back to what Congressman Reed was
saying, and that is the prevention piece of this. And I will
just tell you my experience as a registered nurse and also
coming from the State of Tennessee, where I was on the Child
and Family Services Committee.
I helped to bring a program into our State called Nurse-
Family Partnership, where we had young mothers who were not wed
or in some cases where they may have been but weren't getting
support from that spouse, that we would interact with very
early on to make sure that they understood that they were
carrying a child and bonding with that child and making sure
they got all the services that they needed that we could
possibly give them. And that has been funded by the State of
Tennessee and we have seen very remarkable, remarkable results
there.
And so I am a big prevention kind of person. And I am glad
to see every one of you are nodding your head on that, because,
obviously, that really is the answer, if we could do that.
The evaluation piece is the next piece, that we didn't do a
very good job in our State evaluating, because we saw a lot of
children that were being removed from their homes, and the
evaluations when I asked for the numbers and the statistics and
so on--so if we could just go down the line again about
evaluation. What are you using to evaluate each one of your
programs?
Ms. Willauer.
Ms. WILLAUER. Can you say more on that? What are we using?
Mrs. BLACK. Well, what method are you using? Are you
evaluating----
Ms. WILLAUER. Yes.
Mrs. BLACK [continuing]. On a regular basis? And what kinds
of things are you evaluating when you get involved?
Ms. WILLAUER. Yes. So we are looking at all kinds of
factors, what makes our program work. We are looking at child
removals. We are looking at parental sobriety, reunification,
recurrence, re-entry into foster care, different designs of
program evaluation. But it is critical that we have all of
that.
Mrs. BLACK. And you are evaluating what works and doesn't
work.
Ms. WILLAUER. Absolutely. We are doing a randomized control
trial in Louisville, Kentucky, on START----
Mrs. BLACK. Very good.
Mr. Glynn.
Mr. GLYNN. The University of Yale provides oversight and
evaluation to all the service providers.
Mrs. BLACK. Excellent.
Ms. Barillas.
Ms. BARILLAS. In Texas, we have actually really struggled
with that, and it was only a couple of years ago, when our
Prevention and Early Intervention Division got a new director,
that we started really looking. Because, for the most part,
people were using pre- and post-tests, which really can only
tell you so much. So, as there was a push for more evidence-
based practice, you see more, for example, like, randomized
control trials----
Mrs. BLACK. Good. Yes.
Yes?
Mr. LINDERT. We are working with Casey Family Programs to
evaluate the implementation in four States, and they are using
an interrupted time series design. Although the evaluation is
just about to begin.
Mrs. BLACK. Excellent.
And I just will finish up by saying that if you don't
measure something you can't tell whether it is working or not.
And I think that is one of our problems, Mr. Chairman, is that
we spend a lot of money on a lot of different programs, but
when you ask about their evaluations and how they are measuring
the success, what you see is you are spending a lot of money
and you are getting a lot of information that isn't valid, that
you don't have the real statistical information to show that it
is working.
And so I think every dollar that we expend from the Federal
Government should be required to have an evaluation tool where
we can say that money is actually working. And I will go back
to that ``ounce of prevention is worth a pound of cure.'' That
is really where it is good to be spending most of the money, on
these kinds of programs that we know work.
So thank you for the work that you do. It is God's work.
Thank you.
I yield back.
Chairman BUCHANAN. Thank you.
Let me just ask you--you know, everybody has a family
member or somebody they know, and it just seems to me--and
everybody has touched on it--is the whole investment seems to
be, especially with children, the prevention piece.
And I don't know, I would like to get all of your thoughts
just quickly on it. But, you know, at what level, what grade
level, do you need to start working with children? You know,
you think high school, but then you hear all these stories that
you have to get down to 3rd and 4th grade. It seems that is the
investment we have to make in an aggressive way.
And the reason I say that is because I have seen it in my
own family, where someone ends up having a problem, and then to
move them back off that problem is huge, the toll it takes on a
family and the expense. And many times, I don't know what the
rate is, but they have to be on guard the rest of their life,
many times, because the drug owns them.
So I guess, as it relates to children, what is your
experience, your thoughts about how early in our school systems
and everything--parents--do we need to be investing with these
children in terms of educating them and making sure they
understand if they make a bad choice it is tough to come back
from that?
Ms. Willauer, let's just go down the row real quick.
Ms. WILLAUER. I guess I would just say it starts at birth.
It starts with the family. There are early intervention
services and early childhood services that can help with
bonding and attachment. So it begins there, and I think there
are opportunities all the way through the lifespan of a child's
life.
Chairman BUCHANAN. Mr. Glynn.
Mr. GLYNN. I would agree that, you know, what we know about
brain development really does push us to say we have to invest
more in the 0 to 5 years of development, and that will help to
create the executive functions that you are looking for to
prevent some of the decisions that will be made later on.
Chairman BUCHANAN. Ms. Barillas.
Ms. BARILLAS. You stole my answer.
Yeah, absolutely, the brain development is critical to
giving children the skills they need to make those decisions.
But I also agree, if children are going home to an environment
that is full of these negative influences, then it is not going
to matter what happens in school or in another program.
Chairman BUCHANAN. Mr. Lindert.
Mr. LINDERT. I agree with all of the comments.
I would also add that when we are thinking about children
who have come to the attention of the child protection system,
we have to prioritize early childhood and, in particular,
infancy. The majority of maltreatment fatalities occur within
the first 3 years of life, a significant amount of those in
infancy. And child welfare agencies need to approach early-
childhood cases differently than we approach cases on teenagers
and at other points throughout the lifespan.
That is a recommendation of the Commission. It is also
something I have seen in our systems of care and as a frontline
worker myself.
Chairman BUCHANAN. I would like to thank our witnesses for
appearing before us today. You have given us a lot to think
about as we try to improve our child welfare system to protect
more children from harm.
Please be advised that Members will have 2 weeks to submit
written questions to be answered later in writing. Those
questions and answers will be made part of the formal hearing
record.
With that, the Subcommittee stands adjourned.
[Whereupon, at 4:12 p.m., the Subcommittee was adjourned.]
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