Extended Conversation - Child Welfare and Its Limits

(This article is the second half of the conversation between Professor Mark Courtney and DCFS-IL Director Richard Calica. The first half was printed in the Summer 2012 issue of SSA Magazine.)

Calica: I’d also like to be more focused in terms of what exactly is the purpose of our intervention and how do we know that we’ve achieved it. This is a compliance-driven system, as opposed to an outcome-driven system, and we already have the treatment mapped out for you, it doesn’t matter who you are: All children in Illinois are ADHD oppositional defiant with a touch of manic depressive illness, and all parents in Illinois and nationally need classes in parenting, drug drops, anger management and domestic violence. In addition, if you have a symptom, we have a new provider with the treatment. I often wonder why we bother assessing anyone if we already know their diagnosis and treatment plan. I hope to make a contribution towards changing this.

The real challenge is how can we get parents whose children we’ve taken away involved the day we take them away and keep them involved in the lives of their placed children? When I was a child welfare worker in Los Angeles, all my parents knew where their kids were placed. We don’t tell our parents now where the children are on the assumption that they...will what? That parents will go kidnap them, murder the foster family, do something horrible? So we demonize the parent right away, separate them, and actually make it emotionally easier for them to have another baby and abandon the one we’ve taken. And we set up a dynamic between the natural parent, the foster parent and the child that is very unhealthy.

So I would like to change that dynamic and also make the decision about return home versus adoption a lot earlier. If I asked a parent to come with me to put his kid to bed that night, and if I’ve asked him to help limit the trauma that I’ve caused his child by taking [that child] away, regardless of the fact that he caused that in the beginning­—if he’s not capable of putting aside his own needs long enough to attend to his kid—then he’s giving me very early indications that maybe he’s never going to get his kid back. The first day isn’t the judge, obviously. So I’d like the focus to be getting these kids back to their parents as fast as possible, or if not get them back, then figure out what’s the best permanent alternative.

Courtney: When children come into care, almost immediately they are in the supervision of the court and the child welfare agency. Historically, that wasn’t always the case in the U.S. The child welfare agencies would use voluntary placements.

And there are still some places in the country that use voluntary placements, primarily in two kinds of situations. One is trying to deal with the fact that we don’t have a child mental health system anymore. With older kids who have problems but they haven’t committed a crime, the juvenile justice system won’t intervene. Even when it’s not clear that they’re really being neglected or abused, some child welfare systems are more open to those sorts of kids. They’ll use voluntary placements to get them family treatment, maybe residential treatment.

The other situation is where a child welfare worker goes out, does an investigation, and finds a child who is clearly at risk and the family acknowledges that. Some parents are willing to say please help me. But in so many places in the country now, everybody goes to court. And I’m just kind of wondering why. In most of the world, there would be a conversation with the family: “It seems like foster care would be a good place for your kid to be for some period of time while we work with you. We’ll find a place for the child, you’ll be able to visit them, and we’re going to work with you.” Why don’t we do more of that?

Calica: I wish I knew. I began my career in Los Angeles in 1968, and that’s exactly what I did. Most of my placements were voluntary. I think it speaks about a level of respect for the family, and engaging the family.

Actually, we have a program right now in Illinois that’s run privately that’s called Safe Families, where they not only take the child, but the foster parents “adopt” the family and work with the parents as well. So I’m highly in favor of that. Now why have we evolved from that to demonize parents, I have no idea.

Courtney: And involve the court, so you can’t send the kid home even if he wants to go.

Calica: Well, I can give several explanations. When I wear my clinician hat I say that it’s a parallel process, that we’re beating up the parents in the way they beat up their kids. And there’s some fantasy that if you actually have a court order, that means anything in terms of behavioral change for the parents, just because it says so.

Courtney: That is quite a fantasy.

Calica: I remember testifying in court a couple years ago about a family where I really felt that the parent was not in a position to take care of the child. I said on the stand that the parent loved their child very much, and the court didn’t know how to deal with that. How could you say that the parent both loves their child and is incapable of taking care of him?

Courtney: There are lots of people out there who love their kids and are incapable of caring for them, and maybe never will be. But isn’t that kind of what we need to work with, in a sense?

Calica: Exactly. I don’t think that my staff, though, or many people in the field are capable of both being respectful to somebody and holding in their mind at the same time the possibility that that person could murder their child.

Courtney: I’ve heard that even the administrators are saying, “I want the court backing me. If the court is overseeing this, then somehow my liabilities are less.” The way I read Supreme Court decisions, et cetera, is actually the opposite. Once you remove the child involuntarily, the liability of the state is much more profound than when it’s voluntary. In both cases, I reckon, we’ve intervened and we’re somewhat responsible. When the court assumes jurisdiction, there’s a long case history because if that kid gets hurt, now the agency’s in trouble.

Calica: I think it’s true in Illinois—and everywhere else—that nobody wants the responsibility or the authority for anything. It’s much easier to say that somebody else did it, that the court made the decision. I think people run like rabbits rather than saying, okay, this decision is mine to make and I will accept the responsibility for what happens given I have done what is reasonable and accepted practice.

Once we’ve taken custody, though, we are the parent, and then to what standards should we be held? Held to the standard of the community from which the child was taken? So if 35 percent of the kids graduate from high school in that community, then it’s okay for me to have that same graduation rate for the kids in foster care? It’s an interesting social policy question.

Courtney: In my research on youth aging out of care, I’m actually quite careful to compare the youth aging out of foster care to nationally representative samples. I don’t try to adjust these comparisons for race, socioeconomic status, and other kinds of risk factors.

My rationale for that is that we took these children away from their parents. A meaningful comparison is how are other people at 18, 19, 20 are doing. If we’re not aiming to get foster youth to that standard, which is how kids are doing generally in the county, why did we intervene in the first place? How do you answer that question?

Calica: Well, unfortunately, since I’m from the University of Chicago, I’m an elitist. So my aspirations for the children that we’ve taken into care would be the same as my own kids. I think we’re responsible for providing them the highest level of care. Otherwise, why did we take them? I’m with you on that one. If the best we can do is what the parents did, we ought not to bother. But it is important to remember that our children come into the system with many more emotional, cognitive and physical problems than would be expected in a normal population distribution.

The problem in our field is that we don’t have benchmarks. If you’ve got pancreatic cancer, the odds ratios are that you have a 5 percent chance of surviving the next 12 months. We don’t even have a classification system in this field. We have a legal classification system to justify legally why we’ve intervened in your family, but in terms of a diagnostic classification that would give me odds ratios of your probability of improvement success and standard treatment protocols—our field is way behind medicine. So we’re in the infancy of a science. I’m really interested in benchmarking and seeing if we can improve. So if the benchmark is five percent survival rate, can I get to seven? Can I get to nine?

Courtney: So another issue: A lot of us think that many folks get involved in the child welfare system because of how desperate family poverty is in this country. I want to be clear; the vast majority of even desperately poor people don’t come to the attention of child welfare authorities. But nevertheless, you’ve got people who are typically single parents with no high school diploma and few prospects in the labor force, very depressed, no big surprise there. And the long term prospects of these folks successfully parenting really depends on them being successful in other realms. They’ve got to be able to work, and they’ve got to be able to manage a household.

So I guess my basic question is what role do other parts of the safety net have, whether it’s Medicaid, TANF, welfare-to-work programs, substance abuse treatment, mental health. Do you want the child welfare agency to provide housing? I did a study: The biggest predictor of whether people got their kids back--controlling for substance abuse, mental health, income—was the simple indicator of whether they had been homeless in the last year.

Calica: I’m of mixed mind with that. Yes, other departments are responsible. But I depend upon them to step up for my client who’s had their kid taken away, and then wait around for that to happen. It may be forever. That is why I am in favor of vertical integration—having as many of the services essential to the outcomes I hope to achieve under my agency’s control.

Yes, all those agencies are responsible. But I’m not going to sit around and say, well, that’s not my job, that’s somebody else’s job. So I’m trying to be a “one-stop shop” for just the most severe end. Not providing for everybody in the world. Not teaching somebody like me up in the northern suburbs how to diaper and take care of their baby and do all these nice preventative things, but rather to just work with our population—children who have been found by DCFS to be abused or neglected. And in that sense, I want to keep it all in my house. The problem with social workers is that they always point to factors beyond their control which account for their inability to help their clients. If I can’t account for what percentage of the variance my efforts are responsible for, why am I bothering to do anything? And why should anyone give me any money to do it?

People do need jobs, and people do need housing, and I don’t build houses, and I don’t create jobs. But I do know from the research that if I work with a depressed mom and she becomes less depressed , her kid’s functioning will be better. So I’m all for defining the limits of the scope of my interventions and measuring outcomes given those limits.

Courtney: You point out the problem—that every institution, every silo if you like, only wants to be held accountable for the population that it’s statutorily responsible for. But I think child welfare is a place where you can make a pretty powerful argument that in the absence of people having jobs and mental health and being reasonably free of substances, they will have a hard time becoming the parents we want them to be, and on the kid’s side, we need to provide health care, good schooling, et cetera. And that for the child welfare system to invent a housing system, an employment system, a mental health system is not feasible.

I totally understand when you’re left holding the bag, you would try to do what you can with these issues within the agency, and I have a lot of respect for that. But as a matter of public policy it seems that it would be nice if we could get the federal government and state governments to actually figure out a way to come up with a set of outcomes that we’re trying to achieve for families and kids and hold these institutions collectively responsible in some way.