Saturday, February 21, 2009

Child abuse prevention is less costly for society

For Mother and Child at Risk, Care That Includes a Psychologist

Tarkan, Laurie. The New York Times, Feb. 14, 2009.

When she became pregnant, her grandmother offered to buy her a car if she would have an abortion. Other relatives told her the baby would not live to see its first birthday. She was 22, unmarried and had already been hospitalized several times for suicide attempts.

She gave birth to a boy, and when he was 1 week old, the young woman, who spoke on the condition that she not be named, brought him to a pediatric practice at the Children’s Hospital at Montefiore Medical Center in the Bronx for a checkup. A doctor recommended that she join an infant-parent psychotherapy group; instead she agreed to home visits.

In the presence of a psychologist, the young woman wondered aloud if she was sexually arousing the baby when she changed his diaper; said the newborn was “demanding,” “mean” and “hates men”; and eventually revealed that she had been sexually abused as a girl.

“She was mistrusting and so overwhelmed, and needed much more help,”
said Rahil D. Briggs, the hospital psychologist who worked with the young woman at her home. After three months of home visits, Dr. Briggs persuaded the mother to join group therapy twice a week.

“Without this bridge, and me having the flexibility to go to her home and have her gain my trust, she never would have come to the group,” the psychologist said. “And if she hadn’t, with her set of risk factors, who knows what would have happened to her son? He is securely attached to her, and in my opinion it’s fairly close to a miracle.”

The group is part of a new effort by the Children’s Hospital to protect young children from psychological damage that can be common in poor families.

Experts say Montefiore’s new program is a rare example of mental health services for children under 5, a population that Evelyn Blanck, co-president of the New York Zero to Three Network, described as “under the radar screen.” Many pediatricians are not trained to recognize psychological problems, and surveys show that parents often complain about physicians’ lack of support for behavioral issues.

“There is really a disconnect between the genuine needs and challenges that are facing our young children and their families and what doctors are providing,” said Dr. Dina Lieser, executive director of Docs for Tots, a nonprofit group that advocates for young children.

The National Academy of Sciences released a report on Friday calling on federal, state and local governments to make prevention of mental, emotional and behavioral disorders in young people “a very high priority.” The report called the current emphasis on treatment once mental disorders emerge as “myopic,” and said that prevention means focusing on people with early symptoms and risks, such as maternal depression or poverty.

At Montefiore’s pediatric practice, the Comprehensive Family Care Center, there is a psychologist on site, and doctors — who are trained to recognize depression in parents — screen each patient for mental health concerns. Of 2,400 children screened since 2005, 1,120 have been recommended for mental health services, and 780 have participated.

The screening program currently costs the city $20,000 to $30,000 a year; therapy is generally covered by Medicaid. The Altman Foundation has covered the $150,000 yearly cost for a separate program, known as Healthy Steps, which since 2006 has screened 250 families at the family care center and provided individual and group counseling.

In Healthy Steps at Montefiore, which is part of a national program, 20 percent of the mothers are teenagers, 27 percent grew up in foster care, 37 percent have parents with mental illness, and more than 10 percent were physically or sexually abused — all risk factors for their babies’ healthy mental and social development, according to Dr. Briggs. Research shows that environmental factors like poverty, homelessness, domestic violence and drugs can lead to depression, anxiety, aggression, poor academic performance, autistic behavior and social or developmental delays.

“If a child is exposed to chronic or toxic stress, his reaction to stress gets turned on way too quickly,” Dr. Briggs said, citing one case in which the mother of a 2-year-old boy wondered whether it would be normal for his tantrums to have intensified after he witnessed the fatal shooting of his father on the street.

According to doctors at Montefiore, a child enrolled in the Healthy Steps program is one-third as likely to score “at risk” for social or emotional developmental problems. Among mothers in the program, depression dropped from 30 percent at the first visit to 6 percent after two months, while 35 percent reported feeling unsupported at the first visit compared with 10 percent at two months.

One recent morning at the hospital’s family care center, a half-dozen mothers sat in a circle as their babies and toddlers played with bubbles on a foldout mat. It seemed like a typical mommy-and-me group, with talk of breastfeeding and gassy babies. But in this group, which was run by a social worker, some of the problems preceded the births: Erika Hernandez, 30, said she had been abused by her stepfather and spent most of her pregnancy homeless; Amanda Agosto, 32, said she had been frequently abandoned by her mother, who she said has bipolar disorder and schizophrenia; others were single and poor.

Though cost is often cited as a reason for not providing mental health services to children, Dr. Andrew D. Racine, director of general pediatrics at the Children’s Hospital at Montefiore, said the costs to society only rise if problems are ignored.

“We are seeing the enormous payoffs when you intervene with a child at six or nine months,” said Dr. Racine. “But the ability to intervene or change the trajectory narrows as the kids get older. By the time you get to school-aged children, it already costs a lot more money, time and energy for less returns.”

As an example, Dr. Briggs cited Emily Caraballo, 22, and her son, Hector, who before age 4, she said, had witnessed his father physically and verbally abuse his mother. Before an appointment last fall, Dr. Briggs was summoned by a security guard to the waiting room, where she found Ms. Caraballo “bleeding all over her face because her son has scratched her, and she has him pinned down on the floor so he doesn’t hurt anyone.”

“Hector had never received a single ounce of help of any kind — he’s never even been in a school setting because he’s out of control,” Dr. Briggs said. “This is a kid who should have been seeing me since the time he was an infant and this would have been a different story.”

Ms. Caraballo now lives in a domestic violence shelter, and her son is at one of the city’s two psychiatric hospitals that take children under 5. “They say to be a better parent, you need to be strict,” she said. “But Dr. Briggs took the time not only evaluate him, but to look at the circumstances that cause the situation. He developed a rapport with Dr. Briggs, he feels comfortable speaking about what he’s witnessed between me and his father.”

Saturday, February 14, 2009

Adults conspire to steal thousands intended for care of foster children

Foster-care scam grows by $155G
Zambito, Thomas. New York Daily News, Feb. 11, 2009.

Three women took $155,000 in city funds to care for foster kids they never saw, federal prosecutors said Wednesday as their probe into sham adoption subsidies widened.

Mother and daughter Oletha Rhodes and Tammy Moore took $100,000 in welfare subsidies, Manhattan federal prosecutors said.

The money was funneled their way by Nigel Osarenkhoe, a former adoptions supervisor for the city's Administration for Children's Services, prosecutors say.

Rhodes works as a lunchroom aide at Queens Vocational High School and Moore is a seasonal employee for the city's Housing Authority who used to work at ACS.

Also charged was Brenda Towe, a relative of a dead ACS employee, who's accused of accepting $55,000 in bogus subsidies.

Of the three, only Rhodes cared for foster kids, and she took more money than she was entitled to, prosecutors said.

In exchange for kickbacks, Osarenkhoe doled out $578,000 in adoption subsidies to numerous individuals by claiming they needed the cash to care for hard-to-place foster kids, prosecutors say.

Also yesterday, accused co-conspirator Philbert Gorrick, 54, pleaded guilty to accepting $375,000 in illegal payments from former ACS official Lethem Duncan.

Monday, February 9, 2009

Sister Teresa's long legacy for caring for children

47 years of foster care at N.Y. Foundling Hospital
Richardson, Clem. New York Daily News, Feb. 9, 2009.

The black-and-white photo was among the raft of mementos Sister Teresa Kelly came across while cleaning out her New York Foundling Hospital office.

It shows Kelly, former Mayor Ed Koch, Foundling Hospital President Dr. Vincent Fontana, television weatherman Irv (Mr. G) Gikofsky, several other nuns from Kelly's Sisters of Charity order and 10 children, all with big grins on their faces.

Sister Teresa remembers the moment.

A thunderstorm was raging outside, rattling the walls.

"Mayor Koch looked around and said, 'Don't worry, children, the Mayor is here,'" Sister Kelly recalled. "One of the children said, 'We're not worried; the Sister is here.'"

After a 47-year career with the Foundling Hospital, during which she has been mentor, confidant and surrogate mother to thousands of children, Sister Teresa retired last month.

Her decision had nothing to do with her age, but rather a recent city Administration for Children's Services directive to place fewer foster children in congregate care facilities, said Foundling Communications Director Jennifer Gilbert.

Public acceptance of unwed women having children has also reduced the number of babies being abandoned or put up for adoption.

That has meant fewer children coming into Blaine Hall, the top-floor dormitory facility at Foundling Hospital offices on Avenue of the Americas in Manhattan.

The last child living at Blaine Hall was adopted by a Foundling staff member in December.

Sister Teresa's retirement leaves only one Sister of Charity at the Foundling, down from as many as 60.

Sister Teresa, a bartender's daughter who was a Clairol model before joining the Sisters of Charity order in 1957, has been program director at Blaine Hall since it opened in 1974 to house older Foundling children.

She also was a teacher at the Blaine House school, and said the program was the driving force in her life.

"Blaine Hall has had only one program director for more than 34 years," said Foundling Executive Director Bill Baccaglini. "This is one tough Irish woman who doesn't suffer fools. I will miss her."

Sister Teresa has seen the business of foster care change over the years, and not always for the better.

"You used to be able to take a child to the movies or out to the museum or even home with you at night," she said.

"You could sit on the bed with them and hug them and comfort them. Now, you have to be very careful how you deal with a child, after all those abuse cases in the news.

"People don't know how much some children suffer in their lives," she added. "So many of them just need to feel loved. The people who do this kind of work do it because they love children and want the best for them."

WHAT DID working with children for so many years mean to her?

"I had family and I had love," said Sister Teresa, who plans to live with a sister in Westchester County. "People sometimes ask me if I regret not having any children of my own. I tell them I had everything I every wanted."

Some 138 people, including several of her former charges, turned out for Sister Teresa's retirement party, held at Rosie O'Grady's Restaurant in midtown.

She's not sure what she will do next, only that it will have something to do with caring for children.

National poll indicates public ignorance about foster care experience

National CASA Association Aims to Eliminate the Foster Care Stigma
PR Newswire, Feb. 3, 2009.

When Americans are asked about the kids in the foster care system, a national online Harris Poll, commissioned by the National Court Appointed Special Advocate (CASA) Association, found that 83 percent of adults know little or nothing about the experiences of children in foster care, and nearly half (42 percent) know nothing at all about these children.

When adults do think of children in foster care, only a minority (11 percent) cited positive impressions about these children and the foster care system that serves them. Most often, adults picture foster children as poorly treated, facing a hard life and in need of sympathy; 46 percent of knowledgeable adults believe these youth in foster care face unsuccessful futures.

However, when you talk to the youths themselves, you see an entirely different picture. A national focus group study of 50 current and former foster youth, also commissioned by the National CASA Association, found these youth see themselves as uniquely empowered by overcoming adversity, determined not to repeat the mistakes of their birth parents and optimistic about their futures.

"Yes, I have been through a lot of hell and high water, but because of that I am a stronger person. I'm still standing," said a male Dallas foster youth who participated in the study.

Despite the lack of awareness by the general population of the foster care system, 87 percent agree that foster care should be a national priority. Furthermore, 73 percent of adults believe in their potential to positively influence the lives of foster children.

"These are people we -- and our foster youth -- so desperately need," said National CASA CEO Michael Piraino. "We know that when a CASA volunteer is involved, children are 95 percent less likely to re-enter the foster care system. There are people out there that are willing to help, they just don't know how."

When asked what foster children want they say it's simple -- "we just want someone to be there to listen. We trust people who are willing to listen to us."

"There are a number of ways caring adults can become involved in the lives of these young people, not only as foster parents, but also as mentors or CASA volunteers," said Piraino. "By becoming a CASA volunteer adults provide the stability that foster youth often lack. That stability helps these children transition from care into successful adulthood and helps ensure that each child has the opportunity to reach their fullest potential."

The results of the two studies were presented by Piraino in January, in New York to an audience of national media, National CASA staff, and various members of the child welfare community. Supporting Piraino was a panel of foster youth advocates, featuring best-selling author and long-time CASA supporter, Anna Quindlen; National CASA spokesperson and TV-personality Judge Glenda Hatchett; and former foster youth and author Julia Charles.

Foster care and unaffordable child care?

Working mom's heartbreak: Home-alone son’s is back from foster care, but she needs help
Block, Dorian. NY Daily News, Feb. 6, 2009.

Lillian Lucas-Dixon has her 7-year-old son Juan back in her arms again.

But the reunion may be short-lived.

Juan - the youngest of her 10 children, most of whom are grown - was put into foster care because she left him home alone while she worked.

She is thrilled he's back, but still does not have anyone to watch him while she works at night as a token booth clerk.

"I started crying. I couldn't believe he was finally coming home. Seven weeks and 20 hours. That's a long time," said Lucas-Dixon, 52.

Juan was taken away by the Administration for Children's Services Dec. 14, after he told a school guidance counselor that he was left home alone.

ACS made a surprise visit to Lucas-Dixon's Co-op City apartment during what she said was an hour-long gap between her leaving for work and her daughter arriving to watch Juan.

Lucas-Dixon had a tearful reunion with Juan on Monday, bringing him home to a Christmas tree, stockings and presents that were still waiting for him.

He happily tore the wrapping off gifts that included several chess and checkers sets, a pair of King Kong gloves and a red bicycle.

Still, Lucas-Dixon continues to worry; she fears he will be taken away again if she can not arrange continuous child care.

ACS spokeswoman Sheila Stainback said she could not comment on specific cases, but that if a working parent cannot find child care, the agency works to "find alternative resources and help that parent make a plan to ensure the child's safety while the parent works."

ACS gave her a list of child-care providers, Lucas-Dixon said, but they were unaffordable, located in Manhattan or did not offer service that would cover her night and weekend shifts.

She makes too much money to qualify for subsidized child care.

Lucas-Dixon's dilemma is one thousands of the city's single parents and two-parent working families face, with high child care costs in a tough economy, said Mary Pulido, executive director of the New York Society for the Prevention of Cruelty to Children. She pointed out the dangers of leaving a child home alone, including poisoning or fire inside, and strangers outside.

"It's really understandable that the pressures right now, especially with a tight economy, may prompt some parents, even responsible parents, to leave a child under 12 alone," she said.

"But it can't take the place of placing a child at risk. Single parents especially need to make more of an effort to turn over every single stone to find alternatives."

But Lucas-Dixon says she is running out of stones to turn over. She is considering sending Juan to California again to live with his 29-year-old sister and her family, but said it breaks her heart to be separated from him.

Monday, February 2, 2009

Bridges to Health for foster care youth

Trauma treatment for foster kids gets reprieve: A new state program aimed at helping foster youth in the near and long term is spared the budget ax
McCormack, Lindsey. City Limits, Jan. 26, 2009.

The boy had been screaming for over an hour, and his foster mom was beginning to panic. She didn’t know what had sparked the attack, and already the neighbors were calling to complain about the noise. At this late hour, most foster parents would have no choice but to dial 911 and have the child rushed to a hospital.

Instead, the mother called one of the boy’s new caseworkers, an on-call specialist in emotional disturbances. Soon the worker arrived at her Bronx apartment, helped calm the child and put him to bed. The two women stayed up late discussing ways to help the boy beat his demons, a talk they would continue in their monthly meetings with his caseworker.

Kids who foster families find too tough to handle usually end up in institutional care—at the beginning of last year, nearly a quarter of the 26,199 children in state custody were living in group homes or specialized medical facilities. Despite an increasing emphasis on shifting care to a family setting, achieving permanency is rarely easy.

By avoiding a lengthy hospital stay, the boy and his foster mother made an important step towards stability, according to Roslyn Murov, a child psychiatrist and medical director at Abbott House, a social services agency.

Abbott House is one of 10 agencies to participate in the first year of Bridges to Health, a state program that connects children in foster care to a rich array of health services, thereby improving their chance of finding permanent homes.

The program targets children with disabilities and emotional trauma, who are at high risk of being institutionalized. “Many of our kids were already in foster homes, but their families were overwhelmed with taking care of them,” Murov said. “B2H has given us new choices for keeping kids in families.”

For the shapers of New York’s foster care system, helping children overcome emotional trauma increasingly means being there for the caretakers, too. Ten years ago, when Mimi Weber joined the policy team of the state Office of Children and Family Services (OCFS), she observed two ways the system was failing families:

First, when a foster child was adopted or returned to his birth family he would lose his Medicaid, making it more likely that recurring problems would drive him back into state custody.

Second, medical interventions tended to target the child exclusively, without taking into account the needs of adult caregivers.

Weber began consulting with the heads of child welfare agencies, pediatricians and child psychiatrists like Murov. All agreed that traditional Medicaid coverage of doctor visits and medication did not equip parents to deal with their charges’ complex problems.

According to the American Academy of Child & Adolescent Psychiatry, some 30 percent of children in foster care have severe emotional, behavioral or developmental problems, often from years of neglect or abuse by their own parents. The consequences of early abuse are so complex that psychiatrists recently coined a new term for it, "developmental trauma."

Weber describes the condition as a series of neurological gaps and tears, a condition more severe than the disorders frequently ascribed to foster kids: attention deficit, depression, anxiety, post-traumatic stress. “We think medication might be part of filling those gaps, but clearly it can’t be the only treatment,” said Weber. “We tried to think about serving the child and family in a holistic way, so the family understands how to treat the child.”

Launched during the brief Spitzer administration, Bridges to Health takes advantage of a waiver in federal Medicaid law allowing states to create community care for people with disabilities. The program started with 300 children from Rochester, Albany, and New York City, with the goal to reach 3,305 children statewide within three years.

While some children have medical conditions like cancer or HIV, and others have permanent developmental disabilities, most fall into the category of severe emotional disturbance. In New York City, 182 of the 220 children currently enrolled in Bridges to Health are there because of emotional problems, says Jodi Saitowitz, who coordinates the program at ACS.

The program revolves around an individualized health plan that caseworkers devise in collaboration with children, their foster parents, and sometimes birth parents. The health plan can include up to 14 components, ranging from socialization training to an in-school advocate. Many offerings, such as 24-hour crisis assistance and planned respite care, help parents care for disabled children over the long haul.

Critically, Bridges to Health caseworkers carry a maximum of six cases, far below the average 15 to 20 cases handled by most foster caseworkers. And because the goal is to support permanent family placement, children keep their benefits as long as they need them, up to their 21st birthday.

This mixed service model, combined with intensive home support for parents, is unique in the country. Think tanks are beginning to take notice: Weber and her team were recently invited to apply for an innovations award at Harvard’s Kennedy School of Government.

Workers involved also report promising outcomes. Saitowitz recalled the case of one woman who was on the verge of giving up her foster son after his outbursts in school forced her to leave work for days in a row. Bridges to Health arranged for a special needs advocate to model appropriate behavior for the boy in class, and helped his mom and teachers devise a progress plan. The boy was able to stay with his foster family.

“This program is about making personal connections in intimate settings, as opposed to handing parents an emergency number that connects them to some random stranger,” said Saitowitz, a former social worker. “We’ve been crying out for something like this for years.”

Such intensive services do not come cheap—Bridges to Health costs about $52,000 per child per year—but they are a bargain compared to the average $185,000 price tag for residential care. In addition, the federal government foots half the bill. Nonetheless, last August, amidst a darkening fiscal climate, the state proposed freezing the funding. “We were in disbelief,” said Weber. “The hardest part was telling families we might not be there tomorrow.”

OCFS protested that hundreds of children in the process of joining the program would have to be cut off.

“Foster children are never number one on most funders’ priorities,” said Elizabeth Schnur, senior vice president at the Jewish Child Care Association, which is the largest Bridges to Health provider in New York City. “This is the first program in a long time that came around to make a huge difference in the lives of hundreds of children.”

A lobbying effort ensued, drawing on the support of State Senator Tom Duane and Assembly Member Micah Kellner, both of Manhattan. In December the governor’s budget restored Bridges to Health funding for 610 children, the original enrollment goal for this fiscal year. For the next two fiscal years, the state will spend $61 million on the program; assuming the fiscal situation improves, enrollment will resume sometime in 2011. The goal of reaching 3,305 children is now set for 2013, costing approximately $84 million.

Even if that goal remains steady—and the state’s budget health seems to decline every month—it falls short of the total need. Weber estimates that there are about 9,000 disabled foster children in New York who could qualify for the program. While service providers say they are grateful for the reinstated state support, Kellner and Duane continue to push for broader funding for up to 10,000 slots.

“We can’t afford to leave the most at-risk kids out in the cold,” says Kellner. “It’s better to spend the money to help these kids now, as opposed to condemning them to a lifetime of isolation and institutionalization.”