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Keeping Families Together

Home visits help parents become their baby's best early teachers Credit: Courtesy of Parents as Teachers

An elderly mother describes how in 1942, doctors who were treating her baby’s serious rash quarantined him in a hospital. Teddy had good medical care, but she was allowed to see him only occasionally. Originally a responsive infant who loved being cuddled, she says, her baby boy became aloof and distant as time went on.

When Teddy finally came home after several months he was lethargic and withdrawn, and had completely lost interest in people, including her. “All [the doctors] could see were the physical problems,” says the mother. “I don’t think there was much research on how babies feel about things.”

There is now.

Scared Sick, the new book for which the above videotaped interview serves as an online promotional trailer, traces connections between chronic fear in childhood and its consequences in adult life. The book draws on the Adverse Childhood Experiences (ACE) Study. This groundbreaking research showed that the bodies and brains of children who live with constant fear and loss are neurochemically altered. Later in life, they are prone to learning disorders, social and behavioral problems, chronic depression and physical ailments such as cancer, heart disease, obesity and diabetes, despite making healthy lifestyle choices.

Growing knowledge about the long-term effects of childhood trauma and the importance of relationships is changing the foster care system. Today, more and more families who are reported for child abuse or neglect are staying intact, as long as officials determine that the children’s safety is not at high risk. Instead of removing the kids, child welfare professionals and community groups are providing families with critical support services such as job training or mental health treatment, and coaching them in parenting techniques.

Such family-centric goals and approaches aren’t wholly new to child welfare in Washington State. For example, a Kirkland teen who ran away from home after a fist-fight with his father was quickly reunited with his family once child welfare professionals gave the father, who had been struggling to keep a rebellious kid in line, some better parenting strategies. And though a decade ago a drug-addicted mother would have lost her child, today there are rehabilitation facilities that let that mother keep her child while she’s in treatment.

But soon these kinds of research-based child welfare strategies for preserving families in crisis will systematically govern policy and daily practice throughout the state. In January 2014, the state’s Department of Social & Health Services will launch a “differential response” program called FAR (Family Assessment Response) at the first of 12 of its Children’s Administration offices in regions across Washington. There are dozens of groups and organizations developing birth-family-centered approaches for families reported to the state's foster care system. But due to its wide geographical reach FAR, in particular, promises to make a major impact.

FAR is an alternative to the investigations carried out by the DSHS's Child Protective Services group (CPS), which often end in children being removed from their homes. CPS investigators will still pursue all cases of sexual abuse and severe physical abuse or neglect. But in cases determined to be low-risk, assessment workers from the Children’s Administration (CA) will focus on helping the family, rather than breaking it up.

FAR "isn't just social workers telling parents 'You can’t let your kid run around in dirty diapers for seven hours,'” says Jennifer Strus, CA’s acting secretary. Strus came to DSHS early this year after 14 years on the staff of the state legislature, most recently as senior staff coordinator and counsel for the committee on human services and corrections. If financial and related hardships were what drove shaky parents to mistreat their kids, she continues, “FAR might provide a utility payment to families whose electricity was shut off, or seek affordable housing for them if they couldn’t pay the rent.”

In the process, the family will be connected with community providers for future support. To Strus, 57, an attorney by training, building community networks is “most critical.” When the agency eventually withdraws from a stabilized case, it will leave behind “a support system for that family, in their neighborhood." If the family runs into trouble again, says Strus, "they don’t have to get re-referred to us."

The goal of FAR is to reduce the number of children who are referred to, re-referred to and kept in foster care. That will shrink the huge social and financial costs of the system. But research has shown that FAR-like programs have done more than save money in other states; they have improved children’s future prospects and made them safer in the present. For one thing, says Strus, people are more likely to call CPS “if they think they’re calling to get a neighbor or family member help instead of ratting them out.”

Infants and toddlers still need more specialized interventions. These little ones form the largest group entering or staying in foster care (36 percent of the approximately 10,000 foster kids in the state). They're also the least likely to rejoin their birth parents, and this separation inflicts permanent wounds.

From 2008 through 2011, the Center for Children & Youth Justice (CCYJ) led an innovative project in south King County called Supporting Early Connections (SEC). It was designed to help children up to age 3 who were enmeshed in child welfare cases to strengthen the emotional and physical bonds with their biological parents. Even parents who would never be allowed to regain custody were invited to participate in this voluntary program.

The purpose of SEC was to build a foundation of trust and a capacity for relationships in babies and toddlers. This would give them a chance at future success in school and society. Fathers and mothers involved in child welfare court cases in Kent, Wash., spent regular time, preferably in the home, with their youngest children in the company of child mental health specialists from Navos, a mental health services organization in King County.

Navos staffers trained in Child Parent Psychotherapy (CPP) taught parents nurturing behaviors like holding their children, looking into their eyes, smiling at them and talking to them. Parents accused of serious abuse or neglect had clearly never seen their own mothers or fathers act in such ways, which most people consider natural. “We parent unconsciously,” explains SEC project coordinator Kelly Warner-King. Good or bad, we do “what we learned to do in the past.”

So CPP isn’t just about parenting skills, she says, “it’s unearthing some of that [past]." The program required exceptional deftness from Navos staff. Participating mothers and fathers were often defensive, having been told by the child welfare system that they’re bad parents.

Children from the SEC project who have some additional emotional support as they grow up may, as adults, be able to break the damaging intergenerational cycle and raise healthier offspring. And if SEC participants who lose custody of a child have children in the future, "they have a better sense of what kids need,” says Warner-King.

Most important, the mental health of the children in the program improved. They arrived with serious sleeping and eating disorders, were inconsolably fretful or apathetic and withdrawn. After going through the program, the symptoms diminished, regardless of whether the kids went back to their families or to foster families.

The SEC program succeeded by focusing the sharply separate domains of child welfare, courts and community mental health on the well-being of the littlest kids. It was a first-time collaboration in which judges, attorneys and DSHS workers got training in the mental health of infants and toddlers, and met regularly to strategize. For court and social workers, the approach of repairing the child’s relationship with the abuser was "eye-opening,” says Warner-King.

CCYJ's CEO and founder, Justice Bobbe J. Bridge (retired), explains that safety had long ago eclipsed other legal and child welfare concerns. “But we know so much now from the neuroscience that we can’t ignore,” she says. “We can’t assume that if a child is [unharmed and] diapered and fed, it will be enough to develop and live successfully and be able to learn.”

Now the challenge is to keep the project going, says Bridge, because “judges turn over; advocates and social workers change.” Trainings in south King County need to continue, and the hope is to expand the project countywide and beyond, into Central Washington and the Spokane area.

As for Teddy, the infant who was separated from his mother back in 1942? He became one of America’s most notorious criminals. We can't be sure that being separated from his mother and tended by revolving teams of well-meaning strangers during his early months led the once sociable baby to become a murderer later in life. But the video interview with the mother of Unabomber Ted Kaczynski is chilling.

The strong statistical link between childhood suffering and adult crime drives the child- and family-centered work of many nonprofits. The name of one national organization could serve as a mantra for anyone who needs pragmatic as well as ethical motivations to work hard for the well-being of children: Fight Crime: Invest in Kids.

The Kids at Risk series is made possible by a grant from Ballmer Family Giving. Go here for Crosscut's complete Kids at Risk coverage. Tricycle photo courtesy of ….Tim/Flickr.

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