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Category: Social Services
The other day I met up with a woman I have known for more than 30 years. I do not have a word for our relationship. Friend? No, although I do love her dearly. Caseworker? Not anymore, as that chapter of our story has closed. Relation? Colleague? Not quite.
I had called her for a favor. I’m making a movie about child welfare, and I needed someone to explain to the film director what it feels like to have a caseworker come into your home armed with the threat of separating you from your children.
First, though, we talked about what it feels like to be a mom. Having one and being one are drastically different experiences. Your firstborn crashes you into a new intimacy. The little one responds to your smell and your voice. Feeding him is the joy of a lifetime; you and you alone are keeping this beloved little being alive. We each found, inside us, a mother bear with a ferociousness we did not know we had. The need to be near our baby was desperate. We both theorize this is a thing only mothers know, and we agree that having a child restructured our sense of self. It gave us the profound understanding that the only reason we are on this earth is to care for this little person.
Next comes a part of our story that is harder for us to revisit.
When we first met, it was the early 1990s in Chicago. She had six beautiful children, four of whom were under the age of six. I was her child welfare caseworker, part of a team dispatched to families in an effort to keep their children out of foster care.
She had a lease in public housing and lived in the high rises in the Robert Taylor Homes and, later, Cabrini Green. We both recall a bleak landscape — as if the earth around brutalist buildings had been worn to a nub.
Rats as big as raccoons roaming the halls. Piss-filled elevators that were broken half the time anyway (which was great when you have six kids, a month of groceries, and a unit on the 14th floor). Radiant heat that came up through the floors, with some kind of maniacal thermostat that had the units sweltering in February. Cinderblock walls where even the best tape could not get a drawing to stick. Addicts everywhere with their dope fiend version of crazy. The constant threat of gun violence. Often, being pinned for hours in the apartment until the shooting stopped.
Like most caseworkers, I was young, eager, and well meaning. Despite never having parented, I was taught that I could discern the most vital of questions about a family: does a child belong there? The method of answering that question was to enter the family sphere — at my whim and without advance notice — to observe, inquire and interpret behavior. I was the most dangerous of combinations: bold and ignorant.
Back then, she was embroiled in heroin addiction, an unrelentingly selfish and demanding drug. This had typical byproducts: premature infants failing to thrive, very young children left at home without adult supervision, missed doctor’s appointments, poor school attendance, meager food in the house…. I thought the problem was she did not understand and went about helping her solve those problems with zeal.
When we sat together to talk, there were tears and laughter as we pulled from the depths of our memory and joined the two halves of our story. We recalled the craziness of a house with all those young children. The particular challenge of managing two of them, impossible boys, with their father’s hard blood running through their veins.
The time I saw her four-year-old walking down 41st Street on his own and we realized he had learned the bus routes. (He would exit the craziness of the house unnoticed, then at the bus stop get some stranger boarding the bus to hold his hand and slip on unnoticed to take himself to Grandma’s house.)
The time I came over to find the five-year-old had put a rubber band on his two-year-old brother’s wrist. It was constricting blood flow, and his hand was swelling. But there was so much yelling in the house no one heard his wails. We scrambled to find scissors.
The worry with which we tracked her baby girl’s feeding schedule, praying every day that she would gain weight. The way I would just pop up in public housing as if I were normal and belonged there. How I would often visit just as she was getting high, making her irritated that she had to put all her paraphernalia up until I left.
The flowered couch on which we sat the first time she trusted me and shared that her children’s father was beating the children and had choked her unconscious the previous evening. How mad she was at me when I selected for her an inpatient treatment facility that was out in the country.
The day I took her children from her. The crushing feeling of knowing her newborn daughter would not know her.
That last one is a bitter memory, so we were quiet for a while.
Then she told me the story of her son’s recent, untimely death and the arrival of grandchildren on her doorstep. She was given custody, and the state child welfare agency showed up again. They count now 35 reports to child welfare that allege she is abusing or neglecting her children. That’s when I realized that while my part of the story ended, hers has continued.
Child welfare never left.
She talked about the array of investigators she has known over the past three decades. They treated her like she was stupid because she was uneducated. They spoke to her as if she were incapable. They were always telling her what to do without understanding the context she was in. They came in with all the power and ran roughshod over her house.
By inserting someone who didn’t belong, it disrupted her ability to parent her children. She sees the child welfare system now as the enemy of families, there with the explicit purpose of doing damage. All the while, individual investigators wear convenient blinders, so they do not see themselves as a part of the problem.
From her perspective, it was the visits from caseworkers that tipped her addiction. Caseworker visits were so overwhelming that she turned to her drug of choice for relief. That’s how it works, of course; all addicts are simply seeking relief. By making the stress level intolerable, we threw her into all-encompassing addiction and then “solved” the problem we created by dissecting the family. Which is to say: we thought we were solving a problem when, actually, we were creating it. She and I can run the list of her beautiful children and name the damage it did.
Taking the long view, she is an unusual success story. After losing all her children to foster care, she fought her way back and got them home, one by one. It took years of labor, and the credit for success is hers alone. This weekend she’ll celebrate 28 years sober. She plans to open a home for women who are struggling with domestic violence and addiction — a haven like the one she needed when she was in their shoes.
She says if caseworkers could just come in open to understanding and ask simple questions. “What, in your opinion, is the problem that needs solving?” And “how can I help?” She feels sure that kind of intervention would be more likely to keep families together.
I concede to her that if I could turn back the clock, I’d like to think I would have done things differently. If so, we might have avoided so much of the damage we did. She is gracious and full in her strength of recovery, interpreting the events as critical to her healing journey. Without them, from her perspective, she might not have kicked her habit.
I am less sure. I am not certain the outcome could have been averted, if for no other reason than we arrived at her doorstep so late in the cycle. We began already too far downstream to achieve what we had hoped.
It does leave me more desperate to alter child welfare at its very core. As an industry, we presume a new policy or practice model is the first step. I wonder now if a place to start is a more personal reframe.
Instead of training caseworkers to wield power that most of them are far too inexperienced to manage, we could open their minds to the human condition. It would go something like this: not everyone gets a fair shake in life. You have the chance to stand next to someone who is struggling and see the world from their perspective. If you get it right, you might help them see choices they can make that will ease their burden.
Until then, the movie we make will have her fingerprints all over it. Maybe it’s a start.
https://ssir.org/articles/entry/from_family_data_to_neighborhood_outcomes
From the Stanford Social Innovation Review, November 2016.
By offering better early support for struggling families, child welfare services can reduce the need for more serious interventions down the line and improve the wellbeing of whole neighborhoods.
When I became director at the Baltimore City Department of Social Services in 2008, it was among the most troubled agencies of its kind in the country. The department serves low-income and vulnerable citizens and oversees services including child protection and foster care. When I started, all of the things we worry most about in child welfare services were true: The agency struggled to keep track of its children, a large share of children were living in group homes, children lingered in foster care for years, or even their entire childhood, and some were suffering injury and dying while in foster care. I am proud to say we were able to turn those statistics around. Robust and sustained reform led to a 70 percent reduction in the number of children in foster care over a seven-year period. We accomplished this feat through an unwavering focus on mission, by developing the ability to use data to drive decision-making, and by building a discipline around completing tasks. You can hear more about this dramatic success in my 2014 TEDx Baltimore talk.
When we had achieved measurable success, though, the dust settled and revealed a larger set of problems that I had not anticipated. In short, I saw that if what we intended was to make the world a better place, then we were deploying the wrong intervention. My department was intervening after a family had already become highly unstable, meaning that by the time we arrived, we were left with no other option than to remove a child from their parents. This invariably led to more problems moving forward. A childhood spent outside the boundaries of a permanent family can make it harder for children to forge healthy relationships or mature into pro-social adults. I continue to believe that the concept of separating a child from their family is in error and that it should be used in the rarest of circumstances. At the same time, we can’t very well leave children in peril. So how can we intervene to avoid having to remove kids from families?
Fortunately, we have at our disposal an extraordinary amount of data to inform our answer. Imagine that a family’s stability could be graphed over time. Most families are doing fine. In all families, bad things sometimes happen: the car is totaled, someone gets seriously ill, or someone dies. Most families are able to immediately respond in a way that avoids disaster. They rent a car or take sick time or someone brings over a casserole. But some families aren’t able to respond this way, and so their level of stability plummets. Instability brings on all the really bad stuff: evictions, addiction, domestic violence, abuse, and neglect.
The longer that instability lasts, the harder it is for a family to rise back up. At that point, placing children in foster care may be the only option available to us. But what these families really need is intervention at the top of the curve—when they are beginning to struggle but are still relatively stable, and when the intervention wouldn’t involve breaking up families.
We can shift the point of intervention by focusing on data points that provide child welfare services much earlier indicators that a family is struggling. Chronic absenteeism from school in young children, arrests in early adolescence, the electricity being cut off, children appearing in ERs for psychiatric interventions, and families arriving at homeless shelters are all great examples of data that indicate earlier moments when milder interventions might be able to stave off the dissection of a family unit. By arriving early in the trajectory, we can help support vulnerable families as they respond to misfortune.
Efforts of this nature by my department have shown early signs of success in Baltimore. Under cautious and thoughtfully crafted agreements, we are privy to information from partners, such as public schools, about families that are showing early signs of distress. We can then intervene with methods designed to turn a family’s trajectory in a positive direction. Child welfare caseworkers can engage a family while their children are still at home and provide coaching, connections to community resources, access to treatment, and a steady presence in sometimes chaotic households. Because they arrive at the earliest signs of trouble, they are able to offer support long before things have gotten so bad that we have to send in a child protection investigator. Using this approach, we are able to create partnerships that support family stability and avoid separating a child from their parents.
This is important work. But the fact is that even when we get good at it, we’ll still be moving too slowly if we remain tied to a model of child welfare that manages one case at a time and defines positive outcomes only in terms of individual children. This approach ignores broader demographic trends in many struggling parts of urban America. In Baltimore, like most cities, a subset of neighborhoods post awful outcomes across the spectrum of predictors of family stability. One particular Baltimore neighborhood is the source of almost 40 percent of the reports of child abuse that come to my organization each year. Were you to drive through the area you would clearly see chronic unemployment, vacant housing, rampant substance abuse, a general lack of community resources, and the constant threat of violence. It seems painfully obvious that the factors that contribute to instability occur not in the privacy of individual households, but across entire neighborhoods. And yet we wait for the call, intervening family by family and failing to notice that our efforts are not producing a net effect on the community.
As an alternative, we could start by taking a broader frame of reference. For instance, we could map a particular neighborhood using three years of data for what we call a child’s “home of origin,” the address where a child lived when we took them from their parents. We could analyze this data less to see the specifics of individual homes and more to look for patterns. We might notice that a significant portion of the children who came to the agency’s attention were infants who were injured after having been shaken. We might then theorize that there is an insufficient amount of information in the neighborhood about the dangers of shaking a baby and about what one could do when their newborn will not stop crying. Those insights, which are uniquely available to child welfare services, could inform the decisions of neighborhood leaders: what the preacher might say from the pulpit, what the pediatrician might say at the well-baby visit, what the principal might send home in the backpack. Using data in this way can enable social services to flood the neighborhood with the kind of information and support that would allow vulnerable families to make course adjustments when needed.
These choices would mean that child welfare departments could continue to do the important work of managing individual cases, but with critical insights that could help direct our work at the neighborhood level. Combined, these efforts might actually lead to the net effect that I believe we all hope for.
This shift in approach will be an enormous challenge, largely because the way we measure success in child welfare systems now is by counting negative outcomes such as reports of abuse and neglect, the number of children in foster care, and the number of children who cannot return to their own families. A better approach would ask that we consider additional ways of measuring performance and the possibility that the absence of a negative outcome is itself a positive. Fewer reports of abuse and neglect, fewer children in foster care, and fewer adoptions—if due at least in part to the choice to intervene with families earlier—would actually represent better outcomes because we would have kept more children safe at home with their own families. It will be challenging to learn to see the absence of these negative statistics as a measure of success, but it’s a challenge worth pursuing.
June 2013
What does help really look like in a service environment? There are two places to look: the servant and the recipient. Traditionally, the servant’s role is to help the recipient How can we tell the difference between something that helps the recipient and something that protects the role of the servant?
Beware social service programs that blame their performance on their intended recipients. For instance: GED programs report the cause of their 40% success rate on the students who drop out or don’t attend. I suppose one option is that there is something wrong with the people. An alternative option that deserves exploration is that there is something wrong with the program.
This conclusion offers a nuanced view of programs. Programs actually have two purposes: help the recipient and protect the role of the servant.
Servants are good hearted people who are considered selfless in their choices to build a career or pattern of volunteer work off of helping. These good hearted people design or select roles for themselves because the honestly intend to be helpful. The way they identify who needs help is through a sense of feeling sorry for a particular population. Abused children, drug addicts, the homeless, poor people…. They take this sincere feeling and build programs around it designed to help. They keep programs going by returning to their sense of feeling sorry for people. They want to help and the way the know they are being helpful is this persistent sense of feeling sorry for people. If I maintain this feeling then I can easily identify those who need help and keep helping.
The challenge is that I don’t think you can have both. I don’t think you can maintain the sense of feeling sorry for someone and also help them. I think many servants are actually leveraging their helping activities in order to maintain their sense of feeling sorry for people.
If what I want to do is help, and I do it by maintaining my sense of feeling sorry for poor people, then I — either consciously or sub-consciously — make decisions that ensure my programs or services sound like very good ideas but in implementation miss important details. They miss the very details that ensure the poor person will fall short of success — and I? I will get that familiar feeling that affirms my existence. I will feel sorry for them. And I will keep trying to help.
Over-rides my interest in actually helping someone.
Its difficult then to tell the difference between things that actually help and things that serve my interest in “helping”.
Until I seek something else — say, liberation for another person — I will keep “helping”. Lucky for me, that will ensure plenty of people for whom I can feel sorry. Liberate them from whom? Why, from me, of course.
