Guest Post: Letter to the Governor’s Task Force on the Protection of Children from Dr. Anne Gearity

Thank you for asking for community comments. As a mental health provider, I have long struggled with what seems to be an eroding commitment to at risk children. Recent investigative reporting by the Star Tribune has highlighted specific problems with child protective service. While comments from the Task Force suggest you are focusing on investigation, there is another aspect that demands attention: attending to the needs of traumatized children.

The child protection system was constructed to protect children, but the focus has shifted to investigating adult behavior—often with little attention to damage to
the parent/child relationship or to the profound effects on children. The recently reported cases of Eric Dean and Kendrea Johnson tragically illustrate two different crises: when investigation fails to recognize serious harm and how children are negatively impacted by placement away from family. I want to address the second crisis: the impact on children of placement away from family.

Children placed in alternative care experience a trauma; many feel acute stress and some actually meet criteria for post traumatic stress disorder. Even when professionals rescue children from dangerous situations, the child’s perception may be different. For many children, danger has become familiar, even managed; what they experience as traumatic is the loss of caretakers and daily life as they know it. Older children have some ability to recognize complicated realities: I love my parent but she/ he cannot keep me safe right now. But young children do not have capacity for such appraisal.

Children under six are more surprised and aggrieved by disruption, and struggle to understand what is happening. Young children communicate distress through behavior, changes in routines, sensory sensitivities, shifts in mood and are often harder to understand because they cannot speak their needs, or voice their worries. Young children often blame themselves for this loss, or express their confusion and sadness with behaviors that are interpreted as naughty or angry. They need adults to pay attention, to explain and console. They also need adult company to regain emotional stability and re-set arousal reactivity that results from trauma and stress.

Many young children in placement do not have these necessary supportive services to mediate the negative effects of out of home placement. Assuming foster parents are enough is shortsighted; foster parents are generous with their homes but are usually unprepared for very vulnerable children, are caring for multiple children and have limited expertise in trauma-informed care.

But we must keep children feeling safe. There are changes that I believe can better protect children, changes which are not prohibitively expensive but do require leaders in the child welfare system to make a significant shift in how they view child protection and their role. At the core of this shift is the insistence that all professionals in this system be knowledgable about child development, especially about how stress and trauma effects are expressed, and be willing to engage actively with children to meet their psychological needs.

• Identify a protective coordinator for each child in the child welfare system. When children are no longer with their parents, their care becomes a patchwork of adults: investigators, child welfare workers, foster parents, relatives, mental health providers, teachers. Too often the patchwork is frayed and the child’s needs are misunderstood or distorted. A protective coordinator would be the replacement caretaker/guardian while the child is in care, charged with understanding how the child is struggling, accessing assessments, and assuring effective and congruent interventions that target stability. This role must belong to CPS; while services can be brokered out, coordination cannot be.
• Case loads for workers in charge of children in placement must be reduced. The job of the protective coordinator requires time and attention to how a child is managing this major change. In the Kendrea Johnson case, the worker reported his caseload was too large to permit him to make frequent contact with her or to know her actual diagnoses and treatment needs, which included “suicidal ideation seven days a week” (StarTribune, 1/18/15). CPS supervisors must also have time and knowledge to support their staff in this role; providing supervision that is administrative (adhering to regulations) or forensic (collecting evidence) is not enough. Supervisors must assist the protective coordinator to organize a working formulation about each child in care that assures identification of risk and coordination of services.
• CPS professionals must be trained to understand the effects of stress and trauma on children, as well as the meaning of mental health diagnoses on development and coping. When care is compartmentalized, critical information is lost or ignored. Kendrea’s case worker assumed she had ADHD and Oppositional Defiant Disorder because he relied on behavioral observations, but mental health assessment identified post traumatic stress and acute adjustment difficulties including a clear description of depressive symptoms. Without the lens of trauma and mental health vulnerability, she was identified as angry and defiant instead of aggrieved and despondent. This mistake cannot be repeated for other children.
• Mental health interventions must be coordinated with CPS case planning. Mental health interventions are tools, not cures. Sending a child to therapy is never enough; therapy helps responsible adults understand children’s needs outside of the therapy contact. Mental health assessment identifies critical vulnerabilities and provides guidance for care. Treatment must be coordinated with CPS case planning; changes in visitation, access to family, decisions about custody must be integrated into the mental health work. Mental health services must know about all experiences that impact children’s stability. The mental health clinician can help the child cope and adapt to changes but only if they are informed; too often the mental health provider is out of the information loop or finds out from foster parents about significant changes. This lack of coordination and collaboration defeats mental health care for the child and suggests disrespect from the CPS worker about the very services they have identified to provide the needed support.
• Even when children cannot be with their parents or extended families, they need help staying in contact. Most children ache for their parents, even when protective care is because of abuse. Coping is compromised when children feel deprived of parent access without knowing why, but stability is supported when children know what is happening, and can have ongoing access to parents or extended family. Judge Mark Ireland of Ramsey County Court has been piloting ways to support children in the first 48 hours of placement. Students and faculty at William Mitchell College of Law are working to define child-sensitive visitation access for very young children. Both these efforts demonstrate sensitivity to young children’s needs and solutions that could be beneficial to the child in care.
• CPS interventions must improve parents’ understanding of their children’s developmental needs. When maltreatment is repeated and intentional, the system must act quickly to prevent harm. But most parents identified as maltreating act out of ignorance, lack of resources, or mental health difficulties. They need help knowing their own children’s needs (not generic parenting classes). Many maltreating parents suffer from their own traumatic childhoods, causing them to be blind to their children’s struggles. When CPS workers provide specific insights about children, there is increased motivation to change. The intention of family assessment was to voluntarily engaging families but failed when the focus drifted from children’s needs.
• Wellbeing must be as important as safety and permanence within the child protection system. Recovery from out-of-home placement is made harder when CPS interventions leave the child feeling abandoned, unprotected or neglected. If reunification happens, CPS must return children who are healthier, not more stressed. If relinquishing parents is the outcome, children need help and resources to manage the intense sadness and to trust that other adults can be reliable. Poor care in placement becomes a second trauma, often experienced as more damaging than the first.

To reduce child abuse and neglect, children need to feel as protected as possible when they are in the community’s care. Without concerted efforts to know and understand children—and sensitive interventions that buffer children when they are stressed—we are not protecting children but adding to their vulnerabilities now and as they grow. We need a new paradigm that integrates all we know about children, stress, trauma, and parenting because many maltreating parents are also survivors of the child welfare system.

In closing I reiterate: as a mental health provider, but also as a faculty teaching child welfare staff, I can attest to our depleted system. Helping children should be enjoyable work, even when it is challenging and sometimes painful. I see very little enjoyment among the child welfare professionals I meet. I do see commitment but often this is paired with low morale and insecurity that they will be effective. This system of supporting the welfare of children is not the exclusive domain of child protection: we all have a stake and have contributions to make. But when CPS professionals become isolated, disconnected from children’s needs and dismissive of collaboration, children and families suffer.

I hope your efforts can initiate a movement towards genuine change in how child protection is understood and delivered.

Anne R. Gearity, PhD, LICSW
Independent practice: mental health
Faculty: U of MN School of Social Work, Child Psychiatry, Infant and Early Childhood Mental Health training program (including child welfare cohorts) Community consultant