Category Archives: Foster Care

Help a Child’s Dream Live On

Every so often, I find a story that really touches me in the news.  One that isn’t full of violence, destruction or hatred. Although the story of Matthew McIntyr’s wish to help adopted children, like himself, is not the one that his family would have necessarily written since Matthew passed away at age 9 last June; they are doing all they can to make his wish of helping other children in need of adoption a reality.

The McIntyre family of Cranston adopted Matthew, a former resident of Boys Town in Portsmouth, RI, in 2003.   He had been abused as a small child and through Boys Town he became a member of the McIntyre family.  After he passed away in June 2008, his family established the Matthew McIntyre Memorial Fund to assist children like him who are placed at Boys Town and hope to make the transition to a family of their own.

The Fund’s first event will be held Friday, February 27 at 6:30pm at the West Valley Inn and the money raised at the dinner will assist Boys Town to provide the opportunity for children to experience recreational, educational and other activities that fall outside of the Portsmouth facility’s budget.

For more information about the Fund or to reserve tickets for Friday’s dinner, please visit http://www.MatthewMcIntyreMemorial.com or contact Denise or Paul McIntyre at 828-0001.

E-Prescribing: What is it and Why you should Care

E-prescribing is a method by which we could improve patient care. E-prescribing helps to improve safety in prescribing many ways, as described here. One important way it helps is by eliminating the illegibility problem of many doctors’ handwriting. It also helps by providing a warning and alert system at the point of prescribing with the most updated information about a drug, thus helping to stop the filling of a prescription that may be unsafe.

Sen. Whitehouse will be chairing hearings on this subject tomorrow in Washington, D.C. From the Whitehouse press office:

Washington, D.C. – U.S. Senator Sheldon Whitehouse (D-R.I.) will chair a Senate hearing next week to explore a major barrier to improved health outcomes and cost savings in the health care system – the federal prohibition on electronic prescribing of controlled substances.

While e-prescribing could reduce adverse drug events, increase adherence to prescription regimens, and save billions of dollars each year, federal regulations still require paper prescriptions for controlled substances often used to treat attention-deficit disorder, anxiety, pain, and other ailments. This requirement means that many doctors default to writing all prescriptions by hand, rather than maintaining two systems.

Whitehouse and the Senate Judiciary Committee will hear from federal regulators and health information technology experts on the progress of rule-making in this area and the potential benefits and challenges of an e-prescribing system for controlled substances.

EVENT: Sheldon Whitehouse Chairs Senate Judiciary Committee Hearing on “Electronic Prescribing of Controlled Substances: Addressing Health Care and Law Enforcement Priorities�

WHEN: Tuesday, December 4th

10 a.m.

WHERE: Dirksen Senate Office Building Room 226

Washington, D.C.

Witnesses at the Washington, D.C. event will include Laura Adams, President and CEO of the Rhode Island Quality Institute, an organization Whitehouse founded that is a leader in the state’s efforts to improve health care quality and health information technology utilization.

Whitehouse served as U.S. Attorney for the District of Rhode Island from 1994-98 and as the state’s Attorney General from 1999-2003. A longtime supporter of health information technology, he has introduced Senate legislation to establish a private, non-profit corporation tasked with developing a national, interoperable, secure health IT system (S. 1455).

While I am all in favor of better accuracy in prescription writing and filling, and believe that there is merit in public health tracking the use of prescriptions in order to see how safe and effective they are, a couple of major categories of concern come to mind right away:

1) Confidentiality — Will this make electronic information about patient pharmaceutical use more available to third parties? How would fraud be prevented?

2) Corporate Influence — Will this increase corporate influence from the pharmaceutical industry on people’s lives?

These are broad questions — probably not really answerable by anyone, but meant to provoke thought and discussion as e-prescribing moves forward.

Greg Hessoin, JD, Writes About Medicating Children

This is an interesting article. It’s one-sided, providing mainly the opinions of Dr. Peter Breggin and Kevin Hall of the Citizens Commission on Human Rights, both of whom see little or no value in prescribing psychiatric medications to children. It’s important to remember that there are lots of parents out there and adults with psychiatric diagnoses who will swear by their medications as helping them to function better. And I’m not sure I share Mr. Hessoin’s opinion expressed in his final paragraph that teaching children about God is the answer. While religion and spirituality can bring comfort, focus, and satisfaction for some, it is not the prescription for everybody.

In any case, though, I sympathize with this lawyer’s plight in trying to defend a parent whose child is in state custody and who does not want their child on psychiatric medications. The youngster here is a 6-year-old boy who is reportedly on “Risperdal, Concerta, and Seroquel, plus the stimulant Clonidine and the anti-anxiety drug Klonopin.” I also sympathize with the residential facility or foster home that is trying to care for this child while giving him 5 medications a day. From Mr. Hessoin’s article:

When you are there, standing before an actual judge, real courtroom drama feels much less exciting than what you see on TV. There is no swelling music soundtrack, no scripted performances, and no overblown oratory.

Recently, I participated in a typically dull hearing that likely ruined a life — the life of a little six-year-old mildly autistic boy. The banality of the process was in contrast with the seriousness of the outcome.

Twelve adults gathered in a small, closed courtroom to decide how many powerful, anti-psychotic drugs that the child, who is currently in the custody of the state, would be required to take. The patient did not have a voice, since he was not there. No doctor was present, but plenty of lawyers were. The little boy’s lawyer saw nothing wrong with drugging him into a stupor. As the attorney for the heartbroken mother, I spoke against the whole idea; I suggested to the court that other factors may be causing the child’s problems, and that the compulsory administration of drugs by the state was simply an excuse to avoid addressing those issues.

The verdict: the little guy would be forced to take anti-psychotic drugs Risperdal, Concerta, and Seroquel, plus the stimulant Clonidine and the anti-anxiety drug Klonopin.

This outcome begs the question of whether a six-year-old child, let alone children as young as three, can be diagnosed as psychotic. And, whether children should be drugged by potions so powerful that most of them are not approved by the FDA for use in children. [full text]

The Perils of Foster Care

Hartford Courant staff writer Charles Proctor asked child welfare professionals in Connecticut about the recent study performed by Joseph Doyle on foster children, which we posted about here. This study is being considered the first empirical evidence that children taken out of the home have more problems with teen pregnancy and illegal behavior, and also are less likely to hold jobs than those who remained in the home.

From the Hartford Courant:

[...] The study’s findings suggest that rather than pouring money into foster care systems, “we need money, we need caseworkers to go to families and provide them with services,” Doyle said.

Connecticut DCF officials said the findings affirm their support for keeping children with their families whenever possible.

But critics of the agency have seized on the study to charge that DCF is not doing enough to serve parents and families. They said the agency is more likely to pluck children out of their homes and place them in foster care than to keep them at home. And even when DCF does treat the children and parents in the home, it does not do a thorough job of evaluating families’ needs and monitoring parents to make sure that their child is safe, critics said.

Richard Wexler, executive director of the National Coalition for Child Protection Reform, a nonprofit advocacy group in Virginia, cited federal statistics compiled by his agency that suggest Connecticut removes children from homes at a higher rate than the national average.

According to an index that ranks states with the highest removal rates in 2005, Connecticut came in 24th, with 29.4 children removed for every 1,000 impoverished children in the state. The national average was 24.1.

“The Connecticut mentality can be boiled down to one sentence,” Wexler said. “Take the child and run.”

If children who might be better served with their families are instead placed into foster care, they can drain resources and attention from children who need the out-of-home treatment, Wexler said. The state should focus more money and staff on serving children and parents at home and reserve foster care for those who have an urgent need of it, such as children who face an imminent danger of abuse, he said.

“Connecticut has been constantly obsessed with thinking that the answer to every young person’s problem is an institution,” Wexler said.

Gary Kleeblatt, a DCF spokesman, said the agency has increased the number of families it serves with in-home care from about 2,800 in January 2002 to a little less than 3,700 in April 2007. Over that same period, the number of families DCF serves with out-of-home care remained about the same, from about 5,960 in January 2002 to 5,840 in April 2007. However, it spiked to about 6,600 in 2004. [full text]

I will look up the statistics on where Rhode Island ranks in terms of number of children removed from the home per thousand. In the collaborative spirit of blogging, if anyone wants to look this up and post a link to where the information is available, I would be much obliged.

In Connecticut, it looks like this study may help galvinize a stronger effort to avoid foster care whenever possible and search more thoroughly for other options. Sometimes, however, foster care is necessary.

Foster Care for Illegal Immigrant Children Criticized

Speaking of thorny issues, the issue of illegal immigrant children in the US is one that continues to be a very difficult one to get a handle on. We had a terrible situation recently in New Bedford where illegal immigrants were rounded up for deportation and their children were suddenly parentless and very afraid, as described in this article from The Projo.

The following article from The Associated Press criticizes the way the US takes illegal immigrant children into foster care. From my own perspective seeing illegal immigrant children in the foster care system in Rhode Island, it seems to me that this is not good for the children. Some of them miss their parents terribly, particularly if they are very young. In Rhode Island, some of these children are placed in shelter care for months. If they are in shelter care, often everyone around them is speaking another language. My belief is that it is less traumatizing to deport the children with the parents, if the parents are being deported, than to separate them from the parents. With older children who want to come to the US and have relatives here, I can see how the situation might be different, but I still believe the basic premise of keeping the family together should be honored. Whether they should be kept together in this country or in the country they came from is another discussion.

From the article:

BROWNSVILLE, Texas – The strip mall storefront of International Educational Services opens up into cheerful offices and classrooms decorated with American flags. Open a classroom door, and dozens of smiling children look up from their workbooks for a heavily accented group “good morning.”

The children are illegal immigrants, and all but one are from Central America. In the afternoon, they will go to foster homes, where they will live until they can be united with a “sponsor” a parent, relative or family friend within the United States.

It’s a better scenario than they would have faced in the past, when children caught crossing the border were locked up like adults. But critics say the majority will eventually fade into the nation’s illegal immigrant subculture, easily becoming lost in a maze of homeland security and social service agencies.

In fact, 68 percent of the juveniles never appear in court, according to a 2004 analysis by the Department of Homeland Security’s Office of the Inspector General. Immigration and Customs Enforcement spokesman Carl Rusnok said it was up to the sponsor to bring children to their proceedings.

“This is fraud-prone and this is an inducement to illegal immigration,” said Don Barnett, a fellow at the Washington-based Center for Immigration Studies. “There’s no question that smugglers are totally aware of this program and know how to use it.”

Barnett found that some children are being turned over to non-relatives because their blood relatives are illegal immigrants who fear being deported if they present themselves.

Smugglers are telling parents to separate from the children once they cross the Rio Grande, he said. Even if they are caught by the Border Patrol the children are all but guaranteed to be in a safe, comfortable home within a day or so and placed with a relative or friend within a few weeks or months.

The parents can meanwhile seek “voluntary departure,” which means they can leave without a deportation order on their record — which would prohibit them from entering the United States within the next 10 years and subject them to jail time if they are caught. They can then try to qualify for a visa or attempt to sneak in again.

If they were caught together, the entire family would be detained at one of the federal government’s new family facilities, such as the T. Don Hutto facility in Taylor that has been criticized for prison-like conditions. There would be no chance of avoiding removal proceedings.

Sandra De La Garza, lead case manager at the International Educational Services foster program, said she had heard of families purposely breaking up to avoid Hutto. And staffers said there was no doubt the smugglers and immigrant families knew about their agency.

Children at the Brownsville facility seemed upbeat about the whole process, saying they were happy at their temporary homes.

One, a 13-year-old from Honduras, said she thought the journey was fun.

The foster care programs emerged from the 1997 settlement of Flores vs. Reno, a class-action lawsuit against the former Immigration and Naturalization Service. The suit argued it was wrong for children caught by the Border Patrol to be treated punitively like the adults.

Under the Homeland Security Act of 2002, which abolished INS and created the Department of Homeland Security, the care and placement of illegal immigrant children was transferred to the U.S. Department of Health and Human Services. Children would fall under the purview of social service and not federal law enforcement officials.

“The government felt DHS was doing it from a legal authority perspective,” said Teresa Brooks, an Office of Refugee Resettlement official responsible for overseeing immigrant foster care programs in the Rio Grande Valley. “They’re law enforcement, and that’s the way they are.”

International Educational Services, which is a nonprofit agency, is one of more than 30 under contract with the federal Office of Refugee Resettlement.

Since January, the agency has received $5 million in federal money for two foster programs and the detention center where teens are housed a few miles away in Los Fresnos.

Foster parents are reimbursed for costs of feeding their charges and ensuring they experience “environment” — which can mean trips to parks and malls. All homes are equipped with cribs for the many teenage girls arriving with babies or in advanced pregnancy. Eventually the children will be on their way to a relative or family friend’s home — somewhere on the felt map of the United States that hangs in the agency’s hallway.

“We don’t have contact with them after that,” Brooks said. “It’s up to the sponsors to see that they attend court sessions to see if they can stay or not.”

Kathleen Walker, a longtime immigration lawyer based in El Paso, said such programs should be embraced for treating children like children rather than prisoners.

She said the government had records of every sponsor and should have no problem following up on cases.

“In this case you have citizens and legal permanent residents providing you with all kinds of information about where they are and where the person is going to be. So if there’s a problem it’s not like ICE can’t go and do something,” she said.

“I think what we’re trying to do is be humane,” she said. “Is the objection here that we want to make sure that children are behind bars and behind concertina wires?”

That’s not my objection. My objection is that children should be with their families, not in foster care.

Study Says Foster Care Worse Than Abusive Homes

In case the bad news on Rhode Island’s foster care system wasn’t enough, here’s some bad news on the foster care system in Illinois — a larger, longer-term study that may have broader implications. From USA Today:

Children whose families are investigated for abuse or neglect are likely to do better in life if they stay with their families than if they go into foster care, according to a pioneering study.

The findings intensify a vigorous debate in child welfare: whether children are better served with their families or away from them.

Kids who stayed with their families were less likely to become juvenile delinquents or teen mothers and more likely to hold jobs as young adults, says the study by Joseph Doyle, an economics professor at MIT’s Sloan School of Management who studies social policy.

“The size of the effects surprised me, because all the children come from tough families,” Doyle says. The National Science Foundation funded the study.

Doyle says his research, which tracked at least 15,000 kids from 1990 to 2002, is the largest study to look at the effects of foster care. He studied kids in Illinois because of a database there that links abuse investigations to other government records. [full text]

The news on trends in helping children is not all bad, though, as evidenced by this related story about how the number of single men adopting foster children has increased by 40%.

Substandard Foster Care in Rhode Island

This is sad stuff. When you work for over a decade in the child welfare system in Rhode Island as I have, you like to think that our system is better than most, but the painful reality is that it is not. In fact, if the statistics cited in the Child Advocate’s lawsuit against DCYF are correct, we are worse than most. I have worked with kids who have been abused in foster care and in residential programs, and as a practitioner in this field I feel a keen sense of responsibility about this. I hope that the information coming out in this lawsuit will help repair the systems so that Rhode Island can improve its ability to protect and care for children.

From the Projo:

[...] The lawsuit cited other problems, saying, “DCYF has so few foster homes that it places children in homes without licenses, depriving them of basic protections of foster parent background checks and training.� And, the suit says, “Instead of appropriately investigating and addressing abuse or neglect in foster placements, DCYF continues to rely on foster care settings known to pose a risk of harm to children.�

Guillette [executive director of the Rhode Island Foster Parents Association] said the state could help retain and recruit foster parents by increasing payments for the room and board of foster children. She said Rhode Island’s “foster care board rates� are $14.39 per day for children from birth through age 3; $13.64 per day for age 4 to 11; and $15.79 per day for age 12 and above. By comparison, the rates in Massachusetts are $17.10, $17.96 and $18.59, and the rates in Connecticut are $24.85, $25.22 and $27.42, she said. [full text]

I know some at Anchorrising.com and the head of the Rhode Island Republican party, Giovanni Cicione, complain of the strong poverty advocacy lobby in the state, but when I read statistics like those above, it seems to me that our poverty advocacy lobby is not strong enough. Why are we paying a much lower rate than Connecticut and Massachusetts?

Each year, a bill is introduced to raise the rates in Rhode Island, and each year the bill dies in committee, Guillette said.

So our General Assembly is not willing to give any increase to foster families, but some salaries at DCYF have gone up by 29% in the past six years? This is not right. Support needs to get to the front lines to help kids — the money to take care of the child, the money to train the foster family, the money for staff to supervise and support the family. Please, Rhode Island. With our resources, we should be able to protect kids better than Alabama and Mississippi.

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