State under the gun on broken foster care system

The case of seven-year-old Ricky Holland in Michigan gained national attention in 2005 when the boy's adoptive parents claimed he went missing from their Williamston home, near Lansing. The community spent months looking for Ricky, even landing the effort on an episode of "America's Most Wanted." In the end, it was his adoptive parents, Tim and Lisa Holland, who murdered Ricky, with the woman who was supposed to be his mother hitting him with a hammer and his adoptive father, Tim Holland, hiding the child's body in a swamp.

Making matters worse, state records showed the Michigan Department of Health and Human Services (MDHHS) had been alerted to ongoing abuse that Ricky had been suffering, but failed to take any action.

"Beginning at age three, Ricky endured five years of terror at the hands of foster parents who were approved by MDHHS, first as foster care providers and then as adoptive parents. He was denied food, tied to his bed, led around on a leash, locked in a basement, beaten with a hammer and ultimately killed by his adoptive mother," Cathy R. Crabtree wrote in a 2008 review of MDHS management. "Even though an allegation of abuse was called into MDHHS, Ricky's MDHHS caseworker 'never spoke with Ricky's therapist.' The caseworker had other cases and didn't have time. He later said he was getting four or five new cases a week and his ongoing caseload stood at more than 20. Had the worker met the therapist, he would have learned 'Ricky was opening up more.'.., talking about "Mr. Bloody Bones" who locked him in the basement for a time out. Then he told the therapist in a February 28 session that he was no longer being tied to the bed, saying, 'mom and I promised I will stay in bed and she won't tie me to it.'

"Ricky was beaten to death by his adoptive mother when he was eight-years-old. His adoptive father threw Ricky's body in a pond. MDHHS failed this child by overlooking the severe and continued abuse that was right in front of them."

Foster care systems are intended to remove children from abusive or neglectful homes until issues with birth parents can be addressed or those parents' rights are severed and an adoptive family can be located to raise the child in a stable and loving home. However, stories of reunification or placement of a child who was a victim of such circumstances are often overshadowed by heartbreaking stories of children being shuffled around from situations that go from bad to worse.

Such tragic stories can lead adults both inside and outside of the foster care system to give up all together. In Michigan, Ricky's Holland's death and those of others before him were just one of the factors that led to a class action lawsuit against Michigan's DHHS and federal oversight of the state's foster care system, starting in 2008. While federal monitors say the state has made great improvements in the foster care system, issues remain. Further, some worry that the opioid crisis that is gripping the nation and the state may lead to more children entering the foster care system, which is still struggling to meet goals set out as a result of the court case.

"I think there are always going to be issues. I don't think this is a system that will ever be totally fixed because we are dealing with humans," said Judy Wollack, president of the Association of Accredited Child and Family Agencies, which advocates at the state level for the needs of abused and neglected children. "As a side note, the opioid crisis is going to affect us greatly. We are already seeing more children coming in. If a child comes in for abuse, you can send a parent to therapy and training, and that may work. But opioid addiction isn't easily fixed."

In Michigan, reforms in the foster care system have helped to reduce the number of children in foster care by reuniting them with their parents or by increasing the number of adoptions. For instance, from 2005 to 2016, the number of children in foster care in Michigan dropped from about 20,000 to just more than 11,000 in 2016, with reductions each year. However, that number is slowly increasing, with about 13,000 children currently in the foster care system.

"My people are telling me we are seeing more children (from parents with opioid issues), especially younger children," Wollack said. "So that again, do we really want them caring for those children? We may need to think about how we have to deal with this opioid crisis. There are mandates on how long children can be in foster care, but if you have a drug addicted parent, then you don't want to send a child home. Then you need more addiction therapy."

Adding to the challenge is the high turnover rate of caseworkers and supervisors in the child welfare system. She said providing appropriate funding is key to addressing those challenges.

Children usually enter foster care because of Children Protective Services (CPS) investigations that find it's not safe to leave a child in a home. The state and contracting agencies, such as Samaritas, Oakland Family Services and dozens of other contracted agencies, provide foster homes through volunteers or relatives.

By its nature, foster care is intended to be temporary, while adoption is designed to be permanent. Foster parents are expected to work with the state or agency and birth parents in hopes that the family will be reunited.

It's possible that many people who notice neglect or abusive situations are afraid to report such issues, whether due to retribution or fear that a child will be moved into a worse situation. However, Wollack said the vast majority of foster care parents, whether a relative or not, have a positive impact on a child's life.

"I know many foster parents, and those that truly do it because in their heart are amazing people, and they change children's lives," Wollack said. "Don't you think if you had a niece or nephew that needed you, that you would do it?"

Michelle Adams-Calloway, of northwest Detroit, said she became a foster parent nearly 40 years ago, something her own godmother had done and encouraged her to do. Since then, she has fostered nearly 100 children.

"I started being a foster parent when my children were small. The world was a lot different. It was the 1980s, and I wanted to be selective in who my kids played with. I had two children at the time, and I wanted to give back. I saw so many children suffering. The main problem was neglect, and as the 80's progressed, you saw more kids addicted to drugs at birth. I got involved and said that if I was going to be a foster parent, I was going to be involved with things and truly advocate for children."

During her time as a foster parent, she has continued to work with the same agency, Lutheran Social Services, now renamed as Samaritas, and has served on the Foster Care Association of Michigan, Wayne County's foster Care Review Board, and has helped mentor other foster parents. While she said many children stay temporarily and are reunited with their parents, she has also had long-term stays, adopting eight children over the years.

"I'm currently a legal guardian to one child that is in foster care who has special needs. She just turned 17. And then two sisters, one is five – she's having a birthday party today – and one is six; a nine-year-old who will be 10 in August. So, three foster children, and a guardianship, and I have a 12-year-old I adopted," she said.

Adams-Calloway admits that being a foster parent may not be for everyone, as it's hard for the children in the system as well as the adults serving as foster parents, too.

"You can't be doing it for the money because you only get $17 a day. I have a full-time job, my husband has a full-time job, and we both work," Adams-Calloway said, who holds an administrative position for the Wayne County Health Authority. "It costs money to expose kids to positive things."

Many children have never left the neighborhood from which they were raised, she said, recalling a young girl who had never even been to a mall before. To expose children to new experiences, she and other family members often take children on special trips, including Cedar Point and Disney World. Other times, children discover new worlds because they are exposed to something as basic as different foods.

"It's not easy. I don't want anyone to think it's a piece of cake. There was things I had to experience that I didn't have to with my birth children, like running up to the school because of their behavior," she said. "But it's not really their behavior – they are carrying big baggage that they don't share, and they can't, and they don't understand. Some have been in multiple homes, so they hate you when they come in the door. I'm still learning. You have to be adjustable and be willing to make that adjustment for children. You don't know their past, and lot of times you don't get their history.

"Many times, you know more than the case worker, and you will need to tell them what is happening. We had an emergency one time, and I found out he needed a medication, and his sister had to tell me he took it. Another time we found out a child was with the wrong agency, and they were re-entering the system for a second time," she said. "You have to be aware and know when you can ask questions of a child, and when you can't. When they are comfortable, they will open up. We send a mixed message to children because we tell them about stranger danger – then you are the stranger and ask them to fit in.

"It's hard for the child and the foster parent. Everyone can't be a foster parent, and everyone can't be a parent. You do make personal sacrifices. I've had friends that might ask, 'Don't you think you've done enough?' I'm African American, and we are basically a race of people that sometimes don't seem to look out for each other. As long as there's a need, and God keeps me healthy, I plan to continue."

Lena Wilson, vice president of child and family services with Samaritas, said the agency serves over 800 children throughout the state, with about 3,000 individuals in the agency's preservation program, which aims to keep families together. She said about 74 percent of families working with Samaritas are reunited within 12 months. Most of the cases – about 1,500 per year – are referred to the agency by Children's Protective Services.

"Most of the time, it's neglect and families not having what they need at the time, and that can turn into an abusive situation," Wilson said. "Also, there are underlying mental illnesses that are untreated because those in poverty don't have the resources to seek services. The same is true with drugs.

"Our goal is to reunify a family within 12 months or less. Usually, we are able to do that."

Nationally, there were about 437,465 children in foster care systems in 2016, with figures slowly dropping from about 500,000 in the mid-2000s to under 400,000 in 2013. Since then, there has been a national trending upwards of children in foster care systems. While major reforms in Michigan helped drop the state's number from more than 20,000 children, the number of children entering the system has grown in recent years.

In Michigan, there are about 13,691 children in the state's foster care system as of May 2018, according to MDHHS. That includes about 2,019 children that have a long-term goal of adoption.

Those figures are down from about 20,000 in 2006, when the number of children waiting to be adopted was about 7,000 children. The high number of children waiting to be adopted, along with high profile deaths of children in foster care or who were to be monitored by the state lead to a class action suit being filed against the state's MDHHS in 2006 by Children's Rights Inc, a non-profit organization that has won landmark cases on behalf of children in several states.

"There was a line in 2006 of more than 7,000 children long whose parents' rights were legally terminated, but they weren't adopted – that's really extraordinary. Likewise for children who could be reunified with their birth parents, so there was something really profound happening," said Samantha Bartosz, deputy director of litigation strategy for Children's Rights Inc. "Then, there were some real concerns with the safety of children once they were removed from parental care. ... When we brought the suit, there was a number of child fatalities that occurred, but the rate of maltreatment in foster care was very high. The rate reported to the federal government by the state wasn't (high), but we learned later that the data system was out of date. They had a terrible system, and it was concealing the safety issue to some degree."

Issues in the state's foster care system were well known years before Children's Rights filed the class action.

A 2005 assessment of the then-Michigan's Department of Human Services (DHS) and the agencies it contracted with found several serious issues, including a failure to sufficiently conduct criminal history background checks before and during placing children in potentially unsuitable foster homes; not ensuring caseworkers performed and documented required visits with children in foster care; failed to conform with federal requirements; a lack of training for case workers and supervisors; and other shortcomings.

The audit followed the death of two Michigan foster children who died in the spring of 2003, who died from injuries they received at the hands of their foster parents. In both cases, two four-year-old boys died after being beaten by foster parents in unrelated cases, with both children previously suffering from psychological trauma.

The Michigan's Auditor General's Report, published in August of 2005, cited recurring problems that had been cited in earlier performance audits. For instance, auditors had previously noted in 2002 that DHS caseworkers weren't conducting or documenting visits with children in foster care and their parents.

"WE AGAIN RECOMMEND THAT DHS ENSURE THAT CASEWORKERS PERFORM AND DOCUMENT REQUIRED VISITS WITH FOSTER CHILDREN, THEIR PARENTS AND THEIR FOSTER PARENTS AND FACILITATE VISITS BETWEEN CHILDREN AND THEIR PARENTS," auditors noted in all capitals in one portion of the report.

Additional findings in the 2005 audit report showed that DHS didn't ensure foster care children received required minimum basic healthcare services and that caseworkers didn't document the services received in foster care files.

Anyone applying to foster or adopt must be licensed and meet basic requirements or qualifications, including a criminal background check.

In terms of criminal background checks, auditors in 2005 got criminal history reports from the Michigan State Police for all 12,900 foster care providers and adult household members in licensed homes, then narrowed down those with disqualifying or potentially disqualifying criminal convictions between December 1998 and December 2003, identifying 321 licensed providers and 32 unlicensed adult household members with disqualifying criminal convictions during a five-year period. Auditors further found 16 relatives serving as foster care providers who DHS couldn't provide documentation that any criminal history checks were done. Those convictions included drug-related convictions, domestic violence, and felony and misdemeanor assault charges. Further, the audit found another two adults living in foster homes with criminal sexual conduct convictions, including one with a child, and three with domestic violence convictions.

A main factor in the issues within DHS's management of the state's foster care program was a lack of staffing, with existing staff being so overwhelmed with cases that many were unable to perform their required amount of work.

A 2006 annual report by the Michigan Foster Care Review Board asserted the Michigan Department of Human Services (MDHS) had an inadequate workforce that was "a substantial factor of the abuse and death of children in the foster care system."

The abundance of newly hired and untrained staff trying to provide services in the foster care system was noted by one senior staff in an email between a MDHS manager and an auditing worker: "The senior staff at one location has three months on the job and the senior staff at the other location has only six weeks. None of their staff has had CWI training yet. This continues to be a big problem throughout the agencies," she wrote. "It all adds up to a formula for disaster if continued along this track."

"There was a spate of annual reports and nothing was moving. We got involved and brought the lawsuit, and we did a real deep dive into the system," Bartosz said. "Once you file a lawsuit, you have formal discovery and we found a number of structural failures in the system that needed to be addressed."

In 2008, DHS and Children's Rights reached a settlement agreement upon in federal court that required the system to undergo a number of reforms to improve the system. That same year, a management review of DHS published by Cathy Crabtree took into account testimony from the court case, performance audits, annual reports and additional information. Borrowing from the 2006 email noted in the program's 2006 annual report, the review was titled "Formula For Disaster."

Among the specific disasters cited in the report was the death of Isaac Lethbridge, who was removed from his birth parents when he was just one-year-old and shuffled to three different homes in 11 months before being killed in August of 2006.

"In 2005, one-year-old Isaac was placed in a foster home. He died at age two, the victim of horrendous abuse in the home. According to the MDHS Protective Services Investigation Summary, there were a total of nine separate complaints about the foster home dating back as far as 1999. Despite numerous reports detailing ongoing harm and dangers in the home, MDHS failed to take minimally necessary safety measures and continued to place children in the home year after year. The children survived somehow; but baby Isaac did not," Crabtree wrote in the report. "After Isaac's death, MDHS discovered his caseworker had not seen Isaac or his birth or foster parents as required, had not completed Isaac's service plans on time, and had not provided a medical exam for Isaac. His caseworker was carrying as many as 46 cases at the time of Isaac's death. The caseworker had received a directive from his employer not to visit foster homes except in an emergency so case reports could be kept up to date. This can only be described as a travesty of child welfare practice when paperwork is the priority over child safety.

"The file on Isaac's tragic death included the report that "once the child arrived at the hospital, he was discovered to have second degree burns to his chest and abdomen area, a fresh bruise on the forehead and right ear, old bruises on his chin and left shoulder, and three old bruises on his left upper arm, left thigh and right tibia. MDHS abandoned Isaac to this foster parent and left him completely unprotected."

Failures cited in the review include an unstable, disjointed and inefficient organizational structure; excessive caseloads that exceeded recognized standards by more than twice the normal standard; inadequate staff training; non-existent data management; non-existent quality assurance; poor contract monitoring; poor licensing compliance; inadequate supervision and support of relative foster homes; inadequate service delivery to children; poor permanency planning practices; and inadequate placement arrays.

In terms of caseloads, the review included an assessment of caseloads of workers in the tri-county metro Detroit area conducted in 2007. The assessment found that 22 of 24 caseworkers (92 percent) in Oakland County had more than the maximum nationally recommended number of cases, which was 15, with nine workers having 30 or more cases, and at least one caseworker having 60 cases to work at one time. In Wayne County, 118 of 196 caseworkers (61 percent) had more than the recommended 15 cases, with 24 of those having more than 30 cases. In Macomb County, 29 of 33 caseworkers (88 percent) had case numbers exceeding the national recommendation, with 18 working more than 30 cases.

The assessment, which was conducted by the Children's Research Center, concluded at least 348 additional foster care workers were required at the time to attain acceptable levels within the agency. However, MDHS did nothing to implement the finding.

The report also found that assumptions that children are safe simply because they are with relatives may lead to deadly consequences, as cited in the case of a girl who killed herself while in a relative foster care placement.

"Heather entered care at age 15 in June of 2002 after her mother stabbed her. When she was placed in a relative’s home in 2002, MDHS knew that there were 11 people living in the home and that some were sleeping in the living room. MDHS also knew that a home study had not been done. Six months passed before MDHS completed a home study," the report stated. "The MDHS foster care worker found that: There were 17 people living in a four bedroom home; there were three sets of bunk beds crowded into one bedroom and four individual beds in another bedroom; one person slept in a bed in the living room; walls and floors of the home were 'very dirty;' A two year old child in the home was 'very dirty;' Heather's uncle had an 'explosive' temper and was uncooperative in allowing visits by the caseworker; and the home was 'not environmentally safe.'

"In addition, Heather was diagnosed as in need of psychotropic medication to control a bipolar condition and mental health counseling for emotional disturbance. The relatives discontinued counseling for her health and stopped her medication. Demonstrating a complete lack of judgement, MDHS failed to remove Heather even when her uncle became verbally aggressive with the caseworker and had what was described as a 'fit.' MDHS left Heather with these relatives, subjecting her to further harm after she had already experienced a violent attack at the hands of her own mother.

"After being removed from the home to a residential facility, Heather ran away to live with another relative. She received no education, no medical care or dental care. MDHS essentially abandoned Heather at the home of this unfit relative, where, in November 2004, Heather hanged herself."

Following the class action suit filed by Children's Rights Inc., the state entered into a consent agreement in 2008, putting the system under the federal oversight of U.S. District Court Judge Nancy Edmunds for the Eastern District of Michigan.

The initial agreement, which was signed in October of 2008, has been modified several times, set out goals for DHHS to meet. The agreement was modified in 2016 and an Implementation, Sustainability and Exit Plan (ISEP) was entered by DHHS and Children's Rights. The ISEP required the implementation of a comprehensive child welfare data and tracking system, with the goal of improving DHHS' ability to account for and manage its work with vulnerable children; established benchmarks and performance standards the state committed to meet in order to sustain reforms; and provided a path for DHHS to exit court oversight.

To monitor progress, the court appointed two monitors from Public Catalyst to monitor changes and assess the state's performance. The latest monitoring report was issued in May of 2018. The monitoring report included a mix of accomplishments and continued areas of improvements, as well as commitments regarding children's safety that haven't yet taken hold.

Monitors found DHHS made improvements in assisting youth who age out of foster care transition into adulthood, although some of those improvements haven't been sustained; and significant reductions in the number of caseloads by Children's Protective Services and foster care related caseworkers.

Federal monitors also found DHHS had "significantly undercounted" the number of children in its child welfare custody who were abused or neglected in its care in 2016, with the department unable to accurately report on the number of children who were maltreated. Monitors also said 79.3 percent of relative homes in which children were placed in the latest monitoring period didn't meet safety standards or have a timely home study completed as required.

Additionally, the monitors found issues in the previous monitoring period were inappropriately screened out for CPS investigation, and found similar concerns in the latest monitoring period.

"Definitely, there is work that still needs to be done, and areas that remain that scream out for more attention," Bartosz, with Children's Rights, said of the latest monitoring report. "That is happening. We are working with the state on that assistance. We have about a 10-year run now of implementing the reform, and many things have been fundamentally transformed. Unfortunately, there is a way to go."

Bob Wheaton, spokesman for MDHHS, said reductions in the number of children in foster care was achieved, in part, by expanding family planning and reunification services focused on addressing barriers that may otherwise be left to out-of-home placement, and promoting a safe return home for children who are placed in-out-of-home care.

MDHHS also developed and implemented a centralized intake system for all reports of abuse, neglect and exploitation of children. The 24/7 call center replaced 83 individual county-driven intake processes, resulting in a more consistent and efficient response to reported allegations. He said MDHHS also established a Division of Continuous Quality Improvement to evaluate child welfare practice, both qualitatively and quantitatively, with the goal of making more targeted improvements and providing additional resources and training opportunities. The division also allowed for development of data reports that enable better tracking of performance and compliance.

Additionally, Wheaton said MDHHS implemented the Teaming, Engagement, Assessment and Mentoring (MiTEAM) practice model for child welfare cases, which represents a shift in the way public and private child welfare staff approach casework.

"Child safety goals have been and will continue to be a top priority. In the last court hearing, the department outlined efforts to reduce maltreatment of children who are in care," Wheaton said.

Those efforts, he said, include ongoing training or foster parents with university partnerships; revising forms to clarify distinctions between safety factors and licensing issues; utilizing regional resource teams to recruit, support and develop foster families to meet annual non-relative licensing goals, retain a higher percentage of foster families, preparing families for meeting challenges and developing foster-family skills; supportive visitation contracts to offer support to biological parents during visits to help improve safety for children; and utilizing a safety team to examine data of recurrence patterns to recommend policy changes.

While still having room for improvement, Bartosz said the state agreed the state's improvements are light years beyond where it was when the suit was filed more than a decade earlier, particularly when addressing permanency.

"Oh my gosh, that was a phenomenal job," she said. "That number of 7,000-plus waiting for adoptive parents has been brought down to under 3,000. That is really admirable."

Bartosz said MDHHS' computer system is still being implemented, and as of yet, there have been issues in completing the work. That, she said, leads to other problems, as noted safety issues, with some progress sliding back. She also said the state has a way to go in terms of updating medical passports for children in foster care, which provides a full medical history. The state legislature passed laws requiring the passport to be completed, but its implementation has been stalled due to the lack of an electronic data system.

"There are many achievements for people working in the child welfare system to be proud of," she said. "But, we need to pay and give laser focus to be confident it is going to get there." ­