Child Protective Services Under the Microscope: Is Adult Protective Services Next?

Adult Protective Services (APS) often sees itself as the poor stepsibling of Child Protective Services (CPS). CPS gets more money, more staffing, more attention, and more respect. But as an analysis Adult Abuse Review (AAR) did this summer shows, they also get a lot more criticism.

AAR read and analyzed more than 170 newspaper articles and broadcast stories referring to CPS controversies published from mid-June to the first days of September, 2003. We found such stories for more than half of the states -- 29, to be exact -- during these three months. Although some state CPS systems got by with only one article describing CPS controversies, some were in the news repeatedly. The most hard-hit state, New Jersey, weathered new controversies at an average rate of two per week.

AAR found the impetus for the articles could be sorted into four categories: the death or serious injury of a child known to CPS; a lawsuit filed against CPS; the release of a report by an ongoing or ad hoc CPS oversight or monitoring effort; and other miscellaneous crises.

Death of a child known to CPS

Clearly, the stories with the most potential to raise public anger and increase attention on CPS were those that reported on the death of a child whom CPS was -- or should have been -- monitoring. The media in eleven states took notice of such cases this summer.

Arizona had only one death, but its CPS was roundly criticized in June when it was reported that a CPS worker told a grandmother who was reporting abuse that he was too busy to go out again (there had been nine previous reports on the family, only one of which -- which had, ironically, been handled by a different worker -- had been classified as substantiated), that if she was worried, to call police. Police found a 7-year-old weighing just 36 pounds locked in a closet. In August, 5-year-old Arizona twins were found locked into small cages; it turns out that they had been kept that way most days for most of their lives. CPS had received a report in 2001 that the father caged the children as punishment, but the report had been classified as “neglect” and been sent to a contractor, who offered the family services they refused. No CPS investigation had been made.

New Jersey was one of two states with three such deaths. The most notorious actually came to light in January, when the partially mummified remains of a 7-year-old were found in his mother’s basement. The child and his siblings had been reported as victims of scaldings and beatings 11 months before the body’s discovery, but CPS had closed the case without completing the investigation. (At the time, the caseworker had 100 open cases.) This death prompted investigations that were being reported this summer. The 7-year-old’s death was also brought up when two other deaths occurred: on June 4, when a 21-month-old who had been in the foster care system was beaten to death by his mother, to whom he had been returned by CPS; and on August 19, when a 14-year-old died as a result of a beating by his mother. In this case, the family had been investigated on abuse and neglect complaints four times previously.

Pennsylvania also had three fatal cases involving four children. In July, a father killed his whole family, including two children. Only one of ten previous child abuse claims against the family had been substantiated. On August 12, the body of an emaciated 4-year-old was found in a picnic cooler behind her parents’ house; she had been returned to her parents even though her foster mother had warned the parents seemed uninterested in her welfare. A week later, the body of a 3-year-old was found, badly beaten. CPS had responded to a neighbor’s complaint about bruises on her sister’s face the day before, but had found no one at home and had simply left a note on the door. It turned out that this family’s children had been followed from 1994 to 2000, when they were in the care of their own parents (the children were in the custody of an aunt and her boyfriend at the time of the beatings).

Other deaths resulted in actions taken against caseworkers. Two Georgia caseworkers were fired and their supervisor demoted when a 2-year-old was beaten to death by his stepfather in August. CPS had had an agreement with the mother that the child and his siblings be moved to their grandmother’s, but had never checked to make sure this had been done. In Indiana, a social worker was charged with felony neglect when the body of a disabled 8-year-old on his caseload was found after a fire. An autopsy showed the child had died of pneumonia the day before the fire, but was also malnourished and had not been given his medication to treat seizures. The agency’s director was downgraded in a performance review, and three supervisors were given work improvement plans. In New Jersey, ten “high-ranking” administrators and managers in the Department of Youth and Family Services were fired in June as the result of the investigation into the January 2003 discovery of the 7-year-old’s death discussed above. In Texas, an intake caseworker was fired after a 2-year-old died from her father’s physical and sexual abuse. A pizza delivery person had reported the child when he saw a bruise around her eye, but the intake worker had classified the case as information and referral, and no follow-up had been done.

Lawsuits Against CPS

In nine states, news articles were prompted by the filing of new lawsuits against CPS or new developments in existing suits. In Arkansas, parents filed a lawsuit alleging their children had been sexually abused while in foster care. In Colorado and South Carolina, grandparents filed suits alleging CPS did not act to prevent the deaths of their grandchildren. Florida saw two new cases: one in which an adoptive mother sued because she had not been told that one of the siblings she had adopted had previously sexually assaulted the younger sibling, and one by a former Department of Children and Families lawyer alleging he had been fired when he complained about poor CPS practices. In Illinois, the Cook County Public Guardian filed suit against the Department of Children and Family Services for moving foster children too often. A Nebraska woman filed suit against the state health and human services system and a caseworker alleging the caseworker had threatened to take away her child if she did not testify against her husband in a case alleging the man had abused the child. In July, North Carolina’s Supreme Court ruled that CPS may not force interviews on parents who refuse them. (This controversial case arose out of a report that a naked 2-year-old had chased a kitten into the yard; she’d been quickly returned to the house by an older brother. The circumstances of the initial report may have influenced the final decision that parents have a right to refuse an investigation.)

Oversight Reports

CPS receives far more federal oversight than does APS. Since the 1994 Amendments to the Social Security Act (SSA), the U.S. Department of Health and Human Services (DHHS) has reviewed states’ procedural compliance with titles IV-B and IV-E of the SSA. States that were not in compliance had penalties imposed on them. In January 2000, however, DHHS established a new approach to monitoring state child welfare programs. States now undergo two different reviews: child and family services reviews (CFSR) and title IV-E foster care eligibility reviews. The latter is an audit that focuses on whether children meet statutory eligibility requirements for foster care maintenance payments.

The CFSR, however, sets high standards by which states are measured for the following outcomes:
• Children are, first and foremost, protected from abuse and neglect.
• Children are safely maintained in their homes whenever possible and appropriate.
• Children have permanency and stability in their living situations.
• The continuity of family relationships and connections is preserved for children.
• Families have enhanced capacity to provide for their children’s needs.
• Children receive appropriate services to meet their educational needs.
• Children receive adequate services to meet their physical and mental health needs.

CFSR procedures involve a Statewide (self) Assessment, and an onsite review of child and family services outcomes and program systems (conducted by a joint federal-state team) that includes case record reviews, interviews with children and families receiving services, and interviews with community stakeholders such as courts, community agencies, foster families, caseworkers, and service providers. When states do not achieve “substantial conformity” in all the assessed areas, Program Improvement Plans must be developed and implemented. “States that do not achieve their required improvements successfully will sustain penalties as prescribed in the Federal regulations.”

CFSR have been completed for only 32 states so far. None of those states met more than two of the seven outcome standards. Fourteen states and the District of Columbia met only one of the seven. Fourteen states met none of the standards. This summer, there were articles on the state’s CFSR results in Alaska, Florida, and Virginia. New Jersey was also in the news for failing its second Title IV-E audit; up to $10 million is at stake in that audit.

But there were plenty of other articles about child welfare oversight measures. Both Connecticut’s and New Jersey’s systems are under court monitoring, and progress reports for both were publicized. Quality Assurance Reviews or other systemic reviews took place in Indiana, Maryland, Michigan, New Jersey, and New York, usually as an outgrowth of the death of a child known to CPS. The Maricopa County (Arizona) County Attorney is considering sponsoring a grand jury probe of CPS as a result of deaths there. In New York, the results of both a grand jury review and a legislative investigation of one county’s CPS system were released this summer.

Iowa struggled this summer to quickly implement hearings and work groups to redesign its whole child welfare system and to cope with quickly-enacted budget cuts after consultants the governor hired said privatizing the system would result in better results at less cost. In Hawaii, the state auditor, following up on a 1999 audit, blasted the CPS system again. Two North Carolina papers published a whole series of articles examining CPS; one series had the running title, “Children Who Didn’t Have to Die.”

Other Crises

CPS agencies made the news for a wide variety of other reasons. In California, a CPS “chief” was reassigned to APS pending an investigation that she had ignored warnings that the laboratory CPS was using was selling “clean results” to drug-using parents who wanted their children back. In Delaware, a newspaper printed allegations that CPS workers were placing “we can’t guarantee the safety of these kids” memos in files because of their heavy caseloads, news to both the Division of Family Services director and the union’s president. Florida’s long-awaited centralized computer system made the news twice, once for its $190 million overrun and once because it went down for hours on its first day on the job. In Michigan, parents went to a paper with the news that their three children were being kept in a foster care/relative’s home with a known pedophile. Michigan was also one of three states (New Jersey and Utah were the others) in which public meetings of parents -- both birth and foster -- were held to berate CPS procedures. The Missouri governor’s veto of a bill that would have “made sweeping changes” to CPS got lots of press, as did a resulting public rally to protest the veto.

New Jersey’s child welfare system, as mentioned, was in the papers all summer. One topic of these stories is particularly interesting: because of the initial publicity generated in January when the mummified remains of the 7-year-old were found, reports to the agency rose 24% from January through July, raising caseloads, building backlogs, and further stressing an already volatile system. (At press time, New Jersey was again reeling under another disaster: four adopted boys had been found starved in a family that had been visited by CPS at least 38 times; nine caseworkers and supervisors have been suspended.)

Ohio hit the news for a long-running strike/lockout of CPS workers over, in part, caseloads. Oregon’s experiment to centralize intake calls was ended in the midst of complaints of one-hour holds and non-responsiveness. In Pennsylvania, the roommate of a foster father turned out to have passed a criminal background check by using his son’s Social Security number; he was actually a convicted pedophile. As part of one of South Carolina’s newspaper exposes, CPS had to answer why an average of 74 of its foster kids ran away every month. And in Tennessee, a fired worker and her colleagues made public a letter saying a Department of Social Services administrator was covering up child deaths and had “threatened to fire anyone who complained about the way she ran the office.” After an investigation, the administrator was fired.

Lessons for APS

The (Alabama) Birmingham News on September 3rd printed an editorial that its adult protective services was going to be the next target of lawsuits and bad publicity: “’So sue me.’ That’s what Commissioner Bill Fuller might as well be saying where the state Department of Human Resources’ adult division is concerned,” the opinion piece begins. “More than a decade ago, the state agreed to improve services for abused and neglected children in a federal court case known as ‘R.C.’ Fuller is calling DHR’s adult services ‘R.C. 2,’ warning that the state is vulnerable to a federal lawsuit in adult care similar to the R.C. case. Fuller is not kidding.” After noting that the National Association of Adult Protective Services Administrators (NAAPSA) recommends a caseload of 25 per APS caseworker, the paper says that in Alabama the caseload is 50-plus, so “the chance of a case slipping through the cracks is high.” The editorial ends with a plea for increased resources before federal intervention happens.

The editorial is correct; APS is vulnerable to the same sorts of lawsuits that CPS is seeing. But there are many other parallels and cautions. This summer CPS made news because, among other things,
• Caseloads are too high;
• Supervision is inadequate;
• Turnover is too high;
• Training is inadequate;
• Incoming reports aren’t (in hindsight, at least) properly prioritized;
• Risk assessments are inadequate;
• Record-keeping is poor, particularly when it comes to being able to trace and/or use prior contacts to establish patterns; and
• There is poor coordination with and/or access to law enforcement and other systems.

All of these are issues that face APS, as well. In addition, some states explicitly struggled with the CPS version of APS’s tension between self-determination and safety -- is the overriding goal of CPS to keep children safe or strengthen families? Unfortunately, in all of the cases that made the news this summer, the public nature of the controversies put CPS in the position of defensively reacting to bad news.

Which is one of the primary lessons APS can learn from this analysis. Currently, despite facing very similar challenges as CPS does, articles criticizing APS are still relatively rare (for four 2003 stories that do criticize APS or its sister agencies, see the accompanying article, “Adult Abuse Providers’ Shortcomings Hit the News”). We cannot expect this grace period to continue. The aging of the population, the growth of elder fatality review teams, and the increased attention APS is getting as a result of high-profile federal legislative efforts all point to an increased media awareness of APS and, hence, an increased risk of negative coverage. We are therefore in a unique, and temporary, position. We can wait until the media chooses to put us in the same sort of reactive position CPS is in across the country, or we can choose our own time and subject matter by becoming proactive with the media.

We can cultivate the media now with stories that will help build awareness of and appreciation for the APS system. Such stories can highlight successful cases (virtually none of the more than 170 CPS articles we reviewed mentioned successes), explain how the system actually works (North Carolina’s Washington Daily News series on the CPS system was highly informative), advertise APS’ guiding principles and values (NAAPSA’s Adult Protective Services Ethical Principles and Best Practice Guidelines is available at http://www.elderabusecenter.org/pdf/publication/ethics.pdf), and explain to the public what needs APS has and what the consequences are of not fully meeting those needs. If we do not take this opportunity to act proactively, we will find ourselves in the same position CPS is in: trying to communicate these basic realities in the midst of firestorms of controversies and accusations.