Families off the Deep End

By Janis Prince Inniss

On July 2, a USA Today headline declared that “Troubled homes (are) better than foster care”. Florida has a particularly bad track record with children in its custody. Rilya Wilson and Courtney Alisa Clark are just two of the children that have made headlines regarding the failure of the Florida child welfare system to protect children in its custody. 

Wilson was 5 years old when she disappeared, but is believed to have been murdered more than a year before officials even realized she was missing. Clark was a two-year old, found in a Wisconsin home with a scalded, emaciated 11-year-old boy in the closet and his mother buried in the backyard! It was four months before her caseworker reported Courtney missing to the police.

Equally as disturbing are the typical descriptions of the behaviors of children in the child welfare system: 

• She threw a desk at a teacher!
• He was growing marijuana in their home!
• She kept running away!

In the U.S., there are over 800,000 children in the child welfare system who have been removed from their parents’ homes due to abuse, abandonment, or neglect. Many of them display “externalizing disorders,” behaviors that make other people uncomfortable, in contrast to “internalizing disorders” such as depression and anxiety. 

Among people at various levels of the foster care system—case managers and their supervisors, agency heads, and a variety of service providers—the stories about “bad kids” and their “externalizing disorders” abound. In particular, case managers have tons of stories about the bizarre behavior of children in their caseloads. Their stories describe children who bite, spit, lie, steal, and punch teachers, foster parents, and police officers. 

But let’s consider the other side of the coin. How might you feel if you were raised in a neglectful or abusive home? And, what if, despite the problems in that home, you still loved your Mommy and siblings, so you still wanted to be with them? But the state came along and “rescued” you, separating you from your family. 

And what if you went from foster home to foster home, and were greeted with different rules in each home and sometimes abused in those homes? Or were bounced around between institutional settings and various foster homes? How well behaved would you be then? 

What if years passed and you still had not been reunited with your family? Maybe some of your siblings who cried quietly at night into their pillows were adopted by other families. What if their adoptive parents do not want you coming around or calling because of your behavior? 

Worst of all, what if you were the one who did something triggering the investigation of your home and you were initially glad to be rescued, and were told that you would go back home in a couple months when things were better? And what if two months became two years? How well behaved would you be then? How happy would you be?

Although not acceptable, the behaviors of these children can be understood as normal reactions to bizarre circumstances that may include living in families that are abusive and/or neglectful and being removed from those they love with little warning or preparation. Yet, in the world of child welfare, there is little or no acknowledgement that the many cases of depression, Post-Traumatic Stress Disorder (PTSD), Attention Deficit Hyperactivity Disorder (ADHD), and oppositional defiant disorder (ODD) and other “mental illnesses” may be a result of (or made worse by) the experiences of these troubled children.

Poor parenting has long been a pet peeve of mine; although I acknowledge that to be even a mediocre parent takes hard work. Yet, as I have entered the world of child welfare, I have found that few people focus on what it takes to be a good parent. Though child welfare workers see many examples of poor parenting, many of them seem to ignore it and instead focus on the children and their negative behavior.

Nobody talks about these kids’ strengths or talents. When asked whether these children have ever experienced good times, there is telling silence. 

Why so much discussion about the behavior of these children? Why are attempts at protecting children so focused on “fixing” the children? Pathologizing children makes them abnormal and in need of fixing--an easier goal than attempting to change their parents. All too often, the child welfare system employs psychotherapeutic medications and institutions to respond to the behaviors of children. Except for the most egregious cases, the same methods cannot be applied to their parents. 

Both the use of medications and institutional settings—psychiatric hospitals, group homes and residential treatment centers—are costly and stigmatizing. Unfortunately, institutional placements are quite common. One study found that among seventeen-year-olds still in out–of-home care, three quarters had been in residential facilities, and nearly a half had been in inpatient psychiatric care at some point. Institutional placements are quite common: about half of all children go directly to these so-called “deep end” placements without first going to foster care. This is in spite of the social services mantra that children should be placed in the “least restrictive setting first.” Furthermore, there is little evidence that group homes and psychiatric hospitals are effective. 

At the same time, children in the child welfare system receive psychotropic medications at rates of two to three times other children. Yet few medications are approved for use with this population. Like institutionalizing them, the over reliance on medication and the over medication of children is related to the need to control children’s behavior for the convenience of the adults—foster parents, case managers, residential care managers, and teachers to name a few—around them. Parents, the usual champions of children, are often not available to question their treatment or are unable to do so.

Undoubtedly, children in child welfare have immense emotional and psychological needs and many may benefit from medication and institutional services. However, the very system meant to serve them compounds their problems by overusing these extreme measures. The system focuses too much on the misdeeds of these children and on the treatment of their behaviors and not enough on familial and social explanations for their behavior. These family and social problems are more complex-- and harder to fix.

Comments

[Karen Sternheimer]

It seems like it is easier to "fix" a child than a social system, but in all likelihood the opposite is probably true.