LIVE VIDEO: 9NEWS at 4:00    Watch
 

Failed to Death Denver Post

2:33 PM, Nov 19, 2012   |    comments
  • Allison Wilder, center, of Nurse-Family Partnership, visits with Erica Lim, 20, and her 1-year-old daughter, Suryn, at their Aurora home. Lim, who has split from her husband, is trying to raise the child mostly on her own. (Craig F. Walker, The Denver Post)
  • Allison Wilder, right, of Nurse-Family Partnership visits with Maria Delgado, 20, and her 7-month-old daughter, Kaylee, at their Denver home. During the hour-long visit, they talked about Kaylee's health and development, as well as Delgado's new job, her classes at a community college, and her diet and time management. The partnership, which recruits nurses to visit and mentor moms and mothers-to-be, is used in 400 counties across 41 states, including 52 of Colorado's 64 counties. "A huge part i
    
  • Share
  • Print
  • - A A A +
  • FILED UNDER

By Jennifer Brown, Christopher N. Osher and Jordan Steffen
The Denver Post

Colorado has found at least 139 ways to improve the state's troubled child welfare system in the last six years, from better training for caseworkers to more oversight of the 64 counties that each interpret state policy their own way.

Yet, even with many of those improvements in place, the number of children dying of abuse and neglect is rising - now one kid every 12 days - and so is the percentage of young victims known to child abuse investigators before they end up dead.
That alarming rate does not count accidental drownings, vehicle crashes or kidnappings by strangers. Instead, these are starvation, beating and smothering deaths of kids caused by people who are supposed to take care of them.

We have to do better for our children.

Some of the biggest ideas brainstormed by Colorado's top experts, ideas that would require a major shake-up of the system, have been scrapped because they cost too much or because counties do not want to give up control of their departments.

Colorado has rejected or refused to adequately fund methods that experts say keep children safe in other states, solutions that would rebuild its disjointed structure, take advantage of new technology and expand preventive, holistic intervention from public health nurses.

Instead, Colorado is banking on transparency as a road to improvement, trusting the public will demand better if it knows how the current system works.

The state Department of Human Services, under new leadership this year, is building what officials describe as the best accountability system Colorado has seen yet - a way to put pressure on counties to improve their abuse investigations by rating each county's performance.

The reports show how well counties keep kids safe: timeliness in investigating allegations, accuracy in determining whether kids are at risk with parents and precision in writing plans to keep kids safe. But the state is not releasing those county-by-county reports. Only reports comparing Colorado to federal guidelines, as well as past performance, appear on a state website.

"If each county knows that their social workers aren't getting done what needs to be done, if they are suffering an incongruent number of child fatalities or near fatalities, then that information is going to get out there," said Gov. John Hickenlooper.

In the last two years, Colorado also has opened a training academy for new caseworkers in Parker. The hope is that when those workers sit down to desks stacked with case files across the state, they will know how to properly determine whether a child is in danger.

And, since 2008, the state has hired new staff to focus on quality assurance, research analysis, and recruiting and retaining rural caseworkers.

All were part of recommendations put forth by policymakers and child advocates in eight studies and audits dating back to 2006.
Other recommendations, however, are still just that, recommendations.

Two former governors and numerous child advocates concur: The quality of child welfare in Colorado suffers because the state lacks the power to adequately regulate county departments.
Because of this, Colorado doesn't even have the data - caseworkers' workloads and discipline records, for example - to analyze the system's flaws, figure out who is accountable or embark on major improvements.

"The state, in essence, is almost a toothless system over our counties in the child welfare system - in many dimensions," said former state Rep. Debbie Stafford, an Aurora Democrat who sponsored legislation to improve child welfare.

Colorado is one of nine states that have county-run child welfare systems. The vast majority, 39 states, manage family interventions at the state level, and the rest have hybrid systems.

Hickenlooper said he might consider making another attempt at strengthening the state's power if his administration's new rating system does not work.

"(But) I can warn you," he said, "that that would be a huge battle."

More immediately, Hickenlooper will consider creating a statewide hotline to report child abuse. The centralized call line was recommended by an expert panel under Gov. Bill Ritter, but county leaders objected.

A lack of transparency and accountability has stifled Colorado's child welfare system for nearly a decade.

Seldom before a child dies does the state check to see whether caseworkers followed state policy when investigating allegations of abuse and neglect. A state team reviews the casework after the child is dead.

Mistakes do happen. Child protection workers in Colorado failed to follow at least one state rule while investigating almost half of the cases involving children that died of abuse or neglect since 2007, according to a Denver Post analysis of child fatality reviews.

In one example, state officials found caseworkers erred when they failed to protect 3-year-old Neveah Gallegos, whose body was found in a ditch. Their investigation revealed that before Neveah's mother helped her boyfriend stuff her daughter's body into a trash bag, Denver County child protection workers knew her home was a dangerous place and failed to identify safety concerns for the girl.

The Denver Department of Human Services disagreed with the state's finding.

No caseworkers or supervisors were disciplined in the case.
Even when a state investigation reveals a policy violation, individual counties, not the state, have authority to discipline caseworkers or supervisors.

The state human services department has an administrative review division, which sends a team to the 10 largest counties twice each year and the smaller counties once per year to check whether caseworkers are following state policy. The team can write improvement plans for counties that are out of compliance, said Reggie Bicha, executive director of the department.

The state has written two improvement plans in the past three years - in El Paso and Archuleta counties.

Strife between counties, state
County-versus-state strife was evident as the legislature battled to pass a state law last year that was supposed to improve transparency.

The new law was designed to put Colorado in compliance with a federal rule requiring states to publicly disclose the findings of a child death or "near fatality" investigation.

Prior to the legislation, Colorado did not reveal findings from state reviews of the near-death of children by abuse or neglect.
Many counties fought the proposed law, arguing it would cost too much and create more work if their staff had to review every "egregious" act of child abuse, recalled Sen. Lucia Guzman, D-Denver, the bill's sponsor.

In the end, the legislation passed - but included clauses that child advocates say actually weakened protections for children.
The law declares that the work of the child death review team is exempt from civil lawsuits if caseworkers or county departments are sued. Although the law requires counties to release information about fatalities and near fatalities, they have discretion on when to release such data to the state.

In the last few years, the state Department of Human Services also has weakened its child death reviews.
In 2011, state officials excluded an unknown number of children's deaths from ever being reviewed by decreasing the amount of time within the child welfare system necessary to trigger a review, from within the last five years to within the last two years.

Additionally, beginning this year, child fatality reviews no longer listed every violation made by child protection workers in the way they handled a case. Instead, the state only included violations deemed a "systemic" problem at the county. The new format no longer included "one time mistakes," said Ruby Richards, child protection manager for the state.

After multiple questions from The Post about these changes, state officials late last month discussed revising the report format to again include individual policy violations. The state has not released any fatality reports for children who died this year.

Social workers, the public health system and lawmakers know about a program that doesn't try to fix child abuse after it happens, but tries to prevent it in the first place.

In the last 35 years, the issue has not been whether the program works. It has been whether to fund it.

 The Nurse-Family Partnership identifies pregnant women with characteristics that, statistically, put them and their babies at risk: young, first-time mothers-to-be living in poverty. Some are married, many are not, but all participate voluntarily for two years, starting before their babies are born.

A trained nurse visits the young mom, in her home, armed with everything from advice on how to soothe a crying baby to tips on finding affordable child care.

Allison Wilder, a Nurse-Family Partnership practitioner who works out of St. Anthony Hospital, arrived at a recent home visit with a bag of beans and a scale.

Wilder carried both into the immaculate apartment of Erica Lim, a 20-year-old who works as a bank teller, got married right out of high school and now finds herself trying to raise her daughter, Suryn, largely on her own.

During the last visit, Lim said she was frustrated at being broke by the end of the month. So Wilder brought with her a budgeting "game" made up of laminated cards with illustrated descriptions of various expenses, and an allotment of beans to be divided among those expenses.

The program started in Elmira, N.Y., in the 1970s because a man named David Olds, who was working at an inner-city daycare center, was troubled by the rough lives of low-income children. Olds, now a professor of pediatrics at the University of Colorado Denver, devised a program that recruited public health nurses to visit and mentor moms.

His Nurse-Family Partnership is now being used in 400 counties across 41 states, including 52 of Colorado's 64 counties.

Not long ago, what Wilder expected to be a routine visit became a challenge to her relationship with a new mom. The baby's father was there, and Wilder said, "He was very rough, and it was very clear he was under the influence of drugs."

Wilder asked him to leave, then talked with the mother about why the man's behavior was unacceptable, and why she had to report it to social services.

"None of us like doing it. I always get a queasy feeling. But the most important thing is the safety of the baby," Wilder said.

Social services put the baby in foster care. The teen mom, who had been a runaway and homeless, found a job, and got out of the abusive relationship with the baby's father.

"The biggest issue for some of these moms is their confidence level. They are so beaten down," Wilder said. That's why simply helping them discover they have skills and abilities is often half the battle, she said.

Funding for Nurse-Family Partnership has been an on-again, off-again proposition. In Colorado, money from a multistate lawsuit against major tobacco companies has been the primary source of funding.

"Proactive, nonpunitive intervention works," said Dr. Bruce Perry, a researcher in child trauma and founder of the Houston-based ChildTrauma Academy. It costs about $4,500 per mother.
"But can we get the system to fund this? No," said Perry.

In some parts of the country, child welfare departments have the technology to assign caseworkers and services for families in the same way Starbucks chooses its next coffee shop location or FedEx maps its driving routes.

Geomapping technology starts with child abuse investigators entering data into a computer - children's addresses, family needs, mental health services, food banks and parenting classes.

The system can then link caseworkers to families who live closest to each other, making their jobs more convenient and increasing the chances they will connect with a home where abuse is suspected.

The technology also improves accountability and transparency because it's easier to tell who is responsible when a child slips through the cracks, said Amy Hillier, a University of Pennsylvania professor who specializes in geomapping.

The computer system can record who called to report the child was in danger and which caseworker screened the call. A doctor or school official also could enter data about the family.

The technology generates reminders, alerting caseworkers when it's time to check on a child. It also can tell a caseworker whether there is a foster family within a couple miles of home, close enough the kid could still make it to soccer practice that week.

Over time, child welfare authorities can begin to see patterns - in areas where abuse and neglect are more common, child welfare authorities could concentrate efforts to encourage abuse reporting.

Putting child welfare data into an interactive computer system, especially in Colorado where the human services are county-run, would cost close to a million dollars.

"It's a major investment," Hillier said, but over time it would begin to pay for itself because of increased efficiency. Imagine the time saved if caseworkers could do their "paperwork" on their iPhone before they drove to the next child's house, she said.

Jennifer Brown: 303-954-1593, jenbrown@denverpost.com or twitter.com/jbrowndpost
Follow Christopher N. Osher on Twitter.

Most Watched Videos