Troubled Children Flood Ill-Prepared Care System
CELIA W. DUGGER
New York City's child welfare system, like many others across the nation, has been flooded with thousands of emotionally traumatized children, products of families ruined by crack, AIDS and homelessness.
But the system, already overburdened by the sheer volume of children, has often failed to diagnose, let alone treat, troubled youngsters who range from depressed to suicidal, defiant to violent.
The city estimates that up to 30 percent of the 49,000 children in foster care have emotional and behavior problems, but experts outside the system believe that more than half are troubled. Inadequate Training
Child welfare experts say that there are simply not enough services for all the children who need help. But some of the problem rests with inexperienced and poorly trained caseworkers who do not recognize children's needs or who fail to negotiate the tangled bureaucracy in a way that will get them help. Many, in fact, have little or no background in child development or psychology.
Yet they are encountering children damaged by circumstances that were rare or nonexistent before the 1980's. The upsurge in homelessness in the last decade, fueled by crack and AIDS, has not only led to the destruction of thousands of families and produced a huge influx of children into the foster care system, it has also contributed to an extraordinary new set of deprivations and emotional traumas.
In households governed by crack, for instance, children sometimes go hungry. There are no regular hours for sleep. They often live in filth, their clothes and bodies unwashed. Violence is common. As parents grow desperate for the drugs, they sometimes sell themselves in full view of the children, or they send their children out to steal for them. In many cases, these events are compounded by bouts of homelessness and life in squalid welfare hotels.
One measure of the system's failure to treat children is the number who end up in such bad shape that they must be taken to mental hospitals. In recent years, there has been a dramatic rise in admissions. From 1985 to 1992, the number of children under age 13 admitted to New York state psychiatric hospitals more than doubled. Last year, 747 children went into state hospitals.
A state study of a sample of these children found that 70 percent had been in the city's foster care system. More than a third were not receiving any mental health treatment at the time they were hospitalized.
"We end up with the casualties," said Richard C. Surles, state commissioner of mental health. "By the time we see them, they've been through the foster care system and had up to a dozen placements. On one extreme, the kids are out of control. They will assault you for no reason. On the other, they are withdrawn, suicidal, depressed."
Experts say that the children's behavior often serves to earn them harsh treatment in the foster care system. Frequently, they bounce from home to home, as foster parents throw up their hands. Each move, another rejection, adds to their pain and causes further damage.
"I've spent a lot of years in the field working with these kids and they can provoke you to a breaking point," said Mary Armstrong, director of the Bureau of Children and Families at the State Office of Mental Health. "That can lead to child abuse." When Odd Behavior May Lead to Death Late
In at least two extreme cases, their strange behavior appears to have contributed to their deaths at the hands of foster parents. Three-year-old Quintessa Murreld, a sad and silent girl whose natural mother was a crack addict, died last year of severe abuse by her foster father. Five-year-old Randi Anderson, who infuriated her foster family by hoarding food and defecating on the floor, died of abuse in November 1990.
New York City's Child Welfare Administration, under the leadership of Robert Little, has concentrated in recent years on keeping families together, pouring its resources into services like drug treatment and counseling in an attempt to reunite families.
Mr. Little has said he would rather spend scarce money on social services than on medical care. For example, he said, the best way to help a boy depressed by separation from his mother is not necessarily to send him to a therapist. It may be better to help his mother get off drugs so he can go home to her.
The agency does not keep track of how many of the children in their custody need or receive mental health care, Mr. Little said, and he discounted studies that show a majority of foster children are troubled. Psychologists who study the children tend to see illness because that is what they are trained to do, he said.
While many advocates for children praise Mr. Little's attempts to keep children out of foster care altogether and help them go home, they also point to the thousands of children who spend years in foster care still bearing the scars of life in a home where drugs were a way of life or where there was no home at all. As Families Shatter, Problem Grows
The problem is not unique to New York. Across the nation, the crack epidemic has shattered thousands of families.
Nationally, the number of foster children has soared from 280,000 in 1986 to 430,000 in 1991. Recent surveys in cities from Baltimore to Oakland have found that more than 50 percent of foster children suffer from behavioral, developmental and emotional problems, including depression, hyperactivity and aggressive behavior. Howard Dubowitz, a pediatrician at the University of Maryland, found that the proportion of troubled foster children in Baltimore who got treatment was "alarmingly low."
In New York City, there is no central office that refers children for mental health care, nor is there a computer that enables it to track how many are on waiting lists.
"It's legitimate to ask how many children need mental health care and how many are getting it," said David Fanshel, a professor at the Columbia University School of Social Work. "That question cannot be answered by this system because it doesn't take the trouble to gather the information."
Foster children depend on caseworkers to make sure that they and their families get the services they need. Typically, the workers have a college degree, but little background or experience in child development or psychology. Turnover is high. Last year, almost four out of five of the workers who investigate allegations of child abuse and make the initial assessment of a child's needs quit or were laid off.
A 1990 state survey of caseworkers found that they identified only 16 percent of the children as having mental health problems, much lower than the proportion found by trained professionals.
"They're inexperienced," said Ms. Armstrong, the social worker. "They're young. They turn over very quickly. And many times, they don't know the behavior triggers that are a sign of trouble." Costs Are High And Services Scarce
Even when workers detect a problem, services are hard to find.
Sandra Hagan, executive director of the Queens Child Guidance Center, said that there are as many as 60 children waiting to get help at the center's foster care clinic. The Medicaid reimbursement rate, $60 per session per child, only covers one-third of the clinic's costs. The rest comes from foundations and contributors.
"It would cost the city a fortune to help all these kids," Ms. Hagan said. "We don't have enough therapists and our budget hasn't grown in three years."
Ms. Hagan, an experienced social worker, adopted an emotionally troubled foster child whose mother was a heroin addict. The boy had lived with five foster families before he came to their home. When he first arrived, he threw temper tantrums every day, lashed out with his fists and spoke only in single words. He panicked when Mrs. Hagan went to the bathroom. "He was afraid I wouldn't come back," she said.
He is 8 years old now, and his life is still a struggle. Sometimes, in the blink of an eye, he regresses to babyhood, crawling on the kitchen floor. Or he acts like a toddler, wobbling unsteadily down a subway platform.
"I think he wasn't cared for when he was a year and a half," she said. "There's part of him that's trying to go back and get that. He feels safe enough with us to do that."
Quintessa Murreld probably never felt that safe. A depressed foster child, she was almost 3 years old when she was battered and strangled last year. Her foster father has pleaded guilty to manslaughter; her foster mother to recklessly endangering her life.
The details of Quintessa's story come from city records that are confidential by law. They were provided to the The New York Times by a city official, who was outraged at how the system has handled such children.
The records show that Quintessa's caseworker had recognized for at least four months before her death that the child was extremely sad, silent and unsmiling. And a month before she was killed, the foster mother asked that Quintessa be psychiatrically evaluated. But nothing was done to treat the girl.
When the toddler was admitted to the hospital in February 1991, she was comatose and suffered from malnutrition, burns, bruises and an old arm fracture that appeared to have been untreated. The medical examiner said she had been strangled with a cord.
Quintessa was placed in a foster home because her mother, a crack addict, neglected her. After six months there, she was moved in October 1990 to another foster home with her aunt and uncle, Vicki and Donald Murreld. Attempts to reach Mr. Murreld in prison were unsuccessful. His wife could not be located for comment.
There were signs of trouble from the start. A month after Quintessa arrived, Mrs. Murreld showed caseworkers a photograph she had taken of the toddler defecating on the bathroom floor as evidence of what Mrs. Murreld had had to endure. She made it clear she had no intention of adopting Quintessa.
In November and again in December, the caseworker noticed that Quintessa was sad and withdrawn. On one visit, Quintessa sat listlessly in her bedroom, not playing with her toys.
In January, Mrs. Murreld complained to the caseworker that Quintessa cried all the time and still defecated on herself. When the worker asked Quintessa questions, the girl was silent and unsmiling. The worker picked her up, but Mrs. Murreld instructed her to put the girl down "or she will begin to think she is a baby again and begin to cry," the worker later told city investigators.
Mrs. Murreld also told the worker "she will not tolerate this behavior for long" and asked for a psychiatric evaluation of the girl.
In February, an extremely upset Mrs. Murreld called the caseworker. She had caught Quintessa in the living room next to a broken candy dish that had cost $80. "The foster mother stated that she was so angry that she wanted to kill Quintessa," the city investigative report stated. "She asked the worker to please get the child a psychiatric evaluation."
The worker said she would try to put in a request for the evaluation and visit the home within a few days, but by then Quintessa had been admitted to the hospital in a coma.
Quintessa's caseworker had only been on the job three months when she was assigned the case; she already had a caseload of 31. Her supervisor had only been employed by the agency for two years and had only been a supervisor for two months. The supervisor was given only three days of training before being handed her new responsibilities.
In Quintessa's case, the city panel that reviews deaths of children in foster care recommended better training of caseworkers in recognizing mental illness and behaviors that can signal deeper troubles, such as defecating on the floor.
But as it stands now, researchers say, foster children commonly receive no mental health counseling until they have extreme symptoms. "A child who walks up to you with a dead cat he just lit on fire gets help," said Anthony Urquiza, a psychologist at the University of California-Davis. "The shy little girl who is withdrawn and suicidal is equally in danger, but probably would not be in therapy."
Therapists at the Queens Child Guidance Center see this phenomenon daily. Debra Bondy, a social worker, treated a girl who went into foster care at age 8 when both her parents were sent to prison for drug offenses. For two years, the girl drifted in and out of foster homes before she was finally treated for depression.
"She didn't give anyone any trouble," Ms. Bondy said. "She wasn't stealing or wetting her bed. No one noticed her."
At the age of 12 the girl has now sought solace in having a baby of her own, a decision that is likely to lead only to more heartache and disappointment. She is five months pregnant.
"She says she will love the child and the child will love her and take care of her," Ms. Bondy said. "She is trying to make up for everything she has lost."