Who helps when adoptions unravel?

Who helps when adoptions unravel?

by Mary K. Reinhart - Nov. 24, 2012 10:57 PM

The Republic | azcentral.com

Earlier this year, a Mesa couple found themselves facing a Child Protective Services investigation after refusing to pick up their adopted son from juvenile detention.

The parents were near the breaking point. The boy had been hospitalized twice, spent weekends at a residential treatment center, languished on a waiting list for a therapeutic group home, worked through several therapists and psychiatrists, and been subjected to various psychiatric medications.

He also had admitted to molesting two children in the home, and though authorities believe there may be more victims, he has not been charged.

The parents, whom The Arizona Republic is not naming to protect the identity of their children, some of whom were victims, believed their best hope was to temporarily give the boy back to CPS, which placed him in residential treatment, because they believed it was the only way to get him proper mental-health care and protect their other children.

"We wanted help. We lived a nightmare for over a year and a half," the adoptive mother said. "Then CPS looks at you like, 'What have you done to this child?' "

She has since discovered that CPS received dozens of reports on the boy and his siblings when they were living with their biological mother. CPS reports show that interviews with the children and other relatives indicated that the teenager, his brother and sister had been sexually abused by their mother's boyfriend since they were small. The report also says the boy began molesting his sister when she was a toddler.

"They knew it. They knew it before they put him in my home," she said. "Then they tried to accuse me of neglecting him, when I was the one all along fighting to get him help."

As the number of foster children continues to increase, Arizona child-welfare officials desperately need more families who are willing to provide stable, permanent homes.

But more adoptive parents are returning their kids to the state's care in the hope that the deeply troubled youngsters will receive effective mental-health treatment.

For years, parents have struggled to deal with adopted children who lash out at them, assault other kids, run away, get kicked out of school and spend weeks in juvenile detention. They've fought unsuccessfully to get their kids into residential treatment programs, which they believe could turn the children around or at least keep the rest of the family safe.

Some foster children were born with problems, the products of mentally ill or drug-abusing parents. All experienced trauma before they came to live with their adopted families. Then, as they grow into adolescence, some need the kind of intensive, structured treatment that is often denied, unavailable or financially out of reach for their families.

"This adoptive group has not gotten the attention it deserves. They're really stuck. There are no answers for them," said Jane Kallal, an adoptive mother who founded the Family Involvement Center in 2001 to help Valley families raising children with behavioral-health problems. "I thought we had come so far. I lived this 20 years ago. But it sounds like it's really blowing up."

Adoptive parents speak of children who repeatedly run away, jumping barefoot from a second-story window or dashing into traffic from a moving car. Who assault teachers, animals and family members and make repeated trips to juvenile detention. Who were victims of sexual abuse and now perpetrate it on other children. Who smear feces on bedroom walls. Who upend the entire family until the parents believe they have no choice but to send the children back.

The mothers and fathers who tell their stories do so reluctantly. Most are proud parents of well-adjusted biological and adoptive children. They say fostering and adopting children has been a blessing and they express no regrets over having done it. They delight in their kids' achievements, bragging about their role in the school play or their longevity on the honor roll.

Thousands of foster children are adopted each year in Arizona, and most turn out just fine. So these adoptive parents are loath to discourage others from experiencing the love and happiness that their families have enjoyed.

Still, they want prospective parents to be aware of what could lie ahead. They believe the system is not responding to their children's significant mental-health needs and that, ultimately, everyone pays the price if the kids return to foster care or, worse, are left to fend for themselves as young adults.

National and local child advocates say that a push toward adoptions has spawned an increase in the number of families who are unable or unwilling to cope with children who have been doubly traumatized -- first at the hands of their birth parents and then as products of the foster-care system. Though it's still a small percentage, they believe the number of broken adoptions is growing at least in proportion to the number of overall adoptions.

The number of adoptions from foster care doubled and, in some states, tripled after the passage of federal and state laws in the late 1990s that encouraged adoption. Foster care children are more likely to have mental-health problems, and researchers warned that the kids and their new families would need long-term state support.

Without appropriate and ongoing therapy, schooling, respite for families and other services after adoptions are final, advocates say, children's serious emotional and behavioral issues will lead to more broken adoptions.

The federal government doesn't require states to track broken adoptions or the number of adopted children returned to foster care. Arizona doesn't keep track.

No national studies have been conducted, but research based on smaller samples indicates that 10 to 25 percent of adoptions from foster care fall apart before they're legally finalized, and 1 to 10 percent of foster-care adoptions are severed after they're finalized. Key factors in failures are the child's age and special needs, such as developmental and behavioral problems, and the number of prior placements they've had, according to a June 2012 federal report.

Arizona's most recent statistics show that five children, or fewer than 1 percent, placed in prospective adoptive homes between March 2011 and March 2012 were returned to the system before a judge finalized the adoption.

Deidre Calcoate, who administers Arizona's foster-care and adoption program for the Department of Economic Security, which oversees CPS, and is an adoptive mother herself, understands that children often have what she calls "trust issues" after being let down by one adult after another. But she maintains that adoption-return rates are low.

"We recognize that sometimes there are children who may have to come out of their permanent placement because of their behaviors," Calcoate said. "But we're doing pretty well with children who are adopted."

The number of adoptions from foster care has grown steadily since child-welfare policy turned toward achieving permanent homes for children and shortened the window for birth parents to get them back. Federal policy changes, including hefty payments to states that move more children from foster care to adoption, led to a nearly threefold increase in annual adoptions of Arizona foster children since 2003.

Arizona ranks ninth nationally in the number of children in foster care and fifth in adoptions from foster care with 2,275 last year, following California, Texas, Florida and Michigan.

Still, the state is desperate for foster and adoptive homes. Nearly one-fifth of the state's 14,200 foster children are available for adoption, or soon will be.

Facing a record number of children in foster care, unprecedented worker turnover and overflowing caseloads, CPS struggles to cope with the kids it already has, much less the thousands who fall off the radar screen after adoption.

The state has earned $17.5 million in federal adoption incentives since 1998, when the federal government launched the payment program under the Adoption and Safe Families Act.

In addition to containing several provisions encouraging states to beef up adoption efforts, the federal law sought to prevent kids from getting stuck in foster care by requiring states to terminate parental rights for children who had been in care for 15 out of 22 months. In Arizona, babies and children younger than 3 can be free for adoption six months after coming into foster care.

Nearly all families who adopt Arizona foster children receive a monthly state subsidy equal to the foster-parent subsidy. It averages about $750 a month for some 16,500 children and lasts until they turn 18. During the last fiscal year, Arizona spent about $150 million on adoption subsidies and other payments to families, roughly half of it coming from the federal government.

Children are eligible for the state's Medicaid program, and kids with behavioral-health problems can receive treatment through the state system, operated in Maricopa County by Magellan Health Services. Several hundred families also qualify for respite care and other special services. In addition, parents receive information about support groups and resource centers, and have access to a 24-hour crisis line.

But consistent, effective therapy and inpatient treatment for the most seriously traumatized, troubled kids can be difficult to find and costly. Parents and child-welfare advocates say Magellan and private insurance companies routinely deny residential treatment, which can cost up to $10,000 a month, even if doctors recommend it.

"It seems like we're having a return of parents being forced to use their life savings, give up their houses or return children to CPS," said Kallal, the adoptive mother who founded a behavioral-health center. "What's cheaper? To have them keep going back and forth, blowing out of their placements? Or to help them early on?"

Dr. Shareh O. Ghani, Magellan chief medical officer, said in a statement that they don't discuss individual cases but that their decisions are based on medical necessity. "In the past six years Magellan has made a difference in people's lives challenged with mental illness and has dramatically transformed the behavioral health system."

An adoptive parent typically is treated the same way as a biological parent when it comes to child abuse and neglect. If a parent refused to collect a child from detention, for example, that's considered abandonment and can trigger a CPS investigation. If the charge is upheld, parents are placed on the state's child-abuse registry, which can cost them their jobs.

But cases of desperate adoptive parents turning their children in to CPS to get treatment have become common enough that judges and CPS have informally devised a third way. The judge dismisses the charge and, if the child remains in CPS custody, the judge includes wording in his or her order saying the parents have not been neglectful.

"It says a lot about our system to me that it's savvy enough to work with families and not substantiate abuse and neglect," the DES' Calcoate said.

But the East Valley adoptive mother who refused to pick up her child from detention and other parents say there should be an alternative to putting adoptive parents through the child-welfare system as if they were negligent, then dropping the case.

The last thing Laura DeNigris wanted was to get CPS involved. But her adopted son, Isaac, was running away repeatedly, skipping school, using drugs and defying every rule his parents laid down. Finally, she and her husband were out of options.

After Glendale police picked up the 16-year-old runaway in late August, the DeNigrises refused to pick him up from the police station. They were convinced Isaac would run again, and they feared for his safety.

So CPS placed him in a shelter and opened a neglect investigation against his parents, who have raised Isaac and his brother for 10 years after the boys had basically raised themselves on the streets. A month later, Isaac was back home and CPS closed the case.

Little has changed. He's since run away twice and barely attends school, but has started counseling. DeNigris is considering borrowing against a retirement account to get specialized neurological treatment if the state refuses to pay for it.

"This was a waste of everyone's time. I was grabbing at straws," she said. "We're not trying to have anybody take responsibility for our children. That's not it at all. We need help. I need someone to help me get this child on track."

Though parents and providers might disagree on the cause or the cure, they agree that a failed adoption is a failure in every way: for the parents, the child and the system.

A group of Valley adoptive mothers has formed an informal support group to share ideas and advocate for families that have returned kids to Child Protective Services or fear they may have to. They want state lawmakers and child-welfare administrators to acknowledge the inadequate services and provide appropriate mental-health treatment for their children.

"In my opinion, these kids' rights are being violated," said Nancy Williams, who has adopted seven children from CPS. "The answer is not for these kids to be arrested and sit in a cell. That's not going to fix them. That's going to make the problem worse. We need to have the services now, when they're kids."

Williams, who's struggling to get treatment for her 10-year-old adopted son, and other parents met with Calcoate earlier this year and twice met with DES Director Clarence Carter. Carter, Calcoate and others at the DES seemed sympathetic, even appalled, at what the families were going through, and they vowed to help, she said.

In response to parents' complaints and concerns from DES staff, the agency created a new position -- adoption mental health specialist. Kathleen Michon, formerly an adoption subsidy caseworker, is charged with helping parents navigate the behavioral-health system to find the right care for their children.

CPS didn't make Michon available for comment. But Williams is skeptical that Michon can make much of a difference on her own. She believes it will take a policy shift by state elected officials and the DES to provide post-adoption services for families, along with the coordinated support of parents.

"We're going to support each other, and try to figure out where we need to go next and who we need to talk to," she said. "This is my kid, not my adopted kid, and I want the best for him. And we will continue to try to find it."

They are likely to find a sympathetic ear in Sen. Rick Murphy, R-Glendale, a foster parent who adopted five kids.

Murphy said he will push legislation to allow the DES to oversee its own behavioral-health budget rather than working through Magellan Health Services and other agencies hired by the state to manage care.

"Sometimes undoing the adoption is the only way the parent can get the child the help they need. ... That's absurd," he said. "We need to do a better job of supporting the adoptions after they happen."

Parents also want the state to begin tracking disruptions and dissolutions, not to punish adoptive families but to understand what's gone wrong so it can be fixed.

In Washington, Gov. Christine Gregoire and lawmakers are preparing legislation in response to a rash of children seriously injured or killed by adoptive parents. A committee set up to look into the problem suggests strengthening state oversight of licensing agencies, tracking failed adoptions, improving training for prospective parents and offering better post-adoption support.

"Once the child is adopted, there is no further followup. It's done. The adoption is final," said Mary Meinig, director of Washington's Office of the Family and Children Ombudsman and co-chair of the committee. "There's nobody going out and seeing the child."

Bringing an adopted child into the home, especially older children and those who were mistreated, can present unique challenges. Isolation was a common theme in the cases that Meinig examined, in addition to a tendency by caseworkers to ignore warning signs in favor of meeting state and federal time limits.

"Once you adopt, I don't think it's unreasonable to treat these children like biological children," Meinig said. "But if things fall apart, it's like we were never part of it. I think we need to really look at that."

Without proper treatment for her 15-year-old adopted son, Martha Schubert said she is "really afraid for people's safety."

Schubert and her husband, who have adopted 11 children from Arizona's foster-care system, faced two CPS investigations over the past five years when they refused to bring the boy home. He's not improving at Chandler's Parc Place residential treatment facility, she said, and she's pushing to have him placed at a specialized hospital in Texas.

"When he turns 18, what are they going to do then? Everybody should prepare for a pretty horrific outcome."