We Haven’t Done Enough to Increase the Safety of Adoptions
Roxanna Asgarian’s powerful new book, “We Were Once a Family: A Story of Love, Death, and Child Removal in America” spotlights one of child welfare services’ most correctable deficiencies. When foster care adoptions began, the general belief was that adopted families should be treated like birth families and basically left alone, with the not insignificant exception of receiving adoption subsidies. Some families even refused adoption subsidies because they viewed them as stigmatizing. That view arose from an earlier period when most adoptions were closed, secret and invisible.
We have come a long way in opening up adoptions, but are still held back by a fear of recognizing adoptive families as needing something different or more than other families. But they do.
Although it’s always risky to make policy from rare cases like that of Jen and Sarah Hart — the couple who killed their six adopted children in 2018 — general research on filicide shows that children who live with non-biological parents (e.g., step-parents or partners unrelated to the child) are at greater risk of murder than children living with biological parents. This may apply less to foster and adoptive parents (who must pass background checks and home studies), but as the Harts’ murders suggest, cannot be ignored.
More than forty years of foster-care adoption work leaves an undeniable impression that families who adopt children from foster care have significant difficulties and challenges — and that they should not face them alone. Nor should the adopted children go without any recognition of their elevated risk of poor outcome — albeit not often expressed as child fatalities, but often including stays in residential care and other displacements from the home.
Too many foster and adopted children are dying. Mary Hodorowicz and I wrote a review of foster care and adoption filicides more than a decade ago, looking at the problem and what we were not doing to address it.
I see little improvement. Although we do not keep adequate statistics as states or as a nation, we can read the papers to find stories of murders of adopted children — stories that are often especially disturbing because adopted children who are killed by their families are typically much older than children killed by biological parents. Starvation, strangulation, and other treacherous methods — like those that killed the six children whom Asgarian writes about — are often the means. Another aspect that immediately appears unusual about foster care and adoption filicides is that both parents seem to more often be involved in the maltreatment and murder. We do not now collect enough information to adequately fill in the profile.
The fatality rate of children in foster care and adoption can be tallied. Indeed, this level of information should be the standard across the United States. The U.S. Department of Health and Human Services should obtain annual information from every state on all child deaths (regardless of cause) for those receiving foster care, children who have previously received foster care and are now provided an adoption subsidy, and all children who have had open child welfare cases (involving foster care or otherwise). This would not be difficult: states should be able to basically match child welfare services records and mortality records, which are in the public domain. In time, this effort should be complemented with information about serious injuries to children, because such information helps make the study more informative and because the need to prevent these injuries is great.
The emphasis in this work should be to better understand what practices might have prevented these deaths. This analysis can be the first in a series of theory development and practice-research stages that attempts to increase safety for children in foster care and adoption. For example, in earlier work in North Carolina, adoption disruption risk is associated with the number of household moves a family makes, because moves can be indicative of family difficulties.
Multiple, often rapid, address changes call for child welfare worker outreach to families and children to assess their safety. Had the frequent moves of the Harts prompted more scrutiny, this tragedy might have been avoided.
A 2002 study found that reports of abuse and neglect deaths are likely underreported, as many death review teams are not precisely coding cause of death as child maltreatment. Federal legislation has been proposed to improve this process, but we also need to collect death data from all causes for child welfare-involved children so we do not miss those that are not narrowly identified as child maltreatment.
Hopefully, this can be accomplished without denigrating the significant contributions of foster and adoptive parents or distorting the available evidence that the vast majority of foster and adoptive placements are safe. The benefits that permanency typically helps achieve are noteworthy. Reliance on ad hoc media reports of foster care and adoption filicides threaten to undermine the value and appeal of a program that is a fundamental aspect of our child welfare system. National data is crucial.
Another longer-term path to identifying foster care placements and adoptions that fail by virtue of disruption, abuse or death is to standardize the collection of information about foster and adoptive parents during the home-study process. The Structured Analysis Family Evaluation (SAFE) program offers a template to be used with both foster and adoptive parents and collects information about a range of sensitive topics related to applicants. Although we do not know if SAFE home studies make adoptions safer, the standardized collection of family characteristics would be hugely helpful in understanding risk. A standard home study like SAFE could be matched with statewide automated child welfare information systems and used to guide post-adoption supervision plans that could help higher-risk families succeed in safely and successfully becoming foster or adoptive parents.
More generally, we need to gather risk data on all foster and adoptive parents and enlist this information and other sources that could be useful in understanding the risk under which children are living. In one case of an adoptive mother who had three children placed in her home by the District of Columbia, two were killed. This mother had significant mental health and financial troubles, routinely asked for adjustments to her subsidy and moved to stay ahead of creditors. If a mechanism had been in place to flag her record and bring her history to the attention of someone who could follow up with her, these tragedies might have been prevented.
We are poised to extend outreach to adopted children and families, although just how this would work needs to be determined. “We Were Once A Family” offers a very obvious caveat — check-ins with adoptive families cannot be pro forma and cannot assume that because adoptive parents are typically “middle-class” families of good will that they cannot be dangerous.
Since the passage of the Fostering Connections to Success and Increasing Adoptions Act in 2008, federal law has required that parents who receive a subsidy after adopting children from foster care must show that the children are in school. This was the first federal law to require that any check on an adopted child’s well-being be made, although some states have had such checks. This federal change provides a precedent for keeping statistics on abuse or murder by foster and adoptive parents: it is in keeping with the responsibility of the federal government to ensure the quality of child welfare services. Using that information in real time to include child-wellness checks is a sensible next step.
On any day, America has more than 850,000 children receiving child welfare services through foster care or adoption subsidies. Even though these out-of-home-care placements are often made after child welfare worker, supervisor, and judicial review deemed the actions consistent with the best interest of the children, it is abundantly clear that some form of continuous review of the safety of all placements is needed.
There are enough signs to warrant this additional data collection, and to justify using this information to develop preventive interventions at the policy, program and practice levels. This more refined analysis could suggest more pre- and post-adoption interventions to stop severe abuse or filicide.