Wednesday, December 17, 2008

The Second in a Series of Seven Stories

A .K. was first admitted to Hillsides on 4/05/06 and was discharged on 6/5/07. When A.K. entered Hillsides, he was morbidly obese, weighing more than 148 pounds. When he was discharged a year later, he had dropped to 122 pounds through a combination of diet and intensive exercise supervised by the nursing and recreation departments. While still overweight, his general health had improved dramatically. Upon his re-entry into Hillsides’ residential program in July of this year, after having been removed, he weighed 226 pounds.

At the time of discharge, A.K. was still not stabilized, although he had been doing better. Hillsides’ advocates were opposed to the discharge both for his fragility, and also because his mother had barely been released from jail and had not received services to help her deal with this boy. The Los Angeles County’s Department of Children and Family Services made the decision to move him with no input from Hillsides. It wasn’t until Hillsides’ intervention that the County agreed to a post-discharge Team Decision Making meeting (TDM). (A TDM meeting is an opportunity for all interested parties in the life of the foster care child to convene and address his discharge and treatment plan for a successful replacement.)

At that point, Wraparound Services were initiated and provided by Hillsides’ team. A.K. did not do well at home, and his mother was not effective. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes). He was readmitted to Hillsides on 7/22/08.

1. Have a TDM that would include the mother in the planning process
2. Set up a plan that would insure that she was established back into the community with a job that could support A.K. (the mother and son were homeless when he returned to Hillsides).
3. Provide Wraparound services well in advance of his returning home

1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)

Friday, December 12, 2008

Where is the Bailout for Charities Serving Children and Families?

Teresa De Crescenzo, Executive Director of GLASS Youth and Family Services, wrote an excellent opinion article for the Los Angeles Times where she asks “Where’s the bailout for non-profits?” She continues, “The stock market is in free fall, financial organizations are being bailed out and the Detroit automakers may yet get financial help from Washington. But what about those of us in the non-profit world? Where’s our bailout?” I salute Ms. De Crescenzo for expressing what many of us who devote our lives to helping others feel.

The State of California is enmeshed in their own fiscal meltdown it appears that it will not be in a position to help non-profits for many years. In fact, the exact opposite has been and is occurring. As the Executive Director of a major residential treatment center for children in foster care and families, my Board and I struggle to give abused, neglected and abandoned children the treatment that they need and deserve. Despite the fact that the State has failed for years to cover the costs of these comprehensive services, we continue to treat thousands of children and their families each year with a system of funding that has only given Hillsides an increase of 5% after more than five years of flat funding---not even an annual cost of living increase.

In effect, charities like Hillsides and the clients we serve have been burdened almost to the breaking point while we as a society are willing to bailout corporations who are now experiencing the aftermath of their own mismanagement and greed. Where is the equity for those children who are unfairly being accused of depleting state funds due to an increase in demand for the free lunch programs, as reported in the Pasadena Star-News on December 4? Where is the fairness for those children who are suffering due to the cuts in educational support or whose families have had their child care subsidies slashed?

If I sound angry and frustrated, I am. Everyday, I see firsthand the suffering and challenges people face—particularly the children in foster care who have no voice. Out of a commitment to create safe places for children and families living in Los Angeles County, the Board of Hillsides continues to take the position that rather than cut vital services, our charity is using our limited financial reserves to manage this downturn in the economy. Our reserves are not an endless source of revenue and, frankly, I do not know how much longer we will be able to continue doing this. A non-profit’s only alternative when funding is not available is to turn desperate people away, as we have no bailout to fall back on.

If the choice is between sitting on the sidelines willing to maintain status quo or letting children continue to suffer the ravages of child abuse or go without breakfast and lunch or providing assistance to charities, the answer seems simple to me. While many of you might not like the idea of tax increases, I believe this is the only option left open to the State of California. We’ve tried budget cuts with disastrous human consequences, now it is time to consider “Whoever does this on the least of thee does it to me.”

Monday, December 8, 2008

The First in a Series of Seven Stories

This child was admitted to Hillsides on 4/4/06 and discharged on 4/18/07. Prior to coming to Hillsides, this client had experienced multiple failures in school. In addition to poor academic progress, he had behavioral problems, and was a chronic truant as well. At Hillsides Education Center, he achieved stability in both school attendance and performance, developing a particular interest in the industrial arts program. He reduced his aggressive behavior and truancy.
Upon discharge, he went to a group home in San Bernardino to be closer to his grandfather. M.R. was a street-savvy kid who was not a good fit for Hillsides. His grandfather came in regularly for family treatment, but as he lived almost two hours away, it was difficult for him. Although we were not optimistic about M’s prospects for success, his grandfather very much wanted him to be closer to home. We didn’t oppose this plan.

A DCFS Team Decision Meeting was arranged, but because he moved to another group home, aftercare services was not recommended. He left the group home after two or three weeks (he was considered on status AWOL, Absent Without Leave) and lived on the streets for a while. He apparently was placed in several group homes following his sojourn on the streets.

The plan to move the client closer to his grandfather was a good one. Things DCFS might have done: 1) Explore the suitability of the receiving group home for this client, and 2) Had a Wraparound provider involved with the transition with a goal of placing him with the grandfather. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).

1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)

See below to find out what you can do to help a child and youth in foster care.

Friday, November 14, 2008

Requiring Foster Family Certification for Adoptions May Close Some Family Doors

Just when I think that the administration of the Los Angeles County Department of Children and Family Services (DCFS) is on right path with initiatives to keep families intact with supportive services, to move children in out-of-home care back into their families, extended families or adoptions, they come up with a policy that flies in the face of good practice.

The Department of Child and Family Services and its Director, Trish Phloehn, are insisting that they will not contract with foster family agencies (FFA) who do not certify their foster families for adoption. For those unfamiliar with the process, this direction means the foster family will be required to go through a process for certification that is similar to the process they already go through to be certified foster families. The major difference is that they must be willing to declare that they are interested in adoptions.

At first blush, this would seem to be an improvement in service delivery because it would cut down the time that it takes for a foster home to become an adoptive home. In fact, DCFS is citing this as a reason for wanting it in the contract. They are also saying that an adoptive home study is a higher standard than a foster home study even though FFAs report that they are just as exacting for their foster homes as the adoptive homes. And finally, DCFS is saying they do not want a foster family who wants to adopt to fail the certification and approval process to adopt a child even though DCFS can not cite, nor can the FFAs cite, an instance where this has happened.

What they fail to take into consideration is that foster care homes for some children are temporary homes used to care for the child until reunification or permanency can be worked out. A number of foster care homes would like to assist children in this transition period of their lives, but do not have a desire to adopt. A number of foster care families who entered the foster care system with the idea they did not want to adopt have changed their minds after being foster parents to a child or children. In other words, they fell in love with the child or children and decided to adopt. Demanding that they be certified to adopt prior to accepting foster care children may have stopped these families from being foster parents. The Department could have closed the door of opportunity for adoption at a later date.

Couples like my wife and I who are over 65 who might have the time to do foster care would be eliminated because we are too old to be certified, or because we are not interested in adopting at this stage in our lives. Some wonderful older couples, who take in babies and toddlers while reunification is being worked through, would be eliminated from the pool of potential foster care homes. If, in fact, a foster home does want to adopt, and an infant or toddler is in their care while the biological mother is getting clean and sober, it puts the foster parent in competition with the mother. This unintended competition is not supportive to the reunification process.

Hillsides does not have a foster family agency, however, at one time Hillsides did take in infants and toddlers whose mothers were addicted to drugs and alcohol and worked with them to help them regain their babies. This was one of the most successful programs we operated, because these mothers did not want to be addicted, wanted to get clean and sober, and wanted to regain their babies. Most of the mothers were able to get their children back within 12 months. One of the things we had to do with our own child care staff is to remind them that they were to be role models to these mothers, they were not to put up barriers to helping the mothers bond with their children. Even though they also loved these children, their job was to help the mother regain custody. This would be a difficult task for a foster care mother who wanted to adopt the child she was caring for.

The Department needs both kinds of foster care homes. The Department will have children who will not be able to return to their families and need a permanent home where adoption would be the outcome. Several types of foster care homes exist: those very much interested in adopting children, those that may grow into that frame of mind as the child has lived with them, or those that may have gotten into foster care with the expressed intention of wanting to adopt.

Unfortunately, the Director of DCFS has persuaded the Los Angeles County Board of Supervisors to buy into this policy without hearing some of the strong arguments against doing this. We now have a situation where the Board of Supervisors has publicly supported its DCFS Director, and it is difficult for them to reverse their decision.

The direction taken should not be either or, but a thoughtful discussion on solutions that will meet the needs of all parties involved.

Wednesday, November 12, 2008

Outrageous Reaction Can Result in Further Replacement

It seems like the more reasonable the public policy is for foster care children, the more outrageous the reaction is in carrying it out. Just last week, a child we have had in placement for four years had a Team Decision Making Meeting. The upshot of the meeting was that this girl was in placement too long and needed to move. So Department of Children and Family Services decided to move her the next day, without any thoughtful planning for a transition, determining school placement, and identifying what supportive services she and her placement caregivers might need.

As the executive director of a foster care children’s charity in Los Angeles County, I have seen too many of these thoughtless reactions. I guarantee that she will be replaced before the end of the year. This is a very difficult child who will probably be in some sort of “placement “ for the rest of her life.

This is no way to move children out of placement.

Tuesday, October 21, 2008

Proposition 4 Adds Risk to Young Girls

I am writing to all of you over my concern regarding an initiative that will appear on our November ballot, Proposition 4 “Waiting Period and Parental Notification before Termination of a Minor’s Pregnancy”. This is almost a carbon copy of Proposition 85, which was defeated in the 2006 election. The initiative would require all doctors or clinics to give parents of minor girls 48-hour notice if their child is requesting an abortion.

The significant difference between this proposition and Proposition 85 is an alternative exception to notification requirement, which states that doctors can notify an adult family member instead of a parent, based on a written statement from the minor that (1) she fears abuse from that parent, and (2) her fear is based on a pattern of such abuse.

As a parent, we would all want to know if our daughter was pregnant and if she were requesting an abortion. Certainly, as a professional, well-educated adult who is the parent of a young woman, we would want them to postpone sexual activity until they are mature enough to handle it and that they have the tools to practice safe sex when they do decide to do it.

We know that 70% of young women do speak with their parents about their pregnancy already. We also know that it is impossible to legislate good communications with family members.

As advocates for disadvantaged, abused children, we should be concerned about this proposition because its passage would put this population at the greatest risk. Although the alternative exception requirement to an adult family member has been added, in the real world children who suffer abuse would risk further abuse. The children are in danger of being further abused should they tell, and/or seriously injured or killed, should they try some non-medically approved procedure to abort their pregnancy.

I would urge all of you to study the proposition carefully, keeping in mind what it would mean for the many battered and abused children of our community should it pass.

Tuesday, October 7, 2008

Recent Trends Indicate Poor Performance

As executive director of Hillsides, I am an outspoken supporter of the current trend in public policy to initially evaluate every family who comes to the attention of the Department of Children and Family Services (DCFS) to determine the risk factors in leaving the child/children in the home and providing services to the family to stabilize the children. Hillsides , along with a number of other agencies around the State, demonstrated that this was an effective strategy in a State pilot for Family Preservation. Families received the help they needed, and children remained safe in their own homes.

The dramatic reduction in out-of-home placement from 39,000 in 2000 to 20,000 in 2007 can be attributed to the above strategies and others that DCFS put in place. The net effect has been to reduce the number of children in group homes and to decrease the number of placements that children endure before they are to be placed in a residential treatment center.

All of this is a positive step in the right direction. However, there is a trend in our current placements that is of great concern to me. There is a rush to move children through the residential programs and into “permanent placements,” which has some disturbing and unintended outcomes.

Even though we do not have access to the children’s records once they leave Hillsides, we do learn what happens to many of them.

Over the past 12 months we had 14 DCFS children leave Hillsides. Of those 14, we know that seven returned to placement and of the remaining seven, we do not know the results of five of them; two remain at home. None of the children who left went to another group home, all went to single family homes. These statistics are not good. We know that 50% failed to remain in their placements; it could be and most likely is higher since we do not know the fate of five of the children.

Many factors could be cited for this poor performance. I am not interested in fixing blame, but on studying the individual cases to see if there are steps Hillsides, the County, and the courts can do to improve this poor outcome. I plan to take what few facts we know about each of the seven cases and see if there is something that Hillsides can do directly to influence a better outcome.

This poor performance is not peculiar to us, but it spans the whole placement community. I know for a fact that another large well-respected agency reported a similar trend. I would hope that the Department of Children and Family Services would step back and evaluate what is happening and collaborate with the providers to improve this situation.

Tuesday, September 9, 2008

Response to Guest Letter

In response to our guest letter that was posted on September 5 on my blog, I appreciate the views, opinions, and concerns of our donors, friends, and supporters, including those who differ from Dr. Astrid Heppenstall Heger. My blog is not meant to advocate for one political party, but rather to highlight issues that affect the children and families we serve at Hillsides.

We live in a nation where we can be respectful of opinions and perspectives that differ from each other. We live in a nation where society can be heard, legislation can be signed into law, and justice can prevail. Equally, we live in a nation where some children experience horrific situations and I’m afraid the trauma will be with them for the rest of their lives. I am only hopeful that the men and women who commit these horrific crimes will be prosecuted to the fullest extent.

When a child such as ten-year-old Maria finds herself 16-weeks pregnant and struggling to get through this terrible experience, I am comforted by the fact that she will survive because of a legal medical option available to her. I personally would prefer that we live in a nation where abortions do not occur. However, I also feel this procedure has been going on since the beginning of humanity and legislating against them is not going to stop individuals from having one. Taking in the pros and cons I come down on the side of a woman’s right to choose (believe me this is not an easy decision for them) and sanctioning medically supervised abortions with regulations.

But for children like Maria what is at stake is their survival, their sanity, their healing, their hope for a better childhood, their courage to move forward. As a service provider for children and families in crisis, we must highlight the difficulties and complications of social services that will arise for our clients. And in our 95 years of existence, Hillsides has been creating safe places for children and families who are in crisis. We have been able to serve 35,000 children and their families, providing mental health treatment, giving the tools for a stable home, educating parents on how to better communicate with their children, and finding ways together to preserve the families that will lead to creating safer places for everyone.

We are fortunate to have professional staff with the expertise and knowledge to give this mental health support to our children and families. We are also fortunate to have donors, friends, and supporters who care for the mission of Hillsides—creating safe places for children and families—by giving their time, talent, and treasure to enrich the lives of our foster care children who have been physically, sexually, or mentally abused, to expand services, to empower others and spread awareness of the good work we do in the community, and to join us in the numerous opportunities to make a difference.

With this in mind, I thank you for your time, compassion, and understanding of the many views that make up the fabric of our nation.

John M. Hitchcock, LCSW

Friday, September 5, 2008

Guest Letter: Disgrace and Discouraged

Dear John,

Maria had driven to Tijuana with her mom, sister and little brother to buy a special dress for her aunt's wedding. This was the most beautiful dress she had ever owned--no the most beautiful thing she had ever seen--and she hung it on a nail pounded into the wall of a garage in Bell Gardens that they called home. Every Sunday she tried on the dress--anxious for the time to pass when she could wear it to be in the wedding. But one Sunday the dress had become too small, her mother could not fasten the small white buttons. Her mother rushed her to the emergency room fearing the worst--cancer.

I was summoned to the Emergency room to evaluate Maria--She was sitting in the corner of the windowless exam room with tears running down her face. Her mother had fled the room leaving her to fend for herself. A tiny 10 year old she looked much younger than her age, and now dressed in a too-big dress handed down to her and wearing black Mary-Jane shoes and bright white socks she looked translucent--a shadow of the girl that might have been.

At age 10 she had just been told that she was pregnant. Pregnant by her father who had been raping her for over two years. We spoke and I comforted her--on examination we found her to be 16 weeks pregnant, and because she was so small her womb was now pushing down her vagina making intercourse impossible so her father had been raping her anally. Her sister when asked about whether the little brother had been sexually abused--said "No, he still laughs."

So last night when the Republicans welcomed with thundering applause, a woman who believes that all abortions must be outlawed--my heart stopped in my chest at the very idea that we as a Nation would ever consider taking away the rights of women and children--my patients--raped, abused and violated in the most horrific ways. How careless we are with the lives and souls of those who are less fortunate.

I am moved to tears at the thought of the precipice that we are approaching. I could spend hours on poverty, loss of the middle class, no health care etc etc etc.--but sitting there that day in that stark, cold clinic room with a little girl whose only hope for survival was an abortion--I was glad to have that option. Of course, I would love to see a time come when everyone knew to practice abstinence, or even birth control, or a time when rape and incest were words we did not understand and women had the right to say no and have someone hear her--but apparently none of these words---abstinence, birth control, rape or incest has penetrated the isolated, cold world of Gov. Palin.

Tell me where we go to be heard--I cannot believe that women, and men, across this country who understand what violence against women and children really means--will not stand up to be counted.

Astrid Heppenstall Heger, M.D.
Professor of Clinical Pediatrics
Keck School of Medicine
Executive Director
Violence Intervention Program
Los Angeles, CA

Tuesday, March 25, 2008

In American history women have played a significant role in making our country what it is today. In particular, women addressed a plethora of unmet needs in communities and founded countless nonprofits. Most specifically in Los Angeles County, Deaconess Evelyn Wile envisioned a world where children were safe and nurtured in their homes.

During National Women’s History Month, I wanted to bring attention to Wile’s vision, which has rescued over 35,000 children in 95 years. Founder of Hillsides, formerly the Church Home for Children, a Pasadena foster care children’s charity, Wile saw the devastating affects of death, divorce, desertion, and disease had on children left behind.

Serving children at risk and their families in Los Angeles County, Hillsides follows in the footsteps of its founder who believed in creating safe places for children. Unlike the traditional orphanages of the early 1900s, Hillsides created a cottage concept, an open space home environment where children would experience a normal childhood, share a room with no more than three children, and be cared for by house parents.

Reminiscing, Wile described what was apparent, “I knew there was no money, land or house for such an undertaking--nothing but five hens which a friend had promised me…” With blessings from the Bishop of the Episcopal Diocese of Los Angeles, Wile set forth and purchased the first home in Highland Park in 1913, and in just four years relocated Hillsides to what many children refer to as their safe haven--17 acres in the San Rafael Hills of Pasadena.

Wile continued, “Through the kindness of friends who loaned their cars, we were able to take the children out to the new homesite and allow each of them to turn a little of the sod and thus be in ‘at the beginning.’ We hoped that the lesson of the bare hillside would impress itself upon the children’s hearts and minds, in comparison with what is ‘to come’ through the generous gifts which have been made.”

Today, children continue to turn a little of the sod, tend to the weeds, and discover new life in plants and flowers. In their gardens, they find a peaceful, restful place they can visit to get their minds off of the things that may be weighing on their hearts and minds.

Children living at Hillsides because of their foster care placement or severe emotional disturbances find comfort, security, and trust with our staff. Given intensive treatment combined with recreational therapeutic activities, children begin to thrive and establish connections with adults.

In addition to the residential program Wile founded, Hillsides has expanded its programs and services to serve families in crisis who need support in redirecting their lives to create safe places for their children. We also provide special education and a transitional living and housing program, as well as advocate for children’s rights.

When a man was directed to the home during Wile’s day, he was surprised to hear what Hillsides really was, and said he had “‘supposed those were two real homes--perhaps a father and son were building.’ And that’s exactly what we want them to be--real homes!” Wile recalled.

Wile truly created a real home for children traumatized by their early circumstances. After 95 years, eight homes, and an apartment building, Hillsides remains a true home to 66 children and 20 former foster care youth.