Saturday, June 24, 2017

What Every Parent Should Know Network

Chapter 5 Child Welfare Removal Reunification and Termination

Chapter 5: The Child Welfare System: Removal, Reunification, and Termination
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Tiffany Callo,[208] a wheelchair user with cerebral palsy, dreamed of being a mother. In 1987, Tiffany’s dream came true when she gave birth to her son David. Immediately following David’s delivery, the county’s child welfare agency asserted that Tiffany and her boyfriend, who also had a physical disability, could only take their son home from the hospital if they had a nondisabled caregiver with him at all times. Shortly after David’s birth, Tiffany’s relationship with her boyfriend began to deteriorate, and domestic violence ensued. Unable to deal with the domestic turmoil, David’s live-in caregiver moved out. David was immediately removed to foster care by child welfare workers. Meanwhile, Tiffany learned that she was again pregnant. Her second son, Jesse, was immediately removed to foster care by child welfare workers. Tiffany was granted limited supervised visits with David and Jesse while she fought with the county for custody of her children. Realizing that she would need some assistance to care for her sons, Tiffany requested attendant care to help her with parenting activities, which the county denied.

In June 1988, a custody hearing began. As evidence, the county presented a videotape of Tiffany slowly diapering David during a supervised home visit. The county asserted that the tape demonstrated Tiffany’s inability to care for her child because it documented her slow movements as she changed David’s diaper. This argument ignored Tiffany’s adaptive care for her baby, encouraging him to be patient. Expert testimony supported the mother’s behavior, stating that infants learn to hold still during long diapering sessions when parents support their patience.

Eventually, battling with the child welfare system wore her down. David and Jesse were ultimately adopted by two separate families, despite assurances that they would remain together. Tiffany was granted a supervised annual visit with each child.

Tiffany’s tragic story highlights an all-too-familiar situation for many parents with disabilities. More than two decades since Tiffany lost her children, parents with disabilities still do not fit the norms and expectations of the American nuclear family, and often run afoul of presumptions and myths when they have to deal with the child welfare system. Parents with disabilities and their families are frequently, and often unnecessarily, forced into the system and, once involved, lose their children at disproportionately high rates. This chapter examines the child welfare system’s treatment of parents with disabilities and their families, including state dependency statutes, disparities caused by inadequacies in the ASFA, and the perceived limitations on the application of the ADA. The “unfit parent” standard regularly applied to parents with disabilities is one of the major threats to people with disabilities who choose to parent, and presumptions about “fitness to parent” carve out parents with disabilities as a key population that must prove its ability to parent in American society. Further barriers in representation and access within the child welfare system compound the discriminatory impact on parents with disabilities and the consequent breakup of loving families that can result.
The Child Welfare System: A Brief Overview

The child welfare system “is a group of services designed to promote the well-being of children by ensuring safety, achieving permanency, and strengthening families to care for their children successfully.”[209] The system includes state child welfare agencies, the courts, private child welfare agencies, and other service systems (such as mental health, substance abuse, health care, education, and domestic violence).[210] The goal of the child welfare system is laudable: “To promote the safety, permanency, and well-being of children and families.”[211] The primary responsibility for the child welfare system rests with the states; however, the Federal Government plays a significant role in supporting states in the delivery of services by funding programs and legislative initiatives.[212] The law in most states makes the child welfare system responsible for responding to and following up on allegations concerning the safety of and risk of harm to children in the community.[213]

The ACF at HHS is responsible for the administration and oversight of federal funding to states for child welfare services under Titles IV-B and IV-E of the Social Security Act.[214] Two titles under the Social Security Act provide federal funding targeted specifically at foster care and related child welfare services. Title IV-E provides an open-ended entitlement for foster care maintenance payments to cover a portion of the food, housing, and incidental expenses for all foster children who meet certain federal eligibility criteria.[215] Title IV-E also provides payments on behalf of eligible children with “special needs” who meet other federal eligibility criteria. Special needs are characteristics that can make it more difficult for a child to be adopted and may include disabilities, age, being a member of a sibling group, or being a member of a minority race.[216] Title IV-B provides funding for child welfare services to foster children, as well as children remaining in their homes.[217] Title IV-B also provides funding to states and eligible tribes to support family preservation services, community-based family support services, time-limited reunification services, and adoption promotion and support services.[218]

Families typically become involved with the child welfare system after an allegation of abuse or neglect (also referred to as child maltreatment) is made to child protective services (CPS). CPS is a specialized part of the child welfare system.[219] State laws require CPS agencies to take reports from people who believe a child has been abused or neglected; determine whether abuse or neglect has taken place; ensure that there is a plan in place to keep children safe; and provide services to families to ensure their children’s safety.[220] Anyone who suspects that a child is being abused or neglected can call the local CPS to report the suspicion.[221] Any member of the community, parents, or child victims themselves can initiate an allegation of suspected child abuse or neglect. Professionals who work with children or families—such as doctors, nurses, social workers, teachers, psychologists, and police officers—are “mandated reporters,” legally required to report suspected abuse or neglect.[222]

Once they receive a report of child maltreatment, CPS workers screen the allegation for credibility.[223] A report is screened in when there is sufficient evidence to suggest that an investigation is warranted. Conversely, a report may be rejected for insufficient evidence or if the situation reported does not meet the state’s legal definition of abuse or neglect.[224] These standards are in place to ensure that the state does not run afoul of the 14th Amendment right of parents to be free from state intrusion unless such intrusion is required to protect citizen children.

If CPS deems the allegation credible, workers conduct an investigation to determine whether the child is safe, whether abuse or neglect has occurred, and whether there is a risk of it occurring again.[225] At the end of an investigation, CPS workers typically conclude either that the allegations are substantiated and require further action or unsubstantiated and not worthy of continued investigation or action.[226]

The CPS agency will initiate a juvenile court action if it determines that a dependency proceeding is necessary to keep the child safe.[227] To protect the child, the court can issue temporary orders placing the child in shelter care during the investigation, ordering services, or ordering certain individuals to have no contact with the child. At an adjudicatory hearing, the court hears evidence and decides whether maltreatment occurred and whether the child should be under the continuing jurisdiction of the court. The court then enters a disposition, either at that hearing or at a separate hearing, which may result in the court ordering a parent to comply with services necessary to alleviate the abuse or neglect. Orders can also contain provisions regarding visitation between the parent and the child, agency obligations to provide the parent with services, and services needed by the child. If a child has been abused or neglected, the course of action depends on state policy, the severity of the maltreatment, an assessment of the child’s immediate safety, the risk of continued or future maltreatment, the services available to address the family’s needs, and whether the child was removed from the home and a court action to protect the child was initiated.[228]

For the state to succeed in termination proceedings, clear and convincing evidence must establish that statutory grounds for termination have been met and termination must be in the best interest of the child.[229] Termination of parental rights is devastating and final. Describing the severity and significance of termination of parental rights,

Stephanie Gwillim, in her St. Louis University Public Law Review article, said, “Termination of Parental Rights (TPR) is the death penalty of civil cases. Once a parent’s rights to his or her child are terminated, that parent’s rights to care for, visit, or make decisions for the child are gone forever: the legal parent-child relationship has ended. The parent cannot seek a modification for the permanent custody order after his or her rights have been terminated. The child can immediately be put up for adoption and a biological parent may never see their child again.”[230]
Disability Law and the Child Welfare System

Both the ADA and Section 504 of the Rehabilitation Act (for agencies receiving federal funding) apply to the child welfare system. The ADA was passed with the intent of ensuring “full and equal opportunity” for Americans with disabilities. Undoubtedly, the ADA’s breadth and national mandate of eliminating disability-based discrimination applies to the child welfare system and dependency courts. Indeed, the ADA’s legislative history indicates a clear correlation. For example, during a congressional hearing, Justin Dart, Jr. (referred to as the “father of the ADA” by the disability community) testified, “We have clients whose children have been taken away from them and told to get parent information, but have no place to go because the services are not accessible. What chance do they ever have to get their children back?”[231] Another witness attested, “These discriminatory policies and practices affect people with disabilities in every aspect of their lives… [including] securing custody of their children.”[232] Echoing the need to eliminate discrimination faced by parents with disabilities, another person testified that “being paralyzed has meant far more than being unable to walk—it has meant…being deemed an ‘unfit parent’” in custody proceedings.[233] Thus, “The ADA’s unequivocal rejection of prejudicial stereotypes and inflexible policies that harm people with disabilities could provide an important basis for rethinking child welfare policy toward families in which at least one or more parent has [a disability]”.[234]

Because the child welfare system generally includes state and local agencies, Title II of the ADA applies.[235] Accordingly, the system must comply with Title II’s mandate: “No qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”[236]

Pursuant to Title II, child welfare agencies must do the following:

    Provide parents with disabilities an equal opportunity to participate in programs, services, and activities.[237] To implement this mandate, the agencies must make reasonable modifications in policies, practices, or procedures, unless such modifications would fundamentally alter the nature of the service, program, or activity.[238]
    Administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified people with disabilities.[239]
    Not impose or apply eligibility criteria that screen out or tend to screen out any person with a disability from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.[240]
    Furnish auxiliary aids and services when necessary to ensure effective communication, unless an undue burden or fundamental alteration would result.[241]
    Provide, as needed, benefits, services, or advantages beyond those required by the regulation to people with disabilities.[242]
    Not impose surcharges on people with disabilities to cover the costs of measures to ensure nondiscriminatory treatment, such as making modifications required to provide program accessibility or providing qualified interpreters.[243]
    Not deny the benefits of programs, activities, and services to people with disabilities because entities’ facilities are inaccessible. [244]
    Provide services, programs, and activities that, when viewed in their entirety, are readily accessible to and usable by people with disabilities.[245]

Moreover, the child or children at the heart of the TPR proceeding qualify as a party suffering discrimination in accordance with the ADA owing to their familial association. According to the ADA, “A state or local government may not discriminate against individuals or entities because of their known relationship or association with persons who have disabilities.” This prohibition applies to cases where the public entity has knowledge of both the individual’s disability and his or her relationship to another individual or entity.[246] Thus, the ADA protects the children of parents with disabilities involved in TPR proceedings.

The ADA applies to both TPR proceedings and reunification services. The Supreme Court has said, “The fact that the [ADA] can be ‘applied in situations not expressly anticipated by Congress does not demonstrate ambiguity. It demonstrates breadth.’”[247] According to Dale Margolin, in her article “No Chance to Prove Themselves: The Rights of Mentally Disabled Parents Under the Americans with Disabilities Act and State Law,” “TPR and the ADA are inherently related: The TPR involves an examination of both a person’s disability and the state’s implementation of services. Furthermore, contrary to the fears of some state courts, allowing a parent to assert a violation of the ADA does not mean that that the child’s rights will be compromised. The child is always the focus of a family court proceeding, even when the court is examining a potential violation of the ADA. In virtually every state, the ‘best interest’ of the child is considered during the TPR. Furthermore, a parent’s evidentiary attack should not be viewed as necessarily contrary to the interests and rights of a child; if a parent has been discriminated against, and the parent-child relationship is severed, in part or in whole, because of this discriminatory treatment, the severance has drastic, and potentially harmful, consequences for the child.”[248]

TPR proceedings are services, programs, and activities covered by the ADA, which requires that there be no discrimination in these proceedings and reasonable modifications in policies, practices, and procedures that affect custody determinations if such modifications are necessary to avoid discrimination on the basis of disability (unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity). In fact, DOJ considers court actions to be “state activity” for purposes of the ADA and thus prohibits discrimination in all state judicial systems.[249] Notably, the Ninth Circuit has applied Title II to parole proceedings, which, according to the court, exist to protect the public, just as TPRs exist to protect children.[250] Reunification and other family preservation services should also be recognized as services, programs, and activities. In fact, federal courts have interpreted Title II broadly and specifically held that it applies to social services.[251] In addition, appropriate reunification and preservation services to parents with disabilities should include relationship-based intervention that facilitates the development and experiences of infants and children. When parents are deprived of these services, their children suffer the same deprivation.

In sum, the child welfare system must comply with the ADA, as well as Section 504 of the Rehabilitation Act as long as it receives any federal funding. Agencies may not discriminate on the basis of disability and must provide reasonable accommodations to appropriately serve parents with disabilities.
Disparate Impact of Child Welfare System on Parents with Disabilities and Their Families

Beginning with the investigation into a report of child maltreatment, bias pervades the child welfare system, and “at any step in the process, societal prejudices, myths, and misconceptions may rear their heads.”[252] Systematic discrimination by state courts, child welfare agencies, and legislatures against parents with disabilities and their families has taken a toll. Statistics indicate that children of parents with disabilities are removed from their parents with alarming frequency.

Although no national study has identified the total number of parents with disabilities who have been involved in the child welfare system, TLG recently completed a research study that identified the number of children in the child welfare system who have caregivers[253] with disabilities.[254] To complete this study, TLG analyzed data from 19 states[255] that met a 10 percent threshold for reporting to the National Child Abuse and Neglect Data System (NCANDS), a federally sponsored national data collection effort created to track the volume and nature of child maltreatment reporting each year in the United States. This study found that 29,986 victims (12.9 percent) had a caregiver with a reported disability: 21,543 victims (10.3 percent) had caregivers with a single disability and 5,443 victims (2.6 percent) had a caregiver with multiple disabilities. The race or ethnicity of children whose caregivers had a disability in the child welfare system of this study was as follows: white, 13,671 (50.7 percent); Latino/Hispanic, 4,922 (18.3 percent); African American, 4,255 (15.8 percent); American Indian/Alaskan Native, 1,833 (6.8 percent); Asian/Pacific Islander, 179 (0.7 percent). The types of disability of caregivers with a single disability included emotional disturbance, 12,427 (6 percent); medical condition, 3,598 (2.2 percent); learning disability, 2,885 (1.9 percent); physical disability, 1,350 (0.8 percent); intellectual disability, 726 (0.5 percent); and visual or hearing disability, 419 (0.2 percent). No data were available on the distribution of disabilities among the 2.6 percent of caregivers with multiple disabilities. This research likely greatly underestimates the number of caregivers with a disability, as parents are not routinely assessed for disability at the beginning of cases; even so, it demonstrates that involvement in the child welfare system of caregivers with disabilities is affecting thousands of children.

Researchers at the Center for Advanced Studies in Child Welfare (CASCW) at the University of Minnesota recently completed a study to understand the prevalence of parental disability among cases of termination of parental rights and to assess disability disproportionality in TPR cases.[256] Using MinnLInK data, which includes Minnesota state administrative data from multiple agencies, cases of TPR were identified in the Social Service Information System (SSIS) database in 2000–2009. Parents whose parental rights were terminated were matched to their educational records in the Minnesota Department of Education database. A parent was determined to have a disability on the basis of his or her record of having a disability in the school system. This study found the risk ratio for TPR for a parent with a disability label in his or her education records to be 3.26. In other words, parents who had a disability label in their school records are more than three times more likely to have TPR than parents without a disability label. The risk ratio for child welfare involvement for a parent with a disability label in his or her educational records is 2.37. In other words, parents who had a disability label are more than twice as likely to have child welfare involvement than their peers without such a label. Emotional or behavioral disorders (60.2 percent) were the most common disability labels for parents with TPR in this study. Parents who were labeled in the special education database with a specific learning disability made up 17.3 percent of the sample; those with a developmental or cognitive disability made up 9.3 percent of the sample; and 13.2 percent were labeled as having other types of disabilities. Although this study focused on a limited set of Minnesota parents with disabilities (parents who were involved in child welfare whose records could be located in the education database), it clearly demonstrates that disproportionality related to parental disability exists in child welfare.

Before these studies, little was known about what portion of child welfare populations comprised families with caregiver disability. Because child welfare agencies did not collect this kind of data, information at this level of detail was not available.[257]

Overall, involvement in the child welfare system results in increased numbers of families torn apart by removal of their children from their homes. Indeed, studies concerning the removal rates for parents with disabilities have long hinted at the significant over-involvement of these families with the child welfare system. Removal rates where parents have a psychiatric disability have been found to be as high as 70 percent to 80 percent;[258] where the parent has an intellectual disability, the rates range from 40 percent to 80 percent.[259] In families where the parental disability is physical, 13 percent have reported pathologically discriminatory treatment in custody cases. The deaf and blind communities also report extremely high rates of child removal and loss of parental rights.[260]

Overrepresentation is not a new phenomenon. A 1991 study examined more than 200 consecutive juvenile court cases in Boston and found that despite greater compliance with court orders, parents with intellectual disabilities had their children removed more often than parents without disabilities.[261] These initial removals often led to TPR. This is especially troublesome, as parents with disabilities who are involved with the child protection system are more likely to be facing allegations of neglect than of abuse or risk of abuse.[262]

Parents of color face even more risk of experiencing discrimination in the child welfare system. As stated in the NCD reportMeeting the Unique Needs of Minorities with Disabilities, “Persons with disabilities who are also members of minorities face double discrimination and a double disadvantage in our society.”[263] The child welfare system is no exception. In 2009—according to Children’s Rights, a national child welfare advocacy organization—more than half of the children entering foster care in the United States were children of color. African American and American Indian children are more likely than other children to be reported, investigated, substantiated, and placed in foster care. Thirty-one percent of the children in foster care are African American, double the percentage of African American children in the national population. Children of color, especially African American children and often American Indian children, are more likely to have longer placements in out-of-home care, are less likely to receive comprehensive services, and are less likely to reunify with their families than white children. The rates of child welfare involvement for African American and American Indian children are more than twice those of white children.[264] While no available data look specifically at the overrepresentation of parents of color with disabilities and their families, presumably the numbers are devastatingly high.

Researchers contend that parents with psychiatric disabilities are overrepresented in the child welfare system because of the common stereotype that people with psychiatric disabilities are dangerous. According to Loran B. Kundra and Leslie B. Alexander in their article “Termination of Parental Rights Proceedings: Legal Considerations and Practical Strategies for Parents with Psychiatric Disabilities and the Practitioners Who Serve Them,” “As a result of this stereotype, it may be the case that judges and lawyers, upon hearing a diagnosis, will presume a level of dangerousness on the part of the parent involved in the termination of parental rights proceedings and will remove their children because of it.”[265] Similarly, Diane T. Marsh found “that children of women with serious mental illness frequently enter the foster care system or, less commonly, are given up for adoption; that a majority of these parents have lost custody of their children; and that custody decisions are typically made with little communication between the mother’s treatment team and child protective services.”[266] In fact, Kundra and Alexander note that a recent study found that parents with psychiatric disabilities were almost three times as likely to have child welfare involvement or child custody loss.[267] The reasons for such targeting include the presence of psychiatric disability as a ground for termination of parental rights in many states, which triggers suspicion about these parents. In addition, many parents with psychiatric disabilities receive state services and are therefore under scrutiny.

Similarly, parents with intellectual disabilities are overrepresented in the child welfare system and, once involved, face high rates of TPR. According to Chris Watkins, in his California Law Review article, “One result of the deinstitutionalization movement has been in a dramatic increase in the number of parents with intellectual or developmental disabilities. Additionally, there has been a corresponding increase in the number of parental rights termination cases involving parents with intellectual or developmental disabilities.”[268] Paul Preston of the National Center for Parents with Disabilities and Their Families contends that this “high rate of removal reflects greater discrimination and lack of appropriate services for parents with intellectual disabilities and their children. In discussing the political and social discrimination faced by parents with intellectual disabilities, experts assert that parents with intellectual disabilities are often held to a higher standard of parenting than non-disabled parents. Negative expectations and outmoded beliefs that children will eventually be maltreated and that parenting deficiencies are irremediable have contributed to children being removed from parents with intellectual disabilities despite lack of evidence for any abuse or neglect by the parent.”[269] Like parents with psychiatric disabilities, parents with intellectual disabilities often have frequent contact with professionals, including those in the government, who often end up being the source of a CPS referral. Parents with intellectual disabilities are also likely to be living in poverty.

Bias pervades the child welfare system at every step. The disparities begin with the initial report of suspected abuse or neglect, usually to the police or CPS.[270] For most parents without disabilities, the initial report often comes anonymously from a neighbor, teacher, or physician.[271] However, because parents with disabilities frequently have regular contact with service providers, such as social workers and therapists, reports of suspected abuse or neglect may come from a state professional with whom the parents have had some previous contact.[272] Anecdotal evidence suggests that CPS is likely to take allegations from state professionals more seriously, regardless of whether they are actually more valid.

Poverty plays a significant role in bringing parents with disabilities into contact with service providers who end up being the source of a CPS referral, and poverty itself is the most consistent characteristic in families in which child neglect is found.[273] Unlike people with the financial resources to buy services privately, people who live in poverty are likely to come to the attention of the state by accessing public assistance.[274] Social scientists have often examined this phenomenon—which is referred to as “overexposure bias” or “visibility bias”—in the case of race.[275] For example, “Because children from African American and Native American families are more likely to be poor, they are more likely to be exposed to mandated reporters as they turn to the public social service system for support in times of need. Problems that other families could keep private become public as a family receives TANF, seeks medical care from a public clinic, or lives in public housing…. Research has shown that exposure bias is evident at each decision point in the child welfare system.”[276] According to Ella Callow, legal program director at the National Center for Parents with Disabilities and Their Families, “While people with disabilities have been neglected by researchers examining this phenomenon, the…factors leading to overexposure bias in the African American and Native American communities are unquestionably present in the disability community. Poverty and reliance on public assistance are, unfortunately, the most common characteristic of the families with disabilities we see who are involved in the child welfare system and [are] quite often the reason they ended up there.”[277]

According to Watkins, “These reports may be tainted by the same prejudices regarding parents with disabilities as are held by many members of society.”[278] Further, once state involvement occurs, “Investigations are likely to be more probing, and investigating professionals are less likely to give these parents any benefit of the doubt.”[279]

In 2003, Phillip Swain and Nadine Cameron of the School of Social Work at the University of Melbourne revealed findings from a study that examined the experiences of parents with disabilities with the court system.[280] Swain and Cameron’s research concluded that parents with disabilities experience prejudicial or discriminatory treatment from CPS and the courts.[281] Commentators have characterized the court’s approach to child protection involving parents with disabilities as one of “risk management.”[282] A false dichotomy is established in which the children’s rights are balanced against the rights of the parents.[283]

For example, Christina,[284] who has significant physical and sensory (vision and hearing) disabilities and is the mother of three children, has been inappropriately referred to CPS on various occasions. In one instance, her daughter’s school reported maltreatment after her daughter injured herself doing summersaults. Although the CPS staff knew that Christina is hard of hearing and requires accessible relay services, they called her without the needed services, with the result that she could not effectively communicate. CPS alleged that she was being uncooperative and continued the investigation. The situation was ultimately resolved in Christina’s favor, but it is doubtful that it would have ever progressed to this level if she did not have a disability. In a similar instance of “risk management,” Cassandra,[285] a wheelchair user and mother of one, was inappropriately referred to CPS by her daughter’s pediatrician. CPS commenced an investigation. Cassandra had difficulty securing an attorney who could effectively represent her—a significant barrier for many parents, discussed later in this chapter. She eventually did find an attorney, and her daughter’s medical records refuted the allegations of neglect.

The bias that permeates the child welfare system has many causes. According to law professor Robert L. Hayman, Jr., “Neither the training nor time constraints permit many social workers to transcend biased perceptions. Moreover, under most schemes, these perceptions are enough to justify state intervention.”[286] Many states’ child welfare statutes “generally require evidence of some connection between a parent’s disability and her ability to parent; however, the level of proof required varies from state to state, and within many states, from case to case.”[287] The consequences of this bias are devastating.

In fact, children have been removed from their families even when the evidence of neglect has been refuted and the court has acknowledged the parent’s adequacy.[288] For example, in In re G.C.P., the Court of Appeals of Missouri upheld a termination order even though it acknowledged that there was no indication of intentional abuse and the alleged neglect was supported only by reference to substandard housekeeping.[289]

Parents with disabilities and their families are frequently, and often unnecessarily, referred to the child welfare system. Connie Conley-Jung and Rhoda Olkin found in a study of blind mothers that “Mothers with disabilities feel vulnerable about their parental rights and the custodial rights of parents with disabilities are frequently questioned solely on the basis of the parents’ disabilities.”[290] In fact, nearly all the parents with whom NCD spoke reported living in constant fear that they would eventually be reported because of their disability. Kathryn,[291] a new mother who is a wheelchair user and little person, told NCD that she is “always worried that some random stranger could call [CPS].” Moreover, because of concern that their daughter’s pediatrician will question their ability to parent, Kathryn and her husband, who has similar disabilities, always take a nondisabled person with them to appointments.

Jessica,[292] a wheelchair user and mother of twins, also lives in constant fear of being unnecessarily referred to the child welfare system. This fear leads her to always call her children’s pediatrician before going to the emergency room. When her children were newborns she was constantly worried about scratching them with her wedding ring when changing their diapers, not because it would cause injury but because someone would see a scratch and call CPS.

Danielle,[293] a deaf mother, feels fortunate that she has not yet been reported to CPS. However, she acknowledges that it could easily happen, which leaves her constantly in fear. Dana has witnessed many instances in which deaf parents have been inappropriately referred to CPS; she told NCD that it is very common for the child welfare system to assert that the parents and child have no language if sign language is the primary language used in the home.

This pervasive fear unquestionably affects parenting. Susan,[294] a disability activist and mother with an immune system disorder, told NCD that she hides her disability when she is relating to people who are involved with her children, because she fears being judged on her ability to care for her children. Lindsay, a mother of two children, articulates the detrimental effects of fear on parenting:

    “Some of my fears now, as my disability status and identity have shifted to include recent psychological and cognitive impairments, are, or at least seem to me, more ‘real.’ I am afraid of disclosing the extent of my brain injury (TBI) and associated multiple cognitive impairment (MCI) to fellow parents, teachers, and service providers, and have even avoided some types of medical services for fear of stigmatizing my kids or giving their father ammunition to win full custody of them. For example, I grapple with intrusive symptoms of posttraumatic stress, as well as suicidal ideation, largely alone, with much minimizing and hiding. I expend a lot of energy trying to cover memory loss. I push myself way too hard, in ways that compromise my health by promoting seizures and other ill effects, so that I can process.”[295]

This same fear leaves many parents afraid to ask for help. Jennifer,[296] a wheelchair user and mother of three children, told NCD that she is always afraid to ask for help as someone may view that as being unable to adequately care for her children and may report her to CPS.

Fear that the state will take their children is common among parents with disabilities. According to Michael Stein, internationally recognized disability expert, “Even with the accomplishment of parental tasks through different techniques, mothers with disabilities fear that mainstream society will remove their children because of prevailing misconceptions. The result is the diminishment of parental joy for otherwise able and loving parents.”[297] Overall, bias pervades the child welfare system and disparately affects parents with disabilities. As Ella Callow said, “This is the only class of children facing loss of family integrity due not to the behavior of their parents, but to their parent’s disability status and how this is perceived and understood by child welfare professionals.”[298]
Discriminatory State Statutes

Child welfare allegations of unfitness are usually grounded in parental disability coupled with other factors, such as poverty, but the system also uses parental disability as a sole validating basis for presumed unfitness. In fact, 22 years since the passage of the ADA, states continue to include disability as grounds for TPR. Such statutes are examples of the oppression ADA proponents sought to eradicate, and they run entirely counter to the letter of the law, which prohibits state and local agencies, such as those in the child welfare system, from categorically discriminating on the basis of disability.[299]

In August 2005, a study revealed that 37 states still include disability as grounds for TPR.[300] Most of these state statutes use outdated and offensive terminology, have imprecise definitions of disability, and emphasize conditions rather than behaviors.[301] Parents with disabilities who are involved with the child protection system are more likely to be facing allegations of neglect than of abuse or risk of abuse.[302]

All the states that include disability in their grounds for termination specify explicit types of disabilities for courts to consider. Currently, 36 states list psychiatric disabilities, 32 list intellectual or developmental disability, 18 list “emotional illness,” and 7 list physical disabilities as grounds for TPR.[303] Tennessee also uses the generic term “mental condition,” which can imply a psychiatric disability or an intellectual or developmental disability.[304] North Carolina is the only state that also specifies organic brain syndrome as an explicit disability to consider in TPR.[305] Eleven states use a common combination of disability types—“emotional illness, mental illness and mental deficiency”—that came directly from the Neglected Children Committee of the National Council of Juvenile Court Judges of 1976.[306] For more information on state statutes and their inclusion of disability as grounds for TPR, see Appendix B.

Law professor Robert L. Hayman, Jr., said, “If the label is not used to help, it is inevitably used to hurt.”[307] According to Elizabeth Lightfoot and Traci LaLiberte, a significant concern about the inclusion of disability in the grounds for TPR is that the mention of parental disability can shift the focus from a parent’s behavior to a parent’s condition or diagnosis.[308] No other parental conditions are listed in state statutes.[309] In fact, it is explicitly laid out in most state statutes that the condition of poverty, for instance, shall not in and of itself be considered grounds for TPR.[310] “However, old presumptions do not die easily, and presumptions of unfitness continue to subtly define the law’s approach to parents [with disabilities].”[311] Thus, as Hayman says, “The formal classification should be abolished as a basis for state interference with the parent-child relationship. The classification has no empirical foundation, and its political roots are not ones to be proud of. The classification results, meanwhile, in a schematic processing of the labeled parent’s claim to family, reducing individualized adjudications to formalities and foregone conclusions. In the end, the scheme makes us all a little less human.”[312] Lightfoot and LaLiberte note, “When a parent’s disability is explicitly included in legislation outlining the grounds for termination of parental rights, the disability can easily become the focus of a child protection case, even though the statutes do not say it can be the sole grounds for termination.”[313]

TPR based solely on parental disability clearly violates the ADA’s prohibition of decisions based on a person’s disability status.[314] The full promise of the ADA will not be achieved until DOJ, in collaboration with HHS as appropriate, actively enforces the ADA in child welfare matters and states stop denying parents with disabilities their fundamental right to create and maintain families.

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RIP Daniella Price

It is with a sad heart that I must say the world lost another beautiful soul. Daniella Price has passed away. It wasn't too long ago that Child Protection Services took her children away from and decided to sever all her rights. Child Protection Services has managed to destroy yet another family and indirectly took another life.  I am in a state of shock as we speak and I will go into detail more later and fill all of you in on all the details.

RIP Daniella Price

Thursday, June 1, 2017

What every parent should know network

Monday, May 8, 2017

Is your teen a narcissist?

Is Your Teen a Narcissist? Learn the Warning Signs and Treatment Options
Jul 13, 2014 | Terri DiMatteo | 17 Comments

Is your teen unhappy, lacking in close friends and totally self obsessed? Is this a normal developmental stage of adolescence or do these symptoms indicate narcissistic personality disorder (NPD)? How can you tell the difference?

Firstly, don’t panic! Many teens seem totally self obsessed at some stage and most simply grow-out of their behaviors. As time passes and teens mature – and as responsibilities increase – you may notice that the worrisome behaviors diminish. Perhaps you will observe the formation of healthy interpersonal relationships and behaviors which demonstrate increased awareness, empathy and compassion.

    In effect, these egotistical adolescent ‘narcissistic’ indicators may merely represent a developmental stage in a teen’s personal growth and maturity – and nothing more.

It should be pointed out that – contrary to popular notion -- those with NPD actually do not love and adore themselves excessively rather they are void of self-love and self-worth and can be dangerous to both themselves and others.

NPD is much darker:

    Those diagnosed with NPD often suffer depression, have thoughts of suicide, and exhibit a pattern of repeated failed interpersonal relationships. A swirl of trouble and high conflict at work and at school constantly surrounds them. 

Diagnosing Narcissist Personality Disorder

The DSM-IV-TR defines narcissistic personality disorder as:

    “An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation, and lack of empathy, usually beginning by early adulthood and present in various contexts.”1

A list of traits associated with NPD are listed below. In order for an individual to be diagnosed as NPD at least five (5) of the traits identified must be present.

    Is assuredly convinced that he or she is special, unique and can only interact and associate with other special, uniquely qualified or high-status people (or institutions).
    Insists on being treated with excessive adulation, admiration, attention and  affirmation.  Or, if not, then desires instead to be feared and viewed as infamous or notorious.
    Demonstrates a sense of grandiosity and self-importance (e.g., grossly exaggerates skills, accomplishments, talents, connections and personality traits to the point of lying; demands to be recognized as superior without demonstrating actual achievement to support the claim.)
    Exploits personal relationships focusing only on his or her own goals at the expense of others. 
    Demonstrates characteristics of at least one of the two narcissistic types: 'The Cerebral Narcissist' is driven with fantasies of boundless success, notoriety, tremendous power or omnipotence and incomparable brilliance. 'The Somatic Narcissist' is obsessed with his or her bodily beauty or sexual performance or ideal, everlasting, all-conquering love or passion.
    Believes he or she is “above the law” and all knowing (omnipresent). Behaves in a superior, invincible, immune way, and when questioned or frustrated by people he or she views as either inferior or unworthy – rages.
    The individual presents as arrogant and haughty, possessing a strong sense of entitlement and demanding full and unquestionable compliance with his or her unreasonable expectations for special favor and exemplary treatment.
    Possesses a severe lack of empathy. Cannot accept - or even acknowledge - the  needs, feelings, desires, choices, preferences or priorities of another.
    Demonstrates continuous examples of envy and jealously. Sets out to hurt and demolish the source of his or her frustration. Experiences paranoid delusions believing that others feel identically about him or her and will act in the same manner toward them.

To further determine whether or not an adolescent suffers NPD, consider these developmental and environmental factors, which are thought to contribute to NPD:

    Unreliable or unpredictable caregiving from parents
    Experiences in childhood, such as loss of a father figure
    Suffers severe childhood emotional abuse
    Excessively condescending or critical environment - Is overindulged and over-praised by her parents
    Possesses an oversensitive temperament from birth
    Learned manipulative behaviors as a way to get what she wanted

Note that chronic insomnia, over-work, ongoing exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of a personality disorder.
Treating Teen Narcissistic Personality Disorder

As teens are generally in a fragile mental state it makes it especially difficult to treat teens who suffer narcissistic personality disorder. Treatment attempts are often met with disdain making it impossible to develop the proper and necessary therapeutic therapist-client alliance. The teen’s own self-perception often interferes with this essential process.

    A therapeutic objective is to teach the teenager to value him or herself on a more realistic level and to adjust one's thinking about others' value in relation to his or her own. Exercises designed to assist the teen in developing empathy for others would be an aspect of treatment of this personality disorder.
    In general, medication is not part of the treatment plan, except in those cases where depression and anxiety emerge as the teen struggles to cope with his or her new reality of self.
    Group therapy (such as Dialectical Behavioral Therapy), somatic experiencing, anger management, sleep management, psycho-education and individual psychotherapies can help.
    Neuro-feedback techniques can also be utilized in conjunction with the other therapies.
    Holistic remedies such as yoga, meditation, acupuncture and massage therapy can support and enhance treatment and healing.
    Family therapy groups that incorporate family members and significant others into the therapeutic treatment plan are advantageous.

This combination of treatments can show good result in dealing with personality disorders.
Factors That Slow Recovery

Keep in mind, though, that:

    Narcissists rarely enter treatment and when they do they often view it as a ‘waste of time’. Depression – as well as substance abuse, specifically alcohol, marijuana or cocaine -- are prevalent among persons with this disorder and negatively impact psychological and medical treatment.
    Individuals with NPD typically have interpersonal problems with family, loved ones, classmates and co-workers – therefore, their impaired social support structure adds another layer of difficulty regarding their entrance into and continuation of treatment.
    NPD’s who are excessively impulsive or self-destructive will require more intensive therapy and resolution will come at a slower pace.

Friends and Family Can Accelerate Treatment

It may be very difficult and challenging for friends, family and loved ones to help and support because persons with NPD have great difficulties with interpersonal relationships.

    Family and friends can help by educating themselves about NPD in order to interact emphatically and with compassion for the person who has NPD.
    Family and friends are an indispensable resource when it comes to monitoring symptoms and watching for dangerous maladaptive behaviors.
    There are some treatment centers that specialize in working with individuals with NPD and friends and family can provide emotional support and financial resources.

The Prognosis

    NPD is generally a chronic life-long disturbance with periods of remission and exacerbation (worsening) dependent on changing life circumstances.
    Psychotherapy over time, coupled with sleep and stress management, and psycho-education, can address related problems.
    When a person with NPD develops depression or substance abuse, treatment becomes imperative.
    Clients who do receive effective treatment will experience significant improvement in their ability to function normally in their daily lives, with improvement in their interpersonal relationships.


    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

Terri DiMatteo Terri DiMatteo
Licensed Professional Counselor
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Monday, May 1, 2017

Drug Testing For CPS

1923 Testing for Substance Abuse
1923.1 Detection Periods for Substance Abuse

CPS June 2010

For detection periods, see Appendix 1922.1: Detection Periods for Abused Substances.
1923.2 Diluted Samples Obtained During Testing

CPS June 2010

A diluted sample indicates that a client drank a large amount of water at some time before the drug test.

When the lab indicates that a sample is diluted, the caseworker can take one the following actions to arrive at a conclusion about the client's use:

  •  Have the client retested

  •  Request a different type of testing, such as requesting a hair follicle test instead of a urine test

  •  Rely on credible evidence obtained through observation, information from collateral sources (such as a teacher, neighbor, or family doctor), and the case history
1923.3 Instant (Swab) Tests and Court Hearings

CPS June 2010

An instant test is a swabbing of a client's oral fluids. The test is performed by a caseworker to test for recent drug use. If possible, the test results are confirmed by a laboratory.

Using the Tests in Court

Before presenting the results of instant swab tests as evidence in court, the caseworker must obtain confirmation from a laboratory.
1923.4 Using Acceptable Contractors to Obtain Test Results

CPS June 2010

DFPS accepts lab test results from physicians, hospitals, the legal system (such as the adult probation department), and providers of substance abuse treatment in order to assess safety and to assess the need for services and treatment.
1923.5 Frequency of Random Substance Abuse Testing

CPS June 2010

In general, the caseworker may conduct random drug tests when substance abuse laboratory testing is allowed under 1920 Substance Abuse Testing; that is, when:

  •  a case is scheduled for closure;

  •  reunification of the child with his or her family is contemplated;

  •  there are changes in the parent's appearance, behavior, or affect;

  •  new information is received about possible substance abuse;

  •  the client has terminated substance abuse treatment;

  •  the client shows signs of returning to seeking and using drugs, including  associating with former friends and family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol;

  •  the client refuses to create a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses);

  •  the client minimizes or denies seeking and using drugs seeking and after test results come back positive;

  •  there are signs that abstinence is being threatened; for example, when a client increases the amount of alcohol consumed or begins to smoke cigarettes frequently to relieve anxiety;

  •  the client has made minimal or no effort to mitigate the substance abuse related problems that led to abuse and neglect;

  •  the client is not involved in substance abuse treatment or aftercare, even though it was recommended; and

  •  the regional substance abuse specialist recommends testing.

Hair Follicle Testing

The caseworker determines the frequency with which random hair follicle testing may be conducted, by following regional protocols.
1923.6 Situations Not Appropriate for Drug Testing

CPS June 2010

It is not appropriate for a caseworker to arrange for drug testing when a parent is:

  •  actively involved in substance abuse treatment and the treatment provider conducts random testing that is based on laboratory confirmation.

  •  randomly tested by another entity, such as a probation department or drug court, and the test is confirmed by a laboratory. The caseworker must check into the frequency of testing by the other entity, before random testing is discontinued by CPS.
1923.7 Discontinuing Drug Testing

CPS June 2010

The caseworker must discuss with the supervisor and the client's treatment provider when contemplating discontinuing routine drug testing.

The discontinuation or modification of routine drug testing may be considered when:

  •  A parent does not exhibit substance seeking and using behaviors (for example, when associating with former friends or family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol); and

  •  The parent has a consistent pattern of negative tests results.
1923.8 Assessing Test Results or Accepting an Admission

CPS June 2010

Positive Result

The caseworker must assess a positive drug test result in relationship to the child's safety and risk. The result must be discussed with the parent in a timely manner.

If a parent with a positive drug result is not engaged in substance abuse treatment and is actively parenting a child, the caseworker refers the parent to:

  •  a provider of outreach, screening, assessment, and referral (OSAR) services or

  •  a provider of substance abuse treatment.

The threshold that makes a referral appropriate is based on the definition of a child not being safe. That is, a child is not safe when:

  •  threats or dangers exist in the family that are related to substance use;

  •  the child is vulnerable to such threats; and

  •  the parent who is using substances does not have sufficient protective capacities to manage or control threats.

Client Admission

A client's verbal or written admission is accepted as a positive result of drug use; however good casework practice calls for getting the client to sign a statement of use.

Testing to Rule Out Under-Reporting

If a client admits to drug use, is not engaged in treatment, and is actively parenting children, the caseworker may consider referring the client to a substance abuse provider for screening, assessment, or treatment.

Referral may be necessary because clients sometimes under-report drug use or do not admit to all of the substances that they have used.

Clients likewise may under-report:

  •  the frequency with which they use dugs,

  •  the quantity of drugs they use, and

  •  the amount of money they spend on the drugs.

Negative Result

When the result of a parent's drug test is negative, the caseworker:

  •  notifies the parent about the result in a timely manner; and

  •  encourages the parent's abstinence and provides positive feedback.

Refusal to Test

When testing is appropriate under 1920 Substance Abuse Testing, but the client refuses to take a drug test, the caseworker must document the refusal to be tested.

If a parent refuses to take a drug test or refuses to allow a child who is an alleged perpetrator to be tested, the caseworker consults with the supervisor in a staffing meeting. The supervisor may recommend legal intervention, if the evidence raises concern for the child's safety.

For cases under court jurisdiction, the caseworker must notify the judge and attorneys about the client's refusal to test.
1923.9 Documenting Prescribed Medicine Before Offering Drug Testing

CPS June 2010

When testing is appropriate under 1920 Substance Abuse Testing, the caseworker must document any prescribed medication that the client is taking.

The documentation may be made by:

  •  completing a regional form; or

  •  entering the details in the Contact Narrative in the IMPACT system.

The caseworker must share the information about the client's medication with the lab's medical review officer (MRO).
1924 Special Situations Related to Substance Abuse
1924.1 Methadone and Prescription Medication

CPS June 2010


If the parent tests positive for methadone, the caseworker:

  •  obtains a release (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services) from the parent;

  •  verifies with the methadone clinic, that the parent has a prescription for methadone and is taking methadone as prescribed; and

  •  assesses the effect that the methadone dosage has on the parent's ability to provide consistent and safe supervision of the children.

Prescription Medicine

Similar to methadone, the caseworker must assess the effect that prescription medications have on a parent's ability to provide supervision and to keep children safe.

To determine whether the client is taking his or her medication as prescribed, the caseworker must check with the client's medical provider.

For the caseworker to obtain the information from the medical provider, the client needs to sign a consent-to-release form (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services).

If the client refuses to sign the release form, the caseworker consults with the supervisor about whether to request legal intervention.
1924.2 The Infectious Client

CPS June 2010

If the caseworker is concerned that a client may have an infectious disease, the caseworker, with the supervisor's approval, refers the client to a local drug-testing facility for a urine test in lieu of an oral test.

Testing Within 48 Hours

The client must be tested within 48 hours after the contact with the caseworker.
1924.3 Drug Use During a Parent-Child Visit or FGDM Conference

CPS June 2010

A court order supersedes the following DFPS policies.

Parent-Child Visit

If a parent appears to be under the influence of a controlled substance and or alcohol, the parent-child visit must not occur.

Family Group Decision Making (FGDM) Conferences

A parent or participant who is visibly intoxicated during a family group decision making (FGDM) conference, must be excused from the conference.

The caseworker does not administer an oral test during the FGDM conference. Any required testing occurs at the end of the meeting and preferably at a location away from the FGDM immediate site.

For policy on the testing of youth, see 1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol.

The existence of a positive drug result in the case record does not automatically exclude a parent from visiting with the child or attending a FGDM. The caseworker needs to weigh the benefits of the visit or attendance when confronted with a positive drug reading in the case record.

If the child will not be in danger, the visit or participation may be allowed.
1924.4 The Court Testimony of the Medical Review Officer

CPS June 2010

Because of the high costs, testimony provided by technicians, medical review officers (MRO), or other personnel employed by drug testing facilities is reserved for extreme circumstances; for example, parental termination hearings in substitute care cases when a judge requires testimony in person.

Alternatives to consider before requesting court room testimony from a representative of a drug testing laboratory include:

  •  depositions at locations near the drug testing laboratory; and

  •  testimony provided via teleconference.

If DFPS concludes that court room testimony is necessary from a representative of a drug testing laboratory, the DFPS region requiring the testimony:

  •  negotiates payment rates;

  •  negotiates travel expenses;

  •  renders payment for court-related services; and

  •  renders payment for testimony provided by a representative of a drug-testing laboratory.

Arizona Child Abuse Laws

criminalize physical, emotional, or sexual abuse of minors and also require certain third parties with knowledge of the abuse to report it to the authorities. In Arizona, professionals with access to children (such as teachers and pediatricians) are required to report suspected cases of child abuse. The Arizona Department of Child Safety (DCS) investigates reports of child abuse (and neglect) in the state.

According to the Arizona DCS child abuse and neglect can occur in different forms, including:

Physical abuse -- non-accidental physical injuries such as bruises, broken bones, burns, cuts or other injuries. 
Sexual abuse -- when sex acts are performed with children. Using children in pornography, prostitution or other types of sexual activity is also sexual abuse. 
Neglect -- when children are not given necessary care for illness or injury; leaving young children unsupervised or alone, locked in or out of the house, or without adequate clothing, food, or shelter. Allowing children to live in a very dirty house which could be a health hazard may also qualify as neglect. 
Emotional abuse of a child -- severe anxiety, depression, withdrawal or improper aggressive behavior as diagnosed by a medical doctor or psychologist, and caused by the acts or omissions of the parent or caretaker. • Exploitation -- use of a child by a parent, guardian or custodian for material gain.Abandonment -- the failure of the parent to provide reasonable support and to maintain regular contact with the child, including providing normal supervision, when such failure is intentional and continues for an indefinite period.

Code Section13-3620, 8-201What Constitutes AbuseInfliction or allowing of physical injury, impairment of bodily function or disfigurement, serious emotional damage diagnosed by a doctor or psychologist, and as evidenced by severe anxiety, depression, withdrawal, or aggressive behavior caused by acts or omissions of individual having care and custody of childMandatory Reporting Required ByPhysician, resident, dentist, chiropractor, medical examiner, nurse, psychologist, social worker, school personnel, peace officer, parent, counselor, clergyman/priestBasis of Report of Abuse/neglectObservation or examination of child discloses reasonable grounds to believe minor is a victim of injury or abuseTo Whom ReportedTo peace officer or child protective services of the department of economic securityPenalty for Failure to Report or False ReportingClass 1 misdemeanor

Note: State laws are constantly changing --contact an Arizona criminal defense attorneyor conduct your own legal research to verify the state law(s) you are researching.