Maximum Overhaul

Written by Editorial Staff Category: Hot Topics Issue: January 2013
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After years of highly publicized problems and child deaths on its watch, Arizona’s Child Protective Services is changing its system in major ways. Will it be enough to curb our staggering statistics?

Jacob Gibson was a little boy with a big smile and curly hair who loved to play soccer. His name was familiar to Arizona’s Child Protective Service workers. CPS had received numerous reports of abuse toward Jacob since 2005, including a 2007 report of bruises on his legs,

a 2009 complaint that his father struck him on the head and forced him to stand outside naked, and a 2010 allegation that Jacob’s face was swollen and he’d been forced to stand on a box as punishment. Ultimately, CPS deemed all three allegations “unsubstantiated.”

In May 2011, CPS launched an investigation into a report that Jacob’s father appeared to choke him one day after picking him up from school. In July 2011, CPS began investigating allegations that Jacob had two black eyes and a golf ball-size knot on his head. He was not removed from his parents’ home following either complaint.

Both investigations were ongoing when Jacob Gibson died on August 14, 2011, from brain injuries sustained during a beating. His parents, Benny Gibson and Jennifer Paul, were arrested and charged with child abuse. But the question remains: Why was Jacob left in his parents’ home after CPS received repeated reports he was being abused?

Gibson’s case is one of many extraordinary, seemingly-preventable child abuse tragedies in the Valley over the past decade. According to the Arizona Child Fatality Review Program’s annual report, 70 children in Arizona died from maltreatment in 2010; 18 had prior contact with CPS. Of the 64 children who died from maltreatment in 2009, 23 were previously known to CPS. In both years, five children had open CPS cases when they died. And while it might seem logical to immediately pull a child from a home where there’s an investigation of abuse, caseworkers and child abuse prevention specialists say it’s not that easy; there are numerous factors CPS must consider before making such a decision. 

Unsubstantiated abuse allegations and the diagnosis of potentially dangerous environments are just two of many problems that have plagued Arizona Child Protective Services – there’s also been a record number of kids in foster care and a shortage of foster families, caseloads exceeding the state’s standards, a shortage of caseworkers and a high turnover, and a “computer glitch” that resulted in a reported 30,000 people receiving incomplete public records over the past 15 years.

CPS’ woes prompted Governor Jan Brewer to organize an Arizona Child Safety Task Force in the fall of 2011 to recommend systemic reforms. It’s not the first time there’s been a gubernatorial call for change; in 2004, then-governor Janet Napolitano rolled out an “Action Plan for Reform of Arizona’s Child Protection System” that included changing the focus of CPS – which for decades was to reunite children with their families – to protecting children first. Brewer’s task force recommendations were wider in scope and more specific than previous suggestions, and have led to what is essentially a ground-up, inside-out overhaul of  Child Protective Services.

But critics of CPS say they’ve heard this song before. “It’s not just about reform. In the cases I’ve had, I can say that, probably in all of them, if they had just followed the rules that were in place, the deaths that were involved in my cases could have all been prevented,” says Jorge Franco, a Phoenix-based attorney who has successfully sued CPS several times. “It seems to me it’s going to be a whole lot of effort and a whole lot of talk about something that seems like, on paper, doesn’t need to be fixed tremendously... I believe it’s been a training issue, as well as perhaps a competence issue.”

There’s no question child abuse is a problem in Arizona. Between October 2010 and September 2011, the Department of Economic Security – which oversees the Division of Children, Youth & Families under which CPS operates –  reported 140,262 calls to the Child Abuse Hotline; 37,252 resulted in reports. More than 23 children died by maltreatment between November 2010 and October 2012. There are more than 13,000 children in foster care.

DES director Clarence Carter says major changes will take time. “If we want a true system reform which is sustainable, then we have to improve the processes, we have to strengthen the labor force, and then we have to resource it properly. All of those things have to happen, and you can’t rush that process. It’s painstaking,” Carter says. “A lot of people have said to me, ‘Well, we’ve seen this movie before. It seems to happen every three years or so. What makes this different?’ Well, what makes this different is that we have not taken the ‘hair on fire’ approach and just thrown money at it. We are truly reinventing the system in a way that we believe is sustainable and will ultimately protect children.”

Pleading the Case(workers)   
Jorge Franco has sued CPS roughly 20 times since 2001 with monetary judgments in the seven figures. He’s still haunted by the case that started him on this trajectory: the death of 20-month-old Liana Sandoval. In 2001, the girl was fatally beaten in Phoenix by her mother’s boyfriend, Juan Velasquez, who was sentenced to death in 2004 for her murder. “In the Sandoval case, the reason for the death of Liana and the horrific injuries to Isabella, her sister, was a criminal who did it on purpose,” Franco says. “A criminal who was on CPS’ radar, and they just completely overlooked him – they didn’t look at him, is the point.”

“[Velasquez] had a prior file with CPS, in which he wasn’t permitted by CPS to see his own children, because of his long line of criminal problems, in which he was beating up girlfriends, doing other things that were violent and assaultive and dangerous,” Franco continues. “And they didn’t know they had a file on him. Now, that’s common sense. When you investigate what is reported to be a violent perpetrator of children, isn’t one of your first moves to say, ‘Hey, haven’t we heard of this guy before?’ If they had done that, they would have learned quickly who he was, what he was all about, and they would have taken different steps, and these girls wouldn’t have been beaten and one killed.” 

Franco cites other cases where information on an alleged abuser never made it to Arizona CPS, like the tragedy of Haley Gray, a 4-year-old Phoenix girl who died in 2005 after being locked in her mother’s car for hours while her mother lay passed out, post-party, in her apartment. Franco says in the months leading up to Haley’s death, her father, John Gray, made numerous calls to CPS. The family previously lived in Florida, where Franco says there was documentation showing contact with Child Protective Services there. “There was a ton of information that had to do with [Haley Gray’s mother’s] medical problems, her dependency problems, her incapacities, all the reasons that – had they discovered, here in Arizona – their job would have been so simple,” Franco says. “With just that phone call and that documentation, they would have had the basis to say, ‘Haley Gray is in danger living with this mother.’ But they never picked up that telephone.”

Part of the problem has been understaffed, overwhelmed caseworkers. Currently, each caseworker receives an average of four to five new reports per week and manages 40 to 50 children simultaneously. Tasya Peterson, Director of Communications for DES, says they hired a staff recruitment manager to help with hiring, and they’re currently at full capacity. “But we’re always hiring,” she adds.

Finding qualified CPS caseworkers isn’t easy. There are three job tiers for child protective service specialists – I, II, and III. All require a bachelor’s degree in sociology, psychology or a related field. Upper level specialists must also have three years’ experience in social work.

But the majority of applicants, despite meeting the requirements, aren’t being hired. DES fielded 211 applications in October 2012 but didn’t interview most applicants “due to complications with their background check or references.” Of the 211 applicants in October, the department interviewed 78 and hired 56.

Once hired, new CPS workers must complete 22 weeks of training. The training, part of the system overhaul, was coordinated with Arizona State University. It consists of a Pre-Core phase that includes orientation to the agency and the database, plus shadowing seasoned caseworkers; a second phase consisting of classroom training on topics like domestic violence and substance abuse; and a third phase, where new caseworkers are matched with experienced mentors in the field. But not all new hires complete CPS training – agency reports
show an average annual dropout rate anywhere between 16 and 34 students. The turnover rate for new hires hovers around 30 percent.

There are myriad reasons for the shortages and turnovers. There’s the workload to consider, along with the manpower shortage, limited hours in a day, and the often disturbing nature of the work. It can also be thankless work. While it might seem simple to remove a child from a home where there’s an allegation of abuse, those on the front lines tell a different story. Becky Ruffner, Executive Director of Prevent Child Abuse Arizona, which provides support services specifically to new parents, says, “One of the great challenges CPS workers have is to go into a family’s home... and try to make a decision as to whether or not it would be better for these children to be removed and placed in a safe home but with strangers, people they don’t even know, or whether it’s better to leave them with their parents for a few more days while more information is gathered.”

“And it’s very difficult, because it involves humans and human behavior,” Ruffner continues. “And if we could say ‘That one’s safe’ and ‘That one isn’t safe’ with absolute certainty, well gee, wouldn’t that be great? But that’s not the situation. It’s complicated.”

Detective Greg McKay, a 17-year veteran of the Phoenix Police Department who’s spent his career investigating homicide and crimes against children, says, “Every CPS worker I’ve worked with on any of these cases... whenever we talked, it was always the same thing: ‘Are you going to arrest somebody? Is somebody going to get charged?’ And the reason they wanted to know that was because without that resolve, without a solved incident, they’re stuck. ‘What are we gonna do? How are we gonna articulate what we think is the best thing for this child? What are we going to tell the attorneys? What are they going to eventually be able to tell the judge based on what we’ve done?’”

If the wrong decision’s made, caseworkers are often vilified. “Every situation’s different, and my heart goes out to any CPS worker who’s ever found that they’ve made a decision that didn’t protect the child,” Ruffner says. “Imagine being that person.”

Carter adds that caseworkers were forced into bureaucratic roles, pushing mountains of paperwork while bridging a disconnect with law enforcement. That will hopefully change with the creation of the Office of Child Welfare, headed up by Greg McKay. The office was created to bring in seasoned law enforcement investigators to handle cases with allegations of criminal conduct. With the criminal investigative burden lifted from their primary-proxy duties, caseworkers can once again focus strictly on gathering information for each case and recommending proper CPS action.  
Information, Please
Though the Office of Child Welfare is in its preliminary stages, one of the goals is to gather every bit of information possible about every case. But not all information is obtainable. “CPS doesn’t have the capability to get certain criminal histories outside of local databases and state databases, sometimes,” McKay says, adding that a nationally-linked database is one of his dreams. McKay was a detective on the case of Ame Deal, a 10-year-old Phoenix girl who suffocated after being stuffed in a locker by her family in July 2011. During the investigation, he discovered reports of abuse in two states where the family previously lived. “And there was no CPS component or police component here. They were secretly torturing that child here,” McKay says. “So what happens is, there’s no national structure to say, ‘This person came from here’ or ‘They have that information here.’ We have to manually go out and get it.” 

Twenty-nine people have been appropriated for the OCW. The staff will include four managers, several investigators, and an analytics team. “I want people to have the capabilities and knowledge to go out and get all of the information. I want them to know that this person may not have been convicted for something, but I want to know he was interviewed in Tallahassee for the same type of thing, and released. Or somebody was stopped in a car with a child in Maine and released,” McKay says. “This information is huge. It’s needed to formulate an opinion, to work an investigation, to hold someone accountable, and to make sure a child doesn’t go back into that harmful setting again.”

Carter knows people have expectations. As director of DES, he’s responsible for overseeing the overhaul of an agency that’s been remodeled several times before, and perpetually reshuffled in the budget-priority deck.

In 2003, Governor Napolitano approved a $21 million budget increase to improve CPS, including hiring 220 new employees and increasing the amount paid to foster parents. Her reform plan focused on child abuse prevention, including identifying risk factors (like poverty, substance abuse, and low parental IQ) and mitigating those factors through programs like 24-hour youth drop-in crisis centers, school-based parenting classes, child-focused divorce mediation, family advocacy centers, and domestic violence counseling.

Jorge Franco says one of the most important things Napolitano did was shift the focus of CPS. “For decades and decades around here, it was the goal of CPS to reunify families, because the wisdom was that children should be with their families if possible, because that’s where they flourish and thrive and do better,” Franco says. “Well, I can line up 20 experts right now to tell you that’s bullshit. An abused child reunified with his family is not going to be more functional than a displaced child who was given opportunity by a substitute home, and nourishment and care.”

But hiring caseworkers and placing children into out-of-home care costs money, and by 2010, CPS’ budget had been cut by about 11 percent. DES requested a $49 million budget this year, along with a proposal to resume licensing 24-hour “emergency homes” where children can temporarily stay until placed elsewhere or returned home. And the “elsewhere” part can be tricky. As of June 2012, almost 10,800 children were in foster care, and there was a shortage of foster homes. DES reports between October 2011 and March 2012, there were 663 new family foster homes, but there were also 679 foster home closures.

Carter says every year, about 30 percent of foster families adopt, so they’re no longer available to foster. DES has started surveying exiting foster families to find out what they can do better, and Carter says they’re successfully recruiting new foster homes with help from the community and faith-based organizations. “This really is a multifaceted campaign,” Carter says. “We have to, up-front, protect children. And then we have to strengthen families. When unfortunately... the child’s got to be out, there’s got to be a healthy, safe system for that child while they’re not in their home or if they can never go back to their home.”

A Painstaking Process(or)
Last June, during an annual review, a DES employee noticed something strange about CHILDS, the CPS database. Different sets of records had been released to different parties in the same case. Further examination revealed the database had been programmed since its creation in 1996 to print only one-third of the information considered public record. 

 Last September, DES sent out notices to more than 30,000 people who received partial public records over the past two years. The department says it is unable to notify those who requested records before 2010. Attorneys say some of the records could have been court cases. “I have no doubt there are many, many claims and cases that never became claims or cases because lawyers and parents and people entitled to get those records at the time they needed them didn’t get the right information,” Jorge Franco says. “If I’m a lawyer 10 years ago and I make a records request on behalf of a surviving parent of a dead kid, and I get a partial file, and the file I do get doesn’t give me a basis for liability, I’m going to tell that surviving parent, ‘You don’t have a case.’ And in 2012, it’s possible that I could make the same request and get additional records that do show liability? Those are the cases that are gone.”  

Clarence Carter says DES staff has restored most of the missing records, and the old computer system has been streamlined. They hired a Hotline Program Manager in late 2011 and recently reported a 71 percent increase in the number of calls answered without going into the queue, and a decrease of over two minutes in the average time it took to answer calls.

Ultimately, Carter says, the restructuring of CPS is a long process, and the changes won’t happen overnight. “It’s not as if we’re allowed to lock the doors and put out a sign, ‘Under reconstruction, come back in six months,’” he says. “We literally have to change the tires on this car as it moves down the road. It’s very difficult, but that’s what we have to do and that’s what we’re doing. I feel comfortable that at the end of the day, we’re going to have a much better car, and the tires are all going to work.”