Commentary: DHS must rethink care of children and families

By Mical Raz

Cynthia Figueroa has begun her tenure as commissioner of Philadelphia's Department of Human Services (DHS). She assumes responsibility for a department that is often thrust into the spotlight because of dysfunction and tragedies, such as the 2006 death of Danieal Kelly, a 14-year-old girl with cerebral palsy who had been under the supervision of DHS and a contractor company.

In the past decade, DHS has taken numerous steps to improve its care of children. These reforms have further relied on outsourcing care to private contractor companies in the communities, with the goal of supporting families and caring for children in their homes.

Despite these attempts to improve services, this spring a state audit called attention to ongoing violations and downgraded the agency's license.

Removal of children from their homes has in fact increased. Philadelphia currently has the highest rate of removal of children from their homes in the country. Too many of the city's children are shuffled through institutions and foster homes, to their detriment. These often devastating separations disproportionately impact low-income families of color.

At the same time, the rate of substantiated child abuse in Philadelphia continues to fall. The most common reasons for child removal in Philadelphia are not, as one might expect, abuse or neglect, but rather drug abuse and the child's presumed difficult behavior. Furthermore, to a busy caseworker, poverty and neglect may look suspiciously alike. Even more disturbingly, children who are in imminent danger and should be removed from their homes immediately, remain poorly identified.

More children are removed from their homes, but our city's children are no safer overall. These two findings are the flip side of the same coin.

The unnecessary removal of children from their homes presents a clear danger to our children and to our community. When child welfare services become child "removal" services, it may deter families from seeking the help they may need. Furthermore, in an already overburdened system, fraught caseworkers are more likely to miss those children who require immediate intervention for their safety.

Finally, multiple studies have shown that most children fare better in their imperfect homes than in foster care. Children who have been placed outside their homes are more likely to experience homelessness, substance abuse, and delinquency, and often drop out of school. Unfortunately, abuse is common in both institutions for children and foster homes. High turnover among the individuals who care for our children is an additional challenge. The recent death of 10-year-old Ethan Okula, an intellectually disabled child who died of a potentially preventable medical complication while under the care of a foster family, highlights the risks of fragmented care of children in need.

So why does this persist? A caseworker who makes the difficult decision to keep a child at home faces not only professional but also legal consequences if this decision results in harm to the child. Yet no one is accountable to children or their families when unnecessary removal occurs. This is morally wrong, and deeply unfair to all parties involved. Pitched as a "better safe than sorry" approach, many children are in fact less safe outside their homes.

These fallacies of our child welfare system have been exacerbated by legislation passed in the aftermath of the Jerry Sandusky child-abuse scandal that expanded the definition of "mandatory reporters" of suspected abuse. The DHS now administers a massive reporting system. Perhaps unsurprisingly, a recent audit of this system found significant flaws, including excessive waiting times, unanswered calls, and more than 100,000 calls to DHS that did not lead to the generation of reports or further investigations. State DHS Secretary Ted Dallas has responded to this audit, outlining the ways in which the city agency has implemented changes to streamline the reporting system.

But our goal should not be to perfect a reporting system that can generate more reports. More reporting results in spurious reports, wasted manpower, and a funneling of resources away from children and family who need it the most. Reporting is a means and not an end. It does not make our children safer, and may have the opposite effect.

DHS and the child welfare agencies it contracts should partner with parents and communities to provide services to assist parents in child-rearing. A productive dialogue with community groups that represent families who have been separated could assist in rebuilding mutual trust.

It's time to change the way Philadelphia delivers services to children and families at risk. As Figueroa assumes responsibility for the safety of our city's most vulnerable children, I hope she rises to this challenge.

Mical Raz, M.D., is a practicing physician and author of "What's Wrong with the Poor? Psychiatry, Race, and the War on Poverty." micalraz@mail.med.upenn.edu