Statement of The Honorable Constance Cohen, Associate Juvenile Judge, Fifth Judicial District of Iowa, Des Moines, Iowa, on behalf of Zero to Three

Testimony Before the Subcommittee on Income Security and Family Support
of the House Committee on Ways and Means

May 23, 2006

Mr. Chairman and Members of the Subcommittee:

My name is Constance Cohen.  For the last 12 years I have sat on the Juvenile Court bench in the Fifth Judicial District of Iowa.  My jurisdiction includes dependency, delinquency, termination of parental rights, involuntary juvenile commitments, and adoption.  I appreciate the opportunity to speak to you today on behalf of ZERO TO THREE on ways to improve child protective services and to ensure the safety and permanency of very young children in the child welfare system.  I commend you, Mr. Chairman, and Members of the Subcommittee for holding a hearing on the challenges of improving child protection programs and ensuring that at-risk families receive the services they so desperately need.

Like so many of my colleagues on the bench, my judicial and legal training did not prepare me to make the best decisions for maltreated children and their families. Before I was a juvenile court judge and before I was a teacher, I was a pig farmer. Pig farming, like any other profession, requires practical and scientific expertise. Not everyone has that expertise. I know the gestational period for pigs. I know how to pick up a baby pig. I know these things because I received training. I needed to know those things to be a competent pig farmer. Most people would never consider investing in a venture which required knowledge and skills they didn't possess. But that's exactly what most legally trained judges do when they don't have a child development/mental health expert to provide them with training and consultation. I want to talk to you today about a project that fixes that disconnect, a project called Court Teams for Maltreated Infants and Toddlers.

The Court Teams project focuses on the youngest and most frequent victims of abuse and neglect and the only ones without words to tell us that they hurt – babies and toddlers.  In the time it takes to watch an episode of Law and Order SVU, five U.S. infants are being removed from their homes for abuse or neglect or both.  During the time you’re getting ready to go to work, another five babies move into foster care. Every day in the United States, 118 babies leave their homes because their parents cannot take care of them.[1]  The quality of their entire lives – at home and in foster care – is deeply troubling.

Increasingly in Iowa, these children are victims of the rapid proliferation of methamphetamines. In Polk County, Iowa, a total of 1,300 children younger than five are in the child welfare system; and approximately 90% of those cases involve methamphetamine use and/or manufacture. In recent years, Iowa’s infants and toddlers have been maltreated at twice the national average. Like many states, Iowa has imposed new controls on pseudephedrine products. This law has significantly reduced the number of "mom and pop" meth labs. However, meth addiction is so profound that users are substituting purer and even more toxic forms of the chemical, such as imported crystal meth, and addiction is on the rise.

Even in the face of these daunting conditions, I believe we are changing the outlook for young children.  So I also want to tell you about my Court Team, a promising community-level solution to breaking the cycle of child maltreatment that I have adopted in my court. In my role as a juvenile and family court judge, I partner with a child development specialist to convene a Court Team that literally changes the way we approach the needs of very young children. Members of my Court Team include other judges; pediatricians; child welfare workers; attorneys representing children, parents, and the child welfare system; Court Appointed Special Advocates (CASAs); Guardians Ad Litems (GALs); mental health professionals; substance abuse treatment providers; representatives of foster parent organizations and children’s advocacy groups; Early Head Start and child care providers; and Court Improvement Project staff.  By working together, with support and training from ZERO TO THREE, my Court Team is leading our community to ensure that infants and toddlers have expedited access to the services they need for healthy development and their parents have the opportunity to learn to create a safe home for their children. 

I believe Court Teams greatly enhances our community’s ability to meet the goals of Promoting Safe and Stable Families.  Court Teams are coordinated programs of community-based family support services that work diligently with birth, foster, and adoptive parents to achieve the best outcomes for children.  I also believe that the collaboration and systems change that is the core of the Court Teams approach can increase our community’s capacity for helping families succeed before they come into the child welfare system.

Portrait of Infants and Toddlers in Foster Care

To understand why it is so important to focus on infants and toddlers, one only has to look at the compelling statistics about what happens to them when they are abused or neglected and enter the child welfare system.  Children between birth and three years have the highest rates of abuse and neglect victimization.  Although infants only account for 5.6% of the child population, they represent double that percent of all child maltreatment victims.[2]  Children ages three and younger are also 32% more likely to be placed in foster care than children ages four to 11.[3]  Once they have been removed from their homes and placed in foster care, infants stay in foster care longer than older children.[4]  Half of the babies who enter foster care before they are three months old spend 31 months or longer in placement.[5]  And one-third of all infants discharged from foster care re-enter the child welfare system.[6]  When we consider the dramatic brain development that occurs during the first three years of life, it is clear that far too many children are spending these critical early years in a most precarious living arrangement.

Developmental Impact of Child Abuse and Neglect on Very Young Children

Infants and toddlers who come into contact with the child welfare system are at great risk of compromised development.[7]  Despite their vulnerability, too many of the young children I see in my court on child abuse or neglect cases or other dependency matters do not receive services that can address and ameliorate these risks.  A significant percentage of children in foster care do not even receive basic health care, such as immunizations, dental services, hearing and vision screening, and testing for exposure to lead and communicable diseases.[8]   Approximately 42% of them are developmentally delayed, many of them so delayed that pediatricians consider them developmentally impaired.[9]

Infants and toddlers are the most vulnerable to the effects of maltreatment, and its impact on all aspects of their development can have life-long implications if not properly addressed[10],[11]  Research shows that young children who have experienced physical abuse have deficits in IQ scores, language ability, and school performance, even when the effects of social class are controlled.[12]  Physical abuse extracts a substantial toll on young children’s social adjustment, as seen in elevated levels of aggression that are apparent even in toddlers.[13]  Long-term negative outcomes include school failure, juvenile delinquency, substance abuse, and the continuation of the cycle of maltreatment into new generations.  By waiting until children enter school, we are missing the most critical opportunity for prevention and intervention.[14]

The Challenge:  Ensuring Safety, Permanency and Well-Being

It is clear that our nation’s child welfare system is not meeting the needs of our most vulnerable children.  As you know, the federal government, through Child and Family Services Reviews (CFSR), monitors the states’ performances on 14 child welfare outcomes.  These outcomes include seven measures addressing safety, permanency, the children’s well-being, and seven outcomes focused on system readiness (e.g. statewide information systems, case review systems, and training).  After completing the first round of reviews in 2004, the Children’s Bureau reported[15] that no state was in substantial compliance with the requirements regarding permanency and stability in children’s living arrangements and enhanced capacity of families to meet children’s needs.

In specifically looking at children five and under, the Children’s Bureau found that only slightly over half had permanency and stability in their living arrangements.  In a study of 19 states’ performances on CFSR indicators, no state achieved all specified outcomes and all failed to meet the outcome related to the provision of physical and mental health services.  These dismal findings are particularly troubling for infants and toddlers.  We know that future development in key domains – social, emotional, and cognitive – is based on the experiences and relationships formed during these earliest years. 

Like all 19 states in the study referenced above, my state of Iowa was not meeting the outcome related to the provision of physical and mental health services. Without prompt and adequate assessment and treatment for the developmental and social problems that are endemic to children who have experienced maltreatment[16] the consequences of maltreatment will go unchecked and lead to academic, professional, and personal problems that will plague them throughout their lives.[17], [18],[19]   I would also like to note that in a 2004 report on substance abuse issues covered in Iowa’s Child and Family Service Reviews, “stakeholders noted that there is a considerable communication barrier among child welfare, substance abuse treatment and mental health.  A family could be involved with all three agencies and ‘no one would know that.’” [20] 

Clearly, the CFSR’s identified many needs and gaps in child welfare. I know the Committee is considering how to use the $40 million in new funding for Promoting Safe and Stable Families included in the Deficit Reduction Act to address some of these shortcomings and must choose among many possible uses. I understand that one proposal is to use the new funds as an incentive for states to ensure monthly caseworker visits with children in care. Although strong casework is certainly a factor in good outcomes for children, I am concerned that unless resources are adequate to reduce caseloads the proposed monthly visits by caseworkers will likely be perfunctory, meeting the letter of the law but not the needs of the young child. Moreover, there is an array of interrelated factors that help lead to permanency more quickly, and we need to build a stronger, more coordinated system of child and family services in which these factors can be addressed.

A few of the factors that influence the speed at which children move through the child welfare system include:[21]

• Caseworker consistency: Any changes in the caseworker decrease the likelihood of permanence in a year by 52%. Children and parents are better served when they are able to develop a relationship with the person who is supposed to help them navigate their journey through the child welfare system.
• Fewer placements: Every time a child is moved from one caregiver to another it reduces the chances of achieving permanence in a year by 32%. In addition to this short term negative consequence, we also know that these moves have damaging long term emotional consequences for very young children.
• Increased parent/child visits per week: Very young children need to see their parents many times each week if they are going to build a positive and loving bond with them. The research shows that each additional visit between foster children and their birth parents triples the likelihood of reaching permanence within a year.

In addition, in Iowa we proceed from Day One of each maltreatment case with a Plan A, which is usually reunification, AND a Plan B, which involves another possible permanent placement for the child. The literature suggests that concurrent planning leads to faster permanent homes for children.

Unquestionably, there needs to be more research on effective interventions that lead to positive outcomes for children in the child welfare system. But clearly, it is no longer reasonable to ask our overburdened child protective services workers to bear alone the responsibility for achieving the best possible outcomes for children. Instead, let me describe a new partnership model that speaks to the state Program Improvement Plans and a collaborative approach to achieving the child and family outcomes codified in the CFSR.

A Promising Solution:  Infant-Toddler Court Teams

As a former educator, I know the critical importance of the first years of a child’s life.  So I was most eager to take advantage of the unique opportunity Court Teams provide to improve the well-being of infants and toddlers in the child welfare system.  My role as the leader of our Court Team is consistent with my role as a Juvenile and Family Court Judge, especially as expanded under the Adoption and Safe Families Act (ASFA).  In both instances, I am responsible for the well-being of the children in my court and must ensure they receive the resources and supports they need to address their special needs.  I could not in good conscience sit by, waiting for the child welfare system to be reformed from the top down.  Just as I sought to be a better pig farmer by learning the business, I as well as other legal and social service professionals involved with very young children in our community have welcomed Court Teams’ training and education on babies’ developmental needs. With this knowledge, we are helping to create better outcomes for babies and reduce the recurrence of abuse and neglect through improved coordination and collaboration among Court Team members who represent community service providers and stakeholders in Polk County.

Iowa's social workers have extremely high caseloads, among the highest in the nation. The CFSR reviewers said they were "blown away" by the collaborative spirit in Polk County in light of the extraordinarily high caseloads. Our project has enabled us to enhance the attention families receive from the very beginning of pilot cases in which babies and toddlers have been removed from parents.  Our system is very complicated, and we have employed a navigator to help parents connect to services such as visitation, transportation, and evaluations, within five to ten days of removal.  

Court Teams can help states and communities meet the purpose of the Promoting Safe and Stable Families program directed at addressing the problems of families whose children have been placed in foster care so that reunification may occur in a safe and stable manner as well as helping to improve the way juvenile and family courts function to provide for the safety, well-being and permanence of children in foster care. These are exactly the areas Court Teams addresses.  Many of the services and organizations involved with Court Team families are also the keys to preventing families from crossing the line where their children must be removed from their homes — or of coming to the attention of the child welfare system in the first place.  By promoting better collaboration and greater understanding of the needs of children and families, our Court Team is enhancing our community’s capacity for prevention.

The Court Team model is grounded in the innovative approach taken by the Honorable Cindy Lederman, Presiding Judge of the Juvenile Court in Miami-Dade County, Florida, and Dr. Joy Osofsky, of the Louisiana State University Health Sciences Center, to address the well-being of infants, toddlers and their families. The Miami-Dade project grew out of the science of child development and focuses on ensuring young children have access to high-quality services as well as improving how they and their parents interrelate. A collaborative initiative involving the Miami-Dade Juvenile Court, Louisiana State University and the Linda Ray Center has provided parent-child therapeutic interventions to mothers and babies.  Three years of data in the Miami-Dade Juvenile Court show substantial gains in improving parental sensitivity, child and parent interaction, and behavioral and emotional parental and child responsiveness.  For those families completing treatment, 58 percent of children improved in their developmental functioning.[22]  There were no new substantiated reports of abuse or neglect.[23]  And 100 percent of infants were reunified with their families.^[24]

Research is confirming the effectiveness of the approach used in the Miami-Dade Juvenile Court, and I have adopted a similar approach in my system. The first step is to form a team from committed service providers in the community. This Court Team then works to start services right away. These services include developmental and health assessments, frequent visitation, and supports to ensure stable placements. In addition, we monitor these cases each month, and institute additional services to better promote child well-being.  Our Court Team has already formed solid collaborations among community providers.   The Early Access Early Intervention Project, Drake Head Start, and the Child Guidance Center (a mental health center for children) are formulating flexible ways to deliver services to the population of children in our project.  As I mentioned, we are also undertaking the education of community members on the development and needs of infants and toddlers.  Just last week, our Court Team, in collaboration with the Drake University School of Law and the Middleton Children’s Rights Center, held a joint conference to educate students and professionals in the fields of law and social work on ways to improve the system of services for very young children. Ultimately, it is my hope that mental health interventions similar to the one used in Miami-Dade will be available in my jurisdiction to help improve parents' interactions with infants and toddlers, speed final decisions concerning the futures of young children and break the intergenerational transmission of abuse and neglect.

Widespread Interest in Court Teams Approach

The Court Teams project is in four other communities besides Des Moines, Iowa – Fort Bend County, Texas; Hattiesburg, Mississippi; Allegheny County, Pennsylvania;and New Orleans, Louisiana.  In each jurisdiction a judge is partnering with a child development specialist to create a team of child welfare and health professionals, child advocates and community leaders who provide services to abused and neglected infants and toddlers.  By working together, with support and training from ZERO TO THREE, our teams are developing and enacting comprehensive approaches to meet young children’s complex needs, swiftly and effectively.  We are all working to enhance and better coordinate services for these children and their families. Court orders for cases involving young children are now being written to include services for the children as well as the parents, and monthly reviews are ensuring that court-ordered referrals are implemented as ordered.  Our ultimate goal is to stop the intergenerational cycle of abuse and neglect, heal these children and families and assure their safety and well-being.

The promising developments in our initial sites are only the beginning.  We are starting to see more and more critical developmental services being provided to infants and toddlers and, just as important, increasing evidence of systemic change in the way communities respond to these children’s needs.  As word of the Court Teams project has spread, my colleagues around the country have become enthusiastic about the approach and are seeking to incorporate it into their own court procedures.  However, they lack the resources without outside support.

Conclusion

We must ensure that infants in the child welfare system are healthy and safe.  During the first years of life, children rapidly develop foundational capabilities – cognitive, social and emotional – on which subsequent development builds.  The amazing growth that takes place during these early years creates vulnerability and promise for all children.  These years are even more important for maltreated infants and toddlers.  We know from the science of early childhood development what infants and toddlers need for healthy social, emotional and cognitive development.  We also know that infants and toddlers in the child welfare system are at great risk for poor outcomes.  We must continue to seek support for services and programs that ensure that our nation’s youngest and most vulnerable children are safe and that promote and improve all aspects of their health and development.

Although ASFA made states accountable for providing services to address the “safety, permanency and well-being of children and families,” we know that states are struggling to comply with the law’s requirements.  While ASFA has revolutionized the child welfare system for the better overall, we also know that the best possible outcome for a child caught up in this system is to be reunified as soon as possible with parents who can provide a safe and stable permanent home.  Given what we know about the time it takes to resolve a methamphetamine addiction, families enter the system with two strikes against them.  The scientists tell us it takes about a year after a parent stops using for the brain to begin to function as it did before meth use.  We have fifteen months from the time of removal to help families reunify safely.  Fifteen months is a very long time in the life of a toddler, but not very long in the life of a recovering parent.  ASFA is good for children.  But it also imposes a responsibility – to frontload the system as Judge Lederman did in Miami, for children everywhere – a responsibility that we have not accepted due to lack of resources.  Policies and funding must be directed toward preventing harm to maltreated young children and assuring that they are safe in permanent and stable living arrangements — and beginning these efforts as soon as they come into care and the ASFA clock starts ticking.  I urge the Subcommittee to make the investment now to ensure that the current ill-equipped child welfare system can better protect very young children.

Court Teams is not a global solution to the problems of the child welfare system, Mr. Chairman.  But it is a very concrete approach to addressing a critical need at the local level. To ignore the needs of infants and toddlers when they come into the child welfare system in the earliest stages of life is practically to guarantee that they will experience difficulties later on.  As the Subcommittee looks at ways to operate coordinated programs of community-based family support services, I encourage you to consider the Court Teams approach and provide other judges with opportunities similar to the one I have in my court – to improve the lives of young children under their courts’ jurisdiction.

Thank you for your time and for your commitment to our nation’s most vulnerable infants and toddlers.

[1] Administration for Children & Families. (August 2005) The AFCARS Report: Preliminary FY 2003 Estimates as of April 2005 (10) What were the ages of the children who entered care during FY 2003?, U.S. Department of Health and Human Services, http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report10.htm , retrieved January 23, 2006.

[2]U.S. Department of Health and Human Services, Administration on Children, Youth and Families. (2006) Child Maltreatment 2004, Washington, DC: U.S. Government Printing Office, Table 3-10.

[3] U.S. Department of Health and Human Services, Administration on Children, Youth and Families. (2006) Child Maltreatment 2004, Table 4-8, retrieved on May 19, 2006 from http://www.acf.hhs.gov/programs/cb/pubs/cm04/table6_8.htm.

[4] Wulczyn, F. & Hislop, K. (2002)  Babies in foster care:  The numbers call for attention.  ZERO TO THREE Journal, (22) 4, 14-15.

[5] Ibid.

[6] Wulczyn, F. & Hislop, K. B. (2000).  The placement of infants in foster care. Chicago, IL:  Chapin Hall Center, for Children, University of Chicago.

[7] Family Life Development Center, College of Human Ecology.  (Fall 2004) NSCAW Documents High Risk Level of Children in Child Welfare System. The NDACAN Update, Vol. 15, Ithaca, NY: Cornell University, page 4.

[8] Stahmer, A.C., Leslie, L.K., Hurlburt, M., Barth, R.P., Webb, M.B., Landsverk, J., and Zhang, J. (2005) Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare.Pediatrics, vol. 116, no. 4. Grove Village, IL: American Academy of Pediatrics. Pages 891-900.

[9] Ibid.

[10] Cicchetti, D., and V. Carlson, Eds.  Child Maltreatment:  Theory and Research on the Causes and Consequences of Child Abuse and Neglect.  New York, Cambridge University  Press, 1989; National Research Council.  Understanding Child Abuse and Neglect.  Panel on the Understanding and Control of Violent Behavior.  A.J. Reiss, Jr., and J.A. Roth, eds.  Commission on  Behavioral and Social Sciences and Education.   Washington, DC:  National Academy Press (1993). 

[11] Kolko, D.J.  “Child  physical abuse.”  Pp. 21-50 in The APSAC Handbook on Child Maltreatment.  J. Briere and L. Berliner, eds.  Thousand Oaks, CA:  Sage Publications, Inc.  (1996).

[12] Shonkoff, J., & Phillips, D. (Eds.). (2000) From neurons to neighborhoods: The science of early childhood development. Washington, DC:  National Academy Press.

[13] George, C., and M. Main (1995). “Social interactions of young abused children:  Approach, avoidance, and aggression.”  Child Development, (50) 2, pp. 306-318.

[14] Infant Mental Health Project, Center for Prevention and Early Intervention Policy, Florida State University, Tallahassee.

[15] The following data is drawn from a Children’s Bureau Power Point presentation found on the internet at: http://www.acf.dhhs.gov/programs/cb/cwrp/results/statefindings/statefindings.ppt.

[16]Stahmer, A.C., Leslie, L.K., Hurlburt, M., Barth, R.P., Webb, M.B., Landsverk, J., and Zhang, J. (2005). Op cit.

[17] Halfon, N.; Mendonca, A.; & Berkowitz, G. (1995). Health status of children in foster care: The experience of the Center for the Vulnerable Child.  Archives of Pediatric and Adolescent Medicine, 149(4), 386-391. 

[18] Osofsky, J.D., Maze, C.L., Lederman, C.S., Grace, M., Dicker, S. (2004). Questions every judge and lawyer should ask about infants and toddlers in the child welfare system, Juvenile and Family Court Journal, 55 (2), 47.

[19] Malbin, D.V. (2004). Fetal alcohol spectrum disorder (FASD) and the role of family court judges in improving outcomes for children and families. Juvenile and Family Court Journal, 55 (2), 53-63.

[20] Young, N.K., Gardner, S.L., Whitaker, B., Yeh, S. (September 2004). A Preliminary Review of Alcohol and Other Drug Issues in the States’ Child and Family Services Reviews and Program Improvement Plans. Irvine, California: National Center on Substance Abuse and Child Welfare, page 17.

[21] National Clearinghouse on Child Abuse and Neglect Information (2005). Concurrent planning: What the evidence shows. Washington, DC: U.S. Department of Health and Human Services.

[22] Adams, S., Osofsky, J., Hammer, J., & Graham, M. (2003). Program Evaluation Florida Infant & Young Child Mental Health Pilot Project, Year 3, Final Report. Tallahassee, FL:  Florida State University Center for Prevention & Early Intervention Policy.

[23] Ibid.

[24] Ibid.