For many in child welfare, 2020 is a lost year

This is the third in a series produced under a USC Annenberg Center for Health Journalism 2020 National Fellowship, which focuses on the stories of vulnerable communities. The first two parts of the series explored how COVID-19 has affected young adults "aging out" of the foster care system and grandparents raising kin.

Michael "Mickey" Hogan, 42, and his then wife were living in a camper beside a back road in Denver, preparing to take their newborn son to a doctor's appointment in August 2017, when a child protective services agent from the county showed up at their door.

He told the caseworker that they needed to leave for his son's appointment, and she told him it could wait.

Court records show that a hospital social worker had reported suspected malnutrition and substance use in the home to the Denver Department of Human Services. The social worker's greatest concern was that as a first-time-mother, Hogan's wife had not asked "a lot of questions" or appeared "nervous about the care of a baby." She also refused a drug test for herself or her baby at the hospital, although a subsequent drug test was negative.

Hogan, however, had failed his drug test, police arrived on the scene, and his 6-day-old son was whisked away.

"Honestly, I thought there was no way... I could lose this," Hogan told MedPage Today. "I'm a good father."

When the pandemic hit, Hogan was only two weeks away from having overnight visits with his son -- a privilege extended only to parents who have achieved certain steps in their care plan.

He went from seeing his son alone, in-person 7 hours a week, to speaking with him twice a week for 30 minutes online, with his son's foster mother present.

"That was tough," he said.

Hogan had been sober for over a year when COVID-19 cases in the U.S. began to surge. He regularly met with a drug counselor, attended two outpatient recovery groups a week, and took urine tests and mouth swabs to keep himself accountable.

When stay-at-home orders were implemented in Colorado in late March, all of those services were suspended. Hogan wasn't able to be in the community and meet with his support group or his drug counselor. His sponsor relapsed. Then Hogan did, too.

The pandemic disrupted many of the services necessary for parents involved with the child welfare system to be reunified with their children. While emergency court hearings continued, those intended to assess a parent's fitness and progress toward reunification were delayed, in-person meetings with children froze then shifted to virtual visits, and badly needed behavioral health supports became even more difficult to access

As a result, reunifications and adoptions have been lower in 2020 compared to prior years, and many birth parents, foster parents, and children are stuck in limbo.

Reunifications Stalled

The Juvenile Dependency Court in Los Angeles, which serves the nation's largest child welfare agency, was closed from March 16 to June 21, creating a backlog of cases. The number of reunifications fell 20% in fiscal year 2019-2020 versus the year before, according to the California Child Welfare Indicators Project. The number of adoptions also dropped 17%.

Although the court continued to make the necessary "reasonable efforts" findings on matters when possible, reunification hearings were sidelined in the early months of the pandemic, said Diane Iglesias, senior deputy director for the Department of Children and Family Services in Los Angeles.

"The court said, bring in all these kids that are in danger so we can get jurisdiction over them and we can start helping move these families along, but the only hearings being done were the initial hearings that said, 'Okay, we're going to take your child,'" Iglesias told MedPage Today.

In New York City, which oversees the care of 7,774 children, family courts closed on March 26, except to hear emergency or essential cases. As a result, half as many children were reunified with their parents in April 2020 compared to a year earlier, zero adoptions occurred, and no children were discharged to relatives through a program called KinGAP.

On April 13, the courts proceeded with non-essential and non-emergency applications in pending cases. Still, the number of reunifications to take place between April and August this year was 36% lower than the year prior and KinGAP was down 32%. In 2019, 368 adoptions took place in this time period versus just six in 2020.

Developmental pediatrician Douglas Waite, MD, who co-authored the American Academy of Pediatrics guide to caring for children in foster care during COVID-19, said coordination of services has been fumbled for many families, and timely permanency plans have faltered.

"This is a case where the state has removed a kid from their parents -- a hubris move," Waite told MedPage Today. "We have the responsibility therefore to be the parents for these kids or ensure their care is met at least better than if they were with their parents."

Courts' options for children removed from the home include reunification with a parent or termination of parental rights (TPR), which can lead to adoption or permanent guardianship. If the case is moving toward reunification, parents are required to complete a case plan, which may include parenting classes, mental health services, drug screening, or things like securing stable housing and employment.

However, some parents have met their case plans' criteria but haven't gotten their children back because of bureaucratic barriers, said Raven Sigure, 43, a parent partner mentor at the Extra Mile Resource Center Region IV in Lafayette, Louisiana.

One mother Sigure works with, for example, has been in her new home for a year, completed parenting classes, screened negative on drug tests, and passed the mental health evaluation required for her child's return. But because of a feud between two parishes involved in her case, her children have not been returned.

"It's a waiting game," Sigure told MedPage Today. "And what they fail to realize is, unless we move and act on and help these parents while they actually want the help and are involved, we will lose them."

In her 9-year career as a parent partner, Sigure has lost four parents to suicide or overdose.

Having gone through the reunification process with her own children in 2010, Sigure knew what parents were up against. She spent the first months of the pandemic driving to clients' homes to check on them. She bought phones for some parents who did not have data plans compatible with virtual meetings.

But she still worried. One of her clients, a mother working to be reunified with her three children, had gotten a job at a restaurant, secured an apartment, and was getting outpatient treatment several days a week for substance use.

When the pandemic hit, in-person visits stopped, the restaurant closed, and she could no longer afford her car payments or rent. Instead of seeing her addiction counselor 4-6 hours a week in person, she saw her for just 30 minutes online.

"It was just like boom, boom, boom, boom," Sigure said. "I could see the stress. I could hear it."

Soon, the mother started getting eviction notices. Together, she and Sigure searched for a bed in a treatment facility, but they couldn't get her admitted and before long she went "MIA," Sigure said.

"I have not seen or spoken to her in over two months now," Sigure said. "It hurts... when you actually see what COVID has done."

The Danger of Delay

Part of the reunification process involves birth parents spending time with their children, either under the supervision of a caseworker or independently.

In a letter to state and tribal child welfare leaders on March 27, Jerry Milner, associate commissioner for the Children's Bureau at the U.S. Department of Health and Human Services, wrote, "Family time is important for child and parent well-being, as well as for efforts toward reunification," especially "during times of crisis."

Milner warned that the bureau "strongly discourages the issuance of blanket orders that are not specific to each child and family that suspend family time."

"[D]oing so is contrary to the well-being and best interest of children, may contribute to additional child trauma, and may impede the likelihood of reunification," he wrote.

Although most states have since returned to some form of in-person visitation, 23 suspended in-person visitation in March and April, according to a survey conducted by the Center for Public Integrity.

Michael Huesca, executive director of Paternal Opportunities Programs and Services (POPS), a father-focused advocacy organization in southern California, said virtual visitations did not translate well for some of the fathers in his program.

A parent's disappointment when their child doesn't want to talk to them on a Zoom call, because the television is on or because other siblings are wanting to play, can have outsized impacts on reunification, Huesca told MedPage Today.

"It's created a huge issue, because then Dad doesn't want to engage with the child over Zoom ... because the child didn't want to have anything to do with Dad," he said.

Shorter, more frequent calls with the child may be more appropriate in some situations, but even those may be seen by child services as "failed visits" because they're so brief, Huesca said.

That kind of thinking needs to change, he said.

Sigure said parents rely on visits with their children to give them strength. When a visit goes poorly, hurt parents will express their hurt in different ways.

"They either won't comply, their attitude will be nasty," or, she said, "worst of all they feel useless and hopeless."

Each day that birth parents spend away from their children takes a toll on their well being, said Liyan Bao, vice president of Placement Permanency Support at New York Foundling.

"We have had some families who have just been completely discouraged by all of this, not being able to have their kids go home to them, and they were on the right track," Bao told MedPage Today.

More family visitations have been tied to an increased likelihood of reunification and a reduced likelihood that children will go on to develop depression or externalizing problems. Visitation is viewed as the "primary intervention for maintaining the parent-child relationship," according to the Children's Trust Fund Alliance.

The older children are, and the longer they have been in child welfare, the less likely it is they will find a placement. By the time a child turns 14, the goal of his or her case plan typically shifts from reunification to independent living, and the likelihood of finding permanency with a foster parent or kinship guardian is greatly diminished.

Kate Beatty, PhD, MPH, of East Tennessee State University, took in her foster son, Chance, when he was 5 days old in early April. Chance's biological mother wanted to breastfeed her son and got approval to provide breast milk to Beatty with clean drug screens.

At the time in Tennessee, in-person visitations were on hold. Instead, Beatty and her husband would hold Chance and FaceTime with his mother, who would read him a book or talk with him. But he was an infant and did not engage with the phone. Within a month of physical separation from her son, Chance's mother's milk had dried up.

"She was unable to continue to pump because she was not interacting with the baby, which is a big part of what keeps your milk supplied, hearing the baby cry and being around the baby," Beatty told MedPage Today. "That was the first sad thing that happened."

Services Disrupted

Beatty got a court order to allow in-person visitation, but Chance's mother's progress toward reunification has been stalled because she has struggled to stay connected to parenting classes and support groups since they went online.

At this point, the mother's chances of reunification at the time of their next court hearing in January are slim, and it appears Beatty will care for Chance for another 3 months, amounting to the first year of his life.