Sue LaBella lives in a two-level home in Westminster, with white siding, a wooden fence, and two Labradors playing in the yard out back. It's the classic picture of the suburbs.
Inside the house, however, you won't find the typical nuclear family. Six-year-old Ray, a boy with thick black hair and heavy eyebrows, watches the door with an intent but lost gaze. Ray has Down's syndrome, and he has a cold. He's been tired and irritable the last few days, but today he zips around the first floor trailed by two dozen feet of oxygen tubing that is connected to his nostrils on one end and to an inert canister on the other.
He crawls into what in another home might be an ordinary family room. There's a TV, photos of kids on the wall and a poster of a Salzburg castle. But there's also an IV hooked up to a crib, and in another corner a ventilator hums quietly--there's the occasional warning chirp--and one blue tube and one white tube snake their way across the floor and into the neck of Chuck, a fifteen-month-old infant delivered prematurely whose dysfunctional lungs are kept expanded by the machine. Chuck has chubby cheeks and a tuft of copper hair and appears content to lie on his blanket--at least he's out of the hospital.
"I was never interested in getting married," LaBella says. "But I always wanted kids."
LaBella adopted an eight-year-old girl named Stacey who suffered a severe brain injury when she was two, which led to a stroke, which led to paralysis on her right side and poor eyesight. Now she has problems with memory and self-control, and three-fourths of her brain is dead. She has therapy three times a week.
LaBella also adopted a boy named Vincent Michael, who had been shipped around to four foster homes in less than a year.
There are seven kids in LaBella's home. The former computer-science major and nanny thrives on taking care of these children. With the help of Renee McAfee, a full-time nurse, LaBella's days are full with taking the kids to speech therapy, physical therapy and occupational therapy, as well as with feeding them and watching over them. Several times during the course of an hour, Chuck's ventilator emits its warning bells, and McAfee and LaBella must constantly check to make sure all is well.
"It's the coolest machine I've ever learned," LaBella says.
With few exceptions, foster homes that are overseen directly by the county are not equipped to deal with the problems of LaBella's medically fragile charges. But LaBella contracts through Synthesis, a private child-placement agency. And, she says, without the agency's support, "I couldn't take another baby." Synthesis caseworkers have accompanied her to the hospital for children's surgeries, and they provide an extra set of wheels for trips to the doctor and to school, plus the seven weekly trips to therapy.
LaBella's home is drastically different from another foster home that's been in the news recently, where children also had been placed by a private agency. Three weeks ago, in the same town where LaBella lives, two-and-a-half-year-old Miguel Humberto Arias-Baca died from severe head injuries brought on by a "non-accidental trauma." The boy had been placed in the home of Rick and Evon Haney by an Englewood CPA called All About Kids.
The boy had bruises all over his body, and he had been badly beaten when the Haneys first took him to the hospital. The pair, it turned out, had prior arrest records. After $3,000 turned up missing from an after-school program she supervised at a Thornton elementary school, Evon Haney was arrested in December 1997 but later released. That case is still under investigation. Rick Haney was arrested in February 1997 and charged with drunken driving, careless driving and driving without a license. Police in Westminster had also visited their foster home a few years ago to investigate a reported sexual assault involving two foster children.
The child's death focused media attention on private child-placement agencies, which had previously been a relatively unnoticed element of a state child-welfare system overburdened by levels of bureaucracy, skyrocketing costs and antiquated data-collection methods that make it difficult to gauge whether children benefit from their time in the foster-care system.
Since the late Eighties, private child-placement agencies--some run for profit, others not--have emerged as pivotal players in a system that is seeing more children than ever before, at a younger age and with more serious problems. Last year, 6,288 kids in Colorado were taken out of their homes. Of those, 3,597 were placed in family foster care, and of those, 53 percent, or 1,906, were placed through private child-placement agencies.
The private placement agencies emerged in the mid-Seventies as an alternative way of getting handicapped kids out of institutions. "They were kind of warehouses," says Synthesis executive director Pam Hoggins, whose agency was one of the first handful of CPAs. "Multiply handicapped kids had no shot of living in the community," she says.
By the mid-Eighties, CPAs had become the primary agencies to find homes where parents could care for children with medical problems, and at the end of the decade, CPAs were moving into therapeutic care for kids with emotional and behavioral problems. CPA operators learned, says Hoggins, that if they could provide "well-trained foster parents in the home, [such children] didn't have to be institutionalized."
CPAs are licensed by the state's Child Care Licensing unit; county social service departments contract with CPAs to place kids in homes, which the CPAs then supervise. When the state began collecting statistics in 1986, there were 49 child-placement agencies in Colorado. As of July 1, 1998, that number had almost doubled. Though some of those CPAs handle only adoptions, both in this country and abroad, Dana Andrews, the state's child-care licensing administrator, describes the increase in private child-placement agencies as significant and says the number of CPAs really began to escalate in the early 1990s, due largely to a rise in drug and alcohol cases that required special care.
At the same time, foster parents who worked with counties began jumping ship. "Foster parents who work for counties became very disenchanted with the level of service they were getting," says Sandra Barnes, a foster-care coordinator at a CPA called Adoption Alliance in Aurora. Barnes says kids were coming into the system at a younger age and with more serious medical and behavioral problems, and the counties were not there to provide therapy or to provide support--24-hour hotlines, a caseworker who came by regularly, someone to listen and offer advice when a kid sawed off the end of a living-room table or set something on fire. "Child-placement agencies rose to fulfill that need," she says.
But it came with a cost.
Colorado counties dole out money to both county-run foster homes and to private CPAs. While most of the 104 CPAs in the state are nonprofits, 28 of them are profit-making entities. And the state pays more for the services of the private agencies: In fiscal year 1997, the state paid an average of $1,058 per month to foster parents in county-administered programs; foster parents who worked through CPAs earned $1,691.
Many observers say CPAs are motivated more by money than by helping children. "We now have profit-making agencies finding homes for kids," says attorney David Littman, who has worked many juvenile court cases as a guardian ad litem, or legal representative for kids.
"I think some CPAs are in this for the business," says Joyce Wilson, the supervisor for foster-care licensing at the Jefferson County Department of Social Services. However, she adds that it's not a job that will make anyone rich. But according to an August 1998 audit of the Child Welfare Services Division, as much as 65 percent of the fees paid to CPAs might be used for administrative purposes or purposes other than those related to the direct care and maintenance of the children in placement. Counties also have administrative and clerical costs, but the largest counties are able to spread those costs among more foster homes than CPAs can. That means the average overhead spent on a county foster home in a large county such as Denver is less than for a CPA home.
Child-welfare workers agree that CPA costs are higher because CPAs provide children with more sophisticated services than county-run foster homes. But the state audit notes that "neither the [state] nor the counties know whether this is reasonable or appropriate or whether the comparable services could be provided more or less efficiently by the state. Consequently, the state may be paying too much for activities and tasks not necessarily related to the direct care and treatment of children in out-of-home placement."
"When you don't know what services you're paying for and what the outcomes are, you get a system that doesn't make a lot of sense," says deputy state auditor Joanne Hill, who led the audit.
"There are a lot of good foster parents out there," notes LaBella. Speaking of a young girl with a long list of medical problems whom she's trying to adopt, La Bella says, "If I wasn't able to adopt her, she'd be stuck in the system. They sound like we're putting kids in the closet and making money."
But Jefferson County's Wilson is wary of private placement agencies. "You start making this a business and you start getting abuses that are pretty significant. Businesses want people. They're gonna say, 'So, they lost their driver's license, but we'll give them a lot of counseling.' They'll take risks county agencies won't."
Colorado is one of only a few states that has a state-supervised, county-administered child-welfare system (most other states have state-supervised and state-run child-welfare systems). That means Colorado's Division of Child Welfare Services, part of the Department of Human Services, lays down the rules for all of the state's child-welfare programs and then passes out the money--$196.2 million in fiscal year 1997--to county social service departments, and each county is essentially autonomous. It's as if the state has 63 separate child-welfare programs. And now the state is in the late stages of shifting to a managed-care model in which counties will assume the financial risk of delivering child-welfare programs; legislators hope they will use their now limited resources more efficiently and with greater accountability.
But part of the system's out-of-control costs are attributable to the fact that CPAs are draining a disproportionate amount of funds from the system.
When child-placement agencies began to emerge, says guardian ad litem Littman, "they came in and represented to the state and county that they would do a better job than social services. The reality is, there have been some very good child-placement agencies and very bad ones."
The lack of reliable outcome data gives ammunition to the critics of CPAs, who allege that there is not sufficient county or state oversight of these agencies.
The state human services department conducted an extensive review of CPAs in 1997, spending more than 3,000 hours on the work. The report was favorable to CPAs, concluding that, "Overall, children are getting good care. With few exceptions, children appear to be receiving what is requested or needed despite the absence of an outcome-based system."
Forty-three CPAs were found to operate "efficiently and effectively." Ten were found to be the source of the majority of problems--but they were not named in the report, which, oddly, was put into a final draft form and released to a handful of people but never published. It remains an internal document, not available for public inspection.
Those in the pro-CPA camp suggest that the state did not release the report because its findings were favorable to the private agencies.
But one CPA, Living Waters/Crayon Academy in Denver, had its license pulled in December. A month earlier, a caseworker had reported that a foster child in a home certified by Living Waters had attacked other foster children, eventually threatening the foster father with a knife. The child then threatened to kill himself. Aurora police were called, but they would not transport the child to the Denver Family Crisis Center because it was out of their jurisdiction; the foster father didn't transport the child, either, because he was fearful that the boy would try to jump out of the car.
When the foster father called the executive director and placement supervisor of Living Waters, Mitzi Kennedy, she told him she no longer worked there. So he called the owner of the CPA, Felicia Everett. Her number had been disconnected. He left a message with her through a third party, but weeks passed and he never heard from her.
The state stepped in and charged the agency with "inadequate staff to oversee foster homes." A hearing is scheduled for the end of this month.
In addition to such administrative problems, critics complain about a lack of financial accountability among CPAs. Guardian ad litem Rodney Borwick says he was involved in one case in which a CPA convinced a county to put up the money to hire a psychologist to work with a particular child, but the CPA never hired the psychologist.
"The money gets paid, in spite of everyone knowing that they're not doing the service, but nothing happens," Borwick says.
And for some who must work with both the county-run foster-care programs and the private CPAs, the private CPAs have created a troublesome layer of bureaucracy. Littman tells of a six-year-old boy for whom he is currently serving as guardian at litem. The boy's mom is a glue- and paint-sniffer, and the boy may suffer organ damage as a result of the exposure.
Littman says the boy's case had been heading smoothly toward a termination of parental rights. His foster parents were very committed to him, but because his legal status was still up in the air, he could not yet be adopted. Without notifying Littman, two more children were placed by Arapahoe County, through a CPA, in the foster home. The presence of these other children unbalanced Littman's child, whose behavior suddenly deteriorated. "The foster parents who were willing to adopt him now have demanded his removal," Littman says.
The problem was that the kid needed a psychological assessment, and while the CPA and the county caseworker agreed it needed to be done, each side expected the other to do it. "The [county] caseworker isn't able to work her way through the bureaucracy," Littman says. "And having transferred the responsibility of the child to the CPA, social services is loath to come up with the resources. [The county is] a legal custodian without any real authority.
"This is characteristic of why and how this extra layer of bureaucracy is working to the detriment of the child," he says.
Andrews, the state's child-care licensing supervisor, points out that the state does have regulations overseeing CPAs. Once a year, someone from the state comes to monitor the CPAs and look through the books--and because the counties place children through particular CPAs, that gives the county departments oversight authority. But asked whether that oversight was adequate, she says, "I can't respond to that."
For the most part, CPAs screen foster parents the same way counties do. There are extensive questionnaires and interviews, as well as checks with the Colorado Bureau of Investigation and with the child-abuse registry to see if the applicant has any confirmed incidents of abuse or neglect. Having a criminal record doesn't necessarily disqualify a person from becoming a foster parent. It all depends on circumstance--for example, whether an arrest record stems from an assault the previous month or from a DUI charge twenty years ago.
"The state puts down minimum rules and standards," says Carol Wahlgren, a child-protection program specialist with the state. "Unless we hear of a problem, there's an assumption that everything is going all right."
Those who run CPAs say that the market provides the best oversight: If a county is not satisfied with the service a CPA provides, the agency simply is not given any more referrals and goes out of business.
At the same time, however, other market forces are sending more and more kids into whatever homes will take them.
The crunch is obvious in the juvenile courts, where judges decide what to do with children in abusive or neglectful relationships at home.
"If everything goes swimmingly," Littman says, "you then have a myriad of services to access to overcome problems that got kids into social services to begin with."
Ideally, when a child is removed from his home, a treatment plan for the parents is immediately drawn up, parents are given access to service providers to help them with therapy or counseling, and the kid is placed in a secure environment for a few months and then sent back home.
But things usually don't go so swimmingly.
The way the system works now, says Allen Pollack, program-development specialist for the state's human services department, a caseworker is assigned to a case, and if he or she determines the child needs out-of-home placement, the worker seeks out a provider, "usually the first available bed they can find." The kid is placed, and the worker visits whenever possible, which many times isn't very often.
Pollack says the system currently serves the interests of providers--who are seeking to be paid for services rendered to children in out-of-home placements--rather than the counties, which are the legal custodians of the children and are attempting to return them to their families.
A new law has forced courts to have a permanent placement plan for children within twelve months after they are removed from their homes. The law is designed to force people to work together, be accountable and get kids out of the system faster. But as one Denver juvenile judge admits, it may lead the system to send kids back home before they're ready to be sent.
And the courts are having a hard enough time getting kids settled in eighteen months, which had been the previous standard. According to a 1996 study, in more than 41 percent of Denver's cases, it took longer than eighteen months for children to be placed somewhere permanent: back home, with a relative, or in adoption. Adams, Arapahoe and Jefferson counties did better--but even 18.7 percent of Jeffco's cases took longer than eighteen months, depicting a system that is overloaded in trying to get kids through and out.
The longer kids stay in foster-care limbo, the more they run the risk of developing attachment disorders, which makes them incapable of really bonding with anyone, including their parents, who may have cleaned up their acts during the time kids have been out of the home.
"Forty to fifty percent of children who are reunited with their birth parents end up back in the child-welfare system," says Seth Grob, staff attorney with the Rocky Mountain Children's Law Center. "Someone is making poor decisions. Lack of training [county caseworkers] is a problem, high caseloads is a problem, and failure to take an accurate social history, failure to adequately monitor how the parents do."
And though the idea of private business placing children in foster homes may have the unseemly ring of profiting from children's misfortune, CPAs are quick to trumpet their virtues.
Rexford Nickerson, director of human resources at Presidio, a Wheat Ridge CPA, says the county is to blame for being poor consumers.
"Counties and the state have been pretty bad customers," says Nickerson. "They don't have a system of assuring they're getting their money's worth, paying one agency X amount and another twice that, quite possibly for the same circumstances. It's a real train wreck. Someone needs to provide some leadership, someone who understands basic principles of management accounting."
Nickerson says county social workers should stop doing social work and assume a more supervisory role. "They're paying us to do the social work," he says. "Let us do the work, and you be the check and balance and assure the agency is doing what the agency said it would do."
Andrews doesn't think county failings have anything to do with the rise of CPAs. "The growth is for a variety of reasons," she says. "A lot of them feel they're called to this. They think they can provide services that the county department needs. Some are called by the ministry. Some are called for personal reasons."
That's a good description of Clara Sterling, who became a foster parent in 1971. Children were always around her home: her own kids, and those of relatives and friends. Her first foster child was a teenager named Regina Wilson who stayed with her for nine months, then was emancipated by the system. "I don't know what happened to her," Sterling says. "I still have her birth certificate."
Sterling, who has worked with both Denver county and a CPA called Denver Arapahoe Adams County Care, says the private way has its advantages. In Denver's county system, she says, she only needed to have First Aid, CPR and a twelve-hour core training class. For DAACC, she needed to have forty hours of certified training on topics ranging from pharmacology to sexual perpetrators.
She also says that with the county, there is little time to meet a child before a placement to make sure the match is right. "You might spend one hour with the kid, no more than two, but the kid doesn't really get to know you. But with a CPA, we ate, we reacted. I was able to watch their reaction."
Sterling lives in a spacious duplex in northeast Denver. African art is placed throughout her home, except in the "Broncos room," which is filled with this season-ticket holder's team memorabilia. It is the only place in the house where foster kids must tread lightly.
Sterling now has two foster girls, one age thirteen and the other fourteen. The older girl was a victim of abuse and has a history of hallucinations; the younger one has been bounced around a dozen foster homes and group homes since she was two. The girls share a neat and cozy room, where two stuffed rabbits hang from one wall and a teddy bear hangs from another. Sterling says that so far, these kids have given her little trouble, although one does have a hair-trigger temper, and she often finds the other wandering the house early in the morning.
When Sterling heard about the Haney incident, she says that at first she gave the parents the benefit of the doubt. Now she believes the couple was in it just for the money.
"It's very disappointing," she says. "It makes it hard for foster parents who really love their kids. It puts a black mark on all of us. It makes people wonder.
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