Web Posted: 07/29/2007 01:15 AM CDT
Nancy Martinez
Express-News

Dr. Cynthia Beamer began seeing child abuse up close as a San Antonio pediatrician in 1995. Fractures. Burns. Bites. Bruises. Hair yanked out. Ribs protruding from starved little bodies.

The pageant of misery made her angry.

I thought we needed tougher laws, that we need to nail these people," said Beamer, who now works as an emergency room physician at Christus Santa Rosa Children's Hospital and North Central Baptist Hospital. "But now I see that it really is a medical problem and the only solution is prevention."

Many child advocates agree, citing dramatic success stories such as Pennsylvania's Allegheny County, where no child died of abuse or neglect in 2004 or 2005. But as more states and municipalities move toward education and outreach with dramatic results, Texas remains woefully behind the times.

Faced with an alarming spike in fatalities four years ago, Texas lawmakers responded by cutting funding for prevention by 26 percent.

This year, with a budget of $913 million, CPS will spend $1 out of every $100 on prevention, according to an analysis by Madeline McClure, director of Tex Protects, the advocacy division of Austin nonprofit Prevent Child Abuse Texas.

By comparison, far more will be spent on paying caseworkers, whose focus is removing children from homes where they're thought to be at risk. In 2006, CPS removed 12,205 children statewide, 908 of them in Bexar County. Dozens end up sleeping in CPS offices because they have nowhere else to go.

Meanwhile, the number of deaths attributed to abuse or neglect continues to rise. Last fiscal year, a record 227 children died statewide.

"Until this state and this country are willing to invest in prevention, it's not going to change," said Vickie Ernst, co-chairwoman of the Bexar County Child Fatality Review Team, a multidisciplinary agency that examines all child deaths.

"They will fund roads and schools and hospitals, infrastructure, because those are concrete, but when you talk about raising taxes to prevent a child abuse death, that's a different thing."

In Bexar County, where a record 18 children died in fiscal year 2005, a handful of horrific cases that made the news put a public — and graphic — spotlight on the problem. But, because of state confidentiality laws and other factors, many other deaths occurred and continue to occur and most people never hear about them.

The big picture is grim, Beamer said.

"Child abuse has become an illness. It is an illness that is killing the heart of our city. We're addressing it after the problem, and it's too late."

The problem is social as well as systemic. Despite declines in teenage pregnancy across the country, Texas has the highest rate of teen pregnancy, according to the Annie E. Casey Foundation, a national child advocacy group based in Baltimore. A 2007 Bexar County Metropolitan Health District report found that some parts of the city have up to four times the national rate.

Though countless local programs offer help to struggling families, Beamer said, "it's too fractionalized."

"There are a gazillion little groups without any cohesiveness. If you just had one place where people could get help with mental health, drug use, parenting and resources into the community such as help paying rent and utilities," she said.

Some child welfare departments around the country — including at least 10 that are under consent decrees or court orders to reform — have shifted their focus from removing children to preserving families and preventing abuse.

They are reducing the caseloads of social workers; centralizing outreach performed by independent nonprofits; identifying and getting help to at-risk families before their problems get out of hand; and relying more on extended families for foster care of children when their parents become abusive.

The approach is getting results.

In Alabama, deaths from child abuse and neglect dropped to 20 last year, down from 35 in 2000, continuing a steady decline after the state adopted prevention-based reforms in the 1990s.

In Pennsylvania, Allegheny County achieved a similar turnaround after seven children died from abuse or neglect in 1995.

Outrage led to a restructuring of services and a change in philosophy to focus on prevention. The county assists struggling families with housing, helps them pay bills and buy groceries and provides drug and mental health care.

In 2006, Allegheny County, which has about three-fourths the population of Bexar County, attributed three child deaths to abuse. In the same period, Bexar County reported 14.

"We have been called a national disgrace. We were a system in crisis, but now we're called a shining model," said Marc Cherna, director of the Allegheny County Department of Human Services in Pittsburgh. "We are very values-driven. We build on families' strengths, which is different than most CPS systems."

Well-meaning efforts

Well-meaning social workers and advocates in Texas long have tried for a similar emphasis. But legislators repeatedly have left CPS short-handed and underfunded. Low-paid caseworkers scramble to keep up and often are unable to monitor abusive parents on their watch.

Consider the case of Valerie Lopez, whose two children, 14-month-old Sariyah Garcia and 4-month-old Sebastian Lopez, were found dead under her house in March.

Lopez had a long history with CPS, both as an abuser and a victim. She gave birth to her first child at age 13 and went on to have three more by the time she was 19. She was convicted of assaulting one. CPS removed that child and a sibling and the two were adopted.

But then the agency lost track of Lopez, who managed to hide from CPS in plain sight. Though the agency said its caseworkers made 43 attempts to find Lopez, most of those attempts were unreturned phone calls and e-mails.

Then Sariyah and Sebastian were found dead.

Caseworkers are held accountable for such mistakes, though most quit on their own. Through an open-records request, the Express-News learned that from September 2005 to February of this year, CPS in the San Antonio region had a 246-caseworker turnover rate. Many of them, 94, resigned in lieu of being terminated; 53 were fired for violating rules.

But disciplining overburdened caseworkers doesn't bring back those children the system failed.

"If (CPS) was doing such a great job on prevention, why wasn't Valerie Lopez reached?" said state Sen. Carlos Uresti, who has made child welfare issues a focal point of his tenure. "We've reformed the agency, but what we're doing for prevention is abysmal."

Problems pinpointed

Mounting reports of horrific abuse and an increasing number of child deaths prompted Gov. Rick Perry to order an investigation of CPS three years ago.

Among the inspector general's findings:

In a third of the cases, CPS failed to take appropriate action to protect the child.

In almost half of CPS caseloads — 43 percent — there were allegations similar to those made in a previously closed case with the family.

In two-thirds of the cases, caseworkers did not initiate a safety plan or place the child in substitute care, as required by policy.

Resistance to change also has prevented improvements.

Dr. Fernando Guerra, a longtime pediatrician and director of the San Antonio Metropolitan Health District, said he has tried for years to persuade CPS to place caseworkers in public health clinics so they can have regular access to at-risk mothers as they get their Women, Infants and Children vouchers, immunizations and family planning services.

Guerra calls it "an expanded safety net" that might identify more at-risk mothers.

But Guerra said CPS has never agreed to the change and it would take state legislation to happen.

Abuse in Texas has become so endemic and lawmakers so indifferent to pleas for a new course that some child advocates think the state might be putting itself at risk of lawsuits. So many other states have been taken to court for failing to protect at-risk children that private businesses have cropped up to help with litigation and reform efforts.

The Child Welfare Policy and Practice Group, based in Alabama and led by Paul Vincent, who headed up reform efforts in Alabama when he was the director of the child welfare system, now helps child welfare agencies across the nation improve their systems. Currently the nonprofit group is working with 10 states and has consulted with a third of the child welfare systems across the country.

"Our ability to help agencies keep children safe is housed in the skill of the frontline workers," Vincent said.

A class-action lawsuit in Alabama led to a consent decree in 1991 that required the state to focus on keeping families together and answer to an independent court monitor.

The state has since quadrupled spending on programs while trimming social worker caseloads by almost two-thirds. The number of child removals to foster care fell by 310 from 2005 to 2006, as the number of removals in Texas was rising by more than 5,000.

Most children who become involved with the Alabama system are not abused again. Of new abuse and neglect cases, nine out of 10 files had no allegations of abuse the previous year.

To ensure the system continues working, a state quality-assurance unit reviews each of the 67 counties in Alabama at least once every three years.

There is no such state review of Texas' child welfare system. The only evaluation Texas gets is the same federal review that assesses outcomes for every child welfare system in the country. Texas' next such review will be in March 2008; its first was in 2002.

Pennsylvania's changes

In 1995, Pennsylvania joined Alabama and other states in reforming the child welfare system.

Pennsylvania's director of the Office of Children, Youth and Families resigned after a newspaper reporter brought the department's problems to light, spokeswoman Marge Lubawy said.

County commissioners appointed John Murray, the Duquesne University president, to head the blue-ribbon Committee to Prepare Allegheny County for the 21st Century.

The committee integrated departments and emphasized keeping families together.

Agency officials say the reorganization was crucial to the reform because it gave them the ability to see what other services clients were getting. For example, if a mother who was already getting mental health services at a county health clinic became involved with the children and youth department, a caseworker could call up that history to get a full picture.

There were several other changes.

"One of the primary changes was the philosophy of prevention," Lubawy said. "We provide in-home services to families and teach parenting skills. If there is a need for rehab for drugs or mental health, we provide that. And if children need to be removed, we first consider a reliable family member. We try to work with the families, to heal the whole family, and we've been successful in most cases where we've reunited families."

Colleen Zaremba, a 49-year-old mother of three from Monroeville, a Pittsburgh suburb, said Allegheny County caseworkers took her by the hand more than a year ago.

"The day they intervened, I was very rude to them. I had been smoking crack all day. I told them they had no business in my house, and that I was going to hire an attorney. Here I am acting like this hotshot that is going to get one over on CYF and I threw them out of my house. Of course, they came back."

When they did, Zaremba said she admitted she was dirty before a drug test could be done. The help began right away, with the department offering her a choice of residential treatment options and other assistance.

"They took me to sign up for medical benefits and food stamps, everything. They made sure I sent out forms. If I didn't have a ride to treatment appointments, they gave me a ride. They did everything for me," she said.

Even with the help, Zaremba said she hasn't been completely successful. In November, she relapsed and the department temporarily removed her 11-year-old son and placed him with her parents.

But caseworkers didn't give up. The department still sought help for Zaremba and at one point allowed her to move in with her parents as well. She says she has been clean ever since.

"I am one of the luckiest people in Pittsburgh to have this help," she said. "There were times before they showed that I had a gun in my mouth, I couldn't stand the person I was. I couldn't see any way it could get better, and they encouraged me. They let me know I could get my life back."

'Fragmented' efforts

With little state support for prevention in Texas, nonprofits and advocacy groups largely take it upon themselves to identify and reach out to struggling families.

San Antonio is home to the Children's Shelter, a place devoted to victims of abuse or neglect, and to the Center for Miracles and Child Safe, two organizations that work directly with abused or neglected children.

The Center for Miracles recently got a $1 million grant to use for prevention programs.

Another program, Healthy Families, tries to pre-empt abuse by intervening with at-risk mothers. The organization focuses on first-time mothers who seek advice and assistance with services. About 90 women are counseled every year, with a "parent educator" assigned to visit each one at least once a week.

The program has been a valuable safety net for Jacqueline Vallin and her son, Nathaniel.

Vallin, a high school dropout who lives in a high-crime neighborhood, became pregnant when she was 18, a few years after she had tried to kill herself with sleeping pills.

Healthy Families has helped her learn to be patient with Nathaniel, and to stay on her medication for bipolar disorder.

"I've learned so much in just understanding him," Vallin said. "Parents get frustrated and slap their kids, but this has taught me to understand him."

Program director Shirley Seaney said Healthy Families tries to "break the cycles of substance abuse and discipline habits."

"Our goal is to put CPS out of business."

But, with Texas' increasing rate of abuse and more money thrown at CPS, the agency won't be shut down anytime soon. Just the opposite is happening: Funds have been cut to many nonprofits, including the widely successful Healthy Families, which survives locally on private grants after losing state funding in Texas.

Meanwhile, the human toll mounts. Last fiscal year, 14 Bexar County children died of abuse or neglect. This month the Express-News ran all their photos and stories together to convey the big picture, the crisis as it was never shown before because of confidentiality laws that keep many deaths out of the public eye.

Beamer, the pediatrician who has seen this crisis up close, wants it given more exposure.

"There was a boy with 23 fractures in various stages of healing," she said. "His poor little legs were bowed because of the way they healed."

"One came in here who was starved, his ribs protruding and his skin hanging off like an old man. Parts of his hair were torn out."

"Some come in with pummeled faces," Beamer continued. "And others can't see out of their swollen eyes, yet parents wait several days to bring them in.

"A lot of the kids haven't eaten and there are bite marks, burns. Those are the images people should see."

nmartinez@express-news.net

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Emphasis added by H4K Editor