Child deaths in families involved with the state Department of Children and Families are more likely in cases where agency workers have spent less time assessing and interacting with parents, a preliminary review by the agency indicates.
In recent legislative testimony, a DCF official said that an ongoing review of 248 cases – half in which a child under the age of 4 had died, and half in which there was no fatality – had turned up a number of “risk factors,” including the young age of parents, addiction and mental health problems, and a lack of “quality” contact with DCF social workers.
“We found that, in the comparison or control cases (where no fatalities occurred), we were assessing parents more, we were visiting parents more. The quality of home visits were more of (high) quality than those in which fatalities had occurred,” DCF research supervisor Janet Gonzalez told members of the Committee on Children.
That finding “feeds one of our recommendations, in regards to enhancing the assessments that we do of families in the home,” she said.
The review comes as Connecticut grapples with a high number of child deaths, outlined in a recent report by the state Office of the Child Advocate (OCA). Of 82 deaths of children, birth to 3, in 2013, 38 were deemed non-natural. Of those, 21 lived in families that had current or previous involvement with DCF, the report showed. Nine of those deaths were associated with abuse or neglect.
In its report, the child advocate’s office found that DCF’s response to “at-risk infants” was often insufficient, showing “gaps in risk assessment, treatment planning, case follow-up, and quality assurance.” Of special concern was a spate of deaths due to unsafe sleeping practices, some in which babies were found face down in a parent’s bed. In one such case cited by OCA, a 2-month-old was found dead in her parents’ bed, in a family that had a history of 10 prior DCF reports and parental substance abuse.
At the recent committee hearing, both Child Advocate Sarah Eagan and DCF officials spoke of new efforts to educate parents about unsafe sleep practices. Gonzalez said unsafe sleeping was a “major” concern, and that the department’s own review shows more education is needed.
“Although we saw that staff was providing parents with that information, we didn’t see an ongoing discussion about that,” Gonzalez said. “They give (families) a brochure, they speak about it initially — but then ongoing conversations have to happen after that.”
In her testimony, DCF Commissioner Joette Katz said that every death of a child with DCF involvement triggers a “rigorous review” to help the agency identify patterns, gaps and responsive changes.
“Let me be direct: I am deeply concerned about the increase in child deaths over the past three years,” Katz said. But she added, “The issue is not DCF involvement – it’s whether that involvement is relevant to the fatalities.” Just because DCF is involved with a family “does not mean that the agency is going to foresee future events.”
Katz said a number of the child deaths cited in the OCA report were cases in which DCF’s involvement was “remote from the subsequent cause of death.” In one example, she said, DCF had intervened when a mother giving birth at a hospital had tested positive for drugs – a result that ended up as a false positive. Two years later, she said, one of the mother’s children died after being assaulted by a new boyfriend.
“Simply being involved with a family in the past does not mean we can prevent a death in the future,” Katz said.
She said the ongoing review of child deaths by her department was intended to “better understand the factors that correlate with these fatalities” and to improve “case practice and services.”
Gonzalez said many of the findings of the DCF study “mirror what the child advocate found.” DCF already takes into account the age of parents and substance abuse and mental health issues, agency spokesman Gary Kleeblatt said.
He said that because the study is still underway, “it would be premature to make conclusions about recommendations or ensuing actions,” including whether the quality of home visits and assessments for high-risk families might be improved.
In response to concerns about child fatalities, DCF is now working with hospitals to improve how investigators, hospitals and primary care providers recognize abuse when a child suffers an injury. In addition, social workers are now talking to every family with a child under the age of 1 about safe sleeping practices.
The OCA report notes that DCF, like child welfare agencies in other states, is focusing on “family preservation” – removing fewer children to foster care or group placement settings. Eagan said she was not questioning that general approach, but instead was concerned that high-risk families receive appropriate and intensive assessments, visitations and interventions.
“As DCF moves to family preservation…it is essential to dig in and look at, how effectively are we doing this work?” she said. “Do we have a child welfare policy and practice that is responsive to this high-risk population?”
This summer, a federal court monitor criticized staff reductions at DCF and raised concerns that “thousands of children and families” in need of behavioral health and other supports were struggling to access limited community services. The monitor recommended that DCF consider “tempering further reductions in congregate care… until sufficient levels of community-based services are available.”
In her testimony, Katz defended the policy shift away from institutional care, saying, “If we removed all the children in these families, the system would be overwhelmed. The human toll would be catastrophic.”