99% of Kids Suffer Less Abuse in Scarce Safe Babies Courts

ACES Too High NEWS:

The dirty little secret about family courts — where kids and parents who’ve entered the child welfare system end up — is that they often make things worse, especially for the youngest children — from newborns to 5-year-olds.

It’s not intentional — child welfare systems and family courts were set up to help children and their families. But traditional family courts can further traumatize kids already suffering from adverse childhood experiences (ACEs) by moving them from one foster care home to another, by rarely letting them see their parents (if parents are willing and able) or by leaving them to languish in foster care limbo for years before finding them a permanent home. All this contributes to these children developing chronic diseases when they’re adults, as well as mental illness, violence and being a victim of violence.

The concept behind Safe Babies Courts began in the 1990s, when a Miami-Dade circuit court began exploring the research that shows how toxic stress caused by adversity does long-term damage to children’s brains and bodies. The court also studied how changing the way courts handle cases, especially those involving children 5 years old and under, might reduce toxic stress and increase resilience in children and families.

Since then, decades of research have shown unequivocally how toxic stress caused by adversity does long-term damage to children’s brains and bodies that inspired the creation of courts specifically focused on early childhood cases, some of which are known as Safe Babies Courts, about a decade ago. Such courts are one type of problem-solving courts, which focus on a specific population like veterans, the homeless, people with mental illness and people addicted to drugs or alcohol.

The judges in early childhood courts who have learned about this science of childhood adversity have turned their courts upside down and inside out — sometimes dragging along reluctant child welfare workers and attorneys — to show that a radical new approach that integrates relationships and caring into the court system can actually, truly make things better.

As early data demonstrates, compared to those in traditional family court, infants and toddlers:

• they end up in a permanent family two to three times faster,
• they leave foster care a year earlier,
• they end up with their own family nearly twice as often.

Judges spend more time, provide more resources for children & parents who need the most help

The Adoption and Safe Families Act of 1997 says that family courts have one year to make a decision about where a child will live permanently, but that usually doesn’t happen. Some states push the decisions out to 16 to 18 months; some start the process all over again at 12 months. So children languish in foster care for a year or more while many parents who want to do what it takes to get their children back receive no help in doing so, and live in limbo.

In Lonoke County, Ark., most cases that end up in Safe Babies Court revolve around parental neglect and substance abuse, particularly methamphetamines, says Kristi McGibbony, the court’s community coordinator. Safe Babies Court is the formal name for a program run by the organization Zero to Three, which provides supports to several early childhood courts around the country. In Lonoke County, Judge Barbara Elmore takes an aggressive approach to each case, throwing in every resource possible to help children and their parents.

• Instead of reviewing cases once every three to six months, as the law requires, Elmore reviews cases about once a month.
• She brings together all who have a relationship with the child or parents, including teachers, therapists, caseworkers, parents or extended family, foster parents and probation and parole officers.
• She orders parents to visit their children three times a week instead of once or twice.
• She may order the parents to engage in their own therapy and provides services for them.

At first, attorneys and other staff at the Department of Human Services complained because of the additional work. And people from the different sectors had a difficult time communicating, because they’d never talked with each other or worked together in quite so intensive a fashion.

“But they’re all seeing the benefits now,” says McGibbony. “We’re catching things quicker when they’re going off the rails. We’re catching services that we might not have thought to order. We’re realizing, ‘Oh, my goodness, the child needs tutoring or counseling.’ If we had not been having reviews and having the classroom teachers coming in [to court] saying, ‘She can’t keep up, she can’t sit in her chair,’ I don’t think we would have intervened in as timely a manner.

“Therapists, teachers, child care workers, family, foster parents, caseworkers — everyone has a voice,” she continues. “Everyone is heard. They discuss what [issues] brought the child in and start with specific, simple goals, like, ‘I want to make sure I spend 20 minutes reading to my child,’ or, ‘We’re going to do an art project together.’ It’s an opportunity for the family to receive in-the-moment parenting guidance and instructions.”

Safe Babies Court teams and other early childhood courts try to initiate services to address parents’ own childhood adversity so they can heal and, in turn, be better parents, McGibbony says. “It is difficult for these parents to parent their children effectively and responsibly when they didn’t receive that type of parenting themselves,” she says. “They have no role models; they have no skills to do that.”

McGibbony has seen the same sad patterns in nearly every case. “Almost every parent, typically the mothers, the majority of them were in foster care at some point during their childhood. Or, they were passed around between grandparents and aunts and did not live with one parent the whole time. And, they have had some sort of sexual abuse during their childhood. That blew my mind,” she says.

The ultimate goal is to produce the best parenting possible, and a loving parent-child bond, whether or not the child ends up living with that parent or not, she says. During the process, “our goal is to introduce some services that will actually benefit the parents,” McGibbony says. “Parents agree that once they participate in the project, which is voluntary, more will be asked of them. The judge will consider it noncompliance if they don’t participate in psychotherapy, for example.”

As a result of all these changes, the three Safe Babies Court teams in Arkansas have provided permanent homes for children several months before they would have in traditional family courts, McGibbony says. Since the Safe Babies Court program started in the state in July 2010, not a single case has reopened, she says, although not all have resulted in reunification with parents.

The Safe Babies Court team in Hattiesburg, Miss., which has handled the cases of 105 children since May 2006, has seen similar results, says Josie Brown, community coordinator. The number of times parents visit their children has jumped from once every three weeks to several times a week, and court hearings have gone from twice a year to once a month.

“When you have court hearings that often, you’re going to get to permanency much faster,” she says. “We’ve had parents get their children back within six months. We never before acknowledged fathers with our service plans; we’ve had at least six to 10 successful cases where children were placed with their fathers, and even more than that were placed with the paternal side of the family.”

The first placement for children is often the child’s permanent home, Brown says. “Each time a child is moved, that child is damaged,” she explains. “Now, they have to be placed in a relative’s home or a foster placement” in their hometowns or very nearby. In traditional family court, they could be placed as much as five to six hours away, making it nearly impossible for parents who don’t have a car to visit their children.

Why a safe, stable and nurturing relationship is so important for a child

As recently as 1990, few people thought infants and toddlers remembered enough to suffer long-term effects of trauma, says Mimi Graham, director of the Center for Prevention and Early Intervention Policy at Florida State University. But “quantum leaps” in neuroscience have shown otherwise.

“There’s something imprinted in their soul, in their brain, in their being, that has all these negative connotations,” she says.

“Unfortunately,” says Dr. Joy Osofsky, professor of pediatrics and psychiatry at Louisiana State University Health Sciences Center, “people still think, ‘Oh, they’re so young. They’re not impacted. They’ll get over it’, which we now know is not the case.”

High rates of childhood trauma can result in adult onset of chronic disease, mental illness, violence and being a victim of violence, according to the Kaiser-CDC Adverse Childhood Experiences Study (ACE Study). The study measured 10 types of childhood trauma: sexual, physical and verbal abuse, and physical and emotional neglect; and five types of family dysfunction — witnessing a mother being abused, a household member who’s alcoholic or drug dependent, who’s been imprisoned, or diagnosed with mental illness, or loss of a parent through separation, divorce or other reason. Of course there are other types of trauma — such as bullying, community violence, homelessness, moving often, racism and gender discrimination — but the ACE Study measured only 10.

Each type of trauma was given an ACE score of 1. Think of an ACE score as a cholesterol score for childhood trauma. A person who has been sexually abused and physically neglected, and grew up with an alcoholic mom and an incarcerated dad would have an ACE score of 4. The study found that of the 17,000 mostly white, middle-class, college-educated, Kaiser health-insured adults who participated in the ACE Study, nearly two-thirds experienced at least one type of severe childhood trauma. Nearly 40 percent had suffered two or more. The study found that a person with four or more adverse childhood experiences is 12 times more likely to attempt suicide, 10 times more likely to inject street drugs, seven times more likely to be an alcoholic, 2 1/2 times more likely to have a stroke, and twice as likely to have cancer. People with an ACE score of 6 risk having their lifespan shortened by 20 years. ACE studies have now been done in 29 states and Washington, D.C., with similar results.

When children experience ACEs, their brains instantly react by going into fight, flight or freeze mode. Their brains and bodies produce an overload of stress hormones — such as cortisol and adrenaline — that harm the function and structure of the brain. This is often called “toxic” stress.

If they have no safe adult living in a safe environment to rely on, children with toxic stress respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports and/or work and overachievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.

In working with families and children in her early childhood court in Pasco County, Fla., 6th Judicial Circuit Judge Lynn Tepper says: “I presume trauma in every case. There are always ACEs, it’s just a matter of how many and how best to apply the principles to meet the parents’ needs and not overwhelm them — which can easily happen.”

Roots in the Sunshine State

The concept behind Safe Babies Courts began in the 1990s when the Miami-Dade Circuit Court received a grant from the U.S. Centers for Disease Control and Prevention to study what intervention before age 5 might accomplish, based on then-emerging brain science regarding ACEs.

At that time, Judge Cindy Lederman worked with experts from the National Research Council and the National Academy to delve into the question of what types of impacts the courts could have on infants and toddlers.

“Back then, even I believed, ‘What could you learn from a baby?’” she recalls. But given that 20 percent of children in the child welfare system are under the age of 1, “we were ignoring these children whom we actually had the greatest opportunity to help,” Lederman says. “We realized, ‘Oh my God, we’re missing the most important opportunity for maltreated children that we could ever have, before the age of 3.” Such children are not old enough to be in school and many are not in child care, she adds, so “no one is catching the problems these children have.”

And so she created what’s now called the Miami Child Well Being Court to “change the concept from judges as being an umpire, observing balls and strikes, to judges as conductor of an orchestra.” Such judges work to make their courtrooms less adversarial and more team-oriented, bringing together clinicians, attorneys and the parties themselves to problem-solve together.

In 1994, Dr. Joy Osofsky began developing a similar court in New Orleans, working through an “infant team” of judges, lawyers, therapists and others to provide interventions for abused and neglected babies. They had two goals: to achieve permanency more quickly, although not necessarily reunification, and to prevent further abuse and neglect.

“We brought an intensive relationship-based treatment approach to the court setting,” she says. “What one is able to do is reach those young moms and babies, and provide more than just the usual type of things — referring them to parenting [classes] and other types of community supports, where there wasn’t necessarily an integrated program.”

The Safe Babies Court program was officially created when Zero to Three, with Osofsky as president and Lederman as a fellow, approached foundations to support the project. But when private foundations did not bite, a legislative consultant to the organization suggested looking into federal funding, “aka earmarks,” says Lucy Hudson, project director.

The first funding came into the states and districts of relevant congressional committee chairs like former Sens. Trent Lott, R-Miss., and Tom Harkin, D-Iowa, as well as former Rep. Tom DeLay, R-Texas.

“The funding base has broadened, especially since earmarks don’t exist anymore, right?” Hudson says. “It’s a little like stone soup. Whatever you have on the ground, you can tap into to make important changes. I think of it as a community organizing model.”

Based on the Miami and New Orleans models, the Safe Babies Court Teams Project has provided training and technical assistance to judges, therapists and others. Safe Babies Courts differ from the other models by providing community coordinators who work with court personnel to keep the process on track.

The community coordinators at each site form a liaison to the judges and others, and they help insulate Zero to Three from anyone thinking that “we’re carpetbaggers,” Hudson says. “We have to tread lightly. We do work with the judge. We hire a staff person who is always somebody who has lived in the community for years and years and years.”

The first Safe Babies Courts began in Iowa, Mississippi and Texas in late 2005. Now there is a Safe Babies Court team in each of seven locations: Pulaski and Lonoke counties in Arkansas; New Haven and Milford, Conn.; Des Moines, Iowa; Hattiesburg, Miss.; and Tulsa, Okla. (The 328^th District Court in Fort Bend, Texas, which was part of the Zero to Three program, currently has an Infant and Toddler program.)

As of October 2014, the sites had served a total of 847 children, who had an average of just over two placements. Of those whose records were available, 287 had been reunified with their parents, 126 lived permanently with fit and willing relatives, 26 had been referred to legal guardianship and 173 had been adopted, Hudson says.

Osofsky says there is a second early childhood court in Louisiana, based in Jefferson Parish, while she is aware of five others besides Miami that have been launched in Florida. And there is a court in Omaha that used to be part of the official Safe Babies program and has continued on in a similar vein. Arizona has started its own system of early childhood courts, called Best for Babies. Officially, Safe Babies courts are those that are funded and guided by Zero to Three. The other courts — officially known as early childhood courts — are funded separately.

It’s “fair to say,” said Hudson, that based on the count of “more than 2,300 courts with jurisdiction over 82 percent of the juvenile population,” that less than 1 percent are Safe Babies Courts.

The secret sauce: ACE-informed judges, a team to help kids and parents, a permanent home as soon as possible, and child-parent therapy

In the Child Well Being Court in Miami, Lederman has worked to bring about systems integration, and she’s drawn from the evidence-based practices flowing forth from research around childhood adversity.

“We’re using the concept of science and research to know what to look for, know what issues these children have, and work not in silos but in systems, working together, so that when I leave, or another judge who does this work leaves, there’s still the systems integration,” she says. “We all have the same job, we all have different parts of it, but we have to work together—which is something very unusual in the court system.”

Lederman and other judges are aware that babies living through adverse experiences begin exhibiting disproportionate speech and personal social delays in their early weeks and months.

“We know from the research how to look for it,” she says. “But for the fact that that child has come to us, it wouldn’t be caught. It’s a little like having God on your side because we can look for these problems and address them.”

“Babies can’t tell you that they’ve been abused and neglected,” notes Graham. “You have to be able to read the cues of the babies.” For example, she recalls one baby who anxiously began pulling on her eyelashes when her mother walked in the room. “She couldn’t verbalize how toxic the mother was,” she adds. “There is a real need for people to be able to understand young children.”

Trauma-informed judges also have a sense of whether clinical referrals have produced the desired results. “You can have stability and permanency and still have problems,” Lederman says. “It’s not the length of time in care but the quality of that experience and how it has healed you, which is a lot more difficult to measure than how many months have you been in care.”

Safe Babies Court judges also understand why speeding up the process is critical, says Osofsky. “Babies can’t wait — if the baby comes into care at 3 months, they ought to have a permanent home in as short a time as possible. Not only does it contribute to permanency more quickly, it also reduces repeat abuse and neglect.”

Graham says monthly court visits prevent wasted time and stop people falling “through the cracks.” “You can deal with [problems] sooner,” she explains. “Is the parent making the effort to visit their child, or not?”

As various parties to a case work together, the hearings become less adversarial, Hudson says. “In most child welfare actions, there isn’t a tremendous amount of support for helping the parents get their kids back,” she says. “We go well beyond reasonable efforts. The judge asks far more questions than you would normally ask. She asks the parents how things are going. She talks to social workers. Because the cases are coming before the same judge on a monthly basis, there’s the opportunity for that relationship to become more important and more helpful to parents; so that whether they get their kids back, or not, they would say they felt supported by the people on their teams, including the judge.”

All children are examined by pediatricians and evaluated for speech, occupational and physical therapy, which they receive in their home as needed. “We get a broader and clearer understanding about every possible thing,” she says, comparing the court teams to the shelves at Walmart: “Everything you need is right around the table.”

The monthly court visits provide incentives for parents who need to clean up their act. “If you say, ‘We’ll be back in court in 30 days, and if you’re clean for drugs, we’re going to start recommending unsupervised visitation,’” Brown says. “There might be six things they need to do. If you show them step by step what can be achieved in the first month, the second month and you build from there, parents can say, ‘Hey, I’m going to visit my child every day.’ Then you add time on the weekends, work on transitioning them back home and take that final step.”

Tepper’s court has seen about a dozen cases since September 2013, with three reunifications completed by the end of last year, she says. On the down side, she’s had one closed permanent guardianship “due to the mother’s severe mental health issues, high ACEs,” one case with a change in goal to permanent guardianship due to the parents’ failure to engage — “if we can’t get them to court, we can’t encourage them” — and one that ended in termination of parental rights. “No matter what we offered, she was so far down the ‘rabbit hole’ of ACEs we could not help,” Tepper says, adding, “The cases still pending are making steady, amazing progress.”

Judge Doug Johnson, who presided over a courtroom in Omaha, Neb., that participated in the Safe Babies Court Team Project for many years — and has continued with the same model but with different funding — says he sees the program as a chance to break damaging cycles in generations of families. He uses the same orchestral metaphor as Lederman to describe the dynamic of the court teams.

“That’s what got me fired up,” he says. “The science goes nowhere if lawyers aren’t trained in how to present it and have good court proceedings. If the judge isn’t aware of that [ACEs] stuff, you have good musicians and no conductor. It’s everybody working in concert, is what gets it done.”

The importance of healing parents, too

“Almost every family with an abused or neglected child had an abused or neglected parent,” says Graham, who has observed procedures in Tepper’s courtroom. “So many of these parents were not parented themselves. [They don’t realize] that baby is not crying to piss you off.”

Because of this, Safe Babies Courts advocate the use of child-parent psychotherapy (CPP), which looks at the trauma of the parent, the trauma of the child, the damage done to both as a result and the state of their relationship — or lack thereof, says Graham, who has helped to train more than 200 licensed mental health therapists in CPP over the past 10 years.

“When a judge orders the parent and child into these services, the first thing we do, as in any therapy, is to work to build the relationship and perform a relationship-based evaluation, to learn about the difficulties and the strengths — the strengths of the mother or father and baby, to try to build that relationship,” says Osofsky. “All of these babies are starting out with many adverse experiences, but the mothers and fathers also in most cases have experienced negative things themselves. As part of the process of healing, you work on several levels.”

One of those levels involves “remembering parents were children once and need time and quality interventions to heal,” she says. “With substance abusing or mentally ill parents, there may be relapses, but we must remember it is expected — it’s not the end of progress and healing. This is a slower process and one that requires some individualized solutions and approaches.”

Evaluations show Safe Babies Courts work

Three independent evaluations have detailed the successes of the Safe Babies Court Team Project.

James Bell Associates received funding from the U.S. Department of Justice to evaluate four sites. They found that more than 99 percent of infants and toddlers served through the program were protected from further maltreatment. Of the 88 closed cases that were examined, 95 percent had achieved permanency — 46.5 percent through reunification with parents, 30.6 percent with a fit and willing relative, 4.5 percent through legal guardianship and 13.6 percent through adoption.

More than 50 percent of children in the study had experienced neglect, more than 25 percent had been physically abused and 75 percent had dealt with parental abuse of alcohol or drugs. During their time in Safe Babies Courts, children had had 97 percent of identified service needs fully met or partially met by the time the study had concluded. Such needs can include screening and services for developmental delays, supervised and therapeutic time with their parents and medical care.

A doctoral dissertation published in the journal Children and Youth Services Review showed that compared to a matched sample included in the National Survey of Child and Adolescent Well Being, those served in Safe Babies Courts reached permanency two to three times faster, left foster care a year earlier on average, ended up with family more often (62.4 percent vs. 37.7 percent of the comparison group) and most often ended up reunifying — 38 percent, while the comparison group most often ended up in adoption at 41 percent of the time.

An evaluation by Economics for the Public Good showed that each child represents an average direct cost of $10,000, not unlike those in similar early childhood interventions. But the short-term savings due to these children leaving foster care more quickly represent an estimated average of $7,300 — nearly three-quarters of the upfront cost.

In addition, the study showed that Safe Babies Courts have generated about a dollar of in-kind support for every grant dollar given, and that children in the program were significantly more likely to access other services than a comparison group — 92 percent receive developmental screenings (vs. 25 percent) 94 percent receive health care visits (vs. 76 percent) and 29 percent receive dental visits (vs. 18 percent).

The future of Safe Babies Courts

The compelling build-up of evidence about the efficacy of such courts in breaking that cycle has 22 judges in Florida expressing interest in doing similar work, Graham says.

“My vision, a year from now, is to compare those that have baby courts and those that don’t, and see the huge differences in abuse rates and time to permanency,” Graham says. And then to advocate for more funding. “The therapy sessions are paid by Medicaid, but not the time the therapists spend talking to the judge and being in court,” she says. “Everybody’s kind of piecemealing it together with resources they have in their community.”

Her center has requested funding from the Florida legislature for six pilot sites for early childhood courts not connected to the Zero to Three program; she’s also hoping to establish a demonstration site for a federally funded Safe Babies Court in the state.

And Hudson says Zero to Three is considering applications from 14 additional communities to implement Safe Babies Court Teams. They expect to announce three to five recipients in the near future.

The compelling build-up of evidence isn’t just in the data.

It’s also stories like this: One mother in Mississippi whose baby was born with crack cocaine in his system went into rehab, was allowed only supervised visitation while the baby remained with his grandparents, complied with the service agreement and achieved unsupervised visitation within four months and custody within six months. She went back to school and eventually received a master’s in social work, married and has a second child.

“She says it’s because of the Safe Babies Court Team,” Josie Brown says proudly.

This story originally appeared in ACES Too High NEWS.