Executive Order on Strengthening
the Child Welfare System
for America’s Children
We opened NOT IN MY WORLD!!!! as a one-page gift to Google+ and all it’s users, on August 19, 2014, with 7 members in #OurCircle. Since that day, we have been very active in the war being waged for Our Children, and seen many Blessings.
In those first days, weeks, and possibly even months, at this point in time I think we, for the most part thought the people we were fighting was something like perverted men dressed in raincoats, standing around and flashing women and children.
I don’t mind telling this like it really is, and was… it wasn’t long before everything we read and saw hit us, and opened deep mental wounds, and assaulted all of our senses, and nothing has changed as far as that.
I can’t help but cry as I look back on all this, here we were adults having innocence ripped away from us, by what was/is done to Our Children almost every minute of every day.
It took quiet some time before we learned of Senator Nancy Schaefer, but the rest of what I list here is documented on our website or our blog, down thru January 2016.
Worse yet, the administration acknowledged that it can’t account for each of the 90,000 children it processed and released since the surge peaked in 2014.
My post on January 30, 2016 had a dead link, and I already knew this was one I enjoyed, because Senator John McCain got so upset with Mark Greenberg and CPS, that he walked out of the bipartisan congressional investigation. The article led the reader to believe that possibly 10 – 30 Children were “missing”, when the link was fixed that number had grown to 90,000+ Children.
HHS Official Jerry Milner was appointed three years ago to oversee much of the departments child welfare work.
Health and Human Services Secretary Alex Azar hailed the order as a step toward “bold reforms”. The goals are ambitious – curtailing child maltreatment, strengthening adoption programs and encouraging supports for at-risk families so fewer children need to be separated from their homes and placed in foster care.
Section 1. Purpose. Every child deserves a family. Our States and communities have both a legal obligation, and the privilege, to care for our Nation’s most vulnerable children.
The best foster care system is one that is not needed in the first place. My Administration has been focused on prevention strategies that keep children safe while strengthening families so that children do not enter foster care unnecessarily. Last year, and for only the second time since 2011, the number of children in the foster care system declined, and for the third year in a row, the number of children entering foster care has declined.
Sec. 2. Encouraging Robust Partnerships Between State Agencies and Public, Private, Faith-based, and Community Organizations.
Sec. 5. Improving Processes to Prevent Unnecessary Removal and Secure Permanency for Children.
(iv) Within 6 months of the date of this order, the Secretary shall provide guidance to States regarding flexibility in the use of Federal funds to support and encourage high-quality legal representation for parents and children, including pre-petition representation, in their efforts to prevent the removal of children from their families, safely reunify children and parents, finalize permanency, and ensure that their voices are heard and their rights are protected. The Secretary shall also ensure collection of data regarding State use of Federal funds for this purpose.
Sec. 6. Indian Child Welfare Act. Nothing in this order shall alter the implementation of the Indian Child Welfare Act or replace the tribal consultation process.
Harris County Sheriff: ‘We cannot let
a health pandemic become a
Child Abuse pandemic!’
HOUSTON, TX – With children spending all their time at home, Harris County Sheriff Ed Gonzalez is urging adults to be more vigilant about the children around them and to keep an eye out for signs of abuse.
“The number one reporters of child abuse are teachers,” Sheriff Ed Gonzalez wrote in a tweet. “But kids aren’t seeing them right now. Neighbors and other family members, PLEASE pay close attention.”
We cannot let a health pandemic become a child abuse pandemic! The number one reporters of child abuse are teachers, but kids aren’t seeing them right now. Neighbors and other family members, PLEASE pay close attention. Learn more at @Childhelp & the National Child Abuse Hotline
— Ed Gonzalez (@SheriffEd_HCSO) March 23, 2020
“It’s the time to be proactive (about child abuse) because we may be in this for the long haul,” Gonzalez told KPRC 2 in an interview.
“If you hear what sounds like painful screaming, things like that, that would be a red flag,” Gonzalez said. “You see clear bruising or things like that, anything like that… make sure and call the authorities and let us know, because we need to know.”
The Texas Department of Family Services offers educational videos and other materials to support parents and neighbors on its website.
“Right now the children aren’t seeing their teachers,” Gonzalez said. “It behooves all of us to step up, as neighbors, as family members, and keep a close eye, and make sure that we’re paying attention to anything out of the ordinary.”
Suspected Child Abuse can be reported to local authorities, or using the National Child Abuse Hotline: 1-800-422-4453 (24 hours a day, seven days a week).
If you see or suspect Child Abuse, please call 911 immediately!
Medical Professionals – Trauma: How to address Child Physical Abuse
Arne H. Graff, M.D., is the division chair of Child Abuse Pediatrics at Mayo Clinic’s campus in Rochester, Minnesota. His desire is to equip providers for potential child physical abuse (CPA) cases, helping them feel as comfortable as possible and removing the fear of reporting. He offers perspective on CPA and what trauma professionals’ responsibilities are in this scenario.
How did you get into the child abuse field?
While I was working in North Dakota, a physician at Sanford Medical Center in Fargo talked me into working with him in a volunteer clinic. While there, I ran into enough child abuse cases that I realized I needed to get out of it or get better. So I did a fellowship in child abuse pediatrics.
Is child abuse common in Minnesota?
Around 84,000 reported cases of child maltreatment are reported each year in Minnesota, according to the Minnesota Department of Human Services and documented in the Child Maltreatment Report for 2017. Minnesota has as high an incidence as some other states, like California, but doesn’t see as large of numbers due to population differences between Minnesota and the other states.
There are about 1,500 identified maltreatment deaths in Minnesota each year, but this is assumed underreported due to the difficulty in identifying many of the deaths as clearly caused by maltreatment. In Rochester, Minnesota, and the immediate region, we have around 400 reported maltreatment cases each year.
(1,500÷365=4.1 Child Maltreatment deaths per day just in Minnesota, so how can so many distort the numbers by saying there has ever been 5 Child Maltreatment deaths each day in the last 100 years and possibly the last 150 years)
Which children are at highest risk of abuse?
A young child or infant is at highest risk.
Are any children overlooked for abuse?
Yes — teenagers. I don’t want us as providers to just focus on little kids. Teens have a similar CPA pattern as other children. It’s important you consider whether abuse is occurring if you see a 15-year-old with an injury that doesn’t align with the history. Don’t assume because they’re teenagers, they aren’t experiencing abuse.
Who abuses children?
People who have access to children hurt children: parents, child care providers, grandparents and school personnel. Anyone has the capacity to hurt children.
That said, it’s important to know that 82% of abusers are ages 18 to 44, and 80% of CPA is inflicted by parents, according to data from Child Welfare Information Gateway.
Is denial of mechanism of injury common in these cases? If so, any advice?
Since we don’t know how often abuse is missed, we can’t guess at how often it’s denied. Personal experience is that even with serious injuries, denial is common. Considering that one of the caregivers may not have knowledge of events that occurred with his or her partner, denial can be a normal answer. Therefore, asking about domestic as well as pet violence is important, and also interviewing caregivers separately. By emphasizing mandated reporting requirements and indicating concern about their child, we hopefully will maintain a working relationship with the family.
Any tips for assessing a child’s injury?
Every injury presented must be consistent with the child’s medical history and developmental ability. If it doesn’t line up, ask why. It doesn’t mean there’s abuse occurring, but it does mean something’s going on that doesn’t make sense.
Our job is to consider the injury’s cause — medical, accidental and then nonaccidental trauma — as well as medical history and mechanics. It’s not our job to immediately assume, if we don’t like how it looks, that somebody’s abused the child. We have to start with ruling out other options, especially with a nonverbal child.
In 30% to 40% of cases we see, we have to say we can’t determine if an injury was abuse or accidental, and we need to consider potential options for the injury.
How should I determine which tests are needed?
First, it’s important to know that exams have limits. You can’t determine abuse simply by physical exam. However, being financially responsible means to not shotgun and do every test available.
If you need to consult on a potential CPA case, my colleague Donald (Chris) C. Derauf, M.D., and I are available 24/7 every day for curbside consults at no cost. We do 300 to 400 of these a year. You may call us through the MATC to discuss what you’re seeing in a case, and we can advise on screening. We are your resource and encourage people to call and bounce things off us.
How do I figure out who did it?
You and I don’t care. It’s not our job. Our primary role is to prove it’s not abuse and look at accidental injuries or other conditions that may have caused the injury. Also, our job is not to rule out people who may have abused the child, or determine reason or intent — leave that to the legal system.
How can I help stop CPA?
If you can recognize CPA early through a sentinel event — a case where injuries in children nonmobile or under age 4 can’t be explained by a simple accident, such as significant bruising to the head or neck — you can make a difference. For these children, consider the injury to be caused by someone. Bruising in a nonmobile child should be a red flag if not immediately explained by multiple people.
Sentinel injuries, without witnessed accident, carry high risk of further injury or death. According to an article by Sheets and others in the April 2013 issue of Pediatrics, 27% of kids who’ve been seen by a provider and demonstrated to have had a sentinel event will return with serious injuries or dead.
What’s my responsibility?
These are critical steps for providers in potential CPA cases:
Identify other possible injury causes.
Recognize these things are serious. Once considering CPA as a potential cause, you are a mandated reporter. It doesn’t have to be proved, just suspected. You can’t simply write in your notes that you’re concerned and not report. You must contact child protective services about a safety plan and tell them why there’s concern.
Conduct testing in a timely manner; it’s important for safety and complete diagnosis.
Remember multiple types of abuse can coexist. Do a complete exam for neglect; don’t just focus on a bruise.
Don’t send the family home until all test results come through, or the child potentially may be going into an unsafe environment. While you’re doing your work, child protective services (CPS) will develop a safety plan. We can’t send the family out until this plan is finished and documented by the physician.
Make a complete description of the injury, including photos.
Any suggested approach with the family if CPA is suspected?
Since it’s not our role to decide who did it, I usually use this approach and advise providers to consider it. I say to the caregiver present: “With this type of injury, without a known medical problem causing it or a witnessed accident, I am concerned someone may have hurt your child. Because of this, I am a mandated reporter and have already spoken with child protective services. They will want to talk with you about safety plans for your child. I also want to recommend some tests that may better tell us why the injury occurred and if there are other injuries present we cannot see on the exam.”
It’s important to help families understand that just because the child looks happy and OK, it doesn’t rule out other injuries.
Any pitfalls you’d suggest avoiding with CPA?
We fail to recognize our blinders. If you’re homeless or a minority, statistics say CPA cases are overreported, according to a 2011 publication in Journal of the National Medical Association. However, studies indicate if you’re white middle class and present with an infant to the emergency room, people don’t even think about abuse. Also, if we know members of the family personally, there’s a tendency to say, “They are nice people. They wouldn’t do this.”
If we think there might be abuse, we need to get CPS involved, period. Letting our biases influence who we report puts kids at risk. Remember, reporting may help services be put in place to assist the family.
Which patients who’ve survived potential CPA need transfer for further work-up?
The work-up needs to be completed at the time the concern is raised. Depending on the child’s age, it may include:
A dilated eye exam by an eye expert, to be completed within 48 hours
A skeletal survey immediately and again in two to three weeks
A head CT if under age 1 or obvious head trauma
If testing can’t be completed, transfer to a larger center is indicated. If testing can be done and a safety plan put in place, the child may be evaluated at the local site only and be watched overnight or be sent home, depending on tests and exam.
Resource: MayoClinic.org This publication can be seen HERE complete with links.
Florida parents wrongly accused of Child
Abuse by state experts is ‘shocking,’ says
TAMPA, FL – A Florida lawmaker believes the state’s medical experts on child abuse need more checks and balances after an I-team investigation revealed several pediatricians have made questionable calls against parents who appeared to have done everything right.
“Any position of authority that isn’t checked by something is concerning,” said Florida Democratic Representative Anna Eskamani of Orlando. Eskamani was responding to our investigation that found several cases where child abuse pediatricians, who were hired to be the state’s experts on abuse, wrongly accused Florida parents of child abuse.
Child abuse pediatricians are a recent specialty medical field and hold enormous influence over whether a child’s medical condition is the result of abuse. Their conclusions can also determine if a child needs to be removed from their parents. But court records show, these doctors don’t always make the right call causing children, often babies, to be removed from their parents for months unnecessarily.
Our investigation also found cases where doctors appeared to have come to far reaching conclusions without thorough investigations and, in other cases, where parents were arrested after a doctor’s conclusion of abuse. In 2015, it happened to Jeremy Graham.
Graham, a firefighter and paramedic on Florida’s west coast, was arrested and charged with aggravated child abuse after a child abuse pediatrician determined his 4-month-old son’s seizure was caused by a brain bleed, the result of physical abuse, according to court records provided to us by Jeremy and his wife Vivianna.
About a month leading up to the seizure, the Grahams had visited several doctors because their son was vomiting and “wasn’t acting right,” said Vivianna.
After an 8-month fight, the state dropped its case against the Grahams over “insufficient evidence.”
Last year, Nydia Ortiz’s son and daughter-in-law were torn about from their newborn daughter after a child abuse pediatrician in Miami concluded their newborn daughter’s bruises were also the result of abuse. Turns out, it was a rare genetic disorder.
It’s a problem impacting families around the country.
In Texas, recent media scrutiny has led some state lawmakers to consider introducing a bill next year that would require an independent second medical opinion in some cases before a child is separated from their parents.
“That system would provide the oversight and accountability that parents deserve in facing the potential of a false accusation of abuse,” said Eskamani.
Representative Eskamani believes the additional measure could make sense in Florida. We found child abuse pediatricians who serve as medical directors of child protective teams in Florida often answer to no one and operate independently from region to region.
THE FLORIDA INVESTIGATIVE TEAM
Last summer, Vadim Kushnir and his wife found themselves on the defense after seeking help for their newborn son, who was having seizures. A state child abuse pediatrician determined their newborn’s seizures were “the result of shaken baby or blunt force trauma,” according to court records.
“It took them two minutes of investigation to say we were abusers,” said Kushnir.
The Kushnirs fought back spending $30,000 on attorneys and experts who argued the baby’s condition resulted from a complicated birth not abuse.
The judge agreed and in the final order, even criticized the state’s doctors for not knowing their month old son wasn’t breathing at birth, the umbilical cord wrapped tightly around his neck. One doctor who provided testimony admitted he “never reviewed all his medical records,” according to court records.
With the legislative session starting this week, Eskamani says it may be too late to file legislation here this session, but she vows to bring up the issue in Tallahassee and invites other families to share their stories with her of being torn apart and wrongly accused.
Contact Representative Eskamani
“The doctor was probably in the room with us less than 10 minutes,” said Vivianna Graham. “It’s just sad,” added her husband Jeremy whose son, Tristan, is now a healthy 4-year-old.
The Florida Department of Health oversees child abuse pediatricians who serve as experts for the state. According to an agency spokesperson, their top priority is the health and safety of children but says child protective teams are open to receiving input from others who are also involved in protecting the health and safety of Florida’s children.