Healing is first option

PART TWO OF FOUR

The number of confirmed child abuse cases in Hawaii has dropped by more than half since 2005.  Mirroring that trend, the number of children needing foster care declined by nearly 50 percent. The steep decreases have been attributed in part to the state’s switch in late 2005 to a new but controversial program for determining how child welfare authorities respond to reports of suspected abuse.

The change by the Department of Human Services provided an option of keeping children in the home, rather than removing them, as long as the risk of substantial or imminent harm wasn’t considered high and no safety threats were present.

Instead of removing the children, the state arranged to provide the family with support services, such as counseling, to address underlying problems contributing to their domestic troubles.

Under the old system, the children typically would have been removed, triggering their placement into foster care and a full-blown, generally adversarial Child Protective Services investigation.

The policy shift in 2005 initially had many skeptics, including Family Court judges who thought some cases would slip through the cracks.

But today judges laud the system, which can spare a child the trauma of entering foster care. It also allows for a more tailored response to address the family’s needs.

Judge R. Mark Brow­ning, who heads Family Court on Oahu, said a fellow judge recently remarked at a public forum that he had his doubts about the so-called differential response system when it was launched. But the judge told the audience he had a change of heart because of the positive results he’s seen over the years.

Asked whether he shared that assessment, Brow­ning said, "I don’t have any data to say it’s not true."

Hawaii’s system, also called a diversion program because it diverts children from foster care, is nationally recognized, according to DHS. Hawaii was among the first few states to launch such a program, and the federal government now requires all 50 to have triage procedures for determining the best referral options for children not at risk of imminent harm.

Yet questions persist about Hawaii’s system.

Some social workers, attorneys and others familiar with the process say DHS is too quick to refer cases to diversion, particularly if its risk assessment doesn’t accurately reflect the family situation. Not removing a child in those cases puts him or her at greater risk of additional harm, they say.

Since fiscal 2011 the department has referred a majority of its suspected abuse cases to the diversion process, precluding the need for foster care and a CPS investigation. Last year 55 percent were diverted; in 2007 that figure was 43 percent.

Despite all the questions that surrounded the system’s launch, DHS nearly a decade later has no comprehensive report showing how effective the differential response system is.

"I think, quite frankly, we could do a better job collecting data," Director Pat Mc­Mana­man told the Hono­lulu Star-Advertiser. "We’re really working on that."

But the department does refer to statistics showing improved outcomes in various parts of the CPS system since the implementation of the diversion program, arguing the data demonstrate the success of the differential approach.

Since 2005, for instance, the communitywide fatality rate for children has dropped by half, to 3 per 100,000 in 2012, ranking Hawaii as the 14th-lowest state nationally. In 2004, Hawaii ranked 34th lowest, according to DHS.

Since 2006 the department also has ranked among the top 10 states with the best child welfare programs nationwide, according to data from Right for Kids, a national foundation that focuses on government accountability in the child welfare arena.

Barb Rhinehart, a longtime Hawaii island CPS investigator who retired in July 2012, recalled the big push to get West Hawaii cases into the diversion program, including ones she believed were too risky. In some of those cases, the child was re-abused in a matter of weeks, she added.

"That was a hot issue," said Rhinehart, who spent nearly 25 years with DHS. "There were high-risk cases that should have never gone to voluntary case management but did."

Voluntary case management is one option on the diversion path, available for cases in which the risk of substantial or imminent harm is determined to be moderate. No safety threats can be evident. Services to the family are provided for up to one year. If a family refuses to accept the services or doesn’t comply with a service plan, the case is referred to CPS.

The other diversion option, called family strengthening services, is for cases in which the risk is classified as low and no safety threats are present. Services are provided for up to six months.

Rhinehart said at one point West Hawaii diversion cases were getting kicked back into the CPS system at a steady pace because the service provider considered the risk to the child too high or because it was unable to provide the services the family needed.

"It was almost like there was a revolving door," she said.

McManaman stressed that DHS’ evaluation tools for measuring risk and safety comply with Hawaii law and are considered best-practice procedures in the industry. The tools are used by skilled, experienced professionals whose foremost goal is doing what is in the best interest of the child, she added. "Good, sound, practiced skills and judgment always come into play."

To illustrate how the change has affected responses, DHS officials said children used to be removed from the family if they were homeless. Under the old system, that was considered a safety threat. But with differential response, the child’s well-being and other factors are considered as well.

"There are homeless families who do a terrific job of raising children," Mc­Mana­man said.

Keith Kuboyama, vice president of program and clinical services for Family Programs Hawai‘i, which has a contract with DHS to provide case management services on the Leeward Coast, said the diversion program in that area is working.

About 92 percent of families going through the program successfully complete it and don’t enter the CPS system, he said.

"We’re having good outcomes," agreed Paulette Bethel, president and chief executive of Family Programs.

Nationally, studies generally have found differential response systems to be effective in keeping families intact while dealing with their underlying problems in a nonadversarial manner.

In a 2012 paper, Casey Family Programs, a national foundation that focuses on foster care, noted that such systems have contributed to improved family engagement, better child and family outcomes and cost savings.

Such studies, though, provide little consolation to those who have seen diversion cases go awry.

The Cyrus Belt case is one.

Just six days before a neighbor threw the 23-month-old boy from a pedestrian overpass onto the H-1 freeway in 2008, killing him, a complaint alleging a threat of child abuse by Cyrus’ mother, Nancy Chanco, was filed with the department.

That same day, Chanco, while getting a sore eye checked at a hospital emergency room, tested positive for "ice" use, according to DHS records that were made public in 2008 but are now considered confidential.

Based on the Jan. 11, 2008, complaint, CPS did an assessment, determined no immediate safety issue was evident and referred the matter to voluntary case management.

The referral was made even though Chanco already was known to the agency. She had a history of drug and child abuse, including a 2000 case in which she was found to have physically abused another son, then 7, and a 2006 case in which CPS confirmed a threat of neglect and abuse to Cyrus, then only a few days old.

When Chanco was about five months pregnant with Cyrus, she admitted taking ice again, according to the records.

And before Cyrus was even 5 months old, a relative contacted CPS alleging that Chanco would leave the baby with his grandfather while she did drugs. Cyrus subsequently was placed in foster care for four days.

On the day of his death, police found Cyrus wandering the neighborhood and returned him to his grandfather. Later that day Matthew Higa, high on ice, threw Cyrus from the pedestrian bridge onto the H-1 freeway below.

At Higa’s trial, Chanco testified that she was not at home the morning of her son’s death, but was at an illegal gaming parlor smoking ice with Higa’s father. Higa was convicted of second-degree murder for Cyrus’ death.

If ever there was a case in which CPS should have removed a child from his home, this was it, said Charles Crumpton, the attorney for David Belt, Cyrus’ father. "He’s dead because they didn’t remove him six days earlier."

McManaman, who became director in 2010 as part of the Abercrombie administration, told the Star-Advertiser that she could not comment on individual cases because of confidentiality requirements.

Social workers who deal with child abuse cases increasingly are questioning whether DHS is going too far with diversions, according to several contacted by the Star-Advertiser. Mc­Mana­man said she had not heard such concerns.

State Sen. Suzanne Chun Oakland, chairwoman of the Senate’s Human Services Committee, said she would like to believe the diversion program is working well. But she tempers her optimism, explaining that she has heard from front-line social workers "who are concerned that maybe we are going too far."

Chun Oakland said she would like to think all the changes made to Hawaii’s CPS system over the past few decades are having a positive effect, accounting for the dramatic drop in confirmed child abuse numbers.

But she wonders whether DHS, still recovering from steep budget and personnel cuts in 2009 and 2010, is missing cases as a result.

Wendall Omura, a DHS social worker, said child abuse and neglect are just as prevalent today as in the past — even though the statistics don’t indicate that.

Omura said the lower numbers misrepresent what is happening because abuse cases that go through the diversion program are not labeled abuse. This is akin to describing a zebra as a horse with stripes, he added.

"You’re calling the same animal a different name," Omura said.

ENLARGE PHOTO.

ENLARGE PHOTO.

ENLARGE PHOTO.

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The state of Hawaii has a policy of trying to return abused or neglected children with family members after problems have been addressed, a process known as reunification. In February, the state Supreme Court ruled that the policy of favoring family in permanent placements of foster children was inconsistent with state and federal law. While successful family reunifications promote stability in a child’s life and preserve important biological, cultural and other ties, some reunifications have ended in tragedy.