A case record review of termination of parental rights cases involving parents with a disability

Children and Youth Services Review 79 (2017) 399–407

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Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth

A case record review of termination of parental rights cases involving parents with a disability

MARK

Elizabeth Lightfoot⁎, Traci Laliberte, Minhae Cho School of Social Work, University of Minnesota, Twin Cities Campus, 1404 Gortner Ave, St Paul, MN 55108, USA

A R T I C L E I N F O Keywords: Parent with a disability Termination of parental rights Case record review Disability Child welfare

1. Introduction

2. Background

There has been increasing attention internationally to the disproportionate number of parents with disabilities involved in the child welfare system (Lightfoot & DeZelar, 2016; Llewellyn, McConnell, & Ferronato, 2003; McConnell, Feldman, Aunos, & Prasad, 2010). While there is a growing body of research focusing on prevalence, risk assessment and behavioral modifications of parents with disabilities (Azar, Maggi, & Proctor, 2013; Feldman & Tahir, 2016; Hodes, Meppelder, Moor, Kef, & Schuengel, 2017; Wade, Llewellyn, & Matthews, 2008; Wilson, McKenzie, Quayle, & Murray, 2014), there is little research into the experiences of parents with disabilities who are involved in the child welfare system. A report by the National Council on Disability (2012) has drawn attention to research on discriminatory child welfare practices in the United States, including discriminatory state child welfare statues (Lightfoot & LaLiberte, 2011), and has called for further research into the specific services and service modifications that child protection agencies provide to parents with disabilities involved in the child welfare system. This study aims to increase our knowledge about the experiences of parents with disability involved in child welfare through a case record review of cases involving parents with disabilities who have had their parental rights terminated. The study specifically focused on how disability was identified in case records, the child welfare services and parental supports provided to parents with disabilities throughout their involvement in the child welfare system, and the disability related services and modifications that parents received.

While it is clear that the number of parents with disabilities grew over the past century (Tymchuck, Llewellyn, & Feldman, 1999), our knowledge regarding the population of parents with disabilities is still quite limited. Currently, the best estimate of the population of parents with disabilities in the United States comes from a study by Anderson, Byun, Larson, and Lakin (2005) which uses the nearly twenty-five year old Disability Supplement of the National Health and Information Survey from 1994/1995 to estimate the number of mothers with disabilities. They found that there were approximately 1.35 million mothers with significant functional limitations, and an additional 175,000 mothers with intellectual or developmental disabilities. Despite our limited knowledge on the overall prevalence of parents with disabilities, there has been growing international concerns that parents with disabilities and their families are coming into contact with the child welfare system at high rates (National Council on Disability, 2012; Lightfoot, Hill, & LaLiberte, 2010). A recent study of the Adoption and Foster Care Reporting and Analysis System (AFCARS) found that at least 19% of children in foster care were removed, at least in part, in relation to a parent's disability (Lightfoot & DeZelar, 2016). Studies in England (Booth, Booth, & McConnell, 2005), Australia (Llewellyn et al., 2003), Canada (McConnell, Feldman, Aunos, & Prasad, 2011) and Norway (Tøssebro, Midjo, Paulsen, & Berg, 2017) have found that families headed by parents with disabilities are overrepresented in the child welfare system, more likely to have their children removed from their home, and more likely to lose their parental rights. While there is growing knowledge of the increased involvement of parents with disabilities involved in the child welfare system, there is

⁎

Corresponding author. E-mail addresses: [email protected] (E. Lightfoot), [email protected] (T. Laliberte), [email protected] (M. Cho).

http://dx.doi.org/10.1016/j.childyouth.2017.06.037 Received 28 February 2017; Received in revised form 16 June 2017; Accepted 18 June 2017 Available online 22 June 2017 0190-7409/ © 2017 Elsevier Ltd. All rights reserved.

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provided to parents with disabilities as noted in child welfare case records of parents with disabilities who have lost parental rights? 3. What modifications are provided to child welfare services as noted in child welfare case records of parents with disabilities who have lost parental rights?

still only limited research into their experiences in the child welfare system, particularly in the United States. The majority of research on parents' experiences within child welfare has been conducted in Australia, Great Britain, and Canada. These studies have found that parents with disabilities face systematic bias within the child protection system, and this bias can lead to differential outcomes for parents with disabilities and their family (Booth et al., 2005; McConnell, Llewellyn, & Ferronato, 2002). There are a number of factors that researchers have found that lead to systematic bias in the child welfare system towards parents with disabilities. First, researchers have identified bias that stems from child welfare worker preconceptions, misconceptions or generalizations about parenting by a person with a disability (McConnell & Llewellyn, 2002; McConnell, Llewellyn, & Ferronato, 2006; Tymchuk & Feldman, 1991). These preconceived notions about a parent with disability can lead to subtle differences in all aspects of the child protection process. Second, child welfare workers typically receive little training in working with parents with disabilities (LaLiberte, 2013; Lightfoot & LaLiberte, 2006). They often receive no school-based or onthe-job training about parental disability, and thus may have never been introduced to basic concepts of working with people with disabilities or disability rights under national laws. Third, assessments in child welfare, while often criticized as being of poor quality in general (Azar et al., 2013), are particularly poor in regards to parents with disabilities. Studies have found that caseworker stereotypes of disability can influence assessment (Proctor & Azar, 2013), that findings of abuse are often made without actually conducting a formal assessment (Alexius & Hollander, 2014), that the current ambiguity in defining “good enough” parenting can lead to systematic bias in assessing parents with disabilities (Choate & Engstrom, 2014), and that assessments are usually not modified to meet the needs of parents with disabilities (Azar et al., 2013; McConnell et al., 2006; Tymchuk & Feldman, 1991). Finally, there typically are not specialized services or formal supports available for many parents with disabilities through either the child welfare or disability services (IASSID Special Interest Research Group on Parents and Parenting with Intellectual Disabilities, 2008; Azar et al., 2013; McConnell et al., 2002). Child welfare services are typically short-term services that do not provide lifelong parental supports that some parents with disabilities need, while disability services typically do not provide services and supports for parenting activities, as they are designed and funded to be individual supports for a person with a disability (Lightfoot & LaLiberte, 2008). Child welfare agencies are required under Title II of the Americans with Disabilities Act of 1990 to provide reasonable modifications to parents with disabilities in all aspects of child welfare services, ranging from investigation, assessment, service provision, case planning and out of home care. Due to the rising number of complaints of disability discrimination by child welfare agencies against parents with disabilities, the Department of Health and Human Services and the Department of Justice (2015) released a joint technical assistance document reiterating that child welfare agencies must not discriminate in providing the full range of child welfare services to parents with disabilities and must provide reasonable modifications to services. While these mandates are clear, there have not been any studies in the United States that document the types of services parents with disabilities do receive while in child welfare, nor how child welfare agencies are providing services to parents with disabilities. The purpose of this study was to see how parental disability was identified and addressed in child welfare cases in which a parent with a disability has his or her parental rights terminated through an in depth case record review. In particular, this study seeks to answer:

3. Methods 3.1. Research design and definitions This study used a case record review of parents with disabilities who had a termination of parental rights to answer its research questions. As parents with disabilities might be less likely to be identified in the child welfare system, this study defined parents with disabilities as parents who had been identified as having a disability when they were in the education system, as schools are required to identify students with disabilities under the Individuals with Disabilities Education Act of 2004, and thus are more likely to have detailed disability information than child welfare agencies might have. 3.2. Participant identification and case selection Secondary administrative data from the Minnesota-Linking Information for Kids (Minn-LInK) project was used to identify participants for this study. The Minn-LInK project synthesizes data from several Minnesota state agencies to provide information concerning child well-being in the state of Minnesota. This data is maintained through a data sharing agreement between the Minn-LInK project at the University of Minnesota and participating state agencies. For this study, data from the Minnesota Department of Education and the Minnesota Department of Human Services were utilized to identify individuals with a disability who also had their parental rights terminated as a result of a child protection case. Participants who met the criteria for having a disability, which was having had an Individualized Education Plan (IEP) when they were in school, and had been the subject of a TPR as a parent, were eligible for inclusion in this study. To minimize the number of cases studied and to protect confidentiality, counties with 2 to 4 disability TPRs with disability rates of 60% or more of the total TPR cases, and counties with 5 or more cases were selected for final study resulting in the identification of 54 cases from 11 counties that met study criteria. Counties that met the criteria were contacted to participate in this project, and several of these counties chose not to participate. This study ultimately includes data from 31 cases across 4 counties. The cases represent a mainly urban population from inside counties in a large metropolitan area. All individuals within the study were assigned an independent study ID and all data identifiers were removed assuring participant and case confidentiality. 3.3. Data collection and analysis Data was collected through a case record review using a 75-item multivariable instrument developed specifically for this study. The instrument was constructed over a period of several months and underwent extensive revision by a team of four researchers before usage in data collection. This instrument was designed to capture demographic and basic event data as well as to investigate disability-specific and case-specific indicators. The instrument captured, the type of parental supports or modifications needed by the subject and those actually implemented by the social services agency, and the way in which the subject's disability was identified and treated throughout the case. This study was not designed to be a comparative analysis between individuals with disabilities and those without disabilities whose cases end in a TPR, but rather to give extensive data concerning the influence, or lack of influence of the subject's disability within the case events. To collect data, a primary reader was designated and trained by researchers. The primary reader was involved in the development of the

1. How is parental disability identified by child welfare workers as noted in child welfare case records of parents with disabilities who have lost parental rights? 2. What types of child welfare services and parental supports are 400

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instrument and had previous familiarity with the child welfare and child protection system. This individual was closely supervised by researchers to assure consistency among and accuracy of case record review data. Cases chosen for review were communicated with social service administrative personnel in each county and individual counties provided access to these cases. Most cases involved reviewing hard copy files while several were electronic case files. No notable difference in information was found between electronic and hard copy case files. Cases were read at the county child welfare office to protect privacy. The case was first read completely while the reader took detailed notes. The reader then filled out the instrument based on these notes and referred back to the case record for clarification when necessary. Particular attention was paid to case notes/narrative accounts, psychological/parenting/chemical dependency evaluations, court documents, referrals for services, and case plans. Each case took approximately 3 to 6 h to complete based on the complexity and length of the case. Whenever possible, readings were completed in one day to assure accuracy. Aside from instrument questions, narrative notes were kept for each case detailing reader impressions, potential points of complexity or confusion, and quotations. These notes were used in data analysis to ensure the accuracy of the information gathered from instrument data. Instrument data were retained until all cases had been read in a given county and then were entered into SPSS statistical analysis software by the reader. Original notes were kept until data analysis was complete to provide clarification when needed. Descriptive statistics were used to examine frequencies of demographic, child protection service, case management, subject parent issues and services provided for the subject parent and their families including disability service.

Table 1 Demographics of subject parents (n = 31).

Gender Mother Father Racea American Indian Black/African-American White/Caucasian Unknown Member of tribe Yes No Perhaps Metro/outstate Metro county Employment status Not employed Employed no supports Other Unknown Relationship to other adult in the home Marriage partner Non-married partner Adult sibling Adult parent Other relative Other unrelated adult N/A Identification of disability Yes, explicitly Yes, but not explicitly No How did the worker know the SP's disabilitya Self-disclosed Assessment related to disability IEP SSI/SSDI payments Receiving services related to disability The nature of disabilities disclosed in the case recordsa Hearing disabilities Intellectual/developmental disabilities Mental health Emotional/behavioral disabilities Medical disabilities Other disabilities The point at which the disability was first disclosed Prior to intake During assessment During case management During court process N/A Minnesota Education Department Disability Code Developmental cognitive disabilities Special learning disabilities Emotional/behavioral disabilities Other health disabilities

3.4. Limitations This study has a number of limitations. First, as in any case record review, this study is limited to a description of what is documented in the case records. We were only able to describe and analyze what was documented. Second, while the reviewer received extensive training and ongoing supervision, the reviews still involved subjective judgment. Third, this was a small study, and some counties did not choose to participate. Thus, while we are able to learn lessons from these findings, we are not able to generalize. Fourth, the nature of this case review design doesn't allow for the parents' voice in this study. However, we believe that uncovering what is in the case record is valuable overall for understanding parents' experiences. Finally, the design of this study limited this study to younger parents due to the use of available administrative data. Public school data available for this study to identify the IEP status is since academic year 2000–2001, so participants had not been out of school long.

n

Percent

23 8

74.2 25.8

5 12 17 1

16.1 38.7 54.9 3.2

2 27 2

6.5 6.5 87.1

31

100

22 5 1 3

71 16.1 3.2 9.7

1 9 3 5 1 5 7

3.2 29.1 9.7 16.1 3.2 16.1 22.6

18 9 4

58.1 29 12.9

18 24 19 3 11

58.1 77.4 61.3 9.7 35.5

1 8 23 21 1 1

3.2 25.8 74.3 67.7 3.2 3.2

11 2 13 1 4

35.5 6.5 41.9 3.2 12.9

2 6 21 2

6.5 19.4 67.7 6.5

4. Findings a

Thirty-one subject parents were identified from the data (twentythree mothers and eight fathers). The age of subject parents at intake ranged from 14 to 24, including five minors (M = 18.9, SD = 2.6). The subject parents were all living in metropolitan counties with the following racial/ethnic background in multiple responses: American Indian (16.1%), Black/African-American (38.7%), and Caucasian (54.8%). Two subject parents were identified as Native American tribal members. A majority of subject parents (71%) were reported as unemployed and 16.1% parents had a full or part-time job without any employment supports. Only one subject parent was living with a married partner. Assessment related to disability (77.4%) was the most common source where workers identified the subject parent's disability, followed by an official record of Individualized Education Plan (IEP) (61.3%) and self-disclosure of the subject parent (58.1%). While nearly two-thirds of the subject parents received an Individualized Education

Multiple responses.

Plan (IEP) for an emotional/behavior disability (67.7%), child protection service documents recorded that most of the subject parents (74.2%) had multiple disabilities, and mental health (74.3%) and behavioral disabilities (67.7%) were the most prevalent. Nearly half of the cases (41.9%) documented the subject parent's disability in the case management process and a third of the cases (35.5%) prior to intake (Table 1). At the time of investigation, a total of 51 children were living with the subject parents (see Table 2). The majority of the children (86.3%) were biological children of the subject parents and 58.8% of the children had disabilities. About half of the subject parents (56.9%) were living with one minor child in their household. Of the children residing outside subject parent's household (43.1%), four children (7.8%) were identified as having previous TPR cases. Almost half of the subject 401

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Table 2 Household/family information (n = 31).

Relationship to SP (n = 51) Biological child Other related child other non-related child Location of children at intake (n = 51) Inside SP's household Outside SP's household Reason for residing outside SP's household (n = 51) Non-custodial parent: no visitation Non-custodial parent: unknown visitation Parental rights terminated (TPR) Informal family/friend placement Unknown SPs with children with a disability Yes No Type of disabilities of childrena No disability Mobility/physical disabilities Intellectual or developmental disability Mental health disabilities Behavioral disabilities Medical disabilities Unclear a

Table 3 Initial investigation and CPS history (n = 31). N

Percent

44 5 2

86.3 9.8 3.9

29 22

56.9 43.1

2 2 4 2 41

3.9 3.9 7.8 3.9 80.5

14 17

45.2 54.8

21 1 8 2 2 3 19

37.5 1.8 14.3 3.6 3.6 5.4 33.9

Initial concerns reporteda Neglect (non-medical) Physical abuse Threatened physical abuse Prenatal exposure Infant medical neglect Endangerment Inadequate supervision Medical neglect Abandonment Missing Unknown Reporter who filed the initial CPS Counselor/psychologist/psychiatrist Doctor or health professional Other mandated reporter Relative Unknown Other mandated reporter (n = 15) County social worker Crisis nursery staff Permanency worker Police Shelter worker SP's father Hospital but no definitive evidence Track for reference case after initial report Family assessment Traditional investigation Switch tracks to a traditional investigation Yes No Unknown Substantiation in the case Yes No Substantiated maltreatment report (n = 29)a Neglect (non-medical) Physical abuse Threatened physical abuse Prenatal exposure Endangerment Inadequate supervision Medical neglect Abandonment N/A (no substantiated) Number of children substantiated 1 2 4 Unknown SP is the perpetrator Yes No Unclear N/A Relationship between SP and victim Biological child Partner's child Unknown Prior family assessment Yes No Unclear Prior traditional investigation Yes No Unclear Children previously in out-of home placement Yes No Unclear Number of placement 1

Multiple responses.

parents (45.2%) had at least one child with disability. The initial child protection reports were filed mainly by mandated reporters (83.9%), suspecting the subject parents of mainly non-medical related neglect (74.2%). In Minnesota, reports of child maltreatment that allege substantial child endangerment, sexual abuse, or circumstances of serious danger must receive a traditional family investigation, while reports not involving substantial harm to children may be assigned for family assessment, which is Minnesota's version of alternative response (Minnesota Department of Human Services, 2016). After the maltreatment reports, 87.1% of the reference cases were tracked into traditional investigation and 12.9% of the reference cases went initially into family assessment. During the investigation, two reference cases (6.5%) in family assessment were switched to a traditional investigation. Of the 31 cases, 29 cases had maltreatment substantiated (93.5%). Of those with substantiated maltreatment, in 23 cases the subject parents was the perpetrator. Non-medical neglect (75.9%) was the most common type of substantiated maltreatment. In most cases (90.3%), the victims were biological children. One parent was accused of maltreatment of four children. Of the subject parents, approximately 10% had been previously involved in a family assessment and 35% had a traditional investigation prior to the investigation of the reference case. Of the total 51 children, 15.7% of the children experienced out-of-placement more than twice for months ranging from 1 to 23 (M = 18.5, SD = 25.5). In terms of the documentation for the type of placement that allows multiple responses, more than a half of the children (68.6%) were in non-relative foster care, and one third of the children (33.3%) were placed in relative foster care. A majority of the previous out-of-placement cases (61.2%) had resulted in the termination of the subject parents' parental rights (Table 3). The information regarding safety assessment and decision making process related to placement is shown in Table 4. Approximately 77.4% of cases described threats to the immediate safety of a child living in the subject parent's residence since the case opened. The threat to safety was from the subject parent in more than two thirds of the cases (71%). About 42% of the cases had children placed prior to intake, followed by 29% of cases that described placement-decision making during the initial assessment. About 71% of subject parents did not receive services to prevent their children from being put in an out-of-placement due to placements before the intake and fear of imminent harm to their child. 402

N

Percent

23 6 1 4 1 9 (2) (2) (2) (3) 1

74.2 19.4 3.2 12.9 3.2 29 (22.2) (22.2) (22.2) (11.1) 3.2

1 10 15 1 4

3.2 32.3 48.4 3.2 12.9

1 2 8 1 1 1 1

3.2 6.5 25.8 3.2 3.2 3.2 3.2

4 27

12.9 87.1

2 2 27

6.5 6.5 87.1

29 2

93.5 6.5

22 6 2 1 3 (1) (1) (1) 2

75.9 20.7 6.9 3.4 10.3 (33.3) (33.3) (33.3) 6.9

26 2 1 2

83.9 6.5 3.2 6.5

23 4 2 2

74.2 12.9 6.5 6.5

28 1 2

90.3 3.2 6.5

3 27 1

9.7 87.1 3.2

11 19 1

35.5 61.3 3.2

8 21 22

15.7 41.2 43.1

8

8.6 (continued on next page)

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Table 3 (continued)

2 3 4 Unknown Number of months in placementa 1–6 7–12 13–18 19–24 Unknown Type of placementa Relative foster care Non-relative foster care Group home or institutional setting Other Unknown Result of placemen (n = 67)a Reunification Temporary legal custody Termination of parental rights Other Unknown

Table 4 Safety and placement (n = 31). N

Percent

11 7 1 14

11.8 7.5 1.1 15.1

6 20 12 2 4

13.6 45.5 27.3 4.5 9.1

17 35 1 9 5

33.3 68.6 2 17.6 9.8

12 1 41 1 12

17.9 1.5 61.2 1.5 17.9

Threats to the immediate safety described Yes, described explicitly Yes, not described explicitly No risk of immediate harm Unclear Child not residing with SP Threats to safety froma Subject parent Relative in household Non-relative in household Other Unknown Risk of placement described Yes, explicitly stated Yes, not explicitly stated The child already placed No indication of risk Unknown/unclear Child not residing with SP Time point when the child was placed Prior to intake Within 1 week of the intake During the initial assessment During the case management Unclear Service to prevent the out-of-placement Yes, clearly targeted Not sufficient time for intervention No, due to the imminent harm Unclear SP's visitation granted Yes, supervised No Both supervised and unsupervised Number of SP's visit (M = 15, SD = 15.7) Intentional visits to assess the parenting capabilities Yes No Unclear (After visits) improvement in SP's behaviors Documented with specifics Documented without specifics N/A (After visits) description of parental supports Yes with specifics Yes without specifics Not documented N/A (After visits) modifications to CW service delivery Yes with specifics Not documented N/A

Note. Non-medical neglect indicates any other forms of neglect, such as educational neglect and lack of supervision, except for medical neglect defined as the withholding of medically indicated treatment from a disabled infant with a life-threatening condition. a Multiple responses.

When the child was removed from the subject parent's home, 87% of subject parents were granted visitation of their children. The subject parents visited their children fifteen times on average (M = 15, SD = 15.7). Based on the reviewer's judgment, in half of the cases (48.4%), there seemed to be no intentional worker assessment of parenting capabilities and accommodation needs of the subject parents that guided the provision of future services. Only about 20% of the cases indicated that the workers visited the subject parent to assess parenting capability. When such visits were made, half indicated that the visits helped the subject parent develop behaviors to more safely care for their children. However, there are only two cases in which subject parents received parental supports or services related to their disability and only one case recorded in which modifications to child welfare service delivery were made due to the subject parent's disability (Table 5). Case records indicated that nearly 60% of the workers addressed basic tasks of child protection services, including measurable goals and interventions for behaviors, but that they did not go further in dealing with other basic tasks such as explaining the role of child protection and the social worker, collaboration with the subject parents, and information sharing with service providers. More importantly, according to the records, a majority of the workers did not record addressing subject parent's disability needs (71%), disability modifications (87.1%), or providing parental supports for their children's safety (71%) (Table 6). During the case management and services-providing phase, several parental strengths were identified in case records. A majority of subject parents (87.1%) were reported to have physical health as a protective capacity. The next most common strength of the family listed in the documents was the child's characteristics (64.5%). A similar number of subject parents (61.3%) were reported to have sobriety as being a strength, and about half of the subject parents (54. 8%) were reported to have housing as a strength. From the needs assessment, parenting skills (80.6%) was documented as the most common need of the subject parents. The next most common needs were for life skills (74.2%), positive parenting history (77.4%), and social support system (61.3%). Employment (58.1%) and positive relationships (64.5%) were identified also identified as common needs of these parents with disabilities. Table 7 shows the parental issues identified and addressed

a

N

Percent

20 4 2 1 4

64.5 12.9 6.5 3.2 12.9

22 1 2 9 1

71 3.2 6.5 29 3.2

5 6 11 1 1 7

16.1 19.4 35.5 3.2 3.2 22.6

13 9 3 5 1

41.9 29 9.7 16.1 3.2

4 12 10 5

12.9 38.7 32.3 16.1

27 3 1

87.1 9.7 3.2

6 15 10

19.4 48.4 32.3

3 3 25

9.7 9.7 80.6

1 1 4 25

3.2 3.2 12.9 80.6

1 5 25

3.2 16.1 80.6

Multiple responses.

throughout the child protection service processes. Case records contain detailed information regarding identification of the parental issues at intake and case management regarding parental issues. However, there was limited information in the case records regarding the parental issues as the reason for initial referral, out-of-home placement, and whether those issues were addressed in the safety plan or assessment. A majority of subject parents (87.1%) were reported as having a lack of parenting knowledge as their parental issue. The next most common issue was mental illness or psychological disabilities (74.2%). Also, drug use issues (67.7%) and criminal involvement (64.5%) were commonly documented as issues of the parents. Despite the limited documentation, during the case management process, the lack of parenting knowledge issues were addressed in 80.6% of the subject parents, and mental illness or psychological disabilities issues were addressed for 71% of the subject parents. The lack of transportation also was commonly addressed during the case management process. 403

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Table 5 Case management and services provided (n = 31). No

Role of child protection/the social worker Measureable goals Collaboration with the subject parent Interventions for changing behaviors Subject parent's disability needs Modification to meet disability needs Parental supports for child safety Information sharing with providers Discussion with providers for reducing risk

Yes

Attempted

N/A

N

Percent

N

Percent

N

Percent

N

Percent

16 8 18 11 22 27 22 15 18

51.6 25.8 58.1 35.5 71 87.1 71 48.4 58.1

12 18 8 18 7 2 7 13 10

38.7 58.1 25.8 58.1 22.6 6.5 22.6 41.9 32.3

1 2 3 – – – – – –

3.2 6.5 9.7 – – – – – –

2 3 2 2 2 2 2 3 3

6.5 9.7 6.5 6.5 6.5 6.5 6.5 9.7 9.7

Note. No = undocumented, Yes = documented, Attempted = the worker attempted but not implemented.

received were parenting education (112.9%). Mental health (109.6%) and chemical dependency services (96.8%) were the next common social services that are recorded in their documents. When tracking their case records corresponding to each service, a large majority of subject parents (87.1%) showed a high level of service completion rates. Subject parents' absence or refusal to receive the services was noted as the most common reason for uncompleted services (177.4%). Only a tenth of the received social services (12.2%) were designed to meet subject parent's disability needs (Table 8). Table 9 describes many different types of service modification provided to address the subject parent's disability needs at each serviceproviding phase. During the assessment process, there was no documentation of any disability modification provided. During the case management process, repetition (41.9%) was the most common modification provided for the subject parents, and reminders (35.5%) were the next common modification. During the court proceeding, repetition (29%), reminders (22.6%) and extra time (22.6%) were documented as being provided for the subject parent's disability needs. The case records revealed a wide range of parental services and supports utilized by subject parents before and during the case management processes (see Table 10). Prior to the caseworker's involvement, only five subject parents (16.1%) had received any type of parental services or supports. During case management, nearly half of the subject parents (48.8%) received in-home parent training by case workers, while 12.9% of the subject parents were offered and declined to receive parent training. Supported housing was the second highest parental support that 41.9% of the subject parents received, while 9.7% of the subject parents were offered and declined this support. Parenting classes (35.5%) was the next common parental services provided for subject parents, but 29% of subject parents were offered and declined to

Table 6 Strengths and protective capacities of subject parent (n = 31).

Ability to use community resources Communication/interpersonal skill Emotional/mental health Employment Extended family general support Family relationships in the home supportive Health Housing Life skills Relationship with spouse, partner, other parent Positive relationships, not destructive/abusive Sobriety Parenting skills Positive parenting history Social support system Child characteristics

Strength

Need

Unknown

N

Percent

N

Percent

N

Percent

15 11 8 13 10 13

48.4 35.5 25.8 41.9 32.3 42

15 18 22 18 7 14

48.4 58.1 71 58.1 22.6 45.1

1 2 1 – 14 4

3.2 6.5 3.2 – 45.1 12.9

27 17 8 5

87.1 54.8 25.8 16.1

2 14 23 17

6.5 45.1 74.2 54.8

2 – – 9

6.5 – – 29.1

7

22.6

20

64.5

4

12.9

19 6 5 12 20

61.3 19.4 16.1 38.7 64.5

12 25 24 19 6

38.7 80.6 77.4 61.3 19.4

– – 2 – 5

– – 6.5 – 16.1

Case records reveal that parents had received approximately 7 social services on average, mainly for themselves as the target subject of the social services (90.6% out of the total number of 213 services that they received). A quarter of the parents (25.8%) received more than ten social services, and the same percentage of the subject parents (25.8%) received 4 to 6 services. A total of 35.5% received social services for their families. The most common social services the subject parents

Table 7 Subject parent issues (n = 31). Issue

Lack of knowledge about parenting Mental illness/psychological dis. Other drug use Criminal involvement Lack of transportation Lack of sufficient employment Domestic violence victim Sexual abuse victim Homelessness Allows unsafe conditions Parent-child relationship

Referral

Placement

Plan

Management

N

Percent

N

Percent

N

Percent

N

Percent

N

Percent

27 23 21 20 18 16 15 15 12 10 9

87.1 74.2 67.7 64.5 58.1 51.6 48.4 48.4 38.7 32.3 29

– 4 6 2 – – 2

– 12.9 19.4 6.5 – – 6.5 – 6.5 12.9 –

1 6 7 2 – – – – 3 7 –

3.2 19.4 22.6 6.5 – – – – 9.7 22.6 –

4 5 9 – – – 3 1 2 6 –

12.9 16.1 29 – – – 9.7 3.2 6.5 19.4 –

25 22 15 8 16 6 10 2 9 9 9

80.6 71 48.4 25.8 51.6 19.4 32.3 6.5 29 29 29

2 4 –

Note 1. Each cell indicates the numbers and percentages out of 31 parents. Note 2. Issue = identified as subject parent issues; Referral = reason for initial referral; Placement = reason for out-of-home placement; Plan = addressed in safety plan or assessment; Management = addressed in case management services.

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the subject parents had a TPR filed within 12 months of the opening of their cases. A majority of parents (87.1%) had one child subject to the TPR. In multiple responses, about half of the reference cases (46% out of the total number of 63 responses) documented the best interest of the child as the ground for the TPR Petition. Approximately one-third of the reference cases (30.2%) out of the total number of 63 responses) fell into the voluntary termination of parental rights. There was clear documentation that the county provided reasonable efforts to reunify child for a total of 80.7% subject parents, while in 12.9% of the cases there was clear documentation that the subject parents were not provided reasonable efforts. During the court proceedings, in only four of the cases (12.9%) was the subject parents' disabilities referred to as a reason for TPR (Table 11).

Table 8 Family servicesa (n = 31).

Type of SISS service (N = 213) Family counseling Individual counseling Family-based services - counseling Family-based services - life skills Day care (child) Chemical dependency services Parenting education Child protection services case management Family support services Family preservation services Education and training services Health planning services Housing services Independent and transitional living services Information and referral services Mental health services Pregnancy and parenting services Special services - disabilities Other services Out-of-home placement N/A Subject of services (N = 213) Subject parent Child(ren) Adult household member Family 2N/A Reason code for uncompleted services (N = 206) Client attendance sporadic Client non-attendance or refused Client participation not successful Client not eligible Still involved with services Agency request to end service No longer appropriate services Unclear why not completed N/A Modifications for subject parent's disability needs (N = 213) Yes, modifications explicitly Not modified Unsure/unknown N/A

N

Percent

1 20 3 2 1 30 35 25 2 3 6 2 14 2 1 34 1 3 22 4 2

3.2 64.5 9.7 6.5 3.2 96.8 112.9 80.6 6.5 9.7 19.4 6.5 45.2 6.5 3.2 109.7 3.2 9.7 71 12.9 6.5

193 1 1 16 2

622.6 3.2 3.2 51.6 6.5

30 55 2 1 7 2 23 9 77

96.8 117.4 6.5 3.2 22.6 6.5 74.2 29 248.4

26 37 62 88

83.9 119.4 200 293.9

5. Discussion This case record review of parents with disabilities who had their parental rights terminates provides insights regarding identification of parental disability within child welfare, child welfare services and parental supports provided to parents with disabilities, and disability modifications provided to child welfare services. The following will highlight the key findings from the case record review. Child welfare workers did not have a straightforward method for identifying a parent's disability. While three quarters of parents were identified in the child welfare records correctly as having a disability, there was no straightforward source for this identification. Of those that were identified, only half were identified with a disability label that matched the label they were assigned during their IEP when they were in school. While disability labels themselves are somewhat arbitrary, and can certainly change over time, in this case record review only one quarter of all the cases had a similar disability label as the label listed during the IEP. Further, the case records of an addition one quarter of the parents with disabilities in this study did not have any mention of the parent's disability. Thus, the findings suggest that the child welfare workers might not have recognized a parent as having a disability at all in one quarter of the cases. This is not surprising, as child welfare workers typically receive little or no training regarding parental disability and are typically not experts in disability (Lightfoot & LaLiberte, 2006; Tarleton, 2015). Yet it is concerning that parents who had been identified just a few years earlier as needing an IEP when they were in school did not have their disability mentioned in their child welfare records. This case record review revealed that the parents involved in this study were receiving lots of services, both for themselves as well as for their children and family. The records also show that the parents in the study had a very high level of completion of these services in their treatment plan (87.1%). While there have been many child welfare studies that have shown that completion of services leads to better child welfare outcomes, including reduced maltreatment (DePanfilis & Zuravin, 2002), reduced out-of-home placements (Littell,

Note. SISS = Social Services Information System is a computerized case management and data collection system for foster care, out-of-home placement, children's mental health, and adoption information. a Multiple responses.

receive the support. The same number of parents (35.5%) was reported as having safety planning support, while one parent (3.2%) declined it. A large majority of the subject parents (80.6%) were not referred to a disability service provider, while only eight subject parents (29%) were referred to a disability service provider. More than half (61.3%) of Table 9 Modifications to address the subject parent's disability needs (n = 31).

Frequency Length Repetition Language Reminders Transportation Note Interpreter Specialist Extra time

Not needed N (%)

During assess N (%)

Case management N (%)

During court N (%)

Refused N (%)

Not provided N (%)

Unclear N (%)

2 (6.5) 1 (3.2) 1 (3.2) 2 (6.5) 1 (3.2) 28 (90.3) 2 (6.5) 27 (87.1) 1 (3.2) –

– – – – – – – – – –

5 (16.1) 5 (16.1) 13 (41.9) – 11 (35.5) – – 1 (3.2)

– 1 9 – 7 – – – – 7

– – 1 (3.2%) – – – – – – –

13 (41.9) 12 (38.7) 5 (16.1) 16 (51.9) 11 (35.5) 1 (3.2) 21 (67.7)

11 (35.5) 13 (41.9) 11 (35.5) 13 (41.9) 8 (25.8) 2 (6.5) 8 (25.8) 3 (9.7) 11 (35.5) 2 (6.5)

8 (25.8)

Note. Refused = social worker attempted but the subject parent refused.

405

(3.2) (29) (22.6)

(22.6)

25 (80.6) 12 (38.7)

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Table 10 Parental supports (n = 31).

Day care Respite care Co-parent or mentor Parenting class In-home parent training Long-term family support Long-term family foster care Supported housing Money management assistance Safety planning

Not needed N (%)

Before CW N (%)

CW put in place N (%)

Client refused N (%)

Not provided N (%)

21 (67.7) 22 (71) 3 (9.7) 3 (9.7) 1 (3.2) 1 (3.2) 6 (19.4) 8 (25.8) 4 (12.9) –

1 – – – – 1 1 2 – –

2 (6.5) 1 (3.2) 2 (6.5) 11 (35.5) 15 (48.4) 3 (9.7) 2 (6.5) 13 (41.9) 6 (19.4) 11 (35.5)

– – – 9 4 – 3 3 – 1

3 (9.7) 5 (16.1) 22 (71) 5 (16.1) 8 (25.8) 21 (67.7) 16 (51.6) 3 (9.7) 17 (54.8) 8 (25.8)

(3.2)

(3.2) (3.2) (6.5)

(29) (12.9) (9.7) (9.7) (3.2)

Note. Before CW = service were provided prior to case worker's involvement; CW put in place = case worker helped put in place; Client refused = social worker attempted but the subject parent refused.

them lost custody. We cannot tell from the case record review if completion of the services did not “fix” the underlying problem related to child safety, which is often an issue in child welfare as workers and parents focus on task completion rather than goal attainment (Smith, 2008), or if there were lingering doubts related to the disability. In any case, the high completion rate among these parents with disabilities who had their parental rights terminated points to serious flaws in service provision in these cases. While the parents received a lot of services, it is notable that fourfifths of the parents were never referred to a disability service provider. Despite not referring regularly to disability services, child welfare workers did put into places some parental supports, such as in-home parent training (48.4%), supported housing (41.9%), and parenting classes (35.5%). However, many of the parents did not receive other needed parental supports, such as long-term family supports (67.7%) or long-term family foster care (51.6%). There have been many calls for increased collaboration between child welfare and disability service providers (Aunos & Pacheco, 2013; Azar et al., 2013; LaLiberte & Lightfoot, 2013), and these findings underscore this need as disability services might have been able to help get these parents the longer term supports they needed. While all of the parents in this study had a documented disability while they were children, disability modifications were not regularly provided to the child welfare services they received. None of the parents received any disability modifications during the assessment phase, 40% received disability modifications during the case management phase, and about one-fifth during the court proceedings. Repetition and reminders were the most common modifications provided during both case management and court proceedings. In some ways, this is not surprising, as in over a quarter of the cases the child welfare worker never indicated that the parent had a disability in the case records. But this is also very troubling, as child welfare agencies are required to provide modifications under the Title II of the Americans with Disabilities Act of 1990. The lack of modifications provided in this study demonstrates that child welfare workers need much more awareness of the requirements of the ADA on providing non-discriminatory services to parents with disabilities. The findings of this study also show that parents with disabilities often had their TPR proceedings started before their timelines ran out, and also had high rates of voluntary TPRs. Despite a high rate of service completion, more than half of the parents in this study had a TPR filed within 12 months of the opening of their cases. While 12 months is the time limit for filing a TPR for older children in Minnesota, these parents all had disabilities and were making progress on completing the services in their case plans. These parents were not receiving extensions, which would likely be a reasonable modification under the ADA in many of these cases. Finally, nearly one-third of the cases involved voluntary termination of parental rights. As there have always been concerns regarding coercion related to parenting among persons with

Table 11 Case management for disability service (n = 31).

Referral to a disability service provider Yes No Unclear Type of disability servicea County services Community advocacy org. Private provider Missing Not addressed needs of SP Yes No needs apparent Not clearly identified need Unclear SP's disability accounted for in case plan Yes No Unclear Time point for the TPR Up to 6 months 7–12 months 13–18 months 19–24 months Over 25 months Number of children subject to TPR 1 2 3 4 Grounds for the TPR petitiona Abandonment/extreme parental disinterest Prior involuntary TPR Failure to establish paternity Failure to complete case plan Assault of child Best interest of child Voluntary termination Unclear Reasonable efforts to reunify Yes, with specifics Yes, no specifics Not documented SP's disability mentioned in court proceedings Yes No The way SP's disability mentioned in court proceedings As a reason for the TPR a

N

Percent

6 25 1

19.4 80.6 3.2

6 1 2 22

19.4 3.2 6.5 71

22 1 1 7

71 3.2 3.2 22.6

6 21 4

19.4 67.7 12.9

7 12 9 2 1

22.6 38.7 29.1 6.5 3.2

26 2 1 1

83.9 6.5 3.2 3.2

2 1 1 9 1 29 19 1

6.5 3.2 3.2 29.1 3.2 93.5 61.3 3.2

14 11 4

45.2 35.5 12.9

4 27

12.9 87.1

4

100

Multiple responses.

2001) and reduced terminations of parental rights (Jellinek et al., 1992), for the parents with disabilities in this study, the completion of services were not related to improved outcomes as ultimately all of 406

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disabilities, most notably seen in forced sterilization (Kallianes & Rubenfeld, 1997), child welfare workers must be sure for both legal and ethical reasons that coercion is not occurring in these voluntary terminations. Overall the findings, while limited and not generalizable, suggest that there is a need for increased training on parental disability among child welfare workers. Disability is still a neglected topic in general within schools of social work, and is not a required topic within most child welfare curricula despite the high numbers of parents with disabilities and children with disabilities present within the child welfare system. Further, the findings give further weight to the recommendations by the National Council on Disability (2012) that the child welfare system should consider larger system changes to better address systematic discrimination against parents with disabilities. This goes beyond instituting required disability training, but also changing of processes so that parents with disabilities can be recognized as having a disability without fear of immediately being judged as “at risk”, to receive legally required modifications, to be referred to appropriate disability services, and to have completing services within their case plan connected to their case outcomes. 6. Conclusion The findings from this study indicate that there is clearly much work to be done in child welfare to appropriately serve parents with disabilities. According to their case records, some parents with disabilities appear to be falling through the cracks, as they are unidentified in their child welfare records as having a disability or identified with an inaccurate disability diagnosis. Only a minority of those with a disability received any sort of disability modification to their services as required by the Americans with Disabilities Act, and only a few were referred to a disability service provider. There is a need for much more attention from researchers, policymakers and practitioners into serving parents with disabilities and their families involved in the child welfare system. Acknowledgements The authors gratefully acknowledge the county child protection agencies in Minnesota for participating in this study. This study was supported by the Minnesota Agricultural Experiment Station (Grant #55-055). References Alexius, K., & Hollander, A. (2014). Care assessments concerning involuntary removal of children from intellectually disabled parents. Journal of Social Welfare and Family Law, 36(3), 295–310. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990). Anderson, L., Byun, S., Larson, S. A., & Lakin, K. C. (2005). Mothers with disabilitiescharacteristics and outcomes: An analysis of from the 1994/1994 NHIS-D. DD Data Brief, 7(3), 1–15. Aunos, M., & Pacheco, L. (2013). Changing perspective: Workers' perceptions of interagency collaboration with parents with an intellectual disability. Journal of Public Child Welfare, 7(5), 658–674. Azar, S. T., Maggi, M. C., & Proctor, S. N. (2013). Practices changes in the child protection system to address the needs of parents with cognitive disabilities. Journal of Public Child Welfare, 7(5), 610–632. Booth, T., Booth, W., & McConnell, D. (2005). The prevalence and outcomes of care proceedings involving parents with learning difficulties in the family courts. Journal of Applied Research in Intellectual Disabilities, 18(1), 7–17. Choate, P. W., & Engstrom, S. (2014). The “good enough” parent: Implications for child protection. Child Care in Practice, 20(4), 368–382. DePanfilis, D., & Zuravin, S. J. (2002). The effect of services on the recurrence of child maltreatment. Child Abuse & Neglect, 26(2), 187–205. Feldman, M. A., & Tahir, M. (2016). Skills training for parents with intellectual disabilities. Handbook of evidence-based practices in intellectual and developmental disabilities (pp. 615–631). Springer International Publishing. Hodes, M. W., Meppelder, M., Moor, M., Kef, S., & Schuengel, C. (2017). Alleviating

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