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Helping Abuse Victims Keep Their Children


One night in 1999, Sharwline Nicholson’s former boyfriend showed up at her house and assaulted her when she opened the door. While she was in the hospital being treated for her injuries, the city’s Administration for Children’s Services took her children from the neighbor’s home where they were staying and charged Nicholson with “engaging in domestic violence.”

Nicholson became the lead plaintiff in a class action suit against the New York City foster care system aimed at stopping the practice of removing children from victims of domestic violence solely because the parent has been abused. The plaintiffs won the case. Since then, ACS has had to dramatically change how it handles cases involving domestic violence. It can no longer remove children from victims of domestic violence solely because they are victims.

As a result of the lawsuit, a committee of experts reviewed the child welfare system’s policies and training. The agency then directed more staff and funding to domestic violence programs and improved training. Since the lawsuit, experts say, there is more of an institutional commitment to work with victims of domestic violence and to get them the help that they want or need. The city, however, still removes children from the homes of victims of domestic violence.

While ACS needs to protect children from abuse, it also does not want to unnecessarily separate children, many already scarred by scenes of violence in their homes, from their parent.

The Dangers of a Violent Home

Research shows that domestic violence between adults frequently goes hand in hand with child abuse, and the U.S. Advisory Board on Child Abuse suggests that spouse or partner abuse violence may be the major precursor to child abuse and neglect fatalities in the country. About half of men who batter their partners also frequently abuse their children, and women who have been hit by their husbands are twice as likely to hit a child. Children who are exposed to domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety and violence toward peers than children who are not exposed to violence at home. Children in homes with domestic violence are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teen prostitution and commit sexual assault.

This is something that Princess, a former writer for Represent, a magazine written by teens in foster care, knows firsthand. "I've gone through a lot in my life, including being abused myself, but watching my mother being hurt is the worst thing I've ever gone through," Princess wrote in Represent. "I'm 21, and I still feel such a fear of an unexpected attack that I always double check my doors and windows to make sure they're locked. Sometimes I wake up crying. And I don't think I will ever be able to hear the words 'I'm sorry' without feeling anger at the fact that you may not mean them."

Child protective services can still remove children in Princess' situation if the violence is repeated and serious, and the children are clearly suffering serious emotional harm or the risk of physical harm. They can also remove children if the mother is offered meaningful help and decides not to act on it – if, for instance, a caseworker recommends that the mother goes to a shelter but she does not. In those cases, the battered parent can be charged with “child neglect,” meaning that she did not protect her child from violence or the threat of violence.

Keeping Children and Mothers Together

The Nicholson case raised awareness that many children living in homes with domestic violence should stay with their mothers, so long as the mother is taking steps to protect her children from the violence at home. It's something that many children living with domestic violence want as well.

Merli, another writer for Represent, remembers the trauma of watching her father beat her mother, but she says it would have been even more traumatic to be separated from her mom. "My mother was the most important person in my life," she wrote in Represent. "She needed help to get away from my father, but I needed her. If I had been taken from her, I would have been devastated."

 

Now removal solely on the grounds that a parent is being abused is not supposed to happen. “Obviously, that doesn’t mean that it never happens,” says Jill Zuccardy, one of Nicholson’s lawyers. “Some caseworkers make threats of removal inappropriately, but now it’s the exception and it’s against the law.”

The Victims’ Perspective

An increasing awareness of the perspective of domestic violence victims as well as the overlap between child welfare and domestic violence has permeated the foster care system over the past decade. Advocates say ACS workers are far more sensitive to the issues surrounding domestic violence. The agency has begun working closely with advocates and survivors to develop better policies for cases involving domestic violence, and Commissioner John Mattingly has met with domestic violence survivors to learn about their experiences with the agency. Members of Voices of Women Organizing Project, an advocacy group of domestic violence survivors, now sit on ACS’ Domestic Violence Advisory Committee and the Parent Advisory Workgroup.

Batterers often make false accusations of child abuse or neglect against their victims. Voices of Women and ACS have worked together to come up with protocol for child protective workers to follow when they suspect a report is false. Voices of Women founder and director Susan Lob said the group recently worked on a case where ACS was called about 30 times to a home because of a false allegation. “That’s traumatic to the family and a waste of the city’s time and resources,” said Lob.

Determining whether a report is false or not can be a life or death matter for a child. But partly due to the work between the two groups, ACS developed a protocol that acceptable to both child advocates and advocates for domestic violence survivors. When ACS workers suspect false reports, they now are supposed to contact the liaison between Child Protection and the district attorney’s office. In their latest media campaign, ACS even included a line warning that false and malicious reports are a crime, and the warning now appears on their Web site and brochures as well.

Turning the System Around

Voices of Women members also have made recommendations about the kind of training about domestic violence ACS workers should receive. But coming up with policies has been easier than changing day-to-day casework, said Lob. “On paper, the policies are really great,” she said. “Now we’re working on actually making those policies happen on the front lines.”

Voices of Women keeps a 16-point list of recommendations of policy and practice improvements and tracks the progress made on each point.

“Changing the system is often compared to turning the Queen Mary around in a small channel,” said Lob, “but I feel positive about the direction that ACS is going in. It’s a good sign that survivors are, for the first time, involved in giving feedback to the commissioner and staff and that the domestic violence staff are responsive.”

Sharwline Nicholson remembers that, before her lawsuit, survivors of domestic violence would advise each other in court, “Don’t fight the system. Whatever they give to you, just do it so you can get your kids back.”

After the lawsuit and lobbying for changes, Nicholson has begun began to sense a shift. “I could truly sense the anger the parents were feeling and the encouragement and empowerment I had to give,” she wrote in Rise, a magazine by and for parents in the child welfare system. Nicholson hopes her efforts will help "push forward legislation that will encourage more parent voices in the system, and bring about changes for the better for parents and children dealing with domestic violence.”

This article is adapted from Rise, a magazine by and for parents in the child welfare system, published by our partner, Youth Communication.  

The Catch-22 of Subsidized Day Care


United Community Child Care Center in East New York. (Photo by: Tara Siegel)

For thousands of hardworking low-income New Yorkers with preschool children, the stress and financial burdens of finding a safe, nurturing daytime environment for their kids while they work can be an insurmountable challenge. Yet many of the government day care subsidies earmarked for families in need are left untouched. Why? The reason lies in a number of unnecessarily stringent and seemingly arbitrary barriers to eligibility, which has caused day care programs across the city to be underutilized.

In 30 years of working in social services for families and children, and as the executive director of an agency that provides day care for nearly 800 children in New York City, I have seen first-hand how available childcare slots remain vacant because parents are unable to take advantage of the public funding that could help them afford day care. Families struggling to make ends meet need both parents working to have a decent living; and if both parents are in the workforce, someone else needs to care for their children.

But day care is expensive, which is why subsidies are available for parents who have children from 2 months to 12 years old. A limited number of vouchers, which are available on a first-come, first-serve basis, can be used at any day care facility; thereafter, subsidies are granted for specific local day care facilities, which contract with the state.

This should be a win-win situation: Subsidies provide childcare so both parents can work and better provide for their families. But it doesn't turn out that way. The most egregious of the obstacles is an unfair Catch-22 intended to gauge a family's need for financial assistance.

Currently, a working couple who - like most - cannot afford their own nanny is NOT eligible for state-subsidized day care if their gross household income is a nickel more than $45,000 combined - that is $433 a week per parent before taxes. If that working couple has two children, they would just barely qualify for a day care subsidy; but even then the family would have to pay a weekly fee of $83 - over 19 percent of one parent's gross weekly pay.

And if one parent gets a raise, the family's eligibility disappears. They then would need to pay the full, unsubsidized rate for day care - an average of $170 per week, or almost 40 percent of one parent's gross weekly pay.

Thanks to this artificial, low-income ceiling and restrictive eligibility guidelines, hundreds of available seats for day care in New York City stay unused and empty. Instead, too many children are at home because their low-income parents cannot qualify under the current guidelines.

Consider Linda, Robert and their 3-year-old daughter Mona of Manhattan (who declined to give their last name for confidentiality reasons). Although Robert was unemployed, Linda had a job, and, thanks to their day care subsidy, they were able to enroll their daughter in a local day care center. Mona, who had had behavioral problems in the past, blossomed in day care, where her social skills and creativity began to develop. Then one day Robert came in beaming with the news that he had found a job. But when it came time for the family to be recertified for their subsidy, they were shocked to learn that they were no longer eligible, because with Robert employed they made too much money.

But they didn't make enough to pay the full, unsubsidized fee. So they were suddenly left with an untenable choice: Forego the extra income or scramble to find a less-desirable childcare situation for Mona.

The inexplicable low-income ceiling is not the only reason the city's day care subsidy program is underutilized. Several other barriers to eligibility prevent families from receiving the assistance they need. Among them:

Child support restrictions: A single parent is denied childcare when he or she does not pursue the other parent aggressively for child support. Yet it is widely known that many single parents fear pursuing child support in court: It often upsets fragile, but workable informal agreements between the parents. In other cases the father may be an abuser or unstable or poses another threat.

Red tape: It can take several weeks to get government approval for a subsidized day care slot. Parents must make an appointment at their local resource center, where waits are long. The appointment only comes after an at least three-week processing period. In some neighborhood programs, parents can fill out applications on site, which are then brought by staff to the local resource center. But there is still often a long wait for approval. Job offers and training programs rarely wait that long, so parents often must seek other, usually less desirable, solutions. It is not unusual for a parent to opt for other forms of child care in order to begin a job or start training.

Immigration rules: Any child born in the U.S. is eligible for day care, regardless of whether his or her parent is in the country legally. But rather than simply accept a legal birth certificate as proof of eligibility, current regulations require parents to provide additional personal information. Many do not, for fear of deportation, and so their children cannot participate.

In June 2007 there were 57,673 subsidized day care slots being used by low-income New York City families. That is down from 61,699 the year before - a loss of 4,026 slots or a reduction of 6.5 percent. The slots were cut by the city because they went unused, but not because they were unneeded. The number of slots that are filled still falls far short of the total need. That makes it all the more tragic that outdated policies and bureaucratic red tape have shut out many parents from taking advantage of these valuable services so important to their children's well-being.

It is incumbent upon our city and state elected officials to review these barriers and make the necessary changes to allow existing day care programs to serve their communities by filling empty seats and opening their doors to those who need their services most.

Robert H. Gutheil has served as the executive director of Episcopal Social Services since 2004. Episcopal Social Services is a community service based organization offering comprehensive foster care, family preservation and adoption services; Early Head Start and day care services; after school programs and others. During his tenure, Gutheil has concentrated on the expansion of childcare services. 

Insuring New York's Children


Lanette Murphy is raising four children on the Lower East Side, one with a form of autism and two with chronic asthma, by herself. At one point when a health maintenance organization, or HMO, covered her kids, she was spending $100 a week on doctors visits on a salary of $34,000. Murphy, 43, is uninsured.

"I didn't have enough money to feed them," said Murphy shaking her head at the cost of medical care under the HMO. "For me, OK. Don’t worry about me. But what about the children?"

Murphy has since abandoned her HMO and, at the insistence of a community health center on the Lower East Side, enrolled three of her children in a state and federally subsidized children's insurance program.

Known as Child Health Plus in New York and referred to as the State Children's Health Insurance Program throughout the country, the program allows some low-income families that are ineligible for Medicaid to receive free or at least discounted health care for their children.

Earlier this year, the state legislature and Governor Eliot Spitzer approved an expansion of the state subsidized program, which receives federal matching funds, and increased the income families could receive and still be eligible. The move promised to provide health care to all of New York's 400,000 uninsured children, many of whom live in families that, despite being well above the poverty line, can still not afford health insurance.

But then New York and other like-minded states ran into a huge obstacle. Last month, the federal Centers for Medicare and Medicaid Services announced regulations rolling back the program, making it nearly impossible for states to expand coverage to families whose income was more than 250 percent of the poverty line. The regulations, advocates and New York's state, city and federal officials say, are a leap backward and could potentially spark a heated battle between the federal government and the Empire State. That fight could wind up in court.

Expanding Coverage

Approved in 1997, the State Children's Health Insurance Program was financed for a decade and is slated to expire at the end of the month. The federal program targets children from families making less than 250 percent of the federal poverty level, or $51,630 for a family of four. (The federal poverty level is $20,650 for a family of four.) Under the federal program, states had been given flexible guidelines to design insurance plans and were granted waivers to expand coverage under special circumstances.

Prior to Spitzer's proposal to expand coverage, New York enrolled uninsured children in households below 250 percent of the poverty line.

Earlier this year, the state easily approved the program's expansion to children below 400 percent of the poverty line, or nearly $83,000 a year for a family of four. Seventeen other states and the District of Columbia have all attempted to similarly expand their coverage.

If it had been approved for a required federal waiver, New York State would have had the highest enrollment ceiling in the country.

But the state's plan was rejected by the federal government earlier this month.

“Together, with New York’s congressional delegation, we will ensure that the issue remains at the forefront of the national agenda," said Spitzer in a prepared statement following the plan's rejection. "We will continue reaching across state borders and, if necessary, making the case in the courts to ensure that the nation’s 11 million children have access to check-ups, immunizations and developmental screenings that put them on the path to a brighter, healthier future.”

Under the new federal regulations, which take effect next year, states are not allowed to expand coverage to children in higher income brackets until they cover 95 percent of children below 200 percent of the poverty line.

Not a single state has reached that level of enrollment. New York's participation rate is 88 percent – one of the highest in the country.

Congress and the Bush administration are currently battling over expansion and continuation of the insurance program. While both the House and Senate have approved legislation to expand funding for the program and several senators have introduced a bill that would effectively roll back the new regulations established by the Centers for Medicare and Medicaid Services, President George Bush has promised to veto any legislation that includes insuring "the middle class."

The Effects on New York City

By Mayor Michael Bloomberg's estimates, half of the state's uninsured children live in New York City. So, any cutback or limit on insurance, advocates said, could slash the number of kids covered in the five boroughs.

“Half of all the uninsured children in the state live in the five boroughs of New York City, and providing these youngsters with affordable health insurance is a goal that I wholeheartedly share with the governor," said Bloomberg in a prepared statement.

At the Ryan-NENA Community Health Center in the Lower East Side – the center Murphy has attended for over a decade – 30 percent of all patients are uninsured, said Dr. Roxana Cruz, the medical director. When confronted with uninsured children in particular, Cruz said, the center recommends the state's subsidized insurance program.

Any reduction in coverage within that plan, she added, is sure to affect them.

"If we're not able to do something about it at this time for children, the consequences are far greater than the costs are right now," said Cruz. "It seems each time SCHIP is looked at it gets cut even more. The battle is harder."

Murphy's children have been enrolled in Child Health Plus for less than a year, but she is already more satisfied with this program than any of her previous insurance plans. Because of her income and number of children, Murphy is not at risk of completely losing Child Health Plus eligibility, but she may have to pay a higher premium if she receives a raise in her job as a parent coordinator with the city's Department of Education.

Advocates fear similar consequences from the new federal guidelines, especially for those on the cusp of the program's income eligibility requirements. In New York City, where the cost of living is far higher than the rest of the country, increases in premiums could be difficult to afford.

"If you're living at 300 percent of the poverty level and you're in New York City and you were going to be able to get your kids on a low cost health plan and you can't now, it has a huge effect," said Elizabeth Swain, the chief executive officer for the Community Health Care Association of New York State. "It's a real tragedy."

Insuring the Middle Class

According to the United Hospital Fund, a New York City-based research and policy group, about 7 percent of all kids in New York City -- or approximately 140,000 children -- are uninsured. Of the uninsured children, more than 70 percent of them live in families with incomes under 200 percent of the federal poverty level.

Given that the vast majority of the uninsured already qualify for the program, some see Spitzer's proposal as unnecessary.

A New York Post editorial called Spitzer's proposed expansion "nonsense on stilts." Like many other opponents, the Post argues that the State Children's Health Insurance Program was designed to cover low-income families that could not afford insurance - not the middle class.

"The argument that a program designed for children from low-income families ought to be expanded to a large number of families way above, I think is highly questionable," said Benjamin Zycher, a senior fellow at Center for Medical Progress at the Manhattan Institute. Insuring children from higher income families, Zycher said, would inevitably squeeze doctors, hospitals and pharmaceutical companies and make health care less accessible through low reimbursement rates from public entities.

Statewide, 82 percent of the uninsured children are already eligible for either Medicaid or Child Health Plus. Spitzer's expansion would cover the remaining 18 percent.

Even so, advocates claim that expanding the program could improve its visibility, enabling it to infiltrate a larger population of the poor and get more of New York City's children covered . Even with the program as is, the state has seen its uninsured rate for children climb slightly from 2005 to 2006–an increase of 7.4 percent to 8.4 percent, according to the U.S. Census Bureau.

"I think it's a big problem," said Danielle Holahan, United Hospital Fund's senior health policy analyst. "This being step one of a universal coverage agenda, to derail on your first building block out of the gate is frustrating."

Other advocates add that since the insurance program's premiums are on a sliding scale, families that make more would pay more.

A Legal Battle Ahead?

In both the Daily News and the Huffington Post, Spitzer has charged the Bush administration with abandoning the country's children and compared the new insurance regulations to a "poison pill." Last week, he joined the state's congressional delegation to call for a repeal of the restrictions or else.

Spitzer argues that because the Centers for Medicare and Medicaid Services did not give the public a comment period for the new regulations – state agencies learned of the changes in a letter sent out in August – the rules should be voided.

New Jersey Governor Jon Corzine is also reportedly looking into a lawsuit over the new regulations and is threatening noncompliance.

But those, like Murphy, who have been juggling HMOs and policies for years and who wait in doctor's offices and watch their children suffer from chronic illnesses, are not looking for a lawsuit – only health insurance.

" It's very stressful thinking, 'Oh my god I hope my child doesn't get sick,'" said Murphy. "If you are unable to afford health care for your children you shouldn't be penalized."

 

 



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