Up against the Human Services bureaucracy

Up against the Human Services bureaucracy:
A social worker's story

SARAKAY SMULLENS

A grand jury recently documented the horrific life and death of 14-year-old Danieal Kelly, a cerebral palsy victim who starved to death while under the “care” of Philadelphia’s Department of Human Services. Yet the most sickening thing about this story is the frequency with which such neglect occurs.

Following each catastrophe a blue ribbon panel is appointed to investigate the horror story, and each time the panel’s recommendations are filed away and largely ignored. As the chair of Mayor Ed Rendell’s Child Welfare Advisory Board, I spent months serving on one such panel in the 1990s and more months serving on an implementation committee, all to little avail.

It was not always this way. My first job after receiving my master’s in social work at Penn in 1965 was at the Society to Protect Children, the Philadelphia agency that then worked in the area of abuse and neglect now handled by DHS. Ours was a multicultural agency; I was trained and inspired by the most professional social workers imaginable. They taught me how to use what I had learned in my graduate work, as well as my life experience, to motivate abusive and neglectful parents to change the only lives they had learned to live. For you can bet on one thing with accuracy: The most abusive and neglectful parents were themselves abused and neglected as children. This pattern was all they knew, and all they knew how to offer to their own children.

Taking the parents to court

It could and did take years of work, but the majority of clients my colleagues and I worked with did grow and change. Sometimes, if parents were very overwhelmed, we temporarily sheltered their children in the same enormous Center City building where we worked. We maintained dormitories there as well as classrooms— always believing that change and growth would happen. And it usually did.

When we social workers couldn’t provide safety for our child clients, we’d prepare cases for family court, seeking the children’s removal from their homes. Here comes the truly sickening part: In every case I know of, when the dangerous parent— the parent who would not respond to the best help we knew how to provide— appeared in court with an attorney, the judge ruled to send the child home, often to die.

The attorney sought advice

When I read about Danieal Kelly, I recalled my client, whom I will call Cindy, who also had cerebral palsy, and whose parents flatly refused to provide her with medical care and also refused to feed her. Her only sustenance was a bottle filled with milk and cereal that she could suck on all day, sitting alone in her crib, looking dazed. I knew there was no time to waste for this child: Like Danieal, Cindy was wasting away.

Court papers were prepared to remove her from her home. In Family Court, Cindy’s parents’ attorney promised the judge that Cindy would get the medical care she needed, and the judge ruled in favor of the parents. Afterward, outside the courtroom, the attorney asked me what he should do now. Within days Cindy was dead. And I became one of the many voices supporting the necessity of providing attorneys to represent children like Cindy.

Today such children do have their own lawyers. But with the move of protective service to DHS, the social work standards and professionalism of the Philadelphia Society to Protect Children have been dangerously eroded.

Playing the race card

Let me offer here just one example from my clinical experience of the frustration dealing with the DHS bureaucracy. This case involved an abusive mother who ruled her husband and five children relentlessly and violently. The case was referred to me, and I subsequently developed a close working relationship with each of the children and was able to engage the husband in the helping process. But when he insisted that his wife stop missing appointments, and my DHS colleague backed this decision, the abusive wife and mother contacted a key administrator at DHS as well as an outsource agency also involved, claiming that I was racist.

That mother should have been told: "The City of Philadelphia will not tolerate the physical and emotional abuse of your children. Either work to change your behavior, or lose your children. The choice is yours." Instead, at a staff meeting at DHS, I was told that the family was being removed from my care.

This was a family I had spent dozens of hours with on a pro bono basis, on one occasion leaving synagogue on Rosh Hashanah to respond to the children’s call and calm them. I would have gladly worked with these children and their parents pro bono until they reached young adulthood. I know many other qualified social workers and those in related fields who would have done the same. When I told the children I would not be working with them any longer, they wept, and so did I. A contact looked into their file about a year later and told me that all of the children were lost.

The sexually abused young mother

It’s important to say that so many employed at DHS do unselfish, loyal and committed work, and, as we saw in Danieal’s death, often against great odds. I know of no more difficult challenge than working with abused and neglected children who often live in dire poverty. As demanding as this work is, solutions to their problems do exist.

In another case, a young girl had been continually sexually molested by her stepfather, and she gave birth to two daughters as a result. Knowing that the same fate awaited her daughters, she poisoned their hot chocolate as well as her own, believing she would meet her daughters once again in heaven, where they could at last be safe. Thankfully, she and her daughters were found in time. The District Attorney’s Office and the Probation Department gave the teenage mother the sort of choice that the DHS should offer: Lose your children or work with a clinician— in this case, me. With great hesitation, and enormous, understandable buried rage and terror, she chose me.

As with all of my cases, in this instance I used a model that had been proven very effective: a combination of group therapy, family life education, and individual, couple and family therapy as indicated. (For more details, see “Achieving An Emotional Sense of Direction,” on my website.) I worked with this young mother— again, pro bono—for 15 years. In time she was permitted to see her daughters and regained custody of them. She and they have flourished.

What can be done?

Nothing prevents the Department of Human Services from delivering similar results for its child clients— nothing, of course, other than political and bureaucratic conflict and inertia leading to the protection of those ill-suited to lead, consult, or deliver services. For DHS to heal within, and consequently protect our community, the following is necessary:

1. DHS caseworkers must work in collegial ways with the other resources that serve their client families, especially teachers (who are often first to see a child in pain) and the lawyers who represent the children in need.
2. The divisions and turf wars within the agency must be addressed and resolved.
3. In addition to the commissioner, the department needs a director of clinical services who possesses a strong knowledge of psychosocial development and insists upon the use of technology to know where each child is living and what factors of danger may be present within each home.
4. Only social workers holding an MSW or in the process of working toward this degree or a comparable one should be hired to work with our city’s most vulnerable families.
5. Superb in-house training and supervisory staff must be available on a consistent basis. The emphasis should be on developing psychological and cultural understanding, the implementation of technological protection, and the use of police security in certain settings.
6. Outsourcing of client services should be minimized— and limited to holders of MSW or comparable degrees. (The funds saved by outsourcing can be used to attract further excellent and committed staff.)
7. The commissioner of DHS must be prepared to make bold, innovative and sometimes unpopular decisions in order to protect our city’s most vulnerable children from lives of suffering and danger.♦


SaraKay Smullens is a clinical social worker and family therapist who lives and practices in Center City.
To read a response, click here.