Category Archives: Children noticing race

adoption, Children noticing race, information, innovation, tonsillectomy, Uncategorized

Promises, Promises…

K looks out the front door despite being legally blind. She has some sense of what lays in front of her. It's a walk she does all the time. Sometimes, we don't have to know or be able to see the details to know where we want to go.

As a society, what are we saying when we take a child from their parents? We are saying we can and will take better care of your child than the parents are taking. We only say this when we as a society feel the parents are taking dangerously bad care of the children.
We promise to take care of the children. Part of doing so has historically meant providing stable environments for the children to grow up and create loving bonds. There are many studies on the emotional impact on young children resulting from the loss of each parental bond, and yet the state feels the results of leaving a child in their current care will be worse than the damage caused by removing them from their current parent(s) for however long is needed for the situation to change in a positive way.

The problem is our ability as a state to care for these children is quietly eroding. Currently, I see two imminent threats to our current model that is already resulting in kids moving too often between families and group homes.

The first is our ability to foster children in a family setting rather than a group home. In MD where we foster, there was an average of 5,724 kids in placements outside of their biological family home in any given month. In the last year, there were also 199 new placements per month. Only an average of 4,044 foster children were in one of the 1,596 MD foster family homes.

It would seem we need more foster homes for these children, but the yearly trend is going the other way. Last year MD netted out a loss of 11 homes in which we can raise these children. The 11 may not seem like many, but it is an average over the past year. The number discounts the more distressing recent trends where MD lost 46 foster homes in the most recent three-month time-period between March and May. MD also had less foster children taken in by family in the past year too. (Stats for last two paragraphs can be found in the most recent set of Maryland Child Welfare Services Data: http://www.dhr.state.md.us/blog/?page_id=2856)

The second problem comes from how we chose to provide long-term families to children in the foster care system. Since we started foster care, the primary goal of foster care has been to reunite the children with their biological families. Removing the children has lasting impact on children’s ability to form emotional attachments. It would seem to follow then that removing the kid from both their biological families and their long-term foster families would cause further damage. So, I was not surprised by what I learned last week from Josh Kroll with the North American Council on Adoptable Children. It seems foster families are the families who historically adopt these children 57-59% of the time nationally. Foster parents are the group most likely to adopt these children and provide them with loving stable families.

Maryland (MD) used to try to remove the financial disincentive for foster parents to adopt. By disincentive, I mean MD tried to minimize the difference between what a family is paid to foster a child and the subsidy they will receive after adoption. After all, if the state is going to pay x dollars per year to raise the child, why not try to maximize what the child gets out of the deal by giving them a long-term family. After the adoption, the state can still save on many administrative costs like courts and social workers covering the care of the child, even if the adoption subsidy is close to the foster subsidy. Everyone seems to benefit under this rational.

As of July last year, this rational changed. Now according to the Department of Human Resources Social Services Administration,” Adoption assistance payments are not intended to cover every expense the family may incur to have that child as a member of the family, but rather to offset costs, such as therapy or therapeutic activities, incurred related to the child’s special needs that are reflected in their eligibility criteria for assistance.” With this change, there is a marked difference in what many families will receive in assistance if they adopt the children in their care. Logically, fewer parents will be able to adopt out of foster care, and those who do will be less able to take in/adopt additional children.  It’s worth noting from the stats above, over 5,700 kids in foster care and less than 1,600 homes means we are already depending on the foster homes to take in more than one kid.  Are the families intended to be able to provide everything for these kids when they adopt the majority of those lucky enough to be adopted?  Are we setting practical financial limits on the ability of the group most likely to adopt?

Josh Kroll provided some startling stories of what happens when adoption becomes expensive for the foster families. He told the story of his time working with Minnesota when foster care rates increased with cost of living increases, but adoption rates did not. Eventually, the adoption rate by foster families of kids in foster care fell to 20%, which is a stark contrast to the national historical 57-59% rate. Is MD heading in the same direction? I know J and I have been offered less than 45% of the support we receive as foster parents in an effort to force us to adopt K.

Are we living up to the promises we, as a society, make to children we remove from their biological families, and will we continue to be able to do so with our current policies?

Hands to Work, Hearts to God - A Shaker saying which fits my belief in foster care.
Hands to Work, Hearts to God – A Shaker saying which fits my belief in foster care.
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Bias, Bias in Drug Studies, Children noticing race, Children skin color, Children's theology, Fun with Clinical Articles, MS, optimism

Optimism, Bias, and God

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In October this year at a conference on the treatment and research of MS, a paper was released with some very good news for MS patients in the very first line.  It seems, “Mortality rates are higher in people with multiple sclerosis than in the general population.”  As somebody with MS, I think it’s fantastic news because as far as I know the mortality rate in the general population is 100%.  If one believes this first sentence, I am more likely than a person without MS to get another spin on this cosmic trip we call life.  
Of course, the bummer is contained in the very next sentence where it says, “However, the reasons for the shorter lifespan in people with MS are not well understood.”  I guess it all evens out in the end.  We are likely to have more, though shorter life spans.  Somehow I think the results as I have (misrepresented) presented them in these two quotes are not likely to be repeatable which leads me to the next video forwarded to me about our bias towards reporting findings we want to be true.

I’ve certainly seen this in MS research.  Often times, new medicines become laughed at as the new “bee sting therapy” which still runs around the internet from time to time as well wishing friends and family try to suggest this new therapy.  For MS, the latest is probably CCSVI, an attempt to stint clogged veins carrying blood from the brain.  One cardiologist in Italy thought his wife’s condition was a circulation issue rather than an immune response attacking her nervous system.  Because she showed improvement, he performed the surgery on other MS sufferers. 

Note, while this procedure is performed in the U.S., many reputable centers have stopped.  Nobody has even been able to show these blockages in veins happen more often in MS patients than the general population.  What’s more, the results for all those who have had the surgery are inconclusive.  Still, many patients grab at any hope because hope is what we want to hear.  I worry the stints they use aren’t made for the venous angioplasty, and this may cause problems down the road, though they appear safe at the moment.  I also worry veins seem to be able to find new routes without this surgery, so we may be needlessly introducing new problems and costs 5 years down the line.  Additionally I wonder why so many for whom the procedure works seem to need it again.             

The hard part is I can’t convince myself the doctors are being irresponsible, because every success is trumpeted.  Furthermore, for those whom it doesn’t work, we aren’t seeing negative outcomes yet.  Negative outcomes would include things like deaths, brain damage or other serious complications.

I’ve come to think the one thing patients with long term serious chronic conditions want from their doctor is hope or a validation their idea might help. However, I note there seem to be at least 2 studies saying it doesn’t provide measurable success for every 1 repeating the initial story of success.  Lest one think patients are any better than researchers, one need only look at patientslikeme.com.  Even patients are far less timely reporting why we stop a drug compared with reporting initial successes.  We want any thing to help.  Placebo effects? 

I don’t care.  Give me a placebo if it works :-).

(Continue to next page for family notes and stories)

——————-Family notes—————————

K had her second birthday, and above is a picture of her response to trying a cupcake.  Keep in mind she has had very little to eat by mouth since Jan.  

Funny quote from O, “Daddy, why is your penis so white?  Mine is darker.”  This is a great conversation to have in a public restroom amongst the many chuckles.

Funny conversation with A:
A: “I can’t wait to be an adult!  Then I can watch TV whenever I want.”
Me: “You know I’m a big Redskins fan, right.” Response is a nod affirmative.
Me: “They played today, and I didn’t watch a single minute of it.  I was with you and the rest of the family instead because family is more important than any TV.  Right now I am sitting here in the bathroom waiting for you to finish so we can read a book before bed.  There are TV shows on now which I like watching, but you are more important.”
A: “But you have the power to watch whatever you want on TV.  It’s not fair.”
Me: “With all power comes responsibility.  I have the power to watch whatever I want, but I have a responsibility to you and O and the rest of the family.  Even when you go to bed, I have the responsibility of walking the dogs and cleaning the kitchen.  Then if I have any time and energy, I can watch TV.”
A:”Fine.  If adults have all that responsibility, I wish I were God!”
Me: “You always complain we don’t understand you.  You think I and others don’t understand you now?  People have been trying to understand God for thousands of years.”
A: “What!  Really? Why don’t they understand him?”
Me: “Why do you say he?”
A: “Because he’s big.”
Me: “There are species where the women are bigger.”
A: “There are no big females.”
Me: “Are female wales bigger than me?  Yes.  Being female doesn’t mean small or weak,”
A: “OK then I still want to be God so I can make the rules and watch whatever TV I want.”
Me: “I’ve noticed as I’ve gotten older, more power always brings more responsibility.  I doubt the power of God is different.  It may be, but it’s not my experience.  You would be responsible for all people everywhere.  With that much to do, I suspect TV may not rank high on your priority list.”
A: “Fine I will just be an adult and watch whatever TV I want.  I don’t care about any other responsibilities.”
Me: “I hope you change your mind by the time you are old enough to live your adult days, but for now, it is time for bed.”

Here is another of my favorites of family life from the zoo this weekend:

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