Can a New ‘Strong Starts’ Initiative Make a Difference for Babies in the Bronx?  

By Abigail Kramer

Since 2012, Judge Sarah Cooper has sat in the Bronx County Family Court, presiding over cases involving parents and guardians accused of abusing or neglecting their kids.

On a given day, she might decide whether a toddler should be removed from his mother, send a teenager home from foster care, settle an argument over whose fault it is, exactly, that a father hasn’t found a spot in a drug treatment program, or terminate a parent’s rights to her child forever. On some days, she might have three of those decisions scheduled for the same half-hour time slot.

Last summer, Cooper took on an additional challenge. Her courtroom became host to a pilot project charged with the daunting task of improving life outcomes for some of Family Court’s most vulnerable subjects: babies and toddlers, 3 years old and younger, involved in child protective cases.

While the project, called the Strong Starts Court Initiative, resembles programs elsewhere in the state and nation, it casts a wider net.  Like other programs, it takes in cases involving foster care placements; unlike others, it also engages families where children stay with their parents but remain under court supervision.  And despite a modest launch in just one courtroom in one borough, its backers hope eventually to take it systemwide in the biggest city in the nation.

WHAT’S BEST FOR BABIES

Strong Starts rests on a strong foundation of early childhood research. In recent decades, there’s been a growing consensus that chaos and babies are a very bad mix. Experiences that harm children in general—trauma, upheaval, deep poverty, broken relationships—seem to do a particular kind of damage to the developing brains of infants and toddlers, potentially leading to cognitive or emotional problems that may persist for their entire lives.

Babies involved in Family Court cases are already likelier than other infants to have experienced crisis. Once they come to the attention of the child welfare system, the instability often continues: Babies under age 1 are removed from their parents in greater numbers, move more frequently between foster homes, and stay in care longer than children in any other age group. (For more data see By the Numbers: A Statistical Portrait of the Court's Child Protective Cases.) 

The cumulative upheaval can have severe developmental consequences. In a pair of national studies involving about 12,000 kids, researchers found that approximately one-third of children 3 years old and younger involved in the child welfare system showed evidence of delays in cognition, language, and/or adaptive behavior.

The quicker those kids can get intervention (a stable place to live, for example, or therapy to address developmental deficits), the better the results. But speed is not typically a strength of child welfare systems—especially in New York City, where overburdened Family Courts contribute to chronic deferral and delay. (Read our in-depth story about Family Court here.)

“Babies can’t afford to be left in limbo for six months,” says Lynne Katz, the director of the Miami Child-Wellbeing Court (CWBC) in Miami-Dade County, Florida. Even when their cases do move forward, Katz says, traditional child welfare services aren’t designed to give babies what researchers say they need most: secure, responsive attachments with nurturing adults.

Nationally, various groups have come up with strategies to get Family Court to work better for babies and toddlers—in part by infusing research on child development into the courtroom process.

In the world of early childhood specialists, Katz’s CWBC model is often described as a prototype. For 10 years, it has worked with children under age 6 that courts have removed from their homes, but with a goal of eventually reunifying them with their parents. Judges refer eligible families to clinicians at the University of Miami, who provide a special kind of “dyadic” therapy, in which parent-child pairs attend sessions together. As the child attempts to interact—babbling, for example, or showing his mother a toy—the therapist speaks for him, interpreting his behavior and encouraging empathetic, nurturing parental reactions. Throughout, the therapist takes opportunities to explain the child’s development, with the goal of helping parents better understand how to respond to their kids.

Clinicians then report on the sessions in court, providing information on the developmental progress of the child, the parent’s compliance with and engagement in therapy, and the therapist’s perception of the quality of the relationship. Often, they also make recommendations about whether a child and parent should reunify.

The big-picture goal is not only to provide clinical treatment, Katz says, but to reorient the entire courtroom conversation around the wellbeing of children. “The judge calls on the clinician first, not the attorney for the parent or the child. We start with, ‘Ok Dr. Katz, tell me about what’s happening with Zoe. What’s happening in the relationship with her mother? Is it healing? Is it going to diminish the risk factors?’”

Other players in the courtroom are expected to follow that lead, prioritizing discussion of the parent-child relationship rather than arguing over the rights of their individual clients. “We can do more if we support each other rather than being adversarial,” Katz says.

Various courts in New York have replicated pieces of this child wellbeing model. In Nassau County, for example, children 5 years old and younger who are in foster care are referred for clinical assessments and mental health services at Adelphi University’s Institute for Parenting, and may receive dyadic therapy involving either their birth or foster parents.

In Manhattan, the Court Team for Babies at the Jewish Board of Family and Children’s Services provides dyadic therapy and other mental health treatment to families with kids in foster care under age 4, reporting on their progress to the New York County Family Court. A primary goal, says Dorothy Henderson, the director of Early Childhood Trauma Services at JBFCS, is to get beyond questions of “compliance” and help parents feel supported and competent.

“These mothers go a lot of places that are not respectful or nonjudgmental or empathetic about what they’ve gone through in their own lives. The more positive a working relationship a parent has with us, the more likely we are to be effective,” Henderson says.

 

A BRONX PILOT PROJECT SEEKS TO MAKE THE SYSTEM WORK FOR FAMILIES – ONE BABY AT A TIME

In Judge Cooper’s Courtroom in the Bronx, early childhood specialists are attempting a broader kind of reform. Long-term, the goal is to identify policies and practices that can ultimately be implemented in all five boroughs, harnessing the power of the Family Court to minimize chaos in kids’ lives.

For now, the Strong Starts project, which operates under the auspices of the Center for Court Innovation, is small. It works only with kids age 3 and younger whose cases come in through Cooper’s courtroom—likely no more than two or three new families each month.

Unlike most infant court programs, Strong Starts works with children who stay at home on court-ordered supervision—not just those who are put in foster care—and it doesn’t automatically steer families to any particular kind of therapy or clinic. Instead, Cooper sends eligible parents just down the courthouse hall to the office of Kiran Malpe, a social worker with a specialty in infants’ and toddlers’ mental health.

With the parents’ consent, Malpe conducts clinical assessments on everyone involved in the case, screening parents and sometimes foster parents for issues like depression and anxiety, and assessing kids for any signs of developmental delay. She then works with a family’s case planner to identify specialized resources, such as Early Head Start or home visiting programs, that may not be on the standard menu of child welfare referrals. Her goal is to inject a mental health perspective into the management of the case—a shift that, in many cases, asks child welfare practitioners to think of parents as victims of their own traumatic experiences.

“It’s not always obvious to a case planner what a family’s mental health issues might be,” says Susan Chinitz, who coordinated planning for Strong Starts when she was director of the Einstein College of Medicine’s Early Childhood Center, and now serves as a consultant on the project. “A mother might come across as noncompliant, rather than the case planner seeing that she’s so immobilized by depression that she can't get out of bed in the morning. Or if you have a parent who’s considered highly explosive, instead of sending them to anger management, a mental health clinician might appreciate that behavior as being related to severe trauma.”

Meanwhile, Malpe works to eliminate delays in the cases. Once families are in the program, she convenes monthly conferences, inviting parents, lawyers, and any service providers working with the family. The idea is that, outside the adversarial atmosphere of the courtroom, each player can report on the progress of the family’s plan, identify obstacles, and—ideally—agree on a path forward to present to the judge.

Because Cooper has agreed to see the Strong Starts families after each conference, their cases aren’t subject to the multi-month adjournments and procedural snafus that often slow Family Court down.

In October, for example, Cooper convened a hearing to discuss the case against a mother who’d been charged with neglecting her toddler. Malpe had found the little girl to be severely delayed. At nearly 3 years old, she had almost no speech and couldn’t dress or undress herself. Having spent much of her life in homeless shelters, she’d been cleaned with baby wipes and was terrified of baths and showers.

The mother and daughter were permitted to stay together, under the conditions that they move in with the little girl’s grandmother and the mother attend a drug treatment program. The toddler was referred to services to work on her speech and cognitive development.

Within weeks, each service referral had fallen through. The mother’s drug treatment clinic had shut down—one of several casualties after the clinic chain’s owners were indicted for running a kickback scheme. And the little girl, it turned out, had been given a referral for an early intervention program that works with the wrong age group of kids.

In a typical case, the family might have lost months of potential progress in court—as well as unrecoverable development time for the toddler. Instead, Malpe was able to work with the case planner to get the referrals fixed. Once the mother and daughter are attending services, she’ll collect information from each provider to combine into a report for the court.

Her focus, she says, will largely be clinical: Where a typical court report might focus on compliance (“Is the parent doing what she’s told?”) Malpe says she’ll try to determine whether the family is making progress that benefits the child’s development. “I want to know not just did a mother show up [for a session with her child],” Malpe says. “But what was the visit like? How were the reunion and the separation? Was the parent able to read the child’s cues?”

There are, of course, downsides to an approach that’s so resolutely clinical in emphasis. Courts are adversarial for a reason, says Matthew Fraidin, a professor at the University of the District of Columbia School of Law and a nationally recognized expert in the areas of child abuse, neglect, and custody. Parents rely on attorneys to help them, presenting a different view of the family than the story told by the child welfare agency.

And in order to make the best decisions for kids, Fraidin says, judges need to hear arguments. Everyone is not supposed to agree. “Judges absolutely benefit from the opinions of experts, and they should also have the benefit of differing perspectives. A judge is going to understand the expert’s presentation better if the parent has a lawyer who is listening for inaccuracies or inconsistencies, and who’s asking questions that will fill out the story.”

By putting a mental health perspective so front and center, family courts run the risk of letting a clinician’s point of view dominate every other way of looking at a parent and child—a dilemma that raises questions of both ethics and efficacy.

In most contexts, mental health services are voluntary and confidential. Few of us would want our therapists talking about us in court, and we might be far less inclined to disclose the extent of our problems if we knew they might be used against us.

Some participants in the Strong Starts initiative also question why help for families and their small children has to be linked to the child protective system in the first place.

All parents could benefit from meaningful support, combined with education about child development, says Emma Ketteringham, the managing director of the Family Defense Practice at The Bronx Defenders, which represents parents in child protective cases. And those services are far more helpful when they're voluntary.

“I think expecting and new parents in the Bronx would be better served by community-based resources that offer support that includes information about child development and attachment as well as information about benefits, education, job opportunities and child care,” Ketteringham says. “Court is an entirely involuntary process that uses child apprehension and parent-child separation to get parents to comply with services that are aimed to address therapeutic deficiency, rather than provide the support and information parents need." 

Such a strategy would recognize that the problems that bring families to the attention of child welfare agencies often have more to do with poverty than pathology. "Therapy doesn’t really work when you’re hungry or when you’re worried about where you’re going to sleep at night," Ketteringham says.

Nor, ultimately, is there any guarantee that even a successful Strong Starts program will take root or thrive in the Family Court system. For now, Strong Starts is funded solely through the non-profit Center for Court Intervention, although the Family Court and legal organizations representing parents and children and the City’s child protective agency, the Administration for Children’s Services (ACS), support the effort with contributions of staff time.

At this point, however, it’s far too soon to say whether public tax dollars will one day be committed to the program.  And not-so-ancient history suggests that such consistent funding can be crucial. Nearly two decades ago, the New York State court system launched “Babies Can’t Wait,” a program designed to move babies through foster care more quickly, and to pay better attention to their developmental health. The project ran workshops for court staff and foster care workers, hired social workers to monitor babies’ court cases, and encouraged judges to prioritize babies’ existing attachments when making placement decisions. After the initiative lost its funding in 2005, however, it withered away. 

For Judge Cooper, nevertheless, the hope is that qualitative information grounded in early childhood expertise will help her make better decisions about the long-term safety and wellbeing of kids. "We miss the mark so often,” she says, “because we offer cookie-cutter services and solutions. The reports don't tell us anything about whether a parent is gaining insight. So they attended eight out of 12 appointments. Is that beneficial? Is it even an appropriate referral to begin with? So often the people making referrals are sending folks to places they don't know anything about.”

The goal of Strong Starts, Cooper says, “is partly to try to change the culture away from mistrust,” Cooper says. “If we can demonstrate success, people will see there's another way to do this.”