Nebraska's inspector general for child welfare investigated the deaths of four children in the past year whose families were connected with child welfare, juvenile justice or a state-licensed facility.
Inspector General Julie Rogers has also investigated the deaths or serious injuries of five infants who died in the past four years and whose families had a history with Child Protective Services. They ranged in age from 1 month to 14 months.
Her office investigates critical incidents, injuries and deaths of children and recommends ways the Nebraska child welfare system can be improved, and to identify issues that need to be addressed.
Rogers outlined concerns and recommendations in her seventh annual report, released Tuesday.
From July 1, 2018, through June 30, the inspector general received 317 critical-incident reports, 226 complaints, 37 requests for information, and 10 grievances and accompanying findings from the Department of Health and Human Services.
The critical-incident reports included 52 suicide attempts, 43 escapes, 41 allegations of sexual abuse, 26 deaths and 20 assaults. Forty-seven incidents involved youth involved with DHHS and 84 involved state wards. Sixty-five reports involved probation youth, and 30 where both probation and DHHS were involved.
Rogers is also investigating what is happening with youths residing in the state's youth rehabilitation and treatment centers. Eighteen Geneva youths and 25 at Kearney accounted for the 43 escapes. Other incidents reported at the youth rehabilitation and treatment centers were: two suicide attempts, four sexual assaults and two assaults.
At the present time, there's an uneasiness permeating across the state regarding the welfare of children, Rogers said.
In the past four years, a 14-month-old state ward in the care of a foster mother died of what medical professionals believe was abusive head trauma.
The foster mother reported that after a bath the toddler began vomiting, collapsed and appeared to have a seizure. He stopped breathing and she put him in cold water and "starting slapping and beating him" to get him to breathe. She call 911; he was taken to a hospital, where he died.
Doctors at two hospitals reported they believed the boy's head injuries were not accidental and were similar to those associated with blunt force trauma, or shaken baby syndrome, which can cause bleeding between the surface of the brain and the outer membrane surrounding it, from stretching and tearing of blood veins.
The foster mother was not criminally charged with the death, but was placed on the state's child abuse registry. No foster children will be placed with the family in the future.
Twenty-six child deaths were reported to Rogers' office in the past year. Four of those cases, of children who had contact or involvement with child welfare or juvenile justice, were investigated. They included a suicide of a state ward and one in a publicly-licensed residential facility, the homicide of a youth in juvenile probation, and a sudden unexpected infant death in a licensed child care facility.
As a result of the investigations, Rogers made seven recommendations to the Department of Health and Human Services. Two, based on the death of a child in foster care, were accepted by DHHS officials. Five recommendations made as a result of an investigation into the death or serious injury of four infants born into families with open Child Protective Services cases were rejected, she said.
"I am disappointed that DHHS rejected all recommendations related to the deaths and serious injuries of the four infants," she said.
The state agency's response did not address the systemic issues identified, she said.
"It’s my hope that DHHS will propose more specific solutions to solve the gaps in our child welfare system as a result of these tragic events,” she said.
Department CEO Dannette Smith said DHHS takes all recommendations seriously and noted it has implemented several past inspector general suggestions, including two this year. It has also made other positive changes recently that have improved outcomes and support for Nebraska families.
Since 2015, she said, DHHS has completed, is making progress or no further action is required on 65 of 73 inspector general recommendations.
Of the five rejected recommendations this year, one suggested DHHS offer trauma-informed support to Child Protective Services caseworkers and supervisors, who often experience secondary trauma through daily interactions with families in crisis. Support within the workplace becomes critical not only to well-being, but to maintaining a seasoned and well-developed workforce, Rogers said.
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Responding to Rogers, the department said that in May it implemented interventions to address secondary trauma among frontline workers and supervisors, but not for all staff.
Rogers said all workers need the support.
While there have been improvements and changes to the system, substantial work is still required, she said. Issues causing concerns include:
* An increase in the families served without intervention of the courts;
* Fewer parents and children being drug tested;
* Proposed expansion of Alternative Response program eligibility and changes. Alternative Response is a different way to address allegations of abuse or neglect so children can stay in their homes;
* The lack of services statewide, including those for high-risk youth with complex needs;
* The federal Family First Prevention Services Act set to be fully implemented in Nebraska starting Oct. 1;
* Proposed changes to DHHS child welfare regulations, most of which the department wants to strike in their entirety;
* Ongoing significant facility, staffing, and programming issues with the youth rehabilitation and treatment centers;
* The Douglas and Sarpy counties service area transition in case management provider and the associated pending lawsuit by the current provider, PromiseShip.
Also, with the resignation of Matt Wallen, children and family services director, effective Sept. 8, Rogers said, transitions and changes could be more challenging. Continuity of care for children and families must be maintained, she said.
It's not enough to simply note that Nebraska has fewer state wards, Rogers said.
"We need to dig deeper and ask whether children are safer and more stable because of these changes," she said.
Rogers said that of the child welfare system improvements made in the past year, one DHHS policy change was significant.
The child abuse and neglect hotline is now required to accept all reports made by medical professionals for initial assessment if the child is 5 or younger.
"We are encouraged that now all such medical professional concerns will be assessed, especially as these children are not yet school-age, and a medical professional may be the only ones outside of the family to see and recognize possible child abuse and neglect," Rogers said.
She said the department has also made important changes this year to improving home studies and regulating foster care providers, as well as enhancing training for DHHS staff, foster and adoptive parents on preventing sexual abuse and exploitation, and enhancing the foster parent application process.
"I want to commend DHHS for their dedication to filling in these system gaps,” she said.