Missouri child abuse investigators missed warning signs of fentanyl use among parents before their young children died of accidental overdoses from the drug, according to a new state report.
Late last year, a report by the Missouri Fatality Review Program found 20 children under 5 died of fentanyl or in combination with other substances. In response, a state departmental subcommittee of employees from various agencies, child welfare advocates, juvenile officers, health care professionals and law enforcement officials was commissioned to analyze the cases.
It found that Children's Division investigators, who are tasked with following up on claims of abuse and neglect, “lacked essential procedures, missed warning signs and left vulnerable children at risk.” It didn’t specify how many of the cases featured investigators missing warning signs before a child’s death.
“The subcommittee identified issues like inadequate case assessments and families declining services, leading to case closures,” the report states.
Emily van Schenkhof, executive director of Missouri’s Children’s Trust Fund and a member of the subcommittee, said she reviewed cases in which Children’s Division investigators received a hotline call about possible fentanyl use from parents but didn’t do a thorough enough job of looking into the accusation.
“I think the answers to why that happened are complex,” van Schenkhof said. “But I think that the heart and soul of it is that our child welfare system didn't know how to investigate fentanyl. It was so new and so different than other types of drugs that our standard processes for investigation were not adequate.”
Van Schenkhof, who has spent years examining child fatality cases, said she was shocked by what she found from reading the reports.
“It was really hard to see,” she said.
Jessica Seitz, executive director of Missouri Network Against Child Abuse, said when reviewing cases, she found instances in which a mother tested positive for fentanyl at a hospital but there wasn’t an effort to try to remove a child from that home. Children’s Division workers can’t take a child out of a home – they have to refer the case to a juvenile officer who then asks a judge to take action.
“Not all drugs carry the same level of danger as fentanyl,” Seitz said. “I am concerned that investigators may not have gone far enough to assess the level of risk.”
Van Schenkhof said investigators aren’t getting proper training on what to do when they encounter obvious instances of fentanyl use. And since even a small amount of the drug can be deadly, she said, there needs to be quicker action to either permanently or temporarily remove children from that home or direct families to drug treatment programs.
“Broadly speaking, I would say that, though, that I think we need to rethink all of our Children's Division training,” van Schenkhof said. “I think that the Children's Division would also agree with me in stating this. But with COVID, most of their training for the Children's Division frontline workers went online, that just hasn't worked.”
Department of Social Services Director Robert Knodell said in a statement, “We can prevent this tragedy happening to another child by implementing their recommendations.”
Reexamining triage
The report included a note saying the subcommittee only had access to Children’s Division records during this review, “lacking the worker's perspective on the cases and the factors influencing case decisions.”
“Understanding the worker's viewpoint is vital for enhancing insight into the decision-making process within,” the report states.
Last year, St. Louis Public Radio reported that the state Children’s Division office in St. Louis had a backlog of more than 6,000 cases — which often burdened investigators with unmanageable caseloads.
Children’s Division Director Darrell Missey said last year when discussing the backlog that the agency has had to triage cases — prioritizing serious accusations where a child may be in imminent danger.
“And then you have neglect, which is most of the cases,” Missey said. “And those are normally fueled by addiction, mental illness and poverty. And so, you have some triage going on, obviously, because you got things that are crimes and are emergent — you put on the front burner. And then the dirty house case, the educational neglect case, those things may take some more time because you're not thinking somebody's going to be harmed today because of that.”
Seitz said the report should prompt Children’s Division officials to differentiate between cases of neglect that are more in need of action from the state’s child welfare systems than other situations.
“Neglect needs more scrutiny when triaging — since some neglect carries a risk of imminent harm,” Seitz said.
The pay problem
Van Schenkhof said that the prioritization of cases of imminent abuse makes sense when the Children's Division is dealing with inadequate staffing. But she also said policymakers need to consider raising the pay for investigators who have a starting salary of around $43,000 a year.
So far this year, neither the House nor the Senate version of the budget features more than a 3.2% pay increase for investigators, though the Senate did include language allowing for greater flexibility to shift funds between certain Children’s Division appropriations.
“And so, they have poor pay along with a lot of people that think of them as the bad guy,” van Schenkhof said. “These people knock on your doors, and they see things that most of us couldn't handle seeing. They are everyday heroes, but they don't get treated like heroes. So I certainly think that they absolutely need increased pay.”
Missey said earlier this year that staffing levels at the St. Louis branch of the Children’s Division were improving, which helped reduce the number of unfinished cases. But van Schenkhof said the high turnover rate increases the lack of expertise in how to deal with uncooperative families.
“When someone just says to you: ‘No, I'm not using fentanyl,’ you can't take their word for it and close the case, you have to do a thorough investigation,” van Schenkhof said.
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