Another Prescription Drug Abuse Problem: The Overmedication of Foster Kids

Recently the Obama administration announced that it is taking action to address the growing problem of prescription drug abuse. Of course this is good news, and more must be done to raise awareness of this issue and crack down on those who abuse the system. It reminded me of another problem related to prescription drug use: the inappropriate use of psychotropic drugs for children in foster care.
A recent study by the Tufts Clinical and Translational Science Institute found that over that past decade the use of psychotropic medications -- those used for the treatment of behavioral and mental health issues -- for children between the ages of 2 and 21 has risen significantly. Moreover, while during the same period an estimated 4 percent of the general youth population was prescribed these medications, the figure for kids in foster care was much higher -- anywhere from 13 to 52 percent. Recent studies in Texas and Georgia arrive at similar findings.
We could debate the precise meaning of such statistics, but they are supported by many instances of foster youth who have been so heavily medicated that they can barely talk, or who felt more imprisoned than cared for while on a mixture of these drugs. It's no longer possible to ignore the conclusion that there is a serious problem here. In many cases, psychotropic drugs are being prescribed for foster children not on the basis of legitimate medical diagnosis, but on demand or worse -- for convenience.
Several factors might explain why our foster youth are being prescribed psychotropic medications at rates far higher than for the general population. They are particularly vulnerable and many of the adults responsible for their care are extremely busy with responsibilities for too many children. Yet, the use of psychotropic drugs requires careful monitoring and adjustment. They are only one tool, best used in conjunction with other therapeutic work, under the supervision of a trained mental health professional.
We could come up with lots of reasons why our foster children are being overmedicated: not enough time, not enough money, lack of qualified medical personnel. But, in the end, there simply is no excuse.
Imagine you're a child who has been maltreated at home, who is temporarily living elsewhere, bounced from one unfamiliar home to another. I'll bet you'd be angry too. I certainly would. It's entirely natural to be mad and upset in such circumstances -- this is a normal reaction, not a mental disorder.
If my own child were prescribed any of these medications, I would insist on knowing what's in it, what it will do, and what to watch out for. I would also monitor usage and follow up regularly with the prescribing health care professional to see if any changes were needed or the dose could be reduced or even eliminated at some point.
We should expect no lower level of care for our foster youth. There are children in the foster care system who are facing serious mental health concerns -- anxiety, depression, and worse -- and for these children medication can be a tremendous benefit. But, powerful drugs should be reserved to treat actual disorders. Juvenile courts need to be closely involved in the process to ensure that the child's voice is heard and interests are served. We also need to ensure that each and every child in foster care has the support of a caring adult who can look after his best interests, including monitoring and when necessary, raising concerns about, medications and health care.
The White House has announced action against a very different prescription drug problem. Overmedication of our foster youth is an issue that deserves our attention, too.

Foster child's death under investigation

Authorities are investigating the death this week of a 4-year-old girl who had been in foster care in Livingston County.
Kianna Rudesill was pronounced brain dead at 2:35 p.m. Wednesday at OSF Saint Francis Medical Center, Peoria County Coroner Johnna Ingersoll said.
She was maintained on life support until Thursday to allow time for relatives to arrive from out of state, Ingersoll said.
Ingersoll said the death is being investigated by her office, the Livingston County Sheriff's Department and the Illinois Department of Children and Family Services.
The child, who had been in foster care in Cullom for about nine months, experienced seizure-like activity at home before becoming unresponsive, Ingersoll said.
Emergency officials were called to the home about 2:30 p.m. Tuesday. She was taken to OSF St. James-John W. Albrecht Medical Center in Pontiac and later transferred to St. Francis.
An autopsy is scheduled for Friday.

Foster dad pleads guilty to sexual abuse charges

Two former foster children who said they were sexually abused by their foster care provider years ago got justice without going to court Monday.
On the day the jury was to be selected for his trial in St. Paul, Joseph L. Larson surprised prosecutors by pleading guilty to two counts of felony criminal sexual conduct. He will receive a minimum 12-year prison sentence; a judge could go as high as 17 years.
Larson, 34, submitted an Alford plea, in which he doesn't admit the criminal act and asserts innocence. Under the plea, a defendant acknowledges that there is sufficient evidence for the prosecution to gain a conviction.
As part of the plea deal, felony child pornography possession charges filed in Anoka County will be dismissed. Sentencing will be June 28.
Ramsey County attorney John Choi said his office and the victims were pleased by the outcome. He said that because Larson agreed to a plea, it spares the victims the need to testify at a trial.
Larson's attorney, Katie Rindfleisch, declined to comment. She had recently told the Star Tribune that "Joe has never and would never hurt a child." She planned to call several of his former foster children to share how Larson saved their lives.
Allegations of a foster parent sexually abusing the children entrusted to their care are very rare, prosecutors said.
One of the former foster children, now 17, was in Larson's care from 2002 to 2005; the other, now 23, was with him for three months in 2003.
Before he was charged last summer, Larson was investigated twice by a child pornography task force but not charged. He had his foster care license closed in 2006 after one of the youths made an allegation against him, according to court documents. He later had a second license revoked because he didn't disclose information about his previous license and the investigations.
Larson became a licensed foster parent through a private agency, PATH Minnesota Inc., in Monticello in 2002. He cared for four children, including two brothers, with the agency. In 2004, a state task force received a report from U.S. Immigration and Customs Enforcement about information discovered during an Internet child pornography investigation. Investigators found that credit cards issued to Larson had been used to buy access to child pornography websites in 2002 and 2003, court documents said.
Two officers assigned to the case couldn't gather enough information for a warrant to search Larson's computer. In 2006, officers again investigated Larson, but he told them he wouldn't consent to a search of his computer because it contained private information about foster children, according to a police report.
In February 2010, police were again alerted when the youth who is now 17 told a social worker about sex abuse that allegedly occurred during his time in Larson's care, according to a criminal complaint filed against Larson. Police subsequently interviewed the 23-year-old, who is not related to the 17-year-old, and Larson was charged in August.
Larson remains out of jail on $30,000 bail he posted last year. He is barred from having any contact with the victims.
David Chanen • 612-673-4465

RI asks judge to dismiss foster care lawsuit

PROVIDENCE, R.I.—Attorneys for Rhode Island on Friday argued that a federal judge should dismiss a lawsuit that claims that children in the state's foster care system are routinely abused, neglected and shuffled from home to home.
U.S. District Court Chief Judge Mary Lisi said she hopes to decide soon whether to grant the request for dismissal.
The 2007 lawsuit calls for an overhaul of the foster care system. Jametta Alston, the state's child advocate at the time, filed the suit on behalf of the roughly 3,000 children in state custody. Ten children who were allegedly abused while in foster care, were listed as plaintiffs and identified by pseudonyms.
The lawsuit says the state's child welfare system is underfunded, mismanaged and in need of a radical overhaul. Lawyers for the plaintiffs are seeking class action status.
Since the suit was filed, all but two of the children named in the lawsuit have been adopted and are no longer in the foster care system. Of the original 10 children named, seven remain plaintiffs.
Brenda Baum, a state assistant attorney general representing Rhode Island, argued that adoption invalidates the children's inclusion in the lawsuit.
Lisi did not rule on the argument, but did say that "now the viability of all but two is questionable," referring to the two plaintiffs still in the foster care system.
While asking that the adopted children's claims should not be thrown out, Susan Lambiase, an attorney for the plaintiffs, noted that their exclusion would not dismiss the case. The two remaining children would be sufficient to allow the case to proceed and for class action status to be granted, she said.
The lawsuit is asking the court to order the state to place a cap on the number of cases foster care workers can manage, to improve training for those workers, to increase the number and types of foster homes, to speed up the rate of adoption and to move children in foster care less frequently, Lambiase said.
Another U.S. District Court judge, Ronald Lagueux, dismissed the lawsuit in April 2009 because, he said, the adults standing in for the children weren't close enough to the children to act on their behalf. That decision was overturned by the 1st U.S. Circuit Court of Appeals in Boston last year. Lagueux recused himself and sent the suit to Lisi.
The New York-based advocacy group Children's Rights, which brought the case along with the Rhode Island's child advocate, has succeeded in achieving foster care reform in eleven states and the District of Columbia, Lambiase said.

Autopsy: Foster child died of head injuries

CULLOM -- A four-year-old foster child died as a result of head injuries, an autopsy showed Friday, as authorities continue their investigation into the cause of her injuries.
Peoria County Johnna Ingersoll said she is working with Livingston County authorities to determine "how the injuries were sustained" but would not be more specific. An inquest will be scheduled, she said.
No arrests have been made, said Sgt. Earl Dutko of the Livingston County Sheriff's Department.
The Department of Children and Family Services is investigating allegations of abuse and neglect against the foster mother and allegations of neglect against the foster father, according to DCFS spokesman Kendall Marlowe. He previously described "severe physical abuse" against the girl.
The foster parents had not previously been investigated by DCFS, he said. They received their foster care license on July 13, 2010.
Livingston County State's Attorney Tom Brown said he has not received police reports in connection with the girl's injuries.
Kianna Rudesill was taken by a Cullom Fire Department ambulance from a foster home in Cullom to Saint James-John W. Albrecht Medical Center, Pontiac, at 12:48 p.m. Tuesday. Ingersoll said someone at the Cullom residence called 911 and said the child was having "seizure-like" symptoms.
The child was unresponsive when rescue workers arrived, she said.
Kianna was flown from the Pontiac hospital to OSF Saint Francis Medical Center, Peoria, where she was declared brain dead at 2:35 p.m. Wednesday, Ingersoll said.
Kianna was maintained on life support until Thursday so out-of-state family members could arrive, Ingersoll said.
The girl was the oldest of four siblings placed in the foster home in August, Marlowe said.
According to McLean County court documents, the biological mother, who is from Bloomington, was charged with two counts of child endangerment in August. One charge was dismissed in a plea agreement and she was sentenced to 18 months' conditional discharge.
The state's attorney's office said the mother left broken glass on the floor of her residence.
Marlowe said Kianna and her siblings were the first to be placed in the Cullom foster home. Besides the four foster children, the foster parents have two "young" biological children, he said.
Marlowe said Kianna's siblings and the two other children have been removed from the home and placed in other foster homes.

Man charged in death of foster daughter

A Tangipahoa man is behind bars charged with the murder of his three year-old foster daughter, according to police.

A spokesman with the Tangipahoa Sheriff's Office says 49 year-old Mark Johnson was arrested and booked with second degree murder. He was taken into custody by Jefferson Parish deputies on Wednesday and transported back to Tangipahoa Parish.

Johnson's foster daughter, Faith Saucier, died from blunt force trauma, according to a coroner's report.

The girl's biological mother said she had been battling drug problems and turned the little girl over to the state's foster care system

Cullom foster parents under investigation in girl's death

CULLOM — Livingston County authorities and the Illinois Department of Children and Family Services are investigating the death of a 4-year-old girl who was in state-licensed foster care in Cullom.
Kianna Rudesill died Thursday at OSF Saint Francis Medical Center, Peoria, after being flown by helicopter Tuesday from OSF Saint James-John W. Albrecht Medical Center, Pontiac, said Kendall Marlowe, DCFS spokesman.
DCFS is investigating allegations of abuse and neglect by the foster mother and neglect by the foster father, Marlowe said, adding the child suffered “severe physical abuse.”
Peoria County Coroner Johnna Ingersoll could not be reached late Thursday afternoon.
The child, whose biological mother is from Bloomington, and her three siblings were placed in the foster home in August, Marlowe said. The foster parents were licensed and had not previously been investigated by DCFS, he said.
McLean County court records show the biological mother was sentenced to 18 months’ conditional discharge in September for two counts of child endangerment.
“The children were removed from their biological mother due to a situation of neglect and domestic violence by the mother’s paramour,” Marlowe said.
Marlowe said Rudesill’s siblings and the foster parents’ two biological children have been removed from the Cullom home and placed in other foster homes.
In a statement released late Thursday, the Livingston County Sheriff’s Department said it is investigating the death in conjunction with the state’s attorney’s office.

Fla. can't track child welfare contractors

MIAMI -- A decade ago, Florida began turning its child welfare program over to private contractors instead of state workers. Almost everyone involved feels that the change has been for the best, but that's all it is - a feeling.
Despite spending a half billion dollars a year, the Department of Children and Families does not have a standardized system for evaluating in most areas its 20 child welfare contractors, making it impossible to prove that the 40,000 children in the system are being helped. Nor can the state show with confidence which contractors are performing well, adequately or poorly.
"We've got to create better statewide data. We have very little," new DCF Secretary David Wilkins told The Associated Press. He plans to introduce a new system next year.
Critics and advocates agree that the child welfare system has improved overall and cite numbers that prove their point:
- Adoptions jumped from 2,008 in the 2000-01 fiscal year when the state was in charge to 3,368 last fiscal year.
- Child abuse deaths for those who had a history with the department have remained steady at about 70 a year since 2006, when the state's current criteria that included accidental drowning and suffocations where a sleeping adult rolled on top of a child were adopted.
- The number of children in foster care has dropped 28 percent, from 42,325 in 2000-01 to 30,541 during the last fiscal year.
- The cost per child in foster care during that period dropped 24 percent, from $9,978 to $7,602 during that period though DCF officials and the contractors caution that those figures don't account for tens of millions of dollars spent on prevention services. DCF says it doesn't have an exact total.
Longtime child court Judge Cindy Lederman was initially skeptical about privatization but said the system is a considerable improvement over the old DCF system. Before privatization, caseworkers frequently came to court unprepared, telling a judge they'd just been assigned the case and hadn't had time to read the file. That doesn't happen now, Lederman said.
"People were not fired. Contracts were not terminated. Five o'clock would come and you couldn't find anyone at DCF. Those things don't exist anymore. They take personal responsibility for every's not a bureaucracy," she said of the contractors.
But others child advocates are more circumspect in their praise. Attorney Andrea Moore says many foster children still don't go to the doctor even though they have Medicaid and some aren't enrolled in school.
"Is it better now than it was under DCF? Yes, but twice as much money is also going into the system," Moore said. "The well-being of children is still far behind where it should be given the amount of money being provided to the (contractors) and their claims of how well they're doing."
Sen. Ronda Storms, R-Brandon, was an early supporter of privatization and still backs it but says the providers have become too powerful and agrees there needs to be a way to better measure their success.
"These privatized models have grown up to be nothing more than little governments all over the state that have no accountability," Storms said. "And now it works to the children's detriment and certainly to the taxpayers' detriment."
DCF's partnership with the private contractors has been rocky at times. Publicly the two never disparage each other, but privately there's constant finger-pointing when a child's death makes headlines, including a yearlong fight over insurance premiums and who should be financially responsible when a child is harmed.
In the case of a 10-year old Miami girl found dead in the back of her adoptive father's truck on Valentine's Day, DCF officials released thousands of documents detailing their blunders but privately fumed that the contractor that oversaw the case, Our Kids, was ducking responsibility. Our Kids officials hinted DCF was trying to blame them for problems they didn't cause.
"Nobody wants to take responsibility when a child is hurt. Everybody just points fingers at everybody else and they put Band-Aids on problems rather than really fix things," Moore said.
DCF and lawmakers sheltered providers when they were first starting out. Now the providers have grown into multimillion dollar agencies with influential board members and powerful political connections.
As DCF has tried to increase oversight, the providers have pushed back using their political clout, Storms said.
Provider contracts were written in the infancy of privatization and lack immediate consequences, including financial penalties or probationary periods for failure to comply. For example, providers still refuse to use the agency's multimillion dollar computer system.
Yet DCF has little recourse other than to terminate contracts. Only a handful of providers have lost them in the past decade
"There is not a lot of teeth in those contracts," Wilkins said. He's warned providers new contracts will include more stringent accountability measures and consequences. "There is a new sheriff in town. They are subcontractors to DCF so they have an obligation to report to me and do the things we ask them to do."
The most comprehensive current measurements compares each private contractor against 15 federal performance standards, including abuse rates while kids are in foster care, how long they're in care, and whether they're placed in a stable home or bounced between foster homes. But providers say the measurements are misleading and don't capture the quality of their work.
Our Kids, which cares for 3,500 children in Miami-Dade and Monroe counties, said the standards don't consider improvements that have been made since a provider took over a region. The nonprofit group gets $74 million a year with much of that going to prevention and keeping children with their families while monitoring them. That drives up the costs.
"We can go back to the old way of having large numbers of children in foster care so that the cost per child would look better. However, experts will tell you that we are better served as a community by keeping families together with the support services that they need," spokeswoman Kadie Black said. "We know that the quality of life for children in South Florida has never been higher."

Ex-foster father gets 12 years in prison for sexually abusing two boys in his care

He took young children into his home as a foster parent.
Then he abused them.
A former St. Paul foster father pleaded guilty Monday to sexually abusing two boys in his care.
On the day his trial was to start, Joseph Leonard Larson, 34, of Minneapolis submitted Alford pleas to the charges, meaning he did not directly admit guilt but agreed that the state had enough evidence to convict him.
He will be sentenced June 28 to at least 12 years in prison.
Speaking softly, Foster offered simple "yes" or "no" answers to questions by Ramsey County Prosecutor Eric Leonard.
Two former foster children — one now an adult — disclosed separately that Larson had abused them when they were living at his home in the 600 block of Charles Avenue.
The first boy lived with Larson from about April through July 2003, when he was 15, Larson agreed. No one besides Larson and his foster children lived at the house.
In May 2010, the boy told a detective in Hartford, Conn., that Larson had approached him in the bathroom at one point and performed sex acts.
According to the criminal complaint, the boy said "he did not like the defendant and he was afraid of him." Larson would hug him "a lot" and French-kiss him. The boy said he eventually ran away from Larson's home.
The second boy lived at the home from late August 2003 through Jan. 1, 2006, when he was ages 9 to 11, Larson agreed. His older brother lived there for a time, too.
The boy told a nurse and others at the Midwest Children's Resource Center in St. Paul in February 2010 that Larson had raped him on more than one occasion.
The criminal complaint quoted the boy as saying, "It made my body feel weak and hurt." He didn't tell anyone about the abuse earlier, he said, because he was afraid.
A third boy, who visited Larson's house occasionally, might also have been called as a witness had the case gone to trial, Leonard said. That boy told investigators that Larson kissed him and placed him on his lap "or otherwise made him uncomfortable," Leonard said.
Larson was licensed to provide child foster care in Ramsey County from December 2002 to May 2006, according to the state Department of Human Services.
He applied for another license in December 2007, but it was revoked a year later. He did not house any children during that time.
In a revocation order sent to Larson, the department said Larson had not been truthful in his application for the second license.
The department had found out after approving Larson that the previous license had been closed "due to a pending investigation of you by law enforcement." Larson also said in his application that he had never held a previous license.
A 2004 background check on Larson disclosed that the U.S. Immigration and Customs Enforcement Agency had discovered that two of his credit cards were used to buy access to child pornography websites in 2002 and 2003 and that his email address was connected to those purchases, the criminal complaint said.
It was not clear from the complaint why the background check was being conducted.
When investigators came to Larson's home with questions, he said his credit cards had been stolen. He believed his email address was compromised as well, he told them.
In February 2010, after the first boy's allegations came to light, police executed a search warrant for the Coon Rapids home where he lived at the time. They found "many thousands of images of child pornography," according to the criminal complaint.
Larson acknowledged that the state would have presented that pornography evidence at trial. The porn charge will be dropped as part of the plea agreement.
Larson is out on bail.
The plea agreement calls for Larson to be permanently registered as a predatory offender. After his prison term ends, he'll be on conditional release for at least 10 years and possibly for life.

Gag Order Frustrates Child's Mother

3-Year-Old Girl In Foster Care Killed
HAMMOND, La. -- Tangipahoa Parish detectives are investigating the death of a 3-year-old girl who died while in the care of her foster parents, according to family members.
Faith Saucier died about a week ago, and was buried Friday. Authorities now say her death is a homicide.
"She didn't deserve none of this. The sweetest little thing. She didn't deserve none of this," said Ashley Saucier, Faith's biological mother.
Ashley Saucier battled drug problems for years, so she put her daughter into the state's foster care system. Last Friday, she laid her to rest in the remote family grave in Varnado.
"I want whoever hurt my baby, and killed my baby, to be in jail," she said.
Saucier's attorney, William Arata, showed WDSU the Tangipahoa Parish coroner's report he obtained on Faith, showing the manner of death was homicide.
"Blunt force trauma, sub-scalpular hemorraging about the head along with two perforations of the small intestines," said Arata, reading from the report.
The report also included pictures of apparent bruises on Faith's arms and neck.
"Soon thereafter, I was informed there was a gag order. Nobody's presented me with a copy of this alleged gag order," Arata said.
And that's apparently why few people are talking about Faith's death. The sheriff's office said the gag order was issued by 21st Judicial District Juvenile Judge Blair Edwards.
The sheriff's office will only confirm it has launched in investigation into the child's death.
"Whoever is responsible for this homicide has still not been arrested, and the mother is just looking for closure at this point in time," Arata said. "I can't believe anyone in the city of Hammond would like to know that there is a potential child murderer in their midst."
Arata said only eight people attended Faith's funeral Friday, and many questions remain unanswered.
"She (Saucier) is not going to rest tonight, or tomorrow night, or the day after that, until she knows who killed her child. I agree with her," Arata said.
The office of Children and Family Services in Tangipahoa Parish referred WDSU to the state office in Baton Rouge, but those calls were not returned.
Asked about the gag order Wednesday afternoon, Judge Edwards said, "There is truly no need for a gag order in any juvenile case. All juvenile matters are confidential by law to protect and ensure the safety of all children."

Presidential Proclamation--National Foster Care Month

The White House
Office of the Press Secretary
For Immediate Release
April 29, 2011
Presidential Proclamation--National Foster Care Month

      Progress in America can be measured by the opportunities we pass on to our children.  For nearly half a million youth in foster care across our country, the best path to success we can give them is the chance to experience a loving home where they can feel secure and thrive.  During National Foster Care Month, we renew our commitment to ensuring a brighter future for foster youth, and we celebrate the selfless individuals who make a meaningful difference in their lives.
      Young people in foster care are in the system through no fault of their own, and each of our Nation’s children deserves a stable home and a devoted family.  Strong support structures provide children with the environment needed to learn, grow, and reach their greatest potential.  Permanence is critical to the future success of foster youth and must be a key component of foster care initiatives.
      My Administration is committed to achieving security for every child and supporting adolescents in foster care as they transition to adulthood.  The Permanency Innovations Initiative, spearheaded by the Department of Health and Human Services, is providing support to public-private partnerships focused on decreasing the number of children in long-term foster care.  Over the next 5 years, this program will invest $100 million in new intervention strategies to help foster youth move into permanent homes, test new approaches to reducing time spent in foster care placements, and remove the most serious barriers to finding lasting, loving environments.  Over 110,000 children in foster care today are waiting to be adopted.  Across America, there are families who need these children as much as these children need families.  I encourage those interested in adopting a child in need of a home to explore the life-changing resources available at
      We are also investing in the health and well-being of our young people in foster care.  Through the American Recovery and Reinvestment Act, we have significantly increased funding for the Title IV-E adoption and foster care assistance program to provide safe and stable out-of-home care for children.  As a result of the Healthy, Hunger-Free Kids Act I signed into law last year, all children enrolled in foster care automatically qualify for free meals in all Department of Agriculture child nutrition programs.  Additionally, beginning in 2014, the Affordable Care Act will require States to extend Medicaid coverage up to age 26 for all youth who have aged out of the foster care system.
      As a Nation, we all have a responsibility to remain persistent in the charge to provide the best care possible for children when they cannot remain in their own homes.  During National Foster Care Month, we recognize the efforts of foster families, social workers, faith-based and community organizations, and others that are improving the lives of young people in foster care across our country, and I encourage all Americans to partake in efforts to serve these children in the year ahead.
      NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2011 as National Foster Care Month.  I call upon all Americans to observe this month by taking an active role in activities across our country that recognize not only these cherished children and youth, but also the commitment of so many that touch their lives at a most challenging time.
      IN WITNESS WHEREOF, I have hereunto set my hand this twenty-ninth day of April, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-fifth.

Boy Dies While In State Care

OGALLALA, Neb. -- A family is looking for answers, wondering how their son died while in the care of the state of Nebraska. They’re left wondering if their child got the oversight they feel he needed while in foster care.
Toby and Michelle Mitchell are consumed with guilt and asking, “What if?”
“Maybe if we would've just figured it out ourselves, he wouldn't have ended up there,” Michelle Mitchell said.
A few years ago, Toby Mitchell discovered he had a son in Ohio named Billy. Toby said he moved Billy to their western Nebraska home in Ogallala to make him part of their family.
“(I) just felt like I needed him in my life,” Toby said.
Soon after, Billy began exhibiting disturbing behaviors, his parents said. They said Billy tried to poison the fish tank and made other threats.
“He had thought of how to kill his brother and sister,” Michelle said.
The couple said they tried counseling at first, but Billy wasn’t making progress.
Hoping the Nebraska Department of Health and Human Services could find help for Billy, they opened a voluntary case.
Billy now had access to a case worker and family support specialists and would live with a foster family until it was appropriate for him to come home.
But while in one of those foster homes, tragedy hit. Five days before Billy's 12th birthday and just two days before Christmas, Toby and Michelle rushed to the hospital.
“The doctor came in and told us, ‘I'm sorry. Your son is gone,’” Michelle said.
A post-mortem exam by the Nebraska State Patrol said Billy was found with a belt around his neck. No foul play is suspected, according to authorities.
“We don't know whether it was suicide. We don't know if it was the choking game. We don't know anything,” Michelle said.
The Mitchells want specific answers about Billy's death and want to know why the boy wasn't watched more closely in his foster home.
“I just kept looking at her going, ‘You guys were supposed to watch him. You're supposed to get him help. Why didn't you get him help?’” Michelle said.
KETV NewsWatch 7 posed the family's question to the Nebraska Department of Health and Human Services.
“The death of any child is extremely sad, especially for us, when a child is a state ward and placed in our care,” the department said in a statement. “Department staff did review this case after Billy’s death. The services that had been identified for Billy were provided. There was never a request or concern that he be monitored 24/7, and foster care was an appropriate placement.”
Advocates such as Judy Domina, of the Nebraska Family Support Network, said there's much work to be done. Though she believes there needs to be more access to care, Domina said it’s getting better.
In 2009, the Nebraska Helpline was created, giving families a place to turn for resources to help a child with mental and behavioral issues.
"It’s getting better if you know how to navigate the system, and that's why the helpline is so important for these families,” Domina said.
There’s no way to know, but Toby and Michelle said they can't help but think that if Billy had been in a facility -- getting intensive therapy -- he might still be alive. Now, they only wish things would have turned out differently for their family.
“Before we got him, there was a void. Then we got him, and now I have that void again. But this time it’s going to remain empty because we can't fill it,” Toby said.
The identity of the foster parents under whose care Billy was when he died has not been released, but authorities said they are not under investigation.
Billy's DHHS worker saw him the day of his death and said nothing seemed out of the ordinary.

N.J. paid $7M to settle lawsuits from three abused foster children

TRENTON — Nate was 8 years old when he first accused his foster mother of abusing him. But it took several complaints over a number of years before state child-welfare investigators could prove she was abusive and move him to another foster family.
Then the boy was abused again in another foster home — this time by his foster mother’s son.

“He was taken from his mother at a very young age. He was in 22 different places over the course of his life,” said attorney Joel Garber of Voorhees, who represented the boy and his adoptive family in a lawsuit against the Division of Youth and Family Services. “This kid has been through it all.”
Nate, now 17 and living in Colorado with his adoptive family, received $1.2 million last year from the state to settle the suit.
It was part of the nearly $7 million New Jersey paid out last year to settle lawsuits brought on behalf of three foster children harmed in a system created to protect them, according to information from the state Attorney General’s office. The state admitted no wrongdoing.
The foster care lawsuits represent 15 percent of the $51.7 million the state paid out in 317 suits last year. But attorneys and child advocates say these lawsuits are among the most tragic because DYFS acts as the de facto parent when children are removed from abusive or neglectful homes. The agency is responsible for screening, training and monitoring foster parents.
The lawsuits were paid after New Jersey spent more than $1 billion beginning in 2003 to overhaul its child-welfare system under the supervision of a federal judge.
With DYFS supervising more than 7,000 children living in licensed foster and group homes, advocates and attorneys say it would be unfair to use any one case to indict an entire system. But they also say these cases should raise red flags — and be used to correct flaws.
“DYFS, like everything else, is run by human beings and everyone makes mistakes. The problem is when they make a mistake it’s a devastating mistake because they are dealing with extremely important issues,” said attorney Jeffrey Advokat of Morristown, who represented another boy sexually abused by his foster parents in Hudson County from 1996 to 1998. The state settled that case for $4.5 million last May.
 “While these are individual cases, I would hope that DYFS is looking at them — as they should for all child death and serious injury cases … to identify any problems in practice that must be fixed to prevent similar cases in the future,” said Cecilia Zalkind, executive director of Advocates for Children of New Jersey.
At least one of the three victims endured abuse before the 2003 court order. But another case that settled last year — the June 7, 2006, death of 21-month-old Xavier Jones, who swallowed a bottle of methadone that belonged to a relative living in the foster home — occurred afterward. The state has already publicly acknowledged mistakes in that case.
The state paid $800,000 to Xavier Jones’s family. The family’s attorney did not return calls seeking comment.
According to a 2007 report by the now-defunct Office of the Child Advocate, DYFS failed to regularly communicate with Xavier’s foster mother. She made repeated requests to have children removed because she couldn’t handle their care, to which DYFS “did not always respond,” the report said.
In a response statement on its website, the department said Xavier’s caseworker supervised too many children. The state closed the foster home, and also pledged to “re-emphasize in our training for prospective and ongoing resource parents the need for proper medication storage.”
Lauren Kidd, spokeswoman for DYFS’ parent agency, the Department of Children and Families, declined to discuss any specific cases. But in general, Kidd said, “Changes have begun to take hold since the reform.” The department “has been able to recruit and license more foster parents and focus on appropriate, timely and thorough investigations.”
Judith Meltzer, the court-appointed monitor of New Jersey’s reform effort, praised DYFS for recruiting 7,000 new foster parents since 2005, and for completing the vast majority of abuse investigations in foster care within 60 days.
But Zalkind said these cases call into question the adequacy of foster-care abuse investigations.
“What concerns me is that system problems that put kids at risk in the past have presumably been addressed (by the reforms),” Zalkind said. “With all these positive changes, why are there cases in which the basic safety of children in (foster care) placement — to be free from abuse or neglect — is still at risk?”
Allegations of abuse and neglect in foster homes, schools and other institutions are investigated by a different team than the employees who investigate complaints against a child’s parents. This team, the Institutional Abuse Investigations Unit, has delved into more than 3,000 allegations a year, with one-third of them against foster families, Kidd said.
The percent of allegations confirmed against foster parents or caregivers in other “institutional” settings — such as day care centers, camps and schools — is very low. In 2009, the unit confirmed 2.75 percent of all allegations, down from 7.6 percent in 2006.
Overall, the rate of substantiated abuse and neglect is 0.14 percent in New Jersey, Kidd said. That’s nearly three times lower than the national average of 0.5 percent, according to Fred Wulczyn, a research fellow at Chapin Hall, a child-welfare think tank in Chicago.
While Advokat said he feels there has been some improvement in the foster care situation, there clearly is more work to be done.
Garber, the attorney for Nate and his adoptive family, is not as optimistic about DYFS’ progress. He said the lawsuit “woke me up to how the system doesn’t work. … In foster homes, it’s too hard to police what’s going on.”