The Way It Works

A ragged 10-year-old boy is picking barefoot through an ocean of trash, patiently searching for anything of value that his family can turn into food or shelter. He steps on what turns out to be a fragile crust near the top of the heap, which collapses under his weight, breaking his leg in three places as it hits a sharp, hidden piece of jagged iron. His cries bring other children like himself to his aid; one, seeing blood and exposed bone, shouts to an adult below, who runs to the slum’s nearest phone to call for help. Forty-five long minutes pass before the jingle-jangle of an ambulance signals its slow approach down the rutted road to the screaming child. Gathering together the bare-bones and shoddy emergency medical equipment adds another ten minutes onto the boy’s rescue time before he is finally lifted out of the garbage cave and onto a stretcher. Within another five minutes, still more than half an hour from the nearest hospital, the boy dies from blood loss.

So whose fault is this? A child bled to death, surely there’s someone to blame! Is it the town’s or the county’s fault for dumping garbage haphazardly onto an unfenced, unsecured site? Is it the boy’s fault for being barefoot, or for stepping in the wrong place? Is it his parents’ fault, whose poverty drove them to send the boy out in the first place? Is it the state’s or even the country’s fault for not doing more to feed and shelter its most desperately poor members? Or maybe it’s the hospital’s fault for poorly allocating its meager funds for better emergency service.

This is a hypothetical example that sounds more developing Third World than American, but it’s one that plays out every day to lesser and greater degrees in our own financially strapped rural communities as they struggle with how best to care for their neglected or abused children in families with addictions, mental health issues, and violence ─ and to address the many questions it raises. Is there some way to keep a child in his or her home to minimize the disruption of displacement? Are there responsible and beloved family members willing to step up? If not is there a foster home available, preferably within the county? Are parents open to treatment and reunification with their kids? These are just a few of the questions faced by families in crisis.

The true nature and depth of the problem is shrouded in two impenetrable layers of secrecy.

The first shields the family itself. “As a society we see children as their parents’ property,” said Mendocino County Health and Human Services (HHS) Agency Chief Operations Officer Anne Molgaard, who took over leadership of HHS about a year and a half ago. The county’s Family and Children’s Services (FCS) ─ formerly Child Protective Services ─ is part of HHS.

The second layer of secrecy is the much-touted confidentiality clauses attached to any sort of care (intended for the hopefuls who still believe in the myth that privacy still exists in this country). Then again, unlike banks or financial institutions, few hackers seem interested, at least so far, in run-of-the-mill medical records.

So what we’re left with are numbers, measurements, and graphs – hundreds of pages of them. The arguably most emotionally up-close-and-personal department assesses its strengths and weaknesses through the same sort of monthly and quarterly performance metrics common to all organizations ─ in this case things like emergency response times, employee turnover, and dozens of other data points. The difficulty of this analytical view is duly noted in the three-paragraph summary to the May, 2015, Mendocino Grand Jury Report entitled the Children at Risk report: The Grand Jury reminds the reader that beyond the dry recitation of facts, beneath the numbers and statistics, behind the charts and graphs, there are real human lives involved. There are children in harm’s way. (More on this report later.)

So on a macro level, this is how the whole ball of wax works. It all starts in our nation’s capitol, where guidelines for regulations are developed by the more than 79,000-employee cabinet-level U.S. Health and Human Services, currently under the questionable guidance and leadership of Trump appointee Secretary Alex Azar, a former Eli Lilly executive who says now that he cares a whole lot about skyrocketing drug costs and is making it his priority. The price diabetics pay for Eli Lilly’s insulin drugs Humalog and Humulin have both risen some 225% since 2011. Eli Lilly also has several blockbuster drugs including the erectile dysfunction drug Cialis (Surely you’ve seen their TV commercial where a couple tenderly holds hands across side-by-side footed hot tubs in a forest, next to the banner, When the moment is right why pause to take a pill or stop to find a bathroom?), and the antidepressant Cimbalta (one in six Americans now takes an antidepressant, second only to Iceland). Trump and Company are making noises about drastically cutting funding to the agency, but so far, in looking at the stats, it doesn’t look like many of those cuts have been made ─ yet. But I digress.

From Washington D.C., guidelines and funding flow to the states, in this case to the California Department of Health Care Services in Sacramento. Mendocino County, like all counties in the state, inputs FCS activities and programs into a state database. The state evaluates these monthly progress reports from Mendocino County and meets quarterly with FCS representatives. Progress and problems are currently quantified and assessed in the state’s report entitled the 2016 – 2021 System Improvement Plan, released on September 23, 2016. It’s described as “a 5-year strategic plan” and a “systematic analysis of the county’s Child Welfare and Juvenile Probation systems.” The success or failure of meeting targets in this long-range state plan for Mendocino County then becomes the yardstick by which the state determines the county agency’s improvements and, ultimately, its funding. “We’re a kind of payer department,” Molgaard said, “We are reimbursed 95% by state and federal. We report on things like how many kids we attended to, how many are in foster care.” When asked if this is an incentive system of sorts, Molgaard said not really, that it’s more like “this is what we’re doing, this is what we plan to do, and this is how much it costs.”  She said that the reporting is highly detailed but not perfect. “The farther you get away from the work the less relevant that work,” she said, meaning that, however well intentioned, Sacramento can still be a long way from Mendocino County.

Mendocino County’s 2015 Children at Risk Grand Jury report dropped like a bomb in the county. The stark report laid bare the many ways the county was failing to protect its neglected and abused children, everything from follow-up home visits to closing cases to adequately investigating foster homes and doing thorough background checks on short- and long-term homes where children are placed. According to the report these failures were set in a department with high turnover, poor morale, and a dearth of social workers in general and adequately educated social workers in particular.

One of the first, if not the first to raise the alarm was Tim Turner, a veteran social worker of 20 years who was employed twice by FCS, with a 2-year stint in Virginia in between. Turner says he was demoted on March 27, 2017 from his supervisor position for bringing problems to his supervisor Jena Conner and humiliated when he was escorted from his office in front of members of his staff, an event that Molgaard categorically denies ever happened. Personnel actions are, naturally, confidential. Today Turner still works at HHS, but in a lower position working with adults. He is undeniably passionate about social work and equally passionate about raising a flag when he sees something he thinks is wrong. “We take care of kids whose lives are at stake,” he said. ‘I’m surprised we don’t have a dead kid a day.”

Organizations have love/hate relationships with squeaky wheels like Turner, who expose their organizations’ failings before the unblinking public eye. They may on some level realize that airing their dirty laundry, lancing the boil so to speak, could down the road improve their organizations but they hate to hear it anyway; and they especially hate the messengers. There’s a reason that the message embedded in The Emperor Has no Clothes, a fable first written in 1837 and later adapted by Danish author Hans Christian Anderson in his Fairy Tales Told for Children, still resonates nearly a century-and-a-half later.

There is no doubt that Turner was at the very least one of the first (if not the first) to report to the Grand Jury in 2014 that all was not well at FCS. He produced the email trail that proves it. The name of the Grand Jury member with whom Turner communicated will not be revealed here. California’s 1953 Ralph M. Brown Act, which mandates that California city and county government agencies, boards, and councils conduct their business openly in public, does not, due to the nature of their work, apply to grand jury deliberations. Foreperson of the 2017 Grand Jury follow-up Carol Rosenberg did say “We felt really good about the report…some in the agency got some things right on.” She added that she thought the fixes “are really doable.”

Listing all of the areas of child health and welfare studied in the first Grand Jury report would consume all of the available space in both this and next week’s edition of this newspaper, so only a few highlights appear here.

Set out in stark black-and-white prose, FCS’s situation looked grim. Unfilled social worker positions, high turnover, fewer higher-level social workers than mandated by the state, poor non-crisis response times, weak oversight of foster homes and foster parents, hundreds of cases languishing within the system, unclosed or not revisited.

This was about the time that Molgaard assumed the HHS leadership, which she says she did with her eyes wide open, though she also said “they’re never open enough.” Molgaard moved to Mendocino County 25 years ago after finishing law school in the Bay Area to work in the county’s poverty programs. She came to HHS from running FIRST 5 Mendocino, one of 58 county commissions funded by Proposition 10, a tobacco tax passed by California voters in 1998, to fund non-smoking programs for children from birth to five years old. Those tax dollars are distributed to counties based on birth rate. Molgaard says that a FIRST 5 Mendocino white paper “took us to task, but that the first Grand Jury report did not really take social workers to task. They concluded that social workers did not have the tools to do their jobs.” Technical tools were things like no Smart Phones or tablets to record (and seek when necessary) information from the field (eliminating the need to go back to the office after every home visit).

I’ve yet to meet anyone who thinks he or she makes enough money. Turns out that Mendocino County’s entry-level social worker annual salary of $37,460 is close to the middle in a comparison of the other rural northern California counties of Humboldt, Lake, Glenn, Colusa, and Shasta listed in the second Grand Jury follow-up report. And though the report concludes that low pay is a major issue, especially in hiring higher-level, more educated social workers, the difference between the salaries of those higher-level employees and supervisors in those same counties is only a few thousand dollars a year. But when you add the fact that those salaries were cut 10% across the board back in 2011 it’s easier to understand the mass exodus of experienced social workers between 2011 and 2014. And who cuts social worker salaries, anyway? Priorities…

But money isn’t everything. The FCS work environment and how it affects morale are right up there, too. Molgaard conceded that “People who are satisfied don’t jump.” But Grand Jury interviewees expressed concern that newly hired social workers would train in Mendocino County to get experience then decamp to higher-paying counties, a practice known as “train-and-trot.”

Morale problems cited in the follow-up report include loss of collegiality and leadership team consultation, abrupt personnel changes, lack of adequate staff and equipment, lack of respect for experience and dedication, and fear of retribution.

Jena Conner, who has oversight over social workers, looked hurt and confused when asked if it was true that, heard through the grapevine, she discourages negative information and punishes those who bring it to her attention. “I try to always ask myself if an issue needs my or a supervisor’s attention,” she told me. “It doesn’t do any good to let things fester.” Molgaard added that “Nobody’s perfect,” noting that, “If there are morale problems, people get paranoid.”

Emergency response is another major area addressed in both Grand Jury reports, and in this critical area FCS is not alone in the world. Social workers are often joined at the hip with the Mendocino County Sheriff’s Department, which is tasked with protecting the public and determining if laws have been broken. Mendocino County Captain and Field Services Commander Greg Van Patten, who was born in Ukiah, has 23 years with the county sheriff’s department, and oversees staffing of the county’s 24/7 emergency lines in three stations, said that assessing the immediacy and severity of people calling in with emergencies, about 15% of which involve children, is both science and art. “There’s a gray area between what is abuse and what isn’t,” he said, adding that from the get-go around 60% of incoming calls are bogus (think acrimonious divorce custody cases).

Van Patten says FCS and his department’s detectives (4 for sexual abuse, 12 for all other violent offenses) need to support each other. “In a lot of cases the child can’t tell you what’s going on,” so “you need to get a grasp on what is the truth or a lie.” He says that in an emergency requiring immediate intervention (a panicky kid calling from a suspected crack house to say that his mom and her boyfriend are loaded and the boyfriend has a gun and is beating her up) typically both a social worker and a deputy show up at the scene. Van Patten also says, like FCS, that keeping everything staffed around the clock is a challenge. “You’ve got to have people working all the time, we can’t put up a sign that says ‘we’ll be back in eight hours’.” Also like in FCS, he says that making emergency calls to homes with children takes an emotional toll. “It makes you fearful for your own kids,” he said. “Being a parent myself, I want to just go home and hug my kids.”

Though it does not have direct control over FCS per se (Molgaard reports directly to Mendocino County CEO Carmel Angelo), FCS does make regular reports to the county’s five supervisors.

Outgoing District 5 Supervisor Dan Hamburg came to Mendocino County to manage an alternative school during the 1970s back-to-the-land movement. He says he sees his role as supporting the FCS staff but that the supervisors have a responsibility to respond “when you know things are bad. What county wants to be known as a place where children are unsafe?” He sounds weary and pessimistic, if not outright fatalistic; he believes that Mendocino County’s rising levels of child abuse and neglect mirror the crumbling society throughout the county. “This is a poor county, with many families living paycheck-to-paycheck,” he said. “Inequality is worse than it’s ever been. We don’t invest in healthy lives for our people, and have raised dysfunction to an art form. We’ll just keep shoring up the dike.”

Looking around, it’s hard to disagree with Hamburg’s gloomy scenario, but the county can’t just pick up stakes, load a wagon, and move someplace else. The feds send guidelines, codified into law, to the states. The states in turn take those guidelines and tailor them to their counties, in California’s case 58 of them, one of which is Mendocino County. Mendocino County then looks around at its failing social systems, rising drug addiction and poverty rates, and tries to figure out how children ensnared in that scenario can somehow be saved from conditions that can eventually morph into adult lives of addiction, crime, and violence. Then all that human chaos and suffering has to somehow be reduced to hundreds of pages of action items that will satisfy the state that the county is making things better instead of worse. Would you want that job?

You can feel in the FCS leadership that they’re making an effort to stay positive about the incremental changes they’re making; they know they can’t just throw in the towel in the face of insurmountable societal odds and go home to hide under the covers. Molgaard freely shared all the most recent FCS data that Sacramento will use to measure the county’s improvements since the second and final Grand Jury follow-up: social workers and supervisors have been issued Smart Phones and tablets capable of privacy-protected access to the state’s database, reducing return trips to the office; more vehicles have been purchased so social workers aren’t delayed by waiting for one; Emergency Response units in Ukiah have been relieved of routine court work so they have more time to spend on investigations; the social worker vacancy rate is now 7 out of 47 positions instead of the 16 to 18 vacancies in past years; last summer social worker salaries were raised between 2% to 20%, depending upon classification; numbers show that the county is inching closer to the state mandate that at least 90% of both immediate and 10-day responses meet their response targets; there’s a new marketing plan to attract more foster families so fewer kids need to go out of state, far from their friends and families.

No one pretends that these incremental changes will protect the county’s children from the abuse or neglect they’ve landed in through the collapse of traditional social systems.

Meth use, for example, after starting to fall, is peaking again. Molgaard says that 80% of neglect cases involve drugs. “If they’re doing meth they don’t feed their kids because they’re never hungry,” she said. She’s quick to point out that poverty does not automatically mean abuse or neglect, that plenty of poor families provide love and support for their kids. She also says that the big difference between a healthy and non-healthy home has nothing to do with housekeeping, that it ultimately doesn’t matter if a house is a mess. There are many judgment calls. Is the child left alone too much? Is the child old enough and responsible enough to be a latch-key kid? Is the child safe?

Molgaard disagreed with my suggestion that neglected and abused kids might be better off in a clean, state-run orphanage than in often multiple foster homes, despite all the horrors we read about as kids in novels written by Charles Dickens. “Our society has changed but a child’s needs have not,” she said. “Young children need personal, one-on-one, eye-to-eye contact attention across a dinner table. Those needs have not changed over the millennia.”