Let’s Talk CPS Timeline

Before we can have a discussion about going to court, you need to have some background understanding of how children come into CPS custody and the legal process that follows.  I remember my excitement when we finally came to this point in our foster care training.  Being analytically minded, I was chomping at the bit to take in every ounce of information in an attempt to understand the process we were signing up for.  Again, this is specific for Texas, but at least it provides a point of reference for those of you who live elsewhere.

Okay, let’s say CPS has been called by a school nurse for suspicions of neglectful care of a child.  CPS conducts an investigation, and does confirm concern for neglect.  Depending on the degree of neglect and circumstances, CPS will generally follow one of three tracts:

1.  They recommend Family Based Services.  The child stays in the home, the family receives services, which may include help finding permanent housing, employment, parenting classes, etc.  CPS may choose to follow that family for a year or so to ensure that the child is being cared for and the parents are making progress.

– OR –

2.  The child is placed in a kinship placement.  Now, this is a huge one here in Bexar county, and because this option is always considered first, the majority of kids who need to be removed from their home will land in one of these placements.  From what I understand, the definition of “kinship” can be pretty broad.  There are the obvious options – grandma, grandpa, aunt, uncle, but if none of those come through, well let’s also consider mom’s friend, a neighbor, a friend’s family, uncle’s girlfriend, the family at church, 1st cousin, you get the idea.  CPS will continue to monitor the child without taking custody, and creates a “safety plan” that sets the terms for the placement (for example, bio dad is not allowed to visit the home).

-OR FINALLY –

3.  CPS removes the child from the family, takes custody and places them in a foster home.  Because of #2 above, a fairly high percentage of children who make it down to #3 actually end up being adoptable by the foster family.  The statistics I have heard range from 40-70%.  You can imagine the number of resources you have to fall through and lack of support you have to have for your child not to have a kinship placement option.  Sometimes I muse myself with the thought of how many people I know who would step forward as a kinship placement for my biological children should they be removed from us, heck, I mean I think besides our family and closest friends, likely our entire church could qualify as a kinship placement, and then what about my neighbors, etc., etc. so I hope the list could be pretty long.

Now, let’s say the above child, who was alerted to CPS by the school nurse, has had their home investigated and CPS has deemed it necessary to remove the child from the home.  No appropriate kinship placement has been found and they have now chosen option 3 and are placing the child with a foster family (watch for a future post discussing what that fateful day looks like for the accepting foster family).  Within 72 hours or so, CPS goes to court for what is called the “262 hearing” (termed such after Family Code, Chapter 262, subchapter B “Taking possession of a child”).  CPS may continue to look for a kinship placement while awaiting the first hearing.  At the 262 hearing the case is presented before the judge and a decision is made as to whether the child should be returned home to bio parents or CPS should officially take custody.  72 hours is a rough guideline, 262 can be delayed if the bio family is taking legal action, hiring an attorney, etc.

Okay, so the child’s case has been presented to the judge and the ruling is that CPS will take custody of the child.  Now, the timeline begins.  The bio parent(s) are given a CPS plan as far as what steps they need to take to regain custody of their child and exactly how long they have to complete their plan.  These steps may involve drug rehab, regular drug testing, parenting classes, anger management classes, demonstration of consistent employment, demonstration of a place to live, a psychological evaluation, etc.  This plan is clearly laid out for the parents and dates are set for the future hearings.  An ad litem is assigned to the child, the bio parents are also assigned attorneys.  CPS, the ad litem, the bio parent attorneys, the bio parents, and the foster parents (if they choose to attend as listeners only), will now be in court at 3 months, 6 months, 9 months and 12 months to present progress on the case.

Keep in mind, that when CPS takes custody there are two possible outcomes (you will here these terms frequently):

1.  Reunification (child goes back to bio parent – an outcome that everyone in the process has to hope for unless deemed unsafe)

-OR-

2. Termination (bio parent rights are terminated, either because the court deemed the parent unsafe or because the parent chose to relinquish their rights).  Termination of parental rights is often referred to as “TPR”, that’s another good acronym to store in your back pocket.

Until the 9 month mark, CPS has a legal responsibility to track the case for both possibilities.  As early as 9 months the court can terminate parental rights if it has already become clear that the case is headed in that direction.  If that doesn’t happen, then by 12 months a “decision of permanency” needs to be given – either we’re going for reunification or we’re terminating parental rights.  If bio parent seems to be “working their plan” but isn’t quite there yet, they can give one 6 month extension.  By 18 months, at the latest, everyone should have a final decision.  Of course there are exceptions to any rules, but this is generally how things flow.  If termination of parental rights occurs, the case enters a final 90 day waiting period for any extended family to come forward (although remember, at this point they’ve often already had one year to come forward).  After the 90 days, the foster family is given the chance to adopt.

This sets the stage for me to tell you the story of our court experiences.  Until I have time, you can wow your fostering friends by speaking their lingo and asking them questions such as, “has 262 happened already?”, “does it look like it’s headed towards reunification or termination?”, “has TPR happened?”  Oh yeah, you’ll be down with your CPS peeps.

Does twelve months seem fast to you?  It did to me.  Here’s the thing though, one facet of this process that no one will argue with is that children do not do well in the foster system.  By that I don’t mean that they don’t thrive and heal in loving foster homes.  But as soon as children pass 262, the preeminent goal of everyone involved must be to get them out of CPS custody – either home with bio parent, or permanently into a loving adoptive home, hence the rigid timeline.  We know some sweet foster children whose bio mother was a product of the foster system.  She spent her entire life in foster care, over 30 placements, suffering some abuse, and finally becoming an emancipated minor at 17.  It’s too late to change her past, but it’s not too late to change the course for her bio children who are now in that precarious place that is the foster system.  Get it done, make decisions, get these kids in their forever homes (bio or adoptive) as quickly as possible!

IMG_3036My rough sketch of the above info.  I am in no way an expert, if you have more to add or correct, then please comment below!

Let’s Talk Benefits. I’m Glad You Asked.

Since my last post (Ages ago, I know. Holidays, family in town, celebrations, what can I say?  You know how it goes.), anyway, since my last post, many the astute reader has asked, “are you paying for synagis?”  What a good question!  And a well-informed question as well, since it implies a knowledge that synagis is expensive.

For my non-medical peeps, synagis is a specific antibody, against respiratory syncytial virus (aka RSV), that is given as a shot.  Aaaah, RSV, the archnemesis of the pediatrician during the winter, often arriving with its compatriot, the flu, causing ER censuses to double or more for months, filling hospital beds with infants on oxygen, during bad seasons sending otherwise healthy infants to the PICU.  Synagis is given as a monthly shot at the onset of RSV season (typically October).  Since it is not actually a vaccine, where lasting immunity is built in response to an antigen exposure, the shot is only effective while the recombinant antibody is circulating – typically one month.  Therefore, the shot has to be given monthly through RSV season, 5 months or so.

So as I was crafting this post, I thought to myself, “I wonder if the average, non-medical person knows how much synagis costs?”  So I turned to my resident average non-medical person, Erik, and inquired of him, “how much do you think synagis costs?”  Now to say that Erik has the medical knowledge of the average non-medical person is probably underestimating him.  I like to think that his marriage to me has at least allowed his medical knowledge to increase to slightly above average.  At very least he would understand me if I told him I had a champagne tap at work and he knows that most pediatric ailments can be cured with Tylenol, Motrin, and most importantly, time. I’d like to say that my marriage to him has similarly increased my technology skills, but in fact I am afraid I still dwell at “below average” on that one.

Okay, so I ask Erik how much he thinks synagis costs.  “Well,” he says, “I know you’ve said it’s very expensive, so I’m going to say … $200 per shot?”  Aha, I’m thinking, this is good, he is actually a full order of magnitude off.  So synagis costs approximately $2000 per shot.  It’s hard to put an exact figure on the cost since it is dosed by weight, but $1500-$2500 per shot would be a reasonable range.

Even if I couldn’t anticipate your next question Erik would have revealed it, as he looked at me in shock and said, “What!  That’s crazy!  Our tax dollars are paying for that?  What is this shot for anyway?  Is it really necessary?  If one of our bio kids needed that, there’s no way I would pay $10K for it!”  (LOL, glad someone in the family confronts modern medicine with healthy skepticism.)  So, RSV, like any viral respiratory illness, can masquerade as a common cold, but don’t let its benign act fool you – its effects in infants can be quite severe, sometimes downright scary.  Hypoxic infants with RSV fill pediatric hospitals during the winter season.  And while the full term infant with RSV who needs a little oxygen and some help feeding is so common place that it is considered the bread and butter of pediatric inpatient care training, that same infant with extreme prematurity or cyanotic heart disease likely provokes tachycardia in even the most seasoned of medical staff.  The effects of RSV can be devastating in premature and otherwise at risk infants.  It’s not uncommon for the treatment course in that situation to involve a PICU visit, intubation, a prolonged hospital course and lingering side effects on those susceptible lungs.   Perhaps, someday, we’ll defeat and cage this villain with a simple vaccine, as medicine has done previously and triumphantly over smallpox, polio, Hib, pneumococcus, etc. Then I’ll be the senior ED provider who can speak the lore of “back in the day” when the ED was filled with sick infants with RSV …, just as some of my colleagues can talk with seniority about diagnosing meningitis “all the time” in the 80’s (prior to the development of Hib and prevnar vaccines).  But until an effective vaccine is developed, our only option is the insanely costly synagis course.  In case you’re wondering, there are strict algorithms to determine which infants qualify for synagis.  They typically include premature infants (degree of prematurity and age at onset of RSV season taken into account), significant congenital heart disease and chronic lung disease.  And yes, $10K sounds high, but it’s a steal compared to paying for a PICU admission.

So, all of that brings me to a topic that I have wanted to address for a long time – benefits.  Whether you are considering fostering, know people who are fostering, would never consider fostering, etc. I feel that everyone should be equipped with an understanding of the support the government provides to help enable families to foster.  At very least, it may come up for you at some time as a conversation point when a friend says, “we’ve been thinking about adoption.”

Until we started looking into foster care we had NO idea that foster children come with incredible benefits.  So let me tell you the benefits our kids have.  If I had infinite amounts of time to write, I’d love to do an analysis of how this varies state to state, but – infinite time to write – who am I kidding?  At least this will give you an idea of what benefits Texas foster children have.  To start, they have Medicaid.  So, Medicaid pays for synagis, and everything else for that matter.  Baby boy has had multiple doctors visits, therapist evaluations, a couple of medications along the way, as well as his monthly synagis shot.  I haven’t paid a cent, no copays, nothing.  Nearly every year during open enrollment Erik and I methodically weigh different insurance plans as far as copays and deductibles and prescription coverage and incentives for routine health visits, etc.  I have to say, it feels odd to experience a plan where I pay nothing for anything.  Foster children are also eligible for WIC (similar to food stamps).  As baby boy downs around $250 per month of Alimentum (special formula), the WIC benefit has been substantial for us, as it fully covers this and more.  Incidentally, it is also the benefit that has caused me the most personal dilemma over whether or not I should take advantage of, since it is optional for foster families.  Someday, I’ll write about my experiences as a WIC shopper.  Foster children also come with a monthly stipend.  Children without any significant medical or behavioral needs are considered a “basic” placement and the government pays the foster family $23.10 per day per child.  Children with significant medical needs are considered “moderate” or “advanced” and the stipend is appropriately increased.  If a foster parent who is single or both foster parents of a couple are working they are eligible for coverage of daycare costs.  When a foster child is adopted many of their benefits continue.  Depending on circumstances (age of child at adoption, adoption of a sibling group, etc.) foster children may be eligible for Medicaid and their monthly stipend until they turn 18.  Children adopted through the state receive full tuition at a Texas college.  Adoption fees are – WHOA, wait, what was that, did I just say that adopted children have full in-state college tuition covered?  Yes, I did.  That’s a big one.  And, adoptions fees are covered by the state.

Of course this is not meant to be incentive alone to cause people to foster.  Clearly, foster parents give much more of their hearts and time than could ever be fully compensated by benefits.  But, the benefits do help remove some potential practical roadblocks that could dissuade families from fostering.  Nonetheless, when money is involved, there will be someone looking to take advantage.  I will always remember the first phone call I made researching foster agencies, this was years ago.  The man on the phone at this particular foster agency implored to me repeatedly in the first several minutes of our conversation that individuals/couples considering fostering must make a minimum annual income to qualify.  After repeatedly stressing this point upon me I tried to assuage his concern and assure him that we met the requirement.  Apparently not satisfied, he continued on with his tirade about people fostering for the wrong reasons and wanting to make extra money, etc.  We didn’t go with that agency.  When I first called Pathways, the agency we are licensed through, my conversation with the recruitment director went something like this:  After initial introductions, she said, “the first thing you need to know about fostering is that ALL children who are placed in foster care have been traumatized in some way.”  Pause.  Okay … you’ve got my attention.  Go on, I’m listening.

I’ll leave it at that for the night.  Someday I’ll elaborate fully on the sentiment that all foster children have been traumatized, as well as tell you what it’s like as a physician to be the patient at WIC, and take you on a journey with me to family court – in as much heart wrenching, tear-invoking, eye-opening detail as I can confidentially provide.  Perhaps for some this post has made foster care seem more financially reasonable than you may have thought, hopefully for others you now at least know more than you did when you started reading this post – if not about foster care benefits, then perhaps, about RSV and synagis.

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(baby boy laughing at “ride a little pony”)