Elizabeth Prewitt

Georgia juvenile court judge galvanizes statewide child trauma initiatives

Judge
Douglas County (GA) Juvenile Court Judge Peggy Walker and “Dalton”

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Douglas County Juvenile Court Judge Peggy Walker is an activist judge for the children of Georgia – the children she loves who do not get what they need for healthy, successful lives.  She’s seen how the children are failed when they come back to court again and again. Now she’s doing something about it.  When she takes over later this year as the president of the National Council of Juvenile and Family Court Judges, she’ll have a national platform to promote changes in polices and practices to prevent and treat childhood trauma.  For now, she is spreading the word around the state of Georgia through conferences in four different regions, with the first one held January 10 at the Carter Center in Atlanta.

Woven into Judge Walker’s Georgia Summit on Complex Trauma keynote address to more than 400 participants —  including judges, their staffs, child and family services professionals, and advocates — was a description of a painful case from her work as a judge.  She began her presentation on what science tells us to do for children who have experienced complex trauma with a photo of herself (shown above) holding “Dalton.” He was the first drug-free child in the court’s family drug treatment program; his mother “Tonya” was a participant (both names are pseudonyms).

During the 10 years that “Tonya” had been in and out of her court, Judge Walker did not know her story. When she found out, she learned that  “Tonya’s” mother was alcoholic, emotionally abusive, and manipulative.  At age seven, “Tonya” was raped by a 50-year-old neighbor who was later incarcerated but freed after three years.  She tried drug treatment in

three different places without success and attempted suicide several times.  “Dalton” and her other children were removed from her care after the limits of her judgment and cognition were demonstrated – she put the four children in the trunk of her car because the car was too small to accommodate four car seats.

Other life stories emerged from Judge Walker’s court, leaving her “stunned by the degree of violence that these parents have experienced in their very young lives and the impact it has had on them and the children that they bear.”

Over years, Judge Walker and other Georgia judges who participated in a court improvement group grew increasingly frustrated with the lack of progress being made as the result of the courts’ interventions that were too little, too late.  According to the executive staff of the group, attorney Michelle Barclay, the judges continued their conversations as they gathered more information on effective treatments:  They read Dr. Bruce Perry’s book about what the traumatized child can teach us. They studied evidence that was introduced in court about trauma. They listened to experts in the field, such as the former U.S. Health and Human Services Child and Family Services Commissioner Bryan Samuels (See the Resources section on the Georgia Summit website). As a fellow with the organization Zero to Three, Judge Walker’s understanding of the impact of trauma deepened and her knowledge of what children need for healthy development grew.

As this educational process continued, another resource became a became available to the group in the form a letter dated July 11, 2013 from the heads of three agencies within the U.S. Department of Health and Human Services (HHS) to state directors of child welfare, Medicaid, and mental health.  The letter highlighted the landmark Adverse Childhood Experiences (ACE) Study and detailed the federal resources and funding streams available to combat childhood trauma and improve child wellbeing.

While the letter did not contain new requirements or announce new funding sources for state and local programs, it did provide an exhaustive overview of existing federal programs and requirements to address complex trauma within health and human services.  The three HHS leaders said their agencies “are engaged in an ongoing partnership to address complex interpersonal trauma and improve social-emotional health among children known to child welfare systems.”  States and tribal governments were encouraged to build upon the important work that resulted from the federal partnership to address trauma.

In a statement about the letter, HHS Secretary Kathleen Sebelius said, “Far too many children – especially those known to the child welfare system – have experienced trauma related to neglect.”  Taking a broader view, the same could be said of those “known to the juvenile justice system,” with the strong likelihood that significant numbers of children are in both systems – systems that are unlikely to share information or coordinate in any way. For this reason, it is significant that the leadership for the Georgia summit came from the judiciary rather than child services, and that conference participants represented the numerous systems with responsibility for child wellbeing, including schools and juvenile justice, as well as health and welfare.

Two hours of the three-hour program (video of the entire program is available on the summit site) were devoted to a panel of state agency leaders showcasing how the executive branch is applying scientific knowledge about trauma to practice. The top leadership in juvenile justice, public health, behavioral health and developmental disabilities, Medicaid, child and family services, and education addressed agency-specific initiatives as well as cross-agency collaborations.

The panel moderator, attorney Karlise Grier, asked the panelists to share something significant in their backgrounds that they bring to their positions to the benefit of children. The responses included being:

  • a foster and adoptive parent to boys eleven years or older;
  • a survivor of complex trauma;
  • a pharmacist with experience in curtailing the gross overuse of prescription drugs;
  • raised by a grandmother who took in other children for long or short periods when their parents were incapable of responsible parenting;
  • mentored and encouraged to pursue higher education after dropping out of school;
  • and a physician whose mission is caring for infants and their mothers.

Here are some highlights from the panel:

The chief of the Medicaid Division in the Department of Community Health, Jerry Dubberly, emphasized the importance of Medicaid’s “Early and Periodic Screening, Diagnostic and Treatment (EPSDT)” benefit to encourage early intervention, avoid deep-end services and improve outcomes for children and youth who have experienced complex trauma. He also addressed efforts to reduce overuse of psychotropic drugs and promote the use of electronic medical records. He spoke enthusiastically about a managed care contract with Amerigroup that will begin in March to provide comprehensive services, including a trauma assessment, for all children in the custody system.

Dr. Sharon Hill, director of the Division of Child and Family Services, emphasized the importance of inter-agency communication and information sharing. She said the new contract with Amerigroup should make more vital information available and improve care and service coordination for children in multiple systems. She also addressed the overuse of psychotropic drugs in very young children.

Dr. Brenda Fitzgerald, commissioner of the Department of Public Health, described research findings on the negative impact of late preterm births – as little as two weeks early – on standardized tests given to children in the third grade. Elective early births have been dramatically reduced in Georgia due in part to a public-private collaborative involving the state of Georgia, physicians, hospitals, and advocates. A new policy that began last October in which Medicaid stopped paying for non-medically necessary inductions or cesarean deliveries, also had an impact, said Dubberly.

Fitzgerald said that 50 percent of babies born in Georgia come through the WIC (Women, Infants, and Children) nutrition program. The high participation in the WIC program presents opportunities to look for depression and domestic violence in mothers and intervene when they are identified. It also creates an opening to provide “language nutrition” as well as standard nutrition education. She cited research that shows children from impoverished homes are exposed to 30 million fewer words by age three, putting them at a distinct disadvantage compared to other children when starting school.

Fitzgerald reported that the state is working with the Harvard University Center on the Developing Child to make improvements for at-risk children. A 5-minute video from the Center, “Building Adult Capabilities to Improve Child Outcomes:  A Theory of Change,” was shown at the conference.

Dr. Christy Doyle of the Department of Juvenile Justice reported that trauma-informed systems of care are replacing the negative interventions of the past – restraint, injection, and incarceration.  Evidence-based practices such as SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress) are gaining traction. She recommended a clinical guide for treating children with traumatic stress by Dr. Damion Grasso at the University of Connecticut (Clinical Exercises for Treating Traumatic Stress in Children and Adolescents: Practical Guidance and Ready-to-use Resources).

Dr. Linda Henderson-Smith, of the Department of Behavioral Health and Developmental Disabilities said her agency provides crisis stabilization services and has been training leadership and frontline staff in trauma-informed practices. She spoke of the need to continue working with sister agencies to improve services to children.

Dr. Garry McGiboney, deputy superintendent of the Department of Education said the department is implementing PBIS (Positive Behavioral Interventions and Supports) to improve school climate and bring down the high number of suspensions in the state (Georgia is ranked 10th in the number of students suspended from school).  He expressed the desire to shut down the school-to-prison pipeline, and addressed the importance of recognizing when behavior is symptomatic rather than defiant.

The summit was sponsored by the Carter Center, the Supreme Court of Georgia Committee on Justice for Children, the Georgia Administrative Office of the Courts, Casey Family Programs, and Goshen Valley Boys Ranch. The $8,000 cost of the summit was funded by sponsorships, participant donations and a grant from the federal court improvement program. Georgia Supreme Court Justice P. Harris Hines, who opened the summit, chairs the committee that guides the work of the grant and related programs. The Carter Center donated the meeting space.  The second meeting in the series of four will be held April 25 in Savannah.

In his welcoming remarks, Dr. Thomas H. Bornemann, director of the Carter Center Mental Health Program, observed that now is a time of dynamic change in the state of Georgia, and he cited constructive changes in the adult mental health system that have arisen from tragic and contentious circumstances. He described his intense reaction to the stark and dramatic findings of the CDC’s ACE Study and commented on the power of the courts to engender change. These observations set the stage for the summit proceedings that followed and for the three future events around the state of Georgia.

10 comments

  1. i haven’t seen CASA’s mentioned. I’m a Court Appointed Special Advocate for children. I make weekly visits with the child, and find out what’s really going on, and report those findings to the Guardian ad Litem.

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  3. I believe when there are too many hands in the pot, the soup ends up tasting foul. No single group, can state with absolute sureness, that they are the best ‘group’ to help anyone, and more groups that are there to help, seem to get it wrong. If these groups were there to do something positive, then why the funding? Is the interest in the funds higher than the outcome of the ones they see more important? It seem so.

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  4. I think that a net of support systems have to be in place. Accountability is mandatory on all in the circle. if I could put a circle together it would have: Family Practitioner”; Pediatric Physicians: Dentist who work with trauma patients: 3 ER Trauma physicians”” Alcohol Abuse Expert; Drug Abuser Expert: Pharm D, one who specialized in pediatric care and Trauma Care: Principals and Nurses for grades 1-12. This would be 24 in the circle.
    A Probation Officer: Law Enforcement-Police-Sheriff’: Department of Highway Safety:-with expertise in substance abuse , domestic violence, child abuse and homicide.

    yes, this is a large circle, but to have any group that is limited in scope is leaving important people out of the loop.
    I have files in just on one of my many cases. The reason I list all is because many of these listed above saw physical signs of abuse and the children remained with the alcoholic mother who died of chirrosis recently. She livedd with her alcoholic, abusive boyfriend. the two minor children lived half time with the mother and the father. The father was a professional with absolutely no issues of concern for parenting, nor did he have any substance abuse issues. The Judge felt that just becuase the mother was an alcoholic, it did not mean she was not fit to be with the kids. so during the visits, the boyfriend that also beat the kids mother, had committed acts of terror to both children. They refuse to tell what happened and they told CPS, the ER physician and their father that, “they don’t remember” even when the large raised red swelling on their heads happened the day before. They were and are scared silent.

    One teacher saw signs of sexual abuse in one child. She told the administration, who told her to mind her own business. That teacher left this school for another and told me what she saw in the child. The school did not want to get involved. The children were going to school from the mothers home with no food for over a day or two. They grabbed snacks out of the after school program as if they would never see food again. A teacher finally told the father. The little 6 year old lost so much weight from not eating at his mothers, that eventually he did not want to eat. It was not considered neglect by the school or CPS. The father kept full backpacks in the kids classroom with non-perishable foods with protein and nutrients.
    The little girl started wetting herself and was afraid to go into the bathroom. She refused to say what she was afraid of. The father knew.
    The father called the Sheriff to help when the little girl texted her day and begged for her. She also left crying messages pleading for him to help he and her brother. The sheriff and the father went to the mothers house. She had been passed out, we later learned. The sheriff said all looked good, as the mother kept her hand on the children’s shoulder as the sheriff and the father did the welfare check. An hour later, the little girl called her dad crying again to help them. The father called the sheriff and was told, they already went to the house, no reason to return. Only 9 hours later when the kids arrived at school from the mothers house. One child had a huge fresh welt on his forehead. The school took pictures and the little boy said he had no idea how he got hurt. CPS opened and closed the case immediately. They also told he father that if they got anymore reports, they would remove the kids from the mothers care and put them into foster care.

    The family court judge saw all of the documentation in the mothers extensive medical record, even the mothers statement that her boyfriend beat her. Still the judge allowed that boyfriend to be the supervising person when the children were in their home.
    The court appointed custody expert never went to any of the court hearings and ignored factual evidence that the children have been harmed. Ignored the therapist report that said the children may even be killed if they went back to the mothers home. The lawyers? the moms lawyer looked away at any evidence that the mother had any problems with alcohol. It took almost 2 years for the father to get the Judge to order mandaory alcohol testing. He wanted a hair folice test, but that request was ignored. The kids mom showed up in court-drunk.
    I see so many professionals that should have been taking measures to protect the children once they saw hard evidence things were happening. Children that are traumatized often do not tell anyone out of fear. We all know that. One family member was so outraged they wrote the head of the Sheriff- result-ignored; They contacted two state legislators. One chastised the person for even putting names in the letter. Copies of police reports were in the folder, so of course names were listed. The family member contacted the state attorney general. The respose was, in this state, we have an agreement, All agencies address this issue WITHIN the agency. So this self policiing is right???

    Two children were emotionally and physically damaged and traumatized. The father and his family went through an endless nightmare worring about the kids and trying to get help. Every person, office that should have investigated, looked away. So when we are looking at ways to help children now, we have to have a full circle of professionals that surround the lives of children and are in the position of authority. Yes, we know the school has mandated reporting. But if they father pushed that while the mother was alive, the backlash would have only been on both himself and the children. The mother may have gotten help early on. The father begged the court and his x-wifes attorney to get her help. The court “suggested” she seek counseling, but never made counseling or entering and completing a substance abuse in-patient program a condition. Suggesting is only a concept. At the end of the mother’s life, the father of the children still begged her attorney to get her help. That attorney should have known enough about the damage of substance abuse, as he admitted he attends AAA, as he struggle with his own addiction. Tell me, how in the world can so many people claim they want to protect children, when they, like many, loo away. I will never forget what the little girl who became the mothers care-take said. At that time she was 7. An ambulance took her mother to the ER. That was several weeks just in the ICU. The little girl said, “I never want to clean up blood again”. Her mother was bleeding from the alcohol damage and the little children were the ones who cleaned it up. The court should have have halted all unsupervised time with the mother at that time. Nope, another year went by and the children’s mother, passed away. So sad for her, the children, the father and all that tried to actually help. I know this is long. I have worked in public safety for several decades and see the issue of protection children has to be more than “talk”.

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  5. Dr. Gabor Mate and Dr. Gordon Neufeld would be A1 resources for this inter-disciplinary team approach. Canadians, yes, at the cutting edge of cultural change for the optimal conditions for psychologially, emotionally and physically healthy kids.

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  6. Would you be able to elaborate upon exactly what these programs are, supposedly, doing to help children and families? Are they working with biological parents and family members, assisting them with parenting skills and other resources? Or are they simply removing these children and placing them in foster homes or state care? As ACES is well aware, the latter choice typically leads to even greater childhood trauma and tragic deaths.

    There are several pieces of this article that are troublesome for me.

    “Fitzgerald said that 50 percent of babies born in Georgia come through the WIC (Women, Infants, and Children) nutrition program. The high participation in the WIC program presents opportunities to look for depression and domestic violence in mothers and intervene when they are identified. It also creates an opening to provide “language nutrition” as well as standard nutrition education. She cited research that shows children from impoverished homes are exposed to 30 million fewer words by age three, putting them at a distinct disadvantage compared to other children when starting school.”

    I must wonder….are children from low income households actually MORE at risk for inadequate parenting? Or does the WIC program (or other social programs like Medicaid, etc) simply offer easy opportunities to create “study groups”? What is the control group (which I would expect would be families from a higher socioeconomic status) in these studies? How is the “control group” selected? Were the WIC participants studied informed that they were part of a study?

    Has participation in programs such as WIC now become “hunting grounds” for low income families who may then be forced into HHS programs that receive billions of dollars every year for separating mothers from their children?

    http://www.huffingtonpost.com/anne-stevenson/top-5-hhs-programs-endang_b_1511613.html

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    • The WIC program specifically provides assistance to pregnant women, infants, and children up to age five through grants to states. In every way, it seems to be a program that would strengthen families and help provide for a healthy start on life for babies and moms. I am not aware of any child advocacy organization that does not find WIC to be a valuable program to combat a continuing problem of food insecurity in this country. I’ve never heard that it has been used to separate children from their biological mothers.

      Lots of specific information is available on the WIC program. As described on the website for the WIC program in Georgia, it provides vouchers to buy healthy food for moms, infants and children. The Center on Budget and Policy Priorities says there is strong evidence for the efficacy of WIC in improving birth outcomes and reducing health care costs. The Center says, “The WIC program improves birth outcomes and reduces health care costs. Babies with low birth weights are more likely to die in infancy or to become disabled or ill.”

      I understood Dr. Fitzgerald’s comment about the high utilization of the WIC program providing opportunities to look for depression and domestic violence and intervene to mean that clients could be informed of resources, services and treatments that might be helpful. Dr. Fitzgerald also mentioned that the state is working with the Center on the Developing Child at Harvard University that identifies building parenting skills as a key component in raising healthy children, regardless of family income. If the state follows the Center’s guidance, it will include building parenting skills as a priority.

      Just as ACEs occur in all families along the income spectrum so does good and bad parenting. But poverty makes most things—including being a parent—harder. As the video by the Harvard Center on the Developing Child shown at the Summit conveys, building adult capacities, such as good parenting, improves child outcomes.

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