Noteworthy News Articles on Mental Health Topics, November 1-5, 2007 The initiative by the Department of Public Health mirrors a similar project in Boston, where at least 66 overdoses have been reversed since the program began a year ago. State Public Health Commissioner John Auerbach, who introduced the Narcan program while leading Boston's health agency, said the results are so impressive that he wants to expand it to four areas of the state grappling with heroin epidemics. That drug and other opiates killed 544 people in Massachusetts in 2005, more than double the number felled by firearms. "We are aware sadly that despite our efforts, there are people who will not be ready for treatment, and we want to prevent them from dying from a fatal overdose before we have an opportunity to convince them to get into treatment," said Auerbach, stressing that treatment remains the state's priority. But some substance abuse specialists criticize the distribution of Narcan to addicts, arguing that the practice encourages continued use and delays entry into treatment. Some also question whether it is wise medically to have one addict squirting Narcan up the nose of another user who is overdosing. "You give them the Narcan, where is their motivation to change? The addict is going to say, 'I just overdosed and I got another lease on life - great,' " said Michael Gimbel, a recovering heroin addict who was director of substance abuse in Maryland's Baltimore County for 23 years. "Giving Narcan might give them that false sense that 'I can live forever,' which is not what we want." Narcan has been administered for decades in hospital emergency rooms and by paramedics, but time is crucial: Heroin races to regions of the brain that control breathing. Too much heroin dangerously slows breathing, starving the heart of oxygen and causing it to stop beating. The whole process can take just three to four minutes, making it essential to have the antidote readily available. Heroin attaches itself to receptors in the brain, like a key sliding into a lock. But Narcan wrenches heroin out of brain receptors, taking the place of the opiate and reversing the devastating reduction in breathing. Narcan, known generically as naloxone, was developed as an antidote for overdoses. It is not habit-forming and causes no long-term side effects, although the sudden reversal of a heroin high can induce vomiting, specialists said. A single dose costs about $20. "It's a remarkably safe drug," said Dr. Peter Moyer, medical director for Boston's fire, police, and emergency medical services. "I've used gallons of it in my life to treat patients.State authorities said they believe that Massachusetts will be just the third state with a Narcan program. A number of cities including Chicago, New York, and Baltimore already provide the antidote to drug users. In Baltimore, nearly 1,600 addicts were trained in using the medication from April 2004 through the end of 2005, and participants reported that 194 overdoses were reversed. At the same time, heroin-related deaths in the city reached their lowest point in six years, dropping one-third from the peak recorded in 1999. Heroin has maintained a powerful hold on New England, fueled by high demand and low prices. At $5 or $6 for a small bag of the drug, it can be cheaper to get high on heroin than to buy a six-pack of beer. "It's the perfect storm in all the wrong directions. We talk about availability, price, and potency of the drug," said Kevin Norton, president of CAB Health & Recovery Services, which will work with the state to provide Narcan in cities and towns on the North Shore. State authorities estimate that their campaign, which is being treated as a test run, will cost less than $50,000 and enroll 450 users. If successful at saving lives, it may be expanded. Most of the funds will go to buying the medication, while other costs will be absorbed by four independent agencies that have partnered with the state to enroll users in the North Shore, the Connecticut River Valley, Cape Cod, and Southeastern Massachusetts. In Boston, 358 users have enrolled in the city's Narcan program since September 2006. In training sessions, they are first urged to enter substance-abuse treatment. If they're unwilling, they are then instructed in how to use a Narcan kit, which includes a syringe filled with the liquid and a device that turns the medication into a mist that is inhaled through a cone. In Boston, an average of 119 people died each year between 1999 and 2004 from drugs or alcohol. Drug use is rarely a solitary pursuit, so it makes sense to train addicts in how to give the antidote to their friends, substance-abuse specialists said. "It was easy to implement in Boston," said Andy Epstein, who helped start the program in the city and who will fill a similar role with the state, as a senior adviser to the public health commissioner. "The clients were grateful to see that someone was interested in whether they lived or died. And they were very facile in putting together the Narcan" kits, she said. As part of the training, addicts are told to call 911 even if their friend's overdose is fully reversed, because further medical attention may be needed. A city report on the first year of the program found that most of the time, 911 was not called, a finding that Moyer described as disappointing. Boston's campaign has drawn internal opposition from paramedics. Matt Carty, of the Boston Police Patrolmen's Association EMS Division, said he and some colleagues worry that addicts are not equipped to deliver medical treatment. The White House Office of National Drug Control Policy also condemns the practice of Narcan distribution. A heroin overdose is such a serious medical event that addicts should be cared for by medical professionals, not their injecting friends, said Bertha K. Madras, deputy director for demand reduction in the White House office. "This is a medical emergency - this is not a friendly, communal chit-chat situation," said Madras. Chris Jenkins, Washington Post- 11/3/2007 State mental health officials have launched an investigation into the actions of a Fairfax County psychiatric clinic after a woman who was briefly taken there for treatment allegedly killed her boyfriend less than an hour after being released. The Department of Mental Health, Mental Retardation, and Substance Abuse Services, which licenses and monitors the clinics run by local mental health agencies, has started to interview staff and look through records at the Woodburn Center for Community Mental Health in Annandale. Fawn C. Scott was taken there voluntarily by Fairfax City police last month after she had an argument with her boyfriend. Police have said an officer stayed with Scott until a mental health provider came for her. Less than an hour later, Scott returned to her apartment and allegedly stabbed Dexter O. Richardson Sr., 50. Scott has been charged with murder. It is unclear under what conditions Scott left the clinic. Meghan McGuire, a spokeswoman for the state mental health agency, said the investigation was routine and part of normal agency practice designed to see whether the Fairfax-Falls Church Community Services Board, which runs Woodburn, committed procedural violations. She said any "critical incident" involving a client could trigger a review. "In this case, the alleged crime committed by someone using the services of a program the department licenses would prompt us to determine whether any regulatory violations may have occurred," she said. A spokeswoman for Fairfax County, which is temporarily handling media inquiries for the community services board, said she could not comment. The case is the latest to draw unwelcome attention to Virginia's mental health system. The system has come under intense scrutiny since a troubled Fairfax County man killed 32 people and himself at Virginia Tech in April. Seung Hui Cho had been ordered into outpatient treatment by a court 16 months before the killings but never received the care. But the community services board that serves the Virginia Tech area didn't receive the order and therefore failed to follow up, as required by state law.This week, the Richmond Times-Dispatch reported that a man accused in the stabbing death of an elderly woman in that city suffered from a schizophrenic condition and had not been taking his court-ordered medication. The paper reported that the local mental health agency visited the accused man 11 times in the months before the killing. McGuire said the department is investigating that incident as well. Autism Epidemic May Be All in the Label Associated Press, 11/4/2007 ATLANTA -- A few decades ago, people probably would have said kids like Ryan Massey and Eddie Scheuplein were just odd. Or difficult. Both boys are bright. But Ryan, 11, is hyper and prone to angry outbursts, sometimes trying to strangle another kid in his class who annoys him. Eddie, 7, has a strange habit of sticking his shirt in his mouth and sucking on it. Both were diagnosed with a form of autism. And it's partly because of children like them that autism appears to be skyrocketing: In the latest estimate, as many as one in 150 children have some form of this disorder. Groups advocating more research money call autism ''the fastest-growing developmental disability in the United States.'' Indeed, doctors are concerned there are even more cases out there, unrecognized: The American Academy of Pediatrics last week stressed the importance of screening every kid -- twice -- for autism by age 2. But many experts believe these unsociable behaviors were just about as common 30 or 40 years ago. The recent explosion of cases appears to be mostly caused by a surge in special education services for autistic children, and by a corresponding shift in what doctors call autism. Autism has always been diagnosed by making judgments about a child's behavior; there are no blood or biologic tests. For decades, the diagnosis was given only to kids with severe language and social impairments and unusual, repetitious behaviors. Many children with severe autism hit themselves or others, don't speak and don't make eye contact. Blake Dees, a 19-year-old from Suwanee, Ga., falls into that group. For the past eight years, he has been in a day program with intense services, but he still doesn't talk, he's not toilet-trained, and he has a history of trying to eat anything -- even broken glass. But he's not a typical case. In the 1990s, the autism umbrella expanded, and autism is now shorthand for a group of milder, related conditions, known as ''autism spectrum disorders.'' The spectrum includes Asperger's syndrome and something called PDD-NOS (for Pervasive Developmental Disorder-Not Otherwise Specified). Some support groups report more than half of their families fall into these categories, but there is no commonly accepted scientific breakdown. Gradually, there have been changes in parents' own perception of autism, the autism services schools provide, and the care that insurers pay for, experts say. Eddie, of Buford, Ga., was initially diagnosed with obsessive-compulsive disorder, attention deficit hyperactivity disorder and other conditions. But the services he got in school were not very helpful. His mother, Michelle, said a diagnosis of autism brought occupational therapy and other, better services. ''I do have to admit I almost like the idea of having the autistic label, at least over the other labels, because there's more help out there for you,'' said Scheuplein. ''The truth is there's a powerful incentive for physicians and schools to classify children in a way that gets services,'' said Dr. Edwin Trevathan of the U.S. Centers for Disease Control and Prevention. Many with Asperger's and PDD-NOS succeed in school and do not -- at first glance -- have much in common with children like Blake Dees. At a recent gathering of families with Asperger's children in the Atlanta area, parents told almost comical stories about kids who frequently pick their noses, douse food in ketchup or wear the same shirt day after day. Such a frank, humorous exchange was once a rarity. Doctors for many years believed in the ''refrigerator mom'' theory, which held that autism was the result of being raised by a cold, unloving mother. The theory became discredited, but was difficult to dislodge from the popular conscience. Even in the early 1980s, some parents were more comfortable with a diagnosis of mental retardation than autism, said Trevathan, director of the CDC's National Center on Birth Defects and Developmental Disabilities. Today, parents are more likely to cringe at a diagnosis of mental retardation, which is sometimes equated to a feeble-mindedness and may obscure a child's potential. And increasingly, professionals frown at the term: The special education journal Mental Retardation this year changed its name to Intellectual & Developmental Disabilities. The editor said that ''mentally retarded'' is becoming passe and demeaning, much like the terms idiot, imbecile and moron -- once used by doctors to describe varying degrees of mental retardation. In contrast, autism has become culturally acceptable -- and a ticket to a larger range of school services and accommodations. In 1990, Congress added the word ''autism'' as a separate disability category to a federal law that guarantees special education services, and Education Department regulations have included a separate definition of autism since 1992. Before that, children with autism were counted under other disabling conditions, such as mental retardation, said Jim Bradshaw, an education department spokesman. The Social Security Administration also broadened its definition of disability to include spectrum disorders, like Asperger's. Something else changed: The development of new stimulants and other medicines may have encouraged doctors to make diagnoses with the idea of treating them with these drugs. Perception of the size of the problem changed, too. Fourteen years ago, only 1 in 10,000 children were diagnosed with it. Prevalence estimates gradually rose to the current government estimate of one in 150. That increase has been mirrored in school districts. Gwinnett County Public Schools -- Georgia's largest school system -- had eight classrooms for teaching autistic youngsters 13 years ago; today there are 180. Some researchers suggest that as autism spectrum diagnoses have gone up, diagnoses of mild mental retardation have fallen. U.S. Department of Education data show that the number of students with autism rose steadily, from about 42,500 in 1997 to nearly 225,000 in 2006. Meanwhile, the number of students counted as mentally retarded declined from about 603,000 to about 523,000. CDC scientists believe education numbers are misleading, because they reflect only how kids are categorized for services. They say there's no clear evidence doctors are substituting one diagnosis for the other. Some parents believe environmental factors -- ranging from a preservative in vaccines to contaminants in food or water -- may be important contributors. (The last doses of early childhood vaccines containing the preservative thimerosal expired in 2002, although some children's flu shots still contain it.) Dr. Gary Goldstein, scientific adviser to the national advocacy group Autism Speaks, said the explanation for the rising autism prevalence is probably complex. Labeling and diagnosing probably play a role, as do genetics, but he believes the increase surpasses those two explanations. ''I'm seeing more children with autism than I ever would have expected to see,'' said Goldstein, who is chief executive of the Kennedy Krieger Institute, a treatment center for pediatric developmental disabilities in Baltimore. Autism Speaks budgets more than $4 million each year to research the causes of autism, and about 90 percent of that has gone to genetics research. But organization officials recently have been talking about changing that mix, and spending as much as 50 percent of that money on potential environmental triggers, Goldstein said. Whether it's because of genes or the environment (or both), autism has hit the Massey family hard. Chuck and Julia Massey, of Dacula, Ga., have three sons with Asperger's. The youngest, Ryan, was first diagnosed after he was slow to develop speaking ability. His brothers -- Trevor, 14, and Morgan, 16 -- had learning and behavior problems and were later diagnosed with Asperger's, too. All got special education services and were treated with medications. Morgan has improved, or matured, or both, and is now a social kid in mainstream classes at a Gwinnett County high school. Trevor seems to be making the same transition, his mother said. Ryan is the most extreme. He still has uncontrollable tantrums and must attend an Asperger's-only sixth-grade classroom that teaches social skills along with traditional subjects. In a recent interview at the family's home, Ryan acknowledged he still has anger control issues. One of the three other students in his class is particularly irritating. Ryan said the way he reacts is by ''grabbing his throat.'' But on this night, Ryan was calm. He described himself as happy, and paced the room telling jokes, like a nervous stand-up comedian. (''Why didn't the skeleton go to the party? He didn't have the guts,'' he said, eyes fixed on his audience.) Having three Asperger's boys under one roof has at times been very intense, Massey said, noting a replaced dining room window. Ryan acknowledged it's been educational living in a house full of Asperger's kids. Asked to name something he's learned from his brothers, he replied, ''Swears.'' Centers for Disease Control and Prevention autism information: http://www.cdc.gov/ncbddd/autism/ American Academy of Pediatrics autism reports: http://www.aap.org/advocacy/releases/oct07autism.htm Jerry Harkavy, Associated Press, 11/4/2007 RANGELEY, Maine - It was 50 years ago that physician-scientist Wilhelm Reich, best known for his purported discovery of a cosmic life force associated with sexual orgasm, died in federal prison, his books burned and his equipment destroyed by the government. Ridiculed at the time, the European-born psychiatrist is today largely forgotten and his work on what he called orgone energy remains outside the scientific mainstream. But a small number of scientists and other believers are working to advance his studies - and resurrect his reputation. "Personally, I think it's going to be a long time before all of his work is understood and recognized," said Reich's granddaughter, Renata Reich Moise, a nurse-midwife and artist in the coastal town of Hancock. Reich died on Nov. 3, 1957, in a federal prison in Lewisburg, Pa., where he was sent for ignoring an injunction obtained by the Food and Drug Administration that outlawed his orgone energy accumulator. The 50th anniversary of his death is being marked by a major exhibition on Reich and his work that opens Nov. 15 at the Jewish Museum in Vienna, the city where he attended medical school, began his psychiatric practice and studied under Sigmund Freud. In New Jersey, the American College of Orgonomy, which provides training and research support for physicians and others interested in Reich and his legacy, scheduled a conference and dinner to coincide with the anniversary. Also this month, archives made up of nearly 300 boxes of Reich's unpublished papers that were placed in storage at the Countway Library at Harvard Medical School will become available to researchers for the first time. Before going to prison, Reich directed in his will that the scientific papers, journals and diaries only be opened 50 years after his death. He also specified that his laboratory at the 175-acre site he dubbed Orgonon, overlooking Rangeley Lake, be converted into a museum. In Rangeley, where Reich spent his latter years, scientists and doctors from the U.S. and Europe gathered this summer for a conference that explored the prospects of seeking FDA approval for clinical trials of orgone accumulator blankets to treat burn victims. Reich is described by the American Psychoanalytic Association as "one of the most brilliant, creative and controversial of the pioneering analysts." He was the first to focus on character analysis rather than neurotic symptoms. He linked a healthy sex life, which he called "orgastic potency," to emotional wellness, believing that failure to discharge sexual energy resulted in neurotic disorders. His more controversial work came after he veered away from psychotherapy into laboratory experiments in Norway that led to the discovery of what he called "bions" - basic life forms that gave off orgone energy. After moving to the U.S. just before the start of World War II, he focused on isolating and collecting that energy and went on to test its effect on cancer. His orgone accumulators eventually caught the attention of the FDA. After an investigation, the agency branded the devices consisting of alternating metallic and nonmetallic materials a fraud and in 1954 sought an injunction in U.S. District Court in Portland. Reich refused to appear in court, triggering a default judgment and order that his books and accumulators be destroyed. He was sentenced to two years in prison for contempt of court. He served only eight months before he died of a heart attack. In accordance with his wishes, Reich was entombed above ground at Orgonon, with a bronze bust of him perched above the tomb.
Staying Loyal to a Killer, From His Trial to Their Arrest
Leslie Kaufman, New York Times- 11/5/2007 Two decades ago, New York City embarked on an experiment aimed at better assisting and protecting its most vulnerable black and Latino children. At its heart, the effort involved creating and supporting foster care agencies that would, at long last, be run by men and women of color. The city and state opened their wallets. Child welfare experts embraced the concept. There was the sense among some that a kind of racial justice was about to be won. Luis Medina, a charismatic and outspoken child welfare administrator who had grown up poor in the city, became one of the most aggressive proponents of the new philosophy. Mr. Medina liked to say that foster care in New York had become an evil and racist system that was engaged in little more than rounding up poor minority children. He suggested that the traditional foster care agencies that had long been dominant were too interested in collecting government checks. And so when Mr. Medina took the top job at an old-line agency, St. Christopher’s Inc., in the early 1990s, he began transforming it. He hired additional black and Latino caseworkers, and made a priority of appointing minorities to the agency’s board of directors. He promised to recruit local foster parents from the same neighborhoods as the children coming into their care. He argued that black and Latino families, like all others, had a “sacred right” to stay together, and he pledged that his agency would do everything it could to keep intact the families torn at by poverty, illness and drugs. He said minority parents, long demeaned by the child welfare system, would be respected. Mr. Medina even helped create a traveling show: a troupe of parents who talked on stage about their struggles with a hostile foster care bureaucracy. It played across the nation, from Florida to California, and produced applause and tears. But all these efforts eventually came undone, often at a serious human cost. Twenty years later, the city’s ambitious undertaking to improve foster care for the city’s black and Latino children has spanned four mayoral administrations and consumed hundreds of millions of dollars in city, state and federal money. The New York Times spent months examining the investment in minority-run agencies — what once seemed a bold and overdue shift in one of the most challenging areas of social policy. It is as much a story of trouble as of triumph. The Miracle Makers Inc. of Brooklyn, which swiftly grew into one of the largest of the minority agencies, was banished from foster care in 2005 after years of poor performance that shortchanged children. Two other minority agencies, responsible for hundreds of children, were shuttered and their officials convicted of stealing money. Another closed after city investigators found that agency staff members were giving jobs and contracts to relatives. Children with St. Christopher’s, city records show, were abused or neglected at disturbing rates. Family Court judges and lawyers cited the agency for years for ineptitude in handling children’s cases. In 2002, St. Christopher’s got so few children adopted that the city gave it a grade of zero in its performance scoring system. And from 1999 to 2005, seven children whose families had been involved with St. Christopher’s wound up dead. While city and state investigators did not fault the agency directly in each death, in every case they linked agency personnel to a chain of failures and oversights in protecting the children — a discouraging record even for the perilous world of foster care. Through much of this, though, Mr. Medina maintained the public image of an innovator and a maverick, leading a new, more sensitive effort meant to serve the city’s black and Latino children. His agency was sent thousands of children by the city. He was given grants by major child welfare foundations. He traveled the country preaching the virtues of his ideology. In the end, though, the problems at St. Christopher’s, combined with the troubles at Miracle Makers, helped put the entire experiment with minority agencies at risk. In 2005, with the foster care population falling, the city placed the nine private foster care agencies with the lowest performance records on notice that they might be closed. Six of the nine on the review list were minority-run. Had officials closed them, the city, whose foster children were almost entirely black and Latino, would have been left with just two minority agencies The agencies, and their political supporters, resisted. They argued that they had faced financial obstacles others had not. And the white-run agencies had experienced their share of painful scandals, as well. Ultimately, city child welfare officials said they became convinced that a number of the remaining minority agencies were showing improvement, and so today, seven minority foster care agencies are handling some 2,400 children, or about 14 percent of the city’s foster care population, with the city promising better oversight and assistance. At least one of those agencies, the Coalition for Hispanic Family Services, has a solid reputation earned over many years. For St. Christopher’s, though, the end came in 2005, when the city canceled its foster care contracts. City investigators found that workers at the agency had doctored case files for children in its care — forging signatures and inserting made-up notations about whether foster homes had been inspected for safety, or whether children were receiving things as basic as clothing. “There has been a breach of faith by St. Christopher’s,” said John B. Mattingly, the commissioner of the city’s Administration for Children’s Services. One of the painful truths of child welfare work is that the best agencies can make terrible mistakes. Children can be killed while under the care of organizations with decades of experience and multimillion-dollar endowments. No agency has ever been perfect. Since the embarrassment at St. Christopher’s, several people involved in the movement to create and finance minority foster care agencies have portrayed Mr. Medina as an opportunist who capitalized on a popular philosophy but never established reliable roots in the neighborhoods he sought to serve. Mr. Medina and two former board members now say that the city had not formally regarded St. Christopher’s as a minority agency, and that it was “open to question” whether it was fair to group it with the others. A senior city official, though, said that during Mr. Medina’s tenure, the city indeed considered St. Christopher’s a minority agency. The official said what mattered most about minority agencies were their executive directors, and the values they espoused. The official had admired Mr. Medina, and said what happened at St. Christopher’s was heartbreaking. It is clear, then, that the power of the collapse of Mr. Medina’s dreams — and those of the failed minority agencies — is a consequence of the promise they held: to be better and more committed in caring for the vulnerable families in their own communities. Mr. Medina resigned in 2005, having received $500,000 in deferred and other compensation approved by his board of directors. Mr. Medina, who was not implicated by the authorities in the records scandal, spent parts of the next two years in South Africa, as a handful of his colleagues pleaded guilty in the fraud. For months, Mr. Medina, who has since returned to the United States, would not be interviewed by The Times. Recently, he agreed to address some of what happened at St. Christopher’s. He argued that much good work had been done for poor minority families, and he said the city was also responsible for much of what had gone wrong. The Times’s examination found that the city made numerous missteps over the two decades — allowing agencies like St. Christopher’s to grow too fast, and failing to adequately finance and oversee their operations. Mr. Medina, though, also conceded his own failings, and was blunt about what had become of his larger ambitions, and his attempt to give race a vital role in the experiments tried at St. Christopher’s. “We did little to change foster care,” he said. Reconsidering Race Its decision to hire Luis Medina in 1991, then, was a jolting break from the past. And Mr. Medina underscored the tenor of the agency’s new future early on: He ordered the pictures of white children at the agency’s administrative office taken down and replaced with pictures of black and Latino children. It was a gesture worthy of the moment. Tensions had been growing for years in the city’s black and Latino neighborhoods as the foster care system became overwhelmingly filled with their children, and the agencies charged with caring for them continued to be led by white men and women. The agencies — typically Roman Catholic or Jewish — had long been accused of neglecting minority children, even refusing help of any kind to some of them. The children were often placed in homes far from their parents or with foster parents who did not even speak their language. The tensions only worsened in the late 1980s and early ’90s as the crack epidemic sent tens of thousands of additional children into foster care, nearly all of them black or Latino. Overwhelmed, the foster care system began to fail. Newborn babies were left in hospitals; children who had been removed from their homes for their own safety were made to sleep in city offices for nights on end; those who made it into foster homes regularly became lost in a netherworld of bureaucratic indolence. Over those years, the average stay for a child in foster care in New York City doubled — to four years. An idea about one new way forward emerged. Foster care agencies would be created that would be run by people who looked like, and shared the culture of, the children in their care. The new effort was something of a bow to the politics of the time, and in New York it got a boost when David N. Dinkins became the city’s first black mayor in 1990. To run the city’s distressed child welfare system, Mr. Dinkins appointed Robert Little, a former foster child himself and a brother of Malcolm X. Mr. Little made no secret of his disdain for the way the dozens of agencies in the city had treated minority families: He charged that those agencies, in their haste to take black and Latino children from their parents, had failed to be sensitive to a wide variety of social, cultural and racial considerations in a way that had effectively written off hope for minority families. Starting in the late 1980s, the city and the state provided start-up grants to new minority enterprises; over the years, it awarded those agencies and others that came into existence multimillion-dollar contracts to shelter and protect children. Some of the new agencies grew out of small churches; others sprang from nothing but a proposal by a dedicated community activist. And in one case, St. Christopher’s, a veteran agency began to remake itself through a single act: the hiring of Luis Medina. Something New Mr. Medina’s mother quickly developed a little family secret: She let the natural parents visit their children in her home, a violation of accepted policy. She did it out of good intentions and a kinship with other struggling parents. Mr. Medina said he came to know the parents as aunts and uncles, imperfect but good-hearted people who had been misunderstood by the city’s child welfare authorities. It made sense, then, that by the time Mr. Medina got his first job in foster care in the 1970s he was committed to the idea that minorities should be caring for their own. At St. Joseph’s Children’s Services, a Catholic agency in Brooklyn, an experiment in its Williamsburg office had produced a staff that was almost exclusively Latino. But that was not enough for Mr. Medina. “He felt if you weren’t Hispanic, you couldn’t understand the culture,” said Bruce Henry, who was the white director of the Williamsburg center. “He was constantly telling me that because I am not Hispanic I had no idea how to run the program.” Once at St. Christopher’s, Mr. Medina was in a position to put his philosophy in place. For some members of the board of directors, Mr. Medina represented a thrilling opportunity to right past wrongs. “Luis was very impassioned,” said one board member, Dr. Elizabeth A. Wedemeyer. “And there was a lot of excitement because he was a minority leader in foster care, and that was something new.” Some initial years of distinctive success left Mr. Medina well positioned for what came next. In 1996, stung by the gruesome death of a young Latino girl, Mayor Rudolph W. Giuliani committed to a total reorganization of the city’s child welfare system. By 1997, the city had come up with a reform plan that benefited the minority agencies that were in the city’s poorest neighborhoods. Mr. Medina had served on a panel that shaped the reform plan. As it moved forward with the plan, the city publicly committed to better monitoring the work of its foster care agencies. St. Christopher’s opened two offices in the Bronx and another in Harlem. It won enormous contracts to care for greater numbers of children. Mr. Medina added black and Latino managers to run his programs, and pulled the agency out of the association that lobbied on behalf of foster care agencies; he said the foster care system felt like some version of “apartheid.” And his salary rose significantly, climbing by tens of thousands of dollars a year — by the end his compensation package had topped $300,000 annually — and approved by a board that did not do written performance reviews. “Our goal is to be the biggest agency in New York,” he told his staff. But Mr. Medina’s fierce ideology began to divide that staff. By the fall of 1998, senior staff members had begun to express doubts about what was happening at the agency. Some left. One of those was Jeremy Kohomban, who had been in management positions at St. Christopher’s for nearly a decade. In an interview, he said he had been blunt with a city official about his fears. “I told him Luis has gone mad,” Mr. Kohomban recalled. Keeping It Local The woman, Rosalyn Summers, had been strangled by her boyfriend, and the child had been with the body overnight, police reports said. In fact, Victoria was found only because the murderer himself had called the authorities. He had been moved to act, he said in a statement, by the child’s cries. But it was more than an ugly crime scene that day in September 1999. It also represented a failure by Mr. Medina’s agency to make good on one of his most basic philosophical beliefs about how black and Latino children could be kept safe. Mr. Medina had argued that the benefits of recruiting local foster parents were numerous: They would be better able to keep children in familiar surroundings — in their schools, for example, or their churches. And the foster parents themselves would be easier to monitor for agency caseworkers stationed at nearby offices. But Ms. Summers, it turned out, lived in an apartment miles from Victoria’s Brooklyn neighborhood. She was a drug addict and onetime panhandler, records show, who beat and starved the child. Neighbors had called in reports of beatings and drug use. But Mr. Medina’s caseworker noted nothing of this. The idea of recruiting foster parents from the same neighborhoods as the children coming under their care had been a central aim of the city’s new minority agencies. Mr. Medina had underscored the virtues of the goal to city officials when he was on the panel in 1996. “He was a brilliant advocate for his community,” said Nicholas Scoppetta, who was then commissioner of the city’s Administration for Children’s Services. And so in 1997, the city began rolling out its plan to place foster care operations directly into the neediest neighborhoods. Although he had opened his first office in the South Bronx only a year earlier, Mr. Medina landed a $26 million two-year deal that would put more than 1,300 children under his agency’s care — hundreds more than it had before. But almost from the start, records and interviews show, Mr. Medina’s promise to identify and enlist a network of local, responsible foster parents foundered. Still, Mr. Medina’s reliance on the New Jersey firm, Marketing Dynamics, struck the firm’s president as extraordinary. “They depended almost exclusively on us,” said the president, David Schild. “They did not do their own recruitment.” And in time, according to city records, Mr. Medina’s agency struggled to complete the most fundamental steps for ensuring that its hundreds of new foster homes maintained acceptable levels of care and safety. The city’s evaluations of Mr. Medina’s agency showed that in 2000 and 2001 it was among the worst in the city at performing annual reviews of its foster homes. In its response to the city, the agency admitted why: It had only two employees to recertify more than 900 foster homes. From 2001 to 2003, the city ranked St. Christopher’s below the average for some 40 agencies in confirmed cases of abuse and neglect in its foster homes. Those statistics — in 2001, St. Christopher’s finished as the fourth-worst in the city — captured a variety of harm being done to children. Some were dying. Shantel Lisby was 11 months old when she died of a cocaine overdose in her foster mother’s apartment in Brooklyn, blood seeping from her mouth. The drugs had been left in the open, probably by the foster mother’s boyfriend, a drug dealer. State investigators could not find records of how often Mr. Medina’s caseworkers had visited the home. Two former members of St. Christopher’s board defended the agency, saying that its scores for both abuse and neglect were “reasonably close to average” for most years. They said that each child’s death had been thoroughly investigated and that the agency had completed whatever corrective actions the state required as a result. The troubles at St. Christopher’s certainly did little to damage Mr. Medina’s stature. From 1999 to 2002, the city awarded his agency more than $100 million in additional foster care contracts. Others shared the city’s enduring faith in Mr. Medina. In 2002, St. Christopher’s received a $100,000 grant from a major child welfare foundation for one of his experimental programs. The same year, he was named chairman of the National Council of Latino Executives, and given a seat on the board of the Child Welfare League of America. Shay Bilchik, who was the league’s president until March, said Mr. Medina was always challenging other executives to think about how to provide distinctive services to their black and Latino families. “Luis was a very animated, active, creative thinker,” he said. ‘Mr. System’ The troupe was Mr. Medina’s inspiration. He paid the parents a stipend to participate in workshops, where a script was developed and rehearsed. He helped secure more than $100,000 in grants so the troupe could travel to cities like Los Angeles and Washington. One unspoken part of the script was that for parents like those on stage, things would be different with Mr. Medina’s agency. Parents involved with his agency would have access at all hours to the caseworkers overseeing their children, and a say in decisions about how those children were being raised. They would have frequent visits with their children in warm, homey settings. It did not take long for Mr. Medina’s new model, according to many who worked for him, to fracture. Mr. Medina’s main Bronx office became overrun by parents, some of whom were dangerous and some of whom came simply to hang out. The presence of the parents — often confused or furious — and a chronic shortage of staff created disorder, particularly during visiting hours with their children. Telephones could go unanswered, dirty diapers often collected in the corners, toilets went unfixed, fights broke out, children were snatched. “We felt unsafe,” said Starr Lozada, who was a caseworker based in Mr. Medina’s River Avenue office in the Bronx in 2004. “The birth parents would come and hang out all day. Maybe they would come for the breakfast. Talk with each other. Stay until we closed.” The parents would even bring in people from the neighborhood, and there was screaming and carrying on, Ms. Lozada said. “We didn’t have much say.” Lapses could occur. At one office, a mother whose preschool-age children had been removed from her care, because they had contracted sexually transmitted diseases, was allowed to camp out with them in the bathroom, unsupervised. Another mother, who had lost her older children in part because she had forced them to eat their own vomit, arrived at the Bronx office one day in 2001 and walked out of the visiting center with two younger sons, who were also in foster care. The caseworkers did not intervene; the boys were not found for eight months. Dismay soon led to rampant turnover among the staff. Fully half the work force had to be replaced every year near the end of Mr. Medina’s tenure, as the black and Latino workers Mr. Medina had recruited left in frustration — feeling underpaid and undertrained. Shortcuts, then, were taken. For instance, Jacqueline Thompson showed up at the office on River Avenue to inquire about a position. She was hired that afternoon, she said. “I was a little shocked,” she recalled. But if Ms. Thompson, a caseworker with six years of experience, was taken aback by the swiftness of her hiring, it was nothing like the unease she felt when she was handed case files on about 30 children. Most of the files lacked the basic, required information on the well-being of the children. She contacted the parents and foster parents only to hear that they had not seen a caseworker in months. “There was no monitoring,” she said. With staff members fleeing, something of a solution evolved on its own in the Bronx, and it involved Mr. Medina’s favorite program for assisting parents with children in foster care. The program took parents who had gotten their children back from foster care, gave them the title “parent advocate,” and paid them a salary to mentor parents whose children had just been taken away. By 2003, though, the Bronx office was so shorthanded that some of those parent advocates said they were asked to fill in for overtaxed or uninterested caseworkers. The parents, lacking formal training, would make what amounted to inspection visits to potentially dangerous homes, and their findings, they said, wound up in formal case files. They would even appear in court alongside the families. Hilda Gonzalez, one parent advocate, said caseworkers sometimes telephoned instead of visiting homes. “They would ask questions like, ‘How are you? Do you have food?’” she said. “And then the advocates would go out on our own to do the visits and make sure they just weren’t lying.” Such practices violated fundamental standards for a foster care agency. Making judgments about the safety of a household is difficult and dicey; professionals are trained to notice warning signs and to be brave enough to ask tough questions. In 2003, Angel Centeno, 5 months old, was found dead, his lips a deep purple, his body shoved into a space less than 12 inches wide near the floor of a homeless shelter. The boy had been under the care of a mother with a history of substance abuse, who had had four children permanently removed from her care. A parent advocate had been playing a critical role in trying to keep tabs on the household. Cheryl Hawkins, who worked as a parent advocate with other families, said little felt right or safe about the way the program was run under Mr. Medina. “We worked five hours a day for about $200” a week, Ms. Hawkins said. “I had a caseload of 10. We didn’t have degrees, and we made more home visits than the caseworkers.” ‘A Sacred Right’ Anne Williams-Isom, a senior official with the city’s child welfare agency who saw Mr. Medina in action, remembered being wowed by his nerve. At meetings she attended, she recalled his being confrontational, at times effectively charging that the white agencies were more interested in getting the daily payments for their foster children than in returning them to their homes. For Mr. Medina, the moral obligation to reunite families was such an article of faith that he asked an assistant dean at Columbia University to study the issue. He was certain that the study would prove that his agency had been better able to achieve such reunifications because it was in the hands of minority leaders. The study was done; the thesis could not be proved. But Mr. Medina’s conviction was not shaken. And so Mr. Medina boasted that he aimed to reunify more families than any other agency. Adoption was to be used only as a rare last resort. For a little while it looked as though Mr. Medina’s push was a success. The agency’s record was singled out in an optimistic front-page article in The Times in 1995. That success continued for several years, but then stalled. Mr. Medina said it was because by then he had been left with the more difficult families. The work of nursing those kinds of broken families back to health is hard. And one of Mr. Medina’s ideas for providing such help — the creation of medical and mental health clinics for parents and children — wound up in financial ruins, with the clinics losing hundreds of thousands of dollars a year. So the risks of Mr. Medina’s extreme commitment were considerable: Children could be rushed back into homes that were still dangerous or unstable; or they could languish in foster care as one effort after another was made to work with the most deeply disturbed parents. In both 2000 and 2001, when the city measured how much time it took each agency to reunify children with their parents, St. Christopher’s scored below the average for the city’s 40-plus agencies. By 2002, only two other agencies in the city did worse. Some felt that the reason might be plain indifference. Sara P. Schechter, a family court judge in Manhattan who regularly oversaw the cases of children in Mr. Medina’s care, said: “The problems at St. Christopher’s were both qualitatively and quantitatively worse than other agencies. Things that happened occasionally at other agencies would happen all the time at St. Chris. Things like no one showing up at all for the hearings.” The agency, in responding to complaints at the time, said Mr. Medina’s ideology was partly to blame. It worked far too long with parents who were beyond help. One girl, identified in court papers only as J. P., suffered the consequences. She was 7 when her mother, a drug addict, dropped her off at school and never picked her up. She is 15 today, has suffered psychological breakdowns and is still in foster care. Of Mr. Medina’s agency, J. P. says: “Literally, they gave my mother too many chances. It was just stupid.” J. P. was not alone. Records show that caseworkers at St. Christopher’s repeatedly missed court dates meant to move children into adoptive homes. Scores of the agency’s children ended up spending four or more years in foster care. It was the very fate that had first provoked Mr. Medina into his campaign against the old agencies. But there were also children who were sent back to homes that were no more safe than when they had been removed from them. Destiny Spearman was one of those children. She was 3 when Mr. Medina’s agency and a judge agreed that she should be returned to her mother and father. There was, though, ample cause for concern. When Destiny was a baby, her mother had failed for two days to seek any help for her child after she had broken her femur. And her father had a long criminal record. The court charged Mr. Medina’s agency with making sure Destiny’s return went well. Destiny’s father killed her nine months after her return in 1998, smashing her head against a piece of furniture. State investigators could not determine if the caseworker had even visited the apartment she died in. Citing “poor supervision” of the high-risk case, the city ordered Mr. Medina’s agency to review and improve its performance. Mr. Medina’s foster care programs, though, proved beyond fixing. Today, St. Christopher’s has a new management team, with a white executive director. The state has granted it several contracts to run educational programs for some of the same vulnerable children that had been in its now-defunct foster care programs. City and state officials have given the agency’s recent work high marks. Looking back, Mr. Medina says he now recognizes his shortcomings. “I was not qualified enough to be both an administrator and an advocate,” he said, expressing regret that he had taken such confrontational stands. “Advocacy is perhaps best left to people that do not have to get into the business of delivering the service.” (Click here for #2 of 3 articles)
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