April 22, 2016, Child Welfare and Our Youngest Children CLE Audio Recording

Starts at 4:05 with Tyler Smith, EIC, introduction5:56 Dean Ullem’s Welcome9:02 Professor Brent Pattison introduction

Panelists in the order in which Professor Pattison introduces them:Judy NorrisDr. Rizwan Z. Shah, M.D., FAAPJudge Joseph W SedlinTracy WhiteKathrine Cru

Professor Pattison asks questions of the speakers in the following order:Judy Norris starts around 15:25Dr. Rizwan Z. Shah, M.D., FAAP starts around 22:04Judge Joseph W. Sedlin starts around 32:34Tracy White starts around 41:10Dr. Rizwan Z. Shah, M.D., FAAP answers another question around 53:19Professor Pattison shares an antidote 56:10Then it is a back and forth between the speakersKathrine (“Kat”) Cru starts 1:01:59

Q and A begins around 1:14:00

Panel from Thumb drive

First Speaker – Dean Ullem

Actually, Lyle and Joan Middleton, Lyle when he was still living and Joan now have been friends of mine for decades, so I know them quite well and they’d be very proud of what’s going on here. Joanie today lives and breathes what’s happening in the clinic and in the center. My job is to say hello and welcome and I do see some familiar faces here in the audience. I’ve said “hello and welcome” to many of you several times over the last couple of years, but it’s my pleasure to do it again. This building, for those of you how aren’t familiar with it, is basically a law firm and there are a number of clinics within the building that do things for people who can’t afford legal services. There’s a human rights clinic. There’s a criminal defense and prosecution clinic. There’s a general practice which includes family law and several others. Thousands of hours a year are spent in this place to represent people who don’t get representation otherwise and this a really fabulous thing that’s going on here. The law school, for those of you who don’t know, is about two minutes that direction and I just left there and out in the middle of the painted street, the tradition is occurring right now where it’s getting painted and so are about 500 students painting themselves and other things. The trees are wrapped so the trees don’t get painted, but it's hysterically funny and they’re having a great time. So, if you get time over the next few weeks, it’s be worth while walking by because it’s a treat to see it.

Just so you’ll also know, the law school in addition to the regular full-time JD doctor students program has masters programs as well. They have one in health law that’s become popular for people who already have their undergraduate degree but don’t want a JD. They can get a master’s degree about things that are important to them and health law is a very popular one. We have others as well.

One clinic we’re especially proud of is the one that you are here about today and that’s the Middleton Center for Children’s Rights led by Brent Pattison. Brent is also associate clinical professor of the law school. He directs the center and we’re really proud of what that center does for children. There’s nothing more important than those who can’t take care of themselves and what you’re doing here is advocating for them and learning about what you can do to help them and we’re very pleased with all of that. I understand too that you’ve been very much involved in the Safe Babies court team that Polk County has been working on. We’re really pleased about that happening as well. With that, I’m going to turn it over to Brent Pattison.

Brent Pattison

I’m going to be quick, but I have some thank you to give. First, thanks to Dean Ullem for the introduction and for coming today and talking with us for a little bit. I want to thank everyone for coming on a Friday afternoon. I know this would be an easy time after work to be doing something else, but I’m really pleased that people are willing to come and share some time with us. I really want to thank the law review for being willing to take on this issue. There aren’t that many law reviews around the country that are training their sights on child welfare law and I think it’s really great that our law review looks at that as something that’s important to talk about and cover and I’m especially grateful that they’re recording this event today because even though it’s a Friday afternoon and we wouldn’t expect to fill the court room this conversation that we have here today is going to be recorded so it can be used for CLE across the state. I very grateful to the law review for working that out as well.

We’re really lucky here today to have four panelists and really even five to a certain extent and I want to introduce all of them to you. First, Judy Norris. So Judy Norris is from the national Zero to Three Project. She’s been working with our Safe Babies court team since forever. She’s kind of more loosely connected to it now maybe you could say, but has been a critical component of it. I still remember, when she was in court, going to court hearings and when all of us were the most perplexed we would all just go look at Judy, including Judge Cohen by the way. And we’d be sort of, “figure this out, Judy. Tell us what we need to do,” and she’d just be an invaluable member of the Safe Babies court team.

We also have Dr. Rizwan Shah who has spent years and years as a pediatrician here at Blank Children’s Hospital and also was really involved in the formation of Safe Baby court teams in Iowa. We’re really grateful you’re willing to spend your time here today talking about some of the history of it and the importance of pediatricians being involved in the multidisciplinary nature of this work.

We’re also lucky to have Judge Joseph Silen here. Judge Silen is the presiding judge over the Safe Babies court team in Des Moines now. I don’t know if he sort of knew that was what he’d be stepping into when he became a juvenile court judge, but he’s done an amazing job and I tell him all the time, and I know it doesn’t do me any good with my legal arguments, but we learn something every time we appear in front of him and he does a great job in that court room and in all his other cases as well.

And then, finally, we have Tracey White. Tracey White is a social work administrator as DHS. I think that she probably would say first and foremost she’s a social worker. We’ve had the chance to work on a bunch of issues together over my time here and she’s a tireless advocate for kids and families.

And then we’re also very fortunate to have Katherine Crew here who is the new, well not so new, coordinator for the Safe Babies court team and I hope you’ll get a chance to hear a little from her about how that program’s going now.

Before we get started with the conversation, does everyone here know what the Safe Babies court teams are? Raise your hand if you already know something about them or maybe you have had some limited, great okay. So, they started back in 2004 I think in the country and ours was 2005. They rose for, I think, three or four really important reasons. The first, is that these kids and families are some of the most vulnerable kids and families we have in juvenile court. You know, it’s not just the kids that are young. The parents are very young as well. The timelines for reunification in these cases are as short as six months. So, if a parent’s struggling and comes to court having just lost custody of their child, they have a relatively short period of time to really get the treatment and services they need in order to do a successful reunification. So, it’s critical that we engage families quickly and that we get them the support they need so that we can put families back together.

The other thing that I think is a little bit unique about these cases is the importance of a multidisciplinary approach. That’s one of the things that the Safe Babies court team has really pioneered. Pediatricians, educators, social workers, lawyers, judges all working together towards trying to address the family’s needs and help try to put the family back together again. What arose is a response to all of these problems and trying to do a better job and what we’ve done traditionally and they’ve now been around for eleven years here and maybe twelve in some other places. Hawaii may have been one of the first. So, what we’re going to talk about today is about some of the unique challenges that confront lawyers and judges and social workers and pediatricians in these cases, but also lessons learned, what we know now about what works, and how we can do a better job in all of our cases that involve some of our youngest children. Because the bottom line is that I think there’s only one in the state of Iowa that’s taking this special approach and we’ve got plenty of zero to three kids in other court rooms around the state and so one of the critical questions for us moving forward is how to take some of the best practices from these cases and move them into traditional juvenile court rooms.

So, with that, I’m going to start and where I’d like to start with the panelists is really to start with Judy, if you’re okay with that, and some of the special challenges that you see as a social worker in these cases and coordinator for Safe Babies court rooms for the parents and kids that are in them.

Judy Norris: The challenges for the parents?

Brent Pattison: Yeah, we can start with that.

Judy Norris: I think the challenges for the parents of these young kids is obviously that timeline. When we work in such a multidisciplinary approach where we have – I come from a background of social work and I’m not an expert in early childhood. I’m not an expert in the medical field. I’m not an expert in law. I’m not an expert in any of those really detailed areas that we need to have the best of the best involved with these most vulnerable families. I think the challenge that the parents have is that when we learn

about even so many of the parents come in with substance abuse issues and they have such an uphill battle to get themselves in a good place where they can safely parent and we quickly realized in that I would say the very first case that we took on we said, “Oh, we know what we need to put in place for the child. We have early HeadStart. We have early access, Part C services. We have the Regional Child Protection Center. Those are the best of the best,” and then realized that our reunification wasn’t going to happen like we really wanted to have happen because we weren’t focusing on all of those issues that the parents came to us with. So, we’re working against that timeline and the parents are working against all that they have to overcome so we needed to really band together as a multidisciplinary group and support these parents and get the best of the best for them as well. Because they shouldn’t have to face that challenge without having the support of all of the folks in our committees and our stakeholders group. So, we learned from all of them so we can give the parents what they need.

A good example is when we learned about substance abuse. I’m not a substance abuse counselor, but what we learned and what the judge learned was that when somebody’s recovering from methamphetamines they go through at the point of six months, which is when we’re trying to reunify, the parent goes through some pretty significant struggles and they’re at the highest risk of relapse. We hadn’t know that. We thought, “Oh, they’re just trying to fail.” Right? But, everybody came together and learned about that, so when these parents face these challenges it’s up to us as professionals to learn to support those parents to overcome those.

Brent Pattison: Judy, is one of the problems, sometimes, that there’s a mismatch between what the federal timelines say about reunification and what we know about substance abuse treatment and the length of time it takes to get clean and to stay clean?

Judy Norris: It is a mismatch. It’s an unfortunate mismatch, but I don’t know the answer to that because when you are looking at children at the age of three and you learn the science of their development, six months to them is quite a bit of their life already. Right? So, it’s a delicate balance because we have parents that are trying to get through a lifetime of, probably, trauma and childhood issues, as we learned from ACES and all of that stuff. So, we have to come together to try to figure out how to work that delicate balance and get everybody to the point where they need to be. And if it can’t happen, what’s the second- the lesser of two evils? How do we ensure that these parents might be able to have some sort of relationship beyond it if they can’t redefine their relationship as a parent?

Brent Pattison: Judy, you mentioned a kind of host of services that are put in place that Safe Babies court has kind of built up over time; Part C services, the early access, and early HeadStart. Can you describe a little bit about- not everybody here probably knows what those things are?

Judy Norris: Well, you guys know Dr. Shah, right? We knew who to go to first. One of our first meeting was with Drake with the early HeadStart program because we knew that they are the best in the country in dealing with early childhood development and we had one right here in the city. And our first meeting that we had was going and talking to the director over there saying, “How can we get an opportunity for a teacher from early HeadStart to come and learn about how child welfare works and we learned about how early HeadStart works and developed that collaborative partnership. It took several years, but early HeadStart was able to supply us with a teacher that goes into the homes now and she has specifically the court case loads, so that’s can example. Part C services is through the No Child Left Behind- what is that law, I don’t know- but it was the answer to No Child Left Behind for children under the age of three. And so every child that is placed in foster care is entitled to a developmental assessment through these

Part C services. It happens in every state around the country. So, we were tapping into that element that these families had for their children. It was there, but the process was too difficult, so as a multidisciplinary team that is what we did behind the scenes. Is, how do we make this simpler for these department workers to be able to make an easy referral over there? So, that’s one of the examples that we use. Of course the Regional Child Protection Center, I think it goes without saying, you know, when we have these vulnerable children coming in they usually have some significant delays; whether it’s developmental, physical, or even socio-emotional. So, it was really critical to partner with the Regional Child Protection Center because they are the best of the best, in my opinion, across the country, but in the state here. So, we learned a lot from them in order to apply to the child welfare cases.

Brent Pattison: So, that’s a nice segway to Dr. Shah. And I wonder, Dr. Shah, if you can tell us a little bit about the kind of beginning stages of developing the Safe Babies court team and your involvement in it and what you are trying to do.

Dr. Shah: My contribution is by profession. In my practice, with the vulnerable children in the social welfare system, and especially the children who were living in an environment where their parents were affected by substance abuse, I did not learn and was not taught those skills in my med school, or in my residency training, or in the early part of my practice. So, it takes a sensitivity and, probably, beyond a normal person’s heart to say, “I can take it on”. But, when I was young I was naïve enough to say, “That you know no one wants to tackle child abuse in the medical profession. I’m going to do that because that will encourage other of my colleagues to come on board. They’ll say, ‘Well how hard can it be. If she can do it, we can do it.’ ” But, guess what? For thirty-five-some years I was the lone ranger. So I was doing that. I had large support, but it required my colleagues patting me on the shoulder and saying, “Rizwan, we are so proud of you. You’re doing a good job. Keep on doing it. We’ll send all our problem cases to you.” So, I mean- you need to have- that was the biggest challenge. That there was a time for ten years I did not take a vacation, a single day off- I did not take it. I would be available twenty-four/seven.

And when you’re talking about the challenges you need to have- what you really need- is champions for children. These are the people who I would call them- maybe they are selfish and maybe they don’t know any better- but they’ll stick their neck out and say, “Okay, we’ll take this challenge on. Because the challenges are great. And fortunately at the time of when we said we need to have the Safe Babies court a lot of knowledge was coming in about what babies really know from the very beginning. And, just let me give you an example. I bet most of you are not aware of the fact that every newborn baby is required to perform six really critical skills for their survival- within a minute of their birth, and to perform them with one hundred percent accuracy. Skills that they have never done before. There are a lot of smart people in this room and if I gave you a task to perform that you had never done in your life before, and to do it with one hundred percent accuracy within a minute, none of us could do that. I’m telling you. And almost all babies do that. They are breathing on their own, keep their heart rate, keep their temperature, start eating-you’ve never eaten for nine months before, start pooping and peeing- that’s a skill you learn to do. And all those skills, babies do that. And they do that with one hundred percent accuracy and that means that they have organizational skills as good as most smart adults, but better than that.

And yet, many adults do not understand babies. And they think-well you know why- because we have kind of gotten ourselves limited by this thing we call language. Unless someone talks to us, we

don’t understand each other. And a lot more understanding happens without verbal communication. And that’s what babies do. And as a pediatrician who is dealing with small babies, especially in the zero to three age group, has to learn how to understand that communication. In my clinic, I teach the residents who are physicians, who are past the medical degree education, and as they came to me the first thing I did after introducing myself is take their stethoscope away from them- you know that thing that hangs around and makes us doctors feel like doctors. I call it “doctor’s pacifiers’”. It makes them feel good to cure, but what I don’t like is a doctor when they come to see you they say, “Hi, how are you?” and then they stick those things in their ears. They are not listening to you. And that’s what happens to most of the patients, so I do that. The second thing I did was, I asked every one of my young physicians, “Do you have baby’s permission to go and interact with them and touch them?” And they would look at me and go, “What? A baby that is only a couple of days old?” I said, “You need to. You need to have the babies’ permission before you encroach upon this boundary that is their safe land. And that is what we need to learn. This goes across the disciplines that Safe Babies court does and learns-that babies have a voice too, although they may not be talking. They have feelings. They are very observant. They know everything that goes around them and you better believe it, though they may not be able to say it. And they will interact with us nonverbally, but for a long time people working with little babies did not understand that.

We just kind of moved them- like the blocks- from one place to another place and who will be matched in a foster homes and say, “Okay, how are the visitations going with the parents?” “Oh, the baby’s having too much stress because the mother came and the baby started crying and so, now they are going to have once a month visits.” And I would say, “What?” And wouldn’t you cry if you were taken away from your loved one and you don’t have a sense of time and you haven’t seen them for a whole week, which to you as a baby may be a lifetime. And, then you see that same person that you’re so connected with and you cry because you protest and say, “How could you leave me?” But, we did not understand that. So, Safe Babies court changed that and said, “Wait a minute. There needs to be more interaction rather than stopping.” So, people started listening and that’s what happened.

And what you needed was a team of people because you needed to have young lawyers who were representing them- young or old lawyers, I shouldn’t say young- but sensitive people who could understand the parents’ needs and who could understand the baby’s needs. And you needed to have the social worker who was able to bend the rules and say, “Well if this is not the policy, well so what. This is what the baby needs. I can do that.” You needed to have the judges who not paid attention to what was written in the report, but who looked at the people and saw the child’s needs and the parent’s needs and what the stresses were. Because a lot of these families had twenty-five different services and twenty-four hours a day and they couldn’t meet them and do it. And you know, we can’t do that or expect these parents to do that. And you needed to have a medical professional who would not just be in the role of giving babies the shots so they did not get polio and all that, but also were willing to listen to the babies and also have empathy for both biological parents and look at the needs of the foster parents and connected with these agencies. These were all the challenges because none of us had ever acquired any training anywhere in our profession, and we all had to learn. But, do you know the good thing? The wonderful thing about people in Iowa, and people in Des Moines- we know each other and we have personal connections and we talk to each other, so we can together as a team. And, you know, we said, “Okay, what can you bring, Dr. Shah? What can you tell us? Social workers, yes, what can you

do? Change and bend a little bit of rules and see what we can do for the families. And judges, you can facilitate.”

And one of the best things I remember- it was just an eye opening experience- we used to have a parent release of information form. We had twenty-five forms where the parent had to go to twenty-five different places- in the doctor’s office, in HeadStart, in the visitiong nurses. Okay, release of information so these people can- and the parents would get sick and tired. And with Babies Court we took all those forms, put them on the table at the court, and it took the parent less than half an hour to get release of information signed. Everybody got them. So much time saved and so much better communication.

Judy Norris: And their legal representative is right there.

Dr. Shah: And legal representative is right there! Simple things that you don’t find in the books. They were not in the books. And this was the beauty of the Safe Babies court, I would say. But, if we would have been overrun with all the challenges I think they would say we weren’t smart enough to get around all the challenges- except if you want to do it, you do it.

Brent Pattison: Thank you. Dr. Shah. So, Judge Sedlin, you come to the juvenile court bench probably two years ago?

Judge Sedlin: Over two and a half.

Brent Pattison: Two and a half. And then you get the added challenge of taking over the Safe Babies court. What are the challenges you saw right from the beginning?

Judge Sedlin: First of all, every time I come to this building I am so impressed. I just want to tell you that. When I was going to law school here thirty-some odd years ago the clinic, which I was a big part of then, operated out of an old house on Brattleboro. And how we recruited people into the clinic- for some reason it wasn’t all that popular- was we had a kegger. Free beer.

Brent Pattison: Does that have anything to do with this? Other than remembering that correctly. This shouldn’t be recorded.

Judge Sedlin: But, this is uh-it’s come a long way. I am very impressed and very happy to be here. The challenge for me was ‘what’s my role?’ This program, when I came, had been in place for about eight years. I’ll tell you- the one thing that I didn’t want to do- what irritated me the most when I was a lawyer. And that was when I had a hearing in front of the judge and the judge decided to find authenticate the state of affairs when the judge was the least informed person in the room as to what was going on. Not wanting to be that person, I am being handed this document of opportunities for me. The experts were already in place. My role was to convene them and to give them a laboratory to operate and that is my role in the experiments, the processes that the experts in early childhood development and treatment can work with.

Then, my role is to make sure that the parents who are in my court room leave my court room understanding what just happened. That is an important role, not only for me, but for the lawyers who represent these parents. To put yourselves in their shoes, especially early on in the case, like the removal. They’ve had their child or children whisked away and in our court, Safe Babies court, hopefully that was less of a traumatic experience, as there was a pre and post removal conference in which they

were involved in, and had some say in where their children were going and what their children’s needs were. But, nonetheless, coming to court with their child being moved, and now they’re seeing some guy in a robe come out and all of a sudden their intimidation factor is well underway. And you can talk to these people and encourage them and tell them what’s going to happen- what is happening and what is going to happen next- which I view as a big role of mine. To make sure we explain, this is the purpose of this hearing and this is what we’re doing and this is what we’ve done and then tell them what’s going to happen the next time and explain that. We try to answer their questions. No matter how much we do that, and no matter how much the parent nods and tells you that they have no questions, I know that they’re not hearing most of what’s being said. And that’s why the attorney’s role, and my role of encouraging the attorneys is to make sure that they debrief with their client after each hearing and before the next hearing. But, it’s important right away after a hearing to simply not say, “Okay, you heard the judge. Good job. See you next time.” They don’t know what just happened. So it is very important to go over what just happened, process it. I think that takes large, leaping steps towards potential success.

My other role, the way I see it, at this point in Safe Babies court- and just so you understand what it is from my perspective- there are six juvenile court rooms in Polk County, I don’t know what the percentage of cases are that involve removal of a child between the ages of zero and three, cause I don’t get them all. It doesn’t mean that all cases from zero to three come to Judge Sedlin, thank god. This court is about-runs between fifteen and twenty cases. What we are trying to do, as I said, is convene a laboratory to find out what practices work best and then try to expand on those practices throughout, not just the other cases that I have, but the cases that the other five judges have in Polk County and then throughout the state. Since we got to talk last month to attorneys and judges throughout the state about what we do, it’s a great opportunity for us to tell them what the successes are. So, Safe Babies court is an experimental court and we are doing things that provide opportunities for betterment and success. And I try to keep that in mind.

My other role is to encourage, not just the parents of these children- it’s important to encourage them and help them understand that once we get past the adjudication stage we try to be a team, we try to all work on the same page and work toward the same goal. And I try to make them understand that- help them understand that. But, I also want my role to be that I encourage the attorneys in the room, I encourage the professionals who all show up at these hearings by trying to involve them and find out- ask questions- about what is going to be helpful, what they can do- what we all can do- as we work toward a resolution. So, those are the things that I do, as my role. I could on and on about all the things that happen within those confines, but I could probably expand on those later. I don’t know if that answers your question about where I- but that’s the way I do things ten or twelve years into this program, what the judges role is.

Brent Pattison: That’s great, Judge Sedlin. Thanks. So, Tracy, we come to you. And so, from DHS’ point of view you get a new case with a really young child, whether it’s Safe Babies court or not, what’s the social worker confronting from the very beginning?

Tracy White: Well, I was one of the social workers, when I started at DHS that Dr. Shah referred to. So, sixteen years ago I was a child protection assessment worker and I would go to homes in the middle of the night, I would go to daycares, I would go to schools, and I would have a police officer with me and I would have a court order signed by a judge and I would take that child with me and I would put them in

foster care. I would tell the parents, “We’ll see you in a couple weeks at the removal hearing and we will let you know what is happening then.” And when I came to the department, I was very interested in straight face practice, but it wasn’t the mode of the day. And I see Safe Babies court team as kind of a precursor to practice we have now. And I look at the young social workers we have coming in and they work in Safe Babies court teams. They have, as Judge Sedlin mentioned, pre-removal conferences. This effort was precursor to all of the straight face practices we have now. So, we talked about pre-removal conferences which grew from this effort. And that’s where I, as a social worker, I didn’t take that baby in the middle of the night anymore. I went to the parents and I said, “You know what, your kiddo isn’t safe tonight. Who in your family doesn’t have a criminal background, doesn’t have a history with the Department of Human Services in child abuse that would preclude them from being a placement. Where can your baby go tonight? And tomorrow, bring all your supports to the office and we’re gonna talk.” Precursor to the Parent Partner Program that we started matching parents that have been through our system and had kids removed with parents who are new to our system, so that they can walk them through what will be happening to them. So, all of these practices that we have embedded really grew from this effort of recognizing, like Dr. Shah said, the child’s voice.

I think the biggest challenge for our social workers with kiddos zero to three, first of all, is that time frame we are working under-according to the Adoptions and Safe Families Act, Brent was right, we have six months from the date that judge signs that removal order to get kids returned home. And the majority of our cases are families that are abusing substances, mostly methamphetamine, now abusing prescription drugs, and heroin- you know, we are seeing an influx of heroin in our area, the eastern side of our state. And those families, it takes a lot longer than those six months to be successful in treatment and be able to assume care of their kids again. The other thing we are really seeing is, cases with severe domestic violence and we all know, you know, women that are in a domestically violent relationship leave an average of seven times. Well, it’s probably not in the first six months that we become involved. So, those time frames and these issues that we’re seeing that are so significant for parents, that’s a huge challenge. I think our workers would say- because our workers have to assess a child’s safety using three safety constructs. So, we look at child vulnerability- and these kids are our most vulnerable kids, right? The threat of maltreatment is our second safety construct. So, what’s the threat of repeat maltreatment? If parents are using drugs, if parents are in domestically violent relationships that’s a huge form of maltreatment for a kid who’s very vulnerable. The third thing we look at is the parents’ protective capacities.

What we mandate for our social workers is that they have to visit all of the kids on their caseloads once a month, they have to visit all the parents, and they have to visit all of the placements. If we got a seven year old or a teenager, they can tell us if they’re safe or not. They can talk to us about what’s happening with them. And these kiddos can’t do that, so the workers that are involved with Safe Babies court team, they have to rely on all of these resources they have on the team to talk to them about child development, to talk to them about childhood trauma. Back in my day, we thought the kids were better off over in foster care. Well, now we know so much about ACES and trauma- we know how much that affected those kids. And I look back on the kids that I worked with sixteen years ago and I want to write every single one of them a letter of apology. So, we now are using these best practices that we’ve learned to try and enhance the experience that the kids have moving through our system. But, I think our workers would say, with these young children, their increased vulnerability and threat of maltreatment and our ability to assess safety without being able to ask them what happened to them.

So they have to be knowledgeable about ages and stages. They have to be knowledgeable about child development. They have to be knowledgeable about trauma and they have to be knowledgeable about behavioral indicators. And they really do rely on their experts in the team to help with that. So, I think they would say that that’s their biggest challenge.

We, the Department of Human Services, went through a childhood family service review a few years back, and we are getting ready to go through it again. One of the things that we failed in is placement stability- so kids have placement after placement after placement. And we first took a look at it and thought, “Okay, it’s the obnoxious teenagers. They got into them and people were like ‘no way I can’t handle this.’ ” And so we did a study and what we realized was it was our kids one and under- it was our kids six months and under- because they would get, hopefully, with their relative-

Judy Norris: And that’s a national trend- it was a national trend.

Tracy White: They would- the kiddos- crying all night, they didn’t have good childcare. There’s lots of things about that kids development that made even their relatives give up. And sometimes it’s a good change, because it’s a relative that’s more able to care for the child. But sometimes it’s to foster placements or sometimes it’s to the Crisis Nursery. So, placement stability for our very, very young babies has been an issue for us. So, what we’re learning is Safe Babies court teams is about how to support parents and how to support relatives and hopefully ask for extensions on the time frame. Those are some of the challenges that are workers and supervisors face with this population.

Brent Pattison: So, I wanna leave some time for questions, but first, I wanna do kind of a quick round through all of you- starting with you, Judy- about what are the big things that you think you’re doing in zero to three work that we should be pushing out other places. What are some top things you say we could be doing better in places, generally?

Judy Norris: Well, I think continuous and ongoing training- I don’t know how many of you are law students- but you’re coming into this realm and although we talk about here and you think, “Wait a minute this isn’t law school”. But, if we don’t have a collaborative partnership with legal counsel we don’t get very far either. And I think Kat can attest to how many lawyers come in who have never heard of this, right? And rightfully so, you know, they went to law school to be a lawyer, not a child development expert or anything like that. But, when we can work together- and I didn’t know anything about law when this started, and I went to court and I testified in Judge Coen’s (spelling?) court room and I thought I knew everything, right? But, sitting there and observing court and watching the interactions with the lawyers and what the lawyers have to go through and what they have to follow and how they advocate for their parents- for their clients- is something I needed to learn. So, I think the constant awareness and training- changing laws, lawyers need to help us, social workers, understand when there might be a change in the laws. The community coordinator is in existence, so in case you have any questions about resources your clients might need, she’s the one. She’s like the United Way 411, you know the website- I don’t know if it’s even in existence anymore. But, Kat is in existence. So, I think that’s a constant challenge, we want everybody to be very aware and have this team approach because it can happen in any court room.

But, like Judge Sedlin said, you have to have a place where you can experiment a little bit, because sometimes when you try things it’s not gonna work out all that great. And you go, “Well, maybe we should tweak this a little bit.” And that’s an opportunity to do it. And then you come back- you come

back to the table- and you say, “How can we spread this out to the other court rooms in Polk County or across the state or across the country?” And so what zero to three is doing is we have- I think we have- a total of fifteen sites right now around the country where we are doing research to see how effective we are. I know that we- here’s what we’ve been affected with- we’ve been affected with decreasing the number of placements- very traumatic on children. Can you imagine moving, totally out of your environment, into a new family home- you know nothing about them- as an adult, a reasonable thinking adult, can you imagine what that does to you? It’s very traumatic on children. We are studying the number of placements and the impact on the number of visits they go on- studying that impact. Seeing if we can be effective across the country and across the board and then implementing it in other court rooms besides just our learning lab.

Zero to three is not a service. We are a program and an approach that tries to find services and the resources that are out there. Because if we try to create new ones- you guys know what happens to those- the grant money runs out and then this wonderful idea that you had has to dissolve, right? So, we really need a lot of partnerships, ongoing awareness and understanding, and people’s willingness to step out of their comfort zone of their own profession, so that they can learn and understand other professions, so that they can advocate for their client the most. Kat, she needs to learn about law. Judge Sedlin needs to learn about early childhood stuff, you know. He might have raised kids, but he sure didn’t go to college to learn about early childhood. And we just learned everything from Dr. Shah, so. And knowing how the child welfare system works. You know, they- the stuff that they have to go through- when you develop an appreciation and an understanding of what the Department of- the Child Welfare Agency- goes through, you learn that supporting them, instead of holding them accountable and pointing fingers at them, and finding ways that you can help them accomplish what’s best for those families, is so much more productive. They have a lot on their plate. They have a lot of regulations that they have to go by, not just laws but their own state regulations within the agency. And knowing what they have to do and always being aware- and submerse yourself in all of these community functionings that are happening. Because you’ll be amazed and what you can learn and how it’s gonna impact you in your profession.

Brent Pattison: Dr. Shah, the same kind of question to you. What would you promote as the most important practices?

Dr. Shah: You know I really agree with Judy- with what she has said. I would say building partnerships is very important and thinking out of the box. For my profession, it wasn’t a common practice to go outside of the clinic. People came to you. But, I learned I can do more when I went out of that building, and I didn’t have to talk to only the physicians and nurses, but I needed to talk to everybody that was connected to that child and to that family. In old times, there was not a lot of friendship- buddy, buddy system- between the lawyers and the doctors, but some of my best resources have been the lawyers who know they can pick up the phone and call me anytime, any question. And I would say that Safe Babies court is not a program that exits in isolation, it’s a concept you can find in any community where you have the resources. And that’s what we need- we need to tell you. Because if you want to start, like Judy said, everything from the start-create a new program- that’s not going to be successful. You already have all the components, except they are not talking to each other, they don’t have the communication.

You always will have a medical professional- not necessarily a pediatrician- you have a nurse practitioner, everywhere you have mental health practitioners, you’ve got visiting nurses in the

community. All you guys need to do when you’re representing as a legal counsel, representing the parents, say, “Where can I find them?” And then go and approach those people and say, “Here is what I need from you.” You don’t need to sit down and go through all the child development books and learn it all yourself, you’ve got the resources. And say, “Okay, what are the needs of this child that I need to be aware of because I am representing this child and I need to know that.” You need to go to that medical professional and ask what you need to know about the parent’s needs. Those resources are available in every community. You can go to the social worker and say, “What can you do to coordinate that?” And, as Judy said, your resources the Safe Babies court coordinator, “I need to know what resources I can have in my community.” And form those team members together. And I think, just think out of the box.

Brent Pattison: One of my students recently called an Early Access worker on one of our cases, who’s not one of the typical ones I think that we see often in our Safe Babies court team, and just asked for some input about a bunch of things that were happening in the case and the Early Access worker kind of was taken aback and said, “I think you might be the first person who’s ever called me from a law firm before.” And the student was really proud and she learned a lot from talking to her.

Judy Norris: I would have to say some of the original lawyers that- I won’t mention any names- some of the original lawyers that had worked with us, they said they liked the fact that they learned about those other disciplines because when they went to advocate for their client, that gave them a little extra leverage to challenge and push back with people who weren’t providing them what they were obligated to provide. It’s a nice little tool to have in your tool belt.

Brent Pattison: So, Judge Sedlin, is there anything you’ve seen in Safe Babies court practice that you would really, kind of, encourage other courts to adopt?

Judge Sedlin: I would have them adopt two things. One is internal, one external. The internal being frequent hearings- frequent family team meetings. For instance, a system where starting with the removal hearing, you’re having a hearing or a family team meeting every month. So, that all the professionals, all the parties, the lawyers, are in court or family team meeting every month to keep things moving along- keep people interested. The second would be external. It is, kind of, what we have been hearing here, but it’s advocating to get resources together and talking to each other in the community. A judge can do that by the power of convening- it’s an amazing thing that I learned in this job. Because all I have to do is pick up the phone and say, “Hey, would you like to get together?” “Yes, judge!” It’s an amazing thing, just because I got that designation. So, it’s a power that’s unique to a judge- the power to convene. And I would suggest to all judges that do juvenile work to convene their resources. Get together and talk to each other. Get the lawyer talking, advocate, that convening we call stakeholders meetings. They happen bi-monthly basis here. And it’s amazing when you get the experts- when you get the resources talking to each other and ideas just start growing. “What can we do?” “Oh, I know, we can call this person- get this person” and start talking. And if you’ve got lawyers in these meeting with these resources these lawyers gain the knowledge of what’s available and they bring it to court. And it just grows. That’s something- we don’t need zero to three, or Safe Babies court, we just need people that are interested and can talk the judge into using his or her power to convene and get it started and you’d be amazed when you get everyone in the community working together. Those are the two things I think are most important to spread easily to other communities.

Brent Pattison: Thanks, Judge. Tracy?

Tracy White: Well, I absolutely concur with the Judge on the first point. The frequent court hearings, the frequent family team meetings, the frequent professional staffings- our workers and supervisors feel very supported by that and they can convey that support down to the families. I think the second thing that our workers would say they can carry throughout their caseload- our workers average forty to forty-five cases- is this idea of family engagement. You know, kids do better when they’re with their families and families do better when they feel supported by all of the parties at court. So this idea that they’re touching people involved with their case once a month and feeling supported by all of them. I was in a meeting with a relative placement for a baby that’s part of Safe Babies court teams just this week and she felt incredibly supported by the guardian at light up (?), by the mom’s attorney, and by the ACCESS worker. DHS came in like a solid fourth. So, this idea that all of those parties giving those parents a positive message throughout the duration of their case, I think, really enhances their participation in services and lends to that reunification sooner. And I think that is something that our workers and supervisors can translate to all of the kiddos on their caseloads.

Brent Pattison: So, before we go to questions I want to let Kat have the last word, in a sense. I’m going to put her on the spot. You know, as the coordinator for this team- I mean, one of the things that I’ve seen that’s really great that Judy did and what you do now is that you’re a problem solver, right? So, when we have a coordinator in these meetings, you know, mom can say, “I haven’t been able to get into counseling.” And you work at CFI, so you are able to get on the phone and help her do it. That’s not a resource that’s present in every court across the state, right? So how can we help people do better with the value you add in these cases?

Kat Cru: Well, you’re right that I try to be a problem solver whenever I can, and I know that Judy has experience with that too. But, sometimes I can’t solve all the problems and, you know, obviously there aren’t Safe Babies court teams everywhere. So, a really big thing is the stakeholders meetings that Judge Sedlin brought up. Also, just learning how to collaborate and getting together in meetings with resources around the community. That adds a ton to your work. And just being able to say, “You know what, I don’t know the answer to that question, but I know somebody who probably will. “ So, that’s kind of how I- I don’t know if I’m answering your question correctly.

Brent Pattison: Yeah. I mean, it’s modeling for the social workers, for the lawyers, for GAL, everybody that if you reach out you can solve the problem.

Kat Cru: Yes, yes. Collaboration, I’ve found is the key to a role such as mine, just being able to make connections with tons of different resources. I don’t even know all the resources in Polk County. Polk County is very resource rich, as we kind of discuss in our stakeholders meetings, but just being able to reach out to people that you haven’t made connections with before is a huge help.

Brent Pattison: So, we have a little bit of time for questions. And I think we have some mics too, in case people are further in the back. Anybody have any questions for the panelists.

Someone from Tech: If one minute on the questions. I am going to turn on the recorder up here to record the Q & A.

Judy Norris: If someone wants to ask one, do I get to litigate?

Audience member 1: So, I guess my question is primarily for you, Judge Sedlin. How is it determined what cases are zero to three, what cases aren’t? Who makes that decision?

Judge Sedlin: Good question. First of all, when a removal happens in Polk County, it’s done through the County Attorney’s office. And they have a couple of investigators that collect the information from the department and go see the County Attorney, so what happens sometimes is that they were drafted into the movement to identify circumstances that might be good for including in our program, so they are the frontline workers. We also have our case coordinator through court administration that’s clued in. And what happens is one of those folks will call Kat and say, “Hey, I think we got one you might be interested in.” Run the general facts by Kat- am I getting this right, Kat?

Kat: Yep!

Judge Sedlin: And, she says, “Yep, we’ve got room for one.” And that’s how it gets drafted in. It can come from anywhere, but usually it comes from ones that would get assigned to my docket anyway. Occasionally, we get juicy ones that our case coordinator will say, “Oh, this sounds good for Sedlin’s little experiment”, and so we will get one that was, maybe, meant for a different judge. But, as I said, we keep the numbers- right now it’s probably fifteen cases- it might get twenty at times. And that’s how it works.

Judy Norris: And we kept the process that was already in place and just kind of weaseled ourselves into the existing process because we didn’t want to change what was already happening- and we didn’t want to cherry pick cases. We’re doing research on all of these across the country, and we say, “Oh, you know what, we don’t want this, this, and this for criteria”, then we are cherry picking and we don’t learn from that. We want the worst of the worst, and sometimes some easy ones would be nice, right? So, we infused ourselves and learned about how the department assigns cases and learned how the court house assigns cases and how the judges get them. And that’s how we developed our system- it’s round robin. So, we always want to pay attention to one family, one judge- that’s very, very critical. We don’t want to yank a family out of another court room just because they have a new baby, and put them with a strange judge again and start their life all over again in the judicial system. So, again, we adapt to what is already in existence and try to make it work.

Audience Member 2: So, this question is actually for Dr. Shah. You had said that for a long time you were the lone ranger in the pediatric world. My question is, do you have people who are supporting you now to kind of come in and help out and kind of take over once you decide that you want some time off or retire? Because I know that without the medical profession there that this won’t be quite as effective because Brent is training all of us very well on legal side, so my question is more how’s it going on the medical side?

Dr. Shah: Actually, I am retired now.

Audience Member 2: You wouldn’t know it!

Dr. Shah: I say I am. I am seeing patients every day, but what I did was, I planned my retirement- it took me five years, hand-picked a physician from the residency program, and had him go through the Child Protection Center for a couple of rotations, signed him up to take the fellowship in child abuse and neglect. Then when he returned, I stayed for another three years- kept him learning and getting to know the community, because in the kind of practice where you are looking at the vulnerable children and families with multiple issues of trauma, substance abuse, what not, it’s not enough to have a highly trained physician- but a physician who has the passion and commitment beyond the knowledge base and also has interpersonal skills. They’re going to go across the community for the different business

professionals to interact with them and collaborate. And I did find one. His name is Dr. Ken Kane, and he is very well accepted and treated. We have now, in Iowa, five-plus regional child protection centers, and they do have a combination of family physicians, pediatricians, and practitioners exclusively. These are the programs that don’t do very well in the private practice setting because there’s too much pressure on the physicians to bring in that commonality; that most of our child protection centers are hospital-based, and the medical professionals are celebrated by the organization. And so we have a little bit more luxury of spending time and being in a rush to turn out so many cases a day, because these are complex. And then we should also be free to have time to collaborate and communicate in the meetings, go to the courts and testify, attend the medical seminars and meetings, and give training (and also receive training). So all of that is why an individual makes a commitment beyond what a physician in private practice would do.

Brent Pattison: So I think I have to call time. We have refreshments outside, and if people are interested, I hope you’ll join us. I just want to say thanks to all of you for coming and talking about the important work you do—and doing it on a Friday afternoon after a long week, I’m sure.

Judy Norris: That’s how much we appreciate you.

Brent Pattison: So, just a round of applause for presenters.