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22–105 2017

‘‘THE HEROIN EPIDEMIC AND PARENTAL 

SUBSTANCE ABUSE: USING EVIDENCE AND 

DATA TO PROTECT KIDS FROM HARM’’ 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

MAY 18, 2016 

Serial No. 114–HR10 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

KEVIN BRADY, Texas, Chairman 

SAM JOHNSON, Texas 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

TODD YOUNG, Indiana 

MIKE KELLY, Pennsylvania 

JIM RENACCI, Ohio 

PAT MEEHAN, Pennsylvania 

KRISTI NOEM, South Dakota 

GEORGE HOLDING, North Carolina 

JASON SMITH, Missouri 

ROBERT J. DOLD, Illinois 

TOM RICE, South Carolina 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

DAVID STEWART, Staff Director 

NICK GWYN, Minority Chief of Staff 

SUBCOMMITTEE ON HUMAN RESOURCES 

VERN BUCHANAN, Florida, Chairman 

KRISTI NOEM, South Dakota 

JASON SMITH, Missouri 

ROBERT J. DOLD, Illinois 

TOM RICE, South Carolina 

TOM REED, New York 

DAVID G. REICHERT, Washington 

LLOYD DOGGETT, Texas 

JOHN LEWIS, Georgia 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 


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C O N T E N T S 

Page 

Advisory of May 18, 2016 announcing the hearing .............................................. 2 

WITNESSES 

Panel One 

The Honorable Karen Bass, a Representative in Congress from the State 

of California .......................................................................................................... 7 

The Honorable Tom Marino, a Representative in Congress from the State 

of Pennsylvania .................................................................................................... 6 

Panel Two 

Katherine Barillas, Director, Child Welfare Policy, One Voice Texas ................ 33 

Hector Glynn, Vice President for Programs, The Village for Families & Children ....................................................................................................................... 28 

Bryan Lindert, Senior Quality Director, Eckerd Kids .......................................... 42 

Tina M. Willauer, MPA, Director, Sobriety Treatment and Recovery Teams 

(START), Kentucky Department for Community Based Services, Kentucky 

Cabinet for Health and Family Services, and Consultant, Children and 

Family Futures ..................................................................................................... 9 

SUBMISSIONS FOR THE RECORD 

American Academy of Pediatrics ............................................................................ 90 

Children’s Hospital of Wisconsin ............................................................................ 98 

Donna Butts ............................................................................................................. 101 

New York State Office of Children and Family Services ..................................... 107 

SHIELDS for Families ............................................................................................ 110 

The American Congress of Obstetricians and Gynecologists ............................... 120 

The Premier Healthcare Alliance ........................................................................... 122 


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(1) 

‘‘THE HEROIN EPIDEMIC AND PARENTAL 

SUBSTANCE ABUSE: USING EVIDENCE AND 

DATA TO PROTECT KIDS FROM HARM’’ 

WEDNESDAY, MAY 18, 2016 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, SUBCOMMITTEE ON HUMAN RESOURCES, Washington, DC. 

The Subcommittee met, pursuant to call, at 2:06 p.m., in Room 

1100, Longworth House Office Building, Hon. Vern Buchanan 

[Chairman of the Subcommittee] presiding. 

[The advisory announcing the hearing follows:] 


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ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

SUBCOMMITTEE ON HUMAN RESOURCES 

FOR IMMEDIATE RELEASE CONTACT: (202) 225–3625 

Wednesday, May 11, 2016 

No. HR–10 

Buchanan Announces Human Resources 

Subcommittee Hearing on ‘‘The Heroin Epidemic 

and Parental Substance Abuse: Using Evidence 

and Data to Protect Kids from Harm’’ 

House Human Resources Subcommittee Chairman Vern Buchanan (R–FL), announced today that the Subcommittee will hold a hearing entitled ‘‘The Heroin Epidemic and Parental Substance Abuse: Using Evidence and Data to Protect Kids 

from Harm’’ on Wednesday, May 18, 2016, at 2:00 p.m. in room 1100 of the 

Longworth House Office Building. At the hearing, Members will examine the effectiveness of programs designed to address parental substance abuse and protect 

children from harm. Members also will explore State efforts to better use data to 

identify and serve children most at risk due to parental substance abuse, and the 

impact of the substance abuse epidemic on the child welfare system. 

In view of the limited time available to hear witnesses, oral testimony at this 

hearing will be from invited witnesses only. However, any individual or organization 

not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit written comments for the hearing record must follow the appropriate link on the hearing page 

of the Committee website and complete the informational forms. From the Committee homepage, http://waysandmeans.house.gov, select ‘‘Hearings.’’ Select the hearing for which you would like to make a submission, and click on the link entitled, 

‘‘Click here to provide a submission for the record.’’ Once you have followed the online instructions, submit all requested information. ATTACH your submission as a 

Word document, in compliance with the formatting requirements listed below, by 

the close of business on Wednesday, June 1, 2016. For questions, or if you encounter technical problems, please call (202) 225–3625 or (202) 225–2610. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing 

record. As always, submissions will be included in the record according to the discretion of the Committee. The Committee will not alter the content of your submission, 

but we reserve the right to format it according to our guidelines. Any submission 

provided to the Committee by a witness, any materials submitted for the printed 

record, and any written comments in response to a request for written comments 

must conform to the guidelines listed below. Any submission not in compliance with 

these guidelines will not be printed, but will be maintained in the Committee files 

for review and use by the Committee. 

All submissions and supplementary materials must be submitted in a single document via email, provided in Word format and must not exceed a total of 10 pages. 

Witnesses and submitters are advised that the Committee relies on electronic submissions for printing the official hearing record. 


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All submissions must include a list of all clients, persons and/or organizations on 

whose behalf the witness appears. The name, company, address, telephone, and 

numbers of each witness must be included in the body of the email. Please exclude 

any personal identifiable information in the attached submission. 

Failure to follow the formatting requirements may result in the exclusion of a 

submission. All submissions for the record are final. 

The Committee seeks to make its facilities accessible to persons with disabilities. 

If you are in need of special accommodations, please call 202–225–1721 or 202–226– 

3411 TDD/TTY in advance of the event (four business days notice is requested). 

Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above. 

Note: All Committee advisories and news releases are available online at 

http://www.waysandmeans.house.gov

f 

/. 

Chairman BUCHANAN. The Subcommittee will come to order. 

Welcome to the Ways and Means Subcommittee on Human Resources hearing on ‘‘The Heroin Epidemic and Parental Substance 

Abuse: Using Evidence and Data to Protect Kids from Harm.’’ Welcome to today’s hearing on how the heroin epidemic and more general parental substance abuse is hurting our Nation’s children and 

how we can use evidence and data to protect more of them from 

harm. 

The heroin epidemic is a growing crisis affecting children and 

families across the country and it is reaching into our local communities. In 2014, according to the Centers for Disease Control and 

Prevention, more Americans died from drug overdose than car accidents, and over 60 percent of those deaths were from heroin, painkillers, and other opioids. 

In Florida, we know all too well of the consequences. We started 

to address this epidemic years ago by reducing access to opioids 

and decreasing their supply. Now that it is cheaper, and just as potent, heroin has taken over. Heroin overdose in Florida increased 

by 900 percent 2010 to 2014—900 percent. Unfortunately, the epicenter for the Florida crisis is in my own district, Manatee County, 

where more people died from heroin overdose per capita than in 

any other Florida county in 2014. 

We have been talking about the issues of opioid addiction more 

broadly these last 2 weeks here in Congress, and I have been 

championing a comprehensive approach to provide more education, 

prevention, treatment programs to those in need. I was pleased to 

see a legislative solution, the Comprehensive Opioid Abuse Reduction Act of 2016, pass the House last week. The Senate has passed 

a similar bill, and I hope we can quickly resolve our differences so 

we can help more families immediately. 

While we have made great progress, there is one area that deserves further attention: The impact parental substance abuse has 

on families. This crisis has a serious impact on our children, especially those who come in from foster care because of parental drug 

abuse. According to the data and news reports, parental drug abuse 

is a leading factor in why children enter foster care facilities. And 

multiple States have cited opiate, heroin, and other substance 

abuse as a major reason for the increase in foster care. 


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Caseloads and Federal data support this view. In fiscal year 

2014, more than 25 percent of those children found to be victims 

of abuse and neglect had caregivers with drug abuse problems. 

Thankfully, many States, including Florida, are leading the effort 

to combat this crisis. 

Today, we will learn about some of these approaches, including 

ways to serve families at home or in other settings so children can 

remain safely with their parents or more quickly return home if 

they must enter foster care. Florida and other States are also using 

data gleaned from prior child welfare cases to reform their responses to new cases, allowing them to more quickly and effectively 

respond to prevent tragic consequences. 

In addition to those State efforts, the Senate Finance Committee 

has developed a draft proposal to shift foster care funding into 

services that will help prevent abuse and neglect. These reforms 

will encourage States to support programs that better address parental substance abuse and other issues, as well as implement programs that have proven their effectiveness in addressing the needs 

of parents and their children. 

Today’s hearing will help us take a closer look at the Senate’s 

proposal and help in moving bipartisan, bicameral legislation. We 

have taken positive steps forward in the House to address the 

opioid crisis and substance abuse. Now it is time to turn to the kids 

that need our help as well. 

I look forward to hearing more about these efforts today and discussing how we can work together on a bipartisan effort to protect 

more children from harm, because strong families make for a 

strong community. 

I now yield to the distinguished gentleman, the Ranking Member, Mr. Doggett, for the purposes of an opening statement. 

Mr. DOGGETT. Thank you so much, Mr. Chairman, for your interest in this matter and for holding today’s hearing. 

As I see it, this hearing is addressing one aspect of a critical 

problem. It is addressing the question that I think represents a 

failure by this Congress and by one State after another to deal effectively with child abuse. 

Within the past month, on one of the front pages of the San Antonio Express-News, there was a report: ‘‘Kids who were bound constantly want food.’’ Officers rescued a boy, 4, who was tied by his 

ankle with a dog chain in the yard at his home. His sister, 3, had 

her hands tied with a leash above her head, her arm broken in two 

places. Authorities said the two had been physically abused for at 

least 2 weeks. ‘‘They constantly want food,’’ said their attorney ad 

litem. 

Just a few miles up the road and only a few days apart, a little 

girl, 1 year old, sexually abused by her mother’s boyfriend, along 

with her sister, she was killed by the physical abuse that she suffered. 

And only a few days before that, a young student at the University of Texas was murdered by a child who had been physically 

abused himself, was in the foster system, but had run away from 

it. 

Time after time, not only in Texas, but across the country, we 

see the price that is being paid for our failure to deal effectively 


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with child abuse. And because our courts have also seen it, this is 

an emerging crisis. 

In my home State of Texas, the situation for severely abused and 

neglected children is so bad that a Federal court in Texas has declared the system unconstitutional, as was done previously in the 

State of Mississippi, as has occurred in challenges in one State 

after another. 

In her ruling Judge Jack wrote, ‘‘Years of abuse, neglect, and 

shuttling between inappropriate placements across the State has 

created a population that cannot contribute to society and proves 

a continued strain on the government through welfare, incarceration, or otherwise.’’ 

Certainly the problem with opioids, drug abuse, is a very big factor, from talking to people in the field who deal with this issue 

every day in Texas. 

And it is great that some legislation was passed last week concerning that aspect of the problem. There is only one major concern 

about that and about what we are not doing on child abuse here, 

and that is that talking about it, passing changes without approving necessary resources to get to the problem, where caseworkers 

for child protective services are underskilled and overburdened 

with cases, just talking about it and not putting the resources out 

there to deal with and to prevent these tragedies and moving our 

resources so that they focus on prevention, not just responding 

after one of these horrible events occurs, and not just lurching from 

one tragedy to another, that is what this Congress ought to be focused on. 

Senator Wyden and I have introduced legislation to try to change 

the focus to prevention. Our first speakers today, who have worked 

on child abuse, have raised many of these concerns. A scaled-down 

version of that legislation Senator Wyden and I introduced has 

been circulated now in draft form. There is agreement about some 

of the things that need to be done. There is certainly bipartisan 

agreement in this Committee about the importance of doing something. 

The issue is: Are we willing to put our money where our mouth 

is? Just reorganizing the deck chairs on the Titanic by moving 

some money from one part of child abuse to another will not get 

the job done. Our States need to do more, but we can in this Congress provide resources and provide an incentive to the States, particularly those that are under court order like Texas and Mississippi and the other States that are likely to be under court order 

when their cases are finished, provide them an incentive to do right 

by these children. 

We won’t stop all child abuse, of course, but we can prevent some 

of these tragedies by applying the resources we have within our 

ability to provide and work together to address these kinds of concerns, back up and encourage the States, and get the resources we 

need to reduce the level of child abuse. 

And I yield back. 

Chairman BUCHANAN. Without objection, other Members’ opening statements will be made part of the record. 


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On our first panel this afternoon we will be hearing from two of 

our distinguished colleagues, the Honorable Tom Marino of Pennsylvania and the Honorable Karen Bass of California. 

Mr. Marino, please proceed with your testimony. 

STATEMENT OF THE HON. TOM MARINO, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF PENNSYLVANIA 

Mr. MARINO. Good afternoon, and thank you, Chairman 

Buchanan and Ranking Member Doggett and the Members of the 

Subcommittee, for giving us the opportunity to testify on an issue 

that is important to both of us. 

It is abundantly clear that our Nation is facing a substance 

abuse epidemic. Unfortunately, one group that we fail to mention 

as being affected are the children who have been placed in foster 

care because their parents’ have become addicted to drugs and alcohol. 

Over 400,000 American children are in foster care. In my home 

State of Pennsylvania alone, approximately 15,000 children reside 

in foster care. As a former State and Federal prosecutor, I have 

seen firsthand how substance abuse directly affects children, and 

I have seen my share of children on slabs in morgues. 

Many of the people I had been tasked with prosecuting were parents whose children ended up in foster care. This was done with 

the hopes that following treatment, these offenders could become 

parents again. 

This is not always the case. Many of the individuals who enter 

treatment programs find that their necessary care is cut short due 

to gaps in healthcare insurance and they are unable to afford additional treatment. 

We recognize that substance abuse is a serious disease that requires serious treatment. Nevertheless, there is a great void in the 

way that our current health system treats substance abuse. In 

most cases, the only treatment available to those affected is shortterm intervention like detoxification. 

To adequately treat those who suffer from substance abuse, we 

must provide serious long-term treatment. Those addicted must 

have the ability to be treated by specialists and receive proper 

medications. 

In this current environment, we are doing a disservice to those 

who require treatment. Many addicts are ineffectively treated. Although one may leave treatment and be ‘‘cured’’ by some standards, 

more often than not one ends up behind bars or in another futile 

program because their first attempt failed. 

The question remains: What can we do to ensure that those who 

require help get the proper treatment and are reunited with their 

children? 

One treatment option I have advocated for years would be placing nondealer, nonviolent drug abusers in a secured hospital-type 

setting under the constant care of health professionals. Once the 

person agrees to plead guilty to possession, he or she will be placed 

in an intensive treatment program until experts determine that 

they should be released under intense supervision. If this is accomplished, then the charges are dropped against that person. The 


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charges are only filed to have an incentive for that person to enter 

the hospital/prison, if you want to call it that. 

In an effort to keep them in touch with their children, we can 

offer them the chance to continue to visit with and eventually care 

for their children as they undergo treatment. This is a massive 

project. Not only are we dealing with trying to cure the drug addict, but we are trying to keep a family together. 

And it is going to take a lot of money. The Feds are going to have 

to be involved in this, the States are going to have to be involved 

with this, the local child welfare agencies are going to have to be 

involved with this. This isn’t just one entity that is going to take 

care of this. 

Initially, we would have to separate them. But hopefully, after 

they have been cleared by medical professionals, one can regain 

custody of their children while still receiving treatment in the facility. This treatment option may offer a better chance for addicts to 

finally be cured and have a normal life, but also their children have 

a normal life. 

As with any disease, there is no one-size-fits-all approach to substance abuse treatment. Some people respond to treatment in different ways, and for most it takes a very long time. Congress must 

continue to address the current drug crisis and keep searching for 

better ways to treat addicts and tend to foster children. 

We must also continue to protect the children of parents who are 

suffering from substance abuse. Placing these children in foster 

care is necessary. However, in the instances where we can keep the 

families together, it remains an important key to curing drug addiction. 

With that, I yield back. 

Chairman BUCHANAN. Thank you, Mr. Marino. 

Ms. Bass, please proceed with your testimony. 

STATEMENT OF THE HON. KAREN BASS, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. BASS. Thank you, Chairman Buchanan, Ranking Member 

Doggett, and Members of the Subcommittee. Thank you for the opportunity to give remarks to you today. 

Tom Marino and I serve as two of four Co-Chairs of the Congressional Caucus on Foster Youth and have been very much involved 

in this issue. 

This is a critical time in our country, and from my perspective 

we actually have an opportunity to learn from the last drug epidemic—crack cocaine in the 1980s and 1990s. 

I can assume that many of you were not in Congress during 

those years. I was in Los Angeles serving as a member of the faculty at the USC Medical School and I spent several years working 

in the emergency room in LA County. 

Our response during those years to the crack cocaine epidemic 

was one of outrage and anger. We were angry at people who were 

addicted, and we were particularly outraged at women and mothers 

who suffered from addiction and neglected their babies, and even 

abandoned their babies in the hospital after delivery. 

We passed laws that eventually led to an 800 percent increase 

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moved from home and placed into foster care skyrocketed. At the 

height of the epidemic, there were over 40,000 children in foster 

care in Los Angeles County alone. Today that number has been reduced by over 50 percent. 

The crack cocaine epidemic and advances in science led to today’s 

understanding that addiction is a brain disease. One of the characteristics of addiction, unfortunately, is relapse. And so far in the 

latest epidemic we are not hearing cries for incarceration. I do 

worry, however, that those cries might still be coming. 

So far we seem to be approaching the opioid epidemic and addiction differently. Just as science advanced our understanding of addiction, research has certainly advanced our understanding about 

how to handle families that are in crisis. We know the majority of 

children in foster care are removed from home because of neglect, 

and we know that that neglect is secondary to addiction, mental illness, or both, dual diagnosis. 

We know that removing a child from home is traumatic for the 

child regardless of the circumstances. We certainly know that there 

are times we absolutely must remove a child for their safety. However, we have also learned that families can benefit tremendously 

when services like drug treatment are provided in a fashion that 

allows families to remain intact. 

I agree with my colleague, Mr. Marino, that you need to have a 

variety of approaches. There is no one-size-fits-all. I want to suggest a couple of programs, some of which I believe you are going 

to hear from today. 

Members of this Committee passed legislation allowing States to 

apply for IV–E waivers to use Federal funds in developing evidence-based programs to see if the number of children in care can 

be safely reduced and outcomes can be improved. Many States have 

used the funds to target parents with substance abuse disorders. 

Kentucky and Maine are implementing a program known as 

START, Sobriety Treatment and Recovery Teams. I know you will 

hear from them directly in the next panel. Oklahoma connects parents to substance abuse services. San Francisco has a program 

called Family Link that includes both residential and outpatient 

substance abuse treatment services. 

In LA County, SHIELDS for Families has created a therapeutic 

community where entire families live in an apartment community. 

In the last 5 years, more than 81 percent of the participants have 

completed all phases of the program, which can last up to a year, 

and maintained their sobriety and kept their families intact. This 

program has saved LA County millions of dollars that would have 

been spent placing children in foster care. 

The legislation this Committee passed allowing States to apply 

for title IV–E waivers is set to expire in 3 years, 2019. After years 

of implementing programs, States and counties have developed 

many evidence-based practices that have successfully and safely reduced the number of children in care or improved outcomes. So 

now is the time to consider implementing Federal finance reform. 

I believe this Committee will soon be discussing the Family Stability and Kinship Care Act that will provide flexibility in the use 

of title IV–E dollars. If and when this Committee does consider the 


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legislation, I would hope that substance abuse will be up front and 

center. 

When people suffer from addiction, sometimes they have to hit 

rock bottom before they face the reality of their disease. Sometimes 

rock bottom results in them losing their children. Many times 

women refuse treatment because they don’t want to leave their 

children and enter a program. Then their addiction spirals so far 

out of control the government has to intervene. 

I come before you today out of concern for the individuals and 

families that have lost everything. So if they had insurance, they 

lost it, and if they lost their jobs their families cannot afford expensive drug treatment programs. 

So we as a society have a choice. We can incarcerate them when 

they begin criminal behavior to support their addiction. We can remove their children and place them in foster care. Both choices cost 

the Federal Government billions of dollars and in too many cases 

result in the government supporting the individual their entire life 

when they end up in prison. Or we could look at how we increase 

funding to SAMHSA for community-based drug treatment services. 

Thank you. 

Chairman BUCHANAN. Thank you, Ms. Bass. 

Do any of the Subcommittee Members have questions for our colleagues on the panel? 

If there are no further questions, then you are free to go, and I 

want to thank you for testifying before the Subcommittee today. 

Thank you very much. 

Ms. BASS. Thank you. 

Chairman BUCHANAN. Now we will move on to our second 

panel. On the second panel this afternoon we will be hearing from 

four experts: Ms. Tina Willauer, Director for Sobriety Treatment 

and Recovery Teams, START, of the Kentucky Department for 

Community Based Services with the Kentucky Cabinet for Health 

and Family Services; Mr. Hector Glynn, Vice President for Programs, The Village for Families & Children; Ms. Katherine Barillas, 

Director of Child Welfare Policy for One Voice Texas; and Mr. 

Bryan Lindert, Senior Quality Director for Eckerd Kids. 

We will begin with you, Ms. Willauer, whenever you are ready. 

STATEMENT OF TINA M. WILLAUER, MPA, DIRECTOR, SOBRIETY TREATMENT AND RECOVERY TEAMS (START), KENTUCKY DEPARTMENT FOR COMMUNITY BASED SERVICES, 

KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES, 

AND CONSULTANT, CHILDREN AND FAMILY FUTURES 

Ms. WILLAUER. Thank you, Chairman Buchanan, Ranking 

Member Doggett, and Members of the Subcommittee. Thank you so 

much for conducting this hearing on our Nation’s opioid crisis and 

the effects of parental substance use disorders on our Nation’s child 

welfare system. I am honored to talk with you today about Kentucky’s efforts over the last 10 years to address these very issues. 

And in my career of 25 years in child protective services, this has 

been my dedication. So thank you. 

The good news is that we know a lot more today about what 

works with families in this population. There are good programs all 

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comes. I am going to talk to you today about the Sobriety Treatment and Recovery Team, or START, program that has been implemented in Kentucky, and I have three primary points today. 

First of all, START has better outcomes for children and families 

than standard CPS. 

Number two, strategies that work for families include collaboration across systems, intensive work, quick access to substance use 

disorder treatment, shared decisionmaking, peer supports, and a 

nonpunitive approach, among other strategies. 

Number three, the current opioid epidemic reinforces that the 

most important policy issue in child welfare right now is changing 

the financing model to prevent foster care placements whenever 

safe and possible and taking the programs that work to scale by 

using the lessons of prior Federal investments. 

So why did Kentucky invest in START? Well, in 2006 we had a 

terrible opioid epidemic going on with prescription drugs in Kentucky. And at that time, 80 percent of the children in Kentucky’s 

foster care system were there because a parent had a substance 

use problem. So this was a real crisis and an opportunity for our 

State to invest in a program that works. 

So what is START? START is a child welfare-led program that 

helps parents achieve recovery, and it keeps children in the home 

when safe and possible. START serves CPS-involved families with 

a substance-exposed infant or young children. And in START we 

address addiction as a brain disorder because we know that it affects the whole family and it requires treatment. 

So in START we pair specially trained CPS social workers with 

family mentors, and family mentors are persons in long-term recovery from addiction who actually had a CPS case in their past. They 

are now stable and in recovery, and they help new parents engage 

in treatment. 

Together, that worker and mentor dyad serves families, a very 

small caseload of families, and they intervene very quickly upon 

the CPS report, right away. Kind of maximizing on that window of 

crisis, we partner with substance use treatment providers, and parents can get into treatment from START within 48 hours. 

So creatively working with families, giving quick access to treatment, and providing wraparound supports can allow us to leave 

some children in the home safely while the whole family gets treatment. 

So at the same time that we were implementing START in Kentucky, Kentucky was lucky enough to be awarded with two RPG 

grants, in 2007 and 2012, and it was just the right initiative at just 

the right time. The reason is because we receive a lot of technical 

assistance and there was a real push for rigorous program evaluation that allowed us to study START. 

With RPG support, we have now produced four peer-reviewed 

journal articles, and START is now listed in the California’s Evidence-Based Clearinghouse for Child Welfare as a program with 

promising evidence. 

The work isn’t done, however. We continue to build START 

in Kentucky. And we are building on the evidence. We are actually expanding the program in Louisville, Kentucky, under the title 

IV–E waiver program. 


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So what did we learn? START serves the top highest risk cases 

in the entire State, but the mothers in START achieve double the 

sobriety rates of those moms who didn’t receive START services, 

children in START were 50 percent less likely to enter foster care, 

and at case closure, over 75 percent of the children served by 

START were actually reunified with their biological parent or they 

remained there in the home the whole time. 

Because of our low rate of recurrence of maltreatment, very few 

children ever reenter foster care, and for every dollar spent on 

START, we save the Commonwealth of Kentucky $2.22 just in the 

avoidance of foster care cost alone. 

So in closing, I can’t think of a better time in the midst of this 

opioid crisis to better protect children and families with substance 

use disorders. START has more than a decade of study behind it 

as to what works. We know what works now. And I am thankful 

for the IV–E waiver program, as well as the RPG program. 

But we now must move from demonstration projects to systemwide reform, meeting the problem at the scale of need. So really 

at this point, we would like to move the financing of child welfare 

so the family can remain intact, and receive services. And what we 

know is preventing kids from entering foster care not only saves 

money, but it reduces trauma to children and families. 

Thank you so much. 

[The prepared statement of Ms. Willauer follows:] 


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Chairman BUCHANAN. Thank you, Ms. Willauer. 

Mr. Glynn, please proceed with your testimony. 

STATEMENT OF HECTOR GLYNN, VICE PRESIDENT 

FOR PROGRAMS, THE VILLAGE FOR FAMILIES & CHILDREN 

Mr. GLYNN. Committee Members, thank you for the honor of 

being here. My name is Hector Glynn. I work with The Village for 

Families & Children in Hartford, Connecticut. We are a large nonprofit provider for the area. 

We are part of the National Traumatic Stress Network, which 

has allowed us to expand our expertise in evidence-based models 

and treatment, to include models such as eye desensitization and 

reprocessing, child-parent psychotherapy, modular approach to 

therapy for children with anxiety, depression, trauma, and conduct 

problems, and trauma-focused cognitive-behavioral therapy. 

But today I am here to talk about a truly unique program called 

FBR, Family-Based Recovery. In Connecticut almost half of the foster care placements for children under 3 have at their core an issue 

of substance abuse. 

So in 2006, the Connecticut child welfare agency, the Department for Children and Families, brought together Yale and Johns 

Hopkins to develop a new approach in dealing with this crisis. It 

was really focused on the idea that most parents really have a 

strong desire and drive to be good parents and that that could be 

the motivating factor to changing their behaviors. 

So FBR combines treatment of substance abuse using a reinforcements-based treatment and a child connection adaptation type of 

approach, which helps to motivate and control the desires. 

When FBR started in 2006, it quickly got expanded to 10 regions 

throughout the State of Connecticut. When we looked at the outcomes in this model, it is really about transforming the system, because what we asked the child welfare agency to do is keep families 

together, even though there was evidence and proof of substance 

abuse. 

So these families, we go in three times a week at a minimum to 

provide both the child-parent psychotherapy together and the substance abuse treatment, and we are testing for substance use at 

least three times. This type of monitoring helps to create a shared 

risk profile between us, the providers, and the child welfare agency 

and the parents and constantly gives feedback on how they are 

doing. 

Since 2007, 564 caregivers have been in the program; 51 percent 

of these clients have had positive tests in the first week, and that 

rate drastically drops down to, like, 14 percent by the time they are 

being discharged. Eighty percent of the families that we are working with are intact when we are discharging them from the program, and it really shows the strength. 

And this isn’t just about the program that The Village offers. It 

is a program of network. The model was developed out of Yale. It 

is an evidence-based model. And for our terminology, that means 

there is a higher level of monitoring to fidelity. Yale comes in and 

reviews our tapes of how we are doing within sessions. They look 

at our substance abuse logs. They look at the connections and the 


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types of work that we do. And that is really what is crucial. It is 

about what does work versus just providing services. 

So for us at The Village, 62 percent abstained from drugs or alcohol 30 days prior to their discharge, and 88 percent of the families 

were intact at the point of our discharge. But the network continues to be extremely strong. And like I said, there are 10 others 

that are involved within there. 

The substance abuse, they have tested thousands of parents, and 

only 8.2 percent of the families have had ongoing relapses in which 

they needed a higher level of care or newer levels of treatment. 

We really do believe that this is a model that builds upon the 

strengths of what parents can do and what families can do. And 

this type of approach, along with case management to help support 

the poverty and other factors that make it difficult for families to 

stop using drugs, is the way to—at least one approach—to dealing 

with this crisis. 

Thank you. 

[The prepared statement of Mr. Glynn follows:] 


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Chairman BUCHANAN. Thank you, Mr. Glynn. 

I would like to advise Members that a series of votes has been 

called. I anticipate this series of votes to last about 30 minutes. 

I would ask the Members to return to the hearing as quickly as 

possible from voting. This hearing will stand adjourned subject to 

the—oh, recess, recess, okay—subject to the call of the Chair. 

[Recess.] 

Chairman BUCHANAN. The Committee will come to order. 

I recognize Ms. Barillas for 5 minutes. 

STATEMENT OF KATHERINE BARILLAS, 

DIRECTOR, CHILD WELFARE POLICY, ONE VOICE TEXAS 

Ms. BARILLAS. Good afternoon, Chairman Buchanan, Mr. Doggett, and Members. My name is Dr. Katherine Barillas, and I am 

Director of Child Welfare Policy at One Voice Texas, a health and 

human services advocacy organization. Thank you for the opportunity to testify today. 

As you heard from Mr. Doggett, our child welfare system in 

Texas is in crisis. And let me say this is a crisis of resources, where 

the needs of children in the child welfare system far outpaces the 

State, Federal, and local resources currently allocated. 

Substance use, almost 80 percent of the cases in the foster care 

system, has a profound impact on resources, just as it did when I 

was an investigator for Child Protective Services back in the late 

1990s. What I have observed over my 20-year career is that we 

often do not get to these families and children soon enough. 

One of the reasons it is so critical to ensure cases involving substance abuse receive expedited services is the impact that being 

separated from a parent can have, particularly on a very young 

child. Women and Children Residential Services is one specialized 

program that promotes parent-child bonding. This program allows 

mothers to stay with their children while the former is in inpatient 

treatment. 

Despite the benefits implied with this model, it does face challenges, one of which is judges are seldom willing to put children in 

treatment, so to speak. There is also a myth that women can’t 

focus on their treatment if their children are there ‘‘bothering’’ 

them. The truth is that when women enter programs with their 

children they are able to work on parenting and try out improved 

techniques under supervision and modeling. 

Unfortunately, providers of this program are scarce. Part of the 

challenge is funding, which would be somewhat alleviated if States 

had the option of using title IV–E funding to pay for these services 

and were able to draw down Federal foster care match for the children when they are living with their parent who is receiving treatment. 

Another area where we must direct resources is kinship caregivers, particularly those caring for children not yet in foster care. 

These are fairly stable living arrangements with the right resources, but without them they can easily break apart. 

Texas provides financial benefits to informal arrangements when 

a child is in conservatorship but not to parental child safety placements. A PCSP in Texas is basically an arrangement between CPS, 

a parent, and a relative caregiver to prevent a child from coming 


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into foster care. These are short-term placements used to alleviate 

risk so parents can address issues in the home relatively quickly. 

PCSPs are sometimes used in cases where parents are struggling 

with substance abuse, but time is limited in these cases—not a 

good match unless time and family-based safety services are extended, with strong support to the kinship caregiver. 

The research is clear that children in kinship placements have 

better outcomes than their peers in foster care. So imagine outcomes for those children who age out of the system. These youth 

face far worse than their peers in terms of lower rates of high 

school graduation and college attendance, higher rates of homelessness, substance abuse, and mental health problems. 

These young people have a desire and the ability to be independent, but without the appropriate preparation they can easily 

become the next generation of drug users and parents in the CPS 

system. 

Recommendations for this population include transition living 

services being extended up until youth are 23 years old and the 

time limit on family unification vouchers being extended past 18 

months to 2 years to meet standard lease requirements and give 

youth time to attain stability in their lives. 

For kinship, we need Congress to direct resources such as 

monthly payments and reimbursements at these placements, which 

keep children out of the very expensive and detrimental foster care 

system, and to allow payments to kinship families to be used to 

draw down IV–E dollars. 

Congress also needs to ensure that title IV–E coverage can be 

used for more than just out-of-home care in order to address substance abuse issues early. We also need to support the expansion 

of IV–B funds and a time extension around family-based safety 

services and family reunification. 

We also need States to have guidance regarding the importance 

of family treatment programs and visitation and the promotion of 

women and children’s programs as a vital treatment option for 

women with young children. 

Thank you. 

[The prepared statement of Ms. Barillas follows:] 


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Chairman BUCHANAN. Thank you, Ms. Barillas. 

Mr. Lindert, please proceed with your testimony. 

STATEMENT OF BRYAN LINDERT, 

SENIOR QUALITY DIRECTOR, ECKERD KIDS 

Mr. LINDERT. Chairman Buchanan, Ranking Member Doggett, 

and Subcommittee Members, thank you for the opportunity to address the Committee on the use of data to keep children known to 

the child welfare system safe. 

My name is Bryan Lindert, and I am the Senior Quality Director 

at Eckerd Kids, a nonprofit provider of services to children and 

youth operating in 20 States and the District of Columbia. We also 

manage the largest privately operated child welfare system in the 

country, serving more than 6,000 children and youth in Tampa 

Bay. 

The number-one reason children enter the system is for maltreatment from a substance-abusing parent. The aim of my testimony 

is threefold: To describe how Eckerd Kids ended a tragic pattern 

of homicides that occurred prior to Eckerd’s involvement; to explain 

how that success has led to partnerships with five States to prevent future abuse fatalities; and to explore the implications of our 

approach to other child welfare challenges, including a potential 

improved response to repeat maltreatment due to substance abuse. 

Our work developing a priority tool called Eckerd Rapid Safety 

Feedback was recently featured in the final report of the bipartisan 

Commission to Eliminate Child Abuse and Neglect Fatalities released in March of this year. To understand why, we must explain 

why Eckerd Kids was selected to manage the child welfare system 

in Hillsborough County beginning in July of 2012. 

This occurred after that community experienced an unprecedented nine child deaths from maltreatment in less than 3 years. 

These cases were not co-sleeping deaths or the result of inadequate 

supervision. Instead, they were intentional inflicted injuries, including one child thrown out of a moving car on the interstate. 

Worse still, they occurred under the open jurisdiction of the court. 

In Hillsborough, as in other jurisdictions around the country, the 

Department of Children and Families reviewed these cases and 

came to a frustrating conclusion: The fatalities kept happening to 

children with similar risk factors and lapses in casework. A more 

proactive approach was needed. 

Therefore, in addition to the review of the nine child deaths, 

Eckerd Kids conducted a 100-percent review of the 1,500 open child 

welfare cases in the county. From this review, critical case practice 

issues were identified that, when completed to standard, could reduce the probability of preventable serious injury or death. Among 

these case practices were quality safety planning, quality supervisory reviews, and the quality and frequency of home visits. 

Now that Eckerd knew what to look for, the next step was to determine which cases needed to be prioritized for review. So Eckerd 

Kids secured a technology partner that specializes in predictive 

analytics, Mindshare Technology, to identify the cases most like 

the prior fatalities on incoming cases in realtime. Cases that were 

prioritized had multiple common factors, such as a child under the 


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age of 3, a paramour in the home, intergenerational abuse, and history of substance abuse. 

Eckerd Kids then reviewed these cases against the practices 

identified with better safety outcomes and conducted coaching sessions with the frontline staff when deficits were identified. 

The results have been promising. In Hillsborough, there were no 

maltreatment fatalities in the 3-year period following implementation of the program in the population served by Eckerd. Critical 

case practices also improved an average of 22 percent. As a result, 

Eckerd Kids and Mindshare are now working with Oklahoma, 

Maine, Alaska, Illinois, and Connecticut. 

Regardless of the jurisdiction, the problem needs the same ingredients for success. These include: A narrowly defined challenge the 

jurisdiction is trying to solve, such as the prevention of a fatality 

to a child with prior abuse reports; daily access to the State Automated Child Welfare Information System, allowing for predictions 

that continuously improve and update as new data is entered; access to quality assurance reviews assessing case practice; and experienced staff to review the identified cases for the key safety practices and provide coaching to the field. 

In closing, it is important to note that we are not advocating decisions made by machines. What is needed is a second set of eyes 

to ensure we are doing our best casework and positive outcomes for 

the children and families in our care. 

Therefore, we are advocating that data and coaching together 

provide a support for those men and women working with families 

to help them focus attention where it is needed most. I know from 

past experience as an investigator and supervisor in the field I 

would have appreciated the help. 

Mr. Chairman and Members of the Subcommittee, thank you 

again for the opportunity. I will present my testimony in full for 

the record and look forward to answering any questions. 

[The prepared statement of Mr. Lindert follows:] 


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Chairman BUCHANAN. Thank you, Mr. Lindert. 

I want to thank all of you for excellent testimony. 

We will now proceed to the portion of the hearing that is the 

questions-and-answers session. 

Mr. Lindert, in your testimony, you talked about the thorough review your organization undertook of child welfare cases in Hillsborough County in Florida. As you began handling child welfare 

cases, you noticed that you found a pattern, you noticed certain 

common features, such as parental substance abuse, that were correlated with serious injuries or death. 

I know you have been working with other States to do the same 

things, but, from my understanding, you were the first in this area 

to really work in this area. 

Should other counties be doing the sort of review of data to help 

them better understand the cases of abuse and neglect, from your 

viewpoint? 

Mr. LINDERT. From our view, yes. We are actively searching for 

additional partners to work with and additional jurisdictions to 

work with beyond the initial five. 

It was also one of the recommendations of the Commission to 

Eliminate Child Abuse and Neglect Fatalities, which is Recommendation 2.1, that other States and other jurisdictions take a look at 

all of these cases in the same vein. 

Chairman BUCHANAN. When you look at data, what type of 

data are you looking at? When you say review of data, what—— 

Mr. LINDERT. So we are looking at factors that are demographics, such as the age of the child involved in the case, but we 

are also looking at system factors, such as the number of police reports that have been received on an individual family. 

Chairman BUCHANAN. Why do you find, when you go into 

these other States, that many States aren’t taking advantage of the 

data or best practices or the idea of continuous improvement? What 

is your sense of why they are not taking advantage of that? 

Mr. LINDERT. My sense is that this is a new area of work. Until 

recently, we didn’t have the technology to take our eyes out of the 

rearview mirror and put them on the dashboard. We can now, if 

there is new information learned on a case, adjust what we think 

the risk level of that case is based upon the new information that 

is received right when it happens. Until recently, we weren’t able 

to do that. So this is a new opportunity. 

But I think the broader issue is probably this. Anytime there is 

a tragedy, there is an intense focus, and rightly so, on that tragedy 

that occurs, but it tends to be episodic in nature rather than taking 

the long view. And I think the recommendations of the Commission 

are that we must take the long view so that we understand these 

patterns better, rather than making policy or decisions based on an 

individual case. 

Chairman BUCHANAN. The other thing you mentioned, at least 

I understood, is the way you operate is a private-public partnership. Tell me how that works and why that works. 

Mr. LINDERT. So, in Florida, the child welfare system is called 

the community-based care system. In each community, a nonprofit 

provider partners with the Department of Children and Families in 

order to provide the child welfare services that are received. We opVerDate Sep 11 2014 08:02 Feb 07, 2017 Jkt 022105 PO 00000 Frm 00056 Fmt 6633 Sfmt 6602 I:\WAYS\WAYSPS\22105\22105.XXX 22105

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erate all services once a child is removed from their home up to the 

time that they are adopted or have independent living services and 

even post-adoption support. 

So we manage all of those services through the same partnerships that would be required of any State agency or county agency 

if they were operating the child welfare system. 

Chairman BUCHANAN. Thank you. 

I now recognize the distinguished Ranking Member for any questions that he might have. 

Mr. DOGGETT. Well, thank you, Mr. Chairman. 

And each of you provided valuable testimony. 

Ms. Willauer, I am just reviewing again your written testimony, 

knowing you couldn’t give it all here, but what strikes me as being 

very important is your comment there on page 15 that there are 

hundreds of unserved families in Kentucky and the START sites 

are unable to take all the referrals due to full caseloads. And then 

you say: ‘‘It is time to take the lessons of all of the prior Federal 

investments of these families and move them to scale by providing 

the States with funds and technical assistance needed to reform 

their systems.’’ 

Basically, you have a good approach. It is evidence-based. You 

can show how it has been effective. Haven’t you been doing this in 

some parts of Kentucky now for over two decades? 

Ms. WILLAUER. Yes. Actually, Kentucky implemented START 

in 2007, but it came out of Ohio. It was operating in Cleveland, 

Ohio, from 1997 for about a decade and a half also—— 

Mr. DOGGETT. You still can’t cover all of the State—— 

Ms. WILLAUER. No. 

Mr. DOGGETT [continuing]. Because you don’t have adequate 

resources to cover all of it. 

Ms. WILLAUER. Well, that is true. And I can tell you that in 

Louisville, Kentucky, for example, for every family we served, we 

had to turn away two that had the same exact needs. So we have 

pockets of excellence in Kentucky and across the Nation, but nothing is to scale. 

Mr. DOGGETT. And, Ms. Barillas, in Texas, I believe the same 

IV–E waiver program that she is talking about only covers one 

county, only Houston. 

Tell me about, from your perspective, what additional resources 

will be necessary in Texas to comply with this Federal court order 

declaring the system a failure and unconstitutional to meet the 

needs of these children and their families. 

Ms. BARILLAS. Well, it is definitely a resource issue. Three particular things that the lawsuit mentioned was a lack of oversight 

of facilities, which was leading to children being sexually abused; 

caseworkers lapsing in their duties—in fact, one particular report 

said caseworkers were only able to spend 26 percent of their time 

with children and families, so the majority of their time was spent 

on paperwork and more administrative duties; and then youth 

transitioning out of care. This young man who is accused of the UT 

student’s murder is a prime example. He was 17 and a runaway. 

He had no particular mental health treatment, no transitioning 

services to help prepare him for adulthood. And we see that happening too often. 


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So, certainly, more oversight of our facilities; not just more caseworkers but well-trained caseworkers; and we need a tremendous 

amount of resources to help our youth actually age out, be independent, and be free of that system. 

Mr. DOGGETT. So, in Texas, only about one-fourth of the time 

that these caseworkers have their child protective services is actually about reaching out to troubling situations like the ones that 

I described and others have described. 

Ms. BARILLAS. Yes, sir. 

Mr. DOGGETT. And you have an immense turnover of these 

caseworkers. They come in, the pay is low, they are cycled through 

the system, and then you have someone new. 

And in Texas also, we far exceeded the recommended load for 

these caseworkers, sometimes by really tremendous amounts, so 

that we hear when a child is found chained or a child is found 

abused that Child Protective Services didn’t do its job, and in some 

cases it did not, but in some cases we are loading up those caseworkers with a load that is so big that they can’t possibly do their 

job. 

Ms. BARILLAS. Well, there are certain priority cases where 

caseworkers haven’t been out at all for weeks up to months, especially in Dallas. We have had a crisis in that area, where caseworkers are leaving in droves, and because of all the poor media 

attention, they are having a lot of trouble hiring anybody. So one 

of the things they have done, our Health and Human Services commissioner has indicated he wants to remove the 4-year degree requirement and reduce training hours, which, to me, is a very dangerous and explosive combination. 

Mr. DOGGETT. Would all of you agree that, knowing we have 

limited resources here also that we will be able to focus on this 

problem, that looking at IV–E and prevention moneys, if we have 

to prioritize, that that is a good place to focus our attention? 

Ms. BARILLAS. Yes, sir. 

Ms. WILLAUER. Yes, sir. 

Mr. DOGGETT. Mr. Glynn. 

Mr. GLYNN. Yes, sir. 

Mr. DOGGETT. And Mr. Lindert. 

Mr. LINDERT. Yes. 

Mr. DOGGETT. Thank you very much for your testimony. 

Thank you, Mr. Chairman. 

Chairman BUCHANAN. I now recognize Mr. Reichert. 

Mr. REICHERT. Thank you, Mr. Chairman. 

I want to start out a little philosophical, I guess, with a quote 

from President Adams that kind of goes to the point that Mr. Doggett was making in his opening statement. We can pass all the 

laws we want to pass, but this is just a portion of a quote, where 

he says, ‘‘Our Constitution was made only for a moral and religious 

people. It is wholly inadequate to the government of any other.’’ 

And so, you know, as we talk about parents who are chaining 

their children and locking them in closets and taking their life, 

where is this society headed? Where are we? The fabric of our society is disintegrating and falling apart, and so where is it left? It 

is left in the hands of people like all of you. 


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And thank you so much for all the hard work that you do. My 

daughter was a caseworker, and I know from her experience. You 

don’t know me, but my experience was in law enforcement for 33 

years, so I get this from having had to call CPS, I have had to take 

children out of their homes. 

I ran away from home when I was a senior in high school. I was 

one of those kids at 16 years old who left my home because of domestic violence, because of alcoholism, and but for the grace of God, 

you know, here I am today to be in this position to help you. 

I have so many things that I want to say, I hardly know where 

to begin. Just the 33 years alone should tell you what I have seen 

and where I have been. I was the lead detective on the Green River 

serial murderer case. In that case, that person took over 60 lives. 

Those young girls on the street were addicts. They were abused at 

home. They ran away from home, looking for somebody to care for 

them. They were abused on the street. Then they were abused by 

the judicial system and victimized over and over and over. 

And so we have to start where the problem, you know, really begins, and that is at the family. And that is where we really have 

to focus in order to prevent those kids from getting into that position where—the young man you spoke about, and me as a 16-yearold leaving home and fortunately not falling into that pathway. 

My daughter and her husband also adopted two drug-addicted 

babies from an organization called the Pediatric Interim Care Center in Kent. My grandson, who is now 13, was adopted at 3 

months, and was a meth-addicted baby. My granddaughter, who is 

now 12, was a crack cocaine and heroin-addicted baby. 

PICC, keeping their statistics—a review of 140 infants discharged by PICC in 2013 and 2014 found only 8 of those infants 

who had changed their placements—only 8 out of 140 had changed 

placements, and the majority of those infants had moved from a 

parent to a relative or a relative to a parent again, those 8. So, you 

know, that is one of the success stories in our neck of the woods. 

And you have success stories too. 

I only have a minute and a half left here. I am really excited 

about what PICC does and about the blessing that Emma and 

Briar have brought to our family. And what happened there was 

the visitation between the parents—I have been to PICC, and those 

drug-addicted parents come in, they rock the babies, they hold the 

babies. They try to get off drugs. Sometimes they can, sometimes 

they can’t. Sometimes the babies have to be sent to foster care, and 

then sometimes, guess what, they have to be adopted. And, in our 

case, we have just been blessed. 

I am curious to know if any of you have programs like PICC in 

your State. I will stop talking, because otherwise you won’t be able 

to answer the question. 

I am just passionate about this. You know, PICC, they take the 

babies from the hospital, because the hospitals don’t have the time 

to withdraw them, right? So they take the babies, and they get 

them off drugs. And then they work with the parents, and they 

work—no? Yes? 

Ms. BARILLAS. In Houston, we have a facility called Santa 

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the children and the parents. But that early attachment and bonding is so critical to their—— 

Mr. REICHERT. Yeah. 

Ms. BARILLAS [continuing]. Brain development, that that is 

why they want to keep mom and baby together. And so—— 

Mr. REICHERT. Yep. 

Ms. BARILLAS [continuing]. That has been very successful in 

Houston. 

Mr. REICHERT. Good. Maybe we can share some information 

back and forth and—— 

Ms. BARILLAS. Sure. 

Mr. REICHERT [continuing]. Make the programs better. 

Mr. LINDERT. I would reiterate those comments for Florida. We 

also partner with a number of providers of that nature, and would 

reiterate all the comments made. 

Mr. REICHERT. I yield back. Thank you, Mr. Chairman. 

Chairman BUCHANAN. Thank you. 

I now recognize Mr. Davis for 5 minutes. 

Mr. DAVIS. Thank you, Mr. Chairman. I commend you and 

Ranking Member Doggett for holding this hearing today. 

One of my top priorities on this Subcommittee is modernizing our 

approach to families and child welfare affected by parental substance abuse. For months, I have worked with experts to draft a 

bill that does just this. My bill amends the current Regional Partnership Grants both to focus the grants on what the research 

shows works and to scale up these grants to the State level. 

I will introduce this evidence-based approach this month in 

honor of National Foster Care Month. We need to update our laws 

to reflect the decade of research, and I look forward to continuing 

to work with the Chair and Ranking Member to advance these reforms. 

Although I have championed evidence-based policy, I must raise 

concern from experts about whether we have the data infrastructure and research base necessary for large-scale implementation of 

predictive analytics. 

And I request permission, Mr. Chairman, to submit for the 

record this dissenting report of the Honorable Judge Patricia Martin, a Commissioner on the Commission to Eliminate Child Abuse 

and Neglect Fatalities. 

[The submission of The Honorable Danny Davis follows:] 


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Mr. DAVIS. Judge Martin is a national expert on child welfare 

whom I have known for decades, and if she has concerns, then I 

think our Subcommittee should give serious consideration to them. 

Ms. Willauer, given that timely access to treatment is related to 

child welfare reunification outcomes, can you tell us more about 

how you achieve quick access to services? And what are your recommendations to make this type of quick access available in more 

States and communities? 

Ms. WILLAUER. Thank you for that question. I think it is the 

key to child welfare reform, quick access to parental substance use 

treatment. 

So I think that there are a couple things. We need resources. We 

need treatment providers. Sometimes there is a 3- to 6-month waiting list in Kentucky, for example. 

So, again, I think that I would reiterate what you are saying, 

and that is, for example, Regional Partnership Grants, taking them 

to a State level, providing States with the resources to be able to 

develop those resources so that individuals—so all families can get 

them. Right now, only pockets of families can get those resources. 

So it is critical. 

Mr. DAVIS. Thank you. 

Your testimony also emphasized the necessity to include fathers 

in family treatment, noting that this policy evolved over time. Can 

you expand on the importance of focusing on fathers in your program? 

Ms. WILLAUER. Absolutely. Addiction affects the whole family, 

including moms, dads, kids, extended family. And if we do not include the fathers, then you are not holistically addressing the situation. We should include them in treatment, in decisionmaking. We 

should look at their families for support for placement for children. 

And we should look for gender-specific treatments for those dads. 

Mr. DAVIS. Thank you very much. 

Dr. Barillas, several of the other witnesses have described their 

promising approaches to address parental substance abuse and 

keep children safe. Are these interventions expensive in the short 

term? 

Ms. BARILLAS. Evidence-based practice can be expensive in the 

short term. It requires fidelity to a model, which requires specific 

elements and training. It also requires evaluation, and I have 

found that a lot of times, when programs are funded, they are not 

funded for that evaluation piece. But in the long run, as you can 

hear from the various witnesses, these programs have a major impact and save us money. 

Mr. DAVIS. So we follow the trend that an ounce of prevention 

is worth much more than a pound of cure—— 

Ms. BARILLAS. Yes, sir. 

Mr. DAVIS [continuing]. If we provide it early on. 

Ms. BARILLAS. Absolutely. 

Mr. DAVIS. Thank you very much. 

And, Mr. Chairman, I yield back. 

Chairman BUCHANAN. Thank you. 

I now recognize Mr. Reed for 5 minutes. 

Mr. REED. Well, thank you, Mr. Chairman. 


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And thank you to the panel for your testimony. And each and 

every one of you has a great story, a great piece of information to 

help us on this issue. 

So what I really want to get into is to ask you, on the day-today perspective of a frontline worker dealing with this issue, 

dealing with the people that are involved, we are trying to get to 

prevention. That seems to be a common theme that we are all testifying to in the remarks. 

So, as we go down the path to prevention, what is the existing 

culture with those frontline workers in regards to prevention? Is it 

something they promote? Is it something they are committed to? Or 

are they more focused on the back end, dealing with the situation 

after the crisis has gone on? 

Would anyone like to answer? 

Ms. WILLAUER. I will speak to that. I was a frontline worker 

for 7 years. 

I just think the frontline workers are overwhelmed. The caseloads are huge. They don’t have the resources they need to do their 

work. It is not that they don’t want to do prevention. They don’t 

want to remove these children from the home. But sometimes, 

when your caseload is 30 families and you have nowhere to send 

parents to treatment, sometimes you feel like foster care might be 

a safer way to go, when we know that is not necessarily true. 

Mr. REED. Any other input? 

Mr. Glynn. 

Mr. GLYNN. My organization works with 8,000 families at any 

given point, but this program here is the one that keeps me up at 

night. And it is the same for the child welfare agencies. 

What we are asking is for a greater risk tolerance, right? We are 

asking that they keep babies, 0- to 3-year-olds, with parents who 

have an active substance abuse issue. 

And so the model that will have to be adapted is one of shared 

risk, one in which we are in the home very often, three, four, five 

times a week, where we are on call 24/7. And we share that information with the child welfare workers. And, together, we have to 

make those decisions about is it safe and, when it is not, how do 

we remove the children. 

Mr. REED. Okay. So that is great. So what you are envisioning 

is your organization picking up that risk on the front end—or sharing that risk with the child welfare system workers going forward. 

Now, that being said, how do you then—we measure the success 

of that preventive measure that you are advocating for on the front 

end with your organization. What is the measurement that you 

would offer us as a guide in that culture? 

Mr. GLYNN. I think, one, it should be placement; did the children stay within their biological or natural placement. And, two, 

for us, it is those tox screens. You know, how clean are the parents? Do they remain clean during periods of treatment, and what 

does it look like going out after? 

Mr. REED. Okay. 

And then from the child welfare workers’ perspective, because 

some folks in D.C. think the ultimate solution is just more resources, more resources, and if you keep funding at higher and 

higher levels, you will cure this problem. One of the things I have 


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experienced here in the time I have been here, since 2010, is often 

that is not the best solution, nor will it lead to a solution. So what 

you have to do is reallocate the resources. 

So, from a child welfare workers’ reactive perspective, moving to 

a prevention, what things are they focusing on now on the front 

line that you would say is probably not the best use of resources 

and could be allocated more toward the front end to the prevention 

side of the equation? 

Ms. Barillas, do you have any—— 

Ms. BARILLAS. Making—— 

Mr. REED. Or is every dollar being 100-percent efficiently deployed? 

Ms. BARILLAS. No, no, I would not argue that. But what I 

would say is, you know, in the study we did in Texas, where we 

found that 26 percent of a caseworker’s time is the only time they 

are spending with children and families because they are busy filling out 5 million forms—— 

Mr. REED. Amen. 

Ms. BARILLAS [continuing]. Most of which are repetitive—you 

know, I know you all know nothing about that kind of paperwork— 

you know, instead of—— 

Mr. REED. And why are they filling out so many forms? What 

is causing that, from the frontline workers’ perspective? 

Ms. BARILLAS. It is caused by policy decisions that are made 

at the State level that are sending—we have this great idea, we are 

going to do structured decisionmaking, and we have this great idea, 

we are going to change visitation and make you fill out a form, and 

as part of that policymaking process there is no consideration of 

what implementation is actually going to look like on the front line. 

Mr. REED. So is that a fair piece of input that I hear from you? 

When we move to the prevention side, make sure we don’t duplicate that kind of administrative bureaucratic problem when we go 

to the prevention side? 

Ms. BARILLAS. Oh, absolutely. 

Mr. REED. And what would be the one reform or requirement 

or provision that we could put into that shift in policy that would 

accomplish that to the most successful end? 

Ms. BARILLAS. Well, as I mentioned, considering in the implementation what is going to happen in the implementation process. 

There is a lot of this that can be done electronically or a lot that 

is already included in paperwork caseworkers have. They are literally duplicating the same information on five different forms. 

Mr. REED. So data streamlined and data—— 

Ms. BARILLAS. Absolutely. 

Mr. REED. I appreciate that. 

And I am out of time. With that, I yield back. 

Chairman BUCHANAN. Thank you. 

I now recognize Mrs. Black for 5 minutes. 

Mrs. BLACK. Thank you, Mr. Chairman. I want to thank you as 

a non-Committee Member for allowing me to sit on this Committee 

and also be able to ask questions. 

Gosh, I don’t know where to begin, just like the other Members 

of this Committee. This is such a big issue. 


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But where I do want to start—and if we could just walk down 

the line with this. Help me to understand how you come to know 

that someone needs assistance. Where do you get that first contact 

to say, we need to go and visit this family and become a part of 

helping them to turn the situation around? 

Ms. Willauer, how about you? 

Ms. WILLAUER. Yep. In the START program, families come to 

our attention after a report to the child welfare agency regarding 

some abuse or neglect. START gets involved right after that. 

Mrs. BLACK. Okay. 

Mr. Glynn. 

Mr. GLYNN. The same is true for us. 

Mrs. BLACK. Okay. 

Ms. Barillas. 

Ms. BARILLAS. In prevention, a lot of it is other service providers. So when families are receiving services from WIC or somewhere else and it is noticed that they need assistance, they will be 

referred to a prevention program. 

Mrs. BLACK. Okay. 

Mr. Lindert. 

Mr. LINDERT. In our case in Florida, the families come to our 

attention as a result, primarily, of removal from their parents. 

However—— 

Mrs. BLACK. Primarily? I am sorry, I didn’t catch that. 

Mr. LINDERT. Removal from their parents. 

Mrs. BLACK. Removal from their parents. 

Mr. LINDERT. In some cases, it is also to serve the families inhome prior to removal. 

Mrs. BLACK. Okay. 

Mr. LINDERT. And in the other States where we are working, 

typically it is a result of a hotline call that has been made to the 

State’s health welfare agency. 

Mrs. BLACK. Okay. 

So, again, going down the line, tell me what percentage of these 

moms that you come in contact with, what percentage of them are 

either single mothers or of a divorce, where they may have been 

married and no longer are. 

Ms. WILLAUER. I don’t have numbers on that, but I can tell you 

it depends on the region of the State. 

Mrs. BLACK. Okay. 

Ms. WILLAUER. And we do have a lot of single-headed households. But I can follow up with you. 

Mrs. BLACK. Okay. 

Mr. Glynn. 

Mr. GLYNN. It would be an estimate, but it would be in the high 

70 to 80 percent—— 

Mrs. BLACK. Okay. A high percentage. 

Ms. Barillas. 

Ms. BARILLAS. I would say the same, although I don’t have the 

specific numbers right now. 

Mrs. BLACK. Sure. 

Mr. Lindert. 

Mr. LINDERT. It is the same for me. 

Mrs. BLACK. Okay. 


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So here is—I want to go back to what Congressman Reed was 

saying, and that is the prevention piece of this. And I will just tell 

you my experience as a registered nurse and also coming from the 

State of Tennessee, where I was on the Child and Family Services 

Committee. 

I helped to bring a program into our State called Nurse-Family 

Partnership, where we had young mothers who were not wed or in 

some cases where they may have been but weren’t getting support 

from that spouse, that we would interact with very early on to 

make sure that they understood that they were carrying a child 

and bonding with that child and making sure they got all the services that they needed that we could possibly give them. And that 

has been funded by the State of Tennessee and we have seen very 

remarkable, remarkable results there. 

And so I am a big prevention kind of person. And I am glad to 

see every one of you are nodding your head on that, because, obviously, that really is the answer, if we could do that. 

The evaluation piece is the next piece, that we didn’t do a very 

good job in our State evaluating, because we saw a lot of children 

that were being removed from their homes, and the evaluations 

when I asked for the numbers and the statistics and so on—so if 

we could just go down the line again about evaluation. What are 

you using to evaluate each one of your programs? 

Ms. Willauer. 

Ms. WILLAUER. Can you say more on that? What are we using? 

Mrs. BLACK. Well, what method are you using? Are you evaluating—— 

Ms. WILLAUER. Yes. 

Mrs. BLACK [continuing]. On a regular basis? And what kinds 

of things are you evaluating when you get involved? 

Ms. WILLAUER. Yes. So we are looking at all kinds of factors, 

what makes our program work. We are looking at child removals. 

We are looking at parental sobriety, reunification, recurrence, reentry into foster care, different designs of program evaluation. But 

it is critical that we have all of that. 

Mrs. BLACK. And you are evaluating what works and doesn’t 

work. 

Ms. WILLAUER. Absolutely. We are doing a randomized control 

trial in Louisville, Kentucky, on START—— 

Mrs. BLACK. Very good. 

Mr. Glynn. 

Mr. GLYNN. The University of Yale provides oversight and evaluation to all the service providers. 

Mrs. BLACK. Excellent. 

Ms. Barillas. 

Ms. BARILLAS. In Texas, we have actually really struggled with 

that, and it was only a couple of years ago, when our Prevention 

and Early Intervention Division got a new director, that we started 

really looking. Because, for the most part, people were using preand post-tests, which really can only tell you so much. So, as there 

was a push for more evidence-based practice, you see more, for example, like, randomized control trials—— 

Mrs. BLACK. Good. Yes. 

Yes? 


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Mr. LINDERT. We are working with Casey Family Programs to 

evaluate the implementation in four States, and they are using an 

interrupted time series design. Although the evaluation is just 

about to begin. 

Mrs. BLACK. Excellent. 

And I just will finish up by saying that if you don’t measure 

something you can’t tell whether it is working or not. And I think 

that is one of our problems, Mr. Chairman, is that we spend a lot 

of money on a lot of different programs, but when you ask about 

their evaluations and how they are measuring the success, what 

you see is you are spending a lot of money and you are getting a 

lot of information that isn’t valid, that you don’t have the real statistical information to show that it is working. 

And so I think every dollar that we expend from the Federal 

Government should be required to have an evaluation tool where 

we can say that money is actually working. And I will go back to 

that ‘‘ounce of prevention is worth a pound of cure.’’ That is really 

where it is good to be spending most of the money, on these kinds 

of programs that we know work. 

So thank you for the work that you do. It is God’s work. Thank 

you. 

I yield back. 

Chairman BUCHANAN. Thank you. 

Let me just ask you—you know, everybody has a family member 

or somebody they know, and it just seems to me—and everybody 

has touched on it—is the whole investment seems to be, especially 

with children, the prevention piece. 

And I don’t know, I would like to get all of your thoughts just 

quickly on it. But, you know, at what level, what grade level, do 

you need to start working with children? You know, you think high 

school, but then you hear all these stories that you have to get 

down to 3rd and 4th grade. It seems that is the investment we 

have to make in an aggressive way. 

And the reason I say that is because I have seen it in my own 

family, where someone ends up having a problem, and then to 

move them back off that problem is huge, the toll it takes on a family and the expense. And many times, I don’t know what the rate 

is, but they have to be on guard the rest of their life, many times, 

because the drug owns them. 

So I guess, as it relates to children, what is your experience, your 

thoughts about how early in our school systems and everything— 

parents—do we need to be investing with these children in terms 

of educating them and making sure they understand if they make 

a bad choice it is tough to come back from that? 

Ms. Willauer, let’s just go down the row real quick. 

Ms. WILLAUER. I guess I would just say it starts at birth. It 

starts with the family. There are early intervention services and 

early childhood services that can help with bonding and attachment. So it begins there, and I think there are opportunities all the 

way through the lifespan of a child’s life. 

Chairman BUCHANAN. Mr. Glynn. 

Mr. GLYNN. I would agree that, you know, what we know about 

brain development really does push us to say we have to invest 

more in the 0 to 5 years of development, and that will help to creVerDate Sep 11 2014 08:02 Feb 07, 2017 Jkt 022105 PO 00000 Frm 00092 Fmt 6633 Sfmt 6602 I:\WAYS\WAYSPS\22105\22105.XXX 22105

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ate the executive functions that you are looking for to prevent some 

of the decisions that will be made later on. 

Chairman BUCHANAN. Ms. Barillas. 

Ms. BARILLAS. You stole my answer. 

Yeah, absolutely, the brain development is critical to giving children the skills they need to make those decisions. But I also agree, 

if children are going home to an environment that is full of these 

negative influences, then it is not going to matter what happens in 

school or in another program. 

Chairman BUCHANAN. Mr. Lindert. 

Mr. LINDERT. I agree with all of the comments. 

I would also add that when we are thinking about children who 

have come to the attention of the child protection system, we have 

to prioritize early childhood and, in particular, infancy. The majority of maltreatment fatalities occur within the first 3 years of life, 

a significant amount of those in infancy. And child welfare agencies 

need to approach early-childhood cases differently than we approach cases on teenagers and at other points throughout the lifespan. 

That is a recommendation of the Commission. It is also something I have seen in our systems of care and as a frontline worker 

myself. 

Chairman BUCHANAN. I would like to thank our witnesses for 

appearing before us today. You have given us a lot to think about 

as we try to improve our child welfare system to protect more children from harm. 

Please be advised that Members will have 2 weeks to submit 

written questions to be answered later in writing. Those questions 

and answers will be made part of the formal hearing record. 

With that, the Subcommittee stands adjourned. 

[Whereupon, at 4:12 p.m., the Subcommittee was adjourned.] 

[Submissions for the Record follow:] 


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