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In all, some $90 million in additional support is supposed to be on the way. Two bills increased tax incentives for foster and adoptive parents, while another measure, if signed by the governor, would raise pay rates and clothing allowances for the first time in years.

“Today is a really great day,� Vescovo said in April, . “I don’t think anybody will ever understand how important these two bills will be to some of these future children that we can help.�

While many share his enthusiasm for the outcome, they also express concern about the underlying issues: There’s been a large increase in the number of children coming into state care and a shortage of services to help families stay intact.

“It’s great that we are doing so much to help foster and adoptive families,� said Mallory Rusch, executive director of Empower Missouri. “What is Missouri doing for the birth families? If it’s a situation that the birth parents are doing the best they can under the circumstances they are in, then we need to look at how we can support (them).�

In 2020, there were 20,226 children in the state foster care system, up 37% from 14,776 in 2010. The rate also increased from 10.35 per 1,000 children to 14.19.

Rural Missouri drove the increase. The southeast region of the state alone jumped 79%, from 2,924 to 5,227 children in the foster care system, the largest increase over the past decade, according to a Post-Dispatch analysis of state data. Northeast and northwest Missouri were right behind.

More children in the state foster care system means authorities have removed more children from their parents and filed allegations of abuse and neglect against them in court.

Many say the opioid epidemic is driving the increase in children going into foster care, but rates can vary widely by neighboring judicial circuits, even though both have been slammed by opioid deaths and dependency. For instance, the ºüÀêÊÓƵ region, composed of the city and county, was the only region that didn’t see an increase in the number of children in the state foster care system, despite having the largest death toll from opioids.

Local resources and decisions affect the numbers. The Missouri Department of Social Services Children’s Division runs the foster care system. It fields the 24-hour abuse and neglect hotline statewide and has investigators in each judicial circuit who can make referrals. But only juvenile officers, physicians and police have the authority to remove a child from a home and place them in temporary protective custody.

If a case is filed in court against the parents, alleging abuse and neglect, a juvenile judge ultimately decides whether to reunify the family, terminate parental rights and pursue adoption, or place the child in guardianship or another planned permanent living arrangement. Until then, the child is in the state foster care system.

These cases can last anywhere from months to years, as parents try to prove to the juvenile court that the best interest of their child is to be with them. Reunification is supposed to be the initial goal. But parents in this situation, usually poor and sometimes without legal representation, must overcome a host of obstacles to show they can care for their children. Often, they must show stable income, adequate living conditions and clean drug screens. They often need to participate in drug treatment, parenting classes and domestic violence and couples counseling.

To protect the identities of the children, abuse and neglect dockets aren’t publicized. Some parents don’t fight the allegations. But many do.

“I’ve done everything that was asked of me,� a mother here recently told Associate Judge Edward Page, of the 23rd Circuit in Jefferson County. “I want my kids back.�

“Ma’am,� Page told her during the hearing, “keep doing what you are doing, and we’ll be there.�

During a break, Page said in an interview that each case is complex, with mental illness being the most common factor. Rather than see a doctor, he said, they tend to self-medicate with drugs — meth, pills, heroin, fentanyl.

“Poor people have poor ways,� he said.

All rise

The next day in juvenile court, everyone was lawyered up — except for some of the people who had the most to lose.

The juvenile officer had an attorney who did much of the questioning during the hearings. Children’s Division caseworkers, who testified about each family’s progress, had an attorney. The children who’d been removed from their homes had an appointed attorney, or guardian ad litem, to advocate for their best interests.

Most of the parents represented themselves. Associate Judge Shannon Dougherty told each of them that they had a right to an attorney. And, if they couldn’t afford one, they could apply for one to be appointed. One man in court told the Post-Dispatch that he’d been denied an appointed attorney because he owned a 2012 truck. He did the best he could on his own, and seemed to lean on guidance from an attorney representing the mother of his baby girl.

The girl was born this spring at Mercy Hospital South with fentanyl and methamphetamine in her system, according to details mentioned in court. The parents each had criminal records that reflected significant struggles with alcohol and drugs.

With a neonatal intensive care nurse waiting outside the courtroom to testify for the juvenile office, the mother and father agreed that the accusations made against them would likely be proven if their case went to trial. The parents signed off on a four-page family treatment plan that had a list of court-ordered requirements they’d need to meet to get their daughter back. For the time being, the baby would continue to be placed with a paternal grandparent.

“Our goal is always reunification with a parent when possible,� Dougherty told them. “Ultimately, your parental rights could be terminated.�

Another case involved a 15-year-old boy. Typically, he would have attended the hearing. Not this time. He was on the way to in-patient drug treatment at Preferred Family Healthcare in Kirksville — in northeast Missouri.

Robert Clements, a Children’s Division caseworker, testified that he couldn’t find an option closer to the boy’s mother in southern or southeastern Missouri, so they could do supervised visits. Being far apart was a potential problem, said the child’s court-appointed attorney, Robert Bilbrey, because, in a role reversal, the child felt responsible for the mother’s well-being.

“This is a case we probably should have a bit more of an open mind,� Bilbrey told the court.

The 48-year-old mother appeared in court by Zoom. She sounded overwhelmed that her son was going to be more than 300 miles away. The court questioned her about the possibility of her drug screens being watered down and the status of parenting classes, domestic violence counseling and a psychiatric evaluation. The mother told the court she’d been trying to get the evaluation done but couldn’t find a provider available that accepts Medicaid.

Later, she told the Post-Dispatch by telephone that a Festus police officer and Children’s Division employee took her son away in January 2020.

“They look at me like I am a criminal,� she said. “I work my butt off. Yes, I was homeless. I can’t deny that. But as far as making me do all this drug testing? I admitted that I had a problem, but I had been clean.�

She said she’d started out snorting and smoking methamphetamine, then using a needle. She said she quit meth when one of her other sons went to prison for involuntary manslaughter. She said she has since moved to Poplar Bluff because she wanted to get away and couldn’t find affordable housing in Jefferson County. She said her rent is $750 a month. She said she celebrated three years of sobriety on May 26 by sharing a little birthday cake with an elderly Medicaid patient she takes care of for $11 an hour.

“I have passed background checks to work in state-run facilities and do in-home health care, but I can’t get my kid back?� she said.

She said she sees a counselor every other week. Parenting classes are supposed to start Monday. She said she still needs a psychiatric evaluation. She said she still needs to find an attorney.

As for her teenage son in northeast Missouri, she said, he didn’t receive his medication and was kicked out of the in-patient drug treatment program after one week for horseplay. Last she heard, he was supposed to be moved to another program in West Plains, in south-central Missouri.

Avoiding court

In ºüÀêÊÓƵ, parents in abuse and neglect cases are represented by an attorney at every hearing, said Steven Ohmer, administrative judge of the city’s juvenile court. If they don’t hire their own, an attorney is appointed.

“It’s crucial that the parents have a voice,� Ohmer said. “If they don’t have an attorney, they are on their own. They don’t know the ins and outs … we are not trying to punish. We are trying to figure out what’s best for the child.�

If reunification isn’t possible, he’s said, it’s better to know that sooner than later. But he said many situations don’t come to that. If parents are willing to make changes in their lives — by doing counseling, drug treatment, improving living conditions — then the child can stay out of foster care.

“We have been very proactive,� he said. “A lot of work is done to keep these kids out of the court. A lot of effort is made to help the family to avoid them coming into care.�

A key component of the approach in ºüÀêÊÓƵ is called “Team Decision Making,â€� which started in 2003 as a pilot program funded by the Annie E. Casey Foundation. The team tries to find alternatives beyond coming to court. The model leans heavily on establishing and utilizing relationships in the community with organizations and individuals who can help.

In a common situation, once a major concern is reported, the Children’s Division meets with the family, as well as any invited friends, neighbors, teachers, coaches, pastors or other people who know the child. The team meets quickly to see what services and supports can be provided to keep the child safe. Even if a workable solution can’t be made, and the case goes to court, the team continues to meet before and after any changes in the child’s placement.

In 2002, the year before the program started, there were 3,141 children in the state foster care system from the city of ºüÀêÊÓƵ, according to state records. By 2006, there were 1,879. The numbers continued to drop from there. In 2010, there were 1,218 and 902 in 2020.

“The goal always was to keep the family as intact as you could. To find resources,� said retired Judge Thomas Frawley, who ran the juvenile court in the city when Team Decision Making came into play.

He said it was a collaboration with the Children’s Division, whose director in the city at that time was Tena Thompson.

“We were honest with our numbers. We challenged ourselves. We challenged our community,� Thompson said in an interview, adding: “It is possible to keep children safe and at home with proper support, interventions and follow-up and oversight.�

Naysayers at the time asked what would happen if the support system broke down and tragedy happened, always a stress in child welfare. But on the flip side, Thompson said, there was buy-in.

“You don’t want families to give up hope,� she said. “That keeps them engaged.�

Budget cuts

When she was retiring in 2013, Thompson said Team Decision Making was supposed to be expanded statewide.

As part of state budget cuts that gutted the middle-management ranks of the Children’s Division last summer, all Team Decision Making facilitator positions were eliminated, said Bradley Harmon, vice president of Local 6355 of the Communications Workers of America, the union that represents Children’s Division employees.

He said about 60 of the facilitators, mainly with master’s degrees, focused solely on running emergency team meetings for children and families in crisis. He said many of facilitators stayed on with the division, but took on lower-paying jobs with additional duties.

“It’s been more difficult to get the meetings scheduled because the people who have to facilitate the meetings have other tasks that they have to do now,� Harmon said.

He said many of the meetings are happening after the child has been placed in state care.

“It does defeat the purpose because the whole point of a team decision making meeting was to identify alternatives to the removal of the child and keep the child safe,� he said.

The Missouri Department of Social Services Children’s Division confirmed that Team Decision Making is still used but that the facilitators have taken on additional duties. The spokeswoman said by email that the passage of legislation last year led the agency toward a structure that complies with legislative requirements, “while incorporating the most beneficial elements of previous practice for placement related decisions.�

Asked in a brief interview about the increase in children going into foster care, particularly in southeast Missouri, DSS Acting Director Jennifer Tidball told the Post-Dispatch in April that she didn’t wish to comment without first studying the data. Last week, she said in a prepared statement: “I implicitly trust and have great confidence in Children’s Division leadership. Undoubtedly, they are the experts and I know the decisions they make will be based on years of experience, professional knowledge, and outcomes-based research to ensure we do our very best to keep Missouri children safe and strengthen families.�

Feeling worthless

Here in Jefferson County, the number of foster children in state custody over the past decade increased 34%, near the state average. In 2020, there were 894 children in care, up from 668 in 2010.

“If there were more intense services for the families up front, then maybe we wouldn’t necessarily have to remove so many kids from their homes,� said Karen Stetina, director of child protective services for the juvenile office. “We can’t keep on this path. There aren’t enough foster homes.�

Some families have been in crisis for generations. A 21-year-old woman recently had her two children taken into state custody. The mother was in foster care as child after being raped by her grandfather.

“She needs intense therapy,� Stetina said. “Intense means more than once every other week. She feels like she is worthless.�

The young woman did graduate from high school but doesn’t have a driver’s license. There isn’t public transportation in Jefferson County.

“If you live in Dittmer or Grubville or DeSoto, even getting to ºüÀêÊÓƵ can be a challenge for services,â€� Stetina said.

Bilbrey, who is one of 10 guardian ad litem attorneys in Jefferson County, also said mental health treatment could make a difference.

“More access to mental health services could help families in both preventing the intervention of the state, as well as improving the efforts to reunify the children with the families,� he said.

As is, most of those without insurance tend to go to COMTREA, the largest state-funded behavioral health organization in Jefferson County. It has locations in Arnold, High Ridge, Festus and across the street from the courthouse in Hillsboro.

Wait times to see a psychiatrist are eight to 12 weeks, or much longer for individual therapy.

“Sounds a little crazy, but with COVID, I can’t even describe it,� said a woman who fielded a recent inquiry. “We are a year out. Between the suicides and everything else, there’s just not enough help here to help people in need.�