Kennedy School of Government Case Program
Kennedy School of Government Case Program
C16‐94‐1265.0
This case was written by Pamela Varley for Julie Wilson, director of the Malcolm Wiener Center for Social Policy, and Christine Letts, lecturer in public policy, at the John F. Kennedy School of Government, Harvard University. (1194)
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High Stakes and Frightening Lapses: DSS, La Alianza Hispana and the Public‐Private Question
in Child Protection Work (A)
Introduction
On February 12, 1994, acting on an anonymous tip, police in Boston’s Roxbury neighborhood went to the home of 26‐year‐old Clarabel Ventura, where they reportedly found six hungry children, ages nine months to seven years, confined to a room strewn with human feces. According to the Boston Globe account, the children had gone without food for several days. More gruesome, police found Ventura’s five‐year old son, Ernesto Lara, lying on a mattress soaked with his own blood, urine and feces, his hands scalded from wrists to fingertips, “virtually burned down to the bone,” according to Boston Police Sergeant David Aldrich. Someone, it appeared, had plunged the child’s hands into boiling liquid.1 Lara’s second and third degree burns had become infected, according to reports from the Boston Children’s Hospital, as they had gone untreated for an estimated two to four weeks.2
Over the next few days, disturbing details of the Ventura family situation were reported in the Boston press, embellishing the initial lurid account. Former neighbors of Ventura—a single parent, four months pregnant—reported that she frequently screamed at her children, locked them in their bedrooms, and sent them out into their housing project late at night to bum cigarettes, food, and money from the neighbors. They also reported that Ventura had sold food stamps and the family washing machine to buy crack‐cocaine. And, they said, she had a violent boyfriend who had beaten her and burned her with an iron. Ventura’s children had been in and out of her custody
1 Ventura was charged by the Suffolk County district attorney with scalding her son’s hands, but
members of Ventura’s family claimed that Ventura’s boyfriend was to blame. 2 Boston Globe, February 13 and 14, 1994 and March 24, 1994.
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since 1987, as she made repeated efforts to overcome her drug addiction, secure a high school‐ equivalency diploma, and set her life aright.3
In Boston, the Ventura case quickly became a lightning rod for champions of all kinds of social causes and political agendas: the horrors of crack‐cocaine, the inadequacy of family planning, and the need to track down absent fathers (none of the four men who had fathered Ventura’s children paid child support). Advocates of welfare reform, including Massachusetts Gov. William Weld, used the case to illustrate “the cycle of welfare dependency,” as Ventura, her mother, and nearly all of her 13 siblings received welfare or another form of government income assistance.4
The Ventura scandal also focused a hard light of scrutiny both on the Department of Social Services (DSS), the arm of Massachusetts state government responsible for delivering child protective services, and on La Alianza Hispana, the community‐based agency under contract to DSS to provide protection to Ventura’s children. It soon came to light that La Alianza had not followed a key protocol in the regulations governing child protective work: case workers from the agency had failed to conduct monthly home visits to see Ventura and her children. Records from the agency indicated that, although the case worker had made several attempts, she had not seen Ventura since October 1993, four months before the incident, and no one from La Alianza had seen Ventura’s children since April 1993, ten months before the incident.
DSS publicly “blasted” La Alianza in the press5 for its handling of the Ventura case, alleging a history of problems with the agency. But critics of DSS questioned why the state agency was not doing a better job of monitoring its private contractors. And why, some added, was DSS contracting out such difficult, high stakes work to a community‐based agency in the first place? In addition to addressing these broad questions, DSS had to make an immediate decision in the wake of the Ventura incident either to continue, or to sever, its contracting relationship with La Alianza Hispana.
La Alianza Hispana
La Alianza Hispana, a Roxbury‐based non‐profit organization serving an estimated 5000 Latinos a year, was founded in a small storefront building in 1969 by a group of Hispanic activists who wanted to serve and empower Boston’s Hispanic residents. La Alianza gradually expanded over the next 15 years, and by 1986, when Luis Prado became its executive director, the agency had
3 Boston Globe, February 16, 1994 and March 24, 1994. 4 Boston Globe, February 20, 1994. 5 Boston Globe, February 15, 1994.
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an annual operating budget of $800,000 and was running 10 programs—from teen pregnancy prevention and after school day care to English as a Second Language and employment placement. Under Prado’s leadership, La Alianza expanded rapidly. By the time of the Ventura incident in 1994, the agency had an operating budget of $2.5 million, ran 25 programs, and was the largest Latino organization in Boston.
As part of that larger expansion, La Alianza Hispana began, under DSS contract, to provide child protective services to Hispanic families in 1989. By contrast with many of its other new programs, however, La Alianza had not sought out child protective work; child protective work had sought out La Alianza. Early in 1989, DSS administrators had approached the agency’s board of directors to ask La Alianza to provide child protective services under a new DSS initiative called “PAS,” or Partnership Agency Services program.
The history of private involvement in child protective work
When DSS introduced the PAS program, the Department of Social Services, itself, had been up and running fewer than 10 years. In fact, the involvement of the public sector in the child protection arena was a relatively recent phenomenon. Until the 1960s, child protective work in the state had been almost exclusively the domain of private charitable organizations—in particular, the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC). Gradually during the 1960s and 1970s, in response to changing federal laws, the state Department of Public Welfare (DPW) had assumed ultimate responsibility for child protective services. Some of this work was provided directly by DPW social workers and some was contracted out to the private charitable organizations. During these years, the relationship between the state and the private agencies was a testy one, marked by divergent views of child protective work and also by ethnic snobbery—a vestige of the old Yankee‐Irish power battles in Boston, according to Loretta Kowal, former MSPCC director. Some of the charitable organizations had been run by Yankee society women, Kowal says, and they criticized the state—staffed mostly by uncredentialed, poorly paid white ethnic and minority social workers—for high case loads and unsophisticated work. The state workers, for their part, regarded the private agencies as soft and spoiled, with an inflated view of their own talents. They thought the private agencies served an easier, more middle class population on the whole, and noted that because the private contractors carried smaller case loads, they had the luxury to do less case management and more psychotherapy.
The Massachusetts legislature created DSS in 1980, partly due to a national trend to decouple welfare assistance and child protective work, and, recalls former DSS Commissioner Marie (Sandy) Matava, partly in response to public outcry over the discovery of a young girl who had been murdered and dumped in a trash can during a blizzard in 1978. The new DSS inherited from DPW contracts with the private charitable organizations, but the state also used the
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opportunity, along with some newly available federal funds, to “upgrade” its child protective work, hiring social workers with better training for better salaries. Though it was created with the primary aim of protecting children from abuse and neglect, the DSS leadership at once began to define the agency’s mission more broadly—not simply to protect children in an immediate sense, but to support families in trouble and keep them intact whenever possible. To this end, DSS not only investigated complaints and managed the custody and care of each child in the system6, it also funded a host of ancillary services, from day care and family counseling to parent training and programs for teenagers. In the early to mid 1980s, about two thirds of DSS’ overall budget was contracted out to private providers. The bulk of this funding went to foster parents and group homes for the children. DSS also contracted out all of its day care service and most other ancillary services. In addition, the department contracted out about 10 percent of actual case management services, according to Matava. By the late 1980s, however, the contracting out of case management services had become problematic for several reasons.
The origins of the PAS program: A convergence of woes
During the mid 1980s, public awareness of sexual abuse and the upsurge of crack‐cocaine abuse in inner cities resulted in a dramatic increase in reports of child abuse and neglect—from 36,258 in 1983 to 61,506 in 1988. In the same period, DSS’ load of open cases7 increased from 12,518 to 18,957. The state, however, was struggling with financial troubles and DSS’ budget appropriations did not keep pace with the burgeoning demand. Case loads for DSS social workers increased above the contractual limit of 18 into the twenties, prompting union protests and law suits.
At the same time, public social workers were often resentful that their colleagues in private agencies—under contract to DSS to manage cases—were still working with much smaller case loads, in some agencies as low as six or eight cases. (And in some instances, even fewer. In one notorious situation, a private agency had assigned four social workers to a single difficult case.) Indeed, the disparity in case loads between private and public sectors was the symptom of widespread confusion and inequity in DSS’ contracting practices. Thus, different agencies were
6 Case management entailed taking overall responsibility for a case—deciding whether a child should
remain at home or be placed in foster or group care, determining what services the family and child required and arranging for the delivery of those services, monitoring the progress of the parents in resolving their problems (for example, drug addiction or domestic violence), shepherding cases through the legal system, keeping detailed records for each case, and, all the while, monitoring the health and safety of the child, whether he or she was living at home, in a foster home, or in group care.
7 An open case at DSS was one in which allegations of child abuse and neglect had been filed, investigated, and supported; one that resulted from a voluntary request for services; or one that responded to a court order to provide services.
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paid different rates for the same services. There was a lack of clarity about who was “in charge” of the cases, and what the lines of authority between public and private sectors were. As a result, some cases fell through the cracks altogether. What’s more, case practice—how often clients were visited, for instance, and how cases were documented—varied widely from agency to agency.
Private contractors, meanwhile, had a gripe of their own. Across the state, social workers in the private agencies under contract to DSS were paid less than their counterparts in the public sector. As a result, employees of private agencies began to demand “parity.”
Devising the PAS program
Despite the problems, Matava believed there were several advantages to contracting out the management of some DSS cases. For one, she believed that such a partnership made the system more flexible. It created a community of practitioners who could share insights, compare notes, and, to some extent, share the blame when things went wrong. It gave parents and children in the system some choices. In some cases, it simplified the coordination of cases, by allowing the same agency delivering most of the services to a family also to manage the case. It gave DSS a way to handle conflict of interest situations—for instance, when a state legislator or DSS employee was accused of child abuse. It allowed DSS to send a case with specific kinds of problems to an agency with particular expertise—for instance, agencies that specialized in helping troubled teenagers or mentally retarded children. On particularly explosive cases—allegations of sexual abuse at a day care center, for instance—it allowed DSS to split up the investigative work among private and public social workers, which tended to reinforce the credibility of the findings.
At the same time, however, child protective services was becoming increasingly bound up with the courts and governed by legal requirements. It was therefore important, from Matava’s point of view, to standardize case practice across the system. Thus, the commissioner set out to transform the system of contracting out case management services from a chaotic and inequitable system into a fair and rigorous one. Under her “PAS,” or Partnership Agency Services initiative, all agencies providing case management services would receive the same set rate to manage a standard case load of 15 to 20 cases—about $63,000, including legal and administrative overhead— the same amount DSS itself spent to carry an average case load. In addition, PAS social workers were expected to use the same forms, follow the same procedures, and use the same central computer system as their counterparts at DSS. To perform these new functions, the private contractors would be given computer terminals compatible with DSS’, and they would have access to all DSS training and information. In fact, under the PAS scheme, private agencies were to be treated just like DSS’ own “area” offices. (The DSS organization at the time consisted of a central office, six regional offices and 40 area offices, where the actual case management work took place.)
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