Safety, not just family preservation, is new focus of Missouri’s child welfare efforts

Before Missouri’s new child welfare leader even printed out business cards, she made stickers. A lot of them.

“Centered on safety,” they read. And these stickers, Sara Smith says, remind her of an underlying question that drives her as she begins her tenure running the Children’s Division, an agency where she first started working nearly 20 years ago.

“It’s like, how do we embed safety into every aspect of our work?” Smith said in an interview with The Star last week, after her first full month as the CD director. “... There is definite room for improvement for Children’s Division and looking at safety.”

Smith’s focus on safety comes after nearly three years of the previous leader transforming the system into one that prioritizes keeping families together. Some advocates voiced concern at that time that a narrow focus on family preservation may have sacrificed safety in some cases and ultimately led to bad outcomes, though past leaders and national child advocates disagreed.

The Star’s conversation with Smith came a day after the Missouri Department of Social Services, which oversees the division, finally released records about a Kansas City boy who died in late 2023 after falling from a 17th floor apartment window. Those records show that hotline callers tried in vain for years to help Grayson O’Connor, 5, but more than once his mother refused help without consequence.

The records also show, child welfare advocates say, that more must be done across the state to ensure kids like Grayson are safe when they remain at home. Since 2017, seven hotline calls reported everything from his mother having unstable housing and previous drug use to seeing her berate and scream at him, and on one occasion they said she left him at an intersection.

Improving the system for all kids, advocates say, requires taking a hard look at cases where children died and seeing what more, if anything, could have been done. And Smith said her administrative team will be doing that.

“Seven times somebody showed up at Grayson’s door and walked away and didn’t help him,” said Lisa Mizell, chief executive officer of the Child Protection Center in Kansas City. “Seven times. That breaks my heart. That kills me.”

Prosecutors now accuse the mom of causing her son’s death by removing safety devices from the window of her apartment.

In the hour-long interview detailing her plans for the Children’s Division, Smith outlined several areas she’ll concentrate on in the coming months at an agency that has had a revolving door of directors in the past decade. Those plans include an organized review of random cases to analyze what services were provided and what may have been missed, as well as the implementation of a Critical Investigations Unit.

That team will be made up of experienced members who will respond to “complex investigations,” allowing newer employees to develop their skills before taking on such cases.

Smith, herself, has worked in the investigations unit at the Children’s Division. She’s also spent years working at the state’s child abuse/neglect hotline.

Jessica Seitz, executive director of the Missouri Network Against Child Abuse, formerly known as Missouri KidsFirst, said she’s eager to see what Smith can do as leader of the state’s child welfare agency.

“It’s exciting that you have somebody who came from the Children’s Division,” Seitz said, “and kind of speaks the language.”

It’s when Smith was working at the hotline that she would begin her day by reading the daily fatality report, which details not only alleged abuse and neglect deaths, but also deaths due to natural causes or ones at birth.

Since taking over the top post, she started reading that report again.

“It should put you in the mindset of why we’re here,” Smith said. “We’re here to prevent that. And so our eyes should be on those.”

Balancing family preservation, safety

As Smith hones in on safety, some fear that the focus on keeping families together that previous director Darrell Missey, a former juvenile court judge, emphasized will fade. Missey’s leadership and direction has been praised by many front-line workers, supervisors and experts who have fought to safely keep families together when possible.

On the last day of 2021, just days before Missey took over the top post inside the Children’s Division, there were 14,137 kids in care. That represented a 34% increase from a decade earlier. And at the time, Missouri had among the highest number of children in foster care per capita nationwide.

Missey soon shared that he wanted to begin transforming Missouri’s system, which had a rate double the national average for removing kids. For him, it was all about family preservation, a move that systems across the nation have been embracing.

Numbers show that during Missey’s tenure — he left the department the first of November — the number of kids in Missouri foster care dropped by nearly 3,000 children, with around 11,400 in care at the end of October.

After children who had been on the radar of Children’s Division died — including Grayson and several others in the Kansas City area — child advocates began to worry that children were being kept in unsafe homes in the name of family preservation, a fear Missey and other leaders across the state didn’t agree with.

The hope, advocates say, is that the department will intentionally strike a balance.

“I think safety and family preservation are not mutually exclusive,” Mizell said. “You can do both.”

In the past few years, with the emphasis in Missouri on family preservation, Mizell said she “felt from the beginning, they were missing the safety piece.”

“I would say, ‘Well, what about safety? What are you doing for the kids?’” Mizell said. “There were really no answers given.

“You can’t concentrate on one or the other. … It’s really important just to walk and chew gum at the same time. And I have a lot of faith that Sara will do that.”

Lori Ross — a founder of FosterAdopt Connect who has worked in child welfare in Missouri for decades — agrees that the child welfare system needs to balance the two.

“Family preservation absolutely should remain a major emphasis because it is the right thing for kids and families,” Ross said. “It should never have been an afterthought. Going into foster care, and living in foster care, is incredibly traumatizing for children, for their parents, and for the families that take the children in.

“So doing what we can do to keep kids safe and stable at home should be our priority.”

If Missouri stops “working on preventing kids from coming into foster care through family preservation, then we will be subjecting way too many kids to the trauma of foster care.”

And that, Ross said, can have lifelong negative outcomes with health and mental health.

On the flip side, if child welfare leaders emphasize family preservation without a focus on safety, Ross said, “the efforts result in tragic outcomes.”

“It can never be one without the other,” Ross said. “It should always be both.”

An audit of cases

For years, child advocates have hoped for an organized audit of past cases to see how workers handled investigations and assessments — with the goal to improve overall practices across Missouri.

Smith said she and her team have already begun mapping out that process. By early June, Smith said her team should have “action items on that.”

“We’re going to sit down and read some cases,” she said. “We should be auditing ourselves. We should be doing that.”

Advocates say this type of audit is a smart and valuable move if the review is used to improve the system. For Seitz, it’s a “necessary step for safety.”

“That’s the only way we can look at how to prevent these types of tragedies from occurring.,” Seitz said. “Trying to find out what points of intervention there were, what points were missed, what options were not taken, is the only way to prevent this type of tragedy moving forward.”

This kind of audit, “can also help develop what legislation needs to be passed in Missouri,” Mizell said.

Ross said that “thoroughly reviewing all cases with very negative outcomes” should be standard practice. And it should include recommendations for practice changes, she said. coming from that process,” Ross said in an email.

“I also think pulling random cases (ongoing and with no indication that they are headed for bad outcomes) for review is enlightening,” Ross said.

When Jackson County was under a federal Consent Decree many years ago, Ross said she was part of a few teams that conducted random case reviews. The findings pointed out weaknesses and strengths in how current cases were being handled, and supervisors were able to address any weaknesses in real time.

“The work is cumbersome and requires a pretty decent knowledge of how things work to be effective,” Ross said. “So doing this well will require an investment in building a skilled team and supporting that team to travel, do in person interviews with everyone on a case, read case files, gather documentation, etc.”

Smith said she wants to get samples of closed investigations and assessments from each region where it was determined that the children were safe. The goal is to look at what may have been missed, any missteps, in addition to what went right. Cases where a child was injured or even died will be a significant part of the audit, she said.

“It’ll just really help us know how our practice is going,” Smith said. “What was supposed to kind of come alongside that safety assessment — that for some reason, the work wasn’t done — was the risk assessment. And so we’re picking up that work as well.

“Safety is one component, but risk is a huge other component that we should be looking at.”

Transparency key, new leaders say

With the release of Grayson’s records last week, as well as other child deaths across the state, Jessica Bax, the director of the Missouri Department of Social Services, also sent a letter to The Star.

“Transparency and communication are key values of this DSS leadership team,” Bax wrote. “Our commitment to all Missourians is to ensure these values guide our actions, allowing DSS to work collaboratively toward improvements for Missouri’s children.”

Missouri law leaves the decision on whether to release information after a child fatality or near fatality to the sole discretion of the DSS director after reviewing whether the information could harm siblings. Because of that caveat, in many abuse and neglect deaths across Missouri, the public never does find out what Children’s Division did, or failed to do, to protect those children.

Bax referred to that part of the law when she declined to release information in the death of three children in the Kansas City area since February 2022. Releasing information in the deaths of Karvell Stevens, Ivy House and Tidus Bass could have an impact on the siblings of those children, Bax said.

Child advocates say information should be shared after any fatality or near fatality. That’s the way, they say, the system designed to protect children is improved.

“I think it’s not just transparency that is important, but I think it’s working as a team to address those things,” Mizell said. “And if you’re not transparent with the team and the community, then nobody can help you find a solution. If you’re working in a vacuum, you’re not working together to help make things better.

“I don’t know how you find solutions when you’re not willing to share information.”

Bax did not elaborate on those cases where records were not released. Instead, she focused on the department’s decision to release records in some deaths after learning of outstanding requests for information under the Missouri Sunshine law.

At the Children’s Division, Smith said she’s “very aligned” with Bax on transparency.

“This is why we released these reports,” Smith said. “I value the feedback that comes from that to better the system. And if I’m able to share something, you’ll get it. ... There are areas that we need better practice, not policy, because I think we have the policy. I’s just supporting them for better practice.”

After Grayson’s death, Bax told The Star that DSS reviewed local practice and took several steps to “address and improve” that. Children’s Division also conducted a review of Family Centered Services cases, Bax said, and provided enhanced safety training for Family Centered Services workers, supervisors, and managers.

“This resulted in increased tracking and alignment of supervisor consultations,” Bax said, “as well as oversight of documentation and visitants with children and families involved in Family Centered Services cases.”

“Furthermore, in Jackson County,” Bax said, “the DSS has increased targeted case reviews to monitor for practice and identify safety concerns.”