No Good Choice 

In the dark of night, 5-year-old Emily [not her real name] tried to strangle her older brother with a karate belt. This disturbing incident was part of an accelerating spiral of violence against the girl’s two brothers. In 2010, six years after the first incident, Emily’s adoptive mother, Debora “Rusty” Speake, a hopeful, energetic woman with red hair the color of her nickname and traces of a Texas accent, sent Emily to stay with her grandmother in Houston for seven weeks.

“Literally two hours after she came home, Emily’s first big fight with her older brother broke out,” Speake recalls. “She went after him and was hitting him. She said, ‘If you tell Mom, I’ll kill you.’ ” From past episodes, Emily’s brother knew the violence would escalate if he fought back. Afterward, he let his mom know what happened. “It’s a real hard place for him to be,” says his mother.

Speake didn’t sleep for two nights. “[Emily’s] room is downstairs, and the boys are upstairs. I would lie in bed and worry that she would come up the stairs and hurt one of them,” says Speake.

Emily’s anger and aggression were constant, leading up to the day when she lifted her younger brother’s bike and threw it at him. The bike missed him but hit a neighbor child. Emily denied responsibility, saying, “I am the little girl. I can’t pick up a big bike.” At least six other people had seen Emily throw the bike.

Ever since Speake adopted Emily, she’s known that Emily’s aggression is fueled by assorted diagnoses stemming from being born to a heroin-addicted birth mother. “Her diagnoses are a mixed bag,” says Anna Williams, a child psychiatrist who conducted medication management for Emily. Speake’s been told Emily has everything from reactive detachment disorder, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder to bipolar affective disorder. Emily was also diagnosed with depression, and her neurological conditions are further complicated by seizures.

Her daughter’s conditions required more treatment and therapy that she as a single mom had the means to provide. While the state provides foster parents with an array of medical services, adoptive parents have far less state-funded medical assistance. As Speake constantly worried about the safety of her sons, the mother couldn’t help but feel the family was reaching a breaking point.

After the bike incident, Speake drove Emily to the emergency room at Primary Children’s Medical Center. They arrived at 8 p.m. At 5 a.m. the next morning, a social worker let Speake know that Emily would be admitted to the University Neuropsychiatric Institute (UNI), a 90-bed psychiatric hospital providing mental-health and substance-abuse treatment. “They said the reason they could admit Emily to UNI was that she admitted to a social worker that she hits and kicks her brothers and hurts them and can’t help herself,” Speake said. While devastated, Speake initially felt relief about the UNI placement. She thought that a solution might be in sight at a time when she felt Emily was not getting better, and probably was getting worse. “I can’t tell you how many times I have cried over it,” she says.

Dr. Williams is one of several mental-health professionals who concurs that Emily needs extensive residential therapy, an option that neither Speake’s medical insurance from her work as a respiratory therapist nor Medicaid will provide. “The therapy she needs costs $11,000 a month. What parent can afford that?” Speake asks. Although Medicaid would have paid for residential treatment at the time Speake first adopted Emily, the program stopped paying for residential treatment in July 2010.

Speake’s hopes were dashed when, at her first meeting with a UNI therapist, she heard the words: “We plan to discharge her.” Speake instantly found herself between a rock and a hard place.

“Rusty had a decision to make,” says adoption attorney Dean Ellis, who represents Speake. “If she brought Emily home without the problems being solved, she would still act out in violent ways. If she refused to bring her home, the state would get involved. She made that choice, knowing that it might look bad for her, but the state has resources that aren’t available to her.”

Speake felt she faced possible criminal charges with either taking Emily home or returning her to state custody. Knowing that the two boys show signs of post-traumatic stress disorder as a result of Emily’s attacks, she said, “I can’t take her back home. Every time she comes back home, she puts the boys in danger.”

The UNI therapist responded that if Speake didn’t take Emily home, UNI would call Child Protective Services, and she would be charged with abandonment. On the other hand, Speake knew that if she didn’t protect the boys, she could be charged with failure to protect. “If one sibling injures or kills another, parents can be held liable,” she explains.

Speake felt she had no choice but to return Emily to state custody, a desperate choice that felt like the devastating opposite of her hopes and dreams. “This is by far the hardest thing I have ever done in my life,” she says. “ I feel I have failed one child but also realize I have to protect the other two,” she says.”

No Good Deed Goes Unpunished
Division of Child & Family Services statewide adoption specialist Marty Shannon says that in 2010, of the 609 adoptions that DCFS facilitated, only five babies were drug-exposed or had fetal-alcohol syndrome and were adopted by single women (three of whom were related to the babies). “Very few children come back into state custody from a prior adoption,” she says. “The children who come back into custody from an adoption are no longer infants, and there could be many life factors that could play into the reason they come into DCFS custody.”

Utah Department of Human Services public information officer Elizabeth Sollis says that permanency is always the goal of DCFS. “It is extremely unfortunate for a child and the family when the child returns to state custody, regardless of the reason,” she says. “We are sensitive to these issues and work to ensure the child has what is needed to minimize and deal with any trauma associated with such circumstances.”

Every child is unique, she says, and most parents know what is going on with the children they adopt. “Some children have more or greater medical or mental-health needs, and these needs are discussed with each adoptive family prior to the actual adoption,” she says, “[but] it is difficult to predict long-term medical or mental-health needs.”

Adoption attorney Ellis stresses that Speake was an ideal candidate to adopt. “Rusty does a great job in a very difficult situation. She has a good job and makes a good income. She is nurse who has specialized training in medical problems that might arise. And she is so dedicated to her children’s needs. When Emily needed care that was only available in Texas, Rusty quit a job she had had for a long time and moved to Texas, just to get the care that Emily needed. When the treatment was complete, she moved back.”

He adds that Speake recently held the position of managing respiratory therapist at her work, making more money and working more hours than usual. “She made the choice to give up that job just because of the number of hours it required. Besides making visits to Emily, her two sons attend a charter school that requires her to commit to volunteer hours there. She had to take a substantial pay cut because she wanted to do the best job she could as a parent.”

Her sacrifices must have counted for something because, Ellis said, “When we got to court, we learned that the state was not seeking a finding of abandonment against Rusty. Emily remains in state custody because her condition makes her ‘dependent.’ ”

Ellis explains that Speake’s current status is that she is still Emily’s mother and, while the state has legal custody, Speake is entitled to be involved in the teams that make decisions about Emily’s care and treatment, even though up until Feb. 16, that hadn’t happened. Speake is statutorily required to maintain health insurance for Emily and also pay child support to the state while Emily is in state custody.

A logjam broke loose recently. While DCFS declined to release case-specific information about Speake’s daughter’s case to City Weekly citing privacy issues, on Feb. 16, the day after City Weekly submitted questions to DCFS, Speake began receiving e-mails from DCFS. One e-mail from a DCFS foster-care worker said Speake was partially to blame for not being involved in Emily’s care, reminding her that she missed a meeting in September 2010 as well as subsequent team meetings due to a series of scheduling conflicts.

Also on Feb. 16, Speake received a copy of a Treatment and Service Plan for Emily dated Sept. 27, 2010. The last page is the Treatment Plan Review Team Meeting Signature Sheet, signed by several people and dated Sept. 27, 2010. “I don’t believe I was invited to any meeting on 9-27-10,” Speake says. She also received a page of handwritten notes from a Jan. 27, 2011, meeting that she was not invited to attend. She also received an eight-page behavioral plan with an in-service date of Oct. 5, 2010; however, the bottom of each page is dated Feb. 16, 2011, the day after City Weekly submitted questions to DCFS.

Wrong on So Many Levels
These days, Speake visits Emily once or twice weekly, driving from their family home in Midway to Emily’s foster home in West Valley City. “We go eat, go to movies and go shopping. She is always really happy to see me,” says Speake. Emily is not allowed to visit with her brothers, which requires Speake to make other arrangements for them when she travels the 103 miles per visit. “I don’t have the boys with me, so she gets all of my time and attention.”

Speake does not like to complain about Emily’s status as a ward of the state but does admit to feeling frustrated that Emily has seen a therapist only three times in nearly six months of state custody. “Emily was receiving weekly therapy at Valley Mental Health in Park City when she was in my home,” she says. “UNI told me that Emily needed daily intense therapy, and weekly therapy was not enough. How are three therapy sessions in almost six months going to help her?”

Although she pays child support, Speake also continues to buy her items that she feels Emily needs, such as jeans and socks. Sometimes when Speake visits, she notices that Emily’s hair is dirty. Speake feels that her foster mom doesn’t want to risk one of her meltdowns and therefore doesn’t insist that Emily wash her hair.

In a recent letter to DCFS, Speake requested a different foster home. “I don’t want to make it worse for Emily, but the bottom line is, sometimes I don’t even feel that she is getting some of the basic care she needs. Nobody else is as vested in her as I am.”

During a recent visit with her mom, Emily agreed to speak with City Weekly. She said she understood she is living away from home because of hitting her brothers. “They make me mad and they are annoying. I don’t like talking about it,” she says.

She attends fifth grade in public school, although due to myriad learning disabilities, “the bulk of her classes are resource classes, most at about a third-grade level,” says Speake. Emily appears to get along OK with her classmates and has not exhibited violent behavior toward any children other than her brothers. At her new foster home, most of the children are grown, but a 15-year-old daughter lives there.

Emily says she misses her cat, Kassidy, and her old school. She says that her foster mother sometimes yells at her and once called the police on her. She says she wants to come home and sleep over at Speake’s house. Near the end of the interview, Emily asked her mom, “Why don’t you believe me instead of my brother?” referring to the bicycle-throwing incident.

After Emily left the table, Speake clarified that the question revealed that Emily still denies her responsibility in the bike incident. Speake continues to hope that Emily will soon receive the residential therapy that she needs. “Why won’t [the state] provide the services for her, in my custody, rather than having to put her back into state custody? Now that I have to do this, I am adding issues to a kid that already has issues.”

Speake says she realizes that the state “is not going to be happy with me” for comments made in this article because she knows the state’s position is that adopted children are exactly like natural children in terms of parents’ responsibility. Even though the state makes a good effort to inform parents that kids could have a lot of issues, “the real issue for me is that they make it sound like there will always be support, post-adopt services, in-home services, therapy and respite. Those things don’t exist right now and weren’t available for me.

“I don’t deny my responsibility to Emily and did not want to have to place her back in state custody. I had no other way to get her help,” she says. “How is it in Emily’s best interest to be placed in state custody?” She concludes, “This is just wrong on so many levels.”

Hesitant to Bond
Speake’s situation is not isolated, according to Susan Resko, director of the National Child and Adolescent Bipolar Foundation (CABF). She wrote in a recent blog that some children with severe mental-health needs are too ill to live in a traditional family setting. Residential treatment costs more than most American families earn in a year, and there is a severe shortage of treatment facilities that accept very young children. “We know painfully well how a child’s psychiatric illness can tear apart the fabric of even the most loving families,” says Resko.

CABF recently surveyed its members to learn if parents who were faced with this dilemma were willing to be interviewed on national TV. Thirty-four parents responded affirmatively. “Many of my friends and acquaintances with neurotypical children commented how unfathomable it is that families are faced with this ‘choice,’” Resko writes.

In the wake of caustic online comments that followed the September 2010 publication of a similar family’s story in the Chicago Tribune, Resko was quoted as saying, “There would be a national outcry if families were forced to relinquish custody of a child with cancer in order to receive treatment. Yet, when it involves mental illness, we still look for reasons to blame. It’s high time we as a nation address the shameful way we treat children with mental illness and their families.”

Speake’s two adopted sons are both Emily’s biological brothers, whom Speake has also adopted. They were all born from the same drug-addicted mother. “All three were born with heroin and cocaine in their systems. Emily’s situation was the worst—she had black-tar heroin in her system and spent 23 days in University Hospital withdrawing from that,” says Speake. Today, Emily shows multiple signs and symptoms of reactive-attachment disorder, which often occur “with kids who have been in and out of orphanages and haven’t bonded,” Speake explains. “The confusion over that causes people to ask me, ‘Haven’t you had her since birth?’ If she has reactive-detachment disorder, it is because she spent the first six months of her life withdrawing from heroin. The physical withdrawal is so intense that they can’t emotionally bond.”

Having children was a long-sought goal that Speake once thought was beyond her reach. She was married at 19 for one year and had no children. In her second marriage, she gave birth to one now-grown daughter, April. After that marriage ended in divorce, she still longed for more children. Yet, when she suffered a miscarriage during her third marriage, her husband responded with, “I haven’t been honest with you. I don’t want a baby, and I never will. I’m glad you lost it.” When she didn’t remarry or have another child, Speake decided to pursue “legal-risk” foster care, where children are not legally free for adoption until birth parents terminate their rights.

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Prenatal Addiction Julien Smith, Ph.D., is a pediatric neuropsychologist in Salt Lake City who has evaluated children born with various addictions. “As our brain begins to develop early in gestation,” she says, “even before a woman knows she is pregnant, the use of substances or even poor prenatal care can impact that development. Even prior to conception, the health and general behavior of the mother can affect development. The brain really starts developing early in conception—about Day 3—when the neurons in the brain are actually starting to organize themselves and get in place to be prepared to do their future task or activity,” she says. “The experiences in gestation and any potential toxin in gestation can impact the organizational framework of the developing brain. During gestation, when things are chemically disrupted or disturbed by trauma, then that neurological development and the diversification and specialization of neurons is then altered chemically, functionally and structurally. Those abnormalities have lasting effects on brain area. Any time you are exposing a fetus to a toxin that potentially impacts neurodevelopment, there is a risk factor for inappropriate development.” She adds, “While we clearly know toxins aren’t good for a developing fetus, it’s not the only piece of the puzzle. What are the genetics that went into the birth mother’s own disorder? Was something going on psychiatrically? There are so many pieces of the puzzle when interpreting developmental disabilities. A combination of bad genetics, bad behavior and toxins can impact the child’s development from the moment they are conceived. You get a neurological system that didn’t develop appropriately from the outset.” Regarding Emily’s current situation, Smith says. “These challenges are the nature of our system. We don’t adequately provide for the least among ourselves. There are good outcomes, but it’s not like these kids get cured.”

She received a call from a homeless shelter looking for someone with a medical background to care for a drug-addicted newborn. She took Emily’s older brother home first at 11 days old, with the understanding that he was not adoptable. Social workers told Speake that the boy would stay in her home only a month before entering a special drug-addiction rehab program with his mother.

“I would think he might be leaving any day, and as much as I wanted him to become mine, I tried not to get too bonded.” Speake’s emotions warred as months passed and the boy stayed in her home. “Some months there would be visits, and other times the mother’s drug test would come back ‘dirty’ and she couldn’t see him. It was a hard emotional time.” When his mother never completed rehab, Speake continued to care for him. “We ended up back in court and the state wanted to take him from me and put him in a two-parent home. We had already bonded. The Foster Care Review Board ultimately ruled that there was no guarantee that a two-parent home would stay a two-parent home.”

Foster Parenting vs. Adoption
Foster children often come from at-risk backgrounds, says Mike Hamblin, Utah Foster Care Foundation director of foster/adoptive family recruitment. “Children that are in foster care are typically there due to a background of abuse and neglect.” In Utah, there are 2,600 children in foster care and only 1,400 families providing care.

“Foster care is seen as almost a volunteer labor of love,” says Hamblin. “While there is a basic reimbursement for parents who care for children in foster care, it’s a fairly minimal amount,” requiring some foster parents to fork out their own money for their children to participate in extracurricular activities. On top of that, with the poor economy, the reimbursement rates paid to parents for providing foster care have been reduced each of the past two years.

At the hearing where the birth mother of Speake’s children ultimately relinquished the oldest boy, Speake recalls gazing at the birth mother, a pale dark-haired woman who sat alone with her attorney on the other side of the courtroom. “My heart went out to this woman who was never able to give up cocaine and heroin so that she could go into rehab.” After the hearing, “I just had to hug her. We hugged each other and both broke out sobbing,” Speake remembers. “It was like we were at a funeral—one of the most heart-wrenching things I have ever experienced.”

During December 1998, Speake received calls from DCFS, asking that since she had kept her foster license active, if she could foster Emily. Again, she was told that she wouldn’t have this baby long before the mother entered drug rehab. “They said that this time, there was a father involved and Dad would be getting to see the baby.” Emily’s birth parents visited her just twice in the first seven months. Because the birth mother never completed drug rehab, Emily remained with Speake. To her surprise, she received another call five years later about a third sibling, a son from the same mother, whom she also later adopted. “I feel that it was in God’s hands. I thought I wouldn’t get a baby. Now I have three, and I am trying to keep them together.”

She also thinks it points to the fact there aren’t enough homes or people willing to step forward and do this kind of thing. At the time she adopted her children, had another parent asked if they should adopt instead of remaining a foster parent, “back then, I would have told her to go for it. Now, knowing about the issues that have come up, I probably wouldn’t be so sure.”

She still has no idea how her and Emily’s futures will play out. “Other than the fact that she and the boys are safe, I don’t feel that we have made a lot of progress.” At the one parent meeting she was invited to attend on Feb. 8, Speake says no one could tell her who Emily’s teacher was or how her grades were or provide school pictures. Up until the e-mails she received on Feb. 16, “I’ve gotten no direction, no guidance and no plan for the kind of therapy for Emily.”

Speake recently met with a foster mom who has cared for a little girl, now 6, for several years. “She says that my experience is the reason why she won’t adopt this girl,” says Speake. “She can’t afford to lose all the help she is getting. Why will they give a foster mom all of this money and support—over $2,500 month—when they won’t give that to me? Isn’t the goal a permanent home?”

Sollis says it is unfortunate that there are families who won’t adopt strictly because they will lose foster-care payments. When Speake recently wrote a letter requesting a different foster home for her daughter, she expressed concern about Emily’s bed-wetting episodes in the foster home, possibly due to nocturnal seizures that Emily was known to have. “This is a safety issue and the fact that Emily doesn’t remember [why she wet the bed] is a red flag that she could be having seizures in her sleep, losing bladder control and then not remembering in the morning,” Speake explains. “I am fully aware, probably more than anyone, how difficult Emily’s behavior can be, but I feel her needs still need to be addressed and provided for.”

During almost every visit, Emily asks Speake, “Can you make them let me come home? Why can’t I come home?”

Would Speake want Emily to live at home again? “That’s a tough one,” Speake admits, “but if we could get the right help and it is safe—absolutely. My dream would be for her to get the help that she needs so that she can come back home and be a part of our family. That would be the family life I have always wanted,” she says.%uFFFD