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Why a drug treatment tool to protect Missouri kids is underutilized in the St. Louis area

Elisha Griffith enjoys post-dinner ice creams with her children (L-R) Mia Sykes 12, Romeo Welch 6, Julian Welch 8, Ava Sykes 17, outside the McDonalds Union MO on Thur June 6, 2024.
Theo R. Welling
St. Louis Public Radio
Elisha Griffith enjoys post-dinner ice creams with her children, from left, Mia, 12; Romeo, 6; Julian, 8, and Ava, 17, on Thursday outside a McDonald's in Union.

Elisha Griffith directly experienced the positive impact of a tool that steers parents to drug rehabilitation.

Griffith is a Franklin County resident and the mother of four children. Eight years ago, her daughters were placed in foster care for four years as she struggled with substance use.

“They were super traumatized from it, and I'm traumatized from thinking back to that moment,” Griffith said. “My daughter broke out in blotches and was freaking out and didn't know what was happening or where she was going with strangers.”

Griffith eventually was able to regain custody but relapsed. Instead of having her kids suddenly taken from her again, she entered into what’s known as a Temporary Alternative Placement Agreement.

She got to choose where her kids stayed while she went through a drug treatment program, and she received access to programs that helped her cope with the rigors of parenting. Her children were connected to therapy services.

When asked to compare the two experiences, Griffith said there was no question that a TAPA was less traumatic than what happened to her before. The combination of being held accountable for standing by the agreement and being connected to resources to help her and her family was a lifeline, she said.

Earlier this month, Griffith’s TAPA was lifted — and she is now with her children.

“They make sure you're set up and that you're not going to just fail again,” she said.

A woman kisses her son's head at a water park.
Theo R. Welling
St. Louis Public Radio
Elisha Griffith embraces her son Julian Welch, 8, on Thursday at Veterans Memorial Park in Union.
Elisha Griffith(center) poses for a portrait with her children (L-R) Ava Sykes 17, Romeo Welch 6, Julian Welch 8, and Mia Sykes 12, at Veterans Memorial Park in Union MO on Thur June 6, 2024.
Theo R. Welling
St. Louis Public Radio
Elisha Griffith, center, poses for a portrait alongside her children, from left, Ava, 17; Romeo, 6; Julian, 8, and Mia, 12, at Veterans Memorial Park in Union.

Sporadic use in St. Louis area

But statistics obtained through an open records request to the Department of Social Services show TAPAs haven't been used consistently throughout the state since they were rolled out in 2021.

From August 2021 through late April of this year, the Children’s Division office that includes St. Louis and St. Louis County entered into 84 TAPAs. That’s by far the lowest number of the six regions, behind Kansas City's with 110 TAPAs.

By comparison, the Children’s Division’s southwest Missouri region, which includes places like Springfield and Joplin, entered into 790 TAPAs. The northeast Missouri region, which encompasses St. Charles and Lincoln counties, had 606 TAPAs.

Children’s Division Director Darrell Missey cited staffing issues as to why the St. Louis and Kansas City regions used TAPAs sporadically. He said those offices lacked employees known as family-centered service workers who monitor whether the stipulations around TAPAs are being followed.

STLPR's Jason Rosenbaum discusses this story on 'St. Louis on the Air'

“The way a Temporary Alternative Placement Agreement works is you can’t just say, ‘We’re giving this child to grandma or some other relative and there you go.’ We have to open a Family Centered Service case,” Missey said. “There weren't enough people in either St. Louis or Kansas City to have family-centered service workers at all. So if you can’t open the case, you can’t have a TAPA.”

Missey said staffing levels have stabilized in St. Louis and Kansas City in recent months, which should make TAPAs more available. The agency’s St. Louis office in particular, which has struggled to recruit and retain investigators, is nearly at full staff and close to finishing a massive backlog of cases. As of last week, Missey said there are only around 500 cases that have been open more than 45 days — down from a high of almost 7,000.

“So now that we’re getting more staff, we should be able to reinstitute TAPAs,” he said.

State Sen. Mary Elizabeth Coleman, though, said she was frustrated to hear Missey’s comments that staffing issues prevented TAPAs from being used more consistently across the state. Even after lawmakers allocated the Children's Division more money to help implement programs like TAPAs, Coleman said, “We’re still seeing the same bad outcomes for kids.”

“This is not a funding issue. This is not a statutory problem. It’s a leadership failure,” said Coleman, R-Arnold.

Senators Mary Elizabeth Coleman, R-Arnold, speaks during session on Thursday, Jan. 25, 2024, in Jefferson City. Senate Republican leadership has clashed with members of the Missouri Freedom Caucus holding up business.
Eric Lee
St. Louis Public Radio
State Sen. Mary Elizabeth Coleman, R-Arnold, speaks in session in January in Jefferson City.

Since the release of a report examining child fentanyl deaths from 2022, child welfare advocates and legislators are alarmed that TAPAs weren’t being used consistently throughout the state. That report also found Children’s Division investigators missed warning signs that parents were taking fentanyl before their children died of accidental overdoses — including instances in which a mother gave birth in a hospital and both she and her child tested positive for fentanyl.

“I was shocked by the severity of these cases that led to the fatalities,” said Jessica Seitz of the Missouri Network Against Child Abuse and a member of the committee looking into the fentanyl deaths among children.

Seitz and her colleagues on the committee are calling for better training for investigators when they encounter evidence of the drug — as well as swifter communication with juvenile officers who can remove children from homes. But Seitz and others add that the report showcases substantial gaps in how the state Children’s Division is handling some neglect cases, adding that it should be a wakeup call for the state’s executive branch, agencies and the legislature.

“We can't let a report sit on the shelf,” Seitz said. “And so, I hope to have it in hand when I'm working with lawmakers next year.”

Missouri’s Children’s Division is responsible for looking into accusations of abuse and neglect that are called into a state hotline. If investigators find evidence of abuse or neglect, they can recommend removing children from a home to a juvenile officer — an official employed by Missouri’s court system who decides whether evidence is substantial enough to make such a move.

Juvenile officers are required to be notified that a TAPA is happening, in case they need to act quickly to remove a child if the agreement falls apart.

Lawmakers like Coleman came up with the idea of TAPAs as an alternative to having a judge remove a child from a dangerous home. Before TAPAs existed, the Children’s Division was entering into agreements with parents that were largely voluntary and not overseen by courts.

“We didn't know how many kids there were. And parents didn’t really know what they needed to do to be able to have control of their kids and to end state involvement,” Coleman said. “And the state wasn’t abundantly clear on what was being done to end that diversion. And so kids were falling through the cracks.”

Jaidan Adams, director of behavioral health at PreventEd, an advocacy group that tries to prevent and treat alcohol or drug abuse, said her organization encountered a lot of people like Griffith who have found TAPAs useful.

“It can definitely be an option that eliminates or reduces a lot of that trauma associated with what those children are going through,” Adams said. “We know that trauma is the No. 1 risk factor for future mental health disorders, behavioral health disorders and substance use disorders. So I feel like anything that can be in place that can reduce that trauma, that's definitely a great tool to have.”

A white woman smiles while looking through a mirror
Sophie Proe
St. Louis Public Radio
Jaidan Adams, director of behavioral health at PreventEd, on Friday at the nonprofit's office in Olivette

Agencies don’t always work together

One of the other issues that members of the fentanyl report review committee found was an uneven relationship between juvenile officers and Children’s Division staff.

“We see some places where the juvenile office and children's division work great together,” said Emily Van Schenkhof of the Missouri Children’s Trust Fund. “But we see lots of places where that relationship does not work the way that it needs to and kids get hurt.”

Department of Social Services Director Robert Knodell conceded that there could be improvement in how Children’s Division employees and juvenile officers interact.

“There are areas or judicial circuits in the state where those relationships, candidly, are stronger than others,” Knodell said. “We have a lot of new circuit managers, a lot of new leadership in these communities for the Children's Division around the state — as well as you see a lot of new faces in the juvenile officer community.”

One example of this frayed relationship is encapsulated in an email chain that St. Louis Public Radio obtained through an open records request. It features a lengthy message from Missey about an April meeting that took place between Children’s Division staff and juvenile officers.

He said that meeting featured “blanket allegations of a purported lack of concern on our part for child safety without any evidence to back that up.”

“It was stated yet again that we are somehow violating the TAPA statute. That cannot occur,” Missey wrote. “Again, I would like to know specific circuits where that is occurring so we can work to put a stop to it.”

Marcia Hazelhorst, executive director of the Missouri Juvenile Justice Association, whose membership is primarily comprised of juvenile officers, said there have been instances in which officers only find out a TAPA was agreed to after there’s been a request from Children’s Division to remove a child from a home.

“In some incidents, they’re receiving a referral for something fairly serious,” said Hazelhorst, referring to a request to remove a child from a home. “The [Children’s Division] is asking for removal. And in that referral, they find information that a TAPA was done previously — but the juvenile officer was never notified and never received the TAPA. And now they’re requesting removal.”

Missey said he has heard “rumors of allegations from outside our agency that there have been cases where juvenile officers were not informed of TAPAs, and I am investigating those rumors to see if they are true. “

“To date, no one has directed me to a specific case where this has occurred, and I have no evidence of particular circumstances where a TAPA has been entered without the juvenile office being informed,” Missey said. 

Darrell Missey, the director of the State of Missouri's Children's Division, on Wednesday, Aug. 23, 2023, at St. Louis Public Radio’s headquarters in Grand Center.
Brian Munoz
St. Louis Public Radio
Darrell Missey, the director of Missouri's Children's Division, in August 2023 at St. Louis Public Radio’s headquarters in Grand Center

Handling evidence of fentanyl

One change that Missey and Hazelhorst said could be useful is a requirement to immediately contact a juvenile officer whenever there's evidence of fentanyl use.

“We’ve got to make sure that when we have evidence of fentanyl, that we are acting promptly and thoroughly so that those kids are not in the same space as fentanyl,” Missey said.

While emphasizing that she would need to see specific language, Hazelhorst added, “With a significant number of child fatalities from this last report, we should do everything imaginable to prevent anything like that from ever happening.”

Missey said investigators plan to treat evidence of fentanyl the same way they react when they uncover child abuse.

“I’ve messaged this already and I’m messaging it now: If we see a child who has been exposed to fentanyl, we need to act just like they’re being physically abused and protect them with whatever tools we have,” Missey said.

Frank Tenant, director of the Missouri State Technical Assistance Team, which helps in criminal investigations involving children, said everyone involved in ensuring the welfare of vulnerable children needs to be on guard for the drug.

“One of the other dynamics with older kids [who died of fentanyl overdoses] is they all had some history of drug use, or at least parents and friends thought there was, but none of these kids had any history of fentanyl use,” said Tenant, adding that those children likely unknowingly took the drug.

“I was a narcotics agent working undercover for a number of years in the '80s and early '90s,” he added. “I have never seen an illicit drug have this kind of impact.”  

Jason is the politics correspondent for St. Louis Public Radio.