DHS may require doctor visits in state subsidized adoptions following child deaths



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Sabrina Ray of Perry was unable to walk, talk or eat after her adoptive brother "drop-kicked" her down their basement stairs, according to law enforcement officials.





Families that receive state financial assistance to adopt children will be required to document annual doctor visits under a new policy being considered by Iowa's Department of Human Services. 


The change is intended to create a new layer to the state's child welfare safety net following the high-profile deaths of two teenage girls, both of whom allegedly were abused and neglected by their adoptive families.


“We don’t think it’s an unrealistic expectation," said DHS Director Jerry Foxhoven, who was appointed to take over the agency last month after embattled former director Chuck Palmer resigned. "… It’s what good parents do."



Jerry Foxhoven

Jerry Foxhoven (Photo: Special to the Register)



Iowa spent about $42 million in fiscal year 2017 to provide subsidies to families who adopt difficult-to-place children or children with special needs out of foster care. According to an agency report, 10,518 children were eligible for those subsidies in July 2016, and payments averaged about $7,700 annually per child. 


Sabrina Ray, who died in May, and Natalie Finn, who died in October, both had parents who were collecting those subsidies. The parents have been charged with multiple felonies connected to the girls' deaths. 


The similar circumstances surrounding the cases have prompted investigations from state legislators, the state ombudsman and Iowa's Child Death Review Team. The Department of Human Services also has hired an outside organization to review its policies in an effort to improve child-protection efforts. 




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Natalie Finn suffered cardiac arrest in October from emaciation due to denial of critical care. Her parents, Nicole and Joseph Finn, were charged in her death.





Foxhoven said the policy change requiring adopted children to be seen annually by a physician and possibly a dentist would ensure kids are being seen by someone in a position to identify neglect or abuse. In the cases of Ray and Finn, both girls were home-schooled and were shielded from the public. 


So far, Republican and Democratic legislators say they support the move. 


"I think that absolutely we need to have that safety net in place, because so many of these things will show up in physicals," said Sen. Matt McCoy, D-Des Moines, who has been a vocal advocate for increased oversight of the state's child welfare system. 




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Sabrina Ray, 16, was found dead at a home in Perry. She lived in home where a home daycare last year had two complaints about alleged abuse and mistreatment. Zach Boyden-Holmes/The Register





Rep. Bobby Kaufmann, R-Wilton, led a bipartisan legislative hearing investigating whether the state needs to address systemic flaws in Iowa's child welfare programs. When that committee met in June many members said they supported requiring annual doctor visits. 


Kaufmann said Wednesday he hopes to see Foxhoven's plan enacted quickly. 


"Anybody that wants to harm a child is now going to have a much more difficult time doing that under the radar, because they’ll be accountable for a yearly health checkup," he said, noting that he expects bipartisan support for the idea. "Anyone who has a problem with proving they’re taking care of a child that they’re getting taxpayer money for should think twice about adopting a child, in my opinion."

Foxhoven said the agency wants to find ways to address the problem without overstepping its boundaries. Once children are adopted, he said, they should be treated like any other family. But because some families receive state subsidies, he believes its reasonable to require them to document something they likely are already doing. 


William Pearce, founder of Adoption Associates of Iowa and a board member of Iowans for Adoption, agreed. 


"I think that’s a good idea," he said. "... I’m sure that (families) would rather not have the government in their house at all. But like a lot of policies, you have to sometimes take the least difficult choice that there is. The other choices that are available would probably be seen as far worse overreach than this. You’re going to take your kid to the doctor anyway."


Foxhoven said the issue is not about whether it makes sense to pursue the change, but how best to implement it. 

Families who receive state subsidies enter into adoption agreements with the state. Enacting the change may be as simple as amending those agreements, he said, but it could also require administrative rule changes or an act of the Legislature. 


It also will require the state to create a way to document physician visits. Families who are eligible for adoption subsidies also are eligible for Medicaid. Physicians could flag the visits in the Medicaid system, but families who are privately insured would need a different way to document visits. 


Other concerns involve holding families accountable while ensuring subsidies aren't needlessly revoked, Foxhoven said. 


"Say somebody has a busy doctor," he said. "Their year runs out Aug. 1, but they can’t get in until Aug. 15. Obviously we don’t want to cut off their subsidy for that. ... So it’s going to take a little bit of time."


Still, Foxhoven said, "the sooner the better." 


"It’s a signal to the community that we are constantly open to taking a look at what we do and how we can improve the safety net that we provide for kids," he said. 

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