There comes a point where we need to stop just pulling people out of the river.
We need to go upstream and find out why they’re falling in.
—Desmond Tutu
The Family Intervention Response to Stop Trauma (F.I.R.S.T.) Legal Clinic was launched in 2019 to prevent the removal of newborn babies from mothers who are engaged in treatment for substance use issues. Nearly two years into this new upstream frontier of pre-petition work, F.I.R.S.T. has secured new partnerships and legislative funding and has connected with an enthusiastic network of other state programs pushing for transformative changes to the child welfare system.
Since its founding in 2019, the F.I.R.S.T. Legal Clinic has presented to national conferences, such as the ABA Parent Representation and Youth Representation Conferences, the National CASA conference, the National Association of Counsel for Children, and Zero to Three; within our state, such as to the University of Washington School of Law; and to multiple states interested in pursuing pre-petition work.
With a strong desire to move away from a “one-service-plan-fits-all” approach, F.I.R.S.T. offers a unique set of resources and wraparound supports that are not generally associated with a free legal clinic. Preeminent is access to a parent ally. A parent ally is someone with the lived experience of having gone through an investigation by Child Protective Services (CPS) and a dependency case and who now helps provide support and assistance to parents navigating this confusing, terrifying, and often traumatic process. Parent allies are able to assist with locating resources to obtain stable housing and streamlining access to drug and alcohol evaluations and treatment, employment and skills training support, and referrals to the Nurse-Family Partnership for first-time mothers program, in which an assigned nurse works with a family for the first two years of a child’s life. F.I.R.S.T. also partners with the Parent Child Assistance Program, an award-winning, evidence‐informed home-visitation case management model for pregnant and parenting women with substance use disorders. More information about parent ally Gina Wassemiller and her work with F.I.R.S.T.’s Legal Clinic can be seen in a short film, Being Gina.
In addition to helping clients understand their constitutional rights and providing them with the tools necessary to make informed decisions, attorneys work with clients on locating legal resources for any criminal or legal matters that may present additional barriers. F.I.R.S.T. moms are also given access to material needs and the necessary supplies for parenting a newborn, ranging from maternity clothing for the mother, to a car seat and stroller to ensure mother and baby can continue to access services.
For the first two years of its existence, F.I.R.S.T. operated as an organization staffed by two pro bono attorneys volunteering their time along with a parent, Gina Wassemiller, with her direct lived experience, who acted as a mentor and a guide for our new moms. As F.I.R.S.T. became involved, fewer and fewer babies were being removed from their parents, and more successful engagements with families were occurring with our local child welfare agency. The same organization that once rejected our intervention ideas now sought to actively partner with us.
Part of the ongoing mission of F.I.R.S.T. is to educate providers and other community agencies on what actually happens to families when someone calls CPS. Among medical professionals, there is a common misconception that calling an intake on a pregnant person with suspected substance use disorder will result in the mother being provided with services, treatment, and other resources that will result in a healthy mom and baby.
Any intakes (reports to CPS) in Washington State, called in by mandated reporters on a pregnant person, will automatically “screen out” and be stuck into a department file and later used during an investigation to determine whether removal is needed once the baby is born. The department is unable to provide services or intervention during pregnancy because there is technically no child at risk of abuse or neglect until birth, so intakes during pregnancy have no place to go but “screen out,” meaning no contact occurs with the mom. By clarifying the CPS referral process and encouraging providers to refer the families to F.I.R.S.T., well-meaning providers will get the intended result for their patients—treatment and services that will benefit the baby and help to avoid the unnecessary trauma of separation.
In October 2020, F.I.R.S.T. began receiving “screened out” intakes from our state’s child welfare agency, the Department of Children, Youth and Families (DCYF), through a pilot program, as part of preventive efforts under the Family First Prevention Services Act. This act uses Title IV-E federal funding designated for families who are at risk of entering into foster care. Access to these screened-out intakes provides an even greater opportunity for outreach, intervention, and planning for persons in the earlier stages of pregnancy. This early access enables F.I.R.S.T. attorneys to work with the child welfare agency to determine why the child may be deemed unsafe in the parents’ care and provide wraparound services before CPS is even involved.
The results were astonishing. Between July 2019 and November 2021 (29 months), the data show that, out of 123 F.I.R.S.T. Legal Clinic clients, only 15 percent are known to have had a court case. Furthermore, out of 72 cases with a recorded outcome, 89 percent did not result in removal. While all dependency filings for babies (under 12 months) in Washington State did drop between 2018 to 2020, there was a statistically significant reduction in our jurisdictional area: Snohomish County, where the F.I.R.S.T. clinic is located, saw a 37 percent drop in removals, compared with the 17 percent reduction in the rest of Washington State (according to records maintained by F.I.R.S.T. Legal Clinic and the Office of Public Defense).
This family-centered approach to prevention work is also supported by the medical community. The research is clear that, when newborns are removed from their parents’ care (even for short separations of less than a week), they lose critical mother-infant bonding that is necessary to form a securely attached relationship. Emma S. Ketteringham, Sarah Cremer, Caitlin Becker, “Healthy Mothers, Healthy Babies: A Reproductive Justice Response to the ‘Womb-to-Foster-Care Pipeline’,” 20 CUNY L. Rev. 77 (2016).
A focus on the creation of medical partnerships and use of a multidisciplinary approach has already led to a shift in how hospitals interact with the parents and their counsel. F.I.R.S.T. families regularly benefit from medical professionals’ attendance at family team decision meetings. These meetings are required by DCYF policy whenever a potential change in placement for a child may occur. This participation and direct contact between the medical providers and the legal clinic attorneys about any concerns the hospital nurses or social workers observe allows F.I.R.S.T. the opportunity to work with the parents on addressing what would have otherwise been “unknowns” during subsequent CPS investigations.
Family team decision meetings typically occur without the presence of the mother and baby’s treating physicians. As a result, questions regarding the mother’s care and the infant’s suitability for discharge with the mother often go unanswered. In the world of child welfare, unanswered questions related to infants equals risk, and enough risk leads to the filing of a dependency petition with court intervention and the likely trauma of separation. Involving medical professionals to assist with the CPS investigation, in coordination with attorneys, helps to fill in unknowns and has been highly effective at minimizing risk and preventing trauma.
In Swedish-Ballard, a hospital in Seattle, Washington, Dr. James Walsh and Dr. Vania Rudolph now regularly attend family team meetings where the decision is made by our state agency to either file a dependency petition in court or work with the family. Their presence, input, and advocacy have been transformative for our clients and their families. In this upstream intervention space, the focus is cooperation, not cross-examination, and the tone and mood of these meetings are notably more positive and child-focused. The balance of power during these meetings is also markedly different.
To have treating doctors provide support for moms during meetings enables experts to provide information on how well mom is doing and where mom is in her recovery, and give medical context to each family’s unique situation. It enables the most informed professionals to provide direct medical information regarding what is best and safest for the baby, directly to the department. Bringing the medical perspective to the child welfare system also helps to destigmatize substance use disorder in women who are pregnant and dispel the myths that are commonly associated with medically assisted treatment, such as methadone, Suboxone, and Subutex, during pregnancy. This benefits not only the families currently working with F.I.R.S.T. but all future families that may encounter the system.
In 2020, the legislature in Washington State approved a two-year budget proviso totaling $500,000 that funded the work of the F.I.R.S.T. Legal Clinic for two years while additional data are gathered about the effectiveness of the interventions. Casey Family Programs has provided generous technical support and assistance to help collect and assess the data and impact of our work.
In 2019 and 2020, research conducted in New York City provided compelling evidence of the effectiveness of multidisciplinary representation for parents of children in foster care. Data provided empirical evidence that when parents are represented by a multidisciplinary team of lawyer, social worker, and peer advocate, who are salaried employees of an independent law office with administrative support and supervision, their children spend significantly less time in foster care and reunify with family more quickly without compromising child safety. Lucas Gerber et al., “Effects of an Interdisciplinary Approach to Parental Representation in Child Welfare,” 102 Child. & Youth Servs. Rev. 42, 52 (2019).
At the national level, over 20 states are now represented in a national cohort of pre-petition models led by University of Michigan Clinical Law Professor Vivek Sankaran. As more states explore creating similar models and funding sources, interventions for keeping families safely together are being reimagined across the country.
A report published by the ABA Center on Children and the Law indicates that in December 2018, the U.S. Children’s Bureau changed policy to enable states to claim Title IV-E administrative costs for attorneys and support staff providing independent legal representation to children and parents in child welfare proceedings. The policy was later extended to legal representation of tribes. As of March 2022, 32 states and 4 tribes have entered into agreements to maximize this opportunity.
People talk about rethinking child welfare and restructuring it, or abolishing it altogether, which are admirable goals, given the oppressive and racist system the foundation is built on. But as long as interactions with the child welfare agency include any possibility of modifying someone’s constitutional rights to the care and custody of children, the only answer is to involve an attorney who can protect those rights.
—F.I.R.S.T. Legal Clinic attorney Neil Weiss
Furthering the mission of F.I.R.S.T., successful clinic moms now accompany us to present their voices and their perspectives of lived experience in the schools, universities, and conferences where these disciplines are taught. From law schools, nursing schools, schools of social work, medical schools, and midwifery and doula programs, the F.I.R.S.T. Legal Clinic’s mission is to positively impact the cultures of all the disciplines that engage with our clients.
This type of outreach builds interest and brings attention to an area where quality providers are desperately needed. A recent presentation to the University of Washington School of Law not only gave Jennifer Justice, a F.I.R.S.T. mom-turned-parent-ally, the opportunity to share her lived experience outside of the support group setting, but also provided a real-life introduction to what is happening on the front lines of a largely unknown area of law in crisis. Having a parent ally share her experience in the child welfare system not only provides opportunities for further healing but also inspired three law students to sign on as interns. The legal clinic was then able to use their assistance on a national policy brief that was drafted for Rep. Davis (D-IL) and used in a bill to support the reauthorization of the Child Abuse Prevention and Treatment Act to provide funding for pre-filing representation. Reaching out to the next generation of community service providers and medical and legal professionals is vital to making lasting changes to this system and how these disciplines interact with one another.
I have been able share my story at the University of Washington Law School, Imprint Magazine, a documentary, WSPAC (Washington State Parent Ally Committee) and weekly in the F.I.R.S.T. Mom’s Support group, to name a few places. Sharing my story not only helps spread the word about the wonderful things that the F.I.R.S.T. Clinic does, but also has been very healing to me. Recovery is a long journey, and they are in it for the long haul.
—F.I.R.S.T. Legal Clinic parent ally Jennifer Justice
One of F.I.R.S.T.’s more unique offerings is a weekly women’s support group that takes place virtually for existing and former clients. The goal of the group is to provide a safe space where mothers can support and learn from each other. Here they can build connections and supports that can extend well beyond the clinic’s involvement with their families. This weekly group is hosted by one of the clinic’s parent allies and includes the regular attendance of F.I.R.S.T.’s executive director and clinic attorney, Taila AyAy.
The support group has been one of the biggest surprises. It became so much more than initially intended. Involvement in these cases is very isolating, there is a lot of shame, and a lot of guilt. There are lots of questions that come up and the moms don’t always know who to turn to. This group provides a safe space to connect with other mothers with similar backgrounds. The veteran group participants provide hope and inspiration to the moms coming out of detox, moms that are experiencing fear and anxiety about what is going to happen, shame about using while pregnant, to see other mothers in different stages of recovery working with the clinic and doing well gives them hope.
—Taila AyAy, F.I.R.S.T. Legal Clinic executive director and clinic attorney
For clients to make this transformative journey of self with their babies, very often they first need permission from themselves. Permission to stop beating themselves up. Permission to let go of the past. Permission to see themselves as worthy of healing and worthy of love. Permission to walk away from pain (no matter how familiar) and to finally let go of an identity that was no longer serving them and, instead, to create a powerful new one.
Safety isn’t about the absence of a threat, but the presence of connection.
—Dr. Gabor Mate
When a compassionate parent ally, doula, midwife, nurse, social worker, doctor, or lawyer sets into motion the alchemy of vulnerability through nonjudgment in a parent who is struggling in that space of the unknown, transformational magic happens! Seeing clients dramatically shed their former selves and walk away from cycles of abuse and trauma is awe-inspiring. Watching others heal has been healing.
You have to keep breaking your heart until it opens.
—Rumi
For many attorneys and advocates, the concept of self-compassion makes us very uncomfortable. We all identify with or know compassionate people who very often fail to extend to themselves any semblance of the patience, kindness, compassion, and grace that they would give to a complete stranger in need. During the pandemic, our office read Trauma Stewardship by Laura van Dernoot Lipsky, which had a profound impact on us.
This led to our office introducing reflective practice into our professional lives. Reflective practice is defined by Donald Schon as “cultivating the ability to reflect on one’s actions so as to engage in a process of continuous learning.” Our reflective practice was led by two extraordinary doctors: Dr. Ira Glovinsky, a licensed psychologist specializing in mood disorders in young children with autism spectrum disorder, with a PhD in special education, along with Dr. Gina Veloni, a licensed nurse specializing in perinatal, infant mental health, and reflective practice, with a PhD in infant early childhood development with a specialty in mental health and disabilities. Together we created an informed space for our entire office to process and reflect on the impacts of secondary trauma, burnout, and compassion fatigue.
The essence of trauma is disconnect from self.
—Peter Levine
Working regularly with Dr. Glovinsky and Dr. Veloni was a blessing for our office. And at the personal level, their work helped one of the coauthors of this article gain the perspective to set down the weight of their own past trauma and abuse, a sinking weight that had become almost unbearable. For the entirety of their legal career, they had kept their own childhood trauma and abuse compartmentalized away from their work, or so they thought.
A large part of their energy was spent pretending their past never happened at all, mostly out of fear and shame. Shame is just the truth being denied, and as Dr. Van der Kolk points out in the book The Body Keeps the Score, “the greatest sources of suffering are the lies we tell ourselves.” Setting this weight down and beginning the process of healing has enriched their work as an advocate, deepened their understanding of compassion, and kept them in the practice of law.
Common puzzle pieces contained within all of the disciplines our clients engage with are the motivation to provide compassionate care for the families we serve and an ever-growing frustration with the status quo of the systems we operate within. The F.I.R.S.T. Clinic believes the future of child welfare is in the thoughtful integration of these puzzle pieces currently scattered across nursing, social work, medicine, and law to connect a lasting cross-disciplinary network of community supports that can actually help families.
This cross-disciplinary vision will begin to take shape on August 11th, 2022, when F.I.R.S.T. will cohost the inaugural Washington State Perinatal and Parenting Mental Health and Substance Use Summit in Seattle. All statewide stakeholders in child welfare will be present, and the cohosts of the summit are the Washington State Administrative Office of the Courts, the Department of Children, Youth and Families, the Office of Public Defense, the Department of Health, the Health Care Authority, the Washington Hospital Association, and the Washington chapter of the American Academy of Pediatrics.
Our summit keynote speaker will be Dr. Mishka Terplan, board-certified in obstetrics and gynecology and in addiction medicine. Dr. Terplan is nationally renowned in his work with an emphasis on addiction medicine, drug use in pregnancy, health disparities, stigma, and access to treatment.
Using this occasion, F.I.R.S.T. will introduce our new partnership with Open Table, a community-based, bottom-up, grassroots model drawing together the relational and social capital of communities for the common good. Open Table develops models that train people from an array of community sectors—including business, education, faith communities, healthcare, and others—to organize and co-invest their abundant and sustainable relational and social capital in individuals with complex needs to create solutions to daunting social challenges. It’s hard to imagine a system, organization, or family that would not benefit from having a team share their social capital to help build lasting and meaningful change.
This upcoming summit will be a historic cross-pollination of disciplinary thinking allowing students, teachers, and practitioners from fields that don’t normally communicate (much less cooperate) with each other to arrive at the potential for lasting solutions to decrease childhood trauma and better support the families we serve. Connecting the puzzle pieces across multiple disciplines through communication and collaboration will allow a new vision of child welfare to take shape across the country, a vision that F.I.R.S.T. believes is long overdue.
To learn more about national programs providing pre-petition work or to learn how your state can join this movement, contact Clinical Professor Vivek Sankaran at the University of Michigan Law School or visit Prepetition Legal Representation.
The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.
