Our Choice: V.I.P. or R.I.P.

Barry M. Lester is a professor of psychiatry and human behavior and of pediatrics at the Medical School, and director of the Infant Development Center at Women and Infants Hospital and Bradley Hospital. Jeremiah S. Jeremiah Jr. is chief judge of the Rhode Island Family Court.

by Barry Lester and Jeremiah S. Jeremiah Jr.

We are not very good in this country about prevention. It took Sept. 11 for us to wake up to the threat of terrorism; the Columbia space shuttle crash to prompt reconsideration of NASA policies; and sadly, owing to our own local tragedy, clubs around the country, if not the world, will rethink fire codes and the use of pyrotechnics. These are tough lessons.

The difficult challenge confronting the promotion of prevention is that you have to lay out money now for something you hope to change in the future. The question remains, if we saved the money, would it have turned out OK anyway? It is especially hard to talk prevention during times like these when money is tight. Why spend precious resources for some bad outcome that may or may not happen?

The Vulnerable Infants Program of Rhode Island (VIP-RI) prevents potential problems for drug-exposed babies by intervening early in the infant’s life – and it saves money. In this case it is actually cheaper to prevent problems than to wait for them to occur. A brief history of the program and how it works:

The program is called VIP because drug-exposed infants (mostly infants whose mothers used cocaine, heroin, alcohol, and/or marijuana during pregnancy) are vulnerable, not damaged. They can recover and do quite well in a good environment. And babies are VIPs. In Rhode Island, we see about 150 DCYF-involved babies per year. DCYF (Department of Children, Yough and Families) has to recommend, and the court has to decide, which of these babies should go home with their mothers, which should be removed and put up for adoption, and which should go into a temporary home (foster care) until a final decision can be made. That final resolution is often reunification with the mother but may be permanent removal and adoption.

These are tough decisions. How do we decide which mothers get to keep their babies, which mothers do not, and which mothers may have a chance at reunification? If it is clear that the child’s physical safety is in jeopardy, there is no question. But most cases are not like this, and the concern has more to do with the mother’s ability to provide adequate parenting. Also, removal is not necessarily in the best interest of the child. Foster care is intended to be temporary and short-term. Infancy is when children form attachment relationships. Children cannot develop secure attachments when their relationships with their parents are disrupted or when they experience multiple placements. When attachment relationships are severely disrupted, as happens with multiple placements, the child can develop severe emotional problems.

In 1997, the federal government recognized that there were too many children in foster care in this country (more than 500,000 at that time), and that multiple foster care placements wreaked havoc with the emotional lives of children. To address this problem, the government passed ASFA – the Adoption and Safe Families Act. ASFA requires a permanent placement decision within 12 months of a child being removed from his or her biological mother. Called “concurrent planning," parents are given an opportunity to make changes in their lives so that reunification can occur while planning for alternative permanency options are investigated.