DYSFUNCTION DISORDER

New York, United States (ProPublica) – “These were snapshots. But people started taking them as gospel.”

NYC paid millions for flawed mental health reports. Family court judges relied on them routinely. Parents and children lived with the consequences.

THE YOUNG MOTHER was in danger of losing her child when she met with a psychologist in May of 2014. She had been living in a Manhattan shelter for victims of domestic violence, and New York City’s child welfare agency was considering taking the child from the woman, according to the woman’s lawyer. The psychologist was supposed to conduct an assessment and file a report, a finding that could end up before a Brooklyn Family Court judge who would decide the family’s fate.

The interview lasted barely an hour. The psychologist’s subsequent one-page report stated that the mother was “cognitively limited,” and that her “mental status exam” reflected “primitive and irrational decision-making.” The report, signed by a psychiatrist, also noted that the parenting abilities of the mother, an immigrant from Central America, were suspect because of the kinds of foods she chose to feed the baby.

The child was taken from the mother’s custody immediately after the evaluation, and the removal was approved by a judge days later.

In late 2015, a father in the Bronx lost all chance at custody of his child as the result of another similar evaluation. He had met with a psychologist for an hour shortly after the birth of his child, according to the man’s attorney. The psychologist did not ask a single question about the man’s potential to be a parent, and never saw him in the presence of his newborn. He was instead given what the psychologist called an “abbreviated IQ test,” the attorney said. The subsequent report to Family Court concluded the father’s “cognitive limitations” left him unfit to care for his child.

The mental health professionals in both cases had been recruited by Montego Medical Consulting, a for-profit company under contract with New York City’s child welfare agency. For more than a decade, Montego was paid hundreds of thousands of dollars a year by the city to produce thousands of evaluations in Family Court cases — of mothers and fathers, spouses and children. Those evaluations were then shared with judges making decisions of enormous sensitivity and consequence: whether a child could stay at home or if they’d be safer in foster care; whether a parent should be enrolled in a counseling program or put on medication; whether parents should lose custody of their children altogether.

In 2012, a confidential review done at the behest of frustrated lawyers and delivered to the administrative judge of Family Court in New York City concluded that the work of the psychologists lined up by Montego was inadequate in nearly every way. The analysis matched roughly 25 Montego evaluations against 20 criteria from the American Psychological Association and other professional guidelines. None of the Montego reports met all 20 criteria. Some met as few as five. The psychologists used by Montego often didn’t actually observe parents interacting with children. They used outdated or inappropriate tools for psychological assessments, including one known as a “projective drawing” exercise.

The reviewers warned Family Court judges that they should regard the reports from Montego with extreme caution. They encouraged the city’s child welfare agency — known as the Administration for Children’s Services, or ACS — to consider ending its relationship with the company.

But the review was kept secret, and Montego continued for another two years under contract with ACS. In fact, the agency sent more families to Montego in the ensuing years than it ever had before, setting aside millions for the company to use to provide more mental health evaluations.

Lauren Shapiro, the director of Brooklyn Defender Service’s family defense practice, said her organization had worked with dozens of families broken apart in large part because of Montego’s evaluations.

“We were shocked they were even being used by the court given that they didn’t follow the basic minimum standards for evaluating parents,” said Shapiro, who helped initiate the confidential 2012 survey.

Jama Adams, Montego’s clinical director, didn’t contest the findings of the 2012 review at the time, nor does he now. He said he and the clinicians he had hired had done the best they could, and had capably served untold numbers of families not captured in the limited review, before the city terminated its dealings with Montego in December of 2015.

Today, Adams looks back on the entire arrangement with the city as a kind of empty promise. The city, he said, had never been willing to spend the money it would have taken to produce high-quality mental health assessments. Meaningful examinations of parents or children would require taking weeks, not days, spending thousands of dollars, not hundreds. The city, he said, had set Montego up to fail. Adams said that failure had been shared by the judges in Family Court who relied on Montego‘s reports despite their clear limitations.

“These were snapshots,” Adams said of the reports. “But people started taking them as gospel.”

It is impossible to say precisely just how influential mental health assessments are in any individual Family Court case. Family Court proceedings are open to the public, but most case files, judicial decisions and trial transcripts are secret. Even lawyers who say their clients were harmed by decisions made with Montego’s input are reluctant to share details, in large part because of confidentiality rules governing attorney-client relationships, as well as fear of retribution by ACS or Family Court judges.

What is indisputable is that Family Court cases are complicated and often life-altering. In the last decade, roughly 450 children have died while their families were known to ACS, many of them under the supervision of Family Court judges reliant to some degree on psychologists like those recruited by Montego.

No one would argue that input from mental health professionals could protect families from any and all harm. But the city’s investment in these experts, starting in the 1980s, was supposed to provide critical aid to a system straining under a crushing load. New York’s Family Court, one of the busiest in the nation, handled some 225,000 matters in 2015 alone. There are too few judges and too little money to deal with way too much heartache — families broken by poverty, addiction and violence, cycling through the court’s crowded corridors every year.

Making psychologists’ evaluations a routine part of the roughly 11,000 cases a year dealing with child protection was supposed to create an added safety net, helping judges navigate decisions that often have little to do with the law. City-run mental health clinics absorbed some of this work. But over time, records indicate ACS turned more and more to Montego, sending the contractor upwards of 10,000 referrals over 15 years. Yet Montego’s evaluations were sometimes so poor or inadequate, according to attorneys and psychologists who worked with them, that they could actually be detriments to the decision-making process.

The story of just how completely the city’s partnership with Montego fell short of its aims has never been reported. Neither city nor Family Court officials have ever sought to determine the consequences of what they came to regard as Montego’s unacceptable evaluations.

ProPublica spent months talking with Family Court lawyers, examining case files and reviewing contracts and communications between ACS and Montego. Adams, who today does a mix of teaching and private counseling, also agreed to reconstruct his company’s dealings with the city.

What emerges is a portrait of an often chaotic operation run on the cheap. ACS sent scores of families to Montego — a three-person outfit based in Manhattan — which then scrambled to find competent clinicians to see them. But the families often never showed up. When they did, the rates the city paid meant their dealings with the psychologists were brief and limited. Often, the city failed to provide the most basic background information about the families it sent to be assessed, according to Adams, whose account is supported by documents ProPublica obtained through the Freedom of Information Law. And Adams and the psychologists he hired had little way of determining what became of the families whose futures they might have helped shape.

“The belief that you can sit down with someone for an hour and get an in-depth psychological read on them is a myth,” Adams said. “This work is costly and time-consuming and that is often at odds with institutions that are strapped for cash.”

Adams said he couldn’t talk about specific cases from years ago and would be legally constrained from doing so anyway. He said he suspected the cases of the Central American mother and Bronx father who lost their children were emergency cases, and that there likely were other reasons for removing the infants from the parents that their attorneys would not be eager to share.

Adams said neither the 2012 review nor ProPublica’s inquiry amounted to a rigorous sampling of his agency’s work.

“I obviously would not deny that in some cases inappropriate language was used or that different conclusions could have been drawn,” Adams said. “But I would argue that in the overwhelming amount of cases, we were helpful in giving an accurate sense of the person’s strengths and challenges.”

Today, Adams clearly regrets how little he was able to offer many of the families he worked with daily. And he remains mystified by the outsized role those encounters played with judges. It felt, he said, like he and his psychologists were simultaneously “omnipotent” and “impotent.”

The Administration for Children’s Services issued two brief statements in response to dozens of questions tied to this story. In sum, the statements said ACS increased scrutiny of Montego’s work in 2013, after the previous year’s confidential review. When the company’s work did not improve, the spokesperson said, ACS had no choice but to terminate the company’s contract in December 2015.

Hellish Cases; Few Options

ON OCT. 26, 2016, in a mostly empty courtroom on the fourth floor of Manhattan Family Court, a weary judge sorted through a stack of child welfare cases.

The filings spanned the standard variety of misery: A teenaged girl who needed to take a urine test to prove she hadn’t used drugs and could therefore handle a less restrictive group home; a 16-year-old boy with a string of arrests, the most recent of which his lawyer did not seem to know about. Then, a kind of intergenerational calamity: a father, a mother, their 17-year-old daughter, and her newborn baby, all under the watch of various social service agencies.

As the judge plowed ahead, a court clerk stood up, stretched her arms and declared:

“Today is the day from hell.”

New York City’s Family Court system seems perennially in a state of crisis. It’s been the subject of some reform effort or other for decades. And though there has been some progress recently — in 2015, for instance, the legislature authorized the hiring of nine new judges — those who work in it every day say the workload in family court still overwhelms its resources. Today, not counting magistrates and referees, there are only 56 full-time judges available to help process the more than 200,000 cases that lurch through it every year.

To walk its corridors is to see the consequences of delay and dysfunction in real time. Waiting areas are crowded; screaming matches and fistfights break out regularly. City-paid attorneys hustle with armfuls of records from court to client and back again, taking minutes to learn the details of new and old cases alike. Judges are equally pressed for time. Hearings are rushed; essential parties are often absent. It’s loud. It’s cramped. File rooms have been converted to courtrooms, windowless and dimly lit.

Some of the most difficult cases are those that pertain to alleged child abuse and neglect. Judges who decide on these matters frequently carry caseloads that exceed 500, each one involving an array of scared and angry parties — parents with drug problems accusing one another of abuse; parents in jail; parents in shelters; abusive siblings making sexual assault allegations; grandparents too tired and too old and too broke to take care of newborns; children who are sick, malnourished or visibly injured.

Many Family Court judges lack any background or training in mental health, so experts are supposed to help them identify authentic mental illness, mediate custody battles, figure out what services might best suit which needs and more.

Some of that expertise comes from four mental health clinics run by the City’s Health and Hospitals Corporation on a budget of $5 million dollars a year. Located inside court buildings, these clinics have some 45 staffers and handle 3,000 to 4,000 visits annually. The experts who produced the confidential 2012 report on Montego were critical of the clinics’ work, too, for similar reasons. The report found the clinics’ evaluations often failed to meet even half of the essential professional criteria.

Then there are private agencies like Montego, contractors whose work is chiefly overseen by an already over-extended ACS. Records indicate that Montego was the leading mental health evaluator for ACS for more than a decade.

Attorneys and psychologists who have worked in Family Court say judges lean heavily on assessments made by psychologists, often referred to as “forensic evaluators.” So do judges themselves.

“In many instances, judges rely on forensic evaluators more than perhaps they should,” said Jody Adams, who served as a Family Court judge in New York City for nearly 20 years before leaving the bench in 2012. “They should have more confidence in their own insight and judgment. A forensic evaluator’s evidence should be a piece of the judge’s decision, but not determinative. These are unbelievably difficult decisions; these are not black and white; they are filled with gray areas and they have lifelong consequences for children and their families. So it’s human nature to want to look for help where you can get it.”

David B. Saxe, a judge on the appellate bench in New York for 19 years, spoke in blunter terms.

“I think there is a degree of ‘C.Y.A.’ on the part of some judges,” Saxe said of the use of evaluators, using an acronym for “Cover Your Ass.” “There can be a tendency to get somebody to opine, to get some protection from an expert.”

Lawrence K. Marks, the chief administrative judge of the Courts of New York State, said there had been some recent success in lessening the caseloads for Family Court judges. In an e-mailed statement, he said he was confident that judges could properly assess and make use of such evaluations, citing the training they undergo.

“Judges are particularly qualified to identify the strengths and weaknesses in forensic evaluator reports, place them in the proper context, and determine what weight, if any, to give to the findings and conclusions,” Marks said.

Christine Gottlieb, co-director of the New York University Family Defense Clinic, said that amounts to wishful thinking.

“I don’t agree,” she said of Marks’ statement. “That is the function judges are supposed to serve, but in the Family Court, there isn’t either the amount of time that judges need to do that, or the level of careful evidentiary practice that there is in other courts,” she said. “In other civil cases, the validity of purportedly expert reports would be extensively litigated before they could be used as evidence. That just doesn’t happen in Family Court. When it comes to these mental health evaluations, judges sometimes go with their subjective, gut reactions to unsupported conclusions they’ve read rather than subjecting them to the rigorous vetting they are supposed to.”

Day in, day out, there is little effort made at anything like quality assurance or accountability. Psychologists say they never get feedback from the court about whether their recommendations proved right, or even useful. Judges might only find out they’d relied on a faulty assessment if tragedy strikes.

Records and interviews also suggest that psychologists who work in Family Court almost never have their work investigated by the state and city entities that oversee them.

The Office of Professional Discipline, a division of the State Department of Education, examines complaints related to psychologists and other licensed professionals throughout New York State. If complaints are substantiated, the agency can issue administrative warnings, fines or censures. It can also refer egregious cases to the state’s Board of Regents or attorney general’s office for further investigation.

Discipline involving psychologists appears rare, however. In 2015, there were just 88 complaints filed against New York’s thousands of licensed psychologists. That year, the state issued one warning, two violation decisions, and four regent actions. Since 1994, according to a review by ProPublica, only one evaluator who is today approved for work in Family Court has been disciplined by the state, and it is unclear whether that action had anything to do with work the practitioner may have done for the courts. According to the limited public information on the case, in 1999 the psychologist was “found guilty of willfully, verbally intimidating a patient,” and was subsequently censured.

New York City Courts established their own oversight body for evaluators in 2008. It’s comprised of 17 judges, lawyers, psychiatrists, psychologists and clinical social workers, including several evaluators who are currently active in the Family Court system.

Through June 2015, the most recent date for which records are available, it has received just 10 complaints and issued two admonitions. Of the evaluators who drew complaints, one opted not to recertify, three resigned, one complaint was withdrawn and it appears two complaints were last recorded as “under review.”

The number of complaints the committee has received and the equally few number of actions it has taken suggest that families and lawyers inside Family Court don’t know of it or don’t trust it. None of the attorneys who took part in the 2012 survey of Montego’s work, for example, thought to complain to the committee.

Marcia Robinson Lowry, a lawyer who has been involved in child welfare lawsuits across the country, filed a class action suit against ACS last year. The suit alleged that New York City children frequently stay in foster care for dangerous, illegal lengths of time. It also charged that they are more likely to suffer abuse in the foster system than kids almost anywhere else. The quality of mental health care was referenced as well.

“Most mental health services provided to children in ACS custody are ineffective and of poor quality, but ACS continues to renew contracts with these substandard service providers while the few quality service providers have lengthy waiting lists,” the lawsuit alleged.

In an interview last year, Lowry said, “A lot of families have mental health issues and ACS deals with those issues the same way it deals with everything else it’s involved in — very poorly and with almost no accountability.”

“The level of information that is given to the court and the process that the court has in which to make a decision are both totally dysfunctional,” she said.

Assembly Line Evaluations
Bordering on the “Insane”

THE CITY’S FIRST CONTRACT with Montego was signed in 2001, for $25,000.

Born in England to a Somali father and Jamaican mother, Adams had arrived in New York City in the late 1970’s after years spent teaching school in his mother’s home country. He enrolled at John Jay College in Manhattan and earned a bachelor’s degree in psychology. From there he went on to complete a PhD program in clinical psychology at the City University of New York.

Over the next two decades, Adams worked for city hospitals and foster care agencies, mostly as a clinical psychologist and a trainer of other staff. By the late 1990s, Adams had concluded that what the city’s social service system lacked most was an efficient, valid means of assessing the mental health backgrounds of people caught up in it.

He and a colleague named Lloyd Stoltz, a Jamaican-American business consultant who has since died, decided to try and persuade the city’s child welfare agency that they could fill that vacuum. The pair got some financing together. They filed articles of incorporation with the state. They eventually named their company Montego after Montego Bay, the second largest city in Jamaica.

Initially, Adams was hopeful. He thought Montego and ACS would work collaboratively; that, together, they could develop and implement a model of assessment that would accommodate the needs of each family or individual coming through the system. The $25,000 was to cover evaluations he would do himself.

But what evolved over the years, he said, was something like an assembly line. The child welfare agency wanted Montego to produce as many evaluations as possible, as fast as possible, as cheaply as possible. The agency wanted them to be thorough, but Adams said officials had little appreciation for the effort and money required to ensure depth and nuance.

“They wanted champagne product for lemonade money,” he said. “Large systems like ACS tend to want a one-size-fits-all model as that allows for better administrative oversight.”

Adams said he recruited a pool of about a dozen clinicians — psychologists and psychiatrists — throughout the city whom he’d call on periodically to perform a sort of scripted evaluation. It was comprised of an IQ test, an interview and a battery of psychological tests and questionnaires.

It was hardly ideal, Adams said, and was undercut further by the fact that the people ACS sent to be evaluated — children, parents, grandparents — arrived with next to no background information. Montego’s psychologists had little appreciation of their histories or the particulars of their Family Court cases. At most, Adams said, the psychologists received something called a “tick-off box,” amounting to a vague description of the person’s issues.

“It’s got all these categories,” Adams said. “She’s depressed. We think she uses drugs. She is fighting with her boyfriend. She left the kid neglected.”

ACS did not respond to questions regarding Adams’ allegations. A spokesperson for the agency only pointed out that Montego had signed a contract with the city, agreeing to perform the services as specified.

Adams said he was sympathetic toward his counterparts at ACS. The agency, despite the expenditure of billions of dollars and repeated overhauls over the decades, can never quite seem to operate in anything other than a state of near panic. Agency officials estimate they conduct some 50,000 child endangerment investigations a year.

In 2015, Mayor Bill De Blasio authorized a $26.4 million dollar initiative to once again improve training and supervision in the troubled agency. ACS Chief Gladys Carrión, who has since resigned while under fire for her treatment of child fatalities, had sought to reduce the caseloads of her workers. She aimed to bring their dockets down to an average of nine at a time — in the past, that figure has surged to more than 20. Last October, an ACS caseworker wrote an op-ed in the New York Post that said the effort has fallen far short and suggested that ACS leadership is indifferent toward the burdens of their frontline staff.

“The city is deceptive when it says child welfare workers are now handling an average of about nine cases at a time — when the real figure is easily more than 20, at least in the Bronx,” the anonymous worker wrote, adding that crushing caseloads have caused many of her colleagues to quit.

Officials with ACS declined to respond to the article.

Adams said he saw the fear and frustration in ACS workers every day. They were, he said, “always under the gun.”

Montego’s experience became similarly frenzied. Every new contract — it bid on and secured deals for $1.8 million in 2005 and for $1.7 million in 2010 — brought requests for more evaluations, but the base rate for each assessment increased only marginally. And finding psychologists appropriate for the expanding array of families — clinicians who could speak the same language or who had backgrounds in certain kinds of trauma — proved daunting.

Nothing, however, was as disruptive and damaging as the fact that in great numbers of cases the families never even showed up to be evaluated. In the early years, it happened occasionally, Adams said. But the problem grew to be epidemic. Even the harshest critics of ACS might be inclined to ask what it was supposed to do with families who wouldn’t show up for mandated evaluations, with their futures at risk.

The plague of no-shows also had direct consequences for Montego’s operations. Exasperated psychologists — who got paid $150 for an appointment that didn’t happen rather than $650 for a completed assessment — stopped taking the company’s calls. The no-shows were also one reason Montego was never paid the full value of its contracts with the city.

Adams said ACS at one point also began to shrink its own staff of psychologists and psychiatrists. Previously, such professionals were based in agency field offices around the city. They would correspond directly with Montego, delineating their expectations for reports, providing background information on the subjects, and discussing the results.

But as those people left, so did their expertise and institutional knowledge.

“Now they had people reading our reports that did not know what they were talking about,” Adams said. “We ended up spending a lot of time educating ACS on what the reports meant. They didn’t have the right kind of training or background to interpret the results.”

Interviews and records make clear that many attorneys who handle Family Court cases came to question whether Adams and his team knew what they were doing. Lawyers with a number of nonprofit legal organizations identified Montego’s evaluations as flawed, and thus a threat to their clients.

Emma Ketteringham of the Bronx Defenders said she instructed attorneys in her office to routinely object to evaluations from Montego being used in their cases. Ketteringham said the idea of using drawings done by clients as a forensic evaluation tool seemed “insane.”

Adams acknowledged that some of the testing tools Montego used were dated and perhaps inappropriate. He said that after realizing some of the tests weren’t “normed” for the population he was working with, the company stopped using several of them, including the drawing tests. But he added that the clinicians were also told to make use of the “projective” drawing tests only when they were supported by other “interview data.”

ProPublica examined half a dozen Montego evaluations from 2009 and 2010. They all contained a boilerplate, but formidable, requirement for what typically was a single meeting of no more than a couple of hours: “assess the client’s mental status, personality functioning, including emotional/behavioral problems and strengths, the risk of self-harm or harming others, the ability to provide a nurturing environment and care for children with adequate parenting skills, and the need for psychotropic medication. This is a court ordered request.”

The reports certainly captured information that would give a judge pause about allowing the subject parent to maintain custody of their children. They detail drug dealing and inappropriate sexual behavior, as well as parents leaving their kids with allegedly abusive partners.

But the reviews also contain what read like sweeping conclusions about parenting ability based on single interviews, without any observation of interaction between parents and their children. The evaluations draw on some of the tests the 2012 survey called into question. One was called “Draw-a-Person,” where an evaluator will make inferences about things like a subject’s self-esteem or parenting ability based on a drawing of a human figure. Some use the infamous Rorschach test, in which subjects tell an evaluator what they see in inkblots.

Portions of some reports border on the incoherent. One evaluation, for example, suggested a young mother’s “self-portrait drawing” suggested her self-esteem was “quite diminished” because it was “reminiscent of an adolescent in the opposite gender with institutionalized clothing,” perhaps a reflection of her long stays in group homes and city shelters. The same report suggested the woman had poor judgment because she said she was raped by her father and failed to seek “appropriate help from the proper authorities.”

Another report described a woman’s drawings as “childlike and clownish” and the analysis of them and other test results led the evaluator to believe the woman could not cope with the “ordinary demands of living of everyday living.”

A number of the reports suggest that the subject parents should receive some form of therapy, parenting support or substance counseling. These recommendations gnawed at Adams because such services are rarely made available. In any case, Montego never received any feedback on their clients, so Adams rarely had any idea what came of the suggestions.

Image Source – Pixabay

Family defense attorneys say the evaluations show a profound disconnect between the evaluators and their subjects, particularly the degree of poverty that many of these families live in. Subject families are sometimes criticized for failing to obtain adequate healthcare or housing for their children, but they might not be able to afford the time off work or other costs that middle-class families take for granted.

“The bottom line is, this just would not be happening if these were families of privilege and power,” Gottlieb said.

Adams says he sees their point, but he also suggested that the parent defender agencies can look at their clients through rose-colored glasses.

“Generally speaking, the ACS population presented some combination of the following three issues — substance abuse, domestic violence, depression — so you’re dealing oftentimes with a working class mom who is overwhelmed in some way or another,” he said. “In the old days, they would say, okay, you’re a bad mother, we’re going to take away your kid. That’s wrong. But you also can’t pretend that she’s the best thing since Mother Theresa.”

To him, there’s another deeper, systemic problem that affected nearly every case that came before him.

“It’s a very adversarial system,” he said of New York City Family Court. “Both sides only see one aspect of the client. Bronx Defenders will say ‘you are innocent, you are the best mother that ever occurred, all you need is a little support.’ And ACS is like ‘the kid got burned by hot water because you did not wake up on time…’ There’s no safe space to sit down and say let’s help this woman. She’s got difficulties. How can we help her? That space does not exist.”

Adams said the idea that anyone in the system — ACS, judges — could have regarded Montego’s reports as being of great depth and substance was hard to accept. Adams said he understood that he was meant to provide “screenings,” he said, which are essentially an introduction to someone’s mental health history, not the kind of thorough assessments upon which ACS or judges could base their conclusions. He said the hour many parents or children spent with his psychologists was often their one and only interaction with a mental health professional.

“These were not forensic evaluations, but they were often the only psychological data available to decision makers,” he said.

The evaluations done in child welfare cases — by Montego and by the city-run clinics — eventually prompted action. Beginning in 2010, representatives of the city’s parent defender organizations began meeting privately in the Manhattan Family Court library and elsewhere to discuss a range of potential reform items. The poor quality and inordinate influence of mental health evaluations topped their list. So in 2012, the group organized the independent review of the work of Montego and the city clinics.

When Adams learned of the review, he didn’t have to guess at its findings.

“Given the resources, we just couldn’t uphold that standard,” he said, again insisting his organization effectively did screenings, not in-depth evaluations. “It made assumptions about the amount of information available to us; the willingness of people to share information with us; and the investment made by ACS. In the best possible world, you should get a 30-page, $3,000 document developed over a week of interviews and psychological testing, but they were not going to pay for that.”

Gottlieb, of NYU, said this hardly absolves Montego.

“It’s ethically incumbent on the evaluator to make more clear in the evaluation what its limitations are. If you’re not being paid to do more, okay, I understand why you’re not doing more,” she said. “I don’t think it lets them off the hook entirely, but I certainly agree the main responsibility lies with ACS. They’re the ones who are, first of all, generating this and they’re the ones who are acting as though it should be a basis to break up a family.”

Again, Adams said no one has done an assessment of large numbers of Montego cases.

“The findings,” he said of his agency’s evaluations, “are often broad and tentative with a recommendation for further evaluation. But it is always a challenge to give useful information to the user of the report and at the same time be tentative. The person getting the report wants a definitive answer and might well choose to ignore the caveats in the report, especially if they are not as explicit as they need to be.”

The results of the disturbing independent review were shared among Family Court judges as well as with a variety of city officials, including those at ACS in August 2012. Some of the lawyers involved wanted to make the results public. Ultimately, all parties agreed to keep the results secret, in part because the city mental health clinics and the courts agreed to collaborate on making improvements.

Officials with ACS, however, balked at the proposal to work collaboratively. They promised, instead, to investigate the work of Montego independently.

Asked about the agency’s response to the survey, an ACS spokesperson said: “In 2013, ACS and Montego agreed to a continuous quality improvement plan in response to ACS’s concerns of incomplete evaluations and reporting.”

Records show that plan did not immediately hurt Montego’s business. The city renewed its relationship with Montego in 2014, signing a $2.35 million three-year deal that offered to pay the company to produce more evaluations than it ever had.

“I didn’t know that they did that,” said Shapiro, the director of Brooklyn Defender Services. “But it is shocking that they would not only continue to contract with them, but increase the money they gave them.”

“How Do You Do This Work Ethically
and Not Go Broke?”

THE CONTRACT MONTEGO signed with the city on July 3, 2014 called for the company to provide two evaluators per borough who would work two days a month, and crank out as many as eight evaluations a day.

Adams said he wasn’t surprised by the increased workload, even after the 2012 review. Other agencies had over the years found ACS’s demands to be unworkable, he said, and opted out of their contracts.

Adams, in an email to ACS, tried to get the agency to recognize the problems with how it was conceiving of, and paying for, mental health evaluations.

“Some of the most prominent social services organizations in NYC have tried and failed to make this contract work,” he wrote.

ProPublica obtained records of communications between Montego and ACS over the final tumultuous two years of their relationship through a Freedom of Information request. Though heavily redacted, they capture an escalating degree of frustration and distrust. Montego, for its part, complained that the problem of people failing to show up for evaluations was only worsening. By 2015, Adams said, fully 50 percent of the scheduled evaluations were not happening.

Adams, writing to ACS, accused the agency of a lack of concern for the fate of the families who were not being evaluated, and asserted that the agency was manipulating paperwork to hide the problem.

“Odd that you never ever speak about the risk for those persons scheduled for vital and urgent services but who never show up, repeatedly,” Adams wrote in an October 2015 email to several senior ACS officials. “You appear deaf to the concerns we raise that contributes to this problem. Repeated requests to you to address these issues do not elicit any substantive response from you.”

The officials belonged to a group within ACS called the Mental Health Evaluation Program. The records suggest no one wrote back.

Over the months, ACS responded with a growing number of complaints about Montego’s work. The agency scolded the company for cancelling one scheduled evaluation. It accused the company, in another case, of having submitted an evaluation for the wrong child. “This is not the first time this has occurred,” the agency wrote.

As it turned out, Montego was using the same electronic template for its reports over and over, but sometimes failed to remove confidential, identifying information from each form before reusing it on a new subject. This created the possibility that a judge or caseworker could make a decision about how to handle a case using information for the wrong family.

Adams had to submit something called a Quality Assurance plan to address the issue. But errors continued to surface. In an October 2015 evaluation, a consultant hired by ACS to review the Montego reports identified several — from trivial things, like a Montego clinician missing the letter “T” in the words “the” and “this,” to more substantial issues. He found one exam, for example, that included a psychiatric diagnosis “from another case,” for a person who was “not a member of this family.”

Adams promised to watch the clinician’s work more carefully.

But problems cascaded. Adams said clinicians refused to take assignments. At one point, Montego was assigned nearly 70 evaluations in a week to catch up. Adams said his pleas for more background information were never met.

From June 2014 to June 2015, Montego billed the city for 873 evaluations and 608 no-shows.

Adams said it all made for a stark reckoning: “So then the problem for us is: how do you do this work ethically and not go broke?”

Eventually, communications between Montego and ACS broke down completely.

“We have been told we are liars in as many words,” Adams wrote to ACS in September 2015. “Our requests for clarifications go often unacknowledged. When acknowledged there is no follow up. When we call for real time assistance we invariably get none but if we do not call we get after the fact interrogation.”

The ACS response to that particular email was redacted — a black box, nearly a page long.

Inside his Manhattan office, Adams said he did what he could to be of aid to the families he met with. The parents, he said, knew when they sat down with him they were at risk of losing their children. They knew they could be “labeled for life,” he said. He started focusing on little things. He made sure his clients were fed, for example. He said he gave them Metro cards so they could get home. And he encouraged his clinicians to make their limited time with the clients as meaningful as possible.

“What I was trained to understand is any contact with a client is therapeutic,” he said. “So I’d say, ‘I got you here for an hour, maybe the questions I ask will make you think about how you are treating your child. Or maybe I can think about something that will help you with your child, because sometimes that’s the only intervention this family is going to get.’”

https://commons.wikimedia.org/w/index.php?curid=4646159
NYC Family Court – By Jim.henderson – Own work, Public Domain, Wikimedia Commons

Every now and then, Adams said, he saw a hint of impact. He’d bump into a parent or a grandparent on the street. They’d shake hands and tell them of their family’s progress. He might learn that a troubled teen had turned into an upstanding young man. But such breakthroughs were rare, and the satisfaction fleeting. The broken premise of the operation endured.

Like all ACS contractors, Montego’s performance was reviewed annually. It had been in good standing for all 15 years it worked for the city, even after the damaging 2012 review.

Initially, 2015 appeared no different. In September of that year, just as communication with ACS was spiraling to a new low, Montego still got a performance rating of “excellent.”

But then, two months later, in November 2015, ACS took the rare step of issuing another annual performance review for the same period of time. This time, ACS gave Montego a grade of “poor.”

Adams was enraged by what he said was the duplicity of ACS. On Dec. 2, he wrote a nearly three-page letter directly to the mayor’s office:

“Montego never failed in its performance of its contract with ACS and ACS never expressed any dissatisfaction with Montego’s performance that would support a ‘Poor Rating.’ We, therefore, respectfully request that ACS rescind the November 2015 Evaluation and remove it from Montego’s contract records.”

Weeks after he sent the letter, he was running errands in Midtown Manhattan when a terse email popped up on his cellphone. In just a couple of sentences, it informed him that his latest contract with ACS had been terminated without cause. To this day, ACS still has not given him a formal explanation, he said, but in December of last year, he said he got the mayor’s office to withdraw the “poor” rating.

For ACS, Repeated Scandal, With More Scrutiny to Come

AFTER QUIETLY TERMINATING its dealings with Montego, ACS weathered a torrent of blaring headlines in 2016: preventable child deaths; the resignation of its commissioner; the threatened intervention of an independent monitor installed by the state.

When ProPublica shared its findings about Montego, city officials who have been the main watchdogs over ACS said they were not surprised.

“Too many children and families engaged with ACS are not receiving the mental health care services they need,” Letitia James, the city’s public advocate, said in an emailed statement to ProPublica. “These mental health care services are imperative to maintaining family stability and ensuring the overall well-being of our children. We must ensure that every family and child in our system receives the timely and accurate care they deserve.”

In August 2016, James had released a report examining the deaths of eight children who died while under ACS supervision. Records in four of those cases indicate that a parent was receiving some form of mental health service around the time of their child’s death. It’s difficult to determine from the available records if the kind of mental health assessments done by Montego may have put any of the children in harm’s way.

But officials in the public advocate’s office not authorized to speak publicly on the matter said they have routinely observed long, maddening delays in getting ACS evaluations completed. City and state records are often so vague that it’s impossible to tell whether they happened at all, they said.

Mark Peters, commissioner of the investigation department, issued two damning reports on ACS in 2016, one dealing with its handling of juvenile offenders and another involving two more child fatalities. He told ProPublica his office was currently examining ACS’s history of dealings with outside contractors.

“The problem you discussed regarding mental health vendors brought in by ACS not doing proper evaluations or conducting cursory evaluations is part of a broad concern DOI has regarding ACS, specifically that agency’s lack of supervision of its own staff as well as contracting agencies,” he said. “It will be a focus of our upcoming report that will document the damaging impact of this type of neglect by ACS and other systemic problems.”

And just last week, New York State Comptroller Thomas DiNapoli released a critical report targeted at the agency’s oversight of contractors like Montego. The report found that ACS had failed to improve its supervision after a 2015 state audit identified systemic shortcomings.

The comptroller’s office had encouraged the agency to carefully document and justify any decision to award a contract to a vendor “with a history of poor performance” and that it not “extend or renew existing contracts with vendors until the performance of such contractors has been adequately evaluated.”

In a statement to ProPublica, ACS spokeswoman Aja Worthy-Davis pushed back at the comptroller’s report, citing the agency’s “rigorous monitoring” of companies and organizations it contracted with.

ProPublica asked ACS what had become of the family evaluations that, for a decade, the agency had been sending to Montego. The agency said the work had been given to a number of other contract agencies, but offered no breakdowns or additional information. Interviews with family defense agency lawyers suggest some cases have been shifted to the city’s Family Court mental health clinics, which they said had improved substantially, in part because judges have made their evaluation orders more specific.

Adams still does the occasional evaluation for one of the foster care agencies working with ACS. He said Montego’s work has “ground to a halt,” its name sullied by ACS’s termination.

He has watched the year of turmoil, including the resignation of ACS’s chief, and the pledges of more investigations and monitors and shakeups to come. He said he sees plenty of ways to improve the system, but to do these things, those in it would have to be honest about the advantages, limitations and costs of mental health evaluations. There would need to be a reckoning with the system’s core purpose of assisting families in distress.

“The sad thing about this is people who do this work really care,” Adams said. “But the system doesn’t work the way it should and that’s a tragedy.”

 

This report prepared by Joaquin Sapien for ProPublica.

Joaquin Sapien has covered criminal justice, military healthcare, and environmental issues for ProPublica since 2008.