Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, November 25, 2011

The Nathaniel Craver Case: Many Dissatisfactions With Decisions

If you have been following the trial of the adoptive parents of Nathaniel Craver in York, PA, you know some of the details of the case. Nathaniel (Ivan Skorobogatov) was adopted from Russia in 2003 and died as the result of multiple injuries and malnutrition in 2009. The parents, Michael and Nanette Craver, were recently convicted of involuntary manslaughter and given a sentence which allowed them to be released for time served. Their defense had argued that Nathaniel’s injuries were self-inflicted.

Russian representatives have stated strong objections to this mild sentence, as has been reported by the New York Times (http://www.nytimes.com/2011/11/20/world/europe/russia-angry-at-penalty-against-dead-adopted-boys-parents.html) and also by the English-language version of Pravda (http://english.pravda.ru/russia/politics/22-11-2011/119704-cravers_russian_boy-0/). Pravda reported a statement addressed to Secretary of State Hillary Clinton and Attorney General Eric Holder by the Russian Ombudsman for Children’s Rights Pavel Astakhov. Astakhov remonstrated about the inappropriateness of the sentence and asked for an appeal to be filed. In addition, Vladimir Markin, spokesman of the Investigation Committee of the Russian Federation, stated that documents about the case have been forwarded to the National Central Bureau of Interpol, a step that according to Markin placed the Cravers’ names on an international wanted list with the goal of arresting them and bringing them to Russia for prosecution.

I too am dissatisfied with the results of this trial, but I acknowledge that without far more evidence a death penalty decision would have been profoundly questionable. My concern is directed to the failure of the state of Pennsylvania to discipline persons who were either active or passive accessories to the child’s death. This situation was a regrettable example of similar failures that have occurred in case after case of deaths and injuries of children in the last 15 years. Individuals who were mandatory reporters of child abuse (required by law as members of their professions to bring abusive situations to the attention of child protective services agencies) did not report and were apparently inattentive to indications of trouble. Others who were not mandatory reporters but observed problems failed to take the responsibility they should have taken.

Again and again, therapists and counselors have come forward to testify that children who have been harmed are themselves guilty of their injuries. The two-year-old Russian adoptee David Polreis, who died of injuries in 1996, was said to have beaten himself to death with a wooden spoon. An older Russian boy (State v. Salvetti, North Carolina Court of Appeals 2010) who was poorly nourished and had been kept in isolation was said by a therapist to have refused food offered by his adoptive parents. Staff of the Institute for Children and Families, who were involved with treatment of Nathaniel Craver, stated that Nathaniel knew how to push his mother to the breaking point. One staff member, a school psychologist with a degree from a sometimes-accredited institution, testified that the child’s condition might have been worsened by a period in foster care, apparently implying that his condition was the factor that led to his death.

Where were these people when the harm was being done? If they believed that the children self-injured or precipitated injury by other people, why did they not monitor what was happening more closely? Why not help the parents engage in training programs to help them deal with risk-taking or self-injuring children? If the parents were seen as potential threats to provocative children, why not guide them into counseling that would help them control their own impulses? If a child is refusing to eat or is known to have feeding difficulties, why not enlist the family physician and keep growth records to make sure that growth stays within normal limits? Although legal restraints come into the picture only after harm is done, good practice for mental health professionals includes anticipating problems and helping to prevent them by supplying appropriate interventions.

The First Amendment permits therapists and parent educators to state their opinions to parents, even when those opinions are not supported by systematic evidence. Making mistakes in their practice, advice, even testimony, does not make these professionals liable to prosecution. However, the state of Pennsylvania, like other states, has the option of disciplining mental health and other practitioners through state licensing boards. These boards can investigate professionals for ethical and practice errors and can discipline them in a variety of ways, including license revocation. But a look at the on-line records of state boards shows that investigation and discipline are rare except where there was an injury caused directly by the practitioner, or where there was sexual misconduct, or where drugs and alcohol were involved. Failure to follow up injury or malnutrition is rarely a disciplinary matter-- even when the practitioner later testifies that the child’s own behavior (the practitioner’s presumable focus) caused the problems. State licensing boards justify their disengagement by pointing to their low budgets-- but cases that culminate in physical injury or death of children surely deserve priorities even higher than cases of sexual contact with an adult patient.

It has become abundantly clear in recent years that Russian adoptees are especially likely to be injured, killed, or abandoned. Whether this is due to the problems the children have to start with, to the nature of the adoptive parents, or to both, is unclear. Anecdotes about Russian institutions suggest that there may be pressure for adoptive parents to “take” more children than they had planned for, and this may also be a risk factor. But whatever the causes or mechanism, everyone with an interest in adoption has already heard about the tragic outcomes for some of these arrangements. Doesn’t this suggest that therapists, counselors, caseworkers, teachers, and pediatricians should all be especially alert to signs of trouble in adoptions from Russia? Lark Eshleman, one of the Cravers’ therapists, notes on her website the many years in which she has worked with foreign adoptions; did it not occur to her that a Russian adoptee with unexplained or self-inflicted injuries should receive extra attention, and that his parents needed more careful guidance than most adoptive families? Did not the fact of a previous abuse investigation alert anyone to the need for an appropriate care plan that would not punish the parents but would guide them to safe and effective child-rearing approaches?

If professionals working with foreign adoptions can’t keep these issues in mind, and state licensing boards are indifferent-- well, perhaps the Russians are right in turning to Interpol, but they need to add some names other than the parents’.

9 comments:

  1. In blaming the child for this death, the parents and therapists did indeed box themselves into a corner. Any humane therapist/parent would have, at a minimum, made sure a self-injuring child would be cared for in a safe environment.

    But the "self-injury" defense doesn't hold up well when you look at the findings of the medical examiner and his conclusion that not all of the many dozens of injuries found on the dead boy could be self-inflicted.

    There is a report that the Cravers will be tried in Moscow *in absentia* on November 28th. While highly unlikely the Russians will be able to lay their hands on the Cravers, I hope their outrage will help to keep Nathaniel's sister from returning to the Craver home.

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  2. Your point about the status of the sister is well taken. International opinion may focus a bright light on decisions about this other child adopted by the Cravers, and may prevent caseworkers and others from quietly arranging a continued relationship between adoptive parents and child, as has been attempted in some other cases.

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  3. The real pity in this case is that the politics of the situation has tended to overshadow any notion of justice or sensible policy. Pavel Astakhov is supposed to protect children's interests but seems instead to be playing to domestic xenophobic fears of evil American adoptive parents. It makes for good press at home, I suppose. But what about the thousands of children who have found good homes, good parents, and good lives in the US? The whole things seems tipped to showmanship rather than pursuing reasonable interests of children over the long term.

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    1. I am Russian and I am strongly against giving Russian children to adoptive families in US. Maybe you're right and there are "thousands" of happy cases but I dislike the very idea of renaming Russian Ivan to American Nathaniel and raising him as citizen of any other country but Russia. How can any child be happy living with foreign people in foreign country speaking a foreign language he/she doesn't even know? Even if the new "parents" are nice it's stressful for a child to leave his own country behind and begin an absolutely new life in a new place.

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    2. I agree with you in general-- but is the problem that adoption is rare in Russia?
      Presumably the best solution would be if the children were taken into families whose language and ways were familiar to them. Why does that not happen?

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    3. By the way, memento_mary, I'm not the one who said there were thousands of successes.

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  4. If the deaths and other problems seemed to be genuinely accidental, or if they did not share a pattern, I would agree with you. But there are some problems with taking the approach you present.

    One is that in fact we have very little follow-up information about the lives and development of Russian children adopted in the U.S.-- we have only a few anecdotes about successful adoptions, some stories about those whose lives got into serious difficulties, and a few descriptions by parents who found the children more trying than they expected. In the UK, the English-Romanian Adoptees project has collected much more information about individuals, but if I remember correctly there were only about 300 children in that group.

    The practice of amending birth certificates to conceal adoption is a real barrier to understanding the developmental outcomes for children in the U.S.

    Another problem is that Russian children who were injured or killed in their adoptive homes in the U.S. often had been treated in very similar ways, and that those methods (like limiting food) are advised by persons acting as "adoption educators" or "coaches" or "therapists". It should be possible for adoption agencies to screen applicants for adherence to those harmful methods and for their readiness to seek advice from inappropriate sources. Those methods and advice have genuinely harmful consequences which we can hardly associate with diplomatic grandstanding or with Russian xenophobia (however real and traditional that is, and I certainly acknowledge its reality).

    I'd suggest that the real political issues are on the U.S. side, and involve the fear of offending ultraconservative religious groups, for example by placing strict limits on physical punishment and the use of hunger and cold as disciplinary methods for children.

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  5. Can anyone explain, why do all those American people try to adopt a Russian child just to get rid of him later? I just cannot understand it. To adopt a child, they have to overcome Russian and American bureaucracy, spend so much time and money, collect tons of papers, consult with many specialists etc.... they risk their own comfortable future because any child (especially a troublesome or mentally disabled) change their life to worse... WHY do they begin it all? Does the American law allow them any advantage like decreasing taxes or something like that?

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    1. American law allows an income tax deduction for adopted as well as for biological children. If a child were adopted from the area where the parents live, there might be a state subsidy as well, but this does not apply to foreign-adopted children.

      I am just guessing here, but I think there may be the following reasons why people seek foreign adoptions:

      1. They can be fairly sure that the biological parents will not be able to find the child, nor the child the parents.
      2. They want a child of European rather than African ancestry, so the child resembles them physically and to some extent culturally.
      3. They believe that adoption from a "non-Christian" country gives them some religious merit as they bring the child up in their own religious tradition; also, they are encouraged by their churches to do this, and the church may even organize adoption trips.
      4. They seek adoption as a task for a mother whose children are grown and who is restless but not encouraged to work outside the home.
      5. They are persuaded that someone can tell them how to make their life with the child a comfortable and successful one, and the child will be grateful to them.

      I don't know if any of these are true, but they are my best guesses about the reasons people put themselves in the position that ends with disrupting the adoption or harming the child.


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