Four-year-old Damaud Martin rests in a coma-like state in a Baltimore hospital, his once-bright smile gone. Relatives who visit him at the Kennedy Krieger Institute say doctors have told them it's likely he will never run, jump or play again.
He was a victim of shaken baby syndrome, the Baltimore City Department of Social Services said in a court filing. Police are still investigating what happened to Damaud, who has been hospitalized since Jan. 19, but one thing is clear. The injury occurred two months after the social services agency, with court approval, sent him home.
Damaud and his sister were reunited with their mother under an "order of protective supervision," which required close monitoring. Their grandmother, Rosita Martin, said she had begged the caseworker "not to drop the ball on this." After Damaud's brain injury, the agency fired the worker and disciplined a supervisor for lapses related to the case.
His injury is another example of the social services agency's inability to protect some of the most vulnerable children in Baltimore.
Months earlier, the death of a toddler who swallowed methadone sparked public outrage when it was learned that the agency and the city's health department had missed chances to save Bryanna Harris. Five social services staff members were fired or disciplined. On Tuesday, her mother, Vernice Harris, was given a suspended sentence after pleading guilty to voluntary manslaughter.
Allegations of child abuse and neglect pour in statewide, but Baltimore - which accounts for six of 10 children in Maryland's child welfare system - has by far the most. This is at the heart of the challenge facing Maryland Human Resources Secretary Brenda Donald, who since Bryanna's death has accelerated reform of the agency, one of 24 local arms of the department.
Protecting children is tough in the city, where drug use and crushing poverty tear families apart. The agency faces additional challenges because it is understaffed and its workers generally have weaker credentials than their suburban counterparts, The Sun found in an examination of how child abuse cases are handled.
Only about one in 10 caseworkers holds master's degrees in social work and fewer than 10 percent are licensed social workers. Shorthanded for years, according to standards set by the Child Welfare League of America, the agency's staff of 866 caseworkers and supervisors oversees the care of 7,300 children.
The bleak environment of many city neighborhoods complicates the casework. Children are at risk by virtue of living in dilapidated homes on crime-ridden streets. Mothers sometimes put their babies' cribs on cinder blocks to keep away rats entering through holes in walls and floors. Social services workers often encounter parents addicted to drugs or alcohol or suffering from mental illness.
Since Donald took over early last year, she has directed much of her attention to reforms in Baltimore. "The system did not get broken overnight, and it's not going to get fixed overnight," she said. "We're moving as fast as we can, faster than anyone has before."
She replaced top managers, started training programs, supplied tools such as cell phones and laptops and began to revamp screening procedures so that the agency concentrates on serious allegations. She has also strengthened ties with law enforcement and others who deal with children at risk.
An encounter with Baltimore police in the fall of 2006 led to the placement of Damaud Martin and his sister in foster care. At that time, they were staying with their mother in a homeless shelter, according to interviews with family members.
She and a girlfriend rented a moving van so they could move out of the shelter but got into an argument, they said. Police were called. Authorities placed Damaud and his sister in foster care with their grandmother, Rosita Martin, according to court documents filed by the city social services agency.
They stayed with their grandmother, who became a licensed foster parent, for about a year and were returned to their mother last November. Tamekia Martin had met social services requirements for reunification: she had taken a parenting class, leased a house and had a part-time job, court documents show.
But it wasn't long after the children returned to Martin's home - which their mother shared with the girlfriend, her five children and sometimes the woman's father - that Damaud got hurt.
Responders to a 911 call from the house Jan. 19 reported finding the boy unresponsive in a bedroom. A spokesman for the Fire Department said Tamekia Martin was "not able to provide information as to what happened to the child," according to the paramedics' report .
A lawyer for the social services department later said in a filing for the court, "The child safety team at Johns Hopkins Hospital has ruled this as a case of shaken baby syndrome."
Tamekia Martin said in a recent interview that another child was pushing Damaud on a bike when he fell and hit the back of his head on the curb. Several hours later, she said, the toddler fell down a flight of stairs. She said she is angry at the Hopkins team for its diagnosis.
Hospital officials declined to comment because of confidentiality restrictions, as did the social services agency. The caseworker assigned to the family told a reporter that she handled Damaud's case appropriately and was challenging her dismissal. She declined to elaborate.
"There is an ongoing investigation into the injuries sustained by Damaud Martin," said Baltimore police spokesman Sterling Clifford. No charges have been filed.
Soon after Damaud's injury, the agency took his sister, Sandoria, 7, from her mother's home and placed her with a foster family. In court papers, the social services agency said it would be "contrary to the welfare" of both children to allow their mother to retain custody. Yesterday was Damaud's fourth birthday.
Decisions on keeping a child in foster care or with relatives - and for how long - are made by juvenile court judges and masters. They do so based on information from social services workers, lawyers for parents and court-appointed advocates for the child.
It is often an adversarial proceeding, with attorneys for parents arguing for the child's return and lawyers for the social services agency trying to prevent that.
Ingrid Brinkman, a longtime lawyer for the agency, illustrated how tangled things can get. During a briefing for volunteers preparing to become advocates for children, she described the case of a 15-year-old mother, who was under court supervision as a "child in need of assistance."
The courtroom, Brinkman said, was crowded with attorneys and social workers representing the agency, the girl, her baby and the girl's mother, among others.
"It's sometimes an amazing spectacle to see all of these forms of representation," Brinkman said. "In this one case, I counted 15 professionals in the courtroom."
Information from the caseworkers is pivotal. Social services workers who investigate allegations and monitor families are supposed to extensively document what's going on in a child's life.
Ronna Lazarus, a lawyer who represents children in foster care, said she has often found caseworkers' skills to be lacking. "They come to court without files and records," she recently told the group of new advocates. "They don't return your phone calls. ... I would say they are not serving children as well as they could."
Rhonda Lipkin, an attorney with the Public Justice Center in Baltimore, said, "Basically, what most of these cases need is good social work." She has represented foster children in a long-standing class action suit against the state.
Although she calls Donald "the best hope for reform that the department has had in a very long time," Lipkin and other child advocates say reform hinges on upgrading the Baltimore agency's staff.
Compared with Baltimore County, where nearly eight in 10 caseworkers hold master's degrees and almost all are licensed, the city has far fewer caseworkers with either a master's degree or social work licenses. A number of supervisors are not yet licensed. The agency is assisting at least 16 supervisors to obtain their licenses by July 1, 2009, said Elyn Garrett Jones, a spokeswoman for the Department of Human Resources.
The city agency has been chronically understaffed at both caseworker and supervisory levels, and it is offering a higher starting salary to attract workers for some positions. The difference can amount to as much as $7,000 a year for a licensed social worker with a master's degree. Yet the agency remains 71 caseworker positions short of the 807 needed to meet Child Welfare League of America standards.
"New graduates are not prepared for what they are going to face in Baltimore City," said Donna Edwards, president of Local 112 of the American Federation of State, County and Municipal Employees, which represents the state's caseworkers. "Lots of them don't stay beyond the first year. They are all looking for other opportunities."
They often opt for less stressful positions with hospitals and nonprofit organizations, she said.
The agency has 130 supervisors, 31 short of meeting standards. Turnover among supervisors also has been "extremely high" in Baltimore, said Donald. "A lot of this work is judgment," she said. "You've got to have a supervisor help a worker think through the ramifications of the choices they make."
In Baltimore, the agency screens thousands of allegations of child abuse and neglect. During an eight-month period that began July 1, it investigated nearly 3,500 reports and found evidence to support the claims in 828, most involving neglect.
The inquiries are rarely clear-cut. Caseworkers have to determine the facts from people who may want to conceal them.
"People don't say, 'I'm so glad you are here. I'm a bad parent,'" said Linda Heisner, a consultant who is a former high-level Department of Human Resources administrator. "The first thing they say is, 'Who reported me?' The second is, 'I didn't do it.'"
Caseworkers often agonize over their decisions to keep a child with the parent, Heisner said. "They wonder, 'If I leave, is he going to be alive tomorrow?' There's not one worker who hasn't left a house praying, 'Please don't hurt your child tonight.'"
She and other advocates say many social workers do heroic work. "The public needs to understand that for the most part workers have a lot of success maintaining children safely in their home," said Heisner.
Most parents can handle their kids with the prodding and vigilance of a well-trained caseworker. The difficulty is deciding which parents are capable.
When reuniting children with their families, the agency requires a signed contract, outlining steps they must take such as attending parenting classes. But some advocates say the agency doesn't demand enough of some parents and fails to address fundamental stresses in dysfunctional families.
Linda Koban, an assistant director of Court Appointed Special Advocates of Baltimore, said of the system: "My impression has always been that they have a cookie-cutter approach. You go to parenting classes, drug treatment, whatever, and you get your kids back. But a parenting class is not going to teach you not to break a bone in a kid's arm."
Agency officials dispute the "cookie-cutter" criticism. Parenting classes, for example, can be effective if adults learn anger management techniques and disciplinary methods. They're also taught such basics as how to nourish, clothe and help their children develop.
Donald says she'd like to spend more of the department's $574 million child welfare budget trying to keep fragile families together by helping them get needed services such as child care or mental health counseling.
She noted that each child in out-of-home care - 6,000 at last count in either foster care or group homes - costs taxpayers between $10,000 and $70,000 a year.
"If we're able to divert them from coming in, we'll be able to use those dollars to support more services to families on the ground level," Donald said.
She proposed an "alternative response" program during the recent General Assembly session that, if approved, would have given her agency more flexibility to work with parents in less serious cases to keep children safely at home.
Her proposal was stymied by child advocates who said the administration had failed to properly fund the initiative. Donald said she will try again next year.
Opponents included lawyers who are skeptical of Donald's ability to reform an agency they believe has performed terribly for decades. The attorneys represent children in foster care and group homes in a class action suit that was filed in the 1980s and left the department bound by a consent decree. They want the court to appoint an independent monitor to oversee reform.
"They say Secretary Donald is taking care of it," said Mitchell Y. Mirviss, an attorney with Venable LLP and lead lawyer in the case. "The problem is we have a 20-year record of failure, and we have an agency that's hermetically sealed from public accountability because of confidentiality rules."
Chances missed to protect children
Children have been hurt or killed even after the Baltimore Department of Social Services had become involved with their families. Some examples:
Last summer, a mother was charged with assault for stabbing her daughter in the arm with shards of glass not long after the 16-year-old was returned to her from foster care. The Baltimore state's attorney's office has put the case on hold because the girl, who is the only witness, ran away.
In 2006, a woman injured her infant daughter, fracturing the baby's skull. She was found guilty of child abuse. She had earlier lost custody of an older daughter, who was burned.
In 2005, on New Year's Day, the parents of a 1-month old boy fatally beat him, inflicting injuries to his head and fractures and welts elsewhere on his body. The mother pleaded guilty to manslaughter and child abuse; the father was convicted of reckless endangerment.
In 2004, a baby girl was smothered by her mother to stop her crying. The woman was found guilty of murder.
[ Sources: Baltimore City Circuit Court, Baltimore City state's attorney's office, and a database compiled by Mike Himowitz, The Sun's medical, science and technology editor]
How to help
To report suspected child abuse or neglect in Baltimore, 24 hours, phone: (410) 361-2235.
For links to further information and for telephone numbers of other local offices of child protective services, go to http:--www.dhr.state.md.us/cps/address.htm.
To become a foster parent, call 1-888-MD-KIDS2.
To volunteer as a court-appointed special advocate for a child in foster care, call CASA Baltimore, 410-244-1465.