Parent Child Separation Trauma Memo

Trauma Caused by Separation of Children from Parents
A Tool to Help Lawyers
This tool was created by the Children’s Rights Litigation Committee of the American Bar
Association Section of Litigation. Thank you to everyone who contributed to this document
including DLA Piper LLP (US); Andrew Cohen, Dir. of Appellate Panel, Massachusetts
Committee for Public Counsel Services, Children & Family Law Division, and Aylin
Corapcioglu and Mariel Smith, Legal Interns, Massachusetts Committee for Public Counsel
Services, Children & Family Law Division; and Krista Ellis, former legal intern, American Bar
Association Center on Children and the Law
Information is up to date as of May 2019. To share information to be added to this tool or

provide feedback, please contact [email protected]
© 2019 American Bar Association. May be reproduced, displayed, and distributed with the following
credit: © 2018 American Bar Association. Reproduced with permission.
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. Nothing contained in this book is to be
considered as the rendering of legal advice for specific cases, and readers are responsible for obtaining such advice from their own legal
counsel.
As of January 2020
TABLE OF CONTENTS
PAGE
I. Executive Summary ............................................................................................................ 3

II. Talking Points for Trial and Appellate Lawyers................................................................. 4
III. Harm Resulting From Separation of Parent and Child ....................................................... 6
A. Introduction ............................................................................................................. 6
B. Scientific Research on the Effects of Removal From Parents Generally ............... 6
C. Relevant Case Law and Law Journal Articles ...................................................... 10
1. Case Law ................................................................................................... 10
2. Law Journal Articles and Related Materials ............................................. 13
D. The Effects of Removal Into Foster Care ............................................................. 18
IV. Resources For Parents and Children Facing Removal ...................................................... 25
A. Introduction ........................................................................................................... 25
B. Removal Resources Generally .............................................................................. 25
C. Kinship Placement ................................................................................................ 27
V. The Effects of Toxic Stress in Children ............................................................................ 29
A. Introduction ........................................................................................................... 29
B. Relevant Research ................................................................................................. 29
VI. Additional Resources ........................................................................................................ 32
2
As of January 2020 EAST\171419531.2
I. EXECUTIVE SUMMARY
This memorandum provides a summary of extensive research detailing the grave

consequences that result when a child is separated from his or her parent(s).
Part II sets forth talking points for use by trial and appellate lawyers during oral
argument. These talking points distill the key themes and conclusions of the clinical and legal
research set out in the balance of this memorandum.
Part III begins with a review of the clinical literature concerning the well-documented
psychological and physical effects of removal generally. These resources find that the negative
effects of removal often far outweigh the harm allegedly inflicted on the child by his or her
parent. Part III next reviews relevant case law and legal journal articles applying these clinical
findings in cases involving removal or attempted removal. Because one of the original driving
forces behind development of this memorandum was the federal government’s policy of
separating children from their parents at the border, the cases summarized in this memorandum
generally concern challenges to that policy. The courts rely heavily on literature from the
scientific and medical communities describing the negative effects of parent-child separation.
Part IV reviews literature discussing the effects of placement into foster care, which
concludes that those effects are negative and substantial. The memorandum then reviews
literature that may serve as a resource for parents facing a removal or who have already lost their
children. Some of this literature provides guidance on healthy and effective parenting strategies;
other literature addresses the potential benefits of post-removal visitation, mental health
counseling, and other social services. Though not particularly useful for a memorandum of law
in opposition to a removal petition, these resources may be helpful in counseling the client on
practical actions he or she might take to protect the relationship with his or her child.
Part V reviews literature regarding the physical effects of “toxic stress,” which is
prevalent among children who are removed from the parental home.
Finally, Part VI of the memorandum provides a listing of available additional resources

assessing the effects of removal, including studies on the outcomes for children removed from
the parental home and the long-term effects of the trauma that results from removal.
3
II. TALKING POINTS FOR TRIAL AND APPELLATE LAWYERS
Set forth below is a list of key talking points intended for potential use in oral argument
before a trial or appellate court to encourage the court to consider how separating children from
their family causes them significant trauma. Lawyers can use this research to encourage courts
to weigh the risks of remaining at home with the proven harm from separation from family.
• Although the courts, at the time of initial removal, must focus on harm, risk, and the best
interests of the child in the home, they cannot properly assess those factors without
considering the scientifically established damage caused by removal from primary
caretakers. (Gambril & Shlonsky 2001).
• Several cases, relying on the scientific research and expert testimony, acknowledge that
children’s physical and mental health are seriously damaged by separation from primary
caretakers. See, e.g., Ms. L. v. U.S. Immigration & Customs Enforcement, 310 F.Supp.
3d 1133, 1147 (S.D.Cal. 2018); Nolasco v. U.S. Immigration & Customs Enforcement,
319 F.Supp. 3d 491, 503 (D.D.C. 2018); M.G.U. v. Nielsen, 325 F.Supp. 3d 111, 122
(D.D.C.2018); Nicholson v. Williams, 203 F.Supp. 2d 153, 198-99 (E.D.N.Y. 2002).
A. Harm from Removal

Clinical research shows that:
o Children who are removed are “overwhelmed with feelings of abandonment,
rejection, worthlessness, guilt, and helplessness.” (Folman, 1998).
o Separation floods stress hormones throughout the child’s brain and body, leading to:
 difficulty sleeping, developmental regression, heart disease, hypertension, obesity,
diabetes, and decreased longevity. (Goydarzi 2018; Eck 2018; Carnes 2018)
 permanent architectural changes in the brain, including lower IQs. (Wan 2018)
 depression, more suicide attempts, and more problems with alcohol abuse and
gambling. (Wan 2018; Goydarzi 2018; Eck 2018; Carnes 2018).
o Children generally suffer worse outcomes when removed than if they had been
allowed to remain in marginal homes. In studies of similarly situated children (those
with social services involvement facing possible removal), children who were, in fact,
removed (compared to those remaining at home):
 have two to three times higher delinquency rates. (Ryan & Testa 2005; Doyle
2007; Doyle 2008; Lowenstein 2018)
 have higher teen birth rates. (Doyle 2007)
 have lower earnings as adults. (Doyle 2007)
 are two to three times more likely to enter the criminal justice system as adults.
(Doyle 2008)
 are twice as likely to have learning disabilities and developmental delays.
(Lowenstein 2018)
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 are six times more likely to have behavioral problems. (Lowenstein 2018)
 as adults, are more likely to have substance-related disorders, psychotic or bipolar
disorders, and depression and anxiety disorders. (Côté et al. 2018)
 as adults, have arrest rates two to three times higher, and are more likely to have
criminal convictions for violent offenses. (Doyle 2008; Côté et al. 2018)
o Studies of youth and children who have experienced maltreatment found that:
 maltreated youth who are placed in out-of-home care had a higher risk of criminal
behavior (as both juveniles or adults) compared to maltreated youth who remain
at home. (Yoon, Bender & Park 2018)
 children who experience out-of-home placement due to maltreatment have an
over 1.5 times higher risk of mortality between the ages of 20-56 compared to
children who experience maltreatment but remain at home. (Gao, Brannstrom &
Almquist 2017)
o Studies examining the outcomes for individuals placed in foster care as children
found that:
 more than half of the individuals in one of the studies had clinical levels of at least
one mental health problem, and 20% of the individuals in that study had three or
more mental health problems, both of which are substantially higher than those of
the general population in the same age range as the sample. (Northwest Foster
Care Alumni Study 2005)
 foster children have been shown to have higher rates of health problems than
other poor children receiving Medicaid. (Trivedi 2019)
 68% of the studied children had not been vaccinated for mumps; 36% had not
received vaccination for measles; and 23% had not received protection from
diphtheria, tetanus and pertussis. (Trivedi 2019)
 an estimated 12% received no routine healthcare, 34% received no
immunizations, and 32% had at least some identified health needs that were not
met. (Trivedi 2019)
 foster children experience poorer sexual health outcomes, engage in sexual
behavior at a younger age, and are more likely to engage in riskier sexual
behavior than their peers in the general population (Trivedi 2019)
 post-traumatic stress disorder (PTSD) rates for individuals in one of the studies
was up to twice as high as for U.S. war veterans. (Northwest Foster Care Alumni
Study 2005)
 completion rates for post-secondary education among foster care alumni were
dramatically lower than the general population. (Northwest Foster Care Alumni
Study 2005)
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III. HARM RESULTING FROM SEPARATION OF PARENT AND CHILD
A. Introduction
This section of the memorandum explores three areas of research concerning the harms
visited upon children as a result of forced removal from their parents. First, this section reviews
the scientific literature discussing the general effects of removal on the child. As these resources
indicate, the short- and long-term effects on the child’s mental and physical well-being are often
devastating. These effects include severe anxiety, depression, PTSD, and toxic stress (reviewed
separately in Part V below). Separation can also result in delays in cognitive development.
Further, the child may suffer physical harm that is manifested as a result of stress-induced
releases of hormones that impact brain and organ function. Second, this section summarizes key
court decisions and law journal articles that recognize the deleterious effects of parent-child
separation. With respect to the case law, this memorandum focuses principally on decisions
concerning the challenges to the government’s policy of parent-child separation at the border.
Those decisions recognize that even temporary separation can result in irreparable and grave
harm. The law journal articles similarly build on and adopt the findings of the scientific
community and advocate for the courts’ careful exercise of their discretion in child removal
cases. Third, and finally, this section analyzes research specifically addressing the negative
impact of placement into foster care and the negative effects associated with living in foster care.
B. Scientific Research on the Effects of Removal from Parents Generally
• Allison Eck, Psychological Damage Inflicted by Parent-Child Separation is Deep, Long-

Lasting, NOVA Next (June 20, 2018),
http://www.pbs.org/wgbh/nova/next/body/psychological-damage-inflicted-by-parent-
child-separation-is-deep-long-
lasting/?utm_source=FBPAGE&utm_medium=social&utm_term=20180620&utm_conte
nt=1603761016&linkId=53285432&utm_source=FBPAGE&utm_medium=social&utm_
term=20180623&utm_content=1608267756&linkId=53391996
In response to the separation of families at the border in 2018, this article explores
the harm that can result when a child is removed from his or her parents. Citing
statements released by the scientific community in response to current events, the article
focuses on the devastating effects for both child and parent. The article quotes Erin C.
Dunn, a social and psychiatric epidemiologist at Massachusetts General Hospital’s
Center, who states that, “The scientific evidence against separating children from families
is crystal clear,” and “[w]e all know it is bad for children to be separated from
caregivers.” The article details the harm that can result from the “monsoon of stress
hormones… flood[ing] the brain and body,” noting potential increased risks of
developing heart disease, diabetes, and even certain forms of cancer. Quoting Carmen
Rosa Norona, Child Trauma Clinical Services and Training Lead of Boston Medical
Center’s Child Witness to Violence Project, the article states that even when children are
in the care of parents who may not be able to meet their needs, they “still organize their
behaviors and thinking around these relationships and go to great lengths to maintain
them.”
6
• Sara Goydarzi, Separating Families May Cause Lifelong Health Damage, Scientific
American (June 2018), https://www.scientificamerican.com/article/separating-families-
may-cause-lifelong-health-damage/.
This article documents the potential long-term effects of family separation on
children. The article includes an interview with Alan Shapiro, Assistant Clinical
Professor of Pediatrics at Albert Einstein College of Medicine, in which he examines the
various acute and long-term harms caused by family separation. According to Shapiro,
separation can impact children in various ways, including developmental regression,
difficulty sleeping, depression, and acute stress. Dr. Shapiro also notes that “[t]he
younger you are when you’re exposed to stress . . . , the more likely you will have
negative health outcomes caused by dysregulation of stress response.” That dysregulated
stress response, in turn, “leads to architectural changes in the brain—which means that in
the future children might end up with serious learning, developmental and health
problems." Pointing to the results of a 17,000-patient study called Adverse Child
Experiences (“ACEs”), Dr. Shapiro further asserts that family separation may also lead to
long-term chronic medical conditions like cardiovascular disease, hypertension, obesity,
and decreased longevity.
• National Center for Missing & Exploited Children key facts (2017),
https://web.archive.org/web/20181016212108/http:/www.missingkids.org/KeyFacts.
Separating a child from their parents and putting them into the care of social
services can increase a child’s risk of becoming a runaway and a victim of child sex
trafficking. “Of the nearly 25,000 runaways reported to NCMEC in 2017, one in seven
were likely victims of child sex trafficking. Of those, 88 percent were in the care of social
services when they went missing.”
• Kimberly Howard et al., Early Mother-Child Separation, Parenting, and Child Well-
Being in Early Head Start Families, 13 Attachment & Human Development 5 (2009),
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115616/.
This study examines the impact of early mother-child separation on both maternal
parenting and later child development through the lens of attachment theory, which
generally posits “that caregivers must be present and accessible in order for their children
to become attached to them.” The study defines separation broadly as any separation
from the mother that lasts one week or more within the child’s first two years of life. The
study concludes that any such separation—even those occurring for innocuous reasons—
can “result in distress for a young child who lacks the cognitive abilities to understand the
continuity of maternal availability.” The study’s findings were based on observations of
2,080 predominantly poor families collected over a period of five years. Controlling for
baseline family characteristics and indicators of family instability, the study found that
the separation of mother and child was related to higher levels of child negativity toward
mothers (at age 3) and aggression (at ages 3 and 5).
• Marcia McNutt, Statement on Harmful Consequences of Separating Families at the U.S.

Border, National Academies of Sciences Engineering Medicine (June 20, 2018),
7
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=06202018&_ga
=2.2927672.960183307.1530129958-713614449.1530129958.
This statement deals primarily with the separation of immigrant families at the
border, but bases its conclusions on research concerning the effects of the removal of
children from their parents more generally. Relying on a comprehensive study by the
National Academies of Sciences, Engineering, and Medicine (“NASEM”), the statement
asserts that family separation “jeopardize[s] the short- and long-term health and well-
being of the children involved.” The statement further notes NASEM’s finding that in
light of the complex interactions among genetic, biological, psychological, and social
processes during child development, family disruption can “hinder health development
and increase[] the risk of future disorders.”
This statement points the reader in the direction of several key resources:
1. NASEM, Parenting Matters: Supporting Parents of Children Ages 0-8 (2016),
https://www.nap.edu/read/21868/chapter/2
2. Nat’l Res. Council & Inst. of Med., Preventing Mental Emotional, and Behavior
Disorders Among Young People: Progress and Possibilities, Ch. 4 (2009),
https://www.nap.edu/read/12480/chapter/7#74
3. Nat’l Res. Council & Inst. of Med., From Neurons to Neighborhoods: The
Science of Early Childhood Development, Ch. 20 (2000),
https://www.nap.edu/read/9824/chapter/20#387
4. Inst. of Med., Reducing Suicide: A National Imperative, Exec. Summ. (2002),

https://www.nap.edu/read/10398/chapter/2
• NOVA PBS Official, Inside the Brains of Children Separated from Parents, YouTube
(June 25, 2018), https://www.youtube.com/watch?v=bwpcn8sRtqg&feature=youtu.be.
This short informational film provides a summary of the neurological processes
that occur when a child is separated from her parents. Through visual aids, the film
demonstrates how stress from separation can impact a child’s brain within the first few
minutes of removal. According to psychologists Karlen Lyons-Ruth and Robin Deutsch,
even very brief separations are stressful for infants and young children because cortisol (a
stress hormone) floods the brain and begins to damage brain cells. Additionally, the over-
activation of the amygdala, the portion of the brain responsible for fight-or-flight
instincts, can compromise the child’s ability to evaluate risks and make good decisions.
The ability to form an attachment with a reliable and consistent caregiver is fundamental
to a child’s cognitive and social development. Time is very important when dealing with
young children because deterioration of this attachment can take place very quickly; even
a few weeks away from a parent is an enormous amount of time for an infant.
• William Wan, What Separation from Parents Does to Children: ‘The Effect is
Catastrophic’, Washington Post (June 18, 2018),
https://www.washingtonpost.com/national/health-science/what-separation-from-parents-
8
does-to-children-the-effect-is-catastrophic/2018/06/18/c00c30ec-732c-11e8-805c-
4b67019fcfe4_story.html?noredirect=on&utm_term=.cf5ca597dc72
This article discusses generally the research on child-parent separation that “is
driving pediatricians, psychologists, and other health experts to vehemently oppose the
Trump administration’s new border crossing policy.” The cross-cultural research
presented provides insight into the physical and psychological impact of child-parent
separation in a wide range of circumstances. Of particular interest is the discussion of
Charles Nelson’s research, which studied the neurological development of children in
Romanian orphanages.
A pediatrics professor at Harvard Medical School, Nelson found that the children
“separated from their parents at a young age had much less white matter, which is largely
made up of fibers that transmit information throughout the brain, as well as much less
gray matter, which contains brain-cell bodies that process information and solve
problems.” Nelson also noted that children who were separated from their parents within
the first two years of their life scored significantly lower on IQ tests later in life and their
fight-or-flight response system appeared “permanently broken.” The article also
references research on aboriginal children removed from their parents in Australia who,
when compared to children who remained with their parents, were “nearly twice as likely
to be arrested or criminally charged as adults, 60 percent more likely to have alcohol-
abuse problems, and more than twice as likely to struggle with gambling.” As the article
notes, it is the duration of this damage that is the most troubling aspect of separating
parents and children: “Unlike other parts of the body, most cells in the brain cannot
renew or repair themselves.”
• The Science of Childhood Trauma and Family Separation: A Discussion of Short – and
Long-Term Effects, Cynthia García Coll, Ph.D; Gabriela Livas Stein, Ph.D; Nim
Tottenham, Ph.D; D, Youtube (June 28, 2018) https://www.youtube.com/watch?v=9-
34LJoM1HY&t=3s
This webinar focuses primarily on the issue of separation in the immigration
context, but also generally discusses the impact of separation on children. Of particular
relevance here, Dr. Nim Tottenham details the neuroscientific tools used to show the
changes that occur when children experience trauma. She explains that when humans, as
a species, experience a major threat to survival, “we activate threat systems in our
bodies” like the amygdala. She elaborates, noting “when we keep activating stress
hormones and circuits, it is harder and harder to shut them off – particularly for children.”
Dr. Tottenham also posits that as a species, we are conditioned to expect parental
buffering to take care of our needs. Thus, children who have experienced trauma need
immediate remediation. But for traumatized children who have been separated from their
parents, the major stress buffering system is removed at the very time when it is needed
most—i.e., while the brain is undergoing a period of serious development.
This Webinar also discusses the long-term distress created by separation even
after families are reunited. There is tremendous injury inflicted upon the family unit and
parents. For both parents and children, separation leads to increased risks of depression,
difficulty with social functioning, attachment issues, and PTSD.
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• Stephanie Carnes, The Trauma of Family Separation Will Haunt Children for Decades,
HUFFINGTON POST, June 22, 2018, (https://www.huffingtonpost.com/entry/opinion-
carnes-family-separation-trauma_us_5b2bf535e4b00295f15a96b2).
Exposure to trauma in childhood can both stunt cognitive development and alter
the structure of a young brain in profound ways. Thanks to the groundbreaking Adverse
Childhood Experiences Study, conducted by Kaiser Permanente and the Centers for
Disease Control and Prevention, we know that exposure to traumatic events in childhood
is strongly correlated with increased risk of suicide attempts, drug addiction, depression,
chronic obstructive pulmonary disease, heart disease and liver disease. More detailed
information about the study can be found in “Relationship of Childhood Abuse and
Household Dysfunction to Many of the Leading Causes of Death in Adults,” published in
the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.
• J. Goldstein, A. Freud, & A. Solnit, Beyond the Best Interests of the Child (1973).
https://www.jstor.org/stable/1121526?seq=1#page_scan_tab_contents
This book is cited frequently in law review articles and appears to be a leading
authority on the potential harms associated with removal of a child from the parental
home. A full version of the book does not appear to be available online for free, though it
is available on Amazon for around $15.
C. Relevant Case Law and Law Journal Articles
1. Case Law
• Ms. L. v. U.S. Immigration & Customs Enforcement, 310 F. Supp. 3d 1133

(S.D. Cal. 2018)
In a decision entering a preliminary class-wide injunction with respect to ICE’s

practice of separating the minor children of parents detained for illegally crossing the
border, the court discussed the harms associated with forced parent-child separations in
considerable detail. Drawing from an amicus brief submitted by the Children’s Defense
Fund, the court posited that “there is ample evidence that separating children from their
mothers or fathers leads to serious, negative consequences to children’s health and
development.” 1 Id. at 1146. The disruption that forced separations “put[] children at
increased risk for both physical and mental illness . . . . And the psychological distress,
anxiety, and depression associated with separation from a parent would follow the
children well after the immediate period of separation—even after eventual reunification
with a parent or other family.” Id. at 1147. The court pointed to other evidence
establishing “that separating children from parents is a highly destabilizing, traumatic
experience that has long term consequences on child well-being, safety, and
development.” Id. The court continued:
1
The amicus brief contains a wealth of information and cites to a number of helpful resources. It is discussed
immediately below.
10
Separation from family leaves children more vulnerable to exploitation and abuse,
no matter what the care setting. In addition, traumatic separation from parents
creates toxic stress in children and adolescents that can profoundly impact their
development. Strong scientific evidence shows that toxic stress disrupts the
development of brain architecture and other organ systems, and increases the risk
for stress-related disease and cognitive impairment well into adult years. Studies
have shown that children who experience such traumatic events can suffer from
symptoms of anxiety and PTSD, have poorer behavioral and educational
outcomes, and experience higher rates of poverty and food insecurity.
Id. The court determined that the evidence “conclusively shows that Plaintiffs and the
class members are likely to suffer irreparable injury if a preliminary injunction does not
issue.”
o Children’s Defense Fund – Amicus Brief

The amicus brief referenced above is packed with information regarding the
effects of child separation. The brief also includes a compilation of the laws in
every state governing the circumstances under which a child may be separated
from his or her parents. The brief asserts that those laws “reflect the universal
belief that a child should remain with her parent unless doing so would be
severely detrimental to the child’s welfare, and, even then, separation should be a
last resort. Id. at 7. Further, the brief points to the standards espoused by the
Council on Accreditation, an international human service accrediting
organization, affirming that “it is in a child’s best interest to remain with her
parent whenever possible.” Id. at 9-10.
• Jacinto-Castanon de Nolasco v. U.S. Immigration & Customs Enforcement, 319 F. Supp.

3d 491 (D.D.C. 2018)
In this case, the court also recognized “the profound and long-term consequences
that separation can have on a child’s well-being.” Id. at 503. Relying on the same
authority as the Ms. L. court, the court noted the American Academy of Pediatrics’
research indicating that “[t]he psychological distress, anxiety, and depression associated
with separation from a parent would follow the children well after the immediate period
of separation – even after the eventual reunification with a parent or other family.” Id.
The effects of separation can be so extreme in some circumstances that the “children may
experience high rates of PTSD, anxiety, depression, and suicidal ideation, in addition to
developmental delays or poor psychological adjustment.” Id. The court accordingly
concluded that the plaintiffs had established that they would suffer irreparable harm
absent an injunction. Id.
• M.G.U. v. Nielsen, 325 F. Supp. 3d 111 (D.D.C. 2018)
The same court relied on essentially the same medical findings,

emphasizing that separation may result in “toxic stress, a form of extreme and
repetitive stress that adversely affects brain development,” a concept discussed
11
more fully below, and that the effects can be devastating and long lasting. Id. at
122.
• Nicholson v. Williams, 203 F. Supp. 2d 153 (E.D.N.Y. 2002) (subsequent history before
Second Circuit and N.Y. Court of Appeals follows).
This was an action brought by mothers individually and on behalf of their
children in which the mothers alleged that they were separated from their children
because the New York City Administration for Child Services (“ACS”) determined that
the children had been neglected solely due to their observance of domestic violence
against their mothers. The plaintiffs alleged that these separations violated both the
substantive due process rights of mothers and children and their procedural due process
rights. In considering the plaintiffs’ claims, the court relied in part on expert testimony
regarding the harm that occurs as a result of child-parent separation. Noting that
“attachment between parent and child forms the basis of who we are as humans” and that
the continuity of “that attachment is essential to a child’s natural development,” 203 F.
Supp. 2d at 198-99, plaintiffs’ experts testified that removal of children from parents
results in:
o fear and anxiety;

o diminished sense of stability and self;
o despair accompanied by hyper-vigilant looking, waiting, and hoping for parents’
return; and
o heightened sense of self-blame.
Id. at 199. The experts also noted that “another serious implication of removal is that it
introduces children to the foster system which can be much more dangerous and
debilitating than the home situation.” Such dangers include:
o risk of additional exposure to domestic violence;

o increased risk of abuse and child fatality;
o lack of adequate medical care; and
o disruption of contact with community, school, and siblings.
• Nicholson v. Scoppetta, 344 F.3d 154 (2d Cir. 2003).

On appeal, the Second Circuit held that the District Court had not abused its
discretion in concluding that, in some instances, removals based solely on the child’s
exposure to domestic violence suffered by mother may raise serious questions of federal
constitutional law. However, given the strong preference for avoiding unnecessary
constitutional adjudication, the Second Circuit certified the matter to the Court of
Appeals of New York to be resolved under state statutory law.
• Nicholson v. Scoppetta, 3 N.Y.3d 357 (2004).
The New York Court of Appeals held that far more was required to find neglect
and justify the removal than a showing that the parent had been a victim of domestic
12
violence. According to the Court, the plain language of the statute and its legislative
history demonstrate that “a blanket presumption favoring removal was never intended.”
Rather, it concluded, “a court must weigh, in the factual setting before it, whether the
imminent risk to the child can be mitigated by reasonable efforts to avoid removal” and it
“must balance that risk against the harm removal may bring” to determine factually
which course is in the child’s best interests. Id. at 378. For New York-specific cases, the
cases applying this standard will be particularly relevant. Because this memorandum is
focused on identifying relevant authority discussing the general harms associated with
removal, those cases are not discussed here.
2. Law Journal Articles and Related Materials
• Shanta Trivedi, The Harm of Child Removal, 43 New York University Review of Law &
Social Change 523 (2019),
https://scholarworks.law.ubalt.edu/cgi/viewcontent.cgi?article=2087&context=all_fac.
This article explores how the child welfare system’s goal of protecting children
would be better served if all involved parties utilized information about the harm of
removal when making decisions. Trivedi notes that this includes passing legislation,
allocating funding, considering removals, and lawyers advocating for clients in an effort
to keep their families together. Id. At 526. Trivedi argues that all potential harms of
removal should be considered and weighed against the risks of remaining in the home
before deciding whether removal is in the child' best interest. Id. The article considers
harm caused by parent/child separation (including anxiety and attachment disorders), the
trauma of actually being removed from the home, the grief and confusion surrounding
removal and “the unstable nature and high rates of abuse in the foster system.” Id. at 523
Trivedi notes that removing “minority children from their communities inflicts additional
distinct trauma…” as removal affects “their sense of identity and cultural belonging.” Id.
at 540
The Adoption and Safe Families Act of 1977 (“ASFA”) based removal decisions
on “the child’s health and safety” being “the paramount concern.” However, this
requirement, along with coinciding societal factors, lead to an increase in removal rates.
Trivedi focuses on the ineffectiveness of the ASFA’s undefined requirement that
“reasonable efforts” be made before children are removed. While Trivedi agrees
“reasonable efforts should be required in all cases,” only a few states have offered
guidance on the language. Id. 558 Most jurisdictions do not require courts to consider the
harm of removing a child from home when deciding whether to do so. New Mexico is the
only state that “identifies the harm of removal as a specific factor in the reasonable
efforts inquiry.” New York and the District of Columbia are the only jurisdictions that
overtly require government officials to consider the harm of removal in their substantive
removal statutes.” The District of Columbia affirmatively requires such consideration in
its substantive removal statute. Id. 566-567 According to Trivedi, existing laws can be
improved (for instance, a “statute that simply codifies New York’s case law”) and
reforms can be implemented within the existing child welfare framework at state and
federal levels to better protect children from harm.
13
• Vivek Sankaran, Easy Come, Easy Go: The Plight of Children Who Spend Less Than 30
Days in Foster Care, 19 U. Pa. J. L. & Soc. Change 207-37 (2016),
https://repository.law.umich.edu/cgi/viewcontent.cgi?article=2850&context=artiles.
In this article, Sankaran explores the plight of “short stayers,” children who spend
less than 30 days in the foster care system. According to Sankaran, “removing children—
even abused and neglected children—from the custody of their parents harms them
emotionally, developmentally, and socially.” Citing the work of Joseph Doyle, Sankaran
calls attention to the increased severity and frequency of these problems for children
removed to foster care compared to similar children who have remained in the home.
Presenting a more “child-centered narrative,” he calls for the harm caused by removal to
be balanced with the other factors traditionally considered by the courts (e.g., the interests
of parents and child welfare agencies). Ultimately, Sankaran argues that “juvenile courts
are failing to use two tools—the federal reasonable efforts requirement and the early
appointment of parents’ counsel—to prevent the unnecessary entry of children into foster
care.” According to Sankaran, the federal government “must acknowledge the problem of
short stayers by utilizing data related to children who may unnecessarily enter foster care
in the Child and Family Services Review, the accountability process used to assess state
compliance with federal child welfare requirements.”
• Vivek Sankaran, Christopher Church & Monique Mitchell, A Cure Worse than the
Disease? The Impact on Children and Their Families, 102 Marq. L. Rev. 1163 (2019)
This article focuses on how parents and children interacting with the child welfare
system experience the removal process and analyzes the gaps and emergent issues in
practice, research, and policy related to child removal. The article establishes the case for
why child welfare professionals should be alarmed about the process by which children are
removed from their parents and placed in foster care, details the profound trauma removal
inflicts on children and their parents and haphazard nature of the removal process,
revealing the fact that far too many children are likely unnecessarily removed from their
parents. The article concludes with specific policy and practice recommendations aimed at
curbing child welfare's reliance on removal to foster care as its predominant safety
intervention such as requiring a timely emergency hearing following an emergency
removal to evaluate such removal and narrowing the parties that can remove children from
their parents without a court order.
• David Pimentel, Protecting the Free-Range Kid: Recalibrating Parents’ Rights and the
Best Interest of the Child, 38 Cardozo L. Rev. 1 (2016)
Focusing more on the impact on the parents’ rights as a result of temporary
removal and the importance of legal representation of the parents from the beginning,
Pimentel argues that “even a temporary removal is an enormous imposition on parents’
constitutionally protected interests . . . .” Id. at 52. Noting that “[o]nce removed, it can
be very difficult to obtain the return of the children to their parents,” he concludes that
14
“parents’ rights to the care, custody, and control of their children can be meaningfully
protected only if the parents can keep custody of their kids from the outset.” Id. at 52-53.
• Developing a Trauma-Informed Child Welfare System, Children’s Bureau (May 2015),

https://www.childwelfare.gov/pubPDFs/trauma_informed.pdf
This brief discusses “the steps that may be necessary to create a child welfare
system that is more sensitive and responsive to trauma.” According to the National Child
Traumatic Stress Network, a trauma-informed system “is one in which all parties
involved recognize and respond to the impact of traumatic stress on those who have
contact with the system, including children, caregivers, and service providers.” Trauma-
informed practices, the brief argues, are better able to address children’s safety,
permanency, and well-being needs. The brief provides an overview of trauma and its
effects and then focuses on the primary areas of consideration in the child welfare process
(workforce development, screening and assessment, data systems, evidence-based and
evidence-informed treatments, and funding).
• Rebecca Bonagura, Redefining the Baseline: Reasonable Efforts, Family Preservation,

and Parenting Foster Children in New York, 18 Colum. J. Gender & L. 175 (2008)
Bonagura asserts that “[r]emoval and placement in foster care may have a worse
impact on the child than neglect . . . . Just as neglect can contribute to cognitive, social,
and emotional problems, removal may also cause emotional problems by disrupting a
child’s ability to bond with his or her caregiver.” Id. at 196.
• Theo Liebmann, What’s Missing from Foster Care Reform?: The Need for
Comprehensive, Realistic, and Compassionate Removal Standards, 28 Hamline J. Pub. L.
& Pol’y 141 (2006).
Liebmann argues that in order to protect children from the perils of the foster care
system, “we must examine the outdated and short-sighted standards nearly every state
currently uses to justify initially removing children from their parents.” Liebmann
contends that the exclusive focus on the harm caused by parents fails to acknowledge that
placement in foster care, even temporarily, poses a risk of harm to children. Specifically,
Liebmann highlights data regarding the poor outcomes for many foster children with
respect to education and financial well-being as well as mental, emotional, and physical
harm (e.g., separation anxiety, depression). According to Liebmann, applying Grambrill
and Shlonsky’s comprehensive risk assessment analysis (see annotation above) to the
legal process “would add a critical second step to judicial determinations at temporary
removal hearings and offer a whole new level of protection to the children at issue.”
Under this assessment, in order to determine placement of the child, the judge would
weigh the risks of remaining in the home against the risks of harm to the child if she were
removed from the home, and select the least detrimental alternative.
• Sonja Starr & Lea Brilmayer, Family Separation as a Violation of International Law, 21
Berkeley J. Int’l L. 213 (2003)
15
Though addressed in the context of international law, the authors recognize that
“[c]hild removals are frequently traumatic for all concerned.” Id. at 272. The authors
specifically address temporary removals, emphasizing that they “may cause lasting harm
to the children and to the stability of the family relationship . . . .” Id. They go on to
criticize the “too-hasty resort to removal any time a child’s well-being is at all in doubt—
a practice that, indeed, is the official policy of many child protective services agencies.”
Id.
• Andrea Charlow, Race, Poverty, and Neglect, 28 Wm. Mitchell L. Rev. 763 (2001)
Discussing the adverse effects of removal on children, Charlow notes that
“[c]hildren in foster care exhibit high rates of emotional, behavioral and developmental
problems.” Id. at 782. She ties into this concept attachment theory’s (discussed supra at
p. 1) recognition of “the need for children to bond with their adult care-givers in order
them to develop self-esteem.” Id. Charlow concludes that “the negative effect of
removal likely outweighs any intellectual impairment that may have been caused by
neglect.” Id. at 783.
• Eileen Gambrill & Aron Shlonsky, Need for Comprehensive Risk Management Systems
in Child Welfare, 23 Child & Youth Servs. Rev. 79 (2001).
This article advocates for the use of a more “comprehensive risk assessment”
analysis by child welfare professionals prior to removal. While this study is targeted
specifically at social workers and child welfare professionals, it provides insight into the
various factors that should be balanced in determining whether removal is in the best
interest of the child. The study suggests that the current focus on the harm posed by
parents “ignores a host of other factors that may influence risk to children.” Instead, the
study calls for an assessment that extends beyond the posed threat to children by their
parents to include risks presented by foster parents, child welfare staff, and service
providers and agency procedures. The study concludes, “[i]f we are concerned about risk
to children, we should make efforts to identify and minimize all sources of risk.”
• Joseph Goldstein et al., Best Interests of the Child: The Least Detrimental Alternative
(1996).
This book explores the principles that should guide courts in determining the fate
of children involved in child welfare proceedings. The book presents a child-centric
approach to child welfare and calls upon readers to “‘put [themselves] in a child’s skin’--
the infant, the toddler, the preschooler, the schoolchild, or the teenager—as you consider
what ought to be the guiding principles.” According to the authors, the “least detrimental
alternative” in such cases is the continuity of the child’s relationship with his or her
caregiver. The book provides various guiding questions for the “professional participant
in the child placement process” (e.g., judges, lawyers, social workers, psychiatrists, other
experts) in an effort to recognize the “boundaries of their knowledge and of their
authority to act, the boundaries between their personal and professional beliefs, and the
boundaries between the profession and parental roles.” Of particular interest is the
emphasis on the time period sufficient to disrupt the psychological child-parent
relationship. Noting the unique temporal abilities of young children, the authors contend
16
that “[f]or children under the age of five years, an absence of parents for more than two
months is intolerable.” For younger school-age children, an absence of six months or
more may be similarly detrimental.
• Joseph Goldstein, Medical Care for the Child at Risk: On State Supervention of Parental
Autonomy, 86 Yale L.J. 645 (1977)
This article explores the importance of the rights to parental autonomy and family
privacy, and “the reciprocal liberty interest of parent and child in the familial bond
between them, noting that they require “no greater justification than that they comport
with each state’s fundamental constitutional commitment to individual freedom and
human dignity.” Id. at 649. Goldstein further advocates “for a policy of minimum state
intervention” into the parent-child relationship because of the law’s inability “to deal on
an individual basis with the consequences of its decisions or to act with the deliberate
speed required by a child’s sense of time and essential his well-being.” Id. at 650.
Moreover, the fact that parents are imperfect and may sometimes take actions against
their child’s interests does not justify greater intervention—it justifies less. Id. Indeed,
there is no evidence “that the state necessarily can or will do better.” Id. at 650-51.
• Michael S. Wald, State Intervention on Behalf of “Neglected” Children: Standards for

Removal of Children From Their Homes, Monitoring the Status of Children in Foster
Care, and Termination of Parental Rights, 28 Stan. L. Rev. 623 (1976)
Among other things, this article walks through the harms associated with removal
from the family home. Wald argues that “there is substantial evidence that coercive
intervention often is harmful, not benevolent, to both children and parents. Because
children are strongly attached to their parents, even ‘bad’ parents, intervention that
disrupts the parent-child relationship can be extremely damaging to the child.” Id. at
639-40. For that reason, he argues that the courts’ discretion to decide removal issues
should be strictly limited “by defining in advance those harms justifying intervention and
the steps that may be taken to alleviate the harm . . . .” Id. at 640.
• Michael Wald, State Intervention on Behalf of “Neglected” Children: A Search for

Realistic Standards, 27 Stan. L. Rev. 985 (1975)
Wald advances similar arguments to those he advanced in the article immediately
above. He notes that “[i]t is well recognized by psychiatrists that ‘so far as the child’s
emotions are concerned, interference with [parental] tie[s], whether to a ‘fit’ or ‘unfit’
psychological parent, is extremely painful.’” Id. at 993-94 (quoting J. Goldstein, A.
Freud, & A. Solnit, Beyond the Best Interests of the Child 20 (1973)). For that reason,
“[r]emoving a child from his family may cause serious psychological damage—damage
more serious than the harm intervention is supposed to prevent.” Id. at 994. And even
after the child is placed in a foster home—and the initial damage already done—the child
is “frequently subjected to numerous moves, each destroying the continuity and stability
needed to help a child achieve stable emotional development.” Id. That conclusion
segues neatly into the next topic, which concerns the adverse effects often associated with
a child’s removal into foster care.
17
D. The Effects of Removal into Foster Care
• Laura Bauer and Judy L. Thomas, Throwaway Kids, The Kansas City Star (2019)
https://www.kansascity.com/news/special-reports/article238206754.html
This six-part investigative series examine the outcomes for children taken into
foster care. The series looked at a variety of outcomes, including educational outcomes
and rates of homelessness, and found that the United States sends more foster children to
prison than to college. The series also examined the research illustrating how frequent
moves in foster care impact the brain. Articles contain interviews with former foster
youth and a series of videos.
• Joseph J. Doyle, Jr., Child Protection and Child Outcomes: Measuring the Effects of
Foster Care, 97 Am. Econ. Rev. 1583 (2007).
Examining removal decisions that were “on the margins,” this study found that
children who remained at home had better long-term well-being outcomes than children
who were removed and placed in foster care. The study tracked at least 15,000 children
between 1990 and 2002 and in order to avoid results attributable to family background,
extreme cases of abuse or neglect were screened out and instead, “on the margins” cases
were used. The study defines “on the margins” decisions as instances where there was
disagreement by child protection investigators as to whether removal was necessary. By
using the removal tendencies of investigators as an instrumental-variable (i.e., a variable
that induces change in the explanatory variable but has no effect on the dependent
variable), the study identifies the effects of foster care placement on child outcomes for
school-aged children.
This study provided the first “viable, empirical evidence of the benefits of keeping kids
with their families,” and “confirms what experience and observation tell us: Kids who
can remain in their homes do better than in foster care.” (quote from
http://usatoday30.usatoday.com/news/nation/2007-07-02-foster-study_N.htm).
Ultimately, the study found higher delinquency rates, higher teen birth rates, and lower
earnings among children removed to foster care as compared to similarly situated
children who remained at home.
• Joseph J. Doyle, Jr., Child Protection and Adult Crime: Using Investigator Assignment to
Estimate Causal Effects of Foster Care, 116 J. of Political Econ. 4 (2008),
http://www.mit.edu/~jjdoyle/doyle_jpe_aug08.pdf
Using the assumption that child protection cases are effectively randomized to
investigators, this follow-up study explores an additional outcome: adult crime.
According to the study, children “on the margins” of placement in foster care who are
subsequently placed demonstrate “arrest propensities that are two to three times higher
compared to investigated children who remained with their parents.” Moreover, this
study importantly notes that while the “removal from abusive parents may protect
children from further abuse and reduce the likelihood of criminal activity as adults,” at
18
the same time, “the removal of children from their parents is thought to be traumatic and
may lead to worse adult outcomes” (emphasis added). This study also notes that “[i]n
terms of criminal justice involvement, nearly 20 percent of the U.S. prison population
under the age of 30, and 25 percent of these prisoners with prior convictions, report
spending part of their youth in foster care.”
• Joseph J. Doyle, Jr., Causal Effects of Foster Care: An Instrumental-Variables Approach,

35 Child. & Youth Servs. Rev. 1143 (2013).
This follow-up study uses instrumental-variables to estimate the causal effects of
foster care on short- and long-term outcomes. Again examining children “on the
margins,” the study focuses on two outcomes: juvenile delinquency later in life, and
emergency healthcare usage in the year following a report of abuse. According to the
study, “placing children in foster care increases their likelihood of becoming delinquent
during adolescence and requiring emergency healthcare in the short term.”
• Lowenstein, Kate. Shutting Down the Trauma to Prison Pipeline Early, Appropriate Care
for Child-Welfare Involved Youth, 2018. Citizens for Juvenile Justice,
https://static1.squarespace.com/static/58ea378e414fb5fae5ba06c7/t/5b47615e6d2a73314
1a2d965/1531404642856/FINAL+TraumaToPrisonReport.pdf
This project explores the number of children entering the foster care system and
the resulting foster-care-to-prison pipeline in Massachusetts. The project found that
children placed in foster care are three times more likely than similarly situated children
who remained with their families to be juvenile justice-involved. Additionally, national
and Massachusetts data show that “placement instability—when a child is moved through
multiple out-of-home placements—is a key risk factor for later juvenile justice system
involvement.” The project also discusses a survey of the sources of PTSD among foster
care alumni, which revealed that “many of the alumni identified the initial home removal
itself as a trauma and also considered being returned home as an additional “placement”
as it involved having to re-create relationships.” Finally, this project also provided that
behavioral problems were “six times more likely among children who spent time in foster
care” and that foster youth have a “three times greater risk for ADHD diagnosis, and are
twice as likely to have learning disabilities and developmental delays than children not in
foster care.”
The project then provides various recommendations in response to the numerous
detrimental effects of foster care previously discussed, namely:
1) Invest in promising practices and program models to prevent child removal and
safely promote family stabilization. DCF’s services budget under invests in in-
home and reunification services. The Federal Family First Act presents an
opportunity for additional funding to safely prevent out-of-home removals.
2) Recent research found that opioid-dependent newborns who remain with their
moms have fewer hospital stays (4-5 days compared to 22-23 days) and fewer
infants needed medication assisted withdrawal treatment (14% compared to 98%).
19
Parent’s service plans, however, may conflict with this promising clinical
treatment unless service plans begin to adapt to evolving yet proven science.
3) Early recognition of behavioral problems stemming from exposure to trauma
should result in an investment in interventions that promote positive youth
development, to better prevent the intensification of the problems and the poor
outcomes associated with them. Early efforts to develop a child’s skills, self-
esteem, and positive investments in their futures include consistent involvement
with positive, trusted adults and with positive pro-social community activities.
• Rosalind D. Folman, “I Was Tooken”: How Children Experience Removal from Their
Parents Preliminary to Placement in Foster Care, 2 Adoption Quarterly 2 (1998).
This paper presents the results of a qualitative study of the removal experiences of
90 inner-city children (aged 8-14) who entered foster care in middle childhood due to
abuse and/or neglect. Using attachment theory to interpret the children’s narratives, the
paper demonstrates a “progression of traumatizing events ensuing from the placement
process.” The paper focuses only on the “crisis period” of the fostering process—i.e.,
“the day the child is initially removed from his/her parents.” According to the paper,
separation from a caregiver “is severely threatening for the child, irrespective of the
quality of the child’s experience with the parent.” As a result, the day of placement
“constitutes a crisis for children because everything in their lives changes and the
children are overwhelmed with feelings of abandonment, rejection, worthlessness, guilt,
and helplessness.” The findings suggest that these feelings were intertwined with an
overwhelming sense of loss. Recalling the day of his removal, one child stated: “I thought
that they [the police officer] was gonna take me to where they lived. Bein in a
policeman’s house would be fun, but not fun without being with my parents cause I love
em.” When asked where he thought he was going, another child simply responded:
“Away from my mother… I was going to leave my mother for good.”
• Catherine R. Lawrence et al., Impact of Foster Care on Development, 18 Dev. &

Psychopathology 57 (2006).
This study examines that relationship between foster care placement and the
development of behavioral problems. The study followed 189 children and families at
risk because of poverty and associated factors. Comparisons were made among three
groups: (1) children who experienced foster care; (2) children who were maltreated but
remained in the home; and (3) children who had not experienced foster care or
maltreatment despite similar at-risk demographic characteristics. The impact of foster
placement was evaluated immediately following release from care and at several points
later in development. Controlling for developmental adaptation and social economic
status prior to placement, “the results support a general view that foster care may lead to
an increase in behavior problems that continue after exiting the system” (71). The study
highlights several factors that may account for the increase in problematic behavior,
including foster care as an intervention that can expose its recipients to difficult
developmental challenges and the lack of comprehensive psychological services offered
to foster children.
20
• Joseph P. Ryan & Mark F. Testa, Child Maltreatment and Juvenile Delinquency:
Investigating the Role of Placement and Placement Instability, 27 Child. & Youth Servs.
Rev. 227 (2005), https://www-sciencedirect-
com.ezproxy.bu.edu/science/article/pii/S0190740904002026
This study explores the correlation between the increased risk of maltreated
children engaging in delinquent behavior and the use of substitute care placement and
placement instability. While removing children from high-risk environments should
decrease the risk of delinquency, the study concluded that “children in placement are
more likely to be delinquent.” According to the study, “16% of children placed into
substitute care experience at least one delinquency petition compared to 7% of all
maltreatment victims who are not removed from their family.” One possible explanation
for this increase in deviant behavior, the study argues, is that “multiple placements after
substitute care further depletes a child’s stock of social capital, which weakens social
attachments and social controls.”
• Côté SM, Orri M, Marttila M, Ristikari T. Out-of-home placement in early childhood and
psychiatric diagnoses and criminal convictions in young adulthood: a population-based
propensity score-matched study. Lancet Child Adolesc Health 2018; published online
July 25. https://www.researchgate.net/profile/Sylvana_Cote/publication/326652825_Out-
of-
home_placement_in_early_childhood_and_psychiatric_diagnoses_and_criminal_convicti
ons_in_young_adulthood_a_population-based_propensity_score-
matched_study/links/5b75d16a45851546c90a380b/Out-of-home-placement-in-early-
childhood-and-psychiatric-diagnoses-and-criminal-convictions-in-young-adulthood-a-
population-based-propensity-score-matched-study.pdf
Researchers conducted a population-wide longitudinal study using the 1987

Finnish Birth Cohort, which collects data from child welfare, medical, and criminal
registers for those born in Finland in 1987. The study aimed to “compare the rates
of psychiatric diagnoses and criminal convictions in young adulthood (ages 18–25 years)
among children who were first placed at ages 2–6 years with those of children who were
not placed and who had similar sociodemographic and family characteristics.”
Using this novel propensity score matching approach, the findings of study
showed:
Of 54,814 individuals included in analyses, 388 (1%) were placed out of home at
ages 2 to 6 years, for whom 386 were assigned matched controls. At ages 18 to 25
years, those who had been placed out of home had a greater risk compared with
never-placed controls for substance-related disorders (odds ratio [OR], 2.10; 95%
CI, 1.27-3.48), psychotic or bipolar disorders (OR, 3.98; 95% CI, 1.80-8.80),
depression and anxiety disorders (OR, 2.15; 95% CI, 1.46-3.18),
neurodevelopmental disorders (OR, 3.59; 95% CI, 1.17-11.02), or other mental
disorders (OR, 2.06; 95% CI, 1.25-3.39). Additionally, those who had been placed
as children were more likely to use psychotropic medication (OR, 1.96, 95% CI,
21
1.38-2.80) and to have higher rates of criminal convictions for violent (OR, 2.43;
95% CI, 1.61-3.68) and property (OR, 1.86; 95% CI, 1.17-2.97) offenses.
This data demonstrates that preschool children placed out-of-home are at risk of adverse
outcomes as adults – more than twice that of individuals who were never placed out-of-
home – even accounting for their initial circumstances.
• National Scientific Council on the Developing Child. (2012). The Science of Neglect:
The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working
Paper 12. http://www.developingchild.harvard.edu
This working paper examines children reared in institutions. It explains that
“young children who live in such settings experience little more than transient serve and
return interactions. Frequent staff rotations mean that infants are cared for by many
different people, making it extremely difficult to develop meaningful relationships with
any single caregiver.” In such circumstances, “although basic needs for food, warmth,
shelter, and medical care may be met (thereby avoiding most legal definitions of neglect),
the setting itself may still be a precipitant of severe psychosocial deprivation for the
youngest inhabitants.”
Institutionally-reared children also show differences “in the neural reactions that
occur as an individual is processing information, such as looking at faces to identify
different emotions.” These findings indicate “impairments in the way the brain interprets
such input and are consistent with behavioral observations that neglected children
struggle to correctly recognize different emotions in others.”
Finally, “[w]hen compared with children who have been victimized by overt
physical maltreatment, young children who experienced prolonged periods of neglect
exhibit more severe cognitive impairments, language deficits, academic problems,
withdrawn behavior, and problems with peer interaction. This suggests that sustained
disruption of serve and return interactions in early relationships may be more damaging
to the developing architecture of the brain than physical trauma.”
• Carlo Schuengel et al., Children with Disrupted Attachment Histories: Interventions and
Psychophysiological Indices of Effects, 26 Child & Adolescent Psychiatry & Mental Health
3 (2009), https://dio.org/10.1186?1753-2000-3-26
This study asserts that while a child may be more physically secure if removed
from the home in certain circumstances, they may not necessarily be more emotionally
secure. Young children, “who may not yet have had the opportunity to develop secondary
attachment relationships,” are particularly at risk, since they “may lose the only source of
security and comfort they had, however fallible or limited it was.” Discussing
psychobiological propositions alongside attachment theory, this study demonstrates the
hidden physiological responses to child-parent separation. By examining HPA-axis
activity (activity within the hypothalamus, pituitary gland, and adrenal glands that
controls reactions to stress), the study suggests that foster children show more reactivity
within systems facilitating fight-or-flight behaviors than social engagement. These results
increased in foster children with atypical attachment behavior. If children must be placed
22
out of the home, the study argues, “more is needed than a physically safe family.”
According to the study, well-designed intervention aimed at foster parents “may nudge
back psychophysiological parameters within the normative range.”
• Michelle R. VanTieghem and Nim Tottenham, Neurobiological Programming of Early

Life Stress: Functional Development of Amygdala-Prefrontal Circuitry and Vulnerability
for Stress-Related Psychopathology, Springer International Publishing Switzerland 2017
Curr. Topics Behav. Neurosci. DOI 10.1007/7854_2016_42
http://docs.wixstatic.com/ugd/f0bac7_13e118065ecf478fa7a9b1932f0758f7.pdf
This paper discusses “role of emotion regulation circuitry implicated in stress
related psychopathology from a developmental and transdiagnostic perspective.” Of note,
this paper explains that “[i]n accordance with studies in adult Early Life Stress (ELS)
samples, children and adolescents with a history of early adversity also show enhanced
amygdala reactivity to emotional stimuli. Previously institutionalized (PI) youth with a
history of institutional care exhibit heightened amygdala reactivity to threat-related facial
expressions across childhood and adolescence.” Further, this paper explains that “[i]n a
cross-sectional study from early childhood to late adolescence, PI youth showed an
atypical trajectory of age-related changes in threat-related amygdala-mPFC connectivity
relative to comparison youth, such that PI youth exhibited more mature (i.e., adult-like)
connectivity at younger ages. Youth with trauma exposure also show atypical amygdala-
prefrontal function in response to emotional distractors, with weaker negative
connectivity between the amygdala and pregenual ACC (pgACC) relative to comparison
youth.” This is to say that exposure to childhood trauma creates lasting impacts, but so,
too, does institutionalized care.
When discussing the importance of caregivers, this paper notes that:
Evidence across species has shown that caregivers regulate emotional and
neurobiological development. In rodent pups, maternal presence has transient
effects on cortisol release and amygdala function, such that maternal presence
blocks stress reactivity and fear learning during the early stage of rat pup
development. Similar social buffering effects have been identified in humans;
parent availability reduces cortisol response to social stress and enhances emotion
regulation abilities in children. Moreover, parental stimuli can induce transient
changes in functional connectivity of amygdala-mPFC circuitry, and these
neurobiological changes predict the degree of parental buffering of children’s
emotion regulation abilities. Together, these findings provide a plausible
neurobiological mechanism through which caregivers can directly influence
neuro-affective functioning during development.
Altogether, these findings provide further insight into the “neuro-developmental
mechanisms underlying the emergence of adversity-related emotional disorders and
facilitate the development of targeted interventions that can ameliorate risk for
psychopathology in youth exposed to early life stress.”
• Renee Schneider et al., What Happens to Youth Removed From Parental Care?: Health
and Economic Outcomes for Women with a History of Out-of-Home Placement, 31
23
Child. & Youth Servs. Rev. 440 (2009),
https://s3.amazonaws.com/academia.edu.documents/44083072/What_happens_to_youth_
removed_from_paren20160324-25611-
1dflv7u.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1531767464
&Signature=psL6xfEc0Oxk0I7V8qmq42Ia12s%3D&response-content-
disposition=inline%3B%20filename%3DWhat_happens_to_youth_removed_from_paren
.pdf
This study used data from the California Women’s Health Survey to examine the
mental and physical health problems, low educational attainment, and economic adversity
for women ages 18 and older with and without a history of out-of-home placement. The
study defined “out-of-home placement” as any removal from the parents’ or caregivers’
home by the state or county. Surveying 368 women with a history of out-of-home
placement and 9240 women without, the study found that “history of out-of-home
placement was associated with mental health problems, poor subjective health, smoking,
obesity, low educational attainment, living in poverty, and use of public assistance in
adulthood.” The study contends that overall, these findings “underscore the need for
greater access to mental health and social services for youth in out-of-home placement to
improve their long-term health and economic well-being.”
• Evidence Base for Avoiding Family Separation in Child Welfare Practice: An Analysis of
Current Research. Alia, July 2019.
This report provides an overview of recent research and social science literature
related to the impact of out-of-home placement (or placement into foster care) and family
separation on the wellbeing of children who have experienced maltreatment. The research
and literature reviewed address two main issues, namely, (i) the impact of out-of-home
placement on the wellbeing of children who have been maltreated and (ii) the impact of
placement in foster care with a kin versus placement in foster care with strangers on the
wellbeing of children who must be removed from their biological parents. Although
existing research show the negative physical, mental, behavioral, and social outcomes for
children who experience out-of-home placement, one criticism of a majority of such
research is that they do not isolate the impact of the out-of-home placement from the
impact of the maltreatment that led to the out-of-home placement, raising the question of
whether the negative outcomes are a result of being removed from one’s family or are a
result of the maltreatment experienced prior to the removal. This report reviews research
within the last 15 years that address such criticism by using more advanced statistical
methods to isolate the specific impacts of out-of-home placement on various measures of
child wellbeing. Although the research is still emerging, the results thus far indicate that
that out-of-home placements (i) cause additional harms to children who have experienced
maltreatment in terms of increased risk of juvenile and adult criminal behavior, Reactive
Attachment Disorder, and early mortality and (ii) provide little to no measurable benefits
to children who have experienced maltreatment, in terms of cognitive and language
outcomes, academic achievement, mental health outcomes, behavior problems and
suicide risk. Further (and as discussed in Part IV below), in cases where children must be
removed from their biological parent, the research indicate that children placed with kin
24
have better outcomes than those placed with non-kin in terms of greater placement
stability, fewer emotional and behavioral problems during placement, lower incidence of
Reactive Attachment Disorder and more connections to their biological and socio-cultural
communities.
IV. RESOURCES FOR PARENTS AND CHILDREN FACING REMOVAL
A. Introduction
In this section, we first review studies that may serve as resources for parents
faced with removal of their children or related domestic disputes. Such resources include
studies focused on identifying healthy and effective parenting techniques, potential
avenues by which a separated biological parent may at least be able to obtain visitation
rights, and the effective use of mental health and other social services. Also discussed
are resources advocating for kinship placement—i.e., in the event of removal, the
children are placed with a relative. Studies show that placement with a relative results in
more positive outcomes than does placement into foster care. Thus, even if a court were
to find that removal from the parental home is appropriate, the parents could argue that
the child should be placed with close relatives with whom they already have a
relationship, rather than with a stranger.
B. Removal Resources Generally
• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Administration on

Children, Youth and Families, Family Time and visitation for children and youth in out-
of-home care, Information Memorandum (2020),
https://www.americanbar.org/content/dam/aba/administrative/child_law/cb-
familytimeim.pdf
This information memorandum provides information on research, best practices,

resources and recommendations for providing children and youth in out-of-home care
safe, meaningful and high frequency family time that strengthens the family, expedites
reunification and improves parent and child wellbeing outcomes. The memorandum
emphasizes the importance of family time and visitation in reducing the trauma of
removal and placement of children in out-of-home care, maintaining the integrity of the
parent-child relationship, healthy sibling relationships and overall child and family well-
being.
• Vivian L. Gadsden et al. eds., Parenting Matters: Supporting Parents of Children Ages 0-
8 (2016), https://www.nap.edu/read/21868/chapter/1.
Noting that decades of research have demonstrated that the parent-child dyad and
the environment of the family are “the foundation of children’s well-being and healthy
development,” the study focuses on supporting parents with children under the age of
eight. In particular, the study seeks “to provide a roadmap for the future of parenting and
family support policies, practices, and research in the United States.” According to the
study, children who do not become securely attached to a primary caregiver (e.g., due to
25
maltreatment or separation) may develop insecure behaviors in childhood and potentially
suffer adverse outcomes later in life, such as mental health disorders and disruption in
other social and emotional development. In an effort to facilitate healthy attachment, the
study explores parenting-related knowledge, attitudes, and practices that are associated
with improved developmental outcomes for children and provides guidance for the
development of parenting-related programs, policies, and initiatives. Such
recommendations include how to effectively utilize existing platforms and properly scale
parenting programming to reduce the harm of removal.
In its chapter on parenting knowledge, the study identifies “several parenting
practices that are associated with improvements in” physical health and safety and
emotional, behavioral, social, and cognitive competence:
o Contingent responsiveness (serve and return);
o Showing warmth and sensitivity;
o Routines and reduced household chaos
o Shared book reading and talking to children
o Practices related to promoting children’s health and safety—in particular,
receipt of prenatal care, breastfeeding, vaccination, ensuring children’s
adequate nutrition and physical activity, monitoring, and
household/vehicle safety; and
o Use of appropriate (less harsh) discipline.
• Lenore M. McWey et al., The Impact of Continued Contact with Biological Parents upon
the Mental Health of Children in Foster Care, 32 Child. & Youth Servs. Rev. 10, 1338
(2010), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928481/pdf/nihms205361.pdf
Guided by attachment theory, this study examines the impact of contact with
biological parents on depression and externalizing problems (i.e., aggressive and
delinquent behavior) in children in foster care. Controlling for gender differences and
exposure to violence, the study surveyed 362 children who were subjects of abuse or
neglect between October 1999 and December 2000. The study highlights many of the
purported benefits of visitation between children in foster care and their biological
parents (e.g., maintenance of family ties, lessened grief, increased overall well-being).
While foster parents often challenge the benefit of visitation by reporting that visitation
results in problematic behavior of the children, the study found that “more frequent
contact with the biological mother was marginally associated with lower levels of
depression and significantly associated with lower externalizing problem behaviors.”
• Renee Schneider et al., What Happens to Youth Removed From Parental Care?: Health
and Economic Outcomes for Women with a History of Out-of-Home Placement, 31
Child. & Youth Servs. Rev. 440 (2009),
https://s3.amazonaws.com/academia.edu.documents/44083072/What_happens_to_youth_
removed_from_paren20160324-25611-
1dflv7u.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1531767464
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&Signature=psL6xfEc0Oxk0I7V8qmq42Ia12s%3D&response-content-
disposition=inline%3B%20filename%3DWhat_happens_to_youth_removed_from_paren
.pdf
Exploring the relationship between out-of-home placement and mental and
physical health problems and educational attainment, this study posits the need for
“greater access to mental health care and social services for youth in out-of-home
placement to improve their long-term health and economic well-being.” According to the
study, routine screening for mental health problems and early intervention and prevention
efforts should be targeted to youth in or transitioning to out-of-care placement. (See
Removal into Foster Care for full annotation).
• Aubyn C. Stahmer et al., Developmental and Behavioral Needs and Service Use for
Young Children in Child Welfare, 116 Pediatrics 4, 891 (2005),
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550707/
This paper seeks to “determine the level of developmental and behavioral need in
young children entering child welfare [and] estimate early intervention services use.”
Collecting data on 2,813 children under the age of 6 for whom possible abuse or neglect
was investigated, the study analyzed developmental and behavioral needs across five
domains: cognition, behavior, communication, social, and adaptive functioning. The
study found that across age groups, approximately half of young children in child welfare
had developmental or behavioral problems that would qualify them for early intervention
services. The study found, however, that over the course of year, less than one quarter of
young children in contact with child welfare received any developmental or behavioral
intervention. The study also notes that, although serious developmental and behavioral
problems are as frequent among children that remain home as those that are removed,
children remaining home are much less likely to receive early intervention services. From
a societal prospective, the study contends, “contact with [child welfare] represents an
opportunity to identify children who are likely to be at substantial risk for poor long-term
developmental trajectories,” and access to early intervention services should be increased
whether the child remains in the home or is removed.
• Children with Traumatic Separation: Information for Professionals, National Child

Traumatic Stress Network,
https://www.nctsn.org/sites/default/files/resources//children_with_traumatic_separation_
professionals.pdf.
The NCTSN provides a variety of tips for working with children experiencing
traumatic separation, including allowing the child to have memorabilia (e.g., pictures,
objects from a previous home, a scrapbook) to preserve positive memories of and stay
connected to the absent caregiver and coordinating outside resources and referrals to
whom the child can turn when needing comfort.
C. Kinship Placement
• Deborah Cromer, Through No Fault of Their Own: Reasserting a Child’s Right to Family
Connectedness in the Child Welfare System, 41 Family L. Quarterly 181 (2007).
27
This essay explores “the statutory and public policy frameworks that guide state
intervention in the parent-child relationship, and the negative outcomes resulting from
removal of at-risk children from the family. Cromer suggests that even when families are
dangerous or unhealthy, children “often experience[] separation from a primary caregiver
as a threat to survival.” As an alternative, the essay proposes that “public policy should
demand a refocus of the child welfare system on family connectedness.” Detailing the
success of relative-care initiatives across the United States (e.g. Alemeda County’s
StepUp Project), the essay notes several benefits of relative care:
o connecting with a person the child knows and trusts;
o creating a network of connected, caring support from family even if the child
cannot be reunited with biological parents;
o reinforcing the child’s personal and cultural identity;
o encouraging families to cultivate and rely their own resources and strengths; and
o saving the state significant costs.
• Atalia Mosek & Leah Adler, The Self-Concept of Adolescent Girls in Non-Relative
versus Kin Foster Care, 44 Int’l Soc. Work 149 (2011)
In an effort to determine the “least detrimental placement” for maltreated
children, this study collected data on the “self-concept” of adolescent girls cared for by
kin versus non-relative foster parents in Israel. The study defines “self-concept” as “an
organizing system of traits and ambitions that a person relates to [herself], and according
to which [she] manages [her] life.” The study included adolescent girls (aged 12-18)
placed in foster care for four years or more in the north of Israel. Of this sample, 18 girls
were with non-relative foster care and 20 were with kinship foster parents. Using a
questionnaire that measured 5 dimensions of the self (i.e. psychological self, social self,
sexual self, family self, and coping self), the study found that adolescents who grow up in
kinship care have a more positive self-concept than those adolescents growing up in non-
relative foster care. According to the study, “[i]t is the feeling of stability and
permanency perceived by adolescents who stay with kin that contribute to their inner
self-assurance, in comparison with adolescents staying with non-relative families.”
Adolescents placed with kin report greater closeness with the foster family and fewer
tensions between the foster family and biological family.
• Femke Vanschoonlandt et al., Kinship and Non-Kinship Foster Care: Differences in

Contact with Parents and Foster Child’s Mental Health Problems, 34 Child. & Youth
Servs. Rev. 1533 (2012).
This study compares two aspects of out-of-home kinship placements and out-of-
home non-kinship placements: contact with and attitude of parents and mental health of
the foster children. Following 186 foster children (aged 3-18) in the Flemish child
welfare system, the study found that while non-kinship placements fare better on aspects
of contact with and attitudes of parents, children in kinship placements had significantly
28
fewer behavioral problems and lower levels of mental health problems. The study found
that in non-kinship foster placements there was a 50% chance of severe behavioral
problems compared to only a 35% chance in kinship placements. According to the study,
the better psychosocial functioning of kinship foster children is usually explained by “the
protective effect of cultural and family preservation” because “living with relative may
reinforce the sense of identity and self-esteem that flows from knowing the family history
and culture” (emphasis in original). Notably, the study found that the number of
previous out-of-home placements played a greater role in behavioral problems than the
type of placement. In this regard, the results confirm the importance of stability for foster
child well-being.
• Evidence Base for Avoiding Family Separation in Child Welfare Practice: An Analysis of
Current Research. Alia, July 2019.
As previously mentioned (supra at pp. 22-23), the research and literature reviewed by this
report, in addition to studying the impact of out-of-home placement on the wellbeing of
children who have been maltreated, also studied the impact of placement in foster care with a
kin versus placement in foster care with strangers on the wellbeing of children who must be
removed from their biological parents. Discussed in the report is a 2005 study of 214 children
(aged 4-13) in state custody that found that those in kinship placement had fewer emotional
and behavioral problems than those placed with non-kin. A different study - a systematic
review that included 102 quasi-experimental studies examining the impacts of kinship versus
non-kin placements - found that children in non-kin foster care were two times more likely to
experience mental illness as compared to children in kinship.
V. THE EFFECTS OF TOXIC STRESS IN CHILDREN
A. Introduction
This section includes resources discussing the physical effects visited upon
children as a result of “toxic stress,” which can result from “strong, frequent, and/or
prolonged adversity . . . without adequate adult support.” Center on the Developing
Child, Harvard University, Toxic Stress, https://developingchild.harvard.edu/science/key-
concepts/toxic-stress/ (also linked below). Toxic stress “can disrupt the development of
brain architecture and other organ systems, and increase the risk for stress-related disease
and cognitive impairment, well into the adult years.” Id. As noted in some of the
resources discussed in Part II supra, parent-child separation places the child at significant
risk of developing toxic stress. The research below, therefore, may be grafted onto the
discussion of the harmful effects of removal generally when preparing a submission to a
court in opposition to the government’s removal attempt.
B. Relevant Research
• Laura Santhanam, How the Toxic Stress of Family Separation Can Harm a Child, PBS,
June 28, 2018, (https://www.pbs.org/newshour/health/how-the-toxic-stress-of-family-
separation-can-harm-a-child).
29
Excerpt:
In a situation where children are separated from their parents for a long period of time,
they remain on high alert, and their bodies endure prolonged and severe toxic stress as a
result. See Harvard University Center on the Developing Child – Toxic Stress
Excerpt:
When a child is primed to experience fear and anxiety, those emotions can superimpose
themselves onto how the child interacts with another person, even if that person wants to
nurture and love the child. This condition is called Reactive Attachment Disorder, and it
can start as early as infancy if a child’s basic needs aren’t met by a parent or caregiver,
preventing a healthy bond from forming between them. See Mayo Clinic’s Reactive
Attachment Disorder Research
Excerpt:
Toxic stress is more subtle than a broken bone or distended stomach, but it can leave
permanent mark on a child’s brain and can “create a weak foundation for later learning,
behavior, and health,” according to a 2012 study published in the journal Pediatrics that
explored how adversity and toxic stress in early childhood can manifest itself throughout
a child’s life. After a long period of sustained toxic stress, a child who had seemed
inconsolable may become quiet, dull or withdrawn. That doesn’t mean they have adjusted
to what’s going on, those symptoms emerge because their cortisol levels are depressed
and their stress levels are blunted. See American Academy of Pediatrics News & Journal
Gateway, The Lifelong Effects of Early Childhood Adversity and Toxic Stress, (2012).
• Hillary A. Franke, Toxic Stress: Effects, Prevention and Treatment, 1 Child. 3, 390
(2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928741/.
In this article, Franke summarizes the findings in recent studies on toxic stress and
childhood adversity that followed the American Academy of Pediatrics Policy Report on
the effects of toxic stress. Childhood toxic stress, Franke explains, is defined as “severe,
prolonged, or repetitive adversity with a lack of the necessary nurturance or support of a
caregiver to prevent an abnormal stress response.” Children who experience toxic stress
are at risk for long-term adverse health effects including maladaptive coping skills, poor
stress management, unhealthy lifestyles, mental illness and physical disease.” According
to Franke, “[f]actors that place a child at risk of maltreatment overlap those with risk of
toxic stress” (e.g., social isolation, poverty, non-biological relative living in the home,
depression). However, if primary preventative measures are taken during early
development, appropriate stress responses to adversity may result. Positive factors for
child maltreatment (e.g., structured school environment, positive family changes,
presence of a caring and supportive adult) may also reduce the risk of toxic stress. An
integrative approach to prevention and treatment of toxic stress, Franke argues,
“necessitates individual, community and national focus.”
30
• Alexander C. McFarlane, Long-Term Costs of Traumatic Stress: Intertwined Physical
and Psychological Consequences, 9 World Psychiatry 1, 3 (2010),
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816923/.
This paper explores the delayed, long-term physical and psychological effects of
traumatic stress. Understanding that the effects of stress need to be considered as a major
environmental challenge that places an individual’s physical and psychological health at
risk, this paper focuses on the development and impact of delayed PTSD as a result of
subsequent adverse experiences. While the paper does not deal specifically with child
separation, the focus on the impact of stressful environments following a traumatic
experience speaks to the layered traumatic experiences many children experience
following removal and provides insight into necessary treatment approaches. According
to the paper, the majority of people who develop PTSD do not originally meet the
diagnostic criteria of the disorder; rather, it is only with the passage of time that the
symptoms become sufficiently severe to warrant a clinical diagnosis. This delayed form
of PTSD demonstrates “how a traumatic experience can apparently lie dormant within an
individual only to become manifest at some point in the future.” The paper explores the
various physical and psychological symptoms that may develop in association with
delayed PTSD (e.g., cardiovascular problems, obesity, morbidity) and proposes treatment
that emphasizes addressing underlying psychophysiology in the early periods following
exposure to adversity.
• Jack P. Shonkoff & Committee on Psychological Aspects of Child and Family Health et
al., Lifelong Effects of Early Childhood Adversity and Toxic Stress, 129 Pediatrics 232
(2012).
This report presents an ecobiodevelopmental (EBD) framework that demonstrates
how toxic stress “can leave a lasting signature on the genetic predispositions that affect
emerging brain architecture and long-term health.” Recognizing development as “nature
dancing with nurture” rather than “nature vs. nurture,” an EBD framework examines
“how early experiences affect when, how, and to what degree different genes are actually
activated.” This framework provides insight into the well-documented relationship
between child adversity and adult health impairment. Although moderate levels of stress
are essential to survival, toxic stress describes prolonged exposure to excessively high
levels of stress hormones that leads to chronic “wear and tear” on bodily systems,
including the brain. According to this report, alleviating toxic stress in childhood could
reduce persistent health disparities associated with poverty, discrimination, or
maltreatment. Ultimately, the report proposes “a new role for pediatricians to promote the
development and implementation of science-based strategies to reduce toxic stress in
early childhood.”
• Excessive Stress Disrupts the Architecture of the Developing Brain, Harvard U. Center
on the Developing Child: National Scientific Council on the Developing Child (Jan.
2014), https://developingchild.harvard.edu/wp-
content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_Brain-1.pdf.
Extensive research shows that healthy development can be derailed by excessive
or prolonged activation of stress response systems in the body and the brain. This paper
31
suggests that policies affecting young children generally do not reflect awareness of the
degree to which very early exposure to stressful experiences and environments can affect
the architecture of the brain, the body’s stress response systems, and a host of health
outcomes later in life. Because a child’s ability to cope with stress has consequences for
mental and physical health throughout life, this paper suggests that “understanding the
nature and severity of different types of stress responses to early adverse experiences can
help us make better judgments about the need for interventions that reduce the risk of
later negative impacts.” The paper focuses on the neurological effect of toxic stress that
occurs when children lack a supportive caregiver to act as a buffering agent. According to
the paper, the quality of early care and education that young children receive outside the
home also plays an important role in whether they experience toxic stress.
VI. ADDITIONAL RESOURCES
Resources exhibiting that separation causes trauma:
• Maslow’s Hierarchy of Needs

• Pediatrician Henry Dwight Chapin’s study of institutionalized infants
• John Bowlby’s Attachment Theory
• Psychiatrist Charles Nelson’s Bucharest Project, a study of Romanian Orphanages:
American Psychological Association – the lasting impact of neglect
• Research on “Aboriginal Children in Australia”
• AJPH – A publication of the American Public Health Association - Left Too Early: The
Effects of Age at Separation from Parents on Chinese Rural Children’s Symptoms of
Anxiety and Depression.
• Focusing on the trauma of transitioning into foster care – Monique Mitchell, The
Neglected Transition: Building a Relational Home for Children Entering Foster Care
(Oxford University Press, 2016) (preview available)
• NOVA PBS Official, Inside the Brains of Children Separated from Parents, YouTube
(June 25, 2018), https://www.youtube.com/watch?v=bwpcn8sRtqg&feature=youtu.be.
• Kansas City Star, Taken Into Foster Care, through the eyes of a Child, YouTube (January
3, 2020),
https://www.youtube.com/watch?v=Gb8BGKqVVZM&list=PL02VuT_SObZIXSLG1bc
MzQtdna30mfpqB&index=1&fbclid=IwAR3MfFPDmlLPQ46Nm4QNNdaPOxkjEqfbZ
KwUn7_iar41F8XbvSTd6aiHv2g
Studies on the long-term effects of trauma:
• Kaiser Permanente and the Centers for Disease Control and Prevention’s Adverse
Childhood Experiences Study
• Comorbidity and Continuity of Psychiatric Disorders in Youth After Detention: a
Prospective Longitudinal Study
• Brain Development: Harvard University Center on the Developing Child – Toxic Stress
32
• Long-Term Effect of Toxic Stress on Child: American Academy of Pediatrics News &
Journal Gateway, The Lifelong Effects of Early Childhood Adversity and Toxic Stress,
(2012).
• Emotional Toll: Mayo Clinic’s Reactive Attachment Disorder Research
Resources on family separation and trauma developed by the National Child Traumatic Stress
Network (NCTSN):
• Traumatic Separation and Refugee and Immigrant Children: Tips for Current Caregivers
• Key Points: Traumatic Separation and Refugee and Immigrant Children
• NCTSN Resources Related to Traumatic Separation and Refugee and Immigrant Trauma
Studies conducted to assess child outcomes when removed from primary caregivers:
• Mental and Physical Health of Children in Foster Care by the American Academy of
Pediatrics (2016)
• The importance of visitation and contact with family:
o Information Packet Parent-Child Visiting, National Resources Center for Family-
Centered Practice and Permanency Planning at the Hunter College School of
Social Work (2008)
• The younger the child and the longer the period of uncertainty and separation from the
primary caregiver, the greater the risk of emotional and developmental harm to the child.
o Developmental Issues for Young Children in Foster Care by the American
Academy of Pediatrics Committee on Early Childhood, Adoption and Dependent
Care (2000)
o Visitation with Infants and Toddlers in Foster Care: What Judges and Attorneys
Need to Know by the American Bar Association (2007)
o Mental Health Assessments for Infants and Toddlers by the American Bar
Association in Child Law Practice (Vol. 24 No.9) 129-139 (2005)
• Improving Family Foster Care: Findings from the Northwest Foster Care Alumni Study
(2005) by Casey Family Programs
• Separation may lead to mental health disorders – Parenting Matters: Supporting Parents
of Children Ages 0-8 (2016) by The National Academies: Sciences, Engineering, &
Medicines
• Family disruption can hinder healthy development and increase risk of future disorders –
Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress
and Possibilities (2009) by The National Academies: Sciences, Engineering, & Medicine
Guide to assist attorneys in child welfare practice:
• Child Safety: A Guide for Judges and Attorneys by the American Bar Association
• Martin Guggenheim and Vivek S. Sankaran, Representing Parents in Child Welfare:
Advice and Guidance for Family Defenders (2015) (available for purchase)
33

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Trauma Caused by Separation of Children from Parents

A Tool to Help Lawyers

Information is up to date as of May 2019. To share information to be added to this tool or

I. Executive Summary ............................................................................................................ 3

This memorandum provides a summary of extensive research detailing the grave

Finally, Part VI of the memorandum provides a listing of available additional resources

A. Harm from Removal

• Allison Eck, Psychological Damage Inflicted by Parent-Child Separation is Deep, Long-

• Marcia McNutt, Statement on Harmful Consequences of Separating Families at the U.S.

4. Inst. of Med., Reducing Suicide: A National Imperative, Exec. Summ. (2002),

• Ms. L. v. U.S. Immigration & Customs Enforcement, 310 F. Supp. 3d 1133

In a decision entering a preliminary class-wide injunction with respect to ICE’s

o Children’s Defense Fund – Amicus Brief

• Jacinto-Castanon de Nolasco v. U.S. Immigration & Customs Enforcement, 319 F. Supp.

• M.G.U. v. Nielsen, 325 F. Supp. 3d 111 (D.D.C. 2018)

The same court relied on essentially the same medical findings,

o fear and anxiety;

o risk of additional exposure to domestic violence;

• Nicholson v. Scoppetta, 344 F.3d 154 (2d Cir. 2003).

• Nicholson v. Scoppetta, 3 N.Y.3d 357 (2004).

2. Law Journal Articles and Related Materials

• Developing a Trauma-Informed Child Welfare System, Children’s Bureau (May 2015),

• Rebecca Bonagura, Redefining the Baseline: Reasonable Efforts, Family Preservation,

• Michael S. Wald, State Intervention on Behalf of “Neglected” Children: Standards for

• Michael Wald, State Intervention on Behalf of “Neglected” Children: A Search for

• Joseph J. Doyle, Jr., Causal Effects of Foster Care: An Instrumental-Variables Approach,

• Catherine R. Lawrence et al., Impact of Foster Care on Development, 18 Dev. &

Researchers conducted a population-wide longitudinal study using the 1987

• Michelle R. VanTieghem and Nim Tottenham, Neurobiological Programming of Early

IV. RESOURCES FOR PARENTS AND CHILDREN FACING REMOVAL

• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Administration on

This information memorandum provides information on research, best practices,

• Children with Traumatic Separation: Information for Professionals, National Child

• Femke Vanschoonlandt et al., Kinship and Non-Kinship Foster Care: Differences in

V. THE EFFECTS OF TOXIC STRESS IN CHILDREN

VI. ADDITIONAL RESOURCES

Resources exhibiting that separation causes trauma:

• Maslow’s Hierarchy of Needs

Studies on the long-term effects of trauma:

Guide to assist attorneys in child welfare practice:

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