The child placement crisis: It’s time to lose the slogans and find real solutions

By Judith Schagrin

A note from Child Welfare Monitor: It is a privilege to publish this important essay by Judith Schagrin. Judith earned an undergraduate degree from the University of Pennsylvania and a master’s degree in social work (MSW) from the University of Maryland School of Social Work. She unexpectedly found her passion in public child welfare, and more specifically, foster care after helping start an independent living preparation program for young people in care. After a decade as a foster care social worker specializing in adolescence in a large Maryland county department of social services, she supervised two different units before becoming the county’s director of foster care and adoptions, serving in this position for twenty years. She also worked part-time for the Agency’s after-hours crisis response for a decade. For almost 10 years, she served as a respite foster parent for a private foster care agency, and since 2008, has mentored a young person who aged out of care in California and came east for college. In 2001, with a little help from her friends, Judith founded Camp Connect, a weeklong sleepaway camp to reunify brothers and sisters living apart in foster care and provide memorable experiences siblings can share for a lifetime. For the past 23 years – one year virtual – she has spent the week at Camp Connect immersed in the care of Maryland’s foster children and youth.

The closing of children’s mental hospitals in the 1980s, the subsequent closure of detention centers leaving foster care to take up the slack, the movement to shutter all group homes and residential treatment programs and the prohibition of out-of-state placements have created a slow-motion train wreck whose results could have been predicted easily at every new chain in the sequence. Those results include children and youth staying in psychiatric hospitals long after being ready for discharge, “boarding” in emergency rooms and “placed” in hotels at a cost of $30,000 to $60,000 per child per month. From my 35-year vantage point as a caseworker, supervisor, and then running foster care and adoptions in a large Maryland county, I’ve had a front row seat to the evolution of this crisis and the failure to come up with real solutions.

Deinstitutionalization

The first in a series of events that created this crisis occurred in the 1980s, when the deinstitutionalization that began for adults in the 1960’s with the civil rights movement expanded to include children. Until then, youth remained in state hospital facilities for as long as a year or even more. The closure of those state facilities led to the expansion of Medicaid-funded residential treatment centers (RTC’s), that stepped in to provide the longer term care once provided in the state hospitals. In turn, group homes proliferated to meet the needs of youth discharged from RTC’s. The advent of Medicaid was instrumental in expanding prIvate psychiatric treatment options, including hospitals. But over time, Medicaid stopped funding even 30 days of treatment, limiting payment to only a few days of crisis intervention.

Today, many youth, especially older youth, are entering foster care not because of what we traditionally think of as maltreatment, but due to parental incapacity or unwillingness to care for them due to acutely problematic behavior, and behavioral health and/or developmental needs. Services to meet these needs are often missing or inadequate, and parents of children with high-intensity needs cannot find residential treatment except through the child welfare system. Medicaid doesn’t pay for treatment and care in a group home of any kind; access in Maryland requires the child welfare system’s physical or legal custody.

New approach to juvenile justice

In the early 2000’s, a series of Supreme Court decisions brought welcome changes to juvenile justice and shifted the country from the ‘get tough’ approach of the ‘80’s and 90’s to the ‘kids are different’ era. Moving from punishment to rehabilitation and minimizing detention in favor of community services makes sense on both humanitarian and neuroscience grounds. But it meant that youth who once fell under the purview of Juvenile Services now required child welfare intervention when parents or other caregivers were unwilling or unable to continue to provide care. The mother evicted from four apartments because of her son’s property damage; the grandmother who stepped in years ago and is no longer able to cope with her granddaughter after the third vehicular misuse charge and chronic episodes of running away; or a parent with younger children afraid that an older sibling known to have rages and episodes of violence will harm his siblings, are examples of desperate caregivers I have come across.

In Maryland, the first alarm that child welfare was ill-equipped to care for these youth was sounded in 2002 by local department directors in a memo to the head of the Department of Human Services. Closing detention centers was a good thing, but alternatives weren’t developed for those youth unable to live at home, and no resources were provided to help child welfare accommodate its new clients. As the closure of state psychiatric facilities and detention beds was widely celebrated, the belief that every youth had a family eager and able to provide a home was more than a touch naive, as would soon become clear.

Group home closures

Another domino fell in the early 2000’s, when group homes, many poorly administered with little oversight, became a scandal in Maryland. A series of articles in the Baltimore Sun exposed the flaws of many group care programs, and some were forced to close. With the scandals around bad group homes, the timing was perfect for state leadership, encouraged by a national advocacy group with deep pockets and the laudable dream of a family for every child, to lead a movement to shutter congregate care placements. Funding constraints, too, forced some providers out of business. Reimbursement rates did not keep up with costs, and some programs closed their doors due to inadequate reimbursement. The state lost roughly 450 beds in five or six years, including entire residential treatment center programs. Rate-setting ‘reform’, which began in October of 2021, will not be completed until July of 2026 if it stays on schedule.

At the same time group homes were being closed in Maryland, state agency leadership began to frown on out-of-state placements for youth with highly specialized needs when no placement in Maryland to meet those needs was available. Public officials with little understanding of placement resources pronounced these out-of-state placements to be evil incarnate, and an overwhelming number of bureaucratic obstacles made them nearly impossible.

With the loss of group homes as an option, we were urged to ‘re-imagine’ care for children, yet discouraged from developing individualized plans of care because insufficient flexible funding was allowed to make that happen. We’re fond of slogans in child welfare, as if words will change outcomes, but too many initiatives are about clever slogans and not about substance. If only we would review every child in group care, we were told, we would realize how many had other options. With consultation from the national advocacy group, we spent hours seriously poring over the needs of our children in congregate care and attempting to find matches with kin or foster families. Not at all surprising to our staff, “low hanging fruit” didn’t exist.

We also initiated a rigorous “Family Finding” practice, in hopes of finding kin willing to become providers with services and supports. What we learned is that youth in congregate care had already exhausted family and “kin of the heart” resources. Today it’s not clear that public officials and child welfare leaders grasp that children and youth wouldn’t be in hotels if there were any kin – fictive or otherwise – willing and able to provide care, or if parents could and would be a safe resource.

Youth with intensive, complex needs

As other doors closed, the child welfare system became increasingly tasked with providing residential behavioral health care for children and youth with high-intensity and complex needs for supervision and treatment. The differences between those involved with the juvenile justice system (and may have gone to detention centers in the past) and those who are not are often hard to discern. Both groups tend to engage in behaviors that pose a serious safety hazard to themselves or others. These behaviors may include physical violence; property damage; compulsive self-harm such as cutting or swallowing objects; chronic truancy; frequent runaway episodes; sexual victimization of siblings; aberrant sexual behaviors such as public masturbation; molesting younger siblings; participating in petty crimes; harming family pets; and generally oppositional and dysregulated behavior.

Contrary to the popular notion that the public child welfare system is tearing families apart, these are children whose families are typically frustrated, exhausted, and often eager to place their child. Some even view foster care as a much-needed punishment, imagining that when the youth is ready to “behave,” they can return home. Of course these young people have many strengths to be nurtured, but they need intensive supervision and therapeutic intervention by professionals trained to evaluate and address their special needs and work with families.

The gist of the matter is that we are serving two different out-of-home placement populations with very different needs. One is a younger population in foster care primarily due to maltreatment stemming largely from parental substance abuse and/or untreated mental illness. The other is older youth with complicated behaviors, and behavioral health needs and/or developmental disabilities. The parents and kin of the older group are asking for placement, not objecting to it, and are typically worn out and adamantly opposed to more in-home services. In spite of the stark differences in these two populations, our policymakers and those upon whom they rely have failed to recognize their needs are not the same.

In Maryland and other states, treatment, or ‘therapeutic,’ foster care stepped in to accommodate this new population of older, harder to serve foster youth. To some extent this approach has been effective as an alternative to congregate care, but it’s not the panacea some would like to believe. The desperate need for foster families willing to care for these youth means there’s a certain amount of pressure to lower expectations and even turn a blind eye to foster parents that do a less than stellar job. Tales of locked refrigerators and youth left sitting on the stoop at the end of the school day until the caregiver came home soon proliferated. However, we were told by representatives of a national advocacy group that, “Youth are better off moving from shabby foster home to shabby foster home than in the very best congregate care.” In my own experience, instability begets instability and there’s little more soul-sucking than being rejected from family after family.

Setting aside the question of quality, foster care, whether treatment or not, has great challenges recruiting homes for youth with weapons charges, those with a history of drug dealing, or whose parents have refused to pick them up from the police after another runaway episode. “Cutters” and “swallowers” need 24/7 supervision to keep them safe and in general, kin have already tried to provide care long before the child’s entry into state custody. With the closure of group homes and residential treatment centers in Maryland and the prohibition on out-of-state placements, finding placements willing to accept youth with high-intensity needs became literally impossible. As a result, for years now children have been left in psychiatric hospitals (sometimes for months) after “ready” for discharge, and others are ‘boarding’ in emergency rooms for weeks or months.

A failure to recognize reality

Instead of recognizing the lack of capacity to serve those youth with nowhere to go after being hospitalized, hospital representatives, public officials, and legislators blamed caseworkers for not ‘picking children up’, as though they were simply lazy and incompetent. “Advocates” proposed legislation imposing more caseworker accountability as the solution, as though if caseworkers worked harder and filled out more forms, placements that didn’t exist would magically appear. Fortunately, none of the legislation passed, but being a lonely voice trying to explain the source of the problem wasn’t lazy caseworkers or enough forms was painful. Public officials, leaders and advocates also clamored for more “prevention” services, not recognizing the acute needs of older youth developed over many years and that new services authorized today are not going to keep them safely at home.

During my 20 years as the director for my county’s foster care and adoptions program, I can’t count the nail-biting times we came close to not finding a placement for a child – but we were always able to pull something together. The state made funding available for a 1:1 staff person (or sometimes 2:1) we could offer existing providers, allowing us to use that as a bargaining chip. Of course, increasing reimbursement rates and staff salaries would have been far less expensive than millions for extra staff to support ill-equipped placements, but that change in fiscal allocation has yet to happen.

Five years have now passed since I retired, and hotel placements have become not a rarity but a regular necessity. At the rate of $30,000 to $60,000 per child each month (not including damages to hotels) to warehouse children in hotel rooms supervised by an untrained aide – one can only imagine what that kind of money could be doing productively for children. Caseworkers are overseeing the most precarious and risky “placements,” and being ‘hotel reservation clerks’ isn’t the reason competent social workers choose to do the work. We’ve all heard the tales of youth stealing their 1:1’s car; or youth locking themselves in their rooms doing what we don’t know; a youth who overdosed on his medication; parties taking place with the acquiescence of the 1:1; youth harassing guests; and the youth who leaped over the reservation desk to try to steal cash.

Over the years there have been many, many meetings among high ranking state officials and others; ironically, these meetings didn’t include the experienced and knowledgeable child welfare staff responsible for the children. Lots of strategies, goals, and plans too – a personal favorite was the goal of instructing local department staff on hospital discharge planning, as if they weren’t already experts. Despite all the meetings and all the hand-wringing, progress meeting the needs of the children in our care, or soon to be in our care when parents abandon them at the hospital or elsewhere, has been negligible. Years that could have been spent on developing and promoting new model programs have been wasted. In the meantime, Congress saw fit based on testimony from well-heeled advocacy groups to pass the Family First Prevention Services Act, which limited congregate care even more by restricting funding to approvable options based on criteria seemingly pulled out of a hat.

Today, the deepening and pervasive placement crisis is affecting nearly every state and attracting media attention around the country. Given the financial resources dedicated to keeping children in hotels, finances clearly aren’t the issue. And it certainly isn’t about quality of care, since hotel rooms, overstays in hospitals, and boarding in emergency rooms rank far below a quality congregate care program as a suitable home for a child.

What is to be done?

In the short run, Maryland and other states need respite programs for young people awaiting placements in hospitals, emergency rooms, and hotels. In the long run, we must acknowledge child welfare’s responsibility not only for maltreated children, but also those with high-intensity needs for supervision and treatment once served by other child-serving organizations. We need to bring the finest minds together to reimagine how residential care is provided, and its role in the continuum of child welfare resources to meet the needs of older youth entering foster care because of needs related to behavioral health and/or developmental disabilities. That process should include some of the scholars who have been studying the use of congregate care in other countries where it is more highly valued as a treatment and a professional field. Exploring the development of real alternatives to congregate care is also a worthy investment. Finally, the unintended consequences of the Family First Prevention Services Act that disincentivized needed placements without a credible replacement must be remedied.

How many more years until we wake up? And how many children will have to be harmed? A colleague had a quote in her office that stays with me always, “when we are doing something with somebody else’s child we wouldn’t do with our own, we need to stop and ask ourselves why.” Who among us would consent to our own children boarding in emergency rooms, on overstay at hospitals, or ‘placed’ in hotel rooms? If that’s not okay for our own children, it shouldn’t be okay for the children in our state’s custody either.

Diverse opinions not accepted: Censorship by a contractor of the U.S. Children’s Bureau

Instances of censorship and restrictions of free speech from both ends of the political spectrum have drawn increasing concern as the country’s polarization has increased. I have been very grateful that a digest of child welfare news and opinion articles funded by the federal government has for years been sharing my work–which often takes aim at the ideology prevailing in child welfare. But last July, the government contractor that prepares these digests declined to share one of my opinion pieces–while continuing to share other commentaries with a different perspective. My attempt to get an explanation has resulted in a series of bizarre communications that only heighten my fears that a government-funded organization is censoring the views that it shares.

Child Welfare in the News (CWN), a daily email sponsored by the US Children’s Bureau, has contributed significantly to Child Welfare Monitor‘s growth from its creation in 2016. CWN is an “email subscription service that provides a daily collection of news stories and opinion pieces from across the country and around the world.” It is an activity of the Child Welfare Information Gateway (CWIG), which is part of the Children’s Bureau and is managed by a consulting firm called ICF. For several years, I have been sharing links to Child Welfare Monitor commentaries with the ICF librarians who put together CWN and they have in turn provided links to these pieces, along with excerpts, in their daily mailings. At least until last July.

On July 24, 2023, I published The Misuse of Lived Experience in Child Welfare. The gist of the piece was that while all lived experiences are valid and valuable, their use can be problematic when experiences that support a particular perspective are highlighted and those that contradict it are not, or when evidence from data and research are ignored in favor of curated narratives. When I shared the blog post with the CWN staff as usual, I received a message saying “We’ll get back to you in a few days with a response on this article.” This was unexpected. When I checked for an update on July 31, an ICF librarian responded that “we are still working to review this article, and expect to have a response soon.” I emailed again on September 7 and heard that “We’ve not yet received a response or decision on this article.”

I replied asking to whom my commentary had been submitted and why, what the review criteria would be, and when I could expect a response. Receiving no answer, I wrote on September 14 to the Communications Director of the Administration on Children and Families, parent agency of the Children’s Bureau. I also submitted a Freedom of Information Act request asking for any emails that contain my name or that of Child Welfare Monitor.

On September 22, I received a response from Kai Guterman, the “Senior Manager of Knowledge Management” at ICF, which included the following: “As you know from your past submissions, The Child Welfare Information Gateway is a service of the Children’s Bureau and as such, as part of our standard process our team reviews all requests submitted. Upon our review, this request was not selected for posting as it contains personal fundraising links.” I was totally baffled by this response. I was not aware of any “personal fundraising links” in my piece, but an alert reader informed me after I published this blog that the photo I used of the family of Vanessa Peoples (the mother whose bad experience with CPS was cited by Dorothy Roberts in her book), came from a GoFundMe page set up to help her and her family. Not realizing that at the time I replied, asking Mr. Guterman to describe these links so I could remove them and allow the post to be shared by CWN. Thirteen days later I received the following response:

Thank you for following up and agreeing to exclude the fundraising link.

We have conducted a review of the Misuse of “Lived Experience” in Child Welfare blog submission request. While we appreciate your submission, it has been determined that it will not be included in the Child Welfare in the News since this specific blog post has a strong emphasis on storytelling, calls out individuals [sic] names, makes personal opinion statements about individuals, and focuses on editorial and opinion-based content.

As you consider future submissions, please review how much editorial or opinion-based content is included and ensure the content is not driven by or connected with fundraising purposes.
Email from Kai Guterman, Senior Manager of Knowledge Management, ICF, October 5, 2023

This message from Mr. Guterman was even more confusing than the previous one. It is certainly true that my blog post names several individuals, including the writer Dorothy Roberts and several people who have shared their lived experience with the child welfare system in writing and/or in oral testimony, and I included links to all of their writings. But not many news or opinion articles shared by CWN fail to name individuals. And my post does not make any “personal opinion statements” about these individuals other than summarizing or quoting their views and saying that other types of experiences also exist. The “strong emphasis on storytelling,” leaves me totally baffled. Indeed, the major point of the essay was to question the use of individual stories to make policy. Is it possible that Mr. Guterman missed the point of my blog or did not read it at all? Moreover, removing articles that tell stories would probably exclude more than half the content that is currently included in CWN–pretty much every news story and many opinion pieces as well.

And finally, Mr. Guterman asserts that my piece “focuses on editorial and opinion-based content.” Yes, most of my blog posts are opinion pieces and are labeled as such in the CWN emails, along with opinion pieces by other authors. Since I published my lived experience blog, the newsletter has shared numerous opinion pieces. At least four of these commentaries were by a writer named Richard Wexler. From beginning to end, Wexler’s essays “focus on editorial and opinion-based content,” as Mr. Guterman put it. Here is one example from Child abuse: the surge that wasn’t, a commentary from August 17, 2023 that was shared by CWN.”The American family policing system, a more accurate term than “child welfare” system, is built on ‘health terrorism’ – misrepresenting the true nature and scope of a problem in the name of ‘raising awareness.'” Some of Wexler’s pieces “have a strong emphasis on storytelling.” For example, in Child Well-Being Doesn’t Require Family Policing, also shared by CWN, Wexler devotes seven paragraphs to the story of one family that he says was victimized by a false accusation of child abuse.

As far as “calling out individuals,” CWN shared a piece by Wexler entitled Attn: New Hampshire “Child Advocate – there are horrendous institutions in your state too.” In that commentary, Wexler “calls out” the New Hampshire Child Advocate by name, telling readers that she was “understandably proud of herself” for getting two New Hampshire teenagers out of an abusive institution. But she “took matters too far” when she said according to a local news station that she and her staffers could finally get a good night’s sleep after removing the two teenagers from the institution. But nobody should be getting a good night’s sleep as long as “children are institutionalized,” according to Wexler. “And [the Child Advocate], of all people, should know it” because last year her predecessor issued a report exposing abuse at a New Hampshire institution. He goes on to label as “disheartening” her proposal to form a commission to address the issue of residential care.

It is noteworthy that Wexler’s pieces tend to endorse the prevailing ideology about child welfare, albeit often in an extreme way, while mine tend to challenge it. But Wexler is not the only author of opinion pieces that tell stories and mention individuals and nevertheless are shared by CWN. In addition to commentaries by Wexler, the newsletter has shared opinion pieces with titles like “The Child Welfare System Is Failing Children, Separating Black and Brown Families,” and “What To Do When Children’s Services Comes to the Door,” which also endorse the prevailing view. But my essay has been rejected, ostensibly for the same characteristics that these pieces display. Could it be that the creators of CWN are discriminating based on viewpoint?

As Mr. Guterman mentioned, ICF produces CWN under contract for the Children’s Bureau, which has wholeheartedly endorsed the prevailing view of child welfare promoted by a group of well-heeled foundations and nonprofits, consulting firms and influential commentators. This narrative portrays a racist child welfare system that disproportionately investigates, intervenes with and separates Black children and families. It disregards the evidence that the need for protection is also much greater among Black children, suggesting that they are more likely underrepresented in relation to their need. The dominant viewpoint asserts that foster care is harmful and rarely necessary and that “prevention services” including financial aid can eliminate the need for most child removals. It holds that children should almost never be placed in non-family placements such as group homes or residential treatment centers. Proponents of this perspective hailed the Family First Act, which has failed to add significant preventive services while catastrophically reducing the availability of placements for the most troubled and traumatized young people, resulting in an explosion in the number of youths staying in offices, hotels and other inappropriate placements.

In my censored commentary, I provided examples of how the child welfare establishment and its preferred authors tend to share only the lived experiences that support their views, while ignoring experiences that support different viewpoints. And I gave examples of foster care alumni who have shared experiences of foster care and group homes that contradict the ones that have been repeatedly highlighted. Instead of choosing only the personal stories that support preferred views, I suggested that it is more useful to survey large samples of foster care youths or alumni. And I reported that such surveys result in much more positive views of foster care and group homes than those of the individuals who have been highlighted.

Over the years, Child Welfare Monitor has consistently expressed views that sharply question those of the child welfare establishment. But the CWN staff has never declined to share a piece because of its content. The website description of CWN states that the inclusion of a link “does not imply endorsement of any view expressed in a story and may not reflect the opinions of Child Welfare Information Gateway, the Children’s Bureau, or either organization’s staff.” So they clearly do not need to vet submissions for viewpoint.

The reason for the sudden change in practice (without notification or a change in the website language) remains a mystery, but one might speculate that it has something to do with a decreased tolerance for diverse views. But ICF or the Children’s Bureau would be violating the spirit and possibly the letter of the First Amendment if it were purposely excluding from a government publication content that does not fit the prevailing view. The Supreme Court has ruled that the government cannot discriminate against speech based on viewpoint, stating that: “When the government targets not subject matter but particular views taken by speakers on a subject, the violation of the First Amendment is all the more blatant. Viewpoint discrimination is thus an egregious form of content discrimination. The government must abstain from regulating speech when the specific motivating ideology or the opinion or perspective of the speaker is the rationale for the restriction.”

The possibility of viewpoint discrimination by the federal government or its contractor is deeply disturbing. But ICF’s dishonesty is also concerning. I was told for weeks that the article was still under review. When I persisted, I was told that my piece was censored because of “personal fundraising links” that I could not identify. When I asked to be shown the links so I could remove them, I was then given an entirely different explanation. And the new explanation was equally absurd, citing issues with my blog that either did not exist or were common to many other pieces shared in CWN. So there must be another reason they have not given me, and discrimination based on viewpoint is the only one that comes to mind.

It is unfortunate that my attempt to tell the truth about child welfare has finally come up against the increased intolerance for diverse views, even in a government-funded clearinghouse. Unless I find an organization that wants to take my case to court, it is unlikely that “The Misuse of Lived Experience” will be published in Child Welfare in the News. I’ll have to rely my readers to share my writing with their colleagues. Please share this blog and my censored post and urge people to follow Child Welfare Monitor. We cannot let the censors win.

The misuse of “lived experience” in child welfare

Vanessa Peoples: Gofundme, https://www.gofundme.com/f/nb2wut-help-vanessa-get-back-on-her-feet

“Those closest to the problem have the answers to solving it. Every child welfare policy and project should prioritize incorporating the expertise, perspectives and experiences of the people whose lives have been directly impacted by the system. We call this ‘centering lived experience.'” There is a lot of truth in these words from an organization called Think of Us and a lot of good in the current focus in child welfare and other fields on considering the actual experience of people affected by systems when developing new policies and practices for these systems. But the emphasis on lived experience has potential pitfalls. When experiences that support a particular perspective are highlighted and those that contradict it are not, and when evidence from data and research are ignored in favor of narratives that may be outliers, there is a risk of adopting policies and practices that hurt, rather than help, children and families.

As described in a brilliant article by Naomi Schaefer Riley and Sarah Font, it is “individuals and groups with a platform” like foundations, government agencies, and journalists, that “select the people with lived experience to serve on advisory boards, testify to Congress, give media interviews, or otherwise disseminate their story.” The “lived experiences” that are selected tend to support the views of what I call the “child welfare establishment,” which includes federal, and many state and local child welfare agency leaders; foundations and nonprofits; consulting firms; and influential commentators and writers. They tend to believe that foster care is harmful and rarely necessary, and that on the rare occasions when children are youth must be placed in foster care, they should almost never be placed in “congregate care” placements such as group homes or residential treatment centers.

Let us start with the idea that foster care is rarely necessary, and the child protective services (or the “family policing system” as author Dorothy Roberts and others put it) removes children from loving parents who just need a little bit of help, thus harming rather than helping children. The story of Vanessa Peoples illustrated this thesis so well that it was shared by numerous media outlets before being picked up by Dorothy Roberts to begin her book, Torn Apart, about how the child welfare system “destroys Black families.” Peoples was a mother of three small children who was apparently doing everything right; she was married, going to nursing school, about to rent a townhouse and was even a cancer patient. But Peoples attracted the attention of both the police and child welfare and ended up hogtied and carted off to jail by police, placed on the child abuse registry, and subjected to months of monitoring by CPS after she lost sight of her toddler at a family picnic in June 17 when a cousin was supposed to be watching him.

From the information provided by Roberts and others, it sounds like Peoples’ was the victim of a hyperactive agency and police department, but it is also possible that critical details were omitted from the narrative. Moreover, Roberts did not include any narratives from people with a very different experience, like this one from Kiana Deane writing in The Imprint: “For me, meth became the pernicious thief that stole my home, my sense of belonging and, at times, my well-being. Being placed in a foster home saved me. Though foster parenting is not for everyone, I couldn’t imagine a world without the protection of the foster care system.” The Kiana Deanes are not asked to testify before Congress, highlighted in books by trending authors, or interviewed by the mainstream media for stories on foster care. (But kudos to The Imprint, which has published many narratives from youths who are grateful that they were placed in foster care.)

Then there’s the issue of group homes versus foster family homes. We all “know” that group homes and residential treatment centers are houses of horror because that is the only thing we ever hear. In the two hearings it held on the Family First Act, the Senate Finance Committee heard from only one person with “lived experience” in a group home, and that was Lexie Gruber, who told Senators about the locked food cabinets, punitive disciplinary system, over-medication, and the lack of emotional support that characterized her group home experience in Connecticut. But Senators did not hear from anyone like Imani Young, who wrote in The Imprint: “Eventually, OCFS (the Office of Children and Family Services) brought me to a wonderful placement called St. Christopher’s. …While in the NY child welfare system, I wanted to feel safe, comfortable, respected and not neglected, and St. Christopher’s made me feel all of THOSE above. They taught me independent living skills, helped me manage my money, got the counseling I needed, and taught me that there’s more to life.”

Other than the selective presentation of lived experiences to be highlighted, another problem with using individual narratives to develop policy is that each person presents their own version of their story, which may leave out crucial details. It is rare for a journalist, author, or Congressional committee to check up on the accuracy of a story that supports the broader narrative they are seeking to portray. Vanessa Peoples’ wanted to portray herself as an innocent victim who did nothing to merit the intervention of CPS, and Roberts had no interest in finding inaccuracies in her story. Lexie Gruber, too, was intent on making the case against group care. She did not talk about the support that she must have gotten from the group home in order to get into college, or any other positive aspects of the care she received.

When the media, congressional committees or advocacy groups select only one set of lived experiences to highlight, real harm can result. Take the passage of the flawed Family First Prevention Services Act (FFPSA) in 2018 after only two hearings with a “curated” group of invited speakers who were clearly chosen to support passage of the bill. Lexie Gruber was the only former foster youth who spoke at the hearing on group homes and other congregate care placements, which was titled No Place to Grow Up: How to Safely Reduce Reliance on Foster Care Group Homes. When it was finally passed in 2018, FFPSA contained drastic restrictions on federal reimbursements for group homes and other residential placements. I wrote in a recent post about how those restrictions have contributed to a placement crisis around the country, with the most troubled foster youth spending weeks or months in offices, hotels, jails, hospitals and other inappropriate and harmful settings. I don’t claim that hearing from Lexie Gruber caused Congress to impose drastic restrictions on group homes, but it was certainly used to support that action.

Don’t get me wrong. Every individual’s story has value. Such stories allow us to visualize the reality behind dry data and statistics. But, to make policy, we need to know whether a story we hear is an outlier or representative of the average experience. It’s not that outliers don’t matter; we need to have protections to ensure that the worst possible outcomes (like the killing of 16-year-old Cornelius Fredericks in a residential treatment center run by Sequel Youth and Family Services) don’t occur. But making policy assuming the outliers represent the majority can lead to disastrous outcomes, like the congregate care provisions of FFPSA.

In contrast to individual narratives, surveying a representative sample of people with lived experience in a particular setting or system can provide information that is useful for policy purposes. Such information is not guaranteed to be accurate; survey response rates are often suboptimal and those who do respond may differ systematically from those who don’t. Nevertheless, such surveys are a much more accurate way of assessing lived experience than relying on individual anecdotes.

And it happens that in child welfare, surveys of older foster care youth and alumni present a much more positive picture than what has been presented by the child welfare establishment and the media. In four studies of former foster care youth reviewed by Barth et al, majorities said that they were lucky to have been placed in care. Most recently, the CalYOUTH study followed a cohort of 727 youth who were in foster care at age 17, with personal interviews every other year until they were 23 years old. At 23, 68.4 percent of the 621 respondents said that they were lucky to have been placed in foster care. And 57.4 percent were “generally satisfied” with their experience in foster care.

There are few studies of youth perspectives on residential care, but a recently published study in a leading child welfare journal reports on the experience of 450 youths placed in 127 licensed residential care programs in Florida between 2018 and 2019. The youths responded to a validated quality assessment that asked them to rate their facilities on elements of service quality in seven domains based on evidence and current best practice standards. Overall, youth provided high ratings of their residential programs on all seven domains. The mean ratings indicated that youths felt their facilities were “mostly to completely” meeting the standards across all domains.¹

This does not mean that there are no children who could have stayed safely with their families and not been placed in foster care had the right help been provided. Nor does it mean that there are no terrible group homes. The current placement crisis (to which FFPSA has contributed) means that more youths will be placed in neglectful or even abusive homes or facilities than if this crisis did not exist. But when advocates of one point of view choose to share only those experiences that support their viewpoint, the use of lived experience to support particular policy proposals can lead to policy choices that are harmful to the people they are intended to help.

Note

But not all surveys are based on large, scientifically-chosen samples. For example, the nonprofit,Think of Us, which has the aim of “centering lived experience,” published a report called Away from Home: Youth Experiences of Institutional Placements in Foster Care. That report is based on the responses of 78 young people residing in what it called “institutional placements, which included group homes, homes for pregnant and parenting teens, and therapeutic residential treatment facilities around the country. Among the conclusions of the report were that institutional placements were prisonlike (“carceral”), punitive and traumatic for their residents and failed to meet child welfare mandates to provide safety and wellbeing. The methodology section, relegated to an Appendix, reveals that the 78 participants were recruited through an “open call for participation through youth advisory boards and community partners.” Assuming that these are advisory boards and community partners of Think of Us, and knowing that the nonprofit and its CEO are associated with the dominant viewpoint on group care, one has to wonder whether the recruitment process produced an unbiased sample.

Shiny, happy and homeschooled: the Duggar family and the need to regulate homeschooling

After its premiere on June 2 on Amazon Prime Video, Shiny Happy People: Duggar Family Secrets, reached more viewers in its first nine days than any other Amazon docuseries. The series exposes the fundamental moral corruption underlying the Duggar family, the subject of TLC’s long-running reality series, 19 Kids and Counting, as well a spinoff entitled Counting On. The Amazon series reveals the Duggar family involvement with a fundamentalist Christian movement that endorsed physical child abuse, sanctioned educational neglect, and created a culture of sexual abuse of women and girls. One issue that was not discussed in the series is the key role that unregulated homeschooling plays in allowing the abuse and exploitation of children like the Duggars to occur and persist.

For someone who was hardly aware of the Duggars and their reality-shows empire, Shiny Happy People was a revelation. I learned that the Duggers were the poster children for an organization called the Institute in Basic Life Principles (IBLP), which was formed in the 1960s by a minister named Bill Gothard in reaction to the civil rights, women’s rights, and student protest movements, and to the cultural changes of the period. The first principle of IBLP was “Authority.” Just as God was the ultimate authority over mankind, so did IBLP preach the father’s ultimate authority over his family. Girls remained under the authority of their fathers until they transitioned by arranged marriage to the authority of their husbands.

To reinforce its authority, IBLP preached (and the Duggars used) physical punishment starting from infancy. As babies, the Duggar children were subjected to “blanket training,” promoted by the book To Train Up a Child, which is popular in Christian homeschooling circles. Babies are shown a desirable object, told not to touch it, and hit every time they reach for it. The point is to teach obedience. The survivors interviewed for the series spoke of receiving physical punishment for just about any transgression, no matter how minor.

In 1984, IBLP published a home-schooling curriculum consisting of “wisdom booklets” based on the Bible, which was marketed as an academic curriculum but according to survivors contained little if any actual education. Children learned that all fossils were created by God at the same time and that the rhythm of rock music could be traced to satanic ritual; girls were taught to identify what items of female clothing are provocative and should be avoided. It’s not surprising that many survivors spoke of struggling financially after leaving home without preparation for further education or work beyond the minimum wage level.

The children of IBLP families were brought up with frightening visions of hell and taught to constantly examine their own thoughts for evidence of sin, especially the sin of lust. This practice may have backfired. Survivors interviewed for the series reported that IBLP families were rife with sexual abuse. It was eldest son Josh Duggar’s admitted abuse of his sisters among other girls that put an end to the long running series, 19 Children and Counting. It was replaced by a new series called Counting On, which focused on some of the family’s daughters, but that show in turn was suspended after Josh Duggar was arrested for receipt and possession of child pornography. He is now serving 12.5 years in prison.

IBLP is not the only Christian home schooling movement that promotes physical punishment and educational neglect. The Revolt of the Christian Home-Schoolers, a brilliant article by Peter Jamison in the Washington Post, tells the story of Christina and Aaron Beall, who were brought up in families that were both active in a religious community led by Gary Cox, an evangelical pastor and pioneer of Maryland’s home-schooling movement. (Cox’s son later ran for Governor of Maryland and lost in a landslide to Wes Moore.) Christina and Aaron could not bear to watch their children grow up the way they did – in fear of being beaten several times a week. They rejected corporal punishment for their four children and eventually decided to send them to public school.

Christina and Aaron’s children were lucky. But states’ policies toward homeschooling provide little protection for those who need it, like the Duggar children. The Amazon series did not address the policy context of the abuses suffered by the Duggars and all the other children brought up in IBLP and similar movements, or how future children in these environments could be protected. As Eve Ettinger, the oldest of nine children homeschooled in a fundamentalist Christian home, explains in Salon Magazine, it is the failure of states to meaningfully regulate homeschooling that allows abuse and neglect to take place in these homes.

Before continuing, it is important to note that It is not just fundamentalist Christians who homeschool. Homeschoolers include Black parents who wish to avoid racism in the public schools, parents of elite athletes or musicians whose schedule does not allow for attendance at regular schools, and other parents who simply want to have more input into their children’s education than the public schools allow. And most of these parents are no doubt well-meaning and provide an excellent education. But when homeschooling parents abuse or neglect their children, the protections provided to other students are not available.

According to the Coalition for Responsible Home Education (CRHE), an advocacy group started by homeschool alumni, 11 states require nothing of homeschooling parents, not even notification to the school district when they begin homeschooling. Another 16 states require only that parents who intend to homeschool give notice to state or local officials. The remaining states have some combination of requirements for subjects covered, hours of schooling, academic assessments, parent qualifications, or other provisions. Only nine states require academic assessments that are meaningful because they must be submitted to the government or require a certain level of achievement. Only 11 states require any qualifications (usually a high school degree or GED) for parents who want to homeschool their children, and only two states conduct background checks for parents who want to homeschool their children. Of those two states, Pennsylvania prohibits homeschooling if a parent or other adult in the household has been convicted of any of a range of offenses. Arkansas prohibits homeschooling if a registered sex offender lives in the household, but parents may petition the sentencing court to have this restriction waived. No state provides for monitoring of parents who begin to homeschool during or after a child protective services investigation, or for those with histories of child welfare involvement. Such provisions have been introduced in several states but have failed to become law due to opposition from the homeschool lobby. Shockingly, no state requires that a state employee or contractor ever set eyes on the child once homeschooling is approved.¹

The lack of meaningful standards and monitoring of home education opens the door for educational neglect by parents who reject the importance of anything but a biblical education. Such educational neglect was described eloquently by many survivors in the Amazon series, who reported that their learning outside of religious principles was minimal and that they spent most of their time doing chores and caring for their younger siblings. Such children “graduate” from home schools without the knowledge and skills necessary to thrive in American society. A 2013 article in the Washington Post described one Virginia student’s struggle to fill the gaps in his home education. This determined young man needed several years of remedial education and other courses at the local community college before he could fulfill his dream of attending a four-year-college.

Even worse, the lack of contact with educational staff isolates homeschooled children from adults outside their families, churches, and fundamentalist homeschooling circles, leaving them particularly vulnerable to long-term maltreatment. Teachers and other school staff have traditionally been the most common reporters of child abuse and neglect.²When a child is being abused or neglected at home, it is teachers and others at school who see the bruises or the hunger. If the child does not go to school, that extra set of eyes is missing; there remains only the hope that a doctor or other professional (if the child is lucky enough to see one) will notice something is wrong. The importance of educators as mandatory reporters was illustrated in a chilling manner by the Connecticut Office of the Child Advocate, which found that of children withdrawn from public schools to be homeschooled between 2013 and 2016, 36 percent had at least one prior accepted report for suspected abuse or neglect to the Department of Children’s Services, and the majority of these families had multiple prior reports for suspected maltreatment. So it is not surprising that a disproportionate number of the horrific abuse deaths that make the news (such as the Hart children, Natalie Finn in Iowa, Matthew Tirado in Connecticut and Adrian Jones in Kansas), involved parents who hid their abuse behind the guise of homeschooling, even though schooling rarely took place in these homes.

Before the 1980’s, homeschooling was not even addressed in state laws. The first achievement of the new homeschooling movement was the legalization of homeschooling in the 1980s and early 1990s in every state, as described by Milton Gaither in his history of American homeschooling. This came about thanks to the work of the Home School Legal Defense Association (HSLADA) and allied groups. Since that time, HSLADA and state-level homeschool lobbies have often been successful in getting legislatures to strike requirements that were included in the original legislation. For example In Virginia, homeschool groups succeeded in removing the requirement that homeschooling parents have a bachelor’s degree, replacing it with the lower requirement of a high school degree or GED. In Arizona, the requirements that parents pass a proficiency exam and that students take annual standardized tests were both removed, and the new requirement that parents have a high school diploma or GED was later removed. In Iowa, homeschooling was completely deregulated in 2013.

Homeschool lobbies have also been successful at thwarting attempts to add regulations to protect children, some of which were inspired by egregious instances of abuse. After the 13 Turpin children and young adults were found imprisoned (some chained to their beds) and emaciated in their home in California, a horrified public learned that their parents had elected to homeschool as an individual private school, an option available in that state. California Assemblyman Jose Medina introduced a bill that would require a fire inspection for all private schools, regardless of size.³ Due to a massive outcry from the homeschooling community, the inspection requirement was eliminated, leaving a bill that required nothing but identification of homeschooling families by name and address. When the eviscerated bill was scheduled for a hearing, hundreds or perhaps thousands of homeschooling families poured into the capitol building, testifying for three hours. No committee member even moved to approve the bill, and it died that day.

The Covid-19 pandemic resulted in a jump in homeschooling enrollment which has not yet subsided. There has been an estimated 30 percent rise in homeschooling enrollment since the beginning of the 2019 school year. This increasing trend makes the need for regulation of homeschooling more urgent. CRHE’s recommendations for protection of at-risk children include prohibiting homeschooling by parents who have committed offenses that would disqualify them from teaching school, requiring that students be assessed annually by trained mandatory reporters, and flagging certain at-risk children (such as those in families with a history of child protective services involvement) for additional protections and support. CRHE also recommends requiring a high school degree or GED for the primary homeschooling parent, instruction in the same subjects as public schools, maintenance of academic records, and assessments of annual progress with interventions in case of inadequate progress, among other recommendations.

With Shiny Happy People, Amazon Prime exposed the abuse and neglect hiding behind the happy facade that the Duggar family presented through its reality shows. But unfortunately the series did not let watchers know how we can protect today’s homeschooled children from such maltreatment by increasing regulation and oversight. I wish the series had ended by urging viewers to contact their state legislators and urge them to mandate reasonable regulation and oversight for homeschooling, so that no more children will be victimized.

Notes

Presentation by James Dwyer, Homeschooling Summit, Harvard University, June 2021. See https://childwelfaremonitor.org/2021/07/06/homeschooling-harvard-conference-highlights-need-for-regulation/
In Federal Fiscal Years 2020 and 2021, teachers lost their top ranking as maltreatment reporters to legal and law enforcement personnel due to Covid-19 school closures. It is my guess that they will gain it back in 2022.
There actually already was a fire inspection requirement for schools with 6 or more children, but there was no record that the Turpin home had been inspected.

Residential care in child welfare: An international perspective

In my last post, Family First at five: Not much to celebrate, I discussed how the Family First Prevention Services Act (FFPSA) made it more difficult to provide residential care (often pejoratively called “congregate care” by the Act’s supporters) for the most troubled foster youth while doing little to ensure the development of alternatives. The result has not been surprising–an exacerbated placement crisis, with foster youth around the nation sleeping in hotels, offices, jails and other inappropriate settings. An important new book provides an international perspective on residential care. It shows that the U.S. ranks very low in the percentage of foster youth that are in residential care, casting doubt on the advisability of trying to further reduce residential placements. The obvious conclusion is that we would do better to increase the quality of residential care by raising standards for staff.

The new book, Revitalizing Residential Care for Children and Youth, is a compilation of research on residential care in 16 high and middle-income countries, edited by James K. Whittaker, Lisa Holmes, Jorge F. Del Valle, and Sigrid James, who are professors at universities in the US, England, Spain, and Germany, respectively.¹ The editors define “residential care” as “any group setting where children spend the night,” encompassing settings that vary in size and function and that operate under the auspices of child welfare, juvenile corrections, or mental health. The 16 countries are viewed through a common template, making comparisons possible. However, there are problems with such comparisons. As explained in the second chapter, countries differ in the terms they use for different types of care and how they define these terms, among other things. The editors’ definition of “residential care” does not ensure that the same facilities are being counted across nations. A small group home with paid staff might be classed as “foster care” in some countries, and some facilities (like those for youth offenders) might be counted in the residential totals for some countries and not others.

Keeping in mind the impossibility of obtaining data that is totally comparable across countries, there appears to be a striking variation between nations in the utilization of residential care for youths who are in out-of-home placements. The editors defined the residential care utilization rate as the proportion of out-of-home care dedicated to residential care rather than family foster care or other types of out-of-home placements. This percentage ranged from seven percent in Ireland and Australia to 97 percent in Portugal, as shown in Figure 29.1, which is reproduced below. The United States had the third lowest residential care utilization rate, with ten percent of children in out-of-home placements being in residential settings. Moreover, the number of children in U.S. residential care fell by about 25 percent between 2015 and 2019. According to the editors, it appears that countries in the low-utilization category have made legislative changes (like FFPSA and California’s Continuum of Care Reform in the US) that have led to drastic reductions in residential care. But the countries with medium utilization rates (between 30 and 55 percent) seem to be focused on improving residential care by strengthening the elements believed to be associated with quality care rather than reducing the utilization of residential care.²

Source: James Whittaker et al, *Revitalizing Residential Care for Children and Youth*, page 430.

The authors also found great variability in the education and training requirements for residential care staff. These range from no minimum qualification in the United States, Canada and Australia, to high school level (Israel, Argentina and Portugal), to rigorous multiyear vocational training and/or university education in the other countries. A number of countries use both vocationally trained and university educated staff. For example, in Germany, about 70 percent of residential care staff hold a 3.5 to five-year vocational degree as educators (or in fewer cases two years as assistants) and 30 percent have Bachelors’ degrees in social work or “social pedagogy.”³

The editors found that it is countries with lower educational requirements for staff that have turned against residential care and have sought a drastic reduction of its use. Among those countries was, no surprise, the United States, along with Australia and England. In contrast, countries with a high qualification requirement have higher utilization of residential care. This correlation is not surprising. There is no doubt, say the volume’s editors, that “the quality of the services is directly related, in any field, to the qualifications, training and experience of the professionals who provide them.” In child welfare, they argue, “[I]t is difficult to carry out the work without a qualification based on the learning of very diverse theories related to child development, the clinical expressions of trauma, listening and helping techniques, the framework of family relationships, and ecological theories.” The editors suggest the existence of a vicious cycle, where low staff qualifications may led to poor quality and outcomes, which in turn lead to reduced funding, making it harder to recruit well-qualified staff.

Unfortunately, available data do not tell us what proportion of children and youth in residential care in each country are there for time-limited treatment for behavioral issues with a plan to “step down” to a family setting. Available data suggest that a majority or large minority of children and youth in residential care in the middle-utilization countries have a mental health diagnosis, which does necessarily mean that they are in a time-limited therapeutic setting. Most likely, the residential care population in the middle-utilization countries is a combination of youths with issues that require treatment in residential care and those who could be in family foster care if available As one of the editors notes in the introductory chapter, “residential care across the globe …does not seem to be limited to the narrow treatment-oriented and time-limited setting it is generally reduced to in several Anglo-American nations. In fact, in many countries,…., children and youth still spend years in residential care programs.”

The assumption that family foster care is always the better choice unless a child cannot function in such a setting may be unique to the English-speaking countries. Small, family style group homes, whether freestanding or part of a campus of such homes, may be difficult to distinguish from foster homes, especially if they use a house-parent model. In fact, the authors say, some countries classify “a small “family group” home, staffed by paid staff” as a foster home. I have argued in the past that high-quality family-like group homes may be better for children than mediocre or poor-quality foster homes and are especially appropriate for siblings. Indeed, as discussed in the book, France has 28 children’s villages, which are family-like units especially for siblings.

The evidence shared by Whittaker et al. has important implications for the United States. Given our low position on the scale of residential care utilization, one might logically conclude that further lowering the number of children in residential care would be unrealistic. In the two countries with lower residential utilization rates than the United States, Ireland and Australia, news accounts document an urgent need for more foster parents, with young people being separated from siblings, moving from one emergency placement to another for lack of a suitable home, and spending nights at hotels. Instead of trying to bring the residential share of foster care even lower, the U.S. might be better advised to follow the example of countries like Germany and Finland, which are focusing on improving residential care programs rather than eliminating them.

Cross-national comparisons are valuable in many policy areas, and the absence of such comparisons in child welfare debates is particularly unfortunate. Reading this book brings home the lack of international comparisons informing Congress when it passed the FFPSA. As far as I know, the supporters of FFPSA’s drastic restrictions on residential care never referred to other countries’ use of residential options; that’s not surprising as such comparisons may have led to uncomfortable questions about the premise that too many foster children and youth were in residential care.

Some members of Congress who supported the residential restrictions in FFPSA may have been more concerned about budgets than ideological objections to residential care. Improving residential care costs money, while cutting it may appear to help balance budgets. FFPSA was designed to be budget-neutral, so that restrictions for funding of residential care were required in order to offset the increase in spending for services to families. And it apparently did not matter to Congress if those costs were by necessity picked up by states that had no other options: the federal government would see the savings.

Perhaps the federal coffers have benefited from the restrictions on federal funding for residential care, especially because federal spending for the “prevention services” side of Family First has been negligible. But it is hard to believe that states have gained financially from the new law. Spending as much as $2,000 a night for a hotel room complete with staffing and security for foster youth, as Washington State is reportedly doing, cannot possibly be a better use of funds than improving and expanding residential care. And the effects on children and youth are disastrous. One can only hope that state leaders will be brave and smart enough to take the first steps in the direction of revitalizing residential care to be a nurturing and therapeutic environment for children and youth and a field that is a source of pride for its practitioners.

Revitalizing Residential Care for Children and Youth should be required reading for anyone involved in making policy or drafting legislation regarding foster care. But it is probably too much to hope that the anti-residential crusaders will choose to read this important book. They find it more comfortable to continue believing that cutting funds for these programs without providing an alternative will save money and help children at the same time.

Notes

The countries studied include Argentina, Australia, Canada, Denmark, England, Finland, France, Germany, Ireland, Israel, Italy, the Netherlands, Portugal, Scotlad, Spain, and the United States.
Portugal, with 97 percent of its out-of-home youth in residential care, is in violation of its own law establishing residential care as the last option for out-of-home care. It appears that the country has not developed the supply of foster parents needed to shift the system toward home-based care. Argentina, with 86 percent of children separated from their families living in residential care, is only in the early stages of developing family-based foster care. In Israel, a system of residential facilities or “youth villages” developed as a means of social integration of immigrant groups, starting with survivors of the Holocaust. This system of residential care operates under the MInistry of Education. A separate child welfare system developed later under the Ministry of Labor, Social Affairs and Social Services, to serve the needs of maltreated children, and 63 percent of the children in this system are also in youth villages.
According to the editors, “[s]ocial pedagogy is grounded in a holistic understanding of the person and espouses participation, democratic processes, self-determination, and social and moral education within the context of everyday life as guiding values and principles for practice. Individualization (n contrast to standardization) and professional decision-making are further hallmarks of this approach.”

Family First at five: Not much to celebrate

When the Family First Prevention Services Act (FFPSA) passed as part of the Bipartisan Budget Act of 2018, it was hailed by many as a revolutionary step in the history of U.S. child welfare. Five years after the Act took effect, child welfare leaders have been weighing in with statements like this one from Rebecca Jones Gaston, Commissioner of the Administration on Children, Youth and Families: “Following its passage five years ago, the Family First Prevention Services Act has transformed our approach to child welfare and benefited families across the many states that have used it to provide concrete support and services.”¹ But for those closer to ground-level and less invested in demonstrating the act’s success, there’s not much to celebrate.

FFPSA had two major goals: to keep children out of foster care altogether through services to families and to keep more of those who do have to enter care in family homes. In terms of the first goal, the law’s impacts on services to families have been almost negligible. And in its effort to keep foster children in families, FFPSA has exacerbated the critical shortage of appropriate placements for our most troubled youth, many of whom may need placements in larger settings. In this post, I examine these two goals and their outcomes in greater detail.

FFPSA’s Part I made it possible to allocate funds under Title IV-E of the Social Security Act, previously directed mainly to foster care, to services aimed at keeping children out of care. The law allowed spending on mental health, substance abuse prevention and treatment, and in-home parenting services, “when the need of the child, such a parent, or such a caregiver for the services or programs are directly related to the safety, permanency, or well-being of the child or to preventing the child from entering foster care.”

As I explained in my 2019 post, Family First Act: a False Narrative, a Lack of Review, a Bad Law, Part I was based largely on the false premise that current law, by allowing TItle IV-E funds to pay for foster care and not for services to prevent it, incentivized states to remove children rather than keep families together. While it is true that IV-E funds were not available to pay for services to children and families in their homes, that does not mean that no money was available to help keep families together or that states had an incentive to place children in foster care. In fact, states had long been using Medicaid and other funds for services to prevent placement of children in foster care. In Federal Fiscal Year 2017, according to federal data, out of the children who received services after a CPS investigation or alternative response, only 201,680 were placed in foster care, while 1,332,254 (or more than five times as many children) received in-home services such as case management, family support, and family preservation services.²

Disregarding the role that other funding already played in child welfare, the framers of FFPSA required that Title IV-E would be the “payer of last resort,” so that any services already paid for by Medicaid could not be paid for by Family First. By doing this, they ensured that states with a generous Medicaid programs would be hard-pressed to find any service already existing in the state on which to spend their TItle IV-E money. If not for this provision, such states might have chosen to supplement Medicaid funding for some of these services. Perhaps some states would have allowed Title IV-E funds to be used to pay high-quality providers who do not accept Medicaid funding due to the program’s low reimbursement rates and high paperwork burden. (During my time as a foster care social worker in the District of Columbia, we had contracts with high-quality providers who did not accept Medicaid in order to provide therapy for our most complex clients).

The choice to fund only parenting, mental health and drug treatment services by the framers was another design flaw of FFPSA. The absence of a domestic violence service among the funded services is striking. It is universally acknowledged that drug abuse, mental illness and domestic violence are the “big three” factors that result in foster care placement. But for some reason, the words “domestic violence” are nowhere to be found in FFPSA. Perhaps even more striking is the failure to include one of the most promising services to prevent foster care–high-quality child care. As I have written, not only does quality early care and education prevent foster care placement through multiple pathways, but it also provides an extra set of eyes on the child in case of continued abuse or neglect–greatly needed if FFPSA is to achieve its goal of keeping children both safe and out of foster care. Think of what a difference Congress could have made by providing matching funds to provide quality child care to all families with in-home cases!

Perhaps the most unfortunate feature of FFPSA’s Part I is the requirement that all funds must be spent on “promising, supported or well-supported practices,” with 50 percent of the total spent spent on “well-supported practices” — a percentage that increases after 2026. The law imposes strict requirements for designating a program as promising, supported or well-supported. It set up a clearinghouse to assess the data on existing programs and approve those that met the criteria. As Dee Wilson points out in one of his essential commentaries, the law gets it exactly backwards. We have very little evidence about what works to prevent foster care placement. What we need is to invest in innovative approaches to doing this safely. But FFPSA prevents the use of TItle IV-E funds for this purpose.

Thanks to the various restrictions imposed by FFPSA, the clearinghouse is woefully incomplete. For example, Cognitive Behavioral Therapy (CBT), the therapy of choice for depression and anxiety, which has not been approved nor is it on the list of programs to be examined by the clearinghouse. (“Trauma-Focused CBT,” a newer and much narrower and short-term model, has been approved.) No residential drug treatment program has been approved or is even slated to be considered. The requirement that the practice have a manual may be at fault for the failure to include CBT and residential drug treatment programs, but I’d like to hear from readers who may be better-informed. Buphenorphine therapy for opioid use disorder, which is often preferred to methadone therapy (which is approved by the clearinghouse)because it does not require daily clinic visits, has not been approved and is not slated for consideration, according to the Clearinghouse.. Of course, these popular programs are often funded by Medicaid anyway, so they would be ruled out by the last resort provision as well.

With all these restrictions on Title IV-E spending, it is not surprising that states have been hard-put to find useful ways to spend Title IV-E funds to keep families together. In an important article, Sean Hughes and Naomi Schaefer Riley cited the latest available federal data showing that just 6,200 children across the entire country received an FFPSA-funded service in FFY 2021, costing a grand total of $29 million. That is truly underwhelming given that about 600,000 children were found to be victims of maltreatment in FFY 2021.

The other major purpose of FFPSA was outlined in Part IV, entitled “Ensuring the Necessity of a Placement that is not in a Foster Family Home.” The purpose of this part was to keep more children out of “congregate care,” a term used to designate settings other than foster homes, such as group homes and residential treatment centers. FFPSA made it more difficult to place a child in a congregate placement by imposing conditions on Title IV-E reimbusement for such placements, and by limiting reimbursement after two weeks to facilities that qualify as “Quality Residential Treatment Programs (QRTP’s), a new category defined by the act. QRTP’s must meet strict criteria that many facilities that were caring for foster youth at the time of FFPSA’s passage could not meet without major changes. The act also (perhaps inadvertently) further restricted the number of congregate care beds available to foster youth by creating a conflict with a Medicaid provision called the “Institutions for Mental Diseases (IMD) exclusion” that prevents Medicaid paying the cost of care for children who are placed in facilities with more than 16 beds.“

Like Part I, Part IV of FFPSA was in large part based on a false narrative. The myth this time was that every child does better in a family rather than in a more institutional setting. But as I described here, there are many foster youths who cannot function in an ordinary foster home, at least until after a stay in a high-quality residential treatment program or group home. These are the same young people who bounce from home to home and end up in hotels, offices, jails, and other inappropriate settings, but FFPSA made no provision for them.

Even if too many children had been placed in residential care without sufficient clinical justification (which is probably the case in at least some states), it would not be responsible to shut down congregate care placements before ensuring that appropriate foster homes were available for all the children being displaced. But just as the deinstitution movement of the 1960s closed mental hospitals before putting alternatives in place, FFPSA disregarded the question of where children would go when congregate settings disappeared.

As I described here, FFPSA exacerbated trends that were already underway. Group homes and residential treatment centers were already shutting down due to growing publicity about abusive incidents at some facilities, failure of reimbursement rates to keep up with costs, and resignation of staff due to poor pay and working conditions. Tragically, this reduction in residential capacity coincided with increased demand for care due to the youth mental health crisis and increasing levels of need in the foster care population due at least in part to delays in removing children from abusive and neglectful homes. The restrictions put in place by FFPSA added to the problem. As Hughes and Schaefer Riley put it, “If you want to understand why foster children across the country are being housed in a range of inappropriate temporary settings, including county and state offices, hospitals, hotels and shelters, FFPSA is a significant factor.”

The trends just mentioned have contributed to a foster care placement crisis that has if anything worsened since I described it last October. In Illinois, the Department of Children and Family Services (DCFS) is being sued by the Cook County Public Guardian for allowing foster children to remain locked up in juvenile detention even after they’ve been ordered released. In Maryland, a disability rights group has just filed suit against the Department of Human Services and other agencies for keeping foster children in hospitals and restrictive institutions beyond medical necessity for weeks, months, or even as long as a year. In a must-read article, Dee Wilson documents a 370 percent increase in hotel/office stays in his state of Washington since 2018 despite a federal court order to stop the practice. At an average cost of up $2,000 per night (including the cost of paying two social workers and a security guard), overnight hotel placements cannot possibly be cheaper than group homes or residential treatment centers. Similar problems are reported around the country, differing only in which inappropriate settings each state is relying on.

As is often the case, California paved the way for FFPSA by passing its Continuum of Care Reform, designed to curb the use of congregate placements, in 2015. A new article in the Los Angeles Times recounts the results. The number of children living in congregate care has dropped from 3,655 to 1,727 since implementation of the law, but the state has failed to find the foster homes to replace the congregate care settings. As a result, Los Angeles County has placed more than 200 foster youths in hotels, sometimes for months. County officials report that two social workers have been assaulted by foster youths in separate incidents this year at hotels. Moreover, it appears that care at the existing congregate facilities has grown worse as larger numbers of troubled youths are placed together in fewer facilities. The results of California’s reform and of FFPSA were predictable and indeed predicted by some commentators (including this writer), but these predictions were ignored.

As Dee Wilson puts it, “The implementation of Family First legislation has accelerated the demise of residential care, which has decreased 25% nationally during the past five years. It has been the goal of the federal Children’s Bureau and influential foundations to reduce the use of residential care (which has a bad reputation among advocates and most scholars) and they have succeeded; but without developing — or sometimes even proposing – viable alternatives.”

Anyone who chooses to celebrate the “revolution” wrought by FFPSA is living in a dream world. It’s time for Congress to recognize and correct the many errors it made in passing the law. At a minimum, Congress should add funding for early care and education and domestic violence programs to the models that can receive funding under Title IV-E, loosen the standards for evidence-based practices, modify the last-resort provision to allow payment for services to providers who do not accept Medicaid, eliminate some of the restrictions on congregate care, and provide incentives for states to boost their capacity of quality residential programs. Until such changes are made, there will be nothing to celebrate.

Alexia Suarez (asuarez@wearerally.com), [YOU’RE INVITED] Expert panel on the Family First Prevention Services Act. Email message, May 15, 2023.
These are duplicated counts as children are counted again each time they are the subject of an investigation and receive post-response services.

What is the cause of racial disparity in child welfare?

There is no doubt that Black children and families are reported to child abuse hotlines, investigated, and removed from their homes more than White children. But many leading voices in child welfare today have made the dubious assumption that racial bias in reporting and child protective services is the underlying reason for these disparities. Unfortunately, based on this assumption, they propose policy solutions that risk destroying existing protections for Black children or even for all abused and neglected children. A star-studded group of researchers has collaborated on a paper that ought to put this presumption to bed for good. I hope that this brilliant paper is able to change the minds of some who have unquestionably adopted the fashionable theory that is being promoted by the child welfare establishment.

There is no dispute that Black children are reported to authorities, investigated for abuse or neglect, and placed in foster care at a higher rate than White children. The federal publication, Child Maltreatment 2021, reports that Black children are nearly twice as likely as White children to be the subject of a screened-in report and almost twice as likely to be substantiated as a victim of child abuse or neglect. In 2020, Black children were 14 percent of the child population but 20 percent of the children entering foster care. Kim et al estimated that 53 percent of Black children will experience a CPS investigation by the age of 18, compared with 28 percent for Whites. But are these disparities greater than what would be expected given the higher rates of poverty and other social problems among Black children? That’s the question that a group of 13 researchers addressed in a recent article on racial and ethnic differences in child protective services reporting, substantiation and placement, published in the leading child welfare journal, Child Maltreatment. The authors include most of the top researchers in the field, such as lead author Brett Drake and his co-authors Richard Barth, Sarah Font, Emily Putnam-Hornstein, Jill Duerr-Berrick, and Melissa Jonson-Reid–an accumulation of starpower rarely seen collaborating on a single article.

Previous studies cited in the paper have already concluded that when adjusting for income and family context, Black children were actually reported to CPS at similar or slightly lower rates than White children and that Black children who are the subject of investigations were no more likely to be substantiated or placed in foster care than White children. Despite these results, the belief that racial disparities are due to anti-Black bias in reporting and child protective services (CPS) decisionmaking has been asserted as established fact in publications by the federal government, numerous child welfare groups, the American Bar Association, the American Civil Liberties Union and Human Rights Watch, and many media outlets. A report by a leading legal advocacy group and the Columbia Law School Human Rights Institute urged the UN to investigate the American child welfare system for racial discrimination. After conducting its own review, a UN Committee recommended that the United States “take all appropriate measures to eliminate racial discrimination in the child welfare system, including by amending or repealing laws, policies and practices that have a disparate impact on families of racial and ethnic minorities.” Rather than advocating for reform of child welfare systems, some individuals and organizations, such as upEND, press for the extreme step of abolishing the entire child welfare system.

The new paper provides a needed antidote to the certainty that racial bias is the principal source of racial disproportionalities in reporting, substantiations, and foster care placements, and provide compelling evidence against it. The authors use universal national data to ask two questions:

Are Black-White and Hispanic-White disparities in CPS reporting lower than, similar to, or higher than disparities in non-CPS measures of social risk and child harm?
Once referred and accepted for investigation, do Black or Hispanic children experience substantiation and removal into foster care at rates lower, similar or higher than White children?

The authors focused on Black, White and Hispanic populations. Native American populations, which are also disproportionately involved in child welfare, are difficult to study because many are served by tribal child welfare systems and may not be reflected in the national data that the authors use. The authors used CPS data from the National Child Abuse and Neglect Data System (NCANDS), which gathers information from all 50 states, the District of Columbia, and Puerto Rico about reports of child abuse and neglect and their handling by child welfare agencies. Data from certain states and years had to be eliminated because of data quality problems and missing data. The elimination of all data from New York and Pennsylvania is unfortunate, but it is unlikely that these omissions changed the overall trends. Data for income and other indicators of risk and harm came from the Census Bureau, the Kids Count Data Center, National Vital Statistics records, and the Centers for Disease Control.

Question One: Reporting Disparities

The authors posit that the “expected rate” of Child Protective Services (CPS) involvement for a particular group of children should be “the rate at which children in that population experience child abuse, neglect, or imminent risk thereof.” But the authors explain that we cannot actually observe the incidents of abuse or neglect, as they are not always reported to authorities. And when reports are made, the system may not always make the correct decision when it decides whether or not to “substantiate” or confirm the allegations made by the reporter. To estimate the “expected rate” of being reported to CPS, Drake and colleagues used several categories of risk and harm that are known to be highly correlated with the risk of child abuse and neglect. Indicators of “social risk” included the numbers of children in poverty, children in single parent families, teen birth rate, and adults without a high school degree. To indicate harm to children, the authors used “very low birthweight,” “very preterm births,” infant mortality, homicide injury, and “unintentional death.”

Drake and his colleagues calculated “disparity ratios (DR’s),” by dividing the incidence of social risk or harm for Black or Hispanic children by the rates for White children by year. They found that the DR’s for all the measures of risk, and all of the measures of harm except accidental deaths, were greater than the DR’s for CPS reports. In other words, there was a greater disparity in risk and harm to Black children than there was in CPS reporting. Thus, given their likelihood of being abused or neglected, Black children appear to be reported to CPS less than are White children.

The tables below illustrate the incidence of risk, harm and CPS reports for Black children compared to White children. While Black children were reported to CPS at a rate close to twice the rate of White children throughout the period studied, their poverty rate was three times that of White children in 2019, the proportion of Black children in single-parent households was 2.5 times as as that of Whites, and the disparity in the rate of single-parent households and adults without a high school degree was almost as great. In terms of harm, Black children were four times as likely to be a homicide victim in 2019, nearly three times as likely to have a very low birth weight, and more than twice as likely to die of maltreatment, in 2019.

Disparities in Substantiation and Removal

To address disparities in substantiation and removal following investigation, Drake and coauthors compared the raw data and also ran regressions to adjust for demographic factors that might affect placement, such as poverty. They found that in both adjusted and unadusted estimates, Black children, once investigated, have been less likely to be substantiated and placed in foster care in more recent years. Before 2011, Black children were slightly more likely to be substantiated and placed in foster care than White children before the trend reversed. The unadjusted estimates are shown below.

When they compared Hispanic children to White children, the authors found a very different pattern. While Hispanic children face much more exposure to social risks like poverty than White children, they experience harm and CPS reporting at about the same rate as White children. This pattern is consistent with what is known as the “Hispanic paradox.” This term describes a well-documented phenomenon in the child welfare and medical literatures wherein Hispanic children and families have indicators of well-being similar to their White non-Hispanic counterparts, despite having much higher indicators on risk factors like poverty. For Hispanic children, there were slightly greater unadjusted rates of substantiation and placement than for White children, but these differences disappeared when statistical controls were added.

Conclusions and Implications

The authors draw two primary conclusions from their research. First, “Black-White CPS reporting disparities were consistently lower than Black-White disparities in external indicators of social risk and child harm.” Black children were exposed to more risk and experienced harm at greater rates than White children, and these disparities were consistently greater than the disparities in reporting. If either group is overreported in relationship to their risk it is White children. It is still possible, the authors point out, that all children are overreported to CPS in relation to external indicators of risk and harm. But “if there is systemic overreporting, it is not specific to Black children and thus, unlikely to be driven by racial animus.” They also found no evidence that once investigated, Black children were disproportionately substantiated or placed in foster care.

Second, the authors found continued evidence for the “Hispanic paradox” in CPS reporting compared to observed risk exposure. Although Hispanic children face substantially greater social risks than White children, they experience harm and CPS reporting at about the same rate as White children. This supports the well-documented pattern whereby more recently immigrated Hispanic families, despite having higher risk factors, tend to have indicators of well-being similar to Whites.

In the authors’ own words:

It is indisputable that despite progress in certain areas, the United States has not overcome the legacy of slavery, segregation and Jim Crow. This legacy lingers most clearly in the patterns of segregation that emerge in many of our metro areas…To assert that these patterns, and the poverty and chronic stress they perpetuate, would have no impact on behavioral and psychosocial functioning among the individuals and families in those neighorhoods is to reject decades of scientific consensus on human development. Indeed, this history and its unresolved legacy is essential to understanding why Hispanic families face similar individual socioeconomic disadvatage but appear to have sigificantly lower rates of CPS involvment than Black children.

If I have one quibble with the authors of this brilliant and essential article, it is their lack of attention to the possile psychological impacts of intergenerational trauma from the history of slavery, Jim Crow, and racial hatred and violence. As the child of Holocaust survivors, I can attest that the six years of trauma that my parents suffered after the Nazis invaded Poland has affected me and even my daughter. For families in which nearly every generation going back almost 400 years suffered the trauma imposed by living within slavery, Jim Crow, or a culture of virulent and violent racism that continues in some form today, it would be surprising if there was no current mental health impact on the generation that is parenting children today. Such a impact might include elevated levels of mental illness as well as self-medication through drugs and alcohol, both of which are associated with child maltreatment.

In the section on Implications, the authors assert the need to address the factors that underlie the differing rates of risk and harm to Black children, outside the CPS system itself–factors such as poverty and racial segregation. The belief that abolition of child protections would in and of itself help Black children, the authors point out, relies not only the assumption that CPS is racially discriminatory, which this paper has debunked. It also relies on the assumption that CPS provides no protection to children. Certainly there is room for improvement in our child protection systems, particularly in the quality of care they provide to children removed from their homes. Yet, foster youth testimonies such as “being placed in a foster home saved me,” or “Using my voice is the reason I am no longer in a household that is broken,” as well as the silent testimony of the more than two thousand children who die of abuse and neglect every year,¹ are a testament to the untruth of this statement.

The authors suggest three courses of action for the future. First, we should acknowledge and address the true drivers of racial inequity among families, such as multigenerational poverty, underresourced schools, and lack of access to quality substance abuse and mental health treatment programs. Second, despite their results, we must acknowledge that racial bias may exist in certain localities and be prepared to address it. And third, “there is clearly room to consider restructuring child and family policy generally to include a focus on providing preventive services, including material assistance, to families. (See my discussion of universal yet targeted programs to prevent child maltreatment.)

The authors go on to state that “It is possible that a narrow focus on reducing Black children’s CPS involvement without addressing the pronounced inequities documented by the external indicators will result in systematic and disproportionate unresponsiveness to abuse and neglect experienced by Black children.” And indeed, there are already reports that professionals are already more reluctant to report Black children and CPS employees are more reluctant to substantiate or remove them.² Or to put it more bluntly, the standards for parenting Black children will be lowered, and the level of maltreatment that Black children are expected to endure before getting help will be raised. Ironically, this calls to mind some manifestations of racism that have been cited by scholars and advocates, such as treating Black children as if they are older than their actual age, and thinking that Blacks have a higher pain threshhold than Whites. Of course if the child welfare abolitionists have their way, the entire system will be abolished, destroying protections for all children. That is unlikely to happen, but what is more likely is a weakening or repeal of critical laws like the Child Abuse Prevention and Treatment Act or the Adoption and Safe Families Act, which are both currently under attack, to eliminate or weaken provisions like mandatory reporting.

Sadly, few leaders on either side of our increasingly polarized political scene will be open-minded enough to read, understand and accept the conclusions of this important paper. While the progressive mainstream (and even many others in the child welfare establishment) has blindly accepted the notion that racial bias is the primary driver of child welfare disparities, conservatives remain obsessed with reducing the size of government and cutting taxes, refusing to recognize the need for massive spending, even a domestic Marshall Plan, to rectify the result of centuries of slavery and anti-Black racism in America.

Notes

States reported 1,820 child maltreatment fatalities to NCANDS in 2021. But experts cied by the National Commission to Eliminate Child Abuse and Neglect Fatalities (p. 9) estimate that the actual number is at least twice as many as that reported to NCANDS.
See, for example, Safe Passage for Children of Minnesota, Minnesota Child Fatalities from Maltreatment, 2014-2022. The report authors found evidence that raised the question of whether Minnesota child welfare agencies may have tended to leave Black children in more high-risk situations for longer periods of time than children of other races and ethnicities. See also Stacey Patton, The Neglect Of 4 Texas Brothers Proves That The Village It Takes To Raise A Black Child Is The Same Village That Stands By And Watches Them Die, Madamenoire, November 2, 2021. She states that “To reduce the number of Black children entering into foster care as a result of abuse, child welfare professionals are increasingly “screening out” calls for suspected child abuse. There haven’t been any state or national level studies to show whether disproportionately higher numbers of calls of Black child abuse are being screened out to avoid claims of racial discrimination. However, in my work as a child advocate, I keep hearing stories of non-Black child welfare professionals who don’t report abuse because they either don’t want to be accused of racism, or they just accept that beating kids is an intrinsic part of Back culture.”

No room for child advocates: Why I was kicked off DC’s Child Fatality Review Committee

Until recently, I was one of three “community representatives” on the District of Columbia’s Child Fatality Review Committee. Community representatives are the only members who are not paid to sit on this panel; the rest are agency representatives who sit on it as part of their jobs. My service on the panel was an important aspect of my advocacy for abused and neglected children in the District. But this work ended abruptly for me in March of this year when I was told that my service was over. As described below, I have some ideas about why the panel decided to dismiss perhaps its most engaged, passionate and productive member.

On March 2, 2023 I got a call from the Director of the Mayor’s Office of Talent and Appointments (MOTA). He said he was calling about my position on the District’s Child Fatality Review Committee (CFRC). I told him I had already received a call several weeks earlier from a MOTA staffer telling me that she was working on my reappointment, which should have happened earlier but was backlogged due to the pandemic. She asked me to submit an updated resume and told me she would be back in touch shortly to help me prepare for my DC Council confirmation hearing. But on March 2, the Director told me there had been a mistake. I was not being reappointed to the committee, and since my term had already expired, I was now off the panel.

When I asked why I was not being reappointed, I was told that it was time to give other people a chance to serve. This explanation made no sense. I was one of only three “community members” on the panel, out of eight authorized by DC Code. In her 2017 report, the DC Auditor noted the many vacant seats for community members and the importance of these community representatives, who are not tied to a specific agency. In her remarks preceding the 2017 report, CFRC Co-Chair Cynthia Wright wrote that “the addition of new community members [of which I was one] who provide a fresh perspective to our work …. has increased the vitality of the CFRC.” I doubt that there are five people lined up waiting to be appointed, or even one person ready to replace me. It’s not surprising that there is no long line of community members who want to volunteer two to four hours of their time each month in meetings about children who die, not to mention reading the sad case histories before the meetings. It was clear that my expulsion was not intended “to make room for somebody else.”

My de facto expulsion certainly did not stem from a lack of commitment or shoddy performance. I attended all 13 meetings of the Child Fatality Review Team in FY 2022 and the first quarter of FY 2023. According to the government’s responses to the oversight questions posed by the Committee on the Judiciary and Public Safety, the two other community members attended nine and seven out of 13 meetings respectively. I read every case study in advance of the meeting, and came prepared with questions and comments. Based on the questions asked at the meetings, it was clear that most members never read the case histories (sometimes as long as 20 single-spaced pages) and instead relied on the quick presentations given by Committee staff. In addition, I was a main source of new ideas on the panel; indeed, the two most recent presentations before the committee before my exit stemmed from my suggestions.¹ So there must be another reason I was not reappointed. And I think I know what it is, but let me first say something about the Committee and why I joined it.

As described on the website of the Office of the Chief Medical Examiner (OCME), under which the CFRC is located, the goal of the CFRC is to “reduce the number of preventable child fatalities in the District of Columbia through identifying, evaluating, and improving programs and systems, which are responsible for protecting and serving children, and their families.” Based on the information it reviews about the histories of children who died, the CFRC makes findings and recommendations to prevent such deaths in the future. The CFRC is comprised of two teams, the Infant Mortality Review Team (IMRT), which reviews deaths of District infants from birth through twelve months, and the Child Fatality Review Team (CFRT), which reviews the deaths of children aged one to 18 years old as well as youths aged 18 through 21 who were known to the child welfare system within four years of their deaths or to the juvenile justice system within two years of their deaths.² Their are child fatality review teams in all 50 states and some tribal nations as well.

I joined the CFRC because of my concern about children who are abused or neglected and my belief that CFRC had the potential to have a broader impact beyond preventing fatalities because the conditions that lead to child deaths also cause harm to many more children who do not die. The DC Auditor reported hearing this from several individuals who likened the fatality cases that are examined to a “canary in a coal mine.” I had a particular interest in monitoring the work of the Child and Family Services Agency (CFSA), which is charged with protecting maltreated children in the District. When I joined CFRC, I had recently left my job as a social worker at a private agency that provided foster care as part of the child welfare system led by CFSA. In that capacity, I had heard children’s lawyers express their fear that due to the recent sharp drop in removals of children from their homes into foster care, many were being left in dangerous situations that might eventually result in deaths or irreversible emotional or physical damage.

And indeed, upon joining CFRC, I found a number of reasons for concern about CFSA’s effectiveness in protecting children. It was astounding to learn how many children died after having some contact with CFSA. According to CFRC’s annual reports, 69 percent of families of decedents reviewed by CFRT in 2019 had prior CFSA involvement; that figure could not be calculated for IMRT reviews. Of the cases reviewed by the CFRC³ in 2020, 15 out of 18 (or 83 percent) of the decedents’ families had prior CFSA involvement. Reading the CFSA histories of these families often revealed as many as 20 reports to the hotline over the years. Many of these reports were not even accepted for investigation. Those that were investigated were often not “substantiated” or verified by the investigators, which is required for opening a case, despite what seemed like ample evidence of abuse or neglect cited in the case summaries. Even when a report was substantiated and a case was opened for in-home services, more calls often came in about the same families and investigators continued to find dangerous conditions and parenting practices. Even after the cases closed, the reports would continue to arrive, suggesting that nothing had changed as a result of CFSA’s intervention. And even when children were removed to foster care, they were often returned home with no evidence of improved parenting or conditions, and the reports continued to come in.

But when I expressed my concerns about CFSA’s response to frequently reported families and suggest that a finding or recommendation might be in order, I was repeatedly accused of “picking on” CFSA. It is as though CFSA was a child needing protection from bullying rather than an agency responsible for protecting children. Perhaps I shouldn’t be surprised. In its July 2017 report on CFRC, the DC Auditor reported this exact concern — that several panel members believed “defensive or territorial behavior remains an impediment to productive deliberations.”

It was perhaps during my second term at the CFRC, starting in 2020, that another set of issues arose that also put me outside the mainstream of CFRC members. The District was already at the forefront of a national movement to drastically reform what was described as a racist child welfare system by reducing foster care placements and government intervention in the lives of families. The murder of George Floyd and calls to abolish the police intensified this movement, with some even calling for the abolition of child welfare agencies, which were labeled as a “family policing system.” An effect of this type of thinking was an unwillingness to suggest that parents were unfit, no matter how abusive or neglectful they may have been, or to suggest that CFSA should have intervened more aggressively to protect children who later died. While my concern was for the safety of children, other members of the committee were more interested in demonstrating their opposition to governmental interference in the lives of families, regardless of the cost to children’s lives or safety.

When I joined the panel in 2017, there was more tolerance for diverse viewpoints and more concern for the needs of vulnerable children, regardless of race. There were frequent discussions about how to work with the parents who were repeatedly reported to CFSA but did not ever seem to change. Such families are well-known in the child welfare literature as “chronically neglectful,” “chronically maltreating” or “frequently reported” families. Many of these parents had problems with substance abuse, mental illness, domestic violence, or some combination of these three factors that impaired their ability to parent. They had been offered numerous services to help address these issues, which they either declined, dropped out of or completed without any apparent benefit. Discussions of these families often led to suggestions that the agency make more use of a tool called “community papering,” which means filing a petition for court intervention to compel parental participation in services when a child is not being removed from the home. This resulted in a recommendation in the 2017 report that CFSA should use this tool more consistently for families that need some pressure to participate in services. In the same report, the panel also recommended that CFSA strengthen its policy and practice to “ensure families with multiple referrals to Child Protective Services receive an intensive historical review.” After 2017, there were no more recommendations for strengthening CFSA interventions with frequently reported families.

The changing ideological climate manifested itself in other ways. Serving on the CFRC, I soon realized that a striking number of child fatalities happen in extremely large families, with six, seven or as many as 12 children. Perhaps it is not so surprising. It’s hard to imagine safely caring for that number of children, especially if they are closely spaced. There was a time when this topic could be discussed, especially on the IMRT, whose members were concerned with protecting vulnerable infants. In the 2016 report, two paragraphs described discussions by the IMRT of “the concept of developing a public service media and marketing campaign focused on the health and economic benefits of family planning for all age ranges.” Clearly there was not enough support for this idea to result in a recommendation, but the discussion was robust enough to warrant inclusion in the report. Even in my earlier years on the Committee, this issue was occasionally raised by public health professionals. But it was no longer apparently an acceptable topic for discussion by the time my service ended in 2022.

The changing ideological climate also seemed to affect the CFRC’s willingness to address substance abuse. Parental use of alcohol, marijuana or illegal substances is a common factor cited in the cases reviewed by the panel. That includes the case of Trinity Jabore, who was born with marijuana in her system and later found dead at only seven weeks old, having suffered starvation, thirteen fractured ribs, and severe diaper rash. As the prosecutor of her parents put it, “They deliberately chose not to feed or take care of their infant and to instead smoke marijuana, PCP, get high and take selfies all day.” In 2018, the IMRT formed a subcommittee to look at the impact of marijuana usage on families in the District, in light of concerns raised by the legalization of cannabis use. In the 2019 report, the IMRT expressed concern about the role of marijuana and illicit substances in inducing a deep sleep from which parents did not rouse even as their dying babies fought for breath. But in the 2020 Annual Report, parental substance use was mentioned only in two tables and the text briefly summarizing them.

In the past, CFRC had recommended data sharing between agencies to improve coordination of services for the most troubled families, who are often involved with multiple agencies. In its 2016 report, reflecting the period just before I joined the panel, the CFRC recommended that the District “should allocate funding for the implementation and utilization of DC Cross Connect throughout the human services and public services cluster agencies” in order to better meet the needs of vulnerable children and families. (The recommendation was directed to the Department of Human Services (DHS), which did not have jurisdiction over the other agencies included in the recommendation, and DHS did not respond to that part of the recommendation.) Cross-Connect is an effort to integrate care between DHS, the Department of Behavioral Health, and CFSA, incuding the sharing of data. In 2022, I became aware that a similar proposal for a citywide database to track information on anyone served by DC government agencies is a key element of the Gun Violence Reduction Strategic Plan prepared for the District by the National Institute for Criminal Justice Reform, and I suggested that we might consider such a recommendation. My suggestion resulted in a presentation by the CJCC but not a new recommendation for sharing data between agencies in the District. This new ideological climate, where there is great suspicion that data sharing can be used against marginalized populations, rather than to protect their most vulnerable members, was not fertile soil for such a recommendation.

It is unfortunate that I cannot relate specific details behind the generalities that I have reported here, except those taken from published annual reports. Strict rules around the confidentiality of meetings and information shared govern the operations of CFRC. Before every meeting, members sign a confidentiality agreement promising not to disclose any information discussed during the meeting. Those rules are clearly excessive. The panel is given case histories with no names provided. These case studies can and should be available to the public (with the redaction of any information that could give away the identity of the families.) The public deserves to know that the funds it spends on child protection often fail to protect children. Hiding this information merely protects the agencies involved. That’s why I’m hoping that the DC Council will pass legislation allowing the release of the summaries provided to CFRC (with redaction of any information that would clearly give away the identity of the decedents and their families.

In his preface to the CFRC’s 2018 report, Chief Medical Examiner Roger Mitchell stated that “the CFRC is moving toward being a leading voice in the prevention of child fatalities in the District of Columbia.” But until committee members are willing to put the needs of children first, CFRC will never be such a leading voice in preventing child fatalities in the District. Now that I am off the CFRC, I hope that other members will be courageous enough to stand up for the rights of children to be safe and well cared for, even at the risk of becoming a gadfly–which was clearly the reason for my removal.

Notes

These presentations focused on: (a) Criminal Justice Coordination Committee on DC’s Gun Violence Prevention Plan and its work to implement it; and (b) the US Attorney’s ATTEND program to reduce school truancy.
There was no on-boarding or training when I entered the pane, so it took me at least a year to realize that I was eligible to join the IMRT as well as the CFRT. Once I understood that CFRC members are eligible to participate on both teams, I began attending the IMRT meetings as well.
This includes only those cases reviewed in full by the IMRT; this information was not available for those that were included only as part of a statistical review, which is used as a way of studying the deaths of most infants who died of natural causes. Many IMR cases are reviewed statistically not individually; for example 14 out of the 51 cases reviewed in 2019, (the last normal year before Covid) were reviewed statistically. In 2020, during which the committee missed six months of case reviews, 29 of the 47 cases reviewed were statistical reviews of infant natural deaths.

Using algorithms in child welfare: promise, confusion and controversy

Source: Vaithianathan, et. al, Allegheny Family Screening Tool v2, https://www.alleghenycountyanalytics.us/wp-content/uploads/2019/05/Methodology-V2-from-16-ACDHS-26_PredictiveRisk_Package_050119_FINAL-7.pdf

The use of algorithms developed through machine learning for the purpose of improving human decisionmaking is becoming more common in child welfare and in other areas of government, like criminal justice. These tools are often supported as a way to reduce racial and other biases by those making decisions about how individuals will be treated. But opponents have raised concerns that algorithms will increase bias because they are developed using data on systems that are already known to exhibit racial or other disparities. Early research suggests that algorithms can identify the highest-risk children referred to child protective services while reducing racial disparities. But many questions remain about how these tools work in practice and whether their effectiveness will be limited by the mandate to avoid reinforcing racial disparities in child welfare.

The Allegheny Family Screening Tool (AFST), implemented in 2016, is the first algorithm (of a type known as a Predictive Risk Model) to be used in decisions about the screening of referrals by a child protective services hotline. When a call (known as a “referral”) comes into the hotline in Allegheny County (which includes the city of Pittsburgh), the intake worker (or hotline screener) who takes the call must decide whether to screen it in for investigation or screen it out as not relevant to child abuse or neglect. A referral that alleges abuse or severe neglect is automatically forwarded for investigation. For other calls, the screener reviews the information provided by the caller, as well as information on the family’s previous interactions with the Office of Children Youth and Families (CYF) and other agencies. The screener also runs the AFST, which generates a risk score for each child that is used to supplement the professional judgment of the screener and their supervisor.

The AFST was developed to help hotline screeners decide whether a maltreatment referral warrants an in-person investigation, with the hope of improving the quality and consistency of screening decisions.¹ The designers of the tool, leading child welfare researchers Rhema Vaithianaithan and Emily Putnam-Hornstein, sought to change the focus of screening decisions to the risk of future harm to the child rather than whether a referral meets the current definition of child maltreatment. In doing so, they sought to reduce both false negatives, or referrals that are screened out when maltreatment was present, and false positives, or referrals screened in where no maltreatment was present. The current version of the AFST uses data on all family members from past referrals and interactions with CYF as well as from the courts, jail, juvenile probation, behavioral health systems, and the child’s birth record to generate a risk score between one and 20 for each child included in a referral.² The score represents the estimated risk that the child will experience a court-ordered removal from their home in the next two years. which serves as a proxy for serious abuse or neglect.³ Scores indicating a risk of 17 or higher with at least one child aged 16 or under are labeled as “high risk” and recommended to be screened in; approval from a supervisor is required to override this recommendation. Referrals with a risk score of less than 11 and no children under 12 are displayed as “low risk” and recommended for screening out, but the screener can override this recommendation without supervisory approval. For other referrals, the score is used to inform the screener’s decision, in consultation with their supervisor. The score is not seen by those who later investigate the allegations that are screened in, or by anyone else outside the intake unit.

Allegheny County commissioned an independent study by Goldhaber-Fiebert and Prince (2018) of the effect of the original AFST in the 15 to 17 months following full implementation in 2016.⁴ That study found a “moderate” increase in “screening accuracy,” which the researchers defined for screened-in reports as whether further action (the opening of a new service case or connection with an existing case) was taken by CYF or whether there was another referral within 60 days after the referral wass screened in. Screened-out referrals were deemed “accurate” if a child had no referrals for two months. The researchers found that the number of children being screened in “accurately” increased from about 358 to about 381 per month, or a monthly increase of roughly 24 children. (There are upper and lower bounds provided for all these numbers.) But part of this effect disappeared over time. The number of children being screened out “accurately” actually decreased slightly. The researchers also found that use of the algorithm brought about a halt in the downward trend of screening referrals in for investigaion and no “large or consistent” differences in outcomes across racial or ethnic groups. These results were somewhat disappointing to those who were hoping for a larger impact on accuracy, but also failed to support critics’ fears that the algorithm would increase racial disparities in investigations.⁵

In 2020, Vaithianathan, Putnam-Hornstein et al. published a study that they had done to validate the AFST by comparing risk scores to hospital injury encounters for children who had been reported to CPS. They took a large sample of 83,311 referrals for 47,305 children in Allegheny County between 2010 and 2016 (before AFST was implemented) and calculated an AFST score for each of them. They linked these children’s records with medical records from the Children’s Hospital of Pittsburgh, the sole provider of secondary care for children in the area. The researchers found large differences in the chances of an injury encounter for children depending on their risk levels. Plotting the risk level (from one to 20) against the chance of an injury hospitalization, the researchers found “a clear association between any-cause injury encounters and risk ventile, with an increase in the gradient for those scoring 17 and higher.” For children in the highest five percent risk level, their rate of an injury encounter for any cause was 14.5 per 100, compared with 4.9 per 100 for children classified as low-risk by the algorithm, who were in the bottom half of the risk distribution. For abuse-related injury encounters, the rate for high-risk children was 2.0 per 100, compared to 0.2 per 100 for low-risk children. And for suicide, the rates for the two groups were 1.0 per thousand compared to 0.1 per thousand.⁶

As the researchers explain in the 2020 paper, the AFST, a model that was developed to predict foster care placement is able to predict injury harm as captured in data on medical encounters. This is particularly significant because it is harm to children that they really wanted to predict, not placement in foster care, which is only a proxy for such harm. As Dee Wilson stated in his March 2023 commentary, “the 5% of highest risk children had an any-cause injury rate almost three times higher than 50% of the lowest risk children and a rate of abusive injury and self-harm and suicide 10 times the rate of the lowest risk children! AFST is a powerful algorithm when applied to one of the most important safety outcomes in child protection.” The lack of attention to this result by the media and child welfare leaders is disappointing. The extent to which this is due to poor communication by the authors and others, the complexity of the issue or the unwillingness of the child welfare establishment to receive any information suggesting the utility of predictive risk modeling, is unknown.

In an analysis that has not yet been published, Prindle et al.⁷ built a predictive risk model for San Diego County that was based on CPS data alone, in the absence of a data warehouse. They found a similarly strong relationship between risk scores calculated by the model and hospital encounters due to child maltreatment. Specifically, they found that “children classified by the PRM in the top 10% of risk of future foster care placement had rates of medical encounters for official maltreatment roughly 5 times those of children classified in the bottom 50% of risk.”

Rittenhouse, Putman-Hornstein and Vaithianathan (2022), in an article that is currently undergoing peer review, report finding that among all referrals, the AFST had no significant effect on racial disparities in screening decisions. And among the referrals with the highest risk scores, the AFST significantly reduced Black-White disparities. That result suggests that the high risk protocol for these referrals (requiring an investigation unless the supervisor agrees that it is not needed) plays a role in reducing racial disparities. The researchers also found that the AFST reduced Black-White disparities in case openings and home removal rates for investigated referrals. The reason for this is not clear. The authors speculate that the reduction in screening disparities among the highest-risk group might have played a role, or perhaps that within the lower-risk score groups, screeners might be shifting towards screening in Black and White children with similar risks of foster care placement.⁸

Hao-Fei Cheng et al. (2022), using the data from the original evaluation, compared the results of the AFST reported in the initial evaluation with the results that would have been obtained by the use of the algorithm alone, without input from screeners and their supervisors. That data, as already discussed, showed that racial disparities in screening did not increase with the use of the AFST. But Cheng et al. found that workers’ decisions reduced the disparities in screen-in rates for Black and White children from 20 percent based on the recommendations of the algorithm alone to nine percent with the workers’ input. This is a strictly theoretical result, since the algorithm was never used nor meant to be used without worker judgment. From sitting with workers as they discussed their cases and interviewing them about their use of the tool, the researchers concluded that screeners adjusted for what they saw as limitations of the AFST (such as the failure to consider the nature of the original referral) and that some consciously tried to reduce racial disparities. The researchers also found that workers’ judgments, while producing lower disparities, were also less accurate than the algorithm’s recommendations. It is not surprising that accuracy is associated with greater racial disparities; evidence indicates that the incidence of maltreatment is considerably higher among Black children than White children due to the disparities in their social and economic characteristics, which in turn reflect America’s history of slavery and racism.

Grimon and Mills (2022) studied the use in Colorado of an algorithm that was similar to the AFST but used only child wefare system data. They ran a randomized trial to compare decisions made by hotline teams that had access to the tool and those that did not. The study found that “giving workers access to the tool reduced child injury hospitalizations by 32 percent” and “considerably” narrowed racial disparities. Surprisingly, though, teams with access to the tool were more likely to choose to investigate children predicted to be low-risk, and less likely to refer for investigation those considered to be high-risk, than workers without access to the tool. Based on text analysis of discussion notes, the authors speculated that access to the tool might have allowed teams to focus on other features of the referral that are not included in the algorithm, such as the nature of the allegation itself. This counterintuitive impact on teams’ decisions is confusing and even disconcerting, since the entire purpose of the tool is to identify the children at highest risk.

Taken together, the studies of algorithmic tools used in screening of child maltreatment reports show that these tools by themselves are very good at assessing risk. When the tools actually implemented by human beings, the results are more confusing and we have fewer studies on which to rely. The initial evaluation of AFST shows a modest improvement in screening accuracy. The results of the trial of a similar tool in Colorado suggest that it achieved predictive success by doing the opposite of what was intended. Studies also find that the tools in practice do not increase racial disparities and may even decrease them. One study, however suggests that there may be a tradeoff between accuracy and the reduction of disparities, with workers disregarding the algorithm’s recommendations in order to reduce disparities at the expense of accuracy.

In addition to Allegheny County, one county in Colorado (Douglas County) is using an algorithm developed by the team of Putnam-Hornstein and Vaithanathian and another (Larimer County) is currently testing such a tool. Los Angeles County is piloting a Risk Stratification Tool designed by the same team that is being used to support supervisors in their management of investigations that are already open. It is designed to “identify investigations that may not have immediate safety concerns, but are at risk of future system involvement.” These investigations are recommended for “enhanced support.” This pilot was implemented with the hope of preventing more tragic incidents after three high-profile deaths of children by abuse whose families had had numerous interactions with the county’s child welfare agency.

Unfortunately, media outlets such as the Associated Press and the Los Angeles Times have published articles that are replete with misinformation, ignoring the promising research findings and the confusing ones as well. Both of these outlets misrepresented the study by Cheng et al., suggesting that the AFST increased racial disparities in screening. In its latest piece, the AP questioned the idea of screening in parents with mental illness, cognitive disabilities, or any “factors that parents cannnot control.” But whether or not parents can control a factor has nothing to do with its relevance to the risk to a child. These biased accounts by the press, as well as by orgahizations iike the American Civil Liberties Union, may be having an impact on government actions. Oregon stopped using an algorithm to help make screening decisions, a decision for which the AP appears eager to take credit. The AP and the PBS NewsHour along with other outlets have also reported that the Justice Department is investigating Allegheny County’s use of the AFST to determine whether it discriminates against people with disabilities or other protected groups.

Early research suggests that algorithmic tools used in child welfare have the potential to identify the children who most need protection. In practice, they seem to be capable of improving the accuracy of screening decisions without increasing racial disparities. But whether the kind of striking accuracy obtained by using the algorithms alone can be obtained without actually increasing racial disparities, given the underlying differential rates of abuse and neglect, is unknown. With the current climate that values eliminating racial disparities over the protection of children (and especially Black children), it is clear that such a tradeoff will not be considered.

Notes

See Rittenhouse, K., Putnam-Hornstein, E. & Vaithianathan, R., “Algorithms, Humans and Racial Disparities in Child Protective Services: Evidence from the Allegheny Family Screening Tool,” (2022), available in full at https://krittenh.github.io/katherine-rittenhouse.com/Rittenhouse_Algorithms.pdf, for a fuller description of the screening process.
These are available from Allegheny County’s unique Data Warehouse, which brings together data from a wide variety of sources.
As the developers explained in a paper describing their methodology, a proxy is needed because there was no practical way to measure actual harm to children and use it to develop the algorithm; abuse and neglect data were not available and the number of adverse events like fatalities and near-fatalities would be too small. https://analytics.alleghenycounty.us/2019/05/01/developing-predictive-risk-models-support-child-maltreatment-hotline-screening-decisions/
See Jeremy D. Goldhaber-Fiebert, PhD and Lea Prince, PhD, Impact Evaluation of a Predictive Risk Modeling Tool for Allegheny County’s Child Welfare Office, March 20, 2019, available from https://www.alleghenycountyanalytics.us/wpcontent/uploads/2019/05/Impact-Evaluation-from-16-ACDHS-26_PredictiveRisk_Package_050119_FINAL-6.pdf.
Putnam-Hornstein contends that the results were more promising than they appear to a lay audience. She contends that the algorithm’s ability to achieve the same accuracy with (messy) real-time data as it obtained with (cleaned) historical research data was a victory in itself. She emphasizes that the size of the effect was reduced by the practices surrounding the model rather than the algorithm itself.
There were no differences in rates of cancer encounters by risk level, which were assessed as a “placebo.”
John Prindle, et al, “Validating a Predictive Risk Model for Child Abuse and Neglect using Medical Encounter Data.” Unpublished paper provided by Emily Putnam-Hornstein, March 25, 2023.
Email from Katherine RIttenhouse to author, March 22, 2023.

The Minnesota Child Maltreatment Fatalities Report: Essential reading for child advocates everywhere

A shattering new report from a Minnesota child advocacy group demonstrates that many of the more than 160 deaths of children from abuse and neglect over an eight-year period ending last May were preventable. These deaths, the report concludes, can be attributed to “a child welfare philosophy which gave such a high priority to the interests of parents and other adults in households, as well as to the goals of family preservation and reunification, that child safety and well-being were regularly compromised.” This report is essential reading for child advocates everywhere, because this philosophy reigns around the country, and the troubling factors identified exist in states where most of the child population resides.

Produced by the child advocacy group Safe Passage for Children of Minnesota, and authored by Safe Passage Executive Director Richard Gehrman and Maya Karrow, a fellow from a local law school, the project collected information about 88 children who were killed between 2014 and 2022. The Minnesota Department of Human Services (DHS) told project staff that it was aware of 161 child maltreatment deaths during a period that mostly coincides with the period studied.¹ But DHS refused to provide information on any of these deaths (in violation of state and federal law), so the staff had to rely on news reports, online court records, and information provided by counties for the 88 cases it had identified.

Like child maltreatment fatality victims nationwide, the dead children were young, with 42 percent under a year old and 36 percent between one and three years old. Children under four were 78.4 percent of the Minnesota deaths very similar to the 76.3 percent for child maltreatment fatality victims nationwide. Black children accounted for 26.1 percent of all the fatalities reviewed. In contrast, Black children were 17.8 percent of children involved with child welfare and 10.6 percent of the state’s child population in 2021.² Based on the statistics and case file reviews, the report’s authors expressed concern that chld welfare agencies in Minnesota “may have tended to leave Black children in more high-risk situations for longer periods of time than children of other races and ethnicities.” The report’s authors are not the first to have asked whether fears of being accused of racism may be leading agencies to leave Black children in harm’s way even more than children of other races.

The most common causes of death among the cases reviewed were blunt force trauma to the head (33 percent) and body (19.3 percent). The other major causes of death were asphyxiation (17.0 percent) and gunshot wounds (8.0 percent). Other causes included drowing, sepsis, poisoning from drugs, stabbing, hypothermia/hyperthermia, fire, and undetermined causes.

The most common perpetrators of child fatalities were mothers (27.3 percent), mothers’ significant others (23.9 percent), and fathers (22.7 percent). In 65.9 percent of the cases, one or more of the perpetrators had a history of substance abuse. Shockingly, there were seven deaths in foster care, of which six were in kinship foster care. In another appalling finding, there were seven cases in which a child was killed along with the mother or while attempting to intervene in an assault on the mother.

A concerning pattern was the evidence of child torture in a surprisingly large number of cases. The project’s reviewers identified 14 cases (or 15.9 percent) that displayed signs of torture, according to criteria outlined by experts. The authors used the case of Autumn Hallow, who was killed at the age of eight, as an illustration. Investigators found that Autumn’s father and stepmother frequently bound her in a sleeping bag as punishment, sometimes with her hands tied behind her back or overnight, and starved her for six months so that she weighed only 45 pounds when she died. A particularly appalling feature of her case was the “chilling indifference by all the authorities involved to the screams of a child [reported repeatedly by neighbors] and the pleas of an increasingly distraught mother.” Autumn’s cause of death was declared to be asphyxia and blunt force trauma. Her father and stepmother were convicted of second-degree unintentional murder in her death.

The project uncovered numerous systemic flaws that contributed to the 88 deaths reviewed. These included inappropriate assignment of reports to a “family assessment” rather than a factfinding investigation; the failure to respond adequately to repeated reports suggesting chronic maltreatment; seemingly endless chances given to parents to address chronic problems; the return of children from foster care to homes where safety had not improved; the placement of children with kin without appropriate vetting; leaving children with mothers who repeatedly failed to protect them from violent partners; and the lack of integration between child welfare and child custody cases.

The repeated inappropriate assignment of cases to the “Family Assessment” (FA) track, which is intended for low-risk cases, was a major recurring theme in the case reviews. Minnesota is one of 34 states that initially adopted a two-track model, often known as differential response, for responding to reports of suspected maltreatment. (Some states have since terminated the practice). The idea was that a less-adversarial response than an investigation would be a better way to engage families with lower-risk cases. But with its practices like informing parents of visits beforehand, interviewing children in front of their parents, and making no finding as to whether maltreatment occurred, the report explains that FA is not appropriate when the risk to children is high. Yet, by 2020, 62 percent of CPS reports in Minnesota were assigned to Family Assessment. The researchers found that 31 of the 59 families with Minnesota child protection history had at least one and as many as six Family Assessment cases prior to the fatality. As the authors point out, “it is self evident that the repeated use of FA in chronically referred families is inconsistent with the policy that FA be used only in low-risk cases.”

Among the examples cited by the authors for the inappropriate use of FA was one that occurred following a report that a mother and her boyfriend were hitting their children with objects and dragging them by their hair. This family was the subject of six previous reports that included allegations of “physical abuse, sexual abuse, and unhygienic and unsafe conditions, including rotten food, garbage, drugs, alcohol, and sharp objects accessible to children throughout the home.” Twenty days after that last FA, two-year-old Lyla Koob was dead. Her mother’s boyfriend admitted to shaking her in frustration after she vomited. Her autopsy revealed bleeding on the brain and injuries behind both eyes.

Based on analysis of court records, the researchers found that 71.6 percent of the dead children’s families had previous involvement with child protection. The 61 families included 59 with prior history in Minnesota and two with prior history in another state. In view of these percentages, it is not surprising that the project staff found that Minnesota child welfare had a pattern of failure to respond adequately to chronic maltreatment.

In some cases, the researchers noted a pattern of inaction by child welfare agencies in the face of chronic multitype maltreatment, or maltreatment that includes neglect as well as abuse. The case of Tayvion Davis, who died in 2018 at the age of eight, was used to illustrate this type of negligence. Before he was born, Tayvion’s mother was convicted of malicious punishment of a child after she and two adult relatives held down and beat one of her children. From that time until Tayvion’s death, the family was the subject of at least ten reports of physical abuse, sexual abuse, or neglect. According to court records, the children were hit with a hammer and a metal rod, whipped with a belt, burned with boiling water or chemicals, deprived of food and sleep as punishment, and threatened with death if they talked about the abuse. There were multiple reports of sexual abuse of Tayvion or a sibling by the oldest sibling, juvenile and adult relatives, and an unrelated adult.

Tayvion Davis froze to death in 2018 after his mother locked him in the garage overnight in subzero temperatures. The autopsy found numerous scars that suggested years of abuse that may have escalated into torture. Unbelievably, Tavion’s siblings were returned to their mother after being removed in the wake of Tavion’s death. They remained with her for another five months, during which she was the subject of several additional reports. It was not until they were removed again that they told their foster parents that Tavion was deliberately locked in the garage, resulting in murder charges against the mother.

The researchers also found that counties gave parents multiple chances to address chronic problems, while failing to execute effective safety plans for children remaining at home. One example of this tendency was the case of Aaliya Goodwin, who died at the age of five months. There had been eight reports for two older siblings regarding the parents’ substance abuse. Between 2015 and 2021, four safety plans were mentioned in court records, the oldest sibling was placed in foster care and returned home twice, the mother was charged with nine drug-related offenses and convicted of five, and the father was charged seven times with two convictions. The county opened a new FA in January 2022 due to a report of domestic violence and the mother agreed to a substance abuse assessment. Three days later she was found passed out on the couch after using drugs and alcohol. Aaliyah, squashed between her mother and the couch, was dead of positional asphyxia.

Another pattern cited in the report was counties’ tendency to return children from foster care to a home that was still unsafe. The project revealed that 26 percent of the children who died had been previously removed from their parents and then returned. The case of Khamari Golston was provided as an illustration of this pattern. Multiple abuse injuries to four-month-old Khamari resulted in his and his twin sister’s removal and placement in foster care. Their mother was charged with felony malicious punishment and assault. But only two months after adjudicating these children to be in need of protection, the judge sent them home for a “trial visit.” The mother was said to be cooperating with her case plan but there was no documentation of this in the court record. Eight weeks later, Khamari was dead of suffocation or smothering. He also had multiple injuries consistent with physical abuse. Khamari’s ten-year-old sister reported that their mother frequently choked him and covered him up when he cried.

Some children were returned from foster care to parents with serious mental illness. The report cites six-year-old Eli Hart, whose mother killed him with multiple shotgun blasts to the head and torso nine days after he was returned home. Eli was returned home without evidence that his mother’s mental illness was under control. Instead, her mental health remained a concern throughout the year that he was in foster care and during a trial home visit. She received eight traffic-related convictions (including for speeding and reckless driving) and was also charged with theft of pharmaceutical drugs during the time he was in foster care.

The occurrence of seven deaths of children in foster care, of which six were in kinship care, was a startling revelation of this study. There have been concerns raised around the country that the growing focus on kinship placements may be leading to the placement of children with family members who have not been adequately screened and are not appropriate caregivers. And indeed, the project staff found a “lack of due diligence in deciding whether a kinship placement would ensure the safety and well-being of the child.” To illustrate this pattern, the report offers the history of Leila Jackson, a 17-month-old who was killed by her foster father in 2018. Her autopsy showed “extensive subdural hemorrhages and severe brain injury, as well as extensive bruising on her buttocks.” Layla and her brother were placed in the kinship home after their mother’s parental rights were terminated. The foster parents denied having criminal records or substance abuse histories, but a background check (which was never conducted) would have revealed convictions for DWI, theft, possession of drug paraphernalia, and disorderly conduct.

The pressure to keep children with mothers who were victims of domestic violence, even when these mothers showed they were unable to protect their children, was another systemic problem noted by the project team. The authors found that 28.4 percent of the cases involved domestic violence–not surprising in view of the co-occurrence of child maltreatment with domestic violence. But that seven children were killed along with their mothers, or in an attempt to protect them, was shocking indeed. This is a difficult issue, and removals of children from domestic violence victims by CWS have been harshly criticized. But as the report put it, “at a certain point a line is crossed and it becomes imperative to move children to a safe place.”

In Minnesota, public child welfare cases are heard in juvenile court and custody cases in family court, which means that the same family can have two different court cases with different judges. The findings of the report suggest that the failure to consolidate these cases can place children at risk. In the case of Eli Hart, who was killed by his mentally ill mother, the custody case filed by his father was put on hold pending a resolution of the juvenile court case surrounding his mother. This is despite the fact that the mother’s mental health remained a concern and that all reports indicated that the father was a good and safe parent for Eli.

In sum, the report concludes that “the professional norms currently guiding child protection and foster care are out of alignment with those of the broader community.” As a first step, the report recommends that DHS release more information about child maltreatment fatalities, including making public the fatality and near-fatality reports that counties are required to submit to the state; such reports include information about previous reports and investigations on these families. This recommendation is particularly important because if the public knew about the types of egregious failures described in this report, there might be more public support for changes.

The report contains many specific recommendations to correct the systemic flaws found in the case studies. This year, Safe Passages will be distributing the report to legislators and briefing them on its findings and recommendations. Rick Gehrman, Executive Director Rick Gehrman reports that he will be working with legislators to translate some of these recommendations into legislation to be introduced in the next session, addressing at a minimum some of the Family Assessment practices that endanger children. The ultimate goal, Gehrman says, is to “raise public and legislative awareness of the child welfare practices that endanger children and to bring about a change in the overall philosophy of child welfare services in Minnesota.”

In effect, Safe Passages for Children has unofficially implemented the first recommendation of the Committee to Eliminate Child Abuse and Neglect Fatalities in its 2016 final report, Within Our Reach. That report recommended that each state, with federal funding and assistance, identify and analyze all of their child abuse and neglect fatalities from the previous five years in order to identify factors associated with maltreatment fatalities and agency policies and practices that need improvement to prevent fatalities. Based on this report, every state would develop a fatality prevention plan. Unfortunately, legislation supporting this proposal stalled in Congress and no state has elected to do this on their own. Maryland’s Council on Child Abuse and Neglect and its Child Fatality Review Board, inspired by this recommendation, formed a joint subcommittee that produced an excellent review of child maltreatment fatalities in Baltimore between 2012 and 2015 which identified systemic flaws and made recommendations to correct them.³ Other than that report, I am not aware of any other similar project by a state or local government agency. Let us hope that this report encourages other child advocacy groups and community boards to act where governments have not.

The final words of the report deserve to be repeated. “The erosion in professional norms that has gradually caused human services entities to tolerate the current level of neglect and physical abuse of children has developed over the course of decades. A concerted effort by a community of professionals will be required to restore standards that were once taken for granted, and to place appropriate limits on the ability of adults in a child’s life to harm them.”

Notes

The actual number was likely two to three times as high because the manners of so many maltreatment deaths are misclassified.
See Child Maltreatment 2021. Table C-2, Child Population 2017 to 2021 shows the state’s child population rose from 1,300,061 in 2017 to 1,317,567 in 2021. Table C-3, Child Population Demographics, shows that there were 140,129 Black children in Minnesota in 2021. That figure, divided by 1,317,567 gives the Black percentage of all children in Minnesota as 10.6 percent in 2021.
City of Baltimore Health Department, Eliminating Child Abuse and Neglect Fatalities in Baltimore City. January 2017. This report appears to be no longer available online. Please email marie@childwelfaremonitor.org for a copy.