Child maltreatment deaths raise questions about Michigan’s funding priorities

by Sarah Font (Washington University in St. Louis) and Emily Putnam-Hornstein (University of North Carolina at Chapel Hill)

I am honored to publish this post by two of the leading academic researchers in child welfare. They are also the Principal Investigators of the Lives Cut Short project, which documents child abuse and neglect fatalities around the country.

Armani Evans. Zemar King. Leviathan Froust. These are just three of Wayne County’s children who have been killed by their caregivers in recent years. Wayne County is the home of Michigan’s largest city, Detroit.

As part of the Lives Cut Short project, which aims to document child abuse and neglect fatalities nationwide, we requested and reviewed the Wayne County Medical Examiner records for child deaths since 2022. At least 52 children died due to abuse or neglect in the last 3.5 years, accounting for more than 1 in 10 of all child deaths in the county. Nearly two-thirds of child maltreatment deaths involved children ages 3 years and under.

At least nine children under the age of 3 died of illicit drug poisonings – involving fentanyl, heroin, and methamphetamine.

Equally disturbing, more than half of the child maltreatment deaths – 27 – involved intentional injury rather than negligence: children who were shaken, stabbed, beaten, and smothered. Many young children’s deaths received no media attention – all that is known is that they were killed by homicide, with the injury description merely stating “found beaten.”

The 52 children who died of maltreatment in Wayne County are likely the tip of the iceberg – these deaths are challenging to identify due to limitations in the death investigation process, minimal release of information, and other factors.

What would prevent children from dying at the hands of caregivers and family members?

Wayne County recently announced an expanded partnership with RxKids to provide thousands in no-strings-attached cash to all new and expectant mothers in 6 cities within the county. The county’s $7.5 million investment adds to a statewide investment of $250 million in RxKids for 2025-2026 alone. The governor’s FY2026 budget recommendation further includes $27 million to provide “economic and concrete supports” with the goal of reducing or avoiding involvement with Child Protective Services.

The leaders of RxKids imply on their website and other materials that their cash transfers can produce a large decline in child maltreatment and reduce the need for CPS intervention. Fortunately, a rigorous evaluation of the program was conducted in Flint.

The punchline? No impact.

Such findings should come as little surprise when we take seriously the threats that children face. Neither drug addiction nor extreme violence seems likely to be ameliorated with short-term monthly checks. And many children died after CPS ignored clear warning signs. A wrongful death lawsuit filed on behalf of murdered Detroit toddler Chayce Allen reveals that relatives asked CPS to intervene on at least 13 occasions.

The likely reason so many kids are left to die in horrifying circumstances is that Michigan has a severe shortage of child protection caseworkers. Statewide vacancy rates are 20% and the problem is worse in Wayne County, which has 46 fewer caseworkers than intended, leading to high caseloads and turnover. High caseloads were one of the systemic problems that the state was expected to address as part of the Dwayne B. settlement – a case filed nearly two decades ago. Michigan seeks to exit court supervision as soon as this summer, despite their continued failure to adequately staff their system.

Before massive expansions of cash assistance – much of which is going to families who are not impoverished – perhaps the state should fulfill its existing obligations to kids.

Note: some deaths handled by the Wayne County Medical Examiner may stem from incidents occurring in surrounding counties (from which children were brought to and then died at a Wayne County hospital). Our data do not provide the location of the maltreatment incident.

Home visiting: more hype than hope

Image: homvee.acf.gov

by Marie Cohen

Home visiting has been a highly popular intervention for the prevention of child abuse and neglect and for addressing a much broader set of social problems as well. But the research has never supported the efficacy of home visiting programs as a whole for improving child and family outcomes. The latest study of four popular home visiting programs found that all these programs have negligible impacts after five to seven years. But there was no hint of this message in the government’s press release or the report itself. The bipartisan belief in home visiting is prevening a needed examination of home visiting’s impact and the level of resources devoted to it.

A Brief History of US Home Visiting

While home visiting has existed since Elizabethan times in England, its history in the U.S. began in the late nineteenth century with charities seeking to address urban poverty by changing the behavior of poor families. While it is now considered to be the solution to a number of different social problems mostly related to poverty, modern home visiting was conceived as a way to prevent child abuse and neglect. Publication of Henry Kempe’s The Battered Child in 1968 brought about the recognition of child maltreatment as a national problem. To address child abuse, Kempe called for universal prevention through a network of home health visitors. Inspired by Kempe, Hawaii’s Healthy Start Project (HSP) began in 1975. In 1977, David Olds began testing his Nurse Home Visiting program in Elmira, New York. The first Parents as Teachers program was created in 1991. In 1992, the National Committee to Prevent Child Abuse (now Prevent Child Abuse America) rolled out Healthy Families America (HFA).

In 1993, the Future of Children, an influential academic journal produced by Princeton University and the Brookings Institution until 2021, devoted an issue to home visiting. In the summary article, the authors cautioned that the research so far was limited and had mixed results, but opined that the results were “promising enough” to recommend the expansion of existing programs and the continuation of evaluation efforts. Home visiting programs burgeoned in the wake of that issue, with funding from federal, state, and foundation sources.

In 1999, The Future of Children released its second issue on home visiting, containing evaluations of six demonstration programs. The results were sobering. In their analysis of all six studies, Deanna Gomby and colleagues concluded that “[I]n most of the studies described, programs struggled to enroll, engage and retain families. When program benefits were demonstrated, they usually accrued only to a subset of the families originally enrolled in the programs, they rarely occurred for all of a program’s goals, and the benefits were often quite modest in magnitude.” The one exception was the Nurse Home Visiting Program, (now Nurse-Family Partnership), which differed from the other programs in being delivered by nurses rather than paraprofessionals, and which produced some sizable impacts on child abuse and neglect and second births to mothers.

But the home visiting juggernaut was already in motion. Programs continued to grow, funded by multiple sources, and most of the growth was not in the most promising (and expensive) Nurse-Family Partnership. The National Center to Prevent Child Abuse, renamed Prevent Child Abuse America in 1999, made HFA its signature program despite the lack of evidence that it prevents child abuse. According to the National Home Visiting Resource Center, “evidence-based home visiting was implemented in all 50 states, the District of Columbia, 5 territories, 32 Indigenous communities, and 65 percent of U.S. counties” by 2024. These programs reached over 284,000 families through more than three million home visits in that year, and another 70,000 families were reached by 11 “emerging models.” Of the more than three million home visits provided, approximately 14 percent were provided virtually, down from nearly 23 percent in 2024, as services gradually returned to in-person after the pandemic. Today, there are multiple home visiting programs with different target groups, curricula, goals, and personnel. In addition to the 24 models recognized by the federal government, there are an unknown number of “emerging models” which have not yet earned the label of “evidence-based.”

Undaunted by the scant evidence of success, Congress established, with bipartisan support, the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) as part of the Affordable Care Act of 2010. The goals of the program are to improve the health of mothers and children, prepare children for success in school, improve families’ economic well-being, connect families to other resources in the community, prevent crime and domestic violence and prevent child injuries, abuse and neglect. The funds can be used to implement any one of 24 models that meet the eligibility criteria established by HHS’ Administration for Children and Families (ACF). An evaluation of this program was required by the legislation.

Home visiting programs also became a popular intervention in child welfare with the growing emphasis on keeping children with their families. This began in 1994 with the Title IV-E waivers and continued with the Family First Prevention Services Act (FFPSA), signed by President Trump in 2018. FFPSA allowed states to use Title IV-E funds, formerly reserved for foster care and subsidized adoptions, to support children and families and prevent foster care placements through in-home parent skill-based programs, as well as mental health, drug treatment and kinship navigator services. Programs had to be approved by the new Title IV-E Prevention Services Clearinghouse as “evidence-based” before they could be included in a state’s Family First Prevention Services Plan. According to a research brief from Chapin-Hall at the University of Chicago, at least one home visiting model was included in the Family First Prevention Plans in 28 states as of April 2023. Most commonly included were Parents as Teachers (28) and Healthy Families America (23), with Nurse Family Partnership in third place with 15 programs, and SafeCare in fourth with seven programs.

Home visiting also became popular in growing efforts by child welfare agencies to invest in preventing child abuse and neglect before it occurs, or at least before a family comes to the attention of child protective services. A small source of federal funds, the Community Based Child Abuse Prevention Program (CBCAP), was established by Congress in 1996 to fund such prevention programs and is commonly used to fund home visiting as well.

The bipartisan enthusiasm for home visiting has been unwavering. Created under Obama, MIECHV has been supported by every succeeding administration. Total federal funding on this program is slated to increase from $500 million in 2023 to $800 million in 2027.Earlier this year, the Senate even passed (unanimously) a bipartisan resolution designating April 21 through April 25, 2025 as National Home Visiting Week. Even the Trump Administration has heartily endorsed the home visiting. Yet, the much-vaunted evidence for the value of home visiting really consists of a series of modest impacts affecting different outcomes, often based on less reliable indicators like self-reports, and dwarfed by a sea of findings of no effect. Even the one program (Nurse-Family Partnerhip), that had the most promising early resultsm has no stood up to recent replications–though additional trials with the population that seems to benefit most may be warranted.

Home visiting program evaluations

There have been multiple studies of home visiting programs, including both randomized controlled trials (RCT’s) and comparison group studies, and together these studies have generated hundreds of papers. Therefore, Child Welfare Monitor (CWM) drew from a summary of research on Nurse-Family Partnership from the Arnold Ventures Social Programs that Work website; the evidence assembled on the website of the Title IV-E Prevention Services Clearinghouse for Healthy Families America, Parents as Teachers, and SafeCare; and the Home Visiting Evidence of Effectiveness (HomVEE) Review conducted by the Administration on Children and Families of HHS for Early Head Start Home-Based Option. CWM consulted the original studies as needed, focusing on RCT‘s because randomization is the best way to rule out selection bias as the explanation for any differences between the intervention group and the control group. Otherwise, one cannot know whether the group that participated in the program differed in significant but unmeasured ways from the members of the comparison group. Appendix I includes more details about the program evaluations. Appendix II focuses on the challenges in measuring child abuse and neglect and what the research suggests.

Nurse-Family Partnership

Nurse -Family Partnership (NFP) connects first-time mothers and their babies with a specially trained nurse, who works with the mother and child from early in the pregnancy through the child’s second birthday. It differs from other models in using registered nurses to deliver the visits, making it more expensive and dependent on a scarcer group of providers. Nurse Family Partnership (NFP) has been the subject of RCT‘s in Elmira, NY (launched in 1988); Memphis, TN (launched in 1990), Denver, CO (1994) and in a larger statewide trial in South Carolina that started in 2016. It has also been tried internationally in British Columbia, the Netherlands, the United Kingdom and Germany; though the differences between populations and systems make these results less applicable to the United States, they can be seen as suggestive. The participants in the demonstrations were all first-time mothers but other criteria for inclusion varied by study. Among the effects that were replicated in two or more of the studies identified by the Arnold Ventures’ Social Programs That Work website were reductions in medical treatment for injuries and accidents in Elmira and Memphis), reductions in subsequent births to mothers in their late teens and early twenties (in Elmira, Denver, and Memphis), and an improvement in cognitive or academic outcomes for the children of mothers with lower psychological resources, like intelligence, mental health, and self-confidence (in Memphis and Denver). There were few significant impacts on children’s emotional and behavioral outcomes and mothers’ life trajectories in terms of employment, income and crime, and those impacts were not repeated in more than one study.

A recent scaled-up NFP replication in South Carolina was disappointing, producing no significant positive effects on any of the three primary outcomes studied: the rate of adverse birth outcomes, mothers’ rate of subsequent births within 21 months, and child health, measured as “a composite of mortality or health care utilization associated with major injury or concern for abuse or neglect.” Nor did the researchers find any significant improvements for a prespecified subsample of “socially vulnerable families” that were similar to the families for which earlier studies found positive impacts. There were also no significant findings for the secondary outcomes, which related to healthcare utilization. These results were sobering, and the researchers suggest that the rapid scaling up of the program and the broader population served may have contributed to the weaker results. David Olds, the founder of NFP, suggests¹ that the program’s effectiveness was affected by the relative inexperience of the nurses (due to the rapid implementation), the use of impersonal recruitment methods (unlike Elmira and Memphis, where nurses personally recruited mothers in clinic waiting rooms), and the relatively more advantaged clientele. The program included any pregnant woman who qualified for Medicaid in South Carolina, which funded 46 percent of births in that state in 2023 and includes women up to 200 percent of the poverty level. So it was a less disadvantaged group than was included in the other US demonstrations, and earlier studies suggested that the more disadvantaged benefited more from this program.² Thus, further study of NFP with a highly disadvantaged population should be considered.

Healthy Families America (HFA)

Healthy Families America, an initiative of the national organization, Prevent Child Abuse America, is a flexible program that allows local communities to choose their eligibility criteria, parenting materials, and staff. Services last for a minimum of three years and up to five years. Based on three RCTs of Healthy Families America, the Title IV-E Prevention Services Clearinghouse counted 18 favorable “contrasts” (their term for comparisons between the intervention and control groups) compared to four unfavorable contrasts and 211 contrasts displaying no effect. Among the 18 favorable contrasts, 11 were on self-reports of maltreatment or child behavioral and emotional functioning. Of the other impacts, all were from only one RCT. Many outcome categories showed no favorable impacts. These included child safety measured by administrative reports; child safety based on injuries, Emergency Room use or hospitalizations; child permanency based on out-of-home placements; child social functioning; child physical development and health; parent/caregiver substance abuse; and economic and housing stability. One of the four RCT‘s (Healthy Families Oregon) showed no positive impacts at all.

Parents as Teachers

Parents as Teachers is delivered by “parent educators” who work with families from pregnancy through kindergarten. The Clearinghouse identified one American RCT of this program, one RCT from Switzerland, and one matched comparison group study. The one US RCT, which evaluated two separate demonstrations in California, found that PAT had “little effect on parenting knowledge, attitudes or behaviors as measured in these demonstrations. Nor were significant effects noted on child health or health care.” The demonstration did find small positive effects (a two-month gain at the age of three) on “self-help development” in one of the two sites but no significant effects on cognitive development at either site. In the Swiss study, the clearinghouse found one significant effect on one of two measures of the child’s expressive language.

SafeCare

SafeCare is a brief home visiting model that is delivered in 18 one-hour sessions. SafeCare is designed for parents and caregivers of children birth through five who are either at-risk for or have a history of child neglect and/or physical abuse. It was included in the Title IV-E Prevention Plans of seven states in April 2023. The contrasts reported by the Clearinghouse include only one favorable effect–on foster care placement–based on a matched comparison group study and not an RCT and one unfavorable effect (on child welfare reports), along with 19 findings of no effect.

Early Head Start-Home-Based Option

Early Head Start Home-Based Option provides weekly visits to pregnant women, infants, and toddlers until the child is three years old. The goal is to promote school readiness of young children by enhancing their cognitive, social and emotional development. The federal reviewers of Early Head Start’s Home-Based Option used nine publications based on a large federal RCT of the program at 17 sites as well as the early results of the federal study of MCHIEV programs, which is described below. There were no favorable findings on maternal or child health; child maltreatment; or delinquency, family violence and crime. There were a few favorable impacts on child development and school readiness; positive parenting practices; and family economic self-sufficiency scattered among multiple findings of no effect. These effects were not consistent across age groups or outcomes where one would expect some alignment (like reading to children vs. reading at bedtime). These impacts appeared to be small, although the lack of standardized effect sizes complicates interpretation. In the final report on Early Head Start, the authors stated that at “the end of the program, when children were three, impacts were modest in size and Early Head Start children continued to perform below national norms on cognitive and language assessments.” By the time the children reached fifth grade, all but one favorable impact earlier reported was gone.

The MIHOPE Study

The legislation establishing the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) required an evaluation of the program in its early years. The study, named the Mother and Infant Home Visiting Program Evaluation (MIHOPE), included 88 local programs in 12 states and was carried out by an evaluation nonprofit called MDRC. All of the programs were based on one of the four models most commonly chosen by states in their initial MIECHV plans–Early Head Start Home-based Option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers. A total of 4,229 families enrolled in the demonstrations between 2012 and 2015. Strangely, even though the sample sizes were large enough to estimate the effects of each program model, the researchers opted to report findings for all four models taken as a whole, a decision that has been criticized by experts and funders because of the significant programmatic differences between the models. Early findings released in 2019 from when the children were 15 months old were disappointing. There was little difference between the experimental and control groups. About a third of the 63 outcomes measured were statistically significant and though most comparisons did favor the home-visited groups, the effect sizes were extremely small–too small to be of any practical significance. The authors reported that for most outcomes the effects were slightly smaller than the average effects found in past studies of the models (which were already modest).

On September 11, 2025, the Administration on Children and Families released the long-term results of the MIECHV program evaluation conductd five to seven years after enrollment, when children were in kindergarten or first grade. Summing up their findings in a press release, ACF asserted that “MIECHV-funded home visiting significantly improved maternal and family wellbeing for participants five-to-seven years after enrolling in services…MIHOPE found statistically significant and positive effects of home visiting” for the five categories of maternal and family well-being outcomes. For the three categories of child outcomes, the researchers found “some evidence of positive effects,” but only one was statistically significant and positive.

Unfortunately, the researchers did not distinguish between a statistically significant effect and an effect which is large enough to be meaningful. A more sober analysis by the Coalition for Evidence-Based Policy shows that home visiting produced “negligible outcomes” for each of the eight expected impacts. The review points out that the average effect size across the six statistically significant or near-significant categories of effects was 0.03 – the equivalent of moving the average child or mother from the 50th to the 51st percentile. The study did not report model-specific effect sizes, but the reviewers noted that they are likely to be small or modest given that few reached statistical significance. It is also worth mentioning that many of the outcomes came from maternal answers to a caregiver survey, introducing the possibility of bias..

It is also concerning that the evaluation team at MDRC used a different analysis plan to assess impacts for the kindergarten study than it did for the earlier results. The new analysis plan was dated January, 2025 (but not released until May 2025). The new methodology combined all the 66 outcomes studied into eight new “research questions” some of the outcomes were included under more than one research question. The researchers chose to focus not on the significance of each individual impact, as was done in the earlier report. Instead, they decided to use a method called “omnibus testing” to compute an overall significance level for each research question.³ By choosing this method, they were able to find significant results (at the 0.10 level) for five of the eight research questions, where looking at each outcome would have shown only eight significant outcomes out of 86, or less than 10 percent of the outcomes. Since the new analysis plan was dated January 2025, it seems likely that it was developed after an analysis of the data (which was collected in 2021 and 2022) under the old plan yielded unsatisfactory results.⁴ The Imprint has published a more detailed critique of the MIHOPE study by Sarah Font and Emily Putnam-Hornstein called The Odd Bipartisan Effort to Oversell the Evidence for Home Visiting.

Why have home visiting programs been so unsuccessful at changing outcomes for most children and families?

As Deanna Gomby stated back in 1990, “home visiting programs have struggled to engage and retain families.” Research has documented low levels of enrollment and engagement of families at risk of maltreatment in voluntary services in general and home visiting in particular. According to the MIHOPE implementation report, 17 percent of the home visiting group never even received one visit, as compared to 12 to 22 percent in previous studies. All the models expected families to participate at least until the child’s second birthday, with services available for two or three years longer in three of the programs. Yet, only 46 percent of families were still participating in home visits 12 months after their first visit, consistent with previous research. On average, families who received at least one home visit went on to participate for an average of eight months. While participating, families received fewer visits than expected by the models in which they were enrolled. In the first 12 months, less than 60 percent of families received at least half of the visits prescribed by their model, a result consistent with prior research. Part of the problem might be that many people who need the kind of help that home visiting is designed to provide do not want to let a stranger into their home to scrutinize their parenting and family functioning. Child Welfare Monitor has heard in the District of Columbia and elsewhere that there is an oversupply of home visiting slots, with too few people wanting to participate.

Misleading Congress, the Media and the Public

Ever since the initial excitement about home visiting, there have been high hopes for this service delivery method and unwillingness among policymakers on both sides of the aisle to discard their hopes. At the same time, the federal government along with many advocacy groups, has endorsed a vision of “evidence-based practices” that asks only for a minimal number of statistically significant impacts, with no concern about the size of the impacts or the nature of the evidence–whether it is self-reported, self-contradictory, or unsupported by more than one study. As a result, studies that show only a few modest impacts that may be statistically significant but not meaningful in size or corroborated by other studies can be cited as evidence of program success.

Unfortunately, program evaluations are technical enough that readers who are not schooled in the intricacies of research methods are often forced to rely on the researchers’ interpretation of their findings. The usually well-informed Congressional Research Service has stated that “A large body of research suggests that some home visiting models or services can benefit children and their parents.” Less surprisingly, the press is easily misled. Due to lack of time or expertise in the intricacies of social science research, reporters often simply report what is in the press release announcing new research results. For example, the Imprint, a widely circulated outlet for child welfare content, repeated in its podcast the government’s misleading proclamation about good news from the MIHOPE study.

—–

No matter how painful the process, legislators, agency officials and advocates should remove their blinders about home visiting. It is time to phase out the MIECHV program. State and local governments should begin scaling down their home visiting programs and funneling the money to other uses that are currently underfunded. In this time of budget scarcity, it is time to stop throwing good money after bad. We need new ideas and meaningful evaluations that can bring about the implementation of programs that actually work. If money is being wasted on home visiting services that are not making a difference, or not even being used, surely there are better uses of these scarce funds.

Appendix I

In the absence of time to review the hundreds of publications on the Nurse Family Partnership Program, I used the excellent evidence summary on the Arnold Ventures Social Programs that Work website. For the studies of HFA, Parents as Teachers, and SafeCare, I relied mostly on the compilation of study results provided by the Title IV-E Prevention Services Clearinghouse. For Early Head Start, which was not included in the Clearinghouse, I used the Home Visiting Evidence of Effectiveness review conducted by the Office of Policy Research and Evaluation (OPRE) of the US Department of Health and Human Services.

Nurse Family Partnership

Each of the four U.S. RCT’s of NFP had a different population and eligibility criteria for participants. Elmira is in a small, semirural county in New York State which had the highest rate of child abuse and neglect in the state at the time of the study. In 1980, the community was rated the lowest Standard Metropolitan Statistical Area in the United States for economic conditions. Program participants In Elmira were either teens, unmarried, or low-income, and all were White. They were actively recruited by nurses at the prenatal clinic, private obstetricians’ offices, Planned Parenthood, schools, and other health and human services agencies. In Memphis, the program admitted pregnant women with no previous live births who did not have a chronic illness that might affect the fetus and who had at least two of the following risk factors: being unmarried, having less than 12 years of education, and being unemployed. Ninety-two percent of the women enrolled were Black, 98 percent were unmarried, 64 percent were eighteen years old or younger and 85 percent came from households with incomes at or above the poverty level. In Denver, women were recruited at any point in their pregnancy if they had no previous live births and either qualified for Medicaid or had no health insurance. Almost half of the two groups were Hispanic, another 35 percent were Caucasian, and 16-17 percent were Black. The South Carolina demonstration recruited pregnant women who were 15 years or older and eligible for Medicaid, which meant their incomes were less than two percent of the poverty level. The participants were mainly non-Hispanic Black (54.9 percent) and non-Hispanic White (35.0). In addition to enrolling a different population, each study looked at a different set of outcomes, and sometimes at different times as well, making it hard to compare the results. The findings of the demonstrations are summarized below.

Child safety based on child welfare administrative reports: There was no statistically significant difference among confirmed child maltreatment reports between the experimental and control groups in Elmira. But there is some evidence that the Elmira program reduced child maltreatment among the participants who were most at risk, those who were teenagers, poor and unmarried. Among this group, 19 percent (or a total of eight) of the poor, unmarried teens had a verified maltreatment report compared to only one of their nurse-visited counterparts. But this effect was statistically significant at the p-0.7 level, not the standard level of 0.05. And there were no treatment-control differences in verified maltreatment reports during the two years after the program ended. However, the Elmira study did find a large impact on verified CPS reports when the children were 15; nurse-visited children had received on average of 0.29 verified CPS reports compared to 0.54 in the comparison group. This result is difficult to explain and one wonders if it was due to chance.This outcome was not examined in Memphis or Denver. The Netherlands study also found a large, statistically significant impact on child welfare administrative reports, where the researchers found that 11 percent of the visited children had a CPS report compared to 19 percent of the control group children during the first three years of their lives.
Child safety based on health care for injuries and ingestions: Nurse visited children in Elmira had fewer emergency room visits for injuries and ingestions in their second year of life than the control group. (This was not measured during the first year, when they were less mobile and able to get into trouble. No effect size was provided). When they were between 25 and 50 months old, they had 40 percent fewer mentions for injuries and ingestions in their medical records and 45 percent fewer mentions of child behavioral or parental coping problems. In Memphis the researchers found that in the first two years of life, nurse-visited children had an average of 0.43 health encounters for injuries or ingestions compared to 0.56 for the control group, or 23 percent fewer encounters. They also spent an average of 0.04 days hospitalized for injuries and ingestions, compared to 0.18 days for the control group– a 78% decrease. A more recent evaluation of a large scale implementation of NFP in South Carolina found no difference between the experimental and control groups on child health, measured as “a composite of mortality or health care utilization associated with major injury or concern for abuse or neglect.” In the UK Study, there were no differences in the rates of emergency hospital visits for the experimental and control groups.
Child wellbeing based on behavioral and emotional functioning: This outcome was not included in Elmira at two and four years. But there were large favorable effects on self-reported arrests and convictions for the Elmira children at age 15-19–a finding that was not reported anywhere else and was not matched by effects on other outcomes like high school graduation, teen pregnancy, engagement in work or school at 19, or self-reported substance use or welfare receipt, all of which could have been expected to covary with the arrests and convictions. So it is not clear whether these results occurred by chance. In Memphis there were no effects found on children’s reported behavioral problems at two years, nor were there any results on youth behavioral functioning when they got older. There were significant favorable effects on child emotional functioning in Denver at two years and four years. By ages six to nine in Denver, behavioral and emotional effects were consistently favorable but did not reach statistical significance at standard levels, perhaps because the sample size was not large enough.
Child wellbeing based on cognitive functions and abilities: In Elmira there were no statistically significant cognitive effects on children in the first two years, although the researchers observed “improved intellectual functioning of nine to 11 points on the developmental tests for children from the highest risk families. Although only marginally significant statistically, the researchers observed that it is of clinical importance. Treatment effects in this range are consistent with those obtained for children of this age enrolled in intensive early childhood intervention programs aimed specifically at enhancing cognitive development.” In Memphis, there were no effects at two years on children’s mental development but there were substantial statistically significant effects on academic performance at age 12 for the children whose mothers were in the lower half of the sample on intelligence, mental health and self-confidence. In Denver, there were favorable effects on the cognitive development of children born to mothers with low psychological resources in the two-year follow-up. This group also did better cognitively at ages six to nine but the findings only occasionally reached statistical significance and may be due to attrition differences between the intervention and control groups. But at age 18 there were “sizable, significant” effects on two of three cognitive outcomes for this subgroup in Memphis. Cognitive effects were not studied for Elmira or Denver 18-year-olds.
Maternal life course: When the children were aged 15, the Elmira study found that nurse-visited mothers had 19 percent fewer births than control mothers, an average of 1.3 births compared to 1.6. In Memphis, the mothers had 16 percent fewer births in the first six years of the program. They had caught up by the time the children were 12, but the increase in birth spacing is still a significant favorable outcome. In Denver, home-visited women had fewer subsequent pregnancies (29 percent vs. 41 percent) and births (12 percent vs. 19 percent) by their children’s second birthdays. There was no impact on the rate of second pregnancies after two years in the South Carolina, British Columbia, and UK studies. Where reported, there were no effects on adverse birth outcomes, maternal employment, likelihood of partnership or marriage with the child’s father, substance abuse, psychological distress or foster care placements (mentioned only in Memphis).

Healthy Families America

The contrasts presented by the Title IV-E. Clearinghouse were based on four RCT’s that were rated highly for design and execution by clearinghouse staff. The results of each RCT are based on multiple research papers published for each major study. Reviewing the Clearinghouse’s tabulation of the data, and sometimes comparing it to the actual publications to which it referred, raised several questions about the overall effectiveness of the program:

Child safety measured by child welfare administrative reports: There were no favorable or unfavorable outcomes, as compared with 43 contrasts showing no statistically significant effect.
Child safety, based on maternal self-reports about whether they maltreated their children: There were five favorable contrasts, 38 contrasts with no effect, and one unfavorable contrast. It is hard to be confident about the validity of self-reports of maltreatment, as one could easily imagine the program participants having learned more about what to report, and under-reporting behaviors (such as spanking) that they had been taught were undesirable. The large number of contrasts with no effect is worth noting.
Child safety based on injuries needing medical care, hospitalizations, and emergency use: There were no favorable or unfavorable impacts and 11 contrasts showing no effect.
Child permanency based on out-of-home placements: There were six contrasts showing no effect, and none showing a positive or negative effect.
Child well-being: Behavioral and Emotional Functioning: Five contrasts showed a positive effect, two with no effect, and none with a negative effect. All of the five positive effects were reported by Healthy Families Alaska and were fairly large. But all of these were based on the caregiver’s report of the child’s behavior, and self-reports are not sufficient on their own for making conclusions about impact. Moreover, these outcomes and measures were not replicated in any other study.
Child well-being: social functioning: The Clearinghouse reports no favorable or unfavorable effects and and two contrasts showing no effect.
Child well-being: cognitive functions and abilities: There were two favorable impacts, one unfavorable impact, and 6 contrasts showing no effect. The two favorable impacts came from Alaska and were not found in any other evaluations.
Child well-being: physical development and health: The Clearinghouse reported no favorable or unfavorable impacts and six contrasts with no impact.
Child well-being: delinquent behavior. There was one favorable effect in the one contrast available, which was “child skips school often.” A look at the publication containing this result, which was a report on the RCT of Healthy Families New York (HFNY) seven years after random assignment, showed that fewer children self-reported skipping school, but this result was not supported by reports from their mothers.
Child well-being: educational attainment: The Clearinghouse reported one favorable impact and two findings of no impact. All three findings came from one publication from the HFNY RCT. The researchers found that children in the HFNY group were about half as likely to be retained in first grade (3.54 percent) than children in the control group (7.10 percent), based on official school data. However, there were no impacts found for the other two educational attainment outcomes used by the Clearinghouse–performing above or below grade level in reading or math. Moreover, this contrast was not available from any other study.
Adult well-being: positive parenting practices: There were three favorable impacts and 24 findings of no impact. All of the favorable impacts were from another report on HFNY that was based on observations of how the mothers interacted with their children as they completed three tasks–a puzzle solving task, a delay of gratification task, and a cleanup task. I was not able to judge the size of the effects; all were statistically significant at the 0.05 level. However, there were no significant effects on observed presence of harsh parenting during the same tasks. Moreover, this outcome was not included in the evaluation of any other program.
Adult well-being: parent/caregiver mental/emotional health. The Clearinghouse found three favorable impacts and 16 contrasts showing no impacts from a total of three RCT’s.
Adult well-being: Parent/Caregiver Substance abuse: There were no favorable or unfavorable effects, and 15 instances where no statistically significant effect was found.
Adult well-being: family functioning: There were three favorable impacts, one unfavorable impact, and 28 instances of no impact. The three favorable impacts stemmed from three different contrasts related to Intimate Partner Violence (IPV)–overall maternal IPV victimization rate (child age 1-3), maternal IPV victimization rate: physical assault (child aged 1 to 3), and maternal IPV perpetration rate: physical assault (child age 1 to 3). The size of the effect was not provided and there were nine other maternal IPV contrasts when the child was aged 1 to 3 that showed no effect. There were ~~were~~ no impacts on IPV when the child was older.
Adult well-being: economic and housing stability. There were no favorable impacts, five contrasts showing no impact, and one showing an unfavorable impact.

Parents as Teachers

The results presented by the Title IV-E Clearinghouse are based on two RCT’s and one study based on a matched comparison group. Even when counting all these programs, the results are not impressive.

For child safety based on administrative reports, the Clearinghouse noted two contrasts with a favorable effect and two with no effect. The effect size and implied percentile effect calculated by the Clearinghouse were very small. Moreover, these results were based on a matched comparison group rather than an RCT, casting doubt on the validity of the results.
Child permanency (out-of-home placement): The clearinghouse cited no favorable or unfavorable findings and one finding of no effect.
Child well-being: social functioning. The original article cited by the Clearinghouse, based on an RCT in two California sites, reported that PAT children in one of the sites benefited significantly, advancing by about two months of the control group in self-help development but did not report significant results for the other site or for social development at either site.
Child well-being: cognitive functions and abilities: Based on the American and Swiss RCT’s, The Clearinghouse reported two favorable findings and 10 findings of no effect. But one of the findings was actually of no effect for the PAT-only group; it was the “PAT plus case management group” that experienced an impact.
Child well-being: Physical development and health: The clearinghouse reported no favorable or unfavorable effects and three findings of no effect from one RCT.
Adult well-being: positive parenting practices: The Clearinghouse reported no favorable or unfavorable effects and one finding of no effect from an RCT.
Adult well-being: family functioning: The Clearinghouse reported no favorable effects, 8 findings of no effect, and one unfavorable effect, all from one RCT.
Adult well-being: economic and housing stability. The Clearinghouse reported no favorable effects, one unfavorable effect, and nine findings of no effect, all from one RCT.

SafeCare

SafeCare is a brief home visiting model that is delivered in 18 one-hour sessions. SafeCare is designed for parents and caregivers of children birth through five who are either at-risk for or have a history of child neglect and/or physical abuse.It was included in the Title IV-E Prevention Plans of seven states in April 2023. The contrasts reported by the Clearinghouse include only one favorable effect–on foster care placement–based on a matched comparison group study and not an RCT and one unfavorable effect (on child welfare reports), along with 19 findings of no effect.

Early Head Start Home-based Option

The Early Head Start Home-based option serves low-income women and families with children under three years old. They receive a minimum of weekly 90-minute home visits and two group socialization activities per month. The findings discussed here are based on the HHS Office of Policy Research and Evaluation (OPRE) review of the research on home visiting. OPRE reports that it reviewed 23 “manuscripts” and identified nine of those manuscripts that were based on “impact studies rated high or moderate quality.” By focusing on “manuscripts” instead of studies, OPRE obscured the fact that seven of these manuscripts were actually based on the same study–a large federal demonstration of EHS programs in 17 sites conducted between 1996 and 2002. Of the nine manuscripts, five were based on the full study and two were based on results from one Utah site only. The other two studies reviewed were based on results of the MIHOPE study of four home-visiting models when the children were 15 months old. All but two of the manuscripts were rated high by the OPRE staff in quality for methodology. The manuscripts based on the Utah study and the grade five follow-up for the national study were rated “moderate” in quality because of high attrition. In the nine publications reviewed, there were no favorable findings on maternal or child health; child maltreatment; or delinquency, family violence and crime. There were a few favorable impacts on child development and school readiness; positive parenting practices; and family economic self-sufficiency. These effects were not consistent across age groups or similar outcomes (like reading to children vs. reading at bedtime.) These impacts appeared to be small, although the lack of standardized effect sizes makes the importance of the effects hard to estimate.

For child development and school readiness, the reviewers reported five favorable findings from the 17-site study and the Utah study. All the other 66 contrasts related to child development and school readiness in the two studies showed no effect. By the time the children in the main study reached fifth grade, no effects remained.
For positive parenting practices, the reviewers reported 10 favorable findings from the 17-site study and the Utah study. In total, there were 64 findings of no effect in this area. By the time children reached fifth grade, one favorable impact (which was not noted for the three or five year-olds) was observed.
For family economic self-sufficiency, the reviewers reported 16 favorable findings, one unfavorable finding and 88 findings of no effect from 3 publications in a total of two studies. No economic effects remained by the time the children were in fifth grade.

Appendix II: Home visiting and child maltreatment

Analyzing the effect of any program on child maltreatment poses unique difficulties because it is such a difficult outcome to measure. Obviously, the evaluators cannot see what goes on in a household after the visitor has gone home. Evaluators have used three types of measures to estimate the effects of home visiting programs on child maltreatment–verified child protective services (CPS) reports, health care encounters for injuries or ingestions (or simply emergency room visits), and self-reports of abusive or neglectful behaviors through surveys like the Conflict Tactics Scale.

The most obvious measure of abuse and neglect is official Child Protective Services (CPS) data, but there are several problems with CPS data as a measure of maltreatment. The number of maltreatment reports that are confirmed (substantiated) by CPS is most frequently used, but it is known to be an understatement. Many cases go unreported, and reported cases are often not substantiated. Another problem is that verified abuse is a relatively rare event in a population and a study may not have enough participants to detect it. Finally, h visitors are mandatory reporters and their presence in the home introduces surveillance bias; these families are under more surveillance than families in the control group and may receive more reports for that reason.

Olds and his colleagues did not find statistically significant differences in substantiated CPS reports for the whole program group during the two year period that families participated in the Elmira demonstration or in the subsequent two years. But they found some evidence that the Elmira program did reduce child maltreatment among the participants who were most at risk–those who were teenagers, poor and unmarried. About 19 percent (or a total of eight) of the ~~the~~ poor, unmarried teens had a verified maltreatment report compared to four percent (or one) of their nurse-visited counterparts. But this effect was statistically significant at the p-0.07 level, not the standard level of 0.05. And there were no treatment-control differences in verified maltreatment reports for this subgroup or the whole treatment group during the two years after the program ended. The researchers speculated that this may be due to increased surveillance on the nurse-visited group, because the nurses connected them to other providers before the programs ended.

However, a surprising finding emerged when the children were 15 years old. By that age, nurse-visited children had received on average of 0.29 verified CPS reports compared to 0.54 in the comparison group–a large and highly statistically significant difference. The investigators hypothesized that as young first-time parents mature and develop, small positive changes that [occur while they are in the program] can build and multiply over time, yielding larger effects in later years.” The mechanism by which the Elmira program had such delayed effects is hard to understand. Perhaps it occurred by chance. But in any case, a replication would be necessary to give it credence, and this outcome was not measured in Memphis or Denver.

As an alternative to CPS data, some researchers have used data on health care encounters for children’s injuries or ingestions. Many of these encounters may reflect abuse or neglect but they also would include cases that are not due to either abuse or neglect and would leave out many instances of maltreatment as well. But it is certainly a good indicator of safe parenting. In the four-year followup of the NFP Elmira group, when the children were 25 to 50 months old, the researchers found that nurse-visited children had 40 percent fewer injuries and ingestions (according to notations in their medical records) and ~~and~~ 45 percent fewer notations of or child behavioral or parental coping problems. Nurse-visited children also made 35 percent fewer visits to the emergency room. In the NFP Memphis trial, the evaluators found that nurse-visited children had an average of 0.43 health encounters for injuries or ingestions compared to 0.56 for the control group, or 23 percent fewer encounters in the first two years of their lives. They also spent an average of 0.04 days hospitalized for injuries and ingestions, compared to 0.18 days for the control group. But a more recent evaluation of a large scale implementation of NFP in South Carolina, described above, found no difference found between the experimental and control groups in its composite measure of child mortality and major injury related to abuse or neglect.

Other studies have used parent self-report measures such as the Conflict Tactics Scale. This measure is less valid than the other two because many parents are reluctant to report abusing or neglecting their children. A few studies found positive effects on such measures but without any corroboration from more objective measures.

Notes

Conversation between Marie Cohen and David Olds, October 22, 2025
↩︎
Similar disappointing results from a study in the United Kingdom may have been influenced by a control group that received an average of 16 home visits from a public health nurse and 11 visits from a midwife through the child’s second birthday, as well as targeting a lower-risk population than most of the other studies. A study in British Columbia found no reductions in its primary outcome – child injuries by age two years – or in subsequent maternal pregnancies by the child’s second birthday. The authors speculate that British Columbia’s more comprehensive health and social services may explain the lack of effects. ↩︎
The authors organized the outcomes into five “research questions” focusing on maternal outcomes and three research questions focusing on “child outcomes.” The “maternal outcomes” included “outcomes that could be improved through direct interaction between parents and home visitors;” maternal mental and behavioral health; parent-child interactions; conflict, violence, aggression and maltreatment;” and families’ economic circumstances. The child outcomes included “children’s social-emotional functioning in the home context; children’s social-emotional functioning at school; and children’s cognitive, language and early math skills. ↩︎
Conversation with Emily Putnam-Hornstein, who made me aware of the revised 2025 research plan. ↩︎

This post was edited on November 10, 2025 to add a sentence and links about enrollment and engagement in home visiting and a link to an article about the MIHOPE report.

Child welfare and community norms: a troubling divergence

This summer, I was asked by a reporter to comment on a terrible case in the District of Columbia. Twenty-month old Kemy Washington died of starvation and dehydration, after her mother had had overdosed on a mix of MDMA, cocaine, ethanol and the animal sedative xylazine. An older sibling had been removed from Kemy’s mother due to her neglect and that child’s guardianship with a relative had been ratified only days before Kemy was born. Yet, Kemy was never on the radar screen of the Child and Family Services Agency until her grandmother made two calls, which were apparently screened out as not involving child abuse or neglect. When I read the more than 600 comments on the article, I was struck that over and over again, commenters asked the same question. How is it that a mother who had a previous child removed from her due to neglect could give birth to another child without triggering an investigation, close monitoring, or even removal of the child? The reporter asked me the same question and I explained that such a policy, though clearly logical to members of the community, would never be accepted by the current child welfare establishment, where it would be viewed as an unacceptable infringement on parents’ rights.

I have often remarked on situations where child welfare policy or practice departs from general community norms. Whether it is the continued screening out of calls on the same family, even if a child was previously removed; the refusal to consider policies that would trigger investigations when a new child is born to a parent who committed severe abuse or neglect; the push to “reunify” children with parents who have proved over and over again that they cannot keep them safe or even stop harming them, it seems that policymakers and practitioners of child welfare are operating from a different set of norms than the public. What would be clear to a grandparent, a neighbor, or a random layperson do not seem so evident for those who are charged with protecting our children. This was made very clear in a devastating report on child fatalities in Minnesota. As the authors put it,

Members of the public often express dismay and outrage to us over stories such as those recounted in this report. We infer from this that the professional norms currently guiding child protection and foster care are out of alignment with those of the broader community.

Examples of this divergence abound, and I am sharing just a few here.

“B.B.” was born in the State of Washington in 2022 and died of fentanyl poisoning in March, 2023. Starting in 2014, the Department of Children, Youth and Families (DCYF) had received 30 reports about B.B.’s family for the use of heroin, marijuana and alcohol in the home; lack of supervision of the children; domestic violence; an unsafe adult living with the family; an unsafe and unclean physical environment; unsecured guns in the home, “out-of-control” behaviors by B.B.’s older siblings at school to which the mother was unresponsive, seeming “out of it;” concerns about the children’s hygiene; and the mother driving under the influence of marijuana. A few days before B.B.’s death, a caseworker told B.B.’s mother that the agency was closing a voluntary services case that had been open for about half a year. But the family was already under investigation again at the time B.B. died.

There have been multiple cases around the country of child protection workers disregarding reports of hungry children eating food from the floor or the garbage, until a child finally died or escaped from the torturers. School staff in Utah reported making at least four calls in the 2022-2023 school year (confirmed by a timeline released by DCFS) to CPS alleging that Gavin Peterson was always hungry and eating food from the trash. School staff were buying his lunch but had to stop after his father and stepmother forbade it. One school staffer “said Gavin’s father and stepmother justified Gavin’s small frame and constant desire for food as side effects from his medication, but she didn’t buy it.” Why did CPS? That summer, Gavin was withdrawn from school. A year later he was dead after years of starvation and beatings.

Seven-month-old Emmanuel Haro is missing and presumed dead. Investigators believe that he was abused for an extended period of time before he was killed. But his suffering and death could have been avoided. His father had been arrested for abusing a child from a previous marriage in 2018–abuse so serious that the child is now bedridden. A simple “birth match” policy could have prevented the death of Emmanuel Haro. If birth records were linked to criminal and CPS records, Emmanuel’s birth could have triggered a mandatory investigation and monitoring because the father had been convicted of child abuse–the kind of policy that commenters in the Kemy Washington case were asking for. It is hard to think of a more common-sense idea than birth match. Yet, only five states had such a policy in 2022, according to my report on birth match for the American Enterprise Institute. And most of these programs are very limited both in terms of which parents are covered and of the state response.

Even a birth match policy would not help in cases where a parent’s violent history is known but disregarded. Four-year-old Rykelan Brown died from a beating by his father, Joshua Emmons, in May 2024, two months after he was removed from a loving foster home to be placed with Emmons. The foster parents had repeatedly reported that Rykelan came home from visits with his father bruised and saying his father hit him and he never wanted to go there again. The local Department of Social Services knew that in 2019 Emmons had beat his then-girlfriend’s three-year-old son so severely that he damaged the child’s liver, which must now be checked regularly. But the social services commissioner told an interviewer that the event occurred too long ago to be considered. Really? Even when paired with Rykelan’s bruises and reports of beatings?

As the above examples show, some things that are intuitive to ordinary people – -like that a child going to school hungry (and not because of poverty) – is a sign that something is deeply wrong at home–seemed to be missed by people engaged in child welfare practice, administration and policymaking. Much of the problem stems from a dominant ideology that preaches that abused and neglected children are almost always better off with their own families. The same viewpoint holds that what child welfare calls neglect is just poverty, as if all poor parents neglect their children, and that child welfare is a a racist system that was created to destroy Black and Brown families.¹ Social work schools have adopted and promulgated these positions and agencies have incorporated them in the training for new social workers. Deep-pocketed groups like Casey Family Programs have used their money to foster this ideology through training and technical assistance to state and local agencies. The entire child welfare community in many states has found itself endorsing policies and practices that defy common sense thinking.

We must bring child welfare policy and practice back into alignment with community norms. But that is easier said than done. The public pays little attention to child welfare until there is a tragic fatality or egregious incident that is covered in the media. But many of these cases are never known to the media and therefore to the public. And even when they are, child welfare agencies often refuse to release information about their past involvement with the family, in violation of federal law. So the press, the public and legislators cannot identify what went wrong and what would be needed to prevent future tragedies in the future.

A small but useful first step to align child welfare systems with community norms would be to make the public aware of decisions that clearly violated these norms and harmed children. The federal government should enforce the requirements of the Child Abuse Prevention and Treatment Act (CAPTA), which as interpreted in the federal Child Welfare Policy Manual, requires states to issue specific information and findings on all child maltreatment fatalities and near fatalities caused by maltreatment. That includes information about past dealings between the children’s families and the child welfare agency. Ultimately, the requirement must be expanded to cover all “egregious incidents” where maltreatment is suspected.² Increased public awareness how child welfare agencies knowingly and routinely leave children in harm’s way may help elevate child welfare into a major issue, not a backwater that gets addressed only when there is a tragedy.

Three family members are awaiting trial for murdering 11-year-old Arabella McCormick in August 2022 and torturing her sisters. A kindergarten aide in Arabella’s class told a reporter that she got a disturbing note from Arabella’s foster mother, who went on to adopt her and then allegedly participate in her murder. “In the envelope, it said, ‘Arabella is,’ and it was line items such as ‘a terrible child,’” she said. “‘She’s a liar. You can’t believe anything she says. She’s a thief. She steals everything. Don’t trust her.’ It was just one thing after another of horrible things that you would never say about a 6-year-old.” The teacher’s aide told the grand jury that she contacted child protective services (CPS) after Arabella arrived at school school in the same dirty clothes on several occasions. She also told CPS that Arabella wasn’t allowed to eat fruit, accept rewards or participate in recess with other children. “And the lady from CPS said to me on the phone — after I told her everything, she said, ‘Well, it could be worse,’” the teacher’s aide told the grand jury. Really? I don’t think most members of the public would agree.

Notes

In fact, child welfare systems initially involved White children only. Black children were originally excluded from public child welfare systems. ↩︎
Both Colorado and Wisconsin release information on cases meeting this description. ↩︎

The continued decline in foster care placements: What, if anything, are children and families getting instead?

On May 9, 2025, the US Administration for Children and Families (ACF) announced that the number of children entering foster care had continued to decrease in FFY 2023. Entries to foster care dropped from an estimated 264,000 in FFY 2018 to 175,282 in FFY 2023–a drop of 33.6 percent. But foster care is not the only service provided by child welfare agencies after an investigation or assessment finds that a child needs protection. Instead of being placed in foster care, some children and their families receive “in-home services,” which aim to ameliorate the risks to their safety without removing them from their homes. With the large drop in child removals, it is natural to ask whether home-based services are being provided to more families as fewer children are placed in foster care. Unfortunately, the data to answer to that question is not available on a national basis or for most states.

Clearly we cannot determine what is happening to the children who “would have been placed in foster care” under previous policies and practices. But at least we can ask if declining foster care placements are being offset by the opening of more cases for in-home services–which some states call Intact Family Services, Family Maintenance, or Family Preservation Services, among other terms. These are the services that are provided to children and their parents after an investigation or assessment determines that the situation does not meet the criteria for foster care placement (usually imminent danger to the child) but that the family does need services and monitoring to reduce risks to the children. In a major investigation, Texas Public Radio (TPR) found that a 40 percent drop in child removals by the state’s Department of Family and Protective Services (DFPS) over a six-year period was not accompanied by an increase in family preservation services (as they are called in Texas) but instead by a “radical curtailment” of such services. Children were left in dangerous homes with no services or monitoring.

For many years, many powerful groups like Casey Family Programs blamed the alleged lack of federal reimbursement for services to families, like drug treatment, mental health care, and parenting support, for the removal of many children who could have been helped at home. As I have pointed out, this argument was largely spurious because states were already providing these services using Medicaid and other sources. In any case, the passage in 2018 of the Family First Prevention Services Act (FFPSA) was supported by advocates as a means to alleviate this alleged problem by making funds available for these in-home services. Given the repeated use of that narrative by proponents of FFPSA, it would have been logical to mandate that states report on the numbers of children receiving such in-home services, the characteristics of these children and the services they receive. But such a mandate was not included in the Act.

States are currently required to provide child welfare data to the Children’s Bureau via two separate systems. They must submit foster care and adoption data through the Adoption and Foster Care Analysis and Reporting System (AFCARS). A separate system, the National Child Abuse and Neglect Data System (NCANDS), includes data on abuse, neglect, and child protective services. NCANDS includes numbers of children receiving “postresponse services,” or services provided as a result of needs discovered during an investigation or assessment. But these numbers are provided in a form that is neither meaningful nor comparable to the AFCARS data, and therefore does not allow the comparison of foster care and in-home numbers for each state and the nation.¹

Not only does the federal government not ask the states for meaningful data on in-home cases; most states do not provide such data on public-facing platforms. A review of reviewed publicly available data for the 12 states with the largest number of children in foster care yielded only two (California and Texas) that provided enough data on in-home services to answer the question of whether declines in foster care removals have been offset by the opening of in-home cases. The results are discussed below.

California

California has far more children in foster care than any other state, 43,095 children at the end of Federal Fiscal Year 2023, which was 12.6 percent of the national total, according to AFCARS data. Fortunately, California Child Welfare Indicators Project (CCWIP), a collaboration between University of California at Berkeley and the California Department of Social Services, provides excellent data on all child welfare services provided in California. The CCWIP dashboards include data on the number of entries into foster care and the opening of Family Maintenance cases, as in-home cases are called in California. According to CCWIP, entries into foster care declined from 26,766 in Federal Fiscal Year (FFY) 2019 to to 17,071 in FFY 2024. Rather than increasing to make up for the drop in children entering foster care, the number of children with Family Maintenance case openings as the first service component declined from 25,887 to 18,441 over the same period. The total number of children with cases opened for child welfare services dropped from 44,747 to 29,936 over the five-year period–a drop of 33.1 percent.² Rather than a shift from foster care to in-home services, there has been an reduction in the number of children reached by child welfare services.

Texas

Texas has the third largest state foster care caseload, behind California and Florida. The number of Texas children entering foster care dropped from 16,028 in 2021 to 9,623 in 2022, an incredible 40 percent, and then stayed about the same for the following two years. Confirming the conclusions of TPR, the number of children entering family preservation services dropped from 51,806 in FY 2020 to 39,655 in FY2021 and then to 26,132 in 2022–half of the 2020 total. The drops in foster care and in-home case openings were presumably related to a new Texas law that changed the definition of neglect and put restrictions on child removals. In addition, a 2020 policy change restricted eligibility for Family Preservation Services in Texas, according to the TPR investigation. TPR found that the number of families that DFPS rejected for family preservation services jumped from 300 to about 2,800 in the first year the policy took effect. Perhaps in an effort to rectify the extreme curtailment of services, the number of children with in-home case openings increased in 2023 and 2024, while the number of children entering foster care remained stable. Nevertheless, the overall trend over time was a decrease in foster care entries, and in children with new family preservation cases.³

A look at the two figures above shows a major difference between the California and Texas. In California, substantially more children entered foster care (17,071) than entered family maintenance services (13,473) in FFY 2024. But in Texas, the number of children entering family preservation services (42,855) was more than four times the number of children entering foster care (9,220) in FY 2024. This vast difference makes clear that nationally we have no idea whether more investigations result in foster care or in in-home services. And we don’t know whether the number of children with new in-home cases has increased as the number being placed in foster care has gone down. Moreover, we don’t know what kind of in-home services parents and children are getting. Are children in California’s Family Maintenance Services getting a similar package of services as those in Texas’ Family Preservation Services? We just don’t know. That is not an acceptable state of affairs, especially given the use of federal funds for these services.

In order to make the needed information available, new legislation might be required. Section 479 of the Social Security Act required the establishment of a system to collect data on foster care and adoption in the United States. AFCARS was created based on general guidelines laid out in the law and more detailed regulations promulgated by HHS. But now it is time to expand AFCARS to include data on child welfare services delivered in children’s homes when a case is opened for the provision of such services. The same sorts of data on entries, exits, caseloads, demographics, and reasons for the initiation of services as is required for foster care should be included for in-home servcies. Required variables should also include the types of services provided to each family and whether they are voluntary or mandatory with court involvement.

While data from Texas and California suggest that child welfare has been reducing its footprint since 2018, we cannot assume that this is happening nationwide without data. That is why ACF should request that Congress act to require that states submit data on in-home cases. Even with this information we will not know how effective in-home services are in protecting children andhelping their parents ameliorate the conditions that put their children at risk; there is very little research that addresses this question. More and better research on that issue is needed. But not even knowing whether children who would have once been placed in foster care are now being protected at home while their parents are helped to make them safe is simply not an acceptable situation.

Notes

The numbers provided include foster care as well as in-home services. The number of children provided is a duplicated count. And the number of children receiving each type of services is not provided. ↩︎
These totals are lower than the sum of the children with foster care entries and in-home case openings, presumably because some children entered in-home services and were placed in foster care in the same year. ↩︎
Texas does not provide the total number of children entering services of any type as does California. Adding those entering foster care to those entering in-home services would produce an inflated estimate since we do not know the number of children who may have entered both types of services during the year ↩︎

The Trump Administration is separating families again

by Marie Cohen

The last time Evgeny and Evgenia saw their eight-year-old son Maksim was on May 15. That’s the day that the couple refused to board a commercial flight taking them back to Russia, from which they had fled fearing persecution for their opposition to Valdimir Putin. On August 24, Maksim will turn nine years old in foster care. He has not seen his parents since May 15 and has given up hope for a reunion. Maksim’s family is not unique. The New York Times found a total of nine cases in which parents have been separated from their children after refusing to comply with deportation orders in this new version of the family separation policy that generated such a strong backlash in the first Trump Presidency.

As reported by Hamed Aleaziz in the New York Times and its podcast, The Daily, Evgeny and Evgenia, who prefer not to have their last name revealed, fled Russia because of their political activism. As supporters of Putin’s murdered enemy Alexei Navalny, they felt that they were at risk of losing their freedom, their livelihood or even their lives if they remained in Russia. They fled to Mexico, with the hope of getting an appointment to apply for asylum in the US through a cellphone app created by the Biden Administration to enable asylum-seekers to schedule an appointment from outside the country. But Trump shut down that program when he took office. Seeing no other option, the family went to a port of entry on the southern border and explained that they were there to seek asylum. But asylum applications had been shut down completely at the southern border, and the family was detained in Border Patrol custody. After two weeks, they were taken to JFK airport to be deported.

At the airport, ICE officials told Maksim’s parents that they would be separated from their son if they did not board the flight to Russia. But Evgeny was trying to prevent a longer separation in Russia since he expected to be detained there. With many tears on all sides, Evgeny and Evgenia were taken to detention and Maksim was taken to a shelter for unaccompanied immigrant children. It was May 15, 2025.

In the first Trump administration, thousands of families were separated at the border as a way to deter people from entering the country illegally. Parents were arrested and criminally charged for illegally entering the country and their children were taken away. This policy created a massive outcry worldwide and Trump ended it in 2018. Today, border crossings have slowed to a trickle and the new administration is focused on deporting those who have already crossed. Migrants from many countries can be shackled, cuffed, and loaded onto chartered flights. But for those who came from countries like Russia that do not accept deportation flights from the US, the government must use commercial flights to deport unwanted migrants. And commercial airlines do not accept passengers in restraints or who make a scene. Hence the choice offered to Maksim’s parents.

As Aleaziz puts it for the Times, “the new cases suggest that the administration has decided to use family separation as a tool, at least in some instances, to persuade families to leave and to create a powerful deterrent for those who might come to the United States illegally.” He found nine families who have refused deportation and been separated. But he does not know how many families have faced this choice, including those who have agreed to return to the countries from which they came. A spokeswoman for the Department of Homeland Security told him that there is no family separation policy and that “these families had the right and the ability to depart the country as a family and willfully choose to not comply.”

Evgeny and Evgeniia have not given in–a fact which lends credence to their fear of persecution in Russia. Since Maksim was taken from them, they have passed the rigorous screening for the validity of their asylum claim. Now the government cannot deport them to Russia but can send them to a third country if one can be found. Maksim has been transferred to foster care. His conversations with his parents are heartbreaking; At first he was counting the days that he has been apart from his parents but has now stopped. At this point, he has given up hope that he will see his parents again. Maksim will turn nine on August 24 and it looks like he will not be with his parents on that special day.

My regular readers know that, unlike some people who want to abolish foster care, I support the separation of children from their parents when there is abuse or neglect that is so severe that the child cannot be protected without removal. But perverting these practices in order to deter asylum-seekers is state-committed child abuse. Allowing Maksim to spend his ninth birthday in foster care as a lesson to families with valid asylum claims not to enter the United States is heartless beyond belief. Can a groundswell of opposition be generated and end this family’s ordeal and that of others in a similar situation? I certainly hope so.

Teaching abuse: how some adoptive parents are being taught to maltreat their children

Image: Yadkin Ripple

by Marie Cohen

At a glance:

Reactive Attachment Disorder (RAD) is a diagnosis that is included in the DSM and often applied to foster and adopted children. While RAD refers to a pattern of inhibited, withdrawn behavior, some controversial therapies (often described as varieties of “Attachment Therapy”) are based on a distorted definition of RAD, or on an unauthorized diagnosis of “attachment disorder” that includes a deep-seated rage that if unaddressed will result in antisocial and even criminal behavior.
Among the practices included these controversial therapies are severe disciplinary methods including the establishment of total parental control over children’s actions, including eating, drinking and using the toilet.
Many of these Attachment Therapy technique include a component that involves forcing the child to express underlying rage through physically coercive methods that may include being held down by several adults for as much as three to five hours. Several child deaths have been attributed to such methods.
In order to prevent more damage to children, it is necessary to adequately vet prospective adoptive parents for their readiness to parent children with challenging behaviors due to early trauma and deprivation. Even for parents who are able to meet the challenge, training and continued support are necessary.
Unbelievably, some adoptive parents have not been charged even when their parenting techniques have led to the deaths of their children. It is absolutely necessary for parents who use abusive parenting techniques to be charged and tried in court. Adequate investigations are necessary in order to ensure that the conditions that lead to such cases are identified and remedied.

On January 5, 2023, according to a police warrant filed in Surry County, North Carolina, Joseph Wilson received a text from his wife telling him that something was wrong with their four-year-old adopted son Skyler after he was “swaddled.” She attached a picture of Skyler lying face down on the floor, wrapped in a sheet or blanket with duct tape attaching him to the floor. “Swaddling” is a practice used in many cultures to comfort infants, but Wilson told police he was referring to a parenting technique learned from a parenting expert named Nancy Thomas. (Court documents also state that one of the Wilsons’ former employees described recorded Zoom counseling sessions the couple had with Thomas.) Skyler died at Brenner Children’s Hospital in Winston-Salem on Jan. 9 of a “hypoxic, anoxic brain injury,” meaning that oxygen was unable to reach his brain due to the “swaddling.” Skyler’s adoptive parents, Jodi and Joseph Miller, have been charged with murder and felonious child abuse and are awaiting trial, which has recently been postponed–for the second time–from June 2 to December 1, 2025.

After Skyler’s death, police recovered surveillance cameras and arm and ankle restraints that Wilson had told them his wife used on Skyler during “swaddling.” A former foster parent of Skyler and his brother told police that Jodi Wilson had told her about using practices like “food restriction, the gating of Skyler in a room for excessive ‘alone’ time, and the exorcisms of both children.” The former foster parent was concerned enough to call Child Protective Services a month before the incident that killed Skyler.

Nancy Thomas, mentioned as the source of the swaddling technique and as a counselor to Skyler’s parents, is perhaps the most prominent exponent of a group of approaches to that the American Professional Society on the Abuse of Children (APSAC) described in a 2006 report as “controversial attachment therapies.” These therapies are generally directed at children with “attachment disorders.” The only such disorder that is officially recognized by the mental health community is “Reactive Attachment Disorder” (RAD), a diagnosis that is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This diagnosis involves “a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers” as well as a “persistent social and emotional disturbance characterized by behaviors like minimal responsiveness to others, limited positive affect, and “episodes of unexplained irritability, sadness or fearfulness.” To be diagnosed with RAD, the child must have “experienced a pattern of extremes of insufficient care,.” which explains why this diagnosis is often applied to children who were adopted from orphanages abroad or foster care in the US. Some practitioners of these controversial attachment therapies, like Nancy Thomas, prefer to speak of children with “attachment disorder,” which is not included as a diagnosis in the DSM. Others use the term RAD but ascribe to that term a variety of symptoms that are not part of the DSM definition.

Whatever term they use, practitioners of controversial attachment therapies tend to believe that children who experience early adversity become “enraged at a very deep and primitive level.” This suppressed rage is said to prevent the development of attachment to caregivers and others and to lead to severe behavioral problems, such as violent behavior. These children are described as failing to develop a conscience, not trusting others, seeking to manipulate and control others, and at risk of developing criminal and antisocial behaviors. According to Nancy Thomas, some famous people with “Attachment Disorder” who did not get help in time include Adolph Hitler, Saddam Hussein, Jeffrey Dahmer, and Ted Bundy.

As described in the APSAC report, these controversial attachment therapies suggest that “parenting a child with an attachment disorder is a battle, and winning the battle by defeating the child is paramount.” Parents are often counseled to start by establishing total control over all the child’s actions, and requiring immediate obedience to parental commands. Nancy Thomas’s book, When Love Is Not Enough: A Guide to Parenting Children with RAD-Reactive Attachment Disorder, includes advice like “In the beginning, your child should learn to ask for everything. They must ask to go to the bathroom, to get a drink of water, EVERYTHING. When it starts to feel that they must ask to breathe, you are on the right track.” Another quote: When given directions it is unacceptable for the child to ask ‘”‘why?” or ‘what?’ NEVER answer these questions….Remember, have a consequence ready when a rule is challenged.” Thomas also recommends putting an alarm on a child’s bedroom door, and the window if necessary. Other techniques that have been recommended by attachment therapists include keeping the child at home (even counseling home schooling), barring social contact with others, assigning hard labor or repetitive tasks, and requiring prolonged motionless sitting.

Many proponents of controversial attachment terapies also believe that a child’s rage must be “released” before he or she can function normally. This release is often provided through physically coercive methods that may include being held down by several adults for as much as three to five hours. These techniques can be traced to “holding therapy,” a technique developed by a child psychiatrist named Foster Cline, who was ackhowledged as a mentor by Nancy Thomas in her book. Cline was admonished and restricted from using parts of his holding therapy model by the Colorado Board of Medical Examiners after members saw video of an 11-year-old being subjected to physical and verbal abuse while being restrained.

“Holding therapy” and similar methods designed to address “attachment disorder” have been implicated in the deaths of several adopted children, including that of three-year-old Krystal Tibbets, who died in 1997 when her adoptive father “applied the full weight of his body on the girl by lying across her and pressing his fist into her abdomen,” a technique he said he was taught by a therapist; four-year-old Cassandra Killpack, who in 2002 was forced to guzzle two quarts of water while her arms were bound, and 10-year-old Candace Newmaker, who suffocated in 2000 by a “therapist named Connell Watkins during a 70-minute “rebirthing ceremony” that was supposed to treat her attachment disorder. Nancy Thomas was working for Watkins at the time of Candace’s death. The “swaddling” technique that killed Skyler Wilson is an example of such a method.

Advocates of controversial attachment therapies have come to the defense of Skyler Wilson’s parents. The President of the Board of a nonprofit called Attach Families, Inc. shared an article on Facebook about Skyler’s death with the following preface: “These tragedies are always written one sided with no Investigative reporting, sadly…They obviously were using a swaddling technique that some Professionals promote for Attachment. This is a tragedy. But before these parents are “burned at the cross” our Families want more information.” The Page also posted this: “As we have seen hundreds of others making our Families look like monsters. When the truth is we try and will try ANYTHING to help our children. This is what we are trying to help them heal from before they get too big for us to physically handle their rages. Rages in which they inflict self harm. Rages where they slam their heads over and over on purpose. Rages in which we try to protect them from themselves and others around them. If you don’t live it 24 hours a day you have no idea what it is like.” Attached was an article about a Kansas teen who was arrested in the killing of his mother. The article contained no details about the teen or his mother. It is hard to understand how this talk of rage would apply to four-year-old Skyler. His former foster parent told a reporter that Skyler “was so tiny and small but had a heart three times bigger than he was…”

In some cases, the parents themselves, after reading misleading literature about children with RAD may invent their own disciplinary practices or use those inherited from their own upbringings or family traditions. The Denver Post recently wrote about Isaiah Stark, a seven-year-old who died in 2020 from ingesting too much sodium, likely from drinking olive brine. The newspaper learned that Isaiah’s adoptive parents were forcing him to eat olives and drink olive brine as a form of punishment for his behavior. According to a report from the state’s Child Fatality Review Team, the mother blamed all of Isaiah’s difficult behaviors on RAD and both parents attributed his actions to “manipulative behaviors and wilfulness.” At the funeral, she described Isaiah’s death as “God rescuing him.”

Isaiah Stark’s parents were never charged for his death. Since there was no trial, the public never learned whether the parents received any sort of parenting advice from an “expert.” The failure to charge parents who have tortured and killed adoptive children is all too common: witness the case in Florida of Begidu Morris, whose parents were not charged after starving, confining and beating him for years, ostensibly because the person who actually killed him could not be determined. As developmental psychologist Jean Mercer writes, plea bargains and the failure of investigators to follow up on the development of abusive parenting practices mean that we often don’t know whether abusive parents drew on outside influences or their own family histories or imaginations for the practices that led to a child’s injury or death.

Concern about controversial theories and methods of “Attachment Therapy” about twenty years ago prompted the formation of a task force of the American Professional Society on the Abuse of Children, the leading professional society of professionals who deal with child abuse and neglect. Its 2006 report, mentioned above, concluded that “attachment parenting techniques involving physical coercion, psychologically or physically enforced holding, physical restraint, physical domination, provoked catharsis, ventilation of rage, age regression, humiliation, withholding or forcing food or water intake, prolonged social isolation, or assuming exaggerated levels of control and domination over a child are contraindicated because of risk of harm and absence of proven benefit and should not be used.” The report cautioned child welfare systems not to tolerate any such techniques by foster or adoptive parents. It also stated that “[p]rognostications that certain children are destined to become psychopaths or predators should never be made based on early childhood behavior.” It also condemned “intervention models that portray young children in negative ways, including describing certain groups of young children as pervasively manipulative, cunning or deceitful.”

Some adults are simply not suited to raise challenging children. Yet, agencies desperate to get children adopted, especially children with special needs in foster care, have placed children with such parents despite red flags, or even returned them after abuse was uncovered. In an extreme case in 2016, the 12-year-old adopted daughter of Eugenio and Victoria Erquiaga ran away from home. Neighbors found her with her hands zip-tied and her feet bound. She reported that she was locked inside a small playhouse for long periods of time with no bathroom. The story became national news and it became known that the parents had sought help from a mental health counselor who oversaw a program called “Radical Healing,” which no longer exists. The state charged the parents with child abuse. However, they then offered to drop all of the charges and expunge their records if the Erquiagas agreed to take their daughter back into their home, which they did. The girl ended up in a group home after she turned 18.

Twenty years since the APSAC report, children continue to suffer and die because they have been diagnosed by “experts” or parents with RAD or “attachment disorder.” To prevent more damage to children, state governments must adopt policies to ensure that all adoptive parents are adequately vetted. Agencies must be prepared to screen out potential adoptive parents who lack the patience, self-control and emotional intelligence to raise challenging children, and those who might be susceptible to practitioners offering controversial methods involving harsh discipline and physical restraint to cope with behaviors stemming from previous trauma or deprivation. In 2012, a committee led by Washington’s child welfare agency and children’s ombudsman published a Severe Abuse of Adopted Children Committee Report, which made several recommendations for improving assessment of assessing prospective adoptive families. These included strengthening qualifications for individuals conducting adoption home studies and post-placement reports and enhancing minimum requirements for these home studies and reports.

Training and ongoing support must also be provided to those adoptive parents who are deemed capable of accepting the challenge of raising children with histories of trauma and deprivation. These parents must be prepared to understand the needs and possible behaviors of the children they adopt, given their backgrounds. They also must be educated about the existence of parenting practices and therapies which are not supported by research and potentially harmful to children. And finally, they need ongoing support. The need for a greater investment in post-adoption services has been publicized by authorities like the Donaldson Adoption Institute (now closed) in its major report, Keeping the Promise: The Critical Need for Post-Adoption Services to Enable Children and Families to Succeed. Even RAD parent advocacy organizations like Attach Families Inc. are also asking for ongoing support.

Parents caught confining, starving, or otherwise abusing their children through adherence to “attachment therapies” must receive a criminal trial. This is, not only to ensure that justice is done, but also to provide an understanding of the factors that allow such tragedies to occur. The failure to try cases of parents who were obviously responsible for the torture and death of a child is a national stain and must be addressed.

That vulnerable children who have already been traumatized or deprived in early childhood in have met suffering or even death in licensed foster or adoptive homes should be a source of shame to all Americans. It is time to put an end to the suffering of children who have suffered enough. These tragedies can and must be prevented.

Just before this article went to press, the author became aware of media reports about the arrest of the adoptive parents of a 15-year-old boy, who for the past ten years has been locked in his bedroom for most of the day with no access to food, water or a bathroom. The adoptive father is a former employee of the El Paso County, Texas sheriff’s office. So far there has been no information about the genesis of the situation and whether a diagnosis or behavioral problem was involved. But it seems that hardly a week goes by without news of an egregious case of abuse against and adopted child. There is no time to waste in taking action to prevent more such suffering and damage to children.

This post was edited on June 24, 2025 to add a reference to the Washington report on severe abuse of adopted children and its recommendations and again on June 26 and 27 to correct several small errors and typos.

A Reality Check on Family First: It Has Nothing to Do with the 50% Decline in Indiana’s Foster Care Caseloads

by Emily Putnam-Hornstein (University of North Carolina at Chapel Hill), Sarah Font (Pennsylvania State University), and Brett Drake (Washington University in St. Louis).

I am honored to publish this post by three of the leading academic researchers in child welfare. As often is the case in this blog, they are writing about the flawed use of data to support the user’s claims about a policy or program. In this essay, the authors discuss last year’s testimony by Indiana’s deputy director of child welfare services claiming success for the state’s family preservation program in reducing foster care caseloads without compromising child safety while also reducing racial disparities.

On May 22, 2024, the U.S. Senate Committee on Finance held a hearing titled “The Family First Prevention Services Act (FFPSA): Successes, Roadblocks, and Opportunities for Improvement.” The testimony was striking for its still-aspirational tone 6 years after the law passed and its sanitized depiction of why children enter foster care. As researchers, however, the statistics offered by Indiana’s deputy director of child welfare services, David Reed, caught our attention. Reed’stestimony indicated that FFPSA and associated investments in intensive family preservation services and concrete supports had produced: (1) a 50% decline in the state’s foster care caseload, alongside improved child safety; and (2) a two-thirds decrease in racial disparities among children entering foster care.

These claims are striking and beg the question: How?

On their very face, such dramatic numbers should invite skepticism. Despite continued efforts to move “upstream,” empirical studies of maltreatment prevention programs generally generate null or small effects. But one way for an agency to achieve a rapid reduction in foster care caseloads is to increase the threshold for intervening, leaving children in environments from which they would have been previously removed.

Below, we review data for Indiana and conclude that available evidence does not support the testimony offered.¹ This is problematic not only for Senate Committee Members, but also the field at large. Bold causal claims based on flawed interpretations of data too often lead policymakers, and the public, to conclude that there are easy fixes to complex problems.

Reducing Entries to Foster Care and Improving Child Safety

The ideal way to reduce foster care entries is by reducing the community incidence of child abuse and neglect. Other than a brief drop during the COVID-19 pandemic, and despite investments in voluntary programs such as Healthy Families Indiana, referrals to Indiana’s child maltreatment hotline were largely stable pre- and post-FFPSA implementation (i.e., 168,919 in 2017 vs. 172,077 in 2023). There is no evidence of a decrease in suspected maltreatment identified by community members.

Of note, data indicate that Indiana is now screening in a smaller percentage of referrals (75.0% in 2017 to 57.9% in 2023). Certainly, it is possible that Indiana was responding to allegations of maltreatment that were unwarranted. Indiana issued guidance in 2021 designed to change the state’s response to allegations of “educational neglect.” But if such changes led to the reduction, one would expect that as more “low-risk” referrals were screened out, children who were screened in would have higher risk and a greater share would be identified as victims requiring services.

Yet that is not what the data show. Among children who were screened in, the number of substantiated victims declined by roughly 30% between 2017 and 2023. This decline is particularly notable, given that during this same period, overdose deaths in Indiana were increasing and parental substance abuse is one of the most well-established risk factors for child maltreatment. It would appear that in addition to reducing the number of children who received a response, Indiana also increased its threshold for substantiating maltreatment. Importantly, changes in substantiation thresholds affect not only overall child victim counts, but also the federal measure of repeat maltreatment, which is the indicator of safety cited in Reed’s testimony. The easiest way to document improvements in child safety is to raise the bar for substantiation, thereby reducing both the initial victim count and the likelihood of identifying repeat incidents.

Short of successful efforts to reduce the incidence of maltreatment in the community at large, a second way an agency could theoretically—and safely—reduce the number of children in foster care is by expanding efforts to prevent placement by providing more families with effective services and resources. Yet once again, Indiana’s data show that fewer rather than more children reported for maltreatment have received in-home services. State data suggest a reduced number of children receiving in-home services in absolute numbers (Figures 1 and 2, Table 1) and no change in the proportion (Figure 3). Moreover, as depicted in all three figures and consistent with screening and substantiations, steep declines in in-home services and foster care caseloads began in 2017, before FFPSA was implemented.

A third possibility is that the services provided have become more effective, thus reducing the rate of children entering foster care. Yet the major program touted by Reed in his FFPSA testimony—an intensive family preservation program called Indiana Family Preservation Services—appears to have no effect on removal and a near-zero effect on repeat maltreatment.² Indeed, the program is described as having “0 favorable effects” by the federal clearinghouse for evidence-based programs. There is simply no way to attribute a 50% foster care reduction to Indiana’s prevention services.

Finally, because the number of children in foster care is a function of the number of children entering care relative to the number of children exiting care, an additional possibility is that Indiana found ways to transition children out of its foster care system faster or in greater numbers. However, foster care entries declined from 12,826 in 2017 to 6,212 in 2023. underscoring that the bulk of the 50% caseload reduction likely stemmed from fewer entries.

Decreasing Racial Disparities

Senate committee members also heard about data suggesting that Indiana’s Black–White disparity in foster care entries declined by two thirds. The statistics presented, however, were quite unusual. The typical approach—both in the health literature and as a longstanding practice in child welfare—is to measure disparities as a ratio of rates (known as relative risk). In the context of the testimony presented, this would have been presented as the Black foster care entry rate divided by the White foster care entry rate.

But this is not what was used.

Rather, Indiana’s numbers were presented as the subtracted difference: the Black foster care entry rate minus the White foster care entry rate. The problem with this approach is that it is very sensitive to base rates. Imagine that rates of removal were 10 per 1,000 Black children and 1 per 1,000 White children, then those rates decreased to rates of 1 per 1,000 for Black children and 0.1 per 1,000 for White children. In both cases, the relative risk of removal is 10 times higher for Black children than White children (a 0% change in disparity). But using Indiana’s subtraction-based measure, it would appear that the disparity declined from 9 to 0.9: a 90% reduction.

Using the conventional disparity ratio formula, the Black–White removal rate disparity declined only slightly in 2021–2022 compared with 2016–2017—a reduction of roughly 12%, not the “66.9% decrease” indicated in Reed’s testimony (see Table 2).

Summary

Available data do not support testimony that FFPSA implementation and Indiana’s Family Preservation Services program led to a 50% decline in foster care cases. Likewise, any reported improvements in child safety are likely an artifact of changed thresholds for classifying child maltreatment victims. We also believe that this testimony indicating dramatic reductions in racial disparities is quite overstated.

Of course, it is always possible that we have misunderstood the numbers Reed referenced—which is why we contacted him almost a year ago and shared our analysis. We received no response. If there is additional data that supports the testimony provided, we hope it will be made available. Until then, it is only reasonable to conclude that the striking claims made do not hold up to even modest scrutiny.

Note: On June 3, 2025, the IndyStar published an op-ed by Emily Putnam-Hornstein and Sarah Font summarizing the analysis in this post.

Notes

Regarding data published by Indiana’s Department of Child Services, we relied on publicly available information published as of June 2024 to align with what would have been available at the time this testimony was prepared. We also used data submitted by Indiana and found in the annual Child Maltreatment Reports. We focused on trends from 2017 (before FFPSA) through 2023 (the most recent year available).
↩︎
To elaborate, the intervention produced no “direct effect” on children entering foster care (i.e., no statistically significant reduction occurred in placements among families who were served). Published research has indicated that the intervention may have led to a small reduction in repeat maltreatment. To be generous, Indiana officials might argue that despite no direct effect on removals, the reduction in repeat maltreatment led to reduced removals over time. However, the estimated reduction in repeat maltreatment is only 4%, meaning that any indirect effects on removals cannot be more than this 4%. It is also worth noting that the declines in foster care caseloads began long before the program was implemented at any scale in Indiana. ↩︎

Figures and Tables

Child Welfare Monitor DC: 65 percent of investigations closed as “incomplete” in the second quarter of FY 2025

by Marie Cohen

In a post dated January 10, 2025, I reported that 40 percent of investigations conducted by the District of Columbia’s Child and Family Services Agency (CFSA) in Fiscal Year(FY) 2024, which ended on September 30 2024, were “incomplete.” But by annual rather than quarterly data, that post actually understated the magnitude of the problem, which has worsened in the first half of FY 2025. The percentage of investigations that were terminated with a finding of “incomplete” increased to 65 percent in the second quarter of FY2025. The number of substantiated investigations has increased, while foster care placements and in-home case openings have not kept up with the apparent need for services.

The number of reports to child abuse hotlines varies by season, with reports tending to drop off during the summer when schools are closed and then increase again when schools re-open, along with fluctuations during the school year. Thus, data for part of a year should be compared to the same period of the preceding year. As shown in the table below, the number of reports to the CFSA hotline increased by from 11,945 in the first half of FY 2024 to 12,342 in the first half of FY 2025. The number of reports accepted for investigation actually decreased from 2,197 to 1,973, mostly because the hotline was screening out more of them. Nevertheless, the number of investigations conducted increased from 1,774 to 2,089. Thus, there were more reports, fewer reports accepted, and more reports investigated in the first half of FY 2025 than in the same period of the previous year. The reasons for these changes are unknown.

Table 1: Data for First Half of 2025 Compared to First Half of 2024

	October-March 2024	October-March 2025
Hotline Calls (referrals)	11,945	12,342
Referrals Accepted for Investigation	2,197	1,973
Investigations	1,774	2,089
–Incomplete	456 (26%)	1,305 (62%)
–Unfounded	949 (54%)	327 (16%)
–Substantiated	267 (15%)	377 (18%)
–Inconclusive	94 (5%)	74 (4%)
In-Home Cases Opened	125	169
Children Placed in Foster Care	110	96

Source: CFSA Data Dashboard

An investigation can have several findings. “Substantiated” means that the investigator (with approval from their supervisor) has concluded that the allegation of maltreatment (or risk of maltreatment) is supported by the evidence. “Unfounded” means there is insufficient evidence to support the allegations. “Inconclusive” means there is some evidence that maltreatment occurred but not enough evidence to support it definitively. “Incomplete” is defined as “an investigation finding for referrals in which there were barriers to being able to complete every aspect of the investigation. This could include obtaining confirmation during the investigation that the family was a resident of another state outside D.C., the parent refusing the social worker access to the home to complete a home assessment, or inability to locate the family.” (For the complete definitions, see the Investigations Page on the CFSA Dashboard). It is important to note that “Incomplete” refers to a finding upon closure of an investigation. It is not refer to an investigation that is ongoing.

The total number of investigations increased from 11,945 in the first half of FY 2024 to 12,342 in the first half of Fiscal Year 2025, as Table 1 shows. And there were some big changes in the numbers of investigations that were incomplete, substantiated and inconclusive. The number of incomplete investigations skyrocketed from 456 to 1,305. The number of unfounded investigations dropped from 949 to 327. And the number of substantiated investigations increased from 267 to 377, which is a large increase of 41 percent. This reflects both an increased number of investigations conducted and an increase in the percentage substantiated from 15 percent to 18 percent.

Chart I shows how the percentage of investigations by disposition has changed over the past nine quarters. The percentage of investigations that was incomplete (see the orange segments in the chart below) began to rise in the first quarter of 2024, when it jumped to 20 percent from 13 percent in the previous quarter. It rose to 30 percent in the third quarter of 2024, 45 percent in the third quarter, and 54 percent in the fourth quarter, 60 percent in the first quarter of 2025, and 65 percent in the second quarter of the current fiscal year.

Source: CFSA Dashboard, Investigations of Abuse and Neglect

As the percentage of investigations that are incomplete has increased, the percentage that are unfounded (dark blue in the above chart) has decreased–from 57 percent in the first quarter of 2024 to 13 percent in the first quarter of 2025. That drop of 44 percentage points happened at the same time as the percentage of investigations that were incomplete rose from 21 percent to 65 percent–an increase of 43 percentage points. It appears that investigations that would formerly have been closed as unfounded are now being closed as incomplete. CFSA did not respond to a request for the reasons for this change. The percentage of investigations that are substantiated has changed little since the first quarter of FY 2024.

Once an investigation is substantiated, CFSA may open a case for in-home services, or less often for foster care. As shown in Table I above, 169 in-home cases (each involving one or more children) were opened in the first half of FY 2025, compared to 125 in the first half of FY 2024. And 96 children were placed in foster care in the first half of FY 2025 compared with 110 in the first quarter of FY 2024. Unfortunately these two sets of numbers are not comparable as each in-home case can involve more than one child. But with substantiated reports increasing by over 100, in-home cases increasing by only 44, and foster care removals decreasing, it appears that some of the families with substantiated reports in 2025 are not receiving any CFSA services at all, and that is concerning. Perhaps some of these families are being referred to the collaboratives for services, which are less intensive and delivered by staff with lower credentials. And it is possible that some of these investigations may culminate in an informal kinship placement, but that means no services are provided to the parents or the children.

Clearly the staffing crisis with which CFSA (along with other agencies around the country) is struggling is responsible for the increase in incomplete investigations, and perhaps for the reduced percentage of substantiated cases receiving services as well. At the oversight hearing on February 13, 2025, Interim Director Trice pointed out that the number of investigative social workers has dropped from 100 to below 40. It is no surprise that CFSA’s oversight responses documented that most investigative workers had caseloads above 15. the maximum caseload allowed by CFSA’s Four Pillars Performance Framework. Average caseloads for the 38 investigative workers in the first quarter of FY 2025 were 30 or higher for 10 workers and 20 or higher for a total of 20 workers.

Director Trice reported that the agency is making do by diverting workers from the In-Home units to Investigations, but that is not a good solution. Families with in-home cases are often deeply troubled, with long histories of chronic neglect. According to CFSA’s 2023 Child Fatality Report, two children died while their families had open in-home cases. We cannot afford to divert these critically needed workers. Moreover, it is possible that the diversion of in-home workers to investigations may be part of the reason that in-home case openings did not increase more given the increase in substantiations. With workers not available to handle these cases, the agency may be more reluctant to open them.

What can be done? Creative solutions are needed. It may be necessary to temporarily reduce licensing or degree requirements through a special waiver due to the staffing crisis. Former Director Robert Matthews spoke of obtaining permission from the Board of Social Work Examiners to use workers with Bachelor of Social Work degrees to help investigators (not carry cases), but this plan was not mentioned in this year’s oversight responses. The agency might consider recruiting federal workers who have lost their jobs for these positions. Recruiting retired police officers and military veterans is another idea that has potential. A partnership with local schools of social work, as Maryland and other states maintain, is long past due. Those who agree to take jobs and remain for a given amount of time should receive loan forgiveness and perhaps housing as well. In a housing-hungry citizen, this could be a game changer. CFSA needs to think outside the box to resolve the staffing crisis.

CFSA’s Dashboard data for the first half of FY 2025 raises more questions than it provides answers. The most striking trend is the continuing explosion in the percentage of investigations that were incomplete–which was 65 percent in the second quarter. Also concerning is the failure of in-home case openings and foster care placements to keep up with increased substantiations. Like many other child welfare agencies, CFSA has been devoting much time and attention to programs outside of its core functions, like the warmline and family success centers. In this time of budget stringency and looming recession, it is time for CFSA to focus on its ability to perform its most basic and important function–child protection.

The rejection of child protection

by Marie Cohen

Source: https://www.youtube.com/watch?v=BjwC0xh0afk

Proposed federal budget cuts to child welfare services might hurt New Jersey’s recent progress in child welfare, the Commissioner of New Jersey’s Department of Children and Families told state legislators last month. The anticipated reduction of more than $100 million would force the department to “revert to its most basic role — that of child protection — not prevention, not support or empowerment, just surveillance and foster care,” DCF Commissioner Christine Norbut-Beyer told members of the state Senate’s Budget Appropriations Committee. The relegation of child protection–or “surveillance and foster care”–to the “most basic” version of child welfare is telling. DCF’s Commissioner, like many other progressive child welfare administrators, no longer views child protection as the primary purpose of child welfare services.

For those who regularly read this blog, the devaluation of child protection and foster care by a high-level administrator over child welfare will not be a surprise. There has been a sea-change in child welfare over the past decade. The mainstream view of the purpose of child welfare has shifted from responding to child abuse and neglect to “upstream prevention.” And why not? Why wait until children are abused and neglected if we can prevent the maltreatment altogether?

There is no denying that ideally, it is better to prevent maltreatment than to respond to it. But the services that are discussed as prevention are mainly in the province of other agencies. In seeking to broaden child welfare services through the Family First Act, Congress added mental health, drug treatment, and parenting training. While the latter can be seen as a function of child welfare, drug treatment and mental health are separate systems. There has been increased emphasis on cash and housing and other antipoverty benefits as child maltreatment prevention; we have large programs to address these problems–much larger than the child welfare system. Even some of the “prevention services” that DCF and other state agencies have adopted, like “Family Success Centers,” provide a wide array of place-based services, most of which do not fall into the traditional orbit of child welfare and would be most appropriately funded jointly with other agencies.

If “prevention” could abolish the need for child protection, then there would be no need for child protection agencies. But we know that no amount of “prevention” (at least as envisioned by today’s child welfare establishment) will eliminate child abuse and neglect. We are often talking about patterns of mental illness, drug abuse, family violence, and poverty that have persisted over generations. And then there are families that are not poor or characterized by generations of dysfunction but where a parent’s mental illness or disordered personality makes them incapable of safely raising children. As Jedd Meddefield describes in his brilliant essay called A Watershed Perspective for Child Welfare, “As critical as it is to fully consider upstream factors, it would be wrong not to do all we can to help children who lack safe families today.

But the fact is that many of today’s child welfare leaders like Norbut-Beyer appear not to be interested in child protection and foster care. They often disparage the “reactive” role of child protective services in contrast to the “proactive” nature of prevention. Many agencies have reactive missions–police, firefighters, emergency rooms–and one could argue these are the most important services of all because they save lives. The analogy with the police is revealing. Police react to allegations of crime just as child welfare agencies react to allegations of child abuse and neglect. To prevent crime, we must not rely on the police, who are overburdened already and not trained and equipped to provide the services needed. Instead we must turn to a whole host of agencies dealing with education, public health, mental health, housing, income security and more–the same agencies that we must mobilize if we want to prevent child abuse and neglect. Nobody is saying that the police need to address the underlying causes of crime.

Norbert-Beyer’s use of the word “surveillance” as a synonym for child protection is telling indeed. She clearly doesn’t see CPS investigators as heroes who go out in sometimes dangerous and certainly uncomfortable circumstances to protect children–and maybe even to save them. It’s not surprising because we have all been told that saving children is not what child welfare is about.¹ And foster care? Norbert-Beyer boasts that New Jersey has the lowest rate of child removal in the country, and children who are removed more often than not go to relatives. She’s not very interested in the quality of care these vulnerable young people receive or in all the things her agency could do it improve it, like establishing foster care communities (like Together California) to house large sibling groups or investing in cutting-edge models of high-quality residential care.

When the person who is in charge of child protective services in a state that is acknowledged as a leader in the field calls it “surveillance,” and relegates it along with foster care to “basic” functions that hardly deserve mentioning, it’s hard to have faith that the crucial mission of child protection will be implemented with the passion it deserves. Norbert-Beyer’s comments illustrate the prevalent thinking that leads to the diversion of resources from crucially needed child protective services and foster care to “prevention services” that are and should be provided by other agencies.

See for example this statement from Casey Family Programs, which includes the words “We must continue to evolve from an approach that seeks to “rescue” children from their families to one that invests in supporting families before abuse and neglect occur.” One of the first messages I was given as a CPS trainee is that my job was not to save children.
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A life discounted: The tragic story of Begidu Morris

by Marie Cohen

Ten-year-old Begidu Morris died more than three years ago of horrific child abuse by his parents, who adopted him from Ethiopia. But there was no avalanche of media coverage of his death, no interviews with shocked neighbors saying they had no idea the child even existed. No pyramid of teddy bears and flowers outside his home. No arrests of those who tortured and murdered Begidu, and no demonstrations demanding justice. No anguished commentaries from experts on how we failed and what could be done to prevent such tragedies in the future. There is not even a picture of Begidu by which we can remember him. If not for a child fatality summary released by the Florida Department of Children and Families (DCF) two years after Begidu’s death, nobody outside the family, a few neighbors, and a small group of medical, social service, and law enforcement professionals would have known that it happened.

According to the DCF child fatality summary, Begidu Morris collapsed at home in Lee County, Florida, on March 17, 2022 and was transported to Golisano Children’s Hospital. He was diagnosed with subdural hematoma, hypothermia, cardiac arrest, acute respiratory failure, retinal hemorrhages, and metabolic acidosis.Begidu was placed on life support and died on March 22, 2022. Examination showed bruising to Begidu’s head and significant scarring to his buttocks. Begidu weighed 44 pounds, which was in the 0.1 percentile for his age. An autopsy determined that the cause of death was “complications of hypoxic ischemic encephalopathy due to craniocerebral trauma” and the manner of death was homicide.

The CPS investigation

Begidu lived with his adoptive parents, Jack and Consuela Morris, and their biological son. Their two other biological children were in college and returned home for vacations. Begidu and his biological sister were adopted from Ethiopia by the Morrises, when he was about two years old. His sister’s adoption with the Morris family disrupted and she was re-adopted by another family in 2019. After Begidu’s death, the family quickly obtained a lawyer and was “minimally cooperative” with the CPS and police investigations.

The family’s three-bedroom home was described by the investigator as “pristine.” In addition to the master bedroom and the teenage sibling’s room, the third bedroom served as a guest room for the two adult siblings when they returned home from college. Begidu slept in a small closet, where investigators discovered a pile of urine-soaked clothing on a rollaway bed. The door to the closet was locked from the outside and was monitored by a camera. The closet had no ventilation and there were no toys or personal possessions indicating that a child lived there. Begidu’s adoptive parents claimed that he engaged in behaviors such as temper tantrums and fecal smearing.

The CPS investigation concluded that “[a]lthough it was not able to be determined with certainty who inflicted the injury/injuries that led to this child’s death, it can be concluded that the parents either participated in the abuse that led to the child’s injuries and subsequent death, or they participated in concealing the horrific abuse and neglect that he suffered.” It found the parents Jack and Consuelo Morris responsible for Begidu’s death and for “bizarre punishments,” internal injuries, physical injuries, medical neglect, “failure to thrive/malnutrition/dehydration,” failure to protect, and inadequate supervision.

Deaths due to child abuse or neglect are the tip of the huge iceberg of child maltreatment, most of which remains unseen by the public. All of these deaths should be examined, not only to determine whether maltreatment occurred and who was responsible, but also to identify systemic issues that might suggest policy changes to protect other children. Yet, the investigation summary I received showed a complete lack of curiosity and interest by DCF in drawing lessons from this terrible case and making them available to the public.

Isolation is a common element of severe and chronic child abuse cases. Begidu was clearly isolated. He had not visited a medical provider in three years. Most neighbors were unaware that the child even existed. And perhaps most important, he was not attending school–at least not in person. The Investigation Summary contains three different statements about Begidu’s and his adoptive brother’s schooling, stating in one place that the brother was enrolled in Lee County Schools and Begidu was not, in another place that both were homeschooled, and in two different places that each was enrolled in “virtual school.” DCF did not respond to my request to know which statement was correct. Yet this is crucial information.

If Begidu was enrolled in school virtually, it would have been incumbent on the investigator to contact the school and ask about his attendance and any interactions with Begidu and his family. This would be important in establishing if there was any negligence on the part of school staff or any need for policy changes. If Begidu was not in school at all, the question would be whether the state was aware he was being homeschooled. Homeschooling parents in Florida must provide one-time notice to the local superintendent, maintain a portfolio of their children’s work, and turn in an annual assessment by standardized test or portfolio evaluation. We need to know if Begidu’s parents complied with these requirements, and how he fell through the cracks if they did not.

With the lack of protective educators to respond to Begidu’s plight, DCF should have wanted to know if there were any opportunities for his situation to be brought to the attention of other protective adults. While the Morris family had no history with CPS in Florida or in Michigan, where they adopted Begidu, there may have been an occasion when the abuse in this home could have come to light. Begidu’s sister was re-adopted by another family in Florida in 2019. One cannot help wondering if the sister was the previous target of abuse in the home, thus leading to her adoption by another family. In his medical chart from a primary care visit in 2018 or 2019, there was a note that Begidu said he was “going to be just like his sister.” (These may be the only words of Begidu’s to be recorded).

Fully 19 lines of text about Begidu’s sister are redacted from the Investigation Summary, which says only that she lives in another state and had no contact with Begidu or the Morris family. It is likely that the redacted information concerned the circumstances behind the disruption of the sister’s adoption. Did the sister report any concerning treatment to her new adoptive parents? Did anyone involved in the second adoption have information that should have been reported and investigated? Was a coverup part of the new adoption arrangement? Unfortunately, DCF denied my request for this information. DCF appears to have no interest in learning from Begidu’s death and sharing the implications of what they have learned with the wider community in the interests of protecting children in the future.

Whatever the flaws of the investigation were in terms of uncovering systemic issues, DCF ultimately found Begidu’s parents to be responsible for Begidu’s death and the horrific abuse and neglect that preceded it. But shockingly, the agency decided not to remove Begidu’s adoptive brother from the home. According to the case summary, the teenager reported feeling safe in the home, and “sources familiar with the child” reported no concerns for his safety. (One wonders who these sources were and what they knew about Begidu’s abuse.) The investigator also noted that the teen “appeared physically healthy, was enrolled in virtual school, and was visible in the community, including attending a Mixed Martial Arts program several times weekly. He had his own fully furnished bedroom, and he was allowed to have relationships with others outside the home, including his adult siblings who were away at college.” It is clear that this decision did not come easily. According to the investigation summary, “[W]hile it is concerning that [Begidu’s sibling] remains in the home, it should be noted that he does not share the same vulnerabilities that were present with his younger sibling.” This is quite a statement. Apparently, this child was considered “safe” in the home of where his brother suffered unspeakable abuse and died, because he himself was not ill-treated. There was not even a services case opened to make sure that he received therapy for the trauma he has endured.

The criminal investigation

Three years after Begidu’s death, the police have made no arrests in the case. The DCF Investigation Summary states that CPS was involved in multiple meetings, including with the State Attorney’s Office (SAO) and that

“[u]ltimately no action was taken by the SAO as the perpetrator of abuse could not be determined based on the information that was available at the time of their staffing. There were two individuals (the mother and [the brother]) in the home capable of causing the head trauma to the child; the individual responsible for the abuse could not be determined.

The lack of charges is almost incredible. If they could not have charged anyone with the actual homicide, it is hard not to understand how the parents could not have been charged with multiple counts of child abuse, charges that surely exist in Florida as they do in other states. It is hard not to ask the question, as one child advocate put it, could this happen if Begidu were White? The State’s Attorney denied my request for the investigation records on the grounds that “there is still an active investigation.” But it is hard to believe that the police are still seriously working on this case.

Adoptions and Severe Abuse

Begidu’s story has similarities with the stories of other children adopted from overseas or from foster care. Few readers could have forgotten the six Hart children, adopted from foster care in Texas, who were starved, beaten, and eventually killed in a 2018 murder-suicide by one of their adoptive mothers. In 2013, a Washington State couple were convicted and sentenced to decades in prison in the death of their Ethiopian adopted daughter, Hanna Williams, who died of hypothermia in 2011 after being forced to sleep outside in the rain. Her malnourished body was covered with bruises and scratches and her brother testified that their adoptive parents beat them and deprived them of food. A Pittsburgh couple was sentenced in 2014 for endangering the welfare of two children they adopted from Ethiopia through withholding food from their six-year-old son and causing abusive head trauma to their 18-month-old daughter. In a dispiriting echo of Begidu’s case, the adoptive mother was sentenced to six to 12 months in jail with daily work release to enable her to go home and care for her biological children. The mother who re-adopted these children saw this sentence as “an indication that the court viewed adopted children as different, since it decided that a woman who abused her adopted kids could be trusted with her biological children.” In 2021, a woman in Washington was charged with second-degree criminal maltreatment for beating and starving a 12-year-old boy that she and her husband adopted from Ethiopia. The prosecution decided to drop the case, as reported by KUOW, stating that the boy had “suffered mental health challenges which will prevent him from testifying.” The child had been re-adopted by one of his schoolteachers, who saw his abuse and came to an agreement with his parents–a possible hint to what may have happened with Begidu’s sister.

The vast majority of adoptive families provide loving homes, and a study from the Netherlands suggests that adoptive families are less likely to maltreat their children than birth families. Nevertheless, observers have noted clusters of cases of severe abuse of adopted children. Such a cluster was noted in the State of Washington at the time of Hanna Williams’ death. A committee led by Washington’s child welfare agency and children’s ombudsman in 2012 published a Severe Abuse of Adopted Children Committee Report, which discussed 15 cases of adopted children who had suffered abuse at the hands of their adoptive families. There was a common pattern of concerning parenting practices in these cases, including physical confinement, withholding food, isolation (including withdrawal from school), forcing the child to remain outside the home; and disparaging remarks about the child. The committee observed that these cases tend to occur “when an adoptive family is ill-prepared or ill matched with a child that suffers from unidentified and/or untreated trauma, abuse, and/or neglect.” The analysis suggests that families may respond to their adopted children’s difficult behaviors caused by past trauma by using punishments like sending a child to bed without dinner, which in turn triggers further behaviors, leading to a vicious cycle of behaviors and punishments culminating in egregious abuse.

The Washington committee made multiple recommendations for avoiding such tragedies in the future, including better oversight of child-placing agencies, strengthening the assessment of prospective adoptive families, and improved training for parents and adoption professionals, and post-adoption support services for families. Some of these recommendations required legislation and other required agency action, and it is not clear whether any of them were implemented.

The trial of Larry and Carri Williams for the death of their adopted daughter, Hannah, was a major event in Washington, with Seattle-area Ethiopians attending proceedings every day, “almost as a vigil” as the Seattle Times described it. But with no arrests in Begidu’s case and no media coverage until two years later, Florida’s Ethiopian community may not even be aware of it. Holding Begidu’s adoptive parents accountable won’t bring him back, but the lack of any meaningful response to his death is an offense to all child victims of abuse and neglect and those who care about them. The only thing that can be done now is to hold his torturers and murderers responsible and learn from his suffering to prevent other children from sharing it.

This blog was updated on April 25, 26, 27 and 29.