What is the cause of racial disparity in child welfare?

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

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

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

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

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

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

Question One: Reporting Disparities

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

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

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

Disparities in Substantiation and Removal

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

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

Conclusions and Implications

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

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

In the authors’ own words:

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

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

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

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

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

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

Notes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Notes

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

Using algorithms in child welfare: promise, confusion and controversy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Notes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Notes

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

The new Child Maltreatment 2021 Report: Did child maltreatment really decrease?

The federal government’s annual maltreatment report for 2021 was released on February 9, 2023, and the child welfare establishment is celebrating. New Child Maltreatment Report Finds Child Abuse and Neglect Decreased to a Five-Year Low, crowed the Administration on Children and Families (ACF). “Number of Abuse and Neglect Victims Declines Again,” trumpeted The Imprint, a journal that typically reflects the prevailing voices in child welfare today. Left for the body of the ACF press release (and totally omitted by The Imprint) was the fact that in 2021 the nation was still in a pandemic that kept many schools closed for much of the year, and that child maltreatment “victimization” reflects jurisdictions’ policy and practice much more than it reflects actual maltreatment. Thus, there is no reason to celebrate a decrease in child maltreatment based on this report.

Child Maltreatment 2021 , the latest edition in the annual series from the ACF, combines data from the 50 states, the District of Columbia and Puerto Rico about the number of reports or children involved in each stage of the child welfare system in Federal Fiscal Year (FFY) 2021, which ran from October 1, 2020 to September 30, 2021. The data are obtained from the National Child Abuse and Neglect Data System (NCANDS), a national data collection program run by the Children’s Bureau under ACF. Arizona did not submit data in time to have its data included in this report, so only 49 states are included in this year’s report, along with the District of Columbia and Puerto Rico. Commentaries from most of the states regarding policies and conditions that may affect their data are attached in an appendix. The report’s findings are summarized in Exhibit S-2. All of the figures in this post are taken from the report.

A family’s journey through the child welfare system starts with an initial report, known as a “referral.” Figure 2-D below shows that the total number of referrals (the purple line) rose between 2017 and 2019, dropped sharply in the wake of the Covid pandemic in 2020, as schools closed and many families isolated at home, and increased only slightly in FFY 2021. It is important to remember that in FFY 2021, which began in October 2020, many schools were still closed. Most schools opened over the course of FFY 2021, but some remained closed the entire year. Thus, reporting from school personnel was suppressed for the federal fiscal year.

The rate of referrals as a portion of the child population varied greatly by state. Table 2-1 of the report shows that the total referral rate per 1,000 children in 2021 ranged from a low of 17.8 in Hawaii to a high of 137.0 in Vermont in 2021. Such differences exist every year and reflect factors such as public opinion and knowledge of child maltreatment reporting, as well as state practices. Some states do not even report most referrals to NCANDS, as described in the state commentaries. Pennsylvania has a unique system in which most reports that are not for abuse are classified as “General Protective Services” and not reported to NCANDS. Similarly, Connecticut does not report referrals receiving an alternative (non investigation) to NCANDS. In 2021, state-to-state differences may also reflect how soon in-person schooling resumed in the state after the pandemic. Vermont reported in its commentary that it has been receiving more referrals for concerns that do not reflect maltreatment. Vermont also included several reasons for its high referral rate, including the fact that reports on multiple children in the same family are counted separately. Kansas reported a decrease in reports due to “engaging communities to focus on prevention.”

Once a referral is received, it can be screened in or out by agency hotline or intake units. In general, agencies screen out referrals that do not meet agency criteria, which vary by jurisdiction. Reasons for screening out a referral may include that it does not meet the definition of child abuse or neglect, that not enough information is provided, that another agency should more appropriately respond, or that the children being referred are over 18. Despite receiving slightly more referrals than the previous year, child welfare agencies screened out a larger proportion of them in FY 2021, resulting in a slight decrease in screened in referrals (known as “reports“), from 2020 to 2021 – the blue line in Exhibit 2-D. In the 46 states that provided both data points, 51.5 percent of referrals were screened in and 48.5 percent were screened out.

There is great diversity in the proportion of referrals accepted by states. The percentage of referrals that was screened-in ranged from 15.3 in South Dakota to 98.5 percent in Alabama.¹ There are many reasons for these variations, mostly associated with differing policies and practices between jurisdictions. For example, Georgia mentioned in its commentary that after hotline calls increased in 2021, it adjusted screening criteria to screen out more of them. Indiana tried to reduce its screen-in rate by changing criteria related to sexual behavior among teens and preteens, marijuana use by children, and educational neglect. Kansas reported a decrease in reports due to a change in the screening process for educational neglect. Missouri, on the other hand, changed screening criteria to screen in more referrals out of concern for children isolated because of the pandemic.

In FFY 2019, teachers were the most common source of referrals, submitting 21 percent of all referrals. They lost that position in FFY 2020 with the pandemic school closures, while legal and law enforcement personnel increased their share of reports. Perhaps it is not surprising that teachers did not recoup their leading role in 2021, since many students were still attending school virtually for some part of the year. Teachers actually submitted a smaller proportion of referrals in 2021 (15.4 percent) than in 2020 (17.2 percent). It is possible that teachers were making more calls but that more of these calls were being screened out than in the year before. But since ACF does not show the distribution of all referrals by reporting source, one cannot use this data to test that hypothesis.

Investigations

In Chapter 3 of Child Maltreatment 2021 the focus shifts from the referral or report to the child. ACF estimates that 3.016 million children or 40.7 children per 1,000 in the population received an investigation or alternative response² in 2021. This was a slight decrease over 2020, when 42.0 per 1,000 children received an investigation or alternative response. These rates varied greatly by state, from a low of 12.8 per 1,000 in Pennsylvania to a high of 129.8 in West Virginia. The low in Pennsylvania is not surprising due to its unique system in which most neglect referrals are not reported to NCANDS. But Maryland and Hawaii also investigated small proportions of children– 15.7 and 15.9 per 1,000. These investigation rates reflect the number of referrals and how many were screened in, as well as the number of children per referral.

ACF found that of the children who received an investigation or alternative response, 16.7 percent were found to be victims of child abuse or neglect, as shown in Exhibit 3-B.³ The remaining children were not determined to be victims or received an alternative response. Estimating for missing data from Arizona, ACF calculated a national “victimization rate” of 8.1 per 1,000 children. As Exhibit 3-C shows, this rate has been decreasing since 2018 but the greatest decrease was in 2020 with the arrival of the pandemic.

ACF’s use of the term “victimization” can be misleading. An investigator’s decision about the truth of an allegation is based on limited information and is constrained by available time and staff, and evidence indicates that many referrals are unsubstantiated when maltreatment actually exists. Moreover, these rates are dependent on state policies and practices. Because of the misleading nature of the term “victimization,” the term “substantiation” is used for the rest of this commentary. State substantiation rates per 1,000 children ranged from 1.6 in New Jersey (even lower than Pennsylvania’s 1.8) to 17.0 in West Virginia, suggesting that these rates reflect much more than the prevalence of child abuse and neglect.

Among the many factors that can influence state substantiation rates are:

Differences in referral rates and screening practices, as decribed above;
Different policies about what is considered child maltreatment and different levels of evidence required to substantiate an abuse allegation;
Whether and how much a state uses an alternative (non-investigation response);
Natural and social disasters that may vary in their impact between states. Some states went back to in-person schooling for the entirety of 2021, others opened midyear, and others were virtual almost all year. West Virginia, with the highest substantiation rate, has been particularly hard-hit by the opioid epidemic. The state has the highest overdose mortality rate in the nation;
Differences in the messages coming from an agency’s leadership about the relative importance of child safety versus family preservation;
Variations in the use of kinship diversion, the practice of placing children with a relative without court involvement or case opening. If this happens before the investigation is completed, it may result in an “unsubstantiated finding.

All of these factors can change over time, affecting substantiation rate trends from year to year. It is clear that nationwide, the COVID-19 pandemic continued to suppress reports to CPS hotlines, and therefore investigations and maltreatment findings, in 2021. But the effect of the pandemic differed greatly between states: it appears that some states had more in-person days of school in 2021 than in 2020, and others had less. Additionally, several states described changes in their screening practices in 2021, usually to screen in fewer referrals. Delaware and Washington mentioned an increase in reports diverted to differential response as a reason for declining substantiation numbers in FFY 2021. The emphasis on prevention as an alternative to intervention has been increasing in most states, perhaps affecting the likelihood of substantiation. It is possible also that increases in kinship diversion may have reduced substantiation rates: there is no data to prove or disprove this, but concern over this practice is certainly growing.

To state that maltreatment decreased between 2020 and 2021 is to ignore that “maltreatment victimization” is not a measure of actual abuse and neglect. It is the result of a winnowing process that starts even before a referral arrives. At each stage, the numbers remaining may depend on a wide variety of factors, including policy, practice, natural and man-made disasters and more. The vast differences between state data on referrals, reports, investigations and substantiations shows how unlikely it is that the total number of children found to be victims of maltreatment reflects the actual number of maltreated children, and how irresponsible it is to suggest this might be the case.

A note on Child Fatalities

Last year, ACF used a decline in fatalities due to child maltreatment to headline its press release, Child Fatalities Due to Abuse and Neglect Decreased in FY 2020, Report Finds. This year, the number of child abuse and neglect fatalities reported by states increased slightly, a rise that was not the subject of a headline by ACF. Whether there is a small increase like this year or a decrease like last year means very little, for several reasons. As ACF explains, these child fatality counts reflect the federal fiscal years in which the children were determined to have died of maltreatment, which may be different from the year the child actually died. Such determinations may come much later due to the time it takes to complete a death investigation. For example Alabama reported that for the fatalities reported in FFY 2021, the actual dates of death were between FFY’s 2016 and 2021. Michigan even reported that its child fatality data included the child abuse death of twins in 2003 which was revealed by a cold case investigation.

A second problem with the fatality estimates is that they are widely believed to be too low. One reason is that many states report only on fatalities that came to the attention of child protective services agencies. As the report’s authors point out, many child maltreatment fatalities do not become known to agencies when there are no siblings or the family was not involved with the child welfare agency. Moreover, some fatalities resulting from abuse or neglect are labeled as due to accident, “sudden infant death syndrome,” or undetermined or unknown causes because insufficient evidence was found. I recently reviewed the child fatality review report produced by the District of Columbia’s Child and Family Services agency (CFSA). CFSA relied on the decisions of the medical examiner, which chose not to classify as maltreatment deaths an infant who died after a mother who was high on PCP rolled on top of him when sleeping with him in the same bed (counted as “unknown); a baby left on his stomach with a bottle in his mouth when his mother left the apartment (counted as “undertermined); a child who was shot to death by gunmen trying to kill her father, involved in the violent drug trade, outside a liquor store at 11:00 PM (“non-abuse homicide”), and a child who died of an untreated bacterial infection and had beating injuries diagnosed by doctors as due to abuse (“undetermined”). The total number of maltreatment fatalities was estimated at only three for the District in CY 2021, not including those four deaths. Some researchers suggest that the actual number of abuse and neglect fatalities may be as much as twice or three times that given in the Child Maltreatment reports,⁴ and the District of Columbia data suggest this may well be the case.

Notes

This leaves out three states that are listed as screening in 100 percent of referrals: Illinois, New Jersey and North Dakota. Both Illinois and New Jersey explained in their state commentaries that reports must meet certain criteria to be accepted for investigation, so it is not clear why they responded that they screen in 100 percent of referrals. North Dakota actually screens in all referrals, but that is more semantic than real. Reports that do not meet agency criteria for a report of suspected chlid abuse or neglect are categorized as receiving an “administrative assessment,” and are not investigated. North Dakota does not report the number of referrals receiving an “adminnistrative assessment;” hence the reports that 100 percent of cases are screened in. It is unclear why New Jersey and Ilinois provided this figure of 100 percent but the reason may be similar.
Alternative response is, as defined in NCANDS, the “provision of a response other than an investigation that determines if a child or family needs services. A determination of maltreatment is not made and a perpetrator is not determined.”
NCANDS defines a “victim” as “a child for whom the state determined at least one maltreatment was substantiated or indicated, and a disposition of substantiated or indicated was assigned for a child in a report.” “Indicated” is defined as a disposition that concludes that maltreatment could not be substantiated under state law or policy, but there is a reason to suspect that at least one child may have been maltreated or is at risk of maltreatment.”
Herman-Giddens, M. E., et al. (1999). Underascertainment of child abuse mortality in the United States. JAMA , 282(5), 463-467. Available from http://jama.jamanetwork.com/article.aspx?articleid=190980. Also, Cotton, E. E. (2006). Administrative case review project, Clark County, Nevada: Report of data analysis, findings and recommendations. Crume, T. L., DiGuiseppi, C., Byers, T., Sirotnak, A. P., & Garrett, C. J. (2002). Underascertainment of child maltreatment fatalities by death certificates, 1990-1998. Pediatrics, 110(2). Abstract available from https://pubmed.ncbi.nlm.nih.gov/12165617/. Herman-Giddens et al. estimate actual child abuse and neglect deaths to be as high as three times the national reported amount; Cotton et al. and Crume et al. found the actual number of deaths to be twice that reported.

Neglect as poverty: the myth that won’t go away

It’s one of those myths that won’t go away and instead is gathering steam–the idea that parents who are found to be neglectful by child welfare agencies are really just poor people being judged for their inability to provide sufficient material support to their children. It doesn’t matter how much evidence is cited against it. The myth continues because it is an essential part of the narrative that is currently dominant in the child welfare arena. Nevertheless it’s been over a year since my last attempt to shed some light on this issue, and some new research has become available, thus it seems a good time to revisit the topic.

It’s Time to Stop Confusing Poverty With Neglect, exhorted Jerry Milner, Children’s Bureau Commissioner and his special assistant David Kelly back in January, 2020, in a typical statement of this myth. “Most of the reasons for child welfare involvement fall into what we call “neglect” rather than physical abuse or exploitation. Our most recent child maltreatment data tell us that 60 percent of victims have a finding of neglect only…More times than not, poverty and struggles to meet the basic, concrete needs of a family are a part of the equation in all types of neglect.” Miller and Kelly now sell their expertise at Family Integrity & Justice Works, an arm of the Public Knowledge consulting firm which has the goal of “replacing child welfare.”

Media outlets have taken this story and run with it. Here is the Philadelphia Inquirer: “A common misunderstanding is that the leading reason kids are taken into the foster care system is because of physical or sexual abuse. But that accounts for only one of six cases. Children far more often are removed from their homes for ‘neglect,’ which often amounts to symptoms of poverty, like food insecurity or unstable housing.”

The Biden Administration has endorsed the idea that most neglect findings reflect nothing but poverty. The Administration on Children and Families (ACF) has solicited applications for a grant of between one and two million dollars “to support the development and national dissemination of best practices to strengthen the capacity of child abuse hotline staff to distinguish between poverty and willful neglect.”

There is no federal definition of child neglect, and state definitions vary. In contrast to abuse, it is usually defined as an act of omission rather than comission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect or failure to provide for basic physical needs, failure to provide adequate supervision , educational neglect or failure to educate the child as required by law, and medical neglect.

There is no dispute that more children are found to be neglected than abused. Based on data collected by the federal government and published in Child Maltreatment 2020, three-quarters (76.1 percent) of the children found to be victims of maltreatment in 2020 were found to be neglected. A total of 16.5 percent were found to be physically abused, 9.4 percent were found to be sexually abused, and six percent were found to be victims of some other type of maltreatment.* Of the children who were removed and placed in foster care, according to the 2020 AFCARS Report, 63 percent had neglect listed as a circumstance associated with the child’s removal, compared to 12 percent with physical abuse and four percent with sexual abuse.

But the idea that neglect findings represent nothing but poverty is questionable. First, the neglect deniers would probably agree that most poor parents do not neglect their children but instead find a way to meet their needs, relying on charity, extra work, or subordinating their own wants to the needs of their children. When poor children are deprived of food, clothing or adequate housing, other factors such as substance abuse, mental illness and domestic violence are often involved. Second, more than half of the states exempt from the definition of neglect any deprivation that is due to the lack of financial means of the parents. Third, the definition of neglect is not confined to the failure to provide adequate food, clothing or shelter but instead includes other acts of omission, such as failure to protect a child from dangerous caregivers, or failure to ensure that children go to school and get needed medical care. Lack of supervision, a common form of neglect, can reflect poverty when parents feel they must rely on inadequate arrangements in order to go to work; we just don’t know the degree to which neglect findings reflect such decisions by parents.

But until now we did not have quantitative data concerning the types of neglect being investigated or the importance of risk factors like substance abuse and mental illness. A recent study from California, the nation’s most populous state, begins to fill this data gap. Palmer and colleagues used a representative sample of 295 neglect investigations that took place in California in 2017. They found that only 14 percent of the investigations involved physical neglect–the deprivation of food, clothing, and housing that is most closely connected with poverty. The most common types of neglect that were investigated were inadequate supervision, investigated in 44 percent of the cases, and failure to protect (leaving the child in the care of a known abuser or failure to intervene with known abuse), in 29 percent of cases. Moreover almost all (99 percent) of the investigations of physical neglect included concerns related to substance use, domestic violence, or mental illness; or they involved another type of maltreatment such as physical or sexual abuse or an additional neglect allegation. Thus, the authors conclude that almost no parent was investigated for material deprivation alone, although it is true that they did not separate out any lack of supervision cases that involved the inability to obtain adequate childcare for work or other necessary activities.

The evidence from California is very suggestive, but as the authors caution, it is possible that other states receive more reports that focus on unmet material needs, are less likely to screen out such reports, or emphasize them more during the investigation. This is possible because California, according to a recent study of state neglect definitions, is one of five states that have adopted an “expanded” definition of child neglect, including more neglect types and allowing for the threat of harm, rather than actual harm, in neglect findings. Studies similar to the Palmer study from other states with more limited neglect definitions would be useful.

While the California study is not sufficient to negate the presumption that findings of neglect represent nothing more than poverty, it is important to note that there are no studies supporting this viewpoint. So why does the myth that child welfare treats poverty as neglect persist despite the lack of evidence supporting it, and the many reasons for skepticism? It persists because it supports the narrative and associated policy prescriptions of the child welfare establishment today–child welfare leaders, administrators, legislatures, and influential funders like Casey Family Programs. The dominant narrative describes a racist family policing system that persecutes people only because they are Black, Indigenous or poor. The policy prescriptions involve radically shrinking or even abolishing child welfare systems.

According to the prevailing view, if omissions that are labeled neglect are strictly due to poverty, there is no need to intervene with social services or child removal. Instead, governments should provide economic benefits to neglectful parents. There is a body of research suggesting that economic support for families does help reduce maltreatment, perhaps not only by helping parents meet their children’s financial needs, but also enabling them to provide better childcare and improving parents’ mental health through stress reduction. Independent of their impact on maltreatment, I strongly support increases in the safety net for families and children. But available information suggests that it will take more than financial assistance to cure neglect in most cases. Improved economic supports will not be a replacement for services to help parents address challenges with substance abuse, domestic violence, mental health, and parenting, and for child removal when there is no other option.

What can be done to alleviate the confusion and misinformation around child neglect and poverty? Collecting better data from the states would be helpful. In its annual Child Maltreatment reports, the Children’s Bureau uses data from the National Child Abuse and Neglect Data System (NCANDS). When reporting on the type of maltreatment alleged and then found, states must pick up to four out of eight categories, including physical abuse, “neglect or deprivation of necessities,” medical neglect, sexual abuse, psychological or emotional maltreatment, sex trafficking, no alleged maltreatment, other or “unknown or missing.” It is not clear whether the “neglect” category is supposed to indicate all types of neglect or just those involving “deprivation of necessities,” but there is no way for states to clarify what they mean or to distinguish between the most common types of neglect. The same problem exists with the AFCARS data used to compile federal reports on foster care and adoption.

Clearly, a reform of the data elements that states are required to submit is needed so that resesarchers can see the types of neglect that are being alleged and found for each child. However, such an improvement would not substitute for careful research like the California study cited above because it will never be possible to rely on the thoroughness of database entries by overworked social workers. We cannot be sure they will enter all of the applicable categories, for many reasons, including that not all the applicable categories may be substantiated for a particular case. Moreover, while states are required to report on some caregiver risk factors contributing to abuse and neglect, such as alcohol and drug abuse, emotional disturbance and domestic violence, these seem to be vastly understated by the social workers who enter these factors in state databases. For example, only 26.4 percent of caregivers of maltreated children were found to have the risk factor of drug abuse and only 36 percent of removals involved parental drug abuse, according to federal data. Yet anecdotal reports from states and localities tend to indicate a much higher percentage of cases that involve substance abuse.

Thus, a reform of data collection might help, but would not solve the problem, especially considering that that many child welfare leaders and funders seem inclined to maintain the hypothesis that CPS confuses poverty with neglect. Ideally, the federal government and other funders would support more studies like that of Palmer et al, and more academics would consider performing such studies.

The myth that CPS confuses neglect with poverty is pernicious because, like other myths currently prevalent in child welfare, it runs the risk of hurting abused and neglected children. It is being used to justify dismantling child protective services, eliminating mandatory reporting, or more modest proposals to hamper these critical protections for children. The federal government should improve data collection on child neglect and associated risk factors as well as supporting additional research to provide more accurate estimates of their prevalance.

*According to the report’s authors, “other” could be anything that does not fit into the categories offered by the Child Abuse and Neglect Reporting System and includes threatened abuse and neglect, drug addiction, and lack of supervision according to state comments submitted with the data.

Book Review: A Place Called Home: a needed antidote to the dominant narrative

It’s Christmas in Manhattan, and five-year-old David Ambroz (then called Hugh), six-year-old Alex and seven-year-old Jessica trudge through the freezing nighttime streets. “I’m only five,” writes Ambroz, “and all I know about Christmas is the stories I’ve heard at the churches where we go for free meals.” “Mom, we’re close to the Port Authority, can we go inside?” asks Hugh. “Walk straight. They’re after us” is the reply he receives. “There’s a calculation I make whenever I talk to Mom: Will she hit me, and is it worth it?” Ambroz explains.

So begins David Ambroz’s harrowing account of life with a mother, Mary Ambroz, whose mental state varies from manic to apathetic to floridly paranoid. A former nurse who was once married to a doctor,* Mary has been in the grips of her untreated mental illness for as long as Hugh can remember. The family bounces back and forth between New York City and Albany, eventually relocating to Western Massachusetts. The children are condemned to a life of sleeping at all-night Dunkin Donuts shops, dining on tiny cups of creamer mixed with sugar packets, and eating out of dumpsters, interspersed with short periods of relative normalcy when the family finds a temporary home. Those periods last until Mary decides the CIA or other pursuer is back on their trail. Some years the children don’t go to school at all, other years they change schools one or more times due to their frequent moves. The children don’t receive medical or dental checkups or vaccinations and visit the occasional clinic only for emergencies. When Hugh breaks his arm at the age of four, he is taken to the emergency room to have it set but never brought back to have the cast removed; when it starts to smell, Mary removes it with a kitchen knife.

Over the years the family has been investigated many times without getting any help, reports Ambroz. Mary Ambroz usually manages to convince authorities that she is a good mother, although she has lost custody more than once–one time when she threw a shoe at a judge in eviction court and was carted off to a psychiatric ward. The children went to a friend’s mother, but were returned to their mother as soon as she was released.

When she finds work as a live-in nurse for an older woman who allows the family to live with them, Mary instructs the children to call their benefactor “Aunt Flora.” Hugh is thrilled to live in an apartment where he can take a bath and to be enrolled in third grade only a month into the school year even though he missed most of second grade. In an apparent effort to ingratiate the family with “Aunt Flora,” Mary tells eight-year-old Hugh he is Jewish, renames him David, and immediately takes him to a doctor to be circumcised. But she does not bring him back for follow-up care and the wound becomes infected. Mary refuses to seek medical care despite “Aunt Flora”‘s pleas, rippimg off the protective mesh that had become stuck to the wound. Dismayed at Mary’s refusal to seek medical care for her son, “Aunt Flora” expels the family and they are living in Grand Central station again.

Even during relatively stable periods, when they are able to rent an apartment in Albany with the help of public assistance, life is far from normal for the children. Mary Ambroz doesn’t cook and when the food stamps start to run low the children have strategies for getting fed, like sneaking into Ponderosa Steakhouse by pretending to be part of a family that has already paid. A kitten they were allowed to adopt during a good period starves to death despite David’s attempt to steal enough food to keep him alive. “He ate his own shit and died,” his mother tells him. “Enough whining, David. You should have taken care of him,” she said, putting the body in a trash bag along with the cat toys and the litter box.

Mary Ambroz uses a gift of $500 to take a taxi to Boston, and the family ends up in a domestic violence shelter in Pittsfield, Massachusetts. Shelter staff try to help her get back on her feet and David tries to assist, accompanying her in selling vacuum cleaners door to door. The children are enrolled in school But that situation falls apart when Mary accuses a 65-year-old staffer groundlessly of sexually abusing David, after beating David up for allowing it to happen. “Nobody wants to tangle with my mother….And so, at this shelter for abused women, the response to our mother’s unhinged behavior is to move us to an apartment where they won’t have to witness the abuse.” And that is the same story, reports Ambroz, that repeats over and over again in their lives. Adults intervene with temporary kindnesses but don’t take steps to rescue the children from what is clearly a dangerous situation.

The children are thrilled with their new apartment, but Mary grows worse, alternating between almost catatonic apathy and violence. Twelve-year-old David realizes that foster care could be his salvation. He and his siblings been have been hiding their bruises for years at their mother’s demand but he finally understands that he must reveal his injuries in order to be saved. He shows his bruises to a DARE officer visiting his school. Two weeks later, two social workers knock on their door. “David, does your mother hurt you?” asks one of them, in front of his mother. As often happens when children are asked this question in the presence of the abusive caregiver, David retracts the allegation and the case is closed.

Mary Ambroz’s violence continues to escalate. She beats Alex severely with a curtain rod when he refuses to make a list of all the men with whom he has had sex. The children hatch a plan: 14-year-old Alex will ride a stolen bike 40 miles over the hills of Western Massachusetts at night to get help from a friend’s mother in Albany. The children gather $40 worth of food stamps, candy, and snacks and Alex is off. The family hears nothing for three weeks, and then the police call. Alex had made his way to Albany and disclosed the abuse to police and social services and is now in foster care. Once again, David is interviewed in front of his mother. Once again, denies the abuse. Once again, the social workers leave him and Jessica at home.

Just a few days later, Mary throws David down the stairs of their apartment building and then kicks his head, and everything goes dark. Covered with blood, David drags himself into the nearby courthouse and collapses into the arms of a bailiff. Finally David has had enough. From his hospital bed, he tells the investigating social worker what happened. His mother insists that he fell down the stairs, but the doctor opines that “it is not impossible, but these are pretty extensive injuries for a fall.” The CPS worker, unbelievably, tells David that while the investigation proceeds, “we think it’s best that you go home with your mom.” But a week later, the police knock on the door. A social worker tells David to pack his things. As he drives away from the apartment, David thinks, “This is it. I’m free.”

And now starts David’s life in foster care, which is only slightly less harrowing than his life with his mother. Jessica is placed in the foster home where Alex is living, but the home is not open to David and he knows why; the social workers can tell that he is gay. David spends his first night in foster care sleeping in the Department of Social Services (DSS) office, an experience of many children in foster care today. Then David is brought to a facility for juvenile delinquents, after being told by a social worker that it was not the right place for him but “we don’t have a place that can accept your kind.” At the facility he is called “fag” and “Ms. Ambroz” by a staffer, loses privileges for talking back, and is beaten up by other residents at the apparent instigation of the homophobic staffer. David’s illusion of safety is gone. “I am destroyed. It took everything I had to escape my mother. I thought nothing could be worse, but now, at twelve years old, I feel like this is it.”

David quickly cycles through several foster and group homes. He is finally placed with his siblings in the home of Buck and Mae, a couple who should never have been accepted as foster parents. After the children go to bed in their basement, they are not allowed upstairs for any reason, not even to go to the bathroom. They can’t use the shower without an escort, they can’t go into the kitchen except for mealtimes, and no snacking is allowed. Abetted by a succession of therapists, Buck and Mae try to suppress David’s homosexuality, forbidding him to close the door to the bathroom all the way and designing “manly” chores like clearing a swamp and digging out a backyard swimming pool. He is sent out to hang up wet laundry in the winter without gloves. They say he is too fat and put him on a starvation diet, and now he is hungry again and scrounging for food.

Thanks to a high school friend of David’s siblings, he is hired to work at a summer camp, and that summer changes David’s life. He bonds with the camp director, Holly, and her small daughter, a camper. Holly senses that something is wrong in David’s home. Knowing he needs support, she visits him weekly after camp ends but the visits eventually stop. Later David learns that Holly stopped visiting him after Mae became furious when she bought him new clothes. Holly called David’s social worker and asked to become his foster parent. She and her husband were working on receiving their foster care license until the social worker told them that Mae and Buck insisted it was better for him to be kept with his siblings.

Finally, Jessica and Alex run away. They disclose abuse at the foster home and refuse to go back. But there is no room in the new foster home for David, and DSS keeps David with Buck and Mae even while recognizing their abuse, requiring them to do additional training and not allowing them to take on new children. (Holly is never told that David is no longer with his siblings or invited to apply for her foster care license). Mae restricts David’s food even more while citing his obesity, even though he is dangerously underweight. Nobody at school appears to notice or care. Even when David faints in school, he does not explain that he is starving and no red flags are raised. Buck and Mae begin taking him out of school to work for an acquaintance, pocketing his pay and that too raises no concerns at school.

The torture escalates until one spring morning in 1995, Mae tells David he is staying home from school and David decides he is not going to take it anymore. He leaves the house and tracks down Holly, learning of her attempt to have him placed with her. Finally, David is placed with Holly, her husband Steve, and their two small children. He cannot believe that he is allowed to freely roam upstairs, or that he is allowed to eat whatever he wants, whenever he wants. Steve teaches David how to drive and laughs when he destroys their mailbox, saying he never liked it anyway. Holly ensures that he, Alex and Jessica get the braces that Mae refused to let them get since her kids could not have them.

David always loved school, but the dislocations imposed by his mother, and the hunger and absences posed by his foster parents, often affected his grades. One he is stable and fed, he gets straight A’s. As a high school junior, he joins the Foster Youth Advisory Council and begins attending annual meetings in Washington. But even with loving foster parents, David is tired of the system. He emancipates himself with the help of a fictitious custody arrangement with his siblings’ father and goes off to Spain for a miraculous year of healing and fun with a loving host mother. He applies and is accepted to his dream school, Vassar, with a generous financial aid package.

Even with his financial aid, David struggles to buy books and to survive during school breaks. (It is not clear why he does not ask Holly and Steve for these things or return to them for the holidays; it seems to be a matter of pride or reluctance to burden them.) He eventually gives up on fulfilling his mother’s dream that he become a doctor and switches his major to political science and his plan to law school, remembering his experience as a White House intern the summer before. At a meeting of the Foster Youth Advisory Council, he agrees to be a liaison to a collaboration working to help gay foster youth. That’s when he comes out as a gay man. The story ends with his graduation from Vassar in May 2002. He is on his way to UCLA to study law and public policy. Now, Ambroz works for Amazon as head of Community Engagement (West) and is the founder of Fostermore.org, an organization that encourages those in the entertainment industry, businesses, and nonprofits to raise money and heighten awareness about the needs of foster children.

A Place Called Home provides some important corrections to the prevailing narrative in child welfare. That narrative features struggling parents who are doing the best they can, and who are being persecuted by an evil “family policing system” that is dead set on removing their children. Clearly, that is not the story of David Ambroz and his siblings. At every stage of the child welfare process–reporting, investigation and reunification–the deck was stacked against the children’s interest in safety and stability and in favor of their mother’s keeping them. While it has been some years since David Ambroz was an abused child (he does not give his date of birth but we know that he graduated from Vassar in 2002 and we can assume he was born close to 1980) the problems he identified are very familiar to those with knowledge of the system and indeed some of them may even have worsened due to the current ideological climate in child welfare.

Failure to Report: The number of people who knew that David and his siblings were suffering but took no action to help them is truly staggering. As Ambroz puts it, “Priests, rabbis, teachers, shelter directors, church members, welfare employees and Aunt Flora have all been witnesses to our bruises and lice, our hunger, a ceaseless tide of neglect and abuse.” David acknowledges that reports were made and the children were even removed once or twice, but the vast majority of people who witnessed their abuse apparently did not report it. We often hear similar stories in the wake of a child’s maltreatment death. For example, eight-year-old Dametrious Wilson was killed by his aunt in June 2022. Though he missed 60 days of school in the year before he died, his Denver Colorado school never reported his absences as required by law, even when his aunt said she was keeping him home “for few weeks” as punishment for his behavior!

And yet, today there is a groundswell of opposition to mandatory reporting and serious proposals to eliminate it, mostly on the grounds that children of color are disproportionately reported. It is true that a staggering proportion of Black children are investigated by CPS; it has been estimated that over half of Black children experience a CPS investigation by the time they turn 18, compared to 28 percent for white children and 37 percent of all children. It is possible that reporting is overused in some communities and underused in others. But it seems more logical to address these problems directly (and also educate ordinary citizens about the need to report suspected maltreatment) rather than eliminating mandatory reporting itself.

Flawed investigations: Even when reports were made, the investigations were often flawed. Ambroz states that “Over the years we’ve been investigated many times without getting help. Mom always fights to keep us, and it’s a battle she’s mostly won.” So what went wrong? Ambroz gives us part of the answer when he explains that social workers and police interviewed him at least twice in front of his mother. Both times he recanted and denied the abuse he had alleged earlier, knowing that he risked severe punishment for telling the truth. It seems obvious that children should be interviewed away from their parents since either love or fear or both will lead them to lie. Yet, this clueless and dangerous practice of interviewing children in front of the alleged perpetrator contnues in many jurisdictions. In Minnesota, a young woman named Maya, who was forced to report her fathers’s sexual abuse while he was listening, worked with an advocacy group to draft Maya’s Law, which required that Minnesota children be interviewed privately regarding allegations of abuse. But like the previous attempts, Maya’s Law failed. Instead, the language was revised to read “When it is possible, and the report alleges substantial child endangerment or sexual abuse, the interview may take place outside the presence of the alleged offender…” Sadly, many “advocates” for Black and indigenous children argued against the requirement for private interviews, fearing that it would increase disproportional involvement of these groups in child welfare.

Unwarranted reunifications: Even when David and his siblings were removed from their mother briefly, they were returned at least twice with no indication they would be safe. When Mary returned from the psychiatric ward after throwing a shoe at a judge, “nobody cared that we are being put in the custody of a homeless woman who’d recently thrown a shoe at a judge in a court of law.” We know that many children are reunified with their parents despite a lack of evidence of any change in their behavior or capabilities. In Lethal Reunifications, I wrote about two such cases that ended in a child’s death, but clearly that is just the tip of the iceberg. We never know about the children left to suffer in silence, unless they decide to write about their experiences.

Necessity of foster care in some cases: The current narrative holds that foster care is almost never necessary. But David Ambroz’s story reveals the stark truth that some children must be removed in order to be saved. Of course every effort should be made to help parents conquer their problems while monitoring children for safety in the home. But in cases of chronic maltreatment, ingrained patterns may be impossible to change. As Dee Wilson put it in his briliiant commentary on chronic multitype maltreatment, “Chronic neglect is marked by the erosion or collapse of social norms around parenting resulting from chronically relapsing conditions.” There is no better example of such collapsed social norms than Mary Ambroz, who had completely lost any sense of responsibility to keep her children clothed, fed, and housed, not to mention to avoid abusing them. In such cases, it is wrong to sacrifice the well-being of the child or children for the general value of family preservation.

Ambroz’s story also provides a needed antidote to the current trope that what child welfare describes as neglect is actually just poverty. The confusion of poverty with neglect is a pernicious misconception being perpetrated today by those who wish to eviscerate the child welfare system. David’s story clearly shows the difference. He says of the mother of friends they make in Albany: “Aurora and her sons are poor like us, and yet she still manages to take care of them. She feeds and clothes them. She cares about where they are when they roam around at night. She gives them a home that is stable in all the ways I’ve never dreamed.” And there, in a nutshell ,is the distinction between poverty and neglect.

The dominant narrative portrays foster care as harmful for children and even abusive at times. That part of the narrative is accurate for the first part of David’s time in care, when the system proved incapable of keeping David and his siblings safe, let alone meeting their needs. Among the major reasons for this failure, Ambroz draws attention to the lack of qualified foster parents and overwhelmed social workers.

Lack of Qualified Foster Parents: David fell victim to one of the scourges of our system, insufficient numbers of good foster parents. For this reason, he was initially placed in a facility for juvenile delinquents where he was abused for being gay, and then in a totally unsuitable home. In Buck and Mae, David provides a classic example of a couple who become foster parents to make ends meet. The foster care payments they received helped Buck and Mae keep their house and clothe their children. It is not surprising that such foster parents exist: some foster care agencies leave recruiting brochures in food stamp offices and laundromats; one that I worked for advertised in in a publication called the PennySaver. And yet, even when David’s siblings ran away and their abuse allegations that were taken seriously enough that the agency decided to send no more children to this couple, they were allowed to keep David. One reason, as Ambroz points out, is that there are not enough foster parents, especially for large sibling groups, so the focus is on finding any “bed” for a child. As a foster care social worker in the District of Columbia, I knew many foster parents who were motivated mainly by money. My recommendations to fire such foster parents were never accepted because the agency needed the beds.

To address the shortage of good foster parents, Ambroz recommends recruiting more middle and upper-income foster parents with higher education degrees. In order to do this, he suggests providing benefits that might attract such parents, such as government pensions, participation in the federal employee health plan, and access to free or subsidized tuition and state colleges and universities. I’m not confident that any of these benefits will attract more educated foster parents, and financial incentives also pose the risk of attracting more educated versions of Buck and Mae. Perhaps the lesson of David’s story lies the willingness of Holly and Steve to be his foster parents and the unresponsiveness of the system to this request. There is now a big push to locate kin who can care for children who are removed–and this may be happening much more frequently than when David and his siblings entered care. Perhaps agencies can do more to find unrelated adults who may have bonded with children as their teachers, parents of their friends, mentors or employers, who might serve as foster caregivers. This is certainly done; I myself agreed when asked by CPS to provide a temporary home to a friend of my son’s. If most children who are removed could be placed with adults known to them, it would be easier to fire the Bucks and the Maes and reserve the great foster parents for the children for whom no known adults are available.

Overwhelmed social workers: One reason David’s social worker did not jump at the chance to move him to Holly’s home may be that she was overwhelmed. “I have a rotating cast of social workers, who don’t have the bandwidth to pay attention to anything but immediate and obvious problems,” Ambroz reports. Based on my experience as a social worker in foster care, I could not agree more. Foster care, especially for older and more troubled children, is plagued with constant crises. With caseloads in most jurisdictions far too high, social workers have no time to deal with anything besides the latest crisis. Contributing to the problem are frivolous paperwork and metrics that have nothing to do with child wellbeing. Between the foster parents who did not perform the most basic parental responsibilities, and the caseloads that were too high for me to pick up the slack, I could not spend the time I needed to ensure that each child received the care they needed to thrive, and I eventually left the job.

David Ambroz recommends attracting more and better social workers by decreasing their caseloads and increasing their pay and benefits by either a salary increase or alternative compensation such as student loan forgiveness and home loan assistance. These are excellent ideas. There are other ideas worth considering, such expanding and publicizing the current Title IV-E social work education program that provides tuition assistance for social worker students who want to go into child welfare. Also worth considering are recruiting among populations that do not traditionally seek these jobs, such as military retirees, and perhaps changing education requirements for social workers in child welfare to allow other backgrounds besides social work.

Flaws in the Analysis

While David Ambroz’s story is powerful and carries many important lessons, his acceptance of the current child welfare zeitgeist may have prevented his drawing the conclusions that logically flow from his story. First, he buys into the currently popular misconception that parents are being found neglectful when they are simply poor. Second, he misses the opportunity to advocate for strengthening child protection services, not weakening them.

Poverty vs. neglect: While I’ve already described how Ambroz’ story contradicts the currently popular assertion that “neglect” is synonymous with poverty, he unfortunately repeats that same trope. Describing the domestic violence shelter staff’s decision to place the family in an apartment after observing Mary Ambroz’s abuse of her children, Ambroz states that “[T]his is a pattern that is repeated across the country–children in poverty are given kernels of assistance but are rarely rescued from their circumstances.” But David and his siblings were abused children, not just children in poverty. As mentioned above, he acknowledges that other poor families were not like theirs. By confusing poverty with maltreatment, Ambroz loses a key opportunity to clarify the difference between these problems and to explain that eliminating maltreatment requires more than just economic assistance .

Child protection failures: In his list of policy prescriptions, included in an appendix to the book, Ambroz does not address any of the problems with CPS that were revealed in his memoir. He focuses mainly on foster care, as if his earlier experience as an abused child did not have policy implications. Ambroz could have thrown his weight behind mandatory reporting in light of the movement to end it and could have argued for education of all citizens on the need to report suspected abuse. He could have supported reforms requiring that children be interviewed away from her parents. But these such policies are opposed to the current climate in child welfare which favors hobbling or eliminating CPS and minimizing interference with families. Ambroz appears to be determined to stay within the mainstream, saying “the best way to reform foster care is to decriminalize poverty and help families remain intact whenever possible with wraparound support–be it jobs, mental health care, or whatever is needed.” If abused and neglected children can remain safe with wraparound support that is clearly the best option, but to receive this support, these children must be identified through reporting and investigation. It is unfortunate that Ambroz did not recognize the discrepancies between some of the lessons of his story and the dominant narrative in child welfare and missed the opportunity to spell them out.

Despite its flaws, Ambroz’s story takes its place with other haunting memoirs of abused children, like Stacey Patton’s That Mean Old Yesterday, Regina Calcaterra’s Etched In Sand, and most famously Educated by Tara Westover, which put the lie to the current narrative of good parents vs. the evil state. If only Ambroz had recognized the conflict between his narrative and the dominant one, his book would be even more useful. But the story speaks for itself; the commentary is secondary. David Ambroz’s story is a must-read for anybody who cares about the abused and neglected children among us, including those who are in foster care.

*The doctor was the father of Alex and Jessica, but Mary Ambroz never told David who his father was.

Chronic maltreatment: A blind spot for child welfare

A CPS supervisor in St. Louis City once told the author about something he called “the 500 families.” When asked what this meant, he said that this referred to the small group of families that we see in the city again and again over many years, and sometimes over generations. They consume most of the time of workers and eat up most of the money available to the agency. These are the FE [frequently encountered] families.
L Anthony Loman, PhD., Families Frequently Encountered by Child Protection Services

It is a fact universally acknowledged that some families are reported to child protective services (CPS) again and again over a period of years. Many or most of these referrals involve some type of neglect, but there are often allegations of physical and sexual abuse as well. But in many cases, CPS fails to recognize families that are experiencing chronic maltreatment and when it does provide services, they may conclude with little or no change in the parents’ behavior or the children’s situation. As a result, children suffer lifetime damage, sometimes extending the cycle of maltreatment to the next generation, and sometimes the maltreatment even results in a child’s death. Sadly, today’s climate of anti-interventionism, combined with the reluctance to spend money and the lack of public concern about maltreated children, makes it unlikely that any relief for these at-risk children is forthcoming in the near future.

What is chronic maltreatment?

Every child welfare social worker seems to know families who have been reported to CPS repeatedly over a period of years. Dee Wilson, a former child welfare worker, supervisor and administrator who writes an essential child welfare blog called Sounding Board, asks participants in his training classes to tell him the highest number of CPS reports they have ever seen on one family. For almost 20 years, he has heard no answer less than 30 in any group of caseworkers, and he has received answers as high as 90 or 100 on several occasions.¹

There are different ways of describing those families who are frequently reported to CPS. The most commonly used term is “chronic neglect,” but this term can be misleading, as Anthony Loman explains. While these families usually have multiple reports of neglect, they often have reports of physical and sexual abuse as well. Loman uses the term “frequently encountered families,” meaning families who are reported again and again to CPS, and Jonson-Reid et al write about “chronically reported families” to refer to the same group. Dee Wilson prefers to focus on chronic multitype maltreatment, which he defines as maltreatment that is both chronic and includes more than one maltreatment type, such as neglect, physical abuse, and sexual abuse. But all of these writers are talking about the essentially the same families, as discussed below.

The case histories of frequently reported families consist of a sequence of reports followed by diverse outcomes. Some reports are screened out by hotline staff. Others receive an investigation or alternative response. Some investigated reports are substantiated, others are ruled as “unfounded” or “inconclusive.”² The substantiated reports may result in the opening of an in-home case or the removal of.a child or children, or no action may be taken if the children are deemed safe or not at risk. New reports often come in and are investigated even while a case is open. An in-home case may turn into a foster care case based on a new incident or a new investigation. Removed children are returned home and the cycle continues, with new reports, investigations, case openings, and removals. Loman calls this the “replay cycle.”

There is a surprising lack of research about frequently encountered families, and most of it is over two decades old. Loman, in his magisterial study, used a sample of 33,495 Missouri families who were reported to CPS for the first time between July 1997 and June 1998 and followed for five years after that first report. He defined “frequently encountered families” as those that received five or more reports in five years. He also used a smaller sample of 797 families from one Minnesota county who were selected in 2001 or 2002 and tracked for 27 months; for this sample he defined frequently encountered families as those with three or more reports. Jonson-Reid et al used a longitudinal study of children reported for maltreatment in a midwestern metropolitan area in 1993 or 1994. They limited their sample of 6,412 children under the age of ten at the time that they were first reported to CPS to allow a follow-up period of at least seven years. While there are a number of studies that examine maltreatment recurrence, I found no others that focus on families classified according to the number of reports received.³

The limited research available suggests that frequently reported families are a significant part of the population of families known to child welfare. Loman reports that of his sample of 33,395 Missouri families with screened-in CPS reports, one-fifth had five or more reports in five years. Of this group, nearly half had five or six reports during the five-year follow up period, a quarter had seven or eight reports, and the remaining quarter had nine or more reports. It is important to remember that these families were followed for only five years, and that they could have received many more reports after the follow-up period was over, perhaps as high as the 90 or 100 reports some social workers described to Dee Wilson. In their study, Jonson-Reid et al found that 27 percent of their sample had four or more reports by the end of the seven-year followup period.

Using their entire sample of over 33,000 Missouri families, and defining twelve different types of abuse and neglect. Loman found that the type of maltreatment alleged in the first report on a family is not a reliable predictor of the allegations in subsequent reports. In terms of the broad categories of “abuse” and “neglect,” many family histories showed reports of abuse interspersed between neglect reports, and much diversity in the type of abuse and neglect alleged in different reports. It is often observed that neglect by a single mother opens the door to abuse by her boyfriend, especially when he is caring for her children. And indeed, Turner and her co-authors, using 2011 and 2014 responses from 7,852 children or their parents to the National Surveys of Children’s Exposure to Violence, found that both physical and supervisor neglect were “strongly associated with risk of other maltreatment and most other forms of victimization.” These findings suggest that “chronic neglect,” “frequently encountered families,” and “chronic multitype neglect” refer to mostly the same families.

Using mostly his smaller but richer Minnesota dataset in which “frequently encountered” meant three or more reports in 27 months, Loman was able to compare frequently encountered families to those families that were reported less frequently. He found that frequently enountered families were more likely than others to be in extreme poverty and to have no employed adults. Younger parents, younger children, larger numbers of children, domestic violence, substance abuse, children with mental illness and disabilities, and caregivers with low self-esteem were more prevalent among frequently encountered families. Not surprisingly, these are the same factors that are associated with having any re-report or recurrence of maltreatment after the first report, and they are also associated with child maltreatment in general.

As might be expected, frequently encountered families account for a disproportionate share of child welfare spending. Loman found that the one-fifth of families in his Missouri sample that were defined as frequently encountered accounted for half the spending on families over a five-year period. The majority of these expenditures was for foster and group care and residential treatment. Case management and administrative costs for these families, which were probably disproportionate as well, were not included in this estimate.

Source: I Anthony Loman, Families Frquently Encountered by Child Protection Services, Institute of Applied Research, 2006, https://www.iarstl.org/papers/FEfamiliesChronicCAN.pdf

What are the consequences of chronic maltreatment?

Many studies show that exposure to maltreatment is linked to multiple adverse outcomes, and several have found that children exposed to chronic maltreatment tend to experience worse outcomes than those exposed to a single incident.⁴ In The Science of Neglect, the Harvard Center on the Developing Child explains how chronic severe neglect–defined as “the absence of sufficient attention, responsiveness and protection that are appropriate to the age and needs of a child” –can produce “serious physiological disruptions that lead to lifelong problems in learning, behavior, and health.”

It is also important to note the relationship between reports of child maltreatment and mortality from all causes, which I wrote about in an earlier commentary. There has been a spate of new research demonstrating that children who have been the subject of at least one child abuse or neglect report are more likely than other children to die from many causes, including childhood injury, sudden unexplained infant death, medical causes, suicide and homicide, even when confounding factors are controlled. As a member of the District of Columbia’s Child Fatality Review Committee, I have observed that children who die of all these causes often have long family histories with CPS. For example, the families of many young victims of homicide had a history of CPS reports often starting in the infancy of their first child. Many of these case histories reveal numerous calls to CPS alleging both neglect and abuse, with school absenteeism and lack of supervision being among the most frequent allegations. Eventually, many of these young people became involved in violent and illegal activities, ultimately leading to their violent deaths. There is no evidence of whether chronic maltreatment has worse effects on mortality than a single episode, but common sense suggests that is the case.

In discussing the consequences of chronic maltreatment, it is important to bear in mind the relationship between chronic maltreatment and the placement crisis that is currently plaguing child welfare agencies around the country. Many of the young people currently sleeping in offices and hotels, housed in psychiatric wards after being ready for discharge, and sent out of state, are undoubtedly victims of chronic maltreatment. Because they were allowed to stay in their toxic environments for so long without intervention, they developed cognitive, emotional or physical problems making them difficult to care for in a foster family; some are too hard to handle for most group homes and residential treatment centers and end up being rejected or expelled from those facilities as well.

How does CPS respond to chronic maltreatment?

CPS often fails to respond to chronic maltreatment in a family early enough to help parents make changes in their behavior and prevent serious harm to children. As Dee Wilson describes, many families referred to CPS several times for less serious neglect often receive no services until maltreatment is so ingrained that opportunity for effective early intervention has been lost. Wilson blames CPS’ tendency to focus on the incident alleged in the last report rather than the pattern revealed by a family’s history of reports over time.

And even when CPS responds, the response is often inadequate. The “replay cycle” described by Loman – with repeated reports, case openings, case closures, foster care removals and reunifications – continues because parents’ mental health, substance abuse, domestic violence or parenting style remain problematic. And indeed, research suggests that even when a family receives services as a result of a substantiated report, these services are generally too brief and do not result in behavior change. Chaffin et al, studying parents in home-based child welfare services, found that chronically maltreating parents tend to enter services with high levels of problems and do not improve much as the result of participation in services. They concluded that the “episodic and reactive service model characterizing traditional child welfare services” may be a “mismatch” for chronically matreating families.

Another reason for the “replay cycle” in some jurisdictions may be that at least one of the allegations being investigated must be substantiated in order for the agency to open a case. As a member of the Child Fatality Review Team in the District of Columbia, I have observed that many children who later died were assessed to be at high risk by the CPS investigator but were left at home with no support or monitoring when the allegations were not substantiated. When asked why this happened, agency representatives invariably explain that social workers are not allowed to open a case if an investigation did not result in substantiation of at least one allegation.

Similarly, accounts of child abuse or neglect deaths in states like California and Kansas have revealed that these children were assessed to be at high risk by CPS investigators one or more times but were left at home with no support or monitoring. Again, one reason was the requirement that an allegation be substantiated before a case can be opened.⁵ In the wake of the horrific child abuse death of Yonatan Aguilar in Los Angeles County, who was kept in closets for three years before he died, after four unsubstantiated allegations, the Office of Child Protection analyzed 1,225 referrals investigated by DCFS between 2012 and 2016 involving a child was later seriously injured or killed. They found that as in the case of Yonatan, more than half of the fatalities and near-fatalities occurred when the allegation was not substantiated. Yet we know from research that whether a report has been substantiated is a poor indicator of future behavior among parents who have been reported to CPS.⁶ Requiring substantiation to open a case ensures that some at-risk children will remain unprotected.

How can agencies respond better to chronic maltreatment?

There may be some social problems that we know how to solve but cannot do so due to financial or political constraints. But chronic maltreatment is not one of those problems. There are no easy answers to chronic maltreatment. But one thing is clear. The system itself must stop neglecting chronically maltreated children by leaving them at home without monitoring or support. Different commentators have supported different policies and some of these are discussed below.

Early Identification and support: Loman suggests that many families that will go on to become frequently encountered can be identified after the first or second report. These are the families that have many risk factors for child maltreatment and few protective factors against it and therefore score high on risk assessments. Ideally, child welfare agencies would identify these families after the first or second report and intervene to prevent their becoming chronically maltreating families. But, realistically, this is not going to happen in the current ideological climate, which favors restricting rather than expanding the role of child welfare services. However, it should be possible to offer all of these families a referral to high-quality childcare that includes family support services and staff trained to spot signs of abuse or neglect. For example, Educare, a nationwide network of birth-to-five schools, provides high-quality early childhood education, family support services, and links to needed services in disadvantaged neighborhoods around the country. At least in the Washington DC location, children are checked daily for signs of abuse.

Standards for removal based on age: Dee Wilson contends that the requirement of “imminent danger” for child removal is inappropriate in light of what we now know about the damage that long-term maltreatment causes to children’s developing brains and its contribution to mortality from all causes. He suggests considering developmental harm to children, rather than the narrow criterion of imminent danger, in the decision of whether to place the youngest children (those five and under) in foster care. Conversely, he suggests that children aged six to 17, unless they are in extreme physical danger if they remain at home, should be placed out-of-home only when a child welfare agency has a known therapeutic resource for that child, or when there is an extended family member, family friend or professional with whom the youth has a good relationship and who is committed to the youth. But removing more children at any age is unlikely to gain support in today’s ideological climate, which perceives child removal as punitive “family policing.” Removing fewer older children as Wilson proposes may leave many in harm’s way, especially those who might be in danger of self-harm from emotional abuse. Nevertheless, these ideas are worth further attention and exploration.

Reducing the role of substantiation/mandating services: Jurisdictions where substantiation of an allegation is required in order to open a case can consider changing that requirement. Los Angeles’s Office of Child Protection, in the report referenced above, spoke to experts who supported placing more emphasis on risk (instead of on allegation dispositions) when making case decisions, and on offering services and supports to families that may help to reduce this risk. However, agencies may need to do more than “offer” such services. Children who are assessed to be at high or intensive risk and in families that have multiple reports of maltreatment should not be left in their homes without monitoring. When there are three or more reports, and a child or children are found to be at high or intensive risk, a case should be opened for services and a court petition should be filed if the family refuses to participate. Court petitions should also be used more often during in-home cases to oversee parents’ compliance and incentivize their cooperation with services in in-home cases.

Services for Parents

Unfortunately, there is a dearth of interventions that have been found to be effective for parents with histories of chronic child neglect, especially when accompanied by substance abuse and mental health disorders, as well as parents displaying multiple types of maltreatment. Such families need a variety of services to address all of their risk factors, and the services must be sequenced so as not to overwhelm the parent or to provide certain services before a parent is ready for them. Drug treatment and mental health services are major needs for these parents. They also need services to address their financial need and employability, as research has shown that poverty and financial stress make child maltreatment more likely. Adequate housing will have to be provided for some families. Also needed, as Loman describes, are services to bolster protective factors like social supports, for example by trying to reconnect a family with an estranged relative.

Case management itself should be considered one of the most important services that cna be provided to frequently encountered families. Given the serious issues of these families, case managers need to have lower caseloads or work in teams. Dee Wilson recommends the creation of case management teams consisting of a CPS caseworker, substance abuse assessment specialist, mental health therapist, a public health nurse and a parent advocate to work with these families. Another approach is to assign one case manager with a smaller caseload to such families. The District of Columbia’s Child and Family Services Agency implemented chronic neglect units but they were dropped after barely a year. Case managers or teams should be allowed to work with families for at least a year, or even longer when a parent is mentally ill or cognitively impaired. Deep-seated problems that are often multigenerational cannot be solved in a matter of months.

Serving Parents and Children Simultaneously

Therapeutic childcare: An intervention that has not received enough support is therapeutic childcare, such as that offered by the relief nurseries in Oregon. Relief nurseries seek to prevent the cycle of child abuse and neglect through comprehensive and integrated early childhood therapeutic and family support services. Seattle’s Childhaven used to operate a similar model, combining therapeutic childcare with coaching parents in how to interact with their children. Such therapeutic childcare addresses many of the issues with chronic maltreatment. Quality care with family support can replace some of the missing interaction that is so essential to healthy child development, while at the same time training parents to interact this way themselves. Reducing the hours that a child spends alone with the parent, and enabling observation by staff trained to spot signs of abuse or neglect, increase child safety. Stress on parents is reduced by family support and availability of childcare. It is hard to think of an approach that addresses child maltreatment through so many pathways. As mentioned above, high quality childcare should be offered to families reported for the first time and at every subsequent report. But therapeutic childcare designed for children who are the victims of maltreatment should be mandated for those who have an open in-home case.

Residential Services: Keeping parents and children together while parents get treatment can keep children safe while not disrupting the parent-child bond. Drug treatment programs where children can stay with their parent are one approach that deserves more funding. Dee Wilson, in another helpful commentary about in-home services, also suggests trying out the concept of Shared Family Care, widely used in some Northern European countries, in which whole families with a substance abusing or mentally ill parent are placed with resource families.

Services for Children

Mentoring: Every school-aged child with an in-home case or in foster care should be matched with an adult mentor⁷ providing both another set of eyes on the child and some of the nurturing that the parents may not be providing. Mentors can be volunteers or employees of a professional mentoring program like Friends of the Children, which aims to break the cycle of intergenerational poverty and has a special concentration on children in foster care or involved with child welfare. Credible Messengers is a quickly-spreading model that uses people with similar life experiences to mentor youths involved with juvenile justice, and the District of Columbia’s child welfare agency has begun using it in foster care as well.

Creativity and Mastery: As Dee Wilson suggests,⁷ agencies managing the cases of abused and neglected school-age children should invest as much in their talent development as in their mental health treatment. Developing a child’s talent in arts, sports or another arena provides multiple benefits, including the psychological benefits of mastery of a skill, and in the case of the arts, the opportunity to process and understand trauma, as described in an Imprint article about an arts programs for incarcerated youth.

Specialized Education: Some public education models are designed to support children with child welfare involvement. Haven Academy in the Bronx is a public charter school that is open to all students but prioritizes admitting children whose families are involved with the child welfare system. Their model integrates family support services with the academic program. Some school-aged children who are candidates for foster care may do well in a boarding school that takes them away from their homes for much of the time while their parents receive needed services. Monument Academy Public Charter School in the District of Columbia is a weekday boarding school designed to serve students who have experienced significant adversity, including involvement or risk of involvement in the child welfare system. The school works to provide its students with the “academic, social, emotional, and life skills to be successful in college, career, and community.”

Coordination with other agencies

Shared Data: The families that come back again and again to every child welfare agency are probably the same families known to other agencies that work primarily with the poor–such as income support, mental health, juvenile justice and probation. The schools probably know these families as well because of their children’s issues with absenteeism, behavior, and disabilities. With a database shared between these agencies, families with issues could be identified early and helped in a more coordinated manner, perhaps allowing earlier intervention (and not always by CPS) with chronically maltreating families. But privacy and other concerns are often used to block any attempt at information-sharing between agencies. In a future commentary, I will discuss how such concerns ended San Francisco’s Shared Youth Database, a successful and award-winning data sharing project.

Shared Case Management: Another way to coordinate services between agencies would be to actually merge case management for child welfare and income support programs, returning to something more like the model that existed when cash welfare was administered by social workers who monitored parents to ensure that they were meeting the needs of their children. This model was phased out between 1968 and 1972 after criticism that it was coercive and also to save money, and it is unlikely to get a good reception in today’s ideological climate. But returning to a shared case management arrangement for cash welfare and child protective services would have many advantages. It would make the receipt of benefits contingent on taking proper care of one’s children and provide an incentive for families to cooperate with their case plans.

Recognizing when to give up on birth families: Finally, child welfare agencies must recognize when it is time to remove a child from a toxic family environment or when the prospect of reunification should be given up for good. It is not appropriate to close an in-home services case or to reunify a family if there is no indication that the parents have changed their behavior, and yet this happens all the time. Many of the most egregious child abuse and neglect deaths have been associated with startling failures to remove a child after long histories of abuse, or incomprehensible reunifications with parents who are clearly dangerous. Social workers and judges should be more rigorous about demanding evidence of change before putting a child in harm’s way by closing a case or sending a child home. When starting work with frequently encountered families, social workers should immediately seek out relatives or family friends who could serve as sources of support as the parents try to improve and as alternative caregivers if the children must be permanently removed.

Dee Wilson provides several reasons why there little motivation to find effective responses to the problem of chronic maltreatment. There is certainly no great public concern with the emotional and developmental damage to children from growing up with chronic abuse and neglect. Child welfare commentators in the spotlight today are clamoring for a narrower standard for child welfare intervention, not a broader one. And finally, understaffed and underfunded child welfare agencies are not looking to expand their services to maltreating families, although paradoxically many of them apparently want to expand their mission to encompass prevention of maltreatment among the group of families not yet known to them. The combination of public indifference, resistance to government spending (traditionally the province of the right wing) and resistence to any sort of “family policing or regulation” regardless of the danger to children (now the province of the left wing), is particularly toxic. Nevertheless, those who care for children must keep raising our voices, hoping one day that those in power will understand the need to protect the most vulnerable children and thereby interrupt the transmission of chronic maltreatment from generation to generation.

Notes

Dee Wilson, email to this author, November 29, 2022.
Substantiated means that there is credible evidence that abuse or neglect has occurred. Unsubstantiated or unfounded generally means there is not credible evidence concluding that abuse or neglect has occurred. Some states have an intermediate finding of “inconclusive” or “indicated” meaning that there is some evidence that maltreatment has occurred but not enough to substantiate the case. See Children’s Bureau, Child Protective Services: A Guide for Caseworkers 2018, p. 8-0.
Jonson-Reid, M., et al. (2010). Understanding chronically reported families. Child Maltreatment, 15 (4):271-281. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628675/. Jonson-Reid et al were able to find only one study (the Loman study) that focuses on these chronic cases. To determine if there were any such studies later, I went through the list of articles citing the Reid et al paper and found no more estimates of the proportion of families that are chronically reported by any definition.
English, D. J., Upadhyaya, M. P., Litrownik, A. J., Marshall, J M., Runyan, D. K., Graham, J. C., & Dubowitz, H. (2005). Maltreatment’s wake: The relationship of maltreatment dimensions to child outcomes. Child Abuse and Neglect, 29,597-619; Ethier, L.S., Lemelin, J.P., and Lacharite, C. (2004). A longitudinal study of the effects of chronic maltratment on children’s behavioral and emotional problems. Child Abuse & Neglect, 28, 1265-1278; Jaffee, S., and Malkovich-Fong, A.K (2011). Effects of chronic maltreatment and maltreatment timing on children’s behavior and cognitivec abilities. Journal of Child Psychology and Psychiatry, 52(20, 184-194; Lemmon, J. H. (2006). The effects of maltreatment recurrence and Child Welfare services on dimensions of delinquency. Criminal Justice Review, 31, 5-32.
See my commentary, Risk not substantiation should drive services to families. But not all jurisdictions require substantiation in order to open a case for in-home services or foster care. In Washington State, an allegation does not need to be substantiated for an agency to file a neglect petition in court; the purpose of filing a petition is to “prevent harm” and there is no need to prove that harm already occurred. Nevertheless, we know from Dee Wilson that despite this possibility, families continue maltreating long enough to accrue 30 or more reports, so clearly it is not the only answer. In Michigan and Minnesota, a case can be opened or a child removed because of “threatened harm,” which can be substantiated as a type of maltreatment.
See Drake, Jonson-Reid, Way, & Chung, Substantation and Recidivism; Kohl, Jonson-Reid, and Drake, Time to leave substantiation behind: Findings from a National Probability Study; Putnam-Hornstein et al., Risk of re-reporting among infants who remain at home following alleged maltreatment.
Dee Wilson, Email to the author, December 21, 2022.

The placement crisis for high-needs kids: it is residential facilities, not foster homes, that are lacking

Several housing units leased by DFPS for housing foster youth were adjacent to blighted abandoned housing development. From Court Monitor’s Report, published by Texas Public Radio, https://www.tpr.org/government-politics/2022-01-12/texas-foster-care-in-crisis-after-a-decade-in-litigation-and-5-years-under-federal-oversight

Around the country, child welfare systems are struggling with a placement crisis, especially for their most troubled youths. In North Carolina, an assistant secretary of the health and human services department told county directors that the state’s child welfare system is in crisis and could be hit with a massive class action suit due to children with emotional and behavioral health needs being boarded in offices or left in emergency rooms. In Illinois, the Director of the Department of Children and Family Services has been found in contempt of court a dozen times for not find a appropriate placement for specific children who were left in psychiatric hospitals after they were ready for discharge, left in juvenile detention centers after their sentences expired, or slept on office floors for want of a better placement. A recent case involved a girl who remained in a psychiatric hospital 170 days after being cleared for discharge.

In Colorado, Florida, Kentucky, Maryland, Massachusetts, Michigan, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, and Washington, the stories are similar. State and local agencies are unable to find appropriate placements for foster children and youth with the most severe behavioral health needs. As a result, they are being warehoused in inappropriate settings, such as temporary shelters, hotels, offices, or state-leased houses staffed by social workers; sent far away for residential care, or being left in psychiatric hospitals and detention centers after being cleared for release. Depending on the nature of the setting, these young people are deprived of normal schooling, activities, contact with their families, heathy food, exercise and opportunities to develop the life skills that they need. And equally important, they receive the message that nobody cares about them. As Cook County’s Public Guardian told a reporter about the children left for months in hospitals after a stay that should last no longer than a week or two :

“Imagine what it says to a child to see other kids come in, be treated, leave after a week. And they’re (wards of the state) stuck there for months, and months, and months because there’s nowhere for you,” Golbert said. “imagine the message that that sends to these children. It very powerfully tells these children that you don’t matter. And these are kids that often have attachment issues to begin with, by definition — they’ve been removed from abusive parents to be in DCFS care.”

Not surprisingly, the children languishing in inappropriate placements tend to be those who are hardest to place in foster homes. They tend to be older and with mental and physical disabilities, behavioral health problems, or both. Many of them have been bouncing from foster home to foster home for years until no foster home would take them. Many of these children have displayed violent or self-destructive behavior and are at risk of harming themselves or others. With fewer abused and neglected children being removed from their homes, foster care professionals all over the country are reporting that the children who are being placed today have more serious needs and often need of intensive services from professionals.

Few potential foster parents are willing to open their homes to youth who might be a threat to themselves or others in the home. Furthermore, many of these youth require a placement with intensive therapeutic services before being able to function in a normal foster home. Such a placement might be called a therapeutic group home, residential treatment center, or psychiatric residential treatment facility. Definitions of these terms vary, but the federal government’s foster care data system (AFCARS) classifies all these settings as “congregate care,” a term that has come to mean any setting that is not a foster home. Perhaps a specially trained, paid and supported therapeutic foster home could help some of these youths, but the numbers of such homes are tiny compared to the need.

So how did we get to this place where so many children with acute needs, far from having their needs met, are being housed in inappropriate and harmful settings? The foster care placement crisis is part of a larger crisis in residential care for youth (not just those in foster care) that stem from a push by advocates and governments to reduce the number of children in institutional care. Egregious cases of abuse in residential facilities have led to extensive press coverage, lawsuits, investigations, and the closure of many residential treatment centers. But they have also been used by opponents of residential care to argue that all such facilities are abusive or unnecessary, instead of recognizing that there are high-quality residential placements that can help the most wounded children who cannot be helped in another setting.

In addition to the growing opposition to residential care, other factors have also affected the supply of these facilities. Reimbursement rates have stagnated around the country, resulting in closure of some facilities. And those that are still open cannot pay their employees more than they would make in jobs in fast food or retail, with much less stress and risk. This has resulted in a staffing crisis that has caused facilities to close.

In a disturbing echo of the deinstitutionalization movement of the 1960’s, disappearing residential treatment facilities have not been replaced by other options for providing the necessary care. The Colorado Sun reported on the catastropic state of residential care in that state. More than 44 youth treatment centers, with more than 1,000 beds, have closed since 2007. Only “a handful” of the 40 remaining centers will take the youth with the most severe mental health problems. And the director of human services for Weld County, Colorado, told the Sun that when the county does find a residential bed for a child, the child is often kicked out for displaying behaviors to severe for them to handle.

At the same time as residential facilities for youth in general have been closing down, a series of laws and court settlements has resulted in massive reductions in residential beds available to foster youths specifically. As is often the case, California took the lead by passing its Continuum of Care law, and Congress followed by adopting the Family First Prevention Services Act (FFPSA), of which one of its two main purposes was the reduction of children’s placements in congregate care. FFPSA accomplished its purpose by limiting to two weeks the time a child could spend in congregate care, except for certain specialized facilities for youth who had been sex-trafficked, pregnant and parenting teens, and independent living facilities. The only other exception is a new facility type called a Quality Residential Treatment Program (QRTP), which must meet stringent requirements, like a trauma-informed model, accreditation, and full-time nurses on site, that would require major modifications for many existing facilities. FFPSA also required that any placement beyond two weeks be approved by a court and that a stay longer than 12 months be approved in writing by the head of the agency. FFPSA contains another poison pill for residential care, of which its framers may have been unaware. QRTP’s of over 16 beds will likely be classified by Medicaid as “Institutions of Medical Diseases,” and therefore youth who are placed in these facilities will be ineligible for Medicaid funding of any of their care.

New Mexico is a “window into challenges facing other states, as documented by Searchlight New Mexico and Pro Publica. in the aftermath of a court settlement in which it agreed to reduce its reliance on residential treatment centers for foster youth, the number of group facilities has dropped by about 60 percent over the four years ending last August. But the state has yet to build the the community-based behavioral health system that it had promised. Therefore, the highest-needs youths are spending months in crisis shelters designed for brief stays and not equipped to deal with severe mental illness. Practically every day, reports Searchlight New Mexico, someone at a shelter that accepts foster teens calls 911 with a report of young people harming themselves, attacking or threatening staff or other residents, or running away. According to Pro Publica, the state plans to train four therapeutic foster parents and open two small group homes, with six beds each, for troubled youth. The state has not yet licensed a single QRTP.

The states with the largest numbers of foster youths are facing crises as well. In California, according to a letter from four state associations in April 2022, 1,193 residential therapeutic beds available to foster youth had been lost since January 1, 2020. The writers report that they are “aware of a number of other providers who are either greatly reducing their capacity, shifting program models to serve youth with less intensive needs, or closing.” In Texas, at any time there are as many as 75 children sleeping in unlicensed facilities like hotels or state-leased houses staffed by CPS workers for lack of an appropriate placement. In New York, more than half of residential treatment facility beds for children have shut down in the past ten years, dropping from 554 to 274, according to Pro Publica. In New York City, the Imprint recently reported that at least 40 children currently in the City’s emergency Children’s Center have been there for more than a month. The center, designed for temporary stays, currently houses 72 children. Housing children with a variety of complex diagnoses and speaking multiple languages, the center is responsible frequent calls to 911 and has been the subject of public scrutiny as a result of some of these episodes.

Some commentators and media outlets persist in blaming the placement crisis on a shortage of foster homes. Confounding the foster home shortage with the shortage of placements for high-needs kids is deceptive. As mentioned above, there are not many potential foster homes that would agree to take these children or that could help them. The option of using therapeutic foster care, while politically popular, has so far resulted in only very small programs due to the difficulty in recruiting suitable parents. This is not to say there is no foster home shortage for children who could be accommodated in a foster home; such shortages probably exist in many or most states, especially when we talk about the supply of quality foster homes.

What can be done? As many advocates argue, we should help children earlier so that they don’t become so damaged that they have to be placed in residential care. Many child welfare leaders and and advocates say the answer is to reach out to families before they become involved with child welfare. But they rarely talk about intervening earlier and more intensively with families already known to child welfare agencies. As a member of the District of Columbia’s Child Fatality Review Team for years, I have observed a striking pattern among youths who are victims of gun violence. More often than not, their families have extensive child protective services case histories, often involving multiple children with repeated referrals for excessive absences from school, lack of supervision and physical or sexual abuse. The records show referral after referral being screened out, in-home cases being opened and quickly closed, and children being placed in and returned from foster care without any evidence of improvement in family functioning. Over time, the children’s behavior worsens, they acquire mental health diagnoses, become involved with juvenile justice, and those young people whose sad cases I reviewed eventually were killed by other youth and adults with similar backgrounds. We need to understand the deep intergenerational problems of chronically maltreating families and intervene with more intensity earlier–through intensive in-home services (with participation enforced by a court if necessary) and, when all else fails, removal of the child to a safer environment.

No matter what we do to help children earlier, it is obvious that at least in the short-run we must replace some of the lost residential facilities. These new facilities should be QRTP’s or other high-quality residential placements. But they must be established, and funded adequately enough to hire and adequately reward staff who are dedicated and passionate about their work. Some states have already taken action to boost their residential capacity for high-needs youth. The Legislature in Texas, for example, appropriated $70 million to the Department of Family and Protective Services (DFPS) for supplemental payments to retain providers and increase provider capacity, and another $20 million for new facilities for the young people with the most intense needs. Congress can help by exempting QRTP’s from the IMD exclusion. The federal government could also incentivize creation of QRTP’s through a pilot or grant program.

Around the country, and in states encompassing the vast majority of foster youth, there is a placement crisis that is affecting mostly those youth who require more intensive care and services. This is part of a larger crisis in residential care for youth, which is exacerbated among foster youth because of new laws and policies discouraging their placement in what is called “congregate care.” Those who explain this as a shortage of foster homes fail to understand the nature of the youth affected. Perhaps earlier intervention with children who are chronically abused or neglected can reduce the number of children who are in need of residential care. But at least in the short run, we must increase the supply of quality residential facilities in order to prevent further damage to these youths. It will be costly, but the costs of inaction would be far greater.

A tragic ignorance: support for corporal punishment in certain communities

Photo: Montgomery County Police Department

In March 2021, political and community leaders in progressive Montgomery County, Maryland recoiled in horror at the release of a video showing two Black police officers screaming at a Black five-year-old boy who had thrown objects at his teacher, scratched her when she tried to stop him, and ran out of his school in January 2020. The officers’ behavior – including forcing the tiny child into a chair and screaming at full volume only inches from his face – was appalling enough that it resulted in brief suspensions for the two officers and the settlement of a lawsuit filed by the child’s mother, as recently revealed by the Washington Post. This incident drew attention to the fact that bad police behavior extends beyond inappropriate use of their guns. But there has been little focus on another systemic issue raised by this incident – one that may be even more destructive to at-risk children – and that is the widespread acceptance and promotion of corporal punishment among authority figures such as police.

The video of the 2020 incident is difficult to watch. It shows the two police officers, one male and one female, forcing the child into a chair and screaming into his face as he cries, coughs and hyperventilates. While disparaging and threatening him, they repeatedly prescribe corporal punishment as the remedy for the child’s behavior. “So this is why people need to beat their kids,” states Officer Dionne Holliday as she marches the boy into the building.” I hope your mama lets me beat you,” “Oh my God I’d beat him so bad!” Officer Kevin Christmom chimes in telling the child he misbehaves “because you don’t get no whupping.” “He’s bad. That’s what it is. Because no-one is correcting him,” adds Officer Holliday. As the child cries, gasps, and coughs, the officers continue to lament his bad behavior and upbringing, saying he should be “crated” since he was acting “like a beast.

When she arrives, the little boy’s mother’s top priority is not to comfort him but rather to order him to take off his shirt to demonstrate the lack of marks. It appears that, while on the telephone with the school, she heard one of the officers wondering what was going on in her home, so she wanted to show them that she was not abusing her son. The two officers hasten to reassure her. Says Officer Christmon: “We believe it is the exact opposite.” And the Officer Holliday chimes in, saying “Yeah, we want you to beat him.” The harassed mother insists she cannot beat her son because she does not want to go to prison or lose her child, but the officers insist that there is no such risk. The officers take the mother into a conference room in order to continue their discussion of appropriate discipline away from the child. The boy’s mother insists that she had been told by two school staff that they would call CPS if she spoke about beating her son. Officer Christmom said “you have two uniformed police officers telling you the law,” adding that “when my girlfriend beat her daughter, the officer said do what you need to do, just don’t kill her. Added Officer Holliday, “All I’m telling you is beat that ass.” The mother and the officers appear to bond over their belief that Black people discipline differently from Whites and the officers suggest that she disregard the statements of White school staff.

The child is brought into the room to face his mother’s wrath. After chastising him for his behavior, his mother asks, “What mommy gonna do?” “Beat me on the butt,” responds the little boy. You want me to keep beating your ass?” asked Mom. “You want her to let me do it?” asks Officer Holliday. “I don’t like bad children. Bad, disrespectful children. I think they need to be beaten.” The mother confesses that she has been so frustrated with her son’s behavior at school that she considered finding a therapist. But the officers discarded that option quickly. “He’s just bad,” says Officer Holliday. The officer adds that her mother beat her with anything at hand, including a telephone cord, and told her children, “When CPS comes let them take all of you.” Officer Christmom reiterates: “you can beat your child, just don’t leave no cuts, no cigarette burns…..” The boys’ mother parts with the officers on good terms, and a school staff member lets her know that her son has received two days suspension, clearly adding to the beating she has been licensed to give.

The degree of ignorance displayed by these police officers cannot be overstated. Researchers have been unanimous in finding that corporal punishment is harmful to children and worsens behavior rather than improving it. In an updated policy statement that strengthened its opposition to corporal punishment, the American Academy of Pediatrics found no evidence in the research literature of long-term benefits from corporal punishment and “a strong association between spanking children and subsequent adverse outcomes.” These bad outcomes include a greater likelihood of physical injury among the youngest children; negative impact on the parent-child relationship; increased aggression and defiance among children; increased risk of mental health disorders and cognition problems; and an increased likelihood of adult health problems.

In her book, Spare the Kids: Why Whupping Children Won’t Save Black America, the Black child advocate Stacey Patton contends that corporal punishment in the Black community grew out of the struggle to survive centuries of enslavement followed by Jim Crow and continued state violence. As she explains in a brilliant article about this case, the use of corporal punishment to ensure survival continues today as “many Black parents invoke their fear of their children being harassed, arrested, beaten or killed by police to justify whupping their children. Corporal punishment of Black children is widely considered a necessary step in protecting them from police violence.” But in fact, as Patton points out, corporal punishment has the opposite effect, leading to more problematic behavior at school and in the community, not less. As she puts it, “The last thing any police officer should be telling parents, especially Black parents, is to hit their children.”

Thankfully, the use of corporal punishment appears to be declining in the US. But poor and marginalized families are often late in adopting social trends, whether it be smoking cessation or diet and exercise. Moreover, nineteen states, mostly in the south, allow corporal punishment by school staff. It’s unlikely that police training can change officers’ ingrained beliefs, just as parents can attend any number of parenting classes without changing their minds about the value of corporal punishment. What is needed is a national effort to change social norms around corporal punishment.

Such an initiative already exists but needs more support from governments. Several organizations have collaborated on a national initiative to end corporal punishment, which is working to change social norms about the hitting of children. This alliance has announced a free virtual conference on October 14, 2022. One of the workshops will highlight a creative new intervention called “No Hit Zones,” which are institutional policies adopted by hospitals, courts, libraries and other institutions, that promote employee intervention when parents hit, or threaten to hit, their children. Other workshops, including one by Stacey Patton on how to talk about the harms of corporal punishment with African-American parents, will help professionals talk more effectively with parents about this issue. Approaches such as no-hit zones, professional training, and public health messaging campaigns, need support from federal, state and local governments.

Perhaps I have spent too much time analyzing one video, which may be atypical. But the tone of it rings true with what I have seen and heard as a social worker in the District of Columbia, and read in the writings of authors like Stacey Patton. This video sheds light on the language and thinking of people with whom many policymakers and analysts have little contact. We are rarely given this opportunity to hear what people are saying when they don’t expect it to be publicized. It is important that we learn from this disturbing video. With a widely-acknowledged mental health crisis among American children and youth, this is no time to ignore the promotion of corporal punishment by police and other authority figures.