Miracle Jackson, a seven-month-old in Detroit, died with a sock stuffed down her throat and her face covered in duct tape at the hands of her father in 2000. During the same week in the same city, a five-month-old named Jamar was severely beaten. It turned out that Miracle’s mother and Jamar’s parents had abused or neglected their previous children seriously enough that their rights to parent those children were terminated. Yet, when Miracle and Jamar were born, nobody checked on them to make sure they were safe. But that was about to change in Michigan, which became the first state to match birth and child welfare data to identify new children born to parents who had severely abused or neglected previous children – a practice that has become known as “birth match.”
The logic behind birth match is simple. Research suggests that in parenting as in other areas, past behavior is often the best predictor of future actions. Current technology makes it possible to match existing databases maintained by the child welfare and health agencies in order to identify infants born to parents who have had their parental rights terminated, been convicted of a crime against a child or have other history identifying them as a safety risk to a newborn. So it is not surprising that the Committee to Eliminate Child Abuse and Neglect Fatalities (CECANF) in its 2016 report recommended birth match as one strategy to identify children at high risk of maltreatment so that action can be taken to keep them safe. Yet, only four other states have adopted birth match, and only one (Missouri) has adopted it since the CECANF recommendation.
All of the states that use birth match identify infants born to parents who had their rights terminated because of abuse or neglect, with some specific differences. It is not surprising that they all identify parents with a termination of parental rights (TPR), because a TPR usually means that there has been severe abuse or neglect and and the parent has been given multiple chances to ameliorate the behaviors or conditions that caused the child’s removal.
Each state has chosen to include certain other parents in addition to those who had a TPR. Maryland has the most limited policy, including (in addition to those who had their rights terminated) only parents who have been convicted of the murder, attempted murder, or manslaughter of a child. Minnesota includes the broadest group of parents–all those who were determined to have committed “serious maltreatment,” the highest of four categories of severity that are assigned to all substantiated instances of maltreatment. States also differ in how far back they look in time for evidence of dangerous parental behavior: Texas looks back only two years, Maryland and Missouri look back ten years, and Michigan and Minnesota match all available records, regardless of when the maltreatment or termination occurred.
States also differ in whether they treat birth match referrals as allegations of abuse and neglect, requiring a regular CPS investigation. The first two states to adopt birth match, Michigan and Minnesota, already had a category of child maltreatment called “threatened harm” or “threatened injury.” Birth matches in those cases receive a CPS investigation of an allegation of threatened harm or injury. In Texas, matched infants and their families also receive a regular investigation, but the type of allegation depends on the content of the report.1 In general, investigations result in a finding on the truth of the allegation; if it is “substantiated,” or found to be true, it may result in the removal of a child or children into foster care, the provision of in-home services and monitoring to ensure their safety, or a possibly a placement with a relative or family friend with the consent of the parent.
In contrast to the other three states, Maryland and Missouri treat birth match referrals differently from allegations of child abuse and neglect. In Missouri, birth match referrals are treated as “Non-Child Abuse/Neglect Referrals” and receive a “Newborn Crisis Assessment,” a special type of investigation that was designed to respond to calls from hospital personnel who are hesitant to release newborns from the hospital because of safety concerns. If no safety concerns are identified, parents can decline any services that are offered; if safety concerns are identified, social workers have the same choices as in a regular investigation: they may go to court to request immediate custody, allow the child to stay at home under a safety plan supervised by the department, or negotiate a voluntary placement with a relative.
In Maryland matched families receive an “assessment,” which is less comprehensive than a regular investigation. Families can refuse to participate, unless there is “reason to believe a child has been abused or neglected or is at substantial risk of abuse or neglect,” in which case the local department of social services is directed to make a report to CPS. Similarly, the department is directed to call CPS if there is such a concern at any time during the birth match assessment process.
The lack of data makes it difficult to assess the impact of existing birth match processes. Other than Missouri, where birth match has been in use for less than a year, none of the states publishes data on the results of these programs as part of their regular reporting, and it appears that administrators do not review this data internally. In response to the request for data for the report, child welfare officials had to generate new tables from their databases. But the data raised many questions and without knowing exactly how it is obtained, one cannot judge its accuracy. There were some anomalies that state administrators were unable to explain, like the fact that the total number of matches in Michigan dropped from 1186 in FY 2019 to to 873 in FY2020 and then down to 515 in FY2021–a drop of 50 percent in two years! It appeared that state administrators were unaware this anomaly before being asked about it, and they were unable or unwilling to provide an explanation.
If the data provided by the states is approximately accurate, birth match is identifying significant numbers of children. The number of matched infants identified in FY2019 (before the pandemic) was 1,188 in Michigan, 1,138 in Texas, 420 in Minnesota, and 243 in Maryland. Between half and two-thirds of these children already had an open investigation or case. It is encouraging that so many of these infants were known to CPS without birth matching, but it also shows that a sizable number and proportion of infants at risk due to their parents’ earlier behavior would be unidentified in the absence of this tool.
But the effectiveness of birth match depends on the quality of the investigations or assessments that are conducted and whether they result in actions to ensure child safety. The limited evidence is not encouraging. The number and percentage of matched children and families reported to be actually receiving services was surprisingly low. In Texas, of the 302 families investigated due to birth match in FY2019, only 70 received in-home services and 28 had a child or children removed. In Michigan, of the 484 investigations due to birth match, only 49 cases opened for services and 24 had a removal of a child. In Maryland, only four of the 89 families investigated due to birth match were documented to have received services. Minnesota provided no data beyond the number of matches. Without better data and case reviews, it is impossible to know why so few families received services.
The fact that the data requested had to be specially generated suggests that child welfare administrators in birth match states have little interest in the implementation and effects of of birth match. That was not always the case, at least in Michigan. One former CPS director in Michigan, who had served as a CPS worker and supervisor earlier in his career, had a strong belief in the potential of the process to protect children if correctly implemented. He conducted an internal review of birth match cases and found that 75 percent of the investigations resulted in no finding of threatened harm to the child, and only 6.5 percent of the cases eventually went to court for removal or court-ordered services. He concluded that investigative workers were not following agency policy and that supervisors were nevertheless approving the findings of the flawed investigations. He was working on ways to improve implementation through oversight of supervisory decisions. But with a change of personnel, those efforts never came to fruition. Now, birth match is under review in Michigan as part of a “front end redesign” of the child protection system.
Many former birth match advocates appear to have lost interest as well. In Texas, birth match was adopted in response to a recommendation by the State Child Fatality Review Team (SCFRT). But after requesting updates on implementation in FY2013 (which were never provided) and recommending expanding the program to look back five years in FY2018 (a recommendation which DFPS rejected), the SCFRT stopped making recommendations about the program. In Maryland, advocates pushed to strengthen the program by increasing the “lookback” period from five to ten years. But after such legislation was passed in 2018, it does not appear that advocates asked about its implementation nor about the effects of the expansion. Moreover, in passing the 2018 legislation, the legislature included a provision that appears to be aimed at finding less controversial alternatives to birth match.
The changing ideological climate might be the reason for the loss of interest in birth match among officials and advocates in the first four states to adopt it. In today’s atmosphere, identifying parents based on their past involvement in child welfare or criminal justice is likely to be criticized because these systems involve Black people at a rate that is disproportionate given their share of the population, though proportionate to their rate of abuse and neglect compared to other populations. There is no escaping the conclusion that birth match is simply at odds with the current zeitgeist in child welfare. Missouri was the only state to institute birth match since it was recommended by CECANF in 2016.
The report makes three recommendations. Due to its support in research and common sense, birth match should be added to every state’s set of tools to prevent child abuse and neglect and Congress should consider mandating birth match as a requirement to receive funds under the Child Abuse Prevention and Treatment Act (CAPTA). Birth match provisions should include all parents who committed severe abuse or neglect whether or not they had a TPR or criminal conviction. And finally, states with birth match programs should track and publish data on the children matched and should conduct case reviews to assess the implementation of their programs. But it is not likely that any of these recommendations will be widely adopted until the pendulum swings toward the needs of children living in unsafe homes.
When a new baby is born to parents who had their rights terminated to a previous child due to severe abuse or neglect, or who killed or severely harmed another child, the child welfare agency should be notified, and a professional should make contact with the family to ensure the child is safe and offer the parents any assistance needed. It is such a commonsense idea that it’s hard to imagine anyone would oppose it. Nevertheless, only five states have adopted such a program, and and the four states with programs that have been in effect for more than one year have displayed what appears to be little interest in assessing or improving their implementation; on the contrary, there seems to be some interest in eliminating the programs among administrators and legislators in some states. The current ideological climate in child welfare may be be responsible for our failure to use a simple tool to protect children.
How the allegation type is determined and by whom, and how maltreatment can be found before it has occurred are unclear. Birth match is not mentioned in the department’s policy manual and DFPS’ Media Relations Director was not able or willing to answer these questions.
On June 24, the decomposing body of Chase (also spelled Chayse or Chayce) Allen was discovered in a freezer in the basement of a rundown house in Detroit. It did not take long for the media to learn that Chase’s mother had a history of child abuse, including a conviction in court, resulting in the removal of all six of her children by Children’s Protective Services (CPS). Nevertheless the children were returned over the objections of their grandmother and aunts, whose continued calls to the hotline to report suspected incidents of abuse were to no avail. The last time CPS came out in response to one of their calls, it was too late to save Chase. Shockingly, media interest in this story dropped off after a few days, and legislators and community activists have been totally silent. There have been no demonstrations, no vigils, nobody demanding justice for Chase. One doesn’t have to look far for the reason for this appalling lack of concern. Chase’s story does not fit into the prevailing narrative, which features CPS wresting Black children from their loving parents simply because they are poor.
The discovery of Chase’s body was first reported by media outlets including the Detroit News on June 24. On June 26, Channel 7 and others reported that Chase’s mother, Azuradee France, was charged with first-degree murder, child abuse and torture and concealing the death of an individual, and was jailed. In the next few days, the Detroit News reported that France had a history with the Children’s Services Division of MDHHS dating back at least to 2017 and had been involved with the agency at least seven times as a parent. She had been arrested and convicted for child abuse of a nephew for whom she was caring temporarily, serving two years of probation, and her children had been removed from her. When she gave birth to a fifth child in 2020, MDHHS obtained a court order to take custody of that child, citing her failure to address the conditions (including untreated mental illness) that brought her children into care. Nevertheless, all five children were inexplicably returned to her only three months later, and she apparently gave birth to a sixth child about two months ago. Relatives reported making multiple calls to the child abuse hotline since the return of the children. One visit, due to a burn to Chase, resulted in no action by CPS; the next visit in response to a CPS call resulted in the finding of Chase’s body.
The last bit of media coverage appeared on July 3, when Karen Drew of Channel 4 reported on Chase’s grandmother’s belief that CPS could have prevented his death if he had not been returned to his mother. But since July 3, Chase’s story appears to have totally disappeared. Shockingly, there is no mention of Chase on the website of the city’s paper of record, the Detroit Free Press and the Metro Desk did not respond to a tip from this writer. And amazingly there has been no coverage anywhere of the preliminary court hearings on the case. Even worse, there has been no response to the tragedy from the Detroit City Council, the Michigan Legislature, or community activists.
Is Chase’s story an outlier? Not likely. Several families and attorneys told Kara Berg of the Lansing State Journal earlier this year that Michigan children are often left in abusive households due to inadequate investigations and a failure to act by state employees. An audit of CPS investigations in Michigan published in 2018 by the Michigan Auditor General found that MDHHS’s efforts to ensure “the appropriate and consistent application of selected investigation requirements” such as starting investigations in a timely manner, conducting required child abuse and criminal history checks of adults in the home, and assessing the risk of harm to children were “not sufficient” and that ineffective supervisory review of investigations contributed to the deficiencies they found. Such an inadequate response to children’s suffering almost invariably results in lifelong damage to children, but can also result in severe injury or death as in Chase’s case. Michigan reported 43 children died of abuse or neglect in 2020 (undoubtedly a gross underestimate1) but was not able to report how many of these children were known to CPS. Nationally, the Commission to Eliminate Child Abuse and Neglect Fatalities estimated that one-third-to one half of children killed by maltreatment were known to CPS.2
So what is the explanation for this lack of outrage about Chase’s death, given that evidence of problems already exists? In the wake of George Floyd’s murder, the ensuing “racial reckoning,” and the movement to defund the police, a parallel narrative and associated movement has sprung up in child welfare. Funded by deep-pocketed foundations led by Casey Family Programs and embraced by the US Administration for Children and Families, this narrative portrays CPS as a “family policing system“ that wrests helpless children from parents only because they are poor. Perpetrators of this narrative have devoted obsessive attention to the disparities in the proportion of Black and White children who are involved with the child welfare system at every stage–reporting, investigation, case opening and child removal. There is a problem with this analysis. The evidence suggests that Black children’s higher likelihood of being reported, investigated and removed reflects their higher tendency to be abused and neglected. Reducing their involvement in the system to a rate comparable to that of White children would mean to establish separate, lower standards for the safety of Black children.
But nowadays there appears to be little concern about Black children who are killed by their parents. B As one Black woman told reporter Kara Berg of the Lansing State Journal about her failure to interest CPS on the neglect and sexual abuse of her nephew, “They think this is how Black children are supposed to live.” What could be more racist than disregarding Black children’s suffering and deaths at the hands of their parents, when such suffering and death would be cause for massive protest if it happened to White children? Do Black lives matter only when taken by a White police officer, and not by a Black parent?
If Black lives matter, then surely Black children’s lives matter. More than twice as many Black children are killed by their parents every year as the total number of Black people of all ages killed by police. in 2020, 504 Black children were killed by parental or caregiver abuse or neglect, according to annual child maltreatment report of the US Children’s Bureau, which is widely considered to be an understatement of the actual number of child fatalities.3 That is more than twice the number (243) of Black people of all ages who were killed by police in the same year, according to the Washington Post‘s police shootings database.
The lack of public outrage at the death of yet another Black child means there is no pressure on MDHHS to release information on Chase’s family’s history with its children’s services division. A public information officer for MDHHS has told WXYZ (Channel 7) Detroit, that “The department, by law, cannot release specifics about Children’s Protection Services (CPS) investigations or confirm whether or not CPS has received complaints about a specific family or individual.” The exact opposite is true. The agency is actually required to release certain information in a child abuse or neglect case in which a child who was a part of the case has died.” That information includes anything in the case record related specifically to the department’s actions in responding to a complaint of child abuse or child neglect.”3
The public needs access to the case files in order to understand what went wrong and what policies and practices need to be changed. In addition, the case files are necessary to ensure that public officials, including investigators, supervisors, and court personnel, are held accountable for their decisions. Some of the many questions that need answers include the following:
What caused Chase to go blind? (Relatives indicated he lost his sight “over a year ago.”) Was this the result of some sort of maltreatment? Was he targeted for abuse because he was disabled? Did CPS ever ask these questions?
Why were the children returned to their mother three months after MDHHS filed a petition to take custody of the newest baby she was deemed to be far from ready to parent them? And did the juvenile court referee named by Channel 7 and the Detroit News make this decision at the behest of MDHHS or against its recommendation?
The children were returned to their mother “under the supervision of the department,” according to the court record cited by the Detroit News. Exactly what did this supervision consist of? How long did it last? Who agreed to the end of supervision and why? What does the record state about the mother’s improvement and readiness to parent? What “intensive reunification supports” were provided?.
Why did CPS take no action after the most recent report, when the grandmother reported that three CPS investigators came to the home?
How many calls from Chase’s family were screened out and did not even receive an investigation?
Receiving no response to my emails to local reporters urging them to request the the files on MDHHS’s involvement with Chase and his family, I contacted the agency’s public information office on July 11 to make the request. On July 25, I received a denial of my request based in part on the fact that the investigation of Chase’s death is not complete. It is unclear why the fact of an incomplete investigation is a reason for the denial of my request; the agency could send me the records of all previous investigations now and I would be happy to wait for the latest one. It’s a shame that several media outlets, who have attorneys who can appeal decisions by agencies to withhold information, did not choose to seek this information. Readers can help by sharing this post with their contacts in Michigan and asking them to urge their state and local legislators to demand answers.
The reaction, or lack thereof, to the death of Chase Allen shows a blatant disregard for Black children’s suffering and death at the hands of parents or caregivers, in large part because it does not fit within the prevailing narrative of CPS snatching children from loving Black parents. Anyone who believes Black lives matter should be asking why CPS and the courts left this vulnerable child unprotected in such a dangerous home. We’ve already let Chase die. Let us at least learn from his death how to save children in similar situations.
This is almost certainly an understatement for several reasons. As Michigan describes in its notes for the 2020 Child Maltreatment report, only deaths that are found to be due to maltreatment by a CPS investigation are counted. Second, the count of 43 is considerably lower than the estimates for previous years (63 in 2019, for example), suggesting that the Covid pandemic delayed completion of child death investigations by CPS.
As reported by the Commission to Eliminate Child Abuse and Neglect Fatalities in its final report, this number is considered to be an understatement because not all states currently report on fatalities and in some states the death is not reported to the federal system if the child was not known to the CPS agency.
MCLS Section 722.627c states that “The director shall release specified information in a child abuse or neglect case in which a child who was a part of the case has died.” “Specified information” is defined in Section 722.622bb as “information in a children’s protective services case record related specifically to the department’s actions in responding to a complaint of child abuse or child neglect.”
On June 24, a child protective services worker (CPS) accompanied by police officers knocked on the door of a rundown house on Detroit’s west side to conduct a welfare check. Azuradee France answered the door but tried to keep them out. When they entered the house, they found the badly decomposed body of a three-year-old, later identified as Chayse Allen, in a freezer and five more children living in squalor. The media soon learned that Chayse’s mother had been involved with CPS at least seven times as a parent. She had been arrested and convicted for child abuse, serving two years of probation, and her children had been removed but later returned. And yet, there were no procedures in place to protect France’s six children from her lethal violence. And Chayse Allen, described by family members as a sweet, shy and soft-spoken child who had become blind about a year ago, is dead as a result.
There is a common belief that past behavior is the best predictor of future behavior, and that certainly seems to be the case in child maltreatment. Over twenty years ago, Detroit was transfixed when in one week a child was murdered and another suffered irrevocable brain damage, both in the custody of parents who had lost their rights to previous children. This coincidence of horror was enough to spur change–and a new process was created to protect children whose parents had already harmed other children. On September 23, 2000 the directors of the human services and health department agreed to cross-reference the names of parents of newborns with the names of parents who had severely abused their children. The system, which became known as “Birth Match,” is still in effect. This process as designed would not have saved little Chayse, but the story of its imperfect implementation and the state’s declining interest in its application may shed some light on why he too was abandoned by the public officials who were charged with protecting him.
I researched birth match in Michigan while preparing a report on this important tool for child safety, which is being used in only five states. In Michigan, birth match is an automated system that notifies the statewide child abuse hotline when a new child is born to a parent who previously had parental rights terminated in a child protective proceeding, caused the death of a child due to abuse and/or neglect or was manually added to the match list.1 When a birth match report is received, hotline staff must check whether it is accurate and whether there is a pending investigation or open case, and if so, whether the investigative worker is aware of the historical concerns. If there is a pending investigation, the birth match information must be used in assessing the child’s safety.
If the match is accurate and there is not already a pending investigation, the complaint must be assigned for investigation with the allegation of “threatened harm” to the child. “The MDHHS policy manual lays out requirements for assessing threatened harm, including the severity of the past behavior; the length of time since the last incident; the nature of the services received since that incident and whether the parent benefited from those services; a comparison between the historical incident and the current circumstances; and the vulnerability of the child. As in any other investigation in Michigan, if the investigative worker does confirm the allegation of threatened harm, the next step depends on the worker’s assessment of safety and risk. If the child is assessed to be unsafe, the worker must petition the court to remove the child or place the child under supervision at home. If the child is found to be safe but the risk level is considered high or intensive, the worker must open a case to provide services to the family in the home. And if the risk is found to be low or moderate, the worker is directed to refer the family to community–based services.2
At one time Michigan was very proud of its birth match process. Stacey Bladen, the Acting Deputy Director of Michigan’s Children’s Services Administrator gave a presentation about birth match to the Commission to Eliminate Child Abuse and Neglect Fatalities in 2014. She displayed a graph showing an increasing number of birth matches and case openings over time. Three other states had adopted birth match by this time, and CECANF in its final report recommended its adoption by all states as a way to protect vulnerable infants born to parents who have harmed other children. (Only Missouri has adopted birth match since CECANF made this recommendation.)
But even while Bladen was trumpeting the virtues of birth match, the Manager of CPS in Michigan was already concerned that tool was not fulfilling its potential due to imperfect implementation. Based on an internal review of 105 cases conducted in 2011 and 2012, he told a Harvard Law School class that he was disturbed about the small proportion of investigations that found threatened harm (only about a quarter) and the even smaller percentage (6.5 percent) that resulted in a court petition. Given that 4.5 percent of all investigations resulted in a court petition at the time, he would have expected a much higher proportion of birth match cases to go to court, considering the gravity of the behaviors committed by the parents and the fact that a parent’s rights were rarely terminated without a long history of agency attempts to assist a family. Based on these findings, the CPS Manager concluded that investigators were not following agency policy; in particular, he concluded that they often failed to assess the severity of the earlier maltreatment and parents’ response to services they had received since that time.
I asked MDHHS for an update of the data provided by Bladen to CECANF and quickly learned that birth match was no longer a point of pride for the agency. MDHHS was no longer routinely tracking birth match cases: the agency had to generate the tables to respond to my request. Moreover, once received, the data displayed some anomalies. The number of birth match complaints dropped from 1,186 in FY2019 to 873 in FY2020 and 515 in FY2021—a drop of more than half between FY2019 and FY2021. Stranger still, MDHHS administrators appeared to be unaware of this sharp drop in birth match complaints and had no explanation for why it occurred. This is particularly odd because these matches occur automatically; one wonders whether the drop was related to the pandemic, but the continued sharp decline in 2021 casts doubt on that theory.
Throughout the period from FY2009 to FY2021, about half the matched families already had an open investigation or case when the match was generated. But the number and percentage of the remaining matches that resulted in an open case have fallen considerably, from 99 cases, or 9 percent of all matches, in FY2012, to only 30 cases, or three percent of matches, in FY2020. Child removals also dropped from 41 removals, or 3 percent of matches, in FY2012 to 11 removals, or one percent of matches, in FY2020. MDHHS was unwilling to provide any theories about why these changes occurred. Moreover it appeared that agency leaders were not interested in the fate of birth match, as evidenced by their failure to track the data themselves, or to discuss birth match in their published reports or press releases. Furthermore, Michigan’s policies concerning birth match are currently “under review” as part of a “front end redesign” of the state’s child protection system.
Birth match started in an atmosphere of hope. In a heartfelt essay, a blogger named Donna Pendergast expressed her feeling that “As horrific as the murder of Miracle Jackson was, it can be said that something good came of it,” citing the new practice of birth match. “May [Miracle’s] legacy be that other children are spared her horrific fate.” Unfortunately, Miracle’s legacy appears to be fading.
Even as it was envisioned, Miracle’s legacy of birth match was not broad enough to save Chayse Allen. His birth would not have been matched because his mother’s parental rights were never terminated, she was not found to have caused a child’s death, and she probably would not have been added manually to the birth match list. But the failure to learn from the past which has hampered the implementation of birth match is on full display in the agency’s dealings with Chayse’s mother. As media outlets have revealed, Azudee France had a history of child welfare involvement including at least seven separate episodes. Court records obtained by WXYZ, Detroit’s ABC affiliate, and the Detroit News showed three CPS contacts in 2016 and two in 2017 due to “physical abuse, improper supervision, sexual abuse, failure to protect, and physical neglect.” The records also show that at least the allegations received in November 2017 were substantiated for physical abuse and improper supervision. In 2018, France admitted to assaulting her two year old nephew, who was staying with her temporarily, leaving him with “swollen lips, a black eye, a contusion on the forehead, and bruises to his rib cage and both ankles,” described as “severe physical abuse” in a court document. She was charged with felony child abuse and pleaded guilty to a misdemeanor charge, serving two years of probation.
In April, 2020, MDHHS filed a petition requesting court approval to take custody of France’s newborn son, who was born on April 7, 2020. France’s other four children were already in foster care, apparently due to her conviction for abusing her nephew. The petition stated that France “has not yet rectified the conditions that brought her other children into care” and that she “continues to have untreated mental health concerns.” It also stated that France had a history of postpartum depression and threatened to harm her newborn son.
It appears that the MDHHS petition to take custody of the baby was granted, but three months later following a hearing on August 24, 2020, all five children were returned to France. The court referee3 stated that “Mother has completed parenting classes. … mother is currently in therapy…. mother’s home is suitable.” France’s sister Azunte Sauls told Detroit News reporter George Hunter that she could not imagine how France’s home was deemed suitable as it was filthy and “not suitable for any adult.” And It’s hard to understand how the serious and deep-seated issues outlined in the petition could have been resolved in three months.
Sauls told Hunter that CPS workers came to her sister’s home again last year, to investigate a report of a burn to Chayse. But apparently the investigators, unfazed by France’s history, accepted her explanation that he had burned his hand on some noodles. Sauls and her mother also reported that they and other relatives called CPS many times after incidents of suspected abuse, but to no avail. France subsequently gave birth to a sixth child, who was two months old at the time of Chayse’s death.
When is enough enough? When does an agency accept that it is time to stop waiting for a parent to change and place the children in a safe environment, preferably with loving extended family members? Chayse’s aunt told WXYZ that she had custody of Chayse and his siblings when he was two months old and all of the children were removed from their their mother after her conviction for child abuse. “She should have never gotten her kids back after that,” another aunt told reporter Kimberly Craig of WXYZ. Michigan law allows a parent’s rights to a child to be terminated if “there is a reasonable likelihood, based on the conduct or capacity of the child’s parent, that the child will be harmed if he or she is returned to the home of the parent.” That argument could certainly have been made for any of France’s children long before Chayse was killed.
The desire to let parents start anew with each new child or report is one reason why birth match has been adopted by only four states and appears to be so unpopular among the current DHHS leadership. Moreover, the current child welfare climate is exacerbating the failure to protect children, especially children of Black or Indigenous origin. The concern about racial disparities in child welfare involvement may be discouraging agencies from protecting vulnerable children like Chayse and his siblings.
Azudee France has been charged with with felony murder, first-degree child abuse, torture, and concealing the death of an individual in the death of Chayse, and the children are now with relatives. Maybe by his suffering and death, Chayse was able to save the lives of one or more of his siblings. But they have endured experiences that will leave scars for a lifetime. And it’s all because CPS was unable or unwilling to learn from the past, as its imperfect and waning implementation of birth match illustrates so well.
The provision for manual additions allowed the inclusion of adults who committed an egregious act of maltreatment but did not have their rights terminated, or who harmed a child that was not their own child.
It is not totally clear how “threatened harm” can be found and yet the risk level can be determined to be low or moderate.
A referee is an attorney who holds hearings, examines witnesses, and makes recommendations to a judge.
In my last commentary, I wrote about the tragic case of Harmony Montgomery, who disappeared after being placed with her father after four-and-a-half years in and out of foster care. Massachusetts is not unusual in keeping young children in limbo for excessive periods of time in the interests of reunifying or placing them with family members. While writing about Harmony, I heard from a foster parent in New Jersey about several children who are being sent home to their parents or placed with relatives after more than three years in foster care starting in infancy or early toddlerhood. There is strong evidence that these disruptions are harmful to young children given the attachments they form to their early caregivers. For this reason, a federal law is designed to curb this practice. Talking to foster parents and advocates revealed a conjunction of policy changes, agency culture and circumstances in New Jersey that are resulting in very young children being removed from stable pre-adoptive homes after as much as three years in these homes, starting in infancy or toddlerhood. But a group of advocates is determined to protect these vulnerable children by showing legislators the reality behind the state’s pious pronouncements about the importance of biological family.
I first wrote about New Jersey in February 2021, when the Department of Children and Families (DCF) was turning away would-be foster parents, an unusual situation among states, particularly during the Covid-19 pandemic. My investigation revealed a dramatic decline in substantiated investigations and foster care entries between 2013 and 2020, which could have been due to policy or practice changes making it harder to confirm child maltreatment or to an increased tendency to place children informally with relatives before concluding a maltreatment investigation. Since that time, the number of children entering foster care has leveled off, changing little between 2020 and 2021, and the agency has begun accepting foster parents again. However, the agency’s emphasis on biological ties at the expense of emotional bonds has been raising concerns among child advocates.
Research has shown that “adverse childhood experiences, known as ACES, that disrupt attachment relationships between children and their caregivers are a “significant predictor of risk for child emotional or behavioral problems.” This is why the federal Adoption and Safe Families Act (AFSA) included a provision requiring states to file for termination of parental rights (TPR) after a child has spent 15 out of the past 22 month in foster care, unless the child is living with a relative, services to address the conditions leading to placement have not been provided, or if the state can document a “compelling reason” why TPR is not in the child’s best interests.
But New Jersey’s Division of Child Protection and Permanency (DCP&P), part of its Department of Children and Families (DCF), has been moving away from considering the importance of attachment and timely permanency for young children. In large part, this change has been a response to the current dominance of an ideology emphasizing the importance of biological family bonds, the trauma caused by family separation, and the belief that if a child must be removed from home then the best placement is with an extended family member or family friend. These beliefs were all reflected in the Family First Act, which was passed in 2018 as part of the Bipartisan Budget Act of 2018. And now there are calls to repeal the AFSA timelines that encourage timely permanency to protect children from the trauma of being separated from longtime caregivers to whom they have become attached. Also contributing to the focus on blood ties was the growing attention to racial disparities in many areas, including child welfare. This focus was intensified by the murder of George Floyd by Minneapolis police, which led to comparisons between police and child welfare and calls to abolish the “family policing system.” One organization making this call is upEnd, a collaboration between the University of Houston and the Center for the Study of Social Policy, which just happens to be the court monitor for New Jersey’s long-standing class action suit, Charlie and Nadine H. v. Murphy.
In 2018, Christine Beyer became the DCF Commissioner. She came to New Jersey directly from Casey Family Programs, which describes itself as “the nation’s largest operating foundation focused on safely reducing the need for foster care in the United States.” I’ve written before about Casey’s outsized influence on child welfare policy, which the foundation uses to promulgate its mission to “to provide and improve — and ultimately prevent the need for — foster care.” With assets of $2.4 billion and spending of $111 million in 2019, Casey works to implement its mission by providing free consulting to states and localities, convening meetings, producing research and testimony, and helping place alumni like Beyer in government offices around the country.
In 2019, under Beyer’s leadership, DCF released a new strategic plan, which contained four “transformational goals,” one of which is “preserving kinship connections.” The plan dictates that family separation should be used as rarely as possible, but that when it is necessary to remove children from families to ensure their safety, DCF will ensure that children can remain with extended family or family friends. In aid of this goal, DCF set a target of placing 60 percent of children entering care with kin in the first seven days and 80 percent by the first 30 days.
The New Jersey State Legislature has endorsed the enhanced focus on kinshipn by passing legislation which was signed by Governor Phil Murphy on July 2, 2021. The new law adds a set of “findings” which states that “kinship care is the preferred resource for children who must be removed from their birth families because use of kinship care maintains children’s connections with their families.” But the findings go beyond simply establishing a preference for kinship care. They go on to negate the importance of a child’s attachment to a foster parent in decisions about kinship placement, with the following language:
f. The existence of a healthy attachment between a child and the child’s resource family parent does not in and of itself preclude the child from maintaining, forming or repairing relationships with the child’s parent or caregiver of origin.
g. It is therefore necessary for the Legislature to amend current laws to strengthen support for kinship caregivers, and ensure focus on parents’ fitness and the benefits of preserving the birth parent-child relationship, as opposed to considering the impact of severing the child’s relationship with the resource family parents [bold added by author].
In accord with this finding, the legislation eliminated the provision that allowed the use of evidence that separating a child from the child’s resource family parents would cause “serious and enduring emotional or psychological harm” to the child in initiating a petition to terminate parental rights. This elimination of any consideration of emotional harm to the child, no matter how serious or lasting, is disturbing. The result may be a generation of foster children that are ripped from loving, stable homes with the only parents they have ever known, causing lifelong damage. To make matters even worse, a child’s reunification with a birth parent or placement with kin may not last, but it may be too late to return the child to the foster family that raised them. Witness the case of Harmony Montgomery in Massachusetts. After her third failed reunification with her mother, her behavioral problems had escalated to the extent that the foster family that had provided the only safety and stability she had ever known no longer felt capable of caring for her. (And that’s before she was placed with her unvetted father and disappeared.)
The recent legislation did make some sensible changes that could help children achieve timely permanency. It requires that DCP&P first make reasonable efforts to find a suitable relative or “fictive kin” (family friends or trusted adults who have a preexisting relationship with the child), before placing a child with another person. This is helpful, because placing a child with kin right away prevents the need to remove the child from unrelated caregivers with whom the child has already bonded. It also reduces (to six consecutive months or nine of the last 15 months) the amount of time that a caregiver (including a foster parent) must have cared for a child before qualifying for Kinship Legal Guardianship (KLG), a permanency option that allows an adult with a relationship to a child to raise that child without terminating the parents’ rights.
But aside from the new provision requiring an upfront search for kin and reducing the time to qualify for KLG, the bulk of the policy, practice and legislative changes since 2018 has made it more likely for children in foster care to be removed from foster homes where they have lived for as long as three years. Talking to some of these foster parents raised alarming concerns about DCP&P’s disregard for the damage done to children by tearing them away from the only families they have every known (or can remember) at the age of three or four.
The foster parent who first approached me (I will call her “Ms. R”) has been caring for a child (I will call him “A”) since he was born over three-and-a-half years ago. A was removed from his mother as a result of her substance abuse and mental illness. Although A’s mother did visit, she did not begin to complete goals necessary for reunification until he had been in care for three years. A’s father, late to arrive on the scene due to his mother’s refusal to identify him, was barely engaged. DCP&P had already tried to terminate the rights of both parents, but the judge ruled against the agency, arguing that the father was not given enough time to prepare for reunification. The agency did not appeal, leaving A in limbo beyond timelines and without a clear plan going forward. But after that ruling, the agency began working with A’s mother, whose rights should have been terminated by the judge at the TPR trial. A is currently visiting with his mother twice weekly and has begun to exhibit problem behaviors on visiting days. On one occasion, A’s school called the CPS hotline after A returned from a visit saying “Mommy hurt me,” but DCP&P declined to investigate. A DCP&P worker raised concern about the mother’s rough handling of A during visits, but A’s mother managed to get the worker removed from the case. A’s mental health provider has suggested that the visits end to stop his problem behaviors, as A’s extreme aggression jeopardizes his placement at school and endangers other children. The provider also opposes reunifying A with his mother, but DCP&P appears to be undaunted: the judge has issued a “self-executing order” allowing reunification to proceed at the agency’s discretion without a hearing.
Ms. R referred me to Ms. S, who has been caring for “B” for three-and-a-half years, since she was five days old. B was removed from her parents due to neglect related to substance abuse and mental illness. The father almost killed B in utero by attacking her mother late in her pregnancy, sending her to the emergency room. At 10 months old, B was placed with a relative, but she came back into care neglected and sick after her father had taken her back and was live-streaming himself high with her on Facebook. After the pandemic began, visits became virtual and the parents were given extra time to comply with their case plans. When B was 18 months old, her father began bringing another relative to his visits with her. In her sixties, childless and with mobility problems, the relative nevertheless wanted to raise B and the DCP&P was happy to oblige. When B was two-and-a-half, her goal was changed to Kinship Legal Guardianship with the relative. B began progressively longer visits with the relative, returning to the foster home exhausted with an unused toothbrush, gastrointestinal problems, regressed behaviors and reports that her father was at the visits against agency requirements. The relative refused to speak to the S’s or to take B to trauma therapy. B’s attorney was in favor of adoption by the S’s, and a trial was scheduled and postponed multiple times. Before it could take place, DCP&P simply placed B with the relative at the age of three-and-a-half. B’s lawyer remained opposed to the move but with the new legislation discounting the importance of attachment to the foster parent in TPR cases, told the S’s that his argument would no longer carry weight with the judge.
Ms. R also referred me to Ms. T, who has been caring for “C” for almost three years. “C” came to the R’s at the age of 13 months old malnourished, dehydrated, unable to walk or crawl, and needing hospitalization, after his mother was arrested and her boyfriend brought the three children to New Jersey. C has global developmental delays; his two siblings are autistic and were placed in another home, but the siblings had regular visits. The goal was never changed from reunification, in part due to delays caused by Covid-19. After C had spent nearly three years with the T’s, DCP&P began to plan for adoption, but not with the T’s. C’s two autistic siblings had been moved to an unrelated foster parent who was willing to adopt all three children. Ms. T received a call one morning stating that overnight visits would start that Friday–in a home C had never visited before. Since the visits have started, C has become clingy at home and his behaviors have deteriorated in school to the extent that Ms. S now has to pick him up at noon from his all-day pre-K class. C’s attorney believes he should stay with the T’s and his pediatrician has expressed strong opposition to the move. But DCP&P appears to be resolved on keeping the children together, citing the 80-20 rule, which applies to placements within 30 days, not three years.1 Clearly, the agency believes that the blood ties between siblings who have never lived together outweigh C’s attachment to a foster family that has raised him for the last three-quarters of his life–including the foster “brother” he grew up with, who has now been adopted by the T’s.
In all of these cases, DCP&P chose to remove children from foster parents who had been caring for them for three or more years and wanted to adopt them. This is far beyond the timeline contained in federal and New Jersey law, which requires states to file for TPR after a child has been in foster care for 15 of the past 22 months. States are allowed to make exceptions based on the best interests of the child, the lack of services for the parents, or a child already living with a relative, but it does not appear that these exceptions applied in these cases. For the two children, B and C, who were placed or about to be placed with relatives, those relatives should have been identified and the children placed with them much earlier if the placement was going to happen at all. The goal of having 80 percent of children placed with kin within a month should not be cited to justify moving a child to kin after three years; yet DCP&P staff cited it to justify “C”‘s placement with a stranger after almost three years with his foster family
We should not make policy based on individual cases and we do not know how frequent these extended stays in foster care are or whether they are increasing in New Jersey. Data on how long children stay in foster care before achieving permanency is not available either in New Jersey or nationwide.2 Nor do we know the extent to which the pandemic has contributed to delays in permanency; it did not seem to affect the case of A, whose mother did not start working on her case plan for three years, but it seems to have contributed to the delays in permanency for “B” and “C.” In addition, a historically high shortage of family court judges has also been delaying the scheduling of hearings in New Jersey; the state Senate is moving to fill the vacancies now. However, it appears that policy and practice in New Jersey are moving in the direction of delayed permanency as children in foster care wait for parents to work on their case plans or appropriate relatives to appear. And the New Jersey Legislature’s elimination of attachment to foster parents as a criterion in TPR filings is clearly designed to remove one obstacle to reunification or relative placement outside the timeframes that are considered acceptable by child development experts.
It is unfortunate that New Jersey does not seem to be interested in collecting data that might cast light on the extent and impacts of the increased emphasis on blood ties. For example, child advocates worry that DCP&P may be increasingly waiving foster parent licensing requirements for kin caregivers at the expense of children’s safety, but DCF does not provide data on the number of waivers granted. Data on re-entry into foster care after reunification or permanent placement has not been updated on the data portal maintained by Rutgers University since 2019 and data on maltreatment after reunification has not been updated since 2018. Whether DCF is simply indifferent or prefers not to share this data is not a question I can answer.
BA small but growing group of New Jersey foster parents and child advocates is determined to push back against current trends and place children’s needs front and center where they belong. Begun in response to the dramatic decline in foster care entries and fears that children were being left in dangerous homes, the Child Advocacy Association of New Jersey (CAANJ), is housed inside a nonprofit (Miriam’s Heart) that supports foster and adoptive children and families. CAANJ fought unsuccessfully against removing the provision that allowed the use of evidence that separating a child from the child’s foster parents would harm the child in initiating a petition to terminate parental rights. Currently, the group is supporting bills that would require foster parents, relatives, pre-adoptive parents, or caretakers to be party to reviews or hearings involving a child under DCP&P care; establish an Office of Child Advocate or Ombudsperson; and increase the frequency of permanency hearings from every 12 months to every six months. They also have a wish list of legislation that they would like to draft if they can find sponsors. This includes a foster parents’ bill of rights and legislation allowing foster parents to be considered “kin” for placement and adoption purposes (not just Kinship Legal Guardianship) after the child has been with the family for a specified period of time; strengthening the requirements to search for relatives at the beginning of a child’s foster care placement; requiring TPR hearings to take place within six months of a child’s goal changing to adoption; allowing open adoption to be an option in foster care adoptions; and imposing uniform standards for whether resource, kinship, or biological caregivers when it comes to agency involvement, removal and reunification.
The national movement to place blood ties above attachment and bonding has found a faithful echo in New Jersey, where children’s needs are being disregarded as they are being reunified with parents or placed with relatives long after they should have been settled in permanent homes. Ironically, DCF has a “Statewide Action Plan” for addressing ACES among New Jersey’s children, but the plan does not require the agency itself to stop inflicting ACES on its own clients. But a group of child advocates is fighting back and trying to enlist legislators in the quest to put children’s needs back on the front burner. This child advocate fervently hopes that they succeed.
Moreover, it is not clear that the 80-20 rule was meant to be satisfied by placing a child with siblings in the home of a non-relative.
Ideally we would want to know, for each child exiting to a permanent placement, the amount of time they were in foster care, and how this “time to permanency” has changed over time. Such data are not provided routinely by states and the federal government and requires manipulation of data by researchers using statistical analysis software.
I write with heartbreak and rage about a child who was removed from her drug-abusing mother at the age of two months, placed with a loving family that wanted to adopt her, ripped from this family twice more to return to her mother in a fruitless attempt at reunification, and finally placed after over four years with a father and stepmother she hardly knew without any vetting to ensure their capacity to care for her. The case of Harmony Montgomery has made national news–but only because she is now missing after that last disastrous placement. The Massachusetts Office of the Child Advocate (OCA) has released its report on the tragic case of Harmony Montgomery. The OCA report reveals the extent of the disruption to which Massachusetts subjected this young child, but unfortunately it does not draw the needed conclusions about policy and practice to ensure timely permanency for children in foster care. No child should be subject to the treatment Harmony received in the child welfare system, let alone the abuse and neglect she certainly endured after leaving it, but policy shifts being considered now would make it more likely that other children will suffer similar fates.
Harmony’s child protection case began almost as soon as she was born in June 2014 to Crystal Sorey and Adam Montgomery, who were not married and were no longer together at the time of her birth. Montgomery was incarcerated at the time of Harmony’s birth for “a shooting that involved illicit substances,” according to the report. Harmony was diagnosed at birth with a visual disability and was blind in one eye. Due to her disability, she received early intervention services until age three and then special education services from her local school district until moving to New Hampshire.
Shortly after Harmony’s birth, the Haverhill Area Office of the Massachusetts Department of Children and Families (DCF) received three reports alleging that Sorey was using illegal substances and neglecting Harmony. DCF confirmed the allegation of neglect and opened a case to provide services to the family without removing Harmony. But two more reports were made in August 2014, and DCF concluded that Sorey continued to struggle with substance abuse, putting Harmony at risk. Two-month-old Harmony was removed and placed in foster care. (A chronology at the end of this commentary provides a summary of the case history).
In January 2015, seven-month-old Harmony was returned to the care of her mother. But the following April, at the age of 10 months, Harmony was removed from Sorey again due to neglect associated with her renewed substance abuse. In July 2015, Harmony’s permanency plan was changed from reunification to adoption. In September 2015 Adam Montgomery was released from prison and moved to New Hampshire, but he did not contact DCF for a year. In February 2017, the DCF team changed Harmony’s goal back to reunification with her mother. That March, Harmony was returned to her mother for the second time. She was almost three years old and had been in foster care for a total of 28 months, including approximately 23 consecutive months since her second removal from her mother.
In January 2018, at the age of three-and-a-half, Harmony was once again removed from Sorey due to the latter’s neglect associated with renewed substance abuse, and she was placed in the same foster home where she had lived during both of her previous stays in care. In August 2018, when Harmony was four years old and after eleven months without seeing her, her father resumed supervised visits. According to OCA, in December 2018 the team began working toward “reunification”1,2 with Montgomery instead of Sorey and requested that New Hampshire conduct a home study through the Interstate Compact on the Placement of Children (ICPC).3 Nevertheless, Harmony’s goal was changed back to adoption in that same month.4
A hearing was held in February 2019 to consider both parents’ requests for immediate custody of Harmony, but Sorey was unable to attend because she was at a hearing about another of her children. New Hampshire had not yet acted on the home study request and the DCF attorney objected to the placement of Harmony with Montgomery in the absence of any information about the family. The attorneys for Montgomery, Sorey and Harmony5 all supported giving custody to Montgomery, and the judge awarded him full custody on the grounds that as a “fit parent” as defined by law, Montgomery’s right to parent his child could not be infringed by the ICPC. A week later, Montgomery brought Harmony to New Hampshire to join his household made up of his wife, Kayla Montgomery, and their two children, who were both under five years old. DCF’s involvement with Harmony was over and there was to be no agency or court oversight of the newly reunified family as there would be if Montgomery lived in Massachusetts.
A report from the Governor of New Hampshire provides a glimpse into Harmony’s troubled life after arriving in New Hampshire. On July 19, 2019, an anonymous call was made to the Department of Children, Youth and Families (DCYF) hotline stating that five-year-old Harmony was seen a week before with a black eye that Adam Montgomery admitted causing. In a visit conducted on August 7, 2019, a social worker found signs of a healing black eye, but Harmony and her father said the mark was caused by “horseplay” with a sibling. The allegation was ruled “unfounded,” but Harmony was deemed to be at high risk for future maltreatment.
On January 8, 2020, another call was made to the hotline regarding another child or children in the home. When the investigating social worker asked about Harmony, Adam Montgomery said that she had been back in Massachusetts with her mother since about Thanksgiving of 2019. Kayla Montgomery later confirmed the story, stating that Montgomery told her he was taking Harmony to Sorey on the day after Thanksgiving in 2019. On January 13 and March 16, additional calls were received regarding the household, and Montgomery again stated that Harmony was with her mother and he had not seen her in a year. In September 2021, a person known to Sorey called the DCYF hotline to say that Sorey had not seen Harmony since 2019 and had not been able to reach Montgomery to schedule a visit. DCYF learned that Harmony had never been registered for public school in Manchester.
On December 31, 2021, the Manchester police located Montgomery, but he did not have Harmony in his care and gave “contradictory and unconvincing explanations” of her whereabouts. An exhaustive police search for Harmony began, making national headlines. On January 4, 2022, Adam Montgomery was arrested on charges of second degree assault and endangering the welfare of a child. On January 6, 2022, Manchester police arrested Kayla Montgomery on a charge of welfare fraud for obtaining over $1,500 in Food Stamp benefits for Harmony after she was no longer in their household. The search for Harmony continues.
The case history shared by OCA shows that DCF, the agency charged with protecting children, instead subjected Harmony to the trauma of repeated moves during her crucial infancy and early childhood, including ripping her from a loving home where she had resided for almost two years. After being removed from her mother at two months, returned to her at seven months, removed again at ten months, and then remaining another 23 months in foster care, Harmony deserved to stay with the only family who had provided a safe and stable home for her. This family had even facilitated Harmony’s contact with family members other than her parents,who visited her in the foster home and told OCA they appreciated the care Harmony received there. But DCF sent her back to her mother, only to remove her again 10 months later. There is no better evidence of the damage done by this ill-advised action than the following quote from the OCA report:
Although placed in the same foster home after each removal, each time Harmony returned she struggled with more challenging behavior and increasing feelings of insecurity. While the foster parents provided exceptional care and were committed to Harmony, with each subsequent placement the scope and depth of her behavioral and emotional needs grew. The foster family felt that after Harmony had been removed from Ms. Sorey’s care for the last time, they were no longer able to provide for her increased needs. Several months into her third placement, Harmony’s foster parents determined that it was in Harmony’s best interest to be placed in a therapeutic foster home where she would receive the specialized and dedicated attention she needed. It is evident in the record this was an extraordinarily difficult decision for the foster parents as they consistently expressed their love for Harmony.
Office of the Child Advocate, A Multi System Investigation Regarding Harmony Montgomery, May 2022,
The harm to children of such repeated disruptions has been well documented, as Sarah Font and Lindsey Palmer explain. Humans have a fundamental need to know where and to whom they belong. Foster care sets up a “loyalty conflict” that is familiar to every social worker who has worked in the field, and the harmful impacts of repeated movement between the two families cannot be overstated. Secondly, children need predictability, and research consistently shows that unpredictable environments harm children’s development even more than harmful environments. Every member of Harmony’s case management team should have been aware of the harm that would be caused by the repeated disruptions in her living situation, the on-and-off visitation with her father and the continued uncertainty about her future.
In subjecting Harmony to over four years of uncertainty and disruption, DCF and the court also appear to have flouted both law and policy guidelines. Massachusetts General Laws Chapter 119 Section 26 requires DCF to file a petition in court to “dispense with parental consent to adoption, custody, guardianship or other disposition” if the child has been in foster care in the custody of the state for 15 of the immediately preceding 22 months. This law is based on the Adoption and Safe Families Act of 1997 (ASFA), which requires states to observe this “15/22 rule” in order to receive Federal foster care funds. Federal and Massachusetts law provide three exceptions to the rule: if the child is being cared for by a relative, if there there is a “compelling reason” that filing such a petition would not be in the best interests of the child, and if the family has not been provided with the services that the department has deemed necessary for the child’s safe return home. DCF policy mirrors the provisions of the law by requiring that DCF review all cases of children who have been in placement 15 of the past 22 months and initiate a petition for TPR (termination of parental rights) unless one of the three exceptions described above apply.6 But there is no mention in the OCA report that such a review took place.
DCF policy includes other requirements to ensure the 15/22 rule is followed, mostly through the use of Permanency Planning Conferences (PPC’s). PPC’s are “the Department’s primary internal planning vehicle for reviewing the clinical and legal issues related to permanency decision-making.” PPC’s are required under certain circumstances, including within the first 9 months following the date of placement. At this conference, DCF policy states that:
For most families, based upon a well-reasoned prognosis about the probability of the child’s returning home given the family’s documented capacity to benefit from reunification services, the Department will decide whether to initiate a TPR action at the PPC held within 9 months after the child enters placement. In some of those cases, the Department will decide that one of the exceptions [described above] applies but will schedule another PPC for the 13th month after placement to determine whether initiating TPR is appropriate given the facts as they then exist.
Harmony’s first PPC noted by OCA took place in July 2015, about 11 months after her placement, in apparent violation of the nine-month deadline. The result of that conference was a change of Harmony’s permanency goal to adoption, which presumably entailed “initiating a TPR action” as described by the policy. If for some reason that did not happen, another PPC should have been scheduled for the 13th month after placement. OCA does not cite another PPC until the one that took place in February 2017, which was about two-and-a-half years after placement and actually changed her goal back to reunification. So it is appears that the DCF Area Office was out of compliance with agency policy requiring it to either initiate the TPR or schedule another PPC for the 13th month after placement.
There are more safeguards in DCF policy to ensure timely permanency for children in foster care, but these did not save Harmony either. According to policy, “Any decision not to initiate [a TPR] when a child has been in placement for 15 of the previous 22 months must be the result of a Permanency Planning Conference and approved by the Director of Areas/designee.” Harmony had spent 15 of the past 22 months in care around February 2016. But there is no mention that such a PPC ever took place or that such approval was obtained. As noted above, the next PPC mentioned by OCA occurred after Harmony had been in care for two-and-a-half years.
The OCA report does not mention the 15/22 rule, even though it provides a link to the policy in which the rule is repeatedly mentioned. Presumably, the rule was not mentioned in the case records that OCA reviewed, and this may be typical. When the US Government Accountability Office (GAO) studied early state implementation of AFSA, they found that in the nine states that provided data on the use of the rule in FY 2000, “the number of children exempted from the provision greatly exceeded the number of children to whom it was applied.” This is not surprising because the exceptions can be easily interpreted so broadly as to apply to many or most cases. There is no update on the GAO survey, but available evidence suggests that application of this provision is not widespread. During child welfare monitoring visits conducted by the federal government between 2015 and 2018, practices related to timely termination of parental rights were rated as a strength in only seven of the 50 states plus the District of Columbia and were rated as an “area needing improvement” in the other 44 jurisdictions, according to a federal study. Foster parents from around the country who completed a caregiver survey disseminated by the advocacy group iFoster reported that failure to observe the AFSA timeline resulted in stalled permanency for foster youth. Certainly, the intent of the law is not being fulfilled.
Whether social workers around the country are assessing cases to determine whether the exceptions apply or simply ignoring the 15/22 rule is not clear. In Harmony’s case, no discussion is noted in the OCA report of whether she was exempt from the rule. It certainly appears that her mother received more than enough services before and after her relapses; she was reported to have received both substance abuse treatment and mental health therapy. It might have been possible to argue that Harmony’s father needed more time because he was released from prison when she had already spent ten months in foster care, but since he did not contact DCF for a year after being released, such an argument seems weak.
Respect for the 15/22 rule is if anything decreasing because of the current ideological climate in child welfare that prioritizes the rights of parents over the needs of children. Indeed, there is a new movement to repeal ASFA altogether on the grounds that it is unfair to parents. Parents’ rights advocates argue that states are not providing parents with the services they need, and it is not fair to apply the timeline when parents have not been offered the services they need in time to meet the 15-month deadline. This is a valid point. Enforcement of the timeline needs to be accompanied by prompt assessment and appropriate services for both parents. But the burden should be on the parent to make use of the services offered. An agency should not be required to beg, persuade or repeatedly urge parent to pursue visits and services. if a parent falls out of touch and cannot be reached, the child should not be penalized by delays in permanency.
Parent advocates also argue that it often takes longer than 15 months to correct deep-seated problems. In particular, it is well-known that most substance abusers (like Harmony’s mother) relapse more than once before shaking their addiction. But young children simply don’t have the time to wait for such a parent to be cured without incurring irreversible developmental damage.
In this time when parents’ rights advocates have all but monopolized the current conversation, few seem to be speaking for the rights of children. But in its recent report, Voice of the Foster Care Community, the advocacy group iFoster concluded that greater efforts are needed to support parents before their children are removed, and to help them regain their children quickly once placed in foster care. But if that quick reunification does not happen, caregivers, workers and advocates surveyed stated the need to prioritize the needs of the child over the needs of the parent to avoid delays in termination of parental rights. As one Pennsylvania foster parent put it,
….if parents are unable to work their case plan, then the 15 of 22 months rule must be followed so kids don’t languish in care for years. This is a way-too-common occurrence. Parents are given many chances to work their case plan while their children languish in care, being passed back and forth between families and living in instability.”
Advocates for children in foster care should be asking Congress to strengthen the 15/22 rule, not repeal it. Perhaps there could be different timelines for children of different ages, as has been suggested by Cassie Statuto Bevan, who helped draft ASFA. Children who come into care as teens may not want their bonds with their parents to be disrupted. But the youngest children need to achieve permanency even faster than what is prescribed by ASFA. Infants and young children placed in foster care should not spend their most crucial developmental period in limbo awaiting a parent’s eventual cure.
OCA’s central finding was that “Harmony’s individual needs, wellbeing, and safety were not prioritized or considered on an equal footing with the assertion of her parents’ rights to care for her in any aspect of the decision making by any state entity.” This finding certainly encompasses DCF’s failure to seek timely permanency for Harmony. But OCA’s specific findings and recommendations regarding time to permanency are not as well-developed as they could have been. OCA has one finding regarding permanency as it relates to DCF, but it is quite weak, stating that “the delay in achieving permanency for Harmony impacted her well-being.” OCA goes on to explain that the delay caused trauma for Harmony, which in turn resulted in the disruption of her pre-adoptive placement. In reality, If Harmony had been adopted soon after she had spent 15 months in foster care, she would have found safety and stability in a loving home. The failure to pursue adoption within 15 months of Harmony’s placement in foster care did not just damage her emotionally; it resulted in her disappearance and possible death.
Strangely, OCA made no recommendation to DCF regarding reducing the time to it takes to achieve permanency for children in foster care. There was no mention of the 15/22 rule and the failure to enforce it or follow the procedures designed to ensure its observance. It is only in the section on the legal process that OCA stated (but did not label as a “Recommendation”) that “For children whose parents will not accept services or to whom children cannot be safely returned to their home within the first two years of their removal, DCF should expeditiously move toward another permanency plan.”7
OCA had a number of other findings and recommendations. The Office rightly highlighted DCF’s exclusive focus on Sorey as a potential caregiver for Harmony throughout most of the life of the case, resulting in the failure to complete an assessment of Montgomery and his wife and develop an appropriate service plan for them. This was particularly important in light of Harmony’s disabilities, which required that a caregiver be able to provide adequate care. Clearly, DCF should have done more to engage Montgomery during the first 15 months of the case. If he and his wife had been assessed and provided with an appropriate service plan, perhaps they would have been ruled out as as caregivers long before the fateful hearing. This failure to engage Montgomery resulted in OCA’s only recommendation directed at DCF, which was that “DCF should develop a comprehensive plan to ensure both parents are adequately assessed and receive the support and access to services needed so that their child(ren) can achieve permanency.”
OCA devoted the bulk of its findings and recommendations to the legal process, and specifically to the many problems with the February 2019 hearing that resulted in Harmony’s placement with her father. Clearly, the placement of Harmony with her father in the absence of any assessment of him or his wife or any examination of their home was the immediate cause of the the tragic outcome. But that hearing, conducted over four years from Harmony’s entry into foster care, should have never taken place. OCA’s findings regarding the process are certainly worth consideration, but there should have been much more attention given to the need to ensure permanency for children much earlier.
Despite the flaws in its findings and recommendations, the OCA report is invaluable for its revelation of the problems in social work and legal practice that led to the disappearance and probable murder of Harmony Montgomery. Harmony’s story should be a cautionary tale for anyone supporting, or considering the value of, proposals to repeal the Adoption and Safe Families Act, or at least the requirement that states initiate a termination of parental rights after a child has been in foster care for 15 out of the last 22 months. Rather than eliminated, that provision needs to be strengthened by reducing the scope of the exemptions that make it toothless and perhaps by adjusting it according to the age of the child. No other child should be subjected–by a system designed to protect children– to the suffering that Harmony underwent while in the system and after leaving it.
Timeline of Harmony’s case based on the OCA report
Months in Foster Care
Harmony is born. DCF receives three reports of substance abuse and neglect by her mother. A case is opened
DCF receives two more reports. Harmony is removed.
Harmony meets her father for the first time, in prison, and is returned to her mother
Harmony is removed from her mother again due to substance abuse
Harmony meets her father for the second time, in prison; Harmony’s permanency plan changed to adoption
Harmony’s father is released from prison and moves to New Hampshire
Harmony has spent 15 months in foster care out of the last 22 months
Adam Montgomery contacts DCF for the first time since his release from prison a year earlier
Harmony meets Adam Montgomery for the third time.
Harmony’s permanency plan is changed back to reunification. After visiting with Harmony once a month for five months, Adam Montgomery stops responding to DCF’s efforts to schedule further supervised visits.
Harmony is returned to her mother for the third time. Over the next few months she has unsupervised weekend visits with her father.
Adam Montgomery contacts DCF after a seven-month lapse, and has one supervised visit with Harmony.
Harmony is removed from her mother for the third time due to substance abuse.
Adam Montgomery resumes supervised visits after a lapse of 11 months.
Harmony’s goal is changed back to adoption.
A Juvenile Court Judge awards custody of Harmony to Adam Montgomery. One week later, Montgomery takes her to New Hampshire and DCF involvement ends.
A person known to Crystal Sorey contacts the New Hampshire child ause hotline to report that she has not seen Harmony since April 2019.
Manchester police announce Harmony’s disappearance and their search for her. She has not yet been found.
Notes to Table: For purposes of calculating months in foster care, All dates assumed to be the first of the month
1. Child welfare law and policy refer to “reunification” with a parent even if the child has never lived with that parent.
2. According to OCA, “the Foster Care Review panel kept a permanency goal of reunification for Harmony but for the first time changed their focus of reuniting Harmony with Ms. Sorey to placing her with Mr. Montgomery.” But OCA explained in an earlier text box, foster care review panels make recommendations, not decisions. Therefore this statement appears to be inaccurate.
3. The ICPC is an agreement between the states that allows a state considering placement of a child in another state to request a home study of the family with whom the child will be placed.
4. This goal change raises many questions which are not addressed in the OCA report. It is not clear why the goal was changed so soon after the team reportedly agreed to continue the goal of reunification with a new focus on Adam Montgomery. This discrepancy could be related to OCA’s confusing statement that a Foster Care Review panel made the decision to continue the goal of reunification but shift the focus to Adam Montgomery. Perhaps that panel only recommended this new focus. According to OCA, the panel also recommended convening a Permanency Planning Conference (PPC), which is the body empowered to change the goal and which indeed did change the goal to adoption.
5. According to OCA, Harmony’s attorney supported custody for Montgomery because she was bound to advocate for the expressed wishes of the four-and-a-half-year old, not her best interests.
6. While federal law and DCF policy speak of initiating a TPR petition, Massachusetts law prescribes “dispensing with parental consent,” as described in the previous note. Some jurisdictions, in order to avoid creating “legal orphans” through a TPR, take this approach of dispensing with parental consent to an adoption or guardianship. The practical result would be the same, ending parental rights.
7. In its list of recommendations for the courts, OCA strangely includes a recommendation for the agency, stating that “DCF should review and determine the length of time from permanent custody to a final adjudication of adoption, guardianship or return to parent for a child in order to ensure that the case achieves a safe and expedient resolution.” In addition to being misplaced, this is a very weak statement of what needs to be done.
As the Covid-19 pandemic took hold, stay-at-home orders were declared, and school buildings closed, many child advocates voiced fears that child abuse and neglect would increase but would remain unreported as children were locked in with their maltreaters. But some newly available data has led to a spate of commentaries announcing triumphantly that rather than increase, child maltreatment has actually decreased during the pandemic, suggesting to some that we may not need a child welfare system after all. In fact, while the data provides no definitive evidence of either an increase or decline in child maltreatment, there are some concerning indicators from emergency room visits, teen self-reports, and domestic violence data that there may have been an increase in child abuse and neglect after Covid-19 closed in.
There are many reasons to think that the Covid-19 pandemic and our nation’s response to it would have led to a spike in child abuse and neglect. Research indicates that income loss, increased stress, and increased drug abuse and mental illness among parents (all associated with the pandemic) are all risk factors for child abuse and neglect.* On the other hand, the expansion of mutual aid networks and the influx of new government assistance programs with few strings attached may have protected children against abuse and neglect. Data on hotline calls, emergency room visits, child fatalities, teen self-reports of abuse, and domestic violence are being cited as indicators of what happened to maltreatment during the pandemic. I examine the evidence below.
Child maltreatment referrals
As soon as stay-at-home orders were imposed, child advocates warned of the likely drop in reports to child abuse hotlines as children vanished into their homes. And indeed, this is exactly what happened. Individual jurisdictions began reporting large drops in reports starting in April 2020 But national data did not become available until the publication of Child Maltreatment 2020, the compendium and analysis of data the US Children’s Bureau received from states for the fiscal year ending September 30, 2020. According to the report, there were 484,152 screened-in referrals (reports to hotlines) between April and June 2020, following the declaration of emergencies at the national and local levels and the closure of most schools buildings and subsequent transition to virtual operation. This compares to the 627,338 referrals in the same period of 2019–a decrease of 22.8 percent.** For July through September, referrals decreased from 553,199 in 2019 to 446,900, or 19.2 percent. So even in the summer when schools are mostly out anyway, referrals decreased.***
Despite the concerns among child advocates about the drop in hotline calls as a natural consequence of lockdowns and school closures, some parent advocates, such as Robert Sege and Allison Stephens writing in JAMA Pediatrics, have argued that these decreases in hotline calls show that “child physical abuse did not increase during the pandemic.”**** Similarly, In her article entitled An Unintended Abolition: Family Regulation During the COVID-19 Crisis, Anna Arons argues that the decline in hotline reports during the first three months of pandemic shutdowns in New York City relative to the same period the previous year reflects an actual decline in maltreatment rather than the predictable effects of lockdowns and school closures.
Interpreting the decline in hotline reports to suggest a decline in child maltreatment during the pandemic is either naive or disingenuous. The drop in reports was predicted by experts as soon as schools shut down because school personnel make the largest share of reports in a normal year–about 21 percent in FY 2019. The number of reports from school personnel dropped by 58.4 percent in the spring quarter and by 73.5 percent from July through September.** Exhibit 7-B from Child Maltreatment 2020 shows the drastic decline in reports from school personnel, as well as smaller decreases in reports from medical and social services professionals. To claim that this drop in reports reflects reduced abuse and neglect is to disregard the most obvious explanation-that children were seeing less of teachers and other adults who might report signs of abuse or neglect.
In her article about New York City, Anna Arons cites the absence of an oft-predicted surge of child maltreatment reports when schools reopened in September 2020. Far from such a surge, she states, reports did increase, but only “at a rate in line with the typical increase in a non-pandemic fall, rather than a more dramatic leap.” But the grounds for predicting a surge in reports are far from clear. First, only 25 percent of New York City children returned to school buildings in September, as Arons reports. Moreover, is not obvious that the concept of a backlog makes sense in reference to abuse and neglect reports, as it does with tax returns, for example. Bruises may heal, a hungry child may be fed when there is money in the house; living situations may change. Many of the most troubled families are the subject of multiple reports of maltreatment over the course of a year; a child who would have been reported in the spring and again in the fall will not necessarily receive an “extra” report in the fall.*****
Emergency room visits for suspected maltreatment
As the pandemic closed in, child advocates feared that hospital emergency rooms would see an influx of maltreatment-related injuries among children. To address this question, Elizabeth Swedo and colleagues at the Center for Disease Control and Prevention used a platform that provides information on approximately 73 percent of all Emergency Department (ED) visits in the United States. The authors did not find the increase that these advocates feared, reporting that the total number of ED visits related to child abuse and neglect decreased sharply during the early part of the pandemic as compared to the analogous period in 2019, though ED visits for all causes increased even more during that period. Despite the decreases in the number of ED visits for maltreatment, the number of such visits ending in hospitalization stayed the same, which suggests there was no decrease in maltreatment severe enough to result in hospitalization.
Using an administrative database from 52 U.S. children’s hospitals, Kaiser et al. found a sharp decline in all ED visits and hospital admissions, and in visits and admissions for child physical abuse (not including admissions related to sexual abuse or neglect) during the first six months of the pandemic period compared to previous years. Moreover, they found no increase in the severity of the child physical abuse cases resulting in ED visits or hospitalizations. They concluded that coronavirus aid programs and eviction protections might have resulted in reductions in child physical abuse.
To disentangle the effects of reduced healthcare usage during the pandemic changing levels of child maltreatment, Maassel et al. looked at hospitalizations for abusive head trauma (AHT), arguing that it is more difficult for caregivers to forego medical care for such life-threatening injuries. They found a significant decrease in admissions for AHT among 49 children’s hospitals during the COVID pandemic compared to the three previous years.****** They hypothesize that the marked increase in job losses for women, along with more adults working from home, may have led to more children being cared for by two or more caregivers, and specifically fewer being cared for by sole male caregivers, who are the most common perpetrators of AHT.
Swedo et al’s finding that the number of ED visits for abuse or neglect that ended in hospitalization stayed the same contrasts with Kaiser et al and Maassel et al’s findings that hospitalizations for child abuse (and specifically) AHT declined during the early period of the pandemic. One explanation may be that abuse decreased but neglect did not; it may also be relevant that Swedo et al used a different database than did the other two teams. More research is needed to explain these differences.
One might argue that child maltreatment fatalities are best indicator of maltreatment rates during the pandemic because fatalities are less likely to avoid being reported than non-fatal maltreatment. Child Maltreatment 2020 contains estimates of child fatalities due to abuse and neglect from all states but Massachusetts, plus the District of Columbia and Puerto Rico. These jurisdictions reported a total of 1,750 fatalities, for a population rate of 2.38 per 100,000 children, compared to 1,825 or 2.50 per 100,000 children in FFY 2019. But to say that the maltreatment fatality rate went down in 2020 as compared to 2019 would be incorrect, because the fatalities counted in one year did not necessarily occur in that year. Rather, the authors indicate that “the child fatality count in this report reflects the federal fiscal year … in which the deaths are determined as due to maltreatment,” which may be different from the year the child actually died.” Such determinations may come a year or more after the fatality occurred. So it is not possible to make inferences from this small decrease in the child maltreatment fatality rate in FY 2020. Moreover, it is not not implausible that the pandemic affected reporting, so that year-to-year comparisons between pandemic years and non-pandemic years are particularly problematic.
Teen Self-Reports of Abuse
Results from a nationwide survey of 7,705 high school students conducted in the first half of 2021 and reported by the New York Times revealed disturbing indications that abuse, at least of teens, increased during the pandemic. Over half (55.1 percent) of adolescents reported being emotionally abused by a parent, and more than one in 10 (11.3 percent) reported being physically abused by a parent. Black students reported the highest rate of physical abuse by a parent–15 percent, compared to 9.8 percent for White students. Students who identified as lesbian, gay or bisexual, and those who identified as “other or questioning” experienced the highest rate of emotional abuse (74.4 percent and 75.9 percent respectively). Female students were more likely to experience emotional abuse by a parent than male students (62.8 percent vs. 46.8 percent). While using a different sampling frame, methodology and wording, a survey of a nationally representative sample of children aged 14 to 17 conducted in 2011 (as quoted by the authors of the new survey) found much lower estimates of abuse–13.9 percent for emotional abuse by a caregiver in the past year and 5.5 percent for physical abuse. The change in these percentages, even if accurate, is not necessarily due to the pandemic, but it is a troubling indicator nonetheless.
Trends in Domestic Violence
Domestic violence is highly correlated with child abuse and neglect, and the same risk factors, heightened by the pandemic, contribute to both of these problems. A systematic review of 12 US studies, most including multiple cities, concluded that domestic violence incidents in the US increased by slightly over eight percent after jurisdictions imposed stay-at-home orders. The authors speculated that the increase in domestic violence was driven by factors such as increased unemployment and financial insecurity and stress associated with childcare and homeschooling–the same factors that might contribute to increased child maltreatment.
I have written often about the propensity for wishful thinking in child welfare, whether it relates to home visiting programs, “race-blind removals,” or other programs and issues. Unfortunately, this propensity is on full display in the commentaries that try to portray reduced calls to child abuse hotlines as showing that child maltreatment did not rise during the pandemic. But it is certainly true that emergency room and hospitalization data do not provide evidence of a surge in child abuse and neglect, and there are even some suggestions that abuse may have declined perhaps due to fewer children being left alone with male caregivers. Overall, the data we have so far do not conclusively demonstrate that maltreatment rose or fell. Some children who lived through this period will eventually share their memories of life at home during the period. But these memories of course will be impossible to generalize. We may never know what really happened to maltreatment during the covid-19 pandemic.
This commentary was revised on May 18, and May 19, 2022 to incorporate new findings on ER visits and hospitalizations by Kaiser et al and Maassel et al.
*How neglect would be affected by a pandemic is somewhat less straightforward than with abuse. Many neglect cases involve lack of supervision, which may have increased with parents leaving children alone to work, with schools and childcares closed. Increased drug and alcohol abuse by parents might have also increased the occurrence of neglect. On the other hand, with more parents unemployed or working at home, lack of supervision may have become less prevalent during the pandemic.
**Unfortunately, the Bureau did not provide the total number of referrals including those screened in and screened out, by quarter. For the whole year the report shows that 54.2% of referrals were screened in, compared to 54.5% in FY 2019.
***The continued suppression of hotline calls could be due to fewer children in summer camps, summer schools, and childcare, as well as fewer attending health appointments and family gatherings in the first summer of the pandemic.
****It is not clear why Sege and Stephens refer to physical abuse only, as they data they discuss concern all types of child maltreatment,
*****However, it is interesting that even in September 2022, when almost all NYC children returned to school, reports did not return to their 2022 level. There are several reasons this could be the case, including a decline in child maltreatment and a decrease in reporting due to changes in messaging coming from ACS and advocates.
******Maassel and colleagues compared AHT admissions between March 11 and September 30 in 2020 to admissions during the same period over the previous three years.
The following was submitted as an Op-Ed to the Washington Post in an effort to ensure the. public has the benefit of various viewpoints on this topic but, unfortunately, the Post chose notto publish it.
We were troubled to read Dorothy Roberts’ “Five myths about the child welfare system” in the April 17th Outlook section of the Washington Post. Roberts’ version of reality does not agree with what we see every day as child advocates in the District of Columbia, nor with the research on child welfare.
“Myth” No. 1: Child welfare workers mainly rescue children from abuse. Roberts is correct that at most 17 percent of the children placed in foster care in FY 2020 were found to be victims of physical or sexual abuse. But she is wrong when she implies that most neglect findings reflect parents who are too poor to provide adequate housing, clothing and food to their children. Many of the neglectful parents we have seen have serious, chronic mental illness or substance use disorders that impact their parenting, and they are unwilling or unable to comply with a treatment plan. Meanwhile, the children in their care are often left to fend for themselves because their parents cannot feed and dress them, change their diapers, or get them to school. Many children neglected in this way develop cognitive and social deficits, attachment disorders, and emotional regulation problems. Most poor parents do not neglect their children. Even with scarce resources, they find a way to provide safe and consistent care.
“Myth” No. 2: Homes are investigated only if children are at risk of harm. The purpose of an investigation is to determine whether children are at risk of harm. Professionals who work with children are trained to report concerns about possible maltreatment, not to investigate on their own. The system is not perfect. Some reports are too minor to meet the definition of maltreatment, or even maliciously motivated. A surprisingly large number of children are reported every year and only a minority of these reports are substantiated—but that does not mean they are not true. But to propose that investigations should take place only if it is first determined that children are at risk puts the cart before the horse and disregards the safety of children.
“Myth” No. 3: Foster children are usually placed with loving families. Roberts’ statement that large numbers of children are placed in some form of congregate care — group homes, residential treatment centers and psychiatric hospitals—is misleading. Only eight percent of children in foster care were in a group home or institution at the end of September, 2020, though the percentage is higher for older youth. The problem is the lack of quality therapeutic placements for children who have been so damaged by long histories of abuse and neglect that they cannot function in a family home. It is true that many children bounce from one foster home to another, but these are often youths with acute behavior problems that make it difficult for them to function in a home. Roberts also fails to mention that 34 percent of foster children were residing in the homes of relatives as of September 2020, and that they have more placement stability than children placed in non-kinship homes.
“Myth” No. 3: Foster children are usually placed with loving families. Roberts’ statement that large numbers of children are placed in some form of congregate care — group homes, residential treatment centers and psychiatric hospitals—is misleading. Only eight percent of children in foster care were in a group home or institution at the end of September, 2020, though the percentage is higher for older youth. The problem is the lack of quality therapeutic placements for children who have been so damaged by long histories of abuse and neglect that they cannot function in a family home. It is true that many children bounce from one foster home to another, but these are often youths with acute behavior problems that make it difficult for them to function in a home. Roberts also fails to mention that 34 percent of foster children were residing in the homes of relatives as of September 2020, and that they have more placement stability than children placed in non-kinship homes.
“Myth No. 4: Placing children in foster care improves their well-being.” Arguing that foster care is harmful is like arguing that treatment in a cancer ward increases the risk of dying of cancer. Foster youths are likely to have poor outcomes given their history of maltreatment, which foster care cannot erase. It is difficult to assess how foster care placement affects children, since we cannot do a controlled experiment in which some children are placed and a similar set of children are not. Roberts quotes only one study, from 2007, that shows harm from foster care—and that study included borderline cases only, leaving out children suffering severe and obvious maltreatment. She does not quote the same author’s brand-new paper, which finds both positive and negative effects for different contexts, subgroups, and study designs.
“Myth” No. 5: This system was founded after the case of Mary Ellen Wilson. This is an esoteric myth, as few people have heard of Wilson. Roberts is right that many histories trace the roots of today’s child welfare system to the case of that little girl. We appreciate Roberts’ clarifications but are not convinced of their significance. We believe other myths are much more relevant, such as that neglect is synonymous with poverty, or that all children are betteroff with their parents no matter how badly abused or neglected they are.
It is disappointing that the Post allowed Roberts to use this series to propagate new myths, rather than dispel old ones.
Marie Cohen is a former foster care social worker, current member of the District of Columbia Child Fatality Review Committee, and author of the blog, Child Welfare Monitor. You can findher review of Dorothy Roberts’ new book here. Marla Spindel is the Executive Director of DCKincare Alliance and a recipient of the 2020 Child Welfare League of America’s Champion for Children Award.
In her 2009 book, Shattered Bonds: The Color of Child Welfare, Dorothy Roberts drew attention to the disproportional representation of Black children in foster care and child welfare in general and helped make “racial disproportionality” a buzzword in the child welfare world. In her new book, Torn Apart: How the Child Welfare System Destroys Black Families–And How Abolition Can Build a Safer World, Roberts revisits the issues addressed in Shattered Bonds and creates a new buzzword, renaming child welfare as the “family policing system.” Those who liked Shattered Bonds will likely love Torn Apart. But those who value accuracy in history or in data will find it to be sadly misguided, although it does make some valid points about flaws in the U.S. child welfare system.
Roberts starts with a horrific anecdote about a mother, Vanessa Peoples, who was doing everything right–she was married, going to nursing school, about to rent a townhouse and was even a cancer patient. But Peoples attracted the attention of both the police and child welfare and ended up hogtied and carted off to jail by police, placed on the child abuse registry, and subjected to months of monitoring by CPS after she lost sight of her toddler at a family picnic when a cousin was supposed to be watching him. But citing these extreme anecdotes as typical is very misleading. This particular story has been covered in numerous media outlets since it occurred in 2017 and continues to be cited regularly. One can counter every one of these horrific anecdotes with a story of a Black child who would have been saved if social workers had not believed and deferred to the parents. (See my commentary on the abuse homicides of Rashid Bryant and Julissia Batties, for example).
Roberts’ book restates many of the old myths that have been plaguing child welfare discussions as of late and that seem to have a life of their own, impervious to the facts. Perhaps the most common and pernicious is the myth that poverty is synonymous with neglect. Roberts embraces this misconception, suggesting that most neglect findings reflect parents who are too poor to provide adequate housing, clothing and food to their children. But parents who are found to have neglected their children typically have serious, chronic mental illness or substance use disorders that severely affect their parenting, and have refused or are unable to comply with a treatment plan. Many are chronically neglectful, resulting in children with cognitive and social deficits, attachment disorders, and emotional regulation problems. Commentator Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction…., which often lead to substance abuse as a method of self-medication.” Perhaps the strongest argument against the myth that poverty and neglect are one and the same is that most poor parents do not neglect their children. They find a way to provide safe and consistent care, even without the resources they desperately need and deserve.
Roberts endorses another common myth–that children are worse off in foster care than they would be if they remained in their original homes. She argues that foster care is a “toxic state intervention that inflicts immediate and long-lasting damage on children, producing adverse outcomes for their health, education, income, housing, and relationships.” It is certainly true that foster youth tend to have bad outcomes in multiple domains, including education, health, mental health, education, housing and incarceration. But we also know that child abuse and neglect are associated with similar poor outcomes. Unfortunately, the research is not very helpful for resolving the question of whether these outcomes are caused by the original child maltreatment or by placement in foster care. We cannot, of course, ethically perform a controlled study in which we remove some children and leave a similar set of children at home. We must rely on studies that use various methodologies to disentangle these influences, but all of them have flaws. Roberts cites the study published in 2007 by Joseph Doyle, which compared children who were placed in foster care with children in similar situations who were not. Doyle found that children placed in foster care fared worse on every outcome than children who remained at home. But Doyle focused on marginal cases* and left out the children suffering the most severe and obvious maltreatment. In a brand-new paper, Doyle, along with Anthony Bald and other co-authors, states that both positive and negative effects have been found for different contexts, subgroups, and study designs.
There is one myth that Roberts does not endorse: the myth that disproportional representation of Black children in child welfare is due to racial bias in the child welfare system, rather than different levels of maltreatment in the two populations. After an extensive review of the debate on this issue, Roberts concludes that it focused on the wrong question. In her current opinion, it doesn’t matter if Black children are more likely to be taken into foster care because they are more often maltreated. “It isn’t enough,” she states, “to argue that Black children are in greater need of help. We should be asking why the government addresses their needs in such a violent way, (referring to the child removal). Roberts was clever to abandon the side that believes in bias rather than different need as the source of disparities. The evidence has become quite clear that Black-White disparities in maltreatment are sufficient to explain the disparity of their involvement in child welfare; for example Black children are three times as likely to die from abuse or neglect as White children. As Roberts suggests and as commentators widely agree, these disparities in abuse and neglect can be explained by the disparities in the rates of poverty and other maltreatment risk factors stemming from our country’s history of slavery and racism. Unfortunately, Roberts’ continued focus on these disparities in child welfare involvement will continue to be used by the many professionals who are working inside and outside child welfare systems all over the country to implement various bias reduction strategies, from implicit bias training to “blind removals.”
In Part III, entitled “Design,” Roberts attempts to trace the current child welfare system to the sale of enslaved children and a system of forced “apprenticeship” of formerly enslaved Black children under Jim Crow, whereby white planters seized custody of Black children from their parents as a source of forced labor.** As she puts it, “[t]hroughout its history US family policy has revolved around the racist belief that Black parents are unfit to raise their children. Beginning with chattel slavery and continuing through the Jim Crow, civil rights, and neoliberal eras, the white power structure has wielded this lie as a rationale to control Black communities, exploit Black labor, and quell Black rebellion by assaulting Black families.” In other passages she adds other groups to the list of victims, adding “Indigenous, immigrant and poor people to the list of communities that are being controlled by the “family policing system.” But most of her statements refer to Black victims only.
Roberts’ attempt to connect slavery and Jim Crow practices with child welfare systems highlights a major flaw of the book. She herself explains that due to racism the child welfare system served only White children when it emerged in the nineteenth century with the creation of child protection charities and the passage of state laws allowing maltreated children to be removed from their homes and placed in orphanages. Foster care was established in the middle of the century and also excluded Black children. The system did not begin serving Black children until after World War II, so it is difficult to understand how it could stem from slavery and Jim Crow practices. It seems much more plausible that the child welfare system arose from basically benevolent concerns about children being maltreated, and that with the rise of the civil rights movement, these concerns were eventually extended to Black children as well.
While Black children’s representation as a share of foster care and child welfare caseloads rose rapidly starting in the 1960’s, and Black children are much more likely to be touched by the system than White children, the system still involves more White than Black children. According to the latest figures, there were 175,870 White non-Hispanic children in foster care (or 44 percent of children in foster care) and 92,237 Black (non-Hispanic) children in foster care, or 23 percent of children in foster care. Moreover, the disparity between Black and White participation in child welfare and foster care as a percentage of the population seems to be decreasing.*** So the idea that this whole system exists to oppress the Black community and maintain white supremacy seems farfetched.
Roberts’ attempt to make Black children the focus of the book results in some awkward juxtapositions, like when she admits that though the Senate investigation of abuses by a for-profit foster care agency called MENTOR “highlighted cases involving white children, we should remember that Black children are more likely to experience these horrors in foster care—not only because Black children are thrown in foster care at higher rates, but also because government officials have historically cared less about their well-being.” A page later she states that the “child welfare system’s treatment of children in its custody is appalling but should come as no surprise. It is the predictable consequence of a system aimed at oppressing Black communities, not protecting Black children.” It is hard to understand how White children being maltreated in bad placements supports this narrative.
Fundamental to Roberts’ critique is her system is “not broken.” “Those in power have no interest in fundamentally changing a system that is benefiting them financially and politically, one that continues to serve their interests in disempowering Black communities, reinforcing a white supremacist power structure, and stifling calls for radical social change.” Even if one believes there is a white supremacist power structure, it is hard to see the direct connection between the abuses Roberts is highlighting and the disempowerment of Black communities; it seems more likely that the more abusive the system, the more protests it would generate. And at a time when the federal government and some of the wealthiest foundations and nongovernmental organizations are echoing much of Robert’s rhetoric, her reasoning seems particularly off-target.
Roberts makes some valid criticisms of the child welfare system. Her outrage at the terrible inadequacies of our foster care system is well-deserved. She is right that “The government should be able to show that foster care puts Black children [I’d say “all children”] on a different trajectory away from poverty, homelessness, juvenile detention, and prison and toward a brighter future.” Any society that removes children from their parents needs to be responsible for providing a nurturing environment that is much, much better than what they are removed from. And we are not doing that. As Roberts states, “The state forces children suffering from painful separations from their families into the hands of substitute caretakers…..who often have unstable connections, lack oversight and may be motivated strictly by the monetary rewards reaped from the arrangement.” As a foster care social worker in the District of Columbia, I was driven to despair at my inability to get my superiors to revoke the licenses of such foster parents; the need for “beds” was too great to exclude anyone was not actually guilty of abuse or severe neglect. Roberts is also right to be concerned the outsourcing of foster care to private for-profit organizations that may be more concerned with making money than protecting children, sometimes resulting in scandals like the one involving MENTOR Inc., which was found to hire unqualified foster parents and fail to remove them even after egregious violations like sexual assault.
Roberts also raises valid concerns about children being sent to residential facilities, often out of state, that resemble prisons rather than therapeutic facilities. But she ignores the need for more high-quality congregate care options for those children who have been so damaged by years of maltreatment that they cannot function in a foster home, no matter how nurturing. Instead, she repeats the usual litany of scandals involving deaths, injuries, fights and restraints, without noting the undersupply of truly therapeutic residential settings, resulting in children sleeping in office, cars, and hotels or remaining in hospital wards after they are ready for discharge. Ironically, she supports defunding the system, even if that would mean even worse situations for these children.
Roberts decries the fact that parents sometimes relinquish custody of their children in order to get needed residential care, arguing that “rather than providing mental health care directly to families, child welfare authorities require families to relinquish custody of children so they can be locked in residential treatment centers run by state and business partnerships.” That statement is completely backwards. The child welfare system does not provide mental health services but, like parents, it often struggles to secure them for its clients. Some parents are forced to turn to the child welfare system because their insurance will not pay for residential care for their children. That is not the fault of child welfare systems, which clearly do not want to take custody of these children. The underlying problem is the lack of adequate mental health care (including both outpatient and residential programs), which has destructive consequences for the foster care system. This is exacerbated by the lack of parity for mental health in health insurance programs. It’s hard to believe Robert is unaware of these well-known facts.
Roberts is correct that parents as well as children are shortchanged by inadequacies in our child welfare program, such as the “cookie cutter” service plans which often contain conflicting obligations that are difficult for struggling parents to meet. But she is wrong when she says that parents need only material support, not therapeutic services. But this error flows logically from her concept of neglect as simply a reflection of poverty. In fact, many of these parents need high-quality behavioral health services and drug treatment, which are often not available because of our nation’s mental health crisis, as well as the unwillingness of taxpayers and governments at all levels to adequately fund these services.
In her final chapter, Roberts concludes that, like the prison system, the child welfare system cannot be repaired because it exists to oppress Black people. “The only way to end the destruction caused by the child welfare system is to dismantle it while at the same time building a safer and more caring society that has no need to tear families apart.” In place of family policing, Roberts favors policies that improve children’s well-being, such as “a living wage and income support for parents, high-quality housing, nutrition, education, child care, health care; freedom from state and private violence; and a clean environment.” I agree with Roberts that aid to children must be expanded. The US is benighted when compared to many other Western countries that invest much more heavily in their children through income support, early childhood and K-12 education, healthcare, and housing. But family dysfunction occurs even if a family’s material needs are met. That is why every other developed nation has a child welfare system with the authority to investigate maltreatment allegations and assume custody of children when there are no other options. Moreover, some of the countries with the strongest safety nets for children also have higher percentages of children living in foster care than the United States.****
Torn Apart is a skewed portrait of the child welfare system. In it Roberts restates the common but easily discredited myths that poverty is synonymous with neglect and that foster care makes children worse off than they would have been if left at home. The underlying flaw in her account is the idea that this system exists to repress the Black community, even though it was established solely for the protection of White children. Roberts makes some valid criticisms of child welfare systems and how they shortchange the children and families they are supposed to help. But when she talks of dismantling child protection, she is proposing the abandonment of abused and neglected Black children in homes that are toxic to them, an abandonment that will perpetuate an intergenerational cycle of abuse and neglect. These children are our future; abandoning their well-being to prioritize that of their parents is a bad bargain with history.
*Doyle’s study included only those cases that would have resulted in foster placement by some investigators and not by others, leaving out the cases in which children were in such danger that all investigative social workers would agree that they should be placed.
**In various places, she also attributes it to different combinations of slavery and apprenticeship of Black children with the transfer of Native American children to boarding schools, the exclusion of Black children from charitable aid and the servitude of impoverished White children.
***A recent paper reports that disparities between Black and White children began to decrease in the twenty-first century in nearly every state, closing entirely in several Southern states.
****Unicef’s report, Children in Alternative Care, shows that Denmark has 982 children in “alternative care” per 100,000 and Sweden has 872 per 100,000, compared to 500 per 100,000 for the United States.
I’m not a big fan of these months, days, and weeks dedicated to specific causes, whether they be Social Work Month, Child Abuse Prevention Month or Foster Care Month. These days, weeks, and months often allow us to feel good by paying lip service to a group or a the cause on social media without taking any concrete steps to help the group or address the problem. But when states begin renaming Child Abuse Prevention Month, there is reason to ask whether this change is a significant reflection of a changed child welfare zeitgeist.
Ronald Reagan declared April to be National Child Abuse Prevention Month in 1983, and the designation soon took hold around the country, with public and private agencies displaying blue pinwheels, sharing information about child maltreatment, and urging the public to get involved in preventing child abuse and neglect. But no longer is that the case in Utah, where April has been renamed Family Strengthening Month, or Montana, where it has been declared Strengthening Families Month.
In Utah, a document called, a bit confusingly: Family Strengthening Month: A Toolkit for 2022 Child Abuse and Neglect Prevention Month, begins with an attempt to answer the question, “Why Family Strengthening Month?” Diane Moore, the director of Utah’s Division of Child and Family Services (DCFS) starts by asserting that “focusing on…. an individual family’s failure ignores any societal or economic influence, and the potential for communities to take action to strengthen families to safely care for their own children.” This statement is confusing. Almost every commentator in the field recognizes that socioeconomic factors influence child abuse and neglect. And asking communities to support families has been a focus of child abuse prevention month on the federal level for some time.
Moore goes on to state that 55% of confirmed allegations are related to some type of neglect in Utah. The preponderance of neglect is often used by left-of-center leaders and commentators as support for the argument that child protection agencies are finding parents guilty of neglect when the real problem is poverty. But Utah is a Republican state, and Moore is not about to blame child maltreatment on poverty. Instead, she states that “High stress, substance abuse, social isolation, and lack of support for parents are among the most common risk factors associated with child abuse and neglect.” Not a word about poverty, unless “lack of support for parents” is an euphemism for it. So it’s not clear what purpose is served by the mention of neglect, or what the “economic influences” mentioned in the first sentence might be.
Moore goes on to say that “When we truly care about the safety and well being of children, then we must equally care about the safety and well being of the adults in those children’s lives.” This statement is questionable as well. Children are more vulnerable than adults, especially the youngest children, and the power imbalance is huge. Moreover, children are our future, and will parent the next set of children. Most parents put the needs of their children before their own needs, so why wouldn’t society do the same? That being said, I agree that parents must be safe and well if they are to keep their children safe and well. But if I have to choose between the well-being of a child and that of an abusive or neglectful parent, I’ll go with the wellbeing of the child any day.
Finally, Moore concludes that “We want to do more in Utah than just prevent abuse and neglect. We want to back away from that line of crisis by leaning in as communities and neighbors in order to ensure that every family has the resources and support they need to be truly successful.” More than “just” prevent abuse and neglect? If that were easy, I’d certainly be happy to aim for more, but I think we are a long way from doing that.
So Utah’s justification of the name-change depends on a set of vague and questionable statements. Then what is the real reason to take the focus off child maltreatment and replace it with “strengthening families”? This change is certainly in tune with the current climate n child welfare. We are supposed to lead with family strengths rather than weaknesses, prioritize keeping families together and minimize government intrusion in family life. If those are the priorities, child abuse and neglect prevention may have to take a back seat. We might even be willing to tolerate more abuse and neglect in order to keep families together – a bit of collateral damage, so to speak. The social worker and supervisor working with Noah Cuatro‘s family wanted to concentrate on its strengths, not its weaknesses. So they ignored the signs of abuse, and Noah was killed by his parents. Collateral damage.
It is interesting that two red states were the first to drop the “Child Abuse Prevention Month” designation. As a child advocate, I have been more critical of Democratic leaders and commentators, because they have tended to be more extreme, with statements equating neglect with poverty proposals like abolishing the “family policing system.” But I’ve been equally hard on the Trump and the Biden appointees to the Administration on Children and Families, because their views are essentially the same. And that is because child welfare is an issue where both sides of the aisle often agree on what I think are terrible policies. The focus on parents’ rights rather than children’s needs jibes with the Left’s focus on racism as the cause of almost everything and its reluctance to punish parents who may be victims of poverty. For the right, parents’ rights have always been important: keep your government out of my family, except when it comes to abortion and birth control. That’s how Left and Right could agree on the Family First Act, a terrible bill which transferred the costs of necessary group care to states while paying lip service to family preservation by offering funding for services that were already funded from other sources.
In Texas, Democrats and Republicans agreed in the 2021 legislative session on a slate of reforms designed to restrict CPS intervention into the lives of families. These laws were pushed by a coalition of strange bedfellows indeed: “abolitionists” who want to abolish child welfare along with police and prisons, with conservative groups intent on reducing government intrusion into families.
So it turns out that two “red” states were the first to rename Child Abuse Prevention month to focus on strengthening families. But next to follow suit may be one or more blue states that are eager to demonstrate their progressive bona fides. Who will be the next? Stay tuned.
I have written before about the power of wishful thinking and how it causes people to disregard research and real-life results. In that earlier commentary, I discussed the successful promotion of a practice called race-blind removals based on data from an article by a scholar who now denies knowledge of their provenance, and which have been shown to be inaccurate. A program called Healthy Families America (HFA), which currently serves over 70,000 families per year according to its website, offers another example of the power of wishful thinking. This program has become the centerpiece of the nation’s oldest and largest charity dedicated to the prevention of child abuse, even though the program has failed to demonstrate its utility in preventing child maltreatment. This organization, now called Prevent Child Abuse America, launched HFA based on weak evidence that a program in Hawaii called Healthy Start Program (HSP) could prevent child maltreatment. The first experimental study of HSP found no impact on child maltreatment but did nothing to derail the launch of HFA. Studies of HFA programs around the country have found little evidence of reductions in child maltreatment, but the program has continued to grow and now serves more families than any other home visiting program. The story of HFA is a lesson in the power of wishful thinking and the failure of evidence (or lack thereof) to counteract it.
As told in a helpful history of home visiting, all modern programs can trace their origins to Henry Kempe, whose book, The Battered Child, brought about the recognition of child maltreatment as a national problem. To address child abuse, Kempe called for universal prevention through a network of home health visitors. Inspired by Kempe, modern home visiting began with Hawaii’s implementation of the Healthy Start Project (HSP) in 1975. As described in the 1999 evaluation by Duggan and colleagues, HSP was developed by the Hawaii Family Stress Center (HFSC) on the island of Oahu. It had two components: early identification (at the birthing hospital) of families with newborns at risk of child abuse and neglect and home visiting by trained paraprofessionals for those families classified as at-risk who agreed to participate. This initial program was never evaluated, but anecdotal information suggested it was successful in promoting effective parenting, and six similar programs were established on neighboring islands.
As described by Duggan et al., the Hawaii Legislature authorized a three-year pilot program focusing on one neighborhood in Oahu, which began in 1985. There was no control group in the pilot study, and the researchers used CPS reports and changes in family stress in participating families to measure program effectiveness. During the three-year pilot, there were few reports of physical abuse, neglect or imminent harm for program participants. Because evaluations of other home visiting programs had found much higher rates of reported maltreatment in comparison group families, these results were viewed as evidence that the program had a positive impact. According to Duggan and her co-authors, “The pilot study results might have been given too much weight, given the lack of a control group and the short period of follow-up for most families.” Nevertheless, the results of this unpublished study were enough evidence for the Legislature to expand HSP throughout Hawaii starting in 1989.
Home visiting in general was gathering steam in the 1980s and early 1990’s. In 1990, the U.S. General Accounting Office (GAO) issued a report promoting home visitation as a “promising early intervention strategy for at-risk families.” In its summary of research evidence, GAO focused mostly on health and developmental benefits for children, rather than maltreatment prevention. In 1991, the U.S. Advisory Board on Child Abuse and Neglect issued a report recommending a pilot of universal voluntary neonatal home visitation, stating that the efficacy of home visiting as a preventive measure was “already well-established.” The Board cited the results of a federally-funded demonstration begun 17 years earlier as well as the the nurse home visitation program started by David Olds in 1977. But HSP was not mentioned.
Despite the lack of a rigorous evaluation, the National Committee to Prevent Child Abuse (NCPCA, now called Prevent Child Abuse America) the nation’s “oldest and largest organization committed to preventing child abuse and neglect before it happens,” had become interested in using HSP as the nucleus of a national home visiting program. But first, NCPCA conducted a one-year randomized trial of HSP, as described by Duggan et al. The trial suffered from severe methodological limitations, including “less than ideal followup,” differential dropout rates in the program and control groups, the failure to blind interviewers to experimental or control status, and reliance on program staff rather than researchers to measure some outcomes. Nevertheless, the trial concluded that HSP reduced child maltreatment, and this apparently gave NCPCA the assurance it needed to invest in the model.
NCPCA launched Healthy Families America in 1992, with financial support from Ronald MacDonald House Charities, arranging visits to 22 states by Hawaii Family Stress Center Staff. The “theory of change,” or theoretical basis for the program, as quoted by Duggan et al, started with the targeting to all newborns and their parents, which allows for diversified service options determined by individual need. Also part of the theory was a commitment to change at the individual and community levels. Rather than impose a single service model, HFA contained a set of critical elements, which included the prenatal initiation of services and the assessment of all new parents. A network was launched to bring together researchers doing experimental and quasi-experimental studies of HFA programs.
Unlike NCPCA, The Hawaii Department of Health recognized the limitations of both the pilot study and the NCPCA study and initiated a more rigorous evaluation of HSP in 1994. This was a randomized controlled trial, with at-risk families identified at the hospital and randomly assigned to the experimental and control groups. In 1999 the results of the Evaluation of Hawaii’s Healthy Start Program were released as part of an issue of the Future of Children journal containing evaluations of six different home visiting models. No overall positive program impact emerged after two years of service in terms of child maltreatment (according to maternal reports and child protective services reports). Early HFA evaluation results, published in the same issue, also failed to find effects on abuse and neglect in three randomized trials, which included the HSP evaluation discussed above and another Hawaii HSP study.
David Olds had had begun testing his Nurse Home Visiting Program in 1977 and already had long-term results on the program in Elmira, NY, as well as shorter-term results for a replication in Memphis, Tenn. That program, now known as Nurse Family Partnership, was very different from HFA. It was restricted to first-time teenage mothers and the home visitors were nurses rather than paraprofessionals. The nurses followed detailed protocols for each visit. The researchers found that among low-income unmarried women (but not other participants), the program reduced the rate of childhood injuries and ingestions of hazardous substances that could be associated with child abuse or neglect. Follow-up of the Elmira group when the children were 15 found that the nurse-visited mothers were significantly less likely to have at least one substantiated report of maltreatment. These results are particularly impressive because they overrode a tendency for nurse-visited families to be reported for maltreatment by their nurse visitors. The researchers concluded that the use of nurses, rather than paraprofessionals, was key to the success of the program. In their analysis of all six studies published in the volume, Deanna Gomby et al. concluded that while the HFA and HSP evaluations showed some change in maternal attitudes and self-reported behaviors related to abuse and neglect, only the Nurse Home Visiting Program showed impacts on abuse and neglect other than from self-reports.
Gomby and her co-authors also concluded that the results of the six home visiting evaluations were discouraging for those who had high hopes for home visiting for solving an array of problems. All the programs “struggled to enroll, engage and retain families.” Program benefits generally accrued to only a subset of enrolled families and were often quite modest. The authors explained the disappointing results by concluding that human behavior is hard to change, particularly when problems are community-wide. They recommended that “any new expansion of home visiting programs be reassessed in light of the findings presented in this journal issue” and stated that home visiting services are “best funded as part of a broad set of services for families and children.”
But the home visiting juggernaut was already in motion nationwide. And NCPCA had already made HFA its centerpiece program. Home visiting grew, and HFA grew with it. In 2010, Congress created the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV), which was re-authorized in 2018 with funding of $400 million per year through FY 2022. According to the HFA website, HFA is the model most frequently implemented with MIECHV dollars. Home visiting programs can also receive funding through Medicaid, Title IVB and IVE of the Social Security Act, and many other funding sources.
The infusion of funding for HFA research by NCPCA initiative set in motion a multitude of research projects (both randomized trials and less rigorous studies) that continues to result in publications. Nevertheless, HFA research has yet to find solid evidence that these programs have an impact on child maltreatment: The California Evidence-Based Clearinghouse for Child Welfare (CEBC), the pre-eminent child welfare program clearinghouse, reviewed 19 research reports on HFA. It gave the program a rating of “4” on a scale of 1 to 5 for prevention of child abuse and neglect, meaning the evidence fails to demonstrate that the HFA has an effect on abuse and neglect. HFA did receive a rating of 1 for “child well-being,” based on its impacts on outcomes like physical health, child development, and school readiness. In contrast, Nurse Family Partnership was rated as “1,” “well-supported by the research evidence, for the prevention of child abuse and neglect, as well as for child well-being.
Despite the lack of evidence of its impact on maltreatment, HFA received a rating of “Well Supported” from the new clearinghouse established by the Family First Prevention Services Act (“Family First”) to determine whether a program can receive federal funding under Title IV-E of the Social Security Act. To get such a rating, the program must show improved outcomes based on at least two randomized trials or rigorous quasi-experimental studies. But these outcomes could be any sort of “important child and parent outcome,” (not just child abuse or neglect) and there is no standard for how to measure each outcome. Based on its review of all HFA studies that met their criteria for inclusion, the Clearinghouse found 23 favorable effects, 212 findings of no effect, and four unfavorable effects across 16 outcomes. This included five favorable effects on child safety based on parents’ self-reports of maltreatment, with no favorable effects on other measures of child safety. Self-report is generally frowned upon as a measure of child maltreatment, for obvious reasons. A positive impact of HFA might reflect that participants in HFA were more eager than control group members to provide the “right answer” to questions about maltreatment.
The “well-supported” rating from the Title IV-E clearinghouse opened up a new source of funding for HFA. Passage of Family First as Title VII of the Bipartisan Budget Act of 2018, allowed states to spend Title IV-E funds on programs on services to families with a child welfare in-home case. To take advantage of this new demand, HFA announced in September 2018 that families referred by the child welfare system were now able to enroll until 24 months of age. To serve these families, HFA introduced special child welfare protocols, with limited evidence that that the program was effective for parents who had already abused or neglected their children.* The program had already departed from its initial mission of screening all families with newborns in a geographic area. Even without the child welfare protocols, each program can choose its own admission criteria and there is no universal screening; potential participants are generally referred by health or child welfare agencies, who often can choose between several home visiting programs when referring a client.
Another part of HFA’s original theory of change was a “dual commitment to change at the individual and community levels.” As described by Daro and Harding in their 1999 evaluation of HSA, this meant that HFA “must move beyond direct efforts to help families and begin to serve as a catalyst for reshaping existing child welfare and health care efforts and improving coordination among other prevention and family support initiatives.” This vision has clearly gone by the wayside as HFA has become one choice in a menu of home visiting programs offered by local jurisdictions. Far from trying to enhance and coordinate available community offerings, HFA is busy trying to maximize its share of the pie through its public relations effort, exemplified by the self-promotional statements on its website.
It is disappointing that Prevent Child Abuse America (“Prevent Child Abuse,” formerly NCPCA), an organization that defines its mission as child abuse prevention, decided to fund HFA before it was proven to prevent child maltreatment and without apparently considering other approaches also being tested at the time. And it is concerning that the organization continued with this commitment even after the disappointing evaluations of 1999 might have led them to diversify their investment beyond HFA or even beyond home visiting or to focus more on advocacy rather than services. And finally, that Prevent Child Abuse continues to use charitable contributions made for the prevention of child abuse and neglect to fund a program that has not been proven after 40 years to accomplish this goal, raises serious ethical questions. Twenty-two of the 40 staff listed on the Prevent Child Abuse website have positions with Healthy Families America. Perhaps the charity has backed itself into a corner; it would be difficult to escape this commitment without serious repercussions.
Some federal administrators do not seem to be much more interested in evaluation results than Prevent Child Abuse. The legislation authorizing MCHIEV required a randomized controlled trial (RCT), which may provide useful information on the relative merits of these programs in addressing different outcomes. But strangely, HHS indicated in a response to a critique from the Straight Talk on Evidence Blog that it is not interested in a “horse race” between the models but rather is interested in assessing home visiting in general. This odd statement is an indicator of the kind of thinking that allowed Prevent Child Abuse to invest in HFA for 40 years despite the lack of evidence that it does “Prevent Child Abuse.”
The story of Healthy Families America is not an unusual one. My discussion of the Homebuilders program could also be called “the power of wishful thinking.” Such stories are all too frequent. They show us how wishful thinking can drive leaders to disregard research, especially after they have made a premature decision to commit to one program or course of action.
*One study of Healthy Families New York, published in 2018, looked at a subgroup of 104 mothers who already had a substantiated CPS report, and found a decrease in abuse and neglect among the mothers who were in the experimental group. However, the sample was small and was not planned in advance, so the authors recommend further testing home visiting programs as prevention of repeat maltreatment for child welfare-involved mothers.