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The power of wishful thinking revisited: the improbable growth of Healthy Families America

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.

When parents’ rights trump children’s needs

Photo by Filipe Leme on Pexels.com

Sometimes it seems like basic humanity and common sense get lost in the scramble to affirm parents’ rights at all cost. Nowhere was this more clear than in a quote from Aysha Shomburg, the former New York City child welfare official who was appointed by President Biden to head the Children’s Bureau. As quoted in The Imprint, Schomberg cited a 15-year-old father facing a termination of parental rights as evidence for the need to eliminate the timelines imposed by the Adoption and Safe Families Act. Speaking of this teen dad, Schomberg said, “That stays in my mind and makes me think, how many young fathers are out there and maybe want to take care of their children, but are maybe up against this timeline?”

After picking my jaw up off the floor, I wondered whether Schomberg thought a fifteen-year old was actually capable of parenting an infant, or whether she thinks ASFA should be amended so a child can stay in foster care as many years as it takes for the parent to grow up.

Schomburg’s statement reminded me of one of the saddest cases I carried as a social worker in the District of Columbia’s foster care system. A two-month-old (I’ll call him “Shawn”) came into care when he was removed from his teenage mother (“Shameka”) after she swung him wildly in his carseat and then stalked off in a temper from a home for teen mothers, abandoning her son there. Shawn was placed with one of the best foster families I have ever known–“the Smiths,” a couple who was Black like Shawn and had raised their own children and fostered numerous others. They quickly fell in love with Shawn and gave him the kind of parenting that textbooks envision. Mrs. Smith stayed home with Shawn all day, talking to him, playing with him, and loving him, until the Smiths placed him in a carefully-chosen early childhood education setting at the age of two. Shawn was the center of Mr. and Mrs. Smith’s lives and part of their extended family of children and grandchildren. I’ll never forget that when he fell in love with trains, they found every train-related toy, game or event.

As the months and then years rolled by, Shawn’s mother stopped visiting him. She had named a father for Shawn, but a paternity test came back negative. Shawn’s goal was changed to adoption with the Smiths and I imagined the happy life awaiting him in their loving home. But one day, Shameka admitted that she had lied about the name of the biological father for the sake of revenge against him. She named the real father, and the paternity test was positive. The father (“Antonio”) soon showed up at the agency, a pleasant seventeen-year-old who was delighted to meet his adorable young son. Shawn’s birth father lived with his parents and siblings in subsidized housing and relied on government assistance. Shawn’s grandfather was excited about the new family member. He told me that two of his older sons also had children as teenagers, and that becoming fathers is what made them actually grow up, finish high school, and get jobs.

The Smiths were devastated, but I assured them that the court would not rip a two-year-old away from the only parents he had ever known. But then I talked to the agency attorney and realized there was no question in her mind that the agency had to change the goal to “reunification” with the father, a perfect stranger. And that is exactly what happened. The goal was changed and the Smiths had to bring Shawn to the agency for progressively longer visits with his birth father. At one visit, Mr. Smith was heard crying in the bathroom.

I am glad I was no longer at the agency when Shawn went ‘home’ with his father. But I’ll never forget the day I ran into Shawn’s Guardian ad Litem, the attorney appointed to represent him in court. “We ruined his life,” she told me. She had visited him often in the months following his return home, and and reported that his new household was chaotic, with none of the routine and predictability so crucial for growing children. And we will never know the effects of being ripped away from the Smiths after two years of security and attachment.

I thought about Shawn when I read Aysha Shomburg’s post. I wondered whether Schomburg cared more about the fifteen year-old than about his son. It was not about the infant’s future. It was about the father’s rights. And indeed, most child welfare officials would say Schomburg was correct in not speculating about the child’s future. Child welfare agencies are not in the business of choosing the best parent, just ensuring that the birth parents can provide the minimal acceptable care. But what about the attachment that Shawn had developed over two years with the Smiths? The importance of attachment, and the consequences of disrupting it for a young child, is why the timelines were included in ASFA–the timelines that Schomberg wants to eliminate. So attachment – and the trauma of disrupting it – does not seem to be a significant issue for her.

Schomburg’s citation of a fifteen year old father as an argument against permanency timelines is an illustration of what’s wrong with mainstream child welfare thinking today. It’s all about parents’ rights, while the most basic of children’s needs are disregarded. It is based on an idealized vision of families rather than the way they really are. It’s the kind of thinking that allowed a child named Noah Cuatro to die when the Los Angeles Department of Children and Family Services told social workers to emphasize his family’s strengths more than its weaknesses. We must stop using that kind of thinking to prescribe our actions toward our most vulnerable citizens–our youngest children.

Child Maltreatment 2020: what did and didn’t happen in the first pandemic year

On January 21, 2022, the Children’s Bureau finally released its long awaited report, Child Maltreatment 2020, which contains data submitted by the states, the District of Columbia and Puerto Rico. Coming over a year after the end of the period covers, the report holds few surprises. As we already know from individual state reports, the pandemic resulted in plunging calls to child abuse hotlines and an attendant drop in the numbers of children who were investigated, found to be abused or neglected, receiving family preservation services or placed in foster care. Vast differences between states in these numbers continued to be present, reflecting differing policies, practices, and conditions. These differences remind us that the use of the terms “victimization” and “victim” in the report is deceptive; they describe the state’s finding that maltreatment has occurred – not the actual existence of maltreatment.

Large disparities between racial and ethnic groups in the rate at which children are found to be victims of maltreatment also continued to exist, with Native American and Alaskan Native children having the highest rates, followed by African American children. For child maltreatment fatalities, African-American children having by far the highest rate of all racial and ethnic groups, three times greater than that for White children. This staggering disparity in fatalities (a much clearer concept than “victimization”) suggests that those who blame racial disparities in child welfare system involvement on racism in the system may be missing the main point–the greater need for protection among Black and Native children.

Effects of Covid-19

Almost as soon as governors began issuing stay at home orders and schools closed in the wake of the pandemic, experts and advocates feared that the isolation of children from adults other than their caregivers would result in reductions in calls to child abuse hotlines and in turn investigations and protective interventions like family preservation services and foster care. Data coming directly from states has already confirmed these fears. And on November 19, the Children’s Bureau released the AFCARS Report for 2020, which showed that both entries to and exits from foster care decreased during the first year of the pandemic, but since entries fell more than exits, the total number of children in foster care fell by over four percent, the largest decrease in the past decade. (This report was discussed in my last commentary.)

The annual Child Maltreatment reports from the Children’s Bureau of the federal Administration on Children and Families summarize data from the National Child Abuse and Neglect Data System (NCANDS), which is a federal effort to collect data on child abuse and neglect that is mandated by the CAPTA amendments of 1988. Child Maltreatment 2020 provides the backdrop to the foster care declines documented by AFCARS by showing that the number of hotline calls, children receiving an investigation or alternative response, and children determined to be victims of abuse or neglect all dropped substantially in Federal Fiscal Year (FFY) 2020 relative to FFY 2019. Breaking down the data by quarter showed that these drops relative to the previous year occurred mainly during the second two quarters of the Fiscal Year (April through September 2020), after the pandemic shutdowns began. Exhibit S-1 from the report shows the declines in the rates of total referrals, screened-in referrals, children subject to an investigation or alternative response, and children determined to be victims of abuse or neglect between FFY 2016 and FFY 2020.

Source: Child Maltreatment 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2020.pdf

Referrals

The word “referrals” in child welfare denotes calls to child maltreatment hotlines, as distinct from “reports,” which are referrals that are “screened-in” for investigation. There were a total of 3.925 million referrals involving 7.1 children in FY 2020, for a rate of 53.5 referrals per thousand children. This was a drop of 10.4 percent in the referral rate compared to FFY 2019, which is particularly significant given that the annual number of referrals had been increasing annually since FFY 2016. As in previous years, there were big differences across states: the number of referrals per 1,000 children ranged from a low of 19.1 in Hawaii to highs of 126.9 in Alaska and 137.7 in Vermont. These differences may reflect differing laws and attitudes toward maltreatment reporting in the respective states more than they reflect actual maltreatment rates.

Due to the pandemic, teachers lost their usual place as the source of the largest number of referrals: in 2020 legal and law enforcement personnel made 20.9 percent of referrals, with education personnel coming next (17.2 percent), followed by medical personnel (11.6 percent), social services personnel (10.5 percent), parents and other relatives (6.3 percent each) and smaller amounts from mental health personnel, friends and neighbors, anonymous sources, and others.

Nationally, 54 percent of referrals were “screened in” for investigation or assessment, and the remaining 46 percent were screened out as not meeting the state’s definition of abuse or neglect. There was no change in the screened-in percentage from FY 2019 but the number of screened-in referrals dropped by 10.5 percent from FY 2019 to FY 2020. Of the 47 states reporting screened-in and screened-out referrals, the percentage that were screened in ranged from 17.3 in South Dakota and 17.5 in Vermont (a low that may be related to that state’s very high referral rate) to 98.7 in Alabama.

Investigations and substantiations

The number of children receiving an investigation or alternative response in FFY 2020 was 3.145 million, which was about 46.7 per thousand children. The rate was a decrease of 9.5 percent from FFY 2019, mostly due to decreased activity in April through September. Out of these children, an estimated 618,000, or 8.4 per thousand children, were the subject of reports that were “substantiated” or “indicated,” which means that the agency determined the allegation of abuse or neglect to be true. ACF calls this the “victimization rate,” which is a deceptive term. An investigator’s decision about the truth of an allegation is based on limited information and with limited time, and evidence indicates that many referrals are unsubstantiated when maltreatment actually exists. Moreover, substantiation rates are dependent on state policies and practices, as described below. Because of the confusion caused by the term “victimization,” I will use the term “substantiation” instead.

The national child substantiation rate fell by 5.8 percent in 2020 due to reductions in maltreatment findings in the second half of the fiscal year, suggesting that the drop was mainly the result of the fall in referrals due to the pandemic. This decrease was only about half the magnitude of the 10.5 percent decrease in screened-in referrals, suggesting that a higher percentage of reports was substantiated in FY 2020 than in FFY 2019.* Part of the explanation for this lesser decrease in substantiations may be the reduced proportion of referrals from teachers, whose reports are more likely than others to be unsubstantiated. Many commentators argue this is because teachers often make calls to comply with the mandatory reporting requirement, rather due to genuine concern for a child’s safety. Whether or not this is true, the loss of reports from teachers doubtless meant the loss of serious referrals that would have been been substantiated, as the reduced substantiation rate suggest.

State substantiation rates ranged from a low of 1.9 per thousand children in New Jersey to a high of 19 per thousand in Maine. As the report explains, these rates are affected by state policies and practices, such as their definitions of abuse and neglect, their use of investigation versus alternative response, and the level of evidence they require to substantiate an allegation. Other factors not mentioned by the authors include differences in the messages coming from an agency’s leadership about the relative importance of child safety versus family preservation. Also not mentioned are variations in the use of kinship diversion, the practice of placing children with a relative without court involvement or case opening. If this happens before the investigation is completed, it may result in an “unsubstantiated” finding as the child is now considered safe with a family member. (In a previous commentary, I speculated that New Jersey’s extremely low “victimization” rate might be at least partially due to the practice of kinship diversion.)

Most states had a decrease in the their substantiation rates during FFY 2020, but a few showed little change and some, including Alaska, Arkansas, Illinois, and Maine, even had an increase despite the pandemic. In its commentary, Alaska cited a successful effort to eliminate backlogged investigations and Maine described an increase in reports, which may have been the consequence of several highly-publicized child deaths. North Carolina had a large increase from a very low substantiation rate in 2019 of 2.4 per thousand children to 9.7 in FY 2020 but was “not able” to submit commentary in time to appear in the report. Illinois reported an increase in substantiations due to large increases in the two pre-pandemic quarters but did not provide an explanation. It is worth noting that Arkansas and Illinois were two of only three states to report an increase in foster care entries during FFY 2020 – an increase which is probably related to the increased substantiation rates in those states.

Nationally, children younger than one had the highest substantiation rate at 25.1 per 1,000 children, and the rate decreased with age. Comparison to 2019 shows that the number of children aged eight to 12 who were found to be victims of maltreatment had the largest percentage decrease of 8.2 percent when compared to children aged under one, 1-5 and 13-17, presumably because reporting on this group is most likely to be affected by school closures. Next came children aged 1-5, with a 5.0 percent decrease in the number of substantiated victims, while children under one had a decrease of 3.9 percent. The number of substantiated victims aged 13-17 decreased about the same amount as the youngest group at 3.7 percent.** This is also not surprising because these older children are not dependent on teachers and care providers to report abuse or neglect concerns.

American Indian/Alaskan Native children had the highest substantiation rate of all racial/ethnic groups at 15.5 per thousand children in the population; African-American children had the second highest at 13.2 per thousand, followed by multiple race children at 10.3 per thousand, Pacific Islander children at 10.0 per thousand, Hispanic children at 7.8 per thousand, White non-Hispanic children at 7.0 per thousand, and 1.6 per thousand for Asian children. There is considerable controversy about the higher referral, substantiation, and foster care placement rates for African-American and Native American children. Many scholars and advocates attribute these disparities to racism among those who report alleged maltreatment and those who investigate the reports. Nevertheless, there is evidence from other sources that these disparities may reflect greater underlying maltreatment rates among these populations. The latter view is supported by the even greater racial difference in child maltreatment fatality rates, as described below.

While substantiation rates went down for almost all racial categories during the second half of FFY 2020, these rates actually increased for Native American and Alaskan Native children. Quarterly data reveals that, unlike all other groups, this group experienced an increase in substantiation in the April-June quarter of 2020 relative to that quarter of 2019. But there was a large decrease of 20.3 percent in the July-September quarter relative to FFY 2019. It is almost as if the effects of the pandemic appeared later for this population. Further inquiry is needed to understand what might have caused this anomalous result.

Nationally in FY 2020, three-quarters (76.1 percent) of children found to be maltreatment victims were found to be neglected, 16.5 percent physically abused, 9.4 percent sexually abused, 6.4 percent psychologically maltreated, 6.0 percent victims of an “other” type of maltreatment, and 0.2 percent victims of sex trafficking. A child can be found to be maltreated in more than one way, so the percentages add up to more than 100. The percentages were fairly similar in 2019.

Starting in FFY 2018, states were required to report on the number of infants born with prenatal exposure to drugs or alcohol. In 2020, 49 states reported that 42,821 infants were referred to CPS agencies for prenatal substance exposure. That was an increase over the 38,625 reported by 47 states in FFY 2019; this increase may reflect the addition of two states and an improvement in reporting by states as they phased it in. Many states are clearly not yet reporting all substance-exposed infants, with a large state like Florida reporting only nine substance-exposed infants in FFY 2020.

NCANDS collects data on caregiver risk factors, although these data may be incomplete as many risk factors may go undetected and not every state collects data on every risk factor. From the data available, domestic violence was the most common risk factor, with 37 states reporting 28.7% of the victims had a caregiver with this risk factor. Substance abuse was almost equally prevalent, with caregivers of 26.4 percent of the victims having this risk factor in 41 reporting states; alcohol abuse was reported as a factor for 15.8 percent of caregivers in 34 states; unfortunately mental illness was not included in the reported data. The prevalence of domestic violence as a risk factor confirms reports from around the country about the importance of this factor in families involved with child welfare. This data suggests that domestic violence services should be included in services for which reimbursement should be provided under the Family First Act.

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 deceptive, 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. There is no evidence of a declining or increasing trend in the child maltreatment fatality rate based on data from 2016 through 2020 presented in the report; rather there are small annual fluctuations.

A second problem with the fatality estimates is that they are widely believed to be too low. One reason is that many states report only on fatalities that came to the attention of child protective services agencies. As the report’s authors point out, many child maltreatment fatalities do not become known to agencies when there are no siblings or the family was not involved with the child welfare agency. States are now required to consult certain sources (such as Vital Statistics agencies, medical examiners, and Child Fatality Review Teams), or to explain in their state plans why they are not using these sources. But for 2020, only 28 states reported on such additional fatalities, adding 233 fatalities to the total. And we cannot assume that even those states identified all of the child maltreatment fatalities that were known to other sources. Moreover some fatalities resulting from abuse or neglect are mistakenly labeled as due to accident, sudden infant death syndrome, or undetermined causes for lack of a comprehensive investigation.

As in the case of abuse and neglect in general, younger children are much more likely to die from child maltreatment according to NCANDS data: 68 percent of the fatalities were younger than three years old. As in the past, there were sharp demographic differences in the proportion of the population that was found to be the victim of a child maltreatment fatality. Black children died at a rate that was 3.1 times greater than the rate of White child fatalities and six times greater than the rate of Hispanic child fatalities. These differences cast doubt on the arguments that racial disparities in referrals, substantiations and foster care placements reflect racism in the child welfare system, since unlike substantiation, death is an unambiguous outcome. (It is true that racism could affect decisions about whether a death is attributable to maltreatment, but this unlikely to be a large effect). Looking back at Child Maltreatment reports since 2016 shows that Black child fatalities as a percent of the population increased in four out of the five years, and went up from 4.65 to 5.9 over the entire period, as shown in the second table below, so there is reason to fear that this year’s increase reflects a real trend. American-Indian and Alaskan Native children had the second-highest rate of maltreatment fatalities, followed by children of two or more races.

Source: Child Maltreatment 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2020.pdf

Fatalities per 100,000 children by Race and Ethnicity and Federal Fiscal Year

Race and Ethnicity20162017201820192020
African-American4.654.865.485.065.90
American Indian/Alaska Native3.273.093.122.083.85
Asian0.580.610.440.700.33
Hispanic1.581.591.631.891.65
Pacific Islander3.374.472.223.342.05
White2.081.841.942.181.90
Two or more races2.972.453.503.073.27
Sources: Child Maltreatment 2016-2020, https://www.acf.hhs.gov/cb/data-research/child-maltreatment

NCANDS does not collect data on the cause or manner of a child’s death, but 73.7 percent of the children who died were found to have suffered neglect and 42.6 percent were found to be abused, either exclusively or in combination with other types of maltreatment. More than 80 percent of the perpetrators were parents. Anecdotal information and some research indicates that mothers’ boyfriends are disproportionately found to have perpetrated child abuse homicides, but NCANDS does not collect this information. Nor is NCANDS able to provide an estimate of how many child victims of maltreatment fatalities had prior CPS contact; some states are able to report on how many of them had prior family preservation or reunification services, but as the authors indicate, “the national percentage is sensitive to which states report data.”

Services

Based on state data, the authors of Child Maltreatment estimated that about 1.1 million children received “postresponse” services, which include a wide variety of family preservation services and foster care. This was a decrease of 9.4 percent from the number receiving such services in 2019, with states attributing the decrease to the decline in referrals due to Covid-19. Nationally, based on the reporting states, 59.7 percent of children determined to be maltreatment victims and 27.1 percent of those not determined to be victims received postresponse services. Children who were not determined to be victims may receive post-response services after being assessed as at risk despite the inability to substantiate an allegation, or because their parents voluntarily accepted services. The percentage of such children who received post-response services varied greatly between states, from 2.2 percent in Colorado to 100 percent in Iowa. Such high percentages may reflect the inclusion of very short-term and “light-touch” services, such as the provision of referrals, gift cards for food or clothing, or bassinets for safe sleep.

Based on data provided by 49 states, the report indicates that 124,360 children determined to be victims of maltreatment (or 21.8 percent) were removed from their homes, along with 48,710 (or 1.8 percent) of children not determined to be victims, for a total of 173,079 children.*** The latter may have been removed because they were deemed to be in imminent danger despite the lack of substantiation; some may have been siblings of children for whom abuse or neglect was found that was serious enough to warrant removal of all children from the home.

The data available from some states show that many children found to be maltreatment victims had prior child welfare involvement: data from 30 states indicates that 13.9 percent of these children had received family preservation services in past five years and data from 39 states indicates that 4.9 percent were reunited with their families in the past five years. Of course these percentages do not include children that were the subject of reports, referrals or investigations, but not services, in the previous five years, which would undoubtedly be much larger.

In closing, it is worth reiterating that many of the results of the annual Child Maltreatment reports are open to misinterpretation–even by the very agency that publishes the reports. The press release announcing the report is titled, “Child Fatalities Due to Abuse and Neglect Decreased in FY 2020, Report Finds” even though the report explains that many of the child fatalities counted for a given year actually occurred in previous years. While the report is very clear in attributing the drop in victimization findings to the pandemic, ACF Acting Assistant Secretary JooYeun Chang is quoted in the press release as saying, “While the data in today’s report shows a decrease in child maltreatment, there is still work to do.” These misstatements suggest that agency leaders either did not read the report or knowingly distorted the data to support an optimistic message. It is not surprising that federal leaders are trying to present the data to their advantage. In my commentary on the AFCARS report, I reported that states that were taking credit for the falling foster care rolls due to the pandemic. The urge to take credit seems to be irresistible; that is why it is so important for the media and commentators to analyze these reports independently rather than paste the press release statements into their articles, as some outlets are all too willing to do.

*We cannot assert this as fact because the unit of analysis for substantiation switches to children rather than reports. Theoretically, the difference in percentages could occur if each substantiation involved half as many children in FFY 2020 as in FFY 2019–which is very unlikely.

**Decrease for 13-17 age group was calculated by Child Welfare Monitor from data in Table 7-5.

***In contrast, the AFCARS report indicates 216,838 children were placed in foster care. The reason for the difference might be the missing data from some states in NCANDS as well as the fact that AFCARS includes all removals that took place in 2020, not just those that occurred after a referral made in the same year.

New data show drop in foster care numbers during pandemic

Source: US Children’s Bureau, AFCARS Report $28, https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport28.pdf

A long-awaited report from the federal government shows that most states saw a decrease in their foster care population during the fiscal year ending September 30, 2020, which included the onset of the COVID-19 pandemic. Both entries to foster care and exits from it declined in Fiscal Year (FY) 2020 compared to the previous fiscal year. These results are not surprising. Stay-at-home orders and school closures beginning in March 2021 resulted in a sharp drop in reports to child abuse hotlines, which in turn presumably brought about the reduction in children entering foster care. At the other end of the foster care pipeline, court shutdowns and a slow transition to virtual operations prolonged foster care stays for many youths. One result that is surprising, however, is the lack of a major decrease in children aging out of foster care, despite the widespread concern about young people being forced out of foster care during a pandemic.

Ever since the COVID-19 pandemic resulted in lockdowns and shut down schools around the country, child welfare researchers have been speculating about the pandemic’s impact on the number of children in foster care. While many states have released data on foster care caseloads following the onset of the pandemic, it was not until November 19, 2021 that the federal Children’s Bureau of the Administration of Children and Families (ACF) released the data it received from the 50 states, the District of Columbia and Puerto Rico for Fiscal Year 2020, which ended more than a year ago on September 30, 2020. The pandemic’s lockdowns and school closures began in the sixth month of the fiscal year, March 2020, so its effects should have been felt during approximately seven months, or slightly over half of the year. The data summarized here are drawn from the Adoption and Foster Care Analysis System (AFCARS) report for Fiscal Year 2020 compared to the 2019 report as well as an analysis of trends in foster care and adoption between FY 2011 and FY 2020. State by state data are taken from an Excel spreadsheet available on the ACF website.

The nation’s foster care population declined from 426,566 on September 30, 2020 to 407,493 children on September 30, 2021. That is a decline of 19,073 or 4.47 percent. According to the Children’s Bureau, this is the largest decrease in the past decade, and the lowest number of children in foster care since FY 2014.* Forty-one states plus Washington DC and Puerto Rico had an overall decrease in their foster care population, with only seven states seeing an increase. The seven states with increases were Arizona, Arkansas, Illinois, Maine, Nebraska, North Dakota and West Virginia. The change in a state’s foster care population depends on the number of entries and the number of exits from foster care. And indeed both entries and exits fell to historic lows in FY 2020. The reduction in entries was even greater than the fall in exits, which was why the number of children in foster care declined rather than increasing.

Entries into foster care fell drastically around the country, from 252,352 in FY 2019 to 216,838 in FY 2020 – a decrease of 14 percent. This was the lowest number of foster care entries since AFCARS data collection began 20 years ago. Foster care entries dropped in all but three states – Arkansas, Illinois, and North Dakota. These three states were also among the seven states with increased total foster care caseloads. It is not surprising that entries into foster care dropped in the wake of pandemic stay-at-home orders and school closings. While we are still waiting for the release of national data on child maltreatment reports in the wake of the pandemic, which are included in a different Children’s Bureau publication, media stories from almost every state indicate that calls to child abuse hotlines fell dramatically. This drop in calls would have led to a fall in investigations and likely a decline in the number of children removed from their homes. Monthly data analyzed by the Children’s Bureau drives home the impact of the Covid-19 pandemic on foster care entries. More than half of the decrease in entries was accounted for by the drops in March, April, and May, immediately following the onset of stay-at-home orders, which were later relaxed or removed, as well as school closures.

Source: Trends in Foster Care and Adoption, FY 2011-FY 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_11thru20.pdf

Reasons for entry into foster care in FY 2020 remained about the same proportionally as in the previous year, with 64 percent entering for a reason categorized as “neglect,” 35 percent for parental drug abuse, 13 percent for physical abuse, nine percent for housing related reasons and smaller percentages for parental incarceration, parental alcohol abuse, and sexual abuse. (A child may enter foster care for more than one reason, so the percentages add up to more than 100.)

Exits from foster care also decreased nationwide from 249,675 in FY 2019 to 224,396 in FY 2020 – a decrease of 10 percent – a large decrease but not as big as the decrease in entries, which explains why foster care numbers decreased nationwide. Only six states had an increase in foster care exits: Alaska, Illinois, North Carolina, Rhode island, South Dakota and Tennessee. Along with the decrease in exits, the mean time in care rose only slightly from 20.0 to 20.5 months in care, while the median rose from 15.5 to 15.9 months in care. Again, it is not surprising that the pandemic would lead to reduced exits from foster care. In order to reunify with their children, most parents are required to participate in services such as therapy and drug treatment, to obtain new housing, or to do other things that are contingent on assistance from government or private agencies. Child welfare agency staff and courts are also involved the process of exiting from foster care due to reunification, adoption, or guardianship. All of these systems were disrupted by the pandemic and took time to adjust to virtual operations. Monthly data shows that about 68 percent of the decrease in exits was accounted for by the first three months of the pandemic, when agencies and courts were struggling to transition to virtual operations. It is encouraging that the number of exits was approaching normal by September 2020; it will be interesting to see if the number of exits was higher than normal in the early months of FY 2021.

Source: Trends in Foster Care and Adoption, FY 2011-FY 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_11thru20.pdf

Most exits from foster care occur through family reunification, adoption, guardianship, and emancipation. The proportions exiting for each reason in FY 2020 remained similar to the previous year, while the total number of exits dropped, as shown in Table 3 below. Children exiting through reunification were 48 percent of the young people exiting foster care in FY 2020, and the number of children exiting through reunification dropped by 8.3 percent from FY 2019. Children exiting through adoption were 26 percent of those leaving foster care, and the number of children exiting through adoption fell by 12.6 percent. Exits to guardianships fell by 11 percent and other less frequent reasons for exit fell as well. The drop in reunifications, adoptions and guardianships is not surprising given court delays and also the likely pause in other agency activities during the pandemic. However, nine states did see an increase in children exiting through adoption.

Table 3

Reasons for Exit from Foster Care, FY 2019 and FY 2020

Exit ReasonFY 2019
Number
FY 2019
Percent
FY 2020
(Number)
FY 2020
(Percent)
Decrease
(Number)
Decrease
(Percent)
Reunification117,01047%107,33348%9,6778%
Living with another relative15,4226%12,4636%2,95919%
Adoption54,41526%56,56825%7,84712%
Emancipation20,4458%20,0109%4352%
Guardianship26,10311%23,16010%2,94311%
Transfer to another agency2,7261%2,2631%46317%
Runaway6080%5280%8013%
Death of Child3850%3600%256%
Source: US Children’s Bureau, AFCARS Report $28, https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport28.pdf

It is surprising that the number of foster care exits due to emancipation or “aging out” of foster care fell only slightly, to 20,010 in FY 2020 from 20,445 in FY 2019, making emancipations a slightly higher percentage of exits in FY 2020–8.9 percent, vs. 8.2 percent in FY 2019. There has been widespread concern about youth aging out of foster care during the pandemic, and a federal moratorium on emancipations was passed after the fiscal year ended. At least two jurisdictions, California and the District of Columbia, allowed youth to remain in care past their twenty-first birthdays due to the pandemic. It is surprising that this policy in California, with 50,737 youth in care or 12.45 percent of the nation’s foster youth on September 30, 2020, did not result in a bigger drop in emancipation exits nationwide. California’s foster care extension took effect on April 17, 2020 through an executive order by the Governor and was later expanded through the state budget to June 30, 2021. And indeed, data from California via the Child Welfare Indicators Project show that the number of youth exiting through emancipation dropped by over 1,000 from 3,618 in FY 2019 to 2,615 in FY 2020. Since total emancipation exits dropped by only 435 nationwide, it appears that the number of youth exiting care through emancipation outside of California actually increased. This raises concern about the fate of those young people who aged out of care during the first seven months of the pandemic.

In December 2020 (after the Fiscal Year was already over), Congress passed the Supporting Foster Youth and Families Through the Pandemic Act (P.L. 116-260), which banned states from allowing a child to age out of foster care before October 1, 2021, allowed youth who have exited foster care during the pandemic to return to care and added federal funding for this purpose. But this occurred after the end of FY 2020 so it did not affect the numbers for that year. Moreover, The Imprint reported in March 2021 that many states were not offering youth the option to stay in care despite the legislation, raising fears that the number of emancipations in FY 2021 may not have been much lower than the number for FY 2020.

Among the other data included in the AFCARS report, terminations of parental rights decreased by 11.2 percent in FY 2020. This is not surprising given the court shutdowns and delays. Perhaps this decline in TPR’s explains why the number of children waiting to be adopted actually decreased from 123,809 to 117,470, contrary to what might be expected from the decrease in adoptions.

It is disconcerting that some child welfare leaders and media outlets are portraying the reductions in foster care caseloads during FY 2020 as a beneficial byproduct of the pandemic. Despite the fact that maltreatment reports dropped by about half after the pandemic struck, Commissioner David Hansell of New York City’s Administration for Children’s Services told the Imprint that “It was just as likely that the pandemic was ‘a very positive thing’ for children, who were able to spend more time with their parents.” Based on an interview with Connecticut’s Commissioner of Children and Families, an NBC reporter stated that ‘With the pandemic, the last two years have been difficult, but something positive has also happened during that time span. Today, there are fewer kids in foster care in Connecticut.”

Even In normal times, I take issue with using reductions in foster care numbers as an indicator of success. Certainly if foster care placements can be reduced without increasing harm to children, that is a good thing. But in the wake of the pandemic, we know that many children were isolated from adults other than their parents due to stay-at-home orders and school closures, and we have seen a drastic decline in calls to child abuse hotlines. Thus, it is likely that some children were left in unsafe situations. Moreover, the pandemic caused increased stress to many parents, which may have led to increased maltreatment, as some evidence is beginning to show. So when Oregon’s Deputy Director of Child Welfare Practice and Programming told a reporter that “Even though we had fewer calls, the right calls were coming in and we got to the children who needed us,” one wonders how she knows that was the case, and whether her statement reflects wishful thinking rather than actual information.**

There have been many predictions of an onslaught of calls to child protective services hotlines once children returned to school. And indeed, there have been reports of a surge of calls after schools re-opened in Arizona, Kentucky, upstate New York, and other places, but we will have to wait another year for the national data on CPS reports and foster care entries after pandemic closures lifted.

The FY 2020 data on foster care around the country provided in the long-awaited AFCARS report contains few surprises. As expected by many, foster care entries and exits both fell in the first year of the pandemic. Since entries fell more than exits, the total number of children in foster care fell by over four percent. These numbers raise concerns regarding children who remained in unsafe homes and those who stayed in foster care too long due to agency and court delays. The one surprise was a concerning one: the lack of a major pandemic impact on the number of youth aging out of care. The second pandemic fiscal year has already come and gone, but it will be another year before we can get a national picture of how child welfare systems adjusted to operating during a pandemic.

*Our percentages are slightly different from those in the federal Trends report because the Children’s Bureau calculated their percentages based on numbers rounded to the nearest thousand.

*There is evidence that maltreatment referrals from school personnel are less likely to be substantiated than reports from other groups, and this may reflect their tendency to make referrals that do not rise to the level of maltreatment, perhaps out of concern to comply with mandatory reporting requirements. Data from the first three months of the pandemic shared in a webinar showed that referrals which had a lower risk score (measured by predictive analytics) tended to drop off more than referrals with a higher risk score. However as I pointed out in an earlier post, that low-risk referrals dropped off more does not mean that high-risk referrals were not lost as well.

Child maltreatment, home schooling, and an organization in need of support

The Turpin family has been in the public eye once again after NBC broadcast Diane Sawyer’s interview with two of the victims rescued from the “House of Horrors” in Perris, California on January 24, 2018. In riveting footage, Jordan Turpin describes how as a 17-year-old she escaped through a window and called the police on a de-activated cell phone which her parents did not know she had. Never having left the house by herself or spoken to a stranger, she managed to convince a sheriff’s deputy with cellphone photos of her sisters in chains. “If something happened to me, at least I died trying,” Jordan told Sawyer, stating her parents would have killed her if they had caught her. Body camera footage shows deputies walking through the trash-filled house and finding Jordan’s 12 siblings, all but the youngest stunted by malnutrition, one in chains and two others with bruised wrists from chains that had been removed and hidden while the deputies were knocking on the door. Louise and David Turpin have pleaded guilty to multiple counts of cruelty to a dependent adult abuse, false imprisonment, child abuse, and torture, and have been sentenced to 25 years in prison.

David and Louise Turpin were able to hide their extreme abuse and neglect behind the facade of a “private school” operating out of their home. Calling their home a private school is one of the options for homeschooling parents in California. These “schools” are not monitored or inspected aside from an annual fire inspection for those with six or more students, but city officials in the aftermath of the rescue could find no record that such an inspection was ever conducted on the trash-filled and hazardous Turpin home.

California is not atypical in its minimal regulation of homeschooling. As William and Mary’s James Dwyer stated at a 2021 Homeschooling Summit sponsored by Harvard Law School and described here), twelve states require nothing of homeschooling parents, not even notification to the school district; another 15 or so require notification only. The other half of states have some requirements, such as that the parent have a high school degree, that certain subjects be taught, or that students be assessed requirements, but these are generally not reviewed or enforced in a meaningful way. Moreover, no state requires that a state employee or contractor set eyes on the child once homeschooling is approved.

Clearly, the Turpins could not have gotten away with such severe abuse if the children had been in school. Teachers would have seen the extreme malnutrition of the children and the marks from chains and beatings, and the children would have been able to disclose what was happening to them. Education personnel make more child abuse reports than any other group; they made 21 percent of calls to child abuse hotlines in 2019. So it is not surprising that a disproportionate number of the horrific abuse deaths that make the news (such as the Hart children, Natalie Finn in Iowa, Matthew Tirado in Massachusetts and Adrian Jones in Kansas), involved parents who hid behind the guise of homeschooling, even though schooling rarely took place in these homes.

We have no systematic data about the association of homeschooling with child maltreatment due to data limitations. But there are some troubling reports. Child abuse pediatrician Barbara Knox studied 28 children who were victims of abuse so severe that it merits the definition of torture. In most of these cases, the children were kept out of school; about 29 percent were never enrolled in school and another 49 percent were removed from school, allegedly for homeschooling, often after a CPS report was made by education personnel. Connecticut’s Office of the Child Advocate found that of children withdrawn to be homeschooled between 2013 and 2016, 36 percent had at least one prior accepted report for suspected abuse or neglect to the Department of Children’s Services, and the majority of these families had multiple prior reports for suspected maltreatment. The Coalition for Responsible Home Education maintains a database called Homeschooling’s Invisible Children, which includes 454 cases of severe and fatal child abuse in homeschool settings in the United States since the year 1986. Since these are only the cases that made it into the media and were found by CRHE, there may be many more.

Data from the National Center for Education Statistics indicates that the percentage of Americn children who were homeschooled rose dramatically from 1.7 percent in 1999 to 3.4 percent in 2011-2012, then decreased slightly through 2019. There is some anecdotal and statistical evidence that homeschooling rose considerably during the pandemic but no definitive data as of yet; we also do not know how many children will return to school buildings when the pandemic recedes.

While abusive and neglectful parents are likely a very small minority of those who homeschool, the lobbies that represent them oppose any regulation of homeschooling, arguing that the vast majority of homeschooling parents should not be punished for the actions of a small minority. Homeschool parents who oppose regulation are represented by strong lobbies in both state capitals and at the national level. Homeschooling’s national lobby, the Home School Legal Defense Association (HSLDA) resembles the National Rifle Association in the single-minded passion of its members and its surplus of legal resources. Payment of annual dues of $130 to $144 per year buys free legal defense and representation in court for members. Adults who grew up homeschooled reported at the Harvard summit that their parents kept the organization’s telephone number on their refrigerators to be called as soon as CPS showed up at the door. HSLDA sends out email blasts to its members that can result in a barrage of phone calls that can swamp legislators’ offices and even in-person threats and harassment of state legislators, as an investigation by Pro Publica found. 

There are strong homeschool lobbies at the state level as well. In the aftermath of the Turpin case, California Assemblyman Jose Medina introduced a bill that would require a fire inspection for all private schools, including those with five or fewer students. Due to a “massive outcry” from the homeschooling community, the the inspection requirement was eliminated, leaving a bill that required nothing but identification of homeschooling families by name and address. When the eviscerated bill was scheduled for a hearing, hundreds or perhaps thousands of homeschooling families poured into the capitol building, testifying for three hours. No committee member even moved to approve the bill, and it died that day.

Playing David to HSLDA’s Goliath is a mighty little group called the Coalition for Responsible Home Education. CRHE’s mission is to “empower homeschooled children by educating the public and advocating for child-centered, evidence-based policy and practices for families and professionals.” Among its many recommendations, CRHE has several that are designed to protect homeschooled children against abuse and neglect. These include prohibiting homeschooling by parents who have committed offenses that would disqualify them from teaching school, requiring that students be assessed annually by trained mandatory reporters, and flagging certain at-risk children (such as those in families with a history of child protective services involvement) for additional protections and support.

CRHE was launched in 2013 by a group of homeschool alumni who had met through a network of blogs and Facebook groups. In the past seven years, The Coalition does more with less than any other organization I know. As described on its website, CRHE has driven media coverage of the need for homeschooling oversight; conducted extensive research; developed a set of policy recommendations, advocated for homeschooling oversight in over a dozen states and territories and helped craft successful legislation in Georgia; created a comprehensive suite of resources for homeschooling parents and students; and written a bill of rights for homeschooled children. This has all been done with unpaid staff, including its executive director, and contract workers. Now, CRHE is trying to raise funds to pay a part-time executive director next year, with the hope to grow further in the future.

In my research, I have been surprised at the paucity of organizations that advocate for better protection of children from abuse and neglect, a topic that I hope to address in a future post. While CRHE’s focus is limited to home-schooled children, this is a group that is particularly vulnerable, and evidence suggests that these children are disproportionately represented among the most egregious cases of abuse. For this reason, and in light of CHRE’s extraordinary passion and productivity, I cannot think of an organization more deserving of support by those who care about child maltreatment.

Ten common child welfare misconceptions: essential reading for child welfare commentators and policymakers

In the current rush to make child welfare more “family-friendly,” many proposals are being made for major changes, and even for the total abolition of the current system. But many of these proposals are based on misunderstandings of what we currently know about child abuse, child neglect and child welfare programs. Acting based on these misconceptions may produce policies and practices that actually harm children. A group of eminent child welfare scholars, headed by Richard Barth of the University of Maryland School of Social Work, (and also including leading child welfare scholars Jill Duerr Berrick, Antonio Garcia, Brett Drake and Melissa Jonson-Reid and Johanna Greeson) have addressed ten of the most common misconceptions in one essential article, a must-read for anyone promoting change in our child welfare system.

The article, entitled “Research to Consider While Effectively Re-Designing Child Welfare Services,” was published in the journal Research in Social Work Practice on October 18, 2021. It highlights 10 common misconceptions which the authors assert (rightly in my view) are “inconsistent with the best available contemporary evidence.” Their treatment is structured around ten questions to which a wrong answer is commonly cited and used to justify policy changes. Unfortunately, a paywall blocks access to the article for readers who do not have access to the journal from their institution, though this link provides a one-paragraph summary and the reference list. This post provides a more detailed summary of the article. Readers can contact author Richard Barth at RBarth@ssw.umaryland.edu with questions.

Are Low-Income Children Inappropriately Referred to Child Protective Services (CPS) Due to Implicit Bias?

As the authors describe, there is no doubt that low-income children are referred to CPS at a higher rate than their higher-income peers. One theory is that mandated reporters, who are often middle-class professionals, are biased against low-income parents and their parenting styles. Barth and colleagues cite studies that look at this question in several ways, all suggesting that bias is not the major reason for higher reporting of poor children. First, low-income children experience bad outcomes (in the worst case, death) at differentials consistent with or higher than the differentials in reporting rates. Second, lower-income people are much more likely to self-report maltreatment than their higher-income counterparts. And finally, low-income children who are reported to CPS are more likely to have a range of negative outcomes than their low-income peers who are not reported to CPS.

Are Families who Receive Public Social Services and Have Contact With Mandated Reporters Disproportionately Likely to be Referred to Child Protective Services?

It is often asserted that families that receive more public services (such as clinics rather than private doctors to whom they are known) and encounter more mandated reporters are more likely to be reported to CPS. But the authors show that available evidence does not support this assertion. Two studies estimated “surveillance bias” to increase CPS reporting by less than two percent. Another study found that among children in families receiving income support, those who were reported to CPS also had higher rates of delinquency, mental health problems, and hospital visits for injury. Finally, national and state data show that “as individual or community poverty increases, the proportion of mandated reporters among all reports decreases, making low-income people less likely to be reported by mandated reporters.”

Is the Racial Disproportionality of Black Children in CPS Substantially Driven by Bias?

It is a fact universally acknowledged that Black children are more likely to be involved with child welfare than their share of the population would predict. The latest federal data shows that Black children are more than twice as likely to be reported to CPS than White children. But as I’ve often written, the evidence suggests that bias is not the main reason for this disparity. Among the reasons cited by Barth and colleagues, Black children are more than three times more likely to be poor than white children. Studies suggest that when compared to children with an equal income, Black children are at the same risk or at a slightly lower risk of being reported to CPS. The authors also cite a recent study suggesting that Black substance-abused infants are actually less likely to be reported to CPS than White or Hispanic substance-abused infants. Furthermore, they cite evidence that Black-White disparities in other objective indicators of well-being, such as child mortality, are actually greater than Black-White disparities in CPS reporting. The writers therefore contend that, in order to address racial disproportionality in CPS reporting, we need to address poverty itself, as well as the factors that place Black children at higher risk of growing up in poverty.

I do differ from Barth et al in believing that factors other than poverty affect racial disparities in child abuse and neglect, and the resulting disparities in reports, substantiations, and foster care placements. The importance of factors other than poverty is illustrated by the fact that Hispanic children are less likely to end up in foster care than White children even though their poverty rates are higher, while Native American children, with similar poverty rates, are much more likely to be placed in foster care than Black children. Hundreds of years history of slavery, racial violence, and segregation have left a legacy of intergenerational trauma that has affected mental health, substance abuse, and childrearing styles. Therefore equalizing Black-White poverty rates would probably not immediately equalize their rates of placement into foster care.

Are Decisions to Substantiate or Place in Foster Care Largely Driven by Racial Bias?

Not only are Black children disproportionately more often reported to CPS; they are disproportionately more often the subject of substantiated allegations and placed in foster care.  This is clearly a concern of the authors although their analysis indicates that what is commonly asserted– that this discrepancy is largely due to a racist decision making in the child welfare system—is not supported by the evidence. The authors report that the large majority of recent studies find that “as they move through the system, socioeconomically disadvantaged Black children are generally less likely to be substantiated or removed into foster care compared to White children.” Black children do stay in foster care about 25 percent longer than White children, perhaps because they are less likely to be reunified with their parents or adopted. However, the frequently-cited idea that they are more often substantiated once economic status is taken into account has been roundly disproved, according to the paper’s authors. As I have pointed out relative to this question and the previous one, attempting to reduce disparities that are due to different levels of need might require establishing lower standards for the care of Black children by their parents, allowing them to remain in situations that would cause White children to be removed.

Is Child Neglect Synonymous With Family Poverty?

The trope that child neglect is synonymous with poverty is one of the most common myths used by advocates of child welfare reform, and I devoted part of a recent post to dismantling it. It is true, as Barth and colleagues state, that 70 percent of maltreatment reports and fatalities include neglect as a factor. And they acknowledge that there “is clear evidence establishing the relationship between poverty and child neglect.” However, this association does not mean that poverty and neglect are one and the same. Barth et al point out that studies examining the impact of both poverty and neglect have found distinct negative impacts on children for each one. They also found that studies using both officially reported and self-reported neglect found “unique constellations of risks and/or parenting behaviors” for neglect as opposed to poverty. As the authors point out, much of of the confusion between poverty and neglect is due to the fact that some states allow parents to be found neglectful when a child’s material needs are unmet, even when this deprivation was involuntary on the part of the parent. In those cases, neglect could be seen as reflecting poverty alone. But the authors point to a study showing that only a small proportion of neglect referrals (maybe one in four) is due to material needs, and that these referrals are only about a quarter as likely to be substantiated as other neglect referrals. This is not surprising, since many jurisdictions would respond in such cases by helping the family address the material need rather than substantiating an allegation of neglect by the parent.

Barth et al make an important point that “[N]arratives that conflate poverty and child neglect unfairly characterize low-income families, the majority of whom provide appropriate care for their children.” Most poor parents do not neglect their children, and eliminating poverty alone would not eliminate neglect caused by mental illness, substance abuse, or other non-material factors. Moreover, characterizing neglect as nothing more than poverty risks obscuring the harms caused by neglect, which the authors discuss in their response to the next question.

Is Child Neglect Harmful to Children?

The seriousness of child neglect is often minimized by those who say it is just a reflection of poverty. Yet, Barth and colleagues remind us that severe neglect means “the lack of the basic nurturing, care, and supervision needs of a child.” When such severe neglect is chronic or occurs at critical periods in child development, it can lead to death, hospitalization, and impaired development. The authors cite multiple studies showing the many poor outcomes that have been associated with neglect, including poor cognitive outcomes, mental illness, trauma symptoms, and substance abuse, and point out that such poor outcomes have been found even when controlling for poverty.

Are Research-Supported Practices Effective for Families of Color?

With the passage of the Family First Prevention Services Act allowing Title IV-E funding to be used to pay for “evidence-based practices” to keep families together, some advocates are asserting that programs deemed evidence-based are not actually shown to be effective for people of color. Barth and colleagues cite a study showing that four of popular programs in the California Evidence-Based Clearinghouse for Child Welfare – Parent Child Interaction Therapy, Trauma-Focused Cognitive Behavioral Therapy, Level Four Triple P and Multi-Systemic Therapy – have been found to be well-supported in studies with samples that include at least 40 percent children and families of color. Moreover, Cognitive Behavioral Therapy, the basis of many interventions, has been shown to be broadly effective across populations. Nevertheless, it is clear that the overwhelming majority of the interventions in the clearinghouse have not included many people of color. I am more persuaded by the authors’ suggestion that just because an intervention study did not include people of color does not mean it would not be effective for them with modifications to make them more relevant to families of color. However, I do feel compelled to report on my skepticism about many of these programs that have been found to be “evidence-based,” regardless of the nature of the families served. In the enthusiasm to replace foster care with family preservation, at least one popular program (Homebuilders) has been approved for Family First funding even though the evidence does not strongly support its effectiveness for any families, as I have discussed previously.

Do Children Grow up in Foster Care?

It is very common to read about children “growing up” in foster care, but as Barth et al point out, that is a rare occurrence today. While long-term foster care was common in the past, today’s emphasis on permanency has made stays much shorter. Barth et al cite “overwhelming” evidence that fewer than one percent of infants and ten percent of children 13 and under who enter foster care grow up in care. Infants entering care spend only about 10% of their time between 0 and 18 in care; children who are older when they enter care spend less time in care. Children who “age out” of care are mostly those who entered as teenagers, and many of them were admitted to foster care because of behavioral problems. As the authors point out, talking about children who “grow up” in foster care overemphasize the importance of the foster care experience as part of the life trajectory for most children and understate the importance of foster care as a temporary, last-resort option.

Does Foster Care Cause Poor Outcomes for Children and Youth?

There is no doubt that studies of young adults who have spent time in foster care show that they have worse outcomes than those who have not. Sadly, some commentators use this research to argue that being in foster care leads to worse outcomes than remaining at home. But as Barth and his colleagues had already explained in a previous section of their paper, child maltreatment has been shown to have many negative outcomes, which should not be confounded with the effects of foster care. Another review by Barth and others of “dozens of methodologically rigorous studies” examining outcomes in multiple domains suggests that it is unlikely that foster care worsens outcomes, and it improves them in some areas like child safety–as one would hope. Barth et al attribute the widespread misstatements about the role of foster care in adult outcomes to the strong impact of anecdotes from some foster care alumni about their bad experiences. This is despite the fact that studies reviewed by the authors show that most young people reported satisfaction with their foster care experiences.Majorities of young people in multiple studies reported that they had positive relationships with their caregivers, received quality care, felt safer in their foster homes than in their original homes, and felt that their removal was justified by the circumstances. Another reason for inaccurate conclusions about foster care, according to the authors, may be an over-reliance on studies of youth who aged out of care. This is a group that tends to have more issues even before entering care than other youth. In summary, as the authors state, “an evidence-informed understanding of the role of foster care in the lives of maltreated children indicates that the average experience of care is more favorable than conditions in the birth home at the time of removal.”

Is Adoption Breakdown Common for Former Foster Children?

The final misconception addressed by Barth and his colleagues is that a large fraction of adoptions end in breakdown. They mention commentators who have expressed concerns that the push to permanency may result in some adoptions being finalized too quickly, resulting in later dissolution. Instead, Barth et al show that research suggests adoption dissolution rates typically fall below five percent across a range of studies. Instead of the embracing the misconception that adoptions are likely to dissolve, Barth and his colleagues suggests that advocates for children in foster care should think of adoption as “a stable permanency alternative for children who otherwise cannot be reunified.” As they rightly state, “reform efforts that seek to curtail the opportunity for adoption among children who cannot be reunified would deny… children the lifetime of permanency that our laws seek to promote.”

Policy based on wrong assumptions is likely to be bad policy. Yet, the daily child welfare news is full of reports of child welfare leaders spouting these misconceptions–and worse, making policy and passing legislation based on them. In just one recent example, the New York City Council recently passed legislation requiring the Administration on Children’s Services “to report on various demographic information including race, ethnicity, gender, community district, and primary language of parents and children at every step of the child welfare system and to create a plan to address any disparities identified as a result of such reporting.” Perhaps those voting for this legislation had no idea that anything besides bias could contribute to these disparities, nor that “creating a plan to address them” could mean imposing a lower standard of parental care for children who come from over-represented groups–leaving aside the waste of time and money that could be better spent in helping children.

The misconceptions highlighted by Barth and his colleagues are already affecting child welfare policy and practice around the county in ways that are likely to put abused and neglected children at risk of further harm. This magisterial review, with its more than 140 references, is essential reading for anyone who prescribes or develops child welfare policy or practice. Let us hope it receives the attention it deserves.

No Way to Treat a Child: a needed corrective to the dominant narrative

No Way to Treat a Child: How the Foster Care System, Family Courts, and Racial Activists Are Wrecking Young Lives

These days, It is a bit difficult to be a left-leaning liberal while also being an advocate for abused and neglected children. I would never have expected that a Senior Fellow at the American Enterprise Institute (AEI), Naomi Schaefer Riley, would be one of my closest allies in child advocacy. Or that my proudest achievement since starting this blog would be my service on a child welfare innovation working group that she organized out of AEI, or that, with a few quibbles over details, I would agree with the main points of her new book. But that is the case in these strange times, in which many of my fellow liberals appear effectively indifferent to the fate of children whose parents they view as victims of a racist “family policing system.”

Naomi Schaefer Riley is a journalist, a former editor for the Wall Street Journal, and the author of five previous books. In her new book, No Way to Treat a Child: How the Foster Care System, Family Courts, and Racial Activists Are Wrecking Young Lives, uses examples, data and quotes from experts to show in heartbreaking detail how policymakers from the left and the right have converged in creating a child welfare system that puts adults first. Much of this occurs because in deciding how to treat abused or neglected children, the people who create and carry out child welfare law and policy “consider factors that are completely unrelated to and often at odds with a child’s best interests,” as Riley puts it.

Take family preservation and reunification, for example. Instead of placing the safety of the child as the highest priority, Riley illustrates that child welfare agencies leave many children in dangerous homes long past the time they should have been removed, with sometimes fatal results. They give parents more and more chances to get their children back, long after the law says that parental rights should be terminated. The book is full of stories of children ripped away from loving foster parents (often the only parents they have ever known) only to be returned to biological parents without evidence of meaningful changes in the behaviors that led to the children being removed.

Not only do today’s advocates of “family first” wrest children away from loving families to return home, but Riley describes how they send other hapless children to join distant relatives that they never knew, on the grounds that family is always best even if the relative does not appear until as much as two years after an infant has been placed in foster care. The fact that a relative may display the same dysfunction that the parent showed may be ignored. I would add, based on personal experience, that in my foster care work I often met grandmothers who seemed to have gained wisdom (and finally, for example, gave up drugs) with age, as well as aunts and uncles who avoided the family dysfunction and went on to lead productive lives, making their homes available to the children of their less well-adjusted siblings. But Riley is right to say we should consider not just blood, but also fitness and bonding before removing a child from a good pre-adoptive home to live with a relative.

As Riley describes, one of the primary factors that is now taking precedence over a child’s best interest is that of race or ethnicity. Riley explains how data on the overrepresentation of Black and Native American children in foster care in relation to their size is being attributed to racism in child protective services, as I have explained elsewhere, ignoring the evidence that the underlying disparities in abuse and neglect are largely responsible for these differences in foster care placement. And they don’t seem to have a problem with holding Black parents to a lower standard of parenting than White children to equalize the ratios. Moreover, many of these “racial activists” are recommending eliminating child welfare systems entirely along with abolishing the police. As Riley states, Native children are the canaries in the coal mine, “for what happens when you hold some parents to a lower standard, as we have done with the Indian Child Welfare Act with devastating effects for Native children.

Another way we subordinate the interests of children is by minimizing their parents’ responsibility for their treatment by saying it is simply due to poverty. Riley addresses the common trope that “neglect,” the reason that 63 percent of children children were removed from their families in 2019, is “just a code word for poverty,” a myth that I have addressed as well. I’d venture that anyone who has worked with families in child welfare knows there is often much more going on in these families than poverty alone, including substance abuse, mental illness, and domestic violence. Riley puts her finger on an important issue when she suggests that part of the problem may be that we use a general category called “neglect” as the reason behind many removals. However, I don’t agree with her recommendation to discard neglect as a reason for removal. As I explain in a recent post, we need to distinguish between the over-arching categories of “abuse” and “neglect” and the specific subcategories of neglect such as lack of supervision, educational neglect, and medical neglect. Contrary to Riley’s suggestion that they are types of neglect, substance abuse and mental illness are factors that contribute to it. This important information should be included in the record but should not be confounded with types of neglect.

Another way that policymakers disregard the best interests of the child is by deciding that foster homes are better than institutions for almost all children instead of recognizing that some children need a more intensive level of care for a limited time, or that others can thrive in group homes that simulate a family setting but provide more intensive attention than a typical foster home can provide. The Family First Prevention Services Act (FFPSA), which went into effect for all states on October 1, does allow for children to be placed temporarily in therapeutic institutions, although it sets some unreasonable limits on these institutions and on placement of children in them. But it does not provide any funding for placement in highly-regarded family-like group settings such as the Florida Sheriff’s Youth Ranches. (I’m not sure why Riley says in later in the book that FFPSA “is looking like another piece of federal legislation that will be largely ignored by states, many of which have already been granted waivers from it.” Those waivers were temporary and there is no way states can ignore the restrictions on congregate care).

In her chapter entitled “Searching for Justice in Family Court, Riley describes the catastrophic state of our family courts, which she attributes to a shortage of judges, their lack of training in child development and child welfare, and their leniency with attorneys and parents who do not show up in court. As a model for reform, Riley cites a family drug court in Ohio that meets weekly, hears from service providers working with parents, and imposes real consequences (like jail time) on parents who don’t follow orders. But this type of intensive court experience is much more expensive. These programs are small, and expanding this service to everyone would require a vast infusion of resources.

I appreciated Riley’s chapter on why CPS investigators are underqualified and undertrained.” Having graduated from a Master in Social Work (MSW) program as a midcareer student in 2009, I could not agree with her more when she states that the “capture of schools of social work and child welfare generally by a social-justice ideology has produced the kind of thinking that guides social welfare policy.” I’d add that some students are ill-prepared for their studies and may not get what they need while in school to exercise the best judgment, critical thinking, effective data analysis, and other important hard and soft skills. Riley suggests that the function of a CPS worker is really more akin to the police function than to the type of traditional social work function performed by other social workers in child welfare–those who manage in-home and foster care cases. As a matter of fact, Riley quotes my post suggesting that CPS Investigation should be either a separate specialty in MSW programs or could be folded into the growing field of Forensic Social Work.

Riley’s chapter on the promise of using predictive analytics in child welfare shows how concerns that using algorithms in child welfare would exacerbate current discrimination are not borne out by history or real-world results. Use of an algorithm to inform hotline screening decisions in Allegheny County Pennsylvania actually reduced the disparities in the opening of cases between Black and White children. As Riley states, this should not surprise anyone because data has often served to reduce the impact of bias by those who are making decisions. As she puts it, “if you are concerned about the presence of bias among child-welfare workers and the system at large, you should be more interested in using data, not less.”

Perhaps not surprisingly, it is Riley’s two chapters on the role of faith-based organizations in child welfare that made me uncomfortable. Riley describes the growing role of these groups, especially large evangelical organizations, in recruiting, training, and supporting foster and adoptive parents.” Like it or not,” she states, “most foster families in this country take in needy children at least in part because their religious beliefs demand such an action.” But the Christian Alliance for Orphans, an organization often quoted by Riley, was one of the groups behind the “orphan fever” that took hold among mainstream evangelical churches in the first decade of this century. Many families were not prepared for the behaviors of their new children and some turned to a book by a fundamentalist homeschooling guru named Michael Pearl that advocated physical discipline starting when children are less than a year old. Many of the adoptions were failures, some children were illegally sent back to their own countries, some children were abused, and at least two died of the abuse. But Riley’s narrative suggests that many evangelical churches working with foster youth are using a trauma-focused parenting model (Trust-Based Relational Intervention) that is diametrically opposed to the Pearl approach. Nevertheless, the association of evangelical Christianity with a “spare the rod” parenting philosophy as well as the possibility that saving souls is part of the motivation for fostering or adoption, make me a bit queasy about over-reliance on evangelical families as foster parents, and I would have liked to see Riley address this issue.

In her esteem for religious communities and their role in child welfare, Riley is worried that some jurisdictions will bar all organizations with whom they work from discriminating on the basis of sexual orientation or gender identity, driving religions institutions out of business. Since the book was written, however, the Supreme Court has ruled that the City of Philadelphia violated the First Amendment when it stopped referring children to Catholic Social Services for foster care and adoption because the agency would not certify same-sex foster parents. So this threat may be dwindling for the time being. In general, unlike many liberals, I agree with Riley that, as long as there is an agency to work with any potential foster parent, we should “let a thousand flowers bloom” rather than insisting that every agency accept every potential parent.

Riley ends the book with a list of recommendations for making the system more responsive to the needs of children rather than adults. She agrees with liberals that we need an influx of financial resources as well as “better stewardship of the money we already spend.” We need both a massive reform of our child welfare agencies and a family court overhaul, she argues. She wants recruitment of more qualified candidates for child welfare agencies and better training for them. She urges the child welfare system to move away from “bloodlines and skin color” and allow a child to form new family bonds when the family of origin cannot love and protect that child. I certainly hope that policymakers on both sides of the aisle read and learn from this important book.

What can happen when “Family First” goes too far: a Wisconsin story

On October 1, 2021, the Family First Prevention Services Act (FFPSA) took effect for all states that had not yet implemented it. But many jurisdictions had already been realigning their systems in line with the family preservation emphasis of FFPSA before that time – many with great fervor. An article about one Wisconsin county piqued our curiosity, and further investigation suggests the state may be encouraging a disproportionate emphasis on keeping families together at the expense of child safety. Wisconsin is certainly not unique; the focus on keeping families together at almost all costs has been increasingly prevalent in state and county child welfare systems since long before the passage of FFPSA in 2018.

On August 13, the local Gazette published an article reporting that that foster parents and others in Rock County Wisconsin were asking for an investigation into worker turnover and leadership in the county’s child welfare system. Rock County is a county in southern Wisconsin with a population of 163,354 in 2018 and home of the city of Beloit. The article reported that at a recent meeting of the county board, local foster parents complained about employee turnover and a change in philosophy in the County’s child welfare system since the passage of the Family First Act by Congress in 2018. The foster parents alleged that changes in the child welfare system “have led to a mass exodus of longtime county CPS staff.” According to the speakers, the exodus in turn has resulted in a curtailing of investigations and delays in finding services and permanent homes for foster children.

County reports obtained by the Gazette showed that turnover among Child Protective Services (CPS) investigative and ongoing support workers increased from 57 percent in 2016 to 88 percent since that time. The Gazette found that 56 workers had left these jobs since 2016, leaving only three workers still in place who had been there in 2016. In open letters to the board, CPS workers expressed fear that they would “be fired, demoted or marginalized if they voice[d] ideas that run contrary to the county’s shifts in the foster system.” (The county’s Human Services chief later challenged the information about turnover, telling the Gazette that it had been 70 percent since 2016.)

The Gazette also reported dramatic growth in the backlog of completed investigations. According to data from the state Department of Children and Families (DCF) dashboard, the county had a 94% rate of timely completion of initial child screenings (child maltreatment investigations) in 2016, placing it close to the top of all counties in Wisconsin. But by this year as of September 28, 2021, Rock County had completed only 44.7 percent of initial screenings on time, placing it near the bottom of all counties.

Current trends in child welfare suggest that the change in philosophy to which parents and workers were referring was the increased focus on family preservation incorporated in the Family First Act, which had already been taking hold in many states before they actually implemented it. Information available on the website of Wisconsin’s Department of Children and Families supports that assumption. According to a page titled Child Welfare Strategic Transformation in Wisconsin, [s]ince 2018, Wisconsin has been progressively working toward transitioning the child welfare system to become more in-home, family-focused, and collaborative.” The website also indicates that DCF had “partnered with” a company called Root Inc. (a “change management consulting firm”) “to understand how Wisconsin counties were progressing toward achieving the 4 strategic priorities listed above.” A slide presentation from DCF and Root Inc. indicates that the purpose of the partnership is to “dramatically increase the number of children/families served in home.”

In the first phase of the partnership, according to the slides, Root’s ethnographic researchers studied 13 counties (including Rock County) through interviews, focus groups, and observations and came up with “a set of 17 behaviors that differentiated counties along a continuum of change and transformation.” In choosing the counties for the study, the researchers identified counties that they characterized as “on the way” or “advanced” based on the decline in the rate of their foster care populations, the ratio of entries to exits, and the percentage of calls that lead to removals of children from their families. (They left out counties on the bottom of the continuum of change). The authors of the slides did not provide the classification for each county, but Rock County’s inclusion means it was classified as advanced or at least “on the way.”

The first set of findings about “advanced” counties refers to “Mindsets and Decision-Making.” In these counties, one slide indicates that the “culture prioritizes and reinforces the importance of keeping families in home.” There are six bullets under that heading, which are displayed below. Two are of particular interest. “Decisions to remove are met with critical questioning and even pushback. And in “observation, individuals apologize to their peers when pushing for a [court] petition [for removal of a child].”

Source: Wisconsin Department of Children and Families. Child Welfare Transformation. Available from https://dcf.wisconsin.gov/files/press/2021/wi-dcf-root-insights-03-12-county-detailed.pdf

This language raises some serious concerns. Obviously it is best to keep children at home when it is possible to do it safely. But some children cannot be kept safe at home. And to say a worker should receive pushback, or even apologize, for trying to save a child’s life or prevent injury seems excessive, to say the least

In terms of worker-family relationship, the slides state that advanced counties are “[n]on-judgmental towards actions and optimistic in the belief that families can change.” Specific behaviors cited include that “[w]orkers discuss severe forms of maltreatment with a desire to understand the root causes without passing judgment.” Workers in advanced counties are also said to “easily identify strengths of a family.” In fact, teams in advanced counties “hold each other accountable for negative or pessimistic views of families and work hard to avoid anything that could be perceived as disparaging of a given family.” Moreover, “even with complex cases,” workers in advanced counties “approach a new case with optimism, staying open-minded about the severity of safety concerns and/or the possibility of being able to address challenges.”

It may be good practice for social workers to be optimistic and see family strengths, but unrealistic optimism coupled with blindness to danger signals can leave children vulnerable to severe harm. In Los Angeles County. a belief that social workers should focus exclusively on a family’s strengths led a CPS worker and upper management to disregard glaring evidence that four-year-old Noah Cuatro was being targeted for abuse by his parents. The fact that workers are expected to be “open-minded” even in the face of “severe” safety concerns raises some alarm in a system established to protect children. And asking teams to hold each other accountable to take a rosy view of all the families they serve may be problematic.

To be fair to the authors of the slides, they included in the traits of workers in “advanced” counties some attributes that are important for good child protective services workers, such as knowing “how to probe when kids are being coached,” so they clearly understand that families and children cannot always be believed when they deny that maltreatment has taken place. “Regularly assessing danger threats” is another trait the authors ascribe to workers in “advanced” counties. But the presentation makes a questionable distinction, stating that workers in advanced counties are “laser-focused on identifying and isolating safety threats (as opposed to risk) and desire to expand their skills with respect to isolating and controlling safety.” (The italics are ours). Child welfare systems around the country draw this distinction between safety and risk, defining “safety” as the absence of imminent danger while “risk is defined as danger to the child in some unspecified future. But this distinction is hard to draw and can have the paradoxical result of a child being found “safe” but “at high risk of future harm.”

The idea that child welfare systems may have begun overemphasizing family preservation in the years leading up to and following passage of the Family First Act is not a new one for this blog. We have reported that this reluctance to find fault with parents, remove their children, or terminate parental rights allowed the deaths of children known to child welfare systems around the country, including Zymere Perkins in New York, Adrian Jones and Evan Brewer in Kansas, Gabriel Fernandez in California, and Jordan Belliveau in Florida. Reports have found an extreme reluctance to remove children in Illinois, after the deaths of several children while their families were under supervision by the state. In a case mentioned earlier, the Los Angeles Times‘ found that a core practice model focusing exclusively on family strengths and disregarding obvious red flags resulted in the failure of the agency to implement a court order that would have saved the life of four-year-old Noah Cuatro. We have also discussed how this extreme reluctance to remove a child is related to the current “racial reckoning” and consequent desire to reduce racial disparity in foster care placement.

Returning to Rock County, it may not be surprising that workers who came to child welfare to protect children would leave when confronted with a demand to apologize for requesting to remove a child. On the other hand, all the other counties in Wisconsin are being subjected to the same pressures. Whether the family preservation emphasis is the only cause of Rock County’s loss of veteran staff, or whether there are other factors behind it, Child Welfare Monitor cannot say. However, we can suggest that wholesale departure of a child welfare workforce may be one additional consequence of a system realignment that went too far.

The misuse of data to support preferred programs: the case of family resource centers

Family resource centers, also called family support centers or family success centers, are becoming the prevention program of choice for child welfare agencies around the country. These neighborhood-based centers are being touted as America’s best hope for preventing child maltreatment before it occurs. But the proponents of these centers have been a little too eager in their claims that these programs are supported by research. Two studies recently released to great fanfare do not stand up to close examination. The sites chosen appear to have been chosen for their potential to support the desired conclusion, the evaluations do not convincingly adjust for confounding factors (a major misstatement was made in one of the studies regarding the implementation date of a possibly confounding policy), and the studies are rife with methodological problems related to the measure of success and the attribution of outcomes to the programs.

According to the Child Welfare Information Gateway, family resource centers are “community-based or school-based, flexible, family-focused, and culturally sensitive hubs of support and resources that provide programs and targeted services based on the needs and interests of families.” These centers are known by different names around the country, including Family Centers, Family Success Centers, Family Support Centers, and Parent Child Centers. Services provided often include parenting support, access to resources, child development activities, and parent leadership development.

Family resource centers (FRC’s) are being heavily promoted by child welfare agency leaders, as well as influential private actors such as Casey Family Programs as “less punitive, more open-ended, flexible and voluntary venues where vulnerable families can connect to services, particularly in the communities sending the most children to foster care,” as a recent article in The Imprint put it. FRC’s are gaining increased support around the country. New York City recently announced that it would expand from three to thirty Family Enrichment Centers. In October 2021, the District of Columbia opened ten new Family Success Centers in 2021, under its “Families First DC” initiative. Texas has recently announced that it is investing $1 million to create an unspecified number of Family Resource Centers, and has announced the first five grantees. Many other jurisdictions, such as New Jersey, Vermont, and Allegheny County Pennsylvania, have been operating FRC’s for years. A national membership organization called the National Family Support Network (NFSN) represents and promotes these centers.

Two recent studies have drawn press attention with reports that two family resource centers have been very successful preventing child maltreatment and as a result are saving money for taxpayers. The studies were carried out by a Denver nonprofit called the OMNI Institute, “in partnership with” the NFSN and Casey Family Programs. The researchers report that they identified the two programs by contacting NFSN members and reviewing existing evaluations of FRCs “to identify potential opportunities that could serve as return on investment case studies.”

One of the two programs studied was the Community Partnership Family Resource Center (CPFRP) in Teller County, Colorado, a rural county in central Colorado with a population of approximately 25,000 that is almost all White. As described in their report, the researchers wanted to explore the impact of two new programs that the center implemented in 2014 and 2016, that they hypothesized might have the effect of preventing child abuse and neglect in the county. One of these programs was Colorado Community Response, a voluntary program for parents who were reported for abuse or neglect but were either screened out at the hotline level or investigated but received no child welfare services. A second program, Family Development Services, was a voluntary primary prevention program helping struggling families set goals and connect to resources. The researchers claim that the creation of Colorado Community Response and increased funding for Family Development Services offered “a potential opportunity to examine the Return on Investment for CPFRC to the child welfare system, by comparing child maltreatment outcomes prior to and after the establishment of these new practices.” They decided to use the number of maltreatment allegations that were “substantiated” (or found to be true upon investigation) as their outcome of interest.

In designing their study, the researchers sought to identify other changes that might also affect levels of child maltreatment in order to avoid confounding effects. They learned that Colorado had implemented a “differential response” model in 2013, which was a two-track model for addressing allegations of abuse or neglect. Allegations that are viewed as less serious are assigned to the alternative response track and usually do not receive a substantiation, or finding of abuse or neglect. Obviously, the change to differential response might dramatically affect the number of substantiations. The researchers identified several other policy changes and events that might have affected substantiations, such as the establishment of a statewide child abuse hotline and the inception of the COVID-19 pandemic. According to the report, they decided to use 2015 is the baseline year because “neither Colorado Community Response nor Family Development Services programming were available to the whole CPFRC population, but the statewide child abuse hotline and differential response models were in place.” They chose 2018 as the comparison year because it was the only year that both Colorado Community Response (CCR) and Family Development Services were fully implemented with no other major system-wide changes in place, and before a change in CCR eligibility requirements and the onset of the COVID-19 pandemic.

Using data provided by the state on its online dashboard, the OMNI researchers found that there were 82 substantiated assessments in 2015 and only 30 in 2018. To adjust for population changes they divided each number by the number of children in the County at the time, producing what they called an “outcome weight” for 2015 and a “deadweight rate” for 2018, as described in the first graphic below. Subtracting the deadweight rate from the outcome weight and multiplying by the child population in 2018, the researchers came up with a reduction of 51 fewer substantiated assessments in 2018, as illustrated in the second graphic. (The adjustment made little difference; simply subtracting the 30 from 82 resulted in a reduction of 52 substantiated assessments.) This impressive drop in substantiated cases translates to a “62.84 percent reduction in substantiated assessments from 2015 to 2018.”

Source:
Source: Sara Bayless, Melissa Richmond, Elaine Maskus, and Julia Ricotta, Return on Investment of a
Family Resource Center to the Child Welfare System
. Available from https://childwelfarewatchblog.files.wordpress.com/2021/09/8b78c-communitypartnershipfamilyresourcecenterchildwelfarereturnoninvestmenttechnicalappendix.pdf.

The researchers used the estimated number of children served by CPFRC during 2018 (1,444) relative to the estimated number of children at risk for maltreatment based on income-to-needs (ITN) ratio (1,479)* and age (1,272), to decide how much of the change in substantiations to attribute to the program. The result was an “attribution estimate of 98 percent based on the ITN ratio and 114 percent based on age. Combining these estimates, the researchers decided to attribute the entire reduction in substantiated cases to CPFRC.

Finally, the researchers calculated a return on investment using total child welfare expenditures in 2018 divided by the number of substantiated assessments in that year, resulting in a total cost of $49,026 per substantiated investment. Multiplying that figure by 51, they concluded that the reduction of 51 substantiated assessments, (of which 100 percent were attributed to the program) saved the Teller County child welfare system $2,500,326 in 2018 compared to 2015. Dividing this total by $856,194, they came up with a “Return on Investment” of $2.92 for every dollar spent on the program.

There are many serious problems with this analysis. The choice of substantiations as an indicator of victimization is problematic because of the large body of literature illustrating the difficulty of determining if a child has been maltreated and the absence of differences in future outcomes between children with substantiated vs. unsubstantiated allegations. Allegations (or referrals) seem to be a more meaningful measure of abuse or neglect. Using data from two years without looking at the numbers for the years in-between is also problematic, as the researchers themselves admit. In their discussion of the weaknesses of the study, they acknowledge that using only two years, without the years in between, is not ideal because it provides a less robust understanding of changes in child maltreatment as well as making its estimates more susceptible to influence by other system-level factors.

But there is a much worse –indeed fatal–problem with the two years chosen. The researchers claim that they chose 2015 because Differential Response was already in effect in in that year, having been implemented in 2013. But going to Colorado’s “Community Performance Center” (data dashboard) as helpfully directed by a footnote, one quickly learns that no children were assigned to Family Assessment Response (the option that does not result in substantiation) in Teller County in 2015, as shown in Table One below. In 2018, 82 children, or 44.3 percent of all children assessed, were assigned to Family Assessment Response. So an unknown part of the decrease in the number of children substantiated could have been due to the rollout of Differential Response.

Table One

Source: CDHS Community Performance Center, Number of Children Assessed in Child Welfare, available from https://rom.socwel.ku.edu/CO_Public/AllViews.aspx?RVID=647

If there was any doubt that the advent of Differential Response may be related to the drop in substantiated assessments, one only has to look at Figure One below. It is hard to figure out how the researchers missed this graphic, which is prominently displayed on the relevant page of the data dashboard, and shows how substantiations fell between 2016 and 2018 as the number of children assessed through FAR increased. This is a bizarre error, considering that the researchers specifically cited the prior rollout of differential response as a reason for choosing 2015 as the baseline year for the study.

Source: CDHS Community Performance Center, Number of Children Assessed in Child Welfare, available from https://rom.socwel.ku.edu/CO_Public/AllViews.aspx?RVID=647

Another problem is the method the researchers used to attribute all of the “reduction” in cases to the program. First, the authors provide no explanation of the estimate that 1,444 children received services at CPFRC. We assume this includes every child who ever walked into the center, but we just do not know, since the researchers do not define it. We have no idea of the quantity of services received by each child. We don’t even know if this is an unduplicated count. Moreover, this conclusion simply violates common sense. On the face of it, how could one assume that one family support center caused the entire reduction in child maltreatment substantiations in a county? It just beggars belief.

The second study by OMNI focused on the Westminster Family Resource Center (WFRC), which serves a mostly-Latino population in Orange County, California. WFRC provides a variety of services, including information and referral, family support, case management, counseling, after school programs, domestic violence support, parenting classes, and “family reunification family fun activities.” WFRC belongs to a network of 15 Family Resource Centers known as Families and Communities Together (FaCT). The researchers report that In conducting the study OMNI took advantage of a pre-existing evaluation of all the centers in the FaCT network, which was conducted by Casey Family Programs, Orange County Social Services Agency, another nonprofit and a consulting firm. OMNI reports that “After consultation with the evaluation team and a review of the demographic profile of the areas served by FRCs within Orange County as a whole, OMNI identified Westminster Family Resource Center (WFRC) as a strong option for this project.” (The larger study is listed as “forthcoming” from Casey Family Programs in the references to the OMNI report.)

Unlike the Teller County report, the Orange County report compares outcomes across geographic areas rather than two time periods. The researchers defined WFRC’s service area as the census tracts where at least one percent of the population was served by WFRC. They matched 12 census tracts in Los Angeles County to the area served by WFRP based on ten “community level indicators related to child maltreatment,” such as the percentage of families in poverty and the unemployment rate; the other indicators were not listed.

Using data from the pre-existing evaluation, the researchers subtracted the substantiation rate (number of substantiated children per 1000) in the WFRC areas from the substantiation rate in the matched areas for 2016 and 2017, the most recent years for which data were available, and then multiplied the difference by the number of children in the WFRC service area. The calculation is shown in the attached graphic, which incorrectly divides the number of children in the service area by 1,000. This calculation produced an estimate of 35 fewer substantiated assessments in 2016 and 56 fewer substantiated assessments in 2017. Unlike with the Teller County study, a reader cannot check the underlying data because it comes from an as yet unpublished study. Admitting that there are no guidelines for attributing results to a program in a “quasi-experimental evaluation” using community-level indicators, the researchers rather randomly decided to attribute 50 percent of the difference in substantiated assessments to the program.

Source: Sara Bayless, Melissa Richmond, Elaine Maskus, and Julia Ricotta, Return on Investment of a
Family Resource Center to theChild Welfare System, Westminster Family Resource Center, Orange
County, CA. Available from https://childwelfarewatchblog.files.wordpress.com/2021/09/7845f-westminsterfamilyresourcecenterchildwelfarereturnoninvestmenttechnicalappendix.pdf
Note that the the equations are incorrect. The number of children in the service area was not divided by 1,000.

As in the Teller County study, the researchers went on to calculate a return on investment for WFRC. Although they did not explain their methodology for doing so, it appears they used the same approach of dividing child welfare costs for each year by the number of substantiated assessments for that year to come up with an estimated cost per substantiated assessment in California, adjusting for inflation, and finally subtracting the estimated costs of WFRC. By this method, they arrived at a return on investment of $2.80 in 2016 and $4.51 in 2017, which they averaged to get a total return on investment of $3.65 per dollar spent on the program.

The use of substantiation rates as an indicator of success is as problematic as in the Teller County study. As I have mentioned, substantiation does not equal victimization but instead reflects the agency’s performance in determining whether maltreatment really happened. Using substantiation as an indicator of maltreatment could introduce bias if one of these counties substantiated allegations at a higher proportion of cases than the other, as discussed below.

While there is no mistake as glaring as the Teller County team’s erroneous assumption that differential response had already been implemented in the study’s baseline year, the possibility of significant confounding effects does exist–in this case between places rather than times. California has a county-run child welfare system and the writers do not discuss any policy or practice differences that may exist between Los Angeles County and Orange County and how they might affect the differences in substantiation rate between the two counties. And indeed, data from the Child Welfare Indicators Project at Berkeley shows that Los Angeles County does substantiate a higher proportion of allegations than does Orange County. Of all the children with allegations in 2016 and 2017, 15.7 and 14.7 percent had substantiations in Orange County, versus about 18 percent in Los Angeles County both years. In addition, the fact that the reduction in substantiated assessments, and therefore the estimated cost savings due to the program, varied so much between 2016 and 2017 is already concerning and suggest that the impact found depends upon the year, and could be vastly different if another year were chosen.

The attribution of 50 percent of the difference in substantiations between the two counties to the WFRP has no basis in fact or social science. The researchers did not attempt the kind of calculation reported for Teller County (however problematic) in which they compared the number of children served to the number of children who might be at risk of maltreatment. They indicate that WFP served 1.77 percent of households in its service area as defined by the researchers, and we have no idea how that compares to the number of households where children are at risk of maltreatment.

Looking at the Teller County and Orange County studies together, the choice of these two specific programs out of all the over 3,000 FRC’s represented by NFSN (and the choice of only one out of 15 programs evaluated in Orange County) raises the possibility that the researchers cherry-picked programs to achieve the desired results. In fact, the researchers report that that is exactly what they did! One of the criteria they reported using to select their ultimate sites was that “there were available data demonstrating a plausible connection between FRC services and child welfare system outcomes;” another was that “[t]here were available quantitative data demonstrating that the child welfare system has benefited (e.g., through reductions in the incidence of child abuse/neglect).” The researchers also claim that they were looking for sites representing “demographically different communities,” and I suppose they achieved that with their two sites with mostly White and Latino clientele; but they seem to have been unable to find a suitably promising site with a predominantly Black clientele.

Clearly it is not easy to evaluate programs without random assignment to a treatment and control group, or at least a comparison group that is matched individually to a group of participants. It is also difficult to evaluate a program where each participant gets a different package of services, with some receiving as little as one visit to the center. There is ample reason to doubt that Family Resource Centers will have a large impact on the most serious cases of child abuse and neglect because the parents who use these centers tend to be those who are already open to seeking help, learning new parenting tools, and working toward change. It seems likely that the parents of the most vulnerable children are often the ones who are not willing to seek the kind of help that Family Resource Centers provide. Chronically neglectful parents may lack energy and motivation to go to a Family Resource Center; chronically abusive families are likely to want to avoid letting other adults set eyes on their children. That is why jurisdictions that are really serious about prevention have chosen to adopt more targeted strategies. For example, Allegheny County Pennsylvania, which has a network of 27 Family Resource Centers and was a pioneer in this effort, knew they had to do more for families with more intense needs. They created a three-tier model called Hello Baby, in which families are placed into tiers based on their needs. They are reaching out to all families, and they are referring those in the middle tier to county’s FRC’s. For the families with the greatest needs, a more intensive option is being offered.

A recurrent theme of this blog has been the use of flawed research to promote the programs that the promoters want to support, most recently in my post about race-blind removals. Using flawed research to support programs results in misperceptions by the public and its representatives and in turn to bad policy decisions. One does not have to look beyond Teller County for an example “Child abuse reports have declined dramatically locally due to a partnership between a key Teller government agency and a nonprofit organization,” trumpeted a local paper based on the press release from OMNI. In the article, the DHS Director Kim Mauthe was reported as saying that “the findings of the report are good news for the county. “It’s exciting because the calls we did receive through our child abuse hotline show that we had a decrease of child abuse by 57 percent, which is huge….” It is not clear what would be more disturbing: that Mauthe really believed this program had reduced child maltreatment (not “abuse” as she described it) by 57 percent, knowing that the study period included her county’s adoption of differential response, or that she was cynically misrepresenting the study results to the media. The report was presented at a meeting of county commissioners, who applauded Ms. Mauthe. They now presumably think that child maltreatment is on its way to disappearing, and if anything more is needed it would be to add more funding to the Family Resource Center–not necessarily the best approach if they want to reach the families with the most intense needs.

It is not surprising that this flawed research was funded and promoted by Casey Family Programs, a wealthy and powerful non-profit that has played an outsized role in child welfare in recent decades, funding advocacy-oriented research, providing free consultation to states, and even helping the government hire people who support its views. One of CFP’s goals is to “safely reduce the need for foster care in the United States by 50 percent,” a goal that is incidentally meaningless without a beginning and ending date. Most recently, CFP has publicized the faulty data on race-blind removals that I discussed in a recent post.

Family resource centers can be a great addition to a neighborhood, providing connections to needed programs and services for needy families. But two recent studies that claim to show that these centers reduce child maltreatment and thereby save money to taxpayers are too flawed to provide any meaningful evidence that they indeed have this effect. Any continuing publicity these studies receive may lead unsuspecting public officials to invest in family resource centers at the expense of other programs that may be more promising in preventing child maltreatment.

When ideology can kill: the death of Noah Cuatro

Image: KTLA.com

As many of my regular readers know, I have been fearful that the current climate emphasizing family preservation and racial and ethnic disparities in the child welfare involvement might end up inadvertently harming children. Well, it has happened in California, where a child is dead after the Department of Child and Family Services (DCFS) disregarded a court order to remove a child from a lethal home, motivated in part by hypersensitivity to concerns of possible bias and an exaggerated focus on family strengths that blinded agency staff to glaring problems.

On July 5, 2019, the parents of four-year-old Noah Cuatro called 911, saying their son had drowned in the pool at their apartment complex. But Noah did not look like a drowning victim. He had signs of strangulation, old and new rib fractures, and bruises across his chest, arms, and legs, and a large mark on his forehead. The cause of death was ruled as suffocation. His parents are facing trial for murdering and torturing him.

In August 2019, the Los Angeles Office of Child Protection (OCP) issued a flawed report that exonerated the Department of Child and Family Services of any responsibility for Noah’s death. Fortunately, the Los Angeles Times and the Investigative Reporting Program at UC Berkeley went to court to gain access to documents that would tell them what really happened. They reviewed juvenile court files, emails, and testimony from a grand jury proceeding that led to the indictment of Noah’s parents. In a harrowing article describing the results of their investigation, the journalists document the role of errors, misjudgments, bureaucratic conflict, bias accusations, and a flawed practice model that together “blocked multiple opportunities to protect Noah.” My account is based in part on the Times article as well as the OCP report, which contains some dates and other details that help flesh out the timeline of this tragic case.

Noah Cuatro was first removed from his parents in August 2014 when he left the hospital after birth, after his mother, Ursula Juarez, was alleged to have abused an infant half-sister, causing skull fractures. He ended up in the home of his great-grandmother, Eva Hernandez. At the age of nine months, he was returned to his parents when the agency was unable to prove the allegations against Juarez. But the Times-UC Berkeley investigation found that Noah’s parents always felt that DCFS had robbed them of the first nine months with their newborn. And Hernandez felt that perhaps because they missed his first nine months, they never bonded with Noah and therefore targeted him for abuse.

In November 2016 Kaiser Permanente called the child abuse hotline to report that Noah had missed eight doctor’s appointments over the spring and summer of 2016. An investigation found that Noah had gained only a few ounces between February 2015 and October 2016. His muscles were deteriorating, and he was unable to walk at the age of 27 months. Once again, Noah was removed from his parents and placed first in a facility for medically fragile children and then back with Hernandez.

Two years later, on November 9, 2018 Noah was returned to his parents by a court over the objections of DCFS. Noah had thrived with Hernandez, reaching the appropriate weight and height for his age. He screamed and wet the bed before and after visits with his parents and begged to stay with his great grandmother. Moreover, his parents had not complied with court orders to participate in therapy and visitation with Noah. But the Juvenile Court commissioner, Steven Ipson, saw “substantial progress” by the parents and sent Noah home, requiring that his parents arrange for a visitation schedule with Hernandez, participate in Parent Child Interaction Therapy with Noah, and send him to preschool.

The red flags appeared almost as soon as Noah returned to his parents. On her visits to the family, Susan Johnson, the social worker assigned to the case, learned that Noah’s parents were ignoring the court orders for therapy, preschool and regular visits with his great-grandmother. In April 2019, an aunt made a call to the child abuse hotline, reporting that Noah was losing weight and had thinning hair. Worse, he had changed from an exuberant boy to a scared one. Another relative had told her that during an overnight stay Noah had night terrors and complained of pain in his “butt.”

Johnson went to the home and found Noah with marks on his right arm and neck, a big bruise on his left arm, and lotion covering his back, which his mother attributed to eczema. When Johnson asked what happened when he did something wrong, Noah said “I get hit,” but he quickly retracted. She tried the same question again, and got the same affirmation and quick retraction–characteristic of a scared, abused child. Back at the office, Johnson met with her supervisor and a senior administrator, who told her to file a petition for removal.

But it was not Johnson’s job to assess the truth of the allegations. She was a “Continuing Services Children’s Social Worker” (CS-CSW) in DCFS lingo, whose job was to monitor and assist the families in their journey toward a safe home and case closure. The duty of investigating the allegations fell to an “Emergency Response Children’s Social Worker (ER-CSW often known as a Child Protective Services or CPS worker in other states) named Maggie Vasquez Ducos. When Vasquez Ducos visited the family, Juarez told her that Noah got his injuries by falling off a bunk bed. She also told her, in tears, that Johnson and DCFS had been persecuting her. Noah denied abuse, and a medical exam found that his injuries could have been caused by falling from a bunk bed.

Vasquez Ducos consulted with the social worker who worked with the family before Johnson, Lizbeth Hernandez Aviles. Hernandez Aviles reported that “she had always had concerns for Noah, was opposed to his return home, and felt that the parents are habitual liars who present well,” according to the OCP report. She expressed concern about the existence of bonding between Noah and parents and believed he was the child in the family targeted for abuse.

Nevertheless Vasquez Ducos made a finding of “inconclusive” on the new allegation, meaning that there was insufficient evidence to determine that child abuse had occurred, on May 9, 2019. There is no indication in the records reviewed by the Times and UC Berkeley that Vasquez Ducos reached any of Noah’s relatives, an essential component of any serious child abuse investigation. The police investigation after Noah’s death found text messages between relatives revealing their rising concern during the same time period about the parents’ treatment of Noah.

While Vasquez Ducos was investigating, Johnson was writing and submitting her petition for the removal of Noah and on May 15 it was granted by the court, along with the requirement that Noah be taken for a medical exam. On the same day, a new referral came in alleging domestic violence in the home and sexual abuse of Noah. Assigned to investigate the new referral, Vasquez Ducos learned of the removal order and immediately began to question the need for it. Parroting the words of Noah’s parents, she told her supervisor that Johnson was “harassing them.” She argued that Johnson was biased against the parents and overly influenced by great-grandmother Hernandez.

Investigating the new allegations, Vasquez Ducos visited the family on May 20, 2019, accompanied by the previous social worker, Hernandez Aviles, who had voluntarily taken a demotion to be a Human Services Aide due in part to the stress of managing Noah’s case, according to the Times-UC Berkeley investigation. They found Noah with an injury to his cheek, for which three explanations were given, along with plenty of coaching by Mom for Noah to endorse her explanation. During the visit, Hernandez Aviles reported that Noah “randomly” ran up to her stating ““They feed me a lot,” “They take good care of me,” and “They love me.” It’s hard to imagine better evidence of coaching, and indeed Hernandez Aviles noted that many of Noah’s responses appeared coached.

But Vasquez Ducos was unmoved. In a May 22 meeting with higher management, she argued against the removal order and the top administrator in the room took her side, telling Johnson not to execute the order.* It was agreed that DCFS would facilitate a “child and family team meeting” with the family. Johnson testified that when she tried to state her case, a supervisor elbowed her to be quiet. But she was heard to state, “that she didn’t want a dead kid on her watch,” according to an email quoted in the Times article. Ironically, the new allegation was cited as a reason not to remove Noah until the investigation could be completed. To make matters worse, Johnson, Noah’s main advocate, was removed from the case. It appears that the top administrator who made the decision not to enforce the court order also wanted a Spanish-speaking case manager, although such a person was never appointed and the job of managing the case for the rest of Noah’s life was left to Vasquez-Ducos, who was an investigator, not a case manager.

On June 6, Juarez, who had repeatedly denied being pregnant, gave birth to a baby boy. She had received no prenatal care and initially claimed to be a surrogate, despite lacking any paperwork, and tried to “sneak out of the hospital.” A Kaiser social worker informed DCF about the birth. She also told Vasquez Ducos that Kaiser’s psychiatric exam showed that Juarez had traits of a sociopath and indicated that she was worried about Juarez’ contradictory accounts of her pregnancy. Nevertheless. Vasquez Ducos and her supervisor decided to let Juarez go home with her newborn.

During the month of June, the family seemed to turn against Vasquez Ducos as well, apparently obstructing all her attempts to visit him before the end of the month. Her last visit with Noah was on June 28, 2018. According to the OCP report, Noah was described as “in good spirits and reported that he was doing well.” Vasquez Ducos reported that Noah’s father dismissed her attempt to schedule the long-delayed meeting with DCFS that was agreed at the May 22 meeting, saying they wanted no further involvement with the agency–a strange thing for a social worker to accept as the prompt scheduling of the meeting should have been a condition for keeping Noah at home.

In the final week of Noah’s life, Vasquez Ducos (perhaps sensing impending disaster and seeking justification) set her sights on the people who tried to protect Noah, stating in emails that Johnson was biased towards Noah’s family, that great-grandmother Hernandez (the only person who treated Noah like a mother) was at fault for biasing Johnson, and that Noah’s parents were victims of DCFS. “I feel like as a Department we have been picking on this family,” she wrote on July 3. Three days later Noah was dead.

A close reading of the Times-UC Berkeley article and the OCP report shows that DCFS disregarded numerous red flags that should have been obvious to any competent social worker with a modicum of training: the parents’ repeated failure to comply with the terms of their custody order; the admissions of abuse and subsequent retractions by Noah; his unsolicited comment that his parents treated and fed him well and other obvious signs of coaching; the assessment indicating that the mother had traits of a sociopath; and the comments by the previous social worker, among many others. There were multiple failures in case practice including the ignored removal order, the disregarded court order for a medical exam, the lack of response to the parents’ repeated failure to comply with the terms of their custody (a reason in itself for removal of the child); and the failure to schedule a family meeting which was an essential component of the plan to leave Noah at home.

But what makes this more than yet another story of missed red flags and bad case practice is the explicit evidence of the impact of two factors—bias accusations and “strength-based practice–in the death of Noah Cuatro.

Bias accusations

From the beginning of her involvement, Vasquez Ducos seemed to be convinced by Noah’s parents that Susan Johnson was biased against Noah’s parents. The charge of bias took place in the context of a state and national reckoning with racial and cultural bias against people of color. As I’ve written, there is a growing focus on the disparities in child welfare involvement between different racial and ethnic groups. These disparities are evident as they relate to Black and Native American children, who are much more likely to be reported to CPS, found to be abused or neglected, and placed in foster care, than White children. But this is not the case for Latinos like Noah, who actually are underrepresented in foster care nationally, constituting 25.4 percent of the child population but only 20.8 percent of those in foster care. In California, Latino children enter foster care at the same rate as all children–5.3 per thousand in the population, and in Los Angeles County they enter foster care at a slightly lower rate. Yet, “people of color” who are said to be over-represented in foster care and child welfare services are often assumed to include Latinos.

The extent to which Vasquez Ducos and her supervisors believed that Johnson (a Black woman) was biased against Latino families is unclear. The previous social worker, who had argued for removal, was Latina. The great-grandmother, who Vasquez-Ducos accused of influencing Jackson against Juarez, was also Latina. Yet, the Times reported that the administrator who quashed the removal order also wanted Johnson replaced with a Spanish-speaking social worker, even though the entire family was fluent in English except for one person in the extended family. Whatever the cause, the facile use of the bias label seemed to blind Vasquez Ducos to the evidence that should have been apparent to any minimally-trained investigative social worker.

The reporters found something very telling in Vasquez Ducos’ notes. She quoted Juarez as saying “Why would we hurt our baby when we just got him back? I have had this case open for four years, and I have been told I’m good enough to only have my two kids but not Noah. How does that make sense?” Apparently Vasquez Ducos agreed. She must have never learned about the well-known phenomenon of one child in a family being targeted for abuse, as well as the attachment problems that can ensue when an infant is apart from its mother from birth, information that one hopes is included in training for child protective services workers everywhere.

Strength-based practice

Perhaps even more important than the bias issue is the role that a “signature” DCFS policy played in Noah’s death. In telling testimony reported by the Times, Vasquez Ducos’ supervisor reported that “DCFS management wanted to follow the core “practice model” that requires workers to remain focused on the positive, taking a better look at a family’s strengths and less at its weaknesses.” Similarly, Hernandez Aviles told the grand jury that colleagues decided not to remove Noah in line with the agency’s “strength based approach.”

According to Los Angeles DCFS website, its social workers use a “Core Practice Model that prioritizes child safety while emphasizing strengths over deficits, addressing underlying needs over behaviors, and instilling empowerment over helplessness.” This Core Practice Model is an example of what is generally called “strength-based practice,” a theory of social work practice that emphasizes clients’ self-determination and strengths.

I am familiar with this approach because I was trained in a similar model by the District of Columbia’s Child and Family Services Agency. We learned that in the past, child welfare practice was characterized by an emphasis on deficits, telling parents what is wrong with them and what they must fix. This approach, we were told, created hopelessness among parents and interfered with the development of good relationships with social workers. We were told that strength-based practice empowers families to make positive self-directed change.

It makes sense find a family’s strengths, emphasize them to the family and build on them. I certainly tried to do this when I worked with families that were trying to get their children back from foster care. But to disregard problems that could lead to harm to a child in no way “prioritizes child safety” as DCF claims to do. Noah’s case shows how disregarding family problems despite numerous red flags can lead to tragedy.

But strength-based practice is in line with a national movement focusing on parents’ rights and stressing the importance of keeping families together, with removals eliminated or drastically restricted. This movement has been reinforced by the current racial reckoning, which has produce arguments that child protective services is nothing more than a “family policing system.” Noah’s case shows what can go wrong when this philosophy goes unchecked.

Bobby Cagle, the Director of DCFS, told the reporters that he saw no problems with his agency’s policies or its handling of Noah’s case. He refused to say if any employee was disciplined as a result. Firing people is not a solution to such unnecessary deaths as that of Noah. However, it seems likely that one or more people in the Lancaster office of DSS are so unsuited to their jobs that they pose a danger to children. Keeping them on the job is unacceptable on child protection grounds, not to mention the need for accountability.

The death of Noah Cuatro was a tragedy. The fear and suffering that he endured starting from the time he was returned to his parents at the age of four was also a tragedy. We cannot know many children are suffering at this very moment because social workers or their bosses miss the most obvious red flags due to ignorance, overwork or because their ideology or training does not allow them to see the glaring faults of their parents. DCFS’ Office of Child Protection tried to cover up this horrendous failure that cost the life of a child. The Los Angeles Times and UC Berkeley deserve kudos for providing the answers that OCP tried to cover up.

*According to OCP, a removal order authorizes, but does not require removal of a child. However the court must be notified within ten days if the child is not removed. Nobody notified the court that the removal order obtained by Johnson was not carried out until the hearing on June 25, more than 45 days after the order was approved. The ordered medical exam had never been carried out.