The shift to virtual education caused by the coronavirus pandemic has raised serious concerns about the risks to children’s educational performance and personal safety without the in-person support and monitoring provided by schools. Yet, homeschooled children were in this situation before the pandemic and will remain in it once schools re-open. While most homeschooling parents are dedicated to their children’s education and wellbeing, the lack of oversight of American homeschoolers has provided an opportunity for a small proportion of homeschooling parents to abuse or neglect their children without any interference from the government, as I have described in the past.
I was honored to be invited to a Summit on Homeschooling convened by Harvard Law School’s Child Advocacy Program on June 9-11, 2021. The Summit was cosponsored by the Academy on Violence and Abuse, American Professional Society on Abuse of Children, Institute for Human Services, New York Foundling, William & Mary Bill of Rights Institute, and Zero Abuse Project. The purpose of the conference was to bring together leading experts in the field to discuss the nature of the problem, the reforms needed, and how to achieve them.
Modern homeschooling emerged in the 1970’s and 1980’s largely from a leftist critique of public education, as Sean Peters from the University of Wisconsin explained to summit attendees. But over time, conservative religious families flocked to homeschooling fed by the burgeoning evangelical movement which turned away from public schools due to concerns about the the teaching of sex education and evolution and the absence of prayer and Christian education. According to the National Center for Educational Statistics, the number of homeschooled students nearly doubled from from 850,000 in 1999 to 1.7 million in 2016.
Some of the parents who flocked to homeschooling were motivated by a desire for total parental control. Many of these parents were influenced by writers such as James Dobson and Michael Pearl. Dobson, founder of the conservative Christian media ministry Focus on the Family, wrote a book called The Strong-Willed Child, which described how the two-hundred-pound psychologist beat a 12-pound dachshund into submission and recommended that parents use the same tactics on their children. Michael and Debi Pearl teach a method of child discipline based on “breaking a child’s will.” Their approach involves using switches on babies as young as six months and beating older children with belts and plumbing tubes. Their book, To Train Up a Child, has sold hundreds of thousands of copies and advocates that parents beat their children into submission, withhold food, and hose them down when they soil themselves. Their books have been linked to the abuse deaths of three children.
The current absence of regulation means there is very little protection for children whose parents are following the dictates of Dodson and Pearl. As Professor James Dwyer of William and Mary, one of the co-organizers of the Summit, explained, “There is no question that states constitutionally may impose conditions for homeschooling reasonably designed to ensure children’s physical wellbeing and academic development. Yet the current state of regulation amounts to complete abdication of government responsibility in nearly all states.” 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. Shockingly, there is no requirement in any state that any adult outside the family have any contact with the child.
Harvard’s Elizabeth Bartholet, who co-organized the summit, stated that the U.S. is an outlier in its allowance of homeschooling with minimal regulation, as she explained in a 2020 article. She noted that this is characteristic of a broader problem in the U.S., where “child rights are regularly trumped by adult rights.” Bartholet contrasted this to attitudes in almost all other countries, where child rights are given equal value with adult rights, child rights to education and protection are guaranteed by national constitutions, and homeschooling is banned or carefully regulated.
Unfortunately, we know very little about the association of homeschooling with child maltreatment due to data limitations. But there are some troubling reports. Child abuse pediatrician Barbara Knox described her study of 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. The majority of these families had multiple prior reports for suspected maltreatment. The Coalition for Responsible Home Education (CHRE) 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.
A lack of data on homeschooled children makes large-scale studies of the correlation of homeschooling with child maltreatment or educational performance impossible. Emily Putnam-Hornstein, one of the nation’s leading child welfare researchers, described her inability to obtain a list (without identifiers) of homeschooled children in California to compare against child welfare system data because the state does not collect any data on these children. In order to allow for such a study, a jurisdiction would have to require registration of homeschooled students, who would then be assigned a tracking number to enable crosschecking with other databases, such as maltreated children. (The same problem and potential solution applies to the much larger group of children attending private school).
Some of the most powerful testimony at the summit came from adults who were homeschooled as children. Many are part of the first large wave of homeschooled children, who found each other on Facebook, resulting in the founding of the Coalition for Responsible Home Education (CRHE) in 2013. Fueled by passion, many of them have been working for no pay as staff of the CRHE. Sarah Henderson, CRHE’s advocacy and support coordinator, was the second of nine children. She was homeschooled from the ages of five to 14 and then expected to care for her younger siblings without receiving any education. Her parents fell under the sway of writers like Dodson and Pearl who instructed parents to seek absolute control over their children. She had to watch as her nine-month-old sister was hit with a stick for playing with her food. Her family moved frequently to avoid investigations for child abuse. At 13, she began a campaign to help her siblings, which resulted in her father being removed from the home and her siblings being sent to school. At 17 she went to high school, then went on to get her Bachelor’s degree.
What can be done to ensure that other suffering homeschooled children don’t have to depend on an unusually brave and persistent big sister to rescue them? Participants agreed that regulation is needed but differed on how strict it should be. Rachel Coleman, Founder of CRHE argued for a three-point program, some of which is described in CRHE’s website. Comprehensive oversight would include annual notice of homeschooling, annual (or more frequent) assessment by a mandatory reporter, a requirement for annual physicals, and Individualized Education Plans (IEP’s) for homeschooled students with disabilities. Special protections for at risk children could include a prohibition on homeschooling by parents who have committed offenses that would disqualify them from teaching school and additional monitoring for children considered at risk. Voluntary incentive programs, such as Alaska’s program which gives homeschoolers access to athletics and academic enrichment under the auspices of school districts, would provide benefits for homeschooled children while keeping them under the umbrella of the school system.
While I agree with the CRHE proposals, I would also give priority to requiring that every homeschooled student be registered with their local school districts and receive an identification number for the purposes of tracking student outcomes. It is only through data that we can assess the possible connection of homeschooling to child maltreatment. Whether this could be required on the federal level (perhaps as a condition for education funding) or only individually by state, and whether it would requires legislative action, are topics beyond my expertise, but I hope that this proposal generates a robust discussion.
Unfortunately, the summit made clear that the homeschool lobby is a severe threat to any attempt at reform, no matter how small. 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. HSLADA 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 described by Jessica Huseman in an investigation by Pro Publica. Not all of HSLDA’S legislative campaigns deal strictly with homeschooling. A recent campaign asked members to tell Congress to oppose a national child abuse registry, a requirement under the reauthorization bill for the Child Abuse Prevention and Treatment Act. An interstate child abuse registry would ensure that a parent’s record of child maltreatment would follow them from state to state, so that child protection authorities in the current state can access a parent’s record in states where they live previously. By throwing their weight into this campaign, which has nothing on the surface to do with child abuse, HSLDA has shown how important they think it is to keep child protective services away from homeschooled children.
States also have their own homeschool parent associations, which jump into action to eliminate any perceived threats. Along with HSLDA, they have been successful in preventing even modest attempts to regulate homeschooling, such as one in Pennsylvania that would have required monitoring of children in a household with a founded CPS report for at least six months and up to two years. Huseman’s article has many more examples of homeschooling advocates’ track record in defeating any attempt to regulate the practice.
The homeschooling movement has even been able to influence court decisions. In the notorious Jonathan L. case described Bartholet’s article, two parents had been reported to CPS numerous times over 20 years for physical abuse, neglect, failure to prevent sexual abuse, and unsafe conditions in the home. The parents refused to cooperate with CPS despite a court order to do so, and the children’s lawyer requested an order that they be sent to school so that they would be seen by other adults. The court’s denial was overturned by an appellate court on the grounds that only children in private full-time day schools, or taught by a certified teacher or tutor, were exempted from compulsory public education in California. In response to a huge outcry from the homeschooling movement, Governor Schwartzenegger, the state schools superintendent and other prominent public officials made public statements opposing the appeals court’s decision. The appeals court granted a rehearing. It received amicus briefs from many Christian homeschooling organizations and some members of Congress, and HSLDA helped represent the parents. The court reversed its original ruling and changed its interpretation of California law to allow homeschooling without requirements for parental qualifications by classifying home schools as “private full-time day schools,” which are exempt from the state’s compulsory education requirement. Readers around the country learned of this classification in the aftermath of the discovery of the thirteen Turpin children and young adults, who were found imprisoned and emaciated in their home in Riverside County after a seventeen-year-old escaped and called the police. We learned that this house of horrors was classified as a private school, but was never monitored or inspected by education authorities.
So how can child advocates achieve any success in fighting the homeschooling behemoth? With their money and single-mindedness, HSLADA and its state allies are tough adversaries. CRHE was created to provide an opposing force, with a mission that includes working with lawmakers and others interested in passing legislation to protect homeschooled children. At the summit, CRHE’s representatives stressed their readiness to help with any such efforts. But CHRE cannot match the dollars that HSLDA and state groups collect from homeschooling parents bent on preserving absolute power over their children. Readers should consider making a gift to CRHE, one of my favorite nonprofits for the justice of its cause, the brilliance and passion of its staff, and the bang for the buck, as all of its staff are currently volunteers!
As Elizabeth Bartholet pointed out, the pandemic has made us realize the importance of children going to school, except in certain special cases. So there could not be a better time for a new national push on this issue. As CRHE’s Sarah Henderson pointed out, for every horror story released, many more children may be living in hell. We cannot let this continue.
There is much confusion around child neglect. Opponents of the current child welfare system are fond of stating that most children reported to child protective services (CPS) are suffering from neglect, not abuse, that neglect is synonymous with poverty, and therefore that children are commonly being removed from home because of poverty. While neglect is clearly related to poverty, the facts suggest that the removal of children due to poverty alone is rare. To know more about this most common form of maltreatment, it is necessary to collect more specific data on the types of child neglect that are found when a neglect allegation is substantiated. Nevertheless, child welfare must recognize the important role of poverty in promoting child neglect and the role of poverty alleviation programs in child neglect prevention.
A useful way to distinguish between abuse and neglect of children is that abuse is generally an act of commission, while neglect is an act of omission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect (failure to provide for basic physical needs), medical neglect, inadequate supervision, emotional neglect, and educational neglect. Some states include exemptions for certain types of neglect, like religious exemptions for medical neglect. Twelve states and the District of Columbia exclude financial ability to provide for a child from the definition of neglect.
How true are common statements about neglect?
A number of statements about neglect are are frequently made in support of various views and proposals. These are discussed below.
The national child welfare system was established to address abuse, not neglect. This is absolutely true. The discovery of “battered child syndrome” by Henry Kempe at the University of Colorado led to the passage of child protection laws in every state within a few years. On the federal level, the Child Abuse Prevention and Treatment Act (CAPTA), which established the federal role in supporting and monitoring these systems, was also focused on abuse rather than neglect. According to an oft-quoted book about the history of CAPTA, Democrats feared that President Nixon might veto CAPTA if it was viewed as an anti-poverty program, so they took pains to reiterate that child maltreatment could happen to anybody, regardless of socioeconomic status. As a result, the responses to child maltreatment focused on mental health and parent education services rather than economic supports. In his essay, Poverty, Neglect and Cultural Denial, child welfare commentator Dee Wilson recalls that when he began working as a CPS social worker in the 1970’s, all his training focused on battered children. Yet, in his work he encountered battered babies and toddlers maybe “once or twice annually out of 100 to 150 assigned cases.” Instead, he received both in Colorado and later in Washington “a steady diet of reports of child neglect and, to a lesser extent, reports of excessive punishment of children with minor injuries that did not require medical attention.” Academic literature has contributed to the problem by failing to distinguish between abuse and neglect.
Neglect is the main reason for children’s involvement with child welfare. This is also a true statement. According to the latest data collected from the states and published in Child Maltreatment 2019, three-quarters (74.9 percent) of the 656,000 children found to be victims of maltreatment in 2019, were found to be neglected, 17.5 percent were physically abused, 9.3 percent were sexually abused, and 6.8 percent were “other.” Some children were found to be victims of both neglect and another maltreatment type. These percentages should not be viewed as an exact representation of the relative importance of different types of maltreatment. As Font and Maguire-Jack point out, investigators do not have to substantiate every allegation to justify intervention. So If there is more than one type of maltreatment in the home, investigators may not substantiate all of the different types. Thus a child found to be a victim of neglect only may actually have suffered abuse as well. Comparison of substantiation data with other sources, as shown in Font and Maguire-Jack’s table listed below. suggests that “substantiations are likely to grossly understate all forms of child maltreatment, but especially physical abuse.” So neglect does appear to be more common than abuse as a reason for child welfare involvement, but abuse may be be present in a higher fraction of cases than the percentages indicate.
Child neglect is strongly related to poverty. This is also true. Research demonstrates that poverty is a major risk factor for child neglect. According to the most recent National Incidence Study of Child Abuse and Neglect, children in low socioeconomic status households experienced maltreatment at five times the rate of other children. Studies have also demonstrated that providing economic supports for families (through programs like tax credits, passing on child support, food assistance, and child care subsidies) have direct effects on child maltreatment. We do not know exactly how poverty affects child neglect but in an excellent article in a journal issue devoted to child maltreatment Feely et al provide a useful way to think about it. They posit that the inverse of neglect is what they call “safe and consistent care or SCC,” which they define as “to provide safe, consistent supervision and constantly provide for children’s basic needs.” As they describe, time and money are two core resources a family needs to provide SCC. For a poor parent, it may be very difficult to provide acceptable levels of time and money simultaneously. So a poor parent might have to choose between going to work and letting the children be unsupervised or inappropriately supervised, or losing their job and letting their children go hungry.
Most parents found to be neglectful are actually just poor. The confusion of poverty with neglect is a trope that is cited again and again by those who advocate restricting government intervention in maltreating families. For example, Jerry Millner and David Keller, the former Associate Commissioner of the Children’s Bureau and his special assistant, have written that It’s time to stop confusing poverty with neglect. They claim that many children become involved with child welfare only because their parents are poor. For example, children might be taken into care because a parent gets evicted or cannot afford childcare and leaves them alone. Despite the popularity of this belief, the evidence does not support it. It is clear that most poor parents do not neglect their children. They find a way to provide safe and consistent care, whether it means extensive research on community resources, creative use of existing supports, or delaying the next birth until adequate resources are available to care for the children they already have. Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction, beginning with mood disorders such as depression and PTSD,” which often lead to substance abuse as a method of self-medication.
The most serious cases of neglect are often chronic. Chronic child neglect can be defined as “a parent or caregiver’s ongoing, serious pattern of deprivation of a child’s basic physical, developmental and/or emotional needs for healthy growth and development.” Chronic neglect by a single mother often opens the door for physical or sexual abuse by her boyfriend. Children who have experienced chronic neglect may suffer “serious cognitive and social deficits because of the….lack of responsive parent-to-child interaction that is essential for healthy child development.” Chronic neglect can have effects similar to trauma, such as difficulties with emotion regulation.
Many child neglect reports are frivolous and unnecessary, cluttering up the system and making it harder to identify serious maltreatment. Many critics of mandatory reporting and CPS cite a study estimating that 37.4 percent of all U.S. children (and 53 percent of Black children) experience a CPS investigation by the age of 18. Some argue that many of these reports are the consequence of a racist system that ensnares too many poor and Black families. Some are supporting bills to end anonymous mandatory reporting in New York and Texas. Another, smaller set of reports has drawn attention, as described by Naomi Schaefer Riley in her article, Reforming Child Neglect Laws. These reports target stable, functional middle class families that have chosen to give their children more independence than many other parents in their geographic and demographic stratum. The case of the Meitiv children, who were picked up by police while walking a mile to their home in Silver Spring, Maryland and became the subject of not one but two CPS cases, drew publicity around the country.
It is clear that some reports coming into hotlines do not warrant investigation, but we do not know what proportion. Annual data submitted by states and compiled in the Child Maltreatment 2019 report shows that that 45.5 percent of referrals (for all kinds of maltreatment) in 2019 were screened out. And of all children receiving an investigation or alternative response, only 18.9 percent were found to be victims of maltreatment. However, research suggests that the likelihood of another report, a substantiated report, or a foster care placement is the same for a child who is the subject of a substantiated versus an unsubstantiated report. Chances are that many of the children with unsubstantiated reports were previously the subject of substantiated reports, or will be the subject of such reports later. Moreover, as Font and Maguire-Jack point out, “it seems unavoidable that some number of non-maltreated children will be reported to CPS if mandatory reporters are acting appropriately.” After all, they are told that they do not need to be sure the maltreatment is occurring, but to leave that decision to CPS. Changing that guidance, in my opinion, would be dangerous to children.
Should neglect be treated differently from abuse?
Even if neglect is not “just poverty,” some commentators argue that it should be treated differently from abuse. Two former directors of large child welfare systems, Tom Morton and Jess McDonald, argue that because child protective services were designed around abuse rather than neglect, they were patterned after the criminal justice system and treat all maltreatment as antisocial behavior. Morton and McDonald argue that because neglect is an act of omission rather than commission, it should be treated differently, The response to neglect should occur in a “public health framework” outside the current child protection system.
I do not agree that we need a separate system to deal with neglect. As I have discussed, many neglected children are also victims of abuse, whether or not it is substantiated by authorities, and neglect by one caregiver can pave the way for abuse by another. We already have a criminal justice system that addresses criminal abuse and neglect separately from the child welfare system. While the effect may seem punitive, the goal of CPS is to make children safe, not punish parents. Both abuse and neglect make a child unsafe, and the first mission of child welfare is to ensure child safety. Splitting this mission into two is probably not be the best way to promote children’s safety.
Even if we do not need a separate system to deal with neglect, we need to recognize the importance of anti-poverty strategies to help families provide safe and consistent care and prevent child neglect. Prevention has become a major priority of child welfare leaders and thinkers, so this is a good time to talk about incorporating poverty alleviation into child maltreatment prevention. In this new vision, as Feely et al propose and as I have discussed in an earlier post, child maltreatment (especially neglect) prevention should not be the responsibility of child welfare agencies alone. This responsibility should be shared by all the agencies responsible for alleviating poverty. The new initiatives proposed by the Biden Administration for child tax credits, universal pre-kindergarten and expanded child care assistance should be a good beginning.
Is it time to drop the term “neglect”?
In an article in The Imprint, Rebecca Masterson of Gen Justice argues correctly that the term “child neglect” has become almost meaningless because it is used so broadly and so deceptively as a symptom of poverty. Masterson argues that “neglect” needs to be replaced by more specific terms, such as abandonment or refusal of medical care. I do not agree that the term neglect should be dropped. Just as “child abuse” is an umbrella term that includes physical abuse, sexual abuse, and emotional abuse, “neglect” has value as an umbrella term that refers to acts of omission that harm children, in contrast to abuse, which is an act of commission. It makes sense to have these umbrella categories.
But the umbrella categories of “abuse” and “neglect” should not be put in the same list of categories as the specific acts (or lack thereof) underneath the umbrellas. Unfortunately, state and local data systems often list “neglect” as a category along with other more specific terms for types of neglect. This results in bizarre analyses where “neglect” is often described as the most common category of child maltreatment–more common than its subcategories–as if anything else is possible! Just as social workers do not have to check off “abuse” as well as “physical abuse,” in their agency database, they should not be asked to check off “neglect,” as well as specific types of neglect. In order to fix this problem everywhere, and to make sure we have comparable data from all states, the federal government should mandate that all states use the same subcategories of abuse and neglect, and that “abuse” and “neglect” not be among the specific categories.
In devising these alternative categories, we also must be careful to avoid confounding neglect with conditions that may cause it, such as substance abuse and mental illness. These are contributing factors that should be noted in databases and shared with the federal government but are not in themselves forms of neglect. And indeed, in some jurisdictions, like the District of Columbia, substance abuse is not considered neglect unless it is considered to impair parenting.
Child neglect is the most common form of child maltreatment, yet it received little attention in the first decades of the modern child welfare system. It took a long time for child welfare scholars and leaders to recognize the importance of neglect. Unfortunately now that they have recognized its importance, many leaders are using this new knowledge in order to support their proposals to upend child welfare in ways that may be harmful to neglected children. This misuse of the concept of neglect can be addressed by requiring that child welfare agencies collect uniform data on the types of neglect that are being found. That being said, it is important for child welfare leaders to understand the importance of poverty alleviation strategies in preventing maltreatment in general and to recognize that this job does not belong to the child welfare system.
Last week I discussed the scathing report by Massachusetts’ Child Advocate revealing the many opportunities that the Massachusetts Department of Children and Families (DCF), Juvenile Court, and schools missed to prevent death of David Almond and the serious physical and emotional injuries to his brothers.” All of these agencies were aware of multiple red flags in David’s case but somehow, unbelievably, managed to disregard them all. The report describes seven months of abuse, starvation and denial of their right to education of two autistic boys, as the family systematically lied to school and DCF staff and kept the boys out of their sight. The family’s efforts to use the COVID-19 pandemic to avoid any scrutiny of the boys’ well-being apparently transparently obvious to readers of the Advocate’s report but apparently raised no red flags for those paid to care for and educate these vulnerable children.
On May 4, Massachusetts Child Advocate Maria Mossaides testified about her 107-page report. If her testimony was anything like reading the report itself, it should have been devastating and left little room for questions other than “How could this happen?” and “How can we make sure it never happens again?” But Committee Chair Sen. Adam Gomez did not seem touched by the suffering of the boys and failure of any agency to protect them. As described in Shira Schoenberg’s May 6, 2021 article, Gomez’s first question had to do with race. What he wanted to know was “Did Mossaides’s analysis of the Almond case….incorporate a racial equity lens and consider whether there was a ‘racial difference in the treatment of the Almond family with similarly situated families of color?’”
How could this be the first question asked by the legislator tasked with protecting the most vulnerable Massachusetts children? As I stated in an op-ed published by Commonwealth Magazine, Gomez appears to be in thrall to a dominant narrative that has taken over the child welfare world with the help of some very wealthy foundations. in this view, CPS workers take children away from their capable and loving parents, especially parents of color, and often refuse to give them back. In this narrative CPS is likened to the police, interfering in families of color based on racial bias. Some of these advocating this view argue that both the police and CPS should be abolished.
It is true that Black and indigenous children are more likely to be placed in foster care than White children. National data indicate that Black children represent 23 percent of the children in foster care, compared to only 14 percent of children in the general population. Native American children are approximately two percent of the children in foster care compared to one percent of the child population. Latino children are actually underrepresented in foster care at the national level, though they are overrepresented in some states, including Massachusetts, as Commonwealth Magazine recently reported.
There is considerable evidence that the disparities in foster care placement between Black, Indigenous and White families are due to differences in the underlying rate of child abuse and neglect. However, that is actually beside the point that Senator Gomez was making. He was asking if David Almond would have been reunified with his family had he been Black. Studies do indicate that families of color wait longer to reunify with their children. But new research indicates that after adjusting for other relevant factors (like the cause of removal and the length of stay in foster care), there are no differences in thelikelihood of reunification with their families for Black or multiracial children and White children. Hispanic children are more likely to reunify with their families, and indigenous children do have lower odds of reunification than White children. Moreover, a state’s degree of disproportionality in representation of Black and Hispanic children in foster care did not affect its reunification rates for these children. So there is no evidence that David would not have been reunified with his father had he been Black or Hispanic.
But let us set aside the research and follow Gomez’ thinking to its logical condition. Let us say he is right, and David would not have been returned to his parents had he been Black, Indigenous or of color (or “BIPOC,” as he put it). In that case, David would have been saved. The only logical conclusion is that Massachusetts ought to take steps to ensure that White children receive the same level of protection from deadly parental abuse as is currently afforded “BIPOC” children. Yet somehow this does not appear to be the point Senator Gomez was attempting to make.
Perhaps one key to Gomez’ apparent paradoxical thinking is that he and other child welfare “racialists” like to focus on the rights of parents, not children. According to this thinking, David’s parents benefited from White privilege by being given the benefit of the doubt over and over again. Perhaps if David’s parents had been Black, they would have lost custody of David earlier- before he had been removed from them and returned to them four times. But thanks to their White privilege, David’s parents got to keep (and kill) their child while Black parents would not have been afforded the same privilege.
Of course taking a child-oriented perspective flips the script, so to speak. Where David was allowed to die, a Black child in his his shoes might have been saved by a system that Gomez believes is harder on parents of color. But Gomez is not worrying about Black children dying at the hands of their parents. He and his allies are worried about the unfair treatment of Black parents who might not be extended the privilege of keeping their children long after compassion and common sense dictated a removal to a safe place.
I’m not sure why Gomez and his friends have chosen to focus on the treatment of parents rather than children. Perhaps the answer is that if they talked about children instead, they would have to make clear that they want lower standards for how children of color can be treated compared to White children. And that would hardly be a compelling argument for for anyone who cares about children of any race.
This is an expanded version of an op-ed published in Commonwealth Magazine on May 13, 2021.
I have been trying to avoid writing more posts about children failed by state systems that exist to protect them. No matter how many reports are written, these fatalities continue to occur with devastating regularity, and I’m not sure if my posts do any good. But despite my resolution to avoid such stories, I feel compelled to write about David Almond, a fourteen-year-old boy with Autism Spectrum Disorder who died of abuse and neglect on October 21, 2020. I have to write about David for many reasons, including the sheer number of red flags that were disregarded by child welfare, schools and courts in his case; the light his death sheds on risks to children with special needs, and what it shows about the peril posed to abuse victims by the quarantines due to COVID-19.
The Massachusetts Office of Child Advocate (OCA) issued a scathing report in March that revealed “multiple missed opportunities for prevention and intervention prior to the death of David Almond and the discovery of the serious physical and emotional injuries to his brothers.” David’s family was under the supervision or monitoring of the Department of Children and Families (DCF), the juvenile court, the education system and many service providers at the time of David’s death. Reading OCA’s account of the family’s involvement with DCF alone, it is hard to comprehend the many misguided actions and missed opportunities that allowed David to be returned to a family patently unable to care for him and then to deteriorate physically and emotionally over a period of seven months, culminating in his death. The attachment to this blog lays out the sad chronology assembled by OCA, which I summarize more briefly below..
David, Michael and Noah Almond were triplets born in February, 2006 in Syracuse, NY and diagnosed with Autism Spectrum Disorder at the age of about two. Between 2006 and 2013, the triplets were removed from their parents three times by the New York State Office of Children and Family Services (OCFS) due to substance abuse, mental illness, “deplorable living conditions,” medical neglect, inadequate supervision, and “a general lack of basic care.” After working toward termination of the parents’ rights, OCFS inexplicably shifted gears and a New York Family Court awarded full custody of the boys, now aged ten, to Almond, who was living in Massachusetts, in September 2016.
Upon receiving custody, Almond moved the boys to the one-bedroom apartment in Fall River, Massachusetts, which he shared with his partner, Jaclyn Coleman, and his mother, Ann Shadburn. Almond had been removed as a child from Shadburn, whose parental rights to all her children had been terminated due to abuse and neglect. Almond and Coleman were both in DCF custody for part of their childhoods due to abuse and neglect, mental illness, physical violence, and substance abuse. By August 2017, Coleman had a new baby (Aiden) and three reports had already come into Masachusetts’ child abuse hotline concerning the family.
In October 2017, all four children were removed from Almond and Coleman because of abuse and neglect, parental substance abuse, unsanitary home conditions, medical neglect, and the triplets’ excessive absences from school. In the words of OCA, “This was the fourth time in the triplets’ young lives that they were removed from Mr. Almond for the identical pattern of abuse and neglect.” But four strikes was not enough. The parents agreed to a plan requiring them to engage in therapy to address longstanding substance abuse and mental health issues, submit to random drug tests, participate in family therapy with the triplets, complete psychological evaluations, and complete parenting classes. Aiden was placed in foster care and the triplets were eventually placed in a residential facility specializing in autism spectrum disorder and intellectual disability.
While the triplets thrived in their residential facility, Coleman and Almond displayed minimal compliance with their plans, and the children’s permanency goal was changed to adoption in January 2019. But in July 2019, the children’s goal was changed back to reunification based on the parents’ improved compliance with their case plan, and Aiden was returned home the next day. This occurred, as OCA put it, “despite Mr. Almond’s failure to engage with therapy, despite Ms. Coleman’s limited engagement with therapy, and despite the lack of any documentation of any change in Mr. Almond and Ms. Coleman’s ability to parent, specifically their ability to parent children with special needs.” OCA attributes this decision mainly to a parenting evaluation conducted by a contractor that did not adequately assess the caregivers’ ability to care for the children.
In December 2019, DCF Fall River area office management decided to begin the reunification process for the triplets. This decision was made despite concerns raised by the family support provider and the case management team (social worker and supervisor) that the parents were canceling appointments, and more generally regarding their ability to care for the triplets. Management set a target date of January 2020 for the reunification. They disregarded requests for a delay from the case management team, the residential facility and the boys’ school. These requests were based in part on the need of children for a slower transition given the children’s disability, the logic of waiting until June to eliminate an extra change of school, the limited engagement the parents had demonstrated with services, the difficulties inherent in having seven people in a one-bedroom apartment, and the threat of eviction by the landlord if the boys returned home.
As the reunification date grew nearer, Almond and Coleman canceled scheduled visits with the boys, canceled appointments with the parenting support provider, and failed to take steps to secure larger housing. During the first day visit of the boys to the home on January 10, 2020, Coleman stated that reunification was moving too fast and that the family was not yet ready for overnight visits because the apartment was too small. At the first overnight visit on February 7, Almond and Coleman reported that Noah became aggressive, and he was returned to his facility that night. After this home visit, Noah refused to return to the apartment and was allowed to remain at his residential facility. The goal of reunifying him with his parents was dropped. This young autistic boy’s self-advocacy may have saved his life.
On February 11, 2020, the residential care facility took the “extraordinary” step of sending DCF a letter opposing the reunification of David and Michael with Almond and Coleman, citing the inadequate physical environment of the home to meet the children’s therapeutic needs; the fact the parents were facing eviction; and the need for a slower, more appropriate transition plan. The reunification was delayed, but by one month only. The case management team referred the family for Applied Behavioral Analysis (ABA) Services, an evidence-based approach used in both the residential program and school that the boys attended. This service was considered essential for a successful reunification, but there was a waiting list of at least six months for ABA services. Instead of delaying the reunification, DCF chose to secure “continuum services” for the family even though these services targeted one child only (Michael) and were not a substitute for ABA’s services, which are specific to the needs of autistic children.
David and Michael were returned to Almond and Coleman on March 13, 2020, barely two months after their first day visit. Four days after the reunification, the state’s COVID-19 restrictions went into effect. Starting within days of the boys’ return home and continuing until David’s death, OCA states that Almond and Coleman “deliberately avoided contact with the DCF case management team, the Fall River Public Schools, the continuum service provider, and the parenting support service provider.” They often claimed to have phone or internet access issues that prevented them from responding or being on video. When offered help in dealing with these issues, they refused or provided conflicting information.
Between March and September 2020, the case management team conducted monthly virtual visits with the family and received many communications from providers and schools. During this period, the team missed multiple red flags and opportunities to prevent the tragedy that eventually occurred. The team disregarded evidence from their own virtual visits, such as Coleman’s berating of David for his alleged behavior and her coaching of the boys to provide the desired responses to the case manager’s questions. But they never sought to interview David and Michael outside the presence of the adults. Exactly two months before David’s death, DCF received received a new CPS report about conditions in the home and substance abuse by Coleman and Almond. But the case management team accepted Coleman’s attribution of the report to a malicious neighbor and did not request drug tests for Coleman and Almond.
The team ignored concerning reports from providers and schools. These included the termination of services by the parenting services provider due to Coleman and Almond’s failure to engage with services; consistent reports from the continuum services provider that Coleman refused to allow them to speak to Michael, the targeted child for these services, and were resistant to the support and the strategies offered to address the boys’ behaviors; and David was never allowed to see the therapist obtained by DCF. DCF heard from Fall River Public Schools that Coleman and Almond refused the Chromebooks offered by the school in May but never submitted the paper packets they had chosen to complete instead. Instead, DCF learned that that the boys were not logging into school in the fall semester (a report Coleman denied, as she was logging into the schools’ electronic attendance system to falsely mark the boys “present.” ). They learned that David had missed his physical in July and two subsequently scheduled appointments.
David’s school, despite making multiple concerning reports to DCF case management, also missed many chances to save David. In one striking example, a school attendance officer came to drop off Chromebooks for David and Michael only 20 days before David was found dead. Coleman met the officer outside, refusing him entry in the apartment, and the offer did not attempt to see the boys. Apparently he was there solely to drop off the devices and not to see David or discuss with this family his lack of engagement with school since the previous March.If that officer had seen David and noticed his physical state, David might be alive today.
On the morning of October 21, 2020, emergency medical personnel responded to a 911 call regarding David; he was bruised, emaciated, and not breathing. He was transported to Charlton Memorial Hospital and pronounced deceased. Michael was found emaciated but responsive, and Aiden was well nourished and appeared physically unharmed. Substances believed to be heroin and fentanyl were found in the apartment. Michael and Aiden were immediately removed from Almond and Coleman, who are in jail and facing criminal charges.
OCA found that DCF missed multiple opportunities to protect David and his brothers. DCF gathered insufficient information from service providers and failed to analyze the information they did get; underestimated the impact of Almond and Coleman’s substance use; failed to recognize that Almond and Coleman were using access to technology as a tactic to avoid participation in services for themselves and their children; misinterpreted the “successful” reunification of Aiden (a non-disabled child) as a predictor of a successful reunification for the triplets; disregarded the triplets’ need for a gradual transition to the home; failed to secure the recommended essential services for David and Michael to be stable and successful at home; made David responsible for his own physical safety rather than teaching him to distinguish between appropriate and inappropriate interactions how to to communicate concerns to a trusted adult; and failed to adequately identify and adjust to the complications imposed by the COVID-19 pandemic.
OCA found that DCF management failed to understand that the physical environment of the home, a small one-bedroom apartment, did not meet the needs of the triplets. This is despite hearing this concern from the DCF case management team, Almond, Coleman, Almond’s legal counsel, legal counsel for David and Michael, and several provider agencies. Incredibly, it appears that DCF management interpreted concerns from the various professionals as “an inappropriate consideration of the family’s financial means.” They seem to have disregarded the importance of physical space in the therapeutic management of autistic children and also the fact that Coleman and Almond seemed uninterested in finding a larger apartment and provided multiple excuses for not following up on housing applications.
As OCA states, “It is widely recognized that in times of crisis and economic stress there is an increase in child abuse and neglect.” Yet, OCA found that DCF did not treat the COVID-19 pandemic as a cause for reevaluation of the appropriateness of David and Michael’s reunification and did not consider the implications of the pandemic for the safety or well-being of the children. DCF seemed oblivious of Coleman and Almond’s use of the pandemic to isolate the children. Bizarrely, DCF case management staff urged school staff not to hold Coleman accountable for David and Michael’s complete absence from school, arguing that the problem was lack of technology access in the home. Case management staff also advised Coleman repeatedly to contact the school to explain that technology was the barrier to David and Michael’s participation, in order to prevent the school from filing a child neglect report against her.
Amazingly, DCF did not categorize David and Michael as high-risk children to receive in-person home visits during COVID-19. DCF appeared not to understand that that the boys’ disability, the long history of abuse and neglect in this family, the caregivers’ avoidance of contact with providers, and their reports about David’s behaviors, injuries and illnesses were all signs of children at risk. Moreover, the DCF administration has not issued statewide guidance that provides DCF personnel instructions about how to assess safety and risk during virtual home visits.
And perhaps most shockingly, DCF missed the deterioration in David’s physical and emotional state between March 13, 2020, and his death on October 21. The residential program and school where David lived and studied until March 2020 described him as having good social interaction skills, as being communicative, as having no significant behavioral issues or self-injurious behaviors, as having no aggression toward others and as having the ability to take care of his own activities of daily living. Yet within weeks of reunification Coleman was reporting that David was noncompliant, aggressive, harmed himself, and needed assistance with activities like toileting. During virtual home visits with DCF, David was always quiet and minimally communicative, while Coleman often berated and shamed him for behaviors and defiance. The case management team accepted her account and disregarded the conflict with his observed behavior and past accounts. David was a healthy weight when he left residential care. At his death, David had lost approximately 60 pounds from his last recorded weight in December 2019. It is hard to understand how anyone could have missed such a drastic change, even through a video screen.
OCA found that the Juvenile Court, including the attorney for David and Michael, did not serve as a check on the many egregious decisions of DCF. Instead, perhaps because they all agreed to return the boys home, the court and attorneys relied too heavily on DCF to determine the direction of the case. They accepted DCF’s interpretation of Aiden’s “successful” reunification as an indication of the likelihood of a similar outcome for the triplets, disregarding the differences between Aiden and the autistic triplets; failed to require a submission of a realistic reunification plan despite the judge’s statement that such a plan would be needed; accepted DCF’s narrative of the triplets’ “successful” reunification even though court reports contained information from service providers about the family’s failure to participate in services; disregarded multiple concerns about the small size of the family’s apartment and the stress it caused, based on the apparent belief that it was inappropriate to consider inadequate housing as a barrier to reunification; and never requested an analysis of the effects of the COVID-19 pandemic on the family’s ability to care for these high-needs children.
The education system’s failure of David and Michael was almost as egregious and shocking as that of DCF and the court. OCA found that the state Department of Elementary and Secondary Education (DESE) did not have the resources to monitor the provision of a free and appropriate public education in real time by local school districts during the COVID-19 pandemic. Despite their policy of prioritizing high-risk students for in-person learning, DESE “allowed families to choose the fully remote option for any reason and without a stated reason. In fact, districts were instructed not to counsel families of high risk students to choose in-person learning even if the district felt that remote learning would not be successful for a particular student.” DESE did not set higher standards for monitoring or support for high-risk students, such as those with disabilities and those involved with DFS, regardless of their choice of learning option. DESE issued no guidance to school staff on how to recognize abuse and neglect in a virtual environment. Nor did they address mandatory reporting of attendance issues until January 2021.
In addition to the failures of DESE, Fall River Public Schools (FRPS) missed multiple opportunities to save David. The shift to remote learning, coinciding exactly with the transfer of David and Michael to FRPS, meant that David was never seen by, or spoken to, by any school employee from March 2020 to the time of his death in October 2020. To their credit, school staff made numerous attempts to communicate with the parents and resolve alleged technology problems. Yet, David and Michael’s teachers never attempted to make contact with the boys directly via telephone. While they raised concerns about the boys’ lack of participation to the DCF case management team, school staff never elevated this concern by filing a neglect or truancy report. Moreover, FRPS set no attendance or participation requirements, and David was incredibly promoted to high school after being completely disengaged from his school since being transferred there in March. DESE and FRPS guidance for the fall 2020 concerning attendance tracking, contact, and grading never filtered down to school staff, perhaps preventing an intervention in the last month of David’s life.
There was another entity that could have intervened to raise concerns about the safety of the children, and that was the Massachusetts Probation Service (MPS). Massachusetts children in child welfare cases are assigned a probation officer whose role is to verify compliance with court orders, report to the court on the status of these orders and monitor the well-being of the children. The officer in this case had regular contact with the family and seemed to have a much more clear-eyed view of their problems than did DCF, which did not act on his expressed concerns. However, he did have a worrisome conversation with Coleman only days before David’s death in which she reported on the deterioration of both boys, that they had regressed to wearing adult diapers, that David was picking at his skin causing sores and bleeding, and that Michael had to be hospitalized for self-injury. The officer could have brought these concerns to the attention of the court before the next hearing but did not do so–possibly due to a culture discouraging such communications–and missing the last opportunity to save David.
Several questions remain even after the comprehensive review by OCA. First, what explains the New York Court’s decision to reunify the triplets with their father after taking steps toward terminating his rights? It is very concerning that OCA was not able to obtain this information in its review of court data. A court decision like this would have to be documented and would presumably been based on recommendations from Onondaga County (NY)’s Office of Children and Family Services (OCFS). It is not clear whether OCA requested documents from OCFS, and whether such a request was refused. It is necessary to understand what occasioned this about-face by New York. One cannot help wondering if the agency realized the boys would not be adopted was trying to avoid the expense of caring for the boys into adulthood.
OCA was also unable to explain the DCF area management’s unwillingness to reconsider the appropriateness of the reunification plan in the face of objections from their case management team and almost everyone else involved. OCA states that there was no pressure from the Juvenile Court, Almond, Coleman, their attorneys, nor the children’s attorney to rush a transition home. DCF administration also confirmed during this investigation that there were adequate funds in the Fall River Area Office’s budget to continue the triplets residential placement. Once again, as in New York, one has to wonder whether, despite the existence of “adequate funds” for the boys’ placement, there was in fact pressure on the local DCF office to return the boys due to the financial costs of their placement. Such budget concerns might have explained the unseemly rush to reunify despite the unavailability of a crucial service and adequate housing and the clear logic of waiting until the triplets completed their educational program in June 2020.
It is hard to avoid speculating about whether Almond and his paramour actually wanted custody of David and Michael. It appears that Almond and Coleman wanted Aiden back (not surprising as he was Coleman’s son and not disabled) and that is why they began to cooperate somewhat with services after an initial period of total noncompliance. There is no evidence that the couple were pushing for the return of the triplets and many indications that they tried to delay it as long as possible. Canceling visits to the boys and appointments with providers and failing to take steps to find a larger apartment could all be taken as signs of reluctance to receive the boys at home. Caring for triplets with autism plus a baby is not easy for anyone, it is hard to imagine a troubled couple like this one doing it, especially without the help that was recommended by the expert.
There is no excuse for the sheer inhumanity displayed in this household. Nevertheless, the case does call to mind the reports that are coming from all parts of the country regarding our national failure to help parents care for their mentally ill or developmentally disabled children–a crisis that is leading good parents to consider relinquishing custody of their children in order to obtain the services they need. It is possible that Almond and Coleman (not being good parents in the least) were trying hard to relinquish custody but were unsuccessful in unloading their unwanted triplets onto New York and Massachusetts. The eagerness of agency management to shed this burden and the reluctance of Almond and Coleman to take it on made for a toxic mix that killed David Almond, and left both of his brothers with lifelong wounds.
The OCA report contains many pages of recommendations for DCF, which include improving supervision, reviewing and revamping agency policies on contacts with collaterals, clients with disabilities, reunification; revamping the safety assessment process; setting standards for when and how virtual visits can be conducted, establishing a robust quality assurance system with additional monitoring at critical decision-points in a case and for higher-risk cases, and creating a “culture of continuous learning” where the “identification and correction of errors, miscalculations, or misinterpretations is encouraged and commended.” Many more recommendations targeted the juvenile court, the Probation Services, and the public schools.
While this report is unique due in its exploration of the complications due to the COVID-19 pandemic, we have seen too many similar reports from all of the country over many years. Most recently, Maine’s child welfare ombudsman found that the system continues to struggle with making an informed decision about whether to send a child home from foster care and whether to end agency supervision of reunified children. In a review of 82 cases closed in the past year, they found 20 cases where reunification practices were at issue.
Commonwealth Magazine notes that OCA conducted comprehensive investigations in 2013 and 2015, following three high-profile child deaths. Since 2015, the Legislature and Gov. Charlie Baker’s administration have increased funding for DCF by more than $200 million, added more than 650 positions, reduced caseloads, and introduced numerous reforms. Yet, Fall River State Representative Carole Fiola pointed out that many of the same patterns of agency malfunction were found in the earlier reports. This is indeed discouraging. Perhaps stronger measures are required.
A “three strikes law” for abuse and neglect might be one such stronger measure. Perhaps parents should not be given another chance after three or more removals. And this question brings up the role of ideology, especially as it might be expressed by managers who are unfamiliar with the actual details of the case. In the current child welfare climate, it often seems that parents can do no wrong. As noted repeatedly in the this case, there was too little focus on the problems that brought the children into care, and too little assessment of whether these problems were truly solved before the children were returned. This may not be atypical or surprising, given the current emphasis on family preservation and “strength-based” approaches to working with families, which ask social workers to minimize problems and find strengths wherever they can. There is certainly value in this perspective as a corrective to an earlier focus exclusively on problems, but taken too far it can be deadly.
The reluctance of the agency, lawyers and court personnel to consider housing adequacy as a prerequisite to reunification was another dysfunctional intrusion by ideology into case practice. Today’s dominant narrative asserts that children are being removed from families due to poverty that is being couched as neglect by intrusive child protective services systems. Poverty should not be a reason for removal nor should it be a barrier to reunification. But this case was not so simple. Almond and Coleman took no steps to apply for larger housing, despite being offered many opportunities to do so. It is possible that their reluctance to apply stemmed to their hope that they would not be saddled with the three boys. But the reigning narrative may have blinded agency management, court and lawyers to this concerning lack of action by the boys’ father and his paramour.
David’s case warns us to beware of the blanket statements often pushed by the child welfare establishment. It is often accepted as common knowledge that children do best with their family of origin, that in rare cases where children cannot remain at home the best placement is a relative (like Ann Shadburn?), and that congregate care is always the worst placement for children. None of these “truths” were correct for David and his brothers. Perhaps David’s story will lead some leaders and commentators to ask themselves what a home really is, and to understand that it is the presence of love, not the type of setting, that matters to a child.
“It is tempting to characterize this case as resulting from a ‘perfect storm,'” says the OCA, while not expressing an opinion on whether that is an apt characterization. The “perfect storm” explanation is often used by governments to argue against placing significant weight on individual cases, no matter how egregious. “A system should not be judged by one case, no matter how sad or sensational,” said Joette Katz, Commissioner of Connecticut Department of Children and Families (DCF) as reported by the Hartford Courant. Katz was talking about the death of Matthew Tirado, an autistic 17-year-old, on February 14, 2017 from prolonged abuse and neglect by his mother. Matthew had been known to Connecticut’s Department of Children and Families since the age of five, as revealed by a heartbreaking report from Connecticut’s Office of the Child Advocate. Yes, A System Should be Judged by One Case was my answer to Katz. If David’s death was the outcome of a perfect storm, it was also the tip of the iceberg. If professionals are capable of making the kind of mistakes they made over and over again in this case, similar mistakes are obviously occurring in other cases. For every David Almond or Matthew Tirado, there must be many other children left in abusive and neglectful homes who never come to our attention because they are not actually killed albeit suffer lifetime damage. But the cost in current suffering and future damage is incalculable.
Certainly the COVID-19 pandemic was a large part of the “perfect storm” leading to David’s death. Thankfully, the pandemic appears to be easing and schools should be open full time next fall. However many jurisdictions plan to retain a virtual option next fall. OCA expressed concern that even though an in-person option was offered to the boys in Fall 2020, parents were allowed to choose virtual education without any stated reason and even if the district felt that remote learning would not be successful for a particular student. OCA made many recommendations for improving the oversight of children in virtual education but did not make a recommendation that addressed this finding. It is my view that jurisdictions should establish guidelines for approval of virtual education for each student and require a waiver for any student whose guardians request virtual education for reasons that are not included in these guidelines. Many advocates for children and domestic violence victims, such as Andrew Campbell, have warned from the outset of the pandemic of the dangers facing people who locked in with abusers. David’s case showed how right they were and that planning for future emergencies needs to include better provisions for such vulnerable people, including school-aged children.
COVID-19 will end, but I will continue to write about the Davids, the Matthews and all of the children who are failed by the agencies that exist to protect them. I will continue to write about them until we learn to value our children more than money or ideology, and until we decide as a nation that children will no longer be collateral damage in the pursuit of other goals, whether pandemic containment, “family preservation,” or budget savings.
Attachment: Chronology of the case of David Almond, from the Office of the Child Advocate Report
February, 2006: David, Michael and Noah Almond were born in Syracuse, NY to Sarah and John Almond, as described in OCA’ s devastating report. The triplets were all diagnosed with Autism Spectrum Disorder at the age of about two.
2006 to 2013: the triplets were removed from their parents three times by the New York State Office of Children and Family Services (OCFS) due to substance abuse, mental illness, “deplorable living conditions,” medical neglect, inadequate supervision, and “a general lack of basic care.” Their mother had no contact with them after the final removal, and their father moved to Massachusetts. OCFS began steps to terminate the parents’ rights to the boys, but never completed the process.
September 2016: A New York Family Court awarded full custody of the boys to Almond, who was living in Massachusetts, in September 2016, after years of minimal or no contact. Almond moved the boys to the one-bedroom apartment in Fall River, Massachusetts, which he shared with his partner, Jaclyn Coleman, and his mother, Ann Shadburn. All three had a history of abuse and neglect as a victim or perpetrator. Shadburn’s parental rights to all of her children, including John Almond, had been terminated. Almond and Coleman were both in DCF custody for part of their childhoods due to abuse and neglect, mental illness, physical violence, and substance abuse.
June 2017: The first two abuse or neglect reports were called into the Massachusetts hotline concerning the children. Another report came in that August, citing Coleman’s substance abuse and questions about the parents’ ability to meet the needs of their newborn son, Aiden, as well as of the triplets.
October 2017: All four children were removed from Almond and Coleman because of abuse and neglect, parental substance abuse, unsanitary home conditions, medical neglect, and the triplets’ excessive absences from school. In the words of OCA, “This was the fourth time in the triplets’ young lives that they were removed from Mr. Almond for the identical pattern of abuse and neglect.” But four strikes was not enough. The parents agreed to a plan requiring them to engage in therapy to address longstanding substance abuse and mental health issues, submit to random drug tests, participate in family therapy with the triplets, complete psychological evaluations, and complete parenting classes. Aiden was placed in foster care and the triplets were eventually placed in a residential facility specializing in autism spectrum disorder and intellectual disability.
January 2019: While the triplets thrived in their residential facility, Coleman and Almond displayed minimal compliance with their plans, and the children’s permanency goal was changed to adoption.
July 2019; the goal for all of the children was changed back to reunification after reports that Coleman and Almond’s compliance with their plans had improved, and Aiden was returned home the next day. This occurred, as OCA put it, “despite Mr. Almond’s failure to engage with therapy, despite Ms. Coleman’s limited engagement with therapy, and despite the lack of any documentation of any change in Mr. Almond and Ms. Coleman’s ability to parent, specifically their ability to parent children with special needs.” OCA attributes this decision mainly to a parenting evaluation conducted by a contractor that did not adequately assess the caregivers’ ability to care for the children.
December 2019: DCF management decided to begin the reunification process for the triplets. This decision was made despite concerns raised by the family support provider and the case management team (social worker and supervisor). DCF management set a target date of January 2020 for the reunification. They disregarded independent requests for a delay from the case management team, the residential facility and the boys’ school.
January 10, 2020. The boys had their first day visit to the home and Coleman stated that reunification was moving too fast and that the family was not yet ready for overnight visits because the apartment was too small.
February 7, 2020: At the first overnight visit on February 7, Almond and Coleman reported that Noah became aggressive, resulting in a physical altercation. As a result, Noah was returned to his facility that night. After this home visit, Noah refused to return to the apartment and was allowed to remain at his residential facility. The goal of reunifying him with his parents was dropped.
February 11, 2020: The congregate care provider took the “extraordinary” step of sending DCF a letter opposing the reunification of David and Michael with Almond and Coleman, citing the inadequate physical environment of the home to meet the children’s therapeutic needs; the fact the parents were facing eviction; and the need for a slower, more appropriate transition plan. The reunification was delayed, but by one month only.
March 13, 2020: David and Michael were returned to Almond and Coleman, barely two months after their first day visit, while remaining in the legal custody of DCF. Four days after the reunification, the state’s COVID-19 restrictions went into effect.
April 2020: At the monthly virtual DCF visit Ms. Coleman reported that there were no concerns regarding the children’s behaviors and the children had access to a laptop for the purposes of schooling. The DCF case management team did not recognize that Ms. Coleman provided contradictory information to the continuum service provider.
May, 2020: Ms. Coleman rescheduled a DCF virtual home visit supposedly due to technology access issues. During this phone call, Ms. Coleman reported to the DCF case management team that David was vomiting from having too many snacks and was lying in his own vomit. The DCF case management team did not follow up with Ms. Coleman about how David was feeling or the possibility that David could be sick another reason. When the virtual home visit happened ten days later, Coleman took a “strong and controlling role in the communication between the DCF case management team and the children.” She prompted the children to provide specific answers to the DCF case management team questions. In the same month, the parenting support service provider cancelled the service with Almond and Coleman due to their lack of engagement with the service. Also in May, the school offered Chromebooks to David and Michael. This offer was turned down by Coleman in favor of having the boys complete paper packets. But paper packets were never submitted for either of the boys, and the school took no action.
June 2020, the continuum service provider shared with DCF Coleman’s report that Almond physically restrained David due to David’s aggression and that David was completing his chores, which included scrubbing the floor with a toothbrush. Later in the month, the continuum service provider informed DCF that Ms. Coleman reported being fearful that David and Michael would both attack her at the same time and that David refused to take his medication. The provider reported that Coleman refused an outdoor visit and was not using the provider’s emergency service line that they repeatedly urged her to use.
June 2020: In the monthly virtual DCF visit, Coleman tried to stop the boys from answering a question about whether they wanted to visit with their brother Noah, whom they had not seen since March. OCA believes that “Ms. Coleman intentionally prevented David and Michael from virtually visiting with Noah to isolate them from Noah and isolate them from the congregate care program staff that knew them well and might have identified concerns.”
June 17, 2020: A foster care review panel was held and reviewers found that “Mr. Almond and Ms. Coleman were meeting the needs of the children and participating in the continuum services. According to OCA, “It is unclear if the foster care review panel was aware that the parenting support service provider closed the case in May due to a lack of responsiveness from Mr. Almond and Ms. Coleman, and it was unclear also if the panel knew of the continuum service provider’s description of the challenges facing the family.”
July 17, 2020: The Court returned legal custody to Almond despite the lack of improvement in his and Coleman’s participation in services and no change in Coleman’s description of the boys’ behavioral challenges . Almond was not present at the hearing. On the same day Coleman refused both an outdoor and an indoor visit. According to OCA, “The DCF case management team did not observe the children, the home, or Mr. Almond or Ms. Coleman between June 19, 2020 and July 17, 2020 when David and Michael were legally returned to Mr. Almond’s care.”
July 22, 2020: At the monthly DCF virtual visit, Coleman berated David in front of the case management team for his behavior. When Michael contradicted Coleman’ account of David’s behavior, she said he was “making her look like a liar.” But at no point did the case managers seek to interview David or Michael outside Ms. Coleman’s presence.
August 2020: The continuum service provider informed the DCF case management team that Ms. Coleman had reported David scratched his collar bone until it had become raw. The DCF case management team did not follow-up with Almond or Coleman about this injury. The continuum service provider also expressed that the family was not fully engaging with the service and that the children needed Applied Behavioral Analysis (ABA) services.
August 21, 2020: DCF received a report about conditions in the home and substance abuse by Coleman and Almond. The case management team conducted a virtual home visit three days later. Coleman attributed the report to a malicious neighbor and denied the substance abuse. The team accepted her self-report and did not request drug tests for Coleman and Almond. Coleman attributed a bandage on David’s nose to self-injury and when David was asked, he followed Coleman’s prompting to corroborate her account. As OCA points out, the team neither considered the significance of self-injury as a sign of distress nor considered the possibility of parental violence as the cause of the injury.
September 14, 2020: On September 14, 2020, Michael was brought to an out-of-state hospital emergency department for an injury that Coleman reported was self-inflicted. Michael was admitted for overnight observation and discharged home the next day. This injury was not reported to DCF.
September 25, 2020: The DCF case management team had its last virtual home visit with the family. Ms. Coleman described David as having behavioral issues, and David refused to speak. Between September 20, 2020 and October 3, 2020, the family canceled or did not attend all their scheduled appointments with the continuum service provider.
On October 1, 2020, a school attendance officer came to drop off Chromebooks for David and Michael. Coleman met the officer outside and he did not attempt to see the boys as he was there solely to drop off the devices and not to see David or discuss with this family his lack of engagement with school since the previous March.If that person had seen David and noticed his physical state, David might be alive today. Twice in October, a teacher contacted DCF to report that the boys were not logging into school. The OCF team contacted Coleman, who denied that report.
October: The DCF case management team was made aware that David’s individual therapist had only been successful in contacting the family one time since August. Ms. Coleman told the case management team why that therapist was not appropriate for David.
October 5 and October 14, 2020: A teacher from Fall River Public Schools contacted the DCF case management team and reported that David and Michael were not logging into school virtually. The DCF case management team contacted Ms. Coleman, who denied this report and reported both David and Michael were attending school virtually
On October 7, 2020, the team learned that David had missed his physical in July and two subsequently scheduled appointments. A case review was held on October 14, 2020. Almond and Coleman did not attend. The review panel “inexplicably found that Mr. Almond and Ms. Coleman were meeting all the children’s needs in the home. This determination was made despite concerns regarding the family’s lack of consistent engagement and utilization of services, that David and Michael had not attended school or received any special education services since their reunification in March, and despite Ms. Coleman’s reports of David engaging in serious self-injurious behaviors.”
October 14, 2020: Another foster care review meeting was held in the absence of Almond and Coleman. In OCA’s words, “The foster care review panel inexplicably found that Mr. Almond and Ms. Coleman were meeting all the children’s needs in the home. This determination was made despite concerns regarding the family’s lack of consistent engagement and utilization of services, that David and Michael had not attended school or received any special education services since their reunification in March, and despite Ms. Coleman’s reports of David engaging in serious self-injurious behaviors.”
October 21, 2020: Emergency medical personnel responded to a 911 call regarding David; he was bruised, emaciated, and not breathing. He was transported to Charlton Memorial Hospital and pronounced deceased. Michael was found emaciated but responsive, and Aiden was well nourished and appeared physically unharmed. Substances believed to be heroin and fentanyl were found in the apartment. Michael and Aiden were immediately removed from Almond and Coleman, who are in jail and facing criminal charges.
April is Child Abuse Prevention Month, the blue pinwheels are on view around the country, and the obligatory emails and tweets are urging people to recognize the month with Facebook frames and Zoom backgrounds. And in the past year or so, prevention has become the word of the day in child welfare. This year, the House of Representatives has passed the Stronger CAPTA Act, which would raise the authorization for prevention services to match that of treatment services. CAPTA provides funds to state child welfare agencies for child abuse prevention, investigation and treatment programs. However when it comes to prevention, child welfare agencies are only a small part of the answer. Preventing child maltreatment requires the involvement of many other sectors of the government and society. It is important for prevention advocates to understand this and to work with other child advocates to support these programs.
In searching for guidance in how to view child abuse and neglect prevention, I came across an excellent 2016 publication from the Centers for Disease Control (CDC). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities provides “a select list of strategies ….based upon what we know about risk and protective factors as well as empirical evidence on whether they have been shown to affect child abuse and neglect.” The CDC cites a number of risk factors researchers have found to be associated with the perpetration of child abuse or neglect, including young parental age, single parenthood, large number of dependent children, low parental income, parental substance abuse, parental mental health issues, parental history of abuse or neglect, social isolation, family disorganization, parenting stress, intimate partner violence, poor parent-child relationships, community violence, and concentrated neighborhood disadvantage. In addition, children who are younger and have special needs are more at risk of suffering maltreatment. Protective factors include supportive family environments and social networks, and probably other factors like parental employment, adequate housing, and access to health and social services.
Considering risk and protective factors leads to a broader conception of child abuse prevention than the one promoted by federal, state and local child welfare agencies. The CDC report lays out five strategies, all of which contain approaches that have demonstrated success in preventing child maltreatment. I have added a new strategy to CDC’s list and made some other smaller changes which are explained in notes. My modified list of strategies and approaches is summarized in the table below.
Preventing Child Abuse and Neglect
Strengthen economic supports to families
-Strengthening household financial security -Family-friendly work policies
Encourage pregnancy planning, spacing and prevention*
-Increased availability of long acting contraceptives -Public engagement and education campaigns
Change social norms to support parents and positive parenting
-Public engagement and education campaigns -Legislative approaches to reduce corporal punishment
Provide quality care and education early in life
-Preschool enrichment with family engagement -Improved quality through licensing and accreditation
Provide parenting support to at-risk parents**
-Early childhood home visitation -Other parenting skills and relationship interventions -Enhanced case management plus peer engagement*** -Enhanced primary care to address maltreatment risks****
Intervene in maltreating families to lessen harms and prevent future risk
-Behavioral parent training programs -Treatment to lessen harms of abuse and neglect exposure -Treatment to prevent problem behavior and violence
**Strategy and approach titles modified by Child Welfare Monitor
***Approach added by Child Welfare Monitor
****Approach moved from following strategy by Child Welfare Monitor
As the CDC points out, the strategies address different levels, from the individual to the societal. The first four operate on the community or societal level and the CDC hypothesizes that they are most likely to have a “broad public health impact on child abuse and neglect.” The last two strategies operate on the family and individual level and would have a narrower impact focusing on targeted populations.
Strengthen Economic Support to Families: Low parental income is one of the major risk factors for child maltreatment, as documented by multiple studies cited by the CDC. Economic insecurity leads to maltreatment, presumably by making it more difficult to meet children’s needs and provide quality childcare and by increasing parental stress and depression, both risk factors for child abuse and neglect. Approaches to strengthening economic support for families could include both improving economic assistance to low-income families and intervening to support family-friendly work policies like livable wages, paid leave, and flexible and consistent scheduling. The CDC cites studies of several economic support programs for which research has demonstrated a direct effect on child abuse and neglect or associated risk factors. Perhaps the expanded 2021 child tax credit will have such an effect.
Encourage Pregnancy Planning, Spacing and Prevention: The CDC report identified young parental age and large number of dependent children as risk factors for abuse and neglect, but it did not propose a strategy to address those risk factors. But as I have written before, there are strategies to address these risk factors and they should be considered. One approach would be to expand access to long acting removable contraceptives (LARC’s). A statewide campaign to increase availability of LARC’s in Colorado resulted in a halving of the teen birth rate in five years. Another approach would be public information campaigns to inform people of the dangers of early and closely spaced childbearing and the advantages to both parents and children of pregnancy planning and spacing. Research indicate that such campaigns can change people’s health-related behavior, as in the case of smoking cessation and HIV prevention.
Change social norms to support positive parenting. As the CDC points out, norms about how we discipline our children are especially important to child abuse prevention. An analysis of 50 years of research found that spanking leads to more defiance, and increased antisocial behavior, aggression, mental health problems and cognitive difficulties. A recent study found that the percentage of parents who reported spanking a child in the previous year dropped from 50 percent in 1993 to 35 percent in 2017. Yet corporal punishment remains popular in some communities. While corporal punishment is not necessarily child abuse, it can lead to physical abuse when the parent loses control or goes too far. The CDC recommends both public education campaigns and legislative strategies to reduce the use of corporal punishment. The report cites successful public education campaigns regarding other parenting behaviors, such as emotional abuse. It also cites international studies indicating that bans on corporal punishment were successful at decreasing overall rates of corporal punishment.
Provide quality care and education early in life. Early care and education (ECE) is a particularly appealing child maltreatment prevention strategy because there are so many pathways by which it can operate to reduce child maltreatment. Quality ECE reduces parental stress, exposes the child to mandatory reporters, and reduces the time spent in an abusive or neglectful home or with an unrelated adult–often the perpetrator of severe or fatal child abuse. ECE approaches with a family engagement component may prevent maltreatment by training parents in positive discipline approaches. Approaches to providing ECE could include expanding government support to programs that combine childcare with educational enrichment and parent involvement and improving standards to increase quality. Studies suggest that childcare programs that include parent involvement are effective in preventing child maltreatment. A 15-year follow up of Child Parent Centers found that children who participated for one to two years had a 52 percent reduction in substantiated child abuse and neglect.
Provide parenting support to at-risk parents. Intervening directly with a targeted population of parents to address risk factors for child maltreatment is perhaps the most popular approach to child maltreatment prevention because it has a clear connection with child maltreatment and often falls under the jurisdiction of child welfare agencies. Such approaches include home visiting programs as well as interventions based in doctor’s offices, preschools, school or mental health clinics. These programs vary in their models and the risk factors they address. Many of these programs focus parent education and training, based upon the assumption that poor parenting skills and ineffective discipline practices can lead to maltreatment. Some interventions focus on the parent-child relationship since poor parent-child relationships are a risk factor for child maltreatment. Many of the home visiting programs include a case management component to help parents set goals for their own lives and access needed services, thus addressing risk factors like substance abuse, mental illness, and parental stress. Home visiting interventions like Nurse Family Partnership, SafeCare and Child First and parent training programs like Incredible Years and Triple P have been found to have small to moderate effects on maltreatment and related risk factors. Another approach is to use the pediatrician’s office to identify families at risk of abuse or neglect, address these risk factors at regular visits, and provide information and referrals. Both SEEK and Healthy Steps are examples of this approach that have had some promising results but needs more evaluation. A new generation of programs, as yet unproven, is connecting at risk families with both a case manager and a family engagement specialist who provides peer support. Examples of that approach include the intensive tier of Allegheny County PA’s Hello Baby program and the Detroit Prevention Project.
Intervene in maltreating families to lessen harms and prevent future risk. In this category, CDC places therapeutic programs that seek to limit the damage caused by prior maltreatment. Such programs are often known as tertiary prevention and aim at preventing further abuse and neglect or healing victims so that they do not proceed to abuse the next generation. The CDC divides these programs into three approaches. One approach is “behavioral parent training programs,” like Parent Child Interaction Therapy. Also included in this approach are SafeCare and Incredible Years, which are also in the secondary prevention category. Another approach is treatment for children and families to lessen the harms caused by abuse or neglect, such as Trauma-Focused Cognitive Behavioral Therapy. And the final approach suggested is treatment to prevent problem behavior and later involvement in violence, which includes programs such as Multisystemic Therapy. All of these programs have shown some impact on maltreatment or associated risk factors.
Of the six strategies discussed above, only the last two generally fall under jurisdiction of child welfare agencies–and and even those are often delivered by public health or behavioral health agencies or pediatricians’ offices. But the other four strategies are often not mentioned in discussions of child maltreatment prevention simply because the latter is considered to be the province of child welfare agencies. It is not surprising that the responsibility for preventing child maltreatment is often attributed to the agencies responsible for identifying and treating it. But as described above, the range of risk and protective factors is much larger than what child welfare agencies have the capacity or mandate to address. CDC suggests that public health agencies are well-suited to take the lead in developing community-wide prevention strategies that bring in the other systems that need to be involved.
It took a public health agency to articulate the broad scope of risk factors that lead to child abuse and neglect and the need for a broad spectrum of approaches to address it. Let us hope that public health agencies on the national, state and local levels can take the lead in pushing for a full spectrum of strategies that deserves the name of child maltreatment prevention.
The tide of opinion in the U.S. child welfare arena has been turning against institutional settings for foster youth for some time. A spate of reports of child abuse and improper disciplinary techniques in residential facilities for young people has intensified calls for the elimination of residential care as an option for foster youth. But as all who are intimately involved in the child welfare world know, therapeutic residential care is a critical part of the continuum of services that must be available for foster youth.
Media investigations have targeted abusive behavior by staff at poor-quality residential facilities around the country, with a spotlight on a for-profit company called Sequel. Concern and outrage reached a fever pitch when a 16-year-old boy died at a Sequel home in Michigan after being restrained for 12 minutes. The Imprint and the Texas Observer co-published a harrowing account of Residential Treatment Centers (RTC’s) in Texas, documenting horrific instances of abuse at multiple centers around the state.
Unfortunately, some commentators, like the author of the report on Texas RTC’s, are using reports of abuse and violence to support ending all residential care rather than getting rid of bad providers. These critics of residential care miss two basic points. First, there are children who, for a variety of reasons, are not having their needs met in a family setting. These are the children who bounce from foster home to foster home, spend nights in agency offices or hotels, or even end up sleeping in cars with their caseworkers. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. These children need treatment delivered in a residential setting before they can function safely and thrive in a family setting.
Perhaps some of these youths could heal and thrive in a home with professional therapeutic foster parents, an option which is gaining increasing popularity. These foster parents are highly-trained and paid to take care of children with complex needs full-time. This is an option that deserves more attention but its growth is probably limited by both the lack of willing and qualified candidates and the expense.
Residential care abolitionists also miss the importance of quality. Residential programs can range from outright abusive to very high quality and highly successful in achieving positive outcomes for their clients. In an op-ed in The Imprint, Dana Dorn and Kari Sisson of the Association of Children’s Residential Centers explain that “High-quality residential interventions have the ability to change lives for the better and are a critical part of the continuum of behavioral health services. They have well-trained and supported staff who provide individualized, trauma-informed, youth-guided, family-driven care in environments that are safe, welcoming and encourage healthy relationships.” The authors stress that providers who are incompetent or “prioritize profits” over people should not be allowed to stay in business.
Opponents of residential care often use faulty reasoning to make their point. They often state that children who attend residential care have worse outcomes than those in family care without explaining that it is the most traumatized, troubled kids with complex histories who are placed in residential facilities. Those children would be expected to have worse outcomes than their peers because they have often had the worst past experiences by the time they finally have access to treatment.
The State of Washington provides a cautionary tale of what can happen when residential care in a state almost disappears. Budget pressures stemming from the 2008 recession dovetailed with the growing sentiment against residential options, as described in an excellent article in The Imprint by Elizabeth Amon. Between 2009 and 2019, over 200 residential beds in 13 locations disappeared. Unfortunately, the state lacks enough appropriate placements for youth with psychiatric, behavioral and developmental needs. These young people end up staying overnight in offices, emergency one-night foster homes, hotels, and cars–or sent to out-of-state facilities including some operated by Sequel. Not only are these arrangements anti-therapeutic, but they are extremely expensive, as Amon points out.
In Texas, where the Imprint focused on the poor quality of many RTC’s, child welfare administrators are worried about the declining number of residential centers. Every year, at least one RTC stops contracting with the state due to inadequate reimbursement, which means they cannot pay workers enough to retain them. As a result, the number of Texas foster children sleeping in offices and hotels spiked last year, according to an article in the Austin American-Statesman. These were mainly teenagers with trauma histories and/or significant behavioral and mental health issues, according to a state official.
In New Mexico, the Department of Children, Youth and Families (CYFD) contracts with ten residential treatment centers in the state, but that is not enough to care for all the foster youth who need therapeutic residential care, as the Secretary told the Santa Fe New Mexican. As a result New Mexico still sends children to out-of-state facilities. The Secretary has requested more funding for additional therapeutic residential care resources.
In Maryland, the Baltimore Sun and WYPR reported last February that dozens of children were spending weeks or even months in psychiatric units of hospitals without a medical reason because social workers had nowhere else to place them. Often these children were placed in psychiatric units after experiencing a crisis in a foster home. Most of these children are not ready to move to a foster home upon discharge and need a higher level of supervision and therapeutic care. But there are waitlists for the roughly 350 spots at Maryland residential treatment facilities, and for out-of-state facilities as well. These long hospital stays are destructive and traumatic to the children as well as extremely expensive.
Last January, I wrote about similar problems in Oregon, New York, California, and Illinois. Residential critics miss the point. If states don’t have quality residential facilities, or any residential facilities at all, they will send their kids to facilities run by operators like Sequel, put them up in offices, hotels, temporary placements or cars, or leave them in hospitals. That’s why only three out of 40 states and territories sending children to Sequel facilities have severed ties with the company, despite its awful track record.
Those who oppose all residential care for foster youths are blind to the challenging problems of some foster youth, the life-changing potential of quality therapeutic residential care and the vast differences between high and low-quality residential facilities. We need to make sure quality residential services are well funded and regulated to keep children out of offices, hotel rooms, abusive or out-of-state facilities, and hospitals. Legislators at all levels of government must recognize the need for adequate funding of this crucial service necessary to heal the wounds of our most fragile foster youth.
On September 21, 2020, the Allegheny County (Pennsylvania) Department of Human Services (DHS) began rolling out a “first of its kind” parenting initiative called Hello Baby. The program aims to support and strengthen families of newborns who are at risk of abuse and neglect, so as to prevent the occurrence of maltreatment rather than responding after it occurs. This new program is an innovative approach that attempts to avoid the flaws of many other programs that aim to prevent child maltreatment.
Hello Baby is a “voluntary program for parents of new babies, designed to strengthen families, improve children’s outcomes, and maximize child and family well-being, safety and security.” As described in a Frequently Asked Questions document and a Methodology Report on the Allegheny County Analytics website (which contains. many other relevant documents as well), the program combines a universal entry point with differentiated services in a three-tiered approach, as described below:
Universal Tier: Services available to all new parents in the county include a “warmline,” the Hello Baby website, and a texting service staffed by volunteers to answer questions about newborns and parenting issues.
Family Support Tier: Families with “moderate needs” will be served through the existing network of 27 Family Centers located around the county. These families will have access to the rich array of services offered by these centers, including home visiting, family support, and child care subsidies.
Priority Tier: Families with the most complex needs are offered the support of a two-person team employed by Healthy Start Pittsburgh, which was selected through a Request for Proposals. The teams are made up of a family engagement specialist, who functions as a peer counselor, and a social worker who plays the role of case manager. In the pandemic environment, they will meet with families both virtually and in home visits. These teams work with families to learn about their needs, connect them to resources, and provide wraparound assistance, which will be available until the child turns three years old. This wraparound assistance can include concrete goods, transportation assistance, and connections to community resources. The priority tier model is based on the COACH Model of the Camden Coalition, a behavior change intervention for people with complex needs.
Every new mother in the county receives information about the program through her birthing hospital, OB/GYN, or pediatrician and may receive an initial visit from a nurse to talk about the program in more detail. A few weeks later, each family receives a postcard informing them of the universally available services and giving them the opportunity to opt out of further contact. Families with moderate and higher levels of need who have not opted out of services will be contacted by the Family Centers or two-person teams, respectively.
The placement of newborns into three different risk groups will be based on a predictive risk model (PRM), another unique part of this program. The model is designed to identify the families with the highest likelihood of having a child removed to foster care before the age of three. The model uses data already available from birth records, child protective services, homeless services, and justice system records to calculate a risk level for each child. Model development was led by Rhema Vaithianathan and Emily Putnam-Hornstein, along with the data science team based at the Centre for Social Data Analytics (Auckland University of Technology, NZ). Vaithianathan and Putnam-Hornstein are world leaders on the use of PRM in child welfare, and they have been working with Allegheny DHS since developing the county’s child abuse hotline screening tool in 2015. While most Priority Tier slots will be filled through PRM, some slots will be reserved for parents who request intensive support or those referred by clinical providers.
The program planners made extensive efforts to address potential concerns about privacy, coercion to participate, or involvement with child protective services (CPS). Hello Baby is not connected to CPS. The risk scores will not be shared beyond program staff, used after the initial screening, kept on file, or used for any child welfare purpose. No family will be reported to CPS for refusing to participate in the program. DHS estimates that 40 percent of the families assigned to the most intensive service tier will already be involved with child welfare. These families will be eligible for the program except when safety issues are so grave that the baby is removed right after birth by CPS. If the family agrees, Hello Baby staff can work directly with the child welfare caseworker to make sure the family receives the best services to meet their needs.
The FAQ document cites several reasons for the development of Hello Baby. For one, agency leaders recognized that the county was rich in programmatic resources but that the resources were not reaching those who needed them both. Second, they realized that the historical practice of targeting high-poverty areas for prevention efforts (like the county’s Family Centers) leaves out many families in need because the root causes of child maltreatment (such as substance abuse, mental illness and intimate partner violence) cut across economic lines. Finally, even within a community with a Family Center, evidence suggests that those who need it most may not access the services.
The focus on ages 0 to 3 was chosen because infants and children are most at risk of serious abuse and neglect–and most likely to die of such maltreatment. Almost 80 percent of Allegheny County children who suffered fatalities connected with abuse or neglect were under the age of three. And half of them were unknown to the child welfare system, which means that there had been no earlier opportunity to protect the child.
According to an account on the county’s DHS website, Allegheny’s child welfare leaders began thinking about a child maltreatment prevention program using a tiered approach supported by predictive risk modeling (PRM) in 2015, when they were developing the Allegheny Family Screening Tool (AFST) for screening hotline calls to determine their relative risk level. If they could use PRM to screen child maltreatment reports, DHS leaders asked, would there be a way for them to use these methods to reach families “BEFORE they reach the breaking point?”
The fact that Allegheny County DHS is already using PRM to screen hotline calls is a testament to the vision and courage of its leadership. Few other jurisdictions have implemented PRM in child welfare in part because of the controversy surrounding the use of an algorithm in decisions about case opening. But DHS Director Marc Cherna is one of the longest-serving human services directors, having served in the position since 1997 and has won nationwide recognition for his innovative initiatives. He was was the first director of DHS, a mega-agency that was the outcome of a merger between several discrete departments. As described in a case study, Cherna took the opportunity to create a “data warehouse” integrating information from the formerly separate agencies. This integrated database in turn provided the opportunity to improve decision-making using PRM. In response to a Request for Proposals, DHS chose the team led by Vaithianathan and Putnam-Hornstein to develop the AFST and later the Hello Baby tool as well.
Hello Baby is the outcome of many years of research and planning by DHS leadership working together with community members, according to the FAQ document. The process included an extensive literature review focused on how to engage and retain families with intensive and complex needs. In addition to the internal literature review, DHS commissioned two independent ethical reviews. The developers also met with families receiving services, service providers, clinical experts, judges, Family Court advocates, peer support agencies, national experts, local funders; and civil liberties, civil rights and social justice organizations to identify service gaps and concerns. Finally they conducted case reviews with social workers and child development experts in order to understand the population they were seeking to reach.
Hello Baby was launched on September 1, 2020 and is being piloted at a subset of sites before being rolled out statewide after a year. DHS anticipates providing Priority Tier service to five percent of families with new babies or about 650 families per year when the program is fully implemented. The County has contracted with two respected social science research institutes–Chapin Hall and the Urban Institute–to conduct process and impact evaluations of Hello Baby.
As Vaithianathan and Putnam-Hornstein explain in their methodology document, we know very little about what works, and for whom, to prevent child maltreatment. Therefore, new approaches are needed. Hello Baby’s combination of universality and targeting is appealing based on logic. As DHS. explains in an implementation brief provided to Child Welfare Monitor, universal services have many benefits, like reduced stigma, wider reach and no need for eligibility requirements. But when resources are limited, services are stretched thinly across many families. Families with the greatest needs may not get the intensity of services they need, while families with lesser needs may receive support disproportionate to their needs. Hello Baby addresses this problem with its tiered service array.
DHS has undertaken an elaborate process to protect privacy and self-determination and prevent the use of risk scores in any context other than assigning families to Hello Baby tiers. However it must be recognized that there is a tradeoff between parental self-determination and protecting children. Prior research indicates that it is difficult to engage the highest-risk families in voluntary services. By ruling out the possibility of reporting these families to CPS, DHS may be condemning some children to years of neglect, abuse, injury, or even death. We hope that DHS will collect and report on the number, risk scores, and future maltreatment reports, of those who decline to participate in order to assess the extent of this problem.
We congratulate Allegheny County for the implementation of Hello Baby. The lack of attention to the rollout by prominent child welfare organizations, thought leaders and media is surprising. We hope that child welfare leaders are are paying attention to this important initiative and thinking about options for similar programs.
: Much of the controversy around PRM centers on fears that it will exacerbate racial disparities in child welfare decision making. But an evaluation of the AFST has suggested that it has reduced, rather than increased, racial disparities in the rate of case opening between White and Black children, thus assuaging fears that it would increase such disparities.
Every year when school resumes after summer vacation, child welfare agencies brace themselves for an onslaught of reports as teachers see children after the entire summer and flood hotlines with reports of suspected abuse or neglect. Earlier in the year, many officials and advocates expressed concern that this fall would see any even greater surge of calls than usual and that child welfare agencies would be overwhelmed. But as more and more schools and systems opted for a virtual opening this year, policymakers and advocates began to worry about the opposite problem–a continued dearth of reports to child abuse hotlines and a continued fear that children are suffering unseen.
A chorus of media reports from all over the country last spring documented drastic drops in calls to child abuse hotlines following school closures due to the coronavirus pandemic. As Child Welfare Monitorreported, almost every state reported declines in hotline calls last spring, with calls dropping often by half and sometimes by as much as 70 percent since schools shut their doors. A survey of children’s advocacy centers, which work with victims of physical and sexual abuse nationwide, found a 21 percent drop in the number of children served in January through June of 2020 compared to the same period in 2019; the drop would probably be much greater if only March through June were considered.
The loss of reports from schools was the primary explanation for the drops in reports of child maltreatment. And indeed the shift to online education delivered a double-whammy to any attempts at child protection. For children who did attend virtually, it was harder for teacher to see signs of trouble, like bruises or hunger. And many students who did did not show up for virtual education regularly or at all. The New York Times heard from many teachers around the country that fewer than half of their students were participating in online education. The School Superintendent in Los Angeles has reported that only 60 percent of students participated daily in online learning last spring. A child’s failure to participate may reflect the lack of a dedicated computer or internet access, difficulties in accessing platforms, a child too busy watching siblings or even working, or lack of engagement in virtual education. Whatever the explanation for their absence, these children were not being seen by teachers, counselors or other school staff, often the ones who notice red flags. Other reporters, like doctors and extended family members, were also less likely to see children under the Covid-19 quarantine.
More detailed data from Allegheny County Pennsylvania and two Colorado counties (shared in a webinar from Mathematica Policy Research) and from Maine (shared in a Child Welfare League of America webinar) shed some light on changes in reporting trends in the last school year and what they might mean. The number of calls to child abuse hotlines (also called reports or referrals), as compared to the previous year, fell dramatically in all three states. The decline in reports was especially marked among teachers and other school staff such as counselors. In all the jurisdictions the lower-risk referrals tended to drop off the most. In the data for Colorado and Allegheny County, where predictive risk modeling is used to screen hotline calls, the average risk scores of the children being referred rose, suggesting that the lower-risk referrals tended to drop off more than the higher risk referrals. Maine officials found that reports were generally more severe and that they were getting fewer reports that were screened out as inappropriate or because there were multiple reports from the same family. Participants in both webinars suggested that in normal times schools make too many unnecessary reports for minor issues, and that many of these reports were being suppressed by the school closures.
It is encouraging that less serious referrals are more likely to be dropped than more serious ones, but it is equally clear that higher-risk referrals are being lost as well. Another important indicator is the percentage of referrals that result in a substantiation–or a finding that abuse or neglect has occurred. If the missing referrals were mainly frivolous, we would expect a big increase in the percentage of reports that was substantiated. That did not occur in at least one state–Michigan–spurring its child welfare director to design an initiative discussed below. Unfortunately, substantiation data on a national level for last spring will not be available for another year from the federal government.
At the same time that reports dropped, many child advocates have expressed fear that child maltreatment has actually increased. Based on past research, family violence increases in times of natural or economic disasters, probably in large part due to parental stress. In addition to the stress imposed by job loss and health concerns, parents who are cooped up in close quarters for months with their children may be more prone to respond with violence. And parents who need to work despite school closures may leave their children uncared for or with caregivers who are unprepared.
Despite these reasons to suspect that child maltreatment may be increasing, we do not have any national data to confirm or deny it. Data from individual hospitals in various locations around the country has been cited to demonstrate that cases of severe child abuse are increasing. Hospitals around the country have reported increases in serious injuries and even deaths compared to previous years. Reports of such excessive child abuse injuries and deaths have come from hospitals in Fort Worth, Texas, Orlando, Florida, Colorado Springs, Colorado, Washington, DC, and Pennsylvania. But without systematic data from hospitals, we really cannot know if this represents a national trend.
Last Spring, child advocates worried about the unseen children who would have to wait until schools reopened after the summer to have their situation discovered. But as more and more districts abandoned plans to open school buildings, it became clear that the anticipated onslaught of hotline calls would not occur in these jurisdictions. What can be done to ensure that children are safe? Several different approaches have been tried or suggested.
Public awareness campaigns: Some jurisdictions have instituted publicity campaigns encouraging members of the community to report child abuse and neglect. For example, the New Jersey Department of Children and Families launched a ‘Social Distancing Shouldn’t Mean Social Isolation’ campaign to raise awareness about child abuse, domestic violence and other dangers facing residents while homebound. It include a flyer about warning signs of child abuse as well as a more general resource that includes telephone numbers for the child abuse, domestic violence, mental health, and other hotlines. In a Call to Action for State Governors, CHILD USA, a national think tank focused on child protection, suggests that Governors should add to all their COVID updates a reference to the need for all adults to be alert for signs of abuse and neglect, along with how to reach the child abuse hotline.
Providing new guidance to traditional reporters: Some agencies have created new resources to share with educators and other traditional reporters of child abuse and neglect. Maine issued guidance for educators, medical personnel, and community members to help them identify warning signs of child abuse and neglect in a time of virtual education. CHILD USA released a useful list of Tips for Teachers on Child Welfare and Online Safety during COVID-19 which suggests questions for teachers to ask that are targeted at elementary, middle and high school students. The questions focus on food, physical safety and online safety. The document also includes tips on what to look for in the home environment as perceived through a computer screen. The Zero Abuse Project has published Responding to Child Abuse During a Pandemic: 25 Tips for MDT’s, which provides tips that might be useful for child welfare agencies as well. The authors included some valuable advice, such as a reminder to teachers that abuse has been shown to increase after a child receives a bad report card. They suggest that teachers. contact parents in advance of giving out a bad grade, promise to follow up (with the hope of defusing any violence) and call authorities if parents indicate a plan to punish the child physically,.
Reaching Out to Nontraditional Reporters: Some child advocates like family violence researcher Andrew Campbell have urged states to reach out to nontraditional reporters, such as postal workers, garbage collectors, and home repair agencies, who are continuing to see children as they move through homes and neighborhoods. A simple postcard listing the warning signs of child maltreatment and the phone number of the child abuse hotline could be distributed to businesses and agencies employing such workers. Animal protection agencies are another potential community partner for child welfare agencies, as Campbell also suggests. Animal control officers could be trained and enlisted to check up on the wellbeing of humans as well as animals in homes where animal abuse has been reported.
School Based Approaches: Schools have a critical role to play in ensuring that children can be protected in a time of virtual schooling. Districts must make sure that all students have access to a computer and high-speed internet service. It is critical that they adopt a policy of checking in with all students they have not been able to reach for a specified period of time, whether a day or a week. Clearly this is easier said than done in schools serving largely disadvantaged populations. Media outlets have reported on the herculean efforts of dedicated school staff who have spent months trying to locate students who were missing from virtual education. Schools can also provide training to their teachers in how to spot red flags in virtual meetings, as Pueblo County Colorado has done. Schools should also consider adding to their virtual platforms an option for children to indicate that they are in trouble at home and need help.
Reaching out to at-risk families known to the system: Noticing the precipitous fall in calls to the hotline without a corresponding rise in substantiation rates, Michigan’s child welfare director JooYeun Chang feared that some children in need were “simply invisible,” as she explained to the editor of The Imprint. Before the pandemic arrived, the agency had commissioned an assessment from Chapin-Hall, a child welfare think-tank, which had identified 14,000 families that had been involved with the agency and had a high risk of children entering foster care without receiving additional preventive services. About 1,000 child protection workers freed up by the decline in hotline calls were assigned to reach out to these families to find out if they needed any type of assistance. Data provided to Child Welfare Monitor indicate that workers spoke with 8,267 of the 14,162 families on the list, and 80 percent of the families received a text, email, or mailing. Workers provided general support, information and referrals. Many parents expressed great appreciation for the calls; some conversations lasted 45 to 90 minutes. One worker was able to contact a cash assistance worker and rectify the erroneous closing of a case, another provided referrals to a father struggling with physical and mental health problems who thanked the worker several times just for listening. The agency is now reaching out to another 10,000 families that were investigated since the Covid-19 shutdowns began.
Inspired by Michigan, Allegheny County, Pennsylvania DHS is using staff and community partners to connect with higher-risk families involved in child welfare cases that closed six months earlier, to check in and find out whether they need help with food, housing or other services. Checking in with families to offer assistance is not designed to identify ongoing abuse or neglect. However, it may reduce the probability of child maltreatment recurrence by helping families meet concrete needs for food, clothing and shelter and even by offering them a friendly ear and reducing their social isolation.
Investing in Prevention: Interest in preventing child maltreatment before it occurs as was already growing before the Covid-19 pandemic. The drop in CPS reports under virtual schooling has led to even more interest in prevention. Particularly relevant are secondary prevention approaches, which target families that are at risk of child maltreatment. Michigan DHHS under Jooyeun Chang is working on a new pilot that will be run by a nonprofit in two of the five Detroit zip codes from which the bulk of Detroit’s foster youth were removed. The program will target 400 families (chosen based on the previous calls), who will each receive a peer counselor with similar “lived experience” and a benefits navigator, who will connect the family to needed resources in the community. Combining peer counseling and benefits navigation is an innovative approach that may enhance the value of each of these components when provided together. In addition to the peer navigators, group activities will provide needed information and help participants build their social networks.
The Allegheny County (Pennsylvania) Department of Human Services (DHS) is launching the Hello Baby prevention program in partnership with local Healthy Start and Family Centers. The program, which is voluntary and not affiliated with child protective services, is an interesting hybrid of universal and targeted prevention. It will be offered to all families with a new baby but will offer three levels of services to families depending on how they score based on a predictive risk model using integrated data from multiple sources. The families with the most profound needs will be offered intensive services through Healthy Start Pittsburgh while others will be welcomed to their neighborhood Family Center and/or offered a variety of web-based and “warmline” supports and resources. While the program has not yet launched officially, DHS has soft-launched in some communities with a high density of vulnerable families.
The approaches outlined above fall into two broad categories: initiatives to enhance detection and reporting of child abuse and neglect and those designed to prevent it. These approaches are often supported by different groups in the child welfare space. However, both approaches are valid and important. We cannot go back in time and prevent the abuse and neglect that are already occurring, so we must have a robust system of reporting and investigation to find the children who need protection. On the other hand, to the extent that we can prevent future abuse and neglect before it starts, the benefits would be enormous.
A new report from Eyewitness News has cast doubt on my pieced-together account of the process by which Justyna Zubko-Valva lost custody of Thomas and her other sons. My initial account, relying on reports from other media outlets, suggested that a judge revoked the mother’s custody and gave it to the father in an arbitrary manner without seeking to evaluate either parent’s capability of raising the children. Based on the documents described by Eyewitness News, ot appears that this was not the case. I have updated my post to account for the new information, as described below.
My post initially relied on available media accounts in stating that Judge Hope Schwartz Zimmerman became fed up with Justyna Zubko-Valva for failing to follow two orders, including one to get her children evaluated. In fact, the court documents obtained by Eyewitness News state that the Zubko-Valva was refusing to follow an order that she herself be evaluated, unless the interview could be videotaped. The evaluator refused due to the “sensitive nature of the testing materials.”
Without a psychological evaluation of the mother, Judge Zimmerman stated that she was unable to bring the case to trial. She announced that she was awarding “temporary, temporary” custody to the father. The rationale for that decision is not explained in the quotes from Eyewitness News. Perhaps Judge Zimmerman thought that moving the children would induce Zubko-Valva to obtain the evaluation. Using the children as tools to induce parental compliance would be inappropriate in any case. In this case, the transfer of custody not only failed to achieve the judge’s goal but resulted in the death of one child, horrific abuse of another child, and potential lifelong damage to the two living children. The “temporary, temporary custody” ended up lasting for two years after Valva filed an abuse report against Zubko-Valva and Zubko-Valva later refused supervised visitation, as described below. Nevertheless, my statement the judge cavalierly transferred custody of the boys without evaluating the parents appears to have been wrong. Instead, she apparently transferred custody in order to obtain the evaluation she required
Of course Zubko-Valva could not know that her intransigence about the evaluation would lead to suffering, death and lifelong damage to her children. But there are other disturbing aspects of her behavior cited in the Eyewitness News account. It appears that she did not see her children for two years, from January 2018 until Thomas’ death in January 2020. Eyewitness News stated that visits were cut off in January 2018 due to the abuse accusations against Ms. Zubko-Valva but that another judge, Joseph Lorintz, offered her visits starting in April 2018, when the charges were dismissed. Zubko-Valva reportedly refused to visit the children unless they were moved from Valva’s home–a request which the judge denied. In July 2019 the judge again offered her visits, but said the visits must be supervised because “I’m not going to allow you to see your children after a year and a half without some form of supervision in place.” Eyewitness News reports that Zubko-Valva refused to visit her children in a supervised setting. She reportedly refused the same offer in September, 2019, only four months before Thomas’ death. According to the transcripts cited by Eyewitness News, Judge Lorintz almost pleaded with Zubko-Valva, saying “You haven’t seen your children since January 14, 2018. It may only be a few times, but I need for them to be reintroduced to you.” The transcripts show the judge offering three more times to order visits, without receiving an answer from Zubko-Valva. She would never never again see her son Thomas alive. By refusing the opportunity to see her children, did she miss the chance to save Thomas? We will never know.
Unless the Eyewitness News account of the court transcripts is terribly wrong, it appears that Zubko-Valva was not acting in the best interests of her children when she refused the evaluation and the visits. Her refusal to visit her children is very hard to understand and very concerning as it relates to her current fitness as a parent to her two very damaged young sons. The courts and CPS have already failed these children catastrophically; it is hoped that their continued involvement will serve to protect these children and ensure that they receive the treatment and monitoring they need.
The difficulty of piecing events together based on incomplete press accounts illustrates the need for an independent children’s ombudsman to review such cases of systemic failure and release their reviews (redacted as necessary) to the public. Only with such independent reviews can taxpayers understand how and why the system they paid for has failed. If I knew that such a review was forthcoming, I would not have even tried to come up with a credible narrative of this case without the court transcripts and CPS documents. The public should not have to rely on guesswork to find out how the system failed and what has to change.
The federal Children’s Bureau (CB) has released its annual Child Maltreatment report, containing data provided by the states from Federal Fiscal Year 2018. The high rate of maltreatment victimization and the contrasting numbers and rates between states and populations are two of the major takeaways of the report. A common theme across the report is that differences between states and populations and over time can reflect differences in levels of maltreatment, policy or practice, or even how states collect data.
CB’s annual maltreatment reports use data from the National Child Abuse and Neglect Data System (NCANDS), which is a federal effort that collects and analyzes child welfare data provided voluntarily by the states plus the District of Columbia and Puerto Rico. The data follow children and families from referrals to reports, dispositions and services. One of the most helpful resources is exhibit 2, reproduced below, a flow chart that follows families and children through the process from referral to services. (All tables in this post are reproduced from the report).
Referrals and Reports
During FY 2018, states reported receiving a total of 4.3 million “referrals” (calls to a hotline or other communications alleging abuse or neglect) regarding approximately 7.8 million children. The number of referrals per 1,000 children varied wildly between states, from a low of 15.7 in Hawaii to a high of 167.9 in Vermont. The different referral rates between states may reflect different levels of knowledge about and comfort with child maltreatment reporting, different rates of underlying maltreatment, or even different state practices in defining the term “referrals.” Vermont explains that its high referral rate is the result of its practice of treating all calls to the child abuse hotline as referrals.
The rate of referrals has increased from 50 per 1,000 children in 2014 to 58.5 referrals per 1,000 children in 2018. Differences over time within a state may due to changes in state policy or practice or events in a particular state. For example, Alabama reported that it implemented online mandatory reporter training in 2014, resulting in an increase in referrals. Rhode Island reported a large increase in referrals due to the public trial of a school official for failure to report child abuse, resulting in more than a doubling of hotline calls from school staff.
A referral may be screened in or out by the child welfare agency depending on whether it meets agency criteria. Referrals may be screened out because they do not meet the definition of child abuse and neglect, there is inadequate information, or for other reasons. Screened-in referrals are called “reports” and receive a traditional CPS investigation or an “alternative response” (often called an “assessment”) in states that have two-track or “differential response systems.” These alternative responses, usually reserved for the less serious cases, do not result in an allegation of abuse or neglect but rather are aimed at connecting families with services they might need. Of the 4.3 million referrals, states screened in 2.4 million for an investigation or assessment. The rate of screened-in referrals (known as “reports”) has increased from 29.1 per 1,000 children in 2014 to 32.5 in 2018. The highest number of reports came from education personnel (20.5%), legal and law enforcement personnel (18.7%), and social services personnel (10.7%). Parents, other relatives, friends and neighbors submit the remaining reports.
A total of 3.5 million children received an investigation or alternative response, and states found approximately 678,000 (16.8%) to be victims of child maltreatment; in other words the allegation was “substantiated.” Another 14% received an alternative response rather than an investigation, which meant there was no determination of whether maltreatment occurred. Reports involving 56.3% of these children were unsubstantiated, which meant there was not sufficient evidence to conclude that maltreatment took place.
The 678,000 children who were found to be victims of maltreatment equates to a national rate of 9.2 victims per thousand children in the population, or almost one out of every 100 children. This rate varies greatly by state, from 2.7 in Washington 1 to 23.5 in Kentucky. A lower child victimization rate might reflect less child maltreatment or a system less likely to respond to existing maltreatment or that makes greater use of differential response. Kentucky had the highest proportion of children found to be victims (23.5 per 1000 children or over one in every 50 children) followed by West Virginia, Rhode Island, Massachusetts and Michigan. The ongoing crisis involving opioid and methamphetamine addiction has been blamed for an increase in maltreatment in many states. And indeed, all of the states with the highest rates have been hard-hit by the opioid epidemic and had among the highest opioid overdose death rates in the country in 2017.
The national proportion of children found to be victims of maltreatment has fluctuated since 2014, increasing slightly between 2014 and 2018 from 9.1 to 9.2 per thousand. This small national increase masks large changes in the numbers of victims in certain states, from a 50% decrease in Georgia to a 216% increase in Montana. In their written submissions, the states attribute these diverse trends to changes in child welfare law, policy and practice as well as increases in parental drug abuse and even severe weather events such as Hurricane Maria in Puerto Rico.2Georgia reports a policy change that resulted in a large increase the proportion of cases assigned to the alternative response track, perhaps one reason for the decrease in substantiations. Montana has experienced a surge in children entering foster care due to parental drug abuse, especially methamphetamine, which probably contributed to the increase in children found to be victims.
The disparity in the proportion of children found to be maltreatment victims across states is consistent with the belief that there is no foolproof method of assessing the truth of an allegation and that substantiation may not be a very good indicator of whether maltreatment has taken place. Research has found little or no difference in future reports of maltreatment of children who were the subject of substantiated or unsubstantiated reports.
The proportion of children found to be victims of maltreatment decreases as age increases. The rate of substantiated victimization for babies under a year old is 26.7 per thousand. This rate falls to 11.8 percent for children aged one to two and decreases gradually as age increases. This age effect reflects the greater fragility and helplessness of younger children and also the fact that they are less likely to spend time away from their parents (the primary maltreaters). That is one reason why many child advocates support making early care and education available to all children at risk for maltreatment and particularly to those already involved with the child welfare system.
The rate of children found to be victims of maltreatment varies considerably between racial and ethnic groups. The highest rate is for Native American or Alaska Native children, who were found to be victims at a rate of 15.2 per thousand, followed by African-American children, with a rate of 14 per thousand, compared to 8.2 per thousand for White children, and 1.6 per thousand for Asian children. It is 8.1 per thousand for Hispanic children, who can be of any race. The higher rate of substantiated victimization among African-American and Native American children is a subject of controversy. Some believe it reflects greater tendency of African-American and Native parents to be reported to CPS and later substantiated as perpetrators due to racism. But these differences might also reflect a greater poverty rate for Black and Native children, or cultural factors, such as a preference for corporal punishment in the Black community, or substance abuse in the Native American community.
Neglect continues to be the predominant type of maltreatment. The data shows 60.8% of children were found to be victims of neglect only, 10.7% victims of physical abuse only, and 7.0% to be sexually abused only, with 15.5% suffering from multiple types of maltreatment, mostly commonly neglect and physical abuse. It is important to understand that a given child may be found to have suffered one type of maltreatment when other types are also present. For example, abuse can be hard to substantiate when the parent and child give contradictory accounts, or the child recants, and such children may be substantiated for neglect only when abuse is also present.
For the first time, 18 states reported on victims of sex trafficking. These states reported a total of 339 victims. While one case would be too much, it is encouraging that the scope of the problem is so small compared to other types of maltreatment. This suggests that sex trafficking as a type of child maltreatment is much less widespread than one might have thought given the amount of attention recently attached to this topic through legislation, training, and policy.
There is wide variation among states in the prevalence of different types of substantiated maltreatment. Some of this variation may be due to real underlying differences in parental behavior and some may be due to varying laws, policies and practices. Of particular interest are the states that have much higher percentages of abuse than the national average. While nationally only 10.7% of victims are found to have experienced abuse only, that percentage was 55.3% in Vermont, 48.2% in Alabama, and 39.7% in Pennsylvania. It is known that corporal punishment, which may escalate to abuse, is more popular in Southern states, like Tennessee and Alabama. Vermont’s and Pennsylvania’s high rates of abuse may be due to the assignment of many less-serious cases to an alternative track where there is no disposition (in Vermont) or the disposition is not reported (in Pennsylvania).3 Alabamans are aware of their state’s high abuse rate, which was covered in an excellent story by Al.com that cites the state’s acceptance of corporal punishment as one underlying factor.
For the FY 2018 report, the researchers analyzed three years of data on the presence of alcohol or drug abuse among caregivers. They found that the national percentage of substantiated victims with a caregiver identified as a drug abuser was 30.7% in 2018. Alcohol as a caregiver risk factor was 12.3%. Both of these percentages increased slightly from 2016. As is often the case, there was an astonishing diversity among states, ranging from 2.2% to 45.5% for alcohol abuse, and from 3.1% to 61.5% for drug abuse. This diversity, especially the very low rates in some states, raises concerns about whether they are accurately capturing these factors.
The data show that 90.7% of the victims were maltreated by one or both of their parents. That includes nearly 40% who were maltreated by their mother acting alone and 21.5% by their father acting alone. Relatives (4.7%) and unmarried partners of parents (2.8%) are the largest remaining categories of maltreaters.
There is no standard, mandatory system for reporting child abuse and neglect deaths and it is often extremely difficult to determine where a death was caused by abuse or neglect rather than natural causes. Based on data from all states except Massachusetts, the researchers estimated that 1,770 children died from abuse or neglect in 2018, which is a rate of 2.39 per 100,000 children in the population. That is an 11.3% increase over the estimate for 2014 but this change may reflect data quality rather than a real change in maltreatment deaths. State rates range from 0 (Nebraska) to 6.6 (Arkansas) per 100,000 children but it is hard to know how much of the variation reflects differences in capturing actual child fatality rates. NCANDS maltreatment data are generally viewed as underestimates because, among other factors, many maltreatment fatalities may be unknown to any system or impossible to prove and some states do not report on deaths of children not known to the Child Protective Services Agency. In contrast, the Commission on Child Abuse and Neglect Fatalities reported that the most recent National Incidence Study (where data is collected directly by ACF) reported 2,400 deaths compared to 1,530 deaths in the Child Maltreatment report for a similar period. The CAPTA reauthorization bill which was passed by the House would require the Secretary of the Department of Health and Human Services establish uniform standards for the tracking and reporting of child fatalities and near-fatalities related to maltreatment. This requirement is badly needed.
Like child maltreatment itself, child maltreatment fatalities are more likely occur to the youngest children. Infants under one year old were the most likely to die, at a rate of 22.77 per 100,000. The rate decreases to 6.3 per 100,000 one-year-olds and continues to fall with age. Nearly half of the children who died were younger than one and 70.6% were younger than three. This illustrates again why it is so important to ensure that all children at risk of severe abuse or neglect must be in early care or education.
The child fatality rate for African American children (5.8 per 100,000 children) is over 2.8 times the rates for White children. Mixed-race children had the second highest rate of 3.2, followed by Native American children at 3.12. As discussed above, we do not understand these disparities. They could be due to cultural factors, economic factors, racism in reporting and substantiation, or other factors. The child maltreatment fatality rate for Black children is more than twice that for White children (5.48 vs. 1.94 per 100,000). This is an even greater disparity than the difference in child maltreatment rates (14.2 per 1000 for black children vs. 8.2 per 1000 for white children). Perhaps many Black parents’ embrace of corporal punishment, as described by author Stacey Patton in her important book, Spare the Kids, while not much different in terms of overall percentages from that of White parents, countenances more severe discipline than among other racial and ethnic groups. These disparate child maltreatment death rates should give pause to those self-described anti-racists who want to equalize the rates of investigations, substantiations, and child removals of Black and White children. Such a policy would very likely lead to increased deaths of Black children–hardly an outcome they should welcome.
Of the children who died from maltreatment in 2018, 72.8 percent suffered neglect and 46.1 percent suffered physical abuse, including some children who suffered more than one type of maltreatment. Eighty percent of the deaths were caused by parents or caregivers acting alone or with other individuals. Based on reports from 24 states, 20.3% of the children who died had received family preservation services in the previous five years. And 2.5% had been reunified with their families in the previous five years after being removed.
Approximately 1.3 million children (a duplicated count4) received services at home or in foster care as the result of an investigation or alternative response. This includes 60.7% of the children who were found to be victims of maltreatment and 20.9 percent of the non-victims. It is concerning that such a low percentage of the victims received services. But not every state reports data for every in-home service (especially those provided by other agencies or contractors), so the actual proportion receiving services other than foster care may be higher. Sadly, according to reports from 26 states, only 21.9% of the victims received court-appointed representatives.
About a fifth of the children found to be maltreatment victims (22.5%) and 1.9% of those not found to be victims5 were placed in foster care. It is worth noting that less than half of the maltreatment victims who received services (146,706 out of 391,661) were placed in foster care. The others received family preservation services while remaining at home. Many news reporters and child welfare commentators have incorrectly suggested that no services other than foster care were available to abused or neglected children before the implementation of the Family First Prevention Services Act. This data shows the incorrectness of that assumption.
Infants with prenatal substance exposure
For FFY 2018, States were required to report for the first time on infants exposed prenatally to drugs and alcohol. Forty-five states reported that they had been informed of 27,709 infants born exposed to substances. Nearly 88% of these infants were screened in as appropriate for an investigation or alternative response. It is somewhat concerning that the others were not, given the possible serious effects of prenatal and postnatal substance abuse. Of those screened in, 75.5% had a caregiver identified as a drug abuser, 11.7% had a caregiver identified as a drug and alcohol abuse, and less than one percent had a caregiver identified as abusing alcohol only. The 24,342 children who were screened in in 42 states constituted a shockingly high 10.8 percent of children under one in those states. Of the screened in reports, 68.3 percent were substantiated as victims or abuse or neglect. Nine percent received an alternative response and nine percent were unsubstantiated. The report’s authors caution against comparing states because this was the first year of reporting. The wild disparity between states in the proportions identified suggests they are right to be cautious and that the national figures have a wide margin of error as a result.
The Child Abuse Prevention and Treatment Act (CAPTA) as amended by the Comprehensive Addiction and Recovery Act (CARA) in 2016, requires that all infants “affected by a substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder” receive a “plan of safe care…addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver.” Thirteen responding states reported that 64% of infants with prenatal substance exposure had a plan of safe care. A separate CAPTA provision requires states to report how many infants had a “referral to appropriate services,” and fourteen states reported that only 42.6% of infants had such a referral. The difference between these two percentages is due to California, which provided data on referrals and not plans of safe care. Only 12.7% of California’s substance-exposed infants had referrals to appropriate services. Since the California’s population is larger, and the percentage receiving referrals was low, the overall percentage was reduced significantly by adding California but the two percentages were the same in the other responding states.
Plans of safe care and referrals are voluntary and do not mean much unless they are followed by the families, providers, and agencies. It would be better to know how many of these infants received foster care and other services after an investigation or family assessment. That would probably require opening a services case for all these families. Congress should consider requiring this, as it would be the only way to follow up on what services these families actually receive.
The fact that almost one in 100 children is found to be a victim of child maltreatment should be of concern to all child advocates, especially because it is likely that many other victims were never reported or found to be victimized. It is hard to interpret comparative data between states, populations, and years because of the difficulty in disentangling the amount of actual maltreatment given the variety of policies and practices in how it is defined and reported. Analysis of the report suggests changes in CAPTA that would make it more useful. For example, Congress should to set uniform standards for reporting child maltreatment fatalities by passing the CAPTA reauthorization bill in 2020. And the new version of CAPTA should be further strengthened to replace the plans of state care with a more substantial response to infant substance exposure.
Pennsylvania’s victimization rate was actually the lowest at 1.8% but this low rate reflects the state’s unusual child protective services structure. Allegations that do not concern abuse or specific very serious types of neglect are labeled as General Protective Services and not counted as referrals or reports for federal reporting. ↩
Puerto Rico had a 43% decline in children found to be maltreatment victims between 2014 and 2018. The territory’s commentary explains that its child population was already decreasing due to emigration even before Hurricane Maria struck in October 2017 and then further declined due to emigration. ↩
Vermont’s extremely high abuse rate rate may be due to the fact that about 40% of its cases are assigned to the alternative response track, which does not result in a disposition, and another sizeable group are assigned to a pathway outside CPS, called family assessment. The cases assigned to these alternative tracks are expected to be less serious and more likely to involve neglect rather than abuse. A similar phenomenon likely occurs in Pennsylvania where most neglect allegation are assigned to General Protective Services and not reported to the federal government. ↩
Individual children were counted more than once if they were involved in more than one CPS case. ↩
Many of these children were probably siblings of children who were found to be victims of maltreatment. ↩