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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Table One

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lethal reunifications: two children dead in New York and Florida

Their names were Rashid Bryant and Julissia Battles). She was seven years old and he had lived for only 22 months. He lived in Opa-Locka, Florida, and she lived in the Bronx. They were both taken into state care at birth. Julissia had a life of safety and love with her grandmother, occasionally punctuated by disturbing visits with her mother, until the age of six, when she was dropped off for a visit that ended in her death. Rashid knew 14 months of safety and care starting at birth, before the months of torture began. An inexplicable drive to reunify families, regardless of the lack of change in the parent’ ability to care for their children, is behind both of these tragic stories.

The 694 days of Rashid Bryant

By the time Rashid Bryant was born, on December 13, 2018, his parents were already known to the Florida Department of Children and Families, according to Carol Miller of the Miami Herald, whose articles from May 10 and July 8 are the basis of this account. Rashid’s parents, Jabora Deris and Christopher Bryant of Opa-Locka, had first come to the attention of the Florida Department of Children and Families (DCF) in 2013 and were reported at least 16 times to DCF. The allegations included parental drug abuse, physical injury, domestic violence, and inadequate supervision of their many children. The reports alleged that Deris smoked marijuana with her older children, that most of her children did not to school, that her home had no running water and that the children were hungry and losing weight. An allegation that Bryant had thrown one of his children into a car when escaping from police finally resulted in court-ordered in-home supervision of this family by DCF. When Deris and her newest child tested positive for marijuana, all of the children were removed but were soon returned to the family in August 2018.

By that time, Deris and Bryant had eight children including two younger than two and a hotline report said that the couple were leaving a 15-year-old in charge of several younger siblings, including a two-year-old who was seen outside naked. In October and November 2018, DCF received seven new reports, including drug abuse, inadequate supervision and “environmental hazards.” The couple’s children were taken into custody around Nov. 22, 2018 and were placed with relatives and foster parents. Less than a month later, their ninth child, Rashid, was born and was immediately taken into state care.

The 14 months from his birth in December 13, 2018 until his return “home” on February 2 may have been the only time that Rashid received the love and care he deserved. But the system had reunification on its mind. By August 2019 the parents were given unsupervised visitation, which was revoked after they suddenly moved without notifying the court, but was restarted again in January 2020. That same month, a supervisor with a private case management agency handling the case for the state of Florida stated that conditions for the children’s return had been met. But records reviewed by the Herald show that DCF did not agree, stating that “This determination was not supported, given that the reason for removal had not been remedied.”

On February 28, 2020 14-month-old Rashid and three brothers were returned to their mother by the court, despite the fact that DCF had asked the judge to return the children gradually, starting with one older child. According to agency records reviewed by the Herald, the children were sent home without supportive services to assist the mother with her four young children. As if that were not enough, the judge also saw fit to give “liberal, unsupervised visitation” to Deris with her other five children.

About a month later, Deris’ tenth child was born, to the “complete surprise” of caseworkers, who reported that she had denied in court that she was pregnant. Three weeks after the birth of her tenth child, the judge saw fit to return her remaining four children, leaving the new mother with the custody of ten children including five that were younger than five years old. Oversight of Rashid and the three brothers sent home with him ended in August of 2020, and all monitoring of the family end by October of that year at the judge’s order.

We don’t know when Rashid’s suffering began. We do know that he injured his leg around June 2020, but his mother waited two days to seek medical help, leaving the hospital with Rashid after refusing to allow an X-Rray. It appears Rashid spent the last five months of his life mostly in bed. At a June 22 pool party at the house of an aunt, Rashid and his father never left the car, according to the aunt. When she tried to pick him up from his car seat, she reported that Rashid began to cry. She never saw him again. Rashid’s maternal grandfather, who frequently visited the home, reported not seeing Rashid for about two months. (Why these family members did nothing in view of these red flags is another question.) Rashid’s brother, then 16, told police that he noticed something wrong with Rashid’s leg two months before he died because the little boy cringed and cried when it was touched. The teen described another incident where Rashid vomited all over his bed and then lay still and shaking with his legs up in the air. The teen could not remember if his mother sought medical attention after either of these incidents. After that incident, reported the teen, Rashid could not move his right arm. Four days before he died, a sister saw Rashid vomit after eating. She reported that the right side of his body appeared limp and his eyes were moving in different directions.

On November 6, 2020, two weeks after DCF closed the case on the family by court order, Rashid was dead. He had lived 694 days. The arrest warrant said that Rashid had suffered two seizures in the month before his death but his mother had never bothered to take him to a pediatrician. On the morning of Rashid fatal seizure, Deris called her sister saying he was unresponsive and “foaming from his nose and mouth.” Her sister told her to take him to the hospital. Deris did call for an ambulance–83 minutes later.

The Medical Examiner reported that in the months before his death Rashid had suffered two cracks to his skull — one healing, the other fresh. He also had a healing rib fracture and a recently broken leg. The cause of Rashid’s death was “complications of acute and chronic blunt force injuries.” The contributory cause was “parental neglect.” Deris and Bryant were arrested within a week of Rashid’s death and are awaiting trial on manslaughter and aggravated child abuse.

But somehow, DCF has not decided whether Rashid died of abuse or neglect–so they refuse to release the case files that they are required to release by law when a child dies of abuse or neglect by a caregiver . That requirement is in a state law that was passed requiring such revelations in the wake of the Miami Herald’s publication in 2014 of, Innocents Lost, detailing the deaths of about 500 children after DCF involvement. The Herald has filed suit against DCF and has been joined in the suit by a dozen media companies and advocacy groups.

Julissia Batties: from home to hell

On August 10, police and medics were summoned to the 10th-floor Bronx apartment where Julissia Batties lived with her mother, Navasia Jones, her 17-year-old half-brother, and one-year-old brother, as reported by the New York Times and many other media. Her mother gave inconsistent accounts to the police but it appears that after finding Julissia “vomiting and urinating on herself” at 5am, she waited three hours, and went to the store and the bank, before she called for emergency services shortly after 8:00 AM. Julissia was pronounced dead shortly after 9am. Julissia’s 17-year-old half-brother later told police that he had punched Julissia in the face eight times that morning because he thought she had taken some snacks. But those were not the injuries that killed Julissia. The medical examiner found injuries all over her body. On Friday her death was ruled a homicide caused by blunt force trauma to the abdomen. There have been no arrests so far.

Records show that Julissia’s mother had a long history of involvement with ACS and police. In 2013, the year before Julissia was born, Jones lost custody of her four older children. When Julissia was born in April 2014, she was immediately removed from her mother’s custody and placed with her paternal grandmother, Yolanda Davis. A family court judge initially granted Jones’ motion for custody of the new baby, but ACS appealed, and the appeals court stayed enforcement of the custody transfer pending their decision on the appeal. In 2015, the appellate court agreed with ACS, stating that “the mother had failed to address or acknowledge the circumstances that led to the removal of the child.” The court stated that although the mother complied with the services required by her case plan, “she was still prone to unpredictable emotional outbursts, even during visits with the children, and she was easily provoked and agitated. Indeed, the case planner testified that she had not seen any improvement in the mother’s conduct even after the mother participated in the mandated services.” The court concluded that “until the mother is able to successfully address and acknowledge the circumstances that led to the removal of the other children, we cannot agree that the return of the subject child to the mother’s custody, even with the safeguards imposed by the Family Court, would not present an imminent risk to the subject child’s life or health.” Wise words indeed. Julissia remained with her grandmother, Yolanda Davis, until being returned to her mother on March 2020, when she was almost six years old.

It appears that the COVID-19 pandemic had some role in the transformation of a weekend visit into a custody change that resulted in a child’s death. Davis told a local TV station, PIX-11, that a caseworker told her the visit had been extended due to the pandemic, and the extension never ended. Sources told the New York Post that the mother was officially granted custody in June 2021, though the circumstances are unclear. The decision to return Julissia to her mother appears to have been made at the recommendation of SCO Family of Services, a foster care nonprofit that was managing the case for ACS. After the first month or so, Julissia was not even granted visits with her grandmother, which would have been a much-needed respite and could have saved her, had the grandmother seen or reported injuries or other concerns. The New York Daily News reported that in May 2020, Davis was denied visits with Julissia because she had allowed the child to see her own father, Davis’ son. The motivation behind denying a child visits with the only parent she had known for six years are truly hard to understand.

There were many indications that all was not well in Navasia Jones’ household in the months before Julissia’s death. A neighbor told the Times that “there was always a lot of commotion, always yelling, always screaming” in the apartment. As recently as August 6, his girlfriend had called authorities to report that Julissia had a black eye. The neighbor told the Times that he had spoken to police and ACS staff about the family several times. Police reported to the Times that officers had filed at least nine domestic abuse reports on the family and responded to five reports of a person needing medical attention.

The decision to send Julissia home with her mother after six years apart is particularly strange because the Adoption and Safe Families Act of 1997 (ASFA) requires that a state must file for termination of parental rights after a child has spent 15 of the last 22 months in foster care. The requirement was written into law because children were languishing for years in foster care without a plan for permanency. It was recognized that children need permanency and stability and it is hard to understand why ACS and its contractor would want to move a thriving child from the grandmother who had parented her from birth to age six.

Much needs to be clarified to understand how this child was returned to the family that would kill her. ACS and SCO have declined to comment on the case, citing confidentiality. ACS did issue a statement that “its top priority is protecting the safety and wellbeing of all children in New York City.” But it is clear that other priorities took a front seat in Julissia’s case.

Factors Contributing to lethal reunifications

What explains the adamant determination on the part of some agency personnel and judges to return children to biological parents who have shown no sign of changing the behaviors that caused the system to remove them in the first place? To some extent, it reflects an ideology–one that is becoming increasingly dominant in the nation– that is committed to family preservation and family reunification at almost any cost. Child welfare is known for pendulum shifts in the emphasis on child safety as opposed to family preservation and reunification, but the latter is clearly in the ascendant right now. Extreme deference to this ideology can blind agency employees and judges to what is right in front of their faces: the failure of a parent to change the behaviors and attitudes that resulted in the initial removal of a child.

The obsession with family reunification at all costs can be encoded into social worker evaluations. In Tennessee, a recent survey of social workers suggests that they are being judged by whether they close cases in a timely manner, regardless of child safety. As one worker put it, “Children are returned home or exiting custody to relatives quickly to lower the number of cases without regard to whether the children will be truly safe and the parents ready to parent again.”

The current emphasis on family preservation and reunification is often justified as a way to ratify racial imbalances in child welfare involvement. A growing movement urges drastically scaling down or eliminating current child welfare services on the grounds that the overrepresentation of Black children in care compared to White children is a consequence of racism. Supporters call for elimination of the “disproportionality” between removals of Black and White children from their parents, while disregarding higher rates of poverty and historical trauma that result in more child maltreatment among Black families. To say that Black children need to stay with, or return to, abusive parents in order to equalize the percentages of White and Black children in care is to devalue children and reduce them to nothing more than their race, a strange position for an anti-racist movement to take. As described in a document entitled How we endUP: A Future without Family Policing, parts of this movement are fighting for repeal of ASFA, which would eliminate timelines and encourage jurisdictions to reunify children with their birth parents years after they had established parental bonds with other caregivers, such as grandmothers or former foster parents.

Racial considerations are not the only factor driving systems to support reunification at all calls. Lethal reunifications occur in states like Maine, where 88 percent of the children in foster care are White. Maine’s Office of the Child Advocate recently reported that the state’s child welfare system continues to struggle to make good decisions around two critical points–the initial safety assessment of a child and the finding that it is safe to reunify the child with her parents. In its review of seven cases closed through reunification, the OCA found multiple incidents where children were sent home with insufficient evidence that they would be safe. In one case, the parents had not been visited for a year-and-a-half despite the fact that home conditions were a reason for the original removal. In another case, providers were not contacted or given the information they needed to treat the issues that had resulted in the removal. In another case, the parent “failed to understand or agree to the reasons the children entered custody, but this was not considered significant.” In yet another case, the trial home placement started too soon and the parent never completed required substance abuse treatment. The child was sent home two months after the parent had a positive toxicology screen.

In responding to the criticisms of Maine’s OCA, OCFS admitted that “staff have been challenged with the current workload based on the increase in the number of calls, assessments, and children in care.” It is clear that insufficient of resources lead to excessive caseloads around the country, endangering children. In Tennesseee, for example, while caseloads are not allowed to exceed an average of 20 (a very high number in the experience of this former social worker) data obtained by the Tennessee Lookout, indicated that 30% of caseworkers had caseloads of more than 20, and that many had 30, 40 or even 50 cases. Insufficient funding often means low pay and a difficulty in attracting people with the education and critical thinking skills required for the job. High caseloads and poor pay lead to high turnover, resulting in a loss of institutional memory about specific cases that may drag on for years, such as those discussed here. In turn, high turnover leads to high caseloads as social workers have to pick up cases from those who leave. Such factors may or may not have contributed to the deaths of Rashid and Julissia; they have certainly contributed to other child deaths around the country. Most taxpayers don’t want to think about these systems or fund them; it is easy to avoid reading about the consequences when they occur.

And cost considerations drive reunifications in another way as well. Reunifications save money for cash-strapped child welfare systems. Once a child is sent home and the case is closed, the jurisdiction incurs no more expenditures for foster care. If the child is instead placed in guardianship or adoption with a relative or foster parent, the jurisdiction may end up paying a monthly stipend to the caregiver until the child turns 21. Of course, many relatives who step up to the plate like Julissia’s grandmother are not paid, due to the same budget concerns. giving rise to the current outcry and debate around hidden foster care.

Family court problems contribute to lethal reunifications as well. Rashid’s death appears to be primarily due to a judge who insisted against agency protests on the return of nine children in the space of two months, during which the mother also gave birth to a tenth child. The information available suggests that Florida DCF staff proposed a much slower reunification process. We don’t know what influenced the judge’s decision, but we do know that family courts are overwhelmed and in crisis, resulting too often in the deaths of children in both custody and child protection cases. These courts are inundated with cases, judges often lack the training they need, delays are all too frequent and were worsened by the pandemic. Judges rarely see consequences for decisions that lead to an innocent child’s death, and I have never heard of a judge being removed for the death of a child that was placed in a lethal home against all the evidence. The judge who sent Rashid to his death probably continues to endanger other children daily. This judge must be named, punished, removed and never again allowed to send children to their deaths.

The degree to which the pandemic contributed to Julissia’s and Rashid’s deaths is impossible to estimate. Julissia’s irregular reunification was justified to her grandmother on the grounds of the pandemic. Both Rashid and Julissia should have been visited regularly at least monthly once they were placed with their original families, depending on state regulations. Visits to Rashid should have occurred until the judge terminated them in August, well after the leg injury that left him bedridden, and he should have also been seen in the visits to his siblings that terminated in October. Even if the case managers were visiting (virtually or in real life) only the four children whose cases had not been closed, they should have had the curiosity to ask about little Rashid. For Julissia, there should have been visits throughout her 16 months in hell. Were these visits conducted at all, virtually, or in person? What information was gathered at these visits? This information that must be revealed.

This is not my first post about a lethal reunification in Florida. In January 2019, I wrote about Jordan Belliveau, who was murdered by his mother eight months after being reunified with her, even while a agency in Pinellas County was still monitoring the family. A caseworker for the agency and later resigned told News Channel Eight that the system “puts far too much weight on reuniting kids with unfit parents and makes it nearly impossible for caseworkers to terminate parental rights.” It does not appear that the state learned from Jordan’s death.

I could have written about other lethal reunifications in New Mexico, Ohio, and elsewhere. But I often resist writing about the deaths of a specific child or children known to the system that was supposed to protect them. There are so many reports of such cases, and they are only the tip of the iceberg. Why choose one and not another? I cried for Rashid but I did not write about him until I read about Julissia. Then I knew that I had to write about both, because they represent so many others whose names we will never know. Some of these children’s names may never be known to the general public because there was no outraged grandmother to speak out, no determination of the cause of death, no charges by police, or no alert reporter to reads a crime report and ask questions. But others are unknown because they are suffering in silence and darkness. Because death is not the worst thing that can happen to a child whose life is one of unremitting pain.

Congress must take steps to ensure availability of therapeutic residential care

Around the country, there is a lack of appropriate placements for the most traumatized and hard-to-place foster youth–a shortage that has reached crisis proportions in many states, including Texas, Washington, and Illinois. These children are spending days, weeks or even months in offices and hotels or languishing in inpatient psychiatric units where there is no semblance of normal life. These young people have been damaged by our negligence and now deteriorate daily without the treatment they need and deserve.  Unfortunately, recent federal legislation is likely to worsen the crisis by withdrawing federal funding for children placed in some of the best therapeutic residential settings.

An unforeseen consequence of the much-heralded Family First Prevention Services Act (FFPSA) of 2018 may exacerbate the shortage of therapeutic placements in many states. FFPSA had twin goals: to shift resources from foster care to family preservation, and within foster care, to shift resources from congregate care settings (anything other than a foster home) to foster homes.  However, the framers of the act did recognize that some children need more intensive care than a foster home can provide, and for them FFPSA defined a new category of placement called a Quality Residential Treatment Program (QRTP). QRTP’s must have a trauma-informed treatment model, involve families, be accredited by an approved organization, and provide at least six months of aftercare. A child can be placed in a QRTP only if a qualified professional determines that the child’s needs cannot be met in a foster home, and the placement must be approved by a judge. Other than specialized settings for teen parents, children who have been sex-trafficked, and supervised independent living settings for foster youths aged 18 and older, QRTP’s are the only non-family placements that can be funded under FFPSA.

Unfortunately, in creating QRTP’s, Congress unintentionally created a conflict with a provision of the Medicaid law that may sharply limit the number of children who can benefit from this new category of therapeutic placement. The problem is that federal Title IV-E foster care funding pays for room and board, but not the costs of medical, dental, behavioral and mental health care for children in foster care. States generally extend Medicaid to all foster youths, allowing the program to cover those costs. But the “IMD exclusion,” a provision included in the original 1965 legislation creating the Medicaid program, prohibits federal Medicaid dollars to be used to pay for any care or services to anyone under 65 who is a patient in an “institution for mental diseases” except for in-patient psychiatric services provided to children under 21. An Institution for Mental Diseases (IMD), as defined by Section 1905(i) of the Social Security Act, is a “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases including medical attention, nursing care, and related services.” (For more on the IMD exclusion, see Fact Sheets by the Legal Action Center and the Training and Advocacy Support Center.)

This “IMD exclusion” reflects the sentiment at the time of Medicaid’s creation in 1965 against the large public institutions where the mentally ill were warehoused at the time. The provision was a driving force behind the transformation of public mental health care from an inpatient to an outpatient model, often known as “deinstitutionalization.” But now, many high-quality therapeutic residential programs have more than 16 beds distributed between separate units or cottages on one campus, and in many states these are exactly the facilities that qualify to be licensed as QRTP’s. Without a legislative fix, QRTP’s of over 16 beds may be considered IMD’s and children placed there will not be eligible for federal Medicaid funding for any of their care, including medical, dental, behavioral and mental health services, whether delivered inside or outside the residential program.  States will then have to pay the entire costs of all care for foster children placed in these settings.

Decisions as to whether a facility is an IMD are made on a facility by facility basis based on federal law, regulations and guidance. But the definitions of IMD’s and QRTP’s, as well as the guidance provided by the Center for Medicare and Medicaid Services (CMS) in the State Medicaid Manual section 4390 on how to determine if a facility is an IMD, suggests that QRTP’s are likely to be considered IMD’s. When California wrote to CMS arguing that its “short-term residential treatment programs” (which they were hoping to designate as QRTP’s) should not be considered IMD’s, CMS responded that it was  “unable to provide California the blanket assurance requested that STRTPs are not IMDs.” While a state Medicaid agency can elect not to consider a facility to be an IMD, CMS can essentially overrule these decisions by requiring a state to review the status of these facilities based on its guidance.

Even before the current crisis over QRTP’s, the IMD exclusion had resulted in the loss of Medicaid coverage for foster children living in therapeutic residential facilities in at least two states. For years, Minnesota was using residential programs that would have met the definition of QRTP’s as an alternative to, or a step down from psychiatric hospitalization. But, as reported by the Star-Tribune, after a review ordered by federal officials, 11 treatment centers with a total of 580 beds lost about $4.5 million in federal Medicaid funding–a cost that had to be picked up by counties. Utah went through an “IMD sweep” in 2010, which resulted in its replacing most of its residential treatment centers serving children in foster care with facilities having less than 16 beds.

The Association of Children’s Residential and Community Services (ACRC) has been contacting states to find out how they are dealing with the IMD/QRTP issue. They found that states fall into several groups:

  • Some states are not concerned about the IMD problem because they are not planning to implement QRTP’s. Some already rely on facilities that are exempt from the IMD exclusion (Psychiatric Residential Treatment Facilities or facilities with fewer than 16 beds) or will use state funds to pay for children placed in residential care.
  • Some states are proceeding on the hope that their QRTP’s will not be declared to be IMD’s even if they have more than 16 beds. This includes six states where all of the programs that have been approved as QRTP’s have more than 16 beds.
  • Some states are discussing whether to limit the size of their QRTP’s but have not yet decided whether to do so. In many of these states, the majority of the potential QRTP’s have more than 16 beds–or the majority of the QRTP beds are in facilities with more than 16 beds.
  • Some states are trying workarounds to avoid the IMD designation. Two states have decided to separately license cottages that are on the same campus, which enables them to use the bed count for the individual cottage rather than the entire facility, thus potentially avoiding an IMD designation. Another state has classified all residential facilities as serving youth at risk of sex trafficking, one of the allowable uses of congregate care. Whether these workarounds will be accepted by CMS or the Administration for Children and Families (in the case of the latter state) remains to be seen.

Colorado has decided to limit its QRTP’s to 16 beds or less, and a FAQ document from the Colorado Department of Human Services provides an interesting case study in how one state has tried to address the QRTP issue. Hoping to find a way to license its existing residential facilities as QRTP’s, Colorado’s Medicaid and child welfare agencies worked together to analyze the federal IMD criteria and its application to QRTP’s. These agencies “explored every possible argument that would allow Colorado to confidently move forward with QRTPs without risking an IMD designation.” But ultimately they agreed that the only way to avoid the designation was to reimburse only QRTP’s with 16 beds or less. Currently almost all of Colorado’s residential facilities that could have been designated as QRTP’s have more than 16 beds. Instead of creating smaller programs, the state is planning to serve fewer children in residential facilities. The question is whether they will have appropriate options for those children who have been determined to need therapeutic residential care. There is considerable concern that they will not.

Without legislation exempting QRTP’s from the IMD exclusion, states will be faced with the choice of paying the full costs of care for children in therapeutic residential care or scrapping their current facilities and starting from scratch. Vulnerable children may end up in greater numbers in hotels, offices, and hospital beds or bouncing between foster homes that are not equipped to care for them.

According to ACRC, there is no evidence that residential programs with 16 beds or less produce better outcomes than programs with a higher capacity. As a matter of fact, there are reasons to think that a larger campus would be able to offer more services (like therapeutic riding or other specialized therapeutic modalities) that would not be possible to offer on a smaller campus. It is also possible that the IMD/QRTP conflict might result in more foster youth receiving a higher level of care through Psychiatric Residential Treatment Facilities (PRTF’s). These are facilities that deliver an inpatient level of care outside a hospital and they are not considered IMD’s. They are exempted from the IMD exclusion and Medicaid can pay all costs for these facilities, including room and board. So FFPSA might have the perverse result of having more children in a more restrictive, less homelike setting.

On July 23, ACRC sent a letter to the House and Senate leadership asking them to pass legislation by October 1, 2021, exempting Qualified Residential Treatment Programs (QRTPs) from the Institution for Mental Diseases (IMD) exclusion. In the letter, ACRC argues that that “without the exemption for QRTPs, thousands of children in foster care who are vulnerable will be pushed into more restrictive placements, non-therapeutic shelters, unlicensed or unstable settings, or they will bounce from placement to placement without addressing their true needs – which is opposite the intent of the FFPSA.” So far, about 540 organizations have signed onto the letter, and more signatures are coming in daily.

Many groups concerned with the mentally ill have long been advocating for an end to the IMD exclusion altogether, arguing that it is behind the nationwide shortage of psychiatric beds. Rep. Grace Napolitano, Democrat from California, has introduced a bill (H.R. 2611) to eliminate it. CMS and ACF during the Trump Administration also proposed eliminating the exclusion specifically for QRTP’s in its budget for 2021. There are strong arguments for eliminating this exclusion, but the urgency of the QRTP problem requires immediate action, rather than waiting to change a policy that has lasted 50 years.

Unfortunately, there is opposition to lifting the IMD restriction among powerful and wealthy advocates whose ideology appears to blind them to the reality facing our most vulnerable children. William Bell of Casey Family Programs, the nation’s most influential child welfare funder and a leading force behind the Family First Act, urged Congress in testimony to “stand firm” in resisting modifications to the IMD rule. In the real world, where staff work face-to-face with wounded children, the picture looks very different.

The IMD exclusion for QRTP’s threatens to eliminate one of the most promising avenues to address the desperate shortage of therapeutic residential placements for foster youth that already exists in many states. On the state level, legislators must open their hearts and their minds to the pleas of those who are on the front lines caring for our most troubled children. They must increase funding for the therapeutic residential programs the most vulnerable foster youth so desperately need. Congress must help by exempting QRTP’s from the IMD exclusion, enabling the federal government to ensure access to therapeutic residential care–and ensure that the legislation they authored and passed can actually be implemented by states. 

Homeschooling: Harvard conference highlights need for regulation

Source: Slideshare.net

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.

Child Neglect: a misused and misunderstood term

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.

Source: Sarah Font and Kathryn Maguire-Jack, The Nature and Causes of Child Abuse and Neglect.
ANNALS, AAPSS, 692, November 2020. https://journals.sagepub.com/doi/abs/10.1177/0002716220969642?journalCode=anna

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.

Taking racialized thinking to its illogical conclusion: a state senator responds to David Almond’s death

Image: WJAR

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 the likelihood 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.

The death of David Almond: a perfect storm, or the tip of the iceberg?

Image: WJAR

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.

Preventing child abuse and neglect: It’s time for a broader approach

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

StrategyApproach
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
SOURCE: Modified version of Centers for Disease Control, Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities

Notes on Table

*Strategy added by Child Welfare Monitor

**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.