Tag: child neglect

Charitable contributions to prevent abuse and neglect and protect children when it happens

by Marie Cohen

It’s the time of year when many commentators are recommending charities to which their readers can contribute. So I thought it might be useful to recommend some nonprofits whose work may prevent child abuse and neglect or that are working protect children against maltreatment when it happens. Finding such nonprofits is not easy. A charity called “Prevent Child Abuse America” devotes much of its funding to a program that has not been shown to prevent child maltreatment of any kind, while my very favorite child protection nonprofit does not even have child abuse or neglect in its name.

Protecting homeschooled kids

My favorite child protection nonprofit is the Coalition for Responsible Home Education (CRHE), a small but mighty nonprofit that advocates for legislation to protect homeschooled children, researches homeschooling outcomes and policy and develops resources for homeschooling parents, children, and those who want to help them. There have been many recent reports of children who were withdrawn from school after repeated calls by teachers to child abuse hotlines and then endured years of horrific abuse, often ending in death. In 2025, the Connecticut Office of the Child Advocate (OCA) reported that nearly a quarter of children withdrawn to be homeschooled were in families that had at least one report of abuse or neglect that was accepted for investigation by child protective services. But around the country, any attempt to regulate homeschools is met with massive resistance from well-funded organizations representing homeschoolers, spearheaded by the Home School Legal Defense Association (HSLADA) as well as state homeschooling organizations. Standing against this behemoth is CRHE, with only two paid staff. CRHE spent less than $122,000 in 2024 compared to the $16.7 million spent by HSLADA. CRHE needs more resources to achieve its mission of making homeschool safe for all children.

State Child Advocacy Groups

One might expect every state to have a group that advocates for policies to make child welfare systems more protective of abused and neglected kids. But that is not the case. Some groups with names that include “child advocacy” or “child advocates” have actually bought into the prevailing “families first” ideology, acting as though CPS investigations are more traumatic than abuse or toxic neglect. Abused and neglected children in a few states, including Arizona, Maryland, Massachusetts, Minnesota, Pennsylvania, and Washington, are lucky enough to have an advocacy group that puts children first. New Jersey and New Mexico have foster parent support organizations that also advocate for improved child protection policies. I have been shocked to find no such a group in large states like California, New York, Texas and Florida, Illinois, or in states like Connecticut, where ideology has clearly trumped concerns about child safety and wellbeing. But please let me know if I have missed any organizations that are worthy of support.

Family planning

Prevention of child maltreatment before it starts is all the rage nowadays, and of course it would be fabulous if we know how to do it. Unfortunately there is not much evidence that any programs work to prevent child maltreatment. But we do know very well how to prevent pregnancy and birth As I have written more than once, teen pregnancy, larger numbers of children, and closer child spacing are associated with child abuse and neglect. Access to family planning is not what it should be. Longer-acting methods such as IUD’s and implants, may require a repeat clinic visit, be unavailable or not covered by insurance. I support Upstream, which works to integrate family planning into primary care so that when family planning clinics close (as has been sadly happening around the country), access to contraception is not diminished. When contraception is not used or fails, abortion is the last resort, and many experts have expressed fear that the restriction of access to abortion would increase abuse and neglect and entries into foster care. I support two abortion funds, and an entire list of funds can be found here.

High Quality Early Care and Education

Free high-quality early care and education (ECE) for low-income children, starting in infancy, protects children through multiple pathways, as I have written in the past. Participation in an ECE program with staff trained in detection of abuse and neglect ensures that more adults will be seeing the child and able to report on any warning signs of maltreatment. Taking young children away from home for the day provides respite to the parent, gives them time to engage in services, and may reduce their stress, which contributes to child maltreatment. Attending quality ECE all day improves child safety by reducing the amount of time the children spend with the parents. Quality ECE programs that involve the parents can also improve child safety by teaching parents about child development, appropriate expectations, and good disciplinary practices. They may also connect parents with needed resources in the community and help them feel less isolated. I support a Washington, DC program called Educare, which provides full-day, year-round educational childcare to children in poverty from the age of six months to five years of age. Educare DC is part of a national network of 25 schools that “serve as centers of excellence, where children flourish, families lead, and communities unite to shape systems that ensure every child has access to high-quality early education.”

Helping foster youth

Let us not forget about children who are already in foster care, where they often are neglected if not actually abused. Moreover, adults who have been in foster care are more likely to abuse and neglect their children, so supporting foster youth may help break that cycle. One of my favorite District of Columbia programs is called Family and Youth Initiative, which connects caring adults with teens who are in foster care or have aged out. Adults may choose to mentor a teen or young adult, become a weekend host, or become an adoptive parent. Monthly fun events brings adult and youth together to make the connections that may ultimately lead to deeper involvement. Perhaps there is a program like this in your area that needs support.

Prevent Child Abuse, America?

Having the words “Prevent Child Abuse” in its name does not mean that an organization actually prevents child abuse. Prevent Child Abuse America describes itself as “the nation’s oldest and largest organization committed to preventing child abuse and neglect before it happens.” PCAA runs a program called Healthy Families America (HFA), which has become the largest home visiting program in the country. Billed as a child abuse and neglect prevention program, HFA has never proven its efficacy at achieving that goal. PCAA, then called The National Committee to Prevent Child Abuse, reports that it launched HFA after it “learned of the success” of a home visiting program in Hawaii.” But as I wrote in a post called The Power of Wishful Thinking, that report of success was greatly exaggerated. It was based on a pilot study with no control group and a short follow-up period. When a randomized controlled trial was finally completed and the results released in 1999, it found no impact on abuse or neglect. Early HFA evaluation results, published in the same issue, also failed to find effects on abuse and neglect in three randomized trials. But the HFA juggernaut was already in motion. PCAA does not say what percentage of its budget goes to HFA, but twenty-three members of the 45-person staff work on Healthy Families America. PCAA had total expenditures of $15.6 million in 2024. According to its 2023 IRS Form 990, its CEO earned $339,770 and the 13 members of the executive suite tegether earned over $2 million.

It is not easy to find organizations whose work actually prevents child abuse and neglect or protects children when it happens. Because withdrawal from school is such a common recourse by abusers to isolate their victims from protective adults, my most highly recommended charity is a homeschoolers’ advocacy organization called the Coalition for Responsible Home Education. Because the antecedents of child abuse and neglect are so diverse and reach so far back in time, I recommend supporting organizations that encourage family planning and. provide high-quality early care and education. And I also recommend giving to the woefully small group of organizations that truly advocate for children who are abused or neglected. Unfortunately, the name of an organization is not a good indicator of its purpose or impact. An organization with “Prevent Child Abuse” in its name spends much of what it takes in on a program that has no documented effect on child maltreatment.

Child Welfare Monitor’s Recommended Nonprofits

This post was edited on Monday, December 22, to add friends of the Children, which advocates for abused and neglected children in Massachusetts.

Child maltreatment deaths raise questions about Michigan’s funding priorities

Chayce Allen: The Detroit News

by Sarah Font (Washington University in St. Louis) and Emily Putnam-Hornstein (University of North Carolina at Chapel Hill)

I am honored to publish this post by two of the leading academic researchers in child welfare. They are also the Principal Investigators of the Lives Cut Short project, which documents child abuse and neglect fatalities around the country.

Armani Evans. Zemar King. Leviathan Froust. These are just three of Wayne County’s children who have been killed by their caregivers in recent years. Wayne County is the home of Michigan’s largest city, Detroit.

As part of the Lives Cut Short project, which aims to document child abuse and neglect fatalities nationwide, we requested and reviewed the Wayne County Medical Examiner records for child deaths since 2022. At least 52 children died due to abuse or neglect in the last 3.5 years, accounting for more than 1 in 10 of all child deaths in the county. Nearly two-thirds of child maltreatment deaths involved children ages 3 years and under.

At least nine children under the age of 3 died of illicit drug poisonings – involving fentanyl, heroin, and methamphetamine.

Equally disturbing, more than half of the child maltreatment deaths – 27 – involved intentional injury rather than negligence: children who were shaken, stabbed, beaten, and smothered. Many young children’s deaths received no media attention – all that is known is that they were killed by homicide, with the injury description merely stating “found beaten.”

The 52 children who died of maltreatment in Wayne County are likely the tip of the iceberg – these deaths are challenging to identify due to limitations in the death investigation process, minimal release of information, and other factors.  

What would prevent children from dying at the hands of caregivers and family members?

Wayne County recently announced an expanded partnership with RxKids to provide thousands in no-strings-attached cash to all new and expectant mothers in 6 cities within the county. The county’s $7.5 million investment adds to a statewide investment of $250 million in RxKids for 2025-2026 alone. The governor’s FY2026 budget recommendation further includes $27 million to provide “economic and concrete supports” with the goal of reducing or avoiding involvement with Child Protective Services.

The leaders of RxKids imply on their website and other materials that their cash transfers can produce a large decline in child maltreatment and reduce the need for CPS intervention. Fortunately, a rigorous evaluation of the program was conducted in Flint.

The punchline? No impact.

Such findings should come as little surprise when we take seriously the threats that children face. Neither drug addiction nor extreme violence seems likely to be ameliorated with short-term monthly checks. And many children died after CPS ignored clear warning signs. A wrongful death lawsuit filed on behalf of murdered Detroit toddler Chayce Allen reveals that relatives asked CPS to intervene on at least 13 occasions.

The likely reason so many kids are left to die in horrifying circumstances is that Michigan has a severe shortage of child protection caseworkers. Statewide vacancy rates are 20% and the problem is worse in Wayne County, which has 46 fewer caseworkers than intended, leading to high caseloads and turnover. High caseloads were one of the systemic problems that the state was expected to address as part of the Dwayne B. settlement – a case filed nearly two decades ago. Michigan seeks to exit court supervision as soon as this summer, despite their continued failure to adequately staff their system.

Before massive expansions of cash assistance – much of which is going to families who are not impoverished – perhaps the state should fulfill its existing obligations to kids.

Note: some deaths handled by the Wayne County Medical Examiner may stem from incidents occurring in surrounding counties (from which children were brought to and then died at a Wayne County hospital).  Our data do not provide the location of the maltreatment incident.

Home visiting: more hype than hope

Image: homvee.acf.gov

by Marie Cohen

Home visiting has been a highly popular intervention for the prevention of child abuse and neglect and for addressing a much broader set of social problems as well. But the research has never supported the efficacy of home visiting programs as a whole for improving child and family outcomes. The latest study of four popular home visiting programs found that all these programs have negligible impacts after five to seven years. But there was no hint of this message in the government’s press release or the report itself. The bipartisan belief in home visiting is prevening a needed examination of home visiting’s impact and the level of resources devoted to it.

A Brief History of US Home Visiting

While home visiting has existed since Elizabethan times in England, its history in the U.S. began in the late nineteenth century with charities seeking to address urban poverty by changing the behavior of poor families. While it is now considered to be the solution to a number of different social problems mostly related to poverty, modern home visiting was conceived as a way to prevent child abuse and neglect. Publication of Henry Kempe’s The Battered Child in 1968 brought about the recognition of child maltreatment as a national problem. To address child abuse, Kempe called for universal prevention through a network of home health visitors. Inspired by Kempe, Hawaii’s Healthy Start Project (HSP) began in 1975. In 1977, David Olds began testing his Nurse Home Visiting program in Elmira, New York. The first Parents as Teachers program was created in 1991. In 1992, the National Committee to Prevent Child Abuse (now Prevent Child Abuse America) rolled out Healthy Families America (HFA).

In 1993, the Future of Children, an influential academic journal produced by Princeton University and the Brookings Institution until 2021, devoted an issue to home visiting. In the summary article, the authors cautioned that the research so far was limited and had mixed results, but opined that the results were “promising enough” to recommend the expansion of existing programs and the continuation of evaluation efforts. Home visiting programs burgeoned in the wake of that issue, with funding from federal, state, and foundation sources.

In 1999, The Future of Children released its second issue on home visiting, containing evaluations of six demonstration programs. The results were sobering. In their analysis of all six studies, Deanna Gomby and colleagues concluded that “[I]n most of the studies described, programs struggled to enroll, engage and retain families. When program benefits were demonstrated, they usually accrued only to a subset of the families originally enrolled in the programs, they rarely occurred for all of a program’s goals, and the benefits were often quite modest in magnitude.” The one exception was the Nurse Home Visiting Program, (now Nurse-Family Partnership), which differed from the other programs in being delivered by nurses rather than paraprofessionals, and which produced some sizable impacts on child abuse and neglect and second births to mothers.

But the home visiting juggernaut was already in motion. Programs continued to grow, funded by multiple sources, and most of the growth was not in the most promising (and expensive) Nurse-Family Partnership. The National Center to Prevent Child Abuse, renamed Prevent Child Abuse America in 1999, made HFA its signature program despite the lack of evidence that it prevents child abuse. According to the National Home Visiting Resource Center, “evidence-based home visiting was implemented in all 50 states, the District of Columbia, 5 territories, 32 Indigenous communities, and 65 percent of U.S. counties” by 2024. These programs reached over 284,000 families through more than three million home visits in that year, and another 70,000 families were reached by 11 “emerging models.” Of the more than three million home visits provided, approximately 14 percent were provided virtually, down from nearly 23 percent in 2024, as services gradually returned to in-person after the pandemic. Today, there are multiple home visiting programs with different target groups, curricula, goals, and personnel. In addition to the 24 models recognized by the federal government, there are an unknown number of “emerging models” which have not yet earned the label of “evidence-based.”

Undaunted by the scant evidence of success, Congress established, with bipartisan support, the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) as part of the Affordable Care Act of 2010. The goals of the program are to improve the health of mothers and children, prepare children for success in school, improve families’ economic well-being, connect families to other resources in the community, prevent crime and domestic violence and prevent child injuries, abuse and neglect. The funds can be used to implement any one of 24 models that meet the eligibility criteria established by HHS’ Administration for Children and Families (ACF). An evaluation of this program was required by the legislation.

Home visiting programs also became a popular intervention in child welfare with the growing emphasis on keeping children with their families. This began in 1994 with the Title IV-E waivers and continued with the Family First Prevention Services Act (FFPSA), signed by President Trump in 2018. FFPSA allowed states to use Title IV-E funds, formerly reserved for foster care and subsidized adoptions, to support children and families and prevent foster care placements through in-home parent skill-based programs, as well as mental health, drug treatment and kinship navigator services. Programs had to be approved by the new Title IV-E Prevention Services Clearinghouse as “evidence-based” before they could be included in a state’s Family First Prevention Services Plan. According to a research brief from Chapin-Hall at the University of Chicago, at least one home visiting model was included in the Family First Prevention Plans in 28 states as of April 2023. Most commonly included were Parents as Teachers (28) and Healthy Families America (23), with Nurse Family Partnership in third place with 15 programs, and SafeCare in fourth with seven programs.

Home visiting also became popular in growing efforts by child welfare agencies to invest in preventing child abuse and neglect before it occurs, or at least before a family comes to the attention of child protective services. A small source of federal funds, the Community Based Child Abuse Prevention Program (CBCAP), was established by Congress in 1996 to fund such prevention programs and is commonly used to fund home visiting as well.

The bipartisan enthusiasm for home visiting has been unwavering. Created under Obama, MIECHV has been supported by every succeeding administration. Total federal funding on this program is slated to increase from $500 million in 2023 to $800 million in 2027.Earlier this year, the Senate even passed (unanimously) a bipartisan resolution designating April 21 through April 25, 2025 as National Home Visiting Week. Even the Trump Administration has heartily endorsed the home visiting. Yet, the much-vaunted evidence for the value of home visiting really consists of a series of modest impacts affecting different outcomes, often based on less reliable indicators like self-reports, and dwarfed by a sea of findings of no effect. Even the one program (Nurse-Family Partnerhip), that had the most promising early resultsm has no stood up to recent replications–though additional trials with the population that seems to benefit most may be warranted.

Home visiting program evaluations

There have been multiple studies of home visiting programs, including both randomized controlled trials (RCT’s) and comparison group studies, and together these studies have generated hundreds of papers. Therefore, Child Welfare Monitor (CWM) drew from a summary of research on Nurse-Family Partnership from the Arnold Ventures Social Programs that Work website; the evidence assembled on the website of the Title IV-E Prevention Services Clearinghouse for Healthy Families America, Parents as Teachers, and SafeCare; and the Home Visiting Evidence of Effectiveness (HomVEE) Review conducted by the Administration on Children and Families of HHS for Early Head Start Home-Based Option. CWM consulted the original studies as needed, focusing on RCT‘s because randomization is the best way to rule out selection bias as the explanation for any differences between the intervention group and the control group. Otherwise, one cannot know whether the group that participated in the program differed in significant but unmeasured ways from the members of the comparison group. Appendix I includes more details about the program evaluations. Appendix II focuses on the challenges in measuring child abuse and neglect and what the research suggests.

Nurse-Family Partnership

Nurse -Family Partnership (NFP) connects first-time mothers and their babies with a specially trained nurse, who works with the mother and child from early in the pregnancy through the child’s second birthday. It differs from other models in using registered nurses to deliver the visits, making it more expensive and dependent on a scarcer group of providers. Nurse Family Partnership (NFP) has been the subject of RCT‘s in Elmira, NY (launched in 1988); Memphis, TN (launched in 1990), Denver, CO (1994) and in a larger statewide trial in South Carolina that started in 2016. It has also been tried internationally in British Columbia, the Netherlands, the United Kingdom and Germany; though the differences between populations and systems make these results less applicable to the United States, they can be seen as suggestive. The participants in the demonstrations were all first-time mothers but other criteria for inclusion varied by study. Among the effects that were replicated in two or more of the studies identified by the Arnold Ventures’ Social Programs That Work website were reductions in medical treatment for injuries and accidents in Elmira and Memphis), reductions in subsequent births to mothers in their late teens and early twenties (in Elmira, Denver, and Memphis), and an improvement in cognitive or academic outcomes for the children of mothers with lower psychological resources, like intelligence, mental health, and self-confidence (in Memphis and Denver). There were few significant impacts on children’s emotional and behavioral outcomes and mothers’ life trajectories in terms of employment, income and crime, and those impacts were not repeated in more than one study.

A recent scaled-up NFP replication in South Carolina was disappointing, producing no significant positive effects on any of the three primary outcomes studied: the rate of adverse birth outcomes, mothers’ rate of subsequent births within 21 months, and child health, measured as “a composite of mortality or health care utilization associated with major injury or concern for abuse or neglect.” Nor did the researchers find any significant improvements for a prespecified subsample of “socially vulnerable families” that were similar to the families for which earlier studies found positive impacts. There were also no significant findings for the secondary outcomes, which related to healthcare utilization. These results were sobering, and the researchers suggest that the rapid scaling up of the program and the broader population served may have contributed to the weaker results. David Olds, the founder of NFP, suggests1 that the program’s effectiveness was affected by the relative inexperience of the nurses (due to the rapid implementation), the use of impersonal recruitment methods (unlike Elmira and Memphis, where nurses personally recruited mothers in clinic waiting rooms), and the relatively more advantaged clientele. The program included any pregnant woman who qualified for Medicaid in South Carolina, which funded 46 percent of births in that state in 2023 and includes women up to 200 percent of the poverty level. So it was a less disadvantaged group than was included in the other US demonstrations, and earlier studies suggested that the more disadvantaged benefited more from this program.2 Thus, further study of NFP with a highly disadvantaged population should be considered.

Healthy Families America (HFA)

Healthy Families America, an initiative of the national organization, Prevent Child Abuse America, is a flexible program that allows local communities to choose their eligibility criteria, parenting materials, and staff. Services last for a minimum of three years and up to five years. Based on three RCTs of Healthy Families America, the Title IV-E Prevention Services Clearinghouse counted 18 favorable “contrasts” (their term for comparisons between the intervention and control groups) compared to four unfavorable contrasts and 211 contrasts displaying no effect. Among the 18 favorable contrasts, 11 were on self-reports of maltreatment or child behavioral and emotional functioning. Of the other impacts, all were from only one RCT. Many outcome categories showed no favorable impacts. These included child safety measured by administrative reports; child safety based on injuries, Emergency Room use or hospitalizations; child permanency based on out-of-home placements; child social functioning; child physical development and health; parent/caregiver substance abuse; and economic and housing stability. One of the four RCT‘s (Healthy Families Oregon) showed no positive impacts at all.

Parents as Teachers

Parents as Teachers is delivered by “parent educators” who work with families from pregnancy through kindergarten. The Clearinghouse identified one American RCT of this program, one RCT from Switzerland, and one matched comparison group study. The one US RCT, which evaluated two separate demonstrations in California, found that PAT had “little effect on parenting knowledge, attitudes or behaviors as measured in these demonstrations. Nor were significant effects noted on child health or health care.” The demonstration did find small positive effects (a two-month gain at the age of three) on “self-help development” in one of the two sites but no significant effects on cognitive development at either site. In the Swiss study, the clearinghouse found one significant effect on one of two measures of the child’s expressive language.

SafeCare

SafeCare is a brief home visiting model that is delivered in 18 one-hour sessions. SafeCare is designed for parents and caregivers of children birth through five who are either at-risk for or have a history of child neglect and/or physical abuse. It was included in the Title IV-E Prevention Plans of seven states in April 2023. The contrasts reported by the Clearinghouse include only one favorable effect–on foster care placement–based on a matched comparison group study and not an RCT and one unfavorable effect (on child welfare reports), along with 19 findings of no effect.

Early Head Start-Home-Based Option

Early Head Start Home-Based Option provides weekly visits to pregnant women, infants, and toddlers until the child is three years old. The goal is to promote school readiness of young children by enhancing their cognitive, social and emotional development. The federal reviewers of Early Head Start’s Home-Based Option used nine publications based on a large federal RCT of the program at 17 sites as well as the early results of the federal study of MCHIEV programs, which is described below. There were no favorable findings on maternal or child health; child maltreatment; or delinquency, family violence and crime. There were a few favorable impacts on child development and school readiness; positive parenting practices; and family economic self-sufficiency scattered among multiple findings of no effect. These effects were not consistent across age groups or outcomes where one would expect some alignment (like reading to children vs. reading at bedtime). These impacts appeared to be small, although the lack of standardized effect sizes complicates interpretation. In the final report on Early Head Start, the authors stated that at “the end of the program, when children were three, impacts were modest in size and Early Head Start children continued to perform below national norms on cognitive and language assessments.” By the time the children reached fifth grade, all but one favorable impact earlier reported was gone.

The MIHOPE Study

The legislation establishing the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) required an evaluation of the program in its early years. The study, named the Mother and Infant Home Visiting Program Evaluation (MIHOPE), included 88 local programs in 12 states and was carried out by an evaluation nonprofit called MDRC. All of the programs were based on one of the four models most commonly chosen by states in their initial MIECHV plans–Early Head Start Home-based Option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers. A total of 4,229 families enrolled in the demonstrations between 2012 and 2015. Strangely, even though the sample sizes were large enough to estimate the effects of each program model, the researchers opted to report findings for all four models taken as a whole, a decision that has been criticized by experts and funders because of the significant programmatic differences between the models. Early findings released in 2019 from when the children were 15 months old were disappointing. There was little difference between the experimental and control groups. About a third of the 63 outcomes measured were statistically significant and though most comparisons did favor the home-visited groups, the effect sizes were extremely small–too small to be of any practical significance. The authors reported that for most outcomes the effects were slightly smaller than the average effects found in past studies of the models (which were already modest).

On September 11, 2025, the Administration on Children and Families released the long-term results of the MIECHV program evaluation conductd five to seven years after enrollment, when children were in kindergarten or first grade. Summing up their findings in a press release, ACF asserted that “MIECHV-funded home visiting significantly improved maternal and family wellbeing for participants five-to-seven years after enrolling in services…MIHOPE found statistically significant and positive effects of home visiting” for the five categories of maternal and family well-being outcomes. For the three categories of child outcomes, the researchers found “some evidence of positive effects,” but only one was statistically significant and positive.

Unfortunately, the researchers did not distinguish between a statistically significant effect and an effect which is large enough to be meaningful. A more sober analysis by the Coalition for Evidence-Based Policy shows that home visiting produced “negligible outcomes” for each of the eight expected impacts. The review points out that the average effect size across the six statistically significant or near-significant categories of effects was 0.03 – the equivalent of moving the average child or mother from the 50th to the 51st percentile. The study did not report model-specific effect sizes, but the reviewers noted that they are likely to be small or modest given that few reached statistical significance. It is also worth mentioning that many of the outcomes came from maternal answers to a caregiver survey, introducing the possibility of bias..

It is also concerning that the evaluation team at MDRC used a different analysis plan to assess impacts for the kindergarten study than it did for the earlier results. The new analysis plan was dated January, 2025 (but not released until May 2025). The new methodology combined all the 66 outcomes studied into eight new “research questions” some of the outcomes were included under more than one research question. The researchers chose to focus not on the significance of each individual impact, as was done in the earlier report. Instead, they decided to use a method called “omnibus testing” to compute an overall significance level for each research question.3 By choosing this method, they were able to find significant results (at the 0.10 level) for five of the eight research questions, where looking at each outcome would have shown only eight significant outcomes out of 86, or less than 10 percent of the outcomes. Since the new analysis plan was dated January 2025, it seems likely that it was developed after an analysis of the data (which was collected in 2021 and 2022) under the old plan yielded unsatisfactory results.4 The Imprint has published a more detailed critique of the MIHOPE study by Sarah Font and Emily Putnam-Hornstein called The Odd Bipartisan Effort to Oversell the Evidence for Home Visiting.

Why have home visiting programs been so unsuccessful at changing outcomes for most children and families?

As Deanna Gomby stated back in 1990, “home visiting programs have struggled to engage and retain families.” Research has documented low levels of enrollment and engagement of families at risk of maltreatment in voluntary services in general and home visiting in particular. According to the MIHOPE implementation report, 17 percent of the home visiting group never even received one visit, as compared to 12 to 22 percent in previous studies. All the models expected families to participate at least until the child’s second birthday, with services available for two or three years longer in three of the programs. Yet, only 46 percent of families were still participating in home visits 12 months after their first visit, consistent with previous research. On average, families who received at least one home visit went on to participate for an average of eight months. While participating, families received fewer visits than expected by the models in which they were enrolled. In the first 12 months, less than 60 percent of families received at least half of the visits prescribed by their model, a result consistent with prior research. Part of the problem might be that many people who need the kind of help that home visiting is designed to provide do not want to let a stranger into their home to scrutinize their parenting and family functioning. Child Welfare Monitor has heard in the District of Columbia and elsewhere that there is an oversupply of home visiting slots, with too few people wanting to participate.

Misleading Congress, the Media and the Public

Ever since the initial excitement about home visiting, there have been high hopes for this service delivery method and unwillingness among policymakers on both sides of the aisle to discard their hopes. At the same time, the federal government along with many advocacy groups, has endorsed a vision of “evidence-based practices” that asks only for a minimal number of statistically significant impacts, with no concern about the size of the impacts or the nature of the evidence–whether it is self-reported, self-contradictory, or unsupported by more than one study. As a result, studies that show only a few modest impacts that may be statistically significant but not meaningful in size or corroborated by other studies can be cited as evidence of program success.

Unfortunately, program evaluations are technical enough that readers who are not schooled in the intricacies of research methods are often forced to rely on the researchers’ interpretation of their findings. The usually well-informed Congressional Research Service has stated that “A large body of research suggests that some home visiting models or services can benefit children and their parents.” Less surprisingly, the press is easily misled. Due to lack of time or expertise in the intricacies of social science research, reporters often simply report what is in the press release announcing new research results. For example, the Imprint, a widely circulated outlet for child welfare content, repeated in its podcast the government’s misleading proclamation about good news from the MIHOPE study.

—–

No matter how painful the process, legislators, agency officials and advocates should remove their blinders about home visiting. It is time to phase out the MIECHV program. State and local governments should begin scaling down their home visiting programs and funneling the money to other uses that are currently underfunded. In this time of budget scarcity, it is time to stop throwing good money after bad. We need new ideas and meaningful evaluations that can bring about the implementation of programs that actually work. If money is being wasted on home visiting services that are not making a difference, or not even being used, surely there are better uses of these scarce funds.

Appendix I

In the absence of time to review the hundreds of publications on the Nurse Family Partnership Program, I used the excellent evidence summary on the Arnold Ventures Social Programs that Work website. For the studies of HFA, Parents as Teachers, and SafeCare, I relied mostly on the compilation of study results provided by the Title IV-E Prevention Services Clearinghouse. For Early Head Start, which was not included in the Clearinghouse, I used the Home Visiting Evidence of Effectiveness review conducted by the Office of Policy Research and Evaluation (OPRE) of the US Department of Health and Human Services.

Nurse Family Partnership

Each of the four U.S. RCT’s of NFP had a different population and eligibility criteria for participants. Elmira is in a small, semirural county in New York State which had the highest rate of child abuse and neglect in the state at the time of the study. In 1980, the community was rated the lowest Standard Metropolitan Statistical Area in the United States for economic conditions. Program participants In Elmira were either teens, unmarried, or low-income, and all were White. They were actively recruited by nurses at the prenatal clinic, private obstetricians’ offices, Planned Parenthood, schools, and other health and human services agencies. In Memphis, the program admitted pregnant women with no previous live births who did not have a chronic illness that might affect the fetus and who had at least two of the following risk factors: being unmarried, having less than 12 years of education, and being unemployed. Ninety-two percent of the women enrolled were Black, 98 percent were unmarried, 64 percent were eighteen years old or younger and 85 percent came from households with incomes at or above the poverty level. In Denver, women were recruited at any point in their pregnancy if they had no previous live births and either qualified for Medicaid or had no health insurance. Almost half of the two groups were Hispanic, another 35 percent were Caucasian, and 16-17 percent were Black. The South Carolina demonstration recruited pregnant women who were 15 years or older and eligible for Medicaid, which meant their incomes were less than two percent of the poverty level. The participants were mainly non-Hispanic Black (54.9 percent) and non-Hispanic White (35.0). In addition to enrolling a different population, each study looked at a different set of outcomes, and sometimes at different times as well, making it hard to compare the results. The findings of the demonstrations are summarized below.

  • Child safety based on child welfare administrative reports: There was no statistically significant difference among confirmed child maltreatment reports between the experimental and control groups in Elmira. But there is some evidence that the Elmira program reduced child maltreatment among the participants who were most at risk, those who were teenagers, poor and unmarried. Among this group, 19 percent (or a total of eight) of the poor, unmarried teens had a verified maltreatment report compared to only one of their nurse-visited counterparts. But this effect was statistically significant at the p-0.7 level, not the standard level of 0.05. And there were no treatment-control differences in verified maltreatment reports during the two years after the program ended. However, the Elmira study did find a large impact on verified CPS reports when the children were 15; nurse-visited children had received on average of 0.29 verified CPS reports compared to 0.54 in the comparison group. This result is difficult to explain and one wonders if it was due to chance.This outcome was not examined in Memphis or Denver. The Netherlands study also found a large, statistically significant impact on child welfare administrative reports, where the researchers found that 11 percent of the visited children had a CPS report compared to 19 percent of the control group children during the first three years of their lives.
  • Child safety based on health care for injuries and ingestions: Nurse visited children in Elmira had fewer emergency room visits for injuries and ingestions in their second year of life than the control group. (This was not measured during the first year, when they were less mobile and able to get into trouble. No effect size was provided). When they were between 25 and 50 months old, they had 40 percent fewer mentions for injuries and ingestions in their medical records and 45 percent fewer mentions of child behavioral or parental coping problems. In Memphis the researchers found that in the first two years of life, nurse-visited children had an average of 0.43 health encounters for injuries or ingestions compared to 0.56 for the control group, or 23 percent fewer encounters. They also spent an average of 0.04 days hospitalized for injuries and ingestions, compared to 0.18 days for the control group– a 78% decrease. A more recent evaluation of a large scale implementation of NFP in South Carolina found no difference between the experimental and control groups on child health, measured as “a composite of mortality or health care utilization associated with major injury or concern for abuse or neglect.” In the UK Study, there were no differences in the rates of emergency hospital visits for the experimental and control groups.
  • Child wellbeing based on behavioral and emotional functioning: This outcome was not included in Elmira at two and four years. But there were large favorable effects on self-reported arrests and convictions for the Elmira children at age 15-19–a finding that was not reported anywhere else and was not matched by effects on other outcomes like high school graduation, teen pregnancy, engagement in work or school at 19, or self-reported substance use or welfare receipt, all of which could have been expected to covary with the arrests and convictions. So it is not clear whether these results occurred by chance. In Memphis there were no effects found on children’s reported behavioral problems at two years, nor were there any results on youth behavioral functioning when they got older. There were significant favorable effects on child emotional functioning in Denver at two years and four years. By ages six to nine in Denver, behavioral and emotional effects were consistently favorable but did not reach statistical significance at standard levels, perhaps because the sample size was not large enough.
  • Child wellbeing based on cognitive functions and abilities: In Elmira there were no statistically significant cognitive effects on children in the first two years, although the researchers observed “improved intellectual functioning of nine to 11 points on the developmental tests for children from the highest risk families. Although only marginally significant statistically, the researchers observed that it is of clinical importance. Treatment effects in this range are consistent with those obtained for children of this age enrolled in intensive early childhood intervention programs aimed specifically at enhancing cognitive development.” In Memphis, there were no effects at two years on children’s mental development but there were substantial statistically significant effects on academic performance at age 12 for the children whose mothers were in the lower half of the sample on intelligence, mental health and self-confidence. In Denver, there were favorable effects on the cognitive development of children born to mothers with low psychological resources in the two-year follow-up. This group also did better cognitively at ages six to nine but the findings only occasionally reached statistical significance and may be due to attrition differences between the intervention and control groups. But at age 18 there were “sizable, significant” effects on two of three cognitive outcomes for this subgroup in Memphis. Cognitive effects were not studied for Elmira or Denver 18-year-olds.
  • Maternal life course: When the children were aged 15, the Elmira study found that nurse-visited mothers had 19 percent fewer births than control mothers, an average of 1.3 births compared to 1.6. In Memphis, the mothers had 16 percent fewer births in the first six years of the program. They had caught up by the time the children were 12, but the increase in birth spacing is still a significant favorable outcome. In Denver, home-visited women had fewer subsequent pregnancies (29 percent vs. 41 percent) and births (12 percent vs. 19 percent) by their children’s second birthdays. There was no impact on the rate of second pregnancies after two years in the South Carolina, British Columbia, and UK studies. Where reported, there were no effects on adverse birth outcomes, maternal employment, likelihood of partnership or marriage with the child’s father, substance abuse, psychological distress or foster care placements (mentioned only in Memphis).

Healthy Families America

The contrasts presented by the Title IV-E. Clearinghouse were based on four RCT’s that were rated highly for design and execution by clearinghouse staff. The results of each RCT are based on multiple research papers published for each major study. Reviewing the Clearinghouse’s tabulation of the data, and sometimes comparing it to the actual publications to which it referred, raised several questions about the overall effectiveness of the program:

  • Child safety measured by child welfare administrative reports: There were no favorable or unfavorable outcomes, as compared with 43 contrasts showing no statistically significant effect.
  • Child safety, based on maternal self-reports about whether they maltreated their children: There were five favorable contrasts, 38 contrasts with no effect, and one unfavorable contrast. It is hard to be confident about the validity of self-reports of maltreatment, as one could easily imagine the program participants having learned more about what to report, and under-reporting behaviors (such as spanking) that they had been taught were undesirable. The large number of contrasts with no effect is worth noting.
  • Child safety based on injuries needing medical care, hospitalizations, and emergency use: There were no favorable or unfavorable impacts and 11 contrasts showing no effect.
  • Child permanency based on out-of-home placements: There were six contrasts showing no effect, and none showing a positive or negative effect.
  • Child well-being: Behavioral and Emotional Functioning: Five contrasts showed a positive effect, two with no effect, and none with a negative effect. All of the five positive effects were reported by Healthy Families Alaska and were fairly large. But all of these were based on the caregiver’s report of the child’s behavior, and self-reports are not sufficient on their own for making conclusions about impact. Moreover, these outcomes and measures were not replicated in any other study.
  • Child well-being: social functioning: The Clearinghouse reports no favorable or unfavorable effects and and two contrasts showing no effect.
  • Child well-being: cognitive functions and abilities: There were two favorable impacts, one unfavorable impact, and 6 contrasts showing no effect. The two favorable impacts came from Alaska and were not found in any other evaluations.
  • Child well-being: physical development and health: The Clearinghouse reported no favorable or unfavorable impacts and six contrasts with no impact.
  • Child well-being: delinquent behavior. There was one favorable effect in the one contrast available, which was “child skips school often.” A look at the publication containing this result, which was a report on the RCT of Healthy Families New York (HFNY) seven years after random assignment, showed that fewer children self-reported skipping school, but this result was not supported by reports from their mothers.
  • Child well-being: educational attainment: The Clearinghouse reported one favorable impact and two findings of no impact. All three findings came from one publication from the HFNY RCT. The researchers found that children in the HFNY group were about half as likely to be retained in first grade (3.54 percent) than children in the control group (7.10 percent), based on official school data. However, there were no impacts found for the other two educational attainment outcomes used by the Clearinghouse–performing above or below grade level in reading or math. Moreover, this contrast was not available from any other study.
  • Adult well-being: positive parenting practices: There were three favorable impacts and 24 findings of no impact. All of the favorable impacts were from another report on HFNY that was based on observations of how the mothers interacted with their children as they completed three tasks–a puzzle solving task, a delay of gratification task, and a cleanup task. I was not able to judge the size of the effects; all were statistically significant at the 0.05 level. However, there were no significant effects on observed presence of harsh parenting during the same tasks. Moreover, this outcome was not included in the evaluation of any other program.
  • Adult well-being: parent/caregiver mental/emotional health. The Clearinghouse found three favorable impacts and 16 contrasts showing no impacts from a total of three RCT’s.
  • Adult well-being: Parent/Caregiver Substance abuse: There were no favorable or unfavorable effects, and 15 instances where no statistically significant effect was found.
  • Adult well-being: family functioning: There were three favorable impacts, one unfavorable impact, and 28 instances of no impact. The three favorable impacts stemmed from three different contrasts related to Intimate Partner Violence (IPV)–overall maternal IPV victimization rate (child age 1-3), maternal IPV victimization rate: physical assault (child aged 1 to 3), and maternal IPV perpetration rate: physical assault (child age 1 to 3). The size of the effect was not provided and there were nine other maternal IPV contrasts when the child was aged 1 to 3 that showed no effect. There were were no impacts on IPV when the child was older.
  • Adult well-being: economic and housing stability. There were no favorable impacts, five contrasts showing no impact, and one showing an unfavorable impact.

Parents as Teachers

The results presented by the Title IV-E Clearinghouse are based on two RCT’s and one study based on a matched comparison group. Even when counting all these programs, the results are not impressive.

  • For child safety based on administrative reports, the Clearinghouse noted two contrasts with a favorable effect and two with no effect. The effect size and implied percentile effect calculated by the Clearinghouse were very small. Moreover, these results were based on a matched comparison group rather than an RCT, casting doubt on the validity of the results.
  • Child permanency (out-of-home placement): The clearinghouse cited no favorable or unfavorable findings and one finding of no effect.
  • Child well-being: social functioning. The original article cited by the Clearinghouse, based on an RCT in two California sites, reported that PAT children in one of the sites benefited significantly, advancing by about two months of the control group in self-help development but did not report significant results for the other site or for social development at either site.
  • Child well-being: cognitive functions and abilities: Based on the American and Swiss RCT’s, The Clearinghouse reported two favorable findings and 10 findings of no effect. But one of the findings was actually of no effect for the PAT-only group; it was the “PAT plus case management group” that experienced an impact.
  • Child well-being: Physical development and health: The clearinghouse reported no favorable or unfavorable effects and three findings of no effect from one RCT.
  • Adult well-being: positive parenting practices: The Clearinghouse reported no favorable or unfavorable effects and one finding of no effect from an RCT.
  • Adult well-being: family functioning: The Clearinghouse reported no favorable effects, 8 findings of no effect, and one unfavorable effect, all from one RCT.
  • Adult well-being: economic and housing stability. The Clearinghouse reported no favorable effects, one unfavorable effect, and nine findings of no effect, all from one RCT.

SafeCare

SafeCare is a brief home visiting model that is delivered in 18 one-hour sessions. SafeCare is designed for parents and caregivers of children birth through five who are either at-risk for or have a history of child neglect and/or physical abuse.It was included in the Title IV-E Prevention Plans of seven states in April 2023. The contrasts reported by the Clearinghouse include only one favorable effect–on foster care placement–based on a matched comparison group study and not an RCT and one unfavorable effect (on child welfare reports), along with 19 findings of no effect.

Early Head Start Home-based Option

The Early Head Start Home-based option serves low-income women and families with children under three years old. They receive a minimum of weekly 90-minute home visits and two group socialization activities per month. The findings discussed here are based on the HHS Office of Policy Research and Evaluation (OPRE) review of the research on home visiting. OPRE reports that it reviewed 23 “manuscripts” and identified nine of those manuscripts that were based on “impact studies rated high or moderate quality.” By focusing on “manuscripts” instead of studies, OPRE obscured the fact that seven of these manuscripts were actually based on the same study–a large federal demonstration of EHS programs in 17 sites conducted between 1996 and 2002. Of the nine manuscripts, five were based on the full study and two were based on results from one Utah site only. The other two studies reviewed were based on results of the MIHOPE study of four home-visiting models when the children were 15 months old. All but two of the manuscripts were rated high by the OPRE staff in quality for methodology. The manuscripts based on the Utah study and the grade five follow-up for the national study were rated “moderate” in quality because of high attrition. In the nine publications reviewed, there were no favorable findings on maternal or child health; child maltreatment; or delinquency, family violence and crime. There were a few favorable impacts on child development and school readiness; positive parenting practices; and family economic self-sufficiency. These effects were not consistent across age groups or similar outcomes (like reading to children vs. reading at bedtime.) These impacts appeared to be small, although the lack of standardized effect sizes makes the importance of the effects hard to estimate.

  • For child development and school readiness, the reviewers reported five favorable findings from the 17-site study and the Utah study. All the other 66 contrasts related to child development and school readiness in the two studies showed no effect. By the time the children in the main study reached fifth grade, no effects remained.
  • For positive parenting practices, the reviewers reported 10 favorable findings from the 17-site study and the Utah study. In total, there were 64 findings of no effect in this area. By the time children reached fifth grade, one favorable impact (which was not noted for the three or five year-olds) was observed.
  • For family economic self-sufficiency, the reviewers reported 16 favorable findings, one unfavorable finding and 88 findings of no effect from 3 publications in a total of two studies. No economic effects remained by the time the children were in fifth grade.

Appendix II: Home visiting and child maltreatment

Analyzing the effect of any program on child maltreatment poses unique difficulties because it is such a difficult outcome to measure. Obviously, the evaluators cannot see what goes on in a household after the visitor has gone home. Evaluators have used three types of measures to estimate the effects of home visiting programs on child maltreatment–verified child protective services (CPS) reports, health care encounters for injuries or ingestions (or simply emergency room visits), and self-reports of abusive or neglectful behaviors through surveys like the Conflict Tactics Scale.

The most obvious measure of abuse and neglect is official Child Protective Services (CPS) data, but there are several problems with CPS data as a measure of maltreatment. The number of maltreatment reports that are confirmed (substantiated) by CPS is most frequently used, but it is known to be an understatement. Many cases go unreported, and reported cases are often not substantiated. Another problem is that verified abuse is a relatively rare event in a population and a study may not have enough participants to detect it. Finally, h visitors are mandatory reporters and their presence in the home introduces surveillance bias; these families are under more surveillance than families in the control group and may receive more reports for that reason.

Olds and his colleagues did not find statistically significant differences in substantiated CPS reports for the whole program group during the two year period that families participated in the Elmira demonstration or in the subsequent two years. But they found some evidence that the Elmira program did reduce child maltreatment among the participants who were most at risk–those who were teenagers, poor and unmarried. About 19 percent (or a total of eight) of the the poor, unmarried teens had a verified maltreatment report compared to four percent (or one) of their nurse-visited counterparts. But this effect was statistically significant at the p-0.07 level, not the standard level of 0.05. And there were no treatment-control differences in verified maltreatment reports for this subgroup or the whole treatment group during the two years after the program ended. The researchers speculated that this may be due to increased surveillance on the nurse-visited group, because the nurses connected them to other providers before the programs ended.

However, a surprising finding emerged when the children were 15 years old. By that age, nurse-visited children had received on average of 0.29 verified CPS reports compared to 0.54 in the comparison group–a large and highly statistically significant difference. The investigators hypothesized that as young first-time parents mature and develop, small positive changes that [occur while they are in the program] can build and multiply over time, yielding larger effects in later years.” The mechanism by which the Elmira program had such delayed effects is hard to understand. Perhaps it occurred by chance. But in any case, a replication would be necessary to give it credence, and this outcome was not measured in Memphis or Denver.

As an alternative to CPS data, some researchers have used data on health care encounters for children’s injuries or ingestions. Many of these encounters may reflect abuse or neglect but they also would include cases that are not due to either abuse or neglect and would leave out many instances of maltreatment as well. But it is certainly a good indicator of safe parenting. In the four-year followup of the NFP Elmira group, when the children were 25 to 50 months old, the researchers found that nurse-visited children had 40 percent fewer injuries and ingestions (according to notations in their medical records) and and 45 percent fewer notations of or child behavioral or parental coping problems. Nurse-visited children also made 35 percent fewer visits to the emergency room. In the NFP Memphis trial, the evaluators found that nurse-visited children had an average of 0.43 health encounters for injuries or ingestions compared to 0.56 for the control group, or 23 percent fewer encounters in the first two years of their lives. They also spent an average of 0.04 days hospitalized for injuries and ingestions, compared to 0.18 days for the control group. But a more recent evaluation of a large scale implementation of NFP in South Carolina, described above, found no difference found between the experimental and control groups in its composite measure of child mortality and major injury related to abuse or neglect.

Other studies have used parent self-report measures such as the Conflict Tactics Scale. This measure is less valid than the other two because many parents are reluctant to report abusing or neglecting their children. A few studies found positive effects on such measures but without any corroboration from more objective measures.

Notes

  1. Conversation between Marie Cohen and David Olds, October 22, 2025
    ↩︎
  2. Similar disappointing results from a study in the United Kingdom may have been influenced by a control group that received an average of 16 home visits from a public health nurse and 11 visits from a midwife through the child’s second birthday, as well as targeting a lower-risk population than most of the other studies. A study in British Columbia found no reductions in its primary outcome – child injuries by age two years – or in subsequent maternal pregnancies by the child’s second birthday. The authors speculate that British Columbia’s more comprehensive health and social services may explain the lack of effects. ↩︎
  3. The authors organized the outcomes into five “research questions” focusing on maternal outcomes and three research questions focusing on “child outcomes.” The “maternal outcomes” included “outcomes that could be improved through direct interaction between parents and home visitors;” maternal mental and behavioral health; parent-child interactions; conflict, violence, aggression and maltreatment;” and families’ economic circumstances. The child outcomes included “children’s social-emotional functioning in the home context; children’s social-emotional functioning at school; and children’s cognitive, language and early math skills. ↩︎
  4. Conversation with Emily Putnam-Hornstein, who made me aware of the revised 2025 research plan. ↩︎

This post was edited on November 10, 2025 to add a sentence and links about enrollment and engagement in home visiting and a link to an article about the MIHOPE report.

Child welfare and community norms: a troubling divergence

Arabella McCormack, NBC7 San Diego

This summer, I was asked by a reporter to comment on a terrible case in the District of Columbia. Twenty-month old Kemy Washington died of starvation and dehydration, after her mother had had overdosed on a mix of MDMA, cocaine, ethanol and the animal sedative xylazine. An older sibling had been removed from Kemy’s mother due to her neglect and that child’s guardianship with a relative had been ratified only days before Kemy was born. Yet, Kemy was never on the radar screen of the Child and Family Services Agency until her grandmother made two calls, which were apparently screened out as not involving child abuse or neglect. When I read the more than 600 comments on the article, I was struck that over and over again, commenters asked the same question. How is it that a mother who had a previous child removed from her due to neglect could give birth to another child without triggering an investigation, close monitoring, or even removal of the child? The reporter asked me the same question and I explained that such a policy, though clearly logical to members of the community, would never be accepted by the current child welfare establishment, where it would be viewed as an unacceptable infringement on parents’ rights.

I have often remarked on situations where child welfare policy or practice departs from general community norms. Whether it is the continued screening out of calls on the same family, even if a child was previously removed; the refusal to consider policies that would trigger investigations when a new child is born to a parent who committed severe abuse or neglect; the push to “reunify” children with parents who have proved over and over again that they cannot keep them safe or even stop harming them, it seems that policymakers and practitioners of child welfare are operating from a different set of norms than the public. What would be clear to a grandparent, a neighbor, or a random layperson do not seem so evident for those who are charged with protecting our children. This was made very clear in a devastating report on child fatalities in Minnesota. As the authors put it,

Members of the public often express dismay and outrage to us over stories such as those recounted in this report. We infer from this that the professional norms currently guiding child protection and foster care are out of alignment with those of the broader community. 

Examples of this divergence abound, and I am sharing just a few here.

“B.B.” was born in the State of Washington in 2022 and died of fentanyl poisoning in March, 2023. Starting in 2014, the Department of Children, Youth and Families (DCYF) had received 30 reports about B.B.’s family for the use of heroin, marijuana and alcohol in the home; lack of supervision of the children; domestic violence; an unsafe adult living with the family; an unsafe and unclean physical environment; unsecured guns in the home, “out-of-control” behaviors by B.B.’s older siblings at school to which the mother was unresponsive, seeming “out of it;” concerns about the children’s hygiene; and the mother driving under the influence of marijuana. A few days before B.B.’s death, a caseworker told B.B.’s mother that the agency was closing a voluntary services case that had been open for about half a year. But the family was already under investigation again at the time B.B. died.

There have been multiple cases around the country of child protection workers disregarding reports of hungry children eating food from the floor or the garbage, until a child finally died or escaped from the torturers. School staff in Utah reported making at least four calls in the 2022-2023 school year (confirmed by a timeline released by DCFS) to CPS alleging that Gavin Peterson was always hungry and eating food from the trash. School staff were buying his lunch but had to stop after his father and stepmother forbade it. One school staffer “said Gavin’s father and stepmother justified Gavin’s small frame and constant desire for food as side effects from his medication, but she didn’t buy it.” Why did CPS? That summer, Gavin was withdrawn from school. A year later he was dead after years of starvation and beatings.

Seven-month-old Emmanuel Haro is missing and presumed dead. Investigators believe that he was abused for an extended period of time before he was killed. But his suffering and death could have been avoided. His father had been arrested for abusing a child from a previous marriage in 2018–abuse so serious that the child is now bedridden. A simple “birth match” policy could have prevented the death of Emmanuel Haro. If birth records were linked to criminal and CPS records, Emmanuel’s birth could have triggered a mandatory investigation and monitoring because the father had been convicted of child abuse–the kind of policy that commenters in the Kemy Washington case were asking for. It is hard to think of a more common-sense idea than birth match. Yet, only five states had such a policy in 2022, according to my report on birth match for the American Enterprise Institute. And most of these programs are very limited both in terms of which parents are covered and of the state response.

Even a birth match policy would not help in cases where a parent’s violent history is known but disregarded. Four-year-old Rykelan Brown died from a beating by his father, Joshua Emmons, in May 2024, two months after he was removed from a loving foster home to be placed with Emmons. The foster parents had repeatedly reported that Rykelan came home from visits with his father bruised and saying his father hit him and he never wanted to go there again. The local Department of Social Services knew that in 2019 Emmons had beat his then-girlfriend’s three-year-old son so severely that he damaged the child’s liver, which must now be checked regularly. But the social services commissioner told an interviewer that the event occurred too long ago to be considered. Really? Even when paired with Rykelan’s bruises and reports of beatings?

As the above examples show, some things that are intuitive to ordinary people – -like that a child going to school hungry (and not because of poverty) – is a sign that something is deeply wrong at home–seemed to be missed by people engaged in child welfare practice, administration and policymaking. Much of the problem stems from a dominant ideology that preaches that abused and neglected children are almost always better off with their own families. The same viewpoint holds that what child welfare calls neglect is just poverty, as if all poor parents neglect their children, and that child welfare is a a racist system that was created to destroy Black and Brown families.1 Social work schools have adopted and promulgated these positions and agencies have incorporated them in the training for new social workers. Deep-pocketed groups like Casey Family Programs have used their money to foster this ideology through training and technical assistance to state and local agencies. The entire child welfare community in many states has found itself endorsing policies and practices that defy common sense thinking.

We must bring child welfare policy and practice back into alignment with community norms. But that is easier said than done. The public pays little attention to child welfare until there is a tragic fatality or egregious incident that is covered in the media. But many of these cases are never known to the media and therefore to the public. And even when they are, child welfare agencies often refuse to release information about their past involvement with the family, in violation of federal law. So the press, the public and legislators cannot identify what went wrong and what would be needed to prevent future tragedies in the future.

A small but useful first step to align child welfare systems with community norms would be to make the public aware of decisions that clearly violated these norms and harmed children. The federal government should enforce the requirements of the Child Abuse Prevention and Treatment Act (CAPTA), which as interpreted in the federal Child Welfare Policy Manual, requires states to issue specific information and findings on all child maltreatment fatalities and near fatalities caused by maltreatment. That includes information about past dealings between the children’s families and the child welfare agency. Ultimately, the requirement must be expanded to cover all “egregious incidents” where maltreatment is suspected.2 Increased public awareness how child welfare agencies knowingly and routinely leave children in harm’s way may help elevate child welfare into a major issue, not a backwater that gets addressed only when there is a tragedy.

Three family members are awaiting trial for murdering 11-year-old Arabella McCormick in August 2022 and torturing her sisters. A kindergarten aide in Arabella’s class told a reporter that she got a disturbing note from Arabella’s foster mother, who went on to adopt her and then allegedly participate in her murder. “In the envelope, it said, ‘Arabella is,’ and it was line items such as ‘a terrible child,’” she said. “‘She’s a liar. You can’t believe anything she says. She’s a thief. She steals everything. Don’t trust her.’ It was just one thing after another of horrible things that you would never say about a 6-year-old.” The teacher’s aide told the grand jury that she contacted child protective services (CPS) after Arabella arrived at school school in the same dirty clothes on several occasions. She also told CPS that Arabella wasn’t allowed to eat fruit, accept rewards or participate in recess with other children. “And the lady from CPS said to me on the phone — after I told her everything, she said, ‘Well, it could be worse,’” the teacher’s aide told the grand jury. Really? I don’t think most members of the public would agree.

Notes

  1. In fact, child welfare systems initially involved White children only. Black children were originally excluded from public child welfare systems. ↩︎
  2. Both Colorado and Wisconsin release information on cases meeting this description. ↩︎

The power of wishful thinking: The continued promotion of Healthy Families America as a child abuse prevention program

by Marie Cohen

The original version of this post was published on April 4, 2022. I decided to update and re-publish it after reading a press release from Prevent Child Abuse America stating that “PCAA’s signature home visiting program, Healthy Families America, has been proven to reduce child abuse and intimate partner violence while improving long-term health and educational outcomes.” While I cannot evaluate the claim about domestic violence, the post below show that Healthy Families America has not been “proven” to reduce child abuse.

I have written before about the power of wishful thinking and how it causes people to disregard research and real-life results. A program called Healthy Families America (HFA) offers a good example of the power of wishful thinking. The nation’s oldest and largest charity (now called Prevent Child Abuse America or PCAA) dedicated to the prevention of child abuse launched HFA based on weak evidence that a program in Hawaii could prevent child maltreatment. The first experimental study of the Hawaii program found no impact on child maltreatment but did nothing to derail the launch of HFA, which grew into the centerpiece of PCAA. Studies of HFA programs around the country have found little evidence of reductions in child maltreatment, but the program has continued to grow. The story of HFA is a lesson in the power of wishful thinking and the failure of evidence (or lack thereof) to counteract it.

As told in a helpful history of home visiting, all modern programs can trace their origins to Henry Kempe, whose book, The Battered Child, brought about the recognition of child maltreatment as a national problem. To address child abuse, Kempe called for universal prevention through a network of home health visitors. Inspired by Kempe, modern home visiting began with Hawaii’s implementation of the Healthy Start Project (HSP) in 1975. HSP was developed on the island of Oahu. It had two components: early identification (at the birthing hospital) of families with newborns at risk of child abuse and neglect and home visiting by trained paraprofessionals for those families classified as at-risk who agreed to participate. This initial program was never evaluated, but anecdotal information suggested it was successful in promoting effective parenting, and six similar programs were established on neighboring islands.

The Hawaii Legislature authorized a three-year pilot program focusing on one neighborhood in Oahu, which began in 1985. There was no control group in the pilot study, and the researchers used CPS reports and changes in family stress in participating families to measure program effectiveness. During the three-year pilot, there were few reports of physical abuse, neglect or imminent harm for program participants. Because evaluations of other home visiting programs had found much higher rates of reported maltreatment in comparison group families, these results were viewed as evidence that the program had a positive impact. According to the authors of the first rigorous evaluation of HSP, “The pilot study results might have been given too much weight, given the lack of a control group and the short period of follow-up for most families.” Nevertheless, the results of this unpublished study were enough evidence for the Legislature to expand HSP throughout Hawaii starting in 1989.

Home visiting in general was gathering steam in the 1980s and early 1990’s. In 1990, the U.S. General Accounting Office (GAO) issued a report promoting home visitation as a “promising early intervention strategy for at-risk families.” In its summary of research evidence, GAO focused mostly on health and developmental benefits for children, rather than maltreatment prevention. In 1991, the U.S. Advisory Board on Child Abuse and Neglect issued a report recommending a pilot of universal voluntary neonatal home visitation, stating that the efficacy of home visiting as a preventive measure was “already well-established.” The Board cited the results of a federally-funded demonstration begun 17 years earlier as well as the the nurse home visitation program started by David Olds in 1977. But HSP was not mentioned.

Despite the lack of a rigorous evaluation, the National Committee to Prevent Child Abuse (NCPCA, now called Prevent Child Abuse America), which bills itself as the nation’s “oldest and largest organization committed to preventing child abuse and neglect before it happens,” had become interested in using HSP as the nucleus of a national home visiting program. But first, NCPCA conducted a one-year randomized trial of HSP. The trial suffered from severe methodological limitations, including “less than ideal followup,” differential dropout rates in the program and control groups, the failure to blind interviewers to experimental or control status, and reliance on program staff rather than researchers to measure some outcomes. Nevertheless, the trial concluded that HSP reduced child maltreatment, and this apparently gave NCPCA the assurance it needed to invest in the model.

NCPCA launched Healthy Families America in 1992, with financial support from Ronald MacDonald House Charities. Rather than impose a single service model, HFA was based on a set of principles or critical elements, which included initiation of services prenatally or at birth, assessment of the needs of all new parents in the target area, voluntary nature of services, at least weekly services for families with the highest needs, availability of services for three to five years, comprehensive nature of services, and cultural competence, among others. The typical HFA program included an assessment of all new or first-time parents in a given community at the time their babies are born or prenatally.”

In the meantime, the Hawaii Department of Health recognized the limitations of both the pilot study and the NCPCA study and initiated a more rigorous evaluation of HSP in 1994. This was a randomized controlled trial, with at-risk families identified at the hospital and randomly assigned to the experimental and control groups. In 1999 the results of the Evaluation of Hawaii’s Healthy Start Program were released as part of an issue of the Future of Children journal containing evaluations of six different home visiting models.  No overall positive program impact emerged after two years of service in terms of child maltreatment (according to maternal reports and child protective services reports). Early HFA evaluation results, published in the same issue, also failed to find effects on abuse and neglect in three randomized trials, which included the HSP evaluation discussed above and another Hawaii HSP study.

David Olds had had begun testing his Nurse Home Visiting Program in 1977 and already had long-term results on the program in Elmira, NY, as well as shorter-term results for a replication in Memphis, Tenn. That program, now known as Nurse Family Partnership, was very different from HFA. It was restricted to first-time teenage mothers and the home visitors were nurses rather than paraprofessionals. The nurses followed detailed protocols for each visit. The researchers found that among low-income unmarried women (but not other participants), the program reduced the rate of childhood injuries and ingestions of hazardous substances that could be associated with child abuse or neglect. Follow-up of the Elmira group when the children were 15 found that the nurse-visited mothers were significantly less likely to have at least one substantiated report of maltreatment. These results are particularly impressive because they overrode a tendency for nurse-visited families to be reported for maltreatment by their nurse visitors. The researchers concluded that the use of nurses, rather than paraprofessionals, was key to the success of the program.

In their analysis of all six studies published in the Future of Children volume on home visiting, Deanna Gomby et al. concluded that while the HFA and HSP evaluations showed some change in maternal attitudes and self-reported behaviors related to abuse and neglect, only the Nurse Home Visiting Program showed impacts on abuse and neglect other than from self-reports. Gomby and her co-authors also concluded that the results of all six home visiting evaluations were discouraging for those who had high hopes for home visiting for solving an array of problems. All the programs “struggled to enroll, engage and retain families.” Program benefits generally accrued to only a subset of enrolled families and were often quite modest. The authors explained the disappointing results by concluding that human behavior is hard to change, particularly when problems are community-wide. They recommended that “any new expansion of home visiting programs be reassessed in light of the findings presented in this journal issue” and stated that home visiting services are “best funded as part of a broad set of services for families and children.”

But the home visiting juggernaut was already in motion nationwide. And NCPCA, renamed Prevent Child Abuse America in 1999, had already made HFA its centerpiece program. Home visiting grew, and HFA grew with it. In 2010, Congress created the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV), which was re-authorized in 2018 with funding of $400 million per year through FY 2022. HFA is one of the models that are most frequently implemented with MIECHV dollars. Home visiting programs can also receive funding through Medicaid, Title IV-B and IV-E of the Social Security Act, and many other funding sources. HFA now serves over 70,000 families per year at an average cost of over $3,000 for a family in its first year of home visiting.

The infusion of funding for HFA research resulted in a multitude of research projects (both randomized trials and less rigorous studies) and resulting publications. Nevertheless, research has yet to find solid evidence that these programs have an impact on child maltreatment: The California Evidence-Based Clearinghouse for Child Welfare (CEBC), the pre-eminent child welfare program clearinghouse, reviewed 19 research reports on HFA. Its website as of April 2022 gave the program a rating of “4” on a scale of 1 to 5 for prevention of child abuse and neglect, meaning the evidence fails to demonstrate that HFA has an effect on abuse and neglect. Interestingly, that rating no longer appears on the CEBC website, but the earlier version is preserved by the Wayback Machine. As of April 2025, HFA is no longer listed at all in the CEBC’s document titled Home Visiting Programs for Prevention of Child Abuse and Neglect. When I emailed the CEBC to ask about the missing rating, I received an email stating that Healthy Families America “is still currently under review in the Prevention of Child Abuse and Neglect topic area. The rating for this topic area was pulled from the website during the rereview process. Some programs take longer to review due to the amount of research and other factors.”

HFA was not designed to work with families that have already been found to abuse or neglect their children but that did not stop child welfare agencies from spending federal and state funds delivering HFSA to families under the Family First Prevention Services Act (FFPSA). Despite the lack of evidence of its impact on maltreatment, HFA received a rating of “Well Supported” from the clearinghouse established by FFPSA to determine whether a program can receive federal funding under Title IV-E of the Social Security Act. To get such a rating, the program must show improved outcomes based on at least two randomized trials or rigorous quasi-experimental studies. But these outcomes could be any sort of “important child and parent outcome,” (not just reduction of child abuse or neglect) and there is no standard for how to measure each outcome. Based on its review of all HFA studies that met their criteria for inclusion, the Clearinghouse found 23 favorable effects, 212 findings of no effect, and four unfavorable effects across 16 outcomes. This included five favorable effects on child safety based on parents’ self-reports of maltreatment, with no favorable effects on other measures of child safety. Self-report is generally frowned upon as a measure of child maltreatment, for obvious reasons. A positive impact of HFA might reflect that participants in HFA were more eager than control group members to provide the “right answer” to questions about maltreatment.

The “well-supported” rating from the Title IV-E clearinghouse allowed states to spend Title IV-E funds on services to families with a child welfare in-home case. To take advantage of this new market, HFA announced in September 2018 that families referred by the child welfare system were now able to enroll as long as the child in question was 24 months of age or younger, as opposed to the original requirement that services start at or before birth. To serve these families, HFA introduced special child welfare protocols. HFA advertises these protocols on its website, stating that “HFA’s evidence and the flexibility of enrollment make HFA a great prevention choice for states and child welfare organizations seeking to strengthen families and reduce the number of children placed in foster care.” (Note that there is no mention of reducing abuse and neglect!)

Today, the diversity of HFA programs makes evaluation of the program as a whole impossible. According to the website, “HFA puts communities in the driver’s seat. Local HFA programs are able to choose their eligibility criteria, parenting materials, and hire the staff they deem best to do the job. With the amount of flexibility offered, HFA has been able to be successfully implemented in a wide variety of communities.” It is hard to imagine what the evaluation of one HFA program means about the effectiveness of other programs under the same name.

Critical examination of the HFA website shows that the organization skews its portrayal of available research to present it in the most favorable light and avoids direct statements that the program prevents child abuse and neglect. On its Evidence page, HFA claims the “highest rating possible from CEBC in the category “Home Visiting Programs for Child Well-Being,” without mentioning that in the category “Home Visiting Programs for the Prevention of Child Abuse and Neglect,” HFA is currently unrated after the statement that it was unable to demonstrate an effect was removed. The page goes on to group the effects of HFA into three categories, stating that participants “build nurturing relationships with their children,” “champion their children’s health and development,” and “cultivate a flourishing future for their family.” Reductions in abuse and neglect are not mentioned in the description of how parents “build nurturing relationships with their children.”

It is disappointing that an organization that defines its mission as child abuse prevention, decided to fund HFA before it was proven to prevent child maltreatment and continued with this commitment even after the disappointing evaluations of 1999 might have led them to diversify their investment. That PCAA continues to use charitable contributions made for the prevention of child abuse and neglect to fund a program that has not been proven to accomplish this goal, raises serious ethical questions. Twenty-three members of the 45-person staff (which has grown by five staff in three years !) listed on the Prevent Child Abuse website have duties linked to Healthy Families America.

The story of HFA is not an unusual one. I have written about the similar disregard for evidence in the promotion of models such as Homebuilders and blind foster care removals. Such stories are all too frequent. They show us how wishful thinking can drive leaders to disregard research, especially after they have made a premature decision to commit to one program or course of action.

Did maltreatment fatalities in Texas really decline?

It may be too soon to celebrate. Policy changes may be obscuring the numbers.

This is a revised version of a column by Marie Cohen and Naomi Schaefer Riley that was published in the Dallas Morning News on April 1, 2025. Around the same time, Texas Public Radio published an excellent analysis with the same message, Why Texas’ Massive Drop in Child Neglect and Abuse Deaths is Misleading, as part of a major project called When Home is the Danger.

The Texas Department of Family and Protective Services has reported a dramatic decline in child maltreatment fatalities from 199 in FY 2021 to 99 in FY in 2024. Perhaps most surprising about the purported decline in fatalities is that it occurred alongside a massive drop in the number of children placed in foster care from 16,028 in Fiscal Year 2021 to 9,623 in Fiscal Year 2022, with similar numbers of children placed in 2023 and 2024. 

Supporters of recent changes in Texas law regarding child maltreatment were quick to highlight these findings as evidence that foster care can be greatly reduced or eliminated with no adverse effects on child safety.

But these claims do not stand up under careful scrutiny. Changes to policy and practice can result in dramatic year-to-year changes in official counts of child maltreatment fatalities, and Texas has implemented at least three significant policy or practice changes during this period. 

First, a Texas law that took effect September 21, 2021 tightened the definition of neglect to require the presence of “blatant disregard” for the consequences of an act or failure to act that results in harm to the child or that creates an immediate danger to the child’s physical health or safety. This new requirement means that deaths that would have been attributed to maltreatment prior to the law change are now not investigated at all or not confirmed as maltreatment. Indeed,  DCF cites this changed definition as one cause of the decline in reported fatalities between FY 2021 and FY 2024. 

Child fatality numbers were also affected by a practice change implemented by DCF that involves the way the agency handles reports of child fatalities. Previously, DCFS assigned all child death reports it received for a full investigation. But starting in September 2022, reports to the Texas Child Abuse Hotline that involve a child fatality but include no explicit concern for abuse and neglect are treated as “Case Related Special Requests,” requiring field staff to confirm that the reporter or first responders had no concern for abuse or neglect. If there are any concerns for abuse or neglect, the child fatality is then sent for a full investigation, but otherwise there is no further action. DFPS reports that the number of child fatalities it investigated decreased from 997 in FY2022 to 690 in FY2023 and 587 in FY 2024.  DFPS attributes this decline in investigations to both this practice change and to the legislature’s change in the definition of neglect.

There is one newer policy change that DFPS announced in its recent report. Investigations that are closed “with a disposition of reason to believe for neglect with a fatal severity code” receive a further level of review. It seems possible that this level of review may be reducing the number of reported cases even further.

Given all these policy and practice changes affecting the count of child maltreatment fatalities, It seems highly likely that Texas did not see an actual reduction in these deaths, but rather reclassified them as not due to child maltreatment.  Perhaps it is not surprising that neither DFPS nor the supporters of weaker child protection are interested in exploring what is really happening to vulnerable children in the aftermath of the drastic decline in the use of foster care. 

A fundamental conflict: addressing implicit bias in mandatory reporter training

by Marie Cohen

Recognizing implicit bias in mandated reporting training is a national focus for addressing racial inequity in child welfare. States from New York to Washington have updated their training for mandatory reporters to include implicit bias or highlight the distinction between neglect and poverty in an effort to reduce racial disparities in child welfare involvement. My recent experience taking the updated training in Washington DC made clear that there is a fundamental conflict between preparing mandated reporters for their responsibility to report and advising them to assess their biases before reporting. The basic conflict is this: the core training instructs mandatory reporters to report any suspicion of abuse or neglect, while the implicit bias unit urges mandatory reporters to doubt their instincts and reconsider their duty to report.

In FY 2023, the District of Columbia’s Child and Family Services Agency (CFSA) updated its online mandated reporter training to include a module focused on understanding and addressing implicit bias for mandated reporters. This training is required for all mandated reporters, who include both professionals (doctors, nurses, teachers, social workers, etc.) and volunteers who work with children. I had taken the training several times in the past–first for my work as a social worker with CFSA and later as a mentor to a foster youth. I had my first experience with the updated training last month as part of my preparation to serve as a Court Appointed Special Advocate (CASA) for a child in foster care.

The Implicit Bias Module

The implicit bias module appears to have been shoehorned into the existing DC mandatory reporter training right after a brief introduction to mandatory reporters and their role. The video introducing the section explains that implicit bias harms “families of color” in the child welfare system, without providing any evidence of such harm. It goes on to assert that “the point of this portion of the training is to make sure that reporting is based on observations and not assumptions. Ultimately we want mandated reporters to consider this before responding to a child’s disclosure of suspected abuse or neglect: Do I have any implicit bias in my decision to call or not to call the hotline.” It may sound reasonable, but as the training unfolds, a conflict with the goals of the overall training and mandatory reporting itself becomes clear.

The implicit bias module continues by explaining that nationally and in DC, mandated reporters call the CFSA hotline about Black families disproportionately more than White families; this leads to more “Black and Brown” children having in-home cases or entering foster care because they are assessed more closely. A graph has been provided, with text saying “In this graph, disproportionality is where you see that Black and Brown children make up approximately 64% of hotline calls. However, only 57% of people in the District are a race/ethnicity other than white.” Unfortunately, one does not see this in the graph, which does not include hotline calls at all! It does include children who are the subject of an investigation after a call to the CFSA hotline, and it shows that Black children made up 57 percent of the investigated children, while comprising 53 percent of the population. That is a very small disparity, and in any case could reflect unequal rates of abuse and neglect between Black and White children. The data does show a larger Black-White disparity in confirmed maltreatment (71 percent of the children confirmed as maltreated are Black) and “foster care” (whether this is children in care or entries into care is unclear) at 92 percent. But these increasing disparities come in at the investigation stage (where the substantiation and foster care decisions are made), not at the reporting stage, calling into question the need for training mandatory reporters about implicit bias. To make matters worse, the data on investigations contain a whopping 40 percent without race or ethnicity data; 26 percent of the confirmed maltreatment data, and 23 percent of the in-home case data also lack race and ethnicity information. (Note that the bars of the graph have been shifted by one column to the left of the corresponding columns from the numerical table, as in the original.) So it is impossible to draw meaningful conclusions from these data.

Source: DC Mandated Reporter Training, Lesson 3, page 6, available from

Other than the mention of the hotline call data, which is missing from the graph, the only analysis of the data in the text reads as follows. “Disparity occurs when these children and families have cases open to either in home or foster care support. As you can see that [sic] 85% of in-home cases, and more than 92% of foster care cases in 2020 were opened with Black and brown families, while again the District’s make-up is only 57% Black and brown.” The inclusion of “brown families” is somewhat disingenuous. The graph shows that Hispanics and Asians, the only “brown” children with non-zero populations on the graph, are underrepresented in investigations, confirmed maltreatment, foster care, etc.1 Switching categories, the lecturer goes on to state that “At every stage, Black and Indigenous families face racial discrimination and unequal treatment.” DC is not known to have a large indigenous population; there is no row on the table for Native Americans, and Native Hawaiians and Pacific Islanders are zero percent of every category except that they are listed as making up two percent of children aging out of foster care in 2019.

A central motif of the training is that the confusion of poverty with neglect contributes to the racial and ethnic disparities in child welfare. The video states that “under current law, most children in the US are separated for neglect, a code word that typically represents conditions of poverty, resulting in disproportionate separation and harm to Black families….” But there is a problem with this. We know that neglect is often associated with serious drug abuse and/or mental illness. After all, most poor people don’t neglect their children. Moreover DC Code Section 16.2301 forbids a court to find maltreatment when the deprivation of food, clothing, shelter or medical care is due to the parent’s lack of financial means. The law does not allow removing children because of poverty in DC, and the small number of removals compared to investigations in DC (224 children placed in foster care compared to 3,767 investigations in FY 2024) suggests that CFSA does not remove children for poverty alone.

The training includes practice scenarios to help trainees distinguish between poverty (or “need” according to the training) and neglect. The participant must read the scenarios and decide whether they represent need (and presumably do not call for a hotline report) or neglect. After providing their own answer, trainees learn the “right answer” according to CFSA. One of the three “need” scenarios is particularly troubling and is reproduced here:

The 4-year-old child came into the center smelling of a strong smell and her nails are long and dirty. There is sticky stuff on her chest that is black underneath her shirt on her skin. The child often comes to the center unbathed. She was wearing shoes that were too small, but the dad was made aware, and he got her new shoes. The child comes in with an old pamper not changed, soaked or soiled. Sometimes she comes to school with the same clothes on from the day before or sometimes wears the same clothes for three days.

The child does not talk or engage with staff or peers. The mother has been observed yelling at the child and all she does is cry. The child covers her eyes but does not ask for anything.

The caller is aware that the family was recently evicted after the mother lost her full-time job and they are being supported on the income made from the father’s part-time employment. The family moves from the homes of family and friends because they refuse to go to a shelter. Caller suspects sometimes the family may sleep in the car.

The characterization of this scenario as “need” rather than neglect is troubling. The combination of factors that are cited suggest something more than poverty. The fact that the child “does not talk or engage with staff and peers,” and that the mother “has been observed yelling at the child and all she does is cry” suggest problems this beyond the realm of need. The refusal to go to a shelter under current conditions, when the District of Columbia guarantees shelter to families with children and has replaced its dilapidated shelter with modern new facilities, increases the likelihood that this is a case of neglect.

In the content that follows, a video tells mandatory reporters that although they are required by law to report suspected abuse or neglect, they should not make reports “solely based on assumptions, schemas, or biases.” It seems rather disrespectful to think that a doctor, nurse, teacher, social worker or volunteer would do this. Trainees are presented with the following questions to ask before making a report.

This is confusing indeed. Is the agency saying that mandatory reporters should not make a report “solely out of legal obligation,” even though they are legally required to report and could receive consequences for not doing so? Providing resources to assist the family is fine, but if there is abuse or neglect, does that exempt the reporter from the duty to report? It seems unlikely and unwise.

“Granted,” the presenter continues, “there are many times when you recognize your legal obligation, have the resources to support a family, and have checked your biases, and a report still needs to be made.” But the speaker goes on to state that “Each of us holds a responsibility to address disproportionality and disparity in the lives of Black and Brown families in the District.” She then invites us to “walk through how we can do this together,” by listening to two videos that are a total of five minutes in length. The first video, on “Mitigating Bias” counsels reporters to follow a three-step process consisting of of “deliberate,” “reflect,” and “educate,” with each step containing mutiple steps or suggestions. Mandatory reporters then learn about “cultural humility” and its three attributes: “lifelong learning and critical self-reflection,” “recognition and challenging of power imbalances,” and “institutional accountability.” And then training participants are told that “[u]ltimately, our goal is to ensure that children who are experiencing neglect in the District receive the support they need to thrive within their families. To do this effectively, we each have to ensure our implicit biases, whether personal or institutional, are not the foundation for calls to the CFSA hotline.” Apparently, no children in the District need to be removed from their families in order to thrive; even though the agency providing the training removed 244 children in the last Fiscal Year, as mentioned above.

To sum up, the implicit bias section of the training teaches child-serving professionals and volunteers that mandatory reporting harms Black children and that to avoid that harm, mandatory reporters must engage in a lengthy deliberative process before making a report. Mandatory reporters learn nothing of the costs of not making a report, which include the possible death of a child. They also learn nothing about the different risks facing Black children, who are three times more likely than White children to die of maltreatment.2 Instead, they are told that “we are delinquent in addressing the institutionalized racism and bias that pervades our family and wellbeing systems. This has been perpetuated by the misconception that we are nobly rescuing children from dangerous situations.” The clear implication is that making a report is much more risky than not making one.

A Case of Mixed Messages

After at least an hour of training on implicit bias, mandatory reporters finally arrive at the original training, which seems mainly unchanged. They learn about how to respond to a child’s disclosure of abuse or neglect. They learn they must report when they have reasonable cause to believe a child has been, or is in immediate danger of, being abused or neglected. They learn what and how to report. They learn that the identity of reporters is confidential and that failure to make a report can be punished by a fine of up to $1,000 or imprisonment for up to 180 days. They learn about different types of abuse and neglect, which children have higher risks of being maltreated, situations in which CFSA does not intervene, what happens when a report is made, and how child welfare services work in the District of Columbia. They are told to “[r]eport any suspicion of child abuse and neglect,” and that “every call matters!” A key instruction is buried in the section on how to distinguish discipline from child abuse. It says: “The good news is, as a mandated reporter, you do not need to know the details or all the facts before making a report. You just need to be suspicious of abuse/neglect and CFSA’s response, if it does respond, will do the rest.” (This should be moved to the top and emphasized, as it may have been in an earlier version of the training). In closing, trainees are told that:

Abuse and neglect place children at great risk of physical and emotional injuries and even death. As a mandated reporter, the District is expecting you to do the following:

  • Recognize the signs of child abuse and neglect.
  • When children have the courage to disclose abuse or neglect to you, take them seriously.
  • When you suspect or know of incidents of child abuse or neglect, call CFSA at (202) 671-SAFE.
  • Be responsible for calling the CFSA Hotline yourself, even if you have informed your supervisor.
  • If necessary, be helpful and available during the investigation.

The fundamental conflict between the training’s two messages is clear. According to the original training, abuse and neglect are dangerous to children and it is our responsibility to report. According to the implicit bias section, it is reporting that is dangerous and needs to be inhibited. Neglect is a serious type of maltreatment according to the original training but a “code word”d according to the implicit bias section. It is not really surprising that the implicit bias element of the training seems to be in opposition to the preexisting content. Perhaps those who inserted this content would prefer to eliminate mandatory reporting training entirely and are just trying to minimize it within the requirements of current law. But the half-measure of trying to train the implicit bias out of mandatory reporters creates a training that simply does not make sense.

In addition to this fundamental disconnect, the training exhibits many factual errors and is padded with extraneous content. The factual errors are discussed in an addendum to this post. The extraneous content includes discussions of the racial wealth gap and instructions for “self-reflection, in which trainees are instructed to define their values by a three-step process that is painstakingly described in a three-minute video. Perhaps the most striking extraneous content is a section that describes in detail six types of “mental models related to diversity, equity and inclusion.” One of the six types is “active opposers,” who are typically deeply rooted in their choice to be a strong opponent of DEI. These are the people whose minds cannot be changed and who are committed to disrupting the work of DEI.” One cannot help wondering how the current federal leadership would respond if they knew of this content, and being offended at the disrespect for the time of busy professionals or volunteers.

In summary, there is a fundamental conflict between the original message of CFSA’s mandatory reporter training and the message of the implicit bias unit that has been added to it. Unlike the original message stressing the duty and importance of reporting suspected abuse and neglect, the new message states that reporting damages children and families of color and should be avoided whenever possible. This fundamental conflict is not unique to the District and by necessity affects all mandatory reporter trainings that attempts to temper the duty to report by inserting considerations related to race and ethnicity.

Notes

  1. Nationally, Hispanic children are reported to CPS at about the same rate as White children. Raw data shows them slightly more likely to be substantiated and placed in foster care once reported. See Brett Drake et al., Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005–2019. ↩︎
  2. From U.S. Children’s Bureau, Child Maltreatment 2023, page 59. States reported that 6,04 per 100,000 Black children were found to be victims of a child maltreatment fatality compared to 1.94 per 100,000 White children. These are deaths that have been confirmed as due to maltreatment by child protective services, medical examiners, or police, a process that may be affected by bias. ↩︎

Addendum: Factual Errors in CFSA’s Mandatory Reporter Training Implicit Bias Module

The implicit bias module in CFSA’s mandatory reporter training curtains numerous factual errors and omissions. Here are a few. 

  1. “National studies by the US Department of Health and Human Services reported that minority children and in particular black children are more likely to be in foster care than receive in-home services even when they have the same problems and characteristics as White children.” I asked the CFSA’s Communications Director for a citation and I found the exact language in one of the three references that were provided–a 2019 ABA brief entitled Race and Poverty Bias in the Child Welfare System: Strategies for Child Welfare Practitioners. A footnote referred readers to an essay by Dorothy Roberts for PBS’ Frontline program. That essay in turn attributes the same quote to “a national study of child protective services by the U.S. Department of Health and Human Services” with no citation. When consulted, ChatGPT references the outdated 1996 National Incidence Survey of Child Abuse and Neglect, which has been superseded and contradicted by the more sophisticated study published in 2010.
  2. “Rates of child abuse are not higher for children of color than white children. People of color do not treat their children worse than White families do. Racial disproportionality in CW is due to systemic racism, cultural misunderstandings, stereotypes, and biases that influence the decision to report alleged child report or neglect to CPS.” This is simply not true. First, we don’t have definitive evidence of child abuse rates as it occurs in secret, may not be reported, and investigations may not come up with the right results. But all the evidence we have indicates that Black families do abuse and neglect their children more than White families. This is likely due to the history of slavery and racism, which led to higher poverty and concentration in impoverished neighborhoods characterized by crime, substance abuse, unemployment, and limited community services, as well as a legacy of intergenerational trauma associated with these factors as well.
  3. “Although African American families tend to be assessed with lower risk than White families, they are more likely to have substantiated cases, have their children separated, or be provided family based safety services.” I could not find any resource on the internet that indicates that Black families tend to be assessed with lower risk than White families It is true that Black children tend to have more substantiated cases, have their children removed, or receive in-home services. But that is before controlling for family characteristics that affect risk. The only research article cited by CFSA actually reported that when they controlled for family risk factors, agency and geographic contexts, and caseworker characteristics, Black children were not at significantly higher risk of substantiation or removal.

Child Maltreatment 2023: A reduction in child maltreatment victims or a retrenchment of child protection?

“New Federal Report Demonstrates Reduction in Child Maltreatment Victims and Underscores Need for Continued Action,” the Administration on Children and Families (ACF) of the US Department of Health and Human Services proclaimed in releasing the latest annual report on the government response to child abuse and neglect. As in the past several years, ACF’s language suggested that child abuse and neglect are decreasing. But with states around the country changing law, policy and practice to reduce child welfare agencies’ footprint, the number of “child maltreatment victims” cited by ACF is likely more a reflection of policy and practice than an indicator of actual maltreatment.

The annual Child Maltreatment reports, produced by the Children’s Bureau of ACF, are based on data that states submit to the National Child Abuse and Neglect (NCANDS) data system. The new report, Child Maltreatment 2023 (CM2023), provides data for Federal Fiscal Year (FFY) 2023, which ended on September 30, 2024. The report documents the funnel-like operations child welfare protective services (CPS), which at each stage select only a fraction of the cases or children to proceed to the next stage. Exhibit S-2 summarizes the findings of the newest report. Child welfare agencies received 4.399 million “referrals” alleging maltreatment in Federal Fiscal Year (FFY) 2023 and “screened in” 2.1 million of them as “reports” for “disposition” through an investigation or alternative response. The investigation or assessment of those reports resulted in a total of 546,159 children determined to be victims of child abuse and neglect. (The final stage of the funnel involves services and is not covered in this post.) State and local policies and practice affect every stage of this process, as explained in detail below.

Referrals

NCANDS uses the term “referrals” to mean reports to child welfare agencies alleging maltreatment. Agencies received an estimated total of 4,399,000 referrals through their child abuse hotlines or central registries in FFY 2023, according to CM 2023. This is a very slight increase over the previous year and represents about 7.8 million children, or 60 per 1,000 children. As shown in Exhibit S-1, the total number of referrals has been increasing since 2020, when the COVID-19 pandemic resulted in a large drop in referrals. In FFY 2023, the number of referrals surpassed the pre-Covid 2019 total for the first time as the lingering effects of the pandemic, which acted to suppress reports, finally dissipated.

As in past years, the state-by-state tables document large differences in referral rates, from 19.9 per 1,000 children in Hawaii to 171.2 per 1,000 in Vermont–also the top and bottom states in 2022. These differences reflect not just different numbers of calls to child abuse hotlines but also state policy and practice. Vermont reports that it counts all calls to the hotline as referrals, while other states do not do so. For example, Connecticut reported in CM2022 that none of the calls that are assigned to alternative response are included in NCANDS, resulting in a far lower number of calls than the number they actually receive. Referral rates may also affected by a state’s policy on who is required to report and what must be reported. Such policies are disseminated to mandatory reporters through training and agency communications. New York reported implementing in FFY 2023 a new training for mandated reporters that helps them identify when concerns do not rise to a level legally requiring a report be made.” The training also focuses on implicit bias in order to “reduce the number of SCR reports influenced by bias about race or poverty.” The number of referrals in New York dropped by a very small fraction in FFY 2023. Missouri reported in CM2022 that it stopped accepting educational neglect referrals in 2021 as the COVID emergency ended, resulting in a decreased number of referrals received the following year.

Reports

Once a state agency receives a referral, it will be screened in or out by agency staff. In general, referrals are screened out if they are deemed not to contain an allegation of child abuse or neglect, contain too little information to act on, are more appropriately assigned to another agency, or for some other reason do not fall under the mandate of the child welfare agency. In the language used by NCANDS, a referral becomes a “report” once it is screened in. “Reports” are assigned for an investigation or “alternative response.” State data indicates that child welfare agencies screened in 2.1 million referrals, about 47.5 percent of referrals for an investigation or alternative response, and “screened out” the other 52.5 percent as not warranting a response. The number of screened-in referrals was 11.6 percent less than in FFY 2019 and slightly less than in FFY 2022.

A total of 42 states reported a decrease in the number of screened-in referrals in FFY 2023. In their commentaries, several of these states described policy and practice changes that led to their screening out more referrals. Ohio reported that two of its major metropolitan counties, which had significantly higher screen-in rates than the rest of the state, adjusted their screening procedures to be consistent with the rest of the state, resulting in a lower screen-in rate in those counties and statewide. Mississippi reported an increasing the amount of screening it conducted, especially when a report was received regarding a case that was already open; perhaps this is why its screen-in rate dropped from 41.3 to 36.5 per 1,000 children. Nebraska reported dropping a policy to require accepting all referrals from a medical professional involving children under six. Some states explicitly reported that their screening changes were adopted in order to decrease the number of screened in referrals. Kentucky reported adopting a new SDM® screening tool designed to decrease the number of referrals that are “incorrectly accepted for investigation.” Nevada reported a decrease in screened-in referrals because it established new intake processes to ensure that referrals are screened out when they do not meet criteria for acceptance.

“Victims”

The next phase in the funnel of CPS is the determination of whether abuse or neglect has occurred. At this stage, the level of analysis shifts from the case to the child, and the number of “victims” is the result. In NCANDS, a “victim” is defined as “a child for whom the state determined at least one maltreatment was substantiated or indicated1; and a disposition of substantiated or indicated was assigned for a child in a report.” “Victims” include children who died of abuse or neglect if the maltreatment was verified. Some children receive an “alternative response”2 instead of an investigation; these children are not counted as victims. According to CM2023, states reported a total of 546,159 victims of child abuse and neglect in FY 2023, producing a “victimization rate” of 7.4 per 1,000 children.

The number of “victims” reported by states according to the NCANDS definition does not represent the true number of children who experienced abuse or neglect, which is unknown. Many cases of child maltreatment go unreported. Children assigned to alternative response are not found to be victims unless their case is reassigned to the investigation track. And finally, substantiation may not be an accurate reflection of whether maltreatment occurred. Making a determination of whether maltreatment occurred is difficult. Adults and children do not always tell the truth, the youngest children are nonverbal or not sufficiently articulate to answer the relevant questions. So it is not surprising that research suggests that substantiation decisions are inaccurate3 and a report to the hotline predicts future maltreatment reports and developmental outcomes almost as well as a substantiated report.4 

State “victimization rates” range from a low of 1.5 per 1,000 children in New Jersey to a high of 16.2 in Massachusetts. It is unlikely that Massachusetts has more than ten times more child abuse and neglect victims than New Jersey–a not dissimilar Northeastern state. Policy and practice must be at play, including different definitions of abuse or neglect, levels of evidence required to confirm maltreatment, and policies regarding the use of alternative response or “Plans of Safe Care”5 to divert children from investigation, among other factors. Maine reported the second highest “victimization rate.” The Maine Monitor asked experts why this might be so. Among the reasons suggested were the definition of maltreatment; Maine allows abuse or neglect to be substantiated when there is a “threat” of maltreatment, even if there is no finding that it already occurred. In view of the deceptiveness of these terms, I have put the terms “victims” and “victimization rates,” when not preceded by the word “reported,” in quotation marks in this post.

The national “victimization rate” of 7.4 per 1,000 children, is a small decrease from 7.7 in FFY 2022 and the total number of reported “victims” was 19.3 percent less than the total reported in FFY 2019. This “victimization rate” has declined every year since FFY 2018. Of course, this decline is in part a result of the decline in the number of screened-in referrals that was discussed above. Any referral that is screened out is one less reported “victim,” even though some percentage of the screened-out referrals almost certainly reflected actual incidents of maltreatment.6 It is also clear that changes in policy and practice have contributed to the decline in the number of “victims” reported by states, as described below.

Policy and practice changes affecting “victimization” numbers

The change in the number of “victims” between FFY 2019 and FFY 2023 ranged from a 52 percent decrease in North Dakota to a 32 percent increase in Nevada, suggesting that these changes may reflect policy and practice more than actual trends in abuse and neglect. And indeed, two of the largest states made it more difficult to substantiate maltreatment in FFY 2022, and both found a decline in the number of maltreatment victims. In Texas, the legislature narrowed the definition of neglect, requiring the existence of both “blatant disregard” for the consequences of a parent’s action or inaction and either a “resulting harm or immediate danger.” Perhaps this helps account for the drop in the number of reported victims from 65,253 in FFY 2021 to 54,207 in FFY 2022. But the number of victims actually rose very slightly in FFY 2023. Perhaps the new definition had been assimilated into practice and was no longer resulting in a decrease in substantiations. In New York, the level of evidence required to substantiate an allegation of abuse or neglect was changed from “some credible evidence” to “a fair preponderance of the evidence” in FFY 2022. The number of victims found in New York dropped from 56,760 in FFY 2021 in to 50,056 in FFY 2022, which the Office of Child and Family Services attributed in its CM 2022 commentary to that change in evidentiary standards. The number of reported victims fell further to 46,431 in FY2023; perhaps the changed evidentiary standards were continuing to take hold or other state policies affecting other parts of the funnel–such as the attempt to rein in mandatory reporting–were contributing factors. The agency did not address this issue in its 2023 commentary.

A few states did mention in their CM 2023 commentary changes in policy or practice that might have contributed to changes in the number of “victims” in FFY 2023. North Dakota attributes a decrease partly to a change in state statute and policy which allows protective services to be provided when impending danger is identified, even without a substantiation. The agency appears to believe that workers are not substantiating as many reports now that they do not need a substantiation to provide services. Arkansas attributed a decrease in victims to the adoption of a new assessment tool that may have contributed to the routing of more reports to the differential response pathway. Kentucky reported that the adoption of new “Standards of Practice” may have contributed to the increase in the number of “victims” reported in FFY 2023.

Fatalities

Based on reports from 49 states (all but Massachusetts), the District of Columbia, and Puerto Rico, CM2023 estimated a national maltreatment fatality rate of 2.73 per 100,000 children. That rate was then applied to the child population of all 52 jurisdictions and rounded to the nearest 10 to provide a national estimate of 2,000. But experts agree that the annual estimates of child fatalities from NCANDS significantly undercount the true number of deaths that are due to child maltreatment. I discussed this in detail in A Jumble of Standards: How State and Federal Authorities Have Underestimated Child Maltreatment Fatalities.

The annual fatality estimates presented in the report increased by 12.3 percent between FFY 2019 and FFY 2022 and then fell slightly from 2,050 to 2,000 in FFY 2023, a fact that ACF mentioned in its press release. Such a small reduction of less than three percent over the previous year cannot be statistically distinguished from random fluctuation, especially because it is based on much-smaller numbers from the individual states. State commentaries illustrate the randomness of these year-to-year changes. In CM 2022, two individual states explained year-to-year jumps in fatalities by explaining that many children in one family died and that a large group of fatalities that occurred the previous year were reported in the current year. But even aside from statistical fluctuations, there are many reasons one cannot rely on year-to-year changes. These include the timing of reports and changes in policy and practice.

Timing

According to CM 2023 (and previous reports), “The child fatality count in this report reflects the federal fiscal year (FFY) in which the deaths are determined as due to maltreatment. The year in which a determination is made may be different from the year in which the child died.” The authors go on to explain explain that It may take more than a year to find out about a fatality, gather the evidence (such as autopsy results and police investigations) to determine whether it was due to maltreatment, and then make the determination. Alabama, for example, explained in its commentary that the deaths reported in a given year may have occurred up to five years before.

To add to the uncertainty around timing, the writers of CM 2023 are not exactly correct when they state that all states report on the fatalities determined in the reporting year. In their annual submissions to NCANDS, several states add fatalities for the previous year, implying that their practice is to report on fatalities that occurred in a specific time period, not those determined in the applicable year. Four states revised their number of 2022 fatalities in their submissions to CM2023. This suggests that their 2023 reports are in turn incomplete and will be revised in succeeding years. California, for example, explained that:

Calendar Year (CY) 2022 is the most recent validated annual data and is therefore reported for FFY 2023. It is recognized that counties will continue to determine causes of fatalities to be the result of abuse and/or neglect that occurred in prior years. Therefore, the number reflected in this report is a point in time number for CY 2022 as of December 2023 and may change if additional fatalities that occurred in CY 2022 are later determined to be the result of abuse and/or neglect.

So California is reporting (for CM 2023) a truncated count of child maltreatment deaths for Calendar Year 2022. But it did add 12 fatalities to the count of fatalities that it reported for FFY 2022, raising its total from 164 to 176. California reported 150 fatalities for FY2023; one can assume that additional deaths will be reported in the next report. The four states together added 56 deaths for FFY 2023. Arizona’s total increased from 14 to 39, Maine from three to 10 and Virginia from 39 to 51. .

Policy and Practice: Fatality Definition and Measurement

In addition to timing issues, year-to-year changes in fatality counts can reflect changes in how states screen or define child maltreatment fatalities. In previous issues of CM, states have reported on improvements in their collection of fatality information. Over time, some states have eliminated obsolete practices in screening and information collection. West Virginia reported in its 2016 commentary that it had begun investigating child fatalities in cases where there were no other children in the home. North Carolina ended its restrictive policy of reporting only fatalities determined by a chief medical examiner to be homicide, and it also began efforts to incorporate vital statistics and criminal justice data. 

During FY 2023, some states reported changes that may have resulted in a reduced number of child fatalities reported. 

  • Texas did not submit commentary for FFY 2023. But as reported above, it changed its screening policy so that reports involving a child fatality but include no explicit concern for abuse and neglect are not investigated if the reporter and other pertinent sources had no concern for abuse or neglect. DFPS reports that the number of child fatalities it investigated decreased from 997 in FY2022 to 690 in FY2023 (a 31 percent decrease) due to this new screening policy. And the number of child maltreatment fatalities fell from 182 to 164. But with a drastic drop in foster care placements in Texas, there is reason to fear that maltreatment fatalities increased rather than decreased. If that is the case, this change screening policy may have resulted in the failure to investigate and confirm actual maltreatment deaths.. 
  • The Illinois Division of Child Protection reported that it added a new administrative review process for sleep-related deaths. A senior administrator reviews the investigation to ensure that death included evidence of “blatant disregard.” DCF links this new policy with a decrease of 24.6% in reported child fatalities in FFY 2023.

Other states reported changes that might result in an increased number of child fatalities reported. Maryland attributed an increase in reported fatalities to a policy change requiring local agencies to screen in sleep-related fatalities as part of its prevention effort. Alaska reported a change that may affect fatality counts in future years: in December 2023 the agency dropped its practice of screening out cases where no surviving children remained in the home; from now on the agency will be making maltreatment findings even when there are no surviving children. 

It is regrettable that most state commentaries do not include explanations for the changes in their reported number of referrals, reports, and victims. Worse, several states do not even submit commentaries in time to be included in each year’s report. In CM023, commentaries are missing for Arizona, Hawaii, Kansas, New Hampshire, North Carolina, Oregon, Texas, and West Virginia. Given the importance of the state commentaries for understanding the data they submit, the preparers of the CM reports should reach out to agency personnel in states that have not submitted commentaries by a certain date or have not answered the important questions and ask the questions directly directly. This information is too important to be left out.

It is unfortunate that ACF continues to misuse term “victimization” and “victimization rate” to suggest that child maltreatment (including fatalities) is declining, particularly in its press release and executive summary, which do not provide any explanation of the true meaning of the terms. The deceptive language is not a surprise given the previous Administration’s desire to take credit for ostensible and support the prevailing narrative regarding the need for a reduction in interventions with abusive and neglectful families. One does not have to be a statistician or data scientist to realize that we will never get an accurate measure of child maltreatment because so much of it occurs behind closed doors. Finding fewer victims is one way to reduce CPS intervention in the lives of vulnerable children–and to deny that the reductions are harmful. Sadly, this report will be used as evidence to support policies that continue to roll back protections for our most vulnerable children.

Notes

  1. Substantated is defined as “supported or founded by state law or policy.” “Indicated” is a less commonly used term meaning a “disposition that concludes maltreatment could not be substantiated understate law or policy, but there is a reason to suspect that at least one child may have been maltreated or is at risk of maltreatment.” ↩︎
  2. An “alternative response” includes an assessment and referral to appropriate services if the parent agrees to participate. There is no determination on whether abuse or neglect occurred and no child removal unless the case is transferred to the investigative track. ↩︎
  3. Theodore Cross and Cecilia Casanueva, “Caseworker Judgments and Substantiation,” Child Maltreatment, 14, 1 (2009): 38-52; Desmond K. Runyan et al, “Describing Maltreatment: Do child protective services reports and research definitions agree?” Child Abuse and Neglect 29 (2005): 461-477; Brett Drake, “Unraveling ‘Unsubstantiated,’” Child Maltreatment, August 1996; and Amy M. Smith Slep and Richard E. Heyman, “Creating and Field-Testing Child Maltreatment Definitions: Improving the Reliability of Substantiation Determinations,” Child Maltreatment, 11, 3 (August 2006): 217-236. ↩︎
  4. Brett Drake, Melissa Jonson-Reid, Ineke Wy and Silke Chung, “Substantiation and Recidivism,” Child Maltreatment 8,4 (2003): 248-260; Jon M. Hussey et al., “Defining maltreatment according to substantiation: Distinction without a difference?” Child Abuse and Neglect 29 (2005): 479-492; Patricia L. Kohl, Melissa Jonson-Reid, and Brett Drake, “Time to Leave Substantiation Behind: Findings from a National Probability Study,” Child Maltreatment, 14 (2009), 17-26; Jeffrey Leiter, Kristen A. Myers, and Matthew T. Zingraff, “Substantiated and unsubstantiated cases of child maltreatment: do their consequences differ?” Social Work Research 18 (1994): 67-82; and Diana J. English et al, “Causes and Consequences of the Substantiation Decision in Washington State Child Protective Services,” Children and Youth Services Review, 24, 11 (2002): 817-851. ↩︎
  5. Plans of Safe Care are voluntary plans offered to the families of substance-exposed infants under the Comprehensive Addiction and Recovery Act (CARA). ↩︎
  6. We. know this from child fatality reviews that many children who die have been the subject of previous referrals, which were not substantiated but later found in fatality investigations to have been correct. See discussions of the deaths of Thomas Valva and Gavin Peterson, for example. ↩︎

A Fatal Collision: The Opioid Epidemic and the Dismantling of Child Protection Services in Washington State

by Marie Cohen

“B.B.” was born in 2022 and died of fentanyl poisoning in March 2023. During the ten years before B.B.’s death, DCYF had received 30 reports on B.B.’s family (many before B.B. was born) for issues including use of heroin, marijuana and alcohol in the home; lack of supervision of the children; domestic violence; an unsafe caregiver living with the family; an unsafe and unclean living environment unsecured guns in the home “out-of-control” behaviors by B.B.’s older siblings at school, with the mother described as “out-of-it” and unresponsive to school concerns; concerns about the children’s hygiene; and the mother driving under the influence of marijuana. An in-home services case that had been open since January 2023 was closed days before B.B.’s death. 

On August 24, 2024, the Washington Department of Children, Youth and Families (DCYF) proudly announced in a press statement that it had reduced the number of children in out-of-home care by nearly half since 2018. Specifically, the number of children in foster care had fallen from 9,171 in 2018 to 4,971 as of August 14, 2024. “Outcomes like this demonstrate our agency’s commitment to keeping families together and children and youth safe,” DCYF Secretary Ross Hunter said. “Although the number of reports we are receiving remain [sic] consistent, we are seeing fewer children and youth in out-of-home care as families are being referred to support services rather than having children removed from their homes. Indeed, “safely reduce the number of children and youth in out of home care by half” (without a baseline date from which this can be measured) is one of DCYF’s six strategic priorities. But treating the decline in foster care (the direct result of government actions) as a desirable outcome in itself can contribute to a disregard of actual child welfare outcomes like safety and permanency.

How did DCYF reduce foster care by nearly 50 percent?

How did DCYF manage to slash its foster care rolls so radically in such a short time? Without providing specifics, the press release cites DCYF’s implementation of the Family First Prevention Services Act (FFPSA) and its emphasis on “supporting and collaborating with families by providing access to services and programs.” A DCYF spokesperson told the Seattle Times that the department was using services to avoid removing children or to reunite families sooner, citing efforts to connect parents to substance use or mental health treatment programs, bring a social worker into the home to “problem solve,” or “offer practical items, like diapers, car seats and beds.”

Apparently not satisfied with the changes implemented by DCYF, the Washington legislature in 2021 passed the Keeping Families Together Act (KFTA, also known as HB 1227), which took effect on July 1, 2023. Among other provisions, KFTA increased the standard for the court to order removal of a child from the home, which previously required the agency to demonstrate that “reasonable grounds that the child’s “health safety or welfare will be seriously endangered if not taken into custody and that at least one of the grounds set forth demonstrates a risk of imminent harm to the child.” As amended by KFTA, the law now requires the agency to demonstrate “that removal is necessary to prevent imminent physical harm to the child due to child abuse or neglect.” The petition for removal is required to contain “a clear and specific statement as to the harm that will occur if the child remains in the care of the parent, guardian or custodian, and the facts that support the conclusion.” Moreover, the court must consider whether participation by the parents or guardians in “any prevention services” would eliminate the need for removal. If so, they must ask the parent whether they are willing to participate in such services and shall place the child with the parent if the parent agrees.

On a page dedicated to KFTA implementation, DCYF explains that it has implemented the law by adopting new policies and procedures to determine whether to remove a child and by training and supporting staff to implement the new procedures and determine whether there is an imminent risk of serious harm to the child. DCYF reports that internal reviews show that staff are “taking additional steps to prevent removal of a child and to support a safety plan for the family.” 

Shortly before KFTA took effect, DCYF, along with the Department of Health, the Health Care Authority, and the Washington State Hospital Association issued new guidelines to birthing hospitals and mandatory reporters. These guidelines stated that infants born substance exposed, but for whom there are no other safety concerns, can receive “voluntary wrap-around services from a community organization” without being reported to CPS. These voluntary services are being provided through federally-mandated “Plans of Safe Care (POSC).” Healthcare providers identifying a substance-exposed infant are instructed to access an online portal where they are directed  to call DCYF if safety concerns are identified and to complete a POSC referral if not.

DCYF has been issuing quarterly data updates to assess the impacts of the KFTA. According to the most recent (October 2024) update, the law is having the intended impact of further reducing removals to foster care. DCYF reports a 16 percent decrease in the number of children removed in the July through September quarter of 2024 compared to the same quarter of 2022, before passage of KFTA. However, comparing foster entries for all ages in July through September 2024 to those in the same quarter of the previous year, the data indicate that foster care entries actually increased! Will this be the beginning of the end of the foster care reductions? That remains to be seen.

A longer-term view raises questions about the difference KFTA made, compared to the previous and ongoing efforts by DCYF to reduce foster care placements.  Entries into foster care in Washington have decreased annually from 2017 to 2024, as shown in the chart below. The rate of decrease remained about the same between 2019 and 2024, while KFTA was not implemented until July 2023. Perhaps more children would have entered care if not for KFTA, but there is no way to assess the impact of KFTA as compared with DCYF’s ongoing effort to reduce removals. 

Source: DCYF, Child Welfare Agency Performance Dashboard, Children Entering Care in SFY, https://dcyf.wa.gov/practice/oiaa/agency-performance/reduce-out-of-home-care/cw-dashboard

The reduction in foster care placements was supposed to be accompanied (and made possible) by an increase in in-home services (which DCYF calls Family Voluntary Services or FVS), and DCYF reports that the number of cases receiving FVS increased by nine percent from 1,809 in SFY2023 to 1,994 in SFY2024. This increase in FVS cases cannot be compared to the 17-percent decrease in children placed in foster care over the same period, as the unit of analysis is different (families rather than children). But the key question is the nature and intensity of these services and whether they really kept the children safe. 

The cost of foster care reductions

The purpose of foster care is to keep children safe when they cannot be protected at home. So the essential question is whether the reduction in foster care placements has occurred without any cost to children. Trends in child fatalities and “near fatalities”1 due to child abuse or neglect can provide a clue. These deaths and serious injuries are the tip of the iceberg of abuse and neglect. For each child who dies or is seriously injured, there are many more that are living in fear, pain, or hunger, and incurring lifelong cognitive, emotional, and physical damage. There are troubling signs of an increase in child fatalities and near fatalities over the past several years. In its most recent quarterly update, DCYF reports on the number of “critical events” or child fatalities and near fatalities that met its criteria for receiving an “executive review.” These include the deaths of any minor that had been in DCYF custody or received services within a year of the death that were suspected to be caused by child abuse or neglect.2 They also include near fatality cases in which the child has been in the care of or received services from DCYF within three months preceding the near fatality or was the subject of an investigation for possible abuse or neglect. DCYF reports that the number critical events it reviewed increased from 23 in 2019 to 51 in 2023 and projects that it will increase to 61 in 2024.3

Source: DCYF, Keeping Families Together Act Quarterly Date Update, October 2024, https://dcyf.wa.gov/sites/default/files/pdf/DataUpdate_HB1227_October2024.pdf


The increase in critical events reflects, in part, the growing opioid crisis in Washington, as well as decisions Washington has made regarding how it intervenes to protect children.  Opioid related emergencies have “dramatically increased for the entire population (adults and children) in Washington,” and children have not been immune. Fentanyl is particularly dangerous to young children because it takes only a tiny amount to kill a baby or toddler, who can mistake the pills for candy or put straws or foil meant for smoking the drug in their mouths. The number of fatalities and near fatalities reviewed by DCYF that involved fentanyl climbed from four in 2019 to a projected 35 in 2024. Since 2018, Washington’s Office of the Family and Children’s Ombuds (has observed an annual increase in child fatalities and near fatalities involving accidental ingestions and overdoses. Fifty-seven (or 85 percent) of the 67 incidents examined in 2023 involved fentanyl. Over half of these incidents involved children under three years old and a shocking 14 out of the 85 infants were 12 months old or less.  As Dee Wilson and Toni Sebastian point out, the limited mobility and motor skills of infants suggests that some of these infants may have been given a small amount of fentanyl as a means of sedation.

The Washington Legislature was concerned enough about the possibility that KFTA is contributing to an increase in child fatalities and near fatalities in the context of the fentanyl epidemic that it passed a new law (SB 6109) in 2024. The law provides that a court must give “great weight” to the “lethality of high-potency synthetic opioids.….in determining whether removal is necessary to prevent imminent physical harm to the child due to child abuse or neglect.” However, it appears that there is confusion about exactly what that means.

Has DCYF given up on protecting children?

“We know that supporting and collaborating with families by providing access to services and programs increases their number of protective factors, leading to better outcomes,” said DCYF Assistant Secretary Natalie Green. “Giving families the tools they need to thrive and safely parent means more children and youth remain safely at home.”

DCYF, Washington Reduces the Number of Children in Out-Of-Home Care by Nearly Half, August 14, 2024.

But the work of DCYF’s own analysts, in their quarterly KFTA updates, raises doubts about whether DCYF is adequately performing its child protection function. These updates  acknowledge that the agency is not removing as many children with a high risk of future encounters with child welfare (in other words, those who have a high risk of being harmed). And they also report that the department has seen “an increasing percentage of moderately high to high risk cases being re-referred to CPS within 90 days of the risk assessment. DCYF also reports that the overlap between KFTA and Plan of Safe Care (POSC)  is resulting in fewer screened-in intakes involving substance-exposed newborns because these infants are now being referred to voluntary services under POSC.

There has been a chorus of voices alleging that DCYF is abdicating its child protection responsibilities. One foster parent told the Seattle Times that “she and other foster parents are finding children who now come into their care are in worse shape than they used to be, with more serious mental health conditions or greater exposure to lethal drugs like fentanyl.” She contends they’ve been left too long in unsafe conditions because of the heightened legal standard for removal. In The Erosion of Child Protection in Washington State, Toni Sebastian and Dee Wilson have cited the weakness of the management of Family Voluntary Services, which is often employed as an alternative to foster care. 

A survey of executive reviews of 2023 and 2024 child maltreatment child fatalities with DCYF involvement within a year provided examples of problems with screening, investigations, and case management, including the following:

  • Hotline issues. Reviews documented multiple intakes screened out on the same family even when the family had been the subject of multiple calls. The reviews also suggest that too many cases may be assigned to the Family Assessment Response (FAR) pathway, an alternative to a traditional investigation designed for lower-risk cases. In FAR cases, a social worker assesses the family and refers it to voluntary services. There is no finding about whether maltreatment has occurred and no child removal unless the case is transferred to the investigative track.
  • Premature closure of FAR cases. Reviewers noted instances in which FAR cases were closed after parents failed to cooperate, without caseworkers considering a transfer to the investigative track or before determining that the parent had followed through with services.
  • Assessment failures: Reviewers noted multiple failures to adequately assess parents for domestic violence, mental health, and substance abuse; failures to contact collaterals (relatives and friends) and instead relying on parental self-reports; lack of recognition of chronic maltreatment; ignoring evidence of past problems if not included in the current allegation; and failing to anticipate future behavior based on historical patterns.4
  • Inadequate understanding of substance abuse: Reviewers noted the failure to conduct a full assessment of substance abuse including history, behavioral observations, and collateral contacts; disregarding the unique danger to children posed by fentanyl; downplaying the significance of marijuana use, particularly as an indicator of relapse from harder drugs; and disregarding alcohol abuse because it is legal.
  • Failure to obtain information from treatment and service providers. The failure to communicate with service providers about clients’ participation in services like drug treatment and relying on clients’ self-reports was noted by more than one review team. Sometimes the providers refused to cooperate.  Staff told the team reviewing one case about a substance abuse treatment provider that routinely refuses to cooperate, even when parents sign release forms, and routinely tells clients not to cooperate with DCYF.
  • Lack of subject matter expertise. Reviewers pointed to the lack of deep knowledge about domestic violence, substance use disorder, and mental health among staff doing investigations, assessments, and case management and the need to provide access to subject matter experts when needed.
  • Failure to remove a child despite safety threats. The team reviewing the case of a four-year-old who died after ingesting fentanyl reported that there were at least two different times where an active safety threat was present that would have justified filing a petition in court to place the child in foster care. However, the staff believed, based on past experience, that the court would have denied the petition and therefore did not file. 
  • Delayed Reunifications: “P.L,.” a toddler allegedly beaten to death by his mother, was in foster care for over three years but his mother’s rights were never terminated. He was on a trial return to his mother for just over five months when he was found dead with bruises and burns all over his body. 

Staff shortages and high turnover were mentioned as contributing to the observed deficiencies in case practice in almost every fatality review. In B.B.’s case, the reviewers noted that the office had been functioning with a 50 percent vacancy rate for the last several years, stating that such a vacancy rate leads to high turnover, high caseloads, caseworkers with little experience, and supervisors forced to carry cases rather than support their caseworkers. Even caseloads that comply with state standards may be too high. The standard of 20 families per caseworker in FVS was noted to be unmanageable by one review panel, which noted that FVS cases are often discussed as high risk cases and require multiple contacts per month with family members, services providers, and safety plan participants. As Dee Wilson and Toni Sebastian put it,  “[b]etting young endangered children’s lives on in-home safety plans developed and implemented by inexperienced and overwhelmed caseworkers is reckless, ill-advised public policy.”

Conclusions and Recommendations

Treating the decline in foster care as a desirable outcome in itself, as Washington and other states have done, is both disingenuous and dangerous. Any government can slash the foster care rolls reducing or ending child removals, as many “child welfare abolitionists” recommend. The central purpose of child welfare services, including foster care, is to protect children from child abuse and neglect. A reduction in foster care placements that results in the failure to protect children is no kind of success. 

DCYF told King5 that “the increase in child fatalities and near fatalities in Washington is not being driven by the change in removal standards under House Bill 1227 or the reduction in the number of children in foster care. It is being driven by the increased availability of a highly addictive and hazardous drug and a lack of substance use disorder treatment in our communities.” But whether the agency’s policy or the drug epidemic is more at fault is not the right question. It is DCYF’s job to protect children given the circumstances that exist, including the drug epidemic and the lack of sufficient treatment, keeping in mind that treatment often does not work the first, second, third or subsequent times. 

What can be done? DCYF needs to address the workforce crisis, which will probably require increasing pay and improving working conditions, or even possibly relaxing requirements for employment as a caseworker in investigations, assessment, and FVS. DCYF should consider policy and practice changes such as reducing the FVS caseload cap from 20 cases per worker; Instituting a chronic neglect unit, with expert caseworkers and even lower caseloads, for chronic cases; finding a way to limit the use of FAR to cases that are truly low-risk; and promoting the use of dependency petitions for court supervision when children remain in the home, as suggested by two fatality review committees.5 DCYF should request and the legislature should fund a variety of ancillary services for families, starting with therapeutic childcare for all preschool aged children with FVS cases as well as those who have been reunited with their parents. Such childcare would give parents a break and parenting support, keep children safe for a large part of the day, and ensure another set of eyes on the child, among other benefits. Also needed are more residential drug treatment centers where parents can live with their children. 

Finally, more transparency is needed so that legislators, advocates and the public have access to the findings of DCYF’s executive review teams.  Washington deserves credit for sharing its executive child fatality reviews. But there is no reason that the DCYF should not share its near-fatality reviews as well. We know something about how DCYF failed B.B. and the other children who died. But the public needs access to the reviews of those children who narrowly escaped death as well as those who did not. It is only through such transparency that the public can see the actual impact of all the self-congratulatory proclamations about “safely reducing the number of children in out-of-home care.”

Notes

  1. A “near fatality” is defined by state law as “an act that, as certified by a physician, places the child in serious or critical condition.”
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  2. DCYF relies on the Office of the Family and Children’s Ombuds (OFCO) to determine whether the fatality appears to have been caused by abuse or neglect, therefore requiring DCYF to conduct a review.
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  3. Data collected by OFCO are more confusing. OFCO reviews all fatalities and near fatalities in which the child’s family was involved in Washington’s child welfare system within 12 months of the fatality. There number of near-fatalities reviewed by OCFO increased annually from 21 in 2018 to 70 in 2023, according to its most recent annual report on Child Fatalities and Near Fatalities in Washington State. But fatalities reviewed by OFCO did not show the same pattern. They reached a peak of 87 in 2018 and fell sharply in 2019, then rose yearly until they reached 85 in 2022 and then dropped to 79 in 2023. Nevertheless, adding fatalities and near fatalities together shows an alarming increase in critical incidents from 108 in 2018 to 149 in 2023.
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  4. For example, in the case of “R.W.,” a child who died at age four after ingesting fentanyl, an investigation was closed because the children were staying with relatives, despite the mother’s history of repeatedly removing the children from relatives with whom she had left them. A month later the child was found dead at a motel in the custody of the parents. 
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  5. See https://dcyf.wa.gov/sites/default/files/pdf/reports/mk-cfr-final-redacted.pdf and https://dcyf.wa.gov/sites/default/files/pdf/reports/ecfr-os-24.pdf ↩︎

Seven children and all she needed was a van: large families and the blindness of the child welfare establishment

By Marie Cohen

Working in the field of child protection, it is sometimes hard to avoid the feeling of living in some type of alternate reality, where bizarre statements are accepted and obvious questions go unasked. A case in point was a hearing on the Family First Prevention Services Act (FFPSA) that took place on May 22, 2024 under the leadership of Senator Ron Wyden of Oregon, one of the original sponsors of the FFPSA. This hearing and the fundamental misunderstanding about FFPSA that it uncovered has already been discussed in a previous post on this blog. But today’s post focuses on one particularly jarring vignette–the story of a mother, her seven children, and a van–and what it means about how child welfare policy is made and discussed today.

David Reed, the Deputy Director of Child Welfare Services in Indiana, introduced the story of this family in his testimony. Reed was trying to illustrate how the provision of economic and concrete supports can make children safer–an application of the theory that much of what is called child neglect is actually only poverty, which has been questioned previously in this blog. Reed explained the Indiana Family Preservation Services (IFPS) model requires that “concrete support be provided to families when not doing so would result in children having to come into foster care.” He gave an example of how this worked in a specific case:

DCS was called about a neglect allegation involving a single mother who had seven children, all of whom were school-aged or younger. This mother worked but struggled financially. DCS was called because she was unable to take all seven of her children in rural Indiana to school and/or daycare at the same time so that she could go to work. She took them in “shifts” leaving some children home alone. This resulted in the neglect allegation and the opening of a DCS case. The provider delivering INFPS to this family recognized what this mom really needed to ensure that her children could all be transported together—a bigger vehicle—and used the concrete supports built into INFPS to purchase her a used minivan. That $3,000 van “solved’ the reason for DCS’ involvement and very likely prevented seven children from coming into foster care, which is exactly what most likely would have happened prior to INFPS.

There is something strange about this example. Is it really possible that this mother needed nothing but a van in order to parent her children adequately? The rarity of seven-child families and the association of such large families with family dysfunction, including abuse and neglect, raise doubts about this mother’s appropriateness as a poster child for the provision of material supports as a solution to child maltreatment.

The rarity of a seven-child family

Seven children is such unusual number that it raises questions about why this mother had so many children and how she managed to care for them. The National Center for Health Statistics has estimated that 28 percent of women aged 40-49 (near the end of their childbearing years) who had given birth to children had only one child, 40 percent had two children, 27 percent had three children, and only 13 percent had four or more children.1 It is likely that the proportion with seven or more children is a tiny fraction of that 13 percent–and that is a percentage of women aged 40-48. We don’t know this woman’s age, but the younger she is, the more of an outlier she is, and the more questions this story should raise about her needs.

The association of extremely large families with dysfunction

A family of seven is not just unusual; it is often a marker for family dysfunction and pathology. Despite the rarity of families with five or more children, anyone who has worked in child welfare or juvenile justice knows that children from extra-large families are overrepresented among their clients. These families frequently consist of mothers with children by multiple fathers, with both parents often suffering from mental illness and/or drug abuse, and domestic violence is commonly present. These mothers are often too disorganized or too influenced by drugs and alcohol to use contraception; moreover, they may consciously or unconsciously get pregnant to hold onto a new man. In its Study of the Root Causes of Juvenile Justice System Involvement,” the District of Columbia’s Criminal Justice Coordinating Council interviewed youth service providers with first-hand experience working with justice-involved and at-risk youth. Quotes from these interviews include:


A social service provider described one type of youth they see becoming justice involved, “You have those that the family may have multiple children and if mom has 13 kids and I’m the oldest and mom is high or dad is not involved, then they need to eat because they are looking at me. So, I need to be able to figure out how to get the next meal.

One interviewee who works with the juvenile justice system describedthe youth as coming from families with “Four, five, six, seven children” and growing up where there are “Three kids in a room, total bedlam all the time,” and as a result “They raise each other in the streets … because … a lot of times hanging out at home isn’t the pleasant environment.”

Research has consistently supported the association of larger families and closer birth spacing with higher rates of child abuse and neglect. In a groundbreaking 2024 article, Ahn et al report on their analysis of 20 years of data on almost 200,000 first-time mothers in California. They found a strong correlation between the number of children born to a mother and the likelihood that she would be reported to CPS in the next 20. The percentage of first-time mothers reported to CPS increased from 18.5 percent for mothers with one child to 25.4 percent for mothers with two children, 39.2 percent for mothers with three children, and 63.1 percent for mothers with four or more children.

Missing the Obvious?

Obviously not all large families are characterized by dysfunction and pathology. But common sense tells us that large family size can add to stress that in turn can lead to maltreatment. Moreover, having multiple children that one cannot afford may reflect other dysfunctions that may in turn be associated with child maltreatment. Yet somehow it never occurred to Senator Wyden or any of his colleagues at the hearing to ask whether this mother had any problems with mental health, drugs or domestic violence. Senator Wyden even mused aloud that federal law discriminates against large families, complaining that the child tax credit does not reimburse families based on the number of children they have! It appeared that he actually wanted to encourage unlimited childbearing regardless of the mother’s emotional or financial readiness.

And what about Mr. Reed, who actually provided this case as his only example of how material assistance can help resolve a child maltreatment report? According to the DCS website, Mr. Reed is a “licensed clinical social worker who has spent most of his career working with foster youth and children involved with the child welfare system.” One would think he had noticed that children from very large families were overrepresented among his clients. It is also worth noting, though slightly off-topic, that if this was the best example he could find, then his argument that many neglect cases can be solved with one-time material assistance appears to be in danger of collapsing for lack of support.

Perhaps one reason for Wyden’s and Reed’s blind spot is the current ideological tendency of what might be called the child welfare establishment, including the federal Administration on Children and Families, state leaders, and large and wealthy foundations and advocacy groups like Casey Family Programs. Many posts on this blog show how these groups’ focus on race and identity has restricted discussion about how to help prevent child abuse and neglect, among other problems. There seems to be a special taboo attached to any discussion about family size as it relates to child maltreatment, or any prescription for family planning as part of the solution. This taboo likely stems at least in part from our country’s shameful history of attempting to restrict childbearing by Black and poor women through means including forced sterilization and attempts to mandate that welfare recipients use an early injectable contraceptive called Norplant. But when efforts to be sensitive to past trauma to specific groups prevents the implementation of programs to improve the lives of at-risk children, it is time to set taboos aside.

What could be achieved by seeing extra-large families through clear eyes rather than a lens that is distorted by bias? Frontline workers faced with this type of client could look a little harder to see if the lack of a van was the real issue. Even if it was, requiring the mother to adopt one of today’s safe, long acting contraceptives in return for the gift of a van would hardly be unreasonable. In general, incorporating voluntary family planning, perhaps as a condition of receiving desired benefits, into family case plans might be a good start. Senator Wyden might not know this, but a new pregnancy for a mother who is trying to get her children back from foster care is one of the frequent setbacks observed by front-line workers.

The failure to regard unusually large numbers of children as a possible sign of pathology may reflect a genuine innocence about conditions in low-income urban and rural communities–conditions that are perfectly known to people in those communities and those who work there, but perhaps not to a US Senator like Wyden or his colleagues. A more cynical view is that self-imposed oblivion is needed to stay on the right side of advocacy groups and foundations that dominate the mainstream discourse on child welfare and provide funding to state and local agencies that are willing to toe the line. Whether it is ignorance or fear of losing the support of interest groups, national and local leaders’ disregard of the perils of repeated unplanned childbearing is hurting the very children these leaders claim they want to help.

  1. There is an error in the posted PDF of this report. The percentage of all women aged 40-49 who gave birth to three children was given as 2.4 percent instead of 22.4 percent. This was confirmed by an email to Marie Cohen from Brian Tsai, Public Affairs Specialist, Center for Disease Control and Prevention, November 21, 2024. ↩︎