Tag: child neglect

We are not here to save children: abuse and neglect deaths after contact with child welfare services in the District of Columbia, 2019-2021

To my readers: This blog summarizes a report that is the culmination of nine months of work. It is part of my advocacy for children in the District of Columbia, which I share in my blog, Child Welfare Monitor DC. But I think this post and the underlying report will be of interest to child advocates, policymakers and researchers around the country because the findings and issues discussed are widely applicable.

“We are not here to save children.” That is what I was told on the first day of my training as a child protective services worker at the District of Columbia’s Child and Family Services Agency (CFSA). And indeed, the District is on the cutting edge of the current movement in child welfare around the country that considers child protective services as a “family policing system” that unnecessarily harasses and separates families, especially families of color. The problem with this perspective is that some families do not provide a safe environment for children to grow and develop. In some of these families, children die. That is what happened to the 16 children whose cases are discussed in a new report, which is summarized in this post. And indeed, analysis of the limited information provided suggests that CFSA did not take advantage of the opportunities it had to protect children even after long histories of CFSA involvement in their families. As a result, three children were beaten to death, three more were poisoned by opioids, and others died of burns, a car accident, and unknown causes when the deaths might have been preventable if the agency had been more protective.

When a child dies of abuse or neglect after that child’s family has been on the radar of the agency designed to protect children, it is important for the public to know whether and how this death could have been avoided. The essential question is whether the agency could have prevented the death by doing something differently. Did staff miss any red flags, and therefore fail to take action when necessary? If the death was preventable, what factors must be remedied in order to prevent such failures in the future? It is not enough for the agency itself to have access to this information, or to have an internal team review it. Agencies can fail to learn from their mistakes when they are blinded by ideology, self-interest or just inertia.

For those reasons, federal law requires every state to have a law or program that includes “provisions which allow for public disclosure of the findings or information about the case of child abuse or neglect which has resulted in a child fatality or near fatality.” In compliance with this requirement, DC Code requires the Mayor or the Director of CFSA, upon written request or on their own initiative, to provide findings and information related to “[t]he death of a child where the Chief Medical Examiner cannot rule out child abuse, neglect, or maltreatment as contributing to the cause of death.” In March 2023, we requested such findings and information for all the fatalities that met the criteria and were reviewed by CFSA’s internal fatality review team between 2019 and 2021. It took more than six months of meetings and emails to receive the information that is presented in this report. We agreed to restrict our request to cases reviewed in 2019, 2020 and 2021 and to withdraw our request for information on near-fatalities, which CFSA only began tracking in October, 2022.

Not surprisingly, CFSA interpreted the disclosure requirements in a way that restricted the information provided as much as possible. If a medical examiner did not rule the manner of death to be an abuse or neglect homicide or “undetermined,” no information was provided. Therefore, the agency did not release any information on cases where the manner of death was labeled as accidental, even if it found a parent responsible for the death or removed the children. The “accidental” deaths for which information was not provided included one child who died after he was left in a baby swing for two hours, which most ordinary people would consider to be neglect. The death of seven-week-old Kyon Jones, whose mother told police that she threw his body in a dumpster after she rolled over him while high on PCP, was not included because his body was never found and therefore it did not meet the criteria for release of the information–even though CFSA removed the surviving children from their mother.*

In addition to omitting some cases in which neglect or abuse played a role, CFSA heavily redacted the information it did provide, with many pages and large portions of others blacked out. CFSA refused to provide the names of the children, parents and caregivers, providing a rather convoluted interpretation of DC Code, which clearly requires the release of this information. (See the full report for more information about their reasoning). In three cases, the child’s identity was clear from media coverage of the case, and we used the child’s name. A major source of redactions was the exclusion of “personal or private information unrelated to the child fatality.” It appears that CFSA’s legal team interpreted this term much more broadly than a social worker or researcher would, because they redacted almost all information about parents’ history of criminal activity, substance abuse, mental illness, and domestic violence–which are obviously relevant to many of the fatalities we are discussing.

On investigations, it is unfortunate that DC Code requires that the agency release only ”a description of the conduct of the most recent investigation or assessment” rather than all investigations regarding the family in question. It appears that the agency interpreted “the most recent investigation” as the fatality investigation itself rather than the most recent investigation before the fatality, but the law ought to require a description of all previous investigations. The agency also disregarded language that requires it to provide “the basis for any finding of either abuse or neglect.”

For most cases, we received very little information aside from a list of the previous referrals (reports to the CPS hotline) including only the date of the report, the allegation category and the disposition; an account of in-home and foster care case activities for the families that had such cases; and an account of the investigation of the fatality itself. The information about the parents was heavily redacted, and almost the entire history of agency involvement was blacked out in most cases. Despite the limited information provided, the redacted summaries included some new information, some of which was startling and disturbing. The report is based on the 16 case summaries provided by CFSA, occasionally supplemented with information from the agency’s annual fatality reports, which are available to the public. These cases affected 15 families, as one family had two fatalities in one year. Unless otherwise noted, the information is based on the case summaries. The full report, from which this blog is excerpted, contains summaries of each case.

Cause and Manner of Death

CFSA classifies child deaths by cause and manner. “Cause of death” is the specific disease or injury that led to the death. Manner of death refers to the circumstances that caused the death, and falls into five categories: natural, accidental, suicide, homicide, and undetermined. Of the 16 cases for which information was provided by CFSA, three (19 percent) were abuse homicides, six (37 percent) were neglect homicides, and seven (44 percent) were undetermined in manner. The latter were the cases for which CFSA provided information because the Medical Examiner was unable to rule out child abuse or neglect homicide as the manner of death.

The most common causes of death were blunt-force trauma and opioid poisoning, each claiming the lives of three children, as shown in figure below. The remaining children died from a variety of causes, including drowning, asphyxia, thermal and scald injuries, injuries from a car accident, and unknown causes.

Abuse deaths: Blunt Force Trauma

Three of the children died of blunt force trauma–one of the two most common causes of death in the sample. The murders of two of these children – Makenzie Anderson and Gabriel Eason – – became known to the horrified public through press coverage of their deaths in February and April of 2020. Each of them died from head trauma inflicted by a parent or stepparent. Makenzie suffered from multiple contusions to the face and head, skull fractures, and other injuries, and her mother pleaded guilty to manslaughter, receiving a ten-year prison term with seven years suspended on the condition that she obtain mental health treatment and have no unsupervised contact with children. Gabriel’s autopsy found abrasions and contusions to the head, face and torso; contusions to the heart and thymus gland; liver and kidney laceration; new and healing fractured ribs; and a brain hematoma. His stepfather was sentenced to 12 years and eight months in prison and his mother, who did not seek medical help for Gabriel or his critically-injured three-year-old brother, was sentenced to four years of probation and three years of supervised release.

But there was a third homicide by blunt force trauma. A three-year-old girl died of trauma to the abdomen in the home of an aunt where she was placed by CFSA after being removed from her drug-addicted mother. Her injuries included contusions to the forehead and abdomen, a lacerated liver, and blood in the abdominal cavity. No charges were filed against either the aunt or her boyfriend, and the case received almost no public attention.

Neglect deaths: Opioid Poisoning and other causes

Three children (a three-year-old girl, a three-year-old boy, and a three-month-old girl) died of synthetic opioid toxicity, with fentanyl implicated in all three deaths. (One of the children had also ingested a controlled substance called eutylone.) There is no information about how the children might have ingested the drugs, but all lived with parents who were known or alleged to abuse substances. These deaths never became known to the public, which is not surprising since it appears that none of the parents were arrested or charged.

A 17-month-old boy died of “complications of thermal and scald injuries,” and his mother told the investigator that she had no idea how it happened or how he ended up face-down in the bathtub several hours later. A seven-year-old died of injuries from a car accident. His mother was a long-time substance abuser and was arrested for Driving Under the Influence (DUI) in the accident. She was driving from Florida to Washington and her children were not sitting in car seats or belted in. A five-month-old boy died of asphyxia by drowning after being left alone in the bathtub with a one-year-old sibling while their mother searched for her car keys.

Deaths for Which the Manner was Undetermined

Two deaths has known causes but the manner – whether abuse or neglect or something else – was not determined. A twelve-year-old girl with asthma died of an untreated bacterial infection and pneumonia but also had enough bruising from two separate beatings in the previous two days to support a CFSA substantiation of the mother for physical abuse. It is unclear why this was not considered a medical neglect homicide. A ten-month-old girl died of asphyxia but the manner of death was undetermined. Her mother had left her in the care of her father and returned to find her unresponsive.

The cause as well as the manner of death was unknown or undetermined in five cases. These included an 18-month-old boy with a subdural hematoma, which could have been caused by abuse or a fall, an 11-month-old girl whose mother reported leaving her unsupervised on her stomach with a bottle in her mouth for about 40 minutes, a nine-month-old boy put to bed with a bottle and found face-down on a pillow; a two-month-old girl who died while sleeping with her mother, and a three-month-old girl found unresponsive by her parents one morning. Unsafe sleep practices may have contributed to some of these deaths, but other unsafe sleep fatalities were categorized as accidents, for which case summaries were not provided.

Demographics

A quarter of the children who died were younger than six months old and half of them were one-year-old or younger. Another quarter were two or three. This is not surprising as young children are more vulnerable and similar results are found nationally. But older children were not invulnerable to abuse or neglect, including the seven-year-old who died in a car accident and the 12-year-old who died of an untreated bacterial infection and pneumonia.

Fifteen of the decedents were African American and one was classified as “African-biracial.” According to the latest data from Kids Count, 54 percent of children in the District of Columbia are Black. So Black children were overrepresented among the children who died of maltreatment or possible maltreatment. The overrepresentation of Black children among children who died points to Black children’s particular need for protection. And it suggests that current emphasis in the District and around the country on reducing the involvement of Black families in child welfare may cause more suffering and more deaths among Black children.  

The prevalence of large families among those that lost a child due to abuse or neglect is striking. More than two thirds of the mothers of children who died by maltreatment had four or more children. The average mother in the group had 4.6 children, often with more than one father.

Histories of System Involvement

All the families had been the subject of at least one report to the CFSA hotline before the fatality, or else they would not be included in this report. But many of the families that lost a child had experienced a large number of reports prior to the fatality. Among the 16 fatalities included in this report, only six occurred in families that were the subject of five reports or fewer in the last five years. Five occurred in families that had between six and 10 reports, three occurred in families with 10 to 15 reports, and one family had 24 reports. Three of the families had actually experienced a previous child fatality–a shocking statistic considering the rarity of child fatalities overall.

The families of the two children – Makenzie Anderson and Gabriel Eason – whose abuse homicides shocked the District of Columbia in February and April 2020 were both known to CFSA before the deaths, and the last report to the hotline came five months before the fatalities of both children. Makenzie Anderson’s family was reported to the hotline eight times within five years of her death. The last report alleged exposure to unsafe living conditions, inadequate supervision, and substance abuse by a parent, caregiver, or guardian. All those allegations were unfounded (not confirmed) by CFSA. Gabriel Eason’s family was the subject of 17 prior calls to the hotline since 2012, including 12 in the five years preceding Gabriel’s death. The most recent report was for unexplained physical injury in October 2019 and was also unfounded by CFSA.

Substance abuse by the parent or caregiver was the most frequent allegation CFSA received regarding the families in the five years before the deaths, with 30 substance abuse allegations collectively accumulated by the families of the 16 dead children during that period. Another  eight reports concerned positive toxicity of a newborn, a reflection of parental substance abuse. Substance abuse by the parents was observed or alleged in the families of all but four of the victims included in this report. Inadequate supervision was the second most common allegation, with 25 allegations concerning the 15 families. Almost as common was educational neglect, referring to children with excessive school absences, with 24 allegations received in the five years preceding the fatality. Ten of the 15 families had at least one report for educational neglect before the child’s death. Another major theme was exposure to domestic violence, with 17 allegations received by the families. Domestic violence was mentioned in nine of the 16 case histories as the subject of an allegation or in notes from social workers or police.

Most of these families could be described as “chronically neglectful.” According to the Child Welfare Information Gateway, “Chronic child neglect occurs when a caregiver repeatedly fails to meet a child’s basic physical, developmental, and/or emotional needs. Chronic neglect can have long-term, negative consequences for child health and well-being.” Working with chronically neglectful families is especially difficult and requires special training and skills, which many CFSA social workers may lack. Perhaps that is one reason why they struggled so hard to engage some of these families. Four of the children died while an in-home case was open. Three out of four of the in-home case narratives from CFSA portray caregivers who evaded offers of help from CFSA and other providers and refused to cooperate with efforts to monitor conditions in their homes.

System Failures

The information received suggests several areas where failures in policy and practice by CFSA and other agencies may have allowed these deaths to happen. These areas include:

  • Screened out and unsubstantiated reports: Research points to the difficulty of determining correctly whether a child has been maltreated, as well as the absence of significant differences in subsequent outcomes between children with a substantiated allegation of maltreatment and those with an unfounded allegation. Without information on how hotline and investigation decisions were made, we cannot assess the agency’s performance in these areas. But the fact that most previous reports for families with a subsequent death were screened out or unfounded is concerning.
  • Flawed management of in-home cases: Four of the deaths reviewed here happened while an in-home case was open for the family. In three of these cases, workers struggled to complete face-to-face visits with the families because parents evaded these visits. Social workers and supervisors could have filed a petition to involve the court, an option known as “community papering.” But they did not exercise this option–or they started too late, as in the case of the child who died after a meeting was finally scheduled to discuss community papering the case. The meeting was cancelled after the agency received word of the child’s death.
  • Too many chances: The mother of the seven-year-old killed in the 2020 car accident had been given numerous chances to recover from drug addiction and had relapsed many times over 18 years of involvement with CSFA. The family of the 17-month-old who died of complications of thermal and scald injuries had 24 referrals to CFSA between 2016 and 2021. Three in-home cases were opened and closed, but the children were not removed until the little boy died.
  • A fragmented health care system: In its findings on Gabriel Eason’s death, CFSA pointed out that Gabriel was taken to different medical providers for his various injuries. Because they use different information systems, the providers could not see records of the earlier injuries.

The reaction of CFSA and the criminal justice system after the fatalities obviously did not contribute to the fatalities themselves but may illustrate a pattern that contributes to future deaths. Specifically, CFSA’s tendency to place siblings informally after fatalities and the police and US District Attorney’s failure to charge parents raise concerns.

  • Informal placements after fatalities: CFSA, and child welfare agencies around the country, have been criticized for relying on informal placements with family members, rather than formally removing the children, placing them with the relatives, and opening a case to monitor their safety and well-being. In at least four of the 16 cases reviewed here, CFSA did not officially remove the siblings of the children who died but instead relied on informal placements with fathers or other relatives to keep them safe. Nothing was done to assure that the children were not returned to the home from which they had been removed as soon as the investigations closed, or to verify that the parents or caregivers had rectified the conditions leading to the child deaths.
  • Failures by the criminal justice system: The failure to bring charges against some of the parents and caregivers described here is quite concerning, particularly in the case of the three-year-old who died of blunt-force trauma and the infant and two three-year-olds who died of opioid poisoning. There has been considerable criticism of the US Attorney’s office in the District (which handles adult criminal prosecutions) for its low rate of opting to charge people for crimes. We do not know if the problem is the Metropolitan Police Department’s failure to bring the cases to the US Attorney or the latter’s failure to pursue them.

Recommendations

Without seeing the full case studies that were available to CFSA’s internal review committee, we cannot make detailed recommendations about how to avoid child maltreatment fatalities for children known to CFSA. The minimal recommendations that CFSA’s internal review team made show the need for the City Council, advocates and the public to have access to these complete case studies: in its 2021 report the agency made no recommendations other than those dealing with the fatality review process! Therefore, our first recommendation is to the City Council, urging it to require that CFSA release comprehensive case histories on all proven or suspected child maltreatment fatalities. Our next blog post will discuss the legislative changes that are needed.

The lack of information on how screening and investigation decisions in particular were made precludes specific recommendations. Perhaps a new audit of the hotline is in order. Some changes to hotline screening policy might be advisable, especially around educational neglect. School absences should be investigated regardless of the age of the child (requiring a change in the law) and their academic performance. And perhaps investigative workers could benefit from better training in forensic interviewing techniques that might help them better evaluate parents’ and childrens’ statements for veracity and perceive more subtle signs of abuse or neglect.

The case narratives make clear that in-home social workers struggled to complete home visits to the families of the children who later died. The agency must change its policy to encourage “community papering,” making court involvement routine after a certain number of missed visits or other instances of noncooperation. CFSA might also want to consider strengthening its in-home practice, perhaps by reinstating the Chronic Neglect Units, which were eliminated barely a year after they were implemented. These units would employ specially-trained social workers with lower caseloads and longer time periods to work with families.

Despite the current ideology favoring family preservation and reunification at all costs, the agency must also recognize that sometimes it must give up on a parent and find a safe, permanent alternative for the children. Giving parents multiple chances with successive children over many years belies the true purpose of child welfare services – to protect children.

Not all needed changes fall in CFSA’s bailiwick. Reforms in the criminal justice system are also necessary to ensure that parents who killed one child cannot harm more children. Couples who refuse to cooperate with prosecutors, and parents who expose children to opioids due to their own abuse or drug dealing must also be charged. Other jurisdictions do it, and the District must do it as well.

DC Health and medical providers also have a crucial role to play in making children safer. Encouraging the adoption of a comprehensive medical information platform across the region to prevent families from using different doctors to hide abuse and neglect would be a welcome step. A campaign by DC Health to educate young women on how an early pregnancy, especially when followed quickly by others, compromises their future and that of their children, is a crucial necessity. It must be accompanied by improved access to long-acting reversible contraceptive methods.

In summary, even with the very minimal information we received, some conclusions emerge. CFSA’s extreme deference to parents and guardians emerges clearly through the redactions in these narratives. This is in direct contrast to the picture that is being painted by the foundations, advocacy groups and public agencies dominating the child welfare conversation. Their accounts portray interventionist child welfare agencies that remove children rather than giving their families the help they need and want.  We are seeing the opposite here: families who evade offers of help from the agency and providers and refuse to cooperate with efforts to monitor conditions in the home. The goal of such parents often appears to be to avoid surveillance by outsiders rather than to improve their ability to care for their children. And CFSA workers often seem unwilling or unable to intervene in a way that will protect these children.

‘The tragic deaths of children whose families are known to CFSA are the tip of a much larger iceberg. For every child who dies of abuse or neglect, an unknown number of others are living in fear or pain from abuse, suffering chronic neglect that will cause lifelong intellectual an emotional damage, or lacking the loving attention necessary for optimal mental, emotional and physical development. Sadly, it is only the children who die whose cases can be used to learn lessons to prevent similar tragedies in the future. This information must be public, so that the public can push for a system that protects all children who are not receiving the parental care they need to survive and thrive.

*The case, which received media coverage, was included and easily identifiable in

The Minnesota Child Maltreatment Fatalities Report: Essential reading for child advocates everywhere

A shattering new report from a Minnesota child advocacy group demonstrates that many of the more than 160 deaths of children from abuse and neglect over an eight-year period ending last May were preventable. These deaths, the report concludes, can be attributed to “a child welfare philosophy which gave such a high priority to the interests of parents and other adults in households, as well as to the goals of family preservation and reunification, that child safety and well-being were regularly compromised.” This report is essential reading for child advocates everywhere, because this philosophy reigns around the country, and the troubling factors identified exist in states where most of the child population resides.

Produced by the child advocacy group Safe Passage for Children of Minnesota, and authored by Safe Passage Executive Director Richard Gehrman and Maya Karrow, a fellow from a local law school, the project collected information about 88 children who were killed between 2014 and 2022. The Minnesota Department of Human Services (DHS) told project staff that it was aware of 161 child maltreatment deaths during a period that mostly coincides with the period studied.1 But DHS refused to provide information on any of these deaths (in violation of state and federal law), so the staff had to rely on news reports, online court records, and information provided by counties for the 88 cases it had identified.

Like child maltreatment fatality victims nationwide, the dead children were young, with 42 percent under a year old and 36 percent between one and three years old. Children under four were 78.4 percent of the Minnesota deaths very similar to the 76.3 percent for child maltreatment fatality victims nationwide. Black children accounted for 26.1 percent of all the fatalities reviewed. In contrast, Black children were 17.8 percent of children involved with child welfare and 10.6 percent of the state’s child population in 2021.2 Based on the statistics and case file reviews, the report’s authors expressed concern that chld welfare agencies in Minnesota “may have tended to leave Black children in more high-risk situations for longer periods of time than children of other races and ethnicities.” The report’s authors are not the first to have asked whether fears of being accused of racism may be leading agencies to leave Black children in harm’s way even more than children of other races.

The most common causes of death among the cases reviewed were blunt force trauma to the head (33 percent) and body (19.3 percent). The other major causes of death were asphyxiation (17.0 percent) and gunshot wounds (8.0 percent). Other causes included drowing, sepsis, poisoning from drugs, stabbing, hypothermia/hyperthermia, fire, and undetermined causes.

The most common perpetrators of child fatalities were mothers (27.3 percent), mothers’ significant others (23.9 percent), and fathers (22.7 percent). In 65.9 percent of the cases, one or more of the perpetrators had a history of substance abuse. Shockingly, there were seven deaths in foster care, of which six were in kinship foster care. In another appalling finding, there were seven cases in which a child was killed along with the mother or while attempting to intervene in an assault on the mother.

A concerning pattern was the evidence of child torture in a surprisingly large number of cases. The project’s reviewers identified 14 cases (or 15.9 percent) that displayed signs of torture, according to criteria outlined by experts. The authors used the case of Autumn Hallow, who was killed at the age of eight, as an illustration. Investigators found that Autumn’s father and stepmother frequently bound her in a sleeping bag as punishment, sometimes with her hands tied behind her back or overnight, and starved her for six months so that she weighed only 45 pounds when she died. A particularly appalling feature of her case was the “chilling indifference by all the authorities involved to the screams of a child [reported repeatedly by neighbors] and the pleas of an increasingly distraught mother.” Autumn’s cause of death was declared to be asphyxia and blunt force trauma. Her father and stepmother were convicted of second-degree unintentional murder in her death.

The project uncovered numerous systemic flaws that contributed to the 88 deaths reviewed. These included inappropriate assignment of reports to a “family assessment” rather than a factfinding investigation; the failure to respond adequately to repeated reports suggesting chronic maltreatment; seemingly endless chances given to parents to address chronic problems; the return of children from foster care to homes where safety had not improved; the placement of children with kin without appropriate vetting; leaving children with mothers who repeatedly failed to protect them from violent partners; and the lack of integration between child welfare and child custody cases.

The repeated inappropriate assignment of cases to the “Family Assessment” (FA) track, which is intended for low-risk cases, was a major recurring theme in the case reviews. Minnesota is one of 34 states that initially adopted a two-track model, often known as differential response, for responding to reports of suspected maltreatment. (Some states have since terminated the practice). The idea was that a less-adversarial response than an investigation would be a better way to engage families with lower-risk cases. But with its practices like informing parents of visits beforehand, interviewing children in front of their parents, and making no finding as to whether maltreatment occurred, the report explains that FA is not appropriate when the risk to children is high. Yet, by 2020, 62 percent of CPS reports in Minnesota were assigned to Family Assessment. The researchers found that 31 of the 59 families with Minnesota child protection history had at least one and as many as six Family Assessment cases prior to the fatality. As the authors point out, “it is self evident that the repeated use of FA in chronically referred families is inconsistent with the policy that FA be used only in low-risk cases.”

Among the examples cited by the authors for the inappropriate use of FA was one that occurred following a report that a mother and her boyfriend were hitting their children with objects and dragging them by their hair. This family was the subject of six previous reports that included allegations of “physical abuse, sexual abuse, and unhygienic and unsafe conditions, including rotten food, garbage, drugs, alcohol, and sharp objects accessible to children throughout the home.” Twenty days after that last FA, two-year-old Lyla Koob was dead. Her mother’s boyfriend admitted to shaking her in frustration after she vomited. Her autopsy revealed bleeding on the brain and injuries behind both eyes. 

Based on analysis of court records, the researchers found that 71.6 percent of the dead children’s families had previous involvement with child protection. The 61 families included 59 with prior history in Minnesota and two with prior history in another state. In view of these percentages, it is not surprising that the project staff found that Minnesota child welfare had a pattern of failure to respond adequately to chronic maltreatment.

In some cases, the researchers noted a pattern of inaction by child welfare agencies in the face of chronic multitype maltreatment, or maltreatment that includes neglect as well as abuse. The case of Tayvion Davis, who died in 2018 at the age of eight, was used to illustrate this type of negligence. Before he was born, Tayvion’s mother was convicted of malicious punishment of a child after she and two adult relatives held down and beat one of her children. From that time until Tayvion’s death, the family was the subject of at least ten reports of physical abuse, sexual abuse, or neglect. According to court records, the children were hit with a hammer and a metal rod, whipped with a belt, burned with boiling water or chemicals, deprived of food and sleep as punishment, and threatened with death if they talked about the abuse. There were multiple reports of sexual abuse of Tayvion or a sibling by the oldest sibling, juvenile and adult relatives, and an unrelated adult.

Tayvion Davis froze to death in 2018 after his mother locked him in the garage overnight in subzero temperatures. The autopsy found numerous scars that suggested years of abuse that may have escalated into torture. Unbelievably, Tavion’s siblings were returned to their mother after being removed in the wake of Tavion’s death. They remained with her for another five months, during which she was the subject of several additional reports. It was not until they were removed again that they told their foster parents that Tavion was deliberately locked in the garage, resulting in murder charges against the mother.

The researchers also found that counties gave parents multiple chances to address chronic problems, while failing to execute effective safety plans for children remaining at home. One example of this tendency was the case of Aaliya Goodwin, who died at the age of five months. There had been eight reports for two older siblings regarding the parents’ substance abuse. Between 2015 and 2021, four safety plans were mentioned in court records, the oldest sibling was placed in foster care and returned home twice, the mother was charged with nine drug-related offenses and convicted of five, and the father was charged seven times with two convictions. The county opened a new FA in January 2022 due to a report of domestic violence and the mother agreed to a substance abuse assessment. Three days later she was found passed out on the couch after using drugs and alcohol. Aaliyah, squashed between her mother and the couch, was dead of positional asphyxia.

Another pattern cited in the report was counties’ tendency to return children from foster care to a home that was still unsafe. The project revealed that 26 percent of the children who died had been previously removed from their parents and then returned. The case of Khamari Golston was provided as an illustration of this pattern. Multiple abuse injuries to four-month-old Khamari resulted in his and his twin sister’s removal and placement in foster care. Their mother was charged with felony malicious punishment and assault. But only two months after adjudicating these children to be in need of protection, the judge sent them home for a “trial visit.” The mother was said to be cooperating with her case plan but there was no documentation of this in the court record. Eight weeks later, Khamari was dead of suffocation or smothering. He also had multiple injuries consistent with physical abuse. Khamari’s ten-year-old sister reported that their mother frequently choked him and covered him up when he cried.

Some children were returned from foster care to parents with serious mental illness. The report cites six-year-old Eli Hart, whose mother killed him with multiple shotgun blasts to the head and torso nine days after he was returned home. Eli was returned home without evidence that his mother’s mental illness was under control. Instead, her mental health remained a concern throughout the year that he was in foster care and during a trial home visit. She received eight traffic-related convictions (including for speeding and reckless driving) and was also charged with theft of pharmaceutical drugs during the time he was in foster care.

The occurrence of seven deaths of children in foster care, of which six were in kinship care, was a startling revelation of this study. There have been concerns raised around the country that the growing focus on kinship placements may be leading to the placement of children with family members who have not been adequately screened and are not appropriate caregivers. And indeed, the project staff found a “lack of due diligence in deciding whether a kinship placement would ensure the safety and well-being of the child.” To illustrate this pattern, the report offers the history of Leila Jackson, a 17-month-old who was killed by her foster father in 2018. Her autopsy showed “extensive subdural hemorrhages and severe brain injury, as well as extensive bruising on her buttocks.” Layla and her brother were placed in the kinship home after their mother’s parental rights were terminated. The foster parents denied having criminal records or substance abuse histories, but a background check (which was never conducted) would have revealed convictions for DWI, theft, possession of drug paraphernalia, and disorderly conduct.

The pressure to keep children with mothers who were victims of domestic violence, even when these mothers showed they were unable to protect their children, was another systemic problem noted by the project team. The authors found that 28.4 percent of the cases involved domestic violence–not surprising in view of the co-occurrence of child maltreatment with domestic violence. But that seven children were killed along with their mothers, or in an attempt to protect them, was shocking indeed. This is a difficult issue, and removals of children from domestic violence victims by CWS have been harshly criticized. But as the report put it, “at a certain point a line is crossed and it becomes imperative to move children to a safe place.”

In Minnesota, public child welfare cases are heard in juvenile court and custody cases in family court, which means that the same family can have two different court cases with different judges. The findings of the report suggest that the failure to consolidate these cases can place children at risk. In the case of Eli Hart, who was killed by his mentally ill mother, the custody case filed by his father was put on hold pending a resolution of the juvenile court case surrounding his mother. This is despite the fact that the mother’s mental health remained a concern and that all reports indicated that the father was a good and safe parent for Eli.

In sum, the report concludes that “the professional norms currently guiding child protection and foster care are out of alignment with those of the broader community.” As a first step, the report recommends that DHS release more information about child maltreatment fatalities, including making public the fatality and near-fatality reports that counties are required to submit to the state; such reports include information about previous reports and investigations on these families. This recommendation is particularly important because if the public knew about the types of egregious failures described in this report, there might be more public support for changes.

The report contains many specific recommendations to correct the systemic flaws found in the case studies. This year, Safe Passages will be distributing the report to legislators and briefing them on its findings and recommendations. Rick Gehrman, Executive Director Rick Gehrman reports that he will be working with legislators to translate some of these recommendations into legislation to be introduced in the next session, addressing at a minimum some of the Family Assessment practices that endanger children. The ultimate goal, Gehrman says, is to “raise public and legislative awareness of the child welfare practices that endanger children and to bring about a change in the overall philosophy of child welfare services in Minnesota.”

In effect, Safe Passages for Children has unofficially implemented the first recommendation of the Committee to Eliminate Child Abuse and Neglect Fatalities in its 2016 final report, Within Our Reach. That report recommended that each state, with federal funding and assistance, identify and analyze all of their child abuse and neglect fatalities from the previous five years in order to identify factors associated with maltreatment fatalities and agency policies and practices that need improvement to prevent fatalities. Based on this report, every state would develop a fatality prevention plan. Unfortunately, legislation supporting this proposal stalled in Congress and no state has elected to do this on their own. Maryland’s Council on Child Abuse and Neglect and its Child Fatality Review Board, inspired by this recommendation, formed a joint subcommittee that produced an excellent review of child maltreatment fatalities in Baltimore between 2012 and 2015 which identified systemic flaws and made recommendations to correct them.3 Other than that report, I am not aware of any other similar project by a state or local government agency. Let us hope that this report encourages other child advocacy groups and community boards to act where governments have not.

The final words of the report deserve to be repeated. “The erosion in professional norms that has gradually caused human services entities to tolerate the current level of neglect and physical abuse of children has developed over the course of decades. A concerted effort by a community of professionals will be required to restore standards that were once taken for granted, and to place appropriate limits on the ability of adults in a child’s life to harm them.”

Notes

  1. The actual number was likely two to three times as high because the manners of so many maltreatment deaths are misclassified.
  2. See Child Maltreatment 2021. Table C-2, Child Population 2017 to 2021 shows the state’s child population rose from 1,300,061 in 2017 to 1,317,567 in 2021. Table C-3, Child Population Demographics, shows that there were 140,129 Black children in Minnesota in 2021. That figure, divided by 1,317,567 gives the Black percentage of all children in Minnesota as 10.6 percent in 2021.
  3. City of Baltimore Health Department, Eliminating Child Abuse and Neglect Fatalities in Baltimore City. January 2017. This report appears to be no longer available online. Please email marie@childwelfaremonitor.org for a copy.

The new Child Maltreatment 2021 Report: Did child maltreatment really decrease?

The federal government’s annual maltreatment report for 2021 was released on February 9, 2023, and the child welfare establishment is celebrating. New Child Maltreatment Report Finds Child Abuse and Neglect Decreased to a Five-Year Low, crowed the Administration on Children and Families (ACF). “Number of Abuse and Neglect Victims Declines Again,” trumpeted The Imprint, a journal that typically reflects the prevailing voices in child welfare today. Left for the body of the ACF press release (and totally omitted by The Imprint) was the fact that in 2021 the nation was still in a pandemic that kept many schools closed for much of the year, and that child maltreatment “victimization” reflects jurisdictions’ policy and practice much more than it reflects actual maltreatment. Thus, there is no reason to celebrate a decrease in child maltreatment based on this report.

Child Maltreatment 2021 , the latest edition in the annual series from the ACF, combines data from the 50 states, the District of Columbia and Puerto Rico about the number of reports or children involved in each stage of the child welfare system in Federal Fiscal Year (FFY) 2021, which ran from October 1, 2020 to September 30, 2021. The data are obtained from the National Child Abuse and Neglect Data System (NCANDS), a national data collection program run by the Children’s Bureau under ACF. Arizona did not submit data in time to have its data included in this report, so only 49 states are included in this year’s report, along with the District of Columbia and Puerto Rico. Commentaries from most of the states regarding policies and conditions that may affect their data are attached in an appendix. The report’s findings are summarized in Exhibit S-2. All of the figures in this post are taken from the report.

A family’s journey through the child welfare system starts with an initial report, known as a “referral.” Figure 2-D below shows that the total number of referrals (the purple line) rose between 2017 and 2019, dropped sharply in the wake of the Covid pandemic in 2020, as schools closed and many families isolated at home, and increased only slightly in FFY 2021. It is important to remember that in FFY 2021, which began in October 2020, many schools were still closed. Most schools opened over the course of FFY 2021, but some remained closed the entire year. Thus, reporting from school personnel was suppressed for the federal fiscal year.

The rate of referrals as a portion of the child population varied greatly by state. Table 2-1 of the report shows that the total referral rate per 1,000 children in 2021 ranged from a low of 17.8 in Hawaii to a high of 137.0 in Vermont in 2021. Such differences exist every year and reflect factors such as public opinion and knowledge of child maltreatment reporting, as well as state practices. Some states do not even report most referrals to NCANDS, as described in the state commentaries. Pennsylvania has a unique system in which most reports that are not for abuse are classified as “General Protective Services” and not reported to NCANDS. Similarly, Connecticut does not report referrals receiving an alternative (non investigation) to NCANDS. In 2021, state-to-state differences may also reflect how soon in-person schooling resumed in the state after the pandemic. Vermont reported in its commentary that it has been receiving more referrals for concerns that do not reflect maltreatment. Vermont also included several reasons for its high referral rate, including the fact that reports on multiple children in the same family are counted separately. Kansas reported a decrease in reports due to “engaging communities to focus on prevention.”

Once a referral is received, it can be screened in or out by agency hotline or intake units. In general, agencies screen out referrals that do not meet agency criteria, which vary by jurisdiction. Reasons for screening out a referral may include that it does not meet the definition of child abuse or neglect, that not enough information is provided, that another agency should more appropriately respond, or that the children being referred are over 18. Despite receiving slightly more referrals than the previous year, child welfare agencies screened out a larger proportion of them in FY 2021, resulting in a slight decrease in screened in referrals (known as “reports“), from 2020 to 2021 – the blue line in Exhibit 2-D. In the 46 states that provided both data points, 51.5 percent of referrals were screened in and 48.5 percent were screened out.

There is great diversity in the proportion of referrals accepted by states. The percentage of referrals that was screened-in ranged from 15.3 in South Dakota to 98.5 percent in Alabama.1 There are many reasons for these variations, mostly associated with differing policies and practices between jurisdictions. For example, Georgia mentioned in its commentary that after hotline calls increased in 2021, it adjusted screening criteria to screen out more of them. Indiana tried to reduce its screen-in rate by changing criteria related to sexual behavior among teens and preteens, marijuana use by children, and educational neglect. Kansas reported a decrease in reports due to a change in the screening process for educational neglect. Missouri, on the other hand, changed screening criteria to screen in more referrals out of concern for children isolated because of the pandemic.

In FFY 2019, teachers were the most common source of referrals, submitting 21 percent of all referrals. They lost that position in FFY 2020 with the pandemic school closures, while legal and law enforcement personnel increased their share of reports. Perhaps it is not surprising that teachers did not recoup their leading role in 2021, since many students were still attending school virtually for some part of the year. Teachers actually submitted a smaller proportion of referrals in 2021 (15.4 percent) than in 2020 (17.2 percent). It is possible that teachers were making more calls but that more of these calls were being screened out than in the year before. But since ACF does not show the distribution of all referrals by reporting source, one cannot use this data to test that hypothesis.

Investigations

In Chapter 3 of Child Maltreatment 2021 the focus shifts from the referral or report to the child. ACF estimates that 3.016 million children or 40.7 children per 1,000 in the population received an investigation or alternative response2 in 2021. This was a slight decrease over 2020, when 42.0 per 1,000 children received an investigation or alternative response. These rates varied greatly by state, from a low of 12.8 per 1,000 in Pennsylvania to a high of 129.8 in West Virginia. The low in Pennsylvania is not surprising due to its unique system in which most neglect referrals are not reported to NCANDS. But Maryland and Hawaii also investigated small proportions of children– 15.7 and 15.9 per 1,000. These investigation rates reflect the number of referrals and how many were screened in, as well as the number of children per referral.

ACF found that of the children who received an investigation or alternative response, 16.7 percent were found to be victims of child abuse or neglect, as shown in Exhibit 3-B.3 The remaining children were not determined to be victims or received an alternative response. Estimating for missing data from Arizona, ACF calculated a national “victimization rate” of 8.1 per 1,000 children. As Exhibit 3-C shows, this rate has been decreasing since 2018 but the greatest decrease was in 2020 with the arrival of the pandemic.

ACF’s use of the term “victimization” can be misleading. An investigator’s decision about the truth of an allegation is based on limited information and is constrained by available time and staff, and evidence indicates that many referrals are unsubstantiated when maltreatment actually exists. Moreover, these rates are dependent on state policies and practices. Because of the misleading nature of the term “victimization,” the term “substantiation” is used for the rest of this commentary. State substantiation rates per 1,000 children ranged from 1.6 in New Jersey (even lower than Pennsylvania’s 1.8) to 17.0 in West Virginia, suggesting that these rates reflect much more than the prevalence of child abuse and neglect.

Among the many factors that can influence state substantiation rates are:

  • Differences in referral rates and screening practices, as decribed above;
  • Different policies about what is considered child maltreatment and different levels of evidence required to substantiate an abuse allegation;
  • Whether and how much a state uses an alternative (non-investigation response);
  • Natural and social disasters that may vary in their impact between states. Some states went back to in-person schooling for the entirety of 2021, others opened midyear, and others were virtual almost all year. West Virginia, with the highest substantiation rate, has been particularly hard-hit by the opioid epidemic. The state has the highest overdose mortality rate in the nation;
  • Differences in the messages coming from an agency’s leadership about the relative importance of child safety versus family preservation;
  • Variations in the use of kinship diversion, the practice of placing children with a relative without court involvement or case opening. If this happens before the investigation is completed, it may result in an “unsubstantiated finding.

All of these factors can change over time, affecting substantiation rate trends from year to year. It is clear that nationwide, the COVID-19 pandemic continued to suppress reports to CPS hotlines, and therefore investigations and maltreatment findings, in 2021. But the effect of the pandemic differed greatly between states: it appears that some states had more in-person days of school in 2021 than in 2020, and others had less. Additionally, several states described changes in their screening practices in 2021, usually to screen in fewer referrals. Delaware and Washington mentioned an increase in reports diverted to differential response as a reason for declining substantiation numbers in FFY 2021. The emphasis on prevention as an alternative to intervention has been increasing in most states, perhaps affecting the likelihood of substantiation. It is possible also that increases in kinship diversion may have reduced substantiation rates: there is no data to prove or disprove this, but concern over this practice is certainly growing.

To state that maltreatment decreased between 2020 and 2021 is to ignore that “maltreatment victimization” is not a measure of actual abuse and neglect. It is the result of a winnowing process that starts even before a referral arrives. At each stage, the numbers remaining may depend on a wide variety of factors, including policy, practice, natural and man-made disasters and more. The vast differences between state data on referrals, reports, investigations and substantiations shows how unlikely it is that the total number of children found to be victims of maltreatment reflects the actual number of maltreated children, and how irresponsible it is to suggest this might be the case.

A note on Child Fatalities

Last year, ACF used a decline in fatalities due to child maltreatment to headline its press release, Child Fatalities Due to Abuse and Neglect Decreased in FY 2020, Report Finds. This year, the number of child abuse and neglect fatalities reported by states increased slightly, a rise that was not the subject of a headline by ACF. Whether there is a small increase like this year or a decrease like last year means very little, for several reasons. As ACF explains, these child fatality counts reflect the federal fiscal years in which the children were determined to have died of maltreatment, which may be different from the year the child actually died. Such determinations may come much later due to the time it takes to complete a death investigation. For example Alabama reported that for the fatalities reported in FFY 2021, the actual dates of death were between FFY’s 2016 and 2021. Michigan even reported that its child fatality data included the child abuse death of twins in 2003 which was revealed by a cold case investigation.

A second problem with the fatality estimates is that they are widely believed to be too low. One reason is that many states report only on fatalities that came to the attention of child protective services agencies. As the report’s authors point out, many child maltreatment fatalities do not become known to agencies when there are no siblings or the family was not involved with the child welfare agency. Moreover, some fatalities resulting from abuse or neglect are labeled as due to accident, “sudden infant death syndrome,” or undetermined or unknown causes because insufficient evidence was found. I recently reviewed the child fatality review report produced by the District of Columbia’s Child and Family Services agency (CFSA). CFSA relied on the decisions of the medical examiner, which chose not to classify as maltreatment deaths an infant who died after a mother who was high on PCP rolled on top of him when sleeping with him in the same bed (counted as “unknown); a baby left on his stomach with a bottle in his mouth when his mother left the apartment (counted as “undertermined); a child who was shot to death by gunmen trying to kill her father, involved in the violent drug trade, outside a liquor store at 11:00 PM (“non-abuse homicide”), and a child who died of an untreated bacterial infection and had beating injuries diagnosed by doctors as due to abuse (“undetermined”). The total number of maltreatment fatalities was estimated at only three for the District in CY 2021, not including those four deaths. Some researchers suggest that the actual number of abuse and neglect fatalities may be as much as twice or three times that given in the Child Maltreatment reports,4 and the District of Columbia data suggest this may well be the case.

Notes

  1. This leaves out three states that are listed as screening in 100 percent of referrals: Illinois, New Jersey and North Dakota. Both Illinois and New Jersey explained in their state commentaries that reports must meet certain criteria to be accepted for investigation, so it is not clear why they responded that they screen in 100 percent of referrals. North Dakota actually screens in all referrals, but that is more semantic than real. Reports that do not meet agency criteria for a report of suspected chlid abuse or neglect are categorized as receiving an “administrative assessment,” and are not investigated. North Dakota does not report the number of referrals receiving an “adminnistrative assessment;” hence the reports that 100 percent of cases are screened in. It is unclear why New Jersey and Ilinois provided this figure of 100 percent but the reason may be similar.
  2. Alternative response is, as defined in NCANDS, the “provision of a response other than an investigation that determines if a child or family needs services. A determination of maltreatment is not made and a perpetrator is not determined.”
  3. NCANDS defines a “victim” as “a child for whom the state determined at least one maltreatment was substantiated or indicated, and a disposition of substantiated or indicated was assigned for a child in a report.” “Indicated” is defined as a disposition that concludes that maltreatment could not be substantiated under state 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.”
  4. Herman-Giddens, M. E., et al. (1999). Underascertainment of child abuse mortality in the United States. JAMA , 282(5), 463-467. Available from http://jama.jamanetwork.com/article.aspx?articleid=190980. Also, Cotton, E. E. (2006). Administrative case review project, Clark County, Nevada: Report of data analysis, findings and recommendations. Crume, T. L., DiGuiseppi, C., Byers, T., Sirotnak, A. P., & Garrett, C. J. (2002). Underascertainment of child maltreatment fatalities by death certificates, 1990-1998. Pediatrics, 110(2). Abstract available from https://pubmed.ncbi.nlm.nih.gov/12165617/. Herman-Giddens et al. estimate actual child abuse and neglect deaths to be as high as three times the national reported amount; Cotton et al. and Crume et al. found the actual number of deaths to be twice that reported.

Neglect as poverty: the myth that won’t go away

Image: consumerhealthday.com

It’s one of those myths that won’t go away and instead is gathering steam–the idea that parents who are found to be neglectful by child welfare agencies are really just poor people being judged for their inability to provide sufficient material support to their children. It doesn’t matter how much evidence is cited against it. The myth continues because it is an essential part of the narrative that is currently dominant in the child welfare arena. Nevertheless it’s been over a year since my last attempt to shed some light on this issue, and some new research has become available, thus it seems a good time to revisit the topic.

It’s Time to Stop Confusing Poverty With Neglect, exhorted Jerry Milner, Children’s Bureau Commissioner and his special assistant David Kelly back in January, 2020, in a typical statement of this myth. “Most of the reasons for child welfare involvement fall into what we call “neglect” rather than physical abuse or exploitation. Our most recent child maltreatment data tell us that 60 percent of victims have a finding of neglect only…More times than not, poverty and struggles to meet the basic, concrete needs of a family are a part of the equation in all types of neglect.” Miller and Kelly now sell their expertise at Family Integrity & Justice Works, an arm of the Public Knowledge consulting firm which has the goal of “replacing child welfare.”

Media outlets have taken this story and run with it. Here is the Philadelphia Inquirer: “A common misunderstanding is that the leading reason kids are taken into the foster care system is because of physical or sexual abuse. But that accounts for only one of six cases. Children far more often are removed from their homes for ‘neglect,’ which often amounts to symptoms of poverty, like food insecurity or unstable housing.”

The Biden Administration has endorsed the idea that most neglect findings reflect nothing but poverty. The Administration on Children and Families (ACF) has solicited applications for a grant of between one and two million dollars “to support the development and national dissemination of best practices to strengthen the capacity of child abuse hotline staff to distinguish between poverty and willful neglect.”

There is no federal definition of child neglect, and state definitions vary. In contrast to abuse, it is usually defined as an act of omission rather than comission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect or failure to provide for basic physical needs, failure to provide adequate supervision , educational neglect or failure to educate the child as required by law, and medical neglect.

There is no dispute that more children are found to be neglected than abused. Based on data collected by the federal government and published in Child Maltreatment 2020, three-quarters (76.1 percent) of the children found to be victims of maltreatment in 2020 were found to be neglected. A total of 16.5 percent were found to be physically abused, 9.4 percent were found to be sexually abused, and six percent were found to be victims of some other type of maltreatment.* Of the children who were removed and placed in foster care, according to the 2020 AFCARS Report, 63 percent had neglect listed as a circumstance associated with the child’s removal, compared to 12 percent with physical abuse and four percent with sexual abuse.

But the idea that neglect findings represent nothing but poverty is questionable. First, the neglect deniers would probably agree that most poor parents do not neglect their children but instead find a way to meet their needs, relying on charity, extra work, or subordinating their own wants to the needs of their children. When poor children are deprived of food, clothing or adequate housing, other factors such as substance abuse, mental illness and domestic violence are often involved. Second, more than half of the states exempt from the definition of neglect any deprivation that is due to the lack of financial means of the parents. Third, the definition of neglect is not confined to the failure to provide adequate food, clothing or shelter but instead includes other acts of omission, such as failure to protect a child from dangerous caregivers, or failure to ensure that children go to school and get needed medical care. Lack of supervision, a common form of neglect, can reflect poverty when parents feel they must rely on inadequate arrangements in order to go to work; we just don’t know the degree to which neglect findings reflect such decisions by parents.

But until now we did not have quantitative data concerning the types of neglect being investigated or the importance of risk factors like substance abuse and mental illness. A recent study from California, the nation’s most populous state, begins to fill this data gap. Palmer and colleagues used a representative sample of 295 neglect investigations that took place in California in 2017. They found that only 14 percent of the investigations involved physical neglect–the deprivation of food, clothing, and housing that is most closely connected with poverty. The most common types of neglect that were investigated were inadequate supervision, investigated in 44 percent of the cases, and failure to protect (leaving the child in the care of a known abuser or failure to intervene with known abuse), in 29 percent of cases. Moreover almost all (99 percent) of the investigations of physical neglect included concerns related to substance use, domestic violence, or mental illness; or they involved another type of maltreatment such as physical or sexual abuse or an additional neglect allegation. Thus, the authors conclude that almost no parent was investigated for material deprivation alone, although it is true that they did not separate out any lack of supervision cases that involved the inability to obtain adequate childcare for work or other necessary activities.

The evidence from California is very suggestive, but as the authors caution, it is possible that other states receive more reports that focus on unmet material needs, are less likely to screen out such reports, or emphasize them more during the investigation. This is possible because California, according to a recent study of state neglect definitions, is one of five states that have adopted an “expanded” definition of child neglect, including more neglect types and allowing for the threat of harm, rather than actual harm, in neglect findings. Studies similar to the Palmer study from other states with more limited neglect definitions would be useful.

While the California study is not sufficient to negate the presumption that findings of neglect represent nothing more than poverty, it is important to note that there are no studies supporting this viewpoint. So why does the myth that child welfare treats poverty as neglect persist despite the lack of evidence supporting it, and the many reasons for skepticism? It persists because it supports the narrative and associated policy prescriptions of the child welfare establishment today–child welfare leaders, administrators, legislatures, and influential funders like Casey Family Programs. The dominant narrative describes a racist family policing system that persecutes people only because they are Black, Indigenous or poor. The policy prescriptions involve radically shrinking or even abolishing child welfare systems.

According to the prevailing view, if omissions that are labeled neglect are strictly due to poverty, there is no need to intervene with social services or child removal. Instead, governments should provide economic benefits to neglectful parents. There is a body of research suggesting that economic support for families does help reduce maltreatment, perhaps not only by helping parents meet their children’s financial needs, but also enabling them to provide better childcare and improving parents’ mental health through stress reduction. Independent of their impact on maltreatment, I strongly support increases in the safety net for families and children. But available information suggests that it will take more than financial assistance to cure neglect in most cases. Improved economic supports will not be a replacement for services to help parents address challenges with substance abuse, domestic violence, mental health, and parenting, and for child removal when there is no other option.

What can be done to alleviate the confusion and misinformation around child neglect and poverty? Collecting better data from the states would be helpful. In its annual Child Maltreatment reports, the Children’s Bureau uses data from the National Child Abuse and Neglect Data System (NCANDS). When reporting on the type of maltreatment alleged and then found, states must pick up to four out of eight categories, including physical abuse, “neglect or deprivation of necessities,” medical neglect, sexual abuse, psychological or emotional maltreatment, sex trafficking, no alleged maltreatment, other or “unknown or missing.” It is not clear whether the “neglect” category is supposed to indicate all types of neglect or just those involving “deprivation of necessities,” but there is no way for states to clarify what they mean or to distinguish between the most common types of neglect. The same problem exists with the AFCARS data used to compile federal reports on foster care and adoption.

Clearly, a reform of the data elements that states are required to submit is needed so that resesarchers can see the types of neglect that are being alleged and found for each child. However, such an improvement would not substitute for careful research like the California study cited above because it will never be possible to rely on the thoroughness of database entries by overworked social workers. We cannot be sure they will enter all of the applicable categories, for many reasons, including that not all the applicable categories may be substantiated for a particular case. Moreover, while states are required to report on some caregiver risk factors contributing to abuse and neglect, such as alcohol and drug abuse, emotional disturbance and domestic violence, these seem to be vastly understated by the social workers who enter these factors in state databases. For example, only 26.4 percent of caregivers of maltreated children were found to have the risk factor of drug abuse and only 36 percent of removals involved parental drug abuse, according to federal data. Yet anecdotal reports from states and localities tend to indicate a much higher percentage of cases that involve substance abuse.

Thus, a reform of data collection might help, but would not solve the problem, especially considering that that many child welfare leaders and funders seem inclined to maintain the hypothesis that CPS confuses poverty with neglect. Ideally, the federal government and other funders would support more studies like that of Palmer et al, and more academics would consider performing such studies.

The myth that CPS confuses neglect with poverty is pernicious because, like other myths currently prevalent in child welfare, it runs the risk of hurting abused and neglected children. It is being used to justify dismantling child protective services, eliminating mandatory reporting, or more modest proposals to hamper these critical protections for children. The federal government should improve data collection on child neglect and associated risk factors as well as supporting additional research to provide more accurate estimates of their prevalance.

*According to the report’s authors, “other” could be anything that does not fit into the categories offered by the Child Abuse and Neglect Reporting System and includes threatened abuse and neglect, drug addiction, and lack of supervision according to state comments submitted with the data.

Book Review: A Place Called Home: a needed antidote to the dominant narrative

It’s Christmas in Manhattan, and five-year-old David Ambroz (then called Hugh), six-year-old Alex and seven-year-old Jessica trudge through the freezing nighttime streets. “I’m only five,” writes Ambroz, “and all I know about Christmas is the stories I’ve heard at the churches where we go for free meals.” “Mom, we’re close to the Port Authority, can we go inside?” asks Hugh. “Walk straight. They’re after us” is the reply he receives. “There’s a calculation I make whenever I talk to Mom: Will she hit me, and is it worth it?” Ambroz explains.

So begins David Ambroz’s harrowing account of life with a mother, Mary Ambroz, whose mental state varies from manic to apathetic to floridly paranoid. A former nurse who was once married to a doctor,* Mary has been in the grips of her untreated mental illness for as long as Hugh can remember. The family bounces back and forth between New York City and Albany, eventually relocating to Western Massachusetts. The children are condemned to a life of sleeping at all-night Dunkin Donuts shops, dining on tiny cups of creamer mixed with sugar packets, and eating out of dumpsters, interspersed with short periods of relative normalcy when the family finds a temporary home. Those periods last until Mary decides the CIA or other pursuer is back on their trail. Some years the children don’t go to school at all, other years they change schools one or more times due to their frequent moves. The children don’t receive medical or dental checkups or vaccinations and visit the occasional clinic only for emergencies. When Hugh breaks his arm at the age of four, he is taken to the emergency room to have it set but never brought back to have the cast removed; when it starts to smell, Mary removes it with a kitchen knife.

Over the years the family has been investigated many times without getting any help, reports Ambroz. Mary Ambroz usually manages to convince authorities that she is a good mother, although she has lost custody more than once–one time when she threw a shoe at a judge in eviction court and was carted off to a psychiatric ward. The children went to a friend’s mother, but were returned to their mother as soon as she was released.

When she finds work as a live-in nurse for an older woman who allows the family to live with them, Mary instructs the children to call their benefactor “Aunt Flora.” Hugh is thrilled to live in an apartment where he can take a bath and to be enrolled in third grade only a month into the school year even though he missed most of second grade. In an apparent effort to ingratiate the family with “Aunt Flora,” Mary tells eight-year-old Hugh he is Jewish, renames him David, and immediately takes him to a doctor to be circumcised. But she does not bring him back for follow-up care and the wound becomes infected. Mary refuses to seek medical care despite “Aunt Flora”‘s pleas, rippimg off the protective mesh that had become stuck to the wound. Dismayed at Mary’s refusal to seek medical care for her son, “Aunt Flora” expels the family and they are living in Grand Central station again.

Even during relatively stable periods, when they are able to rent an apartment in Albany with the help of public assistance, life is far from normal for the children. Mary Ambroz doesn’t cook and when the food stamps start to run low the children have strategies for getting fed, like sneaking into Ponderosa Steakhouse by pretending to be part of a family that has already paid. A kitten they were allowed to adopt during a good period starves to death despite David’s attempt to steal enough food to keep him alive. “He ate his own shit and died,” his mother tells him. “Enough whining, David. You should have taken care of him,” she said, putting the body in a trash bag along with the cat toys and the litter box.

Mary Ambroz uses a gift of $500 to take a taxi to Boston, and the family ends up in a domestic violence shelter in Pittsfield, Massachusetts. Shelter staff try to help her get back on her feet and David tries to assist, accompanying her in selling vacuum cleaners door to door. The children are enrolled in school But that situation falls apart when Mary accuses a 65-year-old staffer groundlessly of sexually abusing David, after beating David up for allowing it to happen. “Nobody wants to tangle with my mother….And so, at this shelter for abused women, the response to our mother’s unhinged behavior is to move us to an apartment where they won’t have to witness the abuse.” And that is the same story, reports Ambroz, that repeats over and over again in their lives. Adults intervene with temporary kindnesses but don’t take steps to rescue the children from what is clearly a dangerous situation.

The children are thrilled with their new apartment, but Mary grows worse, alternating between almost catatonic apathy and violence. Twelve-year-old David realizes that foster care could be his salvation. He and his siblings been have been hiding their bruises for years at their mother’s demand but he finally understands that he must reveal his injuries in order to be saved. He shows his bruises to a DARE officer visiting his school. Two weeks later, two social workers knock on their door. “David, does your mother hurt you?” asks one of them, in front of his mother. As often happens when children are asked this question in the presence of the abusive caregiver, David retracts the allegation and the case is closed.

Mary Ambroz’s violence continues to escalate. She beats Alex severely with a curtain rod when he refuses to make a list of all the men with whom he has had sex. The children hatch a plan: 14-year-old Alex will ride a stolen bike 40 miles over the hills of Western Massachusetts at night to get help from a friend’s mother in Albany. The children gather $40 worth of food stamps, candy, and snacks and Alex is off. The family hears nothing for three weeks, and then the police call. Alex had made his way to Albany and disclosed the abuse to police and social services and is now in foster care. Once again, David is interviewed in front of his mother. Once again, denies the abuse. Once again, the social workers leave him and Jessica at home.

Just a few days later, Mary throws David down the stairs of their apartment building and then kicks his head, and everything goes dark. Covered with blood, David drags himself into the nearby courthouse and collapses into the arms of a bailiff. Finally David has had enough. From his hospital bed, he tells the investigating social worker what happened. His mother insists that he fell down the stairs, but the doctor opines that “it is not impossible, but these are pretty extensive injuries for a fall.” The CPS worker, unbelievably, tells David that while the investigation proceeds, “we think it’s best that you go home with your mom.” But a week later, the police knock on the door. A social worker tells David to pack his things. As he drives away from the apartment, David thinks, “This is it. I’m free.”

And now starts David’s life in foster care, which is only slightly less harrowing than his life with his mother. Jessica is placed in the foster home where Alex is living, but the home is not open to David and he knows why; the social workers can tell that he is gay. David spends his first night in foster care sleeping in the Department of Social Services (DSS) office, an experience of many children in foster care today. Then David is brought to a facility for juvenile delinquents, after being told by a social worker that it was not the right place for him but “we don’t have a place that can accept your kind.” At the facility he is called “fag” and “Ms. Ambroz” by a staffer, loses privileges for talking back, and is beaten up by other residents at the apparent instigation of the homophobic staffer. David’s illusion of safety is gone. “I am destroyed. It took everything I had to escape my mother. I thought nothing could be worse, but now, at twelve years old, I feel like this is it.”

David quickly cycles through several foster and group homes. He is finally placed with his siblings in the home of Buck and Mae, a couple who should never have been accepted as foster parents. After the children go to bed in their basement, they are not allowed upstairs for any reason, not even to go to the bathroom. They can’t use the shower without an escort, they can’t go into the kitchen except for mealtimes, and no snacking is allowed. Abetted by a succession of therapists, Buck and Mae try to suppress David’s homosexuality, forbidding him to close the door to the bathroom all the way and designing “manly” chores like clearing a swamp and digging out a backyard swimming pool. He is sent out to hang up wet laundry in the winter without gloves. They say he is too fat and put him on a starvation diet, and now he is hungry again and scrounging for food.

Thanks to a high school friend of David’s siblings, he is hired to work at a summer camp, and that summer changes David’s life. He bonds with the camp director, Holly, and her small daughter, a camper. Holly senses that something is wrong in David’s home. Knowing he needs support, she visits him weekly after camp ends but the visits eventually stop. Later David learns that Holly stopped visiting him after Mae became furious when she bought him new clothes. Holly called David’s social worker and asked to become his foster parent. She and her husband were working on receiving their foster care license until the social worker told them that Mae and Buck insisted it was better for him to be kept with his siblings.

Finally, Jessica and Alex run away. They disclose abuse at the foster home and refuse to go back. But there is no room in the new foster home for David, and DSS keeps David with Buck and Mae even while recognizing their abuse, requiring them to do additional training and not allowing them to take on new children. (Holly is never told that David is no longer with his siblings or invited to apply for her foster care license). Mae restricts David’s food even more while citing his obesity, even though he is dangerously underweight. Nobody at school appears to notice or care. Even when David faints in school, he does not explain that he is starving and no red flags are raised. Buck and Mae begin taking him out of school to work for an acquaintance, pocketing his pay and that too raises no concerns at school.

The torture escalates until one spring morning in 1995, Mae tells David he is staying home from school and David decides he is not going to take it anymore. He leaves the house and tracks down Holly, learning of her attempt to have him placed with her. Finally, David is placed with Holly, her husband Steve, and their two small children. He cannot believe that he is allowed to freely roam upstairs, or that he is allowed to eat whatever he wants, whenever he wants. Steve teaches David how to drive and laughs when he destroys their mailbox, saying he never liked it anyway. Holly ensures that he, Alex and Jessica get the braces that Mae refused to let them get since her kids could not have them.

David always loved school, but the dislocations imposed by his mother, and the hunger and absences posed by his foster parents, often affected his grades. One he is stable and fed, he gets straight A’s. As a high school junior, he joins the Foster Youth Advisory Council and begins attending annual meetings in Washington. But even with loving foster parents, David is tired of the system. He emancipates himself with the help of a fictitious custody arrangement with his siblings’ father and goes off to Spain for a miraculous year of healing and fun with a loving host mother. He applies and is accepted to his dream school, Vassar, with a generous financial aid package.

Even with his financial aid, David struggles to buy books and to survive during school breaks. (It is not clear why he does not ask Holly and Steve for these things or return to them for the holidays; it seems to be a matter of pride or reluctance to burden them.) He eventually gives up on fulfilling his mother’s dream that he become a doctor and switches his major to political science and his plan to law school, remembering his experience as a White House intern the summer before. At a meeting of the Foster Youth Advisory Council, he agrees to be a liaison to a collaboration working to help gay foster youth. That’s when he comes out as a gay man. The story ends with his graduation from Vassar in May 2002. He is on his way to UCLA to study law and public policy. Now, Ambroz works for Amazon as head of Community Engagement (West) and is the founder of Fostermore.org, an organization that encourages those in the entertainment industry, businesses, and nonprofits to raise money and heighten awareness about the needs of foster children.

A Place Called Home provides some important corrections to the prevailing narrative in child welfare. That narrative features struggling parents who are doing the best they can, and who are being persecuted by an evil “family policing system” that is dead set on removing their children. Clearly, that is not the story of David Ambroz and his siblings. At every stage of the child welfare process–reporting, investigation and reunification–the deck was stacked against the children’s interest in safety and stability and in favor of their mother’s keeping them. While it has been some years since David Ambroz was an abused child (he does not give his date of birth but we know that he graduated from Vassar in 2002 and we can assume he was born close to 1980) the problems he identified are very familiar to those with knowledge of the system and indeed some of them may even have worsened due to the current ideological climate in child welfare.

Failure to Report: The number of people who knew that David and his siblings were suffering but took no action to help them is truly staggering. As Ambroz puts it, “Priests, rabbis, teachers, shelter directors, church members, welfare employees and Aunt Flora have all been witnesses to our bruises and lice, our hunger, a ceaseless tide of neglect and abuse.” David acknowledges that reports were made and the children were even removed once or twice, but the vast majority of people who witnessed their abuse apparently did not report it. We often hear similar stories in the wake of a child’s maltreatment death. For example, eight-year-old Dametrious Wilson was killed by his aunt in June 2022. Though he missed 60 days of school in the year before he died, his Denver Colorado school never reported his absences as required by law, even when his aunt said she was keeping him home “for few weeks” as punishment for his behavior!

And yet, today there is a groundswell of opposition to mandatory reporting and serious proposals to eliminate it, mostly on the grounds that children of color are disproportionately reported. It is true that a staggering proportion of Black children are investigated by CPS; it has been estimated that over half of Black children experience a CPS investigation by the time they turn 18, compared to 28 percent for white children and 37 percent of all children. It is possible that reporting is overused in some communities and underused in others. But it seems more logical to address these problems directly (and also educate ordinary citizens about the need to report suspected maltreatment) rather than eliminating mandatory reporting itself.

Flawed investigations: Even when reports were made, the investigations were often flawed. Ambroz states that “Over the years we’ve been investigated many times without getting help. Mom always fights to keep us, and it’s a battle she’s mostly won.” So what went wrong? Ambroz gives us part of the answer when he explains that social workers and police interviewed him at least twice in front of his mother. Both times he recanted and denied the abuse he had alleged earlier, knowing that he risked severe punishment for telling the truth. It seems obvious that children should be interviewed away from their parents since either love or fear or both will lead them to lie. Yet, this clueless and dangerous practice of interviewing children in front of the alleged perpetrator contnues in many jurisdictions. In Minnesota, a young woman named Maya, who was forced to report her fathers’s sexual abuse while he was listening, worked with an advocacy group to draft Maya’s Law, which required that Minnesota children be interviewed privately regarding allegations of abuse. But like the previous attempts, Maya’s Law failed. Instead, the language was revised to read “When it is possible, and the report alleges substantial child endangerment or sexual abuse, the interview may take place outside the presence of the alleged offender…” Sadly, many “advocates” for Black and indigenous children argued against the requirement for private interviews, fearing that it would increase disproportional involvement of these groups in child welfare.

Unwarranted reunifications: Even when David and his siblings were removed from their mother briefly, they were returned at least twice with no indication they would be safe. When Mary returned from the psychiatric ward after throwing a shoe at a judge, “nobody cared that we are being put in the custody of a homeless woman who’d recently thrown a shoe at a judge in a court of law.” We know that many children are reunified with their parents despite a lack of evidence of any change in their behavior or capabilities. In Lethal Reunifications, I wrote about two such cases that ended in a child’s death, but clearly that is just the tip of the iceberg. We never know about the children left to suffer in silence, unless they decide to write about their experiences.

Necessity of foster care in some cases: The current narrative holds that foster care is almost never necessary. But David Ambroz’s story reveals the stark truth that some children must be removed in order to be saved. Of course every effort should be made to help parents conquer their problems while monitoring children for safety in the home. But in cases of chronic maltreatment, ingrained patterns may be impossible to change. As Dee Wilson put it in his briliiant commentary on chronic multitype maltreatment, “Chronic neglect is marked by the erosion or collapse of social norms around parenting resulting from chronically relapsing conditions.” There is no better example of such collapsed social norms than Mary Ambroz, who had completely lost any sense of responsibility to keep her children clothed, fed, and housed, not to mention to avoid abusing them. In such cases, it is wrong to sacrifice the well-being of the child or children for the general value of family preservation.

Ambroz’s story also provides a needed antidote to the current trope that what child welfare describes as neglect is actually just poverty. The confusion of poverty with neglect is a pernicious misconception being perpetrated today by those who wish to eviscerate the child welfare system. David’s story clearly shows the difference. He says of the mother of friends they make in Albany: “Aurora and her sons are poor like us, and yet she still manages to take care of them. She feeds and clothes them. She cares about where they are when they roam around at night. She gives them a home that is stable in all the ways I’ve never dreamed.” And there, in a nutshell ,is the distinction between poverty and neglect.

The dominant narrative portrays foster care as harmful for children and even abusive at times. That part of the narrative is accurate for the first part of David’s time in care, when the system proved incapable of keeping David and his siblings safe, let alone meeting their needs. Among the major reasons for this failure, Ambroz draws attention to the lack of qualified foster parents and overwhelmed social workers.

Lack of Qualified Foster Parents: David fell victim to one of the scourges of our system, insufficient numbers of good foster parents. For this reason, he was initially placed in a facility for juvenile delinquents where he was abused for being gay, and then in a totally unsuitable home. In Buck and Mae, David provides a classic example of a couple who become foster parents to make ends meet. The foster care payments they received helped Buck and Mae keep their house and clothe their children. It is not surprising that such foster parents exist: some foster care agencies leave recruiting brochures in food stamp offices and laundromats; one that I worked for advertised in in a publication called the PennySaver. And yet, even when David’s siblings ran away and their abuse allegations that were taken seriously enough that the agency decided to send no more children to this couple, they were allowed to keep David. One reason, as Ambroz points out, is that there are not enough foster parents, especially for large sibling groups, so the focus is on finding any “bed” for a child. As a foster care social worker in the District of Columbia, I knew many foster parents who were motivated mainly by money. My recommendations to fire such foster parents were never accepted because the agency needed the beds.

To address the shortage of good foster parents, Ambroz recommends recruiting more middle and upper-income foster parents with higher education degrees. In order to do this, he suggests providing benefits that might attract such parents, such as government pensions, participation in the federal employee health plan, and access to free or subsidized tuition and state colleges and universities. I’m not confident that any of these benefits will attract more educated foster parents, and financial incentives also pose the risk of attracting more educated versions of Buck and Mae. Perhaps the lesson of David’s story lies the willingness of Holly and Steve to be his foster parents and the unresponsiveness of the system to this request. There is now a big push to locate kin who can care for children who are removed–and this may be happening much more frequently than when David and his siblings entered care. Perhaps agencies can do more to find unrelated adults who may have bonded with children as their teachers, parents of their friends, mentors or employers, who might serve as foster caregivers. This is certainly done; I myself agreed when asked by CPS to provide a temporary home to a friend of my son’s. If most children who are removed could be placed with adults known to them, it would be easier to fire the Bucks and the Maes and reserve the great foster parents for the children for whom no known adults are available.

Overwhelmed social workers: One reason David’s social worker did not jump at the chance to move him to Holly’s home may be that she was overwhelmed. “I have a rotating cast of social workers, who don’t have the bandwidth to pay attention to anything but immediate and obvious problems,” Ambroz reports. Based on my experience as a social worker in foster care, I could not agree more. Foster care, especially for older and more troubled children, is plagued with constant crises. With caseloads in most jurisdictions far too high, social workers have no time to deal with anything besides the latest crisis. Contributing to the problem are frivolous paperwork and metrics that have nothing to do with child wellbeing. Between the foster parents who did not perform the most basic parental responsibilities, and the caseloads that were too high for me to pick up the slack, I could not spend the time I needed to ensure that each child received the care they needed to thrive, and I eventually left the job.

David Ambroz recommends attracting more and better social workers by decreasing their caseloads and increasing their pay and benefits by either a salary increase or alternative compensation such as student loan forgiveness and home loan assistance. These are excellent ideas. There are other ideas worth considering, such expanding and publicizing the current Title IV-E social work education program that provides tuition assistance for social worker students who want to go into child welfare. Also worth considering are recruiting among populations that do not traditionally seek these jobs, such as military retirees, and perhaps changing education requirements for social workers in child welfare to allow other backgrounds besides social work.

Flaws in the Analysis

While David Ambroz’s story is powerful and carries many important lessons, his acceptance of the current child welfare zeitgeist may have prevented his drawing the conclusions that logically flow from his story. First, he buys into the currently popular misconception that parents are being found neglectful when they are simply poor. Second, he misses the opportunity to advocate for strengthening child protection services, not weakening them.

Poverty vs. neglect: While I’ve already described how Ambroz’ story contradicts the currently popular assertion that “neglect” is synonymous with poverty, he unfortunately repeats that same trope. Describing the domestic violence shelter staff’s decision to place the family in an apartment after observing Mary Ambroz’s abuse of her children, Ambroz states that “[T]his is a pattern that is repeated across the country–children in poverty are given kernels of assistance but are rarely rescued from their circumstances.” But David and his siblings were abused children, not just children in poverty. As mentioned above, he acknowledges that other poor families were not like theirs. By confusing poverty with maltreatment, Ambroz loses a key opportunity to clarify the difference between these problems and to explain that eliminating maltreatment requires more than just economic assistance .

Child protection failures: In his list of policy prescriptions, included in an appendix to the book, Ambroz does not address any of the problems with CPS that were revealed in his memoir. He focuses mainly on foster care, as if his earlier experience as an abused child did not have policy implications. Ambroz could have thrown his weight behind mandatory reporting in light of the movement to end it and could have argued for education of all citizens on the need to report suspected abuse. He could have supported reforms requiring that children be interviewed away from her parents. But these such policies are opposed to the current climate in child welfare which favors hobbling or eliminating CPS and minimizing interference with families. Ambroz appears to be determined to stay within the mainstream, saying “the best way to reform foster care is to decriminalize poverty and help families remain intact whenever possible with wraparound support–be it jobs, mental health care, or whatever is needed.” If abused and neglected children can remain safe with wraparound support that is clearly the best option, but to receive this support, these children must be identified through reporting and investigation. It is unfortunate that Ambroz did not recognize the discrepancies between some of the lessons of his story and the dominant narrative in child welfare and missed the opportunity to spell them out.

Despite its flaws, Ambroz’s story takes its place with other haunting memoirs of abused children, like Stacey Patton’s That Mean Old Yesterday, Regina Calcaterra’s Etched In Sand, and most famously Educated by Tara Westover, which put the lie to the current narrative of good parents vs. the evil state. If only Ambroz had recognized the conflict between his narrative and the dominant one, his book would be even more useful. But the story speaks for itself; the commentary is secondary. David Ambroz’s story is a must-read for anybody who cares about the abused and neglected children among us, including those who are in foster care.

*The doctor was the father of Alex and Jessica, but Mary Ambroz never told David who his father was.

Chronic maltreatment: A blind spot for child welfare

A CPS supervisor in St. Louis City once told the author about something he called “the 500 families.” When asked what this meant, he said that this referred to the small group of families that we see in the city again and again over many years, and sometimes over generations. They consume most of the time of workers and eat up most of the money available to the agency. These are the FE [frequently encountered] families.

L Anthony Loman, PhD., Families Frequently Encountered by Child Protection Services

It is a fact universally acknowledged that some families are reported to child protective services (CPS) again and again over a period of years. Many or most of these referrals involve some type of neglect, but there are often allegations of physical and sexual abuse as well. But in many cases, CPS fails to recognize families that are experiencing chronic maltreatment and when it does provide services, they may conclude with little or no change in the parents’ behavior or the children’s situation. As a result, children suffer lifetime damage, sometimes extending the cycle of maltreatment to the next generation, and sometimes the maltreatment even results in a child’s death. Sadly, today’s climate of anti-interventionism, combined with the reluctance to spend money and the lack of public concern about maltreated children, makes it unlikely that any relief for these at-risk children is forthcoming in the near future.

What is chronic maltreatment?

Every child welfare social worker seems to know families who have been reported to CPS repeatedly over a period of years. Dee Wilson, a former child welfare worker, supervisor and administrator who writes an essential child welfare blog called Sounding Board, asks participants in his training classes to tell him the highest number of CPS reports they have ever seen on one family. For almost 20 years, he has heard no answer less than 30 in any group of caseworkers, and he has received answers as high as 90 or 100 on several occasions.1 

There are different ways of describing those families who are frequently reported to CPS. The most commonly used term is “chronic neglect,” but this term can be misleading, as Anthony Loman explains. While these families usually have multiple reports of neglect, they often have reports of physical and sexual abuse as well. Loman uses the term “frequently encountered families,” meaning families who are reported again and again to CPS, and Jonson-Reid et al write about “chronically reported families” to refer to the same group. Dee Wilson prefers to focus on chronic multitype maltreatment, which he defines as maltreatment that is both chronic and includes more than one maltreatment type, such as neglect, physical abuse, and sexual abuse. But all of these writers are talking about the essentially the same families, as discussed below.

The case histories of frequently reported families consist of a sequence of reports followed by diverse outcomes. Some reports are screened out by hotline staff. Others receive an investigation or alternative response. Some investigated reports are substantiated, others are ruled as “unfounded” or “inconclusive.”2 The substantiated reports may result in the opening of an in-home case or the removal of.a child or children, or no action may be taken if the children are deemed safe or not at risk. New reports often come in and are investigated even while a case is open. An in-home case may turn into a foster care case based on a new incident or a new investigation. Removed children are returned home and the cycle continues, with new reports, investigations, case openings, and removals. Loman calls this the “replay cycle.”

There is a surprising lack of research about frequently encountered families, and most of it is over two decades old. Loman, in his magisterial study, used a sample of 33,495 Missouri families who were reported to CPS for the first time between July 1997 and June 1998 and followed for five years after that first report. He defined “frequently encountered families” as those that received five or more reports in five years. He also used a smaller sample of 797 families from one Minnesota county who were selected in 2001 or 2002 and tracked for 27 months; for this sample he defined frequently encountered families as those with three or more reports. Jonson-Reid et al used a longitudinal study of children reported for maltreatment in a midwestern metropolitan area in 1993 or 1994. They limited their sample of 6,412 children under the age of ten at the time that they were first reported to CPS to allow a follow-up period of at least seven years. While there are a number of studies that examine maltreatment recurrence, I found no others that focus on families classified according to the number of reports received.3

The limited research available suggests that frequently reported families are a significant part of the population of families known to child welfare. Loman reports that of his sample of 33,395 Missouri families with screened-in CPS reports, one-fifth had five or more reports in five years. Of this group, nearly half had five or six reports during the five-year follow up period, a quarter had seven or eight reports, and the remaining quarter had nine or more reports. It is important to remember that these families were followed for only five years, and that they could have received many more reports after the follow-up period was over, perhaps as high as the 90 or 100 reports some social workers described to Dee Wilson. In their study, Jonson-Reid et al found that 27 percent of their sample had four or more reports by the end of the seven-year followup period.

Using their entire sample of over 33,000 Missouri families, and defining twelve different types of abuse and neglect. Loman found that the type of maltreatment alleged in the first report on a family is not a reliable predictor of the allegations in subsequent reports. In terms of the broad categories of “abuse” and “neglect,” many family histories showed reports of abuse interspersed between neglect reports, and much diversity in the type of abuse and neglect alleged in different reports. It is often observed that neglect by a single mother opens the door to abuse by her boyfriend, especially when he is caring for her children. And indeed, Turner and her co-authors, using 2011 and 2014 responses from 7,852 children or their parents to the National Surveys of Children’s Exposure to Violence, found that both physical and supervisor neglect were “strongly associated with risk of other maltreatment and most other forms of victimization.” These findings suggest that “chronic neglect,” “frequently encountered families,” and “chronic multitype neglect” refer to mostly the same families.

Using mostly his smaller but richer Minnesota dataset in which “frequently encountered” meant three or more reports in 27 months, Loman was able to compare frequently encountered families to those families that were reported less frequently. He found that frequently enountered families were more likely than others to be in extreme poverty and to have no employed adults. Younger parents, younger children, larger numbers of children, domestic violence, substance abuse, children with mental illness and disabilities, and caregivers with low self-esteem were more prevalent among frequently encountered families. Not surprisingly, these are the same factors that are associated with having any re-report or recurrence of maltreatment after the first report, and they are also associated with child maltreatment in general.

As might be expected, frequently encountered families account for a disproportionate share of child welfare spending. Loman found that the one-fifth of families in his Missouri sample that were defined as frequently encountered accounted for half the spending on families over a five-year period. The majority of these expenditures was for foster and group care and residential treatment. Case management and administrative costs for these families, which were probably disproportionate as well, were not included in this estimate.

Source: I Anthony Loman, Families Frquently Encountered by Child Protection Services, Institute of Applied Research, 2006, https://www.iarstl.org/papers/FEfamiliesChronicCAN.pdf

What are the consequences of chronic maltreatment?

Many studies show that exposure to maltreatment is linked to multiple adverse outcomes, and several have found that children exposed to chronic maltreatment tend to experience worse outcomes than those exposed to a single incident.4 In The Science of Neglect, the Harvard Center on the Developing Child explains how chronic severe neglect–defined as “the absence of sufficient attention, responsiveness and protection that are appropriate to the age and needs of a child” –can produce “serious physiological disruptions that lead to lifelong problems in learning, behavior, and health.”

It is also important to note the relationship between reports of child maltreatment and mortality from all causes, which I wrote about in an earlier commentary. There has been a spate of new research demonstrating that children who have been the subject of at least one child abuse or neglect report are more likely than other children to die from many causes, including childhood injury, sudden unexplained infant death, medical causes, suicide and homicide, even when confounding factors are controlled. As a member of the District of Columbia’s Child Fatality Review Committee, I have observed that children who die of all these causes often have long family histories with CPS. For example, the families of many young victims of homicide had a history of CPS reports often starting in the infancy of their first child. Many of these case histories reveal numerous calls to CPS alleging both neglect and abuse, with school absenteeism and lack of supervision being among the most frequent allegations. Eventually, many of these young people became involved in violent and illegal activities, ultimately leading to their violent deaths. There is no evidence of whether chronic maltreatment has worse effects on mortality than a single episode, but common sense suggests that is the case.

In discussing the consequences of chronic maltreatment, it is important to bear in mind the relationship between chronic maltreatment and the placement crisis that is currently plaguing child welfare agencies around the country. Many of the young people currently sleeping in offices and hotels, housed in psychiatric wards after being ready for discharge, and sent out of state, are undoubtedly victims of chronic maltreatment. Because they were allowed to stay in their toxic environments for so long without intervention, they developed cognitive, emotional or physical problems making them difficult to care for in a foster family; some are too hard to handle for most group homes and residential treatment centers and end up being rejected or expelled from those facilities as well.

How does CPS respond to chronic maltreatment?

CPS often fails to respond to chronic maltreatment in a family early enough to help parents make changes in their behavior and prevent serious harm to children. As Dee Wilson describes, many families referred to CPS several times for less serious neglect often receive no services until maltreatment is so ingrained that opportunity for effective early intervention has been lost. Wilson blames CPS’ tendency to focus on the incident alleged in the last report rather than the pattern revealed by a family’s history of reports over time.

And even when CPS responds, the response is often inadequate. The “replay cycle” described by Loman – with repeated reports, case openings, case closures, foster care removals and reunifications – continues because parents’ mental health, substance abuse, domestic violence or parenting style remain problematic. And indeed, research suggests that even when a family receives services as a result of a substantiated report, these services are generally too brief and do not result in behavior change. Chaffin et al, studying parents in home-based child welfare services, found that chronically maltreating parents tend to enter services with high levels of problems and do not improve much as the result of participation in services. They concluded that the “episodic and reactive service model characterizing traditional child welfare services” may be a “mismatch” for chronically matreating families.

Another reason for the “replay cycle” in some jurisdictions may be that at least one of the allegations being investigated must be substantiated in order for the agency to open a case. As a member of the Child Fatality Review Team in the District of Columbia, I have observed that many children who later died were assessed to be at high risk by the CPS investigator but were left at home with no support or monitoring when the allegations were not substantiated. When asked why this happened, agency representatives invariably explain that social workers are not allowed to open a case if an investigation did not result in substantiation of at least one allegation.

Similarly, accounts of child abuse or neglect deaths in states like California and Kansas have revealed that these children were assessed to be at high risk by CPS investigators one or more times but were left at home with no support or monitoring. Again, one reason was the requirement that an allegation be substantiated before a case can be opened.5 In the wake of the horrific child abuse death of Yonatan Aguilar in Los Angeles County, who was kept in closets for three years before he died, after four unsubstantiated allegations, the Office of Child Protection analyzed 1,225 referrals investigated by DCFS between 2012 and 2016 involving a child was later seriously injured or killed. They found that as in the case of Yonatan, more than half of the fatalities and near-fatalities occurred when the allegation was not substantiated. Yet we know from research that whether a report has been substantiated is a poor indicator of future behavior among parents who have been reported to CPS.6 Requiring substantiation to open a case ensures that some at-risk children will remain unprotected.

How can agencies respond better to chronic maltreatment?

There may be some social problems that we know how to solve but cannot do so due to financial or political constraints. But chronic maltreatment is not one of those problems. There are no easy answers to chronic maltreatment. But one thing is clear. The system itself must stop neglecting chronically maltreated children by leaving them at home without monitoring or support. Different commentators have supported different policies and some of these are discussed below.

Early Identification and support: Loman suggests that many families that will go on to become frequently encountered can be identified after the first or second report. These are the families that have many risk factors for child maltreatment and few protective factors against it and therefore score high on risk assessments. Ideally, child welfare agencies would identify these families after the first or second report and intervene to prevent their becoming chronically maltreating families. But, realistically, this is not going to happen in the current ideological climate, which favors restricting rather than expanding the role of child welfare services. However, it should be possible to offer all of these families a referral to high-quality childcare that includes family support services and staff trained to spot signs of abuse or neglect. For example, Educare, a nationwide network of birth-to-five schools, provides high-quality early childhood education, family support services, and links to needed services in disadvantaged neighborhoods around the country. At least in the Washington DC location, children are checked daily for signs of abuse.

Standards for removal based on age: Dee Wilson contends that the requirement of “imminent danger” for child removal is inappropriate in light of what we now know about the damage that long-term maltreatment causes to children’s developing brains and its contribution to mortality from all causes. He suggests considering developmental harm to children, rather than the narrow criterion of imminent danger, in the decision of whether to place the youngest children (those five and under) in foster care. Conversely, he suggests that children aged six to 17, unless they are in extreme physical danger if they remain at home, should be placed out-of-home only when a child welfare agency has a known therapeutic resource for that child, or when there is an extended family member, family friend or professional with whom the youth has a good relationship and who is committed to the youth. But removing more children at any age is unlikely to gain support in today’s ideological climate, which perceives child removal as punitive “family policing.” Removing fewer older children as Wilson proposes may leave many in harm’s way, especially those who might be in danger of self-harm from emotional abuse. Nevertheless, these ideas are worth further attention and exploration.

Reducing the role of substantiation/mandating services: Jurisdictions where substantiation of an allegation is required in order to open a case can consider changing that requirement. Los Angeles’s Office of Child Protection, in the report referenced above, spoke to experts who supported placing more emphasis on risk (instead of on allegation dispositions) when making case decisions, and on offering services and supports to families that may help to reduce this risk. However, agencies may need to do more than “offer” such services. Children who are assessed to be at high or intensive risk and in families that have multiple reports of maltreatment should not be left in their homes without monitoring. When there are three or more reports, and a child or children are found to be at high or intensive risk, a case should be opened for services and a court petition should be filed if the family refuses to participate. Court petitions should also be used more often during in-home cases to oversee parents’ compliance and incentivize their cooperation with services in in-home cases.

Services for Parents

Unfortunately, there is a dearth of interventions that have been found to be effective for parents with histories of chronic child neglect, especially when accompanied by substance abuse and mental health disorders, as well as parents displaying multiple types of maltreatment. Such families need a variety of services to address all of their risk factors, and the services must be sequenced so as not to overwhelm the parent or to provide certain services before a parent is ready for them. Drug treatment and mental health services are major needs for these parents. They also need services to address their financial need and employability, as research has shown that poverty and financial stress make child maltreatment more likely. Adequate housing will have to be provided for some families. Also needed, as Loman describes, are services to bolster protective factors like social supports, for example by trying to reconnect a family with an estranged relative.

Case management itself should be considered one of the most important services that cna be provided to frequently encountered families. Given the serious issues of these families, case managers need to have lower caseloads or work in teams. Dee Wilson recommends the creation of case management teams consisting of a CPS caseworker, substance abuse assessment specialist, mental health therapist, a public health nurse and a parent advocate to work with these families. Another approach is to assign one case manager with a smaller caseload to such families. The District of Columbia’s Child and Family Services Agency implemented chronic neglect units but they were dropped after barely a year. Case managers or teams should be allowed to work with families for at least a year, or even longer when a parent is mentally ill or cognitively impaired. Deep-seated problems that are often multigenerational cannot be solved in a matter of months.

Serving Parents and Children Simultaneously

Therapeutic childcare: An intervention that has not received enough support is therapeutic childcare, such as that offered by the relief nurseries in Oregon. Relief nurseries seek to prevent the cycle of child abuse and neglect through comprehensive and integrated early childhood therapeutic and family support services. Seattle’s Childhaven used to operate a similar model, combining therapeutic childcare with coaching parents in how to interact with their children. Such therapeutic childcare addresses many of the issues with chronic maltreatment. Quality care with family support can replace some of the missing interaction that is so essential to healthy child development, while at the same time training parents to interact this way themselves. Reducing the hours that a child spends alone with the parent, and enabling observation by staff trained to spot signs of abuse or neglect, increase child safety. Stress on parents is reduced by family support and availability of childcare. It is hard to think of an approach that addresses child maltreatment through so many pathways. As mentioned above, high quality childcare should be offered to families reported for the first time and at every subsequent report. But therapeutic childcare designed for children who are the victims of maltreatment should be mandated for those who have an open in-home case.

Residential Services: Keeping parents and children together while parents get treatment can keep children safe while not disrupting the parent-child bond. Drug treatment programs where children can stay with their parent are one approach that deserves more funding. Dee Wilson, in another helpful commentary about in-home services, also suggests trying out the concept of Shared Family Care, widely used in some Northern European countries, in which whole families with a substance abusing or mentally ill parent are placed with resource families.

Services for Children

Mentoring: Every school-aged child with an in-home case or in foster care should be matched with an adult mentor7 providing both another set of eyes on the child and some of the nurturing that the parents may not be providing. Mentors can be volunteers or employees of a professional mentoring program like Friends of the Children, which aims to break the cycle of intergenerational poverty and has a special concentration on children in foster care or involved with child welfare. Credible Messengers is a quickly-spreading model that uses people with similar life experiences to mentor youths involved with juvenile justice, and the District of Columbia’s child welfare agency has begun using it in foster care as well.

Creativity and Mastery: As Dee Wilson suggests,7 agencies managing the cases of abused and neglected school-age children should invest as much in their talent development as in their mental health treatment. Developing a child’s talent in arts, sports or another arena provides multiple benefits, including the psychological benefits of mastery of a skill, and in the case of the arts, the opportunity to process and understand trauma, as described in an Imprint article about an arts programs for incarcerated youth.

Specialized Education: Some public education models are designed to support children with child welfare involvement. Haven Academy in the Bronx is a public charter school that is open to all students but prioritizes admitting children whose families are involved with the child welfare system. Their model integrates family support services with the academic program. Some school-aged children who are candidates for foster care may do well in a boarding school that takes them away from their homes for much of the time while their parents receive needed services. Monument Academy Public Charter School in the District of Columbia is a weekday boarding school designed to serve students who have experienced significant adversity, including involvement or risk of involvement in the child welfare system. The school works to provide its students with the “academic, social, emotional, and life skills to be successful in college, career, and community.”

Coordination with other agencies

Shared Data: The families that come back again and again to every child welfare agency are probably the same families known to other agencies that work primarily with the poor–such as income support, mental health, juvenile justice and probation. The schools probably know these families as well because of their children’s issues with absenteeism, behavior, and disabilities. With a database shared between these agencies, families with issues could be identified early and helped in a more coordinated manner, perhaps allowing earlier intervention (and not always by CPS) with chronically maltreating families. But privacy and other concerns are often used to block any attempt at information-sharing between agencies. In a future commentary, I will discuss how such concerns ended San Francisco’s Shared Youth Database, a successful and award-winning data sharing project.

Shared Case Management: Another way to coordinate services between agencies would be to actually merge case management for child welfare and income support programs, returning to something more like the model that existed when cash welfare was administered by social workers who monitored parents to ensure that they were meeting the needs of their children. This model was phased out between 1968 and 1972 after criticism that it was coercive and also to save money, and it is unlikely to get a good reception in today’s ideological climate. But returning to a shared case management arrangement for cash welfare and child protective services would have many advantages. It would make the receipt of benefits contingent on taking proper care of one’s children and provide an incentive for families to cooperate with their case plans.

Recognizing when to give up on birth families: Finally, child welfare agencies must recognize when it is time to remove a child from a toxic family environment or when the prospect of reunification should be given up for good. It is not appropriate to close an in-home services case or to reunify a family if there is no indication that the parents have changed their behavior, and yet this happens all the time. Many of the most egregious child abuse and neglect deaths have been associated with startling failures to remove a child after long histories of abuse, or incomprehensible reunifications with parents who are clearly dangerous. Social workers and judges should be more rigorous about demanding evidence of change before putting a child in harm’s way by closing a case or sending a child home. When starting work with frequently encountered families, social workers should immediately seek out relatives or family friends who could serve as sources of support as the parents try to improve and as alternative caregivers if the children must be permanently removed.

Dee Wilson provides several reasons why there little motivation to find effective responses to the problem of chronic maltreatment. There is certainly no great public concern with the emotional and developmental damage to children from growing up with chronic abuse and neglect. Child welfare commentators in the spotlight today are clamoring for a narrower standard for child welfare intervention, not a broader one. And finally, understaffed and underfunded child welfare agencies are not looking to expand their services to maltreating families, although paradoxically many of them apparently want to expand their mission to encompass prevention of maltreatment among the group of families not yet known to them. The combination of public indifference, resistance to government spending (traditionally the province of the right wing) and resistence to any sort of “family policing or regulation” regardless of the danger to children (now the province of the left wing), is particularly toxic. Nevertheless, those who care for children must keep raising our voices, hoping one day that those in power will understand the need to protect the most vulnerable children and thereby interrupt the transmission of chronic maltreatment from generation to generation.

Notes

  1. Dee Wilson, email to this author, November 29, 2022.
  2. Substantiated means that there is credible evidence that abuse or neglect has occurred. Unsubstantiated or unfounded generally means there is not credible evidence concluding that abuse or neglect has occurred. Some states have an intermediate finding of “inconclusive” or “indicated” meaning that there is some evidence that maltreatment has occurred but not enough to substantiate the case. See Children’s Bureau, Child Protective Services: A Guide for Caseworkers 2018, p. 8-0.
  3. Jonson-Reid, M., et al. (2010). Understanding chronically reported families. Child Maltreatment, 15 (4):271-281. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628675/. Jonson-Reid et al were able to find only one study (the Loman study) that focuses on these chronic cases. To determine if there were any such studies later, I went through the list of articles citing the Reid et al paper and found no more estimates of the proportion of families that are chronically reported by any definition.
  4. English, D. J., Upadhyaya, M. P., Litrownik, A. J., Marshall, J M., Runyan, D. K., Graham, J. C., & Dubowitz, H. (2005). Maltreatment’s wake: The relationship of maltreatment dimensions to child outcomes. Child Abuse and Neglect, 29,597-619; Ethier, L.S., Lemelin, J.P., and Lacharite, C. (2004). A longitudinal study of the effects of chronic maltratment on children’s behavioral and emotional problems. Child Abuse & Neglect, 28, 1265-1278; Jaffee, S., and Malkovich-Fong, A.K (2011). Effects of chronic maltreatment and maltreatment timing on children’s behavior and cognitivec abilities. Journal of Child Psychology and Psychiatry, 52(20, 184-194; Lemmon, J. H. (2006). The effects of maltreatment recurrence and Child Welfare services on dimensions of delinquency. Criminal Justice Review, 31, 5-32.
  5. See my commentary, Risk not substantiation should drive services to families. But not all jurisdictions require substantiation in order to open a case for in-home services or foster care. In Washington State, an allegation does not need to be substantiated for an agency to file a neglect petition in court; the purpose of filing a petition is to “prevent harm” and there is no need to prove that harm already occurred. Nevertheless, we know from Dee Wilson that despite this possibility, families continue maltreating long enough to accrue 30 or more reports, so clearly it is not the only answer. In Michigan and Minnesota, a case can be opened or a child removed because of “threatened harm,” which can be substantiated as a type of maltreatment.
  6. See Drake, Jonson-Reid, Way, & Chung, Substantation and Recidivism; Kohl, Jonson-Reid, and Drake, Time to leave substantiation behind: Findings from a National Probability Study; Putnam-Hornstein et al., Risk of re-reporting among infants who remain at home following alleged maltreatment.
  7. Dee Wilson, Email to the author, December 21, 2022.

Using child welfare data to learn from the past: why is it so unpopular?

Photo by Rene Asmussen on Pexels.com

Miracle Jackson, a seven-month-old in Detroit, died with a sock stuffed down her throat and her face covered in duct tape at the hands of her father in 2000. During the same week in the same city, a five-month-old named Jamar was severely beaten. It turned out that Miracle’s mother and Jamar’s parents had abused or neglected their previous children seriously enough that their rights to parent those children were terminated. Yet, when Miracle and Jamar were born, nobody checked on them to make sure they were safe. But that was about to change in Michigan, which became the first state to match birth and child welfare data to identify new children born to parents who had severely abused or neglected previous children – a practice that has become known as “birth match.”

The logic behind birth match is simple. Research suggests that in parenting as in other areas, past behavior is often the best predictor of future actions. Current technology makes it possible to match existing databases maintained by the child welfare and health agencies in order to identify infants born to parents who have had their parental rights terminated, been convicted of a crime against a child or have other history identifying them as a safety risk to a newborn. So it is not surprising that the Committee to Eliminate Child Abuse and Neglect Fatalities (CECANF) in its 2016 report recommended birth match as one strategy to identify children at high risk of maltreatment so that action can be taken to keep them safe. Yet, only four other states have adopted birth match, and only one (Missouri) has adopted it since the CECANF recommendation.

In a report called Learning from the Past: Using Child Welfare Data to Protect Infants Through Birth Match Policies, published by the American Enterprise Institute, I discussed what we know about birth match in the five states that use it. As the report illustrates, birth match policies and procedures varied widely from state to state.

All of the states that use birth match identify infants born to parents who had their rights terminated because of abuse or neglect, with some specific differences. It is not surprising that they all identify parents with a termination of parental rights (TPR), because a TPR usually means that there has been severe abuse or neglect and and the parent has been given multiple chances to ameliorate the behaviors or conditions that caused the child’s removal.

Each state has chosen to include certain other parents in addition to those who had a TPR. Maryland has the most limited policy, including (in addition to those who had their rights terminated) only parents who have been convicted of the murder, attempted murder, or manslaughter of a child. Minnesota includes the broadest group of parents–all those who were determined to have committed “serious maltreatment,” the highest of four categories of severity that are assigned to all substantiated instances of maltreatment. States also differ in how far back they look in time for evidence of dangerous parental behavior: Texas looks back only two years, Maryland and Missouri look back ten years, and Michigan and Minnesota match all available records, regardless of when the maltreatment or termination occurred.

States also differ in whether they treat birth match referrals as allegations of abuse and neglect, requiring a regular CPS investigation. The first two states to adopt birth match, Michigan and Minnesota, already had a category of child maltreatment called “threatened harm” or “threatened injury.” Birth matches in those cases receive a CPS investigation of an allegation of threatened harm or injury. In Texas, matched infants and their families also receive a regular investigation, but the type of allegation depends on the content of the report.1 In general, investigations result in a finding on the truth of the allegation; if it is “substantiated,” or found to be true, it may result in the removal of a child or children into foster care, the provision of in-home services and monitoring to ensure their safety, or a possibly a placement with a relative or family friend with the consent of the parent.

In contrast to the other three states, Maryland and Missouri treat birth match referrals differently from allegations of child abuse and neglect. In Missouri, birth match referrals are treated as “Non-Child Abuse/Neglect Referrals” and receive a “Newborn Crisis Assessment,” a special type of investigation that was designed to respond to calls from hospital personnel who are hesitant to release newborns from the hospital because of safety concerns. If no safety concerns are identified, parents can decline any services that are offered; if safety concerns are identified, social workers have the same choices as in a regular investigation: they may go to court to request immediate custody, allow the child to stay at home under a safety plan supervised by the department, or negotiate a voluntary placement with a relative.

In Maryland matched families receive an “assessment,” which is less comprehensive than a regular investigation. Families can refuse to participate, unless there is “reason to believe a child has been abused or neglected or is at substantial risk of abuse or neglect,” in which case the local department of social services is directed to make a report to CPS. Similarly, the department is directed to call CPS if there is such a concern at any time during the birth match assessment process.

The lack of data makes it difficult to assess the impact of existing birth match processes. Other than Missouri, where birth match has been in use for less than a year, none of the states publishes data on the results of these programs as part of their regular reporting, and it appears that administrators do not review this data internally. In response to the request for data for the report, child welfare officials had to generate new tables from their databases. But the data raised many questions and without knowing exactly how it is obtained, one cannot judge its accuracy. There were some anomalies that state administrators were unable to explain, like the fact that the total number of matches in Michigan dropped from 1186 in FY 2019 to to 873 in FY2020 and then down to 515 in FY2021–a drop of 50 percent in two years! It appeared that state administrators were unaware this anomaly before being asked about it, and they were unable or unwilling to provide an explanation. 

If the data provided by the states is approximately accurate, birth match is identifying significant numbers of children. The number of matched infants identified in FY2019 (before the pandemic) was 1,188 in Michigan, 1,138 in Texas, 420 in Minnesota, and 243 in Maryland. Between half and two-thirds of these children already had an open investigation or case. It is encouraging that so many of these infants were known to CPS without birth matching, but it also shows that a sizable number and proportion of infants at risk due to their parents’ earlier behavior would be unidentified in the absence of this tool.

But the effectiveness of birth match depends on the quality of the investigations or assessments that are conducted and whether they result in actions to ensure child safety. The limited evidence is not encouraging. The number and percentage of matched children and families reported to be actually receiving services was surprisingly low. In Texas, of the 302 families investigated due to birth match in FY2019, only 70 received in-home services and 28 had a child or children removed. In Michigan, of the 484 investigations due to birth match, only 49 cases opened for services and 24 had a removal of a child. In Maryland, only four of the 89 families investigated due to birth match were documented to have received services. Minnesota provided no data beyond the number of matches. Without better data and case reviews, it is impossible to know why so few families received services.

The fact that the data requested had to be specially generated suggests that child welfare administrators in birth match states have little interest in the implementation and effects of of birth match. That was not always the case, at least in Michigan. One former CPS director in Michigan, who had served as a CPS worker and supervisor earlier in his career, had a strong belief in the potential of the process to protect children if correctly implemented. He conducted an internal review of birth match cases and found that 75 percent of the investigations resulted in no finding of threatened harm to the child, and only 6.5 percent of the cases eventually went to court for removal or court-ordered services. He concluded that investigative workers were not following agency policy and that supervisors were nevertheless approving the findings of the flawed investigations. He was working on ways to improve implementation through oversight of supervisory decisions. But with a change of personnel, those efforts never came to fruition. Now, birth match is under review in Michigan as part of a “front end redesign” of the child protection system.

Many former birth match advocates appear to have lost interest as well. In Texas, birth match was adopted in response to a recommendation by the State Child Fatality Review Team (SCFRT). But after requesting updates on implementation in FY2013 (which were never provided) and recommending expanding the program to look back five years in FY2018 (a recommendation which DFPS rejected), the SCFRT stopped making recommendations about the program. In Maryland, advocates pushed to strengthen the program by increasing the “lookback” period from five to ten years. But after such legislation was passed in 2018, it does not appear that advocates asked about its implementation nor about the effects of the expansion. Moreover, in passing the 2018 legislation, the legislature included a provision that appears to be aimed at finding less controversial alternatives to birth match.

The changing ideological climate might be the reason for the loss of interest in birth match among officials and advocates in the first four states to adopt it. In today’s atmosphere, identifying parents based on their past involvement in child welfare or criminal justice is likely to be criticized because these systems involve Black people at a rate that is disproportionate given their share of the population, though proportionate to their rate of abuse and neglect compared to other populations. There is no escaping the conclusion that birth match is simply at odds with the current zeitgeist in child welfare. Missouri was the only state to institute birth match since it was recommended by CECANF in 2016.

The report makes three recommendations. Due to its support in research and common sense, birth match should be added to every state’s set of tools to prevent child abuse and neglect and Congress should consider mandating birth match as a requirement to receive funds under the Child Abuse Prevention and Treatment Act (CAPTA). Birth match provisions should include all parents who committed severe abuse or neglect whether or not they had a TPR or criminal conviction. And finally, states with birth match programs should track and publish data on the children matched and should conduct case reviews to assess the implementation of their programs. But it is not likely that any of these recommendations will be widely adopted until the pendulum swings toward the needs of children living in unsafe homes.

When a new baby is born to parents who had their rights terminated to a previous child due to severe abuse or neglect, or who killed or severely harmed another child, the child welfare agency should be notified, and a professional should make contact with the family to ensure the child is safe and offer the parents any assistance needed. It is such a commonsense idea that it’s hard to imagine anyone would oppose it. Nevertheless, only five states have adopted such a program, and and the four states with programs that have been in effect for more than one year have displayed what appears to be little interest in assessing or improving their implementation; on the contrary, there seems to be some interest in eliminating the programs among administrators and legislators in some states. The current ideological climate in child welfare may be be responsible for our failure to use a simple tool to protect children.

Notes

  1. How the allegation type is determined and by whom, and how maltreatment can be found before it has occurred are unclear. Birth match is not mentioned in the department’s policy manual and DFPS’ Media Relations Director was not able or willing to answer these questions.

Did child maltreatment fall under COVID-19?

As the Covid-19 pandemic took hold, stay-at-home orders were declared, and school buildings closed, many child advocates voiced fears that child abuse and neglect would increase but would remain unreported as children were locked in with their maltreaters. But some newly available data has led to a spate of commentaries announcing triumphantly that rather than increase, child maltreatment has actually decreased during the pandemic, suggesting to some that we may not need a child welfare system after all. In fact, while the data provides no definitive evidence of either an increase or decline in child maltreatment, there are some concerning indicators from emergency room visits, teen self-reports, and domestic violence data that there may have been an increase in child abuse and neglect after Covid-19 closed in.

There are many reasons to think that the Covid-19 pandemic and our nation’s response to it would have led to a spike in child abuse and neglect. Research indicates that income loss, increased stress, and increased drug abuse and mental illness among parents (all associated with the pandemic) are all risk factors for child abuse and neglect.* On the other hand, the expansion of mutual aid networks and the influx of new government assistance programs with few strings attached may have protected children against abuse and neglect. Data on hotline calls, emergency room visits, child fatalities, teen self-reports of abuse, and domestic violence are being cited as indicators of what happened to maltreatment during the pandemic. I examine the evidence below.

Child maltreatment referrals

As soon as stay-at-home orders were imposed, child advocates warned of the likely drop in reports to child abuse hotlines as children vanished into their homes. And indeed, this is exactly what happened. Individual jurisdictions began reporting large drops in reports starting in April 2020 But national data did not become available until the publication of Child Maltreatment 2020, the compendium and analysis of data the US Children’s Bureau received from states for the fiscal year ending September 30, 2020. According to the report, there were 484,152 screened-in referrals (reports to hotlines) between April and June 2020, following the declaration of emergencies at the national and local levels and the closure of most schools buildings and subsequent transition to virtual operation. This compares to the 627,338 referrals in the same period of 2019–a decrease of 22.8 percent.** For July through September, referrals decreased from 553,199 in 2019 to 446,900, or 19.2 percent. So even in the summer when schools are mostly out anyway, referrals decreased.***

Despite the concerns among child advocates about the drop in hotline calls as a natural consequence of lockdowns and school closures, some parent advocates, such as Robert Sege and Allison Stephens writing in JAMA Pediatrics, have argued that these decreases in hotline calls show that “child physical abuse did not increase during the pandemic.”**** Similarly, In her article entitled An Unintended Abolition: Family Regulation During the COVID-19 Crisis, Anna Arons argues that the decline in hotline reports during the first three months of pandemic shutdowns in New York City relative to the same period the previous year reflects an actual decline in maltreatment rather than the predictable effects of lockdowns and school closures.

Interpreting the decline in hotline reports to suggest a decline in child maltreatment during the pandemic is either naive or disingenuous. The drop in reports was predicted by experts as soon as schools shut down because school personnel make the largest share of reports in a normal year–about 21 percent in FY 2019. The number of reports from school personnel dropped by 58.4 percent in the spring quarter and by 73.5 percent from July through September.** Exhibit 7-B from Child Maltreatment 2020 shows the drastic decline in reports from school personnel, as well as smaller decreases in reports from medical and social services professionals. To claim that this drop in reports reflects reduced abuse and neglect is to disregard the most obvious explanation-that children were seeing less of teachers and other adults who might report signs of abuse or neglect.

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

In her article about New York City, Anna Arons cites the absence of an oft-predicted surge of child maltreatment reports when schools reopened in September 2020. Far from such a surge, she states, reports did increase, but only “at a rate in line with the typical increase in a non-pandemic fall, rather than a more dramatic leap.” But the grounds for predicting a surge in reports are far from clear. First, only 25 percent of New York City children returned to school buildings in September, as Arons reports. Moreover, is not obvious that the concept of a backlog makes sense in reference to abuse and neglect reports, as it does with tax returns, for example. Bruises may heal, a hungry child may be fed when there is money in the house; living situations may change. Many of the most troubled families are the subject of multiple reports of maltreatment over the course of a year; a child who would have been reported in the spring and again in the fall will not necessarily receive an “extra” report in the fall.*****

Emergency room visits for suspected maltreatment

As the pandemic closed in, child advocates feared that hospital emergency rooms would see an influx of maltreatment-related injuries among children. To address this question, Elizabeth Swedo and colleagues at the Center for Disease Control and Prevention used a platform that provides information on approximately 73 percent of all Emergency Department (ED) visits in the United States. The authors did not find the increase that these advocates feared, reporting that the total number of ED visits related to child abuse and neglect decreased sharply during the early part of the pandemic as compared to the analogous period in 2019, though ED visits for all causes increased even more during that period. Despite the decreases in the number of ED visits for maltreatment, the number of such visits ending in hospitalization stayed the same, which suggests there was no decrease in maltreatment severe enough to result in hospitalization.

Using an administrative database from 52 U.S. children’s hospitals, Kaiser et al. found a sharp decline in all ED visits and hospital admissions, and in visits and admissions for child physical abuse (not including admissions related to sexual abuse or neglect) during the first six months of the pandemic period compared to previous years. Moreover, they found no increase in the severity of the child physical abuse cases resulting in ED visits or hospitalizations. They concluded that coronavirus aid programs and eviction protections might have resulted in reductions in child physical abuse.

To disentangle the effects of reduced healthcare usage during the pandemic changing levels of child maltreatment, Maassel et al. looked at hospitalizations for abusive head trauma (AHT), arguing that it is more difficult for caregivers to forego medical care for such life-threatening injuries. They found a significant decrease in admissions for AHT among 49 children’s hospitals during the COVID pandemic compared to the three previous years.****** They hypothesize that the marked increase in job losses for women, along with more adults working from home, may have led to more children being cared for by two or more caregivers, and specifically fewer being cared for by sole male caregivers, who are the most common perpetrators of AHT.

Swedo et al’s finding that the number of ED visits for abuse or neglect that ended in hospitalization stayed the same contrasts with Kaiser et al and Maassel et al’s findings that hospitalizations for child abuse (and specifically) AHT declined during the early period of the pandemic. One explanation may be that abuse decreased but neglect did not; it may also be relevant that Swedo et al used a different database than did the other two teams. More research is needed to explain these differences.

Child Fatalities

One might argue that child maltreatment fatalities are best indicator of maltreatment rates during the pandemic because fatalities are less likely to avoid being reported than non-fatal maltreatment. Child Maltreatment 2020 contains estimates of child fatalities due to abuse and neglect from all states but Massachusetts, plus the District of Columbia and Puerto Rico. These jurisdictions reported a total of 1,750 fatalities, for a population rate of 2.38 per 100,000 children, compared to 1,825 or 2.50 per 100,000 children in FFY 2019. But to say that the maltreatment fatality rate went down in 2020 as compared to 2019 would be incorrect, because the fatalities counted in one year did not necessarily occur in that year. Rather, the authors indicate that “the child fatality count in this report reflects the federal fiscal year … in which the deaths are determined as due to maltreatment,” which may be different from the year the child actually died.” Such determinations may come a year or more after the fatality occurred. So it is not possible to make inferences from this small decrease in the child maltreatment fatality rate in FY 2020. Moreover, it is not not implausible that the pandemic affected reporting, so that year-to-year comparisons between pandemic years and non-pandemic years are particularly problematic.

Teen Self-Reports of Abuse

Results from a nationwide survey of 7,705 high school students conducted in the first half of 2021 and reported by the New York Times revealed disturbing indications that abuse, at least of teens, increased during the pandemic. Over half (55.1 percent) of adolescents reported being emotionally abused by a parent, and more than one in 10 (11.3 percent) reported being physically abused by a parent. Black students reported the highest rate of physical abuse by a parent–15 percent, compared to 9.8 percent for White students. Students who identified as lesbian, gay or bisexual, and those who identified as “other or questioning” experienced the highest rate of emotional abuse (74.4 percent and 75.9 percent respectively). Female students were more likely to experience emotional abuse by a parent than male students (62.8 percent vs. 46.8 percent). While using a different sampling frame, methodology and wording, a survey of a nationally representative sample of children aged 14 to 17 conducted in 2011 (as quoted by the authors of the new survey) found much lower estimates of abuse–13.9 percent for emotional abuse by a caregiver in the past year and 5.5 percent for physical abuse. The change in these percentages, even if accurate, is not necessarily due to the pandemic, but it is a troubling indicator nonetheless.

Trends in Domestic Violence

Domestic violence is highly correlated with child abuse and neglect, and the same risk factors, heightened by the pandemic, contribute to both of these problems. A systematic review of 12 US studies, most including multiple cities, concluded that domestic violence incidents in the US increased by slightly over eight percent after jurisdictions imposed stay-at-home orders. The authors speculated that the increase in domestic violence was driven by factors such as increased unemployment and financial insecurity and stress associated with childcare and homeschooling–the same factors that might contribute to increased child maltreatment.

I have written often about the propensity for wishful thinking in child welfare, whether it relates to home visiting programs, “race-blind removals,” or other programs and issues. Unfortunately, this propensity is on full display in the commentaries that try to portray reduced calls to child abuse hotlines as showing that child maltreatment did not rise during the pandemic. But it is certainly true that emergency room and hospitalization data do not provide evidence of a surge in child abuse and neglect, and there are even some suggestions that abuse may have declined perhaps due to fewer children being left alone with male caregivers. Overall, the data we have so far do not conclusively demonstrate that maltreatment rose or fell. Some children who lived through this period will eventually share their memories of life at home during the period. But these memories of course will be impossible to generalize. We may never know what really happened to maltreatment during the covid-19 pandemic.

This commentary was revised on May 18, and May 19, 2022 to incorporate new findings on ER visits and hospitalizations by Kaiser et al and Maassel et al.

*How neglect would be affected by a pandemic is somewhat less straightforward than with abuse. Many neglect cases involve lack of supervision, which may have increased with parents leaving children alone to work, with schools and childcares closed. Increased drug and alcohol abuse by parents might have also increased the occurrence of neglect. On the other hand, with more parents unemployed or working at home, lack of supervision may have become less prevalent during the pandemic.

**Unfortunately, the Bureau did not provide the total number of referrals including those screened in and screened out, by quarter. For the whole year the report shows that 54.2% of referrals were screened in, compared to 54.5% in FY 2019.

***The continued suppression of hotline calls could be due to fewer children in summer camps, summer schools, and childcare, as well as fewer attending health appointments and family gatherings in the first summer of the pandemic.

****It is not clear why Sege and Stephens refer to physical abuse only, as they data they discuss concern all types of child maltreatment,

*****However, it is interesting that even in September 2022, when almost all NYC children returned to school, reports did not return to their 2022 level. There are several reasons this could be the case, including a decline in child maltreatment and a decrease in reporting due to changes in messaging coming from ACS and advocates.

******Maassel and colleagues compared AHT admissions between March 11 and September 30 in 2020 to admissions during the same period over the previous three years.

“Five Myths about the Child Welfare System” misleads more than it corrects

Source: UAlberta.ca

by Marie Cohen and Marla Spindel

The following was submitted as an Op-Ed to the Washington Post in an effort to ensure the. public has the benefit of various viewpoints on this topic but, unfortunately, the Post chose not to publish it.

We were troubled to read Dorothy Roberts’ “Five myths about the child welfare system” in the April 17th Outlook section of the Washington Post. Roberts’ version of reality does not agree with what we see every day as child advocates in the District of Columbia, nor with the research on child welfare.

“Myth” No. 1: Child welfare workers mainly rescue children from abuse. Roberts is correct that at most 17 percent of the children placed in foster care in FY 2020 were found to be victims of physical or sexual abuse. But she is wrong when she implies that most neglect findings reflect parents who are too poor to provide adequate housing, clothing and food to their children. Many of the neglectful parents we have seen have serious, chronic mental illness or substance use disorders that impact their parenting, and they are unwilling or unable to comply with a treatment plan. Meanwhile, the children in their care are often left to fend for themselves because their parents cannot feed and dress them, change their diapers, or get them to school. Many children neglected in this way develop cognitive and social deficits, attachment disorders, and emotional regulation problems. Most poor parents do not neglect their children. Even with scarce resources, they find a way to provide safe and consistent care.

“Myth” No. 2: Homes are investigated only if children are at risk of harm. The purpose of an investigation is to determine whether children are at risk of harm. Professionals who work with children are trained to report concerns about possible maltreatment, not to investigate on their own. The system is not perfect. Some reports are too minor to meet the definition of maltreatment, or even maliciously motivated. A surprisingly large number of children are reported every year and only a minority of these reports are substantiated—but that does not mean they are not true. But to propose that investigations should take place only if it is first determined that children are at risk puts the cart before the horse and disregards the safety of children.

“Myth” No. 3: Foster children are usually placed with loving families. Roberts’ statement that large numbers of children are placed in some form of congregate care — group homes, residential treatment centers and psychiatric hospitals—is misleading. Only eight percent of children in foster care were in a group home or institution at the end of September, 2020, though the percentage is higher for older youth. The problem is the lack of quality therapeutic placements for children who have been so damaged by long histories of abuse and neglect that they cannot function in a family home. It is true that many children bounce from one foster home to another, but these are often youths with acute behavior problems that make it difficult for them to function in a home. Roberts also fails to mention that 34 percent of foster children were residing in the homes of relatives as of September 2020, and that they have more placement stability than children placed in non-kinship homes.

“Myth” No. 3: Foster children are usually placed with loving families. Roberts’ statement that large numbers of children are placed in some form of congregate care — group homes, residential treatment centers and psychiatric hospitals—is misleading. Only eight percent of children in foster care were in a group home or institution at the end of September, 2020, though the percentage is higher for older youth. The problem is the lack of quality therapeutic placements for children who have been so damaged by long histories of abuse and neglect that they cannot function in a family home. It is true that many children bounce from one foster home to another, but these are often youths with acute behavior problems that make it difficult for them to function in a home. Roberts also fails to mention that 34 percent of foster children were residing in the homes of relatives as of September 2020, and that they have more placement stability than children placed in non-kinship homes.

“Myth No. 4: Placing children in foster care improves their well-being.” Arguing that foster care is harmful is like arguing that treatment in a cancer ward increases the risk of dying of cancer. Foster youths are likely to have poor outcomes given their history of maltreatment, which foster care cannot erase. It is difficult to assess how foster care placement affects children, since we cannot do a controlled experiment in which some children are placed and a similar set of children are not. Roberts quotes only one study, from 2007, that shows harm from foster care—and that study included borderline cases only, leaving out children suffering severe and obvious maltreatment. She does not quote the same author’s brand-new paper, which finds both positive and negative effects for different contexts, subgroups, and study designs.

“Myth” No. 5: This system was founded after the case of Mary Ellen Wilson. This is an esoteric myth, as few people have heard of Wilson. Roberts is right that many histories trace the roots of today’s child welfare system to the case of that little girl. We appreciate Roberts’ clarifications but are not convinced of their significance. We believe other myths are much more relevant, such as that neglect is synonymous with poverty, or that all children are betteroff with their parents no matter how badly abused or neglected they are.

It is disappointing that the Post allowed Roberts to use this series to propagate new myths, rather than dispel old ones.

Marie Cohen is a former foster care social worker, current member of the District of Columbia Child Fatality Review Committee, and author of the blog, Child Welfare Monitor. You can findher review of Dorothy Roberts’ new book here. Marla Spindel is the Executive Director of DCKincare Alliance and a recipient of the 2020 Child Welfare League of America’s Champion for Children Award.

Torn apart: A skewed portrait of child welfare in America

In her 2009 book, Shattered Bonds: The Color of Child Welfare, Dorothy Roberts drew attention to the disproportional representation of Black children in foster care and child welfare in general and helped make “racial disproportionality” a buzzword in the child welfare world. In her new book, Torn Apart: How the Child Welfare System Destroys Black Families–And How Abolition Can Build a Safer World, Roberts revisits the issues addressed in Shattered Bonds and creates a new buzzword, renaming child welfare as the “family policing system.” Those who liked Shattered Bonds will likely love Torn Apart. But those who value accuracy in history or in data will find it to be sadly misguided, although it does make some valid points about flaws in the U.S. child welfare system.

Roberts starts with a horrific anecdote about a mother, Vanessa Peoples, who was doing everything right–she was married, going to nursing school, about to rent a townhouse and was even a cancer patient. But Peoples attracted the attention of both the police and child welfare and ended up hogtied and carted off to jail by police, placed on the child abuse registry, and subjected to months of monitoring by CPS after she lost sight of her toddler at a family picnic when a cousin was supposed to be watching him. But citing these extreme anecdotes as typical is very misleading. This particular story has been covered in numerous media outlets since it occurred in 2017 and continues to be cited regularly. One can counter every one of these horrific anecdotes with a story of a Black child who would have been saved if social workers had not believed and deferred to the parents. (See my commentary on the abuse homicides of Rashid Bryant and Julissia Batties, for example).

Roberts’ book restates many of the old myths that have been plaguing child welfare discussions as of late and that seem to have a life of their own, impervious to the facts. Perhaps the most common and pernicious is the myth that poverty is synonymous with neglect. Roberts embraces this misconception, suggesting that most neglect findings reflect parents who are too poor to provide adequate housing, clothing and food to their children. But parents who are found to have neglected their children typically have serious, chronic mental illness or substance use disorders that severely affect their parenting, and have refused or are unable to comply with a treatment plan. Many are chronically neglectful, resulting in children with cognitive and social deficits, attachment disorders, and emotional regulation problems. Commentator Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction…., which often lead to substance abuse as a method of self-medication.” Perhaps the strongest argument against the myth that poverty and neglect are one and the same is that most poor parents do not neglect their children.  They find a way to provide safe and consistent care, even without the resources they desperately need and deserve.

Roberts endorses another common myth–that children are worse off in foster care than they would be if they remained in their original homes. She argues that foster care is a “toxic state intervention that inflicts immediate and long-lasting damage on children, producing adverse outcomes for their health, education, income, housing, and relationships.” It is certainly true that foster youth tend to have bad outcomes in multiple domains, including education, health, mental health, education, housing and incarceration. But we also know that child abuse and neglect are associated with similar poor outcomes. Unfortunately, the research is not very helpful for resolving the question of whether these outcomes are caused by the original child maltreatment or by placement in foster care. We cannot, of course, ethically perform a controlled study in which we remove some children and leave a similar set of children at home. We must rely on studies that use various methodologies to disentangle these influences, but all of them have flaws. Roberts cites the study published in 2007 by Joseph Doyle, which compared children who were placed in foster care with children in similar situations who were not. Doyle found that children placed in foster care fared worse on every outcome than children who remained at home. But Doyle focused on marginal cases* and left out the children suffering the most severe and obvious maltreatment. In a brand-new paper, Doyle, along with Anthony Bald and other co-authors, states that both positive and negative effects have been found for different contexts, subgroups, and study designs.

There is one myth that Roberts does not endorse: the myth that disproportional representation of Black children in child welfare is due to racial bias in the child welfare system, rather than different levels of maltreatment in the two populations. After an extensive review of the debate on this issue, Roberts concludes that it focused on the wrong question. In her current opinion, it doesn’t matter if Black children are more likely to be taken into foster care because they are more often maltreated. “It isn’t enough,” she states, “to argue that Black children are in greater need of help. We should be asking why the government addresses their needs in such a violent way, (referring to the child removal). Roberts was clever to abandon the side that believes in bias rather than different need as the source of disparities. The evidence has become quite clear that Black-White disparities in maltreatment are sufficient to explain the disparity of their involvement in child welfare; for example Black children are three times as likely to die from abuse or neglect as White children. As Roberts suggests and as commentators widely agree, these disparities in abuse and neglect can be explained by the disparities in the rates of poverty and other maltreatment risk factors stemming from our country’s history of slavery and racism. Unfortunately, Roberts’ continued focus on these disparities in child welfare involvement will continue to be used by the many professionals who are working inside and outside child welfare systems all over the country to implement various bias reduction strategies, from implicit bias training to “blind removals.”

In Part III, entitled “Design,” Roberts attempts to trace the current child welfare system to the sale of enslaved children and a system of forced “apprenticeship” of formerly enslaved Black children under Jim Crow, whereby white planters seized custody of Black children from their parents as a source of forced labor.** As she puts it, “[t]hroughout its history US family policy has revolved around the racist belief that Black parents are unfit to raise their children. Beginning with chattel slavery and continuing through the Jim Crow, civil rights, and neoliberal eras, the white power structure has wielded this lie as a rationale to control Black communities, exploit Black labor, and quell Black rebellion by assaulting Black families.” In other passages she adds other groups to the list of victims, adding “Indigenous, immigrant and poor people to the list of communities that are being controlled by the “family policing system.” But most of her statements refer to Black victims only.

Roberts’ attempt to connect slavery and Jim Crow practices with child welfare systems highlights a major flaw of the book. She herself explains that due to racism the child welfare system served only White children when it emerged in the nineteenth century with the creation of child protection charities and the passage of state laws allowing maltreated children to be removed from their homes and placed in orphanages. Foster care was established in the middle of the century and also excluded Black children. The system did not begin serving Black children until after World War II, so it is difficult to understand how it could stem from slavery and Jim Crow practices. It seems much more plausible that the child welfare system arose from basically benevolent concerns about children being maltreated, and that with the rise of the civil rights movement, these concerns were eventually extended to Black children as well.

While Black children’s representation as a share of foster care and child welfare caseloads rose rapidly starting in the 1960’s, and Black children are much more likely to be touched by the system than White children, the system still involves more White than Black children. According to the latest figures, there were 175,870 White non-Hispanic children in foster care (or 44 percent of children in foster care) and 92,237 Black (non-Hispanic) children in foster care, or 23 percent of children in foster care. Moreover, the disparity between Black and White participation in child welfare and foster care as a percentage of the population seems to be decreasing.*** So the idea that this whole system exists to oppress the Black community and maintain white supremacy seems farfetched.

Roberts’ attempt to make Black children the focus of the book results in some awkward juxtapositions, like when she admits that though the Senate investigation of abuses by a for-profit foster care agency called MENTOR “highlighted cases involving white children, we should remember that Black children are more likely to experience these horrors in foster care—not only because Black children are thrown in foster care at higher rates, but also because government officials have historically cared less about their well-being.” A page later she states that the “child welfare system’s treatment of children in its custody is appalling but should come as no surprise. It is the predictable consequence of a system aimed at oppressing Black communities, not protecting Black children.” It is hard to understand how White children being maltreated in bad placements supports this narrative.

Fundamental to Roberts’ critique is her system is “not broken.” “Those in power have no interest in fundamentally changing a system that is benefiting them financially and politically, one that continues to serve their interests in disempowering Black communities, reinforcing a white supremacist power structure, and stifling calls for radical social change.” Even if one believes there is a white supremacist power structure, it is hard to see the direct connection between the abuses Roberts is highlighting and the disempowerment of Black communities; it seems more likely that the more abusive the system, the more protests it would generate. And at a time when the federal government and some of the wealthiest foundations and nongovernmental organizations are echoing much of Robert’s rhetoric, her reasoning seems particularly off-target.

Roberts makes some valid criticisms of the child welfare system. Her outrage at the terrible inadequacies of our foster care system is well-deserved. She is right that “The government should be able to show that foster care puts Black children [I’d say “all children”] on a different trajectory away from poverty, homelessness, juvenile detention, and prison and toward a brighter future.” Any society that removes children from their parents needs to be responsible for providing a nurturing environment that is much, much better than what they are removed from. And we are not doing that. As Roberts states, “The state forces children suffering from painful separations from their families into the hands of substitute caretakers…..who often have unstable connections, lack oversight and may be motivated strictly by the monetary rewards reaped from the arrangement.” As a foster care social worker in the District of Columbia, I was driven to despair at my inability to get my superiors to revoke the licenses of such foster parents; the need for “beds” was too great to exclude anyone was not actually guilty of abuse or severe neglect. Roberts is also right to be concerned the outsourcing of foster care to private for-profit organizations that may be more concerned with making money than protecting children, sometimes resulting in scandals like the one involving MENTOR Inc., which was found to hire unqualified foster parents and fail to remove them even after egregious violations like sexual assault.

Roberts also raises valid concerns about children being sent to residential facilities, often out of state, that resemble prisons rather than therapeutic facilities. But she ignores the need for more high-quality congregate care options for those children who have been so damaged by years of maltreatment that they cannot function in a foster home, no matter how nurturing. Instead, she repeats the usual litany of scandals involving deaths, injuries, fights and restraints, without noting the undersupply of truly therapeutic residential settings, resulting in children sleeping in office, cars, and hotels or remaining in hospital wards after they are ready for discharge. Ironically, she supports defunding the system, even if that would mean even worse situations for these children.

Roberts decries the fact that parents sometimes relinquish custody of their children in order to get needed residential care, arguing that “rather than providing mental health care directly to families, child welfare authorities require families to relinquish custody of children so they can be locked in residential treatment centers run by state and business partnerships.” That statement is completely backwards. The child welfare system does not provide mental health services but, like parents, it often struggles to secure them for its clients. Some parents are forced to turn to the child welfare system because their insurance will not pay for residential care for their children. That is not the fault of child welfare systems, which clearly do not want to take custody of these children. The underlying problem is the lack of adequate mental health care (including both outpatient and residential programs), which has destructive consequences for the foster care system. This is exacerbated by the lack of parity for mental health in health insurance programs. It’s hard to believe Robert is unaware of these well-known facts.

Roberts is correct that parents as well as children are shortchanged by inadequacies in our child welfare program, such as the “cookie cutter” service plans which often contain conflicting obligations that are difficult for struggling parents to meet. But she is wrong when she says that parents need only material support, not therapeutic services. But this error flows logically from her concept of neglect as simply a reflection of poverty. In fact, many of these parents need high-quality behavioral health services and drug treatment, which are often not available because of our nation’s mental health crisis, as well as the unwillingness of taxpayers and governments at all levels to adequately fund these services.

In her final chapter, Roberts concludes that, like the prison system, the child welfare system cannot be repaired because it exists to oppress Black people. “The only way to end the destruction caused by the child welfare system is to dismantle it while at the same time building a safer and more caring society that has no need to tear families apart.” In place of family policing, Roberts favors policies that improve children’s well-being, such as “a living wage and income support for parents, high-quality housing, nutrition, education, child care, health care; freedom from state and private violence; and a clean environment.” I agree with Roberts that aid to children must be expanded. The US is benighted when compared to many other Western countries that invest much more heavily in their children through income support, early childhood and K-12 education, healthcare, and housing. But family dysfunction occurs even if a family’s material needs are met. That is why every other developed nation has a child welfare system with the authority to investigate maltreatment allegations and assume custody of children when there are no other options. Moreover, some of the countries with the strongest safety nets for children also have higher percentages of children living in foster care than the United States.****

Torn Apart is a skewed portrait of the child welfare system. In it Roberts restates the common but easily discredited myths that poverty is synonymous with neglect and that foster care makes children worse off than they would have been if left at home. The underlying flaw in her account is the idea that this system exists to repress the Black community, even though it was established solely for the protection of White children. Roberts makes some valid criticisms of child welfare systems and how they shortchange the children and families they are supposed to help. But when she talks of dismantling child protection, she is proposing the abandonment of abused and neglected Black children in homes that are toxic to them, an abandonment that will perpetuate an intergenerational cycle of abuse and neglect. These children are our future; abandoning their well-being to prioritize that of their parents is a bad bargain with history.

*Doyle’s study included only those cases that would have resulted in foster placement by some investigators and not by others, leaving out the cases in which children were in such danger that all investigative social workers would agree that they should be placed.

**In various places, she also attributes it to different combinations of slavery and apprenticeship of Black children with the transfer of Native American children to boarding schools, the exclusion of Black children from charitable aid and the servitude of impoverished White children.

***A recent paper reports that disparities between Black and White children began to decrease in the twenty-first century in nearly every state, closing entirely in several Southern states.

****Unicef’s report, Children in Alternative Care, shows that Denmark has 982 children in “alternative care” per 100,000 and Sweden has 872 per 100,000, compared to 500 per 100,000 for the United States.