Report of Maltreatment: a major risk factor for child mortality

When I joined the District of Columbia’s Child Fatality Review Committee, I was expecting to review many deaths of children due to child abuse and neglect. Thankfully, that was not the case–or at least there were few cases that were clearly due to maltreatment. But over time I learned that the relationship between child maltreatment and child fatalities was more complicated. I was shocked to discover how many children who died of of natural causes, accident, homicide, or suicide came from families that had previously reported to Child Protective Services (CPS). There has been a spate of new research demonstrating that children who have been the subject of a child abuse or neglect report are more likely to die from many major causes than other children, even when confounding factors are controlled. This increasing body of evidence has major policy implications, including the need to intervene with high-risk infants at or before birth.

Many of the new studies come from California, where researchers linked prior CPS reports with birth and death records. The size of California, with its more than 10 million children, allowed the researchers to obtain statistically significant results despite the relative rarity of child fatalities. Moreover, the researchers could adjust for sociodemographic factors including birth payment method (public vs. private insurance), maternal age, maternal education, race and paternity establishment, birth order, child gender, and child health risk indicators (low birth weight and birth abnormalities). The researchers chose to focus on children with any maltreatment allegation, rather than only substantiated ones, because of the literature suggesting the difficulty of making an accurate finding of past maltreatment, as well as the absence of differences in subsequent outcomes between children with substantiated and unsubstantiated allegations.

In the first study using this approach, Emily Putnam-Hornstein of the University of California Berkeley sought to establish whether children reported for maltreatment were at higher risk of death by intentional and unintentional injury during their first five years of life. She linked CPS, birth and death records for over 4.3 million children born in California between 1999 and 2006. And what she found was striking: after adjusting for socioeconomic and other risk factors at birth, children with a prior report to CPS died of intentional injuries at a rate that was 5.9 times greater than children who were not reported. More surprisingly perhaps, these children died of unintentional injuries at a rate that was twice as high as that for unreported children. In total, children with a prior allegation of child abuse or neglect were fatally injured at a rate 2.5 times higher than children without a prior allegation. Putnam-Hornstein found that a prior report to CPS was the strongest independent risk factor for injury mortality in the first five years of life out of all the risk factors studied. The existence of more unintentional injuries among children with prior CPS reports may reflect the lack of age-appropriate supervision by parents, as Putnam-Hornstein suggests, given that these parents have already been the subject of CPS reports. But she also notes the probability that some of the injuries classified as unintentional may have actually been intentional injuries that were misclassified on death certificates.*

Putnam-Hornstein and colleagues, using the same dataset, also studied how the risk of fatal injury varies by the type of maltreatment allegation, adjusting for baseline risk factors. They found that children with a previous allegation of physical abuse died from injuries at a rate 1.7 times higher than children referred from neglect. Moreover, these children died from intentional injuries at a rate five times higher than children with an allegation of neglect. Yet, these children had a significantly lower risk of unintentional injuries than children with an allegation of neglect. They point out that these findings are consistent with the general conceptual understanding that abuse is an act of commission, while neglect is an act of omission.

In the next California birth cohort study to be published, Putnam-Hornstein and her colleagues sought to establish whether infants previously reported for maltreatment face a heightened risk of Sudden Unexpected Infant Death (SUID), a term that refers to children who die in the first 12 months of life with no immediately identifiable cause or explanation.** They started with the same dataset of all children born in California between 1999 and 2006 with corresponding CPS and death records through each child’s first birthday. Adjusting for risk factors at birth (including low birth weight and late or absent prenatal care), they found the rate of SUID was more than three times greater among infants who had been previously reported for past maltreatment than among infants who had not been reported. The authors suggest several possible explanations for this finding. The existence of a previous CPS report may indicate the presence of risk factors the researchers were not able to measure, such as maternal substance abuse, which has been found to be associated with SUID. In addition, families reported to CPS may be less likely to adhere to safe sleeping guidelines due to the stressors they face and the fact that they have not yet been reached or convinced by public health messaging around safe sleep practices.

To complement the first two studies, which focused on injury deaths and unexplained non-injury deaths, Schneiderman, Prindle and Putnam-Hornstein looked at non-injury, medically-caused deaths of infants in the first year of life. In this study, the researchers used records for the more than 3.4 million children born in California between 2010 and 2016. They found that after adjusting for baseline risk factors (including low birth-weight and preterm birth), infants with one CPS report were almost twice as likely to die of medical causes than infants with no CPS reports; infants with more than one CPS report were more than three times more likely to die of medical causes than those without a CPS report. The researchers also found that among infants reported for maltreatment, periods of foster care placement reduced the risk of death from medical causes by roughly half. The authors speculate that the higher risk of death from medical causes among infants in families with CPS reports is related to these families’ challenges around mental health, substance abuse, and extreme poverty, as well as their lack of social support. Medical neglect may also be more likely in these families given their CPS history. And unfortunately, as described by child welfare analyst Dee Wilson, there is a strong correlation between medical fragility and parental incapacity to care for a child, as parents with little or no prenatal care and those who abuse drugs are most likely to have babies with low birth weight and birth abnormalities. The protective effect of foster care suggests that many foster parents are better equipped to meet the medical needs of fragile infants than the families from which they have been removed.

But it is not just infants and young children previously reported to CPS who are more likely to die of non-maltreatment causes than their non-reported peers. In a newly published article, Palmer, Prindle and Putnam-Hornstein report on their study of CPS history and risk of suicide. Using linked birth, death and CPS records, they followed all children born in California in 1999 and 2000 and all death records through 2017. Using a “case-control design,” they matched each suicide case to four living controls based on demographic characteristics including sex, year of birth, maternal race and ethnicity, maternal age at birth, maternal education, and insurance type at birth. They found that over half (56.5 percent) of children who died by suicide had a history of past allegations of abuse or neglect, as compared to 30.4 percent of the control youth. Children with any CPS history were three times as likely to end their own lives than children without such a history. In a second study, they compared suicide victims with CPS involvement to a matched group of living adolescents with CPS involvement to determine if the nature of the allegation or the child welfare response affected suicide risk. In that study, they found that teens with one or more substantiated allegations were no more likely to die of suicide than teens with allegations that were not substantiated. Moreover, they found no difference in suicide risk between teens who were placed in foster care and those who were never removed from home. They did find increased odds of suicide among teens with more recent CPS reports, allegations of physical abuse, and allegations of sexual abuse.

As I stated in the top of this column, I have observed that many victims of homicide cases reviewed by the District of Columbia’s Child Fatality Review Committee had a history of CPS reports. Their families had long histories of calls to CPS alleging both abuse and neglect, with school absenteeism being one of the most frequent allegations. Eventually, these young people became involved in violent and illegal activities, ultimately leading to their deaths. There is some relevant evidence from an older study of Washington State children born between 1973 and 1986 who were reported to the state child abuse registry. Matching each reported child to three other children of the same sex, county of birth, and year of birth, the researchers found that children reported to the registry were almost 20 times more likely than the comparison population to die from homicide. These researchers were not able to to control for other variables that might affect homicide risk, including poverty and maternal education, so the differences may be exaggerated but are likely real.

The studies reviewed here show that children who are reported as possible victims of abuse and neglect are at risk for more than “just” further abuse and neglect, but for other bad outcomes, including a sudden infant death and for deaths due to injuries (intentional or unintentional), medical causes, suicide, and homicide. While different factors may come into play for different causes and manners of death, maltreatment allegations generally suggest parents who, even if not actually abusive or neglectful, are not well equipped to protect and nurture their children. As Putnam-Hornstein puts it in her article about injury deaths, these data confirm that “children reported for maltreatment have a truly distinctive risk profile defined by much more than just birth into poverty.”

The research described above suggests that youths who previously reported for abuse or neglect are more likely to die due to their own self-harming behaviors, not just directly through acts of commission or omission by their parents. This is not surprising, as a large body of research links child maltreatment and wide variety of adverse outcomes, including, diminished cognitive and executive function, poor mental and emotional health, attachment and social difficulties, post-traumatic stress, juvenile delinquency, and substance abuse. In a recent commentary, Dee Wilson describes specific pathways by which childhood abuse and neglect lead to early-onset mental health conditions, which in turn result in higher rates of suicide, substance abuse and lethal violence in adolescence and young adulthood.

The growing body of research linking child abuse reports with mortality from causes other than child maltreatment itself has important implications for policy. More intensive supports should be put in place for all children remaining at home after a CPS report, especially infants and young children, who are most vulnerable and whose development is most affected by maltreatment. Such intensive approaches could include supportive housing, residential drug treatment programs where children can stay with their mothers, and high-quality early care and education programs. Older children who are the subject of a report should receive a mental health assessment and access to activities and services that provide them with nurturing relationships and opportunities to develop talents and skills, as Dee Wilson describes in his commentary.

But while one can argue for more intensive services for children with substantiated allegations, the idea of mandating services when allegations are not substantiated is a non-starter at a time when the conversation is about restricting the role of CPS, not expanding it. But the research described above also lends support to the growing chorus of voices that is calling for putting more resources into programs that prevent the occurrence of child abuse and neglect, rather than responding to its occurrence. There is a growing interest in “targeted universal prevention programs,” like Hello Baby in Allegheny County Pennsylvania and Family Connects in North Carolina and Oregon, which reach out to all families but provide a more intensive intervention to the families of children who are most at risk of being abused or neglected. Family Connects has already shown some promising results, reducing CPS referrals and emergency room visits among infants receiving the intervention.

It is important to note that mortality is not the only outcome that matters. Because the definition of death is unambiguous, and death data are collected everywhere, death rates are a good way to calculate risk differentials between groups. But for every child who dies as a direct or indirect consequence of abuse or neglect, there are many more who are seriously disabled or injured or suffering from the kinds of adverse outcomes mentioned above, including poor mental and emotional health, juvenile delinquency, and substance abuse. We need a stronger response to reports of child maltreatment, whether or not they are substantiated or the child is placed in foster care. And we must intervene as early as possible to protect high-risk children, rather than waiting for them to be the subject of a child maltreatment report.

*It should be noted that evidence cited by Putnam-Hornstein shows that death certificates “severely” undercount the number of deaths due to child maltreatment and inflicted injuries, and it is likely that over half of fatalities due to maltreatment may be incorrectly classified as due to accidents, natural causes, or undetermined.

**Ultimately about half of these deaths are classified as caused by sudden infant death syndrome (SIDS), a term which connotes a death that remains unexplained following an in-depth investigation.

***Emily Putnam-Hornstein and colleagues found that in California, 82 percent of infants remained at home following their first CPS report. Of these infants remaining at home, only one in ten of their parents received services through an open case, and 60.7 percent were re-reported within five years. Those who did not receive services through an in-home case may have received community-based services but that information is not available.

The power of wishful thinking: the case of “race-blind removals” in child welfare

Wishful thinking is a very human pattern of thought that can even be functional at times. Thanks to wishful thinking, a placebo can actually cure an illness. Great ideas can gain support even if we don’t know they will succeed. But when wishful thinking is used to distort available data to support a given theory or policy, it becomes a problem. Such is the case with “race-blind” removals. The story of how this simple concept became viewed as a solution to the disproportional share of Black children in foster care, in relationship to their share of the general population, is a case study in the misuse of data to promote a particular viewpoint.

As reported in The Imprint and the Los Angeles Times, the Los Angeles Board of Supervisors has voted to support a project testing “race-blind removal” or “blind removal” of children into foster care. Blind removal was pioneered in Nassau County, New York in 2011 and “discovered” (as they describe it) by a team of researchers headed by Jessica Pryce of Florida State University, who were investigating the practices of two counties that were credited by New York’s Office of Child and Family Services (OCFS) with reducing racial disparities. Before the inception of blind removal, county investigative workers were presenting cases to a committee made up of supervisors, managers, and an attorney before a child could be removed and placed in foster care. Under blind removals, the members of this committee were no longer given information that might give a clue as to the race of the child and family. According to an email from a county official, the information that is withheld includes race, ethnicity, first and last names, addresses, the location of the reporter if that reflects the community where the child lives, and any other information (such as socioeconomic status or receipt of government benefits) that is not deemed to affect safety or risk.

Nassau County adopted the blind removal policy as a way to address its high rate of racial disproportionality in foster care, with Black children being much more likely to be removed and placed in foster care than White children. According to data provided by New York State, Black children were over 14 times more likely than White children to be placed in foster care in Nassau County in 2010. The blind removals policy is based on the belief that implicit racial biases affect the decision to remove a child and that removing this information from the process will remove the bias.

Unless there is strong evidence in support of such a program, one might worry about a practice that relies on people who know so little about a family. One might wonder if such a meeting is the best use of time for overburdened social workers and supervisors. Perhaps it would be better to make sure investigators have enough time to interview everyone who might be able to give them information about the family under consideration rather than burden them with another meeting. And what about emergency situations, where a child cannot be safely left in the home? An article in Children’s Bureau Express documents concerns from social workers who fear that blind removals would make it harder to do their jobs for these and other reasons. Another concern is whether race-blind removals might provide more of an opportunity for investigative workers to express any racial bias they have, since they control the information that is presented to the committee.

But if blind removal truly does cause a significant reduction in racial disparities, perhaps it is worth implementing despite the costs. And if one can believe a TED Talk by Jessica Pryce that has been viewed 1.3 million times, the practice has been spectacularly successful. According to Pryce, “In 2011 57 percent of the kids going into foster care were black, but after five years of blind removals, that is down to 21 percent.”  (At which point the audience broke into applause). Such a simple idea and such a huge impact! Casey Family Programs, the nation’s most influential child welfare funder, highlighted this program in an article on its website, stating without providing numbers that “within five years, the number of Black children removed from their families was reduced considerably, representing the most significant decrease in racial disproportionality within the county system ever.” New York State was so excited that it required all counties to develop a blind removal process effective October 14, 2020, offering a strikingly vague and yet broad description of what information must be kept from the committee: “all demographic and identifiable information (race, gender, language needs, zip code, etc. sic)).” Several other jurisdictions have expressed interest, including Los Angeles County, which is proceeding with its pilot.

Such a great result should be documented and the data made available to the public and researchers, preferably online, so it is surprising that Pryce was unwilling or unable to provide the source of the percentages at the heart of her popular talk. Instead, she referred me to the data team at Nassau County, who did not respond, nor did did the Commissioner’s Office. Nor was Casey Family Programs able or willing to provide the document referenced in their footnote to their statement about the program’s stellar results. Happily, I was able to obtain data from the New York State Office of Child and Family Services showing the percentage of children removed into foster care who were Black every year from 2009 to 2020. Those percentages are shown in Chart One.

Chart One

Source: Data provided by New York State Office of Children and Family Services

The first fact that emerges from the New York data is that Jessica Pryce’s percentages were not accurate. The 57 percent (56.7 percent) that she cites as the percentage of Black children removed in 2011 was actually the percentage of Black children removed in 2010. As for the 2016 data (the endpoint of the five-year-period cited by Pryce), 37.1 percent of the children removed in 2016 were Black, rather than 21 percent cited by Pryce–rather a large difference. There was a sharp increase in the Black share of children removed, from 45.2 percent in 2009 to 56.7 percent in 2010, the year before the program was implemented. With the implementation of blind removals, the percentage of children removed who were Black declined for two years to 45.5 percent in 2012, then rose for two years to 57.4 percent in 2014, fell to its all-time low of 37.1 percent in 2016, then rose to 49.7 percent in 2018, dipping slightly back to 45.1 percent in 2019, then popping back up to 49.5 percent in 2020–higher than it was in 2009 before the program was implemented. With such large fluctuations from year to year, as well as changes in direction, it is hard to imagine drawing any conclusions from the difference between any particular two years.

It is also important to note that the total number of children placed in foster care in Nassau County dropped precipitously from 429 in 2009 to 91 in 2020, as shown in Chart 2. This drastic drop in removals of Black and other children means that there was a lot more going on than the effort to make removals race-blind; cutting removals by three-quarters requires major changes in policy and/or practice. So it is hard to attribute any change with confidence to the race-blind policy. It also means that the numbers of children removed became smaller and smaller, resulting in a larger margin of error.

Chart Two

Source: Data provided by New York State Office of Children and Family Services

OCFS also provided data on Nassau County’s “Black Admissions Disparity Rate.” This rate, which New York State collects for all its counties, is defined as the “ratio of unique Black children admitted to foster care per 1000 Black children under 18 relative to comparable rate for White children.” According to OCFS, the disparity rate for foster care admissions went down from 14.30 (meaning Black children were 14 times more likely to be removed than White children) in 2010 to 12.60 in 2020. But it fluctuated to a surprising degree (between 24.4 and 6.16 between 2011 and 2019) that is not consistent with the percentages shown above and casts doubt on the correctness of the ratios provided. Assuming the 2020 ratio is correct, Nassau County currently has the highest disparity in foster care placement for Black children in the entire state. According to its ranking of counties based on this ratio, Nassau County was at the bottom in 2020 of all counties listed* with its disparity rate of 12.6, compared with 3.34 for the state as a whole. Hardly a role model for New York or the nation! Now this doesn’t mean we should blame Nassau County’s child welfare system for its abysmal disparity ranking. Other factors are probably behind that large disparity compared to other counties, such as the socioeconomic status of the Black and White populations in a given county. Which raises the question, how much can we expect blind removals to change racial disparities in foster care?

New York State recognizes the weaknesses of its data but focuses on the positive overall trend between 2010 and 2020. As John Craig of OCFS put it in his email to Child Welfare Monitor, “While Nassau County has seen fluctuations in the rate of Black children entering care over the past 10 years, overall, the trend has been very positive. OCFS commends Nassau County for recognizing the disproportionality of children of color in the child welfare system and implementing this innovative approach.” 

Despite OCFS’ valiant attempt to portray Nassau County’s data as “very positive,” the data do not provide a strong justification for expanding the program. While the Black percentage of children taken into foster care in 2020 was 49 percent compared to 57 percent in 2019, there were changes in both directions in the years between those two dates, and the 49 percent was actually higher than the Black percentage in 2009, two years before program implementation. There is reason to wonder whether New York, Los Angeles and others were really concerned about what the data showed. Instead, they may have proceeded in part based on the inherent logic of the approach, which addresses racial disparities directly in a way that is appealing to those who seek a relatively simple solution. Most importantly, they wanted it to work, so they decided that it did, regardless of the highly equivocal findings.

It would be wonderful if we had easy solutions to racial disparities in child welfare, but evidence suggests that higher reporting, investigation and removal rates among Black children stem from their greater needs, rather than bias among social workers. LA County would be better off studying how to make CPS decisions more accurate rather than imposing a cumbersome and unproven hurdle on social workers trying to protect endangered children.

* Certain counties were excluded because of very small number of Black children or Black children taken into foster care.

Child Neglect: a misused and misunderstood term

There is much confusion around child neglect. Opponents of the current child welfare system are fond of stating that most children reported to child protective services (CPS) are suffering from neglect, not abuse, that neglect is synonymous with poverty, and therefore that children are commonly being removed from home because of poverty. While neglect is clearly related to poverty, the facts suggest that the removal of children due to poverty alone is rare. To know more about this most common form of maltreatment, it is necessary to collect more specific data on the types of child neglect that are found when a neglect allegation is substantiated. Nevertheless, child welfare must recognize the important role of poverty in promoting child neglect and the role of poverty alleviation programs in child neglect prevention.

A useful way to distinguish between abuse and neglect of children is that abuse is generally an act of commission, while neglect is an act of omission. According to the Child Welfare Information Gateway, neglect is “commonly defined in state law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety and well-being are threatened with harm.” The most commonly recognized categories of neglect include physical neglect (failure to provide for basic physical needs), medical neglect, inadequate supervision, emotional neglect, and educational neglect. Some states include exemptions for certain types of neglect, like religious exemptions for medical neglect. Twelve states and the District of Columbia exclude financial ability to provide for a child from the definition of neglect.

How true are common statements about neglect?

A number of statements about neglect are are frequently made in support of various views and proposals. These are discussed below.

The national child welfare system was established to address abuse, not neglect. This is absolutely true. The discovery of “battered child syndrome” by Henry Kempe at the University of Colorado led to the passage of child protection laws in every state within a few years. On the federal level, the Child Abuse Prevention and Treatment Act (CAPTA), which established the federal role in supporting and monitoring these systems, was also focused on abuse rather than neglect. According to an oft-quoted book about the history of CAPTA, Democrats feared that President Nixon might veto CAPTA if it was viewed as an anti-poverty program, so they took pains to reiterate that child maltreatment could happen to anybody, regardless of socioeconomic status. As a result, the responses to child maltreatment focused on mental health and parent education services rather than economic supports. In his essay, Poverty, Neglect and Cultural Denial, child welfare commentator Dee Wilson recalls that when he began working as a CPS social worker in the 1970’s, all his training focused on battered children. Yet, in his work he encountered battered babies and toddlers maybe “once or twice annually out of 100 to 150 assigned cases.” Instead, he received both in Colorado and later in Washington “a steady diet of reports of child neglect and, to a lesser extent, reports of excessive punishment of children with minor injuries that did not require medical attention.” Academic literature has contributed to the problem by failing to distinguish between abuse and neglect.

Neglect is the main reason for children’s involvement with child welfare. This is also a true statement. According to the latest data collected from the states and published in Child Maltreatment 2019, three-quarters (74.9 percent) of the 656,000 children found to be victims of maltreatment in 2019, were found to be neglected, 17.5 percent were physically abused, 9.3 percent were sexually abused, and 6.8 percent were “other.” Some children were found to be victims of both neglect and another maltreatment type. These percentages should not be viewed as an exact representation of the relative importance of different types of maltreatment. As Font and Maguire-Jack point out, investigators do not have to substantiate every allegation to justify intervention. So If there is more than one type of maltreatment in the home, investigators may not substantiate all of the different types. Thus a child found to be a victim of neglect only may actually have suffered abuse as well. Comparison of substantiation data with other sources, as shown in Font and Maguire-Jack’s table listed below. suggests that “substantiations are likely to grossly understate all forms of child maltreatment, but especially physical abuse.” So neglect does appear to be more common than abuse as a reason for child welfare involvement, but abuse may be be present in a higher fraction of cases than the percentages indicate.

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

Child neglect is strongly related to poverty. This is also true. Research demonstrates that poverty is a major risk factor for child neglect. According to the most recent National Incidence Study of Child Abuse and Neglect, children in low socioeconomic status households experienced maltreatment at five times the rate of other children. Studies have also demonstrated that providing economic supports for families (through programs like tax credits, passing on child support, food assistance, and child care subsidies) have direct effects on child maltreatment. We do not know exactly how poverty affects child neglect but in an excellent article in a journal issue devoted to child maltreatment Feely et al provide a useful way to think about it. They posit that the inverse of neglect is what they call “safe and consistent care or SCC,” which they define as “to provide safe, consistent supervision and constantly provide for children’s basic needs.” As they describe, time and money are two core resources a family needs to provide SCC. For a poor parent, it may be very difficult to provide acceptable levels of time and money simultaneously. So a poor parent might have to choose between going to work and letting the children be unsupervised or inappropriately supervised, or losing their job and letting their children go hungry.

Most parents found to be neglectful are actually just poor. The confusion of poverty with neglect is a trope that is cited again and again by those who advocate restricting government intervention in maltreating families. For example, Jerry Millner and David Keller, the former Associate Commissioner of the Children’s Bureau and his special assistant, have written that It’s time to stop confusing poverty with neglect. They claim that many children become involved with child welfare only because their parents are poor. For example, children might be taken into care because a parent gets evicted or cannot afford childcare and leaves them alone. Despite the popularity of this belief, the evidence does not support it. It is clear that most poor parents do not neglect their children. They find a way to provide safe and consistent care, whether it means extensive research on community resources, creative use of existing supports, or delaying the next birth until adequate resources are available to care for the children they already have. Dee Wilson argues based on his decades of experience in child welfare that “a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction, beginning with mood disorders such as depression and PTSD,” which often lead to substance abuse as a method of self-medication.

The most serious cases of neglect are often chronic. Chronic child neglect can be defined as “a parent or caregiver’s ongoing, serious pattern of deprivation of a child’s basic physical, developmental and/or emotional needs for healthy growth and development.” Chronic neglect by a single mother often opens the door for physical or sexual abuse by her boyfriend. Children who have experienced chronic neglect may suffer “serious cognitive and social deficits because of the….lack of responsive parent-to-child interaction that is essential for healthy child development.” Chronic neglect can have effects similar to trauma, such as difficulties with emotion regulation.

Many child neglect reports are frivolous and unnecessary, cluttering up the system and making it harder to identify serious maltreatment. Many critics of mandatory reporting and CPS cite a study estimating that 37.4 percent of all U.S. children (and 53 percent of Black children) experience a CPS investigation by the age of 18. Some argue that many of these reports are the consequence of a racist system that ensnares too many poor and Black families. Some are supporting bills to end anonymous mandatory reporting in New York and Texas. Another, smaller set of reports has drawn attention, as described by Naomi Schaefer Riley in her article, Reforming Child Neglect Laws. These reports target stable, functional middle class families that have chosen to give their children more independence than many other parents in their geographic and demographic stratum. The case of the Meitiv children, who were picked up by police while walking a mile to their home in Silver Spring, Maryland and became the subject of not one but two CPS cases, drew publicity around the country.

It is clear that some reports coming into hotlines do not warrant investigation, but we do not know what proportion. Annual data submitted by states and compiled in the Child Maltreatment 2019 report shows that that 45.5 percent of referrals (for all kinds of maltreatment) in 2019 were screened out. And of all children receiving an investigation or alternative response, only 18.9 percent were found to be victims of maltreatment. However, research suggests that the likelihood of another report, a substantiated report, or a foster care placement is the same for a child who is the subject of a substantiated versus an unsubstantiated report. Chances are that many of the children with unsubstantiated reports were previously the subject of substantiated reports, or will be the subject of such reports later. Moreover, as Font and Maguire-Jack point out, “it seems unavoidable that some number of non-maltreated children will be reported to CPS if mandatory reporters are acting appropriately.” After all, they are told that they do not need to be sure the maltreatment is occurring, but to leave that decision to CPS. Changing that guidance, in my opinion, would be dangerous to children.

Should neglect be treated differently from abuse?

Even if neglect is not “just poverty,” some commentators argue that it should be treated differently from abuse. Two former directors of large child welfare systems, Tom Morton and Jess McDonald, argue that because child protective services were designed around abuse rather than neglect, they were patterned after the criminal justice system and treat all maltreatment as antisocial behavior. Morton and McDonald argue that because neglect is an act of omission rather than commission, it should be treated differently, The response to neglect should occur in a “public health framework” outside the current child protection system.

I do not agree that we need a separate system to deal with neglect. As I have discussed, many neglected children are also victims of abuse, whether or not it is substantiated by authorities, and neglect by one caregiver can pave the way for abuse by another. We already have a criminal justice system that addresses criminal abuse and neglect separately from the child welfare system. While the effect may seem punitive, the goal of CPS is to make children safe, not punish parents. Both abuse and neglect make a child unsafe, and the first mission of child welfare is to ensure child safety. Splitting this mission into two is probably not be the best way to promote children’s safety.

Even if we do not need a separate system to deal with neglect, we need to recognize the importance of anti-poverty strategies to help families provide safe and consistent care and prevent child neglect. Prevention has become a major priority of child welfare leaders and thinkers, so this is a good time to talk about incorporating poverty alleviation into child maltreatment prevention. In this new vision, as Feely et al propose and as I have discussed in an earlier post, child maltreatment (especially neglect) prevention should not be the responsibility of child welfare agencies alone. This responsibility should be shared by all the agencies responsible for alleviating poverty. The new initiatives proposed by the Biden Administration for child tax credits, universal pre-kindergarten and expanded child care assistance should be a good beginning.

Is it time to drop the term “neglect”?

In an article in The Imprint, Rebecca Masterson of Gen Justice argues correctly that the term “child neglect” has become almost meaningless because it is used so broadly and so deceptively as a symptom of poverty. Masterson argues that “neglect” needs to be replaced by more specific terms, such as abandonment or refusal of medical care. I do not agree that the term neglect should be dropped. Just as “child abuse” is an umbrella term that includes physical abuse, sexual abuse, and emotional abuse, “neglect” has value as an umbrella term that refers to acts of omission that harm children, in contrast to abuse, which is an act of commission. It makes sense to have these umbrella categories.

But the umbrella categories of “abuse” and “neglect” should not be put in the same list of categories as the specific acts (or lack thereof) underneath the umbrellas. Unfortunately, state and local data systems often list “neglect” as a category along with other more specific terms for types of neglect. This results in bizarre analyses where “neglect” is often described as the most common category of child maltreatment–more common than its subcategories–as if anything else is possible! Just as social workers do not have to check off “abuse” as well as “physical abuse,” in their agency database, they should not be asked to check off “neglect,” as well as specific types of neglect. In order to fix this problem everywhere, and to make sure we have comparable data from all states, the federal government should mandate that all states use the same subcategories of abuse and neglect, and that “abuse” and “neglect” not be among the specific categories.

In devising these alternative categories, we also must be careful to avoid confounding neglect with conditions that may cause it, such as substance abuse and mental illness. These are contributing factors that should be noted in databases and shared with the federal government but are not in themselves forms of neglect. And indeed, in some jurisdictions, like the District of Columbia, substance abuse is not considered neglect unless it is considered to impair parenting.

Child neglect is the most common form of child maltreatment, yet it received little attention in the first decades of the modern child welfare system. It took a long time for child welfare scholars and leaders to recognize the importance of neglect. Unfortunately now that they have recognized its importance, many leaders are using this new knowledge in order to support their proposals to upend child welfare in ways that may be harmful to neglected children. This misuse of the concept of neglect can be addressed by requiring that child welfare agencies collect uniform data on the types of neglect that are being found. That being said, it is important for child welfare leaders to understand the importance of poverty alleviation strategies in preventing maltreatment in general and to recognize that this job does not belong to the child welfare system.

What can happen when a child is left in an abusive home: the sad case of Lisa Montgomery

Lisa Montgomery: Mercury News.com

Many Americans recall the horrific case of Bobbie Joe Stinnett, who in 2004 was strangled to death, her belly sliced open, and her baby removed. There is no doubt that the perpetrator was Lisa Montgomery, who brought the baby home, announcing that she had given birth. What most of us don’t know about is the nightmarish childhood that led to Ms. Montgomery’s crime, and the extent to which family members and authorities knew of her suffering and did not take action.

On January 12, Lisa Montgomery is scheduled for execution–the first woman to be executed on federal death row for 70 years. In a hearbreaking op-ed published by the New York Times, writer Rachel Louise Snyder explains Lisa’s hellish upbringing and the multiple failures that allowed the torture to continue.

As Snyder describes, Lisa Montgomery was born to a family “rife with mental illness, including schizophrenia, bipolar disorder, and depression.” Lisa’s father left the family when she was a toddler. Her family moved once a year or more, spending time Washington, Kansas, Colorado, and Oklahoma. Lisa’s mother, Judy Shaughnessy, abused her “in extreme and sadistic ways,” according to interviews with nearly 450 family members, neighbors, lawyers, social workers, and teachers. She was forced to sit in a high chair for hours if she did not finish her food. Her mouth was covered with duct tape so frequently that she learned not to cry. According to her mother, her first words were: “Don’t spank me, it hurts.”

Lisa’s older half sister, Diane Mattingly, told Elle Magazine that Lisa’s mother hit them with brooms and belts. She forced Diane to eat raw onions until she cried and once stripped her naked and put her out of the house in freezing temperatures, telling her not to come back. She made nightly trips to a bar, leaving the girls with “babysitters” who raped Diane, whose “sole purpose in life” was to protect her little sister. At the age of eight, Lisa lost her sole protector when Diane was removed from this home and placed in foster care with a loving family. Diane reports that she vomited all the way to the foster home, knowing the fate that awaited four-year-old Lisa without her protection.

Lisa’s stepfather, Jack Kleiner, a “rampant alcoholic,” began to assault her sexually when she was about 13. He built a “shed-like room” next to the family’s trailer in Tulsa Oklahoma and kept her there. He brought friends over to rape her, “often for hours, often three at once.” As if that was not enough, Lisa’s mother began to prostitute her to pay household bills.

When she was 18, Lisa married her 25-year-old stepbrother, the son of her mother’s fourth husband, who also raped and abused her. By the age of 23 she had four young children (whom she in turn abused and neglected) and suffered from episodes of mania and psychosis. She eventually remarried. In the years before her crime, she repeatedly claimed to be pregnant and then to have lost the baby–despite the fact that she had been sterilized after the birth of her fourth child. One week before Christmas in 2004, Lisa Montgomery arrived at a meeting she had set up with a pregnant dog-breeder, Bobby Jo Stinnett, ostensibly to adopt a puppy. Instead, she took Stinnett’s life and left with her child.

Lisa Montgomery most likely suffered from fetal alcohol syndrome and by the time she was arrested for her crime she was diagnosed with bipolar disorder, temporal lobe epilepsy, complex post-traumatic stress disorder, dissociative disorder, psychosis, and traumatic brain injury. Scans of her brain showed damage and abnormal patterns in the areas responsible for regulating social and emotional behavior and memory, which can be affected by trauma. Her “Adverse Childhood Experiences” (ACES) score was 9 out of 10 and global functioning score showed “severe impairment in daily activities.”

Perhaps the most shocking information in Dr. Snyder’s article is the extent to which many people in authority knew of her abuse and did nothing.

  • Lisa’s older sister was sent to foster care due to abuse or neglect, but there was no help for Lisa. In any child welfare system, Lisa’s life should have been investigated as well. If she was not removed, her family should have at least been monitored. (Her sister says she was afraid to say anything to her foster parents, not wanting them to know of her history of rape and abuse for fear they would send her away. She has regretted this decision for all her life.).
  • An A student in elementary school, Lisa was placed in special needs classes in middle school. An administrator thought this academic deterioration might be due to “deep emotional trauma” but it appears that the school took no action to uncover or report the underlying cause.
  • As a teenager, Lisa told her cousin, a deputy sheriff in Kansas, about being raped by Kleiner and his friends. He told investigators that he knew she was telling the truth and still regrets taking no action.
  • When Lisa’s mother divorced Jack Kleiner, she forced Lisa to testify about the rapes for their divorce proceedings. The mother sat unmoved during Lisa’s testimony. A social worker found Lisa’s claims believable and turned the file over to the Tulsa County District Attorney’s Office, where no action was apparently taken.

It is difficult to understand how so many people in positions of authority knew about Lisa’s plight and did not interfere. The family’s repeated moves from state to state may have been part of the answer, as by the time a pattern was observed the family might have been gone. The events are too far in the past to determine who failed and why. But Lisa’s fate is a cautionary tale against ignoring any suspicion of child abuse.

Sadly, many child welfare leaders and advocates are currently recommending that state intervention in abusive and neglectful families be scaled back or even eliminated, just one more swing of the national pendulum on child welfare. There are concerns about the tendency for teachers and community members to over-report minor concerns that do not rise to the level of abuse. There are also criticisms that some systems are too quick to remove children from their homes instead of trying to help the parents take better care of their children. A new coalition calls for the elimination of “the forcible surveillance and separation of children from their parents.”

Lisa’s case tells us why we must not eliminate mandatory reporting of child abuse and neglect. If anything, we need to enhance training for mandatory reporters in order to increase the reporting of real maltreatment while reducing unnecessary reports. However, given the extreme costs of continuing abuse, it is better to tolerate some frivolous reports than to miss future Lisa Montgomerys.

Nor do we want to eliminate the forcible removal of children from their homes, as some child welfare critics propose. Rather, in the words of former child welfare administrator BJ Walker, systems must learn “to differentiate between the small fraction of parents who have neither the skill nor will to keep children safe [like Judy Shaughnessy], and those who have the capacity to learn, and overcome existing vulnerabilities and limitations.”

Lisa’s story is particularly timely now because abused children are more isolated than ever while school buildings in many places are closed due to COVID-19. Reports to child abuse hotlines dropped drastically around the nation as schools closed, but there is reason to believe that the job loss, deaths, and social isolation caused by COVID-19 have led to increases, not decreases, in child maltreatment. Who knows how many Lisas are suffering in silence now?

Studies have documented the relationship between child abuse and many of the adverse outcomes endured by Lisa Montgomery, including brain damage, diminished executive functioning and cognitive skills, poor mental and emotional health, post-traumatic stress, and adult criminality. Ending the suffering of children should be enough reason to require reporting and investigation of child maltreatment, the huge costs to society of severe child maltreatment provide another incentive to make sure severe maltreatment is found and stopped. If Lisa Montgomery could have been saved, Bobbie Joe would have been saved as well.

Note to my faithful readers: Please excuse the long gap in time since my last post. I’ve been busy working on my local blog, Child Welfare Monitor DC. That blog contains posts that are specific to the District of Columbia but may be of interest to observers of child welfare around the country. Please check it out and consider subscribing!

When school is safer than home: school closures, home schooling and child abuse

takoda collins house
Takoda Collins’ home: WDTN.com

Among the many frightening consequences of the coronavirus epidemic is one that has received little attention from the media. The loss of school as a safe place and school staff as a second set of eyes on children means an  increase in unreported child abuse and neglect. For home-schooled children, however, this vulnerability is the normal state of affairs.

School closures have a double-edged effect on child maltreatment. First, children are spending more hours with their parents without the respite that the school day affords to both.  Second, these children are isolated from teachers and other school staff who might have noticed bruises or other signs of trauma. According to the latest federal data, one-fifth of calls to child abuse hotlines come from school staff, making education personnel the largest single report source. School staff are such important reporters of suspected child maltreatment that reports to child abuse hotlines typically go down every summer and increase when students return to school. During the coronavirus epidemic, we have already learned of drastic reductions in calls to the child abuse hotline in Los Angeles, Connecticut and Georgia.

As we worry about the impact of school closings on both child abuse and its reporting, it is important to note that one population of children never benefits from the protective role of schools. About 1.8 million children, or 3.4 percent of the school-aged population, were homeschooled in America in 2012, the most recent year for which data are available. Clearly most of their parents are not abusive and want to provide the best education for their children, often at great personal sacrifice.

Nevertheless, for a small proportion of these children, homeschooling provides an opportunity for their abusive parents to prevent their abuse from being detected. The Coalition for Responsible Home Education has collected 456 cases of severe or fatal child abuse in homeschool settings. Many of the families had a history of past child abuse reports and child protective services (CPS) involvement. All too often, the homeschooling began after the closure of a CPS case.

Connecticut’s Office of the Child Advocate, in a stunning report, revealed that 36% of the students withdrawn from six districts to be homeschooled between 2013 and 2016 lived in families that had least one prior accepted report of child abuse or neglect. The majority of these families had multiple prior reports. In a landmark 2014 study of child torture cases by pediatricians from five medical centers, 29 percent of the school-aged children studied were not allowed to attend school while another 47 percent were removed from school under the pretext of homeschooling, typically after the closure of a CPS case.

From time to time, an egregious case of abuse of a homeschool child makes headlines and and leads to public calls for monitoring or regulation of homeschooling families. One tragic example was the death of ten-year-old Takoda Collins, in Dayton, Ohio on December 13, 2019. Takoda was tortured, raped and murdered by his father. School officials stated that school staff reported their concerns over Takoda’s safety 17 times over several years.  It was only days after the last report that Takoda’s father pulled him out of school under the pretence of homeschooling.

As Takoda’s art teacher told the Dayton Daily News, “I think his father just got tired of us calling him and calling Children Services because people had been calling for years.”  Now Dayton teachers are asking their legislators to require some scrutiny for children who are pulled out of school after they have been the subject of abuse reports.

Raylee Browning died on December 26, 2018 in West Virginia of sepsis after drinking from the toilet after being deprived of water for three days. When Raylee died, she had bruising, burns and lacerations and a torn rectum. She had been removed from school after multiple reports by school staff expressing their concerns about physical abuse and starvation.  H.B. 4440, sponsored by Del. Shawn Flaherty, would prevent parents from withdrawing a child from school to homeschool them when there is a pending child abuse or neglect investigation, and when a parent has been convicted of domestic violence or child abuse or neglect.

The Coalition for Responsible Home Education, an organization that works to protect homeschooled children from educational neglect and maltreatment, has three recommendations to protect home-schooled children from abuse:

  • Forbid homeschooling by parents who have been previously convicted of any offense that would disqualify them from teaching or volunteering in a public school. Only Pennsylvania currently has such a provision.
  • Flag at risk children–such as those with a history of child-abuse reports–for additional protections and supports.
  • Require that homeschooled students have contact with mandatory reporters once a  year.

Sadly, such laws are often proposed in the wake of egregious cases but fail in the legislature due to vociferous opposition from the homeschool lobby. In Ohio, the death by abuse of another homeschooled boy led to introduction of  Teddy’s Law, which would have required annual interviews of homeschooled children and their parents with social workers, checks to see if homeschool applicants had pending investigations, and delays or denials of permission to homeschool under some circumstances. The bill produced a national outcry from homeschool advocates, including death threats to the sponsors. After entire nation was rocked by the rescue of the 13 Turpin children in California from their imprisonment in a house of horrors that was registered as a home school, two bills to institute protections for homeschooled children failed as well. Similar attempts to protect children after deaths, near-deaths and egregious abuse of homeschooled children failed in Iowa and Kentucky and doubtless many other jurisdictions.

As described in the Washington Post Magazine, the Home School Legal Defense Association is one of Washington’s most effective lobbying groups  – and the current political climate  is in their favor. State homeschooling advocates are vocal as well. The Homeschool Legal Defense Fund is fighting Raylee’s Law and calls it “unconstitutional, un-American, and unnecessary.”

The school closures will eventually end, and we can only hope that the repercussions will not be dire for many children. When they do end, let us not forget those children who remain isolated even after COVID-19 is a bad memory. All children must be protected from maltreatment, even if their parents elect to school them at home.

 

The Murder of Thomas Valva: Corrections to my earlier post

Thomas ValvaA new report from Eyewitness News has cast doubt on my pieced-together account of the process by which Justyna Zubko-Valva lost custody of Thomas and her other sons. My initial account, relying on reports from other media outlets, suggested that a judge revoked the mother’s custody and gave it to the father in an arbitrary manner without seeking to evaluate either parent’s capability of raising the children. Based on the documents described by Eyewitness News, ot appears that this was not the case. I have updated my post to account for the new information, as described below.

My post initially relied on available media accounts in stating that Judge Hope Schwartz Zimmerman became fed up with Justyna Zubko-Valva for failing to follow two orders, including one to get her children evaluated. In fact, the court documents obtained by Eyewitness News state that the Zubko-Valva was refusing to follow an order that she herself be evaluated, unless the interview could be videotaped. The evaluator refused due to the “sensitive nature of the testing materials.”

Without a psychological evaluation of the mother, Judge Zimmerman stated that she was unable to bring the case to trial. She announced that she was awarding “temporary, temporary” custody to the father. The rationale for that decision is not explained in the quotes from Eyewitness News. Perhaps Judge Zimmerman thought that moving the children would induce Zubko-Valva to obtain the evaluation. Using the children as tools to induce parental compliance would be inappropriate in any case. In this case, the transfer of custody not only failed to achieve the judge’s goal but resulted in the death of one child, horrific abuse of another child, and potential lifelong damage to the two living children. The “temporary, temporary custody” ended up lasting for two years after Valva filed an abuse report against Zubko-Valva and Zubko-Valva later refused supervised visitation, as described below. Nevertheless, my statement the judge cavalierly transferred custody of the boys without evaluating the parents appears to have been wrong. Instead, she apparently transferred custody in order to obtain the evaluation she required

Of course Zubko-Valva could not know that her intransigence about the evaluation would lead to suffering, death and lifelong damage to her children. But there are other disturbing aspects of her behavior cited in the Eyewitness News account.  It appears that she did not see her children for two years, from January 2018 until Thomas’ death in January 2020. Eyewitness News stated that visits were cut off in January 2018 due to the abuse accusations against Ms. Zubko-Valva but that another judge, Joseph Lorintz, offered her visits starting in April 2018, when the charges were dismissed. Zubko-Valva reportedly refused to visit the children unless they were moved from Valva’s home–a request which the judge denied. In July 2019 the judge again offered her visits, but said the visits must be supervised because “I’m not going to allow you to see your children after a year and a half without some form of supervision in place.” Eyewitness News reports that Zubko-Valva refused to visit her children in a supervised setting. She reportedly refused the same offer in September, 2019, only four months before Thomas’ death. According to the transcripts cited by Eyewitness News, Judge Lorintz almost pleaded with Zubko-Valva, saying “You haven’t seen your children since January 14, 2018. It may only be a few times, but I need for them to be reintroduced to you.” The transcripts show the judge offering three more times to order visits, without receiving an answer from Zubko-Valva. She would never never again see her son Thomas alive. By refusing the opportunity to see her children, did she miss the chance to save Thomas? We will never know.

Unless the Eyewitness News account of the court transcripts is terribly wrong, it appears that Zubko-Valva was not acting in the best interests of her children when she refused the evaluation and the visits. Her refusal to visit her children is very hard to understand and very concerning as it relates to her current fitness as a parent to her two very damaged young sons. The courts and CPS have already failed these children catastrophically; it is hoped that their continued involvement will serve to protect these children and ensure that they receive the treatment and monitoring they need.

The difficulty of piecing events together based on incomplete press accounts illustrates the need for an independent children’s ombudsman to review such cases of systemic failure and release their reviews  (redacted as necessary) to the public. Only with such independent reviews can taxpayers understand how and why the system they paid for has failed. If I knew that such a review was forthcoming, I would not have even tried to come up with a credible narrative of this case without the court transcripts and CPS documents. The public should not have to rely on guesswork to find out how the system failed and what has to change.

 

 

 

 

Yet another child abandoned by another state: Two-year-old Jordan Belliveau dead at his mother’s hands in Florida

Juliet Warren (left) with her foster child, Jordan Belliveau. The 2-year-old toddler went missing for more than two days and was then found dead late Tuesday. His 21-year-old mother, Charisse Stinson, now faces a charge of first-degree murder in the death of her child. [Photo Courtesy the Warren Family]
Jordan Belliveau, Jr. with his foster mother: Tampa Bay Times
On September 4, 2018, the body of two-year-old Jordan Belliveau was found in a wooded area in Largo, Florida. Two days before, his mother Charisse Stinson told police she was assaulted by a stranger and that her son was missing when she recovered consciousness. She later admitted that she had fabricated this account and in fact had caused the injuries that caused Jordan’s death.

Jordan had been removed from his parents in October 2016 and reunited with Stinson in May 2018. At the time of his death, Jordan was under court-ordered “protective supervision” by a nonprofit agency under subcontract with the Florida Department of Children and Families (DCF). There was also an open investigation of allegations of ongoing domestic violence between Stinson and Jordan’s father, Jordan Belliveau, Sr. DCF convened a special review team to determine why Jordan killed despite being under supervision by the system that was supposed to protect him. The team’s report was issued earlier this month.

To understand the case, one must grasp the particularly fragmented nature of child welfare in Pinellas County, Florida, in which three crucial functions usually vested in one agency are split between three different agencies. The Sheriff’s Department handles child abuse investigations, a private agency called Directions for Living manages in-home service cases under contract with Eckerd Connects, which in turn has a contract with DCF, and the State Attorney’s Office represents DCF in court.

The first call concerning Jordan and his parents came in to the child abuse hotline on October 2016, when Jordan was three months old. Jordan and his parents were living in the home of his paternal grandmother, and the caller was concerned about drugs, gang activity and firearms in the home. The allegations were verified and an emergency hearing was called. Ms. Stinson was ordered to relocate immediately and was referred to a program providing housing and support services to young mothers. However, she  refused to cooperate with the program and was rejected. A second hearing was convened on the same day (November 1, 2016) and Jordan was placed in foster care. In order to get Jordan back, the parents had to comply with a case plan which required each of them to obtain stable housing and income, comply with a “biopsychosocial assessment,” and follow the recommendations of the assessment. Ms. Stinson was also required to obtain counseling.

In January 2017, Jordan was placed with the foster family that would keep him until he was returned to his mother 16 months later. It was in this home, as his foster mother reported in a heartbreaking statement after his death, Jordan learned to roll, crawl, walk and talk and flourished in a supportive community of church members, foster families, and Coast Guard families.

While Jordan was thriving in foster care, an escalating series of violent incidents was reported between his parents. Each parent was in turn arrested for violence against the other but each case was dropped because the other parent did not press charges. Despite these incidents, Ms. Stinson was granted unsupervised visits with her son starting June 18, 2017. During the first unsupervised visit, Ms. Stinson allowed Mr. Belliveau to attend despite the fact that his visits were still required to be supervised. At this visit, which took place at a Burger King, members of a rival gang arrived and a fight ensued. Holding Jordan in her arms, Ms. Stinson struck at a woman who was fighting with Mr.Belliveau. Attempting to hit back, the woman hit Jordan in the mouth, inflicting lacerations. This incident was reported to the child abuse hotline, along with allegations that Mr. Belliveau was selling cocaine and marijuana from their home and that both parents used these drugs. Both parents refused to be tested for drugs. The investigation concluded with a finding of inadequate supervision and failure to protect Jordan by both parents.

In the next court hearing on the family case, the magistrate in charge of the case was not informed that this was a gang-related incident, that Ms. Stinson was involved, or that Jordan was injured. There was no mention of the  need to screen both parents for drug use.

According to Florida statute, DCF was required to file a petition for termination of parental rights within 60 days of November 1, 2017, when Jordan had been in foster care for 12 months. Yet no such petition was filed. At the hearing on January 8, 2018, the court found “compelling reason not to consider termination” because Ms.  Stinson was “partially compliant” with her case plan tasks because she had completed an assessment and was wrongly reported to be in counseling.

During a court hearing on April 23, 2018, Ms. Stinson’s attorney reported that she had completed the counseling mandated by her case plan, but no documentation was provided. As a matter of fact, Ms. Stinson had been terminated from counseling for the second time a week before the hearing. The Guardian ad Litem (GAL appointed to represent Jordan’s interests in court) objected to reunification because there was no documentation that Stinson was going to counseling and it appears that the case management agency objected as well. Without requiring documentation,  Magistrate Jennifer Sue Paullin ordered reunification and gave all parties 20 days to object based on new information. No objection was filed.

The court order, obtained by the Tampa Bay Times, states: “No evidence was presented to show that the circumstances that caused the out-of-home placement have not been remedied to the extent that the return of the child to the mother’s care with an in-home safety plan … will not be detrimental to the child’s safety.”.

On April 25, 2018, in anticipation of Jordan’s return to Ms. Stinson, the latter was referred to an in-home reunification program that provided twice-weekly visits from a licensed clinician. Ms. Stinson missed three or her five scheduled visits prior to reunification, which went ahead as scheduled on May 21, 2018. She missed seven of 11 visits following reunification and was unsuccessfully discharged from the program due to failure to participate

In a court hearing on June 11, 2018,  the court granted reunification to Mr. Belliveau, allowing him to join the family. Ms. Stinson had already missed several appointments with the clinician but the case management agency and government attorney reported that both parents were compliant with services.

On July 14, 2018, police responded to the parents’ residence to find Ms. Stinson bleeding and bruised and reporting that she had been punched by Belliveau. Mr. Belliveau was arrested after threatening to kill Ms. Stinson and “a lot of ….cops.” The child abuse hotline was not notified of this incident until three weeks later, on August 4. Despite the escalating violence and threats, the ensuing investigation did not find Jordan to be in danger warranting removal, but it was still open at the time of Jordan’s death.

On August 17, 2018, the agency filed an amended case plan with the court, including domestic violence services for Belliveau (as a perpetrator) and Ms. Stinson (as a victim). On August 24, Ms. Stinson refused to allow the GAL into the house. The investigator contacted the case manager for the first time on August 29, more than three weeks after the investigation began. The case manager said she normally visited once a week but admitted that he sometimes had trouble  reaching Ms. Stinson. On August 31, the case manager completed a home visit and explained to the parents that they needed to participate in services in order to retain custody of Jordan. Less than 24 hours later, Ms. Stinson reported Jordan missing.

Charisse Stinson has been charged with first degree murder for hitting Jordan, causing him to hit his head and have a seizure. Police report she did not seek medical treatment immediately and Jordan died. She then allegedly dumped his body in a wooded area and lied to police about a stranger kidnapping him, resulting in an Amber Alert and days of searching before Jordan’s body was found.

The special review team made six findings about the system’s  failures to save Jordan:.

  1. The decision to reunify Jordan with his parents was apparently driven by the parents’ perceived compliance to case plan tasks rather than behavioral change. Case decisions were solely based on addressing the reasons Jordan came into care. which related to gang and drug activity in the home where he was living. Although other concerns came to light during the life of the case, like substance abuse, domestic violence and mental health issues among the parents, these factors were not added to the case plan or considered in the decision to reunify Jordan with his parents. Ms. Stinson herself requested anger management training during a meeting in 2016 but this was never included in her case plan or provided. Moreover the court was kept in the dark about many of these concerns. “On multiple occasions, Ms. Stinson provided false information to the court,” which the case management agency and government attorney did not correct.
  2. Following Jordan’s reunification with his parents, staff failed to follow policy and procedures to ensure child well-being, such as making weekly visits. Moreover, they did not notify the court or take any action based on the mother’s lack of compliance with post-reunification services.
  3. When a new report was made to CPS, the investigator “failed to identify the active …threats occurring within the household that were significant, immediate, and clearly observable.” These included: ongoing and escalating violence between the parents, the father’s threat to kill the mother, and his gang membership and access to weapons, among others. In a major understatement, the Special Review Team opined that “Given the circumstances, a modification of Justin’s placement should have been considered.”
  4. There was a “noted lack of communication and collaboration” between investigative staff located in the Sheriff’s Department and case management staff during the August 2018 child abuse investigation. The investigator did not talk to the case manager for over three weeks after opening the investigation.
  5. There was a failure of communication and collaboration between all of the different entities involved in the case. There was a “lack of diligence in conducting multidisciplinary staffings at critical junctures of the case.” Neither the case management agency nor the state attorney provided accurate information to counter the false information provided by the mother to the court. Unbelievably, the case manager attended court hearings with no information about the mother’s participation in counseling, which was provided by the same agency.
  6. Assessments of both parents failed to consider the history and information provided by the parents and resulted in treatment plans that were ineffective to address behavioral change.

The review team did a good job of isolating the specific system failures that occurred in Jordan’s case but was not as successful identifying the systemic problems behind these failures. In this writer’s opinion, three major systemic factors contributed to the failure to protect Jordan:

  1. Lack of coordination and communication between agencies. This was the factor emphasized by the review team, which suggested that this issue was limited to Pinellas County. State Senator Lauren Book castigated the team for for this implication, arguing in a statement that the issue of “siloed communication” goes beyond the county and even beyond child welfare itself, citing the errors that predated the shooting at Marjorie Stoneman Douglas High School.
  2. Inadequate funding of child welfare services, leading to high caseloads and staff turnover.  The review team gave an offhand mention to the difficulty caused by high caseloads and turnover, both of which can be traced to inadequate funding but treated it as a given, rather than a problem to be rectified.
  3. The overemphasis on family reunification. In Florida and around the country, family reunification has been emphasized to the degree that children are often placed at risk. The Tampa Bay Times highlighted this  problem in its editorial entitled, Another child dead, another state failure. The death of a child following reunification is not a new story in Florida or around the country. If Florida law had been followed, Jordan’s parents’ rights should have been terminated before he was ever returned to them. A case manager who left Directions for Living shortly before Justin’s death told Florida’s News Channel 8 that the system “puts far too much weight on reuniting kids with unfit parents and makes it nearly impossible for caseworkers to terminate parental rights.” When asked why workers did not remove Jordan, she replied, “We are on quotas and we are told, ‘If there is any way to keep this kid in home do it.”

What is to be done to prevent future deaths like Jordan’s? It must begin, as the Tampa Bay Times editorial board asserts, with holding those involved accountable. This applies particularly to the magistrate on the case, who should have given the child rather than the parents the benefit of the doubt and held up reunification until she heard from the mother’s counselor. Second, child welfare must be funded adequately so that its staff are well-qualified and able to devote the time to handle cases correctly. Third, the silos must be broken down through improved policies and procedures that mandate data sharing and collaboration, but only adequate funding to enable reasonable caseloads will allow this to happen.

Finally, Florida and other states must rectify the balance between a child’s safety and the value of family reunification. Agencies must recognize that some parents who are suffering from the consequences of intergenerational trauma and dysfunction cannot change–at least within a timeline that is appropriate for a developing child.  This decision must be made early, with the input of qualified staff, high-quality evaluations, and laws and policies that put the child first.

As Justin’s foster parents put it, “Ultimately, we hope that our painful loss will result (in) a fundamental re-examination of the entire system, of how foster care works, of the reunification process. Jordan deserves that, and the other children in the system deserve that.”

Charisse Stinson is awaiting trial on charges of first degree murder and lying to police. She gave birth to another child in December and Belliveau has been determined to be the father. Both parents have filed court documents requesting the child be handed over to Belliveau, who has been arrested twice since Jordan’s death.

 

 

 

 

Why America needs an Interstate Child Abuse and Neglect Registry

HeavenWatkinsOn May 18, 2018, a little girl named Heaven Watkins was found brutally beaten to death in her  home in Norfolk Virginia. Three months earlier, Heaven was hospitalized with third-degree burns that kept her in the hospital for six days and required skin grafts. Child Protective Services in Norfolk was reportedly called but they decided not to intervene to protect Heaven.

Investigations from KARE 11 in Minneapolis and 13News Now in Norfolk revealed that Heaven  was removed from her parents four years before in Minnesota due to concerns about physical punishment, sexual abuse, drug sales and guns in the home. Virginia DSS has refused to tell reporters whether its workers knew of the family’s history in Minnesota. The haunting question is whether Virginia would have done more to protect Heaven had they known of her history in Minnesota.

Heaven was not the only child in the care of a parent who was known to Child Protective Services in another state. A 2012 report by The Oregonian  discussed several other children who died of abuse after investigation that did not unearth their family history in other states. Heaven’s story has triggered renewed calls for an interstate registry of child abuse and neglect. Had a registry existed, Virginia would have known the troubled history of this family and might have opted at least to provide supervision if not to remove the children.

The establishment of an interstate registry of child abuse and neglect was actually mandated more than a decade ago by the same legislation that mandated the national registry of sex offenders. Section 633 of the Adam Walsh Child Safety and Protection Act of 2006 required the Secretary of Health and Human Services to create a national registry of substantiated cases of child abuse and neglect. Yet this registry was never created.

Congress never appropriated funds to establish the registry but it did designate funds for a feasibility study that was also mandated under the act. A Research Report on the feasibility study and a report to Congress based on the results were published in 2012–six years after passage of the Act. The conclusions of the report were somewhat discouraging as to the potential benefits of a national registry. But interestingly, the underlying research reports had a much more positive view of the feasibility and potential benefits of the registry.

In the report to Congress, HHS  emphasized the barriers to developing a functional registry. These include the Adam Walsh Act’s prohibition on including any information other than the perpetrator’s name, the need for stronger due process requirements in some states if the database were to be used for employment checks (which is not the purpose envisioned by the statute), the need to provide funding or other incentives for states to participate, and the need for legislative changes in many or most states. These are serious barriers indeed but could be addressed, albeit with new legislation and funding that would not be trivial to obtain.

Unlike HHS, the authors of the feasibility study addressed the barriers but gave first billing to the conditions that allow for the development of a registry. In the final paragraph of the research report states that “The foundations for a national registry already exist in the child protective services field given that nearly all States maintain the necessary data on child abuse and neglect perpetrators. The technical capacity of the States also supports the feasibility of a national registry.” The authors go on to discuss the barriers, but give first billing to the conditions that support the registry.

In its report to Congress, HHS concluded that even if the barriers to an interstate registry could be resolved, the registry would provided limited information “beyond what is already available from existing single state registries” and therefore “the added safety benefit of a national registry of child maltreatment perpetrators would be quite limited.” HHS concluded that a decision on whether to implement the registry should “consider whether this or alternative child safety investments would be most effective in promoting the well-being of vulnerable children.” The clear implication was that alternative investments would be advisable.

HHS drew its conclusion about the limited safety benefit of a registry from the prevalence study mentioned above. The researchers used the numbers of perpetrators with incidents in more than one state to estimate how many interstate perpetrators would be identified by a registry.  Using information from 22 states with about 54% of the U.S. population, the researchers estimated that 7,852 perpetrators of child maltreatment in 2009 (or 1.5% of all substantiated perpetrators) had any substantiated maltreatment incidents in another state within the preceding five years.

HHS  described 7,852 as a small number, and therefore concluded that there was  “no evidence of a widespread phenomenon of child maltreatment perpetrators who offend in multiple states.” Moreover, HHS added that most of these perpetrators had “a single additional substantiation for child neglect (rather than for physical or sexual abuse) in a single additional state.” Moreover,  just half of one percent of child maltreatment deaths in states participating in the study was attributed to a perpetrator who had a substantiated maltreatment report in another state (4 in total).”

HHS’ interpretations suggest a low valuation of children’s lives and freedom from suffering. Almost 8,000 interstate perpetrators in a year could be considered a large number, even if most of them were substantiated for neglect and not abuse. The downplaying of neglect is a common trope among critics of CPS intervention, but neglect can be equally dangerous and often coexists with abuse that may not be substantiated.  “Just” four deaths in one year is a hard description to stomach while wondering if even one of these deaths could have been prevented with an interstate registry. Moreover, each death implies an unknown but larger number of injuries, and even more children living in pain and fear.

While dismissing the prevalence study’s estimates as “small,” HHS failed to mention the conclusion in a separate report on the prevalence study that the number of positive matches from states’ use of a fully functioning national registry would be much larger than the estimates above would indicate. That’s because the registry would be most commonly used during an investigation before a substantiation decision has been made, and the investigators would be  looking for a substantiation in just one state. Therefore, the researchers concluded that the registry would likely yield “several times the number of matches” that the study found for interstate predators.

HHS also downplayed the benefits found by the Key Informants Survey–the other part of the feasibility study. Of the 36 states participating in the Key Informants Survey, 25 states said participating in a national registry would save time, and 22 states thought it would “provide more timely knowledge that would be useful in assessing child safety.”  The authors of the research report concluded that “There appears to be significant interest in a national registry, primarily because States already have to inquire about possible prior perpetrator status from multiple States.” In the report to Congress, on the other hand, HHS did not report that there was significant interest by states’ in a registry. Instead, the agency reported that survey results indicated that the primary benefit of the registry would be to save time, and then cautioned that this time-saving benefit might not occur.

Similar to the key respondents, the authors of the feasibility study concluded that an interstate registry might be most useful in saving staff time and resources “resulting from the speed and efficiency of making all interstate inquiries, the vast majority of which will not find a match.” The authors added that this could enhance child safety due to faster processing of maltreatment cases. This conclusion was not included in the report to Congress.

Of course an interstate registry could not be produced quickly or on the cheap. Creating and activating it would be a multiyear effort that would have to begin with the amending of the authorizing legislation to include at least sex and date of birth in addition to perpetrator’s name. Many states would need to change their legislation as well in order to eliminate statutory barriers to participation. As the authors of the feasibility study indicated, convincing a “critical mass of states” to participate quickly might require incentives, such as funds to offset costs for initiating a registry. Clearly, an infusion of federal funds for this purpose would be a necessary incentive.  Perhaps Congress could make participation in the registry mandatory in order to receive federal child welfare funds under CAPTA or better still the Social Security Act.

It is concerning that HHS under the last Administration produced such a distorted view of the Congressionally-mandated feasibility study of an interstate child abuse and neglect registry.  It is my hope that this issue can be revived in the current Congress, perhaps as part of the reauthorization of CAPTA. Our children deserve no less.

 

 

Why No One Saved Gabriel Fernandez

Gabriel Fernandez
Image: LATimes.com

On September 13, 2018, a Los Angeles County judge denied a motion to dismiss felony child abuse and falsification of records charges against four former child welfare caseworkers in the 2013 death of eight-year-old Gabriel Fernandez.  The charges, filed in 2016, marked the first time Los Angeles caseworkers were criminally charged for misconduct connected with their work, and is one of only a few similar cases nationwide.

If Gabriel’s case is one of the few child deaths to result in prosecution of state workers, the egregious nature of the state’s failure explains why. A brilliant article by investigative reporter Garret Therolf shows that for seventh months, evidence of Gabriel’s abuse steadily accumulated. Yet again and again, the Los Angeles Department of Child and Family Services (DCFS) failed to intervene. Some of the worst errors are listed below.

  • Gabriel’s mother had been the subject of at least four calls to the child abuse hotline, had abandoned one child, and had lost custody of a son a year older than Gabriel. Yet, this record was never reviewed by workers investigating multiple reports of suspicious injuries to Gabriel.
  • Each time investigators came to the home, they interviewed Gabriel and his siblings with his mother in the room, against agency policy and common sense. And each time they did so, he recanted his previous statements. Even after he came to school with his face full of bruises from being shot by his mother with a BB gun, he recanted and told the investigator the injuries were from playing tag with his siblings. In the face of visible evidence, the investigators repeatedly chose to believe the repeated recantations
  • Investigators never spoke with neighbors or school personnel (other than the teacher who reported the abuse) but according to Therolf the abuse was known widely among school staff.
  • A computer program had found Gabriel to be at “very high risk” of abuse, requiring that the case be “promoted,” usually involving asking a court to require services or foster care. But the investigator, backed up by her supervisor, referred Gabriel’s mother to voluntary family services. Gabriel’s mother Pearl Fernandez withdrew from these services after three visits.
  • During the brief period of voluntary services, Gabriel wrote several notes saying he wanted to kill himself. Gabriel’s therapist informed the caseworker and supervisor, but they took no action.
  • The therapist had grown concerned that Gabriel was being abused, but her supervisor told her not to call the hotline so as not to jeopardize the mother’s participation in the voluntary case.
  • After three visits, Pearl Fernandez asked for her voluntary case to be closed. The caseworker accepted her decision, stating that there were no safety or risk factors for the children. Contrary to policy, her supervisor signed off on the case closure without reading the file.
  • After the case was closed, a security guard at the welfare office saw Gabriel covered with cigarette burns and other marks and being yelled at by his mother. The called DCFS twice and got lost in the automated system. The 911 operator gave him the non emergency line, which he called. He was later told that a sheriff’s deputy had gone to the home and seen nothing wrong.
  • Gabriel’s teacher, who had lost hope of any rescue from DCFS, called the DCFS investigator one more time late in April when Gabriel showed up looking worse than she had ever seen him. One eye was blood-red, skin was peeling off his forehead, and other marks were on his face, neck and ear. Her call was never returned. Gabriel had only about a month left to live.

Investigators later learned that during the weeks before his death, Gabriel  was spending days and nights locked in a cabinet with a sock in his mouth, hands tied, a bandanna over his face, and handcuffs on his ankles. His solitude was interrupted by vicious beatings and torture sessions in which his siblings were required to participate. On May 22, Pearl and Aguirre tortured Gabriel a final time with a BB gun, pepper spray, coat hangers and a baseball bat. When they finally called 911, paramedics found two skull fractures, broken ribs, several teeth knocked out, BB gun pellet marks, cigarette burns on his feet and genitals, a skinned neck, and cat feces in his throat.

Therolf poses a key question regarding Gabriel’s death: “Was [the] failure …to protect Gabriel an isolated one—the fault of four employees so careless and neglectful that they allowed a child to suffer despite a series of glaring warning signs? Or was it a systemic one, the result of a department so ill-equipped to safeguard children that tragedies were bound to happen?”

While Therolf does not actually answer the question, his report offers a number of key findings and insights that point strongly in the direction of systemic factors as the prime contributors to the failure to protect Gabriel. Therolf found that many of the errors made by investigators, such as failure to interview children alone or to speak with witnesses outside the family, were prevalent in Los Angeles County. Sadly, many of the same failures were evident in the very recent case of Anthony Avalos, also in Los Angeles. And we also see similar failures , and in cases around the country, including Kansas, New York, and Oregon.

The systemic factors that cause these failures fall into two major categories–resource constraints and ideological factors.

Resource Constraints

Child welfare involves a balancing act between too much intervention  or “erring on the side of child safety” as Therolf puts it and too little or “erring on the side of family preservation.”  Striking this critical balance requires a combination of  knowledge, skill, and time. In other words, as Therolf puts it, “it requires a highly trained workforce with the resources to carry out a thorough investigation in every case.” Therolf rightly contends that most agencies don’t have these resources. One has only to read the constant stream of news reports of overwhelming caseloads and poor training of child welfare workers around the country. All of this reflects the unwillingness of taxpayers and legislatures to provide what is needed to protect children. Inadequate funds mean caseloads are too high and salaries are too low, both resulting in low standards for caseworkers.

More funding and could buy both lower caseloads and higher salaries, which are necessary to obtain more qualified investigative workers. After reading so many similar stories, and recalling my own rudimentary training as a Child Protective Services (CPS) worker I am beginning to think that ultimately CPS Investigation should be a specialty in Masters in Social Work Programs. Students would learn advanced interviewing skills and how to assess the truthfulness of children and adults rather than, for example, believing children when they recant allegations with their parents in the room.  Alternatively, CPS Investigations could be folded into the growing field of Forensic Social Work. In any case, a Masters-level specialization could be required in order to be a CPS worker, also adding a needed level of prestige to an important, difficult and hard-to-fill  job.

Ideological Constraints

Inadequate resources might result in a random distribution of agency errors between those that involve too much intervention and those that involve too little. But the dominance of a particular ideology may skew the errors in one direction or another. And Garrett Therolf alludes to the rise of an ideology prioritizing family preservation nationwide and particularly in California during the years preceding Gabriel’s death. This ideology contributed to the decline in foster care numbers around the nation and particularly in Los Angeles, where Therolf reports the number of children in foster care fell from about 50,000 in 1998 to 19,000 in 2013. Much of this decline occurred during the tenure of DCFS administrator David Sanders, who later went on to lead Casey Family Programs, a foundation worth over two billion that has played an outsize role in national child welfare policy. The same year that Sanders took over at Casey, it declared a new goal to reduce the number of children in foster care by half by 2020.

Therolf was right to point a finger at Casey Family Programs. In my post about the death of two children by child abuse in Kansas, I wrote about how Casey leverages its massive wealth to affect policy directly, bypassing the voting public. It provides financial and technical assistance to state and local agencies, conducts research, develops publications, and provides testimony to promote its views to public officials around the country. Through its wealth in an underfunded field, Casey has been able to directly influence policy at the federal, state, and local levels.

Therolf points out that opinions on child welfare often cut across traditional political groupings. While Casey tends to support progressive causes, its emphasis on family preservation is often shared by conservatives who desire to reduce the government’s incursions on parental authority and at the same time to reduce spending. Working together, Casey and the George W.  Bush administration created a waiver policy that allowed child welfare agencies to direct unused foster care funds toward family preservation services–a policy change which created an incentive to reduce the use of foster care. Therolf links this incentive to the drastic decline in the Los Angeles County foster care rolls between 1998 and 2013, stating that “When Gabriel came to the attention of DCFS, the chances of an abused child being placed in foster care were “lower than they’d been in many years.”

Perhaps all of the factors that led up to Gabriel’s death can be summed up by a striking statement by the supervisor on Gabriel’s case, who is currently standing trial in Gabriel’s death. He told Therolf that he had  “concluded long ago that some of the children who depended on the department would inevitably be injured, if not killed.” He expressed frustration that administration and the public expected him to prevent all such deaths. This is not an acceptable attitude. It is true that a child welfare agency cannot prevent deaths among children who are unknown to the agency. But to expect that children will die under the agency’s watch–that is a low expectation indeed. We must do better by our most vulnerable children.

No, family separations are not all the same

child protectionThere is an old political adage that you should “never let a crisis go to waste,” meaning that a crisis can awaken public interest and create an opportunity to advance policies that might otherwise be unachievable.

President Franklin D. Roosevelt, for instance, was able to pass much of his New Deal – including a dramatic expansion of the country’s social safety net via the Social Security Act – in the wake of the Great Depression with the American economy in shambles and the American public desperate for government support.

Unfortunately, in a cruel twist of irony, some child advocates are now using the devastation wrought by the Trump administration’s separation of children from their parents at the U.S.-Mexico border to advance arguments undermining a key part of the Social Security Act – support for children who cannot be cared for in their own homes.

Several weeks ago, Sherry Lachman, the executive director of Foster America, authored a Time essay suggesting “family separation is not just a problem at the border.” In this piece, Lachman bizarrely equates the separations at the border with removals of U.S. children from their homes by child protective services, suggesting even the latter are “inherently toxic.”

And last week, Vivek Sankaran associated the two systems, misleadingly citing statements in an opinion piece that were made about the border separations to attack child removals by child protective services – without disclosing that these statements actually referred to the latter rather than the former. Sankaran quotes Dr. Charles Nelson, professor of pediatrics at Harvard, as follows: “[T]here is so much research on [child removal] that if people paid attention at all to the science, they would never do this.”

Finding it hard to believe that a distinguished Harvard professor would suggest that children should never be removed into foster care, we contacted Dr. Nelson, who explained that his words were taken out of context, as he was referring to separations at the U.S.-Mexico border and not the removal of children from abusive or neglectful homes. Dr. Nelson agreed that any comparison of the two systems is misconceived, noting: “It is inappropriate to compare children experiencing forced separations from their parents in the context of migration to children removed from parental care due to maltreatment (abuse, neglect).

The separation of children from their parents at the U.S.-Mexico border was an ill-conceived policy that arose from the desire to discourage migration. Rather than being aimed at protecting children, this policy was adopted despite the obvious fact that it would be extremely harmful to them.

The child welfare system, on the other hand, was created to protect children from harm inflicted by their own parents or guardians. It is a sad fact that some homes are dangerous to their own children. Forty-nine states reported 1,700 child fatalities due to abuse or neglect in 2016, and there is wide consensus that this is likely an under count. We don’t know how many more are severely injured but survive; it is doubtless much higher.

And deaths and severe injuries are only the tip of the iceberg. There is extensive literature on the lifelong consequences of child abuse and neglect. These include chronic health conditions, impaired brain development, poor mental and emotional health, social difficulties, juvenile delinquency and adult criminality, alcohol and drug abuse, and an increased likelihood of abusing one’s own children.

Moreover, foster care is a rarely-used intervention by CPS. Most systems try hard to keep children at home by providing services to the parents to help remedy the conditions that caused the maltreatment. In 2016, according to federal data, agencies placed slightly over 200,000 children involved in maltreatment investigations in foster care and provided other post-investigation services to about 1.1 million children and families.

Yes, removing children from their parents is often traumatic to the child. But it goes without saying that in some terrible home situations, the damage to a child of staying in the current home would be greater than the damage caused by removal.

As Dr. Nelson puts it:

Of course we would like to see the biological parents be successful in changing the family dynamics and preserving the parent-child relationship but if that is impossible, and the harms to the child continue, then the child should be removed from the home, either temporarily, if the home situation can be remedied, or permanently.

But, it is of utmost importance to act with alacrity – I think in many cases children are left for far too long in their biological homes and by the time they are placed into foster care or adoptive care, they may be irreparably harmed.

Setting aside the vastly different reasons for, and targets of, family separations at the border and child removals by child protective services, there are huge differences between the two sets of policies. Cathy Senderling-McDonald recently wrote an instructive and comprehensive summary of the distinctions, outlining the vast differences in living conditions, objectives, legal structure and oversight.

Using the suffering of parents and children at the border to denigrate foster care is not merely an illogical comparison, it is a harmful one that can result in suffering, lifelong damage, and even death to children. Moreover, it is offensive to those professionals who have devoted their lives to protecting children, and to the children who have suffered and died for lack of such protection.

Let us be clear: we want to prevent children from being removed from their parents whenever it is safe and appropriate to do so.

But let us be equally clear: until we eliminate serious child maltreatment and endangerment from every home, there will always be a need for foster care to keep kids safe. To pretend otherwise is naïve, dangerous and irresponsible.

This op-ed was published in the Chronicle of Social Change on September 6, 2018. I wrote it with Sean Hughes, the director of government relations for the consulting firm Social Change Partners.