Did child maltreatment fall under COVID-19?

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

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

Child maltreatment referrals

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

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

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

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

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

Emergency room visits for suspected maltreatment

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

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

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

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

Child Fatalities

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

Teen Self-Reports of Abuse

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

Trends in Domestic Violence

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

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

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

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

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

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

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

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

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

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

Source: UAlberta.ca

by Marie Cohen and Marla Spindel

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

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

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

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

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

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

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

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

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

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

Torn apart: A skewed portrait of child welfare in America

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New data show drop in foster care numbers during pandemic

Source: US Children’s Bureau, AFCARS Report $28, https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport28.pdf

A long-awaited report from the federal government shows that most states saw a decrease in their foster care population during the fiscal year ending September 30, 2020, which included the onset of the COVID-19 pandemic. Both entries to foster care and exits from it declined in Fiscal Year (FY) 2020 compared to the previous fiscal year. These results are not surprising. Stay-at-home orders and school closures beginning in March 2021 resulted in a sharp drop in reports to child abuse hotlines, which in turn presumably brought about the reduction in children entering foster care. At the other end of the foster care pipeline, court shutdowns and a slow transition to virtual operations prolonged foster care stays for many youths. One result that is surprising, however, is the lack of a major decrease in children aging out of foster care, despite the widespread concern about young people being forced out of foster care during a pandemic.

Ever since the COVID-19 pandemic resulted in lockdowns and shut down schools around the country, child welfare researchers have been speculating about the pandemic’s impact on the number of children in foster care. While many states have released data on foster care caseloads following the onset of the pandemic, it was not until November 19, 2021 that the federal Children’s Bureau of the Administration of Children and Families (ACF) released the data it received from the 50 states, the District of Columbia and Puerto Rico for Fiscal Year 2020, which ended more than a year ago on September 30, 2020. The pandemic’s lockdowns and school closures began in the sixth month of the fiscal year, March 2020, so its effects should have been felt during approximately seven months, or slightly over half of the year. The data summarized here are drawn from the Adoption and Foster Care Analysis System (AFCARS) report for Fiscal Year 2020 compared to the 2019 report as well as an analysis of trends in foster care and adoption between FY 2011 and FY 2020. State by state data are taken from an Excel spreadsheet available on the ACF website.

The nation’s foster care population declined from 426,566 on September 30, 2020 to 407,493 children on September 30, 2021. That is a decline of 19,073 or 4.47 percent. According to the Children’s Bureau, this is the largest decrease in the past decade, and the lowest number of children in foster care since FY 2014.* Forty-one states plus Washington DC and Puerto Rico had an overall decrease in their foster care population, with only seven states seeing an increase. The seven states with increases were Arizona, Arkansas, Illinois, Maine, Nebraska, North Dakota and West Virginia. The change in a state’s foster care population depends on the number of entries and the number of exits from foster care. And indeed both entries and exits fell to historic lows in FY 2020. The reduction in entries was even greater than the fall in exits, which was why the number of children in foster care declined rather than increasing.

Entries into foster care fell drastically around the country, from 252,352 in FY 2019 to 216,838 in FY 2020 – a decrease of 14 percent. This was the lowest number of foster care entries since AFCARS data collection began 20 years ago. Foster care entries dropped in all but three states – Arkansas, Illinois, and North Dakota. These three states were also among the seven states with increased total foster care caseloads. It is not surprising that entries into foster care dropped in the wake of pandemic stay-at-home orders and school closings. While we are still waiting for the release of national data on child maltreatment reports in the wake of the pandemic, which are included in a different Children’s Bureau publication, media stories from almost every state indicate that calls to child abuse hotlines fell dramatically. This drop in calls would have led to a fall in investigations and likely a decline in the number of children removed from their homes. Monthly data analyzed by the Children’s Bureau drives home the impact of the Covid-19 pandemic on foster care entries. More than half of the decrease in entries was accounted for by the drops in March, April, and May, immediately following the onset of stay-at-home orders, which were later relaxed or removed, as well as school closures.

Source: Trends in Foster Care and Adoption, FY 2011-FY 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_11thru20.pdf

Reasons for entry into foster care in FY 2020 remained about the same proportionally as in the previous year, with 64 percent entering for a reason categorized as “neglect,” 35 percent for parental drug abuse, 13 percent for physical abuse, nine percent for housing related reasons and smaller percentages for parental incarceration, parental alcohol abuse, and sexual abuse. (A child may enter foster care for more than one reason, so the percentages add up to more than 100.)

Exits from foster care also decreased nationwide from 249,675 in FY 2019 to 224,396 in FY 2020 – a decrease of 10 percent – a large decrease but not as big as the decrease in entries, which explains why foster care numbers decreased nationwide. Only six states had an increase in foster care exits: Alaska, Illinois, North Carolina, Rhode island, South Dakota and Tennessee. Along with the decrease in exits, the mean time in care rose only slightly from 20.0 to 20.5 months in care, while the median rose from 15.5 to 15.9 months in care. Again, it is not surprising that the pandemic would lead to reduced exits from foster care. In order to reunify with their children, most parents are required to participate in services such as therapy and drug treatment, to obtain new housing, or to do other things that are contingent on assistance from government or private agencies. Child welfare agency staff and courts are also involved the process of exiting from foster care due to reunification, adoption, or guardianship. All of these systems were disrupted by the pandemic and took time to adjust to virtual operations. Monthly data shows that about 68 percent of the decrease in exits was accounted for by the first three months of the pandemic, when agencies and courts were struggling to transition to virtual operations. It is encouraging that the number of exits was approaching normal by September 2020; it will be interesting to see if the number of exits was higher than normal in the early months of FY 2021.

Source: Trends in Foster Care and Adoption, FY 2011-FY 2020, https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_11thru20.pdf

Most exits from foster care occur through family reunification, adoption, guardianship, and emancipation. The proportions exiting for each reason in FY 2020 remained similar to the previous year, while the total number of exits dropped, as shown in Table 3 below. Children exiting through reunification were 48 percent of the young people exiting foster care in FY 2020, and the number of children exiting through reunification dropped by 8.3 percent from FY 2019. Children exiting through adoption were 26 percent of those leaving foster care, and the number of children exiting through adoption fell by 12.6 percent. Exits to guardianships fell by 11 percent and other less frequent reasons for exit fell as well. The drop in reunifications, adoptions and guardianships is not surprising given court delays and also the likely pause in other agency activities during the pandemic. However, nine states did see an increase in children exiting through adoption.

Table 3

Reasons for Exit from Foster Care, FY 2019 and FY 2020

Exit ReasonFY 2019
Number
FY 2019
Percent
FY 2020
(Number)
FY 2020
(Percent)
Decrease
(Number)
Decrease
(Percent)
Reunification117,01047%107,33348%9,6778%
Living with another relative15,4226%12,4636%2,95919%
Adoption54,41526%56,56825%7,84712%
Emancipation20,4458%20,0109%4352%
Guardianship26,10311%23,16010%2,94311%
Transfer to another agency2,7261%2,2631%46317%
Runaway6080%5280%8013%
Death of Child3850%3600%256%
Source: US Children’s Bureau, AFCARS Report $28, https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport28.pdf

It is surprising that the number of foster care exits due to emancipation or “aging out” of foster care fell only slightly, to 20,010 in FY 2020 from 20,445 in FY 2019, making emancipations a slightly higher percentage of exits in FY 2020–8.9 percent, vs. 8.2 percent in FY 2019. There has been widespread concern about youth aging out of foster care during the pandemic, and a federal moratorium on emancipations was passed after the fiscal year ended. At least two jurisdictions, California and the District of Columbia, allowed youth to remain in care past their twenty-first birthdays due to the pandemic. It is surprising that this policy in California, with 50,737 youth in care or 12.45 percent of the nation’s foster youth on September 30, 2020, did not result in a bigger drop in emancipation exits nationwide. California’s foster care extension took effect on April 17, 2020 through an executive order by the Governor and was later expanded through the state budget to June 30, 2021. And indeed, data from California via the Child Welfare Indicators Project show that the number of youth exiting through emancipation dropped by over 1,000 from 3,618 in FY 2019 to 2,615 in FY 2020. Since total emancipation exits dropped by only 435 nationwide, it appears that the number of youth exiting care through emancipation outside of California actually increased. This raises concern about the fate of those young people who aged out of care during the first seven months of the pandemic.

In December 2020 (after the Fiscal Year was already over), Congress passed the Supporting Foster Youth and Families Through the Pandemic Act (P.L. 116-260), which banned states from allowing a child to age out of foster care before October 1, 2021, allowed youth who have exited foster care during the pandemic to return to care and added federal funding for this purpose. But this occurred after the end of FY 2020 so it did not affect the numbers for that year. Moreover, The Imprint reported in March 2021 that many states were not offering youth the option to stay in care despite the legislation, raising fears that the number of emancipations in FY 2021 may not have been much lower than the number for FY 2020.

Among the other data included in the AFCARS report, terminations of parental rights decreased by 11.2 percent in FY 2020. This is not surprising given the court shutdowns and delays. Perhaps this decline in TPR’s explains why the number of children waiting to be adopted actually decreased from 123,809 to 117,470, contrary to what might be expected from the decrease in adoptions.

It is disconcerting that some child welfare leaders and media outlets are portraying the reductions in foster care caseloads during FY 2020 as a beneficial byproduct of the pandemic. Despite the fact that maltreatment reports dropped by about half after the pandemic struck, Commissioner David Hansell of New York City’s Administration for Children’s Services told the Imprint that “It was just as likely that the pandemic was ‘a very positive thing’ for children, who were able to spend more time with their parents.” Based on an interview with Connecticut’s Commissioner of Children and Families, an NBC reporter stated that ‘With the pandemic, the last two years have been difficult, but something positive has also happened during that time span. Today, there are fewer kids in foster care in Connecticut.”

Even In normal times, I take issue with using reductions in foster care numbers as an indicator of success. Certainly if foster care placements can be reduced without increasing harm to children, that is a good thing. But in the wake of the pandemic, we know that many children were isolated from adults other than their parents due to stay-at-home orders and school closures, and we have seen a drastic decline in calls to child abuse hotlines. Thus, it is likely that some children were left in unsafe situations. Moreover, the pandemic caused increased stress to many parents, which may have led to increased maltreatment, as some evidence is beginning to show. So when Oregon’s Deputy Director of Child Welfare Practice and Programming told a reporter that “Even though we had fewer calls, the right calls were coming in and we got to the children who needed us,” one wonders how she knows that was the case, and whether her statement reflects wishful thinking rather than actual information.**

There have been many predictions of an onslaught of calls to child protective services hotlines once children returned to school. And indeed, there have been reports of a surge of calls after schools re-opened in Arizona, Kentucky, upstate New York, and other places, but we will have to wait another year for the national data on CPS reports and foster care entries after pandemic closures lifted.

The FY 2020 data on foster care around the country provided in the long-awaited AFCARS report contains few surprises. As expected by many, foster care entries and exits both fell in the first year of the pandemic. Since entries fell more than exits, the total number of children in foster care fell by over four percent. These numbers raise concerns regarding children who remained in unsafe homes and those who stayed in foster care too long due to agency and court delays. The one surprise was a concerning one: the lack of a major pandemic impact on the number of youth aging out of care. The second pandemic fiscal year has already come and gone, but it will be another year before we can get a national picture of how child welfare systems adjusted to operating during a pandemic.

*Our percentages are slightly different from those in the federal Trends report because the Children’s Bureau calculated their percentages based on numbers rounded to the nearest thousand.

*There is evidence that maltreatment referrals from school personnel are less likely to be substantiated than reports from other groups, and this may reflect their tendency to make referrals that do not rise to the level of maltreatment, perhaps out of concern to comply with mandatory reporting requirements. Data from the first three months of the pandemic shared in a webinar showed that referrals which had a lower risk score (measured by predictive analytics) tended to drop off more than referrals with a higher risk score. However as I pointed out in an earlier post, that low-risk referrals dropped off more does not mean that high-risk referrals were not lost as well.

Ten common child welfare misconceptions: essential reading for child welfare commentators and policymakers

In the current rush to make child welfare more “family-friendly,” many proposals are being made for major changes, and even for the total abolition of the current system. But many of these proposals are based on misunderstandings of what we currently know about child abuse, child neglect and child welfare programs. Acting based on these misconceptions may produce policies and practices that actually harm children. A group of eminent child welfare scholars, headed by Richard Barth of the University of Maryland School of Social Work, (and also including leading child welfare scholars Jill Duerr Berrick, Antonio Garcia, Brett Drake and Melissa Jonson-Reid and Johanna Greeson) have addressed ten of the most common misconceptions in one essential article, a must-read for anyone promoting change in our child welfare system.

The article, entitled “Research to Consider While Effectively Re-Designing Child Welfare Services,” was published in the journal Research in Social Work Practice on October 18, 2021. It highlights 10 common misconceptions which the authors assert (rightly in my view) are “inconsistent with the best available contemporary evidence.” Their treatment is structured around ten questions to which a wrong answer is commonly cited and used to justify policy changes. Unfortunately, a paywall blocks access to the article for readers who do not have access to the journal from their institution, though this link provides a one-paragraph summary and the reference list. This post provides a more detailed summary of the article. Readers can contact author Richard Barth at RBarth@ssw.umaryland.edu with questions.

Are Low-Income Children Inappropriately Referred to Child Protective Services (CPS) Due to Implicit Bias?

As the authors describe, there is no doubt that low-income children are referred to CPS at a higher rate than their higher-income peers. One theory is that mandated reporters, who are often middle-class professionals, are biased against low-income parents and their parenting styles. Barth and colleagues cite studies that look at this question in several ways, all suggesting that bias is not the major reason for higher reporting of poor children. First, low-income children experience bad outcomes (in the worst case, death) at differentials consistent with or higher than the differentials in reporting rates. Second, lower-income people are much more likely to self-report maltreatment than their higher-income counterparts. And finally, low-income children who are reported to CPS are more likely to have a range of negative outcomes than their low-income peers who are not reported to CPS.

Are Families who Receive Public Social Services and Have Contact With Mandated Reporters Disproportionately Likely to be Referred to Child Protective Services?

It is often asserted that families that receive more public services (such as clinics rather than private doctors to whom they are known) and encounter more mandated reporters are more likely to be reported to CPS. But the authors show that available evidence does not support this assertion. Two studies estimated “surveillance bias” to increase CPS reporting by less than two percent. Another study found that among children in families receiving income support, those who were reported to CPS also had higher rates of delinquency, mental health problems, and hospital visits for injury. Finally, national and state data show that “as individual or community poverty increases, the proportion of mandated reporters among all reports decreases, making low-income people less likely to be reported by mandated reporters.”

Is the Racial Disproportionality of Black Children in CPS Substantially Driven by Bias?

It is a fact universally acknowledged that Black children are more likely to be involved with child welfare than their share of the population would predict. The latest federal data shows that Black children are more than twice as likely to be reported to CPS than White children. But as I’ve often written, the evidence suggests that bias is not the main reason for this disparity. Among the reasons cited by Barth and colleagues, Black children are more than three times more likely to be poor than white children. Studies suggest that when compared to children with an equal income, Black children are at the same risk or at a slightly lower risk of being reported to CPS. The authors also cite a recent study suggesting that Black substance-abused infants are actually less likely to be reported to CPS than White or Hispanic substance-abused infants. Furthermore, they cite evidence that Black-White disparities in other objective indicators of well-being, such as child mortality, are actually greater than Black-White disparities in CPS reporting. The writers therefore contend that, in order to address racial disproportionality in CPS reporting, we need to address poverty itself, as well as the factors that place Black children at higher risk of growing up in poverty.

I do differ from Barth et al in believing that factors other than poverty affect racial disparities in child abuse and neglect, and the resulting disparities in reports, substantiations, and foster care placements. The importance of factors other than poverty is illustrated by the fact that Hispanic children are less likely to end up in foster care than White children even though their poverty rates are higher, while Native American children, with similar poverty rates, are much more likely to be placed in foster care than Black children. Hundreds of years history of slavery, racial violence, and segregation have left a legacy of intergenerational trauma that has affected mental health, substance abuse, and childrearing styles. Therefore equalizing Black-White poverty rates would probably not immediately equalize their rates of placement into foster care.

Are Decisions to Substantiate or Place in Foster Care Largely Driven by Racial Bias?

Not only are Black children disproportionately more often reported to CPS; they are disproportionately more often the subject of substantiated allegations and placed in foster care.  This is clearly a concern of the authors although their analysis indicates that what is commonly asserted– that this discrepancy is largely due to a racist decision making in the child welfare system—is not supported by the evidence. The authors report that the large majority of recent studies find that “as they move through the system, socioeconomically disadvantaged Black children are generally less likely to be substantiated or removed into foster care compared to White children.” Black children do stay in foster care about 25 percent longer than White children, perhaps because they are less likely to be reunified with their parents or adopted. However, the frequently-cited idea that they are more often substantiated once economic status is taken into account has been roundly disproved, according to the paper’s authors. As I have pointed out relative to this question and the previous one, attempting to reduce disparities that are due to different levels of need might require establishing lower standards for the care of Black children by their parents, allowing them to remain in situations that would cause White children to be removed.

Is Child Neglect Synonymous With Family Poverty?

The trope that child neglect is synonymous with poverty is one of the most common myths used by advocates of child welfare reform, and I devoted part of a recent post to dismantling it. It is true, as Barth and colleagues state, that 70 percent of maltreatment reports and fatalities include neglect as a factor. And they acknowledge that there “is clear evidence establishing the relationship between poverty and child neglect.” However, this association does not mean that poverty and neglect are one and the same. Barth et al point out that studies examining the impact of both poverty and neglect have found distinct negative impacts on children for each one. They also found that studies using both officially reported and self-reported neglect found “unique constellations of risks and/or parenting behaviors” for neglect as opposed to poverty. As the authors point out, much of of the confusion between poverty and neglect is due to the fact that some states allow parents to be found neglectful when a child’s material needs are unmet, even when this deprivation was involuntary on the part of the parent. In those cases, neglect could be seen as reflecting poverty alone. But the authors point to a study showing that only a small proportion of neglect referrals (maybe one in four) is due to material needs, and that these referrals are only about a quarter as likely to be substantiated as other neglect referrals. This is not surprising, since many jurisdictions would respond in such cases by helping the family address the material need rather than substantiating an allegation of neglect by the parent.

Barth et al make an important point that “[N]arratives that conflate poverty and child neglect unfairly characterize low-income families, the majority of whom provide appropriate care for their children.” Most poor parents do not neglect their children, and eliminating poverty alone would not eliminate neglect caused by mental illness, substance abuse, or other non-material factors. Moreover, characterizing neglect as nothing more than poverty risks obscuring the harms caused by neglect, which the authors discuss in their response to the next question.

Is Child Neglect Harmful to Children?

The seriousness of child neglect is often minimized by those who say it is just a reflection of poverty. Yet, Barth and colleagues remind us that severe neglect means “the lack of the basic nurturing, care, and supervision needs of a child.” When such severe neglect is chronic or occurs at critical periods in child development, it can lead to death, hospitalization, and impaired development. The authors cite multiple studies showing the many poor outcomes that have been associated with neglect, including poor cognitive outcomes, mental illness, trauma symptoms, and substance abuse, and point out that such poor outcomes have been found even when controlling for poverty.

Are Research-Supported Practices Effective for Families of Color?

With the passage of the Family First Prevention Services Act allowing Title IV-E funding to be used to pay for “evidence-based practices” to keep families together, some advocates are asserting that programs deemed evidence-based are not actually shown to be effective for people of color. Barth and colleagues cite a study showing that four of popular programs in the California Evidence-Based Clearinghouse for Child Welfare – Parent Child Interaction Therapy, Trauma-Focused Cognitive Behavioral Therapy, Level Four Triple P and Multi-Systemic Therapy – have been found to be well-supported in studies with samples that include at least 40 percent children and families of color. Moreover, Cognitive Behavioral Therapy, the basis of many interventions, has been shown to be broadly effective across populations. Nevertheless, it is clear that the overwhelming majority of the interventions in the clearinghouse have not included many people of color. I am more persuaded by the authors’ suggestion that just because an intervention study did not include people of color does not mean it would not be effective for them with modifications to make them more relevant to families of color. However, I do feel compelled to report on my skepticism about many of these programs that have been found to be “evidence-based,” regardless of the nature of the families served. In the enthusiasm to replace foster care with family preservation, at least one popular program (Homebuilders) has been approved for Family First funding even though the evidence does not strongly support its effectiveness for any families, as I have discussed previously.

Do Children Grow up in Foster Care?

It is very common to read about children “growing up” in foster care, but as Barth et al point out, that is a rare occurrence today. While long-term foster care was common in the past, today’s emphasis on permanency has made stays much shorter. Barth et al cite “overwhelming” evidence that fewer than one percent of infants and ten percent of children 13 and under who enter foster care grow up in care. Infants entering care spend only about 10% of their time between 0 and 18 in care; children who are older when they enter care spend less time in care. Children who “age out” of care are mostly those who entered as teenagers, and many of them were admitted to foster care because of behavioral problems. As the authors point out, talking about children who “grow up” in foster care overemphasize the importance of the foster care experience as part of the life trajectory for most children and understate the importance of foster care as a temporary, last-resort option.

Does Foster Care Cause Poor Outcomes for Children and Youth?

There is no doubt that studies of young adults who have spent time in foster care show that they have worse outcomes than those who have not. Sadly, some commentators use this research to argue that being in foster care leads to worse outcomes than remaining at home. But as Barth and his colleagues had already explained in a previous section of their paper, child maltreatment has been shown to have many negative outcomes, which should not be confounded with the effects of foster care. Another review by Barth and others of “dozens of methodologically rigorous studies” examining outcomes in multiple domains suggests that it is unlikely that foster care worsens outcomes, and it improves them in some areas like child safety–as one would hope. Barth et al attribute the widespread misstatements about the role of foster care in adult outcomes to the strong impact of anecdotes from some foster care alumni about their bad experiences. This is despite the fact that studies reviewed by the authors show that most young people reported satisfaction with their foster care experiences.Majorities of young people in multiple studies reported that they had positive relationships with their caregivers, received quality care, felt safer in their foster homes than in their original homes, and felt that their removal was justified by the circumstances. Another reason for inaccurate conclusions about foster care, according to the authors, may be an over-reliance on studies of youth who aged out of care. This is a group that tends to have more issues even before entering care than other youth. In summary, as the authors state, “an evidence-informed understanding of the role of foster care in the lives of maltreated children indicates that the average experience of care is more favorable than conditions in the birth home at the time of removal.”

Is Adoption Breakdown Common for Former Foster Children?

The final misconception addressed by Barth and his colleagues is that a large fraction of adoptions end in breakdown. They mention commentators who have expressed concerns that the push to permanency may result in some adoptions being finalized too quickly, resulting in later dissolution. Instead, Barth et al show that research suggests adoption dissolution rates typically fall below five percent across a range of studies. Instead of the embracing the misconception that adoptions are likely to dissolve, Barth and his colleagues suggests that advocates for children in foster care should think of adoption as “a stable permanency alternative for children who otherwise cannot be reunified.” As they rightly state, “reform efforts that seek to curtail the opportunity for adoption among children who cannot be reunified would deny… children the lifetime of permanency that our laws seek to promote.”

Policy based on wrong assumptions is likely to be bad policy. Yet, the daily child welfare news is full of reports of child welfare leaders spouting these misconceptions–and worse, making policy and passing legislation based on them. In just one recent example, the New York City Council recently passed legislation requiring the Administration on Children’s Services “to report on various demographic information including race, ethnicity, gender, community district, and primary language of parents and children at every step of the child welfare system and to create a plan to address any disparities identified as a result of such reporting.” Perhaps those voting for this legislation had no idea that anything besides bias could contribute to these disparities, nor that “creating a plan to address them” could mean imposing a lower standard of parental care for children who come from over-represented groups–leaving aside the waste of time and money that could be better spent in helping children.

The misconceptions highlighted by Barth and his colleagues are already affecting child welfare policy and practice around the county in ways that are likely to put abused and neglected children at risk of further harm. This magisterial review, with its more than 140 references, is essential reading for anyone who prescribes or develops child welfare policy or practice. Let us hope it receives the attention it deserves.

No Way to Treat a Child: a needed corrective to the dominant narrative

No Way to Treat a Child: How the Foster Care System, Family Courts, and Racial Activists Are Wrecking Young Lives

These days, It is a bit difficult to be a left-leaning liberal while also being an advocate for abused and neglected children. I would never have expected that a Senior Fellow at the American Enterprise Institute (AEI), Naomi Schaefer Riley, would be one of my closest allies in child advocacy. Or that my proudest achievement since starting this blog would be my service on a child welfare innovation working group that she organized out of AEI, or that, with a few quibbles over details, I would agree with the main points of her new book. But that is the case in these strange times, in which many of my fellow liberals appear effectively indifferent to the fate of children whose parents they view as victims of a racist “family policing system.”

Naomi Schaefer Riley is a journalist, a former editor for the Wall Street Journal, and the author of five previous books. In her new book, No Way to Treat a Child: How the Foster Care System, Family Courts, and Racial Activists Are Wrecking Young Lives, uses examples, data and quotes from experts to show in heartbreaking detail how policymakers from the left and the right have converged in creating a child welfare system that puts adults first. Much of this occurs because in deciding how to treat abused or neglected children, the people who create and carry out child welfare law and policy “consider factors that are completely unrelated to and often at odds with a child’s best interests,” as Riley puts it.

Take family preservation and reunification, for example. Instead of placing the safety of the child as the highest priority, Riley illustrates that child welfare agencies leave many children in dangerous homes long past the time they should have been removed, with sometimes fatal results. They give parents more and more chances to get their children back, long after the law says that parental rights should be terminated. The book is full of stories of children ripped away from loving foster parents (often the only parents they have ever known) only to be returned to biological parents without evidence of meaningful changes in the behaviors that led to the children being removed.

Not only do today’s advocates of “family first” wrest children away from loving families to return home, but Riley describes how they send other hapless children to join distant relatives that they never knew, on the grounds that family is always best even if the relative does not appear until as much as two years after an infant has been placed in foster care. The fact that a relative may display the same dysfunction that the parent showed may be ignored. I would add, based on personal experience, that in my foster care work I often met grandmothers who seemed to have gained wisdom (and finally, for example, gave up drugs) with age, as well as aunts and uncles who avoided the family dysfunction and went on to lead productive lives, making their homes available to the children of their less well-adjusted siblings. But Riley is right to say we should consider not just blood, but also fitness and bonding before removing a child from a good pre-adoptive home to live with a relative.

As Riley describes, one of the primary factors that is now taking precedence over a child’s best interest is that of race or ethnicity. Riley explains how data on the overrepresentation of Black and Native American children in foster care in relation to their size is being attributed to racism in child protective services, as I have explained elsewhere, ignoring the evidence that the underlying disparities in abuse and neglect are largely responsible for these differences in foster care placement. And they don’t seem to have a problem with holding Black parents to a lower standard of parenting than White children to equalize the ratios. Moreover, many of these “racial activists” are recommending eliminating child welfare systems entirely along with abolishing the police. As Riley states, Native children are the canaries in the coal mine, “for what happens when you hold some parents to a lower standard, as we have done with the Indian Child Welfare Act with devastating effects for Native children.

Another way we subordinate the interests of children is by minimizing their parents’ responsibility for their treatment by saying it is simply due to poverty. Riley addresses the common trope that “neglect,” the reason that 63 percent of children children were removed from their families in 2019, is “just a code word for poverty,” a myth that I have addressed as well. I’d venture that anyone who has worked with families in child welfare knows there is often much more going on in these families than poverty alone, including substance abuse, mental illness, and domestic violence. Riley puts her finger on an important issue when she suggests that part of the problem may be that we use a general category called “neglect” as the reason behind many removals. However, I don’t agree with her recommendation to discard neglect as a reason for removal. As I explain in a recent post, we need to distinguish between the over-arching categories of “abuse” and “neglect” and the specific subcategories of neglect such as lack of supervision, educational neglect, and medical neglect. Contrary to Riley’s suggestion that they are types of neglect, substance abuse and mental illness are factors that contribute to it. This important information should be included in the record but should not be confounded with types of neglect.

Another way that policymakers disregard the best interests of the child is by deciding that foster homes are better than institutions for almost all children instead of recognizing that some children need a more intensive level of care for a limited time, or that others can thrive in group homes that simulate a family setting but provide more intensive attention than a typical foster home can provide. The Family First Prevention Services Act (FFPSA), which went into effect for all states on October 1, does allow for children to be placed temporarily in therapeutic institutions, although it sets some unreasonable limits on these institutions and on placement of children in them. But it does not provide any funding for placement in highly-regarded family-like group settings such as the Florida Sheriff’s Youth Ranches. (I’m not sure why Riley says in later in the book that FFPSA “is looking like another piece of federal legislation that will be largely ignored by states, many of which have already been granted waivers from it.” Those waivers were temporary and there is no way states can ignore the restrictions on congregate care).

In her chapter entitled “Searching for Justice in Family Court, Riley describes the catastrophic state of our family courts, which she attributes to a shortage of judges, their lack of training in child development and child welfare, and their leniency with attorneys and parents who do not show up in court. As a model for reform, Riley cites a family drug court in Ohio that meets weekly, hears from service providers working with parents, and imposes real consequences (like jail time) on parents who don’t follow orders. But this type of intensive court experience is much more expensive. These programs are small, and expanding this service to everyone would require a vast infusion of resources.

I appreciated Riley’s chapter on why CPS investigators are underqualified and undertrained.” Having graduated from a Master in Social Work (MSW) program as a midcareer student in 2009, I could not agree with her more when she states that the “capture of schools of social work and child welfare generally by a social-justice ideology has produced the kind of thinking that guides social welfare policy.” I’d add that some students are ill-prepared for their studies and may not get what they need while in school to exercise the best judgment, critical thinking, effective data analysis, and other important hard and soft skills. Riley suggests that the function of a CPS worker is really more akin to the police function than to the type of traditional social work function performed by other social workers in child welfare–those who manage in-home and foster care cases. As a matter of fact, Riley quotes my post suggesting that CPS Investigation should be either a separate specialty in MSW programs or could be folded into the growing field of Forensic Social Work.

Riley’s chapter on the promise of using predictive analytics in child welfare shows how concerns that using algorithms in child welfare would exacerbate current discrimination are not borne out by history or real-world results. Use of an algorithm to inform hotline screening decisions in Allegheny County Pennsylvania actually reduced the disparities in the opening of cases between Black and White children. As Riley states, this should not surprise anyone because data has often served to reduce the impact of bias by those who are making decisions. As she puts it, “if you are concerned about the presence of bias among child-welfare workers and the system at large, you should be more interested in using data, not less.”

Perhaps not surprisingly, it is Riley’s two chapters on the role of faith-based organizations in child welfare that made me uncomfortable. Riley describes the growing role of these groups, especially large evangelical organizations, in recruiting, training, and supporting foster and adoptive parents.” Like it or not,” she states, “most foster families in this country take in needy children at least in part because their religious beliefs demand such an action.” But the Christian Alliance for Orphans, an organization often quoted by Riley, was one of the groups behind the “orphan fever” that took hold among mainstream evangelical churches in the first decade of this century. Many families were not prepared for the behaviors of their new children and some turned to a book by a fundamentalist homeschooling guru named Michael Pearl that advocated physical discipline starting when children are less than a year old. Many of the adoptions were failures, some children were illegally sent back to their own countries, some children were abused, and at least two died of the abuse. But Riley’s narrative suggests that many evangelical churches working with foster youth are using a trauma-focused parenting model (Trust-Based Relational Intervention) that is diametrically opposed to the Pearl approach. Nevertheless, the association of evangelical Christianity with a “spare the rod” parenting philosophy as well as the possibility that saving souls is part of the motivation for fostering or adoption, make me a bit queasy about over-reliance on evangelical families as foster parents, and I would have liked to see Riley address this issue.

In her esteem for religious communities and their role in child welfare, Riley is worried that some jurisdictions will bar all organizations with whom they work from discriminating on the basis of sexual orientation or gender identity, driving religions institutions out of business. Since the book was written, however, the Supreme Court has ruled that the City of Philadelphia violated the First Amendment when it stopped referring children to Catholic Social Services for foster care and adoption because the agency would not certify same-sex foster parents. So this threat may be dwindling for the time being. In general, unlike many liberals, I agree with Riley that, as long as there is an agency to work with any potential foster parent, we should “let a thousand flowers bloom” rather than insisting that every agency accept every potential parent.

Riley ends the book with a list of recommendations for making the system more responsive to the needs of children rather than adults. She agrees with liberals that we need an influx of financial resources as well as “better stewardship of the money we already spend.” We need both a massive reform of our child welfare agencies and a family court overhaul, she argues. She wants recruitment of more qualified candidates for child welfare agencies and better training for them. She urges the child welfare system to move away from “bloodlines and skin color” and allow a child to form new family bonds when the family of origin cannot love and protect that child. I certainly hope that policymakers on both sides of the aisle read and learn from this important book.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.