Sunday, May 6, 2007

Arizona: State of willful ignorance

Last week, I was contacted by a reporter for the Arizona Daily Star, the larger of two competing dailies in Tucson. He’d contacted me the week before, acknowledging he was new to the child welfare beat and knew little about the subject. This time he was calling because he’d gotten a tip.

He’d been sent a memo showing that in Arizona, state employees receive 30 cents an hour of their pay as an incentive bonus. They lose that 30 cents if their agencies fail to meet certain goals each year. The state human services agency, which includes child protective services, needs to meet any two of the following three goals:

● Promote economic self sufficiency
Safely reduce the number of children in out-of-home care (by less than one-third-of-one percent) [emphasis added].
● Reduce the number of children and adults placed in institutions by developing the capacity of extended families and communities.

I told the reporter I certainly understood why this was newsworthy and why he was calling, but I told him it also was a bit frustrating. I explained that child welfare was a system filled with pervasive incentives, financial and otherwise, and almost all of them encouraged everyone in the system to do the wrong thing.

These incentives include:
● Bounties paid to the state by the federal government for every finalized adoption over a baseline number.
●Per diem reimbursements for private agencies, encouraging them to hold children, needlessly, in foster care.
● Avoiding the risk of negative news coverage by taking away huge numbers of children needlessly, since no caseworker ever has been attacked in the press for taking away too many children, whereas such attacks are common if a worker leaves a child in his own home and something goes wrong.
● Avoiding firing, suspension, demotion or any other penalty of any kind by doing the same thing. Though caseworkers often claim they’re “damned if we do and damned if we don’t” that’s simply not true; when it comes to taking away children, they’re only damned if they don’t.

But reporters almost never write about these incentives.

In our previous conversation, I’d told the reporter how Arizona was in a state of perennial foster-care panic. Between 2002 and 2004, removals of children had soared 40 percent - -and, as usual, this had left children less safe. By 2005, deaths of children known-to-the-system had set a record, as workers, overwhelmed with false allegations, trivial cases and children who didn’t belong in foster care, actually had less time to find children in real danger.

And, of course, as a result, thousands of children needlessly were torn from everyone loving and familiar; they were forced to endure the emotional devastation of foster care and they were placed at risk of abuse in foster care; where there probably is abuse in at least one foster home in three.

In most states, after a year or two of foster-care panic, people calm down, look around, say, in effect, “Oh, my God, what have we done to these children?” and change course. But in Arizona, the foster-care panic has never stopped. Children still are being taken at the same rate as when the panic was at its height.

To counter the state of never-ending foster-care panic, the financial incentives to take away children and the non-financial incentives to take away children, the State of Arizona offered one puny counter-incentive: 30 cents an hour, which also could be retained by meeting other goals.

And to top it off: It didn’t work. The incentives didn’t, in fact, reduce removals. There is no evidence that the incentive, which required maintaining safety, compromised that safety. But there is plenty of evidence that foster-care panics, including the one in Arizona, leave children less safe.

But one thing deeply disturbed the reporter: Why, he asked, should there be any incentives at all in child welfare? Why can’t workers exist in a state of noble purity, immune from all base influences and able to make decisions based solely on what was best for the children?

I told him that was a nice idea - but it could work only if the public knew about all of the incentives and if policymakers then were able to eliminate all of them. I pointed out that incentives, good and bad, are a fact of life in every endeavor, including journalism.

Reporters self-censor, avoiding stories they know management hates, and pursue stories that appeal to editors’ interests in order to curry favor. Or they work harder when they know there’s a vacancy in a coveted bureau – or rumors of still another round of layoffs. Or they work a little less hard if it’s the Friday before vacation and they’re anxious to get out of the office - -just as a caseworker may not make the extra phone call to find, say, a relative with whom to place a child if she can just dump that child in a shelter instead.

It’s human nature in journalism, child welfare, or any other line of work.

So what could good leadership in a child welfare agency do about this? They could try to repeal the laws of human nature and eliminate all incentives. Or they could do everything possible to balance the incentives, so workers are encouraged to do what’s best for the children, and discouraged from doing anything else. That’s exactly what Arizona tried, except the attempt at balance was so feeble, so pathetic, that it changed nothing.

But readers of the Arizona Daily Star would learn none of this.

On May 3, they would find, instead, a lead story headlined “CPS staff to see pay cuts if goal is unmet.” They would finish the story left with the impression that there existed one, and only one, incentive in child welfare: The 30-cents-an-hour for goals that include safely keeping families together. CPS did nothing to correct this misimpression (or if they did, the reporter omitted it) saying only that the incentive would not prompt workers to compromise safety. (Going only to CPS - an agency nobody ever believes, often for good reason - is the standard way reporters with an axe to grind give the illusion of presenting all sides, without the substance.)

Readers probably weren’t alone in being left in the dark by the Star story. Editors read what a reporter turns in, not what he leaves out. So I don’t know if the reporter’s own editors know about all the other incentives. At least one editor from another part of the paper had no idea there were any financial incentives other than the one in the story (and when I explained this, didn’t much care).

It does not appear that the reporter explained this to people he contacted for quotes, either. So it is no wonder the story was filled with comments like this one from a legislator: “We’re tipping the scales with performance pay,” he said. In fact, the incentive did not tip the scales at all; rather it was a puny, pathetic, failed effort to bring them back into balance.

And soon, even that will be gone. You can bet that within a week a memo will go out rescinding the incentive either in fact or by implication. And, of course, the story itself will give one more kick-start to the never-ending Arizona Foster Care Panic.

When I e-mailed the reporter to complain about the omission of all mention of other incentives, I discovered that in just a few days, his question about “why are there incentives at all?” had morphed into a decree; a dictat from which no dissent shall be permitted. He wrote:

You seem to miss the point. It is not that keeping kids with the family is good or bad. It is not that putting them in foster care is good or bad. It is, rather, the issue of linking employee bonuses to outcomes. Those decisions should be made based strictly on the best interest of the children involved. Financial motivations, or even the perception someone could be swayed by financial motivations, are inappropriate.

There are several problems with this.

For starters, while such a comment is appropriate coming from a columnist or an editorial writer, such pronouncements have no place coming from a reporter. Whether financial incentives are or are not appropriate is something for readers to decide - after being given enough information to make an informed decision.

Second, the story deals with only one kind of incentive - and since that incentive deals with only one kind of outcome, keeping kids with the family, the story does indeed deal with the issue of whether “keeping kids with the family is good or bad.” Only a story which dealt with incentives in both directions could be genuinely neutral on this point.

And third, by pressuring CPS to abolish an incentive in one direction while leaving all the others intact, the story does the opposite of the reporter’s own alleged goal. Arizona’s vulnerable children are a large step farther away from a system that makes decisions purely on the basis of best interests than they were five days ago, because the scales are now father out of balance. And that means, these children are less safe. (Of course, if the reporter’s real goal was to encourage more foster care, then his goal was accomplished; and I’ll leave for another day the whole issue of defining best interests and what happens when the best interests of the child conflict with the best interests of children.)

As it happens, on the very day the Star story appeared, the need for balance in incentives was illustrated, albeit indirectly, in a story in Tucson’s other daily, the Tucson Citizen.

It reported on the trial of a foster mother charged in connection with the death of her foster child, Dwight Hill. Dwight died in November, 2005, within weeks of the death of another Tucson area foster child, Emily Mays. These cases got far less attention than the recent deaths of children in the same community at the hands of birth parents. (Nothing new, there.)

Dwight was born with cocaine in his system. He was confiscated at birth and parked at the local parking place shelter. Then he was placed in a foster home recruited and overseen by a private agency. They also were caring for three other foster children, including two toddlers, and a birth son with medical problems. The foster father listed his occupation as unemployed, the foster mother listed hers as “foster mother” – raising a question about financial incentives a lot bigger than 30 cents an hour.

Eleven days later Dwight Hill was dead. According to the Citizen: “A Pima County coroner's autopsy report indicated the baby died of blunt-force trauma, bleeding in the brain and a fractured skull.” The prosecutor said he died "in a way no person should have to endure."

The foster mother says she has no idea how Dwight died and was not negligent in getting him medical attention. That, a jury will decide.

But here’s what we do know:

There was every incentive for the caseworker to confiscate Dwight at birth - and no incentive for her to, say, fight extra hard to find a drug treatment program where mother and child could live together, which research shows is far better for a child’s well-being than even a good foster home. There was every incentive to just dump Dwight at the shelter – nothing could be easier, and no one would ever question it - and no incentive to work extra hard to find a relative, if Dwight really couldn’t stay with his mother. There was every incentive for the private agency, paid for every day Dwight was held in foster care, to push to keep him there as long as possible. There was every incentive for that private agency to stuff as many foster children into that home as the law allowed. And there was no incentive for anyone to ask if four very young foster children and a disabled birth child were too much for the foster mother.

This all happened before the state tried to balance the scales with that tiny incentive to think more carefully and work a little harder to keep children like Dwight and Emily out of foster care.

So by the logic of the reporter who wrote the Star story, the decisions to remove Dwight Hill from his own home and place him first in a shelter and then in the foster home where he died were perfect in their purity, utterly untainted by filthy lucre, and so, must have been made solely based on Dwight Hill’s best interests. The same must have been true with the decisions in the case of Emily Mays.

One thing puzzles me, though.

How was it in the best interests of Dwight Hill and Emily Mays to die?