NCCPR in the Everett, Wash. Herald on the Snohomish County CASA scandal

Thanks to The Herald and reporter Noah Haglund for the comprehensive account of the scandal engulfing the Snohomish County Court Appointed Special Advocates (formerly Vollunteer Guardian Ad Litem) program (“Lying, spying and destroying evidence spur guardian reforms,” The Herald, Aug. 18).

In some ways, the most damning revelation about the program isn’t that its staff and volunteers as the story put it, “repeatedly crossed legal and ethical lines.” It’s not the “lying, spying, [and] withholding and destroying evidence” that the trial judge found “pervasive and egregious.”

The most telling revelation comes in the form of one step that the Snohomish County Superior Court felt the need to take in order to claim it was “fixing” the program.

Read the full column here.

And there's more about the Snohomish County CASA scandal here.

NCCPR news and commentary round-up, week ending Sept. 1, 2019

● First up, two items on the Snohomish County CASA scandal.  Just one day after the law firm that exposed the scandal asked a key funder of CASA to investigate, that funder, the federal Office of Juvenile Justice and Delinquency Prevention, said it is looking into the issues raised by the scandal.  I have a blog post on it, and a summary of the issues in this op-ed for The (Everett, Wash.) Herald.

● Just in time for back-to-school, school districts are ramping up their use of child protective services to harass families.  WUSA-TV exposed a particularly egregious example in Washington, D.C.  I have a blog post about it, including a link to WUSA’s story.

● One year ago, a British online news site, The Tortoise held what it calls a “ThinkIn” in the Bronx.  But let the reporter explain:

It was about masculinity and the issues facing the city’s young men. A civil rights lawyer made an intervention in the kind of tone that cuts through the noise. People weren’t so scared of the police knocking on the door, she said. What families in the Bronx most feared was a different wing of the state; it was child protection workers, because that’s when you might face the worst and lose your children.

Not only did this lawyer’s comment lead to a very good story about child welfare in New York, it led to several good stories about the depressingly-similar problems in the British system.  All of the stories are here.

● A federal appeals court ruled against a mother wrongly placed in Hawaii’s central registry of alleged child abusers.  The statute of limitations for appeals had expired – but only because the mother never knew she was in the registry in the first place, and the state never bothered to tell her.  Though the court felt it was forced to rule against the mother, one judge issued a scathing opinion blasting the state for the ultimate Catch-22.  Honolulu Civil Beat has the story.

● More than a year ago, the Associated Press exposed the use of coerced “voluntary” foster-care placements arranged by a county child protective services agency in North Carolina.  These are off-the-books placements in which child protective services says if you don’t place your child “voluntarily,” usually with a relative, they’ll take you to court and place the children with strangers.  It’s actually a common practice all over the country – but in Cherokee County, NC, it was so egregious that the state actually took over the county agency for a while.

Now, Carolina Public Press has dug even deeper and found that things were actually even worse; including a possibly illegal rush to terminate parental rights, and the state knew what was going on for months before acting.  The story is a bit confusing; it’s easier to follow if you read the AP stories first.

● Even as that was being exposed, the North Carolina Legislature actually was considering legislation to further run roughshod over the rights of children to live with their own families.  I discuss that bill in this blog post

● And a lawsuit in Vermont highlights the issue of wrongful removal in that state, which takes away children at one of the highest rates in the country.  VTDigger reports.

Weaponizing CPS: In DC, if you’re late to pick up your child from school, you may have to pick him up from Child Protective Services (assuming they let you have him back)

Remember the school district that got national attention for threatening to turn families in to child protective services if they couldn’t afford to pay for their children’s school lunches?

It turns out it’s not just one school district.  The Philadelphia Inquirer found that in Southern New Jersey alone, at least eight school district that have policies allowing schools to do the same thing.

In New Jersey, as in Luzerne County, Pa., where the practice first came to light, the child protective services agency made clear schools should never do that, calling such threats “a misuse and misrepresentation” of the agency.

But in Washington, D.C., the CPS agency gave a disturbing non-answer when asked about a practice in the District that is as bad or worse: turning in parents for alleged neglect if they’re so much as a minute late picking their children up from school.

The practice was revealed by WUSA-TV, after they heard from a parent.  

She, and other parents at Paterson ElementarySchool, received a “welcome back” to school letter from the school principal that is anything but welcoming.  It is so dripping with condescension and filled with boldfaced, underlined, all-caps finger-wagging admonitions that one can only wonder: If this is how they treat the parents, what is it like to be a student there?

But one threat is particularly disturbing:

If you choose not to have your child remain in the Afterschool Program, then he/she MUST be picked up promptly at 3:15 p.m. For those students that are not picked up on time (3:15pm) the Child and Family Services Agency (CFSA) will be contacted, and parents will be required to pick their child up from their office." [Emphasis most definitely in the original]

Notice the part about the afterschool program.  It’s not as if the school would be empty by 3:30.  On the contrary, when a parent is simply stuck in traffic, or has some kind of emergency, or just thought it was someone else’s turn to pick up the child, presumably the school could simply allow the child to sit in at the afterschool program.  (And if, by some chance there’s some stupid bureaucratic rule prohibiting this, then surely there are adults who could stay a little later to watch the child.)

This cruel policy appears rooted either in making things more convenient for the school or contempt for the families who send children to Patterson Elementary School.

Guess who goes to Patterson Elementary

If you haven’t already guessed, the student population is 99 percent Black.  The other one percent is Hispanic/Latino.  One hundred percent are listed as economically disadvantaged.  These are precisely the parents who generally have the most stress in their lives, and are likely to find it hardest to always get to the school at precisely 3:15pm.

Officially, this appalling infliction of trauma on children is district-wide policy – but do you really think they’d get away with this at a school in tony Georgetown?

Worse than the threatening letter is the fact that schools in the District have, in fact, been carrying out the threat, and CFSA has been going along with it. 

Back when the Pennsylvania school lunch story broke, and the county child welfare agency responded the right way, I wrote this:

I suspect that, while most CPS agencies wouldn’t have endorsed what the school district did, they wouldn’t condemn it either – since their party line is report! report! report!  Call in with anything and everything, no matter how absurd, they say, and let our “professionals” decide.

And sure enough, CFSA lived down to my expectations.  According to WUSA:

[CFSA] Deputy Director Robert Matthews said that in many cases, they call mom or dad to find out they’re just stuck in traffic. CFSA couldn’t tell WUSA9 how often this happens because they don’t keep records of that. But he said they work with schools to track families down. 

Wait. Don’t schools also have telephones?  Why doesn’t CFSA tell the schools to do this themselves – instead of traumatizing children first?

What CFSA should have said is:

We are not in the business of doing the school district’s scut work for them.  We have real cases of abuse and neglect to investigate.  And we’re not here to inflict trauma on children for your convenience.  We will refuse to send our overloaded caseworkers to your school just because a parent is late to pick up a child, and we demand that you immediately stop calling us in such cases.

Instead, they said only this:

Situations like this do not automatically mean it’s a case of neglect or cause for investigation.

Well, isn’t that reassuring.  There are several problems with this.

From the 19^th Century, when Societies for Prevention of Cruelty to Children were known in poor neighborhoods as “the Cruelty,” to today, children in those neighborhoods know exactly what an agency like CFSA is all about.  They have to. For one thing, one recent study says a majority of African-American children will be the subject of a child abuse investigation at some point in their childhoods.

So children have every reason to be scared when caseworkers show up at the school and take them to the CFSA offices downtown.

And while this is not automatically deemed cause for investigation, that call is the equivalent of issuing CFSA a fishing license to poke and pry into every aspect of a family’s life.  Since any family subjected to this is likely to be poor, and poverty often is confused with neglect, the trauma of that first trip to the CFSA office could be only the beginning.

In my previous post, I said this keeps happening because we allow it to happen:

Half a century of horror stories that bear no resemblance to what CPS agencies typically see, combined with politicians trying to score points by “cracking down on child abuse” have led us to this: a child welfare surveillance state where everyone is under constant suspicion and CPS is the weapon of choice for all sorts of bureaucratic bullies.

In DC the problem is worsened by the local Child Advocacy Center, which, undoubtedly means well, but winds up stoking paranoia. Take a look at the repercussions.

There are two legislative bodies that could put a stop to this practice in Washington, D.C.: The schoolboard could bar schools from calling CFSA just because parents are late picking up their kids, or the D.C. Council could bar CFSA from acting on such calls.  Presumably D.C. Mayor Muriel Bowser could do the same.

But the bigger issue is this: As long as we are driven by fear, and as long as child welfare agencies are the enablers, school districts, among others, will be able to exploit that fear for their own convenience.

Another bill takes a swing at drug using parents – if it passes, guess who’s going to get hit

            The story on the online news site North Carolina Health News is headlined “Foster care bill could allow faster termination of parental rights.”  Written by the site’s founder, Rose Hoban, it is a far better take than most on issues involving child welfare and drug use, showing rare care and sensitivity.

It’s not unusual to see stories about the effects of opioid use on children in which reporters consider parents too subhuman even to talk to (Case in point: The Washington Post.) In contrast Hoban’s story begins with such a parent, brings out her humanity, and shows her successful reunification with her child.  Although I’ll spend much of this post citing parts of the story with which I disagree, Hoban goes to unusual lengths to present all sides.

            But (paragraphs like the one above are almost always followed by “but…”) I do disagree with one central premise of the story.  Hoban writes:

At issue is the tussle between the rights of children who have troubled parents to live less chaotic lives, in foster care, or with perhaps adoptive parents, and the rights of birth parents to take the time to get their lives in order, to win back their rights to raise those children.

            That is the standard framing of the issue.  But the problem with bills like the one in North Carolina, known as House Bill 918, is not that they hurt parents – the problem is that they hurt children.

Lessons from the last “Worst Drug Plague Ever”

            That is a lesson we all should have learned from the last “Worst Drug Plague Ever,” crack cocaine.

University of Florida researchers studied two groups of children born with cocaine in their systems; one group was placed in foster care, another left with birth mothers able to care for them.  After six months, the babies were tested using all the usual measures of infant development: rolling over, sitting up, reaching out.  Typically, the children left with their birth mothers did better.  For the foster children, the separation from their mothers was more toxic than the cocaine. 

Similarly, consider what The New York Times found when it looked at the best way to treat infants born with opioids in their systems. According to the Times:

[A] growing body of evidence suggests that what these babies need is what has been taken away: a mother.  Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care.

 “Mom is a powerful treatment,” said Dr. Matthew Grossman, a pediatric hospitalist at Yale-New Haven Children’s Hospital who has studied the care of opioid-dependent babies.

It is extremely difficult to take a swing at so-called “bad mothers” without the blow landing on their children. That doesn’t mean we can simply leave children with hopelessly addicted parents.  But it does mean that in most cases, drug treatment for the mother is a better option than foster care for the child. 

Indeed, as I discuss in this column for the trade journal Youth Today, child welfare’s entire approach to substance abuse exists at the intersection of ignorance and arrogance.

The chaos of foster care

That Florida study is only one example of why House Bill 918 would hurt children. 

The story says that part of the issue is the right of children to have “less chaotic lives, in foster care or with perhaps adoptive parents...” Sometimes that’s what happens; often it isn’t.  Foster care is enormously chaotic.  That’s one reason why study after study after study has found what that Florida study found: in typical cases children left in their own homes fare better even than comparably-maltreated children in foster care.

That’s true even when the foster home is a good one. The majority are.  But another series of studies finds abuse in at least one-quarter to one-third of foster homes, and the rate of abuse in group homes and institutions is even worse.

Yes, I know. The story quotes proponents as suggesting families are lining up to adopt these children.  But that’s also what they said when they fooled Congress into passing the so-called Adoption and Safe Families Act of 1997.  (I say fooled because some of those making the case at the time knew that wasn’t true.)  In any event, it didn’t work. Instead, terminations far outran adoptions, and the number of children “aging out” of foster care with no home increased. 

Attacking kinship care

The bill also seeks to undermine the least harmful form of foster care, kinship foster care, in which children are placed with relatives instead of strangers.

            The story also quotes a lawyer for a county social services agency whining about how hard it is to find relatives.  That simply gives away the fact that a lot of the impetus behind this bill isn’t what’s best for children, it’s what’s easiest for agencies. 

In Allegheny County, Pa. to cite just one example, 56 percent of foster children are placed in kinship foster care.  It’s not impossible; it just takes more effort, and a true dedication to putting the interests of children first – because (yes, it’s that pesky research again) study after study has shown that kinship foster care is better for children’s well-being and, most important, safer than what should properly be called “stranger care.”

There also are the usual trendy claims about brain science, bonding and trauma.  It’s not that those issues aren’t real, but those favoring a take-the-child-and-run approach to child welfare have been cherry-picking from the research.  For example, one of the worst “Adverse Childhood Experiences” a child can endure is removal from a parent. Yet those who cherry-pick from the research propose what amounts to trying to fight trauma with trauma.

As for bonding, that too is real, and really important.  But look at what those Florida infants are trying to tell us, and what we’re learning about how to treat newborns with opioids in their system: Don’t break the bond these children were born with.   More generally, bonding is a lot more complicated and nuanced than simply running a stopwatch and declaring that the child is bonded with, and only with, whoever had her or him the longest.

Indeed, one should be especially wary when child welfare agencies play the bonding card – they tend to deal it from the bottom of the deck.  In fact, the Trump Administration is using it to try to justify keeping apart some of the children torn from their parents at the Mexican border.

Racial and class bias

I was surprised that there was nothing in the story about the two factors that are at the root of almost everything in child welfare: Race and class.  The biggest single problem in child welfare is the confusion of poverty with neglect, compounded by the racial bias that permeates the system.

The North Carolina bill would add even more power to a system riven by racial and class bias. What this bill, and others like it, really would do is turn the child welfare system into the ultimate middle-class entitlement: Step right up and take a poor person’s child for your very own.

UPDATE: A key CASA funder is “looking into” the Snohomish County CASA scandal

● The law firm that exposed the scandal filed complaints with the agency, and with National CASA.

● The Snohomish program is so lily-white it has to use a photo from National CASA to show a Black CASA volunteer. Several other CASA programs use the same photo.

Responding to a complaint from the law firm that exposed the Snohomish County CASA scandal, a key funder for CASA says it’s “looking into” issues raised by the firm.

The federal Office of Juvenile Justice and Delinquency Prevention provides grants to National CASA and local CASA programs. The ABC Law Group is asking that  “funding from OJJDP that goes to the CASA program in Snohomish County, Washington be investigated for ethics violations.”  They’re also asking for “a federal investigation/oversight into this program which receives your funding.”

Less than 24 hours after receiving the request, OJJDP Administrator Caren Harp replied “We’re looking into it.”

The law firm also filed a formal complaint with the Executive Committee of the National CASA Board of Directors. The board is chaired by William Bell, who also is President and CEO of Casey Family Programs.

The complaint asks National CASA to investigate the Snohomish program for “on-going ethics violations which have now been shown to have hurt families.”  The complaint cites the recent scathing decision from a Washington State appellate court which “held that our CASA program engaged in the destruction of evidence, spying, perjury, abusive use of litigation, threatening lawyers and violating the appearance of fairness.”

Up to now, National CASA’s response can be summed up this way:

You can find out all about the Snohomish County CASA scandal here.

And there’s more …

The generic CASA doesn’t look much like the real CASAs

The complaint to National CASA also seeks an investigation into “false advertising and recruitment practices at Snohomish County.”

Among other things, there’s the matter of this flyer published by the program. See that nice picture of an African-American man – the only photo depicting a CASA volunteer?  There’s just one problem:  Right now, according to the Snohomish County program itself, of the 57 volunteers in the program, the total number of African-American volunteers is exactly zero.  The complaint notes that “The flyer to promote CASA contains more diversity regarding African American families than the entire program itself.”

And Snohomish County is not alone. NCCPR ran a Google Image search. We found the same photo of the same volunteer on websites for CASA programs in Kansas City, Missouri, Jefferson Parish, Louisiana, Northern Neck CASA in Virginia, Blue Ridge CASA, also in Virginia, Clayton County CASA in Georgia, the Texarkana Texas CASA program and the Arkansas State CASA Association. On the Arkansas website, his picture appears above the caption “Our spotlight shines on those volunteers who have gone above and beyond the necessary.” But click on the link to find the real volunteer they’re profiling, and it’s a white woman. 

Looks like Generic CASA used to be on the site for Kansas CASA too. That actually would be an improvement. About ten years ago, a local CASA organization in Kansas held a fundraiser that included a Blackface act.

Generic CASA also turns up in a slick promotional video from National CASA itself.

This doesn’t mean that none of these chapters has an African-American volunteer.  But, as noted above, the one in Snohomish does not.

We also know that CASA volunteers are 80 to 90 percent white.  And we know that, according to the most comprehensive study ever done of CASA, commissioned by the National CASA Association itself, volunteers spend less time on a case if the child is Black. 

That study also found that CASA doesn’t work.  A study specific to Snohomish County found that the Snohomish County program doesn’t work either.

Yet still, National CASA has not responded to the scandal in Snohomish County.  Perhaps now, they’ll come up with a response better than this:

News and commentary round-up, week ending August 27, 2019

● Last week’s round-up included an excellent op-ed from The Hill about doctors who actually want their peers to “think less” before suspecting their patients’ parents of child abuse and referring the children to hospitals for batteries of tests – and quite possibly calls to child protective services leading to foster care.  What some of these doctors want is even worse; a wholesale expansion of the child welfare surveillance state.  I have a blog post about it.

● A tragic example of how the “think less” approach plays out in real life can be seen in this excellent op-ed column for The New York Times from Jessica Horan-Block, a lawyer for the Bronx Defenders.  It’s called “A Child Bumps Her Head. What Happens Next Depends on Race.”

● There’s also a great op-ed in the New York Daily News. This one is from Jeannette Vega, training director for Rise. It’s about legislation to bring modest reforms to New York State’s Central Registry of alleged child abusers.  The bill is now on Gov. Andrew Cuomo’s desk.

● Also on the governor’s desk: Legislation that would allow children to keep in contact with their birth parents even after parental rights are terminated, if a judge found it to be in the children’s best interests.  The Albany Times Union has two letters supporting the bill.  One is from family defense pioneer David Lansner.  The other is from lawyers whose organizations represent 90 percent of the children in child welfare cases in New York City.

● In Talk Poverty, Elizabeth Brico has an excellent overview of how financial incentives encourage the misuse and overuse of foster care.

● Remember that story about the school district in Pennsylvania that was threatening to report families to child protective services if they didn’t pay school lunch debts?  It caused a nationwide furor.  But that district is not alone.  The Philadelphia Inquirer reports that several southern New Jersey school districts have policies that allow school officials to do the same thing.  So, in an effort to educate the educators who really ought to know better, here again is a blog post about why this is so harmful to children.

In child welfare, it’s the scientists who want their peers to "think less"

Too much thinking stands in the way of an ever-larger child welfare surveillance state

In the climactic scene of Inherit the Wind a film loosely based on the Scopes Monkey Trial, the character based on Clarence Darrow – making the case for the right to teach evolution - is questioning the character based on William Jennings Bryan, who makes the case for creationism.

But the Darrow character argues that more than creationism vs. evolution is at stake.  The case really is about the right to think:

I love that scene.  I suspect a lot of my fellow liberals love it, too.  Science, after all, is all about thinking, and only fundamentalists could oppose that, right?  In fact, it’s preposterous to even imagine a field in which women and men of science – doctors, no less – would actually urge their fellow professionals to do less thinking – uh, right?  Right?

Well, not exactly.  Because in the upside-down inside-out world of child welfare, there are medical professionals who are doing exactly that – literally.

Andrew Brown, director of the Center for Families and Children at the Texas Public Policy Foundation, first brought this to light in an excellent op-ed column for The Hill called “The doctor will accuse you now.” He writes about how two doctors, Richard Klasco, a professor of emergency medicine, and Daniel Lindberg, a professor of pediatrics, are urging their colleagues to adopt an approach they themselves call “think less, screen more.”

The idea is this: If a child has certain injuries, sometimes even something as minor as a bruise, these injuries are more likely – or, a better way to put it – less unlikely to be caused by abuse than other injuries. 

Up to now, doctors have been told to consider these injuries in the context of things like family medical history and the plausibility of a parent’s explanation.  If there is still genuine concern that the injury might be a sign of another problem – be it abuse or a medical condition – they’re supposed to refer the child for additional medical tests, in particular x-rays – which then are reviewed by professionals who, again, are supposed to consider all possible explanations.

Getting rid of that pesky context

But under the think less-screen more approach, we get rid of all those other pesky considerations. 

● First, the proponents say, we have to vastly expand the definition of what kinds of injuries are deemed suspicious – or maybe even eliminate definitions altogether and deem any visit by any child to an emergency room suspicious.

● Then any such injury, or ER visit, regardless of family medical history or explanation, should automatically prompt, at a minimum, a demand for a “skeletal survey” – equivalent to 20 standard x-rays of the child.

As a family profiled by Brown in his op-ed put it in their own post, it’s like leaping from: “smoking causes lung cancer” to “anyone who has lung cancer is a smoker.” 

Actually, it’s worse. The treatment for lung cancer is likely to be the same regardless of the cause.  But if one leaps to the conclusion that any bruise of a certain nature is probably child abuse, the consequences for the child can be far worse.

Lindberg and Klasco summarize their case, and use the term “think less, screen more” in an op-ed for Time magazine.  But Lindberg goes into far more detail in an essay for the Journal of Pediatrics.  That essay is co-authored by Dr. Rachel Berger. She runs the “Child Advocacy Center” in the Department of Pediatrics at the University of Pittsburgh Medical Center Children’s Hospital.  She also is prone to minimize the enormous harm of foster care, as can be seen in a commentary she co-authored that is discussed toward the end of this previous NCCPR Blog post.

It’s not that Lindberg, Klasco and Berger are ill-motivated. On the contrary.  The nature of their work means they see the very worst that parents can do to their children (though the nature of their work also means they see it so often that it may distort their perception of how often it happens). Like all of us, they are genuinely horrified and want to do something about it.  What they don’t seem to see, however, are the horrifying consequences for children of false allegations and needless foster care.

So in their current article, Berger and Lindberg say referring a child for a skeletal survey, and sometimes even more tests, based on suspicion of child abuse should be routine whenever there is a so-called “sentinel injury,” a term typically applied to a narrow range of bruises and other injuries in infants.

That’s not because children with sentinel injuries probably were abused.  In fact, in any given year, of all Americans under age 18, fewer than two-tenths-of-one-percent were believed by child protective services workers to be victims of any form of physical abuse, from the most minor (some CPS workers consider a spanking to be abuse) to the most severe.  (Even if we assume that the “real number” is twice as high, which is unlikely,* that still means more than 99.5 percent of American children are not physically abused in any way in any given year.)  But, Berger and Lindberg argue, the percentage who show up with “sentinel injuries” and were abused isn’t as low.

Nevertheless, Berger and Lindberg call for vastly broadening the types of injuries that should be deemed “sentinel injuries” and raising the age for labeling them “sentinel injuries” to age 4. And maybe not just actual injuries. Berger and Lindberg say even a baby’s “fussiness” could be a sign of serious abuse.  

If the family doctor – or any other medical practitioner - sees a "sentinel injury," the authors argue, the doctor should, literally “think less, screen more” -- put the family under suspicion and send them to the hospital for a battery of tests on the child.  Those tests may be evaluated by doctors who are so-called “child abuse pediatricians.” Even when they don’t have that designation, the doctors looking at all those x-rays may be predisposed to find abuse by the very fact that child abuse is the suspicion that prompted the referral in the first place.

But even that isn’t enough for Berger and Lindberg.  They go on to cite, with approval, a mechanism Berger developed in which every child who is brought in to an emergency room is automatically “screened” for abuse and, presumably, further tests, via a checklist of “risk factors” – regardless of whether there are “sentinel” injuries. The results go into the child’s electronic health record. And here’s the great news, they write: Berger’s model is based on one already “validated” in the Netherlands.  But you have to follow the endnote to the actual Dutch study to learn that the checklist got it wrong more than 89 percent of the time.

But so what? say Berger and Lindberg. Lots of medical tests are performed routinely for screening and come up negative in most cases.  But none of those other tests can result in a child being confiscated on-the-spot and consigned to the chaos of foster care.  Berger and Lindberg's approach would place many more families under suspicion. That, in turn, would place their children at exactly that risk.

It gets even more absurd

But the absurdity is just beginning. 

Berger and Lindberg actually call for less thinking on the grounds that it will eliminate bias!  In other words, no need to worry about, say, being too suspicious of Black parents and needlessly demanding they get their kids x-rayed if you simply suspect everyone and demand that all parents whose children have certain symptoms subject those children to testing.

On the one hand, I suppose it’s progress that these doctors acknowledge that bias among their colleagues is so pervasive and so deep that the solution is to bar them from even thinking.  But even if one assumes vastly widening the net of a cruel, stressful intervention into children’s lives is the best way to eliminate bias, there’s still a problem – it doesn’t eliminate bias; it just kicks that particular can down the road.

X-rays don’t read themselves.  Conclusions are drawn by doctors.  In this scenario, the doctors already know that the referral is based on a suspicion of child abuse.  If you add to that the fact that the family walking through the door for those x-rays is a family of color you have just as much, if not more, potential for bias than existed before.

Bias may be even more likely if the person looking at those x-rays is a so-called “child abuse pediatrician” and/or part of a “child abuse team.” This is a new subspecialty in which people who already have the certification supervise the training of other doctors who want the same certification. So whatever biases might have been there when the subspecialty was created, in 2009, are likely to be perpetuated.

I am aware of no studies concerning who becomes a child abuse pediatrician and why.  I do know that I have never read a story in which a child abuse pediatrician says: “I kept finding families who were destroyed, and children who suffered enormously when those parents were wrongly accused of child abuse. So I vowed to learn everything I could and become a child abuse pediatrician so I could stop children from being hurt that way, and make sure we were focusing on children in real danger.”

One need only look at how readily the field overdiagnosed “shaken baby syndrome” to see the potential for bias. 

In her book, They Took the Kids Last Night, family defense attorney Diane Redleaf describes case after case of misdiagnosis of child abuse.  But, she notes, “Not one child abuse pediatrician I knew of ever admitted their opinions about abuse were ever mistaken.”   She calls the field “a specialty stacked in favor of finding child abuse.”

And it is not exactly reassuring that Berger, Lindberg and Klasco all repeatedly minimize the harm of a false accusation.  Lindberg and Klasco claim in their op-ed that the worst that will happen is that “some non-abused children will be screened, and some non-abusive parents will be offended.”

No.

As Andrew Brown explains, the worst that can happen is what happened to the children of Rena and Chad Tyson – after the parents were told to get the child x-rayed and the x-rays found fractures:

Rather than attempting to find a medical explanation, doctors at the hospital contacted Child Protective Services. All three of the Tysons’ children were removed by the state and placed in a kinship foster placement. The family would be separated for five months while Rana, Chad, and their children’s pediatrician worked to figure out the cause of the fractures.

The real causes were a series of medical conditions.  But the children were trapped in foster care and the legal and medical bills bankrupted the family.

Oh, wait, that’s not even the worst.  The Tysons’ children were placed with relatives and the parents could see them every day.  Anyone care to bet how this “bias-free” system would have responded had they been poor and nonwhite?  Oh, wait again. We know exactly how it would respond – the same way it always responds - as described here.

There are many other cases, and they all, as the doctors might say, present with similar symptoms: doctors whose specialty is child abuse jump to the conclusion that the cause of the “suspicious” injury is child abuse. 

Adding even more bias

Berger and Lindberg support approaches that would make the process even more biased.  For page after page they go on and on about how decisions can be based on looking objectively at physical injuries.  But then they speak admiringly of a frightening surveillance-state process already in place in Britain thanks to the use of electronic health records.

Berger and Lindberg write:

[Child protective services] shares information with the National Health Service about children who are on a “Child Protection Plan.” If that child then receives medical care in any unscheduled care setting, such as an [emergency department] or urgent care center, the healthcare team is alerted and given access to the contact details for the CPS caseworkers and service providers. In addition, CPS is automatically notified that the child has been to the ED, and both parties can see details of the child’s previous 25 visits to EDs or urgent cares.

Here’s why that’s so scary.

1. The overwhelming majority of cases in which families are under some kind of child welfare agency supervision (our equivalent of a “Child Protection Plan”) don’t involve abuse at all – they involve neglect, where the determinations are most subjective of all.  Indeed, what CPS workers call neglect often is simply poverty.

2. The people most likely to have “receive[d] medical care in any unscheduled care setting” are, of course, poor people. 

So now, under this plan – which Berger and Lindberg seem to love – any poor parent “under supervision” because of “neglect” automatically is doubly suspect if s/he has to take a child to the ER.  And visiting the ER, for any reason, becomes part of the child welfare agency’s case file, ratcheting up suspicion of the family.

Berger and Lindberg also write approvingly of a system in New South Wales, Australia, in which a “Child-At-Risk” alert is in the electronic health record for any child whose parents were subject of any report alleging child abuse or neglect.  But in the United States, more than 80 percent of such reports are false reports.

Now throw in "predictive analytics"

As I read all these glowing accounts of building a bigger and bigger child welfare surveillance state, I thought to myself: Oh God, imagine what would happen in Pittsburgh, where Dr. Berger works, and where the child welfare agency already harvests vast troves of data about poor families Cambridge Analytica-style – that is, without their consent, and uses it against them in its “scarlet number” predictive analytics algorithm.

Sure enough, just a few paragraphs later, Berger and Lindberg start singing the praises of the algorithm.  They repeat the misleading claim that the Pittsburgh algorithm may have reduced racial bias; in fact any reduction was solely a result of screening in more white people.

The solution to bias is not to refer more and more families to “child abuse pediatricians” for less and less reason.  The whole biased process starts the moment the family doctor pulls the trigger and sends the family for additional “screening” when it isn’t necessary.  Berger and Lindberg's approach winds up making all doctors trigger-happy.

But wait, say Berger and Lindberg – at least under the “think less” approach, if the x-rays don’t show abuse, the family can be cleared – so, isn’t it worth getting those x-rays?

But that claim is debunked - by accident - in an editorial in the same issue of the Journal of Pediatrics as the Berger/Lindberg essay.  The editorial, written by Dr. Mary Clyde Pierce, a child abuse pediatrician, is not a critique – it’s highly-supportive of the “think less” approach. But, according to the editorial:

Importantly, the sentinel injury in and of itself may be enough to not only prompt a further workup for other abusive injuries (eg skeletal survey) but also to report the event to social services regardless of the results of the additional workup (eg, negative skeletal survey).

(Emphasis added. And by the way, did you notice how Clyde Pierce says other abusive injuries? In a classic example of the bias that pervades the field, the immediate assumption is that all sentinel injuries are abuse.)

But wait, there’s more:

“When the screening studies are negative, the assumption is sometimes erroneously made that “abuse is ruled out” or it is not abuse because the screening studies were negative. These screening studies … cannot “rule out abuse.”

In fact, Clyde Pierce declares, if an infant with a sentinel injury has no history of trauma and a negative skeletal scan, that actually might put the infant at even greater risk – by lulling professionals into a false sense of security that he wasn’t abused!

So you see, in the world of child abuse pediatrics not only are you guilty until proven innocent, there’s no way to prove your innocence!

The all-purpose fallback argument: Horror stories

In the end, Berger and Lindberg are forced to fall back on the argument that’s always used to get us to “think less” – horror stories.

So they tell us all these elements of the child welfare surveillance state are needed because of the “regular occurrence of fatalities in children previously reported and screened out by CPS…”  “Regular occurrence" is not, of course, a scientific term.  It can mean whatever you want it to mean.  But here’s what we do know: More than 7.5 million children become “known to the system” every year.  An enormously generous estimate of the proportion of those children who die is two-tenths-of-one-percent. 

Each of these deaths is the worst form of tragedy, and the only acceptable goal for such “occurrences” is zero.  But the idea that, in the course of sifting through reports on about 7.5 million children every year, agencies “regularly” screen out cases in which children later die is not borne out by those numbers.  On the contrary, it is graphically obvious that it is an extremely rare occurrence. Here’s the graphic:

For a much more detailed discussion of how figures about child abuse fatalities are regularly misused to get us to “think less” see this previous post.

But the best evidence that the surveillance state approach won’t work comes from the Berger-Lindberg article itself.

The modern process of constantly ratcheting up surveillance of families began more than half a century ago with the first wave of mandatory reporting laws requiring certain professionals, especially doctors, to report their slightest suspicion of abuse or neglect. The scope of the laws and the professions they cover have steadily increased since, despite the fact that there is no evidence these laws actually make children safer.

In 2009, the medical profession created the subspecialty of child abuse pediatrics.  Since then, Berger and Lindberg say, the number of such doctors has more than doubled and the scholarly literature has “increased dramatically.” 

This vast expansion of the child welfare surveillance state gotten to extreme that one study estimates that at some point during their childhoods one-third of American children – and more than half of African-American children will have to endure a child abuse investigation.

Yet Berger and Lindberg themselves admit it hasn’t worked: As examples, they cite studies showing no change in the proportion of cases of “abusive head trauma” (AHT) that are being overlooked. (AHT is the new term the field came up with after all that misdiagnosis of “shaken baby syndrome”) Then they add: “Perhaps most disturbing is that the number of deaths related to physical abuse has remained stable at approximately 600 annually.”

By their own admission, all that additional suffering inflicted on children by the child welfare surveillance state hasn’t done a damn thing to make children safer.  Yet their solution is to make the surveillance state vastly bigger and more intrusive.

Perhaps Berger and Lindberg would have seen the problem with this – if only they’d given it a little more thought.

________

*-While it is, of course, likely that some allegations of physical abuse are mistakenly labeled unfounded, the only study I know of to second-guess these decisions found that caseworkers are two to six times more likely to wrongly substantiate an allegation of child abuse or neglect than to wrongly label it unfounded