Sunday, December 2, 2007

How "Dr. Sooze" distorts the nooze

Last week, I wrote about the harm done by child welfare “ombudsmen” or state Offices of Child Advocate. Because they are almost always created in the wake of deaths of children “known to the system” their primary mandate almost always is to focus on such cases. That inherently distorts the perspective of the office, leaving the impression that systems err in only one direction, leaving children in dangerous homes. The problem is compounded by the fact that the people named to head these offices often come to the job with exactly that preconceived notion.

Last week’s blog focused on one of the two exceptions: Kevin Ryan, New Jersey’s first Child Advocate. It talked about how his tough-minded reports focused on errors in all directions, and how that helped improve one of the nation’s most troubled child welfare agencies.

The New Jersey system was never very good, and a few years ago, under dreadful leadership dominated by a take-the-child-and-run mentality, it hit rock bottom. The number of children taken from their parents started to soar in 2001, engulfing workers and collapsing the system. That became all too apparent when the death of Faheem Williams was discovered in January, 2003. News coverage of that case set off a foster-care panic, making everything worse.

A class-action lawsuit settlement, and the naming of Ryan to run the child welfare agency, brought the first steps in the right direction – reduced entries into care and concrete evidence of improvements in child safety. The improvements were attested to in a report by the independent court-appointed monitor overseeing the settlement.

But those findings soon were overshadowed by the work of “Dr. Sooze.”

That’s how Dr. Susan Hodgson likes to be known. When Ryan went from watchdog over the child welfare system to top dog within that system, Hodgson was named the new “Child Advocate.”

Dr. Sooze is a pediatrician specializing in child abuse cases. In other words, she’s spent much of her life in settings where one sees the very worst cases, cases which bear no resemblance to a typical CPS worker’s load. It’s a background that easily can distort one’s impression of who gets caught up in the system and why, and that helps explain what happened next.

Dr. Sooze promptly abandoned the innovative approach of her predecessor. It was back to spewing out conventional reports filled with conventional wisdom about deaths of children “known to the system” – and nothing else.

And then she did something worse. She broke the previous record for an agency making vast generalizations based on minuscule, unrepresentative samples. The previous record-holder, New York City’s Department of Investigation, trashed the City child welfare agency based on the eleven worst cases it could find over a period of about six months. (See the August 13 entry on this Blog).

New Jersey OCA goes New York DOI one worse. It draws sweeping conclusions about the work of thousands of dedicated people in New Jersey’s child welfare agency based on the absurd notion that a grand total of three horror story cases, one of which dates back to 2004, can possibly tell us anything about the overall status of casework in 2007. The link to this report on the OCA website describes it as a report on “Global Issues.” The press release calls the issues “systemic.” But the report offers not a shred of evidence that the issues are either.

At least, unlike New York City’s DOI, OCA acknowledges on the first page that “from this review, it is impossible to know how widespread the errors are that were present in these cases…” but the report then goes on to generalize anyway.

And it’s the generalizations that are the problem.

On the one hand, the tone of the report is commendably measured and the specific recommendations largely meet the Hitchhikers Guide to the Galaxy test: They’re mostly harmless. A few even are good.

But the biggest problem in this report is the problem that is inherent in how OCA, and its counterparts around the country, are structured. They are geared to examine fatalities and near fatalities. Inevitably, they leave the false impression that the child welfare agency errs in only one direction: leaving children in dangerous homes.

That impression is heightened when Dr. Sooze goes on to make broad, sweeping generalizations based on the three worst failures she can find. The distorted impression that leaves concerning where things stand in New Jersey child welfare, and what’s wrong with it, promptly overshadowed a far more objective, more nuanced – but still highly-critical – report from the court monitor.

Imagine what would happen were any of us judged the way Dr. Sooze judged the child welfare agency. Even the best doctors make mistakes. But what if a doctor’s entire career were judged solely by the three cases in which his or her diagnoses were farthest from the mark. Imagine if any of us walked into one of those annual “performance review” rituals only to be told that we would be judged only by our three worst screw-ups over the past 12 months.

Or to put it more cosmically, for those who believe in such things, suppose when its time to go to our eternal reward, we are judged solely on the basis of the three worst things we ever did in our entire lives. Were that to happen, I suspect most of us would be doomed to spend eternity trapped on one of the more odorous sections of the New Jersey Turnpike.

The issue here is not that Dr. Sooze’s methodology is unfair to the child welfare agency. Rather, it’s unfair to New Jersey’s children. The wrong methodology leads to the wrong diagnosis, and, as every doctor knows, if you get the diagnosis wrong, the patient is far less likely to recover. The New Jersey child welfare system is still in critical condition. To switch metaphors, the monitor’s report offered a road map for further reform, Dr. Sooze offered only a detour.

The detour is especially dangerous in light of one of the three cases that made up the so-called Global Issues report. In this case, the most critical of many tragic errors took place all the way back in 2004; when the system still was laboring under the foster-care panic set off by the death of Faheem Williams. If anything, this case was still one more illustration of how foster-care panics endanger children. But instead of pointing this out, the Global Issues report only increases the likelihood of another panic.

The only way to know the status of typical casework is either to be in a position like that of the court monitor, able to use a wide variety of means to see how the system typically operates, or to review a random sample of cases, using reviewers who either are objective or who are drawn from organizations with differing perspectives that balance each other. That’s exactly what Kevin Ryan did when he was child advocate, producing the Families Under Supervision report described in last week’s blog.

One look at the website of the current New Jersey Child Advocate suggests we’re not going to see anything better anytime soon.

One can see what has gone wrong at the New Jersey Office of Child Advocate just by looking at the agency’s website. Anyone who has seen the website evolve since “Dr. Sooze” took over will notice one thing immediately. The site, which used to be crisp and professional, is now cutesy and cloying. But that’s not the problem.

The problem is summed up by the following item that appeared in October under the heading “Dr. Sooze says:”

“Eating healthy will keep kids awake and aware throughout the school day. All children should be sure to start the day with a healthy breakfast and eat only snacks that help them grow up strong throughout the day.”

Now I just want to go on the record: I, too, favor children eating a good breakfast and healthy snacks. But so do 99 percent of New Jersey parents. They don’t need a smug reminder of the obvious. When it comes to the parents who are likely to be the subject of child welfare agency attention, what they need is help in getting the food.

I’ll bet almost every child taken into foster care was eligible for school lunch and school breakfast programs – precisely because those parents couldn’t afford to give them that “healthy breakfast.” So wouldn’t it be a lot more helpful if “Dr. Sooze” provided links to food pantry locations and to places where these parents could get help obtaining foodstamps? But no. There was only a link to another website full of things like “Halloween Candy Hints” and similar information.

It’s the difference between a mindset that emphasizes a helping hand and one that emphasizes a wagging finger, and a mindset that has some concept of what it means to be poor, and one that doesn't.