Sunday, January 6, 2008

Drowning in Misinformation

You’re late for work one morning. Before you get to work you need to get your two-year-old daughter to day care. You’ve just buckled her into her car seat – or did you? - when you remember some extremely important document you left in the house.

You know what you’re supposed to do – unbuckle your daughter and walk her or carry her back in with you; but you’re running late, it’ll only take a second and, what could possibly happen?

999 times (or more) out of 1000: Nothing. But there’s always that one time that can lead to catastrophe – especially if you hadn’t quite buckled the child in.

That’s just one scenario.

Are you sure you childproofed every electrical outlet? What about the one behind the sofa – until you rearranged the furniture last month? Now that your child is three, are you certain she can’t unlatch the back door? Are there any heavy items of furniture, even big books on high shelves, that can come loose while your back is turned or you’ve just run into another room to answer the phone? And, are you absolutely certain you locked the sliding door that leads to the swimming pool?

The number of such scenarios is endless; I suspect any parent could come up with a dozen variations off the top of her or his head. And, according to the Florida Child Abuse Death Review Team, unless you can honestly say none of them has ever applied to you, you are guilty of child neglect.

That means almost every parent in Florida, and pretty much everyplace else, is guilty of neglect. But if everything is neglect, nothing is neglect. It only desensitizes us to the real thing. And that’s the least of what is wrong with the approach the Team has taken in its latest annual report, which exanmines deaths that occurred in 2006 and was released at the very end of 2007. The worst of it is the incredible cruelty of its recommendations – and the harm those recommendations can do to the siblings who survive after a scenario like the ones suggested above takes the life of a child.

As usual in child welfare, the cruelty and the harm are not intentional. If I’d spent a huge amount of my time pouring over autopsy reports and other documents about the deaths of helpless, innocent children, I think it would distort my perspective as well. The resulting report is another example of the distortion inherent in a skewed sample, something discussed on this Blog previously in connection with reports from the New York City Department of Investigation and the New Jersey Office of Child Advocate. Tragically, the Florida team has a larger sample to work with, since it looks at every child maltreatment death in the state, and it is now applying a very broad definition of maltreatment – but in a state with four million children, the sample is still grossly unrepresentative.

This kind of distorted perspective becomes a form of self-indulgence – indulging one’s righteous wrath, even if the consequences are only more harm to more children.

In one sense, it would be in my interest not to bring all this up. The report generated headlines across Florida about a supposed record number of child abuse deaths. That reinforces what NCCPR has been saying in that state for a long, long time.

We first predicted that deaths would go up in 1999, when the child welfare agency came under the control of a leader more hell-bent on a take-the-child-and-run approach than any we’d encountered anyplace else in the country. She set off a huge foster-care panic; removals soared 50 percent in a single year. Though she’s long gone, and there now are wide variations in different regions, the foster-care panic she started never stopped, and statewide, Florida still takes children at the same rate as in 1999. (For more on all this, see NCCPR’s Florida Rate-of- Removal Index and our other reports on child welfare in Florida).

Unfortunately, our prediction about fatalities was correct. We’ve argued that the only hope for reducing such deaths is to rebuild the system to emphasize safe, proven programs to keep families together. And as the Florida system decentralizes, some parts of the state are trying to do just that.

So, if we used “advocacy numbers” and felt that it was o.k. to bend the truth because, after all, it’s for a good cause, (something done over and over by various alleged ‘child advocates’) NCCPR would put out a press release that said Florida’s ongoing embrace of a take-the-child-and-run approach to child welfare, statewide, had led to still another huge increase in child abuse deaths.

There’s just one problem: We don’t know that it’s true. In fact, it’s probably not.

It’s not entirely clear, either from news accounts or the report itself, but it appears that the “increase” is a result of a concerted effort to label scenarios like those above neglect instead of what they really are: accidents. Terrible, tragic accidents, but accidents nonetheless. The kinds of accidents that should make all parents of young children think twice, but before wagging a finger, also make us think: “There but for the grace of God…”

Consider some real cases, as reported by the St. Petersburg Times in its story about the Death Review Team report:

Joyce White, 54, of Plantation was sitting on the front porch with her 3-year-old grandson when the phone rang.

When she returned, Garcie Luna was gone. He was found in a neighbor's pool. The fence surrounding the pool had been damaged during Hurricane Wilma and was missing a gate.
"It was just a few seconds of carelessness on my part for answering the phone and my neighbor's part because they didn't fix the gate," White said of the death in March 2006.
"It's torn our lives apart. It was more than I could take losing him, especially for something so stupid."

Ann Unger set her 9-month-old daughter on the floor of the family's Plant City home and headed to the bathroom. Angelica, a fast crawler, usually followed close behind. Not this day.
Five minutes passed. Or was it six?
When Unger, 22, returned to the room, Angelica wasn't there. A frantic search ended in the backyard pool, where Unger found the child floating face down.
The mother's screams pierced the neighborhood as efforts to save the baby failed. Angelica Unger died on Jan. 24, 2006, three months before her first birthday.
In the past, her death likely would have been considered accidental, a family tragedy. But investigators labeled her death a result of parental neglect. Unger had left open the door that led to the pool. …

Or consider a case that would, were I to accept the Review Team’s new definition of neglect, reinforce the case I’ve been making for years:

Cara Eaton's drug problems prompted caseworkers to take her infant daughter.
But weeks later, the baby died in foster care. The one-month-old suffocated after her Sarasota County foster mother put her to sleep face down.

Eaton, 31, of North Port blames DCF and its foster care contractor, the Sarasota Family YMCA. She wanted the child with her grandmother, instead of foster care.

But, if this is all that happened, Cara Eaton is mistaken. The Review Team report notes that nationwide there is a “back to sleep” campaign to alert parents to the fact that it is safer to put an infant to sleep on his or her back. Odds are the foster parent simply didn’t know it or, if it was part of her training, she forgot it.

The grandmother might have made the same mistake. (There are lots of other reasons to prefer kin placements, of course). It was an accident. Accidents happen. That doesn’t mean we have to be sanguine about it; on the contrary, we need to focus more efforts on real prevention, but that begins by recognizing accidents for what they are.

Of course the Times story also included some very different scenarios, like these two:

Alyssa Doe's mother left her to die in a West Tampa alley shortly after she was born. Relatives alerted police to her mother, Mary Louise Doe, after finding her no longer pregnant and unable to explain where the baby was. Mary Louise told authorities that alcohol and crack cocaine blurred her memory of the birth in May 2006. A judge sentenced her to five years in prison and 10 years of probation. Alyssa Doe was just one of many children who died while their caretakers were under the influence.

Hunter Lanier, 2, of Santa
 Rosa County died in a car accident after his mother wrecked after drinking and driving.
But that’s the whole point. Any reader can draw common sense distinctions here. The Death Review Team should be able to do so as well. Yes, there also are fact situations that fall in between, where the judgment call is tougher, but that’s part of the job.

Instead, the Review Team seeks to prohibit such judgment calls at all. It demands that every drowning death be reported to the state’s child abuse hotline for a neglect investigation.

The Review Team would argue that I don’t understand; none of this is meant to be punitive, they would say, we just need to label these cases as neglect in order to bolster prevention efforts. But why? Why, exactly, does it require labeling someone neglectful – and possibly taking away surviving siblings – in order to get more people to be sure the door to the backyard pool is locked?

Obviously it doesn’t. As with so much else in child welfare, this is another example of hate disguised as love. It’s not about helping children, it’s about punishing “bad parents.” Almost all of the recommendations involve doing more to treat parents as suspects and/or to punish them. Apparently, nobody on the Review Team even thought of a simple and obvious way to reduce drowning deaths: Florida law already requires fencing around pools built after 2000. So why not give a big tax credit or other incentive to homeowners and landlords who fence in their older pools? But that doesn’t involve wagging a finger at parents, so it’s not on the Team’s radar.

It also is revealing that Manatee County, the county where the chair of the review team is in charge of child abuse investigations, has the highest rate of removal in its region, and one of the higher rates in the state.

And the Review Team’s approach undermines real prevention.

For starters, all the money for all those additional investigations and additional foster care could have been used for things like a more effective “back to sleep” campaign – or those tax credits to put fences around pools.

Worse, it plays into the take-the-child-and-run mentality that still plagues much of Florida.

The worst consequence of that is the danger to the siblings.

There may be no time when it is more important for a family to stay together than in the wake of a tragic accident. But once you label the parent neglectful, the chances soar that the surviving siblings will be torn from their parents, and each other. So at the one time when, say the four-year-old brother of the two-year-old who drowned most needs his big sisters, ages 6 and 8, and his mom and dad, he is taken away from all of them and suddenly placed with strangers. It would be hard to find a better way to almost guarantee lifelong emotional scarring. Indeed, the four-year-old is likely to think he’s somehow responsible for the drowning – why else is he being punished?

Of course that won’t always happen. It depends on who’s running the state child welfare agency. And who’s running the private agency in charge of all substitute care in a given region of the state, under Florida’s “privatized” system. And who’s in charge of the child welfare agency in that particular region. And, perhaps most of all, it depends on whether a high-profile child abuse tragedy is in the headlines locally.

Not only does the Review Team fail to recognize this, the Team actually belittles the compassion of those who do. According to the report: “Often drowning deaths are not reported as neglect. It is felt that ‘the family has suffered enough’ or ‘it’s just a tragic accident.’”

But that’s because, in many cases, the family has suffered enough, and it is a tragic accident. (No one in fact would call something this awful “just” a tragic accident – that’s the Team’s way of stacking the rhetorical deck).

The report argues that any drowning in a bathtub “should be looked at as neglect” since the only way to be sure it never happens is for the caretaker always to be in the bathroom with the child.

And that is the heart of the matter: If a parent in such a circumstances runs out of the room to answer the door or the phone and the child dies, then the death was, indeed, preventable. But what is accomplished by slapping the label neglect on the parent? What is accomplished by, in some cases, throwing the siblings into foster care – where the risk of actual abuse probably is one in three?

Nothing. In fact, under circumstances like these (as opposed to those where the failure to supervise is due to drug abuse, for example) the one person in the state of Florida least likely ever to leave a child alone in a bathtub ever again is the one who has endured such a tragedy.

While not as serious a problem, the Review Team report also contributes to Statistics Abuse. I began this post with one example – claims that there were a record number of deaths in Florida in 2007. This is still another reason why it’s difficult to measure progress, or lack of it, in child welfare based on fatalities. What constitutes a child abuse fatality can be surprisingly subjective. Last year’s accident is this year’s “neglect” death.

And not only can definitions change from year to year, they also vary from state to state, and even region to region within a state. The competence of state death review efforts also varies enormously.

That’s why one of the most intellectually dishonest things an advocate – or a reporter, if she or he knows better – can do is to try to compare fatality rates among the states. The only thing that does is penalize states that are rigorous about determining causes of death and zealous (rightly or wrongly) about labeling a death as maltreatment.

For example, several years ago, Washington State bragged about its low rate of child abuse fatalities compared to other states. Then the Seattle Post-Intelligencer did a series on how many such deaths allegedly were unreported and/or mislabeled.

This kind of statistics abuse also fuels the hype about child maltreatment in general. For example, the St. Petersburg Times story says:

An analysis of 2006 state death reports, the latest data available, shows seven out of 10 child deaths were due to neglect.

Well, yes. And if the Review Team keeps broadening the definition of “neglect” in a couple of years it will be nine out of ten – and it will mean absolutely nothing. But it will make a great “scare number” to make people think “neglect” is far more prevalent than it actually is.

What the Review Team report really illustrates is the need to focus more attention on deaths due to accidents. Of course, Freud said there are no accidents. But I’ll bet Mrs. Freud raised the kids.