Monday, July 10, 2017

Child welfare and the latest “drug plague,” part one: How the Washington Post story on opioids and foster care got almost everything wrong.

First of three parts

Read part two here: You’ll never understand child welfare if your only source isa trade association for child welfare agencies.

Read part three here: An analysis of a far better story on the same topic, from MotherJones.

A list of all the experts on opioid abuse and the effects of opioid abuse on children quoted in the Washington Post Story.


● The Post story is a throwback to the “crack baby” journalism of the 1980s.

● The story ignores the most important lesson from that era: Research showing that even children born with cocaine in their systems do better in their own homes than in foster care.

● Though there are scores of experts who can put the claims of foster parents and child welfare officials into context, experts who say that a knee-jerk rush to more foster care is the wrong answer, the Post either consulted none of them, or simply chose to quote none of them.

● The main story also includes not a single quote from a parent who lost a child to the system – instead they are portrayed in the main story – by the sources the Post reporters preferred – as sadistic brutes or hopeless addicts.

● The story ignores the few places that have bucked the trend and dealt with opioid abuse and child welfare through more and better drug treatment instead of a knee-jerk response of more foster care.

By reinforcing stereotypes, tacitly endorsing failed approaches and ignoring successful alternatives, the story is likely to hurt the very children the reporters almost certainly wanted to help.

Remember “crack babies”?  Sure you do.  Back in the 1980s, they were the infants supposedly doomed to a life of “certain suffering, of probable deviance, of permanent inferiority.”  The predictions were accompanied by graphic depictions of infants going through withdrawal, and condemnation of their mothers for “choosing” addiction over their children.

None of the dire predictions came true. By 2004, Columbia Journalism Review was, in effect, urging reporters to please knock it off. A few years later, The New York Times ran a story headlined “Crack Babies: The Epidemic That Wasn’t.” Years after that, the Times returned to that theme in a short documentary. And when W. Joseph Campbell wrote a book called “Getting It Wrong: Debunking the Greatest Myths in American Journalism” he devoted an entire chapter to “The Fantasy Panic: The News Media and the ‘Crack Baby’ Myth.”

None of that stopped journalists from making the same sorts of mistakes when a new “drug plague” – methamphetamine – became the center of attention.

But the media watchdogs keep trying.

Now that opioid abuse is the new official Worst-Drug-Plague-Ever, public radio’s On The Media is trying to put to rest myths about drug abuse with a “Breaking News Consumer’s Handbook” on the topic – part of an entire program devoted to myths about the war on drugs.

But most important, particularly in the context of child welfare, as early as 1998 pioneering research at the University of Florida confirmed that there is something much worse for infants than cocaine: foster care.

The researchers studied two groups of children born with cocaine in their systems; one group was placed in foster care, another left in their own homes with mothers deemed 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.  Consistently, the children left with their mothers did better.  For the foster children, the separation from their mothers was more toxic than the cocaine.

It is extremely difficult to take a swing at so-called “bad mothers” without the blow landing on their children.

But on June 1, The Washington Post came out swinging.

Like so many stories about crack cocaine and then later about methamphetamine, the Post made sure, right from the start, that readers would be furious with any mother who uses opioids.  In the very first paragraph, the reporters tell us about babies who, thanks to a loving foster mother, “no longer scream and shake for the opioids to which they were born addicted.”

By the third paragraph, the foster parent is telling the reporters “It’s heartbreaking to watch a baby go through withdrawal and then give that baby back to Mom. Because she did that to her.”

And later we’re told that “Other foster parents similarly described hosting children who had sensory disorders, speech delays, and sleep anxieties that developed while the children were living with their drug-addicted parents.”

The message from the Post story is that we should ignore the lessons from that actual study in Florida, pile up third-hand anecdotes (foster parents who heard from caseworkers about terrible birth parents) and conclude that the only answer is to take away the children.  And it’s no wonder the foster care system is bursting at the seams so we need lots more foster parents etc., etc. 

There is molehill of truth in all this – and a mountain of hype.  The problem of drug abuse, like the problem of child abuse, is serious and real. There certainly is evidence of a tragic increase in opioid abuse. It’s also true that some parents with drug problems can’t take care of their children. And among those are some who can’t be treated.  Those children need to be taken away.  But that is a far cry from the message left by the Post.

On balance, the Post story is not the worst of its kind. It’s not as bad as the stories Reuters published a couple of years ago, for example, to which NCCPR responded here. But being in the Post, it’s bound to spawn a host of imitators at the national level. (Many local papers already have done similar stories, of course.)

And in some respects, the Post story is worse. As will be discussed in detail on this Blog tomorrow, The Post story blindly accepts a false history of American child welfare provided by a child welfare agency trade association, stereotypes all parents who lose children to the system as sadists, brutes and/or addicts and accepts drug abuse as the all-purpose excuse for rising foster care numbers.  So while the Post story does not descend to the hyperbolic rhetoric that characterized “crack baby” stories, it sends the same basic message.

Who needs experts when we’ve got horror stories?

For starters consider two groups of people who are entirely absent from the Post story:

● Not surprisingly, the story omits birth parents who lost children to foster care. Apparently, the Post reporters simply assumed they were two scummy even to bother talking to for their main story. (One couple is deemed sufficiently repentant, and their case reflects sufficiently well on foster care, to make it into a video sidebar.) 
 ● But the story also omits another group: Experts on addiction – and experts on the actual effects of opioids on children. People such as the pediatricians who did the Florida study. Or the scores of researchers who, every decade or so, warn about the hype surrounding the latest drug plague – as in this letter  -- begging the media not to do what the Post just did. That letter has more than 50 signers. The Post reporters either did not speak to any of them or chose not to quote any of them.

Among the facts the Post never learned by ignoring all these experts is that, in those cases in which a newborn does go through withdrawal, the best way to treat the infant is by allowing that infant to be held and, when possible, breastfed - by her or his mother. [UPDATE, JULY 14: The New York Times has an in-depth story on why this is the better option for such infants]. So some of the problems those foster parents are describing may be a result of resorting to foster care itself. 

More generally, foster parents quoted in the story describe a range of emotional problems that might be related to parental drug abuse, or might be related to taking the children away from the parents – or both.  But the experts who could have helped the reporters sort that out are entirely absent from the story.

Addiction as a moral failing

There also is widespread consensus that addiction is a disease, not a moral failing. So imagine the following scenario: A parent has a gene that creates a predisposition toward a form of cancer. The gene is passed on to her child and the child gets cancer. Would we then take away the child and quote a foster parent declaring it “heartbreaking” to “give that baby back to Mom. Because she did that to her”? 

We don’t even say this about children born to mothers who smoke tobacco – even though the potential ill effects of tobacco on infants may be as serious as the effects of using cocaine, for example.  In fact, we don’t take away those children in the first place.

So it is not, in fact, opioid abuse that is driving the increase in foster care. Rather, it is the typically dumb, shortsighted response to opioid abuse by American child welfare – a response rooted in our desire to punish “bad parents,” no matter what that does to their children.


Ignoring better alternatives

The Post ignores the few places that are refusing to jump on that bandwagon – the places with a better response.

Joette Katz, who left the Connecticut
Supreme Court to run that state's
child welfare agency understands
how to deal with drug abuse
and child welfare...
While noting a 19 percent increase in the number of children foster care in Massachusetts between 2011 and 2015, the Post ignores the fact that, during those same years, in neighboring Connecticut, the number of foster children declined by more than 20 percent.

That’s not because opioid abuse suddenly stopped at the state line. Rather, it’s because Connecticut’s gutsy child welfare agency chief, Joette Katz, understood two things:

● The state had been misusing and overusing foster care for decades, so there were plenty of children in foster care for all sorts of reasons who could safety be returned to their own homes – and other children who no longer would be taken needlessly.  
 ● In cases where drug use was such that parent really could not safely care for a child, the best option for many such families is home-based drug treatment. So Connecticut made a big investment in that kind of treatment.

And through it all, child safety has improved.

Massachusetts also has been taking away children at an obscene rate – well above the national average – since long before the latest drug plague. But Massachusetts lacked Connecticut’s strong leadership – so the state never kicked its addiction to foster care and was far less prepared to deal with an increase in opioid dependence. The same applies to other states cited by the Post, such as North Dakota.

What else would you expect from Paul LePage?

...Paul LePage, the Trump-loving
tea-party governor of Maine,
does not.  -- Photo by Gage Skidmore
As for Maine, the state that is the primary focus of the Post story, that state has a long, ugly history of
needless removal of children. But when John Baldacci became governor in 2003 he brought in reformers who made enormous progress transforming the system by curbing needless foster care. Maine’s child welfare reform even was a finalist for an Innovations in Government Award from Harvard’s Kennedy School of Government.

But under the current governor, the Trump-loving tea party favorite Paul LePage, there has been backsliding. Of course, with that kind of a governor, the state will rush to tear apart families as soon as someone yells “drugs.” (There’s more about the Maine reforms here and in this perspective – from a Maine foster parent the Post reporters should have talked to, but probably didn’t know about.)

The Post story itself offers a clue to the fact that not all of these entries into foster care are needed.  Citing the head of an adoptive and foster parents group, the story says the influx of removals in Maine is “in large part because of a state law that requires infants to be tested for drugs at birth if their mother is suspected of using them while pregnant.”

In other words, legislators made the default position “a positive drug test means the parent is dangerous” and the child welfare agency got the message.  As for how, exactly, a parent is “suspected” of using drugs while pregnant, the story doesn’t say. I’ll take a guess that whether the parent is poor might have something to do with who is tested and who isn’t.

Similarly, the Post breathlessly reports that, in Ohio, more than 60 percent of children in the system are there because of parental drug abuse.  In fact, that means only that in those cases, a caseworker checked a box on a form alleging use of some sort of drug, not necessarily opioids. And in Ohio, that includes cases such as this one.

The Post reporters simply accepted at face value every statistic and every self-serving explanation for that statistic from a child welfare agency. So, for example, they ignored Arkansas, where claims by the child welfare agency that drug abuse was responsible for a surge in foster care in that state were thoroughly debunked – by the state’s own consultants.

For reasons discussed in our publication Epidemic of Hype, almost all statistics about the alleged intersection of drug abuse and child welfare should be treated with skepticism.

Now, about the video

If the authors of the Post story are reading this, and if they’ve gotten this far, number one on the list of things they’re probably fuming about is: “Why didn’t he say more about the video?  What about the video?  Did he really see the video?”

Yeah, I saw it. It’s a video sidebar about a couple that was allowed to stay with their child while they recover from addiction – because an exceptional foster parent decided to take them all into her foster home. The foster parent also happened to be the adoptive mother of the addicted father, so she was taking in her own son, daughter-in-law and grandchild.

The video reinforces stereotypes. Allowing the family to stay together in their own home is out of the question; it’s all because of the beneficence of the foster parent – who had an extra reason to take in the whole family. And, of course, the parents are deeply sorrowful and repentant for what they have done – since their addiction clearly was a moral failing.

The video gives no particular reason why anyone should bother doing what this foster parent has done.  In fact, everything in the video reinforces the notion that, even if these parents might someday become worthy, the only option when faced with a drug abusing parent is to consign the children to foster care.

The real issue: What do children need?

The message of the video and the larger story is: These are bad parents who don’t “deserve” their children – unless they repent - then maybe they do.

But that framework misses the point. The issue isn’t what parents want. The issue is what children need.  Foster care doesn’t give children what they need. ASFA’s mad rush to termination of parental rights doesn’t give children what they need.

In the New York Times documentary about “crack baby” hysteria, one expert says the myth took hold in part because “there are certain ideas that people want to believe – that really fit in with cultural stereotypes.”  Journalists are people, too.

One of the few journalists to get it right back then, one of the few who focused on what children really need, was Pulitzer Prize winning Boston Globe columnist Ellen Goodman.  “There simply is no way to save the babies,” she wrote, “if you throw away the mothers.”

That’s exactly what those infants in that Florida study are trying to tell us. Isn’t it about time we listened?

Part two: The Post gets the child welfare system wrong, too.

Part three: The Mother Jones reporter who listened – and her far better story.