Wednesday, July 12, 2017

Child welfare and the latest “drug plague,” part three: Mother Jones comes closer to getting it right

The previous two posts to this Blog dealt – at great length – with the failings of a Washington Post story on the intersection of the “opioid epidemic” and child welfare. That story was a throwback to the “crack baby” journalism of 30 years ago.

Just a few days after the Post story, Mother Jones published its own take on opioids and child welfare – and came closer to the mark.  Yes, like the Post, it emphasizes horror stories – something I’ll get to below. But reporter Julie Lurie’s story diverges sharply from the Post, and much typical child welfare reporting, in the lessons learned from the horrors. And the entire story is infused with a sense of humanity and empathy that is missing from much of American journalism about either drug abuse or child welfare.


● No demonization of individual parents. Whereas the Post did not speak to birth parents at all, except in a peculiar video sidebar, Mother Jones dug deep and told stories about how the parents became drug dependent – stories that make clear that this was not due to some sort of a moral failing. On the contrary, anyone with an ounce of humanity would come away thinking “there but for the grace of God…”

As a child protective services worker told Lurie:

“I used to get really pissed off at people—like how could you just let me take your kids and then go on a bender?” As she’s learned more about the parasitic way that opioids co-opt the brain, her attitude has softened. Unlike sex abuse or severe physical abuse cases, she said, there is no good guy or bad guy. “You keep thinking, ‘Without the drugs, what would they be like?'”

● You can’t fight trauma with trauma.  The buzzword in child welfare nowadays is “trauma-informed.” We hear over and over about how certain childhood traumas including child abuse – can damage children’s brains and leave lifelong scars.  They even have their own acronym: ACE, for Adverse Childhood Experience. But the Mother Jones story points out something that every other story I’ve seen about this topic overlooks: One of the key traumas that damage children is “separation from parents.”  So the idea that you can fight childhood trauma by inflicting more trauma is ludicrous.  Or, as Lurie writes, the child protective services workers she followed
 “are torn between mitigating one ACE, exposure to parental substance abuse, and catalyzing another: separating a child from her parents. Which is what makes these conversations [with families they are investigating] so heart-wrenching.
As a result when the story ends by repeating the mantra of a CPS worker that you have to “try again, try again, try again” readers have at least some idea why that’s the right thing to do for the sake of the children.

[SPOILER ALERT – This next point gives away part of how the Mother Jones story ends]

●A mature response to an unhappy ending. One of my favorite media critics likes to say that “Hell hath no fury like a reporter who thinks s/he’s been suckered.” If the central character in a story lets the reporter down, or even doesn’t conform to the image in the reporter’s head, then let that subject beware: Often the reporter will wreak revenge in the story.  Here’s a classic case in point.

But Julia Lurie didn’t let whatever disappointment she may have felt in a mother she profiled bias her story or turn her against her subject. She is scrupulously honest with her readers, even as her story ends with the same insight and empathy she showed throughout.


● Accepting the assumption that foster care is increasing because of opioid abuse. As is discussed at length in the previous posts, foster care is not increasing because of opioid abuse. Foster care is increasing because of child welfare’s typically dumb, knee jerk response to opioid abuse: take the child and run.  And it’s increasing because child welfare did not move to curb the widespread needless removal of children who don’t need to be in foster care – so there would be room for those times in which foster care truly is the only alternative.

The sample is inherently skewed by focusing
on one of the hardest-hit counties
in one of the hardest-hit states.
● An inherent bias in the sample. Lurie did her reporting in Ashtabula County, Ohio, one of the
hardest-hit counties in one of the hardest-hit states. And she spent her time following around child protective services workers. That inherently skews the impression of the impact of drug abuse on families toward the worst cases and reinforces the assumption that removal of the children – at least while the parents get treatment – is the only possible response. 

But not every parent who is drug dependent is leaving her children in filth and making them scrounge for food.  This is clear from the fact that the best available data show that there is far more illicit drug use in America than there is child abuse.

And where intervention is necessary, it does not necessarily require separating the family - as Connecticut is proving.

No, this doesn’t mean that it’s good for children to have parents who use illicit drugs – or who abuse legal drugs such as alcohol. It means only that we should not generalize from horror stories, whether they are about child abuse, drug abuse or both. And in each case we need to balance whatever harm may be done by the drug abuse against the harm of intervening in general, and the harm of foster care in particular.

The celebrity expert

This problem is reinforced by an online sidebar, featuring the only expert in Lurie’s story, Dr. Nadine Burke Harris. That’s one more expert than The Washington Post used, and it’s far less of a problem here because Lurie doesn’t indulge in unscientific stereotyping and jumping to conclusions the way the Post reporters did. But it’s still a problem.

That’s partly because the one expert is the field’s celebrity expert – the one everybody goes to.  As this New York Times documentary makes clear, that was one of the big mistakes made by journalists covering crack cocaine in the 1980s.

While Burke Harris’s fundamental recommendation is humane – treatment, not foster care -- her discussion is still steeped in horror stories and she freely goes beyond what actual research tells us.

At one point, she begins an answer by saying “The scientist in me will tell you that currently we don’t have reference research to measure this… But…” and then she launches into speculation. That didn’t belong in the story and should have been a signal to run her perceptions past other scientists.

Similarly, in discussing a phenomenon known as “serve and return” in which parents respond to cues from their infants, Burke Harris says “you could imagine that a parent who is impaired or clouded or blunted by heroin is not going to be doing as much of that serve and return.” [Emphasis added].

Yes, you could imagine it.  If your imagination is fueled by horror stories about the behavior of the worst drug abusing parents you probably will imagine it. And there are scientific studies saying there are times where this may indeed happen. But this kind of rush to judgment and broad-brush claim fueled the hysteria over crack cocaine in the 1980s, and we should be careful not to let that happen again.

In contrast, as is discussed below we have more definitive research on the harm to infants – even infants born with cocaine in their systems – that comes from being placed in foster care.  Which brings me to …

● Insufficient attention to the trauma of foster care. Though to her great credit, Lurie mentions this and explains the inherent dilemma, it’s hard for a reader to weigh comparative trauma when the trauma of drug abuse is emphasized throughout, complete with horror stories, and the trauma of foster care is mentioned only in passing.

At a minimum, it would have been helpful to include the Florida study discussed in my previous post – which amounted to a head-to-head comparison of the two kinds of trauma, and found that foster care was worse. Additional context could have been provided via these two massive studies on the differing outcomes for children left in their own homes and children placed in foster care in typical cases.

● Treatment that doesn’t sound like treatment. What passes for drug treatment in Lurie’s story seems to consist of shipping the mother to a “detox center” for a short time and then sending her right back to all the same pain and problems she had before, with no support. So it’s hardly surprising that there is a big problem with relapse. An exploration of what constitutes high-quality drug treatment, and its success rate, would have been helpful.

Instead, the only alternative we read about is Burke Harris’s suggestion that

Rather than saying, ‘Automatically you lose your kid,’ maybe it’s automatically you have to go to a mother-child rehab program that is focused on understanding what is the root cause—the driver behind the mom’s substance use to begin with. Because whatever that is, that is probably the most dangerous thing in the household—whether that’s mom’s history of abuse or neglect or sexual assault or whatever it is.

But not every mother needs a mother-child rehab program.  While such an approach beats foster care, it’s still a knee jerk response rooted in horror stories.

And, notice the root causes Burke Harris lists.  She never lists the root cause that also happens to be the single most widespread of all the Adverse Childhood Experiences: Poverty. So we’re back in the territory where doctors feel most comfortable, treating the problem – no matter what the problem may be – as a “public health” problem.  That often leads to the wrong kind of services and “prevention.” What would be vastly more effective than a “public health approach”? A social justice approach.
● A misunderstanding of child welfare finance. Lurie writes:

Meanwhile, federal funding for children’s services decreased by 16 percent between 2004 and 2014. That’s due in part to an arcane law stipulating that the largest pot of federal money for children’s services applies only to kids from below a certain income threshold. In many states, that threshold is about half the poverty level—in Ohio, it’s roughly $14,000 per year for a family of four. But the opioid epidemic has afflicted families of all stripes. “A few years ago, I was constantly just in homes that were clearly in poverty,” says [a CPS worker]. Now she’s struck by her new clients’ well-kept houses: “You pull up to it and it’s like, ‘Really?'”

There are several questionable assumptions here:

--Lurie is right about the arcane law – but that law applies to a giant open-ended entitlement that can fund only foster care and adoption – not all “children’s services.”  And the reason that spending went down is only slightly related to the arcane law – a law that, paradoxically, is essential if child welfare in general and child welfare finance in particular are ever to be reformed. That’s because that very law is the only pressure point that can be used to get the child welfare establishment to detox from its addiction to foster care and support allowing this money to be spent on better alternatives.

Mostly, the decline in spending is for the simple reason that this funding is paid for every eligible foster child and, for almost the entire time period Lurie cites, the number of children in foster care went down.  Indeed, the Department of Health and Human Services now is predicting a big increase in this particular funding stream – precisely because so many more children are being taken away.

--Many poor people are perfectly capable of keeping their homes neat. If household spotlessness is the CPS’ worker’s only basis for her claim about family income, it doesn’t belong in the story.

--More generally, Lurie’s story documents that the whole county on which she focuses is poor. While I’m sure many cases involve families whose income is above the threshold that would allow the county to get federal aid for the children’s foster care, I doubt very much that CPS workers are taking away the children of very many upper middle-class and wealthy drug users.

One final irony

Like other writers, Lurie notes that opioid addiction appears to be getting a more humane response from public policy makers than, for example, crack cocaine. (This is almost certainly because, as Lurie notes and other commentators have discussed, this drug plague looks whiter.)  She quotes Burke Harris on the topic:

The conversations that are happening in the policy world on Capitol Hill around this opioid epidemic feel very different than the conversations that have happened in the past. It feels like people are much more able to frame the issue as a health issue than as a moral failing—or not even moral failing, but depravity that other substance-use epidemics, like the crack epidemic that happened in the inner cities in the ’80’s. It seems like it’s a very different narrative and a very different response.

Except that, as Lurie’s own story documents, whatever they’re saying “in the policy world on Capitol Hill” isn’t being heard much on the frontlines of child welfare. (And, with the exception of Lurie’s own reporting, the response among most journalists covering child welfare isn’t very different either).  

Some caseworkers, such as those Lurie profiled, and some child welfare leaders, such as those in Connecticut, may be more thoughtful this time around. But by and large child welfare is responding to opioids as it responded to meth and to crack: By jerking its collective knee and tearing apart families.