Monday, February 26, 2018

Drug using moms: Threat or menace? The Philadelphia Inquirer veers toward “crack baby journalism”

The Inquirer could learn a lot from some journalism students in Montana

As far back as 1989, when the "drug plague" was crack, Pulitzer prize-winning
columnist Ellen Goodman understood what many reporters still don't get.

In a previous post to this blog, I discussed how actual experts on substance abuse keep pleading with reporters not to make the same mistakes in covering the opioid epidemic that they made covering the crack epidemic – in which coverage was infused with hype and hysteria that did enormous harm to children.  I discussed how the Washington Post ignored all of those warnings.

The Philadelphia Inquirer did a better job in a story about a case going before the Pennsylvania Supreme Court.  So it was disappointing to see what happened when the same reporter wrote a more detailed story on February 23, about infants born with opioids in their systems and how hospitals should respond.  Though it still was an improvement over the Post, the story veered toward “crack baby journalism.”

Perhaps because the stories were written by a longtime health reporter, they show more care than most when discussing the health effects of opioid use on infants.  But to know how child welfare should respond to opioids, knowing about opioids isn’t enough. You need to understand the realities of child welfare.  That’s where the story fails.

In contrast, a much smaller newspaper, the Missoulian, and some outstanding journalism students covered the issue with far more insight and nuance.

In discussing the “debate” over when to turn in mothers to child protective services, the only “sides” discussed by the Inquirer are whether to turn in those who use all drugs or only illegal drugs.  The idea that the best interests of children would be best served by allowing medical professionals to decide on a case-by-case basis if a child truly is endangered is not even offered to readers for consideration.

That’s not surprising given that the entire story is built on a false premise, aptly summed up by this subhead: “Infant safety vs. respect for moms.” 

The Big Lie of child welfare

The idea that taking away children is inherently safe and standing up for “children’s rights” while leaving them in their own homes is inherently risky and a sop to “parents’ rights” is the Big Lie of American child welfare. Framing the debate as “infant safety vs. respect for moms” is a way of tailoring that Big Lie to cases involving substance use.

The real debate is: What is in the best interests of children – automatically turning in their mothers, or respecting professional expertise?  But Inquirer readers will find that nowhere in the story.

When hospitals report substance using mothers to child protective services, the article falsely
suggests, they are just siding with child safety, rather than jeopardizing safety just to show “respect for moms.”  So a state legislator demanding tougher reporting requirements declares: “I am biased in this debate. I am biased toward the child.”

The reporter herself declares at the top of the story that the infants “are known to be at higher risk of neglect or abuse when they go home with mothers battling addiction.”  Later she suggests that even mothers who are in treatment and taking legally prescribed opioids, such as methadone, as part of their treatment, should be turned in to authorities – because, she suggests, you never know when those awful moms will relapse.

Lessons from the crack epidemic

But if the legislator were really “biased toward the child” she would have done her homework and learned from the crack cocaine experience.  She would know about the study that made what amounts to a head-to-head comparison of sending those infants home versus forcing them into foster care:

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.

And if the reporter were truly concerned about what puts children at “higher risk of neglect or abuse” she would have noted the many studies showing abuse in one-quarter to one-third of foster homes.  She also would have shared with readers the data on the long term awful outcomes for children consigned to the foster care system - and how, in typical cases those outcomes are worse than the outcomes even for comparably-maltreated children placed in foster care.  Links to all of these studies and data are available here.

Scaring mothers away from care

There also is no mention of another, obvious consequence, if doctors and nurses at hospitals turn in every mother who uses drugs: The mothers won’t go to the hospitals, significantly increasing the risk to their children. 

The story says that “when women use drugs during pregnancy, they are more likely to neglect prenatal care …” Note the contemptuous term “neglect.” In some cases that’s accurate; in some cases far worse terminology would be accurate.  But in other cases, the mothers can’t get prenatal care due to poverty, don’t know how to find it or are afraid to seek it out, precisely because they fear being turned in to child protective services.

We’ve known about that for decades. Here’s what happened in Utah, according to a 1999 Salt Lake Tribune story* after a highly-publicized crackdown on drug using mothers:

Fewer pregnant women with substance-abuse addictions are seeking treatment and prenatal care -- out of fear they will be arrested or lose custody of their children, according to Utah officials who counsel and treat them.
While Utah prosecutors have not charged a substance-abusing pregnant woman with felony child abuse since January 1998, the fear of legal reprisal apparently still exists, said Lynn Martinez, program manager for the Pregnancy Risk Line at the Utah Department of Health.
"We've been in business for 15 years. Last year and so far this year have been the worst as far as the number of substance-abuse referral calls," she said. "We're probably getting about half the number of calls we are used to."
Donald Dudley, an obstetrician specializing in high-risk cases at University Hospital, said he has noticed a drop.  "And it's not like they're all of a sudden getting better and not using drugs," he said. "I have patients who are methadone users, so they're out there. But I think there is a lot of fear out in the community about this issue. A lot of them have been driven underground."

The Inquirer story even minimizes the findings from the latest research on treating newborns born with opioids in their system. The story mentions in passing that some babies “get sufficient relief with cuddling and swaddling” but it neglects to mention the importance of who does the cuddling:

In contrast here’s what The New York Times found

[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.

In my column about the Washington Post story, I quoted one of the few journalists to get it right during the crack epidemic: 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 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. 

 But we just want to help

To which those supporting turning in all parents probably would say: But that’s all we want!  We just want the moms turned in so child protective services can decide what kind of help to give them.

The story cites the former Pennsylvania congressman James Greenwood, who sponsored amendments to the federal Child Abuse Prevention and Treatment Act requiring reporting all mothers of infants “affected” by prenatal drug exposure to child protective services so they can develop a “plan of safe care” for each child. (If states choose to take a wiser approach and not blindly follow the CAPTA mandate, they only risk losing a relatively small amount of federal money.) 

The story notes how Greenwood stressed that

the goal is to help families, not target struggling women.  “In crafting the federal law, I never envisioned that the ‘referral’ from a health care provider was the same as a child abuse report,” said Greenwood, a former child protection caseworker.

This is, at best, hopelessly naïve. When a doctor picks up a phone and calls the agency that
investigates child abuse reports to report that a mother’s newborn is “affected” by her drug use, you may be sure the agency that investigates child abuse reports will treat it as a child abuse report, and act accordingly.

That doesn’t mean the child automatically will be removed to foster care. But why should we assume that the judgement of a typically inexperienced, underprepared minimally-qualified caseworker for a child protective services agency is superior to the judgment of medical professionals?

And the Utah experience suggests that, once the word gets out that hospitals have to turn in all drug using mothers, a lot of those mothers will steer clear of hospitals.

Mischaracterizing the debate

Given all the unquestioned assumptions the Inquirer reporter brought to the story, it’s disappointing but unsurprising that she mischaracterizes the debate solely in these terms:

One side of the debate argues that hospitals should report all drug-exposed babies to local child protection agencies, while the other side says only babies whose mothers used illegal drugs should be reported.
Behind the distinction are good intentions. Many women work to control their misuse of legal or illegal drugs with counseling and prescribed opioids — namely, methadone or buprenorphine — that prevent wrenching withdrawal symptoms. Some are taking prescribed opioids for chronic pain under a doctor’s care. What’s more, women who are motivated to quit drugs altogether when they discover they’re pregnant are typically prescribed methadone, because going cold turkey increases the risk of miscarriage.
But newborns exposed to legally prescribed opioids still can suffer withdrawal — and still can be at long-term risk of neglect or abuse, given the chronic relapsing nature of addiction.

In other words: Drug using moms: Threat or menace?

Consider what this leaves out:

● Why does the Inquirer consider it relevant that newborns exposed to legal drugs still can suffer withdrawal?   What the writer really is saying is: Look what bad mothers they are to put their infants through this – they don’t deserve to have them. (And they probably “neglected” to get prenatal care, too.)

● How does a referral to child protective services now diminish the possibility of relapse months or years from now?

● And most important: How does the risk of relapse compare to the risk of abuse, and other known harms, if the child is consigned to the chaos of foster care?

Were all these questions to be considered it would require adding a third option to the debate:

1. Do not allow child protective services to accept reports based solely on a mother’s use of legally prescribed medication to control drug abuse. It should be presumed that the risk to a child posed by such a mother – who is already under medical supervision and getting treatment – is less than the risk caused by involving child protective services and placing the child at risk of foster care.

2. Change state laws to give medical professionals discretion to determine when a mother’s substance abuse presents such a danger to her child that a report to child protective services is necessary.

3. Where drug treatment is needed, make it as easy for a doctor or nurse to get a new mother into a high quality drug treatment program as it is to call a child abuse hotline.

In some cases those medical professionals will get it wrong. They will fail to report some children in real danger, and also report some children who are not, in fact, in danger.  But they are likely to make fewer errors than a system that requires a knee-jerk report to child protective circumstances in all circumstances.

I don’t expect the reporters and editors at the Philadelphia Inquirer to rush out and endorse this approach.  I would hope they could bring themselves to at least share the existence of this side of the debate with their readers.

Of course, it’s easy to write off any request from an advocate as biased.  And in this case, those who would make such a claim have a point.

Because I am biased in this debate. I’m biased toward the child.

*-The story does not appear to be available online. NCCPR has a copy.

Wednesday, February 21, 2018

Child abuse fatalities: The Keystone Kops of commissions tries to polish its image

Remember the Keystone Kops of Commissions?  Its official name was the Commission to Eliminate Child Abuse and Neglect Fatalities.  But its entire process was marked by secrecy, chaos, anger, racial bias and a proclivity for making decisions based on newspaper horror stories. So instead of studying the child welfare system, the commission essentially recreated the child welfare system.

Now a member of the commission, Teri Covington, is trying to salvage the commission’s reputation by essentially giving the commission credit for almost anything that anyone is doing, or planning to do, that might have something to do with reducing child abuse deaths.

So Covington declares in The Hill that, thanks to the commission “a tremendous amount of progress and change” has occurred.

Normally when one reads that “a tremendous amount of progress and change” been made in dealing with a problem, one expects evidence that the problem actually has been solved – or at least ameliorated.

But for the Commission the standards are far lower. In lavishing praise on her own work Covington cites no evidence that there are actually fewer child abuse deaths.  The most recent federal data, while not terribly reliable, and only from 2016, actually suggest an increase in such deaths.

Instead, Covington devotes her column largely to bragging about how states are throwing paperwork at the problem.  Some places have prevention plans!  One even has a strategic plan!

The good news: Few seem to take the commission seriously

In one sense this really is good news. Because if states were implementing the worst of the actual recommendations of the Commission, (and, sadly, here and there that is happening) our child welfare system would be even worse than it is now.

The Commission assumed that child abuse fatalities could be isolated from larger problems and predicted in advance.  As Child Trends, among others, has explained, they can’t. The reason for that is one for which we all should be grateful. Though each is the worst imaginable tragedy, the number is too small to detect meaningful patterns.

Even if you double the officially-reported number of child abuse fatalities you get 3,400 – out of 73,600,000 Americans under age 18. That’s a tiny number of needles in a gigantic haystack.

Yes, you can try to isolate this or that “risk factor” – but where that risk factor exists it means only that the chances of a child dying go from infinitesimal to ever-so-slightly less infinitesimal. And you risk wreaking havoc in an enormous number of families who happen to have the same "risk factor" but are not about to harm any children.

You'll never find the needles by trying to vacuum up the haystack
Though couched in the soothing rhetoric of prevention, the Commission recommendations are all about trying to vacuum up the haystack - scarring far more children who were never actually abused by inflicting traumatic investigations and, often, stripsearches and creating a regime of domestic surveillance that would make the NSA blush.  All that would only further overload child welfare systems, actually increasing the chances that children in real danger will be missed.

It also would further overload foster care, filling more foster homes with children who don’t need to be there, notwithstanding the two massive studies that found that, in typical cases, children left in their own homes fared better even than comparably-maltreated children placed in foster care. And it would further lower the quality of foster care, where already study after study has found abuse in one-quarter to one-third of foster homes, and the rate of abuse in group homes and institutions is even higher.

700,000 more useless investigations

Consider just one recommendation: Right now, child abuse hotlines screen millions of calls every year. The standards for screening-in calls are incredibly low, yet, after investigation 83 percent of screened-in allegations turn out to be false. (And you know that oft-repeated claim that the reports aren't false, child protective services just couldn't "prove" abuse or neglect? That's also false.)

Yet, as we discuss in our analysis of the Commission report, the Commission recommended that every call about a child under age 3, no matter how absurd, be investigated with no screening at all. That would add at least 700,000 additional investigations per year – a 39 percent increase for the average caseworker.

Still another recommendation, which the commission called a “surge” or an “accelerant” until they realized that wouldbe bad p.r., would reopen thousands more cases based on the flimsiest criteria.  Again, as we discuss in our response, the one time a state actually tried this it backfired; child abuse deaths increased.

The commission also rushed to embrace the latest fad in child welfare – predictive analytics.  Think of it as Big Brother meets the movie Minority Report. It’s already in use in criminal justice – and, in a comprehensive investigation, ProPublica already has found it rife with racial bias. 

The commission itself was willfully blind to the massive problem of racial bias in child welfare – voting down one recommendation after another to deal with it. The recommendations came from one of only two African-American members of the commission, Judge Patricia Martin.

That should be no surprise. Michael Petit, the commissioner who came up with the idea for the commission, and who was most fervent in advocating what amounts to a take-the-child-and-run approach to child welfare, once told a Congressional committee that the places doing the best jobs of preventing child abuse are the ones with “smaller, whiter populations.”  During commission deliberations his condescension toward Judge Martin was deeply disturbing.

The digital poorhouse

In child welfare, predictive analytics is one pillar of what Prof. Virginia Eubanks, in her book Automating Inequality, calls “the digital poorhouse.” Ultimately, many of those pushing the use of predictive analytics in child welfare want to assign a risk score to every child at birth. Eubanks’ devastating critique of what is actually the least harmful version, in Allegheny County, Pa. was just excerpted in Wired.

The model the Commission endorsed, called Rapid Safety Feedback, may well be worse. Covington brags that seven states adopted it. She neglects to mention that one of them, Illinois, already has dropped it, after it failed spectacularly.

Even the agency that invented Rapid Safety Feedback never claimed it could predict who would kill a child. And one of the nation’s leading proponents of predictive analytics specifically warned the commission that no predictive analytics model could do that.

The commission left that out of its report. To find it you have to look in the scathing dissent published by Judge Martin, after, she says, the commission chair threatened to censor any dissents he didn’t like – still another example of how the commission proved to be at least as dysfunctional as the child welfare system itself.

Better solutions

The only acceptable goal for child abuse fatalities is zero. But approaching that goal requires a radically different approach than the one recommended by the commission.  It requires learning from a study of what does and does not reduce child abuse deaths. That study found:

●The rate at which people report child abuse does not change the number of child abuse deaths.
●The rate at which a state screens reports for investigation does not change the number of child abuse deaths.
●The rate at which a state takes children from their parents does not change the number of child abuse deaths.

The same report found three key factors that do correlate with higher rates of child abuse deaths:

●High rates of poverty

●High rates of teen pregnancy
● Low rates of services to prevent child maltreatment.

That means, of course, if we take some of the millions of dollars states waste investigating false reports, initiating “surges,” and consigning children to needless foster care whenever there is a high-profile tragedy, and spend it instead on proven prevention programs that focus on ameliorating the worst effects of poverty, then, finally, we might see a decline in child abuse deaths that’s significant and sustained. (And no, a new federal law, the Family First Act won’t really do that.)

We might also reduce the burden on caseworkers caused by chasing down all those false allegations and poverty-confused-with-neglect cases, giving them a better chance to find the needles in that giant haystack, reducing child abuse deaths still further.

Tuesday, February 20, 2018

NCCPR in Youth Today on a plan for real reform of child welfare finance – from an unlikely source

The so-called Family First Prevention Services Act has been hailed as a radical change in how child welfare is paid for by the federal government. It’s not.The changes will barely make a dent in a system that lavishes billions of federal dollars on foster care, and far less on efforts to keep children safely in their own homes.

But the Trump administration’s proposed budget, a document that is, in most ways, as dreadful as one might expect, appears to revive a much more far-reaching, and much better, approach to changing the way the federal government reimburses states and localities for child welfare

Friday, February 9, 2018

Don’t believe the hype. The Family First Act is a step backwards for child welfare finance reform

Perhaps you’ve heard. Tacked onto the bill that averted another government shutdown is a child welfare finance “reform” measure called the Family First Prevention Services Act.

The bill was thought to be dead. It was killed last year by what one reformer who transformed his own institution years ago called the group home industry – the collection of private agencies typically paid for every day they hold foster children in the worst form of care, group homes and institutions -- and their public sector allies.

But it came back to life as part of the process of keeping the government open.  Now it’s law.

One might expect advocates of family preservation to celebrate, and some almost certainly will. The bill allows some federal money once restricted to funding foster care to be used for better alternatives.  And, in theory, it curbs federal funding for group homes and institutions.

Some very good child welfare reformers favor the bill. The best case for it was made by one of those reformers, Jeremy Kohomban. He transformed what was once one of the nation’s most regressive residential treatment centers, Children’s Village, in New York, into a leader in emphasizing trying to help children in their own homes or foster homes. Here’s his case for the bill.

Setting up prevention to fail

But I disagree.  In 2016, I wrote that the range of prevention services that could be funded under Family Frist was tiny, and there were absurd restrictions on which programs within that range could get federal aid. And instead of limiting group homes and institutions, I argued that the bill was so weak that it actually strengthened them, creating a whole category of institution that would be, in effect, sanctified in federal law.

So it’s no wonder that in 2016, the Congressional Budget Office estimated that only $130 million in additional federal funds would go to prevention each year – a drop in the bucket compared to the billions spent on foster care. CBO also estimated that the proportion of foster children in group homes and institutions would barely change – declining from 14 percent to 11 percent – over ten years.

So what the bill really does is set prevention up to fail.  When these minor changes don’t do much to curb needless foster care, those wedded to a take-the-child-and-run approach will say See? Changing financial incentives didn’t work, all those children must really need to be in foster care.  In fact, all those kids will still be in foster care because there was almost no real change in financial incentives.

A “presents for pimps” loophole

Nevertheless, the group home industry insisted that even the slightest restriction on their ability to warehouse children in the very worst form of “care” was more than they could handle.

Desperate to get something passed, supporters caved on issue after issue:

● They weakened a provision requiring institutions that supposedly engage in residential treatment to have actual clinical staff on site.

● They added a  “presents for pimps” loophole – creating a whole new category of institution exempt from restrictions on federal funding.

That was in 2016.

The new law

In one respect, the version that just became law may be a little better: although the types of prevention that can be funded are as limited as ever, the standards for specific programs don’t seem to be as onerous.

But in at least one key respect, possibly two, the version that just became law is even worse.

● There’s a provision (Section 2661) allowing funds from a much smaller existing “family support services” program to be diverted to “supporting and retaining foster families for children.” (I’m not sure if this is new, or if I’d simply overlooked it in previous versions.)

● States can delay the minor restrictions on funds for group homes and institutions for two years (though if they did that, they’d also have to forego the limited new prevention funding).  In fact, this is closer to a four-year delay.  The bill’s provisions concerning group homes don’t take effect until October 1, 2019 – states opting to delay would not be affected until October 1, 2021.

This gives the group home industry lots and lots of time to weaken the law still further.

Goldilocks is wrong

And finally, as I wrote last year: Please, spare us all the Goldilocks defense; the one that goes, if some people think the law is too tough and other people think it’s not tough enough, it must be juuuuuuuuust right.

No. The fact that some in the group home industry have the gall to claim this law is too tough just shows how spoiled they’ve gotten after all those years getting to eat all the porridge.

Wednesday, February 7, 2018

Child welfare in Oregon: The audit and the elephant

A new audit of Oregon’s child welfare system is an exercise in willful ignorance. That makes it more part of the problem than part of the solution.

Earlier this week, Oregon Public Broadcasting’s Think Out Loud devoted a program to a new (and, as almost every headline noted, “scathing”) audit of the state child welfare system, conducted by the Oregon Secretary of State’s office. The producers invited me onto the program to respond to comments from the state’s two top child welfare officials and the lead auditor.

I was in a studio near Washington, D.C., so I couldn’t see the other guests. That’s why I’ll probably never know how they managed to fit all those guests and an elephant into one studio in Portland.

The elephant in the studio is, of course, Oregon’s obscenely high rates of tearing children from their families and trapping them in foster care. That elephant has been hanging around for decades – Oregon has been tearing apart families at rates far above the national average since at least the mid-1980s. Through all that time, the elephant has been ignored by the state Department of Human Services.  And the behavior of the auditors is, if anything, even worse.

The audit devotes exactly one sentence to the fact that Oregon is such an outlier when it comes to tearing apart families.  The lead auditor gave it a single sentence on Think Out Loud – and the sentence was shocking. She said she didn’t know if Oregon holding children in foster care at a rate she described as double the national average made the Oregon system “worse or better” than others.

In fact, it’s not quite that bad. Oregon actually holds children in foster care at a rate about 60 percent above thenational average, not double. But the fact that the auditor thinks the rate is double and still doesn’t know whether that makes Oregon better or worse is that much more appalling.

As I said during my segment on the program. which starts at 32 minutes in and can be heard here …

… it’s understandable that someone entirely new to child welfare issues would not know, at the very start of the audit,  if an insane rate of removal is “better or worse.” But how can you go through months and months examining an agency and still not know by the end of the process?  Did the audit team even ask why Oregon is such an outlier?  Apparently not.

Not that you asked, but …

Though the auditors didn’t ask, here’s why a high rate of removal makes a child welfare system worse:
● Most cases are nothing like the horror stories. Far more common are cases in which family poverty is confused with “neglect.” Other cases fall between the extremes. Massive studies of typical cases show that children left in their own homes fare better in later life even than comparably-maltreated children placed in foster care.  And a study of foster children in Oregon and Washington State showed that the foster care system churns out walking wounded four times out of five.
● All that harm occurs even when the foster home is a good one. The majority are. But study after study, including two from Oregon, found abuse in one-quarter to one-third of foster homes. The rate of abuse in group homes and institutions is even worse. 
Oregon, in particular, has seen scandal after scandal over abuse in foster care.  Indeed, on the very day those child welfare officials, the auditor and the elephant piled into that studio, it was revealed that DHS proposed deliberately allowing children to remain in homes where caseworkers admit they think the children are not safe – in order to settle a lawsuit seeking to bar the state from warehousing children in hotels. (It’s another example of how efforts to fix Oregon foster care have become  a pathetic game of whack-a-mole.)
● All the time money and effort wasted on false allegations, cases in which family poverty is confused with neglect and needless foster care, as in this Oregon case and this one, is, in effect, stolen from finding children in real danger who really do need to be taken from their homes.

So the implicit assumption behind the auditor’s ignorance – what she really was saying is: Maybe that high rate of removal makes children safer – is false. In all those months, the audit team never checked to find out.

That makes the entire audit an exercise in willful ignorance. And it invalidates many of its conclusions.

Much of the audit is built around the premise that there is a shortage of foster homes in Oregon.  But if you don’t know why Oregon is taking away so many children, you don’t know if Oregon has too few foster parents, or too many foster children.

So we get page after page about recruiting more foster parents.  Worse, the audit calls for  institutionalizing more children in so-called “residential treatment” – accepting as fact the claims of the residential treatment industry that this is the only option for children with serious behavioral problems.

Apparently in all those months of auditing the auditors never reviewed the mass of research showing that residential treatment is a failure and there is nothing residential treatment does that can’t be done better with Wraparound programs. Such programs bring all the help a child needs into her or his own home or a foster home.  To see how, perhaps the audit team will have a look at this video:

Similarly, the audit refers to DHS resorting to the very worst form of “care” opening up more parking place “shelters” as “potentially positive steps…” They express no concern at all that shelters are terrible for children. The qualifier “potentially” refers only to the fact that the shelter might not be enough to deal with the so-called “shortage” of foster parents.

A gratuitous swipe at kinship care 

The audit even takes a gratuitous swipe at the least harmful form of foster care – kinship foster care, placing children with relatives instead of strangers. Study after study after study has found that kinship foster care is more stable, more humane and, most important, safer than what should properly be called “stranger care.” Yet the audit declares that many foster children “have acute mental and physical health needs that career foster homes may be better equipped and specifically trained to handle.”

Why? Do the auditors think relatives are inherently too stupid to be properly “equipped” and “trained”?

And speaking of biases, just as only one sentence is devoted to Oregon’s high rate of tearing apart families, less than a sentence is devoted to the racial makeup of Oregon foster care. The audit notes that one-third of Oregon foster children are nonwhite. But that is mentioned only in the context of – as you’ve probably guessed by now -- the need to recruit more foster parents of color. The possibility that Oregon’s high rate of removal might be related to racial bias is not even considered.

Even when the auditors are right, they fail to ask the obvious questions. 

●The audit paints a picture of an agency so incompetent it can’t even produce an up-to-date organizational chart.  It also confirms something some of us have long known: Oregon is where good ideas in child welfare go to die.

But the audit doesn’t go back far enough – to the 1990s, when Oregon had a chance to reform its entire system along the lines pioneered by Alabama – and blew it. It’s not as if this information is hard to find – it’s all laid out in the epilogue to this Oregon Public Broadcasting / Salem Statesman Journal story.

●The audit discusses how badly DHS sometimes treats foster parents, and even how badly people in the agency sometimes treat each other. But it never asks the obvious question: DHS really needs foster parents, and it really needs its own employees. If this is how staff and foster parents are treated, how are they treating birth parents?

But since the list of “stakeholders” the auditors spoke to includes virtually everyone with any connection to the system except birth parents who lost their children to that system, it’s not likely the auditors would think to ask that question.  

Given all that, it’s not surprising that the recommendations amount to nothing but more of the same: Recruit lots more foster parents and hire lots more caseworkers.

But we already know exactly what that will produce: The same lousy system only bigger.

That won’t start to change until, at long last, someone in Oregon says “Hey: There’s an elephant in the room!”

Monday, February 5, 2018

Child welfare reform in Arizona: Teeing up the backlash when the frontlash has barely begun

In January, 2003, just four days after taking office, in the wake of the disclosure of a high-profile child abuse tragedy, the governor of Arizona, Janet Napolitano, gave a speech in which she told child protective services caseworkers to just take away the kids “and we’ll sort it out later.”

Fifteen years later, Arizona is only beginning to sort it out. And if a story in the Arizona Republic Sunday is any indication, the groundwork for a backlash already is being laid.

Napolitano’s remarks helped kick-start what would become the nation’s longest foster-care panic. The number of children taken from their parents skyrocketed, increasing year after year after year all the way through 2015. Even with a slight decline in 2016, Arizona took away children at a rate more than 50 percent above the national average.

For some of that time, the panic was encouraged by the state’s largest newspaper, the Republic. But last year that changed.

The Republic received a three-year grant to fund in-depth reporting on child welfare. Editors brought back to the Republic an outstanding investigative reporter, Bob Ortega.  He was tasked with, in effect, leading the Republic to take a bold, new look at child welfare, a look that would question everyone’s assumptions, including the newspaper’s own. That led to superb stories such as this oneAnd this one.

Though the project continues, there’s been a setback. Unfortunately for Arizona, Ortega left the Republic to join the investigative unit at CNN. 

The latest story

This latest story, about promises by the Arizona Department of Child Safety (DCS) to do more to keep families together, still has a lot to commend it. The story focuses on a mother struggling with drug abuse.  But instead of the usual horror story, this case is far closer to the norm – a mother who dearly loves her child and is winning her battle with addition.  In addition, a lot of space is devoted to trying to explain the emotional harm done to children by needless foster care. 

But, at the same time, one can almost feel some of the old Republic assumptions sneaking back into the coverage.

The story resurrects some myths that have plagued child welfare systems and child welfare news coverage for decades.

● The myth that child removal equals child safety. As noted above, the story acknowledges theemotional harm of needless removal – and doesn’t just brush it off in a paragraph.  But it still implies that if you take away the child at least the child will be physically safe.

Like so many stories before, this one implies, wrongly, that child safety and family preservation are opposites that need to be balanced. Leaving the child at home is constantly described in terms of risk – even if the story suggests the risk might be worth it.

But study after study shows high rates of abuse in foster care itself. Indeed, one of Ortega’s stories examined this very point.  He wrote:

In 2014, of 46 states that reported data to the federal Children's Bureau, all claimed that fewer than 2 percent of children in foster care had been harmed in the prior year. Arizona said that barely a tenth of 1 percent of children in care were verifiably harmed. But in surveys going back for decades, from 25 percent to as high as 40 percent of former foster children report having been abused or neglected in care.

For the overwhelming majority of children family preservation is the safer option.  It is foster care that is riskier – in every respect.

Consequences of needless foster care

And discussions of emotional harm that largely lack specifics about outcomes don’t tell the full story of that harm.

Since the mother at the center of the Republic story is recovering from drug addiction, it would seem particularly important to explain why helping her recover without placing her newborn in foster care is better for the child.

But there is no reference to research such as a the  landmak study of 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.

And, of course, there are those two massive studies of more than 15,000 typical cases, which show that children left in their own homes fared better in later life even than comparably maltreated children placed in foster care.

So from the point of view of child safety in all its forms, Arizona’s stated new approach – which emphasizes working harder to find ways to keep children safe without resorting to foster care --  makes sense.

● The myth of the ever-swinging pendulum.  What is it with journalists and pendulums, anyway?

Even when I was a reporter, I never understood the fondness of my fellow journalists for thinking of just about everything in terms of a swinging pendulum.  The Republic story is no exception. It keeps coming back to whether the pendulum is swinging and how to set that pendulum in just the right spot. Editors love those pendulums, too.  The metaphor makes it into a subhead and a pullquote.

The problem with the metaphor is illustrated by how it’s used in the story itself. The story notes a recent drop in the number of children in foster care in Arizona and promptly invokes the pendulum. But even with that decline, Arizona still holds children in foster care at a rate more than 30 percent above the national average. In child welfare, the pendulum generally swings only from taking away too many children to taking away far too many children. (I think I’ll make that one of my pullquotes.)

● Setting the reforms up for scapegoating. The story tells us that

since the new practice started late last summer, there have been child deaths and near-fatalities in which [the State Department of Child Safety] was involved. It's unclear, at this point, whether any of those cases involved a decision to leave a child at home, or under the supervision of a “safety monitor.” Investigations are ongoing.

In fact, even if it hasn’t happened yet there will be cases in which the new approach leads to leaving a child at home and something horrible happens to that child.

But the same thing happened under the old “take the child and run” approach, when caseworkers were so overwhelmed with children who didn’t belong in foster care that they had no time to investigate any case properly, and overlooked more children in real danger. And, of course, it happened every time a child was needlessly removed only to be abused in foster care.

But that won’t stop those wedded to the take-the-child-and-run approach from exploiting the tragedy, whenever it occurs and whatever the circumstances, to try to sabotage this first small effort to curb Arizona’s 14-year foster care panic. As I’ve noted before, opponents of safe, proven alternatives to foster care will never give up their horror stories – because it’s all they’ve got.

There is no approach to child welfare that eliminates every tragedy.  If you judge a system by its horror stories, all systems fail.  The question is which approach typically makes children safer – and on that the evidence is overwhelming: You can’t have child safety without family preservation.

For more about Arizona and its long, long foster-care panic, see our 2007 report on Arizona child welfare.