Monday, September 7, 2020

KENTUCKY FRIED DATA: Nobody knows which state has the “most” child abuse. So please, Kentucky media, could you stop claiming it’s Kentucky?

It’s at least as likely that what Kentucky really leads in is confusing poverty with neglect.


Source: U.S. Dept. of Health and Human Services, Child Maltreatment 2018


 [O]n Thursday, we shared the shameful story that Kentucky is the worst in America at protecting its children.  The U.S. Department for [sic] Health and Human Services has slapped this dubious title on our state: The rate of child abuse and neglect in Kentucky is the worst in the country.                                   – Richard Green, Editor, Louisville Courier-Journal, 2019.

 Kentucky still ranks No. 1 in the nation in rates of child abuse and neglect

                                                            Louisville Courier-Journal, 2020

Kentucky still has highest child abuse rate in U.S….Sentinel Echo, London KY

 Report: Kentucky, Indiana have highest child abuse rate in U.S. – WLKY-TV

 New AG vows to fight child abuse (Ky. ranks No. 1 in it)Kentucky Health News

           

            The first claim, about how a federal agency “slapped this dubious title” on Kentucky is simply false.  Some of the rest might be true. Then again, it might not – and neither the people who wrote the stories nor anyone else has the faintest idea. 

            In fact, the very report cited in all those stories specifically cautions against such comparisons.  So not only did the Department of Health and Human Services not slap any "dubious title" on anyone; Kentucky media have recklessly ignored HHS' warning about making any such comparison.

            It would be hard to read a story about child abuse in Kentucky that doesn’t include this claim – because it’s in the interest of so many people who write and promote the stories to make it.  Particularly in the state’s largest newspaper, the Louisville Courier-Journal, the claim often is paired with gruesome accounts of beatings torture and murder of children.  

That makes it easy for readers to jump to the mistaken conclusion that Kentucky is such a cesspool of depravity that the state is justified in tearing apart families a rate 70 percent above the national average, even when rates of child poverty are factored in.*   

And if they don’t jump to that conclusion on their own, the Courier-Journal is glad to help.  Here’s how one news story summed it all up: 

The Courier Journal reported last year that Kentucky led the nation in abuse and neglect with increasingly violent, sometimes fatal injuries to children so severe an outside panel classified some cases as torture.

 

Full details and sources are available here.

So it’s no wonder anyone reading the stories would be likely to conclude that the rate at which Kentucky tears apart families should be even higher.  And it’s no wonder neither readers nor the authors of such stories would want to listen to concerns about the enormous emotional trauma and terrible life outcomes often inflicted on children needlessly consigned to the chaos of foster care, and the high risk of abuse in foster care itself.  (When the Courier-Journal touches on these outcomes the premise is that foster care can be “even worse” than those awful birth parents, and it’s a shame more kids aren’t adopted.) 

            Kentucky’s take-the-child-and-run approach is one of the reasons the child welfare system is overwhelmed.  It is that overwhelming of the system with false reports, trivial cases and cases in which family poverty is confused with neglect that almost always is the real reason children in real danger of brutality, torture and death - cases that are as rare as they are horrific -- sometimes are overlooked. 

            That’s because though each is the worst form of tragedy child abuse deaths and near deaths are needles in a very large haystack. 


            In 2017, using the larger of two different figures in Courier-Journal stories, we estimate there were between 29 and 58 child abuse deaths or near deaths in Kentucky.  (The graphic above assumes 58.) That year, Kentucky’s child abuse hotline received calls involving roughly 165,000 children.**  Clearly, making the haystack even larger by overloading workers with even more false reports, trivial cases, poverty cases and needless foster care, is only going to make it even harder to find the needles. 

            All this is why the misreading of key data by Kentucky media and advocates makes all Kentucky children less safe.

 Actually we DO need to “quibble about numbers.”

            Before I even start the process of analyzing the claim about child abuse in Kentucky, I need to repeat something I wrote recently about child abuse in Oregon when a data issue arose there:

When those pushing for more policing of overwhelmingly poor, disproportionately nonwhite families, more massive surveillance and more removal of children to foster care get caught hyping the numbers, they have a standard response. Usually it’s some variation of: “How dare you quibble about numbers! Children are dying!  Even one case is too many!”

            


 The second two sentences are, of course, correct.  But precisely because we’ve been suckered by fearmongering, hype and hysteria for decades (at least one organization responsible for it 
effectively admitted as much) we’ve spent those decades embracing “solutions” that only make things worse.

As I noted above, the horror stories represent a tiny fraction of the cases seen by workers for Kentucky’s Cabinet for Health and Family Services.  To get that tiny fraction down to zero requires a vastly different approach than an ever-expanding child welfare surveillance state, and doing what Kentucky keeps doing - tearing apart families, and traumatizing children with needless foster care, at an obscene rate.

            The related hyper-defensive response from some journalists to any attempt to provide context is some variation of: “Oh, so you don’t want us to report on children dying!”

Bullshit. What those of us who have been working for decades to reduce child abuse in all forms to zero want is better reporting on child abuse deaths – and every other aspect of the child welfare system (Why, for example, has the Courier-Journal never, as far as I know, run a story such as this such as this?) because the problem of massive, needless removal of children and the problem of child welfare systems overlooking children in real danger are directly related. 

            We damn well do need to “quibble about numbers.” So let’s start quibbling:

The table that launched those hype-filled headlines

            Where does that “worst-in-the-nation” claim come from?  Well, contrary to what the editor of the Courier Journal implied, it does not come from any statement from the federal Department of Health and Human Services. There is no press release or other document that declares “Kentucky is number one in child abuse.”  There isn’t even a ranking.

             What there is is a single data point on a single table in on page 30 of a 274-page federal report.  That same report (right upfront on page 5) comes with a crucial warning:

[R]eaders should exercise caution in making state-to-state comparisons. Each state defines child abuse and neglect in its own statutes and policies and the child welfare agencies determine the appropriate response for the alleged maltreatment based on those statutes and policies.

             Here's why:

            What that table actually measures is the percentage of the child population for whom  child protective services workers check a box on a form saying they think it’s at least slightly more likely than not that a parent or caretaker abused or neglected a child.  This can be little more than a caseworker’s guess.  In Kentucky workers check the box for a higher proportion of the total child population than any other state. 

            Now, let’s unpack this. 

            For starters, all those stories that claim even the data table said Kentucky leads America in “child abuse” are false – the figure is for alleged abuse and alleged neglect combined.            

            And there are indications that, in Kentucky, we are talking almost entirely about so-called “neglect.” Another table in the same publication, on page 41, shows that, on average 60.8 percent of so-called substantiated reports are for “neglect only.” But in Kentucky it’s 88.1 percent – the second highest such proportion in America.  In contrast, physical abuse and sexual abuse combined account for, at most 11.2 percent.  That compares to a national average of 32 percent. 

            Of course some in Kentucky might say: Well, of course we have a higher proportion of neglect cases, we’re a poor state!  There are two problems with this: First, child welfare agencies say they never confuse poverty with neglect – so that should be largely irrelevant.  Second, there are seven states where the rate of child poverty is as high or higher than Kentucky.  In all of those states, the percentage of cases involving alleged neglect is lower than Kentucky. 

            Perhaps most notable among these is Alabama, a state which became, relatively speaking, a national leader in child welfare when a lawsuit settlement required the state to rebuild its system to emphasize safe, proven alternatives to tearing apart families.  (A member of NCCPR’s volunteer Board of Directors was co-counsel for plaintiffs in that lawsuit.)  So it's worth repeating the graphic at the top of this post:

Source: U.S. Dept. of Health and Human Services, Child Maltreatment 2018

There’s been some backsliding in recent years, but Alabama still takes away children at half the rate of Kentucky – and independent monitors found that child safety improved.  Alabama did this in part by dramatically reducing the confusion of poverty with neglect.  In Alabama of all “substantiated” cases only 31.3 percent involved “neglect only.”

             So if you were to disaggregate the data and actually look only at abuse, it’s quite possible that, even by this grossly flawed measure, Kentucky is not number one. 

Defining “neglect.” 

            That leaves the Courier-Journal, which, for all its other failings, at least says the figure is for “abuse and neglect.”

            So now let’s consider how states define neglect.  Most states have extremely broad, vague definitions that invite the confusion of poverty with neglect.  Kentucky’s is among the worst. Its definition includes a parent who 

“Does not provide the child with adequate care, supervision, food, clothing, shelter, education, or medical care necessary for the child's well-being.” 

            There is hardly a poor child in Kentucky who could not be deemed neglected at some point if a caseworker chose to do so.  That alone may well explain the so-called “worst in the nation” claim.  

But it’s not just the vagueness of the definition.  Different state and local child welfare agencies have different cultures.  As noted above in the discussion of Alabama, there are a few agencies that take seriously trying to avoid confusing poverty with neglect.  But Kentucky does not appear to be one of them. 

On the contrary, Kentucky child welfare’s contempt for families was the subject of a scathing report by the child welfare agency’s own inspector general in 2007. At about the same time the state made national headlines over rushing children needlessly to termination of parental rights.  Recent Kentucky court decisions suggest attitudes haven’t changed.  The Lexington Herald-Leader has covered all this extensively – it is they only news organization in the state I know of that has offered a measure of nuance in its child welfare coverage. 

Defining “substantiation”

             The federal report upon which Kentucky media rely does not, in fact, measure child abuse or neglect. Rather it counts the number of times caseworkers allege abuse or neglect.

             The allegation does not mean there was a comprehensive investigation followed by a decision from a neutral arbiter.  Rather it means only that an often overwhelmed, underprepared caseworker checked a box on a form.  In Kentucky, as in 37 other jurisdictions, workers check the box when they deem it at least slightly more likely than not that what the state defines as abuse or “neglect” occurred.  Seven jurisdictions have a higher standard, seven have a lower standard (D.C. and Puerto Rico bring the total to 52) – still another reason states can’t be compared. 

            We do know that, as of 2017, in Kentucky, in the cases where families manage to make their way through an appeals process, with the appeal decided by the same agency that made the initial determination, well over half the time the decision to “substantiate” the allegation is overturned. 

Other unknowns

             How deep in the weeds do you want to go? The rate at which people call child abuse hotlines and the proportion of those calls that are accepted for investigation also vary widely from state to state.  Both of these affect how many children caseworkers actually see, which may affect the proportion of the child population alleged by caseworkers to be abused or neglected.  (Depending on how you choose to interpret these data they can be used to bolster either side of the “worst-in-the-nation” argument.)

             So, does Kentucky have the more “child abuse” than any other state, or does Kentucky simply confuse poverty with neglect at one of the highest rates in America?

             Obviously, I think it’s more likely the latter.  But I don’t know that.  And, Kentucky journalists and advocates: Neither do you.

 _____________________

*- Normally, when I use that “cesspool of depravity” phrase I’m being sarcastic, but in Kentucky, one of the Courier Journal’s favorite sources for fearmongering quotes – a child abuse pediatrician – actually said "I think Kentucky continues in some areas to have a fairly significant culture of violence."  In fact, this is someone who, however well-intended, has no qualifications I know of to measure the culture of an entire state.  Rather, her job requires her to focus almost entirely on the worst of the worst – which may distort her perspective.  Problems with the perspective of some child abuse pediatricians, have been well documented in The Atlantic and The Marshall Project, and by NBC News and the Houston Chronicle .

            ** Courier Journal stories give two different figures (from different state agencies) for child abuse deaths and one for near deaths.  Using the larger figures, the total is 107. Nationwide, 27.3 percent of child abuse deaths involve children in some way “known to the system” – which can mean no more than that at one time there was a call to the child abuse hotline.  That would mean there were 29 such deaths or near deaths in Kentucky. But just for the sake of argument, I’ve doubled the number in the graphic. 

           State data in the annual Child Maltreatment reports count the number of calls hotlines receive, but not the number of children per call. Other data in the report suggest that calls to Kentucky’s hotline probably involve an average of 1.5 children per call.