Tuesday, October 6, 2020

Child abuse is not a public health problem, it's a social justice problem

  This afternoon, I gave a presentation with the above title
At the Kempe Center International Virtual Conference:
A Call to Action to Change Child Welfare
Here is the text of that presentation

           The summary for this program starts by noting that in the United States, no matter what the problem, sooner or later we’ll see a news story with a headline that says: “Doctors say treat [name of problem here] like a public health problem.”  Funny how it always seems to be doctors who are first to suggest this. Or, to paraphrase a common saying: If you’ve spent eight years training to be a hammer, you’ll see everyone you meet as a nail.

          It isn’t just doctors, of course. 

          One presentation at this conference talks about how “all families need support at different … dosage levels.”  That presentation repeatedly referred to taking a public health approach.

The problem with this approach is not that the people supporting it want to hurt children.  On the contrary, they almost always act with the best of intentions.  But children keep paying the price for those good intentions.  Because as soon as you label something a “health” problem that means somebody has to be sick. 

After following this issue for decades, I’ve heard over and over some variation of this: “You don’t understand.  We just want to help those people. They’re not evil, they’re just sick.”

Well, a tiny percentage of those caught up in the net of child protective services is, in fact evil.  Another small percentage is sick.  And some others were made sick by the failure to address the social justice issues that are the real root of the problem.

But overwhelmingly, what America labels “child maltreatment” is a social justice problem rooted in poverty and racism. 

We can see this in the fact that most of what we label as child abuse falls under the category we call “neglect” – and most of what we call “neglect” is poverty.

Indeed, most state laws define neglect as “lack of adequate food, clothing, shelter or supervision.”  It is, by far, the largest category of  so-called “substantiated” maltreatment and the dominant reason children are placed in foster care.

That is the result of a long, ugly history of treating a social justice problem as a public health problem.

I’ll begin with something I learned only recently, when I was listening to a presentation last month by Maleeka Jihad, who also gave a presentation earlier today.

She cited an article called “Painting Insanity Black,” in which science journalist Annie Murphy Paul wrote that “In the years before the Civil War, inflated estimates of mental illness among free Blacks were used by anti-abolitionists to ‘prove’ that Blacks were better off as slaves.”

At about this same time, the 1850s, we see the real birth of the American foster care system, a system which brought together the perfect combination of bigotry and bad science.

          American foster care began with a Protestant minister by the name of Charles Loring Brace. Brace founded an organization that still exists, New York City’s Children’s Aid Society.

Brace had seen the revolutions in Europe of 1848, and they terrified him. In particular, he was terrified of poor immigrant Catholics, whom he branded a “stupid, foreign criminal class” and the “scum and refuse of ill-formed civilizations.”

Brace explained that these Catholic immigrant parents were genetically inferior, passing bad “gemmules” on to their children. So you see, it was a public health problem.

Fortunately, he said, these ill effects could be reversed – by taking away the children and shipping them out to middle class Protestant farmers in the countryside.

Brace did just that. Over 75 years, his “orphan trains” took at least 100,000 such children. But the name notwithstanding, many of the children were not orphans. And many were taken without the knowledge or consent of their parents.

At a conference of charities in 1883, one of the few dissenters said of Brace’s scheme: “Their slaves [having been] set free, these men needing labor take these boys and treat them as slaves.”

The Children’s Aid Society continues to this day to whitewash the history of the orphan trains.

Claims of genetic inferiority ultimately went out of style – perhaps after the Nazis, who got the whole eugenics idea from the United States, where it was seen as a public health initiative, tried to take it to its hideous end. 

The notion that so-called child abusers and, in fact, poor people in general are psychologically inferior never went out of style. 

We can see this by comparing the comments of 19th Century experts to their 20th Century counterparts.

One 19th Century “expert,” declared: 

“The impress of criminal dispositions and pursuits is stamped upon every feature and movement of the boy – the dress, the walk, the skin, the eye, the shape of their hands and feet, the size and contour of the skull, the voice, the hair all reveal it…”

How much did things change after 100 years?

This is from a pamphlet first published in 1986 and still available at least a decade later, explaining child neglect to the general public. It was distributed by the group now called Prevent Child Abuse America -- the group whose presentation at this conference calls for finding the right “dosage levels” for prevention.

According to this pamphlet:

“Whatever the causes of physical child neglect … the heart of the problem is always an emotional lacking in the parents … The community and the caseworkers see parental behavior as the problem and they are, of course, right … [A] process of re-education must begin.  … This … re-education process …may take years.

“Neglecting parents and, in time, their children, see themselves as victims.  They cannot see that their very failure to act precipitates the problems that afflict them … Instead they feel that misfortunes are directed to them from a hostile and alien world.”

Because, after all, why should an impoverished Black mother holding down two jobs to try to make ends meet and sleeping with the lights on to keep the rats from biting her children ever view the world as hostile and alien?

Things have changed a little from PCAA – their current website language is more nuanced – but there’s still an enormous emphasis on the idea that neglect is a mental health problem.

More important, although PCAA has come remarkably close to admitting that it deliberately exploited horror stories to foment hype and hysteria over child abuse – a speaker from the group at this conference called what they did “health terrorism” -- but he refused to apologize for it when I asked him to yesterday.

The reason that’s so important is because America was indeed terrorized. As a result, to this day, people believe that vast numbers of children are being beaten tortured and killed – and the only way to stop it is by massive surveillance and massive removal. The ugly, false, racist master narrative right now about COVID-19 supposedly unleashing a “pandemic of child abuse” is a testament to the success of that “health terrorism.”

These ugly ideas are so deeply ingrained that, again, to this day, if an American family’s children are taken away, no matter what the reason, almost always, the parents will be ordered to endure a “psychological evaluation” or “psych eval.”

Were the children taken when Mom left the oldest in charge of younger children because she had no childcare and couldn’t afford to lose her job? Send ‘em for a Psych eval.  Were they taken because she did lose her job, fell behind on the rent and now the family is homeless? Psych eval.  Was an infant taken at birth because an impoverished mother smoked marijuana to keep food down during her pregnancy? Psych eval.

And as one family defense lawyer put it, once a court forces parents to do it “Nobody walks out of that office with a clean bill of health.”

That is why almost every one of those cookie-cutter service plans – the hoops families must jump through, includes the same two services: Counseling and parent education. It’s not just that these “services” often do no good; they can actually do harm.

Because now the mother whose children were taken because she was homeless or needs child care or lost her job not only has to remedy all of that, mostly with no more help than a batch of referral slips, she also has to drop everything and schlep down to some counselor’s office to discuss those deep seeded problems for which her poverty is supposedly only a symptom. 

Then, when, God forbid, she might be allowed a moment to rest, she has to make it to the parent education class.


Why are we so obsessed with the notion that people accused of child abuse and neglect are mentally ill?

Well, there is one group that benefits enormously from it: the helpers.  It’s not just that impoverished parents are keeping an entire industry of helpers at work – they also make the helpers’ jobs more satisfying.

Here’s what Malcolm Bush, who ran a group called Voices for Illinois Children wrote in the 1980s in his book Families in Distress:

 “The recognition that the troubled family inhabits a context that is relevant to its problems suggests the possibility that the solution involves some humble tasks … This possibility is at odds with professional status. Professional status is not necessary for humble tasks … Changing the psyche was a grand task, and while the elaboration of theories past their practical benefit would not help families in trouble, it would allow social workers to hold up their heads in the professional meeting or the academic seminar.”

 They do it to the kids, too.  The whole residential treatment industry runs on a similar principle.  In an article called “The Public and Private Purposes of Case Records” Bush quotes from one such record:

This is a rather immature, impulse-ridden boy who does, however, respond to predictable external controls.  The inability to control rather primitive aggressive impulses unless he were exposed to an understanding but firm and neutral environment does indicate the need for placement in a boarding school with reality-oriented rewards for acceptable functioning and immediate delivery of negative reinforcement for unacceptable aspects of his behavior.

          Bush then translates:


The boy behaves badly, needs to be praised when he does well and punished when he misbehaves. 

           The problem goes even deeper. Bush writes that caseworkers are, to use one of their own favorite phrases “in denial” about any cause of neglect other than “the parents are sick.”

          Nearly 20 years later, another study found that housing problems were a key cause of removal and a key barrier to reunification, but caseworkers were – in denial.  They write: 

        “Perhaps child welfare workers … are more focused on parental functioning and less attentive to concrete needs such as housing because of the principles guiding agency practice and the workers’ education and training.”

          But that isn’t even the most important reason Americans so often talk about treating child abuse as a public health problem.  We desperately want to think of everything as a public health problem – because it gets the rest of us off the hook.

          American ideology demands that we view poverty itself as a mental illness.  When homelessness and hunger exploded during the 1980s, conservatives insisted it had nothing to do with Ronald Reagan’s assault on anything that helped poor people. Instead, it was all supposedly a mental health problem, and if only we hadn’t shut down all those hellhole mental institutions everything would be fine.  In fact, as Ann Braden Johnson points out in her book Out of Bedlam, if anything, it’s the other way around:

          Yes, mental illness can sometimes lead to homelessness – but homelessness is a lot more likely to lead to mental illness.


Indeed, I have often been struck by the parallels between how the United States and the former Soviet Union weaponized psychiatry. 

          In the Soviet Union: You can’t make it under communism comrade?  It’s a perfect system, so you must be mentally ill.

          In the United States:  Can’t make it under capitalism buddy?  Everyone has a fair and equal shot in the USA – so you must be mentally ill.

          This has enormous public appeal. Because it means that nothing that causes any of the harms endured by the poor is our fault. 

          And that led us down another blind alley with terrible consequences.

          In the early 1970s, Richard Nixon was president.  He vetoed a pet project of Democratic Senator Walter Mondale: a proposal to provide comprehensive childcare to all low-income Americans. 

The lesson for Democrats was clear: Whatever you do, don’t connect what you want to poverty.  Call it a public health problem that can afflict all Americans. 

And so was born the Child Abuse Prevention and Treatment Act. As Mondale, put it: “Not even Richard Nixon is in favor of child abuse!”

But to get the bill passed, everyone had to pretend that child abuse has nothing to do with poverty. As professor Barbara Nelson writes in her landmark history of CAPTAMaking an Issue of Child Abuse: the bill fits the quintessential American view of all social problems: “Individually rooted, described as an illness, and solvable by occasional doses of therapeutic intervention.” [Emphasis added]

          And so, in the name of public health, we got requirements for child abuse hotlines, we got the mandate turning everyone who works with children into a “mandated reporter” – a scheme that has backfired horrendously, overloading the system with false reports trivial cases and poverty cases, and driving impoverished families away from seeking voluntary help.

          Some of CAPTA’s most odious provisions concern requirements for how hospitals must respond when they suspect a newborn has been “affected” by parental substance use.   Proponents again called the rules a public health solution – we just want to be sure the families get “help.”

But these provisions actually limit the discretion of medical professionals, requiring that they turn those decisions over to often untrained, inexperienced caseworkers whose only credential may be a bachelor’s degree in anything.

          The public health revolution is devouring its own.

          What the public health approach really has given us is a police force - enforcers of a giant coercive child welfare surveillance state that is seen, rightly, in poor communities of color, as every bit as oppressive, and every bit as racist, as the police in blue uniforms.

          Indeed, child protective services workers in the United States have more power than the police.   Police can stop a Black teenager on the street, throw him against a wall and frisk him. Child protective services can march right into the home, strip-search a Black child and walk out with him, consigning the child to the chaos of foster care.

The reason for that is precisely because of the public health approach.  That approach allows us to say: “We’re only here to help you, therefore you have no rights.”  Any assertion of rights is a manifestation of illness and will simply impede our noble efforts to cure you.


This still leaves one question unanswered: How do we know that it isn’t a matter of public health?  How do we know that most or all of the people caught in the net of child protective services aren’t mentally ill?

That’s actually not a question we who favor less coercive intervention should have to answer – because it puts the burden of proof in the wrong place.

Decades ago, it was actually someone who led an adoption agency who told me: The burden of proof should always rest with those who think children don’t belong with their families.

So the burden should be on those who claim the problem isn’t poverty, isn’t racism and isn’t economic inequality.

But I’ll answer the question anyway.

First, we have studies which tell us things like 30 percent of America’s foster children could be home right now if their parents simply had decent housing. We have the simple fact that our neglect laws are so broad that they “define in” virtually all poor families.

But also, all we need to do is see what happens when poor people get just a little more money.  Because if money is the solution, odds are poverty is the problem.

To which traditional child savers reply: But we can’t wait until we’ve wiped out poverty to save the children.

But though wiping out poverty would be an excellent idea; one does not actually need to do that to dramatically reduce what we have labeled as child maltreatment.  In fact, real solutions cost less than foster care and far less than group homes and institutions.

So behold the transformative power of cash:

One study found that if you raise the minimum wage by $1 an hour, you cut the rate of what agencies call child “neglect” by 10 percent.

Another study found increasing the earned income tax credit by $1,000 per year cuts the likelihood of child protective services involvement by seven to ten percent.

Another study that found that increasing income by only $100 per year reduces the likelihood of a “child maltreatment” report by two percentage points.

          And given what I noted at the outset about housing, this one should come as no surprise: A massive study found that when homeless families received housing vouchers, the rate at which they lost children to foster care was cut by half. 


But one part of the study was surprising.  It also found that when the housing vouchers were accompanied by inflicting social work on the families, the results were not nearly as good. 

          The families needed more cash – less social work.  More social justice, less public health.

          Of course, a social justice approach also requires confronting the racial bias that permeates child welfare.

          Step one in that regard is admitting you have a problem.  And by that I don’t mean putting a boilerplate statement with the hashtag #blacklivesmatter on your foster care organization’s website.

          Much of child welfare has been, to use that phrase again -- in denial -- about the problem.

The standard excuse from those in denial about racial bias is, in itself, revealing. For decades foster care apologists insisted that they never took children because of poverty.  But confront them about racial bias and they say: “We don’t take all those children of color because of their race – it’s because they’re poor.”

The research makes clear that it’s both. 

And that means we also need solutions such as “blind removal meetings,”  something I first learned about from Prof. Jessica Pryce who opened this conference.

          Before workers can remove a child, they have to present the facts to a committee – but they must leave out information that gives away the race, or the income status of the family.  That simple step led to a significant drop in removals of Black children.

          But perhaps the most important single reform any system can make is to level the playing field: recognize that running roughshod over human rights in the name of “curing” an “illness” makes everything worse.  That means providing high-quality interdisciplinary defense counsel for families.

          This has been shown to significantly reduce time in foster care with no compromise of child safety.


          Of course no one can say that there is never a mental health problem related to what we define as child abuse and neglect – even if the problem actually was caused by the system – much in the way, as I noted earlier, being homeless can, indeed, induce mental illness.

          But even here, we can take a social justice approach.

          And that brings me to a photo.

          You’re looking at a bunch of therapists in training.

          They have master’s degrees in social work or related fields.  And they’re learning to do things like patch holes in drywall and fix wiring.

They were learning these skills because, for the therapy they were about to practice, they’re essential. They were caseworkers for an Intensive Family Preservation Services program that rigorously follows the model of the first such program, Homebuilders, in Washington state. 

That one photo explains why such programs are so effective — and also why they have been the object of a decades-long smear campaign by pillars of the American child welfare establishment.

          Homebuilders is a last-ditch crisis intervention program for families whose children otherwise would be taken.  There may be no other program that’s gotten as many seals of approval from as many “evidenced based clearinghouses.”

          But it’s been smeared precisely because if you want to work for Homebuilders, you can’t just do talk therapy, you may have to do some of those humble tasks Malcolm Bush was talking about.

          My favorite story about Homebuilders comes from Lisbeth Schorr’s book Common Purpose.  A Homebuilders worker knocks on the door.  The mother of the family comes to the door and says: If there’s one thing I don’t need it’s another social worker telling me what to do. What I need is someone to help me clean this house.

          To which the Homebuilders therapist replies, in effect: Should we start with the kitchen?

          A Social Justice approach to child welfare requires confronting racial and class bias, it requires concrete help for poor families, it requires humble tasks, and it requires stepping out of the role of noble healer and into the role of partner.

          No wonder it’s so threatening.