Cutting through the spin about predictive analytics in child welfare

The Scarlet Number: Allegheny County (metropolitan Pittsburgh) has been
trying to slap a "risk score" on every child at birth. The score could haunt
them their entire lives.

In Allegheny County, Pa., even the county’s hand-picked ethics reviewers had reservations about the county’s Orwellian “Hello Baby” algorithm.  A key feature of the program flunked one reviewer’s ethics test. 

Second of two parts.  Read part one here.

Yesterday’s post to this blog discussed the amazing good fortune of Emily Putnam-Hornstein, America’s foremost evangelist for using “predictive analytics” to advise family policing agencies concerning everything from who should get “preventive services” to which children should be torn from their parents’ arms. (Another term for this is “predictive risk modeling” (PRM), but a better term than either is computerized racial profiling.) 

It seems that whenever Putnam-Hornstein co-authors an algorithm, the people chosen to do an “independent” ethics review are predisposed to favor it.  At a minimum, they seem to be ideological soulmates.  Sometimes they’ve co-authored papers with Putnam-Hornstein herself or with someone who wrote an algorithm with her. 

But even with the deck so stacked, in one case the ethics reviews offered some strong cautions–including suggesting that a key part of the program for which the algorithm would be used is unethical.  Though generally the reviews were favorable, the reviewers’ concerns were so serious that the agency that commissioned the reviews, the Allegheny County, Pa., Department of Human Services, went to great lengths to spin the results and direct readers toward the spin instead of the reviews themselves.  

The algorithm in question is the second of two in use in Allegheny County. 

The first, the Allegheny Family Screening Tool (AFST) stamps an invisible “scarlet number” risk score on every child who is the subject of a neglect allegation screened by the county’s child abuse hotline.  The higher the score, the greater the supposed risk.  Even though the ethics review for that one was co-authored by a faculty colleague of one of the creators of the algorithm, it cautioned that one reason AFST is ethical is that it does not attempt to stamp the scarlet number on every child at birth – something known as “universal-level risk stratification.” 

This is so Orwellian that even other family policing agencies can’t stomach it.  As noted in yesterday’s post, about Putnam-Hornstein’s work in California, the California Department of Social Services declared that 

The Department believes that “universal-level risk stratification” is unethical and has no intention to use it now or in the future. Identifying and proactively targeting services to families with no [child welfare services] involvement is a violation of families’ privacy and their rights to parent as they see fit. This would be an overreach in the roles and responsibilities of a government agency. 

So when Allegheny County decided that, ethics-be-damned, it wanted an algorithm to do exactly what appalled their counterparts in California, and exactly what their own prior ethics review implied would be unethical, the solution was obvious: Commission another ethics review! 

In fact, they commissioned two (or maybe three) – one of them from an ideological soulmate of the co-author of both Allegheny County algorithms -- Putnam-Hornstein.  

Sure enough, the county got much of what it wanted.  But the reviews displayed far more nuance than the county apparently expected, going into detail about serious problems with this approach, even as they claimed these obstacles could be overcome. 

So the county went into full spin mode.  In 2019, its first publication about the new algorithm, part of a program called “Hello Baby” merely declared that the ethics reviews existed, implying that Hello Baby got a seal of approval – but with no link to the documents themselves. 

A year later, the county put out its own summary of the ethics reviews. Although at last the actual reviews were posted online, there were no links from the county’s summary – and the reviews remain harder to find.  As we noted in our previous post, it’s sort of like the way Donald Trump’s attorney general, Willam Barr, handled the Mueller report.  In the case of the Allegheny County algorithm, the gap between the actual documents and the spin isn’t as wide – but it still tells an interesting story. 

So let’s look closely at the parts of those reviews that Allegheny County, and Putnam-Hornstein, probably least want you to notice. 

● The first thing to notice is that one of the two published reviews may never have been completed. It’s labeled a draft. 

● The second thing to notice is that the draft refers to itself as “one out of three perspectives from cross-disciplinary researchers looking different aspects of the risk-scoring system that Allegheny County plans to deploy.” [Emphasis added.]  But the county has only published two, and only ever refers to two.  What happened to the third? UPDATE, FEB. 22: Responding to an email query from NCCPR, Erin Dalton, director of the Allegheny County Department of Human Services, says there were only two ethics reviews. She said the draft may have been referring to a separate review of methodology and data science.

The other published ethics review strongly suggests a key feature of  Hello Baby – the fact that you’re in it unless you remember to opt-out – is unethical.  The review sets criteria for such a feature to be ethical. Hello Baby doesn’t meet the criteria. 

Selling Hello Baby 

There are two key selling points for Hello Baby: One, it’s supposedly a purely voluntary program, two, the vast troves of data will be used only for targeting prevention.  We’ll start with the second. 

Child abuse investigations are run by another division of the same agency that oversees Hello Baby.  Both divisions of this same agency are ultimately overseen by Erin Dalton, who is as nonchalant about the harm of foster care as she is fanatical in her desire to vacuum up data about poor people.  Nevertheless, Dalton’s agency publicly promises that child abuse investigators won’t see the Hello Baby risk scores or other data from that program. 

One of the ethics reviewers, Prof. Michael Veale of University College, London, saw the problem. It turns out, there’s even a name for it: Function Creep.  He writes: 

One underlying anxiety concerning predictive systems in the public sector is that by virtue of being created for one task, they establish an infrastructure consisting of many aspects—including data, technology, expertise and culture—which might expand beyond its original scope into areas its original democratic and societal mandate did not permit. …

Some will be concerned that while [using the Hello Baby risk score only for prevention] might be the policy today, it might not be robust to change in the future. Similarly, those who might have lost trust in a public service more generally might not trust assurances that this inferred data is deleted or not passed onto other actors in the system. 

Veale suggests that the county come up with 

some legally binding declaration … delimiting the purposes of this system in advance to a sufficiently narrow scope and set of actors. This agreement would then serve as a mechanism that could be used to hold future uses of this model to account—at least insofar as it would have to be actively and ideally publicly removed before the purposes of a score or a model could change. 

This appears based on the naïve assumption that, were Allegheny County to want to use Hello Baby for child abuse investigations, the shame of having to go public might be a deterrent. 

On the contrary, when – not if, because it’s going to happen – the data are used to decide who to investigate as a potential child abuser and when to take their children it will be done with pride and fanfare.  Because here’s how it will happen: 

A three-year-old boy, call him Jason, is killed by his father.  Jason was “known to the system,” a previous allegation had been deemed unfounded.  Somebody leaks the fact that Jason’s father had a high risk score using Hello Baby.  The caseworker who investigated the father gives a tearful television interview in which she says: “If only I’d known that Hello Baby thought he was high risk, I never would have left the child in that home.” 

At that point three things happen: 

● A member of the Pennsylvania Legislature introduces “Jason’s Law,” a bill requiring that information from Hello Baby and anything else in the state like it be fully shared with child protective services.  He calls it “Jason’s Law” of course. 

● Erin Dalton or her successor calls a news conference and declares that the Allegheny County Department of Human Services isn’t about to wait for the legislature – they’re ordering full information sharing right now!  

● There are warnings that algorithms that predict terrible harm will come to a child, including AFST, have a record of being wrong more than 95% of the time  - potentially flooding the system with “false positives” that do enormous harm to innocent families and make it harder to find the few children in real danger.  The warnings are ignored. 

A pinky swear is not enough. 

Having raised an urgent concern, Veale comes up with a solution that has all the enforceability of a pinky swear – or maybe something more like this: 

 

There’s still another danger.  Anyone Hello Baby labels high-risk will be offered a series of services not offered to anyone else.  At the highest alleged level of risk, the program calls it “relentless engagement.”  Therefore, the service provider, who will be regularly coming into the home to engage relentlessly will know from day one that a high-tech algorithm has branded these parents high risk for abusing their children.  That service provider almost always will be a mandated reporter, required to report any suspicion of child abuse and neglect (and in Pennsylvania, the training curriculum is fanatical about urging reporters to report! Report! Report!) 

So even the other ethics reviewer, Deborah Daro, a Senior Research Fellow at Chapin Hall, and an ideological soulmate of Putnam-Hornstein expressed concern about this.  She writes: 

All home visitors report a proportion of their participants to child protective services. … The [Predictive Risk Model] gives service providers additional information on a family’s history that may alter the way workers interpret the conditions they do observe. Even if the exact details regarding a family’s history is [sic] not provided to program staff or other providers, the fact parents have been identified through the PRM as being at high-risk will convey a general profile of concerns. As such, key  implementation questions for the county to address include: 

• How might knowledge of a family’s prior history with the child welfare and justice systems impact a provider’s judgment regarding current relationships in the home and the ability of other caretakers (particularly the father) to appropriately care for the infant? 

• How does this knowledge impact how providers might interpret a mother’s actions – will they be less forgiving of minor concerns they observe? 

• Will knowledge of a family’s history increase the likelihood a provider will report the family to child welfare as a potential risk for maltreatment if the family drops out or refuses additional program services? … 

Heightened awareness of a family’s circumstances may create surveillance bias, resulting in a higher probability of a family being reported. Providers will know more about a family and will need to weigh this knowledge against a family’s willingness or reluctance to remain in the program. 

Notice Daro’s own bias here.  Allegheny County brags that all services provided under
Hello Baby are purely voluntary and families are free to drop out at any time.  But Daro seems to think exercising that right is still another reason for heightened suspicion. 

Having raised the surveillance bias issue, Daro then cops out, suggesting the same failed solution that proponents of the child welfare surveillance state fall back on whenever the harm they do comes to light: We’ll fix it with more “training.” 

Defining “voluntary” 

Another key element of the selling of Hello Baby is the claim that it’s purely voluntary.  Technically yes, but you’d better be very sharp and wide awake during the first days and hours of your baby’s life to avoid being forced into the program – and isn’t everyone wide awake and able to absorb everything during that time? 

Because Hello Baby forces you in, unless you affirmatively opt out.  And you get only two chances to opt out.  The first chance is while you and your newborn are still in the hospital.  Amidst everyone else coming and going and handing you forms and discharge papers and God-knows-what else, you are given an information packet selling Hello Baby that also tells you how to opt out.  The second, and last, chance comes in the form of a postcard sent to your home – it’s not clear when, but presumably very soon after coming home with your baby.  You have to mail it back.  Miss those chances and Allegheny County has free reign to dig up all the electronic dirt on you that is called for in the algorithm and slap a risk score on you and your baby.  The score can follow you, and your child, forever. 

Oh, you can drop out of any services offered under the program at any time – though, as noted above that might prompt the service “provider” to call the child abuse hotline on you – but you never again get a chance to opt out of data collection or make them delete the data they’ve already gathered. 

Here’s what Daro writes about when this approach, called “passive consent,” is ethical and when it is not: 

This approach is considered appropriate only if the intervention or strategy involves minimal risk to the participant and if obtaining written approval for the procedure is not practical or feasible. [Emphasis added.] It is not clear if this approach has already been approved by the county’s Institutional Review Board. If it has, then the approach has been judged appropriate in this instance. If it has not, the county will need to make the case as to why it is not asking parents to “opt in” for the screen. 

It is just as “practical and feasible” to presume someone is not in the program until they check a box saying they’re in, as it is to presume they’re in until they check a box that says they’re out.  So by Daro’s own criteria, this key aspect of Hello Baby is unethical. 

And the county’s response illustrates perfectly why putting all this data power in their hands is so dangerous. They respond that: 

The “passive consent” is only for running the PRM, which commits clients to nothing. 

After all, the county continues, families still don’t have to accept the “services.”  But, of course, allowing the county to run the PRM commits the family to surrendering vast amounts of personal data that can then be turned against them at any time. That’s hardly nothing. 

As for Daro’s stipulation that this aspect of Hello Baby should be approved by the county’s Institutional Review Board, the Allegheny County Department of Human Services replied: 

Allegheny County does not have an institutional review board.

RETREAT FROM REFORM: When Marc Cherna first took over child welfare in Pittsburgh it was a national disgrace. Nearly 25 years later, he leaves it – a national disgrace all over again

● “I’m glad I’m leaving this place in very good shape,” Cherna says. In fact, he’s leaving it almost as bad as he found it.  Pittsburgh tears children from families at a rate nearly as high as it was when Cherna arrived in 1996; a rate far higher than many other cities, including Philadelphia.

 ● There were some good years in between, and things aren’t AS bad as they were in 1996. But make no mistake; Cherna has failed – and not just because of predictive analytics.  That’s why Pittsburgh needs to find a new leader who will radically change direction – as Cherna did, before he retreated from reform. 

By Richard Wexler, NCCPR Executive Director 

A story in The Imprint about the decision by Marc Cherna, the longtime director of the Allegheny County (metropolitan Pittsburgh) Pa., Department of Human Services to retire begins with one of Cherna’s favorite lines: 

When Marc Cherna first came to work in Pittsburgh, Allegheny County’s child welfare system was floundering. Plagued by child deaths, burdensome caseloads, staff burnout and attrition and a lot of negative media coverage, it was, Cherna readily acknowledged, “a national disgrace.” 

The Pittsburgh Post-Gazette also used the quote, calling it “a phrase he’s used frequently.” Indeed he has,  But there’s more to it. 

Actually, the full quote is: “Allegheny County once was a pathetic national disgrace. Today, it is a shining national model.”  I know this because I’m the one who said it, in a CNN interview in 2002.  At the time it was true.  

But it hasn’t been true for awhile.  So let me update my quote: “Allegheny County once was a pathetic national disgrace. Then it became is a shining national model.  Now it’s a disgrace again.”  And almost all of it, good and bad, is because of Cherna. 

Marc Cherna

I’ve watched him in action from the beginning; in fact, slightly before the beginning.  In the
mid-1990s, I served on a search committee that unanimously, and with great enthusiasm, recommended Cherna and one other candidate for the job. 

For awhile that was something to brag about. Early on, Cherna significantly reduced the number of children in foster care and made more modest, but real, reductions in entries into care. He put housing counselors in child welfare offices and provided transportation to visits in a county where getting around without a car is notoriously difficult. He supported open court hearings and was a pioneer in emphasizing kinship care. 

But by 2010 the whole effort had stalled – even though it hadn’t gone nearly far enough.  Then things started going backwards. 

Yes, the number of children in foster care was cut in half.  But that’s because the original number was insanely high.  The reduction actually stopped dead in its tracks in 2011.  The most recent number published by the county, for January 1, 2018 – the number Cherna brags about – is, proportionately nearly, 50 percent higher than the state and national averages.  It’s even a little higher than Philadelphia, long excoriated, rightly, for being an outlier in holding children in foster care.  All of these comparisons factor in rates of child poverty.  Oh, and by September 30, 2018, the number of children trapped in foster care in Allegheny County had risen again. 

That isn’t even the worst of it. 

The point-in-time number is not the most important when determining if a community is ripping apart families too quickly. For that, you need to look at entries into care over the course of a year.  The picture there is even more dismal.  The reduction in entries during Cherna’s early years was more modest – about one-third.  Again, the county’s own data on first entries into care show the reduction in first entries ended in 2011 – in almost every year since they’ve gone up.  By 2017 almost all the gains had been erased – children were being torn from their parents at nearly the same rate as when Cherna started. (Look closely: Although line superimposed on the county’s own graph, below, suggests steady decline, the bars themselves show a pattern more like a repeating U. The line distorts the visual impression made by the actual bars in the bar graph.) 

 

These data measure first entries into care.  The county report doesn’t include early data for entries and re-entries combined. By that measure the county might look a little better, since, in recent years the county has reduced the proportion of re-entries.  Nevertheless, when comparing total entries into care – entries and re-entries combined -- to other cities, the rate at which children are taken from their parents in Pittsburgh is obscene. 

 Over the course of a year, Pittsburgh tears apart families at a rate 50 percent higher than Pennsylvania’s longtime exemplar of bad child welfare practice: Philadelphia. (See data tables for all Pennsylvania counties here.)  The rate of removal in Pittsburgh (total entries divided by impoverished child population) is more than triple the rate of New York City and Chicago.  In fact, were Pittsburgh big enough to be among the nation’s ten largest cities, its rate of removal – more than 32 total entries of children into foster care every thousand impoverished children - would be worse than at least nine of them.  Again, these figures factor in rates of child poverty.  

There is no evidence that Pittsburgh is a cesspool of depravity with vastly more child abuse than all these other cities.  There is no evidence from anywhere in America that taking away huge numbers of children makes them safer – and considerable evidence to the contrary. 

The kinship care excuse 

The response from Allegheny County to these figures is likely to rely heavily on the fact that Pittsburgh places a larger proportion of children in kinship foster care – relatives instead of strangers – than the other cities.  

That’s true – thanks largely to the pioneering work of Dr. Sharon McDaniel and her agency, A Second Chance, Inc.  That agency really is a shining national model. It may be the only genuinely positive legacy of Cherna’s tenure.  But here, too, there are limits. 

For starters, kinship foster care is still foster care.  Yes, it’s almost always the least harmful form of foster care, but a kinship placement still can be enormously disruptive and still do harm. 

But also, Pittsburgh is such an extreme outlier that even if you compared only the number of entries into care in which children are placed with strangers in each city, Pittsburgh still would come out badly.  Indeed, Pittsburgh’s seemingly outstanding record in using kinship care may be in part because Cherna’s agency places children with relatives who, in some other cities, would not have been taken from their homes at all. 

How it all plays out 

Case in point: A case portrayed in this story in the Post-Gazette as a success.  The story is all about how much a caseworker for a private agency, Three Rivers Youth, did to help this family – including yes placement with a nearby relative, after the children were taken, and how grateful the mother is for that assistance. 

But look at why the Allegheny County Department of Human Services took the children in the first place: 

There were several holes in Ms. Roberson’s cramped home in the Hill District, giving rodents and other pests unfettered access to rooms where she and her five children ate and slept. She said she was having trouble getting her landlord to repair them. 

Once Allegheny County’s Office of Children, Youth and Families caught wind of the disrepair, along with other issues such as some of her children’s truancy, [her children] were placed into foster care. 

This is a classic example of one the biggest single problems in child welfare – the confusion of poverty with neglect. (Where were the housing counselors?) All of the help from Three Rivers Youth could have been provided without resorting to taking away the children.  And it appears that housing still is the reason this family has not been reunited.  According to the story: 

With [the Three Rivers Youth caseworker’s] help, Ms. Roberson said she is focusing on goals to help get her life back on track — moving to a new, safer home in West Mifflin so she can get her children back, getting her GED and eventually finding a job and learning how to drive. [Emphasis added.] 

This is exactly the kind of misuse and overuse of foster care that some of us on that long-ago search committee hoped hiring Marc Cherna would prevent.  For a few years, it did; but no longer.  And the problems don’t stop there. 

● Cherna’s deputy and, presumably, a possible successor, Erin Dalton wrote an appalling apologia for foster care, dismissing the enormous, and enormously well-documented trauma inflicted on children when they are torn from their homes. 

● Cherna’s agency works hand-in-glove with the University of Pittsburgh Medical Center (UPMC) – where the extremism can be seen in their support for urging doctors to do less thinking before jerking their knees and reporting their slightest suspicion of child abuse.  UPMC and Cherna’s agency also are being sued for an alleged “plan or agreement” that amounts to harassment of pregnant women who so much as smoke marijuana. 

Allegheny DHS has not earned our trust 

All of this, of course, is before we even reach the issue for which Allegheny County child welfare now is best known: It’s embrace of the Allegheny Family Screening Tool, an Orwellian predictive analytics model.  It began with those subject to reports alleging child neglect.  Now, with some modificiations to the algorithm, Cherna’s agency is attempting to stamp an invisible “scarlet number” risk score on every child in the county at birth – a score that could haunt the child for a lifetime. 

I’ve written about how dangerous this is many times (see the links in the previous paragraph and our overview here). So now, I just want to focus on the fact that the way the Allegheny Department of Human Services has sought to market the scheme, in itself, illustrates why neither the plan nor the agency is worthy of our trust. 

● They said that unlike other algorithms that purport to predict who is likely to abuse a child, AFST is transparent; everyone can see what goes into creating the algorithm. But in fact: You can see the ingredients but the weight for each ingredient and even whether it counts in favor or against the accused remains secret.  That makes the ingredients list nearly useless. 

● They said they did an ethics review and got a glowing report.  Well, yes. That’s likely to happen when one of the reviewers is a faculty colleague of the co-designer of the algorithm. In fact, they co-authored papers together.  The review itself is startlingly superficial, citing only papers written by either the designers of AFST or the reviewer himself.  

Even then, the favorable verdict was premised on the idea that the algorithm would be used only in cases where there had been a report alleging child abuse or neglect, not on every child.  (See below about that.) 

● They said that the algorithm curbed racial bias.  But only because the algorithm led to investigating more white families, not sparing more Black families from the enormous trauma of needless investigations. 

● They brag about their algorithm predicting actual child abuse -- based on a study which found that it fails up to 99.8 percent of the time.  (The study was done by the designers of the algorithm itself – in cooperation with UPMC.) 

● When they went full Orwell and created the version of AFST in which the aim is to stamp the risk score on every child at birth in order to target prevention programs, they had a problem: The ethics review that supported AFST was premised in part on not doing just that.  So, they commissioned another ethics review – but once again, they made sure to choose reviewers who would tell them what they wanted to hear. 

● To counter the charge of “poverty profiling” they said that unlike the AFST algorithm the one they hope to use on every child at birth, called "Hello Baby" “only relies on data where the County has the potential to have records for every family." But the key weasel word there is “potential.”  Because right before making this claim, the county acknowledges that they probably will use “child protective services, homeless services and justice system data.” 

● They say Hello Baby is voluntary. But it’s voluntary only in the sense that you are automatically assumed to have agreed to surrender your data unless you are constantly on the alert for your one opportunity, in the first days of your new baby’s life to opt out.  

So ask yourself: If Hello Baby is so great, why does Allegheny County have to, in effect, sneak it past the very people its proponents say are most likely to benefit, instead of being open and aboveboard about exactly what it is, and letting people opt in if they really want it?  If it’s as wonderful as Marc Cherna says, people should be lining up to take part. 

Cherna also says Hello Baby is to be used strictly for targeting prevention; the data from one part of Cherna’s agency won’t be shared with that other part of Cherna’s agency that does the child abuse investigations.  But how long will that last?  What happens after the next high-profile child abuse tragedy? Also: The prevention workers who go out – knowing that the family is “high risk,” and therefore possibly predisposed to see neglect whether it’s there or not -- also are mandated reporters of “child maltreatment.” 

The Hello Baby data are kept out of the hands of child protective services only as long as Marc Cherna or his successor or his successor’s successor decide to keep it that way.  If they change their minds Allegheny County parents can’t change their minds and take back their data.  And the way Cherna and his colleagues have sold AFST and Hello Baby doesn’t inspire confidence. 

Next steps 

Cherna plans to retire on March 5.  But there’s no need to wait.  Allegheny County’s political leaders should do right now what they did in 1996: name a committee to conduct a nationwide search.  Perhaps they’ll find another leader like Marc Cherna – the Marc Cherna from 1996, not the one from 2020.

The Pittsburgh approach to child welfare: Harass the mothers and stigmatize the children

According to a lawsuit, UPMC Magee-Women’s Hospital tested a pregnant woman 

for drugs without her consent. Then, pursuant to “practices, policies, 

and/or agreements” the hospital reported the false positive result 

to child protective services  – which then harassed the family. (Photo by Piotrus)

UPDATES, AUGUST 2, 2022: 

● A federal judge has refused to dismiss the claims against the University of Pittsburgh Medical Center.  As The Legal Intelligencer reported in May, the judge wrote that: 

“Averments set form in the amended complaint allege that [Allegheny County Children Youth and Families] used UPMC as a form of ‘cat’s paw’ to undertake inquiries and to administer drug tests on UPMC’s labor and delivery patients without their consent, and then to use reports of those ostensibly private and confidential medical inquiries and ‘provision and uncertain’ test results as a predicate to launch unwarranted and unconstitutional child abuse investigations.” 

The judge also rejected a claim by UMPC that boiled down to: Well, they didn't actually take away the kids, so what happened to the families is no big deal.

● Lawyers for the plaintiffs say that after the initial suit was filed, more mothers came forward with similar allegations. They are seeking class-action status. 

● Marc Cherna has retired.  Unfortunately he was replaced by Erin Dalton, who is even worse.

● A lawyer for the plaintiffs noted that the decision has implications well beyond Pittsburgh, telling the Legal Intelligencer: “Hospitals across the country need to take note of this decision and evaluate their practices.

● Although for years, media swooned over Pittsburgh's dystopian child welfare "predictive analytics" algorithm, known as AFST the first truly independent evaluation reveals that this algorithmic emperor has no clothes.

 

ONE CASE ILLUSTRATES A REMARKABLE NUMBER OF PROBLEMS COMMON TO CHILD WELFARE, INCLUDING:

 ● The fanatical desire to persecute certain mothers who smoke marijuana – or even are just falsely accused of smoking marijuana – no matter what that persecution does to their children.

● The harm done by journalists whose work has the effect of encouraging that kind of persecution.

● The campaign in Pennsylvania to make it even harder to expunge records of false allegations of child abuse.

● The harm done by the behavior of some doctors who specialize in detecting alleged child abuse.

● How the latest fad in child welfare, “predictive analytics” makes everything worse.

  

            They should have been among the most joyful days in the lives of Cherell Harrington and her family.  But starting just before she gave birth to her third child, late in 2017, the hospital where she gave birth and the child protective services agency in Allegheny County (metropolitan Pittsburgh) brought the worst kind of stress into the family’s life – they effectively threatened the family itself.

            Everyone ultimately agreed that Harrington did not abuse or neglect her newborn in any way.  Now she is suing the county and the hospital.  And it’s not just Cherell Harrington.  According to the lawsuit there is a “plan and/or agreement” between the county and the hospital to do this to new mothers. 

The practices involved allegedly are so common that attorney Margaret Cook of the Law Offices of Timothy P. O’Brien and lawyers from the American Civil Liberties Union of Pennsylvania are seeking class-action status for their suit.  (The ALCU of Pennsylvania’s legal director is a member of NCCPR’s volunteer Board of Directors.)

The hospital claims it just follows state law.  But even in Pennsylvania, where legislators take pride in passing ever more draconian laws so they can look tough on child abuse – no matter what that actually does to the children – there is no requirement to report Harrington and others like her to child protective services.

Even if Harrington wins her lawsuit, the nightmare may not end.  That’s because all this happened in Pittsburgh, home of the nation’s most advanced, Orwellian experiment in using “predictive analytics” in child welfare.

The algorithm used by the Allegheny County Department of Human Services and its Division of Children, Youth and Families (AC-CYF) doesn’t distinguish between true reports and false reports. So even though there were no grounds to report the mother at all, the mere fact that medical professionals reported her to the child welfare agency will raise the “risk score” for the child if the data are still in the system and anyone phones in some other false report against the parents.

 It’s not clear how long such information remains accessible.  Depending on how reports are classified and their disposition the information may be available for a year or for decades.  And there is a campaign underway to make things even worse.  So it’s possible that decades from now, the child himself may be labeled a higher risk for abusing his own children if anyone ever accuses him of abuse or neglect.

           

It all began with a drug test

           

            We don’t know why Magee-Women’s Hospital, a part of the University of Pittsburgh Medical Center (UPMC), decided to test Harrington for drugs.  We do know that Harrington is African-American – which makes such invasions of privacy more likely.

            Here’s what else we know, according to the lawsuit:

● Harrington never consented to the test. 

● The preliminary test came back positive, but only for marijuana.

● Such tests often are unreliable. Later, a more definitive test came back negative.

● The newborn tested negative for any drugs, including marijuana.

● Even were the tests positive, there is no evidence that marijuana use makes one a bad parent. Affluent parents even brag about it in Facebook groups.

Nevertheless, based simply on that one preliminary false positive test, the hospital reported Harrington to Allegheny County CYF.  And that false positive test was enough to launch an investigation.

Or was it just a “plan of safe care”?

This case illustrates that they’re really the same thing.  “Plan of safe care” is a term used in that repository for so much bad child welfare policy, the federal “Child Abuse Prevention and Treatment Act.”  Both CAPTA and Pennsylvania law require medical professionals to turn in new mothers to child protective services agencies if there is evidence the infant was “affected” by parental substance use.  Officially these are not necessarily child abuse reports.  But they are, in all but name.

In the case of Ms. Harrington, according to the lawsuit:

● There were no grounds to turn her in, since the test was a false positive – and her newborn tested negative.

● Allegheny County responded anyway, and the response was identical to a child abuse investigation.

So as you read on, and see what happened to this family, keep in mind that what happened here is exactly the kind of behavior at least one Pennsylvania seemed to want when she wrote this story.

What happened to the Harrington family

            According to the lawsuit:

Less than three days after giving birth to her son by caesarean section, an Allegheny County CYF caseworker entered Harrington’s room and told her that whenever the hospital reports any kind of positive drug test, the agency investigates.

            Two days after Harrington was discharged, the same caseworker showed up at the family home, inspected it from top to bottom, required Harrington and her husband to answer all sorts of personal questions and even questioned their 11-year-old daughter about her mother’s “use of addictive substances.”  The caseworker would go on to question the daughter’s school social worker.

            Then Harrington was coerced into a “counseling” session with a drug treatment program and forced to let the program test her for drugs again.  If she didn’t, she’d be reported to a judge for “failure to cooperate” and forced to go downtown for drug tests every month. 

            Harrington was coerced into signing all sorts of release forms  – but given no copies of what she signed.  According to the lawsuit “Ms. Harrington signed the documents because she feared that if she did not comply with [Allegheny County Children, Youth and Families] directives, her children would be removed from her custody.”

Even after the drug treatment program concluded no treatment was necessary, the harassment continued. The caseworker returned, inspected the home all over again and – again – questioned the Harringtons’ 11-year-old daughter.

Based solely on the false positive drug test the caseworker wrote that Harrington “cannot or will not control [her] behavior” and her “protective capacity” for her children was “diminished.”

A second case

           

            The lawsuit also describes what happened to another African-American mother, Deserae Cook, when she gave birth at another UPMC hospital.  Asked upon admission to the hospital if she’d ever used illegal drugs, Cook replied she’d smoked marijuana in the past but stopped when she found out she was pregnant.

            The hospital secretly tested her – without her consent -- and the test came back negative, confirming Cook’s account.  A drug test on the newborn also came back negative.

            Nevertheless, UPMC reported Cook to Allegheny County CYF – and her family, too, was put through a needless, traumatic investigation.

            All of this happened in spite of the fact that UPMC settled a lawsuit over the same practices in 2014.

            The current lawsuit sums up the routine behavior of UPMC and the Allegheny County Division of Children, Youth and Families (AC-CYF) this way:

UPMC and AC-CYF knew that a new mother’s self-report to a medical professional regarding prior drug use [or a new mother’s ‘unconfirmed positive’ drug test] constituted confidential medical information which UPMC was neither privileged nor legally required to disclose to AC-CYF absent evidence that her newborn was affected by illegal substance abuse or had withdrawal symptoms resulting from prenatal drug exposure. 

Nevertheless, in accordance with past practices, policies, and/or agreements between the Defendants, UPMC routinely, and in bad faith, reported this confidential medical information to AC-CYF and AC-CYF routinely accepted and acted on this confidential medical information to conduct unwarranted highly intrusive, humiliating, coercive and/or unconstitutional child abuse investigations of new mothers.

Why would a hospital be so cruel?

            Why would a big prestigious hospital inflict so much trauma on families? Perhaps they haven’t thought things through.

            UPMC is where Dr. Rachel Berger heads the “Child Advocacy Center.”  Berger co-authored a notorious article that formed the basis for an essay urging medical professionals to – literally – think less before reporting child abuse.  She also has gone out of her way to minimize the harm of foster care – in an essay co-authored by Erin Dalton, a deputy director of the Allegheny County Department of Human Services, where she reports to longtime DHS director Marc Cherna. 

            The fact that it now appears Cherna’s agency has some kind of special “practices, policies, and/or agreements” with Berger’s hospital concerning reports alleging substance use by new mothers is one more indication that Cherna should be deemed to have overstayed his welcome.

            The other indication is his role in creating his agency’s dystopian predictive analytics experiment.

The AFST factor

            All of this would be bad enough anywhere – but this kind of trauma done to overwhelmingly poor disproportionately nonwhite families is actually worse in Pittsburgh. That’s because Pittsburgh is a pioneer in using a “predictive analytics” algorithm whenever a family is the subject of a report alleging child neglect. 

            There are two versions of the Allegheny Family Screening Tool (AFST). The first version canvasses a vast trove of data (most of it collected on poor people) whenever CYF receives a report alleging child neglect.  It then coughs up a “risk score” which helps determine if CYF will investigate the call.  (All calls alleging abuse automatically must be investigated.  And now, it appears, Cherna and Berger have created another category of calls that must be investigated: All those that are part of some kind of arrangement between their respective institutions.)

            So the problem with AFST is not that it affected the initial reports on Harrington and Cook – the problem is what happens next time.

AFST counts reports workers later deem true, and reports they deem to be false. Past reports raise the risk score – period. And if those past reports come from medical professionals, they raise the risk score further.

The amount of time the county’s computers can gain access to such reports does depend in part on whether they are unfounded of not.  Unfounded reports are supposed to be expunged after no more than one year and 120 days.  So if, in fact, the report was labeled unfounded, the report might no longer be accessible to AFST.  But if the report was deemed "substantiated" Harrington and her family remain at risk of being labeled “high risk” and subjected to the whole traumatic process – or much worse – all over again.

            And there’s a move afoot to try to persuade the legislature to let counties keep even unfounded reports – perhaps for as long as they feel like it.  If that happens, then in the future, the danger to families such as the Harringtons could become vastly worse.

            There also is an even more dangerous version of AFST.  In this version, Cherna is trying to slap a risk score on every child – at birth.  Cherna promises this version will be used only to target “prevention.” But there is no way to stop him or a successor from changing her of his mind in the future.

So imagine what the score would be on a child such as the Harringtons’ infant if that version of AFST had been in effect when that child was born.  (In theory, this version is voluntary, but you have to affirmatively opt out and, as we’ve seen, that’s a risk families actually under investigation don’t dare take.)

            The reality of Pittsburgh child welfare under the rule of Marc Cherna was best summed up by Deserae Cook in an interview with the Associated Press:  She said her experience with the hospital and with Cherna’s agency

“…was like a kick in the stomach.  What’s the reasoning? It felt embarrassing and humiliating. It felt like they were trying to find something, trying to take our child away.”

Predictive analytics in child welfare: The selling of Hello Baby

If the Orwellian predictive analytics model in Allegheny County is really so great, why does the county’s human services director have to obfuscate about what it is and how it works?

 Read between the lines in some of the comments of those supporting Allegheny County’s Orwellian use of “predictive analytics” in child welfare – now including a plan to try to label every baby with a “risk score” at birth -- and you find something that boils down to this:  Well, yes, it’s potentially dangerous, but we trust Marc Cherna.  Cherna is the longtime director of the Allegheny County Department of Human Services.  

The sentiment is understandable.  Cherna has held the job since 1997.  I served on a search committee that unanimously recommended him.  For a long time I was proud of that. Cherna built an impressive record as a reformer, curbing the number of children in foster care and becoming a leader in the use of kinship foster care, among other accomplishments.  That built him a reservoir of goodwill.

But there are two principal problems with the “trust Marc” argument. First, Marc won’t be there forever.  And second, the way he is selling the program undermines trust.

It’s not the embrace of predictive analytics that raises questions about trust. There are other good, honorable child welfare system leaders who support it (though it appears that most of the leading proponents also are the most extreme supporters of a take-the-child-and-run approach to child welfare).  The trust questions arise because of how the county has sought to sell the first predictive analytics program, the Allegheny Family Screening Tool (AFST), which is used to help decide when to investigate reports alleging child neglect, and the even worse “Hello Baby” program – the one that seeks to slap that risk score on every newborn in the county.

The problems with the sales job are apparent in an article Cherna wrote for the Department of Health and Human Services publication Children’s Bureau Express.

Compare the rhetoric to reality

Cherna writes that the program is “supported by the use of integrated data and a predictive risk model…”  That’s it; there’s no further explanation.  In fact, the “predictive risk model” is the lynchpin of Hello Baby – the whole thing collapses without it.

Under that model, vast amounts of  data are collected, most of it from systems that enmesh primarily poor people. Then the system coughs up a “risk score” for the newborn based on how their parents have interacted with those systems.   Cherna promises that the risk score will be used only to target prevention programs. Those with the highest risk scores will get the most intensive “help.”  But there is nothing to stop Cherna, or his successor, from using the data in any other way they choose. We just have to trust them.

Cherna writes that “Hello Baby is a program of DHS's Office of Community Services and is not connected with child protective services.”  He neglects two key points:

● The helpers – who are being sent into a home precisely because an algorithm says the baby is at high risk of child abuse -- also are mandated reporters of child abuse. 

● The person in charge of both the Office of Community Services and child protective services is – Marc Cherna. He, or a successor or a successor’s successor, are free to tear down that wall of separation.

Cherna writes that the program is “voluntary.”  Technically, yes.  But when most people think of voluntary, they think of something that is offered to them and they then choose whether to take part.  Hello Baby doesn’t work that way.  Hello Baby assumes that you have agreed to surrender your data and have your baby labeled with a risk score at birth unless you affirmatively opt-out.  And it is unclear how much chance you have to do that.

So ask yourself: If Hello Baby is so great, why do they have to, in effect, sneak it past the very people its proponents say are most likely to benefit, instead of being open and aboveboard about exactly what it is, and letting people opt in if they really want it?  If it’s as wonderful as Cherna says, people should be lining up to take part.

Cherna goes on to tout the “ethical analyses” done of Hello Baby.  But he doesn’t mention how the county has stacked the deck for such analyses from the start. 

The first “ethics review” done for the AFST program, was a once-over-lightly review of a few papers, all of which were written by one of the designers of AFST or by one of the “reviewers” himself.   That reviewer is a faculty colleague of one of the AFST designers – in fact, they’ve co-authored papers together.

Even that review said AFST was ethical, in part, because it was triggered only if someone called the child abuse hotline and alleged maltreatment.  They wrote:

[The issue of informed consent] is one of a number of points at which we think that it is ethically significant that the AFST will provide risk assessment in response to a call to the call center, rather than at the birth of every child. [Emphasis added.]

So, now that Cherna is rolling out a use of analytics that does just that, what to do? First, call it “voluntary” by, as noted above, stretching the meaning of that word almost to the breaking point.  Then, commission more ethics reviews!  But make sure they’re from people strongly predisposed to support Hello Baby or apparently unfamiliar with child welfare.

All of which leaves one question: Should we be comfortable giving so much data and so much power to use that data to an agency that sells the program this way?