Mutual aid vs. the family police: Guess which approach keeps kids safer

A new study debunks not only the “pandemic of child abuse” myth but myths about abolition as well. 

When COVID-19 forced New York City's family policing agency to step back, mutual aid organizations,
such as Bed-Stuy Srong in Brooklyn, stepped up - and child safety improved. 

It should have been obvious from the beginning: The pandemic of child abuse claims were bull--it.  It also should have been obvious that such claims are, uh, racist. 

So I’m pessimistic about how much good it will do to point out the findings of a new study by Prof. Anna Arons of New York University School of Law, looking at actual data from before, during and the transition-to-after COVID-19 in New York City.  And I’m pessimistic about how much good it will do to point out that NCCPR’s own check of similar data in Florida produced similar results.  But let’s give it a try. 

The data show that none of the dire predictions of the fearmongers came to pass.  And the new study shows more: In New York City, when the family police agency – the city’s Administration for Children’s Services – was forced to step back, community-based, community-run mutual aid organizations stepped up.  That, plus direct cash payments to individuals included in federal stimulus bills, made children safer. 

The study has lessons not only when it comes to fearmongering about COVID-19 and child abuse, but also about the word that strikes terror in the heart of the “child welfare” establishment: abolition. 

The study is only the latest challenge to the “master narrative” about child abuse and COVID-19 that emerged as soon as the pandemic began.  You remember the claims (hard to forget, since they still haven’t stopped): As soon as mostly white middle-class mandated reporters – especially teachers and other school personnel – no longer had their “eyes” constantly on overwhelmingly poor disproportionately nonwhite children due to COVID-19 school closings, the children’s parents would unleash upon them a pandemic of child abuse. 

So of course, the fearmongers claimed, there would be a huge surge in child abuse reports once the kids were back in school and their teachers could see what their parents had done to them. There even were calls to recruit more foster parents because, inevitably, so many more children would need to be taken away. 

But even after several national news organizations challenged the fearmongering, local reporters across the country accepted the myth as fact.  Even after that bastion of child welfare establishment scholarship, Chapin Hall at the University of Chicago, challenged the claims, the stories continued.  

That’s partly because of the racism that permeates all aspects of society – even if many in child welfare claim immunity.  But it’s also the result of 50 years of “health terrorism,” decade after decade of suggesting that extremely rare horror stories were common and there’s a child abuser under every bed. 

But the COVID-related claims are especially dangerous. In addition to the dangers of needlessly destroying families and overloading the system with false reports, giving workers less time to find children in real danger, the mythology risks increasing the spread of COVID-19 among families and caseworkers alike. 

These claims also fuel calls for premature full reopening of schools – in order to get those white middle-class eyes back on the kids - based on the idea that Black and Brown parents are a greater danger to their children than a deadly disease.  That was always dangerously wrong – all the more so as we are learning how the more dangerous “UK variant” of COVID-19 is spread. 

Measuring safety 

In the paper, Prof. Arons offers several measures of safety, three of which stand out to me: 

Fewer alleged child abuse fatalities.  Like everything else in the family policing system, child welfare’s pandemic of fear has been driven by lurid stories of child abuse deaths.  The message has been: If you don’t peek inside the door when you’re supposedly helping a neighbor by dropping off food and report anything that your “gut feeling” or “intuition” says is wrong today, that child might be dead tomorrow. At least two recent stories have speculated that a child who died of abuse might have been saved had the schools been open.  They went on to draw sweeping conclusions about how such a case supposedly shows the need for what amounts to a massive child welfare surveillance state.  

But deaths also are the hardest form of child abuse to hide.  And when Prof. Arons compared reports alleging child abuse fatalities between February and June 2019 – before COVID -- to the same period in 2020, during the pandemic, Prof. Arons found that reports to New York’s child abuse hotline alleging fatal child abuse in New York City declined by 25 percent, from 63 such reports to 47.  

One always should be cautious in citing fatality data to as evidence for anything – for a reason for which we all should be grateful: Though each is the worst form a tragedy, they also are extremely rare, so rare that they might rise or fall year-to-year due to random chance. 

But remember – the fearmongers told us to expect a big increase in such fatalities, and the fearmongers will use any one case they can find to “prove” that we desperately need that massive child welfare surveillance state. 

So, at a minimum, since the predicted surge in fatalities hasn’t happened it is at least as likely, and probably more likely, that forcing the family police to step back saved children’s lives, rather than contributing to children’s deaths.  I’ll discuss possible reasons for this below. 

No “rebound” in numbers or severity. Perhaps even more significant is what has happened as schools have reopened in New York City.  If the fearmongers were right, thousands of battered and bruised children would be limping back into their classrooms and shocked teachers, seeing the welts and scars would be rushing to call the hotline – a “rebound” in calls that supposedly was going to swamp child protective services and foster homes.  If the fearmongers were right, there would be far more such calls than in a typical fall (when reports always go up as children return to school) and the proportion alleging physical and sexual abuse would be higher. 

Instead, from September through November 2020, the rate of increase in hotline calls from New York City was about the same as the previous (pre-COVID) year.  And the proportion of such reports alleging anything like the stuff of horror stories remained unchanged. Both years, the proportion of reports alleging only neglect – which usually means poverty – was the same, about 75 percent. 

This is all-the-more remarkable given the power of suggestion: From March 2020, when schools shut down, until their reopening in September, New York City teachers, administrators and other school personnel heard the same messages as the rest of us: Just wait until the kids come back!  You’ll see how horrible those parents were!  But even though they were primed to see a surge in physical and sexual abuse that supposedly had gone undetected, they didn’t.  Because it wasn’t there. 

Different state, similar results 

Of course, desperate apologists for the family police might try to claim that the New York results are because not enough children are learning in person yet.  But data also are available for one of the states that has been most fanatical about trying to force children back to in-person education – a state where the governor has been among the most demagogic about pressuring schools to reopen by exploiting the false narrative of a pandemic of child abuse: Florida (of course). 

From September through November 2019, before COVID, Florida’s child abuse hotline received 84,985 calls.  During the same period in 2020, after Gov. Ron DeSantis was pushing all schools to reopen, the number was 81,688, a difference of 3,297 in a state with more than 4.2 million children.  Each year, the proportion of calls “screened in” for investigation was nearly identical. 

When Florida breaks down reports by type of abuse alleged, it reports the data for the month an investigation was closed, not when it was opened, so that makes comparisons more difficult, but it’s clear that even with all those kids pushed back into in-person instruction there was no surge in reports alleging abuse as opposed to neglect – even though, again, the governor himself was issuing dire warnings. 

Back in November, Prof. Robert Latham, associate director of the Children & Youth Law Clinic at the University of Miami (and probably child welfare’s foremost data nerd) wrote this: 

I wrote last month that if there wasn’t a big jump in the number of kids being removed by October (the typical high-point in Fall removals) then I was going to call the COVID prophecies bunk. And here we are with the October data and…nothing. The October removal numbers came in lower than expected. 

What went right? 

Prof. Arons cites two factors: The first was the emergence of a network of more than 60 mutual aid organizations throughout New York City. 

Mutual aid projects mobilized to provide an extraordinary array of services to community members who requested aid. Nearly every group organized grocery deliveries and provision of essential items like diapers, but others focused on more specialized services, like childcare for workers or mental health care and support groups. Rather than the exacting intake procedures required by charities and government social services, groups kept their barriers for entry low, requiring only that community members complete online request forms or call intake lines, and removing eligibility requirements that judged moral worthiness. 

Families stayed safely together not because of the family regulation system but because of its absence. Even in the midst of the nonstop trauma of 2020, community members worked for and with each other, providing their neighbors food, diapers, childcare, mental health services, and redistributing government wealth. [Emphasis in original]. 

Mutual aid projects had one other crucial feature: The people running them are not “mandatory reporters” of alleged child abuse or neglect – so no one had to be afraid to go to them for help. 

Families had a safe way to ameliorate the poverty that is so often confused with neglect. They had a community-based support system to ease the stress that, in rare cases, might have prompted a parent to lash out and abuse their child.  At the same time, as Prof. Jane Spinak of Columbia University Law School predicted at the start of the pandemic, the reduction in calls may have given workers more opportunity to find the very few children in real danger in time – which might have contributed to the decline in reports alleging fatal child abuse. 

So even as family policing apologists run around yelling about how the sky will fall if we abolish the child welfare surveillance state, something very much like it happened in New York City – and children wound up better off.  Prof. Arons calls her study, “An Unintended Abolition.” 

But what about Florida? I know of only one mutual aid group in that state, though of course there may be many more.  But if, in fact, mutual aid wasn’t as much of a factor in Florida, what was? 

For starters, there is the simple fact that the kind of child abuse we think of when we hear those words – the beatings, torture and murder that the fearmongers revel in – is, in fact, extremely rare, but we’ve been conditioned by health terrorism to think otherwise.  Overwhelmingly, families love their children and cope with whatever stress the world dishes out.  

But there also was a second factor in Prof. Arons’ analysis, one which applies nationwide: 

Money. 

As Prof. Arons writes: 

Together with the increase in mutual aid came a rare influx of government aid with few strings attached. The CARES Act, passed in early April 2020, provided a one-time stimulus payment of $1,200 per adult for individuals earning less than $75,000 annually, with an additional $500 payment for each child under the age of 17, and an extra $600 per week in unemployment benefits, through the end of July 2020. Together, these measures represented a transfer of funds from the government to the people larger than all other non-retirement programs combined. 

This real-world experience adds to the wealth of studies showing that even small additional amounts of cash dramatically reduce what family policing agencies call “child neglect.” This additional cash, and the help of mutual aid organizations to which families can turn without fear also prevent problems from escalating, reducing the already low probability that families will lash out at their children. 

The new danger in believing the fearmongers 

All of this takes on even greater significance as our knowledge of COVID-19 and its variants grows.  At least as early as March 19, one of the nation’s leading infectious disease experts, a member of the Biden Transition Team’s COVID task force was explaining why he’d changed his mind about the safety of a full reopening of schools.  Here’s what Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told a Boston television station: 

“I, for one, was a strong supporter of opening schools, particularly K through 8, saying the epidemiology here is compelling, that there’s just very little transmission -- to kids, from kids, by kids and that we could open schools,” Osterholm said. “Well, B.1.1.7 [The U.K. variant] has totally turned that on its head.” 

“I think school openings today are going to greatly enhance transmission of B.1.1.7 in our communities,” Osterholm said. “And I predict that within weeks we will be revisiting this issue -- unfortunately, after we’ve had substantial transmission.” 

Yet the fearmongering stories remain a staple of local news. 

Three days after Dr. Osterholm spoke, a newspaper published a story (no, I won’t link to it) in which Dr. Rachel Berger, one of the foremost proponents of a massive child welfare surveillance state, someone who's gone out of her way to minimize the harm of tearing apart families said this: 

“I can’t emphasize enough the need to get back in school. …  At least, get them into a classroom. Get a teacher seeing these kids. … At this point, we know you can open schools as long as you do it well.” 

The same story includes a similarly panicky quote from a local district attorney – and, again, all of this was published three days after Dr. Osterholm’s warning.

The fearmongers’ false, dangerous message, is unmistakable: Poor parents, especially poor parents of color are a greater danger to their children than a deadly disease. 

Time for an intended abolition? 

What really endangers children, of course, is the extent to which America’s family policing establishment has dehumanized the Black and Brown families it professes to want to help.  The family policing establishment finds it inconceivable that families who always have had to cope with far more than their white middle-class counterparts also can cope with the stress of a pandemic without taking it out on their kids.  They find it unimaginable that these parents love their children – just like white people do! They find it incomprehensible that the children and families will do better without the “counseling,” “parent education” and, worst of all, foster care, they seek to inflict. 

But now we’ve seen it happen.  We don’t have to ask what abolition would do – we’ve seen an unintended abolition make families safer. 

So imagine how well an intended abolition could work.  Imagine how much the safety and well-being of America’s impoverished children would improve were there a phased transition from agency-inflicted “preventive services” and foster care to a system that emphasized concrete help provided by community-based agencies.  Imagine if we phased out mandatory reporting laws, so no one ever need fear asking for such help.  Imagine if we drastically scaled back the family police. 

COVID-19 didn’t teach us exactly what that would look like.  But it taught us it would look a hell of a lot better than what we have now.

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.”

In child welfare, it’s the scientists who want their peers to "think less"

Too much thinking stands in the way of an ever-larger child welfare surveillance state

In the climactic scene of Inherit the Wind a film loosely based on the Scopes Monkey Trial, the character based on Clarence Darrow – making the case for the right to teach evolution - is questioning the character based on William Jennings Bryan, who makes the case for creationism.

But the Darrow character argues that more than creationism vs. evolution is at stake.  The case really is about the right to think:

I love that scene.  I suspect a lot of my fellow liberals love it, too.  Science, after all, is all about thinking, and only fundamentalists could oppose that, right?  In fact, it’s preposterous to even imagine a field in which women and men of science – doctors, no less – would actually urge their fellow professionals to do less thinking – uh, right?  Right?

Well, not exactly.  Because in the upside-down inside-out world of child welfare, there are medical professionals who are doing exactly that – literally.

Andrew Brown, director of the Center for Families and Children at the Texas Public Policy Foundation, first brought this to light in an excellent op-ed column for The Hill called “The doctor will accuse you now.” He writes about how two doctors, Richard Klasco, a professor of emergency medicine, and Daniel Lindberg, a professor of pediatrics, are urging their colleagues to adopt an approach they themselves call “think less, screen more.”

The idea is this: If a child has certain injuries, sometimes even something as minor as a bruise, these injuries are more likely – or, a better way to put it – less unlikely to be caused by abuse than other injuries. 

Up to now, doctors have been told to consider these injuries in the context of things like family medical history and the plausibility of a parent’s explanation.  If there is still genuine concern that the injury might be a sign of another problem – be it abuse or a medical condition – they’re supposed to refer the child for additional medical tests, in particular x-rays – which then are reviewed by professionals who, again, are supposed to consider all possible explanations.

Getting rid of that pesky context

But under the think less-screen more approach, we get rid of all those other pesky considerations. 

● First, the proponents say, we have to vastly expand the definition of what kinds of injuries are deemed suspicious – or maybe even eliminate definitions altogether and deem any visit by any child to an emergency room suspicious.

● Then any such injury, or ER visit, regardless of family medical history or explanation, should automatically prompt, at a minimum, a demand for a “skeletal survey” – equivalent to 20 standard x-rays of the child.

As a family profiled by Brown in his op-ed put it in their own post, it’s like leaping from: “smoking causes lung cancer” to “anyone who has lung cancer is a smoker.” 

Actually, it’s worse. The treatment for lung cancer is likely to be the same regardless of the cause.  But if one leaps to the conclusion that any bruise of a certain nature is probably child abuse, the consequences for the child can be far worse.

Lindberg and Klasco summarize their case, and use the term “think less, screen more” in an op-ed for Time magazine.  But Lindberg goes into far more detail in an essay for the Journal of Pediatrics.  That essay is co-authored by Dr. Rachel Berger. She runs the “Child Advocacy Center” in the Department of Pediatrics at the University of Pittsburgh Medical Center Children’s Hospital.  She also is prone to minimize the enormous harm of foster care, as can be seen in a commentary she co-authored that is discussed toward the end of this previous NCCPR Blog post.

It’s not that Lindberg, Klasco and Berger are ill-motivated. On the contrary.  The nature of their work means they see the very worst that parents can do to their children (though the nature of their work also means they see it so often that it may distort their perception of how often it happens). Like all of us, they are genuinely horrified and want to do something about it.  What they don’t seem to see, however, are the horrifying consequences for children of false allegations and needless foster care.

So in their current article, Berger and Lindberg say referring a child for a skeletal survey, and sometimes even more tests, based on suspicion of child abuse should be routine whenever there is a so-called “sentinel injury,” a term typically applied to a narrow range of bruises and other injuries in infants.

That’s not because children with sentinel injuries probably were abused.  In fact, in any given year, of all Americans under age 18, fewer than two-tenths-of-one-percent were believed by child protective services workers to be victims of any form of physical abuse, from the most minor (some CPS workers consider a spanking to be abuse) to the most severe.  (Even if we assume that the “real number” is twice as high, which is unlikely,* that still means more than 99.5 percent of American children are not physically abused in any way in any given year.)  But, Berger and Lindberg argue, the percentage who show up with “sentinel injuries” and were abused isn’t as low.

Nevertheless, Berger and Lindberg call for vastly broadening the types of injuries that should be deemed “sentinel injuries” and raising the age for labeling them “sentinel injuries” to age 4. And maybe not just actual injuries. Berger and Lindberg say even a baby’s “fussiness” could be a sign of serious abuse.  

If the family doctor – or any other medical practitioner - sees a "sentinel injury," the authors argue, the doctor should, literally “think less, screen more” -- put the family under suspicion and send them to the hospital for a battery of tests on the child.  Those tests may be evaluated by doctors who are so-called “child abuse pediatricians.” Even when they don’t have that designation, the doctors looking at all those x-rays may be predisposed to find abuse by the very fact that child abuse is the suspicion that prompted the referral in the first place.

But even that isn’t enough for Berger and Lindberg.  They go on to cite, with approval, a mechanism Berger developed in which every child who is brought in to an emergency room is automatically “screened” for abuse and, presumably, further tests, via a checklist of “risk factors” – regardless of whether there are “sentinel” injuries. The results go into the child’s electronic health record. And here’s the great news, they write: Berger’s model is based on one already “validated” in the Netherlands.  But you have to follow the endnote to the actual Dutch study to learn that the checklist got it wrong more than 89 percent of the time.

But so what? say Berger and Lindberg. Lots of medical tests are performed routinely for screening and come up negative in most cases.  But none of those other tests can result in a child being confiscated on-the-spot and consigned to the chaos of foster care.  Berger and Lindberg's approach would place many more families under suspicion. That, in turn, would place their children at exactly that risk.

It gets even more absurd

But the absurdity is just beginning. 

Berger and Lindberg actually call for less thinking on the grounds that it will eliminate bias!  In other words, no need to worry about, say, being too suspicious of Black parents and needlessly demanding they get their kids x-rayed if you simply suspect everyone and demand that all parents whose children have certain symptoms subject those children to testing.

On the one hand, I suppose it’s progress that these doctors acknowledge that bias among their colleagues is so pervasive and so deep that the solution is to bar them from even thinking.  But even if one assumes vastly widening the net of a cruel, stressful intervention into children’s lives is the best way to eliminate bias, there’s still a problem – it doesn’t eliminate bias; it just kicks that particular can down the road.

X-rays don’t read themselves.  Conclusions are drawn by doctors.  In this scenario, the doctors already know that the referral is based on a suspicion of child abuse.  If you add to that the fact that the family walking through the door for those x-rays is a family of color you have just as much, if not more, potential for bias than existed before.

Bias may be even more likely if the person looking at those x-rays is a so-called “child abuse pediatrician” and/or part of a “child abuse team.” This is a new subspecialty in which people who already have the certification supervise the training of other doctors who want the same certification. So whatever biases might have been there when the subspecialty was created, in 2009, are likely to be perpetuated.

I am aware of no studies concerning who becomes a child abuse pediatrician and why.  I do know that I have never read a story in which a child abuse pediatrician says: “I kept finding families who were destroyed, and children who suffered enormously when those parents were wrongly accused of child abuse. So I vowed to learn everything I could and become a child abuse pediatrician so I could stop children from being hurt that way, and make sure we were focusing on children in real danger.”

One need only look at how readily the field overdiagnosed “shaken baby syndrome” to see the potential for bias. 

In her book, They Took the Kids Last Night, family defense attorney Diane Redleaf describes case after case of misdiagnosis of child abuse.  But, she notes, “Not one child abuse pediatrician I knew of ever admitted their opinions about abuse were ever mistaken.”   She calls the field “a specialty stacked in favor of finding child abuse.”

And it is not exactly reassuring that Berger, Lindberg and Klasco all repeatedly minimize the harm of a false accusation.  Lindberg and Klasco claim in their op-ed that the worst that will happen is that “some non-abused children will be screened, and some non-abusive parents will be offended.”

No.

As Andrew Brown explains, the worst that can happen is what happened to the children of Rena and Chad Tyson – after the parents were told to get the child x-rayed and the x-rays found fractures:

Rather than attempting to find a medical explanation, doctors at the hospital contacted Child Protective Services. All three of the Tysons’ children were removed by the state and placed in a kinship foster placement. The family would be separated for five months while Rana, Chad, and their children’s pediatrician worked to figure out the cause of the fractures.

The real causes were a series of medical conditions.  But the children were trapped in foster care and the legal and medical bills bankrupted the family.

Oh, wait, that’s not even the worst.  The Tysons’ children were placed with relatives and the parents could see them every day.  Anyone care to bet how this “bias-free” system would have responded had they been poor and nonwhite?  Oh, wait again. We know exactly how it would respond – the same way it always responds - as described here.

There are many other cases, and they all, as the doctors might say, present with similar symptoms: doctors whose specialty is child abuse jump to the conclusion that the cause of the “suspicious” injury is child abuse. 

Adding even more bias

Berger and Lindberg support approaches that would make the process even more biased.  For page after page they go on and on about how decisions can be based on looking objectively at physical injuries.  But then they speak admiringly of a frightening surveillance-state process already in place in Britain thanks to the use of electronic health records.

Berger and Lindberg write:

[Child protective services] shares information with the National Health Service about children who are on a “Child Protection Plan.” If that child then receives medical care in any unscheduled care setting, such as an [emergency department] or urgent care center, the healthcare team is alerted and given access to the contact details for the CPS caseworkers and service providers. In addition, CPS is automatically notified that the child has been to the ED, and both parties can see details of the child’s previous 25 visits to EDs or urgent cares.

Here’s why that’s so scary.

1. The overwhelming majority of cases in which families are under some kind of child welfare agency supervision (our equivalent of a “Child Protection Plan”) don’t involve abuse at all – they involve neglect, where the determinations are most subjective of all.  Indeed, what CPS workers call neglect often is simply poverty.

2. The people most likely to have “receive[d] medical care in any unscheduled care setting” are, of course, poor people. 

So now, under this plan – which Berger and Lindberg seem to love – any poor parent “under supervision” because of “neglect” automatically is doubly suspect if s/he has to take a child to the ER.  And visiting the ER, for any reason, becomes part of the child welfare agency’s case file, ratcheting up suspicion of the family.

Berger and Lindberg also write approvingly of a system in New South Wales, Australia, in which a “Child-At-Risk” alert is in the electronic health record for any child whose parents were subject of any report alleging child abuse or neglect.  But in the United States, more than 80 percent of such reports are false reports.

Now throw in "predictive analytics"

As I read all these glowing accounts of building a bigger and bigger child welfare surveillance state, I thought to myself: Oh God, imagine what would happen in Pittsburgh, where Dr. Berger works, and where the child welfare agency already harvests vast troves of data about poor families Cambridge Analytica-style – that is, without their consent, and uses it against them in its “scarlet number” predictive analytics algorithm.

Sure enough, just a few paragraphs later, Berger and Lindberg start singing the praises of the algorithm.  They repeat the misleading claim that the Pittsburgh algorithm may have reduced racial bias; in fact any reduction was solely a result of screening in more white people.

The solution to bias is not to refer more and more families to “child abuse pediatricians” for less and less reason.  The whole biased process starts the moment the family doctor pulls the trigger and sends the family for additional “screening” when it isn’t necessary.  Berger and Lindberg's approach winds up making all doctors trigger-happy.

But wait, say Berger and Lindberg – at least under the “think less” approach, if the x-rays don’t show abuse, the family can be cleared – so, isn’t it worth getting those x-rays?

But that claim is debunked - by accident - in an editorial in the same issue of the Journal of Pediatrics as the Berger/Lindberg essay.  The editorial, written by Dr. Mary Clyde Pierce, a child abuse pediatrician, is not a critique – it’s highly-supportive of the “think less” approach. But, according to the editorial:

Importantly, the sentinel injury in and of itself may be enough to not only prompt a further workup for other abusive injuries (eg skeletal survey) but also to report the event to social services regardless of the results of the additional workup (eg, negative skeletal survey).

(Emphasis added. And by the way, did you notice how Clyde Pierce says other abusive injuries? In a classic example of the bias that pervades the field, the immediate assumption is that all sentinel injuries are abuse.)

But wait, there’s more:

“When the screening studies are negative, the assumption is sometimes erroneously made that “abuse is ruled out” or it is not abuse because the screening studies were negative. These screening studies … cannot “rule out abuse.”

In fact, Clyde Pierce declares, if an infant with a sentinel injury has no history of trauma and a negative skeletal scan, that actually might put the infant at even greater risk – by lulling professionals into a false sense of security that he wasn’t abused!

So you see, in the world of child abuse pediatrics not only are you guilty until proven innocent, there’s no way to prove your innocence!

The all-purpose fallback argument: Horror stories

In the end, Berger and Lindberg are forced to fall back on the argument that’s always used to get us to “think less” – horror stories.

So they tell us all these elements of the child welfare surveillance state are needed because of the “regular occurrence of fatalities in children previously reported and screened out by CPS…”  “Regular occurrence" is not, of course, a scientific term.  It can mean whatever you want it to mean.  But here’s what we do know: More than 7.5 million children become “known to the system” every year.  An enormously generous estimate of the proportion of those children who die is two-tenths-of-one-percent. 

Each of these deaths is the worst form of tragedy, and the only acceptable goal for such “occurrences” is zero.  But the idea that, in the course of sifting through reports on about 7.5 million children every year, agencies “regularly” screen out cases in which children later die is not borne out by those numbers.  On the contrary, it is graphically obvious that it is an extremely rare occurrence. Here’s the graphic:

For a much more detailed discussion of how figures about child abuse fatalities are regularly misused to get us to “think less” see this previous post.

But the best evidence that the surveillance state approach won’t work comes from the Berger-Lindberg article itself.

The modern process of constantly ratcheting up surveillance of families began more than half a century ago with the first wave of mandatory reporting laws requiring certain professionals, especially doctors, to report their slightest suspicion of abuse or neglect. The scope of the laws and the professions they cover have steadily increased since, despite the fact that there is no evidence these laws actually make children safer.

In 2009, the medical profession created the subspecialty of child abuse pediatrics.  Since then, Berger and Lindberg say, the number of such doctors has more than doubled and the scholarly literature has “increased dramatically.” 

This vast expansion of the child welfare surveillance state gotten to extreme that one study estimates that at some point during their childhoods one-third of American children – and more than half of African-American children will have to endure a child abuse investigation.

Yet Berger and Lindberg themselves admit it hasn’t worked: As examples, they cite studies showing no change in the proportion of cases of “abusive head trauma” (AHT) that are being overlooked. (AHT is the new term the field came up with after all that misdiagnosis of “shaken baby syndrome”) Then they add: “Perhaps most disturbing is that the number of deaths related to physical abuse has remained stable at approximately 600 annually.”

By their own admission, all that additional suffering inflicted on children by the child welfare surveillance state hasn’t done a damn thing to make children safer.  Yet their solution is to make the surveillance state vastly bigger and more intrusive.

Perhaps Berger and Lindberg would have seen the problem with this – if only they’d given it a little more thought.

________

*-While it is, of course, likely that some allegations of physical abuse are mistakenly labeled unfounded, the only study I know of to second-guess these decisions found that caseworkers are two to six times more likely to wrongly substantiate an allegation of child abuse or neglect than to wrongly label it unfounded