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.

Pittsburgh’s child welfare predictive analytics model has a failure rate of up to 99.8% – according to their own study. (So why are they calling this success?)

Pittsbugh's predictive analytics algorithm slaps a "scarlet number" risk score
on every child who is the subject of a report alleging neglect. 
And they're trying to do it to every child at birth.

Yesterday’s post to this blog noted that in Australia, an algorithm that wreaked havoc in the lives of poor people receiving public assistance was ruled illegal after it had a failure rate of 20 percent.  But apparently, in America, if you just whisper the words “child abuse” in everybody’s ears, even a failure rate of up to 99.8 percent is o.k.

 

          Here’s the thing about those predictive analytics algorithms that supposedly can predict who is going to abuse a child: They tend to fail spectacularly.

           In Los Angeles, the county decided not to roll out a predictive analytics model known as AURA after preliminary tests showed that 95 percent of the time when the algorithm predicted that a parent or guardian would do something terrible to a child – they didn’t.

           In Illinois, a program spreading across the country, Rapid Safety Feedback, managed to sound alarms on thousands of innocent families – and miss children in real danger.

           But what about Allegheny County, Pa. (metropolitan Pittsburgh)?  That’s the program that was supposed to be different from all the others.  That’s the one reporters all over the country have swooned over.  That’s the one where the algorithm is supposedly transparent (it isn’t). That’s the one certified ethical (but one of the ethics reviewers co-authored papers with one of the program’s designers).  Turns out the Allegheny Family Screening Tool doesn’t get it wrong 95 percent of time.  AFST gets it wrong up to 99.8 percent of the time.  That’s according to a study co-authored by the people who created AFST in the first place.

           And yet, they’re touting this as a success. 

 How AFST works

           AFST is used to screen reports of neglect and decide whether to send out a caseworker to investigate. (In Pennsylvania, any abuse report sent on from the state’s child abuse hotline must be investigated.) 

          AFST then consults a vast treasure trove of data gathered disproportionately on poor families without their informed consent. It then coughs up a risk score between 1 and 20 - a "scarlet number" that can wind up haunting a child for life.   And they're trying to do it to every child at birth.

          

Twenty is a risk level so high it literally flashes red on the screens of those responsible for deciding whether to send out an investigator - and the humans are strongly discouraged from overriding the algorithm.

           So of course if the risk score is 20, the investigators must be finding lots and lots of horrific child abuse, right?

Study findings

           Well, let’s see what the study found.

           The Pittsburgh study used a methodology similar to the study of AURA in Los Angeles.  They applied the AFST algorithm to past cases.  Then they looked at records from Children’s Hospital of Pittsburgh, a division of the University of Pittsburgh Medical Center (UPMC), to see how many of the children identified by AFST as high risk or low risk turned up at the hospital with an injury the hospital deemed to be child abuse.

           For low-risk cases  2/100ths of one percent eventually turned up with such an injury.  But for cases that got a risk score of 20, fully  two tenths of one percent – yes, two tenths of one percent! -- actually turned up at the hospital.  

            In other words, the odds of impurity in a bar of Ivory Soap are greater than the odds of a child labeled extremely high risk by AFST turning up at the Children's Hospital ER with an abuse-related injury.

           The conclusion of the researchers (most of whom also designed AFST) boils down to: See how great our algorithm is?  Those with a higher risk score were more likely to suffer an injury.  Indeed, the New Zealand “institute” run by one of the designers of the study put out a statement declaring:

 New research co-authored by Rhema Vaithianathan [the co-designer of AFST] and Diana Benavides-Prado confirms that children identified as at risk by the Allegheny Family Screening Tool, … are also at considerably heightened risk of injury, abuse and self-harm hospitalisation.

           Nowhere does the statement explain that “considerably higher” means two-tenths-of-one percent.

           

So what about the other 99.8 percent?  Unless a human overrides the algorithm, the worker must go to the door, demand entry, search the entire home, poking into cabinets and cupboards and refrigerators (which, at the moment also means increasing the risk of spreading or contracting COVID-19).  They must interrogate every member of the family, often an enormously traumatic experience for a child.  And they may well stripsearch the children. 

          Roughly 99.8 percent of the time, it will be for nothing.  In addition to inflicting all that needless trauma, workers wasted time that could have been used to find the very few children in real danger. 

Disingenuous definitions 

          No doubt AFST proponents will argue that the 99.8 percent figure applies only to the most serious injuries – injuries that involved “hospitalization.”  The statement touting the results repeatedly uses that term, with no further explanation.

           But take a close look at how the study defines hospitalization.  The authors use the term interchangeably with “medical encounters.” While that can mean hospitalization, as in, it was so serious the child had to be admitted to the hospital, it also includes simple visits to an emergency room – which, for many poor people, is the family doctor. 

            It could also be argued that some injured children might show up at other ER's.  But most of them, especially those whose injury is serious or where there's a suspicion of abuse, are likely to wind up at the hospital where the study was done. That's because, according to the authors, "UPMC Children's Hospital is the sole provider of secondary [meaning specialized] care for children in the Allegheny County area."

           Of course, those with a risk score of 20 might also be more likely to be “neglected” – at least in the minds of a caseworker, which would make the true positive rate higher.  But neglect often simply means the family is poor.  We don’t need an algorithm or the child abuse police to find where the poor people are and help them, preferably with money.

            But even if you give AFST so much benefit of the doubt that we assume it's really five times more accurate than this study revealed, that still would mean AFST is wrong 99 percent of the time.

           None of this stopped the AFST co-designer/study-co-author from declaring that their study “proves” AFST can detect actual child abuse, not just system involvement. But even that isn’t clear.  The study defines child abuse as when someone at the hospital said it was child abuse.  When it comes to making these judgments, hospitals in general and UPMC in particular  haven’t always acted wisely.

        

 No amount of tweaking the algorithm is going to improve this track record – and, in one sense, that’s good news.  What the study really shows, once again, is that “child abuse” of the sort that comes to mind when we hear those words actually is extremely rare.  Think of it: Of those children AFST rated at the very highest risk, up to 99.8 percent did not experience a child abuse injury that required either hospitalization or an ER visit.

           There is no way to refine an algorithm to find these very few needles in a huge haystack without sweeping into the net vast numbers of innocent families.

           That may be why even the editors of the journal that published the study, JAMA Pediatrics, appear skeptical.  In an editorial, they write:

Much harm can be done under the umbrella of good intentions, because big data is a big weapon. …  the concerns about the accuracy of the algorithm deployed should be of paramount importance, since the thread of historic biases in large data sets has become increasingly apparent. … The child abuse literature reports that both the evaluation of suspected abuse and subsequent diagnoses can contain racial biases. …

         The editors suggest a better approach they call 

the policy principle of proportionate universalism—broadly providing services or resources without targeting specific families or people. The target of strategies to decrease rates of child maltreatment would be better directed to community-based strategies that support children and families facing adversities and living in poverty.

           That sounds like a fancy way of saying: Find the poor people; send money.

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.”