The Inquirer could learn a lot from some journalism students in Montana
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| As far back as 1989, when the "drug plague" was crack, Pulitzer prize-winning columnist Ellen Goodman understood what many reporters still don't get. |
In a
previous post to this blog, I discussed how actual experts on substance
abuse keep pleading with reporters not to make the same mistakes in covering
the opioid epidemic that they made covering the crack epidemic – in which
coverage was infused with hype and hysteria that did enormous harm to children. I discussed how the Washington Post ignored all of those warnings.
The Philadelphia
Inquirer did a
better job in a story about a case going before the Pennsylvania Supreme
Court. So it was disappointing to see
what happened when the same reporter wrote a more detailed
story on February 23, about infants born with opioids in their systems and
how hospitals should respond. Though it
still was an improvement over the Post,
the story veered toward “crack baby journalism.”
Perhaps because the stories were written by a longtime
health reporter, they show more care than most when discussing the health
effects of opioid use on infants. But to
know how child welfare should respond to opioids, knowing about opioids isn’t
enough. You need to understand the realities of child welfare. That’s where the story fails.
In contrast, a much smaller newspaper, the Missoulian, and
some outstanding journalism students covered the issue with
far more insight and nuance.
In discussing the “debate” over when to turn in mothers to
child protective services, the only “sides” discussed by the Inquirer are whether to turn in those
who use all drugs or only illegal drugs.
The idea that the best interests of children would be best served by
allowing medical professionals to decide on a case-by-case basis if a child
truly is endangered is not even offered to readers for consideration.
That’s not surprising given that the entire story is built
on a false premise, aptly summed up by this subhead: “Infant safety vs. respect
for moms.”
The Big Lie of child welfare
The idea that taking away children is inherently safe and
standing up for “children’s rights” while leaving them in their own homes is
inherently risky and a sop to “parents’ rights” is the
Big Lie of American child welfare. Framing the debate as “infant safety vs.
respect for moms” is a way of tailoring that Big Lie to cases involving
substance use.
The real debate is: What is in the best interests of
children – automatically turning in their mothers, or respecting professional
expertise? But Inquirer readers will find that nowhere in the story.
When hospitals report substance using mothers to child
protective services, the article falsely
The reporter herself declares at the top of the story that
the infants “are known to be at higher risk of neglect or abuse when they go
home with mothers battling addiction.”
Later she suggests that even mothers who are in treatment and taking
legally prescribed opioids, such as methadone, as part of their treatment,
should be turned in to authorities – because, she suggests, you never know when
those awful moms will relapse.
Lessons from the crack epidemic
But if the legislator were really “biased toward the child”
she would have done her homework and learned from the crack cocaine experience. She would know about the study that made what
amounts to a head-to-head comparison of sending those infants home versus forcing
them into foster care:
University of
Florida researchers studied two groups of children born with cocaine in their systems; one group
was placed in foster care, another left with birth mothers able to care for
them. After six months, the babies were
tested using all the usual measures of infant development: rolling over,
sitting up, reaching out. Typically, the
children left with their birth mothers did better. For the foster children, the separation from
their mothers was more toxic than the cocaine.
And if the reporter
were truly concerned about what puts children at “higher risk of neglect or
abuse” she would have noted the many studies showing abuse in one-quarter to
one-third of foster homes. She also
would have shared with readers the data on the long term awful outcomes for
children consigned to the foster care system - and how, in typical cases those
outcomes are worse than the outcomes even for comparably-maltreated children
placed in foster care. Links to all of
these studies and data are available here.
Scaring mothers away from care
There also is no
mention of another, obvious consequence, if doctors and nurses at hospitals turn
in every mother who uses drugs: The mothers won’t go to the hospitals,
significantly increasing the risk to their children.
The story says that
“when women use drugs during pregnancy, they are more likely to neglect
prenatal care …” Note the contemptuous term “neglect.” In some cases that’s
accurate; in some cases far worse terminology would be accurate. But in other cases, the mothers can’t get
prenatal care due to poverty, don’t know how to find it or are afraid to seek
it out, precisely because they fear being turned in to child protective
services.
We’ve known about
that for decades. Here’s what happened in Utah, according to a 1999 Salt Lake Tribune story* after a
highly-publicized crackdown on drug using mothers:
Fewer pregnant women with substance-abuse addictions are seeking treatment and prenatal care -- out of fear they will be arrested or lose custody of their children, according to Utah officials who counsel and treat them.
While Utah prosecutors have not charged a substance-abusing pregnant woman with felony child abuse since January 1998, the fear of legal reprisal apparently still exists, said Lynn Martinez, program manager for the Pregnancy Risk Line at the Utah Department of Health.
"We've been in business for 15 years. Last year and so far this year have been the worst as far as the number of substance-abuse referral calls," she said. "We're probably getting about half the number of calls we are used to."
Donald Dudley, an obstetrician specializing in high-risk cases at University Hospital, said he has noticed a drop. "And it's not like they're all of a sudden getting better and not using drugs," he said. "I have patients who are methadone users, so they're out there. But I think there is a lot of fear out in the community about this issue. A lot of them have been driven underground."
The Inquirer story even minimizes the
findings from the latest research on treating newborns born with opioids in
their system. The story mentions in passing that some babies “get sufficient
relief with cuddling and swaddling” but it neglects to mention the importance
of who does the cuddling:
In contrast here’s
what The
New York Times found
[A] growing body of evidence suggests that what these babies need is what has been taken away: a mother. Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care.
“Mom is a powerful treatment,” said Dr. Matthew Grossman, a pediatric hospitalist at Yale-New Haven Children’s Hospital who has studied the care of opioid-dependent babies.
In my column about
the Washington Post story, I quoted
one of the few journalists to get it right during the crack epidemic: Pulitzer
Prize winning Boston Globe columnist
Ellen Goodman. “There simply is no way
to save the babies,” she wrote, “if you throw away the mothers.”
That doesn’t mean we
can simply leave children with hopelessly addicted parents. But it does mean that in most cases, drug
treatment for the mother is a better option than foster care for the child.
But we just want to help
To which those
supporting turning in all parents probably would say: But that’s all we
want! We just want the moms turned in so
child protective services can decide what kind of help to give them.
The story cites the
former Pennsylvania congressman James Greenwood, who sponsored amendments to
the federal Child Abuse Prevention and Treatment Act requiring reporting all
mothers of infants “affected” by prenatal drug exposure to child protective
services so they can develop a “plan of safe care” for each child. (If states
choose to take a wiser approach and not blindly follow the CAPTA mandate, they only
risk losing a relatively small amount of federal money.)
The story notes how
Greenwood stressed that
the goal is to help families, not target struggling women. “In crafting the federal law, I never envisioned that the ‘referral’ from a health care provider was the same as a child abuse report,” said Greenwood, a former child protection caseworker.
This is, at best, hopelessly naïve.
When a doctor picks up a phone and calls the agency that
That doesn’t mean
the child automatically will be removed to foster care. But why should we
assume that the judgement of a typically inexperienced, underprepared
minimally-qualified caseworker for a child protective services agency is
superior to the judgment of medical professionals?
And the Utah
experience suggests that, once the word gets out that hospitals have to turn in
all drug using mothers, a lot of those mothers will steer clear of hospitals.
Mischaracterizing the debate
Given all the
unquestioned assumptions the Inquirer reporter
brought to the story, it’s disappointing but unsurprising that she
mischaracterizes the debate solely in these terms:
One side of the debate argues that hospitals should report all drug-exposed babies to local child protection agencies, while the other side says only babies whose mothers used illegal drugs should be reported.
Behind the distinction are good intentions. Many women work to control their misuse of legal or illegal drugs with counseling and prescribed opioids — namely, methadone or buprenorphine — that prevent wrenching withdrawal symptoms. Some are taking prescribed opioids for chronic pain under a doctor’s care. What’s more, women who are motivated to quit drugs altogether when they discover they’re pregnant are typically prescribed methadone, because going cold turkey increases the risk of miscarriage.
But newborns exposed to legally prescribed opioids still can suffer withdrawal — and still can be at long-term risk of neglect or abuse, given the chronic relapsing nature of addiction.
In other words: Drug
using moms: Threat or menace?
Consider what this
leaves out:
● Why does the Inquirer consider it relevant that
newborns exposed to legal drugs still can suffer withdrawal? What the writer really is saying is: Look
what bad mothers they are to put their infants through this – they don’t
deserve to have them. (And they probably “neglected” to get prenatal care, too.)
● How does a
referral to child protective services now diminish the possibility of relapse
months or years from now?
● And most important: How does the risk of
relapse compare to the risk of abuse, and other known harms, if the child is
consigned to the chaos of foster care?
Were all these
questions to be considered it would require adding a third option to the
debate:
1. Do not allow
child protective services to accept reports based solely on a mother’s use of legally prescribed medication to
control drug abuse. It should be presumed that the risk to a child posed by
such a mother – who is already under medical supervision and getting treatment
– is less than the risk caused by involving child protective services and
placing the child at risk of foster care.
2. Change state laws
to give medical professionals discretion to determine when a mother’s substance
abuse presents such a danger to her
child that a report to child protective services is necessary.
3. Where drug
treatment is needed, make it as easy for a doctor or nurse to get a new mother
into a high quality drug treatment program as it is to call a child abuse
hotline.
In some cases those
medical professionals will get it wrong. They will fail to report some children
in real danger, and also report some children who are not, in fact, in danger. But they are likely to make fewer errors than
a system that requires a knee-jerk report to child protective circumstances in
all circumstances.
I don’t expect the
reporters and editors at the Philadelphia
Inquirer to rush out and endorse this approach. I would hope they could bring themselves to
at least share the existence of this side of the debate with their readers.
Of course, it’s easy
to write off any request from an advocate as biased. And in this case, those who would make such a
claim have a point.
Because I am biased
in this debate. I’m biased toward the child.
