NCCPR in MinnPost on Minnesota's obscene rate of child removal

Minnesota tears apart families at one of the highest rates in the country. And Minnesota has been an outlier for nearly 20 years - maybe even longer.  Our take on what's gone wrong and how to fix it is in this column for the online news site MinnPost.

Predictive analytics in child welfare: The harm to children when “the stuff stays in the system.”

Marc Cherna is was once one of the best human services leaders in America. But even he shouldn't have the power to be the Mark Zuckerberg of child welfare.

Today, across America and much of the world, the big story will be Facebook CEO Mark Zuckerberg testifying before Congress about how personal data from millions of Americans wound up in the hands of Cambridge Analytica. Although the data breach is outrageous, at least those data were originally uploaded voluntarily – Facebook users have the right to not share their data in the first place.

In Pittsburgh, Pa. poor people have NO. SUCH. CHOICE. They are forced to surrender their data.  And their data can be used to decide whether to take away their children. I’ve written about the implications here and here.  Another example comes courtesy of a Pennsylvania dentist:

Last week, I published a post about a dentist in Pennsylvania who sent threatening form letters to some of his patients. The patients had dared to not schedule follow-up appointments when the dentist thought they should. In the case which brought this to public attention, the patient didn’t like the dental practice and had made clear her intention to go elsewhere.

The letters threaten to report patients who don’t schedule follow up appointments to child protective services.  According to at least one news account, the dentist acknowledges following through on the threat 17 times last year.

The earlier post discusses the potentially devastating consequences for children. If the report is “screened in” – as is likely because it came from a medical professional – it means, at a minimum, a highly intrusive investigation that could do lasting emotional harm to the children.  That harm can’t be undone if the child welfare agency realizes the report was false.

The mere existence of a false report in a child welfare agency file can increase the chances that, if there’s another false report, the new report will be wrongly substantiated – because of a bizarre notion in child welfare that enough false reports are bound to equal a true report. This increases the odds that the children will be consigned to the chaos of foster care.

And, of course, all those false reports steal time caseworkers should be spending finding children in real danger.

The only good news here is that this dentist practices in eastern Pennsylvania.  At least in that part of the state a child abuse “hotline” operator deciding if a case should be “screened-in” can check the file and, seeing a previous allegation based solely on a missed dental appointment, might realize how absurd it was.

Were this dentist at the other end of the state, in Allegheny County (metropolitan Pittsburgh) it could be far worse.

Automating absurdity

That’s because Allegheny County is home to the nation’s most advanced experiment in using “predictive analytics” to decide when to investigate if a child is in danger of being abused or neglected. 

Whenever the county receives a report alleging that a child is being abused or neglected, an algorithm known as the Allegheny Family Screening Tool (AFST) uses more than 100 different data points to spit out a secret “risk score” between 1 and 20 -- an invisible “scarlet number” that tells the county how likely it is that the child is, in fact being abused or neglected or is at risk of abuse or neglect.  The higher the number the more likely the report will be “screened in” and investigators will be sent out.

Though the investigators don’t know the risk score, they do know that a high risk score is why they are being sent out in the first place.

Prof. Virginia Eubanks offers a devastating critique of AFST in her book, Automating Inequality. Part of that chapter is excerpted in Wired magazine. I discussed her findings in detail in Youth Today and I discussed the ethically-challenged “ethics review” used to justify AFST on this blog, so I would repeat that overall critique here.

But the case of the disgruntled dentist prompts me to focus on one particular piece of the Allegheny algorithm: The mere fact that a previous report exists – regardless of how stupid that report may have been – raises the risk score.  No human being intervenes first to see if the report had any legitimacy.

In fact, it appears that the Allegheny County algorithm even counts previous reports that were considered so absurd they were screened out with no investigation at all. 

So suppose, hypothetically, an Allegheny County dentist reported someone just for missing a follow-up appointment.  This was considered too absurd even to investigate.  A few months later someone else calls the child abuse hotline about the same family.  The existence of that previous, uninvestigated report from the dentist raises the risk score.  So now, the child has a higher scarlet number.

Making it even worse: In the Allegheny algorithm still another factor increasing the risk score is if a report, no matter how absurd, was made by a medical professional – such as a dentist.

And Cherna is pretty fanatical about keeping and using data – regardless of the data’s reliability.  This is clear in what he told Prof. Eubanks about a related issue: reports that are legally allowed to be kept for far longer, those in which caseworkers “substantiate” the allegation. In Pennsylvania, as in most states, that means only that the caseworker decides it is slightly more likely than not that abuse or neglect occurred.

In cases alleging actual abuse, there is a long, almost impossible appeals process.  And in a bizarre twist of Pennsylvania law, in less serious cases there is no appeals mechanism at all.  In such cases, the county keeps a record of the case until the child who was the subject of the report turns 23. 

This is where we find out how Marc Cherna feels about keeping junk reports and using them in his algorithm.  He told Eubanks: “The stuff stays in the system.” And, of course, Cherna said what those who hold onto junk reports of child abuse always say. In effect, enough false reports are bound to equal a true report. Said Cherna: “A lot of times where there’s smoke there’s fire.”

But a lot more often there’s someone who’s just blowing smoke.  So let’s just be grateful that a certain dentist hasn’t opened a branch office in Pittsburgh.

And, as we watch what's happening in Congress today, let’s also remember one thing more.  Marc Cherna is now the Mark Zuckerberg of child welfare. Both Zuckerberg and Cherna amass huge quantities of data. Then they decide what will happen to those data.  There are two key differences: Marc Cherna isn’t doing it to make money. In fact both his intentions, and his track record as a child welfare leader are excellent.  On the other hand, Facebook can’t use data to take away your children. Marc Cherna’s agency can.

UPDATE: 11:45 am: In an earlier version of this post, I asked whether inclusion of certain elements in AFST violated Pennsylvania law concerning expungement of records involving unfounded reports. This was based on a list of factors included in AFST. I noted that I had e-mailed Cherna and his deputy Erin Dalton on April 5 and received no response.  I have just received a response from Cherna, in which he makes clear that, in fact, AFST does NOT include any information that legally should be expunged.  Therefore, I have deleted that portion of the original post.

A middle-class adoptive mom’s unusual response to being falsely accused of child abuse: "I learned a lot about the less privileged. I learned a lot of empathy."

It happens over and over. Foster parents and, to a lesser extent, adoptive parents complain about how badly they are treated by child protective services agencies.  Decisions are made about the children in their care without consulting them, they say. They’re not treated as part of a team, they say. They’re even victimized by false allegations of child abuse, they say.

Foster and adoptive parents are more likely to be white and middle class – in other words, people like us instead of people like them. As a result, to paraphrase the old brokerage slogan, when foster and adoptive parents talk, people listen.  They get enormous public sympathy, as in this case.

I don’t begrudge them that.  A lot of the time, their complaints are justified.

But every time I read another story about foster or adoptive parents complaining about their ill-treatment, I keep waiting for one thing to happen – I keep waiting for the proverbial lightbulb to appear over the complaining foster or adoptive parents’ heads. I keep waiting for someone to say:  “The child welfare system really needs us.  If this is how they’re treating us imagine how they’re treating birth parents.  Maybe I need to reconsider my assumptions about who CPS takes away, and why.”

It’s not that it never happens. When Maine foster parent Mary Callahan noticed that almost every child placed with her could have remained safely in their own home had the birth parents simply gotten the aid she received as a foster parent, it helped change an entire state foster care system. 

But such instances are few and far between. When one turns up, it’s worth highlighting, even when it happened five years ago, and I missed it at the time. 

So I want to offer belated thanks to Dr. Christine Deeths, formerly of Bakersfield, California, to her lawyer Shawn McMillan, who has championed families in many similar cases in California, and to former Bakersfield Californian columnist Lois Henry who wrote about what happened to Dr. Deeths’ children.

The details concerning what Kern County Child Protective Services did to doctor Deeths’ adopted children are in this column by Henry, so I won’t go into them here. Suffice it to say that it falls into one of those rare categories of cases in which the overreach of child protective services hits the middle class.  And suffice it to say the needless removal of the 4-year-old and 6-year-old children was so outrageous that the county offered Deeths a settlement of $1.4 million – before she even sued.

As Deeths put it:

My children will never be the same. They lost their innocence the day they were taken. CPS stole that from them and it can never be replaced.

But instead of taking pains to claim she was different from people who typically get caught up in the system, Dr. Deeths realized how much she and they had in common.  As Henry writes:

As part of the original CPS case, Deeths was ordered to attend parenting classes put on by Human Services. The classes themselves were useless, she said. But she met dozens of parents who, like her, had lost their children. Unlike her, however, they weren't nearly as educated nor did they have the same resources, money, strong family support, friends, colleagues, etc.

"I learned a lot about the less privileged," she said. "I learned a lot of empathy."

She had the resources to fight CPS, she said, when most other parents don't. She wonders how many more families have been unfairly torn apart.

"A lot of what they're taking kids for is a lack of knowledge about life skills and CPS isn't helping parents learn those life skills," she said. "Meanwhile they're creating generational problems because when you take a child, they're changed forever.

"They're creating a cycle."

If only more middle class people who encounter the child welfare system had that kind of empathy.

Mandatory child abuse reporting laws: An appalling letter from a dentist – and the awful law that made it possible

When I first saw this photo on Facebook, I thought it might be a hoax. It's not.
A dentist in Pennsylvania actually sent this letter to some of his patients.

A child abuse investigation sometimes is a necessary act. But at other times, it can do great harm to children.

At a minimum, government investigators with the power to have children removed on the spot will question the children about the most intimate aspects of their lives, often stripsearch those children and leave the entire family terrified of what might happen if those government agents come back again. The younger the child the greater the extent to which the investigation becomes, in itself, an act of emotional abuse.

A recent study estimates that about one-third of all American children, and a majority of African American children, will be subjected to this trauma at some point in their childhoods.  And more than 80 percent of the reports turn out to be false.

Even if the report ultimately is labeled false, it often is retained in child welfare agency files and can be used against that family if they are victimized by another false report on the theory that, by some magic, enough false reports equal a true report. 

The consequences go beyond the harm to children victimized by false reports. Workers spend more than four-fifths of their time spinning their wheels, leaving them less time to find children in real danger.  Rushing to report “child abuse” with little or no reason to suspect it makes all children less safe.

So it is an act of willful ignorance for those who defend needlessly inflicting this intrusion on families and needlessly overloading the system to claim that no harm is done as long as the investigator concludes the allegation is false.

What the dentist did

That is the context in which we need to consider what happened to Trey Hoyumpa when she took her children to a dental practice known as Smiles 4 Keeps in eastern Pennsylvania.  As she would later explain on Facebook, and elsewhere there were a number of things that disturbed her about Smiles 4 Keeps. According to Hoyumpa:

            ● They do not allow parents to stay with their children during dental procedures.

            ● The parent never even meets the dentist, only the hygienist.

            ● They claimed her children had seven cavities between them – but she says, they never showed her the x-rays.

            ● They will treat only one child for fillings per day. If the parent has more than one child in need of procedures, they have to make a separate appointment.

Having to take two days off from work for two separate follow-up appointments was the last straw.  So Hoyumpa exercised her right not to return to Smiles 4 Keeps. She told the receptionist she would be seeking dental care elsewhere. And she made her displeasure loud and clear.

At least she thought it was her right.  Until the threat arrived in the mail.  It wasn’t even a custom-tailored threat. It was a form letter threat:

“Dear patient,” the letter says:

“At Smiles 4 Keeps our goal is to keep children as healthy as possible through education, regular dental checkups and timely treatment as needed. In order to do that, you must bring your child to one of our Smile Centers for regular professional cleanings and treatment.

Then things turn ominous:

According to law, failure to bring your child for dental care is considered neglect. Pennsylvania Act 31 (Child Abuse Reporting and Recognition Requirements) states that health care providers must report your failure to bring your child to the dentist for evaluation and care. … Smiles 4 Keeps has not reported your child’s outstanding dental treatment as of yet.  Since this law is in effect, we hope this letter encourages you to schedule an appointment to follow through with needed dental treatment for your child. ...

To keep your child as healthy as possible and avoid a report to state authorities, please call Smiles 4 Keeps immediately to schedule a treatment appointment within the next 30 days…

As for seeking care elsewhere: Well, Smiles 4 Keeps says, you could do that, but you had better prove it – to our satisfaction.  According to the letter:

If you sought a second opinion, please also contact us with the name of your new provider. We would be happy to forward your child’s records upon signing a release form.

 “Highly unethical” …

Another dentist told WNEP-TV the letter is “highly unethical.” Dr. Richard Grossman adds:

I think it's used as a scare tactic actually, to scare parents to bring their kids to those offices … I'm shocked that it's a Pennsylvania group of dentists who've resorted to something like this.

Scott Shackford, an Associate Editor of the libertarian magazine Reason goes further:

Neither Hoyumpa nor any other consumer has any obligation to communicate with Smiles 4 Keeps or to set foot in its offices if she doesn't want to, and she is not required to tell them why or where they've gone instead. Yet [Smiles 4 Keeps founder Dr. Ross] Wezmar and his offices are threatening families with government investigations for declining to do business with him. … Does he even care that he could upend families' lives by reporting them to the state? … Citing this law to try to scare parents into patronizing your business is pretty damned low.

…and inaccurate

The letter from Smiles 4 Keeps also is inaccurate.

Like most state definitions of child abuse and neglect, the one in Pennsylvania is so broad and so vague that almost anything could qualify.  Thus, Pennsylvania’s definition of neglect includes “The failure to provide a child with adequate essentials of life, including food, shelter, or medical care.” But there is nothing in state law requiring that, as the letter claims “health care providers must report your failure to bring your child to the dentist for evaluation and care.”

And while it is true that dentists in Pennsylvania, as in most states, are required to report child abuse, in Pennsylvania they are required to report only when they have “reasonable cause to suspect” such abuse or neglect has occurred – not simply because a parent failed to schedule a follow-up appointment.

As for “Act 31” – which Smiles 4 Keeps enclosed with the letter, that’s just a long, turgid section of state law concerning training requirements for mandated reporters. It says nothing about what must be reported. 

The dentist’s response

In a follow up story, Wezmar, the founder of Smiles 4 Keeps, not only defends the letter, he brags about running the first dental practice in all of America to send such threats to patients.  He makes the usual argument: Horror stories.

Wezmar supplied the television station with photos of severely diseased teeth – though it is never said if these are photos of actual Smiles 4 Keeps patients or simply something from a textbook.  And he claims the threat letters were sent to only 17 patients last year.

But if it involves only 17 patients why a form letter?  Presumably, if Dr. Wezmar cares so profoundly about these particular children’s dental health he’d want to write letters outlining the specific problems in each case and why an appointment supposedly is urgent.  The “Dear Patient” form letter sounds like Smiles 4 Keeps has determined that simply failing to schedule an appointment with Smiles 4 Keeps is de facto evidence of neglect sufficient to merit a report to child protective services. That jibes with Hoyumpa’s account.  (Smiles 4 Keeps is now promising to re-word the letter.)

The fact that she objected so loudly to the practice’s practices also may have contributed to getting Hoyumpa on the Smiles 4 Keeps threat letter list.

Smiles 4 Keeps also issued statements claiming that their threat letters are consistent with the definition of neglect used by the American Academy of of Pediatric Dentistry. That group told Yahoo Lifestyle that it defines dental neglect as

willful failure of parent or guardian, despite adequate access to care, to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.

But  no evidence has been offered indicating that Hoyumpa’s case fits that definition.

An Academy spokesman added that dentists also have obligations to their patients:

To the best of his or her ability, the pediatric dentist should be certain that the caregiver understands the explanation of the disease and its implications and, when barriers to the needed care exist, attempt to assist the family in finding financial aid, transportation, or public facilities for needed services. If, despite these efforts, the parent fails to obtain therapy, the case should be reported to the appropriate child protective services agency.”

Smiles 4 Keeps claims that it makes lots of phone calls and emails to patients urging them to make follow up appointments before sending the threat letters. (Hoyumpa says, however, she received no such warnings). And I know of no public statement from the practice about offering the kinds of help described by the Academy.

Instead, Trisha Richards-Service, described in The Pocono Record as a “spokeswoman” for Smiles 4 Keeps did what people doing this kind of harm to children often do – suggest that they and only they really care about the kids. Said Richards-Service:  “It’s heartbreaking to us that the focus is not on the best interests of the child.”

Right.  Because what could be better for a child than to face the trauma of a child abuse investigation because the family chose to find another dentist?  And what could be better for children than bothering child protective services agencies with more false and trivial reports, stealing the time of caseworkers from finding children in real danger?

 
Little or no real recourse for families

There have been suggestions that Hoyumpa complain to state consumer protection authorities.  That’s not likely to do any good.

Mandatory reporting laws make it easy for professionals who work with children to abuse their power.  There is no penalty for false reports made in good faith – and good luck proving that a medical professional wasn’t acting in good faith.  Indeed, Wezmar and his colleagues may well have persuaded themselves that they are doing the right thing by sending these letters – rationalization is powerful.

But false reports by medical professionals, even when well-meaning, are among the most dangerous, since they are among the reports most likely to be “screened in” for investigation by child protective services hotlines.

All this in spite of the fact that, even after more than 50 years, there is not a shred of evidence that mandatory reporting laws actually make children safer.  Many former proponents of those laws have had second thoughts.

And the climate is especially ugly in Pennsylvania, where hype and hysteria over child abuse have been at a fever pitch for years, largely as a result of the scandal involving former Penn State coach – and former group home operator and foster parent – Jerry Sandusky.

The Pennsylvania Legislature responded to that scandal with 23 separate laws broadening definitions of child abuse and generally encouraging anyone and everyone to report anything and everything.

It’s unlikely that any consumer protection agency is going to want to look “soft on child abuse” by helping families fight back.

Lasting consequences

Even beyond the trauma of the investigation, the consequences for the children of the falsely accused can be severe.

Even when child protective services decides an allegation is patently false, that’s not necessarily the end of it. Laws vary from state to state, but a record of the allegation can stay in a state central registry, sometimes for a decade or more.  And, if another false allegation is made the mere existence of the prior allegation may raise the level of suspicion.  Indeed, you hear it from child welfare agencies all the time: “Where there’s smoke, there’s fire.”

But in child welfare, a lot of people are just blowing smoke.

Blogger Lenore Skenazy, of Free-Range Kids fame, wrote about a strikingly similar case in Canada last year. Mom dared to switch dentists, was reported for “oral neglect,” the case was unfounded – but she can’t get her record expunged.  Skenazy writes:

The child protective agency says it hangs onto files for “accountability.” But if the charges were found meritless, it makes no more sense to keep Melissa’s case on file than it would if she were investigated for bank robbery and found to have been six states away the night of the crime. Should the authorities keep a file on her just because they once, completely mistakenly, thought she robbed a bank?

The issue here is how easy it is to drag a family into an abuse investigation, and how hard it is for the family, like an impacted molar, to get itself extracted.

Still, it could have been worse.  At least this happened in eastern Pennsylvania. Everything would have been worse had it happened at the other end of the state – in Pittsburgh. This post explains why.

If it’s April Fools, it must be Child Abuse Hype and Hysteria Month

Back in 2003, one of the groups most responsible for fomenting hype and hysteria about child abuse came remarkably close to admitting that they did just that – and that it had backfired.

Rather like Dr. Frankenstein admitting he’d created a monster, in a 2003 Request for Proposals concerning how to improve their messaging, Prevent Child Abuse America wrote:

While the establishment of a certain degree of public horror relative to the issue of child abuse and neglect was probably necessary in the early years to create public awareness of the issue, the resulting conceptual model adopted by the public has almost certainly become one of the largest barriers to advancing the issue further in terms of individual behavior change, societal solutions and policy priorities.

This is especially worth remembering as we begin “Child Abuse Awareness Month” – a month, which, appropriately starts on April Fools Day.

So I’ve reprinted below our 2010 blog post on the topic – with some updates and links to newer data – since, unfortunately, aside from those data, nothing has changed. Because it's a lot easier to create a monster than to bring it under control

ORIGINALLY PUBLISHED APRIL 1, 2010 , UPDATED APRIL 1, 2018

Get ready for a seemingly endless stream of cookie-cutter news stories and Astroturf op ed columns (the kind written by national groups with blanks to fill in to make them sound home-grown) touting "Child Abuse Awareness Month" – based on the bizarre premise that the American people are blissfully unaware of child abuse.

There is something appropriate about the fact that "Child Abuse Awareness Month" starts on April Fools Day, since it involves fooling the public in order to push an agenda of hype and hysteria that obscures the real scope of the problem, and real solutions, in favor of approaches that only make a serious and real problem worse. Your typical Child Abuse Awareness month news story or op ed column follows a standard formula:

1.     Take the most horrifying case to occur in your community over the past year, the more lurid the better.

2.     Jump immediately from that story to a gigantic number which actually is only the number of "reports" alleging any form of child maltreatment. Ignore the fact that the vast majority of those reports are false and most of the rest are nothing like the horror story, and often involve the confusion of poverty with neglect. Or…

3.     Use only the total number of cases that caseworkers guess might be true, but call them "confirmed" giving the guesses, which are simply the opinion of a worker checking a box on a form, far more credibility than they deserve. A major federal study found that workers are two- to six-times more likely to wrongly label an innocent family guilty than to wrongly label real child abusers innocent.

4.     Throw in huge lists of "symptoms" or "warning signs" that "might" be "signs" of child abuse – and might as easily be signs of any number of other things.

5.     Instruct us all that it is our duty to phone the local child abuse hotline with any suspicion of anything no matter how vague and how dubious – instead of advising us to report when we have "reasonable cause to suspect" maltreatment, the same standard often used in law to guide "mandated reporters."

6.     Remind us that we are welcome to call the hotline anonymously – thereby encouraging those who want to harass an ex-spouse, a neighbor or anyone else against whom they may have a grudge to go right ahead, secure in the knowledge that they'll never get caught because they can conceal their identity.

It all comes from the same ends-justify-the-means mentality behind the egregiously-misleading report published by Every ChildMatters – the mentality that says: what's a little distortion and exaggeration in the name of a good cause?

In fact, such distortion and exaggeration can do enormous harm to children. 

Hotlines wind up with more false reports and trivial cases; children are harassed and traumatized by needless child abuse investigations – often including stripsearches as caseworkers look for bruises - and some of those children are forced needlessly into foster care. The caseworkers wind up even more overloaded by these false allegations, so they have even less time to find children in real danger.

Reality check

NCCPR has some resources on our website for any journalists and others interested in putting all this into context, countering the hype and hysteria and pressing for real solutions:

·         Issue papers on Understanding Child Abuse Numbers and False Allegations: What the Data Really Show

·         Our analysis of the latest comprehensive study of child abuse, which puts the scope of the problem into context

·         Our Solutions pages, Doing Child Welfare Right and our Due Process Agenda.
·         Our essay on how to really prevent child abuse: take a social justice approach instead of a public health approach.

If the people behind "Child Abuse Awareness Month"  (also known as "Child Abuse Prevention Month") really want to prevent "child abuse" then how about campaigning to ameliorate the worst effects of poverty.  

Poverty increases the stress that can lead to actual abuse and, as noted above, poverty itself often is confused with "neglect."  This can be seen by the fact that the simple act of raising the minimum wage $1 an hour cuts "neglect" by ten percent.

The problem of child abuse is serious and real, but the solutions have been phony. The distortion and exaggeration that typify child abuse "awareness" campaigns only promote phony solutions and make those serious, real problems even worse.

If only there were a Statistics Abuse Prevention Month.