Lessons from History for the Future of Child Welfare

March 16, 2023

Information

3/7/2023

The John P. McGovern Lecture

Cohen Auditorium and Zoom

Mical Raz, MD, PhD

Professor of History, University of Rochester

Charles E. and Dale L. Phelps Professor in Public Health and Policy

Professor of Clinical Medicine, School of Medicine and Dentistry, University of Rochester Medical Center

Andrea Asnes, MD, MSW

Professor of Pediatrics (General Pediatrics), Yale School of Medicine

Director, Resident and Fellow Wellbeing, Graduate Medical Education, Yale School of Medicine

Director, Yale Programs for Safety, Advocacy, and Healing, Pediatrics, Yale School of Medicine

ID9690

To CiteDCA Citation Guide

00:00Hey everybody, welcome to the
00:052023 John P McGovern
00:07Award lecture ship supported
00:09by the John P McGovern Fund
00:10for the Humanities in medicine within
00:12the Yale School of Medicine program
00:14for the Humanities and Medicine.
00:15My name is Anna Reisman and I'm the
00:17director and glad to have a live
00:21audience as well as a zoom audience.
00:23So John P McGovern
00:25is a Texas based medical humanist as
00:27well as an allergist and invent investor.
00:30Gonna say inventor and philanthropist
00:32who established several lectures
00:34bearing his name at medical schools
00:35throughout the country. This award
00:38lectureship is given annually
00:39to a physician who is both
00:41a scientist and a humanist.
00:42And quote demonstrates the true
00:44healing art who is a knowledgeable,
00:46humane and caring physician.
00:48And I'm happy to say that doctor
00:49Michael Raz is all of these things.
00:52So the title of Doctor
00:54Ross's talk this afternoon is lessons from
00:56history for the future of child welfare,
00:59and she will be in conversation with
01:01another wonderful scientist and humanist.
01:04Doctor Andrea Asmus and I will introduce
01:06them both and turn things over to them.
01:09So Michael Raz is the Charles E
01:11and Dale L Phelps professor in public policy
01:14and health at the University of Rochester,
01:16where she also works as an internal medicine
01:19physician at strong Memorial Hospital.
01:21She completed her medical
01:22training at Tel Aviv University,
01:24where she also received a PhD
01:25in the history of medicine.
01:27She completed a postdoc at Yale in 2012,
01:30a residency in internal medicine
01:31at Yale New Haven Hospital in 2015,
01:34followed by Robert Wood Johnson
01:35Clinical Scholars Fellowship at
01:37the University of Pennsylvania,
01:39focusing on health policy.
01:40Research and joined the
01:42University of Rochester in 2019.
01:44She is the author of several
01:45books, the lobotomy letters,
01:47the Making of American psychosurgery.
01:50What's wrong with the poor race,
01:53psychiatry and the war on poverty and,
01:55most recently, abusive policies?
01:57Have the American child
01:59welfare system lost its way?
02:00She has published extensively on
02:02the imperative to protect children
02:04and families from coercive child
02:06welfare intervention and the harms
02:08of conflating poverty with neglect.
02:10Ross has lectured widely on the
02:12unintended consequences of her
02:13child protective interventions and
02:14has been invited to testify between
02:17before different legislative bodies,
02:19primarily on the topic of mandated reporting.
02:21So welcome, Michael
02:23Andrea Asmus and Andrea Asmus is
02:28a professor of Pediatrics and a board
02:30certified child abuse pediatrician
02:32who directs the Yale Programs
02:34for safety advocacy and healing.
02:36She's also the graduate medical
02:37education director of resident and
02:39fellow well-being and associate
02:41designated institutional official
02:43for Yale New Haven Hospital.
02:46Doctor Asmus received her bachelor's
02:48degree from Yale College,
02:49her MSW from NYU,
02:51MD from Mount Sinai, where she
02:53also did her internship and residency in
02:56psychiatry in psychiatry and Pediatrics.
02:58And she was also a fellow at the
03:01Robert Wood Johnson Clinical
03:02Scholars Program at the University
03:04of Michigan. And for our zoom audience,
03:07we have ASL and see close
03:09captioning available.
03:10We will begin with a brief presentation
03:13by Doctor Raz and then Doctor Asnis.
03:15We'll join her up here and
03:17lead her in a conversation.
03:19And then we'll have plenty of time,
03:21I hope, for questions from both
03:23audiences. So thank you all for being here
03:27and welcome Doctor Ross. Congratulations.
03:39And then just. Back and forth with this.
03:42OK. I can do that. Great. Thank you.
03:44Awesome. Alright, thank you so much.
03:46Thank you for this very
03:48generous introduction.
03:49Thank you so much for inviting
03:50me here and for this huge honor.
03:52I also want to thank Miss
03:53Kieran called for doing all the
03:55organization for making this happen.
03:56Obviously. Doctor Anna respond,
03:58my host, thank you.
03:59And Doctor Andy,
04:00Andrea Asness for being in conversation.
04:01I'm excited to have this stuff
04:03to to be here in conversation.
04:04And thank you all for attending
04:05in person or on zoom.
04:07I'm going to have some prepared
04:09remarks and then we'll open it up.
04:11So I want to start a little
04:13bit before we're at today.
04:14And much of this is taken from my book,
04:18which I'm I'm putting,
04:19I don't have slides for all
04:21my beginning comments.
04:22So there's going to be a picture
04:23of my book as I talk.
04:24So experiencing a child abuse
04:27investigation is practically a
04:29commonplace occurrence for many
04:31families in the United States.
04:32It's estimated that about one
04:34out of every three children.
04:36In the United States,
04:37will be the subject of a child
04:38investigation before the age of 18 if
04:40the risk is held constant until then,
04:42and amongst black children
04:44the figures are even higher.
04:45Over half of all black children will be
04:48the subject of a child abuse investigation.
04:51About 10 depends.
04:52Kind of depends on what region and so on.
04:54But overall speaking,
04:56one in 100 children will experience
04:58involuntary termination of parental rights.
05:01That means they will lose the rights
05:02of their parents to to raise them and
05:04they will lose the rights to have
05:06parents and what researchers have
05:07termed state induced parental loss.
05:09So these numbers are actually
05:12quite staggering.
05:12But we also know that there's a steady
05:15decline in child abuse over the past decade,
05:17and in fact the majority of
05:19substantiated cases of child
05:20maltreatment deal with neglect.
05:22And not abuse.
05:24Over the past half century,
05:26the child welfare system has
05:28transformed into one that investigates
05:30and regulates behavior,
05:31and all too often punishes poor
05:34parents for their poverty while
05:36prioritizing investigations over
05:38the provision of needed services.
05:41Kind of thinking.
05:42Historically, since the 1970s,
05:43we've seen a vast shift and what we
05:46consider to be child abuse and neglect,
05:48and a concurrent expansion into coercive
05:51interventions by the child welfare system.
05:53Often,
05:54and I I I also refer to it critically
05:57referred to as the family policing system.
06:00Parents are afforded less freedom
06:01to make decisions for their kids,
06:03such as letting them play
06:05outside in a playground,
06:06unsupervised while Mom works,
06:08or wait in the car while the
06:10parent runs a quick errand.
06:12All cases that have happened and had
06:14kind of pretty, pretty profound,
06:16pretty profound outcomes.
06:19And all this in the backdrop
06:20that we know that our society
06:22generally has become safer with
06:23lower rates of violent crime.
06:25So parenting has been transformed
06:27into a constant role of
06:29vigilance and supervision,
06:31divorced from the actual risks.
06:33And this, of course further
06:35disadvantaged low income parents,
06:36particularly mothers who
06:37need to balance work,
06:39childcare and these expectations of
06:41heightened constant supervision and
06:43a society that fails to offer basic
06:45standards of support for mothers.
06:47And what would this be like, you know?
06:49Like guaranteed maternity leave,
06:50sick leave or subsidized high
06:52quality childcare, so.
06:55How did we create this system
06:57of family policing that sets
06:58up poor families for failure?
07:00How can we have a system that one in
07:02every third child will be the subject
07:03of a child protection investigation?
07:05This has a history,
07:06and I'm going to talk about that
07:07a little bit in the comments so
07:09that we know where we're coming.
07:10And I'm going to argue that two
07:12main policy decisions have shaped
07:13our current child welfare policy.
07:15But first,
07:15the decision to focus on the
07:18psychological makeup of parents rather
07:19than societal risk factors for harms.
07:22So you separate the discussion of
07:24risk for maltreatment from discussions
07:26of economic and racial inequity.
07:28And second,
07:29the decision to focus on the
07:32reporting of suspected child abuse
07:34as a primary and often the only
07:37method to ensure child safety.
07:39And I'm going to argue that
07:40these two policy decisions were
07:42not inevitable or necessary,
07:43and were not based on available evidence.
07:45In fact,
07:46they were the result of political
07:48expedience rather than what would be
07:50most beneficial to kids and families.
07:52This is important to think about our history,
07:55not just, you know,
07:55because I'm a history professor
07:57and I like to profess history,
07:58but also to help us,
07:59you know,
08:00think about how did we end up with
08:01the policies we have and help free
08:03us from certain preconceptions.
08:05And think about, you know,
08:06what could a different system that
08:08was shaped differently, you know,
08:09how could we think about this?
08:10Could we envision a different
08:12system that supports rather than
08:14reports or investigates families
08:15and ensures children can thrive?
08:17So to begin,
08:18I'm going to touch a bit on the history
08:20of child abuse as a medical concept.
08:21Children have been hurt.
08:23Physically,
08:23emotionally,
08:23sexually in their homes throughout history.
08:26But child abuse is a relatively new term.
08:28The 1960 saw the rise of a medical
08:30category that battered child
08:32based on a seminal publication
08:34by pediatrician Henry Kemp,
08:35who you see in this cute little picture
08:37in his 1962 article on the New England.
08:40And he had this article where
08:43she described this new syndrome.
08:45And even in this first article that
08:48kind of created this category,
08:50the author suggested that abuse
08:52was related to.
08:53Defect of character that allows parents
08:56to act on their aggressive impulses.
08:58So from the very beginning,
09:00the focus was on what's psychologically
09:03wrong with abusive parents.
09:05Kemp's research,
09:06which I think many of you who
09:07know a little bit about history
09:08of child abuse heard about him
09:09and heard about his work.
09:10So it's it was very well received,
09:12it was published with much fanfare,
09:14it was in the news,
09:15had a lot of interest in it,
09:16and it's commonly credited with
09:18the rediscovery of child abuse,
09:19although of course it's never one man
09:22doing something and creating something and
09:23in fact have a category of child abuse.
09:26There's a whole bunch of other
09:27knowledge that has to happen,
09:28including the rise of radiology,
09:29for instance,
09:30to be able to to point out broken bones.
09:32But this is kind of a moment in time in
09:34which we think about the category of.
09:36Child abuse and after this publication,
09:38I think 62,
09:39there was an explosion of child
09:40abuse literature and physicians view
09:42child abuse as in medical problem,
09:44and they readily adopted medicalized
09:46theories to make sense of what seems
09:48to be an inexplicable phenomenon,
09:50the deliberate injury of children.
09:51How can even understand that?
09:54In the mid to late 1960s,
09:55numerous academic articles suggested
09:57psychological mechanisms to explain
09:59why adults hurt kids and what forms
10:02of therapy could help prevent that.
10:04Whoops, wrong way.
10:06Also wrong.
10:07Wait, so this is a review of
10:08the child abusing parent.
10:10And of course,
10:11the popular press also took a
10:12role in this debate and embracing
10:14different descriptions of
10:15child abusers as mentally ill,
10:17sensationalizing a topic of great interest.
10:19And so here you see the child
10:21abuse is a retroactive abortion.
10:23So now thinking about abusing
10:25parents as sick helps deep
10:27politicize a political category.
10:30You know,
10:31how do we treat poor and struggling families?
10:34It also helps doctors maintain jurisdiction
10:36over a very complex social problem
10:39by medicalizing what seems to be,
10:41you know,
10:42a category that's much more
10:45complex and political.
10:46But this decision to medicalize
10:48child abuse and medicalize or
10:50psychologize the the problems of
10:52poor parents didn't necessarily
10:54match the existing evidence.
10:56And 1870,
10:57Brandi sociologist David Gill published
10:58a book called Violence Against Children,
11:01a monograph on child abuse in
11:02the United States.
11:03It was funded by the Children's Bureau.
11:04And again it did a nationwide
11:06survey where you got a lot of data
11:07and looked at all the reports
11:09of child abuse in 1967 and 68,
11:10trying to figure out what were
11:11the scope and risk factors for
11:13child abuse in the United States.
11:14And he discovered that were significant
11:17racial and socioeconomic differences
11:19in the incidence of child abuse.
11:20He argued that there was an increased
11:23incidence of physical abuse and
11:24serious injuries to children in poor.
11:26Families and in minority communities
11:28and Gill suggested that I quote life
11:31and poverty generates stressful
11:32experiences which are likely to become
11:35precipitating factors of child abuse.
11:37Poverty, according to gill, rates stressors.
11:40That predispose people to to abusive
11:42behavior and because there are quote,
11:44fewer alternatives than escapes to
11:46deal with these aggressive impulses.
11:49There are many links between poverty
11:50and physical abuse of children,
11:52he argues.
11:52And he said that looking at this,
11:54looking at this data should convince
11:56observers that we have to address
11:58poverty in order to prevent child abuse.
12:01Gillen General was interested
12:03in how society fails children.
12:05In fact, he argued, if you want to look
12:06at who's abusing children the most,
12:08it's the US government,
12:10by creating all these situations
12:11in which children suffer and
12:13cannot meet their full potential.
12:15He also in his first pages of
12:17the book I showed earlier,
12:18he asked, you know,
12:19why do we care so much about physical
12:21abuse of children when we're not asking
12:23why is the government failing kids?
12:25And our focus on the this physical illnesses,
12:29the physical abuse of kids is
12:31a way to divert attention from
12:33the real issues at hand.
12:35And he says it,
12:36it's a relief for the consciousness
12:38of of the conscious of society
12:39and a whole and for the conscious
12:41of many individual parents.
12:42And you know, we're good parents,
12:43other people are bad parents.
12:45And there's no there's no
12:47role to think about society,
12:48and we should be focusing on how
12:50American Society is failing kids.
12:54Interesting, and I think worthwhile,
12:56worthwhile thinking about this.
12:57Like Gil, many researchers in the 70s believe
13:00that poverty and racism were risk factors,
13:02not just for overreporting or over
13:04surveillance, but for abuse itself.
13:06Parents who struggle with
13:08structural inequities, joblessness,
13:09stress, hunger, social isolation,
13:12even not having a phone at home,
13:13which was a risk factor at the time,
13:14are more likely to lash
13:16out and hurt their kids.
13:17And, and we know parenting is hard,
13:19and without sufficient support or respite,
13:22parents are more likely to snap.
13:23Poverty and racism could lead to child
13:25abuse and needed to be addressed
13:27as a way to protect children.
13:28That's what Gil was saying at the time.
13:30But it wasn't his, just him.
13:31It wasn't a radical view at the time.
13:33And today even socioeconomic
13:34hardship is still considered a
13:36risk factor for child abuse.
13:38For instance,
13:38our studies that have compellingly
13:40showed that their association between
13:41rates of abusive head trauma and
13:43infants and showing up to the emergency
13:45room and the economic effects of
13:47the 2008 recession and many other
13:48studies that I'm sure and a child
13:50abuse doctors here are familiar with.
13:52But while many researchers argued
13:54for the importance of addressing
13:56poverty and social inequities as
13:58causal factors in child abuse,
13:59their voices were unheeded by
14:01politicians and policymakers.
14:02So two main approaches emerge in this
14:04first decade of thinking about child abuse.
14:06One medicalized,
14:07focusing on the perceived psychopathology
14:09of these individual parents or caregivers,
14:12what is wrong with them? And the
14:14other focusing on societal risk factors.
14:16What makes children less safe?
14:18But obviously,
14:18policymakers have a vested interest
14:20in adopting the narrower view.
14:22Of child maltreatment rather
14:24than the one that require them
14:26to address social inequities.
14:28Activists also weighed in on the debate,
14:30and one group I examined at length
14:33in my slide is parents anonymous,
14:34and this is her founder Jolly K,
14:37depicted on this slide.
14:38And this group was primarily a group
14:40of white educated women who were
14:41worried that they might physically
14:43or verbally abuse her kids.
14:44And the parents anonymous group
14:46organized in similar ways,
14:47like support groups like Narcotics
14:49Anonymous or Alcoholics Anonymous,
14:51and they worked to kind of give
14:52support for parents.
14:53The group also worked to expand the
14:55definitions of child abuse include
14:56emotional abuse, emotional neglect.
14:58Verbal abuse,
14:59but I'm really expanding and
15:01diluting the concept,
15:02but also working to actively discount
15:04the role of poverty and discrimination.
15:07Instead,
15:07they wanted to enshrine views
15:08of child abuse as an issue of
15:11personal responsibility,
15:11deriving from deep psychological roots.
15:14This script was widely influential,
15:15well known to all the elected
15:17officials and policymakers,
15:18and helps solidify this focus on
15:21individual psychopathology rather
15:22than societal risk factors.
15:24And there's a couple more pictures
15:25of how that this is a piece about
15:27them in the newspaper and Woman's Day
15:29that attracted a lot of attention,
15:30and this is one of their handbooks
15:32that you can see kind of what
15:34their groups look like.
15:35So I'm going to put them pin in this moment
15:37to remind us that the choice to ignore
15:39risk factors such as poverty and racism,
15:41and to prevent child abuses,
15:42that universal equal opportunity
15:44and interest psychic problem,
15:46is exactly that, a choice.
15:48A political choice influenced by activists
15:50who had their own agenda and politicians
15:53who wanted to avoid making certain decisions.
15:56In the 1970s, most child welfare experts,
15:59regardless of their political leanings,
16:01agreed that poverty was an
16:02important risk factor at the heart
16:04of child abuse and neglect,
16:05and they offer different ideas about how
16:07social risk factors could be mitigated.
16:09But the idea to focus on poverty
16:11was never accepted as mainstream,
16:13and one reason is that it could
16:16potentially pathologize poor
16:17parents and their home lives.
16:19By linking poverty as a
16:20risk factor for abuse,
16:21you could argue that poor parents
16:23are actually worse parents,
16:24rather than that their social
16:26situation was detrimental.
16:27To child rearing also,
16:28anti poverty measures were distinctly
16:31unpopular in the mid 1970s even though
16:34child welfare advocates repeatedly argued.
16:36That addressing poverty was a
16:38crucial step in protecting children.
16:39Finally, of course,
16:40reporting parents for abuse at
16:42least appears to cost nothing.
16:44Supporting poor parents could cost money.
16:47So what could an intervention
16:48like this look like?
16:49So one program I look at,
16:50my book was developed by a pediatrician,
16:52Vincent Fontana,
16:53at the New York City Foundling Hospital.
16:55Fontana was a well known physician
16:56but cure for President Eisenhower
16:58and earned some fame from that.
16:59And he said with the medical
17:01director of the founding hospital,
17:02he had long argued that physicians
17:04should pay attention to the social
17:05risk factors for child maltreatment.
17:07And so we developed this
17:08demonstration program where they took,
17:10you know,
17:11Mother infant dyads and provided
17:12them with residential care and
17:14essentially gave them a ton of intense
17:16psychotherapy as well as different.
17:17Courts such as,
17:18you know,
17:18home Eck classes and all kind of
17:21different educational supports but
17:23also housing and material supports.
17:25And on the follow up,
17:27Fontana's team found that they
17:28actually did really well that these
17:30mom infant dads could avoid separation
17:32and were able to kind of, you know,
17:33find a job and and be successful.
17:35But they also did a host or
17:37battery of psychological testing
17:38and they were kind of surprised to
17:40find that there was no change in
17:42the parent psychological makeup.
17:43So fixing their psyche didn't
17:45actually work but offering them.
17:48Real supports like housing and
17:49respite care gave these women
17:51space to get back on their feet
17:53and find housing and employment.
17:55This model that Fontana kind of
17:57discovered by mistake would serve as
17:59a model for the crisis nursery that
18:01offers respite care for struggling families,
18:03which is still open today.
18:05But Fantanas approach of the respite,
18:07care and support is most used
18:09story of what could have been.
18:10Fontana was a vocal advocate and a
18:12well respected child abuse expert,
18:13and New York City was kind of
18:15a semi celebrity.
18:16You see some pictures of
18:16him at the White House,
18:17you see him sitting here with Sophia
18:19Loren and a couple of other, well no people.
18:22But this model was never widely adopted,
18:26while attempts to support families
18:27and address poverty were underfunded
18:29and quietly ignored.
18:30And 1970 saw a growing emphasis on one
18:33singular aspect of child maltreatment policy.
18:35Reporting, reporting suspicions of abuse.
18:38And this began the 60s and hasten
18:40considerably in the early 70s
18:42with the passage of the first
18:43federal child Abuse Prevention Act.
18:45Promoted by Minnesota Democratic Senator
18:47Walter Mondale and with parents anonymous
18:50serving as a very important witness witness,
18:53the child abuse prevention and Treatment Act,
18:55also capped up,
18:56was signed in 1974 by President Nixon.
18:59Nixon was a president notorious
19:01for vetoing legislation,
19:03and he was convinced to support
19:05this law because,
19:06or partially in part because,
19:08it depicted child abuse is completely
19:10unrelated to risk factors.
19:11Any social risk factors.
19:13Capital emphasized mandated
19:14reporting of abuse.
19:15Getting federal standards for
19:17the reporting requirements and
19:19states started open hotlines,
19:20and with significant public awareness
19:22campaigns, the reports started pouring in.
19:24Their reports were primarily about
19:26struggling families, poverty, hunger,
19:28addiction, and adequate supervision.
19:29Yet there were in many states,
19:31most states,
19:32no further appropriation of funds
19:35to provide services.
19:36So we have a whole system of
19:38reporting that bring more reports in,
19:40but no plan on what do we do with this?
19:43And at each juncture,
19:44policymakers work to further.
19:46Expand reporting requirements
19:47and increased penalties for
19:49non reporting the harms,
19:51primarily the poor families and
19:53families of color were easily foreseen.
19:55These downstream harms were even
19:57visible to politicians such as
19:58Walter Mondale right here on the on
20:00the slide a champion of capital.
20:02I'm going to tell you one story about that.
20:03In 1976 a government agency worked to
20:06further expand mandatory reporting
20:07and to set new guidance that requires
20:09even more reporting and especially to
20:11report require more reporting of neglect.
20:13And Mondale did not like that at all,
20:15he wrote.
20:16Be very sharp letter to the
20:17government agency and he said,
20:18you know,
20:19the government has a responsibility
20:21to safeguard families and coding
20:23primarily those who are poor and for
20:25minority groups from being enveloped
20:27in a system which may label them
20:29permanently as criminal or deviants,
20:31but which also lack the resources
20:33to provide necessary services.
20:34Model added that if the government
20:36agency the HW goes ahead with the model
20:39legislation model would personally
20:40write to all our state legislators
20:42and recommend that it not be adopted.
20:44So yeah.
20:45Yeah.
20:45So ultimately this model legislation
20:47was quietly dropped thanks to the
20:49objection of Mondale and others,
20:51you know, different interest groups,
20:52particularly for poor families and families.
20:56Minority backgrounds.
20:57But in the following decades,
20:59the requirements for reporting
21:00have consistently been broadened,
21:02leading to the same clearly foreseeable
21:04outcomes that Mondale had mapped out.
21:07So this is a story kind of not only
21:08that Mondale wasn't mentioned and had,
21:10you know, they could see what was coming,
21:12but also to make us think about what
21:14are we talking about when we talk about
21:17unintended consequences and would it be
21:19better replaced by a term that is clearly
21:21foreseeable and ignored consequences.
21:24In fact, in many states,
21:27reports of child abuse and maltreatment
21:29increased at precisely the same time
21:31that these states were decreasing
21:33funding for state and local services.
21:35Parents often derive no material benefit
21:37from a report about hunger or homelessness.
21:40And the same thing today,
21:41most reports majority of reports and
21:43without the provision of new services.
21:46And this is not just me kind of
21:48judging it and the words of the 1990
21:50report of United States Advisory
21:51Board on child abuse neglect.
21:53I'm going to quote it is far
21:54easier to pick up the phone.
21:56The report one's neighbor then
21:57was to pick up the phone and reach
22:00out to offer help and and support.
22:03And this would focus on reporting
22:05has a real and devastating impact.
22:08As more children are being reported,
22:10child welfare agencies increasing
22:11the number of kids are being removed
22:14from their homes.
22:15In 19,
22:16sixty 272,000 kids were in foster
22:18care in the United States at a
22:19rate of 3.9 per thousand.
22:21A decade later,
22:22the number was almost 320,000
22:24at a rate of 4.4 per thousand.
22:27In 1977,
22:28over half a million kids are in foster care.
22:31These kids are disproportionately from
22:33low income homes and children of color.
22:36With these high rates of child
22:37placement and out of home care,
22:39it's all but inevitable that these kids
22:41are being placed in unsafe situations.
22:43Concerned about kids being abused in
22:45foster care began garnering more attention.
22:47Lawsuits, too.
22:48Furthermore,
22:48foster care was expensive throughout
22:51the 1970s.
22:52The cost of foster care rose,
22:54and the cost is increasingly borne
22:55by state and federal governments.
22:57Between fiscal years 1971 and 79,
22:59the total state and federal
23:01expenditures on AFDC foster care
23:03went from $70 million to 400.
23:06$1,000,000 suddenly,
23:08policymakers were paying attention.
23:11We can see this in the hearings
23:12that preceded the 1980 adoption
23:14assistant and Shall Welfare Act,
23:16which I'm going to call Aqua.
23:17Moving forward.
23:17There was a lot of hearings and testimony,
23:19and witnesses deplored what they
23:21termed the unnecessary removal
23:23of kids from their homes,
23:24which could have been prevented
23:26within home services.
23:27The testimony highlighted the connection
23:29between more reporting, more removal.
23:31And I get 80.
23:33President Carter Science Aqua
23:34outlining 2 main methods to reduce
23:37the number of kids in foster care.
23:39The first,
23:39providing funding for services
23:41to prevent the need to remove
23:43children from their homes,
23:44so services or preservation services.
23:46The second,
23:47creating a federal adoption
23:50assistance program.
23:51For the back end,
23:53Aqua champion enhanced
23:55family preservation services.
23:56But it could have not have passed
23:59at a less opportune time 1980.
24:01And the Reagan administration in
24:05early January 1981 already made
24:07it abundantly clear that its
24:08plans were to reduce funding for
24:10child welfare in general and on
24:12a on appropriations for service specifically.
24:15There was also some talk of block grants,
24:17but it was clear that you know,
24:18this is not going to be funded.
24:20But I can't say that a lack of
24:22funding was the only problem.
24:23In fact, there were many problems with
24:26these family preservation services.
24:27There was no concrete guidance
24:29about how states would implement
24:31family preservation programs.
24:32And what were these programs like at all?
24:34Well, for the most part,
24:36these interventions focus
24:38primarily on offering intensive
24:40short-term casework and therapy,
24:42usually about 90 days.
24:43It's like intense therapy
24:45and parenting education.
24:46And this is a review of kind of
24:48how intensive casework fails to
24:50reduce foster care placements.
24:51They looked at 36 programs like that.
24:55Why is that?
24:56Well,
24:56the interventions were essentially
24:58designed to fix parents rather
25:00than address poverty and the
25:01material challenges parents faced.
25:03As such,
25:04these interventions were destined to fail,
25:06setting the stage to argue that family
25:09preservation was useless or even dangerous.
25:12This would have far reaching implications.
25:17Unfortunately,
25:17these underfunded and ineffective and often
25:20misguided attempts at family preservation,
25:23focusing primarily on fixing parents,
25:26emerged as the main legacy of Aqua.
25:28Child welfare experts and policymakers
25:30use these deficiencies for family
25:33preservation to argue that family
25:35preservation had been tried and failed,
25:38setting the stage for the 1997 passage
25:41of the adoption and Safe Families Act.
25:44Adoption and Safe Families Act reduced
25:47requirements for family preservation
25:48attempts and shifted the focus
25:50towards freeing kids up for adoption.
25:53As for emphasize the termination of
25:54parental rights and new category that
25:56really wasn't utilized much before
25:58that and it was based on an arbitrary
26:01timeline which was a negotiations
26:02between the Senate and the House.
26:04But ended up being if you had spent
26:0615 out of the past 22 months in
26:08substitute care then the state had
26:10to go ahead and move forward the
26:12termination of parental rights or just.
26:14That's why they were not doing so.
26:16And this is not just in the cases of abuse.
26:19This is in all cases,
26:21so there's only an arbitrary
26:22timeline of how long the kid had
26:23been outside of the house.
26:24So regardless of whether
26:25abuse had ever happened.
26:26So if fixing parents was futile,
26:29the next logical step was simply
26:31moving forward to provide kids
26:33with no parents via adoption.
26:35This was the culmination of an approach
26:37that located A cause of abuse or
26:39neglect with an individual parent psyche,
26:42and not a reflection of the societal
26:43challenges of family might.
26:45Space and I I would love to talk more
26:46about Astra because that's my new book
26:48project and it's I can talk about
26:50how it was championed by adoption advocates,
26:53how it was viewed as an anti
26:54abortion measure.
26:55I have a lot of things to say about
26:57asphalt and about the timelines.
26:58Ask me later how I feel about asphalt,
27:00but I'm going to move forward
27:02and and leave time for a debate.
27:04So fixing parents by offering
27:06them parenting classes,
27:07anger management classes,
27:08intensive therapy and so forth has
27:10actually not been proven beneficial.
27:12And it's based on faulty assumptions
27:14that something is wrong with
27:16struggling and poor families.
27:18Parents are often coerced to participate,
27:19complete trainings and certifications,
27:21and then their certification expires,
27:23so they have to go get another one.
27:25And if they don't get it,
27:26then you say if you don't complete these
27:27trains on time or if you don't get a new,
27:29you know, certificate,
27:30then we will remove your kids or your
27:32parental rights might be revoked forever.
27:34But what if we offered services
27:36that were actually valuable,
27:37the parents that parents clamored to
27:39participate that they would want to be using
27:42rather than being forced to participate?
27:44What if we offered high
27:46quality childcare for kids?
27:47What if we offered affordable housing?
27:49Rather than trying to fix parents,
27:51we should focus on fixing poverty and
27:53fixing the additional societal risk
27:55factors we've identified since the 1970s
27:57as being harmful to children and families,
28:00and ensuring that we can lift
28:01up families to thrive and grow
28:04without coercive interventions.
28:05Rather than paying money to move
28:07children outside of their communities by
28:09means of money that's going to foster
28:11care payments and adoption subsidies,
28:14we could reinvest these funds
28:16into communities.
28:17And I'm going to end my brief
28:18presentation with this quote and the
28:20heartbreaking case of Makia Bryant,
28:22who was shot by the police outside
28:23of her foster home.
28:24Mackey is a morning grandmother,
28:26Miss Junior Hammond told the New York
28:28Times that her housing and security
28:29was the reason she was not allowed to
28:32care for her beloved granddaughter.
28:33I quote,
28:34they could have just given me.
28:36What they give one pot foster
28:38parent and then I could have gotten
28:40housing taking care of the kids
28:42and done what I needed to do.
28:44So I'm going to pause here and I look
28:45forward for actually our discussion.
28:47Thank you for your attention.
28:50I stopped. I stopped sharing right.
28:52I should stop sharing my
28:53slide and stop sharing slide.
29:07And use this now OK.
29:24I pushed back. And when
29:25can I take my mask off?
29:25I won't cough on you.
29:26I'm. I'm well. I promise.
29:29Everyone here. OK. Yeah.
29:30I think it's projecting.
29:31Yeah. Thank you for that.
29:34Brilliant walk through history.
29:36There's so much to talk about,
29:40and I think you poignantly described.
29:43A flawed system.
29:44And there's there's nothing about
29:45me as a child abuse pediatrician
29:47that wants to argue about the
29:49flaws in the system at all.
29:50I think you've summarized it beautifully.
29:53What I would like to do is frame our
29:56discussion around the reality of today and.
29:59The problems that I confront
30:01frequently as a child abuse
30:03pediatrician that you know well about,
30:06and I'd like to kind of start by
30:09operationalizing some of the the
30:11challenges you pose to the system
30:12that I again believe are rightly,
30:14rightly posed.
30:18But let's talk about the
30:20problem of child safety,
30:21because it's real, right?
30:23So nothing about your
30:24remarks suggests otherwise.
30:26Not saying that children are harmed,
30:29children are killed at the
30:31hands of caregivers. It's real.
30:33And I don't think anyone doubts that.
30:37Where does responsibility
30:39for keeping children safe?
30:40Why in the system and and I I'd
30:43like to frame it around even,
30:44just like today,
30:46like someone's in trouble.
30:50How do we face, how do we address
30:52safety and your thoughts on that?
30:55Thank you. Wow, that's a that's
30:57a really tough question,
30:58right, but there a couple,
31:00I'm going to answer it in
31:01a couple of different ways.
31:02So the first is that,
31:04you know I really appreciate
31:06the job that. Not visible.
31:10We should gather around the
31:11camera so that you can see that
31:13you cannot be seen in there.
31:14So. Yeah, come over here.
31:17I don't know how to adjust it, I'm sorry.
31:20Sorry folks, can you hear me?
31:24There's a there's a touch
31:26screen down in the bottom right hand
31:27corner of the lectern top there.
31:29If you tap that screen,
31:30it will light up and there should
31:32be some camera presets there.
31:43Oh. Oh, that's smart.
31:47We could just sit here on a higher
31:49chair. Thank you. Works too.
31:54Elegant, simple solution.
32:03You start talking.
32:06Where you are with them.
32:12That's going to be extra time to
32:13think about a tough question, but.
32:18So I think I have a couple of
32:21different answers for how do we
32:23keep kids safe? Does this work?
32:29Good. OK.
32:33So. So I guess my my big answer is
32:36is when we think about safety is
32:38what keeps us safe and the answer
32:40is we keep safe and child offer.
32:42I don't think that the child,
32:44the child protection system
32:45keeps children safe.
32:47And the way why I say that is that
32:48there's so many cases in which there's
32:51already child protection involvement
32:52and cases of severe abuse already
32:54happen and they're already involved.
32:56These are system involved
32:57children and and abuse.
32:59You know this child is returned home
33:00only to have a terrible outcome.
33:02A child is placed in foster care
33:03only to have a terrible outcome.
33:05And also there was the issue of what
33:06happens to foster care children
33:07as they age out of the system.
33:09And we know that there's a host
33:10of other problems.
33:11So I'm not sure that the system is
33:13actually doing what we would like it to do.
33:16The other answer is that you see at the
33:19child's pediatrician the very worst cases,
33:22which certainly need medical attention
33:23and probably needs some kind of
33:25external coercive intervention.
33:27But most cases are in fact most of
33:29the cases of most of the reports.
33:30So one and three children are system
33:32involved, have an investigation.
33:33Most of them are not substantiated.
33:36Of those that are substantiated,
33:37about 90% have to do with neglect
33:40or supervision,
33:40and only a very small minority have to
33:43do with physical abuse and sexual abuse.
33:46So there's already all this space
33:48to be working on to reduce course
33:50of intervention on the many,
33:52many hundreds of thousands of children
33:54who are involved that are are not
33:56being physically and sexually abused.
33:57But then how do we keep children safe?
34:00So aspirationally,
34:01we build systems that help support
34:04families and communities and.
34:06You know,
34:06if somebody would ask me what is
34:07a policy that's actually helpful
34:09and keeping children safe,
34:10I would say the child tax credit.
34:12So we know that, you know,
34:13physical abuse to children has
34:15is reduced when families have
34:17enough food to eat and live.
34:19So interventions like that
34:21help keep families safe.
34:23But if you were asking me today,
34:25you know,
34:25I'm sitting in front of a child
34:26who is being physically abused.
34:28What do I do right now?
34:29And that's a question I get a
34:30lot from pediatricians because
34:31it's a reasonable question.
34:32This is what you do.
34:33This is your job and you,
34:34you have a commitment to care
34:35for the child in front of you.
34:37And and so of course my answer is
34:38you have to follow by the laws of
34:40your state and the policy of your
34:41hospital and if the laws of your state,
34:43the policy of your hospital is to
34:45involve Child Protective Services
34:46and that's what you should be doing.
34:48But most of the cases are are
34:50not that clear cut and there's
34:52this belief that you know if you
34:54even think about abuse you need
34:55to call CPS and
34:57they'll work it out which is actually
34:58not true that's not what the statute
35:00requires but also there's there's
35:02an article called about mutual
35:03deference that that you think the CPS
35:05will started out because there's.
35:07Yes, experts, CPS thinks ohh, the doctor
35:09called us and the doctors and experts.
35:10So and so everybody thinks somebody
35:12else actually knows what's going on.
35:13And I think for physicians, you know,
35:15you are substituting your clinical
35:17judgment and your relationship with this
35:18family for a caseworker who has so many.
35:21You know, it depends on the state but
35:23might have an undergraduate degree and
35:24maybe making 950 an hour in Louisiana
35:27depends on you know and and and you,
35:29they don't necessarily know better than you.
35:31So there's this you know, if you think
35:33about the abuse of course you should call.
35:35But if you don't think there is abuse.
35:38That is not the statute does not require
35:39you to call which is something we see.
35:41I didn't think abuse was going on,
35:43but I called anyway because I I
35:45was worried about a host of other,
35:47you know,
35:47implications if I don't do so I
35:49hope that's answered the part
35:52we're going to have questions.
35:53Also I think you might be interested to know
35:55that one of the initiatives in our work
35:58as child abuse pediatricians here at Yale.
36:00And this is recognized and actually
36:02financially supported by our
36:03state's Child Protective Agency,
36:05the Department of Children and
36:07Families is that we attempt to.
36:10Provide our consultation in order to
36:12prevent those unnecessary reports,
36:13because we strongly agree.
36:15That a report is not a benign thing to do.
36:19It can feel that way.
36:21Let someone else figure it out.
36:23I'll play it safe and call it in.
36:25We would strongly disagree with that.
36:27I would strongly disagree with that
36:28and leave my team and agreeing with
36:31me and and our feel particular
36:33victory when we can prevent an
36:35unnecessary report from being made,
36:36which is actually.
36:37Been a source of enhanced support
36:40of our work by our state.
36:41So I think that's a hopeful sign
36:43that we're moving in the direction.
36:45I think I'm going to push
36:46back a little bit on,
36:47I agree with you that that that the the
36:49intervention is not always safe for
36:51children at harm comes from foster care.
36:53We've already talked about this,
36:54but there are kids I think whose lives
36:56are saved by being separated from parents.
36:59Unfortunately,
37:01I don't know that they have a
37:02better life because of it.
37:03So I would like to get more
37:05granular about how we protect
37:06those children but as safety.
37:08Do you think safety is the is the most
37:12important factor to bring to bear
37:15in in in society's view of children?
37:17I mean it's but one of some other.
37:19Things we could talk about that
37:21benefit children.
37:23Well, first of all,
37:24I'm really excited to hear
37:25about this program that you're
37:27doing and reducing reports and
37:28I have anyone also Pennsylvania,
37:30they're trying to have a separate
37:31pathway as well in New Jersey that
37:32if you used to be that you have
37:34to call CPS for everything and
37:35that's the way to get services.
37:37And that's what child abuse pediatrician and
37:39longtime advocate Eli Newberger is called,
37:42the abuse ification of
37:43child welfare services.
37:44You don't want child abuse investigation.
37:46You want services for your kid.
37:47But how do you get services without
37:49involving the child protection
37:50system and and there should be and
37:52there and there are in some states.
37:54Alternative pathways also.
37:58Especially in hospitals that are well
37:59funded and have a child that used team it,
38:02it seems to me that the policy that would
38:03make more sense is called the experts,
38:05called the child abuse experts and
38:07have them weigh in before you call CPS.
38:09And I think that would be a
38:10very easy policy to institute.
38:11But there's often a reluctance to put
38:13any policy in place that involves
38:15please call us because there's some
38:17thought about liability to that.
38:19And I've also worked with a child
38:20abuse team at CHOP and they said the
38:22most frustrating thing for us is,
38:23you know,
38:23we don't think it's child abuse
38:24where the child abuse team,
38:25but somebody has already called
38:27CPS and once that's called you.
38:28Can't unring that bell.
38:29And then there's a host of
38:31downstream consequences.
38:32So I am certainly on the same page with that.
38:34I guess I'm going to push back
38:36on the use of the term safety,
38:38which to me it seems like a very
38:41political categories like we talk
38:42about you know violent crime or we
38:44talk about anything, there's election,
38:46there's all these concerns about
38:47crime and so on.
38:48Yes, there are children who are unsafe,
38:50it's a small minority.
38:51But child safety is not not by you,
38:54but used by politicians as a way
38:57to to justify a host of.
38:59Coercive interventions that devalue families,
39:03and I don't think it should be.
39:05I I don't think they should be in opposition.
39:07As I say, we keep us safe,
39:09communities keep us safe,
39:10families keep children safe.
39:12So I would like to reclaim what
39:14does it means to be safe and the
39:17adoption and Safe Families Act
39:19is one of perhaps the most.
39:20Most outrageous use of the word safe,
39:23because this is nothing,
39:24nothing about safety.
39:25It's a grab a 15 out of 22 months and
39:28you have to move forward with termination.
39:31And of course the word safe is in
39:33the title and that's really the
39:35discourse was about completely
39:36about thinking about safety.
39:38But children are not safer when they're
39:40removed from their parents and the
39:41parental rights are terminated and
39:43then create a new category of legal
39:45orphans because the rights are terminated,
39:46but doesn't mean that they're
39:48adoptive family wanting to
39:49adopt these children. So we asked for.
39:50Pictured in like high numbers of children
39:52who were separated from their families
39:54of origin but have nowhere to go.
39:56We also know that once an
39:58adoption is finalized.
39:59The case is closed so we
40:00don't know what happens next.
40:01So this is terrible case about two
40:03white women who adopted multiple
40:05black siblings from the same
40:07family and they drove them off
40:09a Cliff and mother wasn't even
40:11informed because there is no data.
40:12Once a child is adopted and the rights are
40:14terminated she's no longer the mother.
40:16So she has three in the newspaper
40:18about about the death of her child.
40:20So this is going to very long answer
40:22to say can we reclaim safety and
40:24think about safety as what happens
40:25in our communities and what happens
40:27in our homes and how do we support.
40:29Safe communities in which children
40:30and families can thrive.
40:34Let's reclaim it.
40:35I'm. I'm for it. Although I think
40:37the the necessity of providing safe
40:39haven for kids in danger remains
40:41a problem for the small few,
40:43we're not necessarily going
40:44to solve this. I am on the same page,
40:46there are a small group of children who
40:48need intervention. I agree with that.
40:52If you could remake the system now
40:55what and and I've asked you these
40:56questions to think about it ahead
40:58of time but you know would you do
41:00away with the child welfare system.
41:01Would you do away with mandated reporting?
41:04I think it's time to to think a
41:06little bit about what could be and
41:09start to envision the possibilities
41:11and then I know I know other people
41:13have probably questions as well.
41:18And so. I'll, I'll leave that on too.
41:22So how would I rethink about
41:24the child welfare system?
41:25So I would like a system that
41:27actually supports child welfare.
41:28So in the 1960s and 70s we
41:30created a system of policing,
41:32of investigating and reporting.
41:33And before that, it's not that the
41:35child welfare system was perfect.
41:36In fact it was very racist,
41:37it was very painful,
41:38but there other things were going on with it.
41:40But it was focused on
41:41providing welfare services.
41:42And what did that look like?
41:43Well, I looked at 272 case
41:46files in Philadelphia and the
41:48towel for records from 1960s.
41:51And very few had to do with safety.
41:52They had to do with mom is in the
41:54hospital for her gallbladder surgery.
41:56She's going to be there for two weeks.
41:57We'll send a homemaker to take care of the
41:59kids because God forbid that has to cook,
42:01it has to do.
42:03No, it had.
42:03So we had very concrete supports
42:05about what are the child welfare
42:06services that child needs.
42:07And I don't want to be like,
42:08oh, you know, this is so great.
42:10At the time there were a
42:11lot of problems with that.
42:11But you can still learn that
42:13there are welfare services that
42:15can be provided without the need
42:16for investigation or reporting.
42:18You don't need the policing system
42:19to provide the supporting system.
42:21And so I would want to divorce the
42:24investigations from the services.
42:25And I think that's the main problem
42:27is from for many investigations
42:28are a gateway to services.
42:30And we see that for mothers who use
42:32substances while they're pregnant,
42:33it's very hard to get.
42:35In many states,
42:36it's very hard to get services
42:37for addiction treatment if not
42:39through the judicial system.
42:40In other cases, we, we see that,
42:43you know, a child in an urgent care case,
42:47pediatrician calls or maybe
42:48not a pediatrician.
42:49It's it's whoever's on that.
42:51Maybe pediatrician would have done that.
42:52But they call CPS because the
42:53child has bad teeth and they're
42:55worried about medical neglect.
42:56No,
42:56they don't want the family
42:58punished for bad teeth.
42:59They want the kid to get dental care.
43:01But that report is not going to get the
43:02kid a dentist because that's not the
43:04pathway in which dental care is provided.
43:06So can we create the pathways in
43:08which these services are provided
43:10without having to do this abusive
43:12fication of child welfare system?
43:14Amended reporting.
43:14I I think I'm actually pretty kind of,
43:17I'm pretty clear on that one.
43:18Stop it.
43:19I I don't think we need mandated reporting.
43:21You don't have to be a mandated
43:23reporter in order to report.
43:24I think people should continue
43:25reporting what they're worried about.
43:27But I have.
43:28I don't think that there's data
43:29to show that mandated reporting
43:31has improved the identification
43:32and outcomes for children who have
43:34who are at risk of serious harms.
43:36And now we don't have a good study
43:38of no mandated reporting because
43:40all states started adopting
43:41mandate reporting
43:42in 1960s. But we have pretty
43:44robust studies that look at
43:45states with universal reporting.
43:46Versus those without.
43:47And those show that states
43:49with universal reporting,
43:50which means that every single adult
43:51is identified as a mandated reporter
43:53in a state that has a universal
43:55mandated reporting versus state
43:56that only have certain categories.
43:58So states that have more in
44:00which everybody's a reporter,
44:01they have more reports,
44:03which seems obvious,
44:04but that doesn't translate to safer kids.
44:06And then we have other studies that
44:08look at different and difference
44:10in state that change the reporting
44:11requirements and these show that when
44:13you change your reporting requirements,
44:15you get more reports.
44:16Uh, but again does it translate
44:18to more safety to join and I know
44:20that from my experience working
44:21in Pennsylvania and I have I work
44:23with the data in Pennsylvania and
44:24after the Sandusky case they they
44:26passed a bunch of laws that explain
44:29with the categories for reporting
44:30the penalties for non reporting
44:32created a registry and in fact kids
44:35were no safer in Pennsylvania.
44:37And in fact the rates of fatalities
44:39and near fatalities increased.
44:40And the aftermath of these changes
44:42which I'm not going to try and
44:43make a causal argument because
44:44somebody could clearly say something
44:45else that has to do with.
44:47How we report them or has to
44:48do with the opioid crisis?
44:49There many other reasons that
44:50you know their fatalities and
44:51near fatalities are rising.
44:52But I think it would be fair to
44:54say that increased reporting in
44:56Pennsylvania was not associated
44:58with better detection or better
45:00outcomes for children so.
45:01I I am in that throw it out.
45:04I I don't think you need mandated reporting.
45:06I think the reason we have mandated
45:08reporting and the reason we experimented
45:10a reporting is to be able to be
45:12punitive at people who didn't report.
45:14Because we always hear these terrible
45:16stories about people who didn't report.
45:18And then we're like how can we punish
45:19the people who didn't report at that
45:21time and that specific person who
45:23didn't report wasn't a mandated reporter?
45:24And then like well we'll make that
45:26guy a mandated reporter and next time
45:27we'll get that's a very bad way to do policy.
45:29But also I mean it's it's not.
45:32It's if the person,
45:33like in this industry case,
45:35they were children,
45:36were being raped by a coach and
45:38this wasn't reported.
45:39So the threat of not being a mandate
45:41report wouldn't have changed outcomes.
45:42I think it's hard to believe that
45:44somebody who was covering up child rape
45:46would be swayed by the fact that, oh,
45:48my goodness, now I'm at a reporter,
45:49now I have to report it.
45:50But I mean,
45:51you said like somebody else could make
45:52an argument that it would have changed.
45:54But my, my sense is,
45:56and I've been called to testify in before,
45:58you know, different legislators,
45:59including in the aftermath of the
46:01Larry Nassar case in Michigan.
46:02And and they wanted to make,
46:04you know, expand mandatory reporting
46:07because they wanted to be able to.
46:10Get all those people who knew or
46:11thought they knew what Larry Nassar
46:13was doing and they didn't report
46:15it and and then the only kind of
46:17expanded it to physical therapist.
46:19So that was the only change that they
46:21did partially because myself and other
46:22like minded people testify from the
46:24experience of Pennsylvania and said you know,
46:26if you want to expand many reporting
46:28you're going to have to put all
46:30this money in the system because.
46:32I mean, even just picking up the
46:33phone and answering reports,
46:34it takes a lot of money and and in
46:36the end that they decided to kind of
46:38narrow down what they were trying to do.
46:40But I am unconvinced that mandated
46:43reporting is an effective policy.
46:44But I am willing to hear another think.
46:47I have my skepticism about it too.
46:49I had the unfortunate experience of
46:51looking back at cases where things were
46:53missed and and abuse was documented
46:54and considered and a report was
46:56made and I've been involved in cases
46:58where the the outcome was fatality.
46:59So it's difficult not.
47:01It's difficult to ignore that and to
47:04say you know that this shouldn't be.
47:06To agree fully that there should be about.
47:08I don't know that I know the answer
47:09and I think that the the thing the
47:11pendulum has swung too far and that
47:12there probably is more reporting
47:13than there should be.
47:14I would totally agree with that.
47:16But the reality of the cases is
47:18hard to get past and and to come
47:20back to blame because I think that
47:22outrage is a big driver of a lot
47:25of the policies you've discussed.
47:27In my experience, at least in our state,
47:28child welfare services here are
47:31very service focused,
47:32not always,
47:33and there are certainly punitive
47:34and they're certainly not
47:36a pleasant experience
47:36to go through. However,
47:39it is a pathway to services and
47:41I and the workers that I actually
47:43spend time with every day.
47:44Do not want to get more punitive.
47:46They're in fact quite protective of not all.
47:48I'm going to say that again,
47:50but many are very protective
47:51of their families that they're
47:53working with and and really try to
47:56be advocates for those families.
47:57As soon as about outcome occurs with
48:00a less restrictive safety plan.
48:03The newspapers are filled with the
48:06outrage of the devastating outcome and.
48:09There's an office for the child.
48:10Advocate that immediately.
48:12Enumerates all of the failures of child
48:15welfare to protect that child,
48:17and then the pendulum swings inevitably
48:20back towards more restrictive.
48:22Quote UN quote we agree
48:23that safety is difficult.
48:24Word safer plans and,
48:26and I don't know how to stop that cycle.
48:29And that speaks to my question about
48:30blame because whose fault is it?
48:32If it's a case that's already involved in
48:34child welfare and something bad happens,
48:36it's obviously child welfare's fault.
48:37At least that's how people think about it.
48:39But when any child dies,
48:40I feel like there's blame laid
48:42and that blame dictates a lot
48:43of the policy that follows.
48:46I just want to touch on what you said
48:48earlier about cases that are missed.
48:49But these were all mandated reporters
48:51who missed it, right? You look,
48:52you look at abuse was missed but but
48:55not missed in the sense they
48:56thought about it but didn't
48:57report it. But that's right.
49:00But not understood.
49:01But these were mandated
49:02reporters who didn't, right?
49:03So that's one of my things,
49:05that reporting as a policy doesn't work.
49:07I think that would speak to that
49:08because these are the men reported
49:10didn't make them report this.
49:12And I think if you think
49:13about why people don't report,
49:15it's usually not because we're not.
49:16Native reporters or it's because
49:18they don't believe CPS will help,
49:20or they don't want to hurt the
49:21relationship with the family,
49:22or they don't think or they
49:24miss abuse is happening.
49:25There's a lot of reasons that
49:26people don't report and there's
49:27some studies about that,
49:28but not a single one of them found
49:29that people don't report because
49:31of penalties were not high enough.
49:32And yet every time you go and make laws,
49:34it's let's put the headcount is higher.
49:36So I think there's a big gulf
49:37between what you see in practice,
49:38which is people are not reporting
49:40things that should be reported.
49:41I'm putting and reporting a ton of
49:43things that shouldn't be reporting
49:44and showing that the policy itself
49:45is not working the way it is.
49:47So you think, you know,
49:48we'll do a whole bunch of colonoscopies,
49:49you'll find more colon cancer.
49:50But here you're doing a whole
49:52bunch of reporting,
49:53but you're not finding more child
49:54abuse because it's not the same way.
49:56It's not,
49:56you're not casting the same net and
49:58you're not getting these people.
50:00And then. Sorry.
50:01Then the other question was about
50:02services and the pendulum swinging so far.
50:04Yeah.
50:05And that's that's really tough.
50:06I mean,
50:07who is to blame?
50:09I think that speaks to the bigger
50:11problem that child welfare services
50:12doesn't keep us safe because their
50:14children were system involved
50:15and the system is not working.
50:17In general and so you have
50:18children who are unsafe or involved
50:20children are undetected.
50:21And so I think the answer shouldn't be we
50:23should be doing more of what we're doing,
50:25but can we revision a different system and,
50:27and I don't I think that's kind
50:29of unsatisfying response perhaps,
50:31but I think it speaks again to
50:32the bigger problem that to my
50:34mind the child welfare system is
50:35not keeping children safe.
50:40Since we started late,
50:41I can go for about 10 more minutes,
50:43but I want to just leave sometime. Guys.
50:51And one more selfish question.
50:52Was there something?
50:59I think. Right.
51:02So this was a fabulous talk and
51:05conversation from 2 brilliant women.
51:07I've learned so much from both of you.
51:09And so my question is,
51:11I understand your point about not blaming
51:14the victim or focusing on the individual,
51:17whether she's blamed or not, the mother.
51:20But I know there are some programs,
51:23small ones, that bring in what
51:25they consider mothers at risk,
51:27and usually they're not mandatory.
51:29I think some of these women want to come
51:31in and either they go into the hospital,
51:34there's some setting to teach them things
51:36about childcare, anger management.
51:38From your perspective of we
51:40need to hit on poverty,
51:42which I think you're right,
51:44and fix the system.
51:45What's your thoughts of those programs?
51:48Are they a stopgap before we do other things,
51:50or are they blaming the mother?
51:52Does this work?
51:52Does this microphone work?
51:56I think it really depends on the program,
51:58but I think if mothers want to
52:00participate then that's wonderful.
52:01The problem is that many of
52:03these programs are mandatory.
52:04They are require a mother
52:05to lose days of work.
52:07They require three different buses.
52:09The buses don't go at the right time.
52:10We have a piece that's coming out now
52:12with the Russell Sage Foundation that
52:14looks at administrative burdens and
52:15looks at all the barriers to accessing
52:17these services so that for many
52:19mothers these these are not services,
52:21these are burdens.
52:22So I think it really depends on
52:24and some of us we can learn from.
52:25Field work with mothers who were
52:27participating and I've had the
52:29good fortune with to partner with
52:31the anthropologists who do this
52:32kind of work and and hear from
52:35the people who are involved.
52:37But I I do think more supports are needed.
52:39And I think part of the problem in
52:41the United States is that parenting
52:42is seen as such a solitary endeavor.
52:44And in fact,
52:45when you engage more people,
52:46sometimes it's seen as if you're failing.
52:49So if if you leave your kid with
52:52with family members and that can be
52:54judged by CPS as an unsafe situation,
52:56especially if you know your aunt
52:58has a former conviction or a
52:59drug charge from 10 years ago.
53:01So instead of using your web,
53:03you're being your your network you're
53:05being charged for or you're being.
53:07Blamed for not being able to manage
53:09by yourself and and I have four
53:11very small children I I can attest
53:13parenting is very hard and people
53:15shouldn't be doing it by themselves.
53:17They've created this culture where
53:18parenting is simply in the interest
53:20of the one person and their child.
53:22But it's in fact the communal endeavor
53:24and and we are we all are invested
53:26in having thriving families and
53:28and healthy children and we lose
53:29sight of that often and in these
53:32in these interventions I think
53:33that answer is in part or your.
53:37I would, I would only add that that
53:39there's there are hopeful programs
53:41in the works that are universal.
53:43You know for like for every mom to have
53:46a home visitor and for every birth and
53:49in certain communities that you know
53:50the data will be coming out from about
53:52the effects of those kinds of programs.
53:54But I think programs that destigmatize
53:56certain parents to your point about
53:58voluntary versus involuntary that
54:00are provide that recognize and you've
54:02made this point very early on,
54:04the parenting is really challenging
54:05and some people have a lot more
54:07support in doing it than others.
54:08So amplifying the support across the board,
54:11I'm very hopeful that some of
54:12these programs are going to show.
54:14Good data.
54:14But they're they're they're very expensive.
54:17And I'm sorry that Doctor Mays left
54:19because she has a fantastic program
54:21in Mentalization and that focuses
54:23on mentalization skills and parents
54:25that allow it's usually mothers to be
54:28able to watch themselves as parents
54:30and gain skills and has shown some
54:32really good data about the impact
54:33of that program as well.
54:38And you're looking at there
54:39anything in the chat,
54:40I look at it. Second, some of
54:43the questions already been answered.
54:48Maybe.
54:50It Scroll down.
54:52There's a question for you miss
54:54all about. You want to get some
54:56more historical background.
55:01Yeah. So I'm surprised I didn't start with
55:03ammonia and report as setting the stage.
55:06And can I talk about the issue of foster
55:09drift and its impact on Aqua and ASPA?
55:11Well, I I guess there was a lot of
55:13history I had to convince because
55:15I I I was asked to keep it short.
55:17I can, I couldn't talk a lot.
55:18But I think you know,
55:19blaming families is something we've
55:23done historically and also in
55:25particular devaluing families and
55:27and certain families are worth the
55:29of protection and kind of putting on
55:31a pedestal of you know the family,
55:33the family values and traditional
55:35families and other families which are
55:37generally black families and poor families,
55:39immigrant families are trying
55:40to pay the border.
55:42Our our children are sold to slavery.
55:44We have a long history of of kind of using,
55:48policing families and and terrorizing
55:50families as a way to maintain the
55:53racial and societal hierarchy in order.
55:58I guess I'm not quite sure about
56:00the foster cured Rift question.
56:06Any questions from? Alright. Question.
56:13So I'm just wondering with foster care is,
56:16is it sort of generational?
56:17I mean do you see a lot of
56:20repeat like if a kid has been?
56:22Remove from the family
56:23then put into a foster.
56:24Like what happens when they if
56:26they have a family.
56:27I mean is it a generational thing
56:29that you can sometimes is that a
56:31place where maybe starting to break
56:32that and trying to get them into
56:34A to realize that they don't want
56:36to do to their own child what what
56:38they had experienced as a child?
56:47So yes, the answer is yes.
56:49So there is a lot of intergenerational
56:51involvement, sometimes 3 generations.
56:52I have the good fortune of being involved
56:55with community groups of people who have
56:57lived experience with this and I hear
56:59from women who are in their 50s and.
57:01It's like third generation of of they're
57:04they're so of involvement but an often has
57:07to do with poverty and use of substances.
57:10But it also kind of want to remind
57:13people what happens when you lose your
57:15parents and you know there was just
57:17cases of termination of parental rights.
57:19You lose all your connection with your
57:21family of origin, which has a lot of meaning,
57:24but also has financial meaning, right.
57:26So there's cases of of a family in which
57:29there was parental rights and dad was right,
57:32had a terrible accident.
57:33Went over by out and buy a car and passed
57:35away and one child received nothing from
57:37the money that was given because of PR.
57:40So, so these are not families are
57:41coming from a lot of wealth but there
57:43is they're losing any connection,
57:45any financial support from their communities,
57:47from their families.
57:47We do see some children who come back
57:50to their communities and families of
57:52origin once they're 18 and are able to
57:55restart the remake these connections.
57:56But yes I think there's a lot of
57:58intergenerational involvement with foster
57:59care and and a lot of poor outcomes for
58:01children who grew up in foster care.
58:03And our system involved and go on
58:05to have poor educational attainment,
58:07early pregnancies,
58:08short of interval preferences and so on.
58:11I would echo that and just it
58:13makes your point all the more.
58:15I think that so many of these problems like.
58:18Having kids removed and
58:20placed into foster care.
58:22There's good evidence that child sexual
58:24abuse is intergenerational like that.
58:25There's more sexual abuse in
58:26families where there is sexual
58:28abuse in the mom and it it can go,
58:29you know, there's studies that
58:31show down to the grandchildren.
58:32Exposure to intimate partner violence,
58:35and this is trauma on trauma
58:37because these are parents who
58:38experience these terrible things.
58:40And this is the kind of thing I hear
58:42day-to-day in my clinical practice.
58:43I having this conversation today
58:45about a family that had a bad
58:47intimate partner violence incident
58:48and the children were exposed to
58:50it and the mother was heartbroken
58:52because she remembers being exposed
58:53to intimate partner violence between
58:56her caregivers when she was a child.
58:58So now.
58:59You have this,
59:01the trauma of your own childhood.
59:02Plus now you haven't prevented your
59:04own child from experience what was for
59:06you a horrible experience and a trauma.
59:08And the same is true for foster care.
59:10So when children of foster children
59:12are placed into foster care,
59:13you know,
59:14once they're old enough to have children,
59:15I think the the guilt and the
59:18heartbreak over that is is another
59:19source of trauma and the fact that
59:22poverty fuels so much of these,
59:24so many of these problems.
59:26It's not surprising that they're
59:28perpetuated through generations,
59:29but it's not enough to say like this is.
59:30This is something that happened
59:31to me that I won't want.
59:32I won't let it happen to my child because
59:35we're not elevating those families.
59:37With enough support to get
59:38them out of this pattern,
59:39and I think the pattern is under of
59:42itself is so incredibly harmful,
59:44and I know you agree with that
59:46as I read your book.
59:50Just say the last word. OK.
59:54Those are the question that Chad
59:55today answer, answer question.
59:58Well, there's a question that chat about
60:00what happens for the fractured trust
01:00:01once you make a report and then how you
01:00:03maintain a clinical relationship with
01:00:05somebody you've made a report about.
01:00:07And I don't know the answer to that.
01:00:10I know that there's a lot of literature
01:00:12that shows that once the report has
01:00:14happened and there's an investigation,
01:00:15mothers are less likely to engage
01:00:17in valuable services, are less,
01:00:19are more likely to come late
01:00:20for prenatal care.
01:00:21So, so a host of bad outcomes from
01:00:24making these reports that really
01:00:26ruptures the trust with educational.
01:00:28Systems thing for your school makes a report?
01:00:30Then you're less likely to be
01:00:31engaged with school for your child.
01:00:33And how do you repair that trust?
01:00:35I don't have an answer.
01:00:36Maybe you do.
01:00:38Well, I think if the,
01:00:40you know,
01:00:40it comes sometimes triangulating
01:00:42with the laws and saying I have to
01:00:43report this, it's not what I want to do.
01:00:44I mean taking away the laws would take
01:00:46away that crutch from providers who
01:00:48who know the law even though they,
01:00:50you know, I think you can report
01:00:52and remain supportive of a family.
01:00:53And oftentimes it's the families who
01:00:55are reported who require the most
01:00:56support because to your point about
01:00:58Child Protective Services workers,
01:00:59they have different degrees of training
01:01:01and different degrees of experience and
01:01:03primary care and other providers can
01:01:05be instrumental in and advocating for
01:01:07families in the child welfare system.
01:01:09But it's not easy to maintain trust.
01:01:11I don't get a lot of grateful.
01:01:13You know, I don't get a lot of
01:01:15presence at at the holidays from
01:01:16grateful families the way some people,
01:01:17some physicians do it.
01:01:20It is an insult to all of us who work
01:01:22in the system that the system is broken
01:01:24and the ways that you've described it.
01:01:26That said,
01:01:27it's a system that we live with
01:01:28because we still have to protect
01:01:30children and there's a lot of work
01:01:32to be done to get to a place where
01:01:33we agree that we should be.
01:01:37I think that was great.
01:01:38Thank you very much and
01:01:38thank you for being in
01:01:39conversation and thank you all.
01:01:40Thank you, Doctor Grossman.
01:01:43Thank you, everybody.
01:01:43Thank you live in zoom
01:01:45audiences. Congratulations
01:01:46again, McCall and Andy.