Child Fatality Commission Criticized from Inside and Out

After $4 million, 13 public listening sessions and eight deliberation meetings (many over the phone), the Commission to Eliminate Child Abuse and Neglect Fatalities is closing in on adoption of final recommendations for the Obama Administration.

No full draft version of the recommendations is available, but early pieces of certain chapters have surfaced on the committee website. The idea is for the commission to make these recommendations to the president and his Department of Health and Human Services (HHS).

Youth Services Insider knows of at least two parties — from opposite sides of child protection vs. family preservation divide — who have lined up against the commission.

One party is, in fact, a member of the commission: Cassie Bevan, former congressional policy advisor and current child welfare fellow at the University of Pennsylvania, who has voiced concern that the recommendation process has steered toward dollar signs and away from practice.

The other is National Coalition for Child Protection Reform Executive Director Richard Wexler, who mounted a preemptive assault on the commission with a report issued by NCCPR this week.

Bevan’s problem with the commission is what she believes to be a growing fixation on recommending new dollars without any substantive review of how the existing spending works (or does not work). The commission appears poised to recommend $1 billion in new federal spending under the Child Abuse Prevention and Treatment Act (CAPTA) to improve state capacity on the investigation and tracking of child fatalities.

Bevan said the $1 billion proposal is attached to “convey a sense of urgency,” but that her fellow commissioners “don’t understand that money comes with bureaucracy.”

“We already duplicate and have a lack of coordination, and I fear that will continue,” Bevan said. “I’m really frustrated.”

At a December meeting in Virginia, Commissioner Michael Petit, an advisor to the Every Child Matters Education Fund, made the case for that funding as a necessary piece to the recommendations:

“I mean, I think we need to actually say a number on this thing, and it has to be a large number. And a billion sounds large to us, but it’s not large in the context of what the federal government spends money on. So I think we need to say that because it’s specific and concrete and will give people something to react to. And then we can negotiate from there in terms of what needs to happen.”

Bevan later said she saw no way that $1 billion was headed to CAPTA and that she didn’t want the commission to put that “out there and look silly,” and have “that be the discussion.”

That led to a quick tête-à-tête between Bevan and Petit on the subject. From the transcript:

PETIT: It’ll be a fight with the Congress perhaps, but Cassie, I don’t think that the interpretation of what is politically feasible on this thing is part of what our task is. Our task is to identify what we think needs to be done. And then it’s going to be up to the Congress to do the right thing.

BEVAN: But we made up the billion dollars and we made it up. There’s no need, it’s a headline.

PETIT: We didn’t make it up.

On a phone call with YSI, Bevan said she did feel that CAPTA was a critical piece of the puzzle on improving the prevention of child fatalities. But in her mind, the law already has the necessary language – the protocol for handling children born to mothers with drug abuse problems – and is simply ignored by states.

“Implement the plan of safe care for infants in CAPTA,” Bevan said. “We have a problem with drugs. And we need to have states take it seriously. Tell hospitals to call CPS, and that it’s not a call for a report, it’s a call for help.”

The failure of some states to adhere to federal standards on that issue is at the heart of the Reuters feature story from last month on opioid-addicted mothers. The series has prompted an inquiry by the House Committee on Education and the Workforce. From the committee’s release on the inquiry:

“The Reuters’ investigation reveals the shocking and deadly consequences when these vital federal and state child welfare policies are not properly implemented and enforced. The current system is clearly not serving the best interests of these vulnerable children and mothers.”

Richard Wexler of NCCPR said he could not agree less with Bevan on that priority because in his opinion, “when you call CPS, it’s never a call for just help.”

Shouldn’t that be something we focus on fixing, YSI asked him, improving the ability of CPS to receive information without it innately causing surveillance?

Yes, he said, “but until we reach that point, we should leave it to the discretion of medical professionals to decide when to call. I’m not saying they should be barred from calling CPS, I’m just saying they’re likely to know when it’s warranted.”

But Wexler, whose organization champions family preservation and fights what he sees as an over-reliance on foster care and adoption, said he does agree with Bevan that the new money proposed by the commission “would do nothing but create the same lousy system, only bigger.”

NCCPR’s “pre-buttal” on the recommendations, “Minority Report,” emanates from Wexler’s belief that the commission wants to up spending on investigations at a time when there’s momentum to invest in keeping families together. From the report:

“At a time when Congress finally is giving serious consideration to allowing funds now reserved for foster care to be used for safe, proven prevention and family preservation programs as well, there are commissioners who seem to have their eye on that pot of money as a way to fund child abuse investigations instead.”

Among the recommendations on Wexler’s hit list is the one suggesting that all hotline calls related to a child under five be investigated. Wexler estimates that this would result in a 44 percent increase (about 800,000) in new child abuse investigations every year.

NCCPR’s report argues that the intrusion of the investigation itself is harmful to the child and family, and that the cost of the new investigations would likely result in cuts to meaningful programs aimed at keeping families together.

The report also takes aim at the commission’s interest in predictive analytics, a process by which large data sets are used in models that can either gauge risk and/or steer outcomes for child- and family-serving agencies.

Wexler calls predictive analytics “a fad that is questionable in itself,” which has become popular in the child welfare field on the heels of one venture: the Rapid Safety Feedback (RSF) program in Hillsborough County, Florida. That program uses predictive analytics to target the children deemed most at risk of suffering a fatality, and increases the attention paid to them.

In the NCCPR report, Wexler points out that the program’s own creator does not claim that RSF was causal in the fact that, after nine child abuse deaths between 2009 and 2012, Hillsborough has not had another.

“The commission shouldn’t either,” Wexler said in the report.

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John Kelly
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John Kelly is editor-in-chief of The Chronicle of Social Change.