In the public testimony on the CFSA budget, there were pleas from several speakers to increase funding for home visiting programs funded by CFSA. So I did a little digging to determine how the current funds are being spent, and what I found was rather shocking. In Fiscal Year 2022 (FY22), CFSA handed over $330,000 to the DC Department of Health, to serve a grand total of 33 families, of whom only 16 completed the program. The agency spent another $360,000 to serve an unknown number of families in home visiting programs that have not been shown to reduce child maltreatment. The generic acceptance of home visiting programs as prevention against all ills appears to be part of the problem; the lack of sufficient options under the Family First Act appears to be another.
First some context. Home visiting is not a program, but rather a service delivery strategy that can be used in many different programs. There are many, many home visiting program models with different goals, services, staffing, and target populations. According to the website of the DC Home Visiting Council, the District currently offers 16 home visiting programs, each with different goals and supporting different needs. There is evidence supporting the impact of some of these programs on certain outcomes, but “home visiting” itself is neither a program nor evidence-based, despite multiple statements to the contrary at the CFSA budget oversight hearing on April 12, 2023.
CFSA supports home visiting programs for two different populations using two different funding streams–Community-based Child Abuse Prevention Grants (CBCAP) and Title IV-E of the Social Security Act. Through CBCAP, CFSA funds three home visiting programs for “primary (universal) prevention“1 of child abuse and neglect before it occurs. CFSA uses Title IV-E funds to pay for services to families known to the agency but who may not have a substantiated allegation or an open case. These funds are transferred to the DC Department of Health (DOH) to pay for slots in two home visiting program models, Healthy Families America and Parents as Teachers, both delivered by Mary’s Center) to this population.
Programs/Clientele: In 2022, CFSA paid three providers directly for programs under CBPAP. Collaborative Solutions for Communities provided Home Instruction for Parents of Preschool Youngsters (HIPPY) to young Latino or immigrant mothers with children aged 0-6; Community Family Life Services provided “Parent Support and Home Visitation”2 to mothers who were homeless, formerly incarcerated, or affected by domestic violence; and Mary’s Center provided a “Father-Child Attachment program”2 to “fathers with children (0-5) deemed at risk.”
Evidence Base: Given the name of the funding source (Community-based Child Abuse Prevention Grants) it would be reasonable to expect that the programs funded would have evidence showing that they prevent child maltreatment. Yet, there is no evidence that any of the programs CFSA funds under this stream reduces child maltreatment. HIPPY is an education-focused program designed to prepare children for success in school and beyond. It is not listed by the California Evidence-Based Clearinghouse for Child Welfare (CEBC), the nation’s leading child welfare clearinghouse, as a home visiting program for prevention of maltreatment. Neither “Parent Support and Home Visitation” nor “Father-Child Attachment” are listed in the clearinghouse and neither appears to be a tested model. Moreover, CFSA provides no information about program outcomes in its oversight responses.
Funding: In 2022, CFSA spent $50,000 on HIPPY, $160,000 on “Parent Support and Home Visitation” and $150,000 on the “Father-Child Attachment program” of Mary’s Center.” The Mayor’s budget does not provide FY23 spending or FY24 requested funding for individual home visiting programs, or even for these programs as a group, and CFSA did not respond when I asked how much it plans to spend this year. But the testimony of DC Action for Children, which lobbies for increases in home visiting funding, suggests that the agency is planning to keep funding level for FY 24.
Number of people served: In its oversight responses, CFSA provided no information on the number of people who were actually served last year by these three programs – only the “projected slot allocation” provided in the table: 50 mothers for HIPPY, 75-125 mothers for CFLS, and 50 fathers for Mary’s Center. FY22 ended on September 30, 2022, so the agency should have been able to report on how many people were served. But CFSA Director Robert Matthews did testify that there is excess capacity in all these programs, so we can assume that fewer than the 175-225 slots allocated were filled.
The DOH programs funded by Title IV-E
Programs and Clientele: CFSA transfers Title IV-E funds to the Department of Health (DOH) in exchange for providing two home visiting programs, Parents as Teachers (PAT) and Healthy Families America (HFA), to eligible families. Potential participants include families known to CFSA but who may not have a substantiated allegation or an open case, as described in CFSA’s Title IV-E Prevention Plan. This includes families receiving services from a collaborative following a CFSA investigation or closed case; families of children who have exited foster care but are at risk of re-entry; families of children born with postive toxicology; families receiving CFSA in-home services; pregnant and parenting youth in foster care or recently exited from foster care, and their children; and siblings of children in foster care.
Evidence Base: In order to be allowable uses of Title IV-E funding, programs must have been approved as Evidence-Based Practices (EBP) by the Title IV-E Prevention Services Clearinghouse, which was created by the Family First Prevention Services Act of 2017 (“Family First”). Family First allowed Title IV-E funds, previously available only for foster care, to be used for services to prevent a child’s placement in foster care. For a program to be approved, the Clearinghouse must find that a evaluation meeting its criteria determined that the program had at least two impacts on any of seven different target outcomes.3 Unfortunately, the programs do not have to demonstrate reductions in child maltreatment, though logic suggests that such reductions would be necessary to prevent placement in foster care. Both PAT and HFA have been approved by the clearinghouse as EBP’s. But neither of these programs was found to produce meaningful reductions in child maltreatment.4One reason may be that, as evaluations have shown, home visiting programs “have struggled to enroll, engage and retain families.”
Funding: CFSA funnels $160,471 in local funds and approximately the same amount in federal TItle IV-E funds to DOH to pay for these two programs, which are delivered by Mary’s Center. According to the oversight responses, this is done through a Memorandum of Understanding (MOU) “which “pays for 40 slots of the PAT model to specifically serve the…. families defined in CFSA’s Title IV-E Prevention Plan. In addition to these 40 PAT slots, the MOU also outlines how CFSA, and DC Health will partner to ensure the child welfare agency is referring families to HFA and PAT whenever appropriate, regardless of candidate eligibility under Family First.” This is confusing. Services to families not eligible under Family First cannot legally be funded using Title IV-E so it is not clear how Title IV-E could be used to provide them.
The missing MOU: In its FY23 oversight questions to CFSA, the Facilities and Family Services Committee requested all MOU’s currently in place or planned. Those MOU’s are listed on page 148 of the Oversight Attachments. There was no CFSA-DOH MOU listed as in place as of January 23, 2023 but there was one “In Process” that dealt with “coordination around home visiting.” That is very odd, given that CFSA referred twice to an existingMOU in its responses describing the home visiting programs provided by DOH. I requested the DOH MOU from CFSA on April 21 and have received no response or explanation. Quite possibly, there is still no MOU in effect.
Numbers Servedand Cost: According to the oversight responses, CFSA referred 105 families to PAT and HFA in FY22, of whom only 33 families were served and 16 completed the programs, as shown in the table. The large dropoffs from referral to service and from service to completion are not surprising in view of CFSA Director Robert Matthews’ remarks at the budget oversight hearing. Explaining why the agency did not need more funding for home visiting, Matthews said that CFSA is not allowed to mandate participation in home visiting and that many CFSA parents do not want to participate in these programs. And it is highly plausible that the ones who do are those who need it least. At a cost of over $160,000 each in local and federal funds to serve only 33 families of whom only 16 completed the program, it looks like CFSA spent about $10,000 per program participant and $20,000 per program completer in PAT and HFA .That would be a scandal. But it is also possible that the money paid for home visiting for additional parents who were not eligible for Title IV-E funding. And that would be illegal.
Learning from the past? FY22 was not an outlier. In FY21, CFSA reported only 26 families served out of 159 referred to Mary’s Center for home visiting programs funded under Title IV-E. One might think that once CFSA saw how few of its clients were participating in FY21, they would have amended their Title IV-E plan and substituted other services for PAT and HFA. After all, CFSA said in its oversight responses that “work completed in FY22 to refer families to these services was, and will continue to be, analyzed to determine ongoing service needs for Family First target populations.” It is hard to understand how this kind of analysis would have resulted in the continuation of current funding levels for these unpopular services.
Questions and Possible Answers
Why is CFSA spending so much money on home visiting programs that are unproven to prevent child maltreatment and not popular among target families? One possible answer, most relevant to the three programs funded through CBCAP, stems from the history of home visiting. Modern home visiting was developed as a child maltreatment prevention program, and there was great hope after some initial results that appeared promising. But once the programs were rigorously evaluated, the results were disappointing. The possible exception was the Nurse Family Partnership (NFP, formally known as the Nurse Home Visiting Program). NFP was the only program shown to reduce child maltreatment using objective measures other than maternal self-reports, and it also had other impressive effects. But NFP, the only program to use nurses as home visitors, is more difficult to implement and is restricted to first-time teen mothers, and its most impressive results were achieved for White teen mothers in rural New York state. Other programs like HFA and PAT, which were easier to implement, grew more and faster, perhaps benefiting from the excitement about NFP. It was in the interests of most of the programs (and the researchers who specialized in evaluating them) to portray “home visiting” as one undifferentiated program model, allowing programs with less encouraging results to benefit from the success of their more promising peers.
One reason for the widespread use of Title IV-E funds on home visiting programs may be the lack of available alternatives. The passage of the Family First Prevention Services Act (FFPSA) in 2017 was hailed as a breakthrough for allowing the expenditure of Title IV-E funds, formerly used only for foster care, to be used for “prevention services” aimed at keeping families together. But as one essential article points out, rigid standards and administrative burdens have crippled the law’s ability to have an impact on the availability of services. Between the requirement that programs be approved by a clearinghouse as EBP’s, and the prohibition of using IV-E funds for services funded by Medicaid, jurisdictions did not have much choice (particularly in the early days of the law) if they wanted to claim federal Title IV-E dollars for “prevention services.” CFSA’s struggle to find appropriate and allowable programs that already existed in the District is made clear in its TItle IV-E Prevention Plan. Of the seven approved programs CFSA chose to implement, four were already funded by Medicaid. PAT and HFA were already being provided by DOH, which made them an attractive option for CFSA. CFSA is claiming Title IV-E funds for only three programs, two of which served only a handful of families. And CFSA is no exception. Nationwide, only 6,200 children in the whole country received a Title IV-E funded “prevention service,” for a grand total of $29 million, in FY 2022.
In light of all these concerns, I believe that CFSA should re-evaluate the home visiting programs it funds based on their effectiveness in preventing child abuse and neglect–and the likelihood that parents will choose to participate. I also believe that Title IV-E funding for HFA and PAT should be eliminated or reduced drastically. Some funds might be diverted to programs that have more recently been approved for Title IV-E funding. With the desperate need among CFSA parents for mental health and drug treatment services, CFSA should consider funneling more funds to the Department of Behavioral Health to purchase such services for its clients.
CFSA’s continued spending on home visiting regardless of purpose, numbers served, interest to families, or effectiveness in preventing maltreatment, may stem from the general misconception about home visiting as an all-purpose prevention program, as well as the lack of choices available under the Family First Act. But CFSA’s spending of Title IV-E funds in particular raises serious concerns. Not only is CFSA wasting resources but it may be diverting Title IV-E funds to an ineligible population–running the risk of having to return funds and possibly receive a penalty from the federal government. And if it is not doing that, then it is spending an unconscionable $20,000 for each person who completes the program.
Notes
While CFSA describes these programs as “primary (universal) prevention” in its oversight responses, they are actually not universal programs. Instead, they are “secondary prevention” services that target at-risk groups.
CFSA listed both these programs as “home visiting” with no program title in its oversight responses, but these program names were provided in the testimony of DC Action for Children.
The seven target outcomes are Child Safety, Child Permanency, Child Well-Being, Adult WellBeing, Access to Services, Referral to Services, and Satisfaction with Programs and Services. A program needs only two positive “contrasts” (out of as many as 80 or evem more different contrasts) between the intervention and comparison group to be approved.
The California Evidence-Based Clearinghouse for Child Welfare (CEBC), the leading child welfare clearinghouse, does not list either of these programs as Home Visiting Programs for the Prevention of Child Abuse and Neglect. The Title IV-E clearinghouse found that PAT had two very small (5% of a standard deviation), not statistically significant effects on substantiated maltreatment and neglect. The only child safety outcome for which HFA had a positive impact was self-reported (by parents) maltreatment, not a very reliable measure. In contrast, HFA had no effect on child welfare administrative reports. HFA also had no effect on any comparison of maltreatment risk assessment or medical indications of maltreatment risk.
Until recently, I was one of three “community representatives” on the District of Columbia’s Child Fatality Review Committee. Community representatives are the only members who are not paid to sit on this panel; the rest are agency representatives who sit on it as part of their jobs. My service on the panel was an important aspect of my advocacy for abused and neglected children in the District. But this work ended abruptly for me in March of this year when I was told that my service was over. As described below, I have some ideas about why the panel decided to dismiss perhaps its most engaged, passionate and productive member.
On March 2, 2023 I got a call from the Director of the Mayor’s Office of Talent and Appointments (MOTA). He said he was calling about my position on the District’s Child Fatality Review Committee (CFRC). I told him I had already received a call several weeks earlier from a MOTA staffer telling me that she was working on my reappointment, which should have happened earlier but was backlogged due to the pandemic. She asked me to submit an updated resume and told me she would be back in touch shortly to help me prepare for my DC Council confirmation hearing. But on March 2, the Director told me there had been a mistake. I was not being reappointed to the committee, and since my term had already expired, I was now off the panel.
When I asked why I was not being reappointed, I was told that it was time to give other people a chance to serve. This explanation made no sense. I was one of only three “community members” on the panel, out of eight authorized by DC Code. In her 2017 report, the DC Auditor noted the many vacant seats for community members and the importance of these community representatives, who are not tied to a specific agency. In her remarks preceding the 2017 report, CFRC Co-Chair Cynthia Wright wrote that “the addition of new community members [of which I was one] who provide a fresh perspective to our work …. has increased the vitality of the CFRC.” I doubt that there are five people lined up waiting to be appointed, or even one person ready to replace me. It’s not surprising that there is no long line of community members who want to volunteer two to four hours of their time each month in meetings about children who die, not to mention reading the sad case histories before the meetings. It was clear that my expulsion was not intended “to make room for somebody else.”
My de facto expulsion certainly did not stem from a lack of commitment or shoddy performance. I attended all 13 meetings of the Child Fatality Review Team in FY 2022 and the first quarter of FY 2023. According to the government’s responses to the oversight questions posed by the Committee on the Judiciary and Public Safety, the two other community members attended nine and seven out of 13 meetings respectively. I read every case study in advance of the meeting, and came prepared with questions and comments. Based on the questions asked at the meetings, it was clear that most members never read the case histories (sometimes as long as 20 single-spaced pages) and instead relied on the quick presentations given by Committee staff. In addition, I was a main source of new ideas on the panel; indeed, the two most recent presentations before the committee before my exit stemmed from my suggestions.1 So there must be another reason I was not reappointed. And I think I know what it is, but let me first say something about the Committee and why I joined it.
As described on the website of the Office of the Chief Medical Examiner (OCME), under which the CFRC is located, the goal of the CFRC is to “reduce the number of preventable child fatalities in the District of Columbia through identifying, evaluating, and improving programs and systems, which are responsible for protecting and serving children, and their families.” Based on the information it reviews about the histories of children who died, the CFRC makes findings and recommendations to prevent such deaths in the future. The CFRC is comprised of two teams, the Infant Mortality Review Team (IMRT), which reviews deaths of District infants from birth through twelve months, and the Child Fatality Review Team (CFRT), which reviews the deaths of children aged one to 18 years old as well as youths aged 18 through 21 who were known to the child welfare system within four years of their deaths or to the juvenile justice system within two years of their deaths.2 Their are child fatality review teams in all 50 states and some tribal nations as well.
I joined the CFRC because of my concern about children who are abused or neglected and my belief that CFRC had the potential to have a broader impact beyond preventing fatalities because the conditions that lead to child deaths also cause harm to many more children who do not die. The DC Auditor reported hearing this from several individuals who likened the fatality cases that are examined to a “canary in a coal mine.” I had a particular interest in monitoring the work of the Child and Family Services Agency (CFSA), which is charged with protecting maltreated children in the District. When I joined CFRC, I had recently left my job as a social worker at a private agency that provided foster care as part of the child welfare system led by CFSA. In that capacity, I had heard children’s lawyers express their fear that due to the recent sharp drop in removals of children from theirt homes into foster care, many were being left in dangerous situations that might eventually result in deaths or irreversible emotional or physical damage.
And indeed, upon joining CFRC, I found a number of reasons for concern about CFSA’s effectiveness in protecting children. It was astounding to learn how many children died after having some contact with CFSA. According to CFRC’s annual reports, 69 percent of families of decedents reviewed by CFRT in 2019 had prior CFSA involvement; that figure could not be calculated for IMRT reviews. Of thecases reviewed by the CFRC3 in 2020, 15 out of 18 (or 83 percent) of the decedents’ families had prior CFSA involvement. Reading the CFSA histories of these families often revealed as many as 20 reports to the hotline over the years. Many of these reports were not even accepted for investigation. Those that were investigated were often not “substantiated” or verified by the investigators, which is required for opening a case, despite what seemed like ample evidence of abuse or neglect cited in the case summaries. Even when a report was substantiated and a case was opened for in-home services, more calls often came in about the same families and investigators continued to find dangerous conditions and parenting practices. Even after the cases closed, the reports would continue to arrive, suggesting that nothing had changed as a result of CFSA’s intervention. And even when children were removed to foster care, they were often returned home with no evidence of improved parenting or conditions, and the reports continued to come in.
But when I expressed my concerns about CFSA’s response to frequently reported families and suggest that a finding or recommendation might be in order, I was repeatedly accused of “picking on” CFSA. It is as though CFSA was a child needing protection from bullying rather than an agency responsible for protecting children. Perhaps I shouldn’t be surprised. In its July 2017 report on CFRC, the DC Auditor reported this exact concern — that several panel members believed “defensive or territorial behavior remains an impediment to productive deliberations.”
It was perhaps during my second term at the CFRC, starting in 2020, that another set of issues arose that also put me outside the mainstream of CFRC members. The District was already at the forefront of a national movement to drastically reform what was described as a racist child welfare system by reducing foster care placements and government intervention in the lives of families. The murder of George Floyd and calls to abolish the police intensified this movement, with some even calling for the abolition of child welfare agencies, which were labeled as a “family policing system.” An effect of this type of thinking was an unwillingness to suggest that parents were unfit, no matter how abusive or neglectful they may have been, or to suggest that CFSA should have intervened more aggressively to protect children who later died. While my concern was for the safety of children, other members of the committee were more interested in demonstrating their opposition to governmental interference in the lives of families, regardless of the cost to children’s lives or safety.
When I joined the panel in 2017, there was more tolerance for diverse viewpoints and more concern for the needs of vulnerable children, regardless of race. There were frequent discussions about how to work with the parents who were repeatedly reported to CFSA but did not ever seem to change. Such families are well-known in the child welfare literature as “chronically neglectful,” “chronically maltreating” or “frequently reported” families. Many of these parents had problems with substance abuse, mental illness, domestic violence, or some combination of these three factors that impaired their ability to parent. They had been offered numerous services to help address these issues, which they either declined, dropped out of or completeded without any apparent benefit. Discussions of these families often led to suggestions that the agency make more use of a tool called “community papering,” which means filing a petition for court intervention to compel parental participation in services when a child is not being removed from the home. This resulted in a recommendation in the 2017 report that CFSA should use this tool more consistently for families that need some pressure to participate in services. In the same report, the panel also recommended that CFSA strengthen its policy and practice to “ensure families with multiple referrals to Child Protective Services receive an intensive historical review.” After 2017, there were no more recommendations for strengthening CFSA interventions with frequently reported families.
The changing ideological climate manifested itself in other ways. Serving on the CFRC, I soon realized that a striking number of child fatalities happen in extremely large families, with six, seven or as many as 12 children. Perhaps it is not so surprising. It’s hard to imagine safely caring for that number of children, especially if they are closely spaced. There was a time when this topic could be discussed, especially on the IMRT, whose members were concerned with protecting vulnerable infants. In the 2016 report, two paragraphs described discussion by the IMRT of “the concept of developing a public service media and marketing campaign focused on the health and economic benefits of family planning for all age ranges.” Clearly there was not enough support for this idea to result in a recommendation, but the discussion was robust enough to warrant inclusion in the report. Even in my earlier years on the Committee, this issue was occasionally raised by public health professionals. But it was no longer apparently an acceptable topic for discussion by the time my service ended in 2022.
The changing ideological climate also seemed to affect the CFRC’s willingness to address substance abuse. Parental use of alcohol, marijuana or illegal substances is a common factor cited in the cases reviewed by the panel. That includes the case of Trinity Jabore,who was born with marijuana in her system and later found dead at only seven weeks old, having suffered starvation, thirteen fractured ribs, and severe diaper rash. As the prosecutor of her parents put it, “They deliberately chose not to feed or take care of their infant and to instead smoke marijuana, PCP, get high and take selfies all day.” In 2018, the IMRT formed a subcommittee to look at the impact of marijuana usage on families in the District, in light of concerns raised by the legalization of cannabis use. In the 2019 report, the IMRT expressed concern about the role of marijuana and illicit substances in inducing a deep sleep from which parents did not rouse even as their dying babies fought for breath. But in the 2020 Annual Report, parental substance use was mentioned only in two tables and the text briefly summarizing them.
In the past, CFRC had recommended data sharing between agencies to improve coordination of services for the most troubled families, who are often involved with multiple agencies. In its 2016 report, reflecting the period just before I joined the panel, the CFRC recommended that the District “should allocate funding for the implementation and utilization of DC Cross Connect throughout the human services and public services cluster agencies” in order to better meet the needs of vulnerable children and families. (The recommendation was directed to the Department of Human Services (DHS), which did not have jurisdiction over the other agencies included in the recommendation, and DHS did not respond to that part of the recommendation.) Cross-Connect is an effort to integrate care between DHS, the Department of Behavioral Health, and CFSA, incuding the sharing of data. In 2022, I became aware that a similar proposal for a citywide database to track information on anyone served by DC government agencies is a key element of the Gun Violence Reduction Strategic Plan prepared for the District by the National Institute for Criminal Justice Reform, and I suggested that we might consider such a recommendation. My suggestion resulted in a presentation by the CJCC but not a new recommendation for sharing data between agencies in the District. This new ideological climate, where there is great suspicion that data sharing can be used against marginalized populations, rather than to protect their most vulnerable members, was not fertile soil for such a recommendation.
It is unfortunate that I cannot relate specific details behind the generalities that I have reported here, except those taken from published annual reports. Strict rules around the confidentiality of meetings and information shared govern the operations of CFRC. Before every meeting, members sign a confidentiality agreement promising not to disclose any information discussed during the meeting. Those rules are clearly excessive. The panel is given case histories with no names provided. These case studies can and should be available to the public (with the redaction of any information that could give away the identity of the families.) The public deserves to know that the funds it spends on child protection often fails to protection children. Hiding this information merely protects the agencies involved. That’s why I’m hoping that the DC Council will pass legislation allowing the release of the summaries provided to CFRC (with redaction of any information that would clearly give away the identity of the decedents and their families.)
In his preface to the CFRC’s 2018 report, Chief Medical Examiner Roger Mitchell stated that “the CFRC is moving toward being a leading voice in the prevention of child fatalities in the District of Columbia.” But until committee members are willing to put the needs of children first, CFRC will never be such a leading voice in preventing child fatalities in the District. Now that I am off the CFRC, I hope that other members will be courageous enough to stand up for the rights of children to be safe and well cared for, even at the risk of becoming a gadfly–which was clearly the reason for my removal.
Notes
These presentations focused on: (a) Criminal Justice Coordination Committee on DC’s Gun Violence Prevention Plan and its work to implement it; and (b) the US Attorney’s ATTEND program to reduce school truancy.
There was no on-boarding or training when I entered the pane, so it took me at least a year to realize that I was eligible to join the IMRT as well as the CFRT. Once I understood that CFRC members are eligible to participate on both teams, I began attending the IMRT meetings as well.
This includes only those cases reviewed in full by the IMRT; this information was not available for those that were included only as part of a statistical review, which is used as a way of studying the deaths of most infants who died of natural causes. Many IMR cases are reviewed statistically not individually; for example 14 out of the 51 cases reviewed in 2019, (the last normal year before Covid) were reviewed statistically. In 2020, during which the committee missed six months of case reviews, 29 of the 47 cases reviewed were statistical reviews of infant natural deaths.
CFSA’s newest Child Fatality Review Report focuses on the deaths of 29 children and young adults whose families were known to CFSA within five years of their deaths and whose cases were reviewed in 2021. This report’s toll includes one mother who lost two little children in one year–one who died of fentanyl poisoning and another left alone with a four-year-old sibling and a propped bottle. It included four overdose deaths from synthetic opioids and ten “non-abuse” homicides including the shooting of a six-year-old at 11pm outside a liquor store. It included a twelve-year-old who died of an untreated bacterial infection but had signs of abuse on her body. Most of the dead children’s families had been reported to CFSA at least four times in the past five years. Many of them had experienced investigations and received CFSA-supervised services. Nevertheless, these children died within five years of their contact with CFSA. But the agency’s child fatality reviewers made no recommendations to improve screening, investigation, or services. That is not a surprise, given the agency’s current tendency to minimize intervention in the lives of troubled families.
When a child known to a child welfare agency dies, a natural question is whether the agency could have prevented that death if it had done more or different things. For that reason, fatality review is an important way to assess the performance of a child welfare agency, both internally and externally. According to an appendix to the report, the mission of the CFSA Child Fatality Review (CFR) Unit is “to reduce the number of preventable child fatalities in the District of Columbia through identifying, evaluating, and improving programs and systems responsible for protecting and serving children and their families.” CFSA’s 17th annual Child Fatality Review Report, based on the work of the CFR Unit, was released on January 30, 2023.1
Before 2019, CFSA followed the common practice of including in a given year’s CFR report all of the fatalities it reviewed during that year, even if they occurred during previous years. This makes sense as these deaths were never discussed in earlier reports. But for the third year in a row, CFSA chose to eliminate some cases from its analysis based on when they occurred. The new CFR report includes only those deaths that occurred during 2021 and were reviewed in the same year. That means their analysis includes only 29 child fatalities instead of the total of 51 fatalities they actually reviewed in 2021. The rest of those fatalities occurred in 2018, 2019, and 2020. See the Note on Timing appended to this commentary for further discussion of this issue.
Manner of Death
The manners of death2 of the 29 young people whose cases are included in the body of the report are displayed in the pie chart below. About a third of these decedents were victims of “non-abuse homicide;” six (or 21 percent) died of accidents; four (or 14 percent) died of natural causes; and three (or 10 percent) died of “neglect homicide.” The other six children’s manners of death were “undetermined” or “unknown.”
Three, or 10 percent of the deaths reviewed in this report, were labeled as “neglect homicides.”(There were no homicides attributed to abuse). All of the victims were age three or under, which is typical of child maltreatment fatalities nationally as well. One of the three was a 17-month-old with “thermal and scald” injuries. The two other fatalities both involved synthetic opioid toxicity, illustrating the spread of this crisis to the District of Columbia. The second fatality was a three-month-old who died of synthetic opioid (eutylone and fentanyl) toxicity and the third was a three-year-old boy dead of fentanyl toxicity.The families of the 17-month-old and the three-year-old both had more than ten hotline calls and had open in-home cases at the time of the fatality.
Non-abuse homicide
By far the most common manner of death reviewed in this report was “non-abuse homicide,” or homicide that was not the result of child abuse. Such “non-abuse homicides” were one-third of all deaths reviewed; eight of the decedents were male and two were female. One victim was only six years old; the remainder were aged 13 and older. Nine of these deaths were caused by gunshot wounds and one was caused by stab wounds. One of the victims was in foster care with a relative at the time of his death. He had been removed from his home in 2015 due to abuse and neglect.
Natural Causes
Three fatalities, or 10 percent of the deaths included in the report, were due to natural causes. All of these children had congenital anomalies. They included a four-day-old girl and a three-year old boy who were both born prematurely and were medically fragile. Both of their families had open cases with CFSA. The three-year-old had been placed with a foster parent experienced in caring for medically fragile children after his mother was determined to have neglected him and was determined to be ill-equipped to care for a medically fragile child.
Accidental Deaths/Unsafe Sleep:
The manner of death was deemed to be accidental for six, or 21 percent of the deaths reviewed. Unsafe sleeping arrangements were involved in three of these six deaths of babies whose ages ranged from 19 days to two months old. In all of these cases, asphyxia was included as a cause of death. Of the remaining accidental deaths, two girls aged 16 and 17 died of opioid overdoses. Both deaths were part of a spate of fatalities in June 2021 that the police attributed to a tainted batch of fentanyl. The final accidental death was that of a four-year-old child who was hit by a car. An observer reported that he wandered away from his mother and two younger siblings before being hit.
Undetermined and unknown
Four of the fatalities were classified as undetermined because the autopsy findings were inconclusive. In one case, the mother left an 11-month-old and her four-year-old sibling sleeping alone in the home, and returned to find the baby unresponsive and foaming at the mouth. In a re-enactment using a doll, the mother demonstrated placing the child on her stomach with a bottle in her mouth in a way that could have impeded her breathing, but the medical examiner was unable to confirm asphyxia as a cause of the baby’s death. In the wake of the fatality, CFSA opened an in-home case to help the mother and her children. But that was not enough to save her three-year-old, who died within six months of opioid toxicity while the in-home case was still open, and was one of the three neglect homicide victims mentioned above. Unsafe sleep environments were involved in two of the other deaths for which the manner was undetermined.
The fourth death for which the manner was undetermined involved a twelve-year-old girl who reportedly collapsed after choking while eating soup. However, the hospital physician observed bruising on the child’s abdomen, back and legs, the mother was found to have abused her, and two siblings were removed from the home. The official cause of death was an untreated bacterial infection coupled with pneumonia but the manner could not be determined.
There were three deaths for which the manners were unknown. A seven-week old boy was reported missing by his father and is presumed dead. The mother was charged with suspected concealment or removal of the body and her other three children were removed from her. Unless there were two babies close to two months old who were reported missing in 2021 under the same circumstances, this is a case that received considerable media attention. The mother told the baby’s father that he had been removed by CFSA. Eventually she told police that she accidentally rolled over her son while under the influence of PCP, then panicked and threw his body into the trash. She was initially charged with murder but the charges were dropped as a body was never discovered. According to police, the mother was stabbed to death by the father in April 2022.
The remaining deaths for which the manner is unknown involved a newborn removed by Caesarian from a mother dying of Covid-19 and a seven-year-old who died in a house fire, for whom autopsy results are pending.
Decedents in Foster Care at TIme of Death
Two of the decedents were in foster care at the time they died. One was the eighteen-year-old who was living with a relative after being removed from his abusive mother, and who was the victim of a non-abuse gun violence homicide. The other victim was the medically fragile two-year-old, who was dependent on a gastrostomy tube and a tracheostomy vent, who died of natural causes and was living with a foster parent who specialized in caring for medically fragile children.
Family Risk Factors
The report provides some demographic information about the parents of the children who died, and that information is in line with research evidence that teen parenting, large families, and a parent’s history of maltreatment as a child are risk factors for child maltreatment. Parents of the children who died tended to be very young when they started having children. Sixty-nine percent of the mothers and 58 percent of the fathers were under age 21 at the birth of their first child. The youngest mother was 13 years old when she gave birth to her first child and the two youngest fathers were 16. Many of the dead children came from large families, which is more common among those who start having children at an early age. All but four of the 29 decedents had two or more siblings. Thirteen had four or more siblings; three had seven or more siblings, including two with 12 siblings and one with 10 siblings. A parent’s maltreatment history as a child is also known to be a risk factor; 13 of the 29 birth mothers had CFSA involvement as children, and both parents of two of the decedents were involved with CFSA involvement in their childhood.
Parents’ CFSA History as Caregivers
Nine of the 29 families reviewed in the report (or about a third) were involved with CFSA at the time of the fatality. Of these nine families, two had an open investigation and five had an open in-home case. Two had an open foster care case, but those are presumably the families of the two children who died while in foster care.
Table 7 shows that 10 families (or more than a third of the 29 families) had CFSA involvement within 12 months of the fatality – only one more family than was involved at the time of the fatality. It appears that all of them had an investigation within that period. However, with fewer families reported to have an in-home or foster care case than in Table 6, there must be some errors in the data; CFSA has not yet responded to a request for clarification.3
Looking at the 17 families that did not have CFSA involvement at the time of the fatality (Figure K in the report)4 CFSA found that the time since they were involved varied from 1 to 56 months, and that 11 of these 17 families (65 percent) were last involved with CFSA more than 18 months before the fatality.
As shown in Figure J, the majority of the families had four or more reports to the hotline (known as referrals) during the five years preceding the fatality. Many of these reports were screened out, as shown in Figure Q. All but 4 of the 29 families had referrals that were screened out during the five-year-review period and ten of those families had five or more referrals screened out.
Table 8 summarizes the results of the reports received regarding these families. The large majority of these families (23 families or 79 percent of families) were investigated at least once , with an additional 6 families investigated twice. Twelve families (41 percent of families) had in-home cases within five years of the fatalities, with eight having one case, three having two cases, and one having three cases.5,6
Figure L in the report (not reproduced here) shows that 16 families, or slightly more than half of the families, had at least one substantiated allegation in the five years before the fatality. Ten of these families had only one substantiation and the remaining families had between one and four substantiated allegations. The most common substantiated allegations were inadequate supervision and educational neglect (four families each), followed by physical abuse, failure to protect, medical neglect and indadequate food/clothing/hygiene (three families each).
“4+ Staffings“
One CFSA practice that is designed to prevent further harm to children known to the system is the “4+ Staffing.” CFSA conducts these meetings for families that have four or more referrals, with the last referral occurring within the past 12 months. These staffings are supposed to uncover gaps in past practice or service delivery that may have contributed to the repeated maltreatment and to find strategies to prevent future maltreatment. In the 2020 CFR report, CFSA stated that of the decedents’ families who had qualified for such a staffing during the five years before the fatality, all had received a 4+ Staffing. Clearly, this figure casts doubt on the effectiveness of these staffings. Unfortunately, the analogous section of the current report appears to focus on the percentage of eligible families that received a 4+ staffing after the fatality, a fact that is less relevant to the purpose of CFR.7
Siblings removed after child fatalities
A new report section states that 11 children were removed from four families in the wake of the child fatalities reviewed in the report.
After an 11-month old girl was left alone with a four-year-old sibling and a propped bottle, the agency opened an in-home case for the family. But when her three-year old brother died of fentanyl intoxication within six months of his sister’s death, the other children were removed and placed with kin. At the time of the writing of the report, their goal was reunification with the parent, who was said to be “receiving services, including grief counseling for the loss of more than one child within a short time frame, as well as substance use and housing.”
The siblings of the 12-year-old girl who died of an untreated bacterial infection but also had signs of physical abuse have already been returned home. CFSA states that the mother and children have received mental health services and the mother has completed court-ordered parenting education.
Of the three siblings of the infant boy who disappeared, one child was with her father at the time of the report’s being written and the other two were placed in foster care with a goal of reunification.7
The 17-month-old who was scalded to death had four siblings, ranging in age from five months to twelve years old, who were all removed from the mother in the aftermath of the toddler’s death. Two were placed with kin and two in a mysteriously named “non-foster care placement,” which probably connotes placement with kin outside the foster care system. There is no mention of reunification; perhaps this case qualified for the exemption from reunification that is allowed under certain aggravated circumstances.8
CFSA’s Findingsand Recommendations
In its Summary of Critical Findings, the CFR report discusses specific areas that received “additional focus” in 2021, including screened-out referrals. Concerns about the accuracy of hotline decision-making have been expressed in the District and around the country. In a 2016 study, conducted by the Center for the Study of Social Policy, the court monitor in the LaShawn class action suit, reviewers disagreed with CFSA’s decision to screen out the referral in 27 percent of the referrals studied. However, the report does not suggest any review of policy or practice in screening out referrals. Instead, it cites the “prevention services” provided by the collaboratives and the family success centers. The report also devoted special focus to families involved with CFSA at the time of the fatality, unsafe sleep fatalities, and gun violence, but the report makes no suggestions about how to avoid such fatalities involving these factors.
Based on its fatality reviews, CFSA’s ICFR Committee approved three recommendations: revision of the critical event and child fatality review policies, integration of child fatality review data into the new computerized case management database currently being developed, and finalizing a Memorandum of Understanding with DC Health “to provide monthly data on applicable fatalities to CFSA to facilitate the timely review of child fatalities.” It is notable that all these recommendations address the child fatality review process itself. There are no recommendations for changes in policy or practice related to screening, investigations, or services. It is also significant that the following language about the purpose of ICFR recommendations which was included in the 2020 report does not appear in this one: “The CFSA ICFR committee makes recommendations concerning appropriate actions that may possibly avert future fatalities.” Perhaps this language was deleted because none of this year’s recommendations are aimed at averting future fatalities, just about amending the fatality review process.
Conclusions
It is important to remember why we study child fatalities. These tragic deaths are the tip of an iceberg – the visible consequence of recurring abuse and neglect after at least one incident of alleged maltreatment was reported to the agency. When a child remains in the home after services end, we may not know that maltreatment has continued unless the child dies. Some children known to CFSA die for causes that are not related to abuse and neglect, like the newborn delivered early from the mother dying of COVID-19, or the three children with congenital abnormalities who died of natural causes. But research shows that simply having a report of child maltreatment increases the risk of deaths from all causes, not just abuse or neglect. Thus, many of the fatalities included in the report may be a consequence of ongoing maltreatment, even if the manner of death was not found to be maltreatment.
Some of the deaths with a manner labeled as accidental or unknown may have been due to neglect, like some of the eight babies who died while sleeping in unsafe arrangements. In total, CFSA reported that unsafe sleep factors were present in eight of the 10 deaths to children aged two or under. In my years of service on the citywide Child Fatality Review Committee,1 I have seen numerous cases of children dying in unsafe sleep environments in families with histories of child welfare involvement. Almost invariably, the parents have used marijuana, alcohol or other intoxicants before lying down with the baby, and they failed to wake up as their children struggled to breathe. With unimpaired parents, these sleeping arrangements might not result in death. This is why a study found that adjusting for risk factors at birth (including low birth weight and late or absent prenatal care), the rate of Sudden Unexplained Infant Death (SUID) was more than three times greater among infants who had been previously reported for past maltreatment than among infants who had not been reported.
And then there are the ten deaths from “non-abuse homicide.” The connection between child maltreatment and violent death became obvious to me soon after I started sitting on the citywide Child Fatality Review Committee. I learned that many young victims of homicide grew up in families with long histories of reports to CFSA regarding lack of supervision, school absences, physical abuse and other concerns. In some cases CFSA screened out the reports or found no maltreatment; in other cases services were provided. But the maltreatment continued. Many of these families exhibited chronic child neglect, which occurs “when a caregiver repeatedly fails to meet a child’s basic physical, developmental, and/or emotional needs over time.” Many of these children, with histories of trauma and little support at home or connection to school, eventually found belonging in the streets and took up violent and illegal activities.
Of course, we do not know how many of the gun violence victims included in this report came from abusive or neglectful homes or were involved in violence themselves. But according to police reports, motives for five of the nine homicides included retaliation for robbery and gang-related activities, implying the victims were involved with such activities. Relatives of the 18-year-old female victim of another homicide indicated that she was involved in a “volatile” relationship with her killer. The six-year-old whose death is reviewed here was obviously an innocent bystander. But she was shot while walking to a liquor store with her parents late on a Friday night. And federal prosecutors stated that the father of the six-year-old shot on July 16, 2021 was involved in the violent drug trade on the street where his daughter was shot, and the judge indicated that he did not understand what the child was doing in that area at 11:00 PM.
The four-year-old who was hit by a car when he wandered away from his mother might also be a victim of neglect, but we do not know because no case details are provided in this report. And as for the teenage girls dead from tainted fentanyl, we will never know what kind of home environment they had and if that contributed to their drug use. But the connection between childhood maltreatment and later substance abuse is well-known.
Of course CFSA understands the linkage between abuse and neglect and all causes of death. That’s why it studies all deaths of children known in the past five years, not just those due to maltreatment. CFSA had many opportunities to intervene in the lives of the 29 children discussed in the report and their families. Nine of the families were involved with CFSA at the time of the fatality. Ten of the families were involved with CFSA within a year of the fatality. Within five years of the fatality, 25 of the families had at least one screened-out report, 23 of the families had at least one investigation, and 12 of the families had at least one in-home case.
Obviously it is concerning that two fatalities occurred in families that were being investigated by CFSA and five occurred in families that had an open in-home case, In which a CFSA worker is expected to visit a family from weekly or twice a month, depending on its perceived need. One has to wonder whether any red flags were missed by the workers who were investigating or monitoring these families. Among the families that had an open in-home case at the time of the fatality were the families of both the 17-month-old and the three-year-old who died of synthetic opioid toxicity. One cannot help wondering how frequently and thoroughly the in-home workers interacted with the families, without noticing that the parents were still using opioids. Nobody wants to remove more children, but perhaps they needed to be removed, and some of these children may have had a protective relative ready and eager to receive them.
I do not mean to say that CFSA could have saved all of the children that they touched who later died. But perhaps it could have prevented some of these deaths. The agency could have chosen to devote special attention to parents who were very young when they started childbearing, families with many children, and parents who were involved with CFSA as children. It could have screened in more referrals, substantiated more allegations, opened more cases, monitored families more effectively, provided more intensive and effective services, or involved the court in more in-home cases. And if necessary it could have removed more children, preferably to a protective relative or other known adult.
The total of 29 children who were known by the end of 2021 to have died after being touched in some way by CFSA will certainly rise as more fatalities are identified and reviewed. (The total for 2020 is 40 so far.) But if present practices continue, the remaining fatalities will not be included in an annual report, except for one or two tables in the appendix. Therefore, the annual reports understate the number of children who died after being touched by CFSA. Strangely, the report authors do not seem to understand the significance of the smaller universe, making comments like “There was a decrease in total infant fatalities in 2021.” That decrease, from 16 to 10, may not mean much when the total number of fatalities reviewed was 29 instead of 40.
It is concerning that all of the report’s recommendations concern the practice of fatality review itself. There are no recommendations to improve CFSA’s practice in conducting the hotline, investigations and in-home and foster care cases. It is hard to avoid thinking that CFSA’s ideology of non-intervention and family preservation has contributed to both these deaths and the lack of recommendations aimed at preventing such deaths in the future. No child welfare agency has a crystal ball. They all have to strike a balance between the harms caused by intervening in families where there is no maltreatment and not intervening in maltreating families. But CFSA has declared its preference clearly. As stated in the report, “For over a decade, CFSA has invested in safely keeping families together and developing robust prevention strategies to help support them.” But these “robust prevention strategies” were not enough to protect the children who died in 2021. For CFSA, these deaths may simply be collateral damage.
The information about the siblings who were removed from their families after the fatalities – a new addition to the report – is quite disturbing. The idea that the agency is still working for reunification with the mother who lost two children in one year – one left alone with a four-year-old and a propped bottle and the other poisoned by fentanyl – and had ten hotline reports in the five preceding years is concerning. And that the siblings of the abused child who died of a bacterial infection are back with their mother after she received mental health services and parenting education is concerning as well. But it is not clear what CFSA could have done differently without action from the DC Council. The DC Code requires CFSA to make “reasonable efforts” to reunify children with their families except in certain aggravating circumstances which probably would not have been found in these cases.9
As always, CFSA’sinternal child fatality report is distressing. It includes two deaths in one year to the same family, ten non-abuse homicides, several deaths involving unsafe sleep, and two high-profile child deaths: an infant whose body was disposed of by the mother and a six-year-old who was killed as part of a drug war involving her father. We learned of four deaths – two of small children and two of teenagers – involving the new scourge of fentanyl and other synthetic opioids. CFSA has made the decision to avoid intervention and prioritize family preservation above child safety, and the report contains no recommendations for improving the agency’s efforts to spot and address abuse and neglect. If CFSA is not going to make any recommendations to protect children in the CFR report, then one might question the report’s purpose and utility.
Notes
It is important to distinguish CFSA’s internal child fatality reports from the annual reports of the citywide Child Fatality Review Team, which covers all deaths of young people up to age 18 and some deaths of those aged 19-21.
‘Manner of death” refers to the circumstances that caused the death, as opposed to “cause of death,” which refers to the specific disease or injury that led to the death.
It is also unclear why only one child is counted as having a foster care case since two of the children were in care at time of death.
This count of 17 families that did not have CFSA involvement at the time of the fatality is inconsistent with Table 6 and the associated text, which says that 20 families did not have active CFSA involvement at the time of the fatality.
The heading “Reports” in this table is confusing but I have followed the lead of CFSA in describing the Table’s data and am awaiting clarification from the agency.
Family assessments were an alternative to an investigation for low-risk cases, and are no longer being used by CFSA.
I have asked CFSA to clarify the meaning of their data on families that received a 4+ staffing but have not received an answer as of the date of this publication.
If this is indeed the case referred to earlier, this reunification will not take place as the mother has been killed by the baby’s father. It is possible that the oldest daughter’s father is a different person and that she can remain with him.
Until 2019, CFSA’s internal child fatality reports covered the agency’s reviews of all fatalities of children whose families were known to the agency within five years of their death. This is normal for child fatality review panels, which often have a long time lag before reviewing a case. But in 2019, ICFR decided to include in its review only the deaths that actually occurred in the year they were reviewed. As I have described, one problem with that approach is that it is clearly impossible to review all deaths that occurred in a given calendar year during that same year. Deaths that occur or become known near the end of the year clearly cannot be reviewed during that same year. Perhaps as a result of that realization, the CFR Unit included in the 2020 child fatality report those child deaths that occurred in 2020 and were reviewed during the same year or in the first three months of CY 2021. That decision gave them a total of 40 cases that were included in the report. However, this year, CFSA, as in 2019, including only the cases reviewed during the calendar year, missing any cases that were reviewed in the first quarter of 2022 or later. This is particularly strange because this report was released so much later than the last report with respect to the calendar year reported on – January 2023 as opposed to October 2021. So they had more time, not less, to include an extra quarter of reviews.
There is another problem with limiting reviews to the current calendar year, which is that deaths occurring in earlier years are missed. In Appendix A and B, the ICFR reports that it actually reviewed 51 deaths in 2021. Thirteen of these deaths occurred in CY 2020 and were apparently reviewed in the first quarter of 2021 and included in the 2020 report. However another 14 fatalities that occurred during 2018 and 2019 were presented to the ICFR committee during 2021 but not included in the report. These fatalities were never included in previous analyses, nor will they be included in the future, so most of the information on these fatalities will never be released to the public, aside from some demographic and cause and manner of death data provided in Appendix C.
There is also an internal inconsistency between the 2021 report and the appendices. The report contains reviews of 29 cases. Appendix A states that “the ICFR Committee reviewed 51 fatalities during CY 2021; all 51 fatalities helped to inform practice and policy recommendations that potentially reduce future child fatalities.” It states that 13 of these fatalities occurred in 2020 and were included in the previous report, and another 14 of these fatalities occurred in 2018 and 2019. That means that out of the 51 fatalities reviewed in 2021, only 24 (51 minus 27) occurred in 2021. Yet, the 2021 analysis includes 29 fatalities. I have asked CFSA about the discrepancy but have not received an answer as of the date of publishing this commentary.
Good morning! Thank you for the opportunity to testify today. My name is Marie Cohen and I write the blogs Child Welfare Monitor and Child Welfare Monitor DC. After my first career as a policy analyst and researcher, I became a social worker and served in the District’s child welfare system until 2015. Soon after leaving that job, I began writing these blogs to share some of the insights I had gained from my time in the field, and I’ve been amazed to see both of my blogs acquiring readers and influence beyond my wildest dreams. I take a child-centered approach, placing the safety and wellbeing of the child above all other considerations. I also take a particular interest in translating academic research for a lay audience and exposing misinterpretations of research by those trying to support their point of view. In my testimony today, I’ll start by talking about CFSA’s performance in child protective services, then continue with in-home services and then foster care. In conclusion, I’ll explain why I fear that CFSA is losing interest in these core services in its desire to become a “child and family well-being agency” and why I hope that the Council will encourage a renewed focus on CFSA’s primary mission.
My testimony draws from several sources. First, I have used recent CFSA reports including the FY 2021 Needs Assessmentand the performance oversight responses recently submitted to the Committee, as well as the CFSA Data Dashboard. I also share some insights from my service on the Child Fatality Review Committee and as a mentor through BEST Kids for almost seven years. Finally, I draw from the national research and policy trends I that I review for my blog.
CFSA has had some successes in the past year. The agency has returned to a mostly normal service posture after the pandemic-induced transition to virtual services. It has found a creative way to claim federal funds for case management and improved one service for families with substance abuse by bringing it in-house. The agency is increasing the number of professional foster parents, though not by enough so far, and the menu of therapeutic services available to foster youths and their parents through a contract with MBI. It has used federal funds to add four new staff members to work with schools and families to reduce school absences due to educational neglect. But CFSA is still falling short on meeting its primary missions of keeping District children safe and providing a physically and emotionally safe haven for those children who must be removed from their homes.
Child Protective Services: CFSA’s primary mission of protecting children has suffered as the agency has continued to emphasize narrowing the front door.
CFSA often boasts about the drop in the foster care rolls, which have fallen from over 1500 on September 30, 2012 to only 614 on September 30, 2021, crediting its policy pillar of “Narrowing the Front Door.” But a drop in foster care numbers is not in itself a positive outcome unless it has been achieved without compromising the safety of children. The choice of “Narrowing the Front Door” rather than “Keeping Children Safe” as the first pillar is not accidental: the goal has become reducing foster care regardless of the impact on child safety. Moreover, CFSA is no longer serving more children in their homes as they place fewer children in foster care; the number of children receiving in-home services has also fallen since 2019, with the total number of children served decreasing from 1994 at the end of FY 2020 to 1904 at the end of FY 2021.
My service on the Child Fatality Review Committee (on which I am thankful to have been joined by Chairperson Nadeau), has revealed many occasions in which CFSA missed chances to protect some of our most at-risk children. I have reviewed death after death of children from families that were the subject of multiple reports to the CFSA hotline dating back many years. Yet these allegations were repeatedly screened out or not substantiated by the agency. CFSA needs to assess the operations of its hotline and investigations, which have both been criticized by the Court Monitor in the past, to make sure that its desire to narrow the front door is not outweighing the concern for child safety. But there is also something the Council can do. I have noticed that many children who later died were at some point assessed to be at high risk but were left after an investigation with no support or monitoring by CFSA. When I ask why, I am reminded that CFSA cannot open a case if abuse or neglect was not substantiated, no matter how risky the situation appears to be. So whether we can protect a child depends on whether harm has already occurred, not whether it is likely to occur. But not all jurisdictions require substantiation in order to open a case for in-home services or foster care. In Washington State, an allegation does not need to be substantiated for an agency to file a neglect petition in court; the purpose of filing a petition is to “prevent harm” and there is no need to prove that harm already occurred. In Michigan and Minnesota, a case can be opened or a child removed because of “threatened harm,” which can be substantiated as a type of maltreatment. I hope the Council will consider changing DC law to make it possible for CFSA to protect at-risk children before it is too late, even without a substantiated allegation.
In-home services: Services provided through CFSA’s Prevention Services Plan are reaching few people and wasting funds, at the same time as CFSA is failing to provide families with needed behavioral health and other services.
The Family First Prevention Services Act allows CFSA to spend Title IV-E funds for evidence-based family preservation or reunification services to prevent entry or re-entry to foster care. However, only evidence-based practices (EBP) that are approved by the Children’s Bureau’s Prevention Services Clearinghouse can receive federal reimbursement. Currently, the only services receiving Title IV-E funding from HHS are Motivational Interviewing, which is part of CFSA’s case management model, and a home visiting program called Parents as Teachers (PAT) that is run by the Health Department. The other services included in CFSA’s Prevention Plan are funded by Medicaid or other local sources.
CFSA deserves credit for realizing that one practice that is reimbursable under Family First, motivational interviewing, could be incorporated into case management, thus allowing CFSA to collect matching funds for case management for all families receiving services in their homes. This was a creative way to claiming federal funds despite the flaws of the Family First Act, under which has not brought about the promised bonanza of federal resources for family preservation services. I also applaud the agency for improving the performance of Project Connect since they brought the program in-house. Project Connect provides intensive home-based services to families with an in-home case who are addressing substance abuse. When provided by a contractor, Project Connect struggled to enroll families, but now that it is operated by CFSA, the agency reports that the program has been at capacity since January 2020. The agency reports 46 families served, and 26 cases closed, with 9 families having disengaged and 17 having completed the program in FY 2021. Of course the longer-term outcomes of the program in terms of sobriety and child maltreatment remain to be seen and I hope CFSA will be reporting on them.
But the other services provided in CFSA’s Prevention Services Plan are reaching few people. According to the FY 2021 Needs Assessment, only 8% of the families referred to DBH received services. Similarly, only 8% of clients referred to the Department of Health home visiting programs, Parents as Teachers and Healthy Families America (HFA, the other DOH-run home-visiting program,) received services. Most of these referrals were either rejected as not appropriate or withdrawn because the family did not engage. According to CFSA’s oversight responses, CFSA referred 159 families to Mary’s Center for home visiting services through the HFA and PAT models in FY 2021, but only 26 of these families were served. CFSA paid over $160,000 to Mary’s Center to provide PAT in 2021; we don’t know how many of the 26 families received PAT or completed the program, since data on PAT and HFA are combined. Several other programs included in the prevention plan served between 0 and 4 families, according to the oversight responses.
At the same time as CFSA was paying $160,000 to enroll 26 families in PAT, parents and children who wanted basic behavioral health services such as cognitive-behavioral therapy and medication management could not get them because of the crisis in the District’s mental health system that affects all residents who must rely on Medicaid to access services. I hope the Council addresses this crisis. But regardless, there is no gain in accessing federal money to serve no-one. CFSA might as well spend this money on services families need, whether or not they are approved for Title IV-E funding.
Another set of services that is sorely needed for CFSA families are services to address domestic violence. According to CFSA’s 2021 Needs Assessment, of 123 child welfare professionals, the largest percentage (64%) ranked domestic violence (DV) as a prevalent risk factor among their clients. It is encouraging that the 2021 Quality Services Reviewers found three-quarters of the families with DV in in-home cases were receiving services. But some of these services were provided by the CFSA social worker themselves, presumably because services were not available. Moreover, the reviewers found that accessing the agency’s one DV specialist for consultation was a challenge for social workers and that case managers for only six of the 16 families reviewed were able to obtain such a consultation. I hope that the Committee will choose to add funding for at least one more DV specialist to make sure that caseworkers can benefit from a real expert to determine what their clients need and link them with services. The Needs Assessment also indicates that there is a general shortage of DV services in the District, which I hope the Council will address.
Early care and education is one service which has great potential to prevent maltreatment recurrence among families with in-home cases, but has been largely ignored by CFSA. Guaranteeing a slot in a high-quality preschool like Educare in Ward 7 for every preschool-aged child involved in an in-home case might do more to prevent child abuse and neglect than any other single strategy. We know that high-quality early care and education prevents child abuse and neglect by multiple pathways: easing parental stress, providing family support and parenting education, increasing monitoring by mandatory reporters (at Educare children are checked for abuse daily), and simply reducing the amount of time a child is alone with caregivers and vulnerable to abuse. And indeed, multiple studies link early care and education with reductions in child maltreatment. I hope the Committee will work with CFSA, the Mayor and OSSE to ensure that all children with in-home cases receive high-quality early care and education.
Foster care is not yet a truly safe haven where youth in CFSA custody can heal from past trauma and address educational deficits.
When CFSA takes the drastic step of removing a child from their home, it has the obligation to make sure the child is placed together with siblings, in the home of either a known relative or family friend if possible, and with all the necessary supports, including mental health services, the best healthcare (including covid-19 vaccines) and educational and vocational supports. And whenever reunification is not possible, CFSA should stop at nothing to support permanency with real or fictive kin. But CFSA is falling short in these areas. Often agency leaders seem to lack the creativity, passion, and outside-the-box thinking that is necessary to make foster care the safe haven that CFSA advertises.
Foster care: CFSA continues to lack appropriate placements for older youth and those with significant behavioral health needs.
The lack of suitable placements for older youth and those with more serious behavioral health needs continues to be a crisis leading to placement disruptions, abscondence, and further deterioration in the mental health of our most vulnerable youth. This issue has been covered in depth the Children’s Law Center in their written testimony. In general, I agree with their findings and recommendations on building an adequate placement array but I would add that CFSA may have to consider adding one or more therapeutic group homes as well as increasing its supply of professional foster parents. There are simply not many potential foster parents who are dedicated and gifted enough to take on these very challenging young people.
Too few foster youth are receiving the behavioral health services they need.
Only 18 children were receiving therapy at CFSA in the first quarter of FY 2022, out of the 600+ children in foster care, according to CFSA’s oversight responses. That means CFSA’s four in-house therapists are being paid to provide therapy to only 18 children, so that each therapist is seeing fewer than five children a week. CFSA did not report on the number of children receiving therapy outside of the agency, but the low number receiving in-house therapy is concerning. Moreover, according to the 2021 Needs Assessment, the percentage of children recommended for therapy who received it went down from 69% in FY 2020 to 40% in the first half of FY 2021. I understand there is a citywide crisis in mental health services, with a catastrophic shortage of providers, not to mention quality, cultural competence and turnover, as the Children’s Law Center explains in its written testimony. I join the CLC in urging that this Committee work with the Committee on Health and the rest of the Council to fix the District’s behavioral health system. However, until this reform can take place, CFSA must not waste the resources it has allocated for behavioral health for its foster care youth.
I do appreciate, however, that CFSA has added two popular evidence-based therapeutic modalities – Dialectical Behavior Therapy (DBT) and Eye Movement Rapid Desensitization Therapy (EMDR) – through its contract with MBI Health. And I’m also happy that CFSA has included parents of children in foster care in its contract with MBI. However, I’m disappointed that MBI served only 16 of the 28 children and parents referred during FY 2020.
CFSA needs to find creative housing solutions to keep siblings together in foster care and to enable children to be placed with kin in foster care, guardianship or adoption.
According to the 2021 Needs Assessment, the Agency has only 50 licensed providers to care for three or more children in foster care. However, there are 194 foster children in a family of three or more siblings, which indicates the need for more foster parents with the capacity and willingness to take groups of three or more siblings. CFSA should look for creative, out-of-the box ideas tor increasing placements for sibling groups. For example, CFSA could seek a public-private partnership to create a community of homes for foster parents who take in large sibling groups, in the mode of SOS Children’s Villages in Illinois and Florida. Perhaps this could be included as part of a development plan for a parcel owned by the city.
CFSA also needs to be more creative and proactive in finding housing for relatives who want to take in children who have been removed from their families, temporarily or permanently. CFSA’s oversight responses state what we already know: “For DC-based kin, the ongoing lack of affordable housing in the District continues to impact the families’ ability and/or willingness to provide licensed kinship care.” And it’s not just kinship care but also permanency. I recently heard of a teenager being pressured to accept guardianship with a foster parent with whom she is not bonded, even though a relative is willing and available but has been unable to find suitable housing. This is unacceptable. As it did with Wayne Place for youths leaving foster care, CFSA should work with the private sector to create housing for relatives who are providing a home for children in foster care – housing like Plaza West, a building for grandparents raising children that was created without CFSA involvement. It is not acceptable to force children into guardianship with unrelated foster parents because relatives cannot find housing.
CFSA is not making sufficient efforts to ensure educational success for foster youth.
Education outcomes for District foster youth are truly horrendous. Foster youth aged 15-21 for whom Grade Point Average (GPA) information was available had a median GPA of 1.98 in the last academic year, according to the oversight responses. And only 68% of the foster youth who were eligible to graduate high school in June 2021 graduated or got a GED by that date. The blame for this abysmal school performance should not be placed entirely on CFSA: most of these children were probably struggling academically when they were removed from home. After all, many of these children came into foster care with a history of chronic absenteeism and school transfers. But if CFSA is going to remove children, it needs to take responsibility for improving their educational performance regardless of what it was before.
There are some things CFSA can do to improve educational performance among foster youth that have drawn little attention. For one, CFSA needs to make sure that foster parents are involved with the schools that the children in their custody attend. It is well-known that home-school communication is critical to school success. But when I was a social worker at a private agency working with Maryland foster parents of CFSA youth, many foster parents I worked with had never even been to the children’s schools, especially when these schools were in the District. They certainly did not attend Back to School Nights and parent-teacher conferences. Foster parents should be told that attendance at these events and regular communication with the schools is required. Secondly, CFSA needs to end the practice of pulling kids out of school for a whole day in order to attend one medical, dental, or court appointment. When I was working in the system, I found that family support workers usually made appointments during school hours because they were busy after school taking youths to family visits or therapy. For the same reason, they usually made these appointments in the middle of the day, ensuring the maximum loss of school time. Requiring foster parents to take children to these appointments might help solve this problem; it should clearly be their job anyway. These two steps, requiring foster parent involvement and stopping system-caused school absenteeism, would be a good place to start in improving foster children’s school performance. Monitoring the performance of the tutoring provider is another; I’ve heard too much over the years about incompetent tutors.
OYE Vocational specialists must be replaced.
The 2022 Needs Assessment states “CFSA has identified a gap for career preparation and available employment supports for youths.” That’s putting it mildly! In FY 2019 CFSA eliminated OYE’s Career Pathways unit and replaced it with the LifeSet program, which is not dedicated to career preparation or staffed with vocational specialists. There are no vocational training specialists at CFSA, only college specialists. As a result, there are NO youth currently enrolled in vocational training programs, according to the 2022 oversight responses. Around the country and here In the District there is a growing recognition that college is not for everyone, especially for those who are not likely to complete it. Many jobs requiring vocational training or apprenticeships provide a path into the middle class and a much better option than college for youths with poor academic skills. At this time of unprecedented labor shortages, it is a shame that the agency is not taking advantage of this opportunity to get our young people into good jobs. In the Needs Assessment CFSA indicates it is working with the Department of Employment Services to address this gap; the Committee should encourage the agency to address it with the urgency and intensity it deserves.
CFSA has neglected its responsibility get foster youth vaccinated
As I have written, CFSA seems to be prioritizing parental consent, even when not required by law, over the health of foster children and containment of Covid-19 in the District of Columbia. Moreover, it appears that the agency been reluctant to educate older foster youth about the benefits of vaccines. They don’t even know how many foster children have been vaccinated. And they have not reported how many have gotten Covid-19. This is not acceptable.
Conclusion: CFSA appears to have lost interest in its primary mission of protecting abused and neglect children.
In conclusion, CFSA continues to struggle to carry out its primary mandates of investigating allegations of abuse and neglect and responding appropriately with in-home supervision and support and foster care when necessary. Yet, despite these struggles, CFSA is eager to add more responsibilities to its plate. As the agency explains in its oversight responses, it wants to “transform from a child welfare system to a child and family well-being system.” This sounds great on first hearing but does not bear closer scrutiny. Child and family well-being are dependent on all the health, education and human services agencies in the District of Columbia. CFSA is having enough trouble accessing the services of these agencies for its current clients. Why not concentrate on performing its core duties rather than expanding them? I must acknowledge that CFSA is being encouraged on this misguided path by the federal Children’s Bureau, which has included the agency in its partnership to do exactly what CFSA is proposing. But just because it is being promulgated by the feds does not make it a wise policy.
The expansion into primary prevention through creation of the Family Success Centers is a prime example of this desire to broaden CFSA’s mission when the agency struggles to perform its core responsibilities adequately. Prevention of child maltreatment is not in the original mandate of child welfare agencies, and for good reason. If anything, child maltreatment prevention is normally conceptualized as a public health function, which is why home visiting programs are generally provided by health departments. More and more jurisdictions, including our neighbors in Maryland and specifically Baltimore, are investing in Family Connects, which provides a hospital visit from a nurse to every newborn to assess risk and refer to appropriate services. Family Connects has been shown by randomized controlled trials to reduce emergency room visits and hospital stays by 50% in the first year of life and CPS investigations by 44% in the first two years of life. The jurisdictions that have adopted Family Connects understand that neighborhood family support centers will never reach the most at-risk children, whose parents are too mentally ill, impaired by drugs, or overwhelmed to recognize that they need help.
I have some ideas about why CFSA (and the Children’s Bureau for that matter) appears to have lost interest in its core mandate of protecting children and providing a safe haven for those who must be removed from their homes. But until we figure out how to prevent child maltreatment, and even after we do, there will still be maltreated children who need to be protected. CFSA may have lost interest in these duties, but it is up to the Committee and the entire Council to remember our most vulnerable children and make sure the agency performs its core mandates.
CFSA’s Internal Child Fatality Report for 2020 was released on October 27, 2021. It provides information on 40 deaths of children and young adults whose families were known to CFSA within five years of their deaths. The report shows that most of these families had been reported to CFSA multiple times in the past five years. Many of them had experienced investigations and received CFSA services through in-home and foster care cases. Despite these interventions, these children had died within five years of CFSA’s ending its involvement. The report contains the lessons that CFSA drew from these deaths, but a careful reading suggests that the agency has not taken full advantage of this opportunity to improve future practice. Moreover, the report does not provide the information that interested readers need to make their own conclusions about agency practices and needed changes.
CFSA’s internal fatality report is different from the annual report of the citywide Child Fatality Review Team, which covers all deaths of young people up to age 18 and some deaths of those aged 19-21. The CFSA report focuses on fatalities of young people up to age 24 whose families were known to the agency within five years of their deaths. These fatalities are reviewed by the agency’s Internal Child Fatality Review (ICFR) Committee, and this report summarizes the results. As the report explains, the internal fatality review process “is one of CFSA’s strategies for examining and strengthening child protection. It provides the Agency with specific information that helps to address areas in need of improvement and to identify any systemic factors that require citywide attention – all with the goal of reducing preventable child deaths.”
The 2020 child fatality report includes only those child deaths that occurred during Calendar Year (CY) 2020 and were reviewed by the ICFR Committee during 2020 or in the first three months of CY 2021. An additional fifteen deaths that occurred in CY 2018 and CY 2019 but were reviewed in CY 2020 are summarized briefly in an appendix but are not included in the narrative and data charts provided in the body of the report. I discussed this timing issue in depth last year, when the report excluded half of the deaths reviewed during 2019. This year CFSA has improved the coverage of its report, at least in part by including cases reviewed up to March 31 of 2021: this report includes 40 (or 72 percent) of the 55 deaths reviewed between January 1, 2020 and March 31, 2021. But it is still hard to understand the purpose of leaving out more than a quarter of the deaths reviewed during the period covered by the report. All of these deaths took place in 2018 and 2019, not many years in the past. The report states that the ICFR Committee reviewed these earlier cases “as part of its internal continuous quality improvement (CQI) efforts,” but also that “[i]n line with CFSA’s CQI efforts and based on the known fatalities that occurred during CY 2020, ICFR Committee members made practice recommendations to potentially help reduce future child fatalities.” So it appears that the 15 fatalities from 2018 and 2019 were reviewed as part of CQI, but were not used to develop recommendations, which is the main purpose of CQI! Leaving out these cases accomplished nothing but giving the committee a smaller group of cases upon which to make recommendations and reducing the amount of information available to the public in the annual report.
Manner of Death
The manners of death* of the 40 children whose cases are included in the body of the report are displayed in the pie chart below. Half of these children were victims of “non-abuse homicide;” nine (or 22 percent) died of natural causes; five (or 12 percent) died in accidents; three (or seven percent) died because of abuse or neglect; and one died by suicide. The other two children’s manners of death were “undetermined” and “unknown.” While children who die from abuse and neglect after having previous contact with child welfare draw the most public concern, research shows that children who have prior contact with child welfare also tend to die more often from all causes than children with no such involvement, as I discussed in my post, Report of maltreatment: a major risk factor for child mortality.
Abuse and neglect homicides of children known to CFSA often draw public concern because the agency’s primary role is to protect children from abuse and neglect. But they are a small proportion of the deaths to children who were involved with CFSA in the past five years. Three, or seven percent of the deaths reviewed in this report, were abuse or neglect homicides. The ICFR Committee also reviewed one abuse or neglect homicide that occurred in 2018 or 2019 and is addressed only in the appendix to the report. We know nothing about this case, not even whether the death was caused by abuse or by neglect. The two abuse homicides that occurred in 2020 were young children who died by blunt force trauma. The information provided suggests that the 11-month-old was Makenzie Anderson. Shortly after Makenzie’s death Petula Dvorak reported in the Washington Post that other residents of the Quality Inn that was then serving as a shelter for homeless families knew that Makenzie was in danger. But CFSA refused to disclose whether anyone had reported their concerns to the hotline. This report tells us that somebody, sometime, did report their concerns about Makenzie’s family, but that is all it reveals.
Given what is publicly known, the other abuse homicide discussed in the report – a two-year-old African-American male who died from multiple blunt force injuries – was probably Gabriel Eason, who died on April 1, 2020. An autopsy showed old and new injuries to Gabriel’s body, including swelling of the head and brain, abrasions and contusions to the head and torso; lacerations of the kidney and liver; injuries to the heart and vena cava; cuts on the face and neck; blunt trauma to the genitals; and 36 rib fractures. We know that Gabriel’s childcare center called the CFSA hotline on October 9, 2019, six months before he died, but we do not know what action CFSA took or if there were other calls. Unfortunately this report does not tell us anything new.
The neglect homicide included in the report involved a seven-year-old African-American boy killed in a car accident. The child and his younger siblings were passengers in a car driven by their mother in a long drive back to the District from another jurisdiction. None of the children were in car seats and the mother had alcohol in her system. The mother was charged with first-degree vehicular homicide, seatbelt violations, and driving under the influence. She was taken into custody and the remaining children were placed with relatives. The report does not tell us when and how often CFSA received reports in this family or how the agency responded.
Gun Violence
By far the most common manner of death for fatalities reviewed in this report was “non-abuse homicide,” or homicide that was not the result of child abuse or neglect. Such “non-abuse homicides” were half of all deaths reviewed, and all 20 of these deaths were caused by gun violence. Unlike in cases of abuse homicide, the media rarely asks about the history of gun violence victims with CFSA. However, the connection between child welfare history and gun violence death became obvious to me as soon as I started sitting on the citywide Child Fatality Review Committee. I learned that many of the young victims of homicide grew up in families with long histories of reports to CFSA. Reports on one family often include allegations of physical abuse, positive toxicology of a newborn, lack of supervision, and extensive unexcused school absences. Many of these reports were unsubstantiated; others were confirmed but resulted in nothing but a referral for voluntary services; others resulted in the opening of in-home cases that eventually closed; and others resulted in children placed in foster care and later returned home. But the abuse and neglect continued. Many of these families fit the pattern of chronic child neglect, which occurs “when a caregiver repeatedly fails to meet a child’s basic physical, developmental, and/or emotional needs over time, establishing a pattern of harmful conditions that can have long-term negative consequences for health and well-being.” Many of these children, with little support at home, histories of trauma, and disconnected from school, find their companionship in the streets and take up violent and illegal activities. Of the male decedents reviewed in the 2020 CFSA report, four were known to have been involved with the juvenile justice system and two were known to be involved in criminal activity when they were killed.
Of course, not all of the children included in this report who died from gun violence came from abusive or neglectful homes or were involved in violence themselves. Some of them died because they lived in a neighborhood plagued by gun violence or were in the wrong place at the wrong time. The eleven-year-old mentioned in the report might have been Davon McNeal, who was caught in the crossfire of a gunfight. And Davon was probably not the only bystander among the 20 who died. But perhaps some of the other deaths could have been prevented with more aggressive CFSA action. For example, the agency could have offered better, more intensive and long-lasting services to the parents, with court supervision to ensure they were taken up. And crucially, the agency could have refused to give second, third, and fourth chances to parents who repeatedly failed to take advantage of these services.
Natural Causes: Nine fatalities, or 22 percent of the deaths included in the report, were due to natural causes. Three of these deaths were due to prematurity and another three were due to medical conditions at birth. One might think that these deaths could not have been prevented by CFSA action, but research suggests otherwise. A population-based study using data from 3.4 million births in California found that, controlling for baseline risk factors like low birthweight and preterm births, infants with more than one CPS report were more than three times more likely to die of medical causes than those without a CPS report. The researchers also found that among infants reported for maltreatment, periods of foster care placement reduced the risk of death from medical causes by roughly half. Unfortunately, as described by child welfare expert Dee Wilson, medically fragile children are often born to the parents that are worst equipped to care for them. Thus, some of these deaths might have been prevented with more aggressive interventions, including foster care, in earlier contacts with the agency.
Accidental Deaths/Unsafe Sleep: Five of the CY 2020 fatalities, or 13 percent, were deemed accidental. Unsafe sleeping arrangements were involved in four of these deaths. (The fourth was a 20-year-old riding a moped without a helmet). In total there were five fatalities related to unsafe sleep. The other one was classified as “undetermined.” On the citywide child fatality review panel, I have seen numerous cases of children dying in unsafe sleep environments in families with long histories of child welfare involvement, often for numerous children. We tend to focus on unsafe sleeping arrangements (such as bed sharing) as the cause of death, but the reality is much more complex. Almost invariably, the parents have used marijuana, alcohol or illegal substances before lying down with the baby, and they fail to wake up when the children are struggling to breathe. With unimpaired parents, these sleeping arrangements might not result in death. That is why another study found that adjusting for risk factors at birth (including low birth weight and late or absent prenatal care), the rate of Sudden Unexplained Infant Death (SUID) was more than three times greater among infants who had been previously reported for past maltreatment than among infants who had not been reported. And that’s why more intensive interventions (including foster care placement) with families that abuse substances might have prevented some of these deaths.
Suicide: The CFR Unit reviewed one death by suicide; incredibly the decedent was an 11-year-old girl who hanged herself from the shower rod in her home. One population-based study estimated that children with any CPS history were three times as likely to end their own lives than children without such a history, and an eleven year old taking her own life suggests that something must have been amiss in her family that the agency might have been able to observe. “The family received grief services,” according to the report. That is nice to know, but it would be more important to know what type of trauma could have caused the suicide of an eleven-year-old, and what CFSA knew and should have known about this family before the child took her own life.
Undetermined and unknown: One child’s cause of death was unknown because the child died outside of the District; that child was in foster care. One fatality was classified as undetermined because the autopsy findings were inconclusive. The decedent was two months old and was found unresponsive after being swaddled for about two hours in a motorized baby swing with a blanket propping up a pacifier so that it would stay in the infant’s mouth. Unsafe sleep practices may have contributed to the infant’s death, according to the CFR Unit. This case raises the same issues as the accidental deaths discussed above. Any family that would leave a two-month-old unsupervised in a swing for two hours with a propped bottle has severe parenting deficiencies beyond their knowledge of safe sleep practices–deficiencies that required aggressive intervention in order to protect the child.
Parents’ CFSA History as Caregivers
Nine of the 40 families reviewed in the report (or about 23 percent) were involved with CFSA at the time of the fatality. Of these nine families, five had an open foster care case, two had an open investigation, one had an open in-home case and an open investigation, and one had an open permanency case and an open CPS investigation. Obviously it is concerning that these fatalities could occur while CFSA was actively involved with the family. One has to wonder whether any red flags were disregarded. But without knowing the details of CFSA’s involvement with these families, it is impossible for readers of this report to make any conclusions about agency practice.
In addition to the nine families who had an open investigation or case at the time of the fatality, four families (10 percent) had a case or investigation closed within three months of the fatality, four families had a case or investigation closed within four to nine months of the fatality, and another four families had a closure within 10 to 12 months of the fatality. It is concerning that so many families had such recent contact with CFSA; one wonders whether the case closures were premature and whether any red flags were missed. One family was not included in these calculations because it had four referrals that were screened out and no investigations or cases. It is concerning that a family with a later fatality had four reports screened out and it would be interesting to know when those referrals came in and whether the CFR unit looked at why they were rejected. There has been some concern about the accuracy of hotline decision-making. In a 2016 study, conducted by the Center for the Study of Social Policy, the court monitor in the LaShawn class action suit, reviewers agreed with the decision to screen out the referral in only 73 percent of the 223 screened-out referrals studied.
The chart below shows the frequency of CFSA involvement for the families with fatalities. All of the families had more than one report to CPS within five years of the fatality, 31 families, or 77 percent of the families, had four or more reports. So these families were very troubled, and there were many opportunities for CFSA to intervene.
What happened as a result of these reports? All but two of the families had referrals that were screened out, with 40 percent having four or more such screened-out referrals. About 83 percent of the families had at least one investigation. Sixty-five of the families had between one and three family assessments, an alternative to traditional investigation that has been dropped by CFSA. Forty-three percent of the families had one or two in-home cases, and 33 percent had one or two permanency (foster care) cases. Again, this table shows that CFSA had many opportunities to assess and intervene with these families before their children died.
According to the table shown above, 33 families were the subject of investigations in the five years before the fatality. In Figure One of the report (not reproduced here) CFSA found that 19 families had at least one substantiated allegation in the five years before the fatality. That 33 of these families had investigations but only 19 (or about 58 percent) had at least one maltreatment finding suggests that many of these investigations may have failed to find existing abuse or neglect. Physical abuse was the type of allegation that had the largest number of substantiations (eight). Unfortunately, we do not know how many families received those eight substantiations; it could have been one family that received them all or several families could each have received a smaller number of substantiations. The other most frequent types of maltreatment substantiated were ‘failure to protect’ (five), and four each for inadequate supervision, substance use by parent or caregiver, unwilling/unable caregiver, positive toxicology of a newborn, educational neglect and exposure to domestic violence. It would also be valuable to see the number and subject of unsubstantiated allegations as well since a large body of literature documents the difficulty of accurately determining whether a child has been maltreated, which is why scholars often prefer to use referrals (rather than substantiations) as a metric for the rate of maltreatment.
It is no surprise that many families of children who died within five years of CFSA involvement had a long history of reports to child protective services. The known high risk level for children in a family that has multiple reports is the reason that CFSA requires a “Four-Plus staffing,” which is a special meeting for families with four or more allegations, when the last report occurred within 12 months. According to the report, these staffings “focus on gaps in practice or service delivery that may have contributed to a family returning to CFSA’s attention.” Among the 40 families included in the report, 15 met the qualifications for a Four-Plus staffing, and all of them received such a staffing. This result raises questions about the efficacy of these staffings in addressing families with multiple reports to CFSA.
CFSA’s Recommendations
Based on its fatality reviews, the ICFR Committee makes recommendations each year for CFSA and other District agencies for actions that might avert future fatalities. This year the committee made only three recommendations: provide support to child welfare professionals who experience traumatic stress; improve information sharing between DC government agencies, and encourage use of a comprehensive medical information platform among hospitals and medical providers in the District. The report explains that the last recommendation would address the problem of abusive parents who bring their children to different medical providers. It is possible that this recommendation was prompted by the case of Gabriel Eason, whose mother brought Gabriel to two different emergency rooms for his injuries, thus making it less likely that abuse would be suspected.
These are all good recommendations. But it is rather surprising that there are no recommendations to improve CFSA’s practice in conducting investigations and in-home and foster care cases. Given that nine of these decedents had an open investigation or case at the time they died, and another 12 had an open investigation or case within a year of the fatality, there is reason to wonder if anything could have been done differently in these cases. But without knowing the details of CFSA’s involvement with these families, it is impossible for reader of this report to make any conclusions about agency practice. The ICFR Committee was given the details on each case. Is it possible that they found no flaws in case practice that would lead to recommendations for the future? That is hard to imagine.
Even without being privy to case details, there are some potential recommendations that come to the mind of an educated reader. Given the fact that all 15 families that qualified for a Four-Plus staffing because of the extent of their history with CFSA actually had such a staffing, and a child died nevertheless, one might wonder if Four-Plus staffings are achieving their purpose. A reasonable recommendation might be to change these staffings or eliminate them entirely and replace them with something else. Given that among the allegations about the 40 decedents’ families by far the most allegations involved abuse, a potential recommendation might be that the agency heighten scrutiny for families that were reported for abuse. There is other evidence for such a proposal: one study found that children with a previous allegation of physical abuse sustained fatal injuries at 1.7 times the rate of children referred for neglect. Several years ago, the agency eliminated its Special Abuse Unit, which investigated allegations of physical and sexual abuse; one wonders if this was a step in the wrong direction.
Perhaps I am being too critical of CFSA’s internal child fatality report. It is difficult for an agency to criticize itself and recommend changes that may go against its ideological orientation. That is why some states give a Child Advocate, Ombudsperson or Inspector General the duty of investigating certain child fatalities in which the family was known to the child welfare agency. The City Council established the Children’s Ombudsperson in the 2020 legislative session and I advocated for that office to be given that responsibility. After putting that requirement in the original draft, the bill’s framers removed that provision. I hope the Council will consider amending the legislation to ensure that an impartial, independent party reviews some of these deaths and makes the reviews available to the public.
Reviewing the fatalities of children who were involved with CFSA in the five years preceding their deaths provides an opportunity for CFSA to suggest changes in its practices. However CFSA has not taken full advantage of this opportunity this year. First, by eliminating over a quarter of the cases it reviewed based on an arbitrary timeframe, the fatality review committee deprived itself of vital fodder for recommendations and withheld important information from the public. Second, the committee made no recommendations for changes in the agency’s investigative and case management practices that may have allowed serious red flags to be missed, leaving children vulnerable to serious maltreatment during or after their involvement with CFSA. Finally, the report represents a failure to inform the public about the performance of an agency that it pays for. Not only does CFSA’s 2020 internal fatality report fail to derive all the available lessons from CFSA’s mistakes but it does not provide the details necessary to enable members of the public to draw its own conclusions about agency performance. That’s why the City Council should give the new Children’s Ombudsperson the responsibility for investigating and reporting about such fatalities.
*”Manner of death” refers to the circumstances that caused the death, as opposed to “cause of death,” which refers to the specific disease or injury that led to the death
The Child and Family Services Agency (CFSA) has updated its Data Dashboard for the fourth quarter of the District of Columbia’s Fiscal Year (FY) 2021, which included July through September of 2021. As usual, hotline calls dropped with the closure of schools for the summer, and then rose again when school started in September. However there was no dramatic onslaught of referrals when students returned to in-person school compared to what happens in a typical September after summer vacation. Hotline workers screened out a smaller percentage of referrals in the fourth quarter than they did in the previous quarter, investigating a larger percentage of them but substantiating a somewhat smaller percentage of those they investigated. CFSA served a fairly constant number of children and families in their homes throughout the year. However, the foster care caseload has been dropping fast – with an 11.5 percent decrease from in the Fiscal Year ending September 30, 2021.
Referrals
Many experts have predicted that hotline calls (known as “referrals”) would skyrocket after children returned to school in person, and indeed this has happened in other jurisdictions around the country. In the District, referrals did begin increasing in the third quarter of FY 2020 and continued to increase in the two succeeding quarters, as shown in Table One, even though most children were still learning virtually. By the third quarter, there were 5,880 referrals, almost as many as the 6,058 referrals that came in the corresponding pre-pandemic quarter of 2019. The quarterly number of referrals fell drastically to only 2,997 in the fourth quarter (July through December 2021), which is a return to the seasonal pattern in which referrals drop in the summer, when school is out of session. The total number of referrals for the third quarter of 2021 (2,997) did not reach the level of the third quarter of FY 2019 (3,274), the last fiscal year before the pandemic. But fourth-quarter data hides the difference between summer vacation and school, which started on August 30 for DC Public Schools students.
As shown in Table One, referrals did rise in September 2021 to 1,148 from only 759 in August. That is considerably more than the 942 referrals in September 2020, but considerably less than the 1,377 calls in September 2019. The absolute difference in referrals between August and September of FY 2021 was smaller than in FY 2019 but the percentage difference was slightly greater. (FY 2020 showed less of an increase between August and September referrals in both number and percentage, showing the effects of the pandemic and virtual schooling.) But there was no dramatic onslaught of referrals in the wake of schools opening in person in September 2021, compared to a normal September. However, based on FY 2019 data, October brings more referrals than September, so we will see what the next quarter’s data show.
Table One
Referrals in August and September, FY 2019-FY 2020
Referrals
FY 2019
FY 2020
2021
August
946
718
759
September
1377
942
1148
Difference
431
224
389
Percent Change
31%
24%
34%
Source: CFSA Data Dashboard, and Child Welfare Monitor, previous posts
Figure Two shows the number of referrals made by each reporting source in Fiscal Years 2019, 2020 and 2021. This number, which had dropped from 17,960 in FY 2019 to 14,046 in 2020 with the onset of the pandemic, bounced back to 17,422 in FY 2021, almost the same number as in FY 2019. School and daycare personnel are traditionally the largest referral source, and they actually made substantially more reports in FY2021 than they did in the pre-pandemic fiscal year, 2019 – 8,482 compared to 7,704. They also made a higher percentage of all reports–48.7% compared to 42.9 percent in FY 2019. This increase in teacher reporting relative to FY 2019 may reflect teachers’ increased concerns about children missing too many days of online schooling last spring, as well as concerns raised by seeing children in the fall for the first time in 18 months.
Once a call comes into the hotline, it can be accepted as an “information and referral” to be referred to another agency; accepted for investigation; linked to an existing open investigation; or screened out as not requiring any response. Figures Three and Four show how as the number of referrals increased in the first three quarters of FY 2021, CFSA reduced the proportion it accepted. In an earlier post we suggested this might reflect the impact of CFSA’s belief that teachers make too many referrals for “compliance” purposes only. This belief led the agency to institute a new policy of rejecting educational neglect referrals for a family with whom the school or CFSA had been in contact within the previous 10 days of school. But in the fourth quarter, as referrals dropped after schools closed, CFSA screened out a smaller percentage of referrals. The agency screened out only 56.6 percent of referrals compared to the 75.0 percent screened out in the previous quarter. So the number of referrals accepted dropped much less than the total number of referrals received from 1124 in Quarter 3 to 1081 in Quarter 4.
Figure Five shows the large drop in the number of investigations in the first four pandemic quarters compared to four preceding quarters. In the fourth quarter of FY 2021, the number of investigations was closer to pre-pandemic levels but still lower – 1030 in FY 21 versus 1176 in FY 2019. Notably, the number of investigations hardly dropped in quarter 4 over quarter 3 even though the number of referrals (shown above) dropped greatly. This lack of a summer drop in investigations reflects the increased percentage of referrals accepted, as discussed above. It’s as if the agency was trying to keep the number of investigations constant by rejecting more referrals when they received more of them, but this may just reflect the lower credence given to referrals from schools.
An investigation can have several possible results. It can result in a finding of “inconclusive,” meaning the evidence is insufficient to prove maltreatment despite some indications it occurred; “unfounded,” which means “there was not sufficient evidence to conclude or suspect child maltreatment has occurred” “substantiated,” indicating that the evidence supports the allegation of maltreatment; “incomplete” (as defined in the CFSA Data Dashboard), or “child fatality,” which is defined as a “suspicious death of a child that may be due to abuse or neglect.” About 23 percent of investigations were substantiated in the most recent quarter, as shown in Figure Six. That was slightly lower than the 26 percent substantiated in the previous quarter. Figure Seven shows that number of substantiations fell in the summer quarter in accord with the smaller number of investigations and the lower substantiation rate.
When an abuse or neglect allegation is substantiated, several things may happen, depending on the assessed level of risk to the child or children in the home. The agency may take no action, refer the family to a community-based collaborative, open an in-home case, or place the child or children in foster care.
In-Home Services
When a CFSA investigator considers children in a family to be at high risk of maltreatment, but not in imminent danger, the policy is to open an in-home case for monitoring and services. Figure Eight shows the number of in-home cases opened by quarter, starting in the first quarter of FY 2020.* There were slightly fewer case openings in the summer quarter than the prior quarter, reflecting the decline in the number of substantiations. Figure Nine shows that the number of in-home case closures rebounded in Quarter 4 following a decline in the previous quarter. These may be random fluctuations or they may reflect unknown factors.
Table One shows that the total number of children being served in their homes was 1,290 on September 30, 2021, very slightly down from 1299 on September 30, 2020. That is not surprising, since the difference between entries to (119) and exits from in-home services (134) was very small as well.**
Table One
\Total Number of Children Served at Home and in Foster Care, FY 2020 and FY 2021
In-Home
In Foster Care
Total
Sept. 30, 2020
1299
694
1993
Sept. 30, 2021
1290
614
1904
Source: CFSA Data Dashboard, cfsadashboard.dc.gov
Foster Care
The number of children entering foster care decreased in the last quarter of FY 2021, after rebounding from a large pandemic-induced drop in the fall and winter quarters and then decreasing in the spring quarter. Fifty-nine children entered foster care in the last quarter of FY 2021, as shown in Figure Ten. Figure Eleven shows that exits from foster care decreased in Quarter 4 but were still more numerous than entries. There were 64 exits from foster care compared to 59 children entering care.
Figure Twelve shows the number and percentage of children exiting foster care for different reasons in FY 2020 and FY 2021. There were no big changes between the two years. In both years, reunification was the main reason for exits from foster care, though the percentage exiting through reunification decreased slightly from 41 percent to 39 percent, at the same time as the percentage exiting through adoption increased from 31 percent to 34 percent. CFSA does not post these data for earlier years, but perhaps this was due to a pandemic-induced suppression of adoptions in FY 2020. Smaller but still significant percentages left the system for guardianship (13 percent in 2020 and 12 percent in FY 2021) and emancipation (14 percent in FY 2020, declining to 12 percent in FY 2021), with very small numbers having died or entered the custody of another agency.
Figure Twelve
Children Exiting Foster Care by Reason for Exit, FY 2020 and FY 2021
Looking at the data for Fiscal Year 2021 in total, there were 251 entries into foster care and 327 exits in the four quarters ending on October 30, 2021. With exits eclipsing entries, the number of children in foster care should have fallen by approximately 76 children. And indeed, Table One above shows that the total number of children in foster care fell by 80 from 694 in September 2020 to 614 in September 2021.** This was a decrease of 11.5 percent, somewhat less than the 13.0 percent decrease between FY 2019 and FY 2020. The foster care rolls have been falling annually for years, but the decrease accelerated in Fiscal Year 2020, as shown in Figure Thirteen,*** and only slightly decelerated in FY 2021. When asked about the drop in the foster care rolls a year ago, CFSA responded that it reflects the agency’s continued commitment to keep families together without formal child welfare involvement when it is safe to do so.
The total number of children served in their homes and in foster care decreased from 1993 to 1904, a decrease of 4.47 percent from FY 2020 to FY 2021, as shown in Table One above. Data from earlier years is available from the Center for the Study of Social Policy for the calendar year only. Figure Fourteen shows the number of children served both in foster care and in their homes in the calendar years from 2010 to 2019 and in September of 2021. That total has been decreasing for the last two fiscal years.
In conclusion, the fourth quarter showed the normal drop in referrals with the closure of school for the summer. There was an increase in hotline calls when schools reopened in person last September, but not the overwhelming influx of calls that some had predicted with the re-opening of school buildings. The number of children and families with in-home cases stayed stable, but the foster care population continued to drop–resulting in a small decline in the number of children served by CFSA from September 2020 to September 2021. CFSA has attributed its declining foster care numbers to its continued commitment to keep families together without formal child welfare involvement when it is safe to do so. We can only hope that CFSA is fulfilling this commitment without jeopardizing child safety.
*These numbers include all in-home cases opened as a result of CPS investigations. It does not include a small number of cases opened as a result of case transfers from foster care or adoption units or in-home cases that are the result of reunifications and are managed by the foster care units.
**There is a small difference between the number of exits (134) minus entries (119) from in-home care and the year-to-year difference in the number of children in in-home care (9) and a similar small difference between the number of exits minus entries to foster care (76) and the year-to-year difference in the foster care caseload (80). The small anomalies reflects standard data entry delays when there is a change in a child’s status.
***The accelerated decrease in the foster care rolls did not seem to be related to the pandemic. When we compared data from March to September of 2019 and 2020, we found that 74 fewer children entered foster care and 68 fewer children exited it, suggesting that the pandemic had little effect on the total foster care caseload.
The COVID-19 vaccine has been approved for all children aged 12 and older and has been proven safe and effective. The Mayor has strongly encouraged all eligible youths to be vaccinated, organized special vaccination clinics in schools, and announced a variety of incentives for youth vaccinations. Children in foster care are wards of the District, and one might think that the agency would act as the Mayor has encouraged parents to do, and make vaccinating its wards the top priority. However, it appears that that for CFSA, vaccinating its youth falls somewhere below other priorities, such as protecting parents’ rights to refuse vaccinations for their children.
In the District of Columbia, all children aged eleven and up are allowed to consent to their own vaccinations under a new law, the Minor Consent for Vaccinations Amendment Act of 2020. However, in a new Administrative Issuance (AI) released on on July 22, CFSA takes pains to clarify that it has chosen not to take full advantage of this opportunity to get foster youth vaccinated. In the AI, titled “How to Obtain Informed Consent for COVID-19 Vaccination for Children Served in Out-of-Home Care,” CFSA states that “This law does not negate the Agency’s ability to first seek parental consent, rather, it provides an avenue for consent when a parent or caregiver does not consent.” The agency goes on to state that it has decided to continue obtaining parental consent for vaccination for youth 11-17 unless parental rights have been terminated. Youths aged 18-21, who are “developmentally capable,” are allowed to consent to their own vaccine.
Given that CFSA has decided to request consent from all parents of children under 18, the agency could have required social workers to ask all parents of children in their caseloads to consent to the COVID-19 vaccine for their eligible children by a certain date. But they did not do so. Instead, the AI states that “Social workers will ensure that parents receive the share (sic) “Fact Sheet for Recipients and Caregivers” before obtaining their consent to ensure they are making an informed decision about their child receiving the COVID-19 vaccine.” Thus, the focus is on ensuring that social workers share the fact sheet if they request consent, rather than requiring that they ask all parents to consent to the vaccination for their children. Moreover, there is no requirements that these conversations be documented so that the agency can determine how many parents have been asked and how many have agreed; documentation is required only when parents “refuse or are unable to provide consent.”
We do not know how proactive the agency is being in requesting parental consent for children aged 12-17 to receive the COVID-19 vaccination. According to Kera Tyler, CFSA’s Communications Director, “our social workers are actively encouraging parental consent for the vaccine for children in care over the age of 11. By sharing relevant educational materials along with District incentives, our Parent Engagement Education and Resource (PEER), family support workers, and social workers are facilitating conversations with both birth and resource parents to support vaccination for youth 12 and older.” The emphasis on educating parents and using peer support workers is laudable. But with no record of how many parents are being reached with such communication and what the results were, there is no way to know how successful these efforts have been.
The AI does provide a procedure for a child aged 17 or under who wants to get vaccinated to consent to the vaccine if the agency has not obtained parental consent for whatever reason. In such a case, “CFSA will ensure that the child meets with their primary care provider,” according to the AI. The social worker must “ensure that age and developmentally appropriate information about the COVID-19 vaccine is provided to the child by the primary care provider…The primary care provider must confirm that the child understands that they are making an informed decision about their consent to receive the vaccine.” And If the child does consent to the vaccine, “the primary care provider will be responsible for arranging and administering, recommending, or prescribing the vaccine.”
This is a rather cumbersome procedure. The extra step of seeing the primary care provider is not required of other District children consenting to their own vaccinations. Arranging and carrying out this visit is a burden for already taxed social workers. It is not even clear that primary care providers are willing to schedule such appointments. In any case, following this procedure is sure to delay vaccination. Perhaps most importantly, this provision makes it harder for young people in foster care than for their peers who are not in foster care to consent to their own vaccinations. One has to wonder if any children have been vaccinated under this provision, but CFSA has not been collecting vaccination data, as discussed below.
The situation is different for foster youth aged 18 to 21. According to the AI, these young people can consent to vaccinations unless they have a mental disability. The AI states that “Social workers will ensure that youth receive the share (sic) “Fact Sheet for Recipients and Caregivers” before obtaining their consent to ensure they are making an informed decision about receiving the COVID-19 vaccine.” Again, the instructions are more about ensuring that social workers share the fact sheet if they do request consent, rather than requiring that they make this request of all youth in this age category. And without a documentation requirement, we have no idea about how often these conversations are being held and what the results have been.
As with parents, CFSA cannot document how proactive it is being in requesting consent for vaccination from older youth in foster care. According to Tyler, “For our older youth, CFSA social workers have distributed educational materials to youth on their caseloads, coordinated appointments, arranged transportation to and from vaccination sites, and promoted the District’s incentives as applicable.” I mentor a nineteen-year-old in foster care who was eligible early for the vaccine early based on medical status, and it was I who provided information about the vaccine, helped her obtain her appointments and drove her to both. She reported that her social worker “mentioned” the vaccine, but there was no offer of assistance in getting vaccinated.
Given the procedures restricting vaccine uptake among CFSA children aged 12 to 17 and the lack of guidance about vaccine among older youth, it is important to know how many youths in CFSA care have been vaccinated. Unfortunately, the agency is not collecting this information. This makes it impossible to know how successful their attempts at obtaining consent have been. CFSA is collecting reports of children who receive a positive diagnosis of COVID-19 but given that these diagnoses are medical data, Tyler states that CFSA is developing some quality control standards before making those figures public.
It is perhaps not surprising that CFSA is sensitive to the beliefs of parents and older youths about COVID vaccines. Most foster youths are Black and vaccine hesitancy is high in the Black community. This hesitancy and the misinformation on which it is based is indeed the biggest barrier to getting older youths vaccinated, according to the Chairperson of the Board of Directors of FAPAC, an organization representing foster parents in DC. It makes sense to focus on sharing educational materials along with incentives to encourage vaccination among foster youth.
But the health of our foster youth, foster parents, and the District of Columbia population overall should be the top priority during this critical time, and CFSA should spare no effort in ensuring that all youth get the necessary information, and that all who are ready to be vaccinated can get the vaccine without delay. We know that foster youths have more health problems than their peers who are not in foster care, some of which put them at high risk if they develop COVID-19. Children’s National Medical Center has reported a “dramatic increase” in pediatric COVID-19 cases over the summer, fueled by the Delta variant. Nationally, cases in children have reached the highest level since the start of the pandemic–more than a quarter of all new weekly cases.
There were 624 children in foster care in the District of Columbia as of June 30, 2021. More than half of these are 12 and older.* This is a small number relative to the total number of children in the District, but these children are under the District’s direct care. The Mayor has made vaccinations a priority for all eligible groups. One might hope that the District would set an example by making vaccination of its wards a top priority.
*According to the CFSA Data Dashboard, 47 percent of CFSA youth were aged 13 to 21 in the third quarter ending June 30; therefore it is likely that at least half of these youth were aged 12 to 21.
The Child and Family Services Agency (CFSA) has updated its Data Dashboard for April through June 2021, which is the third quarter of the District of Columbia’s Fiscal Year (FY) 2021 and the fifth quarter of the COVID-19 pandemic. The new data show that calls to the CFSA hotline have almost returned to pre-pandemic levels as school and childcare staff have increased their hotline calls. However, instead of increasing its investigations to pre-pandemic levels, the agency has been screening out more of these calls every quarter, resulting in a number of investigations that is only 70 percent of its pre-pandemic level for the equivalent quarter. CFSA has maintained a fairly constant number of children and families with in-home cases over the past 12 months. However, the foster care caseload has been dropping fast–with a 14.5 percent decrease from June 2020 to June 2021.
Referrals
Figure One below shows the quarterly number of calls to the CFSA hotline, known as “referrals,” starting in the quarter beginning in January 2019 to enable comparison with pre-pandemic levels. The FY 2019 data represents seasonal variation in referrals in a normal year, with referrals falling in the summer quarter when schools are closed, then rising again in the fall, winter and spring quarters. The pattern changed with the large drop in referrals in the first pandemic quarter of April through June 2020. After remaining low in the summer, referrals rose each quarter starting with October through December 2020. By the most recent quarter, April through June 2021, there were 5,880 referrals, almost as many as the 6058 referrals that came in the corresponding pre-pandemic quarter of 2019.
Figure Two shows the number of hotline calls made by each reporting source, which are available only on an annual basis from CFSA. School and daycare personnel are traditionally the largest referral source, having made 7,704 calls, or 42.9 percent of calls to the hotline, in FY 2019. But they made only 5,006 calls, or 35 percent of calls, in the pandemic fiscal year that ended in September 2020. This is not surprising. While childcare centers resumed operations during the first two quarters of the pandemic, most public and charter schools were operating virtually during that time. Moreover, many children were struggling to log into class, and teachers may have been unwilling to make CPS referrals for students who were not participating due to connectivity problems. But in the first nine months of FY 2021, starting in October 2020, school and childcare staff made 7,610 calls – almost as many as the 7,704 they made in the entire 12 months of FY 2019. In other words, school and childcare providers were reporting at a higher rate and are on track to make more reports in FY 2021 than in the pre-pandemic FY 2019. The percentage of calls that were from schools and childcare centers increased to 47.7 percent in the current fiscal year to date–which is higher than the pre-pandemic share of 42.9 percent in FY 2019. This rebound in referrals from schools and childcare centers could reflect teachers’ concerns about children that returned to classrooms; it could also reflect concerns about those who did not return and teachers’ increased willingness to make reports about children who have been attending sporadically throughout the school year.
Once a call comes into the hotline, it can be accepted as an “information and referral” to be referred to another agency, accepted for investigation, linked to an existing open investigation, or screened out as not requiring any response. As shown in Figure Three, as the number of referrals increased in each quarter, CFSA has reduced the proportion it accepts, thus avoiding a large increase in the number of investigations. The number of referrals more than doubled from 2,396 in the quarter ending September 30, 2020 to 5,880 in the quarter that ended on June 30, 2021. But the number of referrals accepted for investigation increased by only about 17 percent, from 957 to 1124, during the same period. Instead of accepting these new referrals, CFSA was screening them out. In fact, CFSA has been screening out a higher proportion of referrals in each quarter as the number of referrals has increased. The proportion of referrals that were screened out increased from 51.3 percent of referrals in the quarter ending September 30, 2020 to 75 percent of referrals in the quarter ending June 30, 2021, as shown in Figure Four.
In a recent post, I reported that CFSA sent a message to DC Public Schools (DCPS) and the Public Charter School Board early in March 2021 describing a new practice in screening referrals for educational neglect “due to the influx of reports for potential educational neglect and furthermore the city-wide attendance issues caused by the COVID-19 pandemic.” Under the new procedure, CFSA would reject any educational neglect referral for a family with whom the school or CFSA had been in contact within the previous 10 days of school, with some exceptions. It is not clear when CFSA implemented this procedure. It was already screening out 72 percent of referrals in the quarter ending March 30; this increased slightly to 75.2 percent in the quarter ending June 30, 2021, although the number screened out increased from 3,541 to 4,423 in the spring quarter. Of course, these numbers and percentages include all referrals and not just those for educational neglect: Child Welfare Monitor has requested data on educational neglect referrals from CFSA.
Investigations
Figure Five shows the large drop in the number of investigation in the first four pandemic quarters compared to the analogous pre-pandemic quarters. The fifth pandemic quarter continues the pattern. CFSA reported only 1,092 investigations, or only 70 percent of the 1549 investigations in the spring quarter of FY 2019. We have seen that the number of hotline calls had almost reached pre-pandemic levels in that quarter – but the number of investigations did not follow suit, because so many referrals were screened out as described above.
An investigation can have several possible results. It can result in a finding of “inconclusive,” meaning the evidence is insufficient to prove maltreatment despite some indications it occurred; “unfounded,” which means “there was not sufficient evidence to conclude or suspect child maltreatment has occurred” “substantiated,” indicating that the evidence supports the allegation of maltreatment; “incomplete” (as defined in the CFSA Data Dashboard), or “child fatality,” which is defined as a “suspicious death of a child that may be due to abuse or neglect.”
The percentage of investigations that resulted in a substantiation (shown in red) has not changed greatly during the pandemic. It has varied between 21 percent and 26 percent per quarter since the Spring quarter of FY 2019, as shown in Figure Six. Figure Seven shows that the number of substantiations increased from 206 in the quarter ending September 2020 to 279 in the most recent quarter, but is still considerably lower than the 379 substantiated investigations in the same quarter of FY 2019, before the pandemic. The failure of substantiations to rebound to Spring 2019 levels reflects CFSA’s screening out an increased proportion of referrals as the number of referrals increased.
When an abuse or neglect allegation is substantiated, several things may happen, depending on the perceived level of risk to the child or children in the home. The agency may take no action, refer the family to a community-based collaborative, open an in-home case, or place the child or children in foster care. CFSA’s Data Dashboard provides data on how many cases are opened for in-home services and foster care.
In-Home Services
When a CFSA investigator considers children in a family to be at high risk of maltreatment, but not in imminent danger, the policy is to open an in-home case for monitoring and services. Figure Eight shows the number of in-home cases opened by quarter, starting in the first quarter of FY 2020.** The figure shows a large drop in the number in-home case openings in the third quarter of FY 2020, following the onset of the pandemic. This undoubtedly reflects the decline in referrals, investigations, and substantiated reports during that period. Case openings were even lower in the summer quarter, then rebounded somewhat to a total of 131 case openings in the third quarter of FY 2021.
Like in-home case openings, in-home case closures also fell immediately following the pandemic shutdowns, as Figure Nine illustrates. This is not surprising in light of the effects of the pandemic. In-person visits to families with in-home cases became virtual, and there may have been some disruption as new protocols were put into place and online connections were established. Many parents with in-home cases rely on services from other agencies, such as mental health and treatment, to complete their case plans, and these services were presumably disrupted as well. These disruptions doubtless made it difficult for parents to complete required services and thus resulted in a postponement of case closures. Presumably, virtual home visits and services were put into place and bolstered in the following quarters. In-home case closures rebounded in three quarters after April through June 2020, though they fell again to 87 in the Spring quarter of 2021, for unknown reasons. But these are small numbers and random fluctuations can occur.
There were 477 in-home cases opened and a very similar 457 closed in the four quarters ending June 30, 2021, which suggests that the number of open cases changed little over the period. The number of families with in-home cases indeed changed little from June 30 2020 to June 30 2021–from 1,429 to 1,398, as shown in Table One. The total number of children being served in their homes was 1,398 as of June 30, 2021, a very slight decrease from the year before.
Table One
Total Children Served in their Homes, June 2019, 2020, and 2021.
As I have described in earlier posts, there was a big drop in foster care entries before the pandemic, with a surprising increase in entries in the first full pandemic quarter; quarterly entries have remained between 60 and 70 for the last three quarters. Sixty-two children entered foster care in the Spring quarter of 2021, similar to the 64 who entered foster care in the same quarter of FY 2020, as shown in Figure Ten. Figure Eleven shows that while the pandemic seemed to delay foster care exits in its initial stages, that effect seems to have dissipated as the agency and courts adapted to virtual operations. The number of children exiting foster care increased slightly in the Spring quarter of 2021. There were 86 exits from foster care, compared to 62 entries in the March-June quarter resulting in a decrease in the foster care population from 648 children on March 30, 2021 to 624 on June 30.
Looking at the data for the most recent four quarters, there were 234 entries into foster care and 340 exits in the four quarters ending on June 30, 2021. With exits eclipsing entries, the number of children in foster care had to fall. And indeed, Table Two shows that the total number of children in foster care fell from 740 in June 2020 to 624 in June 2021, a decrease of 14.5 percent, very similar to the 14 percent decrease the year before. The foster care rolls have been falling annually for years, but the decrease accelerated in Fiscal Year 2020, as I described in recent testimony. It looks like FY 2021 will show the same trend when the year is complete. When I asked about this trend a year ago, CFSA responded that it reflects CFSA’s continued commitment to keep families together without formal child welfare involvement when it is safe to do so.
Table Two
Total Children Served in Foster Care as of June 30
In conclusion, the third quarter of FY 2021 saw the number of referrals (calls to the CFSA hotline) recover almost to pre-pandemic levels. CFSA responded by screening out more of these referrals and increasing the number of investigations only slightly. CFSA reported only 1,092 investigations, compared to 1549 in the spring quarter of FY 2019. The number of children and families with in-home cases stayed stable, but the foster care population continued to drop–by an annual rate of about 14.5 percent. CFSA has attributed its declining foster care numbers to its continued commitment to keep families together without formal child welfare involvement when it is safe to do so. Whether CFSA is fulfilling this commitment without jeopardizing child safety remains to be seen.
*DCPS buildings closed in March 2020 and remained closed for all students for the remainder of the academic year. Only a few students were welcomed into school buildings in the fall of 2020. Schools reopened in person in February 2021 to some students, but still only about 20 percent of DCPS students and most only part-time.
**These numbers include all in-home cases opened as a result of CPS investigations. It does not include a small number of cases opened as a result of case transfers from foster care or adoption units or in-home cases that are the result of reunifications and are managed by the foster care units.
On Tuesday, Judge Thomas F. Hogan approved a settlement in the 32-year-old case now called LaShwan vs. Bowser–a suit which was filed in 1989 alleging major mismanagement in the District’s foster care system. Today, Mayor Bowser announced the end of court oversight over the Child and Family Services Agency (CFSA). Nevertheless, released by CFSA concerning its operations in the quarter ending March 31, 2021 shows there is still reasons for concern about whether CFSA is complying with its mandate of protecting DC children in a time of pandemic.
A major concern for child advocates has been the possibility that the COVID-19 pandemic would have a double effect–increasing abuse and neglect and also making it less likely to be discovered. As we have already reported, data from the District of Columbia Child and Family Services Agency (CFSA) indeed showed a drastic drop in calls to the CFSA hotline at the onset of the pandemic and associated closures. The most recent data, from the quarter ending March 31, 2021, show the beginning of a return to normal levels of hotline calls, with an uptick in calls from schools and child care providers. But just when calls are starting to return to normal, the agency seems to be focused on limiting these calls and screening out as many as possible. Moreover, a large decrease in the total child population served by CFSA (including those served both in their homes and in foster care) over the course of the pandemic is of concern as it is unlikely to reflect an equal reduction in the number of abused and neglected children.
CFSA’s Data Dashboard is updated 45 days after the end of each quarter. Child Welfare Monitor DC reported on FY 2021 Quarter One (October to December 2020) update in Testimony at the CFSA oversight hearing conducted by the DC Council’s Human Services Committee on February 25, 2021. We also reported on some preliminary data from Quarter two in a post entitled CFSA, DCPS and the Safety of children not in school buildings. This post integrates the full Dashboard data from Quarter Two (the quarter ending March 31, 2021) into an overview of trends since the onset of the pandemic.
Referrals
Figure One below shows the monthly number of calls to the CFSA hotline, known as “referrals,” from March 2020, when the pandemic emergency began, through March 2021, compared to the same dates of the previous year. (Note that March 2020 is included in both 13-month periods as the pandemic closures began in the first half of that month). DC’s sudden closure of schools for an extended spring break in March 2020 was followed by a chaotic virtual reopening, as schools and nonprofits strove to get children connected with computers and internet service. Not surprisingly, the first three months of the pandemic produced a drastic drop in hotline calls, investigations, and substantiated cases of maltreatment. Reports stayed at basically the same level from April to August, unlike a normal year, when reports drop after schools close.
Perhaps in part due to new guidance for educators produced by CFSA about how to spot abuse and neglect in a virtual environment, referrals rose In October 2020 and began to approach the previous year’s level in November and December, then dropping slightly in January in contrast to an uptick in January of 2021. But the number of referrals increased from 1,224 in January 2021 to 1,408 in February and took a staggering jump to 2,233 in March. We don’t know the extent to which this change was due to the fact that about 20 percent of the school system’s population returned to school early in February. Perhaps there was an onslaught of reports from teachers seeing students in person for the first time that school year. March was the first month where the pre-pandemic and pandemic curves crossed: the 2021 uptick contrasted with a downturn in March 2020 when pandemic closures began. In fact, there were many more calls (2,253) in March 2021 than in March 2019 (1858), when all schools were open.
Figure One
Source: Data from CFSA Dashboard and data provided by CFSA for January-March 2020. Note: March 2020 data are shown twice in this table
The number of hotline calls per quarter is shown in Figure Two. This quarterly view shows how referrals plunged in the first full pandemic quarter (April-June 2020) and have increased in each quarter since then. The total number of referrals fell from 18,751 in the four quarters ending March 2020 to 13,172 in the four quarters ending March 31, 2021.
While monthly data on reporting source are not available, annual data for FY 2020 shown in Figure Three suggest that a decline in reports from school personnel was a major factor behind the fall in referrals overall. In FY 2019, school and childcare personnel made 42.9 percent of all calls to the hotline, but this percentage went down to 35 percent in the pandemic year of 2020. But in FY 2021 to date the percentage of calls that come from teachers actually increased to 47.7 percent–which is higher than the pre-pandemic share of 42.9 percent in FY 2019. This change reflects the big increase in referrals from schools in March, after some children returned to school.
Once a referral arrives, it can be accepted as an “information and referral” to be referred to another agency, accepted for investigation, linked to an existing open investigation, or screened out as not requiring any response. It is interesting to look at the numbers (Figure Four) and percentages (Figure Five) of referrals that are assigned to these four categories. Figure Four shows the large drop in the total number of referrals at the onset of the pandemic in April 2020, and the resultant rapid drop in the numbers of referrals that were screened out and accepted. But as the total number of referrals started increasing in September 2020, CFSA began screening out more of these referrals and maintaining a similar number of referrals accepted for investigation. The increase in the number of referrals in February (from 1224 to 1408) resulted in a decline in accepted referrals that month, and a near doubling of calls in March 2021 (from 1408 to 2253) resulted in a much smaller increase of accepted referrals from 307 to 379. Basically, the number of referrals accepted for investigation remained similar from September 2020 (345) to March 2021 (379) despite the big increase in referrals after November.
Figure Five shows that with the rapid drop in referrals due to the pandemic, CFSA began accepting a higher percentage of those referrals starting from May to August 2020. But starting in September 2020, as CFSA began getting more calls, screeners began screening out a higher percentage and accepting a lower percentage or referrals. This trend accelerated in February and March of 2021 with the increase in calls to the hotline. This is particularly notable in March 2021, when the number of calls to the hotline jumped from to 2233 from 1408 the previous month. Confronted with this onslaught of new calls, CFSA increased the percentage screened out from 62.9 percent in January 2021 to 71.1 in February to 78.6 percent in March.
Figure Five
This decline in acceptance of referrals is not surprising because CFSA, citing an influx of referrals in the fourth quarter of previous years, made a conscious effort to reduce calls by telling educators that unnecessary calls would be screened out, as described in our previous post, CFSA, DCPS and the safety of children not in school buildings. CFSA’s increased tendency to screen out referrals is somewhat concerning, especially combined with the strong discouragement of referrals in their most recent guidance. Data provided by CFSA in response to a request from Councilmember Nadeau, shown in Figure Five, shows there is reason for concern. (Because the data provided for School Year 2020-2021 extended only through March 30, we requested data for the same period of the two previous years for comparability purposes, and these are the periods covered by the figures below). The number of educational neglect referrals fell from 3,368 in the first three quarters of the pre-pandemic school year of 2018-2019 to 2,378 during the same three quarters of School Year 2019-2020. This is rather confusing since Covid-19 did not shutter schools until March. In the current academic year through March 30, 2021, educational neglect referrals came roaring back. CFSA had already received 3,581 educational neglect referrals as of March 31–more than in the full pre-pandemic year. But the number of accepted educational neglect referrals declined from 956 in SY 2018-2019 to 443 in SY 2019-2020 to 258 in the current school year through March 31.
FIgure Five
Data Provided by CFSA
Figure Six shows the percentage of educational neglect referrals that were accepted, screened out and other. CFSA accepted 28.4 percent and screened out 71.6 percent of educational neglect referrals in the pre-pandemic academic year, 2018-2019. In the disrupted School Year (SY) 2019-2020, CFSA accepted 18.6 percent of educational neglect referrals and screened out 81.3%. And in the current academic year as of March 31, 2021, CFSA had accepted only 7.2 percent of educational neglect referrals and screened out 86.9 percent.
Figure Six
Source: Data Provided by CFSA
CFSA’s intent to keep a lid on educational neglect referrals is understandable. Administrators are presumably afraid of being overwhelmed by referrals of educational neglect. Moreover, there has been considerable pushback by activists in jurisdictions like New York City about reports of parents being investigated for educational neglect when they were not able to obtain computers or internet service. However, it is important to note that while categorized as “educational neglect,” referrals from schools about absences often serve a much broader purpose than ensuring that children are going to school. Chronic absence is often the first indicator that the child is not safe. It may even be an indicator that the child is missing. In the case of Relisha Rudd, who disappeared in 2014 and was never found, 18 days of absences did not trigger a report to CFSA because the absences were excused with the help of a bogus “doctor” who was probably Relisha’s abductor.
Investigations
An investigation can have several possible results. It can result in a finding of “inconclusive,” meaning the evidence is insufficient to prove maltreatment despite some indications it occurred; “unfounded,” which means “there was not sufficient evidence to conclude or suspect child maltreatment has occurred,” or “substantiated,” indicating that the evidence supports the allegation of maltreatment. (See the CFSA Data Dashboard for the full definitions of these terms as well as of “incomplete investigations.”) It takes up to 30 days, and sometimes more, to complete an investigation, so the trends tend to reflect the previous month’s referrals. Figure Seven shows that the trend in substantiated investigations is very similar to the trend in hotline calls, but with a time lag of about a month. There was a huge decline in substantiated investigations in May, June and July 2020 compared to 2019. Substantiated investigations almost caught up to normal levels in August and September, reflecting the normal decline in hotline during any normal summer, and then fell somewhat below the previous year during the fall. Just as hotline calls approached normal in November and December, so did substantiated investigations in December, January, and February. But in March 2021 there was a big decline in substantiated investigations relative to March 2020, a month that may have been already affected by the pandemic. This may reflect that in January and February, the number of calls again lagged behind the numbers for the previous year. It will be interesting to see what happens in April, after the bulge in new referrals in March.
Educational neglect data provided to the office of Councilmember Nadeau and displayed in Figure Eight show that the proportion of educational neglect referrals that were substantiated increased between School Year (SY) 2018-2019 and SY 2019-2020 (when the pandemic began) and again in SY 2020-2021 as of March 31, 2021. These data may be related to the fact that proportion of referrals that was accepted for investigation has dropped so greatly. Perhaps by screening out such a high proportion of referrals, CFSA is also screening out more allegations that are not worthy of substantiation. But one wonders if there is a cost to this increased discrimination. Perhaps they are also screening out more allegations that would have been substantiated.
Figure Eight
When an abuse or neglect allegation is substantiated, several things may happen, depending on the perceived level of risk to the child or children in the home. The agency may take no action, refer the family to a community-based collaborative, open an in-home case, or place the child or children in foster care.
In-Home Services
When a CFSA investigator considers children in a family to be at high risk of maltreatment, but not meet “in imminent danger of serious harm,” the policy is to open an in-home case for monitoring and servies. In-home cases have become much more common than foster care placements as CFSA has been been laser-focused on keeping children in their homes. On March 31, 2021 there were only 648 children in foster care compared with 1259 children being served in their homes, or 34 percent and 66 percent of the 1907 children being served in total, as Table One shows.
Table One: Number of Children Served in foster care and in their Homes, March 31, 2021
Based on the early data from the CFSA dashboard discussed in an earlier post, there was a drastic drop in in-home case openings after CPS investigations with the onset of the pandemic. The total number of in-home cases opened in the pandemic months of March to June dropped from 533 in March-June 2019 to 267 in the same months of 2020–a decrease of 50 percent. However CFSA stopped publishing these data after the quarter ending June 2020 because the dashboard was not populating as expected, according to CFSA’s response to Child Welfare Monitor DC. So we do not know if that 50 percent decrease was correct nor how many cases have opened since that quarter. But we do know the number of children and families being served in their homes has dropped drastically since the start of the pandemic. The number of children served in their homes dropped by 12.6 percent from 1,441 to 1,259 between March 31, 2020 and the same date in 2021, as shown in Table Two below. This drop in children served in their homes is seriously concerning as in-home services are CFSA’s main way of monitoring the safety of children who are at risk of harm at home.
Table Two: Total Children Served in in their Homes, March 31, 2019, 2020, and 2021
Date
March 31, 2019
March 31, 2020
March 31, 202
March 31, 2019
1365
1441
1259
Source: CFSA Data Dashboard, cfsadashboard.dc.gov
Foster Care
Figure Nine examines foster care entries from March 2020 to March 2021, compared to the previous 13-month period. From March 2020, when the pandemic hit, through November 2020, foster care entries were always lower in the pandemic period, although the number of entries in July 2020 was almost identical to those in July 2019. But starting in December 2020 and continuing through March 2021, foster care entries each month were higher than that month in the previous year. The explanation for this trend is not obvious. Hotline calls and substantiated investigations did not eclipse prior-year levels until March 2021. But I pointed out in an earlier post the pandemic did not seem to be the main cause for changes in foster care entries earlier in the pandemic and this may continue to be the case.
Figure Nine
As shown in Figure Ten, there was a big decrease in foster care entries before the onset of the pandemic from the quarter ending March 31 2019 to the quarter ending September 30, 2019. After that quarter, foster care entries bounced up and down. Nevertheless there was some decline in foster care entries in the pandemic four quarters starting April 2020 compared to the previous four quarters. The number of entries in the four quarters before the pandemic (April 2019 to March 2020) was 269. In the four quarters beginning April 2020, the number of entries was 236. So the number of foster care entries during the pandemic period dropped by 33, or roughly 12.6 percent.
There has been widespread concern around the country that COVID-19 would create delays in the achievement of permanency for foster youth. Family reunifications could be delayed by court closures, cancellation of in-person parent-child visits and increased difficulty facing parents needing to complete services in order to reunify with their children. Court delays could also hamper exits from foster care due to adoption and guardianship. And indeed fewer children did exit foster care every month from March to September 2020 than in the same months in 2019, as Figure Eleven shows. This pattern changed after September, with monthly exits sometimes higher and sometimes lower than the previous year, perhaps as the agency and service providers adjusted to pandemic conditions and delayed reunifications began to occur.
Looking at the total number of foster care exits over time, we can see that foster care exits began to increase after the first two pandemic quarters. But exits did decrease overall during the pandemic period. The total number of foster care exits was 324 during the pandemic year from April 2020 to March 2021 compared to 400 in the previous four quarters, as shown in Figure Twelve.
Figure Twelve
During the four quarters approximately corresponding to the pandemic, there were 236 entries into foster care and 324 exits. As a result of the surplus of exits over entries, the total number of children in foster care declined from 737 in March 2020 to 648 in March 2020, which was a decline of 12 percent–similar to the 13 percent that we found occurred between September 2019 and September 2020. This is a continuation of a multiyear decrease in foster care caseloads. However, we did note in earlier testimony that the percentage drop in the number of children in foster care was greater in FY 2020 than in any other year since FY 2014. So the decline in the foster care rolls seems to be accelerating.
As shown in Table Three, the total number of children served either in-home or in foster care dropped from 2,178 on March 31, 2019 to 1,907 on March 31, 2020–a whopping 12.4 percent, which inclded a drop of 12.6 percent in children with in-home cases and 12.4 percent in children in foster care. It is important to note that this is a decrease of over 12 percent in one year in the total number of children served by CFSA, rather than a shift in the percentage being served from foster care to in-home. Moreover, while the drop in foster cases can be seen as continuing an earlier trend, the drop in in-home cases cannot: the number of in-home cases dropped only slightly more than two percent in the previous year.
Table Three
Date
In-Home No. (diff. from prev. year)
Foster Care No. (diff. from prev. year)
Total No. (difference from previous year)
March 31, 2019
1365
867
2232
March 31, 2020
1441 (5.6%)
737 (-15.0%)
2178 (-2.4%)
March 31, 2021
1259 (-12.6%)
648 (-12.1%)
1907 (-12.4%)
Source: CFSA Data Dashboard, cfsadashboard.dc.gov
To look further back, we used figures from the Center for the Study of Social Policy that date back to 2010 showing the total number of children served in foster care and in home on the last day of the fiscal year. Figure Thirteen shows that this total number served was actually increasing between FY 2017 and FY 2019 as continuing declines in the foster care population were offset by increases in the in-home population.
So the large (12.4 percent) drop in the number of children served by CFSA was not a continuation of an earlier trend. Foster care, but not in-home, caseloads were decreasing before the pandemic. It is extremely unlikely the number of abused and neglected children dropped by 12.4 percent from March 2020 to March 2021. It appears that this big decline results from a combination of a continuing decline in foster care placement and a reduction in in-home case openings due to the COVID-19 pandemic. It is concerning that the agency is serving a significantly decreased population compared to before the pandemic.
In sum, the newest CFSA Dashboard data show some encouraging signs of a movement toward normalcy. Referrals for March 2021 are higher than they were two years before and the number of investigations that are substantiated is approaching pre-pandemic levels as well. However, CFSA has displayed a concerning tendency to screen out a large percentage of the new referrals that are coming in. It is clear that CFSA responded to COVID-19 by screening out more education neglect referrals than ever before. And large decreases in the number of children receiving either in-home services or foster care as of March 31, 2021 compared to a year before raises the question of whether CFSA is performing its duty to protect abused and neglected children in the District. As the agency exits from court oversight in the LaShawn class action suit, it is important to ensure that some oversight continues. As we will argue in upcoming testimony, the Council should authorize an Ombudsperson for CFSA to make sure that somebody is monitoring agency operations in the interests of the District’s abused and neglected children.
Ever since the onset of the COVID-19 pandemic and the attendant lockdowns and school closures, there has been widespread concern about the safety of children who might be abused or neglected and are now spending school days at home. Losing school meant the loss of both a safe space for six hours a day and a set of caring eyes to report on any concerns. In FY 2019, school personnel made 42.9 percent of calls to the Child and Family Services Agency (CFSA) hotline in the District of Columbia. Data on hotline calls show that indeed the number fell greatly in the wake of the pandemic but began to recover in the current school year. The newest data, from January through March of 2021, show that hotline calls were well below 2020 levels in January and February 2021, then jumped above these levels when schools opened in March. These data suggest that there is still reason for concern about the safety of children who are not attending school buildings, and a need for CFSA and DCPS to make a plan to check on the safety of all children who have not recently been seen.
Current DC law requires that students five through 13 years old who have 10 or more full school-day unexcused absences within a school year be referred to CFSA for “educational neglect.” Younger children are not required to attend school nor are their absences required to be reported. Schools are not required to report absences of youths aged 14-17, which are presumed to be the result of truancy rather than educational neglect, except under special circumstances.
Table One below shows the monthly number of calls to the CFSA hotline, known as “referrals,” from March 2020, when the pandemic emergency began, through March 2021, compared to the same dates of the previous year. (Note that March 2020 is included in both 13-month periods as the pandemic closures began in the first half of that month). DC’s sudden closure of schools for an extended spring break in March 2020 was followed by a chaotic virtual reopening, as schools and nonprofits strove to get children connected with computers and internet service. Not surprisingly the first three months of the pandemic produced a drastic drop in hotline calls, investigations, and substantiated cases of maltreatment. Reports stayed at basically the same level from April to August, unlike a normal year, when reports drop after schools close.
Chart One
Source: Data from CFSA Dashboard and data provided by CFSA for January-March 2020. Note: March 2020 data are shown twice in this table
On August 28, CFSA issued new operating procedures for schools in response to attendance concerns under COVID-19. The guidance stressed that child welfare involvement can be an “invasive and traumatic” experience for children and should be a last resort, with schools taking the lead on dealing with chronic absenteeism. CFSA also noted the unique challenges that remote learning provides for parents and stressed that these problems are generally not best addressed by CFSA. Accordingly, CFSA provided a list of steps to try to reach families and recommended that schools should take “as many of these as possible” before calling the hotline. In the guidance, CFSA warned that a report would be screened out “when the reporting school has not demonstrated exhaustive efforts to make contact with a student and family to resolve attendance matters, and/or the report is missing critical information.”
We do not know what impact these guidelines had on referrals from schools once school started on August 31, 2020. There was a modest uptick in in reports in September with the opening of virtual schooling, though it was much less than what occurred in the previous year. In mid-September, CFSA completed a webinar and related documents to be used to train teachers about how to spot abuse and neglect in a virtual environment. These materials were submitted to the Deputy Mayor for Education for distribution to LEAs in mid-September with the direction that all teachers assigned to virtual classrooms complete the trainings.
Perhaps in part due to the new guidance, hotline calls rose In October, and began to approach the previous year’s level in November and December. Unfortunately, the newest data shows that the improving trend did not continue in January 2021, when only 1,224 referrals were made compared to 1,862 in January of 2020. Reports did increase in February and especially in March, after about 20 percent of the school system’s population returned to school early in February. In fact, there were many more calls (2,253) in March 2021 than in March 2019 (1858), when all schools were open.
The big uptick in March referrals is concerning in view of the fact that only about 20 percent of students returned to school buildings that month. One wonders how many calls would have come in if all students had been back in school buildings. It is also interesting in light of a change in practice that CFSA announced early that month. As quoted in a letter from CFSA Brenda Donald to DC Council Member Christina Henderson, CFSA a sent a message to DC Public Schools (DCPS) and the Public Charter School Board early in March 2021 describing a new practice in screening referrals for educational neglect “due to the influx of reports for potential educational neglect and furthermore the city-wide attendance issues caused by the COVID-19 pandemic.” Under the new procedure, CFSA would reject any educational neglect referral for a family with whom the school or CFSA had been in contact within the previous 10 days of school. Exceptions would be allowed for families with a recent substantiation for educational neglect, a recent concern for other types of abuse or neglect, or a “clear demonstration of parental disregard for student’s education preceded by exhaustive school/community based efforts.”
In response to a letter from Council Member Henderson expressing concern about the new screening practice, Donald replied in her letter that in the second half of the school year CFSA often receives “a high volume of reports of children who have accumulated more than 10 absences.” She also stated that “on average, approximately 87 percent of the educational neglect referrals that CFSA receives are screened out and 64 percent of screened in referrals are unsubstantiated.” And she explained that the change was made in order to “meet report triage timeliness and ensure that the agency resources are used most effectively by ….responding to only those reports that contain allegations of parental neglect and/or document the impact of the absences on the student’s academic performance or general well-being; while screening out those reports that are submitted by schools for compliance purposes only.”
We do not have data on the proportion of educational neglect referrals that have been screened out during the pandemic. But it is interesting to look at the proportion of all referrals that were screened out during the pandemic, as shown in Chart Two. The screened-out percentage dropped sharply in May and June 2019, perhaps because of the drop in reports by teachers, who according to CFSA make many reports “for compliance purposes only.” After those months, the percentage of referrals that was screened out during the pandemic was pretty similar to pre-pandemic levels, except for March 2021. In that month, CFSA screened out 78.6 percent of calls, compared to 67.0% in March 2020 and 71.8 percent in March 2019. Perhaps this change reflects CFSA’s new screening procedures.
Chart Two
Source: Data from CFSA Dashboard and data provided by CFSA for January-March 2020
CFSA’s intent to keep a lid on educational neglect referrals is understandable. Administrators are afraid of being overwhelmed by referrals of educational neglect. Moreover, there has been considerable pushback by activists in jurisdictions like New York City about reports of parents being investigated for educational neglect when they were not able to obtain computers or internet service. However, it is important to note that while categorized as “educational neglect,” referrals from schools about absences often serve a much broader purpose than ensuring that children are going to school. Chronic absence is often the first indicator that the child is not safe. It may even be an indicator that the child is missing. In the case of Relisha Rudd, who disappeared in 2014 and was never found, 18 days of absences did not trigger a report to CFSA because the absences were excused with the help of a bogus “doctor” who was probably Relisha’s abductor.
So what can be done? In this extraordinary time of virtual education, CFSA ought to change its emphasis to protecting children (its actual mission) rather than avoiding referrals that it considers to be a nuisance. Rather than threatening schools with rejecting inappropriate referrals, CFSA should work with DCPS to make sure all students are safe. CFSA should first modify its recent screening changes. If a family has been in touch with a school within the past ten days, that does not mean the school has been in touch with the child, who may still be in danger. More important, CFSA and DCPS need to make a plan for checking up on all schoolchildren who have not been seen recently in the classroom. If the issue relates to technology, CFSA can facilitate solving the problem without substantiating the parents for educational neglect.
DCPS welcomed more students to school buildings on April 19, with the beginning of the fourth quarter, but most of these students were in wealthier parts of the city, where abuse and neglect are less prevalent. Without much hope for more in-person student contact before the fall, it is crucial that CFSA and DCPS collaborate to assure the safety of our most vulnerable children.
Child Welfare Monitor DC 