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An infant, a motel room, and a pile of needles: How we set up a vital institution to fail

 

I am prepping for an event at a Santa Fe foundation where my co-author and I will discuss chapter five of our book Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment. Of all our chapters, the one that made me the most nervous focused in reinventing child welfare. I was working with the New York City and Connecticut child welfare departments, setting up quality improvement programs, as we were finalizing this chapter. I was committed to candor but was afraid some random misstatement might make its way into a paragraph during the editing process and the chapter would be misunderstood. We had already agreed to a very provocative title, Chapter 5: An infant, a motel room, and a pile of needles: How we set up a vital institution to fail.

Our goal with the entire book was first and foremost to recognize the vital work of all child welfare staff. We also knew it was our duty to pull back a veil to reveal a system in crisis that was dealing with families in crisis.

As I work on the foundation presentation on improving child welfare, I find myself rereading chapter 5. Out of the 25 pages, seven paragraphs resonate strongly. I include them here to serve as a catalyst for discussion.

We all make mistakes, but when Child Protective Services makes a mistake it can cost a child’s life. While very rare, child fatalities may be the direct cause of a staffer’s misjudgment. It could be the result of missing or incomplete files, a case being transferred to other staff without sufficient briefings, or just having a very distracted week with a million other pressing tasks to finish. As former employees of child welfare operations, we have collaborated with some of the noblest, most hard-working colleagues we’ve ever encountered. But we also know that cases like Anna’s, to varying degrees, happen all too frequently in all too many communities. And that troubles us deeply.

You don’t need a license to have kids, and there’s no authority that routinely checks up on people to make sure they’re not botching the job spectacularly. But once in a while, things get so bad that we as a society decide it’s time to intervene, and that intervention takes the form of sending investigators out in the middle of the night to check up on the safety of a baby left in a hotel room. As we do with the police, we scrape together a pile of intractable problems from society’s most challenging corners, dump them into the lap of some bureaucrat, and say, “here, handle this.” Meanwhile, the rest of us get off easy, raging as we do against irresponsible moms, deadbeat dads, drugs, or perhaps an entire ethnicity, then calling it a day.

All things being equal, of course, kids are better off in the family home. The attachments we form to parents are powerful and rupturing them is all but guaranteed to bring with it major consequences. Kids taken away from their parents have all kinds of trouble relating to others – what we formally call emotional attachment – and those problems can continue for decades. This severely constrains their ability to build their own healthy families, make money, build social capital, and generally be happy.

Taking kids into custody, meanwhile, also causes them trauma. Foster homes are often in short supply, and group homes are a poor imitation of the family life that all kids need. The process, even with the most well-resourced child welfare system, adds a few straws to the camel’s back of emotional health in already traumatized children.

Further complicating matters is the practical matter of the backlash that taking kids into custody can create. Parents tend to dislike it, to say the least, and are often happy to engage in a protracted legal fight to regain custody. It can cause political problems as well, depending on how well the parents know powerful people. And of course, taking kids into custody drives up the numbers of kids in custody, putting pressure on the already overburdened system and possibly attracting unwanted attention from politicians and other higher ups. So there are all kinds of reasons, good and bad, to keep kids where they are, however less-than-functional the situation might be.

The Solution: Child Welfare 2.0

Our modest proposal is this: An in-house unit of a few staffers (staff size would depend on the size of the entire agency workforce and contracted partnering agencies) that is dedicated to a process called continuous quality improvement (CQI). Their mandate would be to use data to identify problems and solutions. They would be engaged in the four-step process of assessing, planning, acting and evaluating progress toward measurable and meaningful results. Their jobs, quite simply, would be to help everyone else do their jobs better, and to enlist elected officials and the general public in that cause.

The CQI unit would bring together the persistent positivity of a life coach, the discipline of an inspector general, and the passion of an evangelist. It would have carte blanche to look at every piece of paper and bit of data the department produced. It would have some degree of political independence, so as to avoid meddling from the people whose feathers it would need to ruffle. And critically, it would have some control over the department’s web site. The tasks of this CQI unit could be broadly broken up into three key areas: assessment and evaluation, planning and action, and publicity/transparency.

Unleashing Innovation

For those of you wanting all the details regarding the new CQI unit (and I hope you do), just turn to page 53. It’s a blueprint for moving forward with a mindset that embraces collaboration, data, technology and cross-sector work. As someone who has implemented child welfare quality improvement programs for societies as different as Santa Fe and New York City, I can safely say that creating the next version of child welfare in New Mexico is absolutely doable. It may sound like a mission to mars, but it’s desperately needed and the momentum is here. It’s not about if, but when. And for the sake of our most vulnerable children and families, Child Welfare 2.0 can’t happen too soon.

 

About the community conversation: The authors of Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment, Katherine Ortega Courtney, PhD and Dominic Cappello, discuss their book focused on how we must and can fix child welfare—a monumental challenge that requires the engagement of all of us. Thursday, June 28, 2018 2:30 PM - 4:30 PM, Santa Fe Community Foundation Fees: FREE. Please register. Contact: amclaughlin@santafecf.org or 505-988-9715. Download a free chapter here: www.AnnaAgeEight.org

 

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