Out of Harm’s Way

by Richard J. Gelles Oxford University Press, 2017, ISBN: 978-0-19-061801-8, 186 pages, $27.95 I was excited to get my copy of Richard Gelles’ widely awaited new book, “Out of Harm’s Way.” Gelles is one of the giants of child welfare. He wrote“The Book of David,” which raised awareness of the unintended consequences of the prevailing family preservation ideology and helped inspire passage of the Adoption and Safe Families Act of 1997. Gelles spends two chapters of his new book on the case of Daniael Kelly, a little girl with cerebral palsy who was allowed to waste away and die in a dark room despite repeated reports to Philadelphia child protective services and an open in-home case. Her case resulted in 17 individuals being convicted of, or pleading guilty to, charges ranging from manslaughter to perjury, including the child’s parents and numerous system employees. Gelles asserts that governments respond to horrific deaths like Daniael’s by “rounding up the usual suspects.” These include adding money, staff and training; firing the commissioner; forming a blue-ribbon panel; and even changing the name of the agency. Advocates for children often respond by filing class action lawsuits, which result in court receiverships that often fail to achieve significant changes for children. In the rest of the book, Gelles lays out his own blueprint for system reform that “eschews the normal calls for more money, more staff, more training and more lawsuits.” His proposal is structured around four key “centers of gravity” that he says must be changed to improve the child welfare system and stop the horror stories. Gelles’ first recommendation is that the system must become child-centered. He asserts that most child welfare workers and administrators consider the parent, not the child, to be the main client. In the Daniael Kelly case, workers used their home visits to try to motivate Ms. Kelly, hardly glancing into Daniael’s darkened room. Gelles explains that U.S. law and tradition grants parents broad discretion in how to rear their children. This bias toward parents was accentuated after the passage of the Adoption Assistance and Child Welfare Act of 1980, which required that agencies make reasonable efforts to maintain a child at home and to reunify those who are placed in foster care. Gelles argues that “the most important step in child welfare system reform is that agencies and the workforce understand that the child is the most important client in the child welfare system. Making the child the client means that the safety and well-being of the child is the primary concern and goal of the child welfare system. Moreover, and equally important, decisions regarding children must be made by considering a child’s sense of time.” Gelles could not have said it better. Making the child the client, and restoring child safety as the preeminent goal in child welfare, is indeed the first step in any meaningful reform. Adhering to a child’s sense of time, even if that means limiting the amount of time it takes to kick a drug habit or treat mental illness, is an important aspect of a child-centered child welfare practice. Gelles goes on to explain the central dilemma in child welfare. We have to decide whether we are more interested in reducing false negatives or false positives. A false negative is a case such as that of Daniael Kelly, who died because social workers missed the actual maltreatment that was going on. In order to avoid more Daniael Kellys, he argues, we must tolerate a larger number of false positives: children removed from homes where they were not in danger. While Gelles is right about the tension between false positives and false negatives, I think he may be too pessimistic. He dismisses the claim that underfunding results in some of these tragedies, but I disagree. There is almost universal agreement from around the country that workers are overwhelmed. (That was certainly true for me as a foster care worker in the District of Columbia, which has some of the lowest caseloads in the country.) If these systems were adequately funded, they could hire more qualified workers and give them lower caseloads. More qualified and less overwhelmed social workers could spend more time with families and make better decisions. Moreover, if we develop better methods for assessing risk, we may reduce the number of false positives we have to incur in order to identify the children who are truly in danger. Indeed, Gelles’ second major recommendation is that social workers must be given better tools — namely predictive analytics tools to assess risk of future abuse and neglect — to help them make better decisions. But Gelles is right when he points out that predictive analytics might not reduce child maltreatment fatalities. That’s because only about half of fatalities occur among children who are known to the system. He demonstrates that even an algorithm that was 99 percent accurate would create more than 10 false positives for each of the fatalities that it actually predicted. Unfortunately, Gelles does not devote any space to how we could prevent those fatalities, as well as other cases of abuse and neglect that are never reported. Most experts agree on the need for primary prevention programs like home visitation that seek to prevent abuse and neglect before they occur. Perhaps this is outside the scope of the book, because it is outside the child welfare system. But it needed to be mentioned. Gelles’ third “center of gravity” is funding structure, and his argument is that the current structure creates a “perverse incentive to keep children in foster care.” As a result, he recommends turning Title IV-E into a block grant. This “perverse incentive” narrative has become accepted in the child welfare community. The only problem is that it is not true. Most of the funding streams states use for child welfare services — Temporary Assistance for Needy Families, Medicaid, Social Services Block Grant and Title IV-B — can be used to support children outside foster care. Moreover, only half of children taken into foster care are eligible for IV-E reimbursement due to the archaic 1996 provision linking IV-E eligibility to eligibility for welfare. Given these facts, it is highly unlikely that states are putting children in foster care for financial reasons. Gelles’ strong advocacy for turning Title IV-E into a block grant based on its past spending is unfortunate and contradicts his call for a more child-centered system. With capped block grants, a state facing a crisis, like the current opioid crisis that is causing caseloads to rise in many states, or simply an increase in population, might find itself without funding to remove children from unsafe homes. Gelles’ last set of recommendations centers around the children who age out of foster care. He calls for a “Transition Account” available to every youth who ages out of foster care. The account would be usable for education expenses, vocational training and housing. A transition account might be a good idea. However, I’m surprised that Gelles makes no proposals for improving foster care quality, instead attempting to atone for its inadequacy once children leave. If more youths in foster care had loving foster parents who worked closely with schools and mental health providers or lived in excellent boarding schools where top-quality education was connected with therapy, sports and arts, many more might graduate from foster care with jobs and careers. Moreover, many emancipated foster youths are part of a much larger population of disconnected youths, who fail to make the transition from school to work. We need new policies that keep youth in school and connect education to work activities. Youth apprenticeships and career-based high schools are among the programs that are gaining in popularity. “Out of Harm’s Way” provides a lot of good information and food for thought. Gelles’ call for a child-centered system is the strongest and most effective part of his book. Perhaps the weakest is his contention that we could fix the system without more funding. If we continue to skimp on addressing child maltreatment, we will continue to pay far more to address its consequences, including crime, mental illness and intergenerational poverty. — Marie K. Cohen worked as social worker in the District of Columbia’s child welfare system for five years. She is a member of the Citizen’s Review Committee for the DC Child and Family Services Agency and the DC Child Fatality Review Commission and a mentor to a foster youth. Find her on Facebook at Fostering Reform or on Twitter@fosteringreform.

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