Baby Doe: Why Can’t We Stop Child Abuse?

Jill Lepore, Baby Doe: Why Can’t We Stop Child Abuse? The New Yorker, 1 February 2016. “Last June [2015], a woman walking her dog on Deer Island, in Boston Harbor, came across a black plastic garbage bag on the beach. Inside was a very little girl, dead. The woman called for help and collapsed in tears. Police searched the island; divers searched the water; a medical examiner collected the body. The little girl had dark eyes and pale skin and long brown hair. She weighed thirty pounds. She was wearing white-and-black polka-dot pants. She was wrapped in a zebra-striped fleece blanket. The National Center for Missing and Exploited Children said that no child matching her description had been reported missing. “Someone has to know who this child is,” an official there said. But for a very long time no one did.”

Nineteen states (including Massachusetts) are being sued for their systems’ failure to protect children; Mississippi’s Division of Family and Children’s Services is struggling to avoid being put into receivership. Last year, the Annie E. Casey Foundation ranked Massachusetts third best in the nation in the over-all well-being of children. The best is not good….

The overwhelming majority of children who die from abuse or neglect are under the age of four; roughly half are less than a year old. In September, 2015, the New England Center for Investigative Reporting, a “Spotlight”-style nonprofit, released a story called “Out of the Shadows: Shining Light on State Failures to Learn from Rising Child Abuse and Neglect Deaths,” reporting that a hundred and ten Massachusetts children died between 2009 and 2013 in circumstances suggesting abuse or neglect, and that a third of them had been under the care of the D.C.F. [Department of Children and Families]. (This rate is the national average: across the country, about one in three children who die from maltreatment belongs to a family that had previously drawn the attention of child-protection services.) Long before anyone knew her name, it seemed all too likely that this would turn out to be the case with Baby Doe.

Even the best reporting, though, can’t help missing a feature of the story that can be seen only from the vantage of history. Child protection is trapped in a cycle of scandal and reform….

Programs for the poor are poor programs. And they are made poorer when they fail, and when they are needed most. Natural disasters like blizzards, earthquakes, and hurricanes drive reform and the allocation of resources, leading to improvements in public safety. The tragic but ordinary deaths of people in situations in which people are likely to die don’t usually change policy…. One feature of a scandal-reform cycle—“Kids die and heads roll,” [Maria Mossaides, director of the MA Office of the Child Advocate]  says—is a policy pendulum. “The pendulum has swung at least four or five times in the last forty years,” Mossaides says. It swings between family preservation (keeping kids with their family of origin) and removal (removing kids from their homes and severing parental rights so that the kids can be adopted). “We inevitably have cases where we don’t get the safety assessment right,” Mossaides says. “Then you have the high-profile death, and the pendulum will swing in the opposite direction.”…

This didn’t start in 2008 or even in 1980. The child-protection movement has origins in 1837, with “Oliver Twist,” Charles Dickens’s indictment of England’s Poor Laws. The policy pendulum was already so firmly in place by the eighteen-eighties that it was accurately described in a treatise called “Children of the State,” by Florence Davenport-Hill, an early advocate for foster care: “First we find the children placed in homes, but not safeguarded,” then “abuses are discovered” and the children are “in consequence massed together in some big institution” until there, too, still more abuses are discovered, and “in desperation they are dispersed again,” until, once again, abuses are discovered in homes, and the children are sent to institutions. The oscillation lately isn’t between foster homes and institutions but between reunification and termination of parental rights. The pattern remains the same….

The modern era in child protection began with the rediscovery of child abuse, in July, 1962, when the Journal of the American Medical Association published a paper called “The Battered-Child Syndrome.” The paper’s lead writer was a pediatrician named C. Henry Kempe. Kempe reported on what he characterized as an invisible epidemic. Only with X-ray evidence could doctors be convinced that the injuries seen in very young children—most of those affected were younger than three—were caused by beatings. Kempe wrote, “The bones tell a story the child is too young or too frightened to tell.”

In 1962, some ten thousand reports of child abuse were filed nationally. Between 1963 and 1967, all fifty states passed child-abuse-reporting laws. By 1976, the number of reports had risen to 669,000; in 1980, it was 1,154,000; it’s currently about three million. The staggering effect of Kempe’s article raises a question: Why, for all the attention paid to preventing cruelty to children during the Victorian and the Progressive eras, did interest fall off so dramatically between 1920 and 1962? There’s no reason to believe that the mistreatment of children declined during those years….

What was new, in 1962, was the extent and nature of the press coverage. Kempe’s article was picked up by Time, Newsweek, and the Saturday Evening Post. Between 1950 and 1980, the historian Barbara Nelson has reported, child abuse was the subject of more than six hundred articles in the Times alone.

Why was the press so interested in child abuse after 1962? One reason is that the unseen catastrophe was a mainstay of the early-sixties exposé. A month before “The Battered-Child Syndrome” appeared, The New Yorker serialized Rachel Carson’s “Silent Spring.” Seven months later, the magazine published “Our Invisible Poor,” by Dwight Macdonald. Carson ushered in the modern environmental movement; Macdonald is credited with helping to launch the War on Poverty. And Kempe launched the campaign against child abuse.

Still, that doesn’t quite explain the relative lack of interest in child abuse in the twenties, thirties, forties, or fifties. This is nicely addressed by Macdonald. “There is a monotony about the injustices suffered by the poor that perhaps accounts for the lack of interest the rest of society shows in them,” he wrote….

Generally, what has made the particular misery of babies and young children less boring is the attention paid to it by female political writers. Public attention to the welfare of poor children, the historian Linda Gordon has argued, coincides with eras in which women have had a strong political voice. It was therefore high when women were most actively fighting for the right to vote (from 1870 to 1920) and during the women’s-liberation movement (from 1961 to 1975).

Interest in the welfare of children in the sixties was also part of that decade’s ambition to end poverty. But the triumph of the report-abuse model marked the abandonment of that ambition. The turn came in the early nineteen-seventies. In 1971, Congress considered the Comprehensive Child Development Act, a last piece of Great Society legislation, an entitlement program providing for universal preschool education (referred to, during congressional debate, as “developmental day care”), with tuition scaled to a family’s ability to pay. The bill’s lead sponsor was Walter Mondale…. Supporters of the Child Development Act cast childcare as a civil-rights measure. Not since the 1964 Civil Rights Act had a bill been subject to more intense lobbying. The bipartisan vote in the Senate was an overwhelming 63–17; the victory in the House was razor-thin, 186–183. In December, 1971, Nixon, who was running for reëlection on the back of a strategy that involved an appeal to conservatives, vetoed the bill. Pat Buchanan drafted Nixon’s veto message, in which Nixon said that “for the Federal Government to plunge headlong financially into supporting child development would commit the vast moral authority of the National Government to the side of communal approaches to child rearing.”…

The abandonment of a federal childcare program made the independence of poor women impossible. What liberals sought, in its place, has proved disastrous…. Nixon had defended his veto of the childcare legislation on the ground that it had not been subject to sufficient debate or hearing. Mondale was determined that the same would not be said of the child-abuse legislation. In 1973, his subcommittee convened four days of public hearings in three cities. The lesson Mondale learned from Nixon’s veto was that the care of children had to be distanced from the care of the poor. Mondale insisted, again and again—and against all evidence—that child abuse has nothing to do with poverty….

Out of those hearings came the Child Abuse Prevention and Treatment Act, signed by Nixon in January, 1974. Caring for children came to mean emergency intervention, to stop them from being murdered—Victorian infant life protection, revisited—notwithstanding the glaring fact that federally funded child-protective services that handle three million reports of child abuse every year represent a far, far more intrusive form of state authority over family life than federally subsidized childcare could ever have constituted. Meanwhile, the idea that the government might have a different kind of obligation to poor mothers and their children slowly faded away….

Between 1970 and 2000, the number of infants murdered, per hundred thousand infants in the population, rose from 5.8 to 9.1. Other measures are even more troubling. Today, the United States has one of the highest rates of childhood poverty of any nation in the developed world. Then, there is the matter of the criminal-justice system. A study conducted last year by Citizens for Juvenile Justice found that seventy-two per cent of youths in the Massachusetts juvenile-justice system had been involved with the D.C.F.; fifty-seven per cent of boys and fifty-nine per cent of girls had their first involvement before the age of five; more than forty per cent had their first involvement before the age of three. The children in both systems are disproportionately nonwhite. The problem isn’t only that the kinds of family that attract D.C.F. involvement tend to raise children who might later have trouble with the law; it’s that D.C.F. involvement itself “can increase the likelihood of future delinquent activity.” The system has contributed to the establishment of a juvenile version of the carceral state, a birth-to-prison pipeline. It is outrageously expensive, devastatingly ineffective, and profoundly unjust….

[Linda] Spears [commissioner of the MA Department of Children and Families (D.C.F.)] believes that responsibility for the scandal-reform cycle lies not only with the press and with legislators but with the child-protection movement itself….

The newest regime in child protection is the quantitative analysis of risk….

The murky science of risk assessment relies on attempts to quantify “trauma” and “adversity,” which, on the one hand, are meaningful clinical concepts but, on the other hand, are proxy terms for poverty….

The noble dream here is that, if only child-protective agencies collected better data and used better algorithms, children would no longer be beaten or killed. Meanwhile, there is good reason to worry that the ACE [adverse childhood experiences]  score is the new I.Q., a deterministic label that is being used to sort children into those who can be helped and those who can’t. And, for all the knowledge gained, the medicalization of misery is yet another way to avoid talking about impoverishment, destitution, and inequality. “Adverse outcomes?” Spears asks. “Adverse outcomes are what happen to poor kids.”

The tragedy of the child-welfare system lies, unnoticed, at the bottom of the chasm that divides American politics. On the right, in the aftermath of Roe v. Wade, Victorian child-saving was reborn as the pro-life movement, complete with the dead-baby exposé, right down to last year’s Planned Parenthood videos of “baby parts”: its concern with the lives of children begins with conception but ends with birth. On the left, feminists have generally aligned with the report-abuse regime, rather than serving as critics of it: when battered-woman syndrome followed battered-child syndrome, the recovery of trauma became feminist dogma. During the decades in which the right and the left battled over abortion, a whole raft of programs designed to prevent the neglect of young children were being dismantled….

A glimpse of what might have been, if the child-welfare path chosen in the nineteen-seventies had been anti-poverty instead of anti-abuse, and based in prevention instead of intervention, is a program called Minding the Baby, run jointly by the Yale Child Study Center and Yale’s School of Nursing…. [T]he program offers services to poor, first-time mothers between the ages of fourteen and twenty-five. The mothers, who are identified by community health centers, volunteer to participate. From pregnancy through the child’s second birthday, a pediatric nurse practitioner and a clinical social worker take turns making frequent home visits. They provide health care, promote development, and support mental health, taking on, to some degree, the role of a kind of grandmother, teaching young mothers how to understand what their babies are saying to them by being curious, and reading cues. This approach is known as reflective parenting. “Minding the baby” is meant to evoke a whole set of skills: how to mind your baby, how to keep your baby in mind, and how to know your baby’s mind….

Minding the Baby has completed studies of the mothers and babies who received care between 2002 and 2014, as compared with control groups. Results include higher rates of on-time pediatric immunization, stronger mother-child bonds, longer spacing between childbirths, and lower rates of child-protection referrals. Support for the studies was provided by grants from the National Institutes of Health and from a number of foundations. Much of that money supports research; it does not—and was never intended to—support the provision of services. In one of the sadder ironies in a field desperately in need of hope, with the clinical trials completed, and the value of prevention demonstrated, sources of funding for programs based on that model are few and far between.