Child Welfare During a Pandemic
(Originally published (April 2020)
One of the scary characteristics of COVID-19 is its appearance of malign intent, i.e., to sicken and kill people (but not pets) by finding, exploiting, and thriving on human vulnerabilities, including:
underlying health conditions such as hypertension, diabetes, heart disease and other chronic illnesses.
the social inequities associated with these conditions such as inadequate housing or homelessness and poorly paid jobs with inadequate protections and no sick leave.
deficiencies in public health infrastructure resulting from decades of neglect by policymakers in both parties.
a lack of social solidarity and social discipline in some countries, states, and communities.
dysfunctional emotional coping mechanisms such as denial of the seriousness of the pandemic, wishful thinking about its duration and end point, and fantasies regarding fake cures; and
disdain for science and for the ethics of shared sacrifice.
The coronavirus acts like a dye injected into the brain to reveal “hot spots”; but the indicator of a vulnerability is not a color on a brain scan but rather, an increase in an infection rates and fatalities. However, like a bright color, COVID-19 fatalities make a vivid impression.
Child welfare vulnerabilities
Child protection systems in the U.S. depend on mandatory reporting of suspected child maltreatment, community surveillance of (mostly) low income families, investigations or assessments of alleged child abuse and neglect as a condition for receiving supportive services. CPS reports during the pandemic have declined in many states, including Washington State, by about 50%. In a typical year, CPS reports peak in the last three months of the school year as teachers and other school staff become better acquainted with children and recognize signs of child maltreatment. When school age children shelter-in-place and receive video on-line instruction, they are not being observed most days by school staff. In addition, other mandated reporters and extended family members are not having frequent personal contact with children and adolescents when families shelter-in-place.
The reality that U.S. child protection systems depend on surveillance of families by mandated reporters and require (by law) involuntary investigations/assessments of care giving practices following screened-in reports is so taken for granted by practitioners and child advocates in this country that this feature of child welfare systems may not be perceived as a vulnerability, even in a pandemic. After all, what is the alternative? Is an abusive parent likely to self-report, or ask for services in dire circumstances?
Public child welfare systems in many Western European countries have a larger voluntary family support component, and a smaller coercive function aimed at child rescue from severe child maltreatment. Parents are far more likely to ask for services when doing so does not invariably lead to a CPS investigation and possible child removal. Since the 1990’s, two distinguished commissions of experts and policymakers which have held hearings on child maltreatment fatalities have recommended that the federal government and states develop a service-oriented family support system or agency parallel to, but not part of CPS. These recommendations were dead on arrival in the 1990’s and in 2016 as well. They have received little or no consideration at the federal level. Currently, parents under severe stress who may be suffering from substance abuse and/or mental health conditions (as well as other problems), often have nowhere to turn for help unless they are willing to accept a CPS investigation. This is a serious design flaw of public child welfare systems exposed in a dramatic way by the coronavirus pandemic.
CPS should never be the only, or first, outreach to a troubled family absent allegations of severe maltreatment. Family support centers created through community collaborations of public and private agencies, with a modest amount of public funding for infrastructure, could offer troubled families services on demand. Some communities already have a family support center; or have some elements of such a center that could be expanded. The cost of funding these centers would not be prohibitive and would motivate families with urgent needs to reach out for help before they are reported to CPS. The main obstacle to an initiative of this type is not economic; rather, it is the inability or unwillingness of advocates and policymakers to imagine a less coercive approach to child welfare.
On March 18, the Washington City Paper ran a story titled “D.C.’s Child Protective Services Agency Doesn’t Yet Have Protective Equipment for Its Social Workers,” which stated that “D.C.’s child protective services agency does not currently have enough medical supplies – including masks, hand sanitizer, or gloves – to provide to all the social workers who serve on the front lines of child welfare investigations, according to several emails … including one by agency director, Brenda Donald.” Perhaps the lack of adequate protective equipment was understandable given the mid-March date and the lack of adequate equipment, including masks, in emergency rooms and hospitals. However, almost a month later (on April 13) the Oregonian published a story titled, “Multiple Oregon child welfare caseworkers have COVID-19, officials tell co-workers.” According to this story, staff in Oregon’s Roseburg office were informed that two of their co-workers had probably contracted coronavirus three weeks earlier.
An agency spokesperson informed the reporter that “some of the employees were out of the office sick for a significant period of time before they self-reported to their managers that their illness is suspected to be … COVID-19.” The director of Oregon’s child welfare system acknowledged that caseworkers who investigate CPS reports “do not always have access to personal protective equipment (PPE) such as N95 masks through work.” The Oregon child welfare director said that his agency had requested large supplies of PPE from the state “a couple of weeks ago”; but had not received the equipment because, by Oregon statute, caseworkers were not classified as first responders. Instead, the agency director asserted, child welfare staff were creating their own masks and reaching out to community partners for assistance. A child welfare spokesperson was unable to inform the reporter of the number of agency staff who had been found to have COVID-19.
It is difficult to find words scathing enough to respond to the information that in mid-April, after a lockdown of a month or more, CPS caseworkers in Oregon still lacked essential PPE and were depending on community partners to provide it, as the state’s policymakers did not view the needs of child welfare caseworkers as a high priority.
In Washington State, the response to caseworker safety was not much better during March and the first couple of weeks of April, despite protestations of some child welfare managers to the contrary. Some DCYF offices did not receive masks and other PPE until the second or third week of April, according to persons in a position to know. In the meantime, DCYF posted the following message on the intranet:
Based on guidance from both the CDC and the Department of Health (DOH) and discussions with Leadership and Labor, the Emergency Operations Center decided that it is in the best interest of our staff, our clients and the community to allow and advise staff to wear masks. This is not a mandate that you must wear a face covering. It is considered an additional layer of protection. Please be advised that if you choose to wear your own face mask, you will be doing so at your own risk. One reason is that face masks used outside of our PPE guidelines can give a false sense of safety and lead to complacency about hygiene measures, which could lead to an increase in the likelihood of touching your face while attempting to adjust the mask.
It is my guess that few caseworkers pay attention to patronizing and dangerous messages of this type from Olympia program managers. It’s not a confidence builder for line staff to be informed (implicitly) that PPE considered vital for personal safety by the CDC was not available through DCYF; and then to be warned that taking the initiative to create this equipment for oneself could be dangerous.
More recent messages to caseworkers from DCYF management have been strong, sensible and praiseworthy on issues related to caseworker safety; but it has taken time for DCYF, like other human services agencies and policymakers, to develop a proper regard for caseworkers’ safety and well-being during the pandemic. Governor Inslee recently issued a directive that human services agencies should not be placing line staff with underlying health condition in harms way. Many child welfare managers (to their credit) had already taken action to limit risk of the most vulnerable agency staff to COVID-19 infection by taking them off the front line. Still, the policy statement from Governor Inslee is likely to have made a positive indelible impression on many state employees in poor health.
Public agency managers have been limited by states’ inability to find adequate supplies of PPE, and (of course) by inadequate capacity for testing employees, foster parents, and children for COVID-19. The puzzle of how one of the most technologically advanced societies in the world has been unable to generate a large supply of an efficient, easy to apply COVID-19 tests has not been adequately explained; and there is surely plenty of blame to go around beginning at the federal level. Nevertheless, potentially life-saving technology is never fully applied to social problems until and unless societies and communities care enough about at-risk groups to demand its full implementation, regardless of cost.
The long-standing lack of social regard reflected in inadequate salaries and benefits combined with overwhelming workloads for first responders and human service professionals cannot be shed overnight, like snakeskin. Consider the following: at the height of the pandemic in New York City and surrounding communities, some first responders (i.e., paramedics) were making $37,000 per year with no paid sick leave or medical benefits, according to a story on PBS’s The News Hour. These paramedics worked 12 hour shifts during the pandemic, until or unless they became ill. Hopefully, one of the positive effects on communities of living through this pandemic will be that professionals and paraprofessionals who provide direct services to sick and emotionally troubled people and children will become more valued; and treated by the organizations that employ them with the understanding that their physical and emotional well-being is critically important to achieving the agency mission.
Home based and virtual child welfare
Caseworkers in Washington State and (presumably) many other states have worked from home during the pandemic; some may have rarely set foot in their office. Modern computer systems and smart phones allow documentation, court reports, supervisory consultation, and much other work to be done at home as easily as in an office. However, carrying out the day-to-day tasks of child welfare without the social interaction that occurs in an office impedes the development and maintenance of cohesive units, a necessary element required for emotional survival in a high stress challenging profession.
It is possible that one of the unintended consequences of the pandemic on child welfare will be a re-evaluation of the need for an office, or a re-purposing of the office as a place for meetings, training, and social contacts. Nevertheless, the emotional support and professional guidance which supervisors provide caseworkers is enhanced by regular personal contact. It is not responsible practice for inexperienced caseworkers to be supervised mainly by phone or email, with infrequent personal contact with their supervisor and other unit members. If after the pandemic has run its course, an experienced (employed more than 2 years in their current position) caseworker wants to work from home one or more days per week, their proposed arrangement can be negotiated with the unit supervisor. Even when an experienced caseworker prefers to work from home, she/he should be expected to assist in the mentoring of newly hired staff and to contribute to the social vitality and cohesion of the unit.
The single most controversial change in child welfare practice during the pandemic has been the use of video conferencing for parent-child visits rather than visits at the child welfare office, in the parent’s home or relative’s home, or in a public place such as a park. Child welfare agencies around the country have adopted different practices ranging from using video conferencing instead of in-person meetings for all visits, arranging visits on a case by case basis, or continuing with parent-child visits as usual. Some parent advocates are incensed that parents have not been able to visit their children in person; and have raised court challenges to the use of video visits.
Child welfare agencies are faced with the reality that foster parents are volunteers and, as such, cannot be required to participate in visitation arrangements that leave them feeling unsafe. This would be true even if there was an ample supply of foster parents, which is not the case. Washington State, like most other states and large cities, has an acute and chronic shortage of foster parents. On the other hand, a surprising number of foster parents develop positive cooperative relationships with birth parents, and might be willing either through COVID-19 testing, or in lieu of testing, taking the temperature of parents and their child prior to a visit, to allow in-person visits in public places or even in their own home. Experienced foster parents should be allowed (but never pressured) to agree to in-person parent-child visits during the pandemic. This is a dilemma, like many others, which COVID-19 testing would quickly resolve. It is not an issue that should be debated on ideological grounds or settled by judges based on case law. Rather, figuring out how to implement parent-child visits in a way that does not threaten foster parents and sustains the emotional connections of parents with their child is one more adaptive challenge created by the pandemic.
In his great history, The Great Influenza: The Story of the Deadliest Pandemic in History, John Barry comments regarding the 1918 Spanish flu: “… the virus would test society as a whole and every element within it. Society would have to gather itself to meet this test, or collapse.” COVID-19’s test of child welfare and other social institutions’ adaptability to changing conditions has just begun.