On the Revolving Door in Human Services, Tom Morton, and CPS Risk Assessments

In a previous posting, I wrote about a peculiar phenomenon in the field of human services. I noted that the boundaries between various compartments in the field of human services are porous, “with state-level human services administrators effortlessly transferring from one tidy compartment to another. Child welfare administrators in particular are apparently immune from the perils of unemployment – even in this difficult economy. Over the years I have observed that they buzz around the nation like so many busy bees pollinating the flowers that will ultimately produce the honey that is increased federal revenue.”

Writing in Arizona Law Review, Professor Daniel L. Hatcher of Baltimore University describes this as the “revolving door” in the field of the human services.

The last time out, I’d used Peter Digre as an example. And why not? After all, he was hailed as a reformer in TIME Magazine, and he testified before a Congressional committee as an acknowledged expert in his field. He was a superstar, as well as a “genius” when it came to raking in federal revenue.

Digre, however, apparently does suffer from something of a memory problem. When he was deposed in a lawsuit, some years ago, he was asked about a particular statement that he’d made while testifying in Congress. Digre claimed that he could not recall the statement. Let me ask you this question: If you had the chance to testify before a Congressional committee, wouldn’t it be an experience that you’d remember for the rest of your life?

In case you’re wondering, Digre candidly admitted to legislators that about half of the removals of children from their homes in Los Angeles are due to poverty, and not to abuse or neglect.

“It gets down to those very specific issues about a place to live, food on the table, medical care, and things like that,” he explained, adding, “about half of the families are not physical abusers, not sexual abusers, not people with propensities to violence but simply people who are struggling to keep ends pulled together and are eminently salvagable.”

This was too much for Congressman Herger, who replied: “Evidently, it is your department’s practice to remove children from families in about 50 percent of the cases because they don’t have enough money.”

To this day, I remember finding those words etched in a dusty volume on a shelf in a local university about a decade ago. But Digre could not recall having made that statement at all. Imagine that. But, enough about Digre. I gave him enough coverage the last time around.

Let’s take Thomas Morton of the Child Welfare Institute of Georgia as an example this time around.

I’d briefly spoken with Morton in September of 1995 in reference to an article by R. Bruce Dold in the Chicago Tribune that said: “The Child Welfare Institute determined that in one-third of the cases, there was absolutely no reason for the children not to be home with their parents. The children were in foster care for the protection of their caseworker, not for their own safety.”

One third of an Illinois sample of foster kids being in care for reasons of defensive social work was big news to me, at the time, and I was rabid for a copy of the study. Morton declined to provide me with one, saying that it was “confidential.”

Morton was furious that the results of his study had been leaked to the Tribune by a DCFS insider, and he made a statement to the effect that the journalist who had reported it would face some serious repercussions.

Morton’s angry chest pounding at the time notwithstanding, I’m happy to report that Bruce Dold is still with the Tribune in the capacity of editorial page editor.

THE FALSE CLAIMS

In an article published in 1999, I wrote about a False Claims Act filing, explaining:

    The second amended civil complaint in the case, a copy of which is in my possession, alleged that contractors Cornell University, the State University of New York at Albany, Brockport and Central, The City Colleges of New York, Unisys Corporation, Motivational Systems, Inc., Child Welfare Institute, Inc., Jeffrey L. Bass Associates, Inc., and the Institute of Child Mental Health, Inc., “knowingly engaged in collusive bidding contrary to federal statutes and regulations,” and that “the contractors submitted knowingly inflated budgets and vouchers for payment, the State and the defendant individuals knowingly approved such budgets and vouchers, and the State knowingly paid such vouchers, all knowingly contrary to federal statutes and regulations. The State then knowingly submitted false claims, statements and reports, and knowingly made false and concealing records, to cause the United States to approve and pay money to the State grant programs.” The settling defendants included the New York State Department of Social Services, the Office of Human Resource Development, the State Universities of New York (SUNY) at Albany and Brockport, SUNY Central Administration, the Research Foundation of SUNY, the State University College at Buffalo, the City University of New York, and NYSDSS employees Robert Donahue, Robert Hagstrom, Carol Polnak, Carol DeCosmo and Will Zwink.

A prepared press release from the U.S. Justice Department describes the settlement that thereafter ensued to the tune of $26.97 million.

THE RISK ASSESSMENT WAR

Subsequent to the collusive bidding scandal, Morton became embroiled in a bitter exchange of words against the Children’s Research Center and the North American Resource Center for Child Welfare concerning risk assessment. All sides raised some good points as they locked horns.

In an article entitled An Alternative View of Structured Decision-Making Research issued in November of 2003, Morton noted that studies touting the Structured Decision Making model being promoted by the Children’s Research Center suffered from “inherent structural limitations of the research designs, questionable statistics,unreported statistics, unanswered questions about the training of raters and the absence of further replication of these studies suggest that while the findings might be encouraging, they are far from definitive in establishing the efficacy of SDM.”

To his credit, Morton argued the salient point that:

    Explained variance may not be essential to classification, but it seems relevant to justifying non-voluntary heightened government intrusion into families. Is a risk scale that explains less than five percent of the variance an adequate basis to compel a government intervention in a specific family? Once classified, families are no longer simply a member of a class. The family is now a child protective services case.

On this point, Morton does seem to be on the right track. A greater degree of precision is clearly needed before the state intervenes in the life of a family.

In September of 2003, Morton critiqued a paper presented as a draft copy at a training workshop in an article entitled The Risk Wars, noting that: “There is no doubt that research is needed to validate safety criteria and better training is needed to improve reliability of judgments. These needs not withstanding, the field is not well served by misrepresenting the realities of actuarial risk assessment and its current inability to estimate safety.”

In its rebuttal to Morton’s critique, the North American Resource Center for Child Welfare accused Morton of “ad hominem attacks on the paper’s authors, straw man posturing, misquotes and misrepresentation, and outright fabrication.”

The North American Resource Center for Child Welfare closed out its critique by saying:

    In conclusion, we would suggest that all try hard to keep self-interests in perspective, refrain from commercializing this important child welfare issue, become reacquainted with the ethical and professional implications of misquoting and misconstruing the work of others, refrain from ad hominem attacks, and to try to contribute to a rational and objective discussion of risk assessment in child welfare practice. The well being of families and children throughout North America depends upon our collective ability and willingness to address child abuse risk assessment issues objectively and rationally.

In an article entitled Response to Thomas Morton’s “Risk Wars” and “An Alternative View of Structured Decision Making Research” issued in February of 2004, the Children’s Research Center writes of Morton’s “proclivity to misquote and misrepresent the work of others” as being “well established.”

The Children’s Research Center painstakingly documents what it describes as “pure fabrication” and “serious distortions” on Morton’s part. The Center notes also that some other of his statements are “totally without foundation.” In its response, the Children’s Research Center explains:

    While it is easy to dismiss most of Mr. Morton’s “points” as distortions intended to only promote his own interests, deliberate misrepresentations such as those noted above should not be dismissed by the child protection field. They represent clear violations of any standard of ethical behavior.

BACK TO THE FUTURE

So, what ever happened to Tom Morton of the Child Welfare Institute after all of these nasty claims under the False Claims Act were finally settled, and the risk assessment battles finally died down?

Well, Morton’s such a “nationally respected” and all around wonderful guy that Clark County, Nevada, appointed him Family Services Director in 2006.

“Not even a heartbeat separated Susan Klein-Rothschild’s abrupt resignation on Wednesday from the announcement of her successor at Clark County’s beleaguered Family Services Department,” the Las Vegas Review-Journal reported in May of 2006.

To be sure, Morton had inherited a deeply dysfunctional department from Klein-Rothschild. The Review-Journal reported that among the problems identified in Clark County’s network of child protective services by an expert panel appointed to investigate included “a lack of oversight that allowed poor practices by case workers to continue unchecked; safety assessments of children’s homes that were added to children’s files after they had already died; a lack of coordination between county entities such as Child Protective Services, law enforcement, the coroner’s office and hospitals; and lax efforts by social services to protect surviving siblings in cases of child death related to abuse.”

Jan Biggerstaff, chairwoman of Citizens Advisory Committee to the Department of Family Services said that many of the issues cited in reports about Family Services were problems that Klein-Rothschild had herself inherited, such as the poor communication between county agencies.

“It just seemed like she was always treading water,” Biggerstaff said. “I’m sure she was overwhelmed.”

Maybe so, but having taken the lucrative position with its annual base salary of about $135,601 in 2001, Klein-Rothschild had fully half a decade to stop being so overwhelmed and to take control over her agency.

The circumstances surrounding Morton’s appointment as her replacement are interesting. “In 2005, the county contracted with Morton’s Child Welfare Institute to review 11 child fatalities related to open CPS cases and recommend improvements. The review, which included several recommendations for improving performance, did not find the county to be negligent in any of the child deaths,” the Review Journal explains.

Morton’s appointment was met with criticism by Donna Coleman of the advocacy group Demanding Justice for America’s Children. Coleman reportedly objected to the county manager’s decision to forgo a national search, since the process could have heightened the profile of child welfare issues in the community.

“This was a huge opportunity for the community to get involved,” Coleman said. “I’m very disappointed with the secrecy and the going behind everyone’s back to hire this person.”

Morton barely had time to settle into his executive office when the Review-Journal reported on the disappearance of Everlyse Cabrerain from her foster home in July.

“There have been so many cases of children who’ve been injured or who’ve died while in foster care,” said Donna Coleman. “But it’s been like no one in Las Vegas has been paying attention until now.”

Coleman, flipping through a notebook that she uses to track the deaths and injuries of children in protective custody, cites the case of Jushai Akua Spurgeon, who was scalded to death in 2005 while in foster care at the age of 14 months.

Three-month-old Genesis Acosta-Garcia died in 2005 while in foster care. The family had requested an autopsy into the death, which was attributed to a viral infection.

As of March of 2010, Everlyse was still among the missing, according to the Charley Project’s page devoted to her case. And there were indeed some questions surrounding her disappearance, as the Project explains:

    On the day Everlyse’s parents last saw her, they noticed she had a burn on her hand. They asked for an explanation but got no answer. Curiously, a previous foster child of the Carrascals sustained second- and third-degree burns. Eight hours later, he was finally taken to the emergency room and had to spend the night in the hospital. Vhee claimed he had been burned by hot soup. Neither she nor her husband were accused of abusing the child, but he was removed from their home. The Carrascals had demanded the immediate removal of several other children placed in their home, leading to concerns from the DFS about their level of commitment to being foster parents. They also failed to complete the training required of foster parents, but their foster home license was renewed anyway, two months prior to Everlyse’s disappearance.

Thomas Morton is now king of the proverbial hill, presumably not only in control over the variety of risk assessment tool that is to be used in the field, but of how it is to be used as well.

It didn’t take the National Center for Youth Law too terribly long to notice that Tom wasn’t particularly up to snuff. An article dated April 14, 2010, cited on the Center’s web site explains that a federal lawsuit had been filed – one that “accuses state and Clark County officials of overseeing a child welfare system that violates state and federal law.”

A press release from the National Center for Youth Law describes “overwhelming evidence of the harms and risks suffered by all children in the system, including physical, sexual, and emotional abuse, denial of medical and mental health care, and chronic instability. In the most tragic cases, children have lost their lives while in the care or under the protection of the Clark County Department of Family Services.”

I’d imagine that Thomas must have around this time developed a major Excedrin headache. Imagine being accused of violating state and federal law twice in one’s lifetime. I’d be worried about that one myself, but then I’m not an administrator in the field of human services.

I sure do hope that Morton thought to call the Child Welfare League of America’s National Center for Field Consultation for help with “coping with child welfare litigation.” Maybe Tom can get a job there if he loses his current one due to the heat. After all, he’s quite familiar with being on the receiving end of child welfare related litigation.

OUT HERE IN THE FIELD

To get a better handle on what was going on, the Youth Law Center called in experts from around the country to conduct a study of what was actually going on in the field. One might imagine that with all of Tom’s pontification about risk assessment, that may have been borne out as a strong point. Guess again.

“A substantial number of the safety assessments simply were illogical,” the report explains.

The report notes that in some cases, no risk factors would be identified, and the child would be determined “safe,” but protective custody was taken anyway, suggesting that the defensive social work that Morton had identified in Illinois 15 years earlier may very well be taking place right under his own nose today in Clark County.

“Another example that occurred frequently is that several factors were checked, but the child was determined to be ‘safe’ and no action was taken,” the reviewers note, adding that some assessments had no factors checked whatsoever, but the child was deemed “unsafe.”

Not only is Morton a “nationally recognized expert,” but he is a self-proclaimed expert on risk assessment as well. And, he’s king of the hill. Yet, this is how it worked out in the field under his watch.

RISK ASSESSMENT REVEALED

A few words about risk assessment generally may be in order at this juncture.

As I’d explained some time ago in a published article, according to the literature of the child protection industry: “Assessing the risk of future harm to a child ‘is central to practice in the field of child welfare.” Risk assessment is “the driving force for any child protection service delivery.” Risk assessment consists of “the systematic collection of information to determine the degree to which a child is likely to be abused or neglected at some future point in time.” In practice, “risk refers to the prediction of future events.”

But can such divination truly be attained with any degree of reliability? The Australian Childhood Foundation explains: “Decisions made by child protection workers have serious implications. Both false positive and false negative predictions may have devastating effects on the lives of both children and families. Many risk assessment instruments, however, are in use despite little research demonstrating that they are more accurate and consistent than clinical risk assessments.”

In a report published by the Centre of Excellence for Child Welfare, researchers concluded that their analysis of risk assessment added to the “mounting body of evidence that clinical judgment using a structured risk assessment tool is an unreliable foundation on which to base critical child protection decisions.”

The reason that this is so is a matter of simple mathematics. A risk assessment instrument’s sensitivity refers to its ability to accurately identify actual or potential cases of abuse, while its specificity refers to its ability to screen out false positives. These two factors are in turn calculated against the base rate of what is being screened for.

Using a base rate of abusiveness of one percent among the general population, Tony Hoffman explained the results of a study sponsored by the National Institute of Health during an annual meeting of the Western Psychological Association, saying that: “considering the low incidence of abuse, even the slightest proportion of errors in detecting nonabusers creates a large proportion of positive cases that are false. Thus, even a test with .99 specificity and .99 sensitivity will diagnose abusiveness incorrectly 50 percent of the time.”

“Considering that such tests are needed for screening in primary prevention efforts, the primary prevention of child abuse may be a crusade doomed to failure,” Hoffman added, explaining that “it may be more valuable and ethical to emphasize secondary prevention efforts than to experience the predictive failures of a primary prevention effort.”

Hoffman concluded that: “An abandonment of the testing effort warrants serious consideration.”

Given that none of the risk assessment instruments in use today even approach such a degree of accuracy, they necessarily all have an unacceptably high error rate. But don’t just take my word for it.

No one would question that Eli Newberger is a man with sterling credentials as a child saver. Together with some associates at Children’s Hospital Medical Center, Boston, Newberger examined the issue of preventive screening, explaining that: “if the prevalence is low, the extent of misclassification is very high even with good sensitivity and specificity.”

Assuming a one percent level of prevalence, using a screening instrument with 90% sensitivity and 95% specificity would lead to an 85% frequency of false positives among all test positives.

Newberger and colleagues ultimately concluded: “The low prevalence of child abuse combined with even the most optimistic estimates of screening effectiveness implies that any child abuse screening program will yield large numbers of false positives – non-abusing families labeled as abusive or potentially abusing. The large social cost of this type of labeling makes such an approach unacceptable.”

Even the Godfather of the Adoption and Safe Families Act, Richard Gelles, conceded in his book that: “Clearly, children could be protected by a system of population wide risk assessment, but the problem of false positives is too great to overcome even with the most accurate risk assessment instrument.”

Given that the crème de la crème of risk assessment instruments – one that provides 99 percent accuracy in terms of both its sensitivity and its specificity – provides the result of 50 percent of the people identified by it being false positives, caseworkers may do well to consider further honing their decisions by means of tarot cards, astrology, phrenology, palm reading, rumpology, and other forms of divination.

BACK TO CLARK COUNTY

Returning once again to Clark County: “Allegation claims Child Haven numbers falsified,” blared the headline in an Las Vegas Sun article printed in August of 2010.

“A former Clark County child welfare administrator charges she was ordered to lie about the number of children at Child Haven to make it appear the county’s Family Services Department was doing a better job of placing children into foster care,” explained journalist Joe Schoenmann.

“Teresa Medina said she quit her $65,000-a-year job because ‘I was asked to falsify documents relating to the time children arrived to the center and when they were pushed out into foster care,’ she wrote in an e-mail to County Manager Virginia Valentine after she resigned,” Schoenmann writes.

“I was afraid of what I’d be asked to do next, what I’d be asked to lie about next,” she added, blaming Family Services Director Tom Morton for creating an “illusion that things are better for Clark County children.”

This is how the smoke is blown and the mirrors are spun in the field of child welfare to provide the illusion of progress. This is a familiar theme to reform advocates who remain perpetually frustrated by the overall lack of progress in the field.

This is due, in no small measure, to human services administrators buzzing around the nation, always ready to move from one locality to another to land another lucrative, do-nothing job in the poverty industry.

In case you’re wondering whatever happened to former Clark County Family Services Department head Susan Klein-Rothschild, not to worry. She landed a cushy executive position in the Public Health Administration in Santa Barbara, California, “where she oversees a broad range of programs that support the health of the general population.”