Recently, I consulted on a child fatality lawsuit case on behalf of a ten-year-old whose family was known to a county child welfare agency. She starved to death.
Every time I read the files in a fatality case, I’m convinced that we could significantly reduce the number of child deaths if we were more intentional and skilled in utilizing community-based, family support teams and programs to keep kids safe and families intact.
Families, especially those with the highest level of challenge, need interventions that are accessible, effective, culturally relevant and capable of creating social connections. This is our only chance to combat the social isolation associated with fatality-related chronic neglect. Families benefit from helpers who prioritize empathy and who understand the value of creating relationships through trust and familiarity. As it relates to child safety, even those families with the most dangerous behavior patterns are more reachable when we reduce the levels of physical and formal distance so that they can become part of a social network.
Starvation is real. It’s not a fabricated child maltreatment construct. In most cases, starvation takes weeks. We know what happens to a child during that period, when all their joint and muscle movements become painful. When they feel cold, tired and weak, and unable to concentrate, resulting in the inability to comprehend their situation.
Mostly, with starvation, there is no disguising the situation from others, unless the adult or adults responsible for the child’s safety and well-being make a conscious effort to hide them. It’s a radical manifestation of social disconnection and isolation by parents. And in the case I reviewed, the system had been called on to help them.
These types of fatalities are egregious outliers in our profession, but they rightfully get our attention. They epitomize the flawed notion that a single social worker visiting the home of a highly fragile family can expect to have much success. We throw parents and helpers together — strangers mostly — in a community or neighborhood where the helper might or might not know the formal and informal resources. Instead, knowledge of the family’s social and family orbit should be the helper’s North Star.
Child fatalities defy logical frameworks and our best attempts to learn from previous tragedies. It’s especially true for those resulting from chronic, long-term neglect, untreated mental illness or parental substance use. The death of a child known to us is a lesson in humility. Regardless of where we fall on the politics of child welfare, child fatalities are zero-sum events. And if a child who is known to our system dies, it means that somewhere along the line, disconnections occurred.
A good deal of the disconnection is based on our obsession with compliance metrics. We confuse the outcomes we can easily elicit and record with the ones we actually need, and then act accordingly. A prime example: handing a parent a referral instead of physically connecting them to a local, trusted provider whose purpose is to assure child safety and family well-being.
We shouldn’t settle for child protection “lite,” because there is no such thing. Alternative responses or community pathways should never be a convenient check box or default. Frankly, I’m not even sure why we consider a response “alternative,” when our primary role in social work is to support families. Family stability, safety and security are all part of the same continuum of responsibility. But when we are embedded in a community, we enhance the likelihood of parental connections to that continuum because we are more likely to do whatever it takes to reach a resident of that community.
The science of studying child fatalities is critical. It allows us to aggregate information and do more to reduce maltreatment-related deaths. Organized approaches and teams are also the system’s reparation of respect and attention that the victim deserved when they were alive. But we need to improve our capacity to measure the isolation and social connections prior to a fatality.
Fatalities should be wake-up calls, exposing a distilled version of how imperfect our current system is and how case mismanagement becomes the norm when we are watching and not working with a family. These types of deaths reflect a cascade of detachments — parent from child, child from nurturing adults, helpers from parents. It’s all part of our current system’s primary design flaw: failing to account for the importance of human connections.
In her best-selling book, “Blue Nights,” Joan Didion reflects on the unexpected passing of her adult daughter. She writes that there is a connection between a parent’s fear of “aging, illness and death,” and that of their child. “When we talk about mortality, we are talking about our children…I was never not afraid…of swimming pools, high tension wires, lye under the sink, aspirin in the medical cabinet…strangers who appeared at the door, unexplained fevers…The source of the fear was obvious: it was the harm that could come to her…”
As I read the files of this child fatality case, I didn’t recognize unrelenting, adult fear related to this child. I say that not in judgment of the adult but as a human condition that had been missed. A barometer for safety that a personalized community-oriented family support team would have addressed with the child’s caregiver, perhaps much sooner — again, another disconnection.
Early in my child welfare career, I decided that I could not be in the middle of nightmare cases every day and survive. I chose to align with family support and prevention programs, figuring if I was going to be pushing a rock up the hill, it might as well be a rock with a patina of hope.
In time, however, I realized that if we do this work correctly, the distinctions between child protection cases and what we refer to as family support are blurry. The common element is the building of relationships and social connections among helpers and the families they serve.
