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Commentary: Struggling families deserve help, not punishment

Commentary: Struggling families deserve help, not punishment

What if I said only deserving individuals — meaning people who meet some government standard of personal responsibility — could get a COVID-19 vaccine? Ridiculous, of course. Everyone is vulnerable to the coronavirus and equally worthy of protection.

But I see disturbing parallels in the child protection system. Too often that system punishes children and families because they don’t measure up. Because they are poor or have other resolvable problems.

Too often these struggling parents are accused of neglect and their children are taken away, when they should have been provided instead with appropriate support to stay. COVID-19 adds to the urgency: The pandemic has taken a heavy toll on families and exacerbated deep racial and class inequities.

As a pediatrician, I’ve known families who were ripped apart and children needlessly traumatized because parents were deemed neglectful when all they needed was a helping hand.

Two young Native American parents I know here in Washington state lost their children to protective services because they couldn’t find work or decent housing and lacked parenting skills. After being placed with another family, their 3-year-old exhibited signs of severe anxiety and depression — being so fearful of abandonment that the child followed others around the house, even into the bathroom. This was a preventable situation.

How do I know? Because in this case, a local nonprofit agency that partners with state government intervened to provide parenting skills, which helped speed the successful return of the child to the home. These interventions should be routine and available in communities nationwide before children are removed.

Imagine, for example, a world in which instead of removing a child, the parents got help with job training, access to day care and subsidized housing. In many cases, the serious but solvable crisis for a mother or father is drug addiction. But instead of treating poverty as a condition and substance abuse disorder as a chronic relapsing illness, a struggling parent in this country too often is treated as a criminal.

The long-term costs of well-meaning, but overly aggressive policing of families is staggering.

No matter how chaotic a home may appear, parents offer love and protection to their children. Removing a child inflicts lasting trauma. Research shows children in foster care are significantly more likely than other youths to drop out of school, face economic hardship as adults and suffer mental health problems. Poverty and trauma from one generation gets carried over to the next.

Of course, dangerous situations sometimes occur when children must be separated from their parents. But physical or sexual abuse represent a small number of child protection cases. About two-thirds of reports allege neglect, defined by nebulous criteria that too often confuse poverty and mistreatment. Systemic racism shapes those judgments: Black, Hispanic and Native American families are disproportionately targeted for child welfare investigations, and bias then factors into removal decisions.

For decades, since awareness of abuse and neglect gained wider attention, the child welfare system in the United States has prioritized keeping children safe by removing them from troubled homes. That approach, while understandable, is too often damaging.

Today we see hope in a growing understanding that poverty is not neglect, and families are worthy of support.

In my home state of Washington, for example, the legislature recently passed a child protection bill that raises the bar for removing a child, specifying that certain conditions in the home, including poverty, cannot be the sole reason for taking action.

In Louisiana, an expanding Family Preservation Court system emphasizes getting parents into drug treatment programs so they can maintain child custody. In Michigan, child welfare officials are working with outside experts on new approaches, a direct acknowledgement that the current system “perpetuates injustices” by taking too many children from families of color.

The organization I represent, the American Academy of Pediatrics, believes keeping families together whenever possible leads to better outcomes for children. And in the long run, it costs less than splitting them up.

My concern: Progress in caring for families is frustratingly piecemeal. Too many families remain vulnerable. What’s required is national recognition of the need to keep children safe with their parents, where they belong, whenever possible. With that commitment must come adequate funding in evidence-based programs to support the well-being of families.

We’ve made a similar promise as a society to end COVID-19. Everyone is worthy of a shot. We must take the same enlightened actions to protect our children.

Dr. Shaquita L. Bell is a clinical associate professor of pediatrics at the University of Washington and immediate past chair of the American Academy of Pediatrics’ Committee of Native American Child Health.


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