This article originally appeared on the Government Innovators Network blog.
The list of potential uses for interagency data-sharing to improve child welfare outcomes is never-ending. Hospital data on low-weight newborns could be shared with Human Services to target in-home nurse visits. Police records of call-outs to domestic violence disputes in the middle of the night could be shared in real time with caseworkers visiting those homes the following morning. Physicians deciding whether to order bone scans for children with suspicious injuries could access child protection records to better inform those decisions. While there is an obvious need to balance this increased surveillance with privacy and procedural fairness, the benefits of sharing data to protect vulnerable children from abuse and neglect are hard to deny.
Beginning as early as 2001 in Michigan, a handful of states have explored the potential of interagency data-sharing through a policy known as Birth Match. The technique, also in place in Maryland, Minnesota, and Texas, involves cross-checking the birth records of newborns to information held by child protective services on whether the biological parents have had their parental rights terminated by a court due to the abuse of a previous child. This cross-check occurs in real time, sending any matches to child protective services to trigger an assessment of whether intervention is required. An intervention may involve the offer of preventative services, or in egregious cases, removing the newborn to a safe environment.
Data from the US Department of Health & Human Services show that approximately 1,670 children died from abuse and neglect in 2015, with children younger than 12 months dying from abuse and neglect at three times the rate of older children. For resource-stretched child protection agencies that allocate most of their casework to older youth moving in and out of foster care, newborn infants represent a highly vulnerable segment, often overlooked due to the absence of third-party witnesses to maltreatment. Using Birth Match to identify possible risks to the child based on the parents’ previous behaviour can allow caseworkers to intervene proactively and less intrusively with families before an injury or fatality occurs.
The most comprehensive Birth Match process is found in Michigan, which uses an automated communication process between its Family Independence Agency (Department of Human Services) and Department of Community Health Vital Records. The matches arrive in the form of daily alerts, leading to over 2,000 matches annually. In comparison, Maryland relies on a manual process of comparing new births against child welfare records, conducted weekly rather than in real time.
In New York City, any child born to a family in which a sibling is in state-supervised out-of-home care becomes the subject of an investigation by the Administration for Children’s Services (ACS), which may lead to the newborn being similarly placed in out-of-home care. Only with approval from the ACS Assistant Commissioner for the borough can the newborn stay in the family home. The justification of this policy, enacted in 2008, was the argument that if a sibling is not safe in the home, there must be a convincing reason why a newborn infant would be safe in that same home.
Currently, New York City’s Birth Match system relies on caseworkers to identify pregnancies or newly parenting families through observation of active cases. However, in September 2017, it was announced that the ACS is partnering with the National Council on Crime and Delinquency (NCCD) to implement SafeMeasures, NCCD’s web-based dashboard service to help child welfare workers access near-real-time data in order to manage their caseloads and prioritize the highest-need families, which may include Birth Match data.
LEGALITY OF DATA-SHARING
The 1997 Adoption and Safe Families Act (ASFA) required states seeking federal funding to adopt a law that limits the right to reunification for parents who have previously had their parental rights terminated by a court or committed other egregious acts such as murder of a previous child. The provisions, which were adopted by all 50 states, allow state child protective services to consider information about the siblings of the child being investigated when making a decision about that child’s safety.
Despite this clear legal framework, privacy issues have still surfaced when implementing Birth Match. For example, in Maryland in 2008, the legislation calling for the sharing of administrative data between the Department of Human Resources (Child Welfare) and the Department of Health and Mental Hygiene (Vital Statistics) initially failed in committee in the House due to concerns around the protection of sensitive data and whether birth records could be used confidentially for the Birth Match purpose.
Concerns regarding bias and procedural fairness when presupposing future child abuse based on the past actions of a parent also arose in Maryland. Therefore, instead of triggering a mandated investigation, matches in Maryland only trigger a voluntary visit from Family Preservation Services, with a formal investigation initiated only if abuse or neglect is suspected. Balancing the risk of harm to the child with the need to give parents the benefit of the doubt regarding their capacity to parent is a perpetual challenge for caseworkers.
Dr. Richard Barth, Dean and Professor of the University of Maryland School of Social Work, noted that “concerns are not infrequently raised about the fairness of Birth Match to mothers who, arguably, are often victims of circumstances well beyond their control and warrant a fresh start even after a documented failure at parenting a previous child.” However, Dr. Barth notes that while this is a reason to conduct a fair assessment of parenting performance and safety of the newborn’s environment, “this is not a reason to overlook the likelihood that preventative services will be needed to protect the child’s well-being or, even more so, that a protective services intervention is needed to protect the child’s life.”
THE WAY FORWARD
In March 2016, the federal Commission to Eliminate Child Abuse and Neglect Fatalities released its final report, providing recommendations for a comprehensive national strategy to reduce fatalities resulting from child abuse and neglect, pursuant to the 2012 Protect Our Kids Act. The report highlighted Birth Match as an important multidisciplinary tool, and recommended that states pass legislation to establish policies for matching birth data to data on termination of parental rights in order to conduct preventive visits. The report found that although no federal policies restrict the sharing of birth data between health departments and child protective services, few states have such systems in place. Professor Elizabeth Bartholet of Harvard Law School believes that “endorsement by the Federal Commission to Eliminate Child Abuse and Neglect Fatalities should encourage states to take this step.”
As more states consider adopting this approach, there will be criticism of the limitations of predictive analytics efforts like Birth Match. One particular barrier is ensuring that all births are captured in the data, which is not possible for children born at home with no birth certificate recorded or where children are born out of state. In addition, Birth Match only searches the biological parents listed on the hospital records, and does not screen other caregivers or partners who may have access to the newborn child at home.
Some critics are also concerned about Birth Match leading to a volume of false positives, where caseworkers open up unnecessary investigations in situations where a parent has successfully rehabilitated. However, Dr. Barth believes that failing to use compelling information of risk to guide child protective services “biases service delivery toward the wishful rather than the tangible.” In comparison, “the harms that young children suffer from highly dangerous parenting are very tangible.” Therefore, while predictive analytics may indeed lead to an over- or under-capture, tools like Birth Match can at least lend some assistance to help child protective services prioritize their scarce resources to higher-risk families to better protect children from potential harm.
The policy changes in New York City, Maryland, and Michigan were initiated by tragic infant deaths at the hands of parents who had previously had their parental rights terminated and were therefore already known to child protective services. Such tragedies reveal the value of data-sharing as a preventative tool, complementing the responsive tools already used by caseworkers, such as child abuse hotlines. States already have the technological and legislative capacity to put Birth Match in place. The data are readily available given that hospitals must report to health departments on the biological parents of newborns, and records of individuals who have had their parental rights terminated are publicly available.
Evaluation of the impact of Birth Match in preventing child abuse and fatalities is ongoing. However, anecdotal evidence from the jurisdictions where it is currently in place suggests that Birth Match provides an important puzzle piece in determining risk of harm. For caseworkers who are often required to make critical decisions in an information vacuum, each additional puzzle piece can help prevent an at-risk child from slipping through the cracks.