The Child Abuse Prevention and Treatment Act (CAPTA) recently turned 50. The act, enacted in January 1974, denoted the beginning of the federal government’s role in providing funding to states for the prevention, identification, and treatment of child abuse and neglect. As part of this, CAPTA provides federal grants to states to fund Child Protective Services (CPS).
Although CPS has undoubtedly protected numerous children from harmful circumstances, a recent study from researchers at Stanford School of Medicine revealed that when it comes to mandated reporting in the U.S., medical staff tend to over-report cases of child abuse involving Black children while under-reporting those involving white children.
Given this alarming news, HHS should institute oversight of those making repeated calls to CPS on Black children and families and implement consequences for healthcare personnel who misuse this authority. Such misuse is a form of medical negligence.
Medical negligence is a situation where a healthcare professional fails to provide the standard of care, leading to harm to the patient. It is well known by healthcare personnel that CPS intervention can cause harm. The cost of constant calls to CPS is high and puts Black children at risk of removal from their homes. Black children are already more likely to be removed from their homes, and they are twice as likely as white children to be placed in foster care. This disparity is especially pronounced in New York and Chicago, where Black children are over four times as likely to be removed from their homes and put in foster care.
Nationally, Black families are overrepresented in reports of suspected maltreatment and are subjected to CPS investigations at higher rates than other families. Alarmingly, over 50% of Black children undergo an investigation by child welfare services before reaching the age of 18.
CPS can be inappropriately used as a weapon against Black families. In medical settings, weaponization of “mandated reporting” to CPS can be punitive in nature or caused by errors or exaggerated reports.
These disparities are a contradiction of professional and ethical standards. The medical community has not acknowledged this issue adequately, which ignores the doctors’ medical ethics of nonmaleficence, “do no harm,” and the social work oath emphasizing a commitment to promoting social justice.
Even now, 50 years later, CAPTA still funds programming that disproportionately harms Black children and families. It is used as an instrument of discrimination by those who are supposed to protect and support. It is not surprising that Black families would not welcome CPS with open arms, further creating a wedge between a family in need of support and the healthcare personnel who should be providing it.
Patients and society place immense trust in healthcare providers, and the consequences of continued deviation from the standard of care should reflect the gravity of their actions and the trust bestowed on them.
To be sure, CAPTA has been successful in many ways. Since its implementation, understanding of the complexities of child abuse and neglect has dramatically expanded. This enhanced knowledge has led to more effective interventions for at-risk children and their families.
Yet, there remains an acknowledged need for CPS reform. For example, in September 2023, the New York State Assembly met with the Children and Families Committee and Foster Care Subcommittee, and is pushing for reform because of these inequities towards Black children and families. States like Colorado and North Carolina are also trying to reform their services.
Despite the ongoing failures of CPS fueling the cries for reform, there are no repercussions for those who inappropriately report under the guise of being a “mandated reporter.” When mandated reporters repeatedly target Black families, these families often find themselves without adequate support to communicate their needs and, when appropriate, get the case closed expeditiously. This leads to a long, drawn-out tug-of-war between a struggling family and a behemoth entity.
To truly address and reduce the disproportionate impact on Black children and families, a multifaceted approach is necessary. Firstly, HHS should initiate a thorough investigation in cases where a Black family faces multiple CPS reports. This investigation would entail scrutinizing the nature and origin of these reports, focusing on identifying whether there is a pattern of targeted reporting by specific healthcare personnel or health system, or if the family needs more support that they have otherwise not been able to obtain. HHS should provide an advocate for the affected family to support them through the CPS process and ensure the family’s needs are represented adequately.
Additionally, there should be a federal database detailing healthcare personnel and health facilities or systems that file CPS reports, the race of the patient and family, and the outcome of each report. This will illuminate a situation where one individual or facility is filing numerous unfounded CPS reports. Then HHS should implement a stepwise approach for healthcare personnel or facilities implicated in repeated unfounded CPS reports.
To start, individuals should be placed under probation and monitoring, and undergo mandatory training to address this deviation from the standard of care, which is a racist practice against Black children and families that leads to harm. Facilities or health systems should be monitored closely as well.
Finally, HHS should consider more stringent measures in severe cases involving multiple deviations from the standard of care in CPS reporting pertaining to Black children and families. The most immediate and significant consequence for healthcare personnel should be losing or suspending their professional license, preventing them from practicing. These steps ensure accountability and deter the misuse of CPS reporting, thereby safeguarding the rights and dignity of Black families unjustly targeted.
Onyi Okeke, MD, is a child psychiatry fellow at the Yale Child Study Center at Yale University in New Haven, Connecticut, and a Public Voices Fellow with the OpEd Project.