In 2020, Allegheny will begin applying a similar algorithm to every family that gives birth in the county, with the goal of linking families in need to supportive services before a maltreatment case is opened. But some critics insist that it will be just another way for government to police the poor.

The new program is called “Hello Baby.” The plan is to eventually apply it across the county, but the January launch will begin in only a select few hospitals. Like the Allegheny Family Screening Tool, the Hello Baby algorithm analyzes family data to apply an individual family score.

Emily Putnam-Hornstein, who helped design both programs, told TalkPoverty that Hello Baby uses slightly different data than the child maltreatment algorithm, which was criticized for targeting poor families because much of the data used was available only for people who used public services.

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“This is a universal program,” explained Putnam-Hornstein. “In the [child services] model the county was being forced to make a decision after an allegation had been received; in this case we’re taking about more proactively using data … so we wanted that to be built around universally available data.”

But these exclusions don’t guarantee that the data will not end up targeting low-income families again. “They rely on data where the county has the potential to have records for every family,” said Richard Wexler, the executive director of the National Coalition for Child Protection Reform. “The county acknowledges they will probably use data from [Child Protective Services], homeless services, and the criminal justice system, so yes, theoretically everyone can be in that, but we know who’s really going to be in it.”

An overview provided by the county online cites “birth records, child welfare records, homelessness, jail/juvenile probation records” as some of the “available service data” incorporated into the predictive risk algorithm, indicating that Wexler’s assessment was absolutely correct. Although that data is potentially available about anyone, several of these systems are known to disproportionately involve low-income people and people of color.

Putnam-Hornstein said via email that the Hello Baby process is “truly voluntary from start to finish.” A family can choose to drop-out of the program or discontinue services at any time.

The option to drop out will be presented at the hospital, when families are first told about the program. A second notification, and chance to opt-out, will then be made by postcard. If a family doesn’t respond to the postcard, they are automatically included in the next phase of the program, which involves running available data through the system to determine how much social support each family needs.

According to Putnam-Hornstein, scores will be generated about four to six weeks after birth for families that do not choose to opt out (or who are too busy to realize they want to). Once a family is scored, what happens next varies based on which of three tiers they fall into.

Under the “universal” tier, the most basic approach, families receive mail notifications about resources available throughout the county. Families grouped in the second, “family support,” tier will receive a visit from a community outreach provider and an invitation to join one of 28 Family Support Centers located around the city of Pittsburgh.

The “priority” tier engages families with a two-person team made up of a peer-support specialist and a social worker who will work closely with the families to identify their needs and partner them with appropriate providers. It is designed to be an individualized program that grants families access to the full range of support services available on a case-by-case basis. That could mean helping a parent navigate the complexities of applying for housing assistance or ensuring timely placement in a substance use treatment program. The county said in its promotional material — which was reinforced by Putnam-Hornstein over the phone and by email — that choosing not to engage with any aspect of the program will not lead to any kind of punitive action.

But parents who need supportive services still have reasons to fear intervention from child services. The reality is that any program putting families in contact with social service and medical providers means, by default, also putting those families at greater risk of being reported to child services by placing them in more frequent contact with mandated reporters.

A mandated reporter is someone who is legally required to report any suspicions of child maltreatment they encounter. The intention is to ensure timely detection of as much child abuse and neglect as possible, but data have not shown that an uptick in mandatory reporting equates to more child safety.

In Pennsylvania, nearly anyone who regularly interacts with children in a professional or semi-professional capacity is legally considered a mandated reporter. An unfortunate side-effect of the mandated reporter system is that even though a referral program like Hello Baby is not directly involved with child services, participating families will always be haunted by the possibility of coming under investigation.

Putnam-Hornstein assured that family’s scores will not be retained or shared with child services, even for families under investigation — but noted that “it is possible that child welfare workers could infer the level of risk if the family has voluntarily agreed to participate in Hello Baby Priority services and a child welfare worker learned that when gathering family history.”

It’s clear that the new program is not designed to get families involved with child services, although it is spearheaded by the Department of Human Services, which oversees the Office of Children, Youth, and Families that conducts child maltreatment investigations and responses. Rather, Hello Baby was created with the goal of offering a more equitable way to expedite service referrals for families with new children who need them.

“Universalizing the assessment of social needs at birth is the only way to avoid discrimination,” said Mishka Terplan, an obstetrician and addiction medicine physician, who was not talking specifically about the Hello Baby program. He observed that patients with obvious social needs, such as those suffering from acute addiction, were often screened and referred for other issues, like postpartum depression or housing assistance, while other parents’ needs were going undetected and unaddressed. “That seemed unfair,” he lamented. Terplan believes that universal screening programs would eliminate both the disparity between services rendered, and reduce the stigma attached to needing behavioral health treatment and other social supports.

Hello Baby’s creators hope that offering families these programs before there is a child maltreatment complaint can help keep them out of the system altogether. But by using imbalanced data points like child welfare history, homeless services, and county prison history to auto-generate scores, it assumes poverty as the main basis for family need. While poverty does generate certain needs, it is not the only indicator for the whole range of unique social supports that new parents require, such as mental health screening or child care assistance.

A system that continues to embed data that target the poor may only end up automating the social inequities that already exist, while placing vulnerable families under increased scrutiny by mandated reporters for the child welfare system — even if it intends to serve as a universal screening process that helps families avoid punitive interventions.

“As long as the system confuses poverty for neglect, any form of such screening is extremely dangerous,” said Wexler.

Unfortunately, it’s very real, and the root cause of many  of the problems in child welfare cases.

“Some people do phrase it as a conspiracy theory,” acknowledged Richard Wexler, executive director of the National Coalition for Child Protection Reform. “When they say the government makes money on foster care, that’s not true … on foster care they still lose money, but they lose less money [than on reunification]. And private agencies do make money on foster care in many cases.”

In the United States, child welfare agencies are tasked with ensuring the health and safety of the nation’s children. Each agency receives a complex web of funding from federal, state, and local sources, leaving it accountable to a hodgepodge of authorities. Although these agencies are often referred to as “child protective services” and considered by many as a cohesive national program, state and local agencies are only linked by a loose set of federal guidelines that provide broad definitions for child maltreatment, along with the Adoption and Safe Families Act (ASFA).

First enacted in 1997 under the Clinton administration, ASFA has undergone several rewrites, but its overarching purpose has remained steady: to ensure “timely permanency planning for children.” Part of the emphasis on “permanency” includes financial reimbursements for foster care programs, as well as adoption bounties, which are lump sums in the thousands paid to states for each child they successfully adopt out after a certain threshold.

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This starts with the Federal Foster Care Program (Title IV-E of the Social Security Act), which functions as an open-ended entitlement grant. There is no upper limit to the amount of funding that can be provided for eligible foster children each year. States receive reimbursements ranging from 50 cents to approximately 76 cents for each dollar spent on daily child care and supervision, administrative costs, training, recruitment, and data collection.

But when it comes to programs that support family reunification, the budget slims. Title IV-B of the Social Security Act, which governs federal reunification funding, includes a capped entitlement component and a discretionary component. So, unlike foster care funding, these dollars come with a set limit.

And that limited money isn’t all for reunification services. Title IV-B also includes provisions that allow for some of this funding to go toward foster care programs. A portion is also required to go toward adoption promotion.

The result of this imbalanced funding structure? The federal government spends almost 10 times more on foster care and adoption than on programs geared toward reunification.

One of the less-known sources of federal funding for child welfare programs is the Temporary Assistance for Needy Families (TANF) program. TANF is supposed to be a cash-assistance program servicing low-income families with children, In reality, TANF funds can be used to support many services designed to help “needy” children, including child protection agencies. The result is that many states use TANF funds to finance foster care, child welfare investigations, and adoption or guardianship payments.

Because child welfare program data are self reported, it can be difficult to track exactly how each dollar is spent, but Wexler was able to identify eight states using TANF to pay for adoption subsidies, 23 states funding CPS investigations, 27 states funding foster care, and three states diverting TANF money to fund residential treatment facilities for child welfare involved children.

Considering that three-quarters of substantiated child maltreatment cases are related to neglect, which is often the result of poverty, it seems exceedingly unjust that funds supposedly intended to offset the worst effects of poverty are instead being used to finance the separation of mostly poor families.

Under ASFA, states are — with few exceptions — required to file for the termination of parental rights when a child has been in foster care for 15 of the past 22 months. In an attempt to curtail the infamous foster care hopscotch, which leaves children whose parents have lost their rights bouncing from foster home to foster home, the government created adoption payment incentives.

Adoption bounties range from $4,000 to $12,000 per child. As Wexler explained, “the harder the system deems the child to place, the higher the bounty.”

But in order to begin collecting that money, a state must exceed the last year’s number of adopted children, thus incentivizing states to permanently re-home an ever-increasing number of children each year. As can be expected, the number of adoptions increased in the five years after the implementation of ASFA, while reunifications declined. The Bush administration’s Adoption and Promotion Act of 2003 further codified this adoption bounty system by allocating $43 million yearly to states that succeed in increasing the number of adoptions from foster care.

Many states contract with private agencies that oversee out-of-home placements and service referrals for child welfare involved children. Said Wexler, “that agency will probably be paid for each day that child remains in foster care … So the private agency has an incentive to convince itself that the child really, really can’t go home and has to stay with them for a long, long time.”

What does this look like on the ground? Painfully delayed referrals to support services such as parenting classes and addiction treatment, judges hesitant to find fault with the way agencies and providers handle cases, and private agencies eager to deem parents unfit for reunification.

There have been some recent moves at the federal level aimed toward shifting some of these financial imbalances. The Family First Act, signed into law in 2018, now allows federal reimbursements for mental health services, evidence-based substance use treatment, and in-home parenting support. Its purpose is to create similar incentives for helping families stay together.

Unfortunately, the act does not support many of the common needs that lead to family separation, such as housing or child care support. And because the programs it does support must meet stringent requirements in order to be eligible for reimbursement, foster care and adoption subsidies continue to exceed reunification programs by the hundreds of millions.

Mandy had tried methadone, another medication similar to buprenorphine, three times unsuccessfully, but was determined to maintain sobriety this time. When she learned that she was pregnant, using again became a “hard no.” She enrolled in a comprehensive, high-risk pregnancy program geared toward people in recovery from substance use disorders.

There, she learned that due to a Massachusetts state statute requiring hospitals to report any prenatal substance use, she would be subject to a child services case once she had given birth. But she was assured that as long as she remained compliant with treatment and continued to prioritize her health and pregnancy, the investigation would be brief and relatively unintrusive.

That’s not how it went, though. Instead, she was charged with neglect and a placed on a statewide child maltreatment registry that would limit her job options and even her ability to attend field trips with her child.

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Mandy was relatively lucky because she had the knowledge and resources to successfully appeal this decision, but many mothers who face similar circumstances are stuck living with the consequences of child welfare involvement simply for seeking treatment.

Media outlets have labeled the uptick in overdose deaths since 2015 the “opioid crisis,” and a rash of sensationalized stories — cops overdosing from contact with crime scenes, babies born “addicted” to drugs, drug dealers compared with serial killers — are fueling a public perception of drug users as a macabre and dangerous population.

The result? A crackdown on parents — especially mothers — who use drugs, with a hard target centered on those with a past or present addiction to opioids. State laws vary, but at least 23 states and the District of Columbia articulate that substance use during pregnancy is child abuse, and virtually every state in the U.S. will open an investigation (at the very least) into a person who tests positive for substances during or shortly after pregnancy.

According to research compiled by the Vanderbilt Center for Child Health Policy, the number of infants entering the foster care system rose by nearly 10,000 between 2011 and 2017, and at least half of those infant removals were due to parental substance use, often during pregnancy.

Not only can these types of punitive measures make pregnant people who use substances wary about seeking medical care, but applying personhood rights to the unborn is a dangerous precedent that criminalizes people for events outside of their control; for example, earlier this year in Alabama, Marshae Jones faced criminal charges for having a miscarriage after she was shot.

Women’s rights advocates continue to fight laws that pursue the rights of fetuses before those of the people who carry them, and have seen some wins — for example, the charges against Jones were ultimately dropped, and last year the Pennsylvania Supreme Court reversed a ruling against a mother who use opioids and marijuana while pregnant, stating that fetuses were not covered in their child maltreatment laws — but it remains an uphill battle around the nation.

At the same time, abortion rights are under fire. Fueled by the Supreme Court’s conservative majority, many conservative states are implementing laws that make abortions virtually impossible to access legally and safely. For example, Alabama’s governor recently signed into law a bill that holds doctors criminally liable, with a penalty of up to 99 years in prison, for performing abortions that are not medically necessary and also bans abortions at all points of pregnancy, even in cases of rape and incest. Georgia, Louisiana, Mississippi, Missouri, and Ohio also passed recent legislation banning abortions after six to eight weeks respectively, which is before many people even realize they are pregnant. Because habitual drug use can interrupt or alter menstruation, it can be even more difficult for those experiencing addiction to catch a pregnancy early enough to terminate it in one these states.

The concurrent rise of anti-abortion laws and punitive prenatal substance-use laws leaves people who become pregnant while having a substance use disorder — whether active or in remission — trapped in a dangerous situation that is often overlooked due to the stigma attached to substance use during pregnancy.

“Among people with substance use disorders, there’s no one more stigmatized than pregnant women,” said Stephen Patrick, a neonatologist and an associate professor of pediatrics and health policy at Vanderbilt University. He added that this pervasive stigma leads some people with substance use disorders to fear and distrust the medical community, even to the point of avoiding treatment.

Unfortunately, that distrust is often warranted. “Pediatricians often don’t know what they are required to do, and often states have a hard time interpreting what the federal government wants them to do,” Patrick explained. At the federal level, child welfare guidelines are vague and general, leaving states with broad discretion when it comes to defining child maltreatment and the subsequent responses. This means that when state or county authorities are misinformed about the reality of substance use and parenthood, that bad information can easily become codified into the system. Worse, it allows those policymakers determined to give the unborn personhood rights a means for policing the behaviors of pregnant people. “The end result is a system that in many cases over intervenes in some families that may be in recovery, and in other cases may not intervene when it needs to,” Patrick said.

Mandy’s story is just one example of the real-world impact of this stigma. My own life is yet another: I gave birth in 2014 while prescribed methadone. My daughter was hospitalized for neonatal abstinence syndrome, which is a common side-effect of appropriate methadone usage. She had no other health problems and, five years later, remains a healthy and developmentally normal child.

Nonetheless, a child welfare case was opened against me in the state of Florida. At the time, the case was deemed unsubstantiated — but four years later, a call by my mother-in-law to the Florida state child abuse hotline triggered another investigation. This time, the investigator made no attempt to speak with me before making her decision. She simply looked at my previous records of having been prescribed methadone while pregnant and filed to have my two daughters removed from my care. More than a year later, I am still fighting to get them back.

I love my daughters, and I have no regrets when it comes to birthing them — but I remember learning I was pregnant with my youngest less than a year after her elder sister was born. I was on a low dose of buprenorphine after having tapered from the methadone I began taking during my previous pregnancy. I had just finished grad school, and before entering treatment had been using heroin intravenously for nearly five years. My husband and I, both in recovery, were broke and sharing a mobile home with his parents in South Florida.

I became pregnant after being unable to access a timely refill on my birth control. Abortions in Florida are not covered by Medicaid. I didn’t feel ready for another child, but I had no way to finance an abortion. I don’t know that I would have decided to get one if I could have; that’s something I will never know, because it was a choice I simply did not have. Now, the same state that gave me no other options is withholding my children from me for having sought treatment for a medical condition.

No woman should feel compelled to terminate a pregnancy because she has a substance use disorder—but when jurisdictions withhold that choice, they force people who use drugs to suffer harsh punishments simply for becoming pregnant. Sometimes, that even includes jail time.

“In 2006, the Alabama legislature passed the chemical endangerment of a child law, and even though the legislation said this has nothing to do with pregnancy and drug use — it has to do with punishing adults who take children to dangerous places like meth labs — it was used as a basis for arresting pregnant women using any controlled substance, even if prescribed,” explained Lynn Paltrow, the executive director of National Advocates for Pregnant Women. This has led to the arrest or child welfare prosecution of thousands of women since it was implemented; in 2015, ProPublica identified 1,800 affected mothers. The law is still being used.

Both anti-choice activists and those who push for criminal or civil prosecution of pregnant people who use substances claim to be protecting children. But the reality is one of oppression and harm. “It is an anti-woman policy and an anti-child policy,” says Richard Wexler, the executive director of the National Coalition for Child Welfare Reform, of child welfare policies aimed toward substance use. “Any time we take a swing at so-called ‘bad mothers,’ it falls to the children.”

You see this in cases like mine; my judge doesn’t see my daughters crying every time I leave our once weekly supervised visit, nor does she have to answer their questions about why they can’t come home, but that doesn’t mean it’s not happening. You see this also in cases like that of Keri, a mother who I interviewed for a story I wrote for Filter Mag, who bought buprenorphine on the street and self-detoxed before giving birth to avoid child welfare intervention. A 2017 paper by Amnesty International reports that doctors across the nation are seeing substance-addicted people avoid timely prenatal care out of fear of prosecution, harming the very infants these laws claim to protect.

Across the country, harm reduction efforts are gaining traction, and the government is slowly increasing access to evidence-based medical care. But even while the general perceptions and treatment of people with addictions are advancing, pregnant people who use drugs continue to be stigmatized and punished.

Said Paltrow, “There’s no question that prosecutors and others have used the stigma and horrific medical info about the impact of controlled substances on pregnancy to establish in the law separate rights for fetuses, and anti-abortion principles that treat pregnant women like criminals.”

But after decades of collecting this data, the government is putting it to use. This information is feeding algorithms that decide everything from whether or not you get health insurance to how much time you spend in jail. Increasingly, it is helping determine whether or not parents get to keep their kids.

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When someone phones in a report of suspected child abuse — usually to a state or county child abuse hotline — a call screener has to determine whether the accusation merits an actual investigation. Sometimes they have background information, such as prior child welfare reports, to assist in their decision-making process, but often they have to make snap determinations with very little guidance besides the details of the immediate report. There are more than 7 million maltreatment reports each year, and caseworkers get overwhelmed and burn out quickly — especially when a serious case gets overlooked. New algorithms popping up around the country review data points available for each case and suggest whether or not an investigation should be opened, in an attempt to offset some of the individual responsibility placed on case workers.

The trouble is, algorithms aren’t designed to find new information that humans miss — they’re designed to use the data that humans have previously input as efficiently as possible.

“If you give it biased data, it will be biased,” explained Cathy O’Neil, mathematician and author of the book Weapons of Math Destruction, while speaking with me for a story I wrote for Undark last year. “The very short version is that when you’re using the past as a kind of reference for how it works well, you’re implicitly assuming the past is doing a good job of rewarding good things and punishing bad things. You’re training the system to say if it worked in the past, it should work in the future.”

Historically, low-income families have had their children removed from their homes at higher rates than wealthier families. As a result, these new algorithms work to codify poverty as a criteria for child maltreatment. Some of the variables that these tools consider are public records that only exist for low-income parents, such as parents’ poverty status, whether they receive welfare benefits like SNAP and TANF, employment status, and whether they receive Medicaid. Other factors, like previous criminal justice involvement and whether or not there have been allegations of substance misuse in the past, are also dramatically more likely for families living in poverty.

This bias exists even in systems that have been highly praised, like the Allegheny Family Screening Tool currently being implemented in Pittsburgh, where prior arrests and parents’ mental health histories are considered factors in whether a child should be removed. It’s similar in other, less-transparent systems, like one in Florida where tech giant SAS contracted with the Florida Department of Children and Families to research which factors were most likely to contribute to the death of a child by maltreatment. According to press releases by SAS (some of which have been unpublished since they began garnering media attention) the company used public records such as Medicaid status, criminal justice history, and substance-use treatment history.

The results led jurisdictions in Florida to zoom in on factors that apply to huge swaths of families, including mine. In April of last year, an allegation of drug use and child abandonment led Broward County, Florida child welfare investigators to investigate my family. When my drug tests were negative, the investigation pivoted to my recent financial setbacks, which had been caused by my husband’s acute health crisis. My children were ultimately removed from my care, and we have been separated for nine months for reasons that are primarily financial. My case is far from unique. Three-quarters of child protective cases in the United States are related to neglect, not abuse, and that neglect usually means lack of food, clothing, shelter, heating, or supervision: problems which are almost always the result of poverty.

Ira Schwartz, a private analytics consultant, thinks he may have found a way to help re-balance this system. He conducted a research study in Broward County — the same county in which my case is based — that discovered the current approach to child welfare substantiation is highly flawed. According to his research, 90 percent of system referrals were essentially useless, and 40 percent of court-involved cases (which typically involve child removal) were overzealous and harmful, rather than beneficial, to the families. He created his own system that, like the Allegheny tool, predicted the likelihood that a family would become re-involved with the system. But he admits quite openly that predictive algorithms like his target the poor.

“We found in our study that lower socioeconomic status was one of the significant variables that was a predictor [for reinvolvement with the system],” said Schwartz. “The issue with higher-income families is … they just don’t really come into the system because they have other options. With higher-income families, when there’s child abuse or neglect or even spouse abuse and it’s reported, they can afford to go to private agencies, get private mental health services; they can see a psychiatrist or social worker or psychologist … it’s a discrimination factor.”

Schwartz believes that these types of admittedly discriminatory computer programs can still be put to good use when combined with prescriptive analytics, which would determine the services that high-risk families need in order to remain out of the system in the future. Schwartz says this would include services like rental assistance, food assistance, day care funding, and housekeeping services. This would help welfare agencies understand which families need what services, and streamline the process of providing them. (All jurisdictions are legally required to make “reasonable efforts” to help families resolve the issues that brought them under investigation, but how agencies go about meeting that standard varies widely by location.)

The issue with these algorithms is certainly not malice on the part of their creators. Even the more secretive, proprietary algorithms being created by companies like SAS claim to want to create a safer system that results in less child maltreatment. But it’s unclear if that is possible with the data that’s available. Without comparable data from wealthier populations, which are better protected by privacy laws, the new systems cannot produce accurate results — and even if more data were added, it would mean more families are being separated and surveilled.