In an evidence-based world, one recent landmark study of foster care would be enough to give America’s child welfare establishment second thoughts. Add to that a second study — with findings the study author called “staggering” — and it should be enough to turn the entire system on its head.
These studies undermine the entire rationale for a child welfare surveillance apparatus so huge that more than one-third of all children, and more than half of Black children, will be forced to endure the trauma of a child abuse investigation before they turn 18 — and almost always it will turn out to be a false allegation or a case in which family poverty is confused with neglect. And though entries into foster care have declined in recent years, more than 170,000 children are torn from everyone they know and love and consigned to the chaos of foster care every year.
The system was not built on an evidence base. No one first asked if it would actually make children safer. Now, at last, somebody checked.
Foster care does not reduce child abuse deaths
A study published last December in the authoritative JAMA Network Open examined 3.4 million records of children in foster care from 2010 to 2023 and 24,108 fatalities that states attributed to child abuse or neglect. The authors conclude:
“Child maltreatment mortality rates did not appear to decrease with higher foster care entry rates or increase with decreasing foster care entry rates.”
Even when they ran hypothetical scenarios in which the number of deaths was much higher than official figures report, the results didn’t change.
That should come as no surprise.
Every child abuse death is the worst imaginable tragedy. They also are as rare as they are horrific. Even if you take the officially reported figure for child abuse deaths in a year — 1,773 in 2024 — and double it, then compare it to the total child population, that still means that in any given year, 99.995% of children will not die of child abuse. The odds of finding an impurity in Ivory Soap are greater than the odds that a child will die of abuse or neglect in the United States this year.
Child abuse deaths are needles in a haystack. But we’ve spent half a century making the haystack bigger. As a result, workers are overwhelmed; they have less time to investigate any particular case, and it becomes harder to find those few children in real danger.
Foster care makes children more likely to die
But that’s only the beginning of the harm. For two decades now, studies from North America have been piling up that compare outcomes for children placed in foster care to comparably maltreated children left in their own homes. With very few exceptions, over and over, the children left in their own homes did better.
Decades of additional research finds abuse in at least one-quarter to one-third of family foster homes, with a rate of abuse in group homes and institutions that’s even worse.
And then, in 2024, came the most disturbing study of all. The study with the “staggering” results that I highlighted in my opening. That study, from Sweden, found the children left in their own homes fared better on the most important measure of all: surviving until adulthood. The foster children were more than four times more likely to die by age 20. The major cause of death: suicide, which would appear to say something about the enormous trauma inherent in removal.
Courtesy of Richard Wexler
Richard Wexler
The researcher cautions that the results may not fully apply in North America, not because our foster care system is better but because our general social safety net is worse. So it’s conceivable that in America, foster children may be “only” two or three times more likely to die.
Consider the implications of these two recent studies together:
Taking away more children will not reduce child abuse deaths.
But the additional children taken will be a lot more likely to die by age 20 than if they were left in their own homes.
In an evidence-based world, we would do better.
- In an evidence-based world, “child welfare” would become laser-focused on ameliorating the worst stresses of poverty — because the evidence is overwhelming that even small amounts of additional concrete help go a long way toward reducing not just poverty-related neglect, but even the worst forms of abuse.
- In an evidence-based world, every family would get high-quality family defense from the moment the child welfare caseworker knocks on the door. No, that’s not to get “bad parents” off; it’s to craft alternatives to the cookie-cutter “service plans” often churned out by child welfare agencies. It’s been found to reduce foster care with no compromise of safety.
- In an evidence-based world, we would end the nearly $10 billion in federal funding for foster care and adoption that pours into states in the form of an open-ended entitlement. We would give states the same amount of money they get now but in the form of a flexible grant indexed to inflation — and we would phase out the amount that could be used for foster care, requiring that it go to safe, proven alternatives instead.
But we don’t live in an evidence-based world. Not yet. But perhaps these latest studies will finally be the wake-up call these systems need.
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Richard Wexler is executive director of the National Coalition for Child Protection Reform, www.nccpr.org.
