Inside the Child Welfare System with Dr. Anu Partap Part 1

[MUSIC PLAYING] True story media. Hello, it's Andrea. And today, we are sharing my conversation with foster care pediatrician, Dr. Anou Parthap. Dr. Parthap has spent nearly three decades as a pediatrician and medical director inside large health systems from 1998 until just last year when she went out on her own. Over the course of her career, she's launched more than a dozen clinics and programs across two states, all aimed at supporting families living with limited income, limited resources, or family violence. In Arizona, she launched the state's first domestic violence program for children, its first family learning center embedded in an outpatient clinic, and new models for screening families for domestic violence in health care settings. In Texas, she helped build the largest integrated health care center for children in foster care, launching the first 24/7 crisis texting line focused on safety and basic needs, and expanding access to free pediatric care. On the policy front, Dr. Parthap helped push through a Texas requirement that children entering foster care receive an early health care visit, a direct response to kids falling through the cracks and experiencing unsafe delays in treatment. She also helped introduce multi-disciplinary case reviews so systems could catch near misses before they became something worse. That review process has unfortunately been discontinued but the early visit requirement stands. We're so grateful to Dr. Parthap for coming on and helping us deepen our understanding of these complex systems. As always, if you have questions for us, feedback or episode topics you'd like us to cover, we'd love to hear from you at Hello at NobodyShitBeliefMe.com. We'll be right back. The best holiday finds aren't always the ones you wouldn't looking for. At Ross, discover unexpected gifts, fashion, decor, and plenty of reasons to keep looking. Ross, expect the unexpected. - Hi, it's so good to see you again. - Yeah, it's good to see you again too. Thank you so much for doing this with us. So to start with, you know, you and I met through the Healther Society. And when I was chatting with you, I had never spoken to a foster care pediatrician before and was not aware that that existed as a subspecialty. And so I just immediately thought, oh, this would be such a wonderful perspective for so many of the things that we're talking about on the show, especially after season seven, where we really dug into a lot of these bigger, broader questions surrounding child welfare. And so, so happy to have you with us. Can you start by just explaining who you are and what you do? - Sure, and thank you for including foster care as a focus on your podcast. It reaches a lot of people and so I'm excited to share lessons and insights from a personal perspective. So I'm a primary care pediatrician and have spent about a half my time really focused on how do we support families who have limited income who may be struggling with life situations like domestic violence or other hardships. And from that, I, after a few years of being a general pediatrician and doing some systems work, became a full-time foster care pediatrician from 2009 to 2018. And then moved back into prevention and early intervention and then got to do some more systems work in the foster care space. And in working with families who have lots of speed bumps ahead of them and roadblocks ahead of them, they still do so much for their children constantly, constantly putting their kids for somehow making things work. The whole like ginger Rogers, backwards and high heels, like that, that's how I would describe the families I met. And then when I went into full-time foster care, it was in Texas and the North Texas area. I was sort of stunned at this whole world of foster care that I was not aware of until I was immersed in it. And what I learned from the families, especially our kids and across all ages, child welfare workers who are doing their best, judges, attorneys, causes, I think everyone who touches that system, I think it really changed how I see how we treat trauma, how we try to move upstream, how we support families. And I think foster care, time frame, really shook me, this is what happens when all systems fail. And so how do we do a much better job of supporting families and children? - Yeah, well that's a great introduction. And I feel like there's so much on pack and everything you just said. I wanna start with a clarifying question. When you say systems work, what does that refer to exactly? - So my heart has always been in, how do we connect the dots between all these fabulous systems of care we have, so that when families are moving through life, they interact with the supports they need when they need them. And I think we build these great puzzle pieces, but they're not initially connected. So a lot of my time in pediatrics, about half my time in pediatrics has been spent either looking at, well what service don't we have yet? Or what service do we have? But it's not supporting families and shelter or families in the ER or families in primary care or in schools or childcare. Or we don't have a policy that supports what families need. So how do we look at the policies or funding? But really it's that a day-to-day life perspective, how do all these systems interact, intersect, and my focus is really around like to mitigate, reduce or prevent the impact of traumatic stress on children's health. - One of the sort of core things that I wanted to talk to you about is the more I have learned about child welfare systems as a whole, which is an area that I still feel very new to. I think it's just one of those spaces where there's sort of complexity upon complexity upon complexity. And I think it has made me sort of suspicious of anyone that sort of describes things in any kind of black and white terms. And I think there is a generally, I think sort of negative view of foster care, I would say, just by general people walking around sort of wherever you fall on the political spectrum, like I think there just is this sort of like foster care is something that people automatically associate with tragedy and probably rightfully so, right? Because something happened for a child to end up there that is obviously going to be traumatic sort of just by its nature. But I wonder from your perspective, where I think that idea goes sideways is this sense that a child is always better off with their biological parents. And I think that that is an idea that exists on the far right and on the far left of the political spectrum. And that's where I've sort of encountered it, right? And this sort of mandate for like reunification above all else. And that I think is very much intention with many of the situation in my family, the situation that I've encountered with a lot of talking to a lot of other family members and survivors and just a lot of these other cases that I look at. And so I wonder if you can sort of help us just have a better framing of how to look at situations where a child is removed from their family of origin. - Yeah, no, it's exactly the right question to start with. I think what struck me when I started doing foster care was these kiddos have been rescued for the sake of their family. And I think this notion that people wanna take your child forever is really the most important perspective to dismantle completely. Nobody wants to take somebody's child in 2026. There's history where we did those things, they're terrible, they're tragic, they're real, they can never be forgotten. We did it to certain communities and we should never forget that that risk is always there. That's not where we are today in 2026. So what I saw even back in 2010 to 2018 was that every child I met in North Texas foster care and they came from all over the state was lucky to have been rescued so that their family had a chance to be the family they were meant to be and for this child to be the child they were meant to be when they were born. I think when families rightfully are upset, angry, feel, cheated, feel, and injustice to it, I think in that moment that makes sense. But when you are really distressed when drugs have really robbed you who you are as a parent, when the domestic violence in your home is leading to serious harm to you and your children, everyone needs a pause. And you need a pause that sometimes is forced because whatever has happened is already affecting the health and safety of your child. So the bar for someone for the state to come in and say we're gonna take your child out of your care and place them with somebody else. That bar in my experience is incredibly high. And when children enter care, the vast majority of the plan for that child like the actual service plan is for the child to go back home. So you have this golden period of time. Once everyone's rage can come down, the services can come into place. You've been given as a gift of belief and time and hope to become a family again. And that is what I saw over and over and over. - I think that is actually a place that I love to expand because I think there has been so much misleading media coverage around particularly separations that happen because of abuse and because of abuse that is severe enough to land a child in the hospital. That's exclusively sort of what we cover on the show. And I want to sort of distinguish between and sort of set some realistic like what you have seen throughout your career in terms of when it is safe for a child to go back home or in the best interest of a child to go back home and when it is not. That's a like very challenging question. And I think that that's why. I think part of what is driving these media narratives and when I look at work like my Kixenba that his primary case that he covered, his first case that he covered and the ones that were featured in the podcast happened in Texas. So that's very much in your backyard. And I think there is this knee jerk response to say either this parent is innocent and it was a wrongful accusation and therefore they should be reunited with their child or their guilty and they should have their child taken away. And I think the really uncomfortable truth for a lot of people, but the truth that everyone who works within the system is familiar with is that it is not that simple. And there are nuances within that and that this really is sort of like an individual thing with families and I think what the most striking example I saw of this, which I talked about last season, right, is like when you look at these sort of like two media stories up against each other, you look at these families that I was following and the people who were in fractured families and were in take care of Maya and these other media stories who are being presented as falsely accused, you would see the initial media coverage of their arrest, right? So that's just the local story, their mug shot on the news and the description of basically usually what was in the police report or the arrest warrant affidavit or what have you. So just kind of the details of what, of the crime. And the commentary and sort of the way that the public absorbs those stories is throw this person off a bridge, lock them away forever. And then when that same story is represented through the lens of this person was falsely accused, then everyone's mad at the doctor and oh, how could they falsely accuse these parents? And I just thought that it sort of was the perfectance encapsulation of this dissonance that we have, right, where it's like we need it to be black and white, we need it there to be either this is a bad parent who heard a child or this is a good parent who had never heard a child and I just don't think that reflects reality. And so I wonder for you what were the circumstances where people had children temporarily removed, so it was something serious and after removed the children, but where they were, in your opinion, safely and successfully re-unified, like where it was re-unification where you're like, that was the right call. That was what was best for the child and the family. - There's so many stories like that. And I think, you know, you said this already, but whenever it's black and white, then you know that's not the story. And foster care is a 24/7 emergency response and very private system of care that protects children that we never really talk about. And I think the most stunning part of foster care is that both the beauty and the pain and the hardships and the things that don't go the way we want are rarely discussed publicly. So I'm gonna describe like some families I can think of, but I also wanna highlight we just had two deaths of infants who were engaged in our foster care system. They were publicly reported on. There's a court document describing a little bit about what happened, but it reminds us that for every success, there's a reason this system is complex and needs to constantly be improved upon. - And the children died in foster care or they died? - Families were engaged with our Texas foster care system at the time that they died. And it led to a massive response from the state and from the courts, it was taken the way that it needed to be taken very seriously. - Just to clarify, so these two children that these two cases that you're talking about, so they died under the care of foster parents or they died under the care of their biological parents? - They died while their cases were engaged in the foster care system. So the families had had their children placed in foster care. And so a foster care case is really the entire family, right? It's the family of origin, all the children involved in that home, the children who are still in their home, the children who are placed in somebody else's care, all the way until the children go back home, the reunification. So we had two infants in separate cases that died during the process of reunification from foster care. - So they were sent back to their biological parents. - And the cases were still open at the time. - Okay. - And so I think, but I say that because when you hear good outcomes, we have to picture how much it takes for everyone who's on the ground working with families. So one of the first stories I thought I was like, I had a hippo's very necessary privacy. So I will change obviously the details of the stories, but young children or seriously affected with their health and safety were extremely underweight for their ages and entered care to a family who was really open for adoption. Now when you're open for adoption, there's still a long road between fostering children who enter your home until you can go into adoption. But the truth is in this case, everyone was so upset about the condition of these kiddos that there was sort of an assumption early on that there's no way we would send these kids back, right? And we don't make those decisions in pediatrics. All we're there to do is support the recovery and the ongoing growth in these childhood. While they're in foster care, they're just trying to grow up and become children, right? They're just growing up during childhood, while this legal case is going on. After about a year, these kids had gone from being very developmentally delayed, very underweight to these adorable kids who are like singing and clinic, dancing on the exam table, connected with their case workers and their family and the clinic and probably we were more protected to them than they felt towards us, but you know, we're just like always fun to see them and to see their success. And we heard that the decision was made for them. They're reunified. We'd never met the family. Our job again is we don't weigh in on as pediatrics, I mean, in primary care, especially, we have no opinion around who should raise children. We know that if you choose to take this sacred task on, here's what they need from you. And we asked if we could work with the family before reunification because the children that were taken out of their home were different than the ones a year later. And so the courts agreed for us to do visits with the family before the children were unified. And over a course of several weeks, we watched this couple really change from being kind of angry about being there, right? These are their kids, like why are we trying to tell them what they need to do to prompt each other to ask questions, writing things down, being really cute with their engagement with their kiddos, very actively participating and planning for how to be the best parents they could for the children they'd always loved, but had hardships that kept them from being the parents they were supposed to be. And towards the end, we were able to really say, based on the needs of these children at this stage in their lives, the parents were able to describe that they can meet their needs. Now again, we don't decide what happens. The courts decide what will happen. And what happened right before reunification was one of the parents passed away. And it was, I still remember the day we got that call. It was so upsetting because A) we'd all formed a connection, but just to know that these kids have now lost someone who was so ready to receive. But we had that connection and plan so that we could now pivot. How do we help now this single parent through a time of grief and loss and hardship embrace these two kiddos? And again, could plan as a family who all could participate in helping raise these children. And those children did get to go back to their family. And that story is a wonderful story and it's an isolated story. What it does highlight though, is the creative courage of child welfare and courts and attorneys to support families in re-assuming care and custody of their children. It also reminds us that by rallying together and making sure that their health and safety needs can be met at the same time, we're positioning everyone for lifelong success. And I think that latter part is what makes foster care pediatrics unique and isn't necessarily hardweired into our current system of foster care. - I'm gonna be honest, I never gave life insurance a second thought when I was younger. And listen, it's just not the most fun thing to think about. And also I am naturally versed to anything that might involve people. for work. But when I had kids, this became an absolute non-negotiable. We all want to make sure that our families are going to be taken care of if something happens to us. You know that's important, especially if you have kiddos. And listen, if you're worried that the process of getting life insurance is going to be a time-consuming slog, I've got good news for you. Our sponsor, Ethos, makes the process fast and easy. You can do it 100% online. You don't have to go anywhere. It takes just seconds to get a quote. You can apply in minutes and get your coverage on the same day. 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I am definitely eyeing their cashmere lined gloves for someone on my list, maybe for me too. So give the gift of quality this holiday season, download the Quince app for app exclusive offers or go to Quince.com. Get free shipping on your order and 365 day returns, now available in Canada and the UK too. And when Quince asked where you heard about them, let them know it was nobody should believe me. It's the best way to support the show. I think one of the things that's so dangerous about a lot of the media coverage that I've talked about that's been very focused on medical kidnapping, right? And sort of like the doctors being this antagonistic force is that we all need to be able to trust our children's doctors and our own doctors. And like that's so important. And there are situations where doctors are not good doctors and they're not trustworthy and people have bad experience. And those things happen. But creating that distrust unnecessarily in a situation where it's not warranted, which I think describes all of the cases I've looked at that were described as medical kidnapping is really dangerous because it creates just this like and that's something that you know I think has been doctors across the country are experiencing just parents being skeptical and mistrustful of everything from vaccines to vitamin K treatments after birth. And just these things that like are so basic and that we are so sort of these you know things that have so improved children's lives and well-being and the ability to eradicate childhood diseases that are coming back. And it's just it's really like that mistrust. I think we are already seeing the horrible consequences of that. And I would assume that in foster care pediatrics like what you're sort of describing with this family that there's like an additional hurdle there of they're probably going to be understandably like sort of mistrustful of anyone who's an outside person who sort of a mandated reporter. And I think that's one of the I think decently sort of salient critiques of the abolitionists that there is this sort of antagonism that's kind of built into these systems where the people who they're supposed to be leaning on for support are also the people who are sort of surveilling them. And obviously you know in many of those situations like that surveillance is warranted because we're looking out for the child who is vulnerable and can't speak for themselves. But I understand where there's where there's some real tension there. So how is that something that you navigate in your field coming into these people's lives who may already sort of have their backup? You know it doesn't bother me and I'll tell you why it's like I'm so focused on I'm here to help you in your role as a parent whether you think I'm here for that or not. And that strong central core that we are here as partners is unwavering. If the parent doesn't feel like they're in partnership with us we're to respect that they don't feel that way but doesn't change how we position ourselves. There is no good way to raise a child with love healthy and health and safety and let's us in partnership with the people raising the child. We are a brief moment in time and I think this almost fixation on the power of the medical community it's a confusing for me because we don't really feel any power as pediatricians. We had this very somewhat mundane but calling which is let's make sure your child is healthy and safe through childhood to get into adulthood. And the rest of this chaos and confusion and noise let's help you through that chaos confusion and noise because our only focus is that your child is healthy and safe through childhood. That there's some joy that they learn that they become the person you picture them to be. When you look at the reports from to CPS hotlines across the country there's like over 4 million calls and then you look at the number that are screened in or screened out and like over half of them are screened up about 47% are screened in. The medical community makes up only 11% of all calls that were actually screened in. It's law enforcement and teachers that make the bulk of the phone calls of CPS that are actually screened in. Out of all those like 2 million right it was in the last reporting year 100,000 kids entered foster care. Incredibly small so by the time you get down to the very small population relatively speaking that's still 100,000 too many right and it's actually a little bit higher than that because siblings come into the picture there's something inherently different at that point that we had to rescue children from this home situation so that nothing worse would happen to them. And to deny that is something that the family needs to relate to discuss with the courts or discuss with the attorneys or discuss with child welfare workers but it's not physicians or nurses that are taking children away from them. It's a system of care designed to protect children from something worse happening to them. In the meantime foster care pediatrics or just any physician, nurse practitioner, nurse therapists, psychiatrists, whoever the medical professional is. Our role while that child is in foster care is to help them recover from what's happened because we know that the circumstances for removal scientifically mean that it's affected some aspect of your health and probably multiple domains of your health. So let's help you get better. Let's make sure that the people who are moving you from home to home or you have visits every week or the caregivers that are raising you are positioned to understand how you might be reacting as a child during this really unusual circumstance at a legal case. You're growing up during a legal case and we mitigate the risks of the legal case on your childhood. And then how do we position you for beautiful permanency? There's really that's the only three goals right? Treat you treat what's happened, mitigate the risks of the legal system itself, and then help you end up in a beautiful forever family. And so the anger and the suspicion and the accusations, I mean I understand where it's coming from but I think it's really important to understand how much noise that is and stay focused on our calling and the task at hand. Yeah it's so interesting that you say that because I think one of the sort of most ridiculous details that shows up consistently in this sort of medical kidnapping story beats right? Because that's kind of what I dug into in the last season. It's like oh every single one of these stories sounds the same and it's because they're being constructed in a certain way not because they actually have these things in common. This is not evidence of a conspiracy theory or of a conspiracy. And one of the things is this idea that like you know you see these doctors Sally Smith and Dr. Debra Jensen and Dr. Nancy Harper and they're sort of all described the same way. And this sort of oh they just came in and they said it was abuse and they yelled and they didn't introduce themselves. And it's like number one you know I've met some of these people and that was not it's sort of you don't buy at the minute you sort of meet them and two of their cases I know they're their former boss. And also like child abuse pediatricians are some of the most unflappable people that you'll probably ever meet right? Like these are in my experience people who are used to very high stress situations they are used to seeing people in their worst moments. I mean, same thing was, you know, ER physicians and people who work in pizza use, it's like, these are not people who are going to be, like just by nature of their work, not to say that none of them ever have done any of these things, but like the sort of picture they paint of them as these sort of antagonistic, it's just like that just doesn't track with reality because they are used to it. They are used to parents having high emotions. They are used to being in tense situations. And I think, you know, when I have asked child abuse pediatrician and sort of about why they sort of felt called to this part of the profession, which is I think just, you know, one of the hardest jobs. And I think your job is very much adjacent, right? I'm just seeing kids suffering in a way that most people would just like to spend most of their lives not thinking about, I think, is partly because they can withstand that because they're not scared off by those sets of circumstances. And so I think what you're saying just really resonates with me as being like, well, yeah, like obviously parents are going to be having a whole bunch of feelings and just remain focused on the child. And that is what I've heard sort of from people in this sort of field writ large. Yeah, and I think I have to respect the tantrum. And then let's get back to the task at hand, which is we both share a goal that your child needs to be the best person that they were meant to be. And we can debate and argue about why your child is injured, has bruises, has broken bones, was sexually abused for a prolonged period of time, was left alone in their home for several weeks with a five-year-old in charge of two younger siblings, why there's cockroaches coming out of your diaper bag and infesting their crib. We can argue about why their younger sibling was carried around in a carrier already passed away while you were still doing drugs. We can debate and argue and spend all day on that. But when we're done, let's get back to making sure your child heals. And so it really is noise. There is an unfortunate drive to stop feeling like they're in trouble. And if there's parents who need to spend a lot of time there, that's a choice they make. But they are exchanging that for getting back to raising their child. And the parents that are able to make that shift, the ones that are able to receive the help they need, either make peace with being wronged if that's where they stay, or make peace with, I wasn't who I was supposed to be for my child and I'm going to now, no matter how hard it is. They're the ones who we really see successful reunification with. And the family is really when they can expand their social support and not be locked in shame and denial because partly what has to happen is you have to be willing to acknowledge what happened and ask for help. But if you can never acknowledge what happened, you're not going to ask for help. Weather is just turning to fall over here in Seattle, so I have been reorganizing my closet, putting my summer stuff away and getting my sweaters and coats out of the back. And in the process of doing this refresh, I was confronted with some clothes that I have not worn in years. And in some cases, gasp have not worn at all. So what to do? 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And that, obviously, on my show includes someone doing something really awful to a child, but then you spend time talking to them, it's impossible I find not to sort of see their humanity through that. And to your point, I worry about the long term for, certainly for the children in those situations, but also for the person themselves, if they are stuck in this loop of denial and grievance and revenge, you should, frankly, that is certainly not helping them. Like, I think that's really where I sort of came down, especially after talking to, obviously, John Stewart at length in our seventh season and looking at these cases like Viviana Graham, who just is still just 10 years almost in her case, and then John's case, it has been 10 years, and they're just still stuck in this loop of anger and wanting to just destroy the reputation of the person who they are scapegoating for what happened and it doesn't seem like there's ever any reflection on any of it. And you just think that can't be good. I mean, that can't be good for anyone, and that can't be healing and helpful to moving forward. And I think like that's what is so concerning about these affinity groups like fractured families is these people are not, even if they see themselves as helping each other and even if they sort of get what they ostensibly want, right? Even if they get, they get their children back, they find some expert to come say it was rickets or some other nonsense, and then that's effective and court and they get their kids back. It's like, they did not benefit from that situation in the long term, I don't think, because yes, maybe they got what they wanted. Like, I wonder about their ability to process the harm that they've caused if they're just surrounded in this echo chamber of like, you were wronged, we were all wronged, the media is telling you where you're wrong, it's sort of like, yes, I'm sure that that feels validating in the moment when it's happening but like, where does that leave that person? Like, I felt that when I was talking to John because he is a grievance machine and he's been in the media, he got very sympathetic treatment in the media. He was presented in a Netflix film as a wronged parent and it's like, okay, like, you did not go to prison, you got your licks in with Sally Smith, like Sally Smith had her reputation completely trashed, ostensibly, these are the things that you wanted to happen and you are not satisfied with that and I think you will never be satisfied with anything because you're just stuck in this loop and I just had this impression that was like very haunting after talking to him for, you know, I was on the phone with him for three hours and then, you know, got these emails from him and just was just sort of this relentless cycle of like, I have to just keep proving that I was wronged and I have to prove it to, it's like, and the, you know, the big mystery of why he reached out to me, never been solved. But it's sort of like, what are you just going to keep this grievance loop up for the rest of your life? And so I think it's like, it's doing, it's sort of almost maybe paradoxically, these families that are featured in these stories. I think it's doing them just as much harm as the doctors who's, I mean, reputations are trashed, even if it's more obvious, the sort of other harm that it's doing, I'm like, I don't think it's helping any of these people to give them this framework. The vast majority of parents whose children temporarily coming to foster care longer, or even whose prune rights are terminated, you'll never hear from the majority of them, right? So we had 500,000 children at some point in the foster care system in the last reporting year. And you can count the number of families. who are out there talking to the media about what's happened to them. The vast majority of families have children who have gone through this tragedy and have come out in some other situation. Either they have done the hard work, they've recovered themselves so they can be the parent and their child is also receiving really life-saving medical treatment or mental health treatment, usually in integrated care treatment hopefully, and then they get to be a family again, but a healthier family and a functional family and a family that can be proud of. And what I love about that is the majority of families involved in the foster care system, their goal is for children to have a loving family. That's the goal of judges, attorneys, causes, foster parents, children, they want to go back home, there are some of them think up other families. But you rarely run into the family who are the ones that you end up hearing about in media. They are the rare family who are locked in to feeling not just wrong, but that is the only focus of their experience. I think what you brought up vitamin K and immunizations, I think the underpinning is in pediatrics, we've been experiencing some hammer or another for over a decade and it started before COVID. But the topic changes and so it tends to feel like the goal is really about a nebulous goal for power and we are a target. That there is a amplified power placed upon us that we don't feel, you know, it's just, I don't even do laugh because I don't mean to be insensitive. It's just so bizarre. Well, a amount of pretend power that is placed upon the medical profession. And I think the risk has been that you can gather up energy right around these false narratives. And then people who are like really reasonable good people get caught up because they saw it on TV and it has to be true. They read it somewhere and it has to be true. And what I would ask is like if everyone just paused and said, you know, if you have a rough personal experience and I include the medical profession in this, if we did something wrong, we need people to help us be the best we can be. That's what our quality and safety systems are set up to do. If my police officer in my tiny town doesn't do something I like, then I just call them and I'm like, hey, this is what happened. And I think y'all might want to look into this, right? We all need feedback and serious feedback and accountability to be better. But to say my personal experience means we should dismantle a system of safety for 73 million children is inherently wrong and immoral. Your personal experience is important and it is personal and you should pursue that path in a way that is going to help all other families and children. And I think if I hadn't been involved with foster care as deeply as I have been, I wouldn't be able to confidently say it is a intended to be a beautiful system of safety for families in the belief of families. And when we don't get it right, we have to unrelentingly be better. And when we get it right, I wish we could celebrate it. And unfortunately, because it's foster care, you don't get to hear those stories, right? But anyway, I hope that makes sense. Yeah, no, it does. And I think it's interesting to look at, you know, obviously I've been examining these compendiums of like falsely accused parents, allegedly falsely accused parents. And every time I have been able to examine a case in depth, because I have access to the records or what have you, it just so clearly wasn't a false accusation of abuse. It just the medical reason they're trying to give for as an explanation for the injury, just flat out does not make any sense. It's completely unscientific. And even if it were not to your point, right, like I wonder, as we're looking at this from like a systemic issue, right? It's like, well, do we have to prove that a doctor has never made an error in order to still have doctors examine abused children? It's like, I don't think, you know, when there are these stories about, you know, let's say Sally Smith, because that's the one I've, you know, looked at the most of her cases in depth, but it's like, okay, so say she was wrong once. I mean, I nobody's presented a case where she made an error that actually held up, right? These stories about her that have been covered in the news. And I'm not saying Sally Smith's never made an error in her career, I want to be clear. But like, okay, so say she did get one wrong call out of like how many or say, you know, yeah, there's, I mean, because of course there are, right? Of course there are doctors, you make wrong calls. But like, is that a reason to dismantle an entire system? It's like, I think the myopia that sort of drives me nuts is like, you're saying, well, this system is harmful, so let's get rid of it. Well, like, but having no system is also extremely harmful. And so there isn't like a solid answer. And I will say, like, you know, I've been chewing on my conversations with this abolitionist, especially professor Alan debt left, since I had it. There are many of his points and historical context that I found really helpful. And as you were saying, right, like, this is not without historical precedent. We have had removal projects as it were that were deeply immoral and were wrong. And that history exists. But what I sort of can never get an answer to from any of these folks, whether it be the medical kidnapping people or the abolitionist is, well, what should we do instead? What is the system that replaces this? And I think, you know, the answer I got from Alan and that seems to be pretty central to the abolition argument is when I really wanted to unpack with you, because they sort of tie it to a resource question. And that I think there's a salient point in there, but it's also like the data is extremely complicated. And it certainly is not applicable in all cases. And certainly like my family had plenty of resources and everything that happens still happened. And like, there's some real things ton packed around there. And so what I wanted to ask you about is there's a statistic that we hear a lot in these child welfare conversations 76% of children who are removed are removed due to neglect. And I think a lot of people hearing that sort of think like neglect resource problem, right? And it's not quite that simple. Number one neglect is this very complex designation and it's a legal designation, it's not a medical or social designation. And there are many cases that I've looked at there were abusive had trauma cases in particular or much as my practices that by the time they ended up in the courts got pled down to neglect neglect is not an accurate description of what happened to that child and what that child experienced. So I have many questions about sort of the meta analysis of 76% but I did want to talk to you about this sort of like the specter that's put out there is, oh, you have a parent who is trying their very best and just doesn't have access to resources doesn't have access to proper medical care is just dealing with life circumstances that have made them unable to provide what the state thinks they should provide for that child. And I'm sure that does happen, but I just wonder like when we say neglect like help us talk like talk us through what neglect means in cases of kids that are removed like what is what is that bar what does that look like. Now it's a really important question and I'm glad we're talking about neglect because we do not talk about neglect enough foster care is only intended for children who have no other family who can help the family out. So if there's no safe caregiver that's when you enter the foster care system right someone has shown up or there's been months of efforts around families care of a child and at some point someone says you know what this child. The child is suffering and their health and safety in your home environment there has been any physical abuse but everything else is leading to and a concern around health and safety in a way that jeopardizes their life and it is time to take action. Who else can help you and when the answer is nobody else can help me is there somewhere else we can take this child to and they can just stay there while you get the help you need. No there's nobody else available in that family system that's when you go to court that's when someone is taking this child into another home. So the threshold is that there's an immediate danger eminent threat to the child's survival life being able to be okay for the next few days. The bar is so high that when I would either meet children in my clinical practice days or when I was more involved on a health system so I would be admitted into the hospital. Either way I was always struck by how long we had waited before we intervened and each state is different so I can only speak for Texas and way north Texas. The amount of effort and support and patience and hope that we will spend it's longer than I would feel comfortable if I was in that position to make that decision. So when we see them clinically you can see the harm on their physical health or emotional health or mental health or developmental health. and the harms they've already had. from neglect take a while to recover from some of that recovery you can see in a few weeks have been in a safe nutrient environment some of those recoveries take months some of them go up and down and sometimes it takes years so the neglect that we're talking about for foster care is at a bar that is already created evidence of harm or an eminent threat of harm for a child and and we hate to think of that the biggest reason I think we don't want to talk about it is because it's almost too painful I had a legislator once they to me you know like the eight-year-old at a park alone at night doesn't belong in foster care so the whole system is you know ridiculous and like well that's not who's entering foster care is your child alone in a parking lot yeah I mean you know you're hitting on it exactly from like a rhetorical standpoint right I think there's this bogeyman of you know of taking getting your kids taken away that like I think it's so effective because every parent feels it the idea of someone taking your child away is just a very easy like nerve to hit for parents I think a lot about why people believe things that are just so sort of patently false it's a sort of like why are and it's not because they're dumb or gullible or no not a lack knowledge right it's like they're very smart people some of whom work in child welfare who should sort of know the realities better than they do but who believe these stories right there's legislators that believe even the most outlandish stories of being sort of falsely accused of child abuse and sort of like why are journalists doing this like I have many questions to why people believe these stories and I think it's not logical I think it's much more emotional than logical and I think it does have to do with just really not wanting to picture it and especially not if that person who's being accused of it seems normal seems like a person like yourself seems like somebody that could be your neighbor seems like somebody that could be your kids teacher it's like I think there's just a very strong aversion to like seeing the world as it is I mean do you think people just walk in around like just don't quite understand how common abuse is and how bad it is to end up in a child removal I mean do you think those are things people just sort of have quite a lot of cognitive dissonance about I think there's cognitive dissonance because it's not human to picture us hurting our young like that is the opposite of how we're wired and how we're meant to survive as a humanity right I also think it's as we've created these systems to rescue and recover and reunify we're so secretive about the process and part of it is privacy of the families involved but I think to some degree that's also when in the absence of information right you make it up you fill in the blanks yourself if we could have families celebrate their unifications the way we celebrate adoption day it would be amazing but that's not gonna happen if we could have children grow up and tell stories constantly just constantly tell stories about the relief and love they received while they were in foster care and how lucky they are to be back with their families or how look they are for their new families adopted welcome to adoption it was started dismantled some of the mystery I think we have made it easy for people to tell different stories because we are so silent about what's happening there was a CDC published survey of high school students and they surveyed the high school students nationally about how many had experienced one of eight adversity and the diversity of our physical abuse sexual abuse emotional abuse physical neglect having a caregiver experienced domestic violence having a caregiver someone substance use disorder incarceration and mental health disorder of a caregiver three out of four high school students I experienced at least one of those but thirty percent that they had already been physically abused by high school so by the age of seventeen one out of three of these high school students said that they had been physically abused and seven percent have been sexually abused that's of the general population of high school students no matter how much work I've done in this space I was so surprised when I saw that data came out it was the 2023 survey published in 2024 less than 0.02 percent or something of all kids winter foster care so the gap between how many children experiencing serious trauma in their childhood compared to the teeny tiny population of children for foster care we have to ask ourselves like what's the difference between the ones who enter foster care and the ones who just grow up in their family and neighborhoods and communities until we're willing to look at that and ask those questions I think there's always this sort of either denial or dismissal of how important foster care is as a core function of a Justin Humane Society so the kids in foster care tend to have much higher occurrences of chronic medical conditions you're the kids who've also had heart disease or neurologic conditions or developmental disabilities or trouble with their motor abilities I mean there's something else that's made them additionally vulnerable where they couldn't just go ahead and muck through with their families in their communities or with their relatives and so it's almost offensive to picture someone dismantling this life-saving loving system and it's still his improvement we still have to keep unrelentingly working on it but that's what foster care is you know if we all accept his wow one and three of our high school students have been physically abused like let's focus on that Matt Sally Smith that was the first part of my conversation with Dr. and new part-tap stay tuned for the rest of my 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