Tennessee Department of Children’s Services Commissioner Kate O’Day concedes that the news there were 31 DCS-related child fatalities in the first six months of 2012 is shocking and tragic. Data shows that four children died in DCS custody, 10 died while a DCS case file was open and 17 died after a case was closed.
But a closer look at the numbers and the circumstances behind the deaths and investigations, reveals some of the monumental societal challenges facing the state — and ultimately, DCS.
After receiving pressure from The Tennessean and state Rep. Sherry Jones of Nashville, DCS released the statistics on the deaths of 31 children last month.
“It’s important to look at the whole context. You talk about 31 deaths in six months — that sounds very alarming. I understand that,” O’Day said. “But if you look at the volume of the work that the department does every day ... we’re touching a lot of the state’s most vulnerable families.”
In the past year alone, the DCS received 170,000 calls, formally investigated 65,000 of them and closed 80,000 cases.
And in many of those cases, the DCS is required to meet a “clear and convincing standard” before it can intervene. O’Day said attorneys have told her that “clear and convincing” evidence means “just a little bit shy of what you need to put someone in jail.”
“That puts us in a lot of situations where things are not great ... and we’re trying to work with engaging people and encouraging them to do what they need to do,
because push to shove, we can’t really force it,” O’Day said.
“It’s not an excuse, but it is the environment that we’re doing this work in, and I think it is a context that is getting overlooked.”
The child fatality statistics also shed light on two critical issues facing child and maternal health: unsafe sleeping and drugs. Nine of the 31 deaths reported by DCS were related to sleep issues: either co-sleeping deaths or other instances of “crib death.”
Co-sleeping deaths occur when parents sleep together with their children and accidentally suffocate them.
But in seven of the nine sleeping-related deaths, drugs also played a factor.
“You see drug use, and wow, why don’t you grab those kids and bring them into care? But you’ve got to look beyond that. ... You have the issue that if you bring that child into care, you’re intervening in a stage where the parent and child are bonding together. That’s not something, if you know anything about child development, that you take lightly,” O’Day said.
“You’ve got to make a balanced decision between what is the safety of that very vulnerable infant versus the need to keep that family together so that bonding can happen and that the parent becomes fully competent to take care of that child.”
Prenatal drug exposure is the second most prevalent cause of death in the DCS statistics — and O’Day said it’s possible parent drug use played a role in other deaths on the list, as well. A lot of times, DCS has its hands tied when it comes to intervening in those cases.
“All use is not illegal. It’s not illegal to drink and have kids. It’s not illegal to have prescription narcotic medication and have kids,” O’Day said.
“I don’t have a direct intervention I can do that’s going to reduce co-sleeping or reduce parents using [drugs] around their kids, because that’s constitutionally private behavior. And Tennessee is one of the most family-protective states.”
Three drug-exposed infants younger than 6 months old died while a DCS case file was open, according to the statistics. DCS executive director of safety Carla Aaron said hospitals notify the agency if they find evidence of drug addiction in mothers or children. But often, it’s too late to help.
“There are a lot of issues early on in that child’s life that have to be dealt with pretty quickly,” Aaron said. “Sometimes, the medical condition of that child, it just can’t be overcome.”
O’Day said she plans on partnering with other agencies to increase educational campaign efforts about the leading causes of death.
Despite recent criticism over the child fatality numbers, O’Day says DCS is doing what they can to prevent child deaths.
“[A campaign] is a very indirect way of changing behavior. It’s not like when the [Tennessee Highway Patrol] decides they are going to put more troopers, they’re going to write more tickets — people slow down, and there are fewer fatalities. They can make that happen in enough time to change the numbers before the end of the year,” O’Day said.
“I don’t have that.”