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STILL BROKEN, Part 2: Abuse and neglect investigations are opened too late and closed too soon

Part 2 in an investigative series by The DC Line supported by SpotlightDC: Capital City Fund for Investigative Journalism.

One day in April 2020, a person renting a room from Diamond Taylor and Tyvez Jackson in their apartment at 2812 Pomeroy St. SE made an anonymous call to the hotline operated by the DC Child and Family Services Agency (CFSA). He told the call taker what he had seen and heard: All four children in the home were being beaten, with D.J., a 5-year-old girl, receiving the worst treatment.

The boarder had plenty of reason to stay quiet. Unlike a police officer, medical professional or child care worker, he was not legally required to report when encountering evidence of a child or youth being harmed. His was an extraordinary step that could have invited trouble. After all, he was a regular heroin user, who seemed unaffected by the fact that Jackson (aka Dawub Balil) smoked marijuana laced with ecstasy, according to court documents. That combination, health experts say, can sometimes cause hallucinations and psychosis. Taylor also used marijuana.

The Child Protective Services (CPS) unit of CFSA is required to follow up on any report of abuse or neglect within 48 hours of receiving the call on its hotline, according to DC government officials. A CFSA spokesperson declined to provide any information about whether anyone went to the apartment where D.J. lived in the spring of 2020.

Several weeks after the boarder made his call to the hotline, Taylor dialed 911 on May 28 asking for help. According to court documents, she told the dispatcher that one of her children had just fallen from the top bunk bed: “I guess she was playing on the top bunk while we weren’t paying attention or that has to be the case, she fell off the bed. She, I don’t know — I don’t know if she, like, passed out or I don’t know. I had put her in a bath. She’s not conscious. I mean she’s breathing but — she’s had a few accidents. Like two weeks ago she fell off her bike outside, so she has a scratch on her head. So I mean I don’t know if that hit in the head would have anything to do with it. I don’t know.”

Even before DC Fire and Emergency Medical Services (FEMS) paramedics arrived on the scene, Taylor seemed to be preparing a script she would use when asked what happened.

FEMS personnel found D.J. unconscious and face up in a tub “with the back of her scalp on the water drain. The shower was running with ice cold water and the tub was filling up,” according to court documents.

They rushed her to Children’s National Hospital, where doctors took a brain scan and immediately ordered neurosurgery. During that procedure, D.J. suffered cardiac arrest, resulting in a prognosis that she would be in a persistent vegetative state with “a very high chance of death.”

The next day, on May 29, Dr. Allison Jackson, division chief of the hospital’s Child and Adolescent Protection Center and a recognized expert on child abuse, asserted that D.J.’s “injuries were not from falling from a bed.” A series of subsequent scans, skeletal surveys, physical exams and a review of the child’s medical history, which included an interview with Taylor, confirmed that assertion.

D.J. suffered acute and healing rib fractures; fractures of both wrists that occurred at different times; fractures of her thoracic vertebrae; and multiple injuries to her head, back, abdomen, arms and lower extremities. Some injuries were loop-shaped and concentrated on the child’s thigh; they looked like belt marks, according to experts.

Dr. Jackson called D.J. “a battered child who experienced multiple incidents of physical abuse that escalated to the life-threatening incident resulting in her hospitalization,” according to court documents.

“The extent of her injuries, that they are varying ages, depicts repeated events of trauma and would be consistent with torture as a means of child abuse,” added Dr. Jackson.

After D.J. was admitted to the hospital, a social worker at the medical center called MPD. Later, a CFSA social worker arrived. Since the child was already severely injured at that point, the agency was fulfilling its duty after the fact, as it had done a month earlier when 2-month-old Gabriel Eason was allegedly murdered at the hands of his mother and her paramour.

Through its investigation, MPD discovered that D.J. often urinated or defecated on herself. When she did so, her father beat her brutally — sometimes with a black belt with a silver buckle. When Jackson hit his daughter, the buckle’s U-shape was imprinted on her young skin.

He never consulted a pediatrician or any other medical professional to determine if D.J. suffered some deficit that made her unable to control her bladder or bowel movements. Instead, he whipped her; other times, he forced her to perform pushups against the wall or in the bathtub as cold water washed over her.

Her siblings — who were all under the age of 5 — told officials that their father sometimes used his bare fist to punch D.J.’s tiny body with unimaginable force. It was just a matter of time before she would succumb.

Jackson and Taylor eventually pleaded guilty to recklessly torturing and abusing D.J.

Each day in DC, thousands of children are subjected to violence. For many, it’s witnessing gun violence in their communities; for others, it’s experiencing personal, brutal assaults in their own homes at the hands of their parents, the paramours of their parents, or some other friend or relative. The city’s child welfare system has failed to act as an advance guard, shielding and protecting them.

The findings from The DC Line’s six-month investigation show that the city’s child welfare system — which is comprised of the MPD, Department of Human Services (DHS), Department of Behavioral Health (DBH), DC Health Department, Office of the State Superintendent of Education, Department of Youth Rehabilitation Services, DC Office of the Attorney General, DC Superior Court’s Family Court Operations Division, Office of the Chief Medical Examiner, and Child and Family Services Agency (CFSA) — is failing its primary mission.

CFSA is the linchpin of the city’s child welfare system — although its acting director, Robert Matthews, has tried to walk away from that description, asserting that his is just one agency among many. However, a ruling in the LaShawn A. class-action lawsuit, filed against the District in 1989 and settled only recently, elevated CFSA to its current position of lead agency. It rose from a mere division within DHS to a full cabinet-level agency. Over the past 20 years, District officials under multiple mayors have sought to highlight the success of reforms underway to make CFSA a radically different institution, fortified in its mission to protect the city’s infants, children and youth.

However, among the myriad problems The DC Line found is that CFSA’s investigations — the kind an anonymous boarder thought might rescue D.J. and her siblings — often aren’t launched in a timely manner as required by law. They frequently are closed too quickly and labeled “unfounded” or “unsubstantiated.”

That’s an assessment the agency could have made itself based on the information in its own “Internal Child Fatality Report: Statistics, Observations and Recommendations, 2020”:

  • The families of 33 of the 40 children whose deaths were reviewed last year had been the subject of at least one CFSA investigation within five years of the fatality.

  • More troubling, 38 of the 40 families were the subject of at least one hotline call that was screened out and 16 of them the subject of four or more such calls. In each instance, the agency decided not to consider an investigation for reasons never explained in the report.

Still, CFSA director Matthews says the agency is on a positive trajectory, which conjures a comment once made by former President George W. Bush: In launching the No Child Left Behind Act, he referred to “the soft bigotry of low expectations.”

That matches the sentiment shared by various advocates: Shouldn’t District children have a high-quality, integrated child welfare system that values them and their lives?


The CFSA hotline is widely seen as the primary vehicle for guaranteeing that the DC government shields, protects and defends its children from abuse, neglect, maltreatment and other behaviors that could be corrosive to their health, safety and well-being. The calls are being taken. But all too often the responses lack consistency and urgency.

A series of agreements under the LaShawn A. court case compelled CFSA to conduct 95% of its investigations within 48 hours of allegations of abuse. Essentially, the agency, as representative of the system, is mandated to reach out to the victims — the children — within that time frame.

An investigation cannot be considered complete unless the “[CFSA] worker has interviewed the alleged victim child outside the presence of the alleged maltreater or there is documentation of good faith efforts [to do so],” according to government documents.

However, CFSA failed to reach the mandated goal during all of 2020, according to a report filed by the Center for the Study of Social Policy, the organization that served as the LaShawn A. court monitor. Examining the 275 investigations that were closed in November 2020, the court monitor found the agency made contact with only 191 (70%) of the victim children.

In 50 of the investigations performed that month, the CFSA’s Child Protective Services (CPS) staff allegedly “made necessary efforts to initiate the investigation although contact was not made with all alleged victim children” — enough progress that it was counted toward compliance with the 95% goal.

“Thus, total performance for the month is 88% (241 of 275),” the court monitor declared in its final report under the LaShawn A. lawsuit. “The Monitor considers this measure not achieved.”

Seemingly contradicting that statement in the report, Judith Meltzer, president of the Center for the Study of Social Policy, told The DC Line during an interview in August 2021 that the CFSA “investigation practice is pretty good now.”

She may be making a distinction between quality and quantity. Meltzer said that CFSA “managers are paying attention to what happens,” ensuring the case reviews and all the processes occur. They’re also “consistently reviewing the quality of their work.”

It should be noted that over the years, Meltzer has been the person evaluating CFSA’s reforms while also selling it as a turnaround agency, cautioned several child welfare advocates. In a 2021 report to the DC Council’s Committee on Human Services, CFSA indicated it paid Meltzer’s organization $449,782 for its services in the prior fiscal year.

In an email to The DC Line, Meltzer offered a different accounting of expenditures. She said her organization billed the city $493,256 in fiscal year 2019, $422,772 in FY 2020, and $385,010 in FY 2021. In October 2021, the monitor’s title changed to independent verification agent; her current contract extends through Sept. 30, 2022, and is for $307,946.

CFSA argued that the COVID-19 pandemic and the subsequent public health emergency made it difficult and unrealistic to meet the 95% goal. Managers pushed for adjustments including extensions for conducting the investigations. The report for 2020, however, found the agency’s timetable around investigations fell short even with the added flexibility.

Well before the coronavirus arrived, CFSA was not achieving the 95% target. In June 2019, the monitor said that only 87% of the time did the agency connect to child abuse victims within the requisite 48 hours or make what the investigators characterized as a “good faith” effort to do so; in December 2019 and again in November 2020, it was 88%.

The negligible performance increase meant nothing to the outcome for D.J. or any of the other children who died or were killed that year.

At the end of 2020, the agency had a backlog of 32 investigations, according to documents that CFSA’s then-director Brenda Donald provided to the DC Council’s Committee on Human Services prior to the legislature’s performance oversight hearings in 2021. According to the standards set in the LaShawn A. lawsuit, investigations must be completed within 35 days. In 2020, however, 23 were between 36 and 60 days old, and another nine were more than 61 days old.

In 2021, the number of late investigations jumped to 74; 56 of those were between 36 and 60 days old, while the other 18 were over 61 days.

The majority of those late investigations involved children living in wards 7 and 8. D.J. lived in Ward 8.

Think of the CFSA investigations as comparable in some ways to the contact tracing that became familiar to many Americans during this coronavirus pandemic. An army of contact tracers were on telephones and even knocking on doors, tracking down how one person after another was infected with COVID-19, the disease caused by the virus. Those tracers protected families, friends and neighbors — and saved lives. The proactive quality of that work drew praise.

DC’s child welfare system, in contrast, is averse to acting proactively. When asked in October about recent shootings in Ward 8 where a 6-year-old girl was killed and a 4-year-old girl was left paralyzed, CFSA’s Matthews didn’t immediately recall the incidents, although both had been in the news. The 6-year-old’s father was allegedly involved in drug dealing, which may have led to the assault on him and his family on a street corner. In the latter, the child’s mother was in another apartment building “doing someone’s hair” while her daughter and two friends — one 7 years old and the other 9 years old — explored a gun stored in someone else’s home.

Are incidents like those considered parental neglect? Should CFSA step in immediately, even if it is after the fact, to ensure the future safety of those children?

CFSA’s Matthews said it’s important that everyone “understand what our legal mandate is.”

“We don’t inject ourselves. We respond to allegations of abuse [and] neglect — and those come through our child abuse and neglect hotline, which is operated 24 hours a day, seven days a week, rain, sleet or snow,” he said. “Based on who calls into that hotline [and] provides information to us, we make a determination whether we have the legal standing to get involved based on the information and based on the CPS investigation.

“If there is gun violence that happens in a community and a child is involved, you’ll have MPD to contact CFSA to say, ‘Hey, here’s a particular case where we have kids that may be involved’ in what I call a family situation, to where it could possibly result in the child being removed, depending on the circumstance,” continued Matthews. “That’s how we get involved, versus us kind of injecting ourselves into those situations.”

Data from two sources — DC Superior Court’s Family Court Operations Division and CFSA — provide a window into the risks under which District children are living. The 2020 Family Court Annual Report indicated that as many as 825 children were under its authority via abuse and neglect cases that year. That number, however, excluded 118 cases that involved “pre-petition custody orders,” meaning that dispositions, such as those that could remove a child from the home, had already occurred. The report said they were left out of the tally to “more accurately reflect cases that were available to be processed,” although similar ones had been included up until 2018.

Of the 825 cases that were counted, nearly a third involved children ages 6 and younger. The specific breakdown, according to the court’s annual report, was 18% for ages 3 and younger; 12% for ages 4 to 6; 12% for ages 7 to 9; 12% for ages 10 to 12; 8% for ages 13 to 14; 18% for ages 15 to 17; and 20% for ages 18 and older.

The court also noted that there had been “fluctuations in the number of referrals,” which is “attributed to policy changes at CFSA such as handling more cases as ‘in-home’ cases.” In 2018, the number of cases filed in family court was 399; filings dropped to 338 in 2019 and to 231 in 2020, according to the court’s annual report.

In written responses to questions from the DC Council’s Committee on Human Services in preparation for the agency’s performance oversight hearing in February 2021, then-CFSA director Donald indicated the agency received 25,868 calls through its hotline in FY 2020; of those, 12,228 were not included in the agency’s database known as FACES.

In her answers, Donald indicated that at least 944 of the ones that were left out were “abandoned calls” or “hang ups”; another 3,780 were “updates, contact notes or additional information,” while 7,504 were “general information.” There wasn’t any explanation of the categories. Using Donald’s documentation, that leaves a remainder of 13,640 that were entered into the database.

These figures, however, don’t match those on CFSA’s website. When asked about the discrepancy between them and the data provided to the council, CFSA spokesperson Kera Tyler wrote in an email to The DC Line: “It is CFSA’s practice and protocol to enter all information pertaining to abuse and neglect allegations received by the hotline into the agency’s automated child welfare system.”

On its website, the CFSA indicated a total of 14,046 hotline calls in FY 2020, with 8,514 screened out for various reasons. Left out, according to the agency, were calls that did not involve child abuse or neglect; calls that did not contain enough information for Child Protective Services to conduct the necessary follow-up; calls for which response by another agency was “deemed more appropriate”; and calls in which the children mentioned were “older than 18,” according to the agency’s published dashboard.

“There are things that they legitimately screen out. One of the things you worry about is, ‘Are they screening out things that they should be accepting?’” asked Meltzer. “By and large, we don’t think they are. There are always going to be cases where they’ve made a mistake in any system, [even] the best system.”

CFSA’s 2020 Internal Child Fatality Report provides evidence of what can happen when calls are screened out too aggressively, as indicated by the fact that 38 of the 40 children whose deaths were reviewed in 2020 had screened-out hotline calls related to them.

A total of 582 hotline calls were referred to other agencies or community-based organizations, according to the CFSA report. Previously, many of those referrals would have been handled by the agency’s family assessment unit. However, in 2019, the agency merged that unit with its Child Protective Services division, and began sending most family assessment cases to third-party contractors, Donald told the council’s Human Services Committee.

Of the 25,868 calls in 2020 that Donald reported to the council as part of its 2021 performance oversight, CFSA ultimately accepted only 4,544 for investigation — and some of those involved previously opened investigations. The allegations covered physical abuse, substance abuse, inadequate supervision, domestic violence, sexual abuse, neglect, and caregiver incapacity. In that report to the council’s Human Services Committee, Donald said that 989 of those investigations were substantiated. However, on its website CFSA indicated that 883 of the investigations were substantiated while another 568 were either unfinished or inconclusive; meanwhile, the agency identified 2,656 of the investigations as unfounded.

When using the numbers provided to the council, that leaves 437 investigations unaccounted for.

Advocates and others who track the work of CFSA repeatedly warn that the data provided by the agency cannot be accepted at face value. The different sets of numbers posted on its website and provided to the council give credence to their alert.

Ward 1 DC Council member Brianne Nadeau, who heads the Committee on Human Services, declined on three occasions to be interviewed for this series.

The 2020 investigations were conducted in all eight wards, though the numbers ranged dramatically and were highest in the city’s eastern areas: 261 in Ward 1; 59 in Ward 2; 86 in Ward 3; 372 in Ward 4; 622 in Ward 5; 352 in Ward 6; 955 in Ward 7; and 1,496 in Ward 8. Another 236 were listed as “no ward.” That totals 4,439, according to Donald’s report to the council. So, once again the numbers vary.

Among the calls incorporated in the statistics is the one from the boarder about the abuse D.J. was enduring. Citing privacy laws, a CFSA spokesperson declined to disclose any details about that call. By doing so, some advocates ask, is the agency protecting the child or the bureaucracy that failed to prevent the near death — and what about the public’s right to know?

“Child welfare functions on civil laws. So, it’s about protecting the child, and the public doesn’t get access to that,” explained Christian Greene, a former CFSA ombudsperson. If the system were based on criminal law, the public would have a better chance of getting access to information. That is underscored by the details available in the court documents that were accessed for this series related to many of the children who are highlighted.

However, Greene said she frequently fought her colleagues at CFSA over their refusal to follow even civil laws, including those related to the rights of children and to the disclosure of information she believed the public and the parents legally had a right to know — the issues that led to her removal. She subsequently acted as a whistleblower and filed a lawsuit in DC Superior Court against the District. A judge dismissed her case; her appeal is pending.

“CFSA’s pushback is always going to be, ‘These records are confidential; you don’t have access to them because they’re civil. And you will only have access to the criminal document, and you need to wait on that,’” continued Greene. “What people don’t realize is most abuse and neglect of children in the District is never criminally prosecuted.”

Greene offered that even when investigations occur, the facts may not be recorded in the system accurately. Without referring to any specific case, she said, “There are certain ways to code documents within CFSA. Say the child died due to suffocation because of the fact the parent left the child on the couch and left the house for five hours.

“You can either code it as a child abuse/neglect fatality, or you could code the fatality as just neglect, lack of supervision,” said Greene. She added that in her experience, including as ombudsperson, definitions are shifted to meet “the needs of the agency rather than the community. Politics and news [are] significant factors in child welfare decisions, even safety decisions.”

The agency has pushed back repeatedly against the 48-hour standard for completing investigations as set by the LaShawn A. lawsuit. Most recently, it used the pandemic as a reason for not achieving that requirement in 2020 and continued to move the goalpost through 2021 while shifting areas of responsibility from CFSA to other DC agencies and community organizations.

For example, CFSA stopped conducting family assessments, as Donald reported to the council’s Committee on Human Services. But a robust review of the environments in which kids live is paramount to preventing abuse, neglect and maltreatment. Meltzer, the former court monitor, said a good investigation practice means the agency isn’t just looking at whether a child has been bruised or not, “but [is also] identifying what is going on with that family.”

“The family is more than just the mother. It does include the father, the paramour, who’s part of the family. It includes all the relatives,” she said.

“As part of the LaShawn A. reforms, we insisted that DC change their investigative practice so that they’re interviewing collaterals all the time,” continued Meltzer. That includes talking with a child’s teachers, neighbors, relatives and close personal friends. “You really need to do a full, robust investigation and assessment before you decide you’re going to close it.”

As to whether a particular CFSA investigation has been thorough or not, the public may never know. Greene said there are a variety of documents “just in the investigation summary or the investigative process that the public doesn’t even know are there,” which are not being reviewed by people outside of CFSA.

The stakes are high.

On Nov. 3, 2021, both Tyvez Jackson and his girlfriend Diamond Taylor pleaded guilty to child cruelty charges. Jackson pleaded guilty to felony first-degree cruelty to children, and Taylor to felony second-degree cruelty to children; both pleaded guilty to obstruction of justice, according to a spokesperson for the U.S. attorney for the District of Columbia. The two also “acknowledged inflicting injuries [on D.J.] on other occasions,” the spokesperson said.

They are expected to be sentenced on Jan. 28.

That outcome may satisfy many, but it came only after the damage had already been done. If there had been an investigation in response to the initial call, D.J. might not still be in a hospital bed and considered brain-dead by medical professionals 18 months later.


Two-year-old Gabriel Eason might also be alive if there were fewer cracks in the investigation process. On Oct. 9, 2019, a day care worker noticed bruises on his body and, as required by law, called the CFSA hotline. It was one of the 17,960 calls made that year by people concerned about the care or physical treatment of District children.

That year, child care providers or school personnel accounted for 7,704 of the total hotline calls, according to the CFSA dashboard. Another 2,289 were from friends or neighbors; 2,342 from counselors, therapists or social workers; 1,891 from law enforcement officers; 923 from parents or guardians; 866 from medical professionals; 801 from anonymous individuals; 218 from psychologists or psychiatrists; 58 from legal professionals, 26 from foster parents; and three from clergy. Interestingly, case managers and social service agency workers accounted for only 771 of those hotline calls.

It’s particularly surprising that nine hotline calls were made by perpetrators and 59 came from alleged victims. Cynthia Wright, assistant U.S. attorney for DC, noted that in a number of cases she has handled, children have documented their own abuse or neglect on their cellphones.

Of the total calls received in 2019 via the hotline, 4,788 were accepted for investigation, according to the oversight report submitted by CFSA to the DC Council in January 2020. That number differs from the 5,005 that was reported on the agency’s website.

Donald, director at the time, indicated that 1,204 of the 4,788 were “substantiated” while 3,584 were “not substantiated.”

Using her calculation, that meant at least 1,204 DC children were being abused, neglected or maltreated in 2019. That is not an insignificant number.

Despite the day care worker’s Oct. 9 hotline call, no CFSA worker knocked on the door at 935 Division Ave. NE where Gabriel lived with his mother, Ta’Jeanna Eason, and her boyfriend, Antonio Dale Turner.

Instead, as a result of the call, an MPD investigator appeared at the home a week later — on Oct. 16 — and conducted an interview with Eason, according to court documents. On Oct. 17, Eason sent a text message to Turner relaying what the investigator had purportedly told her: “She said they are closing out the case. She said there is no sign of abuse.”

CFSA refused to provide any confirmation regarding the investigation. The DC Line filed a Freedom of Information Act request for all investigations opened and closed in 2018, 2019 and 2020, including the outcome of those investigations.

The document provided by the agency redacted the names and case numbers associated with each probe. The FOIA report included the referral date as well as the start and end dates for each investigation. The list shows that there were 427 investigations underway in October 2019. However, only 15 were opened or referred on Oct. 16 (the date that MPD first visited the Division Avenue residence); of those, seven involved accusations of neglect, seven were for abuse, and one was for sexual abuse. All were closed before the end of November. In one case, the finding was inconclusive. The other 14 were marked as unfounded.

Oddly, court documents indicate that on Oct. 18, “CFSA filed a report with the MPD” requesting an investigation based on the initial Oct. 9 hotline referral. However, the police did not officially start their second investigation until Dec. 19. When officers went back to the home that day, they interviewed 11-year-old M.E. — Gabriel’s oldest brother — who denied any physical abuse. CFSA documents, obtained through the FOIA request, indicate there were 15 cases referred and 15 investigations begun on Dec. 19.

On Jan. 16, 2020, MPD ruled the investigation was “unfounded,” according to court records. However, CFSA’s FOIA document does not indicate that any case begun on Dec. 19 actually closed on Jan. 16.

Yet on Jan. 28 — 12 days after MPD had decided it would close the investigation — Turner called 911, saying he heard a thump in the room where the children were; he told the call taker he found Gabriel injured and that the child had fallen from a bunk bed.

Gabriel was taken to Children’s National Hospital. He was diagnosed with a “severe laceration to his forehead,” according to court records. Despite that visit to the hospital, court documents indicate that MPD followed through in “early March” and officially closed the investigation into allegations of abuse. The FOIA response shows that one investigation begun on Dec. 19 closed on March 5 — it could have been Gabriel.

MPD determined that the allegation of abuse received by the hotline was “unfounded.” Less than one month later, on April 1, 2020, Gabriel Eason was dead.

Both investigations that stemmed from the Oct. 9 hotline call — the one begun on Oct. 16 and the later one begun on Dec. 19 — violated the court-imposed standard, which mandated that such probes begin within 48 hours and be completed within 35 days of a referral to CFSA. Instead, those investigations didn’t commence until seven days and 72 days later, respectively.

Without discussing any particular case, Matthews responded to questions about children who have died by seemingly suggesting that his staff cannot thwart abuse or neglect or be held responsible for fatalities, notwithstanding the public’s perception.

“I think the public believes that just because a social worker is involved, or may visit a child, or may interact with the family, that that should be the premise as no abuse should occur,” Matthews told The DC Line.

“Let’s just say, as a scenario, I go out and visit a family today. And through that visit, we see that the child is OK. There are no visible marks or bruises that would indicate any physical abuse. They have adequate running water, clothing, food, [and] the electricity in the home is running. Then, two days later, we have an incident.

“That becomes the story. And the line becomes about, ‘When was the last time the social worker visited the family?’ Well, it was two days ago. People start having questions,” Matthews continued.

“People have to realize that when you’re dealing with abuse and neglect, you can have a social worker out there one day, and something can happen the next day. It doesn’t mean that the agency — or any agency — didn’t pay attention.

“Things can happen in a split second that can totally change the situation in the home. What is our job, though, when that happens, is to investigate that — to see if it’s a different allegation as to the reason that initially brought the child to our attention, and then to address it that way,” added Matthews.

This explanation, however, doesn’t address the consensus among medical experts that abuse and neglect are, in most cases, ongoing issues rather than one-time incidents.

When a child does die from abuse or neglect, the CFSA’s child fatality review unit and the citywide DC Child Fatality Review Committee are supposed to explain what happened and provide guidepost recommendations to prevent future homicides — except these entities, too, are part of the problem.

This series is supported by a grant from SpotlightDC: Capital City Fund for Investigative Journalism and The DC Line.

The team that worked on the series included reporter jonetta rose barras, editor/researcher Deirdre Bannon and editor Chris Kain.

jonetta rose barras can be reached at

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