A Response to Naomi Schaefer Riley on Child Abuse Pediatricians from a Former CPS Social Worker

This essay is in response to this piece written by Naomi Schaefer Riley.

I was a Child Protective Services (CPS) case worker in Kansas for ten years and investigated over 1400 reports, some of which involved child abuse pediatricians. I currently work as a therapist in a Psychiatric Residential Treatment Facility (PRTF) in Kansas and help children heal from traumatic experiences. We treat many children who have had contact with the child welfare system in some capacity, oftentimes through the foster care system.

Rounding out my resume is a plot twist I never expected. Two years after I stopped working for the State, I was investigated for child abuse by my former agency, the police, and a child abuse pediatrician (CAP) working in the SCAN clinic at Children’s Mercy Hospital. This experience gave me an unwelcome perspective on how the system can wreck someone’s life.

It’s hard to dismiss my objectivity, and I’m proud of my ability to be fair and compassionate.

I’m a big fan of data because numbers help us fact check our emotions, but numbers don’t always tell the whole story. It’s been my experience that agencies involved in the child welfare system don’t always do the best job of tracking their own systemic failures.

To argue that CAPs don’t always allege abuse, Schaefer Riley quoted a 2009 study where 200 consecutive families were evaluated at a children’s hospital. James Anderst is the lead author of the study. He is also a child abuse pediatrician and the director of the SCAN clinic at Children’s Mercy Hospital in Kansas City, Missouri. I once sat across from him discussing a skull fracture I was investigating with the police. Years later, he was in leadership in the SCAN clinic when I was investigated. We are not well served by studies whose authors stand to benefit greatly from a favorable view of their work.

If you want to know if CAPs are quick to allege abuse, don’t just ask them. Ask people from other agencies who work investigations alongside them. I sat beside a police officer at a training recently and she said, “They assume abuse first and then work backwards to disprove it.” And beyond other professionals, listen to families who have had contact with CAPs to see if there are common threads you find concerning.

Quite a bit has happened since Dr. Anderst penned his paper in 2009, including my case in 2013 and Sarah Goble’s case in 2025. Doctors at the Children’s Mercy Hospital SCAN clinic were instrumental in both of our lives going off the rails. I spent three years on a Child Abuse Registry for something I didn’t do and couldn’t work in my chosen field because of it. Sarah’s children were removed from her care for six months after SCAN clinic doctors erroneously diagnosed child abuse. There are no numbers that will adequately convey how devastating these investigations are to families.

It’s easy for someone who has never been investigated by a CAP to dismiss my case and Sarah’s as one-offs. But when you’ve been investigated by systems who aren’t forthcoming about their failures, you begin to see patterns in other investigations that mirror your own. Instead of looking at our cases as anomalies, consider that you know what happened to us because we told you about it. And then consider that not every family is willing—or able—to do that. The narrative is often one-sided in favor of the system because most families are too intimidated to say anything publicly. They’ll say it in private to the ones who will say it publicly, though.

Schaefer Riley is correct that doctors do not make the decision to remove children from their parents and that this decision lies solely with CPS and a judge. This is an argument often made by CAPs when the ramifications of their medical opinions are in question. Although technically true, the argument is disingenuous.

Anyone who has worked in the system knows that a medical opinion is what the police and CPS rely on to prove their case. If a CAP has written a medical opinion stating that a child has been abused by a parent, they have painted CPS into a corner on the decision to remove. CPS operates from a place of fear, and nothing is scarier than the thought of leaving children in their home if a doctor says abuse occurred. This is the tricky position CAPs have put themselves in. They are an integral part of an investigation and use their influence to shape the outcome but then put their hands in the air and plead innocence when their incorrect medical opinion results in horrible decisions for families.

CAPs can’t have it both ways. If they are intricately involved in investigations (and they are) then they need to own their influence over the outcomes.

Shaefer Riley used the terms “supposedly false allegations” and “there’s more to the story” when discussing allegations against parents. These are statements often representative of the core belief that clients always lie and the system is always honest. This could not be further from the truth. Yes, clients often lie or misrepresent information, minimize, and deflect blame to get out of trouble. I know that well because I worked in CPS and listened to clients do it for ten years. A hard truth I learned both personally and professionally is that professionals also misrepresent information, minimize, and deflect blame to get out of trouble. The difference between the two groups is that it’s considered bad when clients do it, but it’s considered part of the job when professionals do it.

Schaefer Riley argues that child welfare agencies and hospitals cannot correct the record due to confidentiality. It’s important to note that the system creates the record. My frustration is less with the system being unable to correct the record due to confidentiality and more that they are often unwilling to correct the record when they’ve screwed up.

An example: An Internal Affairs officer approached the CAP on my case in an attempt to get her to change her opinion about me. This occurred after I presented information proving that the investigating officer had omitted large chunks of exculpatory information from his reports that indicated I was innocent. The CAP refused to amend her finding when given additional facts even though all signs pointed to the injury occurring outside of my care.

She protected herself, but where did that leave me? More importantly, where did that leave the child I was alleged to have abused? The doctor was in the child protection business, but when rubber met the road, she protected herself instead. Whether due to internal decision-making or pressure from her institution, the outcome was the same. The narrative was incorrect, and she refused to correct it.

As a CPS social worker, I was on the receiving end of quite a few unhinged rants alleging mistakes when there were none. I didn’t love this, but nothing adverse happened to me because my agency always backed me up. When it happens in reverse—when the system creates a false narrative about a family and refuses to correct it—the consequences for that family are dire and can involve their children being removed from their care.

It’s disconcerting when people say the wrong things about you and you can’t correct it. It’s even worse when the people saying the wrong things are government agencies and doctors with the power to upend your life. Anybody who has run afoul of the child welfare system knows that once the narrative is created it is almost impossible to get them off of it.

Wrong narratives are wrong no matter who creates them.

Calls for heads to roll, threats of lawsuits and violence, and public shaming make professionals afraid and unwilling to work in their profession. They want immunity protection because they fear the consequences of their mistakes. Parents also fear the consequences of their mistakes. The difference is that we talk about protection for the professionals but not the families.

What we really need to wrestle with is what should happen when the system gets it wrong. The threat of lawsuits makes it scary for professionals to do their jobs, but being railroaded by the system makes it hard for families to live their lives. What is the acceptable compensation when a parent takes their sick child to the emergency room, is wrongly accused of abuse, and has their child removed from their care? Can we agree that a parent in this situation will be rightly offended by a doctor refusing to admit they got it wrong to protect themselves?

It has long been troubling to me that a system that exists, in part, to hold people accountable refuses to hold itself accountable. There is no amount of money that would make up for the time I lost as a result of system incompetence. For the longest time, what I wanted more than anything was for the system to acknowledge they messed up and work to fix it.

I wonder how many other people in my position want that same thing.

Shaefer Riley ended her piece by stating, “More than 2,000 children in this country die each year at the hands of their caregivers.”  And this is how we do it. We cite that statistic and become fearful that more children will die if CAPs don’t intervene, and so they intervene. And then we become horrified because families are being ripped apart when they shouldn’t be and insist CAPs back off. We repeatedly swing wildly back and forth between the two but never land in the middle.

Children dying at the hands of their parents is horrific, but children being taken from the hands of their non-abusive parents is also horrific. We should be alarmed by both and work to help our caseworkers, doctors and police officers avoid these two extremes.

A simple place to start is mandating that CAPs inform parents that they are part of a team investigating child abuse. Families know who the police and CPS are and what they do. It is not asking too much for CAPs to be mandated to similarly explain their role.

Another solution is mandating second opinions by specialists when a CAP is involved. Going further, we need a level-headed conversation about what a CAP’s area of expertise is, and what it is not.

We should create an atmosphere of conversation instead of ridicule in which families and professionals talk about their experiences openly to establish and understand core issues and patterns. You can’t have a balanced narrative if each side is only listening to their own camp.

Importantly, give CPS case workers the training to make safety decisions independent of CAP opinions. I navigated around a CAP opinion as a CPS social worker, and I know it can be done.

We don’t make good decisions when we operate from a place of fear. Vulnerable families need us to be our best.

Andrea Verbanic is the author of Renegade Agency: A Memoir of a Family in Crisis and the Systems Meant to Protect Us.


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2 responses to “A Response to Naomi Schaefer Riley on Child Abuse Pediatricians from a Former CPS Social Worker”

  1. Kathy Marie Elkins Avatar
    Kathy Marie Elkins

    Another Response to the AEI Article “A Child’s Worst Nightmare”Mischaracterization of Anderst, Carpenter, Abshire, and Lindberg (2009)

    The AEI article “A Child’s Worst Nightmare” (Nov 2025) written by Naomi Schaefer Riley cites Anderst, Carpenter, Abshire, and Lindberg (2009) as evidence suggesting that child abuse pediatricians (CAPs) are less likely to diagnose abuse than non-CAPs. This portrayal is not merely incomplete—it is materially misleading. In a field where conclusions can separate children from families, such distortions risk real harm when uncertainty is presented as certainty and limitations are ignored. One is left to wonder if the article’s author read the study or skimmed an abstract. 

    Anderst et al. explicitly caution their data “should not be interpreted as a direct statistical comparison of accuracy” between CAP and non-CAP physicians. The AEI article disregards this limitation and presents the findings as proof of CAP diagnostic superiority. That is not interpretation—it is a contradiction.

    The study itself makes clear that CAP and non-CAP physicians operated under fundamentally unequal informational conditions. Non-CAP physicians made initial assessments based on limited clinical data, while CAP physicians rendered opinions after CPS investigation, including scene findings and witness interviews. As the authors state, “Non-CAP physicians did not have the benefit of review of the information gathered during the investigative process,” and CPS investigation frequently adds information “not available at the time of the child’s medical care.” The authors further concede that “it is not possible to discern” whether diagnostic changes were due to additional information or CAP expertise. The AEI article ignores this and attributes changes to CAP skill—an inference the study itself does not support.

    The study’s design further undermines the conclusions drawn from it. Inclusion required both a CPS report and CAP consultation, creating a highly selective cohort of already escalated cases. The authors acknowledge “an inherent selection bias” that may have inflated disagreement rates.

    Though there are needed disclosures, one claim in the research stands out – that non-CAP physicians were “likely unaware” of CAP consultation services is equally unsupported. The study itself is based entirely on cases referred by CPS to a CAP subspecialty group, demonstrating active use within the system. The authors provide no empirical data assessing physician awareness. This assertion is speculative and inconsistent with the study’s own methodology.

    The structure surrounding child abuse pediatrics warrants scrutiny. In some states, contractual arrangements prohibit CAPs from providing second opinions on each other’s work, while immunity provisions limit accountability. Medical Boards routinely ignore complaints made about Child Abuse Pediatricians. These structures can discourage scrutiny and create environments where questioning CAP conclusions carries professional risk. At the same time, CAP roles are embedded within systems funded in part through state and CPS-related mechanisms, raising legitimate questions about independence and incentives.

    Concerns also extend to training and standards within the specialty. Data from the American Board of Pediatrics show that pediatric board pass rates generally fall in the 80–90% range for first-time test takers across all other specialties. Child abuse pediatrics has reported exceptionally high—and in two of the last three cycles a 100% pass rates. In the last six years, only one candidate did not pass on the first try. Such consistently elevated outcomes raise reasonable questions about exam rigor, selectivity, and the threshold for certification in a field making high-stakes determinations. A quick google search of message boards showing discussions about the lack of candidates for CAP fellowships and lack of competition also raises concern.

    Equally concerning is how research is applied in practice. Screening tools such as TEN-4-FACESp explicitly warn against diagnostic use and disclose worrying statistical tradeoffs that accept the balance of twenty false positives to one false negative. That is similar to cancer screenings yet if you are diagnosed with an initial test for cancer, follow up test will ensue that will correct that. The same is not true for families and children harmed by false allegations. Yet these caveats are often minimized or omitted in training, public commentary, and testimony by CAPs. Sentinel injuries are defined as those without plausible explanations, yet CAPs routinely ignore that adjective The pattern is consistent: limitations are acknowledged in the fine print but not in practice.

    This pattern is not confined to external commentary. Misrepresentation of nuanced research findings also occurs within CAP practice itself, where studies are at times presented more definitively than their authors intended. When both internal and external narratives amplify conclusions while minimizing limitations, the risk of error is not theoretical—it is systemic.

    Mischaracterizing studies like Anderst et al. (2009) does more than distort academic discussion—it reinforces a system in which suspicion can be elevated without sufficient evidentiary grounding, while concerns raised by families, treating physicians, and even court findings may be discounted. The study demonstrates the effect of additional information on diagnostic interpretation. It does not demonstrate superior accuracy by CAP physicians.

    The claim that CAPs do not make removal decisions is a distinction without a difference. In reality, CPS and courts rely extensively on CAP opinions, which often function as a single driving force behind those decisions. A diagnosis can set in motion a chain of events leading to removal and prosecution. To deny that influence is to ignore how the system actually operates. CAPs can and do explicitly direct the work of Child Welfare Social workers. 

    When a profession combines repeated exposure to extreme cases with significant unilateral influence over legal and family outcomes, concerns about cumulative bias and loss of impartiality are not speculative—they are predictable. Systems built on such authority must include robust safeguards, because human judgment under these conditions is not immune to distortion.

    Greater balance, transparency, and accountability are urgently needed. Future commentary—especially in influential public forums—must reflect the full context of the underlying research, including its limitations, uncertainties, and potential for bias. Anything less risks perpetuating a one-sided narrative in a field where the consequences of error are profound.

    The article reflects a failure to accurately engage with the underlying research, and by misrepresenting its findings, it advances a narrative that risks real harm to families by dismissing legitimate concerns, conflicting medical opinions, and evidence recognized in court.

    We must stop treating child abuse pediatricians as beyond scrutiny or assuming that criticism of their work endangers children. In reality, this is a field where a single flawed, biased, or even careless assessment can set in motion devastating consequences for children and families, including legal action based on incomplete or misinterpreted information. Accountability and critical examination are not threats to child protection—they are safeguards against harm. Ms. Riley’s prior work has shown greater balance, making the framing of this article especially difficult to understand.

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  2. Kathy Marie Elkins Avatar
    Kathy Marie Elkins

    You should add your reaction to the article here under the article so that even more people see your response.

    https://www.city-journal.org/article/maya-kowalski-child-abuse-pediatricians

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