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Q&A with Nancy Cambria: Keeping Emotions in Check While Covering Day Care Deaths

Q&A with Nancy Cambria: Keeping Emotions in Check While Covering Day Care Deaths

Picture of William Heisel

day care, SIDS, William Heisel, Nancy Cambria, child protective services

Twitter handles can sometimes reveal quite a bit about the person, intentionally or not. Nancy Cambria at the St. Louis Post-Dispatch goes by @nanecam. After reading her "Deadly Day Cares" series, you can't help but read that handle as "nanny cam," and we all should be so fortunate as to have someone like Cambria looking into our child's child care provider. She brought clear-eyed investigative reporting to a sensitive topic: children dying, mostly from suffocation during naps, at child care centers that were either understaffed or ill-prepared to handle young children.

Cambria, a mother of two, regularly writes on children and family policy with an emphasis on child care, early childhood education, foster care, juvenile justice and families at risk. In 2009, she won a first place Missouri Associated Press Managing Editor's Award for her feature, "The foster child thought she had nobody left to love her: She was wrong." She also has won the Terry Hughes Award from the St. Louis Newspaper Guild for her writing and reporting.  A native of New Jersey, Cambria worked at weekly and smaller daily papers there before moving to St. Louis in 1999. She is married to Post-Dispatch investigative reporter Jeremy Kohler. I highlighted five tips from the series on Friday. For the interview, I reached her via email. Her responses have been edited for space and clarity.

Q: This trail started for you in 2008, when you were reporting on the case of Nathan Blecha. How did you take that story and start building this larger investigation?

day care, SIDS, William Heisel, Nancy Cambria, child protective services

A: Yes, in 2008 Nathan's dad sent a one sentence email to our editorial page pointing out that his son had died in a home day care and hardly anything happened afterward. It got forwarded to me. A few months earlier I had met with some people articulate on child care policy, and they had given me an earful about Missouri's weak regulations. It was all rather wonky, and I left that meeting not knowing what I could do with it. But then I met with the Blechas and I saw the consequences of that weak policy on this family, so I wrote a story.

Two years later, Sam Pratt's family surfaced in a very public way because of how they had been treated by a legislator. Then, early this year, I got wind of another local family who had lost a child in an unlicensed day care. My initial intent was to write one story in late March focusing on that new family along the lines of "three deaths, three different years, and yet, the legislature again failed to act..."

But then somebody at the state whispered in my ear that I really needed to check out how many children were actually dying in "illegal" day cares. That number was eight over four years. I was pretty shocked. Then, the logical question was, well how many are dying in licensed care? The answer was four. Then came the big question: how many altogether have died in unlicensed facilities?

Then we realized we had nearly four dozen babies and toddlers that had died in a four-year period. We knew we had to put faces to these statistics. We had to be as specific as possible regarding the circumstances and the state rules and laws that did or didn't come into play, so that the deaths no longer went unnoticed.

Q: I imagine there were times when this story just seemed too hard to report. What did you do during the reporting of this story to keep yourself from just crying all the time?

A: Oddly, I didn't cry until I saw the final layouts and all of those babies' faces together. I lost a lot of sleep, though. I had a rolling crate next to my desk for six months stuffed with growing files on each child. It was a burden having that amount of information and police reports detailing the same terrible thing, and knowing that in some cases I knew more than the parents did. Calling parents was tough, but calling the caregivers was even harder. I notified or talked with every known caregiver, regardless if they were named in the series.

I credit getting through it on three things: First, my editor, Matt Franck, was unwavering in the belief that what we were doing was a public service. Second, I took up running in mid-March, right around the time I realized the scope of the project. A real stress reliever. Third, I reached out to SIDS Resources to, at the very least, notify parents that this series was coming and their child would likely be named or pictured. They agreed. I can't say it gave me total peace of mind, but it made me feel that we had made a genuine, ethical effort to reach out to them through a very responsible party that could soften the blow when the series published.

Q: You quickly found out that there was not going to be one tidy place for you to gather all the records on kids who had been hurt in day cares. How did you decide where to look and when it would be enough to stop searching for more records?

A: I had known all along that state regulators kept child care files on licensed and illegal facilities, and that's where we went first. But I only got about nine sets of files from that office. So we went to child fatality review in the Department of Social Services. They were limited in what they could give me because of confidentiality laws. But they were willing to work with us under the constraints of those laws, and they agreed to run the stats for us in a critical way.

They tallied the deaths from year to year, specifying the number in both licensed and unlicensed care and the cause of death for each. It was a long email that proved to be the backbone of the whole project. They also, by law, were able to give us 24 names of kids who died of factors other than illness and the county where they died, but little else.

It wasn't every child, but it was helpful. With a name and a general location I was able to find these kids through police reports, medical examiner reports, obituaries and memorial blogs. In the end we obtained police reports on about 95 percent of the named children who died of sleep deaths. Those were invaluable because, first, they identified the caregiver so I could do more reporting, and second they often provided a detailed account of how the caregiver placed the child down to sleep.

I'd say around late August I started to feel like we had enough because we had such a firm accounting of the sleep deaths in licensed versus unlicensed care among the known kids. With the rest – the unnamed children - we were able to deduce by process of elimination what had happened to them via the statistical information we had received from child fatality review. Ultimately, I felt the ratios between licensed and unlicensed deaths were solid and the patterns behind those deaths were distinct.

Q: This is a local story but you include enough national context to make it clear that Missouri has a serious lack of tools to deal with this problem. How did you go about finding that national context?

A: I'd done enough reporting previously on other day care issues in Missouri to know where to look and to know what states were doing well and which ones were not. There's a National Association of Child Care Resource and Referral Agencies that ranks states yearly on their quality of child care regulation. Additionally, some of the SIDS research done by pediatrician Rachel Moon took a real look at the types of rules used by states to prevent sleep deaths. Looking down that chart, Missouri got a near goose egg for its standards.

Q: You've done a nice job balancing the hard policy questions surrounding these day care deaths with the personal stories of the families. You've kept a good emotional distance in the stories while providing videos, photos and mini profiles of the children to supplement the stories. What went into the decision to not include all the emotional and personal details in the body of the stories themselves?

A: When I confided with friends who are journalists about what I was working on, the first thing most said was, did you read Gene Weingarten's story? It was the one on distracted parents who'd accidentally left their infants in cars in hot weather. I had read it, and that's the treatment I originally thought I would try to give this subject.

Well, I wasted a good two weeks on that approach. First, I'm no Gene Weingarten. And second, this was a document-driven story with lots of data analysis and many, many children. Every time I tried to sneak a personal detail into it, it just sort of stunk to high heaven. But more importantly, when I spoke to parents who had been through this, I was doing them no service by getting maudlin. They didn't want sympathy. They wanted to see change.

Jean Buchanan, our projects editor, was adamant about sticking strictly to the facts in the main stories, but early on she had suggested we write small vignettes about some of the children. These were where I could highlight those emotional details that couldn't go in the main stories. Keeping them brief added to their intensity.

Also, we had decided early to publish as many faces of infants who had died as possible. So in the back of my mind, I knew that this was going to balance out the stories. In the end, Josh Renaud, the project's online and print designer, decided to frame the first day print story with these babies' faces, and it was devastating.

Q: You focused on policy questions that have allowed this to happen, things like the inability of Missouri to go after unlicensed day cares and the weak punishments available for breaking what few rules Missouri has. Other papers have focused on the day care providers themselves, including stories about their criminal histories. Why did you focus on the policies and not the people?

A: I've never really gotten into law and order reporting, and fortunately my editors have protected me from having to write about every horrific crime against a child for daily print. But I have done "bad day care" stories, too. We had a guy allegedly dealing pounds of pot a week out of his wife's home day care. But I had a lot of bigger questions even with that one. Like, in the search warrant application, a drug task force claimed they'd had the house under surveillance for years. So why had nobody ever called the state to report a potential danger to children? Why hadn't anybody tried to shut it down?

I guess my feeling here is that, excluding cases of child abuse, willful negligence and subsidy fraud, most child care providers mean well. They don't have a lot of other options to support themselves. Most don't get training or benefits. They generally like children. It's hard, lonely work. The system isn't backing them up, either. We have systems for educating children, for taking care of the elderly and the disabled, for protecting patients. Just like everything else, child care regulation is a system to protect the vulnerable and the voiceless, so why isn't the system working for young children and their providers?

Q: Now that the series is out there, what has been the reaction from readers and from people in position to do something about this problem?

A: There are some in the child care community who feel it wasn't fair to unlicensed providers in general – that it failed to give a nod to the hundreds of home providers where this hasn't happened. But otherwise I've had tremendous feedback from the community, to the point where I even had a child care provider call me looking for sleep safety training for her staff.

Our St. Louis morning radio host Charlie Brennan of KMOX had me on immediately to discuss the project and has told me he will be hosting some of the parents down the line. Lawmakers who backed original laws came out of the woodwork and pledged renewed interest. Gov. Jay Nixon also released a statement saying that the state will be looking at the issue internally. It's too early to tell what will come of it from a policy perspective.

Related Posts:

One Child Is Too Many: Five Tips from the St. Louis Post-Dispatch's Deadly Day Care Series

Photo credit: Valentina Powers via Flickr

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