DEE WILSON CONSULTING

(Originally published February 2025)

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NOTE: This commentary is the first in a series about the relationship of knowledge and social values in the development of child welfare policy and practice. The initial commentary discusses the creation and development of state child protection systems between 1962-1985.

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The U.S. child protection system in its current form has a highly unusual origin story as set forth in Barbara Nelson’s book, Making an Issue of Child Abuse: Political Agenda Setting for Social Problems (1984). The July 1962 issue of the Journal of the American Medical Association (JAMA) included an article by C. Henry Kempe and colleagues regarding radiological findings of severe physical abuse to young children inflicted by caregivers. In response, all 50 states and the District of Columbia passed mandatory reporting laws during a five-year period, 1963-67. Kempe and his colleagues did not discover the severe physical abuse of children which they referred to as “battered child syndrome.” Rather, they brought radiological findings published during the previous decade to the attention of medical experts and the popular media, which followed up with alarming stories of this phenomenon. Kempe, et al.  created a memorable name for the severe abuse of children and discussed its implications for public policy.

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In 1974, the U.S. Congress enacted the Child Abuse Prevention and Treatment Act (CAPTA) which provided modest resources for child abuse prevention and research, and established standards for the intake and investigation of reports of child abuse and neglect. During a period of 13 years, all 50 states, acting independently and in concert, along with the federal Children’s Bureau, created laws, standards and administrative structures for the reporting and investigation of child abuse and neglect, and did so without significant political opposition. How was this possible?

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As one might expect, there is more to this story than is apparent at first glance. During the 1950s, the Children’s Bureau (CB) and the American Humane Association (AHA) became aware of the medical evidence of severe physical abuse of children, including infants and toddlers, and began to develop model statutes that could be used by states when there was a political readiness to act. Neither the CB or AHA were surprised by the medical evidence of severe abuse brought to widespread public attention by Kempe and his colleagues; though they may have been surprised by the public outcry that ensued. After all, these scientific findings regarding multiple fractures and other serious injuries inflicted on children had been available for years, with little public response. The immediate powerful reaction to Kempe’s article suggests a dramatic change in social values that only became apparent in response to new information regarding the parental mistreatment of children. In these unusual circumstances, social values regarding the acceptable treatment of children suddenly crystallized when cases of severe child physical abuse became widely publicized.

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Some of the initial state statutes defined child abuse narrowly, i.e., as physical abuse only; while others included neglect. CAPTA included a definition of child abuse and neglect, possibly due to the influential advocacy of AHA. Until the passage of CAPTA, it was uncertain whether public concern with child physical abuse would include a broader concern with child neglect in public policy across the U.S., an important policy debate decided behind the scenes in reconciling the Senate and House versions of CAPTA, according to Nelson.  In an alternative political universe, CAPTA might have set standards for the reporting and investigation of physical abuse and given states the discretion to exclude neglect from reporting statutes if they wished.           

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Nelson explains the “dizzying speed” with which states enacted mandatory reporting laws and new administrative structures for the investigation of reports by the astute framing of this newly recognized phenomenon: a) as a type of medical “deviance” that required medical and psychological expertise rather than (or in addition to) criminal prosecution; b) as infrequent, i.e., unlikely to require large new public expenditures); c) as an occasion for public rectitude among policymakers;  d) as “classless,” i.e., something that occurred in all social classes unrelated to poverty.

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It is unlikely that proponents of states’ mandatory reporting laws and CAPTA could imagine state child welfare systems receiving millions of CPS reports annually, or investigating/assessing allegations of maltreatment concerning more than one-third of American children and more than one-half of Black children before age 18; or seriously entertain the idea that substantiated child victims of neglect would soon outnumber victims of physical abuse by four to one and victims of sexual abuse by 10 to 1 in annual Child Maltreatment reports issued by CB.  

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Knowledge and practice in child protection

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I was a CPS caseworker in Colorado and Washington from 1971-84. During these years, I attended numerous trainings on physical abuse, some of which (in Colorado) were presented by staff at the University of Colorado Medical Center where Kempe and his staff were located. Trainers and most scholarly articles asserted, or implicitly assumed, the following:

1. Child physical abuse was a homogenous phenomenon, the dynamics of which were explained in discussions of “battered child syndrome.”

2. Parents who severely abused their child had themselves been abused and required psychotherapy to undo toxic messages from childhood.    

3. The goal of psychotherapy was to prevent the intergenerational transmission of child maltreatment, which in extreme cases required a “reparenting” of abusive parents.

 

Surprisingly, after so much training on severe physical abuse I encountered only one or two of cases of battered child syndrome annually, while being assigned large numbers of less serious abuse cases requiring no medical treatment, best described as excessive discipline.

Child welfare scholars were quick to point out that allegations of severe physical abuse of children were relatively rare, no more than 1-3% of screened in CPS reports. However, scholars were slow to provide a useful typology of physical abuse cases that recognized important differences in the characteristics and dynamics of physically abused children and their caregivers.

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 In 1990, Carole Bowdry, a child welfare training manager in Texas, published “Toward a Treatment-Relevant Typology of Child Abuse Families,” in the journal, Child Welfare, the first useful classification system for physical abuse I had come across in almost twenty years of working in child welfare. Bowdry’s typology included battered child syndrome as one type of abuse case, far less common than less severe ‘excessive punishment,’ and with different dynamics than an escalating cycle of injuries resulting in serious harm to a child, serial battering, torture, physical abuse combined with rejection and misguided attempts at education. By keeping careful track of physical abuse cases she and her peers encountered in their daily contact with troubled families, Bowdry developed the first useful guidelines I had found for all but a small percentage of physical abuse cases with CPS reports. For years, I had understood that information regarding battered child syndrome was a misrepresentation of most physical abuse cases open on CPS caseloads, but lacked useful operational guidelines for dealing with other types of abuse cases. In a few pages, Bowdry provided more useful guidance than I had received in twenty years of training programs! 

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The neglect of neglect 

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By far the most puzzling feature of the first twenty-five years of the U.S. child protection system developed after 1962 was the ‘neglect of neglect’ in training programs, program development (including essential resources) and among child welfare scholars. For most of the 1970’s I was a CPS caseworker in Colorado where the only training on neglect was provided by a Denver pediatrician, Henrika Cantwell, who in her consultation with child welfare offices had become concerned with the devastating emotional and physical impact of severe neglect on children.

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Here was an odd state of affairs: an abundance of training about a type of physical abuse encountered by caseworkers a few times a year (at most) and little or no training regarding how to respond to and assist large numbers of neglecting families whom caseworkers worked with on a daily basis.

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The same inattention to neglect was apparent in program development within child welfare offices. From the mid 1970’s, child welfare agencies made large (much needed) investments in the development of child sex abuse protocols, and in establishing collaborative partnerships with law enforcement agencies around the investigation of reports of child sexual abuse. There was no similar investment in developing more effective responses to reports of child neglect, or in seeking poverty related services (see below) to assist neglecting families. 

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There was a similar lack of interest in neglect among child welfare scholars. For at least thirty years, most of the few articles about child neglect published in child welfare journals began with a discussion of the ‘neglect of neglect’, a situation that changed in Washington State during the 1990s as Diana English and her colleagues began to disseminate findings from the Seattle LONGSCAN study. 

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It may be a surprise for readers who have never worked in a public child welfare office and view public agencies as insular bureaucracies indifferent to public opinion to learn that child welfare agencies are extraordinarily sensitive to the political environment and social milieu in which they operate. After working in two state child welfare systems for more than 30 years, I have concluded that child welfare agencies are able to develop and sustain commitment to reform agendas only when there is public support for doing so and persistent political pressure to improve outcomes.

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There has never been such support or political pressure to improve services to neglected children and their families except as reflected through a concern with the effects of substance abuse, mental health challenges and/or domestic violence on child safety and well-being. In discussions of policy and practice both within and outside public agencies, mention of neglect acts as a soporific regardless of the large body of outstanding research regarding chronic neglect and the damaging effects of neglect on brain development and health outcomes across the life span. Research studies, regardless of their quality, have little impact on public policy when prevailing social values endorse active denial of their messages.

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Public child welfare agencies did not adapt or redesign their child protection systems to more effectively respond to neglect because there was no pressure from advocates, courts, stakeholders and policymakers to do so, possibly because neglected children were often not injured physically.  Even when serious injuries due to neglect occurred, they were unintentional and conflated with accidental injuries or deaths, not a reason for public outrage.   

     

Poverty and child maltreatment: attitudes and beliefs

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Mandatory reporting and CAPTA became law without strong political opposition, in part because policymakers believed: a) there would be minimal costs, i.e., no need for extensive support services, and b) due to assurances from advocates that child physical abuse – and (by extension) other types of child maltreatment were not associated with poverty. The last thing the U.S. Congress wanted in 1974 was another iteration of the increasingly unpopular War on Poverty. Even scholars who knew better (e.g., David Gil) were manipulated into supporting the “myth of classlessness” during CAPTA hearings.

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The emphasis given to the view that child abuse and neglect occurred in all social classes (a truism) and the belief that the overrepresentation of low-income families in CPS reports was due to the bias of mandated reporters was not cynical. Many of the child welfare staff I worked with through the 1990s adamantly held these views, even after most child welfare scholars were convinced by the first two National Incidence Studies (NIS 1&2) of the strong association between child maltreatment and degrees of poverty, with the strongest association (by far) between severe poverty and neglect.

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NIS studies were based on the knowledge of “sentinel” reporters, for the most part a subset of mandatory reporters, not based on CPS reports. The NIS studies found that mandatory reporters often failed to report suspected child maltreatment for reasons that had nothing to do with social class, but was often influenced by their belief regarding the likely benefit - or lack of benefit - to a child of making a report.

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While the two NIS studies published during the 1980’s had a decisive influence on scholarly opinion, they had little or no influence on the views of child welfare staff and child advocates who rarely read research studies. They had heard credible experts maintain that low- income families were unusually exposed to mandated reporters and for this reason much more likely to be reported to CPS. In addition, many child welfare staff believed that to acknowledge the association between poverty and child maltreatment would reinforce negative social attitudes toward poor families, including racial minorities with elevated rates of poverty, and lead to more punitive practices.  They were skeptical – to say the least – that recognizing the enmeshment of child neglect with poverty would influence legislators and Governors to fund poverty related services.

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One of the consequences of these mistaken beliefs was that during the years I was a CPS caseworker (1971-84), the offices I worked in had no allotted funds for concrete poverty related services. I (and many other caseworkers) spent considerable time contacting churches, clubs, and local philanthropists to feed and clothe families, pay their electricity bills, provide bus passes, dental work, rent deposits (one time only). From about 1985, child welfare offices in Washington were able to access modest amounts of funding for concrete services, a category of expenditures that steadily grew in subsequent decades.

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I am pleased to say that, currently, Washington’s DCYF mandates the provision of poverty related services on open cases to meet the basic needs of children and families, prevent out-of-home placement and hasten reunification; a policy commitment many other state welfare agencies will hopefully soon follow.

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Summary 

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One of the most important lessons from the early history of the modern U.S. child protection system is that when research findings and their interpretation have a large impact on public policy, it is extremely difficult to change course even when it becomes apparent that early scholarly opinion was misguided or mistaken. Scholarly mistakes have a long ‘half-life’. Conceptual errors are highly resistant to revision once they have helped shape public policy.

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However, from the perspective of most child welfare staff, community professionals, advocates and stakeholders the large steady growth in CPS reports, along with the many thousands of children placed in foster care and made legally dependent due to child maltreatment, confirmed the need for CPS interventions in the lives of (mostly) low-income families. The passage of permanent planning legislation in 1980 began to create additional legal structure around the use of foster care.  The question that dominated child welfare discussions in the early 1980s was how to better support and administratively structure “reasonable efforts,” i.e., services, to prevent foster care placement when possible, and how and when to facilitate termination of parental rights when timely reunification proved to be impossible. 

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Next month’s Sounding Board will discuss the huge increase in foster care from 1986-99 resulting from a substance abuse epidemic, passage of the Adoption and Safe Families Act (ASFA) and scholarly debates regarding family preservation services and differential response systems. 

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References

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Bowdry, C., “Toward a Treatment-Relevant Typology of Child Abuse Families,” Child Welfare, 181, July/August 1990.   

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Kempe, C.H, Silverman, F., Steele, B., Droegemueller, W. & Silver, H., “The Battered-Child Syndrome,” The Journal of The American Medical Association, July 1962.

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Myers, J., Child Protection in America: Past, Present and Future (2006), Oxford University Press, Oxford, England, New York City.    

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Nelson, B., Making an Issue of Child Abuse: Political Agenda Setting for Social Problems (1984), The University of Chicago Press, Chicago & London.

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Sedlak, A., A History of the National Incidence Study of Child Abuse and Neglect, Westat, Rockville, Md., February, 2001.   

 

​See past Sounding Board commentaries     

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©Dee Wilson     

  

deewilson13@aol.com

    

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