DEE WILSON CONSULTING

(Originally published May 2016)

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"Within our Reach: A National Strategy to Eliminate Child abuse and Neglect Fatalities," the final report of The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF), has serious deficiencies which I have discussed in the past two Sounding Boards. Nevertheless, the report has two major strengths: (1) it's support of major reform of the nation's child protection system using public health principles and approaches and, (2) the recommendations for improving measurement of child fatalities. In his introductory comments, David Sanders, the Chairman of the Commission, states, “Our current approach waits until a child is severely injured before intervening with vital supports. It relies primarily on a single government agency to intervene with families who face complex and intersecting challenges.” The report calls for “a comprehensive public health approach” that “builds off a public health model used to tackle complex social problems,” with an emphasis on prevention and community mobilization.

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However, the Commission does not describe the administrative structures that would support a new child protection system built on public health principles or how states that currently do not come close to adequately funding their public child welfare systems will be able to afford large new investments in prevention and early intervention.

The open lack of consensus among the Commissioners regarding the recommendation of a billion dollar enhancement in federal support for states' child protection systems suggests that policymakers and advocates have come to a fork in the road: greatly increased federal funding to reduce the chronic inadequate staffing and under-resourcing of states' child protection programs vs. a refusal to make an additional investment in CPS systems widely believed to be failing in their mission to protect children from maltreatment related serious injuries and death until they are redesigned and functioning in a different way. This is a public policy choice that cannot be finessed or postponed. The only alternative is business as usual in child welfare while hoping for a different result; an unreasonable (if not crazy) expectation.

Options for Reform

In most states, child welfare agencies and their CPS programs have been inadequately staffed, often to an extreme degree, and under-resourced to support families with CPS reports. It is a rare child fatality review or study that does not point out the lack of adequate CPS staffing and the consequences for child safety. In addition, child welfare agencies have been systematically mismanaged for decades through ever expanding policy and procedural frameworks, misuse and occasionally even exploitation of their workforces, their refusal to more adequately measure child safety, and to accurately count child maltreatment deaths. It is possible (but not easy) to greatly improve child protection systems by addressing staffing and resource deficits and to make organizational improvements in the way that agencies are managed without addressing design flaws. Child welfare agencies in crisis have repeatedly made such attempts, usually without much success. Most reform initiatives have failed for two main reasons:

1) enhancements to staffing and resources have not come close to meeting the needs of child welfare agencies and have not adequately supported workforce development, and

2) agencies are managed in ways that make the jobs of caseworkers and supervisors increasingly intolerable, thus undermining the organizational ability to retain experienced staff. 

First and foremost, the child protection crisis in this country is the result of workforce problems, especially the inability of public child welfare agencies to attract and retain qualified staff. It is possible to address workforce issues without redesigning child protection systems, and a few states have done so. However, in most states, policymakers and agency managers continue to act in ways that make these problems worse rather than better, and that create the potential for Arizona-like “meltdowns” (see below) following high profile child deaths.

Addressing design flaws requires something more, possibly changes in law and administrative structures, definitely changes in budget priorities and community collaborations, as well as fresh thinking and new approaches to child protection. Ever since the publication of A Nation's Shame: Fatal Child Abuse and Neglect in the United States (1995) it has been common for policymakers and advocates to wax eloquent about the need for a child welfare system committed to prevention and early intervention without an idea of how such a system would be structured or at what cost to current structures and child welfare practices. It is time to give these aspirations some definition and develop a vision that can guide policymakers.

Design Flaws and their Consequences

1. Child protection systems are reactive rather than proactive and preventive. CPS interventions
follow screened in reports which are often too little, too late. Furthermore, CPS systems are
organized to act when children have already been injured or are assessed as Unsafe, i.e., in
danger. Babies, toddlers and other young children are too vulnerable to be adequately
protected after they have been harmed through abuse or neglect or are in danger due to
substance abuse or domestic violence. Furthermore, at least half of families in which
maltreatment fatalities occur have not been involved with CPS prior to a child's death.

2. Child protection systems are organized around investigations/assessments of families
identified in CPS reports. More than two thirds of families with screened in reports receive no
services other than a CPS investigation/assessment. For this reason, the Commission's
recommendation to screen in all reports of children 0-2 and repeat referrals would likely have
little effect on child safety unless effective family support services are made available to a
much larger percentage of families. The most likely effect of this recommendation, if
implemented, would be to further overwhelm child protection systems with little effect on child
safety.

3. No state or community agency or agencies has the responsibility to develop resources which
will support parenting in difficult conditions, for example day treatment programs for
impoverished single parents and their children, respite care on demand, residential substance
abuse treatment programs for mothers and babies, finding housing for homeless families with
children or for teenagers living on the street. Child protection is assumed to require
investigation and child removal in extreme circumstances. In-home services, if offered during
a CPS investigation, are time limited, e.g., 3 months or 6 months. Parents may lose eligibility
for services once their CPS case is closed.

4. Child welfare agencies rarely make sustained attempts to influence social attitudes and
beliefs regarding the care and discipline of children, in part because these agencies are severely
challenged to meet their investigative responsibilities. Child protection authorities make little
or no effort to shape public opinion in ways that would protect children, for example, by
strongly discouraging the use of physical discipline with infants and toddlers and the promotion
of Safe Sleep guidelines through the media and public education campaigns.

5. Child protection is viewed as legally sanctioned interventions in specific families reported to
CPS. Societal neglect is ignored or minimized. It is a seriously disoriented society that
mandates investigations of neglect allegations of homeless families while leaving families
living under freeways or in cars without access to bathrooms, clean water and secure food
supplies.

6. The resources needed by children and families with open CPS cases are controlled by state
and community agencies with no legal responsibility for child protection, for example
substance abuse treatment and mental health agencies, Economic Services and other family
support agencies. In some communities, these agencies actively participate in child protection
initiatives while in others serving children and families with open child welfare cases is a low
priority.

7. Federal funding streams support foster care for children from low income families as an
uncapped entitlement, while funding for in-home services is far less generous and vulnerable to
federal and state budget cutting exercises. The lack of assured funding of various family
support programs makes it difficult to imagine and create innovative programs, much less
sustain them. Washington State, for example has lost most of its FRS program and substance
abuse liaisons stationed in child welfare offices during the past decade because these invaluable
programs were state funded and were sacrificed during budget cutting exercises.

Fixing these design flaws will require new resources, a willingness to experiment with different
administrative arrangement and better thinking regarding what constitutes child protection.

A New Vision for Child Protection

First and foremost, public health agencies should be given a greatly expanded role in child
protection because of (a) their knowledge of early child development and (b) understanding of
prevention. Public health agencies should be entrusted with case management responsibilities
for voluntary in-home services to children, 0-3, and their parents following a CPS investigation
or prior to a CPS report in the following situations:

 

• When a parent is receiving publicly funded substance abuse or mental health treatment and for parents with severe cognitive impairments

• For all babies and toddlers with disabilities or serious medical conditions, and extremely low birth weight babies, and for young children who have been separated from parents for weeks or months due to illness, incarceration, foster care, severe poverty or for other reasons.

Public health agencies should also be funded to develop and manage public education campaigns to inform first time parents of practices that endanger or protect children such as Safe Sleep guidelines and of alternatives to physical discipline of young children. Child welfare
agencies should hire public health nurses as caseworkers and consultants to child protection programs.

Child protection programs should undertake to build their expertise in child development, substance abuse, mental health and cultural competence by hiring persons with extensive training in these disciplines and by funding certification programs for their staff. Caseworkers and supervisors with job relevant certifications should be paid 5-10% more than staff with
comparable experience who lack advanced degrees or certifications.

Every medium sized and large city and rural regions should be required by law to create Child Protection Authorities (CPA) consisting of representatives from child welfare, law enforcement, economic services, public health, substance abuse and mental health treatment agencies, education and a DV advocate. CPAs should be given legal authority over prevention funding provided by federal, state and local governmental entities, and they should be responsible for child fatality reviews and for the measurement of child fatalities. States and the federal government should not bet the bank on one or two evidenced based programs that have not been taken to scale. Rather, local experimentation should be encouraged within well defined parameters.

State law should require that some community agencies whose services are essential for child protection create one or more child protection specialists to facilitate service delivery for vulnerable populations. Agencies that are members of CPAs should be required to fund one or more such positions to ensure that a wide range of community agencies have a stake and a say in child protection.

Every state and large city should create a Children's Ombudsman who reports to the Governor and legislature annually regarding conditions that endanger children, as well evaluating the performance of the state's child protection system. Tribal social service agencies should be authorized and funded to make periodic reports to the Governor and legislature regarding child protection issues on reservations and in cities with large Native American populations.

Child welfare agencies should create an elite cadre of investigative specialists who are housed in child advocacy centers or in law enforcement agencies to conduct joint investigations of some types of CPS reports, including reports of sexual abuse, serious physical abuse or the torture of a child. State law should clarify that systematic denial of food or water to a child by a caregiver is a form of torture. Furthermore, all forms of torture of children merit special criminal sanctions.

Federal finance reform should create incentives for states and communities to invest in prevention programs and initiatives, for example by reimbursing state and local governments 60% of these costs, as well as allowing more flexible use of Title IV-E funds.

These innovations would require additional federal and state funding of child protection but not an enormous increase. The federal government is currently spending about 20 billion dollars per year on child welfare, and states and communities may be spending an additional 10-12 billion dollars each year. States such as Washington, which have had a large increase in CPS reports during recent years and whose child welfare systems are experiencing increasing difficulty in retaining experienced caseworkers and supervisors, are faced with the necessity of large enhancements to their child welfare systems to head off further deterioration in child
protection and child welfare. If policymakers refuse to make these investments, they risk pushing already stressed systems over the cliff following a high profile child death or two. If anyone wants to understand what going “over the cliff” in child welfare means, take a careful
look at Arizona with a child population similar to Washington State's, a foster care population that is approaching 19,000 (compared to Washington's 9000-10,000) and an annual child welfare budget of $850 million, more than $200 million more than Washington State's
Children Administration budget. Most child welfare systems require greatly increased funding to remain functioning as they are.

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Policymakers can make similar or modestly larger investments to create much more effective child protection systems, but not without some innovative thinking and new approaches and not without some political and organizational turmoil.

References 

A Nation's Shame: Fatal Child Abuse and Neglect in the United States: A Report of the U.S. Advisory Board on Child Abuse and Neglect, Administration for Children, Youth and Families, Department of Health and Human Services, 1995.

  

deewilson13@aol.com

    

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