DEE WILSON CONSULTING

(Originally published July 2015)

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In recent Sounding Boards, I have discussed the intense widespread dissatisfaction with U.S. child protection systems and the many failed attempts to reform these systems through programmatic initiatives.  Child protection systems in other English speaking countries have had much the same histories of high profile child deaths and repeated efforts at reform, with much the same disappointing outcomes as in this country. For many years, my commentaries have focused on workforce issues, a dysfunctional management paradigm that transcends national boundaries, knowledge deficits, and the inadequate measurement of child safety outcomes in advancing other reform strategies.  I have also pointed out the unreasonable expectation that child protection systems will prevent all maltreatment related deaths or egregious mistreatment of children in families who have had open cases at any point in a child’s life, and have questioned the assumption that child maltreatment deaths would be greatly reduced by placing many more at-risk children in foster care.

 

What I have not done recently is reconsidered the fundamentals of child protection laws and systems in the U.S., i.e., mandatory reporting, investigation of allegations of child maltreatment, a large, poorly supported and erratic foster care system, a thin array of poverty related services and other family support services; and, mental health, substance abuse and domestic violence services often administered in silos by several agencies.  Even more fundamentally, I have accepted as a given the relative indifference of child welfare agencies to social conditions that endanger the safety and security of children: destitute (not just poor) families, neighborhoods and communities with concentrations of poverty, child homelessness and adolescent homelessness, co-occurring substance abuse and mental health problems frequently combined with family violence.  It is time to consider these fundamentals and what might be done to improve this country’s child protection system.

 

Child Protection and Coercion

 

Viewed in an unflattering light, child protection in the U.S. has evolved as a civil policing of the parenting of poor families.  Both in the 19th and 20th centuries, organized child protection began as a response to the severe abuse of children and quickly broadened its concerns to child neglect and to family practices believed to endanger the health, welfare and even the moral development of children. Even today, some child welfare systems investigate educational neglect, exposure of children to domestic violence and/or prenatal use of illegal drugs, but frequently clarify in statute that inability to meet children’s basic needs due to poverty is not neglect. In most states and for most families reported to CPS, child protection begins with an investigation which may be highly threatening and which, in 5-10% of families (depending on the state or county), leads to an out-of-home placement of a child.  Most, but not all, of these placements are involuntary; a surprising percentage of placements are brief and end within a few days or few weeks, but slightly less than one-fifth end in relinquishment or termination of parental rights and , ultimately, adoption. The steady increase in states that utilize differential response systems has moderated this picture to some degree, though I question whether most families who receive an assessment rather than an investigation from a CPS caseworker are free from anxiety about the results.

 

After 50 years of child protection systems organized around investigation/assessment of families with screened in CPS reports, some assumptions are rarely questioned:

 

• Child protection is concerned with child abuse and neglect, not with other conditions or events that endanger the health and safety of children.

• Child protection always requires interventions in family life, as unwelcome as these may be. Social activism is not a core CPS function, and in some agencies may be strictly forbidden.         

• Child protection is reactive, not proactive, in that it is initiated by a report containing  allegations of child maltreatment.

• Child protection, to use Gary Melton’s description, is often “a dramatic coercive act” in which children are rescued from the life endangering mistreatment of caregivers.     

• Child protection is first and foremost concerned with the physical safety of children; in many states, there are almost no “findings” of emotional abuse and neglect that stand apart from substantiated physical abuse, sexual abuse or neglect of children.    

• Child protection is the primary responsibility of a single child welfare agency, with parallel investigations of child sex abuse and serious physical abuse by law enforcement agencies; and guided by juvenile courts when children have been placed out of the home for longer than a few days or weeks.

 

For decades, child welfare agencies had difficulty funding much in the way of family support services due to the pressure on limited resources resulting from the dramatic increase in CPS reports and CPS investigations. Until the 1990s, a common description of the U.S. child protection system was “so many investigations, so few services.”  Even today, more than two-thirds of screened-in CPS reports are closed with nothing more than an investigation or assessment. However, the service that could always be funded was foster care, in part because of federal IV-E support of a large percentage of foster care placements, and also because foster care has been viewed as a response to “risk of imminent harm,” i.e., the “substantial endangerment” of children. Furthermore, in the U.S., child welfare policy has insisted on court structure for all but a small percentage of foster care placements. A child protection system organized around investigations of  the parenting of mostly poor families that has few, if any, poverty related services and a thin array of other family support services, and that can (and does) initiate out-of-home placement supervised by courts, is intimidating to families who lack the resources to “lawyer up” and challenge agency interventions. This is a system which has coercion as the default setting even when it offers voluntary services to families.

 

There have always been articulate critics of U.S. child protection policies and practices who have pointed out the emotional toll on low income parents and children of investigations, official “findings” of abuse or neglect that remain in agency files for years, involuntary removals of children from parents and frequent terminations of parental rights and adoptions.  However, it’s doubtful that these criticisms of CPS practices would have gained traction within child welfare agencies if they did not resonate with persistent doubts of child welfare staff regarding the effectiveness of coercive approaches to families. When I was a CPS caseworker, supervisor and manager in Washington State in the 1980s and 90s, I understood (before hearing about differential response) that at least half of CPS investigations were a pointless waste of time because there were no allegations of serious maltreatment to investigate and no factual dispute regarding how children were being parented. The safety of children in these families was affected far more by poverty and lack of timely access to high quality mental health, DV and substance abuse services than by inadequate investigations. Furthermore, any caseworker who has placed children in foster care only to have these children experience multiple unplanned placements is likely to question whether foster care has done more harm than good.

 

During the past two decades, child welfare systems in the U.S. and other English speaking countries have sought to develop less coercive and more family friendly through multiple initiatives: family preservation services, family centered practice models, solution based parent engagement safety practices, differential response, birth parent mentoring programs and family treatment drug courts, to name a few.  Family preservation services and differential response have generated bad tempered scholarly debates regarding (in part) their effects on child safety.  Other critics (e.g., Leroy Pelton) who have advocated for decades that CPS investigations be turned over to law enforcement agencies remain skeptical that CPS systems organized around investigations or assessments of parenting practices can ever become effective providers of family support services. Whatever one thinks of the scholarly arguments in these controversies, a main trajectory of child welfare reform will surely continue to be finding less coercive and less damaging ways of intervening in families, prior to or following a CPS report.

 

In addition, most child welfare systems continue to gradually expand the number of evidence based programs available to children and families, though poverty related services (such as housing) remain thin on the ground in many states.  However, even when resources are available, it’s easier said than done to develop an ethos of supporting families in child welfare agencies with chronic workload problems.  In Washington State, it has been common (at least until recently) for the legislature to fund services that remain unused or underutilized by local offices.  In an investigative system, completing investigations and closing cases can become an end in itself; processing families from intake to case closure sometimes becomes a higher priority than providing services to them.    

 

Preventing Multiple Adversities

 

The Adverse Childhood Experiences (ACE) studies, and other studies, have repeatedly found that combination of adversities (rather than any single specific experience), including but not limited to child abuse and neglect, have the greatest negative impact on children’s health, mental health and educational achievement. These adversities include parental substance abuse and chronic mental health conditions, domestic violence and parental incarceration, as well as various types of child maltreatment. These same adversities, along with poverty, are commonly found in families in which children die in maltreatment related incidents and in families chronically referred to CPS. These are (by far) the hardest families to help with available services. Therapeutic programs need to be provided as early as possible in these families before these disempowering conditions become embedded in family life. Some parents grew up with caregivers who had co-occurring substance abuse and mental health disorders, and/or who were violent and abusive; these parents need timely help and parenting supports to prevent the intergenerational transmission of child maltreatment.

 

A broadened and improved concept of child protection would target populations at high risk for multiple co-occurring adversities: destitute families whose annual incomes are less than half of the federal poverty standard which would include most homeless families; neighborhoods or communities with concentrated poverty; parents receiving publicly funded substance abuse or mental health services; parents of young children who have been involved in multiple incidents of domestic violence. The public policy goal should be that families at highest risk for multiple adversities should be contacted by a professional or paraprofessional who offers help for chronically relapsing conditions, poverty related needs and parenting supports prior to a CPS report. The first contact of a troubled family with a helping professional who can mobilize supports for parenting should never be with a CPS caseworker. Many of the young children in these families will require CPS attention, often sooner rather than later, but public policy should prefer a non-threatening offer of help and voluntary services to a coercive intervention when a less coercive approach is still feasible. The need for voluntary approaches to families is increased with parents with multiple adversities who have histories of trauma (arguably most of them): use of coercion re-enacts the experience of powerlessness in which trauma originated. Anyone who works with trauma victims should periodically reread Judith Herman’s classic, Trauma and Recovery (1992), which is eloquent on this point.        

 

There is plenty of uncertainty regarding what programs or services should be offered to families at risk of, or already suffering from multiple adversities, and by which public agency and in what sequence. These questions are easier to answer when considering specific populations, neighborhoods or communities. Homeless families have an urgent need for housing and a stable source of income, but homeless adults usually have drug/ alcohol and mental health

problems as well.  Parents receiving publicly funded substance abuse or mental health treatment are likely to have many poverty related needs. There are two primary models for inter-agency work with multi-problem families: (1) an agency with a narrowly defined mission, for example substance abuse assessment and treatment, expands its purview to include case management for families with a multitude of needs or (2) inter-agency teams, family team meetings, wrap around teams become responsible for case planning. Both of these models have limitations and are a way of working around a misalignment of administrative arrangements and family needs. Creative ways of administering programs for families with multiple adversities are needed.

 

Finally, county and state public health systems must be strengthened and given a lead role in preventing multiple adversities or reducing their impact. Public health nurses are grounded in early childhood development, and so are well equipped to help troubled parents develop nurturing relationships with their babies and toddlers. Furthermore, the public health system has a history of applying epidemiological data and science to reducing child mortality and improving children’s health and well-being. It is long past due to apply a dispassionate public health approach to the prevention of adversities, including child maltreatment, that frequently endanger children’s safety in the short run and potentially damage their health and well-being for a lifetime.                

  

References

 

Anda, R. and Brown, D. (2010), Adverse childhood experiences and population health in Washington: the face of a chronic public health disaster, Family Policy Council, Olympia, Washington.

 

Herman, Judith (1992), Trauma and Recovery, Basic Books, New York, NY. 

 

Longhi, D., (2010), The relationship between two kinds of adverse experiences (AE’s) and academic, behavioral and physical health among youth in Washington State, Family Policy Council, Olympia, Washington. 

 

Steele, W. & Kuban, C., (2012) , Advancing Trauma- Informed Practices: Bringing Trauma Informed Resilience Focused Care to Children, Adolescents and Families, The National Institute for Trauma and Loss in Children.

  

deewilson13@aol.com

    

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