February 2014 Sounding Board: “The Meaning of Empowerment”

The Meaning of Empowerment

by Dee Wilson

The conditions that commonly occur in cases of severe child maltreatment, i.e., substance abuse, mood disorders (especially depression and PTSD), domestic violence and poverty, lead to a loss of power and control of body, mind, emotional reactions, social circumstances and social behavior and interpersonal relationships. These conditions often co-occur in ways that diminish the sense of self efficacy and result in hopeless/ helpless responses to circumstances and challenges that frustrate and sometimes immobilize helpers. Women with co-occurring substance abuse and mental health disorders usually have had histories of childhood trauma, and have often been victims of domestic violence in late adolescence and young adulthood as well.

There is an extraordinary description in Judith Herman’s Trauma and Recovery of how trauma symptoms exacerbate the effects of depression. Herman states:

Protracted depression is the most common finding in virtually all clinical studies of chronically traumatized people. Every aspect of the experience of prolonged trauma works to aggravate depressive symptoms. The chronic hyperarousal and intrusive symptoms of post-traumatic stress disorder fuse with the vegetative symptoms of depression, producing … the “survivor triad” of insomnia, nightmares, and psycho-somatic complaints. The dissociative symptoms of the disorder merge with the concentration difficulties of depression. The paralysis of initiative of chronic trauma combines with the apathy and the helplessness of depression. The disruption in attachment of chronic trauma reinforces the isolation of depression. The debased self- image of chronic trauma fuels the guilty ruminations of depression. And the loss of faith suffered in chronic trauma merges with the hopelessness of depression. (p.94)

Depression and other mood disorders (e.g., anxiety, panic attacks, PTSD) feed off of and intensify the sense of powerlessness to change intolerable conditions. Groups that are unusually susceptible to depression, for example, the elderly, women, the poor and trauma victims are likely to have an acute awareness of powerlessness not only in respect to social conditions but in respect to their bodies, thoughts and emotional reactions.

In Fear and Courage, S.J. Rachman describes the progression of combat trauma for aircrew members in World War II:

The symptoms of fear experienced during combat included palpitation, dryness of the mouth, sweating, stomach discomfort, urinary pressure, trembling, tension, and irritability. The most persistent of these symptoms were tension, tremor, and sleep disturbance.

Rachman comments that “the theme of helplessness was common.” He then adds, “Helplessness is said by Seligman to arise from the sense of the uncontrollability of important aversive events and to cause fear and then depression.” Seligman proceeds to describe the air-crew members gradual loss of control of bodily reactions associated with depression:

The most common pattern was for air-crew members to show a gradual accumulation of adverse effects, such as insomnia, loss of appetite, tremor, extreme startle reactions, irritability and tension … Muscular coordination was replaced by uncontrollable tremors, jerky movements, and tension. … Their ability to sleep was impaired and they started to experience nightmares. Various gastric symptoms such as nausea, vomiting and diarrhea appeared. They also reported a loss of appetite and various pains and aches, with headaches and backaches being particularly common.

One might object that the air-crew members’ lives really were in danger, whereas this is usually not the case with parents who have trauma histories. However, one of the effects of chronic trauma is to seriously impair victims’ capacity to realistically assess safety threats. Both traumatized children and parents may continue to act as if their lives are threatened by events and situations that seem unthreatening to others. Victims’ perception of extreme pervasive danger may far outlive the events in which trauma originated. It is also the case that some maltreated children (including severely neglected children) and DV victims, the chronically homeless and families living in violent neighborhoods have rational reasons to fear extreme bodily harm and early death.

One of the most disabling effects of trauma on children is the impairment of emotional control in response to stress, and the resulting susceptibility to “meltdowns” that frighten family members, school staff and other community professionals. Young children learn to calm down and gradually achieve control of their emotional reactions by modelling the behavior of trusted adults and turning to these adults for help when they are hurt, or hungry, tired or otherwise out of sorts. However, seriously abused and neglected children usually have little or no reason to trust adults, and are likely to have difficulty in using them to calm down. This is the dilemma facing foster parents and adoptive parents who are caring for severely maltreated children. Equipping substitute caregivers to help traumatized children calm down absent “meltdowns” should be a focus of foster parent/adoptive parent training programs.

Poverty, Destitution and Hope

According to a Partners for Our Children (POC) 2009 survey, almost half of parents with open child welfare cases in Washington State had an annual income of $10,000 or less, and about one fifth had no source of income and were not living with a person whose income was greater than $20,000 per year. Severely poor parents are destitute or on the verge of destitution. These parents are likely to have spells of homelessness and food insecurity and to lack regular access to medical care or dental care. Poverty traps parents in dangerous neighborhoods and dangerous relationships, and in a myriad of other ways reduces control over life circumstances. It is no wonder that low income children and adults are unusually vulnerable to mood disorders, especially depression, and that poverty has negative effects on health outcomes and mortality rates, even when medical care is accessible.

The severity and chronicity of poverty, and its concentration in poor neighborhoods, effects parenting behavior, but so do the psychological dimensions of poverty, i.e., the extent to which poverty seems like a life sentence for early disadvantage and/or poor choices. Poverty or destitution is more likely to lead to hopelessness when it is combined with low educational achievement, for example the lack of a high school degree, the long-term inability to find employment, a criminal record or inter-generational histories of poverty in extended families. Furthermore, chronic mental illness and substance abuse combined with lack of education and criminal histories may eliminate hope of a better life. In these circumstances, creating a spark of hope that the future can be better than the past is vital in breaking the iron grip of mood disorders and addiction.

Dimensions of Empowerment

Persons who have had histories of chronic trauma, or who have experienced social stigma, oppression and social exclusion are likely to be highly sensitive to issues of power and control. According to Rachman, one of the most discerning researchers of fear and ways of controlling fear, ” The sense of helplessness is particularly acute if a person feels that important life events are beyond his or her control, that the absence of control stems from personal inadequacies, and that the situation is typical.” Therapeutic endeavors need to be informed by this perspective.

Judith Herman writes that “The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based on empowerment of the survivor and the creation of new connections.” And Herman adds “No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest.” Child welfare systems in the U.S. depend on coercive practices to an unusual degree compared to their counterparts in Western Europe. A trauma informed perspective applied to the parents of abused and neglected children will consider ways of reducing use of coercion and of continuing to offer choices whenever possible even in the context of legal structure. Coercion is sometimes necessary to protect children; but the use of police power and legal structure should not be viewed as a rationale for ignoring the perspective of parents, or bypassing the use of engagement strategies.

Rachman asserts that “Fear seems to feed on a sense of uncontrollability; it arises and persists when a person finds himself in a threatening situation over which he feels he has little or no control. But a sense of personal competence, self confidence if you will, appears to provide protection against fear.” It is the acquisition of skills, and their exercise, that increases a person’s confidence in their ability to cope with tough challenges. Parenting skills are important and so are social skills, emotion regulation skills, employment skills, self- protection skills. Empowerment practice restores and builds self efficacy in coping with life challenges to the extent possible given time and resource limitations. In child welfare settings, the indicator of therapeutic effectiveness in chronic neglect cases is a parent mobilized and able to help themselves and their children. Sobriety and reduction of depressive symptoms are means to this end, not the end itself.

Poor and destitute parents will often need concrete help. It is a puzzling feature of U.S. child welfare systems that the federal government and state governments will often spend thousands of dollars on substance abuse or mental health treatment; but have difficulty purchasing a crib, or paying a month’s rent for parents working to be reunited with their children. Poverty related services are scarce and one time only, or non- existent, in many states while therapeutic services can be extended for months. However, emergency financial assistance is not enough; many poor parents would psychologically benefit from a renewed sense of economic opportunity that can only come from education or job training. Enrollment in educational programs or job training should be a part of reunification programs.

Finally, no empowerment strategy is likely to be effective unless parents have hope in a better future, including hope that children whose early development has been affected by child maltreatment, substance abuse, mental health problems and family violence can recover from these experiences. Hope is a psychic investment, an act of faith that troubled parents must make to regain a reasonable degree of control over their bodies, minds, emotional relationships and social circumstances. Professionals’ confidence in their skills and resourcefulness, and their persistence through the usual ups and downs of treatment, are of the utmost importance in maintaining the spark of hope.


Herman, Judith, Trauma and Recovery: The aftermath of violence — from domestic abuse to political terror, Basic Books, 1992, 1997.

Rachman, S.J., Fear and Courage: Second Edition, W.H. Freeman and Company, 1978, 1990.

The views expressed in this commentary are the author’s, and are not intended to reflect the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized


January 2014: “Controlling Heuristic Biases”

Controlling Heuristic Biases

by Dee Wilson

In common usage, bias refers to fixed ideas that reflect ignorance and/or prejudice, along with a stubborn rejection of conflicting evidence and rational argument. However, cognitive psychologists such as Daniel Kahneman and Amos Tversky have generated a large body of research regarding heuristic biases, i.e., mental shortcuts, that lead to systematic errors in judgment. Heuristic biases are not substantive beliefs; rather they are (mostly unconscious) ways of processing information automatically and quickly which are accompanied by a strong sense of conviction, despite their fallibility. Approximately 20 heuristic biases associated with intuition have been identified. These biases increase the likelihood of jumping quickly to erroneous conclusions. Any professional who makes high stakes decisions regarding children and families should become aware of several of these heuristic biases and begin to develop approaches to combating them. Daniel Kahneman’sThinking Fast and Slow (2011) contains an invaluable discussion of these biases and how they influence decision making.

One of the heuristic biases that often influence child welfare practice is the halo effect, i.e. “the tendency to like (or dislike) everything about a person – including things you have not observed.” According to Kahneman, “the halo effect increases the weight of first impressions, sometimes to the point that subsequent information is mostly wasted.” When caseworkers like parents and empathize with their struggles, they may ignore, minimize or rationalize risk of abuse and neglect; and if they dislike or disapprove of parents, safety threats and risks to children may be exaggerated. One of the challenges of casework in child welfare is the need to combine dispassionate and unblinking assessments of parents and family functioning while emotionally engaging with family members – including abusive or neglectful caregivers – in non-punitive and helpful ways. Finding a workable balance between intellectual detachment, which facilitates seeing people as they are, and emotional engagement, which overcomes barriers to developing partnerships with troubled family members, is a developmental challenge for inexperienced practitioners. Some level of self-awareness, hopefully encouraged by reflective supervision, is essential to successfully meet this challenge.

One reason CPS caseworkers and supervisors may be unusually susceptible to heuristic biases, especially the halo effect and confirmation bias, is that they must make decisions regarding child safety quickly, often with inadequate information. Once caseworkers’ initial impressions regarding child safety develop into beliefs, confirmation bias ensures that these beliefs will be difficult to change. The English scholar, Eileen Munro, has described the impact of confirmation bias on caseworkers’ decision making in 45 child maltreatment fatality cases in England between 1973 and 1994. In these cases, Munro states, “The most striking and persistent criticism (of review teams) was that professionals were slow to revise their judgment. The current risk assessment of a family had a major influence on responses to new evidence.” Similarly, in child welfare agencies, which require initial determinations that children are Safe or Unsafe, these judgments are likely to influence the interpretation of new information that invites reconsideration of child safety assessments.

One of the striking characteristics of persons with strongly held but questionable beliefs is that they are likely to believe there is strong evidence to support their judgment. One of the reasons that biases are difficult to undo is that they are frequently reinforced by what may seem compelling evidence. Biased persons scan the environment for evidence that supports their beliefs, and ignore evidence that conflicts with their beliefs. If, despite one’s best efforts, conflicting evidence cannot be avoided, then the tendency is to give the evidence in question little or no weight. Munro quotes Sutherland (1992) on strategies for avoiding challenges to beliefs:

First, people consistently avoid exposing themselves to evidence that might

          disprove beliefs. Second, on receiving evidence against their beliefs, they often

          refuse to believe it. Third, the existence of a belief distorts people’s interpret-

          tations of new evidence in such a way as to make it consistent with the belief.

          Fourth, people selectively remember items that are in line with their beliefs.

It is easy to understand why persons with strongly held political and religious beliefs would be resistant to entertaining challenges to ideas and values that have become part of their identity. It is not as evident why professionals whose jobs require quick assessments based on limited information and contact with specific families would tenaciously resist evidence that suggests they may have been initially mistaken about child safety and/or risk to children of child maltreatment. Kahneman’s discussion of two different types of mental functioning, i.e., System 1 and System 2, in Thinking Fast and Slow, provides a plausible answer. System 1 takes center stage in mental life whenever personal safety is threatened and/or whenever a person has little or no opportunity to reflect on decisions.

System 1:

  • Operates automatically, quickly, seemingly without effort, and is always “on”
  • Draws on ample stores of energy
  • Is intuitive and confident in its intuitions
  • Is biased to believe and confirm
  • Infers and invents causes and intentions based on whatever information is available
  • Likes coherent stories
  • Neglects ambiguity and suppresses doubt
  • Ignores absent evidence, i.e., What You See Is All There Is (WYSIATI)
  • Is poor at statistics

System 2 on the other hand is:

  • Cautious and deliberate
  • Analytical
  • Draws on limited stores of mental energy
  • Able to control impulses
  • Capable of doubt

System 1 is a set of mental functions oriented around quick assessments of people and situations required for immediate action. For the most part, System 2 endorses and supports the assessments and actions generated by System 1, in part to conserve limited energy and also because System 1’s intuitions have led to actions which create an investment in being viewed as “right”. To acknowledge error is to incur a psychological cost, i.e., reduced confidence in one’s intuitive judgments and a social cost resulting from the public admission that one’s mistakes may have resulted in harm to another person, perhaps a child.

Moderating Confidence In Intuition

According to Daniel Kahneman, “A remarkable aspect of your mental life is that you are rarely stumped. True, you occasionally face a question such as 17 x 24 = ?  to which no answer immediately comes to mind, but these dumbfounding moments are rare. The normal state of your mind is that you have intuitive feelings and opinions about almost everything that comes your way. … Whether you state them or not, you often have answers to questions that you do not completely understand, relying on evidence that you can neither explain or defend.” Practitioners and policymakers need to grasp that intuition, though remarkably powerful and invaluable in some circumstances, is vulnerable to systematic errors that are difficult to control. Unquestioning dependence on intuition leads to overconfidence in decision making and to disregard for evidence that conflicts with strongly held beliefs. System 1, to which intuitive capacities belong, is poor at statistics and given to overestimating the likelihood of extremely rare events. System 1 likes coherent stories with clear causal connections, and is prone to filling in the blanks with assumptions when information is missing, according to Kahneman’s description.

Decision makers should train themselves to carefully examine evidence, and gaps in evidence, before jumping to conclusions even when they have a powerful sense of subjective certainty in the truth of their intuitions. Initial impressions of people and beliefs developed through initial impressions should be viewed and presented to others as provisional, with full awareness of the possibility of error. The capacity to postpone judgment when confronted with ambiguity and complexity should be cultivated despite the uncomfortable emotional tension likely to result.

Kahneman describes one characteristic of System 1 that can be used as a check on intuition: the capacity to be surprised. System 1 employs prototypes, i.e., standard patterns, in making intuitive judgments. Fortunately, System 1 is able to recognize anomalies, that is, behaviors or characteristics that don’t fit expectations. Chronically neglectful parents may be nurturing in some situations; abusive parents may sometimes demonstrate surprising patience and empathy with a disobedient child. Anomalies are indicators that persons, or situations or research findings contain unexpected complexities that require further study, and can activate System 2 : i.e., patient analytical effort to understand someone or something in a deeper way. One of the antidotes for the halo effect and confirmation bias is the capacity to be surprised, and to be opened to inquiry by the unexpected in people, situations and experiences that have previously seemed familiar and well understood.

Developing Expert Intuitions

One of the most productive and praiseworthy collaborations between scholars with very different perspectives has been the sustained discussion regarding intuition between Daniel Kahneman and Gary Klein. Klein is the author of Sources of Power: How People Make Decisions (1998) which is a discussion of studies of naturalistic decision making. Klein bases his discussion of expert decision making on studies of chess masters, expert fire-ground commanders and submarine captains. Experts faced with time pressures, in Klein’s account, do not use analytical methods; instead they depend on holistic pattern recognition in which cues ignored or not even perceived by non-experts immediately generate effective responses. Klein has a low regard for actuarial methods of predicting events of interest, methods for which Kahneman has been a strong proponent. Klein emphasizes the power of intuition while Kahneman has written at length about its pitfalls.  Nevertheless, through a sustained civil and rational discussion, Klein and Kahneman have been able to agree on the conditions for developing expert intuitions.

Both Klein and Kahneman agree that subjective certainty is not evidence for the validity of intuitions. Kahneman writes that “If subjective confidence is not to be trusted, how can we evaluate the probable validity of an intuitive judgment? When do judgments reflect true expertise? The answer comes from the two basic conditions for acquiring a skill:

  • an environment that is sufficiently regular to be predictable
  • an opportunity to learn these regularities through prolonged practice

When both of these conditions are satisfied, intuitions are likely to be skilled.”

Expert intuition recognizes meaningful patterns that have explicit implications for decision making. For example, expert practitioners will recognize indicators of deliberate cruelty in abusive parents’ punishment of children; they will not confuse common instances of excessive discipline with torture of a child or battered child syndrome. Situational neglect, sporadic neglect and chronic neglect require different responses from child welfare systems; ignoring these differences leads to unskilled and ineffective interventions. Operationally useful typologies are helpful in developing pattern recognition, but development of sound typologies usually requires scholarly help which has been in short supply in child protection during the past two decades. Still, there have been some notable attempts to develop operationally useful typologies, for example Carol Bowdry’s typology of physical abuse; and these typologies deserve more attention than they have received.

Ideally, experts can both intuitively and accurately identify meaningful patterns, and explain the rationale for their intuitions. However, one of the interesting features of intuitive expertise is that skilled pattern recognition often occurs before analytical understanding of this skill is developed. An outstanding baseball player may be a great hitter but a poor coach.  Nevertheless, development of intuitive expertise requires repeated exposure to a standard set of elements, features, (game) moves or processes. Training programs can lay the groundwork for pattern recognition, but there is no substitute for experience, as both Klein and Kahneman have pointed out. Kahneman’s estimate is that 10,000 hours of practice are required to produce a chess master, the equivalent of 5 hours of practice per day for 6 years.

Truth Seeking Is A Social Enterprise

Heuristic biases frequently go unrecognized. Any manager who has been part of hiring panels has probably heard job candidates assert that they have no biases, by which they may mean ugly racial biases or biases regarding sexual preferences. I have occasionally heard otherwise intelligent adults in classroom settings confidently state that they lack a culture, a term which perhaps they associated with distinctive food tastes, cultural traditions or information regarding their family’s lineage. Heuristic biases are more difficult to recognize than racist beliefs or cultural traditions because they affect how information is processed and interpreted.  These processes are mostly unconscious; and if there is some degree of awareness of how beliefs are protected from challenges, the influence of biases is likely minimized. Even thoughtful adults tend to be naïve realists:  the world is as it appears.  It’s other people who can’t see the obvious and have weird ideas.

It is not enough to seek self-awareness of biases. The social milieu in which high stakes assessments occur should encourage open expression of differences and debate. Acknowledging intellectual mistakes based on a reconsideration of evidence should be viewed as a personal strength, not a humiliating loss of face.

According to Kahneman, “the way to block errors that originate in System 1 is simple in principle: recognize the signs that you are in a cognitive minefield, slow down and ask for reinforcement from System 2.” In practice, this is difficult to do without the help of others. Kahneman suggests that “… it is much easier to identify a minefield when you observe others wandering into it than when you are about to do so.” Observers are less cognitively busy and more open to information than actors,” he states.

Kahneman has a surprising confidence in the capacity of organizations to avoid errors through orderly procedures and quality control, but he also identifies the importance of organizational culture when he asserts in the final sentence of Thinking Fast and Slowthat “(Decision makers) will make better choices when they trust their critics to be sophisticated and fair, and when they expect their decision to be judged by how it was made, not only by how it turned out.”


Bowdry, Carole, Toward a Treatment- Relevant Typology of Child Abuse Families, Child Welfare, Volume 69, number 4, pp. 333- 40, July-August 1990.

Kahneman, Daniel, Thinking Fast and Slow, Farrar, Straus and Giroux, 2011.

Klein, Gary, Sources of Power: How People Make Decisions, MIT Press, 1998.

Munro, Eileen, “Common Errors in Reasoning in Child Protection,” Child Abuse and Neglect, Volume 23, number 8,  pp.745-758, 1999.

The views expressed in this commentary are the author’s, and are not intended to reflect the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized


December 2013 Sounding Board: “Child Protection Systems in Crisis: Developing More Effective Responses”

Child Protection Systems in Crisis: Developing More Effective Responses

by Dee Wilson 

Most states’ CPS systems are periodically in crisis following high profile apparent failures in child protection. These crises have a powerful political dimension when key legislators, influential child advocates and editorial writers assert that a child welfare system is “broken”,  and call for a comprehensive review of child protection practices. 

It is a common (but not universal) feature of these crises that comprehensive reviews, or in- depth media reports, find that CPS units have been overwhelmed by workload demands which have been intensified by annual turnover rates in line units of 30-50%. In a December 21st newspaper story in the Kansas City Star about Missouri’s CPS system, a CPS supervisor was quoted as stating, “We can’t make the right decisions when we don’t see our families enough, we’re so overwhelmed by paperwork, and all kinds of other things that cases involve… we can’t do it and we’re not going to make the right decisions in that kind of environment.” A supervisor in St. Louis County, Missouri maintained that some investigators have been receiving 8-10 new investigations per week, when a reasonable level of assignment would be closer to 8-10 new investigations per month. This same news story found that the annual turnover rate among caseworkers in Jackson County (Kansas City), Missouri had reached 46%. In Missouri, the resignation of veteran caseworkers and supervisors has intensified the sense of crisis in an agency that pays 1170 caseworkers and supervisors $32,000 per year or less, the lowest caseworker salaries in the country, according to Kansas City Star reporters.

During the past year in Arizona, a turnover rate of 30% or higher has led to an intractable backlog of 6500 uninvestigated CPS reports, a backlog which has been reduced by more than half since the Governor authorized the use of overtime pay as needed. In Los Angeles County, 1600 caseworkers recently went on strike for several days over workload and pay issues.  A union spokesperson claimed that caseworkers in Los Angeles were assigned an average of 19 cases per caseworker, compared to about 9 cases per investigator in New York City. New Jersey has recently adopted a standard of 8 new investigations per month and 12 open cases at a point in time compared to 12 new investigations per month, a CPS workload standard utilized in a number of states or large cities.  

A recent story in the Kansas City Star quoted Clark Peters, an Assistant Professor in the University of Missouri School of Social Work:  “What Missouri is experiencing is,  terrible to say, it’s a typical experience … child welfare is a heart breaking field …” Both in Arizona and Missouri, as in many other states, child advocates and agency managers must overcome legislators’ skepticism that budget increases and additional caseworkers and supervisors will   resolve a child welfare crisis that seems to recur every few years with distressing regularity. Public agency staff may share legislators’ skepticism since past attempts to “fix “ child protection in many states have been short lived responses to a political crisis, and may have led to an increase of prescriptive policies and procedures that have worsened public agencies’ workload problems without having a  positive effect on hoped for outcomes.

Reflections on Reforms of Child Protection Systems  

The most common approach to reforming child protection systems following high profile child deaths has been to mandate practices and procedures which, if followed in a systematic way, might have prevented the most recent child death or deaths that resulted in public outrage and led to a widespread view that the state’s CPS system cannot be counted on to protect at-risk children. Sometimes, these reform efforts include the implementation of new assessment tools and/or practice models, along with large investments in training and quality assurance systems. However, adding mandates to CPS programs that already have practice and procedural requirements that sometimes fill hundreds of pages in policy and procedural manuals is a tough sell to caseworkers and supervisors already overwhelmed by workload requirements. In addition, one-off training programs tend to have modest effects, if any, on caseworkers’ practice.

Nevertheless, there have been few instances in which adoption of new practice models really did transform a child welfare agency’s practice, and in these situations several factors combined to make dramatic improvements possible:

  • A political crisis resulting from media attacks and the intense dissatisfaction of both child advocates and legislators with the jurisdiction’s child welfare system led to unrelenting external pressure and an internal readiness for change.
  • An unprecedented infusion of new resources (see below) resulting from IV–E waivers and/or class action lawsuits/settlement agreements, or in a small number of instances,a political establishment’s determination to transform the jurisdiction’s child welfare system combined with strong philanthropic support.   
  • A strong commitment, i.e., “buy-in”, of agency staff at all levels of the agency.
  • Leaders who won the trust and confidence of child welfare agency staff, external stakeholders and key legislators.
  • An agency’s commitment to a practice model that remained strong following leadership changes.

Unfortunately, this set of conditions rarely occurs and is exceedingly difficult to orchestrate. In particular, policymakers and agency managers usually underestimate what is required to achieve “buy-in”, i.e., commitment of child welfare staff, including management teams, to new practices/ practice models, and mistake absence of dissent, or compliance with implementation plans, as “buy-in”. Internal resistance to change, initiative fatigue, concerns about workload and resources, or reasonable concerns about proposed practice changes or practice models must be overcome in a way that engenders hope and belief of agency staff in the possibility of a much improved child welfare system, not simply induces compliance with top managers’ directives. The more sweeping the practice changes which are envisioned by agency leaders, the more internal “champions” of the proposed changes are required to reach a critical mass of genuine excitement about the new practices/model.  Following implementation of new practices or practice model, if the enthusiasm and belief of caseworkers and supervisors quickly deteriorates into weary or resentful compliance with directives in policy and procedural manuals, practice oriented reforms have run their course. Compliance is as far from commitment as love is from morally correct behavior.

Resource Enhancements: How Much Is Enough?

Imagine states in which the public child welfare agency’s budget is $500-600 million dollars per year. Child welfare crises in these states sometimes result in legislative enhancements of 3-5% of an agency’s annual budget, i.e., 20-30 million dollars. This is a significant budget enhancement in normal years, much less in years when state legislatures must cope with budget deficits. Some of this increased funding is likely to be spent on additional caseworkers in order to relieve workload pressures, and on new or expanded services needed to implement a new practice model. However, in several states (e.g., Illinois, New Jersey) where lasting transformations of child welfare systems have occurred, hundreds of millions of dollars of enhancements (amounting to 50% or more of a child welfare agency’s annual budget) have been invested in service enhancements or in staff increases over at least a decade.

It is a rare circumstance in which the idea of investing hundreds of millions of additional dollars in a child welfare agency widely perceived to be failing in its child protection mission would be seriously considered by legislators pressured from every direction for increased funding of state supported programs. For the most part, it has been class action lawsuits/settlement agreements or IV–E waivers in states or counties with high rates of out-of-home care that have led to these massive new investments in public child welfare systems. Class action lawsuits and settlement agreements that greatly increase the prescriptive requirements (e.g., practices, measures) with which child welfare agencies must comply without greatly increasing resources may do more harm than good. However, there have been a few settlement agreements that resulted in resource enhancements large enough to be “game changers.” IV-E waivers create the opportunity of reinvestment of savings resulting from reductions in foster care expenditures in new or enhanced services and programs. IV-E waivers are an opportunity to reshape a child welfare agency’s service delivery system, but they have dramatic effects on child welfare systems only when agencies are able to make large reductions in numbers of children in foster care or in average foster care costs per child, for example by reducing the number of youth in expensive residential care programs. 

It is worth considering why such huge investments have been required to make fundamental changes in some public child welfare agencies. Some states and large counties have needed to reduce caseloads by more than half through the addition of hundreds of new FTEs. Furthermore, it is not enough to hire more caseworkers; administrative support staff, supervisors and middle management positions must also be added to build infrastructure and bring workloads under control. In addition, states that want to develop more family friendly child protection programs must usually greatly increase funding for family support programs and services that provide an alternative to foster care. Given the opportunity, public child welfare agencies usually make investments in programs which will find permanent homes for “legacy youth” growing up in foster care or residential care and in services needed to make foster care a therapeutic experience for troubled children and youth. In most states, large investments have been needed to “retool” child welfare systems in order to make family support an integral part of child protection systems and implement evidenced based programs.  

Investing in a Stable and Professional Workforce  

A common mistake in child protection reform initiatives in most states has been to make inadequate token investments in workforce development. Most efforts at comprehensive reform include additional casework positions required to stop CPS “meltdowns” and temporarily reduce workloads, but do not increase caseworkers’ and supervisors’ salaries enough to reduce turnover or make strategic investments in the professional development of agency staff other than to fund a few days of training related to practice improvements. Paying caseworkers and supervisors paraprofessional salaries less than 200% of the federal poverty standard, or paying experienced staff top-out salaries less than what they can earn in schools, hospitals or private agencies will not stabilize a workforce. CPS investigation and assessment usually takes a couple of years to learn to a reasonable level of expertise.  Annual turnover rates of 25-50% guarantee that many CPS units will be staffed largely with inexperienced caseworkers, a number of whom will likely be planning to leave CPS at the first opportunity.

Public child welfare agencies are often managed with the expectation of high turnover in CPS units. In many agencies around the country, CPS investigation is an entry level position. Experienced CPS caseworkers, in turn, will often transfer to other units as opportunities present themselves, if they do not first leave the public child welfare agency for greener pastures.

The dominant managerial paradigm in public child welfare has been to standardize job functions so that they can be performed by entry level staff without professional preparation or commitment to a career in child protection. The idea that standardized assessment tools can substitute for expertise gathered from experience has been a persistent managerial error in child protection, and partly accounts for the widespread misuse of these tools. However, it has been the use of steadily expanding policy and procedural frameworks to mandate “best practices” that has created a bureaucratic morass in child welfare agencies that caseworkers and supervisors often find intolerable. Professionals need standards, guidelines and a knowledge base; they do not need prescriptive frameworks that attempt to dictate their every move.  

In order to dramatically improve child protection systems, policymakers and managers should adopt the goal of attracting and developing a stable professional workforce. To this end, the following practices will be useful:

  • Pay caseworkers and supervisors salaries which will attract and retain professional social workers. These salaries will vary from state to state, but they must be high enough to recruit MSWs and retain experienced caseworkers who have achieved a high degree of professionalism in their work, regardless of their educational backgrounds.
  • Public child welfare agencies should make a commitment to workload management that goes far beyond defusing the most recent child welfare crisis. When agencies have high turnover rates, units with vacancies need immediate access to a pool of trained staff that can help with investigations until the vacant position can be filled. States’ child welfare agencies should periodically invest in workload studies to develop an empirical basis for workload standards and for budget requests.
  • Public agencies should develop incentives for professional development of their staff, including funding of enrollment in certification programs in substance abuse, mental health, domestic violence, child development, developmental disabilities, culturally competent practice, etc. Practitioners with a job relevant certification should receive a 5-10% increase in salary.
  • Public agencies should develop a Child Welfare Professional track that requires a Master’s degree, a job relevant certification and three continuous years of above average performance ratings. A Child Welfare Professional should receive at least a 10% increase in salary, and be eligible for a 4 month educational sabbatical every four years.
  • Child Welfare Professionals should be expected to mentor newly hired caseworkers, and received a small amount of compensation for doing so.
  • Public agencies should develop leadership development programs that encourage initiative, “ownership” and creativity, and develop eligibility requirements that allow all agency employees to apply to the program.


Most comprehensive reforms of child protective services have had short lived superficial effects for three main reasons:

1. Child welfare managers have underestimated the importance of their staff’s commitment to proposed practice changes, and have misunderstood what is required to make practice changes at the unit level real and lasting. Absent enthusiasm and persistent effort at the line level to make new practices or practice models work, practice reforms quickly become cosmetic, just another set of requirements in a steadily expanding bureaucratic framework. 

2. Policymakers have underestimated by several orders of magnitude the resource enhancements needed to adequately staff child welfare agencies in crisis and “retool” their  service delivery systems.

3. The goal of developing a far more stable and professional workforce has not been front and center in states’ reform initiatives where it belongs. Some states continue to pay child welfare caseworkers and supervisors paraprofessional salaries, and most states continue to act as if standardizing expectations in policy manuals is the only reliable way to achieve consistent application of “best practices”. The position of CPS investigator in many states remains an entry level position which newly hired caseworkers often aspire to leave as soon as possible.

There have been several instances in which states, large counties or cities have adopted different strategies to child welfare reform: Alabama, Allegheny County, Pennsylvania, Illinois, New Jersey, New York City, Utah. These public child welfare systems have not been immune to crises following their reforms; but when these crises have occurred, child welfare managers in these jurisdictions no longer had to overcome despairing attitudes of advocates, policymakers and practitioners that question whether effective responses to child protection challenges can be found.

Disclaimer: The opinions expressed in this commentary are the author’s, and are not intended to represent the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized


November 2013 Sounding Board: “Trustworthiness and Skill in Child Protection

Trustworthiness and Skill in Child Protection

by Dee Wilson  

Casework in child protection is arguably one of the most difficult human services jobs in the U.S., in part because of the emotionally taxing nature of the work and also due to its intellectual and interpersonal challenges and the ever increasing bureaucratic demands of public child welfare agencies. Popular imagination shrinks from child protection. Unlike police work, which seems endlessly fascinating to American viewers, there are few, if any, television series or movies in which CPS caseworkers are central characters; and when social workers of any stripe appear as secondary characters in movies or television shows they are likely to be half blind rigid bureaucrats, more concerned with agency rules than helping children. Scholars, advocates and managers commonly refer to caseworkers, or social workers, employed by public agencies as “workers”, terminology that underlines their questionable professional status and low organizational rank.   

Even first-hand accounts of casework in child protection are rare, and when they infrequently appear (see Kevin Ramos’ The Department, a fictional story about working in Florida’s child protection system) are likely to be more about the impossible demands placed on CPS caseworkers and lack of organizational resources and support for CPS units than about the skills required to do child protection. Nevertheless, like any challenging job that requires complex skills, casework in child protection can be performed at a remarkable level of excellence. Furthermore, there are experienced caseworkers and or supervisors in most local offices who can serve as exemplary models for inexperienced staff struggling to learn how to do the job well.      

Child welfare training programs frequently develop lists of “competencies” needed for various jobs in child welfare without considering the character traits that are essential to do these jobs well. First and foremost, CPS caseworkers and other caseworkers in child welfare agencies must be trustworthy. Trustworthiness has several dimensions:

  • Integrity – Caseworkers’ actions in gathering, documenting and utilizing evidence, and in court testimony, must be beyond reproach. In our view, the most damaging media stories about failures of child protection in recent years have concerned fraudulent entries into case records following a child’s maltreatment related death, and stories regarding “drive by” investigations or other practices intended to “game” agencies’ performance measures. It only takes one instance of egregious misrepresentation of evidence in a case file, or court document, or in court testimony, to call into question a caseworker’s trustworthiness. Telling the truth, even when a truthful account reveals practice out of compliance with agency rules or errors in judgment is one meaning of integrity.            
  • Discipline – CPS caseworkers must consistently and reliably complete a variety of tasks required to complete and document investigations, assure that providers (including foster parents) are paid, check on the status of safety plans and service plans, maintain children’s placements, meet court requirements for shelter care and/or dependency hearings, fulfill case staffing requirements and sustain relationships with mandated reporters, service providers, children and parents. Concretely, this means that caseworkers have a long list of seemingly minor “must dos” on every work day. Failure to consistently complete these tasks undermines the confidence of supervisors, community professionals, foster parents, birth parents and children in a caseworker’s trustworthiness. One reason caseworkers are often impatient and irritable in mandated trainings is that they must still perform the “must dos” training or no training, or suffer a loss of confidence of key persons in their social networks.
  • Communication – The importance of returning phone calls and responding to emails in a timely way cannot be emphasized too strongly. Parents, foster parents, community professionals and adolescents in out-of-home care quickly lose confidence in caseworkers who cannot be contacted by phone or email and who cannot be counted to promptly respond to messages. Nothing communicates lack of concern, or disrespect, more quickly than silence following repeated attempts to contact a professional whose actions directly affect the safety and well-being of children. In addition, honesty and candor build trust. When parents involved in CPS investigations have been asked by researchers regarding the characteristics of caseworkers that are important to them, “fair” and “honest” tend to be high on the list.  
  • Collaboration – Working in teams, sharing resources, reciprocating favors, engaging in shared decision making can be described as skills, but the effective use of these skills depends fundamentally on an attitude of respect for the talents and contributions of others, and on the willingness to share responsibility for child welfare decision making. Experienced and effective CPS caseworkers understand their emotional and practical need for supervisory support and the support of unit members, and for access to the expertise and resources controlled by other agencies and professionals.

Concretely, working in the spirit of collaboration means that caseworkers must be willing to ask for help from other unit members and their supervisor when needed and give help when requested. It also means communicating appreciation in ways large and small to mandated reporters, service providers, foster parents, guardians ad-litem and others without whom effective child protection would not be possible.

Knowledge and Skills in Child Protection    

The habits, or character traits, described above which reflect trustworthiness, i.e., integrity, discipline, responsive and honest communication, and an attitude of sharing and inter-  dependence are vitally important in child protection; but will not inspire the confidence of other caseworkers, community professionals, parents and foster parents absent the knowledge and skills needed to protect children.

To understand the challenges of child protection, it is worth reflecting on how the goals of CPS investigation/assessment differ from those of law enforcement agencies. Making “findings” of   substantiated or unsubstantiated in regard to specific allegations of child maltreatment is not an end in itself. It is a means of protecting children from future harm by establishing a case history that can reliably be used for case planning or to document a history of child maltreatment for possible legal actions. A CPS caseworker can be conscientious and skilled at investigating factual allegations of child abuse and neglect but unskilled at safety assessment, risk assessment and assessment of families’ needs.

What CPS caseworkers with advanced skills must be able to do is to reliably translate factual information regarding incidents and patterns of child maltreatment, and the events and conditions that have led, or might lead, to child maltreatment into sound judgments regarding child safety and well-being and risk of future harm. For this reason, public child welfare agencies have made enormous investments in safety assessment and risk assessment tools and guidelines both to structure and simplify this translation process, with mixed results. Inexperienced caseworkers often appreciate the structure and guidance afforded by assessment tools; but experienced caseworkers frequently view these tools as a nuisance   and sometimes as an obstacle to skilled assessments. I have frequently heard experienced caseworkers insist that they have incorporated the conceptual framework of assessment tools into their practice though they only actually fill out the assessment forms at case closure. It may also be the case that the understanding and skills embodied in assessment tools do not reflect the understanding and skills of advanced practitioners as indicated by naturalistic studies of decision making (seeSources of Power: How People Make Decisions by Gary Klein). 

Caseworkers with outstanding assessment skills tend to think concretely about safety threats and about risk to children. Their translations of case information into judgments about safety and risk are compelling because they can organize information about risk factors such as substance abuse and domestic violence and protective factors such as a parent’s active concern with their child’s well-being in a plausible narrative about actual and likely parenting behaviors. When confronted with chronically relapsing conditions such as substance abuse and depression, in addition to information regarding patterns of use of drugs and alcohol they will immediately begin to look for the presence or absence of parents’ harm reduction behaviors, and for the extent of practical immediately available social support available to parents and children. Furthermore, experienced and reflective practitioners will not engage in self-deception about parental strengths, or minimize safety threats or risks because they like a parent and empathize with their struggles; or exaggerate the dangers to children because they dislike a parent and morally disapprove of their behavior.  

Developing outstanding assessment skills in child protection takes time and experience because unlike assessments completed in training programs, actual CPS assessments are conducted in the context of developing relationships between caseworkers, parents and children. Possibly the most important piece of practice wisdom developed among experts and practitioners in child protection during the past 10-15 years is that effective in-home safety plans require an active parental partner; and that parents’ willingness to work in partnership with CPS and other child welfare caseworkers depends to a large extent on caseworkers’ engagement skills. Parents are often understandably threatened by being the subject of a CPS investigation. A caseworker’s ability to calm parents’ fears and engage in an honest and candid discussion of safety concerns with all family members is crucial.

Schreiber, et al, (2013) summarize research on CPS caseworker/ parent relationships as follows:

“Results from these studies highlighted two important aspects of the relationship that mattered the most to parents. The first was the importance of being trustworthy, which was accomplished by doing things such as following through on promised tasks, promptly returning phone calls, showing up for meetings and appointments without multiple cancellations, showing knowledge and expertise of their job requirements, and going beyond procedural requirements in their work. When workers are trustworthy, parents were able to let go of their fear and engage. The second aspect of worker behavior that facilitated parent engagement was the ability to project an appearance of warmth, empathy and reassurance as opposed to appearing “bossy, businesslike, and judgmental.”

These authors go on to discuss the importance of caseworkers’ “ability to communicate (with parents) using clear, direct and unambiguous language; relate to parents at their level of understanding; and avoid the use of threatening and judgmental terms.” Caseworkers’ ability to remain calm and to interact with parents in respectful and non-judgmental ways were important engagement skills identified in several research studies, according to these authors.

In the study conducted by Schreiber, et al, “Parents were more likely to be accepting of CPS intervention when they felt that their worker had heard all sides of the story and talked to everyone that had relevant information.” Furthermore, “parents also reacted more positively to the CPS worker when they felt that the worker was impartial in their analysis of the information that had been collected.” Parents interviewed in this study were impressed by indicators of caseworker competence such as familiarity with case histories and conscientious gathering of information from collateral sources. 

Schreiber, et al, also found that parents had a high regard for caseworkers who provided emotional support, including encouragement and recognition of their strengths and positive behaviors, and concrete assistance for their poverty related needs.

Decision Making Skills

The assumption that thorough and thoughtful assessments in child protection will automatically lead to good decisions is highly questionable for several reasons: 

  • Decision makers cannot escape the limitations of knowledge in child protection research, or predict future events in specific cases with a high degree of accuracy. Currently, there is very little research regarding the effectiveness of in  home safety plans; as a result, decisions regarding the elements and implementation of in-home plans depend almost wholly on practice wisdom which may well be flawed. Furthermore, risk assessment tools have modest predictive powers at best when applied to specific families.
  • Caseworkers’ ability to take coercive action on behalf of children is severely limited by law and policy. Caseworkers may be aware that children are at high risk or in danger without being able to take legal action. In addition, caseworkers and agency attorneys are likely to have well informed views regarding how local judges and commissioners are likely to rule regarding various types of dependency actions.  
  • Biases of several types may influence decision making. Eileen Munro’s articles on confirmation bias should be read carefully by anyone who works in child protection.
  • Decisions regarding case plans are greatly affected by the resources available to children and families in open child welfare cases. Information regarding the effectiveness of these services is likely to be anecdotal and/or lacking entirely as case plans are developed.

Nevertheless, experienced caseworkers and supervisors often develop useful guidelines for making key decisions:

  • Make decisions under extreme time pressures only when necessary. CPS caseworkers who work in crisis ridden environments can easily become adrenaline junkies who seem to prefer acting in emergencies to taking time for reflection. This tendency in child welfare agencies should be resisted whenever possible.
  • Postpone judgment during the initial phases of assessment processes to the extent possibleKeeping an open mind to alternative explanations facilitates openness to new information and new perspectives.   
  • Major case decisions should always be subject to the review of well- informed persons, either supervisors or staffing groups. Caseworkers must be willing to provide the rationale for decisions and listen and respond to critical feedback.
  • Caseworkers and supervisors must train themselves to look for anomalous features in patterns of child maltreatment, or evidence which conflicts with their views of what should be doneAbsent an understanding of how easy it is to make critical mistakes, decision makers will follow their natural inclination to look only for evidence that confirms their views and will ignore evidence that conflicts with their version of events in a specific case. This is another reason that the thought processes leading to major decisions must be made transparent. It is next to impossible to counteract powerful biases without conflicting voices in the social environment.
  • Do not confuse social values with evidence from researchDecision makers in every field are most interested in research that supports their social values and the political views that follow from these values. Pretending that evidence from research supports decisions made on the basis of strongly held social values when there is a lack of evidence or conflicting evidence is an obstacle to clear thinking and honest discussion.
  • The willingness to change one’s mind in response to evidence and rational argument is a sign of strength and intellectual integrity, not weakness.

Experience in child protection should teach humility about one’s judgment and decision making regarding highly emotional and contested issues. The inability to tolerate conflicting views or engage in rational discussions with well-informed people who think differently about    key case decisions is a formula for serious indefensible errors in judgment in child protection, as in other fields.


Klein, Gary, Sources of Power: How People Make Decisions, 1999.

Munro, Eilene Munro, “Common Errors in Reasoning in Child Protection,” Child Abuse and Neglect, 23(8). 1999.

Schreiber, Jill, Fuller, Tamara, Paceley, Megan, “Engagement in child protective services: Parent perceptions of worker skills,” 35 (4), 2013. 


I appreciate the assistance of Toni Sebastian and M.K. Deacon in thinking through the characteristics of excellence in child protection.  


The opinions expressed in this commentary are those of the authors and are not intended to represent the views of Casey Family Program or any other organization.    

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Posted by on March 6, 2014 in Uncategorized


October 2013 Sounding Board: “Pathways from Childhood Adversities to Health Outcomes”

Pathways from Childhood Adversities to Health Outcomes 

by Dee Wilson

Dissemination of findings from the Adverse Childhood Experiences Studies (ACES) has led to widespread interest among human services professionals, advocates and policymakers of how poor health outcomes and elevated rates of early mortality associated with child abuse and neglect and other adversities, such as growing up in families with substance abusing or mentally ill parents, or family violence, can be ameliorated. I have occasionally seen professional audiences become restive or even angry when ACE researchers failed to provide clear answers to questions about how the negative effects of childhood adversities can be prevented or about resilience factors that promote health in children and adult despite multiple early adversities.

The ACES studies include one obvious answer to how early adversities translate into poor health (e.g., diabetes, a heart condition, strokes, some cancers, gastrointestinal problems) throughout life: various types of child maltreatment, parental substance abuse and chronic mental health conditions, family violence and loss of a parent at an early age often occur in combination. Large doses of adversities in early life lead to elevated rates of behaviors that damage health such as overeating, smoking, substance abuse, dangerous sexual practices that serve as coping mechanisms for chronic mental health conditions, or take the edge off of pain and misery. In addition, adolescents and adults who were seriously harmed by caregivers at an early age, or who lived in the midst of community violence or war, may not expect to live long and prosper. The sense of a foreshortened future provides little or no motivation to refrain from self-harming behaviors.

However, as ACE researchers have pointed out, self-harming behaviors of children and adolescents are typically preceded by a range of impairments in cognitive, emotional and social development, including serious interpersonal problems that interfere with the capacity for friendship and intimacy. One pathway to reducing the effects of early adversities lies in interrupting the causal nexus that leads to self-harming behaviors and, for seriously abused and neglected children, this means restoring the capacity for positive relationships with caregivers, as well as early identification and treatment of mental health conditions.

The extent to which severe child maltreatment leads directly to poor health and/ or elevated death rates before there is time for self-harming behaviors to develop, should not be underestimated. Rene Spitz’s famous 1940’s research in foundling homes found that physically well cared for babies in institutional settings who lacked mothers died at alarming rates. In one of Spitz’s studies of a foundling home in a U.S. city, more than a third of infants and toddlers with extended stays died at an early age from natural causes. One plausible interpretation of Spitz’s findings is that severe emotional neglect in infancy damages children’s immune systems. The poor health of many abused and neglected children may be the result of both physical and emotional mistreatment and of the lack of a nurturing relationship with caregivers.

The same early adversities that often lead to poor health in both childhood and adult life also increase the risk of early death due to abuse or neglect, or from accidents, or possibly from disease. Eighty to ninety percent of children who die in abuse/neglect related incidents are 0-4 years old at the time of death. An outstanding (but unpublished) study of child mortality conducted by Washington State’s DSHS Office of Research and Data Analysis (ORDA) in the 1990s found that children 0-3 whose mothers received publicly funded substance abuse treatment died at 3.59 times the rate of other children in a large birth cohort. During the past two decades, co-sleeping deaths of infants of substance abusing parents have become a common cause of child death in families with an open/ recently open CPS case.

Emily Putnam-Hornstein’s study of injury related deaths in California found that a CPS report on children 0-5 was a major risk factor for injury related death. In Putnam- Hornstein’s study, young children with CPS reports were almost six times more likely to die from inflicted injuries and 2.5 times more likely to die from non-intentional injuries than other children of the same age. Public child welfare agencies have had little success in reducing maltreatment related child deaths despite (literally) thousands of child death reviews and decades of research studies with similar findings because (1) only about a third of children who die in abuse/neglect related incidents have been reported to CPS prior to death and (2) waiting for young children in high risk families to be clearly endangered before CPS caseworkers offer voluntary help or remove infants and toddlers from the home through legal action is an ineffective approach to child protection. Public health agencies need to be given a much larger role in the protection of infants and other young children; and CPS programs need to make far bigger investments in provision of early intervention services to at-risk families.

Other pathways to poor health and early death

There is a large body of research regarding the effects of organizational rank and status, and income inequality on health and mortality which Michael Marmot discusses in his book, The Status Syndrome (2004). One of the most surprising findings in this research is that differences in status and income effect all social classes and persons with a wide range of incomes, not just the poor and the wealthy. According to Marmot, “There is a large body of literature supporting the importance of these five characteristics, control, predictability, degree of support, threat to status, and presence of outlets, that modulate the impact of a psychologically threatening stimulus. All five of them are likely to be linked to position in the social hierarchy.” Marmot places a particular emphasis on degree of control of life circumstances, a factor directly related to rank in an organizational structure, social status and income. “Sustained, chronic and long term stress is linked to low control of life circumstances,” Marmot maintains, a condition to which persons with low organizational rank and social status, and lack of resources, are especially vulnerable.

Marmot comments that “… there is a syndrome in humans, which goes by various names, latterly called the metabolic syndrome …thought to be the result of insulin resistance. It is characterized by … fat around the abdomen rather the hips, low levels of HDL cholesterol (…the “good” cholesterol), high levels of plasma triglyceride, high levels of blood glucose and insulin in the fasting state, and high blood pressure. This pattern of metabolic change is associated with increased risk of heart disease.”

Some mental health conditions such as depression and PTSD (which often occur in combination) are associated with a sense of powerlessness in regard to both external conditions and one’s own reactions to perceived threats. Over 30 years ago, Richard Totman wrote in his prescient analysis (Social Causes of Illness, 1979) of the relationship between social conditions and illness that “At the heart of this model of psychosomatic influence is the concept of agency – personal commitment – and the assumption that the absence of this is related, in a crucial way, to enhanced susceptibility to illness.” Childhood adversities and other types of trauma are associated with highly elevated rates of mood disorders. Hopeless/helpless reactions to trauma, common among parents with co–occurring substance abuse and mental health disorders (the rule rather the exception among chronically neglecting and chronically maltreating parents), endanger health reflect the loss of self efficacy. Empowerment practices are important in child welfare because parents must regain confidence in their ability to act on their own behalf and the behalf of their children to adequately parent their children.

There is a type of despair that is deeper than demoralized hopeless/helpless reactions and that can undermine the will to live. Social experiences such as loss of family members or comrades during war, or isolation following immigration to a society with a culture vastly different than the culture in which a person was born or raised, or political and social oppression that makes it difficult, if not impossible, to positively affirm cultural identity, destroy a sense of meaning and purpose. The social bonds that protect physical health and mental health depend on shared beliefs, values and cultural traditions that must be expressed to be sustained. Totman comments on the importance of opportunities for the verbal declaration of opinions and attitudes in maintaining health. Expression of beliefs, values and attitudes in the presence of like-minded individuals, or possibly even those who disagree with these views, strengthens social and cultural identity. When cultural identity is stripped away by circumstances or through intentional policies and practices, the health and mental health of members of threatened cultural groups is threatened.

I am old enough to notice groups of elderly persons who meet daily, sometimes for years, in coffee shops and fast food restaurants. Obviously, members of these groups enjoy one another’s company, at least to a minimal degree; but it may be the opportunity to express and strengthen social attitudes and beliefs that keeps the group meeting for months and years. Strong intact social and cultural identity protects health and mental health of members of a group even when they don’t particularly like most other group members.

Preventing the Negative Effects of ACES 

What can be done by individuals, philanthropic entities and governments to reduce the health impacts of childhood adversities?

  • Adolescents and adults can choose to engage in life sustaining behaviors rather than in habits that gradually undermine health and mental health. However, this is easier said than done for persons with chronic mental health conditions or who are emotionally suffering absent a mental health diagnosis. Unfortunately, the decision to forego self-harming behaviors often comes after or as part of (not before), a spiritual decision to seek to stay alive rather than accept the inevitability of an early death. Early identification and treatment of children’s and adolescents’ mental health conditions can limit the appeal of self-harming behaviors.
  • Social agencies, including public child welfare agencies, must commit to the goal of helping children and adults recover from the effects of early abuse and neglect, and other trauma. Safety and well-being concerns must be connected in both child welfare policy and practice. Concretely, this means that child welfare agencies must be far more concerned with identifying and undoing the emotional effects of child abuse and neglect than is currently the case.
  • There needs to be much larger federal and state investments in prevention and early intervention programs and services; in particular, parental substance abuse, chronic mental health conditions, family violence and severe poverty should elicit offers of voluntary services before a CPS report leads to coercive interventions. Public health agencies should be given a far bigger role in child welfare, especially in helping young single mothers develop nurturing relationships with their babies.  Predictive analytics, as developed by Emily Putnam-Hornstein and several of her colleagues, should be used to develop targeted outreach to at- risk families.
  • Birth parents, foster parents and adoptive parents should receive training about trauma and its aftermath in addition to ongoing expert consultation regarding how children who have been severely abused or neglected can learn to use parents and other caregivers to calm down and feel safe. Every child (0-3) entering the foster care system should be assessed by an expert in infant mental health. Every possible effort should be made to ensure that the foster care system becomes a therapeutic entity rather than inflicting further harm on vulnerable children through multiple placements and punitive or non-nurturing care.
  • Programs for both abused and neglected children and their parents can utilize empowerment principles to restore a sense of self efficacy, i.e., personal agency. In practice, this means giving children and adolescents, and their parents, some degree of control over their lives within reasonable limits, even when there is legal structure.
  • Strong cultural identity can be recognized in policy and practice as essential to the health and mental health of children, their families and communities.
  • The federal government and state governments should adopt the policy goal of eliminating long term severe poverty, i.e., annual incomes less than half of the federal poverty standard for more than 5 years. Leaving almost one-tenth of U.S. children to grow up in severe poverty invites a host of expensive social ills resulting from multiple adversities, and accepts the destitution and social exclusion of millions of children and adults.


Marmot, Michael, The Status Syndrome (2004), Henry Holt and Company.

“Mortality of CPS Clients in Washington State From Birth to Age Four,” Office of Research and Data Analysis, Department of Social and Health Services, Olympia, Washington, 1998.

Putnam- Hornstein, Emily, “Report of Maltreatment as a Risk Factor for Injury Death,” Child MaltreatmentVol. 16 (3), August 2011, 163-174.

Spitz, Rene, Cobliner, W. Godfrey, and Freud, Anna, The First Year of Life: A Psychoanalytic Study of Normal & Deviant Development of Object Relations, International Universities Press Inc., June 1966

Totman, Richard, Social Causes of Illness (1979), Pantheon Books.

The opinions expressed in this commentary are solely those of the author and are not intended to represent the views of Casey Family Program or any other organization.

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Posted by on March 6, 2014 in Uncategorized


September 2013 Sounding Board: “To the End of June”

 “To the End of June”

by Dee Wilson 

To The End of June: The Intimate Life of American Foster Care by Chris Beam, Houghton, Mifflin, Harcourt, 2013.

Chris Beam has written a sobering and compelling account of the experience of foster care from the perspective of older youth with lengthy foster care histories, foster parents, birth parents and caseworkers. Beam follows a few foster families and foster youth for several years, choosing to offer an in-depth intimate description of the experiences and challenges of a small number of families, children and youth rather than reviewing foster care research, or offering policy prescriptions. Along the way, Beam provides information (mostly accurate) on topics such as residential care,  financing, waivers, privatization, racial disproportionality, independent living programs, child welfare decision making ; but her discussions barely scratch the surface of these and other complex subjects. It is Beam’s candid, discerning and dispassionate (for lack of a better word) portraits of foster parents and foster youth that make her book worth reading, and suggests a way forward to a better foster care system.

Any book organized around a few stories of families, children and youth is vulnerable to the objection that the stories the author has chosen to tell are not representative. Beam, for example, focuses on children and youth with long lengths of stay, young children who were eventually adopted or older youth who grew up in foster care or residential care and aged out of care, most without a legal permanent plan. Beam has little to say about children who remain in foster care for a few days, weeks or months, or who are successfully reunified with birth parents. Foster care often works as intended for these children, i.e., as a temporary port in the storm for children whose parents need various types of therapeutic services. Most of these children do not have multiple placement histories (i.e., 4-5 placements or more), a quarter to a third are placed with relatives, and many of these children receive specialized assessments and services they may not have been eligible for or had access to in their parents’ homes.

Nevertheless, there are a large number of foster children and youth who remain in care for years (regardless of ASFA timelines), and or/who age out of care. Many of these children are school age when they enter out-of-home care, but a surprising number enter foster care as babies and toddlers, usually because of the combination of substance abuse and neglect. Infants placed in out-of-home care are reunified with birth parents at lower rates than older children, and adoptions frequently take 3 or more years to complete. In To The End of June, very young foster children were placed with pre–adopt parents who loved them deeply but who had to tolerate the uncertainties of an extended reunification process in which substance abusing parents struggled in an up and down recovery process. To their great credit, some of these pre-adopt parents develop supportive relationships with a birth parent, or at least meet and struggle to understand and empathize with the birth parent. Furthermore, they do not attempt to undermine their young foster child’s relationship with birth parents. In To The End of June, young children are eventually adopted by nurturing families (despite many delays) after birth parents either voluntarily relinquish their parental rights or have their parental rights terminated. These are sad stories with happy endings, at least for the young adopted children. Beam’s stories strongly suggest the value of cooperative, even close, relationships between foster parents and birth parents, a challenge which in my experience some foster parents intuitively accept and embrace and others adamantly reject.

However, there are many foster children who cannot be reunited with birth parents, or whose reunifications fail and who are never adopted. These children are often school age, or close to school age, when they enter foster care, and may have serious behavior problems that reduce the likelihood of adoption. Some children are initially placed with extended family members, sometimes for years, before these placements disrupt due to caregivers’ health problems, or children’s behavior problems, or for other reasons. In To The End of June, several of the older youth Beam comes to know well entered foster care or kin care when they were 5 or 6, and then experienced multiple placements in foster homes and/or residential facilities before they aged out of care. One older youth, Fatima, placed with a foster family who eventually adopt her, was in 21 temporary homes or facilities from age 5 until her late teens. Fatimah longs to find the foster parents who sent her away for reasons she doesn’t understand and ask them “Why”. The title, To The End of June reflects Fatimah’s desire for a permanent family and the fear that her wish for a family to whom she truly belongs may remain just beyond reach.

Unfortunately, Beams’ stories of older foster youth reflect common themes in the experiences of youth who age out of foster care. First and foremost is the instability of long term foster care or residential care. 2012 AFCARs data indicates that almost half (45.9%) of children and youth 6-17 in foster care at a point in time with lengths of stay of 2 years or longer had been in 5 or more placements; and it is not unusual for youth who have spent most of their childhoods in care to have been in double digit placements, 10, 15, 20, even 30 homes or facilities. Only one youth featured in To The End of June was in a single placement for several years, and she lived with a family who spoke a different language. These children often feel like they have a different status than other “normal” children. One young woman explains to Beam that “Foster care makes you feel like you don’t deserve anything.”

Older youth with histories of multiple placements often have jaundiced views of foster parents. They may believe that some foster parents were primarily motivated by financial considerations. A surprising percentage of youth (a third in some studies) report being abused or neglected while in foster care or residential care.  However, it is the experience of serial rejections by foster parents, some which occur in pre-adopt homes, that may have the most long lasting effect on older foster youths’ view of themselves. But what happens when older foster youth encounter foster families who are ready to legally adopt them or engage in “moral adoption”, i.e., an unlimited emotional commitment to a life-long relationship with a foster youth?

The two most gripping dramas in To The End of June are about foster families who make strong, seemingly unconditional, commitments to foster children and youth. One of these families, Allyson and Bruce Green, live in Brooklyn and have been licensed by and provided care under the supervision of a private child placing agency. At various points during the several years Beam visits the home and meets with family members,  the Greens have 6 or 7 foster children, both young children and older youth, and a teenage daughter of their own. The Greens, especially Allyson, are a highly religious family; and Allyson believes that she has been called by God to provide care to children who need a family. Bruce Green works at a job that pays him about $80,000 per year, but is also very involved in transporting children to their many appointments and in decision making around disciplinary issues.

According to Beam, “the Greens didn’t expect to wind up with a house full of teenagers, but once they got them, they rallied. The house … was more than a roof and walls: it was a permanent home for a growing family. And once the teenagers came, it was a growing family with a mission.” And Beam writes, “Both Bruce and Allyson were horrified by the stories their new foster children told them about the multiple placements they’d endured,” and the non-nurturing or even abusive treatment  their foster youth experienced in some of these homes. The Greens have a highly structured approach to care in which they know where every child/ youth in the home is supposed to be every hour of every day. They expect the older youth to initially resist the rules but then “relax” into a structure that prepares them for the discipline required to succeed at school and work.  

The Greens receive little or no help from the private agency. “Once they’ve sent a child, both Bruce and Allyson claim, they pretty much wash their hands of him.” “All the goods and services we tracked down for children ourselves,” the Greens told Beam. As the story begins, The Greens are on the verge of adopting Fatimah, a 16 year old with 21 prior placements and are planning to adopt two other youth, Chanel and Dominque, an angry 18 year old who would have been removed from the Greens and placed in a therapeutic home absent their commitment to adopt her. The Greens “basically embody the mission of “rocking with the kids all the way,” according to Beam.

However, Fatimah’s adoption seems to have an unsettling effect on the other older teenagers in the home. Tonya, an older youth who claims to have no interest in adoption, runs away for 33 days soon after Fatimah’s adoption is finalized, and Dominque’s adoption falls apart as 18 year old Dominque leaves the home by mutual agreement with the Greens. As Beam tells the story, “as soon as they planned to adopt her, the tension escalated.” Even Fatimah becomes unhappy after her adoption. Fatimah grows more critical of the Greens and more distant. Eventually, she returns to her birth mother, an arrangement which within a few months leaves her without the ability to house and feed herself. Fatimah then returns to the Green’s home for a place to sleep and eat, but without the emotional closeness to the Greens that preceded her adoption.

This is a sobering story that reflects the emotional complexities and challenges of older youth adoption. It is also apparent that older foster youth and young adults with extensive foster care histories are agents of their own destiny, and are sometimes more responsible for placement disruptions than foster parents. By the end of To The End of June, the Greens have decided not to take additional teenagers though they keep the youth still living in their home. Foster parents, like children and youth, can be seriously burned by placement disruptions. 

Possibly, the most inspiring story in Beam’s book is about Mary Keane, a single parent affiliated with the You Gotta Believe program. Following a divorce in her mid-50s, “Mary parented eleven kids from the system, all over the age of eighteen, save for one who was just under,” Beam states. Mary Keane has taken large sibling groups, runaways and youth who have lived on the street for years into her home. Occasionally, youth have run away from the Keane home “and a handful never came back,” but the runaways who returned to the home were welcome.

Beam comments that Mary Keane “doesn’t push her kids into adulthood with prescribed sets of expectations; she lets them live with her as long as it takes to grow into a kind of faith in themselves and family again” According to Beam, “Nobody ever, under any circumstances, gets kicked out.” Mary Keane allow older teens to regress to earlier developmental stages and understands their need for large doses of praise and encouragement.  Beam is obviously in awe of a woman who models unconditional love and approval to older foster youth from tough backgrounds who have little or no reason to trust adults. Beam writes: “The work at Mary’s was slow, ineffable, improbable… I watched the steady hand of unconditional love work its power on them… This was beyond any system, or program, or mandate.” What impresses Beam the most is the caring and gentleness with which Mary’s adult children treat each other.

Contrast the care of troubled youth provided by the Greens and Mary Keane with the lack of concern and competence embodied in a story Beam tells toward the end of her book. On the way to meet Dominique, the 18 year who left the Green’s home in anger, Beam discovers that Dominique has been hit and injured by a motorist. Beam accompanies Dominique to an emergency room, and calls Dominique’s foster mother who refuses to come to the hospital with clothes for Dominique. The foster mother tells Beam “to call the agency.” The caseworker from the private agency shows up at the hospital after a delay of several hours, and then attempts to foist off her responsibility for dealing with medical personnel and transporting Dominique to her foster home on to Beam. This story is an eloquent account of what it means for older youth to lack a supportive family at critical moments, and to be supervised by a caseworker who is clearly not prepared to do her job.

The strength of To The End of June is Beam’s understanding of foster children’s and youths’ need for committed parents and the challenges which these youth present to substitute caregivers who offer unconditional commitment and stability of care. However, Beam does not describe how foster care systems can find, train and support families willing to make this extraordinary commitment and stick with troubled youth through thick and thin. The Greens and Mary Keane have a religious or spiritual calling, and have developed their own idiosyncratic models of care that owe little to agencies or programs. Beam does not explore professional foster parenting or therapeutic foster care; and it’s an open question whether professional skills and better supports can accomplish what the admirable foster families Beam describes achieve through total dedication and ( in Mary Keane’s case) an enduring state of grace.       

The opinions expressed in this commentary are solely those of the author and are not intended to represent the views of Casey Family Program or any other organization. 

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Posted by on March 6, 2014 in Uncategorized


August 2013 Sounding Board: “Safeguarding Children in England and Northern Europe”

Safeguarding Children in England and Northern Europe

by Dee Wilson

Child welfare scholars who compare Western countries’ child welfare systems have often contrasted systems narrowly focused on child protection with broader family support systems. Child protection systems (such as in the U.S.) tend to be organized around investigations of allegations of abuse and neglect, make official  investigative “findings” that label  some parents as abusive or neglectful, utilize court actions for making out-of-home care placements and often have a thin array of in-home services for children and families. Child welfare systems oriented around family support (e.g., in Northern Europe and Scandinavia) serve children with a broad range of issues and needs, emphasize partnerships with families and voluntary services, and offer generous help and support to poor and socially excluded children and parents.

However, in the past 10-15 years the labeling of countries’ child welfare systems as either Child Protection or Family Support has become increasingly suspect as a steadily increasing number of states in the U.S. have adopted dual track differential response systems in which 50-75% of families are assigned to a family assessment track rather than investigated. Investigative findings such as “substantiated” or “unfounded” are typically not made for the majority of families with screened-in CPS reports in states with differential response systems. Family support services, some evidenced based, have been increased to the point that in-home service cases far outnumber children in out-of-home care in some jurisdictions. Furthermore, rates of out-of-home care per 1000 children have dramatically declined in the U.S. which currently has about half the rate per 1000 of children in foster care or residential care as most countries in Northern Europe and Scandinavia.

During the same years when public child welfare agencies in the U.S. have been adding family support services and implementing differential response systems, Northern European countries have been forced to rethink their approaches to child protection following high profile child deaths. In Germany, for example, “these events (child deaths) caused a massive child protection panic in the public sector, political arena, and also in the professional field that led to a refocusing of child and family welfare services on child protection, with an emphasis on early risk assessment, crisis intervention and quick out-of-home placements,” according to German scholars.  Public confidence in child welfare authorities in Germany and Nordic European countries has been shaken by child deaths following repeated abuse and (sometimes) torture of children by caregivers despite frequent contact with a variety of professionals.

In 2007, under fierce media pressure to act, Germany’s federal government convened a conference of prime ministers of provincial parliaments (later called the “Child Protection Summit”) to consider responses to the country’s child protection crisis.  Conference participants recommended that a new federal law should establish a framework for inter-agency cooperation, institute early health check-ups for children, and provide a variety of other preventative and early intervention services. Several German states have also passed comprehensive child protection laws to encourage or require parents to use early child assessments and screenings and created new family support programs. In addition, according to Wolff, et al, “the threshold for intervention in cases of child abuse and neglect was lowered,” and more power was given to courts to compel parents to use available services and lock up children and youth if necessary to ensure their safety.

Germany’s new child protection framework has increased public investment in a variety of health based services for children and families, added compulsory requirements regarding families’ use of these services and expanded the federal and state regulatory frameworks in which public and private agencies deliver child welfare services. The retreat from a commitment to voluntary child welfare services has been controversial in Germany, and some scholars view the country’s child welfare system as at a “crossroads” with one directional sign reading Voluntary and the other Legal Compulsion.

England’s Child Protection Reforms

England is an interesting example of a child protection system caught between powerful conflicting pressures. Since the mid-1990s, English child welfare jurisdictions have made a persistent determined effort to reshape their approaches to intervention and helping families around family support principles. In both policy and practice, this has meant an effort to work in partnership with families, and to provide a wide range of voluntary services based on families’ needs rather than solely as a response to abuse or neglect, and before major problems in family functioning require coercive interventions. According to Parton and Berridge (2011), “The concept of child protection was superseded by the much broader notion of safeguarding and promoting the welfare of the child.” In England’s child welfare policy under recent Labour governments, safeguarding and promoting the welfare of children included:

  • Protecting children from maltreatment
  • Preventing impairment of children’s health and development
  • Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care; and enabling children to have optimum life chances and enter adulthood successfully

This is, to say the least, a broad mandate, but the important message for U.S. policymakers, advocates and practitioners is that safeguarding children in England has been part of a larger concern with their development and well-being, not a set of child safety concerns that can be distinguished from concerns with child well-being. Parton and Berridge comment that, “Although protecting children from maltreatment is seen as important, in order to prevent impairment to health and development, on its own it is not seen as sufficient to ensure that children are growing up in circumstances that ensure the provision of safe and effective care.” In this formulation and in the conceptual frameworks of Nordic countries, “unsafe” for child welfare purposes does not mean “abused or neglected”, or even more narrowly “in danger of serious abuse or neglect” as in some states in the U.S., but rather “children living in circumstances and conditions that endanger their development.”

However, even more than in the U.S. (if this is possible), England’s child welfare system has been devastated by high profile child deaths which have led to media attacks, public outrage, the firing of child welfare staff and other professionals involved with the child and family and urgent calls for reform. In 2008, a mother, stepfather and family friend were convicted of causing, or allowing, the death of Baby Peter. According to Parton and Berridge,  “During the trial, the court heard that Baby Peter was used as a “punch bag” and that his mother had deceived and manipulated professionals with lies and on one occasion had smeared him with chocolate to hide his bruises. There had been over 60 contacts with the family from a variety of health and social care professionals, and he was pronounced dead just 48 hours after a hospital doctor failed to identify he had a broken spine.” At one point following news stories about this horrendous child death, a British tabloid “delivered a petition to the Prime Minister containing 1.5 million signatures …”

In the U.S., child welfare crises resulting from specific high profile child deaths have mostly affected a single state’s or large city’s child welfare system, but in England there have been a series of well publicized deaths of children that have had national ramifications.  Parton and Berridge assert that one effect of the public outrage regarding the Baby Peter case in England has been increasing difficulties with recruiting and retaining social workers in child welfare jobs.

During the past 2-3 years, the English scholar, Eileen Munro, has been given extraordinary powers to conduct an in-depth review of the English child welfare system, including meetings with managers, practitioners, parents and youth; and to recommend changes in both child welfare practices and management approaches that would interrupt the usual ways English authorities have responded to high profile deaths. Munro (herself an expert on child maltreatment deaths) has pointed out the futility of steadily adding to agencies’ prescriptive frameworks, i.e., policy and procedural manuals, that are already hundreds of pages in length; and has recommended giving child welfare practitioners more, not less, discretion in how they perform their jobs. Munro has also strongly advocated for a more child centered focus in how child welfare systems operate, a recommendation that resonates with changes in conceptual frameworks in several Nordic countries. Munro has also introduced the concept of ‘risk sensible’ practice in which the limitations of current assessment tools in child protection are openly acknowledged, and talk of “ensuring safety” is recognized as unreasonable. The outcome of Munro’s Report and its recommendations on England’s child protection system remains to be seen.   

Out-of-Home Care Rates per 1000 in England and Northern Europe  

One of the most interesting child welfare developments of the past decade has been the decline in out-of-home care rates in the U.S. and the increase in these rates in countries in Northern Europe, including Scandinavia.     

 Country                                             Before                                  Recently    

USA                                                    8 (1997)                                5.4 (2012)

Canada                                               4 (1991)                                9.7 (2007)

England                                              4.5 (1994)                              5.5 (2009)

Sweden                                               6 (2000)                                6.6 (2007)

Finland                                                8 (1994)                                 12 (2007)

Denmark                                             9.5 (1993)                              10.2 (2007)

Norway                                               5.8 (1994)                               8.2 (2008)

Germany                                             9.5 (1995)                               9.9 (2005)

 Belgium                                              7.9 (2004)                               8.6 (2008)

Netherlands                                         8.4 (2000)                               10 (2009)    

Why do the U.S. and England have lower (often much lower) out-of-home care rates than countries in Northern Europe that have stronger social welfare systems and whose child welfare systems have been committed for decades to voluntary family support services? There are three main reasons: (1) a much higher percentage of children and youth in out-of-home care in Northern Europe and Scandinavia were placed for reasons other than child abuse and neglect. Children in out-of-home care in Scandinavia are often older school age youth placed due to behavior problems. Child welfare agencies in the U.S. and England place many more babies and other young children due mainly to child neglect than is the case in Denmark, Sweden, Finland and Norway. (2) A much lower percentage of children placed in out-of-home care in Europe exit to adoption than in the U.S. where adoption is usually viewed as a good permanency outcome. There is a far less positive view of adoption in many European countries. (3) In some countries in Northern Europe, most out-of-home placements are voluntary, and may be viewed as a type of family support rather than as a coercive insult to family integrity.


What can policymakers, advocates and practitioners in the U.S. learn from developments in child protection that have occurred in the past 10-15 years in England and Northern Europe? 

  •  Every child welfare system in English speaking countries and in Northern Europe has experienced horrendous child deaths that have led to public outrage and to strong political pressures to improve child protection systems. High profile child deaths in England and Northern Europe have undermined public confidence in child protection systems, and made it more difficult to recruit and retain social workers for critical child welfare jobs. However,
  • England, Germany and the Nordic countries have strengthened their child protection systems in part by adding to family support systems and enhancing preventative and early intervention services, rather than narrowly focusing on children assessed to be in danger, i.e., at risk of imminent harm. 
  • Safeguarding in Northern Europe and Scandinavia ( and in England until recently) has been concerned with a wide range of conditions that endanger children’s development, not just abuse and neglect; and the emphasis is on identifying and doing something about these challenges to safe care and positive development as early as possible.    
  • All child welfare systems must struggle to find the right combination of family support services and high quality forensic investigations. The expanded use of differential response systems will not eliminate the need for expert investigators; and these investigators should be given high status and first rate support in public child welfare agencies.   
  • Out-of-home care is viewed differently and used differently in Scandinavia than in the U.S.  Countries with well-developed social welfare systems do not have child welfare systems inundated with reports of child neglect and with concerns about the safety of babies and other young children. Nevertheless, these countries have plenty of child welfare issues and challenges due to the same factors associated with child welfare cases in the U.S., i.e., substance abuse, mental health problems, family violence, and poverty.    
  • England has recently begun to examine how child welfare systems are managed and to consider scaling down prescriptive frameworks that guide child welfare practice rather than steadily adding to them. It is long past due for there to be similar initiatives in the United States.


Gilbert, Neil, Parton, Nigel and Skivenes, Marit (Editors) , Child Protection Systems: International Trends and Orientations , Oxford University Press, 2011

Bostock, Lisa, Bairstow, Sue, Fish, Shelia and Macleod, Fiona,  Managing risk and minimizing mistakes in services to children and families, Social Care Institute for Excellence, London, England, 2005

Staying Safe: A consultation document , Department for Children, Schools and Families, Nottingham, England. 2007.


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Posted by on March 6, 2014 in Uncategorized


July 2013 Sounding Board: “Kids Count 2013”

Kids Count 2013

by Dee Wilson

Anna E. Casey’s annual Kids Count reports have ranked states on indicators of child and family well-being since 1990. Taken together, these reports provide a longitudinal picture of national trends in child and family well-being and comparisons of states in four domains: Economic Well-Being, Education, Health and Family and Community. The 2013 Kids Count report is mostly based on 2011or 2010 data regarding 16 indicators, 4 indicators for each domain. The 16 indicators are:

Economic Well-Being  – child poverty rate; children whose parents lack secure employment; children living in households with a high housing burden; teens not in school and not working.

Education – children not attending pre-school; fourth graders not proficient in reading; eighth graders not proficient in math; high school students not graduating on time.

Health – low birth-weight babies; children without health insurance; child and teen death rate; teens who abuse alcohol or drugs.

Family and Community – children in single parent families; children in families where head of household lacks a high school diploma; children living in high poverty areas; teen births per 1000.

Kids Count report gives states a composite ranking for child and family well- being; and these rankings typically have a strong regional flavor: 

 Best                                                                     Worst 

1. New Hampshire                                                50. New Mexico

2. Vermont                                                            49. Mississippi

3. Massachusetts                                                  48. Nevada

4. Minnesota                                                          47. Arizona

5. New Jersey                                                        46. Louisiana

6. North Dakota                                                      45. South Carolina

7. Iowa                                                                    44. Alabama

8. Nebraska                                                            43. Georgia

9. Connecticut                                                        42. Texas

10. Maryland                                                           41. California

11. Virginia                                                              40. Arkansas

12. Wisconsin                                                         39. Tennessee

13. Maine                                                                38. Florida    

States in New England and the upper Midwest usually have the best composite rankings and states in the Deep South and southwest have the lowest rankings, in part because composite rankings are greatly influenced by economic indicators. New England and the upper Midwest rank high on these indicators while the South and Southwest contain many of the poorest states. Of the states ranked 38-50 in Economic Well Being only North Carolina (38th) and Oregon (41st) have a composite ranking better than 38th.

However, Robert Putnam pointed out in Bowling Alone (2000) that Kids Count rankings are also strongly associated with indicators of social capital, i.e., the extent to which persons living in various communities and states are involved in social and civic activities. Social capital is a concept that encompasses everything from club memberships to socializing with friends to voting rates. The various indicators of social capital are, in effect, proxy measures of community spirit and civic involvement. States in the upper Midwest with a strong Scandinavian heritage and states in New England that were settled by religious communities seeking religious liberty rank high on multiple indicators of social capital. Utah ranks 14th  in Kids Count 2013, the highest composite ranking for a Western state.

Interestingly, the strength of community spirit and rates of civic engagement in various states appear to be powerfully influenced by the history of ethnic and religious communities that long ago had to pull together to survive.

States in the West

Kids Count composite rankings for Western states are as follows:

14. Utah

15. Wyoming

19. Washington

20. Idaho

28. Montana

32. Oregon

33. Alaska

41. California

46. Nevada

Wyoming, Utah and Montana ranked in the top 15 states on Economic Well-Being; Wyoming ranked second nationally on economic indicators. Idaho ranked 23rd, Alaska ranked 24th, Washington ranked 28th and Oregon 41st on Economic Well- Being.  Washington’s 2013 disappointing ranking on Economic Well Being was in part the result of the percentage of children whose parents lacked full time secure employment (33%),  the  burden of housing costs, i.e., (41% of families spent more than 30% of their income on housing costs) and the percentage of teens not in school and not working (9%).  On a positive note, Washington’s child poverty rate of 18% was well below the national average of 23%. Washington’s composite Kids Count ranking declined from 13th  to 19th between 2005 and 2011, primarily because of the state’s decline in Economic Well Being compared to other states.     

Washington has very different rankings on the four 2013 Kids Count domains:

Economic Well-being – 28th

Education- 25th

Health- 6th

Family and Community- 17th 

Washington tied for the 5th lowest percentage among states of child and teen deaths from all causes, i.e., 21 per 100, 000 compared to 26 per 100, 000 nationally. 

California ranked 46th among states in Economic Well Being, in part because over half of California’s families had a high housing burden, i.e., housing costs of 30% or more of family income. California ranked 39th in Education, 29th in Health and 42nd in Family and Community. California’s composite ranking was 41st.    

National Trends 

Nationally, there have been modest improvements in education and health well-being indicators during recent years. Perhaps the most impressive improvement has been the reduction in child and teen death rates from 32 per 100,000 in 2005 to 26 per 100,000 in 2010. Concretely, the reduction in the child and teen death rate resulted in 4600 fewer child deaths in 2010 compared to 2005. The death rate for children ages 1-14 has declined from 31 per 100,000 in 1990 to 17 per 100,000 in 2010.

There has also been a long term decline in teen births from 48 per 1000 teens in 2000 to 34 per 1000 in 2010. However, the small improvement in education indicators seems more like a reason for concern than celebration. According to Kids Count 2013, “a stunning 68 percent of fourth graders in public school were reading below proficiency levels in 2011, a slight improvement from 2005 when the figure was 70 percent; “and more than 80 percent of African American, American Indian and Latino fourth graders were not proficient in reading …” The percentage of eighth graders not proficient in math declined from 72 percent in 2005 to 66 percent in 2011.

By far the most concerning Kids Count trend in recent years has been the growth in the child poverty rate from 19% in 2005 to 23% in 2011. In 2011, 15 states and the District of Columbia had child poverty rates of 25 percent or higher, and the poverty rate for African American families (39%) was almost three times higher than the rate for non- Hispanic Whites.  Kids Count 2013 comments that “Even more disturbing is the fact that the poverty rate for very young children – those under 3 years old – was 26 percent.” These poverty rates reflect a 7.5 percent unemployment rate (12 million Americans) and a distressing rate of long term unemployment with 3 million people out of work for a year or more. Poverty has the greatest negative effect on child development when children are 0-3.

Poverty is also related to the percentage of children growing up in single parent families; in 2011 35 percent of all children and 37 percent of infants and toddlers were living in single parent families. Given these statistics, perhaps it is not a surprise that “the gap in standardized test scores between affluent and low income students in the United States has grown about 40 percent since the 1960s, even as the racial gap has narrowed.”

Another recent report on child well-being indicators, America’s Children: Key National Indicators of Well-Being, 2013 from the Federal Interagency Forum on Child and Family Statistics provides a more in-depth account of economic trends affecting families of all social classes. According to this report, “the percentage of children living in families with medium income (200 – 399% greater than the poverty threshold) was lower in 2011 (29%) than in 1990 (37%). At the same time, the percentage of children living in families with high income (26%) was greater in 2011 than in 1990 (21%).” In addition, the percentage of children living in families with very high incomes ($136,800 or more) increased from 7% in 1990 to 12% in 2011.

Income inequality has steadily increased since 1990; the percentage of children living in middle income families has declined while both the child poverty rate and percentage of children in high income families has increased. The percentage of children living in severe poverty and the percentage of children living in families with very high incomes are similar, 10% and 12%; ditto for the percentage of children living in poverty and the percentage of children living in families with high incomes:

Severe poverty (less than 50% of the poverty threshold, about $22,800 for a family of four, less than $11,400 per year – 10%

Very high income (600 % or more than the poverty threshold for a family of four, $136,800 or more per year) — 12%

Child Poverty rate 23%

Children living in high income families (400% of the poverty threshold for a family of four, about $91,200 or more per year – 26% 

This structure of family incomes is likely to result in an almost unbridgeable cultural divide between children living in families able to offer them every possible advantage and children living in families struggling to meet their basic needs, or (worse) on the verge of destitution. Teens and young adults from high income families whose expectations include access to world class universities, entry into the professions, foreign travel and a wealth of opportunities for creative commitments and activities are likely to have far different values and attitudes than youth whose realistic educational aspirations are limited to community college or job training, and who have to continually struggle to meet their basic needs. The growing cultural differences between an economic elite and poor or nearly poor families is the subject of Charles Murray’s provocative book, Coming Apart: The State of of White America, 1960-2010.

 In addition, low and middle income families are being squeezed by increasing costs of housing, education and medical care. According to the Federal Interagency Forum on Child and Family Statistics’ recent report, in 1978 15% of American families had housing costs that were 30% or more of family income; in 2011 41% of families had housing costs that took almost a third of their income or more.


Variations Among States

There are very large differences between and among states on almost all of Kids Count 16 indicators of child and family well- being:

   Indicator                                                Best                                                          Worst 

Child poverty rate                                     New Hampshire – 12%                            Mississippi – 32%


Children living in households

with a high housing burden                       North Dakota  – 21%                               California – 52%


Rate of teens not in school                        Wyoming – 4%                                        Nevada – 13%        

not working


Percentage of fourth graders                     Massachusetts – 50%                            New Mexico – 79%

reading below proficiency level


Percentage of high school                          Vermont – 9%                                       Nevada – 42%

students not graduating from

high school in four years


Child and teen death rates                          Connecticut;                                          Montana

                                                                    Massachusetts (45 per 100,000)

                                                                    Rhode Island (17 per 100,000)                                                                                                                                                                            



Kids Count 2013 and America’s Children: Key National Indicators of Well –Being, 2013 describe a country in which children are physically safer than they were 20 years ago, better behaved and less likely to take on parenting responsibilities in their teenage years. Nevertheless, these reports provide strong evidence of a steady increase in income inequality which includes increases in both the child poverty rate and in the percentage of children living in high and very high income families. Child poverty has powerful negative effects on child development, especially when children are 0-3, and is associated with elevated rates of child behavior problems, chronic health conditions and learning difficulties. It is already evident that educational policies and practices are unlikely to overcome the effects of social class on children’s educational readiness and on their educational achievement. Increases in income inequality have led to vastly different life opportunities for children from high income and low income families and a shrinking percentage of children living in middle income families. This is a trend which has created the potential of a society in which class differences are largely locked in at birth.  

State’s rankings on Kids Count domains such as Health, Education and Family and Community are highly correlated with their rankings on Economic Well- Being; but these rankings are also influenced by citizens’ level of social and civic involvement. Regional differences stand out in Kids Count rankings; and these differences in community spirit and civic involvement appear to be influenced by the history of ethnic and religious groups that settled different areas of the country. 


Anna E. Casey Foundation, 2013 Kids Count Data Book: State Trends in Child Well- Being .

Anna E. Casey Foundation, 2011 Kids Count Data Book: America’s Children, America’s Challenge, Promoting Opportunity for the Next Generation.

Federal Interagency Forum on Child and Family Statistics, America’s Children: Key National Indicators of Well- Being, 2013. 

Murray, Charles, Coming Apart: The State of White America, 1960-2010, pub. 2012.

Putnam, Robert, Bowling Alone: The Collapse and Revival of American Community, Pub. 2000.

The views expressed in this commentary are the author’s, and are not intended to reflect the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized


June 2013 Sounding Board: “10 Ways to Improve Child Protection”

10 Ways to Improve Child Protection  
by Dee Wilson & Alan Puckett

A society’s child protection system is much more than its CPS programs. A system of child protection includes laws and legislators, attorneys, child advocates, law enforcement agencies, courts, mandated reporters, service providers, foster parents, guardian ad-litems or CASAs and prevention programs and media, as well as public agencies that respond to reports of abuse and neglect. Less obviously, child protection also includes agencies that provide various types of economic supports and other supports to low income families, and the social mores that influence parenting behavior and public opinion about how children should be cared for and disciplined. Child protection reform can seek to change any one or all of these groups, organizations, policies or beliefs. Reform efforts do not have to target CPS programs to be effective, though it would be odd for ambitious reform initiatives to ignore the public agencies that have the most direct responsibility for responding to reports of abuse or neglect.

Child protection as a whole is in need of fresh thinking, in part because of the widespread chronic dissatisfaction with the performance of public child welfare agencies. This dissatisfaction has many sources, but none has been more impactful than the public outrage following child deaths that appear to involve egregious failures of CPS programs. Most  states’ and large cities’ child protection systems continue to experience a cycle fueled by media accounts of child deaths or other apparent failures of child protection,  followed by the firing of caseworkers and supervisors (and sometimes managers) believed to be responsible for the case decisions that contributed to child deaths, ambitious reform initiatives that usually add to the prescriptive frameworks – and bureaucratic morass – within which practitioners work, conflicts between media, legislators and agencies over child death counts and reviews, increases in foster care and (usually) temporary reductions in CPS workloads. There is little or no evidence that the cycle of public crisis and agency response has led to a reduction of child maltreatment related deaths; and there is good reason to believe that the net effect of this cycle has been to weaken CPS programs (for a different scholarly perspective, see Jagannathan and Camasso, 2011).

There have also been positive trends in child protection reform during the past decade, including the expansion of differential response systems, a large increase of family support services and family centered practice models in many jurisdictions, the implementation of evidenced based practices and numerous   trauma informed care initiatives. These reforms have been motivated by the determination of practitioners, policymakers, managers and advocates to develop less punitive, more family friendly approaches to child protection, and by scholarly insistence that experimental evidence guide interventions whenever possible. There is some evidence that use of differential response systems has not compromised child safety; but the lack of multi-dimensional measures of child safety, and the dependence of public agencies on a flawed, inconsistently applied and easily “gamed” measure of recurrence to evaluate CPS performance, makes any judgment regarding the aggregate effect of these reforms on child safety tentative at best.

In the midst of these reforms, some persistent characteristics of U.S. child protection systems have hardly changed: (1) the adamant refusal of policymakers to consider the effects of high child poverty rates (approaching or exceeding 25% in many states) on low income groups (2) the related uncertainty about and lack of focus on child neglect, far and away the most common form of maltreatment in the U.S. (3) the misuse, and even exploitation (in some states), of caseworkers employed by public child welfare agencies, many of whom are paid paraprofessional wages even after a decade or two of working for child welfare agencies; and who are often disempowered to an extreme degree by top- down reform initiatives (4) the management of CPS and other child welfare programs through ever expanding regulatory frameworks sometimes amounting to hundreds of pages of policy and procedural manuals (5) the conceptual separation of child safety and well- being, a thinking error that has had far reaching consequences on child protection (6) small inadequate investments in prevention and in public health services for young children (7) the implementation of system wide child welfare reforms without adequate testing, usually modeled on reforms in other states and large cities. Child protection reform initiatives tend to be based on a narrow range of imaginative possibilities, as state or county agencies in crisis tend to copy initiatives already implemented in other states, that have generated favorable responses from policymakers, advocates and practitioners.

Several of the proposals discussed below either address these persistent features (akin to disabilities) of child protection systems, or build on the positive trends discussed above. Some of these proposals may seem unrealistic in the current political milieu; but new thinking about child protection should not be limited to reforms than can be implemented in the near future. A different future has to be imagined before it can become possible.

10 Ways to Improve Child Protection 

1. Adopt the policy goal of eliminating severe long term child poverty (i.e., children growing up in families with annual incomes under $10,000).

A 2009 Partners for Our Children (POC) study found that almost half of families with open cases in Washington State’s child welfare system had annual incomes of $10,000 or less; and many of these families had no regular income nor were they living with a partner who had an annual income of $20,000 or more. Destitution is something different and far more injurious to families than poverty per se. Many of these families have been homeless, or are a small step from homelessness. If the parents have substance abuse or chronic mental health problems, they may have worn out their welcome with extended family members and be left in desperate straits. Destitute families pose formidable challenges to child welfare systems as one-time provision of poverty related services hardly scratches the surface of the families’ concrete needs; and families’ child care standards have often eroded or collapsed under the pressure of severe poverty and multiple chronically relapsing conditions.

Poverty experts and child welfare managers and practitioners should be convened to develop strategies for eliminating severe long term (more than 5 years) poverty.

2. A range of prevention and public health programs should be targeted at low income families with children, 0-4.

Multiple programs, including home visitation, respite care, therapeutic child care, parenting skills programs that include coaching of parent-child interactions, depression treatment and other mental health services, housing services and other family support programs should be available to parents prior to and following a CPS report. These programs should target multiple adversities, not just abuse and neglect. States should not bet the bank on a single program, regardless of how evidenced based it is claimed to be.

Currently, Washington State has one of the highest rates of entry into foster care for children aged 0-2 in the U.S., 11.9 per 1000. A 2008 Washington State Institute of Public Policy (WSIPP) study found that 80% of children in out-of-home care in Washington were from single parent families. Targeting a range of concrete services and other forms of family support at poor single parent families with young children beginning in the prenatal period has the potential to pay huge dividends in reduced foster care costs and improved child development for at-risk babies and toddlers. Washington State’s Parent Child Assistance Program (PCAP) is a model for how home visitation programs can work with substance abusing women.

3. Public health approaches should be used to help reduce specific child behaviors and parenting practices associated with child deaths and serious non- fatal injuries to children.

Some of the most successful efforts to reduce deaths and serious injuries in recent years have been the result of public health campaigns designed to encourage or discourage specific behaviors such as standard use of bike helmets and guidelines for co-sleeping of parents with babies. These approaches can be put to greater use in child protection, for example by disseminating information regarding how caregivers can cope with the inconsolable crying of infants, a major precipitating cause of child maltreatment deaths; and through greater use of depression screening and treatment for all new mothers.

A public health framework for prevention can be widely used to target high risk behaviors as well as provide early intervention services to high risk groups.      

4. CPS programs should develop new approaches to identifying and protecting children, 0-4 who are at high risk of harm due to parental substance abuse, mental health disorders and domestic violence.

Babies and other young children are the victims in 80-90% of child maltreatment related fatalities. Waiting for babies and toddlers to be at risk of imminent harm, i.e., immediate safety threats, or in emerging danger, i.e., living with families in which substance abuse, mental health problems, domestic violence or cognitive impairments periodically put children in danger, before developing safety plans with parents is a highly risky approach to child protection. Instead, safety plans should be a standard part of CPS practice with families of young children receiving in- home services; and CPS programs should enlist professionals in substance abuse assessment and treatment agencies, mental health agencies, DV advocates and specialists in developmental disabilities and academic researchers to develop a better understanding of effective safety plans with high risk families.

In addition, CPS caseworkers need training in clinical assessment skills to understand indicators of unresponsive and risky patterns of parent- child interactions in early childhood. CPS programs should hire public health nurses or other persons well trained in infant mental health to improve the expertise in early childhood development of CPS investigators/assessors.

States should make larger investments in residential programs that allow substance abusing mothers to keep their babies with them while in treatment; and a cadre of foster parents should be trained to coach birth parents and support them with respite care following reunification. The use of “baby courts” and family treatment drug courts should be expanded and carefully evaluated. Administrative arrangements that involve moving babies and toddlers from home to home as permanent plans change should be drastically altered.

5. CPS programs should redesign their assessment processes and interventions to more effectively intervene in chronically neglecting and chronically maltreating families, i.e., children are both abused and neglected).

Currently, CPS programs are not designed to assess, support or “treat” multi-problem chronically referring families who represent the most intractable child welfare challenge in the U.S. Community agencies, neighborhoods and faith communities need to come together to design comprehensive assessment systems, create and maintain family support teams to serve these families,  and provide developmental, educational and mental health services for children growing up with erratic (at best) and (often) non-nurturing care. A safety measure or measures should be developed to evaluate agencies’ and communities’ ability to effectively serve chronically referring families.

6. Workforce development should be at the center of jurisdictions’ child welfare reform initiatives.

The quality of child welfare services is largely determined by the commitment, skills and knowledge, experience and morale of caseworkers and supervisors. Improved practice models are unlikely to be sustained in child welfare agencies that have annual turnover rates among practitioners of 20-30% or higher.  In most states, entry level and top-out salaries of caseworkers need to be increased by 20% or more in order to attract and retain qualified and able personnel; and commitments to maintaining reasonable workloads must be sustained in the years following a child protection crisis. Opportunities for professional development, periodic sabbaticals from case assignment and a much greater voice in the development of policies and programs are important elements of workforce development.

Workforce development requires a long term commitment of state agencies, but potentially has a much greater payoff in improved organizational performance than the vast majority of programmatic initiatives; however, the benefits may not be apparent for several years. States that have led the way in child protection reform in the past two decades, for example Minnesota, have been able to implement promising programmatic reforms both because of outstanding leadership and a first rate workforce.

7. Child welfare agencies need to develop more and better measures of child safety, including measures of severe and chronic maltreatment, and measures of key processes such as in-home safety planning. 

Currently, any assertions regarding the performance of CPS programs in protecting children are questionable due to the lack of credible safety measures. We have argued in a recent Sounding Board that no single measure of child safety can possibly be satisfactory, even if consistently applied; and the current recurrence measure on which agencies depend to evaluate their programs depends on very different approaches to definitions of abuse and neglect and substantiation across the country and can easily be manipulated “to look good at the expense of being good.”

Until better measures of child safety have been developed and utilized by public agencies for several years, there will be no good quantitative approach to evaluating the performance of CPS programs. However, state child welfare systems should not wait for the federal government to come up with better child safety measures, given the wealth of administrative data currently available.

8. Both the federal government and state governments should fund Research and Development sites in one or more field offices to test new programs and practices before they are implemented statewide.

Currently, states’ child welfare agencies utilize three main approaches to selecting programs and practices for statewide implementation: (a) using expert consultants (b) modeling what other public agencies have done or (c) reviewing the ratings of treatment programs on authoritative websites. Each of these three approaches has limitations, and can lead to premature commitments to statewide initiatives that are expensive and time consuming.

Our proposal is to design an intermediate step in which universities work with practitioners in local offices to field test innovative practices before agencies make large investments in the implementation of new programs. Public agencies need more of an experimental ethos in which promising practices and ideas are rigorously tested in-house in a way that is not merely “thumbs-up thumbs-down”, but is an exploration of what is required to make new programs work.

9. A positive vision of foster care is needed.

Richard Barth and colleagues made this proposal in 2007, but their well informed and incisive discussion of kinship care and non kin-ship foster care has seemingly gone unnoticed. There are 400,000 children and young adults in foster care, and whether this number   declines (as it did in the past decade), stabilizes or increases in the next few years, foster care will continue to be an important part of the U.S. child protection system. Foster care should be a therapeutic experience for children who remain in care for several months or years. Studies based on data from the National Study of Child and Adolescent Well Being (NSCAW ) have indicated foster care is frequently not therapeutic for children with behavior problems, even when children are stabilized in care; and that one-tenth to one-fifth of children in both kin and non-kin care receive harsh non-nurturing care.

Public and private agencies need to engage in a new dispassionate non- ideological examination of how to improve foster care for behaviorally troubled children.

10.  Comprehensive child welfare finance reform is urgently needed. 

Under current federal financing rules, foster care is supported for all children from families meeting a low-income threshold, while funding streams that support in-home services are very limited, dependent on periodic Congressional appropriations, or both. Federal support for foster care far exceeds support for in-home services on a dollar basis; and it has required persistent effort and exemplary leadership to build multi-faceted family support programs in some states and large cities. Nevertheless, there continue to be states that have little to offer maltreated children and their parents other than investigations, crisis oriented family preservation services and foster care. One alternative would  be to cap or limit federal foster care funding, while increasing support for in-home services for children on open CPS caseloads. The goal should not be to starve foster care programs, but to limit their growth while giving states incentives to develop robust family support programs.


Barth, R.P., Guo, S., Green, R.N. & McCrae, J.S. (2007). “Kinship Care and Nonkinship Foster Care: Informing the New Debate.” In Haskins, R., Wulczyn, F. & Webb, M.B. (Eds). Child Protection: Using Research to Improve Policy and Practice. The Brookings Institution.

Jaggannathan, R. and Camasso, M.J. (2011), “The crucial role played by social outrage in efforts to reform child protective services.” Children and Youth Services Review, 33 (6), 894-900.

Marcenko, M.O., Hook, J.L., Romich, J.L. & Lee, J.S. (2012). “Multiple Jeopardy: Poor, Economically Disconnected and Child Welfare Involved”. Child Maltreatment 17(3), 195-206.

Marcenko, M.O., Lyons, S.J. & Courtney, M.E. (2011). “Mothers’ experiences, resources and needs: The context for reunification”. Children and Youth Services Review 33 (3), 431-438.

Pew Charitable Trusts (2007). “Time for Reform: Investing in Prevention: Keeping Children Safe at Home.”


The views expressed in this commentary are the author’s, and are not intended to reflect the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized



by Dee Wilson & Alan Puckett


Imagine the following scenario: an 8 month old boy is brought by parents to a hospital emergency room with a skull fracture and retinal hemorrhaging resulting, according to the parents, from a fall from a couch. The child also has bruises on both arms and on the neck, and on further examination is found to have an old healing fracture of one of the upper arms. The emergency room physicians conclude that the baby has likely been abused, and make a report to CPS. A hospital hold is placed on the child. The local police department quickly begins its own investigation. CPS files a dependency action on behalf of the child; and a few days later in a shelter care hearing a juvenile court commissioner orders the child to be placed in the custody of the public child welfare agency pending further investigation. When the child leaves the hospital, he is placed with a maternal aunt who signs an agreement to abide by safety plan developed by the CPS caseworker and supervisor. The safety plan states that until further notice, parental visits with the child must be supervised.

In this scenario, the medical diagnosis of child abuse is confident and unambiguous. Local law enforcement, CPS and the juvenile court follow standard operating procedures to protect the child; and professional roles are clearly defined and well-coordinated. The baby is highly likely to be physically safe for many months, or possibly years, though the quality of care babies and other young children in out-of-home care receive from kin or non-kin caregivers varies greatly.

This is the type of scenario for which modern child protection systems were designed; and in our view CPS programs, with the cooperation of law enforcement agencies, medical professionals and the courts, can almost always be counted on to protect seriously injured children in these circumstances. Prior to 1965-70, this system of protections did not exist in the U.S.; and it is a major social achievement of the past 50 years that these systems are in place in almost every community and usually work as designed.

However, consider a markedly different scenario: the family of 4 year old Cheryl is reported to CPS three times in three months for alleged physical abuse. Initially, the manager of a child care center reported that her staff had seen bruising on Cheryl’s buttocks and lower back; and that the child seemed subdued and fearful when picked up in the afternoon by the mother’s boyfriend. However, by the time Cheryl was examined by a physician the bruises had faded, and there were no other indications of physical injuries. A month later, a family friend who was babysitting called CPS to report that Cheryl recently had a black eye and bruises on the arms, neck and cheeks; and that Cheryl, normally a talkative child, could not or would not tell her how she came by the bruises. While this report was being investigated by CPS, an anonymous person reported witnessing a female caregiver slapping a young child and pulling her hair in the parking area of a fast food restaurant. The caller stated that the caregiver was “totally out of control.” The car’s license number was tracked to Cheryl’s mother who denied that the alleged incident had even occurred. “We can’t afford to waste money at fast food restaurants,” the mother stated to the CPS caseworker.

This scenario describes an escalating cycle of abuse and potential danger as caregivers’ anger at a child deepens, and as caregivers become increasingly desensitized to their abuse of the child. Minor inflicted injuries move from relatively invulnerable to vulnerable areas of the body as caregivers begin to lose control of their reactions to oppositional child behavior. Nevertheless, the causes of specific injuries often remain uncertain to investigators; there is likely to be no firm medical diagnosis of physical abuse, and parents may adamantly deny that they or their romantic partners have harmed their child. In these circumstances, young children may be unable or unwilling to give clear answers to caseworkers’ questions about injuries, disciplinary practices or their feelings of fear or safety.

Identification of an escalating cycle of inflicted injuries requires good investigative skills and a conscientious touching of investigative bases (for example, contacting employees at the fast food restaurant regarding the alleged incident in the parking lot) which requires the time provided by a manageable workload. Caseworkers may never have received training regarding the dynamics of abuse that begins with irritability and anger directed at an oppositional child and gradually develops into a dangerous power struggle between the child and caregivers, or had enough experience to intuitively recognize patterns of maltreatment indicated by referral histories. Even if a caseworker is conscientious and has excellent assessment skills, or has a supervisor who recognizes common patterns in the progression of child maltreatment, the local juvenile court commissioner or judge may not make a finding of abuse absent a firm and unambiguous medical diagnosis of a series of suspicious minor injuries. Children who are reported to CPS with no injuries, or with minor injuries of uncertain origin, are sometimes seriously injured or killed before authorities recognize that a child is in danger due to a caregiver’s hostility and inability to cope with negative child behavior absent use of intimidation and excessive force.

Training programs are important, but they are no substitute for experience in child protection.  Annual turnover rates of 20-25%, or higher in some agencies, make it difficult to develop an experienced workforce with outstanding assessment skills; as a result, caseworkers may often lack the fund of experience needed to recognize indicators and patterns of maltreatment required to conduct highly skilled assessments/ investigations.

In cases that begin with allegations of minor maltreatment related injuries, or no injuries, and alleged maltreatment that does not place children at risk of imminent harm, a recurrence measure (i.e., re-referrals, multiple substantiations) is not an adequate indicator of CPS performance. In the Cheryl scenario discussed above, it’s unlikely that the initial referrals would be substantiated even if the child eventually suffered severe physical injuries at the hands of her caregivers. In this case, as in many others, what is required of CPS programs is to prevent serious harm to a child following an accepted CPS report. Of course, it is not possible for practitioners to protect children from serious harm in all cases due to the inability to accurately predict low base rate phenomena like child deaths and limitations on agency authority; but when indicators of abuse and neglect are present, and/or several high risk factors co-occur in families’ lives, competent child welfare practitioners can, and often do, prevent serious harm to children.

Safety Plans and Service Plans

There is another possibility in the Cheryl scenario: Cheryl’s mother and boyfriend acknowledge that they may have inflicted some – but not all – of the injuries that led to CPS investigations, and they admit that they have become increasingly frustrated with Cheryl’s refusal to mind them; and they agree to engage in whatever parenting program and safety plan the caseworker recommends as long as the child is left in the home. The caseworker, mother and boyfriend sign a safety agreement that Cheryl will return to the child care center that made the initial CPS report, and agree to enter a parenting program that includes coaching of parent-child interactions. The mother and boyfriend promise in writing not to use physical discipline with Cheryl, and to allow unannounced caseworker visits for the next 60 days.

Cases that begin with minor maltreatment related injuries, or no injuries, and cooperative parents often lead to safety plans and service plans intended to protect children in their parents’ homes. This is a plausible course of events for Cheryl and her family given that the child’s injuries to date have been minor.

How effective are in-home safety plans? Unfortunately, there is little or no research that can help to answer this question, or to identify the characteristics of effective in-home safety plans and determine in which types of families (e.g., substance abusing, mentally ill parent) these plans can be counted on to protect children. A 2012 Casey Family Programs report identified several points of agreement and disagreement among experts and practitioners regarding safety planning. Most practitioners who participated in the focus group discussions that contributed to the report viewed safety plans as short term, stop-gap measures intended to control or eliminate immediate safety threats; but did not necessarily agree with the description of safety plans as “in–home”. For example, caseworkers and supervisors in one state described entering into agreements with parents to allow children to live with extended family members for a few days or weeks following CPS intervention without officially placing children out of the home through legal action.

Safety planning is arguably one of the most poorly developed  parts of CPS practice, possibly because for decades CPS practitioners and courts were so focused on placement decisions in serious cases of child maltreatment that in-home safety planning was almost an afterthought. The two models of safety planning used most frequently in the U.S., the safety framework developed by the National Resource Center on Child Protective Services (NRCCPS), and Signs of Safety, a model developed in Western Australia and initially implemented in the U.S. by a few Minnesota counties, differ in their understanding of safety (i.e., children are “safe vs. unsafe”, or safety is a continuum) and in recommendations for when safety plans should be utilized, i.e.,  in response to danger or impending danger (NRCCPS) or as a standard approach to engaging parents during CPS interventions (Signs of Safety).

There is widespread agreement among practitioners and experts (as reflected in the Casey Family Programs report) that safety plans and service plans are different, in part because services provided to families with open CPS cases require time to take effect while safety plans are expected to control safety threats immediately. However, practitioners (more than experts) often have deeply felt anxieties about the capacity of in-home safety plans to eliminate child maltreatment even for a few days or weeks; and safety plans are usually developed to insure that subsequent abuse or neglect of children is quickly identified, if it occurs. Recurrence of non-severe abuse or neglect during a safety plan should not be viewed as a failure of child protection if the maltreatment is quickly identified and steps are taken to protect children.

Practitioners commonly view safety plans as short term solutions to safety threats which cannot indefinitely protect children; at some point therapeutic services are expected to affect positive changes in parental attitudes and behavior toward children. Berkeley Planning Associates’ studies of federally funded model treatment programs in the 1970’s  found a high rate of reoccurrence of serious child maltreatment (approximately 30%) during treatment, and also found that only about half of abusive and neglectful families benefited from therapeutic programs. A number of evidenced based programs have been developed and increasingly utilized for families with open CPS cases during the past thirty years. Nevertheless, most studies of CPS recurrence (with a few notable exceptions) have found that families provided services during or following a CPS intervention have higher, not lower, rates of recurrence of maltreatment, possibly because (a) the highest risk families were referred for services, (b) provision of services led to ongoing surveillance by mandated reporters, or (c) the services families received were not effective. However, it is also possible that even if service programs eventually reduce the frequency and severity of child maltreatment, many families with multiple risk factors are likely to be re-referred to CPS programs and/or further abuse or neglect children following entry into treatment programs. Effective treatment is often likely to involve “two steps forward, one step back” in changing habitual parenting behaviors.


Janice, a single mother of three children, ages 7, 5 and 4 has been reported to CPS eight times in the past 5 years by extended family members, child care providers and teachers for various types of neglect, including lack of supervision, filthy and dangerous conditions in the home, untreated lice in the children’s hair, inadequate clothing in winter months and failure to replace her daughter’s eye glasses after they were broken on the playground. According to family members, Janice used to leave the children with one of them before going on drug binges; but lately she has been using drugs and sleeping off binges with the younger children in the home. Debbie, the 7 year old, takes care of Janice and her younger siblings when Janice is sleeping off drug binges or is too depressed to get out of bed. Debbie does well in school when she attends, but both her younger brother and sister have severe language delays, and little or no ability to initiate social interactions with peers, or engage in sustained learning activities.           

It is not unusual in Washington State to hear about families that have had 20, 30, 40 or more CPS reports, mostly for neglect but often including occasional reports of physical abuse or sexual abuse as well. Parents in these families usually have co-occurring substance abuse and mental health disorders; and they have often been referred to various treatment programs on multiple occasions, and may have participated in these services to some degree.  Young children in chronically referring families are sometimes removed from the home when they are in obvious danger. Nevertheless, many children grow up in families in which neglect, or neglect combined with abuse, is more like a pervasive condition than a series of incidents. Child welfare agencies are often at a loss for what to do for children in these families who may not be in physical danger, but who experience cumulative developmental and emotional harm resulting from chronic neglect of their basic needs, including lack of nurturance.

CPS programs were not designed for chronic neglect that does not meet a threshold for physical danger, and typically collaborative agreements are not in place to facilitate comprehensive assessments of family functioning and child development. Poverty related services, therapeutic child care programs, home support specialists and parent advocates may be unavailable or in short supply. It is not surprising that CPS programs developed for other purposes are generally ineffective in working with chronically referring families, but it is surprising that policymakers and practitioners would tolerate this state of affairs without persistent efforts to find better responses.   


CPS programs are more effective at protecting severely abused and neglected children than widely believed when the danger to children is apparent to involved professionals, and when the roles and responsibilities of various professions have been clearly described in law and policy. CPS performance in circumstances that require outstanding assessment skills developed through experience, training programs and supervision is likely to be erratic in agencies with high turnover rates. In addition, CPS programs designed to protect severely abused or neglected children have been slow to adapt to the challenge of chronic neglect and chronic maltreatment that does not place children in immediate physical danger. Most agencies and communities are not organized to meet the challenges posed by chronically referring families, and until child protection programs are better designed to serve these children and families, CPS interventions are not likely to reduce current rates of chronicity.   



Bowdry, C. (1990). “Toward a Treatment-Relevant Typology of Child Abuse Families”. Child Welfare 69 (4), 333-340.

Graham, J.C., Steptura, K., Baumann, D.J. & Kern, H. (2010). “Predicting child fatalities among less-severe CPS investigations”. Children and Youth Services Review 32, 274-280.

Horowitz, S.M., Hurlburt, M.S., Cohen, S.D., Zhang, J. & Landsverk, J. (2011). “Predictors of placement for children who initially remained in their homes after an investigation for abuse or neglect”.

Jonson-Reid, M., Emery, C.R., Drake, B. & Stahlschmidt, M.J. (2010). “Understanding Chronically Reported Families”. Child Maltreatment 15 (4), 271-281. 

Loman, L.A. (2006). “Families Frequently Encountered by Child Protective Services: A Report on Chronic Child Abuse and Neglect”. Institute of Applied Research. Accessed 05-29-2013. Available:

Wilson, D. & Horner, W. (2005). “Chronic Child Neglect: Needed Developments in Theory and Practice”. Families in Society 86 (4), 471-481.

Wilson, D., Puckett, A. & Myslewicz, M. (2012). “Summary Report of Casey Family Programs’ Multi-State Review of In-Home Safety Planning Project, 2010-2011”. Seattle, WA: Casey Family Programs (unpublished). 

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Posted by on May 31, 2013 in Uncategorized

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