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

06 Mar

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.

References 

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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1 Comment

Posted by on March 6, 2014 in Uncategorized

 

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

  1. Joan Vance

    March 6, 2014 at 11:17 am

    Thank you for this extremely cogent thinking on an exceptionally complex set of issues.

     

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