5


The Child Welfare System

Since 1993, a great deal of attention has been focused on policy, practice, and program initiatives aimed at improving both the delivery of child welfare services and the outcomes for children who come in contact with the public child welfare system—the system that implements, funds, or arranges for many of the programs and services provided when child abuse and neglect is suspected or has actually occurred. As described by Sanders (2012) at a workshop held for this study and elucidated by the discussion of research needs in Chapter 6, there is a need for further study of systemic factors that impact the response to child abuse and neglect. In keeping with the committee’s statement of task, this chapter considers system-level issues and legislative, practice, and policy reforms as context for the discussion of interventions and evidence-based practices and of their implementation and dissemination in the following chapter. An understanding of these issues can illuminate what happens to children after their risk for child abuse and neglect has been determined, including dispositions and outcomes for children and families, as well as how the system that serves them functions. The chapter begins with an overview of the child welfare system. Following this overview, examined in turn are major policy shifts in child welfare since the 1993 National Research Council (NRC) report was issued, research on key policy and practice reforms, and issues that remain to be addressed. The final section presents conclusions.



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5 The Child Welfare System S ince 1993, a great deal of attention has been focused on policy, prac- tice, and program initiatives aimed at improving both the delivery of child welfare services and the outcomes for children who come in contact with the public child welfare system—the system that implements, funds, or arranges for many of the programs and services provided when child abuse and neglect is suspected or has actually occurred. As described by Sanders (2012) at a workshop held for this study and elucidated by the discussion of research needs in Chapter 6, there is a need for further study of systemic factors that impact the response to child abuse and neglect. In keeping with the committee’s statement of task, this chapter considers system-level issues and legislative, practice, and policy reforms as context for the discussion of interventions and evidence-based practices and of their implementation and dissemination in the following chapter. An understand- ing of these issues can illuminate what happens to children after their risk for child abuse and neglect has been determined, including dispositions and outcomes for children and families, as well as how the system that serves them functions. The chapter begins with an overview of the child welfare system. Following this overview, examined in turn are major policy shifts in child welfare since the 1993 National Research Council (NRC) report was issued, research on key policy and practice reforms, and issues that remain to be addressed. The final section presents conclusions. 175

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176 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH OVERVIEW OF THE CHILD WELFARE SYSTEM Public child welfare agencies provide four main sets of services—child protection investigation, family-centered services and supports, foster care, and adoption. Child welfare agencies need to have some availability 24 hours a day, 7 days a week, to respond to child abuse and neglect reports. They are also expected to meet the needs of diverse populations that come to their attention, despite the families’ different histories, needs, resources, cultures, and expectations (McCroskey and Meezan, 1998). For situations involving child abuse and neglect, children come into contact with the designated state or local (county-based) child welfare agency when a call is made to report child abuse and neglect, and the child protective services agency decides whether to accept the report and inves- tigate it, and then decides on a course of action related to the outcome of that investigation. Children found to be abused or neglected may remain in their own home, but those assessed as not being safe in their own home are placed in out-of-home care. Initially, such care is almost always considered to be temporary, providing an opportunity for change in the behavior, social sup- ports, and living environment of the parents and/or the children’s behavior or health status such that is safe to reunify the children with their families. According to data from the 2007-2008 round of Child and Family Service Reviews, which cover 32 states, reasons for a child welfare agency’s open- ing a case were neglect (37 percent), parental substance abuse (15 percent), physical abuse (13 percent), child’s behavior (7 percent), other (5 percent), domestic violence (4 percent), sexual abuse (4 percent), juvenile justice system (4 percent), abandonment (3 percent), medical neglect (3 percent), health of parent (3 percent), health of child (2 percent), emotional mal- treatment (1 percent), and substance abuse of the child (0.4 percent) (ACF, 2012b) (see Figure 5-1). Figure 5-2 depicts a child’s journey through the child welfare system, while Box 5-1 describes the child welfare system for American Indian children. Scope of Child Welfare Placement Each year, more than 3 million referrals for child abuse and neglect are received (3.4 million in 2011) that involve around 6 million individual children (6.2 million in 2011) (ACF, 2012c). In 1998, 560,000 children were in foster care (ACF, 2000). By September 30, 2011, the number of children in foster care had declined to 400,540 (ACF, 2012a). Approxi- mately 3 of 5 referrals to child protective services agencies are screened in for investigation or assessment, and from 1 in 4 to 1 in 5 (25.2 percent in 2007, 20.0 percent in 2011) of these investigations lead to a finding that

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THE CHILD WELFARE SYSTEM 177 Average Percent Across State 40 37 35 30 25 20 15 15 13 10 7 5 4 4 4 5 3 3 3 2 1 0.4 0 FIGURE 5-1  Case-level data: Primary reason for case opening in 32 states. SOURCE: ACF, 2012b. Figure 5-1 at least one child was a victim of child abuse or neglect, resulting in an estimated number of 794,000 unique child victims in 2007 and 681,000 in 2011 (ACF, 2007, 2012c). Neglect is by far the major type of maltreat- ment, with more than four-fifths (78.5 percent) of victims being neglected in 2011, while 17.6 percent were physically abused and 9.1 percent were sexually abused (ACF, 2012c). Although the public perception may be that most substantiated child abuse and neglect reports result in placement of the child in out-of-home care (and perhaps siblings as well, who may or may not have been abused), this is not in fact the case. The number of child victims (and child non- victims) placed in foster care represents a relatively small percentage of substantiated reports and can best be estimated from the National Survey of Child and Adolescent Well-Being (NSCAW). In the first NSCAW cohort, 82.3 percent of the children remained in their home after investigation (Horwitz et al., 2011) (compared with 79.3 percent based on federal data in 2007 [ACF, 2007]). Whether any given abused or neglected child is placed in foster care varies substantially. Children under 1 year old are most likely to be placed (ACF, 2012a). Among black children in this age group, the risk of placement is particularly high. Once children are in foster care, placement trajectories

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178 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH Suspected child abuse and neglect Professional or community member reports suspected abuse to CPS. Worker screens report Situation does not meet the State’s Report is “screened in” definition of maltreatment, or too little information is supplied. Report is “screened out.” Caller may be referred elsewhere Safety concerns exist Safety concerns and There are no safety and/or risk is significant risk are moderate concerns and risk is low CPS may conduct a CPS investigates family assessment Evidence of Insufficient evidence Child welfare or No services are found abuse or neglect or abuse or neglect community-based to be appropriate. “Substantiated” “Unsubstantiated” services may be offered Family may be or “Founded” or “Unfounded” to address family needs referred elsewhere Child has been harmed Case closed and a risk of future Low or no risk of abuse or ongoing safety future abuse found concerns are present Family may be referred for voluntary services Court petition Child stays with family. Risk minimized. may be filed Services are provided to Case closed the child and family Child is placed in out-of-home care and services are provided to the child and family Reunification Custody to Termination of parental rights Independent living with family a relative and adoption or permanent with permanent legal guardianship family connections FIGURE 5-2  A child’s journey through the child welfare system. SOURCE: CWIG, 2013b, p. 9. vary considerably. Although group and other forms of congregate care have been linked to negative developmental sequelae (Barth, 2005; Berger et al., Figure 5-2 Redrawn 2009), 22 percent of all children and 48 percent of all teenagers are placed in some type of group facility upon admission to out-of-home care. Caregiver changes, which also are associated with negative develop- mental sequelae (Aarons et al., 2010; Barth et al., 2007; Newton et al., 2000), affect more than half of all children who are placed, with roughly 30 percent of foster children experiencing three or more placements (Landsverk

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THE CHILD WELFARE SYSTEM 179 BOX 5-1 The Child Welfare System for American Indian Children A child abuse and neglect report relating to an American Indian child may be investigated by the child’s tribe, the Bureau of Indian Affairs, or a state or county agency (Cross, 2012; see also CWIG, 2012b). Child abuse and neglect reports may also be investigated by multiple actors, with tribes being involved in 65 percent of investigations (23 percent as sole investigators), states in 42 percent, counties in 21 percent, the Bureau of Indian Affairs in 19 percent, and a consortium of tribes in 9 percent (Earle, 2000). The aim of the Indian Child Welfare Act (ICWA),* which was passed in 1978, is to preserve tribal authority over decisions to place American Indian children in out-of-home care. According to the ICWA, tribes with active courts maintain ex- clusive jurisdiction for American Indian children residing on the reservation, and states and tribes share jurisdiction for children who do not live on reservations but are members of federally recognized tribes or are eligible for tribal member- ship with a biological parent who is a tribal member. State courts conducting involuntary child welfare proceedings concerning children subject to the ICWA must notify the appropriate tribe, which has the right to intervene in the case. The ICWA requires that American Indian children placed in foster care be placed close to home, with preference for placement with a member of the child’s extended family; a foster home licensed, approved, or specified by the tribe; an American Indian foster home licensed or approved by a nontribal authority; or an institution approved by the tribe. American Indian children placed for adoption should be placed with a member of the child’s extended family, a member of the child’s tribe, or another American Indian family. *P.L. 95-068. and Wulczyn, 2013). About 60 percent of all placed children are reunified with their family; 20 percent are adopted; and the remainder leave for other reasons, including aging out (6 percent). Frequently unaccounted for, however, is the significant variation among and within states with respect to how long children remain in foster care. The median length of stay ranges from 5 to 24 months at the state level and from 2 to 35 months at the county level. Finally, about 1 in 5 children will return to care within 2 years of exit; for some populations, the reentry rate is as high as 35 per- cent (Wulczyn et al., 2007, 2011). Aging out of foster care is strongly related to age at entry, as shown in Figure 5-3. Infants are the least likely to age out. Based on the Multistate Foster Care Data Archive (FCDA), fewer than 25 of 2,500 infants (less than 1 percent) remained in placement for their entire childhood. At the other end of the age continuum, about 50 percent of 17-year-olds aged out

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180 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH FIGURE 5-3  Probability of aging out of foster care by age at admission. SOURCE: Data from Wulczyn, 2012. directly from foster care. Between these two extremes, less than 15 percent of any single age group aged out, except for 16-year-olds. As noted, the youngest children, particularly those under the age of 1 year, have the greatest risk of placement. For that age group, placement rates were never below 10 per 1,000 and reached 12 per 1,000 in 2006. Among children aged 6 and above, the incidence of placement hovered close to 2 per 1,000, also with a peak in 2006. The stark age-graded disparity in placement rates is seen clearly in Figure 5-4. The height of these bars depicts the magnitude of the difference in placement rates for infants relative to three other age groups. Com- pared with 1- to 5-year-olds, infants are about 3.5 times more likely to be placed. The disparity between infant placement rates and the rates for 6- to 12-year-olds averaged 6 placements per 1,000 between 2003 and 2010. Type of Placement Because of how much time foster children spend in living arrangements other than those provided by their parents, the settings in which they are placed make a difference. In general, states offer three main types of place- ment. Family-based care, which is preferred, consists of regular foster family care and relative (kinship) care. Children placed in family foster care may live with other foster children, but the number of unrelated foster children allowed in the home is regulated. More important, the foster parents are in

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THE CHILD WELFARE SYSTEM 181 Infants Infants Infants 1- to 5-yr.-olds 6- to 12-yr.-olds 13- to 17-yr.-olds FIGURE 5-4  Age disparity ratios for infants relative to children of other ages. SOURCE: Data from Wulczyn, 2012. most cases psychological strangers to5-4 child. Relative foster care involves Figure the foster parents who are related to the child either biologically or through fictive kin relationships. Over the past 15 years, kinship care has become the preferred practice option, and its use has increased as a result. The last general placement type is group care. States support a wide variety of group or congregate care settings, from smaller group homes with, for example, six unrelated youth residents to larger campus-based residential treatment facili- ties. States vary considerably in the range of group care settings, with some states using classification systems that differentiate 10 or more group-based settings depending on the level of care needed. The data in Figure 5-5 show, by age at admission, how children spent the majority of their time with regard to placement setting in 2003 and 2010. “Predominant placement setting” refers to the setting where children spent more than half their time in foster care. The mixed care type refers to situations in which no one placement type accounted for more than half the time spent in care. The overwhelming majority of children under the age of 13 spent most of their time in placement in a family setting. Nearly 96 percent of infants admitted between 2003 and 2010 spent the major- ity of their time in a family setting. For older children, group care was the most common care type, with about 38 percent of adolescents spending the majority of their time in foster care in some type of group care setting. Data also suggest that the use of family-based care is on the rise. As shown in Figure 5-6, the data suggest that the use of both regular and

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182 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH Foster Care Relative Care Percent Group Care Other Mixed Age (years) FIGURE 5-5  Predominant placement type. SOURCE: Data from Wulczyn, 2012. kinship foster care increased between 2003 and 2010, whereas the use of Figure 5-5 group care declined. The deleterious impact on children of multiple placements in foster care has been a salient topic in child welfare policy and programmatic debates for decades. Legislative initiatives to promote permanency for foster chil- dren (e.g., the Adoption Assistance and Child Welfare Act, the Adoption and Safe Families Act) have led to increased emphasis on greater placement stability. The U.S. Department of Health and Human Services (HHS) now monitors the number of movements recorded for children in foster care as part of the national outcomes standards (ACF, 2002). Although stable placements are preferred, children do move between Percent FIGURE 5-6  Change in predominant placement settings, 2003-2010. SOURCE: Data from Wulczyn, 2012. Figure 5-6

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THE CHILD WELFARE SYSTEM 183 Percent FIGURE 5-7  Average number of moves per child, 2003-2010. SOURCE: Data from Wulczyn, 2012. Figure 5-7 placement settings (see Figure 5-7). Grouped by how many moves they experienced, the largest group of children (43 percent) experienced but one placement (i.e., no moves). About 28 percent of children experienced two placements, while 30 percent experienced three or more placements. The clinical literature documents the negative effects of placement instability on children. Multiple placements are alleged to affect children’s attachment to primary caregivers, an important early developmental mile- stone (e.g., Fahlberg, 1991; Lieberman, 1987; Provence, 1989; Stovall and Dozier, 1998). Empirical evidence from other strands of research suggests that multiple placements lead to psychopathology and other problematic outcomes in children, such as externalizing behavior problems (Kurtz et al., 1993; Newton et al., 2000; Widom, 1991). Despite what is known about the likely impact of placement moves, relatively little research exists on placement stability. An early review of that literature (Proch and Taber, 1985) indicates that the majority of foster children do not experience more than two placements while in foster care. The limited subsequent research focuses on placement disruption rates and factors associated with movement. Generally, researchers report that between one-third and two-thirds of traditional foster care placements are disrupted within the first 1-2 years (e.g., Berrick et al., 1998; Palmer, 1996; Staff and Fein, 1995). Research on treatment foster care has documented a wider range for rates of disruption, from 17 to 70 percent (Redding et al., 2000; Smith et al., 2001; Staff and Fein, 1995). Although kinship foster homes tend to be more stable than traditional foster homes (Courtney and Needell, 1997), some evidence suggests that kinship placements also may be disrupted fre- quently, reflecting the vulnerability of the child and the family (Terling-Watt, 2001). Findings from Cochrane Collaboration systematic review of kinship care for children who have experienced child abuse and neglect (Winokur et al., 2009) suggest that children in kinship foster care experience better behavioral development, mental health functioning, and placement stability

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184 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH than children in nonkinship foster care. Although no difference in reunifica- tion rates was found, children in nonkinship foster care were more likely to be adopted, while children in kinship foster care were more likely to be in guardianship. Children in nonkinship foster care also were more likely to utilize mental health services. Several studies identify factors associated with placement disruption. Early research by Pardeck and colleagues (Pardeck, 1984, 1985; Pardeck et al., 1985) suggests that such child characteristics as older age and behav- ioral or emotional problems are associated with increased rates of disrup- tion. These findings are corroborated by more recent research (e.g., Palmer, 1996; Smith et al., 2001; Staff and Fein, 1995; Walsh and Walsh, 1990). Findings concerning the relationship of placement disruption to child race and gender are mixed (Palmer, 1996; Smith et al., 2001). Another study on placement stability examined the link between turn- over among child welfare caseworkers and the achievement of permanence for children in Milwaukee County. The authors found that children who ex- perienced caseworker turnover had more placements (Flower et al., 2005). Many studies investigate the attributes of children and their circum- stances in an effort to explain variation in the number of movements. Relatively little work focuses on the movement patterns themselves, and few studies (James et al., 2004; Usher et al., 1999) examine combinations of moves to understand whether the patterns have meaning for child welfare policy and practice. The timing of moves is also important (see Figure 5-8). Movement early in the placement experience may magnify a child’s sense of instability; movement late in the placement experience may signal changes in the child’s status, the caregiver’s capacity, or both. Because movement and length of stay are so closely intertwined, however, care must be taken in isolating when movement is most common. Although placement stability is desirable, placement changes are some- times necessary. For example, children placed in a group care setting may transfer to a family setting if the reasons for placement in group care are no longer material to further progress. Similarly, when caseworkers find a willing and able relative, transfer out of foster care to relative care may be in the long-term best interest of the child. Thus, the number of moves is not the only metric by which to judge whether stability has been achieved. Movement between levels of care or up and down the care continuum provides another view of what happens while children are placed away from home. The data do suggest that changes in the level of care are common. About 60 percent of children who started off in family foster care and were then transferred to a group care setting went on to experience a third place- ment, which half of the time involved a return to family care.

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THE CHILD WELFARE SYSTEM 185 1.00 0.80 Moves per Child 0.60 0.40 0.20 0.00 6 7 to 12 13 to 19 to 25 to 31 to 37 to 18 24 30 36 42 Placement Duration (months) FIGURE 5-8  Period-specific movement rates, 2003-2010. SOURCE: Data from Wulczyn, 2012. Exit from Foster Care For the past 30 years, child welfare policy and practice have focused on reducing the time spent in foster care. The goal of reduced time in care aligns with the notion that foster care is a temporary alternative to care provided by parents. Figure 5-9 shows the cumulative probability of exit for reunification, by age at first admission to foster care. The cumulative prob- ability indicates the likelihood of exit with the passage of time. Referring to Figure 5-9, for example, about 40 percent of infants placed will have been discharged back to their parents within 5 years. Among 13- to 17-year-olds, the figure is closer to 50 percent; for children between the ages of 1 and 12 at the time of admission, the cumulative probability of reunification falls to between 55 and 60 percent.1 The data in Figure 5-9 also suggest that after 2 years, the cumulative probability does not change dramatically, regardless of the age at admission. 1  The cumulative probabilities are based only on those cohorts for which at least 3 years of data are available: 2003, 2004, and 2005. The cumulative probability of reunification within 6 months is based on the experience of the 2003 through 2009 admission cohorts. Thus, for the first interval (i.e., 6 months), seven estimates are averaged together, while for the last interval, only three estimates are available.

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234 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH in child welfare, more research in this area is needed, especially to link practice outcomes and workforce issues. Finding: The evidence base is insufficient on effective strategies for bring- ing in the interdisciplinary knowledge necessary to carry out all the diverse functions of a child welfare agency, including experience in medi- cine, social work, nursing, early childhood, law, and other subject areas. Finding: Child welfare agencies need to employ more effective quality improvement strategies. While agencies currently engage in a program improvement process, little evidence is available on the extent to which these processes are well developed, implemented, and sustained. These processes need to be thoroughly examined to determine the most suc- cessful strategies for quality improvement. CONCLUSIONS The societal response to child abuse and neglect is a complex one. Even before the passage of CAPTA (see Chapter 8), the public child welfare system was supported by the federal government and by states to respond to child abuse and neglect, with roles that ranged from responding to re- ports; to working with children and families; to strategizing on assessment, intervention, placement, and case disposition. This chapter has provided an overview of the children who come into contact with this complex child welfare system and framed the system’s policies and practices as ever changing to best focus on children’s safety, permanency, and well-being. Despite some progress, much remains to be done, and research is needed to connect what is found to work with the structures and processes that need to be addressed to implement evidence-based policy and practice in complex systems. Improved access to empirical data from sources such as the NSCAW and the FCDA has led to a greater understanding of the experiences of children who come in contact with the child welfare system, which can help guide decision making and service delivery. However, further research is needed to fully understand important issues such as the impact of multiple foster care placements, especially the separate effects of movement patterns, the timing of moves, and movement between levels of care; differences in the experiences of children in the child welfare system based on race, socio- economic status, and culture; and the impact of varying state administrative structures on the performance of the child welfare system. Improved access to data also has enabled a more comprehensive exami- nation of the impact of various child welfare system initiatives designed to improve performance with regard to the core goals of safety, permanency,

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THE CHILD WELFARE SYSTEM 235 and well-being. While a growing body of evaluations has shown the benefits of strategies such as differential response, family and parent engagement, and the use of practice models, there is a need for more rigorous evaluations and an even greater need to evaluate strategies used to implement success- ful models across varying settings. As the focus of child welfare system initiatives continues to evolve based on changes to laws and administrative policies and responses to tragic events, the developing evidence base needs to be used to promote the implementation of programs and service delivery strategies that have proven effectiveness. While research on the effectiveness of programs and the science of implementation offers insight into successful strategies for child welfare agencies to replicate, the potential benefits of such research cannot be real- ized without the institutional capacity to implement programs and service delivery strategies. Achieving this capacity requires reconsideration of the competency and commitment of front-line staff, a link between training and education and service delivery, a greater focus on leadership and organiza- tion, and greater alignment of the policies and practice imperatives that are presented to child welfare managers. In light of the many aspects of the causes and consequences of child abuse and neglect (see Chapters 3 and 4, respectively), it is necessary to integrate the multidisciplinary experience needed for child welfare service delivery and to coordinate with the various other systems and service providers that encounter abused and neglected children. To meet the above research needs in the varying contexts of individual agencies and in the face of the difficulties associated with conducting re- search in large, complex systems, a research enterprise needs to be built within child welfare agencies. Doing so would allow for examination of the experiences of children in the child welfare system in relation to the implementation of programs in specific settings, as well as the promotion of strategies to improve institutional performance. REFERENCES Aarons, G. A., S. James, A. R. Monn, R. Raghavan, R. S. Wells, and L. K. Leslie. 2010. Be- havior problems and placement change in a national child welfare sample: A prospective study. Journal of the American Academy of Child and Adolescent Psychiatry 49(1):70-80. ACF (Administration for Children and Families). 2000. Child welfare outcomes 1998: Annual report. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. ACF. 2002. Child welfare outcomes 1999: Annual report. Safety, permanency, well-being. Washington, DC: Administration for Children and Families. ACF. 2007. Child maltreatment, 2007 report. Washington, DC: U.S. Department of Health and Human Services, ACF. ACF. 2010. Child welfare outcomes 2007-2010: Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.

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