Service Provider Perspectives on Family Violence Interventions (1995)

Child victims of family violence include children from infants to adolescents who have experienced physical or sexual abuse or neglect. Child victims can also include children who have witnessed violence directed toward other family members, such as spousal violence. The interventions available for child victims occur in many different institutional settings, such as the courts, hospitals, social services agencies, schools, communities, and the home. They include medical diagnostic and treatment programs, therapeutic counseling programs, child protective services, foster care, residential centers, child witness support programs in judicial settings, and other efforts designed to mitigate the consequences of maltreatment.¹ Other programs, such as family preservation services, are crisis intervention efforts designed to provide intensive support services to families of children who are at risk of external placement in foster care or other form of external care.

A broad range of prevention programs for child abuse has been initiated in the past few decades. These programs include primary, secondary, and tertiary preventive interventions, and they occur in a wide variety of institutional settings as well. Many prevention programs are designed to mitigate risk factors commonly associated with parents who abuse or neglect their children, and the interventions often focus on factors such as harsh forms of corporal punishment, social isolation, substance abuse, and environmental deprivation. Some programs stress the importance of instilling in new parents the ability to understand and respond to an infant or child's developmental needs through family support or home visitation services.

The workshop participants noted that prevention and treatment services present important differences and reveal difficult challenges in dealing with the needs of child victims. Various forms of interventions have been developed in legal, health, and social service settings that focus on particular family, parent, or child needs, but service providers often have limited authority or resources to determine which types or combinations of programs can be provided for selected clients. For example, in the case of home visitation, the family decides which services they want to receive, and the home visitor works with the family in identifying and drawing on resources to focus on the issues they want to address. The home visitor cannot require the family to deal with a substance abuse problem if the family is not ready to address it. However, if the consistent use of alcohol or drugs places a child at risk of abuse, the family can be referred to protective services, which can mandate other forms of service intervention.

The presentations in this section provide a basis for examining the strengths and limitations of programs designed to assist child victims of physical and sexual abuse, as well as programs designed to prevent the occurrence of child maltreatment.

¹For additional information on the research associated with such intervention programs, see National Research Council (1993) Understanding Child Abuse and Neglect. Washington, D.C.: National Academy Press.

Karen S. Steinhauser

Specialization has been a key characteristic of the Denver program. The District Attorney's office has a special prosecution unit staffed by six district attorneys who work only with domestic violence cases and a police unit dedicated to child abuse cases. Victim advocates trained in interviewing children and in investigating child abuse are members of both units. Their sole responsibility is to take care of the children and their families from the time cases are reported until the cases are closed.

The Denver Department of Social Services maintains a 24-hour hotline for receiving all reports of abuse and neglect. Reports of abuse and neglect initiated by Denver Public School employees are referred to the Child Abuse Hotline, as are reports of alleged child sexual abuse received by the Denver Police Department or reports of child sexual abuse received by any personnel in a health care setting or physician's office.

Colorado has enacted laws that make prosecution easier; for example, evidentiary standards have been revised through child hearsay laws to enable prosecutors to use statements children have made to others. Through a constitutional amendment for victims' rights, victims are kept better informed about the status of their case.

The state has also established a Child Fatality Review Committee, comprised of representatives from the Department of Health, the Department of Social Services, the District Attorney's office, police departments, and citizens' organizations. The committee reviews reports of death of all children in the state in order to identify factors or patterns that may contribute to these deaths. The goals of the Child Fatality Review program are (1) to describe trends and patterns of child deaths in Colorado; (2) to identify and investigate the prevalence of risk factors in the population of deceased children; (3) to evaluate service and system responses to children and families who are considered to be at high risk and to offer recommendations for improvements in those services; (4) to characterize high-risk groups in terms that are compatible with the development of public policy; and (5) to improve sources of data by reviewing autopsies, death investigations, and death certificates.

One of the major challenges faced by prosecutors is the lack of resources for treatment or prevention services. Prosecutors may know of children who are indirect victims of violence, especially those who continually witness violence, but the prosecutors cannot intervene unless the children are victims of abuse themselves. Treatment for offenders is not always available, and there is a need for an income-

adjusted fee scale to improve access to services. About 80 percent of the sexual abuse perpetrators are indigent and are unable to pay for treatment services that might be recommended for them. Furthermore, differences exist within the service community over what programs constitute effective treatment.

Definitions of abuse are extremely important in setting the parameters for legal intervention. Colorado statutes include bruising a child as abuse, but the state does not prosecute every time a child is bruised. Similarly, Colorado law also states that appropriate physical discipline is not abuse; however, this can lead to conflicts over what behavior constitutes appropriate physical discipline. Some states, including Colorado, have statutes that hold those individuals who allow a child to be abused to be guilty of abuse themselves, which establishes authority for prosecution of mothers who do not defend their children. Unfortunately, some of these women are themselves victims of abuse by the same perpetrator who is abusing their child and who may intimidate the mother by threatening that she will lose her children and be prosecuted if she reports the spousal abuse.

Child sexual abuse is not only a serious child welfare problem, it is a crime that justifies prosecution by law enforcement and judicial agencies. Yet the prosecution of such crimes often is only a “band-aid ” that seeks to deal with complex problems that have not been addressed by family support or treatment programs.

Vigorous prosecution of child sexual abuse cases involving family members sends a message that both perpetrators and children need to hear--violence in the home is a crime. In addition, assigning responsibility for child victimization can sometimes be the only way to stop criminal behavior.

In developing an emphasis on the prosecution of child sexual abuse cases, the Denver District Attorney's office became concerned that experiences with the criminal justice system can sometimes victimize the children that it was trying to help. Lack of coordination and turf battles among agencies and professionals, such as social workers, police officers, therapists, and district attorneys, can harm the children who are caught in the middle.

The city of Denver attempted to remedy this situation in the early 1980s by integrating services for child sex abuse victims into a separate specialized system. An interagency protocol for child-sex-assault victims was developed to establish a set of common goals and to facilitate procedures of participating organizations. Interagency cooperation efforts have been developed at many different points of the child sexual abuse identification, treatment, and prosecution process, including the initial point of contact, child interviews, and professional training programs.

One result of the service integration effort has been in the child interview process. In the past, numerous, disjointed interviews (where children were interviewed on as many as 14 different occasions) were replaced by a common interview process where all agencies are able to question child at the same time. Literature has been developed to explain to children what will happen in court. Child victims also have an opportunity to tour the courtroom in order to see where the trial will occur and where they will sit.

Leslie Mitchel Bond

Healthy Families America (HFA) was established in 1992 by the National Committee for the Prevention of Child Abuse (NCPCA) in partnership with Ronald McDonald Children's Charities and in collaboration with the Hawaii Family Stress Center. The goal of the initiative is to create a nationwide, voluntary, home visitor program for all new parents, particularly those at high risk for child maltreatment and other poor childhood outcomes. Healthy Families America is based on two decades of research and the experiences of the Hawaii Healthy Start program in putting the research into practice.

Through home visits, Healthy Families America attempts to increase parents' knowledge about child development, improve parenting skills, strengthen parent-child relationships, expand use of formal and informal social support, and reduce social isolation. The program goal is to empower families and to build on their strengths. Data show that such visits can lower child abuse reports and decrease accidents, hospital emergency room visits, physical punishment, and increase the spacing between children (Seitz et al., 1985; Lutzker and Rice, 1987; Olds and Henderson, 1990; Breakey and Pratt, 1991). HFA staff estimate that for every $3 spent in prevention, at least $6 is saved in child welfare services, special education, medical care, foster care, and counseling and housing juvenile offenders (Healthy Families America, 1994).

In the creation of HFA, NCPCA has established a process to help states mobilize planning teams or task forces focused on the development of home visitation programs. HFA staff provide these groups with on-site technical assistance and have also developed a variety of supportive materials for use by state planning teams. Almost all of the states have a planning team in place, and half of the states now provide intensive home visitor services to new parents according to the HFA approach.

NCPCA has focused particular attention on the need to institutionalize long-term funding streams for HFA-type efforts. The 1994 Omnibus Budget Reconciliation Bill included a new Family Preservation and Support Services Program that provides federal funds for state child welfare agencies to develop preventive family support services and family preservation services for families in crisis. The 1994 appropriation for this program is $60 million, with estimates of growth to over $900 million by 1998. The legislation requires states to engage in an innovative and broadly inclusive planning process to assess and enhance state and local service capacity. As of May 1995, 12 states have passed legislation that encourages the availability of home visiting services

for families with newborns. In Oregon, for example, $3.3 million was appropriated for a two-year period to create a statewide task force on home visitation and to establish four community-based programs.

To assure quality, all HFA programs adhere to a set of critical elements or best-practice standards as defined by research. The services of Healthy Families America are voluntary. The program uses standardized assessment tools to identify families and communities that are most in need. Culturally comprehensive services that focus on supporting parents and enhancing parent-child interaction and child development are offered to parents before or immediately after their child is born. Services are intense; they are offered at least once a week at first and extend for three to five years. Services also involve linkages to a medical provider to ensure timely immunizations and well child care, as well as financial, food, and housing assistance.

Service providers are selected because of their personal characteristics and the willingness, education, and experience that qualify them to work with at-risk families in culturally diverse communities. Providers have limited caseloads and are trained to understand their role and the principles of home visitation. They receive ongoing supervision.

Beyond adherence to these central elements, the HFA initiative emphasizes the importance of a community-based approach to service delivery. There is no standard curriculum because each community tailors the program to its own needs. Healthy Families America is designed to build on and integrate with other family support services. To that end, HFA programs and state planning teams are collaborating with other family support programs or advocates in their states. Among the many HFA partners are the American Academy of Pediatrics, the Cooperative Extension System, the National Head Start Association, and HIPPY (Home Instruction Program for Preschool Youngsters).

HFA is fostering the importance of self-evaluation in the design of its program, and is in the process of developing a self-assessment strategy to aid sites in ongoing quality management. A research network has also been established to improve the comparability of different programs in general evaluation efforts. The program materials stress that a comprehensive evaluation component needs to be part of any HFA effort in order to learn how best HFA works in a diversity of communities with different economic, sociocultural, and political climates. HFA has developed a set of guidelines to assist in the evaluation of program initiatives which stress that the establishment of a control or comparison group should be of paramount importance in the design of an assessment strategy. The guidelines are as follows:

1. The evaluation needs to provide for a formal control or comparison group.

2. The evaluation should include a range of outcome measures.

3. If possible, multiple methods of data collection should be utilized to obtain information on all critical outcome measures.

4. The evaluation should not measure outcomes solely in terms of subsequent reports of maltreatment.

5. The evaluation should include, where possible, standardized measures of outcomes.

6. Ideally, the evaluation data collection system should be fully integrated into a program's ongoing client information system.

7. Following an initial assessment of client functioning, subsequent assessment should be conducted on clients in both the treatment and comparison groups every three months for the first year and every six months thereafter until evaluation concludes or the family terminates services.

8. If possible, post-program interviews or observations should be obtained on at least a sample of program recipients.

9. Efforts should be made to have at least one post-program contact with all families who drop out of services.

10. Evaluations should document the process undertaken to establish home visiting services.

The HFA national program office provides detailed evaluation information for its member sites, including description of standardized measures, sample forms that can be used to monitor client progress and service delivery, as well as information regarding the national HFA research network and database.

Breakey, G., and B. Pratt 1991 Healthy growth for Hawaii's Healthy Start: Toward a systematic statewide approach to the prevention of child abuse and neglect. Zero to Three 6(4): 16-22.

Healthy Families America 1994 Building a Healthy Families America System: A Summary of Costs and Benefits. Chicago, Ill.: National Committee for the Prevention of Child Abuse.

Lutzker, J., and J. Rice 1987 Using recidivism data to evaluate Project 12-Ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect . Journal of Family Violence 2:283-290.

Olds, D., and C. Henderson 1990 The prevention of maltreatment. Pp. 722-763 in D. Cicchetti and V. Carlson, eds., Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect. New York, NY.: Cambridge University Press.

Seitz, V., L.K. Rossenbaum, and N.H. Apfel 1985 Effects of family support intervention: A ten year follow-up. ChildDevelopment 56:376-391.

Joyce Thomas

In the wake of growing concerns about the safety and well-being of children, it is extremely important to improve the quality of and outcomes for children who are known to the child protective services (CPS) system. The incidence, severity, and magnitude of the problems encountered by these children and their families are pervasive and represent one of the most challenging and critical social and public health problems that exist today.

In 1992, the states received nearly 1.9 million reports on child abuse and neglect that involve approximately 2.9 million children. According to data provided by the National Child Abuse and Neglect Data System, only 39 percent of these cases were substantiated, which means about 58 percent were not substantiated (National Child Abuse and Neglect Data System, 1993). In this same year, approximately 1,068 children died as a result of abuse by their parent or caretaker. Of these children, about 49 percent were under 1 year of age, and another 25 percent were between 3 and 5 years old (National Committee for the Prevention of Child Abuse, 1994).

The stresses inherent in child protective services are present because the system was not designed to perform many of the services it currently is asked to provide. The CPS system was originally designed to investigate and identify problems that could be referred to other service programs. However, CPS agencies are now called on to provide treatment services, preventive interventions, and other functions that have been simply patched on to the agencies' basic structure and for which they never have been properly funded. The combination of large caseloads, limited resources, lack of a clear mission, and unsupported administrators has resulted in unreasonably stressful situations which affect the service providers as well as the children and families that this system seeks to help.

But determining the best interests of a child can be a tremendous challenge to child protective service workers, compelling them to address various underlying issues, including social and economic patterns, and religious and cultural issues.

More than half of the children that come to the attention of protective services workers live in poverty and deprivation. The neglect of children from low-income families, regardless of their ethnic background, continues to represent the most serious and constant problem overwhelming child protective services agencies. Of the substantiated cases reported in 1992, 49 percent involved neglect, 23 percent were

physical abuse, and 14 percent were classified as sexual abuse (National Child Abuse and Neglect Data System, 1994).

Many abused and neglected children are eventually placed in the foster care system, including foster family homes, group homes, and emergency shelters. Many others are located in juvenile justice system and mental health facilities. Many children are returned home, with the expectation that community services are available, and that the public CPS or child welfare agencies will provide adequate supervision and monitoring for the protection of these children. Children who are not reunited with their families within a reasonable amount of time often become permanently emotionally damaged by the separation from siblings, schools, and “their” communities. Thousands move from foster placement to foster placement and are denied the opportunities to grow up in a consistent, caring home environment (Williams, 1989; National Commission on Children, 1991).

In most counties across the United States, a single CPS agency located within the local Department of Social Services (or welfare department) has countywide jurisdiction for investigating reports of children at risk for abuse or neglect. With over 3,000 counties in this country, the quality of CPS programs will vary (Virginia Child Protection Newsletter, 1993). Many of these agencies experience common problems, however, such as insufficient staff overburdened with excessive caseloads, the pressures associated with investigation, decision making, case management, and serving complex family situations (Williams, 1989). In recent years, public agencies that must respond to reports of child abuse and neglect have faced increasing demands for services, inadequate budgets, criticism about the quality of services, and the tragedies of child fatalities (Krane et al., 1991). Other problems within CPS agencies include workers with no background in human services; inadequately trained staff; resistance from families; undue emphasis on the investigation focus; dealing with “turf” issues with courts, law enforcement, and other public agencies; limited practice capabilities; decreased services for families; fear of liabilities; extensive bureaucratic barriers; confidentiality issues; poor outcome measures; inadequate technology; lack of accountability; and a negative community perception of their role (American Civil Liberties Union, 1990).

Caseworkers often respond to these overwhelming conditions by being openly hostile to their clients and distrustful of the families they serve, rigid in their clinical perceptions, frustrated by the lack of change within the family, angry by the reactions of the public, fatigued by the layers of the bureaucracy and paperwork, and insensitive to the needs of families.

Burn-out and high turnover rates are also common problems. To maintain maximum control and to ensure that resistant parents follow up on directions of the caseworker, “mandated” services are frequently ordered by the court system following a CPS recommendation. Workers are under constant pressure to emphasize “the best interest of the child” and to make sure that the children are in a safe home environment. This has led to an overuse of out-of-home placement of “vulnerable” children. In response to this trend, caseworkers are now advised to rely on a “least restrictive alternative” principle, which emphasizes the desire to allow the child to

remain in the home with the family if the abusive parents can be helped through treatment or program intervention (U.S. Department of Health and Human Services, 1988). Such intervention requires careful monitoring, however.

The CPS agencies also experience universal problems in leadership. Even highly motivated supervisors privately speak of the anxiety they experience because they cannot rely on the caseworkers they supervise. One supervisor, for example, has reported that she made a follow-up visit to a family only to find that their caseworker had not made the visits that had been recorded in the family's case file. An additional problem is the need for greater representation of people of color in the supervisory and senior administrative positions in child welfare and CPS agencies. This issue is being directly addressed by the People of Color Leadership Institute in Washington, D.C., which is supported by the National Center on Child Abuse and Neglect.

People of color, predominantly those in urban communities, are often trapped by poverty, poor housing, unemployment, inadequate parent support, limited educational opportunities, chemical addiction, and health and mental health problems. The collapse of inner-city communities has been accelerated by the success of middle-class blacks, who for the past several decades have left the inner cities and created a vacuum of positive role models for children (Billingsley, 1991).

Public distrust and lack of confidence in the CPS system has resulted in a series of lawsuits filed by the American Civil Liberties Union in the District of Columbia, New York, Connecticut, Kansas, Pennsylvania, Louisiana, New Mexico, Missouri, and Virginia in an attempt to hold the public systems more accountable for the protection of children (American Civil Liberties Union, 1990).

Another sign of shifting public sentiments with regard to the role of CPS to protect children is the emphasis on “permanency planning ” and the preservation of the family that formed the core of P.L. 96-272, The Adoption Assistance and Child Welfare Act, adopted in 1980. The intent of this legislation was to provide increased federal funds to support child abuse prevention efforts while also restricting increases in funds for out-of-home placements. Wood et al. (1988) examined the cost for out-of-home placement versus the cost for services in the home. They determined that the cost per child for placement was $3,583, versus $823 for in-home services. The cost of placement for a family of three children was $7,334, as compared to $1,913 for in-home services for the same family. In 1990, the House Select Committee on Children, Youth and Families projected that by 1995, there would be close to 850,000 children in out-of-home placement.

The emphasis on cost containment, family unification, and permanency planning has led to a search for new strategies and new models of service delivery. In an attempt to improve the quality of case manager decisions for abused and neglected children, new tools such as the risk assessment instrument have emerged in CPS systems. These tools are used by CPS caseworkers to distinguish “high-risk” or “imminent harm” cases from “low-risk” cases in order to prioritize services for children and families. These instruments are often poorly suited to cases of child neglect, however, which may not present crisis situations but exercises a cumulative effect if the neglectful environment is chronic.

Many CPS agencies offer family preservation services through contractual or specialized units. The intent of family preservation services is to intervene with the family to reduce the crisis that led to a potential decision to remove the child from the home and to teach the family basic skills that will promote family strengths and parenting skills. In most cases, these programs have adopted the Homebuilders model, which has specific selection criteria.

Concerns have developed, however, that CPS agencies often lack the resources to follow up family preservation services programs with effective family support services. Many professionals believe that family support services are necessary for both new (not yet reported) at-risk or early problem families as well as families who have received family preservation services assistance but require less frequent monitoring. The new emphasis on family-focused, community-based services has emerged as a major priority, but this approach too is not a panacea.

Parents, community agencies, and other organizations must have some opportunity to gain more power and control over their lives. But children cannot be left unprotected within communities that lack resources to support their families. One area that requires new attention is the development of a capacity to determine when additional expertise is needed to go beyond the tradition of neighbors helping neighbors and focus on how neighborhoods can be established that support interactive family relationships within a community.

Given the overwhelming nature of the problems confronting the CPS system, cost factors, and the trauma of maltreatment to children and families, new emphasis must be placed on prevention and early intervention strategies. Several promising service delivery models have been developed to help strengthen the family; these models vary in their focus on the parent or other caretakers, the at-risk children, or an entire household. Such models include home visitation programs, self-esteem building efforts, nurturing and support groups, drop-in services, intensive monitoring of behavior, parent education/training, violence prevention, respite services, crisis intervention, school-based programs, career assistance, and combinations of individual programs (Ayoub, 1995). Some research studies have documented that strategies for strengthening families and preventing child abuse and neglect can be effective under certain conditions (Kumpfer, 1993), but the knowledge base in this field is still limited.

Other approaches use a combination of educational strategies such as parent courses, public information campaigns, counseling, classroom education on specific topics, peer education and mentoring, and crisis intervention. Some research on these approaches suggests that programs that are persuasive rather than coercive, or mandated, appear to be more effective (Northrop and Hamrick, 1990).

In considering the merits of community-based approaches, we need to recognize that many communities lack the skilled resources that are necessary to support families at risk for violence or neglect. Public and private agencies need to consider how to prepare communities to assume the responsibility and acquire the resources for family support efforts, especially during periods of extreme duress or chronic difficulty. This is an area that is particularly in need of research attention at this time.

American Civil Liberties Union 1990 A Force For Change: Children's Rights Project of the ACLU. New York: American Civil Liberties Union.

Ayoub, C. 1995 Annotated Bibliography for a Critical Review of the Literature on Intervention Approaches for Young Children and Families at Risk of Child Abuse and Neglict. Contract #92MFO3146, National Institute of Mental Health, Rockville, Md. Gutman Library, Harvard University Graduate School of Education .

Billingsley, A. 1988 The impact of technology on Afro-American families. Family Relations October:420-425.

Krane, M., B. O'Brien, S. Barnard, and N. Morehead 1991 Building a positive community response. Protecting Children 8 (Spring) (1):3.

Kumpfer, D. 1993 Substance abuse and child maltreatment. Violence Update 3:6.

National Child Abuse and Neglect Data System 1993 Working Paper Summary Data Component. U.S. Department of Health and Human Services, Washington, D.C.

1994 Prevention Programs: Evaluation Studies. Washington, D.C.: U.S. Department of Health and Human Services.

National Commission on Children 1991 Beyond Rhetoric: A New American Agenda for Children and FamiliesFinal Report. Washington, D.C.: National Commission on Children.

National Committee on the Prevention of Child Abuse 1994 Fifty State Survey Chicago, Ill.: National Committee on the Prevention of Child Abuse.

Northrop, D., and Hamrick, K. 1990 Weapons and Minority Youth Violence. Background paper prepared for the Forum on Youth Violence in Minority Communities: Setting the Agenda for Prevention, December 10-12, Atlanta, Ga.

Select Committee on Children, Youth and Families 1990 No Place to Call Home: Discarded Children in America A Report of the U.S. House of Representatives. Washington, D.C.: U.S. Government Printing Office.

U.S. Department of Health and Human Services 1988 The Family Violence Prevention and Services Act: A Report to Congress . Office of Policy Planning Legislation. Washington, D.C.: U.S. Department of Health and Human Services.

Williams, C. 1989 Decision-making for black children in placement in North Carolina . Perspectives and Prospects. National Child Welfare Leadership Center, School of Social Work. New Haven, Conn.: Yale University Press.

Wood, S., K. Barton, and C. Schroeder 1988 In home treatment of abusive families: Cost and placement at one year. Psychotherapy Fall 25(3):409-414.

Roger Friedman

The irony about intervention services is that many systems designed to resolve issues can actually exacerbate the problems they were created to remedy. Despite the work of exceptional caseworkers, the child welfare service system sometimes seems to create as many problems as it resolves, especially when dealing with low-income, minority families. Strengthening and preserving families is the goal of the child welfare system, and the Child Abuse Prevention and Treatment Act (CAPTA) was designed to establish a federal program that would provide support for families that experience child maltreatment. But with the implementation of CAPTA over the last 21 years, the most common services provided by the child protective and child welfare systems have been case investigations and foster care. Foster care was intended to be a respite and a security measure for children when families experienced crisis. In becoming the major form of intervention, however, it has become social policy by default. Involvement with the child welfare system has often led to fragmentation and divisiveness within families. As a result, other programs have been initiated in more recent years to support family unity and cohesiveness.

One such family support group is modeled on the 12-Step movement, which has been adapted from self-help programs first begun by Alcoholics Anonymous. The passage of the 1993 Family Preservation and Family Support Act now strongly encourages child welfare agencies to revamp services to accomplish the goal of building on family strengths in order to keep families together and avoid child placement in foster care or residential centers. The service system is being challenged to integrate formal and informal helping resources and to establish a continuity of service in a variety of programs in order to meet family needs. Severe measures, such as the removal of a child from a home, are required in only a small minority of cases. The large majority of child welfare cases involve working with a family and a community that experience combinations of problems and risk factors, such as poverty, substance abuse, and a culture of violence, that may endanger children but are beyond the control of individual family members.

Conflicts between the goals of protecting children and preserving and supporting families can create significant tensions between caseworkers, administrators, family support advocates, and child welfare officials. The issues of risk, safety, child protection, child welfare, parental rights, and family preservation pervade a broad spectrum of political and social debates associated with enhancing child and family well-being. The monetary costs of protecting children and supporting families have also emerged as a major area of social concern, stimulating a search for new forms of collaboration between public and private agencies to strengthen family services within communities and also reduce expenses of government programs.

Many service providers lack basic information about the nature of the target population and the type of clients and families that are served by child or family service programs. More elaboration of the special needs of children and families who come to the attention of child protective or welfare services would clarify issues that require attention in the implementation of services. Programs would also benefit from richer descriptions and analysis regarding the nature of the services that are provided, the different components of complex service systems, and the problems that arise in seeking to coordinate services among social service, health, and legal institutions.

The participation of key community leaders and institutions in setting standards and expectations regarding family behavior toward children was acknowledged by workshop participants as an important issue that is often overlooked by public and private agencies concerned with child protection and child welfare. Religious leaders, for example, can be important allies in identifying the values that a community wishes to uphold in protecting its children.

The development of national, state, and local systems to investigate reports of child abuse and neglect has created some dangers and potential biases in defining which factors put families at risk of child maltreatment. In some cases (such as the inclusion of unrelated adults in the family household), the child welfare system may judge harshly some family behaviors that are part of the daily lives of many highly functional families of diverse backgrounds. Risk assessment instruments can be valuable tools to reduce arbitrary judgments by caseworkers, but such assessments need to be highly focused and to concentrate on behaviors that are destructive to the child.

Participants stressed the importance of cultural competence in program design in order to address diverse cultural norms and beliefs within the client population because

the lack of cultural sensitivity may adversely affect the success of an intervention program. In this discussion, participants noted that while no direct measures of the attainment of cultural competence currently exist, it involves more than translating materials into another language--materials should be meaningful to and reflect the values of the community. Discussing cultural competence often invokes broad and deeply held views and practices (especially in areas such as corporal punishment). Such discussions demand that all parties value the views and customs of others in seeking to curb practices that may harm children.

Since many communities disagree about what types of behaviors constitute abuse, participants noted that cultural competence affects perceptions and definitions of violence as well as risk. Outside professionals can support and facilitate the process of defining selected terms, but community representatives play an important role in providing insights into the significance of selected values, beliefs, and attitudes. Thus, everyday decisions, such as whether children need to have regular bedtimes or whether entertaining a houseful of guests at a late hour as a common practice is appropriate, raise basic questions about the standards that should govern a family 's behavior. In many cases, practices that constitute abusive punishment or ineffective parenting are associated with young single parents who have limited education and who experience economic deprivation. Community representatives, in collaboration with service providers, can help identify practices that are harmful to children and identify how child discipline or child welfare can be improved for those who are powerless to escape their social condition. However, community representatives can also discourage service interventions when they spuriously attribute harmful practices to “culture” as part of ideological support for those do not have regular access to resources and services that can improve their family functioning.